BlueCare Direct with Advocate Silver Plans
Chicago-area residents now have a new choice for health care coverage. Blue Cross and Blue Shield of Illinois (BCBSIL) has teamed up with Advocate Health Care* to offer a new, more affordable health plan — BlueCare Direct.
BlueCare Direct. Great Access. More Affordable Coverage.
BlueCare Direct combines the strength, expertise and reputation of two of the state’s most respected leaders in the health industry. Advocate is the largest health system in Illinois, and BCBSIL is the largest health insurer in the state. Advocate is uniquely positioned to deliver quality patient outcomes, while working to manage overall health care costs, with the goal of delivering value to our members. BlueCare may be right for you if you are willing to have a primary care physician (PCP) coordinate your care, prefer or live near an Advocate hospital (Cook, Dupage, Kane, Lake, and Will Counties), are expecting to have surgery or major services in the near future and want the lowest out of pocket costs, or require regular prescription medication. 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- BlueCare Direct Silver 212 Rx Copays – $7,500 individual deductible, 50% coinsurance, and $100 PCP visit.
- *NEW* BlueCare Direct Silver 803 – $5,900 individual deductible, 40% coinsurance, and $40 PCP visit.
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
| 212 Rx Copays | 803 | |
| What is the overrall deductible? | $7,500 / $15,000 | $5,900 / $11,800 |
| Are there services covered before you meet deductible | Yes. | Yes. |
| Are there other deductibles for specific services | No. | No. |
| Out-of-pocket limit Individual/Family** | $9,450 / $18,900 | $9,100 / $18,200 |
| Will you pay less if you use network provider? | Yes. | Yes. |
| Referral to see a specialist? | No. | No. |
**Premiums, balance billing & health care this plan doesn’t cover are not included in the out-of-pocket limit
Office Visit / Testing
| 212 Rx Copays | 803 | |
| Primary Care for injury/illness | $100/visit | $40/visit |
| Specialist visit | $130/visit | $80/visit |
| Preventative care/screening | No Charge | No Charge |
| Diagnostic test (xray, blood) Freestanding / Hospital | $90/test | 40% |
| Imaging (CT/PET/MRI) Freestanding / Hospital | $250/test | 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
| 212 Rx Copays | 803 | |
| Generic Drugs (Preferred) | $25 / $75 | $20 / $60 |
| Generic Drugs (Non Preferred) | $70 / $210 | $20 / $60 |
| Brand drugs (Preferred) | $85 / $255 | $40 / $120 |
| Brand Drugs Non Preferred | $120 / $360 | $80 / $240 |
| Specialty Drugs Preferred | $250 | $350 |
| Specialty Drugs Non Preferred | $500 | $350 |
Outpatient Surgery / Emergency Comparison
| 212 Rx Copays | 803 | |
| Facility Fee Freestanding | $350/visit + 50% | 40% |
| Facility fee Hospital | NA | NA |
| Physician/surgeon Fee | $90/visit | 40% |
| Emergency Room Care | $1,200/visit + 50% | 40% |
| Emergency Medical Transportation | 50% | 40% |
| Urgent Care | $130/visit | $60/visit |
Hospital Stay / Health Services / Pregnancy
| 212 Rx Copays | 803 | |
| Facility Fee for hospital stay | $500/visit + 50% | 40% |
| Physician/surgeon Fees | No Charge | No Charge |
| Mental health, behavioral health, or substance abuse services: Outpatient | $100 office, 50% other | $40 office, 40% other |
| Mental health, behavioral health, or substance abuse services: Inpatient | $500/visit + 50% | 40% |
| If you are pregnant – office visit | Primary: $100 / Specialist: $130 | Primary: $40 / Specialist: $80 |
| Childbirth/delivery/professional services | No Charge | No Charge |
| Childbirth/delivery facility services | $500/visit + 50% | 40% |
Help recovering / other special needs
| 212 Rx Copays | 803 | |
| Home Health Care | No Charge | No Charge |
| Rehabilitation Services | $100/visit | $40/visit |
| Habilitation services | $100/visit | $40/visit |
| Skilled nursing care | 50% | 40% |
| Durable medical equipment | No Charge | No Charge |
| Hospice services | 50% | 40% |
Childrens Dental / Eye care
| 212 Rx Copays | 803 | |
| Children’s eye exam | No Charge | No Charge |
| Children’s Glasses | No Charge | No Charge |
| Children’s Dental check-up | 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.)
| 212 Rx Copays | 803 | |
| Acupuncture | ✓ | ✓ |
| Dental Care (Adult) | ✓ | ✓ |
| Long-term Care | ✓ | ✓ |
| Non-emergency care when traveling outside of US | ✓ | ✓ |
| Weight loss programs | ✓ | ✓ |
| 212 Rx Copays | 803 | |
| Abortion care | ✓ | ✓ |
| Bariatric surgery | ✓ | ✓ |
| Chiropractic care | ✓ | ✓ |
| Cosmetic surgery | ✓ | ✓ |
| Hearing aids | ✓ | ✓ |
| Infertility treatment | ✓ | ✓ |
| Private-duty nursing | ✓ | ✓ |
| Routine eye care | ✓ | ✓ |
| Routine Foot Care | ✓ | ✓ |
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