Chicago Public Schools
Health and Benets Handbook 2022
Chicago Public School Benets Handbook 2
The information in this handbook is effective January 1, 2022, except as otherwise noted.
Nothing in this handbook should be interpreted as creating an employment contract, binding agreement or
agreement to continue employment or as a guarantee of employment. The Board retains the right to
modify, amend, suspend or terminate the benet plans at any time.
The plans, benets and coverage described in this handbook are subject to change at the sole discretion of the
Board. The Health and Benets Team will provide notice of changes through email or other means; however,
such changes will have effect regardless of whether notice is given or received. If there is a conict or
inconsistency among the benets and requirements summarized in this handbook and the actual plan documents
and contracts, the documents and contracts will govern. This handbook is not intended to substitute, replace,
overrule or modify any existing federal and state laws, agency rules, regulations or terms of a collective bargaining
agreement (if applicable).
The Board currently intends to maintain the various plans that comprise the benets program. But the Board
retains the right to amend or terminate any plan or benet to the fullest extent allowed by law at any time, as it
deems advisable, as to any or all of the employees, retirees, former employees or other participants or beneciaries
who are or may become covered. The Board periodically reevaluates the benets program. Any changes to the
plans may be more or less advantageous to a given employee than the provisions of the current plans. The Board,
in its sole discretion, may establish the effective date for any changes that are formally adopted.
The nal interpretation of this handbook’s provisions is the exclusive responsibility of the Board of Education
of the City of Chicago. If you have additional questions, you may call the Health and Benets Team
at (773) 553-HR4U (4748) from 9:00 a.m. to 4:00 p.m. Monday through Friday. Additional information is
online at CPS.edu/Staff then click on the link for HR4U. Correspondence may be directed to:
Board of Education of the City of Chicago
Attention: Health and Benets
2651 W. Washington Blvd.
Chicago, IL 60612
Welcome to the Chicago Public Schools. As a vital part of our students’ futures, it is important to us that you
maintain your health, energy and peace of mind and are able to be your best each day. We are pleased to
offer employees a comprehensive health and wellness benets package with digitally enhanced tools and
mobile access customizable to the way you live. We encourage you to do more than skim this guide; read
it thoroughly and learn how to access perks such as discounts on gym memberships for the whole family;
wellness and stress management coaching; and nancial and legal services through the Employee Assistance
Program (EAP). In the guide, you’ll also nd out how to earn points for your healthy actions and redeem them
for prizes through the new Well on Target wellness program by Blue Cross Blue Shield of Illinois (BCBSIL).
We’re in this together! Our benets specialists are eager to assist, answer your questions and help you make
the most of your benets.
The Best Care at the Best Value
Chicago Public School Benets Handbook 3
Table of Contents
Eligibility 5
Enrollment 8
Enrolling Dependents 9
Enrolling a Domestic Partner/ Afdavit of Domestic Partnership 12
Enrolling a Civil Union Partner 14
Required Documents for Dependents 15
Wellness Program 17
Medical Plans at a Glance 19
BlueAccess for Members 20
BCBSIL BlueAdvantage Health Maintenance Organization (HMO) 21
BCBSIL Preferred Provider Organization (PPO) 22
BCBSIL PPO with Health Savings Account (HSA) 23
BlueCross BlueShield of Illinois Health Savings Account (HSA) 24
Clinical and Pre-Authorization for PPO and
PPO with HSA Plans 25
Prescriptions 28
Dental Plan Options 32
Vision Plan Options 33
Behavioral Health, Addiction and Employee
Assistance Program 34
Short-Term Disability 36
Long-Term Disability 45
Life Insurance, Accidental Death & Dismemberment Coverage 46
Flexible Spending Accounts (FSA) 49
Supplemental Retirement 55
Differences between 403(b) and 457 Plans 55
Bright Start College Savings 57
Maintaining Benets During a Leave of Absence 59
COBRA 62
What Happens to My Benets if I Terminate? 63
Family and Medical Leave Act 65
Employee Rights and Responsibilities 65
Subrogation 68
Glossary 70
Authenticating and Submitting Enrollment Documents 74
Sample of the Benet Documentation Cover Sheet 75
Vendor Contacts 76
Chicago Public School Benets Handbook 5
Eligibility
Timing is critical. If you do not enroll in benets coverage within 31 days
of your hire date or during open enrollment, you will have to wait
until the next Open Enrollment. Coverage would take effect January 1 the
following year.
Dependents
Employees of the Board/CPS
who are represented by the CTU
and who regularly work at least
15 hours each week.
Group Benets: Who Qualies for Coverage
Employees of the Board/CPS who
work at least 30 hours each week,
have Full-Time status or are
a regularly assigned teacher, other
than temporary or seasonal.
Employees of the Board/CPS who
are represented by Local No. 1 or
Local No. 73 and who regularly
work at least 15 hours each week.
When dependent coverage is available, benets-eligible employees can
elect to cover their…
• Legal spouse or civil union partner.
• Dependent children under the age of 26, including natural children,
stepchildren, legally adopted children and/or children under the employee’s
legal guardianship.
• Dependent children ages 26 to 30 who were honorably discharged from
the military and reside in Illinois. For information relating to cost see page 11.
• Children of any age who depend on the employee because of physical
or mental handicap, if they were covered and adequate documentation
of disability was submitted to and approved by the Health and Benets
Team prior to the child’s 26th birthday.
New hires and employees electing coverage due to a family status change may
add disabled dependents age 26 and older when electing coverage for the rst
time, and the age limit for submitting documentation does not apply.
The employee must provide proof that the child was disabled prior to the child’s
26th birthday, and that the child was continuously covered by group health
coverage since the child’s 26th birthday.
Chicago Public School Benets Handbook 6
An eligible employee cannot be covered under any Board-sponsored plan as both
an employee and a dependent. If both you and your spouse are employed by the
Board, you choose one of two options:
• One employee enrolls as the other employee’s dependent.
• Each employee enrolls for individual coverage.
In either option you may also enroll your dependent children (but children may
not be enrolled by both parents in Board-sponsored plans).
Some leaves of absences (LOA) may allow an employee to continue receiving
benets. If you are planning an LOA, you should contact the Absence and
Disability Management Department before your leave or as soon as possible to
conrm your eligibility to continue any benet. When you return from your LOA
you must verify your benet status with the Health and Benets Team within 31
days of your return to avoid a possible lapse in your coverage. If your benets
were discontinued during your LOA, you may re-enroll for benets within 31
days of your return from your LOA, provided that you are eligible for coverage.
Coverage is not automatic. While on an LOA, you are still responsible for
payment of your benets. If you are not receiving a paycheck, you will be sent
a monthly invoice for payment.
You will have the opportunity to change coverage for yourself and/or your depen-
dents during Open Enrollment each year. The change will take effect the following
January 1. Dependents can be added within 31 days of a qualifying event, such as
a marriage or birth of a child, with coverage effective immediately. (For eligibility
see Family Status Change.)
Because of favorable tax treatment you receive by paying for certain benets on
a pre-tax basis, the IRS requires strict compliance with Section 125 of the Internal
Revenue Service Code, which governs when changes are allowed. If you think
you have a qualifying family status change, immediately contact the Health and
Benets Team for more information.
Coverage for you and your eligible dependents will cease:
• If the plan is discontinued
• If you fail to pay premiums for the plan
• If you no longer meet the eligibility requirements to participate in the plan
• When you are no longer part of an employee group covered by this plan
• On the last day of the month in which your employment terminates.
Changing Coverage
Leaves of Absence
(LOA) and Employee
Benets
Dual Eligibility
Chicago Public School Benets Handbook 7
If you have a qualifying Family Status Change during the year, you may change
coverage within 31 days of the event. Documentation is required. Do not wait
until you receive the document(s), however, to notify the Health and Benets Team.
Completion of your enrollment must occur within the 31-day period. Any change
in coverage must be consistent with the change in family status.
Below are some of the most common triggers.
Any enrollment changes will take effect as of the date the event occurred if you
properly notify the Health and Benets Team within 31 days of the event. Other-
wise, your next chance to change coverage will be during Open Enrollment, with
the change taking effect the following January 1.
The district considers submission of documents falsifying a person’s eligibility
to obtain healthcare coverage an act of fraud. Similarly, failing to notify the
Chicago Public Schools that a formerly eligible person (spouse, child, civil union
or domestic partner) is no longer eligible within 31 days of the date that person
became ineligible is an act of fraud. Suspicious acts will be reported to the Ofce
of the Inspector General and are grounds for termination. The employee will also
be held responsible for any PPO claims or HMO premiums paid on behalf of an
ineligible person.
Family Status
Change
Fraudulent Acts
Legal Marital
Status
Employment
Status
Number or Status
of Dependents
Domestic
Relations Orders
Work
Schedule
Medicare and
Medicaid
Marriage, divorce, establishment/
termination of a civil union, termi-
nation of an existing grandfathered
domestic partnership, death.
Birth, adoption, placement
for adoption or death of
a dependent; change in age
or other qualifying criterion
of dependent.
Your spouse/civil union partner/
dependent child(ren) gains or loses
coverage; or employment ends or
starts for the employee, spouse
or dependent that affects benets
eligibility.
A court order resulting from
a divorce, legal separation,
annulment, or change in legal
custody that requires health
plan coverage for the employee’s
child under the employee’s
health plan, or that requests the
employee’s former spouse
to provide the coverage.
A switch between part-time and
full-time work, a strike or lockout,
commencement of or return
from an unpaid leave of absence,
or an increase or decrease in hours
of employment by the employee,
spouse or dependent that affects
benets eligibility.
A corresponding change
is permitted under the
Children’s Health Insurance
Program Reauthorization
Act of 2009 (CHIPRA) due
to the employee’s, spouse’s,
or dependent’s gain or loss
of Medicare or Medicaid
eligibility.
Chicago Public School Benets Handbook 8
Enrollment
If you are eligible for benets, you may elect coverage for yourself, your
spouse, civil union partner and children, provided they all meet eligibility
criteria. Remember, you must submit any required proof of dependency within
31 days of your date of hire. Please log in to CPS.edu/Staff then click on the
link for HR4U for more information to complete your benets enrollment.
If You Don’t Enroll
Coverage Levels
Cost
If you do not enroll for coverage within 31 days after your hire date or during
Open Enrollment, while there are some very limited exceptions (e.g., if you lose
coverage due to a spouse’s loss of work), you will not be able to enroll until the
next Open Enrollment and your coverage will not take effect until the following
January 1. Also, if you decline coverage, you and your eligible dependents will
be ineligible to continue coverage under COBRA if you leave CPS employment
or experience any other qualifying event.
CPS pays a substantial portion of the cost of your medical care plan. Your share
of the cost is deducted from your paycheck, as a percentage of your salary, on
a pre-tax basis, according to Sections 105, 106 and 125 of the Internal Revenue
Service Code. As result, your taxable income will be reduced by the amount
of your premiums. You won’t pay any federal or state taxes (or Medicare taxes
if they apply) on your premiums. Contact the Health and Benets Team for
information about the current cost of coverage. Medical costs are subject to
change each year.
You and your legal spouse
or one child (employee + one)
You, your legal spouse and one
or more children (family)
Yourself
(employee
only)
Chicago Public School Benets Handbook 9
Enrolling Dependents
If you wish to enroll an eligible dependent in a Board-sponsored benet plan,
you must submit the documents specied below as proof of dependency. To ensure
proper identication of your documents, you must use your personalized cover
sheet along with all of the pertinent documentation. It can be downloaded from
CPS.edu/Staff then click on the link for HR4U. Your spouse or dependent
cannot be enrolled if identifying information is not included with your documents.
• Submit a county-certied copy of your marriage certicate. Keep in mind
the following: Marriage licenses are acceptable only if they also have a certi-
cation of the date that the county clerk recorded the marriage. A marriage
license that is signed by the ofcial who performed the marriage ceremony,
but does not have the date the marriage was recorded with the county clerk,
is not acceptable. Ceremonial or church certicates or certicates that are
issued by a justice of the peace are not acceptable.
• Your name and the name of your spouse on the marriage certicate must
match your name and your spouse’s name as they appear on the Board’s/
CPS’s records. Any name change must be documented by court-issued
change documents.
• A person you are divorced from is not eligible for coverage. If you provide
a county-certied copy of your marriage certicate, you are certifying that
you are currently married to the individual named on the certicate. If you
provide a marriage certicate to establish the eligibility of a person you are
divorced from or you fail to notify the Health and Benets Team of a divorce
from a formerly eligible spouse, you are committing fraud. You will be held
responsible for any claims or premiums paid on behalf of an ineligible person.
Spouse
Documentation Required:
Marriage Certicate
Chicago Public School Benets Handbook 10
To enroll a dependent child, submit a county-certied copy of the child’s birth
certicate; you also must establish your relationship to the child’s other parent
(or in the case of a stepchild, your spouse’s relationship). Keep in mind the
following:
• A county-certied copy of a birth certicate is issued by a municipality,
county or state. The certicate must contain parental information and the birth
registration number. Your name must appear on the birth certicate.
• If the child is your stepchild, your spouse’s name must appear on the birth
certicate.
• If you are the child’s legal guardian, you or your spouse must not be named as
one of the two parents.
• If the child is your adopted child and the birth certicate has not yet been
amended to name you as a parent of the child, the letter issued by the govern-
mental agency placing the child in your home will be accepted as documen-
tation until the amended birth certicate can be issued.
If the dependent is your stepchild and you are divorced from the other parent,
you must provide a copy of the divorce decree that is certied by the clerk of the
court in which the divorce was led. The divorce decree must name you only, or
both you and your former spouse, as responsible for providing the child’s health
insurance in order for the child to be covered under the plan. If the divorce decree
does not state who is responsible for providing health care coverage, and reserves
the issue of child support, you must provide a copy of any later child support or-
der. If there is no child support order, you must provide a notarized afdavit stat-
ing that although the issue of child support was reserved, no child support order
has ever been entered in the court. If both the divorce decree and child support
order do not say who is responsible for health insurance, the child can be covered
under a Board plan if the other parent is not named as the person who can claim
the child as a dependent on a federal income tax return. If the other parent is not
named, you must provide a notarized statement that the child is claimed as your
dependent for federal income tax purposes.
