Sen. Neil Anderson

Filed: 4/19/2021

 

 


 

 


 
10200SB2168sam001LRB102 14449 RPS 25527 a

1
AMENDMENT TO SENATE BILL 2168

2    AMENDMENT NO. ______. Amend Senate Bill 2168 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The State Employees Group Insurance Act of
51971 is amended by changing Section 6.5 as follows:
 
6    (5 ILCS 375/6.5)
7    Sec. 6.5. Health benefits for TRS benefit recipients and
8TRS dependent beneficiaries.
9    (a) Purpose. It is the purpose of this amendatory Act of
101995 to transfer the administration of the program of health
11benefits established for benefit recipients and their
12dependent beneficiaries under Article 16 of the Illinois
13Pension Code to the Department of Central Management Services.
14    (b) Transition provisions. The Board of Trustees of the
15Teachers' Retirement System shall continue to administer the
16health benefit program established under Article 16 of the

 

 

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1Illinois Pension Code through December 31, 1995. Beginning
2January 1, 1996, the Department of Central Management Services
3shall be responsible for administering a program of health
4benefits for TRS benefit recipients and TRS dependent
5beneficiaries under this Section. The Department of Central
6Management Services and the Teachers' Retirement System shall
7cooperate in this endeavor and shall coordinate their
8activities so as to ensure a smooth transition and
9uninterrupted health benefit coverage.
10    (c) Eligibility. All persons who were enrolled in the
11Article 16 program at the time of the transfer shall be
12eligible to participate in the program established under this
13Section without any interruption or delay in coverage or
14limitation as to pre-existing medical conditions. Eligibility
15to participate shall be determined by the Teachers' Retirement
16System. Eligibility information shall be communicated to the
17Department of Central Management Services in a format
18acceptable to the Department.
19    Eligible TRS benefit recipients may enroll or re-enroll in
20the program of health benefits established under this Section
21during any applicable annual open enrollment period and as
22otherwise permitted by the Department of Central Management
23Services. A TRS benefit recipient shall not be deemed
24ineligible to participate solely by reason of the TRS benefit
25recipient having made a previous election to disenroll or
26otherwise not participate in the program of health benefits.

 

 

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1    A TRS dependent beneficiary who is a child age 19 or over
2and mentally or physically disabled does not become ineligible
3to participate by reason of (i) becoming ineligible to be
4claimed as a dependent for Illinois or federal income tax
5purposes or (ii) receiving earned income, so long as those
6earnings are insufficient for the child to be fully
7self-sufficient.
8    (d) Coverage. The level of health benefits provided under
9this Section shall be similar to the level of benefits
10provided by the program previously established under Article
1116 of the Illinois Pension Code.
12    Group life insurance benefits are not included in the
13benefits to be provided to TRS benefit recipients and TRS
14dependent beneficiaries under this Act.
15    The program of health benefits under this Section may
16include any or all of the benefit limitations, including but
17not limited to a reduction in benefits based on eligibility
18for federal Medicare benefits, that are provided under
19subsection (a) of Section 6 of this Act for other health
20benefit programs under this Act.
21    (e) Insurance rates and premiums. The Director shall
22determine the insurance rates and premiums for TRS benefit
23recipients and TRS dependent beneficiaries, and shall present
24to the Teachers' Retirement System of the State of Illinois,
25by April 15 of each calendar year, the rate-setting
26methodology (including but not limited to utilization levels

 

 

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1and costs) used to determine the amount of the health care
2premiums.
3        For Fiscal Year 1996, the premium shall be equal to
4    the premium actually charged in Fiscal Year 1995; in
5    subsequent years, the premium shall never be lower than
6    the premium charged in Fiscal Year 1995.
7        For Fiscal Year 2003, the premium shall not exceed
8    110% of the premium actually charged in Fiscal Year 2002.
9        For Fiscal Year 2004, the premium shall not exceed
10    112% of the premium actually charged in Fiscal Year 2003.
11        For Fiscal Year 2005, the premium shall not exceed a
12    weighted average of 106.6% of the premium actually charged
13    in Fiscal Year 2004.
14        For Fiscal Year 2006, the premium shall not exceed a
15    weighted average of 109.1% of the premium actually charged
16    in Fiscal Year 2005.
17        For Fiscal Year 2007, the premium shall not exceed a
18    weighted average of 103.9% of the premium actually charged
19    in Fiscal Year 2006.
20        For Fiscal Year 2008 and thereafter, the premium in
21    each fiscal year shall not exceed 105% of the premium
22    actually charged in the previous fiscal year.
23    Rates and premiums may be based in part on age and
24eligibility for federal medicare coverage. However, the cost
25of participation for a TRS dependent beneficiary who is an
26unmarried child age 19 or over and mentally or physically

