MyBlue Plus POS Gold Plans
Due to CMS limits on the number of products offered by insurance carriers, BCBSIL will be discontinuing BlueFocus Care HMO and will instead launch a new POS product offering, MyBlue Plus. This new network offers a low-cost solution for cost-conscious members who purchase health insurance through state and federal marketplaces. Highlights of MyBlue Plus POS include:
- Claims processing and health care management through Blue Cross and Blue Shield of Illinois
- Primary care provider election assigned at the individual provider level
- Referrals required to access in-network benefits, except for PCP services
- Out-of-network benefit to provide additional access to care
- Service area: Cook, DuPage, Kane, Kankakee and Will counties
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. Below is a quick summary of available plans and what we know so far.
Below is a summary of the three MyBlue Plus POS Gold Plan Options. See toggles below for each plan detail or download the available plan summaries.
- MyBlue Plus Gold 910 – $250 individual deductible, and 40% coinsurance
- MyBlue Plus Gold 909 – $1,500 individual deductible, and 30% coinsurance
- MyBlue Plus Gold Standard – Rx Copays – $1,500 individual deductible, $7,800 Out of Pocket Max, and 25% coinsurance
Compare the features, options and costs of Bronze® 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.
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Deductibles
909 | 910 | Gold Standard – Rx Copays | |
Overall Deductible Individual/Family | $1,500/ $3,000 | $250 / $500 | $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 | $7,500 / $15,000 | $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
909 | 910 | Gold Standard – Rx Copays | |
Primary Care for injury/illness | $15/visit | 20% | $30/visit |
Specialist visit | $60/visit | 40% | $60/visit |
Preventative care/screening | No Charge | No Charge | No Charge |
Diagnostic test (xray, blood) Freestanding / Hospital | $30/test | 40% | 25% |
Imaging (CT/PET/MRI) Freestanding / Hospital | $250/test | 40% | 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
909 | 910 | Gold Standard – Rx Copays | |
Generic Drugs (Preferred) | No charge | 10% | $15 / $45 |
Generic Drugs (Non Preferred) | $20 / $60 | 20% | $15 / $45 |
Brand drugs (Preferred) | 20% | 30% | $30 / $90 |
Brand Drugs Non Preferred | 30% | 35% | $80 / $240 |
Specialty Drugs Preferred | 40% | 45% | $250/prescription |
Specialty Drugs Non Preferred | 50% | 50% | $250/prescription |
Outpatient Surgery / Emergency Comparison
909 | 910 | Gold Standard – Rx Copays | |
Facility Fee | $300/visit + 30% | $600/visit + 40% | 25% |
Facility fee Hospital | NA | NA | NA |
Physician/surgeon Fee | $30/visit | $200/visit + 40% | 25% |
Emergency Room Care | $1,000/visit + 30% | $1,000/visit + 40% | 25% |
Emergency Medical Transportation | 30% | 40% | 25% |
Urgent Care | $60/visit | $45/visit | $45/visit |
Hospital Stay / Health Services / Pregnancy
909 | 910 | Gold Standard – Rx Copays | |
Facility Fee for hospital stay | $750/visit | $850/visit + 40% | 25% |
Physician/surgeon Fees | 30% | 40% | 25% |
Mental health, behavioral health, or substance abuse services: Outpatient | $15 office / 30% other | 20% office / 40% other | $30/office / 25% other |
Mental health, behavioral health, or substance abuse services: Inpatient | $750/visit | $850/visit + 40% | 25% |
If you are pregnant – office visit | Primary: $15 / Specialist: $60 | Primary: 20%/ Specialist: 40% | Primary: $30 / Specialist: $60 |
Childbirth/delivery/professional services | 30% | 40% | 25% |
Childbirth/delivery facility services | $750/visit | $850/visit + 40% | 25% |
Help recovering / other special needs
909 | 910 | Gold Standard – Rx Copays | |
Home Health Care | 30% | 40% | 25% |
Rehabilitation Services | $15/visit | 40% | $30/visit |
Habilitation services | $15/visit | 40% | $30/visit |
Skilled nursing care | $500/day | 40% | 25% |
Durable medical equipment | 30% | 40% | 25% |
Hospice services | 30% | 40% | 25% |
Childrens Dental / Eye care
909 | 910 | 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
Services Your Plan Generally Does NOT Cover (Check your policy or plan document for more information and a list of any other excluded services.)
909 | 910 | Gold Standard – Rx Copays | |
Acupuncture | ✓ | ✓ | |
Dental Care (Adult) | ✓ | ✓ | |
Long-term Care | ✓ | ✓ | |
Non-emergency care when traveling outside of US | ✓ | ✓ | |
Routine eye care (adult) | ✓ | ✓ | |
Weight loss programs | ✓ | ✓ |
Other Covered Services (Limitations may apply to these services. This isn’t a complete list. Please see your plan document.)
909 | 910 | Gold Standard – Rx Copays | |
Abortion care | ✓ | ✓ | ✓ |
Bariatric surgery | ✓ | ✓ | ✓ |
Chiropractic care | ✓ | ✓ | ✓ |
Cosmetic surgery | ✓ | ✓ | ✓ |
Hearing aids | ✓ | ✓ | ✓ |
Infertility treatment | ✓ | ✓ | ✓ |
Private-duty nursing | ✓ | ✓ | ✓ |
Routine Foot Care | ✓ | ✓ | ✓ |
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