Blue Cross Blue Shield Blue Advantage HMO Plan

Blue Advantage HMO is an HMO operated by Blue Cross Blue Shield of Illinois. As an Independent Practice Association (IPA), Blue Advantage HMO contracts with doctors, clinics and hospitals throughout the Chicago area.

Your cost for the plan depends on the coverage you select and your income.

Network Providers

When you enroll in an HMO, you must choose a Primary Care Physician (PCP).  As long as your care is coordinated by your Primary Care Physician, Blue Advantage HMO generally covers 100% of the cost for approved care after you pay your required copayment.  When you need care, you must call or visit your PCP first.  Each member of your family may have his or her own PCP.

Your PCP’s responsibilities include:

• Giving you regular checkups.

• Providing treatment when you are ill.

• Ordering necessary X-rays, lab work and other tests.

• Referring you to a specialist, if medically necessary..

• Arranging for outpatient treatment or hospitalization.

• Filing your claims.

In most cases, you must use doctors and hospitals in the Blue Advantage HMO network to receive benefits. If you go to a doctor or hospital outside the Blue Advantage HMO network for care without prior approval, you will not receive any benefits from the plan, except for emergencies.

Cost of Coverage

Your cost for the plan depends on the coverage you select and your income. Please visit Medical, Dental and Vision Plan Rates. 

Prescription Drugs

Administered  by Prime Therapeutics

Participating Retail Pharmacy - Per prescription for up to 30-day supply

• Generic - $10 Copayment

• Preferred Brand - $30 Copayment

• Non-Preferred Brand - $50 Copayment

• Specialty - $75 Copayment

Mail Order - Per prescription for up to 90-day supply

• Generic - $20 Copayment

• Preferred Brand - $60 Copayment

• Non-Preferred Brand - $100 Copayment

Injectables - $50 Copayment