Blue FocusCare Plans


Blue Cross BlueShield of Illinois
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Blue FocusCare

Blue FocusCare is an HMO plan offered in Cook County. It includes a narrower HMO network and reduced costs compared to the Blue Precision HMO and BlueCare Direct HMO plans.

Blue FocusCare Plans are good for individuals that don’t mind limited networks. If you do not make frequent hospital visits and only need to have your basic needs covered this may be the cost efficient choice for you. If you can accept some reduced hospital and physician choice, Blue FocusCare may be a great option for you. All Blue FocusCare plans offer the same set of essential health benefits, quality and amount of care.

The differences are how much your premium costs each month

The differences are how much your premium costs each month, what portion of the bill you pay for things like hospital visits or prescription medications, and how much your total out-of-pocket costs are.

There are 3 Blue FocusCare Plans:

 

Blue FocusCare Plans

Blue FocusCare Bronze 209

Important Questions Answers Why this Matters:
What is the overall deductible?Individual:
Participating $7,400
Family:
Participating $17,100
Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay. If you have other family members on the plan, each family member must meet their own individual deductible until the total amount of deductible expenses paid by all family members meets the overall family deductible
Are there services covered before you meet your deductible?Yes. In-Network Preventive Health Care services and services with a copay are covered before you meet your deductibleThis plan covers some items and services even if you haven’t yet met the deductible amount. But a copayment or coinsurance may apply. For example, this plan covers certain preventive services without
cost-sharing and before you meet your deductible. See a list of covered preventive services at
www.healthcare.gov/coverage/preventive-care-benefits/.
Are there other
deductibles for specific
services?
NoYou don’t have to meet deductibles for specific services.
What is the out-of-pocket
limit for this plan?
Individual: Participating $8,550
Family: Participating $17,100
The out-of-pocket limit is the most you could pay in a year for covered services. If you have other family members in this plan, they have to meet their own out-of-pocket limits until the overall family out-of-pocket limit has been met.
What is not included in
the out-of-pocket limit?
Premiums, balance-billed charges,
and health care this plan doesn’t
cover.
Even though you pay these expenses, they don’t count toward the out-of-pocket limit.
Will you pay less if you use a network provider? Yes. See www.bcbsil.com or call 1-
800-892-2803 for a list of
Participating Providers.
This plan uses a provider network. You will pay less if you use a provider in the plan’s network. You will
pay the most if you use an out-of-network provider, and you might receive a bill from a provider for the
difference between the provider’s charge and what your plan pays (balance billing). Be aware your network provider might use an out-of-network provider for some services (such as lab work). Check with your provider before you get services.
Do you need a referral to
see a specialist?
Yes.This plan will pay some or all of the costs to see a specialist for covered services but only if you have a
referral before you see the specialist.
Common Medical EventServices You May Need

Your cost if you use
a Participating
Provider

Your cost if you use
a Non-Participating
Provider

Limitations & Exceptions
If you visit a health care provider’s office or clinicPrimary care visit to treat an injury or illness

$60/visit; deductible does not apply

Not Covered

None
Specialist visit

$85/visit; deductible does not apply

Not Covered

Referral Required.
Preventive care/screening/immunization

No Charge; deductible does not apply

Not Covered

You may have to pay for services that aren’t preventive. Ask your provider if the services
needed are preventive. Then check what your plan will pay for.
If you have a testDiagnostic test (x-ray, blood work)

$100/lab, $150/X-Ray;
deductible does not apply

Not Covered

Referral Required.
Imaging (CT / PET scans, MRIs)

$300/test; deductible does not apply

Not Covered

Referral Required.
If you need drugs to treat your illness or condition More information about
prescription drug coverage is available here.
Preferred generic drugs

10% coinsurance

Not CoveredLimited to a 30-day supply at retail (or a 90-day supply at a network of select retail pharmacies).
Up to a 90-day supply at mail order. Specialty
drugs limited to a 30-day supply. Payment of the difference between the cost of a brand name drug and a generic may also be required if a generic drug is available. You may be eligible to synchronize your prescription refills, please see your benefit booklet* for details.
Non-preferred generic drugs

15% coinsurance

Not Covered
Preferred brand drugs

20% coinsurance

Not Covered

Non-preferred brand drugs

30% coinsurance

Not Covered

Preferred specialty drugs

40% coinsurance

Not Covered

Non-preferred specialty drugs

50% coinsurance

Not Covered

If you have outpatient
surgery
Facility fee (e.g., ambulatory surgery center)

$300/visit plus 50% coinsurance

Not Covered

Referral required.
For Outpatient Infusion Therapy, see your benefit
booklet* for details.
Physician/surgeon fees

