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State of Illinois

For more than 30 years, many of those who receive health care benefits through the Department of Central Management Services and the Department of Healthcare and Family Services have put their trust in Health Alliance.

We're in this. Together. State of Illinois members can trust Health Alliance to provide the health care coverage you need, when you need it. You can also trust that decisions about your health care stay where they belong—between you and your doctor. When you choose your Primary Care Physician from our large network of participating providers, you are selecting a personal health care partner to oversee all your health care needs.

We contract with the finest physicians, hospitals and pharmacies in the state to assure you access to a large network of quality providers. Contracting with these providers allows us to offer you a comprehensive benefit package, which includes coverage for hospitalization, physician care and emergency care.

If you are currently a Health Alliance member, log in to continue.

As of March 31, 2015, HealthLink will end its partnership with Health Alliance. We will expand our Illinois direct network to include many of their providers by July 1, 2015. Read more.

Plans and Benefits for Participants

State of Illinois Participants

Plan Year 2014 Highlights (effective July 1, 2014, to June 30, 2015)

State Summary of Benefits and Coverage (SBC)| Plan Documents

Outpatient CareCopayment or Coinsurance (Your Cost)
Physician Office Visits
Copayments apply to office visits with physicians, physician assistants, nurses and other mid-level providers. Other services obtained while in the office may require an additional copayment or coinsurance.
$20 per visit
Specialist Office Visits
Other services obtained while in the office may require an additional copayment or coinsurance.
$30 per visit
Be Healthy Preventive Services
Immunizations, adult and child annual physical exam, mammograms, PAP smears, cancer screenings and more. Age/frequency schedules apply.
$0 copayment
Routine Prenatal Care $50 per pregnancy
Outpatient Surgery/Procedure $250 per visit
Diagnostic Testing
X-rays, lab services
$0 each
Mental Health Care - Outpatient Office Visit
$20 per visit
Substance Use Disorder Treatment - Outpatient Office Visit $20 per visit
Home Health Care
When prescribed by a Health Alliance physician and authorized by the Health Alliance Medical Management Department.
$30 per visit
Rehabilitation Services
Up to 60 visits combined per condition per plan year—includes short-term occupational, speech and physical therapy services.
$30 per visit
Emergency CareCopayment or Coinsurance (Your Cost)
Emergency Room Lower of 50% or $250 per visit
Physician Care $0 per visit
Ambulance
When medically necessary
$0 per trip
Inpatient CareCopayment or Coinsurance (Your Cost)
Hospitalization
Includes semi-private room, physician care, nursing care, operating room, anesthesia, lab services, X-rays, medical supplies and other medically necessary services.
$350 per admission
Maternity Care $350 per admission
Mental Health Care
$350 per admission
Substance Use Disorder Treatment
$350 per admission
Extended Care/Rehabilitation Services
Up to 120 days combined per plan year—Extended Care refers to skilled nursing care received in an approved nursing facility. Rehabilitation Services include inpatient occupational, speech and physical therapy services.
$0 per stay
OtherCopayment or Coinsurance (Your Cost)
Deductible
Per enrollee

Prescription Drugs (Including Specialty Drugs)†* 30-day supply retail copayment; 90-supply available at 2.5 times the one-month copayment for both retail and mail order.

$100    

$8 Tier 1
$26 Tier 2
$50 Tier 3

Durable Medical Equipment 20% coinsurance 
Prosthetic Devices 20% coinsurance
Hearing Aids
every three years
All costs covered except:
$150 per exam
$600 maximum benefit for hearing aids
† Copayment, coinsurance and deductible payments for these services do not apply to the plan year out-of-pocket maximum.
* The Health Alliance Drug Formulary helps Health Alliance HMO members and their doctors choose drugs that give great results at low prices. Doctors and pharmacists meet monthly to keep the Drug Formulary up to date. Members who choose a brand-name drug after the release of a generic drug may pay the Tier 1 copayment plus the difference in cost between the brand-name and generic drugs. In some cases, your doctor may decide a Tier 3 drug is best. If he or she asks Health Alliance to review the drug and we approve, you will pay only the Tier 2 copayment.
Contract Year Out-of-Pocket Maximum
Your Maximum Cost $3,000 per individual,
$6,000 per family
TRIP Participants

Plan Year 2015 Highlights (effective July 1, 2014, to June 30, 2015)

