This link will take you to a new site not afilliated with BCBSTX. It will open in a new window. To return to our Web site, simply close the new window. Refer to important information for our linking policy.
| Health Plan # | Ded In/Out Comb | Office Copay | Urgent Care Copay | ER Copay | Coins % In/Out | Coins Stoploss In/Out | Pharmacy |
|---|---|---|---|---|---|---|---|
| RL100 | $1000 | Ded & Coins | Not Available | $150 | 80% / 60% | $3000/$6000 | $20/35/50 |
| Health Plan # | Office Visit Copay | In-Hospital Copay | ER Copay | Out of Pocket Maximum | PDP Copay |
|---|---|---|---|---|---|
| RPlan99 | $25 per visit | $500 per day/$2500 max | $150 per visit | $5000/$10000 | PD 99 $20/35/50 |
A Division of Health Care Service Corporation, a Mutual Legal Reserve Company,
an Independent Licensee of the Blue Cross and Blue Shield Association.
© Copyright Health Care Service Corporation. All Rights Reserved.
