Blue PPO Bronze Plans
Blue PPO Bronze Plans
Our Rating: 
All Bronze plans offer the same set of essential health benefits, quality and amount of care. 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. Bronze Plans have a higher monthly premium and often lower out-of-pocket costs than silver plans. In most cases, Bronze plans cover 80% of costs, while you cover 20%.
There are 2 Blue PPO Bronze Plan Options:
- Bronze Plan 005 – $5,000 individual deductible and 80% coinsurance
- Bronze Plan 006 – $6,000 individual deductible and 100% coinsurance
PPO Network
The Blue PPO Bronze Plans use the Blue Advantage Entrepreneur (BAE) PPO network, the largest PPO network in Illinois that includes over 90% of metro-area doctors and 98% of Illinois hospitals.
Cost Savings Option
The Blue Choice Bronze Plans offer the identical plan benefits as the Blue PPO Bronze Plans, but use the Blue Choice Network, a smaller version of the “standard” BlueCross BlueShield of Illinois PPO network. If you can accept some reduced hospital and physician choice, the Blue Choice Bronze Plans may be a great lower cost option for you.
Key Blue PPO Bronze® plan features include:
- 80% coinsurance after deductible for the Bronze Plan 005
- 100% coinsurance after deductible for the Bronze Plan 006
- Prescription drug coverage
- Maternity Coverage
- Well-adult care covered at 100%, no deductible
- Well-child care, covered at 100%, no deductible
- Diagnostic testing
- Hospital services
- Access to the BlueCard PPO network when traveling out-of-state
- Optional dental coverage
Bronze® may be right for you if you are an individual or family who:
- Seeks lower cost coverage
- Does not regulary have doctor visits
- Would like an HSA compatible plan
Compare the features, options and costs of Bronze® plans to find the one that’s right for you.
Learn more about valuable member services and features you get when you join the Blue Cross and Blue Shield of Illinois family.
Blue PPO Bronze Plan Costs
Health insurance costs include monthly premium payments, individual/family deductibles, out-of-pocket expenses, copayments, and coinsurance. Here is what you can expect with Bronze® plans:
- Individual in-network deductibles ranging from $5,000 to $6,000
- Individual in-network deductibles of $5,000 or $6,000
- 80% or 100% coinsurance after deductible
- 80% or 100% coinsurance prescription drug coverage after deductible
- Coinsurance of 100% or 80% percent of services provided in-network
- Annual out-of-pocket maximum of $6,000 and $6,350 for individuals and $12,700 for families
By using a contracting BCBS PPO hospital, doctor or specialist you are able to save on premiums and the cost of covered services. You do not need to select a primary care physician or obtain a referral to see a specialist.
For more information on costs, get a quick quote or see the benefit summary.
What’s Included with Blue PPO Bronze Plans®
- Coverage for major hospital, medical and surgical expenses incurred as a result of a covered accident or sickness
- Coverage for daily hospital room and board, miscellaneous hospital services, surgical services, anesthesia services, in-hospital medical services, and out-of-hospital care
- Although you can go to the hospital or doctor of your choice, your benefits under a Bronze® plan will be higher, and your costs lower, when you use the services of participating PPO or BlueChoice® providers.
- Maternity Coverage
- As with all individual Blue Cross and Blue Shield of Illinois plans, the freedom of not having to select a primary care doctor or obtain a referral to see a specialist
More Plan Details
It’s important to know the critical features of the health plan you are considering. Each plan’s Outline of Coverage provides brief descriptions of the basic provisions the Bronze plans, as well as details on policy renewability, benefit exclusions and coverage limitations.
Prescription Drug Coverage
For the Blue PPO Bronze and Blue Choice Bronze Plans, there is a prescription drug card benefit that includes a coinsurance after your deductible. This benefit is not immediately available and subject to the deductible.
There is a also a Home Delivery prescription benefit available with these 3 deductible options where you can receive a 90 day supply in the mail for the cost of a 60 day supply and is subject to a maximum cost of $300 per prescription.
| Outpatient Prescription Drug Benefit | Bronze Plan 005 | Bronze Plan 006 |
|---|---|---|
| Preferred Generics | 80% after deductible | 100% after deductible |
| Non-Preferred Generics | 80% after deductible | 100% after deductible |
| Preferred Formulary | 80% after deductible | 100% after deductible |
| Non-Preferred Formulary | 80% after deductible | 100% after deductible |
| Specialty | 80% after deductible | 100% after deductible |
Plan Renewals
Your BCBSIL policy can ONLY be terminated for the following reasons:
- Failure to pay
- The plan is discontinued (90 days notice given with an option to convert to any plan we offer)
- Discovery of fraud or an intentional misrepresentation of facts (30 days prior written notice given)
- If you no longer reside, live or work in an area where we are authorized to do business
Add-ons and Plan Options
You can customize any Bronze plan to add-on dental insurance.
