[ Search ] [ Legislation ]
[ Home ] [ Back ] [ Bottom ]
| [ Engrossed ] | [ House Amendment 001 ] | [ Senate Amendment 001 ] |
91_HB0133
LRB9100435EGfg
1 AN ACT to amend the State Employees Group Insurance Act
2 of 1971 by changing Sections 6.5 and 10.
3 Be it enacted by the People of the State of Illinois,
4 represented in the General Assembly:
5 Section 5. The State Employees Group Insurance Act of
6 1971 is amended by changing Sections 6.5 and 10 as follows:
7 (5 ILCS 375/6.5)
8 Sec. 6.5. Health benefits for TRS benefit recipients and
9 TRS dependent beneficiaries.
10 (A) Transfer to State health plan.
11 (a) Definitions. For the purposes of this Section and
12 Section 6.6:
13 "State health plan" means the program of health benefits
14 provided for annuitants and survivors under the other
15 Sections of this Act. The term does not include group life
16 insurance benefits.
17 "TRS health plan" means the separate program of health
18 benefits established under subsection (B) of this Section for
19 TRS benefit recipients and TRS dependent beneficiaries.
20 (b) Purpose. It is the purpose of this amendatory Act
21 of 1999 to provide for the termination of the separate
22 program of health benefits established under subsection (B)
23 of this Section for TRS benefit recipients and TRS dependent
24 beneficiaries and to move those persons into the State health
25 plan.
26 (c) Transfer. Upon expiration of the contract currently
27 providing for the separate program of health benefits
28 established under subsection (B) of this Section for TRS
29 benefit recipients and TRS dependent beneficiaries, but in no
30 event later than July 1, 2000, the separate program of health
31 benefits established under subsection (B) shall be
-2- LRB9100435EGfg
1 terminated. All TRS benefit recipients and TRS dependent
2 beneficiaries participating in the TRS health plan on the
3 termination date shall be transferred on that date into the
4 State health plan without any interruption or delay in
5 coverage or limitation as to pre-existing medical conditions.
6 All persons who become TRS benefit recipients or TRS
7 dependent beneficiaries on or after that termination date
8 shall be eligible to participate in the State health plan
9 under this Section. A person who is a TRS benefit recipient
10 or TRS dependent beneficiary on the termination date but has
11 not elected to participate in the TRS health plan may elect
12 to participate in the State health plan under this Section
13 without any delay in coverage or limitation as to
14 pre-existing medical conditions, but that election may be
15 made during the following periods only:
16 (i) the 30 days following the date on which he or
17 she again becomes a TRS benefit recipient or dependent
18 beneficiary by virtue of beginning to receive a different
19 type of annuity or monthly benefit;
20 (ii) the 6 months following the date on which he or
21 she becomes eligible for Medicare Hospital Insurance;
22 (iii) the 30 days following the date on which he or
23 she attains age 65; and
24 (iv) the 30 days following the date on which he or
25 she exhausts all rights to COBRA coverage after losing
26 health insurance coverage under another group health
27 benefit plan as a result of the employer terminating that
28 coverage.
29 The Department of Central Management Services shall
30 continue to administer the TRS health plan established under
31 subsection (B) until that plan has been terminated and all
32 claims under that plan have been resolved.
33 (d) Benefits and costs. A TRS benefit recipient who
34 participates in the State health plan under this Section
-3- LRB9100435EGfg
1 shall participate on the same terms and subject to the same
2 benefits as an annuitant (if the person qualifies as a TRS
3 benefit recipient under subdivision (v)(3)(i) or (v)(3)(ii)
4 of Section 3) or a survivor (if the person qualifies as a TRS
5 benefit recipient under subdivision (v)(3)(iii) or (v)(3)(iv)
6 of Section 3). A TRS dependent beneficiary who participates
7 in the State health plan under this Section shall participate
8 on the same terms and subject to the same benefits as a
9 dependent.
