HMO Scope of Benefits

HMO Illinois®, Blue Advantage HMOSM, BlueCare DirectSM and Blue Precision HMOSM

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

4/1/25

Acupuncture

4/1/25

Allergy Testing/Desensitization

4/1/25

Ambulance Services

4/1/25

Ambulatory Blood Pressure Monitoring

4/1/25

Amniocentesis

4/1/25

Apnea Monitors

4/1/25

Assistant Surgeon

4/1/25

Autism Spectrum Disorder (ASD)

4/1/25

Automatic External Defibrillator

4/1/25

Automatic Implantable Cardioverter Defibrillator (AICD)

4/1/25

Autopsy Examination

4/1/25

BRCA (Breast Cancer Susceptibility) Testing and Related Genetic Counseling

4/1/25

Biofeedback Therapy

4/1/25

Blood and Blood Derivatives

4/1/25

Boarder Babies

 4/1/25

Bone Marrow Transplantation

 4/1/25

Botulinum Toxin

4/1/25

Breast Screening

 4/1/25

Breast Surgery

4/1/25

Cardiac Rehabilitation

4/1/25

CAR-T Therapy

1/1/25

Chemical Dependency/Substance Use Disorder (SUD) Services

 4/1/25

Chemotherapy

 4/1/25

Chiropractic Services

 4/1/25

Cochlear Implantation

4/1/25

Cognitive Therapy

4/1/25

Collagen Implant

 4/1/25

Computerized Knee Evaluation

4/1/25

Contact Lenses/Eyeglasses

 4/1/25

Cosmetic/Reconstructive Surgery

4/1/25

Custodial Care

4/1/25

Day Rehabilitation Program

4/1/25

Dental

 4/1/25

Diabetes Self-Management

4/1/25

Drugs

4/1/25

Durable Medical Equipment (DME)

4/1/25

Earplugs

 4/1/25

Electrical Bone Growth Stimulation

 4/1/25

Emergency Communication Devices

 4/1/25

Emergency Services

4/1/25

Epidural Anesthesia

4/1/25

Erythropoietin (EPO)

4/1/25
Family Planning

4/1/25
Fertility Preservation 4/1/25

Growth Factors for Wound Healing

 4/1/25

Growth Hormone Therapy

4/1/25

Health Examinations

 4/1/25

Hearing Aids

 1/1/25

Hearing Screening

 4/1/25

Hematopoietic Growth Factors (HGF)

4/1/25

Hemodialysis and Peritoneal Dialysis

4/1/25

Hepatitis B Vaccine

4/1/25

Home Health Care Services

4/1/25

Home Uterine Activity Monitoring (HUAM)

4/1/25

Hospice Care

 4/1/25

Hospital Beds

4/1/25

Hyperalimentation (TPN)

4/1/25

Hyaluronan (Durolane, Orthovisc, Monovisc, Euflexxa, Supartz, Hymovis, Gel-ONE, GelSyn-3, GenVisc 850, Hyalgan, Visco-3, Synvisc/Synvisc-One and TriVisc)+

4/1/25

Hyperthermia Therapy

4/1/25

Hypnotherapy (Hypnosis)

 4/1/25

Immunizations

 1/1/25

Infertility and Fertility Treatment

4/1/25

Infusion Pumps (Implanted-Permanent)

 4/1/25

Infusion Pumps (Portable - Temporary)

4/1/25

Intravenous Immunoglobulin (IVIG)

 4/1/25

Investigational Procedures, Drugs, Devices, Services, and/or Supplies

4/1/25

Laboratory Tests

 4/1/25

Lithotripsy (Percutaneous and Extracorporeal)

 4/1/25

Lupron/Lupron Depot

 4/1/25

Mammography

 4/1/25

Maternity/Obstetrical Care

4/1/25

Medical Supplies (Non-Durable Medical Equipment)

 4/1/25

Mental Health Care (Inpatient)

4/1/25

Mental Health Care (Outpatient)

 4/1/25

Monoclonal Antibody Imaging

 4/1/25

Naprapathic Services

4/1/25

Nerve Stimulators (Percutaneous, Transcutaneous, Implanted)

4/1/25

Neuromuscular Stimulation for Scoliosis

4/1/25

Nutritional Services (Dietary Counseling)

4/1/25

Nutritional Supplements/Enteral Nutrition

 4/1/25

Obesity

 4/1/25

Obstructive Sleep Apnea (OSA) Syndrome

 12/1/24

Occupational Therapy

4/1/25

Oral Surgery

 4/1/25

Organ and Tissue Transplantation

4/1/25

Orthodontics

 4/1/25

Orthognathic Surgery

 4/1/25

Orthotic Devices

 4/1/25

Outpatient Surgery

4/1/25

Oxygen

4/1/25

Pain Management Programs

4/1/25

Physical Therapy

4/1/25

Podiatry/Podiatric Services

4/1/25

Pre-implantation Genetic Diagnosis (PGD) – Infertility Related

 4/1/25

Pre-implantation Genetic Diagnosis (PGD) – Non-infertility Related

 4/1/25

Private Duty Nursing

4/1/25

Prostate Procedures

 4/1/25

Prosthetic Devices

4/1/25

Pulmonary Rehabilitation

 4/1/25

Refractive Keratoplasty

 4/1/25

Respiratory Therapy (Inhalation Therapy)

4/1/25

Seat Lift

 4/1/25

Second Opinions

 4/1/25

Sensory Evoked Potentials (SEP)

 4/1/25

Skilled Nursing Facility (SNF)

 4/1/25

Speech Therapy

4/1/25

Sterilizations

4/1/25

Synagis®

4/1/25

Temporomandibular Joint Disorder

4/1/25

Tobacco Cessation

4/1/25

Transgender Services

4/1/25

Ultraviolet Light Treatment for Psoriasis

4/1/25

Vision Screening/Routine Vision Care

4/1/25

Well Child Care

4/1/25

Wheelchairs

4/1/25