reglab/statecodes huggingface dataset:
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2190 - COMMUTER SAVINGS PROGRAM › Subpart H - MISCELLANEOUS › Section 2190.760 - Nonassignability of Rights

Current through Register Vol. 48, No. 28, July 12, 2024
The right of any participant to receive reimbursement under
				  the Plan shall not be alienable by the participant by assignment or any other
				  method except as provided in Section
				  2190.610 of this Part.
				  Any attempt to alienate a participant's interest, other than as specifically
				  authorized, will not be recognized.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2190 - COMMUTER SAVINGS PROGRAM › Subpart H - MISCELLANEOUS › Section 2190.770 - Tax Consequences

Current through Register Vol. 48, No. 28, July 12, 2024
Once enrolled, it shall be the obligation of each participant
				  to determine whether each payment under Section
				  2190.420 is
				  excludable from the participant's compensation for federal and State income tax
				  purposes. Participants should notify the Department if there is reason to
				  believe that any payment is not excludable.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2190 - COMMUTER SAVINGS PROGRAM › Subpart H - MISCELLANEOUS › Section 2190.780 - Indemnification of State by Participants

Current through Register Vol. 48, No. 28, July 12, 2024
If any participant receives reimbursements under Section
				  2190.610 that are not
				  for qualified transportation expenses, the participant shall indemnify and
				  reimburse the State for any liability the State may incur for failure to
				  withhold federal or State income tax.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2190 - COMMUTER SAVINGS PROGRAM › Subpart H - MISCELLANEOUS › Section 2190.790 - Right to Amend and Terminate Reserved

Current through Register Vol. 48, No. 28, July 12, 2024
a) The Department has established the Plan
				with the bona fide intention and expectation that it will be continued
				indefinitely, but the Department will have no obligation to maintain the Plan
				for any given length of time and may discontinue or terminate the Plan at any
				time without liability.
b) Upon
				termination or discontinuance of the Plan, all elections and reductions in
				compensation relating to the Plan shall terminate, and the Department will pay
				any remaining balances to the participants as additional taxable
				compensation.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2200 - STATE EMPLOYEES GROUP INSURANCE PROGRAM RETIREE PREMIUM CONTRIBUTIONS › Subpart A - GENERAL › Section 2200.110 - Governing Authority

Current through Register Vol. 48, No. 28, July 12, 2024
The State Employees Group Insurance Program Retiree Premium
				  Contributions program is governed by the State Employees Group Insurance Act of
				  1971 [5 ILCS 375 ] and this Part.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2200 - STATE EMPLOYEES GROUP INSURANCE PROGRAM RETIREE PREMIUM CONTRIBUTIONS › Subpart A - GENERAL › Section 2200.120 - Purpose

Current through Register Vol. 48, No. 28, July 12, 2024
The purpose of this Part is to outline the premium amount
				  that annuitants, survivors and retired employees of the General Assembly
				  Retirement System, the State Employees' Retirement System, the State
				  Universities Retirement System, the Teachers' Retirement System, and the Judges
				  Retirement System will be required to contribute towards the cost of the basic
				  program of group health benefits provided under the Act.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2200 - STATE EMPLOYEES GROUP INSURANCE PROGRAM RETIREE PREMIUM CONTRIBUTIONS › Subpart A - GENERAL › Section 2200.140 - Records and Certifications

Current through Register Vol. 48, No. 28, July 12, 2024
Records and other necessary certifications will be furnished
				  to the Director as may be necessary for the administration of this Part. These
				  records and certifications will be retained and provided as necessary by each
				  appropriate Department.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2200 - STATE EMPLOYEES GROUP INSURANCE PROGRAM RETIREE PREMIUM CONTRIBUTIONS › Subpart A - GENERAL › Section 2200.150 - Severability

Current through Register Vol. 48, No. 28, July 12, 2024
If any provision of the Act or this Part or application of
				  the Act or this Part to any person or circumstance is held invalid, that
				  invalidity does not affect other provisions or applications of the Act or this
				  Part that can be given effect without the invalid application or provision. To
				  this end, the provisions of the Act and this Part are declared to be
				  severable.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2200 - STATE EMPLOYEES GROUP INSURANCE PROGRAM RETIREE PREMIUM CONTRIBUTIONS › Subpart B - RESPONSIBILITIES OF THE DEPARTMENT › Section 2200.210 - CMS Responsibility

Current through Register Vol. 48, No. 28, July 12, 2024
CMS shall:
a)
				Establish premium contributions consistent with the Act and this
				Part;
b) Calculate the premium
				contribution owed by each Retired Employee, Annuitant or Survivor in accordance
				with Subpart E of this Part and transmit that calculation to the appropriate
				Retirement System on a monthly basis to allow for collection of the premium;
				and
c) Develop information and
				distribute that information to Retired Employees, Annuitants and Survivors
				related to this Part.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2200 - STATE EMPLOYEES GROUP INSURANCE PROGRAM RETIREE PREMIUM CONTRIBUTIONS › Subpart B - RESPONSIBILITIES OF THE DEPARTMENT › Section 2200.220 - Determining Benefits

Current through Register Vol. 48, No. 28, July 12, 2024
CMS will determine the benefits available to Annuitants,
				  Retired Employees, Survivors and their eligible dependents.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2200 - STATE EMPLOYEES GROUP INSURANCE PROGRAM RETIREE PREMIUM CONTRIBUTIONS › Subpart B - RESPONSIBILITIES OF THE DEPARTMENT › Section 2200.230 - Provision for Benefits

