Full Text of HB4972 103rd General Assembly
HB4972ham001 103RD GENERAL ASSEMBLY | Rep. Brandun Schweizer Filed: 4/11/2024 | | 10300HB4972ham001 | | LRB103 37243 RPS 71852 a |
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| 1 | | AMENDMENT TO HOUSE BILL 4972
| 2 | | AMENDMENT NO. ______. Amend House Bill 4972 by replacing | 3 | | everything after the enacting clause with the following: | 4 | | "Section 5. The State Employees Group Insurance Act of | 5 | | 1971 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 |
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| 1 | | Illinois Pension Code through December 31, 1995. Beginning | 2 | | January 1, 1996, the Department of Central Management Services | 3 | | shall be responsible for administering a program of health | 4 | | benefits for TRS benefit recipients and TRS dependent | 5 | | beneficiaries under this Section. The Department of Central | 6 | | Management Services and the Teachers' Retirement System shall | 7 | | cooperate in this endeavor and shall coordinate their | 8 | | activities so as to ensure a smooth transition and | 9 | | uninterrupted health benefit coverage. | 10 | | (c) Eligibility. All persons who were enrolled in the | 11 | | Article 16 program at the time of the transfer shall be | 12 | | eligible to participate in the program established under this | 13 | | Section without any interruption or delay in coverage or | 14 | | limitation as to pre-existing medical conditions. Eligibility | 15 | | to participate shall be determined by the Teachers' Retirement | 16 | | System. Eligibility information shall be communicated to the | 17 | | Department of Central Management Services in a format | 18 | | acceptable to the Department. | 19 | | Eligible TRS benefit recipients may enroll or re-enroll in | 20 | | the program of health benefits established under this Section | 21 | | during any applicable annual open enrollment period and as | 22 | | otherwise permitted by the Department of Central Management | 23 | | Services. A TRS benefit recipient shall not be deemed | 24 | | ineligible to participate solely by reason of the TRS benefit | 25 | | recipient having made a previous election to disenroll or | 26 | | otherwise not participate in the program of health benefits. |
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| 1 | | A TRS dependent beneficiary who is a child age 19 or over | 2 | | and mentally or physically disabled does not become ineligible | 3 | | to participate by reason of (i) becoming ineligible to be | 4 | | claimed as a dependent for Illinois or federal income tax | 5 | | purposes or (ii) receiving earned income, so long as those | 6 | | earnings are insufficient for the child to be fully | 7 | | self-sufficient. | 8 | | (d) Coverage. The level of health benefits provided under | 9 | | this Section shall be similar to the level of benefits | 10 | | provided by the program previously established under Article | 11 | | 16 of the Illinois Pension Code. | 12 | | Group life insurance benefits are not included in the | 13 | | benefits to be provided to TRS benefit recipients and TRS | 14 | | dependent beneficiaries under this Act. | 15 | | The program of health benefits under this Section may | 16 | | include any or all of the benefit limitations, including but | 17 | | not limited to a reduction in benefits based on eligibility | 18 | | for federal Medicare benefits, that are provided under | 19 | | subsection (a) of Section 6 of this Act for other health | 20 | | benefit programs under this Act. | 21 | | (e) Insurance rates and premiums. The Director shall | 22 | | determine the insurance rates and premiums for TRS benefit | 23 | | recipients and TRS dependent beneficiaries, and shall present | 24 | | to the Teachers' Retirement System of the State of Illinois, | 25 | | by April 15 of each calendar year, the rate-setting | 26 | | methodology (including but not limited to utilization levels |
