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Public Act 096-1232
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| HB4863 Enrolled | LRB096 16225 RCE 31481 b |
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AN ACT concerning finance.
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Be it enacted by the People of the State of Illinois,
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represented in the General Assembly:
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Section 5. The State Employees Group Insurance Act of 1971 |
is amended by changing Section 10 as follows:
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(5 ILCS 375/10) (from Ch. 127, par. 530)
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Sec. 10. Payments by State; premiums.
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(a) The State shall pay the cost of basic non-contributory |
group life
insurance and, subject to member paid contributions |
set by the Department or
required by this Section, the basic |
program of group health benefits on each
eligible member, |
except 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, and |
part of each eligible member's
and retired member's premiums |
for health insurance coverage for enrolled
dependents as |
provided by Section 9. The State shall pay the cost of the |
basic
program of group health benefits only after benefits are |
reduced by the amount
of benefits covered by Medicare for all |
members and dependents
who are eligible for benefits under |
Social Security or
the Railroad Retirement system or who had |
sufficient Medicare-covered
government employment, except that |
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such reduction in benefits shall apply only
to those members |
and dependents who (1) first become eligible
for such Medicare |
coverage on or after July 1, 1992; or (2) are
Medicare-eligible |
members or dependents of a local government unit which began
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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 July 1, 1992. The |
Department may determine the aggregate level of the
State's |
contribution on the basis of actual cost of medical services |
adjusted
for age, sex or geographic or other demographic |
characteristics which affect
the costs of such programs.
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The cost of participation in the basic program of group |
health benefits
for the dependent or survivor of a living or |
deceased retired employee who was
formerly employed by the |
University of Illinois in the Cooperative Extension
Service and |
would be an annuitant but for the fact that he or she was made
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ineligible to participate in the State Universities Retirement |
System by clause
(4) of subsection (a) of Section 15-107 of the |
Illinois Pension Code shall not
be greater than the cost of |
participation that would otherwise apply to that
dependent or |
survivor if he or she were the dependent or survivor of an
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annuitant under the State Universities Retirement System.
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(a-1) Beginning January 1, 1998, for each person who |
becomes a new SERS
annuitant and participates in the basic |
program of group health benefits, the
State shall contribute |
toward the cost of the annuitant's
coverage under the basic |
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program of group health benefits an amount equal
to 5% of that |
cost for each full year of creditable service upon which the
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annuitant's retirement annuity is based, up to a maximum of |
100% for an
annuitant with 20 or more years of creditable |
service.
The remainder of the cost of a new SERS annuitant's |
coverage under the basic
program of group health benefits shall |
be the responsibility of the
annuitant. In the case of a new |
SERS annuitant who has elected to receive an alternative |
retirement cancellation payment under Section 14-108.5 of the |
Illinois Pension Code in lieu of an annuity, for the purposes |
of this subsection the annuitant shall be deemed to be |
receiving a retirement annuity based on the number of years of |
creditable service that the annuitant had established at the |
time of his or her termination of service under SERS.
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(a-2) Beginning January 1, 1998, for each person who |
becomes a new SERS
survivor and participates in the basic |
program of group health benefits, the
State shall contribute |
toward the cost of the survivor's
coverage under the basic |
program of group health benefits an amount equal
to 5% of that |
cost for each full year of the deceased employee's or deceased
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annuitant's creditable service in the State Employees' |
Retirement System of
Illinois on the date of death, up to a |
maximum of 100% for a survivor of an
employee or annuitant with |
20 or more years of creditable service. The
remainder of the |
cost of the new SERS survivor's coverage under the basic
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program of group health benefits shall be the responsibility of |
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the survivor. In the case of a new SERS survivor who was the |
dependent of an annuitant who elected to receive an alternative |
retirement cancellation payment under Section 14-108.5 of the |
Illinois Pension Code in lieu of an annuity, for the purposes |
of this subsection the deceased annuitant's creditable service |
shall be determined as of the date of termination of service |
rather than the date of death.
