Full Text of SB2314 99th General Assembly
SB2314eng 99TH GENERAL ASSEMBLY |
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| 1 | | AN ACT concerning State government.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | Section 5. The State Employees Group Insurance Act of 1971 | 5 | | is amended by changing Sections 3, 5, 8, and 10 as follows:
| 6 | | (5 ILCS 375/3) (from Ch. 127, par. 523)
| 7 | | Sec. 3. Definitions. Unless the context otherwise | 8 | | requires, the
following words and phrases as used in this Act | 9 | | shall have the following
meanings. The Department may define | 10 | | these and other words and phrases
separately for the purpose of | 11 | | implementing specific programs providing benefits
under this | 12 | | Act.
| 13 | | (a) "Administrative service organization" means any | 14 | | person, firm or
corporation experienced in the handling of | 15 | | claims which is
fully qualified, financially sound and capable | 16 | | of meeting the service
requirements of a contract of | 17 | | administration executed with the Department.
| 18 | | (b) "Annuitant" means (1) an employee who retires, or has | 19 | | retired,
on or after January 1, 1966 on an immediate annuity | 20 | | under the provisions
of Articles 2, 14 (including an employee | 21 | | who has elected to receive an alternative retirement | 22 | | cancellation payment under Section 14-108.5 of the Illinois | 23 | | Pension Code in lieu of an annuity), 15 (including an employee |
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| 1 | | who has retired under the optional
retirement program | 2 | | established under Section 15-158.2),
paragraphs (2), (3), or | 3 | | (5) of Section 16-106, or
Article 18 of the Illinois Pension | 4 | | Code; (2) any person who was receiving
group insurance coverage | 5 | | under this Act as of March 31, 1978 by
reason of his status as | 6 | | an annuitant, even though the annuity in relation
to which such | 7 | | coverage was provided is a proportional annuity based on less
| 8 | | than the minimum period of service required for a retirement | 9 | | annuity in
the system involved; (3) any person not otherwise | 10 | | covered by this Act
who has retired as a participating member | 11 | | under Article 2 of the Illinois
Pension Code but is ineligible | 12 | | for the retirement annuity under Section
2-119 of the Illinois | 13 | | Pension Code; (4) the spouse of any person who
is receiving a | 14 | | retirement annuity under Article 18 of the Illinois Pension
| 15 | | Code and who is covered under a group health insurance program | 16 | | sponsored
by a governmental employer other than the State of | 17 | | Illinois and who has
irrevocably elected to waive his or her | 18 | | coverage under this Act and to have
his or her spouse | 19 | | considered as the "annuitant" under this Act and not as
a | 20 | | "dependent"; or (5) an employee who retires, or has retired, | 21 | | from a
qualified position, as determined according to rules | 22 | | promulgated by the
Director, under a qualified local | 23 | | government, a qualified rehabilitation
facility, a qualified | 24 | | domestic violence shelter or service, or a qualified child | 25 | | advocacy center. (For definition
of "retired employee", see (p) | 26 | | post).
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| 1 | | (b-5) (Blank).
| 2 | | (b-6) (Blank).
| 3 | | (b-7) (Blank).
| 4 | | (c) "Carrier" means (1) an insurance company, a corporation | 5 | | organized
under the Limited Health Service Organization Act or | 6 | | the Voluntary Health
Services Plan Act, a partnership, or other | 7 | | nongovernmental organization,
which is authorized to do group | 8 | | life or group health insurance business in
Illinois, or (2) the | 9 | | State of Illinois as a self-insurer.
| 10 | | (d) "Compensation" means salary or wages payable on a | 11 | | regular
payroll by the State Treasurer on a warrant of the | 12 | | State Comptroller out
of any State, trust or federal fund, or | 13 | | by the Governor of the State
through a disbursing officer of | 14 | | the State out of a trust or out of
federal funds, or by any | 15 | | Department out of State, trust, federal or
other funds held by | 16 | | the State Treasurer or the Department, to any person
for | 17 | | personal services currently performed, and ordinary or | 18 | | accidental
disability benefits under Articles 2, 14, 15 | 19 | | (including ordinary or accidental
disability benefits under | 20 | | the optional retirement program established under
Section | 21 | | 15-158.2), paragraphs (2), (3), or (5) of
Section 16-106, or | 22 | | Article 18 of the Illinois Pension Code, for disability
| 23 | | incurred after January 1, 1966, or benefits payable under the | 24 | | Workers'
Compensation or Occupational Diseases Act or benefits | 25 | | payable under a sick
pay plan established in accordance with | 26 | | Section 36 of the State Finance Act.
"Compensation" also means |
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| 1 | | salary or wages paid to an employee of any
qualified local | 2 | | government, qualified rehabilitation facility,
qualified | 3 | | domestic violence shelter or service, or qualified child | 4 | | advocacy center.
| 5 | | (e) "Commission" means the State Employees Group Insurance | 6 | | Advisory
Commission authorized by this Act. Commencing July 1, | 7 | | 1984, "Commission"
as used in this Act means the Commission on | 8 | | Government Forecasting and Accountability as
established by | 9 | | the Legislative Commission Reorganization Act of 1984.
| 10 | | (f) "Contributory", when referred to as contributory | 11 | | coverage, shall
mean optional coverages or benefits elected by | 12 | | the member toward the cost of
which such member makes | 13 | | contribution, or which are funded in whole or in part
through | 14 | | the acceptance of a reduction in earnings or the foregoing of | 15 | | an
increase in earnings by an employee, as distinguished from | 16 | | noncontributory
coverage or benefits which are paid entirely by | 17 | | the State of Illinois
without reduction of the member's salary.
| 18 | | (g) "Department" means any department, institution, board,
| 19 | | commission, officer, court or any agency of the State | 20 | | government
receiving appropriations and having power to | 21 | | certify payrolls to the
Comptroller authorizing payments of | 22 | | salary and wages against such
appropriations as are made by the | 23 | | General Assembly from any State fund, or
against trust funds | 24 | | held by the State Treasurer and includes boards of
trustees of | 25 | | the retirement systems created by Articles 2, 14, 15, 16 and
18 | 26 | | of the Illinois Pension Code. "Department" also includes the |
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| 1 | | Illinois
Comprehensive Health Insurance Board, the Board of | 2 | | Examiners established under
the Illinois Public Accounting | 3 | | Act, and the Illinois Finance Authority.
| 4 | | (h) "Dependent", when the term is used in the context of | 5 | | the health
and life plan, means a member's spouse and any child | 6 | | (1) from
birth to age 26 including an adopted child, a child | 7 | | who lives with the
member from the time of the filing of a | 8 | | petition for adoption until entry
of an order of adoption, a | 9 | | stepchild or adjudicated child, or a child who lives with the | 10 | | member
if such member is a court appointed guardian of the | 11 | | child or (2)
age 19 or over who has a mental or physical | 12 | | disability from a cause originating prior to the age of 19 (age | 13 | | 26 if enrolled as an adult child dependent). For
the health | 14 | | plan only, the term "dependent" also includes (1) any person
| 15 | | enrolled prior to the effective date of this Section who is | 16 | | dependent upon
the member to the extent that the member may | 17 | | claim such person as a
dependent for income tax deduction | 18 | | purposes and (2) any person who
has received after June 30, | 19 | | 2000 an organ transplant and who is financially
dependent upon | 20 | | the member and eligible to be claimed as a dependent for income
| 21 | | tax purposes. A member requesting to cover any dependent must | 22 | | provide documentation as requested by the Department of Central | 23 | | Management Services and file with the Department any and all | 24 | | forms required by the Department.
| 25 | | (i) "Director" means the Director of the Illinois | 26 | | Department of Central
Management Services.
