Full Text of SB2168 102nd General Assembly
SB2168eng 102ND GENERAL ASSEMBLY |
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| 1 | | AN ACT concerning government.
| 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 1971 | 5 | | is amended by changing Section 6.5 as follows:
| 6 | | (5 ILCS 375/6.5)
| 7 | | Sec. 6.5. Health benefits for TRS benefit recipients and | 8 | | TRS dependent
beneficiaries. | 9 | | (a) Purpose. It is the purpose of this amendatory Act of | 10 | | 1995 to transfer
the administration of the program of health | 11 | | benefits established for benefit
recipients and their | 12 | | dependent beneficiaries under Article 16 of the Illinois
| 13 | | Pension Code to the Department of Central Management Services.
| 14 | | (b) Transition provisions. The Board of Trustees of the | 15 | | Teachers'
Retirement System shall continue to administer the | 16 | | health benefit program
established under Article 16 of the | 17 | | Illinois Pension Code through December 31,
1995. Beginning | 18 | | January 1, 1996, the Department of Central Management Services
| 19 | | shall be responsible for administering a program of health | 20 | | benefits for TRS
benefit recipients and TRS dependent | 21 | | beneficiaries under this Section.
The Department of Central | 22 | | Management Services and the Teachers' Retirement
System shall | 23 | | cooperate in this endeavor and shall coordinate their |
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| 1 | | activities
so as to ensure a smooth transition and | 2 | | uninterrupted health benefit coverage.
| 3 | | (c) Eligibility. All persons who were enrolled in the | 4 | | Article 16 program at
the time of the transfer shall be | 5 | | eligible to participate in the program
established under this | 6 | | Section without any interruption or delay in coverage
or | 7 | | limitation as to pre-existing medical conditions. Eligibility | 8 | | to
participate shall be determined by the Teachers' Retirement | 9 | | System.
Eligibility information shall be communicated to the | 10 | | Department of Central
Management Services in a format | 11 | | acceptable to the Department.
| 12 | | Eligible TRS benefit recipients may enroll or re-enroll in | 13 | | the program of health benefits established under this Section | 14 | | during any applicable annual open enrollment period and as | 15 | | otherwise permitted by the Department of Central Management | 16 | | Services. A TRS benefit recipient shall not be deemed | 17 | | ineligible to participate solely by reason of the TRS benefit | 18 | | recipient having made a previous election to disenroll or | 19 | | otherwise not participate in the program of health benefits. | 20 | | A TRS dependent beneficiary who is a child age 19 or over | 21 | | and
mentally or physically disabled does not become ineligible | 22 | | to participate
by reason of (i) becoming ineligible to be | 23 | | claimed as a dependent for Illinois
or federal income tax | 24 | | purposes or (ii) receiving earned income, so long as
those | 25 | | earnings are insufficient for the child to be fully | 26 | | self-sufficient.
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| 1 | | (d) Coverage. The level of health benefits provided under | 2 | | this Section
shall be similar to the level of benefits | 3 | | provided by the
program previously established under Article | 4 | | 16 of the Illinois Pension Code.
| 5 | | Group life insurance benefits are not included in the | 6 | | benefits
to be provided to TRS benefit recipients and TRS | 7 | | dependent beneficiaries under
this Act.
| 8 | | The program of health benefits under this Section may | 9 | | include any or all of
the benefit limitations, including but | 10 | | not limited to a reduction in benefits
based on eligibility | 11 | | for federal Medicare benefits, that are provided under
| 12 | | subsection (a) of Section 6 of this Act for other health | 13 | | benefit programs under
this Act.
| 14 | | (e) Insurance rates and premiums. The Director shall | 15 | | determine the
insurance rates and premiums for TRS benefit | 16 | | recipients and TRS dependent
beneficiaries,
and shall present | 17 | | to the Teachers' Retirement System of
the State of Illinois, | 18 | | by April 15 of each calendar year, the rate-setting
| 19 | | methodology (including but not limited to utilization levels | 20 | | and costs) used
to determine the amount of the health care | 21 | | premiums.
