2021 Illinois QHP Small Group Actual Policy Documents

Below is a list of actual policy documents for QHP small group coverage. These policies describe how the plans generally work and include eligible expenses, claim filing and appeals procedures, and coverage limitations and exceptions, among other things.

If you have questions, contact a customer service representative at 1-800-538-8833 for more information.

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Platinum Plans

Blue PPO Platinum Plans
Off Exchange

P503PPO Blue PPO Platinum 119
P5E1PPO Blue PPO Platinum 136

Blue Choice Preferred PPO Platinum Plans
Off Exchange

P5E2BCE Blue Choice Preferred Platinum PPO 119
P5E1BCE Blue Choice Preferred Platinum PPO 136

Blue Precision Platinum Plans
Off Exchange

P506PSN Blue Precision Platinum HMO 107
P5J1PSN Blue Precision Platinum HMO 200
P5E1PSN Blue Precision Platinum HMO 110

Gold Plans

Blue PPO Gold Plans
Off Exchange

G534PPO Blue PPO Gold 114
G532PPO Blue PPO Gold 107
G536PPO Blue PPO Gold 116
G531PPO Blue PPO Gold 102
G537PPO Blue PPO Gold 123
G530PPO Blue PPO Gold 101
G533PPO Blue PPO Gold 113
G535PPO Blue PPO Gold 115

Blue Precision Gold HMO Plans
Off Exchange

G5J2PSN Blue Precision Gold HMO 201
G532PSN Blue Precision Gold HMO 101

Blue Options Gold Plans
Off Exchange

G506OPT Blue Options Gold PPO 101
G508OPT Blue Options Gold PPO 106
G507OPT Blue Options Gold PPO 102

BlueChoice Preferred Gold PPO Plans
Off Exchange

G532BCE Blue Choice Preferred Gold PPO 107
G531BCE Blue Choice Preferred Gold PPO 102
G530BCE Blue Choice Preferred Gold PPO 101
G533BCE Blue Choice Preferred Gold PPO 113
G535BCE Blue Choice Preferred Gold PPO 115

Silver Plans

Blue PPO Silver Plans
Off Exchange

S532PPO Blue PPO Silver 120
S501PPO Blue PPO Silver 135
S531PPO Blue PPO Silver 104
S535PPO Blue PPO Silver 105
S534PPO Blue PPO Silver 133
S5J1PPO Blue PPO Silver 200

Blue Precision Silver HMO Plans
Off Exchange

S531PSN Blue Precision Silver HMO 106
S530PSN Blue Precision Silver HMO 102

BlueChoice Preferred Silver PPO Plans
Off Exchange

S532BCE Blue Choice Preferred Silver PPO 120
S501BCE Blue Choice Preferred Silver PPO 135
S531BCE Blue Choice Preferred Silver PPO 104
S535BCE Blue Choice Preferred Silver PPO 105
S534BCE Blue Choice Preferred Silver PPO 133
S5J1BCE Blue Choice Preferred Silver PPO 200

Blue Options Silver PPO Plans
Off Exchange

S506OPT Blue Options Silver PPO 104
S507OPT Blue Options Silver PPO 107

Bronze Plans

Blue PPO Bronze Plans
Off Exchange

B536PPO Blue PPO Bronze 132
B535PPO Blue PPO Bronze 106

BlueChoice Preferred Bronze PPO Plans
Off Exchange

B536BCE Blue Choice Preferred Bronze PPO 132
B535BCE Blue Choice Preferred Bronze PPO 106