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.
- MyBlue Plus Silver 905 – $5,000 individual deductible, and 50% coinsurance
- MyBlue Plus Silver 906 – $3,850 individual deductible, and 40% coinsurance
- MyBlue Plus Silver 907 (Off Exchange only) – $1,800 individual deductible, and 50% coinsurance
- MyBlue Plus Silver Standard – Rx Copays – $5,000 individual deductible, and 40% 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
| 905 | 906 | 907 (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 deductible
|
Yes. | Yes. | Yes. | Yes. |
|
Are there other deductibles for specific services
|
No. | 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. | Yes | Yes. |
**Premiums, balance billing & health care this plan doesn’t cover are not included in the out-of-pocket limit
Office Visit / Testing
| 905 | 906 | 907 (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/visit | 50% | $80/visit |
|
Preventative care/screening
|
No Charge | No Charge | No Charge | No Charge |
|
Diagnostic test (xray, blood) Freestanding / Hospital
|
$90/test | 40% | 30% / 50% | 40% |
|
Imaging (CT/PET/MRI) Freestanding / Hospital
|
$250/test | 40% | 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
| 905 | 906 | 907 (off ex only) | Silver Standard ? Select Rx Copays | |
|---|---|---|---|---|
|
Generic Drugs (Preferred)
|
$5 / $15 | No Charge | $5 / $15 | $20 / $60 |
|
Generic Drugs (Non Preferred)
|
$15 / $45 | 10% | $15 / $45 | $20 / $60 |
|
Brand drugs (Preferred)
|
15% | 20% | 30% | $40 / $120 |
|
Brand Drugs Non Preferred
|
40% | 30% | 35% | $80 / $240 |
|
Specialty Drugs Preferred
|
45% | 40% | 45% | $350 |
|
Specialty Drugs Non Preferred
|
50% | 50% | 50% | $350 |
Outpatient Surgery / Emergency Comparison
| 905 | 906 | 907 (off ex only) | Silver Standard ? Select Rx Copays | |
|---|---|---|---|---|
|
Facility Fee
|
$250/visit + 50% | 40% | $600/visit + 30% | 40% |
|
Facility fee Hospital
|
NA | NA | NA | NA |
|
Physician/surgeon Fee
|
$90/visit | 40% | $200/visit + 50% | 40% |
|
Emergency Room Care
|
$1,000/visit + 50% | 40% | $950/visit + 50% | 40% |
|
Emergency Medical Transportation
|
50% | 40% | 50% | 40% |
|
Urgent Care
|
$100/visit | $45/visit | $15/visit | $60/visit |
Hospital Stay / Health Services / Pregnancy
| 905 | 906 | 907 (off ex only) | Silver Standard ? Select Rx Copays | |
|---|---|---|---|---|
|
Facility Fee for hospital stay
|
$500/visit plus 50% coinsurance | 40% | $850/visit + 50% | 40% |
|
Physician/surgeon Fees
|
50% | 40% | 50% | 40% |
|
Mental health, behavioral health, or substance abuse services: Outpatient
|
$65 office / 50% other | $30 office / 40% other | 50% 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 visit
|
Primary: $65 / Specialist: $90 | Primary: $30 / Specialist: $45 | Primary: $50 / Specialist: 50% | Primary: $40 / Specialist: $80 |
|
Childbirth/delivery/professional services
|
50% | 40% | 50% | 40% |
|
Childbirth/delivery facility services
|
$500/visit + 50% | 40% | $850/visit + 50% | 40% |
Help recovering / other special needs
| 905 | 906 | 907 (off ex only) | Silver Standard ? Select Rx Copays | |
|---|---|---|---|---|
|
Home Health Care
|
50% | 40% | 50% | 40% |
|
Rehabilitation Services
|
$65/visit | $30/visit | 50% | $40/visit |
|
Habilitation services
|
$65/visit | $30/visit | 50% | $40/visit |
|
Skilled nursing care
|
50% | 40% | 50% | 40% |
|
Durable medical equipment
|
50% | 40% | 50% | 40% |
|
Hospice services
|
50% | 40% | 50% | 40% |
Childrens Dental / Eye care
| 905 | 906 | 907 (off ex only) | Silver Standard ? Select Rx Copays | |
|---|---|---|---|---|
|
Children?s eye exam
|
No Charge | No Charge | No Charge | No Charge |
|
Children?s Glasses
|
No Charge | No Charge | No Charge | No Charge |
|
Children?s Dental check-up
|
Not Covered | 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.)
| 905 | 906 | 907 (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.)
| 905 | 906 | 907 (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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