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90_HB3881
5 ILCS 375/10 from Ch. 127, par. 530
Amends the State Employees Group Insurance Act of 1971.
Provides that for certain annuitants and survivors who (1)
are required to contribute to the cost of their basic health
coverage, (2) have their benefits based on employment that
began before January 1, 1998, and (3) do not qualify for
Medicare coverage, the State shall pay the difference in the
cost of coverage under the basic program of group health
benefits that results from the person being ineligible for
Medicare coverage. Also makes technical corrections.
Effective immediately.
LRB9006866EGfgA
LRB9006866EGfgA
1 AN ACT to amend the State Employees Group Insurance Act
2 of 1971 by changing Section 10.
3 Be it enacted by the People of the State of Illinois,
4 represented in the General Assembly:
5 Section 5. The State Employees Group Insurance Act of
6 1971 is amended by changing Section 10 as follows:
7 (5 ILCS 375/10) (from Ch. 127, par. 530)
8 Sec. 10. Payments by State; premiums.
9 (a) The State shall pay the cost of basic
10 non-contributory group life insurance and, subject to member
11 paid contributions set by the Department or required by this
12 Section, the basic program of group health benefits on each
13 eligible member, except a member, not otherwise covered by
14 this Act, who has retired as a participating member under
15 Article 2 of the Illinois Pension Code but is ineligible for
16 the retirement annuity under Section 2-119 of the Illinois
17 Pension Code, and part of each eligible member's and retired
18 member's premiums for health insurance coverage for enrolled
19 dependents as provided by Section 9. The State shall pay the
20 cost of the basic program of group health benefits only after
21 benefits are reduced by the amount of benefits covered by
22 Medicare for all retired members and retired dependents aged
23 65 years or older who are entitled to benefits under Social
24 Security or the Railroad Retirement system or who had
25 sufficient Medicare-covered government employment except that
26 such reduction in benefits shall apply only to those retired
27 members or retired dependents who (1) first become eligible
28 for such Medicare coverage on or after July 1, 1992; or (2)
29 remain eligible for, but no longer receive Medicare coverage
30 which they had been receiving on or after July 1, 1992. The
31 Department may determine the aggregate level of the State's
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1 contribution on the basis of actual cost of medical services
2 adjusted for age, sex or geographic or other demographic
3 characteristics which affect the costs of such programs.
4 (a-1) Beginning January 1, 1998, for each person who
5 becomes a new SERS annuitant and participates in the basic
6 program of group health benefits, the State shall contribute
7 toward the cost of the annuitant's coverage under the basic
8 program of group health benefits an amount equal to 5% of
9 that cost for each full year of creditable service upon which
10 the annuitant's retirement annuity is based, up to a maximum
11 of 100% for an annuitant with 20 or more years of creditable
12 service. The remainder of the cost of a new SERS annuitant's
13 coverage under the basic program of group health benefits
14 shall be the responsibility of the annuitant, except as
15 provided in subsection (a-8).
16 (a-2) Beginning January 1, 1998, for each person who
17 becomes a new SERS survivor and participates in the basic
18 program of group health benefits, the State shall contribute
19 toward the cost of the survivor's coverage under the basic
20 program of group health benefits an amount equal to 5% of
21 that cost for each full year of the deceased employee's or
22 deceased annuitant's creditable service in the State
23 Employees' Retirement System of Illinois on the date of
24 death, up to a maximum of 100% for a survivor of an employee
25 or annuitant with 20 or more years of creditable service.
26 The remainder of the cost of the new SERS survivor's coverage
27 under the basic program of group health benefits shall be the
28 responsibility of the survivor, except as provided in
29 subsection (a-8).
30 (a-3) Beginning January 1, 1998, for each person who
31 becomes a new SURS annuitant and participates in the basic
32 program of group health benefits, the State shall contribute
33 toward the cost of the annuitant's coverage under the basic
34 program of group health benefits an amount equal to 5% of
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1 that cost for each full year of creditable service upon which
2 the annuitant's retirement annuity is based, up to a maximum
3 of 100% for an annuitant with 20 or more years of creditable
4 service. The remainder of the cost of a new SURS annuitant's
5 coverage under the basic program of group health benefits
6 shall be the responsibility of the annuitant, except as
7 provided in subsection (a-8).
