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Home   >  Health Insurance Companies   >   Blue Cross Blue Shield of Texas   > PPO Select Choice - Plan V

Blue Cross Blue Shield of Texas

PPO Select Choice - Plan V Health Insurance Plan

A plan summary of the Blue Cross Blue Shield of Texas PPO Select Choice - Plan V is detailed out below for both In Network and Out of Network coverage.

                                                In Network Out of Network


20% after deductible

30% after deductible

  Office Visits

$25 (See Brochure) 30% (See Brochure)

  Annual Deductible

Individual:$2,500 Family:$7,500

Individual:$5,000 Family:$15,000

  Annual Out-Of-Pocket  Limit

Individual:$3,000 Family:$6,000 (Deductible not Included)

Individual:$6,000 Family:$12,000 (Deductible not Included)

  Lifetime Maximum

Unlimited Unlimited

  Prescription Drugs

Generic:$10 Preferred Brand:$30 Non-Preferred Brand:$45 ($200 Deductible)

Generic:$10 Preferred Brand:$30 Non-Preferred Brand:$45 ($200 Deductible)

  Laboratory & X-Ray

20% 30%

  Annual Physical Exam

No Charge 30%

  Annual OB-GYN Exam

No Charge 30%

  Well Baby Care

No Charge 30%

  Outpatient Surgery

20% 30%

  Emergency Room

20% 20%

  Inpatient Hospital

20% 30%


20% 20%

  Home Health Care

No Charge 30%

  Mental Health - Outpatient

Not Covered Not Covered

  Chiropractic Care

See Brochure See Brochure


Not Covered Not Covered

  Mental Health - Inpatient

Not Covered

Not Covered

  Chemical Dependency

Not Covered Not Covered

  Maternity Care

Not Covered Not Covered


To learn more about your individual and family Texas health insurance options, the price of each plan and/or a detailed benefit summary of the plans, visit us here.

NOTICE! Final rates and benefits are based on actual plan selection (including plan riders you may request) and the assignment of any rate adjustment factors due to the standard health plan's underwriting guidelines.

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