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(a-3) Beginning January 1, 1998, for each person who |
becomes a new SURS
annuitant and participates in the basic |
program of group health benefits, the
State shall contribute |
toward the cost of the annuitant's
coverage under the basic |
program of group health benefits an amount equal
to 5% of that |
cost for each full year of creditable service upon which the
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annuitant's retirement annuity is based, up to a maximum of |
100% for an
annuitant with 20 or more years of creditable |
service.
The remainder of the cost of a new SURS annuitant's |
coverage under the basic
program of group health benefits shall |
be the responsibility of the
annuitant.
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(a-4) (Blank).
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(a-5) Beginning January 1, 1998, for each person who |
becomes a new SURS
survivor and participates in the basic |
program of group health benefits, the
State shall contribute |
toward the cost of the survivor's coverage under the
basic |
program of group health benefits an amount equal to 5% of that |
cost for
each full year of the deceased employee's or deceased |
annuitant's creditable
service in the State Universities |
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Retirement System on the date of death, up to
a maximum of 100% |
for a survivor of an
employee or annuitant with 20 or more |
years of creditable service. The
remainder of the cost of the |
new SURS survivor's coverage under the basic
program of group |
health benefits shall be the responsibility of the survivor.
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(a-6) Beginning July 1, 1998, for each person who becomes a |
new TRS
State annuitant and participates in the basic program |
of group health benefits,
the State shall contribute toward the |
cost of the annuitant's coverage under
the basic program of |
group health benefits an amount equal to 5% of that cost
for |
each full year of creditable service
as a teacher as defined in |
paragraph (2), (3), or (5) of Section 16-106 of the
Illinois |
Pension Code
upon which the annuitant's retirement annuity is |
based, up to a maximum of
100%;
except that
the State |
contribution shall be 12.5% per year (rather than 5%) for each |
full
year of creditable service as a regional superintendent or |
assistant regional
superintendent of schools. The
remainder of |
the cost of a new TRS State annuitant's coverage under the |
basic
program of group health benefits shall be the |
responsibility of the
annuitant.
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(a-7) Beginning July 1, 1998, for each person who becomes a |
new TRS
State survivor and participates in the basic program of |
group health benefits,
the State shall contribute toward the |
cost of the survivor's coverage under the
basic program of |
group health benefits an amount equal to 5% of that cost for
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each full year of the deceased employee's or deceased |
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annuitant's creditable
service
as a teacher as defined in |
paragraph (2), (3), or (5) of Section 16-106 of the
Illinois |
Pension Code
on the date of death, up to a maximum of 100%;
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except that the State contribution shall be 12.5% per year |
(rather than 5%) for
each full year of the deceased employee's |
or deceased annuitant's creditable
service as a regional |
superintendent or assistant regional superintendent of
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schools.
The remainder of
the cost of the new TRS State |
survivor's coverage under the basic program of
group health |
benefits shall be the responsibility of the survivor.
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(a-8) A new SERS annuitant, new SERS survivor, new SURS
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annuitant, new SURS survivor, new TRS State
annuitant, or new |
TRS State survivor may waive or terminate coverage in
the |
program of group health benefits. Any such annuitant or |
survivor
who has waived or terminated coverage may enroll or |
re-enroll in the
program of group health benefits only during |
the annual benefit choice period,
as determined by the |
Director; except that in the event of termination of
coverage |
due to nonpayment of premiums, the annuitant or survivor
may |
not re-enroll in the program.
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(a-9) No later than May 1 of each calendar year, the |
Director
of Central Management Services shall certify in |
writing to the Executive
Secretary of the State Employees' |
Retirement System of Illinois the amounts
of the Medicare |
supplement health care premiums and the amounts of the
health |
care premiums for all other retirees who are not Medicare |
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eligible.
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A separate calculation of the premiums based upon the |
actual cost of each
health care plan shall be so certified.
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The Director of Central Management Services shall provide |
to the
Executive Secretary of the State Employees' Retirement |
System of
Illinois such information, statistics, and other data |
as he or she
may require to review the premium amounts |
certified by the Director
of Central Management Services.