If your divorce decree states that your ex-spouse is responsible for providing
your child’s (or children’s) health insurance, you cannot provide coverage under
the Board health care plans unless you have the decree amended to name you
as the responsible party, either solely or jointly with your ex-spouse. You must
return to the court where your divorce was granted to have it amended. You will
receive a Notice of Motion indicating your new court date. Submit a copy of it
to the Health and Benets Team. When the amendment has been ordered by the
court, provide the Health and Benets Team with a certied copy to complete
your le.
Children
Documentation Required:
Birth Certicate
Chicago Public School Benets Handbook 11
If the dependent is your stepchild, your spouse must submit a copy of the original
certied birth certicate that veries the dependent’s parent is your spouse. Your
spouse’s name must be on the child’s birth certicate.
If you are the child’s parent, but are not named as the parent on the birth certicate,
the child cannot be covered as a dependent under a Board plan without a certied
copy of the child support order requiring the child to be placed on your health
insurance or an amended birth certicate naming you as the child’s parent.
Unmarried dependent military veteran children who reside in Illinois, between the
ages of 26 and 30, can be covered as dependents if they otherwise meet the criteria
of dependency established for children under the age of 26. Birth certicates and
proof of parental relationship must be established in the same manner as outlined
on the previous pages. To be eligible, a veteran must:
• Have served in the active or reserve components of the U.S. Armed Forces,
including the National Guard;
• Have received a release or discharge other than a dishonorable discharge; and
• Submit proof of service using a DD2-14 (Member 4 or 6) form, otherwise
known as a “Certicate of Release or Discharge from Active Duty.” To obtain
a copy of a DD2-14, the veteran can call the Illinois Department of Veterans
Affairs at (800) 437-9824 or the U.S. Department of Veterans Affairs at
(800) 827-1000.
• The cost to continue the military dependent’s coverage on the group plan is
100% of the cost of coverage (member portion plus the state/employer
contribution), regardless of the number of dependents enrolled on the member’s
coverage. The Illinois mandate validating the cost can be found here
https://www2.illinois.gov/cms/benets/StateEmployee/Pages/State-Dependent-
Enrollment.aspx.
Any children with disabilities who depend on you for support or maintenance
because of their physical or mental handicap will be covered, if you provide
proof of incapacitation, along with the birth certicate and proof of parental
relationship, prior to the child’s 26th birthday. You can request forms from the
Health and Benets Team. The determination of incapacitation will be made
by either the Health and Benets Team or a medical review rm. New hires and
employees electing coverage due to a family status change may add disabled
dependents age 26 and older when electing coverage for the rst time, and the
age limit for submitting documentation does not apply. However, the employee
must provide proof that the child was disabled prior to the child’s 26th birthday
and that the child was continuously covered by group health coverage since
the child’s 26th birthday.
Chicago Public School Benets Handbook 12
Domestic Partner
Afdavit of Domestic Partnership
A domestic partner is eligible for coverage as of the same date that your coverage
becomes effective if you are a new employee. An eligible domestic partner can
be either same or opposite sex. If you are an employee with existing coverage
who is adding a domestic partner, the partner’s coverage becomes effective as of
the date that domestic partner status is established, provided that you submit the
required documents to the Health and Benets Department promptly. In the
event that your domestic partner is conned to a hospital with an illness or
injury, coverage will begin when your domestic partner is no longer conned.
The following eligibility requirements must be met for a domestic partner to be
covered:
• You, the employee, must be enrolled in a Board-sponsored medical or dental
plan; and
• You must submit a completed Afdavit of Domestic Partnership and meet the
eligibility requirements for a Domestic Partner. Your afdavit needs to meet
the minimum requirements listed below:
a.You and your partner are at least 18 years of age
and reside at the same residence;
b. Neither you nor your partner is married (if you or your partner were
previously married, proof of dissolution of marriage is required);
c. You and your partner are not related by blood closer than
would bar marriage in the State of Illinois;
d. You and your partner are each other’s sole domestic partner,
responsible for each other’s common welfare;
e. You must submit certied birth certicates and copies of governmet-issued
ID cards for both you and your partner.
• Acknowledgment of Imputed Income (AII) Form.
AND
At least two of the following four conditions must apply and proof must
be submitted:
1. You and your partner have been residing together for at least twelve (12)
months prior to ling the Afdavit 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:
i. Joint ownership of a motor vehicle;
ii. Joint credit account;
iii. Joint checking account;
iv. Lease for residence identifying both you and your partner as tenants.
4. You declare your partner as a primary beneciary in your will.
The Health and Benets Department will review your afdavit to determine
whether you meet these requirements.
Eligibility Requirements
Chicago Public School Benets Handbook 13
If the Health and Benets Department approves your request, you must com-
plete enrollment for your Partner within 31 days of the date your request for
domestic partnership is approved. If you promptly submit all the required
documentation, coverage will be effective as of the date your Partner is granted
domestic partner status. If you do not enroll within 31 days, the next opportunity
to do so is during the annual Open Enrollment.
The premium contribution deduction for your domestic partner is taken after-tax.
The annual monetary value of the health benet for your domestic partner will
be reported as imputed income on your W-2. Please consult with your tax advi-
sor about the tax consequences. All other eligibility and plan provisions apply.
If at any time your domestic partner becomes ineligible for benets, it is your
responsibility to notify the Health and Benets Department in writing. Certain
limitations exist in regard to continuing coverage for a domestic partner. Contact
the Health and Benets Department for more information. Following the
termination of a domestic partnership, a minimum of 12 months must elapse
before a new domestic partner may be designated.
Coverage Termination
for Domestic Partner
Chicago Public School Benets Handbook 14
Civil union partners may be added during Open Enrollment or as a “Family
Status Change” at the time the civil union certicate is issued.
To add your civil union partner to health coverage you must submit the Civil
Union Partner Information Form and an original certied civil union certicate
and/or a birth certicate if you are adding a dependent of your civil union
partner within 31 days of the date of your civil union.
The premium deduction for your civil union partner is taken after-tax. The
annual monetary value of the health benet for your civil union partner will be
reported as imputed income on your W-2. Please consult with your tax advi-
sor about the tax consequences. All other eligibility and plan provisions apply.
If at any time your Partner becomes ineligible for benets due to a termination
of the partnership, it is your responsibility to notify the Health and Benets Team
in writing. Certain limitations exist in regard to continuing coverage for a civil
union partner. To terminate the partnership submit the Original County Certied
Dissolution of Civil Union certicate. Contact the Health and Benets Team
for details.
The names of both parents and the children’s names must match on the birth
certicates, the marriage certicate, divorce decrees, child support orders and
notarized statements, if any, and on the records of the Board/CPS. If names do
not match, certied court orders of name change must be provided to show the
change in identity.
All documents must be certied as having been led by the governmental unit
that has jurisdiction over issuing such documents. Certied copies of documents
generally have a raised or multi-colored seal, or are issued on multi-colored
paper. Foreign documents must be issued by a governmental unit. If these
documents are not in English, they must be accompanied by an English
translation that is issued by a certied translator; prepared by the consulate of the
foreign country that originally issued the document; or notarized by a notary who
can read and write the language in which the document is prepared and swears
that the translation is a faithful representation of the accompanying document.
Enrolling a Civil Union Partner
Civil Union Partner Certicate
Civil Union Partner
Documentation Required:
Civil Union Certicate
Coverage Termination
for Civil Union Partner
Name Changes
Acceptable
Documentation
Chicago Public School Benets Handbook 15
Required Documents for Dependents:
A Summary
To nalize your benets choices, you must submit the required documentation
within 31 days of the hire date or qualifying event date. Refer to the table below.
See page 68 for instructions on submitting your documentation.
Unmarried Military Dependent
Children Who Are Residents of
Illinois (ages 26 - 30)
(Benets terminate at the end
of the month in which the 30th
birthday occurs.)
Legal dependents
(Court appointed)
Dependent (0-26 yrs.)
Disabled dependent (0-26 yrs.)
Spouse
Benet participant being added Document(s) Needed
An original certied marriage certicate.
An original county certied Birth Certicate (with parental information)
Disabled dependent (0-26 yrs.)
Civil union partner
An original certied civil union certicate.
Acknowledgment of Imputed Income (AII) form.
An original certied birth certicate
and military discharge paperwork (DD2-14).
Adopted children
If the child is your adopted child and the birth certicate has not yet been amended to name you and other adoptive
parent as the child’s parents, then the letter issued by the governmental agency placing the child in your home will
sufce for documentation, until such reasonable time as the amended birth certicate can be issued.
You do not need to prove your relationship to the child’s parents if you are the child’s legal guardian. You must provide
an original of the guardianship appointment certied by the clerk of the court in which the appointment occurred.
Domestic partner
The following eligibility requirements must be met for a domestic partner to be covered:
• You, the employee, must be enrolled in a Board-sponsored medical or dental plan; and
• You must submit a completed Afdavit of Domestic Partnership and meet the eligibility requirements for a samesex
Domestic Partner. Your afdavit needs to meet the minimum requirements listed below:
a. You and your partner are at least 18 years of age and reside at the same residence;
b. Neither you nor your partner is married (if you or your partner were previously married, proof of dissolution
of marriage is required);
c. You and your partner are not related by blood closer than would bar marriage in the State of Illinois;
d. You and your partner are each other’s sole domestic partner, responsible for each other’s common welfare;
e. You must submit certied birth certicates and copies of government-issued ID cards for both you and
your partner.
• Acknowledgment of Imputed Income (AII) Form.
AND
At least two of the following four conditions must apply and proof must be submitted:
1. You and your partner have been residing together for at least twelve (12) months prior to ling the Afdavit 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:
i. Joint ownership of a motor vehicle;
ii. Joint credit account;
iii. Joint checking account;
iv. Lease for residence identifying both you and your partner as tenants.
4. You declare your partner as a primary beneciary in your will.
The Health and Benets Department will review your afdavit to determine whether you meet these requirements.
Chicago Public School Benets Handbook 17
Wellness Program
BlueCross BlueShield of Illinois (BCBSIL) will administer the wellness
program. As the sole medical carrier, BCBSIL will provide CPS employees
with a fully integrated experience that can be customized to meet individual
wellness goals.
The program is called Well onTarget and it is designed to give you the support
you need to make healthy choices. With Well onTarget, you gain access to
a convenient, secure website with personalized tools and resources, right at
your ngertips.
To access Well onTarget, log in to Blue Access for Members (BAM) at
BCBSIL.com. Once you are logged in to BAM, simply click the link on
the right side of the page and it will take you to the Well onTarget portal.
Employees will no longer be penalized for not completing required wellness
activities, but participation is highly encouraged. Take stock of yourself and
your health. This program will help you do that.
Well onTarget Member Wellness Portal
At the heart of Well onTarget is the member portal. It links you to a suite of
innovative programs, including:
onmytime Self-directed Courses
Reach your health goals at your own pace with online, self-directed courses for
topics such as stress management and weight management.
Health and Wellness Content
The health library teaches and empowers through evidence-based,
interesting articles.
Tools and Tracker
Use these interactive tools to help keep you on track for your next 5K or to
monitor your blood pressure levels.
Fitness Program and Health Clubs
A exible membership program gives you unlimited access to a nationwide
network of gyms. Membership is month-to-month and there is no long-
term contract required. Fees are $25 per month per member with a one-time
enrollment fee of $25.
Blue Points
Earn Blue Points by completing activities such as tracking your calories
or connecting a tness tracking device. Blue Points can be redeemed for
items such as gift cards or electronics.
Medical Plans at a Glance 19
BlueAccess for Members 20
BCBSIL BlueAdvantage Health Maintenance Organization (HMO) 21
BCBSIL Preferred Provider Organization (PPO) 22
BCBSIL PPO with Health Savings Account (HSA) 23
BlueCross BlueShield of Illinois Health Savings Account (HSA) 24
Clinical and Pre-Authorization for PPO and
PPO with HSA Plans 25
Prescriptions 28
Dental Plan Options 32
Vision Plan Options 33
Behavioral Health, Addiction and Employee
Assistance Program 34
Revised 2022-01
Chicago Public School Benet Guide 19
HMOs
Lower premiums
No deductibles
Doctor must be selected from pre-
approved list of doctors.
BlueCross BlueShield HMO requires
referral from your primary care doctor
to see a specialist doctor. Your primary
care physician and their staff will
manage and coordinate your care.
Slightly higher premiums
Carry over deductible credit provision only when the
deductible is met during the last two months of the
calendar year.
Covers in-network and out-of-network doctors.
Offers nancial incentives for selecting doctors
from the pre-approved list.
See a specialist doctor without referral. Pre-
approval, however, is required for certain services
such as MRIs and CT scans. (See page 23 for more
information about pre-approval requirements.)
BCBSIL nurses may reach out to you via
a phone call to help coordinate or manage your
care or your medical condition. This is an
additional resource to answer your questions,
help you effectively communicate with your
doctor, and help you understand your benets.
Telemedicine (Virtual Visits) are available only
for PPO and PPO with HSA plans.
PPOs
You can select a PPO or HMO from a single carrier – BlueCross BlueShield
of Illinois. We offer plans that are employee only, employee + one, or family
coverage. CPS shares in the cost of coverage for this benet.
Deductions are based on the paycheck date in accordance with the annual payroll calendar.
HMO and PPO Plans
Key Differences
BlueCross
BlueShield
PPO
BlueCross
BlueShield
BlueAdvantage
HMO
BlueCross
BlueShield
PPO with HSA
Medical Plans At a Glance
Employees and dependents will not incur out-of-
pocket expenses when receiving physical and
occupational therapy at an Athletico clinic.
Deductibles and visit limits still apply.
Chicago Public School Benet Guide 20
BlueAccess for Members
Want to nd more information on your plan?
Log in to BAM, BlueAccess for Members, the BlueCross BlueShield member
website to nd information about your claims, request an ID card, and access
their library of information. Visit bcbsil.com/members.
