BlueCross BlueShield of Illinois – SelectTemp PPO Plan
SelectTemp PPO Overview
SelectTEMP PPO is an affordable short-term health insurance plan from Blue Cross Blue Shield of Illinois that provides individuals and families essential protection against unexpected accidents or illness. This plan utilizes the Blue Cross Blue Shield PPO network of doctors and hospitals and provides coverage from 1 month – 11 months.
SelecTEMP PPO is your temporary health insurance solution if you are:
- Experiencing a gap in employer coverage or can’t afford COBRA.
- Waiting for employer coverage to begin.
- Between jobs or laid off
- Losing dependent status
- Looking for a lower-cost alternative to COBRA
- Recently graduated and still seeking your dream job.
- Age 64 and about to retire, but not yet eligible for Medicare.
SelecTEMP PPO covers many of the most costly health care services, including:
- Access to the Blue Cross Blue Shield of Illinois PPO network, the largest PPO network in Illinois that includes over 90% of doctors and 96% of hospitals
- Inpatient and outpatient medical, surgical and hospital services.
- Diagnostic services.
- Emergency care
- Office visits
- Prescription drug coverage
- Physical, occupation and speech therapy
Who is eligible for SelecTEMP PPO?
- Illinois residents at least 60 days of age and under 65 years of age
- Non-expectant parents
- U.S. citizens or non-U.S. citizens living in the United States for at least two years (a copy of your Alien Registration Receipt Card must be submitted with your application)
Short Term Medical vs COBRA
A short term health plan is an excellent alternative to expenseive COBRA premiums for most healthy individuals. Individuals who will need (or soon need) medical care for an exisiting chronic medical condition should elect COBRA since short term medical insurance does not cover pre-existing conditions.
SelectTemp PPO uses the BlueCross and BlueShield of Illinois PPO Network: the largest PPO network in Illinois that includes over 90% of doctors and 96% of hospitals. The network allows you to save on premiums and the cost of covered services when you use a contracting BCBSIL hospital, doctor or specialist. You do not need to select a primary care physician or obtain a referral to see a specialist.
Learn more about valuable member services and features you get when you join the Blue Cross and Blue Shield of Illinois family.
SelectTemp PPO Costs
Health insurance costs include monthly premium payments, individual/family deductibles, out-of-pocket expenses, copayments, and coinsurance. Here is what you can expect with SelectTemp PPO® plans:
- Individual deductibles for individuals ranging from $500 to $2,500
- Family deductibles ranging from $1,000 to $5,000 (2x individual)
- You pay 20% coinsurance of services provided in-network, after the deductible
- Annual out-of-pocket maximum of $1,000 for individuals and $2,000 for families of 2 or more individuals
By using a contracting BCBS PPO hospital, doctor or specialist you are able to save on premiums and the cost of covered services. You do not need to select a primary care physician or obtain a referral to see a specialist.
What’s Included with SelectTemp PPO®
- Coverage for major hospital, medical, and surgical expenses
- Coverage for daily hospital room and board, miscellaneous hospital services, surgical services, anesthesia services, in-hospital medical services, and out-of-hospital care
- Although you can go to the hospitals and doctors of your choice, your benefits under a SelecTEMP PPO plan will be higher, and your costs lower, when you use the services of participating PPO providers that includes over 90% of doctors and 96% of hospitals in Illinois.
- As with all individual Blue Cross and Blue Shield of Illinois plans, the freedom of not having to select a primary care doctor or obtain a referral to see a specialist
- Choice of deductible amount, payment type and length of benefit period (one to six months)
- Blue Extras discount program
Prescription Drug Coverage
- For the SelectTemp PPO plans, there is a prescription drug card benefit that pays for 80% of prescriptions after satisfying the deductible up to a $500 maximum. All prescription costs incurred go towards satisfying the medical deductible.
- Your benefit plan includes a mail service program that offers you the convenience of having covered maintenance medications delivered directly to you.
- SelecTEMP PPO is a short term health insurance plan for individuals and families who need temporary coverage.
- If you need temporary coverage for an additional period of time, you may apply for a second contract term.
- If accepted, any pre-existing condition incurred during the first contract will not be covered with the new contract.
- If you need a long-term health insurance solution, please consider our other individual and family coverage options.
For more information on renewability, view this SelecTEMP PPO Outline of Coverage document.
What if I don’t know how long I need coverage?
If you are between jobs and not sure how long you need short-term health insurance, you can apply for the maximum length of coverage (180 days). If you obtain health insurance coverage from another source such as an employer before your 180 days of coverage expires, you can cancel your Select Temp policy at any time and BCBSIL will reimburse the amount of unsused coverage.
For example, if you purchased a policy for 180 days and obtained coverage from an employer after 90 days, BCBSIL will reimburse the unused 90 days of coverage if you cancel your short-term policy on the 90th day of coverage.
Please be aware that BCBSIL requires the full premium amount for the length of the policy at the time your application is submitted.
