Full Text of HB4036 101st General Assembly
HB4036ham001 101ST GENERAL ASSEMBLY | Rep. Sue Scherer Filed: 3/5/2020
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| 1 | | AMENDMENT TO HOUSE BILL 4036
| 2 | | AMENDMENT NO. ______. Amend House Bill 4036 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 3 and 8 as follows:
| 6 | | (5 ILCS 375/3) (from Ch. 127, par. 523)
| 7 | | Sec. 3. Definitions. Unless the context otherwise | 8 | | requires, the
following words and phrases as used in this Act | 9 | | shall have the following
meanings. The Department may define | 10 | | these and other words and phrases
separately for the purpose of | 11 | | implementing specific programs providing benefits
under this | 12 | | Act.
| 13 | | (a) "Administrative service organization" means any | 14 | | person, firm or
corporation experienced in the handling of | 15 | | claims which is
fully qualified, financially sound and capable | 16 | | of meeting the service
requirements of a contract of |
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| 1 | | administration executed with the Department.
| 2 | | (b) "Annuitant" means (1) an employee who retires, or has | 3 | | retired,
on or after January 1, 1966 on an immediate annuity | 4 | | under the provisions
of Articles 2, 14 (including an employee | 5 | | who has elected to receive an alternative retirement | 6 | | cancellation payment under Section 14-108.5 of the Illinois | 7 | | Pension Code in lieu of an annuity or who meets the criteria | 8 | | for retirement, but in lieu of receiving an annuity under that | 9 | | Article has elected to receive an accelerated pension benefit | 10 | | payment under Section 14-147.5 of that Article), 15 (including | 11 | | an employee who has retired under the optional
retirement | 12 | | program established under Section 15-158.2 or who meets the | 13 | | criteria for retirement but in lieu of receiving an annuity | 14 | | under that Article has elected to receive an accelerated | 15 | | pension benefit payment under Section 15-185.5 of the Article),
| 16 | | paragraphs (2), (3), or (5) of Section 16-106 (including an | 17 | | employee who meets the criteria for retirement, but in lieu of | 18 | | receiving an annuity under that Article has elected to receive | 19 | | an accelerated pension benefit payment under Section 16-190.5 | 20 | | of the Illinois Pension Code), or
Article 18 of the Illinois | 21 | | Pension Code; (2) any person who was receiving
group insurance | 22 | | coverage under this Act as of March 31, 1978 by
reason of his | 23 | | status as an annuitant, even though the annuity in relation
to | 24 | | which such coverage was provided is a proportional annuity | 25 | | based on less
than the minimum period of service required for a | 26 | | retirement annuity in
the system involved; (3) any person not |
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| 1 | | otherwise covered by this Act
who has retired as a | 2 | | participating member under Article 2 of the Illinois
Pension | 3 | | Code but is ineligible for the retirement annuity under Section
| 4 | | 2-119 of the Illinois Pension Code; (4) the spouse of any | 5 | | person who
is receiving a retirement annuity under Article 18 | 6 | | of the Illinois Pension
Code and who is covered under a group | 7 | | health insurance program sponsored
by a governmental employer | 8 | | other than the State of Illinois and who has
irrevocably | 9 | | elected to waive his or her coverage under this Act and to have
| 10 | | his or her spouse considered as the "annuitant" under this Act | 11 | | and not as
a "dependent"; or (5) an employee who retires, or | 12 | | has retired, from a
qualified position, as determined according | 13 | | to rules promulgated by the
Director, under a qualified local | 14 | | government, a qualified rehabilitation
facility, a qualified | 15 | | domestic violence shelter or service, or a qualified child | 16 | | advocacy center. (For definition
of "retired employee", see (p) | 17 | | post).
| 18 | | (b-5) (Blank).
| 19 | | (b-6) (Blank).
| 20 | | (b-7) (Blank).
| 21 | | (c) "Carrier" means (1) an insurance company, a corporation | 22 | | organized
under the Limited Health Service Organization Act or | 23 | | the Voluntary Health
Services Plans Plan Act, a partnership, or | 24 | | other nongovernmental organization,
which is authorized to do | 25 | | group life or group health insurance business in
Illinois, or | 26 | | (2) the State of Illinois as a self-insurer.
