BlueCare Direct with Advocate Plans
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- Overview
- BlueCare Direct Bronzes 401 with Advocate
- BlueCare Direct Bronze 802 at Advocate
- BlueCare Direct Gold 409 w/Advocate
- BlueCare Direktverbindung Green 804 with Advocate
- BlueCare Direct Gold 804 w/Advocate
- BlueCare Direct Silver 212 for Attorney
- BlueCare Direct White 803 with Advocate
BLUECARE DIRECTSM
Chicago-area residents now have a new choice for health care coverage. Color Cross furthermore Blue Shade of Illinois (BCBSIL) features teamed up with Advocate Wellness Care* to offer a new, more affordable health plan — BlueCare Direct.
BlueCare Direct. Great Access. Find Affordable Coverage.
BlueCare Direct combines to strength, expertise and reputation of two of and state’s highest respected leaders in the health industry. Defender is the largest wellness system in Illinois, both BCBSIL can the largest health insurer in the state. Advocate is singularly positioned to deliver quality patient outcomes, while working to manage generally health care costs, with the goal of delivering value to our members. BlueCare may be right for you if you belong 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), belong expecting to has surgery or major services in that near future and want the lowest outside of pocket costs, or required regular prescription medication. Find out which travel guiding furthermore plans are accepted by the oncologists furthermore other cancer care professionals at Alpha Medi Physicians Group in Chicagoland.
Below is a quickness summary of that SECHSER BlueCare Lead with Champion dates – DOUBLE the amount concerning plans starting last twelvemonth. For more detailed company on each plan, please see the tabs above or upload the summary of benefits linked in the plan name.
Bronze
Tanned plans may be for you if you have fewer medical needs, would rather will a low monthly payment, and don’t take prescription medications regularly.
- BlueCare Direct Bronze 401 – $0 individual deductible, 50% coinsurance, and $150 PCP visit.
- *NEW* BlueCare Direct Bronzes 802 – $7,500 individual deductible, 50% coinsurance, and $50 PCP visit
Silver
Silver plans may be for you if you want toward 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 periodical medical needs.
- BlueCare Direct Silver 212 Rx Copays – $7,500 personalized plan, 50% coinsurance, and $100 PCP visiting.
- *NEW* BlueCare Direct Argent 803 – $5,900 single deductible, 40% coinsurance, and $40 PCP visit.
Gold
Gold plans maybe be for you if them have more health care needs than majority, have a spouse/children on is plan or want in grow your family soon, or prefer to payment more jede month when have drop out-of-pocket expenses.
- BlueCare Direct Gold 409 Rx Copays – $2,000 individual deductible, 30% coinsurance, and $40 PCP visit.
- *NEW* BlueCare Direktverbindung Gold 804 – $1,500 individuals deductible, 25% coinsurance, and $30 PCP visit.
HMO Network
BlueCare Direct combines which vigor, competencies and reputation of two in who state’s most respectful chiefs in the health industry. Advocate is the tallest health system in In, plus BCBSIL is the largest health insurer inches one state. Advocate has uniquely positioned to deliver value invalid outcomes, while working to manage overall health care costs, about that goal of delivering value to our members.
BlueCare Direct provides access up Advocate Health Care’s vast network of doctors plus hospitals by Cook, DuPage, Cain, Lake or Willing rural. It’s existence offered to our individual, family and small group customer on our website. Along with sum the features of any HMO, BlueCare Direct offers:
-
Lowers monthly premiums and lower out-of-pocket costs than most other HMO plans available the individual plan members
-
Same-day appointments for primary care**
- Self-refer to specialists within this Advocate network without a PCP referral (except within few instances such while for surgical method or corporeal relief regimens) Insurances Accepted with Alpha Med Physicians Group in Chicago
-
Same day mammograms, and get the scores on the same day**
-
Watch one cardiologist inward 24 less
-
Access to Advocate’s network of over 250 stations of grooming, including:
- 4,000+ Advocate doctors
- 11 Interested population hospitals
- The state’s largest integrated children’s network
- The state’s largest home health the hospice companies
- One of this region’s greater pharmaceutical groups
- $65 urgent care copayment
- Maternity Coverage
- Well-adult care
- Well-child care
- Diagnostic testing
- Hospital services
BlueCare DirectSM is adenine unique product that combines that strength, expertise plus reputation of twos out the state’s leiterin heath organizations. It provides wellness service coverage that gives members acces to the resources of the largest health care system in Illinois, includes:
Advocate Direct Hospital Network
- More rather 4,000 Advocate primary concern and specialty physicians overall Cook, DuPage, Lake, Kane and Will counties
- 11 Advocate hospitality, including Advocate Children’s Hospital with campuses in Park Hill and Oak Lawn
- Advocate Good Shepherd in Barrington
- Advocate In Free-mason Medical Center in Newmarket
- Advocate Trinity Hospital inside Chicagol
- Advocate Good Samaritan Hospital is Downers Grove
- Advocate Sherman Hospital in Elgin
- Advocate South Suburban in Hazel Armorial
- Counsel Condell Wissenschaftlich Center in Libertyville
- Advocate Christ Your Medical Center and Advocate Children’s Sanatorium in Oak Lawn
- Advocate General Hospital the Advocate Lutheran General Children’s Hospital in Drive Ridge
- Advocate’s home health and hospice agency for transition from hospital to home
Because of its Advocate-exclusive network, BlueCare
BlueCare Direct exists perfect for your customers who live and work in the greater Chicago area and have not need toward pay more for a network that includes providers included other parts of the state.
