Public Act 93-0553

HB0943 Enrolled                      LRB093 05764 RCE 05857 b

    AN ACT in relation to public employee benefits.

    Be it enacted by the People of  the  State  of  Illinois,
represented in the General Assembly:

    Section  5.   The  State Employees Group Insurance Act of
1971 is amended by changing Section 8 as follows:

    (5 ILCS 375/8) (from Ch. 127, par. 528)
    Sec. 8.  Eligibility.
    (a)  Each member eligible under the  provisions  of  this
Act  and  any  rules  and regulations promulgated and adopted
hereunder by the Director shall become  immediately  eligible
and  covered  for  all benefits available under the programs.
Members electing coverage for eligible dependents shall  have
the   coverage   effective  immediately,  provided  that  the
election is properly filed in accordance with required filing
dates and procedures specified by the Director.
         (1)  Every  member  originally  eligible  to   elect
    dependent  coverage,  but  not  electing  it  during  the
    original  eligibility  period,  may  subsequently  obtain
    dependent  coverage  only  in  the  event of a qualifying
    change   in   status,   special    enrollment,    special
    circumstance  as  defined  by the Director, or during the
    annual Benefit Choice Period.
         (2)  Members described above being transferred  from
    previous  coverage  towards  which  the  State  has  been
    contributing   shall   be   transferred   regardless   of
    preexisting   conditions,   waiting   periods,  or  other
    requirements that  might  jeopardize  claim  payments  to
    which they would otherwise have been entitled.
         (3)  Eligible  and covered members that are eligible
    for coverage as dependents except for the fact  of  being
    members  shall  be  transferred  to,  and  covered under,
    dependent status regardless  of  preexisting  conditions,
    waiting   periods,   or  other  requirements  that  might
    jeopardize claim payments to which they  would  otherwise
    have  been  entitled  upon cessation of member status and
    the election of dependent coverage by a  member  eligible
    to elect that coverage.
    (b)  New  employees  shall be immediately insured for the
basic group life insurance and  covered  by  the  program  of
health  benefits  on  the  first day of active State service.
Optional  coverages  or  benefits,  if  elected  during   the
relevant  eligibility  period,  will  become effective on the
date of employment.  Optional coverages or  benefits  applied
for  after  the eligibility period will be effective, subject
to satisfactory evidence of insurability when applicable,  or
other  necessary qualifications, pursuant to the requirements
of the applicable benefit program, unless there is  a  change
in  status  that  would  confer new eligibility for change of
enrollment under rules established supplementing this Act, in
which  event  application  must  be  made  within   the   new
eligibility period.
    (c)  As  to  the group health benefits program contracted
to begin or  continue  after  June  30,  1973,  each  retired
employee  shall  become  immediately eligible and covered for
all benefits available under that program.  Retired employees
may elect coverage for eligible dependents and shall have the
coverage effective immediately, provided that the election is
properly filed in accordance with required filing  dates  and
procedures specified by the Director.
    Except  as  otherwise provided in this Act, where husband
and wife are both eligible members, each shall be enrolled as
a member and coverage on their eligible  dependent  children,
if any, may be under the enrollment and election of either.
    Regardless  of  other  provisions  herein  regarding late
enrollment  or  other  qualifications,  as  appropriate,  the
Director may periodically authorize open  enrollment  periods
for  each  of  the benefit programs at which time each member
may elect enrollment or change of enrollment  without  regard
to  age,  sex,  health,  or  other  qualification  under  the
conditions  as  may  be  prescribed  in rules and regulations
supplementing this Act.  Special open enrollment periods  may
be  declared  by  the  Director for certain members only when
special circumstances occur that affect only those members.
    (d)  Beginning  with  fiscal  year  2003  and   for   all
subsequent   years,   eligible   members  may  elect  not  to
participate in the program of health benefits as  defined  in
this  Act.   The  election  must  be  made  during the annual
benefit choice period, subject  to  the  conditions  in  this
subsection.
         (1)  Members  must  furnish  proof of health benefit
    coverage, either comprehensive major medical coverage  or
    comprehensive managed care plan, from a source other than
    the Department of Central Management Services in order to
    elect not to participate in the program.
         (2)  Members  may  re-enroll  in  the  Department of
    Central Management Services program  of  health  benefits
    upon showing a qualifying change in status, as defined in
    the  U.S.  Internal  Revenue  Code,  without  evidence of
    insurability and with  no  limitations  on  coverage  for
    pre-existing  conditions,  provided  that there was not a
    break in coverage of more than 63 days.
         (3)  Members may also re-enroll in  the  program  of
    health  benefits during any annual benefit choice period,
    without evidence of insurability.
         (4)  Members who elect not  to  participate  in  the
    program  of  health benefits shall be furnished a written
    explanation of the requirements and limitations  for  the
    election  not  to  participate  in  the  program  and for
    re-enrolling in the program. The explanation  shall  also
    be included in the annual benefit choice options booklets
    furnished to members.
    (e)  Notwithstanding  any  other provision of this Act or
the rules adopted under this Act, if a  person  participating
in  the program of health benefits as the dependent spouse of
an eligible member  becomes  an  annuitant,  the  person  may
elect,  at  the  time  of becoming an annuitant or during any
subsequent  annual  benefit  choice   period,   to   continue
participation  as  a  dependent  rather  than  as an eligible
member for as long as the person continues to be an  eligible
dependent.
    An  eligible  member  who has elected to participate as a
dependent may re-enroll in the program of health benefits  as
an  eligible  member (i) during any subsequent annual benefit
choice period or (ii) upon showing  a  qualifying  change  in
status, as defined in the U.S. Internal Revenue Code, without
evidence  of insurability and with no limitations on coverage
for pre-existing conditions.
    A person who elects to  participate  in  the  program  of
health  benefits  as  a  dependent rather than as an eligible
member shall  be  furnished  a  written  explanation  of  the
consequences  of  electing  to participate as a dependent and
the conditions and procedures for re-enrolling as an eligible
member.  The explanation shall also be included in the annual
benefit choice options booklet furnished to members.
(Source: P.A. 91-390, eff. 7-30-99; 92-600, eff. 6-28-02.)

    Section 99. Effective date.  This Act takes  effect  upon
becoming law.