TRIP Summary of Benefits and Coverage (SBC) | Plan Documents

Outpatient CareCopayment or Coinsurance (Your Cost)
Physician Office Visits
Copayments apply to office visits with physicians, physician assistants, nurses and other mid-level providers. Other services obtained while in the office may require an additional copayment or coinsurance.
$20 per visit
Specialist Office Visits
Other services obtained while in the office may require an additional copayment or coinsurance.
$20 per visit
Be Healthy Preventive Services
Immunizations, adult and child annual physical exam, mammograms, PAP smears, cancer screenings and more. Age/frequency schedules apply.
 $0 copayment
Routine Prenatal Care $50 per pregnancy
Outpatient Surgery/Procedure $150 per visit
Diagnostic Testing
X-rays, lab services
$0 each
Mental Health Care - Outpatient Office Visit
$20 per visit
Substance Use Disorder Treatment - Outpatient Office Visit $20 per visit
Home Health Care
When prescribed by a Health Alliance physician and authorized by the Health Alliance Medical Management Department.
$15 per visit
Rehabilitation Services
Up to 60 visits combined per condition per plan year—includes short-term occupational, speech and physical therapy services.
$20 per visit
Emergency CareCopayment or Coinsurance (Your Cost)
Emergency Room lower of 50% or $200 per visit
Physician Care $0 per visit
Ambulance
When medically necessary
$0 per trip
Inpatient CareCopayment or Coinsurance  (Your Cost)
Hospitalization
Includes semi-private room, physician care, nursing care, operating room, anesthesia, lab services, X-rays, medical supplies and other medically necessary services.
$250 per admission
Maternity Care $250 per admission
Mental Health Care
$250 per admission
Substance Use Disorder Treatment
$250 per admission
Extended Care/Rehabilitation Services
Up to 120 days combined per plan year—Extended Care refers to skilled nursing care received in an approved nursing facility. Rehabilitation Services include inpatient occupational, speech and physical therapy services.
$0 per stay
OtherCopayment or  Coinsurance (Your Cost)
Prescription Drugs (Including Specialty)†* 30-day supply retail copayment; 90-supply available at 2.5 times the one-month copayment for both retail and mail order. $10 Tier 1
$20 Tier 2
$40 Tier 3
Durable Medical Equipment 20% coinsurance
Prosthetic Devices 20% coinsurance
† Copayment and coinsurance payments for these services do not apply to the plan year out-of-pocket maximum.
* The Health Alliance Drug Formulary helps Health Alliance HMO members and their doctors choose drugs that give great results at low prices. Doctors and pharmacists meet monthly to keep the Drug Formulary up to date. Members who choose a brand-name drug after the release of a generic drug may pay the Tier 1 copayment plus the difference in cost between the brand-name and generic drugs. In some cases, your doctor may decide a Tier 3 drug is best. If he or she asks Health Alliance to review the drug and we approve, you will pay only the Tier 2 copayment.
Contract Year Out-of-Pocket Maximum
Your Maximum Cost $3,000 per individual,
$6,000 per family
CIP

Plan Year 2015 Highlights (effective July 1, 2014, to June 30, 2015)

CIP Summary of Benefits and Coverage (SBC) | Plan Documents

Outpatient CareCopayment or Coinsurance  (Your Cost)
Physician Office Visits
Copayments apply to office visits with physicians, physician assistants, nurses and other mid-level providers. Other services obtained while in the office may require an additional copayment or coinsurance.
$30 per visit
Specialist Office Visits
Other services obtained while in the office may require an additional copayment or coinsurance.
$30 per visit
Routine Prenatal Care $50 per pregnancy
Be Healthy Preventive Services
Immunizations, adult and child annual physical exam, mammograms, PAP smears, cancer screenings and more. Age/frequency schedules apply.
 $0 copayment
Outpatient Surgery/Procedure $200 per visit
Diagnostic Testing
X-rays, lab services
$0 each
Mental Health Care - Outpatient Office Visit
$30 per visit
Substance Use Disorder Treatment - Outpatient Office Visit $30 per visit
Home Health Care
When prescribed by a Health Alliance physician and authorized by the Health Alliance Medical Management Department.
$30 per visit
Rehabilitation Services
Up to 60 visits combined per condition per plan year—includes short-term occupational, speech and physical therapy services.
$30 per visit
Emergency CareCopayment or Coinsurance (Your Cost)
Emergency Room lower of 50% or $200 per visit
Physician Care $0 per visit
Ambulance
When medically necessary
$0 per trip
Inpatient CareCopayment or Coinsurance (Your Cost)
Hospitalization
Includes semi-private room, physician care, nursing care, operating room, anesthesia, lab services, X-rays, medical supplies and other medically necessary services.
$250 per admission
Maternity Care $250 per admission
Mental Health Care $250 per admission
Substance Use Disorder Treatment
$250 per admission
Extended Care/Rehabilitation Services
Up to 120 days combined per plan year—Extended Care refers to skilled nursing care received in an approved nursing facility. Rehabilitation Services include inpatient occupational, speech and physical therapy services.
$0 per stay
OtherCopayment or Coinsurance (Your Cost)
Prescription Drugs (Including Specialty Drugs)†*
30-day supply retail copayment; 90-supply available at 2.5 times the one-month copayment for both retail and mail order.