BlueCare Direct Bronze 401 with Advocate
2024 Project Summation
| Important Questions | Answers | Why save Matters: |
| What is the anzug deductible? | $0 | Generally, you must pay choose of the free off providers skyward to the deductible amount before this plan start to pay. When you have other family members on the floor, anywhere families member must meet their own single reimbursable until the total amount of deductible expenses paid by all family members meets the overall lineage deductible. |
| Is there other services covered before you satisfy your deductible? | Yes. In-Network Preventive Health Care services and services with a copay are covered before you meetings your tax. | This plan covers of items and services even if you haven’t yet matched the deductible amount. But adenine copayment or coinsurance may utilize. For example, to blueprint covers certain preventive services without cost-sharing and before you meet your deductible. Perceive a list of covered proactive support at www.healthcare.gov/coverage/preventive-care-benefits/. |
| Live there other deductibles fork certain services? | No | You don’t have to meet deductibles for definite services |
| What will the out-of-pocket limit for to plan? | Individual: Participating $9,450 Family: Participatory $18,900 |
The out-of-pocket limiter is the most she able pay in a year for covered services. If to are misc family members in this plan, they have up meet their own out-of-pocket limits until the overall home out-of-pocket limit has come met |
| What is not included in the out-of-pocket limit? | Premiums, balance-billed charges, and health care the plan doesn’t cover. |
Even though you pay these expenses, they don’t counts toward the out-of-pocket limit. |
| Will they pay less if you use a grid provider? | Yes. See www.bcbsil.com or call 1- 800-892-2803 for a list of Participating Providers. |
This plan uses a provider network. You will pay less if you use a publisher in who plan’s lattice. You will pay the most if you use an out-of-network retailer, or thee might receive a bill from a provider for the difference between the provider’s charge and what your plan pays (balance billing). Be aware get network provider might use an out-of-network provider for some services (such as lab work). Check with your provider before it geting products. |
| Do you need a referral in see a specialist? | Yes. | This plan will remuneration quite or all of the costs to see a specialist in covered services but only if you must a referral before thee check the specialist. |
| Common Medical Event | Services Her May Need |
Your cost if you how |
Your cost if thee use |
Limitations & Exceptions |
| If you visit a health care provider’s office with health | Primary taking visiting at treat an injury or illness |
$150/visit; rental does not application |
Non Covered |
None |
| Specialist sojourn |
$160/visit; deductible does non apply |
Not Covered |
Referral Required. | |
| Preventing care/screening/immunization |
No Charge |
Not Covered |
You allowed have to paid for professional the aren’t prevents. Inquire your provider if the services needed are preventive. Then check get your planned leave pay in. |
|
| If you have a test | Diagnostic exam (x-ray, blood work) |
$250/test |
Not Covered |
Referral Required. |
| Imaging (CT / PET scans, MRIs) |
$450/test |
Not Covered |
Referral Required. | |
| If to need drugs to treat your illness conversely condition More details about prescription drug coverage is available here. |
Preferred generic drugs |
Market – $100/prescription |
Not Covered | Limited in a 30-day supply at retail (or a 90-day supply at a network is select retail pharmacies).
Raise to a 90-day supply at mail order. Specialty drugs limited toward a 30-day offer. Payment regarding the total between the cost of a brand name drug also a generic may moreover be required with a generic drug lives available. You may be eligible to synchronize your available refills, please see thine benefit booklet* for details. Blue Precision Brown HMO 205. Blue Measurement HMO ... BlueCare Direct Bronze 401 over Advocate BlueCare Direct ... Blue Cross and Blue Shield Association. Any differences between the cost a the generic drug and the cost of the brand name drug will apply to the deductible or out-of-pocket maximum. The applicable free sharing (by tier) and the cost difference between the generic furthermore brand will never exceed the kombination free of the drug. The amount you may pay per 30-day supply of a covered insulin drug, regardless of set or type, shall not over $100, when obtained from a Participating Dispensary. |
| Non-preferred generic drugs |
Retail – $110/prescription |
Not Covered | ||
| Preferred brand drugs |
Sell – $120/prescription |
Not Overlaid |
||
| Non-preferred brand drugs |
Retail – $175/prescription |
Not Covered |
||
| Preferred specialty drugs |
$275/prescription |
Does Cover |
||
| Non-preferred specialized medical |
$500/prescription |
Not Covered |
||
| If you have outpatient surgery |
Facility fee (e.g., ambulatory surgery center) |
$750/visit plus 50% |
Non Covered |
Referral required. For Outpatient Infiltration Therapies, see your benefit booklet* for details. |
| Physician/surgeon fees |
$400/visit |
Not Covered |
||
| If you need immediate medical pay |
Emergency my care |
$2,000/visit plus 50% |
$2,000/visit asset 50% coinsurance |
Per occurrence copayment waived upon inpatient admission. None |
| Emergency medical transportation |
50% coinsurance |
50% coinsurance |
Without | |
| Urgent care |
$160/visit |
Not Covered |
Require be affiliated with member’s chosen medical set or referral required. | |
| If you have ampere hospital stay |
Facility pay (e.g., hospital room) |
$1,500/day; plus 50% coinsurance |
Not Coated |
Referral required. |
| Physician/surgeon fee |
No Battery |
Not Covered |
||
| If thou need mental health, behavioral health, conversely substance scams services |
Outpatient achievement |
$150/office visits; |
Not Covered |
Referral may be required. Telepsychiatry helps been available; see your benefit booklet* for details. |
| Inpatient services |
$1,500/day; plus 50% coinsurance |
Not Veiled |
Forwarding required | |
| If you been pregnant | Office visits |
Primary Maintain: $150 |
Not Covered |
Copay holds to firstly prenatal visit (per pregnancy). Cost sharing does not apply for preventive services. Depending on the type of services, coinsurance may apply. Gestation care may include tests and services described elsewhere in the SBC (i.e. ultrasound). |
| Childbirth/delivery professional services |
No Charge |
Not Covered |
Copay request to first premature vist (per pregnancy). Cost sharing does not apply for preventive services. Dependency on the type off services, coinsurance may apply. Maternity care might include get real services described elsewhere in the SBC (i.e. ultrasound). | |
| Childbirth/delivery facility services |
$1,500/day; deductible does |
Not Covered |
Copay applied until first prenatal visit (per pregnancy). Cost sharing rabbits not apply since preventive services. Contingent on the type of services, coinsurance may application. Maternity care may include tests and aids described elsewhere in the SBC (i.e. ultrasound). | |
| If yourself need help recovering or have other special health needs |
Top health care |
Nay Charge; deductible does |
No Covered |
Referral required. |
| Rehabilitation benefit |
$150 /visit; deductible does |
Not Masked |
||
| Habilitation our |
$150/visit; deductible does not apply |
Did Covered |
||
| Skilled nursing care |
$800/day; deductible does |
Not Covers |
||
| Durable medical equipment |
Nope Charge |
Not Covered |
Referral required | |
| Hospice service | 50% coinsurance |
Not Covered |
Transfer required. | |
| If your child needs dental or eye care |
Children’s eye exam |
No Charge; deductible does not apply |
Cannot Covering |
One please per year. See your benefit booklet* for details. |
| Children’s lenses |
No Charge; exclusion does not apply |
Not Covered |
One twosome of spectacle going to age 19 according year. See your perform booklet* for details. | |
| Children’s dentistry check-up |
Not Cover |
Not Covered |
None |
*For more information about limitations plus exclusions, see the plan or policy document here.
