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91_HB3863
LRB9111294EGfg
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 Section 10 as follows:
7 (5 ILCS 375/10) (from Ch. 127, par. 530)
8 Sec. 10. Payments by State; premiums.
9 (a) The State shall pay the cost of basic
10 non-contributory group life insurance and, subject to member
11 paid contributions set by the Department or required by this
12 Section, the basic program of group health benefits on each
13 eligible member, except a member, not otherwise covered by
14 this Act, who has retired as a participating member under
15 Article 2 of the Illinois Pension Code but is ineligible for
16 the retirement annuity under Section 2-119 of the Illinois
17 Pension Code, and part of each eligible member's and retired
18 member's premiums for health insurance coverage for enrolled
19 dependents as provided by Section 9. The State shall pay the
20 cost of the basic program of group health benefits only after
21 benefits are reduced by the amount of benefits covered by
22 Medicare for all members and dependents who are eligible for
23 benefits under Social Security or the Railroad Retirement
24 system or who had sufficient Medicare-covered government
25 employment, except that such reduction in benefits shall
26 apply only to those members and dependents who (1) first
27 become eligible for such Medicare coverage on or after July
28 1, 1992; or (2) are Medicare-eligible members or dependents
29 of a local government unit which began participation in the
30 program on or after July 1, 1992; or (3) remain eligible for,
31 but no longer receive Medicare coverage which they had been
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1 receiving on or after July 1, 1992. The Department may
2 determine the aggregate level of the State's contribution on
3 the basis of actual cost of medical services adjusted for
4 age, sex or geographic or other demographic characteristics
5 which affect the costs of such programs.
6 The cost of participation in the basic program of group
7 health benefits for the dependent or survivor of a living or
8 deceased retired employee who was formerly employed by the
9 University of Illinois in the Cooperative Extension Service
10 and would be an annuitant but for the fact that he or she was
11 made ineligible to participate in the State Universities
12 Retirement System by clause (4) of subsection (a) of Section
13 15-107 of the Illinois Pension Code shall not be greater than
14 the cost of participation that would otherwise apply to that
15 dependent or survivor if he or she were the dependent or
16 survivor of an annuitant under the State Universities
17 Retirement System.
18 (a-1) Beginning January 1, 1998, for each person who
19 becomes a new SERS 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 SERS annuitant's
27 coverage under the basic program of group health benefits
28 shall be the responsibility of the annuitant.
29 (a-2) Beginning January 1, 1998, for each person who
30 becomes a new SERS survivor and participates in the basic
31 program of group health benefits, the State shall contribute
32 toward the cost of the survivor's coverage under the basic
33 program of group health benefits an amount equal to 5% of
34 that cost for each full year of the deceased employee's or
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1 deceased annuitant's creditable service in the State
2 Employees' Retirement System of Illinois on the date of
3 death, up to a maximum of 100% for a survivor of an employee
4 or annuitant with 20 or more years of creditable service.
5 The remainder of the cost of the new SERS survivor's coverage
6 under the basic program of group health benefits shall be the
7 responsibility of the survivor.
8 (a-3) Beginning January 1, 1998, for each person who
9 becomes a new SURS annuitant and participates in the basic
10 program of group health benefits, the State shall contribute
11 toward the cost of the annuitant's coverage under the basic
12 program of group health benefits an amount equal to 5% of
13 that cost for each full year of creditable service upon which
14 the annuitant's retirement annuity is based, up to a maximum
15 of 100% for an annuitant with 20 or more years of creditable
16 service. The remainder of the cost of a new SURS annuitant's
17 coverage under the basic program of group health benefits
18 shall be the responsibility of the annuitant.
19 (a-4) (Blank).
20 (a-5) Beginning January 1, 1998, for each person who
21 becomes a new SURS survivor and participates in the basic
22 program of group health benefits, the State shall contribute
23 toward the cost of the survivor's coverage under the basic
24 program of group health benefits an amount equal to 5% of
25 that cost for each full year of the deceased employee's or
26 deceased annuitant's creditable service in the State
27 Universities Retirement System on the date of death, up to a
28 maximum of 100% for a survivor of an employee or annuitant
29 with 20 or more years of creditable service. The remainder
30 of the cost of the new SURS survivor's coverage under the
31 basic program of group health benefits shall be the
32 responsibility of the survivor.
