Plan Year 2017 Individual Retail Products
Links to Summaries of Benefits and Coverage (SBC) and Plan Comparison Chart documents for all Blue Cross and
Blue Shield of Illinois (BCBSIL) products in the under 65 retail market.
PLA N Compari son Charts
COMPARISON CHART
Link to Charts
BCBSIL Platinum Plan Comparison Chart
English ● Spanish
BCBSIL Gold Plan Comparison Chart
English ● Spanish
BCBSIL Silver Plan Comparison Chart
English ● Spanish
BCBSIL Bronze Plan Comparison Chart
English ● Spanish
BCBSIL Multi-State Plan Comparison Chart
English ● Spanish
BCBSIL FocusCare Comparison Chart
English ● Spanish
PLA TI NUM Plan
PLAN NAME
Blue Precision Platinum HMO 104
Plan Variance
Marketplace or
Non Marketplace*
Link to SBC Document
n/a
Non Marketplace
Summary of Benefits
Plan Variance
Marketplace or
Non Marketplace*
Link to SBC Document
n/a
Non Marketplace
Summary of Benefits
GOLD Pl ans
PLAN NAME
Blue FocusCare Gold 101
Blue FocusCare Gold 101
n/a
Marketplace
Summary of Benefits
Blue FocusCare Gold 101
Native American Limited
Marketplace
Summary of Benefits
Blue FocusCare Gold 101
Native American Zero
Marketplace
Summary of Benefits
Non Marketplace
Summary of Benefits
Blue Precision Gold HMO 101
n/a
Blue Precision Gold HMO 101
n/a
Marketplace
Summary of Benefits
Blue Precision Gold HMO 101
Native American Limited
Marketplace
Summary of Benefits
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Blue Precision Gold HMO 101
Native American Zero
BlueCare Direct Gold 101 with Advocate
n/a
Marketplace
Summary of Benefits
Non Marketplace
Summary of Benefits
BlueCare Direct Gold 101 with Advocate
n/a
Marketplace
Summary of Benefits
BlueCare Direct Gold 101 with Advocate
Native American Limited
Marketplace
Summary of Benefits
BlueCare Direct Gold 101 with Advocate
Native American Zero
Marketplace
Summary of Benefits
Blue Cross Blue Shield Premier 101, a Multi-State Plan
n/a
Marketplace
Summary of Benefits
Blue Cross Blue Shield Premier 101, a Multi-State Plan
Native American Limited
Marketplace
Summary of Benefits
Blue Cross Blue Shield Premier 101, a Multi-State Plan
Native American Zero
Marketplace
Summary of Benefits
n/a
Non Marketplace
Summary of Benefits
Plan Variance
Marketplace or
Non Marketplace*
Link to SBC Document
BlueCare Direct Silver 102 with Advocate
n/a
Non Marketplace
Summary of Benefits
BlueCare Direct Silver 102 with Advocate
n/a
Marketplace
Summary of Benefits
BlueCare Direct Silver 102 with Advocate
Native American Limited
Marketplace
Summary of Benefits
BlueCare Direct Silver 102 with Advocate
Native American Zero
Marketplace
Summary of Benefits
BlueCare Direct Silver 102 with Advocate
73% Actuarial Value (AV)
Marketplace
Summary of Benefits
BlueCare Direct Silver 102 with Advocate
87% Actuarial Value (AV)
Marketplace
Summary of Benefits
BlueCare Direct Silver 102 with Advocate
94% Actuarial Value (AV)
Marketplace
Summary of Benefits
Blue FocusCare Silver 102
Blue FocusCare Silver 102
n/a
Non Marketplace
Summary of Benefits
n/a
Marketplace
Summary of Benefits
Blue FocusCare Silver 102
Native American Limited
Marketplace
Summary of Benefits
Blue FocusCare Silver 102
Native American Zero
Marketplace
Summary of Benefits
Blue FocusCare Silver 102
73% Actuarial Value (AV)
Marketplace
Summary of Benefits
Blue FocusCare Silver 102
Blue FocusCare Silver 102
87% Actuarial Value (AV)
Marketplace
Summary of Benefits
94% Actuarial Value (AV)
Marketplace
Summary of Benefits
Blue Choice Preferred Silver PPO 102
n/a
Non Marketplace
Summary of Benefits
Blue Choice Preferred Silver PPO 102
n/a
Marketplace
Summary of Benefits
Blue Choice Preferred Silver PPO 102
Native American Limited
Marketplace
Summary of Benefits
Blue Choice Preferred Silver PPO 102
Native American Zero
Marketplace
Summary of Benefits
Blue Choice Preferred Silver PPO 102
73% Actuarial Value (AV)
Marketplace
Summary of Benefits
Blue Choice Preferred Silver PPO 102
87% Actuarial Value (AV)
Marketplace
