97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
SB1556

 

Introduced 2/9/2011, by Sen. William R. Haine

 

SYNOPSIS AS INTRODUCED:
 
5 ILCS 375/3  from Ch. 127, par. 523
5 ILCS 375/8  from Ch. 127, par. 528

    Amends the State Employees Group Insurance Act of 1971. Provides that in order to be eligible for group insurance benefits under a retirement system: (i) each annuitant or retired employee must meet the vesting requirements of the applicable retirement system and (ii) each survivor must establish that the deceased employee, annuitant, or retired employee upon whom the annuity is based was eligible to participate in the group insurance system under the applicable retirement system. Specifies that certain persons do not qualify as community college dependent beneficiaries or TRS dependent beneficiaries. Provides that only employees (rather than employees, annuitants, retired employees, and survivors) and their elected dependents are eligible and covered for all benefits available under the Act's programs. Provides that annuitants, survivors, and retired employees and their elected dependents are immediately eligible for the group health benefits program and that the coverage of those persons is effective immediately upon the completion of the required forms. Requires, however, each survivor who is seeking coverage under that program to establish that he or she would have been eligible for coverage under the deceased member upon whom the survivor's annuity is based.


LRB097 09499 JDS 49636 b

FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

SB1556LRB097 09499 JDS 49636 b

1    AN ACT concerning government.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The State Employees Group Insurance Act of 1971
5is amended by changing Sections 3 and 8 as follows:
 
6    (5 ILCS 375/3)  (from Ch. 127, par. 523)
7    Sec. 3. Definitions. Unless the context otherwise
8requires, the following words and phrases as used in this Act
9shall have the following meanings. The Department may define
10these and other words and phrases separately for the purpose of
11implementing specific programs providing benefits under this
12Act.
13    (a) "Administrative service organization" means any
14person, firm or corporation experienced in the handling of
15claims which is fully qualified, financially sound and capable
16of meeting the service requirements of a contract of
17administration executed with the Department.
18    (b) "Annuitant" means (1) an employee who retires, or has
19retired, on or after January 1, 1966 on an immediate annuity
20under the provisions of Articles 2, 14 (including an employee
21who has elected to receive an alternative retirement
22cancellation payment under Section 14-108.5 of the Illinois
23Pension Code in lieu of an annuity), 15 (including an employee

 

 

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1who has retired under the optional retirement program
2established under Section 15-158.2), paragraphs (2), (3), or
3(5) of Section 16-106, or Article 18 of the Illinois Pension
4Code; (2) any person who was receiving group insurance coverage
5under this Act as of March 31, 1978 by reason of his status as
6an annuitant, even though the annuity in relation to which such
7coverage was provided is a proportional annuity based on less
8than the minimum period of service required for a retirement
9annuity in the system involved; (3) any person not otherwise
10covered by this Act who has retired as a participating member
11under Article 2 of the Illinois Pension Code but is ineligible
12for the retirement annuity under Section 2-119 of the Illinois
13Pension Code; (4) the spouse of any person who is receiving a
14retirement annuity under Article 18 of the Illinois Pension
15Code and who is covered under a group health insurance program
16sponsored by a governmental employer other than the State of
17Illinois and who has irrevocably elected to waive his or her
18coverage under this Act and to have his or her spouse
19considered as the "annuitant" under this Act and not as a
20"dependent"; or (5) an employee who retires, or has retired,
21from a qualified position, as determined according to rules
22promulgated by the Director, under a qualified local
23government, a qualified rehabilitation facility, a qualified
24domestic violence shelter or service, or a qualified child
25advocacy center. (For definition of "retired employee", see (p)
26post).

 

 

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1    (b-5) "New SERS annuitant" means a person who, on or after
2January 1, 1998, becomes an annuitant, as defined in subsection
3(b), by virtue of beginning to receive a retirement annuity
4under Article 14 of the Illinois Pension Code (including an
5employee who has elected to receive an alternative retirement
6cancellation payment under Section 14-108.5 of that Code in
7lieu of an annuity), and is eligible to participate in the
8basic program of group health benefits provided for annuitants
9under this Act.
10    (b-6) "New SURS annuitant" means a person who (1) on or
11after January 1, 1998, becomes an annuitant, as defined in
12subsection (b), by virtue of beginning to receive a retirement
13annuity under Article 15 of the Illinois Pension Code, (2) has
14not made the election authorized under Section 15-135.1 of the
15Illinois Pension Code, and (3) is eligible to participate in
16the basic program of group health benefits provided for
17annuitants under this Act.
18    (b-7) "New TRS State annuitant" means a person who, on or
19after July 1, 1998, becomes an annuitant, as defined in
20subsection (b), by virtue of beginning to receive a retirement
21annuity under Article 16 of the Illinois Pension Code based on
22service as a teacher as defined in paragraph (2), (3), or (5)
23of Section 16-106 of that Code, and is eligible to participate
24in the basic program of group health benefits provided for
25annuitants under this Act.
26    (c) "Carrier" means (1) an insurance company, a corporation

