BlueCross BlueShield of IL


Blue Cross BlueShield of Illinois
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Blue Cross Blue Shield of Illinois – Plan Descriptions

BlueCross BlueShield of Illinois is the largest health insurance company in the state with over 7.5 million members.

Blue Cross Blue Shield of Illinois is offering 4 different individual plan networks for plans effective January 1st, 2024:

Blue Choice Preferred PPO – Great for those who:

  • Seek coverage comparable to what is offered by employers
  • Prefers fixed doctor visit copayments
  • Regularly visits a doctor
  • Requires regular prescription medication

Blue Precision HMO – Great for those who:

  • Are willing to have a primary care physician (PCP) coordinate your care
  • Prefers fixed doctor visit copayments
  • Are expecting to have surgery or major services in the near future and want the lowest out of pocket costs
  • Requires regular prescription medication

BlueCare Direct Advocate – Great for those who:

  • Are willing to have a primary care physician (PCP) coordinate your care
  • Prefers or lives near an Advocate hospital (Cook, Dupage, Kane, Lake, and Will Counties
  • Are expecting to have surgery or major services in the near future and want the lowest out of pocket costs
  • Requires regular prescription medication

Blue FocusCare – Great for those who:

  • Seek cost efficient coverage
  • Don’t mind limited networks
  • Do not make frequent hospital visits
  • Only need to have basic needs covered

New BCBSIL Plans Effective 2024: 

Plan NamePlan TierDeductibleMax Out-of-Pocket
Blue Choice Preferred Silver PPO 801 – Rx CopaysSilver PPO$6,200$9,450
BlueCare Direct Bronze 802 w/ AdvocateBronze HMO$7,500$9,400
BlueCare Direct Silver 803 w/ AdvocateSilver HMO$5,900$9,100
BlueCare Direct Gold 804 w/ AdvocateGold HMO$1,500$8,700

Dicontinued BCBSIL Plans:

Discontinued Plan Name Plan TierDeductibleMax Out-of-Pocket
Blue Choice Preferred Bronze PPO 302 (Will map to Bronze 202)Bronze PPO $6,350$7,000
Blue Choice Preferred Bronze PPO 502 (Will map to Bronze 202)Bronze PPO$5,000$7,050
Blue Choice Preferred Bronze PPO 705 (Will map to Bronze 708)Bronze PPO$9,100$9,100

What is the difference between PPO and HMO? 

PPO, or Preferred Provider Organization, plans usually carry a higher monthly premium while having access to a larger network of doctors and hospitals to choose from. 

HMO, or Health Maintenance Organization, plans usually have lower monthly premiums than PPO’s and may help keep your costs lower and more predictable. A Primary Care Physician (PCP) will coordinate your health care.

Why BCBSIL? 

Access

  • Health plans on and off exchange in every county
  • Comprehensive, year-round coverage
  • High-quality, efficient networks with focus on preventive care

Affordability

  • Affordable plan options to fit every budget
  • Monthly payments as low as $0 for qualified on-exchange applicants

Stability

  • Serving Illinois communities for 85 years.
  • In the nine years of ACA open enrollment, BCBSIL has been proud to offer multiple qualified health plans in every county across Illinois.

Helpful Resources 24/7

  • Virtual Visits for Blue Choice Preferred PPO members
  • 24/7 Nurseline (English and Spanish) for PPO members
  • Cost Estimator Tool on Blue Access for Members
  • SmartER Care Options – member education campaign on choices for non-emergency care

Mobile App

  • Easy to use – find a doctor, see payment options, access electronic member ID card and more

Blue365®

  • Blue365 member discount program – members save on health club and gym memberships, weight loss programs, dental products and much more
Key Hospitals NOT accepting the Blue Choice Preferred PPO Plans in 2024:
Key Hospitals accepting the Blue Choice Preferred PPO Plans in 2024:
  • Amita Health Hospitals
  • Edwards Memorial
  • Alexian Brothers
  • Loyola Hospital Systems
  • Elmhurst Memorial
  • Galesburg Cottage Hospital
  • Northwestern Hospital Systems
  • Northshore Hospital
  • Swedish Covenant Hospital
  • OSF Hospital System
  • Presence Hospital Systems
  • University of Illinois Chicago
  • Rush University Hospital
  • St. Francis Medical Center
  • St. Mary Medical Center (OSF Hospital Systems)
  • UnityPoint Health Methodist

Effective Jan. 1, 2020: Methodist First Choice #457 will participate in the Blue Precision HMOSM provider network.

The details: Current members of Methodist First Choice will be able to choose doctors that are in the Blue Precision HMO network. Review a list of participating providers  for members impacted by this change.

Chicago BCBSIL Hospital Network Guide

 BCBSIL Plan Network
Network NameBlue Preferred PPOBlue Precision HMOBlueCare Direct AdvocateBlue Focus
Network Hospital ListsHospital ListHospital ListHospital ListHospital List
NorthwesternXX
    
LoyolaXX
    
RushXXX
    
AdvocateX
    
NorthshoreXX
    
Presence HospitalsXX
    
U of CX ✓**XX
    
UICXX
    
Edward/ElmhurstXX

**Specialty care only with referral; No primary care

The BCBSIL 2024 individual health plan options include HMO Plans, Health Savings Accounts, and PPO Plans. The different plans are described below.