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The Department of Healthcare and Family Services, or any |
successor agency designated to procure healthcare contracts |
pursuant to this Act, is authorized to establish funds, |
separate accounts provided by any bank or banks as defined by |
the Illinois Banking Act, or separate accounts provided by any |
savings and loan association or associations as defined by the |
Illinois Savings and Loan Act of 1985 to be held by the |
Director, outside the State treasury, for the purpose of |
receiving the transfer of moneys from the Local Government |
Health Insurance Reserve Fund. The Department may promulgate |
rules further defining the methodology for the transfers. Any |
interest earned by moneys in the funds or accounts shall inure |
to the Local Government Health Insurance Reserve Fund. The |
transferred moneys, and interest accrued thereon, shall be used |
exclusively for transfers to administrative service |
organizations or their financial institutions for payments of |
claims to claimants and providers under the self-insurance |
health plan. The transferred moneys, and interest accrued |
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thereon, shall not be used for any other purpose including, but |
not limited to, reimbursement of administration fees due the |
administrative service organization pursuant to its contract |
or contracts with the Department.
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(b) State employees who become eligible for this program on |
or after January
1, 1980 in positions normally requiring actual |
performance of duty not less
than 1/2 of a normal work period |
but not equal to that of a normal work period,
shall be given |
the option of participating in the available program. If the
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employee elects coverage, the State shall contribute on behalf |
of such employee
to the cost of the employee's benefit and any |
applicable dependent supplement,
that sum which bears the same |
percentage as that percentage of time the
employee regularly |
works when compared to normal work period.
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(c) The basic non-contributory coverage from the basic |
program of
group health benefits shall be continued for each |
employee not in pay status or
on active service by reason of |
(1) leave of absence due to illness or injury,
(2) authorized |
educational leave of absence or sabbatical leave, or (3)
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military leave with pay and benefits. This coverage shall |
continue until
expiration of authorized leave and return to |
active service, but not to exceed
24 months for leaves under |
item (1) or (2). This 24-month limitation and the
requirement |
of returning to active service shall not apply to persons |
receiving
ordinary or accidental disability benefits or |
retirement benefits through the
appropriate State retirement |
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system or benefits under the Workers' Compensation
or |
Occupational Disease Act.
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(d) The basic group life insurance coverage shall continue, |
with
full State contribution, where such person is (1) absent |
from active
service by reason of disability arising from any |
cause other than
self-inflicted, (2) on authorized educational |
leave of absence or
sabbatical leave, or (3) on military leave |
with pay and benefits.
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(e) Where the person is in non-pay status for a period in |
excess of
30 days or on leave of absence, other than by reason |
of disability,
educational or sabbatical leave, or military |
leave with pay and benefits, such
person may continue coverage |
only by making personal
payment equal to the amount normally |
contributed by the State on such person's
behalf. Such payments |
and coverage may be continued: (1) until such time as
the |
person returns to a status eligible for coverage at State |
expense, but not
to exceed 24 months, (2) until such person's |
employment or annuitant status
with the State is terminated, or |
(3) for a maximum period of 4 years for
members on military |
leave with pay and benefits and military leave without pay
and |
benefits (exclusive of any additional service imposed pursuant |
to law).
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(f) The Department shall establish by rule the extent to |
which other
employee benefits will continue for persons in |
non-pay status or who are
not in active service.
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(g) The State shall not pay the cost of the basic |
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non-contributory
group life insurance, program of health |
benefits and other employee benefits
for members who are |
survivors as defined by paragraphs (1) and (2) of
subsection |
(q) of Section 3 of this Act. The costs of benefits for these
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survivors shall be paid by the survivors or by the University |
of Illinois
Cooperative Extension Service, or any combination |
thereof.
However, the State shall pay the amount of the |
reduction in the cost of
participation, if any, resulting from |
the amendment to subsection (a) made
by this amendatory Act of |
the 91st General Assembly.
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(h) Those persons occupying positions with any department |
as a result
of emergency appointments pursuant to Section 8b.8 |
of the Personnel Code
who are not considered employees under |
this Act shall be given the option
of participating in the |
programs of group life insurance, health benefits and
other |
employee benefits. Such persons electing coverage may |
participate only
by making payment equal to the amount normally |
contributed by the State for
similarly situated employees. Such |
amounts shall be determined by the
Director. Such payments and |
coverage may be continued until such time as the
person becomes |
an employee pursuant to this Act or such person's appointment |
is
terminated.
