BlueCare Direct Silver℠ 212 with Advocate – Rx Copays – HMO
94% cost sharing reduction [Popular Plan]
Network type: HMO
Coverage tier: Silver
Primary care visit: No charge
Specialist visit: No charge
Urgent care visit: No charge
Description
This plan has 94% cost sharing reduction [Popular Plan]
Health Care Plan Details
| Network type | HMO |
| Deductible | $0 per person $0 per person |
| Out-of-pocket max | $2,000 per person $4,000 per family |
| Metal tier | Silver |
Visit Copay
| Primary care visit | No charge |
| Specialist visit | No charge |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | No charge |
| Emergency room | $500 copay, 20% coinsurance |
| Ambulance | 20% coinsurance |
| Hospital stay (facility) | $200 copay per Stay, 20% coinsurance |
| Hospital stay (physician) | No charge |
| Outpatient procedure (facility) | 20% coinsurance |
| Outpatient procedure (physician) | No charge |
| Physical rehabilitation | No charge |
Maternitowny and Pregnancy
| Well baby care | No charge |
| Labor, delivery, hospital stay | $200 copay, 20% coinsurance |
Pharmacy, Drugs, and Medication
| Generic | $10 copay |
| Brand | $30 copay |
| Non-preferred Brand | $100 copay |
| Specialty | $250 copay |
Lab Tests and Diagnostic Procedures
| X-rays | No charge |
| Imaging (CT/PET/MRI) | No charge |
| Blood work | No charge |
Mental and Psychiatric Health Care
| Mental Health outpatient services | No charge |
| Psychiatric hospital stay | $200 copay per Stay, 20% coinsurance |
Health Plan Provider Information
| Health Plan Benefits | https://www.bcbsil.com/sbc/ind/sbc-sh6h30bhdiilp-il-2024.pdf |
| Drug and medication plan formulary | https://www.myprime.com/content/dam/prime/memberportal/WebDocs/2024/Formularies/HIM/2024_IL_6T_HMO_HIM.pdf |
| Search doctor list | https://my.providerfinderonline.com/?ci=il-bluecaredirect-retail&corp_code=IL |
