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Illinois HMO Removing Limits on Rehabilitative/Habilitative Therapy

Nov. 12, 2025

Applies to fully insured small group and mid-market, including Grandfathered and Transitional; fully insured large group and large group custom, including Grandfathered and Transitional; HMO and POS

What you need to know:
We are removing visit limits on rehabilitative and habilitative services when medically necessary for impacted Illinois plans, per Illinois Department of Insurance guidance.

What’s changing?
Currently, Blue Cross and Blue Shield of Illinois plans have a combined 60 visit limit on rehabilitative and habilitative services per plan year. This means that a member can have a total of 60 visits between both therapy types.

  • The IDOI has clarified that insurers must cover a minimum of 60 visits for rehabilitative services.
  • BCBSIL is not able to separate visit limits for rehabilitative and habilitative therapy types. To meet IDOI requirements, we are removing the visit limits. Medical necessity, rather than a specific limit, will determine the number of visits.

When is this change effective?

  • Jan. 1, 2026

Are ASO HMO groups impacted?
Yes. In order to implement this change, we’re using coding that systematically applies across multiple accounts, including ASO HMO plans.

  • ASO HMO accounts that do not want to cover unlimited rehabilitative/habilitative therapy visits should inform their BCBSIL account representative to document their request.