*The United Healthcare Shared Savings program is an example. Members are considered out-of-network and receive out-of-network benefits, but due to the Clinic's contract with MultiPlan, members receive a discount on their balance due.

**SOGA Patients Only: (03.01.2011)
The following health plans will remain in-network:

  • PHAI (Physicians Health Associates of Illinois)
  • Healthlink HMO
  • Personal Care HMO/PPO-through June 30, 2011 with the following exceptions: 1. All current pregnancies will be covered through postpartum care under your current plan, and 2. SOGA patients enrolled in the Personal Care Platinum PPO and Coventry First Health products will continue to be in-network.

Looking for a National Provider Identifier (NPI) number?
Please contact our Managed Care Department or visit the national registry.

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