Current through Register Vol. 48, No. 28, July 12, 2024
The Director shall, by contract, self-insurance, or otherwise
				  make available the program of health benefits for Annuitants, Retired
				  Employees, Survivors and their eligible dependents.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2200 - STATE EMPLOYEES GROUP INSURANCE PROGRAM RETIREE PREMIUM CONTRIBUTIONS › Subpart B - RESPONSIBILITIES OF THE DEPARTMENT › Section 2200.240 - Health Insurance Portability and Accountability Act (HIPAA)

Current through Register Vol. 48, No. 28, July 12, 2024
CMS will comply with the uses and disclosures of protected
				  health information, permitted by the Health Insurance Portability and
				  Accountability Act (HIPAA) (
				  PL
				  104-191 ).
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2200 - STATE EMPLOYEES GROUP INSURANCE PROGRAM RETIREE PREMIUM CONTRIBUTIONS › Subpart B - RESPONSIBILITIES OF THE DEPARTMENT › Section 2200.250 - Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA)

Current through Register Vol. 48, No. 28, July 12, 2024
CMS shall be responsible for compliance with the continuation
				  of benefits requirements of COBRA ( PL 99-272 ). All premiums must be collected
				  and transmitted to CMS by the respective retirement system.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2200 - STATE EMPLOYEES GROUP INSURANCE PROGRAM RETIREE PREMIUM CONTRIBUTIONS › Subpart C - RESPONSIBILITIES OF THE APPROPRIATE RETIREMENT SYSTEM › Section 2200.310 - Annuity

Current through Register Vol. 48, No. 28, July 12, 2024
The Retirement Systems shall report the value of the annuity
				  of each Retired Employee, Annuitant and Survivor to CMS on a monthly
				  basis.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2200 - STATE EMPLOYEES GROUP INSURANCE PROGRAM RETIREE PREMIUM CONTRIBUTIONS › Subpart C - RESPONSIBILITIES OF THE APPROPRIATE RETIREMENT SYSTEM › Section 2200.320 - Enrollments and Terminations

Current through Register Vol. 48, No. 28, July 12, 2024
The Retirement Systems shall enroll and terminate their
				  respective Retired Employees, Annuitants, Survivors and their dependents
				  pursuant to CMS' policies and procedures and consistent with the terms of the
				  Act.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2200 - STATE EMPLOYEES GROUP INSURANCE PROGRAM RETIREE PREMIUM CONTRIBUTIONS › Subpart C - RESPONSIBILITIES OF THE APPROPRIATE RETIREMENT SYSTEM › Section 2200.330 - Premium Collection and Payment

Current through Register Vol. 48, No. 28, July 12, 2024
a) The Retirement Systems shall be
				responsible for the collection and transmission to CMS of the premium for their
				respective Retired Employees, Annuitants and Survivors.
b) Individuals whose annuity check is
				insufficient to cover the amount of the monthly premiums due pursuant to
				Subpart E shall be direct billed.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2200 - STATE EMPLOYEES GROUP INSURANCE PROGRAM RETIREE PREMIUM CONTRIBUTIONS › Subpart D - VALUE OF ANNUITY › Section 2200.410 - Calculation

Current through Register Vol. 48, No. 28, July 12, 2024
a) The annuity upon
				which the health insurance premiums are based shall be the gross sum of all
				annuities received by the Retired Employee, Annuitant or Survivor from the
				Retirement Systems.
b) For
				individuals who retired under PA 93-0839 (between August 16, 2004 and October
				31, 2004), PA 94-0109 (between July 1, 2005 and September 30, 2005) or PA
				94-0839 (between June 6, 2006 and August 31, 2006), the annuity shall be
				calculated by SERS and will be equal to the amount of the annuity that would
				have been received.
c) For
				individuals who retired under the University of Illinois Cooperative Extension
				Service, the initial annuity shall be the sum of all annuities as provided by
				each of the Retirement Systems and the U.S. Office of Personnel
				Management.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2200 - STATE EMPLOYEES GROUP INSURANCE PROGRAM RETIREE PREMIUM CONTRIBUTIONS › Subpart E - PREMIUMS › Section 2200.510 - Calculation

Current through Register Vol. 48, No. 28, July 12, 2024
CMS shall calculate the premiums due for the coverage of the
				  Annuitant, Retired Employee or Survivor under this Part as follows:
a) A percentage of the annuity, as outlined
				under Section
				2200.520;
				plus
b) A percentage of cost, as
				outlined under Section
				2200.530.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2200 - STATE EMPLOYEES GROUP INSURANCE PROGRAM RETIREE PREMIUM CONTRIBUTIONS › Subpart E - PREMIUMS › Section 2200.520 - Percentage of Annuity

