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1 | | Illinois Pension Code through December 31,
1995. Beginning |
2 | | January 1, 1996, the Department of Central Management Services
|
3 | | shall be responsible for administering a program of health |
4 | | benefits for TRS
benefit recipients and TRS dependent |
5 | | beneficiaries under this Section.
The Department of Central |
6 | | Management Services and the Teachers' Retirement
System shall |
7 | | cooperate in this endeavor and shall coordinate their |
8 | | activities
so as to ensure a smooth transition and |
9 | | uninterrupted health benefit coverage.
|
10 | | (c) Eligibility. All persons who were enrolled in the |
11 | | Article 16 program at
the time of the transfer shall be |
12 | | eligible to participate in the program
established under this |
13 | | Section without any interruption or delay in coverage
or |
14 | | limitation as to pre-existing medical conditions. Eligibility |
15 | | to
participate shall be determined by the Teachers' Retirement |
16 | | System.
Eligibility information shall be communicated to the |
17 | | Department of Central
Management Services in a format |
18 | | acceptable to the Department.
|
19 | | A TRS dependent beneficiary who is a child age 19 or over |
20 | | and
mentally or physically disabled does not become ineligible |
21 | | to participate
by reason of (i) becoming ineligible to be |
22 | | claimed as a dependent for Illinois
or federal income tax |
23 | | purposes or (ii) receiving earned income, so long as
those |
24 | | earnings are insufficient for the child to be fully |
25 | | self-sufficient.
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26 | | (c-1) On and after the effective date of this amendatory |
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1 | | Act of the 98th General Assembly, eligible TRS benefit |
2 | | recipients and TRS dependent beneficiaries may elect not to |
3 | | participate in the program of health benefits under this |
4 | | Section. The election must be made during the TRS benefit |
5 | | recipient's annual open enrollment period subject to the |
6 | | following conditions: |
7 | | (1) TRS benefit recipients must furnish proof of health |
8 | | benefit coverage, either comprehensive major medical |
9 | | coverage or comprehensive managed care plan, from a source |
10 | | other than the Department of Central Management Services in |
11 | | order to elect not to participate in the program. |
12 | | (2) Regardless of the date that the TRS benefit |
13 | | recipient or TRS dependent beneficiary elected not to |
14 | | participate in the program of health benefits offered under |
15 | | this Section, both the TRS benefit recipient and the TRS |
16 | | dependent beneficiary may also re-enroll in the program of |
17 | | health benefits during any annual open enrollment period, |
18 | | without evidence of insurability. |
19 | | (3) TRS benefit recipients who elect not to participate |
20 | | in the program of health benefits shall be furnished with a |
21 | | written explanation of the requirements and limitations |
22 | | for the election not to participate in the program and for |
23 | | re-enrolling in the program. |
24 | | (4) The changes under this subsection (c-1) impact only |
25 | | those TRS benefit recipients and TRS dependent |
26 | | beneficiaries who are enrolled or had been enrolled in the |
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1 | | Teachers' Retirement Insurance Program before the |
2 | | effective date of this amendatory Act of the 98th General |
3 | | Assembly. |
4 | | (d) Coverage. The level of health benefits provided under |
5 | | this Section
shall be similar to the level of benefits provided |
6 | | by the
program previously established under Article 16 of the |
7 | | Illinois Pension Code.
|
8 | | Group life insurance benefits are not included in the |
9 | | benefits
to be provided to TRS benefit recipients and TRS |
10 | | dependent beneficiaries under
this Act.
|
11 | | The program of health benefits under this Section may |
12 | | include any or all of
the benefit limitations, including but |
13 | | not limited to a reduction in benefits
based on eligibility for |
14 | | federal Medicare medicare benefits, that are provided under
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15 | | subsection (a) of Section 6 of this Act for other health |
16 | | benefit programs under
this Act.
