Agencies
ServicesPossible online services disruption due to Internet related outage
Summary of Benefits and Coverage
These short, easy-to-understand Summary of Benefits and Coverage (SBCs) include a new, standardized plan comparison tool called "coverage examples", like the Nutrition Facts label required for packaged foods. The coverage examples will illustrate sample medical situations and describe how much coverage the plan would provide in an event such as having a baby (normal delivery) or managing Type 2 diabetes (routine maintenance, well-controlled). The Glossary of Health Coverage and Medical Terms will assist you with determining the benefits of each plan.
FY25 SBCs
July 1, 2024, through June 30, 2025
Weight Loss Medication Coverage Requirement
Effective July 1, 2024, per 5 ILCS 375/6.11c, all health plans under the State Employees Group Insurance Program will provide coverage for all types of medically necessary injectable medication prescribed to improve glucose or weight loss for use by adults (age 18 and over) that have been diagnosed with prediabetes, gestational diabetes, or obesity.
Once a member has received their initial prescription of the medication, you MUST reach out to your health plan to enroll in the lifestyle management program (LMP). If you fail to enroll or continue to participate in the LMP, future coverage will be denied.
If you have questions regarding this coverage or to enroll in the LMP, please contact the appropriate number below:
HMOs:
Health Alliance - 800-851-3379
Aetna HMO - 855-339-9731
HMO Illinois or BlueAdvantage - 855-999-7549
OAPs or PPOs (this includes HealthLink, Aetna, BlueCross BlueShield, Quality Care Health Plan (QCHP) and Consumer Driven Health Plan (CDHP)):
CVS Weight Management Program - 800-207-2208