Illinois General Assembly - Full Text of SB1313
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Full Text of SB1313  97th General Assembly

SB1313enr 97TH GENERAL ASSEMBLY

  
  
  

 


 
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1    AN ACT concerning insurance.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 1. The Illinois Administrative Procedure Act is
5amended by changing Section 5-45 as follows:
 
6    (5 ILCS 100/5-45)  (from Ch. 127, par. 1005-45)
7    Sec. 5-45. Emergency rulemaking.
8    (a) "Emergency" means the existence of any situation that
9any agency finds reasonably constitutes a threat to the public
10interest, safety, or welfare.
11    (b) If any agency finds that an emergency exists that
12requires adoption of a rule upon fewer days than is required by
13Section 5-40 and states in writing its reasons for that
14finding, the agency may adopt an emergency rule without prior
15notice or hearing upon filing a notice of emergency rulemaking
16with the Secretary of State under Section 5-70. The notice
17shall include the text of the emergency rule and shall be
18published in the Illinois Register. Consent orders or other
19court orders adopting settlements negotiated by an agency may
20be adopted under this Section. Subject to applicable
21constitutional or statutory provisions, an emergency rule
22becomes effective immediately upon filing under Section 5-65 or
23at a stated date less than 10 days thereafter. The agency's

 

 

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1finding and a statement of the specific reasons for the finding
2shall be filed with the rule. The agency shall take reasonable
3and appropriate measures to make emergency rules known to the
4persons who may be affected by them.
5    (c) An emergency rule may be effective for a period of not
6longer than 150 days, but the agency's authority to adopt an
7identical rule under Section 5-40 is not precluded. No
8emergency rule may be adopted more than once in any 24 month
9period, except that this limitation on the number of emergency
10rules that may be adopted in a 24 month period does not apply
11to (i) emergency rules that make additions to and deletions
12from the Drug Manual under Section 5-5.16 of the Illinois
13Public Aid Code or the generic drug formulary under Section
143.14 of the Illinois Food, Drug and Cosmetic Act, (ii)
15emergency rules adopted by the Pollution Control Board before
16July 1, 1997 to implement portions of the Livestock Management
17Facilities Act, (iii) emergency rules adopted by the Illinois
18Department of Public Health under subsections (a) through (i)
19of Section 2 of the Department of Public Health Act when
20necessary to protect the public's health, (iv) emergency rules
21adopted pursuant to subsection (n) of this Section, or (v)
22emergency rules adopted pursuant to subsection (o) of this
23Section, or (vi) emergency rules adopted pursuant to subsection
24(c-5) of this Section. Two or more emergency rules having
25substantially the same purpose and effect shall be deemed to be
26a single rule for purposes of this Section.

 

 

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1    (c-5) To facilitate the maintenance of the program of group
2health benefits provided to annuitants, survivors, and retired
3employees under the State Employees Group Insurance Act of
41971, rules to alter the contributions to be paid by the State,
5annuitants, survivors, retired employees, or any combination
6of those entities, for that program of group health benefits,
7shall be adopted as emergency rules. The adoption of those
8rules shall be considered an emergency and necessary for the
9public interest, safety, and welfare.
10    (d) In order to provide for the expeditious and timely
11implementation of the State's fiscal year 1999 budget,
12emergency rules to implement any provision of Public Act 90-587
13or 90-588 or any other budget initiative for fiscal year 1999
14may be adopted in accordance with this Section by the agency
15charged with administering that provision or initiative,
16except that the 24-month limitation on the adoption of
17emergency rules and the provisions of Sections 5-115 and 5-125
18do not apply to rules adopted under this subsection (d). The
19adoption of emergency rules authorized by this subsection (d)
20shall be deemed to be necessary for the public interest,
21safety, and welfare.
22    (e) In order to provide for the expeditious and timely
23implementation of the State's fiscal year 2000 budget,
24emergency rules to implement any provision of this amendatory
25Act of the 91st General Assembly or any other budget initiative
26for fiscal year 2000 may be adopted in accordance with this

 

 

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1Section by the agency charged with administering that provision
2or initiative, except that the 24-month limitation on the
3adoption of emergency rules and the provisions of Sections
45-115 and 5-125 do not apply to rules adopted under this
5subsection (e). The adoption of emergency rules authorized by
6this subsection (e) shall be deemed to be necessary for the
7public interest, safety, and welfare.
8    (f) In order to provide for the expeditious and timely
9implementation of the State's fiscal year 2001 budget,
10emergency rules to implement any provision of this amendatory
11Act of the 91st General Assembly or any other budget initiative
12for fiscal year 2001 may be adopted in accordance with this
13Section by the agency charged with administering that provision
14or initiative, except that the 24-month limitation on the
15adoption of emergency rules and the provisions of Sections
165-115 and 5-125 do not apply to rules adopted under this
17subsection (f). The adoption of emergency rules authorized by
18this subsection (f) shall be deemed to be necessary for the
19public interest, safety, and welfare.
20    (g) In order to provide for the expeditious and timely
21implementation of the State's fiscal year 2002 budget,
22emergency rules to implement any provision of this amendatory
23Act of the 92nd General Assembly or any other budget initiative
24for fiscal year 2002 may be adopted in accordance with this
25Section by the agency charged with administering that provision
26or initiative, except that the 24-month limitation on the

 

 

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1adoption of emergency rules and the provisions of Sections
25-115 and 5-125 do not apply to rules adopted under this
3subsection (g). The adoption of emergency rules authorized by
4this subsection (g) shall be deemed to be necessary for the
5public interest, safety, and welfare.
6    (h) In order to provide for the expeditious and timely
7implementation of the State's fiscal year 2003 budget,
8emergency rules to implement any provision of this amendatory
9Act of the 92nd General Assembly or any other budget initiative
10for fiscal year 2003 may be adopted in accordance with this
11Section by the agency charged with administering that provision
12or initiative, except that the 24-month limitation on the
13adoption of emergency rules and the provisions of Sections
145-115 and 5-125 do not apply to rules adopted under this
15subsection (h). The adoption of emergency rules authorized by
16this subsection (h) shall be deemed to be necessary for the
17public interest, safety, and welfare.
18    (i) In order to provide for the expeditious and timely
19implementation of the State's fiscal year 2004 budget,
20emergency rules to implement any provision of this amendatory
21Act of the 93rd General Assembly or any other budget initiative
22for fiscal year 2004 may be adopted in accordance with this
23Section by the agency charged with administering that provision
24or initiative, except that the 24-month limitation on the
25adoption of emergency rules and the provisions of Sections
265-115 and 5-125 do not apply to rules adopted under this

 

 

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1subsection (i). The adoption of emergency rules authorized by
2this subsection (i) shall be deemed to be necessary for the
3public interest, safety, and welfare.
4    (j) In order to provide for the expeditious and timely
5implementation of the provisions of the State's fiscal year
62005 budget as provided under the Fiscal Year 2005 Budget
7Implementation (Human Services) Act, emergency rules to
8implement any provision of the Fiscal Year 2005 Budget
9Implementation (Human Services) Act may be adopted in
10accordance with this Section by the agency charged with
11administering that provision, except that the 24-month
12limitation on the adoption of emergency rules and the
13provisions of Sections 5-115 and 5-125 do not apply to rules
14adopted under this subsection (j). The Department of Public Aid
15may also adopt rules under this subsection (j) necessary to
16administer the Illinois Public Aid Code and the Children's
17Health Insurance Program Act. The adoption of emergency rules
18authorized by this subsection (j) shall be deemed to be
19necessary for the public interest, safety, and welfare.
20    (k) In order to provide for the expeditious and timely
21implementation of the provisions of the State's fiscal year
222006 budget, emergency rules to implement any provision of this
23amendatory Act of the 94th General Assembly or any other budget
24initiative for fiscal year 2006 may be adopted in accordance
25with this Section by the agency charged with administering that
26provision or initiative, except that the 24-month limitation on

