State Employees' Group Insurance Program (SEGIP) - The TRAIL



Welcome to Your TRAIL MAPD
Initial Enrollment Period

The State of Illinois offers retirees, annuitants and survivors a healthcare program called Total Retiree
Advantage Illinois (TRAIL). This program provides Medicare-eligible members and their covered dependents comprehensive medical and prescription drug coverage through TRAIL Medicare Advantage Prescription Drug (commonly referred to as "MAPD") plans. The program includes vision coverage, optional dental coverage and life insurance coverage.

All Illinois counties have an HMO and PPO option. Retirees, annuitants and survivors residing outside Illinois
may elect the PPO option only.

To be eligible for coverage under a Total Retiree Advantage Illinois Medicare Advantage
Prescription Drug (MAPD) plan, you and your eligible dependents must:
• Live in the United States or the U.S. Territories, AND
• Be retired and enrolled in Medicare Parts A and B, due to age or disability.
You Have Important Healthcare Coverage Decisions to Make
The TRAIL Program provides comprehensive medical and prescription drug coverage through MAPD plans.
These types of Medicare Advantage Prescription Drug plans, commonly known as "MAPD" plans, are
Medicare-approved plans that combine the different parts of Medicare into one plan. Since these plans are a
type of Medicare, you must continue to pay your federal Medicare Parts A and B premiums in order to enroll
and remain enrolled in TRAIL MAPD.



 StateInitialEnrollment2021.pdf




As NEWLY‐ELIGIBLE for the TRAIL MAPD Program, you:
• MUST elect one of the TRAIL MAPD health plans during your enrollment period via MyBenefits.illinois.gov or by calling the MyBenefits Service Center (tollfree) 844-251-1777. Due to your Medicare-eligibility, you cannot keep your current State of Illinois health plan. You must complete your enrollment into a TRAIL MAPD plan within your enrollment period.
• Will have your medical and prescription drug claims processed by the TRAIL MAPD health plan instead
of Original Medicare and your current State plan, once your TRAIL MAPD enrollment becomes
effective.
• May waive State coverage. Waiving coverage will terminate your medical, prescription and vision
coverage. Your current dental coverage (if enrolled) and life insurance coverage will remain in effect.
Members electing to waive coverage, may cancel their dental coverage only during the annual TRAIL
MAPD Enrollment Period held in October and November each year.
• Will only have one ID card to show at your doctor visits and when picking up your prescriptions.

 

Important Information You Need to Know about your TRAIL MAPD Plan

• TRAIL MAPD is a retiree healthcare program sponsored by the State of Illinois. The plans offered through the TRAIL Program are Medicare Advantage plans which include prescription drug coverage. These plans are typically called "MAPD" plans. As a State of Illinois retiree, annuitant or survivor, who is newly-eligible for enrollment in a TRAIL MAPD plan, you must make a choice during this TRAIL MAPD Enrollment Period to enroll in one of the plans offered. If you do not want TRAIL MAPD coverage, you can waive the State's coverage. If you waive coverage, you will lose medical, prescription drug and vision coverage. Waiving TRAIL MAPD coverage does not allow you to stay in your current State health plan.

• TRAIL MAPD plans are offered by private companies approved by Medicare. Medicare pays a fixed amount for your care each month to these companies. When you enroll in a Medicare Advantage Prescription Drug (MAPD) plan, you are no longer in Original Medicare, but still have the same covered services and the same rights and protections as people with Original Medicare.

• The TRAIL MAPD plans provide all of your Part A (hospital) and Part B (doctor and outpatient) benefits, including emergency and urgent care, and Medicare Part D (prescription drug) coverage.

You must keep Medicare Parts A and B and continue to pay the applicable Medicare premiums, including applicable IRMAA (Income Related Monthly Adjustment Amount) surcharges.

