Health and Life Insurance

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Health Insurance

The State of Illinois pays the major portion of health insurance premiums for eligible full-time employees. An employee may be required to pay a small portion of the premium, the amount of which is based on the employee's annual salary. The state also pays part of the premium for dependent coverage. Employees choosing dependent coverage pay the remainder (or member portion) of the premium. Part-time employees electing coverage pay a prorated portion of the employer premium as well as the member portion. Employees on leave or seasonal lay-off will be billed for the employee or member portion of their premium. Failure to pay these bills on time may result in termination of coverage. Employee Benefits can provide current rates for these premiums, which are subject to change. Coverage is provided through the State of Illinois Quality Care Health Plan, administered by CIGNA, or by one of several Health Maintenance Organizations (HMOs).

Under the Quality Care Health Plan, employees are free to choose any health-care provider they wish. Major features of the plan are as follows:

  1. employees must pay an annual, income-based deductible for medical services;
  2. after the deductible has been met, the plan pays 80% of most allowable medical and surgical expenses and the employee pays 20% ;
  3. the plan pays 90% of in- and out-patient charges at preferred provider hospitals and 65-80% of such charges at other hospitals;
  4. after the deductible, the plan pays 100% of allowable charges for laboratory and X-ray;
  5. once the employee reaches the $800 maximum for co-payments and deductibles, the plan provides 100% payment for covered services;
  6. the employee is covered by an unlimited lifetime maximum benefit;
  7. the plan provides for a prescription drug benefit with a fixed co-payment charge per 30-day supply (brand-name drugs require a higher co-payment than generic drugs). Drug charges are not counted toward the deductible or maximum discussed above.

HMO coverage, which includes preventive care, offers a higher level of benefits at a lower cost (e.g., no deductible) than the Quality Health Care Program. Under the HMO, patient out-of-pocket charges can be more precisely predicted. Persons covered by an HMO choose a primary-care physician who may, if necessary, refer the patient to HMO-related specialists. Both plans -- Quality Care and HMO -- cover mental health services, requiring, however, screening and approval before coverage is extended.

Since health insurance premiums are deducted from salaries before income tax is calculated, employees itemizing deductions on their tax returns may not deduct these premiums. Plan descriptions, claim forms, and additional information may be obtained from Employee Benefits.

Dental Insurance

All employees and their dependents covered for health benefits also receive dental coverage. (Part-time employees pay a prorated portion of the premium.) There are two plans from which to choose. The first, Quality Care Dental Plan, under which employees are free to select the dentist of their choice, includes preventive care, some restorative services, and partial coverage for dentures, periodontia, and childhood orthodontia. Under this plan the employee has an annual maximum benefit, a non-preventive care deductible, and monthly premiums. The second, Managed Care Plan (MCP), requires that employees enroll with an approved participating dentist. MCP, which provides some additional benefits, has no annual maximum or employee-paid premium. Benefits are paid according to a schedule of fees and copayments for covered procedures. Both plans are administered for the state by Dental Care Plus Management Corporation.

Vision-Care Plan

The vision-care plan, available through participating opticians, provides assistance for exams, glasses, and contact lenses. Although there is no deductible, copayments are required. Information about the plan may be obtained from Employee Benefits.

Life Insurance

The State of Illinois provides each employee, at no cost, one unit of term insurance, a unit equaling the employee's base annual salary. Part-time employees pay a prorated portion of the premium. The employee may elect additional coverage of up to 4 units of term life and accidental death and dismemberment insurance. State term life insurance includes a provision allowing payment of up to half the policy's face value to a terminally ill employee whose life expectancy is 6 months or less. Spouse coverage of up to $5,000 and dependent child coverage of $5,000 is also available. The optional employee life insurance is portable upon termination of employment.

University employees may also purchase university-sponsored term life insurance in units of $5,000, up to five times the employee's annual salary or $200,000, whichever is less. Also available is spouse coverage up to $200,000 (but not to exceed the amount purchased for the employee), child coverage up to $10,000, and individual or full family accidental death and dismemberment insurance.

Flexible Spending Accounts

Employees may use pre-tax dollars to fund accounts from which they can pay medical and dependent care expenses, thus achieving a tax savings.

  1. Medical Care Assistance Plan (MCAP) allows the employee to save tax dollars on health care expenses, such as eyeglasses, crowns and bridgework, and medical deductibles, that are not fully covered by the state-paid health and dental plans.
  2. Dependent Care Assistance Plan (DCAP) provides for coverage of child or elder care expenses with tax-free dollars.

Each plan allows for payroll deductions from $240 to $5000 per year. The plan year runs from July 1 through June 30. Employees may only participate in these plans during months they are on payroll. Since federal regulations require that any unused money in MCAP or DCAP accounts must be forfeited at year end, employees should avoid depositing amounts in excess of projected expenditures.

Tax-Deferred Annuities

Employees may generally elect tax-deferred salary reductions of up to 20% of their includable income,[1] or $9,500 (whichever is less) for investment in a 403b account. Employee Benefits maintains a list of approved companies and their local agents and can explain the procedure for enrolling in or changing a 403b plan.

Deferred Compensation Plan

Employees of the State of Illinois are eligible to enroll in a Deferred Compensation Plan under IRS code 457. Similar to the Tax-Deferred Annuity described above, this plan allows for a reduction of 25% of includable income or $7,500, whichever is less.

Savings Bonds

Employees may enroll for payroll deductions for U.S. Series EE Savings Bonds in $100, $200 or $500 denominations.

Unemployment Compensation

Faculty and staff whose employment is terminated by the university may be eligible for Unemployment Compensation. Application should be made to the Illinois Office of Employment Security. Employees on seasonal layoff and faculty members on semester or summer leaves are ineligible for unemployment benefits during those periods.

Workers' Compensation

All university employees injured during the course of employment are covered by Illinois Workers' Compensation and Occupational Disease laws. Employees with employment-related injuries must notify their immediate supervisors as soon as possible but no later than 45 days after the injury occurs and must also notify the Illinois Early Intervention Program for Workers' Compensation (800-773-3221). It is the employee's responsibility to seek information, available from the Workers' Compensation Coordinator at Human Resources, and apply for appropriate workers' compensation benefits.

Injured employees may seek medical attention from physicians or health facilities of their choice although HMO enrollees should use their primary care physicians to assure coverage in the event the condition is not covered by workers' compensation.

Should the injury result in an absence that extends 3 days beyond the day the incident occurs, the injured employee may be eligible for the total temporary disability benefits (TTD) of the workers' compensation statutes. For time not payable under TTD, accumulated sick leave time may be used. An injury report and any medical charges related to the injury must be submitted to the workers' compensation coordinator at Human Resources.

The Department of Central Management Services in Springfield decides whether claims are compensable under the Illinois Workers' Compensation Act and the Illinois Occupational Diseases Act. If an employee has been out of work for 120 consecutive days and is released by his/her physician to return to work with restrictions, Central Management Services will assist the university to return the employee to gainful employment.

1. Includable income equals gross salary minus the following: contributions to SURS, payments to MCAP and DCAP, and tax-sheltered state-paid health/life premiums.