[ Home ] [ ILCS ] [ Search ] [ Bottom ]
[ Other General Assemblies ]
Public Act 91-0390
HB2720 Enrolled LRB9100169EGfgB
AN ACT to amend the State Employees Group Insurance Act
of 1971.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The State Employees Group Insurance Act of
1971 is amended by changing Sections 3, 5, 6, 8, 9, 10, 13,
13.1, 13.2, and 15 as follows:
(5 ILCS 375/3) (from Ch. 127, par. 523)
Sec. 3. Definitions. Unless the context otherwise
requires, the following words and phrases as used in this Act
shall have the following meanings. The Department may define
these and other words and phrases separately for the purpose
of implementing specific programs providing benefits under
this Act.
(a) "Administrative service organization" means any
person, firm or corporation experienced in the handling of
claims which is fully qualified, financially sound and
capable of meeting the service requirements of a contract of
administration executed with the Department.
(b) "Annuitant" means (1) an employee who retires, or
has retired, on or after January 1, 1966 on an immediate
annuity under the provisions of Articles 2, 14, 15 (including
an employee who has retired under the optional retirement
program established under Section 15-158.2), paragraphs (2),
(3), or (5) of Section 16-106, or Article 18 of the Illinois
Pension Code; (2) any person who was receiving group
insurance coverage under this Act as of March 31, 1978 by
reason of his status as an annuitant, even though the annuity
in relation to which such coverage was provided is a
proportional annuity based on less than the minimum period of
service required for a retirement annuity in the system
involved; (3) any person not otherwise covered by this Act
who has retired as a participating member under Article 2 of
the Illinois Pension Code but is ineligible for the
retirement annuity under Section 2-119 of the Illinois
Pension Code; (4) the spouse of any person who is receiving a
retirement annuity under Article 18 of the Illinois Pension
Code and who is covered under a group health insurance
program sponsored by a governmental employer other than the
State of Illinois and who has irrevocably elected to waive
his or her coverage under this Act and to have his or her
spouse considered as the "annuitant" under this Act and not
as a "dependent"; or (5) an employee who retires, or has
retired, from a qualified position, as determined according
to rules promulgated by the Director, under a qualified local
government or a qualified rehabilitation facility or a
qualified domestic violence shelter or service. (For
definition of "retired employee", see (p) post).
(b-5) "New SERS annuitant" means a person who, on or
after January 1, 1998, becomes an annuitant, as defined in
subsection (b), by virtue of beginning to receive a
retirement annuity under Article 14 of the Illinois Pension
Code, and is eligible to participate in the basic program of
group health benefits provided for annuitants under this Act.
(b-6) "New SURS annuitant" means a person who, on or
after January 1, 1998, becomes an annuitant, as defined in
subsection (b), by virtue of beginning to receive a
retirement annuity under Article 15 of the Illinois Pension
Code, and is eligible to participate in the basic program of
group health benefits provided for annuitants under this Act.
(b-7) "New TRS State annuitant" means a person who, on
or after July 1, 1998, becomes an annuitant, as defined in
subsection (b), by virtue of beginning to receive a
retirement annuity under Article 16 of the Illinois Pension
Code based on service as a teacher as defined in paragraph
(2), (3), or (5) of Section 16-106 of that Code, and is
eligible to participate in the basic program of group health
benefits provided for annuitants under this Act.
(c) "Carrier" means (1) an insurance company, a
corporation organized under the Limited Health Service
Organization Act or the Voluntary Health Services Plan Act, a
partnership, or other nongovernmental organization, which is
authorized to do group life or group health insurance
business in Illinois, or (2) the State of Illinois as a
self-insurer.
(d) "Compensation" means salary or wages payable on a
regular payroll by the State Treasurer on a warrant of the
State Comptroller out of any State, trust or federal fund, or
by the Governor of the State through a disbursing officer of
the State out of a trust or out of federal funds, or by any
Department out of State, trust, federal or other funds held
by the State Treasurer or the Department, to any person for
personal services currently performed, and ordinary or
accidental disability benefits under Articles 2, 14, 15
(including ordinary or accidental disability benefits under
the optional retirement program established under Section
15-158.2), paragraphs (2), (3), or (5) of Section 16-106, or
Article 18 of the Illinois Pension Code, for disability
incurred after January 1, 1966, or benefits payable under the
Workers' Compensation or Occupational Diseases Act or
benefits payable under a sick pay plan established in
accordance with Section 36 of the State Finance Act.
"Compensation" also means salary or wages paid to an employee
of any qualified local government or qualified rehabilitation
facility or a qualified domestic violence shelter or service.
(e) "Commission" means the State Employees Group
Insurance Advisory Commission authorized by this Act.
Commencing July 1, 1984, "Commission" as used in this Act
means the Illinois Economic and Fiscal Commission as
established by the Legislative Commission Reorganization Act
of 1984.
(f) "Contributory", when referred to as contributory
coverage, shall mean optional coverages or benefits elected
by the member toward the cost of which such member makes
contribution, or which are funded in whole or in part through
the acceptance of a reduction in earnings or the foregoing of
an increase in earnings by an employee, as distinguished from
noncontributory coverage or benefits which are paid entirely
by the State of Illinois without reduction of the member's
salary.
(g) "Department" means any department, institution,
board, commission, officer, court or any agency of the State
government receiving appropriations and having power to
certify payrolls to the Comptroller authorizing payments of
salary and wages against such appropriations as are made by
the General Assembly from any State fund, or against trust
funds held by the State Treasurer and includes boards of
trustees of the retirement systems created by Articles 2, 14,
15, 16 and 18 of the Illinois Pension Code. "Department"
also includes the Illinois Comprehensive Health Insurance
Board, the Board of Examiners established under the Illinois
Public Accounting Act, and the Illinois Rural Bond Bank.
(h) "Dependent", when the term is used in the context of
the health and life plan, means a member's spouse and any
unmarried child (1) from birth to age 19 including an adopted
child, a child who lives with the member from the time of the
filing of a petition for adoption until entry of an order of
adoption, a stepchild or recognized child who lives with the
member in a parent-child relationship, or a child who lives
with the member if such member is a court appointed guardian
of the child, or (2) age 19 to 23 enrolled as a full-time
student in any accredited school, financially dependent upon
the member, and eligible to be claimed as a dependent for
Illinois State income tax purposes, or (3) age 19 or over who
is mentally or physically handicapped as defined in the
Illinois Insurance Code. For the health plan only, the term
"dependent" also includes any person enrolled prior to the
effective date of this Section who is dependent upon the
member to the extent that the member may claim such person as
a dependent for Illinois State income tax deduction purposes;
no other such person may be enrolled.
(i) "Director" means the Director of the Illinois
Department of Central Management Services.
(j) "Eligibility period" means the period of time a
member has to elect enrollment in programs or to select
benefits without regard to age, sex or health.
