Health Alliance MAPD for State of Illinois Retirees
We have a rich history of supporting State of Illinois retirees. We are proud to offer our Health Alliance MAPD HMO plan to State, CIP, and TRIP retirees for the 2017 plan year. See our coverage map.
Are you a current State of Illinois employee? Check out your plans
Health Alliance MAPD HMO Plan Details
Medical Benefits
| State | CIP/TRIP | |
|---|---|---|
| Yearly Out-of-Pocket Max | $3,000 | $3,000 |
| Deductible | $0 | $0 |
| PCP | $20 | $20 |
| Specialist | $30 | $20 |
| Emergency Room (Worldwide Coverage) |
$75 | $75 |
| Urgent Care (Worldwide Coverage) |
$30 | $20 |
| Inpatient Hospital | $350 | $250 |
| Outpatient Surgery | $250 | $150 |
| Ambulance | $0 | $0 |
| Laboratory Services | $0 | $0 |
| Diagnostic Radiology | $0 | $0 |
| Preventive Services including Wellness Visit, Pap Smear, Cervical Cancer Screening, and Colorectal Screening* |
$0 | $0 |
*See the Benefit Highlights below for a full list of covered preventive services.
Pharmacy Benefits
| State | CIP/TRIP | |
|---|---|---|
| Deductible | $100 | $0 |
| Do I Have Coverage Through the Gap? | Yes | Yes |
| Initial and Coverage Gap Period | ||
| Tier 1 and Tier 2: Generic, 30-day Supply |
$0 at Walgreens $8 at all other contracted pharmacies |
$0 at Walgreens $10 at all other contracted pharmacies |
| Tier 3: Preferred Brand |
$26 | $20 |
| Tier 4: Non-Preferred Drug |
$50 | $40 |
| Tier 5: Speciality Tier |
$50 | $40 |
| Retail 90 Benefit | Get 90-day supply for 2 X 30-day copayment at Walgreens 2.5 X 30-day copayment at all other contracted pharmacies |
Get 90-day supply for 2 X 30-day copayment at Walgreens 2.5 X 30-day copayment at all other contracted pharmacies |
| Mail-Order | Get 90-day supply for 2.5 copayments through mail order | Get 90-day supply for 2 copayments through mail order |
| Catastrophic Coverage | ||
| Generics | $3.30 or 5% (whichever is higher; amount capped at $50 for a 30-day supply) |
$3.30 or 5% (whichever is higher; amount capped at $40 for a 30-day supply) |
| All other drugs | $8.25 or 5% (whichever is higher; amount capped at $50 for a 30-day supply) |
$8.25 or 5% (whichever is higher; amount capped at $40 for a 30-day supply) |
NOTE: Annual plan deductible must be met before plan benefits apply.
Plan Extras
Using Your Coverage
- Use your ID card whenever you see a doctor or pick up prescriptions from the pharmacy to help you and you providers access your coverage easier.
- Your Health Alliance gives you instant access to your coverage anytime, anywhere.
- Provider Search
- Provider Directory
- See the Benefit Highlights for deductibles, copayments, and coinsurance info for various service.
- College Insurance Program (CIP)
- State of Illinois (State)
- Teacher Retirement Insurance Program (TRIP)
- The Evidence of Coverage (EOC) is your main guiding document, like a policy, for how your health care is covered on this plan:
- The Annual Notice of Change (ANOC) describes the differences from last year's plan:
- Illinois HMO Star Ratings Flier
Pharmacies and Covered Drugs
Directory
Comprehensive Formularies
A complete list of all drugs covered by our plan:
Some covered drugs have rules or limits to when they're covered. See our Pharmacy Coverage Requirements for details.
High Risk Medications
Find high-risk medications for elderly people and alternative treatment options on this list:
Contact Us
The State of Illinois is now using MyBenefits Marketplace as an online enrollment tool. It's designed specifically to streamline your benefit options into a one-stop shop for your insurance needs, which includes learning more about your current benefits, making enrollment decisions, changing your current coverage, and finding contact information for all your plan administrators.
You can also call the MyBenefits Marketplace at 1-844-251-1777 (TTY 1-844-251-1778), Monday through Friday, 8 a.m. to 6 p.m. CST.
Already a Member
1-877-795-6131 (TTY 711)
Daily 8 a.m. to 8 p.m. local time
Voicemail used on holidays and weekends, February 15 to September 30
Anytime Nurse Line
1-855-802-4612
Mailing Address
Health Alliance
301 S. Vine St.
Urbana, IL 61801
File an Appeal or Grievance
Learn how on our Appeals and Grievances page
Visit Us
Health Alliance Medicare
206 W. Anthony Dr.
Champaign, IL 61822