Rep. Sue Scherer

Filed: 3/5/2020

 

 


 

 


 
10100HB4036ham001LRB101 15278 RJF 71144 a

1
AMENDMENT TO HOUSE BILL 4036

2    AMENDMENT NO. ______. Amend House Bill 4036 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The State Employees Group Insurance Act of 1971
5is amended by changing Sections 3 and 8 as follows:
 
6    (5 ILCS 375/3)  (from Ch. 127, par. 523)
7    Sec. 3. Definitions. Unless the context otherwise
8requires, the following words and phrases as used in this Act
9shall have the following meanings. The Department may define
10these and other words and phrases separately for the purpose of
11implementing specific programs providing benefits under this
12Act.
13    (a) "Administrative service organization" means any
14person, firm or corporation experienced in the handling of
15claims which is fully qualified, financially sound and capable
16of meeting the service requirements of a contract of

 

 

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1administration executed with the Department.
2    (b) "Annuitant" means (1) an employee who retires, or has
3retired, on or after January 1, 1966 on an immediate annuity
4under the provisions of Articles 2, 14 (including an employee
5who has elected to receive an alternative retirement
6cancellation payment under Section 14-108.5 of the Illinois
7Pension Code in lieu of an annuity or who meets the criteria
8for retirement, but in lieu of receiving an annuity under that
9Article has elected to receive an accelerated pension benefit
10payment under Section 14-147.5 of that Article), 15 (including
11an employee who has retired under the optional retirement
12program established under Section 15-158.2 or who meets the
13criteria for retirement but in lieu of receiving an annuity
14under that Article has elected to receive an accelerated
15pension benefit payment under Section 15-185.5 of the Article),
16paragraphs (2), (3), or (5) of Section 16-106 (including an
17employee who meets the criteria for retirement, but in lieu of
18receiving an annuity under that Article has elected to receive
19an accelerated pension benefit payment under Section 16-190.5
20of the Illinois Pension Code), or Article 18 of the Illinois
21Pension Code; (2) any person who was receiving group insurance
22coverage under this Act as of March 31, 1978 by reason of his
23status as an annuitant, even though the annuity in relation to
24which such coverage was provided is a proportional annuity
25based on less than the minimum period of service required for a
26retirement annuity in the system involved; (3) any person not

 

 

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1otherwise covered by this Act who has retired as a
2participating member under Article 2 of the Illinois Pension
3Code but is ineligible for the retirement annuity under Section
42-119 of the Illinois Pension Code; (4) the spouse of any
5person who is receiving a retirement annuity under Article 18
6of the Illinois Pension Code and who is covered under a group
7health insurance program sponsored by a governmental employer
8other than the State of Illinois and who has irrevocably
9elected to waive his or her coverage under this Act and to have
10his or her spouse considered as the "annuitant" under this Act
11and not as a "dependent"; or (5) an employee who retires, or
12has retired, from a qualified position, as determined according
13to rules promulgated by the Director, under a qualified local
14government, a qualified rehabilitation facility, a qualified
15domestic violence shelter or service, or a qualified child
16advocacy center. (For definition of "retired employee", see (p)
17post).
18    (b-5) (Blank).
19    (b-6) (Blank).
20    (b-7) (Blank).
21    (c) "Carrier" means (1) an insurance company, a corporation
22organized under the Limited Health Service Organization Act or
23the Voluntary Health Services Plans Plan Act, a partnership, or
24other nongovernmental organization, which is authorized to do
25group life or group health insurance business in Illinois, or
26(2) the State of Illinois as a self-insurer.