Current through Register Vol. 48, No. 28, July 12, 2024
CMS shall calculate the premiums due under this Part as
				  follows:
a) For each Retired Employee,
				Annuitant or Survivor with primary coverage under the State program, the
				premium shall be equal to 2% of the total annual annuity received by the
				Retired Employee, Annuitant or Survivor from any and all of the five State
				Retirement Systems;
b) For each
				Retired Employee, Annuitant or Survivor with primary coverage under the federal
				Medicare health insurance program (Title XVIII of the Social Security Act, as
				added by Public Law 89-97 ), the premium shall be equal to 1% of the total
				annual annuity received by the Retired Employee, Annuitant or Survivor from any
				and all of the five State Retirement Systems;
c) For each Retired Employee, Annuitant or
				Survivor age 65 or older whose primary coverage would otherwise be coverage
				under the federal Medicare health insurance program, except for his or her
				inability to contribute to Medicare while actively working, the premium shall
				be equal to 1% of the total annual annuity received by the Retired Employee,
				Annuitant or Survivor from any and all of the five State Retirement
				Systems.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2200 - STATE EMPLOYEES GROUP INSURANCE PROGRAM RETIREE PREMIUM CONTRIBUTIONS › Subpart E - PREMIUMS › Section 2200.530 - Percentage of Cost

Current through Register Vol. 48, No. 28, July 12, 2024
a) In addition to
				the percentage of annuity outlined in Section 2200.420, any SERS, SURS or TRS
				Annuitant who retired on or after January 1, 1998 with less than 20 years of
				State service, or any SERS, SURS or TRS Survivor whose annuity is based upon
				the work of an individual who retired on or after January 1, 1998 with less
				than 20 years of State service, shall pay 5% of the cost of the elected
				coverage for each year less than 20 upon which the annuity is based.
b) SURS Annuitants who retired under PA
				91-0395, or SURS Survivors whose annuity is based upon the work of an
				individual who retired under PA 91-0395, shall not be required to pay the
				additional amounts outlined in subsection (a)(1).
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2200 - STATE EMPLOYEES GROUP INSURANCE PROGRAM RETIREE PREMIUM CONTRIBUTIONS › Subpart E - PREMIUMS › Section 2200.540 - Dependent Premiums

Current through Register Vol. 48, No. 28, July 12, 2024
a) Annuitants,
				Retired Employees and Survivors shall be required to pay premiums for any
				elected dependent coverage in an amount equal to the premiums charged to active
				employees for elected dependent coverage.
b) Premiums charged for elected dependent
				coverage shall be in addition to any premiums due under Sections
				2200.520
				and
				2200.530.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2200 - STATE EMPLOYEES GROUP INSURANCE PROGRAM RETIREE PREMIUM CONTRIBUTIONS › Subpart E - PREMIUMS › Section 2200.550 - Optional Coverage Premiums

Current through Register Vol. 48, No. 28, July 12, 2024
a)
				Annuitants, Retired Employees and Survivors are required to pay premiums for
				any elected optional coverage, including dental and optional life
				coverage.
b) Premiums paid for
				dental coverage for Annuitants, Retired Employees, Survivors and their enrolled
				dependents shall be in an amount equal to that paid by active
				employees.
c) Premiums paid for
				optional life insurance coverage for Annuitants, Retired Employees, Survivors
				and their enrolled dependents shall be in an amount equal to that paid by
				active employees.
d) Premiums
				charged for elected optional coverage shall be in addition to any premiums due
				under Sections
				2200.520,
				2200.530 and
				2200.540.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2200 - STATE EMPLOYEES GROUP INSURANCE PROGRAM RETIREE PREMIUM CONTRIBUTIONS › Subpart E - PREMIUMS › Section 220.560 - Exempt from Premiums

Current through Register Vol. 48, No. 28, July 12, 2024
a) The
				following individuals shall not be required to pay premiums due under Section
				2200.520 or
				2200.530:
1) Any person not otherwise covered by the
				Act who has retired as a participating member under Article 2 of the Code but
				is ineligible for the retirement annuity under Section 2-119 of the
				Code;
2) University of Illinois
				Cooperative Extension retirees whose member basic health premium is paid by the
				Cooperative Extension Service; and
3) Survivors of employees with less than one
				year of service.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2210 - STATE EMPLOYEES GROUP HEALTH INSURANCE PROGRAM › Subpart A - PURPOSE AND DEFINITIONS › Section 2210.110 - Governing Authority

Current through Register Vol. 48, No. 28, July 12, 2024
The Program will be governed by the State Employees Group
				  Insurance Act of 1971 [5 ILCS 375 ] and this
				  Part.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2210 - STATE EMPLOYEES GROUP HEALTH INSURANCE PROGRAM › Subpart A - PURPOSE AND DEFINITIONS › Section 2210.120 - Purpose and Application

Current through Register Vol. 48, No. 28, July 12, 2024
The purpose of this Part is to give full effect to the
				  purposes of the Act by providing for administration of a program of health
				  benefits for persons in the service of the State of Illinois and their eligible
				  dependents.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2210 - STATE EMPLOYEES GROUP HEALTH INSURANCE PROGRAM › Subpart A - PURPOSE AND DEFINITIONS › Section 2210.140 - Records and Certifications

Current through Register Vol. 48, No. 28, July 12, 2024
Each affected department of the State shall furnish records
				  and other necessary certifications to the Director as necessary for the
				  administration of the Program. These records and certifications shall be
				  retained and provided as necessary by each Department (Section 15(e) of the
				  Act).
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2210 - STATE EMPLOYEES GROUP HEALTH INSURANCE PROGRAM › Subpart A - PURPOSE AND DEFINITIONS › Section 2210.150 - Severability

