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| [ Engrossed ] | [ Enrolled ] | [ House Amendment 002 ] |
91_SB0251
LRB9102764EGfg
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 The cost of participation in the basic program of group
5 health benefits for the dependent or survivor of a living or
6 deceased retired employee who was formerly employed by the
7 University of Illinois in the Cooperative Extension Service
8 and would be an annuitant but for the fact that he or she was
9 made ineligible to participate in the State Universities
10 Retirement System by clause (4) of subsection (a) of Section
11 15-107 of the Illinois Pension Code shall not be greater than
12 the cost of participation that would otherwise apply to that
13 dependent or survivor if he or she were the dependent or
14 survivor of an annuitant under the State Universities
15 Retirement System.
16 (a-1) Beginning January 1, 1998, for each person who
17 becomes a new SERS annuitant and participates in the basic
18 program of group health benefits, the State shall contribute
19 toward the cost of the annuitant'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 creditable service upon which
22 the annuitant's retirement annuity is based, up to a maximum
23 of 100% for an annuitant with 20 or more years of creditable
24 service. The remainder of the cost of a new SERS annuitant's
25 coverage under the basic program of group health benefits
26 shall be the responsibility of the annuitant.
27 (a-2) Beginning January 1, 1998, for each person who
28 becomes a new SERS survivor and participates in the basic
29 program of group health benefits, the State shall contribute
30 toward the cost of the survivor's coverage under the basic
31 program of group health benefits an amount equal to 5% of
32 that cost for each full year of the deceased employee's or
33 deceased annuitant's creditable service in the State
34 Employees' Retirement System of Illinois on the date of
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1 death, up to a maximum of 100% for a survivor of an employee
2 or annuitant with 20 or more years of creditable service.
3 The remainder of the cost of the new SERS survivor's coverage
4 under the basic program of group health benefits shall be the
5 responsibility of the survivor.
6 (a-3) Beginning January 1, 1998, for each person who
7 becomes a new SURS annuitant and participates in the basic
8 program of group health benefits, the State shall contribute
9 toward the cost of the annuitant's coverage under the basic
10 program of group health benefits an amount equal to 5% of
11 that cost for each full year of creditable service upon which
12 the annuitant's retirement annuity is based, up to a maximum
13 of 100% for an annuitant with 20 or more years of creditable
14 service. The remainder of the cost of a new SURS annuitant's
15 coverage under the basic program of group health benefits
16 shall be the responsibility of the annuitant.
17 (a-4) Beginning January 1, 1998, for each person who
18 becomes a new SURS retired employee and participates in the
19 basic program of group health benefits, the State shall
20 contribute toward the cost of the retired employee's coverage
21 under the basic program of group health benefits an amount
22 equal to 5% of that cost for each full year that the retired
23 employee was an employee as defined in Section 3, up to a
24 maximum of 100% for a retired employee who was an employee
25 for 20 or more years. The remainder of the cost of a new
26 SURS retired employee's coverage under the basic program of
27 group health benefits shall be the responsibility of the
28 retired employee.
29 (a-5) Beginning January 1, 1998, for each person who
30 becomes a new SURS survivor and participates in the basic
31 program of group health benefits, the State shall contribute
32 toward the cost of the survivor's coverage under the basic
33 program of group health benefits an amount equal to 5% of
34 that cost for each full year of the deceased employee's or
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1 deceased annuitant's creditable service in the State
2 Universities Retirement System on the date of death, up to a
3 maximum of 100% for a survivor of an employee or annuitant
4 with 20 or more years of creditable service. The remainder
5 of the cost of the new SURS survivor's coverage under the
6 basic program of group health benefits shall be the
7 responsibility of the survivor.
8 (a-6) Beginning July 1, 1998, for each person who
9 becomes a new TRS State annuitant and participates in the
10 basic program of group health benefits, the State shall
11 contribute toward the cost of the annuitant's coverage under
12 the basic program of group health benefits an amount equal to
13 5% of that cost for each full year of creditable service as a
14 teacher as defined in paragraph (2), (3), or (5) of Section
15 16-106 of the Illinois Pension Code upon which the
16 annuitant's retirement annuity is based, up to a maximum of
17 100% for an annuitant with 20 or more years of such
18 creditable service. The remainder of the cost of a new TRS
19 State annuitant's coverage under the basic program of group
20 health benefits shall be the responsibility of the annuitant.
