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92_SB0936eng SB936 Engrossed LRB9205934JSpc 1 AN ACT concerning State employee health 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 5 1971 is amended by changing Section 3 and adding Section 6.14 6 as follows: 7 (5 ILCS 375/3) (from Ch. 127, par. 523) 8 Sec. 3. Definitions. Unless the context otherwise 9 requires, the following words and phrases as used in this Act 10 shall have the following meanings. The Department may define 11 these and other words and phrases separately for the purpose 12 of implementing specific programs providing benefits under 13 this Act. 14 (a) "Administrative service organization" means any 15 person, firm or corporation experienced in the handling of 16 claims which is fully qualified, financially sound and 17 capable of meeting the service requirements of a contract of 18 administration executed with the Department. 19 (b) "Annuitant" means (1) an employee who retires, or 20 has retired, on or after January 1, 1966 on an immediate 21 annuity under the provisions of Articles 2, 14, 15 (including 22 an employee who has retired under the optional retirement 23 program established under Section 15-158.2), paragraphs (2), 24 (3), or (5) of Section 16-106, or Article 18 of the Illinois 25 Pension Code; (2) any person who was receiving group 26 insurance coverage under this Act as of March 31, 1978 by 27 reason of his status as an annuitant, even though the annuity 28 in relation to which such coverage was provided is a 29 proportional annuity based on less than the minimum period of 30 service required for a retirement annuity in the system 31 involved; (3) any person not otherwise covered by this Act SB936 Engrossed -2- LRB9205934JSpc 1 who has retired as a participating member under Article 2 of 2 the Illinois Pension Code but is ineligible for the 3 retirement annuity under Section 2-119 of the Illinois 4 Pension Code; (4) the spouse of any person who is receiving a 5 retirement annuity under Article 18 of the Illinois Pension 6 Code and who is covered under a group health insurance 7 program sponsored by a governmental employer other than the 8 State of Illinois and who has irrevocably elected to waive 9 his or her coverage under this Act and to have his or her 10 spouse considered as the "annuitant" under this Act and not 11 as a "dependent"; or (5) an employee who retires, or has 12 retired, from a qualified position, as determined according 13 to rules promulgated by the Director, under a qualified local 14 government or a qualified rehabilitation facility or a 15 qualified domestic violence shelter or service. (For 16 definition of "retired employee", see (p) post). 17 (b-5) "New SERS annuitant" means a person who, on or 18 after January 1, 1998, becomes an annuitant, as defined in 19 subsection (b), by virtue of beginning to receive a 20 retirement annuity under Article 14 of the Illinois Pension 21 Code, and is eligible to participate in the basic program of 22 group health benefits provided for annuitants under this Act. 23 (b-6) "New SURS annuitant" means a person who (1) on or 24 after January 1, 1998, becomes an annuitant, as defined in 25 subsection (b), by virtue of beginning to receive a 26 retirement annuity under Article 15 of the Illinois Pension 27 Code, (2) has not made the election authorized under Section 28 15-135.1 of the Illinois Pension Code, and (3) is eligible to 29 participate in the basic program of group health benefits 30 provided for annuitants under this Act. 31 (b-7) "New TRS State annuitant" means a person who, on 32 or after July 1, 1998, becomes an annuitant, as defined in 33 subsection (b), by virtue of beginning to receive a 34 retirement annuity under Article 16 of the Illinois Pension SB936 Engrossed -3- LRB9205934JSpc 1 Code based on service as a teacher as defined in paragraph 2 (2), (3), or (5) of Section 16-106 of that Code, and is 3 eligible to participate in the basic program of group health 4 benefits provided for annuitants under this Act. 5 (c) "Carrier" means (1) an insurance company, a 6 corporation organized under the Limited Health Service 7 Organization Act or the Voluntary Health Services Plan Act, a 8 partnership, or other nongovernmental organization, which is 9 authorized to do group life or group health insurance 10 business in Illinois, or (2) the State of Illinois as a 11 self-insurer. 