Your TRAIL Medicare Advantage
Prescription Drug (MAPD) Program
Initial Enrollment Guide
State of Illinois Group Insurance Program
State of Illinois
Department of Central Management Services
Bureau of Benefits
STATE 2023 TRAIL MAPD Plan Year
2
ONLINE ENROLLMENT PLATFORM
Making benet elecons is simple through the MyBenets website.
Follow these steps:
1. Go to MyBenets.illinois.gov.
2. In the top right corner of the home page, click Login.
3. If you are logging in for the rst me, click Register in the boom
right corner of the login box and follow the prompts. You will need
to provide your name as printed on the MAPD Inial Enrollment
materials mailed to your home.
4. Enter your login ID and password. Aer logging in and landing on
the welcome page, explore your benet opons by clicking on the
TRAIL Enrollment Informaon le.
5. Aer exploring your benet opons and determining which
benets you would like to elect, click on the MAPD enrollment
Event, located on the Welcome page.
WHAT YOU NEED TO DO
1. Go to MyBenets.illinois.gov to review your benet opons.
2. Choose the benets you’d like to elect at MyBenets.illinois.gov
by clicking on your Inial MAPD Enrollment or Medicare Eligible
Rerement event.
3. Consider going paperless. Provide, or update your email
address at MyBenets.illinois.gov to receive quick responses and
nocaons through electronic communicaons.
If you choose to enroll online, the TRAIL MAPD online enrollment
process must be completed in its enrety. As you enroll online,
follow the prompts unl the end so you will know you have
completed your coverage-elecon process. If you do not complete
the process, your elecons will not be saved. Please note, although
you may use a post oce box address to receive your mail, federal
Medicare requires a residenal street address. If your preprinted
mailing address on this mailing is dierent than your residenal
address, such as a Post Oce Box, be sure to contact your
rerement system as quickly as possible to ensure your residenal
address is on le with the system.
Need Help?
AVA, the interacve digital assistant, is available online at
MyBenets.illinois.gov
Or
Contact MyBenets Service Center (toll-free)
844-251-1777, or 844-251-1778 (TDD/TTY) with inquiries.
Representaves are available
Monday – Friday, 8:00 AM - 6:00 PM CT.
Table of Contents
Online Enrollment Plaorm ............2
Welcome to Your TRAIL MAPD
Inial Enrollment Period ..............3
Understanding Your Plan ..............4
Important Informaon
About TRAIL.........................4
Health Plan Details ...................7
No-Cost Extras .......................8
Member Health Plan Contribuons .....9
Dependent Health Plan Contribuons ..10
Life Insurance Contribuons ..........10
Vision Coverage ....................11
Dental Contribuons ................11
Prescripon Drug Coverage ...........12
Plan Administrators .................14
MyBenets.illinois.gov
STATE 3
Welcome to Your TRAIL MAPD
Initial Enrollment Period
The State of Illinois oers rerees, annuitants, and survivors a healthcare program called Total Reree Advantage
Illinois (TRAIL). This program provides Medicare-eligible members and their covered dependents comprehensive
medical and prescripon drug coverage through TRAIL Medicare Advantage Prescripon Drug (commonly referred
to as an “MAPD”) plan. The program includes vision coverage, oponal dental coverage, and life insurance
coverage.
All newly-eligible parcipants, who elect to enroll in the TRAIL MAPD Program will be enrolled
in the Aetna Medicare Advantage Prescripon Drug (MAPD) PPO Plan.
To be eligible for coverage under the
Total Reree Advantage Illinois MAPD plan,
you and your eligible dependents must:
•
Live in the United States or the U.S. Territories, AND
•
Be rered and enrolled in Medicare Parts A and B,
due to age or disability.
You Must Take Acon
The TRAIL Program provides comprehensive medical and prescripon drug coverage through the Aetna MAPD PPO
plan, which is a Medicare-approved plan that combines the dierent parts of Medicare into one plan. Since Aetna
MAPD PPO is a type of Medicare, you must connue to pay your federal Medicare Parts A and B premiums in
order to enroll and remain enrolled in TRAIL MAPD.
