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91_HB3218
LRB9110587MWgcA
1 AN ACT to amend the State Employees Group Insurance Act
2 of 1971 by changing Sections 3 and 10.
3 Be it enacted by the People of the State of Illinois,
4 represented in the General Assembly:
5 Section 5. The State Employees Group Insurance Act of
6 1971 is amended by changing Sections 3 and 10 as follows:
7 (5 ILCS 375/3) (from Ch. 127, par. 523)
8 Sec. 3. Definitions. Unless the context otherwise
9 requires, the following words and phrases as used in this Act
10 shall have the following meanings. The Department may define
11 these and other words and phrases separately for the purpose
12 of implementing specific programs providing benefits under
13 this Act.
14 (a) "Administrative service organization" means any
15 person, firm or corporation experienced in the handling of
16 claims which is fully qualified, financially sound and
17 capable of meeting the service requirements of a contract of
18 administration executed with the Department.
19 (b) "Annuitant" means (1) an employee who retires, or
20 has retired, on or after January 1, 1966 on an immediate
21 annuity under the provisions of Articles 2, 14, 15 (including
22 an employee who has retired under the optional retirement
23 program established under Section 15-158.2), paragraphs (2),
24 (3), or (5) of Section 16-106, or Article 18 of the Illinois
25 Pension Code; (2) any person who was receiving group
26 insurance coverage under this Act as of March 31, 1978 by
27 reason of his status as an annuitant, even though the annuity
28 in relation to which such coverage was provided is a
29 proportional annuity based on less than the minimum period of
30 service required for a retirement annuity in the system
31 involved; (3) any person not otherwise covered by this Act
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1 who has retired as a participating member under Article 2 of
2 the Illinois Pension Code but is ineligible for the
3 retirement annuity under Section 2-119 of the Illinois
4 Pension Code; (4) the spouse of any person who is receiving a
5 retirement annuity under Article 18 of the Illinois Pension
6 Code and who is covered under a group health insurance
7 program sponsored by a governmental employer other than the
8 State of Illinois and who has irrevocably elected to waive
9 his or her coverage under this Act and to have his or her
10 spouse considered as the "annuitant" under this Act and not
11 as a "dependent"; or (5) an employee who retires, or has
12 retired, from a qualified position, as determined according
13 to rules promulgated by the Director, under a qualified local
14 government, or a qualified rehabilitation facility, or a
15 qualified domestic violence shelter or service, or a
16 qualified day care center. (For definition of "retired
17 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 (1) 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, (2) has not made the election authorized under Section
29 15-135.1 of the Illinois Pension Code, and (3) is eligible to
30 participate in the basic program of group health benefits
31 provided for annuitants under this Act.
32 (b-7) "New TRS State annuitant" means a person who, on
33 or after July 1, 1998, becomes an annuitant, as defined in
34 subsection (b), by virtue of beginning to receive a
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1 retirement annuity under Article 16 of the Illinois Pension
2 Code based on service as a teacher as defined in paragraph
3 (2), (3), or (5) of Section 16-106 of that Code, and is
4 eligible to participate in the basic program of group health
5 benefits provided for annuitants under this Act.
6 (c) "Carrier" means (1) an insurance company, a
7 corporation organized under the Limited Health Service
8 Organization Act or the Voluntary Health Services Plan Act, a
9 partnership, or other nongovernmental organization, which is
10 authorized to do group life or group health insurance
11 business in Illinois, or (2) the State of Illinois as a
12 self-insurer.
13 (d) "Compensation" means salary or wages payable on a
14 regular payroll by the State Treasurer on a warrant of the
15 State Comptroller out of any State, trust or federal fund, or
16 by the Governor of the State through a disbursing officer of
17 the State out of a trust or out of federal funds, or by any
18 Department out of State, trust, federal or other funds held
19 by the State Treasurer or the Department, to any person for
20 personal services currently performed, and ordinary or
21 accidental disability benefits under Articles 2, 14, 15
22 (including ordinary or accidental disability benefits under
23 the optional retirement program established under Section
24 15-158.2), paragraphs (2), (3), or (5) of Section 16-106, or
25 Article 18 of the Illinois Pension Code, for disability
26 incurred after January 1, 1966, or benefits payable under the
27 Workers' Compensation or Occupational Diseases Act or
28 benefits payable under a sick pay plan established in
29 accordance with Section 36 of the State Finance Act.
30 "Compensation" also means salary or wages paid to an employee
31 of any qualified local government, a or qualified
32 rehabilitation facility, or a qualified domestic violence
33 shelter or service, or a qualified day care center.
34 (e) "Commission" means the State Employees Group
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1 Insurance Advisory Commission authorized by this Act.
2 Commencing July 1, 1984, "Commission" as used in this Act
3 means the Illinois Economic and Fiscal Commission as
4 established by the Legislative Commission Reorganization Act
5 of 1984.
6 (f) "Contributory", when referred to as contributory
7 coverage, shall mean optional coverages or benefits elected
8 by the member toward the cost of which such member makes
9 contribution, or which are funded in whole or in part through
10 the acceptance of a reduction in earnings or the foregoing of
11 an increase in earnings by an employee, as distinguished from
12 noncontributory coverage or benefits which are paid entirely
13 by the State of Illinois without reduction of the member's
14 salary.
