093_HB1031sam001
LRB093 05543 AMC 15641 a
1 AMENDMENT TO HOUSE BILL 1031
2 AMENDMENT NO. . Amend House Bill 1031 by replacing
3 everything after the enacting clause with the following:
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
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1 of the life of the woman seeking such treatment, or except an
2 induced premature birth intended to produce a live viable
3 child and such procedure is necessary for the health of the
4 mother or the unborn child. The program may also include
5 coverage for those who rely on treatment by prayer or
6 spiritual means alone for healing in accordance with the
7 tenets and practice of a recognized religious denomination.
8 The program of health benefits shall be designed by the
9 Director (1) to provide a reasonable relationship between the
10 benefits to be included and the expected distribution of
11 expenses of each such type to be incurred by the covered
12 members and dependents, (2) to specify, as covered benefits
13 and as optional benefits, the medical services of
14 practitioners in all categories licensed under the Medical
15 Practice Act of 1987, (3) to include reasonable controls,
16 which may include deductible and co-insurance provisions,
17 applicable to some or all of the benefits, or a coordination
18 of benefits provision, to prevent or minimize unnecessary
19 utilization of the various hospital, surgical and medical
20 expenses to be provided and to provide reasonable assurance
21 of stability of the program, and (4) to provide benefits to
22 the extent possible to members throughout the State, wherever
23 located, on an equitable basis. Notwithstanding any other
24 provision of this Section or Act, for all members or
25 dependents who are eligible for benefits under Social
26 Security or the Railroad Retirement system or who had
27 sufficient Medicare-covered government employment, the
28 Department shall reduce benefits which would otherwise be
29 paid by Medicare, by the amount of benefits for which the
30 member or dependents are eligible under Medicare, except that
31 such reduction in benefits shall apply only to those members
32 or dependents who (1) first become eligible for such medicare
33 coverage on or after the effective date of this amendatory
34 Act of 1992; or (2) are Medicare-eligible members or
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1 dependents of a local government unit which began
2 participation in the program on or after July 1, 1992; or (3)
3 remain eligible for but no longer receive Medicare coverage
4 which they had been receiving on or after the effective date
5 of this amendatory Act of 1992.
6 Notwithstanding any other provisions of this Act, where a
7 covered member or dependents are eligible for benefits under
8 the federal Medicare health insurance program (Title XVIII of
9 the Social Security Act as added by Public Law 89-97, 89th
10 Congress), benefits paid under the State of Illinois program
11 or plan will be reduced by the amount of benefits paid by
12 Medicare. For members or dependents who are eligible for
13 benefits under Social Security or the Railroad Retirement
14 system or who had sufficient Medicare-covered government
15 employment, benefits shall be reduced by the amount for which
16 the member or dependent is eligible under Medicare, except
17 that such reduction in benefits shall apply only to those
18 members or dependents who (1) first become eligible for such
19 Medicare coverage on or after the effective date of this
20 amendatory Act of 1992; or (2) are Medicare-eligible members
21 or dependents of a local government unit which began
22 participation in the program on or after July 1, 1992; or (3)
23 remain eligible for, but no longer receive Medicare coverage
24 which they had been receiving on or after the effective date
25 of this amendatory Act of 1992. Premiums may be adjusted,
26 where applicable, to an amount deemed by the Director to be
27 reasonably consistent with any reduction of benefits.
28 (b) A member, not otherwise covered by this Act, who has
29 retired as a participating member under Article 2 of the
30 Illinois Pension Code but is ineligible for the retirement
31 annuity under Section 2-119 of the Illinois Pension Code,
32 shall pay the premiums for coverage, not exceeding the amount
33 paid by the State for the non-contributory coverage for other
34 members, under the group health benefits program under this
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1 Act. The Director shall determine the premiums to be paid by
2 a member under this subsection (b).
3 (Source: P.A. 91-390, eff. 7-30-99.)
4 Section 99. Effective date. This Act takes effect on
5 July 1, 2003.".