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Small Group Benefit Program Application Amendment
We are adding one (1) or more non-grandfathered PPO plans. We understand maternity care is automatically included in the coverage as required by federal law in 2014, and that coverage for maternity care will be added to our existing PPO plan.
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Small Group Benefit Program Application
www.bcbstx.comIf HSA/HDHP is selected, provide name of HSA administrator/trustee: Vendor: Select Vendor FSA purchased: Yes No (If yes, select vendor) Vendor: Select Vendor Metallic Levels Blue Choice PPO℠ *Blue Advantage HMO℠ (select up to 6) Plan ID Plan ID BRONZE PLANS B660CHC B660ADT B661CHC B661ADT B662CHC B9E1ADT SILVER PLANS