12 (d) "Compensation" means salary or wages payable on a 13 regular payroll by the State Treasurer on a warrant of the 14 State Comptroller out of any State, trust or federal fund, or 15 by the Governor of the State through a disbursing officer of 16 the State out of a trust or out of federal funds, or by any 17 Department out of State, trust, federal or other funds held 18 by the State Treasurer or the Department, to any person for 19 personal services currently performed, and ordinary or 20 accidental disability benefits under Articles 2, 14, 15 21 (including ordinary or accidental disability benefits under 22 the optional retirement program established under Section 23 15-158.2), paragraphs (2), (3), or (5) of Section 16-106, or 24 Article 18 of the Illinois Pension Code, for disability 25 incurred after January 1, 1966, or benefits payable under the 26 Workers' Compensation or Occupational Diseases Act or 27 benefits payable under a sick pay plan established in 28 accordance with Section 36 of the State Finance Act. 29 "Compensation" also means salary or wages paid to an employee 30 of any qualified local government or qualified rehabilitation 31 facility or a qualified domestic violence shelter or service. 32 (e) "Commission" means the State Employees Group 33 Insurance Advisory Commission authorized by this Act. 34 Commencing July 1, 1984, "Commission" as used in this Act SB936 Engrossed -4- LRB9205934JSpc 1 means the Illinois Economic and Fiscal Commission as 2 established by the Legislative Commission Reorganization Act 3 of 1984. 4 (f) "Contributory", when referred to as contributory 5 coverage, shall mean optional coverages or benefits elected 6 by the member toward the cost of which such member makes 7 contribution, or which are funded in whole or in part through 8 the acceptance of a reduction in earnings or the foregoing of 9 an increase in earnings by an employee, as distinguished from 10 noncontributory coverage or benefits which are paid entirely 11 by the State of Illinois without reduction of the member's 12 salary. 13 (g) "Department" means any department, institution, 14 board, commission, officer, court or any agency of the State 15 government receiving appropriations and having power to 16 certify payrolls to the Comptroller authorizing payments of 17 salary and wages against such appropriations as are made by 18 the General Assembly from any State fund, or against trust 19 funds held by the State Treasurer and includes boards of 20 trustees of the retirement systems created by Articles 2, 14, 21 15, 16 and 18 of the Illinois Pension Code. "Department" 22 also includes the Illinois Comprehensive Health Insurance 23 Board, the Board of Examiners established under the Illinois 24 Public Accounting Act, and the Illinois Rural Bond Bank. 25 (h) "Dependent", when the term is used in the context of 26 the health and life plan, means a member's spouse and any 27 unmarried child (1) from birth to age 19 including an adopted 28 child, a child who lives with the member from the time of the 29 filing of a petition for adoption until entry of an order of 30 adoption, a stepchild or recognized child who lives with the 31 member in a parent-child relationship, or a child who lives 32 with the member if such member is a court appointed guardian 33 of the child, or (2) age 19 to 23 enrolled as a full-time 34 student in any accredited school, financially dependent upon SB936 Engrossed -5- LRB9205934JSpc 1 the member, and eligible to be claimed as a dependent for 2 income tax purposes, or (3) age 19 or over who is mentally or 3 physically handicapped. For the health plan only, the term 4 "dependent" also includes any person enrolled prior to the 5 effective date of this Section who is dependent upon the 6 member to the extent that the member may claim such person as 7 a dependent for income tax deduction purposes; no other such 8 person may be enrolled. For the health plan only, the term 9 "dependent" also includes any person who has received after 10 June 30, 2000 an organ transplant and who is financially 11 dependent upon the member and eligible to be claimed as a 12 dependent for income tax purposes. 13 (i) "Director" means the Director of the Illinois 14 Department of Central Management Services. 15 (j) "Eligibility period" means the period of time a 16 member has to elect enrollment in programs or to select 17 benefits without regard to age, sex or health. 