Experience. Wellness. Everywhere.SM

Information Guide City Colleges of Chicago PPO Plan January 1, 2012

Nearly one in every three Americans has a Blue Cross and Blue Shield product.

ExperiencePreventive care is essential to maintaining a healthier life, and no one understands this better than Blue Cross and Blue Shield of Illinois (BCBSIL). For more than 70 years, BCBSIL has provided quality health care benefi ts and services to its members and communities. BCBSIL provides members with programs and support to create customized wellness action plans, make smarter health care choices and help manage their health care.

Your Journey to WellnessWellness is defi ned as the state of being healthy in body and mind, especially as the result of deliberate effort. The choices you make each day can affect your health now and in the future. Deciding on the best approach for a healthier lifestyle can be challenging, but it may be easier than you think.

BCBSIL offers access to convenient online tools and resources to help you plan and manage your health care. BCBSIL health care plans include fl exible options with the right combination of benefi ts, choice of providers and access to a wide variety of educational resources. Whether you are trying to improve your health or reach the next level of wellness, BCBSIL is here to help.

Take time to explore what Blue Cross and Blue Shield of Illinois has to offer. The coverage options, tools and resources can help you on your journey to wellness.

In This GuideThe following pages include a description of the medical plan and other features and services available to you. In some cases, your employer may be offering you more than one medical plan to choose from. Think carefully about how you and your family will use these benefi ts. Before you make a decision, consider the services that are covered, provider network, potential out-of-pocket costs and other options.

Use the Health Plan Cost Estimator tool to help you see how a medical plan fi ts your budget and your lifestyle. Go to www.bcbsil.com/member and click the Health Plan Decision Tools link.

If you have questions, your employer can provide additional information or direct you to other resources for assistance.

The Choicefor Nearly 1 in 3 Americans

Blue Cross and Blue Shield of Illinois is a leader in health care benefi ts.

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The PPO plan offers a wide range of benefi ts and the fl exibility to choose any doctor or hospital when you need care. The plan includes an annual deductible that you must satisfy before your benefi ts begin. Qualifi ed medical expenses are applied toward your deductible.

PPO NetworkAccess to the large network of contracting providers is one of the many reasons to select the PPO plan. The network includes hospitals, physicians, therapists, behavioral health professionals and alternative care practitioners.

You and your covered dependents can receive care from any licensed doctor, hospital or other provider. However, when you use a contracting network provider, you will pay less out of pocket, you won’t have to fi le any claims and you

will receive the highest level of benefi ts. If you use a doctor outside the network, you’ll still be covered, but your out-of-pocket costs may be signifi cantly higher.

To fi nd a contracting doctor or hospital, just go to bcbsil.com and use the Provider Finder , or call BlueCard® Access at 800-810-BLUE (800-810-2583) for help. Once you become a member, you can also call the toll-free customer service number on the back of your member ID card.

The PPO Plan

*Coverage levels vary by health plan, so refer to your plan documents for details.

Medical CareYour benefi ts may include coverage for*:

• physician offi ce visits

• breast cancer screenings

• cervical cancer screenings

• inpatient hospital services

• muscle manipulation services

• outpatient hospital services

• physical, speech and occupational therapies

• outpatient surgery and diagnostic tests

• infertility treatment

• maternity care

• behavioral health and substance abuse

• hospital emergency medical and accident treatment

With the PPO plan, you can choose any doctor whenever you need care.

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Personal Health ManagerNumerous online tools and information help you manage your health care, whether you want to improve your overall health, manage a chronic health condition or prepare for a specifi c medical treatment. You can:

• Learn about your health status and potential health risks by completing the confi dential Health Risk Assessment (HRA).

• Adopt healthier behaviors and stay motivated using the interactive Get Fit, Eat Right and Live Well tools in the For Your Health section.

• Help identify and understand health symptoms you may be experiencing with the Symptom Checker.

• Set up a personal health record to keep track of and manage your family’s health information.

• Learn more about health conditions, medications and medical procedures to help you manage your care or prepare for diagnostic tests or treatments by researching the health encyclopedia.

Blue PointsEarn Blue Points each time you track a fi tness workout, report a meal or participate in For Your Health interactive programs within the Personal Health Manager*. You can also earn points for completing the general HRA**. Blue Points can be redeemed for health and wellness products and other popular merchandise and services at the Blue Points Account and Redemption Center.

Weight ManagementThis program offers guidance and support to help you lose weight. Use online tools to learn about a healthy weight, healthy eating habits and how to be more active. Set goals and create an action plan, receive coaching to help you change behaviors and stay motivated, and take advantage of discounts for wellness-related products and services. To get started, go to the Personal Health Manager and click the Weight Loss button to enroll in the online program, or call customer service at the number on the back of your ID card.

Blue Care Connection®

Blue Care Connection provides personalized attention, support, online resources and health advocacy, to help you fi nd the right resources, optimize your health care benefi ts and manage your medical conditions. Some Blue Care Connection programs may not be available to all members. Check your group benefi ts plan or call Customer Service.

Use Blue PointsSM to reward yourself

for making the right decisions about your health.

*Blue Points Program Rules are subject to change without prior notice.

** Blue Points are limited to the general HRA and may be earned twice within any 12-month period.

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Tobacco CessationIf you want to quit smoking, this program can help you with online tools, support, coaching and discounts for wellness-related products and services. To participate, go to the Personal Health Manager and click the Stop Smoking button to enroll in the online program, or contact customer service.

The Fitness ProgramYou and your covered dependents (age 18 and older) have unlimited access to a nationwide network of fitness centers for a low monthly membership fee. The Fitness Program provides:

• Flexible membership, no long-term contract required, just a one-time fee of $29 and $29 per month.*

• Easy online enrollment; automatic monthly payment withdrawal.

• Online fitness center locator and views of your fitness center visits.

• An opportunity to earn Blue Points.

• Unlimited access to a nationwide network of participating fitness centers.

• Easy enrollment by calling 888-762-BLUE (2583) toll-free, Monday through Friday, 8 a.m. - 9 p.m., in any U.S. time zone.

24/7 NurselineCall the 24/7 Nurseline at 800-299-0274 for answers to your health-related questions 24 hours a day, seven days a week. Plus you have the option to learn about more than 1,000 health topics over the phone using the audio library system – with more than 600 topics available in Spanish.

*The one-time enrollment fee and monthly membership fee for the Fitness Program are both subject to applicable taxes.

The Fitness Program is available to BCBSIL members. This program is not covered under the member’s health insurance benefit plan. Please refer to your benefit booklet or call the customer service number on the back of your ID card to find out if you are eligible to join the Fitness Program. Use of the Fitness Program does not affect your premium, nor do costs of Fitness Program services or products count toward any maximums and/or plan deductibles. Members are responsible for all fees, dues, taxes and other charges related to the Fitness Program. Refer to the program terms and conditions for further details.

BCBSIL does not guarantee or make any claims or recommendations regarding the services or products offered under the Fitness Program. You may want to consult with your physician prior to use of these services and products. BCBSIL reserves the right to discontinue or change this discount program at any time without notice.