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| 1 | | (j) "Eligibility period" means the period of time a member | 2 | | has to
elect enrollment in programs or to select benefits | 3 | | without regard to
age, sex or health.
| 4 | | (k) "Employee" means and includes each officer or employee | 5 | | in the
service of a department who (1) receives his | 6 | | compensation for
service rendered to the department on a | 7 | | warrant issued pursuant to a payroll
certified by a department | 8 | | or on a warrant or check issued and drawn by a
department upon | 9 | | a trust, federal or other fund or on a warrant issued
pursuant | 10 | | to a payroll certified by an elected or duly appointed officer
| 11 | | of the State or who receives payment of the performance of | 12 | | personal
services on a warrant issued pursuant to a payroll | 13 | | certified by a
Department and drawn by the Comptroller upon the | 14 | | State Treasurer against
appropriations made by the General | 15 | | Assembly from any fund or against
trust funds held by the State | 16 | | Treasurer, and (2) is employed full-time or
part-time in a | 17 | | position normally requiring actual performance of duty
during | 18 | | not less than 1/2 of a normal work period, as established by | 19 | | the
Director in cooperation with each department, except that | 20 | | persons elected
by popular vote will be considered employees | 21 | | during the entire
term for which they are elected regardless of | 22 | | hours devoted to the
service of the State, and (3) except that | 23 | | "employee" does not include any
person who is not eligible by | 24 | | reason of such person's employment to
participate in one of the | 25 | | State retirement systems under Articles 2, 14, 15
(either the | 26 | | regular Article 15 system or the optional retirement program
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| 1 | | established under Section 15-158.2) or 18, or under paragraph | 2 | | (2), (3), or
(5) of Section 16-106, of the Illinois
Pension | 3 | | Code, but such term does include persons who are employed | 4 | | during
the 6 month qualifying period under Article 14 of the | 5 | | Illinois Pension
Code. Such term also includes any person who | 6 | | (1) after January 1, 1966,
is receiving ordinary or accidental | 7 | | disability benefits under Articles
2, 14, 15 (including | 8 | | ordinary or accidental disability benefits under the
optional | 9 | | retirement program established under Section 15-158.2), | 10 | | paragraphs
(2), (3), or (5) of Section 16-106, or Article 18 of | 11 | | the
Illinois Pension Code, for disability incurred after | 12 | | January 1, 1966, (2)
receives total permanent or total | 13 | | temporary disability under the Workers'
Compensation Act or | 14 | | Occupational Disease Act as a result of injuries
sustained or | 15 | | illness contracted in the course of employment with the
State | 16 | | of Illinois, or (3) is not otherwise covered under this Act and | 17 | | has
retired as a participating member under Article 2 of the | 18 | | Illinois Pension
Code but is ineligible for the retirement | 19 | | annuity under Section 2-119 of
the Illinois Pension Code. | 20 | | However, a person who satisfies the criteria
of the foregoing | 21 | | definition of "employee" except that such person is made
| 22 | | ineligible to participate in the State Universities Retirement | 23 | | System by
clause (4) of subsection (a) of Section 15-107 of the | 24 | | Illinois Pension
Code is also an "employee" for the purposes of | 25 | | this Act. "Employee" also
includes any person receiving or | 26 | | eligible for benefits under a sick pay
plan established in |
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| 1 | | accordance with Section 36 of the State Finance Act.
"Employee" | 2 | | also includes (i) each officer or employee in the service of a
| 3 | | qualified local government, including persons appointed as | 4 | | trustees of
sanitary districts regardless of hours devoted to | 5 | | the service of the
sanitary district, (ii) each employee in the | 6 | | service of a qualified
rehabilitation facility, (iii) each | 7 | | full-time employee in the service of a
qualified domestic | 8 | | violence shelter or service, and (iv) each full-time employee | 9 | | in the service of a qualified child advocacy center, as | 10 | | determined according to
rules promulgated by the Director.
| 11 | | (l) "Member" means an employee, annuitant, retired | 12 | | employee or survivor. In the case of an annuitant or retired | 13 | | employee who first becomes an annuitant or retired employee on | 14 | | or after the effective date of this amendatory Act of the 97th | 15 | | General Assembly, the individual must meet the minimum vesting | 16 | | requirements of the applicable retirement system in order to be | 17 | | eligible for group insurance benefits under that system. In the | 18 | | case of a survivor who first becomes a survivor on or after the | 19 | | effective date of this amendatory Act of the 97th General | 20 | | Assembly, the deceased employee, annuitant, or retired | 21 | | employee upon whom the annuity is based must have been eligible | 22 | | to participate in the group insurance system under the | 23 | | applicable retirement system in order for the survivor to be | 24 | | eligible for group insurance benefits under that system. | 25 | | References to the term "member" include State benefit | 26 | | recipients, but only with respect to the basic program of group |
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| 1 | | health benefits and not for the purposes of enrollment in any | 2 | | group life insurance benefits or optional coverages or | 3 | | benefits.
| 4 | | (m) "Optional coverages or benefits" means those coverages | 5 | | or
benefits available to the member on his or her voluntary | 6 | | election, and at
his or her own expense.
| 7 | | (n) "Program" means the group life insurance, health | 8 | | benefits and other
employee benefits designed and contracted | 9 | | for by the Director under this Act.
| 10 | | (o) "Health plan" means a health benefits
program offered
| 11 | | by the State of Illinois for persons eligible for the plan.
| 12 | | (p) "Retired employee" means any person who would be an | 13 | | annuitant as
that term is defined herein but for the fact that | 14 | | such person retired prior to
January 1, 1966. Such term also | 15 | | includes any person formerly employed by
the University of | 16 | | Illinois in the Cooperative Extension Service who would
be an | 17 | | annuitant but for the fact that such person was made ineligible | 18 | | to
participate in the State Universities Retirement System by | 19 | | clause (4) of
subsection (a) of Section 15-107 of the Illinois
| 20 | | Pension Code.
| 21 | | (q) "Survivor" means a person receiving an annuity as a | 22 | | survivor of an
employee or of an annuitant. "Survivor" also | 23 | | includes: (1) the surviving
dependent of a person who satisfies | 24 | | the definition of "employee" except that
such person is made | 25 | | ineligible to participate in the State Universities
Retirement | 26 | | System by clause (4) of subsection (a)
of Section 15-107 of the |
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| 1 | | Illinois Pension Code; (2) the surviving
dependent of any | 2 | | person formerly employed by the University of Illinois in
the | 3 | | Cooperative Extension Service who would be an annuitant except | 4 | | for the
fact that such person was made ineligible to | 5 | | participate in the State
Universities Retirement System by | 6 | | clause (4) of subsection (a) of Section
15-107 of the Illinois | 7 | | Pension Code; and (3) the surviving dependent of a person who | 8 | | was an annuitant under this Act by virtue of receiving an | 9 | | alternative retirement cancellation payment under Section | 10 | | 14-108.5 of the Illinois Pension Code.
| 11 | | (q-2) "SERS" means the State Employees' Retirement System | 12 | | of Illinois, created under Article 14 of the Illinois Pension | 13 | | Code.
| 14 | | (q-2.1) "State benefit recipient" means a person in the | 15 | | service of a department who: (1) is not a member, as defined in | 16 | | this Section; (2) receives salary or wages for personal service | 17 | | rendered to the department; and (3) is employed in a position | 18 | | normally requiring actual performance of duty during not less | 19 | | than 30 hours per week, except that "state benefit recipient" | 20 | | does not include any person deemed to be an independent | 21 | | contractor or any person who is employed by any | 22 | | State-contracted vendor and is performing services pursuant to | 23 | | the contract between the vendor and the State. | 24 | | (q-3) "SURS" means the State Universities Retirement | 25 | | System, created under Article 15 of the Illinois Pension Code.
| 26 | | (q-4) "TRS" means the Teachers' Retirement System of the |
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| 1 | | State of Illinois, created under Article 16 of the Illinois | 2 | | Pension Code.
| 3 | | (q-5) (Blank).
| 4 | | (q-6) (Blank).
| 5 | | (q-7) (Blank).
| 6 | | (r) "Medical services" means the services provided within | 7 | | the scope
of their licenses by practitioners in all categories | 8 | | licensed under the
Medical Practice Act of 1987.
| 9 | | (s) "Unit of local government" means any county, | 10 | | municipality,
township, school district (including a | 11 | | combination of school districts under
the Intergovernmental | 12 | | Cooperation Act), special district or other unit,
designated as | 13 | | a
unit of local government by law, which exercises limited | 14 | | governmental
powers or powers in respect to limited | 15 | | governmental subjects, any
not-for-profit association with a | 16 | | membership that primarily includes
townships and township | 17 | | officials, that has duties that include provision of
research | 18 | | service, dissemination of information, and other acts for the
| 19 | | purpose of improving township government, and that is funded | 20 | | wholly or
partly in accordance with Section 85-15 of the | 21 | | Township Code; any
not-for-profit corporation or association, | 22 | | with a membership consisting
primarily of municipalities, that | 23 | | operates its own utility system, and
provides research, | 24 | | training, dissemination of information, or other acts to
| 25 | | promote cooperation between and among municipalities that | 26 | | provide utility
services and for the advancement of the goals |
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| 1 | | and purposes of its
membership;
the Southern Illinois | 2 | | Collegiate Common Market, which is a consortium of higher
| 3 | | education institutions in Southern Illinois; the Illinois | 4 | | Association of
Park Districts; and any hospital provider that | 5 | | is owned by a county that has 100 or fewer hospital beds and | 6 | | has not already joined the program. "Qualified
local | 7 | | government" means a unit of local government approved by the | 8 | | Director and
participating in a program created under | 9 | | subsection (i) of Section 10 of this
Act.
