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Blue Cross and Blue Shield of Illinois – SelecTEMP PPO – ILLINOIS
A comparison of the SelecTEMP PPO offered by Blue Cross and Blue Shield of Illinois is detailed out below for both Network and Non-Network coverage.
| Network | Non-Network | |
|---|---|---|
|
||
| Network | See Provider | See Provider |
| Application | SelecTEMP PPO Application | SelecTEMP PPO Application |
| Brochure | SelecTEMP PPO Brochure | SelecTEMP PPO Brochure |
| Copay | N/A | N/A |
| Office Visit | 80% | 60% |
| Deductible | $1,000 Individual, $2,000 Family | $2,000 Individual, $4,000 Family |
| Coinsurance | 80% | 60% |
| Coinsurance Limit | $1,000 Individual, $2,000 Family | $2,000 Individual, $4,000 Family |
| Out-of-Pocket Maximum | $2,000 Individual, $4,000 Family | $4,000 Individual, $8,000 Family |
| Lifetime Maximum | $5,000,000 | $5,000,000 |
| Prescription Drugs | 80% after Deductible, $500 maximum | 80% after Deductible, $500 maximum |
| Emergency Room | 80% after you pay $75 copayment | 80% after you pay $75 copayment |
| Adult Preventative Care | SelecTEMP PPO | SelecTEMP PPO |
| Child Preventative Care | SelecTEMP PPO | SelecTEMP PPO |
| Lab / X-Ray | 80% | 60% |
| Maternity | SelecTEMP PPO | SelecTEMP PPO |
| Physical Therapy | 80% does not apply to out-of-pocket expense limit | 60% does not apply to out-of-pocket expense limit |
| Skilled Nursing | 80% | 60% |
| Home Health Care | 80% | 60% |
| Mental Health | SelecTEMP PPO | SelecTEMP PPO |
| Hospital Care | 80% | 60% |
| Optional Benefits | SelecTEMP PPO | SelecTEMP PPO |