 

 

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1the adoption of emergency rules and the provisions of Sections
25-115 and 5-125 do not apply to rules adopted under this
3subsection (k). The Department of Healthcare and Family
4Services may also adopt rules under this subsection (k)
5necessary to administer the Illinois Public Aid Code, the
6Senior Citizens and Disabled Persons Property Tax Relief and
7Pharmaceutical Assistance Act, the Senior Citizens and
8Disabled Persons Prescription Drug Discount Program Act (now
9the Illinois Prescription Drug Discount Program Act), and the
10Children's Health Insurance Program Act. The adoption of
11emergency rules authorized by this subsection (k) shall be
12deemed to be necessary for the public interest, safety, and
13welfare.
14    (l) In order to provide for the expeditious and timely
15implementation of the provisions of the State's fiscal year
162007 budget, the Department of Healthcare and Family Services
17may adopt emergency rules during fiscal year 2007, including
18rules effective July 1, 2007, in accordance with this
19subsection to the extent necessary to administer the
20Department's responsibilities with respect to amendments to
21the State plans and Illinois waivers approved by the federal
22Centers for Medicare and Medicaid Services necessitated by the
23requirements of Title XIX and Title XXI of the federal Social
24Security Act. The adoption of emergency rules authorized by
25this subsection (l) shall be deemed to be necessary for the
26public interest, safety, and welfare.

 

 

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1    (m) In order to provide for the expeditious and timely
2implementation of the provisions of the State's fiscal year
32008 budget, the Department of Healthcare and Family Services
4may adopt emergency rules during fiscal year 2008, including
5rules effective July 1, 2008, in accordance with this
6subsection to the extent necessary to administer the
7Department's responsibilities with respect to amendments to
8the State plans and Illinois waivers approved by the federal
9Centers for Medicare and Medicaid Services necessitated by the
10requirements of Title XIX and Title XXI of the federal Social
11Security Act. The adoption of emergency rules authorized by
12this subsection (m) shall be deemed to be necessary for the
13public interest, safety, and welfare.
14    (n) In order to provide for the expeditious and timely
15implementation of the provisions of the State's fiscal year
162010 budget, emergency rules to implement any provision of this
17amendatory Act of the 96th General Assembly or any other budget
18initiative authorized by the 96th General Assembly for fiscal
19year 2010 may be adopted in accordance with this Section by the
20agency charged with administering that provision or
21initiative. The adoption of emergency rules authorized by this
22subsection (n) shall be deemed to be necessary for the public
23interest, safety, and welfare. The rulemaking authority
24granted in this subsection (n) shall apply only to rules
25promulgated during Fiscal Year 2010.
26    (o) In order to provide for the expeditious and timely

 

 

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1implementation of the provisions of the State's fiscal year
22011 budget, emergency rules to implement any provision of this
3amendatory Act of the 96th General Assembly or any other budget
4initiative authorized by the 96th General Assembly for fiscal
5year 2011 may be adopted in accordance with this Section by the
6agency charged with administering that provision or
7initiative. The adoption of emergency rules authorized by this
8subsection (o) is deemed to be necessary for the public
9interest, safety, and welfare. The rulemaking authority
10granted in this subsection (o) applies only to rules
11promulgated on or after the effective date of this amendatory
12Act of the 96th General Assembly through June 30, 2011.
13(Source: P.A. 95-12, eff. 7-2-07; 95-331, eff. 8-21-07; 96-45,
14eff. 7-15-09; 96-958, eff. 7-1-10; 96-1500, eff. 1-18-11.)
 
15    Section 5. The State Employees Group Insurance Act of 1971
16is amended by changing Sections 3, 10, and 15 as follows:
 
17    (5 ILCS 375/3)  (from Ch. 127, par. 523)
18    Sec. 3. Definitions. Unless the context otherwise
19requires, the following words and phrases as used in this Act
20shall have the following meanings. The Department may define
21these and other words and phrases separately for the purpose of
22implementing specific programs providing benefits under this
23Act.
24    (a) "Administrative service organization" means any

 

 

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1person, firm or corporation experienced in the handling of
2claims which is fully qualified, financially sound and capable
3of meeting the service requirements of a contract of
4administration executed with the Department.
5    (b) "Annuitant" means (1) an employee who retires, or has
6retired, on or after January 1, 1966 on an immediate annuity
7under the provisions of Articles 2, 14 (including an employee
8who has elected to receive an alternative retirement
9cancellation payment under Section 14-108.5 of the Illinois
10Pension Code in lieu of an annuity), 15 (including an employee
11who has retired under the optional retirement program
12established under Section 15-158.2), paragraphs (2), (3), or
13(5) of Section 16-106, or Article 18 of the Illinois Pension
14Code; (2) any person who was receiving group insurance coverage
15under this Act as of March 31, 1978 by reason of his status as
16an annuitant, even though the annuity in relation to which such
17coverage was provided is a proportional annuity based on less
18than the minimum period of service required for a retirement
19annuity in the system involved; (3) any person not otherwise
20covered by this Act who has retired as a participating member
21under Article 2 of the Illinois Pension Code but is ineligible
22for the retirement annuity under Section 2-119 of the Illinois
23Pension Code; (4) the spouse of any person who is receiving a
24retirement annuity under Article 18 of the Illinois Pension
25Code and who is covered under a group health insurance program
26sponsored by a governmental employer other than the State of

 

 

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1Illinois and who has irrevocably elected to waive his or her
2coverage under this Act and to have his or her spouse
3considered as the "annuitant" under this Act and not as a
4"dependent"; or (5) an employee who retires, or has retired,
5from a qualified position, as determined according to rules
6promulgated by the Director, under a qualified local
7government, a qualified rehabilitation facility, a qualified
8domestic violence shelter or service, or a qualified child
9advocacy center. (For definition of "retired employee", see (p)
10post).
11    (b-5) (Blank). "New SERS annuitant" means a person who, on
12or after January 1, 1998, becomes an annuitant, as defined in
13subsection (b), by virtue of beginning to receive a retirement
14annuity under Article 14 of the Illinois Pension Code
15(including an employee who has elected to receive an
16alternative retirement cancellation payment under Section
1714-108.5 of that Code in lieu of an annuity), and is eligible
18to participate in the basic program of group health benefits
19provided for annuitants under this Act.
20    (b-6) (Blank). "New SURS annuitant" means a person who (1)
21on or after January 1, 1998, becomes an annuitant, as defined
22in subsection (b), by virtue of beginning to receive a
23retirement annuity under Article 15 of the Illinois Pension
24Code, (2) has not made the election authorized under Section
2515-135.1 of the Illinois Pension Code, and (3) is eligible to
26participate in the basic program of group health benefits

 

 

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1provided for annuitants under this Act.
2    (b-7) (Blank). "New TRS State annuitant" means a person
3who, on or after July 1, 1998, becomes an annuitant, as defined
4in subsection (b), by virtue of beginning to receive a
5retirement annuity under Article 16 of the Illinois Pension
6Code based on service as a teacher as defined in paragraph (2),
7(3), or (5) of Section 16-106 of that Code, and is eligible to
8participate in the basic program of group health benefits
9provided for annuitants under this Act.
10    (c) "Carrier" means (1) an insurance company, a corporation
11organized under the Limited Health Service Organization Act or
12the Voluntary Health Services Plan Act, a partnership, or other
13nongovernmental organization, which is authorized to do group
14life or group health insurance business in Illinois, or (2) the
15State of Illinois as a self-insurer.
16    (d) "Compensation" means salary or wages payable on a
17regular payroll by the State Treasurer on a warrant of the
18State Comptroller out of any State, trust or federal fund, or
19by the Governor of the State through a disbursing officer of
20the State out of a trust or out of federal funds, or by any
21Department out of State, trust, federal or other funds held by
22the State Treasurer or the Department, to any person for
23personal services currently performed, and ordinary or
24accidental disability benefits under Articles 2, 14, 15
25(including ordinary or accidental disability benefits under
26the optional retirement program established under Section