15 (g) "Department" means any department, institution,
16 board, commission, officer, court or any agency of the State
17 government receiving appropriations and having power to
18 certify payrolls to the Comptroller authorizing payments of
19 salary and wages against such appropriations as are made by
20 the General Assembly from any State fund, or against trust
21 funds held by the State Treasurer and includes boards of
22 trustees of the retirement systems created by Articles 2, 14,
23 15, 16 and 18 of the Illinois Pension Code. "Department"
24 also includes the Illinois Comprehensive Health Insurance
25 Board, the Board of Examiners established under the Illinois
26 Public Accounting Act, and the Illinois Rural Bond Bank.
27 (h) "Dependent", when the term is used in the context of
28 the health and life plan, means a member's spouse and any
29 unmarried child (1) from birth to age 19 including an adopted
30 child, a child who lives with the member from the time of the
31 filing of a petition for adoption until entry of an order of
32 adoption, a stepchild or recognized child who lives with the
33 member in a parent-child relationship, or a child who lives
34 with the member if such member is a court appointed guardian
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1 of the child, or (2) age 19 to 23 enrolled as a full-time
2 student in any accredited school, financially dependent upon
3 the member, and eligible to be claimed as a dependent for
4 income tax purposes, or (3) age 19 or over who is mentally or
5 physically handicapped. For the health plan only, the term
6 "dependent" also includes any person enrolled prior to the
7 effective date of this Section who is dependent upon the
8 member to the extent that the member may claim such person as
9 a dependent for income tax deduction purposes; no other such
10 person may be enrolled.
11 (i) "Director" means the Director of the Illinois
12 Department of Central Management Services.
13 (j) "Eligibility period" means the period of time a
14 member has to elect enrollment in programs or to select
15 benefits without regard to age, sex or health.
16 (k) "Employee" means and includes each officer or
17 employee in the service of a department who (1) receives his
18 compensation for service rendered to the department on a
19 warrant issued pursuant to a payroll certified by a
20 department or on a warrant or check issued and drawn by a
21 department upon a trust, federal or other fund or on a
22 warrant issued pursuant to a payroll certified by an elected
23 or duly appointed officer of the State or who receives
24 payment of the performance of personal services on a warrant
25 issued pursuant to a payroll certified by a Department and
26 drawn by the Comptroller upon the State Treasurer against
27 appropriations made by the General Assembly from any fund or
28 against trust funds held by the State Treasurer, and (2) is
29 employed full-time or part-time in a position normally
30 requiring actual performance of duty during not less than 1/2
31 of a normal work period, as established by the Director in
32 cooperation with each department, except that persons elected
33 by popular vote will be considered employees during the
34 entire term for which they are elected regardless of hours
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1 devoted to the service of the State, and (3) except that
2 "employee" does not include any person who is not eligible by
3 reason of such person's employment to participate in one of
4 the State retirement systems under Articles 2, 14, 15 (either
5 the regular Article 15 system or the optional retirement
6 program established under Section 15-158.2) or 18, or under
7 paragraph (2), (3), or (5) of Section 16-106, of the Illinois
8 Pension Code, but such term does include persons who are
9 employed during the 6 month qualifying period under Article
10 14 of the Illinois Pension Code. Such term also includes any
11 person who (1) after January 1, 1966, is receiving ordinary
12 or accidental disability benefits under Articles 2, 14, 15
13 (including ordinary or accidental disability benefits under
14 the optional retirement program established under Section
15 15-158.2), paragraphs (2), (3), or (5) of Section 16-106, or
16 Article 18 of the Illinois Pension Code, for disability
17 incurred after January 1, 1966, (2) receives total permanent
18 or total temporary disability under the Workers' Compensation
19 Act or Occupational Disease Act as a result of injuries
20 sustained or illness contracted in the course of employment
21 with the State of Illinois, or (3) is not otherwise covered
22 under this Act and has retired as a participating member
23 under Article 2 of the Illinois Pension Code but is
24 ineligible for the retirement annuity under Section 2-119 of
25 the Illinois Pension Code. However, a person who satisfies
26 the criteria of the foregoing definition of "employee" except
27 that such person is made ineligible to participate in the
28 State Universities Retirement System by clause (4) of
29 subsection (a) of Section 15-107 of the Illinois Pension Code
30 is also an "employee" for the purposes of this Act.
31 "Employee" also includes any person receiving or eligible for
32 benefits under a sick pay plan established in accordance with
33 Section 36 of the State Finance Act. "Employee" also includes
34 each officer or employee in the service of a qualified local
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1 government, including persons appointed as trustees of
2 sanitary districts regardless of hours devoted to the service
3 of the sanitary district, and each employee in the service of
4 a qualified rehabilitation facility, and each full-time
5 employee in the service of a qualified domestic violence
6 shelter or service, and each employee in the service of a
7 qualified day care center, as determined according to rules
8 promulgated by the Director.
9 (l) "Member" means an employee, annuitant, retired
10 employee or survivor.
11 (m) "Optional coverages or benefits" means those
12 coverages or benefits available to the member on his or her
13 voluntary election, and at his or her own expense.