8 (a-4) Beginning January 1, 1998, for each person who
9 becomes a new SURS retired employee and participates in the
10 basic program of group health benefits, the State shall
11 contribute toward the cost of the retired employee's coverage
12 under the basic program of group health benefits an amount
13 equal to 5% of that cost for each full year that the retired
14 employee was an employee as defined in Section 3, up to a
15 maximum of 100% for a retired employee who was an employee
16 for 20 or more years. The remainder of the cost of a new
17 SURS retired employee's coverage under the basic program of
18 group health benefits shall be the responsibility of the
19 retired employee, except as provided in subsection (a-8).
20 (a-5) Beginning January 1, 1998, for each person who
21 becomes a new SURS survivor and participates in the basic
22 program of group health benefits, the State shall contribute
23 toward the cost of the survivor's coverage under the basic
24 program of group health benefits an amount equal to 5% of
25 that cost for each full year of the deceased employee's or
26 deceased annuitant's creditable service in the State
27 Universities Employees' Retirement System of Illinois on the
28 date of death, up to a maximum of 100% for a survivor of an
29 employee or annuitant with 20 or more years of creditable
30 service. The remainder of the cost of the new SURS
31 survivor's coverage under the basic program of group health
32 benefits shall be the responsibility of the survivor, except
33 as provided in subsection (a-8).
34 (a-6) A new SERS annuitant, new SERS survivor, new SURS
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1 annuitant, new SURS retired employee, or new SURS survivor
2 may waive or terminate coverage in the program of group
3 health benefits. Any such annuitant, survivor, or retired
4 employee who has waived or terminated coverage may enroll or
5 re-enroll in the program of group health benefits only during
6 the annual benefit choice period, as determined by the
7 Director; except that in the event of termination of coverage
8 due to nonpayment of premiums, the annuitant, survivor, or
9 retired employee may not re-enroll in the program.
10 (a-7) No later than May 1 of each calendar year, the
11 Director of Central Management Services shall certify in
12 writing to the Executive Secretary of the State Employee's
13 Retirement System the amounts of the Medicare supplement
14 health care premiums and the amounts of the health care
15 premiums for all other retirees who are not Medicare
16 eligible.
17 A separate calculation of the premiums based upon the
18 actual cost of each health care plan shall be so certified.
19 The Director of Central Management Services shall provide
20 to the Executive Secretary of the State Employee's Retirement
21 System such information, statistics, and other data he or she
22 as he/she may require to review the premium amounts certified
23 by the Director of Central Management Services.
24 (a-8) In the case of a person who is required under
25 subsection (a-1), (a-2), (a-3), (a-4), or (a-5) to pay a
26 portion of the cost of coverage under the basic program of
27 group health benefits, if the person's status as an
28 annuitant, survivor, or retired employee is based (at least
29 in part) on employment that began before January 1, 1998 and
30 the person does not qualify for Medicare coverage, then (1)
31 the amounts to be contributed by the person and the State
32 under subsection (a-1), (a-2), (a-3), (a-4), or (a-5) shall
33 be calculated as if the person were eligible for Medicare
34 coverage and (2) the State shall also contribute an amount
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1 equal to 100% of the additional cost of coverage under the
2 basic program of group health benefits resulting from the
3 person's ineligibility for Medicare coverage.
4 (b) State employees who become eligible for this program
5 on or after January 1, 1980 in positions, normally requiring
6 actual performance of duty not less than 1/2 of a normal work
7 period but not equal to that of a normal work period, shall
8 be given the option of participating in the available
9 program. If the employee elects coverage, the State shall
10 contribute on behalf of such employee to the cost of the
11 employee's benefit and any applicable dependent supplement,
12 that sum which bears the same percentage as that percentage
13 of time the employee regularly works when compared to normal
14 work period.
