Full Text of HB3626 97th General Assembly
HB3626 97TH GENERAL ASSEMBLY |
| | 97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012 HB3626 Introduced 2/24/2011, by Rep. Patrick J. Verschoore SYNOPSIS AS INTRODUCED: |
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5 ILCS 375/8 | from Ch. 127, par. 528 |
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Amends the State Employees Group Insurance Act of 1971. Requires the Director of Central Management Services, beginning July 1, 2011, to reimburse on a monthly basis each eligible member who has elected not to participate in the program of health benefits under the Act for premiums paid under the eligible member's health benefit coverage. Prohibits the reimbursed amount from exceeding the amount that would otherwise be paid by the State for the program of health benefits under the Act. Effective July 1, 2011.
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| | | FISCAL NOTE ACT MAY APPLY | |
| | A BILL FOR |
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| 1 | | AN ACT concerning government.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | Section 5. The State Employees Group Insurance Act of 1971 | 5 | | is amended by changing Section 8 as follows:
| 6 | | (5 ILCS 375/8) (from Ch. 127, par. 528)
| 7 | | Sec. 8. Eligibility.
| 8 | | (a) Each member eligible under the provisions of this Act | 9 | | and any rules
and regulations promulgated and adopted hereunder | 10 | | by the Director shall
become immediately eligible and covered | 11 | | for all benefits available under
the programs. Members electing | 12 | | coverage for eligible dependents shall have
the coverage | 13 | | effective immediately, provided that the election is properly
| 14 | | filed in accordance with required filing dates and procedures | 15 | | specified by
the Director.
| 16 | | (1) Every member originally eligible to elect | 17 | | dependent coverage, but not
electing it during the original | 18 | | eligibility period, may subsequently obtain
dependent | 19 | | coverage only in the event of a qualifying change in | 20 | | status, special
enrollment, special circumstance as | 21 | | defined by the Director, or during the
annual Benefit | 22 | | Choice Period.
| 23 | | (2) Members described above being transferred from |
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| 1 | | previous
coverage towards which the State has been | 2 | | contributing shall be
transferred regardless of | 3 | | preexisting conditions, waiting periods, or
other | 4 | | requirements that might jeopardize claim payments to which | 5 | | they
would otherwise have been entitled.
| 6 | | (3) Eligible and covered members that are eligible for | 7 | | coverage as
dependents except for the fact of being members | 8 | | shall be transferred to,
and covered under, dependent | 9 | | status regardless of preexisting conditions,
waiting | 10 | | periods, or other requirements that might jeopardize claim | 11 | | payments
to which they would otherwise have been entitled | 12 | | upon cessation of member
status and the election of | 13 | | dependent coverage by a member eligible to elect
that | 14 | | coverage.
| 15 | | (b) New employees shall be immediately insured for the | 16 | | basic group
life insurance and covered by the program of health | 17 | | benefits on the first
day of active State service. Optional | 18 | | life insurance coverage one to 4 times the basic amount, if | 19 | | elected
during the relevant eligibility period, will become | 20 | | effective on the date
of employment. Optional life insurance | 21 | | coverage exceeding 4 times the basic amount and all life | 22 | | insurance amounts applied for after the
eligibility period will | 23 | | be effective, subject to satisfactory evidence of
insurability | 24 | | when applicable, or other necessary qualifications, pursuant | 25 | | to
the requirements of the applicable benefit program, unless | 26 | | there is a change in
status that would confer new eligibility |
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| 1 | | for change of enrollment under rules
established supplementing | 2 | | this Act, in which event application must be made
within the | 3 | | new eligibility period.
| 4 | | (c) As to the group health benefits program contracted to | 5 | | begin or
continue after June 30, 1973, each retired employee | 6 | | shall become immediately
eligible and covered for all benefits | 7 | | available under that program. Retired
employees may elect | 8 | | coverage for eligible dependents and shall have the
coverage | 9 | | effective immediately, provided that the election is properly
| 10 | | filed in accordance with required filing dates and procedures | 11 | | specified
by the Director.
| 12 | | Except as otherwise provided in this Act, where husband and | 13 | | wife are
both eligible members, each shall be enrolled as a | 14 | | member and coverage on
their eligible dependent children, if | 15 | | any, may be under the enrollment and
election of either.
