Below is a list of actual policy documents for Pre-Affordable Care Act – individual grandfathered or grandmothered plan – market coverage. These policies describe how the plans generally work and include eligible expenses, claim filing and appeals procedures, and coverage limitations and exceptions, among other things.
While BCBSIL is posting every actual insurance policy as soon as it becomes available, including policies that contain customized benefit designs, your policy may not yet be available. If you are unable to locate your policy below, you may find it helpful to view one of the sample policies on the previous page, and you can also contact a customer service representative at 800-538-8833 for more information.
Policy Documents
- Alternative
- BasicBlue
- Blue Pathway
- BlueChoice Pathway
- BlueChoice Select
- BlueChoice Select RX
- BlueChoice Value
- BlueEdge 100% BC Network
- BlueEdge HSA 100%
- BlueEdge HSA 5000
- BlueEdge HSA 80%
- BlueValue 1 80%
- BlueValue 100%
- BlueValue 2 80%
- BlueValue 80%
- BlueValue Advantage
- Child Alternative
- Child Major Medical
- Comprehensive Major Medical nonRX
- Comprehensive Major Medical Rx
- Comprehensive/Drug Card
- PPO 100 Series 1
- PPO 1000T Individual
- PPO Series 1 - $250 Deductible
- PPO Series 1 -$1000 Deductible
- PPO Series 1 -$500 Deductible
- Preferred Major Medical nonRx
- Preferred Major Medical Rx
- Preferred/Drug Card
- SelectBlue 100%
- SelectBlue 100% RX
- SelectBlue 80%
- SelectBlue 80% RX
- SelectBlue Advantage
- SelectBlue Advantage RX
- Series 1M PPO - $250 Deductible
- Series 1M PPO - $500 Deductible
- Series 1M PPO -$1000 Deductible
- Series 1M PPO 100
- Traditional Blue 1 80%
- Traditional Blue 100%
- Traditional Blue 2 80%
- Traditional Blue 3 80%
- Traditional Blue 80%
Return to Sample Policy Documents