Full Text of SB1515 98th General Assembly
SB1515ham001 98TH GENERAL ASSEMBLY | Rep. Barbara Flynn Currie Filed: 4/5/2013
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| 1 | | AMENDMENT TO SENATE BILL 1515
| 2 | | AMENDMENT NO. ______. Amend Senate Bill 1515 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 5. The State Employees Group Insurance Act of 1971 | 5 | | is amended by changing Sections 5 and 8 as follows:
| 6 | | (5 ILCS 375/5) (from Ch. 127, par. 525)
| 7 | | Sec. 5. Employee benefits; declaration of State policy.
The | 8 | | General Assembly declares that it is the policy of the State | 9 | | and in the best interest of the State to assure quality | 10 | | benefits to members and their dependents under this Act. The | 11 | | implementation of this policy depends upon, among other things, | 12 | | stability and continuity of coverage, care, and services under | 13 | | benefit programs for members and their dependents. | 14 | | Specifically, but without limitation, members should have | 15 | | continued access, on substantially similar terms and | 16 | | conditions, to trusted family health care providers with whom |
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| 1 | | they have developed long-term relationships through a benefit | 2 | | program under this Act. Therefore, the Director must administer | 3 | | this Act consistent with that State policy, but may consider | 4 | | affordability, cost of coverage and care, and competition among | 5 | | health insurers and providers. All contracts for provision of | 6 | | employee benefits, including those portions of any proposed | 7 | | collective bargaining agreement that would require | 8 | | implementation through contracts entered into under this Act, | 9 | | are subject to the following requirements: | 10 | | (i) By April 1 of each year, the Director must report | 11 | | and provide information to the Commission concerning the | 12 | | status of the employee benefits program to be offered for | 13 | | the next fiscal year. Information includes, but is not | 14 | | limited to, documents, reports of negotiations, bid | 15 | | invitations, requests for proposals, specifications, | 16 | | copies of proposed and final contracts or agreements, and | 17 | | any other materials concerning contracts or agreements for | 18 | | the employee benefits program. By the first of each month | 19 | | thereafter, the Director must provide updated, and any new, | 20 | | information to the Commission until the employee benefits | 21 | | program for the next fiscal year is determined. In addition | 22 | | to these monthly reporting requirements, at any time the | 23 | | Commission makes a written request, the Director must | 24 | | promptly, but in no event later than 5 business days after | 25 | | receipt of the request, provide to the Commission any | 26 | | additional requested information in the possession of the |
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| 1 | | Director concerning employee benefits programs. The | 2 | | Commission may waive any of the reporting requirements of | 3 | | this item (i) upon the written request by the Director. Any | 4 | | waiver granted under this item (i) must be in writing. | 5 | | Nothing in this item is intended to abrogate any | 6 | | attorney-client privilege.
| 7 | | (ii) Within 30 days after notice of the awarding or | 8 | | letting of a contract has appeared in the Illinois | 9 | | Procurement Bulletin in accordance with subsection (b) of | 10 | | Section 15-25 of the Illinois Procurement Code, the | 11 | | Commission may request in writing from the Director and the | 12 | | Director shall promptly, but in no event later than 5 | 13 | | business days after receipt of the request, provide to the | 14 | | Commission information in the possession of the Director | 15 | | concerning the proposed contract. Nothing in this item is | 16 | | intended to waive or abrogate any privilege or right of | 17 | | confidentiality authorized by law. | 18 | | (iii) No contract subject to this Section may be | 19 | | entered into until the 30-day period described in item (ii) | 20 | | has expired, unless the Director requests in writing that | 21 | | the Commission waive the period and the Commission grants | 22 | | the waiver in writing. | 23 | | (iv) If the Director seeks to make any substantive | 24 | | modification to any provision of a proposed contract after | 25 | | it is submitted to the Commission in accordance with item | 26 | | (ii), the modified contract shall be subject to the |
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| 1 | | requirements of items (ii) and (iii) unless the Commission | 2 | | agrees, in writing, to a waiver of those requirements with | 3 | | respect to the modified contract.
