Medical Plans & Pharmacy
Understanding Your Options:
Magnolia Pearl medical plan options are administered by Blue Cross Blue Shield of Texas and are designed to help you maintain your health through preventive care services, access to an extensive network of providers, and affordable prescription medication.
You can choose from four flexible plan options:
- Blue Advantage HMO Silver/BCBS TX Narrow Network $4,250 Deductible (Texas employees only)
- Blue Advantage HMO GOLD/BCBS TX Narrow Network $1,500 Deductible (Texas employees only)
- Blue Choice PPO Silver/BCBS TX Preferred Provider $4,250 Deductible
- Blue Choice PPO Gold/BCBS TX Preferred Provider $1,500 Deductible
Blue Cross Blue Shield of Texas HMO is a type of health insurance plan that limits coverage to doctors, hospitals, and pharmacies that participate in the Blue Cross Blue Shield of Texas HMO network. There is no coverage if you go to out-of-network providers, except for emergency services. A Blue Cross Blue Shield of Texas HMO requires you to live in Texas.
The Blue Cross Blue Shield of Texas PPO plans are a PPO Network with both in-network and out-of-network benefits. Plans have a deductible to meet first for certain services with coinsurance. Physicians’ services and prescriptions have copays.
HOW TO LOCATE A BLUE CROSS BLUE SHIELD OF TEXAS PROVIDER
Use the guest search option to search for medical providers and dentist until you have registered as a member. Log-on to: https://www.bcbstx.com/. The following link takes you to the exact network search.
HMO (Texas employees only)
Medical Network: BCBS Provider Search_Blue Advantage HMO Network
PPO Medical Network: Blue Choice PPO BCBS Provider Search_Blue Choice Network
WHY DO I PAY FOR BENEFITS WITH PRE-TAX MONEY?
There is a definite advantage to paying for some benefits with pre-tax money. Taking the money out before your taxes are calculated lowers the amount of your pay that is taxable. Therefore, you pay less in taxes. Your medical, dental, and vision deductions are pre-tax.
Preferred pharmacies are as follows: Walgreens, HEB, Kroger, Albertsons, Walmart, Brookshire Grocery, & independents per pharmacy directory. CVS is Out-of-Network.
Plan Benefits | Blue Advantage Silver HMO Texas employees only | Blue Advantage HMO Gold Texas employees only |
|---|---|---|
| IN-NETWORK ONLY | IN-NETWORK ONLY | |
| Annual Deductible | $4,250 individual $12,750 family | $1,500 individual $4,500 family |
| Out-of-Pocket Maximums | $9,000 individual $18,000 family | $5,250 individual $10,500 family |
| Preventive Care | No charge | No charge |
| Primary Office Visit | $50 copay (ded waived) | $45 copay (ded waived) |
| Specialist Office Visit | $90 copay (ded waived) | $90 copay (ded waived) |
| Diagnostic Lab & X-ray | 30% coinsurance after deductible | 20% coinsurance after deductible |
| Advanced Diagnostic Imaging | $300 test (ded waived) | $300 test (ded waived) |
| Urgent Care | $100 copay (ded waived) | $100 copay (ded waived) |
| Inpatient Hospital Stays | $300 + 30% coinsurance after deductible | 20% coinsurance after deductible |
| Outpatient Surgery | $250 + 30% coinsurance after deductible | 20% coinsurance after deductible |
| Emergency Room | $650 visit + 30% coinsurance after deductible (waived if admitted) | $500 copay +20% coinsurance after deductible (waived if admitted) |
| Prescription Drugs- 30 day supply | ||
| Generic drugs Preferred / Formulary | $5 copay | No charge |
| Brand drugs Preferred / Formulary | $50 copay | $50 copay |
| Specialty drugs Preferred / Formulary | $250 copay | $150 copay |
Plan Benefits | Blue Choice Gold PPO | Blue Choice Silver PPO |
||
|---|---|---|---|---|
| IN-NETWORK | OUT-OF-NETWORK | IN-NETWORK | OUT-OF-NETWORK | |
| Annual Deductible (Individual / Family) | $1,500 / $4,500 | $3,000 / $9,000 | $4,250 / $12,750 | $8,500 / $25,500 |
| Out-of-Pocket Maximums(Individual / Family) | $6,000 / $12,000 | Unlimited | $9,000 / $18,000 | Unlimited |
| Preventive Care | No charge | 40% coinsurance after deductible | Covered at 100% | 50% coinsurance after deductible |
| Primary/Specialist Office | $40/ $80 copay | 40% coinsurance after deductible | $50/ $90 copay | 50% coinsurance after deductible |
| Diagnostic Lab & X-ray | 20% coinsurance after deductible X-ray $50 test + 20% | 40% coinsurance after deductible | 30% coinsurance after deductible | 50% coinsurance after deductible |
| Advanced Diagnostic Imaging | $100 copay + 20% coinsurance | 40% coinsurance after deductible | $300 test | 50% coinsurance after deductible |
| Urgent Care | $75 copay (deductible waived) | 40% coinsurance after deductible | $100 copay | 50% coinsurance after deductible |
| Inpatient Hospital Stays | 20% coinsurance after deductible | 40% coinsurance after deductible | $300 copay +30% coinsurance after deductible | $350 copay + 50% coinsurance after deductible |
| Outpatient Surgery | 20% coinsurance after deductible | 40% coinsurance after deductible | $250 copay +30% coinsurance after deductible | $300 copay + 50% coinsurance after deductible |
| Emergency Room | $500 copay + 20% coinsurance after deductible (waived if admitted) | $650 copay + 30% coinsurance after deductible (waived if admitted) |
||
| 30 day supply | ||||
| Generic drugs Preferred / Formulary | No charge | $10 copay + 50% | $5 copay | $15 copay + 50% |
| Brand drugs Preferred / Formulary | $50 copay | $70 copay + 50% | $50 copay | $70 copay + 50% |
| Specialty drugs Preferred / Formulary | $150 copay | $150 copay + 50% | $250 copay | $250 copay + 50% |
Preferred pharmacies are as follows: Walgreens, HEB, Kroger, Albertsons, Walmart, Brookshire Grocery, & independents per pharmacy directory. CVS is Out-of-Network.