Accepted Insurance Plans

To meet the widest range of healthcare needs in the region, Northwestern Medicine hospitals participate in a variety of insurance plans and is considered an "in-network" provider for a large number of insurers. Being in-network means that insurance companies have made special contracting arrangements to provide a higher level of payment coverage for their customers who receive care at a Northwestern Medicine facility. If Northwestern Medicine hospitals are part of your insurance network, it could reduce your out-of-pocket health care expenses.

View these comprehensive reference charts of accepted insurance plans. If you have specific questions about your coverage, please contact your insurance company directly.

Note: Most of the physicians providing care at Northwestern Medicine hospitals are independent and may accept different insurance plans than those accepted at a care location. Please contact your physician’s office directly for information about accepted plans. Patients receiving behavioral health services should contact the office directly for information related to in-network insurance plans.

Commercial Insurance is a type of insurance coverage that pays for medical and surgical expenses that are incurred by the insured. Health insurance is often included in benefit packages through employers. Northwestern Medicine participates with a wide variety of commercial insurance plans to meet the needs of the patient community.

Plan legend
Northwestern Medicine Commerical Insurance Plan Legend
Y Participating
N Not Participating
^ Patients must have a referral for services
^^ Specialist Services Only
# Contact your insurance company
## Services for Delnor Physicians Only
Y* Tier 2
**N Only from contracted IPA's, Referrals required for Specialty Services
1 Preferred Plan Only
NMH Northwestern Memorial Hospital
NLFH Northwestern Lake Forest Hospital
NMG Northwestern Medical Group
NHC Northwestern HealthCare (independent physicians at NLFH and NMH – please confirm the provider participation in your plan at the time of scheduling)
CDH Northwestern Medical Central DuPage Hospital
Delnor Northwestern Medicine Delnor Hospital
RMG Northwestern Medicine Regional Medical Group (Formerly Cadence Physician Group)
KH Northwestern Medicine Kishwaukee Hospital
VW Northwestern Medicine Valley West Community Hospital
KPG Kish Physicians Group