| 4 | | (v) By the date of the beginning of the annual benefit | 5 | | choice period, the Director must transmit to the Commission | 6 | | a copy of each final contract or agreement for the employee | 7 | | benefits program to be offered for the next fiscal year. | 8 | | The annual benefit choice period for an employee benefits | 9 | | program must begin on May 1 of the fiscal year preceding | 10 | | the year for which the program is to be offered. If, | 11 | | however, in any such preceding fiscal year collective | 12 | | bargaining over employee benefit programs for the next | 13 | | fiscal year remains pending on April 15, the beginning date | 14 | | of the annual benefit choice period shall be not later than | 15 | | 15 days after ratification of the collective bargaining | 16 | | agreement.
| 17 | | (vi) The Director must provide the reports, | 18 | | information, and contracts required under items (i), (ii), | 19 | | (iv), and (v) by electronic or other means satisfactory to | 20 | | the Commission. Reports, information, and contracts in the | 21 | | possession of the Commission pursuant to items (i), (ii), | 22 | | (iv), and (v) are exempt from disclosure by the Commission | 23 | | and its members and employees under the Freedom of | 24 | | Information Act. Reports, information, and contracts | 25 | | received by the Commission pursuant to items (i), (ii), | 26 | | (iv), and (v) must be kept confidential by and may not be |
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| 1 | | disclosed or used by the Commission or its members or | 2 | | employees if such disclosure or use could compromise the | 3 | | fairness or integrity of the procurement, bidding, or | 4 | | contract process. Commission meetings, or portions of | 5 | | Commission meetings, in which reports, information, and | 6 | | contracts received by the Commission pursuant to items (i), | 7 | | (ii), (iv), and (v) are discussed must be closed if | 8 | | disclosure or use of the report or information could | 9 | | compromise the fairness or integrity of the procurement, | 10 | | bidding, or contract process.
| 11 | | All contracts entered into under this Section are subject | 12 | | to appropriation and shall comply with Section 20-60(b) of the | 13 | | Illinois Procurement Code (30 ILCS 500/20-60(b)).
| 14 | | The Director shall contract or otherwise make available | 15 | | group
life insurance, health benefits and other
employee | 16 | | benefits to eligible members and, where elected,
their eligible | 17 | | dependents. Any contract or, if
applicable, contracts or other | 18 | | arrangement for provision of benefits
shall be on terms | 19 | | consistent with State policy and
based on, but not limited to, | 20 | | such
criteria as administrative cost, service capabilities of | 21 | | the carrier
or other contractor and premiums, fees or charges | 22 | | as related to benefits.
| 23 | | Notwithstanding any other provisions of this Act, by | 24 | | January 1, 2014, the Department of Central Management Services, | 25 | | in consultation with the Chief Procurement Officer, shall | 26 | | contract or make otherwise available a program of group health |
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| 1 | | benefits for Medicare-primary members and their | 2 | | Medicare-primary dependents. The Director may procure a single | 3 | | contract or multiple contracts that provide a program of group | 4 | | health benefits that is comparable in stability and continuity | 5 | | of coverage, care, and services to the program of health | 6 | | benefits offered to other members and their dependents under | 7 | | this Act. The initial procurement of a contract or contracts | 8 | | under this paragraph is not subject to the provisions of the | 9 | | Illinois Procurement Code, except for Sections 20-60, 20-65, | 10 | | 20-70, and 20-160 and Article 50 of that Code, provided that | 11 | | the Chief Procurement Officer may, in writing with | 12 | | justification, waive any certification required under Article | 13 | | 50. A contract entered into pursuant to this paragraph is not | 14 | | subject to review by the Commission, regardless of any other | 15 | | provision in this Section or Act. | 16 | | The Director may prepare and issue specifications
for group | 17 | | life insurance, health benefits, other employee benefits
and | 18 | | administrative services for the purpose of receiving proposals
| 19 | | from interested parties.
| 20 | | The Director is authorized to execute a contract, or
| 21 | | contracts, for the programs of group life insurance, health
| 22 | | benefits, other employee benefits and administrative services
| 23 | | authorized by this Act (including, without limitation, | 24 | | prescription drug benefits). All of the benefits provided under | 25 | | this Act may be
included in one or more contracts, or the | 26 | | benefits may be classified into
different types with each type |
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| 1 | | included under one or more similar contracts
with the same or | 2 | | different companies.
| 3 | | The term of any contract may not extend beyond 5 fiscal | 4 | | years.
