Blue Precision – Bronze HMO Plans – 2024
The plans below use the Blue Precision HMO network, one the largest HMO networks in Illinois. You must select a network primary care physician (PCP), who coordinates your care within the network and referrals are required from your PCP to see a specialists. 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.
Below is a summary of the three Blue Choice Preferred Bronze Plan Options. Please visit the toggles below to see plan information in detail.
There are 3 Bronze HMO plans:
- Blue Precision Bronze HMO 205 – $7,400 individual deductible and 50% coinsurance
- Blue Precision Bronze HMO 701 – $1,500 individual deductible and 50% coinsurance
- Blue Precision Bronze HMO Standard – Select Rx Copays – $7,500 individual deductible and 50% coinsurance
Learn more about valuable member services and features you get when you join the Blue Cross and Blue Shield of Illinois family.
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Deductibles
| 205 | 701 | Standard – Select Rx Copays | |
| Overall Deductible Individual/Family | $7,400 / $14,800 | $1,500 / $3,000 | $7,500 / $15,000 |
| 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 | $9,200 / $18,400 |
| Will you pay less if you use network provider? | Yes. | Yes. | Yes. |
| Referral to see a specialist? | Yes. | Yes. | Yes. |
**Premiums, balance billing & health care this plan doesn’t cover are not included in the out-of-pocket limit
Office Visit / Testing
| 205 | 701 | Standard – Select Rx Copays | |
| Primary Care for injury/illness | $65/visit | $90/visit | $50/visit |
| Specialist visit | $105/visit | $160/visit | $100/visit |
| Preventative care/screening | No Charge | No Charge | No Charge |
| Diagnostic test (xray, blood) | $100/lab, $150/xray | $250/test | 50% |
| Imaging (CT/PET/MRI) | $300/test | $450/test | 50% |
**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
| 205 | 701 | Standard – Select Rx Copays | |
| Generic Drugs (Preferred) | 10% | $40 / $120 | $25 / $75 |
| Generic Drugs (Non Preferred) | 15% | $150 / $450 | $25 / $75 |
| Brand drugs (Preferred) | 20% | 35% | $50 / $150 |
| Brand Drugs Non Preferred | 30% | 40% | $100 / $300 |
| Specialty Drugs Preferred | 40% | 45% | $500 |
| Specialty Drugs Non Preferred | 50% | 50% | $500 |
Outpatient Surgery / Emergency Comparison
| 205 | 701 | Standard – Select Rx Copays | |
| Facility Fee Freestanding | $300/visit + 50% | $750/visit + 50% | 50% |
| Facility fee Hospital | NA | NA | N/A |
| Physician/surgeon Fee | $150/visit | $400/visit | 50% |
| Emergency Room Care | $1,000/visit + 50% | $2,000/visit + 50% | 50% |
| Emergency Medical Transportation | 50% | 50% | 50% |
| Urgent Care | $105/visit | $160/visit | $75/visit |
Hospital Stay / Health Services / Pregnancy
| 205 | 701 | Standard – Select Rx Copays | |
| Facility Fee for hospital stay | $850/visit | $1,500/day + 50% | 50% |
| Physician/surgeon Fees | No Charge | No Charge | No Charge |
| Mental health, behavioral health, or substance abuse services: Outpatient | $65 office, 50% other | $90 office, 50% other | $50 office, 50% other |
| Mental health, behavioral health, or substance abuse services: Inpatient | $850/day | $1,500/day + 50% | 50% |
| If you are pregnant – office visit | Primary: $65 / Specialist: $105 | Primary: $90 / Specialist: $160 | Primary: $50 / Specialist: $100 |
| Childbirth/delivery/professional services | No Charge | No Charge | No Charge |
| Childbirth/delivery facility services | $850/visit | $1,500/day + 50% | 50% |
Help recovering / other special needs
| 205 | 701 | Standard – Select Rx Copays | |
| Home Health Care | No Charge | No Charge | No Charge |
| Rehabilitation Services | $65/visit | $90/visit | $50/visit |
| Habilitation services | $65/visit | $90/visit | $50/visit |
| Skilled nursing care | $500/day | $800/day | 50% |
| Durable medical equipment | No Charge | No Charge | No Charge |
| Hospice services | 50% | 50% | 50% |
Childrens Dental / Eye care
| 205 | 701 | Standard – Select 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.)
| 205 | 701 | Standard – Select Rx Copays | |
| 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.)
| 205 | 701 | Standard – Select Rx Copays | |
| Abortion care | ✓ | ✓ | ✓ |
| Bariatric surgery | ✓ | ✓ | ✓ |
| Chiropractic care | ✓ | ✓ | ✓ |
| Cosmetic surgery | ✓ | ✓ | ✓ |
| Hearing aids | ✓ | ✓ | ✓ |
| Infertility treatment | ✓ | ✓ | ✓ |
| Private-duty nursing | ✓ | ✓ | ✓ |
| Routine eye care | ✓ | ✓ | ✓ |
| Routine Foot Care | ✓ | ✓ | ✓ |
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