Blue Precision Bronze HMO

Blue Precision Bronze HMO Plans

Our Rating:

The plans below use the Blue Precision HMO network, one the largest HMO networks 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. Bronze plans may be for you if you have fewer medical needs, would rather have a low monthly payment, and don’t take prescription drugs regularly.

Below is a summary of the five Blue Choice Preferred Bronze Plan Options. Please visit the tabs above to see plan information in detail.

There are 3 Bronze HMO plans:

Blue Precision Bronze HMO 205 – $7,400 individual deductible and 50% coinsurance
Blue Precision Bronze HMO 701 Rx Copays – $0 individual deductible and 50% coinsurance
Blue Precision Bronze HMO 708 – $7,500 individual deductible and 50% coinsurance

Blue Precision Bronze HMO 205

2024 Benefit Summary

Important Questions	Answers	Why this Matters:
What is the overall deductible?	Individual: Participating $7,400 Family: Participating $14,800	Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay. If you have other family members on the plan, each family member must meet their own individual deductible until the total amount of deductible expenses paid by all family members meets the overall family deductible
Are there services covered before you meet your deductible?	Yes. In-Network Preventive Health Care services and services with a copay are covered before you meet your deductible.	This plan covers some items and services even if you haven’t yet met the deductible amount. But a copayment or coinsurance may apply. For example, this plan covers certain preventive services without cost-sharing and before you meet your deductible. See a list of covered preventive services at www.healthcare.gov/coverage/preventive-care-benefits/.
Are there other deductibles for specific services?	No	You don’t have to meet deductibles for specific services.
What is the out-of-pocket limit for this plan?	Individual: Participating $9,450 Family: Participating $18,900	The out-of-pocket limit is the most you could pay in a year for covered services. If you have other family members in this plan, they have to meet their own out-of-pocket limits until the overall family out-of-pocket limit has been met.
What is not included in the out-of-pocket limit?	Premiums, balance-billed charges, and health care this plan doesn’t cover.	Even though you pay these expenses, they don’t count toward the out-of-pocket limit.
Will you pay less if you use a network provider?	Yes. See www.bcbsil.com or call 1- 800-892-2803 for a list of Participating Providers.	This plan uses a provider network. You will pay less if you use a provider in the plan’s network. You will pay the most if you use an out-of-network provider, and you might receive a bill from a provider for the difference between the provider’s charge and what your plan pays (balance billing). Be aware your network provider might use an out-of-network provider for some services (such as lab work). Check with your provider before you get services
Do you need a referral to see a specialist?	Yes.	This plan will pay some or all of the costs to see a specialist for covered services but only if you have a referral before you see the specialist.

Common Medical Event	Services You May Need	Your cost if you use a Participating Provider	Your cost if you use a Non-Participating Provider	Limitations & Exceptions
If you visit a health care provider’s office or clinic	Primary care visit to treat an injury or illness	$65/visit; deductible does not apply	Not Covered	None
	Specialist visit	$105/visit; deductible does not apply	Not Covered	Referral Required.

