Section 2200.110  Governing Authority

 

The State Employees Group Insurance Program Retiree Premium Contributions program is governed by the State Employees Group Insurance Act of 1971 [5 ILCS 375] and this Part. 

 

Section 2200.120  Purpose

 

The purpose of this Part is to outline the premium amount that annuitants, survivors and retired employees of the General Assembly Retirement System, the State Employees' Retirement System, the State Universities Retirement System, the Teachers' Retirement System, and the Judges Retirement System  will be required to contribute towards the cost of the basic program of group health benefits provided under the Act.

 

Section 2200.130  Definitions

 

Whenever used in this Part, the following terms shall have the meanings set forth in this Section unless otherwise expressly provided, and when the defined meaning is intended, the term is capitalized.

 

"Act" means the State Employees Group Insurance Act of 1971 [5 ILCS 375].

 

"Annuitant" means:

 

an employee who retires, or has retired, on or after January 1, 1966 on an immediate annuity under the provisions of Articles 2, 14 (including an employee who has elected to receive an alternative retirement cancellation payment under Section 14‑108.5 of the Illinois Pension Code in lieu of an annuity), 15 (including an employee who has retired under the optional retirement program established under Section 15‑158.2 of the Code), Section 16‑106(2), (3) or (5) of the Code, or Article 18 of the Code;

 

any person who was receiving group insurance coverage under the Act as of March 31, 1978 by reason of his or her status as an annuitant, even though the annuity in relation to which the 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;

 

any person not otherwise covered by the Act who has retired as a participating member under Article 2 of the Code but is ineligible for the retirement annuity under Section 2‑119 of the Code; or

 

the spouse of any person who is receiving a retirement annuity under Article 18 of the 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 the Act and to have his or her spouse considered as the "annuitant" under the Act and not as a "dependent". 

 

"CMS" means the Illinois Department of Central Management Services.

 

"Code" means the Illinois Pension Code [40 ILCS 5].

 

"Department" means any Department, institution, board, commission, officer, court or any agency of the State government as defined in Section 3(g) of the Act.

 

"Director" means the Director of the Illinois Department of Central Management Services or of any successor agency designated to administer the Act.

 

"GARS" means the General Assembly Retirement System.

 

"JRS" means the Judges Retirement System.

 

"Retired Employee" means any person who would be an annuitant as that term is defined in this Section but for the fact that the person retired prior to January 1, 1966. The 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 the person was made ineligible to participate in SURS by Section 15‑107(a)(4) of the Code.

 

"Retirement Systems" means the General Assembly Retirement System, the Judges Retirement System, the State Employees' Retirement System, the State Universities Retirement System and the Teachers' Retirement System. 

 

"SERS" means the State Employees' Retirement System.

 

"SURS" means the State Universities Retirement System.

 

"Survivor" means a person receiving an annuity as a survivor of an employee or of an annuitant. "Survivor" also includes:

 

the surviving dependent of a person who satisfies the definition of "employee" except that the person is made ineligible to participate in SURS by Section 15‑107(a)(4) of the Code;

 

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 the person was made ineligible to participate in SURS by Section 15‑107(a)(4) of the Code; and

 

the surviving dependent of a person who was an annuitant under the Act by virtue of receiving an alternative retirement cancellation payment under Section 14‑108.5 of the Code.

"TRS" means the Teachers' Retirement System.

 

Section 2200.140  Records and Certifications

 

Records and other necessary certifications will be furnished to the Director as may be necessary for the administration of this Part.  These records and certifications will be retained and provided as necessary by each appropriate Department.

 

Section 2200.150  Severability

 

If any provision of the Act or this Part or application of the Act or this Part to any person or circumstance is held invalid, that invalidity does not affect other provisions or applications of the Act or this Part that can be given effect without the invalid application or provision.  To this end, the provisions of the Act and this Part are declared to be severable.

 

Section 2200.210  CMS Responsibility

 

CMS shall:

 

a)         Establish premium contributions consistent with the Act and this Part;

 

b)         Calculate the premium contribution owed by each Retired Employee, Annuitant or Survivor in accordance with Subpart E of this Part and transmit that calculation to the appropriate Retirement System on a monthly basis to allow for collection of the premium; and

 

c)         Develop information and distribute that information to Retired Employees, Annuitants and Survivors related to this Part.

 

Section 2200.220  Determining Benefits

 

CMS will determine the benefits available to Annuitants, Retired Employees, Survivors and their eligible dependents. 

 

Section 2200.230  Provision for Benefits

 

The Director shall, by contract, self-insurance, or otherwise make available the program of health benefits for Annuitants, Retired Employees, Survivors and their eligible dependents. 

 

Section 2200.240  Health Insurance Portability and Accountability Act (HIPAA)

 

CMS will comply with the uses and disclosures of protected health information, permitted by the Health Insurance Portability and Accountability Act (HIPAA) (PL 104-191).

 

Section 2200.250  Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA)

 

CMS shall be responsible for compliance with the continuation of benefits requirements of COBRA (PL 99-272).  All premiums must be collected and transmitted to CMS by the respective retirement system.

