| Medical PPO Provider: | Blue Cross Blue Shield of Illinois |
| Annual Medical Deductible: | $400.00 per Individual $1,200.00 per Family |
| Annual Medical Out of Pocket Limits: (Including Deductible) |
$3,400.00 per Individual $7,200.00 per Family |
| Annual Prescription Out of Pocket Limits: | $5,700.00 per Individual $11,000.00 per Family |
| Medical Coinsurance: | 20% In-Network (after deductible is met) 30% Out-Of-Network (after deductible is met) |
| Preventive Care Coinsurance: | $0.00 (deductible waived) Click here to see a list of preventive services, as per the Affordable Care Act. |
| Chiropractic Care Limitations: | 25 visits per calendar year |
| Chiropractic Care Coinsurance: | 20% In-Network (after deductible is met) 30% Out-Of-Network (after deductible is met) |
Note: Deductible and Coinsurance applies only to Covered Services under the Plan.
To locate a BCBSIL In-Network PPO provider, please visit www.bcbsil.com or call 1 (800) 810-2583.
To verify Benefits and Eligibility, please contact the Fund Office at 1 (630) 887-4150.
For precertification, call Valenz at 1 (800) 367-1934.
Click here to view the 2023 Summary of Benefits & Coverage.
Visit www.ibt731funds.org for additional information regarding the Local No. 731, I.B. of T. Health and Welfare Funds Benefits.