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| [ Introduced ] | [ Enrolled ] | [ House Amendment 002 ] |
91_SB0251eng SB251 Engrossed LRB9102764EGfg 1 AN ACT to amend the State Employees Group Insurance Act 2 of 1971 by changing Section 10. 3 Be it enacted by the People of the State of Illinois, 4 represented in the General Assembly: 5 Section 5. The State Employees Group Insurance Act of 6 1971 is amended by changing Section 10 as follows: 7 (5 ILCS 375/10) (from Ch. 127, par. 530) 8 Sec. 10. Payments by State; premiums. 9 (a) The State shall pay the cost of basic 10 non-contributory group life insurance and, subject to member 11 paid contributions set by the Department or required by this 12 Section, the basic program of group health benefits on each 13 eligible member, except a member, not otherwise covered by 14 this Act, who has retired as a participating member under 15 Article 2 of the Illinois Pension Code but is ineligible for 16 the retirement annuity under Section 2-119 of the Illinois 17 Pension Code, and part of each eligible member's and retired 18 member's premiums for health insurance coverage for enrolled 19 dependents as provided by Section 9. The State shall pay the 20 cost of the basic program of group health benefits only after 21 benefits are reduced by the amount of benefits covered by 22 Medicare for all retired members and retired dependents aged 23 65 years or older who are entitled to benefits under Social 24 Security or the Railroad Retirement system or who had 25 sufficient Medicare-covered government employment except that 26 such reduction in benefits shall apply only to those retired 27 members or retired dependents who (1) first become eligible 28 for such Medicare coverage on or after July 1, 1992; or (2) 29 remain eligible for, but no longer receive Medicare coverage 30 which they had been receiving on or after July 1, 1992. The 31 Department may determine the aggregate level of the State's SB251 Engrossed -2- LRB9102764EGfg 1 contribution on the basis of actual cost of medical services 2 adjusted for age, sex or geographic or other demographic 3 characteristics which affect the costs of such programs. 4 The cost of participation in the basic program of group 5 health benefits for the dependent or survivor of a living or 6 deceased retired employee who was formerly employed by the 7 University of Illinois in the Cooperative Extension Service 8 and would be an annuitant but for the fact that he or she was 9 made ineligible to participate in the State Universities 10 Retirement System by clause (4) of subsection (a) of Section 11 15-107 of the Illinois Pension Code shall not be greater than 12 the cost of participation that would otherwise apply to that 13 dependent or survivor if he or she were the dependent or 14 survivor of an annuitant under the State Universities 15 Retirement System. 16 (a-1) Beginning January 1, 1998, for each person who 17 becomes a new SERS annuitant and participates in the basic 18 program of group health benefits, the State shall contribute 19 toward the cost of the annuitant's coverage under the basic 20 program of group health benefits an amount equal to 5% of 21 that cost for each full year of creditable service upon which 22 the annuitant's retirement annuity is based, up to a maximum 23 of 100% for an annuitant with 20 or more years of creditable 24 service. The remainder of the cost of a new SERS annuitant's 25 coverage under the basic program of group health benefits 26 shall be the responsibility of the annuitant. 27 (a-2) Beginning January 1, 1998, for each person who 28 becomes a new SERS survivor and participates in the basic 29 program of group health benefits, the State shall contribute 30 toward the cost of the survivor's coverage under the basic 31 program of group health benefits an amount equal to 5% of 32 that cost for each full year of the deceased employee's or 33 deceased annuitant's creditable service in the State 34 Employees' Retirement System of Illinois on the date of SB251 Engrossed -3- LRB9102764EGfg 1 death, up to a maximum of 100% for a survivor of an employee 2 or annuitant with 20 or more years of creditable service. 3 The remainder of the cost of the new SERS survivor's coverage 4 under the basic program of group health benefits shall be the 5 responsibility of the survivor. 6 (a-3) Beginning January 1, 1998, for each person who 7 becomes a new SURS annuitant and participates in the basic 8 program of group health benefits, the State shall contribute 9 toward the cost of the annuitant's coverage under the basic 10 program of group health benefits an amount equal to 5% of 11 that cost for each full year of creditable service upon which 12 the annuitant's retirement annuity is based, up to a maximum 13 of 100% for an annuitant with 20 or more years of creditable 14 service. The remainder of the cost of a new SURS annuitant's 15 coverage under the basic program of group health benefits 16 shall be the responsibility of the annuitant. 