Full Text of SB2525 96th General Assembly
SB2525enr 96TH GENERAL ASSEMBLY |
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| 1 | | AN ACT concerning public employee benefits.
| 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 Sections 3, 6.5, and 10 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 | 17 | | administration executed with the Department.
| 18 | | (b) "Annuitant" means (1) an employee who retires, or has | 19 | | retired,
on or after January 1, 1966 on an immediate annuity | 20 | | under the provisions
of Articles 2, 14 (including an employee | 21 | | who has elected to receive an alternative retirement | 22 | | cancellation payment under Section 14-108.5 of the Illinois | 23 | | Pension Code in lieu of an annuity), 15 (including an employee |
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| 1 | | who has retired under the optional
retirement program | 2 | | established under Section 15-158.2),
paragraphs (2), (3), or | 3 | | (5) of Section 16-106, or
Article 18 of the Illinois Pension | 4 | | Code; (2) any person who was receiving
group insurance coverage | 5 | | under this Act as of March 31, 1978 by
reason of his status as | 6 | | an annuitant, even though the annuity in relation
to which such | 7 | | coverage was provided is a proportional annuity based on less
| 8 | | than the minimum period of service required for a retirement | 9 | | annuity in
the system involved; (3) any person not otherwise | 10 | | covered by this Act
who has retired as a participating member | 11 | | under Article 2 of the Illinois
Pension Code but is ineligible | 12 | | for the retirement annuity under Section
2-119 of the Illinois | 13 | | Pension Code; (4) the spouse of any person who
is receiving a | 14 | | retirement annuity under Article 18 of the Illinois Pension
| 15 | | Code and who is covered under a group health insurance program | 16 | | sponsored
by a governmental employer other than the State of | 17 | | Illinois and who has
irrevocably elected to waive his or her | 18 | | coverage under this Act and to have
his or her spouse | 19 | | considered as the "annuitant" under this Act and not as
a | 20 | | "dependent"; or (5) an employee who retires, or has retired, | 21 | | from a
qualified position, as determined according to rules | 22 | | promulgated by the
Director, under a qualified local | 23 | | government, a qualified rehabilitation
facility, a qualified | 24 | | domestic violence shelter or service, or a qualified child | 25 | | advocacy center. (For definition
of "retired employee", see (p) | 26 | | post).
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| 1 | | (b-5) "New SERS annuitant" means a person who, on or after | 2 | | January 1,
1998, becomes an annuitant, as defined in subsection | 3 | | (b), by virtue of
beginning to receive a retirement annuity | 4 | | under Article 14 of the Illinois
Pension Code (including an | 5 | | employee who has elected to receive an alternative retirement | 6 | | cancellation payment under Section 14-108.5 of that Code in | 7 | | lieu of an annuity), and is eligible to participate in the | 8 | | basic program of group
health benefits provided for annuitants | 9 | | under this Act.
| 10 | | (b-6) "New SURS annuitant" means a person who (1) on or | 11 | | after January 1,
1998, becomes an annuitant, as defined in | 12 | | subsection (b), by virtue of
beginning to receive a retirement | 13 | | annuity under Article 15 of the Illinois
Pension Code, (2) has | 14 | | not made the election authorized under Section 15-135.1
of the | 15 | | Illinois Pension Code, and (3) is eligible to participate in | 16 | | the basic
program of group
health benefits provided for | 17 | | annuitants under this Act.
| 18 | | (b-7) "New TRS State annuitant" means a person who, on or | 19 | | after July
1, 1998, becomes an annuitant, as defined in | 20 | | subsection (b), by virtue of
beginning to receive a retirement | 21 | | annuity under Article 16 of the Illinois
Pension Code based on | 22 | | service as a teacher as defined in
paragraph (2), (3), or (5) | 23 | | of Section 16-106 of that Code, and is eligible
to participate | 24 | | in the basic program of group health benefits provided for
| 25 | | annuitants under this Act.
| 26 | | (c) "Carrier" means (1) an insurance company, a corporation |
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| 1 | | organized
under the Limited Health Service Organization Act or | 2 | | the Voluntary Health
Services Plan Act, a partnership, or other | 3 | | nongovernmental organization,
which is authorized to do group | 4 | | life or group health insurance business in
Illinois, or (2) the | 5 | | State of Illinois as a self-insurer.
| 6 | | (d) "Compensation" means salary or wages payable on a | 7 | | regular
payroll by the State Treasurer on a warrant of the | 8 | | State Comptroller out
of any State, trust or federal fund, or | 9 | | by the Governor of the State
through a disbursing officer of | 10 | | the State out of a trust or out of
federal funds, or by any | 11 | | Department out of State, trust, federal or
other funds held by | 12 | | the State Treasurer or the Department, to any person
for | 13 | | personal services currently performed, and ordinary or | 14 | | accidental
disability benefits under Articles 2, 14, 15 | 15 | | (including ordinary or accidental
disability benefits under | 16 | | the optional retirement program established under
Section | 17 | | 15-158.2), paragraphs (2), (3), or (5) of
Section 16-106, or | 18 | | Article 18 of the Illinois Pension Code, for disability
| 19 | | incurred after January 1, 1966, or benefits payable under the | 20 | | Workers'
Compensation or Occupational Diseases Act or benefits | 21 | | payable under a sick
pay plan established in accordance with | 22 | | Section 36 of the State Finance Act.
"Compensation" also means | 23 | | salary or wages paid to an employee of any
qualified local | 24 | | government, qualified rehabilitation facility,
qualified | 25 | | domestic violence shelter or service, or qualified child | 26 | | advocacy center.
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| 1 | | (e) "Commission" means the State Employees Group Insurance | 2 | | Advisory
Commission authorized by this Act. Commencing July 1, | 3 | | 1984, "Commission"
as used in this Act means the Commission on | 4 | | Government Forecasting and Accountability as
established by | 5 | | the Legislative Commission Reorganization Act of 1984.
| 6 | | (f) "Contributory", when referred to as contributory | 7 | | coverage, shall
mean optional coverages or benefits elected by | 8 | | the member toward the cost of
which such member makes | 9 | | contribution, or which are funded in whole or in part
through | 10 | | the acceptance of a reduction in earnings or the foregoing of | 11 | | an
increase in earnings by an employee, as distinguished from | 12 | | noncontributory
coverage or benefits which are paid entirely by | 13 | | the State of Illinois
without reduction of the member's salary.
| 14 | | (g) "Department" means any department, institution, board,
| 15 | | commission, officer, court or any agency of the State | 16 | | government
receiving appropriations and having power to | 17 | | certify payrolls to the
Comptroller authorizing payments of | 18 | | salary and wages against such
appropriations as are made by the | 19 | | General Assembly from any State fund, or
against trust funds | 20 | | held by the State Treasurer and includes boards of
trustees of | 21 | | the retirement systems created by Articles 2, 14, 15, 16 and
18 | 22 | | of the Illinois Pension Code. "Department" also includes the | 23 | | Illinois
Comprehensive Health Insurance Board, the Board of | 24 | | Examiners established under
the Illinois Public Accounting | 25 | | Act, and the Illinois Finance Authority.
| 26 | | (h) "Dependent", when the term is used in the context of |
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| 1 | | the health
and life plan, means a member's spouse and any | 2 | | unmarried child (1) from
birth to age 26 19 including an | 3 | | adopted child, a child who lives with the
member from the time | 4 | | of the filing of a petition for adoption until entry
of an | 5 | | order of adoption, a stepchild or adjudicated recognized child | 6 | | who lives with the
member in a parent-child relationship , or a | 7 | | child who lives with the member
if such member is a court | 8 | | appointed guardian of the child or , (2)
age 19 to 24 enrolled | 9 | | as a full-time student in any accredited school,
financially | 10 | | dependent upon the member, and eligible to be claimed as a
| 11 | | dependent for income tax purposes, (2.1) age 19 to 24 on a | 12 | | medical leave of absence as described in Section 356z.11 of the | 13 | | Illinois Insurance Code (215 ILCS 5/356z.11), or (3) age 19 or | 14 | | over who is mentally
or physically disabled from a cause | 15 | | originating prior to the age of 19 (age 26 if enrolled as an | 16 | | adult child dependent) handicapped . For the purposes of item | 17 | | (2), an unmarried child age 19 to 24 who is a member of the | 18 | | United States Armed Services, including the Illinois National | 19 | | Guard, and is mobilized to active duty shall qualify as a | 20 | | dependent beyond the age of 24 and until the age of 25 and | 21 | | while a full-time student for the amount of time spent on | 22 | | active duty between the ages of 19 and 24. The individual | 23 | | attempting to qualify for this additional time must submit | 24 | | written documentation of active duty service to the Director. | 25 | | The changes made by this amendatory Act of the 94th General | 26 | | Assembly apply only to individuals mobilized to active duty in |
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| 1 | | the United States Armed Services, including the Illinois | 2 | | National Guard, on or after January 1, 2002. For
the health | 3 | | plan only, the term "dependent" also includes (1) any person
| 4 | | enrolled prior to the effective date of this Section who is | 5 | | dependent upon
the member to the extent that the member may | 6 | | claim such person as a
dependent for income tax deduction | 7 | | purposes and (2) ; no other such
person may be enrolled.