14 (n) "Program" means the group life insurance, health
15 benefits and other employee benefits designed and contracted
16 for by the Director under this Act.
17 (o) "Health plan" means a health benefits program
18 offered by the State of Illinois for persons eligible for the
19 plan.
20 (p) "Retired employee" means any person who would be an
21 annuitant as that term is defined herein but for the fact
22 that such person retired prior to January 1, 1966. Such term
23 also includes any person formerly employed by the University
24 of Illinois in the Cooperative Extension Service who would be
25 an annuitant but for the fact that such person was made
26 ineligible to participate in the State Universities
27 Retirement System by clause (4) of subsection (a) of Section
28 15-107 of the Illinois Pension Code.
29 (q) "Survivor" means a person receiving an annuity as a
30 survivor of an employee or of an annuitant. "Survivor" also
31 includes: (1) the surviving dependent of a person who
32 satisfies the definition of "employee" except that such
33 person is made ineligible to participate in the State
34 Universities Retirement System by clause (4) of subsection
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1 (a) of Section 15-107 of the Illinois Pension Code; and (2)
2 the surviving dependent of any person formerly employed by
3 the University of Illinois in the Cooperative Extension
4 Service who would be an annuitant except for the fact that
5 such person was made ineligible to participate in the State
6 Universities Retirement System by clause (4) of subsection
7 (a) of Section 15-107 of the Illinois Pension Code.
8 (q-5) "New SERS survivor" means a survivor, as defined
9 in subsection (q), whose annuity is paid under Article 14 of
10 the Illinois Pension Code and is based on the death of (i) an
11 employee whose death occurs on or after January 1, 1998, or
12 (ii) a new SERS annuitant as defined in subsection (b-5).
13 (q-6) "New SURS survivor" means a survivor, as defined
14 in subsection (q), whose annuity is paid under Article 15 of
15 the Illinois Pension Code and is based on the death of (i) an
16 employee whose death occurs on or after January 1, 1998, or
17 (ii) a new SURS annuitant as defined in subsection (b-6).
18 (q-7) "New TRS State survivor" means a survivor, as
19 defined in subsection (q), whose annuity is paid under
20 Article 16 of the Illinois Pension Code and is based on the
21 death of (i) an employee who is a teacher as defined in
22 paragraph (2), (3), or (5) of Section 16-106 of that Code and
23 whose death occurs on or after July 1, 1998, or (ii) a new
24 TRS State annuitant as defined in subsection (b-7).
25 (r) "Medical services" means the services provided
26 within the scope of their licenses by practitioners in all
27 categories licensed under the Medical Practice Act of 1987.
28 (s) "Unit of local government" means any county,
29 municipality, township, school district, special district or
30 other unit, designated as a unit of local government by law,
31 which exercises limited governmental powers or powers in
32 respect to limited governmental subjects, any not-for-profit
33 association with a membership that primarily includes
34 townships and township officials, that has duties that
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1 include provision of research service, dissemination of
2 information, and other acts for the purpose of improving
3 township government, and that is funded wholly or partly in
4 accordance with Section 85-15 of the Township Code; any
5 not-for-profit corporation or association, with a membership
6 consisting primarily of municipalities, that operates its own
7 utility system, and provides research, training,
8 dissemination of information, or other acts to promote
9 cooperation between and among municipalities that provide
10 utility services and for the advancement of the goals and
11 purposes of its membership; the Southern Illinois Collegiate
12 Common Market, which is a consortium of higher education
13 institutions in Southern Illinois; and the Illinois
14 Association of Park Districts. "Qualified local government"
15 means a unit of local government approved by the Director and
16 participating in a program created under subsection (i) of
17 Section 10 of this Act.
18 (t) "Qualified rehabilitation facility" means any
19 not-for-profit organization that is accredited by the
20 Commission on Accreditation of Rehabilitation Facilities or
21 certified by the Department of Human Services (as successor
22 to the Department of Mental Health and Developmental
23 Disabilities) to provide services to persons with
24 disabilities and which receives funds from the State of
25 Illinois for providing those services, approved by the
26 Director and participating in a program created under
27 subsection (j) of Section 10 of this Act.
28 (u) "Qualified domestic violence shelter or service"
29 means any Illinois domestic violence shelter or service and
30 its administrative offices funded by the Department of Human
31 Services (as successor to the Illinois Department of Public
32 Aid), approved by the Director and participating in a program
33 created under subsection (k) of Section 10.
34 (v) "TRS benefit recipient" means a person who:
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1 (1) is not a "member" as defined in this Section;
2 and
3 (2) is receiving a monthly benefit or retirement
4 annuity under Article 16 of the Illinois Pension Code;
5 and
6 (3) either (i) has at least 8 years of creditable
7 service under Article 16 of the Illinois Pension Code, or
8 (ii) was enrolled in the health insurance program offered
9 under that Article on January 1, 1996, or (iii) is the
10 survivor of a benefit recipient who had at least 8 years
11 of creditable service under Article 16 of the Illinois
12 Pension Code or was enrolled in the health insurance
13 program offered under that Article on the effective date
14 of this amendatory Act of 1995, or (iv) is a recipient or
15 survivor of a recipient of a disability benefit under
16 Article 16 of the Illinois Pension Code.
17 (w) "TRS dependent beneficiary" means a person who:
18 (1) is not a "member" or "dependent" as defined in
19 this Section; and
20 (2) is a TRS benefit recipient's: (A) spouse, (B)
21 dependent parent who is receiving at least half of his or
22 her support from the TRS benefit recipient, or (C)
23 unmarried natural or adopted child who is (i) under age
24 19, or (ii) enrolled as a full-time student in an
25 accredited school, financially dependent upon the TRS
26 benefit recipient, eligible to be claimed as a dependent
27 for income tax purposes, and either is under age 24 or
28 was, on January 1, 1996, participating as a dependent
29 beneficiary in the health insurance program offered under
30 Article 16 of the Illinois Pension Code, or (iii) age 19
31 or over who is mentally or physically handicapped.