21 (a-7) Beginning July 1, 1998, for each person who
22 becomes a new TRS State survivor and participates in the
23 basic program of group health benefits, the State shall
24 contribute toward the cost of the survivor's coverage under
25 the basic program of group health benefits an amount equal to
26 5% of that cost for each full year of the deceased employee's
27 or deceased annuitant's creditable service as a teacher as
28 defined in paragraph (2), (3), or (5) of Section 16-106 of
29 the Illinois Pension Code on the date of death, up to a
30 maximum of 100% for a survivor of an employee or annuitant
31 with 20 or more years of such creditable service. The
32 remainder of the cost of the new TRS State survivor's
33 coverage under the basic program of group health benefits
34 shall be the responsibility of the survivor.
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1 (a-8) A new SERS annuitant, new SERS survivor, new SURS
2 annuitant, new SURS retired employee, new SURS survivor, new
3 TRS State annuitant, or new TRS State survivor may waive or
4 terminate coverage in the program of group health benefits.
5 Any such annuitant, survivor, or retired employee who has
6 waived or terminated coverage may enroll or re-enroll in the
7 program of group health benefits only during the annual
8 benefit choice period, as determined by the Director; except
9 that in the event of termination of coverage due to
10 nonpayment of premiums, the annuitant, survivor, or retired
11 employee may not re-enroll in the program.
12 (a-9) No later than May 1 of each calendar year, the
13 Director of Central Management Services shall certify in
14 writing to the Executive Secretary of the State Employees'
15 Retirement System of Illinois the amounts of the Medicare
16 supplement health care premiums and the amounts of the health
17 care premiums for all other retirees who are not Medicare
18 eligible.
19 A separate calculation of the premiums based upon the
20 actual cost of each health care plan shall be so certified.
21 The Director of Central Management Services shall provide
22 to the Executive Secretary of the State Employees' Retirement
23 System of Illinois such information, statistics, and other
24 data as he or she may require to review the premium amounts
25 certified by the Director of Central Management Services.
26 (b) State employees who become eligible for this program
27 on or after January 1, 1980 in positions normally requiring
28 actual performance of duty not less than 1/2 of a normal work
29 period but not equal to that of a normal work period, shall
30 be given the option of participating in the available
31 program. If the employee elects coverage, the State shall
32 contribute on behalf of such employee to the cost of the
33 employee's benefit and any applicable dependent supplement,
34 that sum which bears the same percentage as that percentage
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1 of time the employee regularly works when compared to normal
2 work 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 with pay and benefits. This coverage shall
9 continue until expiration of authorized leave and return to
10 active service, but not to exceed 24 months for leaves under
11 item (1) or (2). This 24-month limitation and the requirement
12 of returning to active service shall not apply to persons
13 receiving ordinary or accidental disability benefits or
14 retirement benefits through the appropriate State retirement
15 system or benefits under the Workers' Compensation or
16 Occupational Disease Act.
17 (d) The basic group life insurance coverage shall
18 continue, with full State contribution, where such person is
19 (1) absent from active service by reason of disability
20 arising from any cause other than self-inflicted, (2) on
21 authorized educational leave of absence or sabbatical leave,
22 or (3) on military leave with pay and benefits.
23 (e) Where the person is in non-pay status for a period
24 in excess of 30 days or on leave of absence, other than by
25 reason of disability, educational or sabbatical leave, or
26 military leave with pay and benefits, such person may
27 continue coverage only by making personal payment equal to
28 the amount normally contributed by the State on such person's
29 behalf. Such payments and coverage may be continued: (1)
30 until such time as the person returns to a status eligible
31 for coverage at State expense, but not to exceed 24 months,
32 (2) until such person's employment or annuitant status with
33 the State is terminated, or (3) for a maximum period of 4
34 years for members on military leave with pay and benefits and
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1 military leave without pay and benefits (exclusive of any
2 additional service imposed pursuant to law).
3 (f) The Department shall establish by rule the extent
4 to which other employee benefits will continue for persons in
5 non-pay status or who are not in active service.
6 (g) The State shall not pay the cost of the basic
7 non-contributory group life insurance, program of health
8 benefits and other employee benefits for members who are
9 survivors as defined by paragraphs (1) and (2) of subsection
10 (q) of Section 3 of this Act. The costs of benefits for
11 these survivors shall be paid by the survivors or by the
12 University of Illinois Cooperative Extension Service, or any
13 combination thereof. However, the State shall pay the amount
14 of the reduction in the cost of participation, if any,
15 resulting from the amendment to subsection (a) made by this
16 amendatory Act of the 91st General Assembly.