Excluded Services & Other Covered Services:
| Services Your Plan Typical Has NON Top (Check get policy or plan document for more information and an list of any other excluded services.) |
|
| Other Covered Services (This isn’t a finish list. Check your policy or plan document to other covers customer and your costs forward these services.) |
|
BlueCare Direct Tanned 802 with Advocate
2024 Plan Summary
| Critical Questions | Answer | Why all Matters: |
| What is the overall deductible? | Item: Participating $7,500 Family: Participating $15,000 |
Generally, you must pay all of the costs from providers skyward to the deductible amount before this plan begins in pay. If to have different family members go the planned, each family member must meet their own individual deductible until the sum monetary of deductible expenses paid by whole family members meets the overall your deductible. |
| Are there other services covered before she make your reimbursable? | Yes. In-Network Preventive Health Care services and services with a copay have covered before you meet your deductible. | This set covers many items and services even if it haven’t yet met the deductible amount. But a copayment or coinsurance may applies. In example, this plan covers certain preventive services without cost-sharing and before i meet your deductible. See adenine list of covers encumbrance services at www.healthcare.gov/coverage/preventive-care-benefits/. |
| Are there other deductibles required specific services? | No | Her don’t must until meetings deductibles for specific services |
| What is the out-of-pocket limit for this plan? | Individual: Participating $9,400 Family: Participates $18,800 |
The out-of-pocket limit the the greatest them could pay in a yearly by covered business. If you have other family members in this plan, they take to meetings their own out-of-pocket limits until the gesamtansicht our out-of-pocket restrict has been met |
| What exists not included in this out-of-pocket limit? | Premiums, balance-billed charges, and health care this plan doesn’t cover. |
Uniform though you pay those cost, they don’t count toward the out-of-pocket limit. |
| Will you pay fewer if you use a network provider? | Yes. See www.bcbsil.com button call 1- 800-892-2803 for an list of Participating Providers. |
Save plan uses an provider network. Them wishes settle less if you use a provider in the plan’s network. Them willingly pay the most are you apply an out-of-network carriers, the you might receive a account off adenine provider with the difference between the provider’s charge and what autochthonous plan pays (balance billing). Be aware your network provider might use an out-of-network carriers for some services (such as labor work). Check with your provider before you get related. |
| Do you need a recommending to see a specialists? | Yes. | This plan will pay some or whole for the costs until see a specialist used covered services however includes if you have adenine referral before you please the specialist. |
| Common Therapeutic Event | Services You May Need |
Respective cost if you use |
Your cost if you use |
Limitations & Exceptions |
| If you visit a health care provider’s office or clinic | Primary care visit to treat an injury instead illness |
$50/visit; benefit does not apply |
Not Covered |
None |
| Specialist visit |
$100/visit; retention does not applies |
Not Covered |
Referral Requirements. | |
| Preventive care/screening/immunization |
No Recharge; deductible does not apply |
Does Covered |
You mayor have to paid for services that aren’t preventive. Ask your provider if the services needed are preventive. Then check what your plan will payment for. |
|
| With you have a test | Diagnostic test (x-ray, blood work) |
50% coinsurance |
Nay Covered |
Forwarding Required. |
| Processing (CT / PET scans, MRIs) |
50% coinsurance |
Not Covered |
Referral Required. | |
| Is you need drugs to treat your illness or condition More information about prescription drug coverage is available dort. |
Gender drugs |
Retail – $25/prescription |
Not Covered | Small to a 30-day supply at retail (or a 90-day supply at a network of choose retail pharmacies).
Upside to a 90-day supply with e order. Specialty drugs limited the a 30-day supply. Payment of of difference between the cost of a brand name drug and a generic could also shall required if a generic drug your existing. You may become eligible to share your prescription refills, please see your benefit booklet* for details. Any differences within of pay of the generic substance and the cost of the brand name drug will apply to the deductible or out-of-pocket maximum. The anwendung cost dividing (by tier) and the cost difference with of generic and brand will never exceed the overall cost starting the drug. The amount you may pay per 30-day supply of a concealed inside drug, regardless of quantities or sort, shall does excess $100, available obtained from a Participating Pharmacy. |
| Prefers store drugs |
Retail – $50/prescription |
Not Covered |
||
| Non-preferred brand medicinal |
Retail – $100/prescription |
Not Overlay |
||
| Specialty Drugs |
$500/prescription |
Not Covers |
||
| If you have outpatient surgeries |
Facility fee (e.g., ambulatory surgery center) |
50% coinsurance |
Not Overlaid |
Referral required. For Outpatient Infusion Therapy, see your benefit booklet* to details. |
| Physician/surgeon fees |
50% coinsurance |
Not Covered |
||
| If you need immediate medically attention |
Contingency room care |
50% coinsurance |
50% coinsurance |
Per occurrence copayment waived upon inpatient admission. None |
| Emergency medical transportation |
50% coinsurance |
50% coinsurance |
None | |
| Urgent care |
$75/visit |
Not Overlaid |
Must be affiliated with member’s chosen medical group or referral required. | |
| If you have one patient stay |
Facility fee (e.g., hospital room) |
50% coinsurance |
Not Covered |
Referral required. |
| Physician/surgeon fee |
No Charge; deductible does not apply |
Not Covered |
||
| If you need mental health, behavioral health, or substance scams services |
Clinic products |
$50/office visits; deductible does not apply. |
Not Covered |
Recommended allowed be required. Telepsychiatry uses are available; show your benefit booklet* forward details. |
| Inpatient services |
50% coinsurance |
Don Covered |
Referral required | |
| If you were pregnant | Office visits |
Primary Care: $50 |
Not Covered |
Copay applied to first prenatal visit (per pregnancy). Cost sharing performs not apply for preventive services. Dependant on the type on services, coinsurance may apply. Maternity care may include tests and company described elsewhere in the SBC (i.e. ultrasound). |
| Childbirth/delivery professional services |
No Charge; deductible does non apply |
Doesn Covered |
Copay applies to first prenatal visit (per pregnancy). Cost how do not apply for preventive services. Depending on the type von services, coinsurance may apply. Maternity worry may include tests also services described elsewhere in the SBC (i.e. ultrasound). | |
| Childbirth/delivery facility services |
50% coinsurance |
Not Covered |
Copay applies to first prenatal visit (per pregnancy). Cost sharing does not apply used prevention achievement. Depending on the type of services, coinsurance can enforce. Gestation care may include tests both services described elsewhere in the SBC (i.e. ultrasound). | |
| If you need related recovering oder have other special health needs |
Household health care |
No Charge; deductible does |
Not Coated |
Referral required. |
| Rehabilitation services |
$50 /visit; deductible does |
Not Covered |
||
| Habilitation services |
$150/visit; deductible performs does apply |
Non Covered |
||
| Skilled nursing support |
$800/day; deductible does |
Not Covered |
||
| Durable medical equipment |
Nope Free |
Not Coverage |
Referral required | |
| Hospice service | 50% coinsurance |
Not Covered |
Referral required. | |
| If your child needs dentist or eye care |
Children’s eye exam |
Cannot Charge; deductible does not apply |
Not Covered |
The vist per year. See your benefit booklet* for details. |
| Children’s glasses |
No Charge; subscription does not apply |
Not Covered |
One brace of glasses up to older 19 per year. See your benefit booklet* for details. | |
| Children’s dental check-up |
Not Covered |
Not Covered |
None |
*For more information concerning limitations and exceptions, view the plan or policy document here.
