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Local Health Events This Month
Beginning January 1, 2015, we will feature upcoming community health events. Check back each month to find out what’s going on near you.

School Immunizations, School Physicals and Sports Physicals Are
Due Soon!

Your child’s physicals and immunizations should be completed 3 to 4 months before the start of the school year or sports year.
 

 

Beginning July 1, 2014 Harmony will provide great new benefits for members*:
 

  • Vision – Free pair of approved glasses for members 21 and older.
  • Free Weight loss program – Qualified members get a three-month membership to a Curves gym. That includes one-to-one counseling with a health coach.
  • Discounted Gym – Get 10% off standard monthly dues to Anytime Fitness. Get 50% off a standard enrollment. Bring the posted flyer to an Anytime Fitness club near you for a free 7-day guest pass!
  • Healthy Rewards Program – When you complete a qualified healthy behavior (ex. Visit PCP within the first 90-days of joining plan), get a $20 CVS Select card.
  • Diaper Program – When you complete a postpartum appointment and get baby’s recommended shots, get up to six packs of diapers.
  • GED Test – You can take the GED tests for free if you meet all requirements below:
    • Are at least 16 years old. 
    • Have not graduated from an accredited high school or received a high school equivalency certificate or diploma. 
    • Not currently enrolled in a regular high school. 
    • Have a valid member ID Card. 
    • Complete classroom work at an adult testing center.

 

You will still get all of the benefits listed below:

  • Harmony +15 – FREE over-the-counter (OTC) supplies. You can get $15 for OTC items each month. That’s $180 a year!
  • No co-pays for doctor visits, hospital visits, or generic drugs.
  • Healthy Kids Club – FREE program that provides health tips and tools for kids ages 4–11 to encourage shots and checkups.**
  • FREE cleanings every six months for members age 21 and older, with no co-pay.
  • Hypoallergenic Bedding – Qualified members can get hypoallergenic bedding to avoid asthma triggers.
  • FREE choice of baby stroller or portable play yard after you go to all your prenatal doctor visits.

 

*Harmony will no longer offer root canal and scaling service.

**As of Aug. 2014, the Healthy Kid’s Club monthly birthday parties will no longer be offered.

 

Medical Services
Here is a list of some of the medical services and benefits that are covered by Harmony Health Plan.  You can also look in your Certificate of Coverage for a complete list. You can also have a copy sent to you. Just call Member Services at 1-800-608-8158.

 

Covered

  • Advance Practice Nurse Services
  • Ambulatory Surgical Treatment Center Services
  • Assistive/Augmentative Communication Devices
  • Audiology Services
  • Dental Services (Adult)
  • Dental Services (Children)
  • FQHC and RHC and other approved Clinic visits
  • Hospital inpatient services
  • Hospital Ambulatory Services
  • Home health care services
  • Physical therapy
  • Speech and language therapy
  • Laboratory and X-ray services
  • Transportation
  • Emergency services
  • Transplant services (non-experimental)
  • Family planning services (also at non-affiliated providers covered by the Illinois Medical Assistance Program)
  • Contraceptive devices
  • Durable and non-durable medical equipment and supplies
  • Whole blood and blood products
  • Physician services
  • Hospital outpatient services
  • Behavioral health and substance abuse services
  • Preventive services
  • Alcohol and substance abuse treatment services
  • Early periodic screenings and diagnostic testing services
  • Maternity care services
  • Well-child care services
  • Health education
  • Skilled nursing care (first 90 days)
  • Immunizations
  • Hospice
  • Chiropractic services (limited to enrollees under age 21)
  • Podiatric Services for Enrollees under age 21
  • Podiatric services ( for diabetic members 21 and older and effective 10/01/2014 Podiatric services for all Enrollees age 21 and over)
  • Post-Stabilization Services
  • Practice Visits for Enrollees with Special Needs
  • Orthotic/prosthetic devices, including prosthetic devices or reconstructive surgery incident to mastectomy
  • Nurse midwife services
  • Ophthalmologist (eye specialist)
  • Optical/Vision
  • Pharmacy services *Children under 19 and pregnant women do not have co-pays.
  • Renal Dialysis Services
  • Respiratory Equipment and Supplies

 

Home and Community-Based Services  (HCBS)

These benefits are designed to meet the unique needs of individuals with disabilities, or who are elderly, who qualify for the level of care provided in an institution but who, with special services, may remain in their homes and communities.

 

  • Adult Day Services
  • Adult Day Service Transportation
  • Environmental Accessibility Adaptation Home
  • Supported Employment
  • Home Health Aide
  • Nursing Intermittent
  • Skilled Nursing (RN and LPN)
  • Occupational Therapy
  • Physical Therapy
  • Speech Therapy
  • Prevocational Services
  • Habilitation Day
  • Placement Maintenance Counseling
  • Medically Supervised Day Care
  • Homemaker Services
  • Home Delivered Meals
  • Personal Assistant
  • Personal Emergency Response System
  • Respite
  • Nurse Training
  • Family Training
  • Specialized Medical Equipment and Supplies
  • Behavioral Services
  • Assisted Living
  • Nursing Facility Services

 

Not Covered

  • Elective cosmetic surgery.
  • Custodial care services.
  • Elective abortions.

 

Services and Co-payments

There are no co-pays for office visits, hospital visits or generic drugs.

  • For covered care you do not have any co-pays, deductibles or premiums
  • Pharmacy co-pays are $2 for over-the-counter medications with a prescription and $3.90 for brand name medications with a prescription
  • Children under 19 and pregnant women do not have co-pays.
  • Native Americans and Alaskans do not have co-pays for covered services
     

Prior Authorizations

Sometimes the plan must give its OK before you get a service. This is called prior authorization. Services that need this OK include those that are elective or non-urgent. You can get a prior authorization by asking your doctor or facility.

No prior authorization is needed for the following services:

  • PCP visits and immunizations
  • Preventive and screening services
  • Routine physical exams, vision exams, hearing exams and testing
  • Emergency room visit services
  • Mammograms
  • Family planning services
  • Outpatient behavioral health care

You can find more about these services in your member handbook.

You can call Member Services Monday–Friday, 8 a.m. to 5 p.m. at 1-800-608-8158 (TTY 1-877-650-0952).


When to Call Harmony Health Plan Member Services

  • You can't reach your Primary Care Physician.
  • You change your address or phone number.
  • You lose your ID card and need a replacement.
  • You want to change your primary care physician.
  • You have a question about how Harmony Health Plan works.
  • You have questions about Harmony benefits.
  • Any time you have a question.

 

Member Services
1-800-608-8158
TTY 1-877-650-0952

Transportation
1-888-684-2026
Call any time, 24/7. Schedule your ride 48 hours in advance

Mental Health & Substance Abuse
1-888-684-2026
Call any time. 24/7.

 

To learn more about your Health Plan choices please contact Illinois Client Enrollment Services at 1-877-912-8880 or visit http://enrollhfs.illinois.gov/.


Last modified: 08/25/2015

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