Benefit Information

IlliniCare Benefit Summary

We provide the same medical services as Medicaid. We also have extra benefits and services. All services must be medically necessary.

Some services may:

  • Have coverage limits.
  • Need a doctor’s order.
  • Need prior approval.

Some Medicaid members may not have all the benefits listed.

Click here for more detailed benefit information. This chart and more information about your benefits, programs and services are in your member handbook. For a quick summary of benefits, see below.

Medical Home

Making sure you are in good health is very important. One of the most important ways to make sure you get the healthcare you deserve is through a medical home. This means, where you go to get medical care on a regular basis. IlliniCare offers you the choice of one primary care provider (PCP) to help you maintain your health.  Women can also choose a women’s health care provider in addition to a PCP. Your PCP can be a doctor, a nurse practitioner, or a physician’s assistant. It is easy to choose a PCP. We have a lot of providers to choose from.  You should visit your PCP within 90 days of enrollment with IlliniCare.

Dental Care (benefit limits apply)

IlliniCare members receive the following preventive dental benefits:

  • Annual dental cleaning for those 21 years and older
  • Semi-annual (two times a year) cleanings for those 20 years and younger
  • Simple extractions and oral surgery if medically needed
  • Bitewing x-rays
  • Fillings

Vision Care (benefit limits apply)

IlliniCare offers you a full network of vision providers. We offer exams to all of our members. This includes both routine exams and diabetic eye exams. You also have the choice between glasses or contact lenses. You are allowed:

  • Vision Exam: preventive eye exam from our network of optometrists and ophthalmologists. You are allowed one vision exam every year.
  • Frames: You are allowed one pair of glasses every two years. You can choose from our standard selection of frames. You can also choose to use $100 toward the retail value of frames instead of choosing from our standard line. If the value of the frames is above $100, you must pay for the difference in price out of pocket. 
  • Lenses: if you meet certain requirements, single vision and bifocal lenses are fully covered. Remember, you can only receive lenses once every two years.
  • Contact Lenses if you choose contacts instead of eye glasses, the fitting fee is fully covered. You can also use an $80 allowance toward the price of your contact lenses.  If the value of your lenses is more than $80, you must pay for the difference in price out of pocket.

You must use an in-network vision provider. To find a vision provider, call IlliniCare member services at (866) 329-4701 or click here.

Behavioral Health (benefit limits apply)

IlliniCare members receive the following behavioral health benefits:

  • Counseling
  • Substance Abuse Services
  • Inpatient Mental Health
  • Mental Health Drugs

Transportation

Non-emergency Transportation Services are covered by IlliniCare for medically necessary services. IlliniCare will also provide an escort, if authorized in advance. To schedule transportation, please call 866-329-4701.