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Blue Cross Blue Shield PPO Maroon Plan

The Maroon Plan is a Preferred Provider Option (PPO).  When you need care; you can visit any eligible licensed provider you choose.  Generally, you pay the deductible then the plan covers a percentage of the cost of your medically necessary care.  Once you reach your out-of-pocket maximum, the plan pays 100% of covered benefits for the rest of the year. 

Your cost for the plan depends on the coverage you select and your income.  

Network Providers

If you visit a network provider ((Participating Provider Organization (PPO)),  your care is considered “in-network,” and the plan covers a higher percentage of your costs. Your doctor submits your claims directly to the Maroon Plan claims administrator.

If you do not visit a network provider, your care is considered “out-of-network,” and the plan pays less.  You file your own claims with the Maroon Plan claims administrator.  Plus, if you are admitted to an out-of-network hospital, you must meet an additional $200 deductible before the plan pays benefits.  Amounts above the eligible or allowable charges are not covered and do not apply toward your deductible or your out-of-pocket maximum.

Preventive Care

In general, routine preventive and wellness medical care will be covered at 100%.  Wellness benefits do not count towards your deductible or out-of-pocket maximums.

Teladoc Health Primary Care

Blue Cross Blue Shield of Illinois, in collaboration with Teladoc Health, allows Maroon PPO members to receive care without the time and stress of traveling to an appointment. Primary360 easily connects you with a board-certified primary care provider of your choice to get answers to your health questions, talk through any concerns and discuss any necessary next steps to achieve your health goals. Primary360 doctors and therapists can be used for annual checkups and wellness visits, specialist referrals, the diagnosis and treatment of non-urgent and common conditions, to receive prescriptions if needed, behavioral and mental health visits and for initial assessment of common dermatological conditions.

Cost of Coverage

Your cost for the plan depends on the coverage you select and your income. Please visit Medical, Dental and Vision Plan Rates. 

Prescription Drugs

Administered by CVS Caremark

The Maroon Plan covers prescription drugs and medicines dispensed by a licensed pharmacist or physician with a written prescription at a participating pharmacy or through the mail order program. Drugs must be approved by the U.S. Food and Drug Administration for general use by humans, including oral contraceptives. 

Participating Retail Pharmacy - For a 30-day supply

  • Generic -  $10 Copayment

  • Preferred Brand - $30 Copayment

  • Non-Preferred Brand - $50 Copayment

  • New! Specialty - 30% Coinsurance; $0 copay if you enroll in Prudent RX through CVS Caremark (see Prudent RX below for more information)

Mail Order- For 90-day supply

  • Generic - $20 Copayment

  • Preferred Brand - $60 Copayment

  • Non-Preferred Brand -  $100 Copayment

Separate out-of-pocket maximum for Rx: $2,000 

Prudent RX by CVS Caremark

Prudent Rx works with prescription drug manufacturers to secure copay assistance for your specialty medications. Prudent Rx manages copay assistance enrollment and renewals on behalf of its participants. If you are a Maroon PPO Plan member, you can receive select specialty medications at no cost through this program. This means $0 out-of-pocket (OOP) for any medications on the CVS Specialty Drug List when filled by CVS Specialty®. Eligible members are automatically enrolled in the Prudent Rx program. Members can choose to opt out of the program by calling 800.578.4403. Should you choose to opt out of the program you will be responsible for 30% coinsurance even after your maximum out-of-pocket (MOOP) is met.