Blue Precision Gold HMO Plan


Blue Cross BlueShield of Illinois
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Blue precision – Gold HMO plans

Our Rating:

The Gold HMO Plan 001 is best value HMO plan by including copays for doctor visits, prescription drugs, and reducing premiums by having a $2,000 deductible in case of any major expensive medical needs. By offering $30 copays for primary care visits and $50 copays for specialists, this plan is the perfect fit for someone who frequents the doctor but does not have serious medical conditions or upcoming surgeries.

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 Gold HMO Plan Option:
PPO Network

The The Gold HMO Plan uses the Blue Precision HMO network, one 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 Gold HMO ® Plan 001 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
  • $30 doctor visit copayment for primary care physicians (PCPs) and $50 copay for specialists
  • $50 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
Gold® may be right for you if you are an individual or family who:
  • Are willing to have a primary care physican (PCP) coordinate your care
  • Prefers fixed doctor visit copayments
  • Are not expecting to have surgery or major services in the near future
  • Requires regular prescription medication

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

Blue Precision HMO Gold 001 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:

  • $2,000 single deductible / $6,000 aggregate family deductible
  • $30 primary care office visit copay, $50 copayment for specialists
  • Coinsurance of 80% for major services
  • Annual out-of-pocket maximum of $5,000 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 netowrk, 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 Gold 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 Gold plans, as well as details on policy renewability, benefit exclusions and coverage limitations.

Prescription Drug Coverage

Gold Plans Prescription Drug Coverage

For the Gold HMO 001 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 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 HMO Plan 001
Preferred Generics $0 copay
Non-Preferred Generics $10 copay
Preferred Formulary $50 copay
Non-Preferred Formulary $100 copay
Specialty $150 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

Gold® HMO 001 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 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

Gold HMO 001

Our Rating:

Benefit Highlight Blue Precision Gold HMO 001
Plan Features
Lifetime Maximum Unlimited
Participating providers Blue Precision HMO Network
You must select a network primary care physician
Individual Deductible $2,000
Family Deductible $6,000
Coinsurance 80%
Out of Pocket Maximum
Includes deductible
$5,000
Family Out of Pocket Maximum
Includes deductible
$12,700
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 80% after deductible
Outpatient Surgery $50 copay then 100%
Emergency Room / Outpatient Emergency Care
Physician and Hospital
$400 copay then 80% after deductible
Outpatient Hospital Diagnostic Testing $50 copay then 100% coverage
Mental Illness & Substance Abuse Rehab
(Outpatient Hospital/ Physician Care)
$30 copay
Mental Illness & Substance Abuse Treatment
(Inpatient Hospital Care)
$200 copay then 80% after deductible
Mental Illness & Substance Abuse Treatment
(Inpatient Physician Care)
$50 copay
Preventive Care Covered at 100%, no copay
Maternity Coverage $30 copay for prental and postnatal care, $200 copay for delivery then covered at 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