| 22 | | For Fiscal Year 1996, the premium shall be equal to | 23 | | the premium actually
charged in Fiscal Year 1995; in | 24 | | subsequent years, the premium shall
never be lower than | 25 | | the premium charged in Fiscal Year 1995. | 26 | | For Fiscal Year
2003, the premium shall not exceed |
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| 1 | | 110% of the premium actually charged in
Fiscal Year 2002. | 2 | | For Fiscal Year 2004, the premium shall not exceed | 3 | | 112% of
the premium actually charged in Fiscal Year 2003.
| 4 | | For Fiscal Year 2005, the premium shall not exceed a | 5 | | weighted average of 106.6% of
the premium actually charged | 6 | | in Fiscal Year 2004.
| 7 | | For Fiscal Year 2006, the premium shall not exceed a | 8 | | weighted average of 109.1% of
the premium actually charged | 9 | | in Fiscal Year 2005.
| 10 | | For Fiscal Year 2007, the premium shall not exceed a | 11 | | weighted average of 103.9% of
the premium actually charged | 12 | | in Fiscal Year 2006.
| 13 | | For Fiscal Year 2008 and thereafter, the premium in | 14 | | each fiscal year shall not exceed 105% of
the premium | 15 | | actually charged in the previous fiscal year.
| 16 | | Rates and premiums may be based in part on age and | 17 | | eligibility for federal
medicare coverage. However, the cost | 18 | | of participation for a TRS dependent
beneficiary who is an | 19 | | unmarried child age 19 or over and mentally or physically
| 20 | | disabled shall not exceed the cost for a TRS dependent | 21 | | beneficiary who is
an unmarried child under age 19 and | 22 | | participates in the same major medical or
managed care | 23 | | program.
| 24 | | The cost of health benefits under the program shall be | 25 | | paid as follows:
| 26 | | (1) For a TRS benefit recipient selecting a managed |
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| 1 | | care program, up to
75% of the total insurance rate shall | 2 | | be paid from the Teacher Health Insurance
Security Fund. | 3 | | Effective with Fiscal Year 2007 and thereafter, for a TRS | 4 | | benefit recipient selecting a managed care program, 75% of | 5 | | the total insurance rate shall be paid from the Teacher | 6 | | Health Insurance
Security Fund.
| 7 | | (2) For a TRS benefit recipient selecting the major | 8 | | medical coverage
program, up to 50% of the total insurance | 9 | | rate shall be paid from the Teacher
Health Insurance | 10 | | Security Fund if a managed care program is accessible, as
| 11 | | determined by the Teachers' Retirement System. Effective | 12 | | with Fiscal Year 2007 and thereafter, for a TRS benefit | 13 | | recipient selecting the major medical coverage
program, | 14 | | 50% of the total insurance rate shall be paid from the | 15 | | Teacher
Health Insurance Security Fund if a managed care | 16 | | program is accessible, as
determined by the Department of | 17 | | Central Management Services.
| 18 | | (3) For a TRS benefit recipient selecting the major | 19 | | medical coverage
program, up to 75% of the total insurance | 20 | | rate shall be paid from the Teacher
Health Insurance | 21 | | Security Fund if a managed care program is not accessible, | 22 | | as
determined by the Teachers' Retirement System. | 23 | | Effective with Fiscal Year 2007 and thereafter, for a TRS | 24 | | benefit recipient selecting the major medical coverage
| 25 | | program, 75% of the total insurance rate shall be paid | 26 | | from the Teacher
Health Insurance Security Fund if a |
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| 1 | | managed care program is not accessible, as
determined by | 2 | | the Department of Central Management Services.
| 3 | | (3.1) For a TRS dependent beneficiary who is Medicare | 4 | | primary and enrolled in a managed care plan, or the major | 5 | | medical coverage program if a managed care plan is not | 6 | | available, 25% of the total insurance rate shall be paid | 7 | | from the Teacher Health Security Fund as determined by the | 8 | | Department of Central Management Services. For the purpose | 9 | | of this item (3.1), the term "TRS dependent beneficiary | 10 | | who is Medicare primary" means a TRS dependent beneficiary | 11 | | who is participating in Medicare Parts A and B.
