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91_HB2720
LRB9100169EGfgB
1 AN ACT to amend the State Employees Group Insurance Act
2 of 1971.
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 3, 5, 6, 8, 9, 10, 13,
7 13.1, 13.2, and 15 as follows:
8 (5 ILCS 375/3) (from Ch. 127, par. 523)
9 Sec. 3. Definitions. Unless the context otherwise
10 requires, the following words and phrases as used in this Act
11 shall have the following meanings. The Department may define
12 these and other words and phrases separately for the purpose
13 of implementing specific programs providing benefits under
14 this Act.
15 (a) "Administrative service organization" means any
16 person, firm or corporation experienced in the handling of
17 claims which is fully qualified, financially sound and
18 capable of meeting the service requirements of a contract of
19 administration executed with the Department.
20 (b) "Annuitant" means (1) an employee who retires, or
21 has retired, on or after January 1, 1966 on an immediate
22 annuity under the provisions of Articles 2, 14, 15 (including
23 an employee who has retired under the optional retirement
24 program established under Section 15-158.2), paragraphs (2),
25 (3), or (5) of Section 16-106, or Article 18 of the Illinois
26 Pension Code; (2) any person who was receiving group
27 insurance coverage under this Act as of March 31, 1978 by
28 reason of his status as an annuitant, even though the annuity
29 in relation to which such coverage was provided is a
30 proportional annuity based on less than the minimum period of
31 service required for a retirement annuity in the system
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1 involved; (3) any person not otherwise covered by this Act
2 who has retired as a participating member under Article 2 of
3 the Illinois Pension Code but is ineligible for the
4 retirement annuity under Section 2-119 of the Illinois
5 Pension Code; (4) the spouse of any person who is receiving a
6 retirement annuity under Article 18 of the Illinois Pension
7 Code and who is covered under a group health insurance
8 program sponsored by a governmental employer other than the
9 State of Illinois and who has irrevocably elected to waive
10 his or her coverage under this Act and to have his or her
11 spouse considered as the "annuitant" under this Act and not
12 as a "dependent"; or (5) an employee who retires, or has
13 retired, from a qualified position, as determined according
14 to rules promulgated by the Director, under a qualified local
15 government or a qualified rehabilitation facility or a
16 qualified domestic violence shelter or service. (For
17 definition of "retired employee", see (p) post).
18 (b-5) "New SERS annuitant" means a person who, on or
19 after January 1, 1998, becomes an annuitant, as defined in
20 subsection (b), by virtue of beginning to receive a
21 retirement annuity under Article 14 of the Illinois Pension
22 Code, and is eligible to participate in the basic program of
23 group health benefits provided for annuitants under this Act.
24 (b-6) "New SURS annuitant" means a person who, on or
25 after January 1, 1998, becomes an annuitant, as defined in
26 subsection (b), by virtue of beginning to receive a
27 retirement annuity under Article 15 of the Illinois Pension
28 Code, and is eligible to participate in the basic program of
29 group health benefits provided for annuitants under this Act.
30 (b-7) "New TRS State annuitant" means a person who, on
31 or after July 1, 1998, becomes an annuitant, as defined in
32 subsection (b), by virtue of beginning to receive a
33 retirement annuity under Article 16 of the Illinois Pension
34 Code based on service as a teacher as defined in paragraph
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1 (2), (3), or (5) of Section 16-106 of that Code, and is
2 eligible to participate in the basic program of group health
3 benefits provided for annuitants under this Act.
4 (c) "Carrier" means (1) an insurance company, a
5 corporation organized under the Limited Health Service
6 Organization Act or the Voluntary Health Services Plan Act, a
7 partnership, or other nongovernmental organization, which is
8 authorized to do group life or group health insurance
9 business in Illinois, or (2) the State of Illinois as a
10 self-insurer.
11 (d) "Compensation" means salary or wages payable on a
12 regular payroll by the State Treasurer on a warrant of the
13 State Comptroller out of any State, trust or federal fund, or
14 by the Governor of the State through a disbursing officer of
15 the State out of a trust or out of federal funds, or by any
16 Department out of State, trust, federal or other funds held
17 by the State Treasurer or the Department, to any person for
18 personal services currently performed, and ordinary or
19 accidental disability benefits under Articles 2, 14, 15
20 (including ordinary or accidental disability benefits under
21 the optional retirement program established under Section
22 15-158.2), paragraphs (2), (3), or (5) of Section 16-106, or
23 Article 18 of the Illinois Pension Code, for disability
24 incurred after January 1, 1966, or benefits payable under the
25 Workers' Compensation or Occupational Diseases Act or
26 benefits payable under a sick pay plan established in
27 accordance with Section 36 of the State Finance Act.
28 "Compensation" also means salary or wages paid to an employee
29 of any qualified local government or qualified rehabilitation
30 facility or a qualified domestic violence shelter or service.
31 (e) "Commission" means the State Employees Group
32 Insurance Advisory Commission authorized by this Act.
33 Commencing July 1, 1984, "Commission" as used in this Act
34 means the Illinois Economic and Fiscal Commission as
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1 established by the Legislative Commission Reorganization Act
2 of 1984.
3 (f) "Contributory", when referred to as contributory
4 coverage, shall mean optional coverages or benefits elected
5 by the member toward the cost of which such member makes
6 contribution, or which are funded in whole or in part through
7 the acceptance of a reduction in earnings or the foregoing of
8 an increase in earnings by an employee, as distinguished from
9 noncontributory coverage or benefits which are paid entirely
10 by the State of Illinois without reduction of the member's
11 salary.
12 (g) "Department" means any department, institution,
13 board, commission, officer, court or any agency of the State
14 government receiving appropriations and having power to
15 certify payrolls to the Comptroller authorizing payments of
16 salary and wages against such appropriations as are made by
17 the General Assembly from any State fund, or against trust
18 funds held by the State Treasurer and includes boards of
19 trustees of the retirement systems created by Articles 2, 14,
20 15, 16 and 18 of the Illinois Pension Code. "Department"
21 also includes the Illinois Comprehensive Health Insurance
22 Board, the Board of Examiners established under the Illinois
23 Public Accounting Act, and the Illinois Rural Bond Bank.
24 (h) "Dependent", when the term is used in the context of
25 the health and life plan, means a member's spouse and any
26 unmarried child (1) from birth to age 19 including an adopted
27 child, a child who lives with the member from the time of the
28 filing of a petition for adoption until entry of an order of
29 adoption, a stepchild or recognized child who lives with the
30 member in a parent-child relationship, or a child who lives
31 with the member if such member is a court appointed guardian
32 of the child, or (2) age 19 to 23 enrolled as a full-time
33 student in any accredited school, financially dependent upon
34 the member, and eligible to be claimed as a dependent for
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1 Illinois State income tax purposes, or (3) age 19 or over who
2 is mentally or physically handicapped as defined in the
3 Illinois Insurance Code. For the health plan only, the term
4 "dependent" also includes any person enrolled prior to the
5 effective date of this Section who is dependent upon the
6 member to the extent that the member may claim such person as
7 a dependent for Illinois State income tax deduction purposes;
8 no other such person may be enrolled.
9 (i) "Director" means the Director of the Illinois
10 Department of Central Management Services.
11 (j) "Eligibility period" means the period of time a
12 member has to elect enrollment in programs or to select
13 benefits without regard to age, sex or health.