10 The cost of participation for a TRS benefit recipient who
11 participates in the State health plan under this Section
12 shall be the same as the cost of participation for a new TRS
13 State annuitant (if the person qualifies as a TRS benefit
14 recipient under subdivision (v)(3)(i) or (v)(3)(ii) of
15 Section 3) or for a new TRS State survivor (if the person
16 qualifies as a TRS benefit recipient under subdivision
17 (v)(3)(iii) or (v)(3)(iv) of Section 3). The portion of the
18 cost of participation in the basic program of group health
19 benefits that is payable by a TRS benefit recipient shall be
20 reduced by an amount equal to 5% of that cost for each full
21 year of creditable service upon which the TRS benefit
22 recipient's monthly benefit or retirement annuity is based,
23 up to a maximum of 100% for a TRS benefit recipient whose
24 monthly benefit or retirement annuity is based on 20 or more
25 years of creditable service. The remainder of the cost of a
26 TRS benefit recipient's coverage under the basic program of
27 group health benefits shall be the responsibility of the
28 recipient.
29 The cost of participation for a TRS dependent beneficiary
30 who participates in the State health plan under this Section
31 shall be the same as the cost of participation for a
32 dependent.
33 (d) Financing. To the extent that moneys are available
34 in that Fund, the Department of Central Management Services
-4- LRB9100435EGfg
1 shall pay the costs arising from the participation of TRS
2 benefit recipients and TRS dependent beneficiaries in the
3 State health plan from the Teacher Health Insurance Security
4 Fund, which is created in subdivision (B)(f) of this Section.
5 If the moneys in that Fund are insufficient, the remaining
6 costs may be paid from any other source of funds lawfully
7 available for that purpose.
8 The transfer of TRS benefit recipients and TRS dependent
9 beneficiaries from the separate TRS health plan to the State
10 health plan does not affect the payment of contributions into
11 the Teacher Health Insurance Security Fund under Section 6.6
12 of this Act or Section 1.3 of the State Pension Funds
13 Continuing Appropriation Act.
14 (B) TRS health plan.
15 (a) Purpose. It is the purpose of this amendatory Act
16 of 1995 to transfer the administration of the program of
17 health benefits established for benefit recipients and their
18 dependent beneficiaries under Article 16 of the Illinois
19 Pension Code to the Department of Central Management
20 Services.
21 (b) Transition provisions. The Board of Trustees of the
22 Teachers' Retirement System shall continue to administer the
23 health benefit program established under Article 16 of the
24 Illinois Pension Code through December 31, 1995. Beginning
25 January 1, 1996, the Department of Central Management
26 Services shall be responsible for administering a program of
27 health benefits for TRS benefit recipients and TRS dependent
28 beneficiaries under this subsection (B) Section. The
29 Department of Central Management Services and the Teachers'
30 Retirement System shall cooperate in this endeavor and shall
31 coordinate their activities so as to ensure a smooth
32 transition and uninterrupted health benefit coverage.
33 (c) Eligibility. All persons who were enrolled in the
34 Article 16 program at the time of the transfer shall be
-5- LRB9100435EGfg
1 eligible to participate in the program established under this
2 subsection (B) Section without any interruption or delay in
3 coverage or limitation as to pre-existing medical conditions.
4 Eligibility to participate shall be determined by the
5 Teachers' Retirement System. Eligibility information shall
6 be communicated to the Department of Central Management
7 Services in a format acceptable to the Department.
8 (d) Coverage. The level of health benefits provided
9 under this subsection (B) Section shall be similar to the
10 level of benefits provided by the program previously
11 established under Article 16 of the Illinois Pension Code.
12 Group life insurance benefits are not included in the
13 benefits to be provided to TRS benefit recipients and TRS
14 dependent beneficiaries under this Act.
15 The program of health benefits under this subsection (B)
16 Section may include any or all of the benefit limitations,
17 including but not limited to a reduction in benefits based on
18 eligibility for federal medicare benefits, that are provided
19 under subsection (a) of Section 6 of this Act for other
20 health benefit programs under this Act.
21 (e) Insurance rates and premiums. The Director shall
22 determine the insurance rates and premiums for TRS benefit
23 recipients and TRS dependent beneficiaries under this
24 subsection (B). For Fiscal Year 1996, the premium shall be
25 equal to the premium actually charged in Fiscal Year 1995.
26 In subsequent years, the premium under this subsection (B)
27 shall never be lower than the premium charged in Fiscal Year
28 1995. Rates and premiums may be based in part on age and
29 eligibility for federal medicare coverage.
30 The cost of health benefits under the program shall be
31 paid as follows:
32 (1) For a TRS benefit recipient selecting a managed
33 care program, up to 75% of the total insurance rate shall
34 be paid from the Teacher Health Insurance Security Fund.
