102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
HB5831

 

Introduced 11/16/2022, by Rep. Michael T. Marron and Thomas M. Bennett

 

SYNOPSIS AS INTRODUCED:
 
5 ILCS 375/5  from Ch. 127, par. 525
5 ILCS 375/6.5

    Amends the State Employees Group Insurance Act of 1971. Provides that if, on the effective date of the amendatory Act, the Director of Central Management Services has procured fewer than 2 contracts that provide a program of group health benefits for annuitants or for TRS benefit recipients and their TRS dependent beneficiaries, then, as soon as possible after the effective date of the amendatory Act, the Director shall procure additional contracts that provide a program of group health benefits for annuitants or for TRS benefit recipients and their TRS dependent beneficiaries so that there are at least 2 contracts that provide a program of group health benefits for the respective beneficiaries. Provides that thereafter, the Director shall ensure that there are at least 2 contracts procured that provide a program of group health benefits for annuitants and for TRS benefit recipients and their TRS dependent beneficiaries. Effective immediately.


LRB102 29319 BMS 41296 b

 

 

A BILL FOR

 

HB5831LRB102 29319 BMS 41296 b

1    AN ACT concerning State 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 5 and 6.5 as follows:
 
6    (5 ILCS 375/5)  (from Ch. 127, par. 525)
7    Sec. 5. Employee benefits; declaration of State policy.
8The General Assembly declares that it is the policy of the
9State and in the best interest of the State to assure quality
10benefits to members and their dependents under this Act. The
11implementation of this policy depends upon, among other
12things, stability and continuity of coverage, care, and
13services under benefit programs for members and their
14dependents. Specifically, but without limitation, members
15should have continued access, on substantially similar terms
16and conditions, to trusted family health care providers with
17whom they have developed long-term relationships through a
18benefit program under this Act. Therefore, the Director must
19administer this Act consistent with that State policy, but may
20consider affordability, cost of coverage and care, and
21competition among health insurers and providers. All contracts
22for provision of employee benefits, including those portions
23of any proposed collective bargaining agreement that would

 

 

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1require implementation through contracts entered into under
2this Act, are subject to the following requirements:
3        (i) By April 1 of each year, the Director must report
4    and provide information to the Commission concerning the
5    status of the employee benefits program to be offered for
6    the next fiscal year. Information includes, but is not
7    limited to, documents, reports of negotiations, bid
8    invitations, requests for proposals, specifications,
9    copies of proposed and final contracts or agreements, and
10    any other materials concerning contracts or agreements for
11    the employee benefits program. By the first of each month
12    thereafter, the Director must provide updated, and any
13    new, information to the Commission until the employee
14    benefits program for the next fiscal year is determined.
15    In addition to these monthly reporting requirements, at
16    any time the Commission makes a written request, the
17    Director must promptly, but in no event later than 5
18    business days after receipt of the request, provide to the
19    Commission any additional requested information in the
20    possession of the Director concerning employee benefits
21    programs. The Commission may waive any of the reporting
22    requirements of this item (i) upon the written request by
23    the Director. Any waiver granted under this item (i) must
24    be in writing. Nothing in this item is intended to
25    abrogate any attorney-client privilege.
26        (ii) Within 30 days after notice of the awarding or

 

 

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1    letting of a contract has appeared in the Illinois
2    Procurement Bulletin in accordance with subsection (b) of
3    Section 15-25 of the Illinois Procurement Code, the
4    Commission may request in writing from the Director and
5    the Director shall promptly, but in no event later than 5
6    business days after receipt of the request, provide to the
7    Commission information in the possession of the Director
8    concerning the proposed contract. Nothing in this item is
9    intended to waive or abrogate any privilege or right of
10    confidentiality authorized by law.
11        (iii) Except as otherwise provided in this item (iii),
12    no contract subject to this Section may be entered into
13    until the 30-day period described in item (ii) has
14    expired, unless the Director requests in writing that the
15    Commission waive the period and the Commission grants the
16    waiver in writing. This item (iii) does not apply to any
17    contract entered into after the effective date of this
18    amendatory Act of the 98th General Assembly and through
19    January 1, 2014 to provide a program of group health
20    benefits for Medicare-primary members and their
21    Medicare-primary dependents that is comparable in
22    stability and continuity of coverage, care, and services
23    to the program of health benefits offered to other members
24    and their dependents under this Act.
25        (iv) If the Director seeks to make any substantive
26    modification to any provision of a proposed contract after

