Small Employer Health Benefit Rate Guide
This table lists additional information about health plans. Information is provided by the companies listed. Figures are in whole dollars.
| Aetna Life Insurance Company (866) 899-4379 www.aetna.com |
Carrier's most popular state-mandated plan | Carrier's most popular consumer choice health Benefit Plan | ||
|---|---|---|---|---|
| Indemnity | PPO | Indemnity | PPO | |
| Annual deductible (insured) | 1,000 | 500 | 1,000 | 3,000 |
| Annual deductible (family) | 3,000 | 1,500 | 3,000 | 9,000 |
| Hospital deductible | 1,000 | 500 | 1,000 | 3,000 |
| Physician's office visit copay | NA | 20/40 | NA | 30/50 |
| Does the plan include prescription drug benefits? | Yes | Yes | Yes | Yes |
| If prescription drug benefits are included, list copay | 15/40/60 | 15/35/50 | 15/40/60 | 15/40/60 |
| Network coinsurance | 70% | 80% | 70% | 100% |
| Non-network coinsurance | 60% | 70% | ||
| Lifetime maximum | Unlimited | Unlimited | Unlimited | Unlimited |
| Out-of-pocket maximum | 4,000 | 3,000 | 4,000 | 3,000 |
| Form number | GR-9N/GR-29N | GR-9N/GR-29N | GR-9N/GR-29N | GR-9N/GR-29N |
| Most popular consumer choice plan disclosure form | GR-9N/GR-29N-Removed offer of coverage for speech and hearing, serious mental illness, and in-vitro fertilization. | |||
| American Alternative Insurance Corporation (800) 305-4954 www.americanalternativeinsurancecorporation.com |
Carrier's most popular state-mandated plan | Carrier's most popular consumer choice health Benefit Plan | ||
| Indemnity | PPO | Indemnity | PPO | |
| Annual deductible (insured) | NA | 1,500 | NA | 1,500 |
| Annual deductible (family) | NA | 3,000 | NA | 3,000 |
| Hospital deductible | NA | 1,500 | NA | 1,500 |
| Physician's office visit copay | NA | 30 | NA | 30 |
| Does the plan include prescription drug benefits? | No | Yes | No | Yes |
| If prescription drug benefits are included, list copay | NA | 3/10/30/50 | NA | 3/10/30/50 |
| Network coinsurance | NA | 80% | NA | 80% |
| Non-network coinsurance | NA | 50% | NA | 50% |
| Lifetime maximum | NA | 5,000,000 | NA | 5,000,000 |
| Out-of-pocket maximum | NA | 3,000 | NA | 3,000 |
| Form number | NA | CM2006 | NA | CM2006 |
| Most popular consumer choice plan disclosure form | As required by 28 TAC 21.3530, I have been informed that the Consumer Choice Standard Benefit Plan that I am purchasing does not include all state mandated health insurance benefits. I understand that the following benefits are excluded completely from the plan: Acquired Brain Injury - Chemical Dependency - Osteoporosis, Detection & Prevention - Serious Mental Illness - excl.; Home Health Care (optional mandate) - In-Vitro Fertilization (optional mandate) - Mental Health (optional mandate) - Speech & Hearing Disorders (optional mandate) | |||
| Best Life and Health Insurance Company (800) 433-0088 www.bestlife.com |
Carrier's most popular state-mandated plan | Carrier's most popular consumer choice health Benefit Plan | ||
| Indemnity | PPO | Indemnity | PPO | |
| Annual deductible (insured) | NA | 1,000 | NA | 1,000 |
| Annual deductible (family) | NA | 3,000 | NA | 3,000 |
| Hospital deductible | NA | 0 | NA | 0 |
| Physician's office visit copay | NA | 20 | NA | 20 |
| Does the plan include prescription drug benefits? | No | Yes | No | No |
| If prescription drug benefits are included, list copay | NA | 10/30/50 | NA | NA |
| Network coinsurance | NA | 80% | NA | 80% |
| Non-network coinsurance | NA | 60% | NA | 60% |
