Blue Cross PMM plan

Plans Designs

Illinois residents can buy The Preferred Major Medical plan from Blue Cross and Blue Shield. It pays comprehensive benefits for a variety of services at a more affordable cost than the CMM+ plan. This plan also gives you freedom to choose any doctor or hospital. Coverage is 80% after deductible. Coverage is 60% after deductible when care is received from a non-participating provider. Cost is about 12% less than CMM+ plan.

Plan Highlights
PPO Network	Blue Cross
Maternity	Optional
Well Care	Child
Rx Card	Some Plans
Office Copay	No
App. Fee	No
See The Brochure (1.5mb) .pdf


	The following summary is NOT a solicitation to sell you insurance. Solicitations can only be made with state, and insurance company, approved brochures. Information contained in this web may contain generalities or inaccuracies. Please read the brochures and policies for specific limitations and exclusions.


	Plan Summary - PMM

Benefit Description	If Using Preferred Providers	Outside of Preferred Network
Deductible(3x per family max)	$250, $500, $1000, or $2500
Coinsurance	80%	80% or 60%
Out of Pocket expense limit (3x per family max)	$ 1000
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Inpatient/Outpatient Hospital services	Covered at 80% after deductible	Covered at 60% at non-preferred hospitals. Additional $300 per admission copay.
Inpatient/Outpatient Hospital Diagnostic Services	Covered at 80% after deductible	Covered at 80% after deductible.
Outpatient Emergency Care for both hospital and doctor	Covered at 100%
Physician Charges - Office Visits- lab, diagnostic and allergy Medical/Surgical services- Inpatient and Outpatient	Covered at 80% after deductible.	Covered at 80% after deductible.
Well Child Care.To age 16. Including immunizations and physical exams.	Covered at 80% after deductible	Covered at 80% after deductible
Outpatient Prescription Drug coverage - For those with $250 or $500 Deductible plan. Oral Contraceptives are covered through mail-order only		*Generics-* $10 copay *Name Brand*- $25 copay then covered at 75%.
Outpatient Prescription Drug coverage - For those with $1000 or $2500 Deductible plan.		Covered at 80% after deductible.
Other Covered Services - at 80% after deductible.	Registered physical and occupational therapy to $3,000 per year. Chiropractic to $1,000 per year. ambulance, durable medical equipment, ariticfical limbs, oxygen, blood and blood plasma Private duty nursing to $1,000 per month, TMJ - $1,000 lifetime
Mental Illness coverage - Max lifetime benefit $25,000.	Inpatient Care limited to $10,000 per year. - First 10 days at 80% if using a PPO provider, 60% otherwise, after deductible, thereafter, 50%. Outpatient care limited to $1000 per year - Covered at 50%.
Maternity Optional coverage. (subject to a 366 day waiting period) Delivery and facility charges. Prenatal and post natal Newborn Nursery Charges .	Covered at 80% after deductible.	Covered at 60% for Facility Charges after deductible, 80% for Medical and surgical services.
Lifetime Maximum Benefits	$ 5,000,000

Preexisting condition clause - Preexisting 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 where symptoms existed which would cause an ordinarily prudent person to seek diagnosis or treatment. Any Preexisting condition will be subject to a waiting period of 365 days.

BLUE CROSS, �MEMBERS-FIRST� PACKAGE OF BENEFITS INCLUDED:

VISION PLAN -PAY JUST $25 FOR AN EYE EXAM FOR GLASSES. DISCOUNTS FROM 100 STATEWIDE CENTERS. NOT COVERED BY PLAN.

DENTAL PROGRAM -REDUCED PRICING FROM MEMBER DENTISTS SAVE 25% OR MORE. NOT COVERED BY PLAN.

HEARING PROGRAM - RECEIVE DISCOUNTS ONHEARING AIDS AND HEARING AID EVALUATIONS PAY AS LITTLE AS $49 FOR A BASIC HEARING EXAM.

OTHER INFORMATION

PREEXISTING CONDITION CLAUSE - 12 MONTHS PRIOR NOT COVERED UNTIL ON PLAN FOR 12 MONTHS.

PRE-CERTIFICATION - NOTIFICATION REQUIRED PRIOR TO ALL ELECTIVE HOSPITAL ADMISSIONS. EMERGENCY AND MATERNITY NOTIFICATION REQUIRED WITHIN 2 BUSINESSDAYS OF ADMISSION.