Current through Register Vol. 48, No. 28, July 12, 2024
If any provision of the Act or this Part, or
				  application of the Act or this Part to any person or circumstance, is held
				  invalid, that invalidity shall not affect other provisions or applications of
				  the Act or this Part that can be given effect without the invalid application
				  or provision
. (Section 16 of the Act) To this end, the provisions of
				  the Act and this Part are declared to be severable.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2210 - STATE EMPLOYEES GROUP HEALTH INSURANCE PROGRAM › Subpart A - PURPOSE AND DEFINITIONS › Section 2210.160 - Conflicting Provisions

Current through Register Vol. 48, No. 28, July 12, 2024
If any provision of this Part conflicts with a provision of
				  the Act, the terms of the Act shall control. If any provision of this Part
				  conflicts with a provision of the Benefits Handbook or other publication issued
				  by the Agency, the terms of this Part shall control.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2210 - STATE EMPLOYEES GROUP HEALTH INSURANCE PROGRAM › Subpart B - ELIGIBILITY › Section 2210.210 - Member Eligibility

Current through Register Vol. 48, No. 28, July 12, 2024
a) The following
				individuals are eligible to enroll in the Program as a Member:
1) Employees
A) Newly-hired Employees will be eligible as
				of the first day of active State service, and
B) An Employee who would also otherwise be
				eligible as a Dependent must be enrolled as a Member.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2210 - STATE EMPLOYEES GROUP HEALTH INSURANCE PROGRAM › Subpart B - ELIGIBILITY › Section 2210.220 - Dependent Eligibility

Current through Register Vol. 48, No. 28, July 12, 2024
a) Except
				as limited in this Section, the following categories of individuals are
				eligible to be covered as Dependents under the Program:
1) A Member's spouse
A) Common law spouses, ex-spouses, and
				persons not legally married are not eligible to be covered under the Program;
				and
B) A new spouse of a Survivor
				is not eligible to be covered under the Program.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2210 - STATE EMPLOYEES GROUP HEALTH INSURANCE PROGRAM › Subpart C - ENROLLMENT › Section 2210.310 - Initial Enrollment for New Employees

Current through Register Vol. 48, No. 28, July 12, 2024
a) A New Employee will have an initial
				enrollment period lasting 30 calendar days from the first date of
				employment.
b) The following
				elections may be made by a New Employee during the initial enrollment period:
1) Enroll in either the Basic Health Plan or
				any available Optional Health Plan;
2) Elect not to participate in the
				Program;
3) Enroll eligible
				Dependents, or
4) Enroll in the
				dental plan administered by the Agency.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2210 - STATE EMPLOYEES GROUP HEALTH INSURANCE PROGRAM › Subpart C - ENROLLMENT › Section 2210.320 - Initial Enrollment for New Annuitants and New Survivors Who Are Not Medicare Eligible

Current through Register Vol. 48, No. 28, July 12, 2024
a) A new
				Annuitant has an initial enrollment period lasting 60 days from the date of
				retirement from State employment.
b) A new Survivor has an initial enrollment
				period lasting 60 days from the date the Survivor first becomes eligible to
				receive an annuity as the result of the death of an Employee, Retiree, or
				Annuitant.
c) The following
				elections may be made by a new Annuitant or new Survivor during the initial
				enrollment period:
1) Enroll in either the
				Basic Health Plan or any available Optional Health Plan;
2) Elect not to participate in the
				Program;
3) Enroll eligible
				Dependents, or
4) Enroll in the
				dental plan administered by the Agency.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2210 - STATE EMPLOYEES GROUP HEALTH INSURANCE PROGRAM › Subpart C - ENROLLMENT › Section 2210.330 - Initial Enrollment for New Annuitants and New Survivors Who Are Medicare Eligible

Current through Register Vol. 48, No. 28, July 12, 2024
a) If a new
				Annuitant or new Survivor is already a Medicare eligible beneficiary at the
				time they first become eligible for coverage, the new Annuitant or new Survivor
				will be required to enroll into the TRAIL Program within 60 days after
				retirement, regardless of the Medicare eligibility status of any enrolled
				Dependents.
b) The following
				elections may be made by a new Annuitant or new Survivor during the initial
				enrollment period:
1) Enroll in the TRAIL
				program, failure to enroll in coverage will result in the new Annuitant's or
				Survivor's health coverage being defaulted to a waive status;
2) Elect any available Optional Health
				Plan;
3) Elect not to participate
				in the Program;
4) Enroll eligible
				Dependents, or
5) Enroll in the
				dental plan administered by the Agency.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2210 - STATE EMPLOYEES GROUP HEALTH INSURANCE PROGRAM › Subpart C - ENROLLMENT › Section 2210.340 - Annual Open Enrollment Period for Non-TRAIL Program Members

