SB1245sam003 98TH GENERAL ASSEMBLY

Sen. Christine Radogno

Filed: 4/24/2013

09800SB1245sam003 LRB098 00197 JLS 45048 a

AMENDMENT TO SENATE BILL 1245

AMENDMENT NO. ______. Amend Senate Bill 1245, AS AMENDED, by replacing the enacting clause with the following:

"Section 5. The Public Safety Employee Benefits Act is amended by changing Section 10 and adding Section 17 as follows:

(820 ILCS 320/10)

Sec. 10. Required health coverage benefits.

(a) An employer who employs a full-time law enforcement, correctional or correctional probation officer, or firefighter (hereinafter referred to as "injured employee"), who, on or after the effective date of this Act suffers a catastrophic injury or is killed in the line of duty shall pay the entire premium of the employer's health insurance plan for the injured employee, the injured employee's spouse, and for each dependent child of the injured employee until the child reaches the age of majority or until the end of the calendar year in which the child reaches the age of 25 if the child continues to be dependent for support or the child is a full-time or part-time student and is dependent for support. The term "health insurance plan" does not include supplemental benefits that are not part of the basic group health insurance plan. If the injured employee subsequently dies, the employer shall continue to pay the entire health insurance premium for the surviving spouse until remarried and for the dependent children under the conditions established in this Section. An employer shall not be required to pay the premium of the health insurance plan as provided in this Section if the employee or employee's spouse: (1) is granted disability income benefits under Title II (42 U.S.C. 401 et seq.) or supplemental security income benefits under Title XVI (42 U.S.C. 1381 et seq.) of the Social Security Act, (2) accepts health insurance benefits from another source, or (3) becomes eligible for federal Medicare benefits. However:

(1) Health insurance benefits payable from any other source shall reduce benefits payable under this Section.

(2) It is unlawful for a person to willfully and knowingly make, or cause to be made, or to assist, conspire with, or urge another to make, or cause to be made, any false, fraudulent, or misleading oral or written statement to obtain health insurance coverage as provided under this Section. A violation of this item is a Class A misdemeanor.

(3) Upon conviction for a violation described in item (2), a law enforcement, correctional or correctional probation officer, or other beneficiary who receives or seeks to receive health insurance benefits under this Section shall forfeit the right to receive health insurance benefits and shall reimburse the employer for all benefits paid due to the fraud or other prohibited activity. For purposes of this item, "conviction" means a determination of guilt that is the result of a plea or trial, regardless of whether adjudication is withheld.

(b) In order for the law enforcement, correctional or correctional probation officer, firefighter, spouse, or dependent children to be eligible for insurance coverage under this Act, the injury or death must have occurred as the result of the officer's response to fresh pursuit, the officer or firefighter's response to what is reasonably believed to be an emergency, an unlawful act perpetrated by another, or during the investigation of a criminal act. Nothing in this Section shall be construed to limit health insurance coverage or pension benefits for which the officer, firefighter, spouse, or dependent children may otherwise be eligible.

(c) "Catastrophic injury" means an injury that is one of the following:

(1) spinal cord injury involving severe paralysis of an arm, a leg, or the trunk;

(2) any amputation of an arm, a hand, a foot, or a leg that involves the effective loss of use of that appendage;

(3) severe brain or closed head injury as evidenced by:

(A) severe sensory or motor disturbances;

(B) severe communication disturbances;

(C) severe complex integrated disturbances of cerebral function;

(D) severe disturbances of consciousness;

(E) severe episodic neurological disorders; or

(F) other conditions at least as severe in nature as any condition provided in items (A) through (E);

(4) second or third degree burns over 50% of the body as a whole or third degree burns to 50% or more of the face or hands;

(5) total vision loss; or

(6) any other injury, the direct and proximate cause of which permanently prevents an individual from performing any gainful work.

(d) An injured employee who on or after the effective date of this amendatory Act of the 98th General Assembly suffers an injury that is not considered catastrophic under subsection (c) of this Section, but would otherwise qualify the individual to receive a line-of-duty disability pension that was awarded as a consequence of the officer's response to fresh pursuit, the officer's or firefighter's response to what is reasonably believed to be an emergency, an unlawful act perpetrated by another, or during the investigation of a criminal act or under Section 3-114.1 or 4-110 of the Illinois Pension Code or a duty death benefit under Section 3 of the Line of Duty Compensation Act, shall be considered to have suffered a qualifying disability and shall be entitled to receive health insurance benefits as provided in this subsection.