Northwestern Medicine Commerical Insurance Plans
2018 Commercial Plans  NMH NLFH NMG NHC CDH Delnor RMG KH VW KPG
A
Aetna HMO Y Y Y Y Y Y Y Y Y Y
Aetna Elect Choice Y Y Y Y Y Y Y Y Y Y
Aetna Select Y Y Y Y Y Y Y Y Y Y
Aetna Managed Choice POS Y Y Y Y Y Y Y Y Y Y
Aetna QPOS Y Y Y Y Y Y Y Y Y Y
Aetna Health Network Only Y Y Y Y Y Y Y Y Y Y
Aetna Open Access Elect Choice Y Y Y Y Y Y Y Y Y Y
Aetna Open Access HMO Y Y Y Y Y Y Y Y Y Y
Open Access Aetna Select Y Y Y Y Y Y Y Y Y Y
Aetna Choice POS Y Y Y Y Y Y Y Y Y Y
Aetna Choice POS II Y Y Y Y Y Y Y Y Y Y
Aetna Health Network Option Y Y Y Y Y Y Y Y Y Y
Aetna Open Access Managed Choice Y Y Y Y Y Y Y Y Y Y
Aetna Limited Benefits Insurance Plan (PPO) Y Y Y Y Y Y Y Y Y Y
Aetna Open Choice PPO (including, but not limited to Aetna Signature Administrators® and Open Choice) Y Y Y Y Y Y Y Y Y Y
Aetna Voluntary Group Medical Plan (Indemnity Plan) Y Y Y Y Y Y Y Y Y Y
Aetna Performance Network Y Y Y Y Y* Y Y Y* Y* N
Aetna Premier Care Network Y Y Y# Y# Y# Y Y# Y# Y# Y#
Aetna Premier Care Network Plus Y Y Y# Y# Y# Y Y# Y# Y# Y#
Aetna Traditional Choice Y Y Y Y Y Y Y Y Y Y
Aetna Savings Plus Y Y Y Y Y* Y Y## Y* Y* N
Aetna Student Health Y Y Y Y Y Y Y Y Y Y
American Psych Systems - Behavioral Health(APS) Y N N N Y Y Y N N N
B
Beacon Health Options (Formerly Value Options) N N N N Y Y Y N N N
Beechstreet (Viant) Y Y Y Y Y Y Y N N N
BCBS – PPO Y Y Y N Y Y Y Y Y Y
BCBS - Blue Advantage PPO Y Y Y N Y Y Y Y Y Y
BCBS - Blue Advantage HMO N** N N** N Y Y Y Y^ Y^ Y
BCBS - Blue Choice Options Y* Y* Y* N Y Y Y Y^ Y^ Y^
BCBS - HMOI (Medical Group/IPA information in Legend below) Y^ Y^ Y^ N Y Y Y Y^ Y^ Y^
C
Cigna – PPO Y Y Y Y Y Y Y Y Y Y
Cigna - POS Y Y Y Y Y Y Y Y Y Y
Cigna - Network POS Y Y Y Y Y Y Y Y Y Y
Cigna – HMO (or POS) Y Y Y Y Y Y Y Y Y Y
Cigna – EPO Y Y Y Y Y Y Y Y Y Y
Cigna Connect N N N N N N N N N N
Cigna – Choice Fund Open Access Plus Y Y Y Y Y Y Y Y Y Y
Cigna – Local Plus Y Y Y Y Y Y Y Y Y Y
Cigna – Network Open Access Y Y Y Y Y Y Y Y Y Y
Cigna – Choice Fund Open Access Plus Y Y Y Y Y Y Y Y Y Y
Cigna – HMO (or POS) Open Access Y Y Y Y Y Y Y Y Y Y
Cigna - Global Health Benefits Y Y Y Y Y Y Y Y Y Y
Cigna - Shared Administration PPO and OAP Y Y Y Y Y Y Y Y Y Y
Cigna Behavioral Health Y Y Y N Y Y Y N N N
Cigna - Open Access Y Y Y Y Y Y Y Y Y Y
Cigna - Open Access Plus Y Y Y Y Y Y Y Y Y Y
Cigna - GWH POS Open Access Plus Y Y Y Y Y Y Y Y Y Y
Compsych Behavioral Health Y N N N Y Y N N N N
Coventry Health Care of Illinois HMO, PPO and POS (HMO requires a referral) Y Y Y Y Y Y Y Y Y Y
Coventry Health Care – National HMO, PPO and POS Y Y Y Y Y Y Y Y Y Y
Coventry Health Care – First Health HMO, PPO and POS Y Y Y PPO Only
Y Y Y Y Y Y
Coventry Health Care - WC (First Health) Y Y N N Y Y Y Y Y Y
CoventryOne Y Y Y Y Y Y Y Y N Y
G
Galaxy Health Network PPO Y Y Y Y Y Y Y Y Y Y
H
Health Alliance Y^ Y^ Y^ N Y^ Y^ Y^ Y Y Y
HFN - EPO (HFN20) Y Y Y Y Y Y Y Y Y Y
HFN - PPO (HFN10) Y Y Y Y Y Y Y Y Y Y
HFN – Workers Compensation Y Y Y Y Y Y Y Y Y Y
HFN – CHC / CHC Premiere / CHC Elite Y Y Y Y Y Y Y Y Y Y
HFN – Platinum Y Y Y N Y Y Y Y Y Y
HealthLink PPO and HMO Y Y Y Y Y Y Y Y Y Y
Humana – EPO Y Y Y Y Y Y N Y Y Y
Humana – PPO Y Y Y N Y Y Y Y Y Y
Humana – Preferred PPO Y Y Y N Y Y Y Y Y Y
Humana – National Preferred POS – Open Access Y Y Y N Y Y Y Y Y Y
Humana – National POS Y Y Y Y Y Y Y Y Y Y
Humana – National POS – Open Access Y Y Y N Y Y Y Y Y Y
Humana – Choice POS Y Y Y Y Y Y Y Y Y Y
Humana - ChoiceCare PPO Y Y Y Y Y Y Y Y Y Y
Humana – HMO Premier Y Y Y N Y Y N Y^ Y^ Y
Humana – Illinois Platinum HMO Y Y N N Y Y N Y^ Y^ Y
Humana – HMO Select Y Y Y N Y Y Y^^ Y Y Y
I
Imagine Health Y Y Y Y N N N Y Y Y
Interplan (Chandler/Preferred Plan/ HealthSmart) 1 1 1 1 Y Y Y 1 1 1
L
LifeSynch N N N N Y Y Y N N N
M
Magellan N N N N Y Y N N N N
Managed Health Network - Behavioral Health Y N N N N N N N N N
MultiPlan Y Y Y Y Y Y Y Y Y Y
O
Optum Behavioral Health N N N N Y Y Y N N N
P
Preferred Network Access N N N N N N Y N N N
Private HealthCare System Y Y Y Y Y Y Y Y Y Y
U
United Healthcare – Choice Y Y Y Y Y Y Y Y Y Y
United Healthcare – Choice Plus Y Y Y Y Y Y Y Y Y Y
United Healthcare – Navigate N Y N N Y Y Y Y Y Y
United Healthcare - Catalyst N N N N Y# Y# Y# Y# Y# Y#
United Healthcare – Charter N N N N N N N N N N
United Healthcare – Compass N N N N N N N N N N
United Healthcare – Core N Y N N Y Y Y Y Y Y
United Healthcare – Options PPO Y Y Y Y Y Y Y Y Y Y
United Healthcare – Select Y Y Y Y Y Y Y Y Y Y
United Healthcare – Select Plus Y Y Y Y Y Y Y Y Y Y
United Healthcare Affiliates - Participate through UHC PPO Y Y Y Y Y Y Y Y Y Y