For the | 8 | | health plan only, the term "dependent" also includes 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 or of any successor | 18 | | agency designated to administer this Act.
| 19 | | (j) "Eligibility period" means the period of time a member | 20 | | has to
elect enrollment in programs or to select benefits | 21 | | without regard to
age, sex or health.
| 22 | | (k) "Employee" means and includes each officer or employee | 23 | | in the
service of a department who (1) receives his | 24 | | compensation for
service rendered to the department on a | 25 | | warrant issued pursuant to a payroll
certified by a department | 26 | | or on a warrant or check issued and drawn by a
department upon |
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| 1 | | a trust, federal or other fund or on a warrant issued
pursuant | 2 | | to a payroll certified by an elected or duly appointed officer
| 3 | | of the State or who receives payment of the performance of | 4 | | personal
services on a warrant issued pursuant to a payroll | 5 | | certified by a
Department and drawn by the Comptroller upon the | 6 | | State Treasurer against
appropriations made by the General | 7 | | Assembly from any fund or against
trust funds held by the State | 8 | | Treasurer, and (2) is employed full-time or
part-time in a | 9 | | position normally requiring actual performance of duty
during | 10 | | not less than 1/2 of a normal work period, as established by | 11 | | the
Director in cooperation with each department, except that | 12 | | persons elected
by popular vote will be considered employees | 13 | | during the entire
term for which they are elected regardless of | 14 | | hours devoted to the
service of the State, and (3) except that | 15 | | "employee" does not include any
person who is not eligible by | 16 | | reason of such person's employment to
participate in one of the | 17 | | State retirement systems under Articles 2, 14, 15
(either the | 18 | | regular Article 15 system or the optional retirement program
| 19 | | established under Section 15-158.2) or 18, or under paragraph | 20 | | (2), (3), or
(5) of Section 16-106, of the Illinois
Pension | 21 | | Code, but such term does include persons who are employed | 22 | | during
the 6 month qualifying period under Article 14 of the | 23 | | Illinois Pension
Code. Such term also includes any person who | 24 | | (1) after January 1, 1966,
is receiving ordinary or accidental | 25 | | disability benefits under Articles
2, 14, 15 (including | 26 | | ordinary or accidental disability benefits under the
optional |
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| 1 | | retirement program established under Section 15-158.2), | 2 | | paragraphs
(2), (3), or (5) of Section 16-106, or Article 18 of | 3 | | the
Illinois Pension Code, for disability incurred after | 4 | | January 1, 1966, (2)
receives total permanent or total | 5 | | temporary disability under the Workers'
Compensation Act or | 6 | | Occupational Disease Act as a result of injuries
sustained or | 7 | | illness contracted in the course of employment with the
State | 8 | | of Illinois, or (3) is not otherwise covered under this Act and | 9 | | has
retired as a participating member under Article 2 of the | 10 | | Illinois Pension
Code but is ineligible for the retirement | 11 | | annuity under Section 2-119 of
the Illinois Pension Code. | 12 | | However, a person who satisfies the criteria
of the foregoing | 13 | | definition of "employee" except that such person is made
| 14 | | ineligible to participate in the State Universities Retirement | 15 | | System by
clause (4) of subsection (a) of Section 15-107 of the | 16 | | Illinois Pension
Code is also an "employee" for the purposes of | 17 | | this Act. "Employee" also
includes any person receiving or | 18 | | eligible for benefits under a sick pay
plan established in | 19 | | accordance with Section 36 of the State Finance Act.
"Employee" | 20 | | also includes (i) each officer or employee in the service of a
| 21 | | qualified local government, including persons appointed as | 22 | | trustees of
sanitary districts regardless of hours devoted to | 23 | | the service of the
sanitary district, (ii) each employee in the | 24 | | service of a qualified
rehabilitation facility, (iii) each | 25 | | full-time employee in the service of a
qualified domestic | 26 | | violence shelter or service, and (iv) each full-time employee |
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| 1 | | in the service of a qualified child advocacy center, as | 2 | | determined according to
rules promulgated by the Director.
| 3 | | (l) "Member" means an employee, annuitant, retired | 4 | | employee or survivor.
| 5 | | (m) "Optional coverages or benefits" means those coverages | 6 | | or
benefits available to the member on his or her voluntary | 7 | | election, and at
his or her own expense.
| 8 | | (n) "Program" means the group life insurance, health | 9 | | benefits and other
employee benefits designed and contracted | 10 | | for by the Director under this Act.
| 11 | | (o) "Health plan" means a health benefits
program offered
| 12 | | by the State of Illinois for persons eligible for the plan.
| 13 | | (p) "Retired employee" means any person who would be an | 14 | | annuitant as
that term is defined herein but for the fact that | 15 | | such person retired prior to
January 1, 1966. Such term also | 16 | | includes any person formerly employed by
the University of | 17 | | Illinois in the Cooperative Extension Service who would
be an | 18 | | annuitant but for the fact that such person was made ineligible | 19 | | to
participate in the State Universities Retirement System by | 20 | | clause (4) of
subsection (a) of Section 15-107 of the Illinois
| 21 | | Pension Code.
| 22 | | (q) "Survivor" means a person receiving an annuity as a | 23 | | survivor of an
employee or of an annuitant. "Survivor" also | 24 | | includes: (1) the surviving
dependent of a person who satisfies | 25 | | the definition of "employee" except that
such person is made | 26 | | ineligible to participate in the State Universities
Retirement |
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| 1 | | System by clause (4) of subsection (a)
of Section 15-107 of the | 2 | | Illinois Pension Code; (2) the surviving
dependent of any | 3 | | person formerly employed by the University of Illinois in
the | 4 | | Cooperative Extension Service who would be an annuitant except | 5 | | for the
fact that such person was made ineligible to | 6 | | participate in the State
Universities Retirement System by | 7 | | clause (4) of subsection (a) of Section
15-107 of the Illinois | 8 | | Pension Code; and (3) the surviving dependent of a person who | 9 | | was an annuitant under this Act by virtue of receiving an | 10 | | alternative retirement cancellation payment under Section | 11 | | 14-108.5 of the Illinois Pension Code.
| 12 | | (q-2) "SERS" means the State Employees' Retirement System | 13 | | of Illinois, created under Article 14 of the Illinois Pension | 14 | | Code.
| 15 | | (q-3) "SURS" means the State Universities Retirement | 16 | | System, created under Article 15 of the Illinois Pension Code.
| 17 | | (q-4) "TRS" means the Teachers' Retirement System of the | 18 | | State of Illinois, created under Article 16 of the Illinois | 19 | | Pension Code.
| 20 | | (q-5) "New SERS survivor" means a survivor, as defined in | 21 | | subsection (q),
whose annuity is paid under Article 14 of the | 22 | | Illinois Pension Code and is
based on the death of (i) an | 23 | | employee whose death occurs on or after January 1,
1998, or | 24 | | (ii) a new SERS annuitant as defined in subsection (b-5). "New | 25 | | SERS survivor" includes the surviving dependent of a person who | 26 | | was an annuitant under this Act by virtue of receiving an |
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| 1 | | alternative retirement cancellation payment under Section | 2 | | 14-108.5 of the Illinois Pension Code.
