Rep. Dan Reitz

Filed: 1/4/2011

 

 


 

 


 
09600SB2525ham001LRB096 16690 JDS 44611 a

1
AMENDMENT TO SENATE BILL 2525

2    AMENDMENT NO. ______. Amend Senate Bill 2525 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The State Employees Group Insurance Act of 1971
5is amended by changing Sections 3, 6.5, and 10 as follows:
 
6    (5 ILCS 375/3)  (from Ch. 127, par. 523)
7    Sec. 3. Definitions. Unless the context otherwise
8requires, the following words and phrases as used in this Act
9shall have the following meanings. The Department may define
10these and other words and phrases separately for the purpose of
11implementing specific programs providing benefits under this
12Act.
13    (a) "Administrative service organization" means any
14person, firm or corporation experienced in the handling of
15claims which is fully qualified, financially sound and capable
16of meeting the service requirements of a contract of

 

 

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1administration executed with the Department.
2    (b) "Annuitant" means (1) an employee who retires, or has
3retired, on or after January 1, 1966 on an immediate annuity
4under the provisions of Articles 2, 14 (including an employee
5who has elected to receive an alternative retirement
6cancellation payment under Section 14-108.5 of the Illinois
7Pension Code in lieu of an annuity), 15 (including an employee
8who has retired under the optional retirement program
9established under Section 15-158.2), paragraphs (2), (3), or
10(5) of Section 16-106, or Article 18 of the Illinois Pension
11Code; (2) any person who was receiving group insurance coverage
12under this Act as of March 31, 1978 by reason of his status as
13an annuitant, even though the annuity in relation to which such
14coverage was provided is a proportional annuity based on less
15than the minimum period of service required for a retirement
16annuity in the system involved; (3) any person not otherwise
17covered by this Act who has retired as a participating member
18under Article 2 of the Illinois Pension Code but is ineligible
19for the retirement annuity under Section 2-119 of the Illinois
20Pension Code; (4) the spouse of any person who is receiving a
21retirement annuity under Article 18 of the Illinois Pension
22Code and who is covered under a group health insurance program
23sponsored by a governmental employer other than the State of
24Illinois and who has irrevocably elected to waive his or her
25coverage under this Act and to have his or her spouse
26considered as the "annuitant" under this Act and not as a

 

 

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1"dependent"; or (5) an employee who retires, or has retired,
2from a qualified position, as determined according to rules
3promulgated by the Director, under a qualified local
4government, a qualified rehabilitation facility, a qualified
5domestic violence shelter or service, or a qualified child
6advocacy center. (For definition of "retired employee", see (p)
7post).
8    (b-5) "New SERS annuitant" means a person who, on or after
9January 1, 1998, becomes an annuitant, as defined in subsection
10(b), by virtue of beginning to receive a retirement annuity
11under Article 14 of the Illinois Pension Code (including an
12employee who has elected to receive an alternative retirement
13cancellation payment under Section 14-108.5 of that Code in
14lieu of an annuity), and is eligible to participate in the
15basic program of group health benefits provided for annuitants
16under this Act.
17    (b-6) "New SURS annuitant" means a person who (1) on or
18after January 1, 1998, becomes an annuitant, as defined in
19subsection (b), by virtue of beginning to receive a retirement
20annuity under Article 15 of the Illinois Pension Code, (2) has
21not made the election authorized under Section 15-135.1 of the
22Illinois Pension Code, and (3) is eligible to participate in
23the basic program of group health benefits provided for
24annuitants under this Act.
25    (b-7) "New TRS State annuitant" means a person who, on or
26after July 1, 1998, becomes an annuitant, as defined in

 

 

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1subsection (b), by virtue of beginning to receive a retirement
2annuity under Article 16 of the Illinois Pension Code based on
3service as a teacher as defined in paragraph (2), (3), or (5)
4of Section 16-106 of that Code, and is eligible to participate
5in the basic program of group health benefits provided for
6annuitants under this Act.
7    (c) "Carrier" means (1) an insurance company, a corporation
8organized under the Limited Health Service Organization Act or
9the Voluntary Health Services Plan Act, a partnership, or other
10nongovernmental organization, which is authorized to do group
11life or group health insurance business in Illinois, or (2) the
12State of Illinois as a self-insurer.
13    (d) "Compensation" means salary or wages payable on a
14regular payroll by the State Treasurer on a warrant of the
15State Comptroller out of any State, trust or federal fund, or
16by the Governor of the State through a disbursing officer of
17the State out of a trust or out of federal funds, or by any
18Department out of State, trust, federal or other funds held by
19the State Treasurer or the Department, to any person for
20personal services currently performed, and ordinary or
21accidental disability benefits under Articles 2, 14, 15
22(including ordinary or accidental disability benefits under
23the optional retirement program established under Section
2415-158.2), paragraphs (2), (3), or (5) of Section 16-106, or
25Article 18 of the Illinois Pension Code, for disability
26incurred after January 1, 1966, or benefits payable under the

 

 

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1Workers' Compensation or Occupational Diseases Act or benefits
2payable under a sick pay plan established in accordance with
3Section 36 of the State Finance Act. "Compensation" also means
4salary or wages paid to an employee of any qualified local
5government, qualified rehabilitation facility, qualified
6domestic violence shelter or service, or qualified child
7advocacy center.
8    (e) "Commission" means the State Employees Group Insurance
9Advisory Commission authorized by this Act. Commencing July 1,
101984, "Commission" as used in this Act means the Commission on
11Government Forecasting and Accountability as established by
12the Legislative Commission Reorganization Act of 1984.
13    (f) "Contributory", when referred to as contributory
14coverage, shall mean optional coverages or benefits elected by
15the member toward the cost of which such member makes
16contribution, or which are funded in whole or in part through
17the acceptance of a reduction in earnings or the foregoing of
18an increase in earnings by an employee, as distinguished from
19noncontributory coverage or benefits which are paid entirely by
20the State of Illinois without reduction of the member's salary.
21    (g) "Department" means any department, institution, board,
22commission, officer, court or any agency of the State
23government receiving appropriations and having power to
24certify payrolls to the Comptroller authorizing payments of
25salary and wages against such appropriations as are made by the
26General Assembly from any State fund, or against trust funds

 

 