$150/visit; deductible does not apply

Not Covered

If you need immediate
medical attention
Emergency room care

$1,000/visit plus 50%
coinsurance

$1,000/visit plus 50%
coinsurance

Per occurrence copayment waived upon inpatient admission. None
Emergency medical transportation

50% coinsurance

50% coinsurance

None
Urgent care

$85/visit; deductible does not apply

Not Covered

Must be affiliated with member’s chosen medical group or referral required.
If you have a hospital
stay
Facility fee (e.g., hospital room)

$850/day; deductible does not apply

Not Covered

Referral required.
Physician/surgeon fee

No Charge; deductible does not apply

Not Covered

If you have mental
health, behavioral
health, or substance
abuse needs
Outpatient services$60/office visits; deductible does not apply
50% coinsurance for other outpatient services

$60/office visits; deductible
does not apply
50% coinsurance for other
outpatient services

Telepsychiatry benefits are available; see your benefit booklet* for details.
Inpatient services

$850/day; deductible does not apply

$850/day; deductible does not apply

None
If you are pregnantOffice visits

Primary Care: $60
Specialist: $85; deductible
does not apply

Not Covered

Copay applies to first prenatal visit (per
pregnancy). Cost sharing does not apply for preventive services. Depending on the type of services, coinsurance may apply. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound).
Childbirth/delivery professional services

No Charge; deductible does not apply

Not Covered

Copay applies to first prenatal visit (per
pregnancy). Cost sharing does not apply for preventive services. Depending on the type of services, coinsurance may apply. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound).
Childbirth/delivery facility services

$850/day; deductible does not apply

Not Covered

Copay applies to first prenatal visit (per
pregnancy). Cost sharing does not apply for preventive services. Depending on the type of services, coinsurance may apply. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound).
If you need help
recovering or have other special health needs
Home health care

No Charge; deductible does not apply

Not Covered

Referral required.
Rehabilitation services

$70 /visit; deductible does not apply

Not Covered

Habilitation services

$70/visit; deductible does not apply

Not Covered

Skilled nursing care

$500/day; deductible does not apply

Not Covered

Durable medical equipment

No Charge; deductible does not apply

Not Covered

Referral required.
Hospice service50% coinsurance

Not Covered

Referral required.
If your child needs
dental or eye care
Children’s eye exam

No Charge; deductible does not apply

Not covered

One visit per year. See your benefit booklet* for details
Children’s glasses

No Charge; deductible does not apply

Not covered

One pair of glasses up to age 19 per year. See your benefit booklet* for details.
Dental check-up

Not Covered

Not Covered

None

*For more information about limitations and exceptions, see the plan or policy document here.

Excluded Services & Other Covered Services:

Services Your Plan Generally Does NOT Cover (Check your policy or plan document for more information and a list of any other excluded services.)
  • Acupuncture
  • Dental care (Adult)
  • Long-term care
  • Non-emergency care when traveling outside the U.S.
  • Weight loss programs
Other Covered Services (Limitations may apply to these services. This isn’t a complete list. Please see your plan document.)
  • Abortion care
  • Bariatric surgery
  • Chiropractic care (limited to 25 visits per calendar year)
  • Cosmetic surgery (only for the correction of congenital deformities or conditions resulting from accidental injuries, scars, tumors, or diseases)
  • Hearing aids (for children 1 per ear every 24 months, for adults up to $2,500 per ear every 24 months)
  • Infertility treatment (covered for 4 procedures per benefit period)
  • Private-duty nursing (with the exception of inpatient private duty nursing)
  • Routine eye care (Adult, 1 visit per benefit period)
  • Routine foot care (only in connection with diabetes)

