Tuesday, January 21, 2014

Condition Of Illinois Employees Medical Health Insurance Options

Illinois state employees may choose from several different health insurance options, which include dental, vision, prescription medication, life insurance and behavioral health benefits. Choices include managed health care offered throughout the state by various plan administrators and the Cigna Quality Care Health Care Plan managed by that insurer. Rates vary depending on the type of plan and options. All plans include deductibles for prescription drugs.

Managed Care Health Plan

The managed health care plan for Illinois state employees requires the choice of a primary care physician in the employee's service area for coordination of all medical care. Enrolling in the health maintenance organization plan is less costly, but employees must stay within the provider network and only emergencies are covered outside of the service area.

Non-HMO Options

The Open Access Plan has two tiers, with the first generally paying 100 percent of costs after co-payments. The second tier pays 90 percent with a 10 percent coinsurance after meeting annual deductibles. Those enrolled in the OAP may also use a third tier for out-of-network service, which is 80 percent of "usual and customary" charges after the deductible. .

Employees choosing the Quality Care Health Plan may visit any doctor, pharmacy or hospital to receive medical care or services. If using a provider in the QCHP network, out-of-pocket costs decrease.

Benefit Choice Period

Each year, employees have a two-month period beginning May 1 to change benefit plans and add or drop options or dependent coverage. Employees may also increase or decrease the optional life insurance coverage, although a health statement is necessary to add the life insurance benefit. Employees may elect to opt out of health insurance coverage entirely during the benefit choice period, but doing so also drops all coverage for dependents. Members must provide proof of other health insurance coverage if electing to opt out. Employees who previously opted out may re-enroll during this two-month span.

Additional Benefits

Illinois state employees may qualify for additional benefit options through the health insurance program. This includes a program to stop smoking, which at the time of publication offers $200 in insurance rebates to members or enrolled dependents taking the program and quitting the nicotine habit.

Until the end of June 2011, employees may sign up for long-term care insurance through MetLife. The insurance provides coverage for custodial or other long-term care.

The Employee Assistance Program helps Illinois state workers and families with personal issues in a confidential manner.

Through the Adoption Benefit Program, employees may receive up to $1,500 in adoption expenses reimbursement.

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