HMO Illinois
This HMO's network includes, but is not limited to, St. Francis, NorthShore University Health System and Advocate-Lutheran General.
Plan Benefits
This is a summary of the plan benefits. Complete benefit information is available in the Certificate of Coverage 
and Summary of Benefit Coverage (SBC) .
- Express Scripts - administered prescription plan
- Vision discount - program available through Davis Vision
- Blue Extras - offers a variety of discounts on gym memberships, alternative medicine and hearing aids
Immunizations
- $25 copay
Routine Mammogram & Pap Smear
- Mammogram covered in full when ordered by Primary Care Physician (PCP) and performed according to American Cancer Society guidelines.
- Pap Smear covered in full within network.
Laboratory Tests and X-Rays
- Covered 100% if performed in a physician's office; subject to copay.
Physical Therapy & Chiropractic Care
- $25 copay Maximum 60 visits per calendar year for physicaltherapy.
Minor Surgery in Doctor's Office
- $25 copay.
Outpatient Surgical Operations
- After $250 per occurrence deductible, covered infull with PCP referral.
Diabetes Treatment
- Covered, subject to location of care and copayor deductible.
- Supplies covered under prescription drug program. Equipment covered as durable medical equipment.
- Benefits are provided for outpatientself-management training, education and medical nutritional therapy.
Exclusions
- Hearing aids; discounts available with TruHearing at 866-687-2020.
- Custodial Nursing Home Care.
- Cosmetic Care except for the correction of congenital deformities or for conditions resulting from accidental injuries, tumors or disease.
Find a Doctor
- Navigate to the Provider Finder.
- Select the Group health plan and choose HMO Illinois.
- OB/GYNE and PCP must be from the same medical group.
- To change your PCP to a different medical group, contact HMO Illinois member services.
If an individual will be away from the local area for an extended period of time, HMO Illinois offers a Guest Member program. This program covers routine care and makes arrangements for care to be provided by a provider who has a relationship with HMO Illinois.
Monthly Premiums
|
Annual Salary |
You |
You+Spouse |
You+Child(ren) |
You+sps+child(ren) |
|
|
Full Time |
Up to $42,000 | $83 | $183 | $157 | $275 |
| $42,001 - $75,000 | $109 | $239 | $206 | $359 | |
| $75,001 - $128,000 | $142 | $311 | $268 | $468 | |
| $128,001 - $182,000 | $180 | $395 | $340 | $594 | |
| $182,001 and above | $241 | $528 | $455 | $794 | |
|
Part Time |
Up to $42,000 | $205 | $449 | $387 | $675 |
| $42,001 - $75,000 | $222 | $486 | $419 | $731 | |
| $75,001 - $128,000 | $244 | $535 | $461 | $804 | |
| $128,001 - $182,000 | $270 | $591 | $509 | $889 | |
| $182,001 and above | $310 | $680 | $586 | $1,023 |