Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2160 - LOCAL GOVERNMENT HEALTH PLAN › Subpart A - PURPOSE AND DEFINITIONS › Section 2160.130 - 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, and
				  when the defined meaning is intended, the term is capitalized.
"Act" means the State Employees Group Insurance Act of 1971
				  [5 ILCS 375 ].
"Administrative Service Organization" means any person, firm
				  or corporation the Department or HFS has contracted with to administer the
				  program.
"Agreement" means the Intergovernmental Cooperation Agreement
				  executed by the Department and the Unit.
"Annuitant" means any former Employee, as defined in this
				  Section, who has retired from a Unit and is receiving an annuity from an
				  Illinois Public Pension System or another pension plan as a result of services
				  to the Unit.
"Benefit Choice Period" means the annual election period,
				  designated by the Department, during which Units may add or drop coverage for
				  Annuitants or Dependents, and Members may add or drop Dependents from coverage
				  and select coverage from available plans offered.
"Board" means the Local Government Health Plan Advisory
				  Board.
"Certificate of Creditable Coverage" means the document that
				  indicates the length of time a person has been continuously covered under a
				  qualifying previous healthcare plan.
"Compensation" means salary or wages paid by a Unit to an
				  Employee for personal services currently performed.
"Department" means the Illinois Department of Central
				  Management Services.
"Dependent" means any person participating in the Program as
				  a non-Member.
"Director" means the Director of the Illinois Department of
				  Central Management Services.
"Employee" means and includes an elected government official
				  or a person in the service of a Unit in the State of Illinois who receives
				  Compensation through the regular payroll for work currently performed and
				  receives benefits comparable to others in the same Unit.
"Fiscal Year" means the State's fiscal year, i.e., July 1
				  through June 30.
"Fund" means the Local Government Health Insurance Reserve
				  Fund.
"Health Plan Representative" means an individual from a Unit
				  who serves in the capacity of a liaison through whom the Department shall
				  conduct all business necessary to provide health benefits to that Unit.
"HFS" means the Illinois Department of Healthcare and Family
				  Services.
"Member" means an Employee or Annuitant.
"Plan" means the Local Government Health Plan.
"Pre-Existing Condition" means any disease, injury or
				  condition, excluding maternity, for which the individual was diagnosed,
				  received treatment/services, or took prescribed drugs during the 3 months
				  immediately preceding the effective date of coverage under the Program.
"Program" means a benefits program, as authorized by the
				  State Employees Group Insurance Act of 1971. The coverage offered to Units is
				  similar to that offered to employees of the State of Illinois under the
				  Program.
"Protected Health Information" or "PHI" means information
				  subject to the protections of the Health Insurance Portability and
				  Accountability Act of 1996 (HIPAA),
				  P.L.
				  104-191 and 45 CFR 160 - 164, effective April 14,
				  2001 and amended October 16, 2002 (no subsequent dates or additions).
"Unit" means a "Qualified Unit of Local Government", a
				  "Qualified Domestic Violence Shelter or Service", a "Qualified Rehabilitation
				  Facility" or a "Qualified Child Advocacy Center", as defined in the State
				  Employees Group Insurance Act of 1971.