14 (k) "Employee" means and includes each officer or
15 employee in the service of a department who (1) receives his
16 compensation for service rendered to the department on a
17 warrant issued pursuant to a payroll certified by a
18 department or on a warrant or check issued and drawn by a
19 department upon a trust, federal or other fund or on a
20 warrant issued pursuant to a payroll certified by an elected
21 or duly appointed officer of the State or who receives
22 payment of the performance of personal services on a warrant
23 issued pursuant to a payroll certified by a Department and
24 drawn by the Comptroller upon the State Treasurer against
25 appropriations made by the General Assembly from any fund or
26 against trust funds held by the State Treasurer, and (2) is
27 employed full-time or part-time in a position normally
28 requiring actual performance of duty during not less than 1/2
29 of a normal work period, as established by the Director in
30 cooperation with each department, except that persons elected
31 by popular vote will be considered employees during the
32 entire term for which they are elected regardless of hours
33 devoted to the service of the State, and (3) except that
34 "employee" does not include any person who is not eligible by
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1 reason of such person's employment to participate in one of
2 the State retirement systems under Articles 2, 14, 15 (either
3 the regular Article 15 system or the optional retirement
4 program established under Section 15-158.2) or 18, or under
5 paragraph (2), (3), or (5) of Section 16-106, of the Illinois
6 Pension Code, but such term does include persons who are
7 employed during the 6 month qualifying period under Article
8 14 of the Illinois Pension Code. Such term also includes any
9 person who (1) after January 1, 1966, is receiving ordinary
10 or accidental disability benefits under Articles 2, 14, 15
11 (including ordinary or accidental disability benefits under
12 the optional retirement program established under Section
13 15-158.2), paragraphs (2), (3), or (5) of Section 16-106, or
14 Article 18 of the Illinois Pension Code, for disability
15 incurred after January 1, 1966, (2) receives total permanent
16 or total temporary disability under the Workers' Compensation
17 Act or Occupational Disease Act as a result of injuries
18 sustained or illness contracted in the course of employment
19 with the State of Illinois, or (3) is not otherwise covered
20 under this Act and has retired as a participating member
21 under Article 2 of the Illinois Pension Code but is
22 ineligible for the retirement annuity under Section 2-119 of
23 the Illinois Pension Code. However, a person who satisfies
24 the criteria of the foregoing definition of "employee" except
25 that such person is made ineligible to participate in the
26 State Universities Retirement System by clause (4) of
27 subsection (a) of Section 15-107 of the Illinois Pension Code
28 is also an "employee" for the purposes of this Act.
29 "Employee" also includes any person receiving or eligible for
30 benefits under a sick pay plan established in accordance with
31 Section 36 of the State Finance Act. "Employee" also includes
32 each officer or employee in the service of a qualified local
33 government, including persons appointed as trustees of
34 sanitary districts regardless of hours devoted to the service
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1 of the sanitary district, and each employee in the service of
2 a qualified rehabilitation facility and each full-time
3 employee in the service of a qualified domestic violence
4 shelter or service, as determined according to rules
5 promulgated by the Director.
6 (l) "Member" means an employee, annuitant, retired
7 employee or survivor.
8 (m) "Optional coverages or benefits" means those
9 coverages or benefits available to the member on his or her
10 voluntary election, and at his or her own expense.
11 (n) "Program" means the group life insurance, health
12 benefits and other employee benefits designed and contracted
13 for by the Director under this Act.
14 (o) "Health plan" means a self-insured health benefits
15 insurance program offered by the State of Illinois for
16 persons eligible for the plan the purposes of benefiting
17 employees by means of providing, among others, wellness
18 programs, utilization reviews, second opinions and medical
19 fee reviews, as well as for paying for hospital and medical
20 care up to the maximum coverage provided by the plan, to its
21 members and their dependents.
22 (p) "Retired employee" means any person who would be an
23 annuitant as that term is defined herein but for the fact
24 that such person retired prior to January 1, 1966. Such term
25 also includes any person formerly employed by the University
26 of Illinois in the Cooperative Extension Service who would be
27 an annuitant but for the fact that such person was made
28 ineligible to participate in the State Universities
29 Retirement System by clause (4) of subsection (a) of Section
30 15-107 of the Illinois Pension Code.
31 (p-6) "New SURS retired employee" means a person who, on
32 or after January 1, 1998, becomes a retired employee, as
33 defined in subsection (p), by virtue of being a person
34 formerly employed by the University of Illinois in the
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1 Cooperative Extension Service who would be an annuitant but
2 for the fact that he or she was made ineligible to
3 participate in the State Universities Retirement System by
4 clause (4) of subsection (a) of Section 15-107 of the
5 Illinois Pension Code, and who is eligible to participate in
6 the basic program of group health benefits provided for
7 retired employees under this Act.
8 (q) "Survivor" means a person receiving an annuity as a
9 survivor of an employee or of an annuitant. "Survivor" also
10 includes: (1) the surviving dependent of a person who
11 satisfies the definition of "employee" except that such
12 person is made ineligible to participate in the State
13 Universities Retirement System by clause (4) of subsection
14 (a) of Section 15-107 of the Illinois Pension Code; and (2)
15 the surviving dependent of any person formerly employed by
16 the University of Illinois in the Cooperative Extension
17 Service who would be an annuitant except for the fact that
18 such person was made ineligible to participate in the State
19 Universities Retirement System by clause (4) of subsection
20 (a) of Section 15-107 of the Illinois Pension Code.
21 (q-5) "New SERS survivor" means a survivor, as defined
22 in subsection (q), whose annuity is paid under Article 14 of
23 the Illinois Pension Code and is based on the death of (i) an
24 employee whose death occurs on or after January 1, 1998, or
25 (ii) a new SERS annuitant as defined in subsection (b-5).
26 (q-6) "New SURS survivor" means a survivor, as defined
27 in subsection (q), whose annuity is paid under Article 15 of
28 the Illinois Pension Code and is based on the death of (i) an
29 employee whose death occurs on or after January 1, 1998, (ii)
30 a new SURS annuitant as defined in subsection (b-6), or (iii)
31 a new SURS retired employee as defined in subsection (p-6).
32 (q-7) "New TRS State survivor" means a survivor, as
33 defined in subsection (q), whose annuity is paid under
34 Article 16 of the Illinois Pension Code and is based on the
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1 death of (i) an employee who is a teacher as defined in
2 paragraph (2), (3), or (5) of Section 16-106 of that Code and
3 whose death occurs on or after July 1, 1998, or (ii) a new
4 TRS State annuitant as defined in subsection (b-7).
5 (r) "Medical services" means the services provided
6 within the scope of their licenses by practitioners in all
7 categories licensed under the Medical Practice Act of 1987.
8 (s) "Unit of local government" means any county,
9 municipality, township, school district, special district or
10 other unit, designated as a unit of local government by law,
11 which exercises limited governmental powers or powers in
12 respect to limited governmental subjects, any not-for-profit
13 association with a membership that primarily includes
14 townships and township officials, that has duties that
15 include provision of research service, dissemination of
16 information, and other acts for the purpose of improving
17 township government, and that is funded wholly or partly in
18 accordance with Section 85-15 of the Township Code; any
19 not-for-profit corporation or association, with a membership
20 consisting primarily of municipalities, that operates its own
21 utility system, and provides research, training,
22 dissemination of information, or other acts to promote
23 cooperation between and among municipalities that provide
24 utility services and for the advancement of the goals and
25 purposes of its membership; and the Illinois Association of
26 Park Districts. "Qualified local government" means a unit of
27 local government approved by the Director and participating
28 in a program created under subsection (i) of Section 10 of
29 this Act.
30 (t) "Qualified rehabilitation facility" means any
31 not-for-profit organization that is accredited by the
32 Commission on Accreditation of Rehabilitation Facilities or
33 certified by the Department of Human Services (as successor
34 to the Department of Mental Health and Developmental
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1 Disabilities) to provide services to persons with
2 disabilities and which receives funds from the State of
3 Illinois for providing those services, approved by the
4 Director and participating in a program created under
5 subsection (j) of Section 10 of this Act.
