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91_HB1469
LRB9104603MWpc
1 AN ACT to amend the State Employees Group Insurance Act
2 of 1971 by changing Section 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 Section 10 as follows:
7 (5 ILCS 375/10) (from Ch. 127, par. 530)
8 Sec. 10. Payments by State; premiums.
9 (a) The State shall pay the cost of basic
10 non-contributory group life insurance and, subject to member
11 paid contributions set by the Department or required by this
12 Section, the basic program of group health benefits on each
13 eligible member, except a member, not otherwise covered by
14 this Act, who has retired as a participating member under
15 Article 2 of the Illinois Pension Code but is ineligible for
16 the retirement annuity under Section 2-119 of the Illinois
17 Pension Code, and part of each eligible member's and retired
18 member's premiums for health insurance coverage for enrolled
19 dependents as provided by Section 9. The State shall pay the
20 cost of the basic program of group health benefits only after
21 benefits are reduced by the amount of benefits covered by
22 Medicare for all retired members and retired dependents aged
23 65 years or older who are entitled to benefits under Social
24 Security or the Railroad Retirement system or who had
25 sufficient Medicare-covered government employment except that
26 such reduction in benefits shall apply only to those retired
27 members or retired dependents who (1) first become eligible
28 for such Medicare coverage on or after July 1, 1992; or (2)
29 remain eligible for, but no longer receive Medicare coverage
30 which they had been receiving on or after July 1, 1992. The
31 Department may determine the aggregate level of the State's
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1 contribution on the basis of actual cost of medical services
2 adjusted for age, sex or geographic or other demographic
3 characteristics which affect the costs of such programs.
4 (a-1) Beginning January 1, 1998, for each person who
5 becomes a new SERS 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 SERS annuitant's
13 coverage under the basic program of group health benefits
14 shall be the responsibility of the annuitant.
15 (a-2) Beginning January 1, 1998, for each person who
16 becomes a new SERS survivor and participates in the basic
17 program of group health benefits, the State shall contribute
18 toward the cost of the survivor's coverage under the basic
19 program of group health benefits an amount equal to 5% of
20 that cost for each full year of the deceased employee's or
21 deceased annuitant's creditable service in the State
22 Employees' Retirement System of Illinois on the date of
23 death, up to a maximum of 100% for a survivor of an employee
24 or annuitant with 20 or more years of creditable service.
25 The remainder of the cost of the new SERS survivor's coverage
26 under the basic program of group health benefits shall be the
27 responsibility of the survivor.
28 (a-3) Beginning January 1, 1998, for each person who
29 becomes a new SURS annuitant and participates in the basic
30 program of group health benefits, the State shall contribute
31 toward the cost of the annuitant's coverage under the basic
32 program of group health benefits an amount equal to 5% of
33 that cost for each full year of creditable service upon which
34 the annuitant's retirement annuity is based, up to a maximum
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1 of 100% for an annuitant with 20 or more years of creditable
2 service. The remainder of the cost of a new SURS annuitant's
3 coverage under the basic program of group health benefits
4 shall be the responsibility of the annuitant.
5 (a-4) Beginning January 1, 1998, for each person who
6 becomes a new SURS retired employee and participates in the
7 basic program of group health benefits, the State shall
8 contribute toward the cost of the retired employee's coverage
9 under the basic program of group health benefits an amount
10 equal to 5% of that cost for each full year that the retired
11 employee was an employee as defined in Section 3, up to a
12 maximum of 100% for a retired employee who was an employee
13 for 20 or more years. The remainder of the cost of a new
14 SURS retired employee's coverage under the basic program of
15 group health benefits shall be the responsibility of the
16 retired employee.
17 (a-5) Beginning January 1, 1998, for each person who
18 becomes a new SURS survivor and participates in the basic
19 program of group health benefits, the State shall contribute
20 toward the cost of the survivor's coverage under the basic
21 program of group health benefits an amount equal to 5% of
22 that cost for each full year of the deceased employee's or
23 deceased annuitant's creditable service in the State
24 Universities Retirement System on the date of death, up to a
25 maximum of 100% for a survivor of an employee or annuitant
26 with 20 or more years of creditable service. The remainder
27 of the cost of the new SURS survivor's coverage under the
28 basic program of group health benefits shall be the
29 responsibility of the survivor.
