Nov. 12, 2024
To ensure timely access to medical care for our members, follow CMS guidelines for Qualified Health Plan appointment wait time standards for behavioral health services, routine primary care and non-urgent specialty care.
Impacted health plans: Wait time standards apply to our members with Blue Care DirectSM HMO, MyBlue PlusSM POS, Blue Focus CareSM, Blue Precision HMOSM and Blue Choice Preferred PPOSM health plans. In addition, the standards apply to the following commercial health plans based on Illinois General Assembly House Bill 5395 requirements, which defer to CMS requirements: Blue Choice OptionsSM, Blue Choice Select PPOSM, HMO Illinois® and Blue Advantage HMOSM and PPOSM.
According to CMS guidelines as of Jan. 1, 2025: Ensure that our members seeking an appointment are able to schedule an appointment within the time frames below at least 90% of the time:
Provider specialty type |
Appointments must be available within |
Behavioral health |
10 business days |
Primary care (routine) |
15 business days |
Specialty care (non-urgent) |
30 business days |
For more information, refer to CMS’ Appointment Wait Time FAQs and IL HB 5395 Health Care Protection Act.