(k) "Employee" means and includes each officer or
employee in the service of a department who (1) receives his
compensation for service rendered to the department on a
warrant issued pursuant to a payroll certified by a
department or on a warrant or check issued and drawn by a
department upon a trust, federal or other fund or on a
warrant issued pursuant to a payroll certified by an elected
or duly appointed officer of the State or who receives
payment of the performance of personal services on a warrant
issued pursuant to a payroll certified by a Department and
drawn by the Comptroller upon the State Treasurer against
appropriations made by the General Assembly from any fund or
against trust funds held by the State Treasurer, and (2) is
employed full-time or part-time in a position normally
requiring actual performance of duty during not less than 1/2
of a normal work period, as established by the Director in
cooperation with each department, except that persons elected
by popular vote will be considered employees during the
entire term for which they are elected regardless of hours
devoted to the service of the State, and (3) except that
"employee" does not include any person who is not eligible by
reason of such person's employment to participate in one of
the State retirement systems under Articles 2, 14, 15 (either
the regular Article 15 system or the optional retirement
program established under Section 15-158.2) or 18, or under
paragraph (2), (3), or (5) of Section 16-106, of the Illinois
Pension Code, but such term does include persons who are
employed during the 6 month qualifying period under Article
14 of the Illinois Pension Code. Such term also includes any
person who (1) after January 1, 1966, is receiving ordinary
or accidental disability benefits under Articles 2, 14, 15
(including ordinary or accidental disability benefits under
the optional retirement program established under Section
15-158.2), paragraphs (2), (3), or (5) of Section 16-106, or
Article 18 of the Illinois Pension Code, for disability
incurred after January 1, 1966, (2) receives total permanent
or total temporary disability under the Workers' Compensation
Act or Occupational Disease Act as a result of injuries
sustained or illness contracted in the course of employment
with the State of Illinois, or (3) is not otherwise covered
under this Act and has retired as a participating member
under Article 2 of the Illinois Pension Code but is
ineligible for the retirement annuity under Section 2-119 of
the Illinois Pension Code. However, a person who satisfies
the criteria of the foregoing definition of "employee" except
that such person is made ineligible to participate in the
State Universities Retirement System by clause (4) of
subsection (a) of Section 15-107 of the Illinois Pension Code
is also an "employee" for the purposes of this Act.
"Employee" also includes any person receiving or eligible for
benefits under a sick pay plan established in accordance with
Section 36 of the State Finance Act. "Employee" also includes
each officer or employee in the service of a qualified local
government, including persons appointed as trustees of
sanitary districts regardless of hours devoted to the service
of the sanitary district, and each employee in the service of
a qualified rehabilitation facility and each full-time
employee in the service of a qualified domestic violence
shelter or service, as determined according to rules
promulgated by the Director.
(l) "Member" means an employee, annuitant, retired
employee or survivor.
(m) "Optional coverages or benefits" means those
coverages or benefits available to the member on his or her
voluntary election, and at his or her own expense.
(n) "Program" means the group life insurance, health
benefits and other employee benefits designed and contracted
for by the Director under this Act.
(o) "Health plan" means a self-insured health benefits
insurance program offered by the State of Illinois for
persons eligible for the plan the purposes of benefiting
employees by means of providing, among others, wellness
programs, utilization reviews, second opinions and medical
fee reviews, as well as for paying for hospital and medical
care up to the maximum coverage provided by the plan, to its
members and their dependents.
(p) "Retired employee" means any person who would be an
annuitant as that term is defined herein but for the fact
that such person retired prior to January 1, 1966. Such term
also includes any person formerly employed by the University
of Illinois in the Cooperative Extension Service who would be
an annuitant but for the fact that such person was made
ineligible to participate in the State Universities
Retirement System by clause (4) of subsection (a) of Section
15-107 of the Illinois Pension Code.
(p-6) "New SURS retired employee" means a person who, on
or after January 1, 1998, becomes a retired employee, as
defined in subsection (p), by virtue of being a person
formerly employed by the University of Illinois in the
Cooperative Extension Service who would be an annuitant but
for the fact that he or she was made ineligible to
participate in the State Universities Retirement System by
clause (4) of subsection (a) of Section 15-107 of the
Illinois Pension Code, and who is eligible to participate in
the basic program of group health benefits provided for
retired employees under this Act.
(q) "Survivor" means a person receiving an annuity as a
survivor of an employee or of an annuitant. "Survivor" also
includes: (1) the surviving dependent of a person who
satisfies the definition of "employee" except that such
person is made ineligible to participate in the State
Universities Retirement System by clause (4) of subsection
(a) of Section 15-107 of the Illinois Pension Code; and (2)
the surviving dependent of any person formerly employed by
the University of Illinois in the Cooperative Extension
Service who would be an annuitant except for the fact that
such person was made ineligible to participate in the State
Universities Retirement System by clause (4) of subsection
(a) of Section 15-107 of the Illinois Pension Code.
(q-5) "New SERS survivor" means a survivor, as defined
in subsection (q), whose annuity is paid under Article 14 of
the Illinois Pension Code and is based on the death of (i) an
employee whose death occurs on or after January 1, 1998, or
(ii) a new SERS annuitant as defined in subsection (b-5).
(q-6) "New SURS survivor" means a survivor, as defined
in subsection (q), whose annuity is paid under Article 15 of
the Illinois Pension Code and is based on the death of (i) an
employee whose death occurs on or after January 1, 1998, (ii)
a new SURS annuitant as defined in subsection (b-6), or (iii)
a new SURS retired employee as defined in subsection (p-6).
(q-7) "New TRS State survivor" means a survivor, as
defined in subsection (q), whose annuity is paid under
Article 16 of the Illinois Pension Code and is based on the
death of (i) an employee who is a teacher as defined in
paragraph (2), (3), or (5) of Section 16-106 of that Code and
whose death occurs on or after July 1, 1998, or (ii) a new
TRS State annuitant as defined in subsection (b-7).
(r) "Medical services" means the services provided
within the scope of their licenses by practitioners in all
categories licensed under the Medical Practice Act of 1987.
(s) "Unit of local government" means any county,
municipality, township, school district, special district or
other unit, designated as a unit of local government by law,
which exercises limited governmental powers or powers in
respect to limited governmental subjects, any not-for-profit
association with a membership that primarily includes
townships and township officials, that has duties that
include provision of research service, dissemination of
information, and other acts for the purpose of improving
township government, and that is funded wholly or partly in
accordance with Section 85-15 of the Township Code; any
not-for-profit corporation or association, with a membership
consisting primarily of municipalities, that operates its own
utility system, and provides research, training,
dissemination of information, or other acts to promote
cooperation between and among municipalities that provide
utility services and for the advancement of the goals and
purposes of its membership; and the Illinois Association of
Park Districts. "Qualified local government" means a unit of
local government approved by the Director and participating
in a program created under subsection (i) of Section 10 of
this Act.
(t) "Qualified rehabilitation facility" means any
not-for-profit organization that is accredited by the
Commission on Accreditation of Rehabilitation Facilities or
certified by the Department of Human Services (as successor
to the Department of Mental Health and Developmental
Disabilities) to provide services to persons with
disabilities and which receives funds from the State of
Illinois for providing those services, approved by the
Director and participating in a program created under
subsection (j) of Section 10 of this Act.
