Public Act 094-0032
 
HB0116 Enrolled LRB094 05523 LJB 35572 b

    AN ACT concerning insurance.
 
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
 
    Section 5. The State Employees Group Insurance Act of 1971
is amended by changing Section 3 as follows:
 
    (5 ILCS 375/3)  (from Ch. 127, par. 523)
    Sec. 3. Definitions. Unless the context otherwise
requires, the following words and phrases as used in this Act
shall have the following meanings. The Department may define
these and other words and phrases separately for the purpose of
implementing specific programs providing benefits under this
Act.
    (a) "Administrative service organization" means any
person, firm or corporation experienced in the handling of
claims which is fully qualified, financially sound and capable
of meeting the service requirements of a contract of
administration executed with the Department.
    (b) "Annuitant" means (1) an employee who retires, or has
retired, on or after January 1, 1966 on an immediate annuity
under the provisions of Articles 2, 14 (including an employee
who has elected to receive an alternative retirement
cancellation payment under Section 14-108.5 of the Illinois
Pension Code in lieu of an annuity), 15 (including an employee
who has retired under the optional retirement program
established under Section 15-158.2), paragraphs (2), (3), or
(5) of Section 16-106, or Article 18 of the Illinois Pension
Code; (2) any person who was receiving group insurance coverage
under this Act as of March 31, 1978 by reason of his status as
an annuitant, even though the annuity in relation to which such
coverage was provided is a proportional annuity based on less
than the minimum period of service required for a retirement
annuity in the system involved; (3) any person not otherwise
covered by this Act who has retired as a participating member
under Article 2 of the Illinois Pension Code but is ineligible
for the retirement annuity under Section 2-119 of the Illinois
Pension Code; (4) the spouse of any person who is receiving a
retirement annuity under Article 18 of the Illinois Pension
Code and who is covered under a group health insurance program
sponsored by a governmental employer other than the State of
Illinois and who has irrevocably elected to waive his or her
coverage under this Act and to have his or her spouse
considered as the "annuitant" under this Act and not as a
"dependent"; or (5) an employee who retires, or has retired,
from a qualified position, as determined according to rules
promulgated by the Director, under a qualified local government
or a qualified rehabilitation facility or a qualified domestic
violence shelter or service. (For definition of "retired
employee", see (p) post).
    (b-5) "New SERS annuitant" means a person who, on or after
January 1, 1998, becomes an annuitant, as defined in subsection
(b), by virtue of beginning to receive a retirement annuity
under Article 14 of the Illinois Pension Code (including an
employee who has elected to receive an alternative retirement
cancellation payment under Section 14-108.5 of that Code in
lieu of an annuity), and is eligible to participate in the
basic program of group health benefits provided for annuitants
under this Act.
    (b-6) "New SURS annuitant" means a person who (1) on or
after January 1, 1998, becomes an annuitant, as defined in
subsection (b), by virtue of beginning to receive a retirement
annuity under Article 15 of the Illinois Pension Code, (2) has
not made the election authorized under Section 15-135.1 of the
Illinois Pension Code, and (3) is eligible to participate in
the basic program of group health benefits provided for
annuitants under this Act.
    (b-7) "New TRS State annuitant" means a person who, on or
after July 1, 1998, becomes an annuitant, as defined in
subsection (b), by virtue of beginning to receive a retirement
annuity under Article 16 of the Illinois Pension Code based on
service as a teacher as defined in paragraph (2), (3), or (5)
of Section 16-106 of that Code, and is eligible to participate
in the basic program of group health benefits provided for
annuitants under this Act.
    (c) "Carrier" means (1) an insurance company, a corporation
organized under the Limited Health Service Organization Act or
the Voluntary Health Services Plan Act, a partnership, or other
nongovernmental organization, which is authorized to do group
life or group health insurance business in Illinois, or (2) the
State of Illinois as a self-insurer.
    (d) "Compensation" means salary or wages payable on a
regular payroll by the State Treasurer on a warrant of the
State Comptroller out of any State, trust or federal fund, or
by the Governor of the State through a disbursing officer of
the State out of a trust or out of federal funds, or by any
Department out of State, trust, federal or other funds held by
the State Treasurer or the Department, to any person for
personal services currently performed, and ordinary or
accidental disability benefits under Articles 2, 14, 15
(including ordinary or accidental disability benefits under
the optional retirement program established under Section
15-158.2), paragraphs (2), (3), or (5) of Section 16-106, or
Article 18 of the Illinois Pension Code, for disability
incurred after January 1, 1966, or benefits payable under the
Workers' Compensation or Occupational Diseases Act or benefits
payable under a sick pay plan established in accordance with
Section 36 of the State Finance Act. "Compensation" also means
salary or wages paid to an employee of any qualified local
government or qualified rehabilitation facility or a qualified
domestic violence shelter or service.