Current through Register Vol. 48, No. 28, July 12, 2024
a) The Agency shall
				conduct an annual open enrollment period during which all eligible Employees,
				Retired Employees, Annuitants, and Survivors may make changes to their benefit
				elections under the Program.
b) The
				Agency shall annually determine the beginning date and ending date of the
				annual open enrollment period. The enrollment period must last at least 30
				calendar days.
c) All annual open
				enrollment period elections will be effective as of the beginning of the next
				Plan Year.
d) Members may make the
				following elections during an annual open enrollment period:
1) Change health plans, if more than one
				health plan option is available to the Member;
2) Enroll or re-enroll in the Program if the
				Member had previously elected not to participate in the Program;
3) Re-enroll in the Program if coverage is
				currently terminated due to non-payment of premiums. Such re-enrollment will be
				permitted and coverage reinstated only if the Member makes payment at the time
				of enrollment of all outstanding past-due premiums plus the premium payment for
				the first month of the Plan Year for which the Member is attempting to enroll.
				This election option is available only to Employees and Annuitants, Retired
				Employees, and Survivors terminated due to non-payment of premiums incurred as
				an Employee. Annuitant, Retired Employee, or Survivors terminated due to unpaid
				premiums as an Annuitant, Retired Employee, or Survivor will not be permitted
				to re-enroll in the Program;
4)
				Elect not to participate in the Program;
5) Add or drop coverage for eligible
				Dependents; or
6) Add or drop
				dental coverage.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2210 - STATE EMPLOYEES GROUP HEALTH INSURANCE PROGRAM › Subpart C - ENROLLMENT › Section 2210.350 - Annual Open Enrollment Period for Medicare-primary Members eligible for the TRAIL Program

Current through Register Vol. 48, No. 28, July 12, 2024
a) To be
				eligible for the TRAIL Program the Member, and all covered Dependents, must be
				enrolled in Medicare Parts A and B and be a resident of the United Sates or a
				U.S. Territory.
b) The Agency shall
				conduct an annual open enrollment period during which all eligible Retired
				Employees, Annuitants, and Survivors may make changes to their benefit
				elections under the TRAIL Program.
c) The Agency shall annually determine the
				beginning date and ending date of the TRAIL annual open enrollment period. The
				enrollment period must last at least 30 calendar days.
d) All annual open enrollment period
				elections will be effective as of the beginning of the next Plan
				Year.
e) All newly eligible members
				may enroll into the TRAIL Program during the annual open enrollment period.
				Failure to make an election to enroll into the TRIAL Program will result in
				termination of coverage.
f)
				Eligible individuals may make the following elections during the open
				enrollment period:
1) Elect not to participate
				in the program;
2) Enroll or
				re-enroll in the program if the Member had previously elected not to
				participate;
3) Add or drop dental
				coverage; or
4) Add or drop
				coverage for eligible Dependents.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2210 - STATE EMPLOYEES GROUP HEALTH INSURANCE PROGRAM › Subpart C - ENROLLMENT › Section 2210.360 - Special Enrollment Periods

Current through Register Vol. 48, No. 28, July 12, 2024
a)
				Eligible Members may change their elections under the Program outside of the
				initial enrollment period or an annual open enrollment period only upon
				experiencing a qualifying change in status as defined by the Internal Revenue
				Service Code.
b) Election changes
				made by a Member due to a qualifying change in status must be consistent with
				the qualifying event the Member has experienced and completed within 60 days of
				the qualifying event. The Agency shall determine whether a requested election
				is consistent with the qualifying event.
c) The Agency shall determine the qualifying
				changes in status for which a special enrollment period may be granted to
				Members.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2210 - STATE EMPLOYEES GROUP HEALTH INSURANCE PROGRAM › Subpart C - ENROLLMENT › Section 2210.370 - Dependent Enrollment

Current through Register Vol. 48, No. 28, July 12, 2024
a) All
				non-Medicare eligible Dependents of a non-Medicare eligible, Annuitant, Retired
				Employee, or Survivor must be enrolled in the same health plan and, if
				applicable, dental plan as the Employee, Annuitant, Retired Employee, or
				Survivor.
b) If both parents of a
				child are Employees, either Employee may elect to cover the child as a
				Dependent. Such child may not be covered as a Dependent under both Employees
				for the same type of coverage. A Dependent whose coverage was terminated for
				nonpayment of premium under one parent may not be enrolled under the other
				parent until all premiums due are paid.
c) Employees, Annuitants, Retired Employees,
				and Survivors must complete the enrollment and submit any and all documentation
				required by the Agency in order to enroll Dependents. Failure to submit
				required documentation within the time frame specified by the Agency will
				result in denial of coverage for the Dependent.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2210 - STATE EMPLOYEES GROUP HEALTH INSURANCE PROGRAM › Subpart C - ENROLLMENT › Section 2210.380 - Time Away From Work

Current through Register Vol. 48, No. 28, July 12, 2024
a) An Employee who
				is not in active service may continue to participate in the Program as
				authorized by the Act and this Part.
b) The State shall continue to contribute
				toward the cost of an Employee's elected coverage, at the same rate as if the
				Employee were in active service, if the Employee is not in active service due
				to one of the following reasons:
1)
				Nonoccupational disability leave of absence
A)
				An Employee on a nonoccupational disability leave and is receiving ordinary or
				accidental disability benefits or retirement benefits through the appropriate
				retirement system will remain eligible for State contributions toward the cost
				of coverage until expiration of authorized leave or return to active
				service.
B) An Employee on a
				nonoccupational disability leave but is not receiving ordinary or accidental
				disability benefits or retirement benefits through the appropriate retirement
				system will remain eligible for State contributions toward the cost of coverage
				until expiration of authorized leave or return to active service, subject to a
				maximum period of 24 months.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2210 - STATE EMPLOYEES GROUP HEALTH INSURANCE PROGRAM › Subpart C - ENROLLMENT › Section 2210.390 - Opt Out or Waiver of Coverage