	Preventive care/screening/immunization	No Charge; deductible does not apply	Not Covered	You may have to pay for services that aren’t preventive. Ask your provider if the services needed are preventive. Then check what your plan will pay for.
If you have a test	Diagnostic test (x-ray, blood work)	$100/lab, $150/X-Ray; deductible does not apply	Not Covered	Referral Required.
If you have a test	Imaging (CT / PET scans, MRIs)	$300/test; deductible does not apply	Not Covered	Referral Required.
If you need drugs to treat your illness or condition More information about prescription drug coverage is available at www.bcbsil.com/rx21h	Preferred generic drugs	10% coinsurance	Not Covered	Limited to a 30-day supply at retail (or a 90-day supply at a network of select retail pharmacies). Up to a 90-day supply at mail order. Specialty drugs limited to a 30-day supply. Payment of the difference between the cost of a brand name drug and a generic may also be required if a generic drug is available. You may be eligible to synchronize your prescription refills, please see your benefit booklet* for details Any differences between the cost of the generic drug and the cost of the brand name drug will apply to the deductible or out-of-pocket maximum. The applicable cost sharing (by tier) and the cost difference between the generic and brand will never exceed the overall cost of the drug. The amount you may pay per 30-day supply of a covered insulin drug, regardless of quantity or type, shall not exceed $100, when obtained from a Participating Pharmacy.
	Non-preferred generic drugs	15% coinsurance	Not Covered
	Preferred brand drugs	20% coinsurance	Not Covered
	Non-preferred brand drugs	30% coinsurance	Not Covered
	Preferred specialty drugs	40% coinsurance
	Non-preferred specialty drugs	50% coinsurance
If you have outpatient surgery	Facility fee (e.g., ambulatory surgery center)	$300/visit plus 50% coinsurance	Not Covered	Referral required. For Outpatient Infusion Therapy, see your benefit booklet* for details.
If you have outpatient surgery	Physician/surgeon fees	$150/visit; deductible does not apply	Not Covered
If you need immediate medical attention	Emergency room care	$1,000/visit plus 50% coinsurance	40% coinsurance	Per occurrence copayment waived upon inpatient admission.
	Emergency medical transportation	50% coinsurance	40% coinsurance	None
	Urgent care	$105/visit; deductible does not apply	Not Covered	Must be affiliated with member’s chosen medical group or referral required.
If you have a hospital stay	Facility fee (e.g., hospital room)	$850/day; deductible does not apply	Not Covered	Referral required.
If you have a hospital stay	Physician/surgeon fee	No Charge; deductible does not apply	Not Covered	Referral required.
If you have mental health, behavioral health, or substance abuse needs	Outpatient services	$65/office visits; deductible does not apply 50% coinsurance for other outpatient services	Not Covered	Referral required. Telepsychiatry benefits are available; see your benefit booklet* for details.
	Inpatient services	$850/day; deductible does not apply	Not Covered	Referral required


If you are pregnant	Office visits	Primary Care: $65 Specialist: $105; deductible does not apply	Not Covered	Copay applies to first prenatal visit (per pregnancy). Cost sharing does not apply for preventive services. Depending on the type of services, coinsurance may apply. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound).
	Childbirth/delivery professional services	No Charge deductible does not apply	Not Covered	Copay applies to first prenatal visit (per pregnancy). Cost sharing does not apply for preventive services. Depending on the type of services, coinsurance may apply. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound).
	Childbirth/delivery facility services	$850/day; deductible does not apply	Not Covered	Copay applies to first prenatal visit (per pregnancy). Cost sharing does not apply for preventive services. Depending on the type of services, coinsurance may apply. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound).
If you need help recovering or have other special health needs	Home health care	No Charge; deductible does not apply	Not Covered	Referral required.
	Rehabilitation services	$65 /visit; deductible does not apply	Not Covered
	Habilitation services	$65/visit; deductible does not apply	Not Covered
	Skilled nursing care	$500/day; deductible does not apply	Not Covered
	Durable medical equipment	No Charge; deductible does not apply	Not Covered	Referral required.
	Hospice service	50% coinsurance	Not Covered	Referral required.
If your child needs dental or eye care	Children’s eye exam	No Charge; deductible does not apply	Not Covered	One visit per year. See your benefit booklet* for details.
	Children’s glasses	No Charge; deductible does not apply	Not Covered	One pair of glasses up to age 19 per year. See your benefit booklet* for details.
	Children’s dental check-up	Not Covered	Not Covered	None

Excluded Services & Other Covered Services:

Services Your Plan Generally Does NOT Cover (Check your policy or plan document for more information and a list of any other excluded services.)

Acupuncture
Dental care (Adult)
Long-term care
Non-emergency care when traveling outside the U.S.
Weight loss programs

Other Covered Services (This isn’t a complete list. Check your policy or plan document for other covered services and your costs for these services.)

