Local Government Health Plan (LGHP) Benefit Plans
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.
NEW Coverage for adult children [PDF, 123KB] age 19 up to age 26 (up to age 30 for veteran adult children) is available for dependents meeting the criteria effective July 1, 2009.
Benefit Program Books
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 7 managed care health plans located throughout the State available to LGHP members. Members may view a 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.
Dental
All members and enrolled dependents have the same dental benefits available regardless of the health plan selected. Participants may go to any dental provider for services.
The Local Care Dental Plan (LCDP) is administered by CompBenefits. Only those dental services listed on the FY09 & FY10 Dental Schedule of Benefits [PDF, 55KB] will be reimbursed. Plan Participants are responsible for all charges over the scheduled amount and/or over the annual maximum benefit. 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.
A child orthodontia benefit is available only to children who begin treatment prior to the age of 19. There is a maximum lifetime benefit for child orthodontia of $1,500. This lifetime maximum is subject to course of treatment limitations and begins once the $100 plan year deductible has been met.
A dental
claim form [PDF 88KB] is available for members who need to file a dental claim.
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. Co-payments 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 non-preferred brand. Each level has a different co-payment amount.
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 and the Local Care Health Plan
(LCHP), maintains a list of in-network
pharmacies [PDF, 107KB] that contract with Medco to accept the co-payment amount
for prescriptions. A Medco claim form is
available for members who request reimbursement due to using an out-of-network
pharmacy.
Medco also offers a Mail Order benefit. To access a Mail Order Form for any
of the plans administered by Medco, click on the link that corresponds
to the health plan in which you are enrolled - Health
Alliance Illinois, HealthLink OAP and the Local Care Health Plan (LCHP).
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.
Health Insurance Portability and Accountability Act (HIPAA)
Please click here to view the Health Insurance Portability
and Accountability Act (HIPAA) Notice of Privacy Practices.
 Documents are provided in PDF format, to view documents you will need Adobe's free Reader 7.0 or higher.
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