    (e) "Commission" means the State Employees Group Insurance
Advisory Commission authorized by this Act. Commencing July 1,
1984, "Commission" as used in this Act means the Illinois
Economic and Fiscal Commission as established by the
Legislative Commission Reorganization Act of 1984.
    (f) "Contributory", when referred to as contributory
coverage, shall mean optional coverages or benefits elected by
the member toward the cost of which such member makes
contribution, or which are funded in whole or in part through
the acceptance of a reduction in earnings or the foregoing of
an increase in earnings by an employee, as distinguished from
noncontributory coverage or benefits which are paid entirely by
the State of Illinois without reduction of the member's salary.
    (g) "Department" means any department, institution, board,
commission, officer, court or any agency of the State
government receiving appropriations and having power to
certify payrolls to the Comptroller authorizing payments of
salary and wages against such appropriations as are made by the
General Assembly from any State fund, or against trust funds
held by the State Treasurer and includes boards of trustees of
the retirement systems created by Articles 2, 14, 15, 16 and 18
of the Illinois Pension Code. "Department" also includes the
Illinois Comprehensive Health Insurance Board, the Board of
Examiners established under the Illinois Public Accounting
Act, and the Illinois Finance Authority.
    (h) "Dependent", when the term is used in the context of
the health and life plan, means a member's spouse and any
unmarried child (1) from birth to age 19 including an adopted
child, a child who lives with the member from the time of the
filing of a petition for adoption until entry of an order of
adoption, a stepchild or recognized child who lives with the
member in a parent-child relationship, or a child who lives
with the member if such member is a court appointed guardian of
the child, or (2) age 19 to 23 enrolled as a full-time student
in any accredited school, financially dependent upon the
member, and eligible to be claimed as a dependent for income
tax purposes, or (3) age 19 or over who is mentally or
physically handicapped. For the purposes of item (2), an
unmarried child age 19 to 23 who is a member of the United
States Armed Services, including the Illinois National Guard,
and is mobilized to active duty shall qualify as a dependent
beyond the age of 23 and until the age of 25 and while a
full-time student for the amount of time spent on active duty
between the ages of 19 and 23. The individual attempting to
qualify for this additional time must submit written
documentation of active duty service to the Director. The
changes made by this amendatory Act of the 94th General
Assembly apply only to individuals mobilized to active duty in
the United States Armed Services, including the Illinois
National Guard, on or after January 1, 2002. For the health
plan only, the term "dependent" also includes any person
enrolled prior to the effective date of this Section who is
dependent upon the member to the extent that the member may
claim such person as a dependent for income tax deduction
purposes; no other such person may be enrolled. For the health
plan only, the term "dependent" also includes any person who
has received after June 30, 2000 an organ transplant and who is
financially dependent upon the member and eligible to be
claimed as a dependent for income tax purposes.
    (i) "Director" means the Director of the Illinois
Department of Central Management Services.
    (j) "Eligibility period" means the period of time a member
has to elect enrollment in programs or to select benefits
without regard to age, sex or health.
    (k) "Employee" means and includes each officer or employee
in the service of a department who (1) receives his
compensation for service rendered to the department on a
warrant issued pursuant to a payroll certified by a department
or on a warrant or check issued and drawn by a department upon
a trust, federal or other fund or on a warrant issued pursuant
to a payroll certified by an elected or duly appointed officer
of the State or who receives payment of the performance of
personal services on a warrant issued pursuant to a payroll
certified by a Department and drawn by the Comptroller upon the
State Treasurer against appropriations made by the General
Assembly from any fund or against trust funds held by the State
Treasurer, and (2) is employed full-time or part-time in a
position normally requiring actual performance of duty during
not less than 1/2 of a normal work period, as established by
the Director in cooperation with each department, except that
persons elected by popular vote will be considered employees
during the entire term for which they are elected regardless of
hours devoted to the service of the State, and (3) except that
"employee" does not include any person who is not eligible by
reason of such person's employment to participate in one of the
State retirement systems under Articles 2, 14, 15 (either the
regular Article 15 system or the optional retirement program
established under Section 15-158.2) or 18, or under paragraph
(2), (3), or (5) of Section 16-106, of the Illinois Pension
Code, but such term does include persons who are employed
during the 6 month qualifying period under Article 14 of the
Illinois Pension Code. Such term also includes any person who
(1) after January 1, 1966, is receiving ordinary or accidental
disability benefits under Articles 2, 14, 15 (including
ordinary or accidental disability benefits under the optional
retirement program established under Section 15-158.2),
paragraphs (2), (3), or (5) of Section 16-106, or Article 18 of
the Illinois Pension Code, for disability incurred after
January 1, 1966, (2) receives total permanent or total
temporary disability under the Workers' Compensation Act or
Occupational Disease Act as a result of injuries sustained or
illness contracted in the course of employment with the State
of Illinois, or (3) is not otherwise covered under this Act and
has retired as a participating member under Article 2 of the
Illinois Pension Code but is ineligible for the retirement
annuity under Section 2-119 of the Illinois Pension Code.