15 (c) The basic non-contributory coverage from the basic
16 program of group health benefits shall be continued for each
17 employee not in pay status or on active service by reason of
18 (1) leave of absence due to illness or injury, (2) authorized
19 educational leave of absence or sabbatical leave, or (3)
20 military leave with pay and benefits. This coverage shall
21 continue until expiration of authorized leave and return to
22 active service, but not to exceed 24 months for leaves under
23 item (1) or (2). This 24-month limitation and the requirement
24 of returning to active service shall not apply to persons
25 receiving ordinary or accidental disability benefits or
26 retirement benefits through the appropriate State retirement
27 system or benefits under the Workers' Compensation or
28 Occupational Disease Act.
29 (d) The basic group life insurance coverage shall
30 continue, with full State contribution, where such person is
31 (1) absent from active service by reason of disability
32 arising from any cause other than self-inflicted, (2) on
33 authorized educational leave of absence or sabbatical leave,
34 or (3) on military leave with pay and benefits.
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1 (e) Where the person is in non-pay status for a period
2 in excess of 30 days or on leave of absence, other than by
3 reason of disability, educational or sabbatical leave, or
4 military leave with pay and benefits, such person may
5 continue coverage only by making personal payment equal to
6 the amount normally contributed by the State on such person's
7 behalf. Such payments and coverage may be continued: (1)
8 until such time as the person returns to a status eligible
9 for coverage at State expense, but not to exceed 24 months,
10 (2) until such person's employment or annuitant status with
11 the State is terminated, or (3) for a maximum period of 4
12 years for members on military leave with pay and benefits and
13 military leave without pay and benefits (exclusive of any
14 additional service imposed pursuant to law).
15 (f) The Department shall establish by rule the extent
16 to which other employee benefits will continue for persons in
17 non-pay status or who are not in active service.
18 (g) The State shall not pay the cost of the basic
19 non-contributory group life insurance, program of health
20 benefits and other employee benefits for members who are
21 survivors as defined by paragraphs (1) and (2) of subsection
22 (q) of Section 3 of this Act. The costs of benefits for
23 these survivors shall be paid by the survivors or by the
24 University of Illinois Cooperative Extension Service, or any
25 combination thereof.
26 (h) Those persons occupying positions with any
27 department as a result of emergency appointments pursuant to
28 Section 8b.8 of the Personnel Code who are not considered
29 employees under this Act shall be given the option of
30 participating in the programs of group life insurance, health
31 benefits and other employee benefits. Such persons electing
32 coverage may participate only by making payment equal to the
33 amount normally contributed by the State for similarly
34 situated employees. Such amounts shall be determined by the
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1 Director. Such payments and coverage may be continued until
2 such time as the person becomes an employee pursuant to this
3 Act or such person's appointment is terminated.
4 (i) Any unit of local government within the State of
5 Illinois may apply to the Director to have its employees,
6 annuitants, and their dependents provided group health
7 coverage under this Act on a non-insured basis. To
8 participate, a unit of local government must agree to enroll
9 all of its employees, who may select coverage under either
10 the State group health insurance plan or a health maintenance
11 organization that has contracted with the State to be
12 available as a health care provider for employees as defined
13 in this Act. A unit of local government must remit the
14 entire cost of providing coverage under the State group
15 health insurance plan or, for coverage under a health
16 maintenance organization, an amount determined by the
17 Director based on an analysis of the sex, age, geographic
18 location, or other relevant demographic variables for its
19 employees, except that the unit of local government shall not
20 be required to enroll those of its employees who are covered
21 spouses or dependents under this plan or another group policy
22 or plan providing health benefits as long as (1) an
23 appropriate official from the unit of local government
24 attests that each employee not enrolled is a covered spouse
25 or dependent under this plan or another group policy or plan,
26 and (2) at least 85% of the employees are enrolled and the
27 unit of local government remits the entire cost of providing
28 coverage to those employees. Employees of a participating
29 unit of local government who are not enrolled due to coverage
30 under another group health policy or plan may enroll at a
31 later date subject to submission of satisfactory evidence of
32 insurability and provided that no benefits shall be payable
33 for services incurred during the first 6 months of coverage
34 to the extent the services are in connection with any
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1 pre-existing condition. A participating unit of local
2 government may also elect to cover its annuitants. Dependent
3 coverage shall be offered on an optional basis, with the
4 costs paid by the unit of local government, its employees, or
5 some combination of the two as determined by the unit of
6 local government. The unit of local government shall be
7 responsible for timely collection and transmission of
8 dependent premiums.
