Full Text of HB4310 99th General Assembly
HB4310 99TH GENERAL ASSEMBLY |
| | 99TH GENERAL ASSEMBLY
State of Illinois
2015 and 2016 HB4310 Introduced , by Rep. Margo McDermed SYNOPSIS AS INTRODUCED: |
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Amends the State Employees Group Insurance Act of 1971. For fiscal year 2017, provides that the premium for the major medical coverage health benefits program for a TRS benefit recipient who is at least 65 years old, who is not Medicare primary, who resides in Illinois, and for whom a managed care program is accessible shall not exceed 90% (now, 105%) of the premium actually charged in the previous fiscal year. Effective immediately.
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| | 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 6.5 as follows:
| 6 | | (5 ILCS 375/6.5)
| 7 | | Sec. 6.5. Health benefits for TRS benefit recipients and | 8 | | TRS dependent
beneficiaries. | 9 | | (a) Purpose. It is the purpose of this amendatory Act of | 10 | | 1995 to transfer
the administration of the program of health | 11 | | benefits established for benefit
recipients and their | 12 | | dependent beneficiaries under Article 16 of the Illinois
| 13 | | Pension Code to the Department of Central Management Services.
| 14 | | (b) Transition provisions. The Board of Trustees of the | 15 | | Teachers'
Retirement System shall continue to administer the | 16 | | health benefit program
established under Article 16 of the | 17 | | Illinois Pension Code through December 31,
1995. Beginning | 18 | | January 1, 1996, the Department of Central Management Services
| 19 | | shall be responsible for administering a program of health | 20 | | benefits for TRS
benefit recipients and TRS dependent | 21 | | beneficiaries under this Section.
The Department of Central | 22 | | Management Services and the Teachers' Retirement
System shall | 23 | | cooperate in this endeavor and shall coordinate their |
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| 1 | | activities
so as to ensure a smooth transition and | 2 | | uninterrupted health benefit coverage.
| 3 | | (c) Eligibility. All persons who were enrolled in the | 4 | | Article 16 program at
the time of the transfer shall be | 5 | | eligible to participate in the program
established under this | 6 | | Section without any interruption or delay in coverage
or | 7 | | limitation as to pre-existing medical conditions. Eligibility | 8 | | to
participate shall be determined by the Teachers' Retirement | 9 | | System.
Eligibility information shall be communicated to the | 10 | | Department of Central
Management Services in a format | 11 | | acceptable to the Department.
| 12 | | A TRS dependent beneficiary who is a child age 19 or over | 13 | | and
mentally or physically disabled does not become ineligible | 14 | | to participate
by reason of (i) becoming ineligible to be | 15 | | claimed as a dependent for Illinois
or federal income tax | 16 | | purposes or (ii) receiving earned income, so long as
those | 17 | | earnings are insufficient for the child to be fully | 18 | | self-sufficient.
| 19 | | (d) Coverage. The level of health benefits provided under | 20 | | this Section
shall be similar to the level of benefits provided | 21 | | by the
program previously established under Article 16 of the | 22 | | Illinois Pension Code.
| 23 | | Group life insurance benefits are not included in the | 24 | | benefits
to be provided to TRS benefit recipients and TRS | 25 | | dependent beneficiaries under
this Act.
| 26 | | The program of health benefits under this Section may |
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| 1 | | include any or all of
the benefit limitations, including but | 2 | | not limited to a reduction in benefits
based on eligibility for | 3 | | federal medicare benefits, that are provided under
subsection | 4 | | (a) of Section 6 of this Act for other health benefit programs | 5 | | under
this Act.
| 6 | | (e) Insurance rates and premiums. The Director shall | 7 | | determine the
insurance rates and premiums for TRS benefit | 8 | | recipients and TRS dependent
beneficiaries,
and shall present | 9 | | to the Teachers' Retirement System of
the State of Illinois, by | 10 | | April 15 of each calendar year, the rate-setting
methodology | 11 | | (including but not limited to utilization levels and costs) | 12 | | used
to determine the amount of the health care premiums.