• All members and dependents must ensure that their Medicare information, including the Medicare Beneficiary Identifier (MBI), is on file. If the MBI (found on your Medicare card) is not provided, your TRAIL MAPD and State coverage will be waived.

• You can only be in one Medicare Advantage or Medicare Part D (prescription drug) plan at a time. Enrollment in the TRAIL MAPD plan provides you with Medicare Advantage coverage as well as Medicare Part D coverage. Therefore, enrollment in a different Medicare Advantage or Medicare Part D plan will automatically cause your TRAIL MAPD coverage to end, which will include your medical, prescription drug and vision coverage.

• You may terminate the TRAIL MAPD coverage at any time by contacting the plan administrator in writing. You may reenroll throughout the plan year with a qualifying event and coverage will be effective the first of the month following your enrollment request or during your annual TRAIL MAPD Enrollment Period.

• If your residential or mailing address changes, you must notify both your retirement system and the Social Security Administration in writing as quickly as possible.

• If you enroll in one of the State's TRAIL MAPD HMO plans and move outside of the plan's service area to a different county in Illinois where your current HMO is not available or to a different state, you must elect a new MAPD plan available in your new area. If you move outside the State of Illinois, your coverage will be defaulted to the UnitedHealthcare PPO plan.

• Medicare Advantage Plans are not a Medicare Supplement plan. Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are an "all in one" alternative to Original Medicare. These "bundled" plans include Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), and in the case of your State-Sponsored TRAIL plan, Medicare prescription drug (Part D) is also included.

• Once you have enrolled in TRAIL MAPD plan, you will only use your red, white and blue Medicare card for hospice care. All other claims for your healthcare services (including prescription drugs) should be sent to your MAPD plan administrator for processing and benefit determinations.

• Medicare-eligible retirees, annuitants and survivors who want to continue medical, prescription drug, and vision coverage through the State, are required to enroll in one of the TRAIL MAPD plans if they and their covered dependents are all enrolled in Medicare Parts A and B. Remaining in your current State health plan is not an option. If you do not complete the online enrollment process or call the MyBenefits Service Center by your enrollment deadline, the State will assume you do not want your State of Illinois TRAIL MAPD health insurance and will terminate your medical, prescription drug and vision coverage. If your State medical and prescription coverage is terminated, you will have only Original Medicare for your medical coverage. To obtain additional coverage you may enroll in a Part D prescription drug plan for prescription drug coverage, reenroll in the State-Sponsored TRAIL plan throughout the plan year with coverage effective the first of the month following your enrollment request or enroll during your next annual TRAIL MAPD Enrollment Period. Your dental coverage, if enrolled, and life insurance coverage will remain in place.

• Plan Year deductible and Out-of-Pocket Maximums will start over with your new TRAIL MAPD Plan. The MAPD plans are not permitted to take into account the deductible(s) you might have already paid in your other plan. Any deductible paid to your current medical plan will not count toward your MAPD plan year deductible. The MAPD medical deductible is separate from your dental plan deductible. Your annual PPO deductible and dental deductible, if elected, will start again for the TRAIL MAPD Plan Year.

• Your current health plan may cover services that Original Medicare does not cover. Medicare Advantage plans are required to cover all services covered by Original Medicare. In order to be covered, the service must be considered medically necessary and in certain cases, meet Medicare guidelines for approval. Some services have limits to how often they can be obtained. 



The State of Illinois offers annuitants and survivors under the State Employees Group Insurance Program a Medicare Advantage healthcare program called Total Retiree Advantage Illinois (TRAIL). This program provides eligible members and their covered dependents comprehensive medical and prescription drug coverage through Medicare Advantage Prescription Drug plans (commonly referred to as “MAPD” plans). The group insurance program also includes vision coverage through EyeMed and optional dental coverage through Delta Dental. 

All Illinois counties have an HMO and PPO option. Retirees, annuitants and survivors residing outside Illinois may elect the PPO option available nationwide.

 

 

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