One Health Plan
of Illinois Inc.
6250 River Road, Suite 3030, Rosemont, Ill. 60018; 800-663-9094 or 847-518-0490
Staff/Facilities
Primary practitioners1,884
Specialists4,965
Hospitals46
Pharmacies1,032
Users
Employees & dependents11,628
Total11,628Operational date: June 1996.
Service area: Illinois: statewide.
Officers: Patricia Moldovan, president; Dr. Michael Friedberg, medical director; Jeanne Schutter, manager-provider relations; Wendy Weaver, manager-member services.
Contact: Wendy Weaver.
See One Health Plan consolidated listing under Colorado.
Oxford Health Plans (Illinois) Inc.
9801 W. Higgins Road, Suite 720, Rosemont, Ill. 60018; 847-292-2273; fax: 847-685-2297
Staff/Facilities
Primary practitioners2,021
Board-certified90%
Patients/practitioner14
Specialists3,800
Hospitals73
Pharmacies2,100
Primary care locations2,021
Users
Employer/payer groups237
Total28,151
Revenues
First-half 1997$15,224,214
1996$32,212,093Parent: Oxford Health Plans Inc.
Operational date: August 1994.
Licensed in: Illinois.
Model type: IPA.
For profit.
Service area: Illinois: Cook, DuPage, Kane, Kendall, Lake, McHenry and Will counties.
Contracts with Crescent Optical for vision in Illinois; PCS for prescription drug in Illinois; CompPsych for mental health in Illinois.
Services: General medical, vision, prescription drug, mental health. Services available unbundled. May be customized to meet employer specifications.
Rating options: Community rating by class; adjusted community rating.
Officers: William J. McIvor, president/CEO; William Stapleton, vp/chief financial officer/treasurer; John Harter, vp/director-operations/secretary; Scott Schwartz, assistant secretary; Dr. John Kiefer, medical director.
Contact: Marianne Flanagan, director-public relations, 203-851-1858.
Participating Provider Option
300 E. Randolph St., Chicago, Ill. 60601; 312-653-7181; fax: 312-938-3868
Staff/Facilities
Primary practitioners9,311
Patients/practitioner157
Specialists17,756
Hospitals231
Pharmacies2,400
Users: Group Health
Employees & dependents1,464,535
Ownership: Blue Cross & Blue Shield of Illinois.
Operational date: January 1986.
Not for profit.
Service area: Illinois: statewide; Northwest Indiana.
Contracts with Green Spring for mental health/substance abuse in Illinois; WellPoint for pharmacy benefits management in Illinois.
Services: General medical, prescription drug, mental health. Services available unbundled. May be customized to meet employer specifications.
Compensation: Negotiates hospital charges by per diem, discount off customary rates, DRGs; is compensated by employers/payers; charges by percent of services by doctors/hospitals.
UR: Standard procedures. UR provided by the PPO.
Officers: Raymond McCaskey, president/CEO; Michael Siebold, senior vp-marketing/health care management; Joanne Rounds, senior vp-subscriber services/information technology; Theodore Desch, senior vp-law/corporate affairs; Sherman Wolff, senior vp-finance.
Contact: Steve Hamlin.
Preferred Health Network
301 E. Ocean Blvd., Suite 900, Long Beach, Calif. 90802; 562-983-1616;
fax: 562-436-4389
Staff/Facilities
Primary practitioners3,291
Specialists6,025
Hospitals90
Users: Group Health
Employer/payer groups451
Employees & dependents265,458
Users: Workers Compensation
Employer/payer groups433
Single coverage472,183
Total Users737,641
Operational date: March 1984.
Service area: Illinois: 64 counties.
Services: General medical, vision, mental health, workers compensation, Medicare Select.
See Preferred Health Network consolidated listing under California.
Preferred Plan Inc.
10600 W. Higgins Road, Rosemont, Ill. 60441; 847-564-0235; fax: 847-296-8197
Staff/Facilities
Primary practitioners5,864
Board-certified80%
Specialists8,797
Hospitals224
Users: Group Health
Employees & dependents1,600,000
Operational date: February 1982.
For profit.
Service area: Illinois; Indiana; Eastern Iowa; Southern Wisconsin.
Services: General medical, mental health. Services available unbundled. May be customized to meet employer specifications. Individual enrollment is allowed.
Compensation: Negotiates hospital charges by per diem, discount off customary rates, DRGs; is compensated by employers/payers, insurers; charges flat fee per employee, by percent of savings.
UR: Standard procedures. UR provided by outside contractors.
Officers: James R. Crones, vp; Arlene Pernal, director-administration.