However, a person who satisfies the criteria of the foregoing
definition of "employee" except that such person is made
ineligible to participate in the State Universities Retirement
System by clause (4) of subsection (a) of Section 15-107 of the
Illinois Pension Code is also an "employee" for the purposes of
this Act. "Employee" also includes any person receiving or
eligible for benefits under a sick pay plan established in
accordance with Section 36 of the State Finance Act. "Employee"
also includes each officer or employee in the service of a
qualified local government, including persons appointed as
trustees of sanitary districts regardless of hours devoted to
the service of the sanitary district, and each employee in the
service of a qualified rehabilitation facility and each
full-time employee in the service of a qualified domestic
violence shelter or service, as determined according to rules
promulgated by the Director.
    (l) "Member" means an employee, annuitant, retired
employee or survivor.
    (m) "Optional coverages or benefits" means those coverages
or benefits available to the member on his or her voluntary
election, and at his or her own expense.
    (n) "Program" means the group life insurance, health
benefits and other employee benefits designed and contracted
for by the Director under this Act.
    (o) "Health plan" means a health benefits program offered
by the State of Illinois for persons eligible for the plan.
    (p) "Retired employee" means any person who would be an
annuitant as that term is defined herein but for the fact that
such person retired prior to January 1, 1966. Such term also
includes any person formerly employed by the University of
Illinois in the Cooperative Extension Service who would be an
annuitant but for the fact that such person was made ineligible
to participate in the State Universities Retirement System by
clause (4) of subsection (a) of Section 15-107 of the Illinois
Pension Code.
    (q) "Survivor" means a person receiving an annuity as a
survivor of an employee or of an annuitant. "Survivor" also
includes: (1) the surviving dependent of a person who satisfies
the definition of "employee" except that such person is made
ineligible to participate in the State Universities Retirement
System by clause (4) of subsection (a) of Section 15-107 of the
Illinois Pension Code; (2) the surviving dependent of any
person formerly employed by the University of Illinois in the
Cooperative Extension Service who would be an annuitant except
for the fact that such person was made ineligible to
participate in the State Universities Retirement System by
clause (4) of subsection (a) of Section 15-107 of the Illinois
Pension Code; and (3) the surviving dependent of a person who
was an annuitant under this Act by virtue of receiving an
alternative retirement cancellation payment under Section
14-108.5 of the Illinois Pension Code.
    (q-2) "SERS" means the State Employees' Retirement System
of Illinois, created under Article 14 of the Illinois Pension
Code.
    (q-3) "SURS" means the State Universities Retirement
System, created under Article 15 of the Illinois Pension Code.
    (q-4) "TRS" means the Teachers' Retirement System of the
State of Illinois, created under Article 16 of the Illinois
Pension Code.
    (q-5) "New SERS survivor" means a survivor, as defined in
subsection (q), whose annuity is paid under Article 14 of the
Illinois Pension Code and is based on the death of (i) an
employee whose death occurs on or after January 1, 1998, or
(ii) a new SERS annuitant as defined in subsection (b-5). "New
SERS survivor" includes the surviving dependent of a person who
was an annuitant under this Act by virtue of receiving an
alternative retirement cancellation payment under Section
14-108.5 of the Illinois Pension Code.
    (q-6) "New SURS survivor" means a survivor, as defined in
subsection (q), whose annuity is paid under Article 15 of the
Illinois Pension Code and is based on the death of (i) an
employee whose death occurs on or after January 1, 1998, or
(ii) a new SURS annuitant as defined in subsection (b-6).
    (q-7) "New TRS State survivor" means a survivor, as defined
in subsection (q), whose annuity is paid under Article 16 of
the Illinois Pension Code and is based on the death of (i) an
employee who is a teacher as defined in paragraph (2), (3), or
(5) of Section 16-106 of that Code and whose death occurs on or
after July 1, 1998, or (ii) a new TRS State annuitant as
defined in subsection (b-7).
    (r) "Medical services" means the services provided within
the scope of their licenses by practitioners in all categories
licensed under the Medical Practice Act of 1987.
