Here are details for HMO-POS Premium Rx

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Below are plan details for 2027.

BSW SeniorCare Advantage HMO-POS Premium Rx (Central Texas)

Best for members who prefer predictable healthcare costs from month to month. This plan features the highest monthly premium and the lowest out-of-pocket costs for covered services.

Monthly Premium $258

Deductible $0

Out-of-Pocket Maximum $5,000

Annual Physical Exam $0 copay

Primary Care Physician (PCP) Office Visit $0 copay

Specialty Care Physician (SCP) Office Visit $0 copay

Telehealth Visit (PCP, SCP, urgent care, psychiatry and mental health services) $0 copay

Diagnostic Tests, X-rays, Lab Services(separate office visit copay may apply) $0 copay

Advanced Diagnostic Imaging Services (MRI, MRA, SPECT, CTA) $0 copay

Physical/Occupational/Speech Therapy(per visit) $10 copay

Inpatient Hospital $100/stay

Inpatient Mental Health $100/stay

Skilled Nursing Facility (SNF) Day 1-20: $0/day
Day 21-100: $75/day

Outpatient Surgery(facility) $0 copay

Ambulatory Surgical Center(facility) $0 copay

Ambulance(ground and air) $40 copay

Emergency Care(within the U.S.; copay waived if admitted within 24 hours) $90 copay

Urgent Care(within the U.S.; copay waived if admitted within 24 hours) $40 copay

Durable Medical Equipment (DME) $0 copay

Podiatry $0 copay

Chemotherapy Drugs 0%-20% coinsurance

Other Part B Drugs 0%-20% coinsurance

Heart Health Program* Included

Deductible $250 (Applies to Tiers 3-5)

Tier 1 – Preferred Generic Drugs (30-day supply) $0 copay

Tier 2 – Generic Drugs (30-day supply) $5 copay

Tier 3 – Preferred Brand Drugs (30-day supply) $47 copay

Tier 4 – Non-Preferred Drugs (30-day supply) 35% coinsurance

Tier 5 – Specialty Drugs (30-day supply) 30% coinsurance

Mail Order Copays (90-day supply) Tiers 1 – 2 are $0 copay;
Tier 3 is $94 copay;
Tier 4 is 35% coinsurance

Total Out-of-Pocket You Pay Before Catastrophic Coverage $2,400

Catastrophic Coverage Amounts – You Pay $0 copay

Additional Monthly Premium $30

Deductible $0

Annual Dental Benefit Maximum $2,000

Dentures (every 5 years) 50% coinsurance

Fillings (One filling per surface, per tooth every 24 months) 50% coinsurance

Root Canals 75% coinsurance

Periodontal Maintenance (deep cleaning) 50% coinsurance

Extractions 50% coinsurance

Routine Eye Exam(one per year) $0 copay

Eyewear(annually) $125 allowance

Routine Hearing Exam(one per year) $0 copay

Hearing Aids(every 3 years) $1,000 allowance

In-Home Meals(14 meals per hospital discharge to home; limit 3 discharges per year) $0 copay

Routine Transportation (up to 24 one-way trips per year, or 12 round trips up to 50 miles each way) $0 copay

*Special Supplemental Benefits for the Chronically Ill (SSBCI) are available only to qualifying members with chronic heart failure. Having chronic heart failure alone does not automatically qualify you for these benefits. Eligibility also depends on meeting the Centers for Medicare & Medicaid Services’ definition of a chronically ill enrollee and the Plan’s SSBCI eligibility criteria.

Want help comparing your plans and benefits—and finding the right choice for your needs? Are you ready to enroll?

Call 833.975.0841833.975.0841 (TTY: 711) to speak with a licensed insurance agent.

October 1 – March 31: 7 days a week, 8:00 AM – 8:00 PM
April 1 – September 30: Monday – Friday, 8:00 AM – 5:00 PM
Closed on major holidays.

Para hablar con un representante en español, llame a 833.412.3320833.412.3320.

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