98TH GENERAL ASSEMBLY
State of Illinois
2013 and 2014
HB1226

 

Introduced , by Rep. Patrick J. Verschoore

 

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

    Amends the State Employees Group Insurance Act of 1971. Provides that, beginning July 1, 2013, the Director shall establish a program of financial incentives to encourage current General Assembly members and annuitants of the General Assembly Retirement System to elect not to participate in the program of health benefits provided under the Act. Requires that election to be irrevocable. Prohibits the financial incentive from exceeding 60% of the average cost of the most affordable State-offered health benefit for which the individual qualifies, as determined by the Director. Effective immediately.


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FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

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1    AN ACT concerning government.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The State Employees Group Insurance Act of 1971
5is amended by changing Section 8 as follows:
 
6    (5 ILCS 375/8)  (from Ch. 127, par. 528)
7    Sec. 8. Eligibility.
8    (a) Each employee eligible under the provisions of this Act
9and any rules and regulations promulgated and adopted hereunder
10by the Director shall become immediately eligible and covered
11for all benefits available under the programs. Employees
12electing coverage for eligible dependents shall have the
13coverage effective immediately, provided that the election is
14properly filed in accordance with required filing dates and
15procedures specified by the Director, including the completion
16and submission of all documentation and forms required by the
17Director.
18        (1) Every member originally eligible to elect
19    dependent coverage, but not electing it during the original
20    eligibility period, may subsequently obtain dependent
21    coverage only in the event of a qualifying change in
22    status, special enrollment, special circumstance as
23    defined by the Director, or during the annual Benefit

 

 

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1    Choice Period.
2        (2) Members described above being transferred from
3    previous coverage towards which the State has been
4    contributing shall be transferred regardless of
5    preexisting conditions, waiting periods, or other
6    requirements that might jeopardize claim payments to which
7    they would otherwise have been entitled.
8        (3) Eligible and covered members that are eligible for
9    coverage as dependents except for the fact of being members
10    shall be transferred to, and covered under, dependent
11    status regardless of preexisting conditions, waiting
12    periods, or other requirements that might jeopardize claim
13    payments to which they would otherwise have been entitled
14    upon cessation of member status and the election of
15    dependent coverage by a member eligible to elect that
16    coverage.
17    (b) New employees shall be immediately insured for the
18basic group life insurance and covered by the program of health
19benefits on the first day of active State service. Optional
20life insurance coverage one to 4 times the basic amount, if
21elected during the relevant eligibility period, will become
22effective on the date of employment. Optional life insurance
23coverage exceeding 4 times the basic amount and all life
24insurance amounts applied for after the eligibility period will
25be effective, subject to satisfactory evidence of insurability
26when applicable, or other necessary qualifications, pursuant

 

 

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1to the requirements of the applicable benefit program, unless
2there is a change in status that would confer new eligibility
3for change of enrollment under rules established supplementing
4this Act, in which event application must be made within the
5new eligibility period.
6    (c) As to the group health benefits program contracted to
7begin or continue after June 30, 1973, each annuitant,
8survivor, and retired employee shall become immediately
9eligible for all benefits available under that program. Each
10annuitant, survivor, and retired employee shall have coverage
11effective immediately, provided that the election is properly
12filed in accordance with the required filing dates and
13procedures specified by the Director, including the completion
14and submission of all documentation and forms required by the
15Director. Annuitants, survivors, and retired employees may
16elect coverage for eligible dependents and shall have the
17coverage effective immediately, provided that the election is
18properly filed in accordance with required filing dates and
19procedures specified by the Director, except that, for a
20survivor, the dependent sought to be added on or after January
2113, 2012 (the effective date of Public Act 97-668) this
22amendatory Act of the 97th General Assembly must have been
23eligible for coverage as a dependent under the deceased member
24upon whom the survivor's annuity is based in order to be
25eligible for coverage under the survivor.
26    Except as otherwise provided in this Act, where husband and

 

 