Chicago Public School Benets Handbook 21
Benet Highlights for eligible expenses BlueCross BlueShield BlueAdvantage HMO
Annual deductible
N/A
Out-of-pocket maximum
Single $1,500
Employee+1 $3,000
Family $3,000
Care in doctor’s ofce
• General ofce visits (e.g., x-rays, allergy shots, chemotherapy)
• Wellness/preventive care (e.g., physical check-ups for adults and
children, well baby care, colonoscopies, mammograms, pap smears
and immunizations)
100%
$30 Regular co-pay
$45 Specialist co-pay
$30 Urgent co-pay
100% (no co-pay)
Inpatient hospital services
• Hospital (semi-private) room and board
• Doctor’s visits (including specialists), x-rays, drugs, surgeon fees
and anesthesiologists
100% after $275 co-pay per admission
100%, $0 (co-pay)
Outpatient hospital care (including surgery)
Covered in full after $225 co-pay per visit
Maternity
• $30 copay applies for 1st prenatal visit only
• Prenatal/postnatal
• Hospital coverage (mother and newborn)
100% after $45 co-pay
100% after $275 co-pay
Covered emergency care
• Emergency care (if deemed an emergency)
• Ambulance
100% after $200 co-pay per visit for In-network and Out of network providers
100% with $0 co-pay. Ground Transportation only.
Behavioral/Mental Health (unlimited visits)
• Inpatient
• Outpatient
100% after $275 co-pay
100% after $20 co-pay
Therapy
• Physical, occupational and speech therapy for restoration of function
approved by doctor
• Chiropractic care
100% for the number of visits which, if approved by a doctor, up to 60 visits
combined for all therapies, plus $30 co-pay per visit per calendar year
100% after $45 co-pay per visit up to 30 visits per calendar year
Care in skilled nursing facility 100%; 60 calendar day limit
Coordinated Home Care 100% (no co-pay)
Prosthetic devices and medical equipment
100%
Eligible full-time union employees
Eligible Full - time union employee
Employee Only: 2.0%
Employee + 1: 2.2%
Family: 2.5%
Eligible Half-time Teachers
Employee Only: 4.0%
Employee + 1: 4.4%
Family: 5.0%
Eligible Non-Union Employees
Employee Only: 3.5%
Employee +1: 3.7%
Family: 5.0%
BlueCross BlueShield of Illinois BlueAdvantage
Health Maintenance Organization (HMO)
Chicago Public School Benets Handbook 22
Benet highlights for eligible expenses BlueCross BlueShield PPO
In Network Out of Network
Annual deductible
Single $600
Employee+1 $1,800
Family $1,800
Single $1,200
Employee+1 $3,600
Family $3,600
Out-of-pocket maximum
Single $2,700
Employee+1 $5,200
Family $5,200
Single $5,400
Employee+1 $10,800
Family $10,800
Care in doctor’s ofce
• General ofce visits (e.g., x-rays, allergy
shots and chemotherapy)
• Wellness/preventive care (e.g., routine
physical check-ups for adults and children, well
baby care, colonoscopies, mammograms, pap
smears and immunizations)
80%
$25 Regular co-pay
$40 Specialist co-pay
$25 Urgent co-pay
100% (no co-pay)
50%
$25 Regular co-pay
$40 Specialist co-pay
$25 Urgent co-pay
100% (no co-pay)
Pre-authorization requirements
• Procedure, therapy and surgical
(See page 24 for more information.)
Pre-authorization required, failure can result in 50%
additional co-insurance charge up to $1,000 plus the co-
insurance that is applicable to the service. Benets can be
further reduced or denied completely if it is determined
that treatment or admission is not medically necessary.
Pre-authorization required, failure can result in 50%
additional co-insurance charge up to $1,000 plus the co-
insurance that is applicable to the service. Benets can be
further reduced or denied completely if it is determined
that treatment or admission is not medically necessary.
Telemedicine (Virtual Visits)
$25 co-pay N/A
In-patient hospital services
• Hospital (semi-private room and board)
• Doctor’s visits (including specialists), x-rays,
drugs, surgeon fees and anesthesiologists
$100 deductible per admission and 80% after deductible
Included in inpatient hospitalization
$100 deductible per admission and 50% after deductible
Included in inpatient hospitalization
Outpatient hospital care (including surgery)
80% after deductible 50% after deductible
Maternity
• Prenatal/postnatal
• Hospital coverage (mother and newborn)
100% after $40 co-pay
80% after deductible
50% after deductible
50% after deductible
Covered emergency care
• Emergency care (if deemed an emergency)
• Ambulance
100% after $200 co-pay
100% after deductible
100% after $200 co-pay
100% after deductible
Behavioral/Mental Health (unlimited visits)
• Inpatient
• Outpatient
80% after deductible
100% after $25 co-pay
50% after deductible
80% after $25 co-pay
Therapy
• Physical, occupational and speech therapy for
restoration of function approved by doctor –
up to 60 combined visits per calendar year
• Chiropractic care up to 30 visits per
calendar year
100% after deductible, then $30 co-pay
100% after deductible and $30 co-pay
80% after deductible
80% after deductible
Care in skilled nursing facility (up to 120
days/year if medically necessary)
80% after deductible 50% after deductible
Prosthetic devices and medical equipment
80% after deductible 50% after deductible
Eligible full-time union employees
Employee Only: 2.2% Employee + 1: 2.5% Family: 2.8%
Eligible half-time teachers
Employee Only: 4.4% Employee + 1: 5.0% Family: 5.6%
Eligibile non-union employees
Employee Only: 3.7% Employee +1: 4.0% Family: 5.0%
BlueCross BlueShield of Illinois Preferred
Provider Organization (PPO)
Chicago Public School Benets Handbook 23
In addition to HMO and PPO plans, CPS offers a PPO with Health SavingsAccount (HSA) plan.
An HSA is a tax-favored account used in conjunction with an HSA-compatible health plan. The
funds in the account are used to pay for IRS-qualied medical expenses such as services applied
to the deductible, dental, vision and more.
CPS will contribute up to $600 for single coverage, $1,500 for employee +1 or $2,000 for family
coverage to your individual HSA. Funds will be paid incrementally per pay period. Employer
contributionswill be pro-rated based on the beginning date of enrollment with the PPO with
HSA plan.
Employer and employee contributions will be deposited to the participant’s accounts after each
pay date in one lump sum.
• A CPS employer contribution (seed money) you can apply toward your
deductible and other medical expenses.
• Funds roll over year to year and are yours even if you leave CPS.
• Monthly premiums are lower and tax savings are higher.
Per IRS regulations, employees cannot be enrolled in both the HSA plan and the Health Care
FSA plans concurrently. It is against current IRS regulations to be covered under the PPO
with HSA and contribute to the Health Care FSA plan. More information can be found in IRS
Publication 969.
Per IRS, 2022 employee + employer contribution maximums are:
• Employee Only Coverage: $3,650
• Employee+1 and Family Coverage: $7,300
HSA funds roll over year-to-year; there are tax benets on contributions, earnings and
distributions; and long-term investment opportunities are available.
Per IRS, 2022 catch up for age 55 and up is $1,000
The HSA is the employee’s account, not CPS’. All transactions are handled between the employee
and HSA Bank. It is the employee’s responsibility to complete the process to open their account
within 60 days. If your account is not opened, contributions cannot be deposited.
Monthly maintenance fees may be charged depending on the balance in the
account. Contact HSA Bank for more information on monthly fees.
Use the savings from the lower premium to put into your HSA account and watch your savings
build up faster!
Your contribution amount will be divided among the pay periods in the year. If you do not receive
a paycheck during the summer, for example, a makeup contribution for the missed pay periods
during the summer months will be deposited into your HSA Bank account for the employer
portion at the beginning of the new school year.
BlueCross BlueShield of Illinois PPO
with Health Savings Account (HSA)
Chicago Public School Benets Handbook 24
Benet highlights for eligible expenses In Network Out Of Network
CPS employer contribution*
Single $600 Employee+1 $1,500 Family $2,000
Annual deductible
Single $2,000
Employee+1 $4,000
Family $4,000
Single $4,000
Employee+1 $8,000
Family $8,000
Out-of-pocket maximum
(established by IRS regulations)
Single $4,000
Employee+1 $8,000
Family $8,000
Single $8,000
Employee+1 $16,000
Family $16,000
Care in doctor’s ofce
• General ofce visits (e.g., x-rays, allergy
shots, and chemotherapy)
• Wellness/preventive care (e.g., routine
physical check-ups, well baby care,
colonoscopies, mammograms, pap smears,
and immunizations)
80% after deductible
100% (no co-pay, no deductible)
50% after deductible
100% (no co-pay, no deductible)
Pre-authorization requirements
• Procedure, therapy and surgical.
(See page 24 for more information.)
Pre-authorization required, failure can result in 50%
additional co-insurance charge up to $1,000 plus the
co-insurance that is applicable to the service. Benets
can be further reduced or denied completely if it is
determined that treatment or admission is not medically
necessary.
Pre-authorization required, failure can result in 50%
additional co-insurance charge up to $1,000 plus the co-
insurance that is applicable to the service. Benets can be
further reduced or denied completely if it is determined
that treatment or admission is not medically necessary.
Telemedicine (Virtual Visits)
80% after deductible N/A
Inpatient hospital services
• Hospital (semi-private) room and board
• Doctor’s visits (including specialists), x-rays,
drugs, surgeon fees and anesthesiologists
80% after deductible
Included in inpatient hospitalization
50% after deductible
Included in inpatient hospitalization
Outpatient hospital care (including surgery) 80% after deductible 50% after deductible
Maternity
• Prenatal/postnatal
• Hospital coverage (mother and newborn)
80% after deductible
80% after deductible
50% after deductible
50% after deductible
Covered emergency care
• Emergency care (if deemed an emergency)
• Ambulance
80% after deductible
100% after deductible
80% after deductible
100% after deductible
Behaviorial/Mental Health (unlimited visits)
• Inpatient
• Outpatient
100% after deductible
100% after deductible
80% after deductible
80% after deductible
Therapy
• Physical, occupational and speech therapy for
restoration of function approved by doctor
• Limited to 60 combined visits per calendar year
• Chiropractic care
• Limited to 30 visits per calendar year
100% after deductible, then $30 co-pay
100% after deductible, then $30 co-pay
80% after deductible
80% after deductible, then $30 co-pay
Care in skilled nursing facility (up to 120 days/year
if medically necessary)
80% after deductible 50% after deductible
Prosthetic devices and medical equipment
80% after deductible 50% after deductible
Pharmacy
80% after deductible 50% after deductible
Eligible full-time union employees
Employee Only: 0.0% Employee + 1: 1.0% Family: 1.9%
Eligible half-time teachers
Employee Only: 0.0% Employee + 1: 2.0% Family: 3.8%
Eligible non-union employees
Employee Only: 2.8% Employee +1: 3.0% Family: 3.8%
BlueCross BlueShield of Illinois
Health Savings Account (HSA)
* Health Savings Account (employer contributes this amount to the employee)
Funds will be deposited in the accounts on each pay period and will be calculated incrementally based on pay period.
Chicago Public School Benets Handbook 25
Clinical and Pre-Authorization for PPO
and PPO with HSA Plans
BlueCross BlueShield of Illinois manages the pre-authorization process for
CPS employees and dependents enrolled in the PPO and PPO with HSA health
plans. Pre-authorization is designed to ensure you receive quality medical care
while discouraging unnecessary treatment. To verify that certain treatments
and hospital stays are appropriate, you must obtain approval from the medical
professionals at BCBSIL. They are available from 8 a.m – 6 p.m. Monday
through Friday at (800) 572-3089 for Pre-authorization for medical and for
behavioral health services.
Pre-Authorization
Requirements
Pre-authorization is required for the following services and procedures:
• Inpatient hospital care, including acute rehabilitation hospitals
and surgeries.
• Inpatient skilled nursing facility care.
• Organ transplants.
• Air ambulance transportation.
• Certain outpatient surgeries and procedures such as:
○
Blepharoplasty (surgery to eyelids)
○
Breast surgeries (reduction, reconstruction except when related
to mastectomy, biopsy and lesions)
○
CAT scans
○
MRI
○
Nasal surgery (rhinoplasty and septoplasty)
○
PET scans
○
Sclerotherapy and ligation, vein-stripping
○
Sleep studies
• Hospice: inpatient and home.
• Home nursing visits.
• Private duty nursing.
Chicago Public School Benets Handbook 26
Pre-Authorization
Requirements
• Durable medical equipment and supplies such as:
○
Hospital beds
○
Ventilators
○
Prosthetics
• Other durable medical equipment that costs $1,000 or more.
• Enteral formula (life-sustaining tubal feeding).
• All pregnancy care (during the rst three months or as soon as the pregnancy
is conrmed and within two business days after admission for delivery, not
including weekends).
If you remain an employee after you reach age 65 and become eligible for
Medicare, the Board-sponsored plan will be the primary plan and Medicare will
be secondary. This plan will also be primary for your spouse, if he or she is age 65
or older, eligible for Medicare and is covered by a Board-sponsored plan.
Coordination with
Medicare
Chicago Public School Benets Handbook 27
What If I Don’t Call?
LaTanya, a 32-year-old longtime runner, is experiencing severe back pain during
her workouts. LaTanya’s doctor has diagnosed her with back problems and has
ordered an MRI. LaTanya, her doctor, a family member or a friend must notify
BCBSIL and receive approval prior to her receiving an MRI.
Caleb, age 7, has had numerous bouts of a sore throat and neck swelling over the
past couple of years. During a recent examination, Caleb’s doctor found a lump
in Caleb’s neck. The lump was not viewable with a normal X-ray so his doctor
has suggested that Caleb have an MRI. Because Caleb is a minor, his doctor, the
facility or a family member (parent or legal guardian) must notify BCBSIL prior
to the scheduled date of this outpatient procedure.
Maria, age 55, who has severe osteoarthritis, is scheduled to have a knee replace-
ment. This surgery will require Maria to be in the hospital for several days. Maria,
her doctor, the facility, a family member or friend must notify BCBSIL as soon
as the admission date is scheduled to pre-authorize this inpatient surgery and
hospital admission.
