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Blue - Blue Precision Bronze HMO? 205
Illinois, 2019
Plan Type
HMO
Metal Tier
Bronze
Out of Pocket Maximum
$7,900
Deductible
$6,000
Emergency Room Care: $1000 Copay after deductible + 40% Coinsurance after deductible
Cost Sharing Benefits (In Network)
Policyholders are generally responsible for 100% of costs until the deductible amount is met. After the deductible has been met the policyholder is responsible for the coinsurance / copay until the out of pocket maximum is reached at which point the insurance company assumes 100% of all costs.
| Deductible (Individual) | $6,000 |
|---|---|
| Deductible (Family) | $15,800 |
| Coinsurance | Not applicable |
| Out of Pocket Maximum (Individual) | $7,900 |
| Out of Pocket Maximum (Family) | $15,800 |
Doctor Visits
| Primary Care Visit | Data Not Available |
|---|---|
| Specialist Visit | Data Not Available |
| Inpatient Facility | $850 Copay per day |
| Inpatient Physician | 40% Coinsurance after deductible |
| Emergency Room Services | $1000 Copay after deductible + 40% Coinsurance after deductible |
Tests and Imaging
| Imaging (CT/PET Scans, MRIs) | Data Not Available |
|---|---|
| Laboratory Outpatient and Professional Services | Data Not Available |
| X-Ray and Diagnostic Imaging | Data Not Available |
Health Management Programs
| Asthma | Available |
|---|---|
| Depression | Available |
| Diabetes | Available |
| Heart Disease | Available |
| High Blood Pressure / High Cholesterol | Available |
| Lower Back Pain | Available |
| Pain Management | Available |
| Pregnancy | Available |
| Weight Loss | Not available |
Other
| Mental / Behavioral Health Inpatient | $850 Copay per day |
|---|---|
| Mental / Behavioral Health Outpatient | Data Not Available |
| Rehabilitative Speech Therapy | Data Not Available |
| Rehabilitative Occupational & Physical Therapy | Data Not Available |
| Outpatient Facility | $300 Copay after deductible + 40% Coinsurance after deductible |
| Outpatient Surgery | Data Not Available |
Prescription Drugs
| Generic Rx | 10% Coinsurance after deductible |
|---|---|
| Preferred Brand Rx | 20% Coinsurance after deductible |
| Non Preferred Brand Rx | 30% Coinsurance after deductible |
| Specialty Drugs | 40% Coinsurance after deductible |
Other Plans in Illinois
| Plan | Deductible | Coinsurance | Out of Pocket |
|---|---|---|---|
| Plan Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits | Deductible $6,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Security PPO? 200 | Deductible $7,900 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Silver PPO? 203 | Deductible $2,200 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Precision Silver HMO? 206 | Deductible $2,500 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Gold PPO? 204 | Deductible $750 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Precision Bronze HMO? 205 | Deductible $6,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Gold PPO? 204 | Deductible $750 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Bronze PPO? 202 | Deductible $3,150 | Coinsurance Not applicable | Out of Pocket $6,650 |
| Plan Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits | Deductible $6,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Silver PPO? 203 | Deductible $2,200 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Precision Bronze HMO? 205 | Deductible $6,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue FocusCare Silver? 210 | Deductible $4,150 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Security PPO? 200 | Deductible $7,900 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Bronze PPO? 202 | Deductible $3,150 | Coinsurance Not applicable | Out of Pocket $6,650 |
| Plan Blue Precision Gold HMO? 207 | Deductible $500 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Silver PPO? 203 | Deductible $2,200 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Precision Gold HMO? 207 | Deductible $500 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits | Deductible $6,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Security PPO? 200 | Deductible $7,900 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Security PPO? 200 | Deductible $7,900 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Precision Gold HMO? 207 | Deductible $500 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Security PPO? 200 | Deductible $7,900 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Precision Gold HMO? 207 | Deductible $500 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue FocusCare Gold? 211 | Deductible $500 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Silver PPO? 203 | Deductible $2,200 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Security PPO? 200 | Deductible $7,900 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Bronze PPO? 202 | Deductible $3,150 | Coinsurance Not applicable | Out of Pocket $6,650 |
| Plan Blue Choice Preferred Bronze PPO? 202 | Deductible $3,150 | Coinsurance Not applicable | Out of Pocket $6,650 |