Upon recommendation of the Commission, the Director may | 5 | | exercise renewal
options of the same contract for up to a | 6 | | period of 5 years. Any
increases in premiums, fees or charges | 7 | | requested by a contractor whose
contract may be renewed | 8 | | pursuant to a renewal option contained therein,
must be | 9 | | justified on the basis of (1) audited experience data, (2)
| 10 | | increases in the costs of health care services provided under | 11 | | the contract,
(3) contractor performance, (4) increases in | 12 | | contractor responsibilities,
or (5) any combination thereof.
| 13 | | Any contractor shall agree to abide by all
requirements of | 14 | | this Act and Rules and Regulations promulgated and adopted
| 15 | | thereto; to submit such information and data as may from time | 16 | | to time be
deemed necessary by the Director for effective | 17 | | administration of the
provisions of this Act and the programs | 18 | | established
hereunder, and to fully cooperate in any audit.
| 19 | | (Source: P.A. 93-839, eff. 7-30-04.)
| 20 | | (5 ILCS 375/8) (from Ch. 127, par. 528)
| 21 | | Sec. 8. Eligibility.
| 22 | | (a) Each employee eligible under the provisions of this Act | 23 | | and any rules
and regulations promulgated and adopted hereunder | 24 | | by the Director shall
become immediately eligible and covered | 25 | | for all benefits available under
the programs. Employees |
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| 1 | | electing coverage for eligible dependents shall have
the | 2 | | coverage effective immediately, provided that the election is | 3 | | properly
filed in accordance with required filing dates and | 4 | | procedures specified by
the Director, including the completion | 5 | | and submission of all documentation and forms required by the | 6 | | Director.
| 7 | | (1) Every member originally eligible to elect | 8 | | dependent coverage, but not
electing it during the original | 9 | | eligibility period, may subsequently obtain
dependent | 10 | | coverage only in the event of a qualifying change in | 11 | | status, special
enrollment, special circumstance as | 12 | | defined by the Director, or during the
annual Benefit | 13 | | Choice Period.
| 14 | | (2) Members described above being transferred from | 15 | | previous
coverage towards which the State has been | 16 | | contributing shall be
transferred regardless of | 17 | | preexisting conditions, waiting periods, or
other | 18 | | requirements that might jeopardize claim payments to which | 19 | | they
would otherwise have been entitled.
| 20 | | (3) Eligible and covered members that are eligible for | 21 | | coverage as
dependents except for the fact of being members | 22 | | shall be transferred to,
and covered under, dependent | 23 | | status regardless of preexisting conditions,
waiting | 24 | | periods, or other requirements that might jeopardize claim | 25 | | payments
to which they would otherwise have been entitled | 26 | | upon cessation of member
status and the election of |
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| 1 | | dependent coverage by a member eligible to elect
that | 2 | | coverage.
| 3 | | (b) New employees shall be immediately insured for the | 4 | | basic group
life insurance and covered by the program of health | 5 | | benefits on the first
day of active State service. Optional | 6 | | life insurance coverage one to 4 times the basic amount, if | 7 | | elected
during the relevant eligibility period, will become | 8 | | effective on the date
of employment. Optional life insurance | 9 | | coverage exceeding 4 times the basic amount and all life | 10 | | insurance amounts applied for after the
eligibility period will | 11 | | be effective, subject to satisfactory evidence of
insurability | 12 | | when applicable, or other necessary qualifications, pursuant | 13 | | to
the requirements of the applicable benefit program, unless | 14 | | there is a change in
status that would confer new eligibility | 15 | | for change of enrollment under rules
established supplementing | 16 | | this Act, in which event application must be made
within the | 17 | | new eligibility period.