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17 | | (e) Insurance rates and premiums. The Director shall |
18 | | determine the
insurance rates and premiums for TRS benefit |
19 | | recipients and TRS dependent
beneficiaries,
and shall present |
20 | | to the Teachers' Retirement System of
the State of Illinois, by |
21 | | April 15 of each calendar year, the rate-setting
methodology |
22 | | (including but not limited to utilization levels and costs) |
23 | | used
to determine the amount of the health care premiums.
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24 | | For Fiscal Year 1996, the premium shall be equal to the |
25 | | premium actually
charged in Fiscal Year 1995; in subsequent |
26 | | years, the premium shall
never be lower than the premium |
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1 | | charged in Fiscal Year 1995. |
2 | | For Fiscal Year
2003, the premium shall not exceed 110% |
3 | | of the premium actually charged in
Fiscal Year 2002. |
4 | | For Fiscal Year 2004, the premium shall not exceed 112% |
5 | | of
the premium actually charged in Fiscal Year 2003.
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6 | | For Fiscal Year 2005, the premium shall not exceed a |
7 | | weighted average of 106.6% of
the premium actually charged |
8 | | in Fiscal Year 2004.
|
9 | | For Fiscal Year 2006, the premium shall not exceed a |
10 | | weighted average of 109.1% of
the premium actually charged |
11 | | in Fiscal Year 2005.
|
12 | | For Fiscal Year 2007, the premium shall not exceed a |
13 | | weighted average of 103.9% of
the premium actually charged |
14 | | in Fiscal Year 2006.
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15 | | For Fiscal Year 2008 and thereafter, the premium in |
16 | | each fiscal year shall not exceed 105% of
the premium |
17 | | actually charged in the previous fiscal year.
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18 | | Rates and premiums may be based in part on age and |
19 | | eligibility for federal
medicare coverage. However, the cost of |
20 | | participation for a TRS dependent
beneficiary who is an |
21 | | unmarried child age 19 or over and mentally or physically
|
22 | | disabled shall not exceed the cost for a TRS dependent |
23 | | beneficiary who is
an unmarried child under age 19 and |
24 | | participates in the same major medical or
managed care program.
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25 | | The cost of health benefits under the program shall be paid |
26 | | as follows:
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1 | | (1) For a TRS benefit recipient selecting a managed |
2 | | care program, up to
75% of the total insurance rate shall |
3 | | be paid from the Teacher Health Insurance
Security Fund. |
4 | | Effective with Fiscal Year 2007 and thereafter, for a TRS |
5 | | benefit recipient selecting a managed care program, 75% of |
6 | | the total insurance rate shall be paid from the Teacher |
7 | | Health Insurance
Security Fund.
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8 | | (2) For a TRS benefit recipient selecting the major |
9 | | medical coverage
program, up to 50% of the total insurance |
10 | | rate shall be paid from the Teacher
Health Insurance |
11 | | Security Fund if a managed care program is accessible, as
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12 | | determined by the Teachers' Retirement System. Effective |
13 | | with Fiscal Year 2007 and thereafter, for a TRS benefit |
14 | | recipient selecting the major medical coverage
program, |
15 | | 50% of the total insurance rate shall be paid from the |
16 | | Teacher
Health Insurance Security Fund if a managed care |
17 | | program is accessible, as
determined by the Department of |
18 | | Central Management Services.
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19 | | (3) For a TRS benefit recipient selecting the major |
20 | | medical coverage
program, up to 75% of the total insurance |
21 | | rate shall be paid from the Teacher
Health Insurance |
22 | | Security Fund if a managed care program is not accessible, |
23 | | as
determined by the Teachers' Retirement System. |
24 | | Effective with Fiscal Year 2007 and thereafter, for a TRS |
25 | | benefit recipient selecting the major medical coverage
|
26 | | program, 75% of the total insurance rate shall be paid from |
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1 | | the Teacher
Health Insurance Security Fund if a managed |
2 | | care program is not accessible, as
determined by the |
3 | | Department of Central Management Services.
