Blue Precision HMO Plans


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Blue Precision HMO Plans

Our Rating:

All Blue Precision HMO Plans offer the same set of essential health benefits, quality and amount of care. The Blue Precision Gold HMO Plans are the most expensive plans, but also have the most comprehensive benefits. Gold Plans have a higher monthly premium and often lower out-of-pocket costs than Silver and Bronze plans. BCBSIL Blue Precision HMO Plans cover 100% of costs, while you only cover the copays for medical services in most cases. There are deductibles for this plan, and this is an HMO plan (when applicable for major services). You must select a Blue Precision HMO Network Primary Care Physician (PCP) when enrolling in this plan.

Blue Precision Gold HMO 207 Plan features:
  • $500 single/$1,500 family deductible and 80% coinsurance
  • $20 doctor visit / $40 specialist copayment
  • $40 urgent care copayment
  • No charge for Tier 1 formulary generic drugs
Blue Precision Silver HMO 206 Plan features:
  • $2,250 single/$6,750 family deductible
  • $30 doctor visit / $50 specialist copayment
  • $50 urgent care copayment
  • No charge for Tier 1 formulary generic drugs
Blue Precision Bronze HMO 205 Plan features:
  • $6,000 single/$14,300 family deductible
  • $50 doctor visit / $85 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
  • $20 doctor visit / $40 specialist copayment for Gold HMO Plan 207
  • 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.

Blue Precision Bronze HMO 205

Important Questions Answers Why this Matters:
What is the overall deductible? Individual:
Participating $6,000
Family:
Participating $14,700
Doesn’t apply to preventive care
& certain copayments.
You must pay all the costs up to the deductible amount before this plan begins to pay for covered services you use. Check your policy or plan document to see when the deductible starts over (usually, but not always, January 1st). See the chart starting on page 2 for how much you pay for covered services after you meet the deductible.
Are there other deductibles for specific services? No. You don’t have to meet deductibles for specific services, but see the chart starting on page 2 or other costs for services this plan covers.
Is there an out-of-pocket limit on my expenses? Yes. Individual:
Participating $7,350
Family:
Participating $14,700
The out-of-pocket limit is the most you could pay during a coverage period (usually one year) for your share of the cost of covered services. This limit helps you plan for health care expenses.
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.
Does this plan use a network of providers? Yes. See http://www.bcbsil.com or call 1-800-538-8833 for a list of Participating providers. If you use an in-network doctor or other health care provider, this plan will pay some or all of the costs of covered services. Be aware, your in-network doctor or hospital may use an out-of-network provider for some services. Plans use the term in-network, preferred, or participating for providers in their network. See the chart starting on page 2 for how this plan pays different kinds of providers.
Do I need a referral to see a specialist? Yes. All specialist visits require a
written PCP referral unless it’s for
an OB/GYN or for emergency care.
This plan will pay some or all of the costs to see a specialist for covered services but only if you have the plan’s permission before you see the specialist.
Are there services this plan doesn’t cover? Yes. Some of the services this plan doesn’t cover are listed on page 5. See your policy or plan document for additional information about excluded services.
Common Medical Event Services 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 clinic Primary care visit to treat an injury or illness

$50 copay/visit

Not Covered

Services or supplies that are not ordered by your Primary Care. Physician or Women’s Principal Health Care Provider, except
emergency and routine vision exams, are not covered.
Specialist visit

$85 copayment/visit

Not Covered

Referral Required.
Other practitioner office visit

$85 copayment/visit

Not Covered

Referral Required.
Acupuncture not covered. Chiropractic and Osteopathic Manipulation are limited to 25 visits per calendar year.
Preventive care/screening/immunization

No Charge

Not Covered

—none—
If you have a test Diagnostic test (x-ray, blood work)

Hospital – $200 copay/visit

Non-Hospital – $100 copay/visit

Not Covered

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

Hospital – $600 copay/visit

Non-Hospital – $300 copay/visit

Not Covered

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

10% coinsurance

N/A Retail covers a 30 day supply and home delivery covers a 90 day supply. Non-Participating home delivery is not covered.