17 (a-4) Beginning January 1, 1998, for each person who 18 becomes a new SURS retired employee and participates in the 19 basic program of group health benefits, the State shall 20 contribute toward the cost of the retired employee's coverage 21 under the basic program of group health benefits an amount 22 equal to 5% of that cost for each full year that the retired 23 employee was an employee as defined in Section 3, up to a 24 maximum of 100% for a retired employee who was an employee 25 for 20 or more years. The remainder of the cost of a new 26 SURS retired employee's coverage under the basic program of 27 group health benefits shall be the responsibility of the 28 retired employee. 29 (a-5) Beginning January 1, 1998, for each person who 30 becomes a new SURS 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 SB251 Engrossed -4- LRB9102764EGfg 1 deceased annuitant's creditable service in the State 2 Universities Retirement System on the date of death, up to a 3 maximum of 100% for a survivor of an employee or annuitant 4 with 20 or more years of creditable service. The remainder 5 of the cost of the new SURS survivor's coverage under the 6 basic program of group health benefits shall be the 7 responsibility of the survivor. 8 (a-6) Beginning July 1, 1998, for each person who 9 becomes a new TRS State annuitant and participates in the 10 basic program of group health benefits, the State shall 11 contribute toward the cost of the annuitant's coverage under 12 the basic program of group health benefits an amount equal to 13 5% of that cost for each full year of creditable service as a 14 teacher as defined in paragraph (2), (3), or (5) of Section 15 16-106 of the Illinois Pension Code upon which the 16 annuitant's retirement annuity is based, up to a maximum of 17 100% for an annuitant with 20 or more years of such 18 creditable service. The remainder of the cost of a new TRS 19 State annuitant's coverage under the basic program of group 20 health benefits shall be the responsibility of the annuitant. 21 (a-7) Beginning July 1, 1998, for each person who 22 becomes a new TRS State survivor and participates in the 23 basic program of group health benefits, the State shall 24 contribute toward the cost of the survivor's coverage under 25 the basic program of group health benefits an amount equal to 26 5% of that cost for each full year of the deceased employee's 27 or deceased annuitant's creditable service as a teacher as 28 defined in paragraph (2), (3), or (5) of Section 16-106 of 29 the Illinois Pension Code on the date of death, up to a 30 maximum of 100% for a survivor of an employee or annuitant 31 with 20 or more years of such creditable service. The 32 remainder of the cost of the new TRS State survivor's 33 coverage under the basic program of group health benefits 34 shall be the responsibility of the survivor. SB251 Engrossed -5- LRB9102764EGfg 1 (a-8) A new SERS annuitant, new SERS survivor, new SURS 2 annuitant, new SURS retired employee, new SURS survivor, new 3 TRS State annuitant, or new TRS State survivor may waive or 4 terminate coverage in the program of group health benefits. 5 Any such annuitant, survivor, or retired employee who has 6 waived or terminated coverage may enroll or re-enroll in the 7 program of group health benefits only during the annual 8 benefit choice period, as determined by the Director; except 9 that in the event of termination of coverage due to 10 nonpayment of premiums, the annuitant, survivor, or retired 11 employee may not re-enroll in the program. 12 (a-9) No later than May 1 of each calendar year, the 13 Director of Central Management Services shall certify in 14 writing to the Executive Secretary of the State Employees' 15 Retirement System of Illinois the amounts of the Medicare 16 supplement health care premiums and the amounts of the health 17 care premiums for all other retirees who are not Medicare 18 eligible. 19 A separate calculation of the premiums based upon the 20 actual cost of each health care plan shall be so certified. 21 The Director of Central Management Services shall provide 22 to the Executive Secretary of the State Employees' Retirement 23 System of Illinois such information, statistics, and other 24 data as he or she may require to review the premium amounts 25 certified by the Director of Central Management Services. 26 (b) State employees who become eligible for this program 27 on or after January 1, 1980 in positions normally requiring 28 actual performance of duty not less than 1/2 of a normal work 29 period but not equal to that of a normal work period, shall 30 be given the option of participating in the available 31 program. If the employee elects coverage, the State shall 32 contribute on behalf of such employee to the cost of the 33 employee's benefit and any applicable dependent supplement, 34 that sum which bears the same percentage as that percentage SB251 Engrossed -6- LRB9102764EGfg 1 of time the employee regularly works when compared to normal 2 work period. 