Blue FocusCare Plans

Blue FocusCare Silver 210

Important Questions Answers Why this Matters:
What is the overall deductible?Individual:
Participating $4,150
Family:
Participating $12,450
Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay. If you have other family members on the plan, each family member must meet their own individual deductible until the total amount of deductible expenses paid by all family members meets the overall family deductible
Are there services covered before you meet your deductible?Yes. In-Network Preventive Health Care services and services with a copay are covered before you meet your deductibleThis plan covers some items and services even if you haven’t yet met the deductible amount. But a copayment or coinsurance may apply. For example, this plan covers certain preventive services without
cost-sharing and before you meet your deductible. See a list of covered preventive services at
www.healthcare.gov/coverage/preventive-care-benefits/.
Are there other
deductibles for specific
services?
NoYou don’t have to meet deductibles for specific services.
What is the out-of-pocket
limit for this plan?
Individual: Participating $8,550
Family: Participating $17,100
The out-of-pocket limit is the most you could pay in a year for covered services. If you have other family members in this plan, they have to meet their own out-of-pocket limits until the overall family out-of-pocket limit has been met.
What is not included in
the out-of-pocket limit?
Premiums, balance-billed charges,
and health care this plan doesn’t
cover.
Even though you pay these expenses, they don’t count toward the out-of-pocket limit.
Will you pay less if you use a network provider? Yes. See www.bcbsil.com or call 1-
800-892-2803 for a list of
Participating Providers.
This plan uses a provider network. You will pay less if you use a provider in the plan’s network. You will
pay the most if you use an out-of-network provider, and you might receive a bill from a provider for the
difference between the provider’s charge and what your plan pays (balance billing). Be aware your network provider might use an out-of-network provider for some services (such as lab work). Check with your provider before you get services.
Do you need a referral to
see a specialist?
Yes.This plan will pay some or all of the costs to see a specialist for covered services but only if you have a
referral before you see the specialist.
Common Medical EventServices You May Need

Your cost if you use
a Participating
Provider

Your cost if you use
a Non-Participating
Provider

Limitations & Exceptions
If you visit a health care provider’s office or clinicPrimary care visit to treat an injury or illness

$30/visit; deductible does not apply

Not Covered

None
Specialist visit

$60/visit; deductible does not apply

Not Covered

Referral Required.
Preventive care/screening/immunization

No Charge; deductible does not apply

Not Covered

You may have to pay for services that aren’t preventive. Ask your provider if the services
needed are preventive. Then check what your plan will pay for.
If you have a testDiagnostic test (x-ray, blood work)

$50/test; deductible does not apply

Not Covered

Referral Required.
Imaging (CT / PET scans, MRIs)

$250/test; deductible does not apply

Not Covered

Referral Required.
If you need drugs to
treat your illness or
condition More information about
prescription drug coverage is available here.
Preferred generic drugs

10% coinsurance

Not CoveredLimited to a 30-day supply at retail (or a 90-day supply at a network of select retail pharmacies).
Up to a 90-day supply at mail order. Specialty
drugs limited to a 30-day supply. Payment of the difference between the cost of a brand name drug and a generic may also be required if a generic drug is available. You may be eligible to synchronize your prescription refills, please see your benefit booklet* for details.
Non-preferred generic drugs

15% coinsurance

Not Covered
Preferred brand drugs

20% coinsurance

Not Covered

Non-preferred brand drugs

30% coinsurance

Not Covered

Preferred specialty drugs

40% coinsurance

Not Covered

Non-preferred specialty drugs

50% coinsurance

Not Covered

If you have outpatient
surgery
Facility fee (e.g., ambulatory surgery center)

$300/visit plus 30% coinsurance

Not Covered

Referral required.
For Outpatient Infusion Therapy, see your benefit
booklet* for details.
Physician/surgeon fees

$100/visit; deductible does not apply

Not Covered

If you need immediate
medical attention
Emergency room care

$1,000/visit plus 30%
coinsurance

$1,000/visit plus 30%
coinsurance

Per occurrence copayment waived upon inpatient admission. None
Emergency medical transportation

30% coinsurance

30% coinsurance

None
Urgent care

$60/visit; deductible does not apply

Not Covered

Must be affiliated with member’s chosen medical group or referral required.
If you have a hospital
stay
Facility fee (e.g., hospital room)

$750/day; deductible does not apply

Not Covered

Referral required.
Physician/surgeon fee

No Charge; deductible does not apply

Not Covered

If you have mental
health, behavioral
health, or substance
abuse needs
Outpatient services$30/office visits; deductible does not apply
30% coinsurance for other outpatient services

$30/office visits; deductible
does not apply
30% coinsurance for other
outpatient services

Telepsychiatry benefits are available; see your benefit booklet* for details.
Inpatient services

$750/day; deductible does not apply

Not Covered

None
If you are pregnantOffice visits

Primary Care: $30
Specialist: $60; deductible
does not apply

Not Covered

Copay applies to first prenatal visit (per pregnancy). Cost sharing does not apply for preventive services. Depending on the type of services, coinsurance may apply. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound).
Childbirth/delivery professional services

No Charge; deductible does not apply

Not Covered

Copay applies to first prenatal visit (per pregnancy). Cost sharing does not apply for preventive services. Depending on the type of services, coinsurance may apply. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound).
Childbirth/delivery facility services

$750/day; deductible does
not apply

Not Covered

Copay applies to first prenatal visit (per pregnancy). Cost sharing does not apply for preventive services. Depending on the type of services, coinsurance may apply. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound).
If you need help
recovering or have other special health needs
Home health care

