2024 BCBSIL Group Plans

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2024 Small Group Plan Summaries

2024 BCBSIL Blue PPO

Platinum & Gold

Plan Name	Deductible Ind/Fam	Out of Pocket Ind/Fam	Coinsurance	PCP Visit	Specialist Visit
Blue PPO Platinum 119	$250 / $750	$1,500 / $4,500	80%	$30	$60
Blue PPO Platinum 136	$500 / $1,500	$1,500 / $4,500	90%	$20	$40
Blue PPO Gold 114	$1,000 / $3,000	$7,750 / $18,200	80%	$50	$70
Blue PPO Gold 107	$1,500 / $3,000	$6,250 / $12,500	80%	$40	$60
Blue PPO Gold 116	$2,000 / $6,000	$5,750 / $17,250	90%	$45	$65
Blue PPO Gold 102	$2,500 / $5,000	$5,000 / $10,000	80%	$20	$60
Blue PPO Gold 123	$2,800 / $8,400	$2,800 / $8,400	100%	DC	DC
Blue PPO Gold 101	$4,000 / $12,000	$5,500 / $16,500	100%	$50	$70
Blue PPO Gold 113	$3,200 / $9,600	$3,700 / $11,100	90%	DC	DC
Blue PPO Gold 115	$3,200 / $9,600	$5,250 / $14,000	80%	DC	DC

Silver

Plan Name	Deductible Ind/Fam	Out of Pocket Ind/Fam	Coinsurance	PCP Visit	Specialist Visit
Blue PPO Silver 120	$3,600 / $10,800	$9,100 / $18,200	60%	$60	$80
Blue PPO Silver 104	$5,000 / $15,000	$9,100 / $18,200	70%	$45	$65
Blue PPO Silver 105	$7,900 / $15,800	$9,000 / $18,000	100%	$45	$65
Blue PPO Silver 133	$5,250 / $15,000	$5,250 / $15,000	100%	DC	DC
Blue PPO Silver 200	$6,250 / $12,500	$6,250 / $12,500	100%	DC	DC

Bronze

Plan Name	Deductible Ind/Fam	Out of Pocket Ind/Fam	Coinsurance	PCP Visit	Specialist Visit
Blue PPO Bronze 132	$6,950 / $13,900	$7,300 / $14,600	80%	DC	DC
Blue PPO Bronze 106	$7,200 / $14,400	$7,200 / $14,400	100%	DC	DC
Blue PPO Bronze 401	$7,250 / $14,500	$7,500 / $15,000	70%	DC	DC

2024 BCBSIL Blue Choice Preferred PPO

Platinum & Gold

Plan Name	Deductible Ind/Fam	Out of Pocket Ind/Fam	Coinsurance	PCP Visit	Specialist Visit
Blue Choice Preferred Platinum PPO 119	$250 / $750	$1,500 / $4,500	80%	$30	$60
Blue Choice Preferred Platinum PPO 136	$500 / $1,500	$1,500 / $4,500	80%	$20	$40
Blue Choice Preferred Gold PPO 107	$1,500 / $3,000	$6,250 / $12,500	80%	$40	$40
Blue Choice Preferred Gold PPO 102	$2,500 / $5,000	$5,000 / $10,000	80%	$20	$20
Blue Choice Preferred Gold PPO 101	$4,000 / $12,000	$5,500 / $16,500	100%	$50	$50
Blue Choice Preferred Gold PPO 113	$3,200 / $9,600	$3,700 / $11,100	90%	DC	DC
Blue Choice Preferred Gold PPO 115	$3,200 / $9,600	$5,250 / $14,000	80%	DC	DC

Silver

Plan Name	Deductible Ind/Fam	Out of Pocket Ind/Fam	Coinsurance	PCP Visit	Specialist Visit
Blue Choice Preferred Silver PPO 120	$3,600 / $10,800	$1,500 / $4,500	80%	$60	$80
Blue Choice Preferred Silver PPO 104	$5,000 / $15,000	$1,500 / $4,500	90%	$45	$65
Blue Choice Preferred Silver PPO 105	$7,900 / $15,800	$7,750 / $18,200	80%	$45	$65
Blue Choice Preferred Silver PPO 133	$5,250 / $15,000	$6,250 / $12,500	80%	DC	DC
Blue Choice Preferred Silver PPO 200	$6,250 / $12,500	$5,750 / $17,250	90%	DC	DC

Bronze

Plan Name	Deductible Ind/Fam	Out of Pocket Ind/Fam	Coinsurance	PCP Visit	Specialist Visit
Blue Choice Preferred Bronze PPO 132	$6,950 / $13,900	$7,300 / $14,600	80%	DC	DC
Blue Choice Preferred Bronze PPO 106	$7,200 / $14,400	$7,200 / $14,400	100%	DC	DC
Blue Choice Preferred Bronze PPO 401	$7,250 / $14,500	$7,500 / $15,000	70%	DC	DC