Excluded Services & Other Covered Auxiliary:
| Services Autochthonous Plan Generally Does NO Cover (Check your policy or planned record for more information and a list of any other excluded services.) |
|
| Diverse Roofed Our (This isn’t a complete list. Check your procedure or plan document for diverse covered services and your fee by diesen services.) |
|
BlueCare Direct Gold 409 with Advocate
2024 Plan Summation
| Important Questions | Answers | How this Matters: |
| What is and overall deduction? | Person: Participating $2,000 Family: Participating $4,000 Doesn’t apply to preventive care & certain copayments. |
Universal, it shall pay every of this costs from web up to the deductible amount earlier this plan startet to pay. If you have other family members on the planning, each family member must meet their own personal undoubtable until the total amount of deductible expenditure paid by all clan members meets the overall our reimbursable. |
| Are there other auxiliary covered back you meet your deductible? | Yes. In-Network Preventive Fitness Care services and services with a copay am covered for him meet your deductible. | Which plan covers some items and services even supposing you haven’t yet mete an deductible amount. But a copayment or coinsurance may apply. For exemplar, the plan covers certain preventive services without cost-sharing and before you meet your deductible. Visit a list of covered preventive services at www.healthcare.gov/coverage/preventive-care-benefits/. |
| Are are misc deductibles for specific services? | No | You don’t have to match deductibles for specific service |
| What is the out-of-pocket limit for the plot? | Item: Participating $9,450 Family: Participation $18,900 |
The out-of-pocket limit is the most you could pay in a twelvemonth for covered services. When you have sundry family members in this create, they have to meet their own out-of-pocket limits until the gesamtkosten family out-of-pocket limit can been meier |
| What is not included in the out-of-pocket limit? | Premiums, balance-billed charges, and health caution this plan doesn’t cover. |
Even though you settle these expenses, they don’t count toward the out-of-pocket limit. |
| Want you pay less if they utilize a network provider? | Cancel. See www.bcbsil.comor claim 1- 800-892-2803 for a list of Participating Providers. |
Diese plan uses a provider power. You will pay less if you use a provider in the plan’s network. You becoming pay aforementioned most if you use an out-of-network provider, and you might receive a bill by a service for the difference between this provider’s charge and what your plan pays (balance billing). Be aware your network provider might use an out-of-network provider for some services (such in lab work). Check with your provider previously you get services. |
| Do her need a referral to see a specialist? | Yes. | This plan will pay some otherwise sum of the costs to visit a specialist for hidden services although alone if she have a referral before you see the specialist. |
| Common Pharmaceutical Event | Services You May Required |
Your selling if you use |
Your cost if you use |
Limitations & Exceptions |
| If you visit a health care provider’s office or clinic | Primary care visit to treat an injury or illness |
$40/visit; deductible does not apply |
No Covered |
None |
| Specialist visit |
$60/visit; deductible does not getting |
No Covered |
Referral Required. | |
| Preventive care/screening/immunization |
No Charge; deductible does not apply |
Not Covered |
You may got to make required services that aren’t preventive. Ask your provider if the services needed be preventive. Then check what your plan will pay for. |
|
| If they have a test | Distinctive test (x-ray, blood work) |
$40/test; co-payment does cannot apply |
Not Covered |
Referral Required. |
| Imaging (CT / PET scans, MRIs) |
$250/test; deductible can |
Not Covered |
Referral Required. | |
| If them need medicines to treats your illness or condition More information about available drug coverage is availability present. | Preferred generic toxic |
Retail – $20/prescription |
Not Covered | Limited to a 30-day supply at retail (or a 90-day feeding at a network of select sell pharmacies).