30 (a-6) Beginning July 1, 1998, for each person who
31 becomes a new TRS State annuitant and participates in the
32 basic program of group health benefits, the State shall
33 contribute toward the cost of the annuitant's coverage under
34 the basic program of group health benefits an amount equal to
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1 5% of that cost for each full year of creditable service as a
2 teacher as defined in paragraph (2), (3), or (5) of Section
3 16-106 of the Illinois Pension Code upon which the
4 annuitant's retirement annuity is based, up to a maximum of
5 100% for an annuitant with 20 or more years of such
6 creditable service. The remainder of the cost of a new TRS
7 State annuitant's coverage under the basic program of group
8 health benefits shall be the responsibility of the annuitant.
9 (a-7) Beginning July 1, 1998, for each person who
10 becomes a new TRS State survivor and participates in the
11 basic program of group health benefits, the State shall
12 contribute toward the cost of the survivor's coverage under
13 the basic program of group health benefits an amount equal to
14 5% of that cost for each full year of the deceased employee's
15 or deceased annuitant's creditable service as a teacher as
16 defined in paragraph (2), (3), or (5) of Section 16-106 of
17 the Illinois Pension Code on the date of death, up to a
18 maximum of 100% for a survivor of an employee or annuitant
19 with 20 or more years of such creditable service. The
20 remainder of the cost of the new TRS State survivor's
21 coverage under the basic program of group health benefits
22 shall be the responsibility of the survivor.
23 (a-8) A new SERS annuitant, new SERS survivor, new SURS
24 annuitant, new SURS retired employee, new SURS survivor, new
25 TRS State annuitant, or new TRS State survivor may waive or
26 terminate coverage in the program of group health benefits.
27 Any such annuitant, survivor, or retired employee who has
28 waived or terminated coverage may enroll or re-enroll in the
29 program of group health benefits only during the annual
30 benefit choice period, as determined by the Director; except
31 that in the event of termination of coverage due to
32 nonpayment of premiums, the annuitant, survivor, or retired
33 employee may not re-enroll in the program.
34 (a-9) No later than May 1 of each calendar year, the
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1 Director of Central Management Services shall certify in
2 writing to the Executive Secretary of the State Employees'
3 Retirement System of Illinois the amounts of the Medicare
4 supplement health care premiums and the amounts of the health
5 care premiums for all other retirees who are not Medicare
6 eligible.
7 A separate calculation of the premiums based upon the
8 actual cost of each health care plan shall be so certified.
9 The Director of Central Management Services shall provide
10 to the Executive Secretary of the State Employees' Retirement
11 System of Illinois such information, statistics, and other
12 data as he or she may require to review the premium amounts
13 certified by the Director of Central Management Services.
14 (b) State employees who become eligible for this program
15 on or after January 1, 1980 in positions normally requiring
16 actual performance of duty not less than 1/2 of a normal work
17 period but not equal to that of a normal work period, shall
18 be given the option of participating in the available
19 program. If the employee elects coverage, the State shall
20 contribute on behalf of such employee to the cost of the
21 employee's benefit and any applicable dependent supplement,
22 that sum which bears the same percentage as that percentage
23 of time the employee regularly works when compared to normal
24 work period.
25 (c) The basic non-contributory coverage from the basic
26 program of group health benefits shall be continued for each
27 employee not in pay status or on active service by reason of
28 (1) leave of absence due to illness or injury, (2) authorized
29 educational leave of absence or sabbatical leave, or (3)
30 military leave with pay and benefits. This coverage shall
31 continue until expiration of authorized leave and return to
32 active service, but not to exceed 24 months for leaves under
33 item (1) or (2). This 24-month limitation and the requirement
34 of returning to active service shall not apply to persons
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1 receiving ordinary or accidental disability benefits or
2 retirement benefits through the appropriate State retirement
3 system or benefits under the Workers' Compensation or
4 Occupational Disease Act.
5 (d) The basic group life insurance coverage shall
6 continue, with full State contribution, where such person is
7 (1) absent from active service by reason of disability
8 arising from any cause other than self-inflicted, (2) on
9 authorized educational leave of absence or sabbatical leave,
10 or (3) on military leave with pay and benefits.