Optional Dental Coverage
- Covers cleanings, check-ups and other preventive procedures immediately – no waiting period
- One of the highest maximum benefit amounts available – up to $1,500 per person per year
- Up to 20% discount for orthodontic services at participating providers
- Learn more about optional dental coverage
Blue PPO Bronze Plan 005
Our Rating: 
| Benefit Highlight | Blue PPO Bronze 005 |
|---|---|
| Plan Features | |
| Lifetime Maximum | Unlimited |
| Participating providers | PPO Network 90% of IL doctors; over 200 IL hospitals |
| Individual Deductible | $5,000 |
| Family Deductible | $12,700 |
| Coinsurance | 80% |
| Out of Pocket Maximum Includes deductible |
$6,600 |
| Family Out of Pocket Maximum Includes deductible |
$13,200 |
| Office Visit Copay (Primary Care/Specialist) | $30 primary / $60 specialist copay (applies to first 3 visits only per calendar year, then 80% after deductible) |
| Medical Coverage Details | |
| Outpatient Surgery | 80% after deductible |
| Inpatient Hospital Medical / Surgical Services Hospital Services and Hospital Diagnostic Testing |
80% after deductible |
| Emergency Room / Outpatient Emergency Care Physician and Hospital |
80% after deductible |
| Outpatient Hospital Diagnostic Testing | 80% after deductible |
| Mental Illness & Substance Abuse Rehab (Outpatient Hospital/ Physician Care) |
80% after deductible |
| Mental Illness & Substance Abuse Treatment (Inpatient Hospital Care) |
80% after deductible |
| Mental Illness & Substance Abuse Treatment (Inpatient Physician Care) |
80% coinsurance after deductible |
| Preventive Care | Covered at 100%, no copay |
| Maternity Coverage | 80% after deductible |
| Prescription Drugs | |
| Preferred Generics | 80% after deductible |
| Non Preferred Generics | 80% after deductible |
| Preferred Formulary | 80% after deductible |
| Non-Preferred Formulary | 80% after deductible |
| Specialty | 80% after deductible |
| Prescription Drug Formulary | Standard |
| Cost Reductions | |
| Tax Credit Eligible | Yes |
| Cost Sharing Eligible | No |
| HSA Eligible | No |
| Outline of Coverage | |
Blue PPO Bronze Plan 006
Our Rating: 
| Benefit Highlight | Blue PPO Bronze 006 |
|---|---|
| Plan Features | |
| Lifetime Maximum | Unlimited |
| Participating providers | PPO Network 90% of IL doctors; over 200 IL hospitals |
| Individual Deductible | $6,000 |
| Family Deductible | $12,700 |
| Coinsurance | 100% |
| Out of Pocket Maximum Includes deductible |
$6,000 |
| Family Out of Pocket Maximum Includes deductible |
$12,700 |
| Office Visit Copay (Primary Care/Specialist) | No copay, you pay 100% until deductible unless preventive care, then covered at 100% after deductible |
| Medical Coverage Details | |
| Outpatient Surgery | 100% after deductible |
| Inpatient Hospital Medical / Surgical Services Hospital Services and Hospital Diagnostic Testing |
100% after deductible |
| Emergency Room / Outpatient Emergency Care Physician and Hospital |
100% after deductible |
| Outpatient Hospital Diagnostic Testing | 100% after deductible |
| Mental Illness & Substance Abuse Rehab (Outpatient Hospital/ Physcian Care) |
100% after deductible |
| Mental Illness & Substance Abuse Treatment (Inpatient Hospital Care) |
100% after deductible |
| Mental Illness & Substance Abuse Treatment (Inpatient Physician Care) |
100% coinsurance after deductible |
| Preventive Care | Covered at 100%, no copay |
| Maternity Coverage | 100% after deductible |
| Prescription Drugs | |
| Preferred Generics | 100% after deductible |
| Non Preferred Generics | 100% after deductible |
| Preferred Formulary | 100% after deductible |
| Non-Preferred Formulary | 100% after deductible |
| Specialty | 100% after deductible |
| Prescription Drug Formulary | Standard |
| Cost Reductions | |
| Tax Credit Eligible | Yes |
| Cost Sharing Eligible | No |
| HSA Eligibile | Yes |
| Outline of Coverage | |