Healthways, Inc. is an independent contractor which administers the Prime Network of fitness centers. The Prime Network is made up of independently-owned and managed fitness centers.

Special Beginnings®,

Special Beginnings helps pregnant members better understand and manage their pregnancies by providing support and education, pregnancy risk factor identifi cation, ongoing communication/ monitoring and access to an online resource center. The program offers support from early pregnancy until six weeks after delivery.

Blue Care® AdvisorsRegistered nurses and other health care professionals reach out to members experiencing certain health challenges or chronic conditions. Working with your physician, they provide education and coaching to help you more easily manage your condition or make lifestyle changes.

Case ManagementShould you experience a complex medical situation, registered nurse case managers can help you cope with the situation and access the services you need.

Behavioral Health and Substance AbuseLicensed behavioral health staff professionals help members fi nd providers for mental health and substance abuse treatment and authorize members’ inpatient, partial hospitalization or some outpatient care. Members also receive support with co-existing medical conditions or disorders such as anxiety, depression, etc. Staff members are available to take your call 24 hours a day, seven days a week.

Go to Blue Access® for Members at bcbsil.com and click the Personal Health Manager icon for:

• Ask A Nurse: health issues

• Ask A Dietitian: nutrition questions

• Ask A Trainer: exercise advice

• Ask A Life Coach: manage stress, workplace confl icts and more

BlueExtrasSM

Money-Saving Program

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Through the BlueExtras program, Blue Cross and Blue Shield of Illinois (BCBSIL) members are eligible to save money on health care products and services that help support healthy lifestyles. These savings are for health care products and services not usually covered by your health care benefit plan. There are no claims to file, no referrals or pre-authorizations and no additional fees to participate. It’s just one more advantage of being a BCBSIL member.

Complementary Alternative Medicine(866) 656-6069Complementary Alternative Medicine includes a variety of therapies that may help to improve your health, prevent illness and address existing symptoms and conditions. As a BCBSIL member, you’re automatically eligible to receive up to 30 percent off standard fees through the Healthways WholeHealthMD network of more than 35,000 practitioners, spas and wellness and fitness centers. You can access the WholeHealthMD website to search for a network practitioner by logging in to Blue Access for MembersSM (BAM).

Jenny Craig®’

(877) JENNY70 (877-536-6970)Jenny Craig can help you achieve your weight loss goals. Through one-on-one support provided by a trained weight loss consultant, you will receive a tailored program based on the three essential components of successful weight management: food, body, mind. You can meet with your consultant in-person at a local center, or enjoy the convenience and privacy of the Jenny Craig At Home program. To access a special savings coupon, log in to BAM.

BlueExtrasoffers members and covered

dependents access to savings

on a variety of health care

and wellness products and

services. Simply show your

BCBSIL ID card to a

participating provider to

receive the special offer.

To learn more about these

offers, log in to BAM at

bcbsil.com.

Healthways WholeHealth Networks, Inc. (“Healthways”) is an independent contractor which administers the Complementary Alternative Medicine discount program for BCBSIL.

Seattle Sutton’s Healthy Eating®’ (800) 442-DIET (800-442-3438)Seattle Sutton’s Healthy Eating offers convenient delivery or pick-up (based on the participant’s location) of freshly prepared, calorie-controlled meals designed to help with weight loss and management of certain health conditions. Log in to BAM for further details and to access the Seattle Sutton’s Healthy Eating website, where you can learn more about the program or find a location near you.

Life Time®’ FitnessLife Time Fitness offers a complete health fitness experience no matter your fitness level, interests, schedule or budget. For BCBSIL members who join as new members to this full-service health club, Life Time Fitness will waive the enrollment fee and provide you with a complimentary service offered at one of the clubs.* When you log in to BAM and access the Life Time Fitness website, you can find a free, seven-day pass to try out the location nearest you.

Davis VisionSM’(877) 393-8844Save on eyeglasses (frames and lenses), as well as contact lenses, laser vision correction services, examinations and accessories through one of the nation’s leading providers of routine vision care programs. Find out more when you log in to BAM. For a list of Davis Vision providers near you, go to bcbsil.com, click on Find a Doctor then select Find a Vision Provider. The Davis Vision network consists of major national and regional retail locations, such as EyeMasters and Visionworks, as well as independent ophthalmologists and optometrists.

TruHearing®’(800) 687-4617Save on digital hearing aids through TruHearing. Get a hearing test at no additional charge by a licensed hearing specialist when performed for the purpose of fitting a hearing aid. Enjoy a 45-day, money-back guarantee, a three-year warranty, a one-year supply of batteries with purchase and a selection of hearing aid styles at various price levels. Learn more when you log in to BAM.

The relationship between these vendors and Blue Cross and Blue Shield of Illinois (BCBSIL) is that of independent contractors.

* Proof of Blue Cross and Blue Shield of Illinois coverage is required. The $0 enrollment fee offer is available only to new membership contracts beginning on or after July 1, 2009. An administrative fee applies to all memberships ($85 for Single and $95 for Couple and Family memberships). Monthly dues and state taxes may also apply and will vary by location. Membership prices, dues and fees are subject to change at any time. Other restrictions may apply. See a Life Time Fitness Member Advisor for details. Always check with the Life Time Fitness club in your area for the current promotional offer, which is subject to change.

BlueExtras is a discount program available to BCBSIL members. Some of the services offered through BlueExtras may be covered under your health plan. Please refer to your benefit booklet or call the customer service number on the back of your ID card for specific benefit information under your health plan. Use of BlueExtras does not affect your premium, nor do costs of BlueExtras’ services or products count toward any maximums and/or plan deductibles. Discounts are only available through participating vendors.

BCBSIL does not guarantee or make any claims or recommendations regarding the services or products offered under BlueExtras. You may want to consult with your physician prior to use of these services and products. BCBSIL reserves the right to discontinue or change this discount program at any time without notice.

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For more information about BlueExtras, log in to Blue Access for MembersSM (BAM) at bcbsil.com. Click the My Health tab, and then the BlueExtras Discount Program link.

Preventive CareYour coverage may include preventive care benefits for children and adults, including physical exams, diagnostic tests and immunizations. Check your group plan for the specific coverage.

Emergency CareIf you, as a prudent layperson (with an average knowledge of health and medicine) need to go to the emergency room of any hospital, your care will be covered subject to your plan’s deductible and any applicable copayments or coinsurance. In an emergency, you should seek care from an emergency room or other similar facility. Call 911 or other community emergency resources to obtain assistance in life-threatening situations. Your group plan may require that you, a family member or friend contact BCBSIL if you are admitted to the hospital.

You have nationwide access to contracting providers in networks linked through the BlueCard® program when you or your covered dependents live, work or travel anywhere in the country. The national network includes more than 85 percent of all physicians and hospitals in the country. Be sure to use a BlueCard network provider to receive the highest level of benefits.

With the BlueCard program, there are two ways to locate contracting doctors and hospitals:

• Visit the Web site at www.bcbsil.com to find provider names and locations using the Provider Finder. Maps and driving directions are also available.

• Call the toll-free customer service number on the back of your ID card.

Other Benefits for non-HMO plans

Your health care benefit plan travels with you wherever you go –

across the country or around the world.