| Lifetime maximum | NA | 5,000,000 | NA | 5,000,000 |
| Out-of-pocket maximum | NA | 2,000 | NA | 2,000 |
| Form number | NA | BL-EGH-POL-1006 | NA | BL-CCP-POL-1106 |
| Most popular consumer choice plan disclosure form | BEST offers, but has not yet sold, a consumer choice plan in Texas. Below are the CCP rates based on the most popular state mandated plan | |||
| Blue Cross and Blue Shields of Texas, A Division of Health Care Service Corp. (972) 766-6900 www.bcbstx.com |
Carrier's most popular state-mandated plan | Carrier's most popular consumer choice health Benefit Plan | ||
| Indemnity | PPO | Indemnity | PPO | |
| Annual deductible (insured) | NA | 3,000 | NA | 3,000 |
| Annual deductible (family) | NA | 9,000 | NA | 9,000 |
| Hospital deductible | NA | NA | NA | NA |
| Physician's office visit copay | NA | 30 | NA | 30 |
| Does the plan include prescription drug benefits? | No | Yes | No | Yes |
| If prescription drug benefits are included, list copay | NA | 10/40/60 | NA | 10/40/60 |
| Network coinsurance | NA | 100% | NA | 100% |
| Non-network coinsurance | NA | 70% | NA | 70% |
| Lifetime maximum | NA | NA | NA | NA |
| Out-of-pocket maximum | 3,000 | NA | NA | NA |
| Form number | NA | CON-FP-SG-0110 | NA | CON-FP-SG-0110 |
| Most popular consumer choice plan disclosure form | 1. Chemical Dependency 2. Prescription Contraceptive Drugs and Devices and Related Drugs (Oral ontraceptives not excluded) 3. In-Vitro Fertilization 4. Serious Mental Illness (non-Public Entities only) 5. Speech and Hearing (limited benefit) 6. Home Health (limited benefit) | |||
| Connecticut General Life Insurance Company Corporation (860) 226-6000 www.cigna.com |
Carrier's most popular state-mandated plan | Carrier's most popular consumer choice health Benefit Plan | ||
| Indemnity | PPO | Indemnity | PPO | |
| Annual deductible (insured) | NA | 2000 | NA | NA |
| Annual deductible (family) | NA | 6,000 | NA | NA |
| Hospital deductible | NA | incl in annual | NA | NA0 |
| Physician's office visit copay | NA | 30 | NA | 20/40 |
| Does the plan include prescription drug benefits? | No | Yes | No | NO |
| If prescription drug benefits are included, list copay | NA | 10/35/60 | NA | NA |
| Network coinsurance | NA | 100 | NA | NA |
| Non-network coinsurance | NA | 70 | NA | NA |
| Lifetime maximum | NA | UNLIMITIED | NA | NA |
| Out-of-pocket maximum | NA | NA | NA | NA |
| Form number | NA | 2781067-0 | NA | NA |
| Most popular consumer choice plan disclosure form | We do not offer consumer choice plans | |||
| Federated Mutual Insurance Company (866) 244-8081 www.federatedinsurance.com |
Carrier's most popular state-mandated plan | Carrier's most popular consumer choice health Benefit Plan | ||
| Indemnity | PPO | Indemnity | PPO | |
| Annual deductible (insured) | NA | 1,000 | NA | 5,000 |
| Annual deductible (family) | NA | 2,000 | NA | 10,000 |
| Hospital deductible | NA | NA | NA | NA |
| Physician's office visit copay | NA | 20 | NA | 0 |
| Does the plan include prescription drug benefits? | No | Yes | No | Yes |
| If prescription drug benefits are included, list copay | NA | 10/30/45 | NA | 50% |
| Network coinsurance | NA | 80% | NA | 80% |
| Non-network coinsurance | NA | 55% | NA | 60% |
| Lifetime maximum | NA | 3,000,000 | NA | 3,000,000 |
| Out-of-pocket maximum | NA | 3,000 | NA | 7,000 |
| Form number | NA | 920W | NA | 9299 |
