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 PDF Document and Summary of Benefit Coverage (SBC) PDF Document.

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

  1. Navigate to the Provider Finder.
  2. Select the Group health plan and choose HMO Illinois.
  3. OB/GYNE and PCP must be from the same medical group.
  4. 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 $90 $198 $171 $298
$42,001 - $75,000 $118 $259 $223 $390
$75,001 - $128,000 $154 $338 $291 $508
$128,001 - $182,000 $196 $429 $369 $645
$182,001 and above $262 $574 $494 $862

Part Time

Up to $42,000 $222 $487 $420 $732
$42,001 - $75,000 $241 $528 $454 $794
$75,001 - $128,000 $265 $581 $500 $873
$128,001 - $182,000 $293 $642 $552 $965
$182,001 and above $337 $739 $636 $1,110