reglab/statecodes huggingface dataset:
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2160 - LOCAL GOVERNMENT HEALTH PLAN › Subpart B - RESPONSIBILITIES OF THE DEPARTMENT › Section 2160.240 - Premium Collection and Billing

Current through Register Vol. 48, No. 28, July 12, 2024
a) The Department shall generate a billing
				statement for each Unit participating in the Program on or before the end of
				each month. This billing statement shall represent the total amount due from
				the Unit for the following month's coverage.
b) Membership changes not received on or
				before the 20th of each month shall be reflected in the following month's
				billing statement.
1) Prior month changes
				shall also appear on the billing and be reflected in the total amount
				due.
2) In cases of administrative
				errors on the part of the Unit, or when the Member does not provide information
				to the Unit, a retroactive premium adjustment shall be made. Retroactive
				premium adjustments shall be made contingent upon the Department recovering any
				health care expenses that may have been paid because the Program was not timely
				notified. Retroactive premium refund adjustments shall not exceed 3
				months.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2160 - LOCAL GOVERNMENT HEALTH PLAN › Subpart B - RESPONSIBILITIES OF THE DEPARTMENT › Section 2160.250 - Other Administrative Responsibilities

Current through Register Vol. 48, No. 28, July 12, 2024
a) The Department shall offer an annual
				Benefits Choice Period for Units to:
1) add
				or drop coverage for Annuitants as a group;
2) allow Members to add or drop Dependent
				coverage;
3) allow Members to
				change health plans.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2160 - LOCAL GOVERNMENT HEALTH PLAN › Subpart B - RESPONSIBILITIES OF THE DEPARTMENT › Section 2160.260 - Program Termination

Current through Register Vol. 48, No. 28, July 12, 2024
a) Grounds
				for program termination by the Department include, but are not limited to:
1) any material breach of the
				Agreement;
2) failure to pay the
				full monthly premium by the last day of the coverage month;
3) non-compliance with enrollment
				responsibilities in accordance with Section
				2160.310;
				or
4) failure to meet the
				eligibility requirements of a Unit.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2160 - LOCAL GOVERNMENT HEALTH PLAN › Subpart B - RESPONSIBILITIES OF THE DEPARTMENT › Section 2160.270 - Health Insurance Portability and Accountability Act (HIPAA)

Current through Register Vol. 48, No. 28, July 12, 2024
The State shall comply with the uses and disclosures of
				  Protected Health Information (PHI), permitted by HIPAA and 45 CFR 160 - 164,
				  where applicable, in Plan documents.
a) The Department shall provide an annual
				notice of privacy practices outlining the legal duties and privacy practices
				concerning the PHI of Members and Dependents.
b) PHI may be disclosed:
1) to health care providers who take care of
				Members and Dependents;
2) to
				process claims and make payments for covered services;
3) for healthcare operations;
4) to remind Members or Dependents of an
				upcoming appointment; and
5) as
				required or authorized by law.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2160 - LOCAL GOVERNMENT HEALTH PLAN › Subpart C - RESPONSIBILITIES OF LOCAL GOVERNMENT UNITS › Section 2160.320 - Premium Collection and Payment

Current through Register Vol. 48, No. 28, July 12, 2024
The Unit shall be responsible for the collection and
				  transmission of Member and Dependent premiums.
a) For the first month's premium only, the
				Department must receive the premium by the first day of coverage. This premium
				is non-refundable if the Unit does not enroll.
b) For the subsequent months, the total
				amount due as specified in the billing statement, which includes the combined
				amount due from Members, Dependents and the Unit, shall be paid in full by the
				20th day of the month the billing is
				received.
c) Payments not received
				by the last day of the coverage month shall be considered delinquent and shall
				result in the suspension of payment of claims for services provided to Members
				of the Unit. Payment of claims shall be withheld until the Department receives
				the full monthly premium due.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2160 - LOCAL GOVERNMENT HEALTH PLAN › Subpart C - RESPONSIBILITIES OF LOCAL GOVERNMENT UNITS › Section 2160.330 - Signing the Agreement

Current through Register Vol. 48, No. 28, July 12, 2024
Units must sign an Agreement with the Department.
a) The first Agreement shall cover the actual
				period the Unit is enrolled between July 1 through June 30 of the first Fiscal
				Year and through the end of the second Fiscal Year.
b) Subsequent Agreements shall be effective
				for 2 State Fiscal Years.
c) The
				Agreement shall be prepared by the Department and shall contain the premium
				rates to be charged during the first Fiscal Year.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2160 - LOCAL GOVERNMENT HEALTH PLAN › Subpart C - RESPONSIBILITIES OF LOCAL GOVERNMENT UNITS › Section 2160.335 - Health Insurance Portability and Accountability Act of 1996 (HIPAA)

Current through Register Vol. 48, No. 28, July 12, 2024
The Unit shall comply with the uses and disclosures of
				  Protected Health Information, permitted by HIPAA and 45 CFR 160 - 164, where
				  applicable, in Plan documents.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2160 - LOCAL GOVERNMENT HEALTH PLAN › Subpart D - RESPONSIBILITIES OF LOCAL GOVERNMENT HEALTH PLAN REPRESENTATIVES › Section 2160.410 - Health Plan Representatives

