BCBS Basic PPO Plan: A Comprehensive Overview

The BCBS Basic PPO plan is designed to provide affordable healthcare coverage to individuals and families. It's a type of Preferred Provider Organization (PPO) plan offered by Blue Cross Blue Shield (BCBS).

This plan allows you to see any doctor or specialist you choose, including out-of-network providers, although you'll pay more for those services. You'll also have access to a network of in-network providers who have agreed to discounted rates.

The plan has a deductible, which is the amount you pay out-of-pocket for medical expenses before your insurance kicks in. According to the plan details, the deductible for this plan is $1,500 for individuals and $3,000 for families.

You'll also have to pay a copayment or coinsurance for medical services, which is a percentage of the service cost. For example, the plan requires a $20 copayment for primary care visits.

The BCBS Basic PPO plan has a few key cost-related features to keep in mind. Copayments are a flat fee that applies to various expenses, including doctor's office visits and prescription drugs.

Copays do not count toward the deductible, but they do count toward the out-of-pocket maximum. This means you'll still need to meet the deductible before your plan kicks in, but you can earn credits toward the maximum by paying copays.

Here's a breakdown of the copays for different scenarios:

The annual deductible is a crucial factor to consider when it comes to out-of-pocket expenses. For most eligible expenses, you pay the full amount until you reach the annual deductible.

The deductible amount varies depending on the network you choose and your coverage level. Here's a breakdown of the different deductibles:

You only pay the deductible for certain expenses, such as out-of-network care. The plan covers in-network preventive care, office visits, emergency room visits, and prescription drugs without applying the deductible.

The plan pays benefits when the individual deductible is met. For spouse and dependent coverage, the plan pays benefits for a covered person when they meet the individual deductible amount.

Copayments are a flat fee that applies to certain medical expenses, and they don't count toward the deductible. However, they do count toward the out-of-pocket maximum.

A copayment is a fixed amount you pay for a specific service, such as a doctor's office visit or emergency room visit. For example, if you visit a doctor in the BCBS National PPO Network, you'll pay $15 as a copayment.

Here's a breakdown of copayments for different types of expenses:

Emergency room visits are also subject to copayments, which are the same for in-network and out-of-network providers: $150. Prescription drugs have a copayment, but the exact amount is specified in the Prescription Drugs section.

The annual out-of-pocket maximum is a crucial aspect of your health insurance plan, and it's essential to understand how it works.

The maximum amount you pay for deductible, copays, and coinsurance each calendar year is capped at the out-of-pocket maximum.

In the PPO Plan, separate limits apply to medical expenses and prescription drug expenses. For medical expenses, the out-of-pocket maximum varies depending on whether you're in-network or out-of-network.

Here's a breakdown of the out-of-pocket maximum for medical expenses:

For prescription drug expenses, the out-of-pocket maximum also varies depending on whether you're in-network or not.

The BCBS PPO plan offers flexibility in choosing doctors and hospitals without a primary care physician (PCP) or referrals. This plan is a great option for those who value freedom in their healthcare choices.

You can search for in-network providers through the Provider Finder on the BCBS website. To do this, select Find Care on the navigation bar, then Find a Doctor or Hospital from the dropdown, and log in or search as a guest.

If you're looking for doctors within the Northwestern Medicine network, you can use the Northwestern Medicine Provider Finder. Simply select get medical care in the middle of the screen, and you'll be able to find providers in-network.

Here's a breakdown of the plan's network and provider information:

The Select PPO plan offers flexibility in choosing doctors and hospitals without requiring a primary care physician (PCP) or referrals. This plan allows you to visit any doctor or hospital you want.

The plan has separate deductibles for in-network and out-of-network care. The in-network deductible is $850 for individuals and $2,550 for families, while the out-of-network deductible is $1,700 for individuals and $5,100 for families.

You'll pay 20% coinsurance for in-network care, and the deductible plus 40% coinsurance for out-of-network care. The out-of-pocket maximum is $3,000 for individuals and $8,000 for families for in-network care, and $6,000 for individuals and $16,000 for families for out-of-network care.

Here's a breakdown of the Select PPO benefits by in-network, out-of-network, and Northwestern Medicine network:

All healthcare copays apply toward the out-of-pocket maximums.

Finding a doctor can be a daunting task, especially if you're new to a network. To find a doctor in your network, start by navigating to the Provider Finder.

