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91_SB1022eng SB1022 Engrossed LRB9106120EGdv 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 SB1022 Engrossed -2- LRB9106120EGdv 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 (a-1) Beginning January 1, 1998, for each person who 5 becomes a new SERS annuitant and participates in the basic 6 program of group health benefits, the State shall contribute 7 toward the cost of the annuitant's coverage under the basic 8 program of group health benefits an amount equal to 5% of 9 that cost for each full year of creditable service upon which 10 the annuitant's retirement annuity is based, up to a maximum 11 of 100% for an annuitant with 20 or more years of creditable 12 service. The remainder of the cost of a new SERS annuitant's 13 coverage under the basic program of group health benefits 14 shall be the responsibility of the annuitant. 15 (a-2) Beginning January 1, 1998, for each person who 16 becomes a new SERS survivor and participates in the basic 17 program of group health benefits, the State shall contribute 18 toward the cost of the survivor's coverage under the basic 19 program of group health benefits an amount equal to 5% of 20 that cost for each full year of the deceased employee's or 21 deceased annuitant's creditable service in the State 22 Employees' Retirement System of Illinois on the date of 23 death, up to a maximum of 100% for a survivor of an employee 24 or annuitant with 20 or more years of creditable service. 25 The remainder of the cost of the new SERS survivor's coverage 26 under the basic program of group health benefits shall be the 27 responsibility of the survivor. 28 (a-3) Beginning January 1, 1998, for each person who 29 becomes a new SURS 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 SB1022 Engrossed -3- LRB9106120EGdv 1 of 100% for an annuitant with 20 or more years of creditable 2 service. The remainder of the cost of a new SURS annuitant's 3 coverage under the basic program of group health benefits 4 shall be the responsibility of the annuitant. 5 (a-4) Beginning January 1, 1998, for each person who 6 becomes a new SURS retired employee and participates in the 7 basic program of group health benefits, the State shall 8 contribute toward the cost of the retired employee's coverage 9 under the basic program of group health benefits an amount 10 equal to 5% of that cost for each full year that the retired 11 employee was an employee as defined in Section 3, up to a 12 maximum of 100% for a retired employee who was an employee 13 for 20 or more years. The remainder of the cost of a new 14 SURS retired employee's coverage under the basic program of 15 group health benefits shall be the responsibility of the 16 retired employee. 17 (a-5) Beginning January 1, 1998, for each person who 18 becomes a new SURS survivor and participates in the basic 19 program of group health benefits, the State shall contribute 20 toward the cost of the survivor's coverage under the basic 21 program of group health benefits an amount equal to 5% of 22 that cost for each full year of the deceased employee's or 23 deceased annuitant's creditable service in the State 24 Universities Retirement System on the date of death, up to a 25 maximum of 100% for a survivor of an employee or annuitant 26 with 20 or more years of creditable service. The remainder 27 of the cost of the new SURS survivor's coverage under the 28 basic program of group health benefits shall be the 29 responsibility of the survivor. 30 (a-6) Beginning July 1, 1998, for each person who 31 becomes a new TRS State annuitant and participates in the 32 basic program of group health benefits, the State shall 33 contribute toward the cost of the annuitant's coverage under 34 the basic program of group health benefits an amount equal to SB1022 Engrossed -4- LRB9106120EGdv 1 5% of that cost for each full year of creditable service as a 2 teacher as defined in paragraph (2), (3), or (5) of Section 3 16-106 of the Illinois Pension Code upon which the 4 annuitant's retirement annuity is based, up to a maximum of 5 100% for an annuitant with 20 or more years of such 6 creditable service. The remainder of the cost of a new TRS 7 State annuitant's coverage under the basic program of group 8 health benefits shall be the responsibility of the annuitant. 9 (a-7) Beginning July 1, 1998, for each person who 10 becomes a new TRS State survivor and participates in the 11 basic program of group health benefits, the State shall 12 contribute toward the cost of the survivor'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 the deceased employee's 15 or deceased annuitant's creditable service as a teacher as 16 defined in paragraph (2), (3), or (5) of Section 16-106 of 17 the Illinois Pension Code on the date of death, up to a 18 maximum of 100% for a survivor of an employee or annuitant 19 with 20 or more years of such creditable service. The 20 remainder of the cost of the new TRS State survivor's 21 coverage under the basic program of group health benefits 22 shall be the responsibility of the survivor. 23 (a-8) A new SERS annuitant, new SERS survivor, new SURS 24 annuitant, new SURS retired employee, new SURS survivor, new 25 TRS State annuitant, or new TRS State survivor may waive or 26 terminate coverage in the program of group health benefits. 27 Any such annuitant, survivor, or retired employee who has 28 waived or terminated coverage may enroll or re-enroll in the 29 program of group health benefits only during the annual 30 benefit choice period, as determined by the Director; except 31 that in the event of termination of coverage due to 32 nonpayment of premiums, the annuitant, survivor, or retired 33 employee may not re-enroll in the program. 