Current through Register Vol. 48, No. 28, July 12, 2024
Health Plan Representatives shall:
a) enroll Members and their
				Dependents;
b) provide enrollment,
				termination and change in status information to the Department on forms
				provided by the Department;
c)
				provide coverage, enrollment and termination information to Members in
				accordance with the time schedules set by the Department, as described in the
				Local Government Health Plan Benefits Handbook; and
d) disseminate to Members information
				regarding benefits available under the Program, changes and/or additions to the
				Program, and any materials provided by the Department.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2160 - LOCAL GOVERNMENT HEALTH PLAN › Subpart D - RESPONSIBILITIES OF LOCAL GOVERNMENT HEALTH PLAN REPRESENTATIVES › Section 2160.420 - Appeals Process Responsibilities

Current through Register Vol. 48, No. 28, July 12, 2024
The Member shall be responsible for handling appeals
				  concerning claims payments.
a) All
				correspondence concerning appeals must indicate the Unit in which the Member is
				enrolled in the Program.
b) If a
				Member believes that an error has been made in the benefit amount allowed or
				disallowed, the Member should contact the claims processing office of the
				self-funded managed care plan or the Administrative Service Organization within
				180 days after denial of the initial claim determination.
c) Within 60 days after receiving the results
				of the review process by the self-funded managed care plan or Administrative
				Service Organization, the Member may submit a written request for review to the
				Department for a final determination of either an administrative or medical
				necessity appeal.
d) Administrative
				appeals are based on Plan exclusions and limitations and Plan design, and the
				Department's Group Insurance Division's decision is final and binding on all
				parties.
e) Within 60 days after
				receipt of the notice of the Department's Group Insurance Division's decision,
				a medical necessity appeal may be made to the Board. The Board will review the
				documentation and facts presented to the Department and make a recommendation
				to the Director, whose decision shall be final and binding on all parties. The
				Director's decision shall be in writing.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2160 - LOCAL GOVERNMENT HEALTH PLAN › Subpart E - ADVISORY BOARD › Section 2160.510 - Appointment of Advisors

Current through Register Vol. 48, No. 28, July 12, 2024
The Director shall establish the Local Government Health Plan
				  Advisory Board. This Board shall consist of 7 advisors who are Members of the
				  Plan.
a) Advisors shall be appointed
				by the Director for 3-year terms beginning on September 1.
b) Of the initial appointments, 3 advisors
				shall be appointed for one year, 2 advisors shall be appointed for 2 years, and
				2 advisors shall be appointed for 3 years. All subsequent appointments shall be
				for 3-year terms.
c) If the Unit
				from which the advisor was appointed withdraws from the Plan, the advisor's
				appointment will terminate as of the date of the Unit's withdrawal. The
				Director shall appoint another Member to serve the balance of the
				term.
d) If the advisor ceases to
				be a Member, the advisor's appointment will terminate as of the date membership
				ceased. The Director shall appoint another Member to serve the balance of the
				term.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2160 - LOCAL GOVERNMENT HEALTH PLAN › Subpart E - ADVISORY BOARD › Section 2160.520 - Responsibilities of the Board

Current through Register Vol. 48, No. 28, July 12, 2024
The responsibilities of the Board shall consist of the
				  following:
a) annually review material
				to be distributed to the Units;
b)
				advise the Department concerning any modifications needed to improve the
				administration of the Plan;
c)
				review rate setting methodologies;
d) hear medical necessity appeals and make
				recommendations to the Director, as provided in Section
				2160.420.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2160 - LOCAL GOVERNMENT HEALTH PLAN › Subpart F - FUNDING › Section 2160.610 - Local Government Health Insurance Reserve Fund

Current through Register Vol. 48, No. 28, July 12, 2024
a) Premium payments by Units for group health
				coverage shall be deposited in the Local Government Health Insurance Reserve
				Fund (see
				5 ILCS
				375/10(i) ). The Fund may also
				receive deposits of other revenues and monies.
b) All expenditures from this Fund shall be
				used for payments of Members' health care benefits and to reimburse the
				Department, HFS, Administrative Service Organizations and insurers for all
				expenses incurred in the administration of the Plan. No State funds shall be
				used for these purposes.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2160 - LOCAL GOVERNMENT HEALTH PLAN › Subpart F - FUNDING › Section 2160.620 - Premium Rate Structure

Current through Register Vol. 48, No. 28, July 12, 2024
The Director shall annually determine monthly rates of
				  payment subject to the following constraints.
a) A tiered rate methodology shall be
				employed.
b) Units shall be
				assigned a rate tier based on the projected costs for each Unit according to
				the following guidelines:
1) In the first
				Fiscal Year of coverage the rates shall be based on the cost of administration
				and the cost of medical services adjusted for age, sex, geographic or
				demographic characteristics, or other factors that may affect the costs of the
				Plan. A margin to cover fluctuation in the amount of claims shall also be added
				to the premium.
2) In subsequent
				years, premium rates shall be based on prior years' claims experience, the cost
				of administration and the cost of medical services adjusted for age, sex,
				geographic or demographic characteristics, or other factors that may affect the
				costs of the Plan. A margin to cover fluctuations in the amount of claims shall
				also be added to the premium.
3)
				Premium rates shall remain unchanged throughout the Fiscal Year. A Unit shall
				experience a one-tier rate increase or decrease if the projected costs, based
				on employee demographics and actual prior years' claims experience of Members
				and Dependents, warrant such an increase or decrease for the following Fiscal
				Year.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2160 - LOCAL GOVERNMENT HEALTH PLAN › Subpart G - HEALTH CARE COVERAGE › Section 2160.710 - Local Government Health Plan