Medical Group/IPA Site HMO Illinois
Site 475 (NMPP Central DuPage) X
Site 477 (NMPP Delnor) X
Site 487 (NMPP Lake Forest) X
Site 489 (NMH) X

Health exchanges or health insurance marketplaces were established in accordance with the Affordable Care Act (“Obamacare”) of 2010. These marketplaces provide a set of government-regulated and standardized healthcare plans where individuals may purchase health insurance policies , some of which include federal subsidies.

As one of the leading healthcare systems serving greater Chicago, we are dedicated to providing you and your family with exceptional care and putting our patients first.  Rapidly evolving changes with the individual plans on the insurance exchange may impact the primary care physician selection included in your coverage.

If you wish to continue receiving your care from Northwestern Medicine, Blue Precision HMOSM is the only option for the exchange. However, please know:

Under Blue Precision HMOSM at Northwestern Medicine, you are required to have an assigned primary care physician (PCP).

The current medical group/IPAs to select for Northwestern Medicine are:

475

477

PCPs credentialed at Northwestern Medicine Central DuPage Hospital and at Northwestern Medicine Delnor Hospital are available as options. 

Here is a link to the available PCPs. Upon arriving at the website, please use this guide to find available Medical Group/IPA 475 or 477 PCPs.

If you have questions about a physician’s hospital affiliation, please call 312.926.7440

To sign up for one of these PCPs or to change your PCP, please refer to your enrollment materials for instructions or call 708.240.5145.  

For instructions on how to enroll in this plan please call 312.926.7440.

If the available PCPs and this insurance product is not the right option for you, please review the options on www.healthcare.gov to find a physician that is in the desired location.

Thank you again for choosing Northwestern Medicine as your preferred healthcare provider.

FAQS

Are there any other exchange options to access Northwestern Medicine?

No, Blue Precision HMOSM is the only Exchange option product for Northwestern Medicine access. 

If I do choose Blue Precision HMOSM, what kind of access will I have across the system?

In consultation with your PCP, you may have access to services at all Northwestern Medicine sites when clinically appropriate.

Here is a link to the available PCPs. Upon arriving at the website, please use this guide to find available Medical Group/IPA 475 or 477 PCPs.

Specialty care downtown, at the Streeterville campus, and at Northwestern Medicine Lake Forest Hospital will be available with Northwestern Medical Group specialists, when clinically appropriate. The only exception to this is infertility care and some transplant services, which are managed by the HMO through a separate network of physicians and facilities.

What is the difference between a referral and a pre-authorized referral?

A referral is a form of communication between your PCP and the specialist or facility they are referring you to. In the referral, your PCP indicates your diagnosis, pertinent history, and what they are requesting of the specialist physician or facility. Such examples would be referral to a specialist for care of diabetes, or in the case of a facility, referral for a chest x-ray.

A Pre-authorized referral is a referral that has to be reviewed and approved before the service can be delivered. These are usually done to insure that your benefits of the health plan appropriately cover the service, or when requesting services outside of the NM system. We do this so that you do not end up with inappropriate bills from providers.

In most scenarios, NM does not require referrals to be pre-authorized when done within the NM system, and the number of services that do require a pre-authorized referral is fairly limited.

But I don’t know which PCP I would like to select?

You do not have to pick a PCP at the time of enrollment, but you do need to pick a medical group/IPA. If you select Medical Group/IPA 475 or 477, one of the PCPs available will be assigned to you as close as possible to the home address registered when you selected Blue Precision HMOSM. 

If you would like to research available PCPs:

Here is a link to the available PCPs. Upon arriving at the website, please use this guide to find available Medical Group/IPA 475 or 477 PCPs.

Can all my family members access the same care at NM through this HMO plan?

