97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
HB3626

 

Introduced 2/24/2011, by Rep. Patrick J. Verschoore

 

SYNOPSIS AS INTRODUCED:
 
5 ILCS 375/8  from Ch. 127, par. 528

    Amends the State Employees Group Insurance Act of 1971. Requires the Director of Central Management Services, beginning July 1, 2011, to reimburse on a monthly basis each eligible member who has elected not to participate in the program of health benefits under the Act for premiums paid under the eligible member's health benefit coverage. Prohibits the reimbursed amount from exceeding the amount that would otherwise be paid by the State for the program of health benefits under the Act. Effective July 1, 2011.


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FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

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1    AN ACT concerning government.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
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
17    dependent coverage, but not electing it during the original
18    eligibility period, may subsequently obtain dependent
19    coverage only in the event of a qualifying change in
20    status, special enrollment, special circumstance as
21    defined by the Director, or during the annual Benefit
22    Choice Period.
23        (2) Members described above being transferred from

 

 

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1    previous coverage towards which the State has been
2    contributing shall be transferred regardless of
3    preexisting conditions, waiting periods, or other
4    requirements that might jeopardize claim payments to which
5    they would otherwise have been entitled.
6        (3) Eligible and covered members that are eligible for
7    coverage as dependents except for the fact of being members
8    shall be transferred to, and covered under, dependent
9    status regardless of preexisting conditions, waiting
10    periods, or other requirements that might jeopardize claim
11    payments to which they would otherwise have been entitled
12    upon cessation of member status and the election of
13    dependent coverage by a member eligible to elect that
14    coverage.
15    (b) New employees shall be immediately insured for the
16basic group life insurance and covered by the program of health
17benefits on the first day of active State service. Optional
18life insurance coverage one to 4 times the basic amount, if
19elected during the relevant eligibility period, will become
20effective on the date of employment. Optional life insurance
21coverage exceeding 4 times the basic amount and all life
22insurance amounts applied for after the eligibility period will
23be effective, subject to satisfactory evidence of insurability
24when applicable, or other necessary qualifications, pursuant
25to the requirements of the applicable benefit program, unless
26there is a change in status that would confer new eligibility

 

 

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1for change of enrollment under rules established supplementing
2this Act, in which event application must be made within the
3new eligibility period.
4    (c) As to the group health benefits program contracted to
5begin or continue after June 30, 1973, each retired employee
6shall become immediately eligible and covered for all benefits
7available under that program. Retired employees may elect
8coverage for eligible dependents and shall have the coverage
9effective immediately, provided that the election is properly
10filed in accordance with required filing dates and procedures
11specified by the Director.
12    Except as otherwise provided in this Act, where husband and
13wife are both eligible members, each shall be enrolled as a
14member and coverage on their eligible dependent children, if
15any, may be under the enrollment and election of either.
16    Regardless of other provisions herein regarding late
17enrollment or other qualifications, as appropriate, the
18Director may periodically authorize open enrollment periods
19for each of the benefit programs at which time each member may
20elect enrollment or change of enrollment without regard to age,
21sex, health, or other qualification under the conditions as may
22be prescribed in rules and regulations supplementing this Act.
23Special open enrollment periods may be declared by the Director
24for certain members only when special circumstances occur that
25affect only those members.
26    (d) Beginning with fiscal year 2003 and for all subsequent

 

 

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1years, eligible members may elect not to participate in the
2program of health benefits as defined in this Act. The election
3must be made during the annual benefit choice period, subject
4to the conditions in this subsection.
5        (1) Members must furnish proof of health benefit
6    coverage, either comprehensive major medical coverage or
7    comprehensive managed care plan, from a source other than
8    the Department of Central Management Services in order to
9    elect not to participate in the program.
10        (2) Members may re-enroll in the Department of Central
11    Management Services program of health benefits upon
12    showing a qualifying change in status, as defined in the
13    U.S. Internal Revenue Code, without evidence of
14    insurability and with no limitations on coverage for
15    pre-existing conditions, provided that there was not a
16    break in coverage of more than 63 days.
17        (3) Members may also re-enroll in the program of health
18    benefits during any annual benefit choice period, without
19    evidence of insurability.
20        (4) Members who elect not to participate in the program
21    of health benefits shall be furnished a written explanation
22    of the requirements and limitations for the election not to
23    participate in the program and for re-enrolling in the
24    program. The explanation shall also be included in the
25    annual benefit choice options booklets furnished to
26    members.

 

 

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1    (d-5) Beginning July 1, 2005, the Director may establish a
2program of financial incentives to encourage annuitants
3receiving a retirement annuity from the State Employees
4Retirement System, but who are not eligible for benefits under
5the federal Medicare health insurance program (Title XVIII of
6the Social Security Act, as added by Public Law 89-97) to elect
7not to participate in the program of health benefits provided
8under this Act. The election by an annuitant not to participate
9under this program must be made in accordance with the
10requirements set forth under subsection (d). The financial
11incentives provided to these annuitants under the program may
12not exceed $150 per month for each annuitant electing not to
13participate in the program of health benefits provided under
14this Act.
15    (d-10) Beginning July 1, 2011, the Director shall reimburse
16on a monthly basis each eligible member who has elected
17pursuant to subsection (d) not to participate in the program of
18health benefits under this Act for premiums paid under the
19eligible member's health benefit coverage. The reimbursed
20amount shall not be in excess of the amount that would
21otherwise be paid by the State for the program of health
22benefits under the Act.
23    (e) Notwithstanding any other provision of this Act or the
24rules adopted under this Act, if a person participating in the
25program of health benefits as the dependent spouse of an
26eligible member becomes an annuitant, the person may elect, at

 

 

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1the time of becoming an annuitant or during any subsequent
2annual benefit choice period, to continue participation as a
3dependent rather than as an eligible member for as long as the
4person continues to be an eligible dependent.
5    An eligible member who has elected to participate as a
6dependent may re-enroll in the program of health benefits as an
7eligible member (i) during any subsequent annual benefit choice
8period or (ii) upon showing a qualifying change in status, as
9defined in the U.S. Internal Revenue Code, without evidence of
10insurability and with no limitations on coverage for
11pre-existing conditions.
12    A person who elects to participate in the program of health
13benefits as a dependent rather than as an eligible member shall
14be furnished a written explanation of the consequences of
15electing to participate as a dependent and the conditions and
16procedures for re-enrolling as an eligible member. The
17explanation shall also be included in the annual benefit choice
18options booklet furnished to members.
19(Source: P.A. 94-95, eff. 7-1-05; 94-109, eff. 7-1-05; 95-331,
20eff. 8-21-07.)
 
21    Section 99. Effective date. This Act takes effect July 1,
222011.