3 (c) The basic non-contributory coverage from the basic 4 program of group health benefits shall be continued for each 5 employee not in pay status or on active service by reason of 6 (1) leave of absence due to illness or injury, (2) authorized 7 educational leave of absence or sabbatical leave, or (3) 8 military leave with pay and benefits. This coverage shall 9 continue until expiration of authorized leave and return to 10 active service, but not to exceed 24 months for leaves under 11 item (1) or (2). This 24-month limitation and the requirement 12 of returning to active service shall not apply to persons 13 receiving ordinary or accidental disability benefits or 14 retirement benefits through the appropriate State retirement 15 system or benefits under the Workers' Compensation or 16 Occupational Disease Act. 17 (d) The basic group life insurance coverage shall 18 continue, with full State contribution, where such person is 19 (1) absent from active service by reason of disability 20 arising from any cause other than self-inflicted, (2) on 21 authorized educational leave of absence or sabbatical leave, 22 or (3) on military leave with pay and benefits. 23 (e) Where the person is in non-pay status for a period 24 in excess of 30 days or on leave of absence, other than by 25 reason of disability, educational or sabbatical leave, or 26 military leave with pay and benefits, such person may 27 continue coverage only by making personal payment equal to 28 the amount normally contributed by the State on such person's 29 behalf. Such payments and coverage may be continued: (1) 30 until such time as the person returns to a status eligible 31 for coverage at State expense, but not to exceed 24 months, 32 (2) until such person's employment or annuitant status with 33 the State is terminated, or (3) for a maximum period of 4 34 years for members on military leave with pay and benefits and SB251 Engrossed -7- LRB9102764EGfg 1 military leave without pay and benefits (exclusive of any 2 additional service imposed pursuant to law). 3 (f) The Department shall establish by rule the extent 4 to which other employee benefits will continue for persons in 5 non-pay status or who are not in active service. 6 (g) The State shall not pay the cost of the basic 7 non-contributory group life insurance, program of health 8 benefits and other employee benefits for members who are 9 survivors as defined by paragraphs (1) and (2) of subsection 10 (q) of Section 3 of this Act. The costs of benefits for 11 these survivors shall be paid by the survivors or by the 12 University of Illinois Cooperative Extension Service, or any 13 combination thereof. However, the State shall pay the amount 14 of the reduction in the cost of participation, if any, 15 resulting from the amendment to subsection (a) made by this 16 amendatory Act of the 91st General Assembly. 17 (h) Those persons occupying positions with any 18 department as a result of emergency appointments pursuant to 19 Section 8b.8 of the Personnel Code who are not considered 20 employees under this Act shall be given the option of 21 participating in the programs of group life insurance, health 22 benefits and other employee benefits. Such persons electing 23 coverage may participate only by making payment equal to the 24 amount normally contributed by the State for similarly 25 situated employees. Such amounts shall be determined by the 26 Director. Such payments and coverage may be continued until 27 such time as the person becomes an employee pursuant to this 28 Act or such person's appointment is terminated. 29 (i) Any unit of local government within the State of 30 Illinois may apply to the Director to have its employees, 31 annuitants, and their dependents provided group health 32 coverage under this Act on a non-insured basis. To 33 participate, a unit of local government must agree to enroll 34 all of its employees, who may select coverage under either SB251 Engrossed -8- LRB9102764EGfg 1 the State group health insurance plan or a health maintenance 2 organization that has contracted with the State to be 3 available as a health care provider for employees as defined 4 in this Act. A unit of local government must remit the 5 entire cost of providing coverage under the State group 6 health insurance plan or, for coverage under a health 7 maintenance organization, an amount determined by the 8 Director based on an analysis of the sex, age, geographic 9 location, or other relevant demographic variables for its 10 employees, except that the unit of local government shall not 11 be required to enroll those of its employees who are covered 12 spouses or dependents under this plan or another group policy 13 or plan providing health benefits as long as (1) an 14 appropriate official from the unit of local government 15 attests that each employee not enrolled is a covered spouse 16 or dependent under this plan or another group policy or plan, 17 and (2) at least 85% of the employees are enrolled and the 18 unit of local government remits the entire cost of providing 19 coverage to those employees. Employees of a participating 20 unit of local government who are not enrolled due to coverage 21 under another group health policy or plan may enroll at a 22 later date subject to submission of satisfactory evidence of 23 insurability and provided that no benefits shall be payable 24 for services incurred during the first 6 months of coverage 25 to the extent the services are in connection with any 26 pre-existing condition. A participating unit of local 27 government may also elect to cover its annuitants. Dependent 28 coverage shall be offered on an optional basis, with the 29 costs paid by the unit of local government, its employees, or 30 some combination of the two as determined by the unit of 31 local government. The unit of local government shall be 32 responsible for timely collection and transmission of 33 dependent premiums. 