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Blue Cross and Blue Shield of Illinois – BlueEdge Individual HSA – ILLINOIS
A comparison of the BlueEdge Individual HSA offered by Blue Cross and Blue Shield of Illinois is detailed out below for both Network and Non-Network coverage.
| Network | Non-Network | |
|---|---|---|
|
||
| Network | See Provider | See Provider |
| Application | BlueEdge Individual HSA Application | BlueEdge Individual HSA Application |
| Brochure | BlueEdge Individual HSA Brochure | BlueEdge Individual HSA Brochure |
| Copay | Subject to deductible and coinsurance | Subject to deductible and coinsurance |
| Office Visit | Subject to deductible and coinsurance | Subject to deductible and coinsurance |
| Deductible | BlueEdge Individual HSA | BlueEdge Individual HSA |
| Coinsurance | BlueEdge Individual HSA | BlueEdge Individual HSA |
| Coinsurance Limit | BlueEdge Individual HSA | BlueEdge Individual HSA |
| Out-of-Pocket Maximum | BlueEdge Individual HSA | BlueEdge Individual HSA |
| Lifetime Maximum | $5,000,000 | $5,000,000 |
| Prescription Drugs | BlueEdge Individual HSA | BlueEdge Individual HSA |
| Emergency Room | BlueEdge Individual HSA | BlueEdge Individual HSA |
| Adult Preventative Care | Wellness Care (From age 16 - Covers services associated with both an annual physical exam and an annual gynecological exam. Includes immunizations and routine diagnostic tests received or ordered on the same day as the exam - $500 calendar-year maximum, per person) -
|
BlueEdge Individual HSA |
| Child Preventative Care | Well-Child Care (To age 16 - Includes immunizations, physical exams and routine diagnostic tests - $500 calendar-year maximum per dependent for non-participating provider services only): $20 copayment per office visit, subject to deductible and coinsurance | BlueEdge Individual HSA |
| Lab / X-Ray | BlueEdge Individual HSA | BlueEdge Individual HSA |
| Maternity | Not covered (Optional Maternity Coverage) | Not covered (Optional Maternity Coverage) |
| Physical Therapy | BlueEdge Individual HSA | BlueEdge Individual HSA |
| Skilled Nursing | BlueEdge Individual HSA | BlueEdge Individual HSA |
| Home Health Care | BlueEdge Individual HSA | BlueEdge Individual HSA |
| Mental Health | Mental Health Unit: In order to maximum your benefits, the Policyholder is responsible for notifying the Mental Health Unit for all care related to mental health and substance abuse. In the event of an admission, for either mental illness or substance abuse, notification is required three days prior for non-emergencies and within 24 hours or as soon as reasonably possible for emergencies. If Policyholder does not notify the Mental Health Unit, the Policyholder will then be responsible for the first $1,000 or 50% of the Hospital charge, whichever is less | Mental Health Unit: In order to maximum your benefits, the Policyholder is responsible for notifying the Mental Health Unit for all care related to mental health and substance abuse. In the event of an admission, for either mental illness or substance abuse, notification is required three days prior for non-emergencies and within 24 hours or as soon as reasonably possible for emergencies. If Policyholder does not notify the Mental Health Unit, the Policyholder will then be responsible for the first $1,000 or 50% of the Hospital charge, whichever is less |
| Hospital Care | BlueEdge Individual HSA | BlueEdge Individual HSA |
| Optional Benefits | BlueEdge Individual HSA | BlueEdge Individual HSA |