Current through Register Vol. 48, No. 28, July 12, 2024
An Employee who elects not to participate in the Program may
				  not be enrolled as a Dependent in the Program, the Teachers' Retirement
				  Insurance Program, the College Insurance Program, or the Local Government
				  Health Plan.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2210 - STATE EMPLOYEES GROUP HEALTH INSURANCE PROGRAM › Subpart D - TERMINATION › Section 2210.410 - Effective Date of Termination

Current through Register Vol. 48, No. 28, July 12, 2024
a)
				Termination of Member Coverage Other Than For Non-Payment.
1) An Employee's coverage will terminate on
				the date of termination of State employment, regardless of whether the
				termination of employment was voluntary or involuntary;
2) An Employee's coverage will terminate on
				the date on which the Employee's employment status changes to a part-time
				status in which the Employee is not normally required to work at least fifty
				percent (50%) of a Normal Work Period;
3) An Employee's coverage will terminate on
				the date that the maximum period allowed for a leave of absence (see Section
				10(a-10)(c) of the Act) is reached;
4) An Employee's coverage will terminate on
				the date that the maximum period allowed for premium-free permanent layoff
				benefits, if any, (see Section 10(a-10)(e) of the Act) is reached;
5) A Member's coverage will terminate on the
				date of the Member's death, and
6)
				Coverage for a Member who makes an election during an annual open enrollment
				period not to participate in the Program will terminate on the date immediately
				preceding the beginning of the Plan Year for which the open enrollment period
				was held.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2210 - STATE EMPLOYEES GROUP HEALTH INSURANCE PROGRAM › Subpart D - TERMINATION › Section 2210.420 - Termination of Coverage for Non-Payment

Current through Register Vol. 48, No. 28, July 12, 2024
a) Coverage for a Member who fails to pay the
				required monthly premium due will be terminated on the last day of the month in
				which payment is due, as identified in a final notice of premium due issued by
				the Agency.
b) A Member whose
				coverage is terminated due to non-payment of premium will not be eligible to be
				covered as a Dependent of another Member.
c) A Dependent whose coverage is terminated
				due to non-payment of premium will not be eligible to be covered by any other
				Member until all outstanding premiums are paid.
d) Any Member whose coverage is terminated
				due to non-payment of premium will not be eligible to elect continuation of
				coverage described in Section
				2210.430.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2210 - STATE EMPLOYEES GROUP HEALTH INSURANCE PROGRAM › Subpart D - TERMINATION › Section 2210.430 - Continuation of Coverage

Current through Register Vol. 48, No. 28, July 12, 2024
a) Election of
				Continuation Coverage.
1) Eligible Members who
				lose coverage due an event identified in subsection (b) may elect to continue
				coverage for a specified period of time in accordance with the requirements of
				federal law and sections
				367.2, 367e, and 367e.1 of the
				Illinois Insurance Code [215 ILCS 5
				].
2) A Member electing
				continuation coverage must make a written election to continue coverage within
				60 calendar days after the later of the date coverage is terminated due to a
				qualifying event or the date the Member or Dependent is sent notice of the
				right to elect continuation coverage.
3) A Member electing to enroll in
				continuation coverage must submit payment of all premiums due for such coverage
				within 45 calendar days of the date of election.
4) A Member who timely elects continuation
				coverage and submits payment of all premiums due will not have a gap in
				coverage and will have coverage reinstated retroactive to the date of
				termination.
5) The Agency shall
				establish the monthly premium rates to be paid by Members for continuation
				coverage. These rates are published in the CMS Benefit Program Books available
				at
https://cms.illinois.gov/benefits/stateemployee/benefitsbooks.html
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2210 - STATE EMPLOYEES GROUP HEALTH INSURANCE PROGRAM › Subpart E - PROGRAM OF BENEFITS FOR EMPLOYEES AND NON-MEDICARE PRIMARY ANNUITANTS/SURVIVORS › Section 2210.510 - Program Requirements

Current through Register Vol. 48, No. 28, July 12, 2024
a) The
				Program shall be designed by the Director and administered by the Agency to
				provide benefits on an equitable basis, to the extent possible, to all Members
				throughout the State.
b) The
				Program may include reasonable controls, including but not limited to Member
				copayments, coinsurance, and deductibles, to prevent or minimize unnecessary
				utilization of covered services and to ensure continued stability of the
				Program.
c) The Director shall, in
				accordance with statutory requirements, determine the level of benefits to be
				provided by the Program and each health plan offered through the
				Program.
d) The Program, in
				accordance with Section 6(a) of the Act, shall provide for basic hospital and
				medical/surgical coverage. The Program may also include, but is not limited to,
				benefits such as behavioral health coverage, prescription drug coverage, dental
				coverage, vision coverage, and other group benefits that are now or may become
				available.
e) The Program and any
				health plan offered under the Program may be modified or amended at any time by
				the Director. Modifications or amendments to any material provision of the
				Program or any health plan shall become effective no earlier than 60 days
				following notice of such modification or amendment being issued by the
				Agency.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2210 - STATE EMPLOYEES GROUP HEALTH INSURANCE PROGRAM › Subpart E - PROGRAM OF BENEFITS FOR EMPLOYEES AND NON-MEDICARE PRIMARY ANNUITANTS/SURVIVORS › Section 2210.520 - Covered Services

