Texas health plan · 2026

BSW Prime Silver HMO 008 · 40788TX0460008

Baylor Scott & White Health Plan offers this marketplace health insurance plan (Plan ID 40788TX0460008) so you can compare premiums, coverage levels, and provider access against other health plan insurance options. Use the modules below to decide whether this is the best health insurance plan for your household or if another insurance health plan fits better.

Metal level: Silver Plan type: HMO CSR: Standard Silver Off Exchange Plan Issuer: Baylor Scott & White Health Plan
Telehealth Data pending HSA eligible No Dental Not listed Vision Child
Pay / Manage Plan View issuer site

CMS AV Calculator output: 70.09% (29.91% member share on average). Learn about AV methodology.

2026 cost summary

Key premiums & cost sharing

Rates mirror the latest CMS import (Tue, 02 Dec 2025 06:13 GMT). Personalize costs with your ZIP, age, and subsidies in the plan finder.

Monthly premium

$338 – $2453

Before subsidies

Estimate after subsidies

Deductible

$5,000

$10000 per group

See deductible details

Max out-of-pocket

$8,500

$17000 per group

Review MOOP rules

Office visits

Primary care $35.00
Specialist $70.00
HSA Not eligible

Drug tiers

Generic $20.00
Preferred brand $90.00 Copay after deductible

View formulary tiers

$631 / mo before subsidies

≈ $7577 per year before tax credits.

Start with this unsubsidized premium, then apply marketplace tax credits to see your final monthly payment.

  • Ideal for shoppers comparing Bronze vs. Silver budgets.
  • Update your Marketplace application to apply premium tax credits.

$2002 / mo before subsidies

≈ $24030 per year before tax credits.

Pre-subsidy rate for a couple with one dependent. Switch to Silver CSR plans if you qualify to reduce these numbers.

  • Compares well against PPO vs HMO networks when planning for childcare and telehealth needs.
  • This Silver tier qualifies for CSR if household income is ≤250% FPL.

$2374 / mo before subsidies

≈ $28491 per year before tax credits.

Pairs with cost-sharing reductions (CSR) when you select a Silver tier and qualify based on income.

  • Use this estimate before adding childcare, dental, or vision extras.
  • CSR Silver variants can lower deductibles dramatically for eligible incomes.
  • This Silver tier qualifies for CSR if household income is ≤250% FPL.

$1591 / mo before subsidies

≈ $19091 per year before tax credits.

Shows the combined pre-subsidy rate for two adults. Add dependents or subsidies in your application to refine it.

  • Great for households deciding between PPO and HMO networks.
  • Telehealth and HSA perks (when offered) apply to both members.
Issuer profile See benefits

Preventive Care/Screening/Immunization

No Charge, No Charge

Emergency Room Services

50.00% Coinsurance after deductible

Durable Medical Equipment

50.00% Coinsurance after deductible

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Enrollment guidance

Stay on top of 2026 ACA deadlines

Open Enrollment window

Marketplace enrollment for 2026 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in Texas). Submit changes before the deadline to avoid a coverage gap.

  • Enroll by Dec 15 for Jan 1 starts.
  • Finalize plan switches before the window closes.

Special Enrollment Periods

You can change plans mid-year if you experience a qualifying life event (move, childbirth, marriage, loss of other coverage).

  • Report the event within 60 days.
  • Keep documentation handy for Healthcare.gov or your state exchange.

CSR & subsidy reminders

Premium tax credits and cost-sharing reductions (CSR) update annually when you re-submit your marketplace application.

  • Enter accurate income to maximize Advanced Premium Tax Credits.
  • Standard Silver Off Exchange Plan plans like this one keep deductibles and copays lower if you qualify.

Thinking about switching?

Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.

  • Match provider networks so ongoing care isn’t disrupted.
  • Confirm prescriptions stay on-formulary or budget for tier changes.

Top covered benefits

How this plan handles key care scenarios

Preventive Care/Screening/Immunization

No Charge, No Charge

Emergency Room Services

50.00% Coinsurance after deductible

Durable Medical Equipment

50.00% Coinsurance after deductible

Premium snapshot

Plan identifiers & filings

Track the official identifiers, documents, and filing dates tied to this plan. Open the marketing or formulary links whenever you need the latest PDF from the issuer.

