101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
HB4036

 

Introduced 1/8/2020, by Rep. Sue Scherer

 

SYNOPSIS AS INTRODUCED:
 
5 ILCS 375/3  from Ch. 127, par. 523
5 ILCS 375/8  from Ch. 127, par. 528

    Amends the State Employees Group Insurance Act of 1971. Defines "qualifying change in status" for the purpose of clarifying those persons who may be eligible for health coverage under the Act as an employee, spouse, or dependent due to such change in status. Makes a conforming change. Effective immediately.


LRB101 15278 RJF 64455 b

 

 

A BILL FOR

 

HB4036LRB101 15278 RJF 64455 b

1    AN ACT concerning government.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The State Employees Group Insurance Act of 1971
5is amended by changing Sections 3 and 8 as follows:
 
6    (5 ILCS 375/3)  (from Ch. 127, par. 523)
7    Sec. 3. Definitions. Unless the context otherwise
8requires, the following words and phrases as used in this Act
9shall have the following meanings. The Department may define
10these and other words and phrases separately for the purpose of
11implementing specific programs providing benefits under this
12Act.
13    (a) "Administrative service organization" means any
14person, firm or corporation experienced in the handling of
15claims which is fully qualified, financially sound and capable
16of meeting the service requirements of a contract of
17administration executed with the Department.
18    (b) "Annuitant" means (1) an employee who retires, or has
19retired, on or after January 1, 1966 on an immediate annuity
20under the provisions of Articles 2, 14 (including an employee
21who has elected to receive an alternative retirement
22cancellation payment under Section 14-108.5 of the Illinois
23Pension Code in lieu of an annuity or who meets the criteria

 

 

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1for retirement, but in lieu of receiving an annuity under that
2Article has elected to receive an accelerated pension benefit
3payment under Section 14-147.5 of that Article), 15 (including
4an employee who has retired under the optional retirement
5program established under Section 15-158.2 or who meets the
6criteria for retirement but in lieu of receiving an annuity
7under that Article has elected to receive an accelerated
8pension benefit payment under Section 15-185.5 of the Article),
9paragraphs (2), (3), or (5) of Section 16-106 (including an
10employee who meets the criteria for retirement, but in lieu of
11receiving an annuity under that Article has elected to receive
12an accelerated pension benefit payment under Section 16-190.5
13of the Illinois Pension Code), or Article 18 of the Illinois
14Pension Code; (2) any person who was receiving group insurance
15coverage under this Act as of March 31, 1978 by reason of his
16status as an annuitant, even though the annuity in relation to
17which such coverage was provided is a proportional annuity
18based on less than the minimum period of service required for a
19retirement annuity in the system involved; (3) any person not
20otherwise covered by this Act who has retired as a
21participating member under Article 2 of the Illinois Pension
22Code but is ineligible for the retirement annuity under Section
232-119 of the Illinois Pension Code; (4) the spouse of any
24person who is receiving a retirement annuity under Article 18
25of the Illinois Pension Code and who is covered under a group
26health insurance program sponsored by a governmental employer

 

 

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1other than the State of Illinois and who has irrevocably
2elected to waive his or her coverage under this Act and to have
3his or her spouse considered as the "annuitant" under this Act
4and not as a "dependent"; or (5) an employee who retires, or
5has retired, from a qualified position, as determined according
6to rules promulgated by the Director, under a qualified local
7government, a qualified rehabilitation facility, a qualified
8domestic violence shelter or service, or a qualified child
9advocacy center. (For definition of "retired employee", see (p)
10post).
11    (b-5) (Blank).
12    (b-6) (Blank).
13    (b-7) (Blank).
14    (c) "Carrier" means (1) an insurance company, a corporation
15organized under the Limited Health Service Organization Act or
16the Voluntary Health Services Plans Plan Act, a partnership, or
17other nongovernmental organization, which is authorized to do
18group life or group health insurance business in Illinois, or
19(2) the State of Illinois as a self-insurer.
20    (d) "Compensation" means salary or wages payable on a
21regular payroll by the State Treasurer on a warrant of the
22State Comptroller out of any State, trust or federal fund, or
23by the Governor of the State through a disbursing officer of
24the State out of a trust or out of federal funds, or by any
25Department out of State, trust, federal or other funds held by
26the State Treasurer or the Department, to any person for

