State of Illinois
91st General Assembly
Legislation

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91_SB1022

 
                                               LRB9106120EGdv

 1        AN ACT to amend the State Employees Group  Insurance  Act
 2    of 1971 by changing Section 10.

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

 5        Section 5.  The State Employees Group  Insurance  Act  of
 6    1971 is amended by changing Section 10 as follows:

 7        (5 ILCS 375/10) (from Ch. 127, par. 530)
 8        Sec. 10. Payments by State; premiums.
 9        (a)  The    State   shall   pay   the   cost   of   basic
10    non-contributory group life insurance and, subject to  member
11    paid  contributions set by the Department or required by this
12    Section, the basic program of group health benefits  on  each
13    eligible  member,  except  a member, not otherwise covered by
14    this Act, who has retired as  a  participating  member  under
15    Article  2 of the Illinois Pension Code but is ineligible for
16    the retirement annuity under Section 2-119  of  the  Illinois
17    Pension  Code, and part of each eligible member's and retired
18    member's premiums for health insurance coverage for  enrolled
19    dependents as provided by Section 9.  The State shall pay the
20    cost of the basic program of group health benefits only after
21    benefits  are  reduced  by  the amount of benefits covered by
22    Medicare for all retired members and retired dependents  aged
23    65  years  or older who are entitled to benefits under Social
24    Security  or  the  Railroad  Retirement  system  or  who  had
25    sufficient Medicare-covered government employment except that
26    such reduction in benefits shall apply only to those  retired
27    members  or  retired dependents who (1) first become eligible
28    for such Medicare coverage on or after July 1, 1992;  or  (2)
29    remain  eligible for, but no longer receive Medicare coverage
30    which they had been receiving on or after July 1,  1992.  The
31    Department  may  determine the aggregate level of the State's
 
                            -2-                LRB9106120EGdv
 1    contribution on the basis of actual cost of medical  services
 2    adjusted  for  age,  sex  or  geographic or other demographic
 3    characteristics which affect the costs of such programs.
 4        (a-1)  Beginning January 1, 1998,  for  each  person  who
 5    becomes  a  new  SERS annuitant and participates in the basic
 6    program of group health benefits, the State shall  contribute
 7    toward  the  cost of the annuitant's coverage under the basic
 8    program of group health benefits an amount  equal  to  5%  of
 9    that cost for each full year of creditable service upon which
10    the  annuitant's retirement annuity is based, up to a maximum
11    of 100% for an annuitant with 20 or more years of  creditable
12    service.  The remainder of the cost of a new SERS annuitant's
13    coverage  under  the  basic  program of group health benefits
14    shall be the responsibility of the annuitant.
15        (a-2)  Beginning January 1, 1998,  for  each  person  who
16    becomes  a  new  SERS  survivor and participates in the basic
17    program of group health benefits, the State shall  contribute
18    toward  the  cost  of the survivor's coverage under the basic
19    program of group health benefits an amount  equal  to  5%  of
20    that  cost  for  each full year of the deceased employee's or
21    deceased  annuitant's  creditable  service   in   the   State
22    Employees'  Retirement  System  of  Illinois  on  the date of
23    death, up to a maximum of 100% for a survivor of an  employee
24    or  annuitant  with  20  or more years of creditable service.
25    The remainder of the cost of the new SERS survivor's coverage
26    under the basic program of group health benefits shall be the
27    responsibility of the survivor.
28        (a-3)  Beginning January 1, 1998,  for  each  person  who
29    becomes  a  new  SURS annuitant and participates in the basic
30    program of group health benefits, the State shall  contribute
31    toward  the  cost of the annuitant's coverage under the basic
32    program of group health benefits an amount  equal  to  5%  of
33    that cost for each full year of creditable service upon which
34    the  annuitant's retirement annuity is based, up to a maximum
 
