|
||||||||||||||||||||
|
||||||||||||||||||||
| ||||||||||||||||||||
| ||||||||||||||||||||
| ||||||||||||||||||||
1 | AN ACT concerning health benefits.
| |||||||||||||||||||
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 1971 | |||||||||||||||||||
5 | is amended by
changing Section 6.5 as follows:
| |||||||||||||||||||
6 | (5 ILCS 375/6.5)
| |||||||||||||||||||
7 | (Section scheduled to be repealed on July 1, 2004)
| |||||||||||||||||||
8 | Sec. 6.5. Health benefits for TRS benefit recipients and | |||||||||||||||||||
9 | TRS dependent
beneficiaries.
| |||||||||||||||||||
10 | (a) Purpose. It is The purpose of this amendatory Act of | |||||||||||||||||||
11 | 1995 is to
transfer
the administration of the program of health | |||||||||||||||||||
12 | benefits established for benefit
recipients and their | |||||||||||||||||||
13 | dependent beneficiaries under Article 16 of the Illinois
| |||||||||||||||||||
14 | Pension Code to the Department of Central Management Services.
| |||||||||||||||||||
15 | (b) Transition provisions. The Board of Trustees of the | |||||||||||||||||||
16 | Teachers'
Retirement System shall continue to administer the | |||||||||||||||||||
17 | health benefit program
established under Article 16 of the | |||||||||||||||||||
18 | Illinois Pension Code through December 31,
1995. Beginning | |||||||||||||||||||
19 | January 1, 1996, the Department of Central Management Services
| |||||||||||||||||||
20 | shall be responsible for administering a program of health | |||||||||||||||||||
21 | benefits for TRS
benefit recipients and TRS dependent | |||||||||||||||||||
22 | beneficiaries under this Section.
The Department of Central | |||||||||||||||||||
23 | Management Services and the Teachers' Retirement
System shall | |||||||||||||||||||
24 | cooperate in this endeavor and shall coordinate their | |||||||||||||||||||
25 | activities
so as to ensure a smooth transition and | |||||||||||||||||||
26 | uninterrupted health benefit coverage.
| |||||||||||||||||||
27 | (c) Eligibility. All persons who were enrolled in the | |||||||||||||||||||
28 | Article 16 program at
the time of the transfer shall be | |||||||||||||||||||
29 | eligible to participate in the program
established under this | |||||||||||||||||||
30 | Section without any interruption or delay in coverage
or | |||||||||||||||||||
31 | limitation as to pre-existing medical conditions. Eligibility | |||||||||||||||||||
32 | to
participate shall be determined by the Teachers' Retirement |
| |||||||
| |||||||
1 | System.
Eligibility information shall be communicated to the | ||||||
2 | Department of Central
Management Services in a format | ||||||
3 | acceptable to the Department.
| ||||||
4 | A TRS dependent beneficiary who is an unmarried child age | ||||||
5 | 19 or over and
mentally or physically handicapped does not | ||||||
6 | become ineligible to participate
by reason of (i) becoming | ||||||
7 | ineligible to be claimed as a dependent for Illinois
or federal | ||||||
8 | income tax purposes or (ii) receiving earned income, so long as
| ||||||
9 | those earnings are insufficient for the child to be fully | ||||||
10 | self-sufficient.
| ||||||
11 | (d) Coverage. The level of health benefits provided under | ||||||
12 | this Section
shall be similar to the level of benefits provided | ||||||
13 | by the
program previously established under Article 16 of the | ||||||
14 | Illinois Pension Code.
| ||||||
15 | Group life insurance benefits are not included in the | ||||||
16 | benefits
to be provided to TRS benefit recipients and TRS | ||||||
17 | dependent beneficiaries under
this Act.
| ||||||
18 | The program of health benefits under this Section may | ||||||
19 | include any or all of
the benefit limitations, including but | ||||||
20 | not limited to a reduction in benefits
based on eligibility for | ||||||
21 | federal medicare benefits, that are provided under
subsection | ||||||
22 | (a) of Section 6 of this Act for other health benefit programs | ||||||
23 | under
this Act.
