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1 | AN ACT concerning State employees group insurance.
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2 | Be it enacted by the People of the State of Illinois,
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3 | represented in the General Assembly:
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4 | Section 5. The State Employees Group Insurance Act of 1971 | ||||||||||||||||||||||||
5 | is amended by changing Section 6 as follows:
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6 | (5 ILCS 375/6) (from Ch. 127, par. 526)
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7 | Sec. 6. Program of health benefits.
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8 | (a) The program of health benefits shall provide for | ||||||||||||||||||||||||
9 | protection
against the financial costs of health care expenses | ||||||||||||||||||||||||
10 | incurred in and out
of hospital including basic | ||||||||||||||||||||||||
11 | hospital-surgical-medical coverages. The program
may include, | ||||||||||||||||||||||||
12 | but shall not be limited to, such supplemental coverages as
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13 | out-patient diagnostic X-ray and laboratory expenses, | ||||||||||||||||||||||||
14 | prescription drugs,
dental services, hearing evaluations, | ||||||||||||||||||||||||
15 | hearing aids, the dispensing and
fitting
of hearing aids, and | ||||||||||||||||||||||||
16 | similar group benefits
as are now or may become available. | ||||||||||||||||||||||||
17 | However, nothing in this Act shall
be construed to permit, on | ||||||||||||||||||||||||
18 | or after July 1, 1980, the non-contributory portion
of any such | ||||||||||||||||||||||||
19 | program to include the expenses of obtaining an abortion, | ||||||||||||||||||||||||
20 | induced
miscarriage or induced premature birth unless, in the | ||||||||||||||||||||||||
21 | opinion of a physician,
such procedures are necessary for the | ||||||||||||||||||||||||
22 | preservation of the life of the woman
seeking such treatment, | ||||||||||||||||||||||||
23 | or except an induced premature birth intended to
produce a live | ||||||||||||||||||||||||
24 | viable child and such procedure is necessary for the health
of | ||||||||||||||||||||||||
25 | the mother or the unborn child. The program may also include
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26 | coverage for those who rely on treatment by prayer or spiritual | ||||||||||||||||||||||||
27 | means
alone for healing in accordance with the tenets and | ||||||||||||||||||||||||
28 | practice of a
recognized religious denomination.
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29 | The program of health benefits shall be designed by the | ||||||||||||||||||||||||
30 | Director
(1) to provide a reasonable relationship between the | ||||||||||||||||||||||||
31 | benefits to be
included and the expected distribution of | ||||||||||||||||||||||||
32 | expenses of each such type to
be incurred by the covered |
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1 | members and dependents,
(2) to specify, as covered benefits and | ||||||
2 | as optional benefits, the
medical services of practitioners in | ||||||
3 | all categories licensed under the
Medical Practice Act of 1987, | ||||||
4 | (3) to include
reasonable controls, which may include | ||||||
5 | deductible and co-insurance
provisions, applicable to some or | ||||||
6 | all of the benefits, or a coordination
of benefits provision, | ||||||
7 | to prevent or minimize unnecessary utilization of
the various | ||||||
8 | hospital, surgical and medical expenses to be provided and
to | ||||||
9 | provide reasonable assurance of stability of the program, and | ||||||
10 | (4) to
provide benefits to the extent possible to members | ||||||
11 | throughout the
State, wherever located, on an equitable basis , | ||||||
12 | and (5) to provide, to members in each geographic region of the | ||||||
13 | State, a selection of at least 2 plans for the coverage of | ||||||
14 | vision services available in that region and a selection of at | ||||||
15 | least 2 plans for the coverage of dental services available in | ||||||
16 | that region .
Notwithstanding any other provision of this | ||||||
17 | Section or Act,
for all members or dependents who are eligible | ||||||
18 | for benefits under Social
Security or the
Railroad Retirement | ||||||
19 | system or who had sufficient Medicare-covered government
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20 | employment,
the
Department shall reduce benefits
which would | ||||||
21 | otherwise be paid by Medicare, by the amount of benefits for
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22 | which the member or dependents are eligible
under Medicare, | ||||||
23 | except that such reduction in benefits shall apply only to
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24 | those members or dependents who (1) first become
eligible for | ||||||
25 | such medicare coverage on or after the effective date of this
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26 | amendatory Act of 1992; or (2) are Medicare-eligible members or | ||||||
27 | dependents of
a local government unit which began participation | ||||||
28 | in the program on or after
July 1, 1992; or (3) remain eligible | ||||||
29 | for but no longer receive
Medicare coverage which they had been | ||||||
30 | receiving on or after the effective date
of this amendatory Act | ||||||
31 | of 1992.
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32 | Notwithstanding any other provisions of this Act, where a | ||||||
33 | covered member or
dependents are eligible for benefits under | ||||||
34 | the federal Medicare health
insurance program (Title XVIII of | ||||||
35 | the Social Security Act as added by
Public Law 89-97, 89th | ||||||
36 | Congress), benefits paid under the State of Illinois
program or |
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1 | plan will be reduced by the amount of benefits paid by | ||||||
2 | Medicare.
For members or dependents
who are eligible for | ||||||
3 | benefits under Social Security
or the Railroad Retirement | ||||||
4 | system or who had sufficient Medicare-covered
government | ||||||
5 | employment, benefits shall be reduced by the amount for which
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6 | the member or dependent is eligible under Medicare,
except that | ||||||
7 | such reduction in benefits shall apply only to those
members or | ||||||
8 | dependents who (1) first become eligible for such
Medicare | ||||||
9 | coverage on or after the effective date of this amendatory Act
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10 | of 1992; or (2) are Medicare-eligible members or dependents of | ||||||
11 | a local
government unit which began participation in the | ||||||
12 | program on or after July 1,
1992; or (3) remain eligible for, | ||||||
13 | but no longer receive Medicare
coverage which they had been | ||||||
14 | receiving on or after the effective date of this
amendatory Act | ||||||
15 | of 1992. Premiums may be adjusted, where applicable, to an
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16 | amount deemed by the Director to be reasonably consistent with | ||||||
17 | any reduction
of benefits.
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18 | (b) A member, not otherwise covered by this Act, who has | ||||||
19 | retired as a
participating member under Article 2 of the | ||||||
20 | Illinois Pension Code
but is ineligible for the retirement | ||||||
21 | annuity under Section 2-119 of the
Illinois
Pension Code, shall | ||||||
22 | pay the premiums for coverage, not
exceeding the amount paid by | ||||||
23 | the State for the non-contributory coverage for
other members, | ||||||
24 | under the group health benefits program under this Act. The
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25 | Director shall determine the premiums to be paid
by a member | ||||||
26 | under this subsection (b).
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27 | (Source: P.A. 93-47, eff. 7-1-03.)
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28 | Section 99. Effective date. This Act takes effect upon | ||||||
29 | becoming law.
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