 

 

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1personal services currently performed, and ordinary or
2accidental disability benefits under Articles 2, 14, 15
3(including ordinary or accidental disability benefits under
4the optional retirement program established under Section
515-158.2), paragraphs (2), (3), or (5) of Section 16-106, or
6Article 18 of the Illinois Pension Code, for disability
7incurred after January 1, 1966, or benefits payable under the
8Workers' Compensation or Occupational Diseases Act or benefits
9payable under a sick pay plan established in accordance with
10Section 36 of the State Finance Act. "Compensation" also means
11salary or wages paid to an employee of any qualified local
12government, qualified rehabilitation facility, qualified
13domestic violence shelter or service, or qualified child
14advocacy center.
15    (e) "Commission" means the State Employees Group Insurance
16Advisory Commission authorized by this Act. Commencing July 1,
171984, "Commission" as used in this Act means the Commission on
18Government Forecasting and Accountability as established by
19the Legislative Commission Reorganization Act of 1984.
20    (f) "Contributory", when referred to as contributory
21coverage, shall mean optional coverages or benefits elected by
22the member toward the cost of which such member makes
23contribution, or which are funded in whole or in part through
24the acceptance of a reduction in earnings or the foregoing of
25an increase in earnings by an employee, as distinguished from
26noncontributory coverage or benefits which are paid entirely by

 

 

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1the State of Illinois without reduction of the member's salary.
2    (g) "Department" means any department, institution, board,
3commission, officer, court or any agency of the State
4government receiving appropriations and having power to
5certify payrolls to the Comptroller authorizing payments of
6salary and wages against such appropriations as are made by the
7General Assembly from any State fund, or against trust funds
8held by the State Treasurer and includes boards of trustees of
9the retirement systems created by Articles 2, 14, 15, 16, and
1018 of the Illinois Pension Code. "Department" also includes the
11Illinois Comprehensive Health Insurance Board, the Board of
12Examiners established under the Illinois Public Accounting
13Act, and the Illinois Finance Authority.
14    (h) "Dependent", when the term is used in the context of
15the health and life plan, means a member's spouse and any child
16(1) from birth to age 26 including an adopted child, a child
17who lives with the member from the time of the placement for
18adoption until entry of an order of adoption, a stepchild or
19adjudicated child, or a child who lives with the member if such
20member is a court appointed guardian of the child or (2) age 19
21or over who has a mental or physical disability from a cause
22originating prior to the age of 19 (age 26 if enrolled as an
23adult child dependent). For the health plan only, the term
24"dependent" also includes (1) any person enrolled prior to the
25effective date of this Section who is dependent upon the member
26to the extent that the member may claim such person as a

 

 

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1dependent for income tax deduction purposes and (2) any person
2who has received after June 30, 2000 an organ transplant and
3who is financially dependent upon the member and eligible to be
4claimed as a dependent for income tax purposes. A member
5requesting to cover any dependent must provide documentation as
6requested by the Department of Central Management Services and
7file with the Department any and all forms required by the
8Department.
9    (i) "Director" means the Director of the Illinois
10Department of Central Management Services.
11    (j) "Eligibility period" means the period of time a member
12has to elect enrollment in programs or to select benefits
13without regard to age, sex or health.
14    (k) "Employee" means and includes each officer or employee
15in the service of a department who (1) receives his
16compensation for service rendered to the department on a
17warrant issued pursuant to a payroll certified by a department
18or on a warrant or check issued and drawn by a department upon
19a trust, federal or other fund or on a warrant issued pursuant
20to a payroll certified by an elected or duly appointed officer
21of the State or who receives payment of the performance of
22personal services on a warrant issued pursuant to a payroll
23certified by a Department and drawn by the Comptroller upon the
24State Treasurer against appropriations made by the General
25Assembly from any fund or against trust funds held by the State
26Treasurer, and (2) is employed full-time or part-time in a

 

 

