What I Need to Know About My Insurance Coverage & Payment of Premiums While on Leave

The State of Illinois Employees Group Insurance Program is administered by Central Management Services (CMS). When employees are on an unpaid leave of absence, CMS direct bills them for health, dental and life premiums. The amount billed is based on whether the leave is a State Paid or Non-State Paid leave.
   
State Paid Leaves: The state will continue to pay the same portion of the employer premium as when the employee was active on payroll.  An exception is made for part-time employees on Occupational Disability in which case the employee must be treated the same as a full-time employee for insurance purposes.  

Non-State Paid Leaves: Employee is required to pay 100% of the state/employer and employee premiums.
				 
State Paid Leaves
State Pays Employer Premiums	Maximum Coverage Period	Non-State Paid Leaves
State Does Not Pay 
Employer Premiums	Maximum Coverage Period	
FMLA – Maternity/Family Member	12 weeks	Personal Leave 	24  months	
FMLA - Medical	24 months			
Educational Leave/Sabbatical 	24 months (Lifetime)	Seasonal Layoff except during the months of June, July and Aug.  	Part-time premiums required all year	
Dock-Suspension < 30 days	30 days	Dock Suspension > 30 days	24 months	
Disability/w SURS Benefit	None	Permanent Layoff – Life only	12 months	
Disability/w No SURS Benefit	24 months	Family Military  	30 days 	
Workers Compensation 	None	Family Leave – non medical or FMLA leave expired	12 months	
University Annual Summer Break	3 months			
Seasonal Layoff during the months of June, July and August	3 months	
Military Leave 	None	
Family Leave – Military Caregiver	26 weeks 	

CMS Leave Rules and Policies:
1.	CMS allows employees 60 days from the date the leave began to request a coverage change.  The effective date of a coverage change will be the date the leave began or the date of the request.
a.	Changes made on or before the first day of the leave are effective on the first day of the leave.
b.	Changes made within 60 days after the first day of the leave are effective the date of the request.
2.	Monthly billing statements are mailed out by CMS to employees’ mailing addresses on file.	
a.	Failure to submit payment by the due date may result in a current termination of coverage and/or the filing of an involuntary withholding order to collect the unpaid premium.
3.	Employees are required to update MAILING address changes using NESSIE.
4.	Contact the Urbana Campus UPB Fiscal Control and Management office to report your return to work date.  
a.	UIC employees contact Margaret Caston at 217-265-6342, email caston@uillinois.edu 
b.	UIS employees contact April Buchner at 217-244-3834, email buchner@uillinois.edu 
c.	UIUC employees contact Amy Abrahamson at 217-300-1746, email amyacree@uillinois.edu  

5.	Employees must be actively at work to participate in the Dependent Care Assistance Plan (DCAP) or the Medical Care Assistance Program (MCAP).  Eligible to enroll in both plans when returned to work.   
a.	A COBRA election can be made to continue MCAP.  Contributions may be pre-tax if the Urbana campus UPB office is notified before the last paycheck otherwise post-tax contribution is mailed directly to CMS.  
6.	*When dependent coverage is terminated during a leave, the dependent(s) must be re-enrolled in coverage using NESSIE prior to or within 60 days of the employee returning to work.  
a.	Employees who fail to re-enroll dependents within the time frame cannot add them until they have an eligible qualifying event or the next Benefit Choice period. 

State Paid Leave Insurance Options: 
1.	 Make no changes 
2.	Full-time employees may opt-out of heath/dental/vision by providing proof of other non-State of Illinois group health insurance coverage.  
a.	Employees can retain their opt-out status after returning to work as long as insurance coverage continues.  
3.	Part-time employees may waive heath/dental/vision but are ineligible to be a dependent on a spouse’s State of Illinois group insurance coverage.       
a.	Employees can continue to waive coverage as long as they remain part-time. 
4.	Terminate dependent(s) coverage.*
5.	Reduce or terminate employee or dependent optional life insurance. Statement of Health approval required for reinstatement of coverage.
6.	Health carrier changes are permitted only when employee is moving out of their HMO/OAP coverage area, e.g. out of state or country. 
7.	*If insurance is terminated for non-payment of premiums, employee only coverage is reinstated 1st day of the following pay period. Dependent coverage will require re-enrollment within 60 days of the return to work date. Effective date is the date of the written submission. 