National Coverage

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Reconstructive Surgery Following MastectomyFederal and State of Illinois legislation require group health plans and health insurers to provide coverage for reconstructive surgery following a mastectomy. Specifically, these laws state that health plans that cover mastectomies must also provide coverage in a manner determined in consultation with the attending physician and patient for reconstruction of the breast on which the mastectomy has been performed, surgery and reconstruction of the other breast to produce a symmetrical appearance, and prostheses and treatment of

physical complications for all stages of mastectomy, including lymphedemas.

Your coverage may also include benefits for baseline and annual mammograms. Check your group plan documents for details.

Illinois Dependent Eligibility Mandate Under new, Federal law, your dependents are eligible for health and/or dental coverage up to the dependent limiting age and may not be denied coverage due to marital, student or employment status before age 26. Check with your employer for additional details regarding eligibility requirements. In addition, eligible military personnel may not be denied coverage before age 30 under Illinois law. If you elect BlueChoice Select coverage, your dependents must live within the defined service area.

This Illinois law applies to all individual plans and insured group medical and/or dental plans, as well as self-insured municipalities, counties and schools. The law does not apply to self-funded national account groups or local non-municipal self-funded groups. If you have questions about this law, contact your benefits administrator.

When you travel outside the United States and need medical assistance services, call 800-810-BLUE (800-810-2583) or call collect to 804-673-1177 for information. Blue Cross and Blue Shield has contracts with doctors and hospitals in more than 200 countries. An assistance coordinator, in conjunction with a medical professional, can arrange your doctor’s appointment or hospitalization, if necessary.

Providers that participate in the BlueCard Worldwide® program, in most cases, will not require you to pay up front for inpatient care. You are responsible for the out-of-pocket expenses such as a deductible, copayment, coinsurance and non-covered services. The doctor or hospital should submit your claim.

You also have coverage at non-contracting hospitals, but you will have to pay the doctor or hospital for care at the time of service, then submit an international claim form with original bills. Call the toll-free customer service number on your ID card for the address to send the claim. You can get a claim form from your employer, customer service or online at www.bcbsil.com.

International Coverage

Highlights of the site include:

• Simple steps you can take to live healthier

• Links to useful resources

• Information provided by medical professionals

• Timely newsfeeds from national media

Numerous health and safety topics including mental health, childhood obesity, drug safety and caregiving are presented on the site. New topics are continually added.

Be Smart. Be Well. is sponsored by Health Care Service Corporation, the largest customer-owned health insurer in the United States, with more than 12 million members in its Blue Cross and Blue Shield Plans in Illinois, New Mexico, Oklahoma and Texas.

Be sure to join the daily discussion on Twitter at twitter.com/bsbw and visit us on You Tube at www.youtube.com/besmartbewell.

Be Smart. Be Well. Know the facts. Visit www.besmartbewell.com today.

Be Smart. Be Well.®

Divisions of Health Care Service Corporation,a Mutual Legal Reserve Company, an Independent Licenseeof the Blue Cross and Blue Shield Association.

This information is not intended to be a substitute for professional medical advice. If you are under the care of a doctor and receive advice contrary to this information, follow the doctor’s advice. See your doctor if you are experiencing any symptoms or health problems.

You can increase your odds of living better and living longer by making smart health and safety choices. Be Smart. Be Well. is a unique Web site dedicated to helping you be safe and healthy. Be Smart. Be Well. features engaging video documentaries of the personal lessons learned by real people. The goal of Be Smart. Be Well. is simple: to give you the information and resources you need to make an immediate and positive impact on your everyday life.

Caregiving Childhood Obesity Drug Safety

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Illinois PPO Hospital Network

IllinoisAledoMercer County Hospital

AltonAlton Memorial HospitalSt. Anthony’s Hospital

AnnaUnion County Hospital

Arlington HeightsNorthwest Community Hospital

AuroraProvena Mercy Medical CenterRush Copley Medical Center

BarringtonAdvocate Good Shepherd Hospital

BellevilleMemorial HospitalSt. Elizabeth’s Hospital

BelvidereNorthwest Suburban Community Hospital

BentonFranklin Hospital District

BerwynMacNeal Hospital

BloomingtonSt. Joseph Hospital

Blue IslandMetrosouth Medical Center

BolingbrookAdventist Bolingbrook Hospital

BreeseSt. Joseph’s Hospital -Breese

CantonGraham Hospital Association

CarbondaleMemorial Hospital of Carbondale

CarlinvilleCarlinville Area Hospital

CarrolltonThomas H. Boyd Memorial Hospital

CarthageMemorial Hospital

CentraliaSt. Mary’s Hospital

ChampaignThe Pavilion Foundation Hospital

ChesterMemorial Hospital

ChicagoAdvocate Bethany HospitalAdvocate Illinois Masonic Medical CenterAdvocate Trinity HospitalAurora Chicago Lakeshore HospitalChildren’s Memorial HospitalHoly Cross HospitalJackson Park HospitalJohn H. Stroger Jr. Hospital Cook CountyKindred Chicago Central HospitalLaRabida Children’s HospitalLouis A. Weiss Memorial HospitalMercy Hospital & Medical CenterMethodist Hospital of ChicagoMount Sinai Hospital

Chicago continued Northwestern Memorial HospitalNorwegian American HospitalOur Lady of the Resurrection Rehabilitation Institute of ChicagoResurrection HospitalRoseland Community HospitalRush University Medical Center Schwab Rehabilitation HospitalSt. Anthony HospitalSt. Bernard HospitalSt. Elizabeth Hospital-ChicagoSt. Joseph HospitalSt. Mary of Nazareth HospitalSwedish Covenant HospitalThorek Memorial HospitalUniversity of Chicago Medical CenterUniversity of Illinois Medical Center Chicago