(u) "Qualified domestic violence shelter or service"
means any Illinois domestic violence shelter or service and
its administrative offices funded by the Department of Human
Services (as successor to the Illinois Department of Public
Aid), approved by the Director and participating in a program
created under subsection (k) of Section 10.
(v) "TRS benefit recipient" means a person who:
(1) is not a "member" as defined in this Section;
and
(2) is receiving a monthly benefit or retirement
annuity under Article 16 of the Illinois Pension Code;
and
(3) either (i) has at least 8 years of creditable
service under Article 16 of the Illinois Pension Code, or
(ii) was enrolled in the health insurance program offered
under that Article on January 1, 1996, or (iii) is the
survivor of a benefit recipient who had at least 8 years
of creditable service under Article 16 of the Illinois
Pension Code or was enrolled in the health insurance
program offered under that Article on the effective date
of this amendatory Act of 1995, or (iv) is a recipient or
survivor of a recipient of a disability benefit under
Article 16 of the Illinois Pension Code.
(w) "TRS dependent beneficiary" means a person who:
(1) is not a "member" or "dependent" as defined in
this Section; and
(2) is a TRS benefit recipient's: (A) spouse, (B)
dependent parent who is receiving at least half of his or
her support from the TRS benefit recipient, or (C)
unmarried natural or adopted child who is (i) under age
19, or (ii) enrolled as a full-time student in an
accredited school, financially dependent upon the TRS
benefit recipient, eligible to be claimed as a dependent
for Illinois State income tax purposes, and either is
under age 24 or was, on January 1, 1996, participating as
a dependent beneficiary in the health insurance program
offered under Article 16 of the Illinois Pension Code, or
(iii) age 19 or over who is mentally or physically
handicapped as defined in the Illinois Insurance Code.
(x) "Military leave with pay and benefits" refers to
individuals in basic training for reserves, special/advanced
training, annual training, emergency call up, or activation
by the President of the United States with approved pay and
benefits.
(y) "Military leave without pay and benefits" refers to
individuals who enlist for active duty in a regular component
of the U.S. Armed Forces or other duty not specified or
authorized under military leave with pay and benefits.
(z) "Community college benefit recipient" means a person
who:
(1) is not a "member" as defined in this Section;
and
(2) is receiving a monthly survivor's annuity or
retirement annuity under Article 15 of the Illinois
Pension Code; and
(3) either (i) was a full-time employee of a
community college district or an association of community
college boards created under the Public Community College
Act (other than an employee whose last employer under
Article 15 of the Illinois Pension Code was a community
college district subject to Article VII of the Public
Community College Act) and was eligible to participate in
a group health benefit plan as an employee during the
time of employment with a community college district
(other than a community college district subject to
Article VII of the Public Community College Act) or an
association of community college boards, or (ii) is the
survivor of a person described in item (i).
(aa) "Community college dependent beneficiary" means a
person who:
(1) is not a "member" or "dependent" as defined in
this Section; and
(2) is a community college benefit recipient's: (A)
spouse, (B) dependent parent who is receiving at least
half of his or her support from the community college
benefit recipient, or (C) unmarried natural or adopted
child who is (i) under age 19, or (ii) enrolled as a
full-time student in an accredited school, financially
dependent upon the community college benefit recipient,
eligible to be claimed as a dependent for Illinois State
income tax purposes and under age 23, or (iii) age 19 or
over and mentally or physically handicapped as defined in
the Illinois Insurance Code.
(Source: P.A. 89-21, eff. 6-21-95; 89-25, eff. 6-21-95;
89-76, eff. 7-1-95; 89-324, eff. 8-13-95; 89-430, eff.
12-15-95; 89-502, eff. 7-1-96; 89-507, eff. 7-1-97; 89-628,
eff. 8-9-96; 90-14, eff. 7-1-97; 90-65, eff. 7-7-97; 90-448,
eff. 8-16-97; 90-497, eff. 8-18-97; 90-511, eff. 8-22-97;
90-582, eff. 5-27-98; 90-655, eff. 7-30-98.)
(5 ILCS 375/5) (from Ch. 127, par. 525)
Sec. 5. The Director shall contract or otherwise make
available group life insurance, health benefits and other
employee benefits to eligible members and, where elected,
their eligible dependents. Any contract or, if applicable,
contracts or other arrangement for provision of benefits
shall be on terms deemed by the Director to be in the best
interest of the State of Illinois and its members based on,
but not limited to, such criteria as administrative cost,
service capabilities of the carrier or other contractor and
premiums, fees or charges as related to benefits.
The Director may prepare and issue specifications for
group life insurance, health benefits, other employee
benefits and administrative services for the purpose of
receiving proposals from interested parties.
The Director is authorized to execute a contract, or
contracts, for the programs of group life insurance, health
benefits, other employee benefits and administrative services
authorized by this Act. All of the benefits provided under
this Act may be included in one or more contracts, or the
benefits may be classified into different types with each
type included under one or more similar contracts with the
same or different companies.
The program of health benefits shall offer each member a
choice between high and low options for dependent coverage.
The term of any contract may not extend beyond 5 fiscal
years. Upon recommendation of the Commission, the Director
may exercise renewal options of the same contract for up to a
period of 5 years. Any increases in premiums, fees or
charges requested by a contractor whose contract may be
renewed pursuant to a renewal option contained therein, must
be justified on the basis of (1) audited experience data, (2)
increases in the costs of health care services provided under
the contract, (3) contractor performance, (4) increases in
contractor responsibilities, or (5) any combination thereof.
Any contractor shall agree to abide by all requirements
of this Act and Rules and Regulations promulgated and adopted
thereto; to submit such information and data as may from time
to time be deemed necessary by the Director for effective
administration of the provisions of this Act and the programs
established hereunder, and to fully cooperate in any the
annual audit required under Section 15, paragraph (g) herein.
(Source: P.A. 85-848.)
(5 ILCS 375/6) (from Ch. 127, par. 526)
Sec. 6. (a) The program of health benefits shall provide
for protection against the financial costs of health care
expenses incurred in and out of hospital including basic
hospital-surgical-medical coverages. The program may include,
but shall not be limited to, such supplemental coverages as
out-patient diagnostic X-ray and laboratory expenses,
prescription drugs, dental services and similar group
benefits as are now or may become available. However,
nothing in this Act shall be construed to permit, on or after
July 1, 1980, the non-contributory portion of any such
program to include the expenses of obtaining an abortion,
induced miscarriage or induced premature birth unless, in the
opinion of a physician, such procedures are necessary for the
preservation of the life of the woman seeking such treatment,
or except an induced premature birth intended to produce a
live viable child and such procedure is necessary for the
health of the mother or the unborn child. The program may
also include coverage for those who rely on treatment by
prayer or spiritual means alone for healing in accordance
with the tenets and practice of a recognized religious
denomination.