Non-Participating specialty drug coverage is limited to certain medications that are clarified in the prescription drug rider.

Up to a 90 days supply for mail order

Non-preferred generic drugs

15% coinsurance

N/A
Preferred brand drugs

20% coinsurance

N/A

Non-preferred brand drugs

30% coinsurance

N/A

Preferred Specialty drugs

40% coinsurance

N/A

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

Hospital – $300 copay/visit + 50% coin.

Non-Hospital – $300 copay/visit + 40% coin.

Not Covered

Referral required. Abortions not covered, except where a pregnancy is the result of rape or incest, or for a pregnancy which, as
Certified by a physician, places the woman in danger of death unless an abortion is performed.
Physician/surgeon fees

$150 copay/visit

Not Covered

If you need immediate
medical attention
Emergency room services

$1,000 copayment/
visit plus 10%
coinsurance

$1,000 copayment/
visit plus 40%
coinsurance

Copayment waived if admitted.
Emergency medical transportation

40% coinsurance

40% coinsurance

Ground and air transportation covered.
Urgent care

$85 copay/visit

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

Not Covered

Preauthorization required unless admitted from emergency room.
Physician/surgeon fee

40% coinsurance

Not Covered

If you have mental
health, behavioral
health, or substance
abuse needs
Mental/Behavioral health outpatient services

$50 copay/visit
or 40% coinsurance for outpatient services

Not Covered

Referral required.
Mental/Behavioral health inpatient services

$850/day

Not Covered

Referral required.
Virtual visits may be available for Outpatient services, refer to plan policy for more details
Substance use disorder outpatient services

$50 copay/visit
or 40% coinsurance for outpatient services

Not Covered

Referral required.

Virtual visits may be available for Outpatient services, refer to plan policy for more details

Substance use disorder inpatient services

$850/day

Not Covered

Referral required.
If you are pregnant Prenatal and postnatal care

$50 copay/$85 specialist copay

Not Covered

Copyament applies to first prenatal visit per pregnancy.
Delivery and all inpatient services

40% coinsurance

Not Covered

Referral required. Copayment applies per day until the Out-of-Pocket limit has been met.
If you need help
recovering or have other special health needs
Home health care

40% coinsurance

Not Covered

Referral required.
Rehabilitation services

$70 copay/visit

Not Covered

Habilitation services

$70 copay/visit

Not Covered

Skilled nursing care

$500/day

Not Covered

Durable medical equipment

40% coinsurance

Not Covered

Benefits are limited to items used to serve a medical purpose.

DME benefits are provided for both purchase and rental equipment (up to the purchase price).

Hospice service 50% coinsurance

Not Covered

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

No Charge

Not Covered

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

No Charge

Not Covered

One pair of glasses per year.
See benefit booklet for network details.
Children’s dental check-up

Not Covered

Not Covered

—none—

 

Excluded Services & Other Covered Services:

Services Your Plan Does NOT Cover (This isn’t a complete list. Check your policy or plan document for other excluded services.)
  • Abortions (Except where a pregnancy is the result of rape or incest, or for a pregnancy which, as certified by a physician, places the woman in danger of death unless an abortion is performed)
  • Acupuncture
  • Dental Care (Adult)
  • Long-term care
  • Non-emergency care when traveling outside the U.S.
  • Routine eye care (Adult)
  • Weight loss programs
Other Covered Services (This isn’t a complete list. Check your policy or plan document for other covered services and your costs for these services.)
  • 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 (Two covered every 36 months for children or bone anchored)
  • Infertility treatment
  • Private-duty nursing (With the exception of inpatient private duty nursing)
  • Routine foot care (Only in connection with diabetes)

