TITLE 80: PUBLIC OFFICIALS AND EMPLOYEES
SUBTITLE F: EMPLOYEE BENEFITS
CHAPTER I: DEPARTMENT OF CENTRAL MANAGEMENT SERVICES
PART 2120
STATE OF ILLINOIS MEDICAL CARE ASSISTANCE PLAN
SECTION 2120.10 SUMMARY AND PURPOSE OF PLAN
Section 2120.10 Summary and
Purpose of Plan
This Plan is intended to qualify
as a medical care assistance program under Sections 105, 125, and 213(d) of the
Internal Revenue Code (26 U.S.C. 105, 125, and 213(d)) (Code) and is to be
interpreted in a manner consistent with the requirements of these Sections.
The purpose of the Plan is to enable Participants to elect to receive
Reimbursements of their Medical Care Expenses that are excludable from their
taxable Compensation pursuant to Code Section 105(b).
 | TITLE 80: PUBLIC OFFICIALS AND EMPLOYEES
SUBTITLE F: EMPLOYEE BENEFITS
CHAPTER I: DEPARTMENT OF CENTRAL MANAGEMENT SERVICES
PART 2120
STATE OF ILLINOIS MEDICAL CARE ASSISTANCE PLAN
SECTION 2120.20 PLAN NUMBER
Section 2120.20 Plan Number
The number of this Plan for
purposes of reporting statistical information to the Internal Revenue Service
is 502.
| TITLE 80: PUBLIC OFFICIALS AND EMPLOYEES
SUBTITLE F: EMPLOYEE BENEFITS
CHAPTER I: DEPARTMENT OF CENTRAL MANAGEMENT SERVICES
PART 2120
STATE OF ILLINOIS MEDICAL CARE ASSISTANCE PLAN
SECTION 2120.30 DEFINITIONS
Section 2120.30 Definitions
a) Wherever used in the Plan, the following terms have the
following meanings:
"Anticipated
Payroll" means those payrolls in which the Participant is issued a
paycheck during the pay period that the deduction is taken.
"Card" means the stored value card provided by the Plan
Administrator that deducts funds electronically from a Participant's medical care
assistance account to pay for eligible expenses.
"Change
in Family Status" means marriage, divorce, death of spouse or dependent,
birth or adoption of child, commencement or termination of employment of spouse,
significant change in cost or benefits coverage of the Participant or spouse due
to the spouse's employment, switch from full-time to part-time status of spouse,
or from part-time to full-time, or unpaid leave of absence of Participant or spouse,
or any other events that the Department determines constitute a change in
family status.
"Code"
means the Internal Revenue Code of 1954 (26 USC 1 et seq.) and applicable
regulations, or any successor statute.
"Compensation"
for purposes of this Plan is defined under Code section 414. It means wages,
salaries and other employee compensation received by a Participant as reported
on the Participant's W-2 from this employer. For purposes of discrimination
testing, it may include or exclude all amounts not currently includible in the
Participant's gross income.
"Delayed
Payroll" means those payrolls in which the Participant is issued a
paycheck following the pay period that the deduction is taken.
"Department"
means the Illinois Department of Central Management Services.
"Dependent"
means a Participant's spouse, qualifying child or qualifying relative as
defined in Internal Revenue Code sections 152 and 213(d)(5).
"Discriminatory
Excess" is the excess of any "Highly Compensated Participant"
over the highest permitted benefit.
"Eligible
Employee" means any employee working full time or not less than half-time
who is eligible to participate in the Health Plan authorized by the State
Employees Group Insurance Act of 1971. It includes those employees who have
lost eligibility to participate in the Health Plan because of a reduction in
hours worked but chosen continuation coverage through payroll deduction as
authorized by the Consolidated Omnibus Budget Reconciliation Act (COBRA) (P.L.
99-272) as long as there is no break in coverage or payroll deductions. It
also includes those employees who retire, terminate employment or go on an
unpaid leave of absence, but choose to continue to make contributions to their
MCAP for the balance of the Plan Year. An eligible employee of the employer excludes
independent contractors, temporary employees, and retirees who return to work
for not longer than 75 days per year after they retire.
"Employer"
means the State of Illinois, which includes all officers, boards, commissions,
and agencies created by the Illinois Constitution, whether in the executive,
legislative or judicial branch, all officers, departments, boards, commissions,
agencies, institutions, authorities, universities, bodies politic and corporate
of the State; and administrative units or corporate outgrowths of the State
government that are created by or pursuant to statute other than units of local
government and their officers, school districts and boards of election
commissioners, and all administrative units and corporate outgrowths of the
above as may be created by executive order of the Governor.
"Enrollment
Form" means the form provided by the Department for the purpose of filing
an election and compensation reduction agreement and for making changes
authorized by the Plan.
"Grace
Period" means the period following the close of the Plan Year in which the
Participant can incur a medical care expense eligible for reimbursement from
his or her medical care assistance account from the just completed Plan Year.
The grace period goes from July 1 until September 15 of each calendar year.
"Health
Plan" means health, dental and vision coverage offered by the Department
to eligible persons.