| 13 | | For Fiscal Year 1996, the premium shall be equal to the | 14 | | premium actually
charged in Fiscal Year 1995; in subsequent | 15 | | years, the premium shall
never be lower than the premium | 16 | | charged in Fiscal Year 1995. | 17 | | For Fiscal Year
2003, the premium shall not exceed 110% | 18 | | of the premium actually charged in
Fiscal Year 2002. | 19 | | For Fiscal Year 2004, the premium shall not exceed 112% | 20 | | of
the premium actually charged in Fiscal Year 2003.
| 21 | | For Fiscal Year 2005, the premium shall not exceed a | 22 | | weighted average of 106.6% of
the premium actually charged | 23 | | in Fiscal Year 2004.
| 24 | | For Fiscal Year 2006, the premium shall not exceed a | 25 | | weighted average of 109.1% of
the premium actually charged | 26 | | in Fiscal Year 2005.
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| 1 | | For Fiscal Year 2007, the premium shall not exceed a | 2 | | weighted average of 103.9% of
the premium actually charged | 3 | | in Fiscal Year 2006.
| 4 | | For Fiscal Year 2016 2008 and thereafter, the premium | 5 | | in each fiscal year shall not exceed 105% of
the premium | 6 | | actually charged in the previous fiscal year ; except that | 7 | | for Fiscal Year 2017, for a TRS benefit recipient who is at | 8 | | least 65 years old, who is not Medicare primary, who has | 9 | | been a legal resident of Illinois since at least July 1, | 10 | | 2015, and who selects the major medical coverage program | 11 | | when a managed care program is accessible, the premium | 12 | | shall not exceed 90% of the premium actually charged in | 13 | | Fiscal Year 2016 .
| 14 | | Rates and premiums may be based in part on age and | 15 | | eligibility for federal
medicare coverage. However, the cost of | 16 | | participation for a TRS dependent
beneficiary who is an | 17 | | unmarried child age 19 or over and mentally or physically
| 18 | | disabled shall not exceed the cost for a TRS dependent | 19 | | beneficiary who is
an unmarried child under age 19 and | 20 | | participates in the same major medical or
managed care program.
| 21 | | The cost of health benefits under the program shall be paid | 22 | | as follows:
| 23 | | (1) For a TRS benefit recipient selecting a managed | 24 | | care program, up to
75% of the total insurance rate shall | 25 | | be paid from the Teacher Health Insurance
Security Fund. | 26 | | Effective with Fiscal Year 2007 and thereafter, for a TRS |
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| 1 | | benefit recipient selecting a managed care program, 75% of | 2 | | the total insurance rate shall be paid from the Teacher | 3 | | Health Insurance
Security Fund.
| 4 | | (2) For a TRS benefit recipient selecting the major | 5 | | medical coverage
program, up to 50% of the total insurance | 6 | | rate shall be paid from the Teacher
Health Insurance | 7 | | Security Fund if a managed care program is accessible, as
| 8 | | determined by the Teachers' Retirement System. Effective | 9 | | with Fiscal Year 2007 and thereafter, for a TRS benefit | 10 | | recipient selecting the major medical coverage
program, | 11 | | 50% of the total insurance rate shall be paid from the | 12 | | Teacher
Health Insurance Security Fund if a managed care | 13 | | program is accessible, as
determined by the Department of | 14 | | Central Management Services.
| 15 | | (3) For a TRS benefit recipient selecting the major | 16 | | medical coverage
program, up to 75% of the total insurance | 17 | | rate shall be paid from the Teacher
Health Insurance | 18 | | Security Fund if a managed care program is not accessible, | 19 | | as
determined by the Teachers' Retirement System. | 20 | | Effective with Fiscal Year 2007 and thereafter, for a TRS | 21 | | benefit recipient selecting the major medical coverage
| 22 | | program, 75% of the total insurance rate shall be paid from | 23 | | the Teacher
Health Insurance Security Fund if a managed | 24 | | care program is not accessible, as
determined by the | 25 | | Department of Central Management Services.