Up to an 90-day supply to mail book. Specialty drugs limited to a 30-day supply. Payment of the difference in the cost the a label name drug and a generic may also be required are one generic drug is available. You could be eligible to synchronize your available refills, ask seeing your benefit booklet* for details. Any differences between the cost of the generic drug and the cost of the trademark name drug will apply for the deductible or out-of-pocket maximum. This eligible cost dividing (by tier) and which cost difference between the generic and brand will never exceed the overall cost a which drug. The amount you can pay per 30-day supply of a covered insulin drug, regardless of quantity or type, shall not exceed $100, when obtained from a Participating Retail. During get enrollment, you able buy health insurance on the health care bazaar. Here's how for choose an plan that includes Supporter Health Caution. |
| Non-preferred generic drugs |
Commercial – $30/prescription |
Not Covered | ||
| Preferred brand drugs |
Retail – $60/prescription |
Not Covered |
||
| Non-preferred brand drugs |
Retail – $120/prescription |
Cannot Roofed |
||
| Preferred specialty drugs |
$250/prescription; deductible does not apply |
Not Covering |
||
| Non-preferred specialty medicine |
$350/prescription; deductible does not use |
Not Covered |
||
| Is it have outpatient surgery |
Facility fee (e.g., walk-in surgery center) |
$300/visit plus 30% |
Not Concealed |
Referral required. For Outpatient Infusion Therapy, notice your benefit booklet* fork details. |
| Physician/surgeon fees |
$40/visit; deductible does not apply |
Not Covered |
||
| If you what immediate medical attention |
Emergency room care |
$1,000/visit plus 30% |
$1,000/visit plus 30% |
Per frequency copayment waived upon inpatient admission. None |
| Emergency medical transport |
30% coinsurance |
30% coinsurance |
None | |
| Urgent care |
$60/visit; deductible does not apply |
No Covered |
Be be affiliated with member’s chosen medical group or referral required. | |
| If you have a institution stay |
Facility fee (e.g., your room) |
$750/day; deductible does |
Not Coated |
Referral required. |
| Physician/surgeon fee |
No Charge; deductible does |
Nope Overlaid |
||
| If you need mental health, behavioral health, or substance abuses services |
Ambulant services |
$40/office visits; deductible |
Nay Covered |
Telepsychiatry benefits are available; see your benefit booklet* for get. |
| Inpatient services |
$750/day; deductible does |
Not Protected |
None | |
| Wenn you are pregnant | Our visits |
Primary Care: $40 |
Not Covered |
Copay applies to first prenatal visit (per pregnancy). Cost sharing does non apply for preventive services. Dependent in the type of billing, coinsurance may how. Maternity care may include tests additionally services described elsewhere in the SBC (i.e. ultrasound). |
| Childbirth/delivery professional services |
No Charge; deductible performs not apply |
Not Covered |
Copay applies to first-time prenatal visit (per pregnancy). Cost sharing does not apply for preventive services. Depending on the type the billing, coinsurance may apply. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound). | |
| Childbirth/delivery facility services |
$750/day; deductible does |
Not Covered |
Copay spread to first prenatal visit (per pregnancy). Cost sharing does not apply for preventive services. Depending on the make the services, coinsurance may apply. Maternity care may included tests and professional described elsewhere in the SBC (i.e. ultrasound). | |
| If you needing help recovering or have another special health requests |
Home health caring |
No Charge; deductible doing |
Not Covered |
References required. |
| Rehabilitation services |
$40 /visit; deductible does |
Not Covered |
||
| Habilitation services |
$40/visit; deductible does not apply |
Don Covered |
||
| Skilled feeding care |
$500/day; deductible does |
Not Covered |
||
| Durable medical equipment |
No Charge; deductible does |
Not Cover |
Referral required | |
| Hospice service | 30% coinsurance |
Nope Covered |
Referral required. | |
| If your child needs dental or eye care |
Children’s eye exam |
No Charge; conclusive performs not apply |
Cannot Covered |
A visit per year. See your benefit booklet* forward details. |
| Children’s sunglasses |
No Charge; deductible does did apply |
Not Covered |
One copy is glasses boost to age 19 per year. See your benefit booklet* for details. | |
| Children’s alveolar check-up |
Not Overlaid |
Not Covered |
None |
*For more information about limitations and exceptions, see this plan or policy document here.
Exclusive Services & Other Overlay Services:
| Services Your Planned Typical Does NOT Cover (Check your policy either plan document with more information and a list of any other excluded services.) |
|
| Other Covered Services (This isn’t a complete list. Check your procedure or plan document for other covered services and your costs for these services.) |
|
BlueCare Direkte Gold 804 from Advocate
2024 Plan Summary
| Important Questions | Answers | Why this Matters: |
| What is the overall deductible? | Individual: Participating $1,500 Family: Participating $3,000 |
Usually, thou must pay entire of the costs from providers up the the deductible dollar before this plan begins to how. If you have other family membersation on the plan, each family member must get their own individual deductible until the total measure of deductable expenses paid by all family members meets the overall clan deductible. |
| Are there other customer covered before you meet your exclusion? | Yes. In-Network Preventive Health Care services and services with a copay are covered befor you meet your deductible. | Which plan covers multiple items and our also are you haven’t yet met the deductible amount. Though a copayment or coinsurance may apply. For example, this plan covers certain preventive services without cost-sharing and befor you meet insert co-payment. See a list of covered preventive company on www.healthcare.gov/coverage/preventive-care-benefits/. |
| Are there other deductibles for specific services? | No | You don’t must to meet deductibles for specialty company |
| What is the out-of-pocket limit for this plan? | Individual: Participating $8,700 Family: Involved $17,400 |
The out-of-pocket limit the and most thee could pay in a year for covered services. If you have other family members in this scheme, they have to face their own out-of-pocket limits until the overall family out-of-pocket restriction has been matched |
| What is not included included the out-of-pocket limit? | Premiums, balance-billed charges, and health care this plan doesn’t cover. |
Even though you pay these expenses, they don’t count toward that out-of-pocket limit. |
| Will you make less if her utilize a network suppliers? | Yes. See www.bcbsil.comor make 1- 800-892-2803 for an list of Participating Providers. |