The program of health benefits shall be designed by the
Director (1) to provide a reasonable relationship between the
benefits to be included and the expected distribution of
expenses of each such type to be incurred by the covered
members and dependents, (2) to specify, as covered benefits
and as optional benefits, the medical services of
practitioners in all categories licensed under the Medical
Practice Act of 1987, (3) to include reasonable controls,
which may include deductible and co-insurance provisions,
applicable to some or all of the benefits, or a coordination
of benefits provision, to prevent or minimize unnecessary
utilization of the various hospital, surgical and medical
expenses to be provided and to provide reasonable assurance
of stability of the program, and (4) to provide benefits to
the extent possible to members throughout the State, wherever
located, on an equitable basis. Notwithstanding any other
provision of this Section or Act, for all retired members or
retired dependents aged 65 years or older who are eligible
for entitled to benefits under Social Security or the
Railroad Retirement system or who had sufficient
Medicare-covered government employment, the Department shall
reduce benefits which would otherwise be paid by Medicare, by
the amount of benefits for which the retired member or
retired dependents are eligible under Medicare, except that
such reduction in benefits shall apply only to those retired
members or retired dependents who (1) first become eligible
for such medicare coverage on or after the effective date of
this amendatory Act of 1992; or (2) are Medicare-eligible
members or dependents of a local government unit which began
participation in the program on or after July 1, 1992; or (3)
(2) remain eligible for but no longer receive Medicare
coverage which they had been receiving on or after the
effective date of this amendatory Act of 1992.
Notwithstanding any other provisions of this Act, where a
covered member or dependents are eligible for benefits under
the federal Medicare health insurance program (Title XVIII of
the Social Security Act as added by Public Law 89-97, 89th
Congress), benefits paid under the State of Illinois program
or plan will be reduced by the amount of benefits paid by
Medicare. For retired members or retired dependents aged 65
years or older who are eligible for entitled to benefits
under Social Security or the Railroad Retirement system or
who had sufficient Medicare-covered government employment,
benefits shall be reduced by the amount for which the retired
member or retired dependent is eligible under Medicare,
except that such reduction in benefits shall apply only to
those retired members or retired dependents who (1) first
become eligible for such Medicare coverage on or after the
effective date of this amendatory Act of 1992; or (2) are
Medicare-eligible members or dependents of a local government
unit which began participation in the program on or after
July 1, 1992; or (3) (2) remain eligible for, but no longer
receive Medicare coverage which they had been receiving on or
after the effective date of this amendatory Act of 1992.
Premiums may be adjusted, where applicable, to an amount
deemed by the Director to be reasonably consistent with any
reduction of benefits.
(b) A member, not otherwise covered by this Act, who has
retired as a participating member under Article 2 of the
"Illinois Pension Code" but is ineligible for the retirement
annuity under Section 2-119 of the "Illinois Pension Code",
shall pay the premiums for coverage, not exceeding the amount
paid by the State for the non-contributory coverage for other
members, under the group health benefits insurance program or
the self-insurance health plan under this Act. The Director
shall promulgate rules and regulations to determine the
premiums to be paid by a member under this subsection (b).
(Source: P.A. 87-860.)
(5 ILCS 375/8) (from Ch. 127, par. 528)
Sec. 8. Eligibility.
(a) Each member eligible under the provisions of this
Act and any rules and regulations promulgated and adopted
hereunder by the Director shall become immediately eligible
and covered for all benefits available under the programs.
Members electing coverage for eligible dependents shall have
the coverage effective immediately, provided that the
election is properly filed in accordance with required filing
dates and procedures specified by the Director.
(1) Every member originally eligible to elect
dependent coverage, but not electing it during the
original eligibility period, may subsequently obtain
dependent coverage only in the event of a qualifying
change in status, special enrollment, special
circumstance as defined by the Director, or during the
annual Benefit Choice Period upon submission of
satisfactory evidence of insurability, unless there is a
change of family status that would confer new eligibility
for change of enrollment under rules established
supplementing this Act, in which event application must
be made within the new eligibility period.
(2) Members described above being transferred from
previous coverage towards which the State has been
contributing shall be transferred regardless of
preexisting conditions, waiting periods, or other
requirements that might jeopardize claim payments to
which they would otherwise have been entitled.
(3) Eligible and covered members that are eligible
for coverage as dependents except for the fact of being
members shall be transferred to, and covered under,
dependent status regardless of preexisting conditions,
waiting periods, or other requirements that might
jeopardize claim payments to which they would otherwise
have been entitled upon cessation of member status and
the election of dependent coverage by a member eligible
to elect that coverage.
(b) New employees shall be immediately insured for the
basic group life insurance and covered by the program of
health benefits on the first day of active State service.
Optional coverages or benefits, if elected during the
relevant eligibility period, will become effective on the
date of election or date of employment, whichever is later.
Optional coverages or benefits applied for after the
eligibility period will be effective, subject to satisfactory
evidence of insurability when applicable, or other necessary
qualifications, pursuant to the requirements of the
applicable benefit program, unless there is a change in of
family status that would confer new eligibility for change of
enrollment under rules established supplementing this Act, in
which event application must be made within the new
eligibility period.
(c) As to the group health benefits insurance program
contracted to begin or continue after June 30, 1973, each
retired employee shall become immediately eligible and
covered for all benefits available under that program.
Retired employees may elect coverage for eligible dependents
and shall have the coverage effective immediately, provided
that the election is properly filed in accordance with
required filing dates and procedures specified by the
Director.
Where husband and wife are both eligible members, each
shall be enrolled as a member and coverage on all of their
eligible dependent children, if any, may shall be under the
enrollment and election of either.
Regardless of other provisions herein regarding late
enrollment or changes of enrollments being subject to
submission of satisfactory evidence of insurability or other
qualifications, as appropriate, the Director may periodically
authorize open enrollment periods for each of the benefit
programs at which time each member may elect enrollment or
change of enrollment without regard to age, sex, health, or
other qualification under the conditions as may be prescribed
in rules and regulations supplementing this Act. Special
open enrollment periods may be declared by the Director for
certain members only when special circumstances occur that
affect only those members.
(Source: P.A. 87-367.)
(5 ILCS 375/9) (from Ch. 127, par. 529)
Sec. 9. (a) The eligible member shall be responsible for
his or her portion 100% of the premiums, charges or other
fees for all elected optional coverages or benefits, which
shall be paid by means of the acceptance of a reduction in
earnings or the foregoing of an increase in earnings by an
employee; provided, however, subject to rules and regulations
promulgated by the Department, the eligible member may make
personal payment of the premium, charge or fee for any
wellness programs implemented under the program of health
benefits. For any fiscal year beginning after June 30, 1974
the State shall contribute $7 per month for each eligible
member who has enrolled one or more dependents for coverage
under the program of health benefits established under this
Act. All contributions and payments by the eligible members
and the State for all elected optional coverages and benefits
shall be deposited in the Health Insurance Reserve Fund. The
Department may determine the aggregate level of contribution
required under this Section on the basis of actual cost of
services adjusted for age, sex or the geographical or other
demographic characteristics which affect costs of the
benefit.
