State of Illinois: Frequently Asked Questions
- How are participating physicians and hospitals selected?
- Am I limited to using only participating physicians, hospitals and other health care professionals?
- Do I need to file a claim form when I use a participating physician or hospital?
- What do I need to do if I am going to be admitted to the hospital?
- How do I find the physician I need?
- How do I find the specialist I need?
- Do I need a referral when obtaining care outside of my primary care physician?
- How do I identify participating specialists in radiology, pathology and anesthesia?
- 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?
- What is SpecialOffers?
- What is Member Access?
- Do I need to sign up to use Member Access?
- What is the Telemedicine Program from HealthLink?
- Diagnose & treat a wide range of common ailments and conditions
- Answer questions
- Write a prescription or refill
- Have medication sent to your local pharmacy
- Request lab or imaging tests
- And more
- Does the Telemedicine Program cost extra?
- What are the Telemedicine Hours of Operation?
- Call 855-717-6800 to start your teleconsult
- A telemedicine representative will verify your eligibility and collect basic information, such as date of birth, medical history and your current symptoms.
- Pay you co-pay with a credit or debit card
- If a doctor is available, you will be transferred immediately to start your consult
- If a doctor is not immediately available, your contact number will be confirmed and a doctor will call you back within one hour to start your consult
- Don't forget to tell the doctor if you need a doctor's note for school or work, or if you would like to receive a consult report to share with your primary care physician (PCP)
- Do I have access to an online Health Risk Assessment?
- What is the Lifestyle Management program?
- How Do I Sign Up for Lifestyle Management?
- What is 24-Hour Nurse Line?
- What is Condition Management?
- What is Maternity Management?
- Where can I get more information?
- Can I request printed program materials?
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Member Access is an online secured member website that allows you to review your personalized claim history, ID card, 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.
Yes, you'll need to register to utilize Member Access. Go to memberaccess.healthlink.com, Under the Login 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.
The Telemedicine Program from HealthLink offers a convenient health care alternative that can treat a wide range of aliments and conditions wherever you are. Instead of waiting for a doctor's appointment, spending hours commuting to the office, sitting in the waiting room and exposing yourself to illness, the Telemedicine Program from HealthLink provides unlimited access to on-demand telephone consultations with U.S. board-certified doctors available 24 hours a day, seven days a week and 365 days a year from anywhere - home, work or even vacation! A telemedicine doctor can:
The Telemedicine Program from HealthLink is available to State of Illinois employees participating in the HealthLink Open Access program. The cost to use this program is the same co-pay amount as a doctor's office visit. The co-pay is collected over the phone during the eligibility verification process. Please check your member ID card for co-pay amounts.
The Telemedicine Program from HealthLink is available 24 hours a day, seven days a week, and 365 days a year. Here's how it works:
Yes, the Lifestyle Management program has a built-in Well-Being Assessment (WBA) tool that analyzes your personal lifestyle and overall health. To learn more, review the next Question and Answer.
Lifestyle Management Online is designed to offer members and their adult dependents the resources and guidance to change behaviors and improve their lifestyles. The online program offers members a suite of integrated tools, including:
- Well-Being Assessment (WBA) - This initial step is for members to identify health conditions and access online tools by assessing six major health markers to provide insight to improving a member's well-being year after year.
- Well-Being Plan - members can improve their lifestyles and change behaviors by using this progressive and tailored map.
- Nutrition and Exercise Trackers - Online health trackers and activity logs help participants track their progress.
- Smoking Cessation Program - Tobacco users can turn to this program for resources and support to kick the tobacco habit.
- Online Coaching - Certified personal trainers, registered dietitians and accredited psychologists are all available to answer member questions.
- Cool Tools - Features include the wellbeingGO app for iPhone, iPod Touch or Android, a personalized member home page, appointment and medication reminders, healthy recipes and educational articles to encourage participation
- Rewards - A points-based rewards system is included in the program. The system lets members earn points that are redeemable for great prizes.
Go to healthlink.com, click on "State of Illinois CMS". Click on the "Lifestyle Management" link and the "Sign In" button to begin the registration process. You will need to complete five fields of information including First Name, Last Name, Date of Birth, Zip Code and Gender. You must be 18 years of age to utilize this program.
24-Hour Nurse Line offers access to nurse counselors and audio-taped messages via a health information phone line. The toll-free 24-hour hotline accesses nurse counselors who provide confidential answers to health care questions. You can talk one-on-one with registered nurses about specific ailments, diseases, treatment options, prescription drugs and nutrition. You also may choose to listen to a selection of audio-taped messages on a wide variety of health topics, available in English and Spanish. To contact the 24-Hour Nurse Line, call 866-647-6113. Press 2 to enter the Wellness Support Programs automated system, and press 4.
Condition Management programs provide individualized support for State of Illinois employees with conditions related to asthma, chronic obstructive pulmonary disorder, coronary artery disease, diabetes and heart failure. Each program addresses your total health, not just a specific condition. With personal support from a "health coach," you can feel confident and ready to take on most challenging lifestyle changes successfully. If you have one of the conditions listed above, you can self-enroll by calling 866-647-6113. Press 2 to enter the Wellness Support Programs automated system, and press 1 for Condition Management.
Maternity Management offers personal support and information for mothers-to-be. The program includes early risk assessment; obstetrical nursing support and post delivery follow up. If you are pregnant, you may self-enroll by calling 866-647-6113. Press 2 to enter the Wellness Support Programs automated system, and press 2 for Maternity Management.
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.
Yes. If you need a printed copy of the following program materials, please call the HealthLink Customer Service Department at 800-624-2356. A copy will be shipped to you within 1-2 days. You can also view these materials from the State of Illinois customized website .
- Open Access Overview Brochure
- Benefit Summary Grid
- Summary Plan Description (SPD)
- Summary Benefits and Coverage (SBC)
- Restriction and Authorization Forms
- Medical Management Required Pre-Certification List of Services
- Printed Provider Directory (based on zip up to 30 mile radius)