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91_SB1146eng SB1146 Engrossed 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 SB1146 Engrossed -2- LRB9106059EGfg 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 SB1146 Engrossed -3- LRB9106059EGfg 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 SB1146 Engrossed -4- LRB9106059EGfg 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 schoolsfor an annuitant with 20 or more9years 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 schoolsfor a survivor of an employee or27annuitant 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. SB1146 Engrossed -5- LRB9106059EGfg 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 SB1146 Engrossed -6- LRB9106059EGfg 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 SB1146 Engrossed -7- LRB9106059EGfg 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 SB1146 Engrossed -8- LRB9106059EGfg 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 SB1146 Engrossed -9- LRB9106059EGfg 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 SB1146 Engrossed -10- LRB9106059EGfg 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 SB1146 Engrossed -11- LRB9106059EGfg 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 SB1146 Engrossed -12- LRB9106059EGfg 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 SB1146 Engrossed -13- LRB9106059EGfg 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.