 

Section 2200.310  Annuity

 

The Retirement Systems shall report the value of the annuity of each Retired Employee, Annuitant and Survivor to CMS on a monthly basis. 

 

Section 2200.320  Enrollments and Terminations

 

The Retirement Systems shall enroll and terminate their respective Retired Employees, Annuitants, Survivors and their dependents pursuant to CMS' policies and procedures and consistent with the terms of the Act. 

 

Section 2200.330  Premium Collection and Payment

 

a)         The Retirement Systems shall be responsible for the collection and transmission to CMS of the premium for their respective Retired Employees, Annuitants and Survivors.

 

b)         Individuals whose annuity check is insufficient to cover the amount of the monthly premiums due pursuant to Subpart E shall be direct billed.

 

Section 2200.410  Calculation

 

a)         The annuity upon which the health insurance premiums are based shall be the gross sum of all annuities received by the Retired Employee, Annuitant or Survivor from the Retirement Systems.

 

b)         For individuals who retired under PA 93-0839 (between August 16, 2004 and October 31, 2004), PA 94-0109 (between July 1, 2005 and September 30, 2005) or PA 94-0839 (between June 6, 2006 and August 31, 2006), the annuity shall be calculated by SERS and will be equal to the amount of the annuity that would have been received.

 

c)         For individuals who retired under the University of Illinois Cooperative Extension Service, the initial annuity shall be the sum of all annuities as provided by each of the Retirement Systems and the U.S. Office of Personnel Management.   

 

Section 2200.510  Calculation

 

CMS shall calculate the premiums due for the coverage of the Annuitant, Retired Employee or Survivor under this Part as follows:

 

a)         A percentage of the annuity, as outlined under Section 2200.520; plus

 

b)         A percentage of cost, as outlined under Section 2200.530. 

 

Section 2200.520  Percentage of Annuity

 

CMS shall calculate the premiums due under this Part as follows:

 

a)         For each Retired Employee, Annuitant or Survivor with primary coverage under the State program, the premium shall be equal to 2% of the total annual annuity received by the Retired Employee, Annuitant or Survivor from any and all of the five State Retirement Systems;

 

b)         For each Retired Employee, Annuitant or Survivor with primary coverage under the federal Medicare health insurance program (Title XVIII of the Social Security Act, as added by Public Law 89-97), the premium shall be equal to 1% of the total annual annuity received by the Retired Employee, Annuitant or Survivor from any and all of the five State Retirement Systems;

 

c)         For each Retired Employee, Annuitant or Survivor age 65 or older whose primary coverage would otherwise be coverage under the federal Medicare health insurance program, except for his or her inability to contribute to Medicare while actively working, the premium shall be equal to 1% of the total annual annuity received by the Retired Employee, Annuitant or Survivor from any and all of the five State Retirement Systems. 

 

Section 2200.530  Percentage of Cost

 

a)         In addition to the percentage of annuity outlined in Section 2200.420, any SERS, SURS or TRS Annuitant who retired on or after January 1, 1998 with less than 20 years of State service, or any SERS, SURS or TRS Survivor whose annuity is based upon the work of an individual who retired on or after January 1, 1998 with less than 20 years of State service, shall pay 5% of the cost of the elected coverage for each year less than 20 upon which the annuity is based.

 

b)         SURS Annuitants who retired under PA 91-0395, or SURS Survivors whose annuity is based upon the work of an individual who retired under PA 91-0395, shall not be required to pay the additional amounts outlined in subsection (a)(1).

 

Section 2200.540  Dependent Premiums

 

a)         Annuitants, Retired Employees and Survivors shall be required to pay premiums for any elected dependent coverage in an amount equal to the premiums charged to active employees for elected dependent coverage.

 

b)         Premiums charged for elected dependent coverage shall be in addition to any premiums due under Sections 2200.520 and 2200.530.

 

Section 2200.550  Optional Coverage Premiums

 

a)         Annuitants, Retired Employees and Survivors are required to pay premiums for any elected optional coverage, including dental and optional life coverage. 

 

b)         Premiums paid for dental coverage for Annuitants, Retired Employees, Survivors and their enrolled dependents shall be in an amount equal to that paid by active employees.

 

c)         Premiums paid for optional life insurance coverage for Annuitants, Retired Employees, Survivors and their enrolled dependents shall be in an amount equal to that paid by active employees.

 

d)         Premiums charged for elected optional coverage shall be in addition to any premiums due under Sections 2200.520, 2200.530 and 2200.540. 

 

Section 220.560  Exempt from Premiums

 

a)         The following individuals shall not be required to pay premiums due under Section 2200.520 or 2200.530:

 

1)         Any person not otherwise covered by the Act who has retired as a participating member under Article 2 of the Code but is ineligible for the retirement annuity under Section 2‑119 of the Code;

 

2)         University of Illinois Cooperative Extension retirees whose member basic health premium is paid by the Cooperative Extension Service; and

 

3)         Survivors of employees with less than one year of service. 

 

b)         Individuals receiving benefits under PA 90-0535 (Public Safety Employee Benefit Act) shall not be required to pay premiums due under Section 2200.520, 2200.530 or 2200.540.