18 (k) "Employee" means and includes each officer or 19 employee in the service of a department who (1) receives his 20 compensation for service rendered to the department on a 21 warrant issued pursuant to a payroll certified by a 22 department or on a warrant or check issued and drawn by a 23 department upon a trust, federal or other fund or on a 24 warrant issued pursuant to a payroll certified by an elected 25 or duly appointed officer of the State or who receives 26 payment of the performance of personal services on a warrant 27 issued pursuant to a payroll certified by a Department and 28 drawn by the Comptroller upon the State Treasurer against 29 appropriations made by the General Assembly from any fund or 30 against trust funds held by the State Treasurer, and (2) is 31 employed full-time or part-time in a position normally 32 requiring actual performance of duty during not less than 1/2 33 of a normal work period, as established by the Director in 34 cooperation with each department, except that persons elected SB936 Engrossed -6- LRB9205934JSpc 1 by popular vote will be considered employees during the 2 entire term for which they are elected regardless of hours 3 devoted to the service of the State, and (3) except that 4 "employee" does not include any person who is not eligible by 5 reason of such person's employment to participate in one of 6 the State retirement systems under Articles 2, 14, 15 (either 7 the regular Article 15 system or the optional retirement 8 program established under Section 15-158.2) or 18, or under 9 paragraph (2), (3), or (5) of Section 16-106, of the Illinois 10 Pension Code, but such term does include persons who are 11 employed during the 6 month qualifying period under Article 12 14 of the Illinois Pension Code. Such term also includes any 13 person who (1) after January 1, 1966, is receiving ordinary 14 or 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, (2) receives total permanent 20 or total temporary disability under the Workers' Compensation 21 Act or Occupational Disease Act as a result of injuries 22 sustained or illness contracted in the course of employment 23 with the State of Illinois, or (3) is not otherwise covered 24 under this Act and has retired as a participating member 25 under Article 2 of the Illinois Pension Code but is 26 ineligible for the retirement annuity under Section 2-119 of 27 the Illinois Pension Code. However, a person who satisfies 28 the criteria of the foregoing definition of "employee" except 29 that such person is made ineligible to participate in the 30 State Universities Retirement System by clause (4) of 31 subsection (a) of Section 15-107 of the Illinois Pension Code 32 is also an "employee" for the purposes of this Act. 33 "Employee" also includes any person receiving or eligible for 34 benefits under a sick pay plan established in accordance with SB936 Engrossed -7- LRB9205934JSpc 1 Section 36 of the State Finance Act. "Employee" also includes 2 each officer or employee in the service of a qualified local 3 government, including persons appointed as trustees of 4 sanitary districts regardless of hours devoted to the service 5 of the sanitary district, and each employee in the service of 6 a qualified rehabilitation facility and each full-time 7 employee in the service of a qualified domestic violence 8 shelter or service, as determined according to rules 9 promulgated by the Director. 10 (l) "Member" means an employee, annuitant, retired 11 employee or survivor. 12 (m) "Optional coverages or benefits" means those 13 coverages or benefits available to the member on his or her 14 voluntary election, and at his or her own expense. 15 (n) "Program" means the group life insurance, health 16 benefits and other employee benefits designed and contracted 17 for by the Director under this Act. 18 (o) "Health plan" means a health benefits program 19 offered by the State of Illinois for persons eligible for the 20 plan. 21 (p) "Retired employee" means any person who would be an 22 annuitant as that term is defined herein but for the fact 23 that such person retired prior to January 1, 1966. Such term 24 also includes any person formerly employed by the University 25 of Illinois in the Cooperative Extension Service who would be 26 an annuitant but for the fact that such person was made 27 ineligible to participate in the State Universities 28 Retirement