Contact: James R. Crones.
Principal Health Care Inc.-PPO, Illinois Division
1 Lincoln Center, Suite 1040, Oakbrook Terrace, Ill. 60181; 630-916-6622;
fax: 630-916-9595
Staff/Facilities
Primary practitioners2,719
Board-certified85%
Patients/practitioner25.7
Specialists6,057
Hospitals57
Users: Group Health
Employer/payer groups7
Employees & dependents71,875
Total Users71,875
Operational date: January 1992.
Service area: Illinois: Cook, DeKalb, DuPage, Kendall, Lake, McHenry and Will counties; Indiana: Lake County.
Officers: Kenneth J. Linde, president/CEO; Dr. Donald Levene, medical director; Dan Mulkey, director-marketing; Bob Mrizek, vp/counsel; Sharon Taylor, vp-operations; David Weiss, vp-planning/development.
Contact: Leslie G. Robinson, director-health operations.
See Principal Health Care Inc.-PPO consolidated listing under Maryland.
Private Healthcare Systems Inc.
9399 W. Higgins Road, Suite 500, Rosemont, Ill. 60018; 847-292-6700;
fax: 847-292-6736
Staff/Facilities
Primary practitioners1,781
Board-certified85%
Specialists4,454
Hospitals66
Pharmacies2,110
Users
Employees & dependents46,189
Total46,189Service Area: Illinois: Lake County and the cities of Aurora, Bloomington, Champaign, Chicago, Elgin, Galesburg, Joliet, Kankakee, La Salle, Normal, Peoria, Rantoul, Rockford, Springfield and Urbana.
See Private Healthcare Systems POS consolidated listing under Massachusetts.
Private Healthcare Systems
9399 W. Higgins Road, Suite 500, Rosemont, Ill. 60018; 847-292-6700;
fax: 847-292-6796
Staff/Facilities
Primary practitioners5,639
Board-certified86%
Specialists6,291
Hospitals89
Pharmacies2,110
Users: Group Health
Employees & dependents496,938
Total Users496,938
Operational date: May 1987.
Service area: Illinois: cities of Aurora, Bloomington, Carbondale, Champaign, Chicago, Decatur, Elgin, Galesburg, Joliet, Kankakee, La Salle, Mount Vernon, Normal, Peoria, Rantoul, Rockford, Springfield and Urbana; Lake County.
See Private Healthcare Systems PPO consolidated listing under Massachusetts.
Rush Prudential HMO
233 S. Wacker, Suite 3900, Chicago, Ill. 60606-6309; 312-234-7000; fax: 312-234-8555
Staff/Facilities
Primary practitioners1,947
Board-certified95.2%
Patients/practitioner97
Specialists4,642
Hospitals75
Pharmacies399
Primary care locations1,513
Users
Employer/payer groups946
Employees & dependents183,466
Medicare4,305
Total187,771Ownership: Prudential Insurance Co. of America/Rush Presbyterian St. Luke's Medical Center.
Operational date: August 1993.
Licensed in: Illinois, Indiana.
NCQA fully accredited.
Model type: Group/IPA.
Service area: Illinois: Cook, DuPage, Kane, Kankakee, Kendall, McHenry and Will counties; Indiana: Lake and Porter counties.
Services: General medical, dental, vision, prescription drug, mental health. Services available unbundled. May be customized to meet employer specifications.
Enrollment options: Contracts with HCFA to enroll Medicare beneficiaries. Individual enrollment is allowed.
Officers: Barbara Hill, president/CEO; Carol Coughlin, vp-finance; Jay R. Naftzger, vp/general counsel.
See Prudential HealthCare HMO consolidated listing under New Jersey.
Rush Prudential POS
233 S. Wacker Drive, Suite 3900, Chicago, Ill. 60606; 312-234-7000; fax: 312-234-8555
Staff/Facilities
Primary practitioners2,396
Patients/practitioner64
Specialists7,297
Hospitals75
Pharmacies399
Primary care locations1,768
Users
Employer/payer groups1,100
Total152,793Ownership: Prudential Insurance Co. of America/Rush Presbyterian St. Luke's Medical Center.
Operational date: August 1993.
Licensed in: Illinois, Indiana.
NCQA fully accredited.
Model type: IPA.
Service area: Illinois: Cook, DeKalb, DuPage, Grundy, Iroquois, Kane, Kankakee, Kendall, Lake, La Salle, Livingston, McHenry and Will counties; Indiana: Lake, La Porte and Porter counties.