Current through Register Vol. 48, No. 28, July 12, 2024
The Local Government Health Plan is similar to the benefits
				  offered by the State of Illinois to its employees.
a) The Local Government Health Plan benefits
				are described in the Local Government Health Plan Benefits Handbook that shall
				be provided to all Health Plan Representatives for distribution to all
				Members.
b) All Units participating
				in the Plan shall receive sufficient Local Government Health Plan Benefits
				Handbooks and Benefit Choice Options booklets to distribute to each of their
				Members.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2160 - LOCAL GOVERNMENT HEALTH PLAN › Subpart G - HEALTH CARE COVERAGE › Section 2160.720 - Health Care Coverage

Current through Register Vol. 48, No. 28, July 12, 2024
a) Except as
				provided in subsections (b) and (c), for any Member or Dependent under the
				Plan, there is no coverage for 6 months after enrollment for health conditions
				that have been treated during the 3 months prior to enrollment, as described in
				the Local Government Health Plan Benefits Handbook.
b) For all Members and their covered
				Dependents who enroll under the Plan at the time their respective Unit
				initially enrolls in the Plan, the limitation described in subsection (a) shall
				not apply.
c) 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.
d) Coverage begins for all Members and their
				covered Dependents at 12:01 AM of the day the Unit is enrolled in the
				Plan.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2170 - TEACHERS' RETIREMENT INSURANCE PROGRAM › Subpart A - PURPOSE AND DEFINITIONS › Section 2170.120 - Purpose

Current through Register Vol. 48, No. 28, July 12, 2024
The purpose of the Program is to provide health benefits to
				  TRS Benefit Recipients and TRS Dependent Beneficiaries.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2170 - TEACHERS' RETIREMENT INSURANCE PROGRAM › Subpart B - RESPONSIBILITIES OF THE DEPARTMENT › Section 2170.210 - Determining Enrollment Policies

Current through Register Vol. 48, No. 28, July 12, 2024
a)
				Initial enrollment periods. Initial enrollment in TRIP is limited to the
				following periods:
1) When a TRS Benefit
				Recipient applies for annuity benefits;
2) When a TRS Benefit Recipient or TRS
				Dependent Beneficiary turns age 65;
3) When a TRS Benefit Recipient or TRS
				Dependent Beneficiary becomes eligible for Medicare;
4) When coverage of a TRS Benefit Recipient
				or TRS Dependent Beneficiary is involuntarily terminated by a former group
				plan;
5) During the Benefit Choice
				Period, if never previously enrolled.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2170 - TEACHERS' RETIREMENT INSURANCE PROGRAM › Subpart B - RESPONSIBILITIES OF THE DEPARTMENT › Section 2170.220 - Determining Insurance Rates and Premiums

Current through Register Vol. 48, No. 28, July 12, 2024
The Director of HFS will determine the insurance rates and
				  premiums for TRS Benefit Recipients and TRS Dependent Beneficiaries and present
				  to TRS the rate-setting methodology used to determine the amount of the health
				  care premiums by April 15 of each calendar year. Rates and premiums may be
				  based in part on age and eligibility for federal Medicare coverage. Pursuant to
				  the Act, premiums are based on the plan selected by the Benefit Recipient. The
				  TRS Benefit Recipient shall pay the entire premium for any coverage for a TRS
				  Dependent Beneficiary.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2170 - TEACHERS' RETIREMENT INSURANCE PROGRAM › Subpart B - RESPONSIBILITIES OF THE DEPARTMENT › Section 2170.230 - Determining Benefits

Current through Register Vol. 48, No. 28, July 12, 2024
The Director will determine the benefits available to TRS
				  Benefit Recipients and TRS Dependent Beneficiaries.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2170 - TEACHERS' RETIREMENT INSURANCE PROGRAM › Subpart B - RESPONSIBILITIES OF THE DEPARTMENT › Section 2170.240 - 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 TRS Benefit Recipients and
				  their TRS Dependent Beneficiaries.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2170 - TEACHERS' RETIREMENT INSURANCE PROGRAM › Subpart B - RESPONSIBILITIES OF THE DEPARTMENT › Section 2170.250 - Other Responsibilities

Current through Register Vol. 48, No. 28, July 12, 2024
a) CMS
				will offer an annual Benefit Choice Period for TRS Benefit Recipients to:
1) Initially enroll into the
				Program;
2) Add a Dependent
				Beneficiary, pursuant to enrollment policies;
3) Change health plans.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2170 - TEACHERS' RETIREMENT INSURANCE PROGRAM › Subpart B - RESPONSIBILITIES OF THE DEPARTMENT › Section 2170.260 - Appeals Process Responsibilities