 

 

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115-158.2), paragraphs (2), (3), or (5) of Section 16-106, or
2Article 18 of the Illinois Pension Code, for disability
3incurred after January 1, 1966, or benefits payable under the
4Workers' Compensation or Occupational Diseases Act or benefits
5payable under a sick pay plan established in accordance with
6Section 36 of the State Finance Act. "Compensation" also means
7salary or wages paid to an employee of any qualified local
8government, qualified rehabilitation facility, qualified
9domestic violence shelter or service, or qualified child
10advocacy center.
11    (e) "Commission" means the State Employees Group Insurance
12Advisory Commission authorized by this Act. Commencing July 1,
131984, "Commission" as used in this Act means the Commission on
14Government Forecasting and Accountability as established by
15the Legislative Commission Reorganization Act of 1984.
16    (f) "Contributory", when referred to as contributory
17coverage, shall mean optional coverages or benefits elected by
18the member toward the cost of which such member makes
19contribution, or which are funded in whole or in part through
20the acceptance of a reduction in earnings or the foregoing of
21an increase in earnings by an employee, as distinguished from
22noncontributory coverage or benefits which are paid entirely by
23the State of Illinois without reduction of the member's salary.
24    (g) "Department" means any department, institution, board,
25commission, officer, court or any agency of the State
26government receiving appropriations and having power to

 

 

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1certify payrolls to the Comptroller authorizing payments of
2salary and wages against such appropriations as are made by the
3General Assembly from any State fund, or against trust funds
4held by the State Treasurer and includes boards of trustees of
5the retirement systems created by Articles 2, 14, 15, 16 and 18
6of the Illinois Pension Code. "Department" also includes the
7Illinois Comprehensive Health Insurance Board, the Board of
8Examiners established under the Illinois Public Accounting
9Act, and the Illinois Finance Authority.
10    (h) "Dependent", when the term is used in the context of
11the health and life plan, means a member's spouse and any child
12(1) from birth to age 26 including an adopted child, a child
13who lives with the member from the time of the filing of a
14petition for adoption until entry of an order of adoption, a
15stepchild or adjudicated child, or a child who lives with the
16member if such member is a court appointed guardian of the
17child or (2) age 19 or over who is mentally or physically
18disabled from a cause originating prior to the age of 19 (age
1926 if enrolled as an adult child dependent). For the health
20plan only, the term "dependent" also includes (1) any person
21enrolled prior to the effective date of this Section who is
22dependent upon the member to the extent that the member may
23claim such person as a dependent for income tax deduction
24purposes and (2) any person who has received after June 30,
252000 an organ transplant and who is financially dependent upon
26the member and eligible to be claimed as a dependent for income

 

 

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1tax purposes. A member requesting to cover any dependent must
2provide documentation as requested by the Department of Central
3Management Services and file with the Department any and all
4forms required by the Department.
5    (i) "Director" means the Director of the Illinois
6Department of Central Management Services or of any successor
7agency designated to administer this Act.
8    (j) "Eligibility period" means the period of time a member
9has to elect enrollment in programs or to select benefits
10without regard to age, sex or health.
11    (k) "Employee" means and includes each officer or employee
12in the service of a department who (1) receives his
13compensation for service rendered to the department on a
14warrant issued pursuant to a payroll certified by a department
15or on a warrant or check issued and drawn by a department upon
16a trust, federal or other fund or on a warrant issued pursuant
17to a payroll certified by an elected or duly appointed officer
18of the State or who receives payment of the performance of
19personal services on a warrant issued pursuant to a payroll
20certified by a Department and drawn by the Comptroller upon the
21State Treasurer against appropriations made by the General
22Assembly from any fund or against trust funds held by the State
23Treasurer, and (2) is employed full-time or part-time in a
24position normally requiring actual performance of duty during
25not less than 1/2 of a normal work period, as established by
26the Director in cooperation with each department, except that

 

 

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1persons elected by popular vote will be considered employees
2during the entire term for which they are elected regardless of
3hours devoted to the service of the State, and (3) except that
4"employee" does not include any person who is not eligible by
5reason of such person's employment to participate in one of the
6State retirement systems under Articles 2, 14, 15 (either the
7regular Article 15 system or the optional retirement program
8established under Section 15-158.2) or 18, or under paragraph
9(2), (3), or (5) of Section 16-106, of the Illinois Pension
10Code, but such term does include persons who are employed
11during the 6 month qualifying period under Article 14 of the
12Illinois Pension Code. Such term also includes any person who
13(1) after January 1, 1966, is receiving ordinary or accidental
14disability benefits under Articles 2, 14, 15 (including
15ordinary or accidental disability benefits under the optional
16retirement program established under Section 15-158.2),
17paragraphs (2), (3), or (5) of Section 16-106, or Article 18 of
18the Illinois Pension Code, for disability incurred after
19January 1, 1966, (2) receives total permanent or total
20temporary disability under the Workers' Compensation Act or
21Occupational Disease Act as a result of injuries sustained or
22illness contracted in the course of employment with the State
23of Illinois, or (3) is not otherwise covered under this Act and
24has retired as a participating member under Article 2 of the
25Illinois Pension Code but is ineligible for the retirement
26annuity under Section 2-119 of the Illinois Pension Code.

 

 

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1However, a person who satisfies the criteria of the foregoing
2definition of "employee" except that such person is made
3ineligible to participate in the State Universities Retirement
4System by clause (4) of subsection (a) of Section 15-107 of the
5Illinois Pension Code is also an "employee" for the purposes of
6this Act. "Employee" also includes any person receiving or
7eligible for benefits under a sick pay plan established in
8accordance with Section 36 of the State Finance Act. "Employee"
9also includes (i) each officer or employee in the service of a
10qualified local government, including persons appointed as
11trustees of sanitary districts regardless of hours devoted to
12the service of the sanitary district, (ii) each employee in the
13service of a qualified rehabilitation facility, (iii) each
14full-time employee in the service of a qualified domestic
15violence shelter or service, and (iv) each full-time employee
16in the service of a qualified child advocacy center, as
17determined according to rules promulgated by the Director.
18    (l) "Member" means an employee, annuitant, retired
19employee or survivor. In the case of an annuitant or retired
20employee who first becomes an annuitant or retired employee on
21or after the effective date of this amendatory Act of the 97th
22General Assembly, the individual must meet the minimum vesting
23requirements of the applicable retirement system in order to be
24eligible for group insurance benefits under that system. In the
25case of a survivor who first becomes a survivor on or after the
26effective date of this amendatory Act of the 97th General

 

 

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1Assembly, the deceased employee, annuitant, or retired
2employee upon whom the annuity is based must have been eligible
3to participate in the group insurance system under the
4applicable retirement system in order for the survivor to be
5eligible for group insurance benefits under that system.
6    (m) "Optional coverages or benefits" means those coverages
7or benefits available to the member on his or her voluntary
8election, and at his or her own expense.
9    (n) "Program" means the group life insurance, health
10benefits and other employee benefits designed and contracted
11for by the Director under this Act.
12    (o) "Health plan" means a health benefits program offered
13by the State of Illinois for persons eligible for the plan.
14    (p) "Retired employee" means any person who would be an
15annuitant as that term is defined herein but for the fact that
16such person retired prior to January 1, 1966. Such term also
17includes any person formerly employed by the University of
18Illinois in the Cooperative Extension Service who would be an
19annuitant but for the fact that such person was made ineligible
20to participate in the State Universities Retirement System by
21clause (4) of subsection (a) of Section 15-107 of the Illinois
22Pension Code.
23    (q) "Survivor" means a person receiving an annuity as a
24survivor of an employee or of an annuitant. "Survivor" also
25includes: (1) the surviving dependent of a person who satisfies
26the definition of "employee" except that such person is made