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| 1 | | (d) "Compensation" means salary or wages payable on a | 2 | | regular
payroll by the State Treasurer on a warrant of the | 3 | | State Comptroller out
of any State, trust or federal fund, or | 4 | | by the Governor of the State
through a disbursing officer of | 5 | | the State out of a trust or out of
federal funds, or by any | 6 | | Department out of State, trust, federal or
other funds held by | 7 | | the State Treasurer or the Department, to any person
for | 8 | | personal services currently performed, and ordinary or | 9 | | accidental
disability benefits under Articles 2, 14, 15 | 10 | | (including ordinary or accidental
disability benefits under | 11 | | the optional retirement program established under
Section | 12 | | 15-158.2), paragraphs (2), (3), or (5) of
Section 16-106, or | 13 | | Article 18 of the Illinois Pension Code, for disability
| 14 | | incurred after January 1, 1966, or benefits payable under the | 15 | | Workers'
Compensation or Occupational Diseases Act or benefits | 16 | | payable under a sick
pay plan established in accordance with | 17 | | Section 36 of the State Finance Act.
"Compensation" also means | 18 | | salary or wages paid to an employee of any
qualified local | 19 | | government, qualified rehabilitation facility,
qualified | 20 | | domestic violence shelter or service, or qualified child | 21 | | advocacy center.
| 22 | | (e) "Commission" means the State Employees Group Insurance | 23 | | Advisory
Commission authorized by this Act. Commencing July 1, | 24 | | 1984, "Commission"
as used in this Act means the Commission on | 25 | | Government Forecasting and Accountability as
established by | 26 | | the Legislative Commission Reorganization Act of 1984.
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| 1 | | (f) "Contributory", when referred to as contributory | 2 | | coverage, shall
mean optional coverages or benefits elected by | 3 | | the member toward the cost of
which such member makes | 4 | | contribution, or which are funded in whole or in part
through | 5 | | the acceptance of a reduction in earnings or the foregoing of | 6 | | an
increase in earnings by an employee, as distinguished from | 7 | | noncontributory
coverage or benefits which are paid entirely by | 8 | | the State of Illinois
without reduction of the member's salary.
| 9 | | (g) "Department" means any department, institution, board,
| 10 | | commission, officer, court or any agency of the State | 11 | | government
receiving appropriations and having power to | 12 | | certify payrolls to the
Comptroller authorizing payments of | 13 | | salary and wages against such
appropriations as are made by the | 14 | | General Assembly from any State fund, or
against trust funds | 15 | | held by the State Treasurer and includes boards of
trustees of | 16 | | the retirement systems created by Articles 2, 14, 15, 16 , and
| 17 | | 18 of the Illinois Pension Code. "Department" also includes the | 18 | | Illinois
Comprehensive Health Insurance Board, the Board of | 19 | | Examiners established under
the Illinois Public Accounting | 20 | | Act, and the Illinois Finance Authority.
| 21 | | (h) "Dependent", when the term is used in the context of | 22 | | the health
and life plan, means a member's spouse and any child | 23 | | (1) from
birth to age 26 including an adopted child, a child | 24 | | who lives with the
member from the time of the placement for | 25 | | adoption until entry
of an order of adoption, a stepchild or | 26 | | adjudicated child, or a child who lives with the member
if such |
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| 1 | | member is a court appointed guardian of the child or (2)
age 19 | 2 | | or over who has a mental or physical disability from a cause | 3 | | originating prior to the age of 19 (age 26 if enrolled as an | 4 | | adult child dependent). For
the health plan only, the term | 5 | | "dependent" also includes (1) any person
enrolled prior to the | 6 | | effective date of this Section who is dependent upon
the member | 7 | | to the extent that the member may claim such person as a
| 8 | | dependent for income tax deduction purposes and (2) any person | 9 | | who
has received after June 30, 2000 an organ transplant and | 10 | | who is financially
dependent upon the member and eligible to be | 11 | | claimed as a dependent for income
tax purposes. A member | 12 | | requesting to cover any dependent must provide documentation as | 13 | | requested by the Department of Central Management Services and | 14 | | file with the Department any and all forms required by the | 15 | | Department.
| 16 | | (i) "Director" means the Director of the Illinois | 17 | | Department of Central
Management Services.
| 18 | | (j) "Eligibility period" means the period of time a member | 19 | | has to
elect enrollment in programs or to select benefits | 20 | | without regard to
age, sex or health.
