Northwestern Medical Group

Commercial health insurance is a type of private health insurance coverage. It helps you pay for your medical and surgical expenses. This type of health insurance is often offered by employers.

Northwestern Medicine hospitals and physician clinics have contracts for insurance with the organizations listed below. Coverage for Northwestern Medicine facilities and physicians may be in-network or out-of-network. This depends on your plan. You may require authorization for services by your plan before receive care. Please check with your health plan’s customer service to verify coverage details. This information can impact your out-of-pocket costs.

Aetna

Aetna Choice POS
Aetna Choice POS II
Aetna Elect Choice
Aetna EPO
Aetna Health Network Only
Aetna Health Network Option
Aetna HMO
Aetna Illinois Preferred Plan
Aetna Managed Choice POS
Aetna NAP
Aetna Open Access Elect Choice
Aetna Open Access HMO
Aetna Open Access Managed Choice
Aetna Open Choice PPO (including, but not limited to Aetna Signature Administrators® and Open Choice)
Aetna Performance Network
Aetna Premier Care Network (contact your insurance company)
Aetna Premier Care Network Plus (contact your insurance company)
Aetna QPOS
Aetna Savings Plus
Aetna Select
Aetna Student Health
Aetna Traditional Choice
Aetna Voluntary Group Medical Plan (Indemnity Plan)

Beechstreet (PHCS)

Blue Cross Blue Shield

Please note: Starting April 1, 2021, the number of Blue Cross Blue Shield Northwestern Medicine sites was condensed from six to two. The two remaining sites are now 475 and 489 (please see graph below for sites prior to April 1, 2021). For patients previously enrolled in sites 471, 477, 493 or 487, Blue Cross Blue Shield of Illinois should have sent you communication. They also should have sent you a new insurance card with your new site number. This change should not impact your primary care.

If your Blue Cross Blue Shield HMO plan site number is not listed below, and your primary care provider is not employed by Northwestern Medicine or part of Northwestern Medicine Physician Network, you will need a referral to see a specialist or have other services at Northwestern Medicine.

For questions about referrals, please call Blue Cross Blue Shield’s customer service line. This phone number is on the back of your insurance card.

Blue Cross Blue Shield of Illinois HMO Plans associated with Northwestern Medicine include:

Prior to April 1, 2021 Starting April 1, 2021
Site # Name
471 Northwestern Medicine Physicians Network - McHenry Site #475
Northwestern Medicine Physician Network West and Northwest Suburb
Your BCBS ID card will state: NMPN W, NW Sub
475 Northwestern Medicine Physician Network – Central DuPage
477 Northwestern Medicine Physician Network - Delnor
493 Northwestern Medicine Physician Network - DeKalb
487 Northwestern Medicine Physician Network - North Region Site #489
Northwestern Medicine Physician Network Chicago and North Suburb
Your BCBS ID card will state: NMPN, CHI, N Sub
489 Northwestern Medicine Physician Network - Chicago

Blue Cross Blue Shield

Blue Cross Blue Shield - HMOI

  • Blue Cross Blue Shield of Illinois sites 475 and 489 for Northwestern Medicine Physician Network primary care and specialty care services.
  • If you have a Blue Cross Blue Shield of Illinois HMO site that is not listed on the table above and not affiliated with Northwestern Medicine, you will need an authorized referral for specialty care services. To find out if your physician is with Northwestern Medicine, visit Find a Doctor on nm.org.

Blue Cross Blue Shield - Blue Advantage HMO

  • Blue Cross Blue Shield of Illinois sites 475 and 489 for Northwestern Medicine Physician Network primary care and specialty care services with the exception of Northwestern Medical Group primary care providers.
  • If you have a Blue Cross and Blue Shield of Illinois HMO site that is not listed on the table above and not affiliated with Northwestern Medicine, you will need an authorized referral for specialty care services. To find out if your physician is with Northwestern Medicine, visit Find a Doctor on nm.org.