 

 

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1ineligible to participate in the State Universities Retirement
2System by clause (4) of subsection (a) of Section 15-107 of the
3Illinois Pension Code; (2) the surviving dependent of any
4person formerly employed by the University of Illinois in the
5Cooperative Extension Service who would be an annuitant except
6for the fact that such person was made ineligible to
7participate in the State Universities Retirement System by
8clause (4) of subsection (a) of Section 15-107 of the Illinois
9Pension Code; and (3) the surviving dependent of a person who
10was an annuitant under this Act by virtue of receiving an
11alternative retirement cancellation payment under Section
1214-108.5 of the Illinois Pension Code.
13    (q-2) "SERS" means the State Employees' Retirement System
14of Illinois, created under Article 14 of the Illinois Pension
15Code.
16    (q-3) "SURS" means the State Universities Retirement
17System, created under Article 15 of the Illinois Pension Code.
18    (q-4) "TRS" means the Teachers' Retirement System of the
19State of Illinois, created under Article 16 of the Illinois
20Pension Code.
21    (q-5) (Blank). "New SERS survivor" means a survivor, as
22defined in subsection (q), whose annuity is paid under Article
2314 of the Illinois Pension Code and is based on the death of
24(i) an employee whose death occurs on or after January 1, 1998,
25or (ii) a new SERS annuitant as defined in subsection (b-5).
26"New SERS survivor" includes the surviving dependent of a

 

 

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1person who was an annuitant under this Act by virtue of
2receiving an alternative retirement cancellation payment under
3Section 14-108.5 of the Illinois Pension Code.
4    (q-6) (Blank). "New SURS survivor" means a survivor, as
5defined in subsection (q), whose annuity is paid under Article
615 of the Illinois Pension Code and is based on the death of
7(i) an employee whose death occurs on or after January 1, 1998,
8or (ii) a new SURS annuitant as defined in subsection (b-6).
9    (q-7) (Blank). "New TRS State survivor" means a survivor,
10as defined in subsection (q), whose annuity is paid under
11Article 16 of the Illinois Pension Code and is based on the
12death of (i) an employee who is a teacher as defined in
13paragraph (2), (3), or (5) of Section 16-106 of that Code and
14whose death occurs on or after July 1, 1998, or (ii) a new TRS
15State annuitant as defined in subsection (b-7).
16    (r) "Medical services" means the services provided within
17the scope of their licenses by practitioners in all categories
18licensed under the Medical Practice Act of 1987.
19    (s) "Unit of local government" means any county,
20municipality, township, school district (including a
21combination of school districts under the Intergovernmental
22Cooperation Act), special district or other unit, designated as
23a unit of local government by law, which exercises limited
24governmental powers or powers in respect to limited
25governmental subjects, any not-for-profit association with a
26membership that primarily includes townships and township

 

 

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1officials, that has duties that include provision of research
2service, dissemination of information, and other acts for the
3purpose of improving township government, and that is funded
4wholly or partly in accordance with Section 85-15 of the
5Township Code; any not-for-profit corporation or association,
6with a membership consisting primarily of municipalities, that
7operates its own utility system, and provides research,
8training, dissemination of information, or other acts to
9promote cooperation between and among municipalities that
10provide utility services and for the advancement of the goals
11and purposes of its membership; the Southern Illinois
12Collegiate Common Market, which is a consortium of higher
13education institutions in Southern Illinois; the Illinois
14Association of Park Districts; and any hospital provider that
15is owned by a county that has 100 or fewer hospital beds and
16has not already joined the program. "Qualified local
17government" means a unit of local government approved by the
18Director and participating in a program created under
19subsection (i) of Section 10 of this Act.
20    (t) "Qualified rehabilitation facility" means any
21not-for-profit organization that is accredited by the
22Commission on Accreditation of Rehabilitation Facilities or
23certified by the Department of Human Services (as successor to
24the Department of Mental Health and Developmental
25Disabilities) to provide services to persons with disabilities
26and which receives funds from the State of Illinois for

 

 

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1providing those services, approved by the Director and
2participating in a program created under subsection (j) of
3Section 10 of this Act.
4    (u) "Qualified domestic violence shelter or service" means
5any Illinois domestic violence shelter or service and its
6administrative offices funded by the Department of Human
7Services (as successor to the Illinois Department of Public
8Aid), approved by the Director and participating in a program
9created under subsection (k) of Section 10.
10    (v) "TRS benefit recipient" means a person who:
11        (1) is not a "member" as defined in this Section; and
12        (2) is receiving a monthly benefit or retirement
13    annuity under Article 16 of the Illinois Pension Code; and
14        (3) either (i) has at least 8 years of creditable
15    service under Article 16 of the Illinois Pension Code, or
16    (ii) was enrolled in the health insurance program offered
17    under that Article on January 1, 1996, or (iii) is the
18    survivor of a benefit recipient who had at least 8 years of
19    creditable service under Article 16 of the Illinois Pension
20    Code or was enrolled in the health insurance program
21    offered under that Article on the effective date of this
22    amendatory Act of 1995, or (iv) is a recipient or survivor
23    of a recipient of a disability benefit under Article 16 of
24    the Illinois Pension Code.
25    (w) "TRS dependent beneficiary" means a person who:
26        (1) is not a "member" or "dependent" as defined in this

 

 

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1    Section; and
2        (2) is a TRS benefit recipient's: (A) spouse, (B)
3    dependent parent who is receiving at least half of his or
4    her support from the TRS benefit recipient, or (C) natural,
5    step, adjudicated, or adopted child who is (i) under age
6    26, (ii) was, on January 1, 1996, participating as a
7    dependent beneficiary in the health insurance program
8    offered under Article 16 of the Illinois Pension Code, or
9    (iii) age 19 or over who is mentally or physically disabled
10    from a cause originating prior to the age of 19 (age 26 if
11    enrolled as an adult child).
12    "TRS dependent beneficiary" does not include, as indicated
13under paragraph (2) of this subsection (w), a dependent of the
14survivor of a TRS benefit recipient who first becomes a
15dependent of a survivor of a TRS benefit recipient on or after
16the effective date of this amendatory Act of the 97th General
17Assembly unless that dependent would have been eligible for
18coverage as a dependent of the deceased TRS benefit recipient
19upon whom the survivor benefit is based.
20    (x) "Military leave" refers to individuals in basic
21training for reserves, special/advanced training, annual
22training, emergency call up, activation by the President of the
23United States, or any other training or duty in service to the
24United States Armed Forces.
25    (y) (Blank).
26    (z) "Community college benefit recipient" means a person

 

 

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1who:
2        (1) is not a "member" as defined in this Section; and
3        (2) is receiving a monthly survivor's annuity or
4    retirement annuity under Article 15 of the Illinois Pension
5    Code; and
6        (3) either (i) was a full-time employee of a community
7    college district or an association of community college
8    boards created under the Public Community College Act
9    (other than an employee whose last employer under Article
10    15 of the Illinois Pension Code was a community college
11    district subject to Article VII of the Public Community
12    College Act) and was eligible to participate in a group
13    health benefit plan as an employee during the time of
14    employment with a community college district (other than a
15    community college district subject to Article VII of the
16    Public Community College Act) or an association of
17    community college boards, or (ii) is the survivor of a
18    person described in item (i).
19    (aa) "Community college dependent beneficiary" means a
20person who:
21        (1) is not a "member" or "dependent" as defined in this
22    Section; and
23        (2) is a community college benefit recipient's: (A)
24    spouse, (B) dependent parent who is receiving at least half
25    of his or her support from the community college benefit
26    recipient, or (C) natural, step, adjudicated, or adopted

