Benefits
Your State of Illinois Medicare Advantage patients have a new plan for 2023
Your office may see patients that are State of Illinois retirees and their dependents. The State of Illinois offers health care benefits to more than 150,000 retirees.
Starting January 1, 2023, many of these retirees will have a new Aetna Medicare Advantage plan with prescription drug coverage. It’s called Aetna Medicare℠ Plan (PPO) with Extended Service Area (ESA). It is also known as the Aetna® MAPD PPO. The plan coverage depends on which State of Illinois retiree group your patient is part of:
- College Insurance Program (CIP)
- State Employees Group Insurance Program (SEGIP)
- Teachers’ Retirement Insurance Program (TRIP)
Plan highlights: Aetna MAPD PPO
You can help your State of Illinois patients better understand their Aetna MAPD PPO plan. Here’s an outline of the plan benefits:
Network and out-of-network providers
|
|
SEGIP retirees |
CIP and TRIP retirees |
|---|---|---|
|
Annual medical deductible |
$110 |
$250 |
|
Annual medical maximum out-of-pocket amount |
$1,300 |
$1,100 |
|
Primary care physician visits |
15% coinsurance after deductible |
20% coinsurance after deductible |
|
Physician specialist visits |
15% coinsurance after deductible |
20% coinsurance after deductible |
|
Diagnostic procedures (X-rays, MRIs) |
15% coinsurance after deductible |
20% coinsurance after deductible |
|
Inpatient hospital stay |
15% coinsurance after deductible |
20% coinsurance after deductible |
Benefits |
Annual medical deductible |
|---|---|
SEGIP retirees |
$110 |
CIP and TRIP retirees |
$250 |
Benefits |
Annual medical maximum out-of-pocket amount |
SEGIP retirees |
$1,300 |
CIP and TRIP retirees |
$1,100 |
Benefits |
Primary care physician visits |
SEGIP retirees |
15% coinsurance after deductible |
CIP and TRIP retirees |
20% coinsurance after deductible |
Benefits |
Physician specialist visits |
SEGIP retirees |
15% coinsurance after deductible |
CIP and TRIP retirees |
20% coinsurance after deductible |
Benefits |
Diagnostic procedures (X-rays, MRIs) |
SEGIP retirees |
15% coinsurance after deductible |
CIP and TRIP retirees |
20% coinsurance after deductible |
Benefits |
Inpatient hospital stay |
SEGIP retirees |
15% coinsurance after deductible |
CIP and TRIP retirees |
20% coinsurance after deductible |
Network pharmacies
|
Benefits |
SEGIP retirees |
CIP and TRIP retirees |
|---|---|---|
|
Annual prescription drug deductible |
$125 |
$0 |
|
Tier 1: Generic prescription drugs |
$9 at Preferred network pharmacies |
$9 at Preferred network pharmacies |
Benefits |
Annual prescription drug deductible |
|---|---|
SEGIP retirees |
$125 |
CIP and TRIP retirees |
$0 |
Benefits |
Tier 1: Generic prescription drugs |
SEGIP retirees |
$9 at Preferred network pharmacies |
CIP and TRIP retirees |
$9 at Preferred network pharmacies |
About the Extended Service Area (ESA)
The Aetna MAPD PPO plan with ESA for State of Illinois retirees allows Aetna members to use doctors and hospitals in or out of the Aetna Medicare network. Providers need to be licensed, accept Medicare and accept the Aetna plan.
More information
If you have questions about your patient’s plan, just call our Provider Contact Center at 1-800-624-0756, Monday through Friday, 8 AM to 5 PM, in all time zones.
Legal notices
Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna).
Health benefits and health insurance plans contain exclusions and limitations.