BSW Savers Bronze HMO H S A 009

Baylor Scott and White Health Plan · 2026 plan year

Expanded BronzeHSA eligible

Ind. deductible: $5,300
Family deductible: $10,600
Ind. OOP max: $10,600
Family OOP max: $21,200

Compare with other Expanded Bronze plans in TX

Side by side: deductibles, out-of-pocket limits and copays.

Bronze Simple Chronic Care CKMOscar Insurance Company · Deductible $5,500 · Out-of-pocket max $10,150
Wellpoint Essential Bronze POS 5500 ($0 Virtual PCP + $0 Select Drugs + Incentives)WellPoint · Deductible $5,500 · Out-of-pocket max $10,600
Bronze Simple DiabetesOscar Insurance Company · Deductible $5,500 · Out-of-pocket max $10,150

Compare 4 plans Browse all Expanded Bronze plans in TX

Other cost-sharing reduction variants for this plan:

Limited Cost Sharing Plan Variation Standard Bronze Off Exchange Plan Zero Cost Sharing Plan Variation

More Baylor Scott and White Health Plan plans in TX

BSW Elite Gold HMO 001 (CMS Standardized Plan with $0 Pediatric PCP copay)BSW Elite Gold HMO 004 BSW Prime Silver HMO 005 BSW Savers Bronze HMO H S A 006

Monthly premiums by age

Rating Area 24 — the lowest-priced of the 14 areas this plan covers. Premiums differ by area.

Age	Individual	Individual + tobacco
Under 15	$217	$217
21	$283	$425
30	$321	$482
40	$362	$543
50	$506	$758
60	$769	$1,152
64 and over	$850	$1,274

Live premium estimate

Benefits & cost sharing

Primary Care

Benefit	In-network
Preventive Care/Screening/Immunization	No charge
Primary Care Visit to Treat an Injury or Illness	$40.00

Specialist

Benefit	In-network
Specialist Visit	$100.00

Hospital

Benefit	In-network
Emergency Room Services	30.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)	30.00% Coinsurance after deductible
Outpatient Surgery Physician/Surgical Services	30.00% Coinsurance after deductible
Urgent Care Centers or Facilities	$100.00

Pharmacy

Benefit	In-network
Generic Drugs	$25.00
Non-Preferred Brand Drugs	$150.00 Copay after deductible
Off Label Prescription Drugs	$150.00 Copay after deductible
Preferred Brand Drugs	$55.00 Copay after deductible
Prescription Drugs Other	$150.00 Copay after deductible
Specialty Drugs	$500.00 Copay after deductible

Mental Health

Benefit	In-network
Mental/Behavioral Health Inpatient Services	30.00% Coinsurance after deductible
Mental/Behavioral Health Outpatient Services	$40.00

Other

Benefit	In-network
Brain Injury	30.00% Coinsurance after deductible
Chemotherapy	30.00% Coinsurance after deductible
Abortion for Which Public Funding is Prohibited	Not covered
Accidental Dental	30.00% Coinsurance after deductible
Acupuncture	Not covered
Allergy Testing	30.00% Coinsurance after deductible
Autism Spectrum Disorders	$40.00
Bariatric Surgery	Not covered
Basic Dental Care - Adult	Not covered
Basic Dental Care - Child	Not covered
Chiropractic Care	$40.00
Cosmetic Surgery	Not covered
Delivery and All Inpatient Services for Maternity Care	30.00% Coinsurance after deductible
Dental Check-Up for Children	Not covered
Diabetes Care Management	$40.00
Diabetes Education	$40.00
Dialysis	30.00% Coinsurance after deductible
Durable Medical Equipment	30.00% Coinsurance after deductible
Emergency Transportation/Ambulance	30.00% Coinsurance after deductible
Eye Glasses for Children	$100.00
Habilitation Services	$40.00
Hearing Aids	30.00% Coinsurance after deductible
Home Health Care Services	30.00% Coinsurance after deductible
Hospice Services	30.00% Coinsurance after deductible
Imaging (CT/PET Scans, MRIs)	30.00% Coinsurance after deductible
Infertility Treatment	Not covered
Infusion Therapy	30.00% Coinsurance after deductible
Inherited Metabolic Disorder - PKU	30.00% Coinsurance after deductible
Inpatient Physician and Surgical Services	30.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services	30.00% Coinsurance after deductible
Long-Term/Custodial Nursing Home Care	Not covered
Major Dental Care - Adult	Not covered
Major Dental Care - Child	Not covered
Nutritional Counseling	$40.00
Orthodontia - Adult	Not covered
Orthodontia - Child	Not covered
Other Practitioner Office Visit (Nurse, Physician Assistant)	$40.00
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)	30.00% Coinsurance after deductible
Outpatient Rehabilitation Services	$40.00
Pediatric Services Other	30.00% Coinsurance after deductible
Post-Mastectomy Care	30.00% Coinsurance after deductible
Prenatal and Postnatal Care	$40.00
Private-Duty Nursing	30.00% Coinsurance after deductible
Prosthetic Devices	30.00% Coinsurance after deductible
Radiation	30.00% Coinsurance after deductible
Reconstructive Surgery	30.00% Coinsurance after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy	$40.00
Rehabilitative Speech Therapy	$40.00
Routine Dental Services (Adult)	Not covered
Routine Eye Exam (Adult)	Not covered
Routine Eye Exam for Children	$100.00
Routine Foot Care	Not covered
Skilled Nursing Facility	30.00% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services	30.00% Coinsurance after deductible
Substance Abuse Disorder Outpatient Services	$40.00
Transplant	30.00% Coinsurance after deductible
Transplant Donor Coverage	30.00% Coinsurance after deductible
Treatment for Temporomandibular Joint Disorders	30.00% Coinsurance after deductible
Weight Loss Programs	Not covered
Well Baby Visits and Care	No charge
X-rays and Diagnostic Imaging	30.00% Coinsurance after deductible