Current through Register Vol. 48, No. 28, July 12, 2024
a) Covered and
				optional services of the Program include services provided within the scope of
				their licenses by practitioners in all categories licensed under the Illinois
				Medical Practice Act of 1987 [225 ILCS 60 ].
b) The Director shall determine the type of
				services (e.g., office visits, inpatient, outpatient, diagnostic) to be covered
				by the Basic Health Plan and any Optional Health Plans offered under the
				Program.
c) The Director shall
				determine the amount of coverage available and any applicable Member
				cost-sharing for each service covered by the Basic Health Plan or any Optional
				Health Plan.
d) The Agency, either
				directly or through its contracted Plan Administrators, shall make information
				regarding covered services available to all Members and Dependents.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2210 - STATE EMPLOYEES GROUP HEALTH INSURANCE PROGRAM › Subpart E - PROGRAM OF BENEFITS FOR EMPLOYEES AND NON-MEDICARE PRIMARY ANNUITANTS/SURVIVORS › Section 2210.530 - Coordination of Benefits

Current through Register Vol. 48, No. 28, July 12, 2024
a) If a Member
				or Dependent is entitled to receive primary benefits through a group medical,
				dental, or vision plan other than the Program, the benefits payable by the
				Program may be reduced to the extent that the total payment provided by all
				plans does not exceed the total allowable expense incurred for the
				service.
b) The Program shall
				coordinate benefits with the following types of coverage:
1) Any group insurance plan;
2) Medicare;
3) Any Veterans' Administration plan;
				and
4) A motor vehicle plan
				required by law which provides medical or dental payments, in whole or in part,
				without regard to fault.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2210 - STATE EMPLOYEES GROUP HEALTH INSURANCE PROGRAM › Subpart E - PROGRAM OF BENEFITS FOR EMPLOYEES AND NON-MEDICARE PRIMARY ANNUITANTS/SURVIVORS › Section 2210.540 - Determining Rates and Premiums

Current through Register Vol. 48, No. 28, July 12, 2024
a)
				The Agency shall annually determine the premium rates, including rates for
				Dependent coverage, for each health plan offered through the Program and the
				amount of contributions toward the premium rate that shall be made by
				Members.
b) Actively working
				Employees shall pay the required premium contribution by automatic pre-tax
				payroll deduction.
c) An Employee
				who is in non-pay status as of the first work day of a pay period, or an
				Employee whose paycheck is not sufficient to deduct the amount of premium
				contribution owed to the Agency, will be billed by the Agency for the amount of
				the required premium contribution. Such employee must make personal payment of
				the amount owed within the timeframe specified by the Agency.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2210 - STATE EMPLOYEES GROUP HEALTH INSURANCE PROGRAM › Subpart E - PROGRAM OF BENEFITS FOR EMPLOYEES AND NON-MEDICARE PRIMARY ANNUITANTS/SURVIVORS › Section 2210.550 - Appeals

Current through Register Vol. 48, No. 28, July 12, 2024
a) Members may
				request an appeal of a decision by a Plan Administrator relating to a claim for
				benefits under the Program.
b) The
				Agency shall provide a description of the applicable appeals process in the
				Benefits Handbook made available to Members.
c) The Program's appeals process shall comply
				with applicable federal laws and regulations, including, but not limited to,
				the Affordable Care Act and its implementing regulations (45 CFR
				147.136).
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2210 - STATE EMPLOYEES GROUP HEALTH INSURANCE PROGRAM › Subpart E - PROGRAM OF BENEFITS FOR EMPLOYEES AND NON-MEDICARE PRIMARY ANNUITANTS/SURVIVORS › Section 2210.560 - Requirements to Enroll in Medicare

Current through Register Vol. 48, No. 28, July 12, 2024
a) Members and
				Dependents must contact the Social Security Administration to apply for
				Medicare benefits at least three months prior to turning age 65.
1) Members and Dependents who are determined
				by the Social Security Administration to be eligible for premium-free Medicare
				Part A must accept the Medicare Part A coverage and submit a copy of the
				Medicare identification card to the Agency upon receipt.
2) Members and Dependents who are determined
				by the Social Security Administration to not be eligible for premium-free
				Medicare Part A will not be required to enroll in Medicare Part A coverage.
				Such members must provide a written statement of ineligibility from the Social
				Security Administration to the Agency.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2210 - STATE EMPLOYEES GROUP HEALTH INSURANCE PROGRAM › Subpart E - PROGRAM OF BENEFITS FOR EMPLOYEES AND NON-MEDICARE PRIMARY ANNUITANTS/SURVIVORS › Section 2210.570 - Member Responsibilities

Current through Register Vol. 48, No. 28, July 12, 2024
a)
				Members are responsible for verifying that payroll deductions for the payment
				of premiums are accurate, or paying the required premiums for all elected
				coverages, as applicable.
b)
				Members must report, within 60 days of the event, information pertaining to any
				event which would result in the loss of a Dependent's eligibility under the
				Program. Failure to report a loss of eligibility, or the falsifying of
				information in order to obtain or continue coverage under the Program, will be
				considered a fraudulent act by the Member.
c) Members must timely notify the Agency of
				any other group health coverage in which the Member or a Dependent is enrolled.
				Members shall provide copies of all relevant documents relating to the other
				group health coverage, including, but not limited to, a group health
				identification card.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2210 - STATE EMPLOYEES GROUP HEALTH INSURANCE PROGRAM › Subpart F - PROGRAM OF BENEFITS FOR MEDICARE PRIMARY ANNUITANTS/SURVIVORS (TRAIL PROGRAM) › Section 2210.610 - Program Requirements

