medical plan
Three options (with prescription drug coverage) through BCBSIL.
Your Choice Overview
| Blue Choice | Blue PPO | Blue PPO + HSA |
|---|---|---|
PPO plan with two tiers of in-network benefits |
PPO plan with a broader provider network than Blue Choice |
Consumer-driven health plan (CDHP) uses the same provider network as Blue PPO HSA helps you pay for your eligible medical expenses, including deductible, tax free |
No deductible when you choose Tier 1 providers Moderate deductible when you choose Tier 2 providers |
Moderate deductible |
Higher deductible, but lowest contributions from your pay |
In-network preventive care 100% covered |
||
No benefits out of Tier 1 and Tier 2 networks |
Reduced benefits out-of-network |
Reduced benefits out-of-network |
Lowest overall out-of-pocket cost when you need care and choose Tier 1 providers |
Moderate overall out-of-pocket cost when you need care |
Highest overall out-of-pocket cost when you need care, but HSA helps cover it |
Your Choice Overview
Select the tab for each plan to review the details.
|
PPO plan with two tiers of in-network benefits |
|
No deductible when you choose Tier 1 providers Moderate deductible when you choose Tier 2 providers |
|
In-network preventive care 100% covered |
|
No benefits out of Tier 1 and Tier 2 networks |
|
Lowest overall out-of-pocket cost when you need care and choose Tier 1 providers |
|
PPO Plan with a broader provider network than Blue Choice |
|
Moderate deductible |
|
In-network preventive care 100% covered |
|
Reduced benefits out-of-network |
|
Moderate overall out-of-pocket cost when you need care |
|
Consumer-driven health plan (CDHP) uses the same provider network as Blue PPO |
|
Higher deductible, but lowest contributions from your pay |
|
In-network preventive care 100% covered |
|
Reduced benefits out-of-network |
|
Highest overall out-of-pocket cost when you need care, but HSA helps cover it |
Medical and Prescription Drug Plans at a Glance
Medical Comparison
The plans differ in the providers available to you and how much you pay for your plan, services, and medications.
| In-Network Medical Coverage Details | ||||||||
|---|---|---|---|---|---|---|---|---|
Per Pay Period Cost |
AIC HSA Contribution |
Preventive Care |
Annual Deductible |
Coinsurance |
Office Visit |
Urgent Care/ Emergency Room |
Medical and Presciption Drug Out-of-Pocket Maximum |
|
| Blue Choice1 Chicago Area Only |
|
NA | Tier 1: Blue Choice OPT PPO Network | |||||
| 100% covered | NA |
NA |
$25 copay for primary doctor $40 copay for specialist |
$75 copay for urgent care $250 copay for emergency room |
$1,500 per person $3,000 per family |
|||
| Tier 2: Participating Provider Organization (PPO) Network | ||||||||
100% covered |
$1,000 per person $2,000 per family |
You pay 20% after deductible |
You pay 20% after deductible |
$75 copay for urgent care $250 copay for emergency room |
$3,000 per person $6,000 per family |
|||
| Blue PPO |
|
NA |
100% covered |
$500 per person $1,000 per family |
You pay 15% after deductible |
$25 copay for primary doctor $40 copay for specialist |
You pay 15% after deductible |
$2,500 per person $5,000 per family |
| Blue PPO + HSA |
|
$500 for Employee Only coverage $1,000 for Employee + 1 or Family coverage |
100% covered |
$1,600 per person $3,200 per family |
You pay 15% after deductible |
You pay 15% after deductible |
You pay 15% after deductible |
$3,200 per person $6,400 per family2 |
Prescription Drug Comparison
| Up to 30-Day Supply Prescriptions (Retail) | 90-Day Supply Prescriptions (Mail Order or Walgreens Retail) |
Preventive Drugs Coverages | ||||||
|---|---|---|---|---|---|---|---|---|
Generic |
Preferred Brand |
Non-Preferred Brand |
Generic |
Preferred Brand |
Non-Preferred Brand |
ACA Standard Prescription Drugs3 |
Enhanced Preventive Drugs4 |
|
| Blue Choice1 Chicago Area Only |
$10 copay |
$30 copay |
$50 copay |
$20 copay |
$60 copay |
$100 copay |
100% covered |
NA |
| Blue PPO | $10 copay |
$30 copay |
$50 copay |
$20 copay |
$60 copay |
$100 copay |
100% covered |
NA |
| Blue PPO + HSA | You pay 15% after deductible |
You pay 15% after deductible |
You pay 15% after deductible |
You pay 15% after deductible |
You pay 15% after deductible |
You pay 15% after deductible |
100% covered |
You pay 15% with no deductible; coinsurance counts toward out-of-pocket maximum |
- This plan only covers services within its network of providers. If you choose to go out of network, you will pay the full cost of care. Deductibles and out-of-pocket maximums cross-apply between the tiers, meaning anything that counts toward your Tier 1 deductible or out-of-pocket maximum also counts toward your Tier 2 deductible and out-of-pocket maximum.