-6- LRB9100435EGfg
1 (2) For a TRS benefit recipient selecting the major
2 medical coverage program, up to 50% of the total
3 insurance rate shall be paid from the Teacher Health
4 Insurance Security Fund if a managed care program is
5 accessible, as determined by the Teachers' Retirement
6 System.
7 (3) For a TRS benefit recipient selecting the major
8 medical coverage program, up to 75% of the total
9 insurance rate shall be paid from the Teacher Health
10 Insurance Security Fund if a managed care program is not
11 accessible, as determined by the Teachers' Retirement
12 System.
13 (4) The balance of the rate of insurance, including
14 the entire premium of any coverage for TRS dependent
15 beneficiaries that has been elected, shall be paid by
16 deductions authorized by the TRS benefit recipient to be
17 withheld from his or her monthly annuity or benefit
18 payment from the Teachers' Retirement System; except that
19 (i) if the balance of the cost of coverage exceeds the
20 amount of the monthly annuity or benefit payment, the
21 difference shall be paid directly to the Teachers'
22 Retirement System by the TRS benefit recipient, and (ii)
23 all or part of the balance of the cost of coverage may,
24 at the school board's option, be paid to the Teachers'
25 Retirement System by the school board of the school
26 district from which the TRS benefit recipient retired, in
27 accordance with Section 10-22.3b of the School Code. The
28 Teachers' Retirement System shall promptly deposit all
29 moneys withheld by or paid to it under this subdivision
30 (e)(4) into the Teacher Health Insurance Security Fund.
31 These moneys shall not be considered assets of the
32 Retirement System.
33 (f) Financing. Beginning July 1, 1995, all revenues
34 arising from the administration of the health benefit
-7- LRB9100435EGfg
1 programs established under Article 16 of the Illinois Pension
2 Code or this subsection (B) Section shall be deposited into
3 the Teacher Health Insurance Security Fund, which is hereby
4 created as a nonappropriated trust fund to be held outside
5 the State Treasury, with the State Treasurer as custodian.
6 Any interest earned on moneys in the Teacher Health Insurance
7 Security Fund shall be deposited into the Fund.
8 Moneys in the Teacher Health Insurance Security Fund
9 shall be used only to pay the costs of (1) the health benefit
10 program established under this subsection (B) Section,
11 including associated administrative costs, (2) and the costs
12 associated with the health benefit program established under
13 Article 16 of the Illinois Pension Code, as authorized in
14 this Section, and (3) the costs of participation by TRS
15 benefit recipients and TRS dependent beneficiaries in the
16 State health plan. Beginning July 1, 1995, the Department of
17 Central Management Services may make expenditures from the
18 Teacher Health Insurance Security Fund for those costs.
19 After other funds authorized for the payment of the costs
20 of the health benefit program established under Article 16 of
21 the Illinois Pension Code are exhausted and until January 1,
22 1996 (or such later date as may be agreed upon by the
23 Director of Central Management Services and the Secretary of
24 the Teachers' Retirement System), the Secretary of the
25 Teachers' Retirement System may make expenditures from the
26 Teacher Health Insurance Security Fund as necessary to pay up
27 to 75% of the cost of providing health coverage to eligible
28 benefit recipients (as defined in Sections 16-153.1 and
29 16-153.3 of the Illinois Pension Code) who are enrolled in
30 the Article 16 health benefit program and to facilitate the
31 transfer of administration of the health benefit program to
32 the Department of Central Management Services.
33 (g) Contract for benefits. The Director shall by
34 contract, self-insurance, or otherwise make available the
-8- LRB9100435EGfg
1 program of health benefits for TRS benefit recipients and
2 their TRS dependent beneficiaries that is provided for in
3 this subsection (B) Section. The contract or other
4 arrangement for the provision of these health benefits shall
5 be on terms deemed by the Director to be in the best interest
6 of the State of Illinois and the TRS benefit recipients based
7 on, but not limited to, such criteria as administrative cost,
8 service capabilities of the carrier or other contractor, and
9 the costs of the benefits.