                            -3-                LRB9106120EGdv
 1    of 100% for an annuitant with 20 or more years of  creditable
 2    service.  The remainder of the cost of a new SURS annuitant's
 3    coverage  under  the  basic  program of group health benefits
 4    shall be the responsibility of the annuitant.
 5        (a-4)  Beginning January 1, 1998,  for  each  person  who
 6    becomes  a  new SURS retired employee and participates in the
 7    basic program of  group  health  benefits,  the  State  shall
 8    contribute toward the cost of the retired employee's coverage
 9    under  the  basic  program of group health benefits an amount
10    equal to 5% of that cost for each full year that the  retired
11    employee  was  an  employee  as defined in Section 3, up to a
12    maximum of 100% for a retired employee who  was  an  employee
13    for  20  or  more  years.  The remainder of the cost of a new
14    SURS retired employee's coverage under the basic  program  of
15    group  health  benefits  shall  be  the responsibility of the
16    retired employee.
17        (a-5)  Beginning January 1, 1998,  for  each  person  who
18    becomes  a  new  SURS  survivor and participates in the basic
19    program of group health benefits, the State shall  contribute
20    toward  the  cost  of the survivor's coverage under the basic
21    program of group health benefits an amount  equal  to  5%  of
22    that  cost  for  each full year of the deceased employee's or
23    deceased  annuitant's  creditable  service   in   the   State
24    Universities  Retirement System on the date of death, up to a
25    maximum of 100% for a survivor of an  employee  or  annuitant
26    with  20  or more years of creditable service.  The remainder
27    of the cost of the new SURS  survivor's  coverage  under  the
28    basic   program   of  group  health  benefits  shall  be  the
29    responsibility of the survivor.
30        (a-6)  Beginning  July  1,  1998,  for  each  person  who
31    becomes a new TRS State annuitant  and  participates  in  the
32    basic  program  of  group  health  benefits,  the State shall
33    contribute toward the cost of the annuitant's coverage  under
34    the basic program of group health benefits an amount equal to
 
                            -4-                LRB9106120EGdv
 1    5% of that cost for each full year of creditable service as a
 2    teacher  as  defined in paragraph (2), (3), or (5) of Section
 3    16-106  of  the  Illinois  Pension  Code   upon   which   the
 4    annuitant's  retirement  annuity is based, up to a maximum of
 5    100%  for  an  annuitant  with  20  or  more  years  of  such
 6    creditable service.  The remainder of the cost of a  new  TRS
 7    State  annuitant's  coverage under the basic program of group
 8    health benefits shall be the responsibility of the annuitant.
 9        (a-7)  Beginning  July  1,  1998,  for  each  person  who
10    becomes a new TRS State  survivor  and  participates  in  the
11    basic  program  of  group  health  benefits,  the State shall
12    contribute toward the cost of the survivor's  coverage  under
13    the basic program of group health benefits an amount equal to
14    5% of that cost for each full year of the deceased employee's
15    or  deceased  annuitant's  creditable service as a teacher as
16    defined in paragraph (2), (3), or (5) of  Section  16-106  of
17    the  Illinois  Pension  Code  on  the  date of death, up to a
18    maximum of 100% for a survivor of an  employee  or  annuitant
19    with  20  or  more  years  of  such  creditable service.  The
20    remainder of  the  cost  of  the  new  TRS  State  survivor's
21    coverage  under  the  basic  program of group health benefits
22    shall be the responsibility of the survivor.
23        (a-8)  A new SERS annuitant, new SERS survivor, new  SURS
24    annuitant,  new SURS retired employee, new SURS survivor, new
25    TRS State annuitant, or new TRS State survivor may  waive  or
26    terminate  coverage  in the program of group health benefits.
27    Any such annuitant, survivor, or  retired  employee  who  has
28    waived  or terminated coverage may enroll or re-enroll in the
29    program of group  health  benefits  only  during  the  annual
30    benefit  choice period, as determined by the Director; except
31    that  in  the  event  of  termination  of  coverage  due   to
32    nonpayment  of  premiums, the annuitant, survivor, or retired
33    employee may not re-enroll in the program.
34        (a-9)  No later than May 1 of  each  calendar  year,  the
 