- With family coverage, any individual family member will meet their out-of-pocket maximum when they have paid the individual out-of-pocket maximum of $3,200. The remaining family members will continue to pay until either they reach their individual maximum of $3,200, or the family out-of-pocket maximum of $6,400 is met.
- Includes aspirin, fluoride, folic acid, smoking cessation, contraceptives, drugs for prevention and treatment of cancer. Limitations based on age and health conditions apply.
- Includes certain drugs for asthma, bone disease, diabetes, heart disease, high blood pressure, and to lower cholesterol.
Medical and Prescription Drug Plans at a Glance
Medical Comparison
The plans differ in the providers available to you and how much you pay for your plan, services, and medications.
Per Pay Period Cost |
|
|
AIC HSA Contribution |
NA |
|
| In-Network Medical Coverage Details | Tier 1: Blue Choice OPT PPO Network | Tier 2: Participating Provider Organization (PPO) Network |
Preventive Care |
100% covered |
100% covered |
Annual Deductible |
NA |
$1,000 per person |
Coinsurance |
NA |
You pay 20% after deductible |
Office Visit |
$25 copay for primary doctor |
$75 copay for urgent care |
Urgent Care/Emergency Room |
$75 copay for urgent care |
$75 copay for urgent care |
Medical and Prescription Drug Out-of-Pocket Maximum |
$1,500 per person |
$3,000 per person |
Up to 30-Day Supply Prescriptions (Retail) |
||
Generic |
$10 copay |
|
Brand Formulary |
$30 copay |
|
Brand Non-formulary |
$50 copay |
|
90-Day Supply Prescriptions (Mail Order or Walgreens Retail) |
||
Generic |
$20 copay |
|
Brand Formulary |
$60 copay |
|
Brand Non-formulary |
$100 copay |
|
Preventive Drugs Coverages |
||
ACA Standard Prescription Drugs3 |
100% covered |
|
Enhanced Preventive Drugs4 |
NA |
|
Per Pay Period Cost |
|
AIC HSA Contribution |
NA |
| In-Network Medical Coverage Details | |
Preventive Care |
100% covered |
Annual Deductible |
$500 per person |
Coinsurance |
You pay 15% after deductible |
Office Visit |
$25 copay for primary doctor |
Urgent Care/Emergency Room |
You pay 15% after deductible |
Medical and Prescription Drug Out-of-Pocket Maximum |
$2,500 per person |
Up to 30-Day Supply Prescriptions (Retail) |
|
Generic |
$10 copay |
Brand Formulary |
$30 copay |
Brand Non-formulary |
$50 copay |
90-Day Supply Prescriptions (Mail Order or Walgreens Retail) |
|
Generic |
$20 copay |
Brand Formulary |
$60 copay |
Brand Non-formulary |
$100 copay |
Preventive Drugs Coverages |
|
ACA Standard Prescription Drugs3 |
100% covered |
Enhanced Preventive Drugs4 |
NA |
Per Pay Period Cost |
|
AIC HSA Contribution |
$500 for Employee Only coverage |
| In-Network Medical Coverage Details | |
Preventive Care |
100% covered |
Annual Deductible |
$1,500 per person |
Coinsurance |
You pay 15% after deductible |
Office Visit |
You pay 15% after deductible |
Urgent Care/Emergency Room |
You pay 15% after deductible |
Medical and Prescription Drug Out-of-Pocket Maximum |
$3,000 per person |
Up to 30-Day Supply Prescriptions (Retail) |
|
Generic |
You pay 15% after deductible |
Prefered Brand |
You pay 15% after deductible |
Non-Preferred Brand |
You pay 15% after deductible |
90-Day Supply Prescriptions (Mail Order or Walgreens Retail) |
|
Generic |
You pay 15% after deductible |
Preferred Brand |
You pay 15% after deductible |
Non-Preferred Brand |
You pay 15% after deductible |
Preventive Drugs Coverages |
|
ACA Standard Prescription Drugs4 |
100% covered |
Enhanced Preventive Drugs5 |
You pay 15% with no deductible; coinsurance counts toward out-of-pocket maximum |
- This plan only covers services within its network of providers. If you choose to go out of network, you will pay the full cost of care. Deductibles and out-of-pocket maximums cross-apply between the tiers, meaning anything that counts toward your Tier 1 deductible or out-of-pocket maximum also counts toward your Tier 2 deductible and out-of-pocket maximum.
