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Public Act 097-0668 | ||||
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AN ACT concerning State government.
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Be it enacted by the People of the State of Illinois,
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represented in the General Assembly:
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Section 5. The State Employees Group Insurance Act of 1971 | ||||
is amended by changing Sections 3 and 8 as follows:
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(5 ILCS 375/3) (from Ch. 127, par. 523)
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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.
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(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.
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(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), 15 (including an employee |
who has retired under the optional
retirement program | ||
established under Section 15-158.2),
paragraphs (2), (3), or | ||
(5) of Section 16-106, 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).
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(b-5) "New SERS annuitant" means a person who, on or after | ||
January 1,
1998, becomes an annuitant, as defined in subsection | ||
(b), by virtue of
beginning to receive a retirement annuity | ||
under Article 14 of the Illinois
Pension Code (including an | ||
employee who has elected to receive an alternative retirement | ||
cancellation payment under Section 14-108.5 of that Code in | ||
lieu of an annuity), and is eligible to participate in the | ||
basic program of group
health benefits provided for annuitants | ||
under this Act.
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(b-6) "New SURS annuitant" means a person who (1) on or | ||
after January 1,
1998, becomes an annuitant, as defined in | ||
subsection (b), by virtue of
beginning to receive a retirement | ||
annuity under Article 15 of the Illinois
Pension Code, (2) has | ||
not made the election authorized under Section 15-135.1
of the | ||
Illinois Pension Code, and (3) is eligible to participate in | ||
the basic
program of group
health benefits provided for | ||
annuitants under this Act.
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(b-7) "New TRS State annuitant" means a person who, on or | ||
after July
1, 1998, becomes an annuitant, as defined in | ||
subsection (b), by virtue of
beginning to receive a retirement | ||
annuity under Article 16 of the Illinois
Pension Code based on | ||
service as a teacher as defined in
paragraph (2), (3), or (5) | ||
of Section 16-106 of that Code, and is eligible
to participate | ||
in the basic program of group health benefits provided for
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annuitants under this Act.
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(c) "Carrier" means (1) an insurance company, a corporation |
organized
under the Limited Health Service Organization Act or | ||
the Voluntary Health
Services Plan 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.
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(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), paragraphs (2), (3), or (5) of
Section 16-106, or | ||
Article 18 of the Illinois Pension Code, for disability
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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.
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(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.
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(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.
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(g) "Department" means any department, institution, board,
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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.
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(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 filing of a | ||
petition 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 is mentally
or physically | ||
disabled 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
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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
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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.
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(i) "Director" means the Director of the Illinois | ||
Department of Central
Management Services or of any successor | ||
agency designated to administer this Act.
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(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.
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(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), | ||
paragraphs
(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
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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
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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.
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(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 the effective date of this amendatory Act of the 97th | ||
General Assembly, 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 first becomes a survivor on or after the | ||
effective date of this amendatory Act of the 97th General | ||
Assembly, 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.
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(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.
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(n) "Program" means the group life insurance, health | ||
benefits and other
employee benefits designed and contracted |
for by the Director under this Act.
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(o) "Health plan" means a health benefits
program offered
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by the State of Illinois for persons eligible for the plan.
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(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.
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(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; and (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.
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(q-2) "SERS" means the State Employees' Retirement System | ||
of Illinois, created under Article 14 of the Illinois Pension | ||
Code.
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(q-3) "SURS" means the State Universities Retirement | ||
System, created under Article 15 of the Illinois Pension Code.
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(q-4) "TRS" means the Teachers' Retirement System of the | ||
State of Illinois, created under Article 16 of the Illinois | ||
Pension Code.
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(q-5) "New SERS survivor" means a survivor, as defined in | ||
subsection (q),
whose annuity is paid under Article 14 of the | ||
Illinois Pension Code and is
based on the death of (i) an | ||
employee whose death occurs on or after January 1,
1998, or | ||
(ii) a new SERS annuitant as defined in subsection (b-5). "New | ||
SERS survivor" includes 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.
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(q-6) "New SURS survivor" means a survivor, as defined in | ||
subsection (q),
whose annuity is paid under Article 15 of the | ||
Illinois Pension Code and is
based on the death of (i) an | ||
employee whose death occurs on or after January 1,
1998, or | ||
(ii) a new SURS annuitant as defined in subsection (b-6).
