Documentos de la póliza para grupos pequeños de QHP 2024

Below is a list of actual policy documents for Blue Cross and Blue Shield of Texas QHP small group coverage. Estas pólizas describen cómo funcionan las coberturas en términos generales e incluyen gastos elegibles, presentación de reclamos y procedimientos de apelaciones y limitaciones y excepciones en la cobertura, entre otras cosas.

Si tiene alguna duda, comuníquese con un representante de Servicio al Cliente al 1-888-697-0683 para obtener más información.

Volver a los documentos de ejemplos de pólizas

Coberturas Platino

Coberturas Blue Choice Advantage Platinum PPO
Fuera del Intercambio

Manuales de pólizas

• P9K3CHC Blue Choice Platinum PPO 202
• P9K4CHC Blue Choice Platinum PPO 202 – in vitro
• P9M1CHC Blue Choice Platinum PPO 301
• P9M2CHC Blue Choice Platinum PPO 301-in vitro
• P620CHC Blue Choice Platinum PPO 810
• PV20CHC Blue Choice Platinum PPO 810-in vitro
• P621CHC Blue Choice Platinum PPO 811
• PV21CHC Blue Choice Platinum PPO 811-in vitro

Coberturas Blue Advantage Platinum HMO
Fuera del Intercambio

Manuales de pólizas

• P9K3ADT Blue Advantage Platinum HMO 202
• P9K4ADT Blue Advantage Platinum HMO 202 – in vitro
• P9M1ADT Blue Advantage Platinum HMO 301
• P9M2ADT Blue Advantage Platinum HMO 301-in vitro
• P610ADT Blue Advantage Platinum HMO 807
• PV10ADT Blue Advantage Platinum HMO 807-in vitro
• P611ADT Blue Advantage Platinum HMO 808
• PV11ADT Blue Advantage Platinum HMO 808-in vitro

Descripciones de coberturas

• P9K3ADT Blue Advantage Platinum HMO 202
• P9K4ADT Blue Advantage Platinum HMO 202 – in vitro
• P9M1ADT Blue Advantage Platinum HMO 301
• P9M2ADT Blue Advantage Platinum HMO 301-in vitro
• P610ADT Blue Advantage Platinum HMO 807
• PV10ADT Blue Advantage Platinum HMO 807-in vitro
• P611ADT Blue Advantage Platinum HMO 808
• PV11ADT Blue Advantage Platinum HMO 808-in vitro

Planes Oro

Coberturas Blue Choice Gold PPO
Fuera del Intercambio

Manuales de pólizas

• G9K4CHC Blue Choice Gold PPO 103
• G9K5CHC Blue Choice Gold PPO 103-in-vitro
• G9K6CHC Blue Choice Gold PPO 112
• G9K7CHC Blue Choice Gold PPO 112-in-vitro
• G9K8CHC Blue Choice Gold PPO 114
• G9K9CHC Blue Choice Gold PPO 114-in-vitro
• G9L1CHC Blue Choice Gold PPO 117
• G9L2CHC Blue Choice Gold PPO 117-in-vitro
• G9L5CHC Blue Choice Gold PPO 203
• G9L6CHC Blue Choice Gold PPO 203 - in vitro
• G9L7CHC Blue Choice Gold PPO 204
• G9L7CHC Blue Choice Gold PPO 204 -in vitro
• G650CHC Blue Choice Gold PPO 801
• GV50CHC Blue Choice Gold PPO 801-in vitro
• G651CHC Blue Choice Gold PPO 819
• GV51CHC Blue Choice Gold PPO 819-in vitro
• G652CHC Blue Choice Gold PPO 820
• GV52CHC Blue Choice Gold PPO 820-in vitro
• G653CHC Blue Choice Gold PPO 822
• GV53CHC Blue Choice Gold PPO 822-in vitro
• G654CHC Blue Choice Gold PPO 823
• GV54CHC Blue Choice Gold PPO 823-in vitro
• G656CHC Blue Choice Gold PPO 830
• GV56CHC Blue Choice Gold PPO 830-in vitro