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| 1 | | and costs) used to determine the amount of the health care | 2 | | premiums. | 3 | | For Fiscal Year 1996, the premium shall be equal to | 4 | | the premium actually charged in Fiscal Year 1995; in | 5 | | subsequent years, the premium shall never be lower than | 6 | | the premium charged in Fiscal Year 1995. | 7 | | For Fiscal Year 2003, the premium shall not exceed | 8 | | 110% of the premium actually charged in Fiscal Year 2002. | 9 | | For Fiscal Year 2004, the premium shall not exceed | 10 | | 112% of the premium actually charged in Fiscal Year 2003. | 11 | | For Fiscal Year 2005, the premium shall not exceed a | 12 | | weighted average of 106.6% of the premium actually charged | 13 | | in Fiscal Year 2004. | 14 | | For Fiscal Year 2006, the premium shall not exceed a | 15 | | weighted average of 109.1% of the premium actually charged | 16 | | in Fiscal Year 2005. | 17 | | For Fiscal Year 2007, the premium shall not exceed a | 18 | | weighted average of 103.9% of the premium actually charged | 19 | | in Fiscal Year 2006. | 20 | | For Fiscal Year 2008 and thereafter, the premium in | 21 | | each fiscal year shall not exceed 105% of the premium | 22 | | actually charged in the previous fiscal year. | 23 | | Rates and premiums may be based in part on age and | 24 | | eligibility for federal medicare coverage. However, the cost | 25 | | of participation for a TRS dependent beneficiary who is an | 26 | | unmarried child age 19 or over and mentally or physically |
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| 1 | | disabled shall not exceed the cost for a TRS dependent | 2 | | beneficiary who is an unmarried child under age 19 and | 3 | | participates in the same major medical or managed care | 4 | | program. | 5 | | The cost of health benefits under the program shall be | 6 | | paid as follows: | 7 | | (1) For a TRS benefit recipient selecting a managed | 8 | | care program, up to 75% of the total insurance rate shall | 9 | | be paid from the Teacher Health Insurance Security Fund. | 10 | | Effective with Fiscal Year 2007 and thereafter, for a TRS | 11 | | benefit recipient selecting a managed care program, 75% of | 12 | | the total insurance rate shall be paid from the Teacher | 13 | | Health Insurance Security Fund. | 14 | | (2) For a TRS benefit recipient selecting the major | 15 | | medical coverage program, up to 50% of the total insurance | 16 | | rate shall be paid from the Teacher Health Insurance | 17 | | Security Fund if a managed care program is accessible, as | 18 | | determined by the Teachers' Retirement System. Effective | 19 | | with Fiscal Year 2007 and thereafter, for a TRS benefit | 20 | | recipient selecting the major medical coverage program, | 21 | | 50% of the total insurance rate shall be paid from the | 22 | | Teacher Health Insurance Security Fund if a managed care | 23 | | program is accessible, as determined by the Department of | 24 | | Central Management Services. | 25 | | (3) For a TRS benefit recipient selecting the major | 26 | | medical coverage program, up to 75% of the total insurance |
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| 1 | | rate shall be paid from the Teacher Health Insurance | 2 | | Security Fund if a managed care program is not accessible, | 3 | | as determined by the Teachers' Retirement System. | 4 | | Effective with Fiscal Year 2007 and thereafter, for a TRS | 5 | | benefit recipient selecting the major medical coverage | 6 | | program, 75% of the total insurance rate shall be paid | 7 | | from the Teacher Health Insurance Security Fund if a | 8 | | managed care program is not accessible, as determined by | 9 | | the Department of Central Management Services. | 10 | | (3.1) For a TRS dependent beneficiary who is Medicare | 11 | | primary and enrolled in a managed care plan, or the major | 12 | | medical coverage program if a managed care plan is not | 13 | | available, 25% of the total insurance rate shall be paid | 14 | | from the Teacher Health Security Fund as determined by the | 15 | | Department of Central Management Services. For the purpose | 16 | | of this item (3.1), the term "TRS dependent beneficiary | 17 | | who is Medicare primary" means a TRS dependent beneficiary | 18 | | who is participating in Medicare Parts A and B. | 19 | | (4) Except as otherwise provided in item (3.1), the | 20 | | balance of the rate of insurance, including the entire | 21 | | premium of any coverage for TRS dependent beneficiaries | 22 | | that has been elected, shall be paid by deductions | 23 | | authorized by the TRS benefit recipient to be withheld | 24 | | from his or her monthly annuity or benefit payment from | 25 | | the Teachers' Retirement System; except that (i) if the | 26 | | balance of the cost of coverage exceeds the amount of the |