17 (h) Those persons occupying positions with any
18 department as a result of emergency appointments pursuant to
19 Section 8b.8 of the Personnel Code who are not considered
20 employees under this Act shall be given the option of
21 participating in the programs of group life insurance, health
22 benefits and other employee benefits. Such persons electing
23 coverage may participate only by making payment equal to the
24 amount normally contributed by the State for similarly
25 situated employees. Such amounts shall be determined by the
26 Director. Such payments and coverage may be continued until
27 such time as the person becomes an employee pursuant to this
28 Act or such person's appointment is terminated.
29 (i) Any unit of local government within the State of
30 Illinois may apply to the Director to have its employees,
31 annuitants, and their dependents provided group health
32 coverage under this Act on a non-insured basis. To
33 participate, a unit of local government must agree to enroll
34 all of its employees, who may select coverage under either
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1 the State group health insurance plan or a health maintenance
2 organization that has contracted with the State to be
3 available as a health care provider for employees as defined
4 in this Act. A unit of local government must remit the
5 entire cost of providing coverage under the State group
6 health insurance plan or, for coverage under a health
7 maintenance organization, an amount determined by the
8 Director based on an analysis of the sex, age, geographic
9 location, or other relevant demographic variables for its
10 employees, except that the unit of local government shall not
11 be required to enroll those of its employees who are covered
12 spouses or dependents under this plan or another group policy
13 or plan providing health benefits as long as (1) an
14 appropriate official from the unit of local government
15 attests that each employee not enrolled is a covered spouse
16 or dependent under this plan or another group policy or plan,
17 and (2) at least 85% of the employees are enrolled and the
18 unit of local government remits the entire cost of providing
19 coverage to those employees. Employees of a participating
20 unit of local government who are not enrolled due to coverage
21 under another group health policy or plan may enroll at a
22 later date subject to submission of satisfactory evidence of
23 insurability and provided that no benefits shall be payable
24 for services incurred during the first 6 months of coverage
25 to the extent the services are in connection with any
26 pre-existing condition. A participating unit of local
27 government may also elect to cover its annuitants. Dependent
28 coverage shall be offered on an optional basis, with the
29 costs paid by the unit of local government, its employees, or
30 some combination of the two as determined by the unit of
31 local government. The unit of local government shall be
32 responsible for timely collection and transmission of
33 dependent premiums.
34 The Director shall annually determine monthly rates of
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1 payment, subject to the following constraints:
2 (1) In the first year of coverage, the rates shall
3 be equal to the amount normally charged to State
4 employees for elected optional coverages or for enrolled
5 dependents coverages or other contributory coverages, or
6 contributed by the State for basic insurance coverages on
7 behalf of its employees, adjusted for differences between
8 State employees and employees of the local government in
9 age, sex, geographic location or other relevant
10 demographic variables, plus an amount sufficient to pay
11 for the additional administrative costs of providing
12 coverage to employees of the unit of local government and
13 their dependents.
14 (2) In subsequent years, a further adjustment shall
15 be made to reflect the actual prior years' claims
16 experience of the employees of the unit of local
17 government.
18 In the case of coverage of local government employees
19 under a health maintenance organization, the Director shall
20 annually determine for each participating unit of local
21 government the maximum monthly amount the unit may contribute
22 toward that coverage, based on an analysis of (i) the age,
23 sex, geographic location, and other relevant demographic
24 variables of the unit's employees and (ii) the cost to cover
25 those employees under the State group health insurance plan.
26 The Director may similarly determine the maximum monthly
27 amount each unit of local government may contribute toward
28 coverage of its employees' dependents under a health
29 maintenance organization.
30 Monthly payments by the unit of local government or its
31 employees for group health insurance or health maintenance
32 organization coverage shall be deposited in the Local
33 Government Health Insurance Reserve Fund. The Local
34 Government Health Insurance Reserve Fund shall be a
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1 continuing fund not subject to fiscal year limitations. All
2 expenditures from this fund shall be used for payments for
3 health care benefits for local government and rehabilitation
4 facility employees, annuitants, and dependents, and to
5 reimburse the Department or its administrative service
6 organization for all expenses incurred in the administration
7 of benefits. No other State funds may be used for these
8 purposes.
9 A local government employer's participation or desire to
10 participate in a program created under this subsection shall
11 not limit that employer's duty to bargain with the
12 representative of any collective bargaining unit of its
13 employees.
14 (j) Any rehabilitation facility within the State of
15 Illinois may apply to the Director to have its employees,
16 annuitants, and their dependents provided group health
17 coverage under this Act on a non-insured basis. To
18 participate, a rehabilitation facility must agree to enroll
19 all of its employees and remit the entire cost of providing
20 such coverage for its employees, except that the
21 rehabilitation facility shall not be required to enroll those
22 of its employees who are covered spouses or dependents under
23 this plan or another group policy or plan providing health
24 benefits as long as (1) an appropriate official from the
25 rehabilitation facility attests that each employee not
26 enrolled is a covered spouse or dependent under this plan or
27 another group policy or plan, and (2) at least 85% of the
28 employees are enrolled and the rehabilitation facility remits
29 the entire cost of providing coverage to those employees.