Coberturas Blue Advantage Gold HMO
Fuera del Intercambio

Manuales de pólizas

• G9J1ADT Blue Advantage Gold HMO 103
• G9J2ADT Blue Advantage Gold HMO 103-in vitro
• G9K5ADT Blue Advantage Gold HMO 203
• G9K6ADT Blue Advantage Gold HMO 203 -in vitro
• G9K7ADT Blue Advantage Gold HMO 204
• G9K8ADT Blue Advantage Gold HMO 204 -in vitro
• G660ADT Blue Advantage Gold HMO 801
• GV60ADT Blue Advantage Gold HMO 801-in vitro
• G661ADT Blue Advantage Gold HMO 812
• GV61ADT Blue Advantage Gold HMO 812-in vitro
• G662ADT Blue Advantage Gold HMO 814
• GV62ADT Blue Advantage Gold HMO 814-in vitro
• G663ADT Blue Advantage Gold HMO 816
• GV63ADT Blue Advantage Gold HMO 816-in vitro
• G664ADT Blue Advantage Gold HMO 817
• GV64ADT Blue Advantage Gold HMO 817-in vitro
• G665ADT Blue Advantage Gold HMO 822
• GV65ADT Blue Advantage Gold HMO 822-in vitro
• G666ADT Blue Advantage Gold HMO 830
• GV66ADT Blue Advantage Gold HMO 830-in vitro
• G9E2ADT Blue Advantage Gold HMO 919
• G9E1ADT Blue Advantage Gold HMO 919-in vitro
• G9E3ADT Blue Advantage Gold HMO 922
• G9E4ADT Blue Advantage Gold HMO 922-in vitro
• G9E5ADT Blue Advantage Gold HMO 923
• G9E6ADT Blue Advantage Gold HMO 923-in vitro

Descripciones de coberturas

• G660ADT Blue Advantage Gold HMO 801
• GV60ADT Blue Advantage Gold HMO 801-in vitro
• G661ADT Blue Advantage Gold HMO 812
• GV61ADT Blue Advantage Gold HMO 812-in vitro
• G662ADT Blue Advantage Gold HMO 814
• GV62ADT Blue Advantage Gold HMO 814-in vitro
• G663ADT Blue Advantage Gold HMO 816
• GV63ADT Blue Advantage Gold HMO 816-in vitro
• G664ADT Blue Advantage Gold HMO 817
• GV64ADT Blue Advantage Gold HMO 817-in vitro
• G665ADT Blue Advantage Gold HMO 822
• GV65ADT Blue Advantage Gold HMO 822-in vitro
• G666ADT Blue Advantage Gold HMO 830
• GV66ADT Blue Advantage Gold HMO 830-in vitro
• G9E1ADT Blue Advantage Gold HMO 919
• G9E2ADT Blue Advantage Gold HMO 919-in vitro
• G9E3ADT Blue Advantage Gold HMO 922
• G9E4ADT Blue Advantage Gold HMO 922-in vitro
• G9E5ADT Blue Advantage Gold HMO 923
• G9E6ADT Blue Advantage Gold HMO 923-in vitro

Planes Plata

Coberturas Blue Choice Silver PPO
Fuera del Intercambio

Manuales de pólizas

• S9L3CHC Blue Choice Silver PPO 101
• S9L4CHC Blue Choice Silver PPO 101-in-vitro
• S9L5CHC Blue Choice Silver PPO 102
• S9L6CHC Blue Choice Silver PPO 102-in-vitro
• S9L9CHC Blue Choice Silver PPO 118
• S9M1CHC Blue Choice Silver PPO 118-in-vitro
• S9M4CHC Blue Choice Silver PPO 120
• S9M5CHC Blue Choice Silver PPO 120-in vitro
• S9M2CHC Blue Choice Silver PPO 135
• S9M3CHC Blue Choice Silver PPO 135-in-vitro
• S9L7CHC Blue Choice Silver PPO 146
• S9L8CHC Blue Choice Silver PPO 146-in-vitro
• S9K1CHC Blue Choice Silver PPO 201
• S9K2CHC Blue Choice Silver PPO 201 – in vitro
• S9N1CHC Blue Choice Silver PPO 401
• S9N2CHC Blue Choice Silver PPO 401 - in vitro
• S9N3CHC Blue Choice Silver PPO 402
• S9N4CHC Blue Choice Silver PPO 402 – in vitro
• S660CHC Blue Choice Silver PPO 803
• SV60CHC Blue Choice Silver PPO 803-in vitro
• S661CHC Blue Choice Silver PPO 824
• SV61CHC Blue Choice Silver PPO 824-in vitro
• S662CHC Blue Choice Silver PPO 825
• SV62CHC Blue Choice Silver PPO 825-in vitro
• S663CHC Blue Choice Silver PPO 827
• SV63CHC Blue Choice Silver PPO 827-in vitro
• S665CHC Blue Choice Silver PPO 834
• SV65CHC Blue Choice Silver PPO 834-in vitro
• S666CHC Blue Choice Silver PPO 844
• SV66CHC Blue Choice Silver PPO 844-in vitro
• S667CHC Blue Choice Silver PPO 845
• SV67CHC Blue Choice Silver PPO 845-in vitro

