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Public Act 91-0311
HB1469 Enrolled LRB9104603MWpc
AN ACT to amend the State Employees Group Insurance Act
of 1971 by changing Section 10.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The State Employees Group Insurance Act of
1971 is amended by changing Section 10 as follows:
(5 ILCS 375/10) (from Ch. 127, par. 530)
Sec. 10. Payments by State; premiums.
(a) The State shall pay the cost of basic
non-contributory group life insurance and, subject to member
paid contributions set by the Department or required by this
Section, the basic program of group health benefits on each
eligible member, except 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, and part of each eligible member's and retired
member's premiums for health insurance coverage for enrolled
dependents as provided by Section 9. The State shall pay the
cost of the basic program of group health benefits only after
benefits are reduced by the amount of benefits covered by
Medicare for all retired members and retired dependents aged
65 years or older who are entitled to benefits under Social
Security or the Railroad Retirement system or who had
sufficient Medicare-covered government employment except that
such reduction in benefits shall apply only to those retired
members or retired dependents who (1) first become eligible
for such Medicare coverage on or after July 1, 1992; or (2)
remain eligible for, but no longer receive Medicare coverage
which they had been receiving on or after July 1, 1992. The
Department may determine the aggregate level of the State's
contribution on the basis of actual cost of medical services
adjusted for age, sex or geographic or other demographic
characteristics which affect the costs of such programs.
(a-1) Beginning January 1, 1998, for each person who
becomes a new SERS annuitant and participates in the basic
program of group health benefits, the State shall contribute
toward the cost of the annuitant's coverage under the basic
program of group health benefits an amount equal to 5% of
that cost for each full year of creditable service upon which
the annuitant's retirement annuity is based, up to a maximum
of 100% for an annuitant with 20 or more years of creditable
service. The remainder of the cost of a new SERS annuitant's
coverage under the basic program of group health benefits
shall be the responsibility of the annuitant.
(a-2) Beginning January 1, 1998, for each person who
becomes a new SERS survivor and participates in the basic
program of group health benefits, the State shall contribute
toward the cost of the survivor's coverage under the basic
program of group health benefits an amount equal to 5% of
that cost for each full year of the deceased employee's or
deceased annuitant's creditable service in the State
Employees' Retirement System of Illinois on the date of
death, up to a maximum of 100% for a survivor of an employee
or annuitant with 20 or more years of creditable service.
The remainder of the cost of the new SERS survivor's coverage
under the basic program of group health benefits shall be the
responsibility of the survivor.
(a-3) Beginning January 1, 1998, for each person who
becomes a new SURS annuitant and participates in the basic
program of group health benefits, the State shall contribute
toward the cost of the annuitant's coverage under the basic
program of group health benefits an amount equal to 5% of
that cost for each full year of creditable service upon which
the annuitant's retirement annuity is based, up to a maximum
of 100% for an annuitant with 20 or more years of creditable
service. The remainder of the cost of a new SURS annuitant's
coverage under the basic program of group health benefits
shall be the responsibility of the annuitant.
(a-4) Beginning January 1, 1998, for each person who
becomes a new SURS retired employee and participates in the
basic program of group health benefits, the State shall
contribute toward the cost of the retired employee's coverage
under the basic program of group health benefits an amount
equal to 5% of that cost for each full year that the retired
employee was an employee as defined in Section 3, up to a
maximum of 100% for a retired employee who was an employee
for 20 or more years. The remainder of the cost of a new
SURS retired employee's coverage under the basic program of
group health benefits shall be the responsibility of the
retired employee.
(a-5) Beginning January 1, 1998, for each person who
becomes a new SURS survivor and participates in the basic
program of group health benefits, the State shall contribute
toward the cost of the survivor's coverage under the basic
program of group health benefits an amount equal to 5% of
that cost for each full year of the deceased employee's or
deceased annuitant's creditable service in the State
Universities Retirement System on the date of death, up to a
maximum of 100% for a survivor of an employee or annuitant
with 20 or more years of creditable service. The remainder
of the cost of the new SURS survivor's coverage under the
basic program of group health benefits shall be the
responsibility of the survivor.
(a-6) Beginning July 1, 1998, for each person who
becomes a new TRS State annuitant and participates in the
basic program of group health benefits, the State shall
contribute toward the cost of the annuitant's coverage under
the basic program of group health benefits an amount equal to
5% of that cost for each full year of creditable service as a
teacher as defined in paragraph (2), (3), or (5) of Section
16-106 of the Illinois Pension Code upon which the
annuitant's retirement annuity is based, up to a maximum of
100% for an annuitant with 20 or more years of such
creditable service. The remainder of the cost of a new TRS
State annuitant's coverage under the basic program of group
health benefits shall be the responsibility of the annuitant.
