Blue Precision Gold HMO 207 Plan Details for 2021- HealthPocket

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Applicant Info
Applicant
Date of birth
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Gender
male
female
Income
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Zip Code	60629 (edit)
Applicant	1/15/1986 Male (edit)

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

+ See All Coverage Details

Premium	Plan Name	Deductible
from $393	Blue FocusCare Gold? 211	$750.00	Select
from $539	Blue Precision Gold HMO? 207	$750.00	Select

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Phone Number
(773) 884-1662
Office Locations
2701 W 68th St
Chicago, IL 60629

What is the Gold Plan?
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.
How are Gold Plans different than other Obamacare health plans?
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.
How much does a Gold Plan cost?
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.
When Can I Enroll in a Gold Plan?
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.

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.

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Date of birth
//
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Income
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Blue Precision Gold HMO 207

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Benefits & Coverage

Costs for Medical Care

Prescription drug coverage

Access to doctors and hospitals

Hospital services

Maternity

Mental Health

Medical Management Programs

Vision Coverage

Child Dental Coverage

Adult Dental Coverage

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