CTPF 2027 NON-MEDICARE HEALTH INSURANCE HANDBOOK
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Blue Cross Blue Shield HMO Illinois 
(HMOI)
NETWORK NAME
HMO Illinois (HMO)
PLAN FEATURES
Traditional HMO. You must select an HMOI primary 
care physician (PCP). Referral required for specialty 
care. Plan typically pays 100% after copayment. Must 
use network provider.
CONTACT INFORMATION
Group number: H64047
1-800-892-2803 Customer Service
1-800-423-1973 Pharmacy
www.bcbsil.com
HOW TO ENROLL
Complete CTPF Form 350 (available online at www.
ctpf.org). Return with required documentation to 
CTPF.
SERVICE AREA
Chicago vicinity only
FOREIGN TRAVEL
Foreign travel emergency benefits available.
PHYSICIAN SELECTION
PCP-directed, referrals required.
Must use network provider.
LIFETIME MAXIMUM
No lifetime maximum
OUT-OF-POCKET MAXIMUMS
Individual:	
$1,500
Family: 	
$3,000
Prescription copays, vision, durable medical 
equipment, and prosthetics do not apply to 
out-of-pocket maximums.
Blue Cross Blue Shield PPO
NETWORK NAME
Participating Provider Organization (PPO)
PLAN FEATURES
Traditional PPO. You may use any physician. Plan 
typically pays 90% PPO and 50% Non-PPO of allowed 
charges after the plan year deductible has been met.
CONTACT INFORMATION
Group number: P06675
1-800-331-8032 Customer Service
1-800-851-7498 Mental Health
1-800-423-1973 Pharmacy
www.bcbsil.com
HOW TO ENROLL
Complete CTPF Form 350 (available online at www.
ctpf.org). Return with required documentation to 
CTPF.
SERVICE AREA
Nationwide
FOREIGN TRAVEL
Foreign travel emergency benefits available. Other 
foreign medical coverage may be available. Contact 
BCBS at 1-800-810-2583 for more information.
PHYSICIAN SELECTION
Enhanced benefit level when you use a 
PPO hospital or physician.
LIFETIME MAXIMUM
No lifetime maximum
OUT-OF-POCKET MAXIMUMS
Individual:	
$3,000 	PPO
	
$5,000	 Non-PPO
Family:	
$6,000	 PPO
	
$10,000	 Non-PPO
Prescription copays do not apply toward                      
plan deductible.

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