10 (h) Nature Continuation of program. It is the intention
11 of the General Assembly that the program of health benefits
12 provided under this Section be maintained on an ongoing,
13 affordable basis. The program of health benefits provided
14 under this Section may be amended by the State and is not
15 intended to be a pension or retirement benefit subject to
16 protection under Article XIII, Section 5 of the Illinois
17 Constitution.
18 (Source: P.A. 89-21, eff. 6-21-95; 89-25, eff. 6-21-95.)
19 (5 ILCS 375/10) (from Ch. 127, par. 530)
20 Sec. 10. Payments by State; premiums.
21 (a) The State shall pay the cost of basic
22 non-contributory group life insurance and, subject to member
23 paid contributions set by the Department or required by this
24 Section, the basic program of group health benefits on each
25 eligible member, except a member, not otherwise covered by
26 this Act, who has retired as a participating member under
27 Article 2 of the Illinois Pension Code but is ineligible for
28 the retirement annuity under Section 2-119 of the Illinois
29 Pension Code, and part of each eligible member's and retired
30 member's premiums for health insurance coverage for enrolled
31 dependents as provided by Section 9. The State shall pay the
32 cost of the basic program of group health benefits only after
33 benefits are reduced by the amount of benefits covered by
-9- LRB9100435EGfg
1 Medicare for all retired members and retired dependents aged
2 65 years or older who are entitled to benefits under Social
3 Security or the Railroad Retirement system or who had
4 sufficient Medicare-covered government employment except that
5 such reduction in benefits shall apply only to those retired
6 members or retired dependents who (1) first become eligible
7 for such Medicare coverage on or after July 1, 1992; or (2)
8 remain eligible for, but no longer receive Medicare coverage
9 which they had been receiving on or after July 1, 1992. The
10 Department may determine the aggregate level of the State's
11 contribution on the basis of actual cost of medical services
12 adjusted for age, sex or geographic or other demographic
13 characteristics which affect the costs of such programs.
14 (a-1) Beginning January 1, 1998, for each person who
15 becomes a new SERS annuitant and participates in the basic
16 program of group health benefits, the State shall contribute
17 toward the cost of the annuitant's coverage under the basic
18 program of group health benefits an amount equal to 5% of
19 that cost for each full year of creditable service upon which
20 the annuitant's retirement annuity is based, up to a maximum
21 of 100% for an annuitant with 20 or more years of creditable
22 service. The remainder of the cost of a new SERS annuitant's
23 coverage under the basic program of group health benefits
24 shall be the responsibility of the annuitant.
25 (a-2) Beginning January 1, 1998, for each person who
26 becomes a new SERS survivor and participates in the basic
27 program of group health benefits, the State shall contribute
28 toward the cost of the survivor's coverage under the basic
29 program of group health benefits an amount equal to 5% of
30 that cost for each full year of the deceased employee's or
31 deceased annuitant's creditable service in the State
32 Employees' Retirement System of Illinois on the date of
33 death, up to a maximum of 100% for a survivor of an employee
34 or annuitant with 20 or more years of creditable service.
-10- LRB9100435EGfg
1 The remainder of the cost of the new SERS survivor's coverage
2 under the basic program of group health benefits shall be the
3 responsibility of the survivor.
4 (a-3) Beginning January 1, 1998, for each person who
5 becomes a new SURS annuitant and participates in the basic
6 program of group health benefits, the State shall contribute
7 toward the cost of the annuitant's coverage under the basic
8 program of group health benefits an amount equal to 5% of
9 that cost for each full year of creditable service upon which
10 the annuitant's retirement annuity is based, up to a maximum
11 of 100% for an annuitant with 20 or more years of creditable
12 service. The remainder of the cost of a new SURS annuitant's
13 coverage under the basic program of group health benefits
14 shall be the responsibility of the annuitant.
15 (a-4) Beginning January 1, 1998, for each person who
16 becomes a new SURS retired employee and participates in the
17 basic program of group health benefits, the State shall
18 contribute toward the cost of the retired employee's coverage
19 under the basic program of group health benefits an amount
20 equal to 5% of that cost for each full year that the retired
21 employee was an employee as defined in Section 3, up to a
22 maximum of 100% for a retired employee who was an employee
23 for 20 or more years. The remainder of the cost of a new
24 SURS retired employee's coverage under the basic program of
25 group health benefits shall be the responsibility of the
26 retired employee.