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1held by the State Treasurer and includes boards of trustees of
2the retirement systems created by Articles 2, 14, 15, 16 and 18
3of the Illinois Pension Code. "Department" also includes the
4Illinois Comprehensive Health Insurance Board, the Board of
5Examiners established under the Illinois Public Accounting
6Act, and the Illinois Finance Authority.
7    (h) "Dependent", when the term is used in the context of
8the health and life plan, means a member's spouse and any
9unmarried child (1) from birth to age 26 19 including an
10adopted child, a child who lives with the member from the time
11of the filing of a petition for adoption until entry of an
12order of adoption, a stepchild or adjudicated recognized child
13who lives with the member in a parent-child relationship, or a
14child who lives with the member if such member is a court
15appointed guardian of the child or , (2) age 19 to 24 enrolled
16as a full-time student in any accredited school, financially
17dependent upon the member, and eligible to be claimed as a
18dependent for income tax purposes, (2.1) age 19 to 24 on a
19medical leave of absence as described in Section 356z.11 of the
20Illinois Insurance Code (215 ILCS 5/356z.11), or (3) age 19 or
21over who is mentally or physically disabled from a cause
22originating prior to the age of 19 (age 26 if enrolled as an
23adult child dependent) handicapped. For the purposes of item
24(2), an unmarried child age 19 to 24 who is a member of the
25United States Armed Services, including the Illinois National
26Guard, and is mobilized to active duty shall qualify as a

 

 

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1dependent beyond the age of 24 and until the age of 25 and
2while a full-time student for the amount of time spent on
3active duty between the ages of 19 and 24. The individual
4attempting to qualify for this additional time must submit
5written documentation of active duty service to the Director.
6The changes made by this amendatory Act of the 94th General
7Assembly apply only to individuals mobilized to active duty in
8the United States Armed Services, including the Illinois
9National Guard, on or after January 1, 2002. For the health
10plan only, the term "dependent" also includes (1) any person
11enrolled prior to the effective date of this Section who is
12dependent upon the member to the extent that the member may
13claim such person as a dependent for income tax deduction
14purposes and (2) ; no other such person may be enrolled. For the
15health plan only, the term "dependent" also includes any person
16who has received after June 30, 2000 an organ transplant and
17who is financially dependent upon the member and eligible to be
18claimed as a dependent for income tax purposes. A member
19requesting to cover any dependent must provide documentation as
20requested by the Department of Central Management Services and
21file with the Department any and all forms required by the
22Department.
23    (i) "Director" means the Director of the Illinois
24Department of Central Management Services or of any successor
25agency designated to administer this Act.
26    (j) "Eligibility period" means the period of time a member

 

 

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1has to elect enrollment in programs or to select benefits
2without regard to age, sex or health.
3    (k) "Employee" means and includes each officer or employee
4in the service of a department who (1) receives his
5compensation for service rendered to the department on a
6warrant issued pursuant to a payroll certified by a department
7or on a warrant or check issued and drawn by a department upon
8a trust, federal or other fund or on a warrant issued pursuant
9to a payroll certified by an elected or duly appointed officer
10of the State or who receives payment of the performance of
11personal services on a warrant issued pursuant to a payroll
12certified by a Department and drawn by the Comptroller upon the
13State Treasurer against appropriations made by the General
14Assembly from any fund or against trust funds held by the State
15Treasurer, and (2) is employed full-time or part-time in a
16position normally requiring actual performance of duty during
17not less than 1/2 of a normal work period, as established by
18the Director in cooperation with each department, except that
19persons elected by popular vote will be considered employees
20during the entire term for which they are elected regardless of
21hours devoted to the service of the State, and (3) except that
22"employee" does not include any person who is not eligible by
23reason of such person's employment to participate in one of the
24State retirement systems under Articles 2, 14, 15 (either the
25regular Article 15 system or the optional retirement program
26established under Section 15-158.2) or 18, or under paragraph

 

 

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1(2), (3), or (5) of Section 16-106, of the Illinois Pension
2Code, but such term does include persons who are employed
3during the 6 month qualifying period under Article 14 of the
4Illinois Pension Code. Such term also includes any person who
5(1) after January 1, 1966, is receiving ordinary or accidental
6disability benefits under Articles 2, 14, 15 (including
7ordinary or accidental disability benefits under the optional
8retirement program established under Section 15-158.2),
9paragraphs (2), (3), or (5) of Section 16-106, or Article 18 of
10the Illinois Pension Code, for disability incurred after
11January 1, 1966, (2) receives total permanent or total
12temporary disability under the Workers' Compensation Act or
13Occupational Disease Act as a result of injuries sustained or
14illness contracted in the course of employment with the State
15of Illinois, or (3) is not otherwise covered under this Act and
16has retired as a participating member under Article 2 of the
17Illinois Pension Code but is ineligible for the retirement
18annuity under Section 2-119 of the Illinois Pension Code.
19However, a person who satisfies the criteria of the foregoing
20definition of "employee" except that such person is made
21ineligible to participate in the State Universities Retirement
22System by clause (4) of subsection (a) of Section 15-107 of the
23Illinois Pension Code is also an "employee" for the purposes of
24this Act. "Employee" also includes any person receiving or
25eligible for benefits under a sick pay plan established in
26accordance with Section 36 of the State Finance Act. "Employee"

 

 

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1also includes (i) each officer or employee in the service of a
2qualified local government, including persons appointed as
3trustees of sanitary districts regardless of hours devoted to
4the service of the sanitary district, (ii) each employee in the
5service of a qualified rehabilitation facility, (iii) each
6full-time employee in the service of a qualified domestic
7violence shelter or service, and (iv) each full-time employee
8in the service of a qualified child advocacy center, as
9determined according to rules promulgated by the Director.
10    (l) "Member" means an employee, annuitant, retired
11employee or survivor.
12    (m) "Optional coverages or benefits" means those coverages
13or benefits available to the member on his or her voluntary
14election, and at his or her own expense.
15    (n) "Program" means the group life insurance, health
16benefits and other employee benefits designed and contracted
17for by the Director under this Act.
18    (o) "Health plan" means a health benefits program offered
19by the State of Illinois for persons eligible for the plan.
20    (p) "Retired employee" means any person who would be an
21annuitant as that term is defined herein but for the fact that
22such person retired prior to January 1, 1966. Such term also
23includes any person formerly employed by the University of
24Illinois in the Cooperative Extension Service who would be an
25annuitant but for the fact that such person was made ineligible
26to participate in the State Universities Retirement System by

 

 

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1clause (4) of subsection (a) of Section 15-107 of the Illinois
2Pension Code.
3    (q) "Survivor" means a person receiving an annuity as a
4survivor of an employee or of an annuitant. "Survivor" also
5includes: (1) the surviving dependent of a person who satisfies
6the definition of "employee" except that such person is made
7ineligible to participate in the State Universities Retirement
8System by clause (4) of subsection (a) of Section 15-107 of the
9Illinois Pension Code; (2) the surviving dependent of any
10person formerly employed by the University of Illinois in the
11Cooperative Extension Service who would be an annuitant except
12for the fact that such person was made ineligible to
13participate in the State Universities Retirement System by
14clause (4) of subsection (a) of Section 15-107 of the Illinois
15Pension Code; and (3) the surviving dependent of a person who
16was an annuitant under this Act by virtue of receiving an
17alternative retirement cancellation payment under Section
1814-108.5 of the Illinois Pension Code.
19    (q-2) "SERS" means the State Employees' Retirement System
20of Illinois, created under Article 14 of the Illinois Pension
21Code.
22    (q-3) "SURS" means the State Universities Retirement
23System, created under Article 15 of the Illinois Pension Code.
24    (q-4) "TRS" means the Teachers' Retirement System of the
25State of Illinois, created under Article 16 of the Illinois
26Pension Code.