| 10 | | (t) "Qualified rehabilitation facility" means any | 11 | | not-for-profit
organization that is accredited by the | 12 | | Commission on Accreditation of
Rehabilitation Facilities or | 13 | | certified by the Department
of Human Services (as successor to | 14 | | the Department of Mental Health
and Developmental | 15 | | Disabilities) to provide services to persons with
disabilities
| 16 | | and which receives funds from the State of Illinois for | 17 | | providing those
services, approved by the Director and | 18 | | participating in a program created
under subsection (j) of | 19 | | Section 10 of this Act.
| 20 | | (u) "Qualified domestic violence shelter or service" means | 21 | | any Illinois
domestic violence shelter or service and its | 22 | | administrative offices funded
by the Department of Human | 23 | | Services (as successor to the Illinois Department of
Public | 24 | | Aid),
approved by the Director and
participating in a program | 25 | | created under subsection (k) of Section 10.
| 26 | | (v) "TRS benefit recipient" means a person who:
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| 1 | | (1) is not a "member" as defined in this Section; and
| 2 | | (2) is receiving a monthly benefit or retirement | 3 | | annuity
under Article 16 of the Illinois Pension Code; and
| 4 | | (3) either (i) has at least 8 years of creditable | 5 | | service under Article
16 of the Illinois Pension Code, or | 6 | | (ii) was enrolled in the health insurance
program offered | 7 | | under that Article on January 1, 1996, or (iii) is the | 8 | | survivor
of a benefit recipient who had at least 8
years of | 9 | | creditable service under Article 16 of the Illinois Pension | 10 | | Code or
was enrolled in the health insurance program | 11 | | offered under that Article on
the effective date of this | 12 | | amendatory Act of 1995, or (iv) is a recipient or
survivor | 13 | | of a recipient of a disability benefit under Article 16 of | 14 | | the
Illinois Pension Code.
| 15 | | (w) "TRS dependent beneficiary" means a person who:
| 16 | | (1) is not a "member" or "dependent" as defined in this | 17 | | Section; and
| 18 | | (2) is a TRS benefit recipient's: (A) spouse, (B) | 19 | | dependent parent who
is receiving at least half of his or | 20 | | her support from the TRS benefit
recipient, or (C) natural, | 21 | | step, adjudicated, or adopted child who is (i) under age | 22 | | 26, (ii) was, on January 1, 1996, participating as a | 23 | | dependent
beneficiary in the health insurance program | 24 | | offered under Article 16 of the
Illinois Pension Code, or | 25 | | (iii) age 19 or over who has a mental or physical | 26 | | disability from a cause originating prior to the age of 19 |
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| 1 | | (age 26 if enrolled as an adult child).
| 2 | | "TRS dependent beneficiary" does not include, as indicated | 3 | | under paragraph (2) of this subsection (w), a dependent of the | 4 | | survivor of a TRS benefit recipient who first becomes a | 5 | | dependent of a survivor of a TRS benefit recipient on or after | 6 | | the effective date of this amendatory Act of the 97th General | 7 | | Assembly unless that dependent would have been eligible for | 8 | | coverage as a dependent of the deceased TRS benefit recipient | 9 | | upon whom the survivor benefit is based. | 10 | | (x) "Military leave" refers to individuals in basic
| 11 | | training for reserves, special/advanced training, annual | 12 | | training, emergency
call up, activation by the President of the | 13 | | United States, or any other training or duty in service to the | 14 | | United States Armed Forces.
| 15 | | (y) (Blank).
| 16 | | (z) "Community college benefit recipient" means a person | 17 | | who:
| 18 | | (1) is not a "member" as defined in this Section; and
| 19 | | (2) is receiving a monthly survivor's annuity or | 20 | | retirement annuity
under Article 15 of the Illinois Pension | 21 | | Code; and
| 22 | | (3) either (i) was a full-time employee of a community | 23 | | college district or
an association of community college | 24 | | boards created under the Public Community
College Act | 25 | | (other than an employee whose last employer under Article | 26 | | 15 of the
Illinois Pension Code was a community college |
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| 1 | | district subject to Article VII
of the Public Community | 2 | | College Act) and was eligible to participate in a group
| 3 | | health benefit plan as an employee during the time of | 4 | | employment with a
community college district (other than a | 5 | | community college district subject to
Article VII of the | 6 | | Public Community College Act) or an association of | 7 | | community
college boards, or (ii) is the survivor of a | 8 | | person described in item (i).
| 9 | | (aa) "Community college dependent beneficiary" means a | 10 | | person who:
| 11 | | (1) is not a "member" or "dependent" as defined in this | 12 | | Section; and
| 13 | | (2) is a community college benefit recipient's: (A) | 14 | | spouse, (B) dependent
parent who is receiving at least half | 15 | | of his or her support from the community
college benefit | 16 | | recipient, or (C) natural, step, adjudicated, or adopted | 17 | | child who is (i)
under age 26, or (ii)
age 19 or over and | 18 | | has a mental or physical disability from a cause | 19 | | originating prior to the age of 19 (age 26 if enrolled as | 20 | | an adult child).
| 21 | | "Community college dependent beneficiary" does not | 22 | | include, as indicated under paragraph (2) of this subsection | 23 | | (aa), a dependent of the survivor of a community college | 24 | | benefit recipient who first becomes a dependent of a survivor | 25 | | of a community college benefit recipient on or after the | 26 | | effective date of this amendatory Act of the 97th General |
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| 1 | | Assembly unless that dependent would have been eligible for | 2 | | coverage as a dependent of the deceased community college | 3 | | benefit recipient upon whom the survivor annuity is based. | 4 | | (bb) "Qualified child advocacy center" means any Illinois | 5 | | child advocacy center and its administrative offices funded by | 6 | | the Department of Children and Family Services, as defined by | 7 | | the Children's Advocacy Center Act (55 ILCS 80/), approved by | 8 | | the Director and participating in a program created under | 9 | | subsection (n) of Section 10.
| 10 | | (Source: P.A. 98-488, eff. 8-16-13; 99-143, eff. 7-27-15.)
| 11 | | (5 ILCS 375/5) (from Ch. 127, par. 525)
| 12 | | Sec. 5. Employee benefits; declaration of State policy.
The | 13 | | General Assembly declares that it is the policy of the State | 14 | | and in the best interest of the State to assure quality | 15 | | benefits to members and their dependents under this Act. The | 16 | | implementation of this policy depends upon, among other things, | 17 | | stability and continuity of coverage, care, and services under | 18 | | benefit programs for members and their dependents. | 19 | | Specifically, but without limitation, members should have | 20 | | continued access, on substantially similar terms and | 21 | | conditions, to trusted family health care providers with whom | 22 | | they have developed long-term relationships through a benefit | 23 | | program under this Act. Therefore, the Director must administer | 24 | | this Act consistent with that State policy, but may consider | 25 | | affordability, cost of coverage and care, and competition among |
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| 1 | | health insurers and providers. All contracts for provision of | 2 | | employee benefits, including those portions of any proposed | 3 | | collective bargaining agreement that would require | 4 | | implementation through contracts entered into under this Act, | 5 | | are subject to the following requirements: | 6 | | (i) By April 1 of each year, the Director must report | 7 | | and provide information to the Commission concerning the | 8 | | status of the employee benefits program to be offered for | 9 | | the next fiscal year. Information includes, but is not | 10 | | limited to, documents, reports of negotiations, bid | 11 | | invitations, requests for proposals, specifications, | 12 | | copies of proposed and final contracts or agreements, and | 13 | | any other materials concerning contracts or agreements for | 14 | | the employee benefits program. By the first of each month | 15 | | thereafter, the Director must provide updated, and any new, | 16 | | information to the Commission until the employee benefits | 17 | | program for the next fiscal year is determined. In addition | 18 | | to these monthly reporting requirements, at any time the | 19 | | Commission makes a written request, the Director must | 20 | | promptly, but in no event later than 5 business days after | 21 | | receipt of the request, provide to the Commission any | 22 | | additional requested information in the possession of the | 23 | | Director concerning employee benefits programs. The | 24 | | Commission may waive any of the reporting requirements of | 25 | | this item (i) upon the written request by the Director. Any | 26 | | waiver granted under this item (i) must be in writing. |
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| 1 | | Nothing in this item is intended to abrogate any | 2 | | attorney-client privilege.