                            -5-                LRB9106120EGdv
 1    Director  of  Central  Management  Services  shall certify in
 2    writing to the Executive Secretary of  the  State  Employees'
 3    Retirement  System  of  Illinois  the amounts of the Medicare
 4    supplement health care premiums and the amounts of the health
 5    care premiums for all other retirees  who  are  not  Medicare
 6    eligible.
 7        A  separate  calculation  of  the premiums based upon the
 8    actual cost of each health care plan shall be so certified.
 9        The Director of Central Management Services shall provide
10    to the Executive Secretary of the State Employees' Retirement
11    System of Illinois such information,  statistics,  and  other
12    data  as  he or she may require to review the premium amounts
13    certified by the Director of Central Management Services.
14        (b)  State employees who become eligible for this program
15    on or after January 1, 1980 in positions  normally  requiring
16    actual performance of duty not less than 1/2 of a normal work
17    period  but  not equal to that of a normal work period, shall
18    be  given  the  option  of  participating  in  the  available
19    program. If the employee elects  coverage,  the  State  shall
20    contribute  on  behalf  of  such  employee to the cost of the
21    employee's benefit and any applicable  dependent  supplement,
22    that  sum  which bears the same percentage as that percentage
23    of time the employee regularly works when compared to  normal
24    work period.
25        (c)  The  basic  non-contributory coverage from the basic
26    program of group health benefits shall be continued for  each
27    employee  not in pay status or on active service by reason of
28    (1) leave of absence due to illness or injury, (2) authorized
29    educational leave of absence  or  sabbatical  leave,  or  (3)
30    military  leave  with  pay  and benefits. This coverage shall
31    continue until expiration of authorized leave and  return  to
32    active  service, but not to exceed 24 months for leaves under
33    item (1) or (2). This 24-month limitation and the requirement
34    of returning to active service shall  not  apply  to  persons
 
                            -6-                LRB9106120EGdv
 1    receiving  ordinary  or  accidental  disability  benefits  or
 2    retirement  benefits through the appropriate State retirement
 3    system  or  benefits  under  the  Workers'  Compensation   or
 4    Occupational Disease Act.
 5        (d)  The   basic  group  life  insurance  coverage  shall
 6    continue, with full State contribution, where such person  is
 7    (1)  absent  from  active  service  by  reason  of disability
 8    arising from any cause  other  than  self-inflicted,  (2)  on
 9    authorized  educational leave of absence or sabbatical leave,
10    or (3) on military leave with pay and benefits.
11        (e)  Where the person is in non-pay status for  a  period
12    in  excess  of  30 days or on leave of absence, other than by
13    reason of disability, educational  or  sabbatical  leave,  or
14    military  leave  with  pay  and  benefits,  such  person  may
15    continue  coverage  only  by making personal payment equal to
16    the amount normally contributed by the State on such person's
17    behalf. Such payments and  coverage  may  be  continued:  (1)
18    until  such  time  as the person returns to a status eligible
19    for coverage at State expense, but not to exceed  24  months,
20    (2)  until  such person's employment or annuitant status with
21    the State is terminated, or (3) for a  maximum  period  of  4
22    years for members on military leave with pay and benefits and
23    military  leave  without  pay  and benefits (exclusive of any
24    additional service imposed pursuant to law).
25        (f)  The Department shall  establish by rule  the  extent
26    to which other employee benefits will continue for persons in
27    non-pay status or who are not in active service.
28        (g)  The  State  shall  not  pay  the  cost  of the basic
29    non-contributory group  life  insurance,  program  of  health
30    benefits  and  other  employee  benefits  for members who are
31    survivors as defined by paragraphs (1) and (2) of  subsection
32    (q)  of  Section  3  of  this Act.  The costs of benefits for
33    these survivors shall be paid by  the  survivors  or  by  the
34    University  of Illinois Cooperative Extension Service, or any
 