 

 

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1    (q-5) "New SERS survivor" means a survivor, as defined in
2subsection (q), whose annuity is paid under Article 14 of the
3Illinois Pension Code and is based on the death of (i) an
4employee whose death occurs on or after January 1, 1998, or
5(ii) a new SERS annuitant as defined in subsection (b-5). "New
6SERS survivor" includes the surviving dependent of a person who
7was an annuitant under this Act by virtue of receiving an
8alternative retirement cancellation payment under Section
914-108.5 of the Illinois Pension Code.
10    (q-6) "New SURS survivor" means a survivor, as defined in
11subsection (q), whose annuity is paid under Article 15 of the
12Illinois Pension Code and is based on the death of (i) an
13employee whose death occurs on or after January 1, 1998, or
14(ii) a new SURS annuitant as defined in subsection (b-6).
15    (q-7) "New TRS State survivor" means a survivor, as defined
16in subsection (q), whose annuity is paid under Article 16 of
17the Illinois Pension Code and is based on the death of (i) an
18employee who is a teacher as defined in paragraph (2), (3), or
19(5) of Section 16-106 of that Code and whose death occurs on or
20after July 1, 1998, or (ii) a new TRS State annuitant as
21defined in subsection (b-7).
22    (r) "Medical services" means the services provided within
23the scope of their licenses by practitioners in all categories
24licensed under the Medical Practice Act of 1987.
25    (s) "Unit of local government" means any county,
26municipality, township, school district (including a

 

 

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1combination of school districts under the Intergovernmental
2Cooperation Act), special district or other unit, designated as
3a unit of local government by law, which exercises limited
4governmental powers or powers in respect to limited
5governmental subjects, any not-for-profit association with a
6membership that primarily includes townships and township
7officials, that has duties that include provision of research
8service, dissemination of information, and other acts for the
9purpose of improving township government, and that is funded
10wholly or partly in accordance with Section 85-15 of the
11Township Code; any not-for-profit corporation or association,
12with a membership consisting primarily of municipalities, that
13operates its own utility system, and provides research,
14training, dissemination of information, or other acts to
15promote cooperation between and among municipalities that
16provide utility services and for the advancement of the goals
17and purposes of its membership; the Southern Illinois
18Collegiate Common Market, which is a consortium of higher
19education institutions in Southern Illinois; the Illinois
20Association of Park Districts; and any hospital provider that
21is owned by a county that has 100 or fewer hospital beds and
22has not already joined the program. "Qualified local
23government" means a unit of local government approved by the
24Director and participating in a program created under
25subsection (i) of Section 10 of this Act.
26    (t) "Qualified rehabilitation facility" means any

 

 

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1not-for-profit organization that is accredited by the
2Commission on Accreditation of Rehabilitation Facilities or
3certified by the Department of Human Services (as successor to
4the Department of Mental Health and Developmental
5Disabilities) to provide services to persons with disabilities
6and which receives funds from the State of Illinois for
7providing those services, approved by the Director and
8participating in a program created under subsection (j) of
9Section 10 of this Act.
10    (u) "Qualified domestic violence shelter or service" means
11any Illinois domestic violence shelter or service and its
12administrative offices funded by the Department of Human
13Services (as successor to the Illinois Department of Public
14Aid), approved by the Director and participating in a program
15created under subsection (k) of Section 10.
16    (v) "TRS benefit recipient" means a person who:
17        (1) is not a "member" as defined in this Section; and
18        (2) is receiving a monthly benefit or retirement
19    annuity under Article 16 of the Illinois Pension Code; and
20        (3) either (i) has at least 8 years of creditable
21    service under Article 16 of the Illinois Pension Code, or
22    (ii) was enrolled in the health insurance program offered
23    under that Article on January 1, 1996, or (iii) is the
24    survivor of a benefit recipient who had at least 8 years of
25    creditable service under Article 16 of the Illinois Pension
26    Code or was enrolled in the health insurance program

 

 

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1    offered under that Article on the effective date of this
2    amendatory Act of 1995, or (iv) is a recipient or survivor
3    of a recipient of a disability benefit under Article 16 of
4    the Illinois Pension Code.
5    (w) "TRS dependent beneficiary" means a person who:
6        (1) is not a "member" or "dependent" as defined in this
7    Section; and
8        (2) is a TRS benefit recipient's: (A) spouse, (B)
9    dependent parent who is receiving at least half of his or
10    her support from the TRS benefit recipient, or (C)
11    unmarried natural, step, adjudicated, or adopted child who
12    is (i) under age 26 19, or (ii) enrolled as a full-time
13    student in an accredited school, financially dependent
14    upon the TRS benefit recipient, eligible to be claimed as a
15    dependent for income tax purposes, and either is under age
16    24 or was, on January 1, 1996, participating as a dependent
17    beneficiary in the health insurance program offered under
18    Article 16 of the Illinois Pension Code, or (iii) age 19 or
19    over who is mentally or physically disabled from a cause
20    originating prior to the age of 19 (age 26 if enrolled as
21    adult child) handicapped.
22    (x) "Military leave with pay and benefits" refers to
23individuals in basic training for reserves, special/advanced
24training, annual training, emergency call up, or activation by
25the President of the United States, or any other training or
26duty in service to the United States Armed Forces with

 

 

