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State Insurance Program

Total Retiree Advantage IL (TRAIL)

State Employees' Group Insurance Program (SEGIP)

Welcome to Your TRAIL MAPD

Initial Enrollment Period

The State of Illinois offers retirees, annuitants, and survivors a healthcare program called Total Retiree Advantage Illinois (TRAIL).  This program provides Medicare-eligible members and their covered dependents comprehensive medical and prescription drug coverage through TRAIL Medicare Advantage Prescription Drug (commonly referred to as an “MAPD”) plan.  The program includes vision coverage, optional dental coverage, and life insurance coverage.

All newly-eligible participants, who elect to enroll in the TRAIL MAPD Program will be enrolled in the Aetna Medicare Advantage Prescription Drug (MAPD) PPO Plan. 

To be eligible for coverage under the Total Retiree Advantage Illinois MAPD plan, you and your eligible dependents must:

• Live in the United States or the U.S. Territories, AND

• Be retired and enrolled in Medicare Parts A and B, due to age or disability.

You Must Take Action

The TRAIL Program provides comprehensive medical and prescription drug coverage through the Aetna MAPD PPO plan, which is a Medicare-approved plan that combines the different parts of Medicare into one plan. Since Aetna MAPD PPO is a type of Medicare, you must continue to pay your federal Medicare Parts A and B premiums in order to enroll and remain enrolled in TRAIL MAPD.

As a newly-eligible participant in the TRAIL MAPD Program, you:

• MUST enroll in the TRAIL MAPD health plan during your enrollment period, via MyBenefits.illinois.gov or by calling the MyBenefits Service Center (toll-free) 844-251-1777. Due to your Medicare-eligibility, you cannot keep your current State of Illinois health plan.

• Will have your medical and prescription drug claims processed by the TRAIL MAPD health plan instead of Original Medicare and your current State plan once your TRAIL MAPD enrollment becomes effective.

May waive State coverage. Waiving coverage will terminate your medical, prescription, and vision coverage. Your current dental coverage (if enrolled) and life insurance coverage will remain in effect. Members electing to waive coverage may cancel their dental coverage only during your TRAIL MAPD Enrollment Period.

• Will only have one ID card to show at your doctor visits and when picking up your prescriptions.

For more complete benefit information regarding TRAIL and the health plan benefits with your new Aetna MAPD PPO plan, please review your:

2023 SEGIP TRAIL Initial Enrollment Guide (for Newly-eligible TRAIL Members)

2023 SEGIP Plan Detail

2023 SEGIP No Cost Benefits

2023 SEGIP Less than 20 Contributions

2023 SEGIP Plan Administrator contacts

2023 TRAIL Rx FAQs 

Important Information about TRAIL

• TRAIL MAPD is a retiree healthcare program sponsored by the State of Illinois.  The plan offered through the TRAIL Program is a Medicare Advantage plan which includes prescription drug coverage. As a State of Illinois retiree, annuitant, or survivor, who is newly-eligible for enrollment in the TRAIL MAPD health plan, this is your opportunity to enroll in the Aetna MAPD PPO Plan.  If you do not want TRAIL MAPD coverage or do not enroll in the MAPD plan, you will be waived from the State’s coverage.  If you waive coverage, you will lose medical, prescription drug and vision coverage. Waiving TRAIL MAPD coverage does not allow you to stay in your current State health plan.

• The TRAIL MAPD health plan is offered by Aetna. Medicare pays a fixed amount for your care each month to Aetna.  When you enroll in a Medicare Advantage Prescription Drug (MAPD) plan, you are no longer in Original Medicare, but still have the same covered services and the same rights and protections as people with Original Medicare.

• The TRAIL MAPD health plan provides all of your Part A (hospital) and Part B (doctor and outpatient) benefits, including emergency and urgent care, and Medicare Part D (prescription drug) coverage.

• You must keep Medicare Parts A and B and continue to pay the applicable Medicare premiums, including applicable IRMAA (Income Related Monthly Adjustment Amount) surcharges.

• If the member's and/or dependent's Medicare Beneficiary Identifier (MBI) number is not on file, it must be provided during your enrollment. Please make sure you have this information available.

• If you fail to provide a copy of the Medicare card with your MBI number to the Medicare COB unit or your Retirement system, your TRAIL MAPD and State medical insurance will be waived for the dependent(s) with the missing documentation and waived for the entire household if the member's documentation is not provided.

• You can only be in one Medicare Advantage or Medicare Part D (prescription drug) plan at a time. Enrollment in the TRAIL MAPD health plan provides you with Medicare Advantage coverage as well as Medicare Part D coverage.  Therefore, enrollment in a different Medicare Advantage or Medicare Part D plan will automatically cause your TRAIL MAPD coverage to end, which will include your medical, prescription drug, and vision coverage.

• You may terminate the TRAIL MAPD coverage at any time by contacting the plan administrator in writing. You may re-enroll throughout the plan year and coverage will be effective the first of the month following your enrollment request or during your annual TRAIL MAPD Enrollment Period.

• If your residential or mailing address changes, you must notify both your retirement system and the Social Security Administration in writing as quickly as possible.

• Medicare Advantage Plans are not a Medicare Supplement plans. Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are an “all in one” alternative to Original Medicare. These "bundled" plans include Medicare Part A (Hospital Insurance) and Medicare  Part B (Medical Insurance), and in the case of your State-Sponsored TRAIL plan, Medicare prescription drug (Part D) is also included.

• Once you have enrolled in the TRAIL MAPD health plan, you will only use your red, white, and blue Medicare card for hospice care.  All other claims for your healthcare services (including prescription drugs) should be sent to your MAPD plan administrator for processing and benefit determinations.

• Medicare-eligible retirees, annuitants, and survivors who want to continue medical, prescription drug, and vision coverage through the State, are required to enroll in the TRAIL MAPD health plan if they and their covered dependents are all enrolled in Medicare Parts A and B.  Remaining in your current State health plan is not an option.  If you do not complete the online enrollment process or call the MyBenefits Service Center by your enrollment deadline, the State will assume you do not want your State of Illinois TRAIL MAPD health insurance and will terminate your medical, prescription drug, and vision coverage. If your State medical and prescription coverage is terminated, you will have only Original Medicare for your medical coverage. To obtain additional coverage you may enroll in a Part D prescription drug plan for prescription drug coverage, re-enroll in the State-Sponsored TRAIL plan throughout the plan year with coverage effective the first of the month following your enrollment request, or enroll during your next annual TRAIL MAPD Enrollment Period.  Your dental coverage, if enrolled, and life insurance coverage will remain in place.

• Plan Year deductible and Out-of-Pocket Maximums will start over with your new TRAIL MAPD Health Plan. The MAPD plans are not permitted to consider the deductible(s) you might have already paid in your other plan.  Any deductible paid to your current medical plan will not count toward your MAPD plan year deductible.  The MAPD medical deductible is separate from your dental plan deductible.  Your annual PPO deductible and dental deductible, if elected, will start again for the TRAIL MAPD Plan Year.

• Your current health plan may cover services that Original Medicare does not cover.  Medicare Advantage plans are required to cover all services covered by Original Medicare.  In order to be covered, the service must be considered medically necessary and in certain cases, meet Medicare guidelines for approval. Some services have limits to how often they can be obtained.

 

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Any Required and supporting documentation you may have, may be uploaded online, or faxed (toll-free) 844-676-1725
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