27 (a-5) Beginning January 1, 1998, for each person who
28 becomes a new SURS survivor and participates in the basic
29 program of group health benefits, the State shall contribute
30 toward the cost of the survivor's coverage under the basic
31 program of group health benefits an amount equal to 5% of
32 that cost for each full year of the deceased employee's or
33 deceased annuitant's creditable service in the State
34 Universities Retirement System on the date of death, up to a
-11- LRB9100435EGfg
1 maximum of 100% for a survivor of an employee or annuitant
2 with 20 or more years of creditable service. The remainder
3 of the cost of the new SURS survivor's coverage under the
4 basic program of group health benefits shall be the
5 responsibility of the survivor.
6 (a-6) Beginning July 1, 1998, for each person who
7 becomes a new TRS State annuitant and participates in the
8 basic program of group health benefits, the State shall
9 contribute toward the cost of the annuitant's coverage under
10 the basic program of group health benefits an amount equal to
11 5% of that cost for each full year of creditable service as a
12 teacher as defined in paragraph (2), (3), or (5) of Section
13 16-106 of the Illinois Pension Code upon which the
14 annuitant's retirement annuity is based, up to a maximum of
15 100% for an annuitant with 20 or more years of such
16 creditable service. The remainder of the cost of a new TRS
17 State annuitant's coverage under the basic program of group
18 health benefits shall be the responsibility of the annuitant.
19 The change made to this subsection by this amendatory Act
20 of the 91st General Assembly shall apply beginning on the
21 termination date described in subdivision (A)(c) of Section
22 6.5.
23 (a-7) Beginning July 1, 1998, for each person who
24 becomes a new TRS State survivor and participates in the
25 basic program of group health benefits, the State shall
26 contribute toward the cost of the survivor's coverage under
27 the basic program of group health benefits an amount equal to
28 5% of that cost for each full year of the deceased employee's
29 or deceased annuitant's creditable service in the Teachers'
30 Retirement System of the State of Illinois as a teacher as
31 defined in paragraph (2), (3), or (5) of Section 16-106 of
32 the Illinois Pension Code on the date of death, up to a
33 maximum of 100% for a survivor of an employee or annuitant
34 with 20 or more years of such creditable service. The
-12- LRB9100435EGfg
1 remainder of the cost of the new TRS State survivor's
2 coverage under the basic program of group health benefits
3 shall be the responsibility of the survivor.
4 The change made to this subsection by this amendatory Act
5 of the 91st General Assembly shall apply beginning on the
6 termination date described in subdivision (A)(c) of Section
7 6.5.
8 (a-8) A new SERS annuitant, new SERS survivor, new SURS
9 annuitant, new SURS retired employee, new SURS survivor, new
10 TRS State annuitant, or new TRS State survivor may waive or
11 terminate coverage in the program of group health benefits.
12 Any such annuitant, survivor, or retired employee who has
13 waived or terminated coverage may enroll or re-enroll in the
14 program of group health benefits only during the annual
15 benefit choice period, as determined by the Director; except
16 that in the event of termination of coverage due to
17 nonpayment of premiums, the annuitant, survivor, or retired
18 employee may not re-enroll in the program.
19 (a-9) In the case of a person who participates in the
20 basic program of group health benefits and receives an
21 annuity or monthly benefit under more than one of the
22 retirement systems established under Articles 2, 14, 15, 16,
23 and 18 of the Illinois Pension Code, the person's
24 responsibility for the cost of participation in the basic
25 program of group health benefits shall be reduced to reflect
26 all of the State contributions that the person is entitled to
27 under subsections (a-1) through (a-7) of this Section and, if
28 applicable, the reduction under subdivision (A)(d) of Section
29 6.5.
30 (a-10) (a-9) No later than May 1 of each calendar year,
31 the Director of Central Management Services shall certify in
32 writing to the Executive Secretary of the State Employees'
33 Retirement System of Illinois the amounts of the Medicare
34 supplement health care premiums and the amounts of the health
-13- LRB9100435EGfg
1 care premiums for all other retirees who are not Medicare
2 eligible.
3 A separate calculation of the premiums based upon the
4 actual cost of each health care plan shall be so certified.
5 The Director of Central Management Services shall provide
6 to the Executive Secretary of the State Employees' Retirement
7 System of Illinois such information, statistics, and other
8 data as he or she may require to review the premium amounts
9 certified by the Director of Central Management Services.
