Health Insurance Benefit Plans
Quality Care Health Plan | Managed Care Plans
For detailed information on all insurance benefits, please visit the State Benefit Choice website.
The State of Illinois pays the major portion of health insurance premiums for eligible full-time employees. However, employees are 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 (50-99%) electing coverage pay a prorated portion of the employer premium as well as the member portion. Coverage is provided by the State of Illinois Quality Care Health Plan (QCHP) or one of several Managed Care Plans.Under the Quality Care Health Plan, employees are free to choose any health-care provider they wish. Major features of the plan include:
- Employees must pay an annual, income-based deductible for medical services
- After the deductible has been met, the plan pays 80% of most allowable medical and surgical expenses and the employee pays 20%
- The plan pays 90% of in- and out-patient charges at preferred provider hospitals and 65-80% of such charges at other hospitals
- After the deductible, the plan pays 100% of allowable charges for laboratory and X-ray
- Once the employee reaches the $800 maximum for co-payments and deductibles, the plan provides 100% payment for covered services
- The employee is covered by an unlimited lifetime maximum benefit
- 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
Quality Care Health Plan |
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Managed Care Plans include both Health Maintenance Organizations (HMO) and Open Access Plans (OAP).
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. There are several HMO Insurance companies from which to choose.
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.
The OAP provides three benefit levels broken into tier groups. Tier I and Tier II require the use of network providers and offer benefits with pre-determined co-payments. Tier III (out-of-network) offers members flexibility in selecting health care providers with higher out-of-pocket costs. Tier II and Tier III require a deductible. It is important to remember the level of benefits is determined by the selection of care providers. members enrolled in the OAP can mix and match providers.
Managed Care plans available in Sangamon County and immediate surrounding areas include:
- Health Alliance HMO
- PersonalCare
- HMO Illinois
- HealthLink OAP
For Managed Care providers available in other areas, please refer to the Benefit Choice handbook.
Managed Care Plans
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HMO Websites |
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Definition for eligible employee: The state health, dental, and life insurance benefits are available to employees hired into permanent positions at 50% time or more for a period of at least eight months. If, however, an employee is hired at 50% time or more and the contract is for less than eight months, due to fiscal constraints or grant restrictions, health, dental, and life benefits may be provided if it is the intention of the hiring department to continue the employment.
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