9 The Director shall annually determine monthly rates of
10 payment, subject to the following constraints:
11 (1) In the first year of coverage, the rates shall
12 be equal to the amount normally charged to State
13 employees for elected optional coverages or for enrolled
14 dependents coverages or other contributory coverages, or
15 contributed by the State for basic insurance coverages on
16 behalf of its employees, adjusted for differences between
17 State employees and employees of the local government in
18 age, sex, geographic location or other relevant
19 demographic variables, plus an amount sufficient to pay
20 for the additional administrative costs of providing
21 coverage to employees of the unit of local government and
22 their dependents.
23 (2) In subsequent years, a further adjustment shall
24 be made to reflect the actual prior years' claims
25 experience of the employees of the unit of local
26 government.
27 In the case of coverage of local government employees
28 under a health maintenance organization, the Director shall
29 annually determine for each participating unit of local
30 government the maximum monthly amount the unit may contribute
31 toward that coverage, based on an analysis of (i) the age,
32 sex, geographic location, and other relevant demographic
33 variables of the unit's employees and (ii) the cost to cover
34 those employees under the State group health insurance plan.
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1 The Director may similarly determine the maximum monthly
2 amount each unit of local government may contribute toward
3 coverage of its employees' dependents under a health
4 maintenance organization.
5 Monthly payments by the unit of local government or its
6 employees for group health insurance or health maintenance
7 organization coverage shall be deposited in the Local
8 Government Health Insurance Reserve Fund. The Local
9 Government Health Insurance Reserve Fund shall be a
10 continuing fund not subject to fiscal year limitations. All
11 expenditures from this fund shall be used for payments for
12 health care benefits for local government and rehabilitation
13 facility employees, annuitants, and dependents, and to
14 reimburse the Department or its administrative service
15 organization for all expenses incurred in the administration
16 of benefits. No other State funds may be used for these
17 purposes.
18 A local government employer's participation or desire to
19 participate in a program created under this subsection shall
20 not limit that employer's duty to bargain with the
21 representative of any collective bargaining unit of its
22 employees.
23 (j) Any rehabilitation facility within the State of
24 Illinois may apply to the Director to have its employees,
25 annuitants, and their dependents provided group health
26 coverage under this Act on a non-insured basis. To
27 participate, a rehabilitation facility must agree to enroll
28 all of its employees and remit the entire cost of providing
29 such coverage for its employees, except that the
30 rehabilitation facility shall not be required to enroll those
31 of its employees who are covered spouses or dependents under
32 this plan or another group policy or plan providing health
33 benefits as long as (1) an appropriate official from the
34 rehabilitation facility attests that each employee not
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1 enrolled is a covered spouse or dependent under this plan or
2 another group policy or plan, and (2) at least 85% of the
3 employees are enrolled and the rehabilitation facility remits
4 the entire cost of providing coverage to those employees.
5 Employees of a participating rehabilitation facility who are
6 not enrolled due to coverage under another group health
7 policy or plan may enroll at a later date subject to
8 submission of satisfactory evidence of insurability and
9 provided that no benefits shall be payable for services
10 incurred during the first 6 months of coverage to the extent
11 the services are in connection with any pre-existing
12 condition. A participating rehabilitation facility may also
13 elect to cover its annuitants. Dependent coverage shall be
14 offered on an optional basis, with the costs paid by the
15 rehabilitation facility, its employees, or some combination
16 of the 2 as determined by the rehabilitation facility. The
17 rehabilitation facility shall be responsible for timely
18 collection and transmission of dependent premiums.