| Most popular consumer choice plan disclosure form | You have chosen a Consumer Choice of Benefits Health Insurance Plan that does not contain all the state-mandated health benefits normally required in and accident and sickness policy in Texas. The state-mandated health benefits not included in this policy are: 1) Osteoporosis Screening; 2) In-vitro Fertilization; and 3) Speech and Hearing. | |||
| Guardian Life Insurance Company of America, The (212) 298-8000 www.glic.com |
Carrier's most popular state-mandated plan | Carrier's most popular consumer choice health Benefit Plan | ||
| Indemnity | PPO | Indemnity | PPO | |
| Annual deductible (insured) | 500 | 250/500 | 500 | 500/1,000 |
| Annual deductible (family) | 3/family | 3/family | 3/family | 3/family |
| Hospital deductible | NA | NA | NA | NA |
| Physician's office visit copay | NA | 15 | NA | 20 |
| Does the plan include prescription drug benefits? | Yes | Yes | Yes | Yes |
| If prescription drug benefits are included, list copay | NA | NA | 10/35/50 | 10/35/50 |
| Network coinsurance | 80% | 90% | 80% | 80% |
| Non-network coinsurance | 70% | 70% | ||
| Lifetime maximum | Unlimited | Unlimited | Unlimited | Unlimited |
| Out-of-pocket maximum | 3,000 | 3,000 | 2,000 | 2,000/4,000 |
| Form number | GP-1 | GP-1 | GP-1 | GP-1 |
| Most popular consumer choice plan disclosure form | Disclosure Statement: You have the option to choose this Consumer Choice of Benefits Health Insurance Plan that, either in whole or in part, does not provide state-mandated health benefits normally required in accident and sickness insurance policies in Texas. This standard health plan may provide a more affordable health insurance policy for you although, at the same time, it may provide you with fewer health benefits than those normally included as state-mandated health benefits in policies in Texas. If you choose this standard health benefit plan, please consult with your insurance agent to discover which state-mandated health benefits are excluded in this policy. The following are excluded: contraceptive drugs and devices, infertility drugs and treatments, speech therapy and hearing coverage, home health care, inpatient and outpatient treatments and drugs for mental and nervous disorders, alcohol abuse, drug abuse, and drugs to treat chemical dependencies. | |||
| Humana Insurance Company (800) 558-4444 www.humana.com |
Carrier's most popular state-mandated plan | Carrier's most popular consumer choice health Benefit Plan | ||
| Indemnity | PPO | Indemnity | PPO | |
| Annual deductible (insured) | 500 | 2,500 | NA | 1,500 |
| Annual deductible (family) | 1,500 | 7,500 | NA | 4,500 |
| Hospital deductible | 0 | 0 | NA | 0 |
| Physician's office visit copay | NA | 35/75 | NA | NA |
| Does the plan include prescription drug benefits? | Yes | Yes | No | Yes |
| If prescription drug benefits are included, list copay | 10/30/50/25% | 10/40/70/25% | NA | 10/30/50/25% |
| Network coinsurance | 80 | 100% | NA | 80% |
| Non-network coinsurance | 70% | NA | 50% | |
| Lifetime maximum | Unlimited | Unlimited | NA | Unlimited |
| Out-of-pocket maximum | 1,000 | NA/6,000 | NA | 3,000 |
| Form number | CC2003-P/C | CC2003-P/C | NA | CC2003-P/C |
| Most popular consumer choice plan disclosure form | The following state mandated benefits are excluded from the PPO Consumer Choice Plan: Chemical and Alcohol Dependency, TMJ, Home Health Care, Serious Mental Illness, In-vitro Fertilization, and Speech & Hearing. Source: Humana Small Group Medical Application (2-99). | |||