| 26 | | (3.1) For a TRS dependent beneficiary who is Medicare |
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| 1 | | primary and enrolled in a managed care plan, or the major | 2 | | medical coverage program if a managed care plan is not | 3 | | available, 25% of the total insurance rate shall be paid | 4 | | from the Teacher Health Security Fund as determined by the | 5 | | Department of Central Management Services. For the purpose | 6 | | of this item (3.1), the term "TRS dependent beneficiary who | 7 | | is Medicare primary" means a TRS dependent beneficiary who | 8 | | is participating in Medicare Parts A and B.
| 9 | | (4) Except as otherwise provided in item (3.1), the
| 10 | | balance of the rate of insurance, including the entire | 11 | | premium of
any coverage for TRS dependent beneficiaries | 12 | | that has been elected, shall be
paid
by deductions | 13 | | authorized by the TRS benefit recipient to be withheld from | 14 | | his
or her monthly annuity or benefit payment from the | 15 | | Teachers' Retirement System;
except that (i) if the balance | 16 | | of the cost of coverage exceeds the amount of
the monthly | 17 | | annuity or benefit payment, the difference shall be paid | 18 | | directly
to the Teachers' Retirement System by the TRS | 19 | | benefit recipient, and (ii) all
or part of the balance of | 20 | | the cost of coverage may, at the school board's
option, be | 21 | | paid to the Teachers' Retirement System by the school board | 22 | | of the
school district from which the TRS benefit recipient | 23 | | retired, in accordance
with Section 10-22.3b of the School | 24 | | Code. The Teachers' Retirement System
shall promptly | 25 | | deposit all moneys withheld by or paid to it under this
| 26 | | subdivision (e)(4) into the Teacher Health Insurance |
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| 1 | | Security Fund. These
moneys shall not be considered assets | 2 | | of the Retirement System.
| 3 | | (f) Financing. Beginning July 1, 1995, all revenues arising | 4 | | from the
administration of the health benefit programs | 5 | | established under Article 16 of
the Illinois Pension Code or | 6 | | this Section shall be deposited into the
Teacher Health | 7 | | Insurance Security Fund, which is hereby created as a
| 8 | | nonappropriated trust fund to be held outside the State | 9 | | Treasury, with the
State Treasurer as custodian. Any interest | 10 | | earned on moneys in the Teacher
Health Insurance Security Fund | 11 | | shall be deposited into the Fund.
| 12 | | Moneys in the Teacher Health Insurance Security
Fund shall | 13 | | be used only to pay the costs of the health benefit program
| 14 | | established under this Section, including associated | 15 | | administrative costs, and
the costs associated with the health | 16 | | benefit program established under Article
16 of the Illinois | 17 | | Pension Code, as authorized in this Section. Beginning
July 1, | 18 | | 1995, the Department of Central Management Services may make
| 19 | | expenditures from the Teacher Health Insurance Security Fund | 20 | | for those costs.
| 21 | | After other funds authorized for the payment of the costs | 22 | | of the health
benefit program established under Article 16 of | 23 | | the Illinois Pension Code are
exhausted and until January 1, | 24 | | 1996 (or such later date as may be agreed upon
by the Director | 25 | | of Central Management Services and the Secretary of the
| 26 | | Teachers' Retirement System), the Secretary of the Teachers' |
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| 1 | | Retirement System
may make expenditures from the Teacher Health | 2 | | Insurance Security Fund as
necessary to pay up to 75% of the | 3 | | cost of providing health coverage to eligible
benefit | 4 | | recipients (as defined in Sections 16-153.1 and 16-153.3 of the
| 5 | | Illinois Pension Code) who are enrolled in the Article 16 | 6 | | health benefit
program and to facilitate the transfer of | 7 | | administration of the health benefit
program to the Department | 8 | | of Central Management Services.