You must call at least seven (7) days in advance for most services requiring pre-
authorization. You must call within two (2) business days after emergency
treatment or inpatient admissions. All pregnancies must be pre-authorized twice,
during the rst three (3) months or when the pregnancy is conrmed (if later)
and again within two (2) business days after admission for delivery (not
including weekends).
When to Call
MRI
Outpatient
Procedures
Inpatient surgery and
hospital admission
If you do not call for pre-authorization and/or follow the program’s recom-
mendations, you will be responsible for 50% of eligible charges (capped at
$1,000 per individual per event per hospital stay). You will pay this penalty
plus the co-insurance that applies. Also, benets could be further reduced if it
is determined that the treatment or admission is not medically necessary.
Example 1
Example 2
Example 3
In cases of End Stage Renal Disease (ESRD), the Board-sponsored plan is
primary for the rst 30 months. It is important that you inform the Claims
Administrator if you have ESRD.
Chicago Public School Benets Handbook 28
CVS/Caremark pharmacy staff continually reviews medicines, products and prices
for your plan sponsor. This is done to make sure that medicines that work well and
are cost-effective to become part of your benet plan. As part of this effort, there
are changes to your drug benet plan that could affect certain specialty prescription
drugs. Call CVS Caremark Specialty Pharmacy toll-free at (800) 237-2767
if you have questions.
Prescriptions
We wanted to make it easy, so we offer three convenient ways for CPS employees
to purchase prescription drugs. The program covers eligible drugs purchased:
By mail-order
Specialty Drugs
At a non-partici-
pating pharmacy
At a participating
pharmacy
Chicago Public School Benets Handbook 29
When to
use which
benet
Retail Program Mail Service Program
For immediate or short-term medicine
needs up to a 30-day supply
For maintenance or long-term medicine
needs up to a 90-day supply
Where
You can use your prescription benet at
more than 62,000 Caremark participating
retail pharmacies nationwide, including
Target and over 20,000 independent
community pharmacies. You can ll 90
days of medicine at a retail CVS
or Target store.
To locate a Caremark participating
retail pharmacy in your area, login to
your account at www.caremark.com
and select the ‘Find a Pharmacy’ link
under the ‘My Prescriptions’ tab, or
call CVS Customer Care toll-free at
(866) 409-8523.
Simply mail your original prescription
along with the mail service order
form to CVS. Your medicines will be
sent directly to your home.
Standard delivery is free of charge for
mail orders.
$10 for each generic medicine after
deductible.
$40 for each brand-name medicine on
the drug list after deductible.
$55 for each brand-name medicine not
on the drug list after deductible.
$95 for specialty medicine after
deductible.
80% covered after medical deductible
is satised.
$20 for each generic medicine after
deductible.
$90 for each brand-name medicine on
the drug list after deductible.
$120 for each brand-name medicine not
on the drug list after deductible.
$200 for specialty medicine after
deductible.
80% covered after medical deductible
is satised.
Prescription Drug
Program Details
Cost to you HMO
and PPO
Cost to you PPO
with HSA
Chicago Public School Benets Handbook 30
Important Change
to Prescription
Drug Deductible
Non-Participating
Pharmacy Purchases
Web Services
Important Change
About Generic vs
Brand Name
Prescriptions
All CPS employees enrolled in the BlueAdvantage HMO or PPO plan will
have to pay a $75 prescription drug deductible per calendar year per household.
Employees who are enrolled in the HSA plan must satisfy the medical
deductible before prescription coinsurance applies.
All CPS employees enrolled in a medical plan will only have access to generic
drugs. Brand name drugs will only be covered if approved by Caremark Doctors
through an appeal process or the employee’s doctor completes the Caremark
prior authorization process.
Register at www.caremark.com to nd a local pharmacy and to access tools
that can help you save money and manage your prescription benet. To register,
have your benets ID card handy.
In most cases, you will not need to visit a non-participating pharmacy, because
the Caremark Retail Program includes more than 62,000 participating pharma-
cies. However, if you choose a non-participating pharmacy, you will pay 100%
of the prescription price. You will then need to submit a paper claim form, along
with the original prescription receipt(s), to Caremark for reimbursement of cov-
ered expenses. Covered prescriptions purchased at a non-participating pharmacy
will be reimbursed at 60% of the generic drug cost. The plan will also only pay
60% of the generic drug cost if a brand-name drug is issued when a generic drug
is available. Submit paper claim forms to:
CVS Caremark
P.O. Box 52136
Phoenix, Arizona 85072-2136
Chicago Public School Benets Handbook 31
Drugs that Qualify for
Coverage
Drugs that are Not
Covered
• Federal legend drugs (drugs requiring a prescription).
• Compound prescriptions (limits and exclusions apply).
• Insulin.
• Women’s contraceptives (limits and exclusions apply).
• Men’s Erectile Dysfunction medications (limits and exclusions apply)
• Specic supplements (i.e., folic acid, iron and uoride).
• Low-dosage aspirin.
• Tobacco cessation (generic only).
• Infertility medications.
• Disposable insulin syringes/needles and diabetic supplies.
• Acne medication (with prior certication from Caremark
for participants over age 35).
• Growth hormones (with prior certication from Caremark).
• Cosmetic drugs such as Rogaine.
• Drugs available without a prescription, except insulin.
• Prescription drugs with an over-the-counter equivalent.
• Drugs for the treatment of obesity, morbid obesity, or weight-loss.
• Appetite suppressants.
• Brand contraceptives (oral and injection) and contraceptive devices that
have a generic equivalent.
• Medical supplies and equipment.
• Drugs not prescribed by a provider acting within the scope
of his or her license.
• Experimental, investigational or unproven drugs or therapies.
• Drugs provided to you by the local, state or federal government and
any drug for which payment or benets are provided by the local, state
or federal government (for example, Medicare).
• Prescription vitamins.
• Topical nail-fungal medication (for oral, limits and exclusions apply).
• Replacement prescription drugs resulting from loss or theft.
Chicago Public School Benets Handbook 32
Dental care coverage is provided at no cost to you; CPS covers the full dental
contribution deduction for all coverage levels. And, you get to choose your
own dentist. Just use a facility ID from the provider network sponsored by
Delta Dental, which can be found at www.deltadentalil.com. (Note: Select the
DELTACARE Network when searching for an in-network dentist on Delta
Dental’s website.)
Delta Dental DHMO
If you choose the PPO, CPS will cover the cost of the employee-only contribu-
tion. Employees pay an additional cost for +1 or family coverage. Under the
PPO plan, you can select either an in-network or an out-of-network provider.
The plan will pay a certain percentage of the PPO rate whether or not you use
a network provider.
Delta Dental PPO
Services Delta Dental HMO Delta Dental PPO
In Network Out of Network
Preventive 100% 80% of PPO rate 80% of PPO rate
Basic 75–85% 80% of PPO rate 80% of PPO rate
Major 65–70% 50% of PPO rate 50% of PPO rate
Individual maximums
Deductible None None $100 annually
Benet Limit None $1,500 annually
Employee Contributions – 26 Pay Periods
Employee only None None
Employee +1 None $9.71 per pay period
Family None $20.56 per pay period
Employee Contributions – 20 Pay Periods
Employee only None None
Employee +1 None $12.62 per pay period
Family None $26.73 per pay period
Dental Plan Options
Chicago Public School Benets Handbook 33
Employees and eligible dependents enrolled in BCBSIL medical plans can
access basic vision coverage through EyeMed Vision Care at no cost to you.
The basic vision plan provides you one eye exam per year for a $15 co-pay.
In addition, you will receive discounts on eyewear.
Basic Vision
Enhanced Vision
For a monthly premium, you can upgrade to the Enhanced Vision plan, which
includes coverage for glasses and contacts, and discounts on laser vision correc-
tion. Choose from independent doctors and retail providers to nd the one that
best ts your needs and schedule.
Vision Plan Options
If you decide to upgrade to the Enhanced Vision Plan for a monthly premium, you will receive coverage for glasses and
contacts, and discounts on laser vision correction. Reimbursement is available for out-of-network benets, but the greatest
savings are with in-network providers. See details in the certicate of coverage.
Digital Retinal Exam covered in full w/ $0 co-pay once every calendar year
Standard lenses once every calendar year
• Cost: Single, bifocal, trifocal and lenticular: $25 co-pay.
• Lens Options: UV treatment $10, tint (solid and gradient) $10, standard plastic scratch coating $0, standard polycarbonate
(adults) $35, standard polycarbonate (kids under 19) $0, standard anti-reective coating $45, polarized 20% off retail.
Frames once every calendar year
• Any available frame at provider location – $0 copay, $150 allowance, 20% off balance over $150
Contact lenses once every calendar year
• Conventional – $0 co-pay, $175 allowance, 15% off balance over $175
• Disposable – $0 co-pay, $175 allowance, plus balance over $175
Exam options
• Standard contact lens t and follow-up – up to $55
• Premium contact lens t and follow-up – 10% off retail price
Additional discounts and features
• Receive a 40% discount off complete pair eyeglass purchase
• 20% discount on non-prescription sunglasses
• 20% discount on other lens options and services
• 15% discount on conventional contact lenses once the funded benet has been used.
• 15% off retail price or 5% off promotional price for Lasik or PRK from the US Laser Network,
owned and operated by LCA Vision.
Deductions Per Paycheck
20 Pay Periods
• Employee Only – $4.44
• Employee + 1 Dependent – $6.48
• Family – $11.63
26 Pay Periods
• Employee Only – $3.42
• Employee + 1 Dependent – $4.99
• Family – $8.95
Freedom Pass
• CPS employees and dependents enrolled in the Enhanced Vision Plan can get any pair of frames for free at Target
Optical stores. To redeem your frames, you must log into EyeMed.com and print off the “Freedom Pass” from the
special offers page and present it at the store.
Chicago Public School Benets Handbook 34
The help you need to manage life’s demands and addiction
We’re not here to judge; we’re here to help, maintaining the strictest condence.
As a CPS employee, you can access counseling and substance abuse recovery
services to help you effectively deal with stressful and challenging situations,
and feelings such as:
Stress
Anger management
Relationship problems
Domestic abuse
Work issues
Sadness
Alcohol abuse
Drug abuse
Grief
Problems with food
Gambling problems
CPS offers an Employee Assistance Program (EAP) that can help you and your
household members with a wide range of issues affecting your overall quality
of life. Offered through Magellan Healthcare, all employees are automatically
enrolled in the EAP, which is provided in strict condence and at no cost to you.
The benet includes up to 5 condential counseling sessions with a licensed
behavioral health professional, as well as comprehensive online information
and resources. The program can assist with everything from job stress, family
or relationship concerns, depression or anxiety, substance abuse or misuse, legal
and nancial issues and more. You may reach the EAP by phone, 24/7/365 for
a consultation, or to link to a counselor or crisis intervention at (800) 424-4776
(800-4CHIPSO) or online at www.magellanascend.com.
Employee Assistance
Program (EAP)
Behavioral Health, Addiction,
and Employee Assistance Program
If you are enrolled in the PPO or PPO with HSA, contact BCBSIL at
(800) 851-7498 to access services. If you are in the BlueAdvantage HMO
plan, contact your primary care physician to receive services.
Behavioral Health
Chicago Public School Benets Handbook 36
Short-Term Disability
CPS provides employer-paid Short-Term Disability benets for all eligible
employees. All CPS employees who are members of an eligible class are
covered under short-term disability. The policy in full legal detail can be obtained
on CPS.edu/Staff then click on the link for HR4U. Here are some highlights.
Summary
This benet is designed to replace income lost during periods of disability
resulting from a non-occupational injury, illness, or pregnancy. Employee
contributions and enrollment forms are not required. All CPS employees who are
members of an eligible class are covered under short-term disability.
Eligible Class is dened as:
1) Collectively Bargained Employees; or
2) Non-Union Employees (Employees who are not members of
a bargaining class)
a) Who are full-time benets eligible employees under Board rules or policies;
AND
b) Who are part-time teachers assigned to a position number and benets
eligible employee as a member of the Chicago Teachers Union; and
c) Who are actively employed in their position with CPS
Coverage begins on the rst calendar day of the month following 60 consecutive
days of employment. Employees who are rehired within 12 months from the date
of the employment termination with CPS will be eligible for coverage as of the
date of rehire as long as they worked 60 days in their prior employment with CPS.
Employees suspended without pay are ineligible for Short-Term Disability.
Effective Date of
Coverage
Chicago Public School Benets Handbook 37
Submitting a Request
Ten Sick Day/Seven
General Use Day
Exhaustion Rule
If you meet the eligibility requirements and you have a medical condition that ren-
ders you unable to work, you should initiate your claim within 10 calendar days
from your rst date of absence due to your disability by going to HR4U > Self
Service > Benets > Leave Life Events or by calling (773) 553-4748. After you
complete the Life Event you then have 15 days to submit your medical certica-
tion to the Absence and Disability Management Department. If you do not report
your claim within 10 calendar days from your rst date of absence, your disability
claim may be denied. In addition to ling for Short-Term Disability, your applica-
tion will be evaluated for a leave of absence under the Family Medical Leave Act
(FMLA). An approved Short-Term Disability claim runs concurrently with FMLA
if you are FMLA eligible. To be eligible for FMLA you must work for CPS for
one (1) year and 1250 hours.
For any Period of Disability, the Ten Sick Day/Seven General Use Days Exhaustion
Rule requires, prior to the beginning of your Period of Disability, that you use ten
sick days or seven general use days of your current year allotment.
Chicago Public School Benets Handbook 38
100% During the period beginning on the date of disability, and continuing up
to and including the 30th day, the amount you receive will be 100 percent of the
Daily Rate of Pay*, calculated by multiplying your hourly base pay x scheduled
hours. You will receive this percentage of that.
Calendar Days 1 – 30
Calendar Days 31 – 60
Calendar Days 61 – 90
Submitting a Request
Notify your supervisor
prior to your leave of
absence or within 10
days of your disability.
Follow the required
call off procedures
established by your
manager/principal.
1
Apply online: CPS.
edu/Staff then click
on the link for HR4U.
Download required
forms and submit within
15 calendar days.
2
Absence and Disability
Department will review
medical certication
upon receipt and send a
determination letter to
you and your supervisor
within 4 business days.