| 3 | | (q-6) "New SURS survivor" means a survivor, as defined in | 4 | | subsection (q),
whose annuity is paid under Article 15 of the | 5 | | Illinois Pension Code and is
based on the death of (i) an | 6 | | employee whose death occurs on or after January 1,
1998, or | 7 | | (ii) a new SURS annuitant as defined in subsection (b-6).
| 8 | | (q-7) "New TRS State survivor" means a survivor, as defined | 9 | | in subsection
(q), whose annuity is paid under Article 16 of | 10 | | the Illinois Pension Code and is
based on the death of (i) an | 11 | | employee who is a teacher as defined in paragraph
(2), (3), or | 12 | | (5) of Section 16-106 of that Code and whose death occurs on or
| 13 | | after July 1, 1998, or (ii) a new TRS State annuitant as | 14 | | defined in subsection
(b-7).
| 15 | | (r) "Medical services" means the services provided within | 16 | | the scope
of their licenses by practitioners in all categories | 17 | | licensed under the
Medical Practice Act of 1987.
| 18 | | (s) "Unit of local government" means any county, | 19 | | municipality,
township, school district (including a | 20 | | combination of school districts under
the Intergovernmental | 21 | | Cooperation Act), special district or other unit,
designated as | 22 | | a
unit of local government by law, which exercises limited | 23 | | governmental
powers or powers in respect to limited | 24 | | governmental subjects, any
not-for-profit association with a | 25 | | membership that primarily includes
townships and township | 26 | | officials, that has duties that include provision of
research |
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| 1 | | service, dissemination of information, and other acts for the
| 2 | | purpose of improving township government, and that is funded | 3 | | wholly or
partly in accordance with Section 85-15 of the | 4 | | Township Code; any
not-for-profit corporation or association, | 5 | | with a membership consisting
primarily of municipalities, that | 6 | | operates its own utility system, and
provides research, | 7 | | training, dissemination of information, or other acts to
| 8 | | promote cooperation between and among municipalities that | 9 | | provide utility
services and for the advancement of the goals | 10 | | and purposes of its
membership;
the Southern Illinois | 11 | | Collegiate Common Market, which is a consortium of higher
| 12 | | education institutions in Southern Illinois; the Illinois | 13 | | Association of
Park Districts; and any hospital provider that | 14 | | is owned by a county that has 100 or fewer hospital beds and | 15 | | has not already joined the program. "Qualified
local | 16 | | government" means a unit of local government approved by the | 17 | | Director and
participating in a program created under | 18 | | subsection (i) of Section 10 of this
Act.
| 19 | | (t) "Qualified rehabilitation facility" means any | 20 | | not-for-profit
organization that is accredited by the | 21 | | Commission on Accreditation of
Rehabilitation Facilities or | 22 | | certified by the Department
of Human Services (as successor to | 23 | | the Department of Mental Health
and Developmental | 24 | | Disabilities) to provide services to persons with
disabilities
| 25 | | and which receives funds from the State of Illinois for | 26 | | providing those
services, approved by the Director and |
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| 1 | | participating in a program created
under subsection (j) of | 2 | | Section 10 of this Act.
| 3 | | (u) "Qualified domestic violence shelter or service" means | 4 | | any Illinois
domestic violence shelter or service and its | 5 | | administrative offices funded
by the Department of Human | 6 | | Services (as successor to the Illinois Department of
Public | 7 | | Aid),
approved by the Director and
participating in a program | 8 | | created under subsection (k) of Section 10.
| 9 | | (v) "TRS benefit recipient" means a person who:
| 10 | | (1) is not a "member" as defined in this Section; and
| 11 | | (2) is receiving a monthly benefit or retirement | 12 | | annuity
under Article 16 of the Illinois Pension Code; and
| 13 | | (3) either (i) has at least 8 years of creditable | 14 | | service under Article
16 of the Illinois Pension Code, or | 15 | | (ii) was enrolled in the health insurance
program offered | 16 | | under that Article on January 1, 1996, or (iii) is the | 17 | | survivor
of a benefit recipient who had at least 8
years of | 18 | | creditable service under Article 16 of the Illinois Pension | 19 | | Code or
was enrolled in the health insurance program | 20 | | offered under that Article on
the effective date of this | 21 | | amendatory Act of 1995, or (iv) is a recipient or
survivor | 22 | | of a recipient of a disability benefit under Article 16 of | 23 | | the
Illinois Pension Code.
| 24 | | (w) "TRS dependent beneficiary" means a person who:
| 25 | | (1) is not a "member" or "dependent" as defined in this | 26 | | Section; and
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| 1 | | (2) is a TRS benefit recipient's: (A) spouse, (B) | 2 | | dependent parent who
is receiving at least half of his or | 3 | | her support from the TRS benefit
recipient, or (C) | 4 | | unmarried natural , step, adjudicated, or adopted child who | 5 | | is (i) under age 26
19 , or (ii) enrolled as a full-time | 6 | | student in
an accredited school, financially dependent | 7 | | upon the TRS benefit recipient,
eligible to be claimed as a | 8 | | dependent for income tax
purposes, and
either is under age | 9 | | 24 or was, on January 1, 1996, participating as a dependent
| 10 | | beneficiary in the health insurance program offered under | 11 | | Article 16 of the
Illinois Pension Code, or (iii) age 19 or | 12 | | over who is mentally or physically disabled from a cause | 13 | | originating prior to the age of 19 (age 26 if enrolled as | 14 | | an adult child)
handicapped .
| 15 | | (x) "Military leave with pay and benefits " refers to | 16 | | individuals in basic
training for reserves, special/advanced | 17 | | training, annual training, emergency
call up, or activation by | 18 | | the President of the United States , or any other training or | 19 | | duty in service to the United States Armed Forces with | 20 | | approved pay
and benefits .
| 21 | | (y) (Blank). "Military leave without pay and benefits" | 22 | | refers to
individuals who enlist for active duty in a regular | 23 | | component of the U.S. Armed
Forces or other duty not specified | 24 | | or authorized under military leave with pay
and benefits.
| 25 | | (z) "Community college benefit recipient" means a person | 26 | | who:
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| 1 | | (1) is not a "member" as defined in this Section; and
| 2 | | (2) is receiving a monthly survivor's annuity or | 3 | | retirement annuity
under Article 15 of the Illinois Pension | 4 | | Code; and
| 5 | | (3) either (i) was a full-time employee of a community | 6 | | college district or
an association of community college | 7 | | boards created under the Public Community
College Act | 8 | | (other than an employee whose last employer under Article | 9 | | 15 of the
Illinois Pension Code was a community college | 10 | | district subject to Article VII
of the Public Community | 11 | | College Act) and was eligible to participate in a group
| 12 | | health benefit plan as an employee during the time of | 13 | | employment with a
community college district (other than a | 14 | | community college district subject to
Article VII of the | 15 | | Public Community College Act) or an association of | 16 | | community
college boards, or (ii) is the survivor of a | 17 | | person described in item (i).
| 18 | | (aa) "Community college dependent beneficiary" means a | 19 | | person who:
| 20 | | (1) is not a "member" or "dependent" as defined in this | 21 | | Section; and
| 22 | | (2) is a community college benefit recipient's: (A) | 23 | | spouse, (B) dependent
parent who is receiving at least half | 24 | | of his or her support from the community
college benefit | 25 | | recipient, or (C) unmarried natural , step, adjudicated, or | 26 | | adopted child who is (i)
under age 26 19 , or (ii) enrolled |
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| 1 | | as a full-time student in an accredited school,
financially | 2 | | dependent upon the community college benefit recipient, | 3 | | eligible
to be claimed as a dependent for income tax | 4 | | purposes and under age 23, or (iii)
age 19 or over and | 5 | | mentally or physically disabled from a cause originating | 6 | | prior to the age of 19 (age 26 if enrolled as an adult | 7 | | child) handicapped .