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1position normally requiring actual performance of duty during
2not less than 1/2 of a normal work period, as established by
3the Director in cooperation with each department, except that
4persons elected by popular vote will be considered employees
5during the entire term for which they are elected regardless of
6hours devoted to the service of the State, and (3) except that
7"employee" does not include any person who is not eligible by
8reason of such person's employment to participate in one of the
9State retirement systems under Articles 2, 14, 15 (either the
10regular Article 15 system or the optional retirement program
11established under Section 15-158.2), or 18, or under paragraph
12(2), (3), or (5) of Section 16-106, of the Illinois Pension
13Code, but such term does include persons who are employed
14during the 6 month qualifying period under Article 14 of the
15Illinois Pension Code. Such term also includes any person who
16(1) after January 1, 1966, is receiving ordinary or accidental
17disability benefits under Articles 2, 14, 15 (including
18ordinary or accidental disability benefits under the optional
19retirement program established under Section 15-158.2),
20paragraphs (2), (3), or (5) of Section 16-106, or Article 18 of
21the Illinois Pension Code, for disability incurred after
22January 1, 1966, (2) receives total permanent or total
23temporary disability under the Workers' Compensation Act or
24Occupational Disease Act as a result of injuries sustained or
25illness contracted in the course of employment with the State
26of Illinois, or (3) is not otherwise covered under this Act and

 

 

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1has retired as a participating member under Article 2 of the
2Illinois Pension Code but is ineligible for the retirement
3annuity under Section 2-119 of the Illinois Pension Code.
4However, a person who satisfies the criteria of the foregoing
5definition of "employee" except that such person is made
6ineligible to participate in the State Universities Retirement
7System by clause (4) of subsection (a) of Section 15-107 of the
8Illinois Pension Code is also an "employee" for the purposes of
9this Act. "Employee" also includes any person receiving or
10eligible for benefits under a sick pay plan established in
11accordance with Section 36 of the State Finance Act. "Employee"
12also includes (i) each officer or employee in the service of a
13qualified local government, including persons appointed as
14trustees of sanitary districts regardless of hours devoted to
15the service of the sanitary district, (ii) each employee in the
16service of a qualified rehabilitation facility, (iii) each
17full-time employee in the service of a qualified domestic
18violence shelter or service, and (iv) each full-time employee
19in the service of a qualified child advocacy center, as
20determined according to rules promulgated by the Director.
21    (l) "Member" means an employee, annuitant, retired
22employee or survivor. In the case of an annuitant or retired
23employee who first becomes an annuitant or retired employee on
24or after January 13, 2012 (the effective date of Public Act
2597-668) this amendatory Act of the 97th General Assembly, the
26individual must meet the minimum vesting requirements of the

 

 

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1applicable retirement system in order to be eligible for group
2insurance benefits under that system. In the case of a survivor
3who first becomes a survivor on or after January 13, 2012 (the
4effective date of Public Act 97-668) this amendatory Act of the
597th General Assembly, the deceased employee, annuitant, or
6retired employee upon whom the annuity is based must have been
7eligible to participate in the group insurance system under the
8applicable retirement system in order for the survivor to be
9eligible for group insurance benefits under that system.
10    (m) "Optional coverages or benefits" means those coverages
11or benefits available to the member on his or her voluntary
12election, and at his or her own expense.
13    (n) "Program" means the group life insurance, health
14benefits and other employee benefits designed and contracted
15for by the Director under this Act.
16    (o) "Health plan" means a health benefits program offered
17by the State of Illinois for persons eligible for the plan.
18    (p) "Retired employee" means any person who would be an
19annuitant as that term is defined herein but for the fact that
20such person retired prior to January 1, 1966. Such term also
21includes any person formerly employed by the University of
22Illinois in the Cooperative Extension Service who would be an
23annuitant but for the fact that such person was made ineligible
24to participate in the State Universities Retirement System by
25clause (4) of subsection (a) of Section 15-107 of the Illinois
26Pension Code.

