Blue Precision – Gold 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. Gold plans may be for you if you have more health care needs than most, require regular prescription medication, have a spouse/children on your plan or want to grow your family soon, or prefer to pay more each month but have lower out-of-pocket expenses.
There are 3 Gold HMO plans:
- Blue Precision Gold HMO 207 – $750 individual deductible and 30% coinsurance
- Blue Precision Gold HMO 703 – $1,500 individual deductible and 30% coinsurance
- Blue Precision Gold HMO℠ Standard – Rx Copays (previously 707) – $1,500 individual deductible and 25% coinsurance
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
| 207 | 703 | Gold Standard – Rx Copays | |
| Overall Deductible Individual/Family | $750 / $1,500 | $1,500 / $4,000 | $1,500 / $3,000 |
| 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 | $7,800 / $15,600 |
| 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
| 207 | 703 | Gold Standard – Rx Copays | |
| Primary Care for injury/illness | $20/visit | $15/visit | $30/visit |
| Specialist visit | $40/visit | $60/visit | $60/visit |
| Preventative care/screening | No Charge | No Charge | No Charge |
| Diagnostic test (xray, blood) | $40/test | $30/test | 25% |
| Imaging (CT/PET/MRI) | $250/test | $250/test | 25% |
Generic / Brand / Specialty Drug Comparison
| 207 | 703 | Gold Standard – Rx Copays | |
| Generic Drugs (Preferred) | 10% | No Charge | $15 / $45 |
| Generic Drugs (Non Preferred) | 15% | $20 / $60 | $15 / $45 |
| Brand drugs (Preferred) | 20% | 20% | $30 / $90 |
| Brand Drugs Non Preferred | 30% | 30% | $60 / $180 |
| Specialty Drugs Preferred | 40% | 40% | $250 |
| Specialty Drugs Non Preferred | 50% | 50% | $250 |
Outpatient Surgery / Emergency Comparison
| 207 | 703 | Gold Standard – Rx Copays | |
| Facility Fee Freestanding | $300/visit + 30% | $300/visit + 30% | 25% |
| Facility fee Hospital | NA | NA | NA |
| Physician/surgeon Fee | $40/visit | $30/visit | 25% |
| Emergency Room Care | $1,000/visit + 30% | $1,000/visit + 30% | 25% |
| Emergency Medical Transportation | 30% | 30% | 25% |
| Urgent Care | $40/visit | $60/visit | $45/visit |
Hospital Stay / Health Services / Pregnancy
| 207 | 703 | Gold Standard – Rx Copays | |
| Facility Fee for hospital stay | $750/visit | $750/visit | 25% |
| Physician/surgeon Fees | No Charge | No Charge | No Charge |
| Mental health, behavioral health, or substance abuse services: Outpatient | $20 office / 30% other | $15 office / 30% other | $30 office / 25% other |
| Mental health, behavioral health, or substance abuse services: Inpatient | $750/day | $750/day | 25% |
| If you are pregnant – office visit | Primary: $20 / Specialist: $40 | Primary: $15 / Specialist: $60 | Primary: $30 / Specialist: $60 |
| Childbirth/delivery/professional services | No Charge | No Charge | No Charge |
| Childbirth/delivery facility services | $750/day | $750/day | 25% |
Help recovering / other special needs
| 207 | 703 | Gold Standard – Rx Copays | |
| Home Health Care | No Charge | No Charge | No Charge |
| Rehabilitation Services | $20/visit | $15/visit | $30/visit |
| Habilitation services | $20/visit | $15/visit | $30/visit |
| Skilled nursing care | $500/day | $500/day | 25% |
| Durable medical equipment | No Charge | No Charge | No Charge |
| Hospice services | 30% | 30% | 25% |
Childrens Dental / Eye care
| 207 | 703 | Gold Standard – 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
| 207 | 703 | Gold Standard – 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.)
| 207 | 703 | Gold Standard – 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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