3
Ongoing
communication with
your supervisor and
/ or Absence and
Disability Department
may be required
throughout the
duration of your leave
of absence.
4
80% Beginning on the 31st calendar day from the date of disability and con-
tinuing up to and including the 60th day, you will receive 80 percent of the
Daily Rate of Pay.
60% From the 61st calendar day from the date of disability continuing up to and
including the 90th day, the percentage shall be 60 percent of the Daily Rate of Pay.
• Paid CPS Holidays will be paid by CPS and are counted toward the 90
calendar day maximum benet.
• Paid CPS Holidays will be paid at the rate of the disability period
(100%, 80%, and 60%)
• Intersession pay will be based on the formula as agreed to by the collective
bargaining agreement and are counted towards the 90 calendar day
maximum benet.
• Short-term disability benets you receive from the Plan are taxable income.
• Federal and applicable state and local taxes are withheld from benet
payments.
*If you have a change in your base pay while on disability, your base pay used to calculate your
short-term disability benet will be adjusted based on the new salary rate.
Chicago Public School Benets Handbook 39
An employee may supplement the STD payment in days 31 – 90 to reach 100%
income during such period(s) by usage of sick days from their sick day bank(s).
Employee must complete the authorization form and elect the specic banks for
deductions. Please note, usage of sick days is not an automatic process. Failure
to complete the authorization form within the time period will result in no sick
day usage during the eligible period(s), and no retroactive sick day usage will be
applied to past claim period(s).
Daily Benets shall be paid for each regular work day for which the employee
would have been scheduled had the employee not been disabled, but only for
days during the Period of disability and not in excess of the Maximum Benet
Period. Examples of days not paid by STD include: Holidays, Snow days, and
Intercessions. Short-Term Disability benets will not be paid during the summer
intersession. If the employee remains disabled beginning with the rst scheduled
work date following the end of the summer intercession, the employee will be
responsible for contacting the plan Absence and Disability Department to submit
a new claim.
Benets paid under the Plan are reduced by the total amount of certain other
income for which you may be eligible during any period of disability. These
sources of other income are:
• Any settlement, judgment, or other recovery from any person or entity,
including your own automobile or liability carrier which provides benets that
are intended to replace any portion of your pay
• Any amount of STD benets paid for days determined later that benets were
not due. In the case that there are future benets, overpayments will be
deducted from benets due.
When claim benets are payable: Benets are paid biweekly, for the prior period
for which you are owed, after CPS receives the required proof. If any amount is
unpaid when disability ends, it will be paid when required proof of disability is
in hand. Short-term disability benet payments begin on the rst day after you
have exhausted ten sick days or seven general use days from your current scal
year’s allotment. You must be under the care of a physician who veries, to
the satisfaction of the Absence and Disability Department, that because of your
disability you are unable to perform the essential duties of your employment
with CPS.
Short-term disability benet payments begin on the rst day after you have
exhausted ten sick days or seven general use days from your current scal
year’s allotment. You must be under the care of a physician who veries, to
the satisfaction of the Claims Administrator, that because of your disability
you are unable to perform the essential duties of your employment with CPS.
Supplemental Income
with Usage of Sick Days
Payment of
Daily Benet
Reduction of Benet
Payments
Chicago Public School Benets Handbook 40
Once you begin receiving short-term disability benets, your benets continue
until the earliest of the following events occurs:
• You no longer have a covered disability under the Plan. Either you are able to
resume the essential duties of your regular position or you take a position at
CPS that accommodates your medical restrictions.
• You are unable to provide satisfactory medical evidence of a covered disability.
• You do not follow the treatment plan ordered by your physician.
• You fail to cooperate with a scheduled independent medical examination (IME)
or functional capacity evaluation (FCE).
• You begin work similar to your work with CPS for wage or prot with another
employer or through self-employment.
• You have received benets for a 90-day period.
• You are incarcerated.
• Your employment ends for any reason, including retirement or death.
• The plan terminates.
• You become suspended from your employment at CPS.
Short-Term disability allows you to continue to receive a full or partial salary
for up to 90 days in a rolling 12-month period. A rolling 12-month period is
measured backward from the last date you used any Short-Term Disability.
For example, if a requested Short-Term Disability was to begin on July 1, the
12 months preceding that date would be reviewed to determine whether any
Short-Term Disability time had already been used. If so, that time would be
deducted from the remaining amount of Short-Term Disability time available.
An employee must be actively at work for 5 consecutive business days prior
to being eligible for their new 90 days of benets.
You will be required to provide certain information to the Absence and Disability
Department to have your request reviewed, including the following:
• A signed medical information authorization form.
• Medical documentation of objective ndings to support your medical condition
from your health care provider.
Objective ndings of a disability are necessary to substantiate the period of time
your physician indicates you are unable to work because of your disability. Ob-
jective ndings are those your physician observes through objective means, not
your description of the symptoms.
Objective ndings include:
• Physical examination ndings (functional impairments/capacity).
• Diagnostic test results/imaging studies.
• Diagnoses.
• X-ray results.
• Observation of anatomical, physiological or psychological abnormalities.
• Medications and/or treatment plan
Duration of Short-
Term Disability and
Successive Periods
of Disability
Reduction of Benet
Payments (cont.)
Documentation of
Disability
Chicago Public School Benets Handbook 41
Medical documentation for mental health conditions is required to be supplied
by a Clinical Psychologist and/or a Psychiatrist. Initial diagnosis of postpartum
depression can be accepted from a Doctor of Obstetrics and Gynecology.
Ongoing treatment, however, must be provided by a Clinical Psychologist
and/or a Psychiatrist.
Medical documentation for organ donation is required to qualify for Short-Term
Disability. Donor may qualify for Short-Term Disability with proper medical
certication.
The Absence and Disability Department also may require you to undergo an
independent medical examination and/or a functional capacity test. If you do not
cooperate with this request (for example, you fail to keep a scheduled appoint-
ment), your benets may be terminated. If the Absence and Disability Department
requests that you undergo an independent medical examination (IME) and/or
a functional capacity evaluation (FCE), CPS will pay the fee.
At our discretion, we may ask you to participate in rehabilitation services.
Benets will not be paid for any part of a period of disability that results from
the following:
• A work-related injury for which you are receiving workers’ compensation
benets.
• Participation (or as a consequence of having participated) in the commission
of a felony.
• Any act of war declared or undeclared, service in the armed forces of any
country, performing police duties as a member of any military organization.
• A cosmetic procedure (however, disability benets will be paid for reconstruc-
tive surgery following a mastectomy; for surgery the medical plan determines
to be medically necessary; and for complications that prevent your return to
work within the normal recovery period for a cosmetic surgery procedure).
In the event a claim for Short-Term Disability is denied, the Absence and Dis-
ability Department will send a letter with the following information: The specic
reason(s) for the denial, including:
• Specic reference to all pertinent provisions upon which the denial is based.
• Appropriate information as to the steps to be taken if you wish to submit an
appeal for review of the claim denial.
• Claim Appeal Procedure Level 1.
To appeal a denied Short-Term Disability claim, you must request the appeal in
writing, no more than 30 days from the date of the denial. You are expected to
return to work the next scheduled work day unless you are on an approved Family
Medical Leave of Absence. You must follow the normal absence reporting proce-
dures. No-call-no-show will result in disciplinary action. Failure to return to work
may result in Absence Without an Approved Leave (AWOL) proceedings.
Mental Health
Conditions
Organ Donation
Physical Examination
Short-Term Disability
Coverage Exclusions
A Denied Claim
Chicago Public School Benets Handbook 42
Attn: Absence and Disability Department
2651 W. Washington Blvd.
Chicago, Illinois 60612
When you request this review, you should state the reason(s) you believe the
claim was improperly denied and submit for review any pertinent documents,
including but not limited to additional medical or vocational information and any
facts, data, questions or comments you deem appropriate so that the Absence and
Disability Department may give your appeal proper consideration. The appeal
review determination will be made by the Absence and Disability Department,
ordinarily no later than 30 days after receipt of a request for review, unless special
circumstances require an extension of time for processing the appeal. If special
circumstances require more time to consider an appeal, the Absence and Disability
Department may take up to14 additional days to render a determination. If
this additional time is needed, the Absence and Disability Department will notify
you in writing by mail before the 45-day period has expired.
If the Absence and Disability Department denies your Short-Term Disability
claim for benets on appeal, you have 14 days from the date of receipt of the
written notication of denial to appeal to the Absence and Disability Department
for a nal determination. Requests for review of a nal appeal should include the
reason(s) as outlined in the previous paragraph and should be sent to the Absence
and Disability Department at the above address or fax number (773) 553- FMLA
(3652). The nal appeal decision will be made by an appeal committee at CPS.
The nal appeal review determination will be made by an appeal committee at
CPS, ordinarily no later than 30 days after receipt of a request for review, unless
special circumstances require an extension of time for processing the appeal. If
special circumstances require more time to consider an appeal, the Absence and
Disability Department requires14 additional days to render a determination. If
this additional time is needed, the Absence and Disability Department will notify
you in writing by mail before the 30-day period has expired.
The decision made by the Absence and Disability Department for all Short-Term
Disability appeals is nal and binding.
If the Short-Term disability plan provides or pays benets as a result of a disabling
injury or sickness:
• Caused by the act or omission of another party;
• Covered by Workers’ Compensation;
• For which no-fault or employers’ liability laws also provide coverage;
• Sustained on the property of a third party that has premises liability insurance
available, then:
Claim Appeal
Procedure - Final
Rights of Restitution
and Reimbursement
and Subrogation
Requests for review
of a denied claim
should be sent to:
Chicago Public School Benets Handbook 43
CPS, or a third party acting on behalf of CPS, has an equitable lien on any moneys
that might be owed to you for the injury or sickness as well as the equitable right to
recover the value of services and payments made under the Short-Term Disability
plan. This right is by restitution and reimbursement or subrogation, and exists
because the benet payable under the Plan is the net amount of covered claims
after taking all other forms of recovery into account.
The right of restitution and reimbursement means that the Short-Term Disability
plan has a lien on any recovery that you become entitled to receive. Accordingly,
if you receive benets under any of the circumstances listed, you must repay the
Short-Term Disability plan the amount of the benets you receive from another
source – up to the amount you have received from the Short-Term Disability plan
– because the plan has an equitable lien in that amount. Recovery includes all
amounts received by you from any persons, organizations or insurers by way of
settlement, judgment, and award or otherwise on account of such injury or sick-
ness. The right of subrogation means that CPS, or a third party acting on behalf of
CPS, may make claim in your name or CPS’s name against any persons, organiza-
tions or insurers on account of such injury or sickness.
The rights of restitution and reimbursement or subrogation apply whether or not
you have been fully compensated for your losses or damages by any recovery of
payments. If you settle a claim against a third party, you are deemed to have been
made whole by such settlement so that CPS, or a third-party acting on behalf of
CPS, is entitled to immediately collect the present value of its subrogation rights
as the rst priority claim from said settlement or judgment. CPS is entitled to the
rst dollars recovered. No attorney’s fees may be payable from any subrogation
recovery unless CPS has been notied of the attorney’s proposed representation
in advance, and unless CPS has agreed in writing to the representation of CPS’s
interests by that attorney.
Under certain circumstances, you will be required to hold CPS harmless against
future benet payments due to the injury or sickness for which a settlement is
reached. These rights of restitution and reimbursement or subrogation apply to any
type of recovery from any third party, including but not limited to recoveries from
tort-feasors, underinsured motorist coverage, uninsured motorist coverage, other
substitute coverage or any other right of recovery, whether based on tort, con-
tract, equity or any other theory of recovery. Any amounts you receive from such
a recovery must be held in trust for CPS’s benet to the extent of the Short-Term
Disability plan’s restitution and reimbursement or subrogation claims. You must
cooperate fully with every effort — by CPS, or other third party acting on behalf of
CPS — to enforce CPS’s rights of restitution and reimbursement or subrogation.
Rights of Restitution
and Reimbursement
and Subrogation (cont.)
Chicago Public School Benets Handbook 44
By ling a claim for benets under the Short-Term Disability plan, you authorize
CPS and its Absence and Disability Departments to have access to any health
records or medical information held by any healthcare provider and employment
information held by any employer. You also authorize the Absence and Disability
Department to use your health records, medical information and employment
information for claims processing (including, without limitation, claims for resti-
tution and reimbursement or subrogation under the Short-Term Disability plan),
disability claims data evaluation, and evaluation of potential or actual claims
against the Absence and Disability Department.
CPS, on its own behalf or through a third party administrator, has the right to
recover any benet payments that are made in excess of the amount you are
eligible to receive under the Plan, including but not limited to:
• Erroneous payments.
• Payments made for any periods for which you fail to provide satisfactory
evidence of a covered disability.
• Payments not reduced by amounts you receive from a source listed under
“Reduction of Benet Payments.”
Retroactive payments from any source listed under “Amount of the Benet You
Receive — Reduction of Benet Payments” must be immediately disclosed to
the Absence and Disability Department. Excess payments will be recovered
directly from you, or if necessary, from future benet payments or from your
estate, to the extent permitted by law.
Access to Records
Chicago Public School Benets Handbook 45
Long-Term Disability
In addition to the CPS-provided Short-Term Disability benet, employees have the
option of purchasing Voluntary Long-Term Disability Insurance. Long-Term Disability
(LTD) Insurance is designed to continue part of your income if you have a medically
certied disability. You have two plan options: a 90-day waiting period or a 180-day
waiting period. Your monthly LTD benet would be 60% of your monthly earnings,
reduced by other income you may receive. The waiting period is the amount of time
that you are unable to perform your job duties before you begin to receive a benet.
Newly hired employees, who enroll in a timely manner (within 31 days of) when they
are rst eligible for this Long-Term Disability plan, can elect one of the options with-
out providing proof of good health, known as Evidence of Insurability.
If an employee has been eligible for the Long-Term Disability plan, but not participat-
ing in the plan, and later decides to add LTD coverage, Evidence of Insurability
(EOI) will be required. Evidence of Insurability is provided to our insurance carrier by
completing a questionnaire, and is subject to approval by our LTD insurance carrier.
The program is insured through The Standard. The employee pays the full premium
for LTD coverage. The premium is based upon age and annual salary.