34 The Director shall annually determine monthly rates of SB251 Engrossed -9- LRB9102764EGfg 1 payment, subject to the following constraints: 2 (1) In the first year of coverage, the rates shall 3 be equal to the amount normally charged to State 4 employees for elected optional coverages or for enrolled 5 dependents coverages or other contributory coverages, or 6 contributed by the State for basic insurance coverages on 7 behalf of its employees, adjusted for differences between 8 State employees and employees of the local government in 9 age, sex, geographic location or other relevant 10 demographic variables, plus an amount sufficient to pay 11 for the additional administrative costs of providing 12 coverage to employees of the unit of local government and 13 their dependents. 14 (2) In subsequent years, a further adjustment shall 15 be made to reflect the actual prior years' claims 16 experience of the employees of the unit of local 17 government. 18 In the case of coverage of local government employees 19 under a health maintenance organization, the Director shall 20 annually determine for each participating unit of local 21 government the maximum monthly amount the unit may contribute 22 toward that coverage, based on an analysis of (i) the age, 23 sex, geographic location, and other relevant demographic 24 variables of the unit's employees and (ii) the cost to cover 25 those employees under the State group health insurance plan. 26 The Director may similarly determine the maximum monthly 27 amount each unit of local government may contribute toward 28 coverage of its employees' dependents under a health 29 maintenance organization. 30 Monthly payments by the unit of local government or its 31 employees for group health insurance or health maintenance 32 organization coverage shall be deposited in the Local 33 Government Health Insurance Reserve Fund. The Local 34 Government Health Insurance Reserve Fund shall be a SB251 Engrossed -10- LRB9102764EGfg 1 continuing fund not subject to fiscal year limitations. All 2 expenditures from this fund shall be used for payments for 3 health care benefits for local government and rehabilitation 4 facility employees, annuitants, and dependents, and to 5 reimburse the Department or its administrative service 6 organization for all expenses incurred in the administration 7 of benefits. No other State funds may be used for these 8 purposes. 9 A local government employer's participation or desire to 10 participate in a program created under this subsection shall 11 not limit that employer's duty to bargain with the 12 representative of any collective bargaining unit of its 13 employees. 14 (j) Any rehabilitation facility within the State of 15 Illinois may apply to the Director to have its employees, 16 annuitants, and their dependents provided group health 17 coverage under this Act on a non-insured basis. To 18 participate, a rehabilitation facility must agree to enroll 19 all of its employees and remit the entire cost of providing 20 such coverage for its employees, except that the 21 rehabilitation facility shall not be required to enroll those 22 of its employees who are covered spouses or dependents under 23 this plan or another group policy or plan providing health 24 benefits as long as (1) an appropriate official from the 25 rehabilitation facility attests that each employee not 26 enrolled is a covered spouse or dependent under this plan or 27 another group policy or plan, and (2) at least 85% of the 28 employees are enrolled and the rehabilitation facility remits 29 the entire cost of providing coverage to those employees. 30 Employees of a participating rehabilitation facility who are 31 not enrolled due to coverage under another group health 32 policy or plan may enroll at a later date subject to 33 submission of satisfactory evidence of insurability and 34 provided that no benefits shall be payable for services SB251 Engrossed -11- LRB9102764EGfg 1 incurred during the first 6 months of coverage to the extent 2 the services are in connection with any pre-existing 3 condition. A participating rehabilitation facility may also 4 elect to cover its annuitants. Dependent coverage shall be 5 offered on an optional basis, with the costs paid by the 6 rehabilitation facility, its employees, or some combination 7 of the 2 as determined by the rehabilitation facility. The 8 rehabilitation facility shall be responsible for timely 9 collection and transmission of dependent premiums. 