BlueCare Direct with Advocate Plans


Blue Cross BlueShield of Illinois
Free Online Quote

Find a BlueCare Direct Doctor

BLUECARE DIRECTSM

Blue Care Direct HMO

BlueCare Direct Hospital List

Chicago-area residents now have a new choice for health care coverage. Blue Cross and Blue Shield of Illinois (BCBSIL) has teamed up with Advocate Health Care* to offer a new, more affordable health plan — BlueCare Direct.

BlueCare Direct. Great Access. More Affordable Coverage.

BlueCare Direct combines the strength, expertise and reputation of two of the state’s most respected leaders in the health industry. Advocate is the largest health system in Illinois, and BCBSIL is the largest health insurer in the state. Advocate is uniquely positioned to deliver quality patient outcomes, while working to manage overall health care costs, with the goal of delivering value to our members. BlueCare may be right for you if you are willing to have a primary care physician (PCP) coordinate your care, prefer or live 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, or require regular prescription medication.

Below is a quick summary of the SIX BlueCare Direct with Advocate plans – DOUBLE the amount of plans from last year. For more detailed information on each plan, please see the tabs above or download the summary of benefits linked to the plan name.

Bronze

Bronze plans may be for you if you have fewer medical needs, would rather have a low monthly payment, and don’t take prescription drugs regularly.

Silver

Silver plans may be for you if you want to pay less out-of-pocket for care, qualify for a premium tax credit (also known as a subsidy), have a spouse/children on your health plan, or have regular medical needs.

Gold

Gold plans may be for you if you have more health care needs than most, have a spouse/children on your plan or want to grow your family soon, or prefer to pay more each month but have lower out-of-pocket expenses.

 

HMO Network
BlueCare Direct combines the strength, expertise and reputation of two of the state’s most respected leaders in the health industry. Advocate is the largest health system in Illinois, and BCBSIL is the largest health insurer in the state. Advocate is uniquely positioned to deliver quality patient outcomes, while working to manage overall health care costs, with the goal of delivering value to our members.

BlueCare Direct provides access to Advocate Health Care’s vast network of doctors and hospitals in Cook, DuPage, Kane, Lake and Will counties. It’s being offered to our individual, family and small group customers on our website. Along with all the features of an HMO, BlueCare Direct offers:

  • Lower monthly premiums and lower out-of-pocket costs than most other HMO plans available to individual plan members
  • Same-day appointments for primary care**
  • Self-refer to specialists within the Advocate network without a PCP referral (except in some instances such as for surgical procedures or physical therapy regimens)
  • Same day mammograms, and get the results on the same day**
  • See a cardiologist within 24 hours
  • Access to Advocate’s network of over 250 sites of care, including:
    • 4,000+ Advocate doctors
    • 11 Advocate community hospitals
    • The state’s largest integrated children’s network
    • The state’s largest home health and hospice companies
    • One of the region’s largest medical groups
    • $65 urgent care copayment
    • Maternity Coverage
    • Well-adult care
    • Well-child care
    • Diagnostic testing
    • Hospital services

BlueCare DirectSM is a unique product that combines the strength, expertise and reputation of two of the state’s leading health organizations. It provides health care coverage that gives members access to the resources of the largest health care system in Illinois, including:

Advocate Direct Hospital Network

  • More than 4,000 Advocate primary care and specialty physicians across Cook, DuPage, Lake, Kane and Will counties
  • 11 Advocate hospitals, including Advocate Children’s Hospital with campuses in Park Ridge and Oak Lawn
  • Advocate Good Shepherd in Barrington
  • Advocate Illinois Masonic Medical Center in Chicago
  • Advocate Trinity Hospital in Chicago
  • Advocate Good Samaritan Hospital in Downers Grove
  • Advocate Sherman Hospital in Elgin
  • Advocate South Suburban in Hazel Crest
  • Advocate Condell Medical Center in Libertyville
  • Advocate Christ Hospital Medical Center and Advocate Children’s Hospital in Oak Lawn
  • Advocate General Hospital and Advocate Lutheran General Children’s Hospital in Park Ridge
  • Advocate’s home health and hospice agency for transition from hospital to home

Because of its Advocate-exclusive network, BlueCare

BlueCare Direct is ideal for your customers who live and work in the greater Chicago area and have no need to pay more for a network that includes providers in other parts of the state.