11 (e) Where the person is in non-pay status for a period
12 in excess of 30 days or on leave of absence, other than by
13 reason of disability, educational or sabbatical leave, or
14 military leave with pay and benefits, such person may
15 continue coverage only by making personal payment equal to
16 the amount normally contributed by the State on such person's
17 behalf. Such payments and coverage may be continued: (1)
18 until such time as the person returns to a status eligible
19 for coverage at State expense, but not to exceed 24 months,
20 (2) until such person's employment or annuitant status with
21 the State is terminated, or (3) for a maximum period of 4
22 years for members on military leave with pay and benefits and
23 military leave without pay and benefits (exclusive of any
24 additional service imposed pursuant to law).
25 (f) The Department shall establish by rule the extent
26 to which other employee benefits will continue for persons in
27 non-pay status or who are not in active service.
28 (g) The State shall not pay the cost of the basic
29 non-contributory group life insurance, program of health
30 benefits and other employee benefits for members who are
31 survivors as defined by paragraphs (1) and (2) of subsection
32 (q) of Section 3 of this Act. The costs of benefits for
33 these survivors shall be paid by the survivors or by the
34 University of Illinois Cooperative Extension Service, or any
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1 combination thereof.
2 (h) Those persons occupying positions with any
3 department as a result of emergency appointments pursuant to
4 Section 8b.8 of the Personnel Code who are not considered
5 employees under this Act shall be given the option of
6 participating in the programs of group life insurance, health
7 benefits and other employee benefits. Such persons electing
8 coverage may participate only by making payment equal to the
9 amount normally contributed by the State for similarly
10 situated employees. Such amounts shall be determined by the
11 Director. Such payments and coverage may be continued until
12 such time as the person becomes an employee pursuant to this
13 Act or such person's appointment is terminated.
14 (i) Any unit of local government within the State of
15 Illinois may apply to the Director to have its employees,
16 annuitants, and their dependents provided group health
17 coverage under this Act on a non-insured basis. To
18 participate, a unit of local government must agree to enroll
19 all of its employees, who may select coverage under either
20 the State group health insurance plan or a health maintenance
21 organization that has contracted with the State to be
22 available as a health care provider for employees as defined
23 in this Act. A unit of local government must remit the
24 entire cost of providing coverage under the State group
25 health insurance plan or, for coverage under a health
26 maintenance organization, an amount determined by the
27 Director based on an analysis of the sex, age, geographic
28 location, or other relevant demographic variables for its
29 employees, except that the unit of local government shall not
30 be required to enroll those of its employees who are covered
31 spouses or dependents under this plan or another group policy
32 or plan providing health benefits as long as (1) an
33 appropriate official from the unit of local government
34 attests that each employee not enrolled is a covered spouse
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1 or dependent under this plan or another group policy or plan,
2 and (2) at least 85% of the employees are enrolled and the
3 unit of local government remits the entire cost of providing
4 coverage to those employees, except that a participating
5 school district must have enrolled at least 85% of its
6 full-time employees who have not waived coverage under the
7 district's group health plan by participating in a component
8 of the district's cafeteria plan. A participating school
9 district is not required to enroll a full-time employee who
10 has waived coverage under the district's health plan,
11 provided that an appropriate official from the participating
12 school district attests that the full-time employee has
13 waived coverage by participating in a component of the
14 district's cafeteria plan. For the purposes of this
15 subsection, "participating school district" includes a unit
16 of local government whose primary purpose is education as
17 defined by the Department's rules.