Current through Register Vol. 48, No. 28, July 12, 2024
a) If a Participant believes that an error
				has been made in the benefit amount allowed or disallowed, the Participant
				should contact the claims processing office of the Plan Administrator, pursuant
				to the appeal process detailed in the Benefits Handbook. The Participant must
				utilize the Plan Administrator's review process to the fullest extent prior to
				contacting CMS. The Participant must contact the appropriate Plan Administrator
				within 180 days after the date of the initial claim determination.
b) If the Participant is not satisfied with
				the results of the review by the Plan Administrator, the Participant may submit
				a written request for review to CMS, within 60 days after the date of the
				initial claim determination, for a final determination.
c) If, after receiving the final
				determination, the Participant is still not satisfied, an appeal of the
				determination may be made to an appeal committee, created by the Director,
				within 60 days after the final determination by CMS. The findings of the appeal
				committee shall be final and binding on all parties.
d) The Participant will be notified in
				writing of every decision rendered during the appeal process.
e) The Participant retains all rights under
				Section 15(h) of the Act.
f) Appeal
				committee members are appointed by the Director of CMS.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2170 - TEACHERS' RETIREMENT INSURANCE PROGRAM › Subpart B - RESPONSIBILITIES OF THE DEPARTMENT › Section 2170.270 - Health Insurance Portability and Accountability Act (HIPAA)

Current through Register Vol. 48, No. 28, July 12, 2024
CMS and HFS shall comply with the uses and disclosures of
				  Protected Health Information (PHI), permitted by HIPAA, where applicable as
				  referenced in the plan documents.
a)
				An annual notice of privacy practices shall be provided that outlines the legal
				duties and privacy practices concerning the PHI of Participants.
b) PHI may be disclosed:
1) to healthcare providers who take care of
				Participants;
2) to process claims
				and make payments for covered services;
3) for healthcare operations;
4) to remind Participants of an upcoming
				appointment; and
5) as required or
				authorized by law.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2170 - TEACHERS' RETIREMENT INSURANCE PROGRAM › Subpart C - RESPONSIBILITY OF TEACHERS' RETIREMENT SYSTEM (TRS) › Section 2170.310 - Eligibility

Current through Register Vol. 48, No. 28, July 12, 2024
TRS shall determine eligibility of TRS Benefit Recipients and
				  TRS Dependent Beneficiaries pursuant to Section
				  2170.250(b)(1)(A).
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2170 - TEACHERS' RETIREMENT INSURANCE PROGRAM › Subpart C - RESPONSIBILITY OF TEACHERS' RETIREMENT SYSTEM (TRS) › Section 2170.320 - Enrollments and Terminations

Current through Register Vol. 48, No. 28, July 12, 2024
TRS shall enroll and terminate TRS Benefit Recipients and TRS
				  Dependent Beneficiaries pursuant to Section
				  2170.210
				  and Section
				  2170.250(b)(1)(C).
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2170 - TEACHERS' RETIREMENT INSURANCE PROGRAM › Subpart C - RESPONSIBILITY OF TEACHERS' RETIREMENT SYSTEM (TRS) › Section 2170.330 - Premium Collection and Payment

Current through Register Vol. 48, No. 28, July 12, 2024
TRS shall be responsible for the collection and transmission
				  of Participant premiums into the Teacher Health Insurance Security
				  Fund.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2170 - TEACHERS' RETIREMENT INSURANCE PROGRAM › Subpart C - RESPONSIBILITY OF TEACHERS' RETIREMENT SYSTEM (TRS) › Section 2170.340 - Administering Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA)

Current through Register Vol. 48, No. 28, July 12, 2024
TRS shall be responsible for compliance with the continuation
				  of benefits requirements of COBRA. All premiums must be collected and
				  transmitted by TRS.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2170 - TEACHERS' RETIREMENT INSURANCE PROGRAM › Subpart C - RESPONSIBILITY OF TEACHERS' RETIREMENT SYSTEM (TRS) › Section 2170.350 - Other Responsibilities

Current through Register Vol. 48, No. 28, July 12, 2024
a) TRS
				shall provide enrollment, termination and change in status and/or address
				information to CMS.
b) TRS shall
				inform TRS Benefit Recipients that they must:
1) Notify TRS of coverage options chosen, and
				any changes that may affect eligibility or enrollment, including address
				changes;
2) Notify TRS of the
				existence of, or change to, other group insurance coverage to ensure
				appropriate coordination of benefits; and
3) Review the TRIP Benefits Handbook, annual
				Benefit Choice Options booklet and any other materials provided by TRS or CMS
				and abide by all policies outlined in those publications.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2170 - TEACHERS' RETIREMENT INSURANCE PROGRAM › Subpart C - RESPONSIBILITY OF TEACHERS' RETIREMENT SYSTEM (TRS) › Section 2170.360 - Health Insurance Portability and Accountability Act (HIPAA)

Current through Register Vol. 48, No. 28, July 12, 2024
TRS shall comply with the uses and disclosures of Protected
				  Health Information, permitted by the Health Insurance Portability and
				  Accountability Act (HIPAA), where applicable as outlined in the Program
				  documents.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2170 - TEACHERS' RETIREMENT INSURANCE PROGRAM › Subpart D - FUNDING › Section 2170.410 - Teacher Health Insurance Security Fund