No Charge; deductible does not apply

Not Covered

Referral required.
Rehabilitation services

$60 /visit; deductible does not apply

Not Covered

Habilitation services

$60/visit; deductible does not apply

Not Covered

Skilled nursing care

$500/day; deductible does not apply

Not Covered

Durable medical equipment

No Charge; deductible does not apply

Not Covered

Referral required.
Hospice service30% coinsurance

Not Covered

Referral required.
If your child needs
dental or eye care
Children’s eye exam

No Charge; deductible does not apply

Not covered

One visit per year. See your benefit booklet* for details
Children’s glasses

No Charge; deductible does not apply

Not covered

One pair of glasses up to age 19 per year. See your benefit booklet* for details.
Dental check-up

Not Covered

Not Covered

None

*For more information about limitations and exceptions, see the plan or policy document here.

Excluded Services & Other Covered Services:

Services Your Plan Generally Does NOT Cover (Check your policy or plan document for more information and a list of any other excluded services.)
  • Acupuncture
  • Dental care (Adult)
  • Long-term care
  • Non-emergency care when traveling outside the U.S.
  • Weight loss programs
Other Covered Services (Limitations may apply to these services. This isn’t a complete list. Please see your plan document.)
  • Abortion care
  • Bariatric surgery
  • Chiropractic care (limited to 25 visits per calendar year)
  • Cosmetic surgery (only for the correction of congenital deformities or conditions resulting from accidental injuries, scars, tumors, or diseases)
  • Hearing aids (for children 1 per ear every 24 months, for adults up to $2,500 per ear every 24 months)
  • Infertility treatment (covered for 4 procedures per benefit period)
  • Private-duty nursing (with the exception of inpatient private duty nursing)
  • Routine eye care (Adult, 1 visit per benefit period)
  • Routine foot care (only in connection with diabetes)

Blue FocusCare Plans

Blue FocusCare Gold 211

Important Questions Answers Why this Matters:
What is the overall deductible?Individual:
Participating $750
Family:
Participating $2,250
Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay. If you have other family members on the plan, each family member must meet their own individual deductible until the total amount of deductible expenses paid by all family members meets the overall family deductible
Are there services covered before you meet your deductible?Yes. In-Network Preventive Health Care services and services with a copay are covered before you meet your deductibleThis plan covers some items and services even if you haven’t yet met the deductible amount. But a copayment or coinsurance may apply. For example, this plan covers certain preventive services without
cost-sharing and before you meet your deductible. See a list of covered preventive services at
www.healthcare.gov/coverage/preventive-care-benefits/.
Are there other
deductibles for specific
services?
NoYou don’t have to meet deductibles for specific services.
What is the out-of-pocket
limit for this plan?
Individual: Participating $8,550
Family: Participating $17,100
The out-of-pocket limit is the most you could pay in a year for covered services. If you have other family members in this plan, they have to meet their own out-of-pocket limits until the overall family out-of-pocket limit has been met.
What is not included in
the out-of-pocket limit?
Premiums, balance-billed charges,
and health care this plan doesn’t
cover.
Even though you pay these expenses, they don’t count toward the out-of-pocket limit.
Will you pay less if you use a network provider? Yes. See www.bcbsil.com or call 1-
800-892-2803 for a list of
Participating Providers.
This plan uses a provider network. You will pay less if you use a provider in the plan’s network. You will
pay the most if you use an out-of-network provider, and you might receive a bill from a provider for the
difference between the provider’s charge and what your plan pays (balance billing). Be aware your network provider might use an out-of-network provider for some services (such as lab work). Check with your provider before you get services.
Do you need a referral to
see a specialist?
Yes.This plan will pay some or all of the costs to see a specialist for covered services but only if you have a
referral before you see the specialist.
Common Medical EventServices You May Need

Your cost if you use
a Participating
Provider

Your cost if you use
a Non-Participating
Provider

Limitations & Exceptions
If you visit a health care provider’s office or clinicPrimary care visit to treat an injury or illness

$20/visit; deductible does not apply

Not Covered

None
Specialist visit

$40/visit; deductible does not apply

Not Covered

Referral Required.
Preventive care/screening/immunization

No Charge; deductible does not apply

Not Covered

You may have to pay for services that aren’t preventive. Ask your provider if the services
needed are preventive. Then check what your plan will pay for.
If you have a testDiagnostic test (x-ray, blood work)

$40/test; deductible does not apply

Not Covered

Referral Required.
Imaging (CT / PET scans, MRIs)

$250/test; deductible does not apply

Not Covered

Referral Required.
If you need drugs to treat your illness or condition More information about
prescription drug coverage is available here.
Preferred generic drugs

