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90_HB2484
5 ILCS 375/3 from Ch. 127, par. 523
5 ILCS 375/6.12 new
Amends the State Employees Group Insurance Act of 1971.
Provides that members of the State employee health plan may
elect to not participate in the plan. Provides that persons
who have previously opted out of the health plan may enroll
in the plan at any time. Effective July 1, 1998.
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1 AN ACT to amend the State Employees Group Insurance Act
2 of 1971 by changing Section 3 and adding Section 6.12.
3 Be it enacted by the People of the State of Illinois,
4 represented in the General Assembly:
5 Section 5. The State Employees Group Insurance Act of
6 1971 is amended by changing Section 3 and adding Section 6.12
7 as follows:
8 (5 ILCS 375/3) (from Ch. 127, par. 523)
9 Sec. 3. Definitions. Unless the context otherwise
10 requires, the following words and phrases as used in this Act
11 shall have the following meanings. The Department may define
12 these and other words and phrases separately for the purpose
13 of implementing specific programs providing benefits under
14 this Act.
15 (a) "Administrative service organization" means any
16 person, firm or corporation experienced in the handling of
17 claims which is fully qualified, financially sound and
18 capable of meeting the service requirements of a contract of
19 administration executed with the Department.
20 (b) "Annuitant" means (1) an employee who retires, or
21 has retired, on or after January 1, 1966 on an immediate
22 annuity under the provisions of Articles 2, 14, 15 (including
23 an employee who has retired under the optional retirement
24 program established under Section 15-158.2), paragraphs (b)
25 or (c) of Section 16-106, or Article 18 of the Illinois
26 Pension Code; (2) any person who was receiving group
27 insurance coverage under this Act as of March 31, 1978 by
28 reason of his status as an annuitant, even though the annuity
29 in relation to which such coverage was provided is a
30 proportional annuity based on less than the minimum period of
31 service required for a retirement annuity in the system
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1 involved; (3) any person not otherwise covered by this Act
2 who has retired as a participating member under Article 2 of
3 the Illinois Pension Code but is ineligible for the
4 retirement annuity under Section 2-119 of the Illinois
5 Pension Code; (4) the spouse of any person who is receiving a
6 retirement annuity under Article 18 of the Illinois Pension
7 Code and who is covered under a group health insurance
8 program sponsored by a governmental employer other than the
9 State of Illinois and who has irrevocably elected to waive
10 his or her coverage under this Act and to have his or her
11 spouse considered as the "annuitant" under this Act and not
12 as a "dependent"; or (5) an employee who retires, or has
13 retired, from a qualified position, as determined according
14 to rules promulgated by the Director, under a qualified local
15 government or a qualified rehabilitation facility or a
16 qualified domestic violence shelter or service. (For
17 definition of "retired employee", see (p) post).
18 (b-5) "New SERS annuitant" means a person who, on or
19 after January 1, 1998, becomes an annuitant, as defined in
20 subsection (b), by virtue of beginning to receive a
21 retirement annuity under Article 14 of the Illinois Pension
22 Code, and is eligible to participate in the basic program of
23 group health benefits provided for annuitants under this Act.
24 (b-6) "New SURS annuitant" means a person who, on or
25 after January 1, 1998, becomes an annuitant, as defined in
26 subsection (b), by virtue of beginning to receive a
27 retirement annuity under Article 15 of the Illinois Pension
28 Code, and is eligible to participate in the basic program of
29 group health benefits provided for annuitants under this Act.
30 (c) "Carrier" means (1) an insurance company, a
31 corporation organized under the Limited Health Service
32 Organization Act or the Voluntary Health Services Plan Act, a
33 partnership, or other nongovernmental organization, which is
34 authorized to do group life or group health insurance
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1 business in Illinois, or (2) the State of Illinois as a
2 self-insurer.