| 8 | | (bb) "Qualified child advocacy center" means any Illinois | 9 | | child advocacy center and its administrative offices funded by | 10 | | the Department of Children and Family Services, as defined by | 11 | | the Children's Advocacy Center Act (55 ILCS 80/), approved by | 12 | | the Director and participating in a program created under | 13 | | subsection (n) of Section 10.
| 14 | | (Source: P.A. 95-331, eff. 8-21-07; 95-632, eff. 9-25-07; | 15 | | 96-756, eff. 1-1-10.)
| 16 | | (5 ILCS 375/6.5)
| 17 | | Sec. 6.5. Health benefits for TRS benefit recipients and | 18 | | TRS dependent
beneficiaries.
| 19 | | (a) Purpose. It is the purpose of this amendatory Act of | 20 | | 1995 to transfer
the administration of the program of health | 21 | | benefits established for benefit
recipients and their | 22 | | dependent beneficiaries under Article 16 of the Illinois
| 23 | | Pension Code to the Department of Central Management Services.
| 24 | | (b) Transition provisions. The Board of Trustees of the | 25 | | Teachers'
Retirement System shall continue to administer the |
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| 1 | | health benefit program
established under Article 16 of the | 2 | | Illinois Pension Code through December 31,
1995. Beginning | 3 | | January 1, 1996, the Department of Central Management Services
| 4 | | shall be responsible for administering a program of health | 5 | | benefits for TRS
benefit recipients and TRS dependent | 6 | | beneficiaries under this Section.
The Department of Central | 7 | | Management Services and the Teachers' Retirement
System shall | 8 | | cooperate in this endeavor and shall coordinate their | 9 | | activities
so as to ensure a smooth transition and | 10 | | uninterrupted health benefit coverage.
| 11 | | (c) Eligibility. All persons who were enrolled in the | 12 | | Article 16 program at
the time of the transfer shall be | 13 | | eligible to participate in the program
established under this | 14 | | Section without any interruption or delay in coverage
or | 15 | | limitation as to pre-existing medical conditions. Eligibility | 16 | | to
participate shall be determined by the Teachers' Retirement | 17 | | System.
Eligibility information shall be communicated to the | 18 | | Department of Central
Management Services in a format | 19 | | acceptable to the Department.
| 20 | | A TRS dependent beneficiary who is a an unmarried child age | 21 | | 19 or over and
mentally or physically disabled does not become | 22 | | ineligible to participate
by reason of (i) becoming ineligible | 23 | | to be 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 provided | 3 | | by the
program previously established under Article 16 of the | 4 | | 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 for | 11 | | federal medicare benefits, that are provided under
subsection | 12 | | (a) of Section 6 of this Act for other health benefit programs | 13 | | 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, by | 18 | | April 15 of each calendar year, the rate-setting
methodology | 19 | | (including but not limited to utilization levels and costs) | 20 | | used
to determine the amount of the health care premiums.
| 21 | | For Fiscal Year 1996, the premium shall be equal to the | 22 | | premium actually
charged in Fiscal Year 1995; in subsequent | 23 | | years, the premium shall
never be lower than the premium | 24 | | charged in Fiscal Year 1995. | 25 | | For Fiscal Year
2003, the premium shall not exceed 110% | 26 | | of the premium actually charged in
Fiscal Year 2002. |
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| 1 | | For Fiscal Year 2004, the premium shall not exceed 112% | 2 | | of
the premium actually charged in Fiscal Year 2003.
| 3 | | For Fiscal Year 2005, the premium shall not exceed a | 4 | | weighted average of 106.6% of
the premium actually charged | 5 | | in Fiscal Year 2004.
| 6 | | For Fiscal Year 2006, the premium shall not exceed a | 7 | | weighted average of 109.1% of
the premium actually charged | 8 | | in Fiscal Year 2005.
| 9 | | For Fiscal Year 2007, the premium shall not exceed a | 10 | | weighted average of 103.9% of
the premium actually charged | 11 | | in Fiscal Year 2006.
| 12 | | For Fiscal Year 2008 and thereafter, the premium in | 13 | | each fiscal year shall not exceed 105% of
the premium | 14 | | actually charged in the previous fiscal year.
| 15 | | Rates and premiums may be based in part on age and | 16 | | eligibility for federal
medicare coverage. However, the cost of | 17 | | participation for a TRS dependent
beneficiary who is an | 18 | | unmarried child age 19 or over and mentally or physically
| 19 | | disabled shall not exceed the cost for a TRS dependent | 20 | | beneficiary who is
an unmarried child under age 19 and | 21 | | participates in the same major medical or
managed care program.
| 22 | | The cost of health benefits under the program shall be paid | 23 | | as follows:
| 24 | | (1) For a TRS benefit recipient selecting a managed | 25 | | care program, up to
75% of the total insurance rate shall | 26 | | be paid from the Teacher Health Insurance
Security Fund. |
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| 1 | | Effective with Fiscal Year 2007 and thereafter, for a TRS | 2 | | benefit recipient selecting a managed care program, 75% of | 3 | | the total insurance rate shall be paid from the Teacher | 4 | | Health Insurance
Security Fund.
| 5 | | (2) For a TRS benefit recipient selecting the major | 6 | | medical coverage
program, up to 50% of the total insurance | 7 | | rate shall be paid from the Teacher
Health Insurance | 8 | | Security Fund if a managed care program is accessible, as
| 9 | | determined by the Teachers' Retirement System. Effective | 10 | | with Fiscal Year 2007 and thereafter, for a TRS benefit | 11 | | recipient selecting the major medical coverage
program, | 12 | | 50% of the total insurance rate shall be paid from the | 13 | | Teacher
Health Insurance Security Fund if a managed care | 14 | | program is accessible, as
determined by the Department of | 15 | | Central Management Services.
| 16 | | (3) For a TRS benefit recipient selecting the major | 17 | | medical coverage
program, up to 75% of the total insurance | 18 | | rate shall be paid from the Teacher
Health Insurance | 19 | | Security Fund if a managed care program is not accessible, | 20 | | as
determined by the Teachers' Retirement System. | 21 | | Effective with Fiscal Year 2007 and thereafter, for a TRS | 22 | | benefit recipient selecting the major medical coverage
| 23 | | program, 75% of the total insurance rate shall be paid from | 24 | | the Teacher
Health Insurance Security Fund if a managed | 25 | | care program is not accessible, as
determined by the | 26 | | Department of Central Management Services.
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| 1 | | (3.1) For a TRS dependent beneficiary who is Medicare | 2 | | primary and enrolled in a managed care plan, or the major | 3 | | medical coverage program if a managed care plan is not | 4 | | available, 25% of the total insurance rate shall be paid | 5 | | from the Teacher Health Security Fund as determined by the | 6 | | Department of Central Management Services. For the purpose | 7 | | of this item (3.1), the term "TRS dependent beneficiary who | 8 | | is Medicare primary" means a TRS dependent beneficiary who | 9 | | is participating in Medicare Parts A and B.
| 10 | | (4) Except as otherwise provided in item (3.1), the
| 11 | | balance of the rate of insurance, including the entire | 12 | | premium of
any coverage for TRS dependent beneficiaries | 13 | | that has been elected, shall be
paid
by deductions | 14 | | authorized by the TRS benefit recipient to be withheld from | 15 | | his
or her monthly annuity or benefit payment from the | 16 | | Teachers' Retirement System;
except that (i) if the balance | 17 | | of the cost of coverage exceeds the amount of
the monthly | 18 | | annuity or benefit payment, the difference shall be paid | 19 | | directly
to the Teachers' Retirement System by the TRS | 20 | | benefit recipient, and (ii) all
or part of the balance of | 21 | | the cost of coverage may, at the school board's
option, be | 22 | | paid to the Teachers' Retirement System by the school board | 23 | | of the
school district from which the TRS benefit recipient | 24 | | retired, in accordance
with Section 10-22.3b of the School | 25 | | Code. The Teachers' Retirement System
shall promptly | 26 | | deposit all moneys withheld by or paid to it under this
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| 1 | | subdivision (e)(4) into the Teacher Health Insurance | 2 | | Security Fund. These
moneys shall not be considered assets | 3 | | of the Retirement System.
