State of Illinois Department of Central Management ...

1 State of IllinoisDepartment of Central Management ServicesBureau of BenefitsIllinois State Capitol, SpringfieldClark Bridge, AltonNorth Point Marina, ZionSpoon River Scenic Drive, Fulton CountyJim Edgar Panther CreekState Fish and Wildlife Area, ChandlervilleChicago Skyline, ChicagoGiant City State Park, MakandaDana Thomas House, SpringfieldChicago Theatre, ChicagoIntroduction .. 2 Employee Responsibilities.. 3 Chapter 1: Enrollment and Eligibility InformationEligibility Requirements .. 6 Enrollment Periods .. 8 Qualifying Changes in Status Chart.. 11 Documentation Requirements Adding Dependent Coverage Chart .. 13 Documentation Requirements Terminating Dependent Coverage Chart.

2 14 Documentation Time Limits Chart .. 14 Opt Out and Waiver of Coverage.. 15 Premium Payment .. 17 Time Away from Work .. 20 Time Away from Work Chart .. 25 Termination .. 26 COBRA Coverage .. 27 COBRA Qualifying Events Chart .. 30 COBRA Second Qualifying Events Chart .. 31 Chapter 2: Health, Dental, Vision and Life Coverage InformationHealth Plan Options.. 33 Managed Care Health Plans .. 33 Quality Care Health Plan (QCHP) .. 35 Prescription Coverage .. 49 Employee Assistance Program (EAP) .. 52 Behavioral Health .. 53 Dental Coverage .. 54 Vision Coverage .. 57 Life Insurance Coverage .. 58 Chapter 3: Optional ProgramsFlexible Spending Accounts (FSA).

3 61 Commuter Savings Program (CSP).. 65 Adoption Benefit Program .. 66 Smoking Cessation Program.. 68 Chapter 4: MiscellaneousCoordination of Benefits .. 70 Medicare .. 72 Subrogation and Reimbursement .. 75 Claim Filing .. 77 Claim Appeal Process .. 78 Chapter 5: ReferenceGlossary.. 82 Index .. 86 Table of ContentsBenefits 2 Benefits Group Insurance BenefitsYour benefits are a very important part of your compensationpackage as a State of Illinois employee. Please read thishandbook carefully as it contains vital information aboutyour Bureau of Benefits within the Department of CentralManagement services ( Department ) is the bureau thatadministers the State Employees Group InsuranceProgram (Program) as set forth in the State Employees GroupInsurance Act of 1971 (Act).

4 You have the opportunity to reviewyour choices and change your coverage for each plan yearduring the annual Benefit Choice Period. If a qualifying changein status occurs, you may be allowed to make a change to yourcoverage that is consistent with the qualifying event. See thesection Enrollment Periods for more information. Group InsuranceRepresentative (GIR)A Group Insurance Representative (GIR) is your employingagency s liaison to the Department . Every State agencyhas a GIR. Some of the larger agencies also have GroupInsurance Preparers (GIP) who may assist the GIR withyour insurance needs. GIRs and GIPs are valuableresources for answering questions you may have aboutyour eligibility for coverage and to assist you in enrolling orchanging the benefits you have selected.

5 To identify your GIR, call your agency personnel office orvisit the Benefits website at click on the Contact Information link. If you are onleave of absence, contact your employing agency GIR. Ifyou are on an extended disability leave, your GIR may belocated at your retirement system office. If you haveterminated State service and are continuing coverage underCOBRA, contact the Department s Group Insurance To Get Additional InformationIf you have questions after reviewing this book,please refer to the following:FThe Department s website contains the most up-to-dateinformation regarding benefits and links to planadministrators websites.

6 Visit Benefit Choice Options booklet. This bookletcontains the most current information regardingchanges for the plan year. New benefits, changes inpremium amounts and changes in plan administratorsare included in the booklet. Review this bookletcarefully as it contains important eligibility andbenefit information that may affect your view the individual plan administrator can provide youwith specific information regarding plan coverageinclusions/exclusions. FThe Department can answer your benefit questions orrefer you to the appropriate resource for Group Insurance Division can be reached at:DCMS Group Insurance Division801 S.

7 7th Box 19208 Springfield, IL 62794-9208(800) 442-1300 or (217) 782-2548 TDD/TTY: (800) 526-0844ID CardsThe plan administrators produce ID cards at the time ofenrollment. Cards are mailed to the employee s currentaddress on file with the Bureau of Benefits. To obtainadditional cards, contact the plan administrator. Links tothe plan administrators websites can be found Health Insurance Portability andAccountability Act (HIPAA)Title II of the federally enacted Health Insurance Portabilityand Accountability Act of 1996, commonly referred to asHIPAA, was designed to protect the confidentiality and securityof health information and to improve efficiency in healthcaredelivery.

8 HIPAA standards protect the confidentiality ofmedical records and other personal health information, limitthe use and release of private health information, and restrictdisclosure of health information to the minimum State contracts with business associates (health planadministrators and other carriers) to provide services including,but not limited to, claims processing, utilization review,behavioral health services and prescription drug benefits. If you are enrolled in the Program, a copy of the Notice ofPrivacy Practices will be sent to you on an annual copies are available on the Benefits website. Introduction3 Benefits is each employee s responsibility to know theirbenefits, including coverage limitations andexclusions, and to review the information in thispublication.

9 Referral and/or approval for treatment bya physician does not ensure coverage under the must notify the Group Insurance Representative (GIR)at your employing agency or university if:FYou and/or your dependents experience a change you and/or your dependents move,you must notify the GIR at your employing your address with the personnel office orpayroll Department does not automatically updateyour address for group insurance in the Commuter Savings Program (CSP), youwill need to verify that the plan administrator has thecorrect information on their website. Changing youraddress does not automatically change your health planto a plan in that geographic area.

10 Make sure to contactyour GIR immediately when moving to a new addressas you may be eligible to change health plans. Youhave 60 days from the date of your move to changehealth plans. Refer to the managed care coverage mapin the Benefit Choice Options booklet for health planoptions available in your : Your address may be updated based upon aforwarding order from the United states Post Office. FYour dependent loses that areno longer eligible under the Program (including divorcedspouses or partners of a dissolved civil union or domesticpartner relationship) must be reported to your GIRimmediately. Failure to report an ineligible dependentis considered a fraudulent act.