CTPF 2027 NON-MEDICARE HEALTH INSURANCE HANDBOOK
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Blue Cross Blue Shield PPO
PROFESSIONAL AND OTHER SERVICES
Allergy Shots
90%     PPO provider
50%     Non-PPO provider
Ambulance
90%
Chiropractic Visits
80%     PPO provider
50%     Non-PPO provider
Limited to 30 visits per year
Dental
Accidental care only: coverage provided 
for repair of accidental injury to sound natural teeth
Eyeglasses and Contacts
Not covered
Contact BCBS customer service at 1-800-331-8032 for 
details on the vision discount program.
Physician Office Visits
$10     Copay PPO provider Primary Care
$50     Copay PPO provider Specialist
50%    Non-PPO provider
Preventive Care Services
100%   of allowed charges PPO and 
  50%   non-PPO providers
Includes routine physical examinations, routine tests, 
colorectal cancer screening, and immunizations
Prosthetic Devices and Medical Equipment
90%    PPO provider up to purchase price
50%    Non-PPO provider up to purchase price
Vision Screening and Exams
Not covered
Contact BCBS Customer Service at 1-800-331-8032 for 
details on the vision discount program.
Blue Cross Blue Shield 
HMO Illinois (HMOI)
PROFESSIONAL AND OTHER SERVICES
Allergy Shots
$30   Office Visit copay
Ambulance
No copay
Chiropractic Visits
$30   copay
Limited to 40 visits per year
Dental
Accidental care only: coverage provided for repair of 
accidental injury to sound natural teeth
Eyeglasses and Contacts
Covered up to $75 allowance every 24 months
Contact EyeMed at 1-844-684-2254 for details 
on the vision discount program. 
Physician Office Visits
$30    copay
Preventive Care Services (physicals, diagnostic 
tests, immunizations)
No copay
Prosthetic Devices and Medical Equipment
No copay
Vision Screening and Exams
$30    copay
Limited to one screening/exam every 12 months

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