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Blue PPO Silver Plan 003
Our Rating:
Benefit Highlight | Blue PPO Silver 003 |
---|---|
Plan Features | |
Lifetime Maximum | Unlimited |
Participating providers | PPO Network 90% of IL doctors; over 200 IL hospitals |
Individual Deductible | $6,000 |
Family Deductible | $12,700 |
Coinsurance | 100% |
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 Testing | 100% 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 Care | Covered 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 Formulary | Standard |
Cost Reductions | |
Tax Credit Eligible | Yes |
Cost Sharing Eligible | No |
HSA Eligibile | No |
Outline of Coverage ![]() |
Blue PPO Silver Plan 004
Our Rating:
Benefit Highlight | Blue PPO Silver 004 |
---|---|
Plan Features | |
Lifetime Maximum | Unlimited |
Participating providers | PPO Network 90% of IL doctors; over 200 IL hospitals |
Individual Deductible | $3,000 |
Family Deductible | $9,000 |
Coinsurance | 80% |
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 Testing | 80% 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 Care | Covered 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 Formulary | Standard |
Cost Reductions | |
Tax Credit Eligible | Yes |
Cost Sharing Eligible | No |
HSA Eligibile | No |
Outline of Coverage ![]() |