Chicago Public School Benets Handbook 46
CPS provides Basic Life Insurance coverage of $25,000 for each eligible employee.
CPS also offers the following Supplemental Life Insurance coverage options for
purchase:
Supplemental Employee Term Life Insurance, in amounts equal to one, two, three
or four times your base annual earnings. The maximum amount of coverage avail-
able is $750,000.
• Supplemental Dependent Term Life Insurance, in the amount of $50,000 for your
spouse and/or in the amount of $10,000 for each eligible child.
• Employee Accidental Death & Dismemberment (AD&D) coverage in an amount
equal to the level of Supplemental Employee Term Life Insurance you have.
• Dependent Accidental Death & Dismemberment coverage in an amount equal
to the level of Supplemental Dependent Term Life Insurance you have for your
spouse and/or your eligible children.
To qualify for coverage on your eligible children, you must have some or any
amount of Supplemental Employee Term Life Insurance. To qualify for coverage
on your spouse, you must have at least $25,000 of Supplemental Employee Term
Life Insurance. The coverage available for children is a at amount of $10,000 per
child under age 26 (and it may continue for a child age 26 or older if the child is
disabled). The coverage available for a spouse is a at amount of $50,000.
For some coverage increases, you will need to provide Evidence of Insurability
(EOI) to The Standard by completing a medical questionnaire. Such an increase
will become effective if The Standard approves your request after reviewing the
information provided. Newly hired employees, who enroll in a timely manner
when they are rst eligible for this Life Insurance, may elect one, two or three
times their annual earnings (to a maximum of $500,000) and add spouse Life
Insurance without providing Evidence of Insurability.
The program is insured through The Standard Except for Basic Life Insurance, the
employee pays the full premium, which is calculated based upon age and annual
salary.
If your employment with CPS is ending, and you wish to continue any of the
Life Insurance you had as an active CPS employee, call The Standard at
(833) 960-1238 for Continuation Plan provisions and costs. Your acceptance in
a Continuation Plan is guaranteed, as long as you apply within 45 days after
your active employee Life Insurance ends.
Life Insurance, Accidental Death
& Dismemberment Coverage
Chicago Public School Benets Handbook 47
CPS offers group Critical Illness Insurance from Standard Insurance Company
(“The Standard”) to help cover out-of-pocket expenses that come with being
very ill. A variety of illnesses are covered including heart attack, cancer, or
stroke. The benet goes directly to the insured or covered family member, not
medical providers. Use it to cover the costs of groceries, childcare, or other
expenses such as:
• Medical insurance deductible
• Doctor copays and coinsurance
• Out-of-pocket expenses
• Alternative treatments not covered under your medical plan
• Transportation to medical appointments and treatments
• Lodging near treatment facilities
• Spouse’s lost wages
You can enroll for coverage for you and your family. Visit CPS.edu/HR4U for
more information and to enroll.
CPS offers Group Accident Insurance from The Standard to help pay out-of-
pocket costs following a covered accident. It covers a wide range of treatments
due to an accident. The benet goes directly to the insured or covered family
member, not medical providers. Receive an extra 25% of total benets for injuries
during youth organized sports. Use it to cover the cost of deductibles, copays, or
other expenses such as:
• Ground ambulance
• Emergency room visit
• CAT scan
• Hospital admission
• Five-day hospital stay
• Two physician follow-ups
• Physical therapy (two sessions)
You can enroll for coverage for you and your family. Visit CPS.edu/HR4U for
more information and to enroll.
Accident Insurance
Critical Illness
Insurance
Chicago Public School Benets Handbook 49
Flexible Spending Accounts (FSA)
Flexible Spending Accounts (FSA) are designed to ease the burden of unex-
pected out-of-pocket medical expenses. We encourage all CPS employees to
seriously consider setting up an account during Open Enrollment. An FSA
allows you to contribute pre-tax earnings into a special account that can be
used to pay for eligible medical and dependent care expenses. FSAs expire
at midnight on December 31 every year.
CPS offers an FSA for health care expenses and another for dependent care
expenses. You may enroll in the FSA Program without being enrolled in
a medical or dental plan. Benetexpress administers the FSAs. FSAs allow you
to pay for a variety of expenses that you and your eligible dependents incur
every year as described below.
Your contribution amount will be divided among the pay periods in the year. If you do
not receive a paycheck during the summer, for example, your contribution amount will be
readjusted based on the remaining pay periods once your checks resume.
HOW IT WORKS
There are two ways to le a claim for health care FSA expenses:
Reimbursement is the only way to recover dependent care FSA expenses. Forms are
available at CPSFSA.com.
You may submit a paper submission at any time after you have accumulated
reimbursable expenses. All claims must be led prior to March 31 following the end
of the year in which the eligible expense was incurred.
Please note the following:
• Acceptance of card purchases or claims does not assure IRS acceptance of
the expense as eligible for FSA reimbursement. It is your responsibility to
make sure that expenses paid for with the Benet Express health care expense
card or that you submit for reimbursement are eligible for reimbursement
under IRS rules.
• If you do not incur expenses equal to or exceeding the amount in your
applicable FSA prior to the end of each calendar year, any remainder will
be forfeited in accordance with federal law.
Health Care and
Dependent Care FSAs
Point of Sale
For your co-payments and prescrip-
tion drugs, you may use a debit card
issued by Benet Express to access
your account.
Paper Submission
You may complete a benet claim
form and submit it to Benet Express.
Health-care FSA forms are available
at www.cpsfsa.com.
Chicago Public School Benets Handbook 50
Your FSA account balances may be viewed online at www.cpsfsa.com.
You will be required to create a personalized online account to access this
information. You also may retrieve balance information telephonically by
calling (877) 837-5017.
If you would like to appeal a denial of an FSA claim you must submit a written
appeal within 180 days of the denial. It should include any additional facts and/
or documents supporting approval of the claim. The appeal can be mailed to:
benetexpress
P.O. Box 189
Arlington Heights, IL 60006
Attn: FSA Administrators
Or fax to benetexpress at (253) 793-3766, Attn: FSA Administrators
The health care FSA can reimburse eligible expenses not covered by your basic
medical or dental plan. Examples of eligible expenses include:
• Amounts paid for deductibles, co-payments and co-insurance.
• Amounts paid for prescribed medicine.
• Laser eye surgery.
• Orthodontia services.
• Prescribed smoking cessation programs.
• Maintenance prescriptions, vision exams and eyeglasses, hearing aids,
medical and dental deductibles, co-pays and co-insurance and other services
not covered by your medical benets plan.
A more comprehensive list of eligible expenses is available at
www.MyFSAExpress.com. You can also obtain this information
from IRS Publication 502, available at www.irs.gov.
Per IRS regulations, employees cannot be enrolled in both the HSA plan and the
Health Care FSA plans concurrently. It is against current IRS regulations to be
covered under the PPO with HSA and contribute to the Health Care FSA plan.
More information can be found in IRS Publication 969.
If you terminate, only claims incurred up to the termination date will be eli-
gible for reimbursement. You may submit a paper submission at any time after
you have accumulated reimbursable expenses. All claims must be led prior
to March 31 following the end of the year in which the eligible expense was
incurred.
How to Keep Track of
Your Account Balances
Claims Appeal
Procedures
Health Care FSA
Chicago Public School Benets Handbook 51
To participate in the health care FSA, you must contribute a minimum of
$25 and up to a maximum of $2,850 per calendar year.
The annual pledge amount will be divided equally among the remaining pay-
checks for the calendar year. For employees with 20 pay periods, the deduction
amount will adjust after the summer months since no paychecks are generated
during the break.
Historically, FSA users would forfeit any unused FSA funds at the end of the
plan year as a result of the use-it-or-lose-it rule. While this rule is still in place,
the FSA rollover option provides you with a measure of relief by giving you
the ability to roll over up to $55
0 of unused funds to the following plan year.
The rollover amount does not count toward the maximum allowable contribu-
tion for the following plan year.
How does it work? Here’s an Example:
• During open enrollment, you elect to contribute the maximum allowable
amount of $2,850 to your FSA.
• During the course of the plan year, you spend $2,300 on eligible healthcare
expenses, which means you have $450 remaining in your account at the end of
the plan year.
• You choose to re-enroll in the FSA and expect to incur additional medical
expenses in the coming year so you once again elect to contribute the
maximum allowable amount of $2,850.
• Thanks to the FSA rollover option, the $450 of unused funds from your
previous year’s account is added to your current year account.
• You now have $3,200 available for qualied healthcare expenses for the
current year.
What are the benets of the FSA rollover option?
• Minimizes your risk of forfeiting unused FSA funds at the end of the plan year.
• You no longer have to precisely predict your out-of-pocket healthcare expenses
for the coming year in an effort to choose the “right” FSA election amount
during open enrollment.
• Gives you more exibility to pay for eligible healthcare expenses as they arise,
rather than rushing to spend all unused FSA funds at the end of the plan year.
What is an FSA
rollover?
Minimum/Maximum
Contributions to the
Health Care FSA
Chicago Public School Benets Handbook 52
The dependent care FSA can reimburse you for certain expenses you pay so you
can work. Some examples of eligible dependent care expenses include:
• Day care for your eligible children or adult dependent.
• Babysitters for your eligible child while you work, in or out of your home.
• Housekeepers who primarily care for your eligible child or adult dependent.
• Fees for a licensed elder day care center for an adult dependent.
• Fees for a child care center or nursery school for an eligible child.
• Summer day camp for your qualifying child under age 13.
Expenses for the following dependents may be eligible for reimbursement:
• A child under age 13 in your custody whom you claim as a dependent
on your tax return
• A legal spouse, as dened under federal law, who is physically or mentally
incapable of self-care
• A dependent who lives with you – such as a child age 13 or older, parent,
sibling, in-law or a legal spouse who does not meet the federal law denition
of “spouse” who is physically or mentally incapable of self-care, and whom
you claim as a dependent
• If care is provided outside of your home for a spouse or dependent age 13 or
older, either of whom is incapable of self-care, the spouse or dependent must
live in your home at least eight hours per day.
How long do I have to use my dependent care exible spending account?
As an active employee, you may use the dependent care FSA funds up through
the last day of the calendar year. You may submit a paper submission at any time
after you have accumulated reimbursable expenses. All claims must be led prior
to March 31 following the end of the year in which the eligible expense was
incurred.
If you terminate, only claims incurred up to the termination date will be
eligible for reimbursement. You may submit a paper submission at any time
after you have accumulated reimbursable expenses. All claims must be led
prior to March 31 following the end of the year in which the eligible expense
was incurred.
Dependent Care FSA
Chicago Public School Benets Handbook 53
To participate in the Dependent Care FSA, you must contribute a minimum
of $25 annually. IRS rules limit the amount of money you can put in a dependent
care FSA each calendar year. You may contribute up to the lesser of:
• $5,000 per plan year ($2,500 if you are married and ling a separate
income tax return)
• Your total earned income
• Your spouse’s total earned income (you may not contribute to the dependent
care FSA if your spouse’s earned income is $0 and your spouse is capable
of self-care or is not a full-time student).
Please note that the maximum amount that you can contribute to the dependent
care FSA is the same whether you have one or more than one eligible
dependents. If you choose to have eligible dependent care services reimbursed
by your FSA, they cannot be claimed for a dependent care tax credit on your
federal income tax return. Depending on your family’s total annual income,
a dependent care FSA may save you more. You should consult with a tax advisor
to see which option is best for you.
Refer to IRS Publication 503, available at www.irs.gov for more information.
The annual pledge amount will be divided equally among the remaining pay-
checks for the calendar year. For employees with 20 pay periods, the deduction
amount will adjust after the summer months since no paychecks are generated
during the break.
Minimum/Maximum
Contributions to the
Dependent Care FSA
Chicago Public School Benets Handbook 55
403(b) and 457 Programs
The district’s retirement program was established under Section 403(b) and
457 of the Internal Revenue Service Code. They are exclusive to employees
of tax-exempt organizations such as public schools. Millions of Americans take
advantage of these savings programs every year, as there are few today that
defer income taxes.
It is up to you what percentage of your gross annual earnings you wish to
contribute pre-tax into your retirement account. Both the 403(b) and 457 tax-
deferred compensation programs can be tailored to meet your investment objec-
tives. Participants choose their investment plans from AIG.
Non-union and union-represented employees may enroll with AIG.
Supplemental Retirement
Differences between 403(b) and 457 Plans
403(b) 457 Plan
When you can begin taking
distributions without penalty
Age 59½ Whenever you retire or whenever your
employment with CPS ends, regardless
of age.
Penalty for early withdrawals
10 percent penalty on the sum in addition to the
income tax you will pay on the disbursement.
You may not withdraw funds prior to
ending your employment with CPS.
Age at which you must begin
taking distributions
Age 70½ Age 70½
Taxation
Disbursements are subject to income tax. Disbursements are subject to income tax.
Minimum payroll deduction to
start account
$10 per pay period $10 per pay period
Contribution limits if you are
under age 50
$20,500 for 2022 $20,500 for 2022
Contribution limits if you are
over age 50
Additional “catch-up” contribution of $6,500
is permitted, for a total limit of $27,000. In
addition, if you have at least 15 years of service
with CPS, you may be eligible to contribute up
to an additional $3,000 of pensionable earnings
each year. Please check with AIG, the record
keeper and fund provider, to determine
eligibility.
Additional “catch-up” contribution of $6,500
is permitted, for a total limit of $25,000
Chicago Public School Benets Handbook 56
As of July 1, 2004, CPS contributes, on behalf of eligible retirees, the value
of their eligible unused sick pay to the 403(b) Plan. The contribution of a retired
employee who is currently enrolled in the 403(b) Tax-Deferred Compensation
Program shall be made to the Program Service Provider(s) to which the partici-
pant most recently allocated his/her salary reduction agreement.
The contribution of a retired employee who is currently enrolled in the 403(b)
Tax-Deferred Compensation Program shall be made to the Program Service
Provider(s) to which the participant most recently allocated his/her salary
reduction agreement.
A letter will be sent to the participant stating the amount that represents the
participant’s available unused sick days, as of the date of retirement.
The unused sick day contribution will be sent within 60 days from the date
of this letter.
