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Local Government Health Plan

2024-2025 Plan Highlights

Copayment, coinsurance and deductible payments for the services listed below apply to the out-of-pocket maximum for the plan year (effective July 1, 2024 - June 30, 2025).

Enroll Online 2023-2024 Plan Details

Description of Coverage

Summary of Benefits and Coverage

HMO Policy

State of Illinois Employee Open Enrollment Guide

Formulary

Member Handbook

Plan Year Deductible You pay $0
Deductible for Prescriptions You pay $175
Individual Out-of-Pocket Max You pay $3,000
Family Out-of-Pocket Max You pay $6,000

Benefits Overview

$ = Copay     % = Coinsurance


Medical Benefits

Physician Visit

A visit with your primary care provider or another provider in your doctor’s office.

You pay $40

Specialist

A visit with an in-network provider who specializes in a specific area of healthcare.

You pay $45

Virtual Visits

An on-demand visit with a provider by phone or video.

You pay $10

Wellness and Preventive Services

Immunizations, adult and child annual physical exam, mammograms, PAP smears, cancer screenings and more. Age/frequency schedules apply.

You pay $0

Emergency Room

Care from an emergency department.

You pay $300

Ambulance Transport

You pay $0

Urgent Care

You pay $40

Diagnostic Testing - X-Rays, Lab Services

Preauthorization is required for imaging.

You pay $0

Outpatient Surgery

Preauthorization may be required for certain procedures.

You pay $300

Hospitalization

Preauthorization is required.

You pay $350

Home Health Care

Preauthorization is required.

You pay $45

Rehabilitation Services

Preauthorization is required, up to 60 visits per condition per plan year.

You pay $40

Skilled Nursing Care

Preauthorization is required.

You pay $0

Durable Medical Equipment

Preauthorization may be required for certain medical equipment.

You pay 30%

Hospice Services

You pay $0
View All

Prescriptions

Reduced Generic Tier 1

30-day supply
90-day supply

You pay $4
$10

Generic Tier 1

30-day supply
90-day supply

You pay $15
$37.50

Preferred Brand

30-day supply
90-day supply

You pay $30
$75

Non-Preferred Brand

30-day supply
90-day supply

You pay $60
$150

Specialty Tier 4

30-day supply
90-day supply

You pay $120
N/A

*Specialty medication is limited to a 30-day supply. This 90-day copay amount applies only to non-specialty medication.


Maternity

Prenatal Care

Care during pregnancy.

Per pregnancy $50

Maternity Inpatient

Care received in the hospital for the birth of a baby.

You pay $350

Mental Health

Outpatient

Mental health, behavioral health or substance abuse services.

You pay $40

Inpatient (Prior authorizaion is required.)

Mental health, behavioral health or substance abuse services.

You pay $350

Care Coordination

Get help reaching your health goals (like stress management, weight management or preparing for a marathon) and taking control of long-term conditions (like diabetes, high blood pressure or high-risk pregnancy).

Your care coordinator or health coach is there to support you every step of the way, calling you regularly and acting as your go-to person for support with your goals.

Learn More

Finding Care

With a statewide network of trusted doctors to choose from, you get access to reliable care with lots of options.

  • Find doctors and hospitals in network.
  • Get 24/7 answers to your health questions with the Nurse Advice Line.
  • Schedule a virtual visit from home.

Find Care Now

Perks and Programs

Your plan is made with plenty of perks to help you with your health goals. Get access to a fitness benefit, wellness perks and other programs made with you in mind.

Learn More

Ready to get started?

Call us at (800) 851-3379 (TTY 711), daily from 8 a.m. to 5 p.m. local time. Voicemail is used on holidays and weekends, April 1 to September 30.