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) 2024.
| In-Network | Out-of-Network | Northwestern Medicine | |
|---|---|---|---|
| Group Number | 006171 | 006171 | 006171 |
| Deductible | $2,100 member*, $4,200 family | $3,100 member*, $6,200 family | $1,600 member, $3,200 family |
| Coinsurance | 20% | 40% | 10% |
| Out-of-Pocket (OOP) Maximum | $3,000 member*; $8,000 family | $7,500 member*; $20,000 family | $2,400 member; $6,400 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.
Paying For Medical Expenses
Through the Health Savings Account (HSA), you can set aside pre-tax funds to covers health care expenses incurred by you or your eligible tax dependents not paid by insurance. Complete listing in IRS publication 502 found on the IRS website. For more information, view the HSA Quick Reference Guide. Interested in investing your Health Savings Account dollars? For more information, read this guide.
Saving Money On Health Procedures and Tests
Member Rewards Program
With Member Rewards, you can shop for in-network medical care like CT scans, MRIs and more, compare costs and maybe even earn a cash reward. This program is part of your health plan benefits and administered by Sapphire Digital. It is quick and easy to use.
Step 1
Shop online by logging in to bcbsil.com to find a reward-eligible location for your procedure or service.
Step 2
Get the procedure or service at your chosen reward-eligible location.
Step 3
Receive a cash reward by check, which will be mailed directly to your home, after your claim is paid and the location is verified as reward-eligible
Here’s why Member Rewards is a great program. You can:
- Compare costs for procedures and services, which can vary by provider
- Estimate and save on your out-of-pocket costs
- Earn cash when you select a reward-eligible provide
Eligibility: Those enrolled in any Northwestern BCBSIL PPO plan
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]
Northwestern Medicine participating doctors
- Navigate to the Northwestern Medicine Provider Finder (be sure NOT to log in)
- Select the get medical care in the middle of the screen
Price a medication
Use ExpressScripts online pricing tool to price current or future medications. Shopping around may save you money.
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.
Jump to:
Premiums for full-time employees
| Annual Salary | You | You + Spouse | You + Child(ren) | You + Spouse + Child(ren) |
|---|---|---|---|---|
| Under $42,000 | $20 | $44 | $39 | $64 |
| $42,001-$75,000 | $41 | $90 | $78 | $135 |
| $75,001-$128,000 | $95 | $205 | $173 | $308 |
| $128,001-$182,000 | $149 | $326 | $276 | $487 |
| $182,001 and above | $227 | $494 | $420 | $739 |
For new hires, the salary tier is determined based on your initial, regular salary. The salary tier for current employees is determined by your salary on September 1st of the year proceeding the plan year (e.g. Premiums starting 1/1/2024 are based on your 9/1/2023 salary). Mid-year changes to salary will not change your assigned salary tier, unless you transition from full-time to part-time or part-time to full-time. When your 9/1 salary crosses a salary tier due to a salary increase not associated with a change in full-time/part-time status, you will pay the lower premium for the following year.
Premiums for part-time employees
| Annual Salary | You | You + Spouse | You + Child(ren) | You + Spouse + Child(ren) |
|---|---|---|---|---|
| Under $42,000 | $253 | $551 | $467 | $822 |
| $42,001-$75,000 | $265 | $579 | $494 | $869 |
| $75,001-$128,000 | $302 | $656 | $558 | $985 |
| $128,001-$182,000 | $337 | $740 | $626 | $1,104 |
| $182,001 and above | $390 | $850 | $722 | $1,272 |
For new hires, the salary tier is determined based on your initial, regular salary. The salary tier for current employees is determined by your salary on September 1st of the year proceeding the plan year (e.g. Premiums starting 1/1/2024 are based on your 9/1/2023 salary). Mid-year changes to salary will not change your assigned salary tier, unless you transition from full-time to part-time or part-time to full-time. When your 9/1 salary crosses a salary tier due to a salary increase not associated with a change in full-time/part-time status, you will pay the lower premium for the following year.
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.
Jump to:
Premiums for full-time employees
| Annual Salary | You | You + Spouse | You + Child(ren) | You + Spouse + Child(ren) |
|---|---|---|---|---|
| Under $42,000 | $22 | $51 | $44 | $74 |
| $42,001-$75,000 | $46 | $104 | $87 | $156 |
| $75,001-$128,000 | $106 | $236 | $193 | $355 |
| $128,001-$182,000 | $167 | $376 | $308 | $562 |
| $182,001 and above | $254 | $570 | $469 | $852 |
For new hires, the salary tier is determined based on your initial, regular salary. The salary tier for current employees is determined by your salary on September 1st of the year proceeding the plan year (e.g. Premiums starting 1/1/2025 are based on your 9/1/2024 salary). Mid-year changes to salary will not change your assigned salary tier, unless you transition from full-time to part-time or part-time to full-time. When your 9/1 salary crosses a salary tier due to a salary increase not associated with a change in full-time/part-time status, you will pay the lower premium for the following year.
Premiums for part-time employees
| Annual Salary | You | You + Spouse | You + Child(ren) | You + Spouse + Child(ren) |
|---|---|---|---|---|
| Under $42,000 | $282 | $617 | $522 | $920 |
| $42,001-$75,000 | $296 | $649 | $552 | $975 |
| $75,001-$128,000 | $337 | $737 | $624 | $1,108 |
| $128,001-$182,000 | $376 | $835 | $699 | $1,246 |
| $182,001 and above | $436 | $962 | $806 | $1,439 |
For new hires, the salary tier is determined based on your initial, regular salary. The salary tier for current employees is determined by your salary on September 1st of the year proceeding the plan year (e.g. Premiums starting 1/1/2025 are based on your 9/1/2024 salary). Mid-year changes to salary will not change your assigned salary tier, unless you transition from full-time to part-time or part-time to full-time. When your 9/1 salary crosses a salary tier due to a salary increase not associated with a change in full-time/part-time status, you will pay the lower premium for the following year.
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