(b) If a member is not entitled to receive any salary,
wages or other compensation during a period in which
premiums, charges or other fees are due or does not receive
compensation sufficient to allow deduction of the required
payment of the premium, charge or other fee, such member may
continue the contributory benefit in effect by making
personal payment of the premium, charge or other fee for the
period in such manner, in such amount, and for such duration,
as may be prescribed in rules and regulations promulgated for
the administration of this Act.
(Source: P.A. 85-848.)
(5 ILCS 375/10) (from Ch. 127, par. 530)
Sec. 10. Payments by State; premiums.
(a) The State shall pay the cost of basic
non-contributory group life insurance and, subject to member
paid contributions set by the Department or required by this
Section, the basic program of group health benefits on each
eligible member, except a member, not otherwise covered by
this Act, who has retired as a participating member under
Article 2 of the Illinois Pension Code but is ineligible for
the retirement annuity under Section 2-119 of the Illinois
Pension Code, and part of each eligible member's and retired
member's premiums for health insurance coverage for enrolled
dependents as provided by Section 9. The State shall pay the
cost of the basic program of group health benefits only after
benefits are reduced by the amount of benefits covered by
Medicare for all retired members and retired dependents aged
65 years or older who are eligible for entitled to benefits
under Social Security or the Railroad Retirement system or
who had sufficient Medicare-covered government employment,
except that such reduction in benefits shall apply only to
those retired members and or retired dependents who (1) first
become eligible for such Medicare coverage on or after July
1, 1992; or (2) are Medicare-eligible members or dependents
of a local government unit which began participation in the
program on or after July 1, 1992; or (3) (2) remain eligible
for, but no longer receive Medicare coverage which they had
been receiving on or after July 1, 1992. The Department may
determine the aggregate level of the State's contribution on
the basis of actual cost of medical services adjusted for
age, sex or geographic or other demographic characteristics
which affect the costs of such programs.
(a-1) Beginning January 1, 1998, for each person who
becomes a new SERS annuitant and participates in the basic
program of group health benefits, the State shall contribute
toward the cost of the annuitant's coverage under the basic
program of group health benefits an amount equal to 5% of
that cost for each full year of creditable service upon which
the annuitant's retirement annuity is based, up to a maximum
of 100% for an annuitant with 20 or more years of creditable
service. The remainder of the cost of a new SERS annuitant's
coverage under the basic program of group health benefits
shall be the responsibility of the annuitant.
(a-2) Beginning January 1, 1998, for each person who
becomes a new SERS survivor and participates in the basic
program of group health benefits, the State shall contribute
toward the cost of the survivor's coverage under the basic
program of group health benefits an amount equal to 5% of
that cost for each full year of the deceased employee's or
deceased annuitant's creditable service in the State
Employees' Retirement System of Illinois on the date of
death, up to a maximum of 100% for a survivor of an employee
or annuitant with 20 or more years of creditable service.
The remainder of the cost of the new SERS survivor's coverage
under the basic program of group health benefits shall be the
responsibility of the survivor.
(a-3) Beginning January 1, 1998, for each person who
becomes a new SURS annuitant and participates in the basic
program of group health benefits, the State shall contribute
toward the cost of the annuitant's coverage under the basic
program of group health benefits an amount equal to 5% of
that cost for each full year of creditable service upon which
the annuitant's retirement annuity is based, up to a maximum
of 100% for an annuitant with 20 or more years of creditable
service. The remainder of the cost of a new SURS annuitant's
coverage under the basic program of group health benefits
shall be the responsibility of the annuitant.
(a-4) Beginning January 1, 1998, for each person who
becomes a new SURS retired employee and participates in the
basic program of group health benefits, the State shall
contribute toward the cost of the retired employee's coverage
under the basic program of group health benefits an amount
equal to 5% of that cost for each full year that the retired
employee was an employee as defined in Section 3, up to a
maximum of 100% for a retired employee who was an employee
for 20 or more years. The remainder of the cost of a new
SURS retired employee's coverage under the basic program of
group health benefits shall be the responsibility of the
retired employee.
(a-5) Beginning January 1, 1998, for each person who
becomes a new SURS survivor and participates in the basic
program of group health benefits, the State shall contribute
toward the cost of the survivor's coverage under the basic
program of group health benefits an amount equal to 5% of
that cost for each full year of the deceased employee's or
deceased annuitant's creditable service in the State
Universities Retirement System on the date of death, up to a
maximum of 100% for a survivor of an employee or annuitant
with 20 or more years of creditable service. The remainder
of the cost of the new SURS survivor's coverage under the
basic program of group health benefits shall be the
responsibility of the survivor.
(a-6) Beginning July 1, 1998, for each person who
becomes a new TRS State annuitant and participates in the
basic program of group health benefits, the State shall
contribute toward the cost of the annuitant's coverage under
the basic program of group health benefits an amount equal to
5% of that cost for each full year of creditable service as a
teacher as defined in paragraph (2), (3), or (5) of Section
16-106 of the Illinois Pension Code upon which the
annuitant's retirement annuity is based, up to a maximum of
100% for an annuitant with 20 or more years of such
creditable service. The remainder of the cost of a new TRS
State annuitant's coverage under the basic program of group
health benefits shall be the responsibility of the annuitant.
(a-7) Beginning July 1, 1998, for each person who
becomes a new TRS State survivor and participates in the
basic program of group health benefits, the State shall
contribute toward the cost of the survivor's coverage under
the basic program of group health benefits an amount equal to
5% of that cost for each full year of the deceased employee's
or deceased annuitant's creditable service as a teacher as
defined in paragraph (2), (3), or (5) of Section 16-106 of
the Illinois Pension Code on the date of death, up to a
maximum of 100% for a survivor of an employee or annuitant
with 20 or more years of such creditable service. The
remainder of the cost of the new TRS State survivor's
coverage under the basic program of group health benefits
shall be the responsibility of the survivor.
(a-8) A new SERS annuitant, new SERS survivor, new SURS
annuitant, new SURS retired employee, new SURS survivor, new
TRS State annuitant, or new TRS State survivor may waive or
terminate coverage in the program of group health benefits.
Any such annuitant, survivor, or retired employee who has
waived or terminated coverage may enroll or re-enroll in the
program of group health benefits only during the annual
benefit choice period, as determined by the Director; except
that in the event of termination of coverage due to
nonpayment of premiums, the annuitant, survivor, or retired
employee may not re-enroll in the program.
(a-9) No later than May 1 of each calendar year, the
Director of Central Management Services shall certify in
writing to the Executive Secretary of the State Employees'
Retirement System of Illinois the amounts of the Medicare
supplement health care premiums and the amounts of the health
care premiums for all other retirees who are not Medicare
eligible.
A separate calculation of the premiums based upon the
actual cost of each health care plan shall be so certified.