33 (a-6) Beginning July 1, 1998, for each person who
34 becomes a new TRS State annuitant and participates in the
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1 basic program of group health benefits, the State shall
2 contribute toward the cost of the annuitant's coverage under
3 the basic program of group health benefits an amount equal to
4 5% of that cost for each full year of creditable service as a
5 teacher as defined in paragraph (2), (3), or (5) of Section
6 16-106 of the Illinois Pension Code upon which the
7 annuitant's retirement annuity is based, up to a maximum of
8 100%; except that the State contribution shall be 12.5% per
9 year (rather than 5%) for each full year of creditable
10 service as a regional superintendent or assistant regional
11 superintendent of schools. The remainder of the cost of a
12 new TRS State annuitant's coverage under the basic program of
13 group health benefits shall be the responsibility of the
14 annuitant.
15 The change made to this subsection by this amendatory Act
16 of the 91st General Assembly shall apply beginning on the
17 first day of the next plan year beginning after the effective
18 date of this amendatory Act.
19 (a-7) Beginning July 1, 1998, for each person who
20 becomes a new TRS State survivor and participates in the
21 basic program of group health benefits, the State shall
22 contribute toward the cost of the survivor's coverage under
23 the basic program of group health benefits an amount equal to
24 5% of that cost for each full year of the deceased employee's
25 or deceased annuitant's creditable service in the Teachers'
26 Retirement System of the State of Illinois as a teacher as
27 defined in paragraph (2), (3), or (5) of Section 16-106 of
28 the Illinois Pension Code on the date of death, up to a
29 maximum of 100%; except that the State contribution shall be
30 12.5% per year (rather than 5%) for each full year of the
31 deceased employee's or deceased annuitant's creditable
32 service as a regional superintendent or assistant regional
33 superintendent of schools. The remainder of the cost of the
34 new TRS State survivor's coverage under the basic program of
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1 group health benefits shall be the responsibility of the
2 survivor.
3 The change made to this subsection by this amendatory Act
4 of the 91st General Assembly shall apply beginning on the
5 first day of the next plan year beginning after the effective
6 date of this amendatory Act.
7 (a-8) A new SERS annuitant, new SERS survivor, new SURS
8 annuitant, new SURS survivor, new TRS State annuitant, or new
9 TRS State survivor may waive or terminate coverage in the
10 program of group health benefits. Any such annuitant or
11 survivor who has waived or terminated coverage may enroll or
12 re-enroll in the program of group health benefits only during
13 the annual benefit choice period, as determined by the
14 Director; except that in the event of termination of coverage
15 due to nonpayment of premiums, the annuitant or survivor may
16 not re-enroll in the program.
17 (a-9) In the case of a person who participates in the
18 basic program of group health benefits and receives an
19 annuity or monthly benefit under more than one of the
20 retirement systems established under Articles 14, 15, and 16
21 of the Illinois Pension Code, the person's responsibility for
22 the cost of participation in the basic program of group
23 health benefits shall be reduced to reflect all of the State
24 contributions that the person is entitled to under
25 subsections (a-1) through (a-7) of this Section.
26 (a-10) (a-9) No later than May 1 of each calendar year,
27 the Director of Central Management Services shall certify in
28 writing to the Executive Secretary of the State Employees'
29 Retirement System of Illinois the amounts of the Medicare
30 supplement health care premiums and the amounts of the health
31 care premiums for all other retirees who are not Medicare
32 eligible.
33 A separate calculation of the premiums based upon the
34 actual cost of each health care plan shall be so certified.
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1 The Director of Central Management Services shall provide
2 to the Executive Secretary of the State Employees' Retirement
3 System of Illinois such information, statistics, and other
4 data as he or she may require to review the premium amounts
5 certified by the Director of Central Management Services.
