March 18, 2010

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Blue Cross and Blue Shield of Illinois – Blue Value Advantage – ILLINOIS

A comparison of the Blue Value Advantage offered by Blue Cross and Blue Shield of Illinois is detailed out below for both Network and Non-Network coverage.

  Network Non-Network
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Network See Provider See Provider
Application Blue Value Advantage Application Blue Value Advantage Application
Brochure Blue Value Advantage Brochure Blue Value Advantage Brochure
Copay N/A N/A
Office Visit Subject to deductible and coinsurance Subject to deductible and coinsurance
Deductible $1,750 Individual, $5,250 Family $1,750 Individual, $5,250 Family
Coinsurance 80% 50%
Coinsurance Limit Blue Value Advantage Blue Value Advantage
Out-of-Pocket Maximum Single: $3,000 + deductible
Family: Three times single Out Of Pocket		 Single: $6,000 + deductible
Family: Three times single Out Of Pocket
Lifetime Maximum $5,000,000 $5,000,000
Prescription Drugs You pay 20% after deductible You pay 20% after deductible
Emergency Room
  • (Accident or Illness) For bothHospital and Physician, Blue Value Advantage pays 80% after $75 copayment per visit
  • Deductible does not apply.
    		•
  • (Accident or Illness) For bothHospital and Physician, Blue Value Advantage pays 80% after $75 copayment per visit
  • Deductible does not apply.
    		•
    Adult Preventative Care Not Covered
  • To age 16. Includes immunizations, physical exams, and routine diagnostic tests.
  • $500 calendar year maximum, per dependent.
  • You pay coinsurance after deductible
    		•
    Child Preventative Care
  • To age 16. Includes immunizations, physical exams, and routine diagnostic tests.
  • $500 calendar year maximum, per dependent.
  • You pay coinsurance after deductible
    		•
  • To age 16. Includes immunizations, physical exams, and routine diagnostic tests.
  • $500 calendar year maximum, per dependent.
  • You pay coinsurance after deductible
    		•
    Lab / X-Ray You pay coinsurance after deductible You pay coinsurance after deductible
    Maternity
  • Optional Maternity Coverage
  • You pay coinsurance after deductible
  • When elected, maternity benefits will begin 365 days after the effective date of the maternity coverage.
    		•
  • Optional Maternity Coverage
  • You pay coinsurance after deductible
  • When elected, maternity benefits will begin 365 days after the effective date of the maternity coverage.
    		•
    Physical Therapy
  • You pay coinsurance after deductible
  • Physical, Occupational, and Speech Therapist Services, $3,000 maximum per therapy, per calendar year.
  • You coinsurance payment does not apply to out-of-pocket expense limit
    		•
  • You pay coinsurance after deductible
  • Physical, Occupational, and Speech Therapist Services, $3,000 maximum per therapy, per calendar year.
  • You coinsurance payment does not apply to out-of-pocket expense limit
    		•
    Skilled Nursing You pay coinsurance after deductible You pay coinsurance after deductible
    Home Health Care You pay coinsurance after deductible You pay coinsurance after deductible
    Mental Health
  • Inpatient Care (30 Inpatient Hospital days per calendar year.)- Physician: you pay coinsurance after deductible
    - Hospital: you pay 40% after deductible for First 14 days, and you pay 50% after deductible thereafter
  • Outpatient Care (30 visits per calendar year combined annual maximum and 100 visits per lifetime maximum.)- Physician and Hospital: you pay 50% after deductible
  • You coinsurance payment does not apply to out-of-pocket expense limit
    		•
  • Inpatient Care (30 Inpatient Hospital days per calendar year.)
    - Physician: you pay coinsurance after deductible
    - Hospital: you pay 50% after deductible
  • Outpatient Care (30 visits per calendar year combined annual maximum and 100 visits per lifetime maximum.)
    - Physician and Hospital: you pay 50% after deductible
  • You coinsurance payment does not apply to out-of-pocket expense limit
    		•
    Hospital Care
  • $0 Hospital Admission Deductible per admission, per individual.
  • You pay coinsurance after deductible
  • Includes surgery, pre-admission testing and services received in a skilled nursing facility, coordinated home care program and hospice.
    		•
  • $300 Hospital Admission Deductible per admission, per individual. (does not apply to out-of-pocket expense limit)
  • You pay coinsurance after deductible
  • Includes surgery, pre-admission testing and services received in a skilled nursing facility, coordinated home care program and hospice.
    		•
    Optional Benefits Blue Value Advantage Blue Value Advantage