6 (u) "Qualified domestic violence shelter or service"
7 means any Illinois domestic violence shelter or service and
8 its administrative offices funded by the Department of Human
9 Services (as successor to the Illinois Department of Public
10 Aid), approved by the Director and participating in a program
11 created under subsection (k) of Section 10.
12 (v) "TRS benefit recipient" means a person who:
13 (1) is not a "member" as defined in this Section;
14 and
15 (2) is receiving a monthly benefit or retirement
16 annuity under Article 16 of the Illinois Pension Code;
17 and
18 (3) either (i) has at least 8 years of creditable
19 service under Article 16 of the Illinois Pension Code, or
20 (ii) was enrolled in the health insurance program offered
21 under that Article on January 1, 1996, or (iii) is the
22 survivor of a benefit recipient who had at least 8 years
23 of creditable service under Article 16 of the Illinois
24 Pension Code or was enrolled in the health insurance
25 program offered under that Article on the effective date
26 of this amendatory Act of 1995, or (iv) is a recipient or
27 survivor of a recipient of a disability benefit under
28 Article 16 of the Illinois Pension Code.
29 (w) "TRS dependent beneficiary" means a person who:
30 (1) is not a "member" or "dependent" as defined in
31 this Section; and
32 (2) is a TRS benefit recipient's: (A) spouse, (B)
33 dependent parent who is receiving at least half of his or
34 her support from the TRS benefit recipient, or (C)
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1 unmarried natural or adopted child who is (i) under age
2 19, or (ii) enrolled as a full-time student in an
3 accredited school, financially dependent upon the TRS
4 benefit recipient, eligible to be claimed as a dependent
5 for Illinois State income tax purposes, and either is
6 under age 24 or was, on January 1, 1996, participating as
7 a dependent beneficiary in the health insurance program
8 offered under Article 16 of the Illinois Pension Code, or
9 (iii) age 19 or over who is mentally or physically
10 handicapped as defined in the Illinois Insurance Code.
11 (x) "Military leave with pay and benefits" refers to
12 individuals in basic training for reserves, special/advanced
13 training, annual training, emergency call up, or activation
14 by the President of the United States with approved pay and
15 benefits.
16 (y) "Military leave without pay and benefits" refers to
17 individuals who enlist for active duty in a regular component
18 of the U.S. Armed Forces or other duty not specified or
19 authorized under military leave with pay and benefits.
20 (z) "Community college benefit recipient" means a person
21 who:
22 (1) is not a "member" as defined in this Section;
23 and
24 (2) is receiving a monthly survivor's annuity or
25 retirement annuity under Article 15 of the Illinois
26 Pension Code; and
27 (3) either (i) was a full-time employee of a
28 community college district or an association of community
29 college boards created under the Public Community College
30 Act (other than an employee whose last employer under
31 Article 15 of the Illinois Pension Code was a community
32 college district subject to Article VII of the Public
33 Community College Act) and was eligible to participate in
34 a group health benefit plan as an employee during the
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1 time of employment with a community college district
2 (other than a community college district subject to
3 Article VII of the Public Community College Act) or an
4 association of community college boards, or (ii) is the
5 survivor of a person described in item (i).
6 (aa) "Community college dependent beneficiary" means a
7 person who:
8 (1) is not a "member" or "dependent" as defined in
9 this Section; and
10 (2) is a community college benefit recipient's: (A)
11 spouse, (B) dependent parent who is receiving at least
12 half of his or her support from the community college
13 benefit recipient, or (C) unmarried natural or adopted
14 child who is (i) under age 19, or (ii) enrolled as a
15 full-time student in an accredited school, financially
16 dependent upon the community college benefit recipient,
17 eligible to be claimed as a dependent for Illinois State
18 income tax purposes and under age 23, or (iii) age 19 or
19 over and mentally or physically handicapped as defined in
20 the Illinois Insurance Code.
21 (Source: P.A. 89-21, eff. 6-21-95; 89-25, eff. 6-21-95;
22 89-76, eff. 7-1-95; 89-324, eff. 8-13-95; 89-430, eff.
23 12-15-95; 89-502, eff. 7-1-96; 89-507, eff. 7-1-97; 89-628,
24 eff. 8-9-96; 90-14, eff. 7-1-97; 90-65, eff. 7-7-97; 90-448,
25 eff. 8-16-97; 90-497, eff. 8-18-97; 90-511, eff. 8-22-97;
26 90-582, eff. 5-27-98; 90-655, eff. 7-30-98.)
27 (5 ILCS 375/5) (from Ch. 127, par. 525)
28 Sec. 5. The Director shall contract or otherwise make
29 available group life insurance, health benefits and other
30 employee benefits to eligible members and, where elected,
31 their eligible dependents. Any contract or, if applicable,
32 contracts or other arrangement for provision of benefits
33 shall be on terms deemed by the Director to be in the best
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1 interest of the State of Illinois and its members based on,
2 but not limited to, such criteria as administrative cost,
3 service capabilities of the carrier or other contractor and
4 premiums, fees or charges as related to benefits.
5 The Director may prepare and issue specifications for
6 group life insurance, health benefits, other employee
7 benefits and administrative services for the purpose of
8 receiving proposals from interested parties.
9 The Director is authorized to execute a contract, or
10 contracts, for the programs of group life insurance, health
11 benefits, other employee benefits and administrative services
12 authorized by this Act. All of the benefits provided under
13 this Act may be included in one or more contracts, or the
14 benefits may be classified into different types with each
15 type included under one or more similar contracts with the
16 same or different companies.
17 The program of health benefits shall offer each member a
18 choice between high and low options for dependent coverage.
19 The term of any contract may not extend beyond 5 fiscal
20 years. Upon recommendation of the Commission, the Director
21 may exercise renewal options of the same contract for up to a
22 period of 5 years. Any increases in premiums, fees or
23 charges requested by a contractor whose contract may be
24 renewed pursuant to a renewal option contained therein, must
25 be justified on the basis of (1) audited experience data, (2)
26 increases in the costs of health care services provided under
27 the contract, (3) contractor performance, (4) increases in
28 contractor responsibilities, or (5) any combination thereof.
29 Any contractor shall agree to abide by all requirements
30 of this Act and Rules and Regulations promulgated and adopted
31 thereto; to submit such information and data as may from time
32 to time be deemed necessary by the Director for effective
33 administration of the provisions of this Act and the programs
34 established hereunder, and to fully cooperate in any the
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1 annual audit required under Section 15, paragraph (g) herein.
2 (Source: P.A. 85-848.)
3 (5 ILCS 375/6) (from Ch. 127, par. 526)
4 Sec. 6. (a) The program of health benefits shall provide
5 for protection against the financial costs of health care
6 expenses incurred in and out of hospital including basic
7 hospital-surgical-medical coverages. The program may include,
8 but shall not be limited to, such supplemental coverages as
9 out-patient diagnostic X-ray and laboratory expenses,
10 prescription drugs, dental services and similar group
11 benefits as are now or may become available. However,
12 nothing in this Act shall be construed to permit, on or after
13 July 1, 1980, the non-contributory portion of any such
14 program to include the expenses of obtaining an abortion,
15 induced miscarriage or induced premature birth unless, in the
16 opinion of a physician, such procedures are necessary for the
17 preservation of the life of the woman seeking such treatment,
18 or except an induced premature birth intended to produce a
19 live viable child and such procedure is necessary for the
20 health of the mother or the unborn child. The program may
21 also include coverage for those who rely on treatment by
22 prayer or spiritual means alone for healing in accordance
23 with the tenets and practice of a recognized religious
24 denomination.
