Blue Choice Preferred Gold Plans

 

 

Blue Choice Preferred Gold PPO Plans

Blue Choice Preferred Gold PPO Plans

Our Rating: Blue Choice Preferred Gold Plans

Blue Choice Preferred Gold PPO Plans offers a respectable PPO network of doctors and hospitals and the convenience of never needing a referral to see a specialist. Blue Choice Preferred PPO Plans are coupled with the Blue Choice Preferred PPO network, a smaller version of the “standard” Blue Cross Blue Shield of Illinois PPO network that is was discontinued beginning January 1st, 2016. If you can accept some reduced hospital and physician choices, Blue Choice Preferred Gold PPO may be a great option for you.

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 PPO Plans have a higher monthly premium and often lower out-of-pocket costs than Blue Choice Preferred Silver plans. The Blue Choice Preferred PPO Gold Plans use the Blue Choice Preferred PPO network, a smaller PPO network that includes about 50% of doctors and hospitals in Illinois.

 Blue Choice Preferred Gold PPO Plans:

Learn more about valuable member services and features you get when you join the Blue Cross and Blue Shield of Illinois family.See toggles below for plan comparisons. Information is based on Participating Providers. For Non-Participating Provider information, please download the plan summaries listed above. 

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Deductibles

204 901 Standard – Rx Copays
Overall Deductible Individual/Family $750 / $1,500 $1,000 / $2,000 $1,500 / $3,000
Are there services covered before you meet deductible Yes. Yes. Yes.
Are there other deductibles for specific services No. No. No.
Out-of-pocket limit Individual/Family** $9,200 / $18,400 $9,200 / $18,400 $8,700 / $17,400
Will you pay less if you use network provider? Yes. Yes. Yes.
Referral to see a specialist? No. No. No.

**Premiums, balance billing & health care this plan doesn’t cover are not included in the out-of-pocket limit

Office Visit / Testing

204 901 Standard – Rx Copays
Primary Care for injury/illness $15/visit $5/visit $30/visit
Specialist visit 30% $45 $60/visit
Preventative care/screening  No Charge No Charge No Charge
Diagnostic test (xray, blood) Freestanding Facility / Hospital 20% / 30% 20% / 30% 25%
Imaging (CT/PET/MRI) Freestanding Facility / Hospital 20% / 30% 20% / 30% 25%

**Premiums, balance billing & health care this plan doesn’t cover are not included in the out-of-pocket limit

Generic / Brand / Specialty Drug Comparison

If you need Drugs to treat your illness or condition. For information on whether or not deductibles apply, please download the plan summaries

204 901 Standard – Rx Copays
Generic Drugs (Preferred) No Charge  $5 / $10 / $15 $15 / $45
Generic Drugs (Non Preferred) $10 / $20 / $30 $10 / $20 / $30 $15 / $45
Brand drugs (Preferred) 20% / 30% $50 / $60 / $150 $30 / $90
Brand Drugs Non Preferred 35% / 40%  35% / 40% $60 / $180
Specialty Drugs Preferred 45% 45% $250
Specialty Drugs Non Preferred 50% 50% $250

 

Outpatient Surgery / Emergency Comparison

204 901 Standard – Rx Copays
Facility Fee Freestanding 20% 20% 25%
Facility fee Hospital 30% 30% 25%
Physician/surgeon Fee 30% 30% 25%
Emergency Room Care $1,000/visit + 30% $1,000 / visit + 30% 25%
Emergency Medical Transportation 30% 30% 25%
Urgent Care $25/visit $45/visit $45/visit

 

Hospital Stay / Health Services / Pregnancy

204 901 Standard – Rx Copays
Facility Fee for hospital stay $850/visit + 30% $850/visit +30% 25%
Physician/surgeon Fees 30% 30% 25%
Mental health, behavioral health, or substance abuse services: Outpatient 30% office / 20% other $5 office / 20% other $30 office / 25% other
Mental health, behavioral health, or substance abuse services: Inpatient $850/visit + 30% $850/visit + 30% 25%
If you are pregnant – office visit Primary: $15 / Specialist: 30% Primary: $5 / Specialist: $45 Primary: $30 / Specialist: $60
Childbirth/delivery/professional services 30% 30% 25%
Childbirth/delivery facility services $850/visit + 30% $850/visit + 30% 25%

 

Help recovering / other special needs

204 901 Standard – Rx Copays
Home Health Care 30% 30% 25%
Rehabilitation Services 30% 30% $30/visit
Habilitation services 30% 30% $30/visit
Skilled nursing care 30% 30% 25%
Durable medical equipment 30% 30% 25%
Hospice services 30% 30% 25%

Childrens Dental / Eye care

 

204 901 Standard – Rx Copays
Children’s eye exam No Charge No Charge No Charge
Children’s Glasses No Charge No Charge No Charge
Children’s Dental check-up Not Covered Not Covered Not Covered

 

Excluded & 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.)

204 901 Standard – Rx Copays
Acupuncture  ✓  ✓  ✓
Dental Care (Adult)  ✓  ✓  ✓
Long-term Care  ✓  ✓  ✓
Non-emergency care when traveling outside of US  ✓  ✓  ✓
Routine eye care (adult)  ✓  ✓  ✓
Weight loss programs  ✓  ✓  ✓

Other Covered Services (Limitations may apply to these services. This isn’t a complete list. Please see your plan document.)

204 901 Standard – Rx Copays
Abortion care  ✓  ✓  ✓
Bariatric surgery  ✓  ✓  ✓
Chiropractic care  ✓  ✓  ✓
Cosmetic surgery  ✓  ✓  ✓
Hearing aids  ✓  ✓  ✓
Infertility treatment  ✓  ✓  ✓
Private-duty nursing  ✓  ✓  ✓
Routine Foot Care  ✓  ✓  ✓

 

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