Children's Plans
Blue PathwaySM
BlueChoice PathwaySM
Open enrollment is now closed for this product.
The next open enrollment period is scheduled for July 1, 2013 – July 31, 2013.
Blue Pathway and BlueChoice Pathway — our health insurance plans for individuals ages
1 through 18, who do not have other major medical coverage available to them for purchase.
Coverage includes:
- Benefits for preventive care services
- Diagnostic testing
- Hospital services
- Emergency care
- Prescription drug coverage
- Physical, occupational and speech therapy services
Blue Pathway and BlueChoice Pathway are "guaranteed issue" products. Children who are eligible for these plans will be approved for coverage, regardless of their health status. Remember applicants must still meet any non-health related eligibility criteria and must not have other major medical coverage available to them for purchase.
Compare the features, options and costs of the Blue Pathway plans 
to find the one that's right for you.
Biannual Open Enrollment Periods
Blue Pathway and Blue Choice Parthway enrollment is open two times a year: January 1 – January 31 and July 1 – July 31.
Special Enrollment
A child who is between 1 and 19 years of age, who involuntarily loses his or her major medical coverage and does not have other major medical coverage for purchase, can apply year-round for enrollment in Blue Pathway. A child who is eligible for special enrollment in Blue Pathway must apply within 30 days from the date he or she involuntarily lost coverage, or was notified that he or she lost that coverage – whichever is later.
If you have a qualifying event and are eligible for this product, you can get a quote and apply 
.
Health insurance costs include monthly premium payments, individual/family deductibles, out-of-pocket expenses, copayments and coinsurance. For Blue Pathway plans, here’s what you can expect:
Blue Pathway
- Deductible of $2,500 Individual/$7,500 Family
- Coinsurance levels of 80% in-network/50% out-of-network
- Benefits for preventive care services covered at 100% in-network/50% out-of-network
- Individual Calendar Year Out-of-Pocket of $3,000 in-network/$6,000 out-of-network
- Family Calendar Year Out-of-Pocket of $9,000 in-network/$18,000 out-of-network
BlueChoice Pathway
- Individual Deductible of $2,500 in-network/$7,500 out-of-network
- Family Deductible of $5,000 in-network/$15,000 out-of-network
- Coinsurance levels of 80% in-network/50% out-of-network
- Benefits for preventive care services covered at 100% in-network/50% out-of-network
- Individual Calendar Year Out-of-Pocket of $3,000 in-network/$6,000 out-of-network
- Family Calendar Year Out-of-Pocket of $6,000 in-network/$12,000 out-of-network
BlueChoice Pathway only: The BlueChoice network allows you to save on premiums and the cost of covered services when you use a contracting BlueChoice hospital, doctor or specialist. You do not need to select a primary care physician or obtain a referral to see a specialist.
- Coverage for major hospital, medical and surgical expenses incurred as a result of a covered accident or sickness
- Coverage for daily hospital room and board, miscellaneous hospital services, surgical services, anesthesia services, in-hospital medical services, and out-of-hospital care
- As with all individual Blue Cross and Blue Shield of Illinois plans, the freedom of not having to select a primary care doctor or obtain a referral to see a specialist
- Although you can go to the hospitals and doctors of your choice, your benefits under Blue Pathway will be higher, and your costs lower, when you use the services of participating PPO or BlueChoice providers.
Subject to any deductibles, copayment provisions or other limitations which may be set forth in the Policy.
More Plan Details
It's important to know the unique features of the health plan you are considering. Each plan’s Outline of Coverage provides brief descriptions of the basic provisions of our Blue Pathway and BlueChoice Pathway plans, as well as details on eligibility, policy renewability, benefit exclusions and coverage limitations.
At Blue Cross and Blue Shield of Illinois, we understand your concerns about coverage continuity. Blue Cross and Blue Shield of Illinois will not terminate or refuse to renew your Policy because of the condition of your health. However, to protect you and the rights of all policy holders, there are situations when a plan may be terminated or a renewal refused:
- Failure to pay premiums
- The plan is discontinued (90 days notice given with an option to convert to any plan we offer)
- Discovery of fraud or an intentional misrepresentation of facts (30 days prior written notice given)
- If you no longer reside, live or work in an area where we are authorized to do business
For more information on renewability, see the Blue Pathway Outline of Coverage and BlueChoice Pathway Outline of Coverage
- Generic Drugs (Tier 1*) - $15 copayment in network
- Formulary Brand Drugs (Tier 2*) – 80% coinsurance level in network
- Your benefit plan includes a mail service program that offers you the convenience of having covered maintenance medications delivered directly to you.
- Your out-of-pocket cost for prescription drugs usually is less when you choose generic or formulary
*Tier 1 and 2 benefits paid after plan medical deductible has been satisfied.