Non-State Paid Leave Insurance Options: 
1.	Make no changes.
2.	Employee may be eligible to become a dependent on a State of Illinois-employed spouse’s insurance plan until the employee physically returns to work.
3.	Full-time employees may opt-out of heath/dental/vision by providing proof of other non-State of Illinois group health insurance coverage. 
a.	Employees can retain their opt-out status after returning to work as long as insurance coverage continues.  
4.	Terminate all coverage without proof of other insurance. 
a.	State insurance for monthly employees will be effective the 1st day of the month following the return to work date.  
b.	State insurance for bi-weekly employees will be effective on either the 1st or the 16th day of the month following the return to work date.  
c.	Employees, full or part time, who terminate coverage, must contact the Urbana campus UPB office prior to their return to work to re-enroll or go to NESSIE to make elections.  Employees who fail to re-enroll will be defaulted into the Quality Care Plans with no dependent coverage.
5.	Part-time employees may waive heath/dental/vision.   
6.	Terminate dependent(s) coverage.* 
7.	Reduce or terminate employee or dependent optional life insurance. Statement of Health approval required for reinstatement.
8.	*If insurance is terminated for non-payment of premiums, employee only coverage is reinstated 1st day of the following pay period. Dependent coverage will require re-enrollment within 60 days of the return to work date. Effective date is the date of the written submission. 

To Make a Leave Coverage Election: 
To continue current coverage or change coverage, complete the Leave of Absence Worksheet and return to the address shown on the form. 

Annual Summer Break/Seasonal Layoff During June, July and August
Full and part-time employees who are paid 9/9 and do not have a benefits eligible job over the summer will be automatically billed by CMS for same premium amounts that are deducted from their pay checks through August 31. Employees who are not returning in the fall and wish to discontinue their insurance coverage before August 31 should contact UPB in writing before June 1 requesting termination of coverage.  Employees who request to terminate coverage after June 1 will have their coverage terminated on the date of the request.  Once an employee is billed, there is no option but for the employee to pay the bill.  Employees who will be reappointed for the fall are not eligible to drop coverage over the summer and will have premiums payroll-deducted starting in September.  

Leave of Absence Worksheet
	
Today’s Date:           	University I.D. #:                  SSN: xxx-xx-          Birth Date:      	
Please Print or Type Information	
Last Name:	First Name:	Middle:	
               	                    	     	
Email:	Home Phone #:	Work  Phone #:	
       	(     )            	(     )            	
Street Address: 		
                                                                      		
P.O. Box:	City:	State:	ZIP Code:	
          	                    	     	          	
Leave Type:	 Personal Leave		
	 Disability/Medical
 Seasonal Layoff
 University Annual Summer Break	 Family Medical Leave
 Educational/Sabbatical
 Workers Compensation	 Dock Suspension
 Military Leave	
Leave start date:	Leave end date:	
          	     	
Department HR Contact:                     	HR Contact Phone#: (     )            	
		
I will keep current insurance coverage.  	Yes   (CMS will bill monthly for duration of leave.)
 No   (Please fill out below if selecting “No”.)  	
Optional LIfe Insurance/Accidental Death & dismemberment:	Dropping Health/Dental/Vision Coverage:	
 Cancel Employee Optional Life	 Full-Time Opting Out	
 Reduce Employee Optional Life (select amount below)	 Part-Time Waiving	
 1xBasic	 2xBasic	 3xBasic	 4xBasic	 I elect to terminate health/dental/vision coverage. (Personal Leave Only) *Re-enrollment is required.	
 5xBasic	 6xBasic	 7xBasic	 Cancel All AD&D Coverage	 I will be a dependent on my spouse’s State of Illinois Group Insurance Plan. (Personal Leave Only)	
Qualifying Event:   Address Change 	Spouse’s Name:  	
Employees can change health plan if leaving HMO/OAP Network area.	                    	
New Health Plan:                     
HMO/NPI #                     	Spouse’s UIN or Last 4 Digits of SSN:	
	UIN:                 	or	SSN: xxx-xx-     	

