The Participating Provider Option (PPO) plan gives you freedom of choice, flexibility and a broad range of benefit options. With the PPO product:
- There is no need to select a primary care physician; you can choose a doctor whenever you need care.
- You do not need a referral to see a specialist or to get another opinion about a medical condition.
- The choice of doctors and hospitals is always yours.
PPO Advantages
With the PPO plan, you have access to a large network of contracting doctors and hospitals in the national BlueCard® network.
- The BlueCard network includes more than half a million contracting doctors and specialists—over 23,000 in Illinois alone.
- The network also includes more than 5,000 contracting hospitals across the country.
With the PPO plan, benefits may include coverage for:
- Doctor office visits
- Inpatient hospital services
- Outpatient hospital services
- Maternity care
- Hospital emergency medical and accident treatment
- Breast and cervical cancer screenings
- Muscle manipulation services
- Physical, speech and occupational therapies
- Infertility treatment
- Mental health and chemical dependency treatment
- Reconstructive surgery following a mastectomy
Preventive Care
Coverage may also include preventive care benefits for well-child and adult care, including:
- Physical exams
- Diagnostic tests
- Immunizations
Group plan coverage may vary.
Use Network Doctors and Hospitals for Greater Benefits
Benefits are paid at the highest level when you receive care from network PPO doctors and hospitals. When you receive care from network PPO doctors and hospitals:
- There are no claim forms to complete.
- There are no up-front payments for medical services (except for copayments) and charges for non-covered services.
- There’s no balance billing—network doctors and hospitals accept Blue Cross and Blue Shield of Illinois’ negotiated rates.
You always have the option to receive care outside the network, but your benefits will be paid at a lower level.
|