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(q-7) "New TRS State survivor" means a survivor, as defined | ||
in subsection
(q), whose annuity is paid under Article 16 of |
the Illinois Pension Code and is
based on the death of (i) an | ||
employee who is a teacher as defined in paragraph
(2), (3), or | ||
(5) of Section 16-106 of that Code and whose death occurs on or
| ||
after July 1, 1998, or (ii) a new TRS State annuitant as | ||
defined in subsection
(b-7).
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(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.
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(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.
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(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.
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(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.
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(v) "TRS benefit recipient" means a person who:
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(1) is not a "member" as defined in this Section; and
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(2) is receiving a monthly benefit or retirement | ||
annuity
under Article 16 of the Illinois Pension Code; and
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(3) either (i) has at least 8 years of creditable | ||
service under Article
16 of the Illinois Pension Code, or | ||
(ii) was enrolled in the health insurance
program offered | ||
under that Article on January 1, 1996, or (iii) is the | ||
survivor
of a benefit recipient who had at least 8
years of | ||
creditable service under Article 16 of the Illinois Pension | ||
Code or
was enrolled in the health insurance program | ||
offered under that Article on
the effective date of this | ||
amendatory Act of 1995, or (iv) is a recipient or
survivor | ||
of a recipient of a disability benefit under Article 16 of | ||
the
Illinois Pension Code.
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(w) "TRS dependent beneficiary" means a person who:
| ||
(1) is not a "member" or "dependent" as defined in this | ||
Section; and
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(2) is a TRS benefit recipient's: (A) spouse, (B) | ||
dependent parent who
is receiving at least half of his or | ||
her support from the TRS benefit
recipient, or (C) natural, | ||
step, adjudicated, or adopted child who is (i) under age | ||
26, (ii) was, on January 1, 1996, participating as a | ||
dependent
beneficiary in the health insurance program | ||
offered under Article 16 of the
Illinois Pension Code, or | ||
(iii) age 19 or over who is mentally or physically disabled | ||
from a cause originating prior to the age of 19 (age 26 if |
enrolled as an adult child).
| ||
"TRS dependent beneficiary" does not include, as indicated | ||
under paragraph (2) of this subsection (w), a dependent of the | ||
survivor of a TRS benefit recipient who first becomes a | ||
dependent of a survivor of a TRS benefit recipient on or after | ||
the effective date of this amendatory Act of the 97th General | ||
Assembly unless that dependent would have been eligible for | ||
coverage as a dependent of the deceased TRS benefit recipient | ||
upon whom the survivor benefit is based. | ||
(x) "Military leave" refers to individuals in basic
| ||
training for reserves, special/advanced training, annual | ||
training, emergency
call up, activation by the President of the | ||
United States, or any other training or duty in service to the | ||
United States Armed Forces.
| ||
(y) (Blank).
| ||
(z) "Community college benefit recipient" means a person | ||
who:
| ||
(1) is not a "member" as defined in this Section; and
| ||
(2) is receiving a monthly survivor's annuity or | ||
retirement annuity
under Article 15 of the Illinois Pension | ||
Code; and
| ||
(3) either (i) was a full-time employee of a community | ||
college district or
an association of community college | ||
boards created under the Public Community
College Act | ||
(other than an employee whose last employer under Article | ||
15 of the
Illinois Pension Code was a community college |
district subject to Article VII
of the Public Community | ||
College Act) and was eligible to participate in a group
| ||
health benefit plan as an employee during the time of | ||
employment with a
community college district (other than a | ||
community college district subject to
Article VII of the | ||
Public Community College Act) or an association of | ||
community
college boards, or (ii) is the survivor of a | ||
person described in item (i).
| ||
(aa) "Community college dependent beneficiary" means a | ||
person who:
| ||
(1) is not a "member" or "dependent" as defined in this | ||
Section; and
| ||
(2) is a community college benefit recipient's: (A) | ||
spouse, (B) dependent
parent who is receiving at least half | ||
of his or her support from the community
college benefit | ||
recipient, or (C) natural, step, adjudicated, or adopted | ||
child who is (i)
under age 26, or (ii)
age 19 or over and | ||
mentally or physically disabled from a cause originating | ||
prior to the age of 19 (age 26 if enrolled as an adult | ||
child).
