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Value 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 Value Booklet and Summary of Benefit Coverage (SBC).

Value PPO benefits broken down by in-network, out-of-network and Northwestern Medicine network.
In-Network Out-of-Network Northwestern Medicine
Group Number 006171 006171 006171
Deductible $1,500 member*, $3,000 family $1,500 member*, $3,000 family $1,350 member, $2,700 family
Coinsurance 20% 40% 10%
Out-of-Pocket (OOP) Maximum $3,000 member*; $7,350 family $6,000 member*; $16,000 family $2,100 member; $5,600 family
Prescription OOP Maximum Included in health OOP max 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 Deductible + 20% coinsurance Deductible + 40% coinsurance Deductible + 10% coinsurance
Emergency Room Costs Deductible + 20% coinsurance Deductible + 20% coinsurance Deductible + 20% coinsurance

*All health care copays apply toward the out-of-pocket maximums.

Saving Money On Health Procedures and Tests

Benefit Value Advisors (BVAs)

Blue Cross Blue Shield of Illinois offers a service called Benefit Value Advisors (BVAs) that can help you save money on health procedures and tests, and also:

  • 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 the number on the back of your ID card to speak with a BVA.

Find a doctor

In- and out-of-network
  1. Navigate to the Provider Finder
  2. Select the group health plan and choose PPO
Northwestern Medicine participating doctors
  1. Navigate to the Northwestern Medicine Provider Finder (be sure NOT to log in)
  2. 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

Value 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 $16 $37 $32 $53
$42,001-$75,000 $34 $74 $63 $111
$75,001-$128,000 $77 $169 $142 $253
$128,001-$182,000 $121 $264 $224 $396
$182,001 and above $184 $401 $341 $601

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Premiums for part-time employees

Value PPO monthly premiums for part-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 $171 $375 $316 $558
$42,001-$75,000 $182 $397 $338 $596
$75,001-$128,000 $211 $461 $392 $692
$128,001-$182,000 $240 $527 $446 $787
$182,001 and above $283 $618 $524 $924

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Benefits

Prescription coverage
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
Routine mammogram and pap smear
  • Covered at 100% in network, 60% out of network. Deductible does not apply
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:
    • 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

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