 

 

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1    (d) "Compensation" means salary or wages payable on a
2regular payroll by the State Treasurer on a warrant of the
3State Comptroller out of any State, trust or federal fund, or
4by the Governor of the State through a disbursing officer of
5the State out of a trust or out of federal funds, or by any
6Department out of State, trust, federal or other funds held by
7the State Treasurer or the Department, to any person for
8personal services currently performed, and ordinary or
9accidental disability benefits under Articles 2, 14, 15
10(including ordinary or accidental disability benefits under
11the optional retirement program established under Section
1215-158.2), paragraphs (2), (3), or (5) of Section 16-106, or
13Article 18 of the Illinois Pension Code, for disability
14incurred after January 1, 1966, or benefits payable under the
15Workers' Compensation or Occupational Diseases Act or benefits
16payable under a sick pay plan established in accordance with
17Section 36 of the State Finance Act. "Compensation" also means
18salary or wages paid to an employee of any qualified local
19government, qualified rehabilitation facility, qualified
20domestic violence shelter or service, or qualified child
21advocacy center.
22    (e) "Commission" means the State Employees Group Insurance
23Advisory Commission authorized by this Act. Commencing July 1,
241984, "Commission" as used in this Act means the Commission on
25Government Forecasting and Accountability as established by
26the Legislative Commission Reorganization Act of 1984.

 

 

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1    (f) "Contributory", when referred to as contributory
2coverage, shall mean optional coverages or benefits elected by
3the member toward the cost of which such member makes
4contribution, or which are funded in whole or in part through
5the acceptance of a reduction in earnings or the foregoing of
6an increase in earnings by an employee, as distinguished from
7noncontributory coverage or benefits which are paid entirely by
8the State of Illinois without reduction of the member's salary.
9    (g) "Department" means any department, institution, board,
10commission, officer, court or any agency of the State
11government receiving appropriations and having power to
12certify payrolls to the Comptroller authorizing payments of
13salary and wages against such appropriations as are made by the
14General Assembly from any State fund, or against trust funds
15held by the State Treasurer and includes boards of trustees of
16the retirement systems created by Articles 2, 14, 15, 16, and
1718 of the Illinois Pension Code. "Department" also includes the
18Illinois Comprehensive Health Insurance Board, the Board of
19Examiners established under the Illinois Public Accounting
20Act, and the Illinois Finance Authority.
21    (h) "Dependent", when the term is used in the context of
22the health and life plan, means a member's spouse and any child
23(1) from birth to age 26 including an adopted child, a child
24who lives with the member from the time of the placement for
25adoption until entry of an order of adoption, a stepchild or
26adjudicated child, or a child who lives with the member if such

 

 

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1member is a court appointed guardian of the child or (2) age 19
2or over who has a mental or physical disability from a cause
3originating prior to the age of 19 (age 26 if enrolled as an
4adult child dependent). For the health plan only, the term
5"dependent" also includes (1) any person enrolled prior to the
6effective date of this Section who is dependent upon the member
7to the extent that the member may claim such person as a
8dependent for income tax deduction purposes and (2) any person
9who has received after June 30, 2000 an organ transplant and
10who is financially dependent upon the member and eligible to be
11claimed as a dependent for income tax purposes. A member
12requesting to cover any dependent must provide documentation as
13requested by the Department of Central Management Services and
14file with the Department any and all forms required by the
15Department.
16    (i) "Director" means the Director of the Illinois
17Department of Central Management Services.
18    (j) "Eligibility period" means the period of time a member
19has to elect enrollment in programs or to select benefits
20without regard to age, sex or health.
21    (k) "Employee" means and includes each officer or employee
22in the service of a department who (1) receives his
23compensation for service rendered to the department on a
24warrant issued pursuant to a payroll certified by a department
25or on a warrant or check issued and drawn by a department upon
26a trust, federal or other fund or on a warrant issued pursuant

 

 

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1to a payroll certified by an elected or duly appointed officer
2of the State or who receives payment of the performance of
3personal services on a warrant issued pursuant to a payroll
4certified by a Department and drawn by the Comptroller upon the
5State Treasurer against appropriations made by the General
6Assembly from any fund or against trust funds held by the State
7Treasurer, and (2) is employed full-time or part-time in a
8position normally requiring actual performance of duty during
9not less than 1/2 of a normal work period, as established by
10the Director in cooperation with each department, except that
11persons elected by popular vote will be considered employees
12during the entire term for which they are elected regardless of
13hours devoted to the service of the State, and (3) except that
14"employee" does not include any person who is not eligible by
15reason of such person's employment to participate in one of the
16State retirement systems under Articles 2, 14, 15 (either the
17regular Article 15 system or the optional retirement program
18established under Section 15-158.2), or 18, or under paragraph
19(2), (3), or (5) of Section 16-106, of the Illinois Pension
20Code, but such term does include persons who are employed
21during the 6 month qualifying period under Article 14 of the
22Illinois Pension Code. Such term also includes any person who
23(1) after January 1, 1966, is receiving ordinary or accidental
24disability benefits under Articles 2, 14, 15 (including
25ordinary or accidental disability benefits under the optional
26retirement program established under Section 15-158.2),