(a-7) Beginning July 1, 1998, for each person who
becomes a new TRS State survivor and participates in the
basic program of group health benefits, the State shall
contribute toward the cost of the survivor's coverage under
the basic program of group health benefits an amount equal to
5% of that cost for each full year of the deceased employee's
or deceased annuitant's creditable service as a teacher as
defined in paragraph (2), (3), or (5) of Section 16-106 of
the Illinois Pension Code on the date of death, up to a
maximum of 100% for a survivor of an employee or annuitant
with 20 or more years of such creditable service. The
remainder of the cost of the new TRS State survivor's
coverage under the basic program of group health benefits
shall be the responsibility of the survivor.
(a-8) A new SERS annuitant, new SERS survivor, new SURS
annuitant, new SURS retired employee, new SURS survivor, new
TRS State annuitant, or new TRS State survivor may waive or
terminate coverage in the program of group health benefits.
Any such annuitant, survivor, or retired employee who has
waived or terminated coverage may enroll or re-enroll in the
program of group health benefits only during the annual
benefit choice period, as determined by the Director; except
that in the event of termination of coverage due to
nonpayment of premiums, the annuitant, survivor, or retired
employee may not re-enroll in the program.
(a-9) No later than May 1 of each calendar year, the
Director of Central Management Services shall certify in
writing to the Executive Secretary of the State Employees'
Retirement System of Illinois the amounts of the Medicare
supplement health care premiums and the amounts of the health
care premiums for all other retirees who are not Medicare
eligible.
A separate calculation of the premiums based upon the
actual cost of each health care plan shall be so certified.
The Director of Central Management Services shall provide
to the Executive Secretary of the State Employees' Retirement
System of Illinois such information, statistics, and other
data as he or she may require to review the premium amounts
certified by the Director of Central Management Services.
(b) State employees who become eligible for this program
on or after January 1, 1980 in positions normally requiring
actual performance of duty not less than 1/2 of a normal work
period but not equal to that of a normal work period, shall
be given the option of participating in the available
program. If the employee elects coverage, the State shall
contribute on behalf of such employee to the cost of the
employee's benefit and any applicable dependent supplement,
that sum which bears the same percentage as that percentage
of time the employee regularly works when compared to normal
work period.
(c) The basic non-contributory coverage from the basic
program of group health benefits shall be continued for each
employee not in pay status or on active service by reason of
(1) leave of absence due to illness or injury, (2) authorized
educational leave of absence or sabbatical leave, or (3)
military leave with pay and benefits. This coverage shall
continue until expiration of authorized leave and return to
active service, but not to exceed 24 months for leaves under
item (1) or (2). This 24-month limitation and the requirement
of returning to active service shall not apply to persons
receiving ordinary or accidental disability benefits or
retirement benefits through the appropriate State retirement
system or benefits under the Workers' Compensation or
Occupational Disease Act.
(d) The basic group life insurance coverage shall
continue, with full State contribution, where such person is
(1) absent from active service by reason of disability
arising from any cause other than self-inflicted, (2) on
authorized educational leave of absence or sabbatical leave,
or (3) on military leave with pay and benefits.
(e) Where the person is in non-pay status for a period
in excess of 30 days or on leave of absence, other than by
reason of disability, educational or sabbatical leave, or
military leave with pay and benefits, such person may
continue coverage only by making personal payment equal to
the amount normally contributed by the State on such person's
behalf. Such payments and coverage may be continued: (1)
until such time as the person returns to a status eligible
for coverage at State expense, but not to exceed 24 months,
(2) until such person's employment or annuitant status with
the State is terminated, or (3) for a maximum period of 4
years for members on military leave with pay and benefits and
military leave without pay and benefits (exclusive of any
additional service imposed pursuant to law).
(f) The Department shall establish by rule the extent
to which other employee benefits will continue for persons in
non-pay status or who are not in active service.
(g) The State shall not pay the cost of the basic
non-contributory group life insurance, program of health
benefits and other employee benefits for members who are
survivors as defined by paragraphs (1) and (2) of subsection
(q) of Section 3 of this Act. The costs of benefits for
these survivors shall be paid by the survivors or by the
University of Illinois Cooperative Extension Service, or any
combination thereof.
