Blue PPO Gold Plans
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 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 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:
- $30 doctor visit copayment for Gold Plan 001 and Gold Plan 012
- $10 doctor visit copayment for Gold Plan 002
- 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:
- 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 Eligible | 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 Eligible | 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 Eligible | No |
| Outline of Coverage | |
