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What to Expect for Open Enrollment for 2016 Individual Plans

Sep. 16, 2015

We're getting ready for Open Enrollment for 2016. Blue Cross and Blue Shield of Illinois (BCBSIL) will have health plans that you and your family can choose from across the state, both on and off of "Get Covered Illinois," the Official Health Marketplace. If you have a health plan now or are looking to buy one in 2016, here are some things you need to know.

When is Open Enrollment?

Open Enrollment for individuals and families runs from Nov. 1, 2015 through Jan. 31, 2016. If you are looking to buy your own health plan for 2016, you can do so during this time.

If you already have health coverage, this is also the time you can:

  • Look at other plan choices
  • Compare plans and prices
  • See if you can get help paying for it through a tax credit

You can come back to our website in October when the "window shopping" period begins to see what plans will be available. This will give you time to weigh your choices, ask questions and decide what will work best for you — before it is time to sign up on Nov. 1.

What will be different for individual plans in 2016?

In 2016, we are expanding our Blue Choice Preferred PPO* so that it will be an option in all counties across the state. We are also expanding our Blue Precision HMO to more areas, and we plan to offer a new product for the Chicagoland area. Details will be announced in October. Our broad PPO that was offered for 2014 and 2015 will not be offered for 2016.

Why is the broad PPO going away?

We continually work to make sure the plans we offer are as affordable as possible. Applicable laws require that we set our individual plan rates based on the total medical cost of all of our Illinois individual members. If the costs of one plan are high, it raises the rates of all our individual plans. In our efforts to keep affordable plan options, we decided not to offer the broad PPO, which was the highest cost plan.

I have a broad PPO plan. What will this mean for me?

If you buy your own coverage and you chose a broad PPO plan in 2015, we will automatically enroll you in a similar PPO plan. You do not have to stay with this plan. When the Open Enrollment "window shopping" starts in October, you will be able to see your 2016 plan choices on our website. If you don't choose a different plan, you will stay enrolled in the Blue Choice Preferred PPO, so that your coverage will continue. You can pick your own plan starting Nov. 1, 2015. Choose your plan on or before Dec. 31, 2015, for coverage starting on Jan. 1, 2016.

My broad PPO plan is "grandfathered." Is it changing, too?

No. If you have a grandfathered individual PPO plan, it will still be available in 2016. Grandfathered individual plans are plans that existed on March 23, 2010, when the Affordable Care Act became law. If you don't know if your plan is grandfathered, check your plan details or call the customer service number listed on your member ID card.

In addition, grandmothered (transitional) plans, and BCBSIL members enrolled in Medicare Supplement or Medicare Advantage plans will not be impacted by these changes in 2016.

Will I be able to keep my doctor and/or hospital once the broad PPO goes away?

Some health care providers, including doctors, nurse practitioners, hospitals, physical therapists, and other medical and behavioral facilities and professionals that were in the broad PPO network during 2015 will be in the Blue Choice Preferred PPO network in 2016. However, not all health care providers will be in the 2016 Blue Choice Preferred PPO network. Be sure to check your provider choices in the Provider Finder section of our website when exploring your plan choices during Open Enrollment.

When can I see 2016 plan details and rates?

Individual plan details and rates will be available in October. You can enroll starting on Nov. 1, 2015.

Have questions now? We encourage you to talk with your insurance agent or call the customer service number listed on your Blue Cross and Blue Shield of Illinois member ID card.

* Subject to final approval by the U.S. Health and Human Services Department.