BCBSIL PPO (with HRA)

The PPO plan provides medical and prescription drug coverage to State Farm employees and their eligible dependents in the continental United States. Blue Cross and Blue Shield of Illinois (BCBSIL) administers medical claims, and CVS Caremark handles prescription drug coverage. This plan is not a High-Deductible Health Plan, so it does not qualify for a Health Savings Account (HSA).  

This plan comes with an HRA to help you pay for eligible medical expenses, like coinsurance and your deductible. If you enroll, an HRA is automatically opened for you and completely funded by State Farm.

To see how much you’ll pay for coverage, use the Pricing Modeler.

You can see any provider you like

Under this plan, you can see any doctors or specialists you want without a referral, but keep in mind that you’ll always pay more when your provider is not in-network.

You pay nothing for preventive care

In-network preventive care is covered at 100%. You do not have to meet the deductible first. 

Getting annual physicals and recommended screenings and vaccinations can help you maintain good health and identify potential health issues as soon as possible.

For most other services, you must meet your annual deductible before the plan helps cover the cost of your care

These include doctor visits, hospital stays, labs, and X-rays.

Once you meet the medical plan deductible, you and the plan share the cost of services through coinsurance

You pay less when you visit in-network providers, because they provide services at lower negotiated rates, and the coverage percentage is greater.

With family coverage under this plan, when one member of the family meets the individual deductible, the plan will pay its share of costs for that person for the remainder of the calendar year. Similarly, when the family deductible is reached, the plan will cover its share of costs for the remainder of the calendar year. The full family deductible cannot be satisfied by a single family member.

After you reach the out-of-pocket maximum, the plan pays 100% of the cost of medical services for the rest of the year

The annual deductible and the amount you pay out-of-pocket for coinsurance all count toward your out-of-pocket maximum.

Prior authorization may be required

Some medical services and prescription drugs require prior authorization before they are covered. This means your health care provider must get approval from your insurance provider in advance. If prior authorization isn’t obtained, you may be responsible for the full cost. This process helps ensure care is safe, appropriate, and covered under the plan. Review the plan documents on the My State Farm Benefits Resource website (auto sign-on with SSORestricted access information | log in) for more information. On the home page, select Plan Documents from the left navigation, then select the Health and Insurance dropdown.

Did somebody say free money?! The HRA is funded only by State Farm. You can’t contribute to it. Here’s how it works:

• At the start of every year, State Farm deposits the full annual HRA amount ($1,000 individual coverage or $2,000 employee +1 or family coverage), so funds are available immediately. (The State Farm HRA contribution will be prorated if you join midyear.)
• HRA dollars are applied automatically to eligible medical expenses as claims are processed. This reduces your out-of-pocket medical costs for expenses like the deductible and coinsurance. Your HRA cannot be used to cover your out-of-pocket prescription drug costs. 
• Any unused funds roll over from year to year (up to a maximum of $10,000 for employee-only coverage or $20,000 for employee-plus-dependent coverage).

You’ll pay less when you use an in-network provider through the Blue Cross and Blue Shield of Illinois (BCBSIL) PPO network. To find network providers near you, visit the BCBSIL website (auto sign-on with SSORestricted access information | log in), or call 844-287-3859.

Although the plan pays for care from out-of-network providers, you’ll pay more out of pocket and may be billed for charges that are above plan reimbursement rates.

For additional plan details, review the PPO with HRA Summary of Benefits and Coverage (SBC) on the My State Farm Benefits Resource website (auto sign-on with SSORestricted access information | log in). On the home page, select Plan Documents from the left navigation, then select the Health and Insurance dropdown.

For information about prescription drug coverage, view the Prescription Drugs page.