| ||
"Community college dependent beneficiary" does not | ||
include, as indicated under paragraph (2) of this subsection | ||
(aa), a dependent of the survivor of a community college | ||
benefit recipient who first becomes a dependent of a survivor | ||
of a community college benefit recipient on or after the | ||
effective date of this amendatory Act of the 97th General |
Assembly unless that dependent would have been eligible for | ||
coverage as a dependent of the deceased community college | ||
benefit recipient upon whom the survivor annuity is based. | ||
(bb) "Qualified child advocacy center" means any Illinois | ||
child advocacy center and its administrative offices funded by | ||
the Department of Children and Family Services, as defined by | ||
the Children's Advocacy Center Act (55 ILCS 80/), approved by | ||
the Director and participating in a program created under | ||
subsection (n) of Section 10.
| ||
(Source: P.A. 95-331, eff. 8-21-07; 95-632, eff. 9-25-07; | ||
96-756, eff. 1-1-10; 96-1519, eff. 2-4-11.)
| ||
(5 ILCS 375/8) (from Ch. 127, par. 528)
| ||
Sec. 8. Eligibility.
| ||
(a) Each employee member eligible under the provisions of | ||
this Act and any rules
and regulations promulgated and adopted | ||
hereunder by the Director shall
become immediately eligible and | ||
covered for all benefits available under
the programs. | ||
Employees Members electing coverage for eligible dependents | ||
shall have
the coverage effective immediately, provided that | ||
the election is properly
filed in accordance with required | ||
filing dates and procedures specified by
the Director , | ||
including the completion and submission of all documentation | ||
and forms required by the Director .
| ||
(1) Every member originally eligible to elect | ||
dependent coverage, but not
electing it during the original |
eligibility period, may subsequently obtain
dependent | ||
coverage only in the event of a qualifying change in | ||
status, special
enrollment, special circumstance as | ||
defined by the Director, or during the
annual Benefit | ||
Choice Period.
| ||
(2) Members described above being transferred from | ||
previous
coverage towards which the State has been | ||
contributing shall be
transferred regardless of | ||
preexisting conditions, waiting periods, or
other | ||
requirements that might jeopardize claim payments to which | ||
they
would otherwise have been entitled.
| ||
(3) Eligible and covered members that are eligible for | ||
coverage as
dependents except for the fact of being members | ||
shall be transferred to,
and covered under, dependent | ||
status regardless of preexisting conditions,
waiting | ||
periods, or other requirements that might jeopardize claim | ||
payments
to which they would otherwise have been entitled | ||
upon cessation of member
status and the election of | ||
dependent coverage by a member eligible to elect
that | ||
coverage.
| ||
(b) New employees shall be immediately insured for the | ||
basic group
life insurance and covered by the program of health | ||
benefits on the first
day of active State service. Optional | ||
life insurance coverage one to 4 times the basic amount, if | ||
elected
during the relevant eligibility period, will become | ||
effective on the date
of employment. Optional life insurance |
coverage exceeding 4 times the basic amount and all life | ||
insurance amounts applied for after the
eligibility period will | ||
be effective, subject to satisfactory evidence of
insurability | ||
when applicable, or other necessary qualifications, pursuant | ||
to
the requirements of the applicable benefit program, unless | ||
there is a change in
status that would confer new eligibility | ||
for change of enrollment under rules
established supplementing | ||
this Act, in which event application must be made
within the | ||
new eligibility period.
| ||
(c) As to the group health benefits program contracted to | ||
begin or
continue after June 30, 1973, each annuitant, | ||
survivor, and retired employee shall become immediately
| ||
eligible and covered for all benefits available under that | ||
program. Each annuitant, survivor, and retired employee shall | ||
have coverage effective immediately, provided that the | ||
election is properly filed in accordance with the required | ||
filing dates and procedures specified by the Director, | ||
including the completion and submission of all documentation | ||
and forms required by the Director. Annuitants, survivors, and | ||
retired Retired
employees may elect coverage for eligible | ||
dependents and shall have the
coverage effective immediately, | ||
provided that the election is properly
filed in accordance with | ||
required filing dates and procedures specified
by the Director , | ||
except that, for a survivor, the dependent sought to be added | ||
on or after the effective date of this amendatory Act of the | ||
97th General Assembly must have been eligible for coverage as a |
dependent under the deceased member upon whom the survivor's | ||
annuity is based in order to be eligible for coverage under the | ||
survivor .