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1approved pay and benefits.
2    (y) (Blank). "Military leave without pay and benefits"
3refers to individuals who enlist for active duty in a regular
4component of the U.S. Armed Forces or other duty not specified
5or authorized under military leave with pay and benefits.
6    (z) "Community college benefit recipient" means a person
7who:
8        (1) is not a "member" as defined in this Section; and
9        (2) is receiving a monthly survivor's annuity or
10    retirement annuity under Article 15 of the Illinois Pension
11    Code; and
12        (3) either (i) was a full-time employee of a community
13    college district or an association of community college
14    boards created under the Public Community College Act
15    (other than an employee whose last employer under Article
16    15 of the Illinois Pension Code was a community college
17    district subject to Article VII of the Public Community
18    College Act) and was eligible to participate in a group
19    health benefit plan as an employee during the time of
20    employment with a community college district (other than a
21    community college district subject to Article VII of the
22    Public Community College Act) or an association of
23    community college boards, or (ii) is the survivor of a
24    person described in item (i).
25    (aa) "Community college dependent beneficiary" means a
26person who:

 

 

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1        (1) is not a "member" or "dependent" as defined in this
2    Section; and
3        (2) is a community college benefit recipient's: (A)
4    spouse, (B) dependent parent who is receiving at least half
5    of his or her support from the community college benefit
6    recipient, or (C) unmarried natural, step, adjudicated, or
7    adopted child who is (i) under age 26 19, or (ii) enrolled
8    as a full-time student in an accredited school, financially
9    dependent upon the community college benefit recipient,
10    eligible to be claimed as a dependent for income tax
11    purposes and under age 23, or (iii) age 19 or over and
12    mentally or physically disabled from a cause originating
13    prior to the age of 19 (age 26 if enrolled as an adult
14    child) handicapped.
15    (bb) "Qualified child advocacy center" means any Illinois
16child advocacy center and its administrative offices funded by
17the Department of Children and Family Services, as defined by
18the Children's Advocacy Center Act (55 ILCS 80/), approved by
19the Director and participating in a program created under
20subsection (n) of Section 10.
21(Source: P.A. 95-331, eff. 8-21-07; 95-632, eff. 9-25-07;
2296-756, eff. 1-1-10.)
 
23    (5 ILCS 375/6.5)
24    Sec. 6.5. Health benefits for TRS benefit recipients and
25TRS dependent beneficiaries.

 

 

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1    (a) Purpose. It is the purpose of this amendatory Act of
21995 to transfer the administration of the program of health
3benefits established for benefit recipients and their
4dependent beneficiaries under Article 16 of the Illinois
5Pension Code to the Department of Central Management Services.
6    (b) Transition provisions. The Board of Trustees of the
7Teachers' Retirement System shall continue to administer the
8health benefit program established under Article 16 of the
9Illinois Pension Code through December 31, 1995. Beginning
10January 1, 1996, the Department of Central Management Services
11shall be responsible for administering a program of health
12benefits for TRS benefit recipients and TRS dependent
13beneficiaries under this Section. The Department of Central
14Management Services and the Teachers' Retirement System shall
15cooperate in this endeavor and shall coordinate their
16activities so as to ensure a smooth transition and
17uninterrupted health benefit coverage.
18    (c) Eligibility. All persons who were enrolled in the
19Article 16 program at the time of the transfer shall be
20eligible to participate in the program established under this
21Section without any interruption or delay in coverage or
22limitation as to pre-existing medical conditions. Eligibility
23to participate shall be determined by the Teachers' Retirement
24System. Eligibility information shall be communicated to the
25Department of Central Management Services in a format
26acceptable to the Department.

 

 

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1    A TRS dependent beneficiary who is a an unmarried child age
219 or over and mentally or physically disabled does not become
3ineligible to participate by reason of (i) becoming ineligible
4to be claimed 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 provided
10by the program previously established under Article 16 of the
11Illinois 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 for
18federal medicare benefits, that are provided under subsection
19(a) of Section 6 of this Act for other health benefit programs
20under 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, by
25April 15 of each calendar year, the rate-setting methodology
26(including but not limited to utilization levels and costs)

 

 

09600SB2525ham001- 20 -LRB096 16690 JDS 44611 a

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

 

 

09600SB2525ham001- 21 -LRB096 16690 JDS 44611 a

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

 

 

09600SB2525ham001- 22 -LRB096 16690 JDS 44611 a

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

 

 

09600SB2525ham001- 23 -LRB096 16690 JDS 44611 a

1    benefit recipient, and (ii) all or part of the balance of
2    the cost of coverage may, at the school board's option, be
3    paid to the Teachers' Retirement System by the school board
4    of the school district from which the TRS benefit recipient
5    retired, in accordance with Section 10-22.3b of the School
6    Code. The Teachers' Retirement System shall promptly
7    deposit all moneys withheld by or paid to it under this
8    subdivision (e)(4) into the Teacher Health Insurance
9    Security Fund. These moneys shall not be considered assets
10    of the Retirement System.
11    (f) Financing. Beginning July 1, 1995, all revenues arising
12from 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

 

 

09600SB2525ham001- 24 -LRB096 16690 JDS 44611 a

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 Health
10Insurance Security Fund as necessary to pay up to 75% of the
11cost of providing health coverage to eligible benefit
12recipients (as defined in Sections 16-153.1 and 16-153.3 of the
13Illinois 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 Healthcare and Family 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

 

 

09600SB2525ham001- 25 -LRB096 16690 JDS 44611 a

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 exclusively
5for transfers to administrative service organizations or their
6financial institutions for payments of claims to claimants and
7providers under the self-insurance health plan. The
8transferred moneys, and interest accrued thereon, shall not be
9used for any other purpose including, but not limited to,
10reimbursement of administration fees due the administrative
11service organization pursuant to its contract or contracts with
12the 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, and

 

 

09600SB2525ham001- 26 -LRB096 16690 JDS 44611 a

1shall consider and make recommendations on issues affecting the
2program of health benefits provided under this Section.
3Recommendations of the Committee shall be based on a consensus
4of the members of the Committee.
5    If the Teacher Health Insurance Security Fund experiences a
6deficit balance based upon the contribution and subsidy rates
7established in this Section and Section 6.6 for Fiscal Year
82008 or thereafter, the Committee shall make recommendations
9for adjustments to the funding sources established under these
10Sections.
11    (h) Continuation of program. It is the intention of the
12General Assembly that the program of health benefits provided
13under this Section be maintained on an ongoing, affordable
14basis.
15    The program of health benefits provided under this Section
16may be amended by the State and is not intended to be a pension
17or retirement benefit subject to protection under Article XIII,
18Section 5 of the Illinois Constitution.
19    (i) Repeal. (Blank).
20(Source: P.A. 95-632, eff. 9-25-07.)
 