| 12 | | (4) Except as otherwise provided in item (3.1), the
| 13 | | balance of the rate of insurance, including the entire | 14 | | premium of
any coverage for TRS dependent beneficiaries | 15 | | that has been elected, shall be
paid
by deductions | 16 | | authorized by the TRS benefit recipient to be withheld | 17 | | from his
or her monthly annuity or benefit payment from | 18 | | the Teachers' Retirement System;
except that (i) if the | 19 | | balance of the cost of coverage exceeds the amount of
the | 20 | | monthly annuity or benefit payment, the difference shall | 21 | | be paid directly
to the Teachers' Retirement System by the | 22 | | TRS benefit recipient, and (ii) all
or part of the balance | 23 | | of the cost of coverage may, at the school board's
option, | 24 | | be paid to the Teachers' Retirement System by the school | 25 | | board of the
school district from which the TRS benefit | 26 | | recipient retired, in accordance
with Section 10-22.3b of |
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| 1 | | the School Code. The Teachers' Retirement System
shall | 2 | | promptly deposit all moneys withheld by or paid to it | 3 | | under this
subdivision (e)(4) into the Teacher Health | 4 | | Insurance Security Fund. These
moneys shall not be | 5 | | considered assets of the Retirement System.
| 6 | | (5) If, for any month beginning on or after January 1, | 7 | | 2013, a TRS benefit recipient or TRS dependent beneficiary | 8 | | was enrolled in Medicare Parts A and B and such Medicare | 9 | | coverage was primary to coverage under this Section but | 10 | | payment for coverage under this Section was made at a rate | 11 | | greater than the Medicare primary rate published by the | 12 | | Department of Central Management Services, the TRS benefit | 13 | | recipient or TRS dependent beneficiary shall be eligible | 14 | | for a refund equal to the difference between the amount | 15 | | paid by the TRS benefit recipient or TRS dependent | 16 | | beneficiary and the published Medicare primary rate. To | 17 | | receive a refund pursuant to this subsection, the TRS | 18 | | benefit recipient or TRS dependent beneficiary must | 19 | | provide documentation to the Department of Central | 20 | | Management Services evidencing the TRS benefit recipient's | 21 | | or TRS dependent beneficiary's Medicare coverage and the | 22 | | amount paid by the TRS benefit recipient or TRS dependent | 23 | | beneficiary during the applicable time period. If in any | 24 | | case an error is made in billing a TRS benefit recipient | 25 | | under this Section, the Department shall identify the | 26 | | error and refund the overpaid amount as soon as |
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| 1 | | practicable. A TRS benefit recipient who has overpaid | 2 | | under this Section shall be entitled to a refund of | 3 | | overpayments for up to 7 years of past payments. | 4 | | (f) Financing. Beginning July 1, 1995, all revenues | 5 | | arising from the
administration of the health benefit programs | 6 | | established under Article 16 of
the Illinois Pension Code or | 7 | | this Section shall be deposited into the
Teacher Health | 8 | | Insurance Security Fund, which is hereby created as a
| 9 | | nonappropriated trust fund to be held outside the State | 10 | | Treasury, with the
State Treasurer as custodian. Any interest | 11 | | earned on moneys in the Teacher
Health Insurance Security Fund | 12 | | shall be deposited into the Fund.
| 13 | | Moneys in the Teacher Health Insurance Security
Fund shall | 14 | | be used only to pay the costs of the health benefit program
| 15 | | established under this Section, including associated | 16 | | administrative costs, and
the costs associated with the health | 17 | | benefit program established under Article
16 of the Illinois | 18 | | Pension Code, as authorized in this Section. Beginning
July 1, | 19 | | 1995, the Department of Central Management Services may make
| 20 | | expenditures from the Teacher Health Insurance Security Fund | 21 | | for those costs.
| 22 | | After other funds authorized for the payment of the costs | 23 | | of the health
benefit program established under Article 16 of | 24 | | the Illinois Pension Code are
exhausted and until January 1, | 25 | | 1996 (or such later date as may be agreed upon
by the Director | 26 | | of Central Management Services and the Secretary of the
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| 1 | | Teachers' Retirement System), the Secretary of the Teachers' | 2 | | Retirement System
may make expenditures from the Teacher | 3 | | Health Insurance Security Fund as
necessary to pay up to 75% of | 4 | | the cost of providing health coverage to eligible
benefit | 5 | | recipients (as defined in Sections 16-153.1 and 16-153.3 of | 6 | | the
Illinois Pension Code) who are enrolled in the Article 16 | 7 | | health benefit
program and to facilitate the transfer of | 8 | | administration of the health benefit
program to the Department | 9 | | of Central Management Services.