 

 

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1paragraphs (2), (3), or (5) of Section 16-106, or Article 18 of
2the Illinois Pension Code, for disability incurred after
3January 1, 1966, (2) receives total permanent or total
4temporary disability under the Workers' Compensation Act or
5Occupational Disease Act as a result of injuries sustained or
6illness contracted in the course of employment with the State
7of Illinois, or (3) is not otherwise covered under this Act and
8has retired as a participating member under Article 2 of the
9Illinois Pension Code but is ineligible for the retirement
10annuity under Section 2-119 of the Illinois Pension Code.
11However, a person who satisfies the criteria of the foregoing
12definition of "employee" except that such person is made
13ineligible to participate in the State Universities Retirement
14System by clause (4) of subsection (a) of Section 15-107 of the
15Illinois Pension Code is also an "employee" for the purposes of
16this Act. "Employee" also includes any person receiving or
17eligible for benefits under a sick pay plan established in
18accordance with Section 36 of the State Finance Act. "Employee"
19also includes (i) each officer or employee in the service of a
20qualified local government, including persons appointed as
21trustees of sanitary districts regardless of hours devoted to
22the service of the sanitary district, (ii) each employee in the
23service of a qualified rehabilitation facility, (iii) each
24full-time employee in the service of a qualified domestic
25violence shelter or service, and (iv) each full-time employee
26in the service of a qualified child advocacy center, as

 

 

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1determined according to rules promulgated by the Director.
2    (l) "Member" means an employee, annuitant, retired
3employee or survivor. In the case of an annuitant or retired
4employee who first becomes an annuitant or retired employee on
5or after January 13, 2012 (the effective date of Public Act
697-668) this amendatory Act of the 97th General Assembly, the
7individual must meet the minimum vesting requirements of the
8applicable retirement system in order to be eligible for group
9insurance benefits under that system. In the case of a survivor
10who first becomes a survivor on or after January 13, 2012 (the
11effective date of Public Act 97-668) this amendatory Act of the
1297th General Assembly, the deceased employee, annuitant, or
13retired employee upon whom the annuity is based must have been
14eligible to participate in the group insurance system under the
15applicable retirement system in order for the survivor to be
16eligible for group insurance benefits under that system.
17    (m) "Optional coverages or benefits" means those coverages
18or benefits available to the member on his or her voluntary
19election, and at his or her own expense.
20    (n) "Program" means the group life insurance, health
21benefits and other employee benefits designed and contracted
22for by the Director under this Act.
23    (o) "Health plan" means a health benefits program offered
24by the State of Illinois for persons eligible for the plan.
25    (p) "Retired employee" means any person who would be an
26annuitant as that term is defined herein but for the fact that

 

 

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1such person retired prior to January 1, 1966. Such term also
2includes any person formerly employed by the University of
3Illinois in the Cooperative Extension Service who would be an
4annuitant but for the fact that such person was made ineligible
5to participate in the State Universities Retirement System by
6clause (4) of subsection (a) of Section 15-107 of the Illinois
7Pension Code.
8    (q) "Survivor" means a person receiving an annuity as a
9survivor of an employee or of an annuitant. "Survivor" also
10includes: (1) the surviving dependent of a person who satisfies
11the definition of "employee" except that such person is made
12ineligible to participate in the State Universities Retirement
13System by clause (4) of subsection (a) of Section 15-107 of the
14Illinois Pension Code; (2) the surviving dependent of any
15person formerly employed by the University of Illinois in the
16Cooperative Extension Service who would be an annuitant except
17for the fact that such person was made ineligible to
18participate in the State Universities Retirement System by
19clause (4) of subsection (a) of Section 15-107 of the Illinois
20Pension Code; (3) the surviving dependent of a person who was
21an annuitant under this Act by virtue of receiving an
22alternative retirement cancellation payment under Section
2314-108.5 of the Illinois Pension Code; and (4) a person who
24would be receiving an annuity as a survivor of an annuitant
25except that the annuitant elected on or after June 4, 2018 to
26receive an accelerated pension benefit payment under Section