 

 

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1    child who is (i) under age 26, or (ii) age 19 or over and
2    mentally or physically disabled from a cause originating
3    prior to the age of 19 (age 26 if enrolled as an adult
4    child).
5    "Community college dependent beneficiary" does not
6include, as indicated under paragraph (2) of this subsection
7(aa), a dependent of the survivor of a community college
8benefit recipient who first becomes a dependent of a survivor
9of a community college benefit recipient on or after the
10effective date of this amendatory Act of the 97th General
11Assembly unless that dependent would have been eligible for
12coverage as a dependent of the deceased community college
13benefit recipient upon whom the survivor annuity is based.
14    (bb) "Qualified child advocacy center" means any Illinois
15child advocacy center and its administrative offices funded by
16the Department of Children and Family Services, as defined by
17the Children's Advocacy Center Act (55 ILCS 80/), approved by
18the Director and participating in a program created under
19subsection (n) of Section 10.
20(Source: P.A. 96-756, eff. 1-1-10; 96-1519, eff. 2-4-11;
2197-668, eff. 1-13-12.)
 
22    (5 ILCS 375/10)  (from Ch. 127, par. 530)
23    Sec. 10. Contributions by the State and members Payments by
24State; premiums.
25    (a) The State shall pay the cost of basic non-contributory

 

 

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1group life insurance and, subject to member paid contributions
2set by the Department or required by this Section and except as
3provided in this Section, the basic program of group health
4benefits on each eligible member, except a member, not
5otherwise covered by this Act, who has retired as a
6participating member under Article 2 of the Illinois Pension
7Code but is ineligible for the retirement annuity under Section
82-119 of the Illinois Pension Code, and part of each eligible
9member's and retired member's premiums for health insurance
10coverage for enrolled dependents as provided by Section 9. The
11State shall pay the cost of the basic program of group health
12benefits only after benefits are reduced by the amount of
13benefits covered by Medicare for all members and dependents who
14are eligible for benefits under Social Security or the Railroad
15Retirement system or who had sufficient Medicare-covered
16government employment, except that such reduction in benefits
17shall apply only to those members and dependents who (1) first
18become eligible for such Medicare coverage on or after July 1,
191992; or (2) are Medicare-eligible members or dependents of a
20local government unit which began participation in the program
21on or after July 1, 1992; or (3) remain eligible for, but no
22longer receive Medicare coverage which they had been receiving
23on or after July 1, 1992. The Department may determine the
24aggregate level of the State's contribution on the basis of
25actual cost of medical services adjusted for age, sex or
26geographic or other demographic characteristics which affect

 

 

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1the costs of such programs.
2    The cost of participation in the basic program of group
3health benefits for the dependent or survivor of a living or
4deceased retired employee who was formerly employed by the
5University of Illinois in the Cooperative Extension Service and
6would be an annuitant but for the fact that he or she was made
7ineligible to participate in the State Universities Retirement
8System by clause (4) of subsection (a) of Section 15-107 of the
9Illinois Pension Code shall not be greater than the cost of
10participation that would otherwise apply to that dependent or
11survivor if he or she were the dependent or survivor of an
12annuitant under the State Universities Retirement System.
13    (a-1) (Blank). Beginning January 1, 1998, for each person
14who becomes a new SERS annuitant and participates in the basic
15program of group health benefits, the State shall contribute
16toward the cost of the annuitant's coverage under the basic
17program of group health benefits an amount equal to 5% of that
18cost for each full year of creditable service upon which the
19annuitant's retirement annuity is based, up to a maximum of
20100% for an annuitant with 20 or more years of creditable
21service. The remainder of the cost of a new SERS annuitant's
22coverage under the basic program of group health benefits shall
23be the responsibility of the annuitant. In the case of a new
24SERS annuitant who has elected to receive an alternative
25retirement cancellation payment under Section 14-108.5 of the
26Illinois Pension Code in lieu of an annuity, for the purposes

 

 

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1of this subsection the annuitant shall be deemed to be
2receiving a retirement annuity based on the number of years of
3creditable service that the annuitant had established at the
4time of his or her termination of service under SERS.
5    (a-2) (Blank). Beginning January 1, 1998, for each person
6who becomes a new SERS survivor and participates in the basic
7program of group health benefits, the State shall contribute
8toward the cost of the survivor's coverage under the basic
9program of group health benefits an amount equal to 5% of that
10cost for each full year of the deceased employee's or deceased
11annuitant's creditable service in the State Employees'
12Retirement System of Illinois on the date of death, up to a
13maximum of 100% for a survivor of an employee or annuitant with
1420 or more years of creditable service. The remainder of the
15cost of the new SERS survivor's coverage under the basic
16program of group health benefits shall be the responsibility of
17the survivor. In the case of a new SERS survivor who was the
18dependent of an annuitant who elected to receive an alternative
19retirement cancellation payment under Section 14-108.5 of the
20Illinois Pension Code in lieu of an annuity, for the purposes
21of this subsection the deceased annuitant's creditable service
22shall be determined as of the date of termination of service
23rather than the date of death.
24    (a-3) (Blank). Beginning January 1, 1998, for each person
25who becomes a new SURS annuitant and participates in the basic
26program of group health benefits, the State shall contribute

 

 

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1toward the cost of the annuitant's coverage under the basic
2program of group health benefits an amount equal to 5% of that
3cost for each full year of creditable service upon which the
4annuitant's retirement annuity is based, up to a maximum of
5100% for an annuitant with 20 or more years of creditable
6service. The remainder of the cost of a new SURS annuitant's
7coverage under the basic program of group health benefits shall
8be the responsibility of the annuitant.
9    (a-4) (Blank).
10    (a-5) (Blank). Beginning January 1, 1998, for each person
11who becomes a new SURS survivor and participates in the basic
12program of group health benefits, the State shall contribute
13toward the cost of the survivor's coverage under the basic
14program of group health benefits an amount equal to 5% of that
15cost for each full year of the deceased employee's or deceased
16annuitant's creditable service in the State Universities
17Retirement System on the date of death, up to a maximum of 100%
18for a survivor of an employee or annuitant with 20 or more
19years of creditable service. The remainder of the cost of the
20new SURS survivor's coverage under the basic program of group
21health benefits shall be the responsibility of the survivor.
22    (a-6) (Blank). Beginning July 1, 1998, for each person who
23becomes a new TRS State annuitant and participates in the basic
24program of group health benefits, the State shall contribute
25toward the cost of the annuitant's coverage under the basic
26program of group health benefits an amount equal to 5% of that

 

 

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1cost for each full year of creditable service as a teacher as
2defined in paragraph (2), (3), or (5) of Section 16-106 of the
3Illinois Pension Code upon which the annuitant's retirement
4annuity is based, up to a maximum of 100%; except that the
5State contribution shall be 12.5% per year (rather than 5%) for
6each full year of creditable service as a regional
7superintendent or assistant regional superintendent of
8schools. The remainder of the cost of a new TRS State
9annuitant's coverage under the basic program of group health
10benefits shall be the responsibility of the annuitant.
11    (a-7) (Blank). Beginning July 1, 1998, for each person who
12becomes a new TRS State survivor and participates in the basic
13program of group health benefits, the State shall contribute
14toward the cost of the survivor's coverage under the basic
15program of group health benefits an amount equal to 5% of that
16cost for each full year of the deceased employee's or deceased
17annuitant's creditable service as a teacher as defined in
18paragraph (2), (3), or (5) of Section 16-106 of the Illinois
19Pension Code on the date of death, up to a maximum of 100%;
20except that the State contribution shall be 12.5% per year
21(rather than 5%) for each full year of the deceased employee's
22or deceased annuitant's creditable service as a regional
23superintendent or assistant regional superintendent of
24schools. The remainder of the cost of the new TRS State
25survivor's coverage under the basic program of group health
26benefits shall be the responsibility of the survivor.