 

 

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1disabled shall not exceed the cost for a TRS dependent
2beneficiary who is an unmarried child under age 19 and
3participates in the same major medical or managed care
4program.
5    The cost of health benefits under the program shall be
6paid as follows:
7        (1) For a TRS benefit recipient selecting a managed
8    care program, up to 75% of the total insurance rate shall
9    be paid from the Teacher Health Insurance Security Fund.
10    Effective with Fiscal Year 2007 and thereafter, for a TRS
11    benefit recipient selecting a managed care program, 75% of
12    the total insurance rate shall be paid from the Teacher
13    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. Effective
19    with Fiscal Year 2007 and thereafter, for a TRS benefit
20    recipient selecting the major medical coverage program,
21    50% of the total insurance rate shall be paid from the
22    Teacher Health Insurance Security Fund if a managed care
23    program is accessible, as determined by the Department of
24    Central Management Services.
25        (3) For a TRS benefit recipient selecting the major
26    medical coverage program, up to 75% of the total insurance

 

 

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1    rate shall be paid from the Teacher Health Insurance
2    Security Fund if a managed care program is not accessible,
3    as determined by the Teachers' Retirement System.
4    Effective with Fiscal Year 2007 and thereafter, for a TRS
5    benefit recipient selecting the major medical coverage
6    program, 75% of the total insurance rate shall be paid
7    from the Teacher Health Insurance Security Fund if a
8    managed care program is not accessible, as determined by
9    the Department of Central Management Services.
10        (3.1) For a TRS dependent beneficiary who is Medicare
11    primary and enrolled in a managed care plan, or the major
12    medical coverage program if a managed care plan is not
13    available, 25% of the total insurance rate shall be paid
14    from the Teacher Health Security Fund as determined by the
15    Department of Central Management Services. For the purpose
16    of this item (3.1), the term "TRS dependent beneficiary
17    who is Medicare primary" means a TRS dependent beneficiary
18    who is participating in Medicare Parts A and B.
19        (4) Except as otherwise provided in item (3.1), the
20    balance of the rate of insurance, including the entire
21    premium of any coverage for TRS dependent beneficiaries
22    that has been elected, shall be paid by deductions
23    authorized by the TRS benefit recipient to be withheld
24    from his or her monthly annuity or benefit payment from
25    the Teachers' Retirement System; except that (i) if the
26    balance of the cost of coverage exceeds the amount of the

 

 

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1    monthly annuity or benefit payment, the difference shall
2    be paid directly to the Teachers' Retirement System by the
3    TRS benefit recipient, and (ii) all or part of the balance
4    of the cost of coverage may, at the school board's option,
5    be paid to the Teachers' Retirement System by the school
6    board of the school district from which the TRS benefit
7    recipient retired, in accordance with Section 10-22.3b of
8    the School Code. The Teachers' Retirement System shall
9    promptly deposit all moneys withheld by or paid to it
10    under this subdivision (e)(4) into the Teacher Health
11    Insurance Security Fund. These moneys shall not be
12    considered assets of the Retirement System.
13        (5) If, for any month beginning on or after January 1,
14    2013, a TRS benefit recipient or TRS dependent beneficiary
15    was enrolled in Medicare Parts A and B and such Medicare
16    coverage was primary to coverage under this Section but
17    payment for coverage under this Section was made at a rate
18    greater than the Medicare primary rate published by the
19    Department of Central Management Services, the TRS benefit
20    recipient or TRS dependent beneficiary shall be eligible
21    for a refund equal to the difference between the amount
22    paid by the TRS benefit recipient or TRS dependent
23    beneficiary and the published Medicare primary rate. To
24    receive a refund pursuant to this subsection, the TRS
25    benefit recipient or TRS dependent beneficiary must
26    provide documentation to the Department of Central

 

 