| 3 | | (ii) Within 30 days after notice of the awarding or | 4 | | letting of a contract has appeared in the Illinois | 5 | | Procurement Bulletin in accordance with subsection (b) of | 6 | | Section 15-25 of the Illinois Procurement Code, the | 7 | | Commission may request in writing from the Director and the | 8 | | Director shall promptly, but in no event later than 5 | 9 | | business days after receipt of the request, provide to the | 10 | | Commission information in the possession of the Director | 11 | | concerning the proposed contract. Nothing in this item is | 12 | | intended to waive or abrogate any privilege or right of | 13 | | confidentiality authorized by law. | 14 | | (iii) Except as otherwise provided in this item (iii), | 15 | | no contract subject to this Section may be entered into | 16 | | until the 30-day period described in item (ii) has expired, | 17 | | unless the Director requests in writing that the Commission | 18 | | waive the period and the Commission grants the waiver in | 19 | | writing. This item (iii) does not apply to any contract | 20 | | entered into after the effective date of this amendatory | 21 | | Act of the 98th General Assembly and through January 1, | 22 | | 2014 to provide a program of group health benefits for | 23 | | Medicare-primary members and their Medicare-primary | 24 | | dependents that is comparable in stability and continuity | 25 | | of coverage, care, and services to the program of health | 26 | | benefits offered to other members and their dependents |
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| 1 | | under this Act. | 2 | | (iv) If the Director seeks to make any substantive | 3 | | modification to any provision of a proposed contract after | 4 | | it is submitted to the Commission in accordance with item | 5 | | (ii), the modified contract shall be subject to the | 6 | | requirements of items (ii) and (iii) unless the Commission | 7 | | agrees, in writing, to a waiver of those requirements with | 8 | | respect to the modified contract.
| 9 | | (v) By the date of the beginning of the annual benefit | 10 | | choice period, the Director must transmit to the Commission | 11 | | a copy of each final contract or agreement for the employee | 12 | | benefits program to be offered for the next fiscal year. | 13 | | The annual benefit choice period for an employee benefits | 14 | | program must begin on May 1 of the fiscal year preceding | 15 | | the year for which the program is to be offered. If, | 16 | | however, in any such preceding fiscal year collective | 17 | | bargaining over employee benefit programs for the next | 18 | | fiscal year remains pending on April 15, the beginning date | 19 | | of the annual benefit choice period shall be not later than | 20 | | 15 days after ratification of the collective bargaining | 21 | | agreement.
| 22 | | (vi) The Director must provide the reports, | 23 | | information, and contracts required under items (i), (ii), | 24 | | (iv), and (v) by electronic or other means satisfactory to | 25 | | the Commission. Reports, information, and contracts in the | 26 | | possession of the Commission pursuant to items (i), (ii), |
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| 1 | | (iv), and (v) are exempt from disclosure by the Commission | 2 | | and its members and employees under the Freedom of | 3 | | Information Act. Reports, information, and contracts | 4 | | received by the Commission pursuant to items (i), (ii), | 5 | | (iv), and (v) must be kept confidential by and may not be | 6 | | disclosed or used by the Commission or its members or | 7 | | employees if such disclosure or use could compromise the | 8 | | fairness or integrity of the procurement, bidding, or | 9 | | contract process. Commission meetings, or portions of | 10 | | Commission meetings, in which reports, information, and | 11 | | contracts received by the Commission pursuant to items (i), | 12 | | (ii), (iv), and (v) are discussed must be closed if | 13 | | disclosure or use of the report or information could | 14 | | compromise the fairness or integrity of the procurement, | 15 | | bidding, or contract process.
| 16 | | All contracts entered into under this Section are subject | 17 | | to appropriation and shall comply with Section 20-60(b) of the | 18 | | Illinois Procurement Code (30 ILCS 500/20-60(b)).
| 19 | | The Director shall contract or otherwise make available | 20 | | group
life insurance , health benefits and other
employee | 21 | | benefits to eligible members and, where elected,
their eligible | 22 | | dependents. The Director shall contract or otherwise make | 23 | | available health benefits to eligible State benefit | 24 | | recipients, members, and, where elected,
their eligible | 25 | | dependents. Any contract or, if
applicable, contracts or other | 26 | | arrangement for provision of benefits
shall be on terms |
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| 1 | | consistent with State policy and
based on, but not limited to, | 2 | | such
criteria as administrative cost, service capabilities of | 3 | | the carrier
or other contractor and premiums, fees or charges | 4 | | as related to benefits.
| 5 | | Notwithstanding any other provisions of this Act, by | 6 | | January 1, 2014, the Department of Central Management Services, | 7 | | in consultation with and subject to the approval of the Chief | 8 | | Procurement Officer, shall contract or make otherwise | 9 | | available a program of group health benefits for | 10 | | Medicare-primary members and their Medicare-primary | 11 | | dependents. The Director may procure a single contract or | 12 | | multiple contracts that provide a program of group health | 13 | | benefits that is comparable in stability and continuity of | 14 | | coverage, care, and services to the program of health benefits | 15 | | offered to other members and their dependents under this Act. | 16 | | The initial procurement of a contract or contracts under this | 17 | | paragraph is not subject to the provisions of the Illinois | 18 | | Procurement Code, except for Sections 20-60, 20-65, 20-70, and | 19 | | 20-160 and Article 50 of that Code, provided that the Chief | 20 | | Procurement Officer may, in writing with justification, waive | 21 | | any certification required under Article 50. | 22 | | The Director may prepare and issue specifications
for group | 23 | | life insurance, health benefits, other employee benefits
and | 24 | | administrative services for the purpose of receiving proposals
| 25 | | from interested parties.
| 26 | | The Director is authorized to execute a contract, or
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| 1 | | contracts, for the programs of group life insurance, health
| 2 | | benefits, other employee benefits and administrative services
| 3 | | authorized by this Act (including, without limitation, | 4 | | prescription drug benefits). All of the benefits provided under | 5 | | this Act may be
included in one or more contracts, or the | 6 | | benefits may be classified into
different types with each type | 7 | | included under one or more similar contracts
with the same or | 8 | | different companies.
| 9 | | The term of any contract may not extend beyond 5 fiscal | 10 | | years.
Upon recommendation of the Commission, the Director may | 11 | | exercise renewal
options of the same contract for up to a | 12 | | period of 5 years. Any
increases in premiums, fees or charges | 13 | | requested by a contractor whose
contract may be renewed | 14 | | pursuant to a renewal option contained therein,
must be | 15 | | justified on the basis of (1) audited experience data, (2)
| 16 | | increases in the costs of health care services provided under | 17 | | the contract,
(3) contractor performance, (4) increases in | 18 | | contractor responsibilities,
or (5) any combination thereof.
| 19 | | Any contractor shall agree to abide by all
requirements of | 20 | | this Act and Rules and Regulations promulgated and adopted
| 21 | | thereto; to submit such information and data as may from time | 22 | | to time be
deemed necessary by the Director for effective | 23 | | administration of the
provisions of this Act and the programs | 24 | | established
hereunder, and to fully cooperate in any audit.
| 25 | | (Source: P.A. 98-19, eff. 6-10-13.)
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| 1 | | (5 ILCS 375/8) (from Ch. 127, par. 528)
| 2 | | Sec. 8. Eligibility.
| 3 | | (a) Each employee eligible under the provisions of this Act | 4 | | and any rules
and regulations promulgated and adopted hereunder | 5 | | by the Director shall
become immediately eligible and covered | 6 | | for all benefits available under
the programs. Employees | 7 | | electing coverage for eligible dependents shall have
the | 8 | | coverage effective immediately, provided that the election is | 9 | | properly
filed in accordance with required filing dates and | 10 | | procedures specified by
the Director, including the completion | 11 | | and submission of all documentation and forms required by the | 12 | | Director.
| 13 | | (1) Every member originally eligible to elect | 14 | | dependent coverage, but not
electing it during the original | 15 | | eligibility period, may subsequently obtain
dependent | 16 | | coverage only in the event of a qualifying change in | 17 | | status, special
enrollment, special circumstance as | 18 | | defined by the Director, or during the
annual Benefit | 19 | | Choice Period.
| 20 | | (2) Members described above being transferred from | 21 | | previous
coverage towards which the State has been | 22 | | contributing shall be
transferred regardless of | 23 | | preexisting conditions, waiting periods, or
other | 24 | | requirements that might jeopardize claim payments to which | 25 | | they
would otherwise have been entitled.
| 26 | | (3) Eligible and covered members that are eligible for |
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| 1 | | coverage as
dependents except for the fact of being members | 2 | | shall be transferred to,
and covered under, dependent | 3 | | status regardless of preexisting conditions,
waiting | 4 | | periods, or other requirements that might jeopardize claim | 5 | | payments
to which they would otherwise have been entitled | 6 | | upon cessation of member
status and the election of | 7 | | dependent coverage by a member eligible to elect
that | 8 | | coverage.
