| Field | Data |
|---|---|
| Health Insurance Plan ID | 36096IL0810142 |
| Health Insurance Plan Year | 2023 |
| State | Illinois |
| Health Insurance Issuer | Blue Cross Blue Shield of Illinois |
| Plan Formulary Description URL | Formulary URL |
| Plan Marketing Materials URL | Marketing URL |
| Last Plan Update Date | Thu, 12 Jan 2023 00:00 GMT |
| Last Import Date | Sun, 01 Oct 2023 10:53 GMT |
| Health Insurance Plan Variant | 36096IL0810142-01 |
| Available Variants of the Health Plan | |
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.780017779 |
| Begin Primary Care Cost-Sharing After Number Of Visits | 0 |
| Begin Primary Care Deductible Coinsurance After Number Of Copays | 0 |
| Business Year | 2023 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Gold On Exchange Plan |
| Dental Only Plan | No |
| Design Type | Design 1 |
| Disease Management Programs Offered | Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy |
| EHB Percent of Total Premium | 0.998457631 |
| First Tier Utilization | 100% |
| Formulary ID | ILF015 |
| Formulary URL | URL |
| HIOS Product ID | 36096IL081 |
| Import Date | 1/12/2023 20:00 |
| Limited Cost Sharing Plan Variation - Estimated Advanced Payment | $0.00 |
| Inpatient Copayment Maximum Days | 0 |
| HSA Eligible | No |
| New/Existing Plan | New |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | Yes |
| Issuer ID | 36096 |
| Issuer Marketplace Marketing Name | Blue Cross and Blue Shield of Illinois |
| Market Coverage | Individual |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Gold |
| Multiple In Network Tiers | No |
| National Network | No |
| Network ID | ILN002 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | 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. |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Coverage outside our service area is available for Emergency and Urgent Care services only. |
| Plan Brochure | URL |
| Plan Effective Date | 1/1/2023 |
| Plan ID (Standard Component ID with Variant) | 36096IL0810142-01 |
| Plan Marketing Name | Blue Precision Gold HMO℠ 707 |
| Plan Type | HMO |
| Plan Variant Marketing Name | Blue Precision Gold HMO℠ 707 |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $1,600 |
| SBC Scenario, Having a Baby, Copayment | $40 |
| SBC Scenario, Having a Baby, Deductible | $2,000 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $900 |
| SBC Scenario, Having Diabetes, Deductible | $100 |
| SBC Scenario, Having Diabetes, Limit | $20 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $300 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $1,800 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | ILS022 |
| Source Name | SERFF |
| Specialist Requiring a Referral | Referrals are required for some services. Please check with your Medical Group for details. |
| Plan ID | 36096IL0810142 |
| State Code | IL |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group | per group not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person | per person not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual | Not Applicable |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group | per group not applicable |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person | per person not applicable |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance | 25.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group | $4000 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person | $2000 per person |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $2,000 |
| TEHBDedOutOfNetFamilyPerGroup | per group not applicable |
| TEHBDedOutOfNetFamilyPerPerson | per person not applicable |
| Combined Medical and Drug EHB Deductible, Out of Network, Individual | Not Applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group | $17400 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person | $8700 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $8,700 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group | per group not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person | per person not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | Not Applicable |
| Unique Plan Design | No |
| URL for Enrollment Payment | URL |
| URL for Summary of Benefits & Coverage | URL |
| Wellness Program Offered | No |
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about Blue Precision Gold HMO℠ 707, 36096IL0810142 Health Insurance Plan, 36096IL0810142
Does Blue Precision Gold HMO℠ 707 Health Insurance Plan, 36096IL0810142 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (36096IL0810142) Health Insurance Plan, Variant (36096IL0810142-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy
Does (36096IL0810142) Health Insurance Plan, Variant (36096IL0810142-01) have Out Of Country Coverage?
Yes. Details: 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.
Does (36096IL0810142) Health Insurance Plan, Variant (36096IL0810142-01) have Out of Service Area Coverage?
Yes. Details: Coverage outside our service area is available for Emergency and Urgent Care services only.
Does (36096IL0810142) Health Insurance Plan, Variant (36096IL0810142-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy
Does Blue Precision Gold HMO℠ 707 Health Insurance Plan, Variant (36096IL0810142-01) offer Disease Management Programs for Asthma?
Yes, the Blue Precision Gold HMO℠ 707 Health Insurance Plan Variant 36096IL0810142-01 offers Disease Management Program for Asthma.
Does Blue Precision Gold HMO℠ 707 Health Insurance Plan, Variant (36096IL0810142-01) offer Disease Management Programs for Heart disease?
Yes, the Blue Precision Gold HMO℠ 707 Health Insurance Plan Variant 36096IL0810142-01 offers Disease Management Program for Heart disease.
Does Blue Precision Gold HMO℠ 707 Health Insurance Plan, Variant (36096IL0810142-01) offer Disease Management Programs for Depression?
Yes, the Blue Precision Gold HMO℠ 707 Health Insurance Plan Variant 36096IL0810142-01 offers Disease Management Program for Depression.
Does Blue Precision Gold HMO℠ 707 Health Insurance Plan, Variant (36096IL0810142-01) offer Disease Management Programs for Diabetes?
Yes, the Blue Precision Gold HMO℠ 707 Health Insurance Plan Variant 36096IL0810142-01 offers Disease Management Program for Diabetes.
Does Blue Precision Gold HMO℠ 707 Health Insurance Plan, Variant (36096IL0810142-01) offer Disease Management Programs for High blood pressure & high cholesterol?
Yes, the Blue Precision Gold HMO℠ 707 Health Insurance Plan Variant 36096IL0810142-01 offers Disease Management Program for High blood pressure & high cholesterol.
Does Blue Precision Gold HMO℠ 707 Health Insurance Plan, Variant (36096IL0810142-01) offer Disease Management Programs for Low back pain?
Yes, the Blue Precision Gold HMO℠ 707 Health Insurance Plan Variant 36096IL0810142-01 offers Disease Management Program for Low back pain.
Does Blue Precision Gold HMO℠ 707 Health Insurance Plan, Variant (36096IL0810142-01) offer Disease Management Programs for Pain management?
Yes, the Blue Precision Gold HMO℠ 707 Health Insurance Plan Variant 36096IL0810142-01 offers Disease Management Program for Pain management.
Does Blue Precision Gold HMO℠ 707 Health Insurance Plan, Variant (36096IL0810142-01) offer Disease Management Programs for Pregnancy?
Yes, the Blue Precision Gold HMO℠ 707 Health Insurance Plan Variant 36096IL0810142-01 offers Disease Management Program for Pregnancy.
Disclaimer: This is based on the import(Date: Sun, 01 Oct 2023 10:53 GMT) of the data from Healthcare Issuers listed by CMS. While we make every effort to ensure that data is accurate, you should assume all results are unvalidated. Source: CMS.gov, HealthPorta HEALTHCARE MRF API