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.
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
| 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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