 

BlueCare Direct Bronze 401 with Advocate

2024 Plan Summary

Important Questions Answers Why this Matters:
What is the overall deductible? $0 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 other 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 deductible. This 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?  No You don’t have to meet deductibles for specific services
What is the out-of-pocket limit for this plan? Individual: Participating $9,450
Family: Participating $18,900
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 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

$150/visit; deductible does not apply

Not Covered

None
Specialist visit

$160/visit; deductible does not apply

Not Covered

Referral Required.
Preventive care/screening/immunization

No Charge

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 test Diagnostic test (x-ray, blood work)

$250/test

Not Covered

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

$450/test

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

Retail – $100/prescription
Mail – $300/prescription

Not Covered Limited 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.

 Any differences between the cost of the generic drug and the cost of the brand name drug will apply to the deductible or out-of-pocket maximum.

The applicable cost sharing (by tier) and the cost difference between the generic and brand will never exceed the overall cost of the drug.

The amount you may pay per 30-day supply of a covered insulin drug, regardless of quantity or type, shall not exceed $100, when obtained from a Participating Pharmacy.

Non-preferred generic drugs

Retail – $110/prescription
Mail – $330/prescription

Not Covered
Preferred brand drugs

Retail – $120/prescription
Mail – $360/prescription

Not Covered

Non-preferred brand drugs

Retail – $175/prescription
Mail – $525/prescription

Not Covered

Preferred specialty drugs

$275/prescription

Not Covered

Non-preferred specialty drugs

$500/prescription

Not Covered

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

$750/visit plus 50%
coinsurance

Not Covered

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

$400/visit

Not Covered

If you need immediate
medical attention
Emergency room care

$2,000/visit plus 50%
coinsurance

$2,000/visit plus 50% coinsurance

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

50% coinsurance

50% coinsurance

None
Urgent care

$160/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)

$1,500/day; plus 50% coinsurance

Not Covered

Referral required.
Physician/surgeon fee

No Charge

Not Covered

If you need mental
health, behavioral health,
or substance abuse
services
Outpatient services

$150/office visits;
50% coinsurance for other outpatient services

Not Covered

Referral may be required. Telepsychiatry benefits are available; see your benefit booklet* for details.
Inpatient services

$1,500/day; plus 50% coinsurance

Not Covered

Referral required
If you are pregnant Office visits

Primary Care: $150
Specialist: $160

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

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

$1,500/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

$150 /visit; deductible does
not apply

Not Covered

Habilitation services

$150/visit; deductible does not apply

Not Covered

Skilled nursing care

$800/day; deductible does
not apply

Not Covered

Durable medical equipment

No Charge

Not Covered

Referral required
Hospice service 50% 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.
Children’s 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 (This isn’t a complete list. Check your policy or plan document for other covered services and your costs for these services.)
  • 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)

 

BlueCare Direct Bronze 802 with Advocate

2024 Plan Summary

Important Questions Answers Why this Matters:
What is the overall deductible? Individual: Participating $7,500
Family: Participating $15,000
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 other 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 deductible. This 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?  No You don’t have to meet deductibles for specific services
What is the out-of-pocket limit for this plan? Individual: Participating $9,400
Family: Participating $18,800
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 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/visit; deductible does not apply

Not Covered

None
Specialist visit

$100/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 test Diagnostic test (x-ray, blood work)

50% coinsurance

Not Covered

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

50% coinsurance

Not Covered

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

Retail – $25/prescription
Mail – $75/prescription; deductible
does not apply

Not Covered Limited 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.

 Any differences between the cost of the generic drug and the cost of the brand name drug will apply to the deductible or out-of-pocket maximum.

The applicable cost sharing (by tier) and the cost difference between the generic and brand will never exceed the overall cost of the drug.

The amount you may pay per 30-day supply of a covered insulin drug, regardless of quantity or type, shall not exceed $100, when obtained from a Participating Pharmacy.

Preferred brand drugs

Retail – $50/prescription
Mail – $150/prescription

Not Covered

Non-preferred brand drugs

Retail – $100/prescription
Mail – $300/prescription

Not Covered

Specialty Drugs

$500/prescription

Not Covered

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

 50% coinsurance

Not Covered

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

50% coinsurance

Not Covered

If you need immediate
medical attention
Emergency room care

50% coinsurance

50% coinsurance

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

50% coinsurance

50% coinsurance

None
Urgent care

$75/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)

50% coinsurance

Not Covered

Referral required.
Physician/surgeon fee

No Charge; deductible does not apply

Not Covered

If you need mental
health, behavioral health,
or substance abuse
services
Outpatient services

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

Not Covered

Referral may be required. Telepsychiatry benefits are available; see your benefit booklet* for details.
Inpatient services

