BCBSIL Platinum HMO Plans – Overview


Blue Cross BlueShield of Illinois
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Platinum HMO Plans

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All Platinum plans offer the same set of essential health benefits, quality and amount of care. The Platinum Plans are the most expensive plans, but also have the most comprehensive benefits. Platinum Plans have a higher monthly premium and often lower out-of-pocket costs than Gold plans. BCBSIL Platinum Plans cover 100% of costs, while you only cover the copays for medical services. There is no deductible for this plan, but this is an HMO plan. You must select a Blue Precision HMO Network Primary Care Physician (PCP) when enrolling in this plan.

There are is only 1 BCBSIL Platinum Plan Option:
PPO Network

The The Platinum HMO Plan uses 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.

Key Platinum ® 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
  • $25 doctor visit copayment for Platinum Plan 004
  • Prescription drug coverage
  • Maternity Coverage
  • Well-adult care
  • Well-child care
  • Diagnostic testing
  • Hospital services
  • Optional dental coverage
Platinum® may be right for you if you are an individual or family who:
  • Are willing to have a primary care physician (PCP) coordinate your care
  • Prefers fixed doctor visit copayments
  • Are expecting to have surgery or major services in the near future and want the lowest out of pocket costs
  • 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 Precision HMO Platinum 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 Platinum® plans:

  • No deductible
  • $25 primary care office visit copaymeny, $45 office visit copayment for specialists
  • $0 or $10 copayments for generic prescription drugs
  • Coinsurance of 100%, only copayments are required
  • Annual out-of-pocket maximum of $1,500 for individuals and $4,500 for families

You must use a contracting BCBS HMO hospital, doctor or specialist for covered services. If you see a doctor or hospital that is not in the HMO netowrk, you will be responsible for all costs with the exception of hospital emergencies.

For more information on costs, get a quick quote or see the benefit summary.

What’s Included with Blue PPO Platinum 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
  • Maternity Coverage

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 Platinum plans, as well as details on policy renewability, benefit exclusions and coverage limitations.

Prescription Drug Coverage

Platinum HMO Plan 004 Prescription Drug Coverage

For the Platinum HMO Plan, there is a prescription drug card benefit that includes a $0 or $10 copay for generic, $50 or $100 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 Platinum Plan 004
Preferred Generics $0 copay
Non-Preferred Generics $10 copay
Preferred Formulary $50 copay
Non-Preferred Formulary $100 copay
Specialty $150 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 Platinum 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

Platinum HMO 104

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Benefit Highlight Blue Precision Platinum HMO 004
Plan Features
Lifetime Maximum Unlimited
Participating providers Blue Precision HMO Network
You must select a network primary care physician
Individual Deductible $0
Family Deductible $0
Coinsurance 100%
Out of Pocket Maximum
Includes deductible
Family Out of Pocket Maximum
Includes deductible
Office Visit Copay (Primary Care/Specialist) $25 / $45 specialist
Medical Coverage Details
Inpatient Hospital Medical / Surgical Services
Hospital Services and Hospital Diagnostic Testing
$150 copay then 100%
Outpatient Surgery $100 copay then 100%
Emergency Room / Outpatient Emergency Care
Physician and Hospital
$300 copay then 100%
Outpatient Hospital Diagnostic Testing $45 copay then 100% coverage
Mental Illness & Substance Abuse Rehab
(Outpatient Hospital/ Physician Care)
$25 copay
Mental Illness & Substance Abuse Treatment
(Inpatient Hospital Care)
$150 copay then 100%
Mental Illness & Substance Abuse Treatment
(Inpatient Physician Care)
100% coverage, no copay
Preventive Care Covered at 100%, no copay
Maternity Coverage $25 copay for prenatal and postnatal care, $150 copay for delivery then 100%
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 Formulary Standard
Cost Reductions
Tax Credit Eligible Yes
Cost Sharing Eligible No
HSA Eligible No
Outline of Coverage