Under Age 65
PPO Plan/HDP
Both the PPO Plan and the High Deductible Health Plan (HDP) use the large, national Blue Cross Blue Shield of Texas (BCBSTX) Blue Choice PPO℠ (BCA) network. Prescription drug benefits are administered by Prime Therapeutics and Mental Health/Substance Abuse services are provided by Blue Cross Blue Shield of Texas (BCBSTX). All mental health services must be pre-certified through Blue Cross Blue Shield of Texas (BCBSTX).
The following apply to retirees under age 65 with spouses of any age.
If you cover your spouse on the PPO Plan (includes spouse covered on PMD or MPD) or the HDP, your monthly cost is subject to the Spouse Medical Plan Surcharge and an affidavit is required. If you do not provide the affidavit by the date due, you will pay $200 more per month in addition to the applicable monthly premium.