3-ATTACHMENT C - 2026 Proposed Medical Plan Designs.pdf
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- Attached to
- Stop Loss Insurance
- Solicitation number
- 26RFP020
- Issued by
- Travis County, Austin City, Texas
About this file
The document is a health insurance plan design proposal from Blue Cross Blue Shield of Texas (BCBSTX) for the year 2026, prepared by Arthur J. Gallagher & Co. The proposal outlines three distinct health plan options: a BCBS HMO with a Blue Essentials Narrow Network, a BCBS HDHP Buy-Up plan, and a BCBS HDHP Base plan with different network and coverage configurations.
The plans vary in key aspects such as coinsurance rates (50-80%), calendar year deductibles (ranging from $1,800 to $5,000 for individuals), and maximum out-of-pocket limits ($4,500 to $10,000). Both High Deductible Health Plans (HDHP) offer a $1,600 Health Savings Account (HSA) funding for employees. The plans differ in physician visit copays, with the HMO offering fixed copays and the HDHP plans requiring coinsurance after meeting the deductible. Prescription benefits also vary, with the HMO having a tiered copay structure and the HDHP plans applying coinsurance after the deductible. Preventive care services are covered at 100% across all plans, and each plan provides different levels of coverage for services like urgent care, emergency room visits, and hospital treatments.
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©2025 ARTHUR J. GALLAGHER & CO. 1
Plan Designs – 3 Plans 2026 Proposed
Carrier Current
BCBSTX
Plan Name BCBS HMO BCBS HDHP Buy-Up BCBS HDHP Base
Network Blue Essentials
Narrow Network Blue Essentials
Narrow Network Blue Choice
Broad Network
In-Network Only In-Network In-Network Out-of-Network
Coinsurance 80% 70% 70% 50%
Calendar Year Deductible (Individual / Family) $1,800/$3,400 $2,000/$4,000 $3,400/$6,600 $5,000/$10,000
Maximum Out of Pocket Limits: To include copays, coinsurance any charges that apply to your deductible
$4,500/$9,000 $5,400/$10,800 $6,600/$13,200 $10,000/$20,000
HSA Funding N/A $1,600 EE Only $1,600 EE Only
Physician Office Visit Copay $35 Coinsurance after Ded Coinsurance after Ded Coinsurance after Ded
Specialist Office Visit Copay $50 Coinsurance after Ded Coinsurance after Ded Coinsurance after Ded
Preventive Care Services Covered at 100% Covered at 100% Covered at 100% Coinsurance after Ded
Urgent Care $50 Coinsurance after Ded Coinsurance after Ded Coinsurance after Ded
Emergency Room Visit $500 Coinsurance after Ded Coinsurance after Ded
Hospital Inpatient $500 Copay plus 80% after
Ded Coinsurance after Ded Coinsurance after Ded Coinsurance after Ded
Hospital Outpatient Coinsurance after Ded Coinsurance after Ded Coinsurance after Ded Coinsurance after Ded
Lab & X-Ray Coinsurance after Ded Coinsurance after Ded Coinsurance after Ded Coinsurance after Ded
Major Diagnostics (CT, PET, MRI, MRA & Nuclear Medicine) Coinsurance after Ded Coinsurance after Ded Coinsurance after Ded Coinsurance after Ded
Annual Prescription Deductible None None None None
Prescription Benefit -- up to 30-day supply $10/$55/$75 Coinsurance after Ded Coinsurance after Ded Coinsurance after Ded
Mail-order copay for 90-day supply $25/$137.50/$187.50 Coinsurance after Ded Coinsurance after Ded Coinsurance after Ded
Slide 1: Plan Designs – 3 Plans
File details come from the government source that posted it. Updated .