 

 

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1    it is submitted to the Commission in accordance with item
2    (ii), the modified contract shall be subject to the
3    requirements of items (ii) and (iii) unless the Commission
4    agrees, in writing, to a waiver of those requirements with
5    respect to the modified contract.
6        (v) By the date of the beginning of the annual benefit
7    choice period, the Director must transmit to the
8    Commission a copy of each final contract or agreement for
9    the employee benefits program to be offered for the next
10    fiscal year. The annual benefit choice period for an
11    employee benefits program must begin on May 1 of the
12    fiscal year preceding the year for which the program is to
13    be offered. If, however, in any such preceding fiscal year
14    collective bargaining over employee benefit programs for
15    the next fiscal year remains pending on April 15, the
16    beginning date of the annual benefit choice period shall
17    be not later than 15 days after ratification of the
18    collective bargaining agreement.
19        (vi) The Director must provide the reports,
20    information, and contracts required under items (i), (ii),
21    (iv), and (v) by electronic or other means satisfactory to
22    the Commission. Reports, information, and contracts in the
23    possession of the Commission pursuant to items (i), (ii),
24    (iv), and (v) are exempt from disclosure by the Commission
25    and its members and employees under the Freedom of
26    Information Act. Reports, information, and contracts

 

 

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1    received by the Commission pursuant to items (i), (ii),
2    (iv), and (v) must be kept confidential by and may not be
3    disclosed or used by the Commission or its members or
4    employees if such disclosure or use could compromise the
5    fairness or integrity of the procurement, bidding, or
6    contract process. Commission meetings, or portions of
7    Commission meetings, in which reports, information, and
8    contracts received by the Commission pursuant to items
9    (i), (ii), (iv), and (v) are discussed must be closed if
10    disclosure or use of the report or information could
11    compromise the fairness or integrity of the procurement,
12    bidding, or contract process.
13    All contracts entered into under this Section are subject
14to appropriation and shall comply with Section 20-60(b) of the
15Illinois Procurement Code (30 ILCS 500/20-60(b)).
16    The Director shall contract or otherwise make available
17group life insurance, health benefits and other employee
18benefits to eligible members and, where elected, their
19eligible dependents. Any contract or, if applicable, contracts
20or other arrangement for provision of benefits shall be on
21terms consistent with State policy and based on, but not
22limited to, such criteria as administrative cost, service
23capabilities of the carrier or other contractor and premiums,
24fees or charges as related to benefits.
25    If, on the effective date of this amendatory Act of the
26102nd General Assembly, the Director has procured fewer than 2

 

 

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1contracts that provide a program of group health benefits for
2annuitants, then, as soon as possible after the effective date
3of this amendatory Act of the 102nd General Assembly, the
4Director shall procure additional contracts that provide a
5program of group health benefits for annuitants so that there
6are at least 2 contracts that provide a program of group health
7benefits for annuitants. Thereafter, the Director shall ensure
8that there are at least 2 contracts procured that provide a
9program of group health benefits for annuitants.
10    Notwithstanding any other provisions of this Act, by
11January 1, 2014, the Department of Central Management
12Services, in consultation with and subject to the approval of
13the Chief Procurement Officer, shall contract or make
14otherwise available a program of group health benefits for
15Medicare-primary members and their Medicare-primary
16dependents. The Director may procure a single contract or
17multiple contracts that provide a program of group health
18benefits that is comparable in stability and continuity of
19coverage, care, and services to the program of health benefits
20offered to other members and their dependents under this Act.
21The initial procurement of a contract or contracts under this
22paragraph is not subject to the provisions of the Illinois
23Procurement Code, except for Sections 20-60, 20-65, 20-70, and
2420-160 and Article 50 of that Code, provided that the Chief
25Procurement Officer may, in writing with justification, waive
26any certification required under Article 50.