"Highly
Compensated Participant" means any Participant who was in either of the
following categories at any time during the current Plan Year:
an employee of
the State or its administrative units or corporate outgrowths who has annual
total compensation greater than $75,000 or any other amount established by the
Internal Revenue Service; or
an employee of
the State who receives compensation in excess of $50,000 or any other amount
established by the Internal Revenue Service and is in the top 20% of all State employee
salaries.
"Medical
Care Expense" means any expense incurred by a Participant or dependent of
the Participant that was paid for as a medical service expense eligible under
Internal Revenue Code section 213(d). Expenses that result in a double
deduction for tax purposes are not eligible. For example:
Premiums for
health insurance coverage carried by the eligible employee, spouse or
dependent; and
Premiums for
other health coverage carried by the Participant.
"Participant"
means each eligible employee who participates in the Plan in accordance with
Section 2120.210 of this Part.
"Pay
Period" means a regular accounting period established by the State of
Illinois for measuring and paying compensation earned by employees. A pay
period may be monthly, semi-monthly or biweekly.
"Plan"
means the State of Illinois Medical Care Assistance Plan as set forth in this
Part, and as may be amended from time to time in compliance with the Illinois
Administrative Procedure Act [5 ILCS 100].
"Plan
Administrator" means an organization, company or other entity designated
by the Director to perform certain duties related to the administration of a
specific plan in accordance with the terms of the contract between the
organization and the Department.
"Plan
Year" means the 12-consecutive-month period beginning July 1 comprising
the State fiscal year.
"Qualifying Child" means
an individual 26 years old or younger at the end of the taxable year who has a
specified family-type relationship to the Participant, lives in the Participant's
household for more than half of the taxable year and has not provided more than
one-half of his or her own support during the taxable year. There is no age
requirement if the individual is physically and/or mentally incapable of self
care.
"Qualifying Relative"
means an individual who has a specified family-type relationship with the
Participant, is not someone else's qualifying child and receives more than
one-half of his or her support from the Participant during the taxable year or,
if no specified family-type relationship to the Participant exists, is a member
of and lives in the Participant's household (without violating local law) for
the entire taxable year and receives more than one-half of his or her support
from the Participant during the taxable year.
"Reimbursement"
means to pay a Participant in this Plan for medical care expenses from his or
her medical care assistance account.
"Spouse"
means the person to whom the Participant is married. Spouse does not include a
person separated from the Participant under a decree of divorce.
"Termination"
means the permanent severance of the Participant's employment relationship with
the employer as provided by the appropriate rules of the employer.
"Unsubstantiated
Expenses" are expenses for medical care paid for with the Card for which
the Plan Administrator requires additional documentation to substantiate the
expense.
b) A pronoun or adjective in the masculine gender includes the
feminine gender and the singular includes the plural, unless the context
clearly indicates otherwise.
(Source: Amended at 37 Ill.
Reg. 4241, effective March 22, 2013)
SUBPART B: ADMINISTRATION
| TITLE 80: PUBLIC OFFICIALS AND EMPLOYEES
SUBTITLE F: EMPLOYEE BENEFITS
CHAPTER I: DEPARTMENT OF CENTRAL MANAGEMENT SERVICES
PART 2120
STATE OF ILLINOIS MEDICAL CARE ASSISTANCE PLAN
SECTION 2120.110 ROLE OF THE DEPARTMENT/PLAN ADMINISTRATOR
Section 2120.110 Role of the
Department/Plan Administrator
a) The Plan shall be administered by the Plan Administrator.
b) The Department reserves the right to enter into agreements
with other agencies to delegate various record keeping and other administrative
functions to the employing agencies of Participants.
c) It shall be a principal duty of the Department to see that the
Plan is carried out for the exclusive benefit of persons entitled to
participate in the Plan without discrimination among them.
(Source: Amended at 30 Ill.
Reg. 15119, effective September 6, 2006)
| TITLE 80: PUBLIC OFFICIALS AND EMPLOYEES
SUBTITLE F: EMPLOYEE BENEFITS
CHAPTER I: DEPARTMENT OF CENTRAL MANAGEMENT SERVICES
PART 2120
STATE OF ILLINOIS MEDICAL CARE ASSISTANCE PLAN
SECTION 2120.120 EXPENSES OF ADMINISTRATION
Section 2120.120 Expenses of
Administration
Any expenses incurred relative
to the administration of the Plan shall be paid by the Department.
SUBPART C: PARTICIPATION
| TITLE 80: PUBLIC OFFICIALS AND EMPLOYEES
SUBTITLE F: EMPLOYEE BENEFITS
CHAPTER I: DEPARTMENT OF CENTRAL MANAGEMENT SERVICES
PART 2120
STATE OF ILLINOIS MEDICAL CARE ASSISTANCE PLAN
SECTION 2120.210 DATE OF PARTICIPATION
Section 2120.210 Date of
Participation
a) An eligible employee will become a Participant upon an
election under this Plan to receive medical care assistance.
b) New eligible employees may become Participants upon an
election to receive medical care assistance that is made within 60 days after becoming
an employee.
c) Employees who are eligible because they have chosen
continuation coverage as authorized by COBRA must continue their medical
assistance deductions. Otherwise, they will be considered revoked as described
in Section 2120.220.
d) Eligible employees who experience a change in family status may
elect to participate at any time within the Plan Year. The election must be
made within 60 days after the change in family status.
e) Elections from new eligible employees or those who have had a change
in family status will be effective the first pay period after the signature
date of the Participant on the enrollment form or the date of the change in family
status, whichever is later.