Chicago HeightsSt. James Hospital and Health Centers

ClintonDr. John Warner Hospital

DanvilleProvena-United Samaritan Medical Center

DecaturDecatur Memorial HospitalSt. Mary’s Hospital

DeKalbKishwaukee Community Hospital

Des PlainesHoly Family Medical Center

DixonKatherine Shaw Bethea Hospital

Downers GroveAdvocate Good Samaritan Hospital

Du QuoinMarshall Browning Hospital Associates

East St LouisKenneth Hall Regional HospitalTouchette Regional Hospital

Effi nghamSt. Anthony’s Memorial Hospital

EldoradoFerrell Hospital

ElginProvena Saint Joseph HospitalSherman Hospital

Elk Grove VillageAlexian Brothers Medical Center

ElmhurstElmhurst Memorial Hospital

EurekaEureka Hospital

EvanstonNorthshore University Health SystemSt. Francis Hospital

Evergreen ParkLittle Company of Mary Hospital

Fairfi eldFairfi eld Memorial Hospital

FloraClay County Hospital

Forest ParkRiveredge Hospital

FreeportFreeport Memorial Hospital

GalenaMidwest Medical Center

GalesburgSt. Mary’s Hospital

GeneseoHammond Henry District Hospital

GenevaDelnor Community Hospital

Gibson CityGibson Community Hospital Associates

Glendale HeightsAdventist Glen Oaks Hospital

GlenviewGlenbrook Hospital

Granite CityGateway Regional Medical Center

GreenvilleGreenville Regional Hospital

HarrisburgHarrisburg Medical Center

HarvardMercy Harvard Hospital

HarveyIngalls Memorial Hospital

HavanaMason District Hospital

Hazel CrestAdvocate South Suburban Hospital

HerrinHerrin Hospital

HighlandSt. Joseph’s Hospital

Highland ParkHighland Park Hospital

HillsboroHillsboro Hospital

HinsdaleAdventist Hinsdale HospitalRML Specialty Hospital

Hoffman EstatesAlexian Brothers Behavioral HealthSt. Alexius Medical Center

HoopestonHoopeston Community Memorial Hospital

HopedaleHopedale Hospital

JacksonvillePassavant Memorial Area Hospital

JerseyvilleJersey Community Hospital

JolietProvena Saint Joseph Medical CenterSilver Cross Hospital

KankakeeProvena St. Mary’s HospitalRiverside Medical Center

KewaneeKewanee Hospital Association

La GrangeAdventist La Grange Memorial Hospital

Lake ForestLake Forest Hospital

LawrencevilleLawrence County Memorial Hospital

LibertyvilleAdvocate Condell Medical Center

LincolnAbraham Lincoln Memorial Hospital

Litchfi eldSt. Francis Hospital

MacombMcDonough District Hospital

MarionHeartland Regional Medical Center

MaryvilleAnderson Hospital

MattoonSarah Bush Lincoln Health Center

MaywoodLoyola University Medical Center

McHenryCentegra Hospital McHenry

McLeansboroHamilton Memorial Hospital

Melrose ParkGottlieb Memorial HospitalWestlake Community Hospital

MendotaMendota Community Hospital

MetropolisMassac Memorial Hospital

MolineTrinity Medical Center

MonmouthOSF Holy Family Medical Center

MonticelloJohn & Mary E. Kirby Hospital

MorrisMorris Hospital

MorrisonMorrison Community Hospital

Mount CarmelWabash General Hospital

Mount VernonCrossroads Community HospitalGood Samaritan Regional Health Center

MurphysboroSt. Joseph Memorial Hospital

NapervilleEdward HospitalLinden Oaks Hospital

NashvilleWashington County Hospital

NormalBroMenn Regional Medical Center

NorthlakeKindred Hospital Northlake

Oak LawnAdvocate Christ Hospital Medical Center

Oak ParkRush Oak Park HospitalWest Suburban Hospital

OlneyRichland Memorial Hospital

Olympia FieldsSt. James Hospital and Health Centers

OttawaOttawa Regional Hospital Center

Palos HeightsPalos Community Hospital

PanaPana Community Hospital

ParisParis Community Hospital

Park RidgeAdvocate Lutheran General Hospital

PekinPekin Memorial Hospital

PeoriaProctor HospitalSt. Francis Hospital Medical Center

PeruIllinois Valley Community Hospital

PinckneyvillePinckneyville Community Hospital

Pittsfi eldIllini Community Hospital

PontiacSt. James Hospital

PrincetonPerry Memorial Hospital

QuincyBlessing Hospital

Red BudRed Bud Regional Hospital

RobinsonCrawford Memorial Hospital

RochelleRochelle Community Hospital

RockfordSt. Anthony Medical CenterSwedish American HospitalVan Matre HealthSouth Rehabilitation Center

Rock IslandTrinity Regional Health System

RosiclareHardin County General Hospital

RushvilleSarah D. Culbertson Memorial Hospital

SalemSalem Township Hospital

SandwichValley West Community Hospital

SchaumburgBehavioral Healthcare Associations

ShelbyvilleShelby Memorial Hospital

SilvisIllini Hospital

SkokieSkokie Hospital

SpartaSparta Community Hospital

Spring ValleySt. Margaret’s Hospital

Springfi eldMemorial Medical CenterSt. John’s Hospital

StauntonCommunity Memorial Hospital Associates

SterlingCGH Medical Center

StreamwoodStreamwood Hospital

StreatorSt. Mary’s Hospital

TaylorvilleTaylorville Memorial Hospital

UrbanaCarle Foundation HospitalProvena-Covenant Medical Center Urbana

VandaliaFayette County Hospital

WatsekaIroquois Memorial Hospital

WaukeganVista Medical Center EastVista Medical Center West

WheatonMarianjoy RehabLink

Winfi eldCentral DuPage Hospital

WoodstockCentegra Hospital Woodstock

IndianaCrown PointSt. Anthony Medical Center of Crown Point

DyerSt. Margaret Mercy Hospital South

GaryMethodist Hospital Northlake

HammondSt. Margaret Mercy Healthcare Center

MerrillvilleMethodist Hospital-Southlake Campus

Michigan CityMemorial Medical CenterSt. Anthony Memorial Health Center

MunsterSurgical Hospital of Munster

Benefi ts for covered services will be considered at the higher PPO payment level, however, the applicable Average Discount Percentage (ADP) may be lower than that at other PPO hospitals.

PPO Network HospitalsThe PPO hospital network offers broad access to every medical service through community, teaching, specialty and tertiary care hospitals located throughout Illinois and Northwest Indiana.

All hospitals listed in this brochure are PPO hospitals at the time of this printing. Your benefi ts are greater when you use the services of a PPO network hospital. A PPO hospital is a hospital which has a written agreement with Blue Cross and Blue Shield of Illinois (BCBSIL) to provide services to participants in the PPO program, or a hospital which has a written agreement with BCBSIL to provide services to you and has been designated by BCBSIL as a PPO hospital. Hospitals designated as PPO are included in this listing with a star ( ).

BCBSIL may receive discounts and/or allowances as a result of its agreements with PPO hospitals. The Average Discount Percentage (ADP) is a percentage discount determined by BCBSIL that is applied to charges for covered services for purposes of calculating your coinsurance amounts, deductibles, out-of-pocket maximums and/or benefi t maximums.

The ADP takes into account various factors, including product line, contract type, facility type, geographic area, and service category. The ADP will often vary from claim to claim. The ADP applied to claims for services at hospitals listed with a cross may be lower than at other PPO hospitals listed in this brochure. In the case of outpatient hospital services, no discount may be applicable at all.

Any applicable ADP is applied to the covered hospital charges, reducing your coinsurance amount (if any), thereby minimizing your share of the costs. For example:

Example Inpatient Claim

Hospital Hospital A B

Covered hospital $10,000 $8,000 charges

Applicable ADP 50% 35%

-ADP Dollars -$5,000 -$2,800 =Blue Cross

Blue Cross Allowable Charge =$5,000 =$5,200

Your Coinsurance Amount (based on 20%) $1,000 $1,040

The actual ADP applied to your claim will be based on the ADP current on the date the covered service is rendered.

The applicable deductible amount, coinsurance, benefi t maximums and/or benefi t limitations, if any, will be based on the actual terms of your group health plan. This example demonstrates that while discounts can vary by hospital, so can the billed amount for covered charges. In any event, you will not be responsible for any ADP dollars.