6 (b) State employees who become eligible for this program
7 on or after January 1, 1980 in positions normally requiring
8 actual performance of duty not less than 1/2 of a normal work
9 period but not equal to that of a normal work period, shall
10 be given the option of participating in the available
11 program. If the employee elects coverage, the State shall
12 contribute on behalf of such employee to the cost of the
13 employee's benefit and any applicable dependent supplement,
14 that sum which bears the same percentage as that percentage
15 of time the employee regularly works when compared to normal
16 work period.
17 (c) The basic non-contributory coverage from the basic
18 program of group health benefits shall be continued for each
19 employee not in pay status or on active service by reason of
20 (1) leave of absence due to illness or injury, (2) authorized
21 educational leave of absence or sabbatical leave, or (3)
22 military leave with pay and benefits. This coverage shall
23 continue until expiration of authorized leave and return to
24 active service, but not to exceed 24 months for leaves under
25 item (1) or (2). This 24-month limitation and the requirement
26 of returning to active service shall not apply to persons
27 receiving ordinary or accidental disability benefits or
28 retirement benefits through the appropriate State retirement
29 system or benefits under the Workers' Compensation or
30 Occupational Disease Act.
31 (d) The basic group life insurance coverage shall
32 continue, with full State contribution, where such person is
33 (1) absent from active service by reason of disability
34 arising from any cause other than self-inflicted, (2) on
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1 authorized educational leave of absence or sabbatical leave,
2 or (3) on military leave with pay and benefits.
3 (e) Where the person is in non-pay status for a period
4 in excess of 30 days or on leave of absence, other than by
5 reason of disability, educational or sabbatical leave, or
6 military leave with pay and benefits, such person may
7 continue coverage only by making personal payment equal to
8 the amount normally contributed by the State on such person's
9 behalf. Such payments and coverage may be continued: (1)
10 until such time as the person returns to a status eligible
11 for coverage at State expense, but not to exceed 24 months,
12 (2) until such person's employment or annuitant status with
13 the State is terminated, or (3) for a maximum period of 4
14 years for members on military leave with pay and benefits and
15 military leave without pay and benefits (exclusive of any
16 additional service imposed pursuant to law).
17 (f) The Department shall establish by rule the extent
18 to which other employee benefits will continue for persons in
19 non-pay status or who are not in active service.
20 (g) The State shall not pay the cost of the basic
21 non-contributory group life insurance, program of health
22 benefits and other employee benefits for members who are
23 survivors as defined by paragraphs (1) and (2) of subsection
24 (q) of Section 3 of this Act. The costs of benefits for
25 these survivors shall be paid by the survivors or by the
26 University of Illinois Cooperative Extension Service, or any
27 combination thereof. However, the State shall pay the amount
28 of the reduction in the cost of participation, if any,
29 resulting from the amendment to subsection (a) made by this
30 amendatory Act of the 91st General Assembly.
31 (h) Those persons occupying positions with any
32 department as a result of emergency appointments pursuant to
33 Section 8b.8 of the Personnel Code who are not considered
34 employees under this Act shall be given the option of
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1 participating in the programs of group life insurance, health
