Medical Benefits

Your employer offers medical insurance to protect the health of you and your family. It covers medical expenses such as visits to the doctor’s office, emergency care, and prescription drugs. It’s important to have a medical plan that meets your needs and the needs of your family.
Keep in mind that your out-of-pocket costs will be lower if you receive care from an in-network doctor and facility. To find an in-network doctor, please visit www.bcbstx.com.

SJRC Texas contributes 75% towards the Employee Only premium and 20% towards the Dependent premium

Blue Cross Blue Shield of Texas In-Network Benefits	HDHP Base Plan	PPO Middle Plan	PPO Buy-Up Plan
Deductible (Individual/Family)	$5,000/$10,000	$3,000/$9,000	$1,000/$3,000
Out-of-Pocket Max (Individual/Family)	$5,000/$10,000	$9,000/$18,000	$4,000/$12,000
Physician Visits
Preventive Annual Exam	Covered 100%	Covered at 100%	Covered at 100%
Primary Care Visit	Deductible	$55 Copay	$30 Copay
Specialist Visit	Deductible	$110 Copay	$60 Copay
Virtual Care
with MDLive	No Copay	No Copay	No Copay
with Primary Care Physician	Deductible	Subject to Provider's Office Copay	Subject to Provider's Office Copay
Hospitalization
Inpatient Hospitalization	Deductible	Deductible + 30% Coinsurance	Deductible + 20% Coinsurance
Outpatient Surgery	Deductible	Deductible + 30% Coinsurance	Deductible + 20% Coinsurance
Additional Services
Urgent Care	Deductible	$75 Copay	$75 Copay
Emergency Room	Deductible	$500 Copay + 30%	$500 Copay + 20%
Retail Prescriptions
Tier 1	Deductible	$0-$10	$0-$10
Tier 2	Deductible	$10-$20	$10-$20
Tier 3	Deductible	$50-$70	$50-$70
Tier 4	Deductible	$100-$120	$100-$120
Tier 5	Deductible	$150-$250	$150-$250
Mail Order Prescriptions
90-Day Supply	2.5 x Retail	2.5 x Retail	2.5 x Retail

Per 24 Pay Period Cost	HDHP Base Plan EMPLOYEE	HDHP Base Plan EMPLOYER	PPO Middle Plan EMPLOYEE	PPO Middle Plan EMPLOYER	PPO Buy-Up Plan EMPLOYEE	PPO Buy-Up Plan EMPLOYER
Employee Only	$82.81	$496.84	$89.43	$536.58	$112.35	$674.12
Employee + Spouse	$353.07	$632.02	$381.31	$682.57	$479.05	$857.54
Employee + Child(ren)	$358.37	$634.67	$387.04	$685.43	$486.24	$861.13
Employee + Family	$530.62	$720.76	$573.06	$778.41	$719.96	$977.95