21    (5 ILCS 375/10)  (from Ch. 127, par. 530)
22    Sec. 10. Payments by State; premiums.
23    (a) The State shall pay the cost of basic non-contributory
24group life insurance and, subject to member paid contributions
25set by the Department or required by this Section, the basic

 

 

09600SB2525ham001- 27 -LRB096 16690 JDS 44611 a

1program of group health benefits on each eligible member,
2except a member, not otherwise covered by this Act, who has
3retired as a participating member under Article 2 of the
4Illinois Pension Code but is ineligible for the retirement
5annuity under Section 2-119 of the Illinois Pension Code, and
6part of each eligible member's and retired member's premiums
7for health insurance coverage for enrolled dependents as
8provided by Section 9. The State shall pay the cost of the
9basic program of group health benefits only after benefits are
10reduced by the amount of benefits covered by Medicare for all
11members and dependents who are eligible for benefits under
12Social Security or the Railroad Retirement system or who had
13sufficient Medicare-covered government employment, except that
14such reduction in benefits shall apply only to those members
15and dependents who (1) first become eligible for such Medicare
16coverage on or after July 1, 1992; or (2) are Medicare-eligible
17members or dependents of a local government unit which began
18participation in the program on or after July 1, 1992; or (3)
19remain eligible for, but no longer receive Medicare coverage
20which they had been receiving on or after July 1, 1992. The
21Department may determine the aggregate level of the State's
22contribution on the basis of actual cost of medical services
23adjusted for age, sex or geographic or other demographic
24characteristics which affect the costs of such programs.
25    The cost of participation in the basic program of group
26health benefits for the dependent or survivor of a living or

 

 

09600SB2525ham001- 28 -LRB096 16690 JDS 44611 a

1deceased retired employee who was formerly employed by the
2University of Illinois in the Cooperative Extension Service and
3would be an annuitant but for the fact that he or she was made
4ineligible to participate in the State Universities Retirement
5System by clause (4) of subsection (a) of Section 15-107 of the
6Illinois Pension Code shall not be greater than the cost of
7participation that would otherwise apply to that dependent or
8survivor if he or she were the dependent or survivor of an
9annuitant under the State Universities Retirement System.
10    (a-1) Beginning January 1, 1998, for each person who
11becomes a new SERS annuitant and participates in the basic
12program of group health benefits, the State shall contribute
13toward the cost of the annuitant's coverage under the basic
14program of group health benefits an amount equal to 5% of that
15cost for each full year of creditable service upon which the
16annuitant's retirement annuity is based, up to a maximum of
17100% for an annuitant with 20 or more years of creditable
18service. The remainder of the cost of a new SERS annuitant's
19coverage under the basic program of group health benefits shall
20be the responsibility of the annuitant. In the case of a new
21SERS annuitant who has elected to receive an alternative
22retirement cancellation payment under Section 14-108.5 of the
23Illinois Pension Code in lieu of an annuity, for the purposes
24of this subsection the annuitant shall be deemed to be
25receiving a retirement annuity based on the number of years of
26creditable service that the annuitant had established at the

 

 

09600SB2525ham001- 29 -LRB096 16690 JDS 44611 a

1time of his or her termination of service under SERS.
2    (a-2) Beginning January 1, 1998, for each person who
3becomes a new SERS survivor and participates in the basic
4program of group health benefits, the State shall contribute
5toward the cost of the survivor's coverage under the basic
6program of group health benefits an amount equal to 5% of that
7cost for each full year of the deceased employee's or deceased
8annuitant's creditable service in the State Employees'
9Retirement System of Illinois on the date of death, up to a
10maximum of 100% for a survivor of an employee or annuitant with
1120 or more years of creditable service. The remainder of the
12cost of the new SERS survivor's coverage under the basic
13program of group health benefits shall be the responsibility of
14the survivor. In the case of a new SERS survivor who was the
15dependent of an annuitant who elected to receive an alternative
16retirement cancellation payment under Section 14-108.5 of the
17Illinois Pension Code in lieu of an annuity, for the purposes
18of this subsection the deceased annuitant's creditable service
19shall be determined as of the date of termination of service
20rather than the date of death.
21    (a-3) Beginning January 1, 1998, for each person who
22becomes a new SURS annuitant and participates in the basic
23program of group health benefits, the State shall contribute
24toward the cost of the annuitant's coverage under the basic
25program of group health benefits an amount equal to 5% of that
26cost for each full year of creditable service upon which the

 

 

09600SB2525ham001- 30 -LRB096 16690 JDS 44611 a

1annuitant's retirement annuity is based, up to a maximum of
2100% for an annuitant with 20 or more years of creditable
3service. The remainder of the cost of a new SURS annuitant's
4coverage under the basic program of group health benefits shall
5be the responsibility of the annuitant.
6    (a-4) (Blank).
7    (a-5) Beginning January 1, 1998, for each person who
8becomes a new SURS survivor and participates in the basic
9program of group health benefits, the State shall contribute
10toward the cost of the survivor's coverage under the basic
11program of group health benefits an amount equal to 5% of that
12cost for each full year of the deceased employee's or deceased
13annuitant's creditable service in the State Universities
14Retirement System on the date of death, up to a maximum of 100%
15for a survivor of an employee or annuitant with 20 or more
16years of creditable service. The remainder of the cost of the
17new SURS survivor's coverage under the basic program of group
18health benefits shall be the responsibility of the survivor.
19    (a-6) Beginning July 1, 1998, for each person who becomes a
20new TRS State annuitant and participates in the basic program
21of group health benefits, the State shall contribute toward the
22cost of the annuitant's coverage under the basic program of
23group health benefits an amount equal to 5% of that cost for
24each full year of creditable service as a teacher as defined in
25paragraph (2), (3), or (5) of Section 16-106 of the Illinois
26Pension Code upon which the annuitant's retirement annuity is

 

 

09600SB2525ham001- 31 -LRB096 16690 JDS 44611 a

1based, up to a maximum of 100%; except that the State
2contribution shall be 12.5% per year (rather than 5%) for each
3full year of creditable service as a regional superintendent or
4assistant regional superintendent of schools. The remainder of
5the cost of a new TRS State annuitant's coverage under the
6basic program of group health benefits shall be the
7responsibility of the annuitant.
8    (a-7) Beginning July 1, 1998, for each person who becomes a
9new TRS State survivor and participates in the basic program of
10group health benefits, the State shall contribute toward the
11cost of the survivor's coverage under the basic program of
12group health benefits an amount equal to 5% of that cost for
13each full year of the deceased employee's or deceased
14annuitant's creditable service as a teacher as defined in
15paragraph (2), (3), or (5) of Section 16-106 of the Illinois
16Pension Code on the date of death, up to a maximum of 100%;
17except that the State contribution shall be 12.5% per year
18(rather than 5%) for each full year of the deceased employee's
19or deceased annuitant's creditable service as a regional
20superintendent or assistant regional superintendent of
21schools. The remainder of the cost of the new TRS State
22survivor's coverage under the basic program of group health
23benefits shall be the responsibility of the survivor.
24    (a-8) A new SERS annuitant, new SERS survivor, new SURS
25annuitant, new SURS survivor, new TRS State annuitant, or new
26TRS State survivor may waive or terminate coverage in the