For maximum Plan benefi ts, be sure to follow the care management callingrequirements for your group. Refer to yourCertifi cate/Benefi t Booklet for details.

Although there may be changes in the PPO Hospital Network from time to time, selection of Contracting Hospitals will continue to be based upon range of services, geographic location, and cost effectiveness of care.Notice of changes in the PPO Hospital Network will be provided to your group administrator annually or as required to allow you to make selections within the PPO Network. You are urged, however, to check with the hospital before undergoingtreatment to ensure its PPO status.

For more information on the PPO Network you can call Member Services at the phone number listed on the back of your ID card. For local and national Blue Cross and Blue Shield PPO information, visit our Web site at www.bcbsil.com. To fi nd a contracting provider near you, you can also call(800) 810 BLUE (800-810-2503).

Health Insurance FraudWhat You Should Know

Don’t Be a VictimIn addition to losing money through fraud, members have also experienced physical and mental harm as a result of health care fraud schemes in which a provider performed unnecessary or dangerous procedures.

Identifying FraudCommonly identifi ed schemesinvolving providers include:• Misrepresenting Services – Intentionally billing procedures

under different names or codes to obtain coverage for services that aren’t included in a member’s plan.

• Upcoding – Deliberately charging for more complex or more expensive services than those actually provided.

• Non-rendered and/or “Free” Services – Some providers intentionally bill for tests or services never provided. This can also mean that the provider offered “free” services to bill the insurance company for services not performed or needed.

• Kickbacks, Bribes or Rebates – Referring patients to a provider or facility where the referring provider has a fi nancial interest.

Commonly identifi ed member schemes include:• Identity Swapping – Allowing an uninsured individual to

use a member’s insurance card.

• Identity Theft – Using false identifi cation to gain employment to obtain health insurance benefi ts or coverage.

• Non-eligible Members – Adding someone to a policy who is not eligible or failing to remove someone when that person becomes ineligible.

• Prescription Medicine Abuse and Diversion – Controlled substances can be obtained through deception or dishonesty for personal use or sale “on the street.” Prescription medications can be obtained through doctor shopping, visiting several emergency rooms or stealing doctors’ prescription pads.

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Fraud Affects EveryoneFraud costs the health care industry more than $60 billion each year. As a member of Blue Cross and Blue Shield of Illinois (BCBSIL ), this fraud may cause you to face rising premiums, increased copayments and deductibles, the elimination of certain benefi ts and lower lifetime maximum benefi ts.

Fraud increases costs and decreases benefi ts.

• Know your own benefi ts and scope of coverage.

• Review all Explanation of Benefi ts (EOB) forms. Make sure the exams, procedures and tests billed were the ones you actually had with the provider who treated you.

• Understand your responsibility to pay deductibles and copayments, and what you can and cannot be balanced billed for once your claim has been processed.

• Guard your health insurance card and personal insurance information. Notify BCBSIL immediately if your card or insurance information is lost or stolen.

• Sign and date only one claim form per offi ce visit.

• Never lend your member ID card to another person.

• Don’t give out insurance or personal information if services are offered as “free.” Be sure you understand what is “free” and what you or your employer will be charged for.

• Ask your doctors exactly what tests or procedures they want you to have and why. Ask why the tests or procedures are necessary before you have them.

• Be sure any referrals you receive from your network provider are to other network doctors or facilities. If you’re not sure, ask.

• Monitor your prescription utilization via the BCBSIL Web site or your Pharmacy Benefi t Manager (PBM). Make sure the medications billed to your insurance are accurate.

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Fighting FraudBCBSIL offers these tips:

Preventing Health Care FraudBCBSIL created the Special Investigations Department (SID) to fi ght fraud and help lower health care costs. The staff includes individuals with medical, insurance and law enforcement backgrounds as well as data analysts experienced in detecting fraudulent billing schemes. The SID aggressively investigates reports of fraud and refers cases for criminal prosecution.

Fraud Isn’t Fair. Help Us Fight It.Reducing health care fraud is a collaborative effort between BCBSIL, its providers and its members. Additional information and a fraud awareness training program are available through the SID Web site at www.bcbsil.com/sid.

We also encourage you to report any suspected incidence of fraud by calling our Health Care Fraud Hotline, completing a form online or sending us a note in the mail. Suspicions of fraud can be reported to the SID anonymously.

Three Ways To Report Fraud To BCBSILThe SID is here to help you. You can contact the SID in any of the following ways:

1. (800) 543-0867The toll-free Fraud Hotline operates 24 hours a day, seven days a week. You can remain anonymous or provide information if you want to be contacted by a member of the SID.

2. www.bcbsil.com/sid/reportingThis Web site address links to an online fraud reporting form that can be completed and sent to the SID electronically.

3. U.S. MailYou can write the SID at:Blue Cross and Blue Shield of IllinoisSpecial Investigations Department300 E Randolph Street, 11th FloorChicago, Illinois 60601

Our Special Investigations Department is one of the most effective in the industry.

Understanding Your EOB

An Explanation of Benefi ts (EOB) Statement is a notifi cation form provided to members when a health care benefi ts claim is processed by Blue Cross and Blue Shield of Illinois (BCBSIL). The EOB displays the expenses submitted by the provider and shows how the claim was processed.

The EOB has four major sections:• Claim Information includes the member

and patient name, the member’s group and ID numbers, and the claim number.

• Summary highlights the fi nancial information – the amount billed, total benefi ts approved and the amount you may owe the provider.

• Service Information identifi es the health care facility or physician, dates of service and charges.

• Coverage Information shows what was paid to whom, what discounts and deductions apply, and what part of the total expense was not covered.

The EOB may includeadditional information. • Information About Amounts Not Covered

will show what benefi t limitations or exclusions apply.

• Information About Out-Of-Pocket Expenses will show an amount when a claim applies toward your deductible or counts toward your out-of-pocket expenses.

• Information About Appeals explains your rights regarding review of claim denials.

• Fraud Hotline is a toll-free number you can call if you think you are being charged for services you did not receive or if you suspect any fraudulent activity.

A Guide to Reading Your Explanation of Benefi ts Statement

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Your EOBs are Always Available Online!Sign up for Blue Access® for Members (BAM) at www.bcbsil.com for quick, convenient and confi dential access to your claim information and history. To support our commitment to eco-friendly business practices, you can choose to opt out of receiving EOBs by mail. This saves resources and offers you additional confi dentiality. Just go to BAM, click on User Profi le and change your User Preferences.

Sample EOB

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77

899

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Sample EOBAccount name (member’s company or organization)

Date claim was fi nalized

Toll-free number to call for additional information

Member’s name and mailing address

BCBSIL messages

Member’s name

Employer or group identifi cation number*

Member number that appears on the ID card*

Claim number*

Person who received the services*

Summary box, including the total amount billed by the provider for the services, the benefi ts approved and paid by BCBSIL, and the remainder you may owe.(See also 14, 20 and 21).

Provider name (top line) and description of service (below)

Beginning and end service dates

Amount billed by the provider for each service

Portion of the billed amount not covered by the plan(a footnote explains the reason)

Amount covered by the plan*

Total charges included on this claim

Plan reductions subtracted from billed amount, such as PPO allowances

Deductible and copayment or coinsurance amounts

Payment approved before benefi ts are coordinated with other insurers, such as Medicare

Amount the member may be responsible for paying

Total benefi t approved for provider

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* Please provide this information when contacting us about a claim.