| ||||||
24 | (e) Insurance rates and premiums. The Director shall | ||||||
25 | determine the
insurance rates and premiums for TRS benefit | ||||||
26 | recipients and TRS dependent
beneficiaries, and shall present | ||||||
27 | to the Teachers' Retirement System of
the State of Illinois, by | ||||||
28 | April 15 of each calendar year, the rate-setting
methodology | ||||||
29 | (including but not limited to utilization levels and costs) | ||||||
30 | used
to determine the amount of the health care premiums.
| ||||||
31 | For Fiscal Year 1996, the premium shall be equal to the | ||||||
32 | premium actually
charged in Fiscal Year 1995; in subsequent | ||||||
33 | years, the premium shall
never be lower than the premium | ||||||
34 | charged in Fiscal Year 1995. For Fiscal Year
2003, the premium | ||||||
35 | shall not exceed 110% of the premium actually charged in
Fiscal | ||||||
36 | Year 2002. For Fiscal Year 2004, the premium shall not exceed |
| |||||||
| |||||||
1 | 112% of
the premium actually charged in Fiscal Year 2003.
| ||||||
2 | Rates and premiums may be based in part on age and | ||||||
3 | eligibility for federal
medicare coverage. However, the cost of | ||||||
4 | participation for a TRS dependent
beneficiary who is an | ||||||
5 | unmarried child age 19 or over and mentally or physically
| ||||||
6 | handicapped shall not exceed the cost for a TRS dependent | ||||||
7 | beneficiary who is
an unmarried child under age 19 and | ||||||
8 | participates in the same major medical or
managed care program.
| ||||||
9 | The cost of health benefits under the program shall be paid | ||||||
10 | as follows:
| ||||||
11 | (1) For a TRS benefit recipient selecting a managed | ||||||
12 | care program, up to
75% of the total insurance rate shall | ||||||
13 | be paid from the Teacher Health Insurance
Security Fund.
| ||||||
14 | (2) For a TRS benefit recipient selecting the major | ||||||
15 | medical coverage
program, up to 50% of the total insurance | ||||||
16 | rate shall be paid from the Teacher
Health Insurance | ||||||
17 | Security Fund if a managed care program is accessible, as
| ||||||
18 | determined by the Teachers' Retirement System.
| ||||||
19 | (3) For a TRS benefit recipient selecting the major | ||||||
20 | medical coverage
program, up to 75% of the total insurance | ||||||
21 | rate shall be paid from the Teacher
Health Insurance | ||||||
22 | Security Fund if a managed care program is not accessible, | ||||||
23 | as
determined by the Teachers' Retirement System.
| ||||||
24 | (4) The balance of the rate of insurance, including the | ||||||
25 | entire premium of
any coverage for TRS dependent | ||||||
26 | beneficiaries that has been elected, shall be
paid
by | ||||||
27 | deductions authorized by the TRS benefit recipient to be | ||||||
28 | withheld from his
or her monthly annuity or benefit payment | ||||||
29 | from the Teachers' Retirement System;
except that (i) if | ||||||
30 | the balance of the cost of coverage exceeds the amount of
| ||||||
31 | the monthly annuity or benefit payment, the difference | ||||||
32 | shall be paid directly
to the Teachers' Retirement System | ||||||
33 | by the TRS benefit recipient, and (ii) all
or part of the | ||||||
34 | balance of the cost of coverage may, at the school board's
| ||||||
35 | option, be paid to the Teachers' Retirement System by the | ||||||
36 | school board of the
school district from which the TRS |
| |||||||
| |||||||
1 | benefit recipient retired, in accordance
with Section | ||||||
2 | 10-22.3b of the School Code. The Teachers' Retirement | ||||||
3 | System
shall promptly deposit all moneys withheld by or | ||||||
4 | paid to it under this
subdivision (e)(4) into the Teacher | ||||||
5 | Health Insurance Security Fund. These
moneys shall not be | ||||||
6 | considered assets of the Retirement System.