32 (x) "Military leave with pay and benefits" refers to
33 individuals in basic training for reserves, special/advanced
34 training, annual training, emergency call up, or activation
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1 by the President of the United States with approved pay and
2 benefits.
3 (y) "Military leave without pay and benefits" refers to
4 individuals who enlist for active duty in a regular component
5 of the U.S. Armed Forces or other duty not specified or
6 authorized under military leave with pay and benefits.
7 (z) "Community college benefit recipient" means a person
8 who:
9 (1) is not a "member" as defined in this Section;
10 and
11 (2) is receiving a monthly survivor's annuity or
12 retirement annuity under Article 15 of the Illinois
13 Pension Code; and
14 (3) either (i) was a full-time employee of a
15 community college district or an association of community
16 college boards created under the Public Community College
17 Act (other than an employee whose last employer under
18 Article 15 of the Illinois Pension Code was a community
19 college district subject to Article VII of the Public
20 Community College Act) and was eligible to participate in
21 a group health benefit plan as an employee during the
22 time of employment with a community college district
23 (other than a community college district subject to
24 Article VII of the Public Community College Act) or an
25 association of community college boards, or (ii) is the
26 survivor of a person described in item (i).
27 (aa) "Community college dependent beneficiary" means a
28 person who:
29 (1) is not a "member" or "dependent" as defined in
30 this Section; and
31 (2) is a community college benefit recipient's: (A)
32 spouse, (B) dependent parent who is receiving at least
33 half of his or her support from the community college
34 benefit recipient, or (C) unmarried natural or adopted
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1 child who is (i) under age 19, or (ii) enrolled as a
2 full-time student in an accredited school, financially
3 dependent upon the community college benefit recipient,
4 eligible to be claimed as a dependent for income tax
5 purposes and under age 23, or (iii) age 19 or over and
6 mentally or physically handicapped.
7 (bb) "Qualified day care center" means any day care
8 center that is licensed under the Child Care Act of 1969
9 whose child care services are funded by the Department of
10 Human Services (as successor to the Department of Children
11 and Family Services) through grants or individual voucher,
12 approved by the Director, and participating in a program
13 created under subsection (n) of Section 10.
14 (Source: P.A. 90-14, eff. 7-1-97; 90-65, eff. 7-7-97; 90-448,
15 eff. 8-16-97; 90-497, eff. 8-18-97; 90-511, eff. 8-22-97;
16 90-582, eff. 5-27-98; 90-655, eff. 7-30-98; 91-390, eff.
17 7-30-99; 91-395, eff. 7-30-99; 91-617, eff, 8-19-99; revised
18 10-19-99.)
19 (5 ILCS 375/10) (from Ch. 127, par. 530)
20 Sec. 10. Payments by State; premiums.
21 (a) The State shall pay the cost of basic
22 non-contributory group life insurance and, subject to member
23 paid contributions set by the Department or required by this
24 Section, the basic program of group health benefits on each
25 eligible member, except a member, not otherwise covered by
26 this Act, who has retired as a participating member under
27 Article 2 of the Illinois Pension Code but is ineligible for
28 the retirement annuity under Section 2-119 of the Illinois
29 Pension Code, and part of each eligible member's and retired
30 member's premiums for health insurance coverage for enrolled
31 dependents as provided by Section 9. The State shall pay the
32 cost of the basic program of group health benefits only after
33 benefits are reduced by the amount of benefits covered by
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1 Medicare for all members and dependents who are eligible for
2 benefits under Social Security or the Railroad Retirement
3 system or who had sufficient Medicare-covered government
4 employment, except that such reduction in benefits shall
5 apply only to those members and dependents who (1) first
6 become eligible for such Medicare coverage on or after July
7 1, 1992; or (2) are Medicare-eligible members or dependents
8 of a local government unit which began participation in the
9 program on or after July 1, 1992; or (3) remain eligible for,
10 but no longer receive Medicare coverage which they had been
11 receiving on or after July 1, 1992. The Department may
12 determine the aggregate level of the State's contribution on
13 the basis of actual cost of medical services adjusted for
14 age, sex or geographic or other demographic characteristics
15 which affect the costs of such programs.