| Plan Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits | Deductible $6,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Silver PPO? 203 | Deductible $2,200 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Precision Bronze HMO? 205 | Deductible $6,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue FocusCare Bronze? 209 | Deductible $6,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Gold PPO? 204 | Deductible $750 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Precision Bronze HMO? 205 | Deductible $6,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Gold PPO? 204 | Deductible $750 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits | Deductible $6,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Security PPO? 200 | Deductible $7,900 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Silver PPO? 203 | Deductible $2,200 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Precision Silver HMO? 206 | Deductible $2,500 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Precision Silver HMO? 206 | Deductible $2,500 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Gold PPO? 204 | Deductible $750 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Gold PPO? 204 | Deductible $750 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Bronze PPO? 202 | Deductible $3,150 | Coinsurance Not applicable | Out of Pocket $6,650 |
| Plan Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits | Deductible $6,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Silver PPO? 203 | Deductible $2,200 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits | Deductible $6,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Bronze PPO? 202 | Deductible $3,150 | Coinsurance Not applicable | Out of Pocket $6,650 |
| Plan Blue Choice Preferred Silver PPO? 203 | Deductible $2,200 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Precision Bronze HMO? 205 | Deductible $6,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan BlueCare Direct Silver? 212 with Advocate | Deductible $2,500 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Gold PPO? 204 | Deductible $750 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits | Deductible $6,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Bronze PPO? 202 | Deductible $3,150 | Coinsurance Not applicable | Out of Pocket $6,650 |
| Plan Blue Precision Gold HMO? 207 | Deductible $500 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Gold PPO? 204 | Deductible $750 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Gold PPO? 204 | Deductible $750 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Silver PPO? 203 | Deductible $2,200 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Bronze PPO? 202 | Deductible $3,150 | Coinsurance Not applicable | Out of Pocket $6,650 |
| Plan Blue Choice Preferred Security PPO? 200 | Deductible $7,900 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan BlueCare Direct Silver? 212 with Advocate | Deductible $2,500 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Security PPO? 200 | Deductible $7,900 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Precision Silver HMO? 206 | Deductible $2,500 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Precision Silver HMO? 206 | Deductible $2,500 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits | Deductible $6,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Security PPO? 200 | Deductible $7,900 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Precision Silver HMO? 206 | Deductible $2,500 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Bronze PPO? 202 | Deductible $3,150 | Coinsurance Not applicable | Out of Pocket $6,650 |
| Plan Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits | Deductible $6,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Security PPO? 200 | Deductible $7,900 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Security PPO? 200 | Deductible $7,900 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Precision Silver HMO? 206 | Deductible $2,500 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Gold PPO? 204 | Deductible $750 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Silver PPO? 203 | Deductible $2,200 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Bronze PPO? 202 | Deductible $3,150 | Coinsurance Not applicable | Out of Pocket $6,650 |
| Plan Blue Choice Preferred Security PPO? 200 | Deductible $7,900 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan BlueCare Direct Silver? 212 with Advocate | Deductible $2,500 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Precision Gold HMO? 207 | Deductible $500 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Silver PPO? 203 | Deductible $2,200 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan BlueCare Direct Silver? 212 with Advocate | Deductible $2,500 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Gold PPO? 204 | Deductible $750 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits | Deductible $6,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Bronze PPO? 202 | Deductible $3,150 | Coinsurance Not applicable | Out of Pocket $6,650 |
| Plan Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits | Deductible $6,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Bronze PPO? 202 | Deductible $3,150 | Coinsurance Not applicable | Out of Pocket $6,650 |
| Plan Blue Choice Preferred Silver PPO? 203 | Deductible $2,200 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Precision Bronze HMO? 205 | Deductible $6,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Gold PPO? 204 | Deductible $750 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Bronze PPO? 202 | Deductible $3,150 | Coinsurance Not applicable | Out of Pocket $6,650 |
| Plan Blue Choice Preferred Bronze PPO? 201 - Two $40 PCP Visits | Deductible $6,000 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Silver PPO? 203 | Deductible $2,200 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Precision Gold HMO? 207 | Deductible $500 | Coinsurance Not applicable | Out of Pocket $7,900 |
| Plan Blue Choice Preferred Gold PPO? 204 | Deductible $750 | Coinsurance Not applicable | Out of Pocket $7,900 |