Blue Precision Gold HMO 207

Important Questions Answers Why this Matters:
What is the overall deductible? Individual:
Participating $500
Family:
Participating $1,500
Doesn’t apply to preventive care
& certain copayments.
You must pay all the costs up to the deductible amount before this plan begins to pay for covered services you use. Check your policy or plan document to see when the deductible starts over (usually, but not always, January 1st). See the chart starting on page 2 for how much you pay for covered services after you meet the deductible.
Are there other deductibles for specific services? No. You don’t have to meet deductibles for specific services, but see the chart starting on page 2 or other costs for services this plan covers.
Is there an out-of-pocket limit on my expenses? Yes. Individual:
Participating $7,350
Family:
Participating $14,700
The out-of-pocket limit is the most you could pay during a coverage period (usually one year) for your share of the cost of covered services. This limit helps you plan for health care expenses.
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.
Does this plan use a network of providers? Yes. See http://www.bcbsil.com or call 1-800-538-8833 for a list of Participating providers. If you use an in-network doctor or other health care provider, this plan will pay some or all of the costs of covered services. Be aware, your in-network doctor or hospital may use an out-of-network provider for some services. Plans use the term in-network, preferred, or participating for providers in their network. See the chart starting on page 2 for how this plan pays different kinds of providers.
Do I need a referral to see a specialist? Yes. All specialist visits require a
written PCP referral unless it’s for
an OB/GYN or for emergency care.
This plan will pay some or all of the costs to see a specialist for covered services but only if you have the plan’s permission before you see the specialist.
Are there services this plan doesn’t cover? Yes. Some of the services this plan doesn’t cover are listed on page 5. See your policy or plan document for additional information about excluded services.
Common Medical Event Services 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 clinic Primary care visit to treat an injury or illness

$20 copay/visit

Not Covered

Services or supplies that are not ordered by your Primary Care. Physician or Women’s Principal Health Care Provider, except
emergency and routine vision exams, are not covered.
Specialist visit

$40 copayment/visit

Not Covered

Referral Required.
Other practitioner office visit

$40 copayment/visit

Not Covered

Referral Required.
Acupuncture not covered. Chiropractic and Osteopathic Manipulation are limited to 25 visits per calendar year.
Preventive care/screening/immunization

No Charge

Not Covered

—none—
If you have a test Diagnostic test (x-ray, blood work)

$50 copayment/visit

Not Covered

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

$250 copayment/visit

Not Covered

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

No Charge

$10 copay Retail covers a 30 day supply and home delivery covers a 90 day supply. Non-Participating home delivery is not covered.

Non-Participating specialty drug coverage is limited to certain medications that are clarified in the prescription drug rider.

Up to a 90 days supply for mail order

Non-preferred generic drugs

$10 copay

$20 copay
Preferred brand drugs

$50 copay

$70 copay

Non-preferred brand drugs

$100 copay

$120 copay

Specialty drugs

30% coinsurance

30% coinsurance

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

Hospital – $300 /visit plus 50% coinsurance

Not Covered

Abortions not covered, except where a pregnancy is the result of rape or incest, or for a pregnancy which, as
Certified by a physician, places the woman in danger of death unless an abortion is performed.
Physician/surgeon fees

$50 copayment/visit

Not Covered

If you need immediate
medical attention
Emergency room services

$1,000 copayment/
visit plus 30%
coinsurance

$1,000 copayment/
visit plus 30%
coinsurance

Copayment waived if admitted.
Emergency medical transportation

20% coinsurance

20% coinsurance

Ground and air transportation covered.
Urgent care

$40 copayment/visit

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)

$500 copay plus 30% coinsurance

Not Covered

Preauthorization required unless admitted from emergency room.
Physician/surgeon fee

No Charge

Not Covered

If you have mental
health, behavioral
health, or substance
abuse needs
Mental/Behavioral health outpatient services

$20 copayment/visit Not Covered
or 20% coinsurance

Not Covered

Referral required.
Mental/Behavioral health inpatient services

$400 copayment/day

Not Covered

Referral required.
Copayment applies per day until the
Out-of-Pocket limit has been met.
Substance use disorder outpatient services

$25 copayment/visit
or 20% coinsurance

Not Covered

Referral required.
Substance use disorder inpatient services

$400 copayment/day

Not Covered

Referral required.
Copayment applies per day until the
Out-of-Pocket limit has been met.
If you are pregnant Prenatal and postnatal care

$20 copayment

Not Covered

Copyament applies to first prenatal visit per pregnancy.
Delivery and all inpatient services

$400 copayment/day

Not Covered

Referral required. Copayment applies per day until the Out-of-Pocket limit has been met.
If you need help
recovering or have other special health needs
Home health care

20% coinsurance

Not Covered

Referral required.
Rehabilitation services

$40 copayment/visit

Not Covered

Habilitation services

$40 copayment/visit

Not Covered

Skilled nursing care

20% coinsurance

Not Covered

Durable medical equipment

20% coinsurance

Not Covered

Benefits are limited to items used to serve a medical purpose.

