Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2210 - STATE EMPLOYEES GROUP HEALTH INSURANCE PROGRAM › Subpart A - PURPOSE AND DEFINITIONS › Section 2210.130 - Definitions

Current through Register Vol. 48, No. 28, July 12, 2024
Whenever used in this Part, the following terms shall have
				  the meanings set forth in this Section, unless otherwise expressly
				  provided:
"Act" means the State Employees Group Insurance Act of 1971.
				  [5 ILCS
				  375/1 ]
"Agency" means the Illinois Department of Central Management
				  Services, or any successor agency responsible for administration of the
				  Program.
"Annuitant" means an individual as defined by Section 3(b) of
				  the Act. [5
				  ILCS 375/3(b) ]
"Basic Program" or "Basic Health Plan" means the default
				  health benefits plan, as determined by the Agency, offered to Employees,
				  Annuitants, Retirees, and Survivors.
"Benefit Choice Period" means the annual open enrollment
				  period, during which time members may elect to add or change benefits coverage
				  options.
"COBRA" means the federal Consolidated Omnibus Budget
				  Reconciliation Act [29
				  U.S.C. 1161] as amended.
"Commission" means the Commission on Government Forecasting
				  and Accountability (COGFA).
"Compensation" means salary or wages payable as defined by
				  Section 3(d) of the Act. [5 ILCS 375/3(d)
				  ]
"Department" means any department, institution, board,
				  commission, officer, court or agency of the State government as defined by
				  Section 3(g) of the Act. [5 ILCS 375/3(g)
				  ]
"Dependent" means an individual as defined in Section 3(h) of
				  the Act. [5
				  ILCS 375/3(h) ]
"Director" means the Director of the Agency.
"Employee" means an individual as defined by Section 3(k) of
				  the Act. [5
				  ILCS 375/3(k) ]
"HIRF" means the Health Insurance Reserve Fund.
"Member" means an individual as defined by Section 3(l) of
				  the Act. [5
				  ILCS 375/3(l) ]
"Normal Work Period" means a specified number of hours worked
				  on a weekly or monthly basis, as established by the Director in cooperation
				  with each Department.
"Optional Program" or "Optional Health Plan" means any health
				  benefits plan, other than the Basic Program, offered to Employees, Annuitants,
				  Retirees and Survivors.
"Part-time Employee" means an Employee who works in a
				  position normally requiring actual performance of duty during 50% to 99% of a
				  Normal Work Period.
"Plan Administrator" means a third party organization,
				  company, or other entity responsible for performing duties related to the
				  administration of a specific benefit option in accordance with the terms of a
				  contract between such entity and Agency.
"Plan Participant" means a Member or Dependent properly
				  enrolled and participating in the Program.
"Plan Year" means a period of time, typically 12 months in
				  duration, on which the operation of the Program is based.
"Program" means the program of group health benefits,
				  including the Basic Program and any Optional Programs, designed and/or
				  contracted for by the Agency in accordance with the Act and this Part.
"Qualifying Change in Status" means an event recognized under
				  Section 125 of the Internal Revenue Code (26 U.S.C. 125) for
				  which the Program may permit changes in coverage elections outside of an
				  Initial Enrollment Period or Annual Open Enrollment Period.
"Retired Employee" means an individual as defined in Section
				  3(p) of the Act. [5 ILCS 375/3(p)
				  ]
"Survivor" means an individual as defined in Section 3(q) of
				  the Act. [5
				  ILCS 375/3(q) ]
"TRAIL Program" means the program of group health benefits
				  designed and/or contracted for by the Agency and made available for
				  Medicare-primary members and their Medicare-primary
				  dependents.