SelectBlue Advantage Plans
SelectBlue Advantage Overview
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Key SelectBlue Advantage® plan features include:
- Access to the BCBS of Illinois PPO network, the largest PPO network in Illinois
- $30 office visit copayment
- Preventive care benefits for adults and children
- 80% coinsurance
- Diagnostic testing
- Hospital services
- Prescription drug coverage
- Access to the BlueCard PPO network when traveling out-of-state
- Optional dental coverage
- Unlimited lifetime maximum
SelectBlue Advantage is a slightly watered-down version of SelectBlue. It provides identical benefits to SelectBlue with 3 DIFFERENCES:
- $30 office visit copayment (SelectBlue is $20)
- Only 80% coinsurance is available (SelectBlue offers 100% and 80%)
- The individual in-network maximum out-of-pocket expense is $3,000 (SelectBlue is $1,000)
SelectBlue Advantage® 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 SelectBlue 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.
SelectBlue 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 SelectBlue Advantage® plans:
- Individual in-network deductibles ranging from $250 to $5000 – customize your plan by choosing a deductible amount that works best for your situation
- $30 office visit copayments
- $10 copayments for generic prescription drugs (on $250 and $500 deductible plans)
- You pay 20% coinsurance of major services provided in-network, after deductible and copayments are 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.
For more information on costs, get a quick quote or see the benefit summary.
What's Included with SelectBlue 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 SelectBlue 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
SelectBlue Advantage Plans with $0, $250, and $500 Deductibles
For the SelectBlue Advantage plans with a $0, $250, or $500 deductible, there is a prescription drug card benefit that includes a $10 copay for generic, 35% coinsurance for brand, and 50% coinsurance for non-formulary drugs with a maximum out-of-pocket expense of $100 per perscription. 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 | You Pay | SelectBlue Advantage Pays |
| $0, $250 and $500 Deductible Plans ONLY | ||
| Generic | $10 co-payment | 100% |
| Brand formulary & Insulin and Insulin syringes | 35% | 65% |
| Brand non-formulary | 50% | 50% |
| Home Delivery Up to a 90-day supply of maintenance drugs is available through home delivery and is subject to $300 maximum per prescription. |
||
| Generic | $20 co-payment | 100% |
| Brand formulary & Insulin and Insulin syringes | 35% | 65% |
| Brand non-formulary | 50% | 50% |
SelectBlue Advantage $1,000, $2,500, and $5,000 Plan Deductibles
For the SelectBlue Advantage plans with a $1,000, $2,500, or $5,000 individual deductible, the a prescription drug card benefit is subject to deductible and coinsurance. This means that you pay for prescriptions costs (at BCBS negotitated discount rates) until you reach your individual deductible. After you reach your deductible, the plan pays 80% of all prescription drug costs until you reach your $3,000 individual out-of-pocket expense limit. If you reach your out-of-pocket expense limit, BCBS pays 100% of your prescription costs. Both your medical and prescription costs accumulate towards your deductible and out-of-pocket expense limit.
| Outpatient Prescription Drug Benefit | You Pay | SelectBlue Advantage Pays |
| $1,000, $2,500 and $5,000 Deductible plans ONLY (subject to deductible and coinsurance) |
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
SelectBlue 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 SelectBlue 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