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Health Insurance Plans

Northwestern offers US-based employees four Blue Cross Blue Shield medical plans and Qatar employees are offered the Cigna International Health plan. Additionally, US-based employees who are eligible and wish to enroll in ACA benefits, can choose the ACA Value PPO option. Below is information about the plans, what they cover and how much they cost.

Plan options

The following health insurance plans are available to Northwestern employees:

Blue Cross Blue Shield of Illinois administers all four medical plans for US-based employees. Read the summary plan description for Northwestern’s health and welfare insurance coverage.

Preferred Provider Options (PPOs)

Three preferred provider options (PPOs) that offer the flexibility to go to any provider you choose (though you will receive greater benefits and pay lower out-of-pocket costs when you see a provider who is a member of the Northwestern Medicine or Blue Cross Blue Shield PPO network).

Health Maintenance Organizations (HMOs)

One health maintenance organization (HMO) that offer a coverage option that gives you access to the HMO Illinois provider Network, but pays no benefits when you see a provider who is not a member of the network (except in an emergency).

Forms and policies

Benefits

Using Northwestern Medicine

Plan costs when using a provider in the Northwestern-Medicine network.
Premier PPO Select PPO Value PPO HMO Illinois
Deductible $150 individual, $450 family $250 individual, $750 family $1,300 individual, $2,600 family N/A
Out-of-Pocket Minimum $1,000 individual, $3,000 family $1,500 individual, $4,500 family $2,100 individual, $5,600 family N/A
Coinsurance 0% 10% 10% N/A
Office Visit Copay $10 physician/$20 specialist $10 physician/$20 specialist 10% after deductible N/A
Emergency Room Copay $100 (waived if admitted) + 10% coinsurance $100 (waived if admitted) + 20% coinsurance 20% after deductible N/A

Using in-network provider

Plan costs when using an in-network provider.
Premier PPO Select PPO Value PPO HMO Illinois
Deductible $250 individual, $750 family $500 individual, $1,500 family $1,400 individual, $2,800 family N/A
Out-of-Pocket Minimum $2,200 individual, $6,600 family $2,650 individual, $7,750 family $3,000 individual, $8,000 family $1,500 individual, $3,000 family
Coinsurance 10% 20% 20% N/A
Office Visit Copay $10 physician/$20 specialist $10 physician/$20 specialist 10% after deductible $25 PCP/$35 specialist
Emergency Room Copay $100 (waived if admitted) + 10% coinsurance $100 (waived if admitted) + 20% coinsurance 20% after deductible $100 (waived if admitted)
Outpatient Event Copay N/A N/A N/A $250
Impatient Event Copay N/A N/A N/A $500

Using out-of-network provider

Plan costs when using an out-of-network provider.
Premier PPO Select PPO Value PPO HMO Illinois
Deductible $250 individual, $750 family $500 individual, $1,500 family $1,400 individual, $2,800 family N/A
Out-of-Oocket Minimum $4,400 individual, $13,200 family $5,300 individual, $15,500 family $6,000 individual, $16,000 family N/A
Coinsurance 30% 40% after deductible 40% after deductible N/A
Office Visit Copay 30% after deductible 40% after deductible 40% after deductible N/A
Emergency Room Copay $100 (waived if admitted) + coinsurance $100 (waived if admitted) + coinsurance 40% after deductible $100 (waived if admitted)

 

  1. The deductible is the same for in- and out-of-network provider usage; a separate out-of-pocket maximum applies.
  2. Copays apply toward the out-of-pocket maximums.
  3. The deductible is the same dollar amount for in- and out-of-network provider usage (but these deductibles are tracked separate); a separate out-of-pocket maximum applies.
  4. For Value PP participants who choose You + Spouse, or You + Spouse + Child(ren) coverage, the family deductible and out-of-pocket rates apply.