The first step is to select "Find Care" on the navigation bar at the top of the page. From there, you can choose to find a doctor or hospital.

If you want to search for a doctor, you'll need to log in or select "Search as a Guest". If you're already a member, you can log in to get more personalized results. If not, selecting "Search as a Guest" will still give you a list of participating providers.

If you're looking for a doctor in the Northwestern Medicine network, be sure to navigate to their Provider Finder without logging in. Once you're on the page, select "get medical care" in the middle of the screen.

Here are the steps to find a doctor in your network:

With the BCBS basic PPO plan, you can expect to pay a monthly premium based on your annual salary. If you're a full-time employee, your premiums will be determined by your salary tier, which is based on your initial salary for new hires or your salary on September 1st of the previous year for current employees.

The premiums vary depending on your family size and salary tier, with the highest premium for a family of four being $1,265 per month for those earning $182,001 and above.

You can find a breakdown of the premiums for full-time employees by annual salary and family size in the table below:

If you're a full-time employee, your monthly premiums will depend on your annual salary and the number of family members insured.

The premiums are tiered based on your salary, with different rates for employees making under $42,000, between $42,001 and $75,000, and so on.

Here's a breakdown of the premiums for full-time employees:

The salary tier for current employees is determined by your salary on September 1st of the previous year, and mid-year changes to salary won't change your assigned salary tier unless you change from full-time to part-time or vice versa.

You can save money on health procedures and tests by using Member Rewards, a program that's part of your health plan benefits.

With Member Rewards, you can shop online and compare costs for procedures and services, which can vary by provider.

This means you can estimate and save on your out-of-pocket costs, making healthcare more affordable.

By selecting a reward-eligible provider, you can even earn cash rewards, which will be mailed directly to your home after your claim is paid and the location is verified.

Here are some benefits of using Member Rewards:

To be eligible for Member Rewards, you must be enrolled in any Northwestern BCBSIL PPO plan.

The BCBS Basic PPO plan offers a range of benefits that can help you save money and stay healthy. You can take advantage of an Express Scripts-administered prescription plan to manage your medication costs.

One of the benefits of this plan is access to a vision discount program through Davis Vision. You can also get discounts on gym memberships, alternative medicine, and hearing aids through the Blue Discount Program.

You'll also appreciate the fact that some services are covered with no cost-sharing, including mammograms for women aged 35 and older. Additionally, children up to age 16 are covered under the Well Child Care provisions.

Here are some key benefits of the BCBS Basic PPO plan:

FEP Blue Benefits are designed to help you stay healthy and save money on medical expenses. You can get preventive care screenings, immunizations, and services without paying a dime.

Telemedicine is a convenient option for non-emergency medical issues. You can have virtual doctor visits with Teladoc, with the first two visits and all nutrition visits costing nothing, and additional visits costing just $15.

Urgent care centers are also available, with a $35 copay for each visit. This can be a huge time-saver if you need medical attention but it's not an emergency.

Prescription medication costs vary depending on the type of medication and pharmacy you use. Here's a breakdown of the copays for different tiers of medication:

Maternity care is also covered, with a $250 copay for inpatient care and no copay for outpatient care. Hospital care has a $250 per day copay for inpatient stays, with a maximum of $1,500 per admission. Outpatient hospital care costs $150 per day per facility.

As you explore the benefits of this plan, you'll find that it offers a range of features to support your health and wellness. You can take advantage of an Express Scripts administered prescription plan for convenient and cost-effective medication management.

One of the plan's standout features is its vision discount program, available through Davis Vision. You can also enjoy discounts on gym memberships, alternative medicine, and hearing aids through the Blue Discount Program. To learn more about hearing aid discounts, simply call TruHearing at 866-687-2020.

The plan also covers well child care provisions for children up to age 16, which means you can rest assured that your little ones are receiving the care they need. Additionally, you'll only need to pay a $25 office visit copay.

Preventive care is also a priority with this plan, as mammograms are covered for women 35 and older with no cost-sharing. This means you can take proactive steps to maintain your health without worrying about added expenses.

If you're concerned about out-of-pocket costs, you'll be relieved to know that coinsurance only kicks in after your deductible is met. This means you can budget for your healthcare expenses with confidence.

To give you a better idea of what to expect, here's a breakdown of the coinsurance rates for different services:

This plan is designed to support your health and wellness, and its features reflect that. By understanding what's covered and what to expect, you can make informed decisions about your care and stay on top of your expenses.