home > Member Advocacy
Major Changes to Blue Cross Blue Shield of Illinois ACA Marketplace Offerings

Blue Cross Blue Shield of Illinois (BCBSIL) recently announced they are discontinuing their broadest PPO network product offered through Illinois' ACA Marketplace, Get Covered Illinois (also known as the "health insurance exchange"). As of January 1, the "Blue PPO" will no longer be availableas an option for individuals who purchase coverage through the health insurance exchange. The approximately 173,000 patients in Illinois who currently have this coverage will be transitioned to BCBSIL's most comparable exchange product, the Blue Choice Preferred PPO, unless they actively choose a different health plan during the 2016 Marketplace open enrollment period. 

This only affects patients who receive coverage through the ACA Marketplace. Individuals who have coverage through their employers will not be affected by this change.

But take note! The Blue Choice Preferred PPO network is SIGNIFICANTLY more limited than the Blue PPO network. Notably, the Blue Choice Preferred network only includes about half of the hospitals in the state, which will reduce in-network options for your patients if they allow themselves to be passively enrolled in the Blue Choice Preferred PPO.

With open enrollment underway, it is critical that practices work with their patients now to minimize disruptions in care. Here are five steps you can take if you have patients enrolled in a Blue PPO plan:

  1. Determine how you and other physicians, hospitals and health care facilities you work with frequently are affected by this change. Your BCBSIL Provider Network Consultant can assist you in confirming network participation.

  2. Determine whether your patients’ regular sources of care will still be in-network if patients transition to the Blue Choice Preferred PPO. You and your patients cansearch for physicians and facilities that are included in the Blue Choice Preferred PPO by clicking here. The tool is searchable by name, specialty, physician, hospital, and zip code.

  3. If you or your preferred hospitals or other facilities are not part of the Blue Choice Preferred PPO network, you can let your patients know which Marketplace plans you do participate in, and encourage them to investigate these options further on the Marketplace web site.

  4. Try to identify your patients who are enrolled in Blue PPO plans purchased through the health insurance exchange. The plan name should be identified on the front of the patient's member ID card (e.g., Blue PPO Silver). Remember, patients who have BCBSIL PPO plans through their employers are not affected by this change. You may be able to run a search in your practice management system to identify these patients. 

  5. Send a letter or otherwise reach out to the patients who are currently enrolled in a Blue PPO plan and advise them if you or other physicians to whom you commonly refer will no longer be part of a BCBSIL product offered on the health insurance exchange. Help your patients understand how the change in BCBSIL's Marketplace offerings could affect routine care and any ongoing treatment plans if you or your preferred hospital is no longer in-network.

Questions? Contact the ISMS Division of Member Advocacy at 800-782-4767 ext. 1470 or send an email.

 ISMS needs your help determining how the decision to eliminate the Blue PPO option will impact patient access to care. 

Please click this link to answer a very brief 5 question survey.

View Full Site View Mobile Site