34 (a-9) No later than May 1 of each calendar year, the SB1022 Engrossed -5- LRB9106120EGdv 1 Director of Central Management Services shall certify in 2 writing to the Executive Secretary of the State Employees' 3 Retirement System of Illinois the amounts of the Medicare 4 supplement health care premiums and the amounts of the health 5 care premiums for all other retirees who are not Medicare 6 eligible. 7 A separate calculation of the premiums based upon the 8 actual cost of each health care plan shall be so certified. 9 The Director of Central Management Services shall provide 10 to the Executive Secretary of the State Employees' Retirement 11 System of Illinois such information, statistics, and other 12 data as he or she may require to review the premium amounts 13 certified by the Director of Central Management Services. 14 (b) State employees who become eligible for this program 15 on or after January 1, 1980 in positions normally requiring 16 actual performance of duty not less than 1/2 of a normal work 17 period but not equal to that of a normal work period, shall 18 be given the option of participating in the available 19 program. If the employee elects coverage, the State shall 20 contribute on behalf of such employee to the cost of the 21 employee's benefit and any applicable dependent supplement, 22 that sum which bears the same percentage as that percentage 23 of time the employee regularly works when compared to normal 24 work period. 25 (c) The basic non-contributory coverage from the basic 26 program of group health benefits shall be continued for each 27 employee not in pay status or on active service by reason of 28 (1) leave of absence due to illness or injury, (2) authorized 29 educational leave of absence or sabbatical leave, or (3) 30 military leave with pay and benefits. This coverage shall 31 continue until expiration of authorized leave and return to 32 active service, but not to exceed 24 months for leaves under 33 item (1) or (2). This 24-month limitation and the requirement 34 of returning to active service shall not apply to persons SB1022 Engrossed -6- LRB9106120EGdv 1 receiving ordinary or accidental disability benefits or 2 retirement benefits through the appropriate State retirement 3 system or benefits under the Workers' Compensation or 4 Occupational Disease Act. 5 (d) The basic group life insurance coverage shall 6 continue, with full State contribution, where such person is 7 (1) absent from active service by reason of disability 8 arising from any cause other than self-inflicted, (2) on 9 authorized educational leave of absence or sabbatical leave, 10 or (3) on military leave with pay and benefits. 11 (e) Where the person is in non-pay status for a period 12 in excess of 30 days or on leave of absence, other than by 13 reason of disability, educational or sabbatical leave, or 14 military leave with pay and benefits, such person may 15 continue coverage only by making personal payment equal to 16 the amount normally contributed by the State on such person's 17 behalf. Such payments and coverage may be continued: (1) 18 until such time as the person returns to a status eligible 19 for coverage at State expense, but not to exceed 24 months, 20 (2) until such person's employment or annuitant status with 21 the State is terminated, or (3) for a maximum period of 4 22 years for members on military leave with pay and benefits and 23 military leave without pay and benefits (exclusive of any 24 additional service imposed pursuant to law). 25 (f) The Department shall establish by rule the extent 26 to which other employee benefits will continue for persons in 27 non-pay status or who are not in active service. 28 (g) The State shall not pay the cost of the basic 29 non-contributory group life insurance, program of health 30 benefits and other employee benefits for members who are 31 survivors as defined by paragraphs (1) and (2) of subsection 32 (q) of Section 3 of this Act. The costs of benefits for 33 these survivors shall be paid by the survivors or by the 34 University of Illinois Cooperative Extension Service, or any SB1022 Engrossed -7- LRB9106120EGdv 1 combination thereof. 2 (h) Those persons occupying positions with any 3 department as a result of emergency appointments pursuant to 4 Section 8b.8 of the Personnel Code who are not considered 5 employees under this Act shall be given the option of 6 participating in the programs of group life insurance, health 7 benefits and other employee benefits. Such persons electing 8 coverage may participate only by making payment equal to the 9 amount normally contributed by the State for similarly 10 situated employees. Such amounts shall be determined by the 11 Director. Such payments and coverage may be continued until 12 such time as the person becomes an employee pursuant to this 13 Act or such person's appointment is terminated. 