BlueChoice Select
(51-150 employees) (151+ employees)
BlueChoice Select includes the same important PPO features, such as automatic claims filing and no balance billing when members use network providers. Members can see any physician for care and do not need referrals to see specialists. This product is available only in specific areas of Illinois (check with your Blue Cross and Blue Shield of Illinois account representative or broker for details).
In-Network Benefits — 90% / 60% Coinsurance
Coinsurance | Deductible (Individual/Family) | Out-of-Pocket Max* (Individual/Family) | Office Visit/ Emergency Room Copay |
---|---|---|---|
90% | $500 / $1,500 | $1,000 / $3,000 | $20 / $150 |
90% | $1,000 / $3,000 | $1,000 / $3,000 | $20 / $150 |
90% | $1,500 / $4,500 | $1,000 / $3,000 | $20 / $150 |
90% | $2,500 / $7,500 | $1,000 / $3,000 | $20 / $150 |
90% | $3,500 / $10,500 | $1,000 / $3,000 | $20 / $150 |
Out-of-Network Benefits
Coinsurance | Deductible (Individual/Family) | Out-of-Pocket Max* (Individual/Family) |
---|---|---|
60% | $1,000 / $4,500 | $2,000 / $6,000 |
60% | $2,000 / $6,000 | $2,000 / $6,000 |
60% | $3,000 / $9,000 | $2,000 / $6,000 |
60% | $5,000 / $15,000 | $2,000 / $6,000 |
60% | $7,000 / $21,000 | $2,000 / $6,000 |
In-Network Benefits — 80% / 50% Coinsurance
Coinsurance | Deductible (Individual/Family) | Out-of-Pocket Max* (Individual/Family) | Office Visit/ Emergency Room Copay |
---|---|---|---|
80% | $500 / $1,500 | $2,000 / $6,000 | $30 / $150 |
80% | $1,000 / $3,000 | $2,000 / $6,000 | $30 / $150 |
80% | $1,500 / $4,500 | $2,000 / $6,000 | $30 / $150 |
80% | $2,500 / $7,500 | $2,000 / $6,000 | $30 / $150 |
80% | $3,500 / $10,500 | $2,000 / $6,000 | $30 / $150 |
Out-of-Network Benefits
Coinsurance | Deductible (Individual/Family) | Out-of-Pocket Max* (Individual/Family) |
---|---|---|
50% | $1,000 / $3,000 | $4,000 / $12,000 |
50% | $2,000 / $6,000 | $4,000 / $12,000 |
50% | $3,000 / $9,000 | $4,000 / $12,000 |
50% | $5,000 / $15,000 | $4,000 / $12,000 |
50% | $7,000 / $21,000 | $4,000 / $12,000 |
* The out-of-pocket maximums does not include the deductible.
Contact Us
Blue Cross and Blue Shield of Illinois
300 East Randolph Street
Chicago, Illinois 60601-5099
(800) 654-7385
Three-Tier Formulary Prescription Drug Card
Each health product can be paired with one of three prescription drug cards. Drug card copayments are listed in the following order: Generic / Preferred / Non Preferred.
- $15 / $30 / $50
- $15 / 35% / 50%
- $10 / $40 / $60