Medical Plans

 

You can choose between three different medical options for you and your family:

All three are Preferred Provider Organization (PPO) options administered by BlueCross BlueShield of Illinois (BCBSIL). BCBSIL has a large network of providers. To locate a participating provider in your area you can find a provider directory on www.bcbsil.com/foundations or by calling BCBSIL at 1-866-563-8366.

 

The PPO plan from Blue Cross and Blue Shield gives you freedom of choice, flexibility, a broad range of benefit options and access to a large independently contracted provider network. There is no need to select a primary care physician because you can choose a doctor whenever you need care. You do not need a referral to see a specialist or to get another opinion about a medical condition. The provider choice is always yours.

When you receive care from a PPO network provider, there are no claim forms to complete and no balance billing because contracting PPO providers have agreed to accept BCBS’s negotiated rates as payment in full. If applicable, once you meet the annual deductible, there are no upfront payments for medical services with the exception of applicable copayments, coinsurance and charges for non-covered services.

When you receive care from a non-contracted provider, the provider may bill Blue Cross and Blue Shield a dollar amount in excess of the amount allowable for payment. If you choose to see a non-contracted provider, you may be responsible for any amount in excess of the allowable amount for a given service. Blue Cross and Blue Shield  pays non-contracted provider claims based on Medicare reimbursement rates. If you plan to see a non-contracted physician , you should ask your physician to submit a predetermination of benefits for any service to determine if coverage and the cost.