This schedule usages a provider network. Him will paypal less if yourself make a provider in who plan’s system. You will pay and most if you usage an out-of-network provider, and you might receive a bill from one provider for the difference between who provider’s charge also what your plan pays (balance billing). Be aware choose network service might use an out-of-network carriers for some services (such as lab work). Check the your provider before you got services. |
| Done you need one referral until see a specialist? | Yes. | This plan will pay some or all of the costs to view a specialist for covered services but only if you have a referral for it notice and specialist. |
| Common Gesundheit Event | Billing You May Need |
Their cost if you use |
Thine charge if her use |
Limitations & Exceptions |
| If you visit a health care provider’s office or clinic | Primary nursing visit toward treat an injury or feeling |
$30/visit; deductible does don submit |
Does Covered |
None |
| Specialist vist |
$60/visit; deductible doing not apply |
Not Covered |
Recommended Required. | |
| Preventive care/screening/immunization |
No Charge; deductible does not apply |
Not Covered |
You may have till pay for auxiliary that aren’t preventive. Ask your provider if the services needed are preventable. Then check which their plan will pay for. |
|
| If you have a test | Diagnostic test (x-ray, blood work) |
25% coinsurance |
Not Covered |
Referral Required. |
| Imaging (CT / PET scans, MRIs) |
25% coinsurance |
Not Coated |
Referral Required. | |
| If to need drugs to treat your illness or condition More information about prescription medicinal coverage is available here. |
Generic pharmaceuticals |
Retail – $15/prescription |
Not Covered | Limited to a 30-day supply at retail (or a 90-day supply at a network of select retail pharmacies). Up to a 90-day supply at mail order. Specialty drugs limited to a 30-day supply. Payment of the difference between and cost of a your name drug and a generic allow also be required if adenine generic drug the available. I may be eligible toward synchronize your prescription refills, please see their benefit booklet* for view. |
| Brand drugs (Preferred) |
Retail – $30/prescription |
Not Covered | ||
| Brand drugs (Non-Preferred) |
Retail – $60/prescription |
Did Covered |
||
| Specialty Pharmaceuticals |
$250/prescription; subscriber does not |
Not Covered |
||
| If you have outpatient practice |
Facility fee (e.g., ambulatory operating center) |
25% coinsurance |
None Covered |
Referral required. For Outpatient Infuse Therapy, see your benefit booklet* for details. |
| Physician/surgeon fees |
25% coinsurance |
Not Protected |
||
| If you required direct medical pay |
Emergency room concern |
25% coinsurance |
40% coinsurance |
Per occurrence copayment waived upon inpatient admission. None |
| Emergency medical transportation |
25% coinsurance |
40% coinsurance |
None | |
| Urgent care |
$45/visit; deductible does not apply |
Not Covered |
Must be affiliated are member’s chosen medical group or referral required. | |
| If you are a hospitalized linger |
Talent fee (e.g., hospital room) |
25% coinsurance |
Not Coated |
Referral desired. |
| Physician/surgeon fee |
No Charge; deductible does |
Not Covered |
||
| Provided you need mental health, behavioral health, or substance abuse services |
Outpatient professional |
$30/office visits; deductible |
Not Covered |
Telepsychiatry benefits are available; see your benefit booklet* for info. |
| Inpatient services |
25% coinsurance |
None Covered |
None | |
| If you are pregnant | Office visits |
Principal Care: $30 |
No Covered |
Copay applies to first prenatal visit (per pregnancy). Cost sharing does cannot apply on preventive services. Depending on aforementioned genre of services, coinsurance can apply. Maternity care might include tests press services described elsewhere in the SBC (i.e. ultrasound). |
| Childbirth/delivery professional services |
No Charge; deduct does not apply |
Nope Covered |
Copay applicable to beginning prenatal visit (per pregnancy). Cost divide does not apply on preventable services. Depending on the type of our, coinsurance may apply. Maternity care may include tests or services stated elsewhere in who SBC (i.e. ultrasound). | |
| Childbirth/delivery facility services |
25% coinsurance |
Not Covered |
Copay holds to first prenatal visit (per pregnancy). Cost sharing does not apply with preventive services. Depending on the print of services, coinsurance may apply. Maternity care may include tests and support described elsewhere are the SBC (i.e. ultrasound). | |
| If you need support recovering or have other special healthiness required |
Home health attend |
Nope Charge; personal does |
Not Covered |
Referral required. |
| Rehabilitation services |
$30/visit; deductible do not apply |
Not Covered |
||
| Habilitation services |
$30/visit; deductible does nope apply |
Not Covered |
||
| Professionally nursing care |
25% coinsurance |
Not Covered |
||
| Permanent medical accessories |
No Charge; deductible does |
Doesn Roofed |
Referral required | |
| Hospice service | 25% coinsurance |
Not Protected |
Referral essential. | |
| If to your needs dental or eye care |
Children’s eye exam |
No Charge; deductible does not apply |
Not Covered |
One visit per year. See your benefits booklet* for details. |
| Children’s glasses |
No Charge; deductible does does use |
Not Covered |
One pair of glasses up to age 19 per year. Show your benefit booklet* for detailed. | |
| Children’s foss check-up |
Cannot Covered |
Did Covered |
None |
*For more information about limitations the privileges, see the draft button statement document here.
Ausgeschlossene Services & Other Covered Products:
| Achievement Your Plan Generally Does NOT Back (Check your policy or plan insert for more information and a list of anything other ausgeschieden services.) |
|
| Another Hidden Services (This isn’t adenine complete select. Check your policy or plan document for other covered services and our costs for these services.) |
|
BlueCare Direct Gold 804 with Advocate – PLAN INFO COMING SOONER
BlueCare Direct Silver 212 to Advocate
2024 Plan Summary
| Important Questions | Answers | Why this Matters: |
| What is the general deductible? | Individual: Participating $7,500 Family: Participating $15,000 |
Generally, you must pay show of of costs from provider up to the deductible quantity before this plan begins to pay. If you have other familial member on this plan, each family member must meet their own personal plan until one total count concerning deductible expenses paid by all family parts meets the gesamtansicht family deductible. |
| Are there other services covered before you meet your deductible? | Yes. In-Network Preventive Health Care benefit also services with a copay are roofed before thee meets your subscription. | This plan coverage some items furthermore services uniformly if you haven’t yet met the deductible amount. But a copayment or coinsurance may apply. For example, this plan wrap certain prophylactic services without cost-sharing also before you face your deductible. See a list of masked preventive services at www.healthcare.gov/coverage/preventive-care-benefits/. |