| Independence American Insurance Company of America (212) 355-4141 www.independenceamerican.com |
Carrier's most popular state-mandated plan | Carrier's most popular consumer choice health Benefit Plan | ||
| Indemnity | PPO | Indemnity | PPO | |
| Annual deductible (insured) | NA | 1,000 | NA | 1,000 |
| Annual deductible (family) | NA | 3,000 | NA | 3,000 |
| Hospital deductible | NA | 0 | NA | 100 |
| Physician's office visit copay | NA | 25 | NA | 50 |
| Does the plan include prescription drug benefits? | No | No | No | No |
| If prescription drug benefits are included, list copay | NA | 10/30/50 | NA | 15/30 |
| Network coinsurance | NA | 80% | NA | 80% |
| Non-network coinsurance | NA | 50% | NA | 50% |
| Lifetime maximum | NA | 5,000,000 | NA | 1,000,000 |
| Out-of-pocket maximum | NA | 2,000 | NA | 2,000 |
| Form number | NA | IAIC MMP 0606 | NA | IAIC MMP 0606 |
| Most popular consumer choice plan disclosure form | In-Vitro Fertilization, Speech and Hearing, Home Health Care, Osteoporosis, Detection and Prevention This PPO Consumer Choice Health Benefit Plan may include requirements and/or restrictions on deductibles, coinsurance, copayments or annual lifetime maximum benefit amounts that differ from other PPO plans. I understand that I may obtain from the Department of Insurance a consumer brochure with more information on Consumer Choice Health Benefit Plans, either by the visiting the TDI website at: www.tdi.state.tx.us/consumer/indexc.html, or by calling 1.800.252.3439. | |||
| Insurance Company of Scott and White (254) 298-3000 www.swhp.org |
Carrier's most popular state-mandated plan | Carrier's most popular consumer choice health Benefit Plan | ||
| Indemnity | PPO | Indemnity | PPO | |
| Annual deductible (insured) | 500 | NA | NA | NA |
| Annual deductible (family) | 1,000 | NA | NA | NA |
| Hospital deductible | NA | NA | NA | NA |
| Physician's office visit copay | NA | NA | NA | NA |
| Does the plan include prescription drug benefits? | Yes | No | No | No |
| If prescription drug benefits are included, list copay | 50% copay | NA | NA | NA |
| Network coinsurance | 80% | NA | NA | NA |
| Non-network coinsurance | NA | NA | NA | |
| Lifetime maximum | 2,000,000 | NA | NA | NA |
| Out-of-pocket maximum | 3,000 | NA | NA | NA |
| Form number | MMPSE-6/2003 | NA | NA | NA |
| Most popular consumer choice plan disclosure form | ||||
| John Alden Life Insurance Company (800) 800-1212 www.assuranthealth.com |
Carrier's most popular state-mandated plan | Carrier's most popular consumer choice health Benefit Plan | ||
| Indemnity | PPO | Indemnity | PPO | |
| Annual deductible (insured) | 500 | 500 | NA | NA |
| Annual deductible (family) | 1,000 | 1,000 | NA | NA |
| Hospital deductible | 500 | 500 | NA | NA |
| Physician's office visit copay | 0 | 25 | NA | NA |
| Does the plan include prescription drug benefits? | Yes | Yes | NA | NA |
| If prescription drug benefits are included, list copay | 15/50/50 $250 | 15/45/60 | NA | NA |
| Network coinsurance | 50% | 50% | NA | NA |
| Non-network coinsurance | 50% | NA | NA | |
| Lifetime maximum | 5,000,000 | 5,000,000 | NA | NA |
| Out-of-pocket maximum | 1,000 | 2,000 | NA | NA |
| Form number | JGM.TRT.TX | JGM.TRT.TX | NA | NA |
| Most popular consumer choice plan disclosure form | We have not sold any consumer choice plans so we did not include that for this survey. | |||
| Madison National Life Insurance Company (800) 356-9601 www.madisonlife.com |