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(i) Any unit of local government within the State of |
Illinois
may apply to the Director to have its employees, |
annuitants, and their
dependents provided group health |
coverage under this Act on a non-insured
basis. To participate, |
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a unit of local government must agree to enroll
all of its |
employees, who may select coverage under either the State group
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health benefits plan or a health maintenance organization that |
has
contracted with the State to be available as a health care |
provider for
employees as defined in this Act. A unit of local |
government must remit the
entire cost of providing coverage |
under the State group health benefits plan
or, for coverage |
under a health maintenance organization, an amount determined
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by the Director based on an analysis of the sex, age, |
geographic location, or
other relevant demographic variables |
for its employees, except that the unit of
local government |
shall not be required to enroll those of its employees who are
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covered spouses or dependents under this plan or another group |
policy or plan
providing health benefits as long as (1) an |
appropriate official from the unit
of local government attests |
that each employee not enrolled is a covered spouse
or |
dependent under this plan or another group policy or plan, and |
(2) at least
50% of the employees are enrolled and the unit of |
local government remits
the entire cost of providing coverage |
to those employees, except that a
participating school district |
must have enrolled at least 50% of its full-time
employees who |
have not waived coverage under the district's group health
plan |
by participating in a component of the district's cafeteria |
plan. A
participating school district is not required to enroll |
a full-time employee
who has waived coverage under the |
district's health plan, provided that an
appropriate official |
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from the participating school district attests that the
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full-time employee has waived coverage by participating in a |
component of the
district's cafeteria plan. For the purposes of |
this subsection, "participating
school district" includes a |
unit of local government whose primary purpose is
education as |
defined by the Department's rules.
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Employees of a participating unit of local government who |
are not enrolled
due to coverage under another group health |
policy or plan may enroll in
the event of a qualifying change |
in status, special enrollment, special
circumstance as defined |
by the Director, or during the annual Benefit Choice
Period. A |
participating unit of local government may also elect to cover |
its
annuitants. Dependent coverage shall be offered on an |
optional basis, with the
costs paid by the unit of local |
government, its employees, or some combination
of the two as |
determined by the unit of local government. The unit of local
|
government shall be responsible for timely collection and |
transmission of
dependent premiums.
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The Director shall annually determine monthly rates of |
payment, subject
to the following constraints:
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(1) In the first year of coverage, the rates shall be |
equal to the
amount normally charged to State employees for |
elected optional coverages
or for enrolled dependents |
coverages or other contributory coverages, or
contributed |
by the State for basic insurance coverages on behalf of its
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employees, adjusted for differences between State |
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employees and employees
of the local government in age, |
sex, geographic location or other relevant
demographic |
variables, plus an amount sufficient to pay for the |
additional
administrative costs of providing coverage to |
employees of the unit of
local government and their |
dependents.
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(2) In subsequent years, a further adjustment shall be |
made to reflect
the actual prior years' claims experience |
of the employees of the unit of
local government.
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In the case of coverage of local government employees under |
a health
maintenance organization, the Director shall annually |
determine for each
participating unit of local government the |
maximum monthly amount the unit
may contribute toward that |
coverage, based on an analysis of (i) the age,
sex, geographic |
location, and other relevant demographic variables of the
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unit's employees and (ii) the cost to cover those employees |
under the State
group health benefits plan. The Director may |
similarly determine the
maximum monthly amount each unit of |
local government may contribute toward
coverage of its |
employees' dependents under a health maintenance organization.
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Monthly payments by the unit of local government or its |
employees for
group health benefits plan or health maintenance |
organization coverage shall
be deposited in the Local |
Government Health Insurance Reserve Fund.