Plan ID 40788TX0460008
Coverage year 2026
State Texas
Issuer Baylor Scott & White Health Plan
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 40788TX0460008-00
Available variants

Standard Off Exchange Plan · 40788TX0460008-00

Standard On Exchange Plan · 40788TX0460008-01

Open to Indians below 300% FPL · 40788TX0460008-02

Open to Indians above 300% FPL · 40788TX0460008-03

73% AV Silver Plan · 40788TX0460008-04

87% AV Silver Plan · 40788TX0460008-05

94% AV Silver Plan · 40788TX0460008-06
Last plan update Wed, 15 Oct 2025 00:00 GMT
Last HealthPorta import Tue, 02 Dec 2025 06:13 GMT

Network stats

Provider access snapshot

Review the network branding plus the number of in-network clinicians we track from issuer filings. Counts update with each CMS import (Tue, 02 Dec 2025 06:13 GMT).

All providers in Texas 30403
PCPs in Texas 4623
Telehealth support Data pending
Nationwide providers 92198
30,403 doctors statewide 4,623 PCPs 183 OB/GYN

Provider network(s)

Providers Texas All US states
All 30403 92198
PCP 4623 5158
Allergy 18 20
OB/GYN 183 202
Dentists 29 33

Drug coverage overview

4,090 drugs tracked

Inspect tier distribution plus authorization, step therapy, and quantity-limit counts sourced from HealthPorta’s formulary import.

Tier Covered drugs
GENERIC 2,289
SPECIALTY 933
NON-PREFERRED-BRAND 501
PREFERRED-BRANDS 367
Prior authorization Drugs
Required 968
Not Required 3,122
Step therapy Drugs
Required 751
Not Required 3,339
Quantity limits Drugs
Has Limit 1,455
No Limit 2,635

Customer highlights

What stands out for members

  • Issuer: Baylor Scott & White Health Plan · Plan ID 40788TX0460008 · 2026 filing.
  • Disease management programs available: Asthma, Diabetes, Heart Disease, Pregnancy.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 40788TX0460008-00 (Standard Off Exchange Plan) currently displayed.
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Benefits

Covered services & limitations

Everyday care

Office visits, preventive care, labs, imaging, and home health.

Chiropractic Care

$35.00
Tier 1 in-network $35.00
Out-of-network 100.00%

Limit: 35.0 Visit(s) per Year

Diabetes Care Management

$35.00
Tier 1 in-network $35.00
Out-of-network 100.00%

Diabetes Education

$35.00
Tier 1 in-network $35.00
Out-of-network 100.00%

Home Health Care Services

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 60.0 Days per Year

Laboratory Outpatient and Professional Services

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Refer to Plan Document for cost associated with certain outpatient laboratory and professional services.

Other Practitioner Office Visit (Nurse, Physician Assistant)

$35.00
Tier 1 in-network $35.00
Out-of-network 100.00%

Covered at no cost for dependent members through the age of 18.

Preventive Care/Screening/Immunization

No Charge, No Charge
Tier 1 in-network No Charge, No Charge
Out-of-network 100.00%

Primary Care Visit to Treat an Injury or Illness

$35.00
Tier 1 in-network $35.00
Out-of-network 100.00%

Covered at no cost for dependent members through the age of 18.

Rehabilitative Occupational and Rehabilitative Physical Therapy

$35.00
Tier 1 in-network $35.00
Out-of-network 100.00%

Limit: 35.0 Visit(s) per Year

Rehabilitative Speech Therapy

$35.00
Tier 1 in-network $35.00
Out-of-network 100.00%

Limit: 35.0 Visit(s) per Year

Specialist Visit

$70.00
Tier 1 in-network $70.00
Out-of-network 100.00%

Urgent Care Centers or Facilities

$70.00
Tier 1 in-network $70.00
Out-of-network $70.00

X-rays and Diagnostic Imaging

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Refer to Plan Document for cost associated with certain outpatient laboratory and professional services.

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Delivery and All Inpatient Services for Maternity Care

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Will cover 48-hour hospital stay for uncomplicated vaginal delivery and 96-hour hospital stay for uncomplicated caesarean section.

Dialysis

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Durable Medical Equipment

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Emergency Room Services

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Emergency Transportation/Ambulance

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Hospice Services

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Preauthorization is required.

Inpatient Hospital Services (e.g., Hospital Stay)

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

All usual Hospital services and supplies, including semiprivate room, intensive care, and coronary care units; Preauthorization is required.

Inpatient Physician and Surgical Services

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Mental/Behavioral Health Inpatient Services

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Certain services require preauthorization.

Mental/Behavioral Health Outpatient Services

$35.00
Tier 1 in-network $35.00
Out-of-network 100.00%

Copay applies for office visits. All other outpatient benefits will pay at the same cost share level as any other medical/surgical benefit. Certain services require preauthorization.

Outpatient Facility Fee (e.g., Ambulatory Surgery Center)

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Outpatient Rehabilitation Services

$35.00
Tier 1 in-network $35.00
Out-of-network 100.00%

Limit: 35.0 Visit(s) per Year

Outpatient Surgery Physician/Surgical Services

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Radiation

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Skilled Nursing Facility

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 25.0 Days per Year

Substance Abuse Disorder Inpatient Services

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Certain services require preauthorization.

