Loyola University Chicago

Your Primary Care

Physician (PCP)

Physician network includes Loyola primary care physicians.

Use the HMO IL website to select a physician near you: www.bcbsil.com or call 1-800-892-2803.

Referrals

Referral requires primary care physician approval

In-Patient Hospital

Payment Level: 100%

After $100 Co-Pay per Admission

Out-Patient Hospital

Payment level: 100%

Physician Services

Office visits

$20 Co-pay

Emergency Care

$75 Co-pay

Standard Mental Health

Inpatient: ($100 co-pay per admission)Payment level: 100%(maximum 20 days per calendar year) 

Outpatient:  Payment level: 100% after you pay $20/visit co-pay (maximum 20 visits per calendar year)

Must call HMO Illinois Chemical Dependency Hotline at 800/346-3986 or treatment will not be covered.

Inpatient: ($100 co-pay per admission)Payment level at 100% (maximum 20 days per year)

Outpatient: Payment level at 100% after you pay $20 per visit co-pay (max 20 visits per year)

Prescription Drug Benefit

Co-pay levels:

   $15  Generic

   $35  Brand Name, Formulary

   $45 Nonformulary

Mail Order Prescription Drug Program (Optional)

Available by contacting BC/BS at

1-800-423-1973 (3 month supply for 2x co-pay).  Also available at participating retail providers.

Vision Benefit  (through Participating Providers)

Note:  Must use Eye Med Vision Care (1-866-273-0817) effective 1/1/08 through 6/30/08.  Effective July 1, 2008, use Davis Vision provider - go on line to www.bcbsil.com to view participating providers.

- Optical services only through participating providers.

- Payment level:  100% for eye exam once in every 12 months ($20 co-pay).

- Discounts available on eyewear in addition to a $75 allowance for the purchase of glasses or contacts every 24 months.