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4 | | (3.1) For a TRS dependent beneficiary who is Medicare |
5 | | primary and enrolled in a managed care plan, or the major |
6 | | medical coverage program if a managed care plan is not |
7 | | available, 25% of the total insurance rate shall be paid |
8 | | from the Teacher Health Security Fund as determined by the |
9 | | Department of Central Management Services. For the purpose |
10 | | of this item (3.1), the term "TRS dependent beneficiary who |
11 | | is Medicare primary" means a TRS dependent beneficiary who |
12 | | is participating in Medicare Parts A and B.
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13 | | (4) Except as otherwise provided in item (3.1), the
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14 | | balance of the rate of insurance, including the entire |
15 | | premium of
any coverage for TRS dependent beneficiaries |
16 | | that has been elected, shall be
paid
by deductions |
17 | | authorized by the TRS benefit recipient to be withheld from |
18 | | his
or her monthly annuity or benefit payment from the |
19 | | Teachers' Retirement System;
except that (i) if the balance |
20 | | of the cost of coverage exceeds the amount of
the monthly |
21 | | annuity or benefit payment, the difference shall be paid |
22 | | directly
to the Teachers' Retirement System by the TRS |
23 | | benefit recipient, and (ii) all
or part of the balance of |
24 | | the cost of coverage may, at the school board's
option, be |
25 | | paid to the Teachers' Retirement System by the school board |
26 | | of the
school district from which the TRS benefit recipient |
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1 | | retired, in accordance
with Section 10-22.3b of the School |
2 | | Code. The Teachers' Retirement System
shall promptly |
3 | | deposit all moneys withheld by or paid to it under this
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4 | | subdivision (e)(4) into the Teacher Health Insurance |
5 | | Security Fund. These
moneys shall not be considered assets |
6 | | of the Retirement System.
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7 | | (f) Financing. Beginning July 1, 1995, all revenues arising |
8 | | from the
administration of the health benefit programs |
9 | | established under Article 16 of
the Illinois Pension Code or |
10 | | this Section shall be deposited into the
Teacher Health |
11 | | Insurance Security Fund, which is hereby created as a
|
12 | | nonappropriated trust fund to be held outside the State |
13 | | Treasury, with the
State Treasurer as custodian. Any interest |
14 | | earned on moneys in the Teacher
Health Insurance Security Fund |
15 | | shall be deposited into the Fund.
|
16 | | Moneys in the Teacher Health Insurance Security
Fund shall |
17 | | be used only to pay the costs of the health benefit program
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18 | | established under this Section, including associated |
19 | | administrative costs, and
the costs associated with the health |
20 | | benefit program established under Article
16 of the Illinois |
21 | | Pension Code, as authorized in this Section. Beginning
July 1, |
22 | | 1995, the Department of Central Management Services may make
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23 | | expenditures from the Teacher Health Insurance Security Fund |
24 | | for those costs.
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25 | | After other funds authorized for the payment of the costs |
26 | | of the health
benefit program established under Article 16 of |
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1 | | the Illinois Pension Code are
exhausted and until January 1, |
2 | | 1996 (or such later date as may be agreed upon
by the Director |
3 | | of Central Management Services and the Secretary of the
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4 | | Teachers' Retirement System), the Secretary of the Teachers' |
5 | | Retirement System
may make expenditures from the Teacher Health |
6 | | Insurance Security Fund as
necessary to pay up to 75% of the |
7 | | cost of providing health coverage to eligible
benefit |
8 | | recipients (as defined in Sections 16-153.1 and 16-153.3 of the
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9 | | Illinois Pension Code) who are enrolled in the Article 16 |
10 | | health benefit
program and to facilitate the transfer of |
11 | | administration of the health benefit
program to the Department |
12 | | of Central Management Services.