(Source: Amended at 30 Ill.
Reg. 15119, effective September 6, 2006)
| TITLE 80: PUBLIC OFFICIALS AND EMPLOYEES
SUBTITLE F: EMPLOYEE BENEFITS
CHAPTER I: DEPARTMENT OF CENTRAL MANAGEMENT SERVICES
PART 2120
STATE OF ILLINOIS MEDICAL CARE ASSISTANCE PLAN
SECTION 2120.220 INSUFFICIENT SALARY
Section 2120.220
Insufficient Salary
a) Participation can only be through payroll deduction except as
specifically allowed in this Part.
b) In the event the Comptroller fails to make a deposit in the
Participant's account because there are inadequate funds to satisfy the
Participant's elected deduction, the Participant's deduction will be revoked.
c) The revoked Participant described in this Section can request reimbursement
of medical care expenses in accordance with Subpart F of this Part.
d) The revoked Participant described in this Section can
re-enroll the next election period in accordance with Section 2120.310.
(Source: Amended at 30 Ill.
Reg. 15119, effective September 6, 2006)
| TITLE 80: PUBLIC OFFICIALS AND EMPLOYEES
SUBTITLE F: EMPLOYEE BENEFITS
CHAPTER I: DEPARTMENT OF CENTRAL MANAGEMENT SERVICES
PART 2120
STATE OF ILLINOIS MEDICAL CARE ASSISTANCE PLAN
SECTION 2120.230 ERRORS
Section 2120.230 Errors
a) Participants are responsible for monitoring their accounts and
notifying the employer of any payroll or other errors.
b) In the event a deduction is missed or an incorrect amount is
taken because of payroll or other processing errors, the error must be
corrected on a later payroll or direct billed to the Participant if he or she
is off payroll.
c) If the correction of the error causes an economic hardship for
the Participant, the funds sufficient to correct the error will be deducted
from the Participant's paycheck over the two months immediately following the
discovery of the error.
d) In the event of overpayment because of error, the Participant
will be asked to refund to the Department the excess reimbursement.
e) If the Participant refuses to reimburse the Department for the
overpayment, the Department will request the Comptroller to withhold the
required amount from the Participant's next available paycheck pursuant to 74
Ill. Adm. Code 285. If the Participant is off payroll, the overpayment will be
added as income to the Participant's W-2.
(Source: Amended at 30 Ill.
Reg. 15119, effective September 6, 2006)
SUBPART D: ELECTION TO RECEIVE MEDICAL CARE ASSISTANCE
| TITLE 80: PUBLIC OFFICIALS AND EMPLOYEES
SUBTITLE F: EMPLOYEE BENEFITS
CHAPTER I: DEPARTMENT OF CENTRAL MANAGEMENT SERVICES
PART 2120
STATE OF ILLINOIS MEDICAL CARE ASSISTANCE PLAN
SECTION 2120.310 ELECTION PROCEDURE
Section 2120.310 Election
Procedure
a) An eligible employee may elect to receive medical care
assistance under this Plan by making an election and compensation reduction
agreement on an enrollment form provided by the Department.
b) The enrollment period will be at a time to be determined by
the Department prior to the beginning of the Plan Year. The enrollment period
shall be sufficient to allow eligible employees to enroll in the Plan and shall
in no case be less than 30 days prior to the beginning of the Plan Year.
c) Eligible employees must participate for a full 12-month
period. Participants who terminate, retire or go on unpaid leave of absence may
continue participation by making the elected monthly deduction via a personal
check or money order. As the payments are not made through payroll deduction,
no tax benefits are allowed. If continuation is not elected, eligible expenses
will include only those expenses incurred through the date of the last pay period
following the pay period in which the last deduction was made.
d) The election must be for a specified annual dollar amount
evenly divisible by the number of pay periods in the Plan Year.
e) The Participant must re-enroll each year to continue
participation.
(Source: Amended at 30 Ill.
Reg. 15119, effective September 6, 2006)
| TITLE 80: PUBLIC OFFICIALS AND EMPLOYEES
SUBTITLE F: EMPLOYEE BENEFITS
CHAPTER I: DEPARTMENT OF CENTRAL MANAGEMENT SERVICES
PART 2120
STATE OF ILLINOIS MEDICAL CARE ASSISTANCE PLAN
SECTION 2120.320 IRREVOCABILITY OF ELECTION
Section 2120.320
Irrevocability of Election
a) An election to participate shall be irrevocable during the
Plan Year unless a change in family status has occurred.
b) A change in family status will permit a change or revocation
of an election during a Plan Year under the Code. To the extent consistent
with the Code, this provision shall be liberally construed by the Department to
maximize the benefit to the Participant.
c) Election changes must be consistent with changes in family
status.
d) The form requesting the change in the election must be filed
with the Department within 60 days after the change in family status.
e) The Department shall require documentation substantiating the change
in family status consisting of group insurance records maintained by the
Department or personnel transaction records maintained by the employing agency
or other documents substantiating the claimed change in family status.
f) Any new election under this Section shall be effective the
first pay period after the signature date of the Participant on the enrollment form
or the date of the change in family status, whichever is later.