 

 

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1    (a-8) Any A new SERS annuitant, new SERS survivor, or
2retired employee , new SURS annuitant, new SURS survivor, new
3TRS State annuitant, or new TRS State survivor may waive or
4terminate coverage in the program of group health benefits. Any
5such annuitant, or survivor, or retired employee who has waived
6or terminated coverage may enroll or re-enroll in the program
7of group health benefits only during the annual benefit choice
8period, as determined by the Director; except that in the event
9of termination of coverage due to nonpayment of premiums, the
10annuitant, or survivor, or retired employee may not re-enroll
11in the program.
12    (a-8.5) Beginning on the effective date of this amendatory
13Act of the 97th General Assembly, the Director of Central
14Management Services shall, on an annual basis, determine the
15amount that the State shall contribute toward the basic program
16of group health benefits on behalf of annuitants (including
17individuals who (i) participated in the General Assembly
18Retirement System, the State Employees' Retirement System of
19Illinois, the State Universities Retirement System, the
20Teachers' Retirement System of the State of Illinois, or the
21Judges Retirement System of Illinois and (ii) qualify as
22annuitants under subsection (b) of Section 3 of this Act),
23survivors (including individuals who (i) receive an annuity as
24a survivor of an individual who participated in the General
25Assembly Retirement System, the State Employees' Retirement
26System of Illinois, the State Universities Retirement System,

 

 

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1the Teachers' Retirement System of the State of Illinois, or
2the Judges Retirement System of Illinois and (ii) qualify as
3survivors under subsection (q) of Section 3 of this Act), and
4retired employees (as defined in subsection (p) of Section 3 of
5this Act). The remainder of the cost of coverage for each
6annuitant, survivor, or retired employee, as determined by the
7Director of Central Management Services, shall be the
8responsibility of that annuitant, survivor, or retired
9employee.
10    Contributions required of annuitants, survivors, and
11retired employees shall be the same for all retirement systems
12and shall also be based on whether an individual has made an
13election under Section 15-135.1 of the Illinois Pension Code.
14Contributions may be based on annuitants', survivors', or
15retired employees' Medicare eligibility, but may not be based
16on Social Security eligibility.
17    (a-9) No later than May 1 of each calendar year, the
18Director of Central Management Services shall certify in
19writing to the Executive Secretary of the State Employees'
20Retirement System of Illinois the amounts of the Medicare
21supplement health care premiums and the amounts of the health
22care premiums for all other retirees who are not Medicare
23eligible.
24    A separate calculation of the premiums based upon the
25actual cost of each health care plan shall be so certified.
26    The Director of Central Management Services shall provide

 

 

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1to the Executive Secretary of the State Employees' Retirement
2System of Illinois such information, statistics, and other data
3as he or she may require to review the premium amounts
4certified by the Director of Central Management Services.
5    The Department of Healthcare and Family Services, or any
6successor agency designated to procure healthcare contracts
7pursuant to this Act, is authorized to establish funds,
8separate accounts provided by any bank or banks as defined by
9the Illinois Banking Act, or separate accounts provided by any
10savings and loan association or associations as defined by the
11Illinois Savings and Loan Act of 1985 to be held by the
12Director, outside the State treasury, for the purpose of
13receiving the transfer of moneys from the Local Government
14Health Insurance Reserve Fund. The Department may promulgate
15rules further defining the methodology for the transfers. Any
16interest earned by moneys in the funds or accounts shall inure
17to the Local Government Health Insurance Reserve Fund. The
18transferred moneys, and interest accrued thereon, shall be used
19exclusively for transfers to administrative service
20organizations or their financial institutions for payments of
21claims to claimants and providers under the self-insurance
22health plan. The transferred moneys, and interest accrued
23thereon, shall not be used for any other purpose including, but
24not limited to, reimbursement of administration fees due the
25administrative service organization pursuant to its contract
26or contracts with the Department.

 

 

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1    (b) State employees who become eligible for this program on
2or after January 1, 1980 in positions normally requiring actual
3performance of duty not less than 1/2 of a normal work period
4but not equal to that of a normal work period, shall be given
5the option of participating in the available program. If the
6employee elects coverage, the State shall contribute on behalf
7of such employee to the cost of the employee's benefit and any
8applicable dependent supplement, that sum which bears the same
9percentage as that percentage of time the employee regularly
10works when compared to normal work period.
11    (c) The basic non-contributory coverage from the basic
12program of group health benefits shall be continued for each
13employee not in pay status or on active service by reason of
14(1) leave of absence due to illness or injury, (2) authorized
15educational leave of absence or sabbatical leave, or (3)
16military leave. This coverage shall continue until expiration
17of authorized leave and return to active service, but not to
18exceed 24 months for leaves under item (1) or (2). This
1924-month limitation and the requirement of returning to active
20service shall not apply to persons receiving ordinary or
21accidental disability benefits or retirement benefits through
22the appropriate State retirement system or benefits under the
23Workers' Compensation or Occupational Disease Act.
24    (d) The basic group life insurance coverage shall continue,
25with full State contribution, where such person is (1) absent
26from active service by reason of disability arising from any

 

 

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1cause other than self-inflicted, (2) on authorized educational
2leave of absence or sabbatical leave, or (3) on military leave.
3    (e) Where the person is in non-pay status for a period in
4excess of 30 days or on leave of absence, other than by reason
5of disability, educational or sabbatical leave, or military
6leave, such person may continue coverage only by making
7personal payment equal to the amount normally contributed by
8the State on such person's behalf. Such payments and coverage
9may be continued: (1) until such time as the person returns to
10a status eligible for coverage at State expense, but not to
11exceed 24 months or (2) until such person's employment or
12annuitant status with the State is terminated (exclusive of any
13additional service imposed pursuant to law).
14    (f) The Department shall establish by rule the extent to
15which other employee benefits will continue for persons in
16non-pay status or who are not in active service.
17    (g) The State shall not pay the cost of the basic
18non-contributory group life insurance, program of health
19benefits and other employee benefits for members who are
20survivors as defined by paragraphs (1) and (2) of subsection
21(q) of Section 3 of this Act. The costs of benefits for these
22survivors shall be paid by the survivors or by the University
23of Illinois Cooperative Extension Service, or any combination
24thereof. However, the State shall pay the amount of the
25reduction in the cost of participation, if any, resulting from
26the amendment to subsection (a) made by this amendatory Act of

 

 

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1the 91st General Assembly.
2    (h) Those persons occupying positions with any department
3as a result of emergency appointments pursuant to Section 8b.8
4of the Personnel Code who are not considered employees under
5this Act shall be given the option of participating in the
6programs of group life insurance, health benefits and other
7employee benefits. Such persons electing coverage may
8participate only by making payment equal to the amount normally
9contributed by the State for similarly situated employees. Such
10amounts shall be determined by the Director. Such payments and
11coverage may be continued until such time as the person becomes
12an employee pursuant to this Act or such person's appointment
13is terminated.
14    (i) Any unit of local government within the State of
15Illinois may apply to the Director to have its employees,
16annuitants, and their dependents provided group health
17coverage under this Act on a non-insured basis. To participate,
18a unit of local government must agree to enroll all of its
19employees, who may select coverage under either the State group
20health benefits plan or a health maintenance organization that
21has contracted with the State to be available as a health care
22provider for employees as defined in this Act. A unit of local
23government must remit the entire cost of providing coverage
24under the State group health benefits plan or, for coverage
25under a health maintenance organization, an amount determined
26by the Director based on an analysis of the sex, age,