Abortion care
Bariatric surgery
Chiropractic care (limited to 25 visits per calendar year)
Cosmetic surgery (only for the correction of congenital deformities or conditions resulting from accidental injuries, scars, tumors, or diseases)
Hearing aids (for children 1 per ear every 24 months, for adults up to $2,500 per ear every 24 months)
Infertility treatment (covered for 4 procedures per benefit period)
Private-duty nursing (with the exception of inpatient private duty nursing)
Routine eye care (Adult, 1 visit per benefit period)
Routine foot care (only in connection with diabetes)

Blue Precision Bronze HMO 708

2024 Benefit Summary

Important Questions	Answers	Why this Matters:
What is the overall deductible?	Individual: Participating $7,500 Family: Participating $15,000	Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay. If you have other family members on the plan, each family member must meet their own individual deductible until the total amount of deductible expenses paid by all family members meets the overall family deductible
Are there services covered before you meet your deductible?	Yes. In-Network Preventive Health Care services and services with a copay are covered before you meet your deductible.	This plan covers some items and services even if you haven’t yet met the deductible amount. But a copayment or coinsurance may apply. For example, this plan covers certain preventive services without cost-sharing and before you meet your deductible. See a list of covered preventive services at www.healthcare.gov/coverage/preventive-care-benefits/.
Are there other deductibles for specific services?	No	You don’t have to meet deductibles for specific services.
What is the out-of-pocket limit for this plan?	Individual: Participating $9,400 Family: Participating $18,800	The out-of-pocket limit is the most you could pay in a year for covered services. If you have other family members in this plan, they have to meet their own out-of-pocket limits until the overall family out-of-pocket limit has been met.
What is not included in the out-of-pocket limit?	Premiums, balance-billed charges, and health care this plan doesn’t cover.	Even though you pay these expenses, they don’t count toward the out-of-pocket limit.
Will you pay less if you use a network provider?	Yes. See www.bcbsil.com or call 1- 800-892-2803 for a list of Participating Providers.	This plan uses a provider network. You will pay less if you use a provider in the plan’s network. You will pay the most if you use an out-of-network provider, and you might receive a bill from a provider for the difference between the provider’s charge and what your plan pays (balance billing). Be aware your network provider might use an out-of-network provider for some services (such as lab work). Check with your provider before you get services
Do you need a referral to see a specialist?	Yes.	This plan will pay some or all of the costs to see a specialist for covered services but only if you have a referral before you see the specialist.

Common Medical Event	Services You May Need	Your cost if you use a Participating Provider	Your cost if you use a Non-Participating Provider	Limitations & Exceptions
If you visit a health care provider’s office or clinic	Primary care visit to treat an injury or illness	$50/visit; deductible does not apply	Not Covered	None
	Specialist visit	$100/visit; deductible does not apply	Not Covered	Referral Required.

	Preventive care/screening/immunization	No Charge; deductible does not apply	Not Covered	You may have to pay for services that aren’t preventive. Ask your provider if the services needed are preventive. Then check what your plan will pay for.
If you have a test	Diagnostic test (x-ray, blood work)	50% coinsurance	Not Covered	Referral Required.
If you have a test	Imaging (CT / PET scans, MRIs)	50% coinsurance	Not Covered	Referral Required.
If you need drugs to treat your illness or condition More information about prescription drug coverage is available at www.bcbsil.com/rx21h	Generic drugs	Retail – $25/prescription Mail – $75/prescription; deductible does not apply	Not Covered	Limited to a 30-day supply at retail (or a 90-day supply at a network of select retail pharmacies). Up to a 90-day supply at mail order. Specialty drugs limited to a 30-day supply. Payment of the difference between the cost of a brand name drug and a generic may also be required if a generic drug is available. You may be eligible to synchronize your prescription refills, please see your benefit booklet* for details Any differences between the cost of the generic drug and the cost of the brand name drug will apply to the deductible or out-of-pocket maximum. The applicable cost sharing (by tier) and the cost difference between the generic and brand will never exceed the overall cost of the drug. The amount you may pay per 30-day supply of a covered insulin drug, regardless of quantity or type, shall not exceed $100, when obtained from a Participating Pharmacy.
	Preferred Brand Drugs	Retail – Preferred – $50/prescription Mail – $150/prescription	Not Covered
	Non-Preferred Brand Drugs	Retail – Preferred – $100/prescription Mail – $300/prescription	Not Covered
	Specialty Drugs	$500/prescription	Not Covered


