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Individual & Family

Important Benefits Change

We’d like to highlight some important benefits information for Blue Choice Preferred PPO℠ and MyBlue Plus℠.

Woman getting her blood pressure checked.

What Should You Know?

Non-emergency, non-urgent care out of state beyond the counties that border Illinois is not a covered benefit under your plan.

Coverage for non-emergency or non-urgent care outside your plan’s service area or border counties is not available only if adequate care is not available in your plan’s service area. If a service you need is not available in your plan’s service area, coverage may be available if you ask for a waiver in advance and it is approved.

To find in-network care, log in to your member account or visit our Provider Finder® tool.

If a service you need is not available in your plan’s service area, coverage may be available if you request a waiver in advance, and it is approved. To ask for a waiver, call Customer Service at the number on your member ID card.

You need an approved out-of-service-area waiver from BCBSIL prior to receiving non-emergency or non-urgent care from any providers, whether in network or out of network, outside Illinois or the counties that border Illinois (also known as “contiguous counties”). Additionally, you need an approved out-of-service-area waiver from BCBSIL prior to receiving non-emergency or non-urgent care from out-of-network providers in counties that border Illinois.

Please refer to this page's Answers to Questions You May Have section to find what counties border (are contiguous to) Illinois and for additional information on out-of-service-area waivers and how to obtain a waiver. Once you receive your member contract for 2025, you may also refer to the “Out of State Services” section for further details on this benefit change.

Remember:

Out-of-state care beyond the border counties is not covered, unless you obtain an out-of-service area waiver. A waiver for otherwise covered services will be approved only if the services are not available in the plan’s service area. A waiver will be denied if adequate care is available in Illinois or its border counties. You may be redirected to available, local in-network services.

If you do not receive the appropriate waiver in advance, Blue Cross and Blue Shield of Illinois will not pay the claim.

As always, if you are facing a medical emergency call 911 or proceed to the nearest emergency room.

Understand Your Access to Care

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Benefits

You can choose to go to an out-of-network provider or facility within Illinois without a waiver. If you do, however, you may pay more for your care than if you were to stay in network.

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Access to emergency & urgent care

You are able to get emergency and urgent care nationwide without the need for a waiver.

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Finding care

You can find in-network providers through your member account under Find Care.

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Freedom to choose

You can visit a range of in-network providers, specialists, and hospitals throughout Illinois and its border counties.

How to Request a Waiver

To request a waiver, call Customer Service at 1-800-538-8833. An agent will need the following information, so it may be helpful to speak with your doctor ahead of calling:

  • Provider name, address and phone number
  • Provider type
  • Provider number/NPI (10-digits)
  • Provider tax ID (9-digits with a hyphen after the 2nd digit)
  • Diagnosis code
  • Estimated number of visits
  • First date of service (if your service date isn't on or after 1/1/2025, the waiver will not be considered)

Answers to Questions You May Have