 

 

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114-147.5, 15-185.5, or 16-190.5 of the Illinois Pension Code in
2lieu of receiving an annuity.
3    (q-2) "SERS" means the State Employees' Retirement System
4of Illinois, created under Article 14 of the Illinois Pension
5Code.
6    (q-3) "SURS" means the State Universities Retirement
7System, created under Article 15 of the Illinois Pension Code.
8    (q-4) "TRS" means the Teachers' Retirement System of the
9State of Illinois, created under Article 16 of the Illinois
10Pension Code.
11    (q-5) (Blank).
12    (q-6) (Blank).
13    (q-7) (Blank).
14    (r) "Medical services" means the services provided within
15the scope of their licenses by practitioners in all categories
16licensed under the Medical Practice Act of 1987.
17    (s) "Unit of local government" means any county,
18municipality, township, school district (including a
19combination of school districts under the Intergovernmental
20Cooperation Act), special district or other unit, designated as
21a unit of local government by law, which exercises limited
22governmental powers or powers in respect to limited
23governmental subjects, any not-for-profit association with a
24membership that primarily includes townships and township
25officials, that has duties that include provision of research
26service, dissemination of information, and other acts for the

 

 

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1purpose of improving township government, and that is funded
2wholly or partly in accordance with Section 85-15 of the
3Township Code; any not-for-profit corporation or association,
4with a membership consisting primarily of municipalities, that
5operates its own utility system, and provides research,
6training, dissemination of information, or other acts to
7promote cooperation between and among municipalities that
8provide utility services and for the advancement of the goals
9and purposes of its membership; the Southern Illinois
10Collegiate Common Market, which is a consortium of higher
11education institutions in Southern Illinois; the Illinois
12Association of Park Districts; and any hospital provider that
13is owned by a county that has 100 or fewer hospital beds and
14has not already joined the program. "Qualified local
15government" means a unit of local government approved by the
16Director and participating in a program created under
17subsection (i) of Section 10 of this Act.
18    (t) "Qualified rehabilitation facility" means any
19not-for-profit organization that is accredited by the
20Commission on Accreditation of Rehabilitation Facilities or
21certified by the Department of Human Services (as successor to
22the Department of Mental Health and Developmental
23Disabilities) to provide services to persons with disabilities
24and which receives funds from the State of Illinois for
25providing those services, approved by the Director and
26participating in a program created under subsection (j) of

 

 

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1Section 10 of this Act.
2    (u) "Qualified domestic violence shelter or service" means
3any Illinois domestic violence shelter or service and its
4administrative offices funded by the Department of Human
5Services (as successor to the Illinois Department of Public
6Aid), approved by the Director and participating in a program
7created under subsection (k) of Section 10.
8    (v) "TRS benefit recipient" means a person who:
9        (1) is not a "member" as defined in this Section; and
10        (2) is receiving a monthly benefit or retirement
11    annuity under Article 16 of the Illinois Pension Code or
12    would be receiving such monthly benefit or retirement
13    annuity except that the benefit recipient elected on or
14    after June 4, 2018 to receive an accelerated pension
15    benefit payment under Section 16-190.5 of the Illinois
16    Pension Code in lieu of receiving an annuity; and
17        (3) either (i) has at least 8 years of creditable
18    service under Article 16 of the Illinois Pension Code, or
19    (ii) was enrolled in the health insurance program offered
20    under that Article on January 1, 1996, or (iii) is the
21    survivor of a benefit recipient who had at least 8 years of
22    creditable service under Article 16 of the Illinois Pension
23    Code or was enrolled in the health insurance program
24    offered under that Article on June 21, 1995 (the effective
25    date of Public Act 89-25) this amendatory Act of 1995, or
26    (iv) is a recipient or survivor of a recipient of a