(h) Those persons occupying positions with any
department as a result of emergency appointments pursuant to
Section 8b.8 of the Personnel Code who are not considered
employees under this Act shall be given the option of
participating in the programs of group life insurance, health
benefits and other employee benefits. Such persons electing
coverage may participate only by making payment equal to the
amount normally contributed by the State for similarly
situated employees. Such amounts shall be determined by the
Director. Such payments and coverage may be continued until
such time as the person becomes an employee pursuant to this
Act or such person's appointment is terminated.
(i) Any unit of local government within the State of
Illinois may apply to the Director to have its employees,
annuitants, and their dependents provided group health
coverage under this Act on a non-insured basis. To
participate, a unit of local government must agree to enroll
all of its employees, who may select coverage under either
the State group health insurance plan or a health maintenance
organization that has contracted with the State to be
available as a health care provider for employees as defined
in this Act. A unit of local government must remit the
entire cost of providing coverage under the State group
health insurance plan or, for coverage under a health
maintenance organization, an amount determined by the
Director based on an analysis of the sex, age, geographic
location, or other relevant demographic variables for its
employees, except that the unit of local government shall not
be required to enroll those of its employees who are covered
spouses or dependents under this plan or another group policy
or plan providing health benefits as long as (1) an
appropriate official from the unit of local government
attests that each employee not enrolled is a covered spouse
or dependent under this plan or another group policy or plan,
and (2) at least 85% of the employees are enrolled and the
unit of local government remits the entire cost of providing
coverage to those employees, except that a participating
school district must have enrolled at least 85% of its
full-time employees who have not waived coverage under the
district's group health plan by participating in a component
of the district's cafeteria plan. A participating school
district is not required to enroll a full-time employee who
has waived coverage under the district's health plan,
provided that an appropriate official from the participating
school district attests that the full-time employee has
waived coverage by participating in a component of the
district's cafeteria plan. For the purposes of this
subsection, "participating school district" includes a unit
of local government whose primary purpose is education as
defined by the Department's rules.
Employees of a participating unit of local government who
are not enrolled due to coverage under another group health
policy or plan may enroll at a later date subject to
submission of satisfactory evidence of insurability and
provided that no benefits shall be payable for services
incurred during the first 6 months of coverage to the extent
the services are in connection with any pre-existing
condition. A participating unit of local government may also
elect to cover its annuitants. Dependent coverage shall be
offered on an optional basis, with the costs paid by the unit
of local government, its employees, or some combination of
the two as determined by the unit of local government. The
unit of local government shall be responsible for timely
collection and transmission of dependent premiums.
The Director shall annually determine monthly rates of
payment, subject to the following constraints:
(1) In the first year of coverage, the rates shall
be equal to the amount normally charged to State
employees for elected optional coverages or for enrolled
dependents coverages or other contributory coverages, or
contributed by the State for basic insurance coverages on
behalf of its employees, adjusted for differences between
State employees and employees of the local government in
age, sex, geographic location or other relevant
demographic variables, plus an amount sufficient to pay
for the additional administrative costs of providing
coverage to employees of the unit of local government and
their dependents.
(2) In subsequent years, a further adjustment shall
be made to reflect the actual prior years' claims
experience of the employees of the unit of local
government.
In the case of coverage of local government employees
under a health maintenance organization, the Director shall
annually determine for each participating unit of local
government the maximum monthly amount the unit may contribute
toward that coverage, based on an analysis of (i) the age,
sex, geographic location, and other relevant demographic
variables of the unit's employees and (ii) the cost to cover
those employees under the State group health insurance plan.
The Director may similarly determine the maximum monthly
amount each unit of local government may contribute toward
coverage of its employees' dependents under a health
maintenance organization.
Monthly payments by the unit of local government or its
employees for group health insurance or health maintenance
organization coverage shall be deposited in the Local
Government Health Insurance Reserve Fund. The Local
Government Health Insurance Reserve Fund shall be a
continuing fund not subject to fiscal year limitations. All
expenditures from this fund shall be used for payments for
health care benefits for local government and rehabilitation
facility employees, annuitants, and dependents, and to
reimburse the Department or its administrative service
organization for all expenses incurred in the administration
of benefits. No other State funds may be used for these
purposes.
A local government employer's participation or desire to
participate in a program created under this subsection shall
not limit that employer's duty to bargain with the
representative of any collective bargaining unit of its
employees.
(j) Any rehabilitation facility within the State of
Illinois may apply to the Director to have its employees,
annuitants, and their dependents provided group health
coverage under this Act on a non-insured basis. To
participate, a rehabilitation facility must agree to enroll
all of its employees and remit the entire cost of providing
such coverage for its employees, except that the
rehabilitation facility shall not be required to enroll those
of its employees who are covered spouses or dependents under
this plan or another group policy or plan providing health
benefits as long as (1) an appropriate official from the
rehabilitation facility attests that each employee not
enrolled is a covered spouse or dependent under this plan or
another group policy or plan, and (2) at least 85% of the
employees are enrolled and the rehabilitation facility remits
the entire cost of providing coverage to those employees.
