HMO Scope of Benefits

HMO Illinois^®, Blue Advantage HMO^SM, BlueCare Direct^SM and Blue Precision HMO^SM

This page is intended to provide a quick reference of covered and non-covered services. It includes frequently asked benefit issues and issues that have been misinterpreted in the past. However, it is not possible to include everything. Additional information regarding benefits and/or financial responsibility can be found in the Medical Service Agreement. The IPA may contact the Customer Assistance Unit Staff at 312-653-6600 for more help with benefits interpretation. Read Introduction

Guideline for Benefit Interpretation	Reviewed
Abortion	8/2024
Acupuncture	5/2024
Allergy Testing/Desensitization	5/1/2023
Ambulance Services	5/2024
Ambulatory Blood Pressure Monitoring	8/2024
Amniocentesis	8/2024
Apnea Monitors	5/2024
Assistant Surgeon	8/2024
Autism Spectrum Disorder (ASD)	5/2024
Automatic External Defibrillator	5/2024
Automatic Implantable Cardioverter Defibrillator (AICD)	5/2024
Autopsy Examination	5/1/2023
BRCA (Breast Cancer Susceptibility) Testing and Related Genetic Counseling	5/1/2023
Biofeedback Therapy	5/2024
Blood and Blood Derivatives	5/2024
Boarder Babies	5/1/2023
Bone Marrow Transplantation	5/1/2023
Botulinum Toxin	5/1/2023
Breast Screening	5/1/2023
Breast Surgery	5/1/2023
Cardiac Rehabilitation	5/1/2023
CAR-T Therapy	1/2025
Chemical Dependency/Substance Use Disorder (SUD) Services	5/1/2023
Chemotherapy	5/1/2023
Chiropractic Services	5/1/2023
Cochlear Implantation	5/1/2023
Cognitive Therapy	5/1/2023
Collagen Implant	5/1/2023
Computerized Knee Evaluation	5/1/2023
Contact Lenses/Eyeglasses	5/1/2023
Cosmetic/Reconstructive Surgery	5/1/2023
Custodial Care	5/1/2023
Day Rehabilitation Program	5/1/2023
Dental	3/2024
Diabetes Self-Management	5/1/2023
Drugs	8/2024
Durable Medical Equipment (DME)	5/1/2023
Earplugs	5/1/2023
Electrical Bone Growth Stimulation	5/1/2023
Emergency Communication Devices	5/1/2023
Emergency Services	6/1/2023
Epidural Anesthesia	5/1/2023
Erythropoietin (EPO)	5/1/2023
Family Planning	7/1/2023
Fertility Preservation	1/2024
Growth Factors for Wound Healing	5/1/2023
Growth Hormone Therapy	5/1/2023
Health Examinations	5/1/2023
Hearing Aids	1/2025
Hearing Screening	5/1/2023
Hematopoietic Growth Factors (HGF)	5/1/2023
Hemodialysis and Peritoneal Dialysis	5/1/2023
Hepatitis B Vaccine	5/1/2023
Home Health Care Services	5/1/2023
Home Uterine Activity Monitoring (HUAM)	5/1/2023
Hospice Care	5/1/2023
Hospital Beds	5/1/2023
Hyperalimentation (TPN)	5/1/2023
Hyaluronan (Durolane, Orthovisc, Monovisc, Euflexxa, Supartz, Hymovis, Gel-ONE, GelSyn-3, GenVisc 850, Hyalgan, Visco-3, Synvisc/Synvisc-One and TriVisc)+	5/1/2023
Hyperthermia Therapy	5/1/2023
Hypnotherapy (Hypnosis)	5/1/2023
Immunizations	1/2025
Infertility and Fertility Treatment	3/2023
Infusion Pumps (Implanted-Permanent)	5/1/2023
Infusion Pumps (Portable - Temporary)	5/1/2023
Intravenous Immunoglobulin (IVIG)	5/1/2023
Investigational Procedures, Drugs, Devices, Services, and/or Supplies	5/1/2023
Laboratory Tests	4/2023
Lithotripsy (Percutaneous and Extracorporeal)	5/1/2023
Lupron/Lupron Depot	5/1/2023
Mammography	5/1/2023
Maternity/Obstetrical Care	5/1/2023
Medical Supplies (Non-Durable Medical Equipment)	5/1/2023
Mental Health Care (Inpatient)	7/1/2023
Mental Health Care (Outpatient)	7/1/2023
Monoclonal Antibody Imaging	5/1/2023
Naprapathic Services	5/1/2023
Nerve Stimulators (Percutaneous, Transcutaneous, Implanted)	5/1/2023
Neuromuscular Stimulation for Scoliosis	5/1/2023
Nutritional Services (Dietary Counseling)	5/1/2023
Nutritional Supplements/Enteral Nutrition	5/1/2023
Obesity	5/1/2023
Obstructive Sleep Apnea (OSA) Syndrome	12/2024
Occupational Therapy	5/1/2023
Oral Surgery	6/1/2023
Organ and Tissue Transplantation	4/7/2025
Orthodontics	5/1/2023
Orthognathic Surgery	5/1/2023
Orthotic Devices	6/1/2023
Outpatient Surgery	4/2023
Oxygen	5/1/2023
Pain Management Programs	5/1/2023
Physical Therapy	5/1/2023
Podiatry/Podiatric Services	5/1/2023
Pre-implantation Genetic Diagnosis (PGD) – Infertility Related	5/1/2023
Pre-implantation Genetic Diagnosis (PGD) – Non-infertility Related	5/1/2023
Private Duty Nursing	11/2023
Prostate Procedures	5/1/2023
Prosthetic Devices	5/1/2023
Pulmonary Rehabilitation	5/1/2023
Refractive Keratoplasty	5/1/2023
Respiratory Therapy (Inhalation Therapy)	5/1/2023
Seat Lift	5/1/2023
Second Opinions	5/1/2023
Sensory Evoked Potentials (SEP)	5/1/2023
Skilled Nursing Facility (SNF)	5/1/2023
Speech Therapy	5/1/2023
Sterilizations	5/1/2023
Synagis^®	5/1/2023
Temporomandibular Joint Disorder	5/1/2023
Tobacco Cessation	5/1/2023
Transgender Services	1/2024
Ultraviolet Light Treatment for Psoriasis	5/1/2023
Vision Screening/Routine Vision Care	5/1/2023
Well Child Care	5/1/2023
Wheelchairs	5/1/2023