14 (i) Any unit of local government 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 unit of local government must agree to enroll 19 all of its employees, who may select coverage under either 20 the State group health insurance plan or a health maintenance 21 organization that has contracted with the State to be 22 available as a health care provider for employees as defined 23 in this Act. A unit of local government must remit the 24 entire cost of providing coverage under the State group 25 health insurance plan or, for coverage under a health 26 maintenance organization, an amount determined by the 27 Director based on an analysis of the sex, age, geographic 28 location, or other relevant demographic variables for its 29 employees, except that the unit of local government shall not 30 be required to enroll those of its employees who are covered 31 spouses or dependents under this plan or another group policy 32 or plan providing health benefits as long as (1) an 33 appropriate official from the unit of local government 34 attests that each employee not enrolled is a covered spouse SB1022 Engrossed -8- LRB9106120EGdv 1 or dependent under this plan or another group policy or plan, 2 and (2) at least 85% of the employees are enrolled and the 3 unit of local government remits the entire cost of providing 4 coverage to those employees; except that a participating 5 school district is required to enroll at least 85% of the 6 district's full-time employees who have not waived coverage 7 in the district's group health plan through participation in 8 a component of the district's cafeteria plan. A 9 participating school district shall not be required to enroll 10 a full-time employee who has waived coverage in the 11 district's group health plan, provided that an appropriate 12 official from the participating school district attests that 13 the full-time employee has waived coverage in the district's 14 group health plan through participation in a component of the 15 district's cafeteria plan and is covered under another group 16 policy or plan providing health benefits. Employees of a 17 participating unit of local government who are not enrolled 18 due to coverage under another group health policy or plan may 19 enroll at a later date subject to submission of satisfactory 20 evidence of insurability and provided that no benefits shall 21 be payable for services incurred during the first 6 months of 22 coverage to the extent the services are in connection with 23 any pre-existing condition. A participating unit of local 24 government may also elect to cover its annuitants. Dependent 25 coverage shall be offered on an optional basis, with the 26 costs paid by the unit of local government, its employees, or 27 some combination of the two as determined by the unit of 28 local government. The unit of local government shall be 29 responsible for timely collection and transmission of 30 dependent premiums. 31 The Director shall annually determine monthly rates of 32 payment, subject to the following constraints: 33 (1) In the first year of coverage, the rates shall 34 be equal to the amount normally charged to State SB1022 Engrossed -9- LRB9106120EGdv 1 employees for elected optional coverages or for enrolled 2 dependents coverages or other contributory coverages, or 3 contributed by the State for basic insurance coverages on 4 behalf of its employees, adjusted for differences between 5 State employees and employees of the local government in 6 age, sex, geographic location or other relevant 7 demographic variables, plus an amount sufficient to pay 8 for the additional administrative costs of providing 9 coverage to employees of the unit of local government and 10 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 unit of local 14 government. 15 In the case of coverage of local government employees 16 under a health maintenance organization, the Director shall 17 annually determine for each participating unit of local 18 government the maximum monthly amount the unit may contribute 19 toward that coverage, based on an analysis of (i) the age, 20 sex, geographic location, and other relevant demographic 21 variables of the unit's employees and (ii) the cost to cover 22 those employees under the State group health insurance plan. 23 The Director may similarly determine the maximum monthly 24 amount each unit of local government may contribute toward 25 coverage of its employees' dependents under a health 26 maintenance organization. 27 Monthly payments by the unit of local government or its 28 employees for group health insurance or health maintenance 29 organization coverage shall be deposited in the Local 30 Government Health Insurance Reserve Fund. The Local 31 Government Health Insurance Reserve Fund shall be a 32 continuing fund not subject to fiscal year limitations. All 33 expenditures from this fund shall be used for payments for 34 health care benefits for local government and rehabilitation SB1022 Engrossed -10- LRB9106120EGdv 1 facility employees, annuitants, and dependents, and to 2 reimburse the Department or its administrative service 3 organization for all expenses incurred in the administration 4 of benefits. No other State funds may be used for these 5 purposes. 6 A local government employer's participation or desire to 7 participate in a program created under this subsection shall 8 not limit that employer's duty to bargain with the 9 representative of any collective bargaining unit of its 10 employees. 11 (j) Any rehabilitation facility within the State of 12 Illinois may apply to the Director to have its employees, 13 annuitants, and their dependents provided group health 14 coverage under this Act on a non-insured basis. To 15 participate, a rehabilitation facility must agree to enroll 16 all of its employees and remit the entire cost of providing 17 such coverage for its employees, except that the 18 rehabilitation facility shall not be required to enroll those 19 of its employees who are covered spouses or dependents under 20 this plan or another group policy or plan providing health 21 benefits as long as (1) an appropriate official from the 22 rehabilitation facility attests that each employee not 23 enrolled is a covered spouse or dependent under this plan or 24 another group policy or plan, and (2) at least 85% of the 25 employees are enrolled and the rehabilitation facility remits 26 the entire cost of providing coverage to those employees. 