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

204901Standard – Rx Copays
Overall Deductible Individual/Family$750 / $1,500$1,000 / $2,000$1,500 / $3,000
Are there services covered before you meet deductibleYes.Yes.Yes.
Are there other deductibles for specific servicesNo.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

204901Standard – Rx Copays
Primary Care for injury/illness$15/visit$5/visit$30/visit
Specialist visit30%$45$60/visit
Preventative care/screening No ChargeNo ChargeNo Charge
Diagnostic test (xray, blood) Freestanding Facility / Hospital20% / 30%20% / 30%25%
Imaging (CT/PET/MRI) Freestanding Facility / Hospital20% / 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

204901Standard – 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 Preferred35% / 40% 35% / 40%$60 / $180
Specialty Drugs Preferred45%45%$250
Specialty Drugs Non Preferred50%50%$250

 

Outpatient Surgery / Emergency Comparison

204901Standard – Rx Copays
Facility Fee Freestanding20%20%25%
Facility fee Hospital30%30%25%
Physician/surgeon Fee30%30%25%
Emergency Room Care$1,000/visit + 30%$1,000 / visit + 30%25%
Emergency Medical Transportation30%30%25%
Urgent Care$25/visit$45/visit$45/visit

 

Hospital Stay / Health Services / Pregnancy

204901Standard – Rx Copays
Facility Fee for hospital stay$850/visit + 30%$850/visit +30%25%
Physician/surgeon Fees30%30%25%
Mental health, behavioral health, or substance abuse services: Outpatient30% 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 visitPrimary: $15 / Specialist: 30%Primary: $5 / Specialist: $45Primary: $30 / Specialist: $60
Childbirth/delivery/professional services30%30%25%
Childbirth/delivery facility services$850/visit + 30%$850/visit + 30%25%

 

Help recovering / other special needs

204901Standard – Rx Copays
Home Health Care30%30%25%
Rehabilitation Services30%30%$30/visit
Habilitation services30%30%$30/visit
Skilled nursing care30%30%25%
Durable medical equipment30%30%25%
Hospice services30%30%25%

Childrens Dental / Eye care

 

204901Standard – Rx Copays
Children’s eye examNo ChargeNo ChargeNo Charge
Children’s GlassesNo ChargeNo ChargeNo Charge
Children’s Dental check-upNot CoveredNot CoveredNot 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.)

204901Standard – 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.)

204901Standard – Rx Copays
Abortion care ✓ ✓ ✓
Bariatric surgery ✓ ✓ ✓
Chiropractic care ✓ ✓ ✓
Cosmetic surgery ✓ ✓ ✓
Hearing aids ✓ ✓ ✓
Infertility treatment ✓ ✓ ✓
Private-duty nursing ✓ ✓ ✓
Routine Foot Care ✓ ✓ ✓

 

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