| 4 | | (f) Financing. Beginning July 1, 1995, all revenues arising | 5 | | 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 Health | 3 | | Insurance Security Fund as
necessary to pay up to 75% of the | 4 | | cost of providing health coverage to eligible
benefit | 5 | | recipients (as defined in Sections 16-153.1 and 16-153.3 of the
| 6 | | 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 Healthcare and Family 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 exclusively | 24 | | for transfers to administrative service organizations or their | 25 | | financial institutions for payments of claims to claimants and | 26 | | providers under the self-insurance health plan. The |
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| 1 | | transferred moneys, and interest accrued thereon, shall not be | 2 | | used for any other purpose including, but not limited to, | 3 | | reimbursement of administration fees due the administrative | 4 | | service organization pursuant to its contract or contracts with | 5 | | 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, and | 20 | | shall consider and make recommendations on issues affecting the | 21 | | program of health benefits provided under this
Section. | 22 | | Recommendations of the Committee shall be based on a consensus | 23 | | of the members of the Committee.
| 24 | | If the Teacher
Health Insurance Security Fund experiences a | 25 | | deficit balance based upon the contribution and subsidy rates | 26 | | established in this Section and Section 6.6 for Fiscal Year |
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| 1 | | 2008 or thereafter, the Committee shall make recommendations | 2 | | for adjustments to the funding sources established under these | 3 | | Sections. | 4 | | (h) Continuation of program. It is the intention of
the | 5 | | General Assembly that the program of health benefits provided | 6 | | under this
Section be maintained on an ongoing, affordable | 7 | | basis.
| 8 | | The program of health benefits provided under this Section | 9 | | may be amended by
the State and is not intended to be a pension | 10 | | or retirement benefit subject to
protection under Article XIII, | 11 | | Section 5 of the Illinois Constitution.
| 12 | | (i) Repeal. (Blank).
| 13 | | (Source: P.A. 95-632, eff. 9-25-07.)
| 14 | | (5 ILCS 375/10) (from Ch. 127, par. 530)
| 15 | | Sec. 10. Payments by State; premiums.
| 16 | | (a) The State shall pay the cost of basic non-contributory | 17 | | group life
insurance and, subject to member paid contributions | 18 | | set by the Department or
required by this Section, the basic | 19 | | program of group health benefits on each
eligible member, | 20 | | except a member, not otherwise
covered by this Act, who has | 21 | | retired as a participating member under Article 2
of the | 22 | | Illinois Pension Code but is ineligible for the retirement | 23 | | annuity under
Section 2-119 of the Illinois Pension Code, and | 24 | | part of each eligible member's
and retired member's premiums | 25 | | for health insurance coverage for enrolled
dependents as |
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| 1 | | provided by Section 9. The State shall pay the cost of the | 2 | | basic
program of group health benefits only after benefits are | 3 | | reduced by the amount
of benefits covered by Medicare for all | 4 | | members and dependents
who are eligible for benefits under | 5 | | Social Security or
the Railroad Retirement system or who had | 6 | | sufficient Medicare-covered
government employment, except that | 7 | | such reduction in benefits shall apply only
to those members | 8 | | and dependents who (1) first become eligible
for such Medicare | 9 | | coverage on or after July 1, 1992; or (2) are
Medicare-eligible | 10 | | members or dependents of a local government unit which began
| 11 | | participation in the program on or after July 1, 1992; or (3) | 12 | | remain eligible
for, but no longer receive Medicare coverage | 13 | | which they had been receiving on
or after July 1, 1992. The | 14 | | Department may determine the aggregate level of the
State's | 15 | | contribution on the basis of actual cost of medical services | 16 | | adjusted
for age, sex or geographic or other demographic | 17 | | characteristics which affect
the costs of such programs.
| 18 | | The cost of participation in the basic program of group | 19 | | health benefits
for the dependent or survivor of a living or | 20 | | deceased retired employee who was
formerly employed by the | 21 | | University of Illinois in the Cooperative Extension
Service and | 22 | | would be an annuitant but for the fact that he or she was made
| 23 | | ineligible to participate in the State Universities Retirement | 24 | | System by clause
(4) of subsection (a) of Section 15-107 of the | 25 | | Illinois Pension Code shall not
be greater than the cost of | 26 | | participation that would otherwise apply to that
dependent or |
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| 1 | | survivor if he or she were the dependent or survivor of an
| 2 | | annuitant under the State Universities Retirement System.
| 3 | | (a-1) Beginning January 1, 1998, for each person who | 4 | | becomes a new SERS
annuitant and participates in the basic | 5 | | program of group health benefits, the
State shall contribute | 6 | | toward the cost of the annuitant's
coverage under the basic | 7 | | program of group health benefits an amount equal
to 5% of that | 8 | | cost for each full year of creditable service upon which the
| 9 | | annuitant's retirement annuity is based, up to a maximum of | 10 | | 100% for an
annuitant with 20 or more years of creditable | 11 | | service.
The remainder of the cost of a new SERS annuitant's | 12 | | coverage under the basic
program of group health benefits shall | 13 | | be the responsibility of the
annuitant. In the case of a new | 14 | | SERS annuitant who has elected to receive an alternative | 15 | | retirement cancellation payment under Section 14-108.5 of the | 16 | | Illinois Pension Code in lieu of an annuity, for the purposes | 17 | | of this subsection the annuitant shall be deemed to be | 18 | | receiving a retirement annuity based on the number of years of | 19 | | creditable service that the annuitant had established at the | 20 | | time of his or her termination of service under SERS.
| 21 | | (a-2) Beginning January 1, 1998, for each person who | 22 | | becomes a new SERS
survivor and participates in the basic | 23 | | program of group health benefits, the
State shall contribute | 24 | | toward the cost of the survivor's
coverage under the basic | 25 | | program of group health benefits an amount equal
to 5% of that | 26 | | cost for each full year of the deceased employee's or deceased
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| 1 | | annuitant's creditable service in the State Employees' | 2 | | Retirement System of
Illinois on the date of death, up to a | 3 | | maximum of 100% for a survivor of an
employee or annuitant with | 4 | | 20 or more years of creditable service. The
remainder of the | 5 | | cost of the new SERS survivor's coverage under the basic
| 6 | | program of group health benefits shall be the responsibility of | 7 | | the survivor. In the case of a new SERS survivor who was the | 8 | | dependent of an annuitant who elected to receive an alternative | 9 | | retirement cancellation payment under Section 14-108.5 of the | 10 | | Illinois Pension Code in lieu of an annuity, for the purposes | 11 | | of this subsection the deceased annuitant's creditable service | 12 | | shall be determined as of the date of termination of service | 13 | | rather than the date of death.
| 14 | | (a-3) Beginning January 1, 1998, for each person who | 15 | | becomes a new SURS
annuitant and participates in the basic | 16 | | program of group health benefits, the
State shall contribute | 17 | | toward the cost of the annuitant's
coverage under the basic | 18 | | program of group health benefits an amount equal
to 5% of that | 19 | | cost for each full year of creditable service upon which the
| 20 | | annuitant's retirement annuity is based, up to a maximum of | 21 | | 100% for an
annuitant with 20 or more years of creditable | 22 | | service.
