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 putting patients first and providing you and your family with exceptional care. Rapidly evolving changes with individual plans on the insurance exchange may impact the primary care physician selection included in your coverage.
At this time, Blue Precision HMOSM is the only insurance option on the healthcare exchange that includes Northwestern Medicine. If you wish to continue to receive healthcare services from Northwestern Medicine, you will need to select Blue Precision HMOSM during your open enrollment period. However, please be aware of the following:
- 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, 493
PCPs credentialed at Northwestern Medicine Central DuPage Hospital, Northwestern Medicine Delnor Hospital and Northwestern Medicine Kishwaukee Hospital are available as options.
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 PCP or this insurance product are not the right for you, please review additional 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.
Are there any other insurance options on the exchange that provide access Northwestern Medicine?
No, Blue Precision HMOSM is the only exchange product that includes Northwestern Medicine.
If I do choose Blue Precision HMOSM, what kind of access will I have across the system?
In consultation with your primary care physician (PCP), you may have access to services at all Northwestern Medicine sites when clinically appropriate.
Specialty care downtown, on 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 should 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, 477 or 493, one of the PCPs available will be assigned to you at a location that is as close as possible to the home address registered when you selected Blue Precision HMOSM.
Can all of 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, 477 and 493.
Northwestern Medicine Exchange Insurance Plan Legend
||Patients must select Site 475, 477 and 493 participating NMPN primary care physician, patients can be referred to NMPN contracted specialists across Northwestern Medicine.
||Patients of Sites 475, 477 and 493 can be referred to specialists based on appropriate medical need across Northwestern Medicine.
||Patients of Sites 475, 477 and 493 can be referred to facilities across Northwestern Medicine based on appropriate medical need.
||Blue Precision HMO site 471 only (includes Bronze, Silver, Gold products)
||Requires referral from PCP/Referring Specialist.
||Northwestern Memorial Hospital
||Northwestern Lake Forest Hospital
||Northwestern Medical Group
||Northwestern Medical Central DuPage Hospital
||Northwestern Medicine Delnor Hospital
||Northwestern Medicine Regional Medical Group (Formerly Cadence Medical Group and formerly Kishwaukee Physician Group)
||Northwestern Medicine Kishwaukee Hospital
||Northwestern Medicine Valley West Community Hospital
||Centegra Health System
||Now part of Regional Medical Group (RMG)
|Medical Group/IPA Site
||Blue Precision HMOSM
|Site 471 (CHWN/Northwestern Centegra)
|Site 475 (NMPN Central DuPage)
|Site 477 (NMPN Delnor)
|Site 493 (NMPN DeKalb)