(Source: Amended at 30 Ill.
Reg. 15119, effective September 6, 2006)
| TITLE 80: PUBLIC OFFICIALS AND EMPLOYEES
SUBTITLE F: EMPLOYEE BENEFITS
CHAPTER I: DEPARTMENT OF CENTRAL MANAGEMENT SERVICES
PART 2120
STATE OF ILLINOIS MEDICAL CARE ASSISTANCE PLAN
SECTION 2120.330 MAXIMUM MEDICAL CARE ASSISTANCE
Section 2120.330 Maximum
Medical Care Assistance
a) The maximum amount that the Participant may payroll deduct for
use under this Plan during the Plan Year shall not exceed $2,500 for tax year
2013 and, after tax year 2013, an amount adjusted for cost of living to the
extent provided under Section 125(i) of the Code (indexed to the CPI-U, with
any increase that is not a multiple of $50 rounded to the next lowest multiple
of $50).
b) The pay period maximum is the annual maximum divided by the
number of pay periods in the Plan Year.
c) The pay period maximum cannot be exceeded if there is a change
in family status, as provided in Section 2120.610 of this Part, or if there are
circumstances requiring prepayment of the contributions for the balance of the
year.
d) If the Department determines during the Plan Year that highly
compensated Participants are benefiting from the Plan more than non-highly
compensated Participants, the Department shall reduce the maximum deduction for
the highly compensated Participants the minimal amount necessary to bring the
Plan into compliance with the non-discrimination requirements of the Code (26 USC
125).
(Source: Amended at 37 Ill.
Reg. 4241, effective March 22, 2013)
| TITLE 80: PUBLIC OFFICIALS AND EMPLOYEES
SUBTITLE F: EMPLOYEE BENEFITS
CHAPTER I: DEPARTMENT OF CENTRAL MANAGEMENT SERVICES
PART 2120
STATE OF ILLINOIS MEDICAL CARE ASSISTANCE PLAN
SECTION 2120.340 MINIMUM MEDICAL CARE ASSISTANCE
Section 2120.340 Minimum
Medical Care Assistance
The minimum level of
participation in this Plan is $20 per month.
SUBPART E: MEDICAL CARE ASSISTANCE ACCOUNTS
| TITLE 80: PUBLIC OFFICIALS AND EMPLOYEES
SUBTITLE F: EMPLOYEE BENEFITS
CHAPTER I: DEPARTMENT OF CENTRAL MANAGEMENT SERVICES
PART 2120
STATE OF ILLINOIS MEDICAL CARE ASSISTANCE PLAN
SECTION 2120.410 ESTABLISHMENT OF ACCOUNTS
Section 2120.410
Establishment of Accounts
The Plan Administrator will
establish and maintain a medical care assistance account for each Plan Year for
each Participant who has enrolled for the Plan Year.
(Source: Amended at 30 Ill.
Reg. 15119, effective September 6, 2006)
| TITLE 80: PUBLIC OFFICIALS AND EMPLOYEES
SUBTITLE F: EMPLOYEE BENEFITS
CHAPTER I: DEPARTMENT OF CENTRAL MANAGEMENT SERVICES
PART 2120
STATE OF ILLINOIS MEDICAL CARE ASSISTANCE PLAN
SECTION 2120.420 CREDITING OF ACCOUNTS
Section 2120.420 Crediting
of Accounts
a) There shall be credited to a Participant's medical care
assistance account for each Plan Year, as of each Pay Period, an amount equal
to the reduction made in the Participant's Compensation in accordance with the
Participant's election.
b) All amounts credited to each such medical care assistance
account shall be the property of the State until paid out pursuant to Subpart F
of this Part.
c) No interest will be credited to the Participants Accounts on
balances in the medical care assistance account.
| TITLE 80: PUBLIC OFFICIALS AND EMPLOYEES
SUBTITLE F: EMPLOYEE BENEFITS
CHAPTER I: DEPARTMENT OF CENTRAL MANAGEMENT SERVICES
PART 2120
STATE OF ILLINOIS MEDICAL CARE ASSISTANCE PLAN
SECTION 2120.430 DEBITING OF ACCOUNTS
Section 2120.430 Debiting of
Accounts
A Participant's medical care
assistance account for each Plan Year shall be debited as of the date the reimbursement
is processed by the Plan Administrator under Section 2120.520.
