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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.
- BlueCare Direct Gold Standard – Rx Copays with Advocate– $2,000 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? | $2,000 / $4,000 |
| Are there services covered before you meet deductible | Yes. |
| Are there other deductibles for specific services | No. |
| Out-of-pocket limit Individual/Family** | $8,200 / $16,400 |
| Will you pay less if you use network provider? | Yes. |
| Referral to see a specialist? | Yes. |
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
| 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
| Gold Standard – Rx Copays with Advocate | |
| Acupuncture | Not Covered |
| Dental Care (Adult) | Not Covered |
| Long-term Care | Not Covered |
| Non-emergency care when traveling outside of US | Not Covered |
| Weight loss programs | Not Covered |
| Gold Standard – Rx Copays with Advocate | |
| Abortion care | Covered |
| Bariatric surgery | Covered |
| Chiropractic care | Covered. Chiropractic and osteopathic manipulation limited to 25 visits per calendar year |
| Cosmetic surgery | Covered when medically necessary |
| Hearing aids | Covered. Limit 1 per ear every 24 months |
| Infertility treatment | Covered. Limit 4 procedures per benefit period |
| Private-duty nursing | Not covered, with the exception of inpatient private-duty nursing |
| Routine eye care | Covered. Adult, 1 visit per benefit period |
| Routine Foot Care | Covered when medically necessary |
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