ACA 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.
Non-benefits eligible faculty and staff who have worked an average of 30 hours per week during a 12-month initial measurement period (first 12-months) will become eligible for this plan. To remain eligible, faculty and staff must continue to work an average of 30 hours per week during a 12-month standard measurement period (fiscal year). Those who qualify will be invited to participate via an email to their Northwestern email address.
This is a summary of the plan benefits. Complete benefit information is available in the BCBS PPO ACA Value PPO Booklet and Summary of Benefit Coverage (SBC) 2025 [Spanish].
| In-Network | Out-of-Network | |
|---|---|---|
| Group Number | 006171 | 006171 |
| Deductible | $2,100 member*, $4,200 family | $3,100 member*; $6,200 family |
| Coinsurance | 20% | 40% |
| Out-of-Pocket (OOP) Maximum | $3,000 member*, $8,000 family | $7,500 member; $20,000 family |
| Prescription OOP Maximum | Included in health OOP max | N/A |
| Wellness Checkup | Covered 100% according to age/sex guidelines | Deductible + 40% coinsurance |
| Office Visit | Deductible + 20% coinsurance | Deductible + 40% coinsurance |
| Emergency Room Costs | Deductible + 20% coinsurance | Deductible + 20% coinsurance |
*All health care copays apply toward the out-of-pocket maximums.
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]
Those on this plan will be billed on a monthly basis for the premiums owed. Our billing vendor Wage Works/WageWorks will administer the billing process. Monthly premiums must be paid on time.
| You | You + Spouse | You + Child(ren) | You + Spouse + Child(ren) |
|---|---|---|---|
| $113 | $1,086 | $816 | $1,980 |
Those on this plan will be billed on a monthly basis for the premiums owed. Our billing vendor Wage Works/WageWorks will administer the billing process. Monthly premiums must be paid on time.
| You | You + Spouse | You + Child(ren) | You + Spouse + Child(ren) |
|---|---|---|---|
| $113 | $1,086 | $816 | $1,980 |
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
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