State of Illinois - HealthLink

Section V – Continuation of Coverage
Upon termination from this plan, you and your enrolled dependents may be eligible for
continuing coverage. Please see your insurance representative or contact the Illinois
Department of Central Management Services for more information.
Section VI – Qualified Medical Child Support Orders (QMCSO)
A "qualified medical child support order" is a child support order from a court of competent
jurisdiction, or State Child Care Agency, which requires that an employee benefit plan provide
coverage for a dependent child or a participant if the plan normally provides coverage for
dependent children. Typically these types of orders are generated as a part of a divorce
proceeding or a paternity action.
A. If this plan receives a QMCSO for one or more of your children, your insurance
representative will notify you and each child affected by the order.
B. If you receive the QMCSO as part of your divorce decree or as a result of a paternity suit,
contact the insurance representative immediately after receipt of your decree.
C. Contact your insurance representative or HealthLink Customer Service for additional
information.
Section VII – Coordination of Benefits (COB)
Overview
Often, because both husbands and wives work, members of a family are covered under more than
one plan. Your plan has adopted coordination of benefit rules to avoid duplication of coverage –
two plans paying benefits for the same allowable expenses. When you or your dependents are
covered by more than one plan, these rules determine the order in which the plan pays benefits.
A. The amount of benefits payable under this plan will take into account any coverage you or
your dependent has under another plan. For purposes of COB, the term "Plan" is defined as
any plan that provides medical care coverage including the following:
1. Any group or individual insurance plan including Health Maintenance Organizations
(HMOs);
2. Any governmental plan, except the Illinois Medical Assistance Program (Medicaid);
3. Any "no-fault" motor vehicle plan. This term means a motor vehicle plan which is required
by law and provides medical or dental care payments which are made, in whole or in part,
without regard to fault. A person subject to such law who has not complied with the law will
be deemed to have received the benefits required by the law;
4. As required by law;
5. The plan does not coordinate benefits with private individual insurance plans,
elementary, high school and college accident insurance and Medicaid.
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