(5 ILCS 375/6) (from Ch. 127, par. 526)
Sec. 6. Program of health benefits.
(a) The program of health benefits shall provide for protection
against the financial costs of health care expenses incurred in and out
of hospital including basic hospital-surgical-medical coverages. The program
may include, but shall not be limited to, such supplemental coverages as
out-patient diagnostic X-ray and laboratory expenses, prescription drugs,
dental services, hearing evaluations, hearing aids, the dispensing and
fitting
of hearing aids, and similar group benefits
as are now or may become available. The program may also include
coverage for those who rely on treatment by prayer or spiritual means
alone for healing in accordance with the tenets and practice of a
recognized religious denomination.
The program of health benefits shall be designed by the Director
(1) to provide a reasonable relationship between the benefits to be
included and the expected distribution of expenses of each such type to
be incurred by the covered members and dependents,
(2) to specify, as covered benefits and as optional benefits, the
medical services of practitioners in all categories licensed under the
Medical Practice Act of 1987, (3) to include
reasonable controls, which may include deductible and co-insurance
provisions, applicable to some or all of the benefits, or a coordination
of benefits provision, to prevent or minimize unnecessary utilization of
the various hospital, surgical and medical expenses to be provided and
to provide reasonable assurance of stability of the program, and (4) to
provide benefits to the extent possible to members throughout the
State, wherever located, on an equitable basis.
Notwithstanding any other provision of this Section or Act,
for all members or dependents who are eligible for benefits under Social
Security or the
Railroad Retirement system or who had sufficient Medicare-covered government
employment,
the
Department shall reduce benefits
which would otherwise be paid by Medicare, by the amount of benefits for
which the member or dependents are eligible
under Medicare, except that such reduction in benefits shall apply only to
those members or dependents who (1) first become
eligible for such medicare coverage on or after the effective date of this
amendatory Act of 1992; or (2) are Medicare-eligible members or dependents of
a local government unit which began participation in the program on or after
July 1, 1992; or (3) remain eligible for but no longer receive
Medicare coverage which they had been receiving on or after the effective date
of this amendatory Act of 1992.
Notwithstanding any other provisions of this Act, where a covered member or
dependents are eligible for benefits under the federal Medicare health
insurance program (Title XVIII of the Social Security Act as added by
Public Law 89-97, 89th Congress), benefits paid under the State of Illinois
program or plan will be reduced by the amount of benefits paid by Medicare.
For members or dependents
who are eligible for benefits under Social Security
or the Railroad Retirement system or who had sufficient Medicare-covered
government employment, benefits shall be reduced by the amount for which
the member or dependent is eligible under Medicare,
except that such reduction in benefits shall apply only to those
members or dependents who (1) first become eligible for such
Medicare coverage on or after the effective date of this amendatory Act
of 1992; or (2) are Medicare-eligible members or dependents of a local
government unit which began participation in the program on or after July 1,
1992; or (3) remain eligible for, but no longer receive Medicare
coverage which they had been receiving on or after the effective date of this
amendatory Act of 1992. Premiums may be adjusted, where applicable, to an
amount deemed by the Director to be reasonably consistent with any reduction
of benefits.
(b) A member, 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, shall pay the premiums for coverage, not
exceeding the amount paid by the State for the non-contributory coverage for
other members, under the group health benefits program under this Act. The
Director shall determine the premiums to be paid
by a member under this subsection (b).
(Source: P.A. 100-538, eff. 1-1-18.)
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