 

 

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1    disability benefit under Article 16 of the Illinois Pension
2    Code.
3    (w) "TRS dependent beneficiary" means a person who:
4        (1) is not a "member" or "dependent" as defined in this
5    Section; and
6        (2) is a TRS benefit recipient's: (A) spouse, (B)
7    dependent parent who is receiving at least half of his or
8    her support from the TRS benefit recipient, or (C) natural,
9    step, adjudicated, or adopted child who is (i) under age
10    26, (ii) was, on January 1, 1996, participating as a
11    dependent beneficiary in the health insurance program
12    offered under Article 16 of the Illinois Pension Code, or
13    (iii) age 19 or over who has a mental or physical
14    disability from a cause originating prior to the age of 19
15    (age 26 if enrolled as an adult child).
16    "TRS dependent beneficiary" does not include, as indicated
17under paragraph (2) of this subsection (w), a dependent of the
18survivor of a TRS benefit recipient who first becomes a
19dependent of a survivor of a TRS benefit recipient on or after
20January 13, 2012 (the effective date of Public Act 97-668) this
21amendatory Act of the 97th General Assembly unless that
22dependent would have been eligible for coverage as a dependent
23of the deceased TRS benefit recipient upon whom the survivor
24benefit is based.
25    (x) "Military leave" refers to individuals in basic
26training for reserves, special/advanced training, annual

 

 

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1training, emergency call up, activation by the President of the
2United States, or any other training or duty in service to the
3United States Armed Forces.
4    (y) (Blank).
5    (z) "Community college benefit recipient" means a person
6who:
7        (1) is not a "member" as defined in this Section; and
8        (2) is receiving a monthly survivor's annuity or
9    retirement annuity under Article 15 of the Illinois Pension
10    Code or would be receiving such monthly survivor's annuity
11    or retirement annuity except that the benefit recipient
12    elected on or after June 4, 2018 to receive an accelerated
13    pension benefit payment under Section 15-185.5 of the
14    Illinois Pension Code in lieu of receiving an annuity; and
15        (3) either (i) was a full-time employee of a community
16    college district or an association of community college
17    boards created under the Public Community College Act
18    (other than an employee whose last employer under Article
19    15 of the Illinois Pension Code was a community college
20    district subject to Article VII of the Public Community
21    College Act) and was eligible to participate in a group
22    health benefit plan as an employee during the time of
23    employment with a community college district (other than a
24    community college district subject to Article VII of the
25    Public Community College Act) or an association of
26    community college boards, or (ii) is the survivor of a

 

 

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1    person described in item (i).
2    (aa) "Community college dependent beneficiary" means a
3person who:
4        (1) is not a "member" or "dependent" as defined in this
5    Section; and
6        (2) is a community college benefit recipient's: (A)
7    spouse, (B) dependent parent who is receiving at least half
8    of his or her support from the community college benefit
9    recipient, or (C) natural, step, adjudicated, or adopted
10    child who is (i) under age 26, or (ii) age 19 or over and
11    has a mental or physical disability from a cause
12    originating prior to the age of 19 (age 26 if enrolled as
13    an adult child).
14    "Community college dependent beneficiary" does not
15include, as indicated under paragraph (2) of this subsection
16(aa), a dependent of the survivor of a community college
17benefit recipient who first becomes a dependent of a survivor
18of a community college benefit recipient on or after January
1913, 2012 (the effective date of Public Act 97-668) this
20amendatory Act of the 97th General Assembly unless that
21dependent would have been eligible for coverage as a dependent
22of the deceased community college benefit recipient upon whom
23the survivor annuity is based.
24    (bb) "Qualified child advocacy center" means any Illinois
25child advocacy center and its administrative offices funded by
26the Department of Children and Family Services, as defined by

 

 

