(5 ILCS 375/3) (from Ch. 127, par. 523)
Sec. 3. Definitions. Unless the context otherwise requires, the
following words and phrases as used in this Act shall have the following
meanings. The Department may define these and other words and phrases
separately for the purpose of implementing specific programs providing benefits
under this Act.
(a) "Administrative service organization" means any person, firm or
corporation experienced in the handling of claims which is
fully qualified, financially sound and capable of meeting the service
requirements of a contract of administration executed with the Department.
(b) "Annuitant" means (1) an employee who retires, or has retired,
on or after January 1, 1966 on an immediate annuity under the provisions
of Articles 2, 14 (including an employee who has elected to receive an alternative retirement cancellation payment under Section 14-108.5 of the Illinois Pension Code in lieu of an annuity or who meets the criteria for retirement, but in lieu of receiving an annuity under that Article has elected to receive an accelerated pension benefit payment under Section 14-147.5 of that Article), 15 (including an employee who has retired under the optional
retirement program established under Section 15-158.2 or who meets the criteria for retirement but in lieu of receiving an annuity under that Article has elected to receive an accelerated pension benefit payment under Section 15-185.5 of the Article), paragraph
(2), (3), or (5) of Section 16-106 (including an employee who meets the criteria for retirement, but in lieu of receiving an annuity under that Article has elected to receive an accelerated pension benefit payment under Section 16-190.5 of the Illinois Pension Code), or
Article 18 of the Illinois Pension Code; (2) any person who was receiving
group insurance coverage under this Act as of March 31, 1978 by
reason of his status as an annuitant, even though the annuity in relation
to which such coverage was provided is a proportional annuity based on less
than the minimum period of service required for a retirement annuity in
the system involved; (3) any person not otherwise covered by this Act
who has retired as a participating member under Article 2 of the Illinois
Pension Code but is ineligible for the retirement annuity under Section
2-119 of the Illinois Pension Code; (4) the spouse of any person who
is receiving a retirement annuity under Article 18 of the Illinois Pension
Code and who is covered under a group health insurance program sponsored
by a governmental employer other than the State of Illinois and who has
irrevocably elected to waive his or her coverage under this Act and to have
his or her spouse considered as the "annuitant" under this Act and not as
a "dependent"; or (5) an employee who retires, or has retired, from a
qualified position, as determined according to rules promulgated by the
Director, under a qualified local government, a qualified rehabilitation
facility, a qualified domestic violence shelter or service, or a qualified child advocacy center. (For definition
of "retired employee", see (p) post).
(b-5) (Blank).
(b-6) (Blank).
(b-7) (Blank).
(c) "Carrier" means (1) an insurance company, a corporation organized
under the Limited Health Service Organization Act or the Voluntary Health
Services Plans Act, a partnership, or other nongovernmental organization,
which is authorized to do group life or group health insurance business in
Illinois, or (2) the State of Illinois as a self-insurer.
(d) "Compensation" means salary or wages payable on a regular
payroll by the State Treasurer on a warrant of the State Comptroller out
of any State, trust or federal fund, or by the Governor of the State
through a disbursing officer of the State out of a trust or out of
federal funds, or by any Department out of State, trust, federal or
other funds held by the State Treasurer or the Department, to any person
for personal services currently performed, and ordinary or accidental
disability benefits under Articles 2, 14, 15 (including ordinary or accidental
disability benefits under the optional retirement program established under
Section 15-158.2), paragraph (2), (3), or (5) of
Section 16-106, or Article 18 of the Illinois Pension Code, for disability
incurred after January 1, 1966, or benefits payable under the Workers'
Compensation or Occupational Diseases Act or benefits payable under a sick
pay plan established in accordance with Section 36 of the State Finance Act.
"Compensation" also means salary or wages paid to an employee of any
qualified local government, qualified rehabilitation facility,
qualified domestic violence shelter or service, or qualified child advocacy center.