Employees of a participating rehabilitation facility who are
not enrolled due to coverage under another group health
policy or plan may enroll at a later date subject to
submission of satisfactory evidence of insurability and
provided that no benefits shall be payable for services
incurred during the first 6 months of coverage to the extent
the services are in connection with any pre-existing
condition. A participating rehabilitation facility may also
elect to cover its annuitants. Dependent coverage shall be
offered on an optional basis, with the costs paid by the
rehabilitation facility, its employees, or some combination
of the 2 as determined by the rehabilitation facility. The
rehabilitation facility shall be responsible for timely
collection and transmission of dependent premiums.
The Director shall annually determine quarterly rates of
payment, subject to the following constraints:
(1) In the first year of coverage, the rates shall
be equal to the amount normally charged to State
employees for elected optional coverages or for enrolled
dependents coverages or other contributory coverages on
behalf of its employees, adjusted for differences between
State employees and employees of the rehabilitation
facility in age, sex, geographic location or other
relevant demographic variables, plus an amount sufficient
to pay for the additional administrative costs of
providing coverage to employees of the rehabilitation
facility and their dependents.
(2) In subsequent years, a further adjustment shall
be made to reflect the actual prior years' claims
experience of the employees of the rehabilitation
facility.
Monthly payments by the rehabilitation facility or its
employees for group health insurance shall be deposited in
the Local Government Health Insurance Reserve Fund.
(k) Any domestic violence shelter or service within the
State of Illinois may apply to the Director to have its
employees, annuitants, and their dependents provided group
health coverage under this Act on a non-insured basis. To
participate, a domestic violence shelter or service must
agree to enroll all of its employees and pay the entire cost
of providing such coverage for its employees. A
participating domestic violence shelter may also elect to
cover its annuitants. Dependent coverage shall be offered on
an optional basis, with employees, or some combination of the
2 as determined by the domestic violence shelter or service.
The domestic violence shelter or service shall be responsible
for timely collection and transmission of dependent premiums.
The Director shall annually determine quarterly rates of
payment, subject to the following constraints:
(1) In the first year of coverage, the rates shall
be equal to the amount normally charged to State
employees for elected optional coverages or for enrolled
dependents coverages or other contributory coverages on
behalf of its employees, adjusted for differences between
State employees and employees of the domestic violence
shelter or service in age, sex, geographic location or
other relevant demographic variables, plus an amount
sufficient to pay for the additional administrative costs
of providing coverage to employees of the domestic
violence shelter or service and their dependents.
(2) In subsequent years, a further adjustment shall
be made to reflect the actual prior years' claims
experience of the employees of the domestic violence
shelter or service.
(3) In no case shall the rate be less than the
amount normally charged to State employees or contributed
by the State on behalf of its employees.
Monthly payments by the domestic violence shelter or
service or its employees for group health insurance shall be
deposited in the Local Government Health Insurance Reserve
Fund.
(l) A public community college or entity organized
pursuant to the Public Community College Act may apply to the
Director initially to have only annuitants not covered prior
to July 1, 1992 by the district's health plan provided health
coverage under this Act on a non-insured basis. The
community college must execute a 2-year contract to
participate in the Local Government Health Plan. Those
annuitants enrolled initially under this contract shall have
no benefits payable for services incurred during the first 6
months of coverage to the extent the services are in
connection with any pre-existing condition. Any annuitant
who may enroll after this initial enrollment period shall be
subject to submission of satisfactory evidence of
insurability and to the pre-existing conditions limitation.
The Director shall annually determine monthly rates of
payment subject to the following constraints: for those
community colleges with annuitants only enrolled, first year
rates shall be equal to the average cost to cover claims for
a State member adjusted for demographics, Medicare
participation, and other factors; and in the second year, a
further adjustment of rates shall be made to reflect the
actual first year's claims experience of the covered
annuitants.
(m) The Director shall adopt any rules deemed necessary
for implementation of this amendatory Act of 1989 (Public Act
86-978).
(Source: P.A. 89-53, eff. 7-1-95; 89-236, eff. 8-4-95;
89-324, eff. 8-13-95; 89-626, eff. 8-9-96; 90-65, eff.
7-7-97; 90-582, eff. 5-27-98; 90-655, eff. 7-30-98; revised
8-3-98.)
Section 99. Effective date. This Act takes effect upon
becoming law.
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