3 (d) "Compensation" means salary or wages payable on a
4 regular payroll by the State Treasurer on a warrant of the
5 State Comptroller out of any State, trust or federal fund, or
6 by the Governor of the State through a disbursing officer of
7 the State out of a trust or out of federal funds, or by any
8 Department out of State, trust, federal or other funds held
9 by the State Treasurer or the Department, to any person for
10 personal services currently performed, and ordinary or
11 accidental disability benefits under Articles 2, 14, 15
12 (including ordinary or accidental disability benefits under
13 the optional retirement program established under Section
14 15-158.2), paragraphs (b) or (c) of Section 16-106, or
15 Article 18 of the Illinois Pension Code, for disability
16 incurred after January 1, 1966, or benefits payable under the
17 Workers' Compensation or Occupational Diseases Act or
18 benefits payable under a sick pay plan established in
19 accordance with Section 36 of the State Finance Act.
20 "Compensation" also means salary or wages paid to an employee
21 of any qualified local government or qualified rehabilitation
22 facility or a qualified domestic violence shelter or service.
23 (e) "Commission" means the State Employees Group
24 Insurance Advisory Commission authorized by this Act.
25 Commencing July 1, 1984, "Commission" as used in this Act
26 means the Illinois Economic and Fiscal Commission as
27 established by the Legislative Commission Reorganization Act
28 of 1984.
29 (f) "Contributory", when referred to as contributory
30 coverage, shall mean optional coverages or benefits elected
31 by the member toward the cost of which such member makes
32 contribution, or which are funded in whole or in part through
33 the acceptance of a reduction in earnings or the foregoing of
34 an increase in earnings by an employee, as distinguished from
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1 noncontributory coverage or benefits which are paid entirely
2 by the State of Illinois without reduction of the member's
3 salary.
4 (g) "Department" means any department, institution,
5 board, commission, officer, court or any agency of the State
6 government receiving appropriations and having power to
7 certify payrolls to the Comptroller authorizing payments of
8 salary and wages against such appropriations as are made by
9 the General Assembly from any State fund, or against trust
10 funds held by the State Treasurer and includes boards of
11 trustees of the retirement systems created by Articles 2, 14,
12 15, 16 and 18 of the Illinois Pension Code. "Department"
13 also includes the Illinois Comprehensive Health Insurance
14 Board, the Board of Examiners established under the Illinois
15 Public Accounting Act, and the Illinois Rural Bond Bank.
16 (h) "Dependent", when the term is used in the context of
17 the health and life plan, means a member's spouse and any
18 unmarried child (1) from birth to age 19 including an adopted
19 child, a child who lives with the member from the time of the
20 filing of a petition for adoption until entry of an order of
21 adoption, a stepchild or recognized child who lives with the
22 member in a parent-child relationship, or a child who lives
23 with the member if such member is a court appointed guardian
24 of the child, or (2) age 19 to 23 enrolled as a full-time
25 student in any accredited school, financially dependent upon
26 the member, and eligible as a dependent for Illinois State
27 income tax purposes, or (3) age 19 or over who is mentally or
28 physically handicapped as defined in the Illinois Insurance
29 Code. For the health plan only, the term "dependent" also
30 includes any person enrolled prior to the effective date of
31 this Section who is dependent upon the member to the extent
32 that the member may claim such person as a dependent for
33 Illinois State income tax deduction purposes; no other such
34 person may be enrolled.
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1 (i) "Director" means the Director of the Illinois
2 Department of Central Management Services.
3 (j) "Eligibility period" means the period of time a
4 member has to elect enrollment in programs or to select
5 benefits without regard to age, sex or health.