(Source:
Amended at 30 Ill. Reg. 15119, effective September 6, 2006)
| TITLE 80: PUBLIC OFFICIALS AND EMPLOYEES
SUBTITLE F: EMPLOYEE BENEFITS
CHAPTER I: DEPARTMENT OF CENTRAL MANAGEMENT SERVICES
PART 2120
STATE OF ILLINOIS MEDICAL CARE ASSISTANCE PLAN
SECTION 2120.440 FORFEITURE OF ACCOUNTS
Section 2120.440 Forfeiture
of Accounts
a) The amount credited to a Participant's medical care assistance
account for any Plan Year shall be used:
1) only to reimburse the Participant for medical care expenses incurred
during the applicable Plan Year or during the grace period (until September 15)
following the close of the Plan Year; and
2) only if the Participant applies for reimbursement on or before
September 30 following the close of the Plan Year.
b) If any balance remains in the Participant's medical care
assistance account for any Plan Year after all reimbursements under the Plan, the
balance shall not be carried over to reimburse the Participant for medical care
expenses incurred during a subsequent Plan Year, with the exception of expenses
incurred during the grace period, and shall not be available to the Participant
in any other form or manner.
c) Any remaining balance shall be used to reimburse the Plan for
any reimbursements to Participants in excess of deposits that were not
recovered as provided in Section 2120.610.
d) Any remaining balance in the fund shall be distributed to the 202
Fund.
(Source: Amended at 30 Ill.
Reg. 15119, effective September 6, 2006)
SUBPART F: PAYMENT OF MEDICAL CARE ASSISTANCE ACCOUNTS
| TITLE 80: PUBLIC OFFICIALS AND EMPLOYEES
SUBTITLE F: EMPLOYEE BENEFITS
CHAPTER I: DEPARTMENT OF CENTRAL MANAGEMENT SERVICES
PART 2120
STATE OF ILLINOIS MEDICAL CARE ASSISTANCE PLAN
SECTION 2120.510 CLAIMS FOR REIMBURSEMENT
Section 2120.510 Claims for
Reimbursement
a) A Participant who has enrolled for a Plan
Year may apply to the Plan Administrator for reimbursement of medical care
expenses incurred by the Participant between July 1 of the Plan Year and September
15 of the following Plan Year. For purposes of this Part, expenses are treated
as having been incurred when the Participant is provided with the medical care
that gives rise to the expenses, and not when the Participant is formally
billed, charged for, or pays for the medical care.
b) New Participants who enrolled during the open enrollment
period may apply for reimbursement of medical care expenses incurred between
the first day of the Plan Year (in accordance with Section 2120.210) and September
15 of the following Plan Year. New Participants who enroll through a mid-year
enrollment due to a change in family status may apply for reimbursement of medical
care expenses incurred between the first day of the pay period following the
signature date on the enrollment form, or the date of the change in family status,
whichever is later, and September 15 of the following Plan Year.
c) Participants who revoke participation in accordance with
Sections 2120.220 and 2120.320 before the end of the Plan Year may apply for reimbursement
of medical care expenses incurred between July 1 and, if on an anticipated payroll,
the last day of the pay period that the last deduction was taken or, if on a delayed
payroll, the last day of the pay period following the pay period when the last
deduction was taken.
d) Participants who terminate, retire or go on unpaid leave of
absence and choose to pay any contributions for the balance of the Plan Year, in
accordance with Section 2120.310(c), will have coverage for the entire Plan
Year and may apply for reimbursement of medical care expenses incurred between
July 1 of the Plan Year and September 15 of the following Plan Year.
e) The Participant may apply for reimbursement by submitting an
application in writing to the Plan Administrator on a claim form provided by
the Plan Administrator setting forth:
1) the amount, beginning and ending service date and type of
service for which reimbursement is requested;
2) the name of the person, organization or entity to which the
expense was paid;
3) third party verification of the expense, such as bills,
invoices, receipts, or other statements showing the amounts of such expenses;
and
4) a statement that the medical expense has not been reimbursed
and is not reimbursable under any health plan coverage.
(Source: Amended at 30 Ill.
Reg. 15119, effective September 6, 2006)
| TITLE 80: PUBLIC OFFICIALS AND EMPLOYEES
SUBTITLE F: EMPLOYEE BENEFITS
CHAPTER I: DEPARTMENT OF CENTRAL MANAGEMENT SERVICES
PART 2120
STATE OF ILLINOIS MEDICAL CARE ASSISTANCE PLAN
SECTION 2120.520 REIMBURSEMENT OF PARTICIPANT
Section 2120.520
Reimbursement of Participant
a) The Plan Administrator shall reimburse the Participant from
the Participant's medical care assistance account for medical care expenses incurred
during the Plan Year through September 15 of the following Plan Year for which
the Participant submits documentation in accordance with Sections 2120.510 and
2120.525.
b) The reimbursement schedule will be established by the Plan
Administrator in a manner that allows the Participant to receive reimbursement no
less than once a month.
c) The Plan Administrator will reimburse Participants who have
filed claims in the prescribed manner:
1) at least once a month if the claim equals or exceeds $5, and
if there is eligibility for reimbursement remaining in the account; and
2) at least once the twelfth month (or the final month of participation)
regardless of the amount.
d) If a claim for reimbursement under this Section exceeds the
balance of the Participant's medical care assistance account, the Participant
will be paid the amount of the claim as long as the claim is no greater than the
annual election amount less any reimbursements paid to date.
e) Claims for expenses incurred between July 1 and September 15
will be paid, first, from any funds remaining from the previous Plan Year and,
then, from funds available under the current Plan Year.