| 21 | | (k) "Employee" means and includes each officer or employee | 22 | | in the
service of a department who (1) receives his | 23 | | compensation for
service rendered to the department on a | 24 | | warrant issued pursuant to a payroll
certified by a department | 25 | | or on a warrant or check issued and drawn by a
department upon | 26 | | a trust, federal or other fund or on a warrant issued
pursuant |
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| 1 | | to a payroll certified by an elected or duly appointed officer
| 2 | | of the State or who receives payment of the performance of | 3 | | personal
services on a warrant issued pursuant to a payroll | 4 | | certified by a
Department and drawn by the Comptroller upon the | 5 | | State Treasurer against
appropriations made by the General | 6 | | Assembly from any fund or against
trust funds held by the State | 7 | | Treasurer, and (2) is employed full-time or
part-time in a | 8 | | position normally requiring actual performance of duty
during | 9 | | not less than 1/2 of a normal work period, as established by | 10 | | the
Director in cooperation with each department, except that | 11 | | persons elected
by popular vote will be considered employees | 12 | | during the entire
term for which they are elected regardless of | 13 | | hours devoted to the
service of the State, and (3) except that | 14 | | "employee" does not include any
person who is not eligible by | 15 | | reason of such person's employment to
participate in one of the | 16 | | State retirement systems under Articles 2, 14, 15
(either the | 17 | | regular Article 15 system or the optional retirement program
| 18 | | established under Section 15-158.2) , or 18, or under paragraph | 19 | | (2), (3), or
(5) of Section 16-106, of the Illinois
Pension | 20 | | Code, but such term does include persons who are employed | 21 | | during
the 6 month qualifying period under Article 14 of the | 22 | | Illinois Pension
Code. Such term also includes any person who | 23 | | (1) after January 1, 1966,
is receiving ordinary or accidental | 24 | | disability benefits under Articles
2, 14, 15 (including | 25 | | ordinary or accidental disability benefits under the
optional | 26 | | retirement program established under Section 15-158.2), |
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| 1 | | paragraphs
(2), (3), or (5) of Section 16-106, or Article 18 of | 2 | | the
Illinois Pension Code, for disability incurred after | 3 | | January 1, 1966, (2)
receives total permanent or total | 4 | | temporary disability under the Workers'
Compensation Act or | 5 | | Occupational Disease Act as a result of injuries
sustained or | 6 | | illness contracted in the course of employment with the
State | 7 | | of Illinois, or (3) is not otherwise covered under this Act and | 8 | | has
retired as a participating member under Article 2 of the | 9 | | Illinois Pension
Code but is ineligible for the retirement | 10 | | annuity under Section 2-119 of
the Illinois Pension Code. | 11 | | However, a person who satisfies the criteria
of the foregoing | 12 | | definition of "employee" except that such person is made
| 13 | | ineligible to participate in the State Universities Retirement | 14 | | System by
clause (4) of subsection (a) of Section 15-107 of the | 15 | | Illinois Pension
Code is also an "employee" for the purposes of | 16 | | this Act. "Employee" also
includes any person receiving or | 17 | | eligible for benefits under a sick pay
plan established in | 18 | | accordance with Section 36 of the State Finance Act.
"Employee" | 19 | | also includes (i) each officer or employee in the service of a
| 20 | | qualified local government, including persons appointed as | 21 | | trustees of
sanitary districts regardless of hours devoted to | 22 | | the service of the
sanitary district, (ii) each employee in the | 23 | | service of a qualified
rehabilitation facility, (iii) each | 24 | | full-time employee in the service of a
qualified domestic | 25 | | violence shelter or service, and (iv) each full-time employee | 26 | | in the service of a qualified child advocacy center, as |
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| 1 | | determined according to
rules promulgated by the Director.
| 2 | | (l) "Member" means an employee, annuitant, retired | 3 | | employee or survivor. In the case of an annuitant or retired | 4 | | employee who first becomes an annuitant or retired employee on | 5 | | or after January 13, 2012 ( the effective date of Public Act | 6 | | 97-668) this amendatory Act of the 97th General Assembly , the | 7 | | individual must meet the minimum vesting requirements of the | 8 | | applicable retirement system in order to be eligible for group | 9 | | insurance benefits under that system. In the case of a survivor | 10 | | who first becomes a survivor on or after January 13, 2012 ( the | 11 | | effective date of Public Act 97-668) this amendatory Act of the | 12 | | 97th General Assembly , the deceased employee, annuitant, or | 13 | | retired employee upon whom the annuity is based must have been | 14 | | eligible to participate in the group insurance system under the | 15 | | applicable retirement system in order for the survivor to be | 16 | | eligible for group insurance benefits under that system.
| 17 | | (m) "Optional coverages or benefits" means those coverages | 18 | | or
benefits available to the member on his or her voluntary | 19 | | election, and at
his or her own expense.