                            -7-                LRB9106120EGdv
 1    combination thereof.
 2        (h)  Those   persons   occupying   positions   with   any
 3    department as a result of emergency appointments pursuant  to
 4    Section  8b.8  of  the  Personnel Code who are not considered
 5    employees under  this  Act  shall  be  given  the  option  of
 6    participating in the programs of group life insurance, health
 7    benefits  and other employee benefits.  Such persons electing
 8    coverage may participate only by making payment equal to  the
 9    amount  normally  contributed  by  the  State  for  similarly
10    situated  employees.  Such amounts shall be determined by the
11    Director.  Such payments and coverage may be continued  until
12    such  time as the person becomes an employee pursuant to this
13    Act or such person's appointment is terminated.
14        (i)  Any unit of local government  within  the  State  of
15    Illinois  may  apply  to  the Director to have its employees,
16    annuitants,  and  their  dependents  provided  group   health
17    coverage   under   this  Act  on  a  non-insured  basis.   To
18    participate, a unit of local government must agree to  enroll
19    all  of  its  employees, who may select coverage under either
20    the State group health insurance plan or a health maintenance
21    organization  that  has  contracted  with  the  State  to  be
22    available as a health care provider for employees as  defined
23    in  this  Act.   A  unit  of  local government must remit the
24    entire cost of  providing  coverage  under  the  State  group
25    health  insurance  plan  or,  for  coverage  under  a  health
26    maintenance   organization,   an  amount  determined  by  the
27    Director based on an analysis of  the  sex,  age,  geographic
28    location,  or  other  relevant  demographic variables for its
29    employees, except that the unit of local government shall not
30    be required to enroll those of its employees who are  covered
31    spouses or dependents under this plan or another group policy
32    or   plan  providing  health  benefits  as  long  as  (1)  an
33    appropriate  official  from  the  unit  of  local  government
34    attests that each employee not enrolled is a  covered  spouse
 
                            -8-                LRB9106120EGdv
 1    or dependent under this plan or another group policy or plan,
 2    and  (2)  at  least 85% of the employees are enrolled and the
 3    unit of local government remits the entire cost of  providing
 4    coverage  to  those  employees;  except  that a participating
 5    school district is required to enroll at  least  85%  of  the
 6    district's  full-time  employees who have not waived coverage
 7    in the district's group health plan through participation  in
 8    a   component   of   the   district's   cafeteria   plan.   A
 9    participating school district shall not be required to enroll
10    a  full-time  employee  who  has  waived  coverage   in   the
11    district's  group  health  plan, provided that an appropriate
12    official from the participating school district attests  that
13    the  full-time employee has waived coverage in the district's
14    group health plan through participation in a component of the
15    district's cafeteria plan and is covered under another  group
16    policy  or  plan  providing  health benefits.  Employees of a
17    participating unit of local government who are  not  enrolled
18    due to coverage under another group health policy or plan may
19    enroll  at a later date subject to submission of satisfactory
20    evidence of insurability and provided that no benefits  shall
21    be payable for services incurred during the first 6 months of
22    coverage  to  the  extent the services are in connection with
23    any pre-existing condition.  A participating  unit  of  local
24    government may also elect to cover its annuitants.  Dependent
25    coverage  shall  be  offered  on  an optional basis, with the
26    costs paid by the unit of local government, its employees, or
27    some combination of the two as  determined  by  the  unit  of
28    local  government.   The  unit  of  local government shall be
29    responsible  for  timely  collection  and   transmission   of
30    dependent premiums.
31        The  Director  shall  annually determine monthly rates of
32    payment, subject to the following constraints:
33             (1)  In the first year of coverage, the rates  shall
34        be   equal  to  the  amount  normally  charged  to  State
 
