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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

Gender Affirming Coverage Requirement

The State of Illinois is committed to providing its employees with needed gender-affirming care, in compliance with State law which requires coverage for medically necessary services, procedures, or surgical treatments for gender dysphoria.  50 Ill. Adm. Code 2603.35; Department of Insurance Company Bulletin 2024-01.  All State Employees Group Insurance Program plans must adhere to these non-discrimination laws and provide gender-affirming care as required.

Employees who have questions about plan coverage for gender-affirming care should contact their elected health plan (if OAP or PPO) or the Illinois Department of Insurance (if HMO) for additional information.  Employees may also contact the CMS legal department. if they have been denied care that they believe should be covered under State law.