(Source: Amended at 33 Ill.
Reg. 11791, effective August 3, 2009)
| TITLE 80: PUBLIC OFFICIALS AND EMPLOYEES
SUBTITLE F: EMPLOYEE BENEFITS
CHAPTER I: DEPARTMENT OF CENTRAL MANAGEMENT SERVICES
PART 2120
STATE OF ILLINOIS MEDICAL CARE ASSISTANCE PLAN
SECTION 2120.525 ELECTRONIC CARD REIMBURSEMENT PROGRAM
Section 2120.525 Electronic
Card Reimbursement Program
a) A Participant may elect to pay medical care
expenses through the use of a stored value card (Card) provided by the Plan
Administrator. The Card deducts funds directly from the Participant's medical
care assistance account and avoids any up-front, out-of-pocket expenses for the
Participant.
b) In order to be eligible for the Card, the
Participant must agree to abide by the terms and conditions associated with the
Card as established by the Plan Administrator and provided to the participant
prior to enrollment, limitations as to Card usage and the Plan Administrator's
right to withhold and offset payment for unsubstantiated expenses. The
Participant must further certify that the Card will be used only for eligible medical
care expenses.
c) Use of this Card is limited to payments for
Medical Care Expenses.
d) The maximum reimbursable amount under the
Card is the full amount of the Participant's contribution to the medical care
assistance account for the Plan Year, less any previously submitted reimbursements.
e) The Participant must obtain a receipt or
third party statement (i.e., explanation of benefits form or invoice) each time
the Card is used. The receipt must be retained for 1 year following the end of
the Plan Year in which the expense was incurred and must be available for
presentation to the Plan Administrator upon request. At a minimum, the receipt
must contain the following information:
1) the type of service provided (i.e., office visit; prescription;
over-the-counter purchase);
2) the date the medical care was provided
(i.e., when the expense was incurred);
3) the amount of the expense;
4) the provider's or vendor's name; and
5) the patient's name.
f) If the Participant fails to provide the
requested documentation to the Plan Administrator within the requested time
frame, the expenses will be deemed unsubstantiated and the Participant will be
required to repay the unsubstantiated expenses. Repayments may be made by
either:
1) submitting payment to reimburse the Plan
for the cost of the unsubstantiated expense. Payment must be in the form of a
check payable to the State of Illinois, submitted to the Plan Administrator;
or
2) submitting other paper claims for the fiscal
year with third-party receipts in amounts equal to, or greater than, the unsubstantiated
expenses. These paper claims will automatically be substituted to offset the
outstanding Card transactions.
g) Failure to submit requested documentation
or provide payment for unsubstantiated expenses will result in suspension of
the Card and termination of future use of the Card. Participants may be subject to involuntary
withholding for the unsubstantiated expenses or outstanding transactions may be
reported to the IRS as income and the Participant's W-2 form adjusted accordingly.
h) Participants may elect the Card at any time
during the Plan Year. Cards are automatically suspended upon termination or
cancellation of participation in the Plan.
(Source:
Amended at 37 Ill. Reg. 4241, effective March 22, 2013)
| TITLE 80: PUBLIC OFFICIALS AND EMPLOYEES
SUBTITLE F: EMPLOYEE BENEFITS
CHAPTER I: DEPARTMENT OF CENTRAL MANAGEMENT SERVICES
PART 2120
STATE OF ILLINOIS MEDICAL CARE ASSISTANCE PLAN
SECTION 2120.530 EXCLUSIONS
Section 2120.530 Exclusions
A Participant shall not be
reimbursed for any expense that would otherwise be a medical care expense if:
a) the expense was incurred at a time when the Participant was
not a Participant in the Plan; or
b) a claim for reimbursement of the expense has not been filed in
accordance with provisions of Section 2120.510; or
c) the expense was claimed as a credit or deduction on the
Participant's federal or state income tax form; or
d) the expense is reimbursable under any other benefit plan
maintained by the employer or purchased privately by the Participant.
(Source: Amended at 30 Ill.
Reg. 15119, effective September 6, 2006)
| TITLE 80: PUBLIC OFFICIALS AND EMPLOYEES
SUBTITLE F: EMPLOYEE BENEFITS
CHAPTER I: DEPARTMENT OF CENTRAL MANAGEMENT SERVICES
PART 2120
STATE OF ILLINOIS MEDICAL CARE ASSISTANCE PLAN
SECTION 2120.540 STATEMENTS
Section 2120.540 Statements
a) On or before January 31 of each year, the Department shall
furnish to each Participant who was enrolled in the Plan during the prior calendar
year a written statement showing the amount of contributions into his or her
account during that year with respect to the Participant.
b) The Plan Administrator shall notify each Participant electing
a Card in writing, or electronically if the Participant has opted for electronic
communication, via a quarterly statement of the unused balance in his or her
account. Any unsubstantiated expenses will be clearly delineated on the quarterly
statement.
c) The Plan Administrator shall notify each Participant not activating
a Card in writing, or electronically if the Participant has opted for electronic
communication, via a quarterly statement of the unused balance in his or her
account.