25 The program of health benefits shall be designed by the
26 Director (1) to provide a reasonable relationship between the
27 benefits to be included and the expected distribution of
28 expenses of each such type to be incurred by the covered
29 members and dependents, (2) to specify, as covered benefits
30 and as optional benefits, the medical services of
31 practitioners in all categories licensed under the Medical
32 Practice Act of 1987, (3) to include reasonable controls,
33 which may include deductible and co-insurance provisions,
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1 applicable to some or all of the benefits, or a coordination
2 of benefits provision, to prevent or minimize unnecessary
3 utilization of the various hospital, surgical and medical
4 expenses to be provided and to provide reasonable assurance
5 of stability of the program, and (4) to provide benefits to
6 the extent possible to members throughout the State, wherever
7 located, on an equitable basis. Notwithstanding any other
8 provision of this Section or Act, for all retired members or
9 retired dependents aged 65 years or older who are eligible
10 for entitled to benefits under Social Security or the
11 Railroad Retirement system or who had sufficient
12 Medicare-covered government employment, the Department shall
13 reduce benefits which would otherwise be paid by Medicare, by
14 the amount of benefits for which the retired member or
15 retired dependents are eligible under Medicare, except that
16 such reduction in benefits shall apply only to those retired
17 members or retired dependents who (1) first become eligible
18 for such medicare coverage on or after the effective date of
19 this amendatory Act of 1992; or (2) are Medicare-eligible
20 members or dependents of a local government unit which began
21 participation in the program on or after July 1, 1992; or (3)
22 (2) remain eligible for but no longer receive Medicare
23 coverage which they had been receiving on or after the
24 effective date of this amendatory Act of 1992.
25 Notwithstanding any other provisions of this Act, where a
26 covered member or dependents are eligible for benefits under
27 the federal Medicare health insurance program (Title XVIII of
28 the Social Security Act as added by Public Law 89-97, 89th
29 Congress), benefits paid under the State of Illinois program
30 or plan will be reduced by the amount of benefits paid by
31 Medicare. For retired members or retired dependents aged 65
32 years or older who are eligible for entitled to benefits
33 under Social Security or the Railroad Retirement system or
34 who had sufficient Medicare-covered government employment,
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1 benefits shall be reduced by the amount for which the retired
2 retired dependent is eligible under Medicare,
3 except that such reduction in benefits shall apply only to
4 those retired members or retired dependents who (1) first
5 become eligible for such Medicare coverage on or after the
6 effective date of this amendatory Act of 1992; or (2) are
7 Medicare-eligible members or dependents of a local government
8 unit which began participation in the program on or after
9 July 1, 1992; or (3) (2) remain eligible for, but no longer
10 receive Medicare coverage which they had been receiving on or
11 after the effective date of this amendatory Act of 1992.
12 Premiums may be adjusted, where applicable, to an amount
13 deemed by the Director to be reasonably consistent with any
14 reduction of benefits.
15 (b) A member, not otherwise covered by this Act, who has
16 retired as a participating member under Article 2 of the
17 "Illinois Pension Code" but is ineligible for the retirement
18 annuity under Section 2-119 of the "Illinois Pension Code",
19 shall pay the premiums for coverage, not exceeding the amount
20 paid by the State for the non-contributory coverage for other
21 members, under the group health benefits insurance program or
22 the self-insurance health plan under this Act. The Director
23 shall promulgate rules and regulations to determine the
24 premiums to be paid by a member under this subsection (b).
25 (Source: P.A. 87-860.)
26 (5 ILCS 375/8) (from Ch. 127, par. 528)
27 Sec. 8. Eligibility.
28 (a) Each member eligible under the provisions of this
29 Act and any rules and regulations promulgated and adopted
30 hereunder by the Director shall become immediately eligible
31 and covered for all benefits available under the programs.
32 Members electing coverage for eligible dependents shall have
33 the coverage effective immediately, provided that the
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1 election is properly filed in accordance with required filing
2 dates and procedures specified by the Director.
3 (1) Every member originally eligible to elect
4 dependent coverage, but not electing it during the
5 original eligibility period, may subsequently obtain
6 dependent coverage only in the event of a qualifying
7 change in status, special enrollment, special
8 circumstance as defined by the Director, or during the
9 annual Benefit Choice Period upon submission of
10 satisfactory evidence of insurability, unless there is a
11 change of family status that would confer new eligibility
12 for change of enrollment under rules established
13 supplementing this Act, in which event application must
14 be made within the new eligibility period.
15 (2) Members described above being transferred from
16 previous coverage towards which the State has been
17 contributing shall be transferred regardless of
18 preexisting conditions, waiting periods, or other
19 requirements that might jeopardize claim payments to
20 which they would otherwise have been entitled.
21 (3) Eligible and covered members that are eligible
22 for coverage as dependents except for the fact of being
23 members shall be transferred to, and covered under,
24 dependent status regardless of preexisting conditions,
25 waiting periods, or other requirements that might
26 jeopardize claim payments to which they would otherwise
27 have been entitled upon cessation of member status and
28 the election of dependent coverage by a member eligible
29 to elect that coverage.
30 (b) New employees shall be immediately insured for the
31 basic group life insurance and covered by the program of
32 health benefits on the first day of active State service.
33 Optional coverages or benefits, if elected during the
34 relevant eligibility period, will become effective on the
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1 date of election or date of employment, whichever is later.
2 Optional coverages or benefits applied for after the
3 eligibility period will be effective, subject to satisfactory
4 evidence of insurability when applicable, or other necessary
5 qualifications, pursuant to the requirements of the
6 applicable benefit program, unless there is a change in of
7 family status that would confer new eligibility for change of
8 enrollment under rules established supplementing this Act, in
9 which event application must be made within the new
10 eligibility period.
11 (c) As to the group health benefits insurance program
12 contracted to begin or continue after June 30, 1973, each
13 retired employee shall become immediately eligible and
14 covered for all benefits available under that program.
15 Retired employees may elect coverage for eligible dependents
16 and shall have the coverage effective immediately, provided
17 that the election is properly filed in accordance with
18 required filing dates and procedures specified by the
19 Director.
20 Where husband and wife are both eligible members, each
21 shall be enrolled as a member and coverage on all of their
22 eligible dependent children, if any, may shall be under the
23 enrollment and election of either.
24 Regardless of other provisions herein regarding late
25 enrollment or changes of enrollments being subject to
26 submission of satisfactory evidence of insurability or other
27 qualifications, as appropriate, the Director may periodically
28 authorize open enrollment periods for each of the benefit
29 programs at which time each member may elect enrollment or
30 change of enrollment without regard to age, sex, health, or
31 other qualification under the conditions as may be prescribed
32 in rules and regulations supplementing this Act. Special
33 open enrollment periods may be declared by the Director for
34 certain members only when special circumstances occur that
-19- LRB9100169EGfgB
1 affect only those members.
2 (Source: P.A. 87-367.)
3 (5 ILCS 375/9) (from Ch. 127, par. 529)
4 Sec. 9. (a) The eligible member shall be responsible for
5 his or her portion 100% of the premiums, charges or other
6 fees for all elected optional coverages or benefits, which
7 shall be paid by means of the acceptance of a reduction in
8 earnings or the foregoing of an increase in earnings by an
9 employee; provided, however, subject to rules and regulations
10 promulgated by the Department, the eligible member may make
11 personal payment of the premium, charge or fee for any
12 wellness programs implemented under the program of health
13 benefits. For any fiscal year beginning after June 30, 1974
14 the State shall contribute $7 per month for each eligible
15 member who has enrolled one or more dependents for coverage
16 under the program of health benefits established under this
17 Act. All contributions and payments by the eligible members
18 and the State for all elected optional coverages and benefits
19 shall be deposited in the Health Insurance Reserve Fund. The
20 Department may determine the aggregate level of contribution
21 required under this Section on the basis of actual cost of
22 services adjusted for age, sex or the geographical or other
23 demographic characteristics which affect costs of the
24 benefit.