(e) "Commission" means the State Employees Group Insurance Advisory
Commission authorized by this Act. Commencing July 1, 1984, "Commission"
as used in this Act means the Commission on Government Forecasting and Accountability as
established by the Legislative Commission Reorganization Act of 1984.
(f) "Contributory", when referred to as contributory coverage, shall
mean optional coverages or benefits elected by the member toward the cost of
which such member makes contribution, or which are funded in whole or in part
through the acceptance of a reduction in earnings or the foregoing of an
increase in earnings by an employee, as distinguished from noncontributory
coverage or benefits which are paid entirely by the State of Illinois
without reduction of the member's salary.
(g) "Department" means any department, institution, board,
commission, officer, court or any agency of the State government
receiving appropriations and having power to certify payrolls to the
Comptroller authorizing payments of salary and wages against such
appropriations as are made by the General Assembly from any State fund, or
against trust funds held by the State Treasurer and includes boards of
trustees of the retirement systems created by Articles 2, 14, 15, 16, and
18 of the Illinois Pension Code. "Department" also includes the Illinois
Comprehensive Health Insurance Board, the Board of Examiners established under
the Illinois Public Accounting Act, and the Illinois Finance Authority.
(h) "Dependent", when the term is used in the context of the health
and life plan, means a member's spouse and any child (1) from
birth to age 26 including an adopted child, a child who lives with the
member from the time of the placement for adoption until entry
of an order of adoption, a stepchild or adjudicated child, or a child who lives with the member
if such member is a court appointed guardian of the child or (2)
age 19 or over who has a mental or physical disability from a cause originating prior to the age of 19 (age 26 if enrolled as an adult child dependent). For
the health plan only, the term "dependent" also includes (1) any person
enrolled prior to the effective date of this Section who is dependent upon
the member to the extent that the member may claim such person as a
dependent for income tax deduction purposes and (2) any person who
has received after June 30, 2000 an organ transplant and who is financially
dependent upon the member and eligible to be claimed as a dependent for income
tax purposes. A member requesting to cover any dependent must provide documentation as requested by the Department of Central Management Services and file with the Department any and all forms required by the Department.
(i) "Director" means the Director of the Illinois Department of Central
Management Services.
(j) "Eligibility period" means the period of time a member has to
elect enrollment in programs or to select benefits without regard to
age, sex or health.
(k) "Employee" means and includes each officer or employee in the
service of a department who (1) receives his compensation for
service rendered to the department on a warrant issued pursuant to a payroll
certified by a department or on a warrant or check issued and drawn by a
department upon a trust, federal or other fund or on a warrant issued
pursuant to a payroll certified by an elected or duly appointed officer
of the State or who receives payment of the performance of personal
services on a warrant issued pursuant to a payroll certified by a
Department and drawn by the Comptroller upon the State Treasurer against
appropriations made by the General Assembly from any fund or against
trust funds held by the State Treasurer, and (2) is employed full-time or
part-time in a position normally requiring actual performance of duty
during not less than 1/2 of a normal work period, as established by the
Director in cooperation with each department, except that persons elected
by popular vote will be considered employees during the entire
term for which they are elected regardless of hours devoted to the
service of the State, and (3) except that "employee" does not include any
person who is not eligible by reason of such person's employment to
participate in one of the State retirement systems under Articles 2, 14, 15
(either the regular Article 15 system or the optional retirement program
established under Section 15-158.2), or 18, or under paragraph (2), (3), or
(5) of Section 16-106, of the Illinois
Pension Code, but such term does include persons who are employed during
the 6-month qualifying period under Article 14 of the Illinois Pension
Code. Such term also includes any person who (1) after January 1, 1966,
is receiving ordinary or accidental disability benefits under Articles
2, 14, 15 (including ordinary or accidental disability benefits under the
optional retirement program established under Section 15-158.2), paragraph
(2), (3), or (5) of Section 16-106, or Article 18 of the
Illinois Pension Code, for disability incurred after January 1, 1966, (2)
receives total permanent or total temporary disability under the Workers'
Compensation Act or Occupational Disease Act as a result of injuries
sustained or illness contracted in the course of employment with the
State of Illinois, or (3) is not otherwise covered under this Act and has
retired as a participating member under Article 2 of the Illinois Pension
Code but is ineligible for the retirement annuity under Section 2-119 of
the Illinois Pension Code. However, a person who satisfies the criteria
of the foregoing definition of "employee" except that such person is made
ineligible to participate in the State Universities Retirement System by
clause (4) of subsection (a) of Section 15-107 of the Illinois Pension
Code is also an "employee" for the purposes of this Act. "Employee" also
includes any person receiving or eligible for benefits under a sick pay
plan established in accordance with Section 36 of the State Finance Act.