| 18 | | (c) As to the group health benefits program contracted to | 19 | | begin or
continue after June 30, 1973, each annuitant, | 20 | | survivor, and retired employee shall become immediately
| 21 | | eligible for all benefits available under that program. Each | 22 | | annuitant, survivor, and retired employee shall have coverage | 23 | | effective immediately, provided that the election is properly | 24 | | filed in accordance with the required filing dates and | 25 | | procedures specified by the Director, including the completion | 26 | | and submission of all documentation and forms required by the |
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| 1 | | Director. Annuitants, survivors, and retired
employees may | 2 | | elect coverage for eligible dependents and shall have the
| 3 | | coverage effective immediately, provided that the election is | 4 | | properly
filed in accordance with required filing dates and | 5 | | procedures specified
by the Director, except that, for a | 6 | | survivor, the dependent sought to be added on or after the | 7 | | effective date of this amendatory Act of the 97th General | 8 | | Assembly must have been eligible for coverage as a dependent | 9 | | under the deceased member upon whom the survivor's annuity is | 10 | | based in order to be eligible for coverage under the survivor.
| 11 | | Except as otherwise provided in this Act, where husband and | 12 | | wife are
both eligible members, each shall be enrolled as a | 13 | | member and coverage on
their eligible dependent children, if | 14 | | any, may be under the enrollment and
election of either.
| 15 | | Regardless of other provisions herein regarding late | 16 | | enrollment or other
qualifications, as appropriate, the
| 17 | | Director may periodically authorize open enrollment periods | 18 | | for each of the
benefit programs at which time each member may | 19 | | elect enrollment or change
of enrollment without regard to age, | 20 | | sex, health, or other qualification
under the conditions as may | 21 | | be prescribed in rules and regulations
supplementing this Act. | 22 | | Special open enrollment periods may be declared by
the Director | 23 | | for certain members only when special circumstances occur that
| 24 | | affect only those members.
| 25 | | (d) Beginning with fiscal year 2003 and for all subsequent | 26 | | years, eligible
members may elect not to participate in the |
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| 1 | | program of health benefits as
defined in this Act. The election | 2 | | must be made during the annual benefit
choice period, subject | 3 | | to the conditions in this subsection.
| 4 | | (1) Members must furnish proof of health benefit | 5 | | coverage, either
comprehensive major medical coverage or | 6 | | comprehensive managed care plan,
from a source other than | 7 | | the Department of Central Management Services in
order to | 8 | | elect not to participate in the program.
| 9 | | (2) Members may re-enroll in the Department of Central | 10 | | Management Services
program of health benefits upon | 11 | | showing a qualifying change in status, as
defined in the | 12 | | U.S. Internal Revenue Code, without evidence of | 13 | | insurability
and with no limitations on coverage for | 14 | | pre-existing conditions, provided
that there was not a | 15 | | break in coverage of more than 63 days.
| 16 | | (3) Members may also re-enroll in the program of health | 17 | | benefits during
any annual benefit choice period, without | 18 | | evidence of insurability.
| 19 | | (4) Members who elect not to participate in the program | 20 | | of health benefits
shall be furnished a written explanation | 21 | | of the requirements and limitations
for the election not to | 22 | | participate in the program and for re-enrolling in the
| 23 | | program. The explanation shall also be included in the | 24 | | annual benefit choice
options booklets furnished to | 25 | | members.
| 26 | | (d-5) Beginning July 1, 2005, the Director may establish a |
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| 1 | | program of financial incentives to encourage annuitants | 2 | | receiving a retirement annuity from the State Employees | 3 | | Retirement System , but who are not eligible for benefits under | 4 | | the federal Medicare health insurance program (Title XVIII of | 5 | | the Social Security Act, as added by Public Law 89-97) to elect | 6 | | not to participate in the program of health benefits provided | 7 | | under this Act. The election by an annuitant not to participate | 8 | | under this program must be made in accordance with the | 9 | | requirements set forth under subsection (d). The financial | 10 | | incentives provided to these annuitants under the program may | 11 | | not exceed $150 per month for each annuitant electing not to | 12 | | participate in the program of health benefits provided under | 13 | | this Act.