Blue Cross Blue Shield - Blue Choice PPO
Blue Cross Blue Shield - Blue Choice Options (Tier 1)
Blue Cross Blue Shield – PPO

Cigna

CIGNA Behavioral Health, Inc
Cigna - Open Access
Cigna - Open Access Plus
Cigna - Choice Fund Open Access Plus
Cigna - ChoiceCare PPO
Cigna - EPO
Cigna - Global Health Benefits
Cigna - GWH POS Open Access Plus
Cigna - HMO (or POS)
Cigna - HMO (or POS) Open Access
Cigna - Local Plus
Cigna - Network Open Access
Cigna - Network POS
Cigna - One Health HMO eff 4/1/19
Cigna Plus with Northwestern Medicine (Effective 1/1/2021)
Cigna - POS
Cigna - PPO
Cigna - Shared Administration PPO and OAP

Coventry Health Care - First Health HMO, PPO and POS

Global Excel - PPO

Health Alliance PPO and HMO

HFN

HFN - EPO (HFN20)
HFN - PPO (HFN10)
HFN - Workers' Compensation Program/Network

Humana

Humana - Choice POS
Humana - ChoiceCare PPO
Humana - EPO
Humana - HMO Premier (patients must have a referral for services)
Humana - HMO Select (specialist services only)
Humana - Illinois Platinum HMO (specialist services only)
Humana - National Preferred POS - Open Access
Humana - PPO
Humana - Preferred PPO

Imagine Health

MultiPlan/PHCS

The Alliance

United Behavioral Health - Optum

United Healthcare

United Healthcare - All Savers
United Healthcare - Choice
United Healthcare - Choice Plus
United Healthcare - Core
United Healthcare - HMO (Patients must have a referral for services)
United Healthcare - HMO Plus
United Healthcare - Navigate
United Healthcare - Open Access (Patients must have a referral for services)
United Healthcare - Options PPO
United Healthcare - Select Plus
United Healthcare - Select
United Healthcare Affiliates - Participate through UHC PPO

Health exchanges or health insurance marketplaces were established in accordance with the Affordable Care Act (ACA) 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.

2021 Options

The plans below offer current access to Northwestern Medicine on Get Covered Illinois, the official health insurance marketplace for Illinois for the 2021 calendar year.

  • Blue Choice Preferred PPO
  • Blue Cross Blue Shield Precision

    Please note: Starting April 1, 2021, the number of Blue Cross Blue Shield Northwestern Medicine sites was condensed from six to two. The only remaining site for Blue Precision is now 475 (please see graph below for sites prior to April 1, 2021). For patients previously enrolled in sites 471, 477, 493 or 487, Blue Cross Blue Shield of Illinois should have sent you communication. They should have also sent you a new insurance card with your new site number. This change should not impact your primary care.

    If your Blue Cross Blue Shield HMO plan site number is not listed below, and your primary care provider is not employed by Northwestern Medicine or part of Northwestern Medicine Physician Network, you will need a referral to see a specialist or have other services at Northwestern Medicine.

    For questions about referrals, please call Blue Cross Blue Shield’s customer service line. This phone number is on the back of your insurance card.

    Blue Cross Blue Shield of Illinois HMO Plans associated with Northwestern Medicine include:

    Prior to April 1, 2021 Starting April 1, 2021
    Site # Name
    471 Northwestern Medicine Physicians Network - McHenry Site #475
    Northwestern Medicine Physician Network West and Northwest Suburb
    Your BCBS ID card will state: NMPN W, NW Sub
    475 Northwestern Medicine Physician Network – Central DuPage
    477 Northwestern Medicine Physician Network - Delnor
    493 Northwestern Medicine Physician Network - DeKalb
    • Blue Cross Blue Shield of Illinois sites 475 for Northwestern Medicine Physician Network primary care and specialty care services with the exception of Northwestern Medical Group primary care providers.
    • If you have a Blue Cross Blue Shield of Illinois HMO site that is not listed on the table above and not affiliated with Northwestern Medicine, you will need an authorized referral for specialty care services. To find out if your physician is with Northwestern Medicine, visit Find a Doctor on nm.org.
  • Cigna Plus With Northwestern Medicine
    An HMO product that requires the selection of a primary care physician at Northwestern Medicine.