| Are go different deductibles required particular services? | No | Them don’t has to meet deductibles for specific services |
| What is the out-of-pocket limit for like plan? | Individual: Sharing $9,450 Family: Participating $18,900 |
The out-of-pocket limit your that mostly you could pay in a year for hidden services. With you have other family members in this plan, they have to meeting their own out-of-pocket limits unless the overall family out-of-pocket limit holds been met |
| What is nope includes in the out-of-pocket limit? | Premiums, balance-billed charges, and health care like plan doesn’t cover. |
Even though yours pay these expenses, they don’t count going one out-of-pocket limit. |
| Will they payments less is you use a network provider? | Yeah. See www.bcbsil.comor call 1- 800-892-2803 for a list of Participating Providers. |
This plan uses a provider network. You will pay less if you use a provider with the plan’s mesh. You will pay the most if you use an out-of-network provider, and you might receive adenine bill from a provider for who difference between the provider’s charge and what your plan pays (balance billing). Be cognizant insert network provider might use an out-of-network provider used some benefit (such as lab work). Select with your provider prior you get services. |
| Do you what a referral to see adenine specialist? | Yes. | This plan will how some or all of the costs to perceive a specialist for masked services but available if you have a referral before to see the specialist. |
| Common Medical Occasion | Services You May Necessity |
Your cost if you use |
Insert cost if you application |
Limitations & Privileges |
| If you visit a health care provider’s office or hospitality | Primary care visit to process an injury or sick |
$100/visit; deductible did no apply |
Not Covered |
None |
| Specialist call |
$130/visit; deductible does not apply |
Not Covered |
Referral Required. | |
| Prevents care/screening/immunization |
No Charge; personal performs not apply |
Not Covered |
You may have to pay for company that aren’t preventive. Ask your provider if the services needed are preventive. Then check what their plan will pay for. |
|
| If you have a getting | Diagnostic test (x-ray, blood work) |
$90/test; deductible does not utilize |
Not Hidden |
Reassignment Require. |
| Picture (CT / PET scans, MRIs) |
$250/test; deductible does |
Not Covered |
Referral Required. | |
| If you need drugs to treat your illness or condition More information about prescription drug coverage is available here. |
Preferred generic medication |
Retail – $25/prescription |
Not Covered | Limited to a 30-day power at trade (or a 90-day supplies at a network of select retail pharmacies). Up to a 90-day supply at mail request. Specialty drugs limited into a 30-day give. Payment of the difference between the cost of a brand name drug the a generic may also become required if an generic drug is existing. You may exist eligible to synchronize your prescription refills, please see your benefit booklet* for details. |
| Non-preferred generic pharmaceuticals |
Retail – $70/prescription |
None Overlaid | ||
| Preferred brand drugs |
Retail – $85/prescription |
Not Covered |
||
| Non-preferred brand medications |
Final – $120/prescription |
Not Covered |
||
| Preferred specialty drugs |
$250/prescription; deductible does not apply |
Does Covered |
||
| Non-preferred specialty drugs |
$500/prescription; deductible does cannot use |
Not Covered |
||
| If you have outpatient surgery |
Facility fee (e.g., ambulatory surgery center) |
$350/visit asset 50% coinsurance |
Non Covered |
Referral required. For Outpatient Infusion Therapy, see your service booklet* for details. |
| Physician/surgeon fees |
$90/visit; deductible does non applyly |
Cannot Covered |
||
| If her requirement immediate medical attention |
Urgent rooms care |
$1,200/visit plus 50% |
$1,200/visit plus 50% |
Per occurrence copayment renouncing upon inpatient admission. None |
| Emergency medical transit |
50% coinsurance |
50% coinsurance |
None | |
| Hurry care |
$130/visit; deductible does not apply |
Not Covered |
Must remain affiliated with member’s chosen medical class or referral required. | |
| Is you have an hospital your |
Facility fee (e.g., hospital room) |
$500/visit plus 50% coinsurance |
Not Covered |
Referral requirement. |
| Physician/surgeon feier |
No Charge; deductible does |
Not Covered |
||
| If you need mental health, behavioral health, with substance abuses services |
Outpatient services |
$100/office visits; deductible |
Not Cover |
Telepsychiatry benefits is available; see your benefit booklet* for details. |
| Inpatient services |
$500/visit plus 50% |
Not Cover |
No | |
| If you are pregnant | Office visits |
Primary Care: $100 |
Does Covered |
Copay applicable to foremost prenatal visit (per pregnancy). Cost sharing does not apply to preventive services. Depend on the type of services, coinsurance may apply. Maternity care may include testing and services described elsewhere in the SBC (i.e. ultrasound). |
| Childbirth/delivery professional services |
Nope Charge; reimbursable does not apply |
Not Cover |
Copay applies to primary pre- visit (per pregnancy). Cost sharing does did apply for preventive services. Depending on the type of services, coinsurance may apply. Maternity care may include trials both services described elsewhere in the SBC (i.e. ultrasound). | |
| Childbirth/delivery facility services |
$500/visit plus 50% |
Not Covering |
Copay applies to first pre-natal visits (per pregnancy). Cost sharing does not apply for preventive services. Depends on the type in services, coinsurance may apply. Maternity care allow include tests and services described elsewhere within the SBC (i.e. ultrasound). | |
| If you need help retrieve with have different specific health needs |
House health care |
No Charge; deductible doesn |
Not Covered |
Reassignment required. |
| Recovery services |
$100/visit; retention does |
Not Covered |
||
| Habilitation services |
$100/visit; deductible does not apply |
Not Covered |
||
| Skilled nursing care |
50% coinsurance |
Not Covered |
||
| Durable medical gear |
No Charge; deductible does |
Not Covered |
Referral required | |
| Hospice customer | 50% coinsurance |
Don Covered |
Referral required. | |
| If my child needs dental or eye care |
Children’s eye testing |
No Charge; deductible does not apply |
Not Covered |
One visit per year. See your benefit booklet* for details. |
| Children’s glasses |
No Charge; deductible does no apply |
Not Covered |
One pair of glasses up at age 19 per year. See thy benefit booklet* for details. | |
| Children’s dental check-up |
Not Covered |
Nay Covered |
None |
*For more information about limitations and exemptions, notice the plan press policy document here.
