Joining A Medical Plan 

Who Is Eligible

You are eligible to participate in a medical plan if you are: 

a full-time salaried employee; 

a full-time employee paid at an hourly or daily rate; 

a part-time employee regularly scheduled to work at least 84 hours a month (except Library Pages); 

a regularly scheduled part-time School Dentist, School Crossing Guard or City Council Investigator if earning 
at least the Grade 1, Step 1 salary in Schedule B of 
the Salary Resolution issued by the Department of 
Personnel; or 

classified by the City as a foster grandparent and covered by a medical plan on May 31, 1984. 

a seasonal employee who has completed 365 days of service. 

You are not eligible to participate in a medical plan if you are: 

a seasonal employee scheduled to work less than 180 days in a calendar year; 

a seasonal employee who has completed less than 365 days of service; 

hired for a temporary program; 

an emergency appointment employee; 

paid by voucher; 

a Library Page; 

a part-time employee regularly scheduled to work less than 84 hours a month; or 

an employee earning less than the Grade 1, Step 1 salary in Schedule B of the Salary Resolution issued by the Department of Personnel. 

Your Eligible Dependents

You may enroll the following dependents in a medical care plan: 

your spouse; 

your Domestic Partner (see page ME-7); 

your unmarried children under age 25, if you are a uniformed Fire or sworn Police Department employee or an eligible employee hired before August 1, 1984; 

your unmarried children under age 19, if you were hired  on or after  August 1, 1984 and you are not a uniformed Fire or sworn Police department employee; 

your unmarried children of any age who are certified as mentally and /or physically disabled and dependent on the employee for support and maintenance for the duration of the incapacity, provided the coverage does not terminate for any other reason. Satisfactory proof of incapacitation is required and all other eligibility requirements must be met. You may continue their coverage as long as you remain an eligible employee and provide proof of incapacity each year; 

your unmarried children between the ages of 19 and 22 if they are full-time students enrolled in an approved college, community college or university, if you were hired on or after August 1, 1984; 

The term "children" includes: 

natural children; 

stepchildren; 

children placed in your home for adoption; 

legally adopted children; and 

children in your custody under legal guardianship. 

If you and/or your spouse were or are divorced, you can cover your eligible children if a divorce decree or other valid 
judgment states that you or your current spouse are responsible for providing medical coverage for the children. 

Any dependent who is in the military service of any country is not eligible for coverage. 

An eligible dependent who loses coverage through one of the City of Chicago medical, dental and vision plans, may within 60 days of the date coverage was lost, elect to continue coverage through the City of Chicago PHSA Continuation of Coverage program. 

The member or dependent must contact the Benefits 
Management Office to receive PHSA information and an enrollment application. (Refer to the When Your Medical Coverage Ends section of this handbook for more details.) 

No Dual Coverage 

You may be covered under a medical care plan as either 
an employee or a spouse; you may not be covered as both. 
An eligible dependent can only be covered by one City of Chicago employee. If you have a child who is a full-time City employee, he or she must be covered as an employee, not as a dependent under your coverage. 

If you are married to another City employee who is participating as an employee in a medical plan offered by the City, you may elect: 

to be covered as an employee and pay the required premium. For example, your spouse may want HMO coverage and you may not want HMO coverage. If you and your spouse maintain separate coverage, you can each select a plan; 

to cover your spouse as your dependent. The premium you pay will be based on your salary; or 

to be covered as a dependent spouse. Your spouse will pay premiums based on his or her salary. 

It may be financially advantageous for the spouse in the lower salary band to elect coverage for the family. Keep in mind, however, that the age limit for coverage for dependent children depends on the date of hire and/or the bargaining unit of the person who holds coverage (see page ME-2). 

When Coverage Begins 

Coverage For You

The City's medical care plans have been set up as an Internal Revenue Code Section 125 plan that allows you to pay for coverage with before-tax contributions. As a result, you must enroll in a plan before your coverage is effective. Your coverage will be effective on the first day of the month after your hire date if: 

you complete enrollment by that date, and 

the City begins the required payroll deduction. 

For example, if you are hired on March 5th, your coverage will begin on April 1 if you enroll by that date and your payroll deductions begin. 

However, if you are confined to a hospital when coverage is scheduled to begin, coverage will begin when you are no longer confined. 