The remainder of the cost of a new SURS annuitant's | 23 | | coverage under the basic
program of group health benefits shall | 24 | | be the responsibility of the
annuitant.
| 25 | | (a-4) (Blank).
| 26 | | (a-5) Beginning January 1, 1998, for each person who |
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| 1 | | becomes a new SURS
survivor and participates in the basic | 2 | | program of group health benefits, the
State shall contribute | 3 | | toward the cost of the survivor's coverage under the
basic | 4 | | program of group health benefits an amount equal to 5% of that | 5 | | cost for
each full year of the deceased employee's or deceased | 6 | | annuitant's creditable
service in the State Universities | 7 | | Retirement System on the date of death, up to
a maximum of 100% | 8 | | for a survivor of an
employee or annuitant with 20 or more | 9 | | years of creditable service. The
remainder of the cost of the | 10 | | new SURS survivor's coverage under the basic
program of group | 11 | | health benefits shall be the responsibility of the survivor.
| 12 | | (a-6) Beginning July 1, 1998, for each person who becomes a | 13 | | new TRS
State annuitant and participates in the basic program | 14 | | of group health benefits,
the State shall contribute toward the | 15 | | cost of the annuitant's coverage under
the basic program of | 16 | | group health benefits an amount equal to 5% of that cost
for | 17 | | each full year of creditable service
as a teacher as defined in | 18 | | paragraph (2), (3), or (5) of Section 16-106 of the
Illinois | 19 | | Pension Code
upon which the annuitant's retirement annuity is | 20 | | based, up to a maximum of
100%;
except that
the State | 21 | | contribution shall be 12.5% per year (rather than 5%) for each | 22 | | full
year of creditable service as a regional superintendent or | 23 | | assistant regional
superintendent of schools. The
remainder of | 24 | | the cost of a new TRS State annuitant's coverage under the | 25 | | basic
program of group health benefits shall be the | 26 | | responsibility of the
annuitant.
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| 1 | | (a-7) Beginning July 1, 1998, for each person who becomes a | 2 | | new TRS
State survivor and participates in the basic program of | 3 | | group health benefits,
the State shall contribute toward the | 4 | | cost of the survivor's coverage under the
basic program of | 5 | | group health benefits an amount equal to 5% of that cost for
| 6 | | each full year of the deceased employee's or deceased | 7 | | annuitant's creditable
service
as a teacher as defined in | 8 | | paragraph (2), (3), or (5) of Section 16-106 of the
Illinois | 9 | | Pension Code
on the date of death, up to a maximum of 100%;
| 10 | | except that the State contribution shall be 12.5% per year | 11 | | (rather than 5%) for
each full year of the deceased employee's | 12 | | or deceased annuitant's creditable
service as a regional | 13 | | superintendent or assistant regional superintendent of
| 14 | | schools.
The remainder of
the cost of the new TRS State | 15 | | survivor's coverage under the basic program of
group health | 16 | | benefits shall be the responsibility of the survivor.
| 17 | | (a-8) A new SERS annuitant, new SERS survivor, new SURS
| 18 | | annuitant, new SURS survivor, new TRS State
annuitant, or new | 19 | | TRS State survivor may waive or terminate coverage in
the | 20 | | program of group health benefits. Any such annuitant or | 21 | | survivor
who has waived or terminated coverage may enroll or | 22 | | re-enroll in the
program of group health benefits only during | 23 | | the annual benefit choice period,
as determined by the | 24 | | Director; except that in the event of termination of
coverage | 25 | | due to nonpayment of premiums, the annuitant or survivor
may | 26 | | not re-enroll in the program.
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| 1 | | (a-9) No later than May 1 of each calendar year, the | 2 | | Director
of Central Management Services shall certify in | 3 | | writing to the Executive
Secretary of the State Employees' | 4 | | Retirement System of Illinois the amounts
of the Medicare | 5 | | supplement health care premiums and the amounts of the
health | 6 | | care premiums for all other retirees who are not Medicare | 7 | | eligible.
| 8 | | A separate calculation of the premiums based upon the | 9 | | actual cost of each
health care plan shall be so certified.
| 10 | | The Director of Central Management Services shall provide | 11 | | to the
Executive Secretary of the State Employees' Retirement | 12 | | System of
Illinois such information, statistics, and other data | 13 | | as he or she
may require to review the premium amounts | 14 | | certified by the Director
of Central Management Services.
| 15 | | The Department of Healthcare and Family Services, or any | 16 | | successor agency designated to procure healthcare contracts | 17 | | pursuant to this Act, is authorized to establish funds, | 18 | | separate accounts provided by any bank or banks as defined by | 19 | | the Illinois Banking Act, or separate accounts provided by any | 20 | | savings and loan association or associations as defined by the | 21 | | Illinois Savings and Loan Act of 1985 to be held by the | 22 | | Director, outside the State treasury, for the purpose of | 23 | | receiving the transfer of moneys from the Local Government | 24 | | Health Insurance Reserve Fund. The Department may promulgate | 25 | | rules further defining the methodology for the transfers. Any | 26 | | interest earned by moneys in the funds or accounts shall inure |
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| 1 | | to the Local Government Health Insurance Reserve Fund. The | 2 | | transferred moneys, and interest accrued thereon, shall be used | 3 | | exclusively for transfers to administrative service | 4 | | organizations or their financial institutions for payments of | 5 | | claims to claimants and providers under the self-insurance | 6 | | health plan. The transferred moneys, and interest accrued | 7 | | thereon, shall not be used for any other purpose including, but | 8 | | not limited to, reimbursement of administration fees due the | 9 | | administrative service organization pursuant to its contract | 10 | | or contracts with the Department.
| 11 | | (b) State employees who become eligible for this program on | 12 | | or after January
1, 1980 in positions normally requiring actual | 13 | | performance of duty not less
than 1/2 of a normal work period | 14 | | but not equal to that of a normal work period,
shall be given | 15 | | the option of participating in the available program. If the
| 16 | | employee elects coverage, the State shall contribute on behalf | 17 | | of such employee
to the cost of the employee's benefit and any | 18 | | applicable dependent supplement,
that sum which bears the same | 19 | | percentage as that percentage of time the
employee regularly | 20 | | works when compared to normal work period.
| 21 | | (c) The basic non-contributory coverage from the basic | 22 | | program of
group health benefits shall be continued for each | 23 | | employee not in pay status or
on active service by reason of | 24 | | (1) leave of absence due to illness or injury,
(2) authorized | 25 | | educational leave of absence or sabbatical leave, or (3)
| 26 | | military leave with pay and benefits . This coverage shall |
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| 1 | | continue until
expiration of authorized leave and return to | 2 | | active service, but not to exceed
24 months for leaves under | 3 | | item (1) or (2). This 24-month limitation and the
requirement | 4 | | of returning to active service shall not apply to persons | 5 | | receiving
ordinary or accidental disability benefits or | 6 | | retirement benefits through the
appropriate State retirement | 7 | | system or benefits under the Workers' Compensation
or | 8 | | Occupational Disease Act.
| 9 | | (d) The basic group life insurance coverage shall continue, | 10 | | with
full State contribution, where such person is (1) absent | 11 | | from active
service by reason of disability arising from any | 12 | | cause other than
self-inflicted, (2) on authorized educational | 13 | | leave of absence or
sabbatical leave, or (3) on military leave | 14 | | with pay and benefits .
| 15 | | (e) Where the person is in non-pay status for a period in | 16 | | excess of
30 days or on leave of absence, other than by reason | 17 | | of disability,
educational or sabbatical leave, or military | 18 | | leave with pay and benefits , such
person may continue coverage | 19 | | only by making personal
payment equal to the amount normally | 20 | | contributed by the State on such person's
behalf. Such payments | 21 | | and coverage may be continued: (1) until such time as
the | 22 | | person returns to a status eligible for coverage at State | 23 | | expense, but not
to exceed 24 months or , (2) until such | 24 | | person's employment or annuitant status
with the State is | 25 | | terminated , or (3) for a maximum period of 4 years for
members | 26 | | on military leave with pay and benefits and military leave |
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| 1 | | without pay
and benefits (exclusive of any additional service | 2 | | imposed pursuant to law).
| 3 | | (f) The Department shall establish by rule the extent to | 4 | | which other
employee benefits will continue for persons in | 5 | | non-pay status or who are
not in active service.
| 6 | | (g) The State shall not pay the cost of the basic | 7 | | non-contributory
group life insurance, program of health | 8 | | benefits and other employee benefits
for members who are | 9 | | survivors as defined by paragraphs (1) and (2) of
subsection | 10 | | (q) of Section 3 of this Act. The costs of benefits for these
| 11 | | survivors shall be paid by the survivors or by the University | 12 | | of Illinois
Cooperative Extension Service, or any combination | 13 | | thereof.
