Blue Choice Preferred Silver PPO Plans
Blue Choice Preferred Silver 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 and the largest PPO network BCBSIL offers to individual health plans. If you can accept some reduced hospital and physician choice, Blue Choice Preferred Silver PPO may be a great option for you. All Blue Choice Preferred Silver PPO plans offer the same set of essential health benefits, quality and amount of care.
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 Silver 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 Silver Plans use the Blue Choice Preferred PPO network, a smaller PPO network that includes about 68% of doctors and hospitals in Illinois.
Below is a summary of the four Blue Choice Preferred Silver Plan Options. See toggles below for each plan detail or download the available plan summaries.
- Blue Choice Preferred Silver Plan 203 – $1,700 individual deductible and 50% coinsurance
- Blue Choice Preferred Silver Plan 303 – $1,500 individual deductible and 50% coinsurance
- Blue Choice Preferred Silver PPO℠ Standard – Select Rx (previously 706) – $5,000 individual deductible and 50% coinsurance
- Blue Choice Preferred Silver Plan 801 – $4,300 individual deductible and 50% coinsurance
Compare the features, options and costs of Blue Choice Preferred Silver® PPO 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.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
| 203 | 303 | 801 | Standard – Select Rx | |
| Overall Deductible Individual/Family | $1,700 / $3,400 | $1,500/ $3,000 | $4,300 / $8,600 | $5,000 / $10,000 |
| Are there services covered before you meet deductible | Yes. | Yes. | Yes. | Yes. |
| Are there other deductibles for specific services | No. | No. | No. | No. |
| Out-of-pocket limit Individual/Family** | $8,900/ $17,800 | $8,900/ $17,800 | $9,200 / $18,400 | $8,000 / $16,000 |
| Will you pay less if you use network provider? | Yes. | Yes. | Yes. | Yes. |
| Referral to see a specialist? | No. | 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
| 203 | 303 | 801 | Standard – Select Rx | |
| Primary Care for injury/illness | $5/visit | $10/visit | $30/visit | $40/visit |
| Specialist visit | 50% | 50% | $40/visit | $80/visit |
| Preventative care/screening | No Charge | No Charge | No Charge | No Charge |
| Diagnostic test (xray, blood) Freestanding / Hospital | 30% / 50% | 30% / 50% | 30% / 40% | 40% |
| Imaging (CT/PET/MRI) Freestanding / Hospital | 30% / 50% | 30% / 50% | 30% / 40% | 40% |
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
| 203 | 303 | 801 | Standard – Select Rx | |
| Generic Drugs (Preferred) | $5/$10/$15 | $5/$10/$15 | $10/$10/$30 | $20/$60 |
| Generic Drugs (Non Preferred) | $15/$25/$45 | $15/$25/$45 | $65/$65/$195 | $20/$60 |
| Brand drugs (Preferred) | 30% / 35% | 30% / 35% | 30% / 30% | $40/$120 |
| Brand Drugs Non Preferred | 35% / 40% | 35% / 40% | 35% / 35% | $80/ $240 |
| Specialty Drugs Preferred | 45% | 45% | 45% | $350 |
| Specialty Drugs Non Preferred | 50% | 50% | 50% | $350 |
Outpatient Surgery / Emergency Comparison
| 203 | 303 | 801 | Standard – Select Rx | |
| Facility Fee Freestanding | $900/visit + 30% | $600/visit + 30% | 30% | 40% |
| Facility fee Hospital | $900/visit + 50% | $600/visit + 50% | 40% | 40% |
| Physician/surgeon Fee | $750/visit + 50% | $200/visit + 50% | 40% | 40% |
| Emergency Room Care | $1,000/visit + 50% | $1,000/visit + 50% | 40% | 40% |
| Emergency Medical Transportation | 50% | 50% | 40% | 40% |
| Urgent Care | $15/visit | $15/visit | $40/visit | $40/visit |
Hospital Stay / Health Services / Pregnancy
| 203 | 303 | 801 | Standard – Select Rx | |
| Facility Fee for hospital stay | $900/visit + 50% | $850/visit + 50% | 40% | 40% |
| Physician/surgeon Fees | 50% | 50% | 40% | 40% |
| Mental health, behavioral health, or substance abuse services: Outpatient | 50% office / 30% other | 50% office / 30% other | $40/office / 40% other | $40/office / 40% other |
| Mental health, behavioral health, or substance abuse services: Inpatient | $900/visit + 50% | $850/visit + 50% | 40% | 40% |
| If you are pregnant – office visit | Primary: $5 / Specialist: 50% | Primary: $10 / Specialist: 50% | Primary: $30 / Specialist: $40 | Primary: $40 / Specialist: $80 |
| Childbirth/delivery/professional services | 50% | 50% | 40% | 40% |
| Childbirth/delivery facility services | $900/visit + 50% | $850/visit + 50% | 40% | 40% |
Help recovering / other special needs
| 203 | 303 | 801 | Standard – Select Rx | |
| Home Health Care | 50% | 50% | 40% | 40% |
| Rehabilitation Services | 50% | 50% | 40% | $40/visit |
| Habilitation services | 50% | 50% | 40% | $40/visit |
| Skilled nursing care | 50% | 50% | 40% | 40% |
| Durable medical equipment | 50% | 50% | 40% | 40% |
| Hospice services | 50% | 50% | 40% | 40% |
Childrens Dental / Eye care
| 203 | 303 | 801 | Standard – Select Rx | |
| Children’s eye exam | No Charge | No Charge | No Charge | No Charge |
| Children’s Glasses | No Charge | No Charge | No Charge | No Charge |
| Children’s Dental check-up | Not Covered | 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.)
| 203 | 303 | 801 | Standard – Select Rx | |
| 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.)
| 203 | 303 | 801 | Standard – Select Rx | |
| Abortion care | ✓ | ✓ | ✓ | ✓ |
| Bariatric surgery | ✓ | ✓ | ✓ | ✓ |
| Chiropractic care | ✓ | ✓ | ✓ | ✓ |
| Cosmetic surgery | ✓ | ✓ | ✓ | ✓ |
| Hearing aids | ✓ | ✓ | ✓ | ✓ |
| Infertility treatment | ✓ | ✓ | ✓ | ✓ |
| Private-duty nursing | ✓ | ✓ | ✓ | ✓ |
| Routine Foot Care | ✓ | ✓ | ✓ | ✓ |
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