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91_SB1146
LRB9106059EGfg
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 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
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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
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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 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
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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%; except that the State contribution shall be 12.5% per
6 year (rather than 5%) for each full year of creditable
7 service as a regional superintendent or assistant regional
8 superintendent of schools for an annuitant with 20 or more
9 years of such creditable service. The remainder of the cost
10 of a new TRS State annuitant's coverage under the basic
11 program of group health benefits shall be the responsibility
12 of the annuitant.
13 (a-7) Beginning July 1, 1998, for each person who
14 becomes a new TRS State survivor and participates in the
15 basic program of group health benefits, the State shall
16 contribute toward the cost of the survivor's coverage under
17 the basic program of group health benefits an amount equal to
18 5% of that cost for each full year of the deceased employee's
19 or deceased annuitant's creditable service as a teacher as
20 defined in paragraph (2), (3), or (5) of Section 16-106 of
21 the Illinois Pension Code on the date of death, up to a
22 maximum of 100%; except that the State contribution shall be
23 12.5% per year (rather than 5%) for each full year of the
24 deceased employee's or deceased annuitant's creditable
25 service as a regional superintendent or assistant regional
26 superintendent of schools for a survivor of an employee or
27 annuitant with 20 or more years of such creditable service.
28 The remainder of the cost of the new TRS State survivor's
29 coverage under the basic program of group health benefits
30 shall be the responsibility of the survivor.
31 (a-8) A new SERS annuitant, new SERS survivor, new SURS
32 annuitant, new SURS retired employee, new SURS survivor, new
33 TRS State annuitant, or new TRS State survivor may waive or
34 terminate coverage in the program of group health benefits.
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1 Any such annuitant, survivor, or retired employee who has
2 waived or terminated coverage may enroll or re-enroll in the
3 program of group health benefits only during the annual
4 benefit choice period, as determined by the Director; except
5 that in the event of termination of coverage due to
6 nonpayment of premiums, the annuitant, survivor, or retired
7 employee may not re-enroll in the program.
8 (a-9) No later than May 1 of each calendar year, the
9 Director of Central Management Services shall certify in
10 writing to the Executive Secretary of the State Employees'
11 Retirement System of Illinois the amounts of the Medicare
12 supplement health care premiums and the amounts of the health
13 care premiums for all other retirees who are not Medicare
14 eligible.
15 A separate calculation of the premiums based upon the
16 actual cost of each health care plan shall be so certified.
17 The Director of Central Management Services shall provide
18 to the Executive Secretary of the State Employees' Retirement
19 System of Illinois such information, statistics, and other
20 data as he or she may require to review the premium amounts
21 certified by the Director of Central Management Services.
22 (b) State employees who become eligible for this program
23 on or after January 1, 1980 in positions normally requiring
24 actual performance of duty not less than 1/2 of a normal work
25 period but not equal to that of a normal work period, shall
26 be given the option of participating in the available
27 program. If the employee elects coverage, the State shall
28 contribute on behalf of such employee to the cost of the
29 employee's benefit and any applicable dependent supplement,
30 that sum which bears the same percentage as that percentage
31 of time the employee regularly works when compared to normal
32 work period.
33 (c) The basic non-contributory coverage from the basic
34 program of group health benefits shall be continued for each
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1 employee not in pay status or on active service by reason of
2 (1) leave of absence due to illness or injury, (2) authorized
3 educational leave of absence or sabbatical leave, or (3)
4 military leave with pay and benefits. This coverage shall
5 continue until expiration of authorized leave and return to
6 active service, but not to exceed 24 months for leaves under
7 item (1) or (2). This 24-month limitation and the requirement
8 of returning to active service shall not apply to persons
9 receiving ordinary or accidental disability benefits or
10 retirement benefits through the appropriate State retirement
11 system or benefits under the Workers' Compensation or
12 Occupational Disease Act.
13 (d) The basic group life insurance coverage shall
14 continue, with full State contribution, where such person is
15 (1) absent from active service by reason of disability
16 arising from any cause other than self-inflicted, (2) on
17 authorized educational leave of absence or sabbatical leave,
18 or (3) on military leave with pay and benefits.
19 (e) Where the person is in non-pay status for a period
20 in excess of 30 days or on leave of absence, other than by
21 reason of disability, educational or sabbatical leave, or
22 military leave with pay and benefits, such person may
23 continue coverage only by making personal payment equal to
24 the amount normally contributed by the State on such person's
25 behalf. Such payments and coverage may be continued: (1)
26 until such time as the person returns to a status eligible
27 for coverage at State expense, but not to exceed 24 months,
28 (2) until such person's employment or annuitant status with
29 the State is terminated, or (3) for a maximum period of 4
30 years for members on military leave with pay and benefits and
31 military leave without pay and benefits (exclusive of any
32 additional service imposed pursuant to law).
33 (f) The Department shall establish by rule the extent
34 to which other employee benefits will continue for persons in
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1 non-pay status or who are not in active service.