6 (k) "Employee" means and includes each officer or
7 employee in the service of a department who (1) receives his
8 compensation for service rendered to the department on a
9 warrant issued pursuant to a payroll certified by a
10 department or on a warrant or check issued and drawn by a
11 department upon a trust, federal or other fund or on a
12 warrant issued pursuant to a payroll certified by an elected
13 or duly appointed officer of the State or who receives
14 payment of the performance of personal services on a warrant
15 issued pursuant to a payroll certified by a Department and
16 drawn by the Comptroller upon the State Treasurer against
17 appropriations made by the General Assembly from any fund or
18 against trust funds held by the State Treasurer, and (2) is
19 employed full-time or part-time in a position normally
20 requiring actual performance of duty during not less than 1/2
21 of a normal work period, as established by the Director in
22 cooperation with each department, except that persons elected
23 by popular vote will be considered employees during the
24 entire term for which they are elected regardless of hours
25 devoted to the service of the State, and (3) except that
26 "employee" does not include any person who is not eligible by
27 reason of such person's employment to participate in one of
28 the State retirement systems under Articles 2, 14, 15 (either
29 the regular Article 15 system or the optional retirement
30 program established under Section 15-158.2) or 18, or under
31 paragraph (b) or (c) of Section 16-106, of the Illinois
32 Pension Code, but such term does include persons who are
33 employed during the 6 month qualifying period under Article
34 14 of the Illinois Pension Code. Such term also includes any
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1 person who (1) after January 1, 1966, is receiving ordinary
2 or accidental disability benefits under Articles 2, 14, 15
3 (including ordinary or accidental disability benefits under
4 the optional retirement program established under Section
5 15-158.2), paragraphs (b) or (c) of Section 16-106, or
6 Article 18 of the Illinois Pension Code, for disability
7 incurred after January 1, 1966, (2) receives total permanent
8 or total temporary disability under the Workers' Compensation
9 Act or Occupational Disease Act as a result of injuries
10 sustained or illness contracted in the course of employment
11 with the State of Illinois, or (3) is not otherwise covered
12 under this Act and has retired as a participating member
13 under Article 2 of the Illinois Pension Code but is
14 ineligible for the retirement annuity under Section 2-119 of
15 the Illinois Pension Code. However, a person who satisfies
16 the criteria of the foregoing definition of "employee" except
17 that such person is made ineligible to participate in the
18 State Universities Retirement System by clause (4) of
19 subsection (a) of Section 15-107 of the Illinois Pension Code
20 is also an "employee" for the purposes of this Act.
21 "Employee" also includes any person receiving or eligible for
22 benefits under a sick pay plan established in accordance with
23 Section 36 of the State Finance Act. "Employee" also includes
24 each officer or employee in the service of a qualified local
25 government, including persons appointed as trustees of
26 sanitary districts regardless of hours devoted to the service
27 of the sanitary district, and each employee in the service of
28 a qualified rehabilitation facility and each full-time
29 employee in the service of a qualified domestic violence
30 shelter or service, as determined according to rules
31 promulgated by the Director.
32 (l) "Member" means an employee, annuitant, retired
33 employee, or survivor. "Member", when used in the context of
34 the health plan, does not include a member who has opted out
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1 of the health plan.
2 (m) "Optional coverages or benefits" means those
3 coverages or benefits available to the member on his or her
4 voluntary election, and at his or her own expense.
5 (n) "Program" means the group life insurance, health
6 benefits and other employee benefits designed and contracted
7 for by the Director under this Act.
8 (o) "Health plan" means a self-insured health insurance
9 program offered by the State of Illinois for the purposes of
10 benefiting employees by means of providing, among others,
11 wellness programs, utilization reviews, second opinions and
12 medical fee reviews, as well as for paying for hospital and
13 medical care up to the maximum coverage provided by the plan,
14 to its members and their dependents.
15 (p) "Retired employee" means any person who would be an
16 annuitant as that term is defined herein but for the fact
17 that such person retired prior to January 1, 1966. Such term
18 also includes any person formerly employed by the University
19 of Illinois in the Cooperative Extension Service who would be
20 an annuitant but for the fact that such person was made
21 ineligible to participate in the State Universities
22 Retirement System by clause (4) of subsection (a) of Section
23 15-107 of the Illinois Pension Code.
24 (p-6) "New SURS retired employee" means a person who, on
25 or after January 1, 1998, becomes a retired employee, as
26 defined in subsection (p), by virtue of being a person
27 formerly employed by the University of Illinois in the
28 Cooperative Extension Service who would be an annuitant but
29 for the fact that he or she was made ineligible to
30 participate in the State Universities Retirement System by
31 clause (4) of subsection (a) of Section 15-107 of the
32 Illinois Pension Code, and who is eligible to participate in
33 the basic program of group health benefits provided for
34 retired employees under this Act.