| 20 | | (n) "Program" means the group life insurance, health | 21 | | benefits and other
employee benefits designed and contracted | 22 | | for by the Director under this Act.
| 23 | | (o) "Health plan" means a health benefits
program offered
| 24 | | by the State of Illinois for persons eligible for the plan.
| 25 | | (p) "Retired employee" means any person who would be an | 26 | | annuitant as
that term is defined herein but for the fact that |
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| 1 | | such person retired prior to
January 1, 1966. Such term also | 2 | | includes any person formerly employed by
the University of | 3 | | Illinois in the Cooperative Extension Service who would
be an | 4 | | annuitant but for the fact that such person was made ineligible | 5 | | to
participate in the State Universities Retirement System by | 6 | | clause (4) of
subsection (a) of Section 15-107 of the Illinois
| 7 | | Pension Code.
| 8 | | (q) "Survivor" means a person receiving an annuity as a | 9 | | survivor of an
employee or of an annuitant. "Survivor" also | 10 | | includes: (1) the surviving
dependent of a person who satisfies | 11 | | the definition of "employee" except that
such person is made | 12 | | ineligible to participate in the State Universities
Retirement | 13 | | System by clause (4) of subsection (a)
of Section 15-107 of the | 14 | | Illinois Pension Code; (2) the surviving
dependent of any | 15 | | person formerly employed by the University of Illinois in
the | 16 | | Cooperative Extension Service who would be an annuitant except | 17 | | for the
fact that such person was made ineligible to | 18 | | participate in the State
Universities Retirement System by | 19 | | clause (4) of subsection (a) of Section
15-107 of the Illinois | 20 | | Pension Code; (3) the surviving dependent of a person who was | 21 | | an annuitant under this Act by virtue of receiving an | 22 | | alternative retirement cancellation payment under Section | 23 | | 14-108.5 of the Illinois Pension Code; and (4) a person who | 24 | | would be receiving an annuity as a survivor of an annuitant | 25 | | except that the annuitant elected on or after June 4, 2018 to | 26 | | receive an accelerated pension benefit payment under Section |
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| 1 | | 14-147.5, 15-185.5, or 16-190.5 of the Illinois Pension Code in | 2 | | lieu of receiving an annuity.
| 3 | | (q-2) "SERS" means the State Employees' Retirement System | 4 | | of Illinois, created under Article 14 of the Illinois Pension | 5 | | Code.
| 6 | | (q-3) "SURS" means the State Universities Retirement | 7 | | System, created under Article 15 of the Illinois Pension Code.
| 8 | | (q-4) "TRS" means the Teachers' Retirement System of the | 9 | | State of Illinois, created under Article 16 of the Illinois | 10 | | Pension Code.
| 11 | | (q-5) (Blank).
| 12 | | (q-6) (Blank).
| 13 | | (q-7) (Blank).
| 14 | | (r) "Medical services" means the services provided within | 15 | | the scope
of their licenses by practitioners in all categories | 16 | | licensed under the
Medical Practice Act of 1987.
| 17 | | (s) "Unit of local government" means any county, | 18 | | municipality,
township, school district (including a | 19 | | combination of school districts under
the Intergovernmental | 20 | | Cooperation Act), special district or other unit,
designated as | 21 | | a
unit of local government by law, which exercises limited | 22 | | governmental
powers or powers in respect to limited | 23 | | governmental subjects, any
not-for-profit association with a | 24 | | membership that primarily includes
townships and township | 25 | | officials, that has duties that include provision of
research | 26 | | service, dissemination of information, and other acts for the
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| 1 | | purpose of improving township government, and that is funded | 2 | | wholly or
partly in accordance with Section 85-15 of the | 3 | | Township Code; any
not-for-profit corporation or association, | 4 | | with a membership consisting
primarily of municipalities, that | 5 | | operates its own utility system, and
provides research, | 6 | | training, dissemination of information, or other acts to
| 7 | | promote cooperation between and among municipalities that | 8 | | provide utility
services and for the advancement of the goals | 9 | | and purposes of its
membership;
the Southern Illinois | 10 | | Collegiate Common Market, which is a consortium of higher
| 11 | | education institutions in Southern Illinois; the Illinois | 12 | | Association of
Park Districts; and any hospital provider that | 13 | | is owned by a county that has 100 or fewer hospital beds and | 14 | | has not already joined the program. "Qualified
local | 15 | | government" means a unit of local government approved by the | 16 | | Director and
participating in a program created under | 17 | | subsection (i) of Section 10 of this
Act.
