Under this POS prefix, the member can access care both in-network and out-of-network, with cost-sharing that varies based on how the care is accessed. In-network care coordinated through the member's PCP has the lowest out-of-pocket cost. Include referral documentation when billing at the in-network benefit level.
PPO coverage under this prefix means the member can access any provider. In-network providers have negotiated rates with the plan, while out-of-network providers are reimbursed based on usual and customary charges. Prior authorization is generally not required for routine services but may be needed for high-cost procedures.
HDHP (High-Deductible Health Plan) coverage means the member has a higher deductible than traditional plans, often paired with a Health Savings Account (HSA). Most services require the member to pay out-of-pocket until the deductible is met. Preventive care is typically covered before the deductible. Submit claims normally to the payer listed above.
State's only statewide customer-owned health insurer and independent licensee of the Blue Cross Blue Shield Association. Serves Illinois with commercial, Medicare, Medicaid and other plans.