Election to Update Dependent(S) pcp FOR NEW HEALTH PLAN:	 CHECK  COVERAGE TO 
 TERMINATE	
Last Name:	First Name:	Last 4 SSN#:	PCP	Health/Dental:	Life:	
               	               	     	          	 	 	
               	               	     	          	 	 	
               	               	     	          	 	 	
               	               	     	          	 	 	
Re-enrollment of dependent(s) is NOT automatic when you return to work.  Please use NESSIE to enroll dependents in health, dental and life coverage prior to returning to work.  Contact Urbana Campus UPB Office with questions or additional information.	
If you are currently enrolled in the U of I Accidental Death and Dismemberment or Long Term Disability plans, you will be billed monthly by UPB. 

I authorize premiums, as established annually, to be deducted from my pay for those plans I have selected.  I understand that if my paycheck is insufficient or if I am not on payroll, I will be direct billed.  The information contained in this form is complete and true.  I agree to abide by all Group Insurance Program rules.  I agree to furnish additional information requested for enrollment or administration of the plan I have elected.  I understand it is my responsibility to review my paycheck and verify the amounts of the insurance deductions are accurate.  I understand that if my deductions are not correct I must immediately contact my GIR.  Falsification of the information contained on this form may result in discipline up to and including discharge.  Additionally, the Department of Central Management Services (CMS) may impose a financial penalty, including, but not limited to, repayment of all premiums the Program made on behalf of the enrolled individual, as well as expenses incurred by the Program.	

				
	Employee’s  Signature		Date  		

Please return form to the Urbana UPB Fiscal Control and Management Office	
Room 177 HAB
506 S. Wright Street
Urbana, IL 61801 (MC 318) 
Fax (217) 244-0993	UIC employees contact Margaret Caston 217-265-6342
UIS employees contact April Buchner 217-244-3834
UIUC employees contact Amy Abrahamson 217-300-1746 

FY2017 Monthly Premium Example for State-Paid Leaves  
Health Plan Based on 
Employee Salary $30,200 or Less 	Employee Only	Employee +1 
Dependent	Employee +2 or more Dependents	
Quality Care	$93.00	$342.00	$380.00	
Health Alliance HMO	$68.00	$181.00	$227.00	
Coventry Health Care HMO	$68.00	$179.00	$224.00	
HMO Illinois	$68.00	$168.00	$207.00	
Blue Advantage	$68.00	$164.00	$200.00	
HealthLink OAP	$68.00	$194.00	$247.00	
Coventry Health Care OAP	$68.00	$179.00	$224.00	
Dental Plan	Employee Only	Employee +1 
Dependent	Employee +2 or More Dependents	
Quality Care Dental Plan 	$11.00	  $17.00	  $19.50	

FY2017 Monthly Premiums for Non-State Paid Leaves
Health Plan 
	Employee Only	Employee +1 Dependent	Employee +2 or more Dependents	
Quality Care	$995.94	$2,075.24	$2,518.38	
Health Alliance HMO	$834.46	$1,541.94	$2,105.00	
Coventry Health Care HMO 	$815.62	$1,507.26	$2,059.02	
HMO Illinois	$745.78	$1,378.78	$1,888.62	
Blue Advantage	$723.10	$1,337.02	$1,833.28	
HealthLink OAP	$918.20	$1,699.32	$2,336.02	
Coventry Health Care OAP	$811.70	$1,503.34	$2,075.24	
Dental Plan	Employee Only	Employee + 1 Dependent	Employee + 2 or More Dependents	
Quality Care Dental Plan 	  $35.32	    $67.76	   $104.54