25 (b) If a member is not entitled to receive any salary,
26 wages or other compensation during a period in which
27 premiums, charges or other fees are due or does not receive
28 compensation sufficient to allow deduction of the required
29 payment of the premium, charge or other fee, such member may
30 continue the contributory benefit in effect by making
31 personal payment of the premium, charge or other fee for the
32 period in such manner, in such amount, and for such duration,
33 as may be prescribed in rules and regulations promulgated for
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1 the administration of this Act.
2 (Source: P.A. 85-848.)
3 (5 ILCS 375/10) (from Ch. 127, par. 530)
4 Sec. 10. Payments by State; premiums.
5 (a) The State shall pay the cost of basic
6 non-contributory group life insurance and, subject to member
7 paid contributions set by the Department or required by this
8 Section, the basic program of group health benefits on each
9 eligible member, except a member, not otherwise covered by
10 this Act, who has retired as a participating member under
11 Article 2 of the Illinois Pension Code but is ineligible for
12 the retirement annuity under Section 2-119 of the Illinois
13 Pension Code, and part of each eligible member's and retired
14 member's premiums for health insurance coverage for enrolled
15 dependents as provided by Section 9. The State shall pay the
16 cost of the basic program of group health benefits only after
17 benefits are reduced by the amount of benefits covered by
18 Medicare for all retired members and retired dependents aged
19 65 years or older who are eligible for entitled to benefits
20 under Social Security or the Railroad Retirement system or
21 who had sufficient Medicare-covered government employment,
22 except that such reduction in benefits shall apply only to
23 those retired members and or retired dependents who (1) first
24 become eligible for such Medicare coverage on or after July
25 1, 1992; or (2) are Medicare-eligible members or dependents
26 of a local government unit which began participation in the
27 program on or after July 1, 1992; or (3) (2) remain eligible
28 for, but no longer receive Medicare coverage which they had
29 been receiving on or after July 1, 1992. The Department may
30 determine the aggregate level of the State's contribution on
31 the basis of actual cost of medical services adjusted for
32 age, sex or geographic or other demographic characteristics
33 which affect the costs of such programs.
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1 (a-1) Beginning January 1, 1998, for each person who
2 becomes a new SERS annuitant and participates in the basic
3 program of group health benefits, the State shall contribute
4 toward the cost of the annuitant's coverage under the basic
5 program of group health benefits an amount equal to 5% of
6 that cost for each full year of creditable service upon which
7 the annuitant's retirement annuity is based, up to a maximum
8 of 100% for an annuitant with 20 or more years of creditable
9 service. The remainder of the cost of a new SERS annuitant's
10 coverage under the basic program of group health benefits
11 shall be the responsibility of the annuitant.
12 (a-2) Beginning January 1, 1998, for each person who
13 becomes a new SERS survivor and participates in the basic
14 program of group health benefits, the State shall contribute
15 toward the cost of the survivor's coverage under the basic
16 program of group health benefits an amount equal to 5% of
17 that cost for each full year of the deceased employee's or
18 deceased annuitant's creditable service in the State
19 Employees' Retirement System of Illinois on the date of
20 death, up to a maximum of 100% for a survivor of an employee
21 or annuitant with 20 or more years of creditable service.
22 The remainder of the cost of the new SERS survivor's coverage
23 under the basic program of group health benefits shall be the
24 responsibility of the survivor.
25 (a-3) Beginning January 1, 1998, for each person who
26 becomes a new SURS annuitant and participates in the basic
27 program of group health benefits, the State shall contribute
28 toward the cost of the annuitant'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 creditable service upon which
31 the annuitant's retirement annuity is based, up to a maximum
32 of 100% for an annuitant with 20 or more years of creditable
33 service. The remainder of the cost of a new SURS annuitant's
34 coverage under the basic program of group health benefits
-22- LRB9100169EGfgB
1 shall be the responsibility of the annuitant.
2 (a-4) Beginning January 1, 1998, for each person who
3 becomes a new SURS retired employee and participates in the
4 basic program of group health benefits, the State shall
5 contribute toward the cost of the retired employee's coverage
6 under the basic program of group health benefits an amount
7 equal to 5% of that cost for each full year that the retired
8 employee was an employee as defined in Section 3, up to a
9 maximum of 100% for a retired employee who was an employee
10 for 20 or more years. The remainder of the cost of a new
11 SURS retired employee's coverage under the basic program of
12 group health benefits shall be the responsibility of the
13 retired employee.
14 (a-5) Beginning January 1, 1998, for each person who
15 becomes a new SURS survivor and participates in the basic
16 program of group health benefits, the State shall contribute
17 toward the cost of the survivor'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 the deceased employee's or
20 deceased annuitant's creditable service in the State
21 Universities Retirement System on the date of death, up to a
22 maximum of 100% for a survivor of an employee or annuitant
23 with 20 or more years of creditable service. The remainder
24 of the cost of the new SURS survivor's coverage under the
25 basic program of group health benefits shall be the
26 responsibility of the survivor.
27 (a-6) Beginning July 1, 1998, for each person who
28 becomes a new TRS State annuitant and participates in the
29 basic program of group health benefits, the State shall
30 contribute toward the cost of the annuitant's coverage under
31 the basic program of group health benefits an amount equal to
32 5% of that cost for each full year of creditable service as a
33 teacher as defined in paragraph (2), (3), or (5) of Section
34 16-106 of the Illinois Pension Code upon which the
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1 annuitant's retirement annuity is based, up to a maximum of
2 100% for an annuitant with 20 or more years of such
3 creditable service. The remainder of the cost of a new TRS
4 State annuitant's coverage under the basic program of group
5 health benefits shall be the responsibility of the annuitant.
6 (a-7) Beginning July 1, 1998, for each person who
7 becomes a new TRS State survivor and participates in the
8 basic program of group health benefits, the State shall
9 contribute toward the cost of the survivor'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 the deceased employee's
12 or deceased annuitant's creditable service as a teacher as
13 defined in paragraph (2), (3), or (5) of Section 16-106 of
14 the Illinois Pension Code on the date of death, up to a
15 maximum of 100% for a survivor of an employee or annuitant
16 with 20 or more years of such creditable service. The
17 remainder of the cost of the new TRS State survivor's
18 coverage under the basic program of group health benefits
19 shall be the responsibility of the survivor.
20 (a-8) A new SERS annuitant, new SERS survivor, new SURS
21 annuitant, new SURS retired employee, new SURS survivor, new
22 TRS State annuitant, or new TRS State survivor may waive or
23 terminate coverage in the program of group health benefits.
24 Any such annuitant, survivor, or retired employee who has
25 waived or terminated coverage may enroll or re-enroll in the
26 program of group health benefits only during the annual
27 benefit choice period, as determined by the Director; except
28 that in the event of termination of coverage due to
29 nonpayment of premiums, the annuitant, survivor, or retired
30 employee may not re-enroll in the program.
31 (a-9) No later than May 1 of each calendar year, the
32 Director of Central Management Services shall certify in
33 writing to the Executive Secretary of the State Employees'
34 Retirement System of Illinois the amounts of the Medicare
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1 supplement health care premiums and the amounts of the health
2 care premiums for all other retirees who are not Medicare
3 eligible.
4 A separate calculation of the premiums based upon the
5 actual cost of each health care plan shall be so certified.
6 The Director of Central Management Services shall provide
7 to the Executive Secretary of the State Employees' Retirement
8 System of Illinois such information, statistics, and other
9 data as he or she may require to review the premium amounts
10 certified by the Director of Central Management Services.
11 (b) State employees who become eligible for this program
12 on or after January 1, 1980 in positions normally requiring
13 actual performance of duty not less than 1/2 of a normal work
14 period but not equal to that of a normal work period, shall
15 be given the option of participating in the available
16 program. If the employee elects coverage, the State shall
17 contribute on behalf of such employee to the cost of the
18 employee's benefit and any applicable dependent supplement,
19 that sum which bears the same percentage as that percentage
20 of time the employee regularly works when compared to normal
21 work period.
