Which Medical Plan is Right?
Evaluate Your Needs. Consider your prior health care usage and select plans and options that fit your lifestyle and needs.
- Do you take regular prescription medications?
- Are you anticipating surgery or non-preventive dental care?
- Did you experience a qualifying life event this year?
- Review your current plans to ensure you have the coverage you need.
Review this benefits website to learn about your plan options.
A little bit of planning will help you select the best plans, coverage levels, and financial programs for your unique situation.
Medical Plan Comparison
Plan Option Summary
Benesch offers the option of a Traditional PPO or High Deductible Health Plan (HDHP) administered through Blue Cross Blue Shield of Illinois.
Please note that the network is nationwide, even though the plan is administered by BCBS of Illinois. For more detailed coverage information, please refer to the BCBSIL plan documents.documents.
| Plan Options | Traditional PPO* | High Deductible Health Plan (HDHP) |
||||||
|---|---|---|---|---|---|---|---|---|
| Calendar Year Deductible | In-Network | Non-Network | In-Network | Non-Network | ||||
| Embedded – no one individual must meet more than the individual limit | Embedded – no one individual must meet more than the individual limit | |||||||
| Individual | $1,500 | $3,000 | $3,300 | $3,300 | ||||
| Family | $3,000 | $6,000 | $6,600 | $6,600 | ||||
| Out-of-Pocket Max | Includes your Deductible | Includes your Deductible | ||||||
| Individual | $5,000 | $10,000 | $5,000 | $5,000 | ||||
| Family | $10,000 | $20,000 | $10,000 | $10,000 | ||||
| Coinsurance – You Pay |
In-Network 20% |
Non-Network 40% |
In-Network 20% |
Non-Network 40% | ||||
| Wellness/ Preventive Care Visit | $0 | 40% after deductible | $0 | 40% after deductible | ||||
| Physician Care Visit | $25 copay* | 40% after deductible | 20% after deductible | 40% after deductible | ||||
| Specialist Office Visit | $50 copay* | 40% after deductible | 20% after deductible | 40% after deductible | ||||
| Urgent Care | 20% after deductible | 40% after deductible | 20% after deductible | 40% after deductible | ||||
| Hospital Services | In-Network | Non-Network | In-Network | Non-Network | ||||
| Inpatient | 20% after deductible | 40% after deductible | 20% after deductible | 40% after deductible | ||||
| Outpatient | 20% after deductible | 40% after deductible | 20% after deductible | 40% after deductible | ||||
|
Complex Imaging (MRI, CAT, PET, etc.) |
20% after deductible | 40% after deductible | 20% after deductible | 40% after deductible | ||||
| Emergency Room | $400 Copay* (waived if admitted) plus 20% after deductible |
10% after deductible | ||||||
| Rehabilitation Services | In-Network | Non-Network | In-Network | Non-Network | ||||
| Physical, Speech & Occupational Therapy | 20% after deductible | 40% after deductible | 20% after deductible | 40% after deductible | ||||
*For the PPO, copays do not count towards the deductible, but do count towards the out-of-pocket maximum.
Prescription Plan
All medical plan participants have prescription drug coverage based on their selected plan. A way to save money is by requesting generics and/or mail order options when available.
| Prescription Drug | Traditional PPO* | High Deductible Health Plan (HDHP) | ||
|---|---|---|---|---|
| Retail Prescription Drug Copays Via Prime Therapeutics* |
$15 / $50 / $75 / 20% coinsurance Out-of-Network, responsible for copay plus 25% of eligible amount |
20% after deductible Out-of-Network, pay 40% after deductible + 25% of eligible amount after payment | ||
| 90 Day Mail Order Prescription Drug Copays Via Express Scripts |
2 x Retail (In-Network Only) |
20% after deductible (In-Network Only) | ||
| Specialty Prescription Drugs Via Accredo |
20% to $250 Max (In-Network Only) |
20% after deductible (In-Network Only) | ||
*For the PPO, copays do not count towards the deductible, but do count towards the out-of-pocket maximum.
**To access your pharmacy benefits, link out to MyPrime via the BCBS Member Portal.
Employee Contributions
| Bi-Weekly Medical Contributions | HDHP Plan | PPO Plan |
|---|---|---|
| Employee | $73.15 | $142.72 |
| Employee & Spouse | $148.22 | $268.10 |
| Employee & Child(ren) | $126.42 | $238.96 |
| Family | $209.70 | $386.06 |
Finding A Physician
Visit www.bcbsil.com and click “Find a Doctor or Hospital.”