| 9 | | The Department of Central Management Services, or any | 10 | | successor agency designated to procure healthcare contracts | 11 | | pursuant to this Act, is authorized to establish funds, | 12 | | separate accounts provided by any bank or banks as defined by | 13 | | the Illinois Banking Act, or separate accounts provided by any | 14 | | savings and loan association or associations as defined by the | 15 | | Illinois Savings and Loan Act of 1985 to be held by the | 16 | | Director, outside the State treasury, for the purpose of | 17 | | receiving the transfer of moneys from the Teacher Health | 18 | | Insurance Security Fund. The Department may promulgate rules | 19 | | further defining the methodology for the transfers. Any | 20 | | interest earned by moneys in the funds or accounts shall inure | 21 | | to the Teacher Health Insurance Security Fund. The transferred | 22 | | moneys, and interest accrued thereon, shall be used exclusively | 23 | | for transfers to administrative service organizations or their | 24 | | financial institutions for payments of claims to claimants and | 25 | | providers under the self-insurance health plan. The | 26 | | transferred moneys, and interest accrued thereon, shall not be |
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| 1 | | used for any other purpose including, but not limited to, | 2 | | reimbursement of administration fees due the administrative | 3 | | service organization pursuant to its contract or contracts with | 4 | | the Department.
| 5 | | (g) Contract for benefits. The Director shall by contract, | 6 | | self-insurance,
or otherwise make available the program of | 7 | | health benefits for TRS benefit
recipients and their TRS | 8 | | dependent beneficiaries that is provided for in this
Section. | 9 | | The contract or other arrangement for the provision of these | 10 | | health
benefits shall be on terms deemed by the Director to be | 11 | | in the best interest of
the State of Illinois and the TRS | 12 | | benefit recipients based on, but not limited
to, such criteria | 13 | | as administrative cost, service capabilities of the carrier
or | 14 | | other contractor, and the costs of the benefits.
| 15 | | (g-5) Committee. A Teacher Retirement Insurance Program | 16 | | Committee shall be established, to consist of 10 persons | 17 | | appointed by the Governor.
| 18 | | The Committee shall convene at least 4 times each year, and | 19 | | shall consider and make recommendations on issues affecting the | 20 | | program of health benefits provided under this
Section. | 21 | | Recommendations of the Committee shall be based on a consensus | 22 | | of the members of the Committee.
| 23 | | If the Teacher
Health Insurance Security Fund experiences a | 24 | | deficit balance based upon the contribution and subsidy rates | 25 | | established in this Section and Section 6.6 for Fiscal Year | 26 | | 2008 or thereafter, the Committee shall make recommendations |
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| 1 | | for adjustments to the funding sources established under these | 2 | | Sections. | 3 | | In addition, the Committee shall identify proposed | 4 | | solutions to the funding shortfalls that are affecting the | 5 | | Teacher Health Insurance Security Fund, and it shall report | 6 | | those solutions to the Governor and the General Assembly within | 7 | | 6 months after August 15, 2011 (the effective date of Public | 8 | | Act 97-386). | 9 | | (h) Continuation of program. It is the intention of
the | 10 | | General Assembly that the program of health benefits provided | 11 | | under this
Section be maintained on an ongoing, affordable | 12 | | basis.
| 13 | | The program of health benefits provided under this Section | 14 | | may be amended by
the State and is not intended to be a pension | 15 | | or retirement benefit subject to
protection under Article XIII, | 16 | | Section 5 of the Illinois Constitution.
| 17 | | (i) Repeal. (Blank).
| 18 | | (Source: P.A. 97-386, eff. 8-15-11; 97-813, eff. 7-13-12; | 19 | | 98-488, eff. 8-16-13.)
| 20 | | Section 99. Effective date. This Act takes effect upon | 21 | | becoming law.
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