| 9 | | (b) New employees shall be immediately insured for the | 10 | | basic group
life insurance and covered by the program of health | 11 | | benefits on the first
day of active State service. Optional | 12 | | life insurance coverage one to 4 times the basic amount, if | 13 | | elected
during the relevant eligibility period, will become | 14 | | effective on the date
of employment. Optional life insurance | 15 | | coverage exceeding 4 times the basic amount and all life | 16 | | insurance amounts applied for after the
eligibility period will | 17 | | be effective, subject to satisfactory evidence of
insurability | 18 | | when applicable, or other necessary qualifications, pursuant | 19 | | to
the requirements of the applicable benefit program, unless | 20 | | there is a change in
status that would confer new eligibility | 21 | | for change of enrollment under rules
established supplementing | 22 | | this Act, in which event application must be made
within the | 23 | | new eligibility period.
| 24 | | (c) As to the group health benefits program contracted to | 25 | | begin or
continue after June 30, 1973, each annuitant, | 26 | | survivor, and retired employee shall become immediately
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| 1 | | eligible for all benefits available under that program. Each | 2 | | annuitant, survivor, and retired employee shall have coverage | 3 | | effective immediately, provided that the election is properly | 4 | | filed in accordance with the required filing dates and | 5 | | procedures specified by the Director, including the completion | 6 | | and submission of all documentation and forms required by the | 7 | | Director. Annuitants, survivors, and retired
employees may | 8 | | elect coverage for eligible dependents and shall have the
| 9 | | coverage effective immediately, provided that the election is | 10 | | properly
filed in accordance with required filing dates and | 11 | | procedures specified
by the Director, except that, for a | 12 | | survivor, the dependent sought to be added on or after the | 13 | | effective date of this amendatory Act of the 97th General | 14 | | Assembly must have been eligible for coverage as a dependent | 15 | | under the deceased member upon whom the survivor's annuity is | 16 | | based in order to be eligible for coverage under the survivor.
| 17 | | Except as otherwise provided in this Act, where husband and | 18 | | wife are
both eligible members, each shall be enrolled as a | 19 | | member and coverage on
their eligible dependent children, if | 20 | | any, may be under the enrollment and
election of either.
| 21 | | Regardless of other provisions herein regarding late | 22 | | enrollment or other
qualifications, as appropriate, the
| 23 | | Director may periodically authorize open enrollment periods | 24 | | for each of the
benefit programs at which time each member may | 25 | | elect enrollment or change
of enrollment without regard to age, | 26 | | sex, health, or other qualification
under the conditions as may |
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| 1 | | be prescribed in rules and regulations
supplementing this Act. | 2 | | Special open enrollment periods may be declared by
the Director | 3 | | for certain members only when special circumstances occur that
| 4 | | affect only those members.
| 5 | | (d) Beginning with fiscal year 2003 and for all subsequent | 6 | | years, eligible
members may elect not to participate in the | 7 | | program of health benefits as
defined in this Act. The election | 8 | | must be made during the annual benefit
choice period, subject | 9 | | to the conditions in this subsection.
| 10 | | (1) Members must furnish proof of health benefit | 11 | | coverage, either
comprehensive major medical coverage or | 12 | | comprehensive managed care plan,
from a source other than | 13 | | the Department of Central Management Services in
order to | 14 | | elect not to participate in the program.
| 15 | | (2) Members may re-enroll in the Department of Central | 16 | | Management Services
program of health benefits upon | 17 | | showing a qualifying change in status, as
defined in the | 18 | | U.S. Internal Revenue Code, without evidence of | 19 | | insurability
and with no limitations on coverage for | 20 | | pre-existing conditions, provided
that there was not a | 21 | | break in coverage of more than 63 days.
| 22 | | (3) Members may also re-enroll in the program of health | 23 | | benefits during
any annual benefit choice period, without | 24 | | evidence of insurability.
| 25 | | (4) Members who elect not to participate in the program | 26 | | of health benefits
shall be furnished a written explanation |
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| 1 | | of the requirements and limitations
for the election not to | 2 | | participate in the program and for re-enrolling in the
| 3 | | program. The explanation shall also be included in the | 4 | | annual benefit choice
options booklets furnished to | 5 | | members.
| 6 | | (d-5) Beginning July 1, 2005, the Director may establish a | 7 | | program of financial incentives to encourage annuitants | 8 | | receiving a retirement annuity, but who are not eligible for | 9 | | benefits under the federal Medicare health insurance program | 10 | | (Title XVIII of the Social Security Act, as added by Public Law | 11 | | 89-97) to elect not to participate in the program of health | 12 | | benefits provided under this Act. The election by an annuitant | 13 | | not to participate under this program must be made in | 14 | | accordance with the requirements set forth under subsection | 15 | | (d). The financial incentives provided to these annuitants | 16 | | under the program may not exceed $150 per month for each | 17 | | annuitant electing not to participate in the program of health | 18 | | benefits provided under this Act.
| 19 | | (d-6) Beginning July 1, 2013, the Director may establish a | 20 | | program of financial incentives to encourage annuitants with 20 | 21 | | or more years of creditable service but who are not eligible | 22 | | for benefits under the federal Medicare health insurance | 23 | | program (Title XVIII of the Social Security Act, as added by | 24 | | Public Law 89-97) to elect not to participate in the program of | 25 | | health benefits provided under this Act. The election by an | 26 | | annuitant not to participate under this program must be made in |
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| 1 | | accordance with the requirements set forth under subsection | 2 | | (d). The program established under this subsection (d-6) may | 3 | | include a prorated incentive for annuitants with fewer than 20 | 4 | | years of creditable service, as determined by the Director. The | 5 | | financial incentives provided to these annuitants under this | 6 | | program may not exceed $500 per month for each annuitant | 7 | | electing not to participate in the program of health benefits | 8 | | provided under this Act. | 9 | | (e) Notwithstanding any other provision of this Act or the | 10 | | rules adopted
under this Act, if a person participating in the | 11 | | program of health benefits as
the dependent spouse of an | 12 | | eligible member becomes an annuitant, the person may
elect, at | 13 | | the time of becoming an annuitant or during any subsequent | 14 | | annual
benefit choice period, to continue participation as a | 15 | | dependent rather than
as an eligible member for as long as the | 16 | | person continues to be an eligible
dependent. In order to be | 17 | | eligible to make such an election, the person must have been | 18 | | enrolled as a dependent under the program of health benefits | 19 | | for no less than one year prior to becoming an annuitant.
| 20 | | An eligible member who has elected to participate as a | 21 | | dependent may
re-enroll in the program of health benefits as an | 22 | | eligible member (i)
during any subsequent annual benefit choice | 23 | | period or (ii) upon showing a
qualifying change in status, as | 24 | | defined in the U.S. Internal Revenue Code,
without evidence of | 25 | | insurability and with no limitations on coverage for
| 26 | | pre-existing conditions.
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| 1 | | A person who elects to participate in the program of health | 2 | | benefits as
a dependent rather than as an eligible member shall | 3 | | be furnished a written
explanation of the consequences of | 4 | | electing to participate as a dependent and
the conditions and | 5 | | procedures for re-enrolling as an eligible member. The
| 6 | | explanation shall also be included in the annual benefit choice | 7 | | options booklet
furnished to members.
| 8 | | (f) State benefit recipients shall be eligible to enroll in | 9 | | the program of health benefits on the first day of active State | 10 | | service. State benefit recipients who were not eligible to | 11 | | enroll in the program of health benefits immediately prior to | 12 | | the effective date of this amendatory Act of the 99th General | 13 | | Assembly, but who became eligible to enroll in the program of | 14 | | health benefits as a result of this amendatory Act of the 99th | 15 | | General Assembly, may elect to participate in coverage in | 16 | | accordance with procedures specified
by the Director or during
| 17 | | any annual benefit choice period. Notwithstanding any other | 18 | | provision of this Act, State benefit recipients shall be | 19 | | eligible only for the program of health benefits and shall not | 20 | | be eligible for group life insurance benefits or other optional | 21 | | coverages or benefits available to employees. | 22 | | (Source: P.A. 97-668, eff. 1-13-12; 98-19, eff. 6-10-13.)
| 23 | | (5 ILCS 375/10) (from Ch. 127, par. 530)
| 24 | | Sec. 10. Contributions by the State and members.
