MyBlue Plus POS Silver

Silver | MyBlue Plus Plans

MyBlue Plus POS Silver 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

Silver plans may be for you if you want to pay less out-of-pocket for care, qualify for a premium tax credit (also known as a subsidy), have a spouse/children on your health plan, or have regular medical needs. Below is a quick summary of available plans and what we know so far.

Below is a summary of the four MyBlue Plus POS Silver Plan Options. See toggles below for each plan detail or download the available plan summaries.

    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.

    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

    905906907 (off ex only)Silver Standard – Select Rx Copays
    Overall Deductible Individual/Family$5,000/ $10,000$3,850/ $7,700$1,800/ $3,600$5,000 / $10,000
    Are there services covered before you meet deductibleYes.Yes.Yes.Yes. 
    Are there other deductibles for specific servicesNo.No.No.No. 
    Out-of-pocket limit Individual/Family**$7,850/ $15,700$9,200 / $18,400$8,900/ $17,800$8,000 / $16,000
    Will you pay less if you use network provider?Yes.Yes.Yes.Yes.
    Referral to see a specialist?Yes.Yes.YesYes.

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

    Office Visit / Testing

    905906907 (off ex only)Silver Standard – Select Rx Copays
    Primary Care for injury/illness$65/visit$30/visit$5/visit$40/visit
    Specialist visit$90/visit$45/visit50%$80/visit
    Preventative care/screeningNo ChargeNo ChargeNo ChargeNo Charge
    Diagnostic test (xray, blood) Freestanding / Hospital$90/test40%30% / 50%40%
    Imaging (CT/PET/MRI) Freestanding / Hospital$250/test40%30% / 50%40%

     

    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

    905906907 (off ex only)Silver Standard – Select Rx Copays
    Generic Drugs (Preferred)$5 / $15No Charge$5 / $15$20 / $60 
    Generic Drugs (Non Preferred)$15 / $4510%$15 / $45$20 / $60
    Brand drugs (Preferred)15%20%30%$40 / $120
    Brand Drugs Non Preferred40%30%35%$80 / $240
    Specialty Drugs Preferred45%40%45%$350 
    Specialty Drugs Non Preferred50%50%50%$350

     

    Outpatient Surgery / Emergency Comparison

    905906907 (off ex only)Silver Standard – Select Rx Copays
    Facility Fee$250/visit + 50%40%$600/visit + 30%40%
    Facility fee HospitalNANANANA
    Physician/surgeon Fee$90/visit40%$200/visit + 50%40%
    Emergency Room Care$1,000/visit + 50%40%$950/visit + 50%40%
    Emergency Medical Transportation50%40%50%40%
    Urgent Care$100/visit$45/visit$15/visit$60/visit

     

    Hospital Stay / Health Services / Pregnancy

    905906907 (off ex only)Silver Standard – Select Rx Copays
    Facility Fee for hospital stay$500/visit plus 50% coinsurance40%$850/visit + 50%40%
    Physician/surgeon Fees50%40%50%40%
    Mental health, behavioral health, or substance abuse services: Outpatient$65 office / 50% other$30 office / 40% other50% office / 30% other$40 office / 40% other
    Mental health, behavioral health, or substance abuse services: Inpatient$500/visit + 50%40%$850/visit + 50%40%
    If you are pregnant – office visitPrimary: $65 / Specialist: $90Primary: $30 / Specialist: $45Primary: $50 / Specialist: 50%Primary: $40 / Specialist: $80
    Childbirth/delivery/professional services50%40%50%40%
    Childbirth/delivery facility services$500/visit + 50%40%$850/visit + 50%40%

     

    Help recovering / other special needs

    905906907 (off ex only)Silver Standard – Select Rx Copays
    Home Health Care50%40%50%40%
    Rehabilitation Services$65/visit$30/visit50%$40/visit
    Habilitation services$65/visit$30/visit50%$40/visit
    Skilled nursing care50%40%50%40%
    Durable medical equipment50%40%50%40%
    Hospice services50%40%50%40%

    Childrens Dental / Eye care

     

    905906907 (off ex only)Silver Standard – Select Rx Copays
    Children’s eye examNo ChargeNo ChargeNo ChargeNo Charge
    Children’s GlassesNo ChargeNo ChargeNo ChargeNo Charge
    Children’s Dental check-upNot CoveredNot CoveredNot 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.)

    905906907 (off ex only)Silver Standard – Select 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.)

    905906907 (off ex only)Silver Standard – Select Rx Copays
    Abortion care ✓ ✓ ✓ ✓
    Bariatric surgery ✓ ✓ ✓ ✓
    Chiropractic care ✓ ✓ ✓ ✓
    Cosmetic surgery ✓ ✓ ✓ ✓
    Hearing aids ✓ ✓ ✓ ✓
    Infertility treatment ✓ ✓ ✓ ✓
    Private-duty nursing ✓ ✓ ✓ ✓
    Routine Foot Care ✓ ✓ ✓ ✓

     

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