Summary of Benefits
Blue Precision Gold HMO 105
SI LVER Pl ans
PLAN NAME
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P AG E 2 O F 5
94% Actuarial Value (AV)
n/a
Marketplace
Non Marketplace
Summary of Benefits
Summary of Benefits
Blue Precision Silver HMO 102
n/a
Marketplace
Summary of Benefits
Blue Precision Silver HMO 102
Native American Limited
Marketplace
Summary of Benefits
Blue Precision Silver HMO 102
Native American Zero
Marketplace
Summary of Benefits
Blue Precision Silver HMO 102
73% Actuarial Value (AV)
Marketplace
Summary of Benefits
Blue Precision Silver HMO 102
87% Actuarial Value (AV)
Marketplace
Summary of Benefits
Blue Precision Silver HMO 102
94% Actuarial Value (AV)
Marketplace
Summary of Benefits
Blue Cross Blue Shield Solution 102, a Multi-State Plan
n/a
Marketplace
Summary of Benefits
Blue Cross Blue Shield Solution 102, a Multi-State Plan
Native American Limited
Marketplace
Summary of Benefits
Blue Cross Blue Shield Solution 102, a Multi-State Plan
Native American Zero
Marketplace
Summary of Benefits
Blue Cross Blue Shield Solution 102, a Multi-State Plan
73% Actuarial Value (AV)
Marketplace
Summary of Benefits
Blue Cross Blue Shield Solution 102, a Multi-State Plan
87% Actuarial Value (AV)
Marketplace
Summary of Benefits
Blue Cross Blue Shield Solution 102, a Multi-State Plan
94% Actuarial Value (AV)
Marketplace
Summary of Benefits
Blue FocusCare Silver 103
n/a
Non Marketplace
Summary of Benefits
Blue FocusCare Silver 103
n/a
Marketplace
Summary of Benefits
Blue FocusCare Silver 103
Native American Limited
Marketplace
Summary of Benefits
Blue FocusCare Silver 103
Native American Zero
Marketplace
Summary of Benefits
Blue FocusCare Silver 103
73% Actuarial Value (AV)
Marketplace
Summary of Benefits
Blue FocusCare Silver 103
87% Actuarial Value (AV)
Marketplace
Summary of Benefits
Blue FocusCare Silver 103
94% Actuarial Value (AV)
Marketplace
Summary of Benefits
Blue Choice Preferred Silver PPO 103 – Three $0 PCP
n/a
Non Marketplace
Summary of Benefits
Blue Choice Preferred Silver PPO 103 – Three $0 PCP
n/a
Marketplace
Summary of Benefits
Blue Choice Preferred Silver PPO 103 – Three $0 PCP
Native American Limited
Marketplace
Summary of Benefits
Blue Choice Preferred Silver PPO 103 – Three $0 PCP
73% Actuarial Value (AV)
Marketplace
Summary of Benefits
Blue Choice Preferred Silver PPO 103 – Three $0 PCP
87% Actuarial Value (AV)
Marketplace
Summary of Benefits
Blue Choice Preferred Silver PPO 103 – Five $0 PCP
94% Actuarial Value (AV)
Marketplace
Blue Choice Preferred Silver PPO 103
BlueCare Direct Silver 104 with Advocate
BlueCare Direct Silver 104 with Advocate
BlueCare Direct Silver 104 with Advocate
BlueCare Direct Silver 104 with Advocate
BlueCare Direct Silver 104 with Advocate
BlueCare Direct Silver 104 with Advocate
BlueCare Direct Silver 104 with Advocate
Blue Precision Silver HMO 106
Native American Zero
n/a
n/a
Native American Limited
Native American Zero
73% Actuarial Value (AV)
87% Actuarial Value (AV)
94% Actuarial Value (AV)
n/a
Marketplace
Non Marketplace
Marketplace
Marketplace
Marketplace
Marketplace
Marketplace
Marketplace
Non Marketplace
Summary of Benefits
Summary of Benefits
Summary of Benefits
Summary of Benefits
Summary of Benefits
Summary of Benefits
Summary of Benefits
Summary of Benefits
Summary of Benefits
Summary of Benefits
Blue Choice Preferred Silver PPO 102
Blue Precision Silver HMO 102
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P AG E 3 O F 5
n/a
Marketplace
Summary of Benefits
Native American Limited
Native American Zero
73% Actuarial Value (AV)
87% Actuarial Value (AV)
94% Actuarial Value (AV)
n/a
n/a
Native American Limited
Native American Zero
73% Actuarial Value (AV)
87% Actuarial Value (AV)
94% Actuarial Value (AV)
Marketplace
Marketplace
Marketplace
Marketplace
Marketplace
Non Marketplace
Marketplace
Marketplace
Marketplace
Marketplace
Marketplace
Marketplace
Summary of Benefits
