HMO Illinois
This HMO's network includes, but is not limited to, St. Francis, NorthShore University Health System and Advocate-Lutheran General.
- 2019 Plan Benefits and Discounts
- 2020 Plan Benefits and Discounts
- 2019 Monthly Premiums
- 2020 Monthly Premiums
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
- 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.
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
- 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.
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
| 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
| 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 |
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
| 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
| 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 |