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1wife are both eligible members, each shall be enrolled as a
2member and coverage on their eligible dependent children, if
3any, may be under the enrollment and election of either.
4    Regardless of other provisions herein regarding late
5enrollment or other qualifications, as appropriate, the
6Director may periodically authorize open enrollment periods
7for each of the benefit programs at which time each member may
8elect enrollment or change of enrollment without regard to age,
9sex, health, or other qualification under the conditions as may
10be prescribed in rules and regulations supplementing this Act.
11Special open enrollment periods may be declared by the Director
12for certain members only when special circumstances occur that
13affect only those members.
14    (d) Beginning with fiscal year 2003 and for all subsequent
15years, eligible members may elect not to participate in the
16program of health benefits as defined in this Act. The election
17must be made during the annual benefit choice period, subject
18to the conditions in this subsection.
19        (1) Members must furnish proof of health benefit
20    coverage, either comprehensive major medical coverage or
21    comprehensive managed care plan, from a source other than
22    the Department of Central Management Services in order to
23    elect not to participate in the program.
24        (2) Members may re-enroll in the Department of Central
25    Management Services program of health benefits upon
26    showing a qualifying change in status, as defined in the

 

 

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1    U.S. Internal Revenue Code, without evidence of
2    insurability and with no limitations on coverage for
3    pre-existing conditions, provided that there was not a
4    break in coverage of more than 63 days.
5        (3) Members may also re-enroll in the program of health
6    benefits during any annual benefit choice period, without
7    evidence of insurability.
8        (4) Members who elect not to participate in the program
9    of health benefits shall be furnished a written explanation
10    of the requirements and limitations for the election not to
11    participate in the program and for re-enrolling in the
12    program. The explanation shall also be included in the
13    annual benefit choice options booklets furnished to
14    members.
15    (d-5) Beginning July 1, 2005, the Director may establish a
16program of financial incentives to encourage annuitants
17receiving a retirement annuity from the State Employees
18Retirement System, but who are not eligible for benefits under
19the federal Medicare health insurance program (Title XVIII of
20the Social Security Act, as added by Public Law 89-97) to elect
21not to participate in the program of health benefits provided
22under this Act. The election by an annuitant not to participate
23under this program must be made in accordance with the
24requirements set forth under subsection (d). The financial
25incentives provided to these annuitants under the program may
26not exceed $150 per month for each annuitant electing not to

 

 

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1participate in the program of health benefits provided under
2this Act.
3    (d-6) Beginning July 1, 2013, the Director shall establish
4a program of financial incentives to encourage current General
5Assembly members and annuitants of the General Assembly
6Retirement System to elect not to participate in the program of
7health benefits provided under this Act. The election by a
8current General Assembly member or annuitant of the General
9Assembly Retirement System not to participate must be a
10one-time irrevocable election. The financial incentives
11provided to these current General Assembly members and
12annuitants of the General Assembly Retirement System under the
13program may not exceed 60% of the average cost of the most
14affordable State-offered health benefit (as determined by the
15Director) for which that person qualifies.
16    (e) Notwithstanding any other provision of this Act or the
17rules adopted under this Act, if a person participating in the
18program of health benefits as the dependent spouse of an
19eligible member becomes an annuitant, the person may elect, at
20the time of becoming an annuitant or during any subsequent
21annual benefit choice period, to continue participation as a
22dependent rather than as an eligible member for as long as the
23person continues to be an eligible dependent. In order to be
24eligible to make such an election, the person must have been
25enrolled as a dependent under the program of health benefits
26for no less than one year prior to becoming an annuitant.

 

 

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1    An eligible member who has elected to participate as a
2dependent may re-enroll in the program of health benefits as an
3eligible member (i) during any subsequent annual benefit choice
4period or (ii) upon showing a qualifying change in status, as
5defined in the U.S. Internal Revenue Code, without evidence of
6insurability and with no limitations on coverage for
7pre-existing conditions.
8    A person who elects to participate in the program of health
9benefits as a dependent rather than as an eligible member shall
10be furnished a written explanation of the consequences of
11electing to participate as a dependent and the conditions and
12procedures for re-enrolling as an eligible member. The
13explanation shall also be included in the annual benefit choice
14options booklet furnished to members.
15(Source: P.A. 97-668, eff. 1-13-12.)
 
16    Section 99. Effective date. This Act takes effect upon
17becoming law.