BlueCare Direct with Advocate Gold

 

BlueCare Direct Gold

BlueCare Direct with Advocate Gold Plans

 Chicago-area residents now have a new choice for health care coverage. Blue Cross and Blue Shield of Illinois (BCBSIL) has teamed up with Advocate Health Care* to offer a new, more affordable health plan — BlueCare Direct.

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. 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.

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

409 Rx Copays804
What is the overrall deductible?$2,000 / $4,000$1,500 / $3,000
Are there services covered before you meet deductibleYes.Yes.
Are there other deductibles for specific servicesNo.No.
Out-of-pocket limit Individual/Family**$9,450 / $18,900$8,700 / $17,400
Will you pay less if you use network provider?Yes.Yes.
Referral to see a specialist?No.No.

**Premiums, balance billing & health care this plan doesn’t cover are not included in the out-of-pocket limit

Office Visit / Testing

409 Rx Copays804
Primary Care for injury/illness$40/visit$30/visit
Specialist visit$60/visit$60/visit
Preventative care/screeningNo ChargeNo Charge
Diagnostic test (xray, blood) Freestanding / Hospital$40/test25%
Imaging (CT/PET/MRI) Freestanding / Hospital$250/test25%

 

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

409 Rx Copays804
Generic Drugs (Preferred)$20 / $60$15 / $45
Generic Drugs (Non Preferred)$30 / $90$15 / $45
Brand drugs (Preferred)$60 / $180$30 / $90
Brand Drugs Non Preferred$120 / $360$60 / $180
Specialty Drugs Preferred$250$250
Specialty Drugs Non Preferred$350$250
 

Outpatient Surgery / Emergency Comparison

409 Rx Copays804
Facility Fee Freestanding$300/visit + 30%25%
Facility fee HospitalNANA
Physician/surgeon Fee$40/visit 25%
Emergency Room Care$1,000/visit + 30%25%
Emergency Medical Transportation30%25%
Urgent Care$60/visit$45/visit

 

Hospital Stay / Health Services / Pregnancy

409 Rx Copays804
Facility Fee for hospital stay$750/day25%
Physician/surgeon FeesNo ChargeNo Charge
Mental health, behavioral health, or substance abuse services: Outpatient$40/office, 30% other$30/office, 25% other
Mental health, behavioral health, or substance abuse services: Inpatient$750/day25%
If you are pregnant – office visitPrimary: $40 / Specialist: $60Primary: $30 / Specialist: $60
Childbirth/delivery/professional servicesNo ChargeNo Charge
Childbirth/delivery facility services$750/day25%

 

Help recovering / other special needs

409 Rx Copays804
Home Health CareNo ChargeNo Charge
Rehabilitation Services$40/visit$30/visit
Habilitation services$40/visit$30/visit
Skilled nursing care$500/day25%
Durable medical equipmentNo ChargeNo Charge
Hospice services30%25%

Childrens Dental / Eye care

 

409 Rx Copays804
Children’s eye examNo ChargeNo Charge
Children’s GlassesNo ChargeNo Charge
Children’s Dental check-upNot CoveredNot 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.)

409 Rx Copays804
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.)
409 Rx Copays804
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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