| 18 | | (t) "Qualified rehabilitation facility" means any | 19 | | not-for-profit
organization that is accredited by the | 20 | | Commission on Accreditation of
Rehabilitation Facilities or | 21 | | certified by the Department
of Human Services (as successor to | 22 | | the Department of Mental Health
and Developmental | 23 | | Disabilities) to provide services to persons with
disabilities
| 24 | | and which receives funds from the State of Illinois for | 25 | | providing those
services, approved by the Director and | 26 | | participating in a program created
under subsection (j) of |
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| 1 | | Section 10 of this Act.
| 2 | | (u) "Qualified domestic violence shelter or service" means | 3 | | any Illinois
domestic violence shelter or service and its | 4 | | administrative offices funded
by the Department of Human | 5 | | Services (as successor to the Illinois Department of
Public | 6 | | Aid),
approved by the Director and
participating in a program | 7 | | created under subsection (k) of Section 10.
| 8 | | (v) "TRS benefit recipient" means a person who:
| 9 | | (1) is not a "member" as defined in this Section; and
| 10 | | (2) is receiving a monthly benefit or retirement | 11 | | annuity
under Article 16 of the Illinois Pension Code or | 12 | | would be receiving such monthly benefit or retirement | 13 | | annuity except that the benefit recipient elected on or | 14 | | after June 4, 2018 to receive an accelerated pension | 15 | | benefit payment under Section 16-190.5 of the Illinois | 16 | | Pension Code in lieu of receiving an annuity; and
| 17 | | (3) either (i) has at least 8 years of creditable | 18 | | service under Article
16 of the Illinois Pension Code, or | 19 | | (ii) was enrolled in the health insurance
program offered | 20 | | under that Article on January 1, 1996, or (iii) is the | 21 | | survivor
of a benefit recipient who had at least 8
years of | 22 | | creditable service under Article 16 of the Illinois Pension | 23 | | Code or
was enrolled in the health insurance program | 24 | | offered under that Article on June 21, 1995 ( the effective | 25 | | date of Public Act 89-25) this amendatory Act of 1995 , or | 26 | | (iv) is a recipient or
survivor of a recipient of a |
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| 1 | | disability benefit under Article 16 of the
Illinois Pension | 2 | | Code.
| 3 | | (w) "TRS dependent beneficiary" means a person who:
| 4 | | (1) is not a "member" or "dependent" as defined in this | 5 | | Section; and
| 6 | | (2) is a TRS benefit recipient's: (A) spouse, (B) | 7 | | dependent parent who
is receiving at least half of his or | 8 | | her support from the TRS benefit
recipient, or (C) natural, | 9 | | step, adjudicated, or adopted child who is (i) under age | 10 | | 26, (ii) was, on January 1, 1996, participating as a | 11 | | dependent
beneficiary in the health insurance program | 12 | | offered under Article 16 of the
Illinois Pension Code, or | 13 | | (iii) age 19 or over who has a mental or physical | 14 | | disability from a cause originating prior to the age of 19 | 15 | | (age 26 if enrolled as an adult child).
| 16 | | "TRS dependent beneficiary" does not include, as indicated | 17 | | under paragraph (2) of this subsection (w), a dependent of the | 18 | | survivor of a TRS benefit recipient who first becomes a | 19 | | dependent of a survivor of a TRS benefit recipient on or after | 20 | | January 13, 2012 ( the effective date of Public Act 97-668) this | 21 | | amendatory Act of the 97th General Assembly unless that | 22 | | dependent would have been eligible for coverage as a dependent | 23 | | of the deceased TRS benefit recipient upon whom the survivor | 24 | | benefit is based. | 25 | | (x) "Military leave" refers to individuals in basic
| 26 | | training for reserves, special/advanced training, annual |
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| 1 | | training, emergency
call up, activation by the President of the | 2 | | United States, or any other training or duty in service to the | 3 | | United States Armed Forces.
| 4 | | (y) (Blank).
