093_HB1031enr HB1031 Enrolled LRB093 05543 DRJ 05635 b 1 AN ACT in relation to State employees. 2 Be it enacted by the People of the State of Illinois, 3 represented in the General Assembly: 4 Section 5. The State Employees Group Insurance Act of 5 1971 is amended by changing Section 6 as follows: 6 (5 ILCS 375/6) (from Ch. 127, par. 526) 7 Sec. 6. Program of health benefits. 8 (a) The program of health benefits shall provide for 9 protection against the financial costs of health care 10 expenses incurred in and out of hospital including basic 11 hospital-surgical-medical coverages. The program may 12 include, but shall not be limited to, such supplemental 13 coverages as out-patient diagnostic X-ray and laboratory 14 expenses, prescription drugs, dental services, hearing 15 evaluations, hearing aids, the dispensing and fitting of 16 hearing aids, and similar group benefits as are now or may 17 become available. However, nothing in this Act shall be 18 construed to permit, on or after July 1, 1980, the 19 non-contributory portion of any such program to include the 20 expenses of obtaining an abortion, induced miscarriage or 21 induced premature birth unless, in the opinion of a 22 physician, such procedures are necessary for the preservation 23 of the life of the woman seeking such treatment, or except an 24 induced premature birth intended to produce a live viable 25 child and such procedure is necessary for the health of the 26 mother or the unborn child. The program may also include 27 coverage for those who rely on treatment by prayer or 28 spiritual means alone for healing in accordance with the 29 tenets and practice of a recognized religious denomination. 30 The program of health benefits shall be designed by the 31 Director (1) to provide a reasonable relationship between the HB1031 Enrolled -2- LRB093 05543 DRJ 05635 b 1 benefits to be included and the expected distribution of 2 expenses of each such type to be incurred by the covered 3 members and dependents, (2) to specify, as covered benefits 4 and as optional benefits, the medical services of 5 practitioners in all categories licensed under the Medical 6 Practice Act of 1987, (3) to include reasonable controls, 7 which may include deductible and co-insurance provisions, 8 applicable to some or all of the benefits, or a coordination 9 of benefits provision, to prevent or minimize unnecessary 10 utilization of the various hospital, surgical and medical 11 expenses to be provided and to provide reasonable assurance 12 of stability of the program, and (4) to provide benefits to 13 the extent possible to members throughout the State, wherever 14 located, on an equitable basis. Notwithstanding any other 15 provision of this Section or Act, for all members or 16 dependents who are eligible for benefits under Social 17 Security or the Railroad Retirement system or who had 18 sufficient Medicare-covered government employment, the 19 Department shall reduce benefits which would otherwise be 20 paid by Medicare, by the amount of benefits for which the 21 member or dependents are eligible under Medicare, except that 22 such reduction in benefits shall apply only to those members 23 or dependents who (1) first become eligible for such medicare 24 coverage on or after the effective date of this amendatory 25 Act of 1992; or (2) are Medicare-eligible members or 26 dependents of a local government unit which began 27 participation in the program on or after July 1, 1992; or (3) 28 remain eligible for but no longer receive Medicare coverage 29 which they had been receiving on or after the effective date 30 of this amendatory Act of 1992. 31 Notwithstanding any other provisions of this Act, where a 32 covered member or dependents are eligible for benefits under 33 the federal Medicare health insurance program (Title XVIII of 34 the Social Security Act as added by Public Law 89-97, 89th HB1031 Enrolled -3- LRB093 05543 DRJ 05635 b 1 Congress), benefits paid under the State of Illinois program 2 or plan will be reduced by the amount of benefits paid by 3 Medicare. For members or dependents who are eligible for 4 benefits under Social Security or the Railroad Retirement 5 system or who had sufficient Medicare-covered government 6 employment, benefits shall be reduced by the amount for which 7 the member or dependent is eligible under Medicare, except 8 that such reduction in benefits shall apply only to those 9 members or dependents who (1) first become eligible for such 10 Medicare coverage on or after the effective date of this 11 amendatory Act of 1992; or (2) are Medicare-eligible members 12 or dependents of a local government unit which began 13 participation in the program on or after July 1, 1992; or (3) 14 remain eligible for, but no longer receive Medicare coverage 15 which they had been receiving on or after the effective date 16 of this amendatory Act of 1992. Premiums may be adjusted, 17 where applicable, to an amount deemed by the Director to be 18 reasonably consistent with any reduction of benefits. 19 (b) A member, not otherwise covered by this Act, who has 20 retired as a participating member under Article 2 of the 21 Illinois Pension Code but is ineligible for the retirement 22 annuity under Section 2-119 of the Illinois Pension Code, 23 shall pay the premiums for coverage, not exceeding the amount 24 paid by the State for the non-contributory coverage for other 25 members, under the group health benefits program under this 26 Act. The Director shall determine the premiums to be paid by 27 a member under this subsection (b). 28 (Source: P.A. 91-390, eff. 7-30-99.) 29 Section 99. Effective date. This Act takes effect on 30 July 1, 2003.