                            -9-                LRB9106120EGdv
 1        employees for elected optional coverages or for  enrolled
 2        dependents  coverages or other contributory coverages, or
 3        contributed by the State for basic insurance coverages on
 4        behalf of its employees, adjusted for differences between
 5        State employees and employees of the local government  in
 6        age,   sex,   geographic   location   or  other  relevant
 7        demographic variables, plus an amount sufficient  to  pay
 8        for  the  additional  administrative  costs  of providing
 9        coverage to employees of the unit of local government and
10        their dependents.
11             (2)  In subsequent years, a further adjustment shall
12        be  made  to  reflect  the  actual  prior  years'  claims
13        experience  of  the  employees  of  the  unit  of   local
14        government.
15        In  the  case  of  coverage of local government employees
16    under a health maintenance organization, the  Director  shall
17    annually  determine  for  each  participating  unit  of local
18    government the maximum monthly amount the unit may contribute
19    toward that coverage, based on an analysis of  (i)  the  age,
20    sex,  geographic  location,  and  other  relevant demographic
21    variables of the unit's employees and (ii) the cost to  cover
22    those  employees under the State group health insurance plan.
23    The Director may  similarly  determine  the  maximum  monthly
24    amount  each  unit  of local government may contribute toward
25    coverage  of  its  employees'  dependents  under   a   health
26    maintenance organization.
27        Monthly  payments  by the unit of local government or its
28    employees for group health insurance  or  health  maintenance
29    organization   coverage  shall  be  deposited  in  the  Local
30    Government  Health  Insurance  Reserve   Fund.    The   Local
31    Government   Health   Insurance   Reserve  Fund  shall  be  a
32    continuing fund not subject to fiscal year limitations.   All
33    expenditures  from  this  fund shall be used for payments for
34    health care benefits for local government and  rehabilitation
 
                            -10-               LRB9106120EGdv
 1    facility   employees,  annuitants,  and  dependents,  and  to
 2    reimburse  the  Department  or  its  administrative   service
 3    organization  for all expenses incurred in the administration
 4    of benefits.  No other State funds  may  be  used  for  these
 5    purposes.
 6        A  local government employer's participation or desire to
 7    participate in a program created under this subsection  shall
 8    not   limit   that   employer's  duty  to  bargain  with  the
 9    representative of  any  collective  bargaining  unit  of  its
10    employees.
11        (j)  Any  rehabilitation  facility  within  the  State of
12    Illinois may apply to the Director  to  have  its  employees,
13    annuitants,   and  their  dependents  provided  group  health
14    coverage  under  this  Act  on  a   non-insured   basis.   To
15    participate,  a  rehabilitation facility must agree to enroll
16    all of its employees and remit the entire cost  of  providing
17    such   coverage   for   its   employees,   except   that  the
18    rehabilitation facility shall not be required to enroll those
19    of its employees who are covered spouses or dependents  under
20    this  plan  or  another group policy or plan providing health
21    benefits as long as (1)  an  appropriate  official  from  the
22    rehabilitation   facility  attests  that  each  employee  not
23    enrolled is a covered spouse or dependent under this plan  or
24    another  group  policy  or  plan, and (2) at least 85% of the
25    employees are enrolled and the rehabilitation facility remits
26    the entire cost of providing  coverage  to  those  employees.
27    Employees  of a participating rehabilitation facility who are
28    not enrolled due  to  coverage  under  another  group  health
29    policy  or  plan  may  enroll  at  a  later  date  subject to
30    submission  of  satisfactory  evidence  of  insurability  and
31    provided that no  benefits  shall  be  payable  for  services
32    incurred  during the first 6 months of coverage to the extent
33    the  services  are  in  connection  with   any   pre-existing
34    condition.  A  participating rehabilitation facility may also
 
                            -11-               LRB9106120EGdv
 1    elect to cover its annuitants. Dependent  coverage  shall  be
 2    offered  on  an  optional  basis,  with the costs paid by the
 3    rehabilitation facility, its employees, or  some  combination
 4    of  the  2  as determined by the rehabilitation facility. The
 5    rehabilitation  facility  shall  be  responsible  for  timely
 6    collection and transmission of dependent premiums.
 7        The Director shall annually determine quarterly rates  of
 8    payment, subject to the following constraints:
 9             (1)  In  the first year of coverage, the rates shall
10        be  equal  to  the  amount  normally  charged  to   State
11        employees  for elected optional coverages or for enrolled
12        dependents coverages or other contributory  coverages  on
13        behalf of its employees, adjusted for differences between
14        State  employees  and  employees  of  the  rehabilitation
15        facility  in  age,  sex,  geographic  location  or  other
16        relevant demographic variables, plus an amount sufficient
17        to   pay  for  the  additional  administrative  costs  of
18        providing coverage to  employees  of  the  rehabilitation
19        facility and their dependents.
20             (2)  In subsequent years, a further adjustment shall
21        be  made  to  reflect  the  actual  prior  years'  claims
22        experience   of   the  employees  of  the  rehabilitation
23        facility.
24        Monthly payments by the rehabilitation  facility  or  its
25    employees  for  group  health insurance shall be deposited in
26    the Local Government Health Insurance Reserve Fund.
27        (k)  Any domestic violence shelter or service within  the
28    State  of  Illinois  may  apply  to  the Director to have its
29    employees, annuitants, and their  dependents  provided  group
30    health  coverage  under  this Act on a non-insured basis.  To
31    participate, a domestic  violence  shelter  or  service  must
32    agree  to enroll all of its employees and pay the entire cost
33    of  providing   such   coverage   for   its   employees.    A
34    participating  domestic  violence  shelter  may also elect to
 
