Blue PPO Gold Plans


Blue Cross BlueShield of Illinois
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Blue PPO Gold Plans

Our Rating:

All Gold 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. Gold Plans have a higher monthly premium and often lower out-of-pocket costs than silver plans. In most cases, gold plans cover 80% of costs, while you cover 20%.

There are 3 Blue PPO Gold Plan Options:
  • Gold Plan 001 – $3,250 individual deductible and 100% coinsurance
  • Gold Plan 002 – $1,500 individual deductible and 80% coinsurance
  • Gold Plan 012 – $1,000 individual deductible and 80% coinsurance
PPO Network

The Blue PPO Gold Plans use the Blue Avantage 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 Gold Plans offer the identical plan benefits as the Blue PPO Gold Plans, but use the Blue Choice Network, a smaller version of the “standard” Blue Cross Blue Sheild of Illinois PPO network. If you can accept some reduced hospital and physician choice, the Blue Choice Gold Plans may be a great lower cost option for you.

Key Blue PPO Gold® plan features include:
Gold® may be right for you if you are an individual or family who:
  • Seeks coverage comparable to what is offered by employers
  • Prefers fixed doctor visit copayments
  • Regularly visits a doctor
  • Requires regular prescription medication

Compare the features, options and costs of Gold® 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 Gold 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 Gold® plans:

  • Individual in-network deductibles ranging from $1,000 to $3,250
  • $10 or $30 office visit copayments
  • $0 or $10 copayments for generic prescription drugs
  • Coinsurance of 100% to 80% percent of services provided in-network, after deductible and copayments are met
  • Annual out-of-pocket maximum of $3,250 and $3,500 for individuals and $9,750 or $10,500 for families, depending on the plan

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 Gold 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 Gold® plan will be higher, and your costs lower, when you use the services of participating PPO or BlueChoice® providers.
  • Maternity Coverage
  • 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 Gold plans, as well as details on policy renewability, benefit exclusions and coverage limitations.

Prescription Drug Coverage

For the Blue PPO Gold and Blue Choice Gold Plans, there is a prescription drug card benefit that includes a $0 or $10 copay for generic, $35 or $75 copay for formulary drugs, and a $150 copay for specialty medications. This benefit is immediately available and not subject to a 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 Gold Plan 001 Gold Plan 002
Preferred Generics $0 copay $0 copay
Non-Preferred Generics $10 copay $10 copay
Preferred Formulary $35 copay $35 copay
Non-Preferred Formulary $75 copay $75 copay
Specialty $150 copay $150 copay
Home Delivery
Up to a 90-day supply of maintenance drugs is available through home delivery and is subject to $300 maximum per prescription.
Preferred Generics $0 copay $0 copay
Non-Preferred Generics $20 copay $20 copay
Preferred Formulary $70 copay $70 copay
Non-Preferred Formulary $150 copay $150 copay
Specialty $300 copay $300 copay

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 Gold 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 Gold Plan 001

Our Rating:

Benefit Highlight Blue PPO Gold 001
Plan Features
Lifetime Maximum Unlimited
Participating providers PPO Network
90% of IL doctors; over 200 IL hospitals
Individual Deductible $3,250
Family Deductible $9,750
Coinsurance 100%
Out of Pocket Maximum
Includes deductible
$3,250
Family Out of Pocket Maximum
Includes deductible
$9,750
Office Visit Copay (Primary Care/Specialist) $30 / $50 specialist
Medical Coverage Details
Inpatient Hospital Medical / Surgical Services
Hospital Services and Hospital Diagnostic Testing
$200 copay then 100% after deductible
Outpatient Surgery $150 copay then 100% after deductible
Emergency Room / Outpatient Emergency Care
Physician and Hospital
$400 copay then 100% after deductible
Outpatient Hospital Diagnostic Testing 100% after deductible
Mental Illness & Substance Abuse Rehab
(Outpatient Hospital/ Physcian Care)
$30 copay
Mental Illness & Substance Abuse Treatment
(Inpatient Hospital Care)
$200 copay then 100% coinsurance after deductible
Mental Illness & Substance Abuse Treatment
(Inpatient Physician Care)
100% coinsurance after deductible
Preventive Care Covered at 100%, no copay
Maternity Coverage $200 copay then 100% after deductible
Prescription Drugs
Preferred Generics $0 copay
Non Preferred Generics $10 copay
Preferred Formulary $35 copay
Non-Preferred Formulary $75 copay
Specialty $150 copay
Prescription Drug Formulary Standard
Cost Reductions
Tax Credit Eligible Yes
Cost Sharing Eligible No
HSA Eligibile No
Outline of Coverage