DME benefits are provided for both purchase and rental equipment (up to the purchase price).

Hospice service 20% coinsurance

Not Covered

Referral required.
If your child needs
dental or eye care
Eye exam

No Charge

Covered

One visit per year. Reimbursed up to
$30 out-of-network. See benefit booklet for network details.
Glasses

Covered

Covered

One pair of glasses per year. Reimbursed up to $45 out-of-network.
See benefit booklet for network details.
Dental check-up

Not Covered

Not Covered

—none—

 

Excluded Services & Other Covered Services:

Services Your Plan Does NOT Cover (This isn’t a complete list. Check your policy or plan document for other excluded services.)
  • Abortions (Except where a pregnancy is the result of rape or incest, or for a pregnancy which, as certified by a physician, places the woman in danger of death unless an abortion is performed)
  • Acupuncture
  • Dental Care (Adult)
  • Long-term care
  • Non-emergency care when traveling outside the U.S.
  • Routine eye care (Adult)
  • Weight loss programs
Other Covered Services (This isn’t a complete list. Check your policy or plan document for other covered services and your costs for these services.)
  • 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 (Two covered every 36 months for children or bone anchored)
  • Infertility treatment
  • Private-duty nursing (With the exception of inpatient private duty nursing)
  • Routine foot care (Only in connection with diabetes)

Blue Precision Silver HMO 206

Important Questions Answers Why this Matters:
What is the overall deductible? Individual:
Participating $2,250
Family:
Participating $6,750
Doesn’t apply to preventive care
& certain copayments.
You must pay all the costs up to the deductible amount before this plan begins to pay for covered services you use. Check your policy or plan document to see when the deductible starts over (usually, but not always, January 1st). See the chart starting on page 2 for how much you pay for covered services after you meet the deductible.
Are there other deductibles for specific services? No. You don’t have to meet deductibles for specific services, but see the chart starting on page 2 or other costs for services this plan covers.
Is there an out-of-pocket limit on my expenses? Yes. Individual:
Participating $7,350
Family:
Participating $14,700
The out-of-pocket limit is the most you could pay during a coverage period (usually one year) for your share of the cost of covered services. This limit helps you plan for health care expenses.
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.
Does this plan use a network of providers? Yes. See http://www.bcbsil.com or call 1-800-538-8833 for a list of Participating providers. If you use an in-network doctor or other health care provider, this plan will pay some or all of the costs of covered services. Be aware, your in-network doctor or hospital may use an out-of-network provider for some services. Plans use the term in-network, preferred, or participating for providers in their network. See the chart starting on page 2 for how this plan pays different kinds of providers.
Do I need a referral to see a specialist? Yes. All specialist visits require a
written PCP referral unless it’s for
an OB/GYN or for emergency care.
This plan will pay some or all of the costs to see a specialist for covered services but only if you have the plan’s permission before you see the specialist.
Are there services this plan doesn’t cover? Yes. Some of the services this plan doesn’t cover are listed on page 5. See your policy or plan document for additional information about excluded services.
Common Medical Event Services 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 clinic Primary care visit to treat an injury or illness

$30 copay/visit

Not Covered

Services or supplies that are not ordered by your Primary Care. Physician or Women’s Principal Health Care Provider, except
emergency and routine vision exams, are not covered.
Specialist visit

$65 copayment/visit

Not Covered

Referral Required.
Other practitioner office visit

$65 copayment/visit

Not Covered

Referral Required.
Acupuncture not covered. Chiropractic and Osteopathic Manipulation are limited to 25 visits per calendar year.
Preventive care/screening/immunization

No Charge

Not Covered

—none—
If you have a test Diagnostic test (x-ray, blood work)

$20 copay/visit

Not Covered

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

$250 copayment/visit

Not Covered

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

No Charge

N/A Retail covers a 30 day supply and home delivery covers a 90 day supply. Non-Participating home delivery is not covered.