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13 | | The Department of Central Management Services, or any |
14 | | successor agency designated to procure healthcare contracts |
15 | | pursuant to this Act, is authorized to establish funds, |
16 | | separate accounts provided by any bank or banks as defined by |
17 | | the Illinois Banking Act, or separate accounts provided by any |
18 | | savings and loan association or associations as defined by the |
19 | | Illinois Savings and Loan Act of 1985 to be held by the |
20 | | Director, outside the State treasury, for the purpose of |
21 | | receiving the transfer of moneys from the Teacher Health |
22 | | Insurance Security Fund. The Department may promulgate rules |
23 | | further defining the methodology for the transfers. Any |
24 | | interest earned by moneys in the funds or accounts shall inure |
25 | | to the Teacher Health Insurance Security Fund. The transferred |
26 | | moneys, and interest accrued thereon, shall be used exclusively |
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1 | | for transfers to administrative service organizations or their |
2 | | financial institutions for payments of claims to claimants and |
3 | | providers under the self-insurance health plan. The |
4 | | transferred moneys, and interest accrued thereon, shall not be |
5 | | used for any other purpose including, but not limited to, |
6 | | reimbursement of administration fees due the administrative |
7 | | service organization pursuant to its contract or contracts with |
8 | | the Department.
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9 | | (g) Contract for benefits. The Director shall by contract, |
10 | | self-insurance,
or otherwise make available the program of |
11 | | health benefits for TRS benefit
recipients and their TRS |
12 | | dependent beneficiaries that is provided for in this
Section. |
13 | | The contract or other arrangement for the provision of these |
14 | | health
benefits shall be on terms deemed by the Director to be |
15 | | in the best interest of
the State of Illinois and the TRS |
16 | | benefit recipients based on, but not limited
to, such criteria |
17 | | as administrative cost, service capabilities of the carrier
or |
18 | | other contractor, and the costs of the benefits.
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19 | | (g-5) Committee. A Teacher Retirement Insurance Program |
20 | | Committee shall be established, to consist of 10 persons |
21 | | appointed by the Governor.
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22 | | The Committee shall convene at least 4 times each year, and |
23 | | shall consider and make recommendations on issues affecting the |
24 | | program of health benefits provided under this
Section. |
25 | | Recommendations of the Committee shall be based on a consensus |
26 | | of the members of the Committee.
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1 | | If the Teacher
Health Insurance Security Fund experiences a |
2 | | deficit balance based upon the contribution and subsidy rates |
3 | | established in this Section and Section 6.6 for Fiscal Year |
4 | | 2008 or thereafter, the Committee shall make recommendations |
5 | | for adjustments to the funding sources established under these |
6 | | Sections. |
7 | | In addition, the Committee shall identify proposed |
8 | | solutions to the funding shortfalls that are affecting the |
9 | | Teacher Health Insurance Security Fund, and it shall report |
10 | | those solutions to the Governor and the General Assembly within |
11 | | 6 months after August 15, 2011 (the effective date of Public |
12 | | Act 97-386). |
13 | | (h) Continuation of program. It is the intention of
the |
14 | | General Assembly that the program of health benefits provided |
15 | | under this
Section be maintained on an ongoing, affordable |
16 | | basis.
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17 | | The program of health benefits provided under this Section |
18 | | may be amended by
the State and is not intended to be a pension |
19 | | or retirement benefit subject to
protection under Article XIII, |
20 | | Section 5 of the Illinois Constitution.
|
21 | | (i) Repeal. (Blank).
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22 | | (Source: P.A. 97-386, eff. 8-15-11; 97-813, eff. 7-13-12; |
23 | | 98-488, eff. 8-16-13.)
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24 | | (5 ILCS 375/6.9)
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25 | | Sec. 6.9. Health benefits for community college benefit |
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1 | | recipients and
community college dependent beneficiaries. |
2 | | (a) Purpose. It is the purpose of this amendatory Act of |
3 | | 1997 to establish
a uniform program of health benefits for |
4 | | community college benefit recipients
and their dependent |
5 | | beneficiaries under the administration of the Department of
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6 | | Central Management Services.
