Participating Provider Option (PPO)
(2-50) Employees
PPO members are not required to select a primary care physician. They have the freedom to choose a doctor whenever they need care, including specialists, from one of the largest PPO networks in Illinois.
When your employees use contracting network doctors and hospitals, there are no claims forms to complete and no "balance billing" because providers agree to accept Blue Cross and Blue Shield of Illinois' negotiated rates.
You can choose from a wide range of benefit designs that offer several coinsurance, deductible, out-of-pocket maximum and office visit copayment options.
The chart below presents the different BlueAdvantage Entreprenuer PPO options and includes a comparison of in-network versus out-of-network benefits. It is organized first by coinsurance percentage and further by deductible amounts.
Contact information and the three-tier formulary prescription drug options can be found below the chart.
In-Network Benefits — 90% / 70% Coinsurance
| Coinsurance | Deductible(Individual/Family) | Out-of-Pocket Max*(Individual/Family) | Office Visit PCP/PSP |
Emergency Room Copay |
|---|---|---|---|---|
| $500 DEDUCTIBLE | ||||
| 90% | $500 / $1,500 | $1,000 / $3,000 | $20 / $40 | $150 |
| $1,000 DEDUCTIBLE | ||||
| 90% | $1,000 / $3,000 | $1,000 / $3,000 | $20 / $40 | $150 |
| $1,500 DEDUCTIBLE | ||||
| 90% | $1,500 / $4,500 | $2,000 / $6,000 | $20 / $40 | $150 |
| $2,500 DEDUCTIBLE | ||||
| 90% | $2,500 / $7,500 | $2,000 / $6,000 | $20 / $40 | $150 |
| $3,500 DEDUCTIBLE | ||||
| 90% | $3,500 / $10,500 | $2,000 / $6,000 | $20 / $40 | $150 |
Out-of-Network Benefits
| Coinsurance | Deductible(Individual/Family) | Out-of-Pocket Max*(Individual/Family) |
|---|---|---|
| $500 DEDUCTIBLE | ||
| 70% | $1,000 / $3,000 | $2,000 / $6,000 |
| $1,000 DEDUCTIBLE | ||
| 70% | $2,000 / $6,000 | $2,000 / $6,000 |
| $1,500 DEDUCTIBLE | ||
| 70% | $3,000 / $9,000 | $4,000 / $12,000 |
| $2,500 DEDUCTIBLE | ||
| 70% | $5,000 / $15,000 | $4,000 / $12,000 |
| $3,500 DEDUCTIBLE | ||
| 70% | $7,000 / $21,000 | $4,000 / $12,000 |
In-Network Benefits — 80% / 60% Coinsurance
| Coinsurance | Deductible(Individual/Family) | Out-of-Pocket Max*(Individual/Family) | Office Visit PCP/PSP |
Emergency Room Copay |
|---|---|---|---|---|
| $500 DEDUCTIBLE | ||||
| 80% | $500 / $1,500 | $2,000 / $6,000 | $20 / $40 | $150 |
| 80% | $500 / $1,500 | $2,000 / $6,000 | $30 / $50 | $150 |
| $1,000 DEDUCTIBLE | ||||
| 80% | $1,000 / $3,000 | $2,000 / $6,000 | $20 / $40 | $150 |
| 80% | $1,000 / $3,000 | $2,000 / $6,000 | $30 / $50 | $150 |
| $1,500 DEDUCTIBLE | ||||
| 80% | $1,500 / $4,500 | $2,000 / $6,000 | $20 / $40 | $150 |
| 80% | $1,500 / $4,500 | $2,000 / $6,000 | $30 / $50 | $150 |
| $2,500 DEDUCTIBLE | ||||
| 80% | $2,500 / $7,500 | $2,000 / $6,000 | $20 / $40 | $150 |
| 80% | $2,500 / $7,500 | $2,000 / $6,000 | $30 / $50 | $150 |
| $3,500 DEDUCTIBLE | ||||
| 80% | $3,500 / $10,500 | $2,000 / $6,000 | $20 / $40 | $150 |
| 80% | $3,500 / $10,500 | $2,000 / $6,000 | $30 / $50 | $150 |
Out-of-Network Benefits
| Coinsurance | Deductible(Individual/Family) | Out-of-Pocket Max*(Individual/Family) |
|---|---|---|
| $500 DEDUCTIBLE | ||
| 60% | $1,000 / $3,000 | $4,000 / $12,000 |
| 60% | $1,000 / $3,000 | $4,000 / $12,000 |
| $1,000 DEDUCTIBLE | ||
| 60% | $2,000 / $6,000 | $4,000 / $12,000 |
| 60% | $2,000 / $6,000 | $4,000 / $12,000 |
| $1,500 DEDUCTIBLE | ||
| 60% | $3,000 / $9,000 | $4,000 / $12,000 |
| 60% | $3,000 / $9,000 | $4,000 / $12,000 |
| $2,500 DEDUCTIBLE | ||
| 60% | $5,000 / $15,000 | $4,000 / $12,000 |
| 60% | $5,000 / $15,000 | $4,000 / $12,000 |
| $3,500 DEDUCTIBLE | ||
| 60% | $7,000 / $21,000 | $4,000 / $12,000 |
| 60% | $7,000 / $21,000 | $4,000 / $12,000 |
* 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
(800) 654-7385
Three-Tier Formulary Prescription Drug Card
Each health product can be paired with one of three prescription drug cards. Drug card copayments are listed in the following order: Generic / Preferred / Non Preferred.
- $15 / $30 / $50
- $15 / 35% / 50%
- $10 / $40 / $60