If you have outpatient surgery	Facility fee (e.g., ambulatory surgery center)	50% coinsurance	Not Covered	Referral required. For Outpatient Infusion Therapy, see your benefit booklet* for details.
If you have outpatient surgery	Physician/surgeon fees	50% coinsurance	Not Covered
If you need immediate medical attention	Emergency room care	50% coinsurance	40% coinsurance	Per occurrence copayment waived upon inpatient admission.
	Emergency medical transportation	50% coinsurance	40% coinsurance	None
	Urgent care	$75/visit; deductible does not apply	Not Covered	Must be affiliated with member’s chosen medical group or referral required.
If you have a hospital stay	Facility fee (e.g., hospital room)	50% coinsurance	Not Covered	Referral required.
If you have a hospital stay	Physician/surgeon fee	No Charge; deductible does not apply	Not Covered	Referral required.
If you have mental health, behavioral health, or substance abuse needs	Outpatient services	$50/office visits; deductible does not apply 50% coinsurance for other outpatient services	Not Covered	Referral required. Telepsychiatry benefits are available; see your benefit booklet* for details.
	Inpatient services	50% coinsurance	Not Covered	None


If you are pregnant	Office visits	Primary Care: $50 Specialist: $100; deductible does not apply	Not Covered	Copay applies to first prenatal visit (per pregnancy). Cost sharing does not apply for preventive services. Depending on the type of services, coinsurance may apply. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound).
	Childbirth/delivery professional services	No Charge deductible does not apply	Not Covered	Copay applies to first prenatal visit (per pregnancy). Cost sharing does not apply for preventive services. Depending on the type of services, coinsurance may apply. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound).
	Childbirth/delivery facility services	50% coinsurance	Not Covered	Copay applies to first prenatal visit (per pregnancy). Cost sharing does not apply for preventive services. Depending on the type of services, coinsurance may apply. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound).
If you need help recovering or have other special health needs	Home health care	No Charge; deductible does not apply	Not Covered	Referral required.
	Rehabilitation services	$50 /visit; deductible does not apply	Not Covered
	Habilitation services	$50/visit; deductible does not apply	Not Covered
	Skilled nursing care	50% coinsurance	Not Covered
	Durable medical equipment	No Charge; deductible does not apply	Not Covered	Referral required.
	Hospice service	50% coinsurance	Not Covered	Referral required.
If your child needs dental or eye care	Children’s eye exam	No Charge; deductible does not apply	Not Covered	One visit per year. See your benefit booklet* for details.
	Children’s glasses	No Charge; deductible does not apply	Not Covered	One pair of glasses up to age 19 per year. See your benefit booklet* for details.
	Children’s dental check-up	Not Covered	Not Covered	None

Excluded Services & Other Covered Services:

Services Your Plan Generally Does NOT Cover (Check your policy or plan document for more information and a list of any other excluded services.)

Acupuncture
Dental care (Adult)
Long-term care
Non-emergency care when traveling outside the U.S.
Weight loss programs

Other Covered Services (This isn’t a complete list. Check your policy or plan document for other covered services and your costs for these services.)

Abortion care
Bariatric surgery
Chiropractic care (limited to 25 visits per calendar year)
Cosmetic surgery (only for the correction of congenital deformities or conditions resulting from accidental injuries, scars, tumors, or diseases)
Hearing aids (for children 1 per ear every 24 months, for adults up to $2,500 per ear every 24 months)
Infertility treatment (covered for 4 procedures per benefit period)
Private-duty nursing (with the exception of inpatient private duty nursing)
Routine eye care (Adult, 1 visit per benefit period)
Routine foot care (only in connection with diabetes)