SelectTemp PPO – Outline of Coverage
|Length of Coverage||Choose any length from 1 month up to 11 months|
|PPO Network||BCBSIL PPO Network
Includes over 96% of doctors and 90% of hospitals
|Lifetime Maximum Benefit||$5,000,000 per person|
Per individual, per calendar year. No individual will be required to satisfy the more than the individual deductible amount toward the family deductible amount.
| $500 per individual / $1,000 per family1
$1,000 per individual / $2,000 per family1
$1,500 per individual / $3,000 per family1
$2,000 per individual / $4,000 per family1
$2,500 per individual / $5,000 per family1
$5,000 per individual / $10,000 per family1
The level of coverage provided by the plan after the calendar year deductible has been satisfied.
|Out-of-Pocket Expense Limit
The amount of money an individual pays toward covered hospital and medical expenses during any one calendar year. Does not include deductible.
|Family Out-of-Pocket Expense Limit||$2,000||$4,000|
|Inpatient/Outpatient Physician Medical/Surgical Services||80%||60%|
|Emergency Room||80% after $75 copay2|
|Outpatient Prescription Drug Benefit||SelectTemp PPO Pays|
Up to a 30-day supply.
|80% after deductible, $500 maximum|
1 Does not apply to out-of-pocket expense limit.
2 Deductible does not apply.
PRE-EXISTING CONDITIONS LIMITATION
Pre-existing Conditions are those health conditions which were diagnosed or treated by a Provider during the 12 months prior to the coverage effective date, or for which symptoms existed which would cause an ordinarily prudent person to seek diagnosis or treatment. Any Pre-existing Condition will be subject to a waiting period of 365 days.
Blue Cross Blue Shield of Illinois may change premium rates only if they do so on a class basis for all DB-43 HCSC policies. Premiums can be changed based on age, sex, and rating area.
Coverage under this Policy will be terminated for non-payment of premium. Blue Cross Blue Shield of Illinois can refuse to renew this Policy only for the following reasons:
A. If all Policies bearing form number DB-43 HCSC are not renewed, written notice will be provided at least 90 days before coverage is discontinued. Furthermore, you may convert to any other individual policy Blue Cross Blue Shield of Illinois offer to the individual market.
B. In the event of fraud or an intentional misrepresentation of material fact under the terms of the coverage, written notice will be given at least 30 days before coverage is discontinued.
Hospitalization, Services, and supplies which are not Medically Necessary; Services or supplies that are not specifically mentioned in this Policy; Services or supplies for any illness or injury arising out of or in the course of employment for which benefits are available under any Workers’ Compensation Law or other similar laws whether or not you make a claim for such compensation or receive such benefits except where not required by law; Services or supplies that are furnished to you by the local, state, or federal government; Services and supplies for any illness or injury occurring on or after your Coverage Date as a result of war or an act of war; Services or supplies that do not meet accepted standards of medical or dental practice; Investigational Services and Supplies, including all related services and supplies; Custodial Care Service; Routine physical examinations, unless specifically stated in this Policy; Services or supplies received during an Inpatient stay when the stay is primarily related to behavioral, social maladjustment, lack of discipline, or other antisocial actions which are not specifically the result of Mental Illness; Cosmetic Surgery and related services and supplies, except for the correction of congenital deformities or for conditions resulting from accidental injuries, scars, tumors, or diseases; Services or supplies for which you are not required to make payment or would have no legal obligation to pay if you did not have this or similar coverage; Charges for failure to keep a scheduled visit or charges for completion of a Claim form; Personal hygiene, comfort, or convenience items commonly used for other than medical purposes, such as air conditioners, humidifiers, physical fitness equipment, televisions, and telephones; Special braces, splints, specialized equipment, appliances, ambulatory apparatus, battery controlled implants, except as specifically mentioned in this Policy; Eyeglasses, contact lenses, or cataract lenses and the examinations for prescribing or fitting of glasses or contact lenses or for determining the refractive state of the eye, except as specifically mentioned in this Policy; Treatment of flat foot conditions and the prescription of supportive devices for such conditions and the treatment of subluxations of the foot or routine foot care; Immunizations, unless otherwise stated in this Policy; Maintenance Occupational Therapy, Maintenance Physical Therapy, and Maintenance Speech Therapy; Speech Therapy when rendered for the treatment of psychosocial speech delay, behavioral problems (including impulsive behavior and impulsivity syndrome), attention disorder, conceptual handicap, or mental retardation; Hearing aids or examinations for the prescription or fitting of hearing aids; Diagnostic Service as part of routine physical examinations or check-ups, premarital examinations, determination of the refractive errors of the eyes, auditory problems, surveys, case finding, research studies, screening, or similar procedures and studies, or tests which are Investigational, unless otherwise specified in this Policy; Procurement or use of prosthetic devices, special appliances, and surgical implants which are for cosmetic purposes, or unrelated to the treatment of a disease or injury; Services and supplies provided for the diagnosis and/or treatment of infertility including, but not limited to, Hospital services, Medical Care ,therapeutic injection, fertility and other drugs, Surgery, artificial insemination, and all forms of in-vitro fertilization; Maternity Service, including related services and supplies, unless selected as an option (Complications of Pregnancy are covered as any other illness); Long Term Care; Inpatient Private Duty Nursing Service; Maintenance Care; Wigs (also referred to as cranial prothesis); and services and supplies rendered or provided for human organ or tissue transplants other than those specifically named in this policy.
READ YOUR POLICY CAREFULLY — This outline of coverage provides a brief description of the important features of the Policy. This is not the insurance contract, and only the actual Policy provisions will control. The Policy itself sets forth in detail the rights and obligations of both you and your insurance company. It is, therefore, important that you READ YOUR POLICY CAREFULLY!