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1the Children's Advocacy Center Act (55 ILCS 80/), approved by
2the Director and participating in a program created under
3subsection (n) of Section 10.
4    (cc) "Placement for adoption" means the assumption and
5retention by a member of a legal obligation for total or
6partial support of a child in anticipation of adoption of the
7child. The child's placement with the member terminates upon
8the termination of such legal obligation.
9    (dd) "Qualifying change in status" means an event that
10effects an individual's eligibility for coverage under a
11program of benefits offered under this Act, which may include,
12but is not limited to, the following:
13        (1) events that change an employee's legal marital
14    status, including marriage, death of spouse, divorce,
15    legal separation, or annulment;
16        (2) events that change an employee's number of
17    dependents, including birth, death, adoption, or placement
18    for adoption;
19        (3) events that change the employment status of the
20    employee, the employee's spouse, or the employee's
21    dependent, including termination or commencement of
22    employment, strike or lockout, commencement of or return
23    from an unpaid leave of absence, change in worksite, or
24    change in the individual's employment when they cease to be
25    eligible for the program provided under this Act;
26        (4) events that cause an employee's dependent to

 

 

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1    satisfy or cease to satisfy eligibility requirements for
2    coverage; and
3        (5) a change of residence for the employee, spouse, or
4    dependent.
5(Source: P.A. 100-355, eff. 1-1-18; 100-587, eff. 6-4-18;
6101-242, eff. 8-9-19; revised 9-19-19.)
 
7    (5 ILCS 375/8)  (from Ch. 127, par. 528)
8    Sec. 8. Eligibility.
9    (a) Each employee eligible under the provisions of this Act
10and any rules and regulations promulgated and adopted hereunder
11by the Director shall become immediately eligible and covered
12for all benefits available under the programs. Employees
13electing coverage for eligible dependents shall have the
14coverage effective immediately, provided that the election is
15properly filed in accordance with required filing dates and
16procedures specified by the Director, including the completion
17and submission of all documentation and forms required by the
18Director.
19        (1) Every member originally eligible to elect
20    dependent coverage, but not electing it during the original
21    eligibility period, may subsequently obtain dependent
22    coverage only in the event of a qualifying change in
23    status, as defined under this Act and to the extent
24    permitted in accordance with federal regulations governing
25    Section 125 of the Internal Revenue Code, special

 

 

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1    enrollment, special circumstance as defined by the
2    Director, or during the annual Benefit Choice Period. Any
3    request to elect dependent coverage due to a qualifying
4    change in status must be consistent with the change in
5    status experienced by the member.
6        (2) Members described above being transferred from
7    previous coverage towards which the State has been
8    contributing shall be transferred regardless of
9    preexisting conditions, waiting periods, or other
10    requirements that might jeopardize claim payments to which
11    they would otherwise have been entitled.
12        (3) Eligible and covered members that are eligible for
13    coverage as dependents except for the fact of being members
14    shall be transferred to, and covered under, dependent
15    status regardless of preexisting conditions, waiting
16    periods, or other requirements that might jeopardize claim
17    payments to which they would otherwise have been entitled
18    upon cessation of member status and the election of
19    dependent coverage by a member eligible to elect that
20    coverage.
21    (b) New employees shall be immediately insured for the
22basic group life insurance and covered by the program of health
23benefits on the first day of active State service. Optional
24life insurance coverage one to 4 times the basic amount, if
25elected during the relevant eligibility period, will become
26effective on the date of employment. Optional life insurance

 

 

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1coverage exceeding 4 times the basic amount and all life
2insurance amounts applied for after the eligibility period will
3be effective, subject to satisfactory evidence of insurability
4when applicable, or other necessary qualifications, pursuant
5to the requirements of the applicable benefit program, unless
6there is a change in status that would confer new eligibility
7for change of enrollment under rules established supplementing
8this Act, in which event application must be made within the
9new eligibility period.
10    (c) As to the group health benefits program contracted to
11begin or continue after June 30, 1973, each annuitant,
12survivor, and retired employee shall become immediately
13eligible for all benefits available under that program. Each
14annuitant, survivor, and retired employee shall have coverage
15effective immediately, provided that the election is properly
16filed in accordance with the required filing dates and
17procedures specified by the Director, including the completion
18and submission of all documentation and forms required by the
19Director. Annuitants, survivors, and retired employees may
20elect coverage for eligible dependents and shall have the
21coverage effective immediately, provided that the election is
22properly filed in accordance with required filing dates and
23procedures specified by the Director, except that, for a
24survivor, the dependent sought to be added on or after the
25effective date of this amendatory Act of the 97th General
26Assembly must have been eligible for coverage as a dependent