Substance Abuse Disorder Outpatient Services

$35.00
Tier 1 in-network $35.00
Out-of-network 100.00%

Copay applies for office visits. All other outpatient benefits will pay at the same cost share level as any other medical/surgical benefit. Certain services require preauthorization.

Transplant

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Preauthorization is required.

Transplant Donor Coverage

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Mental health & substance use

Behavioral health visits and substance use treatment.

Autism Spectrum Disorders

$35.00
Tier 1 in-network $35.00
Out-of-network 100.00%

Copay applies for office visits. All other outpatient benefits will pay at the same cost share level as any other medical/surgical benefit. Certain services require preauthorization.

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Hearing Aids

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 1.0 Item(s) per 3 Years

To restore or correct impaired speech or hearing loss.

Major Dental Care - Child

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Prenatal and Postnatal Care

$35.00
Tier 1 in-network $35.00
Out-of-network 100.00%

No charge for prenatal visits; postnatal visits are covered at the PCP office visit copay.

Routine Eye Exam for Children

$70.00
Tier 1 in-network $70.00
Out-of-network 100.00%

Limit: 1.0 Exam(s) per Year

Well Baby Visits and Care

No Charge, No Charge
Tier 1 in-network No Charge, No Charge
Out-of-network 100.00%

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

$20.00
Tier 1 in-network $20.00
Out-of-network 100.00%

If copay applies, copay amount is for 30 day supply. Copay for 90 day supply is three times the copay for 30 day supply.

Non-Preferred Brand Drugs

$140.00 Copay after deductible
Tier 1 in-network $140.00 Copay after deductible
Out-of-network 100.00%

If copay applies, copay amount is for 30 day supply. Copay for 90 day supply is three times the copay for 30 day supply.

Off Label Prescription Drugs

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Preferred Brand Drugs

$90.00 Copay after deductible
Tier 1 in-network $90.00 Copay after deductible
Out-of-network 100.00%

If copay applies, copay amount is for 30 day supply. Copay for 90 day supply is three times the copay for 30 day supply.

Prescription Drugs Other

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Specialty Drugs

$500.00 Copay after deductible
Tier 1 in-network $500.00 Copay after deductible
Out-of-network 100.00%

If copay applies, copay amount is for 30 day supply.

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Basic Dental Care - Adult

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Dental Check-Up for Children

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Infusion Therapy

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Major Dental Care - Adult

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Nutritional Counseling

$35.00
Tier 1 in-network $35.00
Out-of-network 100.00%

Copay waived if provided as preventive care.

Orthodontia - Adult

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Orthodontia - Child

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Prosthetic Devices

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Medically necessary foot orthotics are not subject to a calendar year maximum.

Routine Dental Services (Adult)

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Weight Loss Programs

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Additional benefits

Other plan-specific services and limitations.

Abortion for Which Public Funding is Prohibited

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Acupuncture

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Allergy Testing

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Bariatric Surgery

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Brain Injury

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Cosmetic Surgery

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Eye Glasses for Children

$70.00
Tier 1 in-network $70.00
Out-of-network 100.00%

Limit: 1.0 Item(s) per Year

1 pair of glasses (lenses and frames) per year

Habilitation Services

$35.00
Tier 1 in-network $35.00
Out-of-network 100.00%

Limit: 35.0 Visit(s) per Year

Imaging (CT/PET Scans, MRIs)

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Infertility Treatment

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Inherited Metabolic Disorder - PKU

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Long-Term/Custodial Nursing Home Care

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Pediatric Services Other

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Post-Mastectomy Care

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Private-Duty Nursing

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

When pre-approved in a limited set of circumstances under the Home Health Care benefit. Refer to plan document.

Reconstructive Surgery

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Routine Eye Exam (Adult)

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Routine Foot Care

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Treatment for Temporomandibular Joint Disorders

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Examples of covered services include: Treatment provided for reconstructive surgery following cancer surgery; Reconstruction of the breast on which mastectomy has been performed.

Variant attributes

BSW Prime Silver HMO 008 · Variant 40788TX0460008-00

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2026

CSR Variation Type

Standard Silver Off Exchange Plan

HIOS Product ID

40788TX046

Metal Level

Silver

Plan ID (Standard Component ID with Variant)

40788TX0460008-00

Plan Marketing Name

BSW Prime Silver HMO 008

Plan Variant Marketing Name

BSW Prime Silver HMO 008 ($0 Pediatric PCP visits)

Issuer & service area

Issuer-provided metadata for this variant.