The contribution of a retired employee who is not currently enrolled in the
403(b) Tax-Deferred Compensation Program will be sent a letter notifying him/
her of the retired employee’s eligibility to receive a contribution.
The letter represents the amount of the participant’s available unused sick days,
as of the date of retirement and will be sent within 60 days from the date of
this letter.
The maximum contribution is $80,000.
I
f a retired employee has more than $80,000 in accumulated sick pay, the excess
will be paid directly to the retired employee.
The maximum annual contribution limit is $61,000. If the retired employee is
currently contributing to a 403(b) plan, the amount will be subtracted from the
$61,000.
Contribution for
a Participant
Currently Enrolled
Unused Sick
Day/403(b)
Contribution:
Contribution for
a Participant Not
Currently Enrolled
Contribution Amount
a)
b)
c)
a)
b)
a)
b)
c)
Chicago Public School Benets Handbook 57
Bright Start College Savings
Oppenheimer Funds offers parents an easy and convenient way to start their
children’s college funds through payroll deductions. For more information and
enrollment instructions call (800) 655-4853 or visit www.brightstartsavings.com.
Chicago Public School Benets Handbook 59
Benets Billing allows employees who are temporarily off the payroll, on an ap-
proved Leave of Absence (LOA), to continue to make their medical contribution
directly to the Health and Benets Team via the Benets Billing vendor.
COBRA allows employees who have been terminated or whose hours have been
reduced to continue their medical plan coverage by paying the full premium plus
a 2% administrative fee. The full premium is the monthly amount that the Board
pays for health insurance plus the employee’s contribution.
The Board contributes a major portion of the cost of medical and dental coverage
for eligible employees. Your share of the cost is deducted from your paycheck on
a pre-tax basis, according to Sections 105, 106 and 125 of the Internal Revenue
Service Code. The Benets Billing program allows employees who are tempo-
rarily off the payroll on an approved LOA to continue to make their contributions
directly to the benets billing lockbox.
The Absence and Disability Department will send you a notice and billing state-
ment if you are eligible for Benets Billing. Your period of eligibility will be
determined by the Absence and Disability Department. If you receive a paycheck
and your deduction for medical coverage was not taken, you will be billed for
each pay period you miss.
While you are enrolled in the Benets Billing program, your contributions are
based on a monthly premium amount. The amount of your contribution will be
indicated on each coupon or billing statement.
You will be sent benet billing statements with the due date indicated on each
statement. Payments must be made directly to the benets billing lockbox
address indicated on your benet billing statement. Payment must be in the form
of a Check or Money Order. Cash will not be accepted. You must submit your
coupon with your check or money order.
Maintaining Benets During
a Leave of Absence
Benets Billing provides eligible employees with ways to sustain health
benets coverage if they go on a leave of absence or experience another
interruption in work.
Benets Billing
Cost
Billing Process
Chicago Public School Benets Handbook 60
Your payment due date is indicated on each coupon. In accordance with the
Family and Medical Leave Act, you have an additional 16-day Grace Period. If
you do not pay your Benets Billing contributions by the due date, your cover-
age may be terminated until your balance has been paid in full. A notice will also
be sent to your provider.
If you pay with a check that is returned for Non-Sufcient Funds (NSF) or can
otherwise not be processed, your account will be treated as though you failed to
make payment and all the rules of non-payment will apply. In accordance with
current CPS policy, you will be charged a $34 service fee. You will be required
to replace the check with a Money Order or a Certied Check. If you fail to re-
place a bad check by the end of the grace period, you will be responsible to your
provider for any health claims and expenses incurred during that period and your
coverage will be terminated.
When you return to work you must pay your Benets Billing account in full if
you want your benets to be reinstated. If you cannot pay your balance in full
you can request a Wage Authorization form so that bi-weekly deductions can be
withdrawn from your paycheck until you satisfy your balance.
If there are any pay periods for which your account is more than 30 days past
due, you will be responsible for any health claims and expenses incurred dur-
ing those periods. Your provider will be notied and directed to bill you for any
expenses incurred for any periods for which you have not made payment.
You will have all the same health plans, at the same coverage level (Single, Em-
ployee +1 or Family), that you had the pay period prior to your LOA. Your eli-
gible family members will continue coverage while you are under this program.
The maximum period for continued medical is based on the Chicago Board of
Education Rules or your Collective Bargaining Agreement.
You may add a spouse or dependents if you have a change in Family Status as
outlined in the Chicago Board Of Education Pre-Tax Contribution Plan (Internal
Revenue Code Section 125) or during Open Enrollment. You may change your
provider during Open Enrollment, subject to Open Enrollment rules.
You will receive an email notication from the Absence and Disability Depart-
ment once you have been cleared to return to work. Once reinstated, you will
be removed from Benet Billing effective the rst of the following month.
NSF Payments
Outstanding Payments
Coverage
Coverage and Changes
Return to Work
Grace Period
Chicago Public School Benets Handbook 61
How to reinstate benets upon return to work:
1) Reach out to the Health and Benets team at healthandbene[email protected] to
notify Health and Benets of your return to work date.
2) Complete the Benets Enrollment/Reinstatement form (provided to you by
the Health and Benets department).
3) Submit the Benets Enrollment/Reinstatement form to the Health and
Benets Department.
To submit your documentation via fax or scan, you will need to access your
personalized Scanning Cover Sheet by navigating to CPS.edu/Staff then click
on the link for HR4U. Fill it out and submit it with your documents either by
fax to 773-553-4DOC or by scan to bene[email protected].
4) Your benets effective date is the rst of the month following your return to
work date.
JPMorgan Chase
Attn: CPS Benets Billing
28541 Network Place
Chicago, IL 60673-1285
Benets Billing
Address
Chicago Public School Benets Handbook 62
Qualifying Event
(reason coverage ended)
Who May Continue Maximum Coverage Period
Your termination or layoff. You, spouse and dependents 18 months*.
Your hours are reduced resulting in
loss of coverage.
You, spouse and dependents 18 months*
You divorce or legally separate. Spouse and dependents 36 months
Your dependents are no longer eligible
when they reach the limiting age.
Dependents 36 months
You drop out of the plan because you
choose Medicare as primary coverage.
Non-Medicare eligible spouse and
dependents
36 months
You die. Spouse and dependents 36 months
* If you or a dependent is disabled at the time of the qualifying event,
coverage may be continued for up to a total of 29 months.
COBRA
CPS offers you and your covered family members an opportunity to
continue medical, dental and vision coverage after your employment with
CPS ends. In accordance with the Public Health Service Act (PHSA),
commonly known as COBRA, when coverage is lost due to termination of
employment (except for gross misconduct) or a reduction in work hours,
you and your covered family members are eligible to continue coverage
under PHSA. If you are not enrolled in a medical or dental plan on the day
your employment terminates or your work hours are reduced, you do not
have a right to elect coverage under PHSA.
PHSA also provides for continuation of medical, dental and vision
coverage for a covered spouse due to:
• Death
• Divorce
• Legal separation
PHSA provides continuation coverage for a dependent who loses coverage
because he/she is no longer eligible under rules of the plan. COBRA is
administered by Payex, which may be reached at (800) 359-3921.
In accordance with the Public Health Service Act, when coverage under the
Medical Plan ends, you and your covered dependents may be eligible to continue
your medical benets at your own expense for a temporary period. T
o be
eligible, a “qualifying event” causing the loss of coverage must occur. The
following chart shows who is eligible to continue coverage under the plan
and how long coverage may continue.
Chicago Public School Benets Handbook 63
What Happens to my Benets if I Terminate?
Medical
Your coverage ends on the last day of the month in which you terminate
Dental
Your coverage ends on the last day of the month in which you terminate.
Vision
Your coverage ends on the last day of the month in which you terminate.
Flexible Spending
Account (FSA)
You may incur claims up to the last day worked. You have until March 31 of the
next year to be reimbursed for claims incurred in the previous year.
Health Savings Account
(HSA)
You may use your available funds.
Short-Term Disability
Your coverage ends the same day as your last day worked.
Long-Term Disability
Your coverage ends the same day as your last day worked.
Life Insurance (Employ-
ee and Dependents)
Your coverage ends the same day as your last day worked.
Supplemental Retirement
Plans 403(b) or 457
Voluntary payroll contributions will end on the last paycheck containing the
last day worked. Contact your vendor for information about transactions.
Chicago Public School Benets Handbook 65
Family and Medical Leave Act
Employee Rights and Responsibilities
FMLA requires covered employers to provide up to 12 weeks of unpaid,
job-protected leave to eligible employees for the following reasons:
• For incapacity due to pregnancy, prenatal medical care or childbirth
• To care for the employee’s child after birth, or placement
for adoption or foster care
• To care for the employee’s spouse, son, daughter or parent,
who has a serious health condition
• For a serious health condition that makes the employee unable
to perform the employee’s job
Eligible employees whose spouse, son, daughter or parent is on covered active
duty or called to covered active duty status may use their 12-week leave entitle-
ment to address certain qualifying exigencies. Qualifying exigencies may include
attending certain military events, arranging for alternative childcare, addressing
certain nancial and legal arrangements, attending certain counseling sessions, and
attending post-deployment reintegration briengs. FMLA also includes a special
leave entitlement that permits eligible employees to take up to 26 weeks of leave
to care for a covered service member during a single 12-month period.
A current member of the armed forces, including a member of the national guard
or reserves, who is undergoing medical treatment, recuperation or therapy, is other-
wise in outpatient status, or is otherwise on the temporary disability retired list, for
a serious injury or illness*; or
A veteran who was discharged or released under conditions other than dishonorable
at any time during the ve-year period prior to the rst date the eligible employee
takes FMLA leave to care for the covered veteran, and who is undergoing medical
treatment, recuperation, or therapy for a serious injury or illness.*
*The FMLA denitions of “serious injury or illness” for current service members and veter-
ans are distinct from the FMLA denition of “serious health condition.”
During FMLA leave, the employer must maintain the employee’s health cover-
age under any group health plan on the same terms as if the employee had
continued to work. Upon return from FMLA leave, most employees must be
restored to their original or equivalent positions with equivalent pay, benets
and other employment terms. Use of FMLA leave cannot result in the loss of
any employment benet that accrued prior to the start of an employee’s leave.
Basic Leave Entitlement
Military Family Leave
Entitlements
A Covered Service
Member is:
Benets and Protections
1.
2.
Chicago Public School Benets Handbook 66
Eligibility Requirements
Denition of Serious
Health Condition
Use of Leave
Substitution of Paid
Leave for Unpaid Leave
Employee
Responsibilities
Employees are eligible if they have worked for a covered employer for at least
12 months, have 1,250 hours of service in the previous 12 months*, and if at least
50 employees are employed by the employer within 75 miles.
*Special hours of service eligibility requirements apply to school-based employees.
A serious health condition is an illness, injury, impairment, or physical or mental
condition that involves either an overnight stay in a medical care facility, or con-
tinuing treatment by a health care provider for a condition that either prevents the
employee from performing the functions of the employee’s job, or prevents the
qualied family member from participating in school or other daily activities.
Subject to certain conditions, the continuing treatment requirement may be met
by a period of incapacity of more than three consecutive calendar days combined
with at least two visits to a health care provider or one visit and a regimen of con-
tinuing treatment, or incapacity due to pregnancy, or incapacity due to a chronic
condition. Other conditions may meet the denition of continuing treatment.
An employee does not need to use this leave entitlement in one block. Leave can
be taken intermittently or on a reduced leave schedule when medically necessary.
Employees must make reasonable efforts to schedule leave for planned medi-
cal treatment so as not to unduly disrupt the employer’s operations. Leave due to
qualifying exigencies may also be taken on an intermittent basis.
Employers may require use of accrued paid leave while taking FMLA leave. In
order to use paid leave for FMLA leave, employees must comply with the em-
ployer’s normal paid leave policies.
Employees must provide 30 days’ advance notice of the need to take FMLA leave
when the need is foreseeable. When 30 days’ notice is not possible, the employee
must provide notice as soon as practicable and generally must comply with an em-
ployer’s normal call-in procedures. Employees must provide sufcient informa-
tion for the employer to determine if the leave may qualify for FMLA protection
and the anticipated timing and duration of the leave. Sufcient information may
include that the employee is unable to perform job functions, the family member
is unable to perform daily activities, the need for hospitalization or continuing
treatment by a health care provider, or circumstances supporting the need for mili-
tary family leave.
Employees also must inform the employer if the requested leave is for a reason
for which FMLA leave was previously taken or certied. Employees also may
be required to provide a certication and periodic recertication supporting the
need for leave.
Chicago Public School Benets Handbook 67
Covered employers must inform employees requesting leave whether they are
eligible under FMLA. If they are, the notice must specify any additional informa-
tion required as well as the employees’ rights and responsibilities. If they are not
eligible, the employer must provide a reason for the ineligibility.
Covered employers must inform employees if leave will be designated as FMLA
protected and the amount of leave counted against the employee’s leave entitle-
ment. If the employer determines that the leave is not FMLA-protected, the
employer must notify the employee.
FMLA makes it unlawful for any employer to:
• Interfere with, restrain, or deny the exercise of any right provided under
FMLA; and
• Discharge or discriminate against any person for opposing any practice
made unlawful by FMLA or for involvement in any proceeding under or
relating to FMLA.
Paid Parental leave offers 10 consecutive paid days to an FMLA eligible employee
who is the non-birth parent to care for a child after the child’s birth or adoption by
the employee, the spouse, civil union or domestic partner of the employee. An eli-
gible employee is any regular full-time employee who works for Chicago Public
Schools for at least 12 months before taking the leave and has worked 1250 hours
in a rolling 12-month period. Employee must be eligible to take an FMLA leave
in order to qualify for this leave.
• An employee can receive 100% of base pay for up to ten (10) consecutive
work days.
• Paid parental leave runs concurrently with any unpaid FMLA leave and will
be administered in conjunction with the Family Medical Leave Act of 1993.
• Parental leave must be taken within 1 year of the child’s birth or adoption and
cannot be taken more than one (1) time in a rolling 12-month period.
