Blue Precision Gold HMO
2024 Blue Precision Gold 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. Gold plans may be for you if you have more health care needs than most, require regular prescription medication, have a spouse/children on your plan or want to grow your family soon, or prefer to pay more each month but have lower out-of-pocket expenses.
Below is a summary of the five Blue Precision Gold Plan Options. Please visit the tabs above to see plan information in detail.
There are 3 Gold HMO plans:
- Blue Precision Gold HMO 207 – $750 individual deductible and 30% coinsurance, $20 PCP
- Blue Precision Gold HMO 703 Rx Copays – $2,000 individual deductible and 30% coinsurance, $40 PCP
- Blue Precision Gold HMO 707 – $1,500 individual deductible and 25% coinsurance, $30 PCP
Key Gold HMO plan features include:
- Lower out-of-pocket costs than PPO plans
- You must select a network primary care physician (PCP), who coordinates your care within the network
- Referral required to see a specialist
- $20-40 doctor visit copayment for primary care physicians (PCPs)
- 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
Learn more about valuable member services and features you get when you join the Blue Cross and Blue Shield of Illinois family.
Blue Precision Gold HMO 207
| Important Questions | Answers | Why this Matters: |
| What is the overall deductible? | Individual: Participating $750 Family: Participating $1,500 |
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 copay mentor 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.comor 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 I 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 the plan’s permission before you see the specialist. |
| Common Medical Event | Services You May Need |
Your cost if you use |
Your cost if you use |
Limitations & Exceptions |
| If you visit a health care provider’s office or clinic | Primary care visit to treat an injury or illness |
$20/visit; deductible does not apply |
Not Covered |
None |
| Specialist visit |
$40/visit; deductible does not apply |
Not Covered |
Referral Required. | |
| Preventive care/screening/immunization |
No Charge; deductible does |
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) |
$40/test; deductible does not apply |
Not Covered |
Referral Required. |
| Imaging (CT / PET scans, MRIs) |
$250/test; deductible does |
Not Covered |
Referral Required. | |
| If you need drugs to treat your illness or condition More information about prescription drug coverage is available here. |
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 |
Not Covered |
||
| Non-preferred specialty drugs |
50% coinsurance |
Not Covered |
||
| If you have outpatient surgery |
Facility fee (e.g., ambulatory surgery center) |
$300/visit plus 30% |
Not Covered |
Referral required. For Outpatient Infusion Therapy, see your benefit booklet* for details. |
| Physician/surgeon fees |
$40/visit; deductible does not apply |
Not Covered |
||
| If you need immediate medical attention |
Emergency room services |
$1,000 copayment/ |
$1,000 copayment/ |
Per occurrence copayment waived upon inpatient admission. |
| Emergency medical transportation |
30% coinsurance |
30% coinsurance |
None | |
| Urgent care |
$40/visit; deductible does not |
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) |
$750/day; deductible does |
Not Covered |
Referral required. |
| Physician/surgeon fee |
No Charge, deductible does not apply |
Not Covered |
||
| If you need mental health, behavioral health, or substance abuse services |
Mental/Behavioral health outpatient services |
$20/office visits; deductible |
Not Covered |
Referral required. Telepsychiatry benefits are available; see your benefit booklet* for details. |
| Mental/Behavioral health inpatient services |
$750/day; deductible does |
Not Covered |
None | |
| If you are pregnant | Office visits |
Primary Care: $20 |
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 |
$750/day |
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 Covered |
Referral required. |
| Rehabilitation services |
$20 /visit; deductible does |
Not Covered |
||
| Habilitation services |
$20/visit; deductible does not |
Not Covered |
||
| Skilled nursing care |
$500/day; deductible does |
Not Covered |
||
| Durable medical equipment |
No Charge; deductible does not apply |
Not Covered |
Referral required. | |
| Hospice service | 30% coinsurance |
Not Covered |
Referral required. | |
| If your child needs dental or eye care |
Eye exam |
No Charge; deductible does |
Not Covered |
One visit per year. See your benefit booklet* for details. |
| Glasses |
No Charge; deductible does |
Not Covered |
One pair of glasses up to age 19 per year. See your benefit booklet* for details. | |
| Dental check-up |
Not Covered |
Not Covered |
None |
Excluded Services & Other Covered Services:
| Services Your Plan Does NOT Cover (This isn’t a complete list. Check your policy or plan document for other excluded services.) |
|
| 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.) |
|
Blue Precision Gold HMO 707
| Important Questions | Answers | Why this Matters: |
| What is the overall deductible? | Individual: Participating $2,000 Family: Participating $4,000 |
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 copay mentor 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 $8,700 Family: Participating $17,400 |
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.comor 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 I 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 the plan’s permission before you see the specialist. |
| Common Medical Event | Services You May Need |
Your cost if you use |
Your cost if you use |
Limitations & Exceptions |
| If you visit a health care provider’s office or clinic | Primary care visit to treat an injury or illness |
$30/visit; deductible does not apply |
Not Covered |
None |
| Specialist visit |
$60/visit; deductible does not apply |
Not Covered |
Referral Required. | |
| Preventive care/screening/immunization |
No Charge; deductible does |
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) |
25% coinsurance |
Not Covered |
Referral Required. |
| Imaging (CT / PET scans, MRIs) |
25% coinsurance |
Not Covered |
Referral Required. | |
| If you need drugs to treat your illness or condition More information about prescription drug coverage is available here. |
Generic drugs |
Retail – $15/prescription |
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 – Preferred – $60/prescription |