System by clause (4) of subsection (a) of Section 29 15-107 of the Illinois Pension Code. 30 (q) "Survivor" means a person receiving an annuity as a 31 survivor of an employee or of an annuitant. "Survivor" also 32 includes: (1) the surviving dependent of a person who 33 satisfies the definition of "employee" except that such 34 person is made ineligible to participate in the State SB936 Engrossed -8- LRB9205934JSpc 1 Universities Retirement System by clause (4) of subsection 2 (a) of Section 15-107 of the Illinois Pension Code; and (2) 3 the surviving dependent of any person formerly employed by 4 the University of Illinois in the Cooperative Extension 5 Service who would be an annuitant except for the fact that 6 such person was made ineligible to participate in the State 7 Universities Retirement System by clause (4) of subsection 8 (a) of Section 15-107 of the Illinois Pension Code. 9 (q-5) "New SERS survivor" means a survivor, as defined 10 in subsection (q), whose annuity is paid under Article 14 of 11 the Illinois Pension Code and is based on the death of (i) an 12 employee whose death occurs on or after January 1, 1998, or 13 (ii) a new SERS annuitant as defined in subsection (b-5). 14 (q-6) "New SURS survivor" means a survivor, as defined 15 in subsection (q), whose annuity is paid under Article 15 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 SURS annuitant as defined in subsection (b-6). 19 (q-7) "New TRS State survivor" means a survivor, as 20 defined in subsection (q), whose annuity is paid under 21 Article 16 of the Illinois Pension Code and is based on the 22 death of (i) an employee who is a teacher as defined in 23 paragraph (2), (3), or (5) of Section 16-106 of that Code and 24 whose death occurs on or after July 1, 1998, or (ii) a new 25 TRS State annuitant as defined in subsection (b-7). 26 (r) "Medical services" means the services provided 27 within the scope of their licenses by practitioners in all 28 categories licensed under the Medical Practice Act of 1987. 29 (s) "Unit of local government" means any county, 30 municipality, township, school district, special district or 31 other unit, designated as a unit of local government by law, 32 which exercises limited governmental powers or powers in 33 respect to limited governmental subjects, any not-for-profit 34 association with a membership that primarily includes SB936 Engrossed -9- LRB9205934JSpc 1 townships and township officials, that has duties that 2 include provision of research service, dissemination of 3 information, and other acts for the purpose of improving 4 township government, and that is funded wholly or partly in 5 accordance with Section 85-15 of the Township Code; any 6 not-for-profit corporation or association, with a membership 7 consisting primarily of municipalities, that operates its own 8 utility system, and provides research, training, 9 dissemination of information, or other acts to promote 10 cooperation between and among municipalities that provide 11 utility services and for the advancement of the goals and 12 purposes of its membership; the Southern Illinois Collegiate 13 Common Market, which is a consortium of higher education 14 institutions in Southern Illinois; and the Illinois 15 Association of Park Districts. "Qualified local government" 16 means a unit of local government approved by the Director and 17 participating in a program created under subsection (i) of 18 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 23 to the Department of Mental Health and Developmental 24 Disabilities) to provide services to persons with 25 disabilities and which receives funds from the State of 26 Illinois for providing those services, approved by the 27 Director and participating in a program created under 28 subsection (j) of Section 10 of this Act. 29 (u) "Qualified domestic violence shelter or service" 30 means any Illinois domestic violence shelter or service and 31 its administrative offices funded by the Department of Human 32 Services (as successor to the Illinois Department of Public 33 Aid), approved by the Director and participating in a program 34 created under subsection (k) of Section 10. SB936 Engrossed -10- LRB9205934JSpc 1 (v) "TRS benefit recipient" means a person who: 2 (1) is not a "member" as defined in this Section; 3 and 4 (2) is receiving a monthly benefit or retirement 5 annuity under Article 16 of the Illinois