Yes, there are Northwestern Medicine Internal Medicine, Family Medicine, Pediatricians and OB/GYN PCPs available in Medical Groups/IPAs 475 and 477. 

 

Plan legend
Northwestern Medicine Exchange Insurance Plan Legend
Y Participating
N Not Participating
+ Patients must select Site 475 or 477 and a participating NMPP primary care physician, patients can be referred to NMPP contracted specialists across Northwestern Medicine.
# Patients of Sites 475 or 477 can be referred to specialists based on appropriate medical need across Northwestern Medicine.
* Patients of Sites 475 or 477 can be referred to facilities across Northwestern Medicine based on appropriate medical need.
NMH Northwestern Memorial Hospital
NLFH Northwestern Lake Forest Hospital
NMG Northwestern Medical Group
NHC Northwestern HealthCare (independent physicians at NLFH and NMH – please confirm the provider participation in your plan at the time of scheduling)
CDH Northwestern Medical Central DuPage Hospital
Delnor Northwestern Medicine Delnor Hospital
RMG Northwestern Medicine Regional Medical Group (Formerly Cadence Physician Group)
Harken Health Harken Health is an affiliate of United HealthCare
KH Northwestern Medicine Kishwaukee Hospital
VW Northwestern Medicine Valley West Community Hospital
KPG Kish Physicians Group

Northwestern Medicine Exchange Insurance Plans
NORTHWESTERN MEDICINE: ILLINOIS INSURANCE EXCHANGE PLANS 2018
Metal Level Insurer Name Exchange
Plan Type
NMH NLFH NMG NHC CDH Delnor RMG NMPP KH VW KPG
Blue Cross Blue Shield of Illinois
Bronze Blue Cross and Blue Shield of Illinois Blue Precision Bronze HMO 205 HMO Y* Y* Y# N Y* Y* Y# Y+ Y# Y# N
Silver Blue Cross and Blue Shield of Illinois Blue Precision Silver HMO 206 HMO Y* Y* Y# N Y* Y* Y# Y+ Y# Y# N
Gold Blue Cross and Blue Shield of Illinois Blue Precision Gold HMO 207 HMO Y* Y* Y# N Y* Y* Y# Y+ Y# Y# N
Medical Group/IPA Site Blue Advantage HMO
Site 475 (NMPP Central DuPage) X
Site 477 (NMPP Delnor) X










Government plans are a wide range of plans that include a variety of Medicare and/or Medicaid plans. Northwestern Medicine participates in traditional Medicare and Medicaid as well as Family Health Plans (FHP), Integrated Care Plans (ICP) and Medicare-Medicaid Alignment Initiative (MMAI). FHP, ICP and MMAI plans are often available to individuals who were previously eligible for traditional Medicaid but are now accessing Managed Medicaid plans through expansion of the Affordable Care Act or “Obamacare.”

In addition, Northwestern Medicine participates with TriCare Military Services. For active duty military personnel and their families, this is administered by a plan for the Department of Defense.

Plan legend
Northwestern Medicine Government Health Insurance Plan Legend
Y Participating
N Not Participating
^ Patients must have a referral for services.
^^ Patients must have a referral if seeking services from a physician outside of Northwestern.
* Referrals required for specialty care, NO primary care is covered.
*** Referrals required from Advocate for specialty care only, NO primary care is covered.
# This includes select NMG Providers, verify at time of scheduling
NMH Northwestern Memorial Hospital
NLFH Northwestern Lake Forest Hospital
NMG Northwestern Medical Group
NHC Northwestern HealthCare (independent physicians at NLFH and NMH – please confirm the provider participation in your plan at the time of scheduling)
CDH Northwestern Medical Central DuPage Hospital
Delnor Northwestern Medicine Delnor Hospital
RMG Northwestern Medicine Regional Medical Group. Formerly known as Cadence Physician Group.
KH Northwestern Medicine Kishwaukee Hospital
VW Northwestern Medicine Valley West Community Hospital
KPG Kish Physicians Group