Not Covered | ||
| Preferred brand drugs |
Retail – Preferred – $30/prescription |
Not Covered |
||
| Specialty Drugs |
$250/prescription; deductible does not |
Not Covered |
||
| If you have outpatient surgery |
Facility fee (e.g., ambulatory surgery center) |
25% coinsurance |
Not Covered |
Referral required. For Outpatient Infusion Therapy, see your benefit booklet* for details. |
| Physician/surgeon fees |
25% coinsurance |
Not Covered |
||
| If you need immediate medical attention |
Emergency room services |
25% coinsurance |
$1,000 copayment/ |
None |
| Emergency medical transportation |
25% coinsurance |
30% coinsurance |
None | |
| Urgent care |
$45/visit; deductible does not |
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) |
25% coinsurance |
Not Covered |
Referral required. |
| Physician/surgeon fee |
No Charge, deductible does not apply |
Not Covered |
||
| If you need mental health, behavioral health, or substance abuse services |
Mental/Behavioral health outpatient services |
$30/office visits; deductible |
Not Covered |
Telepsychiatry benefits are available; see your benefit booklet* for details. |
| Mental/Behavioral health inpatient services |
25% coinsurance |
Not Covered |
Referral Required | |
| If you are pregnant | Office visits |
Primary Care: $30 |
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 |
25% 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 Covered |
Referral required. |
| Rehabilitation services |
$30 /visit; deductible does |
Not Covered |
||
| Habilitation services |
$30/visit; deductible does not |
Not Covered |
||
| Skilled nursing care |
25% coinsurance |
Not Covered |
||
| Durable medical equipment |
No Charge; deductible does not apply |
Not Covered |
Referral required. | |
| Hospice service | 25% coinsurance |
Not Covered |
Referral required. | |
| If your child needs dental or eye care |
Eye exam |
No Charge; deductible does |
Not Covered |
One visit per year. See your benefit booklet* for details. |
| Glasses |
No Charge; deductible does |
Not Covered |
One pair of glasses up to age 19 per year. See your benefit booklet* for details. | |
| Dental check-up |
Not Covered |
Not Covered |
None |
Excluded Services & Other Covered Services:
| Services Your Plan Does NOT Cover (This isn’t a complete list. Check your policy or plan document for other excluded services.) |
|
| 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.) |
|
Blue Precision Gold HMO 703 rx
| Important Questions | Answers | Why this Matters: |
| What is the overall deductible? | Individual: Participating $2,000 Family: Participating $4,000 |
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 copay mentor 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.comor 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 I 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 the plan’s permission before you see the specialist. |
| Common Medical Event | Services You May Need |
Your cost if you use |
Your cost if you use |
Limitations & Exceptions |
| If you visit a health care provider’s office or clinic | Primary care visit to treat an injury or illness |
$40/visit; deductible does not apply |
Not Covered |
None |
| Specialist visit |
$60/visit; deductible does not apply |
Not Covered |
Referral Required. | |
| Preventive care/screening/immunization |
No Charge; deductible does |
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) |
$40/test; deductible does not apply |
Not Covered |
Referral Required. |
| Imaging (CT / PET scans, MRIs) |
$250/test; deductible does |
Not Covered |
Referral Required. | |
| If you need drugs to treat your illness or condition More information about prescription drug coverage is available here. |
Preferred generic drugs |
Retail – $20/prescription |
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 – $30/prescription |
Not Covered | ||
| Preferred brand drugs |
Retail – $60/prescription |
Not Covered |
||
| Non-preferred brand drugs |
Retail – $120/prescription |
Not Covered |
||
| Preferred specialty drugs |
$250/prescription; deductible does not |
Not Covered |
||
| Non-preferred specialty drugs |
$350/prescription; deductible does not |
Not Covered |
||
| If you have outpatient surgery |
Facility fee (e.g., ambulatory surgery center) |
$300/visit plus 30% |
Not Covered |
Referral required. For Outpatient Infusion Therapy, see your benefit booklet* for details. |
| Physician/surgeon fees |
$40/visit; deductible does not apply |
Not Covered |
||
| If you need immediate medical attention |
Emergency room services |
$1,000 copayment/ |
$1,000 copayment/ |
Per occurrence copayment waived upon inpatient admission. |
| Emergency medical transportation |
30% coinsurance |
30% coinsurance |
None | |
| Urgent care |
$60/visit; deductible does not |
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) |
$750/day; deductible does |
Not Covered |
Referral required. |
| Physician/surgeon fee |
No Charge, deductible does not apply |
Not Covered |
||
| If you need mental health, behavioral health, or substance abuse services |
Mental/Behavioral health outpatient services |
$40/office visits; deductible |
Not Covered |
Telepsychiatry benefits are available; see your benefit booklet* for details. |
| Mental/Behavioral health inpatient services |
$750/day |
Not Covered |
Referral required | |
| If you are pregnant | Office visits |
Primary Care: $40 |
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 |
$750/day |
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 Covered |
Referral required. |
| Rehabilitation services |
$40 /visit; deductible does |
Not Covered |
||
| Habilitation services |
$40/visit; deductible does not |
Not Covered |
||
| Skilled nursing care |
$500/day; deductible does |
Not Covered |
||
| Durable medical equipment |
No Charge; deductible does not apply |
Not Covered |
Referral required. | |
| Hospice service | 30% coinsurance |
Not Covered |
Referral required. | |
| If your child needs dental or eye care |
Eye exam |
No Charge; deductible does |
Not Covered |
One visit per year. See your benefit booklet* for details. |
| Glasses |
No Charge; deductible does |
Not Covered |
One pair of glasses up to age 19 per year. See your benefit booklet* for details. | |
| Dental check-up |
Not Covered |
Not Covered |
None |
Excluded Services & Other Covered Services:
| Services Your Plan Does NOT Cover (This isn’t a complete list. Check your policy or plan document for other excluded services.) |
|
| 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.) |
|