Services: General medical, dental, mental health, prescription drug, vision. Services available unbundled. May be customized to meet employer specifications.
Officers: Barbara Hill, president/CEO; Jay R. Naftzger, vp/general counsel; Carol Coughlin, vp/CFO.
See Prudential HealthCare POS consolidated listing under New Jersey.
Rush Prudential PPO
233 S. Wacker Drive, Suite 3900, Chicago, Ill. 60606; 312-234-7000; fax: 312-234-8555
Staff/Facilities
Primary practitioners2,358
Patients/practitioner2
Specialists7,297
Hospitals75
Pharmacies399
Ownership: Prudential Insurance Co. of America/Rush Presbyterian St. Luke's Medical Center.
Operational date: 1996.
Service area: Illinois: Cook, DuPage, Kane, Kankakee, Kendall, Lake, McHenry and Will counties; Indiana: Lake and Porter counties.
Services: General medical, prescription drug, mental health. Services available unbundled. May be customized to meet employer specifications.
Compensation: Negotiates hospital charges by per diem; is compensated by employers/payers; charges flat fee per employee.
UR: Standard procedures. UR provided by the PPO.
Officers: Barbara B. Hill, president/CEO; Jay Naftzger, vp/general counsel; Carol Coughlin, vp/CFO.
Contact: 312-234-7000.
See Prudential HealthCare PPO consolidated listing under New Jersey.
Signature Dental Plan/Vision Care Advantage
200 N. Martingale Road, Schaumburg, Ill. 60646; 847-605-3000; fax: 847-605-7439
Specialty: dental/vision
Staff/Facilities
Primary practitioners47,000
Pharmacies25,000
Total Users1,600,000
Ownership: Signature Group.
Operational date: 1987.
For profit.
Service area: Alabama, Alaska, Arizona, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Illinois, Indiana, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia.
Contracts with American Chiropractic Network for chiropractic nationwide; Beltone for hearing nationwide; Managed Pharmacy Benefits for prescription drug nationwide.
Services: Dental, vision, prescription drug, hearing, chiropractic. Services available unbundled. May be customized to meet employer specifications. Individual enrollment is allowed.
Compensation: Is compensated by employers/payers; charges flat fee per employee.
UR: Member survey. UR provided by the PPO.
Officers: Paul Misniak, senior vp; Joe McGowean, vp-marketing; Carol Ree, director-dental network; Diane Takaes, director-vision network.
Contact: Joe McGowean.
USA H&W Network
7301 N. 16th St., Suite 201, Phoenix, Ariz. 85020; 602-371-3860; fax: 602-371-3889
Staff/Facilities
Primary practitioners7,401
Specialists10,557
Hospitals149
Users: Group Health
Single/family coverage188,865
Employees & dependents434,389
Total Users434,389
Operational date: June 1986.
Service Area: Illinois: 81 counties.
See USA H&W Network consolidated listing under Arizona.
USA Workers' Injury Network
916 S. Capital of Texas Highway, Austin, Texas 78746; 512-306-0201; fax: 512-328-6785
Specialty: workers compensation
Staff/Facilities
Primary practitioners3,372
Specialists7,344
Hospitals71
Users: Workers Compensation
Single coverage225,024
Total Users225,024
Operational date: June 1986.
Service area: Illinois: 81 counties.
See USA Workers' Injury Network consolidated listing under Texas.
United HealthCare Insurance Co.
1 S. Wacker Drive, P.O. Box 909714, Chicago, Ill. 60690-9714; 312-424-4460; fax: 312-424-4448
Staff/Facilities
Primary practitioners2,395
Board-certified59%
Specialists5,656
Hospitals45
Pharmacies638
Users:
Employer/payer groups1,003
Total Users82,374
Operational date: January 1987.
Service area: Illinois: Boone, Cook, DeKalb, DuPage, Kane, Kankakee, Kendall, Lake, McHenry, Porter, Will and Winnebago counties; Indiana: La Porte, Lake and St. Joseph counties.
Services: General medical, prescription drug, mental health/substance abuse.
Contact: Herman Wright, vp-marketing/sales.
See United HealthCare Corp. PPO consolidated listing under Minnesota.
United HealthCare of Illinois Inc.-Chicago
1 S. Wacker Drive, P.O. Box 909714, Chicago, Ill. 60690-9714; 312-424-4460; fax: 312-424-4914
Staff/Facilities
Primary practitioners2,016
Board-certified57%
Specialists4,701
Hospitals45
Pharmacies638
Users
Employer/payer groups204
Total Users136,964
Operational date: January 1991.
Federally qualified.
