| Plan Type | PPO |
| Office Visit for Primary Doctor Find Doctors | $20 Copay |
| Office Visit for Specialist | $20 Copay |
| Office Visit for Other Practitioner (Nurse, Physician Assistant) | $20 Copay |
| Annual Deductible | None |
| Separate Prescription Drugs Deductible | per person not applicable | per group not applicable |
| Coinsurance | 30% |
| Retail Prescription Drugs | Generic Drugs: $0 Copay; Preferred Brand Drugs: $30 Copay; Non-Preferred Brand Drugs: $150 Copay; Specialty Drugs: 50% Coinsurance; |
| Annual Out-of-Pocket Limit | Individual: $7,500 |
| Lifetime Maximum | Unlimited |
| Health Savings Account (HSA) Eligible | No |
| Out-of-Network Coverage | Yes (Details in plan brochure below) |
| Out-of-Country Coverage | Yes. Coverage is provided through the Blue Cross Blue Shield Global Core when a Member requires Emergency Care Services or Urgent Care Services while traveling or living outside the United States. All Emergency Care Services and Urgent Care Services are covered in accordance within the Member's Agreement. |
| Primary Care Physician Required | No |
| Specialist Referrals Required | No |
| Periodic Health Exam | No Charge |
| Periodic OB-GYN Exam | No Charge |
| Well Baby Care | No Charge |
| Emergency Room | $300 Copay |
| Emergency Ambulance Services | 30% Coinsurance |
| Urgent Care Facility | $40 Copay |
| Retail Prescription Drugs | Generic Drugs: $0 Copay; Preferred Brand Drugs: $30 Copay; Non-Preferred Brand Drugs: $150 Copay; Specialty Drugs: 50% Coinsurance; |
| Separate Prescription Drugs Deductible | per person not applicable | per group not applicable |
| Mail Order Prescription Drugs | N/A |
| Mail Order Supply | N/A |
| Outpatient Surgery | Outpatient Surgery Physician/Surgical Services: $250 Copay Outpatient Facility Fee: $250 Copay |
| Outpatient Lab/X-Ray | Outpatient Lab: $50 Copay X-rays: $50 Copay |
| Imaging (CT and PET scans, MRIs) | $400 Copay |
| Outpatient Mental Health | $20 Copay |
| Outpatient Substance Abuse | $20 Copay |
| Outpatient Rehabilitation Services (PT, OT, ST) | $17 Copay, limited to 30 Visit(s) per Benefit Period |
| Hospitalization | Inpatient Hospital Services: $500 Copay per Stay Inpatient Physician and Surgical Services: 30% Coinsurance |
| Skilled Nursing Facility | $500 Copay per Stay, limited to 120 Days per Benefit Period |
| Inpatient Mental Health | $500 Copay per Stay |
| Inpatient Substance Abuse | $500 Copay per Stay |
| Home Healthcare | 30% Coinsurance, limited to 100 Visit(s) per Benefit Period |
| Pre & Postnatal Office Visit | 30% Coinsurance |
| Labor & Delivery Hospital Stay | $500 Copay |
| Dental Checkup for Children | No Charge, limited to 1 Exam(s) per 6 Months |
| Vision Screening for Children | No Charge, limited to 1 Exam(s) per Year |
| Eye Glasses for Children | No Charge, limited to 1 Item(s) per Year |
| Major Dental Coverage (Pediatric) | 50% Coinsurance |
| Chiropractic Coverage | 25% Coinsurance after deductible, limited to 30 Visit(s) per Benefit Period |
| Durable Medical Equipment | 30% Coinsurance |
| Hospice | 30% Coinsurance |
| Major Dental Coverage (Adult) | Not Covered |
| Vision Coverage (Adult) | Not Covered |
| Out-of-Network Authorization Required | No |
| Out-of-Network Annual Deductible | $2000 per person | $4000 per group |
| Out-of-Network Annual Coinsurance | 50% |
| Out-of-Network Annual Out-of-Pocket Limit | $15000 per person | $30000 per group |
| A.M. Best Rating | A as of 09/17/2021 |
| Electronic Signature for Application Available | Yes |
| View Plan Brochure Exclusions and Limitations |
Important notices and disclaimers
- The information shown here is a summary of benefits for informational purposes only. Review the official plan documents (such as evidence of coverage, plan brochure, or insurance policy) for a detailed description of coverage benefits, limitations, and exclusions. Only the terms and conditions of coverage benefits listed in the policy are binding.
- The benefits listed may be contingent on your use of physicians, hospitals, and services within the specific insurance company's provider network.
- The Copayment, Deductible, and Coinsurance amounts are your share of the costs for covered benefits. These amounts are subject to change.
- Each insurance carrier may have unique Notices, Disclaimers, and Fees. Please check below for information regarding the plans and carriers you selected.
- The quotes or rates shown above are estimates only. Your premium is subject to change based on the optional benefits you selected, if any, and other relevant factors, such as changes in rates that take effect before your coverage start date. The insurance company always determines your actual premium. Insurance companies reserve the right to change the terms of a policy upon proper notification.
- The Summary of Benefits & Coverage can be found at healthcare.gov. A paper copy of this Summary of Benefits & Coverage is available upon request by calling our toll free number. Click here to view the Uniform Glossary of Coverage and Medical Terms.
Is Anthem the same as Blue Cross in Illinois?
Blue Cross Blue Shield is part of the Anthem family of brands, but the two entities each sell health insurance in different areas of the country, and each company provides Medicare health benefits and prescription drug coverage to beneficiaries in those areas.
What type of insurance is Blue Cross Blue Shield of Illinois?
Blue Cross and Blue Shield of Illinois (BCBSIL) is a customer-owned health insurance company serving Illinois residents. The company offers individuals and families healthcare and prescription drug coverage through its Blue Choice Preferred PPO, Blue Precision HMO, and BlueCare Direct HMO plans.
Is access Blue New England an HMO?
This plan gives you the option to go to a specialist or any doctor in the HMO Blue® New England network. No referrals are ever needed.
What is out of pocket maximum?
The most you have to pay for covered services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance for in-network care and services, your health plan pays 100% of the costs of covered benefits.