• RRD Benefits Center

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    National Medical Options

    Last Updated March 31, 2025

    Jump to: Overview Medical Program Options

    Your RRD Medical Program can help support your health and manage your health care costs.

    Overview

    You have four National Medical Program options provided by Blue Cross and Blue Shield of Illinois (BCBSIL):

    All options include prescription drug coverage provided through CVS Caremark.

    Depending on where you live, you might be eligible for a regional medical option.

    Requirements for Cost-Effective Health Care

    Applies to National Medical Program options other than BCBS Coupe PPO

    To help you get the best care at the best price, BCBSIL requires you do the following:

    • Contact a health advocate prior to receiving an MRI or CT scan, or pay a $200 penalty. (The $200 penalty does not apply to an MRI or CT scan done in an emergency room.) A health advocate will help you compare service locations and costs so you can make an informed decision about your care. You may also go to Blue Access for Members.
    • Use a “Blue Distinction Specialty Care” facility for these five surgical specialties: bariatric, cardiac, knee and hip replacement, spine and transplant surgeries. Blue Distinction facilities are recognized for delivering higher quality care. If you choose not to use a Blue Distinction Specialty Care facility, you will pay higher coinsurance: 40% for the HSA Advantage and Copay Advantage National Medical Program options, and 45% for HSA Value National Medical Program option.
    • Receive prior authorization for hospitalizations, radiation therapy (proton treatment, radiation treatment, etc.), skilled nursing and rehabilitation, home health care, and other services listed in the SPD that require preauthorization.

    For more details about these requirements and the additional costs you’ll avoid by following them, contact a health advocate at 1-800-537-9765.

    Choosing Your Providers

    With any of the National Medical Program options, you can use in-network or out-of-network providers, but you will save money when you receive care from in-network providers. Use the BCBSIL Provider Finder tool to find providers by location, and compare them based on price, patient reviews and recognition. You can also check to be sure your providers are in-network by calling the number on the back of your insurance ID card prior to receiving services.

    2025 National Medical Program Options

    Here’s an overview of the National Medical Program options. The annual deductible (amount you pay before receiving benefits) applies to all services except in-network preventive care. Your out-of-pocket maximum protects you in case of unexpected or catastrophic expenses. This is the most you will ever have to pay in a calendar year for covered and allowed medical expenses.

    Related Information

    BCBS Coupe PPO

    Regional Medical Options

    Summaries of Benefits and Coverage

    Summary Plan Descriptions

    Prescription Drug

    Health Savings Account (HSA)

    Contact Information

    BCBSIL

    Network Names

    Value and Advantage Medical Program Network Name: PPO

    Florida Network Names: BCBS HSA Value FL; BCBS HSA Advantage FL; BCBS Copay Advantage FL

    Georgia Network Names: BCBS HSA Value GA; BCBS HSA Advantage GA; BCBS Copay Advantage GA

    Maryland Network Names: BCBS HSA Value MD; BCBS HSA Advantage MD; BCBS Copay Advantage MD

    New Jersey Network Names: BCBS HSA Value NJ; BCBS HSA Advantage NJ; BCBS Copay Advantage NJ

    New York Network Names: BCBS HSA Value NY; BCBS HSA Advantage NY; BCBS Copay Advantage NY

    Tennessee Network Names: BCBS HSA Value TN; BCBS HSA Advantage TN; BCBS Copay Advantage TN

    Wisconsin Network Names: BCBS HSA Value WI; BCBS HSA Advantage WI; BCBS Copay Advantage WI

    1-800-537-9765

    BCBSIL app

    Coverage Transparency

    The federal Transparency in Coverage rule requires our group health plan to publicly share detailed price and cost-sharing information starting July 1, 2022. The Rule requires health plans to post machine readable files (MRFs) that show the negotiated rates for in-network providers and the allowed amounts for out-of-network providers, for certain services covered by the group health plan. Each of our health plan insurers and third-party administrators will publish the MRFs online and update them each month at the following links:

    Note that MRFs are formatted to allow third parties, such as researchers, regulators and app developers, to more easily access and analyze data about health care costs and may be difficult for others to review.

    HSA Advantage
    Medical    		 Copay Advantage
    Medical    		 HSA Value
    Medical
    Annual Deductible

    Employee Only: $2,000

    Family: $4,000

    Employee Only: $1,900

    Family: $3,800

    Employee Only: $2,900

    Family: $5,800
    Annual Out-of-Pocket Maximum

    Employee Only: $7,600

    Family: $15,200; Individual cap of $7,600

    Employee Only: $7,600

    Family: $15,200; Individual cap of $7,600

    Employee Only: $7,600

    Family: $15,200; Individual cap of $7,600
    Office Visit

    In-Network: 20% after deductible

    Out-of-Network: 40% after deductible

    In-Network: $25 PCP or Mental health; $40 Specialist 

    Out-of-Network: 40% after deductible

    In-Network: 25% after deductible

    Out-of-Network: 50% after deductible
    Preventive Care

    In-Network: $25 PCP or Mental health; $40 Specialist

    Out-of-Network: 40% after deductible

    In-Network: 0%

    Out-of-Network: 40% after deductible

    In-Network: 0%

    Out-of-Network: 50% after deductible
    Emergency Room

    In-Network: 20% after deductible

    Out-of-Network: 20% if true emergency; otherwise 40% after deductible

    In-Network: $500 copay + 20% of remaining balance after deductible

    Out-of-Network: $500 copay + 20% of remaining balance if true emergency; otherwise 50% of remaining balance after deductible i

    In-Network: 25% after deductible

    Out-of-Network: 25% if true emergency; otherwise 50% after deductible