Click above for Benefit Choice information and options
The Benefit Choice Period will begin May 1, 2012, for all members. Even though the Benefit Choice Period will begin May 1st, an end date has not been set since the health carrier options for plan year 2013 have not yet been finalized. Once the health carrier contracts are finalized, the Benefit Choice Period end date will be announced. Members will be given sufficient time to make an informed decision regarding their health plan election.
During the annual Benefit Choice Period, members are allowed to make changes to their group insurance coverage, such as add or drop dependent coverage. This year, members should delay making health plan changes until the health carrier contracts have been finalized. Once the Benefit Choice Period end date has been announced, the Benefit Choice Election form will need to be submitted to the unit's Health Plan Representative (HPR) by the announced due date. Any elected changes in coverage will be effective July 1, 2012.
Members who enroll in the Local Government Health Plan (LGHP) receive health, prescription, dental, vision and behavioral health benefits. Dependents can be enrolled in the program at an additional cost and will have the same health plan and benefits as the member.
The health, dental, vision and prescription benefits offered to LGHP participants are administered by various plan administrators. Members interested in changing their coverage elections may do so upon experiencing an eligible qualifying change in status and should contact their Health Plan Representative (HPR) for more information.
All available benefit plans and programs are explained in detail in the Member Handbook and Benefit Choice Options Booklet. Also included are amendments that update the handbook and a summary document indicating the benefit levels of the Local Care Health Plan (LCHP).
Health
The health insurance plans available to LGHP members differ in the benefit levels they provide, the doctors and hospitals you can access and the out-of-pocket cost to you. In general, managed care plans, such as Health Maintenance Organizations (HMOs) and the Open Access Plan (OAP), deliver healthcare through a system of network providers and have a lower monthly premium than the Local Care Health Plan (LCHP).
There are several managed care health plans located throughout the State available to LGHP members. Members may view the map of the managed care plans' coverage areas.
The LGHP is administered by Cigna and allows plan participants to access any provider nationwide; however, enhanced benefits are available when services are received from a LCHP network provider.
Medicare
Information regarding Medicare and how it affects your Local Government Health Plan coverage.
Dental
The Local Care Dental Plan (LCDP) is a dental plan that offers a comprehensive range of benefits. All plan participants have the same dental benefits available regardless of the health plan selected. Participants may go to any dental provider for services. The LCDP is administered by Delta Dental of Illinois.
Plan participants can choose any dental provider for services; however, plan participants may pay less out-of-pocket when they receive services from a network dentist. There are two separate networks of dentists that a plan participant may utilize for dental services in addition to out-of-network providers: Delta Dental PPOSM network and the Delta Dental PremierSM.
The LCDP reimburses only those services listed on the Dental Schedule of Benefits. Listed services are reimbursed at a predetermined maximum scheduled amount. Each plan participant is subject to an annual plan deductible for all dental services, except those listed in the Schedule of Benefits as ‘Diagnostic’ or ‘Preventive’. The annual plan deductible is $100 per participant per plan year. Once the deductible has been met, the plan participant has a maximum annual dental benefit of $2,000 for all dental services.
Most providers will file the dental claim with Delta Dental electronically, but for those who do not, the member must complete a Delta Dental of Illinois Claim form and send to the address on the form. For claims incurred prior to July 1, 2011, the member should complete a CompBenefits Claim form and send to the address on the form.
Vision
Vision coverage is provided at no additional cost to members enrolled in any of the LGHP health plans. All members and enrolled dependents have the same vision coverage regardless of the health plan selected. All vision benefits are available once every 24 months from the last date used. Copayments [PDF, 73KB] are required.
The plan administrator for the vision benefit is EyeMed. EyeMed’s Certificate of Coverage [PDF, 123KB] is available for viewing. Requests for reimbursement for services provided by an out-of-network vision provider must be submitted on an EyeMed claim form [PDF, 134KB].
Prescription
Plan participants enrolled in any LGHP health plan have prescription drug benefits included in the coverage. All prescription medications are compiled on a preferred drug list ("formulary list") maintained by each health plan's Prescription Benefit Manager (PBM). Formulary lists categorize drugs in three levels: generic, preferred brand and nonpreferred brand. Each level has a different copayment amount. Effective July 1, 2012, a 'specialty' drug category with a separate copayment will be added.
Coverage for specific drugs may vary depending upon the health plan. It is important to note that formulary lists are subject to change any time during the plan year. To compare formulary lists, cost-savings programs and to obtain a list of pharmacies that participate in the various health plan networks, plan participants should visit the website of each health plan they are considering. Plan participants who have additional prescription drug coverage, including Medicare, should contact their plan’s PBM for Coordination of Benefits (COB) information.
Medco the prescription drug plan administrator for Health Alliance Illinois, HealthLink OAP, Coventry Health Care OAP (formerly PersonalCare OAP) and the Local Care Health Plan (LCHP), maintains a list of retail pharmacies within Illinois [PDF, 276KB] and retail pharmacies outside of Illinois [PDF, 5MB] that contract with Medco to accept the copayment amount for prescriptions. A Medco claim form [PDF, 26KB] is available for members who request reimbursement due to using an out-of-network pharmacy.
Contact Information
Please contact your unit’s Health Plan Representative for more information regarding the Local Government Health Plan (LGHP).
FAQs
A list of Frequently Asked Questions is available.
Forms
Members and Health Plan Representatives can complete and print group insurance forms.
Notices