Non-Participating specialty drug coverage is limited to certain medications that are clarified in the prescription drug rider.

Up to a 90 days supply for mail order

Non-preferred generic drugs

10% coinsurance

N/A
Preferred brand drugs

20% coinsurance

N/A

Non-preferred brand drugs

30% coinsurance

N/A

Specialty drugs

40% coinsurance

N/A

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

50% coinsurance

Not Covered

Referral required. Abortions not covered, except where a pregnancy is the result of rape or incest, or for a pregnancy which, as
Certified by a physician, places the woman in danger of death unless an abortion is performed.
Physician/surgeon fees

$30 copay/visit

Not Covered

If you need immediate
medical attention
Emergency room services

$1,000 copayment/
visit plus 50%
coinsurance

$1,000 copayment/
visit plus 30%
coinsurance

Copayment waived if admitted.
Emergency medical transportation

50% coinsurance

20% coinsurance

Ground and air transportation covered.
Urgent care

$65 copayment/visit

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)

$500 copay plus 50% coinsurance

Not Covered

Preauthorization required unless admitted from emergency room.
Physician/surgeon fee

50% coinsurance

Not Covered

If you have mental
health, behavioral
health, or substance
abuse needs
Mental/Behavioral health outpatient services

$30 copay/visit
or 50% coinsurance for outpatient services

Not Covered

Referral required.
Mental/Behavioral health inpatient services

$500 copay plus 50% coinsurance

Not Covered

Referral required.
Virtual visits may be available for Outpatient services, refer to plan policy for more details
Substance use disorder outpatient services

$30 copay/visit
or 50% coinsurance for outpatient services

Not Covered

Referral required.

Virtual visits may be available for Outpatient services, refer to plan policy for more details

Substance use disorder inpatient services

$500 copay plus 50% coinsurance

Not Covered

Referral required.
If you are pregnant Prenatal and postnatal care

$30 copay/$65 specialist copay

Not Covered

Copyament applies to first prenatal visit per pregnancy.
Delivery and all inpatient services

50% coinsurance

Not Covered

Referral required. Copayment applies per day until the Out-of-Pocket limit has been met.
If you need help
recovering or have other special health needs
Home health care

50% coinsurance

Not Covered

Referral required.
Rehabilitation services

$30 copayvisit

Not Covered

Habilitation services

$40 copayment/visit

Not Covered

Skilled nursing care

50% coinsurance

Not Covered

Durable medical equipment

50% coinsurance

Not Covered

Benefits are limited to items used to serve a medical purpose.

DME benefits are provided for both purchase and rental equipment (up to the purchase price).

Hospice service 50% coinsurance

Not Covered

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

No Charge

Not Covered

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

No Charge

Not Covered

One pair of glasses per year.
See benefit booklet for network details.
Children’s dental check-up

Not Covered

Not Covered

—none—

 

Excluded Services & Other Covered Services:

Services Your Plan Does NOT Cover (This isn’t a complete list. Check your policy or plan document for other excluded services.)
  • Abortions (Except where a pregnancy is the result of rape or incest, or for a pregnancy which, as certified by a physician, places the woman in danger of death unless an abortion is performed)
  • Acupuncture
  • Dental Care (Adult)
  • Long-term care
  • Non-emergency care when traveling outside the U.S.
  • Routine eye care (Adult)
  • Weight loss programs
Other Covered Services (This isn’t a complete list. Check your policy or plan document for other covered services and your costs for these services.)
  • 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 (Two covered every 36 months for children or bone anchored)
  • Infertility treatment
  • Private-duty nursing (With the exception of inpatient private duty nursing)
  • Routine foot care (Only in connection with diabetes)