State of Illinois

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Notice Regarding HMO and OAP Claims Payment Delays

The state of Illinois funds claims as quickly as possible, but at times, claims payment may be delayed.  Enrollees can view claims information before the state or health plan pays providers by visiting www.chcillinois.com > My Online ServicesSM > Member Login or Register.  Click here for more information on My Online Services.

If an enrollee receives a bill from a provider, he or she can print and send an Explanation of Benefits (EOB) to the provider or call Customer Service at 800-431-1211 for help.

An EOB indicates the following:
• The amount of the bill the enrollee should pay
• The amount the state of Illinois should pay
• The amount Coventry Health Care of Illinois, Inc. should pay

Open Access Plan (OAP)

Click here for more information regarding claims payment delays.  Claims processed through 7/29/13 have been released.  This information will be updated when the release date changes.

HMO

Click here for more information regarding claims payment delays.  Claims with dates of service through 11/30/13 have been released.  This information will be updated when the release date changes.

Nothing is more important than your health.

That's why we take your health care personally. Since 1984, we have helped State of Illinois employees manage their most important asset - their health.  At Coventry Health Care, we know the importance of health benefits that meet your needs and the needs of your family.  Click here for health and wellness resources.

If you have specific benefit questions or need help finding a provider, please call Customer Service during normal business hours at 800-431-1211 or visit the State of Illinois benefit page.

 

Great Coverage for Out-of-Area Dependents

The Passport Program provides members who have enrolled dependents outside of the Coventry service area with coverage at the highest level of benefits.  Services must be obtained from providers that are in the Coventry National Network. 

To find a Coventry National Network provider, use our online provider search at www.chcillinois.com.  Click on Find a Doctor, then click on Coventry National Network - Out of Area to find a provider near you.  Click here for more service area information. 

Open Access Plan (OAP) Resources and Documents


State of Illinois

Local Government Health Plan Teachers Retirement Insurance Program
College Insurance Program
Services Requiring Our Prior Approval 2013

OAP Service Area

The Coventry Health Care OAP is available in all 120 counties throughout Illinois.  Please click here for a map of our OAP service area.

OAP Provider Network

The three-tier provider network is a valuable feature of the OAP:

  • Tier One — highest level of benefits, includes more than 220 hospitals and nearly 36,000 participating providers throughout the State of Illinois and neighboring communities
  • Tier Two — includes coverage for services received from more than 5,000 participating providers in Illinois, as well as nationwide access to more than 557,000 providers in the Coventry National Network
  • Tier Three — includes out-of-network providers
Coventry Health Care continues our discussions with prominent Illinois providers and hospitals to expand OAP members' options for quality care at an affordable price.

Our provider lookup tool is a convenient and easy way for you to find the right in-network doctor or physician to suit your health care needs.  Click here for instructions on using our provider lookup tool.  Click here to locate a provider.  The provider directory does not include behavioral health providers.  To locate a behavioral health provider, call 800-423-8070.

OAP Pharmacy Benefits

Express Scripts administers the pharmacy benefits provided by the State of Illinois.  For questions about OAP pharmacy benefits, call Express Scripts at 800-735-4404 or visit www.express-scripts.com.

Click here to find out how to enroll in the State of Illinois OAP. 

Once enrolled in a Coventry Health Care health insurance plan, please complete a Transition of Care form to help ensure a smooth transition for you or any covered dependents that are receiving or may be receiving medical services involving the following:

Upcoming surgery or hospitalization
Recent transplant (within past 12 months), or in evaluation
Receiving dialysis
Pregnancy (second or third trimester) and under the care of an out-of-network provider
Under a current plan of care (post-operative surgical care, cancer care, etc.)
Using durable medical equipment (oxygen, c-pap machine, etc.)
Under the care of a mental health provider
Diagnosed with one of the following five health conditions, and would like to receive information on our disease management programs: asthma, diabetes, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF) and coronary artery disease (CAD).

*Please note that if you are a current State of Illinois member enrolled with Coventry Health Care you do not have to fill out a Transition of Care form, as your authorizations are currently on file.
 

HMO Resources and Documents

State of Illinois

Local Government Health Plan Teachers Retirement Insurance Program College Insurance Program

Services Requiring Our Prior Approval 2013

 

HMO Service Area

The Coventry Health Care HMO is available in 115 counties throughout Illinois. Please see below for a map with our HMO service area.


Service Area Map

HMO Provider Network

The HMO's provider network includes 220 hospitals and 20,000 participating providers.  Our provider lookup tool is a convenient and easy way for you to find the right in-network doctor or physician to suit your needs.  Click here for instructions on using our provider lookup tool.  Click here to locate a provider.  The provider directory does not include behavioral health providers.  To locate a behavioral health provider, call 800-423-8070. 

HMO Pharmacy Benefits

Express Scripts administers the pharmacy benefits provided by Coventry Health Care.  For questions about the HMO pharmacy benefits, please call Coventry Health Care at 800-431-1211, or visit the website at www.chcillinois.com.   

2013 Prescription Formulary

Click here to find out how to enroll in the State of Illinois HMO.

Once enrolled in a Coventry Health Care health insurance plan, please complete a Transition of Care form to help ensure a smooth transition for you or any covered dependents that are receiving or may be receiving medical services involving the following:

Upcoming surgery or hospitalization
Recent transplant (within past 12 months), or in evaluation
Receiving dialysis
Pregnancy (second or third trimester) and under the care of an out-of-network provider
Under a current plan of care (post-operative surgical care, cancer care, etc.)
Using durable medical equipment (oxygen, c-pap machine, etc.)
Under the care of a mental health provider
Diagnosed with one of the following five health conditions, and would like to receive information on our disease management programs: asthma, diabetes, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF) and coronary artery disease (CAD).

*Please note that if you are a current State of Illinois member enrolled with Coventry Health Care you do not have to fill out a Transition of Care form, as your authorizations are currently on file.
 

If you have specific benefit questions, or need assistance, please call Customer Service during normal business hours at 800-431-1211 or visit the State of Illinois benefit page.





 

Didn't find what you needed? Don't hesitate to call our Customer Service department during regular business hours at 800-431-1211.

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