Carrier's most popular state-mandated plan | Carrier's most popular consumer choice health Benefit Plan | ||
| Indemnity | PPO | Indemnity | PPO | |
| Annual deductible (insured) | NA | 2,000 | NA | 2,000 |
| Annual deductible (family) | NA | 4,000 | NA | 4,000 |
| Hospital deductible | NA | 250 | NA | 250 |
| Physician's office visit copay | NA | 40 | NA | 40 |
| Does the plan include prescription drug benefits? | No | Yes | No | Yes |
| If prescription drug benefits are included, list copay | NA | 10/50/100 | NA | 10/50/100 |
| Network coinsurance | NA | 80% | NA | 80% |
| Non-network coinsurance | NA | 50% | NA | 50% |
| Lifetime maximum | NA | 5,000,000 | NA | 5,000,000 |
| Out-of-pocket maximum | NA | 2,000 | NA | 2,000 |
| Form number | NA | SEE BELOW | NA | SEE BELOW |
| Most popular consumer choice plan disclosure form | FORM#MNL MMC PPO SB TX 0205----FORM#MNL MMC PPO SB TX 0205 Disclosure: As required by 28 TAC §21.3530, I have been informed that the Consumer Choice Standard Benefit Plan that I am purchasing does not include all state mandated health insurance benefits. I understand that I may elect benefits which are provided at a reduced level from what is mandated, or are excluded completely from the plan. Disclosure: As required by 28 TAC §21.3530, I have been informed that the Consumer Choice Standard Benefit Plan that I am purchasing does not include all state mandated health insurance benefits. I understand that I may elect benefits which are provided at a reduced level from what is mandated, or are excluded completely from the plan. | |||
| Nippon Life Insurance Company of America (800) 937-6542 www.nlia.com |
Carrier's most popular state-mandated plan | Carrier's most popular consumer choice health Benefit Plan | ||
| Indemnity | PPO | Indemnity | PPO | |
| Annual deductible (insured) | NA | 3,500 | NA | 1,000 |
| Annual deductible (family) | NA | 7,000 | NA | 3,000 |
| Hospital deductible | NA | 0 | NA | 0 |
| Physician's office visit copay | NA | 35/50 | NA | 25 |
| Does the plan include prescription drug benefits? | No | Yes | No | Yes |
| If prescription drug benefits are included, list copay | NA | 15/25/50 | NA | 10/20/30 |
| Network coinsurance | NA | 80% | NA | 80% |
| Non-network coinsurance | NA | 60% | NA | 50% |
| Lifetime maximum | NA | Unlimited | NA | Unlimited |
| Out-of-pocket maximum | NA | 4,000 | NA | 4,000 |
| Form number | NA | NP-5500-CCP | NA | NP-5500-CCP |
| Most popular consumer choice plan disclosure form | As required by 28 TAC §21.3530, I have been informed that the Consumer Choice Standard Benefit Plan that I am purchasing does not include all state mandated health insurance benefits. I understand that the following benefits are provided at a reduced level from what is mandated, or are excluded completely from the plan. | |||
| Southwest Life & Health Insurance Company (800) 884-4901 www.firstcare.com |
Carrier's most popular state-mandated plan | Carrier's most popular consumer choice health Benefit Plan | ||
| Indemnity | PPO | Indemnity | PPO | |
| Annual deductible (insured) | NA | 1,000 | NA | NA |
| Annual deductible (family) | NA | 2,000 | NA | NA |
| Hospital deductible | NA | NA | NA | NA |
| Physician's office visit copay | NA | 25 | NA | NA |
| Does the plan include prescription drug benefits? | No | Yes | No | No |
| If prescription drug benefits are included, list copay | NA | 5/25/50 | NA | NA |
| Network coinsurance | NA | 80% | NA | NA |