$12 Tier 1
$24 Tier 2
$48 Tier 3
$96 Specialty

Durable Medical Equipment 20% coinsurance
Prosthetic Devices 20% coinsurance
† Copayment, coinsurance and deductible payments for these services do not apply to the plan year out-of-pocket maximum.
* The Health Alliance Drug Formulary helps Health Alliance HMO members and their doctors choose drugs that give great results at low prices. Doctors and pharmacists meet monthly to keep the Drug Formulary up to date. Members who choose a brand-name drug after the release of a generic drug may pay the Tier 1 copayment plus the difference in cost between the brand-name and generic drugs. In some cases, your doctor may decide a Tier 3 drug is best. If he or she asks Health Alliance to review the drug and we approve, you will pay only the Tier 2 copayment.
Contract Year Out-of-Pocket Maximum
Your Maximum Cost $3,000 per individual,
$6,000 per family
LGHP

Plan Year 2014 Highlights (effective July 1, 2014, to June 30, 2015)

LGHP Summary of Benefits and Coverage (SBC) | Plan Documents

Outpatient CareCopayment or Coinsurance  (Your Cost)
Physician Office Visits
Copayments apply to office visits with physicians, physician assistants, nurses and other mid-level providers. Other services obtained while in the office may require an additional copayment or coinsurance.
$30 per visit
Specialist Office Visits
Other services obtained while in the office may require an additional copayment or coinsurance.
$30 per visit
Be Healthy Preventive Services
Immunizations, adult and child annual physical exam, mammograms, PAP smears, cancer screenings and more. Age/frequency schedules apply.
 $0 copayment
Routine Prenatal Care $50 per pregnancy
Outpatient Surgery/Procedure $200 per visit
Diagnostic Testing
X-rays, lab services
$0 each
Mental Health Care - Outpatient Office Visit
$30 per visit
Substance Use Disorder Treatment - Outpatient Office Visit $30 per visit
Home Health Care
When prescribed by a Health Alliance physician and authorized by the Health Alliance Medical Management Department.
$30 per visit
Rehabilitation Services
Up to 60 visits combined per condition per plan year—includes short-term occupational, speech and physical therapy services.
$30 per visit
Emergency CareCopayment or Coinsurance (Your Cost)
Emergency Room lower of 50% or $200 per visit
Physician Care $0 per visit
Ambulance
When medically necessary
$0 per trip
Inpatient CareCopayment or Coinsurance (Your Cost)
Hospitalization
Includes semi-private room, physician care, nursing care, operating room, anesthesia, lab services, X-rays, medical supplies and other medically necessary services.
$250 per admission
Maternity Care $250 per admission
Mental Health Care $250 per admission
Substance Use Disorder Treatment
$250 per admission
Extended Care/Rehabilitation Services
Up to 120 days combined per plan year—Extended Care refers to skilled nursing care received in an approved nursing facility. Rehabilitation Services include inpatient occupational, speech and physical therapy services.
$0 per stay
OtherCopayment or Coinsurance (Your Cost)
Prescription Drugs (Including Specialty Drugs)†*
30-day supply retail copayment; 90-supply available at 2.5 times the one-month copayment for both retail and mail order.

$12 Tier 1
$24 Tier 2
$48 Tier 3
$96 Specialty

Durable Medical Equipment 20% coinsurance
Prosthetic Devices 20% coinsurance
† Copayment, coinsurance and deductible payments for these services do not apply to the plan year out-of-pocket maximum.
* The Health Alliance Drug Formulary helps Health Alliance HMO members and their doctors choose drugs that give great results at low prices. Doctors and pharmacists meet monthly to keep the Drug Formulary up to date. Members who choose a brand-name drug after the release of a generic drug may pay the Tier 1 copayment plus the difference in cost between the brand-name and generic drugs. In some cases, your doctor may decide a Tier 3 drug is best. If he or she asks Health Alliance to review the drug and we approve, you will pay only the Tier 2 copayment. 
Contract Year Out-of-Pocket Maximum
Your Maximum Cost $3,000 per individual,
$6,000 per family

Rally—Better Begins Now

You are now leaving the Health Alliance website to begin your journey to better health with Rally. Rally is more than a wellness tool—it's a lifestyle tool that will coach you to your health goals and reward you along the way. It's time for your next adventure—your quest to a healthier you.

The privacy and security policies of Rally may differ from the privacy and security policies of Health Alliance. We hope you enjoy your next big adventure.

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