Current through Register Vol. 48, No. 28, July 12, 2024
a) The Director shall establish the Teacher
				Health Insurance Security Fund (Fund) (see
				5
				ILCS 375/6.6 ). This Fund shall be a continuing fund
				not subject to Fiscal Year limitations.
b) All active contributors to the Teachers'
				Retirement System who are not employees of a Department shall make
				contributions toward the cost of annuitant and survivor health benefits. These
				contributions shall be at the following rates: until January 1, 2002, 0.5 % of
				salary; beginning January 1, 2002, 0.65 % of salary; beginning July 1, 2003,
				0.75 % of salary; beginning July 1, 2005, 0.80 % of salary; and, beginning July
				1, 2007 through June 30, 2010, 0.84 % of salary. Future contributions shall be
				at a percentage of salary to be determined by the Director based on actual
				costs of the program, but in no Fiscal Year shall the salary required to be
				paid exceed 105% of the percentage of salary actually paid in the previous
				Fiscal Year. These contributions shall be paid to TRS as service agent for
				CMS.
c) Every employer of a
				teacher, other than an employer that is a Department, shall pay an employer
				contribution toward the cost of annuitant and survivor health benefits. The
				contributions are computed as follows: January 1, 2002 through June 30, 2003,
				0.4 % of each teacher's salary; July 1, 2003, 0.5%; beginning July 1, 2005, 0.6
				% of each teacher's salary; and, beginning July 1, 2007 through June 30, 2010,
				0.63 % of each teacher's salary. Future contributions shall be at a percentage
				of salary to be determined by the Director based on actual costs of the
				program, but in no Fiscal Year shall the salary required to be paid exceed 105%
				of the percentage of salary actually paid in the previous Fiscal Year. These
				contributions shall be paid to TRS as service agent for CMS.
d) TRS shall deposit all moneys collected
				pursuant to the terms of the Act and this Section into the Fund.
e) On or before November 15 of each year, the
				Board of Trustees of TRS shall certify to the Governor, the Directors of CMS
				and HFS and the State Comptroller its estimate of the total amount of
				contributions to be paid for the next Fiscal Year. The amount certified shall
				be increased or decreased each year by the amount that the actual active
				teacher contributions either fell short of or exceeded the estimate used by the
				Board in making the certification for the previous Fiscal Year.
f) On the first day of each month, the State
				Treasurer and the State Comptroller shall transfer from the General Revenue
				Fund to the Fund 1/12 of the annual amount appropriated for that Fiscal Year to
				the State Comptroller for deposit into the Fund pursuant to
				5
				ILCS 375/6.6(c) and (d).
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2180 - COLLEGE INSURANCE PROGRAM › Subpart A - PURPOSE AND DEFINITIONS › Section 2180.120 - Purpose

Current through Register Vol. 48, No. 28, July 12, 2024
The purpose of the Program is to provide health benefits to
				  State Universities Retirement System (SURS) Benefit Recipients and SURS
				  Dependent Beneficiaries.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2180 - COLLEGE INSURANCE PROGRAM › Subpart B - RESPONSIBILITIES OF THE DEPARTMENT › Section 2180.210 - Determining Enrollment Policies

Current through Register Vol. 48, No. 28, July 12, 2024
a)
				Initial enrollment periods. Initial enrollment in CIP is limited to the
				following periods:
1) When a SURS Benefit
				Recipient applies for annuity benefits;
2) When a SURS Benefit Recipient or SURS
				Dependent Beneficiary turns age 65;
3) When coverage of a SURS Benefit Recipient
				or SURS Dependent Beneficiary is terminated by a former group plan;
4) During the Benefit Choice
				Period.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2180 - COLLEGE INSURANCE PROGRAM › Subpart B - RESPONSIBILITIES OF THE DEPARTMENT › Section 2180.220 - Determining Insurance Rates and Premiums

Current through Register Vol. 48, No. 28, July 12, 2024
The Director will determine the insurance rates and premiums
				  for SURS Benefit Recipients and SURS Dependent Beneficiaries. Rates and
				  premiums may be based in part on age and eligibility for federal Medicare
				  coverage. Pursuant to the Act, premiums are based on the plan selected by the
				  Benefit Recipient. The SURS Benefit Recipient shall pay the entire premium for
				  any coverage for a SURS Dependent Beneficiary.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2180 - COLLEGE INSURANCE PROGRAM › Subpart B - RESPONSIBILITIES OF THE DEPARTMENT › Section 2180.230 - Determining Benefits

Current through Register Vol. 48, No. 28, July 12, 2024
CMS will determine the benefits available to SURS Benefits
				  Recipients and SURS Dependent Beneficiaries.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2180 - COLLEGE INSURANCE PROGRAM › Subpart B - RESPONSIBILITIES OF THE DEPARTMENT › Section 2180.240 - 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 SURS Benefit Recipients and
				  their SURS Dependent Beneficiaries.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2180 - COLLEGE INSURANCE PROGRAM › Subpart B - RESPONSIBILITIES OF THE DEPARTMENT › Section 2180.250 - Other Responsibilities