2 (g) The State shall not pay the cost of the basic
3 non-contributory group life insurance, program of health
4 benefits and other employee benefits for members who are
5 survivors as defined by paragraphs (1) and (2) of subsection
6 (q) of Section 3 of this Act. The costs of benefits for
7 these survivors shall be paid by the survivors or by the
8 University of Illinois Cooperative Extension Service, or any
9 combination thereof.
10 (h) Those persons occupying positions with any
11 department as a result of emergency appointments pursuant to
12 Section 8b.8 of the Personnel Code who are not considered
13 employees under this Act shall be given the option of
14 participating in the programs of group life insurance, health
15 benefits and other employee benefits. Such persons electing
16 coverage may participate only by making payment equal to the
17 amount normally contributed by the State for similarly
18 situated employees. Such amounts shall be determined by the
19 Director. Such payments and coverage may be continued until
20 such time as the person becomes an employee pursuant to this
21 Act or such person's appointment is terminated.
22 (i) Any unit of local government within the State of
23 Illinois may apply to the Director to have its employees,
24 annuitants, and their dependents provided group health
25 coverage under this Act on a non-insured basis. To
26 participate, a unit of local government must agree to enroll
27 all of its employees, who may select coverage under either
28 the State group health insurance plan or a health maintenance
29 organization that has contracted with the State to be
30 available as a health care provider for employees as defined
31 in this Act. A unit of local government must remit the
32 entire cost of providing coverage under the State group
33 health insurance plan or, for coverage under a health
34 maintenance organization, an amount determined by the
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1 Director based on an analysis of the sex, age, geographic
2 location, or other relevant demographic variables for its
3 employees, except that the unit of local government shall not
4 be required to enroll those of its employees who are covered
5 spouses or dependents under this plan or another group policy
6 or plan providing health benefits as long as (1) an
7 appropriate official from the unit of local government
8 attests that each employee not enrolled is a covered spouse
9 or dependent under this plan or another group policy or plan,
10 and (2) at least 85% of the employees are enrolled and the
11 unit of local government remits the entire cost of providing
12 coverage to those employees. Employees of a participating
13 unit of local government who are not enrolled due to coverage
14 under another group health policy or plan may enroll at a
15 later date subject to submission of satisfactory evidence of
16 insurability and provided that no benefits shall be payable
17 for services incurred during the first 6 months of coverage
18 to the extent the services are in connection with any
19 pre-existing condition. A participating unit of local
20 government may also elect to cover its annuitants. Dependent
21 coverage shall be offered on an optional basis, with the
22 costs paid by the unit of local government, its employees, or
23 some combination of the two as determined by the unit of
24 local government. The unit of local government shall be
25 responsible for timely collection and transmission of
26 dependent premiums.
27 The Director shall annually determine monthly rates of
28 payment, subject to the following constraints:
29 (1) In the first year of coverage, the rates shall
30 be equal to the amount normally charged to State
31 employees for elected optional coverages or for enrolled
32 dependents coverages or other contributory coverages, or
33 contributed by the State for basic insurance coverages on
34 behalf of its employees, adjusted for differences between
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1 State employees and employees of the local government in
2 age, sex, geographic location or other relevant
3 demographic variables, plus an amount sufficient to pay
4 for the additional administrative costs of providing
5 coverage to employees of the unit of local government and
6 their dependents.
7 (2) In subsequent years, a further adjustment shall
8 be made to reflect the actual prior years' claims
9 experience of the employees of the unit of local
10 government.
11 In the case of coverage of local government employees
12 under a health maintenance organization, the Director shall
13 annually determine for each participating unit of local
14 government the maximum monthly amount the unit may contribute
15 toward that coverage, based on an analysis of (i) the age,
16 sex, geographic location, and other relevant demographic
17 variables of the unit's employees and (ii) the cost to cover
18 those employees under the State group health insurance plan.
19 The Director may similarly determine the maximum monthly
20 amount each unit of local government may contribute toward
21 coverage of its employees' dependents under a health
22 maintenance organization.
23 Monthly payments by the unit of local government or its
24 employees for group health insurance or health maintenance
25 organization coverage shall be deposited in the Local
26 Government Health Insurance Reserve Fund. The Local
27 Government Health Insurance Reserve Fund shall be a
28 continuing fund not subject to fiscal year limitations. All
29 expenditures from this fund shall be used for payments for
30 health care benefits for local government and rehabilitation
31 facility employees, annuitants, and dependents, and to
32 reimburse the Department or its administrative service
33 organization for all expenses incurred in the administration
34 of benefits. No other State funds may be used for these
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1 purposes.
2 A local government employer's participation or desire to
3 participate in a program created under this subsection shall
4 not limit that employer's duty to bargain with the
5 representative of any collective bargaining unit of its
6 employees.
7 (j) Any rehabilitation facility within the State of
8 Illinois may apply to the Director to have its employees,
9 annuitants, and their dependents provided group health
10 coverage under this Act on a non-insured basis. To
11 participate, a rehabilitation facility must agree to enroll
12 all of its employees and remit the entire cost of providing
13 such coverage for its employees, except that the
14 rehabilitation facility shall not be required to enroll those
15 of its employees who are covered spouses or dependents under
16 this plan or another group policy or plan providing health
17 benefits as long as (1) an appropriate official from the
18 rehabilitation facility attests that each employee not
19 enrolled is a covered spouse or dependent under this plan or
20 another group policy or plan, and (2) at least 85% of the
21 employees are enrolled and the rehabilitation facility remits
22 the entire cost of providing coverage to those employees.