2 benefits and other employee benefits. Such persons electing
3 coverage may participate only by making payment equal to the
4 amount normally contributed by the State for similarly
5 situated employees. Such amounts shall be determined by the
6 Director. Such payments and coverage may be continued until
7 such time as the person becomes an employee pursuant to this
8 Act or such person's appointment is terminated.
9 (i) Any unit of local government within the State of
10 Illinois may apply to the Director to have its employees,
11 annuitants, and their dependents provided group health
12 coverage under this Act on a non-insured basis. To
13 participate, a unit of local government must agree to enroll
14 all of its employees, who may select coverage under either
15 the State group health benefits plan or a health maintenance
16 organization that has contracted with the State to be
17 available as a health care provider for employees as defined
18 in this Act. A unit of local government must remit the
19 entire cost of providing coverage under the State group
20 health benefits plan or, for coverage under a health
21 maintenance organization, an amount determined by the
22 Director based on an analysis of the sex, age, geographic
23 location, or other relevant demographic variables for its
24 employees, except that the unit of local government shall not
25 be required to enroll those of its employees who are covered
26 spouses or dependents under this plan or another group policy
27 or plan providing health benefits as long as (1) an
28 appropriate official from the unit of local government
29 attests that each employee not enrolled is a covered spouse
30 or dependent under this plan or another group policy or plan,
31 and (2) at least 85% of the employees are enrolled and the
32 unit of local government remits the entire cost of providing
33 coverage to those employees, except that a participating
34 school district must have enrolled at least 85% of its
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1 full-time employees who have not waived coverage under the
2 district's group health plan by participating in a component
3 of the district's cafeteria plan. A participating school
4 district is not required to enroll a full-time employee who
5 has waived coverage under the district's health plan,
6 provided that an appropriate official from the participating
7 school district attests that the full-time employee has
8 waived coverage by participating in a component of the
9 district's cafeteria plan. For the purposes of this
10 subsection, "participating school district" includes a unit
11 of local government whose primary purpose is education as
12 defined by the Department's rules.
13 Employees of a participating unit of local government who
14 are 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 unit of local government may also
19 elect to cover its annuitants. Dependent coverage shall be
20 offered on an optional basis, with the costs paid by the unit
21 of local government, its employees, or some combination of
22 the two as determined by the unit of local government. The
23 unit of local government shall be responsible for timely
24 collection and transmission of dependent premiums.
25 The Director shall annually determine monthly 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, or
31 contributed by the State for basic insurance coverages on
32 behalf of its employees, adjusted for differences between
33 State employees and employees of the local government 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 unit of local government and
4 their 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 unit of local
8 government.
9 In the case of coverage of local government employees
10 under a health maintenance organization, the Director shall
11 annually determine for each participating unit of local
12 government the maximum monthly amount the unit may contribute
13 toward that coverage, based on an analysis of (i) the age,
14 sex, geographic location, and other relevant demographic
15 variables of the unit's employees and (ii) the cost to cover
16 those employees under the State group health benefits plan.
17 The Director may similarly determine the maximum monthly
18 amount each unit of local government may contribute toward
19 coverage of its employees' dependents under a health
20 maintenance organization.
21 Monthly payments by the unit of local government or its
22 employees for group health benefits plan or health
23 maintenance organization coverage shall be deposited in the
24 Local Government Health Insurance Reserve Fund. The Local
25 Government Health Insurance Reserve Fund shall be a
26 continuing fund not subject to fiscal year limitations. All
27 expenditures from this fund shall be used for payments for
28 health care benefits for local government and rehabilitation
29 facility employees, annuitants, and dependents, and to
30 reimburse the Department or its administrative service
31 organization for all expenses incurred in the administration
32 of benefits. No other State funds may be used for these
33 purposes.
34 A local government employer's participation or desire to
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1 participate in a program created under this subsection shall
2 not limit that employer's duty to bargain with the
3 representative of any collective bargaining unit of its
4 employees.
5 (j) Any rehabilitation facility within the State of
6 Illinois may apply to the Director to have its employees,
7 annuitants, and their eligible dependents provided group
8 health coverage under this Act on a non-insured basis. To
9 participate, a rehabilitation facility must agree to enroll
10 all of its employees and remit the entire cost of providing
11 such coverage for its employees, except that the
12 rehabilitation facility shall not be required to enroll those
13 of its employees who are covered spouses or dependents under
14 this plan or another group policy or plan providing health
15 benefits as long as (1) an appropriate official from the
16 rehabilitation facility attests that each employee not
17 enrolled is a covered spouse or dependent under this plan or
18 another group policy or plan, and (2) at least 85% of the
19 employees are enrolled and the rehabilitation facility remits
20 the entire cost of providing coverage to those employees.
21 Employees of a participating rehabilitation facility who are
22 not enrolled due to coverage under another group health
23 policy or plan may enroll in the event of a qualifying change
24 in status, special enrollment, special circumstance as
25 defined by the Director, or during the annual Benefit Choice
26 Period. A participating rehabilitation facility may also
27 elect to cover its annuitants. Dependent coverage shall be
28 offered on an optional basis, with the costs paid by the
29 rehabilitation facility, its employees, or some combination
30 of the 2 as determined by the rehabilitation facility. The
31 rehabilitation facility shall be responsible for timely
32 collection and transmission of dependent premiums.
