BluePrintSM PPO Product Summary

(51-150) Employees

BluePrint PPO offers a wide range of benefit designs that offer options for coinsurance, deductible and out-of-pocket maximums, as well as office visit and three-tier drug card copays. PPO members are not required to select a primary care physician and have the freedom to choose a doctor whenever they need care, including specialists, from one of the largest PPO networks in Illinois. When members use contracting network doctors and hospitals, there are no claim forms to complete and no "balance billing" because providers agree to accept Blue Cross and Blue Shield of Illinois' negotiated rates.

This chart below presents the different options available within this product and a comparison of in-network benefits versus out-of-network Benefits. Contact information, a mental health care coordination reminder and the three-tier formulary prescription drug options can be found below the chart.

In-Network Benefits — 100% / 80% Coinsurance

Out-of-Network Benefits

In-Network Benefits — 90% / 70% Coinsurance

Out-of-Network Benefits

In-Network Benefits — 80% / 60% Coinsurance

Out-of-Network Benefits

* The out-of-pocket maximum does not include the deductible.

Contact Us

Blue Cross and Blue Shield of Illinois
300 East Randolph Street
Chicago, Illinois 60601-5099
1-800-654-7385

Three-Tier Formulary Prescription Drug Card

Each health product can be paired with one of three prescription drug cards. Drug card copays are listed in the following order: Generic / Preferred / Non Preferred.

  1. $15 / $30 / $50
  2. $15 / 35% / 50%
  3. $10 / $40 / $60