An injured employee who has suffered a qualifying disability is entitled to purchase or continue to purchase the same health insurance benefits provided by the unit of government at the time that the injured employee was injured for a period of 5 years following the qualifying disability. The employer shall pay not less than 50% of the total insurance premium.

The injured employee is entitled to purchase or continue to purchase health insurance coverage until the earlier of: (1) a decision being rendered granting disability income benefits under Title II (42 U.S.C. 401 et seq.) or supplemental security income benefits under Title XVI (42 U.S.C. 1381 et seq.) of the Social Security Act, (2) the injured employee accepting health insurance benefits from another source, or (3) the date the injured employee becomes eligible for federal Medicare benefits.

(e) By July 1 of every year, a person receiving benefits under this Act shall be required to submit to the employer, on a form provided by the employer, a report that shall include the following:

(1) gainful employment by the beneficiary within the reporting period;

(2) compensation earned by the beneficiary as a result of the employment;

(3) current annual household income;

(4) whether the injured employee, or his or her spouse, has been offered any insurance from another source; and

(5) whether the injured employee, or his or her spouse, is currently enrolled in any insurance plan from another source.

Any information collected by the employer under this Section shall be exempt from the requirements of the Freedom of Information Act except data collected in the aggregate that does not reveal any personal information of the injured employee.

(f) The employer may cancel benefits being provided under this Act for any beneficiary (1) whose household income exceeds 800% of the poverty level; (2) who has rejected an offer of insurance coverage from another source; or (3) who is currently enrolled in an insurance plan from another source. Benefits may be denied any individual who fails to timely file a completed report under this Section. Not less than 60 days prior to July 1, an employer shall notify any employee receiving benefits under this Act of that employee's obligation to file a report under this Section. Any employee that fails to timely file a report under this Section by July 1 shall be notified that he or she has 30 days to submit the report. Any employee who fails to file 30 days after receiving this notice may be denied benefits.

(Source: P.A. 90-535, eff. 11-14-97.)

(820 ILCS 320/17 new)

Sec. 17. Claims report.

(a) An employer subject to this Act shall file a claims report with the Public Pension Division of the Department of Insurance in the format prepared by the Division. The Division shall design the form and prescribe the content of the report. At least 60 days before the filing deadline, the Division shall provide the form to the employers subject to this Act. The claims report shall be filed no later than December 31 of each year. The claims report shall set forth the required information for the 12-month period ending on June 30 preceding the deadline date for filing the report. The claims report shall, at a minimum, contain the following information:

(1) the number of claims filed under this Act during the reporting period;

(2) the number of claims awarded under this Act during the reporting period;

(3) the dollar amount of all claims awarded under this Act during the reporting period;

(4) the number of claims paid under this Act during the reporting period regardless of when the claim was awarded;

(5) the dollar amount of all claims paid under this Act during the reporting period regardless of when the claim was awarded;

(6) the annual cost of the benefit and any available long-term cost projections;

(7) the nature of the injury;

(8) any gainful employment during the annual reporting period;

(9) the compensation earned as a result of that employment; and

(10) any accessible insurance options. The claims report shall redact any information as required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

(b) On or before July 1 of each year, the Public Pension Division of the Department of Insurance shall submit a report to the Governor and General Assembly setting forth the information received under subsection (a) with respect to the most recently completed reporting period. The requirement for reporting to the General Assembly shall be satisfied by filing copies of the report with the Speaker, Minority Leader, and Clerk of the House of Representatives, the President, Minority Leader, and Secretary of the Senate, the Legislative Research Unit as required under Section 3.1 of the General Assembly Organization Act, and the State Government Report Distribution Center for the General Assembly as required under paragraph (t) of Section 7 of the State Library Act. Upon request, the Division shall provide copies of the report at no charge to employers subject to this Act, to public libraries, and to State agencies.

(c) By July 1 of every year, a person receiving benefits under this Act shall be required to file, on a form provided by the employer, a report that shall include the following:

(1) gainful employment by the beneficiary within the reporting period;

(2) compensation earned by the beneficiary as a result of the employment;

(3) current annual household income;

(4) whether the injured employee, or his or her spouse, has been offered comparable insurance from another source; and

(5) whether the injured employee, or his or her spouse, is currently enrolled in a comparable insurance plan from another source.

Benefits may be denied any individual who fails to timely file a report under this subsection.

Section 99. Effective date. This Act takes effect upon becoming law.".