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Update: Out-of-State Care Beyond Contiguous Counties Waiver Ends Jan. 1, 2027
Act
by Dec 31, 2026
Effective date
Jan 1, 2027
Identified
Sep 18, 2026
Summary
Effective January 1, 2027, Blue Cross Blue Shield of Illinois will end all out-of-state care waivers for Blue Choice Preferred PPO and MyBlue Plus PPO plan members. Members will no longer be able to request waivers for non-emergency/non-urgent care outside the state service area and will pay standard out-of-network rates instead. All existing waivers expire on this date, and no new waivers will be issued.
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What to do
by Dec 31, 2026 · 7 steps
01Billing team must implement the following changes.
02Update billing system to identify Blue Choice Preferred PPO and MyBlue Plus PPO members from BCBSIL.
03Remove any logic that applies in-network benefit levels to out-of-state claims for these plans.
04Configure system to apply out-of-network rates for non-emergency/non-urgent services rendered outside the state service area for these plans beginning January 1, 2027.
05Update claim submission procedures and staff training to reflect that out-of-state waivers are no longer available.
06Notify providers in contracting relationships with BCBSIL that direct contract claims submitted for out-of-state services will process at in-network rates only if the provider is contracted, otherwise out-of-network rates apply.
07Before rendering services, verify member eligibility and benefits through Availity Essentials or preferred vendor portal.
If missed: Failure to properly apply out-of-network rates after January 1, 2027 may result in claim denials or underpayment.
Original notice
Update: Out-of-State Care Beyond Contiguous Counties Waiver Ends Jan. 1, 2027
bcbsil.com · Always check the source before changing claims.