10% coinsurance

Not CoveredLimited to a 30-day supply at retail (or a 90-day supply at a network of select retail pharmacies).
Up to a 90-day supply at mail order. Specialty
drugs limited to a 30-day supply. Payment of the difference between the cost of a brand name drug and a generic may also be required if a generic drug is available. You may be eligible to synchronize your prescription refills, please see your benefit booklet* for details.
Non-preferred generic drugs

15% coinsurance

Not Covered
Preferred brand drugs

20% coinsurance

Not Covered

Non-preferred brand drugs

30% coinsurance

Not Covered

Preferred specialty drugs

40% coinsurance

Not Covered

Non-preferred specialty drugs

50% coinsurance

Not Covered

If you have outpatient
surgery
Facility fee (e.g., ambulatory surgery center)

$300/visit plus 30% coinsurance

Not Covered

Referral required.
For Outpatient Infusion Therapy, see your benefit
booklet* for details.
Physician/surgeon fees

$40/visit; deductible does not apply

Not Covered

If you need immediate
medical attention
Emergency room care

$1,000/visit plus 30%
coinsurance

$1,000/visit plus 30%
coinsurance

Per occurrence copayment waived upon inpatient admission. None
Emergency medical transportation

30% coinsurance

30% coinsurance

None
Urgent care

$40/visit; deductible does not apply

Not Covered

Must be affiliated with member’s chosen medical group or referral required.
If you have a hospital
stay
Facility fee (e.g., hospital room)

$850/day; deductible does not apply

Not Covered

Referral required.
Physician/surgeon fee

No Charge; deductible does not apply

Not Covered

If you have mental
health, behavioral
health, or substance
abuse needs
Outpatient services$20/office visits; deductible does not apply
30% coinsurance for other outpatient services

$20/office visits; deductible
does not apply
30% coinsurance for other
outpatient services

Telepsychiatry benefits are available; see your benefit booklet* for details.
Inpatient services

$750/day; deductible does not apply

$750/day; deductible does not apply

None
If you are pregnantOffice visits

Primary Care: $20
Specialist: $40; deductible
does not apply

Not Covered

Copay applies to first prenatal visit (per pregnancy). Cost sharing does not apply for preventive services. Depending on the type of services, coinsurance may apply. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound).
Childbirth/delivery professional services

$750/day; deductible does not apply

Not Covered

Copay applies to first prenatal visit (per pregnancy). Cost sharing does not apply for preventive services. Depending on the type of services, coinsurance may apply. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound).
Childbirth/delivery facility services

No Charge; deductible does not apply

Not Covered

Copay applies to first prenatal visit (per pregnancy). Cost sharing does not apply for preventive services. Depending on the type of services, coinsurance may apply. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound).
If you need help
recovering or have other special health needs
Home health care

No Charge; deductible does not apply

Not Covered

Referral required.
Rehabilitation services

$40 /visit; deductible does not apply

Not Covered

Habilitation services

$40/visit; deductible does not apply

Not Covered

Skilled nursing care

$500/day; deductible does not apply

Not Covered

Durable medical equipment

No Charge; deductible does not apply

Not Covered

Referral required.
Hospice service30% coinsurance

Not Covered

Referral required.
If your child needs
dental or eye care
Children’s eye exam

No Charge; deductible does not apply

Not covered

One visit per year. See your benefit booklet* for details
Children’s glasses

No Charge; deductible does not apply

Not covered

One pair of glasses up to age 19 per year. See your benefit booklet* for details.
Dental check-up

Not Covered

Not Covered

None

*For more information about limitations and exceptions, see the plan or policy document here.

Excluded Services & Other Covered Services:

Services Your Plan Generally Does NOT Cover (Check your policy or plan document for more information and a list of any other excluded services.)
  • Acupuncture
  • Dental care (Adult)
  • Long-term care
  • Non-emergency care when traveling outside the U.S.
  • Weight loss programs
Other Covered Services (Limitations may apply to these services. This isn’t a complete list. Please see your plan document.)
  • Abortion care
  • Bariatric surgery
  • Chiropractic care (limited to 25 visits per calendar year)
  • Cosmetic surgery (only for the correction of congenital deformities or conditions resulting from accidental injuries, scars, tumors, or diseases)
  • Hearing aids (for children 1 per ear every 24 months, for adults up to $2,500 per ear every 24 months)
  • Infertility treatment (covered for 4 procedures per benefit period)
  • Private-duty nursing (with the exception of inpatient private duty nursing)
  • Routine eye care (Adult, 1 visit per benefit period)
  • Routine foot care (only in connection with diabetes)