| 16 | | Regardless of other provisions herein regarding late | 17 | | enrollment or other
qualifications, as appropriate, the
| 18 | | Director may periodically authorize open enrollment periods | 19 | | for each of the
benefit programs at which time each member may | 20 | | elect enrollment or change
of enrollment without regard to age, | 21 | | sex, health, or other qualification
under the conditions as may | 22 | | be prescribed in rules and regulations
supplementing this Act. | 23 | | Special open enrollment periods may be declared by
the Director | 24 | | for certain members only when special circumstances occur that
| 25 | | affect only those members.
| 26 | | (d) Beginning with fiscal year 2003 and for all subsequent |
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| 1 | | years, eligible
members may elect not to participate in the | 2 | | program of health benefits as
defined in this Act. The election | 3 | | must be made during the annual benefit
choice period, subject | 4 | | to the conditions in this subsection.
| 5 | | (1) Members must furnish proof of health benefit | 6 | | coverage, either
comprehensive major medical coverage or | 7 | | comprehensive managed care plan,
from a source other than | 8 | | the Department of Central Management Services in
order to | 9 | | elect not to participate in the program.
| 10 | | (2) Members may re-enroll in the Department of Central | 11 | | Management Services
program of health benefits upon | 12 | | showing a qualifying change in status, as
defined in the | 13 | | U.S. Internal Revenue Code, without evidence of | 14 | | insurability
and with no limitations on coverage for | 15 | | pre-existing conditions, provided
that there was not a | 16 | | break in coverage of more than 63 days.
| 17 | | (3) Members may also re-enroll in the program of health | 18 | | benefits during
any annual benefit choice period, without | 19 | | evidence of insurability.
| 20 | | (4) Members who elect not to participate in the program | 21 | | of health benefits
shall be furnished a written explanation | 22 | | of the requirements and limitations
for the election not to | 23 | | participate in the program and for re-enrolling in the
| 24 | | program. The explanation shall also be included in the | 25 | | annual benefit choice
options booklets furnished to | 26 | | members.
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| 1 | | (d-5) Beginning July 1, 2005, the Director may establish a | 2 | | program of financial incentives to encourage annuitants | 3 | | receiving a retirement annuity from the State Employees | 4 | | Retirement System, but who are not eligible for benefits under | 5 | | the federal Medicare health insurance program (Title XVIII of | 6 | | the Social Security Act, as added by Public Law 89-97) to elect | 7 | | not to participate in the program of health benefits provided | 8 | | under this Act. The election by an annuitant not to participate | 9 | | under this program must be made in accordance with the | 10 | | requirements set forth under subsection (d). The financial | 11 | | incentives provided to these annuitants under the program may | 12 | | not exceed $150 per month for each annuitant electing not to | 13 | | participate in the program of health benefits provided under | 14 | | this Act.
| 15 | | (d-10) Beginning July 1, 2011, the Director shall reimburse | 16 | | on a monthly basis each eligible member who has elected | 17 | | pursuant to subsection (d) not to participate in the program of | 18 | | health benefits under this Act for premiums paid under the | 19 | | eligible member's health benefit coverage. The reimbursed | 20 | | amount shall not be in excess of the amount that would | 21 | | otherwise be paid by the State for the program of health | 22 | | benefits under the Act. | 23 | | (e) Notwithstanding any other provision of this Act or the | 24 | | rules adopted
under this Act, if a person participating in the | 25 | | program of health benefits as
the dependent spouse of an | 26 | | eligible member becomes an annuitant, the person may
elect, at |
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| 1 | | the time of becoming an annuitant or during any subsequent | 2 | | annual
benefit choice period, to continue participation as a | 3 | | dependent rather than
as an eligible member for as long as the | 4 | | person continues to be an eligible
dependent.
| 5 | | An eligible member who has elected to participate as a | 6 | | dependent may
re-enroll in the program of health benefits as an | 7 | | eligible member (i)
during any subsequent annual benefit choice | 8 | | period or (ii) upon showing a
qualifying change in status, as | 9 | | defined in the U.S. Internal Revenue Code,
without evidence of | 10 | | insurability and with no limitations on coverage for
| 11 | | pre-existing conditions.
| 12 | | A person who elects to participate in the program of health | 13 | | benefits as
a dependent rather than as an eligible member shall | 14 | | be furnished a written
explanation of the consequences of | 15 | | electing to participate as a dependent and
the conditions and | 16 | | procedures for re-enrolling as an eligible member. The
| 17 | | explanation shall also be included in the annual benefit choice | 18 | | options booklet
furnished to members.
| 19 | | (Source: P.A. 94-95, eff. 7-1-05; 94-109, eff. 7-1-05; 95-331, | 20 | | eff. 8-21-07.)
| 21 | | Section 99. Effective date. This Act takes effect July 1, | 22 | | 2011.
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