16 The cost of participation in the basic program of group
17 health benefits for the dependent or survivor of a living or
18 deceased retired employee who was formerly employed by the
19 University of Illinois in the Cooperative Extension Service
20 and would be an annuitant but for the fact that he or she was
21 made ineligible to participate in the State Universities
22 Retirement System by clause (4) of subsection (a) of Section
23 15-107 of the Illinois Pension Code shall not be greater than
24 the cost of participation that would otherwise apply to that
25 dependent or survivor if he or she were the dependent or
26 survivor of an annuitant under the State Universities
27 Retirement System.
28 (a-1) Beginning January 1, 1998, for each person who
29 becomes a new SERS annuitant and participates in the basic
30 program of group health benefits, the State shall contribute
31 toward the cost of the annuitant's coverage under the basic
32 program of group health benefits an amount equal to 5% of
33 that cost for each full year of creditable service upon which
34 the annuitant's retirement annuity is based, up to a maximum
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1 of 100% for an annuitant with 20 or more years of creditable
2 service. The remainder of the cost of a new SERS annuitant's
3 coverage under the basic program of group health benefits
4 shall be the responsibility of the annuitant.
5 (a-2) Beginning January 1, 1998, for each person who
6 becomes a new SERS survivor and participates in the basic
7 program of group health benefits, the State shall contribute
8 toward the cost of the survivor's coverage under the basic
9 program of group health benefits an amount equal to 5% of
10 that cost for each full year of the deceased employee's or
11 deceased annuitant's creditable service in the State
12 Employees' Retirement System of Illinois on the date of
13 death, up to a maximum of 100% for a survivor of an employee
14 or annuitant with 20 or more years of creditable service.
15 The remainder of the cost of the new SERS survivor's coverage
16 under the basic program of group health benefits shall be the
17 responsibility of the survivor.
18 (a-3) Beginning January 1, 1998, for each person who
19 becomes a new SURS annuitant and participates in the basic
20 program of group health benefits, the State shall contribute
21 toward the cost of the annuitant's coverage under the basic
22 program of group health benefits an amount equal to 5% of
23 that cost for each full year of creditable service upon which
24 the annuitant's retirement annuity is based, up to a maximum
25 of 100% for an annuitant with 20 or more years of creditable
26 service. The remainder of the cost of a new SURS annuitant's
27 coverage under the basic program of group health benefits
28 shall be the responsibility of the annuitant.
29 (a-4) (Blank).
30 (a-5) Beginning January 1, 1998, for each person who
31 becomes a new SURS survivor and participates in the basic
32 program of group health benefits, the State shall contribute
33 toward the cost of the survivor's coverage under the basic
34 program of group health benefits an amount equal to 5% of
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1 that cost for each full year of the deceased employee's or
2 deceased annuitant's creditable service in the State
3 Universities Retirement System on the date of death, up to a
4 maximum of 100% for a survivor of an employee or annuitant
5 with 20 or more years of creditable service. The remainder
6 of the cost of the new SURS survivor's coverage under the
7 basic program of group health benefits shall be the
8 responsibility of the survivor.
9 (a-6) Beginning July 1, 1998, for each person who
10 becomes a new TRS State annuitant and participates in the
11 basic program of group health benefits, the State shall
12 contribute toward the cost of the annuitant's coverage under
13 the basic program of group health benefits an amount equal to
14 5% of that cost for each full year of creditable service as a
15 teacher as defined in paragraph (2), (3), or (5) of Section
16 16-106 of the Illinois Pension Code upon which the
17 annuitant's retirement annuity is based, up to a maximum of
18 100%; except that the State contribution shall be 12.5% per
19 year (rather than 5%) for each full year of creditable
20 service as a regional superintendent or assistant regional
21 superintendent of schools. The remainder of the cost of a
22 new TRS State annuitant's coverage under the basic program of
23 group health benefits shall be the responsibility of the
24 annuitant.
25 (a-7) Beginning July 1, 1998, for each person who
26 becomes a new TRS State survivor and participates in the
27 basic program of group health benefits, the State shall
28 contribute toward the cost of the survivor's coverage under
29 the basic program of group health benefits an amount equal to
30 5% of that cost for each full year of the deceased employee's
31 or deceased annuitant's creditable service as a teacher as
32 defined in paragraph (2), (3), or (5) of Section 16-106 of
33 the Illinois Pension Code on the date of death, up to a
34 maximum of 100%; except that the State contribution shall be
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1 12.5% per year (rather than 5%) for each full year of the
2 deceased employee's or deceased annuitant's creditable
3 service as a regional superintendent or assistant regional
4 superintendent of schools. The remainder of the cost of the
5 new TRS State survivor's coverage under the basic program of
6 group health benefits shall be the responsibility of the
7 survivor.
8 (a-8) A new SERS annuitant, new SERS survivor, new SURS
9 annuitant, new SURS survivor, new TRS State annuitant, or new
10 TRS State survivor may waive or terminate coverage in the
11 program of group health benefits. Any such annuitant or
12 survivor who has waived or terminated coverage may enroll or
13 re-enroll in the program of group health benefits only during
14 the annual benefit choice period, as determined by the
15 Director; except that in the event of termination of coverage
16 due to nonpayment of premiums, the annuitant or survivor may
17 not re-enroll in the program.
18 (a-9) No later than May 1 of each calendar year, the
19 Director of Central Management Services shall certify in
20 writing to the Executive Secretary of the State Employees'
21 Retirement System of Illinois the amounts of the Medicare
22 supplement health care premiums and the amounts of the health
23 care premiums for all other retirees who are not Medicare
24 eligible.