18 Employees of a participating unit of local government who
19 are not enrolled due to coverage under another group health
20 policy or plan may enroll at a later date subject to
21 submission of satisfactory evidence of insurability and
22 provided that no benefits shall be payable for services
23 incurred during the first 6 months of coverage to the extent
24 the services are in connection with any pre-existing
25 condition. A participating unit of local government may also
26 elect to cover its annuitants. Dependent coverage shall be
27 offered on an optional basis, with the costs paid by the unit
28 of local government, its employees, or some combination of
29 the two as determined by the unit of local government. The
30 unit of local government shall be responsible for timely
31 collection and transmission of dependent premiums.
32 The Director shall annually determine monthly rates of
33 payment, subject to the following constraints:
34 (1) In the first year of coverage, the rates shall
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1 be equal to the amount normally charged to State
2 employees for elected optional coverages or for enrolled
3 dependents coverages or other contributory coverages, or
4 contributed by the State for basic insurance coverages on
5 behalf of its employees, adjusted for differences between
6 State employees and employees of the local government in
7 age, sex, geographic location or other relevant
8 demographic variables, plus an amount sufficient to pay
9 for the additional administrative costs of providing
10 coverage to employees of the unit of local government and
11 their dependents.
12 (2) In subsequent years, a further adjustment shall
13 be made to reflect the actual prior years' claims
14 experience of the employees of the unit of local
15 government.
16 In the case of coverage of local government employees
17 under a health maintenance organization, the Director shall
18 annually determine for each participating unit of local
19 government the maximum monthly amount the unit may contribute
20 toward that coverage, based on an analysis of (i) the age,
21 sex, geographic location, and other relevant demographic
22 variables of the unit's employees and (ii) the cost to cover
23 those employees under the State group health insurance plan.
24 The Director may similarly determine the maximum monthly
25 amount each unit of local government may contribute toward
26 coverage of its employees' dependents under a health
27 maintenance organization.
28 Monthly payments by the unit of local government or its
29 employees for group health insurance or health maintenance
30 organization coverage shall be deposited in the Local
31 Government Health Insurance Reserve Fund. The Local
32 Government Health Insurance Reserve Fund shall be a
33 continuing fund not subject to fiscal year limitations. All
34 expenditures from this fund shall be used for payments for
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1 health care benefits for local government and rehabilitation
2 facility employees, annuitants, and dependents, and to
3 reimburse the Department or its administrative service
4 organization for all expenses incurred in the administration
5 of benefits. No other State funds may be used for these
6 purposes.
7 A local government employer's participation or desire to
8 participate in a program created under this subsection shall
9 not limit that employer's duty to bargain with the
10 representative of any collective bargaining unit of its
11 employees.
12 (j) Any rehabilitation facility within the State of
13 Illinois may apply to the Director to have its employees,
14 annuitants, and their dependents provided group health
15 coverage under this Act on a non-insured basis. To
16 participate, a rehabilitation facility must agree to enroll
17 all of its employees and remit the entire cost of providing
18 such coverage for its employees, except that the
19 rehabilitation facility shall not be required to enroll those
20 of its employees who are covered spouses or dependents under
21 this plan or another group policy or plan providing health
22 benefits as long as (1) an appropriate official from the
23 rehabilitation facility attests that each employee not
24 enrolled is a covered spouse or dependent under this plan or
25 another group policy or plan, and (2) at least 85% of the
26 employees are enrolled and the rehabilitation facility remits
27 the entire cost of providing coverage to those employees.
28 Employees of a participating rehabilitation facility who are
29 not enrolled due to coverage under another group health
30 policy or plan may enroll at a later date subject to
31 submission of satisfactory evidence of insurability and
32 provided that no benefits shall be payable for services
33 incurred during the first 6 months of coverage to the extent
34 the services are in connection with any pre-existing
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1 condition. A participating rehabilitation facility may also
2 elect to cover its annuitants. Dependent coverage shall be
3 offered on an optional basis, with the costs paid by the
4 rehabilitation facility, its employees, or some combination
5 of the 2 as determined by the rehabilitation facility. The
6 rehabilitation facility shall be responsible for timely
7 collection and transmission of dependent premiums.
