b'UnitedHealthcare Choice Plus PPO Blue Cross Blue Shield HMO Illinois (HMOI)NETWORK NAME NETWORK NAMEUnitedHealthcare Choice Plus HMO Illinois (HMO)PLAN FEATURES PLAN FEATURESTraditional PPO. You may use any physician. PlanTraditional HMO. You must select an HMOI primary typically pays 80% PPO and 50% Non-PPO of allowedcare physician (PCP). Referral required for specialty charges after the plan year deductible has been met.care. Plan typically pays 100% after copayment. Must Some services are available for a copayment. use network provider.CONTACT INFORMATION CONTACT INFORMATIONGroup number: 717511 Group number: H640471-866-633-2446 Customer Service 1-800-892-2803 Customer Service1-866-633-2446 Mental Health 1-800-423-1973 Pharmacywww.myuhc.com 1-800-299-0274 Nurse Linewww.bcbsil.comHOW TO ENROLL HOW TO ENROLLComplete CTPF Form 350 (available in the center ofComplete CTPF Form 350 (available in the center of this book or online at www.ctpf.org). Return withthis book or online at www.ctpf.org). Return with required documentation to CTPF. required documentation to CTPF.SERVICE AREA SERVICE AREANationwide Chicago vicinity onlyFOREIGN TRAVEL FOREIGN TRAVELForeign travel emergency benefits available. Foreign travel emergency benefits available.PHYSICIAN SELECTION PHYSICIAN SELECTIONEnhanced benefit level when you use a PCP directed, referrals required.PPO hospital or physician. No referral required. Must use network provider.LIFETIME MAXIMUM LIFETIME MAXIMUMNo lifetime maximum No lifetime maximumOUT-OF-POCKET MAXIMUMS OUT-OF-POCKET MAXIMUMSIndividual:$6,500PPO $10,000Non-PPO Individual:$1,500Family: $13,000PPO Family: $3,000$20,000Non-PPO Prescription copays, vision, durable medical equipment, and prosthetics do not apply toPrescription copays apply toward out-of-pocket maximums.out-of-pocket maximums.12 CTPF 2024 NON-MEDICARE HEALTH INSURANCE HANDBOOK CTPF 2024 NON-MEDICARE HEALTH INSURANCE HANDBOOK'