Current through Register Vol. 48, No. 28, July 12, 2024
a) The Director
				shall design the TRAIL Program to be reasonably comparable in overall stability
				and continuity of coverage, care, and services to the Basic Health
				Plan.
b) The Director may make the
				TRAIL Program available to eligible Medicare-primary Members through a contract
				or contracts with one or more vendors.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2210 - STATE EMPLOYEES GROUP HEALTH INSURANCE PROGRAM › Subpart F - PROGRAM OF BENEFITS FOR MEDICARE PRIMARY ANNUITANTS/SURVIVORS (TRAIL PROGRAM) › Section 2210.620 - Covered Services

Current through Register Vol. 48, No. 28, July 12, 2024
a) The TRAIL
				Program shall provide coverage for services covered by Medicare. Coverage will
				be provided only for services considered to be medically necessary.
b) The Director may establish reasonable
				controls, including but not limited to coinsurance, copayments, and deductibles
				for covered services to the extent permitted by the Centers for Medicare and
				Medicaid Services.
c) The TRAIL
				Program shall include coverage for prescription drugs. The Director shall
				design such coverage to comply with coverage requirements established by the
				Centers for Medicare and Medicaid Services for Medicare Part D plans (see
				42 CFR
				423.100).
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2210 - STATE EMPLOYEES GROUP HEALTH INSURANCE PROGRAM › Subpart F - PROGRAM OF BENEFITS FOR MEDICARE PRIMARY ANNUITANTS/SURVIVORS (TRAIL PROGRAM) › Section 2210.630 - Determining Rates and Premiums

Current through Register Vol. 48, No. 28, July 12, 2024
The Agency shall annually determine the premium rates,
				  including rates for Dependent coverage, for each plan offered through the TRAIL
				  Program. These rates are published at
https://cms.illinois.gov/benefits/trail.html
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2210 - STATE EMPLOYEES GROUP HEALTH INSURANCE PROGRAM › Subpart F - PROGRAM OF BENEFITS FOR MEDICARE PRIMARY ANNUITANTS/SURVIVORS (TRAIL PROGRAM) › Section 2210.640 - Premium Contributions

Current through Register Vol. 48, No. 28, July 12, 2024
a)
				Member and State contributions toward the monthly premium cost for elected
				coverage shall be in accordance with 80 Ill. Adm. Code 2200 (State Employees
				Group Insurance Program Retiree Premium Contributions).
b) The Agency shall annually determine the
				amount of monthly contributions to be made by Members toward the cost of
				Dependent coverage for each plan offered through the TRAIL Program.
c) The Agency shall annually determine the
				amount of monthly contributions to be made by Members toward the cost of any
				dental coverage elected by the Member.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2210 - STATE EMPLOYEES GROUP HEALTH INSURANCE PROGRAM › Subpart F - PROGRAM OF BENEFITS FOR MEDICARE PRIMARY ANNUITANTS/SURVIVORS (TRAIL PROGRAM) › Section 2210.650 - Appeals

Current through Register Vol. 48, No. 28, July 12, 2024
a) A Member who is unsatisfied with a
				coverage decision made by a Plan Administrator may appeal such decision by
				complying with the appeals process established by the Plan
				Administrator.
b) Each Plan
				Administrator's appeals process shall comply with all applicable federal and
				state laws and regulations.
c)
				Unless a health plan is maintained on a self-insured basis, the Agency will
				have no direct involvement in appeals relating to coverage decisions made by a
				Plan Administrator, since non-self-insured plans are regulated by the
				Department of Insurance. For any health plan maintained on a self-insured
				basis, the Agency may permit a Member who has exhausted all available appeal
				levels through the Plan Administrator to submit a final appeal request to the
				Agency only if the appeal is based on an administrative denial, not on a
				medical denial. The final appeal request will be reviewed by the Agency and
				granted or denied based on the requirements of the Act or this Part.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2210 - STATE EMPLOYEES GROUP HEALTH INSURANCE PROGRAM › Subpart G - PROGRAM FUNDING › Section 2210.710 - Health Insurance Reserve Fund

Current through Register Vol. 48, No. 28, July 12, 2024
a) All
				contributions, appropriations, interest, dividend payments, and all other
				revenues arising from the administration of the Program shall be deposited into
				HIRF.
b) The Director shall direct
				all expenditures from HIRF. Such expenditures shall be only for one or more of
				the following purposes:
1) Payment of
				administrative expenses incurred by the Department for the Program;
2) Payment of administrative expenses
				incurred by a Plan Administrator;
3) Payment of monthly premiums owed to Health
				Maintenance Organizations or other vendors administering a plan on a
				fully-insured basis;
4) Payment to
				claimants or providers for health benefits;
5) Payment of medical expenses incurred by
				the Agency for the treatment of Employees who suffer accidental injury or death
				within the scope of their employment;
6) Refunds to Employees for erroneous payment
				of their elected coverage;
7)
				Payment of premium for stop-loss or re-insurance;
8) Payment of adoption program benefits, if
				any; and
9) Payment of other
				benefits offered to Members and Dependents under the Act.