    (s) "Unit of local government" means any county,
municipality, township, school district (including a
combination of school districts under the Intergovernmental
Cooperation Act), special district or other unit, designated as
a unit of local government by law, which exercises limited
governmental powers or powers in respect to limited
governmental subjects, any not-for-profit association with a
membership that primarily includes townships and township
officials, that has duties that include provision of research
service, dissemination of information, and other acts for the
purpose of improving township government, and that is funded
wholly or partly in accordance with Section 85-15 of the
Township Code; any not-for-profit corporation or association,
with a membership consisting primarily of municipalities, that
operates its own utility system, and provides research,
training, dissemination of information, or other acts to
promote cooperation between and among municipalities that
provide utility services and for the advancement of the goals
and purposes of its membership; the Southern Illinois
Collegiate Common Market, which is a consortium of higher
education institutions in Southern Illinois; and the Illinois
Association of Park Districts. "Qualified local government"
means a unit of local government approved by the Director and
participating in a program created under subsection (i) of
Section 10 of this Act.
    (t) "Qualified rehabilitation facility" means any
not-for-profit organization that is accredited by the
Commission on Accreditation of Rehabilitation Facilities or
certified by the Department of Human Services (as successor to
the Department of Mental Health and Developmental
Disabilities) to provide services to persons with disabilities
and which receives funds from the State of Illinois for
providing those services, approved by the Director and
participating in a program created under subsection (j) of
Section 10 of this Act.
    (u) "Qualified domestic violence shelter or service" means
any Illinois domestic violence shelter or service and its
administrative offices funded by the Department of Human
Services (as successor to the Illinois Department of Public
Aid), approved by the Director and participating in a program
created under subsection (k) of Section 10.
    (v) "TRS benefit recipient" means a person who:
        (1) is not a "member" as defined in this Section; and
        (2) is receiving a monthly benefit or retirement
    annuity under Article 16 of the Illinois Pension Code; and
        (3) either (i) has at least 8 years of creditable
    service under Article 16 of the Illinois Pension Code, or
    (ii) was enrolled in the health insurance program offered
    under that Article on January 1, 1996, or (iii) is the
    survivor of a benefit recipient who had at least 8 years of
    creditable service under Article 16 of the Illinois Pension
    Code or was enrolled in the health insurance program
    offered under that Article on the effective date of this
    amendatory Act of 1995, or (iv) is a recipient or survivor
    of a recipient of a disability benefit under Article 16 of
    the Illinois Pension Code.
    (w) "TRS dependent beneficiary" means a person who:
        (1) is not a "member" or "dependent" as defined in this
    Section; and
        (2) is a TRS benefit recipient's: (A) spouse, (B)
    dependent parent who is receiving at least half of his or
    her support from the TRS benefit recipient, or (C)
    unmarried natural or adopted child who is (i) under age 19,
    or (ii) enrolled as a full-time student in an accredited
    school, financially dependent upon the TRS benefit
    recipient, eligible to be claimed as a dependent for income
    tax purposes, and either is under age 24 or was, on January
    1, 1996, participating as a dependent beneficiary in the
    health insurance program offered under Article 16 of the
    Illinois Pension Code, or (iii) age 19 or over who is
    mentally or physically handicapped.
    (x) "Military leave with pay and benefits" refers to
individuals in basic training for reserves, special/advanced
training, annual training, emergency call up, or activation by
the President of the United States with approved pay and
benefits.
    (y) "Military leave without pay and benefits" refers to
individuals who enlist for active duty in a regular component
of the U.S. Armed Forces or other duty not specified or
authorized under military leave with pay and benefits.
    (z) "Community college benefit recipient" means a person
who:
        (1) is not a "member" as defined in this Section; and
        (2) is receiving a monthly survivor's annuity or
    retirement annuity under Article 15 of the Illinois Pension
    Code; and
        (3) either (i) was a full-time employee of a community
    college district or an association of community college
    boards created under the Public Community College Act
    (other than an employee whose last employer under Article
    15 of the Illinois Pension Code was a community college
    district subject to Article VII of the Public Community
    College Act) and was eligible to participate in a group
    health benefit plan as an employee during the time of
    employment with a community college district (other than a
    community college district subject to Article VII of the
    Public Community College Act) or an association of
    community college boards, or (ii) is the survivor of a
    person described in item (i).
    (aa) "Community college dependent beneficiary" means a
person who:
        (1) is not a "member" or "dependent" as defined in this
    Section; and
        (2) is a community college benefit recipient's: (A)
    spouse, (B) dependent parent who is receiving at least half
    of his or her support from the community college benefit
    recipient, or (C) unmarried natural or adopted child who is
    (i) under age 19, or (ii) enrolled as a full-time student
    in an accredited school, financially dependent upon the
    community college benefit recipient, eligible to be
    claimed as a dependent for income tax purposes and under
    age 23, or (iii) age 19 or over and mentally or physically
    handicapped.
(Source: P.A. 92-16, eff. 6-28-01; 92-186, eff. 1-1-02; 92-204,
eff. 8-1-01; 92-651, eff. 7-11-02; 93-205, eff. 1-1-04; 93-839,
eff. 7-30-04.)
 
    Section 99. Effective date. This Act takes effect upon
becoming law.