Select PPO: Human Resources - Northwestern University

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).

Select PPO benefits broken down by in-network, out-of-network and Northwestern Medicine network.
	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 Partners Webpage

Find a doctor

In- and out-of-network

Navigate to the Provider Finder
Select Find Care on the navigation bar at the top
Select Find a Doctor or Hospital from the drop down
Log in or select Search as a Guest
From the Plans drop down select Participating Provider Organization [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

Price a medication

Use ExpressScripts online pricing tool to price current or future medications. Shopping around may save you money.

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:

Full-time employees
Part-time employees

Premiums for full-time employees

Select PPO monthly premiums for full-time employees by annual salary and members of family insured.
Annual Salary	You	You + Spouse	You + Child(ren)	You + Spouse + Child(ren)
Under $42,000	$49	$108	$90	$160
$42,001-$75,000	$89	$193	$163	$289
$75,001-$128,000	$142	$311	$267	$468
$128,001-$182,000	$206	$454	$386	$680
$182,001 and above	$301	$656	$557	$986

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 1/1/2022 are based on your 9/1/2021 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. When your 9/1 salary crosses a salary tier due to a salary increase not associated with a change in full-time/part-time status, you will pay the lower premium for the following year.

Premiums for part-time employees

Select PPO monthly premiums for part-time employees by annual salary and family members insured.
Annual Salary	You	You + Spouse	You + Child(ren)	You + Spouse + Child(ren)
Under $42,000	$233	$510	$432	$763
$42,001-$75,000	$260	$566	$479	$850
$75,001-$128,000	$296	$646	$549	$970
$128,001-$182,000	$339	$740	$630	$1,112
$182,001 and above	$402	$876	$744	$1,317

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