HMO Illinois is an HMO operated by Blue Cross Blue Shield of Illinois. As an Independent Practice Association (IPA), HMO Illinois contracts with doctors, clinics and hospitals throughout the Chicago area. You can can compare HMO Illinois benefits to the other medical plans to determine if it will meet your medical needs.
When you enroll in an HMO, you must choose a Primary Care Physician (PCP). As long as your care is coordinated by your Primary Care Physician, HMO Illinois generally covers 100% of the cost for approved care after you pay your required copayment. When you need care, you must call or visit your PCP first. Each member of your family may have his or her own PCP.
Your PCP’s responsibilities include:
- Giving you regular checkups.
- Providing treatment when you are ill.
- Ordering necessary X-rays, lab work and other tests.
- Referring you to a specialist, if medically necessary..
- Arranging for outpatient treatment or hospitalization.
- Filing your claims.
In most cases, you must use doctors and hospitals in the HMO Illinois network to receive benefits. If you go to a doctor or hospital outside the HMO Illinois network for care without prior approval, you will not receive any benefits from the plan, except for emergencies.
Prescriptions DrugsParticipating Retail Pharmacy - Per prescription for up to 30-day supply
- Generic - 100% after $10 Copayment
- Preferred brand-name - 100% after $30 Copayment
- Non-preferred brand-name - 100% after $45 Copayment
- Specialty - 100% after $75 Copayment
- Generic - 100% after $20 Copayment
- Preferred brand-name - 100% after $60 Copyamnet
- Non-preferred brand-name - 100% after $90 Copayment