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1    Management Services evidencing the TRS benefit recipient's
2    or TRS dependent beneficiary's Medicare coverage and the
3    amount paid by the TRS benefit recipient or TRS dependent
4    beneficiary during the applicable time period. If in any
5    case an error is made in billing a TRS benefit recipient
6    under this Section, the Department shall identify the
7    error and refund the overpaid amount as soon as
8    practicable. A TRS benefit recipient who has overpaid
9    under this Section shall be entitled to a refund of
10    overpayments for up to 7 years of past payments.
11    (f) Financing. Beginning July 1, 1995, all revenues
12arising from the administration of the health benefit programs
13established under Article 16 of the Illinois Pension Code or
14this Section shall be deposited into the Teacher Health
15Insurance Security Fund, which is hereby created as a
16nonappropriated trust fund to be held outside the State
17Treasury, with the State Treasurer as custodian. Any interest
18earned on moneys in the Teacher Health Insurance Security Fund
19shall be deposited into the Fund.
20    Moneys in the Teacher Health Insurance Security Fund shall
21be used only to pay the costs of the health benefit program
22established under this Section, including associated
23administrative costs, and the costs associated with the health
24benefit program established under Article 16 of the Illinois
25Pension Code, as authorized in this Section. Beginning July 1,
261995, the Department of Central Management Services may make

 

 

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1expenditures from the Teacher Health Insurance Security Fund
2for those costs.
3    After other funds authorized for the payment of the costs
4of the health benefit program established under Article 16 of
5the Illinois Pension Code are exhausted and until January 1,
61996 (or such later date as may be agreed upon by the Director
7of Central Management Services and the Secretary of the
8Teachers' Retirement System), the Secretary of the Teachers'
9Retirement System may make expenditures from the Teacher
10Health Insurance Security Fund as necessary to pay up to 75% of
11the cost of providing health coverage to eligible benefit
12recipients (as defined in Sections 16-153.1 and 16-153.3 of
13the Illinois Pension Code) who are enrolled in the Article 16
14health benefit program and to facilitate the transfer of
15administration of the health benefit program to the Department
16of Central Management Services.
17    The Department of Central Management Services, or any
18successor agency designated to procure healthcare contracts
19pursuant to this Act, is authorized to establish funds,
20separate accounts provided by any bank or banks as defined by
21the Illinois Banking Act, or separate accounts provided by any
22savings and loan association or associations as defined by the
23Illinois Savings and Loan Act of 1985 to be held by the
24Director, outside the State treasury, for the purpose of
25receiving the transfer of moneys from the Teacher Health
26Insurance Security Fund. The Department may promulgate rules

 

 

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1further defining the methodology for the transfers. Any
2interest earned by moneys in the funds or accounts shall inure
3to the Teacher Health Insurance Security Fund. The transferred
4moneys, and interest accrued thereon, shall be used
5exclusively for transfers to administrative service
6organizations or their financial institutions for payments of
7claims to claimants and providers under the self-insurance
8health plan. The transferred moneys, and interest accrued
9thereon, shall not be used for any other purpose including,
10but not limited to, reimbursement of administration fees due
11the administrative service organization pursuant to its
12contract or contracts with the Department.
13    (g) Contract for benefits. The Director shall by contract,
14self-insurance, or otherwise make available the program of
15health benefits for TRS benefit recipients and their TRS
16dependent beneficiaries that is provided for in this Section.
17The contract or other arrangement for the provision of these
18health benefits shall be on terms deemed by the Director to be
19in the best interest of the State of Illinois and the TRS
20benefit recipients based on, but not limited to, such criteria
21as administrative cost, service capabilities of the carrier or
22other contractor, and the costs of the benefits.
23    (g-5) Committee. A Teacher Retirement Insurance Program
24Committee shall be established, to consist of 10 persons
25appointed by the Governor.
26    The Committee shall convene at least 4 times each year,

 

 

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1and shall consider and make recommendations on issues
2affecting the program of health benefits provided under this
3Section. Recommendations of the Committee shall be based on a
4consensus of the members of the Committee.
5    If the Teacher Health Insurance Security Fund experiences
6a deficit balance based upon the contribution and subsidy
7rates established in this Section and Section 6.6 for Fiscal
8Year 2008 or thereafter, the Committee shall make
9recommendations for adjustments to the funding sources
10established under these Sections.
11    In addition, the Committee shall identify proposed
12solutions to the funding shortfalls that are affecting the
13Teacher Health Insurance Security Fund, and it shall report
14those solutions to the Governor and the General Assembly
15within 6 months after August 15, 2011 (the effective date of
16Public Act 97-386).
17    (h) Continuation of program. It is the intention of the
18General Assembly that the program of health benefits provided
19under this Section be maintained on an ongoing, affordable
20basis.
21    The program of health benefits provided under this Section
22may be amended by the State and is not intended to be a pension
23or retirement benefit subject to protection under Article
24XIII, Section 5 of the Illinois Constitution.
25    (i) Repeal. (Blank).
26(Source: P.A. 100-1017, eff. 8-21-18; 101-483, eff. 1-1-20.)
 

 

 

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1    Section 99. Effective date. This Act takes effect upon
2becoming law.".