22 (c) The basic non-contributory coverage from the basic
23 program of group health benefits shall be continued for each
24 employee not in pay status or on active service by reason of
25 (1) leave of absence due to illness or injury, (2) authorized
26 educational leave of absence or sabbatical leave, or (3)
27 military leave with pay and benefits. This coverage shall
28 continue until expiration of authorized leave and return to
29 active service, but not to exceed 24 months for leaves under
30 item (1) or (2). This 24-month limitation and the requirement
31 of returning to active service shall not apply to persons
32 receiving ordinary or accidental disability benefits or
33 retirement benefits through the appropriate State retirement
34 system or benefits under the Workers' Compensation or
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1 Occupational Disease Act.
2 (d) The basic group life insurance coverage shall
3 continue, with full State contribution, where such person is
4 (1) absent from active service by reason of disability
5 arising from any cause other than self-inflicted, (2) on
6 authorized educational leave of absence or sabbatical leave,
7 or (3) on military leave with pay and benefits.
8 (e) Where the person is in non-pay status for a period
9 in excess of 30 days or on leave of absence, other than by
10 reason of disability, educational or sabbatical leave, or
11 military leave with pay and benefits, such person may
12 continue coverage only by making personal payment equal to
13 the amount normally contributed by the State on such person's
14 behalf. Such payments and coverage may be continued: (1)
15 until such time as the person returns to a status eligible
16 for coverage at State expense, but not to exceed 24 months,
17 (2) until such person's employment or annuitant status with
18 the State is terminated, or (3) for a maximum period of 4
19 years for members on military leave with pay and benefits and
20 military leave without pay and benefits (exclusive of any
21 additional service imposed pursuant to law).
22 (f) The Department shall establish by rule the extent
23 to which other employee benefits will continue for persons in
24 non-pay status or who are not in active service.
25 (g) The State shall not pay the cost of the basic
26 non-contributory group life insurance, program of health
27 benefits and other employee benefits for members who are
28 survivors as defined by paragraphs (1) and (2) of subsection
29 (q) of Section 3 of this Act. The costs of benefits for
30 these survivors shall be paid by the survivors or by the
31 University of Illinois Cooperative Extension Service, or any
32 combination thereof.
33 (h) Those persons occupying positions with any
34 department as a result of emergency appointments pursuant to
-26- LRB9100169EGfgB
1 Section 8b.8 of the Personnel Code who are not considered
2 employees under this Act shall be given the option of
3 participating in the programs of group life insurance, health
4 benefits and other employee benefits. Such persons electing
5 coverage may participate only by making payment equal to the
6 amount normally contributed by the State for similarly
7 situated employees. Such amounts shall be determined by the
8 Director. Such payments and coverage may be continued until
9 such time as the person becomes an employee pursuant to this
10 Act or such person's appointment is terminated.
11 (i) Any unit of local government within the State of
12 Illinois may apply to the Director to have its employees,
13 annuitants, and their dependents provided group health
14 coverage under this Act on a non-insured basis. To
15 participate, a unit of local government must agree to enroll
16 all of its employees, who may select coverage under either
17 the State group health benefits insurance plan or a health
18 maintenance organization that has contracted with the State
19 to be available as a health care provider for employees as
20 defined in this Act. A unit of local government must remit
21 the entire cost of providing coverage under the State group
22 health benefits insurance plan or, for coverage under a
23 health maintenance organization, an amount determined by the
24 Director based on an analysis of the sex, age, geographic
25 location, or other relevant demographic variables for its
26 employees, except that the unit of local government shall not
27 be required to enroll those of its employees who are covered
28 spouses or dependents under this plan or another group policy
29 or plan providing health benefits as long as (1) an
30 appropriate official from the unit of local government
31 attests that each employee not enrolled is a covered spouse
32 or dependent under this plan or another group policy or plan,
33 and (2) at least 85% of the employees are enrolled and the
34 unit of local government remits the entire cost of providing
-27- LRB9100169EGfgB
1 coverage to those employees. Employees of a participating
2 unit of local government who are not enrolled due to coverage
3 under another group health policy or plan may enroll in the
4 event of a qualifying change in status, special enrollment,
5 special circumstance as defined by the Director, or during
6 the annual Benefit Choice Period at a later date subject to
7 submission of satisfactory evidence of insurability and
8 provided that no benefits shall be payable for services
9 incurred during the first 6 months of coverage to the extent
10 the services are in connection with any pre-existing
11 condition. A participating unit of local government may also
12 elect to cover its annuitants. Dependent coverage shall be
13 offered on an optional basis, with the costs paid by the unit
14 of local government, its employees, or some combination of
15 the two as determined by the unit of local government. The
16 unit of local government shall be responsible for timely
17 collection and transmission of dependent premiums.
18 The Director shall annually determine monthly rates of
19 payment, subject to the following constraints:
20 (1) In the first year of coverage, the rates shall
21 be equal to the amount normally charged to State
22 employees for elected optional coverages or for enrolled
23 dependents coverages or other contributory coverages, or
24 contributed by the State for basic insurance coverages on
25 behalf of its employees, adjusted for differences between
26 State employees and employees of the local government in
27 age, sex, geographic location or other relevant
28 demographic variables, plus an amount sufficient to pay
29 for the additional administrative costs of providing
30 coverage to employees of the unit of local government and
31 their dependents.
32 (2) In subsequent years, a further adjustment shall
33 be made to reflect the actual prior years' claims
34 experience of the employees of the unit of local
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1 government.
2 In the case of coverage of local government employees
3 under a health maintenance organization, the Director shall
4 annually determine for each participating unit of local
5 government the maximum monthly amount the unit may contribute
6 toward that coverage, based on an analysis of (i) the age,
7 sex, geographic location, and other relevant demographic
8 variables of the unit's employees and (ii) the cost to cover
9 those employees under the State group health benefits
10 insurance plan. The Director may similarly determine the
11 maximum monthly amount each unit of local government may
12 contribute toward coverage of its employees' dependents under
13 a health maintenance organization.
14 Monthly payments by the unit of local government or its
15 employees for group health benefits plan insurance or health
16 maintenance organization coverage shall be deposited in the
17 Local Government Health Insurance Reserve Fund. The Local
18 Government Health Insurance Reserve Fund shall be a
19 continuing fund not subject to fiscal year limitations. All
20 expenditures from this fund shall be used for payments for
21 health care benefits for local government and rehabilitation
22 facility employees, annuitants, and dependents, and to
23 reimburse the Department or its administrative service
24 organization for all expenses incurred in the administration
25 of benefits. No other State funds may be used for these
26 purposes.
27 A local government employer's participation or desire to
28 participate in a program created under this subsection shall
29 not limit that employer's duty to bargain with the
30 representative of any collective bargaining unit of its
31 employees.
32 (j) Any rehabilitation facility within the State of
33 Illinois may apply to the Director to have its employees,
34 annuitants, and their eligible dependents provided group
-29- LRB9100169EGfgB
1 health coverage under this Act on a non-insured basis. To
2 participate, a rehabilitation facility must agree to enroll
3 all of its employees and remit the entire cost of providing
4 such coverage for its employees, except that the
5 rehabilitation facility shall not be required to enroll those
6 of its employees who are covered spouses or dependents under
7 this plan or another group policy or plan providing health
8 benefits as long as (1) an appropriate official from the
9 rehabilitation facility attests that each employee not
10 enrolled is a covered spouse or dependent under this plan or
11 another group policy or plan, and (2) at least 85% of the
12 employees are enrolled and the rehabilitation facility remits
13 the entire cost of providing coverage to those employees.