 

 

09600SB2525ham001- 32 -LRB096 16690 JDS 44611 a

1program of group health benefits. Any such annuitant or
2survivor who has waived or terminated coverage may enroll or
3re-enroll in the program of group health benefits only during
4the annual benefit choice period, as determined by the
5Director; except that in the event of termination of coverage
6due to nonpayment of premiums, the annuitant or survivor may
7not re-enroll in the program.
8    (a-9) No later than May 1 of each calendar year, the
9Director of Central Management Services shall certify in
10writing to the Executive Secretary of the State Employees'
11Retirement System of Illinois the amounts of the Medicare
12supplement health care premiums and the amounts of the health
13care premiums for all other retirees who are not Medicare
14eligible.
15    A separate calculation of the premiums based upon the
16actual cost of each health care plan shall be so certified.
17    The Director of Central Management Services shall provide
18to the Executive Secretary of the State Employees' Retirement
19System of Illinois such information, statistics, and other data
20as he or she may require to review the premium amounts
21certified by the Director of Central Management Services.
22    The Department of Healthcare and Family Services, or any
23successor agency designated to procure healthcare contracts
24pursuant to this Act, is authorized to establish funds,
25separate accounts provided by any bank or banks as defined by
26the Illinois Banking Act, or separate accounts provided by any

 

 

09600SB2525ham001- 33 -LRB096 16690 JDS 44611 a

1savings and loan association or associations as defined by the
2Illinois Savings and Loan Act of 1985 to be held by the
3Director, outside the State treasury, for the purpose of
4receiving the transfer of moneys from the Local Government
5Health Insurance Reserve Fund. The Department may promulgate
6rules further defining the methodology for the transfers. Any
7interest earned by moneys in the funds or accounts shall inure
8to the Local Government Health Insurance Reserve Fund. The
9transferred moneys, and interest accrued thereon, shall be used
10exclusively for transfers to administrative service
11organizations or their financial institutions for payments of
12claims to claimants and providers under the self-insurance
13health plan. The transferred moneys, and interest accrued
14thereon, shall not be used for any other purpose including, but
15not limited to, reimbursement of administration fees due the
16administrative service organization pursuant to its contract
17or contracts with the Department.
18    (b) State employees who become eligible for this program on
19or after January 1, 1980 in positions normally requiring actual
20performance of duty not less than 1/2 of a normal work period
21but not equal to that of a normal work period, shall be given
22the option of participating in the available program. If the
23employee elects coverage, the State shall contribute on behalf
24of such employee to the cost of the employee's benefit and any
25applicable dependent supplement, that sum which bears the same
26percentage as that percentage of time the employee regularly

 

 

09600SB2525ham001- 34 -LRB096 16690 JDS 44611 a

1works when compared to normal work period.
2    (c) The basic non-contributory coverage from the basic
3program of group health benefits shall be continued for each
4employee not in pay status or on active service by reason of
5(1) leave of absence due to illness or injury, (2) authorized
6educational leave of absence or sabbatical leave, or (3)
7military leave with pay and benefits. This coverage shall
8continue until expiration of authorized leave and return to
9active service, but not to exceed 24 months for leaves under
10item (1) or (2). This 24-month limitation and the requirement
11of returning to active service shall not apply to persons
12receiving ordinary or accidental disability benefits or
13retirement benefits through the appropriate State retirement
14system or benefits under the Workers' Compensation or
15Occupational Disease Act.
16    (d) The basic group life insurance coverage shall continue,
17with full State contribution, where such person is (1) absent
18from active service by reason of disability arising from any
19cause other than self-inflicted, (2) on authorized educational
20leave of absence or sabbatical leave, or (3) on military leave
21with pay and benefits.
22    (e) Where the person is in non-pay status for a period in
23excess of 30 days or on leave of absence, other than by reason
24of disability, educational or sabbatical leave, or military
25leave with pay and benefits, such person may continue coverage
26only by making personal payment equal to the amount normally

 

 

09600SB2525ham001- 35 -LRB096 16690 JDS 44611 a

1contributed by the State on such person's behalf. Such payments
2and coverage may be continued: (1) until such time as the
3person returns to a status eligible for coverage at State
4expense, but not to exceed 24 months or , (2) until such
5person's employment or annuitant status with the State is
6terminated, or (3) for a maximum period of 4 years for members
7on military leave with pay and benefits and military leave
8without pay and benefits (exclusive of any additional service
9imposed pursuant to law).
10    (f) The Department shall establish by rule the extent to
11which other employee benefits will continue for persons in
12non-pay status or who are not in active service.
13    (g) The State shall not pay the cost of the basic
14non-contributory group life insurance, program of health
15benefits and other employee benefits for members who are
16survivors as defined by paragraphs (1) and (2) of subsection
17(q) of Section 3 of this Act. The costs of benefits for these
18survivors shall be paid by the survivors or by the University
19of Illinois Cooperative Extension Service, or any combination
20thereof. However, the State shall pay the amount of the
21reduction in the cost of participation, if any, resulting from
22the amendment to subsection (a) made by this amendatory Act of
23the 91st General Assembly.
24    (h) Those persons occupying positions with any department
25as a result of emergency appointments pursuant to Section 8b.8
26of the Personnel Code who are not considered employees under

 

 

09600SB2525ham001- 36 -LRB096 16690 JDS 44611 a

1this Act shall be given the option of participating in the
2programs of group life insurance, health benefits and other
3employee benefits. Such persons electing coverage may
4participate only by making payment equal to the amount normally
5contributed by the State for similarly situated employees. Such
6amounts shall be determined by the Director. Such payments and
7coverage may be continued until such time as the person becomes
8an employee pursuant to this Act or such person's appointment
9is terminated.
10    (i) Any unit of local government within the State of
11Illinois may apply to the Director to have its employees,
12annuitants, and their dependents provided group health
13coverage under this Act on a non-insured basis. To participate,
14a unit of local government must agree to enroll all of its
15employees, who may select coverage under either the State group
16health benefits plan or a health maintenance organization that
17has contracted with the State to be available as a health care
18provider for employees as defined in this Act. A unit of local
19government must remit the entire cost of providing coverage
20under the State group health benefits plan or, for coverage
21under a health maintenance organization, an amount determined
22by the Director based on an analysis of the sex, age,
23geographic location, or other relevant demographic variables
24for its employees, except that the unit of local government
25shall not be required to enroll those of its employees who are
26covered spouses or dependents under this plan or another group

