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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.

Price a medication

Use ExpressScripts online pricing tool to price current or future medications.  Shopping around may save you money.

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 $106 $233 $201 $350
$42,001-$75,000 $139 $304 $262 $457
$75,001-$128,000 $181 $395 $341 $595
$128,001-$182,000 $230 $503 $433 $757
$182,001 and above  $307 $673 $580 $1,013

For new hires, the salary tier is determined based on your initial, regular salary. The salary tier for current employees is determined by your salary on September 1st of the year proceeding the plan year (e.g. Premiums starting 1/1/2020 are based on your 9/1/2019 salary). Mid-year changes to salary will not change your assigned salary tier, unless you transition from full-time to part-time or part-time to full-time.  When your 9/1 salary crosses a salary tier due to a salary increase not associated with a change in full-time/part-time status, you will pay the lower premium for the following year.

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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 $274 $600 $518 $903
$42,001-$75,000 $296 $648 $559 $975
$75,001-$128,000 $324 $709 $611 $1,067
$128,001-$182,000 $357 $781 $673 $1,176
$182,001 and above  $409 $895 $772 $1,347

For new hires, the salary tier is determined based on your initial, regular salary. The salary tier for current employees is determined by your salary on September 1st of the year proceeding the plan year (e.g. Premiums starting 1/1/2020 are based on your 9/1/2019 salary). Mid-year changes to salary will not change your assigned salary tier, unless you transition from full-time to part-time or part-time to full-time.  When your 9/1 salary crosses a salary tier due to a salary increase not associated with a change in full-time/part-time status, you will pay the lower premium for the following year.

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