| 14 | | (d-6) Beginning July 1, 2013, the Director may establish a | 15 | | program of financial incentives to encourage annuitants with 20 | 16 | | or more years of creditable service but who are not eligible | 17 | | for benefits under the federal Medicare health insurance | 18 | | program (Title XVIII of the Social Security Act, as added by | 19 | | Public Law 89-97) to elect not to participate in the program of | 20 | | health benefits provided under this Act. The election by an | 21 | | annuitant not to participate under this program must be made in | 22 | | accordance with the requirements set forth under subsection | 23 | | (d). The program established under this subsection (d-6) may | 24 | | include a prorated incentive for annuitants with fewer than 20 | 25 | | years of creditable service, as determined by the Director. The | 26 | | financial incentives provided to these annuitants under this |
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| 1 | | program may not exceed $500 per month for each annuitant | 2 | | electing not to participate in the program of health benefits | 3 | | provided under this Act. | 4 | | (e) Notwithstanding any other provision of this Act or the | 5 | | rules adopted
under this Act, if a person participating in the | 6 | | program of health benefits as
the dependent spouse of an | 7 | | eligible member becomes an annuitant, the person may
elect, at | 8 | | the time of becoming an annuitant or during any subsequent | 9 | | annual
benefit choice period, to continue participation as a | 10 | | dependent rather than
as an eligible member for as long as the | 11 | | person continues to be an eligible
dependent. In order to be | 12 | | eligible to make such an election, the person must have been | 13 | | enrolled as a dependent under the program of health benefits | 14 | | for no less than one year prior to becoming an annuitant.
| 15 | | An eligible member who has elected to participate as a | 16 | | dependent may
re-enroll in the program of health benefits as an | 17 | | eligible member (i)
during any subsequent annual benefit choice | 18 | | period or (ii) upon showing a
qualifying change in status, as | 19 | | defined in the U.S. Internal Revenue Code,
without evidence of | 20 | | insurability and with no limitations on coverage for
| 21 | | pre-existing conditions.
| 22 | | A person who elects to participate in the program of health | 23 | | benefits as
a dependent rather than as an eligible member shall | 24 | | be furnished a written
explanation of the consequences of | 25 | | electing to participate as a dependent and
the conditions and | 26 | | procedures for re-enrolling as an eligible member. The
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| 1 | | explanation shall also be included in the annual benefit choice | 2 | | options booklet
furnished to members.
| 3 | | (Source: P.A. 97-668, eff. 1-13-12.)
| 4 | | Section 10. The Illinois Procurement Code is amended by | 5 | | adding Section 25-205 as follows: | 6 | | (30 ILCS 500/25-205 new) | 7 | | Sec. 25-205. Procurement of health benefits for | 8 | | Medicare-primary members and their dependents. The Department | 9 | | of Central Management Services, in consultation with the Chief | 10 | | Procurement Officer, shall contract or make otherwise | 11 | | available a program of group health benefits for | 12 | | Medicare-primary members and their Medicare-primary | 13 | | dependents. The Director may procure a single contract or | 14 | | multiple contracts that provide a program of group health | 15 | | benefits that is comparable in stability and continuity of | 16 | | coverage, care, and services to the program of health benefits | 17 | | offered to other members and their dependents under the State | 18 | | Employees Group Insurance Act of 1971. The Department of | 19 | | Central Management Services shall provide administrative | 20 | | support and provide consultation to assist with the | 21 | | procurement. The initial procurement is not subject to the | 22 | | provisions of this Code, except for Sections 20-60, 20-65, | 23 | | 20-70, and 20-160, and Article 50, provided that the Chief | 24 | | Procurement Officer may, in writing with justification, waive |
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| 1 | | any certification required under Article 50.
| 2 | | Section 99. Effective date. This Act takes effect upon | 3 | | becoming law.".
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