b'Blue Cross Blue Shield PPO Blue Cross Blue Shield HMO Illinois (HMOI)NETWORK NAME NETWORK NAMEParticipating Provider Organization (PPO) HMO Illinois (HMO)PLAN FEATURES PLAN FEATURESTraditional PPO. You may use any physician. PlanTraditional HMO. You must select an HMOI primary typically pays 90% 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 use network provider.CONTACT INFORMATION CONTACT INFORMATIONGroup number: P06675 Group number: H640471-800-331-8032 Customer Service 1-800-892-2803 Customer Service1-800-851-7498 Mental Health1-800-423-1973 Pharmacy 1-800-423-1973 Pharmacy1-800-299-0274 Nurse Line 1-800-299-0274 Nurse Linewww.bcbsil.com www.bcbsil.comHOW TO ENROLL HOW TO ENROLLComplete CTPF Form 350 (available online at www. Complete CTPF Form 350 (available online at www.ctpf.org). Return with required documentation toctpf.org). Return with required documentation to CTPF. CTPF.SERVICE AREA SERVICE AREANationwide Chicago vicinity onlyFOREIGN TRAVEL FOREIGN TRAVELForeign travel emergency benefits available. OtherForeign travel emergency benefits available.foreign medical coverage may be available. Contact BCBS at 1-800-810-2583 for more information. PHYSICIAN SELECTIONPHYSICIAN SELECTIONPCP directed, referrals required.Enhanced benefit level when you use a Must use network provider.PPO hospital or physician.LIFETIME MAXIMUM LIFETIME MAXIMUMNo lifetime maximum No lifetime maximumOUT-OF-POCKET MAXIMUMS OUT-OF-POCKET MAXIMUMSIndividual:$3,000PPO$5,000Non-PPO Individual:$1,500Family:$6,000PPO Family: $3,000$10,000Non-PPO Prescription copays, vision, durable medical Prescription copays do not apply toward equipment, and prosthetics do not apply toout-of-pocket maximums.plan deductible.12 CTPF 2025 NON-MEDICARE HEALTH INSURANCE HANDBOOK CTPF 2025 NON-MEDICARE HEALTH INSURANCE HANDBOOK'