 

 

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1geographic location, or other relevant demographic variables
2for its employees, except that the unit of local government
3shall not be required to enroll those of its employees who are
4covered spouses or dependents under this plan or another group
5policy or plan providing health benefits as long as (1) an
6appropriate official from the unit of local government attests
7that each employee not enrolled is a covered spouse or
8dependent under this plan or another group policy or plan, and
9(2) at least 50% of the employees are enrolled and the unit of
10local government remits the entire cost of providing coverage
11to those employees, except that a participating school district
12must have enrolled at least 50% of its full-time employees who
13have not waived coverage under the district's group health plan
14by participating in a component of the district's cafeteria
15plan. A participating school district is not required to enroll
16a full-time employee who has waived coverage under the
17district's health plan, provided that an appropriate official
18from the participating school district attests that the
19full-time employee has waived coverage by participating in a
20component of the district's cafeteria plan. For the purposes of
21this subsection, "participating school district" includes a
22unit of local government whose primary purpose is education as
23defined by the Department's rules.
24    Employees of a participating unit of local government who
25are not enrolled due to coverage under another group health
26policy or plan may enroll in the event of a qualifying change

 

 

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1in status, special enrollment, special circumstance as defined
2by the Director, or during the annual Benefit Choice Period. A
3participating unit of local government may also elect to cover
4its annuitants. Dependent coverage shall be offered on an
5optional basis, with the costs paid by the unit of local
6government, its employees, or some combination of the two as
7determined by the unit of local government. The unit of local
8government shall be responsible for timely collection and
9transmission of dependent premiums.
10    The Director shall annually determine monthly rates of
11payment, subject to the following constraints:
12        (1) In the first year of coverage, the rates shall be
13    equal to the amount normally charged to State employees for
14    elected optional coverages or for enrolled dependents
15    coverages or other contributory coverages, or contributed
16    by the State for basic insurance coverages on behalf of its
17    employees, adjusted for differences between State
18    employees and employees of the local government in age,
19    sex, geographic location or other relevant demographic
20    variables, plus an amount sufficient to pay for the
21    additional administrative costs of providing coverage to
22    employees of the unit of local government and their
23    dependents.
24        (2) In subsequent years, a further adjustment shall be
25    made to reflect the actual prior years' claims experience
26    of the employees of the unit of local government.

 

 

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1    In the case of coverage of local government employees under
2a health maintenance organization, the Director shall annually
3determine for each participating unit of local government the
4maximum monthly amount the unit may contribute toward that
5coverage, based on an analysis of (i) the age, sex, geographic
6location, and other relevant demographic variables of the
7unit's employees and (ii) the cost to cover those employees
8under the State group health benefits plan. The Director may
9similarly determine the maximum monthly amount each unit of
10local government may contribute toward coverage of its
11employees' dependents under a health maintenance organization.
12    Monthly payments by the unit of local government or its
13employees for group health benefits plan or health maintenance
14organization coverage shall be deposited in the Local
15Government Health Insurance Reserve Fund.
16    The Local Government Health Insurance Reserve Fund is
17hereby created as a nonappropriated trust fund to be held
18outside the State Treasury, with the State Treasurer as
19custodian. The Local Government Health Insurance Reserve Fund
20shall be a continuing fund not subject to fiscal year
21limitations. The Local Government Health Insurance Reserve
22Fund is not subject to administrative charges or charge-backs,
23including but not limited to those authorized under Section 8h
24of the State Finance Act. All revenues arising from the
25administration of the health benefits program established
26under this Section shall be deposited into the Local Government

 

 

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1Health Insurance Reserve Fund. Any interest earned on moneys in
2the Local Government Health Insurance Reserve Fund shall be
3deposited into the Fund. All expenditures from this Fund shall
4be used for payments for health care benefits for local
5government and rehabilitation facility employees, annuitants,
6and dependents, and to reimburse the Department or its
7administrative service organization for all expenses incurred
8in the administration of benefits. No other State funds may be
9used for these purposes.
10    A local government employer's participation or desire to
11participate in a program created under this subsection shall
12not limit that employer's duty to bargain with the
13representative of any collective bargaining unit of its
14employees.
15    (j) Any rehabilitation facility within the State of
16Illinois may apply to the Director to have its employees,
17annuitants, and their eligible dependents provided group
18health coverage under this Act on a non-insured basis. To
19participate, a rehabilitation facility must agree to enroll all
20of its employees and remit the entire cost of providing such
21coverage for its employees, except that the rehabilitation
22facility shall not be required to enroll those of its employees
23who are covered spouses or dependents under this plan or
24another group policy or plan providing health benefits as long
25as (1) an appropriate official from the rehabilitation facility
26attests that each employee not enrolled is a covered spouse or

 

 

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1dependent under this plan or another group policy or plan, and
2(2) at least 50% of the employees are enrolled and the
3rehabilitation facility remits the entire cost of providing
4coverage to those employees. Employees of a participating
5rehabilitation facility who are not enrolled due to coverage
6under another group health policy or plan may enroll in the
7event of a qualifying change in status, special enrollment,
8special circumstance as defined by the Director, or during the
9annual Benefit Choice Period. A participating rehabilitation
10facility may also elect to cover its annuitants. Dependent
11coverage shall be offered on an optional basis, with the costs
12paid by the rehabilitation facility, its employees, or some
13combination of the 2 as determined by the rehabilitation
14facility. The rehabilitation facility shall be responsible for
15timely collection and transmission of dependent premiums.
16    The Director shall annually determine quarterly rates of
17payment, subject to the following constraints:
18        (1) In the first year of coverage, the rates shall be
19    equal to the amount normally charged to State employees for
20    elected optional coverages or for enrolled dependents
21    coverages or other contributory coverages on behalf of its
22    employees, adjusted for differences between State
23    employees and employees of the rehabilitation facility in
24    age, sex, geographic location or other relevant
25    demographic variables, plus an amount sufficient to pay for
26    the additional administrative costs of providing coverage

 

 

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1    to employees of the rehabilitation facility and their
2    dependents.
3        (2) In subsequent years, a further adjustment shall be
4    made to reflect the actual prior years' claims experience
5    of the employees of the rehabilitation facility.
6    Monthly payments by the rehabilitation facility or its
7employees for group health benefits shall be deposited in the
8Local Government Health Insurance Reserve Fund.
9    (k) Any domestic violence shelter or service within the
10State of Illinois may apply to the Director to have its
11employees, annuitants, and their dependents provided group
12health coverage under this Act on a non-insured basis. To
13participate, a domestic violence shelter or service must agree
14to enroll all of its employees and pay the entire cost of
15providing such coverage for its employees. The domestic
16violence shelter shall not be required to enroll those of its
17employees who are covered spouses or dependents under this plan
18or another group policy or plan providing health benefits as
19long as (1) an appropriate official from the domestic violence
20shelter attests that each employee not enrolled is a covered
21spouse or dependent under this plan or another group policy or
22plan and (2) at least 50% of the employees are enrolled and the
23domestic violence shelter remits the entire cost of providing
24coverage to those employees. Employees of a participating
25domestic violence shelter who are not enrolled due to coverage
26under another group health policy or plan may enroll in the

 

 

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1event of a qualifying change in status, special enrollment, or
2special circumstance as defined by the Director or during the
3annual Benefit Choice Period. A participating domestic
4violence shelter may also elect to cover its annuitants.
5Dependent coverage shall be offered on an optional basis, with
6employees, or some combination of the 2 as determined by the
7domestic violence shelter or service. The domestic violence
8shelter or service shall be responsible for timely collection
9and transmission of dependent premiums.
10    The Director shall annually determine rates of payment,
11subject to the following constraints:
12        (1) In the first year of coverage, the rates shall be
13    equal to the amount normally charged to State employees for
14    elected optional coverages or for enrolled dependents
15    coverages or other contributory coverages on behalf of its
16    employees, adjusted for differences between State
17    employees and employees of the domestic violence shelter or
18    service in age, sex, geographic location or other relevant
19    demographic variables, plus an amount sufficient to pay for
20    the additional administrative costs of providing coverage
21    to employees of the domestic violence shelter or service
22    and their dependents.
23        (2) In subsequent years, a further adjustment shall be
24    made to reflect the actual prior years' claims experience
25    of the employees of the domestic violence shelter or
26    service.