| Non-network coinsurance | 60% | NA | ||
| Lifetime maximum | NA | NA | NA | NA |
| Out-of-pocket maximum | NA | 2,000/4,000 | NA | NA |
| Form number | NA | PP12S251 | NA | NA |
| Most popular consumer choice plan disclosure form | NA | |||
| Standard Security Life Insurance Company of New York (212) 355-4141 www.sslicny.com |
Carrier's most popular state-mandated plan | Carrier's most popular consumer choice health Benefit Plan | ||
| Indemnity | PPO | Indemnity | PPO | |
| Annual deductible (insured) | NA | 2,000 | NA | 2,000 |
| Annual deductible (family) | NA | 4,000 | NA | 4,000 |
| Hospital deductible | NA | 250 | NA | 250 |
| Physician's office visit copay | NA | 40 | NA | 40 |
| Does the plan include prescription drug benefits? | No | Yes | No | Yes |
| If prescription drug benefits are included, list copay | NA | 10/50/100 | NA | 10/50/100 |
| Network coinsurance | NA | 80% | NA | 50% |
| Non-network coinsurance | NA | 50% | NA | 50% |
| Lifetime maximum | NA | 5,000,000 | NA | 5,000,000 |
| Out-of-pocket maximum | NA | 2,000 | NA | 2,000 |
| Form number | NA | SEE BELOW | NA | SEE BELOW |
| Most popular consumer choice plan disclosure form | FORM#SSL MMC PPO SB TX 0205-Disclosure - As required by 28 TAC §21.3530, I have been informed that the Consumer Choice Standard Benefit Plan that I am purchasing does not include all state mandated health insurance benefits. I understand that I may elect benefits which are provided at a reduced level from what is mandated, or are excluded completely from the plan. | |||
| Time Insurance Company (800) 800-1212 www.assuranthealth.com |
Carrier's most popular state-mandated plan | Carrier's most popular consumer choice health Benefit Plan | ||
| Indemnity | PPO | Indemnity | PPO | |
| Annual deductible (insured) | 500 | 500 | NA | NA |
| Annual deductible (family) | 1,000 | 1,000 | NA | NA |
| Hospital deductible | 500 | 500 | NA | NA |
| Physician's office visit copay | 0 | 25 | NA | NA |
| Does the plan include prescription drug benefits? | Yes | Yes | No | No |
| If prescription drug benefits are included, list copay | 15/25/50 $250 | 15/45/60 | NA | NA |
| Network coinsurance | 50% | 50% | NA | NA |
| Non-network coinsurance | 50% | NA | ||
| Lifetime maximum | 5,000,000 | 5,000,000 | NA | NA |
| Out-of-pocket maximum | 1,000 | 2,000 | NA | NA |
| Form number | TGM.TRT.TX | TGM.TRT.TX | NA | NA |
| Most popular consumer choice plan disclosure form | ||||
| Trustmark Life Insurance Company (212) 355-4141 www.sslicny.com |
Carrier's most popular state-mandated plan | Carrier's most popular consumer choice health Benefit Plan | ||
| Indemnity | PPO | Indemnity | PPO | |
| Annual deductible (insured) | NA | 2,000/4,000 | 500 | 500 |
| Annual deductible (family) | NA | 4,000/8,000 | NA | NA |
| Hospital deductible | NA | 250 | NA | 250 |
| Physician's office visit copay | NA | 30 | NA | NA |
| Does the plan include prescription drug benefits? | No | Yes | No | No |
| If prescription drug benefits are included, list copay | NA | 10/30/50 | NA | NA |
| Network coinsurance | NA | 80% | 80% | 90% |
| Non-network coinsurance | NA | 60% | 70% | |
| Lifetime maximum | NA | 3,500,000 | 2,000,000 | 2,000,000 |
| Out-of-pocket maximum | NA | 4,000/12,000 | 3,500 | 3,500 |
| Form number | NA | S989C | TMCCP | TMCCP |
