The Classic PPO and HSA-Compatible PPO options have key features.

How the coverage options are the same

• Covered services: Comprehensive coverage for medical services, such as doctor office visits and hospital stays.
• Carrier: Both options are available through BCBS, which offers both in-network and out-of-network coverage.
• Preventive care coverage: In-network preventive care is covered at 100% (e.g., annual physical, mammogram, well-child care).
• Medical copay and coinsurance amounts: After reaching the deductible, you pay a portion of the cost for most covered services. That portion is either a flat-dollar amount per service (copay) or a percentage of the cost (coinsurance). Once you reach the out-of-pocket maximum, you pay nothing.
• Prescription drug copay/coinsurance amounts (retail pharmacy): For a 30-day supply, pay a copay for Generic and Preferred Brand prescriptions. For Non-Preferred Brand prescriptions, you pay a copay under the HSA-Compatible PPO option and coinsurance under the Classic PPO option. With the HSA-Compatible PPO, you must satisfy the deductible first before the copay applies. With the Classic PPO option, there’s no deductible for prescription drug coverage so cost sharing applies immediately.

How they are different

Here’s a quick comparison.

The carrier has a large selection of network providers, for example doctors and hospitals, across the country. And, when you stay in-network, covered services are provided at a discount.

Here’s a snapshot of the carrier, type of network offered, and the name of the carrier’s network.

To confirm whether your doctor, hospital, or other care provider participates in the carrier’s network, be sure to use the provider look-up tool on MyBenefits Online. However, it’s also a good idea to double-check directly with your provider to make sure they participate in the network before you receive care. Your provider will have the most up-to-date information about their network participation.

To decide what’s right for you, take a close look at your costs and consider how you prefer to pay for coverage.

• Classic PPO means you’ll have higher contributions, but coverage will begin sooner (lower in-network deductible and out-of-pocket maximum).
• HSA-Compatible PPO means your contributions will be lower, but it will take longer for coverage to begin (higher deductible and out-of-pocket maximum).

Here’s how the options compare against some of the key features that affect how and when you pay for care:

Need a quick refresher on how you and the Medical Plan—regardless of whether you select the Classic PPO or HSA-Compatible PPO option—share in the cost of coverage? Check out the graphic below.

If you cover family members, it’s important to understand how the deductibles and out-of-pocket maximums work—it affects when the Medical Plan’s benefits kick in.

Embedded

The Classic PPO option has an embedded approach to the deductible, which is the more traditional way of thinking about deductibles. With this approach, once one family member meets their individual deductible, it’s considered met for that person. Benefits begin for them, but not yet for the other family members. This means:

• Each person only needs to meet the individual deductible before the Medical Plan begins paying benefits for that individual.
• Other covered family members will continue to pay all of their health care expenses until two or more combined meet the family deductible. When that happens, the Medical Plan then begins paying benefits for all covered family members.
• If you have a family member who tends to have more health care costs than the others, you might want to consider choosing an option with this approach, as it could save you money.

Aggregate

In order to meet IRS rules to be paired with an HSA, the HSA-Compatible PPO option has an aggregate approach to the deductible. With this approach, there’s one deductible for the whole family. This means:

• You ignore the individual deductible amount completely.
• Only the family deductible applies to each covered family member.
• Once one person or a combination of covered family members meet the deductible, it’s considered met for all covered family members and benefits begin for everyone.

The embedded and aggregate methodologies work the same for out-of-pocket maximums as they do for deductibles. Note, however, that even though the HSA-Compatible option’s deductible is aggregate; its out-of-pocket maximum approach is embedded. As a result, both the Classic PPO and HSA-Compatible options have embedded out-of-pocket maximums.

Both coverage options offer telemedicine. With telemedicine, you can talk to a doctor 24/7 for a variety of services (e.g., general medical, behavioral/mental health). Per-visit costs vary by the type of service received; but are often less than what you would pay for in-office care.

For specifics on telemedicine options and costs, contact the carrier directly at 1-800-770-4622 or access the MD Live Website.

Learn more about telemedicine in this video.

Blue Cross and Blue Shield of Illinois (BCBS)

• BCBS of Illinois Website
• MD Live Website
• Main Phone: 1-877-238-5948
  • Telemedicine: 1-800-770-4622
  • Nurseline: 1-800-299-0274
• Mobile App: APPLE APP STORE | GOOGLE PLAY STORE
• Group Number: See your member ID card
• Network: Broad—Blue Card PPO or Blues Alternate Networks (depending on location)