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| 1 | | monthly annuity or benefit payment, the difference shall | 2 | | be paid directly to the Teachers' Retirement System by the | 3 | | TRS benefit recipient, and (ii) all or part of the balance | 4 | | of the cost of coverage may, at the school board's option, | 5 | | be paid to the Teachers' Retirement System by the school | 6 | | board of the school district from which the TRS benefit | 7 | | recipient retired, in accordance with Section 10-22.3b of | 8 | | the School Code. The Teachers' Retirement System shall | 9 | | promptly deposit all moneys withheld by or paid to it | 10 | | under this subdivision (e)(4) into the Teacher Health | 11 | | Insurance Security Fund. These moneys shall not be | 12 | | considered assets of the Retirement System. | 13 | | (5) If, for any month beginning on or after January 1, | 14 | | 2013, a TRS benefit recipient or TRS dependent beneficiary | 15 | | was enrolled in Medicare Parts A and B and such Medicare | 16 | | coverage was primary to coverage under this Section but | 17 | | payment for coverage under this Section was made at a rate | 18 | | greater than the Medicare primary rate published by the | 19 | | Department of Central Management Services, the TRS benefit | 20 | | recipient or TRS dependent beneficiary shall be eligible | 21 | | for a refund equal to the difference between the amount | 22 | | paid by the TRS benefit recipient or TRS dependent | 23 | | beneficiary and the published Medicare primary rate. To | 24 | | receive a refund pursuant to this subsection, the TRS | 25 | | benefit recipient or TRS dependent beneficiary must | 26 | | provide documentation to the Department of Central |
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| 1 | | Management Services evidencing the TRS benefit recipient's | 2 | | or TRS dependent beneficiary's Medicare coverage and the | 3 | | amount paid by the TRS benefit recipient or TRS dependent | 4 | | beneficiary during the applicable time period. | 5 | | (f) Financing. Beginning July 1, 1995, all revenues | 6 | | arising from the administration of the health benefit programs | 7 | | established under Article 16 of the Illinois Pension Code or | 8 | | this Section shall be deposited into the Teacher Health | 9 | | Insurance Security Fund, which is hereby created as a | 10 | | nonappropriated trust fund to be held outside the State | 11 | | Treasury, with the State Treasurer as custodian. Any interest | 12 | | earned on moneys in the Teacher Health Insurance Security Fund | 13 | | shall be deposited into the Fund. | 14 | | Moneys in the Teacher Health Insurance Security Fund shall | 15 | | be used only to pay the costs of the health benefit program | 16 | | established under this Section, including associated | 17 | | administrative costs, and the costs associated with the health | 18 | | benefit program established under Article 16 of the Illinois | 19 | | Pension Code, as authorized in this Section. Beginning July 1, | 20 | | 1995, the Department of Central Management Services may make | 21 | | expenditures from the Teacher Health Insurance Security Fund | 22 | | for those costs. | 23 | | After other funds authorized for the payment of the costs | 24 | | of the health benefit program established under Article 16 of | 25 | | the Illinois Pension Code are exhausted and until January 1, | 26 | | 1996 (or such later date as may be agreed upon by the Director |
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| 1 | | of Central Management Services and the Secretary of the | 2 | | Teachers' Retirement System), the Secretary of the Teachers' | 3 | | Retirement System may make expenditures from the Teacher | 4 | | Health Insurance Security Fund as necessary to pay up to 75% of | 5 | | the cost of providing health coverage to eligible benefit | 6 | | recipients (as defined in Sections 16-153.1 and 16-153.3 of | 7 | | the Illinois Pension Code) who are enrolled in the Article 16 | 8 | | health benefit program and to facilitate the transfer of | 9 | | administration of the health benefit program to the Department | 10 | | of Central Management Services. | 11 | | The Department of Central Management Services, or any | 12 | | successor