Illinois/Outside of Wisconsin Medical Plan


In 2024 UMR is the new medical claims administrator for colleagues who reside in Illinois or outside of Wisconsin.

You have three medical options through HSHS:

  • Value option (formerly Basic option)
  • Premier option (formerly High option)
  • High Deductible Health Plan (HDHP) with Health Savings Account (HSA) - see below for more HSA information
  • Waive Coverage
     

Coverage Options

When you enroll in medical (including prescription drug coverage),you can choose from these coverage levels:

  • Colleague only
  • Colleague + Spouse/LDA
  • Colleague + Child(ren)
  • Colleague + Spouse and Child(ren)
     

Network

Each medical plan option (Value, Premier, HDHP) has three network tiers which determine the benefit paid by the plan based on the tier your provider falls in. These tiers apply based on the providers you use. You do not have to elect a tier during enrollment. To confirm which tier your providers fall in, use the Find a Provider information below.

  • HSHS Select Tier (Tier 1) – HSHS, PCC and Prevea providers and facilities. 
  • HSHS Extended Tier (Tier 2) – local partners such as Springfield Clinic, SIU, PCIN network, SSM, SLU, Mercy and others. 
  • UCH Choice Plus Tier (Tier 3) – nationwide United Healthcare network 


Find a Provider


Before determining which tier a provider is in, you need to determine if you live inside the HSHS Service Area. Colleagues that live outside of the service area will receive the HSHS Extended Tier benefit level for services received from any UHC Choice Plus provider.

Click here to determine if you are in the HSHS Service Area.


HSHS Select Tier

    AE-Find-a-Provider-(1).png
  • HSHS Medical Group, Prairie, and Prevea providers will be notated with the applicable logo in the provider finder.
  • Non-HSHS/PCC/Prevea providers may be listed in the provider finder (no logo) and are not covered at the HSHS Select benefit level.

HSHS Extended Tier 


     PCIN-Providers-(3).png            SUI-Providers-(2).png
                  PCIN Provider Search Tips

     SSM-SLU-Providers-(2).png            Mercy-Providers-(2).png


                                             Other-Providers-(2).png

 


UCH Choice Plus Tier


    UHC-Choice-Plus1-(2).png
    *Springfield Clinic Ambulatory Surgical Center is covered under the UHC Choice Plus tier.


 

Out-of-area Dependents

If you have a dependent who lives outside of the HSHS service area, such as a child attending college, you can register your dependent with UMR after you receive your ID card. Call UMR to get started.

Once your dependent is registered, they will receive the HSHS Extended benefit level for all in-network services.
 

Health Savings Account (HSA)

Colleagues enrolled in the High Deductible Health Plan are eligible to utilize a health savings account (HSA) offered through HealthEquity. Money in your HSA is yours to use on qualified medical, dental and vision expenses or save for retirement. After signing up for your HSA you will receive a debit card in the mail from HealthEquity.

Advantages of HSAs include:

  • No "use it or lose it". The money is yours and the HSA rolls over year after year for use in the future or in retirement.
  • HSAs are triple-tax advantaged - contributions are deducted before taxes, investments and interest earned are tax-free, and money is never taxed if you use it to pay qualified medical, dental and vision expenses.
  • HSAs are individually owned accounts that you keep regardless of employer or insurance changes.

HSHS will make a $25 per-pay-period employer contributions to your HSA regardless of whether you are able to contribute anything to the account yourself. You are able to make additional pre-tax contributions up to IRS limits ($4,150 for self-coverage and $8,300 if you cover any dependents). Those 55 and older can contribute an additional $1,000. HSHS employer contributions count towards the IRS limits.

Colleagues who have other non-HDHP coverage are not eligible to contribute to an HSA. This includes those covered by Medicare, Medicaid, TRICARE, or a FSA or HRA that reimburses expenses before the HDHP deductible is met.

Visit learn.healthequity.com/hshs/hsa to learn more about HSAs and review a list of qualifying expenses.


Additional Resources