However, the State shall pay the amount of the | 14 | | reduction in the cost of
participation, if any, resulting from | 15 | | the amendment to subsection (a) made
by this amendatory Act of | 16 | | the 91st General Assembly.
| 17 | | (h) Those persons occupying positions with any department | 18 | | as a result
of emergency appointments pursuant to Section 8b.8 | 19 | | of the Personnel Code
who are not considered employees under | 20 | | this Act shall be given the option
of participating in the | 21 | | programs of group life insurance, health benefits and
other | 22 | | employee benefits. Such persons electing coverage may | 23 | | participate only
by making payment equal to the amount normally | 24 | | contributed by the State for
similarly situated employees. Such | 25 | | amounts shall be determined by the
Director. Such payments and | 26 | | coverage may be continued until such time as the
person becomes |
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| 1 | | an employee pursuant to this Act or such person's appointment | 2 | | is
terminated.
| 3 | | (i) Any unit of local government within the State of | 4 | | Illinois
may apply to the Director to have its employees, | 5 | | annuitants, and their
dependents provided group health | 6 | | coverage under this Act on a non-insured
basis. To participate, | 7 | | a unit of local government must agree to enroll
all of its | 8 | | employees, who may select coverage under either the State group
| 9 | | health benefits plan or a health maintenance organization that | 10 | | has
contracted with the State to be available as a health care | 11 | | provider for
employees as defined in this Act. A unit of local | 12 | | government must remit the
entire cost of providing coverage | 13 | | under the State group health benefits plan
or, for coverage | 14 | | under a health maintenance organization, an amount determined
| 15 | | by the Director based on an analysis of the sex, age, | 16 | | geographic location, or
other relevant demographic variables | 17 | | for its employees, except that the unit of
local government | 18 | | shall not be required to enroll those of its employees who are
| 19 | | covered spouses or dependents under this plan or another group | 20 | | policy or plan
providing health benefits as long as (1) an | 21 | | appropriate official from the unit
of local government attests | 22 | | that each employee not enrolled is a covered spouse
or | 23 | | dependent under this plan or another group policy or plan, and | 24 | | (2) at least
50% of the employees are enrolled and the unit of | 25 | | local government remits
the entire cost of providing coverage | 26 | | to those employees, except that a
participating school district |
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| 1 | | must have enrolled at least 50% of its full-time
employees who | 2 | | have not waived coverage under the district's group health
plan | 3 | | by participating in a component of the district's cafeteria | 4 | | plan. A
participating school district is not required to enroll | 5 | | a full-time employee
who has waived coverage under the | 6 | | district's health plan, provided that an
appropriate official | 7 | | from the participating school district attests that the
| 8 | | full-time employee has waived coverage by participating in a | 9 | | component of the
district's cafeteria plan. For the purposes of | 10 | | this subsection, "participating
school district" includes a | 11 | | unit of local government whose primary purpose is
education as | 12 | | defined by the Department's rules.
| 13 | | Employees of a participating unit of local government who | 14 | | are not enrolled
due to coverage under another group health | 15 | | policy or plan may enroll in
the event of a qualifying change | 16 | | in status, special enrollment, special
circumstance as defined | 17 | | by the Director, or during the annual Benefit Choice
Period. A | 18 | | participating unit of local government may also elect to cover | 19 | | its
annuitants. Dependent coverage shall be offered on an | 20 | | optional basis, with the
costs paid by the unit of local | 21 | | government, its employees, or some combination
of the two as | 22 | | determined by the unit of local government. The unit of local
| 23 | | government shall be responsible for timely collection and | 24 | | transmission of
dependent premiums.
| 25 | | The Director shall annually determine monthly rates of | 26 | | payment, subject
to the following constraints:
|
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| 1 | | (1) In the first year of coverage, the rates shall be | 2 | | equal to the
amount normally charged to State employees for | 3 | | elected optional coverages
or for enrolled dependents | 4 | | coverages or other contributory coverages, or
contributed | 5 | | by the State for basic insurance coverages on behalf of its
| 6 | | employees, adjusted for differences between State | 7 | | employees and employees
of the local government in age, | 8 | | sex, geographic location or other relevant
demographic | 9 | | variables, plus an amount sufficient to pay for the | 10 | | additional
administrative costs of providing coverage to | 11 | | employees of the unit of
local government and their | 12 | | dependents.
| 13 | | (2) In subsequent years, a further adjustment shall be | 14 | | made to reflect
the actual prior years' claims experience | 15 | | of the employees of the unit of
local government.
| 16 | | In the case of coverage of local government employees under | 17 | | a health
maintenance organization, the Director shall annually | 18 | | determine for each
participating unit of local government the | 19 | | maximum monthly amount the unit
may contribute toward that | 20 | | coverage, based on an analysis of (i) the age,
sex, geographic | 21 | | location, and other relevant demographic variables of the
| 22 | | unit's employees and (ii) the cost to cover those employees | 23 | | under the State
group health benefits plan. The Director may | 24 | | similarly determine the
maximum monthly amount each unit of | 25 | | local government may contribute toward
coverage of its | 26 | | employees' dependents under a health maintenance organization.
|
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| 1 | | Monthly payments by the unit of local government or its | 2 | | employees for
group health benefits plan or health maintenance | 3 | | organization coverage shall
be deposited in the Local | 4 | | Government Health Insurance Reserve Fund.
| 5 | | The Local Government Health Insurance Reserve Fund is | 6 | | hereby created as a nonappropriated trust fund to be held | 7 | | outside the State Treasury, with the State Treasurer as | 8 | | custodian. The Local Government Health Insurance Reserve Fund | 9 | | shall be a continuing
fund not subject to fiscal year | 10 | | limitations. The Local Government Health Insurance Reserve | 11 | | Fund is not subject to administrative charges or charge-backs, | 12 | | including but not limited to those authorized under Section 8h | 13 | | of the State Finance Act. All revenues arising from the | 14 | | administration of the health benefits program established | 15 | | under this Section shall be deposited into the Local Government | 16 | | Health Insurance Reserve Fund. Any interest earned on moneys in | 17 | | the Local Government Health Insurance Reserve Fund shall be | 18 | | deposited into the Fund. All expenditures from this Fund
shall | 19 | | be used for payments for health care benefits for local | 20 | | government and rehabilitation facility
employees, annuitants, | 21 | | and dependents, and to reimburse the Department or
its | 22 | | administrative service organization for all expenses incurred | 23 | | in the
administration of benefits. No other State funds may be | 24 | | used for these
purposes.
| 25 | | A local government employer's participation or desire to | 26 | | participate
in a program created under this subsection shall |
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| 1 | | not limit that employer's
duty to bargain with the | 2 | | representative of any collective bargaining unit
of its | 3 | | employees.
| 4 | | (j) Any rehabilitation facility within the State of | 5 | | Illinois may apply
to the Director to have its employees, | 6 | | annuitants, and their eligible
dependents provided group | 7 | | health coverage under this Act on a non-insured
basis. To | 8 | | participate, a rehabilitation facility must agree to enroll all
| 9 | | of its employees and remit the entire cost of providing such | 10 | | coverage for
its employees, except that the rehabilitation | 11 | | facility shall not be
required to enroll those of its employees | 12 | | who are covered spouses or
dependents under this plan or | 13 | | another group policy or plan providing health
benefits as long | 14 | | as (1) an appropriate official from the rehabilitation
facility | 15 | | attests that each employee not enrolled is a covered spouse or
| 16 | | dependent under this plan or another group policy or plan, and | 17 | | (2) at least
50% of the employees are enrolled and the | 18 | | rehabilitation facility remits
the entire cost of providing | 19 | | coverage to those employees. Employees of a
participating | 20 | | rehabilitation facility who are not enrolled due to coverage
| 21 | | under another group health policy or plan may enroll
in the | 22 | | event of a qualifying change in status, special enrollment, | 23 | | special
circumstance as defined by the Director, or during the | 24 | | annual Benefit Choice
Period. A participating rehabilitation | 25 | | facility may also elect
to cover its annuitants. Dependent | 26 | | coverage shall be offered on an optional
basis, with the costs |
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| 1 | | paid by the rehabilitation facility, its employees, or
some | 2 | | combination of the 2 as determined by the rehabilitation | 3 | | facility. The
rehabilitation facility shall be responsible for | 4 | | timely collection and
transmission of dependent premiums.