25 A separate calculation of the premiums based upon the
26 actual cost of each health care plan shall be so certified.
27 The Director of Central Management Services shall provide
28 to the Executive Secretary of the State Employees' Retirement
29 System of Illinois such information, statistics, and other
30 data as he or she may require to review the premium amounts
31 certified by the Director of Central Management Services.
32 (b) State employees who become eligible for this program
33 on or after January 1, 1980 in positions normally requiring
34 actual performance of duty not less than 1/2 of a normal work
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1 period but not equal to that of a normal work period, shall
2 be given the option of participating in the available
3 program. If the employee elects coverage, the State shall
4 contribute on behalf of such employee to the cost of the
5 employee's benefit and any applicable dependent supplement,
6 that sum which bears the same percentage as that percentage
7 of time the employee regularly works when compared to normal
8 work period.
9 (c) The basic non-contributory coverage from the basic
10 program of group health benefits shall be continued for each
11 employee not in pay status or on active service by reason of
12 (1) leave of absence due to illness or injury, (2) authorized
13 educational leave of absence or sabbatical leave, or (3)
14 military leave with pay and benefits. This coverage shall
15 continue until expiration of authorized leave and return to
16 active service, but not to exceed 24 months for leaves under
17 item (1) or (2). This 24-month limitation and the requirement
18 of returning to active service shall not apply to persons
19 receiving ordinary or accidental disability benefits or
20 retirement benefits through the appropriate State retirement
21 system or benefits under the Workers' Compensation or
22 Occupational Disease Act.
23 (d) The basic group life insurance coverage shall
24 continue, with full State contribution, where such person is
25 (1) absent from active service by reason of disability
26 arising from any cause other than self-inflicted, (2) on
27 authorized educational leave of absence or sabbatical leave,
28 or (3) on military leave with pay and benefits.
29 (e) Where the person is in non-pay status for a period
30 in excess of 30 days or on leave of absence, other than by
31 reason of disability, educational or sabbatical leave, or
32 military leave with pay and benefits, such person may
33 continue coverage only by making personal payment equal to
34 the amount normally contributed by the State on such person's
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1 behalf. Such payments and coverage may be continued: (1)
2 until such time as the person returns to a status eligible
3 for coverage at State expense, but not to exceed 24 months,
4 (2) until such person's employment or annuitant status with
5 the State is terminated, or (3) for a maximum period of 4
6 years for members on military leave with pay and benefits and
7 military leave without pay and benefits (exclusive of any
8 additional service imposed pursuant to law).
9 (f) The Department shall establish by rule the extent
10 to which other employee benefits will continue for persons in
11 non-pay status or who are not in active service.
12 (g) The State shall not pay the cost of the basic
13 non-contributory group life insurance, program of health
14 benefits and other employee benefits for members who are
15 survivors as defined by paragraphs (1) and (2) of subsection
16 (q) of Section 3 of this Act. The costs of benefits for
17 these survivors shall be paid by the survivors or by the
18 University of Illinois Cooperative Extension Service, or any
19 combination thereof. However, the State shall pay the amount
20 of the reduction in the cost of participation, if any,
21 resulting from the amendment to subsection (a) made by this
22 amendatory Act of the 91st General Assembly.
23 (h) Those persons occupying positions with any
24 department as a result of emergency appointments pursuant to
25 Section 8b.8 of the Personnel Code who are not considered
26 employees under this Act shall be given the option of
27 participating in the programs of group life insurance, health
28 benefits and other employee benefits. Such persons electing
29 coverage may participate only by making payment equal to the
30 amount normally contributed by the State for similarly
31 situated employees. Such amounts shall be determined by the
32 Director. Such payments and coverage may be continued until
33 such time as the person becomes an employee pursuant to this
34 Act or such person's appointment is terminated.
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1 (i) Any unit of local government within the State of
2 Illinois may apply to the Director to have its employees,
3 annuitants, and their dependents provided group health
4 coverage under this Act on a non-insured basis. To
5 participate, a unit of local government must agree to enroll
6 all of its employees, who may select coverage under either
7 the State group health benefits plan or a health maintenance
8 organization that has contracted with the State to be
9 available as a health care provider for employees as defined
10 in this Act. A unit of local government must remit the
11 entire cost of providing coverage under the State group
12 health benefits plan or, for coverage under a health
13 maintenance organization, an amount determined by the
14 Director based on an analysis of the sex, age, geographic
15 location, or other relevant demographic variables for its
16 employees, except that the unit of local government shall not
17 be required to enroll those of its employees who are covered
18 spouses or dependents under this plan or another group policy
19 or plan providing health benefits as long as (1) an
20 appropriate official from the unit of local government
21 attests that each employee not enrolled is a covered spouse
22 or dependent under this plan or another group policy or plan,
23 and (2) at least 85% of the employees are enrolled and the
24 unit of local government remits the entire cost of providing
25 coverage to those employees, except that a participating
26 school district must have enrolled at least 85% of its
27 full-time employees who have not waived coverage under the
28 district's group health plan by participating in a component
29 of the district's cafeteria plan. A participating school
30 district is not required to enroll a full-time employee who
31 has waived coverage under the district's health plan,
32 provided that an appropriate official from the participating
33 school district attests that the full-time employee has
34 waived coverage by participating in a component of the
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1 district's cafeteria plan. For the purposes of this
2 subsection, "participating school district" includes a unit
3 of local government whose primary purpose is education as
4 defined by the Department's rules.