                            -12-               LRB9106120EGdv
 1    cover its annuitants.  Dependent coverage shall be offered on
 2    an optional basis, with employees, or some combination of the
 3    2 as determined by the domestic violence shelter or  service.
 4    The domestic violence shelter or service shall be responsible
 5    for timely collection and transmission of dependent premiums.
 6        The  Director shall annually determine quarterly rates of
 7    payment, subject to the following constraints:
 8             (1)  In the first year of coverage, the rates  shall
 9        be   equal  to  the  amount  normally  charged  to  State
10        employees for elected optional coverages or for  enrolled
11        dependents  coverages  or other contributory coverages on
12        behalf of its employees, adjusted for differences between
13        State employees and employees of  the  domestic  violence
14        shelter  or  service  in age, sex, geographic location or
15        other relevant  demographic  variables,  plus  an  amount
16        sufficient to pay for the additional administrative costs
17        of  providing  coverage  to  employees  of  the  domestic
18        violence shelter or service and their dependents.
19             (2)  In subsequent years, a further adjustment shall
20        be  made  to  reflect  the  actual  prior  years'  claims
21        experience  of  the  employees  of  the domestic violence
22        shelter or service.
23             (3)  In no case shall the  rate  be  less  than  the
24        amount normally charged to State employees or contributed
25        by the State on behalf of its employees.
26        Monthly  payments  by  the  domestic  violence shelter or
27    service or its employees for group health insurance shall  be
28    deposited  in  the  Local Government Health Insurance Reserve
29    Fund.
30        (l)  A  public  community  college  or  entity  organized
31    pursuant to the Public Community College Act may apply to the
32    Director initially to have only annuitants not covered  prior
33    to July 1, 1992 by the district's health plan provided health
34    coverage   under  this  Act  on  a  non-insured  basis.   The
 
                            -13-               LRB9106120EGdv
 1    community  college  must  execute  a   2-year   contract   to
 2    participate  in  the  Local  Government  Health  Plan.  Those
 3    annuitants enrolled initially under this contract shall  have
 4    no  benefits payable for services incurred during the first 6
 5    months  of  coverage  to  the  extent  the  services  are  in
 6    connection with any pre-existing  condition.   Any  annuitant
 7    who  may enroll after this initial enrollment period shall be
 8    subject   to   submission   of   satisfactory   evidence   of
 9    insurability and to the pre-existing conditions limitation.
10        The Director shall annually determine  monthly  rates  of
11    payment  subject  to  the  following  constraints:  for those
12    community colleges with annuitants only enrolled, first  year
13    rates  shall be equal to the average cost to cover claims for
14    a  State   member   adjusted   for   demographics,   Medicare
15    participation,  and  other factors; and in the second year, a
16    further adjustment of rates shall  be  made  to  reflect  the
17    actual   first   year's  claims  experience  of  the  covered
18    annuitants.
19        (m)  The Director shall adopt any rules deemed  necessary
20    for implementation of this amendatory Act of 1989 (Public Act
21    86-978).
22    (Source:  P.A.  89-53,  eff.  7-1-95;  89-236,  eff.  8-4-95;
23    89-324,  eff.  8-13-95;  89-626,  eff.  8-9-96;  90-65,  eff.
24    7-7-97;  90-582,  eff. 5-27-98; 90-655, eff. 7-30-98; revised
25    8-3-98.)

26        Section 99. Effective date.  This Act takes  effect  July
27    1, 1999.

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