Zip Code | 60629 |
Applicant | 1/15/1986 Male |
Insurance Type | ACA (Obamacare) |
Plan Name | Blue Precision Gold HMO 207 |
Plan ID | hhs-36096IL0810080 |
Plan Year | 2020 |
Insurance Provider | Blue Cross Blue Shield of Illinois |
Metal Level | Gold |
Plan Type | HMO |
Deductible | $750 |
Out-of-Pocket Maximum | $8,150 |
Plan Highlights |
Costs for Medical Care | |
---|---|
Primary Care Visit to Treat an Injury or Illness | $20 Copay |
Specialist Visit | $40 Copay |
Laboratory Outpatient and Professional Services | $40 Copay |
X-rays and Diagnostic Imaging | $40 Copay |
Diagnostic Imaging such as MRIs, CT, and PET scans | $250 Copay |
Deductible - Family | $2250 per group |
Out-of-Pocket Maximum - Family | $16300 per group |
Prescription drug coverage | |
---|---|
Generic Drugs | 10.00% Coinsurance after deductible |
Preferred Brand Drugs | 20.00% Coinsurance after deductible |
Non-Preferred Brand Drugs | 30.00% Coinsurance after deductible |
Specialty Drugs | 40.00% Coinsurance after deductible |
Access to doctors and hospitals | |
---|---|
Provider directory URL | http://www.bcbsil.com/providers/index.htm |
Does this plan have access to a national provider network? | No |
Is a referral required to see a Specialist? | Yes - Referrals are required for some services. Please check with your Medical Group for details. |
Does this plan cover services outside plan service area? | Yes - Coverage outside our service area is available for Emergency and Urgent Care services only. |
Does this plan cover services outside the country? | Yes - This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs. |
Hospital services | |
---|---|
Emergency Room Services | $1000 Copay with deductible, 30.00% Coinsurance after deductible. See plan brochure for when Copay is applicable. |
Inpatient Hospital Services (e.g., Hospital Stay) | $750 Copay per Day |
Inpatient Physician and Surgical Services | Not Applicable |
Emergency Transportation or Ambulance Service | 30.00% Coinsurance after deductible |
Maternity | |
---|---|
Prenatal and Postnatal Care | $20 Copay |
Delivery and all inpatient services for maternity care | $750 Copay |
Mental Health | |
---|---|
Mental/Behavioral Health Outpatient Services | $20 Copay |
Mental/Behavioral Health Inpatient Services | $750 Copay per Day |
Substance use disorder outpatient services | $20 Copay |
Substance use disorder inpatient services | $750 Copay per Day |
Medical Management Programs | |
---|---|
Does this plan offer disease managment programs? | Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy |
Does this plan offer a wellness program? | Not Covered |
Vision Coverage | |
---|---|
Routine Eye Exam for Children | Included |
Eye Glasses for Children | Included |
Routine Eye Exam for Adults | Included |
Child Dental Coverage | |
---|---|
Child Dental Coverage - Routine Dental Care | Not Covered |
Child Dental Coverage - Basic Dental Care | Not Covered |
Child Dental Coverage - Orthodontia | Not Covered |
Child Dental Coverage - Major Dental Care | Not Covered |
Adult Dental Coverage | |
---|---|
Adult Dental Coverage - Routine Dental Care | Not Covered |
Adult Dental Coverage - Basic Dental Care | Not Covered |
Adult Dental Coverage - Orthodontia | Not Covered |
Adult Dental Coverage - Major Dental Care | Not Covered |
Exclusions and Limitations | |
---|---|
More Included Benefits | Other Practitioner Office Visit (Nurse, Physician Assistant) Preventive Care/Screening/Immunization Skilled Nursing Facility Bariatric Surgery Cosmetic Surgery Private-Duty Nursing Imaging (CT/PET Scans, MRIs) Outpatient Surgery Physician/Surgical Services Urgent Care Centers or Facilities Inpatient Physician and Surgical Services Home Health Care Services Outpatient Rehabilitation Services Habilitation Services Durable Medical Equipment Hospice Services Routine Foot Care Abortion for Which Public Funding is Prohibited Accidental Dental Allergy Testing Chemotherapy Diabetes Education Dialysis Infusion Therapy Laboratory Outpatient and Professional Services Nutritional Counseling Prosthetic Devices Radiation Reconstructive Surgery Rehabilitative Occupational and Rehabilitative Physical Therapy Rehabilitative Speech Therapy Transplant Treatment for Temporomandibular Joint Disorders Well Baby Visits and Care Prescription Drugs Other Outpatient Facility Fee (e.g., Ambulatory Surgery Center) |
More Limited Benefits | Hearing Aids Infertility Treatment Chiropractic Care |
More Excluded Benefits | Acupuncture Long-Term/Custodial Nursing Home Care Weight Loss Programs Dental Check-Up for Children |
ObamaCare’s Gold Plan is a type of Metal Plan on the Health Insurance Marketplace. Gold Plans qualify for Tax Credits, have high premiums, and good cost sharing. Gold plans mean higher premiums, less Tax Credits, but much better cost sharing on average than Silver or Bronze.
The fundamental difference among the new Obamacare health plans is the percentage of covered medical costs paid by the health plan. The Gold Plan typically pays 80% of covered medical costs.
The monthly premium for a Gold Plan depends on the insurer from whom you purchase the plan, the number of people to be insured by the plan, your age, whether you smoke, and your geographic region. You can use HealthPocket’s comparison tool to compare Gold Plan premiums in your area.
The Open Enrollment period for the 2018 Affordable Care Act health plans begins November 1, 2017 and ends December 15, 2017. See our Open Enrollment article for more information.
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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, or an individual and family health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is part of the Benefytt Technologies, Inc. family of companies.