Blue Choice PPO
The Blue Cross and Blue Shield of Illinois (BCBSIL) Blue Choice PPO plan offers a variety of benefits, including medical coverage, emergency care, vision services and more.
The Blue Choice PPO plan gives you access to a wide scope of benefits and a value-based network of doctors and hospitals any time you need care.
Blue Choice PPO Advantages
With the Blue Choice PPO plan, you have access to a value-based network of contracting doctors and hospitals in Illinois at an affordable cost. With Blue Choice PPO:
- You don’t need to select a primary care physician to coordinate your care.
- You never need a referral to see a specialist.
- You have the freedom to visit any doctor you choose.
The Blue Choice PPO plan includes coverage for:
- Doctor office visits
- Inpatient hospital services
- Outpatient hospital services
- Outpatient surgery and diagnostic tests
- Maternity services
- Hospital emergency medical and accident treatment
- Breast cancer screenings
- Muscle manipulation services
- Physical, occupational and speech therapy services
- Reconstructive surgery following a mastectomy
Additional benefit coverage may include:
- Prescription drug benefits
- Mental health and substance abuse coverage
The Blue Choice PPO plan provides full coverage for services that can keep you and your covered family members healthy. Preventive services include:
- Prenatal care
- Routine child care and immunizations
- Annual physical exam for adults
- Yearly gynecological exam
Use Network Doctors and Hospitals for Greater Benefits
When you receive care from network doctors and hospitals:
- Benefits are paid at the higher level.
- A minimal co-payment will be required at the time of service.
You can receive care from a doctor or hospital outside the network, but benefits will be paid at a lower level and your out-of-pocket cost will be higher.
The Blue Choice PPO plan offers access to a focused hospital and physician network.
The hospital network is based on geographic accessibility, the number of board certified doctors on staff, status with the Joint Commission on Accreditation of Healthcare Organizations and clinical care indicators developed by the Agency for Healthcare Research and Quality, an agency of the U.S. Department of Health and Human Services. Clinical care indicator scores of hospitals in the network for the Blue Choice PPO product are comparable to the scores of those in the broad network for the Point of Service product.
The Blue Choice PPO plan provides emergency care coverage for members, even when traveling out-of-state or abroad.
- In an emergency, members can seek care from any emergency room or other similar facility.
- Call 911 or other community emergency resources to obtain assistance in life-threatening situations.
- Emergency room care at any hospital is covered (subject to plan deductible and coinsurance/copayments).
- Some group plans require that the member, a family member or a friend contact the Medical Services Advisory (MSA) upon admittance to a non-network hospital within two business days, or benefits may be reduced.
Whether you're traveling across the country or around the world, you can take your Blue Cross and Blue Shield of Illinois BlueChoice Select health care benefits with you.
The Blue Choice PPO plan includes nationwide access to contracting doctors and hospitals in Participating Provider Organization (PPO) network linked through the BlueCard® PPO program.
Members who use a BlueCard PPO network doctor or hospital receive the highest level of benefits.
When you travel outside the United States and need urgent or immediate care, you are covered. Blue Cross and Blue Shield of Illinois contracts with doctors and hospitals in more than 200 countries, but you may receive care anywhere you choose.
- When receiving care at BlueCard Worldwide® contracting hospital, you will not have to pay up-front for inpatient care
- You are responsible for any out-of-pocket expenses (deductible, copayment, etc.)
- You also have coverage at non-BlueCard Worldwide hospitals, but you may have to pay the doctor or hospital up-front for care.
Federal and State of Illinois laws require group health plans and insurers to provide coverage for reconstructive surgery following a mastectomy. These laws state that health plans that cover mastectomies must also provide coverage in a manner determined in consultation with the attending physician and patient for:
- Reconstruction of the breast on which the mastectomy has been performed;
- Surgery and reconstruction of the other breast to produce a symmetrical appearance; and
- Prostheses and treatment for physical complications for all stages of mastectomy, including lymphedemas.
BCBSIL plans traditionally offered this coverage before it was required. We continue to provide this coverage if the procedures are provided by a licensed physician according to each plan’s provisions. Coverage may also include benefits for annual mammograms.
If you have prescription drug coverage through BCBSIL:
- Your coverage may be based on either the standard formulary or the generics plus formulary
- Your benefit plan includes a mail service program that offers you the convenience of having covered maintenance medications delivered directly to you.
- Your plan also includes a specialty pharmacy program, through which members using covered self-injectable medications can have them delivered directly to them or their doctor, as well as receive services that may help them in managing their therapy.
- Helpful information is provided to assist you in understanding your prescription drug coverage and options, including convenient services and any limitations.
- A variety of online tools are available that can help you learn more about prescription drugs and manage your pharmacy benefits. Just log in to Blue Access for MembersSM and visit your Rx Drugs page.