Definitions of Terms

Section 2106.130  Definitions of Terms Unless the context otherwise requires, the following words and phrases as used in the Act shall have the following meanings for the purpose of implementing and administering the Opt Out Incentive: "Act" means the State Employees Group Insurance Act [5 ILCS 375]. "Annuitant" means a retiree or annuitant who is receiving an annuity from one of the five State retirement systems. "Benefit Choice Period" means a designated time when members may change benefit coverage elections. "CMS" means the Illinois Department of Central Management Services. "Director" means the Director of CMS. "Health Plan" means the health, dental and vision benefits offered by the program to eligible persons. "Major Medical Coverage" refers to policies that provide coverage for most health-related expenses that can be incurred. Coverage included in a major medical insurance policy usually includes prescription drugs; casts and other necessary equipment needed for bone breaks or fractures; x-rays; both outpatient and inpatient services as a result of required medical care; diagnostic tests and examinations; ambulance services; and necessary medical supplies and therapies. This coverage may include deductibles, coinsurance and co-payment requirements. "Member" means an employee, annuitant, retired employee or survivor, as defined in the Act. "Opt Out/In Qualifying Change in Status" means an event that effects eligibility for Health Plan coverage, including but not limited to the following:  member becomes eligible for non-State administered health benefits coverage; marriage; loss or gain of Medicare for any reason; coordination of spouse's open enrollment period; spouse gains or loses non-State administered health benefits. "Opt Out Incentive" means the retiree/annuitant insurance opt out incentive authorized by Section 8(d-5) and (d-6) of the Act, which provides a financial incentive for each annuitant who is not eligible for benefits under the federal Medicare health insurance program who elects not to participate in the Health Plan on or after January 1, 2006 under Section 8(d-5) of the Act and, on or after July 1, 2013, under Section 8(d-6) of the Act. "Program" means the group life insurance, health and other benefits designed and/or contracted for by CMS that are provided under the Act. "SERS" means the State Employees' Retirement System. "Special Enrollment Period" means a designated time period defined by the Director of CMS for certain members to change specific benefit coverage elections when special circumstances occur that affect only those members.