 

 

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1    Monthly payments by the domestic violence shelter or
2service or its employees for group health insurance shall be
3deposited in the Local Government Health Insurance Reserve
4Fund.
5    (l) A public community college or entity organized pursuant
6to the Public Community College Act may apply to the Director
7initially to have only annuitants not covered prior to July 1,
81992 by the district's health plan provided health coverage
9under this Act on a non-insured basis. The community college
10must execute a 2-year contract to participate in the Local
11Government Health Plan. Any annuitant may enroll in the event
12of a qualifying change in status, special enrollment, special
13circumstance as defined by the Director, or during the annual
14Benefit Choice Period.
15    The Director shall annually determine monthly rates of
16payment subject to the following constraints: for those
17community colleges with annuitants only enrolled, first year
18rates shall be equal to the average cost to cover claims for a
19State member adjusted for demographics, Medicare
20participation, and other factors; and in the second year, a
21further adjustment of rates shall be made to reflect the actual
22first year's claims experience of the covered annuitants.
23    (l-5) The provisions of subsection (l) become inoperative
24on July 1, 1999.
25    (m) The Director shall adopt any rules deemed necessary for
26implementation of this amendatory Act of 1989 (Public Act

 

 

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186-978).
2    (n) Any child advocacy center within the State of Illinois
3may apply to the Director to have its employees, annuitants,
4and their dependents provided group health coverage under this
5Act on a non-insured basis. To participate, a child advocacy
6center must agree to enroll all of its employees and pay the
7entire cost of providing coverage for its employees. The child
8advocacy center shall not be required to enroll those of its
9employees who are covered spouses or dependents under this plan
10or another group policy or plan providing health benefits as
11long as (1) an appropriate official from the child advocacy
12center attests that each employee not enrolled is a covered
13spouse or dependent under this plan or another group policy or
14plan and (2) at least 50% of the employees are enrolled and the
15child advocacy center remits the entire cost of providing
16coverage to those employees. Employees of a participating child
17advocacy center who are not enrolled due to coverage under
18another group health policy or plan may enroll in the event of
19a qualifying change in status, special enrollment, or special
20circumstance as defined by the Director or during the annual
21Benefit Choice Period. A participating child advocacy center
22may also elect to cover its annuitants. Dependent coverage
23shall be offered on an optional basis, with the costs paid by
24the child advocacy center, its employees, or some combination
25of the 2 as determined by the child advocacy center. The child
26advocacy center shall be responsible for timely collection and

 

 

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1transmission of dependent premiums.
2    The Director shall annually determine rates of payment,
3subject to the following constraints:
4        (1) In the first year of coverage, the rates shall be
5    equal to the amount normally charged to State employees for
6    elected optional coverages or for enrolled dependents
7    coverages or other contributory coverages on behalf of its
8    employees, adjusted for differences between State
9    employees and employees of the child advocacy center in
10    age, sex, geographic location, or other relevant
11    demographic variables, plus an amount sufficient to pay for
12    the additional administrative costs of providing coverage
13    to employees of the child advocacy center and their
14    dependents.
15        (2) In subsequent years, a further adjustment shall be
16    made to reflect the actual prior years' claims experience
17    of the employees of the child advocacy center.
18    Monthly payments by the child advocacy center or its
19employees for group health insurance shall be deposited into
20the Local Government Health Insurance Reserve Fund.
21(Source: P.A. 95-331, eff. 8-21-07; 95-632, eff. 9-25-07;
2295-707, eff. 1-11-08; 96-756, eff. 1-1-10; 96-1232, eff.
237-23-10; 96-1519, eff. 2-4-11.)
 
24    (5 ILCS 375/15)  (from Ch. 127, par. 535)
25    Sec. 15. Administration; rules; audit; review.

 

 

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1    (a) The Director shall administer this Act and shall
2prescribe such rules and regulations as are necessary to give
3full effect to the purposes of this Act. To facilitate the
4maintenance of the program of group health benefits provided to
5annuitants, survivors, and retired employees under this Act,
6rules adopted by the Director to alter the contributions to be
7paid by the State, annuitants, survivors, retired employees, or
8any combination of those entities, for that program of group
9health benefits, shall be adopted as emergency rules in
10accordance with Section 5-45 of the Illinois Administrative
11Procedure Act.
12    (b) These rules may fix reasonable standards for the group
13life and group health programs and other benefit programs
14offered under this Act, and for the contractors providing them.
15    (c) These rules shall specify that covered and optional
16medical services of the program are services provided within
17the scope of their licenses by practitioners in all categories
18licensed under the Medical Practice Act of 1987 and shall
19provide that all eligible persons be fully informed of this
20specification.
21    (d) These rules shall establish eligibility requirements
22for members and dependents as may be necessary to supplement or
23clarify requirements contained in this Act.
24    (e) Each affected department of the State, the State
25Universities Retirement System, the Teachers' Retirement
26System, and each qualified local government, rehabilitation

 

 

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1facility, domestic violence shelter or service, or child
2advocacy center, shall keep such records, make such
3certifications, and furnish the Director such information as
4may be necessary for the administration of this Act, including
5information concerning number and total amounts of payroll of
6employees of the department who are paid from trust funds or
7federal funds.
8    (f) Each member, each community college benefit recipient
9to whom this Act applies, and each TRS benefit recipient to
10whom this Act applies shall furnish the Director, in such form
11as may be required, any information that may be necessary to
12enroll such member or benefit recipient and, if applicable, his
13or her dependents or dependent beneficiaries under the programs
14or plan, including such data as may be required to allow the
15Director to accumulate statistics on data normally considered
16in actuarial studies of employee groups. Information about
17community college benefit recipients and community college
18dependent beneficiaries shall be furnished through the State
19Universities Retirement System. Information about TRS benefit
20recipients and TRS dependent beneficiaries shall be furnished
21through the Teachers' Retirement System.
22    (g) There shall be audits and reports on the programs
23authorized and established by this Act prepared by the Director
24with the assistance of a qualified, independent accounting
25firm. The reports shall provide information on the experience,
26and administrative effectiveness and adequacy of the program

 

 

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1including, when applicable, recommendations on up-grading of
2benefits and improvement of the program.
3    (h) Any final order, decision or other determination made,
4issued or executed by the Director under the provisions of this
5Act whereby any contractor or person is aggrieved shall be
6subject to review in accordance with the provisions of the
7Administrative Review Law and all amendments and modifications
8thereof, and the rules adopted pursuant thereto, shall apply to
9and govern all proceedings for the judicial review of final
10administrative decisions of the Director.
11(Source: P.A. 94-860, eff. 6-16-06.)
 
12    Section 99. Effective date. This Act takes effect July 1,
132012.