Welcome to Texas Blue Cross Blue Shield PPO Select ® Saver Series III

Get choice and flexibility from your individual health care coverage. Freedom to Choose doctors and hospitals, add dependents, change deductible later. Very affordable and cost effective coverage from the name you trust. This plan will provide you with good benefits at a reasonable premium, making it one of the most sensible plans on the market.

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PPO Select Saver (I-VII)   Annual Deductible (+ Individual Co-insurance Max, when applicable) Affects premium and benefits Deductible Choices $500 $3,500 $1,000 $5,000 $1,500 $10,000 $2,500 Coverage Level Affects premium and benefits 75% Coverage Optional Dental Coverage Monthly Premium Network BlueChoice or BlueCard Preferred Provider Organization Lifetime Benefit $5 Million Individual Out-of-pocket Limit Deductible plus $3,000 Family Out-of-pocket Limit Deductible plus $9,000 Office Visit Co-pay Deductible and Coinsurance Outpatient Physician Medical Services Deductible and Coinsurance Outpatient Physician Surgical Services Deductible and Coinsurance Preventive Care 75% after deductible; $300 max per year Childhood Immunizations 100% to 8 years of age Inpatient Physician Medical/Surgical Services Deductible and Coinsurance Outpatient Hospital Services Deductible and Coinsurance Outpatient Hospital Diagnostic Testing Deductible and Coinsurance Inpatient Hospital Services and Diagnostic Testing Deductible and Coinsurance Outpatient Emergency Care (Physician and Hospital) Deductible and Coinsurance Emergency Care Emergency Room Care 75% Urgent Care 75% Outpatient Prescription Drugs $10 Generic, $40 Preferred, $55 Non-Preferred Outline of Coverage