Important: If you don't enroll in a plan within 30 days of your hire date or the date you have a change in family status, as defined on pages ME-9 and ME-10, your next chance to enroll won't be until the open enrollment period for the following January 1st. You must complete an Employee Information Form within 30 days of your return to work date after a leave of absence, suspension or similar break in service. Otherwise, your next chance to enroll won't be until the open enrollment period for the following January 1st. 

Coverage for Your Dependents 

Your dependents are eligible for coverage at the same time you are, if you submit the required documents to the Benefits Management Office. However, if your dependent is confined to a hospital with an illness or injury, coverage will begin when your dependent is no longer confined. 

Required documents include the enrollment form and proof of dependency documentation as defined on pages ME-5 and ME-6. All enrollment forms can be obtained from your personnel department benefits liaison. Forms can also be downloaded from the City of Chicago Web site: www.cityofchicago.org/finance. 

Enrollment Form - You must complete an enrollment form indicating that you want coverage for your dependents. Your enrollment form must be submitted before the effective date of your coverage, but not later than 30 days from your hire date. 

If you wait more than 30 days to apply for dependent coverage, you won't be able to add your dependents until the next open enrollment period for coverage beginning the following January 1st. 

Proof of Dependency - Along with an enrollment form, you must provide one or more of the following documents as proof of dependency within 60 days of the date your coverage is effective: 

certified marriage certificate; 

certified birth certificate for each child you claim as a dependent, including a newborn child (the birth certificate must contain the names of the child and parent or parents); 

certified divorce decree if you and your spouse are not the two parents shown on your child's birth certificate; 

adoption papers for legally adopted children. Once you have obtained legal custody and you have brought the child home, you will have 30 days to fill out and submit a Dependent Information Form to the Benefits Management Office. 

You will also need to submit a certified birth certificate and certified adoption papers within 60 days of the effective date of coverage. Please have foreign document(s) trans-
lated prior to submission to avoid a delay in processing. 

court orders if you are required to provide coverage for other children; 

proof of mental or physical incapacity for a disabled child on a form provided annually by the Benefits Management Office; or 

a statement of academic standing and a paid tuition receipt for children enrolled full time in an accredited community college, college or university. 

Student status is required by November 15th but not earlier than October 1st for the fall school schedule and student status is required by March 15th but not earlier than January 31st for the spring school schedule. 

You will need the following: 

1. letter from school on school letterhead verifying full-time enrollment 

2. full or partial paid tuition bill 

All certificates, court orders and divorce decrees must be certified; photocopies will not be accepted. Your documents will be returned to you if you provide the City Benefits Management Office with a self-addressed stamped envelope. 

If you submit the required proof of dependency within 60 days of the date your coverage begins, coverage for your dependents will begin when your coverage begins. If you don't submit proof within 60 days, you won't be able to add your dependents until the next open enrollment period for the following January 1st. 

Coverage for Your Domestic Partner

The City of Chicago has extended health benefits to same sex domestic partners ("partners") of employees enrolled in a City of Chicago medical care plan for employees. 
Partners are eligible to participate in the medical, dental and vision plans offered by the City to eligible employees. 

Your domestic partner is eligible for coverage at the same time you are, if you submit the required documents to the Benefits Management Office. However, if your domestic partner is confined to a hospital with an illness or injury, coverage will begin when your domestic partner is no longer confined. 

How do you enroll your partner?

Proof of domestic partnership is required. To determine if your partner qualifies for enrollment, the following eligibility requirements must be met: 

First you, the employee, must be enrolled in the PPO Plan, the POS Plan or an HMO offered by the City. 

Then, you must obtain a Certificate of Partnership from the Department of Personnel. To obtain a certificate you must submit a completed Affidavit of Domestic Partnership and meet the eligibility requirements for a Domestic Partner. 

The Department of Personnel will review your affidavit to determine if you meet the minimum requirements listed 
below: 

You may enroll your domestic partner if: 

You and your partner are each other's sole domestic partner, responsible for each other's common welfare, and 

Neither you or your partner are married (if you or your partner were previously married proof of dissolution of marriage is required), and 

You and your partner are not related by blood closer than would bar marriage in the State of Illinois, and 

You and your partner are at least 18 years of age, and are the same sex, and reside at the same residence, and 

At least two of the following four conditions must apply: 

1. You and your partner have been residing together for at least twelve (12) months prior to filing the Affidavit of Domestic Partnership. 

