093_HB0943sam001

 










                                     LRB093 05764 EFG 15054 a

 1                     AMENDMENT TO HOUSE BILL 943

 2        AMENDMENT NO.     .  Amend House Bill  943  by  replacing
 3    the title with the following:
 4        "AN ACT in relation to public employee benefits."; and

 5    by  replacing  everything  after the enacting clause with the
 6    following:

 7        "Section 5.  The State Employees Group Insurance  Act  of
 8    1971 is amended by changing Section 8 as follows:

 9        (5 ILCS 375/8) (from Ch. 127, par. 528)
10        Sec. 8.  Eligibility.
11        (a)  Each  member  eligible  under the provisions of this
12    Act and any rules and  regulations  promulgated  and  adopted
13    hereunder  by  the Director shall become immediately eligible
14    and covered for all benefits available  under  the  programs.
15    Members  electing coverage for eligible dependents shall have
16    the  coverage  effective  immediately,  provided   that   the
17    election is properly filed in accordance with required filing
18    dates and procedures specified by the Director.
19             (1)  Every   member  originally  eligible  to  elect
20        dependent  coverage,  but  not  electing  it  during  the
21        original  eligibility  period,  may  subsequently  obtain
 
                            -2-      LRB093 05764 EFG 15054 a
 1        dependent coverage only in  the  event  of  a  qualifying
 2        change    in    status,   special   enrollment,   special
 3        circumstance as defined by the Director,  or  during  the
 4        annual Benefit Choice Period.
 5             (2)  Members  described above being transferred from
 6        previous  coverage  towards  which  the  State  has  been
 7        contributing   shall   be   transferred   regardless   of
 8        preexisting  conditions,  waiting   periods,   or   other
 9        requirements  that  might  jeopardize  claim  payments to
10        which they would otherwise have been entitled.
11             (3)  Eligible and covered members that are  eligible
12        for  coverage  as dependents except for the fact of being
13        members shall  be  transferred  to,  and  covered  under,
14        dependent  status  regardless  of preexisting conditions,
15        waiting  periods,  or  other  requirements   that   might
16        jeopardize  claim  payments to which they would otherwise
17        have been entitled upon cessation of  member  status  and
18        the  election  of dependent coverage by a member eligible
19        to elect that coverage.
20        (b)  New employees shall be immediately insured  for  the
21    basic  group  life  insurance  and  covered by the program of
22    health benefits on the first day  of  active  State  service.
23    Optional   coverages  or  benefits,  if  elected  during  the
24    relevant eligibility period, will  become  effective  on  the
25    date  of  employment.  Optional coverages or benefits applied
26    for after the eligibility period will be  effective,  subject
27    to  satisfactory evidence of insurability when applicable, or
28    other necessary qualifications, pursuant to the  requirements
29    of  the  applicable benefit program, unless there is a change
30    in status that would confer new  eligibility  for  change  of
31    enrollment under rules established supplementing this Act, in
32    which   event   application  must  be  made  within  the  new
33    eligibility period.
34        (c)  As to the group health benefits  program  contracted
 
                            -3-      LRB093 05764 EFG 15054 a
 1    to  begin  or  continue  after  June  30,  1973, each retired
 2    employee shall become immediately eligible  and  covered  for
 3    all benefits available under that program.  Retired employees
 4    may elect coverage for eligible dependents and shall have the
 5    coverage effective immediately, provided that the election is
 6    properly  filed  in accordance with required filing dates and
 7    procedures specified by the Director.
 8        Except as otherwise provided in this Act,  where  husband
 9    and wife are both eligible members, each shall be enrolled as
10    a  member  and coverage on their eligible dependent children,
11    if any, may be under the enrollment and election of either.
12        Regardless of  other  provisions  herein  regarding  late
13    enrollment  or  other  qualifications,  as  appropriate,  the
14    Director  may  periodically authorize open enrollment periods
15    for each of the benefit programs at which  time  each  member
16    may  elect  enrollment or change of enrollment without regard
17    to  age,  sex,  health,  or  other  qualification  under  the
18    conditions as may be  prescribed  in  rules  and  regulations
19    supplementing  this Act.  Special open enrollment periods may
20    be declared by the Director for  certain  members  only  when
21    special circumstances occur that affect only those members.
22        (d)  Beginning   with   fiscal  year  2003  and  for  all
23    subsequent  years,  eligible  members  may   elect   not   to
24    participate  in  the program of health benefits as defined in
25    this Act.  The  election  must  be  made  during  the  annual
26    benefit  choice  period,  subject  to  the conditions in this
27    subsection.
28             (1)  Members must furnish proof  of  health  benefit
29        coverage,  either comprehensive major medical coverage or
30        comprehensive managed care plan, from a source other than
31        the Department of Central Management Services in order to
32        elect not to participate in the program.
33             (2)  Members may  re-enroll  in  the  Department  of
34        Central  Management  Services  program of health benefits
 
                            -4-      LRB093 05764 EFG 15054 a
 1        upon showing a qualifying change in status, as defined in
 2        the U.S.  Internal  Revenue  Code,  without  evidence  of
 3        insurability  and  with  no  limitations  on coverage for
 4        pre-existing conditions, provided that there  was  not  a
 5        break in coverage of more than 63 days.
 6             (3)  Members  may  also  re-enroll in the program of
 7        health benefits during any annual benefit choice  period,
 8        without evidence of insurability.
 9             (4)  Members  who  elect  not  to participate in the
10        program of health benefits shall be furnished  a  written
11        explanation  of  the requirements and limitations for the
12        election not  to  participate  in  the  program  and  for
13        re-enrolling  in  the program. The explanation shall also
14        be included in the annual benefit choice options booklets
15        furnished to members.
16        (e)  Notwithstanding any other provision of this  Act  or
17    the  rules  adopted under this Act, if a person participating
18    in the program of health benefits as the dependent spouse  of
19    an  eligible  member  becomes  an  annuitant,  the person may
20    elect, at the time of becoming an  annuitant  or  during  any
21    subsequent   annual   benefit   choice  period,  to  continue
22    participation as a  dependent  rather  than  as  an  eligible
23    member  for as long as the person continues to be an eligible
24    dependent.
25        An eligible member who has elected to  participate  as  a
26    dependent  may re-enroll in the program of health benefits as
27    an eligible member (i) during any subsequent  annual  benefit
28    choice  period  or  (ii)  upon showing a qualifying change in
29    status, as defined in the U.S. Internal Revenue Code, without
30    evidence of insurability and with no limitations on  coverage
31    for pre-existing conditions.
32        A  person  who  elects  to  participate in the program of
33    health benefits as a dependent rather  than  as  an  eligible
34    member  shall  be  furnished  a  written  explanation  of the
 
                            -5-      LRB093 05764 EFG 15054 a
 1    consequences of electing to participate as  a  dependent  and
 2    the conditions and procedures for re-enrolling as an eligible
 3    member.  The explanation shall also be included in the annual
 4    benefit choice options booklet furnished to members.
 5    (Source: P.A. 91-390, eff. 7-30-99; 92-600, eff. 6-28-02.)

 6        Section  99.  Effective date.  This Act takes effect upon
 7    becoming law.".