Pension Code; 6 and 7 (3) either (i) has at least 8 years of creditable 8 service under Article 16 of the Illinois Pension Code, or 9 (ii) was enrolled in the health insurance program offered 10 under that Article on January 1, 1996, or (iii) is the 11 survivor of a benefit recipient who had at least 8 years 12 of creditable service under Article 16 of the Illinois 13 Pension Code or was enrolled in the health insurance 14 program offered under that Article on the effective date 15 of this amendatory Act of 1995, or (iv) is a recipient or 16 survivor of a recipient of a disability benefit under 17 Article 16 of the Illinois Pension Code. 18 (w) "TRS dependent beneficiary" means a person who: 19 (1) is not a "member" or "dependent" as defined in 20 this Section; and 21 (2) is a TRS benefit recipient's: (A) spouse, (B) 22 dependent parent who is receiving at least half of his or 23 her support from the TRS benefit recipient, or (C) 24 unmarried natural or adopted child who is (i) under age 25 19, or (ii) enrolled as a full-time student in an 26 accredited school, financially dependent upon the TRS 27 benefit recipient, eligible to be claimed as a dependent 28 for income tax purposes, and either is under age 24 or 29 was, on January 1, 1996, participating as a dependent 30 beneficiary in the health insurance program offered under 31 Article 16 of the Illinois Pension Code, or (iii) age 19 32 or over who is mentally or physically handicapped. 33 (x) "Military leave with pay and benefits" refers to 34 individuals in basic training for reserves, special/advanced SB936 Engrossed -11- LRB9205934JSpc 1 training, annual training, emergency call up, or activation 2 by the President of the United States with approved pay and 3 benefits. 4 (y) "Military leave without pay and benefits" refers to 5 individuals who enlist for active duty in a regular component 6 of the U.S. Armed Forces or other duty not specified or 7 authorized under military leave with pay and benefits. 8 (z) "Community college benefit recipient" means a person 9 who: 10 (1) is not a "member" as defined in this Section; 11 and 12 (2) is receiving a monthly survivor's annuity or 13 retirement annuity under Article 15 of the Illinois 14 Pension Code; and 15 (3) either (i) was a full-time employee of a 16 community college district or an association of community 17 college boards created under the Public Community College 18 Act (other than an employee whose last employer under 19 Article 15 of the Illinois Pension Code was a community 20 college district subject to Article VII of the Public 21 Community College Act) and was eligible to participate in 22 a group health benefit plan as an employee during the 23 time of employment with a community college district 24 (other than a community college district subject to 25 Article VII of the Public Community College Act) or an 26 association of community college boards, or (ii) is the 27 survivor of a person described in item (i). 28 (aa) "Community college dependent beneficiary" means a 29 person who: 30 (1) is not a "member" or "dependent" as defined in 31 this Section; and 32 (2) is a community college benefit recipient's: (A) 33 spouse, (B) dependent parent who is receiving at least 34 half of his or her support from the community college SB936 Engrossed -12- LRB9205934JSpc 1 benefit recipient, or (C) unmarried natural or adopted 2 child who is (i) under age 19, or (ii) enrolled as a 3 full-time student in an accredited school, financially 4 dependent upon the community college benefit recipient, 5 eligible to be claimed as a dependent for income tax 6 purposes and under age 23, or (iii) age 19 or over and 7 mentally or physically handicapped. 8 (Source: P.A. 90-14, eff. 7-1-97; 90-65, eff. 7-7-97; 90-448, 9 eff. 8-16-97; 90-497, eff. 8-18-97; 90-511, eff. 8-22-97; 10 90-582, eff. 5-27-98; 90-655, eff. 7-30-98; 91-390, eff. 11 7-30-99; 91-395, eff. 7-30-99; 91-617, eff, 8-19-99; revised 12 10-19-99.) 13 (5 ILCS 375/6.14 new) 14 Sec. 6.14. Organ donor costs. With respect to organ 15 transplants occurring after June 30, 2000 when both a donor 16 and donee are members of the same family and are both covered 17 by the program of health benefits, the program of health 18 benefits shall pay 100% of the donor's expenses without the 19 imposition of any deductible or copayment. 20 Section 99. Effective date. This Act takes effect upon 21 becoming law.