AUTHORITY: Authorized by the State Employees Group Insurance Act of 1971 [5 ILCS 375].

SOURCE: Adopted at 27 Ill. Reg. 9139, effective May 27, 2003.

SUBPART A: PURPOSE AND DEFINITIONS

 

Section 2180.110  Name of Program

 

The name of this Program is the College Insurance Program.

 

Section 2180.120  Purpose

 

The purpose of the Program is to provide health benefits to State Universities Retirement System (SURS) Benefit Recipients and SURS Dependent Beneficiaries.

 

Section 2180.130  Definitions

 

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].

 

"Benefit Choice Period" means the annual benefit election period (usually May 1 through May 31 each year).

 

"CCHP" means the College Choice Health Plan (indemnity medical plan offered under CIP).

 

"CIP" means the College Insurance Program, as authorized by the State Employees Group Insurance Act of 1971.

 

"COBRA" means the federal Consolidated Omnibus Budget Reconciliation Act of 1985.

 

"State Department" means any department, institution, board, commission, officer, court or any agency of the State government receiving appropriations and having power to certify payrolls to the Comptroller authorizing payments of salary and wages against such appropriations as are made by the General Assembly from any State fund, or against trust funds held by the State Treasurer and includes boards of trustees of the retirement systems created by Articles 2, 14, 15, 16 and 18 of the Illinois Pension Code.  "Department" also includes the Illinois Comprehensive Health Insurance Board, the Board of Examiners established under the Illinois Public Accounting Act, and the Illinois Rural Bond Bank

 

"CMS" means the Illinois Department of Central Management Services.

 

"Director" means the Director of the Illinois Department of Central Management Services (CMS).

 

"Fiscal Year" means the State's fiscal year from July 1 through June 30.

 

"Fund" means the Community College Health Insurance Security Fund.

 

"Participant" means a SURS Benefit Recipient and/or SURS Dependent Beneficiary.

 

"Plan Administrator" means an organization, company or other entity contracted by CMS to review and approve benefit payments; pay claims; and perform other duties related to the administration of a specific plan.

 

"Program" means the College Insurance Program, as authorized by the State Employees Group Insurance Act of 1971.

 

"SURS" means the State Universities Retirement System.

 

"SURS Benefit Recipient" means a person who is not a "member" as defined in the Act; and is receiving a monthly survivor's annuity or retirement annuity under Article 15 of the Illinois Pension Code [40 ILCS 5/Art. 15]; and either was a full-time employee of a community college district or an association of community college boards created under the Public Community College Act (other than an employee whose last employer under Article 15 of the Illinois Pension Code was a community college district subject to Article VII of the Public Community College Act) and was eligible to participate in a group health benefit plan as an employee during the time of employment with a community college district (other than a community college district subject to Article VII of the Public Community College Act) or an association of community college boards; or is the survivor of a person described in this definition.

 

"SURS Dependent Beneficiary" means a person who is not a "member" or "dependent" as defined in the Act, and is a SURS Benefit Recipient's spouse; dependent parent who is receiving at least half of his or her support from the SURS Benefit Recipient; or unmarried natural, step, or adopted child who is under age 19; or enrolled as a full-time student in an accredited school, financially dependent upon the SURS Benefit Recipient, eligible to be claimed as a dependent for income tax purposes, and either is under age 23; or age 19 or over who is mentally or physically handicapped.

SUBPART B: RESPONSIBILITIES OF THE DEPARTMENT

 

Section 2180.210  Determining Enrollment Policies

 

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.

 

b)         Re-enrollment period limitations.  Re-enrollment into the Program is limited to the following periods:

 

1)         When a SURS Benefit Recipient or SURS Dependent Beneficiary turns age 65;

 

2)         When coverage of a SURS Benefit Recipient or SURS Dependent Beneficiary is terminated by a former employer.

 

Section 2180.220  Determining Insurance Rates and Premiums

 

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.

 

Section 2180.230  Determining Benefits

 

CMS will determine the benefits available to SURS Benefits Recipients and SURS Dependent Beneficiaries.

 

Section 2180.240  Provision for Benefits

 

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.

 

Section 2180.250  Other Responsibilities

 

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.

 

b)         CMS will provide information regarding benefits and requirements of the Program in a CIP Benefits Handbook and an annual Benefit Choice Options booklet.

 

            1)         The CIP Benefits Handbook shall embrace the following topics:

 

A)        Eligibility guidelines pursuant to the definitions of Benefit Recipient and Dependent Beneficiary in Section 2180.130.

 

B)        Enrollment opportunities pursuant to Section 2180.210.

 

C)        Termination guidelines.  Coverage for a Benefit Receipient terminates at midnight on the last day of the month when eligibility requirements are no longer met, CIP coverage terminates, a written request is received by SURS that coverage should be terminated, the Benefit Recipient becomes eligible for and enrolls in the State of Illinois Employees Group Insurance Program, or upon dealth.  Coverage for a Dependent Beneficiary terminates at midnight on the last day of the month simultaneously with termination of a Benefit Recipient's coverage; when coverage is terminated by the Benefit Recipient; when eligibility requirements are no longer met or upon death.

 

D)        Covered Benefits under CCHP (e.g., chemotherapy, durable medical equipment, hospital services, infertility treatments, lab and x-ray, physician services, speech therapy, organ and tissue transplant, urgent care, preventive services, prescription drug, mental health/substance abuse and exclusions.

 

E)        CCHP claims filing deadlines and procedures.

 

2)         The Benefit Choice Options booklet shall detail information not provided in the Benefits Handbook (e.g., premium amounts, coverage changes, managed care plan availability and preferred provider information).

 

c)         CMS will provide training seminars for SURS.

 

Section 2180.260  Appeals Process Responsibilities

 

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.

 

Section 2180.270  Health Insurance Portability and Accountability Act (HIPAA)

 

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.

SUBPART C: RESPONSIBILITY OF STATE UNIVERSITIES RETIREMENT SYSTEM (SURS)

 

Section 2180.310  Eligibility

 

SURS shall determine eligibility of SURS Benefit Recipients and SURS Dependent Beneficiaries pursuant to Section 2180.250(b)(1)(A).

 

Section 2180.320  Enrollments and Terminations

 

SURS shall enroll and terminate SURS Benefit Recipients and SURS Dependent Beneficiaries pursuant to Section 2180.210 and Section 2180.250(b)(1)(C).

 

Section 2180.330  Premium Collection and Payment

 

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.

 

Section 2180.340  Administering Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA)

 

SURS shall be responsible for compliance with the continuation of benefits requirements of COBRA.  All premiums must be collected and transmitted by SURS.

 

Section 2180.350  Other Responsibilities

 

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.

 

Section 2180.360  Health Insurance Portability and Accountability Act (HIPAA)

 

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.

SUBPART D: FUNDING

 

Section 2180.410  Community College Health Insurance Security Fund

 

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.

 

c)         Every community college district or association of community college boards that is an employer under SURS contributes toward the cost of the community college health benefits in an amount equal to 0.5% of the salary paid to its full-time employees who participate in SURS and are not members as defined in the Act.  These contributions shall be paid to SURS as service agent for CMS.

 

d)         SURS shall deposit all moneys collected into the Community College Health Insurance Security Fund.

 

e)         On or before November 15 of each year, the Board of Trustees of SURS shall certify to the Governor, the Director of CMS and the State Comptroller its estimate of the total amount of contributions to be paid for the next 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 Community College Health Insurance Fund 1/12 of the annual amount appropriated for that fiscal year to the State Comptroller for deposit into the Community College Health Insurance Security Fund pursuant to 5 ILCS 375/6.10(c) and (d).