102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
SB4236

 

Introduced 11/14/2022, by Sen. Chapin Rose

 

SYNOPSIS AS INTRODUCED:
 
5 ILCS 375/8  from Ch. 127, par. 528

    Amends the State Employees Group Insurance Act of 1971. Provides that beginning January 1, 2023, the Director of Central Management Services shall establish a program of financial incentives to encourage Medicare-primary members to elect not to participate in the group health benefits program for Medicare-primary members and their Medicare-primary dependents. Provides that the program of financial incentives shall include a monthly voucher in the amount that the State would have contributed toward that member's monthly premium if the Medicare-primary member elected to participate in the group health benefits program. Provides that the voucher shall be used by the Medicare-primary member to pay the monthly premium cost of an individual Medicare Advantage plan of his or her choosing. Effective immediately.


LRB102 29332 BMS 41318 b

 

 

A BILL FOR

 

SB4236LRB102 29332 BMS 41318 b

1    AN ACT concerning State government.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The State Employees Group Insurance Act of 1971
5is amended by changing Section 8 as follows:
 
6    (5 ILCS 375/8)  (from Ch. 127, par. 528)
7    Sec. 8. Eligibility.
8    (a) Each employee eligible under the provisions of this
9Act and any rules and regulations promulgated and adopted
10hereunder by the Director shall become immediately eligible
11and covered for all benefits available under the programs.
12Employees electing coverage for eligible dependents shall have
13the coverage effective immediately, provided that the election
14is properly filed in accordance with required filing dates and
15procedures specified by the Director, including the completion
16and submission of all documentation and forms required by the
17Director.
18        (1) Every member originally eligible to elect
19    dependent coverage, but not electing it during the
20    original eligibility period, may subsequently obtain
21    dependent coverage only in the event of a qualifying
22    change in status, special enrollment, special circumstance
23    as defined by the Director, or during the annual Benefit

 

 

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1    Choice Period.
2        (2) Members described above being transferred from
3    previous coverage towards which the State has been
4    contributing shall be transferred regardless of
5    preexisting conditions, waiting periods, or other
6    requirements that might jeopardize claim payments to which
7    they would otherwise have been entitled.
8        (3) Eligible and covered members that are eligible for
9    coverage as dependents except for the fact of being
10    members shall be transferred to, and covered under,
11    dependent status regardless of preexisting conditions,
12    waiting periods, or other requirements that might
13    jeopardize claim payments to which they would otherwise
14    have been entitled upon cessation of member status and the
15    election of dependent coverage by a member eligible to
16    elect that coverage.
17    (b) New employees shall be immediately insured for the
18basic group life insurance and covered by the program of
19health benefits on the first day of active State service.
20Optional life insurance coverage one to 4 times the basic
21amount, if elected during the relevant eligibility period,
22will become effective on the date of employment. Optional life
23insurance coverage exceeding 4 times the basic amount and all
24life insurance amounts applied for after the eligibility
25period will be effective, subject to satisfactory evidence of
26insurability when applicable, or other necessary

 

 

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1qualifications, pursuant to the requirements of the applicable
2benefit program, unless there is a change in status that would
3confer new eligibility for change of enrollment under rules
4established supplementing this Act, in which event application
5must be made within the new eligibility period.
6    (c) As to the group health benefits program contracted to
7begin or continue after June 30, 1973, each annuitant,
8survivor, and retired employee shall become immediately
9eligible for all benefits available under that program. Each
10annuitant, survivor, and retired employee shall have coverage
11effective immediately, provided that the election is properly
12filed in accordance with the required filing dates and
13procedures specified by the Director, including the completion
14and submission of all documentation and forms required by the
15Director. Annuitants, survivors, and retired employees may
16elect coverage for eligible dependents and shall have the
17coverage effective immediately, provided that the election is
18properly filed in accordance with required filing dates and
19procedures specified by the Director, except that, for a
20survivor, the dependent sought to be added on or after the
21effective date of this amendatory Act of the 97th General
22Assembly must have been eligible for coverage as a dependent
23under the deceased member upon whom the survivor's annuity is
24based in order to be eligible for coverage under the survivor.
25    Except as otherwise provided in this Act, where husband
26and wife are both eligible members, each shall be enrolled as a

 

 