2024 BCBSIL Blue Options PPO

Platinum & Gold

Plan Name	Deductible Ind/Fam	Out of Pocket Ind/Fam	Coinsurance	PCP Visit	Specialist Visit
Blue Options Platinum PPO 403	$250 Tier 1/ $750 Tier 2 \|\| $750 Tier 1/ $2,250 Tier 2	$2,250 Tier 1/ $6,750 Tier 2 \|\| $6,750 Tier 1/ $18,900 Tier 2	90% Tier 1/ 70% Tier 2	$15 Tier 1/ $30 Tier 2	$30 Tier 1/ $60 Tier 2
Blue Options Gold PPO 101	$750 Tier 1/ $2,250 Tier 2 \|\| $2,250 Tier 1/ $6,000 Tier 2	$6,750 Tier 1/ $8,500 Tier 2 \|\| $17,300 Tier 1/ $18,200 Tier 2	80% Tier 1/ 60% Tier 2	$40 Tier 1/ $60 Tier 2	$60 Tier 1/ $100 Tier 2
Blue Options Gold PPO 106	$1,500 Tier 1/ $3,750 Tier 2 \|\| $1,500 Tier 1/ $3,750 Tier 2	$5,850 Tier 1/ $7,850 Tier 2 \|\| $14,650 Tier 1/ $18,200 Tier 2	90% Tier 1/ 70% Tier 2	$35 Tier 1/ $60 Tier 2	$50 Tier 1/ $100 Tier 2
Blue Options Gold PPO 102	$1,500 Tier 1/ $3,750 Tier 2 \|\| $4,000 Tier 1/ $8,500 Tier 2	$4,350 Tier 1/ $7,350 Tier 2 \|\| $9,300 Tier 1/ $18,200 Tier 2	90% Tier 1/ 70% Tier 2	$35 Tier 1/ $60 Tier 2	$50 Tier 1/ $100 Tier 2
Blue Options Gold PPO 200	$3,200 Tier 1/ $4,700 Tier 2 \|\| $9,600 Tier 1/ $14,100 Tier 2	$3,200 Tier 1/ $6,650 Tier 2 \|\| $9,600 Tier 1/ $14,100 Tier 2	100% Tier 1/ 80% Tier 2	DC	DC

Tier 1 refers to the benefit level when using the Blue Choice OPT PPO network, Tier 2 refers to the benefit level when using the PPO network.

Silver

Plan Name	Deductible Ind/Fam	Out of Pocket Ind/Fam	Coinsurance	PCP Visit	Specialist Visit
Blue Options Silver PPO 104	$5,250 Tier 1/ $6,250 Tier 2 \|\| $15,750 Tier 1/ $18,200	$8,150 Tier 1/ $9,100 Tier 2 \|\| $18,200 Tier 1/ $18,200 Tier 2	80% Tier 1/ 60% Tier 2	$50 Tier 1/ $70 Tier 2	$70 Tier 1/ $110 Tier 2
Blue Options Silver PPO 107	$4,800 Tier 1/ $5,500 Tier 2 \|\| $14,000 Tier 1/ $14,300 Tier 2	$4,800 Tier 1/ $7,250 Tier 2 \|\| $14,000 Tier 1/ $14,300 Tier 2	100% Tier 1/ 70% Tier 2	DC	DC
Blue Options Silver PPO 404	$5,250 Tier 1/ $6,250 Tier 2 \|\| $5,250 Tier 1/ $6,250 Tier 2	$5,250 Tier 1/ $7,500 Tier 2 \|\| $13,125 Tier 1/ $15,000 Tier 2	100% Tier 1/ 70% Tier 2	DC	DC

Tier 1 refers to the benefit level when using the Blue Choice OPT PPO network, Tier 2 refers to the benefit level when using the PPO network.

2024 BCBSIL Blue Precision HMO

Platinum & Gold

Plan Name	Deductible Ind/Fam	Out of Pocket Ind/Fam	Coinsurance	PCP Visit	Specialist Visit
Blue Precision Platinum HMO 107	$0 / NC	$0 / NC	100% / NC	$10	$45
Blue Precision Platinum HMO 200	$0 / NC	$0 / NC	100% / NC	$20	$30
Blue Precision Platinum HMO 110	$1,000 / NC \|\| $3,000 / NC	$3,000 / NC \|\| $9,000 / NC	80% / NC	$25	$50
Blue Precision Gold HMO 402	$0 / NC	$0 / NC	80% / NC	$50	$75
Blue Precision Gold HMO 201	$0 / NC	$0 / NC	100% / NC	$50	$70
Blue Precision Gold HMO 101	$2,750 / NC \|\| $8,250/NC	$9,100 / NC \|\| $18,200 / NC	70% / NC	$55	$75

Tier 1 refers to the benefit level when using the Blue Choice OPT PPO network, Tier 2 refers to the benefit level when using the PPO network.

Silver

Plan Name	Deductible Ind/Fam	Out of Pocket Ind/Fam	Coinsurance	PCP Visit	Specialist Visit
Blue Precision Silver HMO 106	$3,250/NC \|\| $9,750/NC	$9,100/NC \|\| $18,200/NC	70% / NC	$30	$60
Blue Precision Silver HMO 102	$7,000/NC \|\| $17,100/NC	$9,100/NC \|\| $18,200/NC	70% / NC	$55	$75

Tier 1 refers to the benefit level when using the Blue Choice OPT PPO network, Tier 2 refers to the benefit level when using the PPO network.