 

 

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1organized under the Limited Health Service Organization Act or
2the Voluntary Health Services Plan Act, a partnership, or other
3nongovernmental organization, which is authorized to do group
4life or group health insurance business in Illinois, or (2) the
5State of Illinois as a self-insurer.
6    (d) "Compensation" means salary or wages payable on a
7regular payroll by the State Treasurer on a warrant of the
8State Comptroller out of any State, trust or federal fund, or
9by the Governor of the State through a disbursing officer of
10the State out of a trust or out of federal funds, or by any
11Department out of State, trust, federal or other funds held by
12the State Treasurer or the Department, to any person for
13personal services currently performed, and ordinary or
14accidental disability benefits under Articles 2, 14, 15
15(including ordinary or accidental disability benefits under
16the optional retirement program established under Section
1715-158.2), paragraphs (2), (3), or (5) of Section 16-106, or
18Article 18 of the Illinois Pension Code, for disability
19incurred after January 1, 1966, or benefits payable under the
20Workers' Compensation or Occupational Diseases Act or benefits
21payable under a sick pay plan established in accordance with
22Section 36 of the State Finance Act. "Compensation" also means
23salary or wages paid to an employee of any qualified local
24government, qualified rehabilitation facility, qualified
25domestic violence shelter or service, or qualified child
26advocacy center.

 

 

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1    (e) "Commission" means the State Employees Group Insurance
2Advisory Commission authorized by this Act. Commencing July 1,
31984, "Commission" as used in this Act means the Commission on
4Government Forecasting and Accountability as established by
5the Legislative Commission Reorganization Act of 1984.
6    (f) "Contributory", when referred to as contributory
7coverage, shall mean optional coverages or benefits elected by
8the member toward the cost of which such member makes
9contribution, or which are funded in whole or in part through
10the acceptance of a reduction in earnings or the foregoing of
11an increase in earnings by an employee, as distinguished from
12noncontributory coverage or benefits which are paid entirely by
13the State of Illinois without reduction of the member's salary.
14    (g) "Department" means any department, institution, board,
15commission, officer, court or any agency of the State
16government receiving appropriations and having power to
17certify payrolls to the Comptroller authorizing payments of
18salary and wages against such appropriations as are made by the
19General Assembly from any State fund, or against trust funds
20held by the State Treasurer and includes boards of trustees of
21the retirement systems created by Articles 2, 14, 15, 16 and 18
22of the Illinois Pension Code. "Department" also includes the
23Illinois Comprehensive Health Insurance Board, the Board of
24Examiners established under the Illinois Public Accounting
25Act, and the Illinois Finance Authority.
26    (h) "Dependent", when the term is used in the context of

 

 

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1the health and life plan, means a member's spouse and any
2unmarried child (1) from birth to age 19 including an adopted
3child, a child who lives with the member from the time of the
4filing of a petition for adoption until entry of an order of
5adoption, a stepchild or recognized child who lives with the
6member in a parent-child relationship, or a child who lives
7with the member if such member is a court appointed guardian of
8the child, (2) age 19 to 24 enrolled as a full-time student in
9any accredited school, financially dependent upon the member,
10and eligible to be claimed as a dependent for income tax
11purposes, (2.1) age 19 to 24 on a medical leave of absence as
12described in Section 356z.11 of the Illinois Insurance Code
13(215 ILCS 5/356z.11), or (3) age 19 or over who is mentally or
14physically handicapped. For the purposes of item (2), an
15unmarried child age 19 to 24 who is a member of the United
16States Armed Services, including the Illinois National Guard,
17and is mobilized to active duty shall qualify as a dependent
18beyond the age of 24 and until the age of 25 and while a
19full-time student for the amount of time spent on active duty
20between the ages of 19 and 24. The individual attempting to
21qualify for this additional time must submit written
22documentation of active duty service to the Director. The
23changes made by this amendatory Act of the 94th General
24Assembly apply only to individuals mobilized to active duty in
25the United States Armed Services, including the Illinois
26National Guard, on or after January 1, 2002. For the health