8 The Director shall annually determine quarterly rates of
9 payment, subject to the following constraints:
10 (1) In the first year of coverage, the rates shall
11 be equal to the amount normally charged to State
12 employees for elected optional coverages or for enrolled
13 dependents coverages or other contributory coverages on
14 behalf of its employees, adjusted for differences between
15 State employees and employees of the rehabilitation
16 facility in age, sex, geographic location or other
17 relevant demographic variables, plus an amount sufficient
18 to pay for the additional administrative costs of
19 providing coverage to employees of the rehabilitation
20 facility and their dependents.
21 (2) In subsequent years, a further adjustment shall
22 be made to reflect the actual prior years' claims
23 experience of the employees of the rehabilitation
24 facility.
25 Monthly payments by the rehabilitation facility or its
26 employees for group health insurance shall be deposited in
27 the Local Government Health Insurance Reserve Fund.
28 (k) Any domestic violence shelter or service within the
29 State of Illinois may apply to the Director to have its
30 employees, annuitants, and their dependents provided group
31 health coverage under this Act on a non-insured basis. To
32 participate, a domestic violence shelter or service must
33 agree to enroll all of its employees and pay the entire cost
34 of providing such coverage for its employees. A
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1 participating domestic violence shelter may also elect to
2 cover its annuitants. Dependent coverage shall be offered on
3 an optional basis, with employees, or some combination of the
4 2 as determined by the domestic violence shelter or service.
5 The domestic violence shelter or service shall be responsible
6 for timely collection and transmission of dependent premiums.
7 The Director shall annually determine quarterly rates of
8 payment, subject to the following constraints:
9 (1) In the first year of coverage, the rates shall
10 be equal to the amount normally charged to State
11 employees for elected optional coverages or for enrolled
12 dependents coverages or other contributory coverages on
13 behalf of its employees, adjusted for differences between
14 State employees and employees of the domestic violence
15 shelter or service in age, sex, geographic location or
16 other relevant demographic variables, plus an amount
17 sufficient to pay for the additional administrative costs
18 of providing coverage to employees of the domestic
19 violence shelter or service and their dependents.
20 (2) In subsequent years, a further adjustment shall
21 be made to reflect the actual prior years' claims
22 experience of the employees of the domestic violence
23 shelter or service.
24 (3) In no case shall the rate be less than the
25 amount normally charged to State employees or contributed
26 by the State on behalf of its employees.
27 Monthly payments by the domestic violence shelter or
28 service or its employees for group health insurance shall be
29 deposited in the Local Government Health Insurance Reserve
30 Fund.
31 (l) A public community college or entity organized
32 pursuant to the Public Community College Act may apply to the
33 Director initially to have only annuitants not covered prior
34 to July 1, 1992 by the district's health plan provided health
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1 coverage under this Act on a non-insured basis. The
2 community college must execute a 2-year contract to
3 participate in the Local Government Health Plan. Those
4 annuitants enrolled initially under this contract shall have
5 no benefits payable for services incurred during the first 6
6 months of coverage to the extent the services are in
7 connection with any pre-existing condition. Any annuitant
8 who may enroll after this initial enrollment period shall be
9 subject to submission of satisfactory evidence of
10 insurability and to the pre-existing conditions limitation.
11 The Director shall annually determine monthly rates of
12 payment subject to the following constraints: for those
13 community colleges with annuitants only enrolled, first year
14 rates shall be equal to the average cost to cover claims for
15 a State member adjusted for demographics, Medicare
16 participation, and other factors; and in the second year, a
17 further adjustment of rates shall be made to reflect the
18 actual first year's claims experience of the covered
19 annuitants.
20 (m) The Director shall adopt any rules deemed necessary
21 for implementation of this amendatory Act of 1989 (Public Act
22 86-978).
23 (Source: P.A. 89-53, eff. 7-1-95; 89-236, eff. 8-4-95;
24 89-324, eff. 8-13-95; 89-626, eff. 8-9-96; 90-65, eff.
25 7-7-97; 90-582, eff. 5-27-98; 90-655, eff. 7-30-98; revised
26 8-3-98.)
27 Section 99. Effective date. This Act takes effect upon
28 becoming law.