QUESTIONS AND ANSWERS About HMO Coverage

What do I gain by becoming an OSF HealthPlans member?

There are many benefits to becoming a Plan member, including:

• No age limit on immunizations
• Low copayments for office visits
• The attention of a personally selected Primary Care Physician
• No annual deductible
• No pre-existing condition limitations
• No lifetime maximum benefit
• No claim forms to file

What is a Health Maintenance Organization (HMO)?

The HMO being offered to you through OSF HealthPlans is an integrated healthcare delivery system. It is specifically designed to provide high-quality care in an efficient manner. The OSF HealthPlans HMO emphasizes preventive care and exams to help you stay healthy. Working as partners, OSF HealthPlans, local hospitals, physicians, and other healthcare service providers can assure greater value by coordinating the care today's families need and want.

How do I select my Primary Care Physician?

A Primary Care Physician is a Family Practice, Internal Medicine or Pediatric physician who participates in the OSF HealthPlans HMO network. You must select a Primary Care Physician from our panel for each member of your family. These doctors are listed by name and office location in the Provider Directory. It can be the same physician - or a different one for each family member.

How do I receive medical care when I'm an OSF HealthPlans member?

From periodic check-ups to the management of a serious illness, your Primary Care Physician will coordinate all of your medical care. Each time you need medical care, you visit or call your Primary Care Physician. He or she will coordinate all your medical care and treatment, including care you receive from physician specialists, hospitalization or other forms of treatment. The partnership you build with your Primary Care Physician works to your benefit in two ways: It assures you greater continuity of care, and it makes talking about health concerns easier.

What if I need to see a specialist?

Your Primary Care Physician can provide many of the medical services you need. However, in those instances where a specialist is necessary, your Primary Care Physician will refer you to a specialist who is also part of the provider panel. If you need specialty care from an out-of-network specialist, and it is approved by the OSF HealthPlans HealthCare Management Department, you will have the same coverage as you would with HMO network providers.

What if I choose to see a provider who is not in the HMO network?

If you seek care on your own from a provider who is not in the OSF HealthPlans HMO network, your medical expenses will not be covered.

My dependents have other primary medical coverage. Will the HMO provide secondary coverage?

Yes, but to receive such coverage, your dependents must follow all the rules of the HMO - the same rules you must follow to receive primary benefits. This means seeking care through an OSF HealthPlans Primary Care Physician and using HMO participating providers for medical care.

Who do I call when I have questions about my HMO coverage?

Our Member Services Department is available if you have a question regarding your coverage. Simply call 309-677-8222 or 800-673-5222.