| 5 | | (z) "Community college benefit recipient" means a person | 6 | | who:
| 7 | | (1) is not a "member" as defined in this Section; and
| 8 | | (2) is receiving a monthly survivor's annuity or | 9 | | retirement annuity
under Article 15 of the Illinois Pension | 10 | | Code or would be receiving such monthly survivor's annuity | 11 | | or retirement annuity except that the benefit recipient | 12 | | elected on or after June 4, 2018 to receive an accelerated | 13 | | pension benefit payment under Section 15-185.5 of the | 14 | | Illinois Pension Code in lieu of receiving an annuity; and
| 15 | | (3) either (i) was a full-time employee of a community | 16 | | college district or
an association of community college | 17 | | boards created under the Public Community
College Act | 18 | | (other than an employee whose last employer under Article | 19 | | 15 of the
Illinois Pension Code was a community college | 20 | | district subject to Article VII
of the Public Community | 21 | | College Act) and was eligible to participate in a group
| 22 | | health benefit plan as an employee during the time of | 23 | | employment with a
community college district (other than a | 24 | | community college district subject to
Article VII of the | 25 | | Public Community College Act) or an association of | 26 | | community
college boards, or (ii) is the survivor of a |
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| 1 | | person described in item (i).
| 2 | | (aa) "Community college dependent beneficiary" means a | 3 | | person who:
| 4 | | (1) is not a "member" or "dependent" as defined in this | 5 | | Section; and
| 6 | | (2) is a community college benefit recipient's: (A) | 7 | | spouse, (B) dependent
parent who is receiving at least half | 8 | | of his or her support from the community
college benefit | 9 | | recipient, or (C) natural, step, adjudicated, or adopted | 10 | | child who is (i)
under age 26, or (ii)
age 19 or over and | 11 | | has a mental or physical disability from a cause | 12 | | originating prior to the age of 19 (age 26 if enrolled as | 13 | | an adult child).
| 14 | | "Community college dependent beneficiary" does not | 15 | | include, as indicated under paragraph (2) of this subsection | 16 | | (aa), a dependent of the survivor of a community college | 17 | | benefit recipient who first becomes a dependent of a survivor | 18 | | of a community college benefit recipient on or after January | 19 | | 13, 2012 ( the effective date of Public Act 97-668) this | 20 | | amendatory Act of the 97th General Assembly unless that | 21 | | dependent would have been eligible for coverage as a dependent | 22 | | of the deceased community college benefit recipient upon whom | 23 | | the survivor annuity is based. | 24 | | (bb) "Qualified child advocacy center" means any Illinois | 25 | | child advocacy center and its administrative offices funded by | 26 | | the Department of Children and Family Services, as defined by |
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| 1 | | the Children's Advocacy Center Act (55 ILCS 80/), approved by | 2 | | the Director and participating in a program created under | 3 | | subsection (n) of Section 10.
| 4 | | (cc) "Placement for adoption" means the assumption and | 5 | | retention by a member of a legal obligation for total or | 6 | | partial support of a child in anticipation of adoption of the | 7 | | child. The child's placement with the member terminates upon | 8 | | the termination of such legal obligation. | 9 | | (dd) "Qualifying change in status" means an event that | 10 | | effects an individual's eligibility for coverage under a | 11 | | program of benefits offered under this Act, which may include, | 12 | | but is not limited to, the following: | 13 | | (1) events that change an employee's legal marital | 14 | | status, including marriage, death of spouse, divorce, | 15 | | legal separation, or annulment; | 16 | | (2) events that change an employee's number of | 17 | | dependents, including birth, death, adoption, or placement | 18 | | for adoption; | 19 | | (3) events that change the employment status of the | 20 | | employee, the employee's spouse, or the employee's | 21 | | dependent, including termination or commencement of | 22 | | employment, strike or lockout, commencement of or return | 23 | | from an unpaid leave of absence, change in worksite, or | 24 | | change in the individual's employment when they cease to be | 25 | | eligible for the program provided under this Act; | 26 | | (4) events that cause an employee's dependent to |
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| 1 | | satisfy or cease to satisfy eligibility requirements for | 2 | | coverage; and | 3 | | (5) a change of residence for the employee, spouse, or | 4 | | dependent. | 5 | | (Source: P.A. 100-355, eff. 1-1-18; 100-587, eff. 6-4-18; | 6 | | 101-242, eff. 8-9-19; revised 9-19-19.)
| 7 | | (5 ILCS 375/8) (from Ch. 127, par. 528)
| 8 | | Sec. 8. Eligibility.
| 9 | | (a) Each employee eligible under the provisions of this Act | 10 | | and any rules
and regulations promulgated and adopted hereunder | 11 | | by the Director shall
become immediately eligible and covered | 12 | | for all benefits available under
the programs. Employees | 13 | | electing coverage for eligible dependents shall have
the | 14 | | coverage effective immediately, provided that the election is | 15 | | properly
filed in accordance with required filing dates and | 16 | | procedures specified by
the Director, including the completion | 17 | | and submission of all documentation and forms required by the | 18 | | Director.