| 5 | | The Director shall annually determine quarterly rates of | 6 | | payment, subject
to the following constraints:
| 7 | | (1) In the first year of coverage, the rates shall be | 8 | | equal to the amount
normally charged to State employees for | 9 | | elected optional coverages or for
enrolled dependents | 10 | | coverages or other contributory coverages on behalf of
its | 11 | | employees, adjusted for differences between State | 12 | | employees and
employees of the rehabilitation facility in | 13 | | age, sex, geographic location
or other relevant | 14 | | demographic variables, plus an amount sufficient to pay
for | 15 | | the additional administrative costs of providing coverage | 16 | | to employees
of the rehabilitation facility and their | 17 | | dependents.
| 18 | | (2) In subsequent years, a further adjustment shall be | 19 | | made to reflect
the actual prior years' claims experience | 20 | | of the employees of the
rehabilitation facility.
| 21 | | Monthly payments by the rehabilitation facility or its | 22 | | employees for
group health benefits shall be deposited in the | 23 | | Local Government Health
Insurance Reserve Fund.
| 24 | | (k) Any domestic violence shelter or service within the | 25 | | State of Illinois
may apply to the Director to have its | 26 | | employees, annuitants, and their
dependents provided group |
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| 1 | | health coverage under this Act on a non-insured
basis. To | 2 | | participate, a domestic violence shelter or service must agree | 3 | | to
enroll all of its employees and pay the entire cost of | 4 | | providing such coverage
for its employees. The domestic | 5 | | violence shelter shall not be required to enroll those of its | 6 | | employees who are covered spouses or dependents under this plan | 7 | | or another group policy or plan providing health benefits as | 8 | | long as (1) an appropriate official from the domestic violence | 9 | | shelter attests that each employee not enrolled is a covered | 10 | | spouse or dependent under this plan or another group policy or | 11 | | plan and (2) at least 50% of the employees are enrolled and the | 12 | | domestic violence shelter remits the entire cost of providing | 13 | | coverage to those employees. Employees of a participating | 14 | | domestic violence shelter who are not enrolled due to coverage | 15 | | under another group health policy or plan may enroll in the | 16 | | event of a qualifying change in status, special enrollment, or | 17 | | special circumstance as defined by the Director or during the | 18 | | annual Benefit Choice Period. A participating domestic | 19 | | violence shelter may also elect
to cover its annuitants. | 20 | | Dependent coverage shall be offered on an optional
basis, with
| 21 | | employees, or some combination of the 2 as determined by the | 22 | | domestic violence
shelter or service. The domestic violence | 23 | | shelter or service shall be
responsible for timely collection | 24 | | and transmission of dependent premiums.
| 25 | | The Director shall annually determine rates of payment,
| 26 | | subject to the following constraints:
|
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| 1 | | (1) In the first year of coverage, the rates shall be | 2 | | equal to the
amount normally charged to State employees for | 3 | | elected optional coverages
or for enrolled dependents | 4 | | coverages or other contributory coverages on
behalf of its | 5 | | employees, adjusted for differences between State | 6 | | employees and
employees of the domestic violence shelter or | 7 | | service in age, sex, geographic
location or other relevant | 8 | | demographic variables, plus an amount sufficient
to pay for | 9 | | the additional administrative costs of providing coverage | 10 | | to
employees of the domestic violence shelter or service | 11 | | and their dependents.
| 12 | | (2) In subsequent years, a further adjustment shall be | 13 | | made to reflect
the actual prior years' claims experience | 14 | | of the employees of the domestic
violence shelter or | 15 | | service.
| 16 | | Monthly payments by the domestic violence shelter or | 17 | | service or its employees
for group health insurance shall be | 18 | | deposited in the Local Government Health
Insurance Reserve | 19 | | Fund.
| 20 | | (l) A public community college or entity organized pursuant | 21 | | to the
Public Community College Act may apply to the Director | 22 | | initially to have
only annuitants not covered prior to July 1, | 23 | | 1992 by the district's health
plan provided health coverage | 24 | | under this Act on a non-insured basis. The
community college | 25 | | must execute a 2-year contract to participate in the
Local | 26 | | Government Health Plan.
Any annuitant may enroll in the event |
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| 1 | | of a qualifying change in status, special
enrollment, special | 2 | | circumstance as defined by the Director, or during the
annual | 3 | | Benefit Choice Period.
| 4 | | The Director shall annually determine monthly rates of | 5 | | payment subject to
the following constraints: for those | 6 | | community colleges with annuitants
only enrolled, first year | 7 | | rates shall be equal to the average cost to cover
claims for a | 8 | | State member adjusted for demographics, Medicare
| 9 | | participation, and other factors; and in the second year, a | 10 | | further adjustment
of rates shall be made to reflect the actual | 11 | | first year's claims experience
of the covered annuitants.
| 12 | | (l-5) The provisions of subsection (l) become inoperative | 13 | | on July 1, 1999.
| 14 | | (m) The Director shall adopt any rules deemed necessary for
| 15 | | implementation of this amendatory Act of 1989 (Public Act | 16 | | 86-978).
| 17 | | (n) Any child advocacy center within the State of Illinois | 18 | | may apply to the Director to have its employees, annuitants, | 19 | | and their dependents provided group health coverage under this | 20 | | Act on a non-insured basis. To participate, a child advocacy | 21 | | center must agree to enroll all of its employees and pay the | 22 | | entire cost of providing coverage for its employees. The child
| 23 | | advocacy center shall not be required to enroll those of its
| 24 | | employees who are covered spouses or dependents under this plan
| 25 | | or another group policy or plan providing health benefits as
| 26 | | long as (1) an appropriate official from the child advocacy
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| 1 | | center attests that each employee not enrolled is a covered
| 2 | | spouse or dependent under this plan or another group policy or
| 3 | | plan and (2) at least 50% of the employees are enrolled and the | 4 | | child advocacy center remits the entire cost of providing | 5 | | coverage to those employees. Employees of a participating child | 6 | | advocacy center who are not enrolled due to coverage under | 7 | | another group health policy or plan may enroll in the event of | 8 | | a qualifying change in status, special enrollment, or special | 9 | | circumstance as defined by the Director or during the annual | 10 | | Benefit Choice Period. A participating child advocacy center | 11 | | may also elect to cover its annuitants. Dependent coverage | 12 | | shall be offered on an optional basis, with the costs paid by | 13 | | the child advocacy center, its employees, or some combination | 14 | | of the 2 as determined by the child advocacy center. The child | 15 | | advocacy center shall be responsible for timely collection and | 16 | | transmission of dependent premiums. | 17 | | The Director shall annually determine rates of payment, | 18 | | subject to the following constraints: | 19 | | (1) In the first year of coverage, the rates shall be | 20 | | equal to the amount normally charged to State employees for | 21 | | elected optional coverages or for enrolled dependents | 22 | | coverages or other contributory coverages on behalf of its | 23 | | employees, adjusted for differences between State | 24 | | employees and employees of the child advocacy center in | 25 | | age, sex, geographic location, or other relevant | 26 | | demographic variables, plus an amount sufficient to pay for |
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| 1 | | the additional administrative costs of providing coverage | 2 | | to employees of the child advocacy center and their | 3 | | dependents. | 4 | | (2) In subsequent years, a further adjustment shall be | 5 | | made to reflect the actual prior years' claims experience | 6 | | of the employees of the child advocacy center. | 7 | | Monthly payments by the child advocacy center or its | 8 | | employees for group health insurance shall be deposited into | 9 | | the Local Government Health Insurance Reserve Fund. | 10 | | (Source: P.A. 95-331, eff. 8-21-07; 95-632, eff. 9-25-07; | 11 | | 95-707, eff. 1-11-08; 96-756, eff. 1-1-10; 96-1232, eff. | 12 | | 7-23-10.)
| 13 | | Section 99. Effective date. This Act takes effect upon | 14 | | becoming law.
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