27 Employees of a participating rehabilitation facility who are 28 not enrolled due to coverage under another group health 29 policy or plan may enroll at a later date subject to 30 submission of satisfactory evidence of insurability and 31 provided that no benefits shall be payable for services 32 incurred during the first 6 months of coverage to the extent 33 the services are in connection with any pre-existing 34 condition. A participating rehabilitation facility may also SB1022 Engrossed -11- LRB9106120EGdv 1 elect to cover its annuitants. Dependent coverage shall be 2 offered on an optional basis, with the costs paid by the 3 rehabilitation facility, its employees, or some combination 4 of the 2 as determined by the rehabilitation facility. The 5 rehabilitation facility shall be responsible for timely 6 collection and transmission of dependent premiums. 7 The Director shall annually determine quarterly rates of 8 payment, subject to the following constraints: 9 (1) In the first year of coverage, the rates shall 10 be equal to the amount normally charged to State 11 employees for elected optional coverages or for enrolled 12 dependents coverages or other contributory coverages on 13 behalf of its employees, adjusted for differences between 14 State employees and employees of the rehabilitation 15 facility in age, sex, geographic location or other 16 relevant demographic variables, plus an amount sufficient 17 to pay for the additional administrative costs of 18 providing coverage to employees of the rehabilitation 19 facility and their dependents. 20 (2) In subsequent years, a further adjustment shall 21 be made to reflect the actual prior years' claims 22 experience of the employees of the rehabilitation 23 facility. 24 Monthly payments by the rehabilitation facility or its 25 employees for group health insurance shall be deposited in 26 the Local Government Health Insurance Reserve Fund. 27 (k) Any domestic violence shelter or service within the 28 State of Illinois may apply to the Director to have its 29 employees, annuitants, and their dependents provided group 30 health coverage under this Act on a non-insured basis. To 31 participate, a domestic violence shelter or service must 32 agree to enroll all of its employees and pay the entire cost 33 of providing such coverage for its employees. A 34 participating domestic violence shelter may also elect to SB1022 Engrossed -12- LRB9106120EGdv 1 cover its annuitants. Dependent coverage shall be offered on 2 an optional basis, with employees, or some combination of the 3 2 as determined by the domestic violence shelter or service. 4 The domestic violence shelter or service shall be responsible 5 for timely collection and transmission of dependent premiums. 6 The Director shall annually determine quarterly rates of 7 payment, subject to the following constraints: 8 (1) In the first year of coverage, the rates shall 9 be equal to the amount normally charged to State 10 employees for elected optional coverages or for enrolled 11 dependents coverages or other contributory coverages on 12 behalf of its employees, adjusted for differences between 13 State employees and employees of the domestic violence 14 shelter or service in age, sex, geographic location or 15 other relevant demographic variables, plus an amount 16 sufficient to pay for the additional administrative costs 17 of providing coverage to employees of the domestic 18 violence shelter or service and their dependents. 19 (2) In subsequent years, a further adjustment shall 20 be made to reflect the actual prior years' claims 21 experience of the employees of the domestic violence 22 shelter or service. 23 (3) In no case shall the rate be less than the 24 amount normally charged to State employees or contributed 25 by the State on behalf of its employees. 26 Monthly payments by the domestic violence shelter or 27 service or its employees for group health insurance shall be 28 deposited in the Local Government Health Insurance Reserve 29 Fund. 30 (l) A public community college or entity organized 31 pursuant to the Public Community College Act may apply to the 32 Director initially to have only annuitants not covered prior 33 to July 1, 1992 by the district's health plan provided health 34 coverage under this Act on a non-insured basis. The SB1022 Engrossed -13- LRB9106120EGdv 1 community college must execute a 2-year contract to 2 participate in the Local Government Health Plan. Those 3 annuitants enrolled initially under this contract shall have 4 no benefits payable for services incurred during the first 6 5 months of coverage to the extent the services are in 6 connection with any pre-existing condition. Any annuitant 7 who may enroll after this initial enrollment period shall be 8 subject to submission of satisfactory evidence of 9 insurability and to the pre-existing conditions limitation. 10 The Director shall annually determine monthly rates of 11 payment subject to the following constraints: for those 12 community colleges with annuitants only enrolled, first year 13 rates shall be equal to the average cost to cover claims for 14 a State member adjusted for demographics, Medicare 15 participation, and other factors; and in the second year, a 16 further adjustment of rates shall be made to reflect the 17 actual first year's claims experience of the covered 18 annuitants. 19 (m) The Director shall adopt any rules deemed necessary 20 for implementation of this amendatory Act of 1989 (Public Act 21 86-978). 22 (Source: P.A. 89-53, eff. 7-1-95; 89-236, eff. 8-4-95; 23 89-324, eff. 8-13-95; 89-626, eff. 8-9-96; 90-65, eff. 24 7-7-97; 90-582, eff. 5-27-98; 90-655, eff. 7-30-98; revised 25 8-3-98.) 26 Section 99. Effective date. This Act takes effect July 27 1, 1999.