| 25 | | (a) The State shall pay the cost of basic non-contributory |
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| 1 | | group life
insurance and, subject to member paid contributions | 2 | | set by the Department or
required by this Section and except as | 3 | | provided in this Section, the basic program of group health | 4 | | benefits on each
eligible member, except a member, not | 5 | | otherwise
covered by this Act, who has retired as a | 6 | | participating member under Article 2
of the Illinois Pension | 7 | | Code but is ineligible for the retirement annuity under
Section | 8 | | 2-119 of the Illinois Pension Code, and part of each eligible | 9 | | member's
and retired member's premiums for health insurance | 10 | | coverage for enrolled
dependents as provided by Section 9. The | 11 | | State shall pay the cost of the basic
program of group health | 12 | | benefits only after benefits are reduced by the amount
of | 13 | | benefits covered by Medicare for all members and dependents
who | 14 | | are eligible for benefits under Social Security or
the Railroad | 15 | | Retirement system or who had sufficient Medicare-covered
| 16 | | government employment, except that such reduction in benefits | 17 | | shall apply only
to those members and dependents who (1) first | 18 | | become eligible
for such Medicare coverage on or after July 1, | 19 | | 1992; or (2) are
Medicare-eligible members or dependents of a | 20 | | local government unit which began
participation in the program | 21 | | on or after July 1, 1992; or (3) remain eligible
for, but no | 22 | | longer receive Medicare coverage which they had been receiving | 23 | | on
or after July 1, 1992. The Department may determine the | 24 | | aggregate level of the
State's contribution on the basis of | 25 | | actual cost of medical services adjusted
for age, sex or | 26 | | geographic or other demographic characteristics which affect
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| 1 | | the costs of such programs.
| 2 | | The cost of participation in the basic program of group | 3 | | health benefits
for the dependent or survivor of a living or | 4 | | deceased retired employee who was
formerly employed by the | 5 | | University of Illinois in the Cooperative Extension
Service and | 6 | | would be an annuitant but for the fact that he or she was made
| 7 | | ineligible to participate in the State Universities Retirement | 8 | | System by clause
(4) of subsection (a) of Section 15-107 of the | 9 | | Illinois Pension Code shall not
be greater than the cost of | 10 | | participation that would otherwise apply to that
dependent or | 11 | | survivor if he or she were the dependent or survivor of an
| 12 | | annuitant under the State Universities Retirement System.
| 13 | | (a-1) (Blank).
| 14 | | (a-2) (Blank).
| 15 | | (a-3) (Blank).
| 16 | | (a-4) (Blank).
| 17 | | (a-5) (Blank).
| 18 | | (a-6) (Blank).
| 19 | | (a-7) (Blank).
| 20 | | (a-8) Any annuitant, survivor, or retired employee may | 21 | | waive or terminate coverage in
the program of group health | 22 | | benefits. Any such annuitant, survivor, or retired employee
who | 23 | | has waived or terminated coverage may enroll or re-enroll in | 24 | | the
program of group health benefits only during the annual | 25 | | benefit choice period,
as determined by the Director; except | 26 | | that in the event of termination of
coverage due to nonpayment |
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| 1 | | of premiums, the annuitant, survivor, or retired employee
may | 2 | | not re-enroll in the program.
| 3 | | (a-8.5) Beginning on the effective date of this amendatory | 4 | | Act of the 97th General Assembly, the Director of Central | 5 | | Management Services shall, on an annual basis, determine the | 6 | | amount that the State shall contribute toward the basic program | 7 | | of group health benefits on behalf of annuitants (including | 8 | | individuals who (i) participated in the General Assembly | 9 | | Retirement System, the State Employees' Retirement System of | 10 | | Illinois, the State Universities Retirement System, the | 11 | | Teachers' Retirement System of the State of Illinois, or the | 12 | | Judges Retirement System of Illinois and (ii) qualify as | 13 | | annuitants under subsection (b) of Section 3 of this Act), | 14 | | survivors (including individuals who (i) receive an annuity as | 15 | | a survivor of an individual who participated in the General | 16 | | Assembly Retirement System, the State Employees' Retirement | 17 | | System of Illinois, the State Universities Retirement System, | 18 | | the Teachers' Retirement System of the State of Illinois, or | 19 | | the Judges Retirement System of Illinois and (ii) qualify as | 20 | | survivors under subsection (q) of Section 3 of this Act), and | 21 | | retired employees (as defined in subsection (p) of Section 3 of | 22 | | this Act). The remainder of the cost of coverage for each | 23 | | annuitant, survivor, or retired employee, as determined by the | 24 | | Director of Central Management Services, shall be the | 25 | | responsibility of that annuitant, survivor, or retired | 26 | | employee. |
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| 1 | | Contributions required of annuitants, survivors, and | 2 | | retired employees shall be the same for all retirement systems | 3 | | and shall also be based on whether an individual has made an | 4 | | election under Section 15-135.1 of the Illinois Pension Code. | 5 | | Contributions may be based on annuitants', survivors', or | 6 | | retired employees' Medicare eligibility, but may not be based | 7 | | on Social Security eligibility. | 8 | | (a-9) No later than May 1 of each calendar year, the | 9 | | Director
of Central Management Services shall certify in | 10 | | writing to the Executive
Secretary of the State Employees' | 11 | | Retirement System of Illinois the amounts
of the Medicare | 12 | | supplement health care premiums and the amounts of the
health | 13 | | care premiums for all other retirees who are not Medicare | 14 | | eligible.
| 15 | | A separate calculation of the premiums based upon the | 16 | | actual cost of each
health care plan shall be so certified.
| 17 | | The Director of Central Management Services shall provide | 18 | | to the
Executive Secretary of the State Employees' Retirement | 19 | | System of
Illinois such information, statistics, and other data | 20 | | as he or she
may require to review the premium amounts | 21 | | certified by the Director
of Central Management Services.
| 22 | | The Department of Central Management Services, or any | 23 | | successor agency designated to procure healthcare contracts | 24 | | pursuant to this Act, is authorized to establish funds, | 25 | | separate accounts provided by any bank or banks as defined by | 26 | | the Illinois Banking Act, or separate accounts provided by any |
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| 1 | | savings and loan association or associations as defined by the | 2 | | Illinois Savings and Loan Act of 1985 to be held by the | 3 | | Director, outside the State treasury, for the purpose of | 4 | | receiving the transfer of moneys from the Local Government | 5 | | Health Insurance Reserve Fund. The Department may promulgate | 6 | | rules further defining the methodology for the transfers. Any | 7 | | interest earned by moneys in the funds or accounts shall inure | 8 | | to the Local Government Health Insurance Reserve Fund. The | 9 | | transferred moneys, and interest accrued thereon, shall be used | 10 | | exclusively for transfers to administrative service | 11 | | organizations or their financial institutions for payments of | 12 | | claims to claimants and providers under the self-insurance | 13 | | health plan. The transferred moneys, and interest accrued | 14 | | thereon, shall not be used for any other purpose including, but | 15 | | not limited to, reimbursement of administration fees due the | 16 | | administrative service organization pursuant to its contract | 17 | | or contracts with the Department.
| 18 | | (b) State employees who become eligible for this program on | 19 | | or after January
1, 1980 in positions normally requiring actual | 20 | | performance of duty not less
than 1/2 of a normal work period | 21 | | but not equal to at least 30 hours per week that of a normal | 22 | | work period ,
shall be given the option of participating in the | 23 | | available program. If the
employee elects coverage, the State | 24 | | shall contribute on behalf of such employee
to the cost of the | 25 | | employee's benefit and any applicable dependent supplement,
| 26 | | that sum which bears the same percentage as that percentage of |
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| 1 | | time the
employee regularly works when compared to normal work | 2 | | period.
| 3 | | (c) The basic non-contributory coverage from the basic | 4 | | program of
group health benefits shall be continued for each | 5 | | employee not in pay status or
on active service by reason of | 6 | | (1) leave of absence due to illness or injury,
(2) authorized | 7 | | educational leave of absence or sabbatical leave, or (3)
| 8 | | military leave. This coverage shall continue until
expiration | 9 | | of authorized leave and return to active service, but not to | 10 | | exceed
24 months for leaves under item (1) or (2). This | 11 | | 24-month limitation and the
requirement of returning to active | 12 | | service shall not apply to persons receiving
ordinary or | 13 | | accidental disability benefits or retirement benefits through | 14 | | the
appropriate State retirement system or benefits under the | 15 | | Workers' Compensation
or Occupational Disease Act.
| 16 | | (c-1) Notwithstanding any other provision of law, a State | 17 | | benefit recipient electing to participate in the program of | 18 | | health benefits shall be required to pay the entire premium of | 19 | | the coverage that has been elected, including the entire | 20 | | premium of any coverage elected for eligible dependents of the | 21 | | State benefit recipient. | 22 | | (d) The basic group life insurance coverage shall continue, | 23 | | with
full State contribution, where such person is (1) absent | 24 | | from active
service by reason of disability arising from any | 25 | | cause other than
self-inflicted, (2) on authorized educational | 26 | | leave of absence or
sabbatical leave, or (3) on military leave.