Not all EOBs are the same. The format and content of your EOB depends on your benefi t plan and the services provided. Deductible and copayment amounts vary.

On your mobile device - New! Go to bcbsil.com from your mobile phone’s Web browser and click on Find a Doctor or Hospital. Or download the Provider Finder App for your iPhone® or Android® phone. If you use your GPS location or input a ZIP code, the App can pinpoint the closest provider locations for you.

Quick and Easy Ways to Find a DoctorUse Provider Finder®, a reliable and convenient tool, to locate doctors, dentists and pharmacies in your network. Filter search results by provider type, specialty, network type, ZIP code, language and gender. Get directions from Google Maps™, too. It’s now faster and simpler to do than ever before!

Online Go to bcbsil.com and click on Find a Doctor. The improved search experience on Provider Finder means you need fewer clicks and required fields to get your results!

On the phone If you prefer, call a Blue Cross and Blue Shield of Illinois (BCBSIL) Customer Service Advocate at the toll-free telephone number on the back of your BCBSIL member ID card for help in locating a provider.

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Blue Distinction is a designation awarded by the Blue Cross and Blue Shield companies to hospitals that have demonstrated expertise in delivering clinically proven specialty health care. Its goal is to help consumers fi nd specialty care on a consistent basis, while enabling and encouraging health care professionals to improve the overall quality and delivery of care nationwide.

Blue Distinction Centers for Bariatric Surgery® Provides a full range of bariatric surgical care services, including inpatient care, post-operative care, follow-up and patient education.

Blue Distinction Centers for Cardiac Care® Provides a full range of cardiac care services, including inpatient cardiac care, cardiac rehabilitation, cardiac catheterization and cardiac surgery.

Blue Distinction Centers for Transplants® Transplant program that provides services, such as global pricing, fi nancial savings analysis, and global claims administration and support services.

Blue Distinction Centers for Complex and Rare Cancers® Inpatient cancer care programs for adults, including those treating complex and rare subtypes of cancer, delivered by multidisciplinary teams with subspecialty training and distinguished clinical expertise, focus on treatment planning and complex, major surgical treatments.

Blue Distinction Centers for Knee and Hip ReplacementSM Provides inpatient knee and hip replacement services,including total knee and total hip replacement surgeries.

Blue Distinction Centers for Spine Surgery® Inpatient spine surgery services, including discectomy,fusion and decompression procedures.

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Use the Blue Distinction Center Finder.

• Go to bcbsil.com

• Select the Provider Finder® tool and search for hospitals

• To fi nd a Blue Distinction center near you, search by designated area of specialty and state

Blue Distinction® For hospitals with expertise in specialty care

Wellness Information

As part of Blue Care Connection®, when you use the Personal Health Manager (PHM) to track a fitness workout, report a meal, complete and update the online Health Risk Assessment, or participate in For Your Health interactive programs, you can earn Blue Points*. These points are redeemable for popular health and wellness merchandise and services at the Blue Points Account and Redemption Center, accessed through the PHM.

The PHM is an online suite of wellness resources that can help you maintain your health and adopt healthier behaviors.

How do I check or redeem my Blue Points?

• Go to Blue Access® for Members at www.bcbsil.com and click

• Click the Blue Points link on the PHM home page

• View your point totals

• Choose the point/redemption levels to select your reward

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Reward Yourself with Blue PointsSM

*Blue Points Program Rules are subject to change without prior notice. See the Program Rules and Frequently Asked Questions for further information.

Don’t wait... check out the Personal Health Manager today!

Health concerns don’t always follow a 9-to-5 schedule. Fortunately, registered nurses are on call at (800) 299-0274 to answer your health questions, wherever you may be, 24 hours a day, seven days a week.

The 24/7 Nurseline’s registered nurses can understand your health concerns and give general health tips. Get trusted guidance on possible emergency care, urgent care, family care and more.

When should you call?The toll-free Nurseline can help you or a covered family member get answers to health problem questions, such as:

• Asthma, back pain or chronic health issues

• Dizziness or severe headaches

• High fever

• A baby’s nonstop crying

• Cuts or burns

• Sore throat

Plus, when you call, you can access an audio library of more than 1,000 health topics—from allergies to women’s health—with more than 600 topics available in Spanish.

24/7 Nurseline* – Around-the-Clock, Toll-Free Support

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The 24/7 Nurseline can help you figure out if you should call your doctor, go to the ER or treat the problem yourself.

Get the information you need, just when you need it.

Note: For medical emergencies, call 911 or your local emergency services first. This program is not a substitute for a doctor’s care. Talk to your doctor about any health questions or concerns.

*The 24/7 Nurseline is not available to HMO members.

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Insulin is a hormone needed to change sugar, starches and other food into energy necessary for daily life. Diabetes is a condition in which the body does not make or correctly use insulin. The cause of diabetes continues to be unknown, although both genetics and environmental factors such as obesity and lack of exercise appear to play roles.

Living with diabetes can be a challenge. High blood sugar can damage your heart, eyes, feet and kidneys over time. Maintaining close-to-normal levels of blood sugar has been shown to reduce the risk of diabetes-related problems. So it is important for people with diabetes to monitor their blood sugar levels by using a blood glucose meter.

Choosing a Blood Glucose MeterAlmost any meter will provide correct, fairly consistent results. Here are a few things to consider when making your choice: • How does the meter score for accuracy? Does

it come with a control solution or test strip to check for accuracy?

• Does the meter fit in your backpack, supply kit or purse?

• How skillful are you at handling those test strips? Are they so small that you can’t get a good grip on them? You might want to try a meter that uses cartridges instead of individual strips.

• How big a drop of blood does the meter require? Smaller is better.

• Do you want to be able to download results to a home computer, or be able to e-mail them

periodically to your doctor’s office?• Interested in alternative site testing? There

are meters that can test samples from various places on the body.

Checking Your Blood GlucoseBlood glucose checks are one of the best ways to help you manage your diabetes. Regular checks and consistent record-keeping give you a good picture of where you are in your diabetes care.

One reason to do checks is to find out how often your blood glucose levels are in your target range. Your target range is a personalized blood glucose range that you set with your doctor. Once you know how often and when to check, stick to the schedule and check at those times each day. Keep a blood glucose daily log book to record your levels.

