Rep. Patrick J. Verschoore

Filed: 3/10/2011

 

 


 

 


 
09700HB0450ham001LRB097 03277 JDS 51863 a

1
AMENDMENT TO HOUSE BILL 450

2    AMENDMENT NO. ______. Amend House Bill 450 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 Section 8 as follows:
 
6    (5 ILCS 375/8)  (from Ch. 127, par. 528)
7    Sec. 8. Eligibility.
8    (a) Each member eligible under the provisions of this Act
9and any rules and regulations promulgated and adopted hereunder
10by the Director shall become immediately eligible and covered
11for all benefits available under the programs. Members electing
12coverage for eligible dependents shall have the coverage
13effective immediately, provided that the election is properly
14filed in accordance with required filing dates and procedures
15specified by the Director.
16        (1) Every member originally eligible to elect

 

 

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1    dependent coverage, but not electing it during the original
2    eligibility period, may subsequently obtain dependent
3    coverage only in the event of a qualifying change in
4    status, special enrollment, special circumstance as
5    defined by the Director, or during the annual Benefit
6    Choice Period.
7        (2) Members described above being transferred from
8    previous coverage towards which the State has been
9    contributing shall be transferred regardless of
10    preexisting conditions, waiting periods, or other
11    requirements that might jeopardize claim payments to which
12    they would otherwise have been entitled.
13        (3) Eligible and covered members that are eligible for
14    coverage as dependents except for the fact of being members
15    shall be transferred to, and covered under, dependent
16    status regardless of preexisting conditions, waiting
17    periods, or other requirements that might jeopardize claim
18    payments to which they would otherwise have been entitled
19    upon cessation of member status and the election of
20    dependent coverage by a member eligible to elect that
21    coverage.
22    (b) New employees shall be immediately insured for the
23basic group life insurance and covered by the program of health
24benefits on the first day of active State service. Optional
25life insurance coverage one to 4 times the basic amount, if
26elected during the relevant eligibility period, will become

 

 

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1effective on the date of employment. Optional life insurance
2coverage exceeding 4 times the basic amount and all life
3insurance amounts applied for after the eligibility period will
4be effective, subject to satisfactory evidence of insurability
5when applicable, or other necessary qualifications, pursuant
6to the requirements of the applicable benefit program, unless
7there is a change in status that would confer new eligibility
8for change of enrollment under rules established supplementing
9this Act, in which event application must be made within the
10new eligibility period.
11    (c) As to the group health benefits program contracted to
12begin or continue after June 30, 1973, each retired employee
13shall become immediately eligible and covered for all benefits
14available under that program. Retired employees may elect
15coverage for eligible dependents and shall have the coverage
16effective immediately, provided that the election is properly
17filed in accordance with required filing dates and procedures
18specified by the Director.
19    Except as otherwise provided in this Act, where husband and
20wife are both eligible members, each shall be enrolled as a
21member and coverage on their eligible dependent children, if
22any, may be under the enrollment and election of either.
23    Regardless of other provisions herein regarding late
24enrollment or other qualifications, as appropriate, the
25Director may periodically authorize open enrollment periods
26for each of the benefit programs at which time each member may

 

 

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1elect enrollment or change of enrollment without regard to age,
2sex, health, or other qualification under the conditions as may
3be prescribed in rules and regulations supplementing this Act.
4Special open enrollment periods may be declared by the Director
5for certain members only when special circumstances occur that
6affect only those members.
7    (d) Beginning with fiscal year 2003 and for all subsequent
8years, eligible members may elect not to participate in the
9program of health benefits as defined in this Act. The election
10must be made during the annual benefit choice period, subject
11to the conditions in this subsection.
12        (1) Members must furnish proof of health benefit
13    coverage, either comprehensive major medical coverage or
14    comprehensive managed care plan, from a source other than
15    the Department of Central Management Services in order to
16    elect not to participate in the program.
17        (2) Members may re-enroll in the Department of Central
18    Management Services program of health benefits upon
19    showing a qualifying change in status, as defined in the
20    U.S. Internal Revenue Code, without evidence of
21    insurability and with no limitations on coverage for
22    pre-existing conditions, provided that there was not a
23    break in coverage of more than 63 days.
24        (3) Members may also re-enroll in the program of health
25    benefits during any annual benefit choice period, without
26    evidence of insurability.

 

 

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1        (4) Members who elect not to participate in the program
2    of health benefits shall be furnished a written explanation
3    of the requirements and limitations for the election not to
4    participate in the program and for re-enrolling in the
5    program. The explanation shall also be included in the
6    annual benefit choice options booklets furnished to
7    members.
8    (d-5) Beginning July 1, 2005, the Director may establish a
9program of financial incentives to encourage annuitants
10receiving a retirement annuity from the State Employees
11Retirement System, but who are not eligible for benefits under
12the federal Medicare health insurance program (Title XVIII of
13the Social Security Act, as added by Public Law 89-97) to elect
14not to participate in the program of health benefits provided
15under this Act. The election by an annuitant not to participate
16under this program must be made in accordance with the
17requirements set forth under subsection (d). The financial
18incentives provided to these annuitants under the program may
19not exceed $150 per month for each annuitant electing not to
20participate in the program of health benefits provided under
21this Act.
22    (d-6) Beginning July 1, 2011, the Director shall establish
23a program of financial incentives to encourage current General
24Assembly members and annuitants of the General Assembly
25Retirement System to elect not to participate in the program of
26health benefits provided under this Act. The election by a

 

 

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1current member or annuitant not to participate must be a
2one-time irrevocable election. The financial incentives
3provided to these current General Assembly members and
4annuitants under the program may not exceed 60% of the average
5cost of the most affordable State-offered health benefit (as
6determined by the Director) for which the member or annuitant
7qualifies.
8    (e) Notwithstanding any other provision of this Act or the
9rules adopted under this Act, if a person participating in the
10program of health benefits as the dependent spouse of an
11eligible member becomes an annuitant, the person may elect, at
12the time of becoming an annuitant or during any subsequent
13annual benefit choice period, to continue participation as a
14dependent rather than as an eligible member for as long as the
15person continues to be an eligible dependent.
16    An eligible member who has elected to participate as a
17dependent may re-enroll in the program of health benefits as an
18eligible member (i) during any subsequent annual benefit choice
19period or (ii) upon showing a qualifying change in status, as
20defined in the U.S. Internal Revenue Code, without evidence of
21insurability and with no limitations on coverage for
22pre-existing conditions.
23    A person who elects to participate in the program of health
24benefits as a dependent rather than as an eligible member shall
25be furnished a written explanation of the consequences of
26electing to participate as a dependent and the conditions and

 

 

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1procedures for re-enrolling as an eligible member. The
2explanation shall also be included in the annual benefit choice
3options booklet furnished to members.
4(Source: P.A. 94-95, eff. 7-1-05; 94-109, eff. 7-1-05; 95-331,
5eff. 8-21-07.)
 
6    Section 99. Effective date. This Act takes effect upon
7becoming law.".