Individual and Group Health Care Forms |
CLICK
HERE to view and
print a BlueCross and BlueShield of Texas Individual Application
BCBSTX
Individual Coverage Product Information and Applications
PPO
Select® plan options from BlueCross
and BlueShield of Texas, offer choice and flexibility for individual
health care coverage. They are not pre-packaged, one-size-fits-all
health insurance plans, but rather health coverage that gives
you a selection of benefits to fit your health care coverage
needs now and in the future.
Child-Only
coverage is available through BlueCross and BlueShield of Texas
Individual Products.
Click
here for a quick comparison of all three PPO Select Series III
products. 40127.0305
- Select
Blue Advantage - Series III
Click here for a Select Blue Advantage Enrollment Guide and
Application - be sure to return your application to All Plan
Insurance for processing. 42978.0405
- PPO
Select® Choice - Series III
Click here for a PPO Select Choice Enrollment Guide and Application
- be sure to return your application to All Plan Insurance
for processing.
42979.0405
- PPO
Select Saver® - Series III
Click here for a PPO Select Saver Enrollment Guide and Application
- be sure to return your application to All Plan Insurance
for processing. 42980.0405
- Changes
to your existing PPO Select Series III plan?
Click here for a Series III Enrollment Application / Miscellaneous
Change Form - be sure to return this form to All Plan Insurance
for processing. 41745.1004
-
BlueEdgeSM Individual HSA
- BlueEdge Individual HSA is a new kind of health plan - a
consumer-centered plan. This plan allows you to decide how,
when and where your health care dollars are spent.
Click
here for information about BlueEdge Individual HSA. 43240.0905
Click here for BlueEdge Individual HSA banking information from
Mellon Bank. 42997.0405
Click
here to download a BlueEdge Individual HSA application. Be sure
to return your application to All Plan Insurance for processing.
42498.0505
-
PPO Select®
Value Care - offers you several health care
coverage options that help you control the monthly cost of
your insurance protection and gives you a choice of health
care providers from the BlueChoice network. The higher coinsurance
maximum level you choose, the lower your premiums can be!
Click
here for a quick comparison of the PPO Select Value Care plan
options.
43235.0505
Click
here for a PPO Select Value Care Enrollment Guide and Application.
Be sure to return your application to All Plan Insurance for
processing. 42989-0505
-
PPO Select®
Basic – this preferred provider health
insurance plan, 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
benefits plan may provide a more affordable health insurance
policy for you although, at the same time, may provide fewer
health benefits.
Click
here for a PPO Select Basic Enrollment Guide and Application.
Be sure to return your application to All Plan Insurance for
processing. 40835-804
Foundation
Hospital Care
A plan that provides the freedom to choose your hospital each
and every time you need inpatient hospital care, 24 hour worldwide
coverage, BlueCard Program, no balance billing above the allowable
amount, and no claims to file for inpatient hospital services.
- SelecTEMP®
- is the affordable temporary health insurance plan from BlueCross
and Blue Shield of Texas. It is individual health coverage
that provides you, your spouse and your children essential,
basic protection against unexpected accidents or illnesses.
SelecTEMP offers various benefit periods and deductibles to
give you the control to tailor coverage, premium rates and
out-of-pocket expenses according to your own needs.
Click
here to download the SelecTEMP Enrollment Guide and Application.
Be sure to return your application to All Plan Insurance for
processing. 8710.792-0605
Dental
Indemnity USA
The Individual Dental Indemnity plan is available in combination
with your Individual BlueCross and Blue Shield of Texas health
insurance plan. There is an additional premium for the Individual
Dental Indemnity plan.
Dental
Indemnity USA can be used to provide dental benefits to:
• A single individual above
the age of 18;
• An individual plus one
eligible dependent; or
• Family
Region
2 Gold
Zip Codes beginning with - 754-759; 764; 766-767; 765, 778,
768-769; 788; 797-798; 776-777; 779, 781; 780, 782, 783-785,
790-792, 793-796.
(Longview, Tyler, Lufkin, Stephenville, Hillsboro, Waco, Killeen,
Bryan, College Station, San Angelo, Odessa, Del Rio, Midland,
Beaumont, Port Arthur, Victoria, Beeville, Karnes City, San
Antonio, Laredo, Kerrville, Corpus Christi, Brownsville, McAllen,
Amarillo, Planview, Dumas, Abilene, Lubbock)
Click
here to download dental benefits for Region 2 Gold. 40107.404
Region
4 Gold
Zip Codes beginning with – 750-751; 752-753, 760-761;
762-763; 770; 772; 773-775; 786-787; 789; 799; 885
(Garland, Irving,. Sherman, Denison, Dallas, Arlington, Fort
Worth, Wichita Falls, Denton, Houston, Conroe, Pasadena, Galveston,
Austin, San Marcos, La Grange, El Paso)
Click
here to download dental benefits for Region 4 Gold. 40108.404 |