(Source: Amended at 37 Ill.
Reg. 4241, effective March 22, 2013)
SUBPART G: TERMINATION OF PARTICIPATION
| TITLE 80: PUBLIC OFFICIALS AND EMPLOYEES
SUBTITLE F: EMPLOYEE BENEFITS
CHAPTER I: DEPARTMENT OF CENTRAL MANAGEMENT SERVICES
PART 2120
STATE OF ILLINOIS MEDICAL CARE ASSISTANCE PLAN
SECTION 2120.610 TERMINATION OR DEATH OF PARTICIPANT
Section 2120.610 Termination
or Death of Participant
a) In the event that a Participant terminates State service or
dies, the Participant's participation shall terminate unless continuation of
coverage as authorized by COBRA has been elected. If COBRA is not elected,
eligible medical care expenses will include only those expenses incurred
through the last day of the pay period when the last deduction was taken, if on
an anticipated payroll, or on the last day of the pay period following the pay period
when the last deduction was taken, if on a delayed payroll.
b) If the Participant returns to State service the same Plan
Year, the Participant can re-enroll in accordance with the provisions of
Section 2120.210. If re-enrollment occurs within 30 days after termination or
departure from State service, the contribution amount per pay period must be
the same as the amount contributed prior to termination.
c) If the Participant's employment status has changed from full
time or part time (equal to or greater than 50 percent of a normal work period)
to a status that no longer allows participation in the State Employees Group
Health Plan, the Participant will be considered revoked as described in Section
2120.220 unless the Participant has chosen continuation coverage as authorized
by COBRA.
d) If participation continues in this Plan because of
COBRA-qualification, the Participant shall be considered terminated from State
service at the end of the 18-month period of COBRA-coverage or whenever
COBRA-qualification ceases.
(Source: Amended at 37 Ill.
Reg. 4241, effective March 22, 2013)
| TITLE 80: PUBLIC OFFICIALS AND EMPLOYEES
SUBTITLE F: EMPLOYEE BENEFITS
CHAPTER I: DEPARTMENT OF CENTRAL MANAGEMENT SERVICES
PART 2120
STATE OF ILLINOIS MEDICAL CARE ASSISTANCE PLAN
SECTION 2120.620 FRAUD
Section 2120.620 Fraud
In the event a Participant
knowingly supplies the Department or Plan Administrator with false information
or knowingly files a claim that is not qualified for reimbursement as
adjudicated by the Internal Revenue Service or a court of competent
jurisdiction, the Department shall exclude the Participant from further
participation in the Plan for all subsequent Plan Years.
(Source: Amended at 30 Ill.
Reg. 15119, effective September 6, 2006)
SUBPART H: MISCELLANEOUS
| TITLE 80: PUBLIC OFFICIALS AND EMPLOYEES
SUBTITLE F: EMPLOYEE BENEFITS
CHAPTER I: DEPARTMENT OF CENTRAL MANAGEMENT SERVICES
PART 2120
STATE OF ILLINOIS MEDICAL CARE ASSISTANCE PLAN
SECTION 2120.710 NON-DISCRIMINATION
Section 2120.710
Non-discrimination
a) This Plan shall meet the requirements of Code sections 125 and
414 that require that all benefits provided for Participants who are highly
compensated are provided for all other Participants.
b) If this Plan fails to meet these requirements, the discriminatory
excess will be included in the high compensated Participants' taxable income
for the Plan Year.
(Source: Amended at 30 Ill.
Reg. 15119, effective September 6, 2006)
| TITLE 80: PUBLIC OFFICIALS AND EMPLOYEES
SUBTITLE F: EMPLOYEE BENEFITS
CHAPTER I: DEPARTMENT OF CENTRAL MANAGEMENT SERVICES
PART 2120
STATE OF ILLINOIS MEDICAL CARE ASSISTANCE PLAN
SECTION 2120.720 ILLEGALITY OF A PARTICULAR PROVISION
Section 2120.720 Illegality
of a Particular Provision
The illegality of any provision
of this Plan shall not affect the other provisions of the Plan and the Plan
shall be construed in all respects as if the invalid provision were omitted.
(Source: Amended at 30 Ill.