5 Employees of a participating unit of local government who
6 are not enrolled due to coverage under another group health
7 policy or plan may enroll in the event of a qualifying change
8 in status, special enrollment, special circumstance as
9 defined by the Director, or during the annual Benefit Choice
10 Period. A participating unit of local government may also
11 elect to cover its annuitants. Dependent coverage shall be
12 offered on an optional basis, with the costs paid by the unit
13 of local government, its employees, or some combination of
14 the two as determined by the unit of local government. The
15 unit of local government shall be responsible for timely
16 collection and transmission of dependent premiums.
17 The Director shall annually determine monthly rates of
18 payment, subject to the following constraints:
19 (1) In the first year of coverage, the rates shall
20 be equal to the amount normally charged to State
21 employees for elected optional coverages or for enrolled
22 dependents coverages or other contributory coverages, or
23 contributed by the State for basic insurance coverages on
24 behalf of its employees, adjusted for differences between
25 State employees and employees of the local government in
26 age, sex, geographic location or other relevant
27 demographic variables, plus an amount sufficient to pay
28 for the additional administrative costs of providing
29 coverage to employees of the unit of local government and
30 their dependents.
31 (2) In subsequent years, a further adjustment shall
32 be made to reflect the actual prior years' claims
33 experience of the employees of the unit of local
34 government.
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1 In the case of coverage of local government employees
2 under a health maintenance organization, the Director shall
3 annually determine for each participating unit of local
4 government the maximum monthly amount the unit may contribute
5 toward that coverage, based on an analysis of (i) the age,
6 sex, geographic location, and other relevant demographic
7 variables of the unit's employees and (ii) the cost to cover
8 those employees under the State group health benefits plan.
9 The Director may similarly determine the maximum monthly
10 amount each unit of local government may contribute toward
11 coverage of its employees' dependents under a health
12 maintenance organization.
13 Monthly payments by the unit of local government or its
14 employees for group health benefits plan or health
15 maintenance organization coverage shall be deposited in the
16 Local Government Health Insurance Reserve Fund. The Local
17 Government Health Insurance Reserve Fund shall be a
18 continuing fund not subject to fiscal year limitations. All
19 expenditures from this fund shall be used for payments for
20 health care benefits for local government and rehabilitation
21 facility employees, annuitants, and dependents, and to
22 reimburse the Department or its administrative service
23 organization for all expenses incurred in the administration
24 of benefits. No other State funds may be used for these
25 purposes.
26 A local government employer's participation or desire to
27 participate in a program created under this subsection shall
28 not limit that employer's duty to bargain with the
29 representative of any collective bargaining unit of its
30 employees.
31 (j) Any rehabilitation facility within the State of
32 Illinois may apply to the Director to have its employees,
33 annuitants, and their eligible dependents provided group
34 health coverage under this Act on a non-insured basis. To
-22- LRB9110587MWgcA
1 participate, a rehabilitation facility must agree to enroll
2 all of its employees and remit the entire cost of providing
3 such coverage for its employees, except that the
4 rehabilitation facility shall not be required to enroll those
5 of its employees who are covered spouses or dependents under
6 this plan or another group policy or plan providing health
7 benefits as long as (1) an appropriate official from the
8 rehabilitation facility attests that each employee not
9 enrolled is a covered spouse or dependent under this plan or
10 another group policy or plan, and (2) at least 85% of the
11 employees are enrolled and the rehabilitation facility remits
12 the entire cost of providing coverage to those employees.
13 Employees of a participating rehabilitation facility who are
14 not enrolled due to coverage under another group health
15 policy or plan may enroll in the event of a qualifying change
16 in status, special enrollment, special circumstance as
17 defined by the Director, or during the annual Benefit Choice
18 Period. A participating rehabilitation facility may also
19 elect to cover its annuitants. Dependent coverage shall be
20 offered on an optional basis, with the costs paid by the
21 rehabilitation facility, its employees, or some combination
22 of the 2 as determined by the rehabilitation facility. The
23 rehabilitation facility shall be responsible for timely
24 collection and transmission of dependent premiums.
25 The Director shall annually determine quarterly rates of
26 payment, subject to the following constraints:
27 (1) In the first year of coverage, the rates shall
28 be equal to the amount normally charged to State
29 employees for elected optional coverages or for enrolled
30 dependents coverages or other contributory coverages on
31 behalf of its employees, adjusted for differences between
32 State employees and employees of the rehabilitation
33 facility in age, sex, geographic location or other
34 relevant demographic variables, plus an amount sufficient
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1 to pay for the additional administrative costs of
2 providing coverage to employees of the rehabilitation
3 facility and their dependents.
4 (2) In subsequent years, a further adjustment shall
5 be made to reflect the actual prior years' claims
6 experience of the employees of the rehabilitation
7 facility.
