Blue Choice Options^SM PPO

Blue Choice Options' unique benefit plan tiered design helps you control your care — and expenses. It's a lower-cost PPO choice with:

• Lower out-of-pocket costs when you use independently contracted doctors and hospitals that are in the Blue Choice OPT PPO network*
• The choice to use contracted doctors and hospitals in the larger PPO network at a higher cost

This PPO's unique benefit plan tiered design helps you control your care — and expenses.

* The Blue Choice OPT PPO network covers the Chicago Metro area in Illinois with contracted providers in Cook, Lake, McHenry, DuPage, Kane, Grundy, Kankakee, Kendall and Will counties.

Using Blue Choice Options PPO

In addition to not having to select a PCP or get referrals for specialist, you'll have three tiers to keep in mind:

• Tier 1 — You'll have the lowest out-of-pocket costs if you see a contracted provider in the Blue Choice OPT PPO network.
• Tier 2 — You'll have higher out-of-pocket costs if you see a contracted provider in the larger PPO network.
• Tier 3 — You'll have the highest out-of-pocket cost if you see an out-of-network doctor.

The way you use this plan is the same as other PPOs, there's just extra networks and tiers to consider.

Medical Care

Benefit coverage under Blue Choice Options PPO includes:

• Preventive care services
• Doctor office visits
• Outpatient hospital services
• Outpatient surgery and diagnostic testing
• Maternity services
• Hospital emergency medical and accident
• Out of state coverage
• Breast Cancer screening
• Occupational and speech therapy

Additional benefit coverage available:

• Prescription drug benefit with mail service for maintenance medications
• Mental health and substance abuse coverage

This is only a brief description of some of the plan benefits. For more complete details, including benefits, limitations and exclusions, please refer to your certificate of coverage.