Licensed in: Illinois.
Model type: Mixed.
Service area: Illinois: Boone, Cook, Dekalb, DuPage, Kane, Kankakee, Kendall, Lake, McHenry, Will and Winnebago counties; Indiana: La Porte, Lake, Porter and St. Joseph counties.
Services: General medical, prescription drug, mental health/substance abuse.
Rating options: Adjusted community rating, experience rating.
Contact: Herman Wright, vp-sales/marketing.
See United HealthCare Corp. HMO consolidated listing under Minnesota.
United HealthCare of Illinois Inc.-Chicago
1 S. Wacker Drive, P.O. Box 909714, Chicago, Ill. 60690-9714; 312-424-4460; fax: 312-424-4914
Staff/Facilities
Primary practitioners2,872
Specialists3,468
Hospitals78
Pharmacies638
Users
Employer/payer groups1,060
Total Users318,100
Operational date: July 1983.
Licensed in: Illinois.
Model type: Mixed.
Service area: Illinois: Cook, DuPage, Kane, Kankakee, Lake, McHenry and Will counties; Indiana: La Porte, Lake and Porter counties; Wisconsin: Kenosha County.
Services: General medical, prescription drug, mental health/substance abuse, workers compensation.
Rating options: Adjusted community rating, experience rating.
Contact: Herman Wright, vp-sales/marketing.
See United HealthCare Corp. HMO consolidated listing under Minnesota.
United HealthCare
of Illinois Inc.-Chicago
1 S. Wacker Drive, P.O. Box 909714, Chicago, Ill. 60690-9714; 312-424-4460; fax: 312-424-4914
Staff/Facilities
Primary practitioners1,480
Specialists2,176
Hospitals77
Pharmacies638
Users
Employer/payer groups1,830
Total Users189,600
Operational date: January 1984.
Federally qualified.
Licensed in: Illinois.
Model type: Mixed.
Service area: Illinois: Cook, DuPage, Kane, Lake, McHenry and Will counties.
Services: General medical, prescription drug, mental health/substance abuse, workers compensation.
Rating options: Adjusted community rating, experience rating.
Contact: Herman Wright, vp-sales/marketing.
See United HealthCare Corp. HMO consolidated listing under Minnesota.
United HealthCare
of Illinois Inc.Northwest Indiana
1 S. Wacker Drive, P.O. Box 909714, Chicago, Ill. 60690-9715; 312-424-4460; fax: 312-424-4914
Staff/Facilities
Primary practitioners55
Board-certified53%
Specialists123
Users
Employer/payer groups39
Total Users284
Service area: Illinois: Boone, Cook, DeKalb, DuPage, Kane, Kankakee, Kendall, Lake, McHenry, Will and Winnebago counties; Indiana: La Porte, Lake, Porter and St. Joseph counties.
Services: General medical, prescription drug, mental health/substance abuse, workers compensation.
Contact: Herman Wright, vp-sales/marketing.
See United HealthCare Corp. HMO consolidated listing under Minnesota.
Wellmark Health Network Inc.
1420 Kensington Road, Suite 203, Oak Brook, Ill. 60523; 630-954-2900;
fax: 630-954-1518
Staff/Facilities
Primary practitioners5,952
Board-certified88%
Specialists24,093
Hospitals683
Users
Employer/payer groups124
Employees & dependents1,506,141
Total Users1,506,141
Ownership: Wellmark Inc.
Operational date: 1985.
For profit.
AAHC/URAC accreditation status: Health Utilization Management Standards.
Service area: Illinois, Indiana, Wisconsin.
Services: General medical.
Services available unbundled. May be customized to meet employer specifications.
Compensation: Negotiates hospital charges by per diem, discount off customary rates; is compensated by employers/payers, insurers, TPAs; charges flat fee per employee, by percent of savings.
UR: Standard procedures. UR provided by the PPO.
Officers: George C. Phillips Jr., CEO/president; David M. Gillies, vp-business development; Lore Stanley, vp-operations; Rick Hindon, vp-contractual/regulatory affairs; Dr. Raymond McDermott, medical adviser.
Contact: Kathy Przybylski, 630-954-2900 ext. 4221.
**Figures are consolidated, including all PPO plans in this organization.
Wellmark Health Network Inc.
1420 Kensington Road, Suite 203, Oak Brook, Ill. 60523; 630-954-2900;
fax: 630-954-1518
Staff/Facilities
Primary practitioners2,155
Specialists11,854
Hospitals156
Service area: Illinois: statewide.
See Wellmark Health Network Inc. consolidated listing under Illinois.