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1 (q) "Survivor" means a person receiving an annuity as a
2 survivor of an employee or of an annuitant. "Survivor" also
3 includes: (1) the surviving dependent of a person who
4 satisfies the definition of "employee" except that such
5 person is made ineligible to participate in the State
6 Universities Retirement System by clause (4) of subsection
7 (a) of Section 15-107 of the Illinois Pension Code; and (2)
8 the surviving dependent of any person formerly employed by
9 the University of Illinois in the Cooperative Extension
10 Service who would be an annuitant except for the fact that
11 such person was made ineligible to participate in the State
12 Universities Retirement System by clause (4) of subsection
13 (a) of Section 15-107 of the Illinois Pension Code.
14 (q-5) "New SERS survivor" means a survivor, as defined
15 in subsection (q), whose annuity is paid under Article 14 of
16 the Illinois Pension Code and is based on the death of (i) an
17 employee whose death occurs on or after January 1, 1998, or
18 (ii) a new SERS annuitant as defined in subsection (b-5).
19 (q-6) "New SURS survivor" means a survivor, as defined
20 in subsection (q), whose annuity is paid under Article 15 of
21 the Illinois Pension Code and is based on the death of (i) an
22 employee whose death occurs on or after January 1, 1998, (ii)
23 a new SURS annuitant as defined in subsection (b-6), or (iii)
24 a new SURS retired employee as defined in subsection (p-6).
25 (r) "Medical services" means the services provided
26 within the scope of their licenses by practitioners in all
27 categories licensed under the Medical Practice Act of 1987.
28 (s) "Unit of local government" means any county,
29 municipality, township, school district, special district or
30 other unit, designated as a unit of local government by law,
31 which exercises limited governmental powers or powers in
32 respect to limited governmental subjects, any not-for-profit
33 association with a membership that primarily includes
34 townships and township officials, that has duties that
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1 include provision of research service, dissemination of
2 information, and other acts for the purpose of improving
3 township government, and that is funded wholly or partly in
4 accordance with Section 85-15 of the Township Code; any
5 not-for-profit corporation or association, with a membership
6 consisting primarily of municipalities, that operates its own
7 utility system, and provides research, training,
8 dissemination of information, or other acts to promote
9 cooperation between and among municipalities that provide
10 utility services and for the advancement of the goals and
11 purposes of its membership; and the Illinois Association of
12 Park Districts. "Qualified local government" means a unit of
13 local government approved by the Director and participating
14 in a program created under subsection (i) of Section 10 of
15 this Act.
16 (t) "Qualified rehabilitation facility" means any
17 not-for-profit organization that is accredited by the
18 Commission on Accreditation of Rehabilitation Facilities or
19 certified by the Department of Human Services (as successor
20 to the Department of Mental Health and Developmental
21 Disabilities) to provide services to persons with
22 disabilities and which receives funds from the State of
23 Illinois for providing those services, approved by the
24 Director and participating in a program created under
25 subsection (j) of Section 10 of this Act.
26 (u) "Qualified domestic violence shelter or service"
27 means any Illinois domestic violence shelter or service and
28 its administrative offices funded by the Department of Human
29 Services (as successor to the Illinois Department of Public
30 Aid), approved by the Director and participating in a program
31 created under subsection (k) of Section 10.