 

 

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1    The Director may prepare and issue specifications for
2group life insurance, health benefits, other employee benefits
3and administrative services for the purpose of receiving
4proposals from interested parties.
5    The Director is authorized to execute a contract, or
6contracts, for the programs of group life insurance, health
7benefits, other employee benefits and administrative services
8authorized by this Act (including, without limitation,
9prescription drug benefits). All of the benefits provided
10under this Act may be included in one or more contracts, or the
11benefits may be classified into different types with each type
12included under one or more similar contracts with the same or
13different companies.
14    The term of any contract may not extend beyond 5 fiscal
15years. Upon recommendation of the Commission, the Director may
16exercise renewal options of the same contract for up to a
17period of 5 years. Any increases in premiums, fees or charges
18requested by a contractor whose contract may be renewed
19pursuant to a renewal option contained therein, must be
20justified on the basis of (1) audited experience data, (2)
21increases in the costs of health care services provided under
22the contract, (3) contractor performance, (4) increases in
23contractor responsibilities, or (5) any combination thereof.
24    Any contractor shall agree to abide by all requirements of
25this Act and Rules and Regulations promulgated and adopted
26thereto; to submit such information and data as may from time

 

 

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1to time be deemed necessary by the Director for effective
2administration of the provisions of this Act and the programs
3established hereunder, and to fully cooperate in any audit.
4(Source: P.A. 98-19, eff. 6-10-13.)
 
5    (5 ILCS 375/6.5)
6    Sec. 6.5. Health benefits for TRS benefit recipients and
7TRS dependent beneficiaries.
8    (a) Purpose. It is the purpose of this amendatory Act of
91995 to transfer the administration of the program of health
10benefits established for benefit recipients and their
11dependent beneficiaries under Article 16 of the Illinois
12Pension Code to the Department of Central Management Services.
13    (b) Transition provisions. The Board of Trustees of the
14Teachers' Retirement System shall continue to administer the
15health benefit program established under Article 16 of the
16Illinois Pension Code through December 31, 1995. Beginning
17January 1, 1996, the Department of Central Management Services
18shall be responsible for administering a program of health
19benefits for TRS benefit recipients and TRS dependent
20beneficiaries under this Section. The Department of Central
21Management Services and the Teachers' Retirement System shall
22cooperate in this endeavor and shall coordinate their
23activities so as to ensure a smooth transition and
24uninterrupted health benefit coverage.
25    (c) Eligibility. All persons who were enrolled in the

 

 

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1Article 16 program at the time of the transfer shall be
2eligible to participate in the program established under this
3Section without any interruption or delay in coverage or
4limitation as to pre-existing medical conditions. Eligibility
5to participate shall be determined by the Teachers' Retirement
6System. Eligibility information shall be communicated to the
7Department of Central Management Services in a format
8acceptable to the Department.
9    Eligible TRS benefit recipients may enroll or re-enroll in
10the program of health benefits established under this Section
11during any applicable annual open enrollment period and as
12otherwise permitted by the Department of Central Management
13Services. A TRS benefit recipient shall not be deemed
14ineligible to participate solely by reason of the TRS benefit
15recipient having made a previous election to disenroll or
16otherwise not participate in the program of health benefits.
17    A TRS dependent beneficiary who is a child age 19 or over
18and mentally or physically disabled does not become ineligible
19to participate by reason of (i) becoming ineligible to be
20claimed as a dependent for Illinois or federal income tax
21purposes or (ii) receiving earned income, so long as those
22earnings are insufficient for the child to be fully
23self-sufficient.
24    (d) Coverage. The level of health benefits provided under
25this Section shall be similar to the level of benefits
26provided by the program previously established under Article

 

 