8 Monthly payments by the rehabilitation facility or its
9 employees for group health benefits shall be deposited in the
10 Local Government Health Insurance Reserve Fund.
11 (k) Any domestic violence shelter or service within the
12 State of Illinois may apply to the Director to have its
13 employees, annuitants, and their dependents provided group
14 health coverage under this Act on a non-insured basis. To
15 participate, a domestic violence shelter or service must
16 agree to enroll all of its employees and pay the entire cost
17 of providing such coverage for its employees. A
18 participating domestic violence shelter may also elect to
19 cover its annuitants. Dependent coverage shall be offered on
20 an optional basis, with employees, or some combination of the
21 2 as determined by the domestic violence shelter or service.
22 The domestic violence shelter or service shall be responsible
23 for timely collection and transmission of dependent premiums.
24 The Director shall annually determine rates of payment,
25 subject to the following constraints:
26 (1) In the first year of coverage, the rates shall
27 be equal to the amount normally charged to State
28 employees for elected optional coverages or for enrolled
29 dependents coverages or other contributory coverages on
30 behalf of its employees, adjusted for differences between
31 State employees and employees of the domestic violence
32 shelter or service in age, sex, geographic location or
33 other relevant demographic variables, plus an amount
34 sufficient to pay for the additional administrative costs
-24- LRB9110587MWgcA
1 of providing coverage to employees of the domestic
2 violence shelter or service and their dependents.
3 (2) In subsequent years, a further adjustment shall
4 be made to reflect the actual prior years' claims
5 experience of the employees of the domestic violence
6 shelter or service.
7 Monthly payments by the domestic violence shelter or
8 service or its employees for group health insurance shall be
9 deposited in the Local Government Health Insurance Reserve
10 Fund.
11 (l) A public community college or entity organized
12 pursuant to the Public Community College Act may apply to the
13 Director initially to have only annuitants not covered prior
14 to July 1, 1992 by the district's health plan provided health
15 coverage under this Act on a non-insured basis. The
16 community college must execute a 2-year contract to
17 participate in the Local Government Health Plan. Any
18 annuitant may enroll in the event of a qualifying change in
19 status, special enrollment, special circumstance as defined
20 by the Director, or during the annual Benefit Choice Period.
21 The Director shall annually determine monthly rates of
22 payment subject to the following constraints: for those
23 community colleges with annuitants only enrolled, first year
24 rates shall be equal to the average cost to cover claims for
25 a State member adjusted for demographics, Medicare
26 participation, and other factors; and in the second year, a
27 further adjustment of rates shall be made to reflect the
28 actual first year's claims experience of the covered
29 annuitants.
30 (l-5) The provisions of subsection (l) become
31 inoperative on July 1, 1999.
32 (m) The Director shall adopt any rules deemed necessary
33 for implementation of this amendatory Act of 1989 (Public Act
34 86-978).
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1 (n) Any day care center licensed under the Child Care
2 Act of 1969 may apply to the Director to have its employees,
3 annuitants, and their dependants provided group health
4 insurance under this Act on a non-insured basis. To
5 participate, a day care center must agree to enroll all of
6 its employees and to pay the entire cost of providing such
7 coverage for its employees, except that the day care center
8 is not required to enroll those of its employees who are
9 covered spouses or dependents under another group policy or
10 plan providing health benefits as long as (i) the day care
11 center attests that each employee not enrolled is a covered
12 spouse or dependent under another group policy or plan and
13 (ii) at least 85% of its employees are enrolled. Employees of
14 a participating day care center who are not enrolled due to
15 coverage under another group policy or plan may enroll at a
16 later date subject to submission of satisfactory evidence of
17 insurability and provided that no benefits may be payable
18 for services incurred during the first 6 months of coverage
19 to the extent the services are in connection with any
20 pre-existing condition. A participating day care center may
21 also elect to cover its annuitants. Dependent coverage shall
22 be offered on an optional basis, with employees, or some
23 combination of the 2 as determined by the day care center.
24 The day care center is responsible for timely collection and
25 transmission of dependent premiums.
26 The Director shall annually determine quarterly rates of
27 payment, subject to the following constraints:
28 (1) In the first year of coverage, the rates shall
29 be equal to the amount normally charged to State
30 employees for elected optional coverages or for enrolled
31 dependents coverages or other contributory coverages on
32 behalf of its employees, adjusted for differences between
33 State employees and employees of the day care center in
34 age, sex, geographic location, or other relevant
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1 demographic variables, plus an amount sufficient to pay
2 for the additional administrative costs of providing
3 coverage to employees of the day care center and their
4 dependents.
5 (2) In subsequent years, a further adjustment shall
6 be made to reflect the actual prior years' claims
7 experience of the employees of the day care center.
8 (3) In no case shall the rate be less than the
9 amount normally charged to State employees or contributed
10 by the State on behalf of its employees.
11 Monthly payments by the day care center or its employees
12 for group health insurance shall be deposited into the Local
13 Government Health Insurance Reserve Fund.
14 (Source: P.A. 90-65, eff. 7-7-97; 90-582, eff. 5-27-98;
15 90-655, eff. 7-30-98; 91-280, eff. 7-23-99; 91-311; eff.
16 7-29-99; 91-357, eff. 7-29-99; 91-390, eff. 7-30-99; 91-395,
17 eff. 7-30-99; 91-617, eff. 8-19-99; revised 8-31-99.)