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Medical Services

Here is a list of some of the medical services and benefits that are covered by Harmony Health Plan. You can also look in your Certificate of Coverage for a complete list. You can also have a copy sent to you. Just call Member Service at 1-800-608-8158.

Covered Medical Services

  • Advance Practice Nurse Services 
  • Ambulatory Surgical Treatment Center Services 
  • Assistive/Augmentative Communication Devices 
  • Audiology Services 
  • Dental Services, including oral surgeons
  • Preventive dental services for Enrollees under age twenty-one (21)
  • EPSDT services for Enrollees under age twenty-one (21) excluding shift nursing for Enrollees in the MFTD HCBS Waiver for individuals who are medically fragile and technology dependent (MFTD)
  • FQHC and RHC and other approved Clinic visits 
  • Hospital inpatient services 
  • Hospital Ambulatory Services
  • Home health care services
  • Hospital emergency room visits
  • Physical, Occupational and Speech Therapy Services
  • Speech and language therapy  
  • Laboratory and X-ray services 
  • Medical supplies, equipment, prostheses and orthoses, and respiratory equipment and supplies
  • Mental health services provided under the Medicaid Clinic Option or Medicaid Rehabilitation Option
  • Nursing care for Enrollees under age twenty-one (21) not in the HCBS Waiver for individuals who are MFTD
  • Nursing care for the purpose of transitioning children from a hospital to home placement or other appropriate setting for Enrollees under age twenty-one (21)
  • Transportation to secure covered services
  • Emergency services 
  • Transplant services (non-experimental)
  • Family planning services (also at non-affiliated providers covered by the Illinois Medical Assistance Program) 
  • Contraceptive devices
  • Durable and non-durable medical equipment and supplies 
  • Whole blood and blood products 
  • Physician services 
  • Hospital outpatient services
  • Preventive services 
  • Services to prevent illness and promote health
  • Subacute alcoholism and substance abuse services
  • Early periodic screenings and diagnostic testing services 
  • Maternity care services 
  • Well-child care services 
  • Health education 
  • Nursing Facility services for the first ninety (90) days*
  • Immunizations 
  • Palliative and Hospice services
  • Chiropractic services (limited to enrollees under age 21) 
  • Podiatric Services for Enrollees under age 21 
  • Podiatric services (for diabetic members 21 and older and for all Enrollees age 21 and over) 
  • Post-Stabilization Services 
  • Practice Visits for Enrollees with Special Needs 
  • Orthotic/prosthetic devices, including prosthetic devices or reconstructive surgery incident to mastectomy 
  • Nurse midwife services 
  • Ophthalmologist (eye specialist)
  • Optical/Vision 
  • Pharmacy services**
  • Renal Dialysis Services 

* Excludes Enrollees who are Residents of a Nursing Facility on the date of enrollment with Contractor

The following category of Medicaid eligibles are exempt from copays:
  • Pregnant women, including a postpartum period of 60 days
  • Children under the age of 19 covered under Title 19 All Kids Assist
  • Hospice patients
  • American Indians and Alaskan Natives
  • Non-institutionalized individuals whose care is subsidized by the Department of Children and Family Services or the Department of Corrections
  • Indivduals enrolled in the Health Benefits for Persons with Breast or Cervical Cancer Program
  • Residents of nursing homes, intermediate care facilities for the developmentally disabled and supportive living facilities
  • Residents of a State-certified, State-licensed, or State-contracted residential care program

Not Covered

  • Elective cosmetic surgery
  • Custodial care services
  • Elective abortions


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Last Updated On: 3/19/2018