The Director of Central Management Services shall provide
to the Executive Secretary of the State Employees' Retirement
System of Illinois such information, statistics, and other
data as he or she may require to review the premium amounts
certified by the Director of Central Management Services.
(b) State employees who become eligible for this program
on or after January 1, 1980 in positions normally requiring
actual performance of duty not less than 1/2 of a normal work
period but not equal to that of a normal work period, shall
be given the option of participating in the available
program. If the employee elects coverage, the State shall
contribute on behalf of such employee to the cost of the
employee's benefit and any applicable dependent supplement,
that sum which bears the same percentage as that percentage
of time the employee regularly works when compared to normal
work period.
(c) The basic non-contributory coverage from the basic
program of group health benefits shall be continued for each
employee not in pay status or on active service by reason of
(1) leave of absence due to illness or injury, (2) authorized
educational leave of absence or sabbatical leave, or (3)
military leave with pay and benefits. This coverage shall
continue until expiration of authorized leave and return to
active service, but not to exceed 24 months for leaves under
item (1) or (2). This 24-month limitation and the requirement
of returning to active service shall not apply to persons
receiving ordinary or accidental disability benefits or
retirement benefits through the appropriate State retirement
system or benefits under the Workers' Compensation or
Occupational Disease Act.
(d) The basic group life insurance coverage shall
continue, with full State contribution, where such person is
(1) absent from active service by reason of disability
arising from any cause other than self-inflicted, (2) on
authorized educational leave of absence or sabbatical leave,
or (3) on military leave with pay and benefits.
(e) Where the person is in non-pay status for a period
in excess of 30 days or on leave of absence, other than by
reason of disability, educational or sabbatical leave, or
military leave with pay and benefits, such person may
continue coverage only by making personal payment equal to
the amount normally contributed by the State on such person's
behalf. Such payments and coverage may be continued: (1)
until such time as the person returns to a status eligible
for coverage at State expense, but not to exceed 24 months,
(2) until such person's employment or annuitant status with
the State is terminated, or (3) for a maximum period of 4
years for members on military leave with pay and benefits and
military leave without pay and benefits (exclusive of any
additional service imposed pursuant to law).
(f) The Department shall establish by rule the extent
to which other employee benefits will continue for persons in
non-pay status or who are not in active service.
(g) The State shall not pay the cost of the basic
non-contributory group life insurance, program of health
benefits and other employee benefits for members who are
survivors as defined by paragraphs (1) and (2) of subsection
(q) of Section 3 of this Act. The costs of benefits for
these survivors shall be paid by the survivors or by the
University of Illinois Cooperative Extension Service, or any
combination thereof.
(h) Those persons occupying positions with any
department as a result of emergency appointments pursuant to
Section 8b.8 of the Personnel Code who are not considered
employees under this Act shall be given the option of
participating in the programs of group life insurance, health
benefits and other employee benefits. Such persons electing
coverage may participate only by making payment equal to the
amount normally contributed by the State for similarly
situated employees. Such amounts shall be determined by the
Director. Such payments and coverage may be continued until
such time as the person becomes an employee pursuant to this
Act or such person's appointment is terminated.
(i) Any unit of local government within the State of
Illinois may apply to the Director to have its employees,
annuitants, and their dependents provided group health
coverage under this Act on a non-insured basis. To
participate, a unit of local government must agree to enroll
all of its employees, who may select coverage under either
the State group health benefits insurance plan or a health
maintenance organization that has contracted with the State
to be available as a health care provider for employees as
defined in this Act. A unit of local government must remit
the entire cost of providing coverage under the State group
health benefits insurance plan or, for coverage under a
health maintenance organization, an amount determined by the
Director based on an analysis of the sex, age, geographic
location, or other relevant demographic variables for its
employees, except that the unit of local government shall not
be required to enroll those of its employees who are covered
spouses or dependents under this plan or another group policy
or plan providing health benefits as long as (1) an
appropriate official from the unit of local government
attests that each employee not enrolled is a covered spouse
or dependent under this plan or another group policy or plan,
and (2) at least 85% of the employees are enrolled and the
unit of local government remits the entire cost of providing
coverage to those employees. Employees of a participating
unit of local government who are not enrolled due to coverage
under another group health policy or plan may enroll in the
event of a qualifying change in status, special enrollment,
special circumstance as defined by the Director, or during
the annual Benefit Choice Period at a later date subject to
submission of satisfactory evidence of insurability and
provided that no benefits shall be payable for services
incurred during the first 6 months of coverage to the extent
the services are in connection with any pre-existing
condition. A participating unit of local government may also
elect to cover its annuitants. Dependent coverage shall be
offered on an optional basis, with the costs paid by the unit
of local government, its employees, or some combination of
the two as determined by the unit of local government. The
unit of local government shall be responsible for timely
collection and transmission of dependent premiums.
The Director shall annually determine monthly rates of
payment, subject to the following constraints:
(1) In the first year of coverage, the rates shall
be equal to the amount normally charged to State
employees for elected optional coverages or for enrolled
dependents coverages or other contributory coverages, or
contributed by the State for basic insurance coverages on
behalf of its employees, adjusted for differences between
State employees and employees of the local government in
age, sex, geographic location or other relevant
demographic variables, plus an amount sufficient to pay
for the additional administrative costs of providing
coverage to employees of the unit of local government and
their dependents.
(2) In subsequent years, a further adjustment shall
be made to reflect the actual prior years' claims
experience of the employees of the unit of local
government.
In the case of coverage of local government employees
under a health maintenance organization, the Director shall
annually determine for each participating unit of local
government the maximum monthly amount the unit may contribute
toward that coverage, based on an analysis of (i) the age,
sex, geographic location, and other relevant demographic
variables of the unit's employees and (ii) the cost to cover
those employees under the State group health benefits
insurance plan. The Director may similarly determine the
maximum monthly amount each unit of local government may
contribute toward coverage of its employees' dependents under
a health maintenance organization.
Monthly payments by the unit of local government or its
employees for group health benefits plan insurance or health
maintenance organization coverage shall be deposited in the
Local Government Health Insurance Reserve Fund. The Local
Government Health Insurance Reserve Fund shall be a
continuing fund not subject to fiscal year limitations. All
expenditures from this fund shall be used for payments for
health care benefits for local government and rehabilitation
facility employees, annuitants, and dependents, and to
reimburse the Department or its administrative service
organization for all expenses incurred in the administration
of benefits. No other State funds may be used for these
purposes.
A local government employer's participation or desire to
participate in a program created under this subsection shall
not limit that employer's duty to bargain with the
representative of any collective bargaining unit of its
employees.
(j) Any rehabilitation facility within the State of
Illinois may apply to the Director to have its employees,
annuitants, and their eligible dependents provided group
health coverage under this Act on a non-insured basis. To
participate, a rehabilitation facility must agree to enroll
all of its employees and remit the entire cost of providing
such coverage for its employees, except that the
rehabilitation facility shall not be required to enroll those
of its employees who are covered spouses or dependents under
this plan or another group policy or plan providing health
benefits as long as (1) an appropriate official from the
rehabilitation facility attests that each employee not
enrolled is a covered spouse or dependent under this plan or
another group policy or plan, and (2) at least 85% of the
employees are enrolled and the rehabilitation facility remits
the entire cost of providing coverage to those employees.