| ||
Except as otherwise provided in this Act, where husband and | ||
wife are
both eligible members, each shall be enrolled as a | ||
member and coverage on
their eligible dependent children, if | ||
any, may be under the enrollment and
election of either.
| ||
Regardless of other provisions herein regarding late | ||
enrollment or other
qualifications, as appropriate, the
| ||
Director may periodically authorize open enrollment periods | ||
for each of the
benefit programs at which time each member may | ||
elect enrollment or change
of enrollment without regard to age, | ||
sex, health, or other qualification
under the conditions as may | ||
be prescribed in rules and regulations
supplementing this Act. | ||
Special open enrollment periods may be declared by
the Director | ||
for certain members only when special circumstances occur that
| ||
affect only those members.
| ||
(d) Beginning with fiscal year 2003 and for all subsequent | ||
years, eligible
members may elect not to participate in the | ||
program of health benefits as
defined in this Act. The election | ||
must be made during the annual benefit
choice period, subject | ||
to the conditions in this subsection.
| ||
(1) Members must furnish proof of health benefit | ||
coverage, either
comprehensive major medical coverage or | ||
comprehensive managed care plan,
from a source other than | ||
the Department of Central Management Services in
order to |
elect not to participate in the program.
| ||
(2) Members may re-enroll in the Department of Central | ||
Management Services
program of health benefits upon | ||
showing a qualifying change in status, as
defined in the | ||
U.S. Internal Revenue Code, without evidence of | ||
insurability
and with no limitations on coverage for | ||
pre-existing conditions, provided
that there was not a | ||
break in coverage of more than 63 days.
| ||
(3) Members may also re-enroll in the program of health | ||
benefits during
any annual benefit choice period, without | ||
evidence of insurability.
| ||
(4) Members who elect not to participate in the program | ||
of health benefits
shall be furnished a written explanation | ||
of the requirements and limitations
for the election not to | ||
participate in the program and for re-enrolling in the
| ||
program. The explanation shall also be included in the | ||
annual benefit choice
options booklets furnished to | ||
members.
| ||
(d-5) Beginning July 1, 2005, the Director may establish a | ||
program of financial incentives to encourage annuitants | ||
receiving a retirement annuity from the State Employees | ||
Retirement System, but who are not eligible for benefits under | ||
the federal Medicare health insurance program (Title XVIII of | ||
the Social Security Act, as added by Public Law 89-97) to elect | ||
not to participate in the program of health benefits provided | ||
under this Act. The election by an annuitant not to participate |
under this program must be made in accordance with the | ||
requirements set forth under subsection (d). The financial | ||
incentives provided to these annuitants under the program may | ||
not exceed $150 per month for each annuitant electing not to | ||
participate in the program of health benefits provided under | ||
this Act.
| ||
(e) Notwithstanding any other provision of this Act or the | ||
rules adopted
under this Act, if a person participating in the | ||
program of health benefits as
the dependent spouse of an | ||
eligible member becomes an annuitant, the person may
elect, at | ||
the time of becoming an annuitant or during any subsequent | ||
annual
benefit choice period, to continue participation as a | ||
dependent rather than
as an eligible member for as long as the | ||
person continues to be an eligible
dependent. In order to be | ||
eligible to make such an election, the person must have been | ||
enrolled as a dependent under the program of health benefits | ||
for no less than one year prior to becoming an annuitant.
| ||
An eligible member who has elected to participate as a | ||
dependent may
re-enroll in the program of health benefits as an | ||
eligible member (i)
during any subsequent annual benefit choice | ||
period or (ii) upon showing a
qualifying change in status, as | ||
defined in the U.S. Internal Revenue Code,
without evidence of | ||
insurability and with no limitations on coverage for
| ||
pre-existing conditions.
| ||
A person who elects to participate in the program of health | ||
benefits as
a dependent rather than as an eligible member shall |
be furnished a written
explanation of the consequences of | ||
electing to participate as a dependent and
the conditions and | ||
procedures for re-enrolling as an eligible member. The
| ||
explanation shall also be included in the annual benefit choice | ||
options booklet
furnished to members.
| ||
(Source: P.A. 94-95, eff. 7-1-05; 94-109, eff. 7-1-05; 95-331, | ||
eff. 8-21-07.)
| ||
Section 99. Effective date. This Act takes effect upon | ||
becoming law.
|