2. You and your partner have common or joint ownership of a residence. 

3. You and your partner have at least two of the following arrangements: 

a. Joint ownership of a motor vehicle; 

b. A joint credit account; 

c. A joint checking account; 

d. A lease for residence identifying both you and your partner as tenants. 

4. You declare your partner as a primary beneficiary in your will. 

1. Submitting a Domestic Partner Enrollment Form within 30 days of certification, 

2. Submitting a Certificate of Partnership within 60 days of certification, 

3. Submitting a Statement of Dependence (if you are claiming your partner as a dependent as defined by Section 152 of the Internal Revenue Code) 

If you submit the enrollment form after 30 days or you submit the Certificate of Partnership after 60 days, coverage will be effective the next January 1st. 

The premium deduction for your partner is taken after-tax. Please consult with your tax advisor about the tax consequences. All other eligibility and plan provisions apply. 

Termination of Coverage for Your Domestic Partner

If at any time your partner becomes ineligible for benefits, it is your (the employee's) responsibility to notify the City of Chicago Department of Personnel in writing. Certain limitations exist in regard to continuing coverage for a domestic partner. Contact the Benefits Management Office for more information. 

Following the termination of a domestic partnership, a minimum of twelve (12) months must elapse before a new domestic partner may be designated. 

Choose A Plan Once a Year

Each year, you'll have the opportunity to enroll or change the level of your coverage during the open enrollment period. 

Limited Changes During the Year 

You'll be able to change your level of coverage during the year only if you have a change in family status, such as: 

your marriage or divorce, 

your enrollment or termination of an eligible domestic partner, 

birth or adoption of a child, 

death of a spouse or a covered dependent, 

a covered dependent reaching the limiting age, or 

a change in employment status for you or your spouse. 

You must notify the Benefits Management Office of a family status change and submit documentation to support the change with your request. This means you cannot drop or add dependents during the year unless: 

you experience a change in family status as described above, and 

you notify the Benefits Management Office within 30 days of the change. 

To change your benefits as a result of a family status change, you must submit a completed enrollment form and provide proper documentation. 

Payroll deductions cannot be changed unless the Benefits Management Office is notified within 30 days of the qualifying event. The change in deduction must be consistent with the change in family status. 

Enrollment Form - You must notify the Benefits Management Office within 30 days of a change in family status. In this case, coverage will be effective on the date of the family status change, assuming you also submit proof of the change in the required time period (see below). If your enrollment form indicating your request for a change in coverage is not 
submitted within 30 days, you won't be able to make the change until the next open enrollment period for the following January 1st. 

Proof of Change - You must also submit documentation to support the change in coverage. This documentation must be submitted within 60 days of an eligible change in family status. If you don't submit the required documents within 60 days, you won't be able to make the change until the next open enrollment period for the following January 1st. 

You must drop ineligible dependents such as divorced spouses or you will be billed the cost of coverage. (See the When Your Medical Coverage Ends section, page M-4.) 

Examples of Mid-year Changes

Any mid-year change must be consistent with your status change. 

Example 1 - If you have coverage for yourself and then get married, you'll be able to add medical coverage for your spouse. 

Example 2 - If you adopt or give birth to a child, you can add your new child to your coverage. 

Example 3 - If your spouse loses medical coverage
because he or she is laid off from his or her job, you can add your spouse to your medical coverage. 

Example 4 - You currently cover your spouse and/or your dependents under the medical plan, your spouse decides to elect coverage at work during his or her employer's open enrollment period. You can drop yourself, your spouse and/or your dependents and change your level of coverage. This change must be requested within 30 days of your new coverage. 

Here are some examples of changes not considered family status changes: 

Example 1 - You get married but you don't notify the Benefits Management Office for six months. Since you did not request coverage for your spouse within 30 days of your marriage, you will have to wait until the next open enrollment period to add this coverage. 

Example 2 - You decide that you no longer want coverage for your children. Since this is not a family status change, you'll have to wait until the next open enrollment period to drop coverage for your children. 

Coverage for Newborn Children

Children born after you are covered by the plan will be covered as of their date of birth, if you submit to the Benefits Management Office: 

an enrollment application within 30 days of the birth, and 

a certified birth certificate within 180 days of the birth. 

If you submit the enrollment form after 30 days or you submit the birth certificate after 180 days, coverage will be effective the next January 1st. The enrollment form and the documentation to establish eligibility can be sent in separately as each has a different due date. Each form must be submitted on time. 