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116 of the Illinois Pension Code.
2    Group life insurance benefits are not included in the
3benefits to be provided to TRS benefit recipients and TRS
4dependent beneficiaries under this Act.
5    The program of health benefits under this Section may
6include any or all of the benefit limitations, including but
7not limited to a reduction in benefits based on eligibility
8for federal Medicare benefits, that are provided under
9subsection (a) of Section 6 of this Act for other health
10benefit programs under this Act.
11    (e) Insurance rates and premiums. The Director shall
12determine the insurance rates and premiums for TRS benefit
13recipients and TRS dependent beneficiaries, and shall present
14to the Teachers' Retirement System of the State of Illinois,
15by April 15 of each calendar year, the rate-setting
16methodology (including but not limited to utilization levels
17and costs) used to determine the amount of the health care
18premiums.
19        For Fiscal Year 1996, the premium shall be equal to
20    the premium actually charged in Fiscal Year 1995; in
21    subsequent years, the premium shall never be lower than
22    the premium charged in Fiscal Year 1995.
23        For Fiscal Year 2003, the premium shall not exceed
24    110% of the premium actually charged in Fiscal Year 2002.
25        For Fiscal Year 2004, the premium shall not exceed
26    112% of the premium actually charged in Fiscal Year 2003.

 

 

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1        For Fiscal Year 2005, the premium shall not exceed a
2    weighted average of 106.6% of the premium actually charged
3    in Fiscal Year 2004.
4        For Fiscal Year 2006, the premium shall not exceed a
5    weighted average of 109.1% of the premium actually charged
6    in Fiscal Year 2005.
7        For Fiscal Year 2007, the premium shall not exceed a
8    weighted average of 103.9% of the premium actually charged
9    in Fiscal Year 2006.
10        For Fiscal Year 2008 and thereafter, the premium in
11    each fiscal year shall not exceed 105% of the premium
12    actually charged in the previous fiscal year.
13    Rates and premiums may be based in part on age and
14eligibility for federal medicare coverage. However, the cost
15of participation for a TRS dependent beneficiary who is an
16unmarried child age 19 or over and mentally or physically
17disabled shall not exceed the cost for a TRS dependent
18beneficiary who is an unmarried child under age 19 and
19participates in the same major medical or managed care
20program.
21    The cost of health benefits under the program shall be
22paid as follows:
23        (1) For a TRS benefit recipient selecting a managed
24    care program, up to 75% of the total insurance rate shall
25    be paid from the Teacher Health Insurance Security Fund.
26    Effective with Fiscal Year 2007 and thereafter, for a TRS

 

 

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1    benefit recipient selecting a managed care program, 75% of
2    the total insurance rate shall be paid from the Teacher
3    Health Insurance Security Fund.
4        (2) For a TRS benefit recipient selecting the major
5    medical coverage program, up to 50% of the total insurance
6    rate shall be paid from the Teacher Health Insurance
7    Security Fund if a managed care program is accessible, as
8    determined by the Teachers' Retirement System. Effective
9    with Fiscal Year 2007 and thereafter, for a TRS benefit
10    recipient selecting the major medical coverage program,
11    50% of the total insurance rate shall be paid from the
12    Teacher Health Insurance Security Fund if a managed care
13    program is accessible, as determined by the Department of
14    Central Management Services.
15        (3) For a TRS benefit recipient selecting the major
16    medical coverage program, up to 75% of the total insurance
17    rate shall be paid from the Teacher Health Insurance
18    Security Fund if a managed care program is not accessible,
19    as determined by the Teachers' Retirement System.
20    Effective with Fiscal Year 2007 and thereafter, for a TRS
21    benefit recipient selecting the major medical coverage
22    program, 75% of the total insurance rate shall be paid
23    from the Teacher Health Insurance Security Fund if a
24    managed care program is not accessible, as determined by
25    the Department of Central Management Services.
26        (3.1) For a TRS dependent beneficiary who is Medicare

 

 

