Blue Choice Preferred Gold PPO Plans

Blue Cross BlueShield of Illinois
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Blue Choice Preferred Gold PPO Plans

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Blue Choice Preferred Gold PPO Plans offer the same benefits as Blue PPO Gold Plans, but are coupled with the Blue Choice PPO network, a smaller version of the “standard” Blue Cross Blue Shield of Illinois PPO network. If you can accept some reduced hospital and physician choice, Blue Choice Preferred Gold PPO may be a great option for you. All Blue Choice 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. Blue Choice Preferred Gold Plans have a higher monthly premium and often lower out-of-pocket costs than Blue Choice Preferred Silver plans.

There is 1 Blue Choice Preferred Gold PPO Plan:
Blue Choice Preferred PPO Network

The Blue Choice PPO Gold Plans use the Blue Choice network, a smaller PPO network that includes about 50% of doctors and hospitals in Illinois.

Key Blue Choice Preferred Gold® plan features include:
  • $15 copay for primary care office visits
  • $40 copay for specialist office visits
  • 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
Blue Choice Preferred Gold PPO Plans 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

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

Blue Choice 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 Blue Choice 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 Blue Choice Gold® plan will be higher, and your costs lower, when you use the services of participating BlueChoice® PPO providers.
  • Maternity Coverage
  • 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

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 Blue Choice 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