HMO Scope of Benefits

HMO Illinois^®, Blue Advantage HMO^SM, Blue Precision HMO^SM, BlueCare Direct^SMand Blue FocusCare^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	5/1/2022
Acupuncture	5/1/2022
Allergy Testing/Desensitization	5/1/2022
Ambulance Services	5/1/2022
Ambulatory Blood Pressure Monitoring	5/1/2022
Amniocentesis	5/1/2022
Apnea Monitors	5/1/2022
Assistant Surgeon	5/1/2022
Autism Spectrum Disorder (ASD)	5/1/2022
Automatic External Defibrillator	5/1/2022
Automatic Implantable Cardioverter Defibrillator (AICD)	5/1/2022
Autopsy Examination	5/1/2022
BRCA (Breast Cancer Susceptibility) Testing and Related Genetic Counseling	5/1/2022
Biofeedback Therapy	5/1/2022
Blood and Blood Derivatives	5/1/2022
Boarder Babies	5/1/2022
Bone Marrow Transplantation	5/1/2022
Botulinum Toxin	5/1/2022
Breast Screening	5/1/2022
Breast Surgery	5/1/2022
Cardiac Rehabilitation	5/1/2022
CAR-T Therapy	5/1/2022
Chemical Dependency/Substance Use Disorder (SUD) Services	5/1/2022
Chemotherapy	5/1/2022
Chiropractic Services	5/1/2022
Cochlear Implantation	5/1/2022
Cognitive Therapy	5/1/2022
Collagen Implant	5/1/2022
Computerized Knee Evaluation	5/1/2022
Contact Lenses/Eyeglasses	5/1/2022
Cosmetic/Reconstructive Surgery	5/1/2022
Custodial Care	5/1/2022
Day Rehabilitation Program	5/1/2022
Dental	5/1/2022
Diabetes Self-Management	5/1/2022
Drugs	5/1/2022
Durable Medical Equipment (DME)	5/1/2022
Earplugs	5/1/2022
Electrical Bone Growth Stimulation	5/1/2022
Emergency Communication Devices	5/1/2022
Emergency Services	5/1/2022
Epidural Anesthesia	5/1/2022
Erythropoietin (EPO)	5/1/2022
Family Planning	5/1/2022
Growth Factors for Wound Healing	5/1/2022
Growth Hormone Therapy	5/1/2022
Health Examinations	5/1/2022
Hearing Aids	5/1/2022
Hearing Screening	5/1/2022
Hematopoietic Growth Factors (HGF)	5/1/2022
Hemodialysis and Peritoneal Dialysis	5/1/2022
Hepatitis B Vaccine	5/1/2022
Home Health Care Services	5/1/2022
Home Uterine Activity Monitoring (HUAM)	5/1/2022
Hospice Care	5/1/2022
Hospital Beds	5/1/2022
Hyperalimentation (TPN)	5/1/2022
Hyaluronan (Durolane, Orthovisc, Monovisc, Euflexxa, Supartz, Hymovis, Gel-ONE, GelSyn-3, GenVisc 850, Hyalgan, Visco-3, Synvisc/Synvisc-One and TriVisc)+	5/1/2022
Hyperthermia Therapy	5/1/2022
Hypnotherapy (Hypnosis)	5/1/2022
Immunizations	5/1/2022
Infertility and Fertility Treatment	8/2022
Infusion Pumps (Implanted-Permanent)	5/1/2022
Infusion Pumps (Portable - Temporary)	5/1/2022
Intravenous Immunoglobulin (IVIG)	5/1/2022
Investigational Procedures, Drugs, Devices, Services, and/or Supplies	5/1/2022
Laboratory Tests	5/1/2022
Lithotripsy (Percutaneous and Extracorporeal)	5/1/2022
Lupron/Lupron Depot	5/1/2022
Mammography	5/1/2022
Maternity/Obstetrical Care	5/1/2022
Medical Supplies (Non-Durable Medical Equipment)	5/1/2022
Mental Health Care (Inpatient)	5/1/2022
Mental Health Care (Outpatient)	5/1/2022
Monoclonal Antibody Imaging	5/1/2022
Naprapathic Services	5/1/2022
Nerve Stimulators (Percutaneous, Transcutaneous, Implanted)	5/1/2022
Neuromuscular Stimulation for Scoliosis	5/1/2022
Nutritional Services (Dietary Counseling)	5/1/2022
Nutritional Supplements/Enteral Nutrition	5/1/2022
Obesity	5/1/2022
Obstructive Sleep Apnea (OSA) Syndrome	5/1/2022
Occupational Therapy	5/1/2022
Oral Surgery	5/1/2022
Organ and Tissue Transplantation	12/2022
Orthodontics	5/1/2022
Orthognathic Surgery	5/1/2022
Orthotic Devices	5/1/2022
Outpatient Surgery	5/1/2022
Oxygen	5/1/2022
Pain Management Programs	5/1/2022
Physical Therapy	5/1/2022
Podiatry/Podiatric Services	5/1/2022
Pre-implantation Genetic Diagnosis (PGD) – Infertility Related	5/1/2022
Pre-implantation Genetic Diagnosis (PGD) – Non-infertility Related	5/1/2022
Private Duty Nursing	5/1/2022
Prostate Procedures	5/1/2022
Prosthetic Devices	5/1/2022
Pulmonary Rehabilitation	5/1/2022
Refractive Keratoplasty	5/1/2022
Respiratory Therapy (Inhalation Therapy)	5/1/2022
Seat Lift	5/1/2022
Second Opinions	5/1/2022
Sensory Evoked Potentials (SEP)	5/1/2022
Skilled Nursing Facility (SNF)	5/1/2022
Speech Therapy	5/1/2022
Sterilizations	5/1/2022
Synagis^®	5/1/2022
Temporomandibular Joint Disorder	5/1/2022
Tobacco Cessation	5/1/2022
Transgender Services	5/1/2022
Ultraviolet Light Treatment for Psoriasis	5/1/2022
Vision Screening/Routine Vision Care	5/1/2022
Well Child Care	5/1/2022
Wheelchairs	5/1/2022