 

 

09600SB2525ham001- 37 -LRB096 16690 JDS 44611 a

1policy or plan providing health benefits as long as (1) an
2appropriate official from the unit of local government attests
3that each employee not enrolled is a covered spouse or
4dependent under this plan or another group policy or plan, and
5(2) at least 50% of the employees are enrolled and the unit of
6local government remits the entire cost of providing coverage
7to those employees, except that a participating school district
8must have enrolled at least 50% of its full-time employees who
9have not waived coverage under the district's group health plan
10by participating in a component of the district's cafeteria
11plan. A participating school district is not required to enroll
12a full-time employee who has waived coverage under the
13district's health plan, provided that an appropriate official
14from the participating school district attests that the
15full-time employee has waived coverage by participating in a
16component of the district's cafeteria plan. For the purposes of
17this subsection, "participating school district" includes a
18unit of local government whose primary purpose is education as
19defined by the Department's rules.
20    Employees of a participating unit of local government who
21are not enrolled due to coverage under another group health
22policy or plan may enroll in the event of a qualifying change
23in status, special enrollment, special circumstance as defined
24by the Director, or during the annual Benefit Choice Period. A
25participating unit of local government may also elect to cover
26its annuitants. Dependent coverage shall be offered on an

 

 

09600SB2525ham001- 38 -LRB096 16690 JDS 44611 a

1optional basis, with the costs paid by the unit of local
2government, its employees, or some combination of the two as
3determined by the unit of local government. The unit of local
4government shall be responsible for timely collection and
5transmission of dependent premiums.
6    The Director shall annually determine monthly rates of
7payment, subject to the following constraints:
8        (1) In the first year of coverage, the rates shall be
9    equal to the amount normally charged to State employees for
10    elected optional coverages or for enrolled dependents
11    coverages or other contributory coverages, or contributed
12    by the State for basic insurance coverages on behalf of its
13    employees, adjusted for differences between State
14    employees and employees of the local government in age,
15    sex, geographic location or other relevant demographic
16    variables, plus an amount sufficient to pay for the
17    additional administrative costs of providing coverage to
18    employees of the unit of local government and their
19    dependents.
20        (2) In subsequent years, a further adjustment shall be
21    made to reflect the actual prior years' claims experience
22    of the employees of the unit of local government.
23    In the case of coverage of local government employees under
24a health maintenance organization, the Director shall annually
25determine for each participating unit of local government the
26maximum monthly amount the unit may contribute toward that

 

 

09600SB2525ham001- 39 -LRB096 16690 JDS 44611 a

1coverage, based on an analysis of (i) the age, sex, geographic
2location, and other relevant demographic variables of the
3unit's employees and (ii) the cost to cover those employees
4under the State group health benefits plan. The Director may
5similarly determine the maximum monthly amount each unit of
6local government may contribute toward coverage of its
7employees' dependents under a health maintenance organization.
8    Monthly payments by the unit of local government or its
9employees for group health benefits plan or health maintenance
10organization coverage shall be deposited in the Local
11Government Health Insurance Reserve Fund.
12    The Local Government Health Insurance Reserve Fund is
13hereby created as a nonappropriated trust fund to be held
14outside the State Treasury, with the State Treasurer as
15custodian. The Local Government Health Insurance Reserve Fund
16shall be a continuing fund not subject to fiscal year
17limitations. The Local Government Health Insurance Reserve
18Fund is not subject to administrative charges or charge-backs,
19including but not limited to those authorized under Section 8h
20of the State Finance Act. All revenues arising from the
21administration of the health benefits program established
22under this Section shall be deposited into the Local Government
23Health Insurance Reserve Fund. Any interest earned on moneys in
24the Local Government Health Insurance Reserve Fund shall be
25deposited into the Fund. All expenditures from this Fund shall
26be used for payments for health care benefits for local

 

 

09600SB2525ham001- 40 -LRB096 16690 JDS 44611 a

1government and rehabilitation facility employees, annuitants,
2and dependents, and to reimburse the Department or its
3administrative service organization for all expenses incurred
4in the administration of benefits. No other State funds may be
5used for these purposes.
6    A local government employer's participation or desire to
7participate in a program created under this subsection shall
8not limit that employer's duty to bargain with the
9representative of any collective bargaining unit of its
10employees.
11    (j) Any rehabilitation facility within the State of
12Illinois may apply to the Director to have its employees,
13annuitants, and their eligible dependents provided group
14health coverage under this Act on a non-insured basis. To
15participate, a rehabilitation facility must agree to enroll all
16of its employees and remit the entire cost of providing such
17coverage for its employees, except that the rehabilitation
18facility shall not be required to enroll those of its employees
19who are covered spouses or dependents under this plan or
20another group policy or plan providing health benefits as long
21as (1) an appropriate official from the rehabilitation facility
22attests that each employee not enrolled is a covered spouse or
23dependent under this plan or another group policy or plan, and
24(2) at least 50% of the employees are enrolled and the
25rehabilitation facility remits the entire cost of providing
26coverage to those employees. Employees of a participating

 

 

09600SB2525ham001- 41 -LRB096 16690 JDS 44611 a

1rehabilitation facility who are not enrolled due to coverage
2under another group health policy or plan may enroll in the
3event of a qualifying change in status, special enrollment,
4special circumstance as defined by the Director, or during the
5annual Benefit Choice Period. A participating rehabilitation
6facility may also elect to cover its annuitants. Dependent
7coverage shall be offered on an optional basis, with the costs
8paid by the rehabilitation facility, its employees, or some
9combination of the 2 as determined by the rehabilitation
10facility. The rehabilitation facility shall be responsible for
11timely collection and transmission of dependent premiums.
12    The Director shall annually determine quarterly rates of
13payment, subject to the following constraints:
14        (1) In the first year of coverage, the rates shall be
15    equal to the amount normally charged to State employees for
16    elected optional coverages or for enrolled dependents
17    coverages or other contributory coverages on behalf of its
18    employees, adjusted for differences between State
19    employees and employees of the rehabilitation facility in
20    age, sex, geographic location or other relevant
21    demographic variables, plus an amount sufficient to pay for
22    the additional administrative costs of providing coverage
23    to employees of the rehabilitation facility and their
24    dependents.
25        (2) In subsequent years, a further adjustment shall be
26    made to reflect the actual prior years' claims experience

