Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2120 - STATE OF ILLINOIS MEDICAL CARE ASSISTANCE PLAN › Subpart A - INTRODUCTION AND DEFINITIONS › Section 2120.30 - Definitions

Current through Register Vol. 48, No. 28, July 12, 2024
a) Wherever used in
				the Plan, the following terms have the following meanings:
"Anticipated Payroll" means those payrolls in which the
				  Participant is issued a paycheck during the pay period that the deduction is
				  taken.
"Card" means the stored value card provided by the Plan
				  Administrator that deducts funds electronically from a Participant's medical
				  care assistance account to pay for eligible expenses.
"Change in Family Status" means marriage, divorce, death of
				  spouse or dependent, birth or adoption of child, commencement or termination of
				  employment of spouse, significant change in cost or benefits coverage of the
				  Participant or spouse due to the spouse's employment, switch from full-time to
				  part-time status of spouse, or from part-time to full-time, or unpaid leave of
				  absence of Participant or spouse, or any other events that the Department
				  determines constitute a change in family status.
"Code" means the Internal Revenue Code of 1954 (
				  26
				  USC 1 et seq.) and applicable regulations, or
				  any successor statute.
"Compensation" for purposes of this Plan is defined under
				  Code section 414. It means wages, salaries and other employee compensation
				  received by a Participant as reported on the Participant's W-2 from this
				  employer. For purposes of discrimination testing, it may include or exclude all
				  amounts not currently includible in the Participant's gross income.
"Delayed Payroll" means those payrolls in which the
				  Participant is issued a paycheck following the pay period that the deduction is
				  taken.
"Department" means the Illinois Department of Central
				  Management Services.
"Dependent" means a Participant's spouse, qualifying child or
				  qualifying relative as defined in Internal Revenue Code sections 152 and
				  213(d)(5).
"Discriminatory Excess" is the excess of any "Highly
				  Compensated Participant" over the highest permitted benefit.
"Eligible Employee" means any employee working full time or
				  not less than half-time who is eligible to participate in the Health Plan
				  authorized by the State Employees Group Insurance Act of 1971. It includes
				  those employees who have lost eligibility to participate in the Health Plan
				  because of a reduction in hours worked but chosen continuation coverage through
				  payroll deduction as authorized by the Consolidated Omnibus Budget
				  Reconciliation Act (COBRA) ( P.L. 99-272 ) as long as there is no break in
				  coverage or payroll deductions. It also includes those employees who retire,
				  terminate employment or go on an unpaid leave of absence, but choose to
				  continue to make contributions to their MCAP for the balance of the Plan Year.
				  An eligible employee of the employer excludes independent contractors,
				  temporary employees, and retirees who return to work for not longer than 75
				  days per year after they retire.
"Employer" means the State of Illinois, which includes all
				  officers, boards, commissions, and agencies created by the Illinois
				  Constitution, whether in the executive, legislative or judicial branch, all
				  officers, departments, boards, commissions, agencies, institutions,
				  authorities, universities, bodies politic and corporate of the State; and
				  administrative units or corporate outgrowths of the State government that are
				  created by or pursuant to statute other than units of local government and
				  their officers, school districts and boards of election commissioners, and all
				  administrative units and corporate outgrowths of the above as may be created by
				  executive order of the Governor.
"Enrollment Form" means the form provided by the Department
				  for the purpose of filing an election and compensation reduction agreement and
				  for making changes authorized by the Plan.
"Grace Period" means the period following the close of the
				  Plan Year in which the Participant can incur a medical care expense eligible
				  for reimbursement from his or her medical care assistance account from the just
				  completed Plan Year. The grace period goes from July 1 until September 15 of
				  each calendar year.
"Health Plan" means health, dental and vision coverage
				  offered by the Department to eligible persons.
"Highly Compensated Participant" means any Participant who
				  was in either of the following categories at any time during the current Plan
				  Year:
an employee of the State or its administrative units or
				  corporate outgrowths who has annual total compensation greater than $75,000 or
				  any other amount established by the Internal Revenue Service; or
an employee of the State who receives compensation in excess
				  of $50,000 or any other amount established by the Internal Revenue Service and
				  is in the top 20% of all State employee salaries.
"Medical Care Expense" means any expense incurred by a
				  Participant or dependent of the Participant that was paid for as a medical
				  service expense eligible under Internal Revenue Code section 213(d). Expenses
				  that result in a double deduction for tax purposes are not eligible. For
				  example:
Premiums for health insurance coverage carried by the
				  eligible employee, spouse or dependent; and
Premiums for other health coverage carried by the
				  Participant.
"Participant" means each eligible employee who participates
				  in the Plan in accordance with Section
				  2120.210 of
				  this Part.
"Pay Period" means a regular accounting period established by
				  the State of Illinois for measuring and paying compensation earned by
				  employees. A pay period may be monthly, semi-monthly or biweekly.
"Plan" means the State of Illinois Medical Care Assistance
				  Plan as set forth in this Part, and as may be amended from time to time in
				  compliance with the Illinois Administrative Procedure Act [5 ILCS 100 ].
"Plan Administrator" means an organization, company or other
				  entity designated by the Director to perform certain duties related to the
				  administration of a specific plan in accordance with the terms of the contract
				  between the organization and the Department.
"Plan Year" means the 12-consecutive-month period beginning
				  July 1 comprising the State fiscal year.
"Qualifying Child" means an individual 26 years old or
				  younger at the end of the taxable year who has a specified family-type
				  relationship to the Participant, lives in the Participant's household for more
				  than half of the taxable year and has not provided more than one-half of his or
				  her own support during the taxable year. There is no age requirement if the
				  individual is physically and/or mentally incapable of self care.
"Qualifying Relative" means an individual who has a specified
				  family-type relationship with the Participant, is not someone else's qualifying
				  child and receives more than one-half of his or her support from the
				  Participant during the taxable year or, if no specified family-type
				  relationship to the Participant exists, is a member of and lives in the
				  Participant's household (without violating local law) for the entire taxable
				  year and receives more than one-half of his or her support from the Participant
				  during the taxable year.
"Reimbursement" means to pay a Participant in this Plan for
				  medical care expenses from his or her medical care assistance account.
"Spouse" means the person to whom the Participant is married.
				  Spouse does not include a person separated from the Participant under a decree
				  of divorce.
"Termination" means the permanent severance of the
				  Participant's employment relationship with the employer as provided by the
				  appropriate rules of the employer.
"Unsubstantiated Expenses" are expenses for medical care paid
				  for with the Card for which the Plan Administrator requires additional
				  documentation to substantiate the expense.
b) A pronoun or adjective in the masculine
				gender includes the feminine gender and the singular includes the plural,
				unless the context clearly indicates otherwise.