 

 

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1plan only, the term "dependent" also includes any person
2enrolled prior to the effective date of this Section who is
3dependent upon the member to the extent that the member may
4claim such person as a dependent for income tax deduction
5purposes; no other such person may be enrolled. For the health
6plan only, the term "dependent" also includes any person who
7has received after June 30, 2000 an organ transplant and who is
8financially dependent upon the member and eligible to be
9claimed as a dependent for income tax purposes.
10    (i) "Director" means the Director of the Illinois
11Department of Central Management Services or of any successor
12agency designated to administer this Act.
13    (j) "Eligibility period" means the period of time a member
14has to elect enrollment in programs or to select benefits
15without regard to age, sex or health.
16    (k) "Employee" means and includes each officer or employee
17in the service of a department who (1) receives his
18compensation for service rendered to the department on a
19warrant issued pursuant to a payroll certified by a department
20or on a warrant or check issued and drawn by a department upon
21a trust, federal or other fund or on a warrant issued pursuant
22to a payroll certified by an elected or duly appointed officer
23of the State or who receives payment of the performance of
24personal services on a warrant issued pursuant to a payroll
25certified by a Department and drawn by the Comptroller upon the
26State Treasurer against appropriations made by the General

 

 

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1Assembly from any fund or against trust funds held by the State
2Treasurer, and (2) is employed full-time or part-time in a
3position normally requiring actual performance of duty during
4not less than 1/2 of a normal work period, as established by
5the Director in cooperation with each department, except that
6persons elected by popular vote will be considered employees
7during the entire term for which they are elected regardless of
8hours devoted to the service of the State, and (3) except that
9"employee" does not include any person who is not eligible by
10reason of such person's employment to participate in one of the
11State retirement systems under Articles 2, 14, 15 (either the
12regular Article 15 system or the optional retirement program
13established under Section 15-158.2) or 18, or under paragraph
14(2), (3), or (5) of Section 16-106, of the Illinois Pension
15Code, but such term does include persons who are employed
16during the 6 month qualifying period under Article 14 of the
17Illinois Pension Code. Such term also includes any person who
18(1) after January 1, 1966, is receiving ordinary or accidental
19disability benefits under Articles 2, 14, 15 (including
20ordinary or accidental disability benefits under the optional
21retirement program established under Section 15-158.2),
22paragraphs (2), (3), or (5) of Section 16-106, or Article 18 of
23the Illinois Pension Code, for disability incurred after
24January 1, 1966, (2) receives total permanent or total
25temporary disability under the Workers' Compensation Act or
26Occupational Disease Act as a result of injuries sustained or

 

 

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1illness contracted in the course of employment with the State
2of Illinois, or (3) is not otherwise covered under this Act and
3has retired as a participating member under Article 2 of the
4Illinois Pension Code but is ineligible for the retirement
5annuity under Section 2-119 of the Illinois Pension Code.
6However, a person who satisfies the criteria of the foregoing
7definition of "employee" except that such person is made
8ineligible to participate in the State Universities Retirement
9System by clause (4) of subsection (a) of Section 15-107 of the
10Illinois Pension Code is also an "employee" for the purposes of
11this Act. "Employee" also includes any person receiving or
12eligible for benefits under a sick pay plan established in
13accordance with Section 36 of the State Finance Act. "Employee"
14also includes (i) each officer or employee in the service of a
15qualified local government, including persons appointed as
16trustees of sanitary districts regardless of hours devoted to
17the service of the sanitary district, (ii) each employee in the
18service of a qualified rehabilitation facility, (iii) each
19full-time employee in the service of a qualified domestic
20violence shelter or service, and (iv) each full-time employee
21in the service of a qualified child advocacy center, as
22determined according to rules promulgated by the Director.
23    (l) "Member" means an employee, annuitant, retired
24employee or survivor. In the case of an annuitant or retired
25employee, the individual must meet the minimum vesting
26requirements of the applicable retirement system in order to be

 

 

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

 

 