Northwestern Medicine Government Health Insurance Plans 2018
2018 Governmental Plan  Plan Type NMH NLFH NMG NHC CDH Delnor RMG KH VW KPG
Medicare Traditional Medicare Y Y Y N Y Y Y Y Y Y
Medicaid Traditional Medicare Y Y Y N Y Y Y Y Y Y
Tricare - Prime Military Health Plan Y Y Y Y N N N Y N N
Tricare - Prime Extra Military Health Plan Y Y Y Y N N N Y N N
Tricare - Prime Remote Military Health Plan Y Y Y Y N N N Y N N
Tricare - Prime Select Military Health Plan Y Y Y Y N N N Y N N
Tricare - Prime Standard Military Health Plan Y Y Y Y N N N Y N N
Tricare - Reserve Select Military Health Plan Y Y Y Y N N N Y N N
Medicare Advantage Plans
Aetna - PPO Medicare Advantage Y Y Y N Y Y Y Y Y Y
Aetna - HMO Medicare Advantage Y Y Y N Y Y Y Y Y Y
Aetna - Open Access HMO Medicare Advantage Y Y Y N Y Y Y Y Y Y
Aetna - POS Medicare Advantage N N N N Y Y Y Y Y Y
BCBS - Blue Medicare Advantage HMO Medicare Advantage N** N N N Y Y Y Y^ Y^ Y^
BCBS - Choice Premier PPO Medicare Advantage Y Y Y N Y Y Y Y Y Y
BCBS - Choice Plus PPO Medicare Advantage Y Y Y N Y Y Y Y Y Y
BCBS - PPO Medicare Advantage Y Y Y N Y Y Y N N N
Family Health Network/CCAI Medicare Advantage N N N N Y Y Y N N N
Cigna HealthSpring Advantage HMO Medicare Advantage N N N N Y Y Y N N N
Cigna HealthSpring Premier HMO-POS Medicare Advantage N N N N Y Y Y N N N
Cigna HealthSpring Primary Plan IHMO Medicare Advantage N N N N Y Y Y Y Y Y
Cigna HealthSpring Total Care HMO SNP Medicare Advantage N N N N Y Y Y Y Y Y
Coventry Advantra Medicare Advantage N N N N Y Y Y Y Y Y
Family Health Network HMO Medicare Advantage N N N N Y Y Y N N N
Health Alliance Medicare Advantage Y^ Y^ Y^ N Y^ Y^ Y^ Y Y Y
Humana PPO Medicare Advantage N N N N Y Y Y N N N
Humana HMO Medicare Advantage N N N N Y Y N Y Y Y
Humana PFFS Medicare Advantage N N N N Y Y Y Y Y Y
Humana Choice PPO Medicare Advantage N N N N Y Y Y N N N
Meridian Medicare Advantage N N N N Y Y Y Y Y Y
United HealthCare Group Medicare Advantage PPO Medicare Advantage Y Y Y Y Y Y Y Y Y Y
United HealthCare AARP Medicare Complete Access Medicare Advantage *N *N *N *N *N *N *N *N *N *N
United HealthCare AARP Medicare Complete Advocate Healthcare Medicare Advantage ***N ***N ***N N ***N ***N ***N N N N
United HealthCare AARP MedicareComplete Plan 1 Medicare Advantage Y^^ Y^^ Y^^ Y^^ Y^^ Y^^ Y^^ Y^^ Y^^ Y^^
United HealthCare AARP MedicareComplete Plan 2 Medicare Advantage Y^^ Y^^ Y^^ Y^^ Y^^ Y^^ Y^^ Y^^ Y^^ Y^^
Medicare/Medicaid Alignment Initiative Agreements (MMAI)
Aetna Better Health MMAI N N N N Y Y Y N N N
Beacon Health Strategies MMAI N N N N Y Y N N N N
Blue Cross Blue Shield MMAI
Y Y Y N Y Y Y Y Y Y
Humana MMAI
N N N N N N N N N N
Meridian HealthChoice IL MMAI
N N N N Y Y Y Y Y Y
Family Health Plan (Formerly Temporary Assistance For Needy Families [TANF] and ACA Medicaid Expansion
Blue Cross Blue Shield MMCP Y Y Y N Y Y Y Y Y Y
CountyCare MMCP Y Y Y N Y Y Y Y Y Y
Harmony Health Plan MMCP N N N N N N N N N N
Harmony Behavioral Health MMCP N N N N N N N N N N
Meridian HealthChoice IL MMCP Y Y Y N Y Y Y Y Y Y
Integrated Care Plan
Beacon Health Strategies ICP N N N N Y Y N N N N
Cigna - HealthSpring ICP
N N N N Y Y Y N N N
Blue Cross Blue Shield ICP
Y Y Y N Y Y Y** N N N
CountyCare ICP Y Y Y N Y Y Y Y Y Y
Meridian HealthChoice IL ICP Y Y Y N Y Y Y** Y Y Y
Medical Group/IPA Site Blue Advantage HMO
Site 475 (NMPP Central DuPage) X
Site 477 (NMPP Delnor) X