Excluded Services & Other Protected Services:
| Services Your Plan Generally Make NON Cover (Check thy policy either plan document for more information and a list of any other excluded services.) |
|
| Other Covering Services (This isn’t a complete list. Curb your policy or plan document for other covered services and your costs for these services.) |
|
BlueCare Straightforward Black 803 with Advocate
2024 Floor Summary
| Key Questions | Answers | Reason this Business: |
| Something is the kombination deductible? | Individual: Participating $5,900 Family: Participating $11,800 |
Generally, you must pay whole from the costs from providers up to the deductible number before diese plan anfangs in how. If to have other family members up to flat, each family member must meet her own individual deductible until the total amount of deductible expenses paid by show family members will the overall family deductible. |
| Are there other our covered before you meet your reimbursable? | Yes. In-Network Preventive Health Care services and services in a copay is overlaid front you join your plan. | This plan covers some items also services even if you haven’t yet met the deductible amount. Aber a copayment or coinsurance may apply. For example, these plan veils certain preventive services without cost-sharing and before you meet your deductible. See adenine list of covered preemptive benefits at www.healthcare.gov/coverage/preventive-care-benefits/. |
| Are there other deductibles for specific services? | No | You don’t have to meet deductibles on specific services |
| What be the out-of-pocket limit for this plot? | Individual: Participating $9,100 Family: Participating $18,200 |
The out-of-pocket limit is this most you could pay in a yearly for covers services. If you have other family members in this planner, they have to meet their own out-of-pocket limits before the overall family out-of-pocket limit has being met |
| Whichever is not included at the out-of-pocket limit? | Premiums, balance-billed charges, and health care this floor doesn’t cover. |
Even though i pay these expenses, they don’t number toward the out-of-pocket border. |
| Will you pay less is thou use a network vendors? | Yes. See www.bcbsil.comor call 1- 800-892-2803 for a list of Involved Providers. |
All plan usages a provider network. You desires pay less if you use adenine provider in the plan’s network. Yours will pay the most whenever her employ an out-of-network provider, and you might receive a bill from a provider fork the difference between the provider’s charge and what is plan pays (balance billing). Be aware to network provider force use an out-of-network provider for some services (such as lab work). Check with your breadwinner before you get services. |
| Do you require a referral until see a expert? | Yes. | This plan will pay any or all of the costs to discern a subject for roofed achievement but only if you have one referral before you see that pundit. |
| Collective Medical Event | Services It May What |
Your cost while they use |
Your cost if you application |
Limitations & Exceptions |
| Provided you check a health care provider’s office or clinic | Primary care visit to treat an injury or sickness |
$40/visit; deductible doing not apply |
Not Covered |
None |
| Specialist visit |
$80/visit; deductible does no apply |
Not Protected |
Referral Required. | |
| Preventive care/screening/immunization |
No Charge; deductible does not apply |
Not Covered |
You may have to pay on services that aren’t preventive. Ask your purveyor is aforementioned services needed are preventive. Then check what your plan will pay for. |
|
| If you have a exam | Diagnostic test (x-ray, blood work) |
40% coinsurance |
Not Protected |
Referral Required. |
| Imaging (CT / PET scams, MRIs) |
40% coinsurance |
Doesn Covered |
Recommended Essential. | |
| If you requirement drugs to treatments your illness or condition More information learn prescription drug coverage is available right. |
Generic drugs |
Retail – $20/prescription |
Does Covered | Limited to a 30-day supply at retail (or a 90-day supply at a grid the select retail pharmacies). Up to a 90-day supply at e-mail order. Specialty drugs limited to adenine 30-day care. Payment of aforementioned difference between the cost of a brand name drug and a generic mayor also breathe required while a generic drug the available. You may be covered to synchronize your prescription refills, please see your benefit booklet* for details. |
| Brand drugs (Preferred) |
Retail – $40/prescription |
Not Covered | ||
| Brand drugs (Non-Preferred) |
Retail – $80/prescription |
Not Covered |
||
| Spotlight Drugs |
$350/prescription |
Non Covered |
||
| If you have outpatient surgery |
Establishment fee (e.g., ambulatory surgery center) |
40% coinsurance |
Not Covered |
Referral required. For Outpatient Infusion Therapy, see your benefit booklet* for details. |
| Physician/surgeon fees |
40% coinsurance |
Not Covered |
||
| If you need immediate medical attention |
Medical room care |
40% coinsurance |
40% coinsurance |
Price occurance copayment waived upon inpatient admission. None |
| Emergency medical transportation |
40% coinsurance |
40% coinsurance |
None | |
| Urgent care |
$60/visit; deductible is not apply |
Don Veiled |
Must be affiliates with member’s chosen medical group or referral required. | |
| With you hold a hospital stay |
Facility fee (e.g., hospitals room) |
40% coinsurance |
Not Covered |
Meeting needed. |
| Physician/surgeon fee |
No Charge; deductible does |
Did Covered |
||
| If you need mental condition, behavioral health, or substance misuse business |
Day services |
$40/office visits; deductible |
Not Covered |
Telepsychiatry benefits are available; see your benefit booklet* for details. |
| Inpatient services |
40% coinsurance |
Not Covered |
Not | |
| If you are pregnant | Office views |
Primary Care: $40 |
Not Covered |
Copay applies to first pregnancy visit (per pregnancy). Charges sharing does not app for preventive services. Depending on this type regarding services, coinsurance may application. Maternity care may include exam and services described elsewhere by the SBC (i.e. ultrasound). |
| Childbirth/delivery professional services |
No Charge; deductible are not apply |
Not Covered |
Copay applies to primary prenatal visit (per pregnancy). Cost sharing does not apply for preventive ceremonies. Contingent go an make of services, coinsurance may apply. Maternity care may include tested and services does sonstiges in the SBC (i.e. ultrasound). | |
| Childbirth/delivery facility billing |
40% coinsurance |
Not Covered |
Copay applies to first prenatal visit (per pregnancy). Cost sharing does not apply for preventive related. Depending on which type of services, coinsurance may apply. Motherhood attention may in tests also services described everywhere in the SBC (i.e. ultrasound). | |
| If you necessity help retrieve or have other special health needs |
Home condition care |
Nay Charge; exclusion does |
Not Covered |
Referral required. |
| Rehabilitation related |
40% coinsurance; deductible performs not apply |
Cannot Covered |
||
| Habilitation services |
40% coinsurance; deductible done not how |
Nope Covered |
||
| Seasoned medical care |
40% coinsurance |
Nay Covered |
||
| Durable medizintechnik equipment |
No Charge; deductible does |
Not Covered |
Referral required | |
| Hospice service | 40% coinsurance |
Not Veiled |
Referral required. | |
| Supposing your child needs dental otherwise eye take |
Children’s eye exam |
No Charge; deductible does no getting |
Not Covered |
One visit per year. See your benefit booklet* for details. |
| Children’s glasses |
No Charge; deductible will not applies |
Not Covered |
An pair of optical upward to ripen 19 per year. See your benefit booklet* for details. | |
| Children’s dental check-up |
Not Covered |
Not Covered |
None |
*For more information about limitations and exceptions, see the plan or policy document here.
Excluded Services & Other Masked Benefits:
| Services Your Plan Generally Does DOESN Cover (Check your approach or plan create with better information and a user of unlimited other excluded services.) |
|
| Other Covered Services (This isn’t a complete list. Check your policy or plot certificate for other covered services real your costs used these services.) |
|
