BlueCare Direct with Advocate Gold Plans
BlueCare Direct. Great Access. More Affordable Coverage.
BlueCare Direct combines the strength, expertise and reputation of two of the state’s most respected leaders in the health industry. Advocate is the largest health system in Illinois, and BCBSIL is the largest health insurer in the state. Advocate is uniquely positioned to deliver quality patient outcomes, while working to manage overall health care costs, with the goal of delivering value to our members. BlueCare may be right for you if you are willing to have a primary care physician (PCP) coordinate your care, prefer or live near an Advocate hospital (Cook, Dupage, Kane, Lake, and Will Counties), are expecting to have surgery or major services in the near future and want the lowest out of pocket costs, or require regular prescription medication.
Gold plans may be for you if you have more health care needs than most, 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.
- BlueCare Direct Gold℠ Standard – Rx Copays with Advocate– $1,500 individual deductible, 25% coinsurance (previously 804)
Compare the features, options and costs of Gold® 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.
Discontinued Plans:
- BlueCare Direct Gold 409 Rx Copays – $2,000 individual deductible, 30% coinsurance, and $40 PCP visit.
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Deductibles
| Gold Standard – Rx Copays with Advocate | |
| What is the overrall deductible? | $1,500 / $3,000 |
| Are there services covered before you meet deductible | Yes. |
| Are there other deductibles for specific services | No. |
| Out-of-pocket limit Individual/Family** | $7,800 / $15,600 |
| Will you pay less if you use network provider? | Yes. |
| Referral to see a specialist? | Yes. |
**Premiums, balance billing & health care this plan doesn’t cover are not included in the out-of-pocket limit
Office Visit / Testing
| Gold Standard – Rx Copays with Advocate | |
| Primary Care for injury/illness | $30/visit |
| Specialist visit | $60/visit |
| Preventative care/screening | No Charge |
| Diagnostic test (xray, blood) Freestanding / Hospital | 25% |
| Imaging (CT/PET/MRI) Freestanding / Hospital | 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
| Gold Standard – Rx Copays with Advocate | |
| Generic Drugs (Preferred) | $15 / $45 |
| Generic Drugs (Non Preferred) | $15 / $45 |
| Brand drugs (Preferred) | $30 / $90 |
| Brand Drugs Non Preferred | $60 / $180 |
| Specialty Drugs Preferred | $250 |
| Specialty Drugs Non Preferred | $250 |
Outpatient Surgery / Emergency Comparison
| Gold Standard – Rx Copays with Advocate | |
| Facility Fee Freestanding | 25% |
| Facility fee Hospital | NA |
| Physician/surgeon Fee | 25% |
| Emergency Room Care | 25% |
| Emergency Medical Transportation | 25% |
| Urgent Care | $45/visit |
Hospital Stay / Health Services / Pregnancy
| Gold Standard – Rx Copays with Advocate | |
| Facility Fee for hospital stay | 25% |
| Physician/surgeon Fees | No Charge |
| Mental health, behavioral health, or substance abuse services: Outpatient | $30/office, 25% other |
| Mental health, behavioral health, or substance abuse services: Inpatient | 25% |
| If you are pregnant – office visit | Primary: $30 / Specialist: $60 |
| Childbirth/delivery/professional services | No Charge |
| Childbirth/delivery facility services | 25% |
Help recovering / other special needs
| Gold Standard – Rx Copays with Advocate | |
| Home Health Care | No Charge |
| Rehabilitation Services | $30/visit |
| Habilitation services | $30/visit |
| Skilled nursing care | 25% |
| Durable medical equipment | No Charge |
| Hospice services | 25% |
Childrens Dental / Eye care
| Gold Standard – Rx Copays with Advocate | |
| Children’s eye exam | No Charge |
| Children’s Glasses | No Charge |
| Children’s Dental check-up | 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.)
| Gold Standard – Rx Copays with Advocate | |
| 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.)
| Gold Standard – Rx Copays with Advocate | |
| 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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