33 The Director shall annually determine quarterly rates of
34 payment, subject to the following constraints:
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1 (1) In the first year of coverage, the rates shall
2 be equal to the amount normally charged to State
3 employees for elected optional coverages or for enrolled
4 dependents coverages or other contributory coverages on
5 behalf of its employees, adjusted for differences between
6 State employees and employees of the rehabilitation
7 facility in age, sex, geographic location or other
8 relevant demographic variables, plus an amount sufficient
9 to pay for the additional administrative costs of
10 providing coverage to employees of the rehabilitation
11 facility and their dependents.
12 (2) In subsequent years, a further adjustment shall
13 be made to reflect the actual prior years' claims
14 experience of the employees of the rehabilitation
15 facility.
16 Monthly payments by the rehabilitation facility or its
17 employees for group health benefits shall be deposited in the
18 Local Government Health Insurance Reserve Fund.
19 (k) Any domestic violence shelter or service within the
20 State of Illinois may apply to the Director to have its
21 employees, annuitants, and their dependents provided group
22 health coverage under this Act on a non-insured basis. To
23 participate, a domestic violence shelter or service must
24 agree to enroll all of its employees and pay the entire cost
25 of providing such coverage for its employees. A
26 participating domestic violence shelter may also elect to
27 cover its annuitants. Dependent coverage shall be offered on
28 an optional basis, with employees, or some combination of the
29 2 as determined by the domestic violence shelter or service.
30 The domestic violence shelter or service shall be responsible
31 for timely collection and transmission of dependent premiums.
32 The Director shall annually determine rates of payment,
33 subject to the following constraints:
34 (1) In the first year of coverage, the rates shall
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1 be equal to the amount normally charged to State
2 employees for elected optional coverages or for enrolled
3 dependents coverages or other contributory coverages on
4 behalf of its employees, adjusted for differences between
5 State employees and employees of the domestic violence
6 shelter or service in age, sex, geographic location or
7 other relevant demographic variables, plus an amount
8 sufficient to pay for the additional administrative costs
9 of providing coverage to employees of the domestic
10 violence shelter or service and their dependents.
11 (2) In subsequent years, a further adjustment shall
12 be made to reflect the actual prior years' claims
13 experience of the employees of the domestic violence
14 shelter or service.
15 Monthly payments by the domestic violence shelter or
16 service or its employees for group health insurance shall be
17 deposited in the Local Government Health Insurance Reserve
18 Fund.
19 (l) A public community college or entity organized
20 pursuant to the Public Community College Act may apply to the
21 Director initially to have only annuitants not covered prior
22 to July 1, 1992 by the district's health plan provided health
23 coverage under this Act on a non-insured basis. The
24 community college must execute a 2-year contract to
25 participate in the Local Government Health Plan. Any
26 annuitant may enroll in the event of a qualifying change in
27 status, special enrollment, special circumstance as defined
28 by the Director, or during the annual Benefit Choice Period.
29 The Director shall annually determine monthly rates of
30 payment subject to the following constraints: for those
31 community colleges with annuitants only enrolled, first year
32 rates shall be equal to the average cost to cover claims for
33 a State member adjusted for demographics, Medicare
34 participation, and other factors; and in the second year, a
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1 further adjustment of rates shall be made to reflect the
2 actual first year's claims experience of the covered
3 annuitants.
4 (l-5) The provisions of subsection (l) become
5 inoperative on July 1, 1999.
6 (m) The Director shall adopt any rules deemed necessary
7 for implementation of this amendatory Act of 1989 (Public Act
8 86-978).
9 (Source: P.A. 90-65, eff. 7-7-97; 90-582, eff. 5-27-98;
10 90-655, eff. 7-30-98; 91-280, eff. 7-23-99; 91-311; eff.
11 7-29-99; 91-357, eff. 7-29-99; 91-390, eff. 7-30-99; 91-395,
12 eff. 7-30-99; 91-617, eff. 8-19-99; revised 8-31-99.)
13 Section 99. Effective date. This Act takes effect upon
14 becoming law.