Coberturas Blue Advantage Silver HMO
Fuera del Intercambio

Manuales de pólizas

• S9J3ADT Blue Advantage Silver HMO 101
• S9J4ADT Blue Advantage Silver HMO 101-in-vitro
• S9J5ADT Blue Advantage Silver HMO 102
• S9J6ADT Blue Advantage Silver HMO 102-in-vitro
• S9K2ADT Blue Advantage Silver HMO 120
• S9J7ADT Blue Advantage Silver HMO 127
• S9J8ADT Blue Advantage Silver HMO 127-in-vitro
• S9J9ADT Blue Advantage Silver HMO 134
• S9K1ADT Blue Advantage Silver HMO 134-in-vitro
• S9L1ADT Blue Advantage Silver HMO 201
• S9L2ADT Blue Advantage Silver HMO 201 – in vitro
• S9N1ADT Blue Advantage Silver HMO 401
• S9N2ADT Blue Advantage Silver HMO 401-in vitro
• S9N3ADT Blue Advantage Silver HMO 402
• S9N4ADT Blue Advantage Silver HMO 402-in vitro
• S640ADT Blue Advantage Silver HMO 803
• SV40ADT Blue Advantage Silver HMO 803-in vitro
• S641ADT Blue Advantage Silver HMO 804
• SV41ADT Blue Advantage Silver HMO 804-in vitro
• S642ADT Blue Advantage Silver HMO 818
• SV42ADT Blue Advantage Silver HMO 818-in vitro
• S643ADT Blue Advantage Silver HMO 820
• SV43ADT Blue Advantage Silver HMO 820-in vitro
• S644ADT Blue Advantage Silver HMO 846
• SV44ADT Blue Advantage Silver HMO 846-in vitro
• S9E1ADT Blue Advantage Silver HMO 925
• S9E2ADT Blue Advantage Silver HMO 925-in vitro
• S9E3ADT Blue Advantage Silver HMO 935
• S9E4ADT Blue Advantage Silver HMO 935-in vitro
• S9E5ADT Blue Advantage Silver HMO 945
• S9E6ADT Blue Advantage Silver HMO 945-in vitro

Descripciones de coberturas

• S640ADT Blue Advantage Silver HMO 803
• SV40ADT Blue Advantage Silver HMO 803-in vitro
• S641ADT Blue Advantage Silver HMO 804
• SV41ADT Blue Advantage Silver HMO 804-in vitro
• S642ADT Blue Advantage Silver HMO 818
• SV42ADT Blue Advantage Silver HMO 818-in vitro
• S643ADT Blue Advantage Silver HMO 820
• SV43ADT Blue Advantage Silver HMO 820-in vitro
• S644ADT Blue Advantage Silver HMO 846
• SV44ADT Blue Advantage Silver HMO 846-in vitro
• S9E1ADT Blue Advantage Silver HMO 925
• S9E2ADT Blue Advantage Silver HMO 925-in vitro
• S9E3ADT Blue Advantage Silver HMO 935
• S9E4ADT Blue Advantage Silver HMO 935-in vitro
• S9E5ADT Blue Advantage Silver HMO 945
• S9E6ADT Blue Advantage Silver HMO 945-in vitro
• S9K2ADT Blue Advantage Silver HMO 120
• S9K3ADT Blue Advantage Silver HMO 120-in vitro

Planes Bronce

Coberturas Blue Choice Bronze PPO
Fuera del Intercambio

Manuales de pólizas

• B660CHC Blue Choice Bronze PPO 805
• BV60CHC Blue Choice Bronze PPO 805-in vitro
• B661CHC Blue Choice Bronze PPO 806
• BV61CHC Blue Choice Bronze PPO 806-in vitro
• B662CHC Blue Choice Bronze PPO 833
• BV62CHC Blue Choice Bronze PPO 833-in vitro

Coberturas Blue Advantage Bronze HMO
Fuera del Intercambio

Libro de pólizas

• B660ADT Blue Advantage Bronze HMO 806
• BV60ADT Blue Advantage Bronze HMO 806-in vitro
• B661ADT Blue Advantage Bronze HMO 833
• BV61ADT Blue Advantage Bronze HMO 833-in vitro
• B9E1ADT Blue Advantage Bronze HMO 905
• B9E2ADT Blue Advantage Bronze HMO 905 -in vitro

Descripciones de coberturas

• B661ADT Blue Advantage Bronze HMO 833
• BV61ADT Blue Advantage Bronze HMO 833-in vitro
• B660ADT Blue Advantage Bronze HMO 806
• BV60ADT Blue Advantage Bronze HMO 806-in vitro
• B9E1ADT Blue Advantage Bronze HMO 905
• B9E2ADT Blue Advantage Bronze HMO 905 -in vitro