14 Employees of a participating rehabilitation facility who are
15 not enrolled due to coverage under another group health
16 policy or plan may enroll in the event of a qualifying change
17 in status, special enrollment, special circumstance as
18 defined by the Director, or during the annual Benefit Choice
19 Period at a later date subject to submission of satisfactory
20 evidence of insurability and provided that no benefits shall
21 be payable for services incurred during the first 6 months of
22 coverage to the extent the services are in connection with
23 any pre-existing condition. A participating rehabilitation
24 facility may also elect to cover its annuitants. Dependent
25 coverage shall be offered on an optional basis, with the
26 costs paid by the rehabilitation facility, its employees, or
27 some combination of the 2 as determined by the rehabilitation
28 facility. The rehabilitation facility shall be responsible
29 for timely collection and transmission of dependent premiums.
30 The Director shall annually determine quarterly rates of
31 payment, subject to the following constraints:
32 (1) In the first year of coverage, the rates shall
33 be equal to the amount normally charged to State
34 employees for elected optional coverages or for enrolled
-30- LRB9100169EGfgB
1 dependents coverages or other contributory coverages on
2 behalf of its employees, adjusted for differences between
3 State employees and employees of the rehabilitation
4 facility in age, sex, geographic location or other
5 relevant demographic variables, plus an amount sufficient
6 to pay for the additional administrative costs of
7 providing coverage to employees of the rehabilitation
8 facility and their dependents.
9 (2) In subsequent years, a further adjustment shall
10 be made to reflect the actual prior years' claims
11 experience of the employees of the rehabilitation
12 facility.
13 Monthly payments by the rehabilitation facility or its
14 employees for group health benefits insurance shall be
15 deposited in the Local Government Health Insurance Reserve
16 Fund.
17 (k) Any domestic violence shelter or service within the
18 State of Illinois may apply to the Director to have its
19 employees, annuitants, and their dependents provided group
20 health coverage under this Act on a non-insured basis. To
21 participate, a domestic violence shelter or service must
22 agree to enroll all of its employees and pay the entire cost
23 of providing such coverage for its employees. A
24 participating domestic violence shelter may also elect to
25 cover its annuitants. Dependent coverage shall be offered on
26 an optional basis, with employees, or some combination of the
27 2 as determined by the domestic violence shelter or service.
28 The domestic violence shelter or service shall be responsible
29 for timely collection and transmission of dependent premiums.
30 The Director shall annually determine quarterly rates of
31 payment, subject to the following constraints:
32 (1) In the first year of coverage, the rates shall
33 be equal to the amount normally charged to State
34 employees for elected optional coverages or for enrolled
-31- LRB9100169EGfgB
1 dependents coverages or other contributory coverages on
2 behalf of its employees, adjusted for differences between
3 State employees and employees of the domestic violence
4 shelter or service in age, sex, geographic location or
5 other relevant demographic variables, plus an amount
6 sufficient to pay for the additional administrative costs
7 of providing coverage to employees of the domestic
8 violence shelter or service and their dependents.
9 (2) In subsequent years, a further adjustment shall
10 be made to reflect the actual prior years' claims
11 experience of the employees of the domestic violence
12 shelter or service.
13 (3) In no case shall the rate be less than the
14 amount normally charged to State employees or contributed
15 by the State on behalf of its employees.
16 Monthly payments by the domestic violence shelter or
17 service or its employees for group health insurance shall be
18 deposited in the Local Government Health Insurance Reserve
19 Fund.
20 (l) A public community college or entity organized
21 pursuant to the Public Community College Act may apply to the
22 Director initially to have only annuitants not covered prior
23 to July 1, 1992 by the district's health plan provided health
24 coverage under this Act on a non-insured basis. The
25 community college must execute a 2-year contract to
26 participate in the Local Government Health Plan. Those
27 annuitants enrolled initially under this contract shall have
28 no benefits payable for services incurred during the first 6
29 months of coverage to the extent the services are in
30 connection with any pre-existing condition. Any annuitant
31 who may enroll in the event of a qualifying change in status,
32 special enrollment, special circumstance as defined by the
33 Director, or during the annual Benefit Choice Period after
34 this initial enrollment period shall be subject to submission
-32- LRB9100169EGfgB
1 of satisfactory evidence of insurability and to the
2 pre-existing conditions limitation.
3 The Director shall annually determine monthly rates of
4 payment subject to the following constraints: for those
5 community colleges with annuitants only enrolled, first year
6 rates shall be equal to the average cost to cover claims for
7 a State member adjusted for demographics, Medicare
8 participation, and other factors; and in the second year, a
9 further adjustment of rates shall be made to reflect the
10 actual first year's claims experience of the covered
11 annuitants.
12 (l-5) The provisions of subsection (l) become
13 inoperative on July 1, 1999.
14 (m) The Director shall adopt any rules deemed necessary
15 for implementation of this amendatory Act of 1989 (Public Act
16 86-978).
17 (Source: P.A. 89-53, eff. 7-1-95; 89-236, eff. 8-4-95;
18 89-324, eff. 8-13-95; 89-626, eff. 8-9-96; 90-65, eff.
19 7-7-97; 90-582, eff. 5-27-98; 90-655, eff. 7-30-98; revised
20 8-3-98.)
21 (5 ILCS 375/13) (from Ch. 127, par. 533)
22 Sec. 13. There is established a Group Insurance Premium
23 Fund administered by the Director which shall include: (1)
24 amounts paid by covered members for optional life insurance
25 or health benefits insurance coverages, and (2) refunds which
26 may be received from (a) the group carrier or carriers which
27 may result from favorable experience as described in Section
28 12 herein or (b) from any other source from which the State
29 is reasonably and properly entitled to refund as a result of
30 the group health benefits insurance program. The Group
31 Insurance Premium Fund shall be a continuing fund not subject
32 to fiscal year limitations.
33 The State of Illinois shall at least once each month make
-33- LRB9100169EGfgB
1 payment on behalf of each member, except one who is a member
2 by virtue of participation in a program created under
3 subsection (i), (j), (k), or (l) of Section 10 of this Act,
4 to the appropriate carrier or, if applicable, carriers
5 insuring State members under the contracted group life
6 insurance and group health benefits insurance program
7 authorized by this Act.
8 Refunds to members for premiums paid for coverage for
9 their dependents may be paid from the Group Insurance Premium
10 Fund without regard to the fact that the premium being
11 refunded may have been paid in a different fiscal year.
12 (Source: P.A. 86-978; 87-627; 87-1259.)
13 (5 ILCS 375/13.1) (from Ch. 127, par. 533.1)
14 Sec. 13.1. (a) All contributions, appropriations,
15 interest, and dividend payments to fund the program of health
16 benefits and other employee benefits shall be deposited in a
17 trust fund outside the State Treasury, with the State
18 Treasurer as ex-officio custodian, to be known as the Health
19 Insurance Reserve Fund.
20 (b) Upon the adoption of a self-insurance health plan,
21 any monies attributable to the group health insurance program
22 shall be deposited in or transferred to the Health Insurance
23 Reserve Fund for use by the Department. As of the effective
24 date of this amendatory Act of 1986, the Department shall
25 certify to the Comptroller the amount of money in the Group
26 Insurance Premium Fund attributable to the State group health
27 insurance program and the Comptroller shall transfer such
28 money from the Group Insurance Premium Fund to the Health
29 Insurance Reserve Fund. Contributions by the State to the
30 Health Insurance Reserve Fund to meet the requirements of
31 this Act, as established by the Director, from the General
32 Revenue Fund and the Road Fund to the Health Insurance
33 Reserve Fund shall be by annual appropriations, and all other
-34- LRB9100169EGfgB
1 contributions to meet the requirements of the programs of
2 health benefits or other employee benefits shall be deposited
3 in the Health Insurance Reserve Fund. The Department shall
4 draw the appropriation from the General Revenue Fund and the
5 Road Fund from time to time as necessary to make expenditures
6 authorized under this Act.
