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HEALTH PLANS COMPARISON CHART

Effective September 1, 2018

HealthSelect of Texas Consumer Directed HealthSelect HMOs
Benefits
In-Area HealthSelect Out-of-State
Network Non-Network Community First
Network Non-Network Network Non-Network
$2,100 $4,200
Annual deductible None $500 per person1 None $500 per person1 per person1 per person1 None
$1,500 per family1 $1,500 per family1 $4,200 $8,400
per family1 per family1
Out-of-pocket $2,000 $7,000 $2,000 $7,000
coinsurance None None $2,000 per person3
per person1 per person1 per person1 per person1
maximum2
Total out-of-pocket
maximum **$6,650 **$6,650 **$6,650
(including deductibles, per person1 None per person1 None per person1 None $6,650 per person1
$13,300
$13,300
$13,300
coinsurance and $13,300 per family1
per family1 per family1 per family1
copays)4,5
Primary care Yes No No No No No Yes
physician required
Primary care
physicians’ $25 copay 40%* $25 copay 40%* 20%** 40%* $25
office visit
Mental health care
a. Outpatient
physician or mental $25 copay 40%* $25 copay 40%* 20%** 40%* $25
health provider
office visit
$150/day copay plus $150/day copay plus $150/day copay plus $150/day copay plus
20% 40%* 20% 40%*
b. Hospital Mental ($750 copay max, up ($750 copay max, up ($750 copay max, up ($750 copay max, up 20% coinsurance (plus
health inpatient to 5 days per hospital to 5 days per hospital to 5 days per hospital to 5 days per hospital 20%** 40%* $150 per day copay per
stay9 stay. $2,250 copay stay. $2,250 copay stay. $2,250 copay stay. $2,250 copay admission)
max per calendar max per calendar max per calendar max per calendar
year per person) year per person) year per person) year per person)
c. Outpatient
facility care (partial $25 copay
hospitalization/day 20% 40%* 20% 40%* 20%** 40%* (prior authorization
treatment and extensive required)
outpatient treatment)7
Physicals# No charge 40%* No charge 40%* No charge 40%* No charge

Specialty physicians’ office visits $40 40%* $40 40%* 20%** 40%* $40
Routine eye exam,
one per year per $40 40%* $40 40%* 20%** 40%* $403,6
participant
Routine preventive care# No charge 40%* No charge 40%* No charge 40%* No charge
Diagnostic x-rays,
lab tests, and 20% 40%* 20% 40%* 20%** 40%* 20%
mammography
Office surgery and diagnostic 20% 40%* 20% 40%* 20%** 40%* 20%
procedures
High-tech radiology $100 copay $100 copay $100 copay $100 copay $100 copay
(CT scan, MRI, and plus 20% plus 40%* plus 20% plus 40%* 20%** 40%* plus 20% coinsurance
nuclear medicine)7,8,9
Urgent care clinic $50 copay 40%* $50 copay 40%* 20%** 40%* $50 copay
plus 20% plus 20% plus 20%

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