For instructions on how to enroll in any of these plans, please call 312.926.7440, TTY 711.

Bronze

Blue Cross Blue Shield of Illinois Blue Precision Bronze HMO 205*
Blue Cross Blue Shield of Illinois Blue Choice Preferred Bronze PPO 201
Blue Cross Blue Shield of Illinois Blue Choice Preferred Bronze PPO 202
Blue Cross Blue Shield of Illinois Blue Choice Preferred Bronze PPO 302
Cigna Plus With Northwestern Medicine 8550 (available for 2021 open enrollment)
Cigna Plus With Northwestern Medicine 7150 (available for 2021 open enrollment)
Cigna Plus With Northwestern Medicine 6750 (available for 2021 open enrollment)

Silver

Blue Cross Blue Shield of Illinois Blue Precision Silver HMO 206*
Blue Cross Blue Shield of Illinois Blue Choice Preferred Silver PPO 203
Blue Cross Blue Shield of Illinois Blue Choice Preferred Silver PPO 303
Cigna Plus With Northwestern Medicine 5000 (available for 2021 open enrollment)
Cigna Plus With Northwestern Medicine 2800 (available for 2021 open enrollment)
Cigna Plus With Northwestern Medicine 3500 Diabetes Care (available for 2021 open enrollment)

Gold

Blue Cross Blue Shield of Illinois Blue Precision Gold HMO 207*
Blue Cross Blue Shield of Illinois Blue Choice Preferred Gold PPO 204
Cigna Plus With Northwestern Medicine 1000 (available for 2021 open enrollment)

All Levels

Health Alliance Marketplace Plans HMO (requires referral from primary care physician/referring specialist)

*Northwestern Medical Group is in network by referral only for specialty care physicians, such as cardiologists and orthopaedic surgeons.

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) plans. 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.

Please Note: Cigna HealthSpring is no longer in-network with any NM location effective 7/31/19

Beginning January 1, 2021, Northwestern Medicine will be participating in the following Humana Medicare Advantage offerings:

  • Humana HMO Gold Plus
  • Humana PFFS
  • Humana PPO
  • Humana Honor PPO (Veterans Plan)

We will also be participating in Humana MMAI.

If you have any questions about our participation in these or other insurance programs, please call 312.926.7440, TTY 711.

Governmental Advantage Plans

Medicare
Medicaid
Veteran Affairs Community Care Network administered by Optum
TriCare East Administered by Humana Military

Medicare Advantage Plans

Aetna - HMO 
Aetna - PPO 
Aetna - Open Access HMO
Blue Cross Blue Shield - PPO  
Blue Cross Blue Shield - HMO 
Health Alliance  (Referrals required for specialty care, NO primary care is covered)
Humana HMO Gold Plus
Humana PFFS
Humana PPO
Humana Honor PPO (Veterans Plan)
United HealthCare Medicare Complete Access (Referrals required for specialty care, NO primary care is covered)
United HealthCare Medicare Advantage PPO 
United HealthCare Medicare Advantage 
United HealthCare AARP® Medicare Advantage Plan 1 (HMO) 
United HealthCare AARP® Medicare Advantage Plan 2 (HMO) 
United HealthCare Medicare Advantage Assure 
United HealthCare AARP® Medicare Advantage Choice (PPO) 
United Healthcare AARP Medicare Advantage Walgreens (PPO) 
United HealthCare AARP® Medicare Advantage Patriot (PPO)

Medicare/Medicaid Alignment Initiative Agreements (MMAI)

Blue Cross Blue Shield
Humana

Medicaid Managed Care Programs/HealthChoice Illinois

Blue Cross Blue Shield
CountyCare 
Meridian 

Medical Group/IPA Site Medicare Advantage HMO
Site 757 (Northwestern Medicine) X