R2024-342 Resolution Authorizing Agreement and Amendment with BlueCross BlueShield of Ilinois for Administration of the City Group Health Benefit Plan for Calendar Year 2025

Home Browse Search

7. Limiting Age for covered children: Twenty-six (26) years, regardless of presence or absence of a child's financial dependency, residency, student status, employment status, marital status, eligibility for other coverage, or any combination of those factors. Other: If Employer is an Illinois county,municipality,the State of Illinois,or subject to the Illinois School Code,this Limiting Age is extended to thirty(30)years,for unmarried eligible military personnel as described in the Employer's Plan. 8. Termination of coverage upon reaching the Limiting Age: ❑ The last day of coverage is the day prior to the birthday. ® The last day of coverage is the last day of the month in which the limiting age is reached. ❑ The last day of coverage is the last day of the billing month. ❑ The last day of coverage is the last day of the year(12131)in which the limiting age is reached. ❑ The last day of coverage is the day prior to the Employer's Anniversary Date. Will coverage for a child who is medically certified as disabled and dependent on the employee terminate upon reaching the limiting age even if the child continues to be both disabled and dependent on the employee? ❑Yes ®No However, such coverage shall be extended in accordance with any applicable federal or state law and the Disabled Dependent provisions of this BPA. The Employer will notify BCBSIL of any instance where the continuation of disabled dependent coverage is required. 9. Disabled dependent: A disabled dependent means a dependent child who is medically certified as disabled and dependent upon the Employee or his/her spouse.A child is a disabled child when the child is unable to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months, per Internal Revenue Code Section 22(e)(3). To administer medical certification of disabled dependents, you may select option (a) Standard Rules or(b) Custom Rules. BCBSIL will administer its standard process for administration of disabled dependent coverage if(a) below is selected by Employer, or at the Employers direction memorialized below, BCBSIL will follow a customized process if Employer selects(b). if(b)is selected there are additional selections regarding age,proof of prior coverage, certification review, forms, and previous medical certification approvals. (a) ® Disabled dependent administration will follow Standard Rules. A disabled dependent is eligible to continue coverage beyond the limiting age,provided the disability began before the child attained the age of 26. A disabled dependent is eligible to add coverage beyond the limiting age, provided the disability began before the child attained the age of 26, and proof of coverage as a disabled dependent is provided. Administration of certification review is administered by BCBSIL; a disabled dependent certification form must be submitted to BCBSIL. (b) ❑ Disabled dependent Administration will follow Custom Rules. Please make the following sections: Age:Please select one option regarding age of when the disability began. ❑ The disability must have begun before the child attained the age of 26. ❑ All disabled dependents are covered regardless of when the disability began. Proof of prior coverage:Please select required or not required below. When adding coverage, proof of prior coverage as a disabled dependent is ❑ required ❑ not required. Certification review: Please select one option regarding the administration of certification review. ❑ Certification review is administered by BCBSIL; a disabled dependent certification form must be submitted to BCBSIL. ❑ Certification review is administered by the Employer; there are no disabled dependent certification form requirements. If certification review is administered by BCBSIL, please select one option regarding forms: Proprietary and Confidential Information of Claim Administrator Not for use or disclosure outside Claim Administrator,Employer,their respective affiliated companies and third-party representatives,except with written permission of Claim Administrator. IL GEN ASO VBD BPA(Rev.06.24)Blue Cross and Blue Shield of Illinois,a Division of Health Care Service Corporation,a Mutual Legal Reserve Company,an Independent Licensee of the Blue Cross and Blue Shield Association 4