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.
Below is a summary of the five Blue Precision Gold Plan Options. Please visit the tabs above to see plan information in detail.
There are 3 Gold HMO plans:
- Blue Precision Gold HMO 207 – $750 individual deductible and 30% coinsurance, $20 PCP
- Blue Precision Gold HMO 703 Rx Copays – $2,000 individual deductible and 30% coinsurance, $40 PCP
- Blue Precision Gold HMO 707 – $1,500 individual deductible and 25% coinsurance, $30 PCP
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 Rx Copays | 707 | |
| Overall Deductible Individual/Family | $750 / $1,500 | $2,000 / $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** | $9,450 / $18,900 | $9,450 / $18,900 | $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
| 207 | 703 Rx Copays | 707 | |
| Primary Care for injury/illness | $20/visit | $40/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 | $40/test | 25% |
| Imaging (CT/PET/MRI) | $250/test | $250/test | 25% |
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
| 207 | 703 Rx Copays | 707 | |
| Generic Drugs (Preferred) | 10% | $20 / $60 | $15 / $45 |
| Generic Drugs (Non Preferred) | 15% | $30 / $90 | $15 / $45 |
| Brand drugs (Preferred) | 20% | $60 / $180 | $30 / $90 |
| Brand Drugs Non Preferred | 30% | $120 / $360 | $60 / $180 |
| Specialty Drugs Preferred | 40% | $250 | $250 |
| Specialty Drugs Non Preferred | 50% | $350 | $250 |
Outpatient Surgery / Emergency Comparison
| 207 | 703 Rx Copays | 707 | |
| Facility Fee Freestanding | $300/visit + 30% | $300/visit + 30% | 25% |
| Facility fee Hospital | NA | NA | NA |
| Physician/surgeon Fee | $40/visit | $40/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 Rx Copays | 707 | |
| Facility Fee for hospital stay | $750/day | $750/day | 25% |
| Physician/surgeon Fees | No Charge | No Charge | No Charge |
| Mental health, behavioral health, or substance abuse services: Outpatient | $20 office / 30% other | $40 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: $40 / 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 Rx Copays | 707 | |
| Home Health Care | No Charge | No Charge | No Charge |
| Rehabilitation Services | $20/visit | $40/visit | $30/visit |
| Habilitation services | $20/visit | $40/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 Rx Copays | 707 | |
| 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.)
| 207 | 703 Rx Copays | 707 | |
| 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 Rx Copays | 707 | |
| 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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