Employees of a participating rehabilitation facility who are
not enrolled due to coverage under another group health
policy or plan may enroll in the event of a qualifying change
in status, special enrollment, special circumstance as
defined by the Director, or during the annual Benefit Choice
Period at a later date subject to submission of satisfactory
evidence of insurability and provided that no benefits shall
be payable for services incurred during the first 6 months of
coverage to the extent the services are in connection with
any pre-existing condition. A participating rehabilitation
facility may also elect to cover its annuitants. Dependent
coverage shall be offered on an optional basis, with the
costs paid by the rehabilitation facility, its employees, or
some combination of the 2 as determined by the rehabilitation
facility. The rehabilitation facility shall be responsible
for timely collection and transmission of dependent premiums.
The Director shall annually determine quarterly rates of
payment, subject to the following constraints:
(1) In the first year of coverage, the rates shall
be equal to the amount normally charged to State
employees for elected optional coverages or for enrolled
dependents coverages or other contributory coverages on
behalf of its employees, adjusted for differences between
State employees and employees of the rehabilitation
facility in age, sex, geographic location or other
relevant demographic variables, plus an amount sufficient
to pay for the additional administrative costs of
providing coverage to employees of the rehabilitation
facility and their dependents.
(2) In subsequent years, a further adjustment shall
be made to reflect the actual prior years' claims
experience of the employees of the rehabilitation
facility.
Monthly payments by the rehabilitation facility or its
employees for group health benefits insurance shall be
deposited in the Local Government Health Insurance Reserve
Fund.
(k) Any domestic violence shelter or service within the
State of Illinois may apply to the Director to have its
employees, annuitants, and their dependents provided group
health coverage under this Act on a non-insured basis. To
participate, a domestic violence shelter or service must
agree to enroll all of its employees and pay the entire cost
of providing such coverage for its employees. A
participating domestic violence shelter may also elect to
cover its annuitants. Dependent coverage shall be offered on
an optional basis, with employees, or some combination of the
2 as determined by the domestic violence shelter or service.
The domestic violence shelter or service shall be responsible
for timely collection and transmission of dependent premiums.
The Director shall annually determine quarterly rates of
payment, subject to the following constraints:
(1) In the first year of coverage, the rates shall
be equal to the amount normally charged to State
employees for elected optional coverages or for enrolled
dependents coverages or other contributory coverages on
behalf of its employees, adjusted for differences between
State employees and employees of the domestic violence
shelter or service in age, sex, geographic location or
other relevant demographic variables, plus an amount
sufficient to pay for the additional administrative costs
of providing coverage to employees of the domestic
violence shelter or service and their dependents.
(2) In subsequent years, a further adjustment shall
be made to reflect the actual prior years' claims
experience of the employees of the domestic violence
shelter or service.
(3) In no case shall the rate be less than the
amount normally charged to State employees or contributed
by the State on behalf of its employees.
Monthly payments by the domestic violence shelter or
service or its employees for group health insurance shall be
deposited in the Local Government Health Insurance Reserve
Fund.
(l) A public community college or entity organized
pursuant to the Public Community College Act may apply to the
Director initially to have only annuitants not covered prior
to July 1, 1992 by the district's health plan provided health
coverage under this Act on a non-insured basis. The
community college must execute a 2-year contract to
participate in the Local Government Health Plan. Those
annuitants enrolled initially under this contract shall have
no benefits payable for services incurred during the first 6
months of coverage to the extent the services are in
connection with any pre-existing condition. Any annuitant
who may enroll in the event of a qualifying change in status,
special enrollment, special circumstance as defined by the
Director, or during the annual Benefit Choice Period after
this initial enrollment period shall be subject to submission
of satisfactory evidence of insurability and to the
pre-existing conditions limitation.
The Director shall annually determine monthly rates of
payment subject to the following constraints: for those
community colleges with annuitants only enrolled, first year
rates shall be equal to the average cost to cover claims for
a State member adjusted for demographics, Medicare
participation, and other factors; and in the second year, a
further adjustment of rates shall be made to reflect the
actual first year's claims experience of the covered
annuitants.
(l-5) The provisions of subsection (l) become
inoperative on July 1, 1999.
(m) The Director shall adopt any rules deemed necessary
for implementation of this amendatory Act of 1989 (Public Act
86-978).
(Source: P.A. 89-53, eff. 7-1-95; 89-236, eff. 8-4-95;
89-324, eff. 8-13-95; 89-626, eff. 8-9-96; 90-65, eff.
7-7-97; 90-582, eff. 5-27-98; 90-655, eff. 7-30-98; revised
8-3-98.)
(5 ILCS 375/13) (from Ch. 127, par. 533)
Sec. 13. There is established a Group Insurance Premium
Fund administered by the Director which shall include: (1)
amounts paid by covered members for optional life insurance
or health benefits insurance coverages, and (2) refunds which
may be received from (a) the group carrier or carriers which
may result from favorable experience as described in Section
12 herein or (b) from any other source from which the State
is reasonably and properly entitled to refund as a result of
the group health benefits insurance program. The Group
Insurance Premium Fund shall be a continuing fund not subject
to fiscal year limitations.
The State of Illinois shall at least once each month make
payment on behalf of each member, except one who is a member
by virtue of participation in a program created under
subsection (i), (j), (k), or (l) of Section 10 of this Act,
to the appropriate carrier or, if applicable, carriers
insuring State members under the contracted group life
insurance and group health benefits insurance program
authorized by this Act.
Refunds to members for premiums paid for coverage for
their dependents may be paid from the Group Insurance Premium
Fund without regard to the fact that the premium being
refunded may have been paid in a different fiscal year.
(Source: P.A. 86-978; 87-627; 87-1259.)
(5 ILCS 375/13.1) (from Ch. 127, par. 533.1)
Sec. 13.1. (a) All contributions, appropriations,
interest, and dividend payments to fund the program of health
benefits and other employee benefits shall be deposited in a
trust fund outside the State Treasury, with the State
Treasurer as ex-officio custodian, to be known as the Health
Insurance Reserve Fund.
(b) Upon the adoption of a self-insurance health plan,
any monies attributable to the group health insurance program
shall be deposited in or transferred to the Health Insurance
Reserve Fund for use by the Department. As of the effective
date of this amendatory Act of 1986, the Department shall
certify to the Comptroller the amount of money in the Group
Insurance Premium Fund attributable to the State group health
insurance program and the Comptroller shall transfer such
money from the Group Insurance Premium Fund to the Health
Insurance Reserve Fund. Contributions by the State to the
Health Insurance Reserve Fund to meet the requirements of
this Act, as established by the Director, from the General
Revenue Fund and the Road Fund to the Health Insurance
Reserve Fund shall be by annual appropriations, and all other
contributions to meet the requirements of the programs of
health benefits or other employee benefits shall be deposited
in the Health Insurance Reserve Fund. The Department shall
draw the appropriation from the General Revenue Fund and the
Road Fund from time to time as necessary to make expenditures
authorized under this Act.
