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91_HB2720enr HB2720 Enrolled 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 HB2720 Enrolled -2- LRB9100169EGfgB 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 HB2720 Enrolled -3- LRB9100169EGfgB 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 HB2720 Enrolled -4- LRB9100169EGfgB 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 HB2720 Enrolled -5- LRB9100169EGfgB 1Illinois Stateincome tax purposes, or (3) age 19 or over who 2 is mentally or physically handicappedas defined in the3Illinois 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 forIllinois Stateincome 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 HB2720 Enrolled -6- LRB9100169EGfgB 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 HB2720 Enrolled -7- LRB9100169EGfgB 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 aself-insuredhealth benefits 15insuranceprogram offered by the State of Illinois for 16 persons eligible for the planthe purposes of benefiting17employees by means of providing, among others, wellness18programs, utilization reviews, second opinions and medical19fee reviews, as well as for paying for hospital and medical20care up to the maximum coverage provided by the plan, to its21members 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 HB2720 Enrolled -8- LRB9100169EGfgB 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 HB2720 Enrolled -9- LRB9100169EGfgB 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 HB2720 Enrolled -10- LRB9100169EGfgB 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) HB2720 Enrolled -11- LRB9100169EGfgB 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 forIllinois Stateincome 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 handicappedas 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 HB2720 Enrolled -12- LRB9100169EGfgB 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 forIllinois State18 income tax purposes and under age 23, or (iii) age 19 or 19 over and mentally or physically handicappedas defined in20the 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 HB2720 Enrolled -13- LRB9100169EGfgB 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. 17The program of health benefits shall offer each member a18choice 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 anytheHB2720 Enrolled -14- LRB9100169EGfgB 1annualauditrequired 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, HB2720 Enrolled -15- LRB9100169EGfgB 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 allretiredmembers or 9retireddependentsaged 65 years or olderwho are eligible 10 forentitled tobenefits 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 theretiredmember or 15retireddependents are eligible under Medicare, except that 16 such reduction in benefits shall apply only to thoseretired17 members orretireddependents 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. Forretiredmembers orretireddependentsaged 6532years or olderwho are eligible forentitled tobenefits 33 under Social Security or the Railroad Retirement system or 34 who had sufficient Medicare-covered government employment, HB2720 Enrolled -16- LRB9100169EGfgB 1 benefits shall be reduced by the amount for which theretired2member orretireddependent is eligible under Medicare, 3 except that such reduction in benefits shall apply only to 4 thoseretiredmembers orretireddependents 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 benefitsinsuranceprogramor22the self-insurance health planunder this Act. The Director 23 shallpromulgate rules and regulations todetermine 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 HB2720 Enrolled -17- LRB9100169EGfgB 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 Periodupon submission of10satisfactory evidence of insurability, unless there is a11change of family status that would confer new eligibility12for change of enrollment under rules established13supplementing this Act, in which event application must14be 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 HB2720 Enrolled -18- LRB9100169EGfgB 1 date ofelection or date ofemployment, 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 inof7familystatus 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 benefitsinsuranceprogram 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 onall oftheir 22 eligible dependent children, if any, mayshallbe under the 23 enrollment and election of either. 24 Regardless of other provisions herein regarding late 25 enrollment orchanges of enrollments being subject to26submission of satisfactory evidence of insurability orother 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 HB2720 Enrolled -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 portion100%of the premiums, charges or other 6 fees for all electedoptionalcoverages 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, 197414the State shall contribute $7 per month for each eligible15member who has enrolled one or more dependents for coverage16under the program of health benefits established under this17Act.All contributions and payments by the eligible members 18 and the State for all electedoptionalcoverages 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 HB2720 Enrolled -20- LRB9100169EGfgB 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 allretiredmembers andretireddependentsaged1965 years or olderwho are eligible forentitled tobenefits 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 thoseretiredmembers andor retireddependents 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. HB2720 Enrolled -21- LRB9100169EGfgB 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 HB2720 Enrolled -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 HB2720 Enrolled -23- LRB9100169EGfgB 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 HB2720 Enrolled -24- LRB9100169EGfgB 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 HB2720 Enrolled -25- LRB9100169EGfgB 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 HB2720 Enrolled -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 benefitsinsuranceplan 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 benefitsinsuranceplan 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 HB2720 Enrolled -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 Periodat a later date subject to7submission of satisfactory evidence of insurability and8provided that no benefits shall be payable for services9incurred during the first 6 months of coverage to the extent10the services are in connection with any pre-existing11condition. 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 HB2720 Enrolled -28- LRB9100169EGfgB 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 10insuranceplan. 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 planinsuranceor 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 HB2720 Enrolled -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 Periodat a later date subject to submission of satisfactory20evidence of insurability and provided that no benefits shall21be payable for services incurred during the first 6 months of22coverage to the extent the services are in connection with23any 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 HB2720 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 benefitsinsuranceshall 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 determinequarterlyrates 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 HB2720 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 the14amount normally charged to State employees or contributed15by 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.Those27annuitants enrolled initially under this contract shall have28no benefits payable for services incurred during the first 629months of coverage to the extent the services are in30connection with any pre-existing condition.Any annuitant 31whomay 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 Periodafter34this initial enrollment period shall be subject to submissionHB2720 Enrolled -32- LRB9100169EGfgB 1of satisfactory evidence of insurability and to the2pre-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 benefitsinsurancecoverages, 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 benefitsinsuranceprogram. 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 HB2720 Enrolled -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 benefitsinsuranceprogram 7 authorized by this Act. 8 Refunds to members for premiums paid for coveragefor9their dependentsmay 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 HB2720 Enrolled -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 HB2720 Enrolled -35- LRB9100169EGfgB 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 to19the 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 theself-insurance24 health plansplan. The eligible members shall be responsible 25 for their portionpayment of 100%of such optional premium 26and shall pay by means of payroll deduction. The State shall 27 contribute an amount$7per month for each eligible member 28 who has enrolled one or more dependents under the 29self-insurancehealth plansplan. 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 theself-insurancehealth 33 plan by making personal payments with the premiums to be 34 deposited in the Health Insurance Reserve Fund. HB2720 Enrolled -36- LRB9100169EGfgB 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 HB2720 Enrolled -37- LRB9100169EGfgB 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 HB2720 Enrolled -38- LRB9100169EGfgB 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 auditsan annual auditand reports 14reporton the programs authorized and established by this Act 15 prepared by the Director with the assistance of a qualified, 16 independent accounting firm. The reportsannual reportshall 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.