7 The Director may employ such assistance and services and
8 may purchase such goods as may be necessary for the proper
9 development and administration of any of the benefit programs
10 authorized by this Act. The Director may promulgate rules
11 and regulations in regard to the administration of these
12 programs.
13 All monies received by the Department for deposit in or
14 transfer to the Health Insurance Reserve Fund, through
15 appropriation or otherwise, shall be used to provide for the
16 making of payments to claimants and providers and to
17 reimburse the Department for all expenses directly incurred
18 relating to Department development and administration of the
19 program of health benefits and other employee benefits.
20 Any administrative service organization administering any
21 self-insurance health plan and paying claims and benefits
22 under authority of this Act may receive, pursuant to written
23 authorization and direction of the Director, an initial
24 transfer and periodic transfers of funds from the Health
25 Insurance Reserve Fund in amounts determined by the Director
26 who may consider the amount recommended by the administrative
27 service organization. Notwithstanding any other statute,
28 such transferred funds shall be retained by the
29 administrative service organization in a separate account
30 provided by any bank as defined by the Illinois Banking Act.
31 The Department may promulgate regulations further defining
32 the banks authorized to accept such funds and all methodology
33 for transfer of such funds. Any interest earned by monies in
34 such account shall inure to the Health Insurance Reserve
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1 Fund, shall remain in such account and shall be used
2 exclusively to pay claims and benefits under this Act. Such
3 transferred funds shall be used exclusively for
4 administrative service organization payment of claims to
5 claimants and providers under the self-insurance health plan
6 by the drawing of checks against such account. The
7 administrative service organization may not use such
8 transferred funds, or interest accrued thereon, for any other
9 purpose including, but not limited to, reimbursement of
10 administrative expenses or payments of administration fees
11 due the organization pursuant to its contract or contracts
12 with the Department of Central Management Services.
13 The account of the administrative service organization
14 established under this Section, any transfers from the Health
15 Insurance Reserve Fund to such account and the use of such
16 account and funds shall be subject to (1) audit by the
17 Department or private contractor authorized by the Department
18 to conduct audits, such audit including but not limited to
19 the annual audit required by this Act, and (2) post audit
20 pursuant to the Illinois State Auditing Act.
21 (c) The Director, with the advice and consent of the
22 Commission, shall establish premiums for optional coverage
23 for dependents of eligible members for the self-insurance
24 health plans plan. The eligible members shall be responsible
25 for their portion payment of 100% of such optional premium
26 and shall pay by means of payroll deduction. The State shall
27 contribute an amount $7 per month for each eligible member
28 who has enrolled one or more dependents under the
29 self-insurance health plans plan. Such contribution shall be
30 made directly to the Health Insurance Reserve Fund. Those
31 employees described in subsection (b) of Section 9 of this
32 Act shall be allowed to continue in the self-insurance health
33 plan by making personal payments with the premiums to be
34 deposited in the Health Insurance Reserve Fund.
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1 (d) The Health Insurance Reserve Fund shall be a
2 continuing fund not subject to fiscal year limitations. All
3 expenditures from that fund shall be at the direction of the
4 Director and shall be only for the purpose of:
5 (1) the payment of administrative expenses incurred by
6 the Department for the program of health benefits or other
7 employee benefit programs, including but not limited to the
8 costs of audits or actuarial consultations, professional and
9 contractual services, electronic data processing systems and
10 services, and expenses in connection with the development and
11 administration of such programs;
12 (2) the payment of administrative expenses incurred by
13 the Administrative Service Organization;
14 (3) the payment of health benefits;
15 (4) refunds to employees for erroneous payments of their
16 selected dependent coverage;
17 (5) payment of premium for stop-loss or re-insurance;
18 (6) payment of premium to health maintenance
19 organizations pursuant to Section 6.1 of this Act;
20 (7) payment of adoption program benefits; and
21 (8) payment of other benefits offered to members and
22 dependents under this Act.
23 (Source: P.A. 85-848.)
24 (5 ILCS 375/13.2) (from Ch. 127, par. 533.2)
25 Sec. 13.2. Insurance reserve funds; investments. All
26 amounts held in the Health Insurance Reserve Fund, the Group
27 Insurance Premium Fund, and the Local Government Health
28 Insurance Reserve Fund shall be invested, at interest, by the
29 State Treasurer. The investments shall be subject to terms,
30 conditions, and limitations imposed by the laws of Illinois
31 on State funds. All income derived from the investments
32 shall accrue and be deposited to the respective funds no less
33 frequently than quarterly. The Health Insurance Reserve Fund
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1 and the Local Government Health Insurance Reserve Fund shall
2 be administered by the Director.
3 (Source: P.A. 87-771.)
4 (5 ILCS 375/15) (from Ch. 127, par. 535)
5 Sec. 15. Administration; rules; audit; review.
6 (a) The Director shall administer this Act and shall
7 prescribe such rules and regulations as are necessary to give
8 full effect to the purposes of this Act.
9 (b) These rules may fix reasonable standards for the
10 group life and group health programs and other benefit
11 programs offered under this Act, and for the contractors
12 providing them.
13 (c) These rules shall specify that covered and optional
14 medical services of the program are services provided within
15 the scope of their licenses by practitioners in all
16 categories licensed under the Medical Practice Act of 1987
17 and shall provide that all eligible persons be fully informed
18 of this specification.
19 (d) These rules shall establish eligibility requirements
20 for members and dependents as may be necessary to supplement
21 or clarify requirements contained in this Act.
22 (e) Each affected department of the State, the State
23 Universities Retirement System, the Teachers' Retirement
24 System, and each qualified local government, rehabilitation
25 facility, or domestic violence shelter or service, shall keep
26 such records, make such certifications, and furnish the
27 Director such information as may be necessary for the
28 administration of this Act, including information concerning
29 number and total amounts of payroll of employees of the
30 department who are paid from trust funds or federal funds.
31 (f) Each member, each community college benefit
32 recipient to whom this Act applies, and each TRS benefit
33 recipient to whom this Act applies shall furnish the
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1 Director, in such form as may be required, any information
2 that may be necessary to enroll such member or benefit
3 recipient and, if applicable, his or her dependents or
4 dependent beneficiaries under the programs or plan, including
5 such data as may be required to allow the Director to
6 accumulate statistics on data normally considered in
7 actuarial studies of employee groups. Information about
8 community college benefit recipients and community college
9 dependent beneficiaries shall be furnished through the State
10 Universities Retirement System. Information about TRS
11 benefit recipients and TRS dependent beneficiaries shall be
12 furnished through the Teachers' Retirement System.
13 (g) There shall be audits an annual audit and reports
14 report on the programs authorized and established by this Act
15 prepared by the Director with the assistance of a qualified,
16 independent accounting firm. The reports annual report shall
17 provide information on the experience, and administrative
18 effectiveness and adequacy of the program including, when
19 applicable, recommendations on up-grading of benefits and
20 improvement of the program.
21 (h) Any final order, decision or other determination
22 made, issued or executed by the Director under the provisions
23 of this Act whereby any contractor or person is aggrieved
24 shall be subject to review in accordance with the provisions
25 of the Administrative Review Law and all amendments and
26 modifications thereof, and the rules adopted pursuant
27 thereto, shall apply to and govern all proceedings for the
28 judicial review of final administrative decisions of the
29 Director.
30 (Source: P.A. 89-21, eff. 6-21-95; 89-25, eff. 6-21-95;
31 90-497, eff. 8-18-97.)
32 Section 99. Effective date. This Act takes effect upon
33 becoming law.