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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, 2009 and June 30, 2010

BENEFIT	Tier I HealthLink HMO Network	Tier II HealthLink PPO Network	Tier III Non-HealthLink 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 $250 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	Full coverage after $20 copayment	90% of network charges for covered services after $20 copayment	80% of U&C for covered services
Preventive Health Services Including immunizations, allergy testing and treatment	Full coverage after $20 copayment	90% of network charges for covered services after $20 copayment	Not Covered Under Tier III
Chiropractic Care	Full coverage after $20 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	Not Covered Under Tier III
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	Not Covered Under Tier III
Transplant Coverage	Full coverage	80% of network charges for covered services	Not Covered Under Tier III
Home Health Visits	Full coverage after $20 copayment per visit	90% of network charges for covered services after $20 copayment	Not Covered Under Tier III

Please Note:
* 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

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

*** Covered services received from Tier III providers (out-of-network) are covered for “Usual & Customary” (U&C) 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. For more information on U&C, consult your Summary Plan Description (SPD) booklet.

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. Discount offerings made available by third-party vendors.