093_HB2531eng

 
HB2531 Engrossed                     LRB093 00009 JLS 00009 b

 1        AN ACT concerning State employee benefits.

 2        Be it enacted by the People of  the  State  of  Illinois,
 3    represented in the General Assembly:

 4        Section  5.  The  State  Employees Group Insurance Act of
 5    1971 is amended by changing Section 6 as follows:

 6        (5 ILCS 375/6) (from Ch. 127, par. 526)
 7        Sec. 6.  Program of health benefits.
 8        (a)  The program of health  benefits  shall  provide  for
 9    protection   against  the  financial  costs  of  health  care
10    expenses incurred in and  out  of  hospital  including  basic
11    hospital-surgical-medical   coverages.    The   program   may
12    include,  but  shall  not  be  limited  to, such supplemental
13    coverages as  out-patient  diagnostic  X-ray  and  laboratory
14    expenses,   prescription   drugs,  dental  services,  hearing
15    evaluations, hearing aids,  the  dispensing  and  fitting  of
16    hearing  aids,  and  similar group benefits as are now or may
17    become available.   However, nothing in  this  Act  shall  be
18    construed   to   permit,  on  or  after  July  1,  1980,  the
19    non-contributory portion of any such program to  include  the
20    expenses  of  obtaining  an  abortion, induced miscarriage or
21    induced  premature  birth  unless,  in  the  opinion   of   a
22    physician, such procedures are necessary for the preservation
23    of the life of the woman seeking such treatment, or except an
24    induced  premature  birth  intended  to produce a live viable
25    child and such procedure is necessary for the health  of  the
26    mother  or  the  unborn  child.  The program may also include
27    coverage for  those  who  rely  on  treatment  by  prayer  or
28    spiritual  means  alone  for  healing  in accordance with the
29    tenets and practice of a recognized religious denomination.
30        The program of health benefits shall be designed  by  the
31    Director (1) to provide a reasonable relationship between the
 
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 1    benefits  to  be  included  and  the expected distribution of
 2    expenses of each such type to  be  incurred  by  the  covered
 3    members  and  dependents, (2) to specify, as covered benefits
 4    and  as  optional   benefits,   the   medical   services   of
 5    practitioners  in  all  categories licensed under the Medical
 6    Practice Act of 1987, (3)  to  include  reasonable  controls,
 7    which  may  include  deductible  and co-insurance provisions,
 8    applicable to some or all of the benefits, or a  coordination
 9    of  benefits  provision,  to  prevent or minimize unnecessary
10    utilization of the various  hospital,  surgical  and  medical
11    expenses  to  be provided and to provide reasonable assurance
12    of stability of the program, and (4) to provide  benefits  to
13    the extent possible to members throughout the State, wherever
14    located,  on  an  equitable  basis. Notwithstanding any other
15    provision  of  this  Section  or  Act,  for  all  members  or
16    dependents  who  are  eligible  for  benefits  under   Social
17    Security  or  the  Railroad  Retirement  system  or  who  had
18    sufficient   Medicare-covered   government   employment,  the
19    Department shall reduce benefits  which  would  otherwise  be
20    paid  by  Medicare,  by  the amount of benefits for which the
21    member or dependents are eligible under Medicare, except that
22    such reduction in benefits shall apply only to those  members
23    or dependents who (1) first become eligible for such medicare
24    coverage  on  or  after the effective date of this amendatory
25    Act  of  1992;  or  (2)  are  Medicare-eligible  members   or
26    dependents   of   a   local   government   unit  which  began
27    participation in the program on or after July 1, 1992; or (3)
28    remain eligible for but no longer receive  Medicare  coverage
29    which  they had been receiving on or after the effective date
30    of this amendatory Act of 1992.
31        Notwithstanding any other provisions of this Act, where a
32    covered member or dependents are eligible for benefits  under
33    the federal Medicare health insurance program (Title XVIII of
34    the  Social  Security  Act as added by Public Law 89-97, 89th
 
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 1    Congress), benefits paid under the State of Illinois  program
 2    or  plan  will  be  reduced by the amount of benefits paid by
 3    Medicare.  For members or dependents  who  are  eligible  for
 4    benefits  under  Social  Security  or the Railroad Retirement
 5    system or  who  had  sufficient  Medicare-covered  government
 6    employment, benefits shall be reduced by the amount for which
 7    the  member  or  dependent is eligible under Medicare, except
 8    that such reduction in benefits shall  apply  only  to  those
 9    members  or dependents who (1) first become eligible for such
10    Medicare coverage on or after  the  effective  date  of  this
11    amendatory  Act of 1992; or (2) are Medicare-eligible members
12    or  dependents  of  a  local  government  unit  which   began
13    participation in the program on or after July 1, 1992; or (3)
14    remain  eligible for, but no longer receive Medicare coverage
15    which they had been receiving on or after the effective  date
16    of  this  amendatory  Act of 1992.  Premiums may be adjusted,
17    where applicable, to an amount deemed by the Director  to  be
18    reasonably consistent with any reduction of benefits.
19        (b)  A member, not otherwise covered by this Act, who has
20    retired  as  a  participating  member  under Article 2 of the
21    Illinois Pension Code but is ineligible  for  the  retirement
22    annuity  under  Section  2-119  of the Illinois Pension Code,
23    shall pay the premiums for coverage, not exceeding the amount
24    paid by the State for the non-contributory coverage for other
25    members, under the group health benefits program  under  this
26    Act.  The Director shall determine the premiums to be paid by
27    a member under this subsection (b).
28    (Source: P.A. 91-390, eff. 7-30-99.)

29        Section  99.   Effective  date.  This Act takes effect on
30    July 1, 2003.