An employee may le a complaint with the U.S. Department of Labor or may
bring a private lawsuit against an employer. FMLA does not affect any Federal
or State law prohibiting discrimination, or supersede any State or local law or
collective bargaining agreement which provides greater family or medical
leave rights.
FMLA section 109 (29 U.S.C. § 2619) requires FMLA covered employers to post the
text of this notice. Regulation 29 C.F.R. § 825.300(a) may require additional disclosures.
For additional information:
Call: (866) 4US-WAGE (866) 487-9243
TTY: (877) 889-5627
WWW.WAGEHOUR.DOL.GOV
U.S. Department of Labor Wage and Hour Division
WHD Publication 1420 · Revised February 2013
Employer
Responsibilities
Unlawful Acts
by Employers
Parental Leave
Enforcement
Chicago Public School Benets Handbook 68
Right of Recovery
If the plan provides benets for injury, illness, medical care or other loss to any
person, the plan is entitled to claim its share of any present and future compensa-
tion that person, his parents, heirs, guardians, executors or other representatives
(individually and collectively called the “participant”) may receive as a result of the
injury or loss.
Those subrogation rights include, without limitation, all rights to recovery a
participant has:
• Against any person, insurance company or other entity that is in any way
responsible for providing or does provide damages, compensation,
indemnication or benets for the injury
• Under any law or policy of insurance or accident benet plan providing no
fault, personal injury protection or nancial responsibility insurance
• Under uninsured or underinsured motorist insurance
• Under motor vehicle medical reimbursement insurance
• Under specic risk or group accident and health coverage or insurance,
including, without limitation, premises or homeowners medical reimbursement,
athletic team, school or workers’ compensation coverage or insurance.
Upon notice of an injury claim, the plan may assert a subrogation lien to the
extent it has provided, or may be required to provide, injury-related benets.
Notice of either the plan’s right of subrogation or the plan’s subrogation lien is
sufcient to establish the plan’s rights of subrogation and entitlement to claim
reimbursement from insurers, third parties, or other persons or entities against
whom a participant may have an injury-related right of recovery. The plan shall
not be required to intervene in any litigation in order to enforce its subrogation
rights. The plan is authorized, but not required, to institute legal action in its
name and/or in the name of the participant in order to enforce the plan’s subro-
gation rights.
The participant and anyone acting on his behalf shall promptly provide the plan
or its authorized agents with information to protect its rights of subrogation
and shall do nothing to impede enforcement of those rights. The amount of the
plan’s subrogation claim shall be deducted rst from any recovery by or on be-
half of the participant. Neither a participant nor his attorney or other represen-
tative is authorized to accept subrogation or other injury-related reimbursement
payments on behalf of the plan, to negotiate or compromise the plan’s subroga-
tion claim, or to release any right of recovery prior to the payment of the plan’s
subrogation claim.
Subrogation
Chicago Public School Benets Handbook 69
The participant and all other parties to a recovery are required to contact the plan
to determine, and arrange to pay, the plan’s subrogation claim at or prior to the
time an injury-related payment or settlement is made to or for the benet of the
participant. If the participant obtains a payment or settlement is made to or for the
benet of the participant.
If the participant obtains a payment or settlement from a party without the plan’s
knowledge and agreement, the plan shall be entitled to immediate reimbursement
of its total subrogation claim from the participant or any party providing any
injury-related payment. In addition, the plan may deny payment of benets to or
on behalf of the participant or any otherwise eligible member of the participant’s
family for any otherwise-covered claim until the amount of the unpaid coverage
is equal to and offset by the unrecovered amount of the plan’s subrogation claim.
The plan administrator or its authorized agents are vested with full authority
to construe subrogation and other plan terms and to reduce or compromise
the amount of the plan’s recoverable interest where warranted, in the sole
discretion of the plan administrator or its authorized agents. The plan shall not
be responsible for any litigation-related expenses or attorney fees incurred by
or on behalf of a participant in connection with an injury claim unless the plan
specically agrees in writing to pay such expenses or fees.
The payment of benets to or on behalf of the participant is contingent
on both the participant’s full compliance with the plan’s provisions,
including the subrogation provision, and, when the plan deems appropriate,
the participant’s signing of a reimbursement agreement. However, the
participant’s failure to sign this reimbursement agreement will not affect the
plan’s subrogation rights or its right to assert a lien against any source of
possible recovery and to collect the amount of its subrogation claim.
Right of Recovery (cont.)
Chicago Public School Benets Handbook 70
CPS employees who can assist you in understanding your benets
Board of Education of the City of Chicago
A partner of a CPS employee with whom the employee has entered into a
relationship that is identied by a certied civil union certicate duly recognized by
the state in which the certicate was granted
BlueCross and BlueShield of Illinois
After you meet the annual deductible, where it applies, the plan will pay
a percentage of covered expenses; you pay the remaining portion. Your share
is called your co-insurance.
You will be required to pay a small fee each time certain services are received. This
co-payment, which is not part of your deductible, may vary, depending upon the type
of service received
An organized skilled patient care program in which care is provided in the home.
Care may be provided by a hospital’s licensed home health department or by other
licensed home health agencies. You must be unable to leave the home without assis-
tance and require supportive devices or special transportation and you must require
skilled nursing service on an occasional basis under the direction of your doctor to
qualify for coordinated home care. The program includes skilled nursing service by
a registered professional nurse, the services of physical, occupational and speech
therapists, hospital labs and necessary medical supplies.
A service or supply for which benets will be paid.
Glossary
The following phrases are used throughout this Handbook. Some of them
are general terms that have specic meaning in the language of benets.
Health and Benets
Team
Board
Co-Insurance
Civil Union Partner
Co-Pay
Claims Administrator
Coordinated Home
Care Program
Covered Service
Chicago Public School Benets Handbook 71
CPS
CTU
Deductibles
A Certied Registered Nurse Anesthetist who:
• Is a graduate of an approved school of nursing and is licensed as a registered
nurse
• Is a graduate of an approved program of nurse anesthesia accredited by the
council of accreditation of nurse anesthesia education programs/schools
• Has been certied by the council of certication of nurse anesthetists
• Is recertied every two years by the council on recertication of nurse
anesthetists.
Care that is provided at a nursing facility or at home when a patient’s condition is
such that further progress is not expected and medical treatment is not provided.
Custodial care is mainly provided to help the patient with daily living activities,
such as walking, bathing, dressing, eating with a spoon, tube or gastrostomy.
Custodial care also includes care that could be provided safely and reasonably
by a person who is not medically skilled.
Chicago Public Schools. All persons employed at Chicago Public Schools are
employees of the Board.
Chicago Teachers Union
The deductible, where it applies, is the portion of your medical expenses that
you pay each year before the plan pays benets. If you and one dependent are
covered by the plan, each of you must meet the individual deductible. If you have
family coverage, three members of the family must satisfy the deductible.
In addition, if two or more members of your family obtain covered services as
a result of injuries suffered in the same accident, expenses for those services will
be applied to only one deductible.
A change in an employee’s personal situation that permits her/him to make
a change in medical and dental coverage outside of Open Enrollment, provided
that the Health and Benets Team is notied promptly, as specied
in this Handbook. Additional information regarding Family Status Change
is available in the “Eligibility” section of this handbook.
CRNA
Custodial Care
Family Status Change
Chicago Public School Benets Handbook 72
Emergency
Accident Care
Emergency
Medical Care
Inpatient
Investigational
The initial outpatient treatment of accidental injuries, including related
diagnostic service, which have severe symptoms. If immediate medical attention
is not obtained, the injury could result in serious and permanent medical
consequences. Examples of such injuries include fractures and concussions.
The initial outpatient treatment of accidental injuries, including related diagnostic
service, of the sudden and unexpected onset of a medical condition that has severe
symptoms. If immediate medical attention is not obtained, the symptoms could
result in serious and permanent medical consequences. Examples of such
symptoms are severe chest pains, convulsions or persistent, severe abdominal pains.
A registered bed patient treated as such in a hospital, skilled nursing facility or
hospice unit.
Procedures, drugs, devices, services and/or supplies that:
• Are provided or performed in special settings for research purposes or under
a controlled environment and that are being studied for safety, efciency
and effectiveness;
• Are awaiting endorsement by the appropriate national medical specialty col-
lege or federal government agency for general use by the medical community
at the time they are provided to you; and
• Specically with regard to drugs, combination of drugs and/or devices, are
not nally approved by the federal drug administration at the time used or
administered to you.
The Claims Administrator will initially determine if a service or supply is
medically necessary. The plan will not pay for the cost of hospital stays or any
other health care services or supplies that are not medically necessary. The
judgment of the Claims Administrator relates only to benet coverage under this
plan. You should not use the availability of benet coverage to determine what
medical care or treatment you or your dependents decide to receive.
Chicago Public School Benets Handbook 73
A period that occurs once per year, normally during fall, when eligible
employees choose whether and how they will participate in the various benets
plans being offered for the following year; they also may add or drop covered
dependents and coverage. Absent a qualifying family status change as described
in this Handbook, Open Enrollment is the only time when employees are
permitted to change their benet elections, and the elections may be subject to
certain additional conditions or approvals. Elections that are approved that are
made during Open Enrollment become effective the following Jan. 1.
PPO plans cap the amount of money you will have to pay for eligible medical
expenses incurred each year. Once you reach the out-of-pocket maximum via the
deductible and your share of expenses for covered services, the PPO plans will
pay 100% of eligible in-network medical expenses for the rest of the calendar
year. Expenses incurred out-of-network do not count toward the out-of-pocket
maximum. You will continue to pay a percentage of covered expenses.
The following expenses cannot be applied to the out-of-pocket maximum and
will not be paid at 100% once the out-of-pocket maximum is reached:
• Charges that are greater than the eligible charge or maximum allowance
• Charges for covered services that have a separate dollar maximum
• Co-payments that result when you do not follow the provisions of the
pre-treatment review program
• Prescription drug co-payments
• Vision care co-payments
• Ofce visit co-payments
If you and one dependent are covered by the plan, each of you must meet the
individual out-of-pocket maximum. If you have family PPO coverage, two
individuals must each meet the out-of-pocket maximum.
The period from Jan. 1 up to and including Dec. 31 of each year.
Drugs or medicines that require a doctor’s signature to dispense and are
approved by the U.S. Federal Drug Administration for use in treating the
sickness or injury for which they are prescribed.
A licensed institution (other than a hospital) that specializes in inpatient physical
rehabilitation, skilled nursing or medical care. The skilled nursing facility must:
• Maintain all facilities necessary for medical treatment
• Provide treatment under the supervision of doctors
• Provide nursing services 24 hours every day
• Maintain daily clinical records on all patients.
NOTE: A skilled nursing facility does not include any institution or part of
an institution that is used primarily for educational care, custodial care, or
for the care and treatment of drug addiction or alcoholism.
Open Enrollment
Plan Year
Out-of-Pocket
Maximum
Prescription Drugs
Skilled Nursing Facility
Chicago Public School Benets Handbook 74
Before you submit, complete your personalized benets documentation cover
sheet, available by logging into CPS.edu/Staff then click on the link for HR4U
(see sample on next page). This cover sheet is required to certify your documents
and process your benets elections.
There are four ways to submit your documents and required personalized
cover sheet.
By scan to bene[email protected]
By fax to (773) 553-4DOC (4362)
By drop box located on the main oor of the Benets Ofce at
2651 W. Washington Blvd., near the security station, Monday-Friday
from 8 a.m. to 5 p.m.
By mail to Health and Benets, 2651 W. Washington, Chicago, IL. 60612
Note: Drop box submissions must contain original certied documents.
Originals will be mailed back to your address on le. Your elections cannot be
processed without your personalized benets documentation cover sheet.
For new hires, documentation must be submitted within 31 days of your hire
date to complete processing.
Authenticating and Submitting
Enrollment Documents
Chicago Public School Benets Handbook 75
Sample of the Benet Documentation
Cover Sheet
Chicago Public Schools Benefits Guide 2017 34
This is only an example of the personalized
Benet Documentation Cover Sheet
Sample Benet Documentation Cover Sheet
This is only a sample of the personalized
Benet Documentation Cover Sheet
Chicago Public School Benets Handbook 76
Vendor Contacts
The Health and Benets Team is your primary resource for benets questions. If
you have questions about claims, doctors, or hospital locations, you may contact
one of our providers.
Provider/Group Number Phone Number Address Website
BlueCross BlueShield
BlueAdvantage HMO
(Medical) B12709
(866) 248-3092 P.O.Box 1364
Chicago, IL 60690
www.bcbsil.com/members
BlueCross BlueShield
PPO (Medical)
P12709
(800) 331-8032 P.O.Box 2352
Chicago, IL 60690
www.bcbsil.com/members
BlueCross BlueShield PPO
with HSA (Medical)
191904
(800) 331-8032 P.O.Box 2352
Chicago, IL 60690
www.bcbsil.com/members
Delta Dental HMO/PPO
(Dental)
10083
(800) 323-1743 P.O.Box 5402
Lisle, IL 60532-5402
www.deltadentalil.com
Caremark (Prescription Carrier)
CPSRX
(866) 409-8523 P.O.Box 686005
SanAntonio, TX 78268-6005
www.caremark.com
EyeMed Vision Care
(Vision Plan)
Insight
(855) 347-6900 4000 Luxottica Place
Mason, Ohio 45040
www.eyemed.com
The Standard
(Optional Life Insurance,
Accidental Death & Dismember-
ment, Beneciary Designations,
Evidence of Insurability Status,
Accident Insurance, Critical
Illness, Long Term Disability)
(833) 960-1238 http://standard.com/
Magellan
(Employee Assistance Program)
(800) 424-4776 www.magellanascend.com
Benetexpress
(Flexible Spending Accounts)
(877) 837-5017 220 W. Campus Dr. Suite 203
Arlington Heights, IL 60004
www.CPSFSA.com
BrightStart
(College Savings Program)
(800) 655-4853 www.brightstartsavings.com
AIG
(800) 448-2542 500 W Madison, Suite 2850
Chicago, IL 60606
www.valic.com/CPS
HSA Bank (Health Savings
Account)
(855) 731-5220 605 N. 8th St. Ste 320
Sheboygan, WI 53081
https://hcsc.hsabank.com
