BlueEdgeSM gives employees freedom of choice, flexibility, a broad range of benefits and the largest contracting network in Illinois. Across the country, PPO networks are linked through the BlueCard® PPO program so it should be easy for employees to find a doctor or hospital when traveling or if some family members live, work or study anywhere in the United States.
When employees receive care from contracting PPO network doctors and hospitals:
- Benefits are paid at the highest level.
- There are no claim forms to complete.
- They are not responsible for any charges above the Blue Cross and Blue Shield negotiated fee or allowable amount.
- They do not need a referral to see the doctor of their choice.
- Once PPO coverage begins, the only other out-of-pocket expenses are any plan-specific coinsurance payments for covered benefits, plus any charges for non-covered services.
Employees can always choose to receive care from doctors and hospitals outside the network, but benefits will be paid at a lower level.
BlueEdge Benefits Overview
Preventive Care Benefits
Services covered at 100 percent when received in network
- Well-child and adult care, including immunizations
- Screenings such as cholesterol, breast cancer and cervical cancer
Doctor and Hospital Benefits
- Doctor office visits
- Hospital and surgical care
- Diagnostic testing
- Emergency care benefits
- Maternity care
- Rehabilitation therapy (physical, speech, occupational therapy)
- Mental health and substance abuse treatment
- Prescription drug card benefits (with mail service for maintenance medications)
- Vision discounts
- Hearing aid discounts
- Reconstructive surgery following a mastectomy
- Medical Services Advisory (pre-notify inpatient hospital stays)
- Mental health/Substance abuse