Current through Register Vol. 48, No. 28, July 12, 2024
a) CMS
				will offer an annual Benefit Choice Period for SURS Benefit Recipients to:
1) Initially enroll into the
				Program;
2) Add a Dependent
				Beneficiary, pursuant to enrollment policies;
3) Change health plans.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2180 - COLLEGE INSURANCE PROGRAM › Subpart B - RESPONSIBILITIES OF THE DEPARTMENT › Section 2180.260 - Appeals Process Responsibilities

Current through Register Vol. 48, No. 28, July 12, 2024
a) If a Participant believes that an error
				has been made in the benefit amount allowed or disallowed, the Participant
				should contact the claims processing office of the Plan Administrator pursuant
				to the Appeal Process as detailed in the Benefits Handbook. The Participant
				must utilize the Plan Administrator's review process to the fullest extent
				prior to contacting CMS. The Participant must contact the appropriate Plan
				Administrator within 180 days after the date of the initial claim
				determination.
b) If the
				Participant is not satisfied with the results of the review process by the Plan
				Administrator, the Participant may submit a written request for review to CMS,
				within 60 days after the date of the Initial Review determination for a Final
				Determination.
c) If the
				Participant is still not satisfied, an appeal of the determination may be made
				to an appeal committee, created by the Director, within 60 days after the Final
				Review by CMS. The findings of the appeal committee shall be final and binding
				on all parties.
d) The Participant
				will be notified in writing of every decision rendered during the Appeal
				Process.
e) The Participant retains
				all rights under Section 15(h) of the Group Insurance Act.
f) Appeal Committee members are appointed by
				the Director.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2180 - COLLEGE INSURANCE PROGRAM › Subpart B - RESPONSIBILITIES OF THE DEPARTMENT › Section 2180.270 - 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), where applicable as referenced in the plan
				  documents.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2180 - COLLEGE INSURANCE PROGRAM › Subpart C - RESPONSIBILITY OF STATE UNIVERSITIES RETIREMENT SYSTEM (SURS) › Section 2180.310 - Eligibility

Current through Register Vol. 48, No. 28, July 12, 2024
SURS shall determine eligibility of SURS Benefit Recipients
				  and SURS Dependent Beneficiaries pursuant to Section
				  2180.250(b)(1)(A).
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2180 - COLLEGE INSURANCE PROGRAM › Subpart C - RESPONSIBILITY OF STATE UNIVERSITIES RETIREMENT SYSTEM (SURS) › Section 2180.320 - Enrollments and Terminations

Current through Register Vol. 48, No. 28, July 12, 2024
SURS shall enroll and terminate SURS Benefit Recipients and
				  SURS Dependent Beneficiaries pursuant to Section
				  2180.210
				  and Section
				  2180.250(b)(1)(C).
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2180 - COLLEGE INSURANCE PROGRAM › Subpart C - RESPONSIBILITY OF STATE UNIVERSITIES RETIREMENT SYSTEM (SURS) › Section 2180.330 - Premium Collection and Payment

Current through Register Vol. 48, No. 28, July 12, 2024
SURS shall be responsible for the collection and transmission
				  of SURS Benefit Recipient and SURS Dependent Beneficiary premiums into the
				  Community College Health Insurance Security Fund.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2180 - COLLEGE INSURANCE PROGRAM › Subpart C - RESPONSIBILITY OF STATE UNIVERSITIES RETIREMENT SYSTEM (SURS) › Section 2180.340 - Administering Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA)

Current through Register Vol. 48, No. 28, July 12, 2024
SURS shall be responsible for compliance with the
				  continuation of benefits requirements of COBRA. All premiums must be collected
				  and transmitted by SURS.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2180 - COLLEGE INSURANCE PROGRAM › Subpart C - RESPONSIBILITY OF STATE UNIVERSITIES RETIREMENT SYSTEM (SURS) › Section 2180.350 - Other Responsibilities

Current through Register Vol. 48, No. 28, July 12, 2024
a) SURS
				shall provide enrollment, termination and change in status and/or address
				information to CMS.
b) SURS shall
				inform SURS Benefit Recipients that they must:
1) Notify SURS of coverage options chosen,
				and any changes that may affect eligibility or enrollment, including address
				changes.
2) Review the CIP Benefits
				Handbook, annual Benefit Choice Options booklet and any other materials
				provided by SURS or CMS and abide by all policies outlined in these
				publications.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2180 - COLLEGE INSURANCE PROGRAM › Subpart C - RESPONSIBILITY OF STATE UNIVERSITIES RETIREMENT SYSTEM (SURS) › Section 2180.360 - Health Insurance Portability and Accountability Act (HIPAA)

Current through Register Vol. 48, No. 28, July 12, 2024
SURS shall comply with the uses and disclosures of Protected
				  Health Information, permitted by the Health Insurance Portability and
				  Accountability Act (HIPAA), where applicable as outlined in the Program
				  documents.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2180 - COLLEGE INSURANCE PROGRAM › Subpart D - FUNDING › Section 2180.410 - Community College Health Insurance Security Fund