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1the definition of "employee" except that such person is made
2ineligible to participate in the State Universities Retirement
3System by clause (4) of subsection (a) of Section 15-107 of the
4Illinois Pension Code; (2) the surviving dependent of any
5person formerly employed by the University of Illinois in the
6Cooperative Extension Service who would be an annuitant except
7for the fact that such person was made ineligible to
8participate in the State Universities Retirement System by
9clause (4) of subsection (a) of Section 15-107 of the Illinois
10Pension Code; and (3) the surviving dependent of a person who
11was an annuitant under this Act by virtue of receiving an
12alternative retirement cancellation payment under Section
1314-108.5 of the Illinois Pension Code.
14    (q-2) "SERS" means the State Employees' Retirement System
15of Illinois, created under Article 14 of the Illinois Pension
16Code.
17    (q-3) "SURS" means the State Universities Retirement
18System, created under Article 15 of the Illinois Pension Code.
19    (q-4) "TRS" means the Teachers' Retirement System of the
20State of Illinois, created under Article 16 of the Illinois
21Pension Code.
22    (q-5) "New SERS survivor" means a survivor, as defined in
23subsection (q), whose annuity is paid under Article 14 of the
24Illinois Pension Code and is based on the death of (i) an
25employee whose death occurs on or after January 1, 1998, or
26(ii) a new SERS annuitant as defined in subsection (b-5). "New

 

 

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1SERS survivor" includes the surviving dependent of a person who
2was an annuitant under this Act by virtue of receiving an
3alternative retirement cancellation payment under Section
414-108.5 of the Illinois Pension Code.
5    (q-6) "New SURS survivor" means a survivor, as defined in
6subsection (q), whose annuity is paid under Article 15 of the
7Illinois Pension Code and is based on the death of (i) an
8employee whose death occurs on or after January 1, 1998, or
9(ii) a new SURS annuitant as defined in subsection (b-6).
10    (q-7) "New TRS State survivor" means a survivor, as defined
11in subsection (q), whose annuity is paid under Article 16 of
12the Illinois Pension Code and is based on the death of (i) an
13employee who is a teacher as defined in paragraph (2), (3), or
14(5) of Section 16-106 of that Code and whose death occurs on or
15after July 1, 1998, or (ii) a new TRS State annuitant as
16defined in subsection (b-7).
17    (r) "Medical services" means the services provided within
18the scope of their licenses by practitioners in all categories
19licensed under the Medical Practice Act of 1987.
20    (s) "Unit of local government" means any county,
21municipality, township, school district (including a
22combination of school districts under the Intergovernmental
23Cooperation Act), special district or other unit, designated as
24a unit of local government by law, which exercises limited
25governmental powers or powers in respect to limited
26governmental subjects, any not-for-profit association with a

 

 

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

 

 

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

 

 

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1        (1) is not a "member" or "dependent" as defined in this
2    Section; and
3        (2) is a TRS benefit recipient's: (A) spouse, (B)
4    dependent parent who is receiving at least half of his or
5    her support from the TRS benefit recipient, or (C)
6    unmarried natural or adopted child who is (i) under age 19,
7    or (ii) enrolled as a full-time student in an accredited
8    school, financially dependent upon the TRS benefit
9    recipient, eligible to be claimed as a dependent for income
10    tax purposes, and either is under age 24 or was, on January
11    1, 1996, participating as a dependent beneficiary in the
12    health insurance program offered under Article 16 of the
13    Illinois Pension Code, or (iii) age 19 or over who is
14    mentally or physically handicapped.
15    "TRS dependent beneficiary" does not include, as indicated
16under paragraph (2) of this subsection (w), a dependent of the
17survivor of a TRS benefit recipient unless that dependent would
18have been eligible for coverage as a dependent of the deceased
19TRS benefit recipient upon whom the survivor benefit is based.
20    (x) "Military leave with pay and benefits" refers to
21individuals in basic training for reserves, special/advanced
22training, annual training, emergency call up, or activation by
23the President of the United States with approved pay and
24benefits.
25    (y) "Military leave without pay and benefits" refers to
26individuals who enlist for active duty in a regular component

 

 

