BlueCare Direct with Advocate Bronze

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BlueCare Direct with Advocate Bronze Plans

Chicago-area residents now have a new choice for health care coverage. Blue Cross and Blue Shield of Illinois (BCBSIL) has teamed up with Advocate Health Care* to offer a new, more affordable health plan — BlueCare Direct.

BlueCare Direct. Great Access. More Affordable Coverage.

BlueCare Direct combines the strength, expertise and reputation of two of the state’s most respected leaders in the health industry. Advocate is the largest health system in Illinois, and BCBSIL is the largest health insurer in the state. Advocate is uniquely positioned to deliver quality patient outcomes, while working to manage overall health care costs, with the goal of delivering value to our members. BlueCare may be right for you if you are willing to have a primary care physician (PCP) coordinate your care, prefer or live near an Advocate hospital (Cook, Dupage, Kane, Lake, and Will Counties), are expecting to have surgery or major services in the near future and want the lowest out of pocket costs, or require regular prescription medication.

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.

BlueCare Direct Bronze℠ Standard – Select Rx Copays with Advocate – $7,500 individual deductible, 50% coinsurance (Previously 802)

Compare the features, options and costs of Bronze® plans to find the one that’s right for you.

Learn more about valuable member services and features you get when you join the Blue Cross and Blue Shield of Illinois family.

Discontinued Plan:

BlueCare Direct Bronze 401 – $0 individual deductible, 50% coinsurance, and $150 PCP visit.

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

	Standard – Select Rx Copays with Advocate
Overall Deductible Individual/Family	$7,500 / $15,000
Are there services covered before you meet deductible	Yes.
Are there other deductibles for specific services	No.
Out-of-pocket limit Individual/Family**	$9,200 / $18,400
Will you pay less if you use network provider?	Yes.
Referral to see a specialist?	Yes.

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

Office Visit / Testing

	Standard – Select Rx Copays with Advocate
Primary Care for injury/illness	$50/visit
Specialist visit	$100/visit
Preventative care/screening	No Charge
Diagnostic test (xray, blood) Freestanding / Hospital	50%
Imaging (CT/PET/MRI) Freestanding / Hospital	50%

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

	Standard – Select Rx Copays with Advocate
Generic Drugs (Preferred)	$25 / $75
Generic Drugs (Non Preferred)	$50 / $150
Brand drugs (Preferred)	$100 / $300
Brand Drugs Non Preferred	$100 / $300
Specialty Drugs Preferred	$500
Specialty Drugs Non Preferred	$500

Outpatient Surgery / Emergency Comparison

	Standard – Select Rx Copays with Advocate
Facility Fee Freestanding	50%
Facility fee Hospital	50%
Physician/surgeon Fee	50%
Emergency Room Care	50%
Emergency Medical Transportation	50%
Urgent Care	$75/visit

Hospital Stay / Health Services / Pregnancy

	Standard – Select Rx Copays with Advocate
Facility Fee for hospital stay	50%
Physician/surgeon Fees	No Charge
Mental health, behavioral health, or substance abuse services: Outpatient	$50 office, 50% other
Mental health, behavioral health, or substance abuse services: Inpatient	50%
If you are pregnant – office visit	Primary: $50 / Specialist: $100
Childbirth/delivery/professional services	No Charge
Childbirth/delivery facility services	50%

Help recovering / other special needs

	Standard – Select Rx Copays with Advocate
Home Health Care	No Charge
Rehabilitation Services	$50/visit
Habilitation services	$50/visit
Skilled nursing care	50%
Durable medical equipment	No Charge
Hospice services	50%

Childrens Dental / Eye care

	Standard – Select Rx Copays with Advocate
Children’s eye exam	No Charge
Children’s Glasses	No Charge
Children’s Dental check-up	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.)

	Standard – Select Rx Copays with Advocate
Acupuncture	✓
Dental Care (Adult)	✓
Long-term Care	✓
Non-emergency care when traveling outside of US	✓
Weight loss programs	✓

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

	Standard – Select Rx Copays with Advocate
Abortion care	✓
Bariatric surgery	✓
Chiropractic care	✓
Cosmetic surgery	✓
Hearing aids	✓
Infertility treatment	✓
Private-duty nursing	✓
Routine eye care	✓
Routine Foot Care	✓

BlueCare Direct with Advocate Bronze