| 19 | | (1) Every member originally eligible to elect | 20 | | dependent coverage, but not
electing it during the original | 21 | | eligibility period, may subsequently obtain
dependent | 22 | | coverage only in the event of a qualifying change in | 23 | | status, as defined under this Act and to the extent | 24 | | permitted in accordance with federal regulations governing | 25 | | Section 125 of the Internal Revenue Code, special
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| 1 | | enrollment, special circumstance as defined by the | 2 | | Director, or during the
annual Benefit Choice Period. Any | 3 | | request to elect dependent coverage due to a qualifying | 4 | | change in status must be consistent with the change in | 5 | | status experienced by the member.
| 6 | | (2) Members described above being transferred from | 7 | | previous
coverage towards which the State has been | 8 | | contributing shall be
transferred regardless of | 9 | | preexisting conditions, waiting periods, or
other | 10 | | requirements that might jeopardize claim payments to which | 11 | | they
would otherwise have been entitled.
| 12 | | (3) Eligible and covered members that are eligible for | 13 | | coverage as
dependents except for the fact of being members | 14 | | shall be transferred to,
and covered under, dependent | 15 | | status regardless of preexisting conditions,
waiting | 16 | | periods, or other requirements that might jeopardize claim | 17 | | payments
to which they would otherwise have been entitled | 18 | | upon cessation of member
status and the election of | 19 | | dependent coverage by a member eligible to elect
that | 20 | | coverage.
| 21 | | (b) New employees shall be immediately insured for the | 22 | | basic group
life insurance and covered by the program of health | 23 | | benefits on the first
day of active State service. Optional | 24 | | life insurance coverage one to 4 times the basic amount, if | 25 | | elected
during the relevant eligibility period, will become | 26 | | effective on the date
of employment. Optional life insurance |
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| 1 | | coverage exceeding 4 times the basic amount and all life | 2 | | insurance amounts applied for after the
eligibility period will | 3 | | be effective, subject to satisfactory evidence of
insurability | 4 | | when applicable, or other necessary qualifications, pursuant | 5 | | to
the requirements of the applicable benefit program, unless | 6 | | there is a change in
status that would confer new eligibility | 7 | | for change of enrollment under rules
established supplementing | 8 | | this Act, in which event application must be made
within the | 9 | | new eligibility period.
| 10 | | (c) As to the group health benefits program contracted to | 11 | | begin or
continue after June 30, 1973, each annuitant, | 12 | | survivor, and retired employee shall become immediately
| 13 | | eligible for all benefits available under that program. Each | 14 | | annuitant, survivor, and retired employee shall have coverage | 15 | | effective immediately, provided that the election is properly | 16 | | filed in accordance with the required filing dates and | 17 | | procedures specified by the Director, including the completion | 18 | | and submission of all documentation and forms required by the | 19 | | Director. Annuitants, survivors, and retired
employees may | 20 | | elect coverage for eligible dependents and shall have the
| 21 | | coverage effective immediately, provided that the election is | 22 | | properly
filed in accordance with required filing dates and | 23 | | procedures specified
by the Director, except that, for a | 24 | | survivor, the dependent sought to be added on or after the | 25 | | effective date of this amendatory Act of the 97th General | 26 | | Assembly must have been eligible for coverage as a dependent |
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| 1 | | under the deceased member upon whom the survivor's annuity is | 2 | | based in order to be eligible for coverage under the survivor.
| 3 | | Except as otherwise provided in this Act, where husband and | 4 | | wife are
both eligible members, each shall be enrolled as a | 5 | | member and coverage on
their eligible dependent children, if | 6 | | any, may be under the enrollment and
election of either.
| 7 | | Regardless of other provisions herein regarding late | 8 | | enrollment or other
qualifications, as appropriate, the
| 9 | | Director may periodically authorize open enrollment periods | 10 | | for each of the
benefit programs at which time each member may | 11 | | elect enrollment or change
of enrollment without regard to age, | 12 | | sex, health, or other qualification
under the conditions as may | 13 | | be prescribed in rules and regulations
supplementing this Act. | 14 | | Special open enrollment periods may be declared by
the Director | 15 | | for certain members only when special circumstances occur that
| 16 | | affect only those members.
| 17 | | (d) Beginning with fiscal year 2003 and for all subsequent | 18 | | years, eligible
members may elect not to participate in the | 19 | | program of health benefits as
defined in this Act. The election | 20 | | must be made during the annual benefit
choice period, subject | 21 | | to the conditions in this subsection.
| 22 | | (1) Members must furnish proof of health benefit | 23 | | coverage, either
comprehensive major medical coverage or | 24 | | comprehensive managed care plan,
from a source other than | 25 | | the Department of Central Management Services in
order to | 26 | | elect not to participate in the program.