Blue Precision Bronze HMO 701 Rx Copays

2024 Benefit Summary

Important Questions	Answers	Why this Matters:
What is the overall deductible?	$0	Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay. If you have other family members on the plan, each family member must meet their own individual deductible until the total amount of deductible expenses paid by all family members meets the overall family deductible
Are there services covered before you meet your deductible?	Yes. In-Network Preventive Health Care services and services with a copay are covered before you meet your deductible.	This plan covers some items and services even if you haven’t yet met the deductible amount. But a copayment or coinsurance may apply. For example, this plan covers certain preventive services without cost-sharing and before you meet your deductible. See a list of covered preventive services at www.healthcare.gov/coverage/preventive-care-benefits/.
Are there other deductibles for specific services?	No	You don’t have to meet deductibles for specific services.
What is the out-of-pocket limit for this plan?	Individual: Participating $9,450 Family: Participating $18,900	The out-of-pocket limit is the most you could pay in a year for covered services. If you have other family members in this plan, they have to meet their own out-of-pocket limits until the overall family out-of-pocket limit has been met.
What is not included in the out-of-pocket limit?	Premiums, balance-billed charges, and health care this plan doesn’t cover.	Even though you pay these expenses, they don’t count toward the out-of-pocket limit.
Will you pay less if you use a network provider?	Yes. See www.bcbsil.com or call 1- 800-892-2803 for a list of Participating Providers.	This plan uses a provider network. You will pay less if you use a provider in the plan’s network. You will pay the most if you use an out-of-network provider, and you might receive a bill from a provider for the difference between the provider’s charge and what your plan pays (balance billing). Be aware your network provider might use an out-of-network provider for some services (such as lab work). Check with your provider before you get services
Do you need a referral to see a specialist?	Yes.	This plan will pay some or all of the costs to see a specialist for covered services but only if you have a referral before you see the specialist.

Common Medical Event	Services You May Need	Your cost if you use a Participating Provider	Your cost if you use a Non-Participating Provider	Limitations & Exceptions
If you visit a health care provider’s office or clinic	Primary care visit to treat an injury or illness	$150/visit; deductible does not apply	Not Covered	None
	Specialist visit	$160/visit; deductible does not apply	Not Covered	Referral Required.

	Preventive care/screening/immunization	No Charge; deductible does not apply	Not Covered	You may have to pay for services that aren’t preventive. Ask your provider if the services needed are preventive. Then check what your plan will pay for.
If you have a test	Diagnostic test (x-ray, blood work)	$250/test; deductible does not apply	Not Covered	Referral Required.
If you have a test	Imaging (CT / PET scans, MRIs)	$450/test; deductible does not apply	Not Covered	Referral Required.
If you need drugs to treat your illness or condition More information about prescription drug coverage is available at www.bcbsil.com/rx21h	Preferred generic drugs	Retail – $100/prescription Mail – $300/prescription; deductible does not apply	Not Covered	Limited to a 30-day supply at retail (or a 90-day supply at a network of select retail pharmacies). Up to a 90-day supply at mail order. Specialty drugs limited to a 30-day supply. Payment of the difference between the cost of a brand name drug and a generic may also be required if a generic drug is available. You may be eligible to synchronize your prescription refills, please see your benefit booklet* for details Any differences between the cost of the generic drug and the cost of the brand name drug will apply to the deductible or out-of-pocket maximum. The applicable cost sharing (by tier) and the cost difference between the generic and brand will never exceed the overall cost of the drug. The amount you may pay per 30-day supply of a covered insulin drug, regardless of quantity or type, shall not exceed $100, when obtained from a Participating Pharmacy.
	Non-preferred generic drugs	Retail – $110/prescription Mail – $330/prescription; deductible does not apply	Not Covered
	Preferred Brand Drugs	Retail – $120/prescription Mail – $360/prescription; deductible does not apply	Not Covered
	Non-Preferred Brand Drugs	Retail – $175/prescription Mail – $525/prescription; deductible does not apply	Not Covered
	Preferred specialty drugs	$275/prescription; deductible does not apply
	Non-preferred specialty drugs	$500/prescription; deductible does not apply
If you have outpatient surgery	Facility fee (e.g., ambulatory surgery center)	$750/visit plus 50% coinsurance	Not Covered	Referral required. For Outpatient Infusion Therapy, see your benefit booklet* for details.
If you have outpatient surgery	Physician/surgeon fees	$400/visit;	Not Covered
If you need immediate medical attention	Emergency room care	$2,000/visit plus 50% coinsurance	$2,000/visit plus 50% coinsurance	Per occurrence copayment waived upon inpatient admission.
	Emergency medical transportation	50% coinsurance	50% coinsurance	None
	Urgent care	$160/visit	Not Covered	Must be affiliated with member’s chosen medical group or referral required.
If you have a hospital stay	Facility fee (e.g., hospital room)	$1,500/day plus 50% coinsurance	Not Covered	Referral required.
If you have a hospital stay	Physician/surgeon fee	No Charge	Not Covered	Referral required.
If you have mental health, behavioral health, or substance abuse needs	Outpatient services	$150/office visit; 50% coinsurance for other outpatient services	Not Covered	Referral required. Telepsychiatry benefits are available; see your benefit booklet* for details.
	Inpatient services	$1,500/day plus 50% coinsurance	Not Covered	Referral required