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7 | | (b) Creation of program. Beginning July 1, 1999, the |
8 | | Department of
Central Management Services shall be responsible |
9 | | for administering a program of
health benefits for community |
10 | | college benefit recipients and community college
dependent |
11 | | beneficiaries under this Section. The State Universities |
12 | | Retirement
System and the boards of trustees of the various |
13 | | community college districts
shall cooperate with the |
14 | | Department in this endeavor.
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15 | | (c) Eligibility. All community college benefit recipients |
16 | | and community
college dependent beneficiaries shall be |
17 | | eligible to participate in the program
established under this |
18 | | Section, without any interruption or delay in coverage
or |
19 | | limitation as to pre-existing medical conditions. Eligibility |
20 | | to
participate shall be determined by the State Universities |
21 | | Retirement System.
Eligibility information shall be |
22 | | communicated to the Department of Central
Management Services |
23 | | in a format acceptable to the Department.
|
24 | | (c-1) On and after the effective date of this amendatory |
25 | | Act of the 98th General Assembly, eligible community college |
26 | | benefit recipients and community college dependent |
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1 | | beneficiaries may elect not to participate in the program of |
2 | | health benefits under this Section. The election must be made |
3 | | during the community college benefit recipient's annual open |
4 | | enrollment period subject to the following conditions: |
5 | | (1) Community college benefit recipients must furnish |
6 | | proof of health benefit coverage, either comprehensive |
7 | | major medical coverage or comprehensive managed care plan, |
8 | | from a source other than the Department of Central |
9 | | Management Services in order to elect not to participate in |
10 | | the program. |
11 | | (2) Regardless of the date that the community college |
12 | | benefit recipient or community college dependent |
13 | | beneficiary elected not to participate in the program of |
14 | | health benefits offered under this Section, both the |
15 | | community college benefit recipient and the community |
16 | | college dependent beneficiary may also re-enroll in the |
17 | | program of health benefits during any annual open |
18 | | enrollment period, without evidence of insurability. |
19 | | (3) Community college benefit recipients who elect not |
20 | | to participate in the program of health benefits shall be |
21 | | furnished with a written explanation of the requirements |
22 | | and limitations for the election not to participate in the |
23 | | program and for re-enrolling in the program. |
24 | | (4) The changes under this subsection (c-1) impact only |
25 | | those community college benefit recipients and community |
26 | | college dependent beneficiaries who are enrolled or had |
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1 | | been enrolled in the College Insurance Program before the |
2 | | effective date of this amendatory Act of the 98th General |
3 | | Assembly. |
4 | | (d) Coverage. The health benefit coverage provided under |
5 | | this Section
shall be a program of health, dental, and vision |
6 | | benefits.
|
7 | | The program of health benefits under this Section may |
8 | | include any or all of
the benefit limitations, including but |
9 | | not limited to a reduction in benefits
based on eligibility for |
10 | | federal Medicare medicare benefits, that are provided under
|
11 | | subsection (a) of Section 6 of this Act for other health |
12 | | benefit programs under
this Act.
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13 | | (e) Insurance rates and premiums. The Director shall |
14 | | determine the
insurance rates and premiums for community |
15 | | college benefit recipients and
community college dependent |
16 | | beneficiaries. Rates and premiums may be based
in part on age |
17 | | and eligibility for federal Medicare coverage.
The Director |
18 | | shall also determine premiums that will allow for the
|
19 | | establishment of an actuarially sound reserve for this program.