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1of the U.S. Armed Forces or other duty not specified or
2authorized under military leave with pay and benefits.
3    (z) "Community college benefit recipient" means a person
4who:
5        (1) is not a "member" as defined in this Section; and
6        (2) is receiving a monthly survivor's annuity or
7    retirement annuity under Article 15 of the Illinois Pension
8    Code; and
9        (3) either (i) was a full-time employee of a community
10    college district or an association of community college
11    boards created under the Public Community College Act
12    (other than an employee whose last employer under Article
13    15 of the Illinois Pension Code was a community college
14    district subject to Article VII of the Public Community
15    College Act) and was eligible to participate in a group
16    health benefit plan as an employee during the time of
17    employment with a community college district (other than a
18    community college district subject to Article VII of the
19    Public Community College Act) or an association of
20    community college boards, or (ii) is the survivor of a
21    person described in item (i).
22    (aa) "Community college dependent beneficiary" means a
23person who:
24        (1) is not a "member" or "dependent" as defined in this
25    Section; and
26        (2) is a community college benefit recipient's: (A)

 

 

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1    spouse, (B) dependent parent who is receiving at least half
2    of his or her support from the community college benefit
3    recipient, or (C) unmarried natural or adopted child who is
4    (i) under age 19, or (ii) enrolled as a full-time student
5    in an accredited school, financially dependent upon the
6    community college benefit recipient, eligible to be
7    claimed as a dependent for income tax purposes and under
8    age 23, or (iii) age 19 or over and mentally or physically
9    handicapped.
10    "Community college dependent beneficiary" does not
11include, as indicated under paragraph (2) of this subsection
12(aa), a dependent of the survivor of a community college
13benefit recipient unless that dependent would have been
14eligible for coverage as a dependent of the deceased community
15college benefit recipient upon whom the survivor annuity is
16based.
17    (bb) "Qualified child advocacy center" means any Illinois
18child advocacy center and its administrative offices funded by
19the Department of Children and Family Services, as defined by
20the Children's Advocacy Center Act (55 ILCS 80/), approved by
21the Director and participating in a program created under
22subsection (n) of Section 10.
23(Source: P.A. 95-331, eff. 8-21-07; 95-632, eff. 9-25-07;
2496-756, eff. 1-1-10.)
 
25    (5 ILCS 375/8)  (from Ch. 127, par. 528)

 

 

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1    Sec. 8. Eligibility.
2    (a) Each employee member eligible under the provisions of
3this Act and any rules and regulations promulgated and adopted
4hereunder by the Director shall become immediately eligible and
5covered for all benefits available under the programs.
6Employees Members electing coverage for eligible dependents
7shall have the coverage effective immediately, provided that
8the election is properly filed in accordance with required
9filing dates and procedures specified by the Director,
10including the completion and submission of all documentation
11and forms required by the Director.
12        (1) Every member originally eligible to elect
13    dependent coverage, but not electing it during the original
14    eligibility period, may subsequently obtain dependent
15    coverage only in the event of a qualifying change in
16    status, special enrollment, special circumstance as
17    defined by the Director, or during the annual Benefit
18    Choice Period.
19        (2) Members described above being transferred from
20    previous coverage towards which the State has been
21    contributing shall be transferred regardless of
22    preexisting conditions, waiting periods, or other
23    requirements that might jeopardize claim payments to which
24    they would otherwise have been entitled.
25        (3) Eligible and covered members that are eligible for
26    coverage as dependents except for the fact of being members

 

 

SB1556- 19 -LRB097 09499 JDS 49636 b

1    shall be transferred to, and covered under, dependent
2    status regardless of preexisting conditions, waiting
3    periods, or other requirements that might jeopardize claim
4    payments to which they would otherwise have been entitled
5    upon cessation of member status and the election of
6    dependent coverage by a member eligible to elect that
7    coverage.
8    (b) New employees shall be immediately insured for the
9basic group life insurance and covered by the program of health
10benefits on the first day of active State service. Optional
11life insurance coverage one to 4 times the basic amount, if
12elected during the relevant eligibility period, will become
13effective on the date of employment. Optional life insurance
14coverage exceeding 4 times the basic amount and all life
15insurance amounts applied for after the eligibility period will
16be effective, subject to satisfactory evidence of insurability
17when applicable, or other necessary qualifications, pursuant
18to the requirements of the applicable benefit program, unless
19there is a change in status that would confer new eligibility
20for change of enrollment under rules established supplementing
21this Act, in which event application must be made within the
22new eligibility period.
23    (c) As to the group health benefits program contracted to
24begin or continue after June 30, 1973, each annuitant,
25survivor, and retired employee shall become immediately
26eligible and covered for all benefits available under that

