Blue PPO Silver Plans


Blue Cross BlueShield of Illinois
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Blue PPO Silver Plans

Blue PPO Silver Plan 003

Our Rating: Blue PPO Silver Plans

Benefit HighlightBlue PPO Silver 003
Plan Features
Lifetime MaximumUnlimited
Participating providersPPO Network
90% of IL doctors; over 200 IL hospitals
Individual Deductible$6,000
Family Deductible$12,700
Coinsurance100%
Out of Pocket Maximum
Includes deductible
$6,000
Family Out of Pocket Maximum
Includes deductible
$12,700
Office Visit Copay (Primary Care/Specialist)$30 / $50 specialist
Medical Coverage Details
Inpatient Hospital Medical / Surgical Services
Hospital Services and Hospital Diagnostic Testing
$250 copay then 100% after deductible
Outpatient Surgery$200 copay then 100% after deductible
Emergency Room / Outpatient Emergency Care
Physician and Hospital
$500 copay then 100% after deductible
Outpatient Hospital Diagnostic Testing100% after deductible
Mental Illness & Substance Abuse Rehab
(Outpatient Hospital/ Physician Care)
$30 copay
Mental Illness & Substance Abuse Treatment
(Inpatient Hospital Care)
$250 copay then 100% coinsurance after deductible
Mental Illness & Substance Abuse Treatment
(Inpatient Physician Care)
100% after deductible
Preventive CareCovered at 100%, no copay
Maternity Coverage$250 copay then 100% after deductible
Prescription Drugs
Preferred Generics$0 copay
Non Preferred Generics$10 copay
Preferred Formulary$50 copay
Non-Preferred Formulary$100 copay
Specialty$150 copay
Prescription Drug FormularyStandard
Cost Reductions
Tax Credit EligibleYes
Cost Sharing EligibleNo
HSA EligibileNo
Outline of Coverage PDF icon

Blue PPO Silver Plans

Blue PPO Silver Plan 004

Our Rating: Blue PPO Silver Plans

Benefit HighlightBlue PPO Silver 004
Plan Features
Lifetime MaximumUnlimited
Participating providersPPO Network
90% of IL doctors; over 200 IL hospitals
Individual Deductible$3,000
Family Deductible$9,000
Coinsurance80%
Out of Pocket Maximum
Includes deductible
$6,350
Family Out of Pocket Maximum
Includes deductible
$12,700
Office Visit Copay (Primary Care/Specialist)$30 / $50 specialist
Medical Coverage Details
Outpatient Surgery$200 copay then 80% after deductible
Inpatient Hospital Medical / Surgical Services
Hospital Services and Hospital Diagnostic Testing
$250 copay then 80% after deductible
Emergency Room / Outpatient Emergency Care
Physician and Hospital
$500 copay then 80% after deductible
Outpatient Hospital Diagnostic Testing80% after deductible
Mental Illness & Substance Abuse Rehab
(Outpatient Hospital/ Physcian Care)
$30 copay
Mental Illness & Substance Abuse Treatment
(Inpatient Hospital Care)
$250 copay then 80% coinsurance after deductible
Mental Illness & Substance Abuse Treatment
(Inpatient Physician Care)
80% coinsurance after deductible
Preventive CareCovered at 100%, no copay
Maternity Coverage$200 copay then 80% after deductible
Prescription Drugs
Preferred Generics$0 copay
Non Preferred Generics$10 copay
Preferred Formulary$50 copay
Non-Preferred Formulary$100 copay
Specialty$150 copay
Prescription Drug FormularyStandard
Cost Reductions
Tax Credit EligibleYes
Cost Sharing EligibleNo
HSA EligibileNo
Outline of Coverage PDF icon