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.