Summary of Benefits
Summary of Benefits
Summary of Benefits
Summary of Benefits
Summary of Benefits
Summary of Benefits
Summary of Benefits
Summary of Benefits
Summary of Benefits
Summary of Benefits
Summary of Benefits
Plan Variance
Marketplace or
Non Marketplace*
Link to SBC Document
BlueCare Direct Bronze 103 with Advocate
BlueCare Direct Bronze 103 with Advocate
n/a
Non Marketplace
Summary of Benefits
n/a
Marketplace
Summary of Benefits
BlueCare Direct Bronze 103 with Advocate
Native American Limited
Marketplace
Summary of Benefits
BlueCare Direct Bronze 103 with Advocate
Native American Zero
Marketplace
Summary of Benefits
Blue Precision Bronze HMO 103
n/a
Non Marketplace
Summary of Benefits
Blue Precision Bronze HMO 103
n/a
Marketplace
Summary of Benefits
Blue Precision Bronze HMO 103
Native American Limited
Marketplace
Summary of Benefits
Blue Precision Bronze HMO 103
Native American Zero
Marketplace
Summary of Benefits
Blue Cross Blue shield Basic 103, a Multi-State Plan
n/a
Marketplace
Summary of Benefits
Blue Cross Blue shield Basic 103, a Multi-State Plan
Native American Limited
Marketplace
Summary of Benefits
Blue Cross Blue shield Basic 103, a Multi-State Plan
Native American Zero
Marketplace
Summary of Benefits
Blue FocusCare Bronze 104
n/a
Non Marketplace
Summary of Benefits
Blue FocusCare Bronze 104
n/a
Marketplace
Summary of Benefits
Blue FocusCare Bronze 104
Native American Limited
Marketplace
Summary of Benefits
Blue FocusCare Bronze 104
Native American Zero
Marketplace
Summary of Benefits
n/a
n/a
Native American Limited
Non Marketplace
Marketplace
Marketplace
Summary of Benefits
Summary of Benefits
Summary of Benefits
Blue Precision Silver HMO 106
Blue Precision Silver HMO 106
Blue Precision Silver HMO 106
Blue Precision Silver HMO 106
Blue Precision Silver HMO 106
Blue Precision Silver HMO 106
Blue Choice Preferred Silver PPO 109 - Standardized
Blue Choice Preferred Silver PPO 109 - Standardized
Blue Choice Preferred Silver PPO 109 - Standardized
Blue Choice Preferred Silver PPO 109 - Standardized
Blue Choice Preferred Silver PPO 109 - Standardized
Blue Choice Preferred Silver PPO 109 - Standardized
Blue Choice Preferred Silver PPO 109 - Standardized
BRONZE Pl ans
PLAN NAME
Blue Choice Preferred Bronze PPO 105
Blue Choice Preferred Bronze PPO 105
Blue Choice Preferred Bronze PPO 105
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P AG E 4 O F 5
Blue Choice Preferred Bronze PPO 105
Native American Zero
Marketplace
Summary of Benefits
Blue Choice Preferred Bronze PPO 106
n/a
Non Marketplace
Summary of Benefits
Blue Choice Preferred Bronze PPO 106
n/a
Marketplace
Summary of Benefits
Blue Choice Preferred Bronze PPO 106
Native American Limited
Marketplace
Summary of Benefits
Blue Choice Preferred Bronze PPO 106
Native American Zero
Marketplace
Summary of Benefits
n/a
Non Marketplace
Summary of Benefits
Blue Choice Preferred Bronze PPO 107 - One $0 PCP Visit
n/a
Marketplace
Summary of Benefits
Blue Choice Preferred Bronze PPO 107 - One $0 PCP Visit
Native American Limited
Marketplace
Summary of Benefits
Blue Choice Preferred Bronze PPO 107
Native American Zero
Marketplace
Summary of Benefits
Blue Choice Preferred Bronze PPO 108
Blue Choice Preferred Bronze PPO 108
n/a
Non Marketplace
Summary of Benefits
n/a
Marketplace
Summary of Benefits
Blue Choice Preferred Bronze PPO 108
Native American Limited
Marketplace
Summary of Benefits
Blue Choice Preferred Bronze PPO 108
Native American Zero
Marketplace
Summary of Benefits
Plan Variance
Marketplace or
Non Marketplace*
Link to SBC Document
Blue Choice Preferred Security PPO 100
n/a
Non Marketplace
Summary of Benefits
Blue Choice Preferred Security PPO 100
n/a
Marketplace
Summary of Benefits
Blue Choice Preferred Bronze PPO 107 – One $0 PCP Visit
CATASTROPHIC Plans
PLAN NAME
* Marketplace = On Exchange; Non-Marketplace = Off Exchange
10-02-2016
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