Public Act 93-0047

HB1031 Enrolled                      LRB093 05543 DRJ 05635 b

    AN ACT in relation to State employees.

    Be it enacted by the People of  the  State  of  Illinois,
represented in the General Assembly:

    Section  5.  The  State  Employees Group Insurance Act of
1971 is amended by changing Section 6 as follows:

    (5 ILCS 375/6) (from Ch. 127, par. 526)
    Sec. 6.  Program of health benefits.
    (a)  The program of health  benefits  shall  provide  for
protection   against  the  financial  costs  of  health  care
expenses incurred in and  out  of  hospital  including  basic
hospital-surgical-medical   coverages.    The   program   may
include,  but  shall  not  be  limited  to, such supplemental
coverages as  out-patient  diagnostic  X-ray  and  laboratory
expenses,   prescription   drugs,  dental  services,  hearing
evaluations, hearing aids,  the  dispensing  and  fitting  of
hearing  aids,  and  similar group benefits as are now or may
become available.   However, nothing in  this  Act  shall  be
construed   to   permit,  on  or  after  July  1,  1980,  the
non-contributory portion of any such program to  include  the
expenses  of  obtaining  an  abortion, induced miscarriage or
induced  premature  birth  unless,  in  the  opinion   of   a
physician, such procedures are necessary for the preservation
of the life of the woman seeking such treatment, or except an
induced  premature  birth  intended  to produce a live viable
child and such procedure is necessary for the health  of  the
mother  or  the  unborn  child.  The program may also include
coverage for  those  who  rely  on  treatment  by  prayer  or
spiritual  means  alone  for  healing  in accordance with the
tenets and practice of a recognized religious denomination.
    The program of health benefits shall be designed  by  the
Director (1) to provide a reasonable relationship between the
benefits  to  be  included  and  the expected distribution of
expenses of each such type to  be  incurred  by  the  covered
members  and  dependents, (2) to specify, as covered benefits
and  as  optional   benefits,   the   medical   services   of
practitioners  in  all  categories licensed under the Medical
Practice Act of 1987, (3)  to  include  reasonable  controls,
which  may  include  deductible  and co-insurance provisions,
applicable to some or all of the benefits, or a  coordination
of  benefits  provision,  to  prevent or minimize unnecessary
utilization of the various  hospital,  surgical  and  medical
expenses  to  be provided and to provide reasonable assurance
of stability of the program, and (4) to provide  benefits  to
the extent possible to members throughout the State, wherever
located,  on  an  equitable  basis. Notwithstanding any other
provision  of  this  Section  or  Act,  for  all  members  or
dependents  who  are  eligible  for  benefits  under   Social
Security  or  the  Railroad  Retirement  system  or  who  had
sufficient   Medicare-covered   government   employment,  the
Department shall reduce benefits  which  would  otherwise  be
paid  by  Medicare,  by  the amount of benefits for which the
member or dependents are eligible under Medicare, except that
such reduction in benefits shall apply only to those  members
or dependents who (1) first become eligible for such medicare
coverage  on  or  after the effective date of this amendatory
Act  of  1992;  or  (2)  are  Medicare-eligible  members   or
dependents   of   a   local   government   unit  which  began
participation in the program on or after July 1, 1992; or (3)
remain eligible for but no longer receive  Medicare  coverage
which  they had been receiving on or after the effective date
of this amendatory Act of 1992.
    Notwithstanding any other provisions of this Act, where a
covered member or dependents are eligible for benefits  under
the federal Medicare health insurance program (Title XVIII of
the  Social  Security  Act as added by Public Law 89-97, 89th
Congress), benefits paid under the State of Illinois  program
or  plan  will  be  reduced by the amount of benefits paid by
Medicare.  For members or dependents  who  are  eligible  for
benefits  under  Social  Security  or the Railroad Retirement
system or  who  had  sufficient  Medicare-covered  government
employment, benefits shall be reduced by the amount for which
the  member  or  dependent is eligible under Medicare, except
that such reduction in benefits shall  apply  only  to  those
members  or dependents who (1) first become eligible for such
Medicare coverage on or after  the  effective  date  of  this
amendatory  Act of 1992; or (2) are Medicare-eligible members
or  dependents  of  a  local  government  unit  which   began
participation in the program on or after July 1, 1992; or (3)
remain  eligible for, but no longer receive Medicare coverage
which they had been receiving on or after the effective  date
of  this  amendatory  Act of 1992.  Premiums may be adjusted,
where applicable, to an amount deemed by the Director  to  be
reasonably consistent with any reduction of benefits.
    (b)  A member, not otherwise covered by this Act, who has
retired  as  a  participating  member  under Article 2 of the
Illinois Pension Code but is ineligible  for  the  retirement
annuity  under  Section  2-119  of the Illinois Pension Code,
shall pay the premiums for coverage, not exceeding the amount
paid by the State for the non-contributory coverage for other
members, under the group health benefits program  under  this
Act.  The Director shall determine the premiums to be paid by
a member under this subsection (b).
(Source: P.A. 91-390, eff. 7-30-99.)

    Section  99.   Effective  date.  This Act takes effect on
July 1, 2003.