State Health Plan Coverage

The health insurance plans available to State 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 Quality Care Health Plan (QCHP).  Members will find a listing of providers who participate in the health plan's network when they go to the provider directory page on the plan's website. There are several managed care plans located throughout the state available to State members. In addition to managed care, the State plan offers the Quality Care Health Plan (QCHP), administered by Aetna, which allows plan participants to access any provider nationwide.  Enhanced benefits are available for QCHP members who receive services from a QCHP network provider.

New this year to active State employees is the Consumer Driven Health Plan (CDHP). This is a high deductible health plan as defined by the IRS.  Consumer Driven Health Plan (CDHP) members may choose any physician or hospital for medical services; however, members receive enhanced benefits, resulting in lower out-of-pocket costs, when receiving services from a CDHP in network provider. And, when paired with the Health Savings Account (HSA), CDHP/HSA members will receive a $500 State contribution for an individual member or $1,000 for family. CDHP has a nationwide network of providers through Aetna PPO. Benefits are outlined in the plan's Summary Plan Document (SPD). It is the member's responsibility to know and follow the specific requirements of the CDHP. 

For a more comprehensive comparison of all the plans being offered for FY22, click on the following links to:

  1. Understand How the Plans Differ
  2. Understand How You Pay for Healthcare in Each Plan
  3. Get Plan Suggestions

Dental Only Coverage 

State employees, in addition to retirees, now have the option to enroll in Dental Only coverage. However, if you enroll in health coverage and choose dental coverage, dependents must mirror the coverage of the member.

Health Plan Availability

New this plan year, effective July 1, 2021, members now have the option of choosing from three OAP plans.

We are pleased to announce that these Open Access Plans (OAP) will now be offered by:

Additionally, members may choose from an HMO Plan, or the Consumer Driven Health Plan (CDHP), or Quality Care Health Plan (QCHP):

Be sure to check the Benefit Choice Booklet and carrier websites for coverage details and provider availability to pick the plan that's right for you.

HealthLink Service Area Outside of Illinois

HealthLink members will continue to have network access in Missouri, Arkansas, Indiana, Kentucky, Ohio and Wisconsin. Network access outside of Illinois and the states listed here will be limited to emergency services.

Behavioral Health

For those enrolled in the Quality Care Health Plan (QCHP) and the Consumer Driven Health Plan (CDHP), your behavioral health provider network and claims will now be administered by Aetna. Please be sure to review the Aetna provider directory to ensure your provider is in-network, or contact Aetna to discuss transition of care.

Benefit recipients may view a map of the various plans' coverage areas below:

Medical Care Assistance Plan (MCAP) & Dependent Care Assistance plan (DCAP)

For FY2022, the IRS has extended and added to the temporary COVID-19 flexibility for MCAP and DCAP (per the guidance of Notice 2021-15):

  • Any unused funds from your MCAP/DCAP account will be rolled over as long as you re-enroll in that program.
  • Additional election flexibility allowed, contact

The American Rescue Plan has increased DCAP contributions to $5,250 for the FY22 plan year.

You must enroll or re-enroll in a Flexible Spending Account each plan year. The MCAP benefit is not available if enrolling in an HSA.

Members will find a listing of providers who participate in the health plan's network when they go to the provider directory page on the plan's website.

The Affordable Care Act rules require health plans to provide a summary of benefits and coverage (SBC) and a glossary of health coverage and medical terms.  Both are designed to make it easier for you to compare your options and understand exactly what you are buying. The new requirements will also make it easier for employers to compare health insurance options to provide for their employees. Members can view the summary of benefits and coverage for each plan.  The benefit levels listed in the SBCs go into effect July 1st of each year.

Updated 04/22/2021