093_HB1031sam001











                                     LRB093 05543 AMC 15641 a

 1                    AMENDMENT TO HOUSE BILL 1031

 2        AMENDMENT NO.     .  Amend House Bill 1031  by  replacing
 3    everything after the enacting clause with the following:

 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
 
                            -2-      LRB093 05543 AMC 15641 a
 1    of the life of the woman seeking such treatment, or except an
 2    induced  premature  birth  intended  to produce a live viable
 3    child and such procedure is necessary for the health  of  the
 4    mother  or  the  unborn  child.  The program may also include
 5    coverage for  those  who  rely  on  treatment  by  prayer  or
 6    spiritual  means  alone  for  healing  in accordance with the
 7    tenets and practice of a recognized religious denomination.
 8        The program of health benefits shall be designed  by  the
 9    Director (1) to provide a reasonable relationship between the
10    benefits  to  be  included  and  the expected distribution of
11    expenses of each such type to  be  incurred  by  the  covered
12    members  and  dependents, (2) to specify, as covered benefits
13    and  as  optional   benefits,   the   medical   services   of
14    practitioners  in  all  categories licensed under the Medical
15    Practice Act of 1987, (3)  to  include  reasonable  controls,
16    which  may  include  deductible  and co-insurance provisions,
17    applicable to some or all of the benefits, or a  coordination
18    of  benefits  provision,  to  prevent or minimize unnecessary
19    utilization of the various  hospital,  surgical  and  medical
20    expenses  to  be provided and to provide reasonable assurance
21    of stability of the program, and (4) to provide  benefits  to
22    the extent possible to members throughout the State, wherever
23    located,  on  an  equitable  basis. Notwithstanding any other
24    provision  of  this  Section  or  Act,  for  all  members  or
25    dependents  who  are  eligible  for  benefits  under   Social
26    Security  or  the  Railroad  Retirement  system  or  who  had
27    sufficient   Medicare-covered   government   employment,  the
28    Department shall reduce benefits  which  would  otherwise  be
29    paid  by  Medicare,  by  the amount of benefits for which the
30    member or dependents are eligible under Medicare, except that
31    such reduction in benefits shall apply only to those  members
32    or dependents who (1) first become eligible for such medicare
33    coverage  on  or  after the effective date of this amendatory
34    Act  of  1992;  or  (2)  are  Medicare-eligible  members   or
 
                            -3-      LRB093 05543 AMC 15641 a
 1    dependents   of   a   local   government   unit  which  began
 2    participation in the program on or after July 1, 1992; or (3)
 3    remain eligible for but no longer receive  Medicare  coverage
 4    which  they had been receiving on or after the effective date
 5    of this amendatory Act of 1992.
 6        Notwithstanding any other provisions of this Act, where a
 7    covered member or dependents are eligible for benefits  under
 8    the federal Medicare health insurance program (Title XVIII of
 9    the  Social  Security  Act as added by Public Law 89-97, 89th
10    Congress), benefits paid under the State of Illinois  program
11    or  plan  will  be  reduced by the amount of benefits paid by
12    Medicare.  For members or dependents  who  are  eligible  for
13    benefits  under  Social  Security  or the Railroad Retirement
14    system or  who  had  sufficient  Medicare-covered  government
15    employment, benefits shall be reduced by the amount for which
16    the  member  or  dependent is eligible under Medicare, except
17    that such reduction in benefits shall  apply  only  to  those
18    members  or dependents who (1) first become eligible for such
19    Medicare coverage on or after  the  effective  date  of  this
20    amendatory  Act of 1992; or (2) are Medicare-eligible members
21    or  dependents  of  a  local  government  unit  which   began
22    participation in the program on or after July 1, 1992; or (3)
23    remain  eligible for, but no longer receive Medicare coverage
24    which they had been receiving on or after the effective  date
25    of  this  amendatory  Act of 1992.  Premiums may be adjusted,
26    where applicable, to an amount deemed by the Director  to  be
27    reasonably consistent with any reduction of benefits.
28        (b)  A member, not otherwise covered by this Act, who has
29    retired  as  a  participating  member  under Article 2 of the
30    Illinois Pension Code but is ineligible  for  the  retirement
31    annuity  under  Section  2-119  of the Illinois Pension Code,
32    shall pay the premiums for coverage, not exceeding the amount
33    paid by the State for the non-contributory coverage for other
34    members, under the group health benefits program  under  this
 
                            -4-      LRB093 05543 AMC 15641 a
 1    Act.  The Director shall determine the premiums to be paid by
 2    a member under this subsection (b).
 3    (Source: P.A. 91-390, eff. 7-30-99.)

 4        Section  99.   Effective  date.  This Act takes effect on
 5    July 1, 2003.".