| ||||||
7 | (f) Financing. Beginning July 1, 1995, all revenues arising | ||||||
8 | from the
administration of the health benefit programs | ||||||
9 | established under Article 16 of
the Illinois Pension Code or | ||||||
10 | this Section shall be deposited into the
Teacher Health | ||||||
11 | Insurance Security Fund, which is hereby created as a
| ||||||
12 | nonappropriated trust fund to be held outside the State | ||||||
13 | Treasury, with the
State Treasurer as custodian. Any interest | ||||||
14 | earned on moneys in the Teacher
Health Insurance Security Fund | ||||||
15 | shall be deposited into the Fund.
| ||||||
16 | Moneys in the Teacher Health Insurance Security
Fund shall | ||||||
17 | be used only to pay the costs of the health benefit program
| ||||||
18 | established under this Section, including associated | ||||||
19 | administrative costs, and
the costs associated with the health | ||||||
20 | benefit program established under Article
16 of the Illinois | ||||||
21 | Pension Code, as authorized in this Section. Beginning
July 1, | ||||||
22 | 1995, the Department of Central Management Services may make
| ||||||
23 | expenditures from the Teacher Health Insurance Security Fund | ||||||
24 | for those costs.
| ||||||
25 | After other funds authorized for the payment of the costs | ||||||
26 | of the health
benefit program established under Article 16 of | ||||||
27 | the Illinois Pension Code are
exhausted and until January 1, | ||||||
28 | 1996 (or such later date as may be agreed upon
by the Director | ||||||
29 | of Central Management Services and the Secretary of the
| ||||||
30 | Teachers' Retirement System), the Secretary of the Teachers' | ||||||
31 | Retirement System
may make expenditures from the Teacher Health | ||||||
32 | Insurance Security Fund as
necessary to pay up to 75% of the | ||||||
33 | cost of providing health coverage to eligible
benefit | ||||||
34 | recipients (as defined in Sections 16-153.1 and 16-153.3 of the
| ||||||
35 | Illinois Pension Code) who are enrolled in the Article 16 | ||||||
36 | health benefit
program and to facilitate the transfer of |
| |||||||
| |||||||
1 | administration of the health benefit
program to the Department | ||||||
2 | of Central Management Services.
| ||||||
3 | (g) Contract for benefits. The Director shall by contract, | ||||||
4 | self-insurance,
or otherwise make available the program of | ||||||
5 | health benefits for TRS benefit
recipients and their TRS | ||||||
6 | dependent beneficiaries that is provided for in this
Section. | ||||||
7 | The contract or other arrangement for the provision of these | ||||||
8 | health
benefits shall be on terms deemed by the Director to be | ||||||
9 | in the best interest of
the State of Illinois and the TRS | ||||||
10 | benefit recipients based on, but not limited
to, such criteria | ||||||
11 | as administrative cost, service capabilities of the carrier
or | ||||||
12 | other contractor, and the costs of the benefits.
| ||||||
13 | (h) Continuation and termination of program. It is the | ||||||
14 | intention of
the General Assembly that the program of health | ||||||
15 | benefits provided under this
Section be maintained on an | ||||||
16 | ongoing, affordable basis through June 30, 2004.
The program of | ||||||
17 | health benefits provided under this Section is terminated on
| ||||||
18 | July 1, 2004.
| ||||||
19 | The program of health benefits provided under this Section | ||||||
20 | may be amended by
the State and is not intended to be a pension | ||||||
21 | or retirement benefit subject to
protection under Article XIII, | ||||||
22 | Section 5 of the Illinois Constitution.
| ||||||
23 | (i) Repeal. This Section is repealed on July 1, 2004.
| ||||||
24 | (Source: P.A. 92-505, eff. 12-20-01; 92-862, eff. 1-3-03; | ||||||
25 | revised 1-10-03.)
|