50% coinsurance

Not Covered

Referral required
If you are pregnant Office visits

Primary Care: $50
Specialist: $100; 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

50% coinsurance

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

$50 /visit; deductible does
not apply

Not Covered

Habilitation services

$150/visit; deductible does not apply

Not Covered

Skilled nursing care

$800/day; deductible does
not apply

Not Covered

Durable medical equipment

No Charge

Not Covered

Referral required
Hospice service 50% 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.
Children’s 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 (This isn’t a complete list. Check your policy or plan document for other covered services and your costs for these services.)
  • 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)

 

BlueCare Direct Gold 409 with Advocate

2024 Plan Summary

Important Questions Answers Why this Matters:
What is the overall deductible? Individual:
Participating $2,000
Family:
Participating $4,000
Doesn’t apply to preventive care
& certain copayments.
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 other 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 deductible. This 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?  No You don’t have to meet deductibles for specific services
What is the out-of-pocket limit for this plan? Individual: Participating $9,450
Family: Participating $18,900
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.comor 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 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

$40/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 test Diagnostic 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

Retail – $20/prescription
Mail – $60/prescription; deductible does not apply

Not Covered Limited 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.  Any differences between the cost of the generic drug and the cost of the brand name drug will apply to the deductible or out-of-pocket maximum. 

The applicable cost sharing (by tier) and the cost difference between the generic and brand will never exceed the overall cost of the drug.

 The amount you may pay per 30-day supply of a covered insulin drug, regardless of quantity or type, shall not exceed $100, when obtained from a Participating Pharmacy.

Non-preferred generic drugs

Retail – $30/prescription
Mail – $90/prescription; deductible does not apply

Not Covered
Preferred brand drugs

Retail – $60/prescription
Mail – $180/prescription; deductible does not apply

Not Covered

Non-preferred brand drugs

Retail – $120/prescription
Mail – $360/prescription; deductible does not apply

Not Covered

Preferred specialty drugs

$250/prescription; deductible does not apply

Not Covered

Non-preferred specialty drugs

$350/prescription; deductible does not apply

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

$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 need mental
health, behavioral health,
or substance abuse
services
Outpatient services

$40/office visits; deductible
does not apply
30% coinsurance for other outpatient services

Not Covered

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

$750/day; deductible does
not apply

Not Covered

None
If you are pregnant Office visits

Primary Care: $40
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

$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 service 30% 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.
Children’s 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 (This isn’t a complete list. Check your policy or plan document for other covered services and your costs for these services.)
  • 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)

 

BlueCare Direct Gold 804 with Advocate

2024 Plan Summary

Important Questions Answers Why this Matters:
What is the overall deductible? Individual:
Participating $1,500
Family:
Participating $3,000
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 other 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 deductible. This 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?  No You don’t have to meet deductibles for specific services
What is the out-of-pocket limit for this plan? Individual: Participating $8,700
Family: Participating $17,400
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.comor 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 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/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 test Diagnostic test (x-ray, blood work)

25% coinsurance

Not Covered

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

25% coinsurance

Not Covered

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

Retail – $15/prescription
Mail – $45/prescription; deductible
does not apply

Not Covered Limited 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.
Brand drugs (Preferred)

Retail – $30/prescription
Mail – $90/prescription; deductible
does not apply

Not Covered
Brand drugs (Non-Preferred)

Retail – $60/prescription
Mail – $180/prescription; deductible
does not apply

Not Covered

Specialty Drugs

$250/prescription; deductible does not
apply

Not Covered

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

25% coinsurance

Not Covered

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

25% coinsurance

Not Covered

If you need immediate
medical attention
Emergency room care

25% coinsurance

40% coinsurance

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

25% coinsurance

40% coinsurance

None
Urgent care

$45/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)

25% coinsurance

Not Covered

Referral required.
Physician/surgeon fee

No Charge; deductible does
not apply

Not Covered

If you need mental
health, behavioral health,
or substance abuse
services
Outpatient services

$30/office visits; deductible
does not apply
25% coinsurance for other outpatient services

Not Covered

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

25% coinsurance

Not Covered

None
If you are pregnant Office 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

25% coinsurance

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

$30/visit; deductible does not apply

Not Covered

Habilitation services

$30/visit; deductible does not apply

Not Covered

Skilled nursing care

25% coinsurance

Not Covered

Durable medical equipment

No Charge; deductible does
not apply

Not Covered

Referral required
Hospice service 25% 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.
Children’s 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 (This isn’t a complete list. Check your policy or plan document for other covered services and your costs for these services.)
  • 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)

 