| 10 | | The Department of Central Management Services, or any | 11 | | successor agency designated to procure healthcare contracts | 12 | | pursuant to this Act, is authorized to establish funds, | 13 | | separate accounts provided by any bank or banks as defined by | 14 | | the Illinois Banking Act, or separate accounts provided by any | 15 | | savings and loan association or associations as defined by the | 16 | | Illinois Savings and Loan Act of 1985 to be held by the | 17 | | Director, outside the State treasury, for the purpose of | 18 | | receiving the transfer of moneys from the Teacher Health | 19 | | Insurance Security Fund. The Department may promulgate rules | 20 | | further defining the methodology for the transfers. Any | 21 | | interest earned by moneys in the funds or accounts shall inure | 22 | | to the Teacher Health Insurance Security Fund. The transferred | 23 | | moneys, and interest accrued thereon, shall be used | 24 | | exclusively for transfers to administrative service | 25 | | organizations or their financial institutions for payments of | 26 | | claims to claimants and providers under the self-insurance |
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| 1 | | health plan. The transferred moneys, and interest accrued | 2 | | thereon, shall not be used for any other purpose including, | 3 | | but not limited to, reimbursement of administration fees due | 4 | | the administrative service organization pursuant to its | 5 | | contract or contracts with the Department.
| 6 | | (g) Contract for benefits. The Director shall by contract, | 7 | | self-insurance,
or otherwise make available the program of | 8 | | health benefits for TRS benefit
recipients and their TRS | 9 | | dependent beneficiaries that is provided for in this
Section. | 10 | | The contract or other arrangement for the provision of these | 11 | | health
benefits shall be on terms deemed by the Director to be | 12 | | in the best interest of
the State of Illinois and the TRS | 13 | | benefit recipients based on, but not limited
to, such criteria | 14 | | as administrative cost, service capabilities of the carrier
or | 15 | | other contractor, and the costs of the benefits.
| 16 | | (g-5) Committee. A Teacher Retirement Insurance Program | 17 | | Committee shall be established, to consist of 10 persons | 18 | | appointed by the Governor.
| 19 | | The Committee shall convene at least 4 times each year, | 20 | | and shall consider and make recommendations on issues | 21 | | affecting the program of health benefits provided under this
| 22 | | Section. Recommendations of the Committee shall be based on a | 23 | | consensus of the members of the Committee.
| 24 | | If the Teacher
Health Insurance Security Fund experiences | 25 | | a deficit balance based upon the contribution and subsidy | 26 | | rates established in this Section and Section 6.6 for Fiscal |
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| 1 | | Year 2008 or thereafter, the Committee shall make | 2 | | recommendations for adjustments to the funding sources | 3 | | established under these Sections. | 4 | | In addition, the Committee shall identify proposed | 5 | | solutions to the funding shortfalls that are affecting the | 6 | | Teacher Health Insurance Security Fund, and it shall report | 7 | | those solutions to the Governor and the General Assembly | 8 | | within 6 months after August 15, 2011 (the effective date of | 9 | | Public Act 97-386). | 10 | | (h) Continuation of program. It is the intention of
the | 11 | | General Assembly that the program of health benefits provided | 12 | | under this
Section be maintained on an ongoing, affordable | 13 | | basis.
| 14 | | The program of health benefits provided under this Section | 15 | | may be amended by
the State and is not intended to be a pension | 16 | | or retirement benefit subject to
protection under Article | 17 | | XIII, Section 5 of the Illinois Constitution.
| 18 | | (i) Repeal. (Blank).
| 19 | | (Source: P.A. 100-1017, eff. 8-21-18; 101-483, eff. 1-1-20 .)
| 20 | | Section 99. Effective date. This Act takes effect upon | 21 | | becoming law.
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