Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2160 - LOCAL GOVERNMENT HEALTH PLAN › Subpart C - RESPONSIBILITIES OF LOCAL GOVERNMENT UNITS › Section 2160.310 - Enrollment Responsibilities

Current through Register Vol. 48, No. 28, July 12, 2024
a) Any
				Unit within the State of Illinois interested in the Program may apply to the
				Director to have its Employees provided group health coverage under the Act.
				Annuitants and Dependents may also be offered coverage.
b) To participate, Units must agree to enroll
				all Employees who work 90% or more of the Unit's normal work period, except as
				provided in subsection (b)(4). Employees may select coverage under either the
				self-funded health plan or a managed care plan that has contracted with the
				State, with the costs paid by the Unit, its Members or some combination of both
				as determined by the Unit.
1) Employees must
				be employed at least half of the normal work period as measured yearly or meet
				the standard for participation in the Illinois Municipal Retirement Fund,
				except that elected government officials employed by a Qualified Unit of Local
				Government have the option to participate in the Plan, regardless of the number
				of hours worked.
2) Employees,
				other than elected government officials, must receive Compensation through the
				regular payroll process from the Unit.
3) Units may permit Employees who work 50% to
				90% of the Unit's normal work period to enroll as Members under the
				plan.
4) An Employee of a
				participating Unit of Local Government or a Qualified Rehabilitation Facility
				who is covered as a spouse or Dependent under this or another group plan may
				elect to waive coverage, as long as the Health Plan Representative attests to
				this other coverage and at least 85% of the full-time Employees of the Unit are
				covered. A participating school district must have enrolled at least 85% of its
				full-time Employees who have not waived coverage under the district's group
				health plan by participating in a component of the district's cafeteria plan. A
				participating school district is not required to enroll a full-time Employee
				who has waived coverage under the district's health plan, provided that an
				appropriate official from the participating school district attests that the
				full-time Employee has waived coverage by participating in a component of the
				district's cafeteria plan. For the purposes of this subsection (b)(4),
				"participating school district" includes school districts and career,
				vocational and special education school districts.
5) Employees of a participating Unit who are
				not enrolled due to coverage under another group health policy or plan may
				enroll during the annual Benefit Choice Period or at a later date if the
				Employee experiences a qualifying change in status. This coverage is subject to
				possible health benefit limitations based on Pre-Existing Conditions. No
				benefits shall be payable for services incurred during the first 6 months of
				coverage to the extent the services are in connection with any Pre-Existing
				Condition. The Pre-Existing Condition time period may be reduced by the amount
				of creditable coverage Members or Dependents may have had with another
				insurance plan prior to enrollment, provided there was not a break in coverage
				of more than 63 days. A Certificate of Creditable Coverage from the prior plan
				must be provided to the employing Unit to reduce the Pre-Existing Condition
				time period.