Blue Choice Options PPOSM Offers Tiered Benefit Levels

Dec. 3, 2024

Blue Choice Options PPO is a tiered product designed to help employer groups and members manage their health care spending. With a tiered product, the member’s cost-share is determined by the network of the provider they choose for their services. An employer may customize the benefit levels for each tier. All PPO participating providers and Blue Choice PPOSM participating providers are in-network for Blue Choice Options members.

Tiered product benefit structure

  • Tier 1 is the highest benefit level and most cost-effective level for the member. Members have access to a narrow network of providers. Tier 1 providers must be contracted with Blue Choice Options PPO.
  • Tier 2 offers members a broader network of providers at a higher out-of-pocket expense. Providers in Tier 2 are not contracted with Blue Choice Options PPO but are contracted with PPO.
  • Tier 3 includes out-of-network providers and is the highest cost option for covered services. Providers in Tier 3 are not contracted with Blue Choice Options PPO or PPO.

For more information, refer to the Network and Benefit Plans section within the Provider Manual. 

Always check eligibility and benefits first to confirm membership and other important information, including prior authorization requirements and utilization management vendors, if applicable. To identify these members, look for Blue Choice Options or Blue Options on the member ID card and verify eligibility and benefits through Availity® Essentials or your preferred vendor portal. If you have questions, call the provider services number on the member ID card.

Checking eligibility and/or benefit information and/or obtaining prior authorization is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage, including, but not limited to, exclusions and limitations applicable on the date services were rendered. If you have any questions, call the number on the member’s ID card.

Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSIL. BCBSIL makes no endorsement, representations or warranties regarding third party vendors and the products or services they offer.