23 Employees of a participating rehabilitation facility who are
24 not enrolled due to coverage under another group health
25 policy or plan may enroll at a later date subject to
26 submission of satisfactory evidence of insurability and
27 provided that no benefits shall be payable for services
28 incurred during the first 6 months of coverage to the extent
29 the services are in connection with any pre-existing
30 condition. A participating rehabilitation facility may also
31 elect to cover its annuitants. Dependent coverage shall be
32 offered on an optional basis, with the costs paid by the
33 rehabilitation facility, its employees, or some combination
34 of the 2 as determined by the rehabilitation facility. The
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1 rehabilitation facility shall be responsible for timely
2 collection and transmission of dependent premiums.
3 The Director shall annually determine quarterly rates of
4 payment, subject to the following constraints:
5 (1) In the first year of coverage, the rates shall
6 be equal to the amount normally charged to State
7 employees for elected optional coverages or for enrolled
8 dependents coverages or other contributory coverages on
9 behalf of its employees, adjusted for differences between
10 State employees and employees of the rehabilitation
11 facility in age, sex, geographic location or other
12 relevant demographic variables, plus an amount sufficient
13 to pay for the additional administrative costs of
14 providing coverage to employees of the rehabilitation
15 facility and their dependents.
16 (2) In subsequent years, a further adjustment shall
17 be made to reflect the actual prior years' claims
18 experience of the employees of the rehabilitation
19 facility.
20 Monthly payments by the rehabilitation facility or its
21 employees for group health insurance shall be deposited in
22 the Local Government Health Insurance Reserve Fund.
23 (k) Any domestic violence shelter or service within the
24 State of Illinois may apply to the Director to have its
25 employees, annuitants, and their dependents provided group
26 health coverage under this Act on a non-insured basis. To
27 participate, a domestic violence shelter or service must
28 agree to enroll all of its employees and pay the entire cost
29 of providing such coverage for its employees. A
30 participating domestic violence shelter may also elect to
31 cover its annuitants. Dependent coverage shall be offered on
32 an optional basis, with employees, or some combination of the
33 2 as determined by the domestic violence shelter or service.
34 The domestic violence shelter or service shall be responsible
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1 for timely collection and transmission of dependent premiums.
2 The Director shall annually determine quarterly rates of
3 payment, subject to the following constraints:
4 (1) In the first year of coverage, the rates shall
5 be equal to the amount normally charged to State
6 employees for elected optional coverages or for enrolled
7 dependents coverages or other contributory coverages on
8 behalf of its employees, adjusted for differences between
9 State employees and employees of the domestic violence
10 shelter or service in age, sex, geographic location or
11 other relevant demographic variables, plus an amount
12 sufficient to pay for the additional administrative costs
13 of providing coverage to employees of the domestic
14 violence shelter or service and their dependents.
15 (2) In subsequent years, a further adjustment shall
16 be made to reflect the actual prior years' claims
17 experience of the employees of the domestic violence
18 shelter or service.
19 (3) In no case shall the rate be less than the
20 amount normally charged to State employees or contributed
21 by the State on behalf of its employees.
22 Monthly payments by the domestic violence shelter or
23 service or its employees for group health insurance shall be
24 deposited in the Local Government Health Insurance Reserve
25 Fund.
26 (l) A public community college or entity organized
27 pursuant to the Public Community College Act may apply to the
28 Director initially to have only annuitants not covered prior
29 to July 1, 1992 by the district's health plan provided health
30 coverage under this Act on a non-insured basis. The
31 community college must execute a 2-year contract to
32 participate in the Local Government Health Plan. Those
33 annuitants enrolled initially under this contract shall have
34 no benefits payable for services incurred during the first 6
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1 months of coverage to the extent the services are in
2 connection with any pre-existing condition. Any annuitant
3 who may enroll after this initial enrollment period shall be
4 subject to submission of satisfactory evidence of
5 insurability and to the pre-existing conditions limitation.
6 The Director shall annually determine monthly rates of
7 payment subject to the following constraints: for those
8 community colleges with annuitants only enrolled, first year
9 rates shall be equal to the average cost to cover claims for
10 a State member adjusted for demographics, Medicare
11 participation, and other factors; and in the second year, a
12 further adjustment of rates shall be made to reflect the
13 actual first year's claims experience of the covered
14 annuitants.
15 (m) The Director shall adopt any rules deemed necessary
16 for implementation of this amendatory Act of 1989 (Public Act
17 86-978).
18 (Source: P.A. 89-53, eff. 7-1-95; 89-236, eff. 8-4-95;
19 89-324, eff. 8-13-95; 89-626, eff. 8-9-96; 90-65, eff.
20 7-7-97; 90-582, eff. 5-27-98; 90-655, eff. 7-30-98; revised
21 8-3-98.)
22 Section 99. Effective date. This Act takes effect upon
23 becoming law.