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The Local Government Health Insurance Reserve Fund is |
hereby created as a nonappropriated trust fund to be held |
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outside the State Treasury, with the State Treasurer as |
custodian. The Local Government Health Insurance Reserve Fund |
shall be a continuing
fund not subject to fiscal year |
limitations. The Local Government Health Insurance Reserve |
Fund is not subject to administrative charges or charge-backs, |
including but not limited to those authorized under Section 8h |
of the State Finance Act. All revenues arising from the |
administration of the health benefits program established |
under this Section shall be deposited into the Local Government |
Health Insurance Reserve Fund. Any interest earned on moneys in |
the Local Government Health Insurance Reserve Fund shall be |
deposited into the Fund. All expenditures from this Fund
shall |
be used for payments for health care benefits for local |
government and rehabilitation facility
employees, annuitants, |
and dependents, and to reimburse the Department or
its |
administrative service organization for all expenses incurred |
in the
administration of benefits. No other State funds may be |
used for these
purposes.
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A local government employer's participation or desire to |
participate
in a program created under this subsection shall |
not limit that employer's
duty to bargain with the |
representative of any collective bargaining unit
of its |
employees.
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(j) Any rehabilitation facility within the State of |
Illinois may apply
to the Director to have its employees, |
annuitants, and their eligible
dependents provided group |
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health coverage under this Act on a non-insured
basis. To |
participate, a rehabilitation facility must agree to enroll all
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of its employees and remit the entire cost of providing such |
coverage for
its employees, except that the rehabilitation |
facility shall not be
required to enroll those of its employees |
who are covered spouses or
dependents under this plan or |
another group policy or plan providing health
benefits as long |
as (1) an appropriate official from the rehabilitation
facility |
attests that each employee not enrolled is a covered spouse or
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dependent under this plan or another group policy or plan, and |
(2) at least
50% of the employees are enrolled and the |
rehabilitation facility remits
the entire cost of providing |
coverage to those employees. Employees of a
participating |
rehabilitation facility who are not enrolled due to coverage
|
under another group health policy or plan may enroll
in the |
event of a qualifying change in status, special enrollment, |
special
circumstance as defined by the Director, or during the |
annual Benefit Choice
Period. A participating rehabilitation |
facility may also elect
to cover its annuitants. Dependent |
coverage shall be offered on an optional
basis, with the costs |
paid by the rehabilitation facility, its employees, or
some |
combination of the 2 as determined by the rehabilitation |
facility. The
rehabilitation facility shall be responsible for |
timely collection and
transmission of dependent premiums.
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The Director shall annually determine quarterly rates of |
payment, subject
to the following constraints:
|
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(1) In the first year of coverage, the rates shall be |
equal to the amount
normally charged to State employees for |
elected optional coverages or for
enrolled dependents |
coverages or other contributory coverages on behalf of
its |
employees, adjusted for differences between State |
employees and
employees of the rehabilitation facility in |
age, sex, geographic location
or other relevant |
demographic variables, plus an amount sufficient to pay
for |
the additional administrative costs of providing coverage |
to employees
of the rehabilitation facility and their |
dependents.
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(2) In subsequent years, a further adjustment shall be |
made to reflect
the actual prior years' claims experience |
of the employees of the
rehabilitation facility.
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Monthly payments by the rehabilitation facility or its |
employees for
group health benefits shall be deposited in the |
Local Government Health
Insurance Reserve Fund.
|
(k) Any domestic violence shelter or service within the |
State of Illinois
may apply to the Director to have its |
employees, annuitants, and their
dependents provided group |
health coverage under this Act on a non-insured
basis. To |
participate, a domestic violence shelter or service must agree |
to
enroll all of its employees and pay the entire cost of |
providing such coverage
for its employees. The domestic |
violence shelter shall not be required to enroll those of its |
employees who are covered spouses or dependents under this plan |
|
or another group policy or plan providing health benefits as |
long as (1) an appropriate official from the domestic violence |
shelter attests that each employee not enrolled is a covered |
spouse or dependent under this plan or another group policy or |
plan and (2) at least 50% of the employees are enrolled and the |
domestic violence shelter remits the entire cost of providing |
coverage to those employees. Employees of a participating |
domestic violence shelter who are not enrolled due to coverage |
under another group health policy or plan may enroll in the |
event of a qualifying change in status, special enrollment, or |
special circumstance as defined by the Director or during the |
annual Benefit Choice Period. A participating domestic |
violence shelter may also elect
to cover its annuitants. |
Dependent coverage shall be offered on an optional
basis, with
|
employees, or some combination of the 2 as determined by the |
domestic violence
shelter or service. The domestic violence |
shelter or service shall be
responsible for timely collection |
and transmission of dependent premiums.
