• Enrolled Provider A provider that is credentialed and enrolled in the Early Intervention System to provider direct service to children.
  • Approved Provider A provider that is authorized to provide services and bill an insurance company as part of their network of providers.

Commercial Health Insurance Plans (also referred to as Private Plans)

  • Health Maintenance Organization-HMO  - An HMO relies heavily on their network of providers and will typically require documentation and a standardized process to cover providers outside the network.
  • Preferred Provider Organization-PPO - A PPO contracts with a network of preferred providers, but will reimburse at a lower rate for out-of-network providers.
  • Point-of-Service-POS - A POS plan combines an HMO and PPO. A provider may subscribe to one or both plans. Because of the PPO component, out-of-network providers may be used. When requesting a list of network providers make certain both HMO and PPO providers are being included.
  • Private Insurance-Group (may also be HMO, PPO or POS) Group insurance is usually offered through an employer. The employer may purchase a policy from an insurance company or may administer its own (selfinsured) plan. Group health insurance may also be offered through other organizations or special-interest groups. Coverage varies with each plan.
  • Private Insurance-Individual (may also be HMO, PPO or POS) - Health insurance is purchased out-of-pocket directly from an insurance company to cover one of more members of a family. Coverage varies widely with each plan. This type of plan is eligible for an Insurance Exemption.

Government - Sponsored Health Plans (Also referred to as Public Plans)

  1. Civilian Health and Medical Program of the Uniformed Services (CHAMPUS)
    Civilian Health and Medical Program of the Veterans Administration (CHAMPVA) These are federal programs to cover health expenses of the dependents of military personnel and veterans. They are secondary to commercial health plans. Military medical-care providers are to be used if available. Prior authorization may be required for use of civilian providers. Administered by TriCare.
  2. MEDICAID-KidCare Assist
    Medicaid is a federally assisted program to help with medical expenses of eligible low-income families. It is administrated through the Illinois Department of Public Aid.
  3. KidCare Share, Premium or Rebate
    Children whose families are not eligible for Medicaid (KidCare Assist) due to income may be eligible for these low-income programs. KidCare Share and Premium require the insured to render co-payment for services. KidCare Premium also requires payment of a premium. Through KidCare Rebate, IDPA reimburses the policyholder for the cost of health insurance.
  4. Illinois Comprehensive Health Insurance Plan-CHIP
    CHIP is a state-subsidized program for Illinois residents who cannot otherwise purchase major medical insurance due to a pre-existing condition or disability. It is administered by Blue Cross/Blue Shield of Illinois.
  5. Division of Specialized Care for Children-DSCC
    DSCC offers low or no-cost diagnostic and medical services for children with certain eligible medical conditions that can be improved through treatment.