Alternative Coverage

(For employees represented by AFSCME, Labor and Trade bargaining units and non-represented employees) 

If you applied for coverage for an otherwise eligible dependent and were denied coverage because of failure to meet the enrollment deadlines of the Plan, you will be notified of the denial by the Benefits Management Office. This notice will inform you of the availability of the Alternative Coverage. If you wish to enroll in the Alternative Coverage you must complete an Alternative Coverage Enrollment Form and submit it to the Benefits Management Office within 30 days of the date of the denial notice. If you submit the Alternative Coverage enrollment form after 30 days from the date of notice, you may not enroll in the Alternative Coverage. 

Coverage for the otherwise eligible dependent will be effective the next January 1st under the Medical Plan elected by the employee. 

Alternative Coverage will be offered to individuals who: 

1. would otherwise be eligible under the Plan, 

2. have submitted all necessary documents, 

3. have been denied coverage under the Plan because they failed to comply with the Plan's enrollment requirements, 

4. first became eligible for coverage subsequent to the close of the most recent open enrollment period, and 

5. agree to pay the required premium. 

Persons who are entitled to coverage as the spouse of an eligible employee and who have been denied coverage under the Plan because the employee failed to comply with the Plan's enrollment requirements will not be eligible for this provision if: 

1. the spouse is currently covered by other medical coverage, or 

2. the employee is covering another person as a spouse at the time of application. 

You must indicate on the Alternative Coverage Enrollment Form the type of coverage you are requesting. The two types of coverage available are: 

Retrospective coverage. If you elect retrospective coverage, coverage will be effective as of the date you and or your dependent(s) would have been eligible for coverage if you had completed enrollment in a timely manner. You will be required to pay the Alternative Coverage premium from the date you would have been eligible through the next December 31st. Premium payment for Alternative Coverage is due at the time of application for the period of retrospective coverage. 

Premiums shall be due thereafter no later than the first day of the month for which the coverage is effective. 

Prospective coverage. If you elect prospective coverage, coverage will be effective on the first day of the month following the month in which you submit the required premium. Premiums are due thereafter no later than the first day of the month for which coverage is effective. 

Examples of coverage: 

Example 1- You have a new baby on June 1, 1997 and apply for coverage for the baby on August 10, 1997. You would receive a denial notice from the Benefits Management Office because you failed to apply for coverage within 30 days of the family status change, which in this case is the birth of your child. You would have 30 days from the date of the denial notice to apply for alternative coverage for your newborn. If you apply for Retrospective coverage, coverage is effective from the date of birth of the child and you would be required to pay premium from June 1, 1997 until December 31, 1997. 

Example 2 - You are married on February 14, 1997 and apply for coverage for your spouse on May 1, 1997. You would receive a denial notice from the Benefits Management Office because you failed to apply within 30 days of the family status change, your marriage. You would have 30 days from the date of the denial notice to apply for alternative coverage for your spouse. If you complete enrollment for Prospective coverage on May 15, 1997, coverage will be effective June 1, 1997 if you pay the required premium. You would pay premium from June 1, 1997 until December 31, 1997. 

Example 3 - You are hired and fail to apply for coverage within 30 days of your date of hire. Several months later you submit enrollment forms and the required documentation. If an open enrollment period has not occurred between your hire date and the time you apply you may apply for Alternative Coverage. 

However, if an open enrollment period occurred you would not be eligible for Alternative Coverage because you had the opportunity to enroll during the open enrollment period. You will be eligible to enroll during the next open enrollment period for the following January 1st. 

Spouses or dependents will be enrolled in the plan in which the employee is enrolled. All Plan terms will apply. Covered expenses will be included in any calculation of deductibles, out-of-pocket expenses, annual and lifetime benefit maximums in accordance with the applicable plan. 

Premiums are subject to change each January 1st. 

Premiums for Alternative Coverage must be paid directly to the Benefits Management Office by check or money order. No deduction can be taken from an employee's check. In the event an employee submits a check that is returned from the bank because of non-sufficient funds (NSF), the Alternative Coverage shall be terminated as of the last day of the month for which premium payments were received. 

Coverage can be terminated for failure to make required payments in a timely manner. No one whose Alternative Coverage is terminated can be enrolled until the open enrollment period for the following January 1st. 

November 2002

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