| 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 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.
Definition
for eligible employees: 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. |