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1    primary and enrolled in a managed care plan, or the major
2    medical coverage program if a managed care plan is not
3    available, 25% of the total insurance rate shall be paid
4    from the Teacher Health Security Fund as determined by the
5    Department of Central Management Services. For the purpose
6    of this item (3.1), the term "TRS dependent beneficiary
7    who is Medicare primary" means a TRS dependent beneficiary
8    who is participating in Medicare Parts A and B.
9        (4) Except as otherwise provided in item (3.1), the
10    balance of the rate of insurance, including the entire
11    premium of any coverage for TRS dependent beneficiaries
12    that has been elected, shall be paid by deductions
13    authorized by the TRS benefit recipient to be withheld
14    from his or her monthly annuity or benefit payment from
15    the Teachers' Retirement System; except that (i) if the
16    balance of the cost of coverage exceeds the amount of the
17    monthly annuity or benefit payment, the difference shall
18    be paid directly to the Teachers' Retirement System by the
19    TRS benefit recipient, and (ii) all or part of the balance
20    of the cost of coverage may, at the school board's option,
21    be paid to the Teachers' Retirement System by the school
22    board of the school district from which the TRS benefit
23    recipient retired, in accordance with Section 10-22.3b of
24    the School Code. The Teachers' Retirement System shall
25    promptly deposit all moneys withheld by or paid to it
26    under this subdivision (e)(4) into the Teacher Health

 

 

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1    Insurance Security Fund. These moneys shall not be
2    considered assets of the Retirement System.
3        (5) If, for any month beginning on or after January 1,
4    2013, a TRS benefit recipient or TRS dependent beneficiary
5    was enrolled in Medicare Parts A and B and such Medicare
6    coverage was primary to coverage under this Section but
7    payment for coverage under this Section was made at a rate
8    greater than the Medicare primary rate published by the
9    Department of Central Management Services, the TRS benefit
10    recipient or TRS dependent beneficiary shall be eligible
11    for a refund equal to the difference between the amount
12    paid by the TRS benefit recipient or TRS dependent
13    beneficiary and the published Medicare primary rate. To
14    receive a refund pursuant to this subsection, the TRS
15    benefit recipient or TRS dependent beneficiary must
16    provide documentation to the Department of Central
17    Management Services evidencing the TRS benefit recipient's
18    or TRS dependent beneficiary's Medicare coverage and the
19    amount paid by the TRS benefit recipient or TRS dependent
20    beneficiary during the applicable time period.
21    (f) Financing. Beginning July 1, 1995, all revenues
22arising from the administration of the health benefit programs
23established under Article 16 of the Illinois Pension Code or
24this Section shall be deposited into the Teacher Health
25Insurance Security Fund, which is hereby created as a
26nonappropriated trust fund to be held outside the State

 

 

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1Treasury, with the State Treasurer as custodian. Any interest
2earned on moneys in the Teacher Health Insurance Security Fund
3shall be deposited into the Fund.
4    Moneys in the Teacher Health Insurance Security Fund shall
5be used only to pay the costs of the health benefit program
6established under this Section, including associated
7administrative costs, and the costs associated with the health
8benefit program established under Article 16 of the Illinois
9Pension Code, as authorized in this Section. Beginning July 1,
101995, the Department of Central Management Services may make
11expenditures from the Teacher Health Insurance Security Fund
12for those costs.
13    After other funds authorized for the payment of the costs
14of the health benefit program established under Article 16 of
15the Illinois Pension Code are exhausted and until January 1,
161996 (or such later date as may be agreed upon by the Director
17of Central Management Services and the Secretary of the
18Teachers' Retirement System), the Secretary of the Teachers'
19Retirement System may make expenditures from the Teacher
20Health Insurance Security Fund as necessary to pay up to 75% of
21the cost of providing health coverage to eligible benefit
22recipients (as defined in Sections 16-153.1 and 16-153.3 of
23the Illinois Pension Code) who are enrolled in the Article 16
24health benefit program and to facilitate the transfer of
25administration of the health benefit program to the Department
26of Central Management Services.