 

 

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1    (q) "Survivor" means a person receiving an annuity as a
2survivor of an employee or of an annuitant. "Survivor" also
3includes: (1) the surviving dependent of a person who satisfies
4the definition of "employee" except that such person is made
5ineligible to participate in the State Universities Retirement
6System by clause (4) of subsection (a) of Section 15-107 of the
7Illinois Pension Code; (2) the surviving dependent of any
8person formerly employed by the University of Illinois in the
9Cooperative Extension Service who would be an annuitant except
10for the fact that such person was made ineligible to
11participate in the State Universities Retirement System by
12clause (4) of subsection (a) of Section 15-107 of the Illinois
13Pension Code; (3) the surviving dependent of a person who was
14an annuitant under this Act by virtue of receiving an
15alternative retirement cancellation payment under Section
1614-108.5 of the Illinois Pension Code; and (4) a person who
17would be receiving an annuity as a survivor of an annuitant
18except that the annuitant elected on or after June 4, 2018 to
19receive an accelerated pension benefit payment under Section
2014-147.5, 15-185.5, or 16-190.5 of the Illinois Pension Code in
21lieu of receiving an annuity.
22    (q-2) "SERS" means the State Employees' Retirement System
23of Illinois, created under Article 14 of the Illinois Pension
24Code.
25    (q-3) "SURS" means the State Universities Retirement
26System, created under Article 15 of the Illinois Pension Code.

 

 

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1    (q-4) "TRS" means the Teachers' Retirement System of the
2State of Illinois, created under Article 16 of the Illinois
3Pension Code.
4    (q-5) (Blank).
5    (q-6) (Blank).
6    (q-7) (Blank).
7    (r) "Medical services" means the services provided within
8the scope of their licenses by practitioners in all categories
9licensed under the Medical Practice Act of 1987.
10    (s) "Unit of local government" means any county,
11municipality, township, school district (including a
12combination of school districts under the Intergovernmental
13Cooperation Act), special district or other unit, designated as
14a unit of local government by law, which exercises limited
15governmental powers or powers in respect to limited
16governmental subjects, any not-for-profit association with a
17membership that primarily includes townships and township
18officials, that has duties that include provision of research
19service, dissemination of information, and other acts for the
20purpose of improving township government, and that is funded
21wholly or partly in accordance with Section 85-15 of the
22Township Code; any not-for-profit corporation or association,
23with a membership consisting primarily of municipalities, that
24operates its own utility system, and provides research,
25training, dissemination of information, or other acts to
26promote cooperation between and among municipalities that

 

 

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1provide utility services and for the advancement of the goals
2and purposes of its membership; the Southern Illinois
3Collegiate Common Market, which is a consortium of higher
4education institutions in Southern Illinois; the Illinois
5Association of Park Districts; and any hospital provider that
6is owned by a county that has 100 or fewer hospital beds and
7has not already joined the program. "Qualified local
8government" means a unit of local government approved by the
9Director and participating in a program created under
10subsection (i) of Section 10 of this Act.
11    (t) "Qualified rehabilitation facility" means any
12not-for-profit organization that is accredited by the
13Commission on Accreditation of Rehabilitation Facilities or
14certified by the Department of Human Services (as successor to
15the Department of Mental Health and Developmental
16Disabilities) to provide services to persons with disabilities
17and which receives funds from the State of Illinois for
18providing those services, approved by the Director and
19participating in a program created under subsection (j) of
20Section 10 of this Act.
21    (u) "Qualified domestic violence shelter or service" means
22any Illinois domestic violence shelter or service and its
23administrative offices funded by the Department of Human
24Services (as successor to the Illinois Department of Public
25Aid), approved by the Director and participating in a program
26created under subsection (k) of Section 10.

 

 

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1    (v) "TRS benefit recipient" means a person who:
2        (1) is not a "member" as defined in this Section; and
3        (2) is receiving a monthly benefit or retirement
4    annuity under Article 16 of the Illinois Pension Code or
5    would be receiving such monthly benefit or retirement
6    annuity except that the benefit recipient elected on or
7    after June 4, 2018 to receive an accelerated pension
8    benefit payment under Section 16-190.5 of the Illinois
9    Pension Code in lieu of receiving an annuity; and
10        (3) either (i) has at least 8 years of creditable
11    service under Article 16 of the Illinois Pension Code, or
12    (ii) was enrolled in the health insurance program offered
13    under that Article on January 1, 1996, or (iii) is the
14    survivor of a benefit recipient who had at least 8 years of
15    creditable service under Article 16 of the Illinois Pension
16    Code or was enrolled in the health insurance program
17    offered under that Article on June 21, 1995 (the effective
18    date of Public Act 89-25) this amendatory Act of 1995, or
19    (iv) is a recipient or survivor of a recipient of a
20    disability benefit under Article 16 of the Illinois Pension
21    Code.
22    (w) "TRS dependent beneficiary" means a person who:
23        (1) is not a "member" or "dependent" as defined in this
24    Section; and
25        (2) is a TRS benefit recipient's: (A) spouse, (B)
26    dependent parent who is receiving at least half of his or