agency designated to procure healthcare contracts | 13 | | pursuant to this Act, is authorized to establish funds, | 14 | | separate accounts provided by any bank or banks as defined by | 15 | | the Illinois Banking Act, or separate accounts provided by any | 16 | | savings and loan association or associations as defined by the | 17 | | Illinois Savings and Loan Act of 1985 to be held by the | 18 | | Director, outside the State treasury, for the purpose of | 19 | | receiving the transfer of moneys from the Teacher Health | 20 | | Insurance Security Fund. The Department may promulgate rules | 21 | | further defining the methodology for the transfers. Any | 22 | | interest earned by moneys in the funds or accounts shall inure | 23 | | to the Teacher Health Insurance Security Fund. The transferred | 24 | | moneys, and interest accrued thereon, shall be used | 25 | | exclusively for transfers to administrative service | 26 | | organizations or their financial institutions for payments of |
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| 1 | | claims to claimants and providers under the self-insurance | 2 | | health plan. The transferred moneys, and interest accrued | 3 | | thereon, shall not be used for any other purpose including, | 4 | | but not limited to, reimbursement of administration fees due | 5 | | the administrative service organization pursuant to its | 6 | | contract or contracts with the Department. | 7 | | (g) Contract for benefits. The Director shall by contract, | 8 | | self-insurance, or otherwise make available the program of | 9 | | health benefits for TRS benefit recipients and their TRS | 10 | | dependent beneficiaries that is provided for in this Section. | 11 | | The contract or other arrangement for the provision of these | 12 | | health benefits shall be on terms deemed by the Director to be | 13 | | in the best interest of the State of Illinois and the TRS | 14 | | benefit recipients based on, but not limited to, such criteria | 15 | | as administrative cost, service capabilities of the carrier or | 16 | | other contractor, and the costs of the benefits. | 17 | | (g-5) Committee. A Teacher Retirement Insurance Program | 18 | | Committee shall be established, to consist of 10 persons | 19 | | appointed by the Governor. | 20 | | The Committee shall convene at least 4 times each year, | 21 | | and shall consider and make recommendations on issues | 22 | | affecting the program of health benefits provided under this | 23 | | Section. Recommendations of the Committee shall be based on a | 24 | | consensus of the members of the Committee. | 25 | | If the Teacher Health Insurance Security Fund experiences | 26 | | a deficit balance based upon the contribution and subsidy |
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| 1 | | rates established in this Section and Section 6.6 for Fiscal | 2 | | Year 2008 or thereafter, the Committee shall make | 3 | | recommendations for adjustments to the funding sources | 4 | | established under these Sections. | 5 | | In addition, the Committee shall identify proposed | 6 | | solutions to the funding shortfalls that are affecting the | 7 | | Teacher Health Insurance Security Fund, and it shall report | 8 | | those solutions to the Governor and the General Assembly | 9 | | within 6 months after August 15, 2011 (the effective date of | 10 | | Public Act 97-386). | 11 | | (h) Continuation of program. It is the intention of the | 12 | | General Assembly that the program of health benefits provided | 13 | | under this Section be maintained on an ongoing, affordable | 14 | | basis. | 15 | | The program of health benefits provided under this Section | 16 | | may be amended by the State and is not intended to be a pension | 17 | | or retirement benefit subject to protection under Article | 18 | | XIII, Section 5 of the Illinois Constitution. | 19 | | (i) Repeal. (Blank). | 20 | | (j) At least 60 days prior to the effective date of any | 21 | | changes to the coverage or benefit recipient cost share | 22 | | allowed under this Section, the Department shall post those | 23 | | changes on its website and shall submit the changes to the | 24 | | Commission on Government Forecasting and Accountability. | 25 | | (Source: P.A. 101-483, eff. 1-1-20; 102-210, eff. 7-30-21.)". |
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