10 The Director shall annually determine quarterly rates of 11 payment, subject to the following constraints: 12 (1) In the first year of coverage, the rates shall 13 be equal to the amount normally charged to State 14 employees for elected optional coverages or for enrolled 15 dependents coverages or other contributory coverages on 16 behalf of its employees, adjusted for differences between 17 State employees and employees of the rehabilitation 18 facility in age, sex, geographic location or other 19 relevant demographic variables, plus an amount sufficient 20 to pay for the additional administrative costs of 21 providing coverage to employees of the rehabilitation 22 facility and their dependents. 23 (2) In subsequent years, a further adjustment shall 24 be made to reflect the actual prior years' claims 25 experience of the employees of the rehabilitation 26 facility. 27 Monthly payments by the rehabilitation facility or its 28 employees for group health insurance shall be deposited in 29 the Local Government Health Insurance Reserve Fund. 30 (k) Any domestic violence shelter or service within the 31 State of Illinois may apply to the Director to have its 32 employees, annuitants, and their dependents provided group 33 health coverage under this Act on a non-insured basis. To 34 participate, a domestic violence shelter or service must SB251 Engrossed -12- LRB9102764EGfg 1 agree to enroll all of its employees and pay the entire cost 2 of providing such coverage for its employees. A 3 participating domestic violence shelter may also elect to 4 cover its annuitants. Dependent coverage shall be offered on 5 an optional basis, with employees, or some combination of the 6 2 as determined by the domestic violence shelter or service. 7 The domestic violence shelter or service shall be responsible 8 for timely collection and transmission of dependent premiums. 9 The Director shall annually determine quarterly rates of 10 payment, subject to the following constraints: 11 (1) In the first year of coverage, the rates shall 12 be equal to the amount normally charged to State 13 employees for elected optional coverages or for enrolled 14 dependents coverages or other contributory coverages on 15 behalf of its employees, adjusted for differences between 16 State employees and employees of the domestic violence 17 shelter or service in age, sex, geographic location or 18 other relevant demographic variables, plus an amount 19 sufficient to pay for the additional administrative costs 20 of providing coverage to employees of the domestic 21 violence shelter or service and their dependents. 22 (2) In subsequent years, a further adjustment shall 23 be made to reflect the actual prior years' claims 24 experience of the employees of the domestic violence 25 shelter or service. 26 (3) In no case shall the rate be less than the 27 amount normally charged to State employees or contributed 28 by the State on behalf of its employees. 29 Monthly payments by the domestic violence shelter or 30 service or its employees for group health insurance shall be 31 deposited in the Local Government Health Insurance Reserve 32 Fund. 33 (l) A public community college or entity organized 34 pursuant to the Public Community College Act may apply to the SB251 Engrossed -13- LRB9102764EGfg 1 Director initially to have only annuitants not covered prior 2 to July 1, 1992 by the district's health plan provided health 3 coverage under this Act on a non-insured basis. The 4 community college must execute a 2-year contract to 5 participate in the Local Government Health Plan. Those 6 annuitants enrolled initially under this contract shall have 7 no benefits payable for services incurred during the first 6 8 months of coverage to the extent the services are in 9 connection with any pre-existing condition. Any annuitant 10 who may enroll after this initial enrollment period shall be 11 subject to submission of satisfactory evidence of 12 insurability and to the pre-existing conditions limitation. 13 The Director shall annually determine monthly rates of 14 payment subject to the following constraints: for those 15 community colleges with annuitants only enrolled, first year 16 rates shall be equal to the average cost to cover claims for 17 a State member adjusted for demographics, Medicare 18 participation, and other factors; and in the second year, a 19 further adjustment of rates shall be made to reflect the 20 actual first year's claims experience of the covered 21 annuitants. 22 (m) The Director shall adopt any rules deemed necessary 23 for implementation of this amendatory Act of 1989 (Public Act 24 86-978). 25 (Source: P.A. 89-53, eff. 7-1-95; 89-236, eff. 8-4-95; 26 89-324, eff. 8-13-95; 89-626, eff. 8-9-96; 90-65, eff. 27 7-7-97; 90-582, eff. 5-27-98; 90-655, eff. 7-30-98; revised 28 8-3-98.) 29 Section 99. Effective date. This Act takes effect upon 30 becoming law.