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20 | | The cost of health benefits under the program shall be paid |
21 | | as follows:
|
22 | | (1) For a community college benefit recipient, up to |
23 | | 75% of the total
insurance rate shall be paid from the |
24 | | Community College Health Insurance
Security Fund.
|
25 | | (2) The balance of the rate of insurance, including the |
26 | | entire premium
for any coverage for community college |
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1 | | dependent beneficiaries that has been
elected, shall be |
2 | | paid by deductions authorized by the community college
|
3 | | benefit recipient to be withheld from his or her monthly |
4 | | annuity or benefit
payment from the State Universities |
5 | | Retirement System; except that (i) if the
balance of the |
6 | | cost of coverage exceeds the amount of the monthly annuity |
7 | | or
benefit payment, the difference shall be paid directly |
8 | | to the State
Universities Retirement System by the |
9 | | community college benefit recipient, and
(ii) all or part |
10 | | of the balance of the cost of coverage may, at the option |
11 | | of
the board of trustees of the community college district, |
12 | | be paid to
the State Universities Retirement System by the |
13 | | board of the community college
district from which the |
14 | | community college benefit recipient retired. The State
|
15 | | Universities Retirement System shall promptly deposit all |
16 | | moneys withheld by or
paid to it under this subdivision |
17 | | (e)(2) into the Community College Health
Insurance |
18 | | Security Fund. These moneys shall not be considered assets |
19 | | of the
State Universities Retirement System.
|
20 | | (f) Financing. All revenues arising from the |
21 | | administration of the health
benefit program established under |
22 | | this Section shall be deposited into the
Community College |
23 | | Health Insurance Security Fund, which is hereby created as a
|
24 | | nonappropriated trust fund to be held outside the State |
25 | | Treasury, with the
State Treasurer as custodian. Any interest |
26 | | earned on moneys in the Community
College Health Insurance |
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1 | | Security Fund shall be deposited into the Fund.
|
2 | | Moneys in the Community College Health Insurance Security |
3 | | Fund shall be used
only to pay the costs of the health benefit |
4 | | program established under this
Section, including associated |
5 | | administrative costs and the establishment of a
program |
6 | | reserve. Beginning January 1, 1999,
the Department of Central |
7 | | Management Services may make expenditures from the
Community |
8 | | College Health Insurance Security Fund for those costs.
|
9 | | (g) Contract for benefits. The Director shall by contract, |
10 | | self-insurance,
or otherwise make available the program of |
11 | | health benefits for community
college benefit recipients and |
12 | | their community college dependent beneficiaries
that is |
13 | | provided for in this Section. The contract or other arrangement |
14 | | for
the provision of these health benefits shall be on terms |
15 | | deemed by the Director
to be in the best interest of the State |
16 | | of Illinois and the community college
benefit recipients based |
17 | | on, but not limited to, such criteria as
administrative cost, |
18 | | service capabilities of the carrier or other contractor,
and |
19 | | the costs of the benefits.
|
20 | | (h) Continuation of program. It is the intention of the |
21 | | General Assembly
that the program of health benefits provided |
22 | | under this Section be maintained
on an ongoing, affordable |
23 | | basis. The program of health benefits provided under
this |
24 | | Section may be amended by the State and is not intended to be a |
25 | | pension or
retirement benefit subject to protection under |
26 | | Article XIII, Section 5 of the
Illinois Constitution.
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1 | | (i) Other health benefit plans. A health benefit plan |
2 | | provided by a
community college district (other than a |
3 | | community college district subject to
Article VII of the Public |
4 | | Community College Act) under the terms of a
collective |
5 | | bargaining agreement in effect on or prior to the effective |
6 | | date of
this amendatory Act of 1997 shall continue in force |
7 | | according to the terms of
that agreement, unless otherwise |
8 | | mutually agreed by the parties to that
agreement and the |
9 | | affected retiree.
A community college benefit recipient or |
10 | | community college dependent
beneficiary whose coverage under |
11 | | such a plan expires shall be eligible to begin
participating in |
12 | | the program established under this Section without any
|
13 | | interruption or delay in coverage or limitation as to |
14 | | pre-existing medical
conditions.
|
15 | | This Act does not prohibit any community college district |
16 | | from offering
additional health benefits for its retirees or |
17 | | their dependents or survivors.
|
18 | | (Source: P.A. 90-497, eff. 8-18-97; 90-655, eff. 7-30-98.)
|
19 | | Section 99. Effective date. This Act takes effect upon |
20 | | becoming law.".
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