Illinois Plans Overview:

Blue FocusCare HMO: 1 Bronze, 1 Silver, 1 Gold

  • Network: BlueFocus CareSM (BFC)
  • Approximately 15 hospitals, 1,806 providers*
  • Micro network for Cook County
  • Lower-cost HMO plan

BlueCare Direct w/ Advocate: 2 Bronze, 2 Silver, 2 Gold

  • Network: BlueCare DirectSM (BHD)
  • Approximately 11 hospitals, 4,083 providers*
  • In collaboration with Advocate Health Care1
  • Competitive HMO plan with low out-of-pocket costs
  • Call today, be seen today by primary care doctors

Blue Precision HMO: 3 Bronze, 4 Silver, 3 Gold

  • Network: Blue Precision HMO SM (BAV)
  • Approximately 66 hospitals, 17,467 providers*
  • Helps keep costs low and predictable
  • Personalized with a primary care physician (PCP), who coordinates health care
  • Flexibility to change medical group

Blue Choice Preferred PPO: 5 Bronze, 4 Silver, 2 Gold

  • Network: Blue Choice Preferred PPO (BCE)
  • Approximately 176 hospitals, 73,027 providers*
  • New Silver plan –
    • Blue Choice Preferred Silver PPO 801 – Rx Copays
  • Greater flexibility and array of product options
  • Available in all counties
  • Virtual Visits available via phone, video or mobile app
  • Electronic prescriptions, when appropriate, can be sent to member’s pharmacy of choice

Dental

BlueCare Dental

  • Coverage for cleanings, preventive services and much more
  • Preventive dental services deductible waived

Prescription and Pharmacy

  • Six prescription payment level tiers for all ACA plans – generic, brand and specialty have preferred and non-preferred benefit levels
  • All plans include a drug list. PPO includes Preferred Pharmacy Network – Walgreens, Walmart, Sam’s Club, Albertsons and select Independent Pharmacies
*Estimates as of 6/1/2021 
1. An independently contracted provider. 
2. A “preferred” or “participating” pharmacy has a contract with BCBSIL’s pharmacy benefit manager (Prime Therapeutics) to provide pharmacy services at a negotiated rate. A pharmacy benefit  manager administers prescription drug benefits for a health plan. The terms “preferred” and “participating” should not be construed as a recommendation, referral or any other statement as 

SelectTemp PPO (short-term medical)

SelectTemp PPO plans are not available at this time – United HealthOne short term plans are an available alternative.

Our Rating:

SelectTEMP PPO is an affordable short-term individual health plan that provides basic protection against unexpected accident or illness.
Individuals who are temporarily without health insurance because COBRA is too expensive, are in-between jobs, or waiting for employer coverage to begin find SelectTEMP PPO to be an affordable alternative.

SelectTEMP PPO offers various benefit periods and deductibles to allows you the control to tailor coverage, premium rates and out-of-pocket expenses according to your own needs.

You are able to choose:

  • The date you want coverage to begin
  • The coverage period – 1 to 11 months (6 month limitation in IL)
  • The deductible – from $500 to $5,000
  • From over 200 Illinois hospitals

SelectTemp PPO Deductibles
$500 single / $1,000 family
$1,000 single / $2,000 family
$1,500 single / $3,000 family
$2,000 single / $4,000 family
$5,000 single / $10,000 family

2017 Discontinued Plans

BlueChoice Preferred Gold Plan 101 was discontinued January 1, 2017

The BCBSIL 2017 individual health plan options include HMO Plans, Health Savings Accounts, and PPO Plans. The different plans are described below.

Blue Precision HMO Plans

Our Rating:

Blue Precision Gold HMO 101 Plan features:
  • $1,750 single/$5,250 family deductible and 80% coinsurance
  • $25 doctor visit / $50 specialist copayment
  • $25 urgent care copayment
  • No charge for Tier 1 formulary generic drugs
Blue Precision Silver HMO 102 Plan features:
  • $2,600 single/$6,000 family deductible and 80% coinsurance
  • $30 doctor visit / $50 specialist copayment
  • $30 urgent care copayment
  • No charge for Tier 1 formulary generic drugs
Blue Precision Bronze HMO 103 Plan features:
  • $7,100 single/$13,700 family deductible and 80% coinsurance
  • $50 doctor visit / $100 specialist copayment
  • $50 urgent care copayment
  • No charge for Tier 1 formulary generic drugs
HMO Network

The Blue Precision HMO Plans use the Blue Precision HMO network, one the largest HMO networks in Illinois. You must select a network primary care physician (PCP), who coordinates your care within the network and referrals are required from your PCP to see a specialists.

Key Blue Precision HMO® Plan features include:
  • Lower out-of-pocket costs than PPO plans
  • You must select a network primary care physician (PCP), who coordinates your care within the network
  • Referral required to see a specialist
  • $25 doctor visit / $50 specialist copayment for Gold HMO Plan 101
  • Prescription drug coverage
  • Maternity Coverage
  • Well-adult care
  • Well-child care
  • Diagnostic testing
  • Hospital services
  • Optional dental coverage
Blue Precision HMO® Plans may be right for you if you are an individual or family who:
  • Are willing to have a primary care physician (PCP) coordinate your care
  • Prefers fixed doctor visit copayments
  • Are expecting to have surgery or major services in the near future and want the lowest out of pocket costs
  • Requires regular prescription medication

Learn more about valuable member services and features you get when you join the Blue Cross and Blue Shield of Illinois family.