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) 2023 and Summary of Benefit Coverage (SBC) 2024.
| 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) |
|---|---|---|---|
| $101 | $972 | $730 | $1,772 |
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