Select PPO
This plan gives you the flexibility to choose any doctor/hospital that you wish without requiring a primary care physician (PCP) or referrals. If you choose a Blue Cross doctor, you will be charged the in-network rates.
This is a summary of the plan benefits. Complete benefit information is available in the BCBS PPO Select Booklet and Summary of Benefit Coverage (SBC).
| In-Network | Out-of-Network | Northwestern Medicine | |
|---|---|---|---|
| Group Number | 006168 | 006168 | 006168 |
| Deductible | $750 member, $2,250 family |
$1,500 member; $4,500 family | $500 member, $1,500 family |
| Out-of-Pocket (OOP) Maximum | $3,000 member, $8,000 family | $6,000 member, $16,000 family | $1,800 member, $4,800 family |
| Prescription OOP Maximum | $1,500/year per member | N/A | N/A |
| Wellness Checkup | Covered 100% according to age/sex guidelines | Deductible + 40% coinsurance | Covered 100% according to age/sex guidelines |
| Office Visit | $25 physician/ $35 specialist |
Deductible + 40% coinsurance | $10 physician/ $20 specialist |
| Emergency Room Costs | $150 copay + 20% coinsurance | $150 Copay + 20% coinsurance | $150 copay (waived if admitted) + 20% coinsurance |
*All health care copays apply toward the out-of-pocket maximums.
Saving Money On Health Procedures and Tests
Health Advocacy Solutions (HAS)
You’ve got some great resources in your Blue Cross and Blue Shield of State (BCBSIL) plan that can help you on your health journey. Read on and learn more about them!
- Simplify complex benefit options, making them easier to understand
- Help you use your benefits more wisely and get better value
- Maximize your benefits
- Get cost estimates for various providers and procedures
- Help to schedule appointments
- Assist with referrals to clinical staff/programs
- Help with preauthorization
Call toll- free 888-901-9357 (weekdays 7 a.m. to 7 p.m. CT). If you call after hours, you can speak with a nurse.
For More Information Visit the Health Advocacy Solutions Webpage
Find a doctor
In- and out-of-network
- Navigate to the Provider Finder
- Select the group health plan and choose PPO
Northwestern Medicine participating doctors
- Navigate to the Northwestern Medicine Provider Finder (Be sure NOT to log in)
- Select the get medical care in the middle of the screen
Premiums are deducted from your paycheck on a pre-tax basis. Employees who are paid bi-weekly will have half of the monthly deduction taken from the first two checks of each month.
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Premiums for full-time employees
| Annual Salary | You | You + Spouse | You + Child(ren) | You + Spouse + Child(ren) |
|---|---|---|---|---|
| Under $42,000 | $46 | $102 | $86 | $152 |
| $42,001-$75,000 | $84 | $183 | $155 | $275 |
| $75,001-$128,000 | $135 | $295 | $253 | $444 |
| $128,001-$182,000 | $195 | $431 | $366 | $646 |
| $182,001 and above | $285 | $623 | $529 | $937 |
For new hires, the salary tier is determined based on your initial, regular salary. The salary tier for current employees is determined by your salary on September 1st of the year proceeding the plan year (e.g. Premiums starting 1/1/2020 are based on your 9/1/2019 salary). Mid-year changes to salary will not change your assigned salary tier, unless you transition from full-time to part-time or part-time to full-time.
Premiums for part-time employees
| Annual Salary | You | You + Spouse | You + Child(ren) | You + Spouse + Child(ren) |
|---|---|---|---|---|
| Under $42,000 | $221 | $484 | $411 | $725 |
| $42,001-$75,000 | $247 | $583 | $456 | $808 |
| $75,001-$128,000 | $281 | $613 | $521 | $921 |
| $128,001-$182,000 | $321 | $703 | $598 | $1,057 |
| $182,001 and above | $381 | $832 | $707 | $1,251 |
For new hires, the salary tier is determined based on your initial, regular salary. The salary tier for current employees is determined by your salary on September 1st of the year proceeding the plan year (e.g. Premiums starting 1/1/2020 are based on your 9/1/2019 salary). Mid-year changes to salary will not change your assigned salary tier, unless you transition from full-time to part-time or part-time to full-time.
Premiums are deducted from your paycheck on a pre-tax basis. Employees who are paid bi-weekly will have half of the monthly deduction taken from the first two checks of each month.
Jump to:
Premiums for full-time employees
| Annual Salary | You | You + Spouse | You + Child(ren) | You + Spouse + Child(ren) |
|---|---|---|---|---|
| Under $42,000 | $47 | $105 | $88 | $156 |
| $42,001-$75,000 | $86 | $188 | $159 | $282 |
| $75,001-$128,000 | $139 | $304 | $260 | $456 |
| $128,001-$182,000 | $201 | $443 | $376 | $664 |
| $182,001 and above | $293 | $640 | $543 | $962 |
For new hires, the salary tier is determined based on your initial, regular salary. The salary tier for current employees is determined by your salary on September 1st of the year proceeding the plan year (e.g. Premiums starting 1/1/2020 are based on your 9/1/2019 salary). Mid-year changes to salary will not change your assigned salary tier, unless you transition from full-time to part-time or part-time to full-time.
Premiums for part-time employees
| Annual Salary | You | You + Spouse | You + Child(ren) | You + Spouse + Child(ren) |
|---|---|---|---|---|
| Under $42,000 | $227 | $497 | $422 | $745 |
| $42,001-$75,000 | $253 | $552 | $468 | $830 |
| $75,001-$128,000 | $289 | $631 | $535 | $946 |
| $128,001-$182,000 | $331 | $722 | $614 | $1,086 |
| $182,001 and above | $391 | $855 | $726 | $1,285 |
For new hires, the salary tier is determined based on your initial, regular salary. The salary tier for current employees is determined by your salary on September 1st of the year proceeding the plan year (e.g. Premiums starting 1/1/2020 are based on your 9/1/2019 salary). Mid-year changes to salary will not change your assigned salary tier, unless you transition from full-time to part-time or part-time to full-time.
Benefits
Prescription coverage
- Express Scripts - administered prescription plan
Discounts
- Vision discount - program available through Davis Vision
- Blue Discount Program - offers a variety of discounts on gym memberships, alternative medicine and hearing aids
- Hearings aids discounts available with TruHearing at 866-687-2020
Immunizations
- Covered under the Well Child Care provisions for children up to age 16
- $25 office visit copay
Routine mammogram and pap smear
- Covered with no cost-sharing
- Mammogram covered for women age 35+
Laboratory tests and x-rays
- Coinsurance after deductible is met
Physical therapy and chiropractic care
- Coinsurance after deductible is met
- Member's condition must show continued improvement with physical therapy
Minor surgery in doctor's office or outpatient surgical operations
- Coinsurance after deductible is met
Diabetes treatment
- Covered at coinsurance after deductible is met:
- Glucometer
- Self management training services rendered by a physician or licensed health care professional with expertise in diabetes management
- Regular foot care examinations by a physician or podiatrist
- Other supplies and equipment are covered under prescription drug program
Exclusion examples
- Hearings aids; discounts available with TruHearing at 866-687-2020
- Custodial Nursing Home Care
- Cosmetic Care except for the correction of congenital deformities or for conditions resulting from accidental injuries, tumors or disease
- For a comprehensive list of exclusions, contact BCBS at 800-327-8497