10 (b) State employees who become eligible for this program
11 on or after January 1, 1980 in positions normally requiring
12 actual performance of duty not less than 1/2 of a normal work
13 period but not equal to that of a normal work period, shall
14 be given the option of participating in the available
15 program. If the employee elects coverage, the State shall
16 contribute on behalf of such employee to the cost of the
17 employee's benefit and any applicable dependent supplement,
18 that sum which bears the same percentage as that percentage
19 of time the employee regularly works when compared to normal
20 work period.
21 (c) The basic non-contributory coverage from the basic
22 program of group health benefits shall be continued for each
23 employee not in pay status or on active service by reason of
24 (1) leave of absence due to illness or injury, (2) authorized
25 educational leave of absence or sabbatical leave, or (3)
26 military leave with pay and benefits. This coverage shall
27 continue until expiration of authorized leave and return to
28 active service, but not to exceed 24 months for leaves under
29 item (1) or (2). This 24-month limitation and the requirement
30 of returning to active service shall not apply to persons
31 receiving ordinary or accidental disability benefits or
32 retirement benefits through the appropriate State retirement
33 system or benefits under the Workers' Compensation or
34 Occupational Disease Act.
-14- LRB9100435EGfg
1 (d) The basic group life insurance coverage shall
2 continue, with full State contribution, where such person is
3 (1) absent from active service by reason of disability
4 arising from any cause other than self-inflicted, (2) on
5 authorized educational leave of absence or sabbatical leave,
6 or (3) on military leave with pay and benefits.
7 (e) Where the person is in non-pay status for a period
8 in excess of 30 days or on leave of absence, other than by
9 reason of disability, educational or sabbatical leave, or
10 military leave with pay and benefits, such person may
11 continue coverage only by making personal payment equal to
12 the amount normally contributed by the State on such person's
13 behalf. Such payments and coverage may be continued: (1)
14 until such time as the person returns to a status eligible
15 for coverage at State expense, but not to exceed 24 months,
16 (2) until such person's employment or annuitant status with
17 the State is terminated, or (3) for a maximum period of 4
18 years for members on military leave with pay and benefits and
19 military leave without pay and benefits (exclusive of any
20 additional service imposed pursuant to law).
21 (f) The Department shall establish by rule the extent
22 to which other employee benefits will continue for persons in
23 non-pay status or who are not in active service.
24 (g) The State shall not pay the cost of the basic
25 non-contributory group life insurance, program of health
26 benefits and other employee benefits for members who are
27 survivors as defined by paragraphs (1) and (2) of subsection
28 (q) of Section 3 of this Act. The costs of benefits for
29 these survivors shall be paid by the survivors or by the
30 University of Illinois Cooperative Extension Service, or any
31 combination thereof.
32 (h) Those persons occupying positions with any
33 department as a result of emergency appointments pursuant to
34 Section 8b.8 of the Personnel Code who are not considered
-15- LRB9100435EGfg
1 employees under this Act shall be given the option of
2 participating in the programs of group life insurance, health
3 benefits and other employee benefits. Such persons electing
4 coverage may participate only by making payment equal to the
5 amount normally contributed by the State for similarly
6 situated employees. Such amounts shall be determined by the
7 Director. Such payments and coverage may be continued until
8 such time as the person becomes an employee pursuant to this
9 Act or such person's appointment is terminated.
10 (i) Any unit of local government within the State of
11 Illinois may apply to the Director to have its employees,
12 annuitants, and their dependents provided group health
13 coverage under this Act on a non-insured basis. To
14 participate, a unit of local government must agree to enroll
15 all of its employees, who may select coverage under either
16 the State group health insurance plan or a health maintenance
17 organization that has contracted with the State to be
18 available as a health care provider for employees as defined
19 in this Act. A unit of local government must remit the
20 entire cost of providing coverage under the State group
21 health insurance plan or, for coverage under a health
22 maintenance organization, an amount determined by the
23 Director based on an analysis of the sex, age, geographic
24 location, or other relevant demographic variables for its
25 employees, except that the unit of local government shall not
26 be required to enroll those of its employees who are covered
27 spouses or dependents under this plan or another group policy
28 or plan providing health benefits as long as (1) an
29 appropriate official from the unit of local government
30 attests that each employee not enrolled is a covered spouse
31 or dependent under this plan or another group policy or plan,
32 and (2) at least 85% of the employees are enrolled and the
33 unit of local government remits the entire cost of providing
34 coverage to those employees. Employees of a participating
-16- LRB9100435EGfg
1 unit of local government who are not enrolled due to coverage
2 under another group health policy or plan may enroll at a
3 later date subject to submission of satisfactory evidence of
4 insurability and provided that no benefits shall be payable
5 for services incurred during the first 6 months of coverage
6 to the extent the services are in connection with any
7 pre-existing condition. A participating unit of local
8 government may also elect to cover its annuitants. Dependent
9 coverage shall be offered on an optional basis, with the
10 costs paid by the unit of local government, its employees, or
11 some combination of the two as determined by the unit of
12 local government. The unit of local government shall be
13 responsible for timely collection and transmission of
14 dependent premiums.
