BlueValue Advantage Plan
BlueValue Advantage Overview
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If you don't want all the bells and whistles, but are looking for a comprehensive coverage plan with a lower cost, the BlueValue Advantage plan may be right for you. This plan keeps your premium low by not including an office visit co-pay. This plan provide coverage for the most frequently used health care services.
Key BlueValue Advantage® plan features include:
- Access to the BCBS of Illinois PPO network, the largest PPO network in Illinois
- Benefits for preventive care services
- 80% coinsurance
- Diagnostic testing
- Hospital services
- An emergency room co-pay benefit. Emergency room visits are covered at 80% after $75 copay and not subject to the annual deductible.
- Prescription drug coverage
- Access to the BlueCard PPO network when traveling out-of-state
- Optional dental coverage
- Unlimited lifetime maximum
BlueValue Advantage has all the benefits of the BlueValue plan with additional cost-sharing features that bring the costs down about 10% more than BlueValue. There are only 2 major differences than the BlueValue plan:
- Only 80% coinsurance is available (BlueValue offers a choice of 100% or 80%)
- The annual individual Out-of-Pocket Maximum is $3,000 (BlueValue has $1,000 OOP Maximum)
Like the BlueValue plan, BlueValue Advantage does NOT include:
- An office visit co-payment benefit. Office visits are subject to the annual deductible and 80% coinsurance.
- Prescription drug co-payments for any plan. Prescriptions are covered, but are subject to the deductible and 80% coinsurance.
BlueValue Advantage® may be right for you if you are an individual or family who:
- Is willing to assume a portion of health care cost in exchange for a lower monthly premium
- Visits doctors primarily for annual check-ups
- Requires occasional prescription medication
Compare the features, options and costs of the BlueValue Advantage® 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.
BlueValue Advantage 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 BlueValue Advantage® plans:
- Individual in-network deductibles ranging from $250 to $5,000 – customize your plan by choosing a deductible amount that works best for your situation
- 20% coinsurance on prescriptions drugs after deductible is met
- You pay 20% coinsurance of services in-network, after deductible is met
- Annual out-of-pocket maximum of $3,000 for individuals and $9,000 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.
What's Included with BlueValue Advantage®
- 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 BlueValue Advantage® plan will be higher, and your costs lower, when you use the services of participating PPO or BlueChoice® providers.
- 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
Prescription Drug Coverage
For the BlueValue Advantage plans, there is a prescription drug benefit of 80% coinsurance after the deductible is satisfied for all BlueValue Advantage plans.
| Outpatient Prescription Drug Benefit | You Pay | BlueValue Advantage Pays |
| Retail After deductible |
||
| Generic | 20% | 80% |
| Brand formulary & Insulin and Insulin syringes | 20% | 80% |
| Brand non-formulary | 20% | 80% |
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
BlueValue Advantage® Limits
Every insurance plan has limitations. These limits are there to keep health care costs down for everyone. A pre-existing condition is just one example of a plan limitation. For example:
- A pre-existing condition may limit or exclude your participation in a plan.
- There is a waiting period of 365 days for pre-existing conditions, including optional maternity coverage.
- This means your health care expenses related to that specific condition will not be covered by the plan during the specified time.
It's important to know the limitations of your health plan. For a list of exclusions and limitations, see the benefit summary.
Add-ons and Plan Options
You can customize any BlueValue Advantage plan with add-on coverage and insurance.
Optional Maternity Coverage
- Covers inpatient and outpatient hospital services
- Includes coverage for medical and surgical services
- Maternity benefits begin 365 days after the effective date of the maternity coverage
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 percent discount for orthodontic services at participating providers
- Learn more about optional dental coverage