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2024 Small Group Plan Summaries
2024 BCBSIL Blue PPO
Platinum & Gold
Plan Name | Deductible Ind/Fam | Out of Pocket Ind/Fam | Coinsurance | PCP Visit | Specialist Visit |
Blue PPO Platinum 119 | $250 / $750 | $1,500 / $4,500 | 80% | $30 | $60 |
Blue PPO Platinum 136 | $500 / $1,500 | $1,500 / $4,500 | 90% | $20 | $40 |
Blue PPO Gold 114 | $1,000 / $3,000 | $7,750 / $18,200 | 80% | $50 | $70 |
Blue PPO Gold 107 | $1,500 / $3,000 | $6,250 / $12,500 | 80% | $40 | $60 |
Blue PPO Gold 116 | $2,000 / $6,000 | $5,750 / $17,250 | 90% | $45 | $65 |
Blue PPO Gold 102 | $2,500 / $5,000 | $5,000 / $10,000 | 80% | $20 | $60 |
Blue PPO Gold 123 | $2,800 / $8,400 | $2,800 / $8,400 | 100% | DC | DC |
Blue PPO Gold 101 | $4,000 / $12,000 | $5,500 / $16,500 | 100% | $50 | $70 |
Blue PPO Gold 113 | $3,200 / $9,600 | $3,700 / $11,100 | 90% | DC | DC |
Blue PPO Gold 115 | $3,200 / $9,600 | $5,250 / $14,000 | 80% | DC | DC |
Silver
Plan Name | Deductible Ind/Fam | Out of Pocket Ind/Fam | Coinsurance | PCP Visit | Specialist Visit |
Blue PPO Silver 120 | $3,600 / $10,800 | $9,100 / $18,200 | 60% | $60 | $80 |
Blue PPO Silver 104 | $5,000 / $15,000 | $9,100 / $18,200 | 70% | $45 | $65 |
Blue PPO Silver 105 | $7,900 / $15,800 | $9,000 / $18,000 | 100% | $45 | $65 |
Blue PPO Silver 133 | $5,250 / $15,000 | $5,250 / $15,000 | 100% | DC | DC |
Blue PPO Silver 200 | $6,250 / $12,500 | $6,250 / $12,500 | 100% | DC | DC |
Bronze
Plan Name | Deductible Ind/Fam | Out of Pocket Ind/Fam | Coinsurance | PCP Visit | Specialist Visit |
Blue PPO Bronze 132 | $6,950 / $13,900 | $7,300 / $14,600 | 80% | DC | DC |
Blue PPO Bronze 106 | $7,200 / $14,400 | $7,200 / $14,400 | 100% | DC | DC |
Blue PPO Bronze 401 | $7,250 / $14,500 | $7,500 / $15,000 | 70% | DC | DC |
2024 BCBSIL Blue Choice Preferred PPO
Platinum & Gold
Plan Name | Deductible Ind/Fam | Out of Pocket Ind/Fam | Coinsurance | PCP Visit | Specialist Visit |
Blue Choice Preferred Platinum PPO 119 | $250 / $750 | $1,500 / $4,500 | 80% | $30 | $60 |
Blue Choice Preferred Platinum PPO 136 | $500 / $1,500 | $1,500 / $4,500 | 80% | $20 | $40 |
Blue Choice Preferred Gold PPO 107 | $1,500 / $3,000 | $6,250 / $12,500 | 80% | $40 | $40 |
Blue Choice Preferred Gold PPO 102 | $2,500 / $5,000 | $5,000 / $10,000 | 80% | $20 | $20 |
Blue Choice Preferred Gold PPO 101 | $4,000 / $12,000 | $5,500 / $16,500 | 100% | $50 | $50 |
Blue Choice Preferred Gold PPO 113 | $3,200 / $9,600 | $3,700 / $11,100 | 90% | DC | DC |
Blue Choice Preferred Gold PPO 115 | $3,200 / $9,600 | $5,250 / $14,000 | 80% | DC | DC |
Silver
Plan Name | Deductible Ind/Fam | Out of Pocket Ind/Fam | Coinsurance | PCP Visit | Specialist Visit |
Blue Choice Preferred Silver PPO 120 | $3,600 / $10,800 | $1,500 / $4,500 | 80% | $60 | $80 |
Blue Choice Preferred Silver PPO 104 | $5,000 / $15,000 | $1,500 / $4,500 | 90% | $45 | $65 |
Blue Choice Preferred Silver PPO 105 | $7,900 / $15,800 | $7,750 / $18,200 | 80% | $45 | $65 |
Blue Choice Preferred Silver PPO 133 | $5,250 / $15,000 | $6,250 / $12,500 | 80% | DC | DC |
Blue Choice Preferred Silver PPO 200 | $6,250 / $12,500 | $5,750 / $17,250 | 90% | DC | DC |
Bronze
Plan Name | Deductible Ind/Fam | Out of Pocket Ind/Fam | Coinsurance | PCP Visit | Specialist Visit |
