Blue FocusCare Bronze? 209 Plan Details for 2021- HealthPocket

Blue FocusCare Bronze? 209

$256.43/mo

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Zip Code60629
Applicant11/26/1985 Male
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameBlue FocusCare Bronze? 209
Plan IDhhs-36096IL1000009
Plan Year2021
Insurance ProviderBlue Cross Blue Shield of Illinois
Metal LevelExpanded Bronze
Plan TypeHMO
Deductible$7,400
Out-of-Pocket Maximum$0
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$60 Copay
Specialist Visit$85 Copay
Laboratory Outpatient and Professional Services$100 Copay
X-rays and Diagnostic Imaging$150 Copay
Diagnostic Imaging such as MRIs, CT, and PET scans$300 Copay
Deductible - Family$17100 per group

Prescription drug coverage

Generic Drugs10.00% Coinsurance after deductible
Preferred Brand Drugs20.00% Coinsurance after deductible
Non-Preferred Brand Drugs30.00% Coinsurance after deductible
Specialty Drugs40.00% Coinsurance after deductible

Access to doctors and hospitals

Provider directory URLhttps://public.hcsc.net/providerfinder/search.do?corpEntCd=IL1
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, 50.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Inpatient Hospital Services (e.g., Hospital Stay)$850 Copay per Day
Inpatient Physician and Surgical ServicesNot Applicable
Emergency Transportation or Ambulance Service50.00% Coinsurance after deductible

Maternity

Prenatal and Postnatal Care$60 Copay
Delivery and all inpatient services for maternity care$850 Copay

Mental Health

Mental/Behavioral Health Outpatient Services$60 Copay
Mental/Behavioral Health Inpatient Services$850 Copay per Day
Substance use disorder outpatient services$60 Copay
Substance use disorder inpatient services$850 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 ChildrenIncluded
Eye Glasses for ChildrenIncluded
Routine Eye Exam for AdultsIncluded

Child Dental Coverage

Child Dental Coverage - Routine Dental CareNot Covered
Child Dental Coverage - Basic Dental CareNot Covered
Child Dental Coverage - OrthodontiaNot Covered
Child Dental Coverage - Major Dental CareNot Covered

Adult Dental Coverage

Adult Dental Coverage - Routine Dental CareNot Covered
Adult Dental Coverage - Basic Dental CareNot Covered
Adult Dental Coverage - OrthodontiaNot Covered
Adult Dental Coverage - Major Dental CareNot Covered

Exclusions and Limitations

More Included BenefitsOther 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 BenefitsHearing Aids
Infertility Treatment
Chiropractic Care
More Excluded BenefitsAcupuncture
Long Term Care
Weight Loss Programs
Dental Check-Up for Children
Dental Care - Adult
Long-Term/Custodial Nursing Home Care
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Ambetter Balanced Care 4 (2021) + Vision + Adult Dental
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  • Phone Number
    (773) 884-1662
  • Office Locations
    2701 W 68th St
    Chicago, IL 60629
2701 W 68th St Chicago IL, 60629

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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.