BCBSIL Bronze HMO Plans – Overview


Blue Cross BlueShield of Illinois
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Bronze HMO Plans

Bronze HMO Plans

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The Bronze HMO Plan 003 is the least expensive HMO plan, but also includes comprehensive benefits. Bronze Plans have a lower monthly premium and often higher out-of-pocket costs than Platinum, Gold, and Silver plans. This is an HMO plan. You must select a Blue Precision HMO Network Primary Care Physician (PCP) when enrolling in this plan.

There are is only 1 BCBSIL Bronze HMO Plan Option:

HMO Network

The The Bronze HMO Plan uses the Blue Precision HMO network, one of the largest HMO network 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 Bronze HMO ® Plan 003 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
  • $25 doctor visit copayment for primary care physicians (PCPs)
  • $100 office visit copayment for specialists
  • Prescription drug coverage
  • Maternity Coverage
  • Well-adult care
  • Well-child care
  • Diagnostic testing
  • Hospital services
  • Access to the BlueCard PPO network when traveling out-of-state
  • Optional dental coverage

Bronze® HMO 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 not expecting to have surgery or major services in the near future and want the lowest cost plan for emergencies
  • Is generally in good health and does not taken expensive prescription medications

Learn more about valuable member services and features you get when you join the Blue Cross and Blue Shield of Illinois family.

Blue HMO 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:

  • No deductible
  • $25 primary care office visit copay, $100 office visit copay for specialists
  • Coinsurance prescription drug benefit AFTER deductible is met
  • Coinsurance of 70%
  • Annual out-of-pocket maximum of $6,250 for individuals and $12,700 for families

You must use a contracting BCBS HMO hospital, doctor or specialist for covered services. If you see a doctor or hospital that is not in the HMO network, you will be responsible for all costs with the exception of hospital emergencies.

For more information on costs, get a quick quote or see the benefit summary.

What’s Included with Blue Precision HMO Bronze Plans

  • Preventive Care Covered at 100%, no deductible
  • 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
  • Maternity Coverage
  • Prescription Drug Coverage

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

Bronze HMO Plans Prescription Drug Coverage

For the Bronze HMO Plan, 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 coinsurance 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 003
Preferred Generics 70% coinsurance after deductible
Non-Preferred Generics 70% coinsurance after deductible
Preferred Formulary 60% coinsurance after deductible
Non-Preferred Formulary 50% coinsurance after deductible
Specialty 50% coinsurance 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

Blue Precision Bronze® HMO Plan Limits

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 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

Bronze HMO 003

Benefit Highlight Blue Precision Bronze HMO 003
Plan Features
Lifetime Maximum Unlimited
Participating providers Blue Precision HMO Network
You must select a network primary care physician
Individual Deductible $6,000
Family Deductible $12,700
Coinsurance 70%
Out of Pocket Maximum
Includes deductible
$6,250
Family Out of Pocket Maximum
Includes deductible
$12,700
Office Visit Copay (Primary Care/Specialist) $25 / $100 specialist
Medical Coverage Details
Outpatient Physician Medical Services
Services received from a hospital or other specified provider as an outpatient
$100 copay then 100% coinsurance after deductible
Outpatient Physician Surgial Services $100 copay then 100% coinsurance after deductible
Inpatient Hospital Medical / Surgical Services
Hospital Services and Hospital Diagnostic Testing
$300 copay then 70% after deductible
Outpatient Hospital Surgery $250 copay then 100% coinsurance after deductible
Emergency Room / Outpatient Emergency Care
Physician and Hospital
$600 copay then 70% after deductible
Outpatient Hospital Diagnostic Testing $100 copay then 100% coinsurance after deductible
Mental Illness & Substance Abuse Rehab
(Outpatient Hospital/ Physician Care)
$25 copay
Mental Illness & Substance Abuse Treatment
(Inpatient Hospital Care)
$300 copay then 70% after deductible
Mental Illness & Substance Abuse Treatment
(Inpatient Physician Care)
70% coinsurance after deductible
Preventive Care Covered at 100%, no copay
Maternity Coverage $300 copay after deductible
Prescription Drugs
Preferred Generics 70% coinsurance after deductible
Non Preferred Generics 70% coinsurance after deductible
Preferred Formulary 60% coinsurance after deductible
Non-Preferred Formulary 50% coinsurance after deductible
Specialty 50% coinsurance after deductible
Prescription Drug Formulary Standard
Cost Reductions
Tax Credit Eligible Yes
Cost Sharing Eligible No
HSA Eligibile No
Outline of Coverage PDF icon