Reg. 15119, effective September 6, 2006)
| TITLE 80: PUBLIC OFFICIALS AND EMPLOYEES
SUBTITLE F: EMPLOYEE BENEFITS
CHAPTER I: DEPARTMENT OF CENTRAL MANAGEMENT SERVICES
PART 2120
STATE OF ILLINOIS MEDICAL CARE ASSISTANCE PLAN
SECTION 2120.730 APPLICABLE LAW
Section 2120.730 Applicable
Law
To the extent not preempted by
federal law, the Plan shall be governed by and construed according to the laws
of the State of Illinois.
| TITLE 80: PUBLIC OFFICIALS AND EMPLOYEES
SUBTITLE F: EMPLOYEE BENEFITS
CHAPTER I: DEPARTMENT OF CENTRAL MANAGEMENT SERVICES
PART 2120
STATE OF ILLINOIS MEDICAL CARE ASSISTANCE PLAN
SECTION 2120.740 EFFECT ON PENSION
Section 2120.740 Effect on
Pension
Participation in this Plan will
not affect the amount paid into a Participant's pension nor reduce benefits
received.
| TITLE 80: PUBLIC OFFICIALS AND EMPLOYEES
SUBTITLE F: EMPLOYEE BENEFITS
CHAPTER I: DEPARTMENT OF CENTRAL MANAGEMENT SERVICES
PART 2120
STATE OF ILLINOIS MEDICAL CARE ASSISTANCE PLAN
SECTION 2120.750 EFFECT ON SOCIAL SECURITY
Section 2120.750 Effect on
Social Security
Participation in this Plan
reduces a Participant's Social Security wages by the amount contributed and may
therefore reduce the benefits received.
| TITLE 80: PUBLIC OFFICIALS AND EMPLOYEES
SUBTITLE F: EMPLOYEE BENEFITS
CHAPTER I: DEPARTMENT OF CENTRAL MANAGEMENT SERVICES
PART 2120
STATE OF ILLINOIS MEDICAL CARE ASSISTANCE PLAN
SECTION 2120.760 BENEFITS SOLELY FROM GENERAL ASSETS
Section 2120.760 Benefits
Solely From General Assets
The benefits provided by this
Plan will be paid solely from the general assets of the State. The State will
not be required to maintain any fund or segregate any amount for the benefit of
any Participant, and no Participant or other person shall have any claim
against, right to, or security or interest in, any asset of the State from
which any payment under the Plan may be made.
(Source: Amended at 21 Ill. Reg. 2955, effective February 21, 1997)
| TITLE 80: PUBLIC OFFICIALS AND EMPLOYEES
SUBTITLE F: EMPLOYEE BENEFITS
CHAPTER I: DEPARTMENT OF CENTRAL MANAGEMENT SERVICES
PART 2120
STATE OF ILLINOIS MEDICAL CARE ASSISTANCE PLAN
SECTION 2120.770 NONASSIGNABILITY OF RIGHTS
Section 2120.770
Nonassignability of Rights
The right of any Participant to
receive Reimbursement under the Plan shall not be alienable by the Participant
by assignment or any other method. Any attempt to alienate a Participant's
interest will not be recognized.
| TITLE 80: PUBLIC OFFICIALS AND EMPLOYEES
SUBTITLE F: EMPLOYEE BENEFITS
CHAPTER I: DEPARTMENT OF CENTRAL MANAGEMENT SERVICES
PART 2120
STATE OF ILLINOIS MEDICAL CARE ASSISTANCE PLAN
SECTION 2120.780 TAX CONSEQUENCES
Section 2120.780 Tax
Consequences
Once enrolled it shall be the
obligation of each Participant to determine whether each payment under Section
2120.420 of this Part is excludable from the Participant's Compensation for
federal and state income tax purposes. Participants should notify the Department
if there is reason to believe that any payment is not excludable.
| TITLE 80: PUBLIC OFFICIALS AND EMPLOYEES
SUBTITLE F: EMPLOYEE BENEFITS
CHAPTER I: DEPARTMENT OF CENTRAL MANAGEMENT SERVICES
PART 2120
STATE OF ILLINOIS MEDICAL CARE ASSISTANCE PLAN
SECTION 2120.790 INDEMNIFICATION OF STATE BY PARTICIPANTS
Section 2120.790
Indemnification of State by Participants
If any Participant receives reimbursements
under Section 2120.520 or 2120.525 that are not for medical care expenses, the
Participant shall indemnify and reimburse the State for any liability the State
may incur for failure to withhold federal or state income tax or Social
Security tax from the reimbursements.
(Source: Amended at 30 Ill.
Reg. 15119, effective September 6, 2006)
| TITLE 80: PUBLIC OFFICIALS AND EMPLOYEES
SUBTITLE F: EMPLOYEE BENEFITS
CHAPTER I: DEPARTMENT OF CENTRAL MANAGEMENT SERVICES
PART 2120
STATE OF ILLINOIS MEDICAL CARE ASSISTANCE PLAN
SECTION 2120.800 RIGHT TO AMEND AND TERMINATE RESERVED
Section 2120.800 Right to
Amend and Terminate Reserved
a) The Department has established the Plan with the bona fide
intention and expectation that it will be continued indefinitely, but the
Department will have no obligation to maintain the Plan for any given length of
time and may discontinue or terminate the Plan at any time without liability.
b) Upon termination or discontinuance of the Plan, all elections
and reductions in compensation relating to the Plan shall terminate, and the
Department will pay any remaining balances to the Participants as additional taxable
compensation.
(Source: Amended at 30 Ill.
Reg. 15119, effective September 6, 2006)
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