The most important thing is to remember to write down your results every time you check. Then, take your log book with you when you go see your doctor, educator or other member of your diabetes care team. They will be able to help you answer questions about your diabetes from the information in the log book.

bcbsil.com

It’s All About Diabetes

Roche, the Makers of ACCU-CHEK® ProductsTo order an ACCU-CHEK meter, call 1-888-355-4242. For more detailed descriptions, visit accu-chek.com

ACCU–CHEK® AvivaTM System1• ACCU-CHEK Multiclix lancing device – proven

least painful*• Easy-to-handle, quick-fill test strip makes

sampling easier• Small, 0.6 microliter sample

size means less blood• Fast, accurate results in five

seconds• The only meter and strip

combination manufactured in the U.S.A.**

• Discovery tools included so you can discover how to best use your numbers

ACCU–CHEK® Compact Plus® System• Load-and-go drum of 17 preloaded

test strips• Detachable, least painful lancing

device*• No coding • Bright, easy-to-read display• Discovery tools included so you can

discover how to best use your numbers

The Aviva and Compact Plus meter systems are compatible with all ACCU-CHEK data management tools, including the ACCU-CHEK 360˚ diabetes management system. You also may download data to your PC with the ACCU-CHEK Smart Pix Device Reader; no additional software required. * Least painful, when compared to leading competitive systems. Data on file. ** Manufactured in U.S.A., using U.S. and imported materials.

Bayer’s Blood Glucose Monitoring Systems To order a Bayer meter, call 1-877-229-3777. For more detailed descriptions, visit simplewins.com

BLOOD GLUCOSE MONITORING SYSTEM

Simple to learn and use.• Identify trouble spots with personalized

HI/LO target range and test result summary

• See effect of food choices with pre-meal and post-meal markers

• The audible testing reminder feature helps you remember to test after meals

• No Coding™ technology

BLOOD GLUCOSE MONITORING SYSTEM

Eliminates handling individual strips.• Easy to use with 10-test disc• 94% of BREEZE®2 meter users like

the disc because they do not have to handle individual strips1

• Both the BREEZE®2 meter and the 10-test disc received the Ease-Of Use Commendation from the Arthritis Foundation

• Results in just 5 seconds• No Coding™ technology

Disclaimer: This information is not intended to be a substitute for professional medical advice. If you are under the care of a doctor and receive advice different from the information contained in this flier, follow the doctor’s advice. See your doctor if you are experiencing any diabetes symptoms or health problems.

1Data on file. TNS Healthcare Survey, April-May 2009

This offer is available from April 1, 2011,

through March 31, 2012.

Glucose Meters Are Available to YouBlue Cross and Blue Shield of Illinois (BCBSIL) offers glucose meters to members with diabetes at no additional charge to help you manage your condition.

Please review the following options and ask your doctor which meter best fits your needs. To order a meter†, call the phone number listed, identify yourself as a BCBSIL member and provide the group number on your ID card.

†The meters may be replaced by the vendor with newer models. This offer is available only to current Blue Cross and Blue Shield of Illinois members through March 31, 2012. Members who do not have a glucose meter or need a replacement can request one meter a year. If you prefer a different glucose meter, check your health plan’s benefits. Generally, you can purchase one and submit a medical claim for durable medical equipment and be reimbursed according to your plan’s benefits.

Making Fitness Easy, Fun and Affordable!

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In a world where life is constantly on the move, people need solutions to fit into their ever-changing fitness schedules. Blue Cross and Blue Shield of Illinois (BCBSIL) just made it easier with the Fitness Program, the latest feature from Blue Care Connection®.

Are you ready for fitness?Visit www.bcbsil.com and log in to your Blue Access® for Members (BAM) account. Click the My Health tab to find the Fitness Program button. Use this link to search for participating locations and complete your enrollment. You can also enroll by calling 888-762-BLUE (2583) toll-free, Monday through Friday, 8 a.m. – 9 p.m., in any U.S. time zone.

• Flexible membership, no long-term contract required. Enroll for a one-time fee of $29 and $29 per month.*

• Easy online enrollment; automatic monthly payment withdrawal.

• Online views of your fitness center visits online.

• Blue PointsSM** – earn up to 400 points per week. Redeem them for fitness items, merchandise gift cards, electronics, airline miles and much more.

• Unlimited access to a nationwide network of participating fitness centers and select YMCA locations.

The Fitness Program opens the door to a network of fitness centers for only $29 per month! For a limited time – earn 2,500 bonus Blue Points for joining.

Available exclusively to BCBSIL members and their covered dependents (age 18 and older), the Fitness Program provides:

Rewards beyond Health and FitnessRegular exercise is an essential part of healthier living. It gives you energy to participate in family activities, sports, dance, travel and other everyday events that make life more enjoyable.

• Feel good about your commitment to a better you.• Accomplish your fitness goals.• Maintain healthy weight.• Lower your blood pressure.• Minimize stress.• Reduce your risk for other health-related diseases.• Boost your stamina and strength.• Improve sleep.• Improve your overall health.

* The one-time enrollment fee and monthly membership fee for the Fitness Program are both subject to applicable taxes.

** Please review the Blue Points Program Rules listed on the Personal Health Manager for complete information on the program. Program Rules are subject to change without prior notice.

The Fitness Program is a discount program available to Blue Cross and Blue Shield of Illinois (BCBSIL) members. This program is not covered under the member’s health insurance benefit plan. Please refer to your benefit booklet or call the customer service number on the back of your ID card for specific benefit information under your health plan. Use of the Fitness Program does not affect your premium, nor do costs of Fitness Program services or products count toward your calendar year or lifetime maximums and/or plan deductibles. Members are responsible for all fees, dues, taxes and other charges related to the Fitness Program. Refer to the program terms and conditions for further details.

BCBSIL does not guarantee or make any claims or recommendations regarding the services or products offered under the Fitness Program. You may want to consult with your physician prior to use of these services and products. BCBSIL reserves the right to discontinue or change this discount program at any time without notice.

Healthways, Inc. is an independent contractor which administers the Prime Network of fitness centers. The Prime Network is made up of independently-owned and managed fitness centers.

Take this card for a spin

... a lift

... or a stretch!

Make new friends, take a class, try something new! Join the Fitness Program today. Log in to BAM.

Click the My Health tab to find the Fitness Program button. Or call 888-762-BLUE (2583) toll-free, Monday through Friday, 8 a.m. – 9 p.m., in any U.S. time zone.

Member since 01/2010

1234-5678-9101

Jane Smith

YOUR PASSPORT TO FITNESSFitness Program Member Card

Fan us at www.facebook.com/bluecrossblueshieldofillinois

Tweet us at www.twitter.com/bcbsil

1. Go to bcbsil.com and click the Log In tab.

2. Choose I’m a Member to log in to Blue Access for MembersSM.If this is your first visit, click “Register Now” on the right to choose a User Name and Password. Make sure you have your Blue Cross and Blue Shield of Illinois ID card, so you can type in your Group and ID/Subscriber numbers.

3. Under Quick Links, choose Fitness Program. On this page you can enroll, search for fitness centers near you by ZIP code and learn more about the program.

4. Click Begin Enrollment, then search and select the fitness center that is best for you. Remember, you can visit any participating fitness center after you sign up.

5. Verify your personal information and method

of payment.Print your temporary Fitness Program membership card.

6. Visit a facility today!

Join the Fitness Program Today!

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It’s easy to sign up.*

*You must be 18 or older to join the Fitness Program.

The Fitness Program is:

About the Fitness Program Membership

*See Blue Points Program Rules at bcbsil.com.

If you have questions or would rather enroll by phone,call 888-762-BLUE (2583), Monday – Friday, between 8 a.m. and 9 p.m. in any U.S. time zone.

