§2210.130. Definitions

 

Whenever used in this Part, the following terms shall have the meanings set forth in this Section, unless otherwise expressly provided:

 

“Act” means the State Employees Group Insurance Act of 1971.  [5 ILCS 375/1]

 

“Agency” means the Illinois Department of Central Management Services, or any successor agency responsible for administration of the Program.

 

“Annuitant” means an individual as defined by Section 3(b) of the Act. [5 ILCS 375/3(b)]

 

“Basic Program” or “Basic Health Plan” means the default health benefits plan, as determined by the Agency, offered to Employees, Annuitants, Retirees, and Survivors.

 

“Benefit Choice Period” means the annual open enrollment period, during which time members may elect to add or change benefits coverage options.

 

“COBRA” means the federal Consolidated Omnibus Budget Reconciliation Act [29 U.S.C. 1161] as amended.

 

“Commission” means the Commission on Government Forecasting and Accountability (COGFA).

 

“Compensation” means salary or wages payable as defined by Section 3(d) of the Act. [5 ILCS 375/3(d)]

 

“Department” means any department, institution, board, commission, officer, court or agency of the State government as defined by Section 3(g) of the Act. [5 ILCS 375/3(g)]

 

“Dependent” means an individual as defined in Section 3(h) of the Act. [5 ILCS 375/3(h)]

 

“Director” means the Director of the Agency.

 

“Employee” means an individual as defined by Section 3(k) of the Act. [5 ILCS 375/3(k)]

 

“HIRF” means the Health Insurance Reserve Fund.

 

“Member” means an individual as defined by Section 3(l) of the Act. [5 ILCS 375/3(l)]

 

“Normal Work Period” means a specified number of hours worked on a weekly or monthly basis, as established by the Director in cooperation with each Department.

 

“Optional Program” or “Optional Health Plan” means any health benefits plan, other than the Basic Program, offered to Employees, Annuitants, Retirees and Survivors.

 

“Part-time Employee” means an Employee who works in a position normally requiring actual performance of duty during 50% to 99% of a Normal Work Period.

 

“Plan Administrator” means a third party organization, company, or other entity responsible for performing duties related to the administration of a specific benefit option in accordance with the terms of a contract between such entity and Agency.

 

“Plan Participant” means a Member or Dependent properly enrolled and participating in the Program.

 

“Plan Year” means a period of time, typically 12 months in duration, on which the operation of the Program is based.

 

“Program” means the program of group health benefits, including the Basic Program and any Optional Programs, designed and/or contracted for by the Agency in accordance with the Act and this Part.

 

“Qualifying Change in Status” means an event recognized under Section 125 of the Internal Revenue Code (26 U.S.C. 125) for which the Program may permit changes in coverage elections outside of an Initial Enrollment Period or Annual Open Enrollment Period.

 

“Retired Employee” means an individual as defined in Section 3(p) of the Act. [5 ILCS 375/3(p)]

 

“Survivor” means an individual as defined in Section 3(q) of the Act. [5 ILCS 375/3(q)]

 

“TRAIL Program” means the program of group health benefits designed and/or contracted for by the Agency and made available for Medicare-primary members and their Medicare-primary dependents.