 

 

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1    her support from the TRS benefit recipient, or (C) natural,
2    step, adjudicated, or adopted child who is (i) under age
3    26, (ii) was, on January 1, 1996, participating as a
4    dependent beneficiary in the health insurance program
5    offered under Article 16 of the Illinois Pension Code, or
6    (iii) age 19 or over who has a mental or physical
7    disability from a cause originating prior to the age of 19
8    (age 26 if enrolled as an adult child).
9    "TRS dependent beneficiary" does not include, as indicated
10under paragraph (2) of this subsection (w), a dependent of the
11survivor of a TRS benefit recipient who first becomes a
12dependent of a survivor of a TRS benefit recipient on or after
13January 13, 2012 (the effective date of Public Act 97-668) this
14amendatory Act of the 97th General Assembly unless that
15dependent would have been eligible for coverage as a dependent
16of the deceased TRS benefit recipient upon whom the survivor
17benefit is based.
18    (x) "Military leave" refers to individuals in basic
19training for reserves, special/advanced training, annual
20training, emergency call up, activation by the President of the
21United States, or any other training or duty in service to the
22United States Armed Forces.
23    (y) (Blank).
24    (z) "Community college benefit recipient" means a person
25who:
26        (1) is not a "member" as defined in this Section; and

 

 

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1        (2) is receiving a monthly survivor's annuity or
2    retirement annuity under Article 15 of the Illinois Pension
3    Code or would be receiving such monthly survivor's annuity
4    or retirement annuity except that the benefit recipient
5    elected on or after June 4, 2018 to receive an accelerated
6    pension benefit payment under Section 15-185.5 of the
7    Illinois Pension Code in lieu of receiving an annuity; and
8        (3) either (i) was a full-time employee of a community
9    college district or an association of community college
10    boards created under the Public Community College Act
11    (other than an employee whose last employer under Article
12    15 of the Illinois Pension Code was a community college
13    district subject to Article VII of the Public Community
14    College Act) and was eligible to participate in a group
15    health benefit plan as an employee during the time of
16    employment with a community college district (other than a
17    community college district subject to Article VII of the
18    Public Community College Act) or an association of
19    community college boards, or (ii) is the survivor of a
20    person described in item (i).
21    (aa) "Community college dependent beneficiary" means a
22person who:
23        (1) is not a "member" or "dependent" as defined in this
24    Section; and
25        (2) is a community college benefit recipient's: (A)
26    spouse, (B) dependent parent who is receiving at least half

 

 

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1    of his or her support from the community college benefit
2    recipient, or (C) natural, step, adjudicated, or adopted
3    child who is (i) under age 26, or (ii) age 19 or over and
4    has a mental or physical disability from a cause
5    originating prior to the age of 19 (age 26 if enrolled as
6    an adult child).
7    "Community college dependent beneficiary" does not
8include, as indicated under paragraph (2) of this subsection
9(aa), a dependent of the survivor of a community college
10benefit recipient who first becomes a dependent of a survivor
11of a community college benefit recipient on or after January
1213, 2012 (the effective date of Public Act 97-668) this
13amendatory Act of the 97th General Assembly unless that
14dependent would have been eligible for coverage as a dependent
15of the deceased community college benefit recipient upon whom
16the survivor annuity is based.
17    (bb) "Qualified child advocacy center" means any Illinois
18child advocacy center and its administrative offices funded by
19the Department of Children and Family Services, as defined by
20the Children's Advocacy Center Act (55 ILCS 80/), approved by
21the Director and participating in a program created under
22subsection (n) of Section 10.
23    (cc) "Placement for adoption" means the assumption and
24retention by a member of a legal obligation for total or
25partial support of a child in anticipation of adoption of the
26child. The child's placement with the member terminates upon

 

 