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| 1 | | (e) Where the person is in non-pay status for a period in | 2 | | excess of
30 days or on leave of absence, other than by reason | 3 | | of disability,
educational or sabbatical leave, or military | 4 | | leave, such
person may continue coverage only by making | 5 | | personal
payment equal to the amount normally contributed by | 6 | | the State on such person's
behalf. Such payments and coverage | 7 | | may be continued: (1) until such time as
the person returns to | 8 | | a status eligible for coverage at State expense, but not
to | 9 | | exceed 24 months or (2) until such person's employment or | 10 | | annuitant status
with the State is terminated (exclusive of any | 11 | | additional service imposed pursuant to law).
| 12 | | (f) The Department shall establish by rule the extent to | 13 | | which other
employee benefits will continue for persons in | 14 | | non-pay status or who are
not in active service.
| 15 | | (g) The State shall not pay the cost of the basic | 16 | | non-contributory
group life insurance, program of health | 17 | | benefits and other employee benefits
for members who are | 18 | | survivors as defined by paragraphs (1) and (2) of
subsection | 19 | | (q) of Section 3 of this Act. The costs of benefits for these
| 20 | | survivors shall be paid by the survivors or by the University | 21 | | of Illinois
Cooperative Extension Service, or any combination | 22 | | thereof.
However, the State shall pay the amount of the | 23 | | reduction in the cost of
participation, if any, resulting from | 24 | | the amendment to subsection (a) made
by this amendatory Act of | 25 | | the 91st General Assembly.
| 26 | | (h) Those persons occupying positions with any department |
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| 1 | | as a result
of emergency appointments pursuant to Section 8b.8 | 2 | | of the Personnel Code
who are not considered employees under | 3 | | this Act shall be given the option
of participating in the | 4 | | programs of group life insurance, health benefits and
other | 5 | | employee benefits. Such persons electing coverage may | 6 | | participate only
by making payment equal to the amount normally | 7 | | contributed by the State for
similarly situated employees. Such | 8 | | amounts shall be determined by the
Director. Such payments and | 9 | | coverage may be continued until such time as the
person becomes | 10 | | an employee pursuant to this Act or such person's appointment | 11 | | is
terminated.
| 12 | | (i) Any unit of local government within the State of | 13 | | Illinois
may apply to the Director to have its employees, | 14 | | annuitants, and their
dependents provided group health | 15 | | coverage under this Act on a non-insured
basis. To participate, | 16 | | a unit of local government must agree to enroll
all of its | 17 | | employees, who may select coverage under either the State group
| 18 | | health benefits plan or a health maintenance organization that | 19 | | has
contracted with the State to be available as a health care | 20 | | provider for
employees as defined in this Act. A unit of local | 21 | | government must remit the
entire cost of providing coverage | 22 | | under the State group health benefits plan
or, for coverage | 23 | | under a health maintenance organization, an amount determined
| 24 | | by the Director based on an analysis of the sex, age, | 25 | | geographic location, or
other relevant demographic variables | 26 | | for its employees, except that the unit of
local government |
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| 1 | | shall not be required to enroll those of its employees who are
| 2 | | covered spouses or dependents under this plan or another group | 3 | | policy or plan
providing health benefits as long as (1) an | 4 | | appropriate official from the unit
of local government attests | 5 | | that each employee not enrolled is a covered spouse
or | 6 | | dependent under this plan or another group policy or plan, and | 7 | | (2) at least
50% of the employees are enrolled and the unit of | 8 | | local government remits
the entire cost of providing coverage | 9 | | to those employees, except that a
participating school district | 10 | | must have enrolled at least 50% of its full-time
employees who | 11 | | have not waived coverage under the district's group health
plan | 12 | | by participating in a component of the district's cafeteria | 13 | | plan. A
participating school district is not required to enroll | 14 | | a full-time employee
who has waived coverage under the | 15 | | district's health plan, provided that an
appropriate official | 16 | | from the participating school district attests that the
| 17 | | full-time employee has waived coverage by participating in a | 18 | | component of the
district's cafeteria plan. For the purposes of | 19 | | this subsection, "participating
school district" includes a | 20 | | unit of local government whose primary purpose is
education as | 21 | | defined by the Department's rules.
| 22 | | Employees of a participating unit of local government who | 23 | | are not enrolled
due to coverage under another group health | 24 | | policy or plan may enroll in
the event of a qualifying change | 25 | | in status, special enrollment, special
circumstance as defined | 26 | | by the Director, or during the annual Benefit Choice
Period. A |
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| 1 | | participating unit of local government may also elect to cover | 2 | | its
annuitants. Dependent coverage shall be offered on an | 3 | | optional basis, with the
costs paid by the unit of local | 4 | | government, its employees, or some combination
of the two as | 5 | | determined by the unit of local government. The unit of local
| 6 | | government shall be responsible for timely collection and | 7 | | transmission of
dependent premiums.
| 8 | | The Director shall annually determine monthly rates of | 9 | | payment, subject
to the following constraints:
| 10 | | (1) In the first year of coverage, the rates shall be | 11 | | equal to the
amount normally charged to State employees for | 12 | | elected optional coverages
or for enrolled dependents | 13 | | coverages or other contributory coverages, or
contributed | 14 | | by the State for basic insurance coverages on behalf of its
| 15 | | employees, adjusted for differences between State | 16 | | employees and employees
of the local government in age, | 17 | | sex, geographic location or other relevant
demographic | 18 | | variables, plus an amount sufficient to pay for the | 19 | | additional
administrative costs of providing coverage to | 20 | | employees of the unit of
local government and their | 21 | | dependents.
| 22 | | (2) In subsequent years, a further adjustment shall be | 23 | | made to reflect
the actual prior years' claims experience | 24 | | of the employees of the unit of
local government.
| 25 | | In the case of coverage of local government employees under | 26 | | a health
maintenance organization, the Director shall annually |
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| 1 | | determine for each
participating unit of local government the | 2 | | maximum monthly amount the unit
may contribute toward that | 3 | | coverage, based on an analysis of (i) the age,
sex, geographic | 4 | | location, and other relevant demographic variables of the
| 5 | | unit's employees and (ii) the cost to cover those employees | 6 | | under the State
group health benefits plan. The Director may | 7 | | similarly determine the
maximum monthly amount each unit of | 8 | | local government may contribute toward
coverage of its | 9 | | employees' dependents under a health maintenance organization.
| 10 | | Monthly payments by the unit of local government or its | 11 | | employees for
group health benefits plan or health maintenance | 12 | | organization coverage shall
be deposited in the Local | 13 | | Government Health Insurance Reserve Fund.
| 14 | | The Local Government Health Insurance Reserve Fund is | 15 | | hereby created as a nonappropriated trust fund to be held | 16 | | outside the State Treasury, with the State Treasurer as | 17 | | custodian. The Local Government Health Insurance Reserve Fund | 18 | | shall be a continuing
fund not subject to fiscal year | 19 | | limitations. The Local Government Health Insurance Reserve | 20 | | Fund is not subject to administrative charges or charge-backs, | 21 | | including but not limited to those authorized under Section 8h | 22 | | of the State Finance Act. All revenues arising from the | 23 | | administration of the health benefits program established | 24 | | under this Section shall be deposited into the Local Government | 25 | | Health Insurance Reserve Fund. Any interest earned on moneys in | 26 | | the Local Government Health Insurance Reserve Fund shall be |
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| 1 | | deposited into the Fund. All expenditures from this Fund
shall | 2 | | be used for payments for health care benefits for local | 3 | | government and rehabilitation facility
employees, annuitants, | 4 | | and dependents, and to reimburse the Department or
its | 5 | | administrative service organization for all expenses incurred | 6 | | in the
administration of benefits. No other State funds may be | 7 | | used for these
purposes.
| 8 | | A local government employer's participation or desire to | 9 | | participate
in a program created under this subsection shall | 10 | | not limit that employer's
duty to bargain with the | 11 | | representative of any collective bargaining unit
of its | 12 | | employees.