 

 

HB5831- 16 -LRB102 29319 BMS 41296 b

1    The Department of Central Management Services, or any
2successor agency designated to procure healthcare contracts
3pursuant to this Act, is authorized to establish funds,
4separate accounts provided by any bank or banks as defined by
5the Illinois Banking Act, or separate accounts provided by any
6savings and loan association or associations as defined by the
7Illinois Savings and Loan Act of 1985 to be held by the
8Director, outside the State treasury, for the purpose of
9receiving the transfer of moneys from the Teacher Health
10Insurance Security Fund. The Department may promulgate rules
11further defining the methodology for the transfers. Any
12interest earned by moneys in the funds or accounts shall inure
13to the Teacher Health Insurance Security Fund. The transferred
14moneys, and interest accrued thereon, shall be used
15exclusively for transfers to administrative service
16organizations or their financial institutions for payments of
17claims to claimants and providers under the self-insurance
18health plan. The transferred moneys, and interest accrued
19thereon, shall not be used for any other purpose including,
20but not limited to, reimbursement of administration fees due
21the administrative service organization pursuant to its
22contract or contracts with the Department.
23    (g) Contract for benefits. The Director shall by contract,
24self-insurance, or otherwise make available the program of
25health benefits for TRS benefit recipients and their TRS
26dependent beneficiaries that is provided for in this Section.

 

 

HB5831- 17 -LRB102 29319 BMS 41296 b

1The contract or other arrangement for the provision of these
2health benefits shall be on terms deemed by the Director to be
3in the best interest of the State of Illinois and the TRS
4benefit recipients based on, but not limited to, such criteria
5as administrative cost, service capabilities of the carrier or
6other contractor, and the costs of the benefits.
7    If, on the effective date of this amendatory Act of the
8102nd General Assembly, the Director has procured fewer than 2
9contracts that provide a program of group health benefits for
10TRS benefit recipients and their TRS dependent beneficiaries,
11then, as soon as possible after the effective date of this
12amendatory Act of the 102nd General Assembly, the Director
13shall procure additional contracts that provide a program of
14group health benefits for TRS benefit recipients and their TRS
15dependent beneficiaries so that there are at least 2 contracts
16that provide a program of group health benefits for TRS
17benefit recipients and their TRS dependent beneficiaries.
18Thereafter, the Director shall ensure that there are at least
192 contracts procured that provide a program of group health
20benefits for TRS benefit recipients and their TRS dependent
21beneficiaries.
22    (g-5) Committee. A Teacher Retirement Insurance Program
23Committee shall be established, to consist of 10 persons
24appointed by the Governor.
25    The Committee shall convene at least 4 times each year,
26and shall consider and make recommendations on issues

 

 

HB5831- 18 -LRB102 29319 BMS 41296 b

1affecting the program of health benefits provided under this
2Section. Recommendations of the Committee shall be based on a
3consensus of the members of the Committee.
4    If the Teacher Health Insurance Security Fund experiences
5a deficit balance based upon the contribution and subsidy
6rates established in this Section and Section 6.6 for Fiscal
7Year 2008 or thereafter, the Committee shall make
8recommendations for adjustments to the funding sources
9established under these Sections.
10    In addition, the Committee shall identify proposed
11solutions to the funding shortfalls that are affecting the
12Teacher Health Insurance Security Fund, and it shall report
13those solutions to the Governor and the General Assembly
14within 6 months after August 15, 2011 (the effective date of
15Public Act 97-386).
16    (h) Continuation of program. It is the intention of the
17General Assembly that the program of health benefits provided
18under this Section be maintained on an ongoing, affordable
19basis.
20    The program of health benefits provided under this Section
21may be amended by the State and is not intended to be a pension
22or retirement benefit subject to protection under Article
23XIII, Section 5 of the Illinois Constitution.
24    (i) Repeal. (Blank).
25(Source: P.A. 101-483, eff. 1-1-20; 102-210, eff. 7-30-21.)
 
26    Section 99. Effective date. This Act takes effect upon

 

 

HB5831- 19 -LRB102 29319 BMS 41296 b

1becoming law.