Begin your enrollment here

BlueExtrasSM Vision Discount Program

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Discount vision programBlue Cross and Blue Shield of Illinois (BCBSIL) is pleased to offer members a discount vision program through Davis Vision, Inc., a leading national provider of routine vision care programs. Save on eyeglasses, contact lenses, eye exams and accessories.

How do I locate a Davis Vision provider?The Davis Vision network consists of major national and regional retail locations, such as EyeMasters and Visionworks, as well as independent ophthalmologists and optometrists.

For a list of Davis Vision providers near you, go to bcbsil.com, click Provider Finder®, then click Find a Vision Provider. For more information about BlueExtras, log in to Blue Access for MembersSM (BAM) at bcbsil.com. Click the My Coverage tab at the top, and then click the BlueExtras Discount Program link.

How to maximize your benefits• Yourhealthplanmayoffersomelevelofvisionbenefits.Ifyour

planoffersvisionbenefits,youshouldcontinuetofollownetworkguidelinesforyourroutineeyeexams.

• IfyouroptometristorophthalmologistisaDavisVisionproviderorifyouuseaDavisVisionproviderforproductsandservices,youcanreceivediscountsonframes,lensesandcontactsbypresentingyourBCBSILIDcard.DiscountsareonlyavailableatDavisVisionproviders.

Laser vision correctionDavis Vision offers you and your eligible dependents with the opportunity to receive discounts on laser vision correction services through the TLC/TruVision network. To schedule an appointment call TLC/TruVision directly at 866-484-2020 or contact Davis Vision at 877-393-8844 for more information.

Mail order contact lensesThe Lens 1 2 3® Mail Order Contact Lens Replacement Program is fast, convenient and offers significant savings. For more information, call 800-LENS-123 (800-536-7123) or visit the Lens 1 2 3 website at lens123.com.

Are there any exclusions?The following items are not covered by this vision discount program:

• Medicaltreatmentofeyediseaseorinjury

• Visiontherapy

• Speciallensdesignsorcoatings,otherthanthoselistedontheothersideofthisflier

• ServicesperformedbyaproviderwhoisnotintheDavisVisionnetwork

• Replacementoflosteyewear

• Servicesnotperformedbylicensedpersonnel

1 These discounted fees apply at most provider locations. However, fees may vary. For example, at Wal-Mart, members will receive comparable values on spectacle lens and contact lens purchases with Wal-Mart’s s tandard retail cost. Members buying frames at Wal-Mart will receive a flat 10 percent discount on Wal-Mart’s price, rather than the discounts shown. Confirm discounts with your selected provider.

2 Discount will be applied to the provider’s usual and customary price for services.

3 Special lens designs, materials, powers and frames may require additional cost.

4 Pricing at some retail locations may vary.

The relationships between Blue Cross and Blue Shield of Illinois and Davis Vision, Inc., and Davis Vision, Inc., on behalf of TLC/TruVision are that of independent contractors.

BlueExtras is a discount program available to BCBSIL members. Some of the services offered through BlueExtras may be covered under your health plan. Please refer to your benefit booklet or call the customer service number on the back of your ID card for specific benefit information under your health plan. Use of BlueExtras does not affect your premium, nor do costs of BlueExtras’ services or products count toward any maximums and/or plan deductibles. Discounts are only available through participating vendors.

BCBSIL does not guarantee or make any claims or recommendations regarding the services or products offered under BlueExtras. You may want to consult with your physician prior to use of these services and products. Services and products are subject to availability by location. BCBSIL reserves the right to discontinue or change this discount program at any time without notice.

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You Pay:

Examinations

Comprehensive examination15% off or $5 off

retail cost

Contact lens examination15% off or $10 off

retail cost

Frames3

Priced up to $70 retail $40

Priced over $70 retail

$40 plus 10%

off the amount over

$70

Contact LensesConventional2 20% offDisposable/Planned replacement2 10% off

Spectacle Lens Options (Add to lens prices)3

Standard progressive4 $60 or $75Premium progressive4 $110 or $125Glass lenses $18Polycarbonate lenses $30Blended invisible bifocals $20Intermediate vision lenses $30Photogrey Extra® lenses $35Scratch-resistant coating $15Anti-reflective coating $45Ultraviolet coating $15Solid tint $10Gradient tint $12Hi-index lenses $55Plastic photosensitive lenses $65Polarized lenses $75

Eye exam and vision hardware discount fee schedule1

If your plan offers vision benefits, see your BCBSIL network provider for your initial eye exam2. You can receive the following discounts on any additional exams and hardware when using a Davis Vision provider.

For more information, call Davis Vision at 877-393-8844 or visit davisvision.com, click Members and enter Control Code 4513 in the Open Enrollment section.

Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

Save on Hearing Aids

Blue Cross and Blue Shield of Illinois (BCBSIL) has arranged a discount program* through TruHearing that offers digital hearing aids at a reduced price. This program is available to you as a BCBSIL member, as well as your parents and grandparents who are not enrolled in a BCBSIL plan.

With the digital hearing aids offered through TruHearing, you simply select the style that you prefer within your chosen price level.

The TruHearing program includes:

• Free hearing screening

• One-year supply of batteries with purchase

• 45-day money back guarantee

• 3-year warranty, including one-time coverage for a damaged or lost hearing aid

• 12 months, no interest fi nancing upon approved credit

To learn more or to take advantage of the savings, call TruHearing at (800) 687-4617 and identify yourself as a BCBSIL member. The operator will assist you in scheduling a hearing test at a convenient location. Operators are available from 8 a.m. to 8 p.m. (CT), Monday through Friday. You can also visit www.truhearing.com for more information. Be sure to present your BCBSIL ID card at all appointments.

www.bcbsil.com*BlueExtras is a discount program available to BCBSIL members. This is NOT insurance. Some of the services offered through BlueExtras may be covered under your health plan. Please refer to your benefi t booklet or call the customer service number on the back of your ID card for specifi c benefi t information under your health plan. Use of BlueExtras does not affect your premium, nor do costs of BlueExtras’ services or products count toward your plan deductible, calendar year or lifetime maximums. Discounts are only available through participating vendors.

BCBSIL does not guarantee or make any claims or recommendations regarding the services or products offered under BlueExtras. You may want to consult with your physician prior to use of these services and products. Services and products are subject to availability by location. BCBSIL reserves the right to discontinue or change this discount program at any time without notice.

**Products and prices may be subject to change without notice.

The relationship between Blue Cross and Blue Shield of Illinois (BCBSIL) and TruHearing is that of independent contractors.

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Basic• Value in 100% Digital

Medallion• Technology & Value

Ultra• Highest Technology• Complete Features

$995 each**

Regular price: $1,595 each• 100 percent digital• 2 channels• 2 memories• Microphone noise reduction

$1,495 each**

Regular price: $3,595 each• 100 percent digital• 7 channels• 3 memories• Microphone noise reduction• Sensitive voice processing• Adaptive feedback detection

$1,995 each**

Regular price: $4,755 each• 100 percent digital• 14 channels• 3 memories• Microphone and adaptive

noise reduction• Sensitive voice processing• 6 compression areas• Speech preservation

BlueExtrasSM TruHearing

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

bcbsil.com