|
The Director shall annually determine rates of payment,
|
subject to the following constraints:
|
(1) In the first year of coverage, the rates shall be |
equal to the
amount normally charged to State employees for |
elected optional coverages
or for enrolled dependents |
coverages or other contributory coverages on
behalf of its |
employees, adjusted for differences between State |
employees and
employees of the domestic violence shelter or |
|
service in age, sex, geographic
location or other relevant |
demographic variables, plus an amount sufficient
to pay for |
the additional administrative costs of providing coverage |
to
employees of the domestic violence shelter or service |
and their dependents.
|
(2) In subsequent years, a further adjustment shall be |
made to reflect
the actual prior years' claims experience |
of the employees of the domestic
violence shelter or |
service.
|
Monthly payments by the domestic violence shelter or |
service or its employees
for group health insurance shall be |
deposited in the Local Government Health
Insurance Reserve |
Fund.
|
(l) A public community college or entity organized pursuant |
to the
Public Community College Act may apply to the Director |
initially to have
only annuitants not covered prior to July 1, |
1992 by the district's health
plan provided health coverage |
under this Act on a non-insured basis. The
community college |
must execute a 2-year contract to participate in the
Local |
Government Health Plan.
Any annuitant may enroll in the event |
of a qualifying change in status, special
enrollment, special |
circumstance as defined by the Director, or during the
annual |
Benefit Choice Period.
|
The Director shall annually determine monthly rates of |
payment subject to
the following constraints: for those |
community colleges with annuitants
only enrolled, first year |
|
rates shall be equal to the average cost to cover
claims for a |
State member adjusted for demographics, Medicare
|
participation, and other factors; and in the second year, a |
further adjustment
of rates shall be made to reflect the actual |
first year's claims experience
of the covered annuitants.
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(l-5) The provisions of subsection (l) become inoperative |
on July 1, 1999.
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(m) The Director shall adopt any rules deemed necessary for
|
implementation of this amendatory Act of 1989 (Public Act |
86-978).
|
(n) Any child advocacy center within the State of Illinois |
may apply to the Director to have its employees, annuitants, |
and their dependents provided group health coverage under this |
Act on a non-insured basis. To participate, a child advocacy |
center must agree to enroll all of its employees and pay the |
entire cost of providing coverage for its employees. The child
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advocacy center shall not be required to enroll those of its
|
employees who are covered spouses or dependents under this plan
|
or another group policy or plan providing health benefits as
|
long as (1) an appropriate official from the child advocacy
|
center attests that each employee not enrolled is a covered
|
spouse or dependent under this plan or another group policy or
|
plan and (2) at least 50% of the employees are enrolled and the |
child advocacy center remits the entire cost of providing |
coverage to those employees. Employees of a participating child |
advocacy center who are not enrolled due to coverage under |
|
another group health policy or plan may enroll in the event of |
a qualifying change in status, special enrollment, or special |
circumstance as defined by the Director or during the annual |
Benefit Choice Period. A participating child advocacy center |
may also elect to cover its annuitants. Dependent coverage |
shall be offered on an optional basis, with the costs paid by |
the child advocacy center, its employees, or some combination |
of the 2 as determined by the child advocacy center. The child |
advocacy center shall be responsible for timely collection and |
transmission of dependent premiums. |
The Director shall annually determine rates of payment, |
subject to the following constraints: |
(1) In the first year of coverage, the rates shall be |
equal to the amount normally charged to State employees for |
elected optional coverages or for enrolled dependents |
coverages or other contributory coverages on behalf of its |
employees, adjusted for differences between State |
employees and employees of the child advocacy center in |
age, sex, geographic location, or other relevant |
demographic variables, plus an amount sufficient to pay for |
the additional administrative costs of providing coverage |
to employees of the child advocacy center and their |
dependents. |
(2) In subsequent years, a further adjustment shall be |
made to reflect the actual prior years' claims experience |
of the employees of the child advocacy center. |