 

 

09600SB2525ham001- 42 -LRB096 16690 JDS 44611 a

1    of the employees of the rehabilitation facility.
2    Monthly payments by the rehabilitation facility or its
3employees for group health benefits shall be deposited in the
4Local Government Health Insurance Reserve Fund.
5    (k) Any domestic violence shelter or service within the
6State of Illinois may apply to the Director to have its
7employees, annuitants, and their dependents provided group
8health coverage under this Act on a non-insured basis. To
9participate, a domestic violence shelter or service must agree
10to enroll all of its employees and pay the entire cost of
11providing such coverage for its employees. The domestic
12violence shelter shall not be required to enroll those of its
13employees who are covered spouses or dependents under this plan
14or another group policy or plan providing health benefits as
15long as (1) an appropriate official from the domestic violence
16shelter attests that each employee not enrolled is a covered
17spouse or dependent under this plan or another group policy or
18plan and (2) at least 50% of the employees are enrolled and the
19domestic violence shelter remits the entire cost of providing
20coverage to those employees. Employees of a participating
21domestic violence shelter who are not enrolled due to coverage
22under another group health policy or plan may enroll in the
23event of a qualifying change in status, special enrollment, or
24special circumstance as defined by the Director or during the
25annual Benefit Choice Period. A participating domestic
26violence shelter may also elect to cover its annuitants.

 

 

09600SB2525ham001- 43 -LRB096 16690 JDS 44611 a

1Dependent coverage shall be offered on an optional basis, with
2employees, or some combination of the 2 as determined by the
3domestic violence shelter or service. The domestic violence
4shelter or service shall be responsible for timely collection
5and transmission of dependent premiums.
6    The Director shall annually determine rates of payment,
7subject to the following constraints:
8        (1) In the first year of coverage, the rates shall be
9    equal to the amount normally charged to State employees for
10    elected optional coverages or for enrolled dependents
11    coverages or other contributory coverages on behalf of its
12    employees, adjusted for differences between State
13    employees and employees of the domestic violence shelter or
14    service in age, sex, geographic location or other relevant
15    demographic variables, plus an amount sufficient to pay for
16    the additional administrative costs of providing coverage
17    to employees of the domestic violence shelter or service
18    and their dependents.
19        (2) In subsequent years, a further adjustment shall be
20    made to reflect the actual prior years' claims experience
21    of the employees of the domestic violence shelter or
22    service.
23    Monthly payments by the domestic violence shelter or
24service or its employees for group health insurance shall be
25deposited in the Local Government Health Insurance Reserve
26Fund.

 

 

09600SB2525ham001- 44 -LRB096 16690 JDS 44611 a

1    (l) A public community college or entity organized pursuant
2to the Public Community College Act may apply to the Director
3initially to have only annuitants not covered prior to July 1,
41992 by the district's health plan provided health coverage
5under this Act on a non-insured basis. The community college
6must execute a 2-year contract to participate in the Local
7Government Health Plan. Any annuitant may enroll in the event
8of a qualifying change in status, special enrollment, special
9circumstance as defined by the Director, or during the annual
10Benefit Choice Period.
11    The Director shall annually determine monthly rates of
12payment subject to the following constraints: for those
13community colleges with annuitants only enrolled, first year
14rates shall be equal to the average cost to cover claims for a
15State member adjusted for demographics, Medicare
16participation, and other factors; and in the second year, a
17further adjustment of rates shall be made to reflect the actual
18first year's claims experience of the covered annuitants.
19    (l-5) The provisions of subsection (l) become inoperative
20on July 1, 1999.
21    (m) The Director shall adopt any rules deemed necessary for
22implementation of this amendatory Act of 1989 (Public Act
2386-978).
24    (n) Any child advocacy center within the State of Illinois
25may apply to the Director to have its employees, annuitants,
26and their dependents provided group health coverage under this

 

 

09600SB2525ham001- 45 -LRB096 16690 JDS 44611 a

1Act on a non-insured basis. To participate, a child advocacy
2center must agree to enroll all of its employees and pay the
3entire cost of providing coverage for its employees. The child
4advocacy center shall not be required to enroll those of its
5employees who are covered spouses or dependents under this plan
6or another group policy or plan providing health benefits as
7long as (1) an appropriate official from the child advocacy
8center attests that each employee not enrolled is a covered
9spouse or dependent under this plan or another group policy or
10plan and (2) at least 50% of the employees are enrolled and the
11child advocacy center remits the entire cost of providing
12coverage to those employees. Employees of a participating child
13advocacy center who are not enrolled due to coverage under
14another group health policy or plan may enroll in the event of
15a qualifying change in status, special enrollment, or special
16circumstance as defined by the Director or during the annual
17Benefit Choice Period. A participating child advocacy center
18may also elect to cover its annuitants. Dependent coverage
19shall be offered on an optional basis, with the costs paid by
20the child advocacy center, its employees, or some combination
21of the 2 as determined by the child advocacy center. The child
22advocacy center shall be responsible for timely collection and
23transmission of dependent premiums.
24    The Director shall annually determine rates of payment,
25subject to the following constraints:
26        (1) In the first year of coverage, the rates shall be

 

 

09600SB2525ham001- 46 -LRB096 16690 JDS 44611 a

1    equal to the amount normally charged to State employees for
2    elected optional coverages or for enrolled dependents
3    coverages or other contributory coverages on behalf of its
4    employees, adjusted for differences between State
5    employees and employees of the child advocacy center in
6    age, sex, geographic location, or other relevant
7    demographic variables, plus an amount sufficient to pay for
8    the additional administrative costs of providing coverage
9    to employees of the child advocacy center and their
10    dependents.
11        (2) In subsequent years, a further adjustment shall be
12    made to reflect the actual prior years' claims experience
13    of the employees of the child advocacy center.
14    Monthly payments by the child advocacy center or its
15employees for group health insurance shall be deposited into
16the Local Government Health Insurance Reserve Fund.
17(Source: P.A. 95-331, eff. 8-21-07; 95-632, eff. 9-25-07;
1895-707, eff. 1-11-08; 96-756, eff. 1-1-10; 96-1232, eff.
197-23-10.)
 
20    Section 99. Effective date. This Act takes effect upon
21becoming law.".