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REGIONAL HEALTH MAINTENANCE ORGANIZATION PLANS If you live or work in certain counties, you can enroll in one of our regional HMO plans. The chart on the next page shows the HMO plan options and benefits summaries.Blue Essentials - South Texas HMOSMBrought to you by TRS-ActiveCareBlue Essentials - West Texas HMOSMBrought to you by TRS-ActiveCareYou can choose this plan if you live in one of these counties: Cameron, Hidalgo, Starr, WillacyYou can choose this plan if you live in one of these counties: Andrews, Armstrong, Bailey, Borden, Brewster, Briscoe, Callahan, Carson, Castro, Childress, Cochran, Coke, Coleman, Collingsworth, Comanche, Concho, Cottle, Crane, Crockett, Crosby, Dallam, Dawson, Deaf Smith, Dickens, Donley, Eastland, Ector, Fisher, Floyd, Gaines, Garza, Glasscock, Gray, Hale, Hall, Hansford, Hartley, Haskell, Hemphill, Hockley, Howard, Hutchinson, Irion, Jones, Kent, Kimble, King, Knox, Lamb, Lipscomb, Llano, Loving, Lubbock, Lynn, Martin, Mason, McCulloch, Menard, Midland, Mitchell, Moore, Motley, Nolan, Ochiltree, Oldham, Parmer, Pecos, Potter, Randall, Reagan, Reeves, Roberts, Runnels, San Saba, Schleicher, Scurry, Shackelford, Sherman, Stephens, Sterling, Stonewall, Sutton, Swisher, Taylor, Terry, Throckmorton, Tom Green, Upton, Ward, Wheeler, Winkler, YoakumType of Coverage In-Network Coverage Only In-Network Coverage OnlyIndividual and Family Deductible $500/$1,000 $950/$2,850Coinsurance 20% after deductible 25% after deductibleIndividual and Family Maximum Out-of-Pocket$4,500/$9,000 $7,450/$14,900Primary Care $25 copay $20 copaySpecialist $60 copay $70 copayUrgent Care $75 copay $50 copayEmergency Care 20% after deductible $500 copay before deductible plus 25% after deductibleDrug Deductible $100 $150Days Supply 30-day supply/90-day supply 30-day supply/90-day supplyGenerics $10/$30 copay $5/$12.50 copay, $0 for certain genericsPreferred Brand $40/$120 copay 30% after deductibleNon-preferred Brand $65/$195 copay 50% after deductibleSpecialty 20% after deductible 15%/25% after deductible (preferred/non-preferred)www.bcbstx.com/trsactivecare 45