Prescription Drug Plan

Providing prescription drug coverage if enrolled in one of our medical plans.

When you enroll in one of our medical plans, you are automatically enrolled in the prescription plan. Prescription coverage has three tier categories: generic, brand preferred and brand non-preferred. The amount you pay depends on the tier of your prescription.

PLAN PROVISION BCBS High Deductible PPO + HSA BCBS PPO BCBS Blue Advantage HMO
In-Network Out-of-Network In-Network Out-of-Network In-Network Only
RETAIL RX (UP TO 34-DAY SUPPLY) — YOU PAY:
Generic 20%* 20% $10 $10 $10
Brand Preferred $40 $40 $40
Brand Non-Preferred $60 $60 $60
MAIL ORDER RX (UP TO 90-DAY SUPPLY) — YOU PAY:
Generic 20%* 20% $20 $20 $20
Brand Preferred $80 $80 $80
Brand Non-Preferred $120 $120 $120

*After deductible

Note: This is a summary only of your coverage. Please refer to your summary plan descriptions for the full scope of coverage. In-network services are based on negotiated charges: out-of-network services are based on reasonable and customary (R&C) charges.

Visit www.bcbsil.com or call:
PPO and HSA Plans: 800.828.3116
HMO Plan: 800.892.2803

Contact Info 

Blue Cross Blue Shield of Illinois

PPO and HSA Plans: 800.828.3116
HMO Plan: 800.892.2803
Visit: www.bcbsil.com

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