"Employee" also includes (i) each officer or employee in the service of a
qualified local government, including persons appointed as trustees of
sanitary districts regardless of hours devoted to the service of the
sanitary district, (ii) each employee in the service of a qualified
rehabilitation facility, (iii) each full-time employee in the service of a
qualified domestic violence shelter or service, and (iv) each full-time employee in the service of a qualified child advocacy center, as determined according to
rules promulgated by the Director.
(l) "Member" means an employee, annuitant, retired employee, or survivor. In the case of an annuitant or retired employee who first becomes an annuitant or retired employee on or after January 13, 2012 (the effective date of Public Act 97-668), the individual must meet the minimum vesting requirements of the applicable retirement system in order to be eligible for group insurance benefits under that system. In the case of a survivor who is not entitled to occupational death benefits pursuant to an applicable retirement system or death benefits pursuant to the Illinois Workers' Compensation Act, and who first becomes a survivor on or after January 13, 2012 (the effective date of Public Act 97-668), the deceased employee, annuitant, or retired employee upon whom the annuity is based must have been eligible to participate in the group insurance system under the applicable retirement system in order for the survivor to be eligible for group insurance benefits under that system. In the case of a survivor who is entitled to occupational death benefits pursuant to the deceased employee's applicable retirement system or death benefits pursuant to the Illinois Workers' Compensation Act, and first becomes a survivor on or after January 1, 2022, the survivor is eligible for group health insurance benefits regardless of the deceased employee's minimum vesting requirements under the applicable retirement system, with a State contribution rate of 100%, until an unmarried child dependent reaches the age of 18, or the age of 22 if the dependent child is a full-time student, or until the adult survivor becomes eligible for benefits under the federal Medicare health insurance program (Title XVIII of the Social Security Act, as added by Public Law 89-97). In the case of a survivor currently receiving occupational death benefits pursuant to the deceased employee's applicable retirement system or has received death benefits pursuant to the Illinois Workers' Compensation Act, who first became a survivor prior to January 1, 2022, the survivor is eligible for group health insurance benefits regardless of the deceased employee's minimum vesting requirements under the applicable retirement system, with a State contribution rate of 100%, until an unmarried child dependent reaches the age of 18, or the age of 22 if the dependent child is a full-time student, or until the adult survivor becomes eligible for benefits under the federal Medicare health insurance program (Title XVIII of the Social Security Act, as added by Public Law 89-97). The changes made by this amendatory Act of the 102nd General Assembly with respect to survivors who first became survivors prior to January 1, 2022 shall apply upon request of the survivor on or after the effective date of this amendatory Act of the 102nd General Assembly.
(m) "Optional coverages or benefits" means those coverages or
benefits available to the member on his or her voluntary election, and at
his or her own expense.
(n) "Program" means the group life insurance, health benefits and other
employee benefits designed and contracted for by the Director under this Act.
(o) "Health plan" means a health benefits
program offered
by the State of Illinois for persons eligible for the plan.