BlueCare Direct Gold 804 with Advocate – PLAN INFO COMING SOON

BlueCare Direct Silver 212 with Advocate

2024 Plan Summary

Important Questions Answers Why this Matters:
What is the overall deductible? Individual:
Participating $7,500
Family:
Participating $15,000
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 other 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 deductible. This 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?  No You don’t have to meet deductibles for specific services
What is the out-of-pocket limit for this plan? Individual: Participating $9,450
Family: Participating $18,900
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.comor 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 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

$100/visit; deductible does not apply

Not Covered

None
Specialist visit

$130/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 test Diagnostic test (x-ray, blood work)

$90/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

Retail – $25/prescription
Mail – $75/prescription; deductible does not apply

Not Covered Limited 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

Retail – $70/prescription
Mail – $210/prescription; deductible does not apply

Not Covered
Preferred brand drugs

Retail – $85/prescription
Mail – $255/prescription; deductible does not apply

Not Covered

Non-preferred brand drugs

Retail – $120/prescription
Mail – $360/prescription; deductible does not apply

Not Covered

Preferred specialty drugs

$250/prescription; deductible does not apply

Not Covered

Non-preferred specialty drugs

$500/prescription; deductible does not apply

Not Covered

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

$350/visit plus 50% coinsurance

Not Covered

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

$90/visit; deductible does not applyly

Not Covered

If you need immediate
medical attention
Emergency room care

$1,200/visit plus 50%
coinsurance

$1,200/visit plus 50%
coinsurance

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

50% coinsurance

50% coinsurance

None
Urgent care

$130/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)

$500/visit plus 50% coinsurance

Not Covered

Referral required.
Physician/surgeon fee

No Charge; deductible does
not apply

Not Covered

If you need mental
health, behavioral health,
or substance abuse
services
Outpatient services

$100/office visits; deductible
does not apply
50% coinsurance for other outpatient services

Not Covered

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

$500/visit plus 50%
coinsurance

Not Covered

None
If you are pregnant Office visits

Primary Care: $100
Specialist: $130; 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

$500/visit plus 50%
coinsurance

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

$100/visit; deductible does
not apply

Not Covered

Habilitation services

$100/visit; deductible does not apply

Not Covered

Skilled nursing care

50% coinsurance

Not Covered

Durable medical equipment

No Charge; deductible does
not apply

Not Covered

Referral required
Hospice service 50% 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.
Children’s 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 (This isn’t a complete list. Check your policy or plan document for other covered services and your costs for these services.)
  • 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)

 

BlueCare Direct Silver 803 with Advocate

2024 Plan Summary

Important Questions Answers Why this Matters:
What is the overall deductible? Individual:
Participating $5,900
Family:
Participating $11,800
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 other 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 deductible. This 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?  No You don’t have to meet deductibles for specific services
What is the out-of-pocket limit for this plan? Individual: Participating $9,100
Family: Participating $18,200
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.comor 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 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

$40/visit; deductible does not apply

Not Covered

None
Specialist visit

$80/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 test Diagnostic test (x-ray, blood work)

40% coinsurance

Not Covered

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

40% coinsurance

Not Covered

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

Retail – $20/prescription
Mail – $60/prescription; deductible does not apply

Not Covered Limited 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.
Brand drugs (Preferred)

Retail – $40/prescription
Mail – $120/prescription; deductible does not apply

Not Covered
Brand drugs (Non-Preferred)

Retail – $80/prescription
Mail – $240/prescription

Not Covered

Specialty Drugs

$350/prescription

Not Covered

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

40% coinsurance

Not Covered

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

40% coinsurance

Not Covered

If you need immediate
medical attention
Emergency room care

40% coinsurance

40% coinsurance

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

40% coinsurance

40% 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)

40% coinsurance

Not Covered

Referral required.
Physician/surgeon fee

No Charge; deductible does
not apply

Not Covered

If you need mental
health, behavioral health,
or substance abuse
services
Outpatient services

$40/office visits; deductible
does not apply
40% coinsurance for other outpatient services

Not Covered

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

40% coinsurance

Not Covered

None
If you are pregnant Office visits

Primary Care: $40
Specialist: $80; 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

40% coinsurance

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% coinsurance; deductible does not apply

Not Covered

Habilitation services

40% coinsurance; deductible does not apply

Not Covered

Skilled nursing care

40% coinsurance

Not Covered

Durable medical equipment

No Charge; deductible does
not apply

Not Covered

Referral required
Hospice service 40% 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.
Children’s 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 (This isn’t a complete list. Check your policy or plan document for other covered services and your costs for these services.)
  • 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)