| 13 | | (j) Any rehabilitation facility within the State of | 14 | | Illinois may apply
to the Director to have its employees, | 15 | | annuitants, and their eligible
dependents provided group | 16 | | health coverage under this Act on a non-insured
basis. To | 17 | | participate, a rehabilitation facility must agree to enroll all
| 18 | | of its employees and remit the entire cost of providing such | 19 | | coverage for
its employees, except that the rehabilitation | 20 | | facility shall not be
required to enroll those of its employees | 21 | | who are covered spouses or
dependents under this plan or | 22 | | another group policy or plan providing health
benefits as long | 23 | | as (1) an appropriate official from the rehabilitation
facility | 24 | | attests that each employee not enrolled is a covered spouse or
| 25 | | dependent under this plan or another group policy or plan, and | 26 | | (2) at least
50% of the employees are enrolled and the |
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| 1 | | rehabilitation facility remits
the entire cost of providing | 2 | | coverage to those employees. Employees of a
participating | 3 | | rehabilitation facility who are not enrolled due to coverage
| 4 | | under another group health policy or plan may enroll
in the | 5 | | event of a qualifying change in status, special enrollment, | 6 | | special
circumstance as defined by the Director, or during the | 7 | | annual Benefit Choice
Period. A participating rehabilitation | 8 | | facility may also elect
to cover its annuitants. Dependent | 9 | | coverage shall be offered on an optional
basis, with the costs | 10 | | paid by the rehabilitation facility, its employees, or
some | 11 | | combination of the 2 as determined by the rehabilitation | 12 | | facility. The
rehabilitation facility shall be responsible for | 13 | | timely collection and
transmission of dependent premiums.
| 14 | | The Director shall annually determine quarterly rates of | 15 | | payment, subject
to the following constraints:
| 16 | | (1) In the first year of coverage, the rates shall be | 17 | | equal to the amount
normally charged to State employees for | 18 | | elected optional coverages or for
enrolled dependents | 19 | | coverages or other contributory coverages on behalf of
its | 20 | | employees, adjusted for differences between State | 21 | | employees and
employees of the rehabilitation facility in | 22 | | age, sex, geographic location
or other relevant | 23 | | demographic variables, plus an amount sufficient to pay
for | 24 | | the additional administrative costs of providing coverage | 25 | | to employees
of the rehabilitation facility and their | 26 | | dependents.
|
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| 1 | | (2) In subsequent years, a further adjustment shall be | 2 | | made to reflect
the actual prior years' claims experience | 3 | | of the employees of the
rehabilitation facility.
| 4 | | Monthly payments by the rehabilitation facility or its | 5 | | employees for
group health benefits shall be deposited in the | 6 | | Local Government Health
Insurance Reserve Fund.
| 7 | | (k) Any domestic violence shelter or service within the | 8 | | State of Illinois
may apply to the Director to have its | 9 | | employees, annuitants, and their
dependents provided group | 10 | | health coverage under this Act on a non-insured
basis. To | 11 | | participate, a domestic violence shelter or service must agree | 12 | | to
enroll all of its employees and pay the entire cost of | 13 | | providing such coverage
for its employees. The domestic | 14 | | violence shelter shall not be required to enroll those of its | 15 | | employees who are covered spouses or dependents under this plan | 16 | | or another group policy or plan providing health benefits as | 17 | | long as (1) an appropriate official from the domestic violence | 18 | | shelter attests that each employee not enrolled is a covered | 19 | | spouse or dependent under this plan or another group policy or | 20 | | plan and (2) at least 50% of the employees are enrolled and the | 21 | | domestic violence shelter remits the entire cost of providing | 22 | | coverage to those employees. Employees of a participating | 23 | | domestic violence shelter who are not enrolled due to coverage | 24 | | under another group health policy or plan may enroll in the | 25 | | event of a qualifying change in status, special enrollment, or | 26 | | special circumstance as defined by the Director or during the |
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| 1 | | annual Benefit Choice Period. A participating domestic | 2 | | violence shelter may also elect
to cover its annuitants. | 3 | | Dependent coverage shall be offered on an optional
basis, with
| 4 | | employees, or some combination of the 2 as determined by the | 5 | | domestic violence
shelter or service. The domestic violence | 6 | | shelter or service shall be
responsible for timely collection | 7 | | and transmission of dependent premiums.
| 8 | | The Director shall annually determine rates of payment,
| 9 | | subject to the following constraints:
| 10 | | (1) In the first year of coverage, the rates shall be | 11 | | equal to the
amount normally charged to State employees for | 12 | | elected optional coverages
or for enrolled dependents | 13 | | coverages or other contributory coverages on
behalf of its | 14 | | employees, adjusted for differences between State | 15 | | employees and
employees of the domestic violence shelter or | 16 | | service in age, sex, geographic
location or other relevant | 17 | | demographic variables, plus an amount sufficient
to pay for | 18 | | the additional administrative costs of providing coverage | 19 | | to
employees of the domestic violence shelter or service | 20 | | and their dependents.
| 21 | | (2) In subsequent years, a further adjustment shall be | 22 | | made to reflect
the actual prior years' claims experience | 23 | | of the employees of the domestic
violence shelter or | 24 | | service.
| 25 | | Monthly payments by the domestic violence shelter or | 26 | | service or its employees
for group health insurance shall be |
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| 1 | | deposited in the Local Government Health
Insurance Reserve | 2 | | Fund.
| 3 | | (l) A public community college or entity organized pursuant | 4 | | to the
Public Community College Act may apply to the Director | 5 | | initially to have
only annuitants not covered prior to July 1, | 6 | | 1992 by the district's health
plan provided health coverage | 7 | | under this Act on a non-insured basis. The
community college | 8 | | must execute a 2-year contract to participate in the
Local | 9 | | Government Health Plan.
Any annuitant may enroll in the event | 10 | | of a qualifying change in status, special
enrollment, special | 11 | | circumstance as defined by the Director, or during the
annual | 12 | | Benefit Choice Period.
| 13 | | The Director shall annually determine monthly rates of | 14 | | payment subject to
the following constraints: for those | 15 | | community colleges with annuitants
only enrolled, first year | 16 | | rates shall be equal to the average cost to cover
claims for a | 17 | | State member adjusted for demographics, Medicare
| 18 | | participation, and other factors; and in the second year, a | 19 | | further adjustment
of rates shall be made to reflect the actual | 20 | | first year's claims experience
of the covered annuitants.
| 21 | | (l-5) The provisions of subsection (l) become inoperative | 22 | | on July 1, 1999.
| 23 | | (m) The Director shall adopt any rules deemed necessary for
| 24 | | implementation of this amendatory Act of 1989 (Public Act | 25 | | 86-978).
| 26 | | (n) Any child advocacy center within the State of Illinois |
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| 1 | | may apply to the Director to have its employees, annuitants, | 2 | | and their dependents provided group health coverage under this | 3 | | Act on a non-insured basis. To participate, a child advocacy | 4 | | center must agree to enroll all of its employees and pay the | 5 | | entire cost of providing coverage for its employees. The child
| 6 | | advocacy center shall not be required to enroll those of its
| 7 | | employees who are covered spouses or dependents under this plan
| 8 | | or another group policy or plan providing health benefits as
| 9 | | long as (1) an appropriate official from the child advocacy
| 10 | | center attests that each employee not enrolled is a covered
| 11 | | spouse or dependent under this plan or another group policy or
| 12 | | plan and (2) at least 50% of the employees are enrolled and the | 13 | | child advocacy center remits the entire cost of providing | 14 | | coverage to those employees. Employees of a participating child | 15 | | advocacy center who are not enrolled due to coverage under | 16 | | another group health policy or plan may enroll in the event of | 17 | | a qualifying change in status, special enrollment, or special | 18 | | circumstance as defined by the Director or during the annual | 19 | | Benefit Choice Period. A participating child advocacy center | 20 | | may also elect to cover its annuitants. Dependent coverage | 21 | | shall be offered on an optional basis, with the costs paid by | 22 | | the child advocacy center, its employees, or some combination | 23 | | of the 2 as determined by the child advocacy center. The child | 24 | | advocacy center shall be responsible for timely collection and | 25 | | transmission of dependent premiums. | 26 | | The Director shall annually determine rates of payment, |
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| 1 | | subject to the following constraints: | 2 | | (1) In the first year of coverage, the rates shall be | 3 | | equal to the amount normally charged to State employees for | 4 | | elected optional coverages or for enrolled dependents | 5 | | coverages or other contributory coverages on behalf of its | 6 | | employees, adjusted for differences between State | 7 | | employees and employees of the child advocacy center in | 8 | | age, sex, geographic location, or other relevant | 9 | | demographic variables, plus an amount sufficient to pay for | 10 | | the additional administrative costs of providing coverage | 11 | | to employees of the child advocacy center and their | 12 | | dependents. | 13 | | (2) In subsequent years, a further adjustment shall be | 14 | | made to reflect the actual prior years' claims experience | 15 | | of the employees of the child advocacy center. | 16 | | Monthly payments by the child advocacy center or its | 17 | | employees for group health insurance shall be deposited into | 18 | | the Local Government Health Insurance Reserve Fund. | 19 | | (Source: P.A. 97-695, eff. 7-1-12; 98-488, eff. 8-16-13.)
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