Blue PPO Gold Plan 002

Our Rating:

Benefit Highlight Blue PPO Gold 002
Plan Features
Lifetime Maximum Unlimited
Participating providers PPO Network
90% of IL doctors; over 200 IL hospitals
Individual Deductible $1,500
Family Deductible $4,500
Coinsurance 80%
Out of Pocket Maximum
Includes deductible
$3,500
Family Out of Pocket Maximum
Includes deductible
$10,500
Office Visit Copay (Primary Care/Specialist) $10 / $60 specialist
Medical Coverage Details
Outpatient Surgery $150 copay then 80% after deductible
Inpatient Hospital Medical / Surgical Services
Hospital Services and Hospital Diagnostic Testing
$200 copay then 80% after deductible
Emergency Room / Outpatient Emergency Care
Physician and Hospital
$400 copay then 80% after deductible
Outpatient Hospital Diagnostic Testing 80% after deductible
Mental Illness & Substance Abuse Rehab
(Outpatient Hospital/ Physcian Care)
$10 copay
Mental Illness & Substance Abuse Treatment
(Inpatient Hospital Care)
$200 copay then 80% coinsurance after deductible
Mental Illness & Substance Abuse Treatment
(Inpatient Physician Care)
80% coinsurance after deductible
Preventive Care Covered at 100%, no copay
Maternity Coverage $200 copay then 80% after deductible
Prescription Drugs
Preferred Generics $0 copay
Non Preferred Generics $10 copay
Preferred Formulary $35 copay
Non-Preferred Formulary $75 copay
Specialty $150 copay
Prescription Drug Formulary Standard
Cost Reductions
Tax Credit Eligible Yes
Cost Sharing Eligible No
HSA Eligibile No
Outline of Coverage

Blue PPO Gold Plan 012

Our Rating:

Benefit Highlight Blue PPO Gold 012
Plan Features
Lifetime Maximum Unlimited
Participating providers PPO Network
90% of IL doctors; over 200 IL hospitals
Individual Deductible $1,000
Family Deductible $3,000
Coinsurance 80%
Out of Pocket Maximum
Includes deductible
$3,000
Family Out of Pocket Maximum
Includes deductible
$9,000
Office Visit Copay (Primary Care/Specialist) $30 / $50 specialist
Medical Coverage Details
Inpatient Hospital Medical / Surgical Services
Hospital Services and Hospital Diagnostic Testing (Inpatient / Outpatient Surgery)
$200 copay then 80% after deductible
Outpatient Surgery $150 copay then 80% after deductible
Emergency Room / Outpatient Emergency Care
Physician and Hospital
$400 copay then 80% after deductible
Outpatient Hospital Diagnostic Testing 80% after deductible
Mental Illness & Substance Abuse Rehab
(Outpatient Hospital/ Physcian Care)
$30 copay
Mental Illness & Substance Abuse Treatment
(Inpatient Hospital Care)
$200 copay then 80% coinsurance after deductible
Mental Illness & Substance Abuse Treatment
(Inpatient Physician Care)
80% coinsurance after deductible
Preventive Care Covered at 100%, no copay
Maternity Coverage $200 copay then 80% after deductible
Prescription Drugs
Preferred Generics $0 copay
Non Preferred Generics $10 copay
Preferred Formulary $50 copay
Non-Preferred Formulary $100 copay
Specialty $150 copay
Prescription Drug Formulary Standard
Cost Reductions
Tax Credit Eligible Yes
Cost Sharing Eligible No
HSA Eligibile No
Outline of Coverage