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| 1 | | (2) Members may re-enroll in the Department of Central | 2 | | Management Services
program of health benefits upon | 3 | | showing a qualifying change in status, as
defined in the | 4 | | U.S. Internal Revenue Code, without evidence of | 5 | | insurability
and with no limitations on coverage for | 6 | | pre-existing conditions, provided
that there was not a | 7 | | break in coverage of more than 63 days.
| 8 | | (3) Members may also re-enroll in the program of health | 9 | | benefits during
any annual benefit choice period, without | 10 | | evidence of insurability.
| 11 | | (4) Members who elect not to participate in the program | 12 | | of health benefits
shall be furnished a written explanation | 13 | | of the requirements and limitations
for the election not to | 14 | | participate in the program and for re-enrolling in the
| 15 | | program. The explanation shall also be included in the | 16 | | annual benefit choice
options booklets furnished to | 17 | | members.
| 18 | | (d-5) Beginning July 1, 2005, the Director may establish a | 19 | | program of financial incentives to encourage annuitants | 20 | | receiving a retirement annuity, but who are not eligible for | 21 | | benefits under the federal Medicare health insurance program | 22 | | (Title XVIII of the Social Security Act, as added by Public Law | 23 | | 89-97) to elect not to participate in the program of health | 24 | | benefits provided under this Act. The election by an annuitant | 25 | | not to participate under this program must be made in | 26 | | accordance with the requirements set forth under subsection |
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| 1 | | (d). The financial incentives provided to these annuitants | 2 | | under the program may not exceed $150 per month for each | 3 | | annuitant electing not to participate in the program of health | 4 | | benefits provided under this Act.
| 5 | | (d-6) Beginning July 1, 2013, the Director may establish a | 6 | | program of financial incentives to encourage annuitants with 20 | 7 | | or more years of creditable service but who are not eligible | 8 | | for benefits under the federal Medicare health insurance | 9 | | program (Title XVIII of the Social Security Act, as added by | 10 | | Public Law 89-97) to elect not to participate in the program of | 11 | | health benefits provided under this Act. The election by an | 12 | | annuitant not to participate under this program must be made in | 13 | | accordance with the requirements set forth under subsection | 14 | | (d). The program established under this subsection (d-6) may | 15 | | include a prorated incentive for annuitants with fewer than 20 | 16 | | years of creditable service, as determined by the Director. The | 17 | | financial incentives provided to these annuitants under this | 18 | | program may not exceed $500 per month for each annuitant | 19 | | electing not to participate in the program of health benefits | 20 | | provided under this Act. | 21 | | (e) Notwithstanding any other provision of this Act or the | 22 | | rules adopted
under this Act, if a person participating in the | 23 | | program of health benefits as
the dependent spouse of an | 24 | | eligible member becomes an annuitant, the person may
elect, at | 25 | | the time of becoming an annuitant or during any subsequent | 26 | | annual
benefit choice period, to continue participation as a |
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| 1 | | dependent rather than
as an eligible member for as long as the | 2 | | person continues to be an eligible
dependent. In order to be | 3 | | eligible to make such an election, the person must have been | 4 | | enrolled as a dependent under the program of health benefits | 5 | | for no less than one year prior to becoming an annuitant.
| 6 | | An eligible member who has elected to participate as a | 7 | | dependent may
re-enroll in the program of health benefits as an | 8 | | eligible member (i)
during any subsequent annual benefit choice | 9 | | period or (ii) upon showing a
qualifying change in status, as | 10 | | defined in the U.S. Internal Revenue Code,
without evidence of | 11 | | insurability and with no limitations on coverage for
| 12 | | pre-existing conditions.
| 13 | | A person who elects to participate in the program of health | 14 | | benefits as
a dependent rather than as an eligible member shall | 15 | | be furnished a written
explanation of the consequences of | 16 | | electing to participate as a dependent and
the conditions and | 17 | | procedures for re-enrolling as an eligible member. The
| 18 | | explanation shall also be included in the annual benefit choice | 19 | | options booklet
furnished to members.
| 20 | | (Source: P.A. 97-668, eff. 1-13-12; 98-19, eff. 6-10-13 .)
| 21 | | Section 99. Effective date. This Act takes effect upon | 22 | | becoming law.".
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