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1the termination of such legal obligation.
2    (dd) "Qualifying change in status" means an event that
3effects eligibility for health plan coverage, including, but
4not limited to, the following:
5        (1) events that change an employee's legal marital
6    status, including marriage, death of spouse, divorce,
7    legal separation, or annulment;
8        (2) events that change an employee's number of
9    dependents, including birth, death, adoption, or placement
10    for adoption;
11        (3) events that change the employment status of the
12    employee, the employee's spouse, or the employee's
13    dependent, including termination or commencement of
14    employment, strike or lockout, commencement of or return
15    from an unpaid leave of absence, change in worksite, or
16    change in the individual's employment when they cease to be
17    eligible for the program provided under this Act;
18        (4) events that cause an employee's dependent to
19    satisfy or cease to satisfy eligibility requirements for
20    coverage based on age, student status, marital status, or
21    any similar circumstance; and
22        (5) a change of residence for the employee, spouse, or
23    dependent.
24(Source: P.A. 100-355, eff. 1-1-18; 100-587, eff. 6-4-18;
25101-242, eff. 8-9-19; revised 9-19-19.)
 

 

 

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1    (5 ILCS 375/8)  (from Ch. 127, par. 528)
2    Sec. 8. Eligibility.
3    (a) Each employee eligible under the provisions of this Act
4and any rules and regulations promulgated and adopted hereunder
5by the Director shall become immediately eligible and covered
6for all benefits available under the programs. Employees
7electing coverage for eligible dependents shall have the
8coverage effective immediately, provided that the election is
9properly filed in accordance with required filing dates and
10procedures specified by the Director, including the completion
11and submission of all documentation and forms required by the
12Director.
13        (1) Every member originally eligible to elect
14    dependent coverage, but not electing it during the original
15    eligibility period, may subsequently obtain dependent
16    coverage only in the event of a qualifying change in
17    status, as defined under this Act, special enrollment,
18    special circumstance as defined by the Director, or during
19    the annual Benefit Choice Period.
20        (2) Members described above being transferred from
21    previous coverage towards which the State has been
22    contributing shall be transferred regardless of
23    preexisting conditions, waiting periods, or other
24    requirements that might jeopardize claim payments to which
25    they would otherwise have been entitled.
26        (3) Eligible and covered members that are eligible for

 

 

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1    coverage as dependents except for the fact of being members
2    shall be transferred to, and covered under, dependent
3    status regardless of preexisting conditions, waiting
4    periods, or other requirements that might jeopardize claim
5    payments to which they would otherwise have been entitled
6    upon cessation of member status and the election of
7    dependent coverage by a member eligible to elect that
8    coverage.
9    (b) New employees shall be immediately insured for the
10basic group life insurance and covered by the program of health
11benefits on the first day of active State service. Optional
12life insurance coverage one to 4 times the basic amount, if
13elected during the relevant eligibility period, will become
14effective on the date of employment. Optional life insurance
15coverage exceeding 4 times the basic amount and all life
16insurance amounts applied for after the eligibility period will
17be effective, subject to satisfactory evidence of insurability
18when applicable, or other necessary qualifications, pursuant
19to the requirements of the applicable benefit program, unless
20there is a change in status that would confer new eligibility
21for change of enrollment under rules established supplementing
22this Act, in which event application must be made within the
23new eligibility period.
24    (c) As to the group health benefits program contracted to
25begin or continue after June 30, 1973, each annuitant,
26survivor, and retired employee shall become immediately

 

 

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1eligible for all benefits available under that program. Each
2annuitant, survivor, and retired employee shall have coverage
3effective immediately, provided that the election is properly
4filed in accordance with the required filing dates and
5procedures specified by the Director, including the completion
6and submission of all documentation and forms required by the
7Director. Annuitants, survivors, and retired employees may
8elect coverage for eligible dependents and shall have the
9coverage effective immediately, provided that the election is
10properly filed in accordance with required filing dates and
11procedures specified by the Director, except that, for a
12survivor, the dependent sought to be added on or after the
13effective date of this amendatory Act of the 97th General
14Assembly must have been eligible for coverage as a dependent
15under the deceased member upon whom the survivor's annuity is
16based in order to be eligible for coverage under the survivor.
17    Except as otherwise provided in this Act, where husband and
18wife are both eligible members, each shall be enrolled as a
19member and coverage on their eligible dependent children, if
20any, may be under the enrollment and election of either.
21    Regardless of other provisions herein regarding late
22enrollment or other qualifications, as appropriate, the
23Director may periodically authorize open enrollment periods
24for each of the benefit programs at which time each member may
25elect enrollment or change of enrollment without regard to age,
26sex, health, or other qualification under the conditions as may