- With family coverage, any individual family member will meet their out-of-pocket maximum when they have paid the individual out-of-pocket maximum of $3,000. The remaining family members will continue to pay until either they reach their individual maximum of $3,000, or the family out-of-pocket maximum of $6,000 is met.
- Includes aspirin, fluoride, folic acid, smoking cessation, contraceptives, drugs for prevention and treatment of cancer. Limitations based on age and health conditions apply.
How to Get the Most from Your Medical Benefits
Choose in-network providers (e.g., doctors, hospitals, facilities)
Call a BCBSIL Health Advocate at (855) 418-9393 or find a BCBSIL provider.
- Enrolled in Blue Choice?
Warning! This plan does not cover out-of-network care, so you must use in-network providers.- For Blue Choice Tier 1: Blue Choice Options [BCO] network
- For Blue Choice Tier 2: Participating PPO Organization network
- Enrolled in Blue PPO or Blue PPO + HSA? While these plans do cover out-of-network care, your benefits are greater—and cost for services is lower—when you use in-network providers.
- For Blue PPO or Blue PPO + HSA: Participating PPO Organization network
Pick a primary doctor
- They’ll know your overall health status and can treat a wide range of health issues.
- If you can’t see your primary doctor as soon as you need, you have other options. See the Save time and money tip below.
Save time and money—avoid the ER when not a true emergency
- MDLIVE telemedicine visits—See a qualified health care provider from the comfort and privacy of home, via online video or phone call. Virtual visits are convenient for many routine medical or behavioral health needs, including prescriptions as appropriate.
- Urgent care facilities—Just walk into one of these facilities when you need to see a doctor right away; for example, for sore throats, migraines, urinary tract infections, cuts that need stitches, and animal bites.
- Retail convenience clinics—The nurse practitioners and physician assistants that staff these clinics (such as MinuteClinic at CVS) are well-qualified to handle minor illnesses and injuries at a lower cost than a visit to the emergency room or urgent care.
Don’t skimp on preventive care—in-network care is free!
- Even if you’re feeling fine, regular physicals and screenings are the key to staying healthy.
- Certain preventive medications are covered at 100%.
See if your medications are on these lists:
- Balanced Drug List (formulary), preferred with all three medical plans
- No-Cost Preventive Drugs, no cost for all three medical plans
- HSA Preventive Drugs, no deductible, 15% coinsurance for Blue PPO + HSA only (also referred to as Enhanced Drug List)
If not, talk to your doctor about switching to similar medications that are listed.
Some medications have special requirements like prior authorization, step therapy, or quantity limits.
Opt for generics
Generics are FDA-approved to be just as safe and effective as their brand-name counterparts, yet usually cost a lot less. If your doctor prescribes a brand-name drug and specifies “dispense as written,” you won’t be responsible for paying the difference between the brand name and generic (if available) cost.
If your doctor does not specify “dispense as written” and you choose a brand name over a generic drug, you’ll have to pay the cost difference.
Use mail order or your local Walgreens for long-term meds
For prescription drugs you take on an ongoing basis (maintenance medications), you have two convenient options for 90-day supplies:
- Express Scripts mail order service for home delivery, or
- Pick up at your local Walgreens.
Maintenance medications aren’t covered at non-Walgreens pharmacies or in quantities of less than 90 days. If you have questions about mail order prescriptions, contact Express Scripts at (833) 715-0942
Consult with a BCBSIL Health Advocate
Via phone, mobile app, or online chat, this dedicated team can help you connect with the right clinician, navigate the health care system, schedule appointments, get cost estimates, and much more.
Use in-network pharmacies
Check if your pharmacy is in-network with Prime Therapeutics. Continue without sign in > BCBSIL > No to Medicare > Other BCBSIL Plans > Traditional Select Network
If you enroll in the Blue PPO + HSA, the Art Institute contributes to your HSA once you open your account.
- Blue Choice—No copay
- Blue PPO—No copay
- Blue PPO + HSA—You pay $44 for most visits with a primary care physician; costs range from $80–$175 for behavioral health visits. You can use your HSA to pay for these services and they apply toward the plan’s deductible.