You may search either by physician name or network; the network for each of the plans offered is:
- Participating Provider Organization (PPO)
Blue Access for Members (BAM)
- All participants have access to BAM. You may create your own account at www.bcbsil.com
- Members can check the status of claims, view benefit information, access wellness information, compare hospitals, request replacement ID cards, and more.
- Employees can even access their accounts through their mobile or smart phone
Blue365 ®
Blue365 is a discount program for members. With this program, you can save money on health care products and services that are most often not covered by your benefit plan. There are no claims to file and no referrals or pre-authorizations.
See all the Blue365 deals and learn more at www.blue365deals.com/BCBSIL.
FlexAccess
Start Saving Money on High-Cost Medications with FlexAccess. FlexAccess is a cost assistance program designed to help you lower your costs if you take certain high-cost medications. This program is part of the Blue Cross Blue Shield of Illinois health plans Benesch offers.
Get the Most From the FlexAccess Program:
- If you or your dependents take one or more of the medications in our program, you may get a
letter or, in some cases, a phone call from the FlexAccess team to help you get started. - The team will review your cost share (what you pay when you buy your prescription) at the
pharmacy you use now. The new amount you would pay may be as low as $0. - Speak with the FlexAccess team, even if you are using a drug manufacturer’s coupon now, to
make sure you are paying the lowest cost. - Participating in this program is your choice. If you don’t take part, you may pay up to the full
price of your medications.
Call FlexAccess at 888-302-3618, M-F, 7 a.m. to 7 p.m. CT, or email FlexAccess Member Services at member.services@flexaccessrx.com to ask any questions or find out if your prescription drug is part of this program.
Group Pharmacy FlexAccess with Qualified HDHP Member Flyer
Group Pharmacy FlexAccess Cost Assistance Program Member Flyer
Hinge Health
With Hinge Health, you can get virtual physical therapy and more at no cost to you and your covered dependents (18+) if you are enrolled in one of Benesch’s medical plans. Help reduce everyday joint and muscle aches, recover from an injury, and improve your mobility.
Partner with real people who are dedicated to helping you feel your best with personalized care
that includes:
- A care plan designed for your everyday activities and long-term goals — and to treat multiple
areas of your body at once - Exercise therapy sessions you can do in as little as 15 minutes — anytime, anywhere with the
Hinge Health app - 1-on-1 support from a physical therapist or health coach to tailor your sessions as needed and
help you reach your goals - Instant feedback during your exercise sessions with precise motion tracking — to improve your
form and build confidence
Join the Women’s Pelvic Health Program
Get personalized pelvic floor care at no cost to you and your covered dependents (18+).
What’s your pelvic floor?
Your pelvic floor is the group of muscles supporting the bladder, uterus, and bowel. Pregnancy, menopause, injury and certain conditions can sometimes weaken those muscles resulting in pain, bladder control issues and more.
Why join?
- Get personalized exercise therapy for pregnancy and postpartum, bladder control, pelvic
muscle strengthening, or pelvic muscle relaxation. - Work 1-on-1 with a clinical care team that specializes in pelvic floor care
- Exercise from the privacy of your own home, on your schedule
To learn more and apply, scan the QR code or visit hinge.health/enroll-today.
Hinge Health Overview Flyer
Women's Pelvic Health Program
MDLIVE Telehealth
Virtual Visits, provided by Blue Cross and Blue Shield of Illinois (BCBSIL) and powered by MDLIVE, allow you and your eligible family members to see a doctor wherever you go, whenever you need a doctor.
MDLIVE is a service outside of your traditional in network provider access. MDLIVE offers the following:
- Telemedicine visits
- Calls for non-emergency medical issues such as cold, flu, ear infection, pink eye
- Visits via phone or video
- 24 hours a day, 7 days a week
- Employees and covered dependents
- The cost is standardly $48 (behavioral health could be more) until the deductible is met
- Then $20 copay after deductible for PPO / $10 copay after deductible for HDHP
There is no charge to set up your account, but you may have a charge for your visit depending on your benefit plan.
Activate your account – pick the way that is easiest for you:
• Call MDLIVE at 888-676-4204
• Go to MDLIVE.com/bcbsil
• Text BCBSIL to 635-483
• Download the MDLIVE app
Alfred Benesch and Company PPO Plan
Alfred Benesch and Company HDHP w/HSA
Benefits Terminology
Specialty Pharmacy
Medications Member Flier
Pharmacy Mail Order Member Flier
Learn to Live Member Flyer
Well onTarget Wellness Portal
Ovia Maternity & Family Benefit
Ovia LGBTQ+ Support
BCBS HDHP w/HSA Booklet
BCBS PPO Booklet
Summary Plan Description
BCBS of IL
Non-Discrimination
Disabled Dependent Review Process - Certification Form
Rx Claim Form