As a newly-eligible parcipant in the TRAIL MAPD Program, you:
•
MUST enroll in the TRAIL MAPD health plan during your enrollment period, via MyBenets.illinois.gov
or by calling the MyBenets 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 prescripon drug claims processed by the TRAIL MAPD health plan instead of
Original Medicare and your current State plan once your TRAIL MAPD enrollment becomes eecve.
•
May waive State coverage. Waiving coverage will terminate your medical, prescripon and vision coverage.
Your current dental coverage (if enrolled) and life insurance coverage will remain in eect. Members elecng
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 prescripons.
STATE 2023 TRAIL MAPD Plan Year
4
Understanding Your Plan
Aetna Medicare Advantage PPO Plan
The Aetna Medicare Advantage Preferred Provider Organizaon (PPO) plan is a “passive” PPO plan. If you enroll
in this plan, you may see any provider as long as they parcipate in Medicare and accept the plan. You will not
have the restricons of in-and out-of-network providers. So even though Aetna has a network of plan providers,
if you receive care from a provider not in the Aetna network (i.e., an out-of-network provider), the PPO plan pays
those providers the same amount Medicare would have paid; you pay the same out-of-pocket percentage as if you
had received in-network care.
The majority of providers in Illinois and across the naon parcipate in Medicare and will accept the
State-sponsored Aetna group plan. If the provider is not willing to bill Aetna, call Aetna at the number on page 14
and ask them to contact your provider to explain the plan. If your provider sll refuses to bill Aetna for your visit,
you must pay the bill and submit a request for reimbursement to Aetna for payment. Aetna will then reimburse
you the Medicare allowable amount, minus any deducble or coinsurance for which you are responsible.
Important Information About TRAIL
•
TRAIL MAPD is a reree healthcare program sponsored by the State of Illinois. The plan oered through the
TRAIL Program is a Medicare Advantage plan which includes prescripon drug coverage. As a State of Illinois
reree, 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, prescripon 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 oered by Aetna. Medicare pays a xed amount for your care each month
to Aetna. When you enroll in a Medicare Advantage Prescripon Drug (MAPD) plan, you are no longer in
Original Medicare, but sll have the same covered services and the same rights and protecons as people
with Original Medicare.
MyBenets.illinois.gov
STATE 5
•
The TRAIL MAPD health plan provides all of your
Part A (hospital) and Part B (doctor and outpaent)
benets, including emergency and urgent care, and
Medicare Part D (prescripon 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
Beneciary Idener (MBI) number is not on le,
it must be provided during your enrollment. Please
make sure you have this informaon available.
•
If you fail to provide a copy of the Medicare card
with your MBI number to the Medicare COB unit
or your Rerement system, your TRAIL MAPD and
State medical insurance will be waived for the
dependent(s) with the missing documentaon and
waived for the enre household if the member's
documentaon is not provided.
•
You can only be in one Medicare Advantage or Medicare Part D (prescripon drug) plan at a me.
Enrollment in the TRAIL MAPD health plan provides you with Medicare Advantage coverage as
well as Medicare Part D coverage. Therefore, enrollment in a dierent Medicare Advantage or
Medicare Part D plan will automacally cause your TRAIL MAPD coverage to end, which will include
your medical, prescripon drug and vision coverage.
•
You may terminate the TRAIL MAPD coverage at any me by contacng the plan administrator in wring.
You may re-enroll throughout the plan year and coverage will be eecve the rst of the month following
your enrollment request or during your annual TRAIL MAPD Enrollment Period.
•
If your residenal or mailing address changes, you must nofy both your rerement system and the Social
Security Administraon in wring as quickly as possible.
•
Medicare Advantage Plans are not a Medicare Supplement plan. Medicare Advantage Plans, somemes
called "Part C" or "MA Plans," are an “all in one” alternave 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 prescripon 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 prescripon drugs)
should be sent to your MAPD plan administrator for processing and benet determinaons.
STATE 2023 TRAIL MAPD Plan Year
6
•
Medicare-eligible rerees, annuitants and survivors who want to connue medical, prescripon 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 opon. If you do not complete the online enrollment process or call the MyBenets
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, prescripon drug and vision coverage.
If your State medical and prescripon coverage is terminated, you will have only Original Medicare for
your medical coverage. To obtain addional coverage you may enroll in a Part D prescripon drug plan
for prescripon drug coverage, re-enroll in the State-Sponsored TRAIL plan throughout the plan year with
coverage eecve the rst 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 deducble and Out-of-Pocket Maximums will start over with your new TRAIL MAPD Health Plan.
The MAPD plans are not permied to consider the deducble(s) you might have already paid in your
other plan. Any deducble paid to your current medical plan will not count toward your MAPD plan year
deducble. The MAPD medical deducble is separate from your dental plan deducble. Your annual PPO
deducble and dental deducble, 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 oen they can be obtained.
Do You Have
Questions?
Visit our website at MyBenets.illinois.gov
on your computer, smartphone, or tablet.
AVA, the interacve digital assistant is
available 24/7.
Or contact MyBenets Service Center
(toll-free) 844-251-1777, or 844-251-1778 (TDD/
TTY) with inquiries. Representaves are available
Monday – Friday, 8:00 AM – 6:00 PM CT.
MyBenets.illinois.gov
STATE 7
Health Plan Details
Aetna MAPD PPO
The chart below highlights Medicare Advantage Prescripon Drug (MAPD) benets under the Total Reree
Advantage Illinois program.
2023 Plan Year PPO Prescription Drug Benefit
Rx Plan Year Deducble $125
Retail and Mail Order Pharmacy
(Inial and Coverage Gap Stages)
Maintenance and nonmaintenance medicaons are available in a 90-day supply at
retail pharmacies and through mail order. The copayment for a 61-90-day supply is
2.5 mes the 30-day copayment amount.
30-Day Supply 60-Day Supply 90-Day Supply
Retail and Mail-Order Pharmacies
Tier 1 (generic brand)
Preferred
$9
Standard
$10
Preferred
$18
Standard
$20
Preferred
$22.50
Standard
$25
Tier 2 (preferred brand) $30 $60 $75
Tier 3 (non-preferred brand)
Tier 4 (specialty brand)
$60 $120 $150
Catastrophic Coverage Stage
Copayments are capped as indicated below once a member
reaches $7,400 in true out-of-pocket prescripon drug costs.
Aetna MAPD PPO
30-Day Supply 60-Day Supply 90-Day Supply
Greater of 5% of the retail cost of the drug OR $4.15/Generic
or $10.35/Non-generic; the 5% but not more than $60.
2023 Plan Year Medical Benefit
Members may see any provider who participates in Medicare and accepts the plan
Annual medical deducble $110
Annual out-of-pocket maximum $1,300
Doctor oce visit Plan pays 85%; you pay 15% aer annual deducble
Specialist oce visit Plan pays 85%; you pay 15% aer annual deducble
Prevenve services Plan pays 100%; you pay 0%
Emergency Plan pays 100% aer you pay $120 copay per visit;
copay is waived if you are admied within 24 hours
Inpaent hospital Plan pays 85%; you pay 15% aer annual deducble
Outpaent surgery Plan pays 85%; you pay 15% aer annual deducble
Transportaon (non-emergency) 24 trips with unlimited miles allowed per trip
Lab Plan pays 100%; you pay 0%
Diagnosc tests | X-ray | Radiology Plan pays 85%; you pay 15% aer annual deducble
Home Health Care Plan pays 100%; you pay 0%
Compression Stockings 2 per year without prior authorizaon
Plan pays 85%; you pay 15% aer annual deducble
Hearing Instruments and related services $2,500 per hearing instrument and related services every 24 months
for all individuals when a hearing care professional prescribes a hearing
instrument. Contact plan for addional details. Aetna will cover 1 exam
every 12 months.
Acupuncture for chronic lower back pain $12 (in and out-of-network) for each Medicare-covered visit.
Up to 12 visits in 90 days, if medically necessary.
STATE 2023 TRAIL MAPD Plan Year
8
Aetna Medicare Advantage (MAPD) PPO Plan
Comes with these NO-COST EXTRAS
With your new plan, you get access to these extra benets
Aetna Healthy Rewards Get rewarded with a gi card when you complete important healthcare acvies.
SilverSneakers®
Fitness Program
Get a gym membership at thousands of parcipang locaons naonwide. Or get
moving from the comfort of your home with live online classes.
MDLIVE® Behavioral
Health Support
Get access to virtual mental health visits by phone or video through an MDLIVE® board-
cered psychiatrist or licensed therapist. There are no visit limits, and the copay is $0.
Teledoc® Telemedicine
Teledoc® is a low-cost, convenient, and quality alternave to emergency room and
urgent care visits for non-emergency medical care. Care is available 24/7 by web, phone,
and the Teledoc® mobile app. Teledoc® physicians can diagnose, treat, and write short-
term prescripons for a wide range of general health issues.
Transportaon to
Appointments
Focus on your health and treatment plan and worry less about geng to the doctor.
With Aetna MAPD PPO, you get rides for non-emergency trips to and from medical
appointments.
Meal Home Delivery Get delicious and nutrious meals delivered to your home aer your hospital stay.
Healthy Lifestyle Coaching
Talking with a health coach can help you create a realisc plan to improve your health.
This program could help you do things such as quit smoking, lose weight, or eat beer.
You coach will set up regular calls with you. You’ll work together to help you reach your
health goals.
Health Home Visit
Have a licensed healthcare professional assess your health and safety needs right in your
own home. They’ll also review your medicaons and family history.
Hearing Aid Reimbursement
Submit your itemized bills showing your costs on hearing aids from any licensed provider
that accepts Medicare to Aetna, and you can get reimbursed for $2,500 per ear every 24
months.
Nurse Line
You have toll-free, 24-hour access to nurses who can help answer your health quesons.
This doesn’t replace care from your regular doctor.
Resources For Living®
Program
A consultant can refer you to local services that can make life easier and more enjoyable.
You only pay the cost of any services you use.
To learn more, visit
stateofillinois.aetnamedicare.com
or call 855-223-4807.
MyBenets.illinois.gov
STATE 9
Member Health Plan Contributions
Rerees and annuitants who have 20 or more years of service, as well as survivors whose annuity is based on
the death of an employee who had 20 years or more of creditable service, receive their healthcare coverage
premium-free through the State. This premium-free coverage includes medical, prescripon and vision coverage.
All members are required to pay a premium for dental and dependent coverage.
Rerees, annuitants and survivors with less than 20 years of service are required to pay 5% of the cost of
coverage for every year of service they have less than 20 years.* See chart below:
* The 5% rates in the chart above do not apply to the following members: U of I federal rerees, SURS rerees who elected a
lower pension in exchange for free insurance, rerees, annuitants and survivors of vested rered judges and general assembly
members, SURS and SERS members who rered prior to 1/1/1998, TRS members who rered prior to 7/1/1999, and vested regional
superintendents who rered under TRS on or aer 7/1/1998.
2023 TRAIL MAPD Health Plan Monthly Contributions
for Retirees, Annuitants and Survivors with Less than 20 Years of Service
Years of
Service
Member’s
Responsibility:
Percentage of Cost
Aetna
MAPD PPO
0 100% $8.09
1 95% $7.68
2 90% $7.28
3 85% $6.87
4 80% $6.47
5 75% $6.06
6 70% $5.66
7 65% $5.25
8 60% $4.85
9 55% $4.45
10 50% $4.04
11 45% $3.64
12 40% $3.23
13 35% $2.83
14 30% $2.42
15 25% $2.02
16 20% $1.61
17 15% $1.21
18 10% $0.80
19 5% $0.40
20+ 0% $0.00
STATE 2023 TRAIL MAPD Plan Year
10
Life Insurance Contributions
Life insurance coverage opons, administered by MetLife, depend upon when you rered and whether you are
an immediate annuitant, deferred annuitant, or survivor. If you are uncertain of your life insurance benets,
contact your rerement system. To request a change in your life insurance coverage, members must go online
at MyBenets.illinois.gov and follow the instrucons. Medical underwring will be required to add or increase
Member Oponal Life and to add Spouse Life coverage.
Optional Term Life Plan
Monthly Contributions
Member’s Age
Monthly Contribution
Per $1,000 of Coverage
Under 30 $0.03
30-39 $0.05
40-44 $0.09
45-49 $0.12
50-54 $0.19
55-59 $0.36
60-64 $0.56
65-69 $1.26
70 and Older $2.06
Spouse Life Monthly Contributions
Coverage
Monthly
Contribution
Spouse Life $10,000 coverage
(Annuitant under age 60)
$5.70
Spouse Life $5,000 coverage
(Annuitant aged 60 or older)
$2.85
AD&D Monthly Contribution
Coverage
Monthly Contribution
Per $1,000 of Coverage
Accidental Death
& Dismemberment
$0.02
Child Life Monthly Contribution
Coverage Monthly Contribution
Child Life
$10,000 coverage
$0.60
Dependent Health Plan Contributions
The monthly dependent contribuon is in addion to the member health plan contribuon, if applicable.
Dependents will be enrolled in the same plan as the member.
2023 Monthly Health Plan Contributions for Dependent Coverage
Aetna MAPD PPO Plan
One Dependent Two or More Dependents
$2.46 $5.05
MyBenets.illinois.gov
STATE 11
Vision Coverage
Vision coverage is provided at no addional cost to members enrolled in any of the TRAIL MAPD health plans.
All members and enrolled dependents have the same vision coverage regardless of the health plan selected.
Eye exams are covered once every 12 months from the last date the exam benet was used. The benet for
replacement lenses is also once every plan year from the last date used. Standard frames are available once
every 24 months from the last date used.
Service
Network
Provider Benefit
Out of Network**
Provider Benefit
Benefit Frequency
Eye Exam $30 copayment $30 reimbursement Once every 12 months
Standard Frames
$30 copayment
(up to $175 retail
frame cost; member
responsible for
balance over $175)
$70 reimbursement Once every 24 months
Vision Lenses*
(single, bifocal and trifocal)
$30 copayment
$50 allowance for single
vision lenses
$80 allowance for bifocal
and trifocal lenses
Once every 12 months
Contact Lenses
(All contact lenses are in
lieu of vision lenses)
$120 allowance $120 reimbursement Once every 12 months
Use your Eye Med card for vision services.
* Vision Lenses: Plan parcipant pays any and all oponal lens enhancement charges. Network providers may oer addional
discounts on lens enhancements and mulple pair purchases.
** Out of network claims must be led within one year from the date of service.
Dental Contributions
All members and enrolled dependents have the same dental benets available regardless of the health plan
selected. During your TRAIL MAPD Enrollment Period, members have the opon to add or drop dental coverage.
The elecon to add or drop dental coverage will remain in eect the enre plan year, without excepon.
The annual plan year deducble for dental coverage for the TRAIL MAPD plan year (January 1 through December
31) is $175 per parcipant per plan year. Once the annual deducble has been met, each member is subject to a
maximum annual dental benet. Each member has a maximum dental benet of $2,500 (including orthodona)
when services are rendered by an in-network provider; however, parcipants who use an out of network
provider are limited to a maximum benet of $2,000.
Delta Dental Plan Monthly Contributions
Dental Plan Year Deductible $175
Coverage Monthly Contribution
Member Only
$14.00
Member Plus 1 Dependent $23.00
Member Plus 2 or More Dependents $25.50
Use your Delta Dental card for dental services.
STATE 2023 TRAIL MAPD Plan Year
12
Prescription Drug Coverage
A TRAIL MAPD plan includes Medicare Part D prescripon drug coverage. Prescripon drug formularies
(i.e., list of drugs covered) vary by health plan. The TRAIL MAPD prescripon drug plan must follow Medicare
rules for which types of drugs can be covered. Drugs covered under a non-Medicare Part D plan may not be
covered under a Medicare Part D plan. If you are uncertain whether a drug will be covered, you should call the
health plan.
Part D Coverage Stages
Since the TRAIL MAPD prescripon drug coverage is a Medicare Part D plan, the member’s cost for prescripon
drugs under the TRAIL MAPD Program must follow the Medicare Part D drug coverage stages. There are four
drug payment stages: Annual Deducble, Inial Coverage, Coverage Gap, and Catastrophic Coverage. At
the beginning of the year, you start out in the Annual Deducble stage. If the plan has no prescripon drug
deducble, then you begin in the second stage, the Inial Coverage stage. You progress to the next stage once
you have met the cost requirements for the current stage.
Unlike a standard Part D plan in which the enrollee is required to pay a percentage of the full retail cost of the
drug, State members enrolled in the TRAIL MAPD Program pay only the plan’s standard copayment through the
Inial Coverage and Coverage Gap stages. Paying only the standard copayment through the Coverage Gap is a
valuable benet for TRAIL MAPD members. Once a member reaches the Catastrophic Coverage stage (when
the true out-of-pocket costs reach $7,400 for prescripon drugs in 2023), the member will pay either a small
copayment or 5% coinsurance that is capped to limit a member’s out-of-pocket costs.
Part D IRMAA Premium
Medicare requires those enrolled in a Medicare Part D plan whose annual income is above a certain limit to pay
an addional premium called IRMAA (Income-Related Monthly Adjustment Amount). Medicare will look back at
your tax return from two years ago to determine your income. For those members whose income is veried by
the IRS to exceed the established limits, the Social Security Administraon will send a predeterminaon leer. If
applicable, IRMAA applies to both Medicare Parts B and D; therefore, members who pay an addional premium
for their Medicare Part B coverage are the same members who will be charged the Medicare Part D IRMAA
amount. Members will receive a quarterly bill in the mail from Social Security for these addional premiums.
To remain in the Medicare Advantage plan, aected members must pay these addional premiums. Go to
medicare.gov for IRMAA premium amounts.
Annual
Deductible
You start here. You will pay the full cost of your Part D prescripons drugs. Once you have paid
the plan's deducble, you move on to the next stage.
Initial
Coverage
If the plan has no prescripon drug deducble, you start here. You will pay copays in this stage.
Once you and the plan have spent $4,660 on your Part D prescripon drugs, you move to the
next stage.
Coverage
Gap
You will pay no more for your prescripon drugs in this stage as you did in the previous stage.
Once you have spent $7,400 on your Part D prescripon drugs, then you move on to the next
stage.
Catastrophic
Coverage
If you reach this stage, you stay in this stage through the end of the plan year (December 31).
You may pay more for your prescripon drugs in this stage, but what you will pay will be capped
(a limit is placed on the most you can pay for a prescripon, see page 8 or Catastrophic Coverage
amounts).
MyBenets.illinois.gov
STATE 13
Go Online at MyBenefits.illinois.gov, or call 844-251-1777 (toll-free) if:
• Your dependents experience a change of address.
• Your dependent loses eligibility. Dependents who are no longer eligible under the Program (including divorced
spouses or partners of a dissolved civil union or domesc partner relaonship) must be reported online immediately.
• You get married or enter into a civil union partnership, or your marriage, or civil union partnership is dissolved.
• You gain legal guardianship of a child or adopt a child.
• You have insurance benet quesons • to enroll into an insurance plan • to add a dependent to your insurance
plan • to provide a marriage cercate to add a new spouse to your insurance plan • to term a dependent from
your insurance plan • and to nd out more about your insurance coverage.
Contact:
State of Illinois Medicare Coordinaon of Benets Unit (MCOB Unit) 800-442-1300
• For Medicare requirements for the State of Illinois Group Insurance plans
• To turn in a copy of a Medicare idencaon card
• To inform the State of the loss of Medicare benets
• For quesons regarding the Medicare Advantage Plans aer enrollment or a terminaon of coverage has occurred.
• You experience a change in Medicare status. A copy of the red, white and blue Medicare card must be provided
to the State of Illinois Medicare Coordinaon of Benets (COB) Unit when a change in your or your dependent's
Medicare status occurs. The Medicare COB Unit’s address and phone number can be found on page 14.
Social Security Administraon (SSA) 800-772-1213, or go online at: ssa.gov/medicare
• To enroll in Medicare
• To check on the status of Medicare enrollment
• To request a Medicare idencaon card
• For quesons about Medicare premiums or about IRMAA premiums.
Federal CMS Medicare & Medicaid Services 800-633-4227, or go online at: medicare.gov
• To nd out other Medicare plan informaon.
Who Do I Call if I Have Questions About. . .?
• Plan ID cards, Claims, provider networks, prescripon formularies or coverage for specic procedures, call the plan
directly:
Aetna MAPD PPO Plan 855-223-4807
• If you have a nancial or medical power of aorney (POA) whom you would like to be able to make decisions and
get informaon on your behalf if you become incapacitated, or you have changes to the member's address, call
your rerement system:
State Employees’ Rerement System 217-785-7444
State Universies Rerement System 800-275-7877
Teachers’ Rerement System 877-927-5877
Judges’ Rerement System 217-782-8500
General Assembly Rerement System 217-782-8500
• TRAIL MAPD eligibility criteria or compleng the TRAIL MAPD online enrollment process, call the MyBenets
Service Center:
MyBenets Call Service Center (toll-free) 844-251-1777 or 844-251-1778 TDD/TTY
STATE 2023 TRAIL MAPD Plan Year
14
Plan Administrators
Plan
Administrators'
Name and Address
Customer Service
Phone Numbers
Websites
Aetna MAPD PPO Plan Aetna MAPD PPO Plan
PO Box 981106
El Paso, TX 79998-1106
855-223-4807
TTY users, call 711
stateollinois.aetnamedicare.com
Vision Plan EyeMed
Out-of-Network Claims
PO Box 8504
Mason, OH 45040-7111
866-723-0512
TTY users, call 711
eyemedvisioncare.com/sl
Quality Care
Dental Plan
(QCDP)
Delta Dental of Illinois
Group Number 20240
PO Box 5402
Lisle, IL 60532
800-323-1743
800-526-0844
(TDD/TTY)
soi.deltadentalil.com
Life Insurance Plan MetLife Insurance Company
Group Life Claims
PO Box 6100
Scranton, PA 18505
800-880-6394
TTY users, call 711
metlife.com/stateollinois
Medicare COB Unit CMS Group Insurance
801 South 7th Street
PO Box 19208
Springeld, IL
62794-9208
217-782-7007
800-442-1300
800-526-0844
(TDD/TTY)
CMS.BEN.MedicareC[email protected]
State Employees'
Rerement System
2101 South Veterans' Parkway
PO Box 19255
Springeld, IL 62794-9255
217-785-7444
866-321-7625
(TDD/TTY)
srs.illinois.gov
State Universies
Rerement System
1901 Fox Drive
Champaign, IL 61820-7333
800-275-7877
surs.org
Teachers’ Rerement
System
2815 W. Washington Street
PO Box 19253
Springeld, IL 62794-9253
877-927-5877 TTY
users, call 711 trsil.org
Disclaimer
The State of Illinois intends that the terms of this plan are legally enforceable and that the plan is maintained
for the exclusive benet of members. The State reserves the right to change any of the benets, program
requirements and contribuons described in Your TRAIL Medicare Advantage Prescripon Drug (MAPD) Program
Decision Guide. This Guide is intended to supplement the Benets Handbook. If there is a discrepancy between
the Benets Handbook and state or federal law, the law will control.
MyBenets.illinois.gov
STATE 15
Notes
TRAIL MAPD Seminar
An Informaonal TRAIL MAPD Enrollment seminar (recording) is
available online for Medicare-eligible rerees. This pre-recorded seminar
is an opportunity to learn about the Total Reree Advantage Illinois
(TRAIL) Program and the Aetna MAPD PPO plan. You can log on to your
computer, smartphone, or tablet at hp://cms.illinois.gov/thetrail to
view the recorded TRAIL MAPD Enrollment seminar. Click on the TRAIL
MAPD seminar link and watch from the comforts of your home.
Printed by the Authority of the State of Illinois. 10/22 7,500 copies IOCI 23-0365 102622-ADA