Find a Doctor

Need to find a
Doctor or Hospital?
Check the On-Line
Physician/Hospital
Directory. You
can also create
a customized
directory.

Find a Doctor

On-Line Videos

Check out HealthLink’s videos for members to learn healthy lifestyle tips and tools.

Learn More

Wellness Newsletter

Published monthly, eHouseCall features health and wellness topics for the whole family along with advice from HealthLink’s Chief Medical Officer, Robert Sorrenti, MD.

Learn More

Local Government Health Plan Members Printer Friendly

HealthLink is pleased to offer the Open Access III network program for the Local Government Health Plan members.

With HealthLink Open Access III, you may use any participating physician or hospital in the HealthLink Tier I and Tier II networks. If you prefer to use an out-of-network practitioner, your benefit administrator still pays benefits - but keep in mind, you'll pay less out of pocket when you choose HealthLink participating physicians and hospitals.

This benefit overview is a summary only and it is subject to the benefits, exclusions, modifications and limitations contained in the plan's 'certificate' of coverage.

Benefits effective July 1, 2008 - June 30, 2009

BENEFIT	Tier I HealthLink HMO Network	Tier II HealthLink PPO Network	Tier III Non-HealthLink Network Providers
Plan Year Maximum Benefit	Unlimited	Unlimited	$1,000,000
Lifetime Maximum Benefit	Unlimited	Unlimited	$1,000,000
Annual Out-of-Pocket Max Per Individual Enrollee Per Family	$0 $0	$1,000 $2,500	$2,000 $5,000
Annual Plan Deductible Must be satisfied for all services	$0	$300 per Enrollee*	$500 per Enrollee*
HOSPITAL SERVICES
Inpatient	Full coverage after $200 copayment per admission	90% of network charges for covered services after $300 copayment per admission	80% of U&C for covered services after $400 copayment per admission
Inpatient Psychiatric	Full coverage after $250 copayment per admission up to 30 days per plan year	90% of network charges after $300 copayment per admission up to 30 days per plan year	80% of U&C for covered services after $400 copayment per admission up to 30 days per plan year
Inpatient Alcohol and Substance Abuse	Full coverage after $250 copayment per admission, up to 10 days rehabilitation per plan year	90% of network charges after $300 copayment per admission up to 10 days rehabilitation per plan year	80% of U&C for covered services after $400 copayment per admission up to 10 days rehabilitation per plan year
Emergency Room	Full coverage after $200 copayment	90% of network charges after $200 copayment	80% of U&C for covered services after $200 copayment
Outpatient Surgery	Full coverage after $150 copayment	90% of network charges for covered services after $150 copayment	80% of U&C for covered services after $150 copayment
Outpatient Psychiatric and Substance Abuse	Full coverage after $20 copayment up to 30 visits per plan year	90% of network charges after $20 copayment up to 30 visits per plan year	80% of U&C after for covered charges after $20 copayment up to 30 visits per plan year
Diagnostic Lab & X-Ray	Full Coverage	90% of network charges for covered services	80% of U&C for covered services
PHYSICIAN AND OTHER PROFESSIONAL SERVICES
Physician Office Visits Including Well Baby Care	Full coverage after $20 copayment	90% of network charges for covered services after $20 copayment	80% of U&C for covered services
Preventive Services Including immunizations, allergy testing and treatment	Full coverage after $20 copayment	90% of network charges for covered services after $20 copayment	Covered in-network only
Chiropractic Care	Full coverage after $15 copayment up to 25 visits per plan year	90% of network charges for covered services up to 25 visits per plan year	80% of U&C for covered services up to 25 visits per plan year
Well Baby Care	Full coverage after $20 copayment	90% of network charges for covered services after $20 copayment	Covered in-network only
OTHER SERVICES
Durable Medical Eqpt	80% of network charges for covered services	80% of network charges for covered services	80% of U&C for covered services
Skilled Nursing Facility	80% of network charges for covered services	80% of network charges for covered services	Covered in-network only
Transplant Coverage	Full coverage	80% of network charges for covered services	Covered in-network only
Home Health Visits	100% after $20 copayment per visit	90% of network charges for covered services after $20 copayment	Covered in-network only

Please Note:
Benefits are provided for covered expenses only. This is a summary only; your benefit booklet includes a complete listing of expenses that are covered by the plan along with exclusions, modifications, limitations, and controls over this summary.

Tier III covered expenses (out-of-network doctors and hospitals) are covered for "Usual and Customary" charges - fees normally charged for comparable treatment in the same geographic area. Participating Tier I and Tier II physicians and facilities usually charge a lower, contracted rate for services.

Your out-of-pocket maximum is the most you will be required to pay for any covered expenses.

Plan payments do not count toward the out-of-pocket maximum.

Plan copayments do not count toward the out-of-pocket maximum.

* Annual plan deductible must be met before plan benefits apply. Benefit limits are measured on a plan year.

HealthLink®, Inc., is an Illinois corporation. HealthLink, Inc. is an organizer of independently contracted provider networks, which it makes available by contract to a variety of payors of health benefits, including insurers, third party administrators or employers. HealthLink has no control or right of control over the professional, medical judgment of contracted providers, and is not liable for any acts or failures to act, by contracted providers. HealthLink, Inc. is not an insurance company and has no liability for benefits under benefit plans offered or administered by payors. HealthLink® is a registered trademark of HealthLink, Inc. and a separately incorporated and capitalized subsidiary of WellPoint, Inc. Any reference in the material to other organizations or companies, including their Internet sites, is not an endorsement or warranty of the services, information or products provided by those organizations or companies.