15 The Director shall annually determine monthly rates of
16 payment, subject to the following constraints:
17 (1) In the first year of coverage, the rates shall
18 be equal to the amount normally charged to State
19 employees for elected optional coverages or for enrolled
20 dependents coverages or other contributory coverages, or
21 contributed by the State for basic insurance coverages on
22 behalf of its employees, adjusted for differences between
23 State employees and employees of the local government in
24 age, sex, geographic location or other relevant
25 demographic variables, plus an amount sufficient to pay
26 for the additional administrative costs of providing
27 coverage to employees of the unit of local government and
28 their dependents.
29 (2) In subsequent years, a further adjustment shall
30 be made to reflect the actual prior years' claims
31 experience of the employees of the unit of local
32 government.
33 In the case of coverage of local government employees
34 under a health maintenance organization, the Director shall
-17- LRB9100435EGfg
1 annually determine for each participating unit of local
2 government the maximum monthly amount the unit may contribute
3 toward that coverage, based on an analysis of (i) the age,
4 sex, geographic location, and other relevant demographic
5 variables of the unit's employees and (ii) the cost to cover
6 those employees under the State group health insurance plan.
7 The Director may similarly determine the maximum monthly
8 amount each unit of local government may contribute toward
9 coverage of its employees' dependents under a health
10 maintenance organization.
11 Monthly payments by the unit of local government or its
12 employees for group health insurance or health maintenance
13 organization coverage shall be deposited in the Local
14 Government Health Insurance Reserve Fund. The Local
15 Government Health Insurance Reserve Fund shall be a
16 continuing fund not subject to fiscal year limitations. All
17 expenditures from this fund shall be used for payments for
18 health care benefits for local government and rehabilitation
19 facility employees, annuitants, and dependents, and to
20 reimburse the Department or its administrative service
21 organization for all expenses incurred in the administration
22 of benefits. No other State funds may be used for these
23 purposes.
24 A local government employer's participation or desire to
25 participate in a program created under this subsection shall
26 not limit that employer's duty to bargain with the
27 representative of any collective bargaining unit of its
28 employees.
29 (j) Any rehabilitation facility within the State of
30 Illinois may apply to the Director to have its employees,
31 annuitants, and their dependents provided group health
32 coverage under this Act on a non-insured basis. To
33 participate, a rehabilitation facility must agree to enroll
34 all of its employees and remit the entire cost of providing
-18- LRB9100435EGfg
1 such coverage for its employees, except that the
2 rehabilitation facility shall not be required to enroll those
3 of its employees who are covered spouses or dependents under
4 this plan or another group policy or plan providing health
5 benefits as long as (1) an appropriate official from the
6 rehabilitation facility attests that each employee not
7 enrolled is a covered spouse or dependent under this plan or
8 another group policy or plan, and (2) at least 85% of the
9 employees are enrolled and the rehabilitation facility remits
10 the entire cost of providing coverage to those employees.
11 Employees of a participating rehabilitation facility who are
12 not enrolled due to coverage under another group health
13 policy or plan may enroll at a later date subject to
14 submission of satisfactory evidence of insurability and
15 provided that no benefits shall be payable for services
16 incurred during the first 6 months of coverage to the extent
17 the services are in connection with any pre-existing
18 condition. A participating rehabilitation facility may also
19 elect to cover its annuitants. Dependent coverage shall be
20 offered on an optional basis, with the costs paid by the
21 rehabilitation facility, its employees, or some combination
22 of the 2 as determined by the rehabilitation facility. The
23 rehabilitation facility shall be responsible for timely
24 collection and transmission of dependent premiums.