| Most popular consumer choice plan disclosure form | The following mandated benefits are NOT covered under this plan: 1. Brain Injury Coverage; 2. Contraceptive Drugs and Devices; 3. Treatment for Temporomandibular Joint Disease; 4. Inpatient and outpatient treatment for Mental or Nervous Disorders, other than Serious Mental Illness; 5. Treatment for Chemical Abuse; 6. Hearing Impairment Screenings for Newborns and Children; 7. Bone mass measurement for detection of low bone mass and to determine osteoporosis risk; 8. Minimum Inpatient Stays Following Mastectomy; 9. In-Vitro Fertilization; 10. Treatment for Loss of Speech or Hearing; 11. Home Health Care]. | |||
| U S Health and Life Insurance Company (800) 839-6048 www.ushealthandlife.com |
Carrier's most popular state-mandated plan | Carrier's most popular consumer choice health Benefit Plan | ||
| Indemnity | PPO | Indemnity | PPO | |
| Annual deductible (insured) | NA | 5,000 | NA | 5,000 |
| Annual deductible (family) | NA | 15,000 | NA | 15,000 |
| Hospital deductible | NA | Same as annual | NA | Same as annual |
| Physician's office visit copay | NA | 40 | NA | 40 |
| Does the plan include prescription drug benefits? | No | Yes | NA | Yes |
| If prescription drug benefits are included, list copay | NA | 15/30/60 | NA | 15/30/60 |
| Network coinsurance | NA | 80% | NA | 80% |
| Non-network coinsurance | 50% | 50% | ||
| Lifetime maximum | NA | NA | NA | NA |
| Out-of-pocket maximum | NA | 2,000 | NA | 2,000 |
| Form number | NA | USHL-GP-2005 | NA | USHL-GP-2005 |
| Most popular consumer choice plan disclosure form | ||||
| United Healthcare Insurance Company (269) 216-2104 www.uhc.com |
Carrier's most popular state-mandated plan | Carrier's most popular consumer choice health Benefit Plan | ||
| Indemnity | PPO | Indemnity | PPO | |
| Annual deductible (insured) | 500 | 3,000 | NA | 1,500 |
| Annual deductible (family) | 1,500 | 9,000 | NA | 4,500 |
| Hospital deductible | NA | NA | NA | NA |
| Physician's office visit copay | NA | 30/60 | NA | NA |
| Does the plan include prescription drug benefits? | Yes | Yes | No | Yes |
| If prescription drug benefits are included, list copay | 15/35/60 | 15/35/60 | NA | 15/35/60 |
| Network coinsurance | 20% | 0% | NA | 20% |
| Non-network coinsurance | 30% | NA | 40% | |
| Lifetime maximum | Unlimited | Unlimited | NA | Unlimited |
| Out-of-pocket maximum | 3,000 | 3,000 | NA | 3,500 |
| Form number | CCOV.1.07 | CHOICEP | NA | STDCCP |
| Most popular consumer choice plan disclosure form | This Consumer Choice of Benefits Health Insurance Plan, either in whiole or in part, does not provide state-mandated health benefits normally required in accident and sickness insurance policies in Texas. | |||
| Valley Baptist Insurance Company (800) 829-6440 www.valleyhealthplans.com |
Carrier's most popular state-mandated plan | Carrier's most popular consumer choice health Benefit Plan | ||
| Indemnity | PPO | Indemnity | PPO | |
| Annual deductible (insured) | NA | 2,000 | NA | NA |
| Annual deductible (family) | NA | 4,000 | NA | NA |
| Hospital deductible | NA | NA | NA | NA |
| Physician's office visit copay | NA | 25 | NA | NA |
| Does the plan include prescription drug benefits? | No | Yes | No | No |
| If prescription drug benefits are included, list copay | NA | 5/25/50 | NA | NA |
| Network coinsurance | NA | 80% | NA | NA |
| Non-network coinsurance | NA | 60% | NA | NA |
| Lifetime maximum | NA | NA | NA | NA |
| Out-of-pocket maximum | NA | 4,000/8,000 | NA | NA |
| Form number | NA | VP12S266 | NA | NA |
| Most popular consumer choice plan disclosure form | ||||
For more information contact:
