093_HB3561

 
                                     LRB093 03466 LRD 11086 b

 1        AN ACT concerning health coverage  under  State  employee
 2    programs.

 3        Be  it  enacted  by  the People of the State of Illinois,
 4    represented in the General Assembly:

 5        Section 5.  The State Employees Group  Insurance  Act  of
 6    1971  is  amended by changing Sections 2, 3, 10, 13.2, and 15
 7    as follows:

 8        (5 ILCS 375/2) (from Ch. 127, par. 522)
 9        Sec. 2. Purpose.  The purpose of this Act is to provide a
10    program of group life insurance, a program of health benefits
11    and other employee benefits for persons in the service of the
12    State of Illinois, employees of local governments,  employees
13    of   rehabilitation  facilities  and  employees  of  domestic
14    violence  shelters  and  services,  and  certain   of   their
15    dependents.   It is also the purpose of this Act to provide a
16    program of health benefits (i) for certain benefit recipients
17    of the Teachers' Retirement System of the State  of  Illinois
18    and  their  dependent  beneficiaries  and  (ii)  for  certain
19    eligible   retired  community  college  employees  and  their
20    dependent beneficiaries.  It is also the purpose of this  Act
21    to  provide  a  program of health benefits for (i) owners and
22    employees of qualified small businesses and their  dependents
23    and (ii) self-employed persons and their dependents.
24    (Source: P.A. 89-25, eff. 6-21-95; 90-497, eff. 8-18-97.)

25        (5 ILCS 375/3) (from Ch. 127, par. 523)
26        Sec.   3.  Definitions.   Unless  the  context  otherwise
27    requires, the following words and phrases as used in this Act
28    shall have the following meanings.  The Department may define
29    these and other words and phrases separately for the  purpose
30    of  implementing  specific  programs providing benefits under
 
                            -2-      LRB093 03466 LRD 11086 b
 1    this Act.
 2        (a)  "Administrative  service  organization"  means   any
 3    person,  firm  or  corporation experienced in the handling of
 4    claims  which  is  fully  qualified,  financially  sound  and
 5    capable of meeting the service requirements of a contract  of
 6    administration executed with the Department.
 7        (b)  "Annuitant"  means  (1)  an employee who retires, or
 8    has retired, on or after January  1,  1966  on  an  immediate
 9    annuity under the provisions of Articles 2, 14, 15 (including
10    an  employee  who  has  retired under the optional retirement
11    program established under Section 15-158.2), paragraphs  (2),
12    (3),  or (5) of Section 16-106, or Article 18 of the Illinois
13    Pension  Code;  (2)  any  person  who  was  receiving   group
14    insurance  coverage  under  this  Act as of March 31, 1978 by
15    reason of his status as an annuitant, even though the annuity
16    in  relation  to  which  such  coverage  was  provided  is  a
17    proportional annuity based on less than the minimum period of
18    service required for  a  retirement  annuity  in  the  system
19    involved;  (3)  any  person not otherwise covered by this Act
20    who has retired as a participating member under Article 2  of
21    the   Illinois   Pension  Code  but  is  ineligible  for  the
22    retirement  annuity  under  Section  2-119  of  the  Illinois
23    Pension Code; (4) the spouse of any person who is receiving a
24    retirement annuity under Article 18 of the  Illinois  Pension
25    Code  and  who  is  covered  under  a  group health insurance
26    program sponsored by a governmental employer other  than  the
27    State  of  Illinois  and who has irrevocably elected to waive
28    his or her coverage under this Act and to  have  his  or  her
29    spouse  considered  as the "annuitant" under this Act and not
30    as a "dependent"; or (5) an  employee  who  retires,  or  has
31    retired,  from  a qualified position, as determined according
32    to rules promulgated by the Director, under a qualified local
33    government  or  a  qualified  rehabilitation  facility  or  a
34    qualified domestic violence shelter or  service;  or  (6)  an
 
                            -3-      LRB093 03466 LRD 11086 b
 1    owner  or  employee  who  retires,  or  has  retired,  from a
 2    qualified  position,  as  determined   according   to   rules
 3    promulgated  by the Director, with a qualified small business
 4    or as a self-employed person.  (For  definition  of  "retired
 5    employee", see (p) post).
 6        (b-5)  "New  SERS  annuitant"  means  a person who, on or
 7    after January 1, 1998, becomes an annuitant,  as  defined  in
 8    subsection   (b),   by  virtue  of  beginning  to  receive  a
 9    retirement annuity under Article 14 of the  Illinois  Pension
10    Code,  and is eligible to participate in the basic program of
11    group health benefits provided for annuitants under this Act.
12        (b-6)  "New SURS annuitant" means a person who (1) on  or
13    after  January  1,  1998, becomes an annuitant, as defined in
14    subsection  (b),  by  virtue  of  beginning  to   receive   a
15    retirement  annuity  under Article 15 of the Illinois Pension
16    Code, (2) has not made the election authorized under  Section
17    15-135.1 of the Illinois Pension Code, and (3) is eligible to
18    participate  in  the  basic  program of group health benefits
19    provided for annuitants under this Act.
20        (b-7)  "New TRS State annuitant" means a person  who,  on
21    or  after  July  1, 1998, becomes an annuitant, as defined in
22    subsection  (b),  by  virtue  of  beginning  to   receive   a
23    retirement  annuity  under Article 16 of the Illinois Pension
24    Code based on service as a teacher as  defined  in  paragraph
25    (2),  (3),  or  (5)  of  Section  16-106 of that Code, and is
26    eligible to participate in the basic program of group  health
27    benefits provided for annuitants under this Act.
28        (c)  "Carrier"   means   (1)   an  insurance  company,  a
29    corporation  organized  under  the  Limited  Health   Service
30    Organization Act or the Voluntary Health Services Plan Act, a
31    partnership,  or other nongovernmental organization, which is
32    authorized  to  do  group  life  or  group  health  insurance
33    business in Illinois, or (2)  the  State  of  Illinois  as  a
34    self-insurer.
 
                            -4-      LRB093 03466 LRD 11086 b
 1        (d)  "Compensation"  means  salary  or wages payable on a
 2    regular payroll by the State Treasurer on a  warrant  of  the
 3    State Comptroller out of any State, trust or federal fund, or
 4    by  the Governor of the State through a disbursing officer of
 5    the State out of a trust or out of federal funds, or  by  any
 6    Department  out  of State, trust, federal or other funds held
 7    by the State Treasurer or the Department, to any  person  for
 8    personal   services  currently  performed,  and  ordinary  or
 9    accidental disability  benefits  under  Articles  2,  14,  15
10    (including  ordinary  or accidental disability benefits under
11    the optional retirement  program  established  under  Section
12    15-158.2),  paragraphs (2), (3), or (5) of Section 16-106, or
13    Article 18 of  the  Illinois  Pension  Code,  for  disability
14    incurred after January 1, 1966, or benefits payable under the
15    Workers'   Compensation   or  Occupational  Diseases  Act  or
16    benefits  payable  under  a  sick  pay  plan  established  in
17    accordance  with  Section  36  of  the  State  Finance   Act.
18    "Compensation" also means salary or wages paid to an employee
19    of any qualified local government or qualified rehabilitation
20    facility or a qualified domestic violence shelter or service.
21    "Compensation" also means salary or wages paid to an employee
22    or  owner  of  a  qualified  small business and earned income
23    earned by a self-employed person.
24        (e)  "Commission"  means  the   State   Employees   Group
25    Insurance   Advisory   Commission  authorized  by  this  Act.
26    Commencing July 1, 1984, "Commission" as  used  in  this  Act
27    means   the   Illinois  Economic  and  Fiscal  Commission  as
28    established by the Legislative Commission Reorganization  Act
29    of 1984.
30        (f)  "Contributory",  when  referred  to  as contributory
31    coverage, shall mean optional coverages or  benefits  elected
32    by  the  member  toward  the  cost of which such member makes
33    contribution, or which are funded in whole or in part through
34    the acceptance of a reduction in earnings or the foregoing of
 
                            -5-      LRB093 03466 LRD 11086 b
 1    an increase in earnings by an employee, as distinguished from
 2    noncontributory coverage or benefits which are paid  entirely
 3    by  the  State  of Illinois without reduction of the member's
 4    salary.
 5        (g)  "Department"  means  any  department,   institution,
 6    board,  commission, officer, court or any agency of the State
 7    government  receiving  appropriations  and  having  power  to
 8    certify payrolls to the Comptroller authorizing  payments  of
 9    salary  and  wages against such appropriations as are made by
10    the General Assembly from any State fund,  or  against  trust
11    funds  held  by  the  State  Treasurer and includes boards of
12    trustees of the retirement systems created by Articles 2, 14,
13    15, 16 and 18 of the  Illinois  Pension  Code.   "Department"
14    also  includes  the  Illinois  Comprehensive Health Insurance
15    Board, the Board of Examiners established under the  Illinois
16    Public Accounting Act, and the Illinois Rural Bond Bank.
17        (h)  "Dependent", when the term is used in the context of
18    the  health  and  life  plan, means a member's spouse and any
19    unmarried child (1) from birth to age 19 including an adopted
20    child, a child who lives with the member from the time of the
21    filing of a petition for adoption until entry of an order  of
22    adoption,  a stepchild or recognized child who lives with the
23    member in a parent-child relationship, or a child  who  lives
24    with  the member if such member is a court appointed guardian
25    of the child, or (2) age 19 to 23  enrolled  as  a  full-time
26    student  in any accredited school, financially dependent upon
27    the member, and eligible to be claimed  as  a  dependent  for
28    income tax purposes, or (3) age 19 or over who is mentally or
29    physically  handicapped.  For  the health plan only, the term
30    "dependent" also includes any person enrolled  prior  to  the
31    effective  date  of  this  Section  who is dependent upon the
32    member to the extent that the member may claim such person as
33    a dependent for income tax deduction purposes; no other  such
34    person  may  be  enrolled. For the health plan only, the term
 
                            -6-      LRB093 03466 LRD 11086 b
 1    "dependent" also includes any person who has  received  after
 2    June  30,  2000  an  organ  transplant and who is financially
 3    dependent upon the member and eligible to  be  claimed  as  a
 4    dependent for income tax purposes.
 5        (i)  "Director"   means  the  Director  of  the  Illinois
 6    Department of Central Management Services.
 7        (j)  "Eligibility period" means  the  period  of  time  a
 8    member  has  to  elect  enrollment  in  programs or to select
 9    benefits without regard to age, sex or health.
10        (k)  "Employee"  means  and  includes  each  officer   or
11    employee  in the service of a department who (1) receives his
12    compensation for service rendered  to  the  department  on  a
13    warrant   issued   pursuant  to  a  payroll  certified  by  a
14    department or on a warrant or check issued  and  drawn  by  a
15    department  upon  a  trust,  federal  or  other  fund or on a
16    warrant issued pursuant to a payroll certified by an  elected
17    or  duly  appointed  officer  of  the  State  or who receives
18    payment of the performance of personal services on a  warrant
19    issued  pursuant  to  a payroll certified by a Department and
20    drawn by the Comptroller upon  the  State  Treasurer  against
21    appropriations  made by the General Assembly from any fund or
22    against trust funds held by the State Treasurer, and  (2)  is
23    employed  full-time  or  part-time  in  a  position  normally
24    requiring actual performance of duty during not less than 1/2
25    of  a  normal  work period, as established by the Director in
26    cooperation with each department, except that persons elected
27    by popular vote  will  be  considered  employees  during  the
28    entire  term  for  which they are elected regardless of hours
29    devoted to the service of the  State,  and  (3)  except  that
30    "employee" does not include any person who is not eligible by
31    reason  of  such person's employment to participate in one of
32    the State retirement systems under Articles 2, 14, 15 (either
33    the regular Article 15  system  or  the  optional  retirement
34    program  established  under Section 15-158.2) or 18, or under
 
                            -7-      LRB093 03466 LRD 11086 b
 1    paragraph (2), (3), or (5) of Section 16-106, of the Illinois
 2    Pension Code, but such term  does  include  persons  who  are
 3    employed  during  the 6 month qualifying period under Article
 4    14 of the Illinois Pension Code.  Such term also includes any
 5    person who (1) after January 1, 1966, is  receiving  ordinary
 6    or  accidental  disability  benefits under Articles 2, 14, 15
 7    (including ordinary or accidental disability  benefits  under
 8    the  optional  retirement  program  established under Section
 9    15-158.2), paragraphs (2), (3), or (5) of Section 16-106,  or
10    Article  18  of  the  Illinois  Pension  Code, for disability
11    incurred after January 1, 1966, (2) receives total  permanent
12    or total temporary disability under the Workers' Compensation
13    Act  or  Occupational  Disease  Act  as  a result of injuries
14    sustained or illness contracted in the course  of  employment
15    with  the  State of Illinois, or (3) is not otherwise covered
16    under this Act and has  retired  as  a  participating  member
17    under   Article  2  of  the  Illinois  Pension  Code  but  is
18    ineligible for the retirement annuity under Section 2-119  of
19    the  Illinois  Pension Code.  However, a person who satisfies
20    the criteria of the foregoing definition of "employee" except
21    that such person is made ineligible  to  participate  in  the
22    State   Universities  Retirement  System  by  clause  (4)  of
23    subsection (a) of Section 15-107 of the Illinois Pension Code
24    is  also  an  "employee"  for  the  purposes  of  this   Act.
25    "Employee" also includes any person receiving or eligible for
26    benefits under a sick pay plan established in accordance with
27    Section 36 of the State Finance Act. "Employee" also includes
28    each  officer or employee in the service of a qualified local
29    government,  including  persons  appointed  as  trustees   of
30    sanitary districts regardless of hours devoted to the service
31    of the sanitary district, and each employee in the service of
32    a   qualified  rehabilitation  facility  and  each  full-time
33    employee in the service  of  a  qualified  domestic  violence
34    shelter   or   service,  as  determined  according  to  rules
 
                            -8-      LRB093 03466 LRD 11086 b
 1    promulgated by the  Director.  "Employee"  also  includes  an
 2    owner  and a full-time employee in the service of a qualified
 3    small business and  a  self-employed  person,  as  determined
 4    according to rules promulgated by the Director.
 5        (l)  "Member"   means  an  employee,  annuitant,  retired
 6    employee or survivor.
 7        (m)  "Optional  coverages  or   benefits"   means   those
 8    coverages  or  benefits available to the member on his or her
 9    voluntary election, and at his or her own expense.
10        (n)  "Program" means the  group  life  insurance,  health
11    benefits  and other employee benefits designed and contracted
12    for by the Director under this Act.
13        (o)  "Health  plan"  means  a  health  benefits   program
14    offered by the State of Illinois for persons eligible for the
15    plan.
16        (p)  "Retired  employee" means any person who would be an
17    annuitant as that term is defined herein  but  for  the  fact
18    that such person retired prior to January 1, 1966.  Such term
19    also  includes any person formerly employed by the University
20    of Illinois in the Cooperative Extension Service who would be
21    an annuitant but for the  fact  that  such  person  was  made
22    ineligible   to   participate   in   the  State  Universities
23    Retirement System by clause (4) of subsection (a) of  Section
24    15-107 of the Illinois Pension Code.
25        (q)  "Survivor"  means a person receiving an annuity as a
26    survivor of an employee or of an annuitant.  "Survivor"  also
27    includes:  (1)  the  surviving  dependent  of  a  person  who
28    satisfies  the  definition  of  "employee"  except  that such
29    person  is  made  ineligible  to  participate  in  the  State
30    Universities Retirement System by clause  (4)  of  subsection
31    (a)  of  Section 15-107 of the Illinois Pension Code; and (2)
32    the surviving dependent of any person  formerly  employed  by
33    the  University  of  Illinois  in  the  Cooperative Extension
34    Service who would be an annuitant except for  the  fact  that
 
                            -9-      LRB093 03466 LRD 11086 b
 1    such  person  was made ineligible to participate in the State
 2    Universities Retirement System by clause  (4)  of  subsection
 3    (a) of Section 15-107 of the Illinois Pension Code.
 4        (q-5)  "New  SERS  survivor" means a survivor, as defined
 5    in subsection (q), whose annuity is paid under Article 14  of
 6    the Illinois Pension Code and is based on the death of (i) an
 7    employee  whose  death occurs on or after January 1, 1998, or
 8    (ii) a new SERS annuitant as defined in subsection (b-5).
 9        (q-6)  "New SURS survivor" means a survivor,  as  defined
10    in  subsection (q), whose annuity is paid under Article 15 of
11    the Illinois Pension Code and is based on the death of (i) an
12    employee whose death occurs on or after January 1,  1998,  or
13    (ii) a new SURS annuitant as defined in subsection (b-6).
14        (q-7)  "New  TRS  State  survivor"  means  a survivor, as
15    defined in  subsection  (q),  whose  annuity  is  paid  under
16    Article  16  of the Illinois Pension Code and is based on the
17    death of (i) an employee who  is  a  teacher  as  defined  in
18    paragraph (2), (3), or (5) of Section 16-106 of that Code and
19    whose  death  occurs  on or after July 1, 1998, or (ii) a new
20    TRS State annuitant as defined in subsection (b-7).
21        (r)  "Medical  services"  means  the  services   provided
22    within  the  scope  of their licenses by practitioners in all
23    categories licensed under the Medical Practice Act of 1987.
24        (s)  "Unit  of  local  government"  means   any   county,
25    municipality,   township,   school   district   (including  a
26    combination of school districts under  the  Intergovernmental
27    Cooperation  Act), special district or other unit, designated
28    as a unit of local government by law, which exercises limited
29    governmental  powers  or  powers  in   respect   to   limited
30    governmental  subjects, any not-for-profit association with a
31    membership that primarily  includes  townships  and  township
32    officials, that has duties that include provision of research
33    service, dissemination of information, and other acts for the
34    purpose  of improving township government, and that is funded
 
                            -10-     LRB093 03466 LRD 11086 b
 1    wholly or partly in accordance  with  Section  85-15  of  the
 2    Township Code; any not-for-profit corporation or association,
 3    with  a  membership  consisting  primarily of municipalities,
 4    that operates its own utility system, and provides  research,
 5    training,  dissemination  of  information,  or  other acts to
 6    promote cooperation between  and  among  municipalities  that
 7    provide utility services and for the advancement of the goals
 8    and   purposes  of  its  membership;  the  Southern  Illinois
 9    Collegiate Common Market, which is  a  consortium  of  higher
10    education institutions in Southern Illinois; and the Illinois
11    Association  of Park Districts.  "Qualified local government"
12    means a unit of local government approved by the Director and
13    participating in a program created under  subsection  (i)  of
14    Section 10 of this Act.
15        (t)  "Qualified   rehabilitation   facility"   means  any
16    not-for-profit  organization  that  is  accredited   by   the
17    Commission  on  Accreditation of Rehabilitation Facilities or
18    certified by the Department of Human Services  (as  successor
19    to   the   Department  of  Mental  Health  and  Developmental
20    Disabilities)   to   provide   services   to   persons   with
21    disabilities and which  receives  funds  from  the  State  of
22    Illinois  for  providing  those  services,  approved  by  the
23    Director   and  participating  in  a  program  created  under
24    subsection (j) of Section 10 of this Act.
25        (u)  "Qualified domestic  violence  shelter  or  service"
26    means  any  Illinois domestic violence shelter or service and
27    its administrative offices funded by the Department of  Human
28    Services  (as  successor to the Illinois Department of Public
29    Aid), approved by the Director and participating in a program
30    created under subsection (k) of Section 10.
31        (v)  "TRS benefit recipient" means a person who:
32             (1)  is not a "member" as defined in  this  Section;
33        and
34             (2)  is  receiving  a  monthly benefit or retirement
 
                            -11-     LRB093 03466 LRD 11086 b
 1        annuity under Article 16 of the  Illinois  Pension  Code;
 2        and
 3             (3)  either  (i)  has at least 8 years of creditable
 4        service under Article 16 of the Illinois Pension Code, or
 5        (ii) was enrolled in the health insurance program offered
 6        under that Article on January 1, 1996, or  (iii)  is  the
 7        survivor  of a benefit recipient who had at least 8 years
 8        of creditable service under Article 16  of  the  Illinois
 9        Pension  Code  or  was  enrolled  in the health insurance
10        program offered under that Article on the effective  date
11        of this amendatory Act of 1995, or (iv) is a recipient or
12        survivor  of  a  recipient  of a disability benefit under
13        Article 16 of the Illinois Pension Code.
14        (w)  "TRS dependent beneficiary" means a person who:
15             (1)  is not a "member" or "dependent" as defined  in
16        this Section; and
17             (2)  is  a  TRS benefit recipient's: (A) spouse, (B)
18        dependent parent who is receiving at least half of his or
19        her support  from  the  TRS  benefit  recipient,  or  (C)
20        unmarried  natural  or adopted child who is (i) under age
21        19, or  (ii)  enrolled  as  a  full-time  student  in  an
22        accredited  school,  financially  dependent  upon the TRS
23        benefit recipient, eligible to be claimed as a  dependent
24        for  income  tax  purposes, and either is under age 24 or
25        was, on January 1, 1996,  participating  as  a  dependent
26        beneficiary in the health insurance program offered under
27        Article  16 of the Illinois Pension Code, or (iii) age 19
28        or over who is mentally or physically handicapped.
29        (x)  "Military leave with pay  and  benefits"  refers  to
30    individuals  in basic training for reserves, special/advanced
31    training, annual training, emergency call up,  or  activation
32    by  the  President of the United States with approved pay and
33    benefits.
34        (y)  "Military leave without pay and benefits" refers  to
 
                            -12-     LRB093 03466 LRD 11086 b
 1    individuals who enlist for active duty in a regular component
 2    of  the  U.S.  Armed  Forces  or  other duty not specified or
 3    authorized under military leave with pay and benefits.
 4        (z)  "Community college benefit recipient" means a person
 5    who:
 6             (1)  is not a "member" as defined in  this  Section;
 7        and
 8             (2)  is  receiving  a  monthly survivor's annuity or
 9        retirement annuity  under  Article  15  of  the  Illinois
10        Pension Code; and
11             (3)  either  (i)  was  a  full-time  employee  of  a
12        community college district or an association of community
13        college boards created under the Public Community College
14        Act  (other  than  an  employee whose last employer under
15        Article 15 of the Illinois Pension Code was  a  community
16        college  district  subject  to  Article VII of the Public
17        Community College Act) and was eligible to participate in
18        a group health benefit plan as  an  employee  during  the
19        time  of  employment  with  a  community college district
20        (other than  a  community  college  district  subject  to
21        Article  VII  of  the Public Community College Act) or an
22        association of community college boards, or (ii)  is  the
23        survivor of a person described in item (i).
24        (aa)  "Community  college  dependent beneficiary" means a
25    person who:
26             (1)  is not a "member" or "dependent" as defined  in
27        this Section; and
28             (2)  is a community college benefit recipient's: (A)
29        spouse,  (B)  dependent  parent who is receiving at least
30        half of his or her support  from  the  community  college
31        benefit  recipient,  or  (C) unmarried natural or adopted
32        child who is (i) under age 19,  or  (ii)  enrolled  as  a
33        full-time  student  in  an accredited school, financially
34        dependent upon the community college  benefit  recipient,
 
                            -13-     LRB093 03466 LRD 11086 b
 1        eligible  to  be  claimed  as  a dependent for income tax
 2        purposes and under age 23, or (iii) age 19  or  over  and
 3        mentally or physically handicapped.
 4        (bb)  "Qualified   small   business"   means  a  business
 5    situated in Illinois having 25 or fewer  employees,  approved
 6    by  the Director and participating in a program created under
 7    subsection (k-5) of Section 10.
 8        (cc)  "Self-employed person" means a person engaged in  a
 9    business  enterprise  or profession as a self-employed person
10    or who is conducting another self-employed occupation and  is
11    participating  in a program created under subsection (k-5) of
12    Section 10.
13    (Source: P.A. 91-390, eff.  7-30-99;  91-395,  eff.  7-30-99;
14    91-617,  eff.  8-19-99;  92-16,  eff.  6-28-01;  92-186, eff.
15    1-1-02; 92-204, eff. 8-1-01; 92-651, eff. 7-11-02.)

16        (5 ILCS 375/10) (from Ch. 127, par. 530)
17        Sec. 10. Payments by State; premiums.
18        (a)  The   State   shall   pay   the   cost   of    basic
19    non-contributory  group life insurance and, subject to member
20    paid contributions set by the Department or required by  this
21    Section,  the  basic program of group health benefits on each
22    eligible member, except a member, not  otherwise  covered  by
23    this  Act,  who  has  retired as a participating member under
24    Article 2 of the Illinois Pension Code but is ineligible  for
25    the  retirement  annuity  under Section 2-119 of the Illinois
26    Pension Code, and part of each eligible member's and  retired
27    member's  premiums for health insurance coverage for enrolled
28    dependents as provided by Section 9.  The State shall pay the
29    cost of the basic program of group health benefits only after
30    benefits are reduced by the amount  of  benefits  covered  by
31    Medicare  for all members and dependents who are eligible for
32    benefits under Social Security  or  the  Railroad  Retirement
33    system  or  who  had  sufficient  Medicare-covered government
 
                            -14-     LRB093 03466 LRD 11086 b
 1    employment, except that  such  reduction  in  benefits  shall
 2    apply  only  to  those  members  and dependents who (1) first
 3    become eligible for such Medicare coverage on or  after  July
 4    1,  1992;  or (2) are Medicare-eligible members or dependents
 5    of a local government unit which began participation  in  the
 6    program on or after July 1, 1992; or (3) remain eligible for,
 7    but  no  longer receive Medicare coverage which they had been
 8    receiving on or  after  July  1,  1992.  The  Department  may
 9    determine  the aggregate level of the State's contribution on
10    the basis of actual cost of  medical  services  adjusted  for
11    age,  sex  or geographic or other demographic characteristics
12    which affect the costs of such programs.
13        The cost of participation in the basic program  of  group
14    health  benefits for the dependent or survivor of a living or
15    deceased retired employee who was formerly  employed  by  the
16    University  of  Illinois in the Cooperative Extension Service
17    and would be an annuitant but for the fact that he or she was
18    made ineligible to  participate  in  the  State  Universities
19    Retirement  System by clause (4) of subsection (a) of Section
20    15-107 of the Illinois Pension Code shall not be greater than
21    the cost of participation that would otherwise apply to  that
22    dependent  or  survivor  if  he  or she were the dependent or
23    survivor  of  an  annuitant  under  the  State   Universities
24    Retirement System.
25        (a-1)  Beginning  January  1,  1998,  for each person who
26    becomes a new SERS annuitant and participates  in  the  basic
27    program  of group health benefits, the State shall contribute
28    toward the cost of the annuitant's coverage under  the  basic
29    program  of  group  health  benefits an amount equal to 5% of
30    that cost for each full year of creditable service upon which
31    the annuitant's retirement annuity is based, up to a  maximum
32    of  100% for an annuitant with 20 or more years of creditable
33    service. The remainder of the cost of a new SERS  annuitant's
34    coverage  under  the  basic  program of group health benefits
 
                            -15-     LRB093 03466 LRD 11086 b
 1    shall be the responsibility of the annuitant.
 2        (a-2)  Beginning January 1, 1998,  for  each  person  who
 3    becomes  a  new  SERS  survivor and participates in the basic
 4    program of group health benefits, the State shall  contribute
 5    toward  the  cost  of the survivor's coverage under the basic
 6    program of group health benefits an amount  equal  to  5%  of
 7    that  cost  for  each full year of the deceased employee's or
 8    deceased  annuitant's  creditable  service   in   the   State
 9    Employees'  Retirement  System  of  Illinois  on  the date of
10    death, up to a maximum of 100% for a survivor of an  employee
11    or  annuitant  with  20  or more years of creditable service.
12    The remainder of the cost of the new SERS survivor's coverage
13    under the basic program of group health benefits shall be the
14    responsibility of the survivor.
15        (a-3)  Beginning January 1, 1998,  for  each  person  who
16    becomes  a  new  SURS annuitant and participates in the basic
17    program of group health benefits, the State shall  contribute
18    toward  the  cost of the annuitant's coverage under the basic
19    program of group health benefits an amount  equal  to  5%  of
20    that cost for each full year of creditable service upon which
21    the  annuitant's retirement annuity is based, up to a maximum
22    of 100% for an annuitant with 20 or more years of  creditable
23    service.  The remainder of the cost of a new SURS annuitant's
24    coverage under the basic program  of  group  health  benefits
25    shall be the responsibility of the annuitant.
26        (a-4)  (Blank).
27        (a-5)  Beginning  January  1,  1998,  for each person who
28    becomes a new SURS survivor and  participates  in  the  basic
29    program  of group health benefits, the State shall contribute
30    toward the cost of the survivor's coverage  under  the  basic
31    program  of  group  health  benefits an amount equal to 5% of
32    that cost for each full year of the  deceased  employee's  or
33    deceased   annuitant's   creditable   service  in  the  State
34    Universities Retirement System on the date of death, up to  a
 
                            -16-     LRB093 03466 LRD 11086 b
 1    maximum  of  100%  for a survivor of an employee or annuitant
 2    with 20 or more years of creditable service.   The  remainder
 3    of  the  cost  of  the new SURS survivor's coverage under the
 4    basic  program  of  group  health  benefits  shall   be   the
 5    responsibility of the survivor.
 6        (a-6)  Beginning  July  1,  1998,  for  each  person  who
 7    becomes  a  new  TRS  State annuitant and participates in the
 8    basic program of  group  health  benefits,  the  State  shall
 9    contribute  toward the cost of the annuitant's coverage under
10    the basic program of group health benefits an amount equal to
11    5% of that cost for each full year of creditable service as a
12    teacher as defined in paragraph (2), (3), or (5)  of  Section
13    16-106   of   the   Illinois  Pension  Code  upon  which  the
14    annuitant's retirement annuity is based, up to a  maximum  of
15    100%;  except  that the State contribution shall be 12.5% per
16    year (rather than  5%)  for  each  full  year  of  creditable
17    service  as  a  regional superintendent or assistant regional
18    superintendent of schools.  The remainder of the  cost  of  a
19    new TRS State annuitant's coverage under the basic program of
20    group  health  benefits  shall  be  the responsibility of the
21    annuitant.
22        (a-7)  Beginning  July  1,  1998,  for  each  person  who
23    becomes a new TRS State  survivor  and  participates  in  the
24    basic  program  of  group  health  benefits,  the State shall
25    contribute toward the cost of the survivor's  coverage  under
26    the basic program of group health benefits an amount equal to
27    5% of that cost for each full year of the deceased employee's
28    or  deceased  annuitant's  creditable service as a teacher as
29    defined in paragraph (2), (3), or (5) of  Section  16-106  of
30    the  Illinois  Pension  Code  on  the  date of death, up to a
31    maximum of 100%; except that the State contribution shall  be
32    12.5%  per  year  (rather  than 5%) for each full year of the
33    deceased  employee's  or  deceased   annuitant's   creditable
34    service  as  a  regional superintendent or assistant regional
 
                            -17-     LRB093 03466 LRD 11086 b
 1    superintendent of schools. The remainder of the cost  of  the
 2    new  TRS State survivor's coverage under the basic program of
 3    group health benefits shall  be  the  responsibility  of  the
 4    survivor.
 5        (a-8)  A  new SERS annuitant, new SERS survivor, new SURS
 6    annuitant, new SURS survivor, new TRS State annuitant, or new
 7    TRS State survivor may waive or  terminate  coverage  in  the
 8    program  of  group  health  benefits.   Any such annuitant or
 9    survivor who has waived or terminated coverage may enroll  or
10    re-enroll in the program of group health benefits only during
11    the  annual  benefit  choice  period,  as  determined  by the
12    Director; except that in the event of termination of coverage
13    due to nonpayment of premiums, the annuitant or survivor  may
14    not re-enroll in the program.
15        (a-9)  No  later  than  May  1 of each calendar year, the
16    Director of Central  Management  Services  shall  certify  in
17    writing  to  the  Executive Secretary of the State Employees'
18    Retirement System of Illinois the  amounts  of  the  Medicare
19    supplement health care premiums and the amounts of the health
20    care  premiums  for  all  other retirees who are not Medicare
21    eligible.
22        A separate calculation of the  premiums  based  upon  the
23    actual cost of each health care plan shall be so certified.
24        The Director of Central Management Services shall provide
25    to the Executive Secretary of the State Employees' Retirement
26    System  of  Illinois  such information, statistics, and other
27    data as he or she may require to review the  premium  amounts
28    certified by the Director of Central Management Services.
29        (b)  State employees who become eligible for this program
30    on  or  after January 1, 1980 in positions normally requiring
31    actual performance of duty not less than 1/2 of a normal work
32    period but not equal to that of a normal work  period,  shall
33    be  given  the  option  of  participating  in  the  available
34    program.  If  the  employee  elects coverage, the State shall
 
                            -18-     LRB093 03466 LRD 11086 b
 1    contribute on behalf of such employee  to  the  cost  of  the
 2    employee's  benefit  and any applicable dependent supplement,
 3    that sum which bears the same percentage as  that  percentage
 4    of  time the employee regularly works when compared to normal
 5    work period.
 6        (c)  The basic non-contributory coverage from  the  basic
 7    program  of group health benefits shall be continued for each
 8    employee not in pay status or on active service by reason  of
 9    (1) leave of absence due to illness or injury, (2) authorized
10    educational  leave  of  absence  or  sabbatical leave, or (3)
11    military leave with pay and  benefits.  This  coverage  shall
12    continue  until  expiration of authorized leave and return to
13    active service, but not to exceed 24 months for leaves  under
14    item (1) or (2). This 24-month limitation and the requirement
15    of  returning  to  active  service shall not apply to persons
16    receiving  ordinary  or  accidental  disability  benefits  or
17    retirement benefits through the appropriate State  retirement
18    system   or  benefits  under  the  Workers'  Compensation  or
19    Occupational Disease Act.
20        (d)  The  basic  group  life  insurance  coverage   shall
21    continue,  with full State contribution, where such person is
22    (1) absent  from  active  service  by  reason  of  disability
23    arising  from  any  cause  other  than self-inflicted, (2) on
24    authorized educational leave of absence or sabbatical  leave,
25    or (3) on military leave with pay and benefits.
26        (e)  Where  the  person is in non-pay status for a period
27    in excess of 30 days or on leave of absence,  other  than  by
28    reason  of  disability,  educational  or sabbatical leave, or
29    military  leave  with  pay  and  benefits,  such  person  may
30    continue coverage only by making personal  payment  equal  to
31    the amount normally contributed by the State on such person's
32    behalf.  Such  payments  and  coverage  may be continued: (1)
33    until such time as the person returns to  a  status  eligible
34    for  coverage  at State expense, but not to exceed 24 months,
 
                            -19-     LRB093 03466 LRD 11086 b
 1    (2) until such person's employment or annuitant  status  with
 2    the  State  is  terminated,  or (3) for a maximum period of 4
 3    years for members on military leave with pay and benefits and
 4    military leave without pay and  benefits  (exclusive  of  any
 5    additional service imposed pursuant to law).
 6        (f)  The  Department  shall  establish by rule the extent
 7    to which other employee benefits will continue for persons in
 8    non-pay status or who are not in active service.
 9        (g)  The State shall  not  pay  the  cost  of  the  basic
10    non-contributory  group  life  insurance,  program  of health
11    benefits and other employee  benefits  for  members  who  are
12    survivors  as defined by paragraphs (1) and (2) of subsection
13    (q) of Section 3 of this Act.   The  costs  of  benefits  for
14    these  survivors  shall  be  paid  by the survivors or by the
15    University of Illinois Cooperative Extension Service, or  any
16    combination  thereof. However, the State shall pay the amount
17    of the reduction  in  the  cost  of  participation,  if  any,
18    resulting  from  the amendment to subsection (a) made by this
19    amendatory Act of the 91st General Assembly.
20        (h)  Those   persons   occupying   positions   with   any
21    department as a result of emergency appointments pursuant  to
22    Section  8b.8  of  the  Personnel Code who are not considered
23    employees under  this  Act  shall  be  given  the  option  of
24    participating in the programs of group life insurance, health
25    benefits  and other employee benefits.  Such persons electing
26    coverage may participate only by making payment equal to  the
27    amount  normally  contributed  by  the  State  for  similarly
28    situated  employees.  Such amounts shall be determined by the
29    Director.  Such payments and coverage may be continued  until
30    such  time as the person becomes an employee pursuant to this
31    Act or such person's appointment is terminated.
32        (i)  Any unit of local government  within  the  State  of
33    Illinois  may  apply  to  the Director to have its employees,
34    annuitants,  and  their  dependents  provided  group   health
 
                            -20-     LRB093 03466 LRD 11086 b
 1    coverage   under   this  Act  on  a  non-insured  basis.   To
 2    participate, a unit of local government must agree to  enroll
 3    all  of  its  employees, who may select coverage under either
 4    the State group health benefits plan or a health  maintenance
 5    organization  that  has  contracted  with  the  State  to  be
 6    available  as a health care provider for employees as defined
 7    in this Act.  A unit  of  local  government  must  remit  the
 8    entire  cost  of  providing  coverage  under  the State group
 9    health  benefits  plan  or,  for  coverage  under  a   health
10    maintenance   organization,   an  amount  determined  by  the
11    Director based on an analysis of  the  sex,  age,  geographic
12    location,  or  other  relevant  demographic variables for its
13    employees, except that the unit of local government shall not
14    be required to enroll those of its employees who are  covered
15    spouses or dependents under this plan or another group policy
16    or   plan  providing  health  benefits  as  long  as  (1)  an
17    appropriate  official  from  the  unit  of  local  government
18    attests that each employee not enrolled is a  covered  spouse
19    or dependent under this plan or another group policy or plan,
20    and  (2)  at  least 85% of the employees are enrolled and the
21    unit of local government remits the entire cost of  providing
22    coverage  to  those  employees,  except  that a participating
23    school district must  have  enrolled  at  least  85%  of  its
24    full-time  employees  who  have not waived coverage under the
25    district's group health plan by participating in a  component
26    of  the  district's  cafeteria  plan.  A participating school
27    district is not required to enroll a full-time  employee  who
28    has   waived  coverage  under  the  district's  health  plan,
29    provided that an appropriate official from the  participating
30    school  district  attests  that  the  full-time  employee has
31    waived coverage  by  participating  in  a  component  of  the
32    district's   cafeteria   plan.   For  the  purposes  of  this
33    subsection, "participating school district" includes  a  unit
34    of  local  government  whose  primary purpose is education as
 
                            -21-     LRB093 03466 LRD 11086 b
 1    defined by the Department's rules.
 2        Employees of a participating unit of local government who
 3    are not enrolled due to coverage under another  group  health
 4    policy or plan may enroll in the event of a qualifying change
 5    in   status,  special  enrollment,  special  circumstance  as
 6    defined by the Director, or during the annual Benefit  Choice
 7    Period.   A  participating  unit of local government may also
 8    elect to cover its annuitants.  Dependent coverage  shall  be
 9    offered on an optional basis, with the costs paid by the unit
10    of  local  government,  its employees, or some combination of
11    the two as determined by the unit of local  government.   The
12    unit  of  local  government  shall  be responsible for timely
13    collection and transmission of dependent premiums.
14        The Director shall annually determine  monthly  rates  of
15    payment, subject to the following constraints:
16             (1)  In  the first year of coverage, the rates shall
17        be  equal  to  the  amount  normally  charged  to   State
18        employees  for elected optional coverages or for enrolled
19        dependents coverages or other contributory coverages,  or
20        contributed by the State for basic insurance coverages on
21        behalf of its employees, adjusted for differences between
22        State  employees and employees of the local government in
23        age,  sex,  geographic   location   or   other   relevant
24        demographic  variables,  plus an amount sufficient to pay
25        for the  additional  administrative  costs  of  providing
26        coverage to employees of the unit of local government and
27        their dependents.
28             (2)  In subsequent years, a further adjustment shall
29        be  made  to  reflect  the  actual  prior  years'  claims
30        experience   of  the  employees  of  the  unit  of  local
31        government.
32        In the case of coverage  of  local  government  employees
33    under  a  health maintenance organization, the Director shall
34    annually determine  for  each  participating  unit  of  local
 
                            -22-     LRB093 03466 LRD 11086 b
 1    government the maximum monthly amount the unit may contribute
 2    toward  that  coverage,  based on an analysis of (i) the age,
 3    sex, geographic  location,  and  other  relevant  demographic
 4    variables  of the unit's employees and (ii) the cost to cover
 5    those employees under the State group health  benefits  plan.
 6    The  Director  may  similarly  determine  the maximum monthly
 7    amount each unit of local government  may  contribute  toward
 8    coverage   of   its  employees'  dependents  under  a  health
 9    maintenance organization.
10        Monthly payments by the unit of local government  or  its
11    employees   for   group   health   benefits  plan  or  health
12    maintenance organization coverage shall be deposited  in  the
13    Local Government Health Insurance Reserve Fund.
14        The  Local Government Health Insurance Reserve Fund shall
15    be a continuing fund not subject to fiscal year  limitations.
16    All  expenditures  from  this Fund shall be used for payments
17    for health  care  benefits  for  local  government,  domestic
18    violence  shelter  or  service,  and  rehabilitation facility
19    employees, annuitants, and dependents, and to  reimburse  the
20    Department or its administrative service organization for all
21    expenses  incurred  in  the  administration  of benefits.  No
22    other State funds may be used for these purposes.
23        A local government employer's participation or desire  to
24    participate  in a program created under this subsection shall
25    not  limit  that  employer's  duty  to   bargain   with   the
26    representative  of  any  collective  bargaining  unit  of its
27    employees.
28        (j)  Any rehabilitation  facility  within  the  State  of
29    Illinois  may  apply  to  the Director to have its employees,
30    annuitants, and  their  eligible  dependents  provided  group
31    health  coverage  under  this  Act on a non-insured basis. To
32    participate, a rehabilitation facility must agree  to  enroll
33    all  of  its employees and remit the entire cost of providing
34    such  coverage   for   its   employees,   except   that   the
 
                            -23-     LRB093 03466 LRD 11086 b
 1    rehabilitation facility shall not be required to enroll those
 2    of  its employees who are covered spouses or dependents under
 3    this plan or another group policy or  plan  providing  health
 4    benefits  as  long  as  (1)  an appropriate official from the
 5    rehabilitation  facility  attests  that  each  employee   not
 6    enrolled  is a covered spouse or dependent under this plan or
 7    another group policy or plan, and (2) at  least  85%  of  the
 8    employees are enrolled and the rehabilitation facility remits
 9    the  entire  cost  of  providing coverage to those employees.
10    Employees of a participating rehabilitation facility who  are
11    not  enrolled  due  to  coverage  under  another group health
12    policy or plan may enroll in the event of a qualifying change
13    in  status,  special  enrollment,  special  circumstance   as
14    defined  by the Director, or during the annual Benefit Choice
15    Period.  A participating  rehabilitation  facility  may  also
16    elect  to  cover  its annuitants. Dependent coverage shall be
17    offered on an optional basis, with  the  costs  paid  by  the
18    rehabilitation  facility,  its employees, or some combination
19    of the 2 as determined by the  rehabilitation  facility.  The
20    rehabilitation  facility  shall  be  responsible  for  timely
21    collection and transmission of dependent premiums.
22        The  Director shall annually determine quarterly rates of
23    payment, subject to the following constraints:
24             (1)  In the first year of coverage, the rates  shall
25        be   equal  to  the  amount  normally  charged  to  State
26        employees for elected optional coverages or for  enrolled
27        dependents  coverages  or other contributory coverages on
28        behalf of its employees, adjusted for differences between
29        State  employees  and  employees  of  the  rehabilitation
30        facility  in  age,  sex,  geographic  location  or  other
31        relevant demographic variables, plus an amount sufficient
32        to  pay  for  the  additional  administrative  costs   of
33        providing  coverage  to  employees  of the rehabilitation
34        facility and their dependents.
 
                            -24-     LRB093 03466 LRD 11086 b
 1             (2)  In subsequent years, a further adjustment shall
 2        be  made  to  reflect  the  actual  prior  years'  claims
 3        experience  of  the  employees  of   the   rehabilitation
 4        facility.
 5        Monthly  payments  by  the rehabilitation facility or its
 6    employees for group health benefits shall be deposited in the
 7    Local Government Health Insurance Reserve Fund.
 8        (k)  Any domestic violence shelter or service within  the
 9    State  of  Illinois  may  apply  to  the Director to have its
10    employees, annuitants, and their  dependents  provided  group
11    health  coverage  under  this Act on a non-insured basis.  To
12    participate, a domestic  violence  shelter  or  service  must
13    agree  to enroll all of its employees and pay the entire cost
14    of  providing   such   coverage   for   its   employees.    A
15    participating  domestic  violence  shelter  may also elect to
16    cover its annuitants.  Dependent coverage shall be offered on
17    an optional basis,  with  the  costs  paid  by  the  domestic
18    violence   shelter   or   service,  its  employees,  or  some
19    combination of the 2 as determined by the  domestic  violence
20    shelter or service.  The domestic violence shelter or service
21    shall  be  responsible for timely collection and transmission
22    of dependent premiums.
23        The Director shall annually determine rates  of  payment,
24    subject to the following constraints:
25             (1)  In  the first year of coverage, the rates shall
26        be  equal  to  the  amount  normally  charged  to   State
27        employees  for elected optional coverages or for enrolled
28        dependents coverages or other contributory  coverages  on
29        behalf of its employees, adjusted for differences between
30        State  employees  and  employees of the domestic violence
31        shelter or service in age, sex,  geographic  location  or
32        other  relevant  demographic  variables,  plus  an amount
33        sufficient to pay for the additional administrative costs
34        of  providing  coverage  to  employees  of  the  domestic
 
                            -25-     LRB093 03466 LRD 11086 b
 1        violence shelter or service and their dependents.
 2             (2)  In subsequent years, a further adjustment shall
 3        be  made  to  reflect  the  actual  prior  years'  claims
 4        experience of the  employees  of  the  domestic  violence
 5        shelter or service.
 6        Monthly  payments  by  the  domestic  violence shelter or
 7    service or its employees for group health insurance shall  be
 8    deposited  in  the  Local Government Health Insurance Reserve
 9    Fund.
10        (k-5)  Any  qualified  small  business  or  self-employed
11    person within the State of Illinois may apply to the Director
12    to have  its  employees,  annuitants,  and  their  dependents
13    provided   group   health   coverage  under  this  Act  on  a
14    non-insured basis.  The Department may set  a  limit  on  the
15    number   of  qualified  small  businesses  and  self-employed
16    persons that may receive group  health  coverage  under  this
17    subsection  (k-5).   In  order  to  control  its  costs,  the
18    Department  may  designate  which  plans  it  will  offer  to
19    qualified  small  businesses  and self-employed persons under
20    this subsection (k-5). Those plans may include, but need  not
21    be  limited  to,  minimum, limited, or comprehensive coverage
22    plans; Health Maintenance Organization and Preferred Provider
23    Organization plans; and medical savings plans.   In  offering
24    plans  under  this  subsection  (k-5) the Department shall be
25    subject to ratings and minimum coverage in the same manner as
26    a  private  insurer.    A   qualified   small   business   or
27    self-employed  person  may  select  one  or more of the plans
28    offered by the Department  to  offer  to  its  employees.  To
29    participate,  a  qualified  small  business  or self-employed
30    person must agree to offer to enroll all of its employees and
31    pay the entire  cost  of  providing  such  coverage  for  its
32    employees.   A  participating  qualified  small  business  or
33    self-employed  person may also elect to cover its annuitants.
34    Dependent coverage shall be offered  on  an  optional  basis,
 
                            -26-     LRB093 03466 LRD 11086 b
 1    with  the  costs  paid  by  the self-employed person or small
 2    business, its employees, or some  combination  of  the  2  as
 3    determined  by  the  self-employed  person or qualified small
 4    business.  The  qualified  small  business  or  self-employed
 5    person   shall  be  responsible  for  timely  collection  and
 6    transmission of dependent premiums.
 7        The Director shall annually determine rates  of  payment,
 8    subject to the following constraints:
 9             (1)  In  the first year of coverage, the rates shall
10        be  equal  to  the  amount  normally  charged  to   State
11        employees  for elected optional coverages or for enrolled
12        dependents coverages or other contributory  coverages  on
13        behalf of its employees, adjusted for differences between
14        State  employees  and  employees  of  the qualified small
15        business or self-employed person in age, sex,  geographic
16        location or other relevant demographic variables, plus an
17        amount    sufficient    to   pay   for   the   additional
18        administrative costs of providing coverage  to  employees
19        of  the  qualified small business or self-employed person
20        and their dependents.
21             (2)  In subsequent years, a further adjustment shall
22        be  made  to  reflect  the  actual  prior  years'  claims
23        experience  of  the  employees  of  the  qualified  small
24        business or self-employed person.
25        Monthly payments  by  the  qualified  small  business  or
26    self-employed  person  for  group  health  insurance shall be
27    deposited into the Small Employers Health  Insurance  Reserve
28    Fund.   The  Small  Employers  Health  Insurance Reserve Fund
29    shall be  a  continuing  fund  not  subject  to  fiscal  year
30    limitations.   All  expenditures from this fund shall be used
31    for payments  for  health  care  benefits  for  self-employed
32    persons and employees of qualified small businesses and their
33    annuitants  and dependents and to reimburse the Department or
34    its administrative  service  organization  for  all  expenses
 
                            -27-     LRB093 03466 LRD 11086 b
 1    incurred  in  the administration of benefits.  No other State
 2    funds may be used for these purposes.
 3        (l)  A  public  community  college  or  entity  organized
 4    pursuant to the Public Community College Act may apply to the
 5    Director initially to have only annuitants not covered  prior
 6    to July 1, 1992 by the district's health plan provided health
 7    coverage   under  this  Act  on  a  non-insured  basis.   The
 8    community  college  must  execute  a   2-year   contract   to
 9    participate   in   the  Local  Government  Health  Plan.  Any
10    annuitant may enroll in the event of a qualifying  change  in
11    status,  special  enrollment, special circumstance as defined
12    by the Director, or during the annual Benefit Choice Period.
13        The Director shall annually determine  monthly  rates  of
14    payment  subject  to  the  following  constraints:  for those
15    community colleges with annuitants only enrolled, first  year
16    rates  shall be equal to the average cost to cover claims for
17    a  State   member   adjusted   for   demographics,   Medicare
18    participation,  and  other factors; and in the second year, a
19    further adjustment of rates shall  be  made  to  reflect  the
20    actual   first   year's  claims  experience  of  the  covered
21    annuitants.
22        (l-5)  The   provisions   of   subsection   (l)    become
23    inoperative on July 1, 1999.
24        (m)  The  Director shall adopt any rules deemed necessary
25    for implementation of this amendatory Act of 1989 (Public Act
26    86-978).
27    (Source: P.A. 91-280, eff.  7-23-99;  91-311;  eff.  7-29-99;
28    91-357,  eff.  7-29-99;  91-390,  eff.  7-30-99; 91-395, eff.
29    7-30-99; 91-617, eff. 8-19-99; 92-16, eff.  6-28-01;  revised
30    2-25-02.)

31        (5 ILCS 375/13.2) (from Ch. 127, par. 533.2)
32        Sec.  13.2.  Insurance  reserve  funds; investments.  All
33    amounts held in the Health Insurance Reserve Fund, the  Group
 
                            -28-     LRB093 03466 LRD 11086 b
 1    Insurance  Premium Fund, the Small Employers Health Insurance
 2    Reserve Fund,  and  the  Local  Government  Health  Insurance
 3    Reserve  Fund  shall  be  invested, at interest, by the State
 4    Treasurer.   The  investments  shall  be  subject  to  terms,
 5    conditions, and limitations imposed by the laws  of  Illinois
 6    on  State  funds.   All  income  derived from the investments
 7    shall accrue and be deposited to the respective funds no less
 8    frequently than  quarterly.   The  Health  Insurance  Reserve
 9    Fund,  the Small Employers Health Insurance Reserve Fund, and
10    the Local Government Health Insurance Reserve Fund  shall  be
11    administered by the Director.
12    (Source: P.A. 91-390, eff. 7-30-99.)

13        (5 ILCS 375/15) (from Ch. 127, par. 535)
14        Sec. 15. Administration; rules; audit; review.
15        (a)  The  Director  shall  administer  this Act and shall
16    prescribe such rules and regulations as are necessary to give
17    full effect to the purposes of this Act.
18        (b)  These rules may fix  reasonable  standards  for  the
19    group  life  and  group  health  programs  and  other benefit
20    programs offered under this  Act,  and  for  the  contractors
21    providing them.
22        (c)  These  rules shall specify that covered and optional
23    medical services of the program are services provided  within
24    the   scope   of  their  licenses  by  practitioners  in  all
25    categories licensed under the Medical Practice  Act  of  1987
26    and shall provide that all eligible persons be fully informed
27    of this specification.
28        (d)  These rules shall establish eligibility requirements
29    for  members and dependents as may be necessary to supplement
30    or clarify requirements contained in this Act.
31        (e)  Each affected department of  the  State,  the  State
32    Universities  Retirement  System,  the  Teachers'  Retirement
33    System,  and  each qualified local government, rehabilitation
 
                            -29-     LRB093 03466 LRD 11086 b
 1    facility, or domestic  violence  shelter  or  service,  small
 2    business,  or  self-employed  person shall keep such records,
 3    make such  certifications,  and  furnish  the  Director  such
 4    information  as  may  be  necessary for the administration of
 5    this Act, including information concerning number  and  total
 6    amounts  of  payroll  of  employees of the department who are
 7    paid from trust funds or federal funds.
 8        (f)  Each  member,   each   community   college   benefit
 9    recipient  to  whom  this  Act  applies, and each TRS benefit
10    recipient  to  whom  this  Act  applies  shall  furnish   the
11    Director,  in  such  form as may be required, any information
12    that may be  necessary  to  enroll  such  member  or  benefit
13    recipient  and,  if  applicable,  his  or  her  dependents or
14    dependent beneficiaries under the programs or plan, including
15    such data as  may  be  required  to  allow  the  Director  to
16    accumulate   statistics   on   data  normally  considered  in
17    actuarial studies  of  employee  groups.   Information  about
18    community  college  benefit  recipients and community college
19    dependent beneficiaries shall be furnished through the  State
20    Universities   Retirement   System.   Information  about  TRS
21    benefit recipients and TRS dependent beneficiaries  shall  be
22    furnished through the Teachers' Retirement System.
23        (g)  There  shall  be  audits and reports on the programs
24    authorized and  established  by  this  Act  prepared  by  the
25    Director  with  the  assistance  of  a qualified, independent
26    accounting firm.  The reports shall  provide  information  on
27    the experience, and administrative effectiveness and adequacy
28    of the program including, when applicable, recommendations on
29    up-grading of benefits and improvement of the program.
30        (h)  Any  final  order,  decision  or other determination
31    made, issued or executed by the Director under the provisions
32    of this Act whereby any contractor  or  person  is  aggrieved
33    shall  be subject to review in accordance with the provisions
34    of the Administrative  Review  Law  and  all  amendments  and
 
                            -30-     LRB093 03466 LRD 11086 b
 1    modifications   thereof,   and  the  rules  adopted  pursuant
 2    thereto, shall apply to and govern all  proceedings  for  the
 3    judicial  review  of  final  administrative  decisions of the
 4    Director.
 5    (Source: P.A. 90-497, eff. 8-18-97; 91-390, eff. 7-30-99.)

 6        Section 10.  The State Finance Act is amended by changing
 7    Section 25 as follows:

 8        (30 ILCS 105/25) (from Ch. 127, par. 161)
 9        Sec. 25.  Fiscal year limitations.
10        (a)  All   appropriations   shall   be   available    for
11    expenditure for the fiscal year or for a lesser period if the
12    Act  making that appropriation so specifies.  A deficiency or
13    emergency appropriation shall be  available  for  expenditure
14    only  through  June  30  of the year when the Act making that
15    appropriation is enacted unless that Act otherwise provides.
16        (b)  Outstanding liabilities as of June 30, payable  from
17    appropriations  which have otherwise expired, may be paid out
18    of the expiring  appropriations  during  the  2-month  period
19    ending  at  the  close of business on August 31.  Any service
20    involving professional or artistic  skills  or  any  personal
21    services  by  an  employee  whose  compensation is subject to
22    income tax withholding must be performed as of June 30 of the
23    fiscal  year  in  order  to  be  considered  an  "outstanding
24    liability as of June 30" that is thereby eligible for payment
25    out of the expiring appropriation.
26        However, payment of tuition  reimbursement  claims  under
27    Section 14-7.03 or 18-3 of the School Code may be made by the
28    State  Board  of  Education from its appropriations for those
29    respective purposes for any  fiscal  year,  even  though  the
30    claims  reimbursed  by the payment may be claims attributable
31    to a prior fiscal year, and  payments  may  be  made  at  the
32    direction  of  the State Superintendent of Education from the
 
                            -31-     LRB093 03466 LRD 11086 b
 1    fund from which the appropriation is made without  regard  to
 2    any fiscal year limitations.
 3        Medical  payments  may  be  made  by  the  Department  of
 4    Veterans'  Affairs from its appropriations for those purposes
 5    for any fiscal year, without regard  to  the  fact  that  the
 6    medical  services  being  compensated for by such payment may
 7    have been rendered in a prior fiscal year.
 8        Medical payments may be made by the Department of  Public
 9    Aid  and child care payments may be made by the Department of
10    Human Services (as successor to the Department of Public Aid)
11    from appropriations for those purposes for any  fiscal  year,
12    without  regard  to  the  fact that the medical or child care
13    services being compensated for by such payment may have  been
14    rendered  in a prior fiscal year; and payments may be made at
15    the  direction  of  the  Department  of  Central   Management
16    Services  from  the  Health Insurance Reserve Fund, the Small
17    Employers  Health  Insurance  Reserve  Fund,  and  the  Local
18    Government Health Insurance Reserve Fund  without  regard  to
19    any fiscal year limitations.
20        Additionally,  payments  may be made by the Department of
21    Human Services from its appropriations, or  any  other  State
22    agency  from  its  appropriations  with  the  approval of the
23    Department of Human Services, from the Immigration Reform and
24    Control  Fund  for  purposes  authorized  pursuant   to   the
25    Immigration Reform and Control Act of 1986, without regard to
26    any fiscal year limitations.
27        Further,  with  respect to costs incurred in fiscal years
28    2002 and 2003  only,  payments  may  be  made  by  the  State
29    Treasurer from its appropriations from the Capital Litigation
30    Trust Fund without regard to any fiscal year limitations.
31        (c)  Further,  payments  may be made by the Department of
32    Public Health and the Department of Human Services (acting as
33    successor to  the  Department  of  Public  Health  under  the
34    Department  of  Human  Services  Act)  from  their respective
 
                            -32-     LRB093 03466 LRD 11086 b
 1    appropriations for grants for medical care to or on behalf of
 2    persons  suffering  from  chronic  renal   disease,   persons
 3    suffering  from  hemophilia,  rape victims, and premature and
 4    high-mortality risk infants and their mothers and for  grants
 5    for  supplemental  food  supplies  provided  under the United
 6    States Department of Agriculture Women, Infants and  Children
 7    Nutrition  Program, for any fiscal year without regard to the
 8    fact that the services being compensated for by such  payment
 9    may have been rendered in a prior fiscal year.
10        (d)  The  Department  of Public Health and the Department
11    of Human Services (acting as successor to the  Department  of
12    Public  Health  under  the  Department of Human Services Act)
13    shall each annually submit to the State  Comptroller,  Senate
14    President,  Senate  Minority  Leader,  Speaker  of the House,
15    House  Minority  Leader,  and  the  respective  Chairmen  and
16    Minority Spokesmen of the Appropriations  Committees  of  the
17    Senate  and  the House, on or before December 31, a report of
18    fiscal year funds used to pay for services  provided  in  any
19    prior  fiscal year.  This report shall document by program or
20    service category those expenditures from  the  most  recently
21    completed  fiscal  year  used to pay for services provided in
22    prior fiscal years.
23        (e)  The Department of Public Aid and the  Department  of
24    Human  Services  (acting  as  successor  to the Department of
25    Public  Aid)  shall  each  annually  submit  to   the   State
26    Comptroller,   Senate   President,  Senate  Minority  Leader,
27    Speaker of the House, House Minority Leader,  the  respective
28    Chairmen   and   Minority  Spokesmen  of  the  Appropriations
29    Committees of the Senate and the House, on or before November
30    30, a report  that  shall  document  by  program  or  service
31    category  those expenditures from the most recently completed
32    fiscal year used to pay for (i) services  provided  in  prior
33    fiscal years and (ii) services for which claims were received
34    in prior fiscal years.
 
                            -33-     LRB093 03466 LRD 11086 b
 1        (f)  The  Department  of  Human Services (as successor to
 2    the Department of Public Aid) shall annually  submit  to  the
 3    State  Comptroller, Senate President, Senate Minority Leader,
 4    Speaker  of  the  House,  House  Minority  Leader,  and   the
 5    respective   Chairmen   and   Minority   Spokesmen   of   the
 6    Appropriations  Committees of the Senate and the House, on or
 7    before December 31, a report of fiscal year funds used to pay
 8    for services (other than medical care) provided in any  prior
 9    fiscal  year.   This  report  shall  document  by  program or
10    service category those expenditures from  the  most  recently
11    completed  fiscal  year  used to pay for services provided in
12    prior fiscal years.
13        (g)  In addition,  each  annual  report  required  to  be
14    submitted  by  the  Department of Public Aid under subsection
15    (e) shall include the following information with  respect  to
16    the State's Medicaid program:
17             (1)  Explanations   of   the  exact  causes  of  the
18        variance between the previous year's estimated and actual
19        liabilities.
20             (2)  Factors  affecting  the  Department  of  Public
21        Aid's liabilities, including but not limited  to  numbers
22        of  aid recipients, levels of medical service utilization
23        by aid recipients, and inflation in the cost  of  medical
24        services.
25             (3)  The  results  of  the  Department's  efforts to
26        combat fraud and abuse.
27        (h)  As provided in Section 4  of  the  General  Assembly
28    Compensation  Act, any utility bill for service provided to a
29    General  Assembly  member's  district  office  for  a  period
30    including portions of 2 consecutive fiscal years may be  paid
31    from funds appropriated for such expenditure in either fiscal
32    year.
33        (i)  An agency which administers a fund classified by the
34    Comptroller as an internal service fund may issue rules for:
 
                            -34-     LRB093 03466 LRD 11086 b
 1             (1)  billing  user  agencies  in  advance  based  on
 2        estimated charges for goods or services;
 3             (2)  issuing  credits  during  the subsequent fiscal
 4        year for all user agency  payments  received  during  the
 5        prior  fiscal  year  which  were  in  excess of the final
 6        amounts owed by the user agency for that period; and
 7             (3)  issuing  catch-up  billings  to  user  agencies
 8        during the subsequent fiscal year for  amounts  remaining
 9        due  when  payments  received from the user agency during
10        the prior fiscal year were less  than  the  total  amount
11        owed for that period.
12    User  agencies  are  authorized to reimburse internal service
13    funds for catch-up billings by vouchers drawn  against  their
14    respective  appropriations  for  the fiscal year in which the
15    catch-up billing was issued.
16    (Source: P.A. 92-885, eff. 1-13-03.)

17        Section 99.  Effective date.  This Act  takes  effect  on
18    January 1, 2004.