Plan Information for HMO's | Human Resources | SIU

HMO Benefits

The HMO coverage described below represent the minimum level of coverage the HMO is required to provide. Benefits are outlined in each plan's Summary Plan Document.  It is the member's responsibility to know and follow the specific requirements of the HMO plan selected. 

Some HMOs may have benefit limitations on a calendar year.

Important Reminders About Managed Care

Provider Network Changes: Managed care plan provider networks are subject to change.  Always call the respective plan or visit their web site to verify participation of a particular provider and/or receive specific coverage information.

PCP'S Leaving a Network: If your PCP leaves the managed care plan’s network, you have three options: 1) choose another PCP with that plan; 2) change managed care plans; 3) enroll in the Quality Care Health Plan. The opportunity to change plans applies to Primary Care Physicians leaving the network only. It does not apply to specialists or women's health care providers who are not designated Primary Care Physicians.

Out-of-County Managed Care Plans: Members interested in enrolling in a managed care plan that is not available in their county of residence should contact the plan directly to determine if an exception can be made that would allow the member to participate in the managed care plan. 

Full-Time Student Dependents:  Eligible dependents who are full-time students in accredited schools and live apart from the member's residence of record for any part of a plan year may be subject to limited service coverage when living away. If you have such a dependent, it is critical to contact the managed care plan you are enrolled in (or considering enrolling in) to understand the plan’s guidelines on this type of coverage.

June/July Hospitalizations: If you change health plans, and are hospitalized in June, it is recommended you contact both your current plan/PCP and future plan/PCP well in advance of June 30/July 1.

Transplant Services: Both organ and tissue transplant services are eligible for coverage under all participating managed care plans. Each plan establishes its own certification criteria, coverage, and provider network. Contact your respective managed care plan for specific information.

Certificate of Coverage: For detailed information on HMO/POS service coverage, exclusions, limitations, and other information, contact each respective plan. You do not need to be enrolled in a managed care plan to request this important information.