19 The Director shall annually determine quarterly rates of
20 payment, subject to the following constraints:
21 (1) In the first year of coverage, the rates shall
22 be equal to the amount normally charged to State
23 employees for elected optional coverages or for enrolled
24 dependents coverages or other contributory coverages on
25 behalf of its employees, adjusted for differences between
26 State employees and employees of the rehabilitation
27 facility in age, sex, geographic location or other
28 relevant demographic variables, plus an amount sufficient
29 to pay for the additional administrative costs of
30 providing coverage to employees of the rehabilitation
31 facility and their dependents.
32 (2) In subsequent years, a further adjustment shall
33 be made to reflect the actual prior years' claims
34 experience of the employees of the rehabilitation
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1 facility.
2 Monthly payments by the rehabilitation facility or its
3 employees for group health insurance shall be deposited in
4 the Local Government Health Insurance Reserve Fund.
5 (k) Any domestic violence shelter or service within the
6 State of Illinois may apply to the Director to have its
7 employees, annuitants, and their dependents provided group
8 health coverage under this Act on a non-insured basis. To
9 participate, a domestic violence shelter or service must
10 agree to enroll all of its employees and pay the entire cost
11 of providing such coverage for its employees. A
12 participating domestic violence shelter may also elect to
13 cover its annuitants. Dependent coverage shall be offered on
14 an optional basis, with employees, or some combination of the
15 2 as determined by the domestic violence shelter or service.
16 The domestic violence shelter or service shall be responsible
17 for timely collection and transmission of dependent premiums.
18 The Director shall annually determine quarterly rates of
19 payment, subject to the following constraints:
20 (1) In the first year of coverage, the rates shall
21 be equal to the amount normally charged to State
22 employees for elected optional coverages or for enrolled
23 dependents coverages or other contributory coverages on
24 behalf of its employees, adjusted for differences between
25 State employees and employees of the domestic violence
26 shelter or service in age, sex, geographic location or
27 other relevant demographic variables, plus an amount
28 sufficient to pay for the additional administrative costs
29 of providing coverage to employees of the domestic
30 violence shelter or service and their dependents.
31 (2) In subsequent years, a further adjustment shall
32 be made to reflect the actual prior years' claims
33 experience of the employees of the domestic violence
34 shelter or service.
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1 (3) In no case shall the rate be less than the
2 amount normally charged to State employees or contributed
3 by the State on behalf of its employees.
4 Monthly payments by the domestic violence shelter or
5 service or its employees for group health insurance shall be
6 deposited in the Local Government Health Insurance Reserve
7 Fund.
8 (l) A public community college or entity organized
9 pursuant to the Public Community College Act may apply to the
10 Director initially to have only annuitants not covered prior
11 to July 1, 1992 by the district's health plan provided health
12 coverage under this Act on a non-insured basis. The
13 community college must execute a 2-year contract to
14 participate in the Local Government Health Plan. Those
15 annuitants enrolled initially under this contract shall have
16 no benefits payable for services incurred during the first 6
17 months of coverage to the extent the services are in
18 connection with any pre-existing condition. Any annuitant
19 who may enroll after this initial enrollment period shall be
20 subject to submission of satisfactory evidence of
21 insurability and to the pre-existing conditions limitation.
22 The Director shall annually determine monthly rates of
23 payment subject to the following constraints: for those
24 community colleges with annuitants only enrolled, first year
25 rates shall be equal to the average cost to cover claims for
26 a State member adjusted for demographics, Medicare
27 participation, and other factors; and in the second year, a
28 further adjustment of rates shall be made to reflect the
29 actual first year's claims experience of the covered
30 annuitants.
31 (m) The Director shall adopt any rules deemed necessary
32 for implementation of this amendatory Act of 1989 (Public Act
33 86-978).
34 (Source: P.A. 89-53, eff. 7-1-95; 89-236, eff. 8-4-95;
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1 89-324, eff. 8-13-95; 89-626, eff. 8-9-96; 90-65, eff.
2 7-7-97.)
3 Section 99. Effective date. This Act takes effect upon
4 becoming law.