(p) "Retired employee" means any person who would be an annuitant as
that term is defined herein but for the fact that such person retired prior to
January 1, 1966. Such term also includes any person formerly employed by
the University of Illinois in the Cooperative Extension Service who would
be an annuitant but for the fact that such person was made ineligible to
participate in the State Universities Retirement System by clause (4) of
subsection (a) of Section 15-107 of the Illinois
Pension Code.
(q) "Survivor" means a person receiving an annuity as a survivor of an
employee or of an annuitant. "Survivor" also includes: (1) the surviving
dependent of a person who satisfies the definition of "employee" except that
such person is made ineligible to participate in the State Universities
Retirement System by clause (4) of subsection (a)
of Section 15-107 of the Illinois Pension Code; (2) the surviving
dependent of any person formerly employed by the University of Illinois in
the Cooperative Extension Service who would be an annuitant except for the
fact that such person was made ineligible to participate in the State
Universities Retirement System by clause (4) of subsection (a) of Section
15-107 of the Illinois Pension Code; (3) the surviving dependent of a person who was an annuitant under this Act by virtue of receiving an alternative retirement cancellation payment under Section 14-108.5 of the Illinois Pension Code; and (4) a person who would be receiving an annuity as a survivor of an annuitant except that the annuitant elected on or after June 4, 2018 to receive an accelerated pension benefit payment under Section 14-147.5, 15-185.5, or 16-190.5 of the Illinois Pension Code in lieu of receiving an annuity.
(q-2) "SERS" means the State Employees' Retirement System of Illinois, created under Article 14 of the Illinois Pension Code.
(q-3) "SURS" means the State Universities Retirement System, created under Article 15 of the Illinois Pension Code.
(q-4) "TRS" means the Teachers' Retirement System of the State of Illinois, created under Article 16 of the Illinois Pension Code.
(q-5) (Blank).
(q-6) (Blank).
(q-7) (Blank).
(r) "Medical services" means the services provided within the scope
of their licenses by practitioners in all categories licensed under the
Medical Practice Act of 1987.
(s) "Unit of local government" means any county, municipality,
township, school district (including a combination of school districts under
the Intergovernmental Cooperation Act), special district or other unit,
designated as a
unit of local government by law, which exercises limited governmental
powers or powers in respect to limited governmental subjects, any
not-for-profit association with a membership that primarily includes
townships and township officials, that has duties that include provision of
research service, dissemination of information, and other acts for the
purpose of improving township government, and that is funded wholly or
partly in accordance with Section 85-15 of the Township Code; any
not-for-profit corporation or association, with a membership consisting
primarily of municipalities, that operates its own utility system, and
provides research, training, dissemination of information, or other acts to
promote cooperation between and among municipalities that provide utility
services and for the advancement of the goals and purposes of its
membership;
the Southern Illinois Collegiate Common Market, which is a consortium of higher
education institutions in Southern Illinois; the Illinois Association of
Park Districts; and any hospital provider that is owned by a county that has 100 or fewer hospital beds and has not already joined the program. "Qualified
local government" means a unit of local government approved by the Director and
participating in a program created under subsection (i) of Section 10 of this
Act.
(t) "Qualified rehabilitation facility" means any not-for-profit
organization that is accredited by the Commission on Accreditation of
Rehabilitation Facilities or certified by the Department
of Human Services (as successor to the Department of Mental Health
and Developmental Disabilities) to provide services to persons with
disabilities
and which receives funds from the State of Illinois for providing those
services, approved by the Director and participating in a program created
under subsection (j) of Section 10 of this Act.
(u) "Qualified domestic violence shelter or service" means any Illinois
domestic violence shelter or service and its administrative offices funded
by the Department of Human Services (as successor to the Illinois Department of
Public Aid),
approved by the Director and
participating in a program created under subsection (k) of Section 10.
(v) "TRS benefit recipient" means a person who:
(1) is not a "member" as defined in this Section; and
(2) is receiving a monthly benefit or retirement |