Texas Short Term Health Insurance Select Temp Blue Cross Blue Shield Plans

Do you need health insurance coverage for 6 months or less? Consider SelecTEMP PPO. This plan offers individual health coverage that provides you, your spouse and your children essential, basic protection against unexpected accidents or illnesses. This plan may be effective as soon as tomorrow, it is ideal for situations like when you are between jobs or employer provided coverage.

When you apply for a multi-month benefit period and then later find that they don't need coverage for the requested period, Blue Cross and Blue Shield of Texas (BCBSTX) will allow cancellation of their temporary policy as of the next billing period and then issue a refund of their premiums for the unused months.

SelecTEMP PPO (Temporary Coverage)

Benefit Period Deductible (+ Individual Co-insurance Max, when applicable)
Affects premium and benefits

The Benefit Period Deductible will be subtracted once during each Benefit Period from each
Participant’s total Eligible Expense.
The family Deductible is three times the individual Deductible amount.
No Participant will be required to satisfy more than the individual Deductible amount toward the family Deductible
amount.

Deductible Choices

$500	$2,000
$1,000	$2,500
$1,500

Coverage Level
Affects premium and benefits

80% Coverage

Monthly Premium

Network

BlueChoice Solutions or BlueCard Preferred Provider Organization

Lifetime Benefit

$2 Million

Individual Out-of-pocket Limit

Deductible plus $1,000

Family Out-of-pocket Limit

Deductible plus $3,000

Office Visit Co-pay

Deductible and Coinsurance

Outpatient Physician Medical Services

Deductible and Coinsurance

Outpatient Physician Surgical Services

Deductible and Coinsurance

Preventive Care

Not Covered

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

$100 copay (80% coverage applied to services)

Urgent Care

80%

Outpatient Prescription Drugs

$10 Generic, $40 Preferred, $55 Non-Preferred

This is a single term, non-renewable, short term Contract, and is therefore not intended to be a permanent plan. If
you need coverage for an additional period of time, you may apply for a second SelecTEMP Contract. Any
condition which may have existed or occurred under the prior Contract will be a Preexisting Condition under the
subsequent Contract and will not be covered under the subsequent Contract.

Maximum Benefit Period is Six Months
When you apply for a multi-month benefit period and then later find that they don't need coverage for the requested period, Blue Cross and Blue Shield of Texas (BCBSTX) will allow cancellation of their temporary policy as of the next billing period and then issue a refund of their premiums for the unused months.

Outline of Coverage

RxMom.com Insurance 401 Congress Ave., Suite 1540 Austin, Texas 78701 Tel (888)490-8782

RxMom.com Insurance Service 6565 N. MacArthur Blvd., Suite 225 Dallas, Texas 75039 Tel (888)490-8782

RxMom.com Insurance Service 2300 George Dieter Dr. El Paso, TX 79936 Tel (888)490-8782

RxMom.com Insurance Service 7362 Remcon Circle El Paso, TX 79912 Tel (888)490-8782