32 (v) "TRS benefit recipient" means a person who:
33 (1) is not a "member" as defined in this Section;
34 and
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1 (2) is receiving a monthly benefit or retirement
2 annuity under Article 16 of the Illinois Pension Code;
3 and
4 (3) either (i) has at least 8 years of creditable
5 service under Article 16 of the Illinois Pension Code, or
6 (ii) was enrolled in the health insurance program offered
7 under that Article on January 1, 1996, or (iii) is the
8 survivor of a benefit recipient who had at least 8 years
9 of creditable service under Article 16 of the Illinois
10 Pension Code or was enrolled in the health insurance
11 program offered under that Article on the effective date
12 of this amendatory Act of 1995, or (iv) is a recipient or
13 survivor of a recipient of a disability benefit under
14 Article 16 of the Illinois Pension Code.
15 (w) "TRS dependent beneficiary" means a person who:
16 (1) is not a "member" or "dependent" as defined in
17 this Section; and
18 (2) is a TRS benefit recipient's: (A) spouse, (B)
19 dependent parent who is receiving at least half of his or
20 her support from the TRS benefit recipient, or (C)
21 unmarried natural or adopted child who is (i) under age
22 19, or (ii) enrolled as a full-time student in an
23 accredited school, financially dependent upon the TRS
24 benefit recipient, eligible as a dependent for Illinois
25 State income tax purposes, and either is under age 24 or
26 was, on January 1, 1996, participating as a dependent
27 beneficiary in the health insurance program offered under
28 Article 16 of the Illinois Pension Code, or (iii) age 19
29 or over who is mentally or physically handicapped as
30 defined in the Illinois Insurance Code.
31 (x) "Military leave with pay and benefits" refers to
32 individuals in basic training for reserves, special/advanced
33 training, annual training, emergency call up, or activation
34 by the President of the United States with approved pay and
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1 benefits.
2 (y) "Military leave without pay and benefits" refers to
3 individuals who enlist for active duty in a regular component
4 of the U.S. Armed Forces or other duty not specified or
5 authorized under military leave with pay and benefits.
6 (z) "Community college benefit recipient" means a person
7 who:
8 (1) is not a "member" as defined in this Section;
9 and
10 (2) is receiving a monthly survivor's annuity or
11 retirement annuity under Article 15 of the Illinois
12 Pension Code; and
13 (3) either (i) was a full-time employee of a
14 community college district or an association of community
15 college boards created under the Public Community College
16 Act (other than an employee whose last employer under
17 Article 15 of the Illinois Pension Code was a community
18 college district subject to Article VII of the Public
19 Community College Act) and was eligible to participate in
20 a group health benefit plan as an employee during the
21 time of employment with a community college district
22 (other than a community college district subject to
23 Article VII of the Public Community College Act) or an
24 association of community college boards, or (ii) is the
25 survivor of a person described in item (i).
26 (aa) "Community college dependent beneficiary" means a
27 person who:
28 (1) is not a "member" or "dependent" as defined in
29 this Section; and
30 (2) is a community college benefit recipient's: (A)
31 spouse, (B) dependent parent who is receiving at least
32 half of his or her support from the community college
33 benefit recipient, or (C) unmarried natural or adopted
34 child who is (i) under age 19, or (ii) enrolled as a
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1 full-time student in an accredited school, financially
2 dependent upon the community college benefit recipient,
3 eligible as a dependent for Illinois State income tax
4 purposes and under age 23, or (iii) age 19 or over and
5 mentally or physically handicapped as defined in the
6 Illinois Insurance Code.
7 (Source: P.A. 89-21, eff. 6-21-95; 89-25, eff. 6-21-95;
8 89-76, eff. 7-1-95; 89-324, eff. 8-13-95; 89-430, eff.
9 12-15-95; 89-502, eff. 7-1-96; 89-507, eff. 7-1-97; 89-628,
10 eff. 8-9-96; 90-14, eff. 7-1-97; 90-65, eff. 7-7-97; 90-448,
11 eff. 8-16-97; 90-497, eff. 8-18-97; 90-511, eff. 8-22-97;
12 revised 10-13-97.)
13 (5 ILCS 375/6.12 new)
14 Sec. 6.12. Health plan; election to opt out. Any member
15 may at any time elect to remove himself or herself from
16 coverage under the health plan. Members who have been
17 removed from coverage under the health plan shall not be
18 assessed premiums. Members who have removed themselves or
19 their dependents from coverage under the health plan may
20 enroll in the health plan and may arrange to have their
21 dependents enroll in the health plan at any time.
22 Section 99. Effective date. This Act takes effect July
23 1, 1998.