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Benefits • Medical - Consumer Choice PPO

The Consumer Choice PPO Plan offers flexibility to see any health care provider you choose, however when you go to an in-network BlueCross BlueShield provider you are going to receive services at a negotiated discounted fee.

Resources

Plan Documents - Handbooks

2009 Benefits Guide

Prescription Drug Coverage

Benefit Vendor Directory

Medical Plan Decision Toolkit

Terms to Know

Eligibility Information

Price Sheets FT / PT

To locate PPO providers contact BCBS Customer Service at 1-866-563-8366 or online at www.bcbsil.com/foundations (click on Network Providers).

See the Consumer Choice Plan Handbook for a complete summary of benefits.

The Consumer Choice PPO Plan is a qualified high deductible health plan (HDHP), which entitles you to a health savings account (HSA). Be sure to review the HSA section for more information!

The Consumer Choice PPO Plan has a $2,700 deductible for employee coverage or $5,450 deductible for all other tiers. One family member or a combination of family members can satisfy the family deductible and the full family deductible must be met before post deductible benefits are paid.

	Monthly Premiums	Annual Deductibles	Annual Out-of-Pocket Maximums In Network	Annual Out-of-Pocket Maximums Out of Network
Employee	$(33)	$2,700	$2,700	$5,450
Employee + Spouse/DP*	$(28)	$5,450	$5,450	$10,900
Employee + Child(ren)	$(30)	$5,450	$5,450	$10,900
Family	$(21)	$5,450	$5,450	$10,900

*DP = Domestic Partner

Pre-existing condition exclusion	None
Out-of-Pocket Expenses	In-Network	Out-of-Network
Deductible	Employee Coverage $2,700 Family Coverage $5,450 (full family deductible must be met before plan starts)
Annual Out-of-Pocket Maximum (includes deductible)	$2,700 Employee Cvg $5,450 All Other Cvg	$5,400 Indiv. $10,900 Family
Benefits	In-Network	Out-of-Network
Coinsurance (paid after deductible) applies to all professional services except as noted below	Plan Pays 100%	You Pay 40%
Office Visit Copays (Copays do not apply to deductible or out-of-pocket maximum)	Subject to deductible & coinsurance	Subject to deductible & coinsurance
Labwork / Professional Services	Subject to deductible & coinsurance then plan pays 100%
Emergency Room Visit Copayment	Subject to deductible & coinsurance then plan pays 100%
Wellness Benefit (not subject to deductible)	100% up to $750 annually
Maximum Lifetime Benefit	Unlimited

Coverage through Caremark network pharmacy or mail order only	Retail (30-day supply)	Retail (90-day supply)	Mail Order (90-day supply)
Generic Copay Preferred Brand Copay Non-Preferred Brand Copay	Subject to same deductible and coinsurance as other medical benefits

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