25 The Director shall annually determine quarterly rates of
26 payment, subject to the following constraints:
27 (1) In the first year of coverage, the rates shall
28 be equal to the amount normally charged to State
29 employees for elected optional coverages or for enrolled
30 dependents coverages or other contributory coverages on
31 behalf of its employees, adjusted for differences between
32 State employees and employees of the rehabilitation
33 facility in age, sex, geographic location or other
34 relevant demographic variables, plus an amount sufficient
-19- LRB9100435EGfg
1 to pay for the additional administrative costs of
2 providing coverage to employees of the rehabilitation
3 facility and their dependents.
4 (2) In subsequent years, a further adjustment shall
5 be made to reflect the actual prior years' claims
6 experience of the employees of the rehabilitation
7 facility.
8 Monthly payments by the rehabilitation facility or its
9 employees for group health insurance shall be deposited in
10 the Local Government Health Insurance Reserve Fund.
11 (k) Any domestic violence shelter or service within the
12 State of Illinois may apply to the Director to have its
13 employees, annuitants, and their dependents provided group
14 health coverage under this Act on a non-insured basis. To
15 participate, a domestic violence shelter or service must
16 agree to enroll all of its employees and pay the entire cost
17 of providing such coverage for its employees. A
18 participating domestic violence shelter may also elect to
19 cover its annuitants. Dependent coverage shall be offered on
20 an optional basis, with employees, or some combination of the
21 2 as determined by the domestic violence shelter or service.
22 The domestic violence shelter or service shall be responsible
23 for timely collection and transmission of dependent premiums.
24 The Director shall annually determine quarterly rates of
25 payment, subject to the following constraints:
26 (1) In the first year of coverage, the rates shall
27 be equal to the amount normally charged to State
28 employees for elected optional coverages or for enrolled
29 dependents coverages or other contributory coverages on
30 behalf of its employees, adjusted for differences between
31 State employees and employees of the domestic violence
32 shelter or service in age, sex, geographic location or
33 other relevant demographic variables, plus an amount
34 sufficient to pay for the additional administrative costs
-20- LRB9100435EGfg
1 of providing coverage to employees of the domestic
2 violence shelter or service and their dependents.
3 (2) In subsequent years, a further adjustment shall
4 be made to reflect the actual prior years' claims
5 experience of the employees of the domestic violence
6 shelter or service.
7 (3) In no case shall the rate be less than the
8 amount normally charged to State employees or contributed
9 by the State on behalf of its employees.
10 Monthly payments by the domestic violence shelter or
11 service or its employees for group health insurance shall be
12 deposited in the Local Government Health Insurance Reserve
13 Fund.
14 (l) A public community college or entity organized
15 pursuant to the Public Community College Act may apply to the
16 Director initially to have only annuitants not covered prior
17 to July 1, 1992 by the district's health plan provided health
18 coverage under this Act on a non-insured basis. The
19 community college must execute a 2-year contract to
20 participate in the Local Government Health Plan. Those
21 annuitants enrolled initially under this contract shall have
22 no benefits payable for services incurred during the first 6
23 months of coverage to the extent the services are in
24 connection with any pre-existing condition. Any annuitant
25 who may enroll after this initial enrollment period shall be
26 subject to submission of satisfactory evidence of
27 insurability and to the pre-existing conditions limitation.
28 The Director shall annually determine monthly rates of
29 payment subject to the following constraints: for those
30 community colleges with annuitants only enrolled, first year
31 rates shall be equal to the average cost to cover claims for
32 a State member adjusted for demographics, Medicare
33 participation, and other factors; and in the second year, a
34 further adjustment of rates shall be made to reflect the
-21- LRB9100435EGfg
1 actual first year's claims experience of the covered
2 annuitants.
3 (m) The Director shall adopt any rules deemed necessary
4 for implementation of this amendatory Act of 1989 (Public Act
5 86-978).
6 (Source: P.A. 89-53, eff. 7-1-95; 89-236, eff. 8-4-95;
7 89-324, eff. 8-13-95; 89-626, eff. 8-9-96; 90-65, eff.
8 7-7-97; 90-582, eff. 5-27-98; 90-655, eff. 7-30-98; revised
9 8-3-98.)
10 Section 99. Effective date. This Act takes effect upon
11 becoming law.