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Medical

Health insurance is available to eligible employees as provided by Central Management Services and authorized managed care representatives.  Human Resource Services provides this information as a resource for employees.  While every effort to assure the accuracy and completeness of this information is made, employees are urged to directly access the information provided by Central Management Services and the designated care providers who establish and maintain the official policies and procedures.  Where possible, HRS has provided links to relevant websites for your convenience in accessing additional information and clarification.

Medical insurance coverage is available to employees through the State of Illinois, Department of Central Management Services (CMS). CMS offers a number of medical coverage options; one preferred provider organization plan, Quality Care Health Plan (QCHP) and seven managed care plans. (Health Alliance HMO,  HMO Illinois, Blue Advantage HMO, Aetna HMO, Health Link OAP, and Aetna OAP. The options differ in the benefit levels they provide, the doctors and hospitals you can use, the cost, and the geographic area (county) covered. 

Coverage

The effective date of coverage for new employees is the first date of their appointment/contract (Faculty/Supportive Professional Staff) or the first date of employment (Operating Staff).

New employees eligible for medical insurance are required to select or opt out of a medical plan within the first ten calendar days of employment. If a plan selection is not made within the first ten days of employment, employees are automatically defaulted into the QCHP and dependents will not be eligible for coverage until the next Benefit Choice period, or, upon verification of a qualifying event.

If an employee and the employee's spouse are both employees of the university or any other State of Illinois agency, each must be insured individually. Either or both employees may elect health coverage for dependents; however, the same dependent cannot be enrolled under both spouses for the same type of health, dental or life coverage.

Employees cannot select dental insurance unless they enroll in medical coverage.

Pursuant to Section 125 of the Internal Revenue Code, premiums paid by the employee for health and dental are tax exempt.  The tax exemption applies only to premiums that are payroll deducted.

Eligibility

Generally, full-time status and part-time status employees (with a full-time equivalency (FTE) of 50 percent or more) are eligible for medical insurance from the State of Illinois. Eligible employees must take the insurance unless they can opt out/waive coverage.

Special Eligibility Information for Non-U.S. Citizens

Employees who hold a certain visa and have not established residency status for tax purposes may not be eligible for insurance. F1 and J1 visa holders generally fall in this category. Employees in this category are encouraged to contact Human Resource Services at 815.753.6000 for assistance in the determination of eligibility for benefits.

Eligible Dependents of a Member may participate in the same health, dental and vision plans as the Member. Documentation requirements must be met in order for the dependent to be added to and/or remain on the coverage. Eligibility for Spouse Life and Child Life insurance varies, see the Life Coverage page for information. Dependent coverage is an additional cost for all members. Dependent in certain categories must certify eligibility each year.

Spouse (does not include ex-spouses, common-law spouses, a new spouse of a survivor or persons not legally married).

Same-Sex Domestic Partner (enrolled prior to June 1, 2011).

Civil Union Partner (Same-Sex or Opposite-Sex). Eligibility to enroll begins June 1, 2011.

Child from birth up to age 26, including:

  • Natural child.
  • Adopted child.
  • Stepchild or child of a civil union partner.
  • Child for whom the employee has permanent legal guardianship.
  • Adjudicated child for whom a U.S. court decree has established a member’s financial responsibility for the child’s medical, dental or other healthcare. Note: All dependent children enrolled in any of the ‘student’ categories will automatically be reclassified into the ‘sponsored adult child’ category during the month of July 2011, and will no longer need to provide proof of student status.

Child age 26 and older, including:

  • Disabled. Child age 26 or older who is continuously disabled from a cause originating prior to age 26. In addition, for tax years in which the child is age 27 or above, eligible to be claimed as a dependent for income tax purposes by the employee.
  • Veteran Adult Child (IRS). Adult child age 26 up to, but not including, age 30, an Illinois resident and has served as an employee of the active or reserve components of any of the branches of the U.S. Armed Forces and received a release or discharge other than a dishonorable discharge. In addition, for tax years in which the child is age 27 or above, the child must be unmarried and eligible to be claimed as a dependent for income tax purposes by the employee.
  • Veteran Adult Child (Non-IRS). Unmarried adult child age 26 up to, but not including, age 30, an Illinois resident and has served as a member of the active or reserve components of any of the branches of the U.S. Armed Forces and received a release or discharge other than a dishonorable discharge.

Other. The ‘Other’ category includes a dependent who is:

    1. a recipient of an organ transplant after June 30, 2000, and eligible to be claimed as a dependent for income tax purposes by the employee, except for a dependent child who need only be eligible to be claimed for tax years in which the child is age 27 or above, or
    2. an unmarried individual continuously enrolled as a dependent of the employee in the State Insurance Program (or CNA for university staff) since 2/11/83 with no break in coverage and eligible to be claimed as a dependent for income tax purposes by the employee. The period of time the dependent was enrolled with Golden Rule Insurance Company (prior to April 1, 1988) does not count toward the requirement of continuous enrollment.

Updated 05/09/11

Opting Out

Eligible full-time employees may elect to opt out of medical insurance if proof of comprehensive major medical health coverage not through the State of Illinois can be provided to the Insurance and Benefits area. Full-time employees electing to opt out of coverage cannot be enrolled as a dependent of their state-employed spouse.

Eligible part-time employees may elect to waive coverage for which they are required to pay a portion of the State-paid premium.  Part-time employees electing to waive coverage cannot be enrolled as a dependent of their State-employed spouse.

Need More Information?

MyBenefits Marketplace
MyBenefits.illinois.gov
1-844-251-1777
1-844-251-1778 (tdd/tty)

Call the HRS Service Center at 815-753-6000 and ask to be connected to one of our HR associates.

Central Management Services http://www.cms.illinois.gov

Quality Care Health Plan (QCHP)

Aetna HMO / OAP
1.855.339.9731 (p)
1.800.628.3323 (tdd/tty)
www.aetnastateofillinois.com
Health Alliance HMO
1.800.851.3379 (p)
1.800.526.0844 (tdd/tty)
www.healthalliance.org
Health Link OAP
1.800.624.2356 (p)
1.800.624.2356 ext. 6280 (tdd/tty)
www.healthlink.com
HMO Illinois and Blue Advantage HMO
1.800.868.9520 (p)
1.866.876.2194 (tdd/tty)
www.bcbsil.com


Insurance Forms & Documents