Accepted Health Plans

Carle Foundation Hospital Accepted Health Plans as of January 1, 2008*

All patients are encouraged to verify their benefits with their plan administrator by referring to their insurance membership card for contact information. Many insurance companies may be included in the listed plans below.

Carle Foundation Hospital accepts plans that may not be listed below.  Carle Foundation Hospital also contracts directly with some employers. Please check with your employer or insurance carrier if you have questions about coverage.

Insurance Plan Products (Definitions)

HMO, PPO, POS, TPA, Medicare Advantage Classic Choice (Medicare Supplement)

Aetna PPO
BlueCross BlueShield PPO
CCN Network (now part of PersonalCare) PPO
CIGNA PPO
Community Partners Health Plans PPO, TPA
CorVel Corporation PPO
First Health Network (now part of PersonalCare)
 PPO
Great West Healthcare PPO
HealthLink PPO
HFN, Inc. PPO
Immergrun PPO
MCS Patient Centered National Healthcare PPO
Methodist First Choice PPO
Medicaid Standard Medicaid
Medicare Standard Medicare
MultiPlan (formerly BCE Emergis) PPO
PersonalCare Insurance of Illinois PPO Platinum
PHCS (Private Healthcare Systems, Inc.) PPO Network
Pyramid Life Insurance Medicare SELECT; Medicare Supplement
Three Rivers Provider Network (TRPN) PPO
TriCare (CHAMPUS) PPO, HMO
United HealthCare PPO
USA Managed Care Organization PPO

Definitions

Health Maintenance Organization (HMO): HMOs offer prepaid, comprehensive health coverage for both hospital and physician services. An HMO contracts with health care providers, e.g., physicians, hospitals, and other health professionals, and members are required to use participating providers for all health services. Members are enrolled for a specified period of time. Model types include staff, group practice, network and IPA.

Preferred Provider Organization (PPO): Some combination of hospitals and physicians that agrees to render particular services to a group of people, perhaps under contract with a private insurer. The services may be furnished at discounted rates and the insured population may incur out-of-pocket expenses for covered services received outside the PPO if the outside charge exceeds the PPO payment rate.

Exclusive Provider Organization (EPO): A managed care organization that is organized similarly to PPOs in that physicians do not receive capitated payments, but that only allows patients to choose medical care from network providers. If a patient elects to seek care outside of the network, then he or she will not be reimbursed for the cost of the treatment.

Medicare Supplement:  A variety of health insurance plans designed to cover expenses not covered by Medicare.

Point-of-Service (POS): Also known as an open-ended HMO, POS plans encourage, but do not require, members to choose a primary care physician. As in traditional HMOs, the primary care physician acts as a "gatekeeper" when making referrals; plan members may, however, opt to visit non-network providers at their discretion. Subscribers choosing not to use the primary care physician must pay higher deductibles and copays than those using network physicians.

TPA: Third-party administrators of a health plan.

Workers Compensation: A state-mandated program providing insurance coverage for work-related injuries and disabilities.

Indemnity: A plan which reimburses physicians for services performed, or beneficiaries for medical expenses incurred. Such plans are contrasted with group health plans, which provide service benefits through group medical practice.

* Carle Clinic Association and Carle Foundation Hospital contract with insurance providers separately and may or may not choose to participate in all of the same insurance plans. Patients are urged to check with their carriers as to whether services are covered for either or both organizations.