Current through Register Vol. 48, No. 28, July 12, 2024
a) The Director shall establish the Community
				College Health Insurance Security Fund (see
				5
				ILCS 375/6.10 ). This Fund shall be a continuing fund
				not subject to Fiscal Year limitations.
b) An active contributor to the State
				Universities Retirement System who:
1) is a
				full-time employee of a community college district or an association of
				community college boards and
2) is
				not an employee of a State Department as defined in the Act shall make
				contributions toward the cost of annuitant and survivor health benefits at the
				rate of 0.5 % of salary. These contributions shall be paid to SURS as service
				agent for CMS.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2190 - COMMUTER SAVINGS PROGRAM › Subpart A - INTRODUCTION AND DEFINITIONS › Section 2190.10 - Summary and Purpose of the Commuter Savings Program (CSP)

Current through Register Vol. 48, No. 28, July 12, 2024
The Commuter Savings Program (CSP) is intended to serve as a
				  qualified transportation fringe program under section 132(f) of the Internal
				  Revenue Code (
				  26 USC
				  132(f) ) and is to be
				  interpreted in a manner consistent with the requirements of this Section. The
				  purpose of CSP is to enable participants the opportunity to pay qualified
				  transportation expenses with pre-tax payroll deducted contributions, limited to
				  expenses not claimed on federal tax forms.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2190 - COMMUTER SAVINGS PROGRAM › Subpart B - ADMINISTRATION › Section 2190.110 - Administration of the Plan

Current through Register Vol. 48, No. 28, July 12, 2024
Section
				  2190.110
				  Administration of the Plan
a) The Plan
				shall be administered by the Plan Administrator.
b) The Department reserves the right to enter
				into agreements with other agencies to
delegate various record keeping and other administrative
				  functions to the employing agencies of the participants.
c) It shall be the principal duty of the
				Department to see that the Plan is carried out for the exclusive benefit of
				persons entitled to participate in the Plan without discrimination among
				them.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2190 - COMMUTER SAVINGS PROGRAM › Subpart B - ADMINISTRATION › Section 2190.120 - Expenses of Administration

Current through Register Vol. 48, No. 28, July 12, 2024
Section
				  2190.120
				  Expenses of Administration
Any expenses incurred relative to the administration of the
				  Plan shall be paid by the Department.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2190 - COMMUTER SAVINGS PROGRAM › Subpart C - PARTICIPATION › Section 2190.210 - Date of Participation

Current through Register Vol. 48, No. 28, July 12, 2024
Section
				  2190.210
				  Date of Participation
a) An eligible
				employee will become a participant upon an election under this Plan to
				participate.
b) Eligible employees
				may enroll in the Plan at any time.
c) Participation can only be through payroll
				deduction.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2190 - COMMUTER SAVINGS PROGRAM › Subpart C - PARTICIPATION › Section 2190.220 - Errors

Current through Register Vol. 48, No. 28, July 12, 2024
a) Participants are
				responsible for notifying their GIR of any payroll deduction errors.
b) In the event a deduction is missed or an
				incorrect amount is deducted because of payroll or other processing errors, the
				error must be corrected on the payroll immediately following the discovery of
				the error.
c) If the correction of
				the error causes an economic hardship for the participant, funds sufficient to
				correct the error will be deducted from the participant's paycheck over the two
				months immediately following the discovery of the error.
d) If the error is unable to be corrected on
				payroll and the participant's account does not contain funds sufficient to
				cover the costs of participation in the Plan, the participant will be asked to
				refund to the Department any amount owed.
e) If the participant refuses, the Department
				will request the Comptroller to withhold the required amount from the
				participant's next available paycheck pursuant to 74 Ill. Adm. Code
				285.
f) If the error is unable to
				be corrected on payroll and the participant's account contains funds in excess
				of those necessary to participate in the Plan, the Plan Administrator will
				refund the participant any excess amount.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2190 - COMMUTER SAVINGS PROGRAM › Subpart D - ELECTION › Section 2190.310 - Election Procedures

Current through Register Vol. 48, No. 28, July 12, 2024
a) An
				eligible employee may elect to participate in this Plan by contacting the Plan
				Administrator. The Plan Administrator will notify the Department and the
				participant's GIR of the enrollment and the amount of the deduction.
b) Enrollment decisions or changes must be
				made and communicated to the Plan Administrator on or before the
				10th day of each month to be effective at the start
				of the following month.
c) Eligible
				employees may enroll in the Plan at any time. Eligible employees are not
				required to re-enroll each Plan year.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2190 - COMMUTER SAVINGS PROGRAM › Subpart D - ELECTION › Section 2190.320 - Benefit Options and Limits

Current through Register Vol. 48, No. 28, July 12, 2024
Section
				  2190.320
				  Benefit Options and Limits
a) Maximum
				contributions are in accordance with limitations set forth in the federal
				guidelines at
				26 USC
				132(f)(2).
b) Separate maximums apply to each qualified
				transportation benefit.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2190 - COMMUTER SAVINGS PROGRAM › Subpart E - QUALIFIED TRANSPORTATION BENEFIT ACCOUNTS › Section 2190.410 - Establishment of Accounts

Current through Register Vol. 48, No. 28, July 12, 2024
The Plan Administrator shall establish and maintain a
				  qualified transportation benefit account for each
				  participant.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2190 - COMMUTER SAVINGS PROGRAM › Subpart E - QUALIFIED TRANSPORTATION BENEFIT ACCOUNTS › Section 2190.420 - Crediting to Accounts

