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91_HB1469enr HB1469 Enrolled 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 HB1469 Enrolled -2- LRB9104603MWpc 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 HB1469 Enrolled -3- LRB9104603MWpc 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 HB1469 Enrolled -4- LRB9104603MWpc 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 HB1469 Enrolled -5- LRB9104603MWpc 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 HB1469 Enrolled -6- LRB9104603MWpc 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 HB1469 Enrolled -7- LRB9104603MWpc 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 HB1469 Enrolled -8- LRB9104603MWpc 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 HB1469 Enrolled -9- LRB9104603MWpc 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 HB1469 Enrolled -10- LRB9104603MWpc 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 HB1469 Enrolled -11- LRB9104603MWpc 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 HB1469 Enrolled -12- LRB9104603MWpc 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 HB1469 Enrolled -13- LRB9104603MWpc 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.