How do I select my Primary Care Physician?
A Primary Care Physician (PCP) is a Family Practice, Internal Medicine or Pediatric physician who participates in the OSF HealthPlans HMO network. You must select a Primary Care Physician from our panel for each member of your family. These doctors are listed by name and office location in the Provider Directory. It can be the same physician - or a different one for each family member.

Is my physician participating in your network?
We provide you several ways to determine if a particular physician is part of our network or not. We provide a printed version and an electronic version of our participating provider directory. You may click here to view our on-line directory. The printed directory is updated twice a year, while the on-line directory is updated at least weekly. If you cannot find a particular physician listed in the directory, please call Member Services at 888-716-9138 and we can look up the latest information for you.

How do I receive medical care when I’m an OSF HealthPlans member?
From periodic check-ups to the management of a serious illness, your Primary Care Physician will coordinate all of your medical care. Each time you need medical care, you visit or call your Primary Care Physician. He or she will coordinate all your medical care and treatment, including care you receive from physician specialists, hospitalization or other forms of treatment. The partnership you build with your Primary Care Physician works to your benefit in two ways: It assures you greater continuity of care, and it makes talking about health concerns easier.

What if I need to see a specialist?
Your Primary Care Physician can provide many of the medical services you need. However, in those instances where a specialist is necessary, your Primary Care Physician will refer you to a specialist who is also part of the provider panel. If you need specialty care from an out-of-network specialist, and it is approved by the OSF HealthPlans HealthCare Management Department, you will have the same coverage as you would with HMO network providers.

Do I need a referral to see a Specialist even if they are listed in the Provider Directory?
Yes, any visits to a specialist must be coordinated through your Primary Care Physician.

What if I choose to see a provider who is not listed in the Provider Directory?
If you seek care on your own from a provider who is not in the OSF HealthPlans network, your medical expenses will not be covered.

How do I change my Primary Care Physician?
If you would like to change your PCP, you should check with the new physician to make sure you can be taken as a new patient. If so, you should call our Members Services Department at 888-716-9138 to request the change.

Why was my claim denied?
There are several answers for this, depending on what the claim was for and what reason it was denied. Each inquiry is individually based and you should call Member Services at 888-716-9138 to speak with a Representative about your claim.

Why does this physician keep sending me bills?
There are several answers for this, all depending on what the claim was for and what provider you went to for services. Please call Member Services at 888-716-9138 and we can research this to find out if it was a denied claim, possible balance billing or any other reason.

What is my prescription drug copay?
The copay you are responsible for when filling a prescription depends on the drug you are receiving and for how long of a supply is being filled. Your benefit summary for prescription drugs is available for you on the dedicated State of Illinois page of our website.

What is the Preferred Drug List?
The Preferred Drug List (PDL) is a list of drugs that meet high standards from physicians and pharmacists. Preferred drugs include generic and specific brand name drugs. Prescription drugs may now be given to you in either a 30-day supply or a 31-90 day supply, depending on the pharmacy you receive them at. You will have a lower copay for drugs on the PDL.

How do I know what prescription drugs are on the Preferred Drug List?
The Preferred Drug List (PDL) is available to you on the dedicated State of Illinois page of our website.