 

 

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1program. Each annuitant, survivor, and retired employee shall
2have coverage effective immediately, provided that the
3election is properly filed in accordance with the required
4filing dates and procedures specified by the Director,
5including the completion and submission of all documentation
6and forms required by the Director. Annuitants, survivors, and
7retired Retired employees may elect coverage for eligible
8dependents and shall have the coverage effective immediately,
9provided that the election is properly filed in accordance with
10required filing dates and procedures specified by the Director,
11except that, for a survivor, the dependent to be added must
12have been eligible for coverage under the deceased member upon
13whom the survivor's annuity is based in order to be eligible
14for coverage under the survivor.
15    Except as otherwise provided in this Act, where husband and
16wife are both eligible members, each shall be enrolled as a
17member and coverage on their eligible dependent children, if
18any, may be under the enrollment and election of either.
19    Regardless of other provisions herein regarding late
20enrollment or other qualifications, as appropriate, the
21Director may periodically authorize open enrollment periods
22for each of the benefit programs at which time each member may
23elect enrollment or change of enrollment without regard to age,
24sex, health, or other qualification under the conditions as may
25be prescribed in rules and regulations supplementing this Act.
26Special open enrollment periods may be declared by the Director

 

 

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1for certain members only when special circumstances occur that
2affect only those members.
3    (d) Beginning with fiscal year 2003 and for all subsequent
4years, eligible members may elect not to participate in the
5program of health benefits as defined in this Act. The election
6must be made during the annual benefit choice period, subject
7to the conditions in this subsection.
8        (1) Members must furnish proof of health benefit
9    coverage, either comprehensive major medical coverage or
10    comprehensive managed care plan, from a source other than
11    the Department of Central Management Services in order to
12    elect not to participate in the program.
13        (2) Members may re-enroll in the Department of Central
14    Management Services program of health benefits upon
15    showing a qualifying change in status, as defined in the
16    U.S. Internal Revenue Code, without evidence of
17    insurability and with no limitations on coverage for
18    pre-existing conditions, provided that there was not a
19    break in coverage of more than 63 days.
20        (3) Members may also re-enroll in the program of health
21    benefits during any annual benefit choice period, without
22    evidence of insurability.
23        (4) Members who elect not to participate in the program
24    of health benefits shall be furnished a written explanation
25    of the requirements and limitations for the election not to
26    participate in the program and for re-enrolling in the

 

 

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1    program. The explanation shall also be included in the
2    annual benefit choice options booklets furnished to
3    members.
4    (d-5) Beginning July 1, 2005, the Director may establish a
5program of financial incentives to encourage annuitants
6receiving a retirement annuity from the State Employees
7Retirement System, but who are not eligible for benefits under
8the federal Medicare health insurance program (Title XVIII of
9the Social Security Act, as added by Public Law 89-97) to elect
10not to participate in the program of health benefits provided
11under this Act. The election by an annuitant not to participate
12under this program must be made in accordance with the
13requirements set forth under subsection (d). The financial
14incentives provided to these annuitants under the program may
15not exceed $150 per month for each annuitant electing not to
16participate in the program of health benefits provided under
17this Act.
18    (e) Notwithstanding any other provision of this Act or the
19rules adopted under this Act, if a person participating in the
20program of health benefits as the dependent spouse of an
21eligible member becomes an annuitant, the person may elect, at
22the time of becoming an annuitant or during any subsequent
23annual benefit choice period, to continue participation as a
24dependent rather than as an eligible member for as long as the
25person continues to be an eligible dependent.
26    An eligible member who has elected to participate as a

 

 

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1dependent may re-enroll in the program of health benefits as an
2eligible member (i) during any subsequent annual benefit choice
3period or (ii) upon showing a qualifying change in status, as
4defined in the U.S. Internal Revenue Code, without evidence of
5insurability and with no limitations on coverage for
6pre-existing conditions.
7    A person who elects to participate in the program of health
8benefits as a dependent rather than as an eligible member shall
9be furnished a written explanation of the consequences of
10electing to participate as a dependent and the conditions and
11procedures for re-enrolling as an eligible member. The
12explanation shall also be included in the annual benefit choice
13options booklet furnished to members.
14(Source: P.A. 94-95, eff. 7-1-05; 94-109, eff. 7-1-05; 95-331,
15eff. 8-21-07.)