Issuer ID

40788

Issuer Marketplace Marketing Name

Baylor Scott and White Health Plan

Market Coverage

Individual

Multiple In Network Tiers

No

National Network

No

Network ID

TXN001

Out of Country Coverage

No

Out of Service Area Coverage

No

Out of Service Area Coverage Description

Emergency Only

Service Area ID

TXS001

State Code

TX

URL for Summary of Benefits & Coverage

Open link

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

AV Calculator Output Number

0.7009318081661511

Begin Primary Care Deductible Coinsurance After Number Of Copays

0

Inpatient Copayment Maximum Days

0

Medical Drug Deductibles Integrated

Yes

Medical Drug Maximum Out of Pocket Integrated

Yes

SBC Scenario, Having a Baby, Coinsurance

$3,100

SBC Scenario, Having a Baby, Copayment

$0

SBC Scenario, Having a Baby, Deductible

$5,000

SBC Scenario, Having Diabetes, Coinsurance

$0

SBC Scenario, Having Diabetes, Copayment

$900

SBC Scenario, Having Diabetes, Deductible

$900

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$0

SBC Scenario, Treatment of a Simple Fracture, Copayment

$400

SBC Scenario, Treatment of a Simple Fracture, Deductible

$1,700

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group

per group not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person

per person not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual

Not Applicable

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance

50.00%

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group

$17000 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person

$8500 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual

$8,500

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group

per group not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person

per person not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual

Not Applicable

Enrollment & documents

Issuer-provided metadata for this variant.

Formulary ID

TXF004

Formulary URL

Open link

Plan Brochure

Open link

SBC Scenario, Having a Baby, Limit

$60

SBC Scenario, Having Diabetes, Limit

$20

SBC Scenario, Treatment of a Simple Fracture, Limit

$0

URL for Enrollment Payment

Open link

Additional attributes

Issuer-provided metadata for this variant.

Begin Primary Care Cost-Sharing After Number Of Visits

0

Child-Only Offering

Allows Adult and Child-Only

Composite Rating Offered

No

Dental Only Plan

No

Design Type

Not Applicable

Disease Management Programs Offered

Asthma, Diabetes, Heart Disease, Pregnancy

EHB Percent of Total Premium

1

First Tier Utilization

100%

Import Date

10/15/2025

Limited Cost Sharing Plan Variation - Estimated Advanced Payment

$0.00

HSA Eligible

No

New/Existing Plan

Existing

Notice Required for Pregnancy

No

Is a Referral Required for Specialist?

No

Plan Effective Date

1/1/2026

Plan Type

HMO

QHP/Non QHP

Both

Source Name

HIOS

Plan ID

40788TX0460008

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group

per group not applicable

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person

per person not applicable

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual

Not Applicable

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group

$10000 per group

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person

$5000 per person

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual

$5,000

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group

per group not applicable

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person

per person not applicable

Combined Medical and Drug EHB Deductible, Out of Network, Individual

Not Applicable

Unique Plan Design

No

Wellness Program Offered

No

Copay & coinsurance

Pharmacy cost sharing by tier

Drug tier Pharmacy type Copay amount Copay option Coinsurance rate Coinsurance option Mail order

Questions & answers

Frequently asked questions

How do I choose the right ACA plan in Texas?

BSW Prime Silver HMO 008 (40788TX0460008) is a Silver HMO from Baylor Scott & White Health Plan in Texas for the 2026 coverage year.

Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.

Does BSW Prime Silver HMO 008 support telehealth or virtual urgent care?

The issuer has not published telehealth details yet. Review the Summary of Benefits and Coverage to confirm if virtual visits are included.

Is BSW Prime Silver HMO 008 HSA-eligible and does it include dental or vision coverage?

It is not marked as HSA-eligible, so confirm with the issuer before relying on tax-advantaged savings.

Dental coverage is not listed for this plan.

Vision add-ons: Child.

Does BSW Prime Silver HMO 008 support mail-order prescriptions?

Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.

Which disease management programs come with BSW Prime Silver HMO 008?

The issuer lists disease management resources for: Asthma, Diabetes, Heart Disease, Pregnancy.

Is there out-of-country coverage for BSW Prime Silver HMO 008?

No, out-of-country services are not covered for this plan.

Does BSW Prime Silver HMO 008 cover care outside the service area?

No, the issuer indicates out-of-service-area care is not covered except for emergencies. Details: Emergency Only

Disclaimer: Based on the Tue, 02 Dec 2025 06:13 GMT HealthPorta import from CMS issuer filings. Data is best-effort and should be validated with the issuer directly. Sources: CMS.gov and the HealthPorta Healthcare MRF API.
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