How are participating physicians and hospitals selected?
Participation in the HealthLink network programs is voluntary and subject to application and/or credentialing processes. Physicians, medical facilities, and other health care professionals apply for membership in the HealthLink network by completing an application or credentialing form and contract. HealthLink’s credentialing process includes, but is not limited to, the following elements, as appropriate to the health care profession or specialty of the applicant:

• Verification of license
• Accreditation or certification for hospitals and medical facilities
• Physician training
• Education and certification that is appropriate to the practice
• Professional standing and hospital admitting privileges

Additional considerations include the applicant’s willingness to participate in HealthLink’s Medical Management program, to observe HealthLink’s policies and procedures, and to be available and accessible to enrollees of health plans contracted with HealthLink.

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Am I limited to using only HealthLink network physicians, hospitals and other health care professionals?
No. However, health plans using the HealthLink Open Access network program offer three levels of benefits for covered services. You’ll be eligible for the highest level of benefits for covered services if you use physicians and facilities who participate in the HealthLink Tier I network. You’ll be eligible for a second, lower level of benefits for covered services if you use physicians and facilities who participate in the HealthLink Tier II network. You may also use out-of-network practitioners with further reduced benefits for covered services.

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Do I need to file a claim form when I use a HealthLink network physician or hospital?
Your participating physician or hospital will file all claim forms for you. You may be asked to sign a claim form or provide other information your health plan may require. Please respond promptly and directly to these requests from your health plan administrator so that medical claims may be processed in a timely manner.

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What do I need to do if I am going to be admitted to the hospital?
Before you are admitted to the hospital, you or your physician should call HealthLink Medical Management toll-free at 877-284-0102, unless otherwise indicated on your enrollee health ID card and health plan literature. Phone lines are open from 8:00-5:00 CST on business days. An answering service is available at all other times. In an emergency, you or your representative (a family member, your physician or hospital) should call HealthLink Medical Management as soon as reasonably possible. Your emergency admission will not be delayed.

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How do I find the physician I need?
The Physician/Hospital Locator from www.healthlink.com organizes providers according to specialty. The primary specialties (General Practice, Family Practice, Internal Medicine, Gynecology and Pediatrics) are listed first, and the subspecialties follow alphabetically.

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How do I find the specialist I need?
Your physician may recommend a HealthLink participating specialist. However you may use any specialist of your choice, although the benefits available for covered services may be lower if you do not use a HealthLink participating specialist.

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Do I need a referral when obtaining care from a doctor other than my primary care physician?
The HealthLink Open Access network program does not require a referral from your primary care physician when you need specialist care. You may take your primary care physician’s advice, or you may use any specialist, in or out-of-network, and receive benefits for covered services. It is important to understand your specific health plan provisions in order to make the best decision regarding your benefit coverage.

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How do I identify participating specialists in radiology, pathology and anesthesia?
HealthLink endeavors to contract with all hospital-based specialists at participating hospitals. However, hospital network participation is not a guarantee that specialists in radiology, pathology and anesthesiology are contracted with HealthLink. Please contact HealthLink Customer Service at 1-800-624-2356 for verification of physician/hospital participation status in HealthLink.

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If I use a doctor or facility participating in the HealthLink Open Access Network, will I be eligible for Tier I benefits for covered services?
In order to qualify for Tier I benefits for covered services, you need to use a Tier I provider. If you use a Tier II provider, you will be eligible for Tier II benefits for covered services. Tier I and Tier II providers are in the HealthLink Open Access network but different levels of benefits apply for each tier.

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What is SpecialOffers?
SpecialOffers is an online vendor discount program providing health and wellness products and services. The SpecialOffers website is accessible from the customized State of Illinois website from www.healthlink.com.

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What is Member Access?
Member Access is an online secured member website that allows you to review your personalized claim history, claim payment and Explanation of Benefits (EOBs) information. You also have access the provider locator with the customized directory feature and links to member publications, health tips and tools, discounts and wellness resources.

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Do I need to sign up to use Member Access?
Yes, you’ll need to register to utilize Member Access. Go to www.healthlink.com, click on "State of Illinois CMS". Click on the "Login" button under the Member Access section. Click on the "Register Now" link. You will be asked a series of questions to complete the easy 3-step registration process. Once you've registered, you will be assigned a username and password that will allow you to access Member Access at your convenience.

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Do I have access to an online Health Risk Assessment?
Yes, the Lifestyle Management program has a built-in Health Risk Assessment tool that analyzes your personal lifestyle and overall health. To learn more, review the next two Questions and Answers below.

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What is the Lifestyle Management program?
The Lifestyle Management program includes online support services to assist you in making healthier behavior choices in five key areas: tobacco cessation, weight management, stress management, physical activity and diet/nutrition. For the tobacco cessation component, a telephonic one-on-one coach is available who may recommend various nicotine replacement therapy treatments.

At the heart of the Lifestyle Management program is the MyHealth Assessment (MyHA), an interactive questionnaire that indicates the propensity for certain health conditions based on the results of the personal lifestyle and health assessment. MyHA identifies 12 specific health risks and up to 11 chronic health conditions, prioritizes their importance to your health, and scores you on a scale of 0-100. MyHA includes a summary report about your risk level for factors such as alcohol and tobacco use, blood pressure, diet, physical activity and stress, among others. MyHA can also create a personalized action plan for improving your health. The questionnaire can be retaken over time to measure results.

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Will I receive a new ID card after I’ve enrolled in the HealthLink Open Access network program?
Yes and No – please see both responses to determine which circumstance applies to you.

If you are enrolling with HealthLink for the first time during the 2009-2010 Benefit Choice enrollment period, you will receive a new ID card and an enrollment packet with information about the HealthLink Open Access network program.

If you are a current HealthLink member (prior to the 2009-2010 Benefit Choice enrollment period), new ID cards will not be re-issued. You will be able to utilize your card from last year because the information has not change. You will also receive an enrollment packet with information about the HealthLink Open Access network program.

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Where can I get more information?
If you need more information about the HealthLink Open Access network program and its participating physicians, hospitals and other health care professionals, please call HealthLink toll-free at 1-800-624-2356.

If you need information about your health benefit coverage, please contact your health plan administrator, identified on your enrollee health ID card.

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