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Plan Comparison

We understand that every individual is unique and each family has different needs — and we have the perfect plan to fit your health care needs and budget. Compare our 2017 bronze, silver, and gold HMO and PPO plans in the charts below to see which is best for you.

Compare 2017 plans below. Additional information is available via our Individual Product Brochure.

To compare 2016 plans, click here.

Compare HMO Plans

 Gold
001 HMO
Gold
1000 HMO
Gold
2500 HMO
Silver
4500 HMO
Bronze
6550 H.S.A. HMO
Bronze
6850 HMO
Deductible$0$1,000$2,500$4,500$6,550$6,850
Family Deductible$0$2,000$5,000$9,000$13,100$13,700
Out-of-Pocket Maximum (Individual)
$7,150

$3,000

$3,000

$7,150

$6,550

$7,150
Out-of-Pocket Maximum (Family)$14,300$6,000$6,000$14,300$13,100$14,300
Member Coinsurance0%20%0%30%0%50%
PCP$5020% coinsurance after deductible$30$30No charge after deductible50% coinsurance after deductible
Specialist$10020% coinsurance after deductible$50$75No charge after deductible50% coinsurance after deductible
Telemedicine/TelehealthNo chargeNo chargeNo chargeNo charge$40 applies to deductibleNo charge
Urgent Care$10020% coinsurance after deductible$50$80No charge after deductible50% coinsurance after deductible
Emergency Room$75020% coinsurance after deductible$500 then deductible$500No charge after deductible50% coinsurance after deductible
Hearing & Speech Exams$80$50No charge after deductible$70No charge after deductible50% coinsurance after deductible
Independent & Outpatient Lab/Pathology$4020% coinsurance after deductibleNo charge after deductible30% coinsurance after deductibleNo charge after deductible50% coinsurance after deductible
Radiology/X-rays$8020% coinsurance after deductibleNo charge after deductible30% coinsurance after deductibleNo charge after deductible50% coinsurance after deductible
MRI/Scans/Nuclear Medicine$35020% coinsurance after deductibleNo charge after deductible30% coinsurance after deductibleNo charge after deductible50% coinsurance after deductible
Inpatient Hospital$750/day for first 3 days of admission20% coinsurance after deductible$600/day30% coinsurance after deductibleNo charge after deductible50% coinsurance after deductible
PT/OT/Chiro$8020% coinsurance after deductibleNo charge after deductible30% coinsurance after deductibleNo charge after deductible50% coinsurance after deductible
Retail Generic Rx$4$4$4$4No charge after deductible$4
Retail Brand Rx$50$50$30$50No charge after deductible50% coinsurance after deductible
Retail Non-Formulary Brand Rx$100$100$60$100No charge after deductible50% coinsurance after deductible
Retail Specialty Rx50% coinsurance50% coinsurance after deductible50% coinsurance after deductible50% coinsurance after deductibleNo charge after deductible50% coinsurance after deductible

*The following notice is required upon enrollment if selecting an HMO Consumer Choice Health Benefit Plan you have the option to choose this Consumer Choice of Benefits Health Maintenance Organization health care plan that, either in whole or in part, does not provide state-mandated health benefits normally required in evidences of coverage in Texas. This standard health benefit plan may provide a more affordable health plan for you although, at the same time, it may provide you with fewer health plan benefits than those normally included as state-mandated health benefits 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 evidence of coverage.

Rates are valid from 1/1/2017 – 12/31/2017

HMO Service Area: Harris, Fort Bend and Montgomery counties

For individuals, find the rate that matches your age for the plan you’re interested in.

For families, find the rate that matches the age for all members of your family and add them together. If you have more than three (3) children, only add the rate for the three (3) oldest up to age 26.

Compare PPO Plans

 Silver
4500 PPO
Silver
2850 H.S.A. PPO
Deductible$4,500$2,850
Family Deductible$9,000$5,700
Out-of-Pocket Maximum (Individual)$7,150$6,550
Out-of-Pocket Maximum (Family)$14,300$13,100
Member Coinsurance30%15%
PCP $3015% coinsurance after deductible
Specialist$7515% coinsurance after deductible
Telemedicine/TelehealthNo charge$40 applies to deductible
Urgent Care$7515% coinsurance after deductible
Emergency Room$50015% coinsurance after deductible
Hearing & Speech Exams$7015% coinsurance after deductible
Independent & Outpatient Lab/Pathology30% coinsurance after deductible15% coinsurance after deductible
Radiology/X-rays30% coinsurance after deductible15% coinsurance after deductible
MRI/Scans/Nuclear Medicine30% coinsurance after deductible15% coinsurance after deductible
Inpatient Hospital30% coinsurance after deductible15% coinsurance after deductible
PT/OT/Chiro30% coinsurance after deductible15% coinsurance after deductible
Retail Generic Rx$4$4 after deductible
Retail Brand Rx$50$50 after deductible
Retail Non-Formulary Brand Rx$100$100 after deductible
Retail Specialty Rx50% coinsurance after deductible50% coinsurance after deductible

Rates are valid from 1/1/2017 – 12/31/2017

PPO Service Area: Harris, Fort Bend, Montgomery, Brazoria, Galveston, Walker and Wharton counties

For individuals, find the rate that matches your age for the plan you’re interested in.

For families, find the rate that matches the age for all members of your family and add them together. If you have more than three (3) children, only add the rate for the three (3) oldest up to age 26.

The PPO is a Limited Hospital Care Network.


Exclusions and Limitations >