 

 

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

 

 

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1        (2) Members may re-enroll in the Department of Central
2    Management Services program of health benefits upon
3    showing a qualifying change in status, as defined in the
4    U.S. Internal Revenue Code, without evidence of
5    insurability and with no limitations on coverage for
6    pre-existing conditions, provided that there was not a
7    break in coverage of more than 63 days.
8        (3) Members may also re-enroll in the program of health
9    benefits during any annual benefit choice period, without
10    evidence of insurability.
11        (4) Members who elect not to participate in the program
12    of health benefits shall be furnished a written explanation
13    of the requirements and limitations for the election not to
14    participate in the program and for re-enrolling in the
15    program. The explanation shall also be included in the
16    annual benefit choice options booklets furnished to
17    members.
18    (d-5) Beginning July 1, 2005, the Director may establish a
19program of financial incentives to encourage annuitants
20receiving a retirement annuity, but who are not eligible for
21benefits under the federal Medicare health insurance program
22(Title XVIII of the Social Security Act, as added by Public Law
2389-97) to elect not to participate in the program of health
24benefits provided under this Act. The election by an annuitant
25not to participate under this program must be made in
26accordance with the requirements set forth under subsection

 

 

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1(d). The financial incentives provided to these annuitants
2under the program may not exceed $150 per month for each
3annuitant electing not to participate in the program of health
4benefits provided under this Act.
5    (d-6) Beginning July 1, 2013, the Director may establish a
6program of financial incentives to encourage annuitants with 20
7or more years of creditable service but who are not eligible
8for benefits under the federal Medicare health insurance
9program (Title XVIII of the Social Security Act, as added by
10Public Law 89-97) to elect not to participate in the program of
11health benefits provided under this Act. The election by an
12annuitant not to participate under this program must be made in
13accordance with the requirements set forth under subsection
14(d). The program established under this subsection (d-6) may
15include a prorated incentive for annuitants with fewer than 20
16years of creditable service, as determined by the Director. The
17financial incentives provided to these annuitants under this
18program may not exceed $500 per month for each annuitant
19electing not to participate in the program of health benefits
20provided under this Act.
21    (e) Notwithstanding any other provision of this Act or the
22rules adopted under this Act, if a person participating in the
23program of health benefits as the dependent spouse of an
24eligible member becomes an annuitant, the person may elect, at
25the time of becoming an annuitant or during any subsequent
26annual benefit choice period, to continue participation as a

 

 

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1dependent rather than as an eligible member for as long as the
2person continues to be an eligible dependent. In order to be
3eligible to make such an election, the person must have been
4enrolled as a dependent under the program of health benefits
5for no less than one year prior to becoming an annuitant.
6    An eligible member who has elected to participate as a
7dependent may re-enroll in the program of health benefits as an
8eligible member (i) during any subsequent annual benefit choice
9period or (ii) upon showing a qualifying change in status, as
10defined in the U.S. Internal Revenue Code, without evidence of
11insurability and with no limitations on coverage for
12pre-existing conditions.
13    A person who elects to participate in the program of health
14benefits as a dependent rather than as an eligible member shall
15be furnished a written explanation of the consequences of
16electing to participate as a dependent and the conditions and
17procedures for re-enrolling as an eligible member. The
18explanation shall also be included in the annual benefit choice
19options booklet furnished to members.
20(Source: P.A. 97-668, eff. 1-13-12; 98-19, eff. 6-10-13.)
 
21    Section 99. Effective date. This Act takes effect upon
22becoming law.".