30 Employees of a participating rehabilitation facility who are
31 not enrolled due to coverage under another group health
32 policy or plan may enroll at a later date subject to
33 submission of satisfactory evidence of insurability and
34 provided that no benefits shall be payable for services
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1 incurred during the first 6 months of coverage to the extent
2 the services are in connection with any pre-existing
3 condition. A participating rehabilitation facility may also
4 elect to cover its annuitants. Dependent coverage shall be
5 offered on an optional basis, with the costs paid by the
6 rehabilitation facility, its employees, or some combination
7 of the 2 as determined by the rehabilitation facility. The
8 rehabilitation facility shall be responsible for timely
9 collection and transmission of dependent premiums.
10 The Director shall annually determine quarterly rates of
11 payment, subject to the following constraints:
12 (1) In the first year of coverage, the rates shall
13 be equal to the amount normally charged to State
14 employees for elected optional coverages or for enrolled
15 dependents coverages or other contributory coverages on
16 behalf of its employees, adjusted for differences between
17 State employees and employees of the rehabilitation
18 facility in age, sex, geographic location or other
19 relevant demographic variables, plus an amount sufficient
20 to pay for the additional administrative costs of
21 providing coverage to employees of the rehabilitation
22 facility and 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 rehabilitation
26 facility.
27 Monthly payments by the rehabilitation facility or its
28 employees for group health insurance shall be deposited in
29 the Local Government Health Insurance Reserve Fund.
30 (k) Any domestic violence shelter or service within the
31 State of Illinois may apply to the Director to have its
32 employees, annuitants, and their dependents provided group
33 health coverage under this Act on a non-insured basis. To
34 participate, a domestic violence shelter or service must
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1 agree to enroll all of its employees and pay the entire cost
2 of providing such coverage for its employees. A
3 participating domestic violence shelter may also elect to
4 cover its annuitants. Dependent coverage shall be offered on
5 an optional basis, with employees, or some combination of the
6 2 as determined by the domestic violence shelter or service.
7 The domestic violence shelter or service shall be responsible
8 for timely collection and transmission of dependent premiums.
9 The Director shall annually determine quarterly 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 on
15 behalf of its employees, adjusted for differences between
16 State employees and employees of the domestic violence
17 shelter or service in age, sex, geographic location or
18 other relevant demographic variables, plus an amount
19 sufficient to pay for the additional administrative costs
20 of providing coverage to employees of the domestic
21 violence shelter or service and their dependents.
22 (2) In subsequent years, a further adjustment shall
23 be made to reflect the actual prior years' claims
24 experience of the employees of the domestic violence
25 shelter or service.
26 (3) In no case shall the rate be less than the
27 amount normally charged to State employees or contributed
28 by the State on behalf of its employees.
29 Monthly payments by the domestic violence shelter or
30 service or its employees for group health insurance shall be
31 deposited in the Local Government Health Insurance Reserve
32 Fund.
33 (l) A public community college or entity organized
34 pursuant to the Public Community College Act may apply to the
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1 Director initially to have only annuitants not covered prior
2 to July 1, 1992 by the district's health plan provided health
3 coverage under this Act on a non-insured basis. The
4 community college must execute a 2-year contract to
5 participate in the Local Government Health Plan. Those
6 annuitants enrolled initially under this contract shall have
7 no benefits payable for services incurred during the first 6
8 months of coverage to the extent the services are in
9 connection with any pre-existing condition. Any annuitant
10 who may enroll after this initial enrollment period shall be
11 subject to submission of satisfactory evidence of
12 insurability and to the pre-existing conditions limitation.
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
17 a 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
20 actual first year's claims experience of the covered
21 annuitants.
22 (m) The Director shall adopt any rules deemed necessary
23 for implementation of this amendatory Act of 1989 (Public Act
24 86-978).
25 (Source: P.A. 89-53, eff. 7-1-95; 89-236, eff. 8-4-95;
26 89-324, eff. 8-13-95; 89-626, eff. 8-9-96; 90-65, eff.
27 7-7-97; 90-582, eff. 5-27-98; 90-655, eff. 7-30-98; revised
28 8-3-98.)
29 Section 99. Effective date. This Act takes effect upon
30 becoming law.