The Director may employ such assistance and services and
may purchase such goods as may be necessary for the proper
development and administration of any of the benefit programs
authorized by this Act. The Director may promulgate rules
and regulations in regard to the administration of these
programs.
All monies received by the Department for deposit in or
transfer to the Health Insurance Reserve Fund, through
appropriation or otherwise, shall be used to provide for the
making of payments to claimants and providers and to
reimburse the Department for all expenses directly incurred
relating to Department development and administration of the
program of health benefits and other employee benefits.
Any administrative service organization administering any
self-insurance health plan and paying claims and benefits
under authority of this Act may receive, pursuant to written
authorization and direction of the Director, an initial
transfer and periodic transfers of funds from the Health
Insurance Reserve Fund in amounts determined by the Director
who may consider the amount recommended by the administrative
service organization. Notwithstanding any other statute,
such transferred funds shall be retained by the
administrative service organization in a separate account
provided by any bank as defined by the Illinois Banking Act.
The Department may promulgate regulations further defining
the banks authorized to accept such funds and all methodology
for transfer of such funds. Any interest earned by monies in
such account shall inure to the Health Insurance Reserve
Fund, shall remain in such account and shall be used
exclusively to pay claims and benefits under this Act. Such
transferred funds shall be used exclusively for
administrative service organization payment of claims to
claimants and providers under the self-insurance health plan
by the drawing of checks against such account. The
administrative service organization may not use such
transferred funds, or interest accrued thereon, for any other
purpose including, but not limited to, reimbursement of
administrative expenses or payments of administration fees
due the organization pursuant to its contract or contracts
with the Department of Central Management Services.
The account of the administrative service organization
established under this Section, any transfers from the Health
Insurance Reserve Fund to such account and the use of such
account and funds shall be subject to (1) audit by the
Department or private contractor authorized by the Department
to conduct audits, such audit including but not limited to
the annual audit required by this Act, and (2) post audit
pursuant to the Illinois State Auditing Act.
(c) The Director, with the advice and consent of the
Commission, shall establish premiums for optional coverage
for dependents of eligible members for the self-insurance
health plans plan. The eligible members shall be responsible
for their portion payment of 100% of such optional premium
and shall pay by means of payroll deduction. The State shall
contribute an amount $7 per month for each eligible member
who has enrolled one or more dependents under the
self-insurance health plans plan. Such contribution shall be
made directly to the Health Insurance Reserve Fund. Those
employees described in subsection (b) of Section 9 of this
Act shall be allowed to continue in the self-insurance health
plan by making personal payments with the premiums to be
deposited in the Health Insurance Reserve Fund.
(d) The Health Insurance Reserve Fund shall be a
continuing fund not subject to fiscal year limitations. All
expenditures from that fund shall be at the direction of the
Director and shall be only for the purpose of:
(1) the payment of administrative expenses incurred by
the Department for the program of health benefits or other
employee benefit programs, including but not limited to the
costs of audits or actuarial consultations, professional and
contractual services, electronic data processing systems and
services, and expenses in connection with the development and
administration of such programs;
(2) the payment of administrative expenses incurred by
the Administrative Service Organization;
(3) the payment of health benefits;
(4) refunds to employees for erroneous payments of their
selected dependent coverage;
(5) payment of premium for stop-loss or re-insurance;
(6) payment of premium to health maintenance
organizations pursuant to Section 6.1 of this Act;
(7) payment of adoption program benefits; and
(8) payment of other benefits offered to members and
dependents under this Act.
(Source: P.A. 85-848.)
(5 ILCS 375/13.2) (from Ch. 127, par. 533.2)
Sec. 13.2. Insurance reserve funds; investments. All
amounts held in the Health Insurance Reserve Fund, the Group
Insurance Premium Fund, and the Local Government Health
Insurance Reserve Fund shall be invested, at interest, by the
State Treasurer. The investments shall be subject to terms,
conditions, and limitations imposed by the laws of Illinois
on State funds. All income derived from the investments
shall accrue and be deposited to the respective funds no less
frequently than quarterly. The Health Insurance Reserve Fund
and the Local Government Health Insurance Reserve Fund shall
be administered by the Director.
(Source: P.A. 87-771.)
(5 ILCS 375/15) (from Ch. 127, par. 535)
Sec. 15. Administration; rules; audit; review.
(a) The Director shall administer this Act and shall
prescribe such rules and regulations as are necessary to give
full effect to the purposes of this Act.
(b) These rules may fix reasonable standards for the
group life and group health programs and other benefit
programs offered under this Act, and for the contractors
providing them.
(c) These rules shall specify that covered and optional
medical services of the program are services provided within
the scope of their licenses by practitioners in all
categories licensed under the Medical Practice Act of 1987
and shall provide that all eligible persons be fully informed
of this specification.
(d) These rules shall establish eligibility requirements
for members and dependents as may be necessary to supplement
or clarify requirements contained in this Act.
(e) Each affected department of the State, the State
Universities Retirement System, the Teachers' Retirement
System, and each qualified local government, rehabilitation
facility, or domestic violence shelter or service, shall keep
such records, make such certifications, and furnish the
Director such information as may be necessary for the
administration of this Act, including information concerning
number and total amounts of payroll of employees of the
department who are paid from trust funds or federal funds.
(f) Each member, each community college benefit
recipient to whom this Act applies, and each TRS benefit
recipient to whom this Act applies shall furnish the
Director, in such form as may be required, any information
that may be necessary to enroll such member or benefit
recipient and, if applicable, his or her dependents or
dependent beneficiaries under the programs or plan, including
such data as may be required to allow the Director to
accumulate statistics on data normally considered in
actuarial studies of employee groups. Information about
community college benefit recipients and community college
dependent beneficiaries shall be furnished through the State
Universities Retirement System. Information about TRS
benefit recipients and TRS dependent beneficiaries shall be
furnished through the Teachers' Retirement System.
(g) There shall be audits an annual audit and reports
report on the programs authorized and established by this Act
prepared by the Director with the assistance of a qualified,
independent accounting firm. The reports annual report shall
provide information on the experience, and administrative
effectiveness and adequacy of the program including, when
applicable, recommendations on up-grading of benefits and
improvement of the program.
(h) Any final order, decision or other determination
made, issued or executed by the Director under the provisions
of this Act whereby any contractor or person is aggrieved
shall be subject to review in accordance with the provisions
of the Administrative Review Law and all amendments and
modifications thereof, and the rules adopted pursuant
thereto, shall apply to and govern all proceedings for the
judicial review of final administrative decisions of the
Director.
(Source: P.A. 89-21, eff. 6-21-95; 89-25, eff. 6-21-95;
90-497, eff. 8-18-97.)
Section 99. Effective date. This Act takes effect upon
becoming law.
[ Top ]