Current through Register Vol. 48, No. 28, July 12, 2024
a) There shall
				be credited to each account, as of each pay period, an amount equal to the
				reduction made in the participant's compensation in accordance with the
				participant's election.
b) All
				amounts credited shall be the property of the State until paid out pursuant to
				Subpart G of this Part.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2190 - COMMUTER SAVINGS PROGRAM › Subpart F - TERMINATION › Section 2190.510 - Termination of Enrollment

Current through Register Vol. 48, No. 28, July 12, 2024
a)
				Participants may terminate enrollment in the Plan at any time.
b) Termination decisions must be made and
				communicated to the Plan Administrator on or before the
				10th day of each month to be effective at the start
				of the following month.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2190 - COMMUTER SAVINGS PROGRAM › Subpart F - TERMINATION › Section 2190.520 - Termination, Leave of Absence or Death of Participant

Current through Register Vol. 48, No. 28, July 12, 2024
a) If a participant terminates employment or
				takes a leave of absence, the participant must notify the Plan Administrator
				and his or her GIR by the 10th of the month prior to
				the termination or leave of absence in order for cancellation of enrollment to
				be effective at the start of the following month. Participants who do not
				cancel enrollment by the 10th of the month prior to
				the termination or leave of absence will continue to be enrolled in the Plan
				through the month following the date that notice of cancellation is provided
				and shall remain responsible for the contributions associated with the
				enrollment.
b) If the participant
				returns to State service, the participant may re-enroll in the Plan.
c) In the event a participant dies, the
				participant's participation in the Plan shall be terminated.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2190 - COMMUTER SAVINGS PROGRAM › Subpart F - TERMINATION › Section 2190.530 - Fraud

Current through Register Vol. 48, No. 28, July 12, 2024
In the event a participant knowingly supplies the Department
				  or the Plan Administrator with false information or knowingly files a claim
				  that is not qualified for reimbursement as adjudicated by the Internal Revenue
				  Service or a court of competent jurisdiction, the Department shall exclude the
				  participant from further participation in the Plan.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2190 - COMMUTER SAVINGS PROGRAM › Subpart G - REIMBURSEMENT › Section 2190.610 - Procedures

Current through Register Vol. 48, No. 28, July 12, 2024
a) Fees for transit
				passes are paid directly to the pass provider and the transit pass is mailed to
				the participant before the beginning of the month the pass is to be
				used.
b) Fees for qualified parking
				may be paid directly to the parking provider or the participant may be
				reimbursed by submitting a claim form and proof of service directly to the Plan
				Administrator.
c) Claims for
				mileage reimbursement for transportation in a commuter highway vehicle must be
				submitted on a claim form with proof of expense directly to the Plan
				Administrator.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2190 - COMMUTER SAVINGS PROGRAM › Subpart G - REIMBURSEMENT › Section 2190.620 - Exclusions

Current through Register Vol. 48, No. 28, July 12, 2024
A participant shall not be reimbursed for any expense that
				  would otherwise be a qualified transportation expense if:
a) The expense was incurred at a time when
				the participant was not a participant in the Plan; or
b) A claim for reimbursement of such expense
				has not been filed in accordance with the provisions of Section
				2190.610 of this Part;
				or
c) The expense was claimed as a
				credit or deduction on the participant's federal or State income tax form;
				or
d) The expense is reimbursable
				under any other benefit plan maintained by the employer or purchased privately
				by the participant.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2190 - COMMUTER SAVINGS PROGRAM › Subpart H - MISCELLANEOUS › Section 2190.710 - Illegality of a Particular Provision

Current through Register Vol. 48, No. 28, July 12, 2024
The illegality of any provision of this Part shall not affect
				  the other provisions of the Part and this Part shall be construed in all
				  respects as if the invalid provisions were omitted.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2190 - COMMUTER SAVINGS PROGRAM › Subpart H - MISCELLANEOUS › Section 2190.720 - Applicable Law

Current through Register Vol. 48, No. 28, July 12, 2024
To the extent not preempted by federal law, the Plan shall be
				  governed and construed according to the laws of the State of
				  Illinois.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2190 - COMMUTER SAVINGS PROGRAM › Subpart H - MISCELLANEOUS › Section 2190.740 - Effect on Social Security

Current through Register Vol. 48, No. 28, July 12, 2024
Participation in the Plan reduces a participant's Social
				  Security wages by the amount contributed and may therefore reduce the benefits
				  received.
Illinois Administrative Code › Title 80 - PUBLIC OFFICIALS AND EMPLOYEES › Part 2190 - COMMUTER SAVINGS PROGRAM › Subpart H - MISCELLANEOUS › Section 2190.750 - Benefits Solely from General Assets

Current through Register Vol. 48, No. 28, July 12, 2024
The benefits provided by the Plan will be paid solely from
				  the general assets of the State. The State will not be required to maintain any
				  fund or segregate any amount for the benefit of any participant, and no
				  participant or other person shall have any claim against, right to, or security
				  or interest in, any asset of the State from which any payment under the Plan
				  may be made.