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HMO Illinois

This HMO's network includes, but is not limited to, St. Francis, NorthShore University Health System and Advocate-Lutheran General.

This is a summary of the plan benefits. Complete benefit information is available in the Certificate of Coverage and Summary of Benefit Coverage (SBC).

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.

Benefits

Prescription coverage
  • Express Scripts - administered prescription plan
Immunizations
  • $25 copay
Routine mammogram and 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 and chiropractic care
  • $25 copay Maximum 60 visits per calendar year for physical therapy.
Minor surgery in doctor's office
  • $25 copay.
Outpatient surgical operations
  • After $250 per occurrence deductible, covered in full 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 outpatient self-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.

Discounts

  • Vision discount - program available through Davis Vision
  • Blue Discount Program - offers a variety of discounts on gym memberships, alternative medicine and hearing aids
  • Hearings aids discounts available with TruHearing at 866-687-2020

This is a summary of the plan benefits. Complete benefit information is available in the Certificate of Coverage and Summary of Benefit Coverage (SBC).

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.

Benefits

Prescription coverage
  • Express Scripts - administered prescription plan
Immunizations
  • $25 copay
Routine mammogram and 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 and chiropractic care
  • $25 copay Maximum 60 visits per calendar year for physical therapy.
Minor surgery in doctor's office
  • $25 copay.
Outpatient surgical operations
  • After $250 per occurrence deductible, covered in full 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 outpatient self-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.

Discounts

  • Vision discount - program available through Davis Vision
  • Blue Discount Program - offers a variety of discounts on gym memberships, alternative medicine and hearing aids
  • Hearings aids discounts available with TruHearing at 866-687-2020

Premiums are deducted from your paycheck on a pre-tax basis.  Employees who are paid bi-weekly will have half of the monthly deduction taken from the first two checks of each month.

Premiums for full-time employees

HMO Illinois monthly premiums for full-time employees by annual salary and members of family insured.
Annual Salary You You + Spouse You + Child(ren) You + Spouse + Child(ren)
Up to $42,000 $100 $218 $188 $328
$42,001-$75,000 $130 $285 $246 $429
$75,001-$128,000 $169 $371 $320 $559
$128,001-$182,000 $215 $472 $406 $710
$182,001 and above  $288 $631 $544 $949

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Premiums for part-time employees

HMO Illinois monthly premiums by annual salary and family members insured.
Annual Salary You You + Spouse You + Child(ren) You + Spouse + Child(ren)
Up to $42,000 $245 $536 $462 $806
$42,001-$75,000 $265 $581 $501 $873
$75,001-$128,000 $291 $638 $550 $873
$128,001-$182,000 $322 $706 $608 $1,062
$182,001 and above  $371 $812 $700 $1,222
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Premiums are deducted from your paycheck on a pre-tax basis.  Employees who are paid bi-weekly will have half of the monthly deduction taken from the first two checks of each month.

Premiums for full-time employees

HMO Illinois monthly premiums for full-time employees by annual salary and members of family insured.
Annual Salary You You + Spouse You + Child(ren) You + Spouse + Child(ren)
Up to $42,000 $103 $226 $195 $341
$42,001-$75,000 $135 $296 $255 $446
$75,001-$128,000 $176 $386 $335 $580
$128,001-$182,000 $224 $490 $422 $737
$182,001 and above  $299 $655 $564 $985

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Premiums for part-time employees

HMO Illinois monthly premiums by annual salary and family members insured.
Annual Salary You You + Spouse You + Child(ren) You + Spouse + Child(ren)
Up to $42,000 $254 $556 $479 $837
$42,001-$75,000 $275 $603 $519 $907
$75,001-$128,000 $303 $663 $571 $997
$128,001-$182,000 $335 $733 $631 $1,102
$182,001 and above  $385 $843 $726 $1,268
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