If you are pregnant	Office visits	Primary Care: $150 Specialist: $160; deductible does not apply	Not Covered	Copay applies to first prenatal visit (per pregnancy). Cost sharing does not apply for preventive services. Depending on the type of services, coinsurance may apply. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound).
	Childbirth/delivery professional services	No Charge deductible does not apply	Not Covered	Copay applies to first prenatal visit (per pregnancy). Cost sharing does not apply for preventive services. Depending on the type of services, coinsurance may apply. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound).
	Childbirth/delivery facility services	$1,500/day plus 50% coinsurance	Not Covered	Copay applies to first prenatal visit (per pregnancy). Cost sharing does not apply for preventive services. Depending on the type of services, coinsurance may apply. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound).
If you need help recovering or have other special health needs	Home health care	No Charge	Not Covered	Referral required.
	Rehabilitation services	$150/visit; deductible does not apply	Not Covered
	Habilitation services	$150/visit; deductible does not apply	Not Covered
	Skilled nursing care	$800/day	Not Covered
	Durable medical equipment	No Charge; deductible does not apply	Not Covered	Referral required.
	Hospice service	50% coinsurance	Not Covered	Referral required.
If your child needs dental or eye care	Children’s eye exam	No Charge	Not Covered	One visit per year. See your benefit booklet* for details.
	Children’s glasses	No Charge	Not Covered	One pair of glasses up to age 19 per year. See your benefit booklet* for details.
	Children’s dental check-up	Not Covered	Not Covered	None

Excluded Services & Other Covered Services:

Services Your Plan Generally Does NOT Cover (Check your policy or plan document for more information and a list of any other excluded services.)

Acupuncture
Dental care (Adult)
Long-term care
Non-emergency care when traveling outside the U.S.
Weight loss programs

Other Covered Services (This isn’t a complete list. Check your policy or plan document for other covered services and your costs for these services.)

Abortion care
Bariatric surgery
Chiropractic care (limited to 25 visits per calendar year)
Cosmetic surgery (only for the correction of congenital deformities or conditions resulting from accidental injuries, scars, tumors, or diseases)
Hearing aids (for children 1 per ear every 24 months, for adults up to $2,500 per ear every 24 months)
Infertility treatment (covered for 4 procedures per benefit period)
Private-duty nursing (with the exception of inpatient private duty nursing)
Routine eye care (Adult, 1 visit per benefit period)
Routine foot care (only in connection with diabetes)

Plan Name	Individual/Family Deductible	Out of Pocket Max	Coinsurance	PCP/Specialist
Blue Precision Bronze HMO 205	$7,400/$14,800	$9,450/$18,900	50%	$65/$105
Blue Precision Bronze HMO 701 Rx Copays	$0	$9450/$18,900	50%	$150/$160
Blue Precision Bronze HMO 708	$7,500/$15,000	$9,400/$18,800	50%	$50/$100