Blue Choice Preferred Bronze PPO 132 | $6,950 / $13,900 | $7,300 / $14,600 | 80% | DC | DC |
Blue Choice Preferred Bronze PPO 106 | $7,200 / $14,400 | $7,200 / $14,400 | 100% | DC | DC |
Blue Choice Preferred Bronze PPO 401 | $7,250 / $14,500 | $7,500 / $15,000 | 70% | DC | DC |
2024 BCBSIL Blue Options PPO
Platinum & Gold
Plan Name | Deductible Ind/Fam | Out of Pocket Ind/Fam | Coinsurance | PCP Visit | Specialist Visit |
Blue Options Platinum PPO 403 | $250 Tier 1/ $750 Tier 2 || $750 Tier 1/ $2,250 Tier 2 | $2,250 Tier 1/ $6,750 Tier 2 || $6,750 Tier 1/ $18,900 Tier 2 | 90% Tier 1/ 70% Tier 2 | $15 Tier 1/ $30 Tier 2 | $30 Tier 1/ $60 Tier 2 |
Blue Options Gold PPO 101 | $750 Tier 1/ $2,250 Tier 2 || $2,250 Tier 1/ $6,000 Tier 2 | $6,750 Tier 1/ $8,500 Tier 2 || $17,300 Tier 1/ $18,200 Tier 2 | 80% Tier 1/ 60% Tier 2 | $40 Tier 1/ $60 Tier 2 | $60 Tier 1/ $100 Tier 2 |
Blue Options Gold PPO 106 | $1,500 Tier 1/ $3,750 Tier 2 || $1,500 Tier 1/ $3,750 Tier 2 | $5,850 Tier 1/ $7,850 Tier 2 || $14,650 Tier 1/ $18,200 Tier 2 | 90% Tier 1/ 70% Tier 2 | $35 Tier 1/ $60 Tier 2 | $50 Tier 1/ $100 Tier 2 |
Blue Options Gold PPO 102 | $1,500 Tier 1/ $3,750 Tier 2 || $4,000 Tier 1/ $8,500 Tier 2 | $4,350 Tier 1/ $7,350 Tier 2 || $9,300 Tier 1/ $18,200 Tier 2 | 90% Tier 1/ 70% Tier 2 | $35 Tier 1/ $60 Tier 2 | $50 Tier 1/ $100 Tier 2 |
Blue Options Gold PPO 200 | $3,200 Tier 1/ $4,700 Tier 2 || $9,600 Tier 1/ $14,100 Tier 2 | $3,200 Tier 1/ $6,650 Tier 2 || $9,600 Tier 1/ $14,100 Tier 2 | 100% Tier 1/ 80% Tier 2 | DC | DC |
Silver
Plan Name | Deductible Ind/Fam | Out of Pocket Ind/Fam | Coinsurance | PCP Visit | Specialist Visit |
Blue Options Silver PPO 104 | $5,250 Tier 1/ $6,250 Tier 2 || $15,750 Tier 1/ $18,200 | $8,150 Tier 1/ $9,100 Tier 2 || $18,200 Tier 1/ $18,200 Tier 2 | 80% Tier 1/ 60% Tier 2 | $50 Tier 1/ $70 Tier 2 | $70 Tier 1/ $110 Tier 2 |
Blue Options Silver PPO 107 | $4,800 Tier 1/ $5,500 Tier 2 || $14,000 Tier 1/ $14,300 Tier 2 | $4,800 Tier 1/ $7,250 Tier 2 || $14,000 Tier 1/ $14,300 Tier 2 | 100% Tier 1/ 70% Tier 2 | DC | DC |
Blue Options Silver PPO 404 | $5,250 Tier 1/ $6,250 Tier 2 || $5,250 Tier 1/ $6,250 Tier 2 | $5,250 Tier 1/ $7,500 Tier 2 || $13,125 Tier 1/ $15,000 Tier 2 | 100% Tier 1/ 70% Tier 2 | DC | DC |
2024 BCBSIL Blue Precision HMO
Platinum & Gold
Plan Name | Deductible Ind/Fam | Out of Pocket Ind/Fam | Coinsurance | PCP Visit | Specialist Visit |
Blue Precision Platinum HMO 107 | $0 / NC | $0 / NC | 100% / NC | $10 | $45 |
Blue Precision Platinum HMO 200 | $0 / NC | $0 / NC | 100% / NC | $20 | $30 |
Blue Precision Platinum HMO 110 | $1,000 / NC || $3,000 / NC | $3,000 / NC || $9,000 / NC | 80% / NC | $25 | $50 |
Blue Precision Gold HMO 402 | $0 / NC | $0 / NC | 80% / NC | $50 | $75 |
Blue Precision Gold HMO 201 | $0 / NC | $0 / NC | 100% / NC | $50 | $70 |
Blue Precision Gold HMO 101 | $2,750 / NC || $8,250/NC | $9,100 / NC || $18,200 / NC | 70% / NC | $55 | $75 |
Silver
Plan Name | Deductible Ind/Fam | Out of Pocket Ind/Fam | Coinsurance | PCP Visit | Specialist Visit |
Blue Precision Silver HMO 106 | $3,250/NC || $9,750/NC | $9,100/NC || $18,200/NC | 70% / NC | $30 | $60 |
Blue Precision Silver HMO 102 | $7,000/NC || $17,100/NC | $9,100/NC || $18,200/NC | 70% / NC | $55 | $75 |