 

 

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1be prescribed in rules and regulations supplementing this Act.
2Special open enrollment periods may be declared by the Director
3for certain members only when special circumstances occur that
4affect only those members.
5    (d) Beginning with fiscal year 2003 and for all subsequent
6years, eligible members may elect not to participate in the
7program of health benefits as defined in this Act. The election
8must be made during the annual benefit choice period, subject
9to the conditions in this subsection.
10        (1) Members must furnish proof of health benefit
11    coverage, either comprehensive major medical coverage or
12    comprehensive managed care plan, from a source other than
13    the Department of Central Management Services in order to
14    elect not to participate in the program.
15        (2) Members may re-enroll in the Department of Central
16    Management Services program of health benefits upon
17    showing a qualifying change in status, as defined in the
18    U.S. Internal Revenue Code, without evidence of
19    insurability and with no limitations on coverage for
20    pre-existing conditions, provided that there was not a
21    break in coverage of more than 63 days.
22        (3) Members may also re-enroll in the program of health
23    benefits during any annual benefit choice period, without
24    evidence of insurability.
25        (4) Members who elect not to participate in the program
26    of health benefits shall be furnished a written explanation

 

 

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1    of the requirements and limitations for the election not to
2    participate in the program and for re-enrolling in the
3    program. The explanation shall also be included in the
4    annual benefit choice options booklets furnished to
5    members.
6    (d-5) Beginning July 1, 2005, the Director may establish a
7program of financial incentives to encourage annuitants
8receiving a retirement annuity, but who are not eligible for
9benefits under the federal Medicare health insurance program
10(Title XVIII of the Social Security Act, as added by Public Law
1189-97) to elect not to participate in the program of health
12benefits provided under this Act. The election by an annuitant
13not to participate under this program must be made in
14accordance with the requirements set forth under subsection
15(d). The financial incentives provided to these annuitants
16under the program may not exceed $150 per month for each
17annuitant electing not to participate in the program of health
18benefits provided under this Act.
19    (d-6) Beginning July 1, 2013, the Director may establish a
20program of financial incentives to encourage annuitants with 20
21or more years of creditable service but who are not eligible
22for benefits under the federal Medicare health insurance
23program (Title XVIII of the Social Security Act, as added by
24Public Law 89-97) to elect not to participate in the program of
25health benefits provided under this Act. The election by an
26annuitant not to participate under this program must be made in

 

 

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1accordance with the requirements set forth under subsection
2(d). The program established under this subsection (d-6) may
3include a prorated incentive for annuitants with fewer than 20
4years of creditable service, as determined by the Director. The
5financial incentives provided to these annuitants under this
6program may not exceed $500 per month for each annuitant
7electing not to participate in the program of health benefits
8provided under this Act.
9    (e) Notwithstanding any other provision of this Act or the
10rules adopted under this Act, if a person participating in the
11program of health benefits as the dependent spouse of an
12eligible member becomes an annuitant, the person may elect, at
13the time of becoming an annuitant or during any subsequent
14annual benefit choice period, to continue participation as a
15dependent rather than as an eligible member for as long as the
16person continues to be an eligible dependent. In order to be
17eligible to make such an election, the person must have been
18enrolled as a dependent under the program of health benefits
19for no less than one year prior to becoming an annuitant.
20    An eligible member who has elected to participate as a
21dependent may re-enroll in the program of health benefits as an
22eligible member (i) during any subsequent annual benefit choice
23period or (ii) upon showing a qualifying change in status, as
24defined in the U.S. Internal Revenue Code, without evidence of
25insurability and with no limitations on coverage for
26pre-existing conditions.

 

 

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1    A person who elects to participate in the program of health
2benefits as a dependent rather than as an eligible member shall
3be furnished a written explanation of the consequences of
4electing to participate as a dependent and the conditions and
5procedures for re-enrolling as an eligible member. The
6explanation shall also be included in the annual benefit choice
7options booklet furnished to members.
8(Source: P.A. 97-668, eff. 1-13-12; 98-19, eff. 6-10-13.)
 
9    Section 99. Effective date. This Act takes effect upon
10becoming law.