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CTPF 2027 NON-MEDICARE HEALTH INSURANCE HANDBOOK
Blue Cross Blue Shield PPO
BEHAVIORAL HEALTH SERVICES
Inpatient
90%    PPO hospital
50%    Non-PPO hospital 
Outpatient
$10     Copay PPO provider 
50%    Non-PPO provider
PRESCRIPTION DRUG BENEFITS*
Retail up to 30-Day Supply
$5  	    Generic copay
$40	     Formulary brand copay
$75	     Non-formulary brand copay
Retail up to 90-Day Supply
$10	     Generic copay
$80 	   Formulary brand copay
	$150 	  Non-formulary brand copay
Mail Order up to 90-Day Supply
$10  	 Generic copay
$80  	 Formulary brand copay
	$150	 Non-formulary brand copay
* Specialty medications limited 
   to an up to 30-day supply
INFO
Blue Cross Blue Shield HMO Illinois 
(HMOI)
BEHAVIORAL HEALTH SERVICES
Inpatient
$200    deductible per hospital admission           
            (not to exceed 2 per year)
Outpatient
$30    Copay
          All care coordinated through your PCP
PRESCRIPTION DRUG BENEFITS*
Retail up to 30-Day Supply
 $10	   Generic copay
	$30	   Formulary brand copay
 $50     Non-formulary brand copay 
Retail up to 90-Day Supply
	  $25   Generic copay
	  $75	  Formulary Brand copay
$125	  Non-formulary brand copay
Mail Order up to 90-Day Supply
  $25	  Generic copay
  	$75	  Formulary brand copay
	$125	  Non-formulary brand copay
* Specialty medications limited 
    to an up to 30-day supply
Prescription Drug Plan Changes
Each health insurance plan utilizes a formulary (a list of preferred prescription drugs). 
Formularies may change annually, so make sure you review your plan’s 2027
formulary to determine if your prescription expenses will change. 
*

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