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1member and coverage on their eligible dependent children, if
2any, may be under the enrollment and election of either.
3    Regardless of other provisions herein regarding late
4enrollment or other qualifications, as appropriate, the
5Director may periodically authorize open enrollment periods
6for each of the benefit programs at which time each member may
7elect enrollment or change of enrollment without regard to
8age, sex, health, or other qualification under the conditions
9as may be prescribed in rules and regulations supplementing
10this Act. Special open enrollment periods may be declared by
11the Director for certain members only when special
12circumstances occur that affect only those members.
13    (d) Eligible members may elect not to participate in the
14program of health benefits as defined in this Act. The
15election must be made during the annual benefit choice period
16or upon showing a qualifying change in status as defined in the
17U.S. Internal Revenue Code, subject to the conditions in this
18subsection.
19        (1) (Blank).
20        (2) Members may re-enroll in the Department of Central
21    Management Services program of health benefits upon
22    showing a qualifying change in status, as defined in the
23    U.S. Internal Revenue Code, without evidence of
24    insurability and with no limitations on coverage for
25    pre-existing conditions.
26        (3) Members may also re-enroll in the program of

 

 

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1    health benefits during any annual benefit choice period,
2    without evidence of insurability.
3        (4) Members who elect not to participate in the
4    program of health benefits shall be furnished a written
5    explanation of the requirements and limitations for the
6    election not to participate in the program and for
7    re-enrolling in the program. The explanation shall also be
8    included in the annual benefit choice options booklets
9    furnished to members.
10    (d-5) Beginning July 1, 2005, the Director may establish a
11program of financial incentives to encourage annuitants
12receiving a retirement annuity, but who are not eligible for
13benefits under the federal Medicare health insurance program
14(Title XVIII of the Social Security Act, as added by Public Law
1589-97) to elect not to participate in the program of health
16benefits provided under this Act. The election by an annuitant
17not to participate under this program must be made in
18accordance with the requirements set forth under subsection
19(d). The financial incentives provided to these annuitants
20under the program may not exceed $150 per month for each
21annuitant electing not to participate in the program of health
22benefits provided under this Act.
23    (d-6) Beginning July 1, 2013, the Director may establish a
24program of financial incentives to encourage annuitants with
2520 or more years of creditable service but who are not eligible
26for benefits under the federal Medicare health insurance

 

 

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1program (Title XVIII of the Social Security Act, as added by
2Public Law 89-97) to elect not to participate in the program of
3health benefits provided under this Act. The election by an
4annuitant not to participate under this program must be made
5in accordance with the requirements set forth under subsection
6(d). The program established under this subsection (d-6) may
7include a prorated incentive for annuitants with fewer than 20
8years of creditable service, as determined by the Director.
9The financial incentives provided to these annuitants under
10this program may not exceed $500 per month for each annuitant
11electing not to participate in the program of health benefits
12provided under this Act.
13    (d-7) Beginning January 1, 2023, the Director shall
14establish a program of financial incentives to encourage
15Medicare-primary members to elect not to participate in the
16group health benefits program for Medicare-primary members and
17their Medicare-primary dependents provided under this Act. The
18program of financial incentives established under this
19subsection (d-7) shall include a voucher, to be issued
20monthly, in the amount that the State would have contributed
21toward that member's monthly premium if the Medicare-primary
22member elected to participate in the group health benefits
23program for Medicare-primary members and their
24Medicare-primary dependents provided under this Act. The
25voucher shall be used by the Medicare-primary member to pay
26the monthly premium cost of an individual Medicare Advantage

 

 

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1plan of his or her choosing. Any amount of premium cost in
2excess of the amount of the voucher is the Medicare-primary
3member's responsibility.
4    (e) Notwithstanding any other provision of this Act or the
5rules adopted under this Act, if a person participating in the
6program of health benefits as the dependent spouse of an
7eligible member becomes an annuitant, the person may elect, at
8the time of becoming an annuitant or during any subsequent
9annual benefit choice period, to continue participation as a
10dependent rather than as an eligible member for as long as the
11person continues to be an eligible dependent. In order to be
12eligible to make such an election, the person must have been
13enrolled as a dependent under the program of health benefits
14for no less than one year prior to becoming an annuitant.
15    An eligible member who has elected to participate as a
16dependent may re-enroll in the program of health benefits as
17an eligible member (i) during any subsequent annual benefit
18choice period or (ii) upon showing a qualifying change in
19status, as defined in the U.S. Internal Revenue Code, without
20evidence of insurability and with no limitations on coverage
21for pre-existing conditions.
22    A person who elects to participate in the program of
23health benefits as a dependent rather than as an eligible
24member shall be furnished a written explanation of the
25consequences of electing to participate as a dependent and the
26conditions and procedures for re-enrolling as an eligible

 

 

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1member. The explanation shall also be included in the annual
2benefit choice options booklet furnished to members.
3(Source: P.A. 102-19, eff. 7-1-21.)
 
4    Section 99. Effective date. This Act takes effect upon
5becoming law.