Public Act 095-0632
 
SB1523 Enrolled LRB095 07679 JAM 27831 b

    AN ACT concerning government.
 
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
 
    Section 3. House Bill 938 of the 95th General Assembly is
amended, if and only if that bill becomes law, by adding
Section 99 as follows:
 
    (H.B. 938, 95th G.A., Sec. 99 new)
    Sec. 99. This Act (House Bill 938 of the 95th General
Assembly) takes effect on the effective date of this amendatory
Act of the 95th General Assembly (Senate Bill 1523 of the 95th
General Assembly).
 
    Section 5. The State Employees Group Insurance Act of 1971
is amended by changing Sections 3, 6.5, 6.10, 10, 12, 13, and
13.1 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, a qualified rehabilitation facility, a qualified
domestic violence shelter or service, or a qualified child
advocacy center. (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, qualified rehabilitation facility, qualified
domestic violence shelter or service, or qualified child
advocacy center.
    (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 Commission on
Government Forecasting and Accountability 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 or of any successor
agency designated to administer this Act.
    (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 (i) 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, (ii) each employee in the
service of a qualified rehabilitation facility, (iii) each
full-time employee in the service of a qualified domestic
violence shelter or service, and (iv) each full-time employee
in the service of a qualified child advocacy center, 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; the Illinois
Association of Park Districts; and any hospital provider that
is owned by a county that has 100 or fewer hospital beds and
has not already joined the program. "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.
    (bb) "Qualified child advocacy center" means any Illinois
child advocacy center and its administrative offices funded by
the Department of Children and Family Services, as defined by
the Children's Advocacy Center Act (55 ILCS 80/), approved by
the Director and participating in a program created under
subsection (n) of Section 10.
(Source: P.A. 93-205, eff. 1-1-04; 93-839, eff. 7-30-04;
93-1067, eff. 1-15-05; 94-32, eff. 6-15-05; 94-82, eff. 1-1-06;
94-860, eff. 6-16-06; revised 8-3-06.)
 
    (5 ILCS 375/6.5)
    Sec. 6.5. Health benefits for TRS benefit recipients and
TRS dependent beneficiaries.
    (a) Purpose. It is the purpose of this amendatory Act of
1995 to transfer the administration of the program of health
benefits established for benefit recipients and their
dependent beneficiaries under Article 16 of the Illinois
Pension Code to the Department of Central Management Services.
    (b) Transition provisions. The Board of Trustees of the
Teachers' Retirement System shall continue to administer the
health benefit program established under Article 16 of the
Illinois Pension Code through December 31, 1995. Beginning
January 1, 1996, the Department of Central Management Services
shall be responsible for administering a program of health
benefits for TRS benefit recipients and TRS dependent
beneficiaries under this Section. The Department of Central
Management Services and the Teachers' Retirement System shall
cooperate in this endeavor and shall coordinate their
activities so as to ensure a smooth transition and
uninterrupted health benefit coverage.
    (c) Eligibility. All persons who were enrolled in the
Article 16 program at the time of the transfer shall be
eligible to participate in the program established under this
Section without any interruption or delay in coverage or
limitation as to pre-existing medical conditions. Eligibility
to participate shall be determined by the Teachers' Retirement
System. Eligibility information shall be communicated to the
Department of Central Management Services in a format
acceptable to the Department.
    A TRS dependent beneficiary who is an unmarried child age
19 or over and mentally or physically disabled does not become
ineligible to participate by reason of (i) becoming ineligible
to be claimed as a dependent for Illinois or federal income tax
purposes or (ii) receiving earned income, so long as those
earnings are insufficient for the child to be fully
self-sufficient.
    (d) Coverage. The level of health benefits provided under
this Section shall be similar to the level of benefits provided
by the program previously established under Article 16 of the
Illinois Pension Code.
    Group life insurance benefits are not included in the
benefits to be provided to TRS benefit recipients and TRS
dependent beneficiaries under this Act.
    The program of health benefits under this Section may
include any or all of the benefit limitations, including but
not limited to a reduction in benefits based on eligibility for
federal medicare benefits, that are provided under subsection
(a) of Section 6 of this Act for other health benefit programs
under this Act.
    (e) Insurance rates and premiums. The Director shall
determine the insurance rates and premiums for TRS benefit
recipients and TRS dependent beneficiaries, and shall present
to the Teachers' Retirement System of the State of Illinois, by
April 15 of each calendar year, the rate-setting methodology
(including but not limited to utilization levels and costs)
used to determine the amount of the health care premiums.
        For Fiscal Year 1996, the premium shall be equal to the
    premium actually charged in Fiscal Year 1995; in subsequent
    years, the premium shall never be lower than the premium
    charged in Fiscal Year 1995.
        For Fiscal Year 2003, the premium shall not exceed 110%
    of the premium actually charged in Fiscal Year 2002.
        For Fiscal Year 2004, the premium shall not exceed 112%
    of the premium actually charged in Fiscal Year 2003.
        For Fiscal Year 2005, the premium shall not exceed a
    weighted average of 106.6% of the premium actually charged
    in Fiscal Year 2004.
        For Fiscal Year 2006, the premium shall not exceed a
    weighted average of 109.1% of the premium actually charged
    in Fiscal Year 2005.
        For Fiscal Year 2007, the premium shall not exceed a
    weighted average of 103.9% of the premium actually charged
    in Fiscal Year 2006.
        For Fiscal Year 2008 and thereafter, the premium in
    each fiscal year shall not exceed 105% of the premium
    actually charged in the previous fiscal year.
    Rates and premiums may be based in part on age and
eligibility for federal medicare coverage. However, the cost of
participation for a TRS dependent beneficiary who is an
unmarried child age 19 or over and mentally or physically
disabled shall not exceed the cost for a TRS dependent
beneficiary who is an unmarried child under age 19 and
participates in the same major medical or managed care program.
    The cost of health benefits under the program shall be paid
as follows:
        (1) For a TRS benefit recipient selecting a managed
    care program, up to 75% of the total insurance rate shall
    be paid from the Teacher Health Insurance Security Fund.
    Effective with Fiscal Year 2007 and thereafter, for a TRS
    benefit recipient selecting a managed care program, 75% of
    the total insurance rate shall be paid from the Teacher
    Health Insurance Security Fund.
        (2) For a TRS benefit recipient selecting the major
    medical coverage program, up to 50% of the total insurance
    rate shall be paid from the Teacher Health Insurance
    Security Fund if a managed care program is accessible, as
    determined by the Teachers' Retirement System. Effective
    with Fiscal Year 2007 and thereafter, for a TRS benefit
    recipient selecting the major medical coverage program,
    50% of the total insurance rate shall be paid from the
    Teacher Health Insurance Security Fund if a managed care
    program is accessible, as determined by the Department of
    Central Management Services.
        (3) For a TRS benefit recipient selecting the major
    medical coverage program, up to 75% of the total insurance
    rate shall be paid from the Teacher Health Insurance
    Security Fund if a managed care program is not accessible,
    as determined by the Teachers' Retirement System.
    Effective with Fiscal Year 2007 and thereafter, for a TRS
    benefit recipient selecting the major medical coverage
    program, 75% of the total insurance rate shall be paid from
    the Teacher Health Insurance Security Fund if a managed
    care program is not accessible, as determined by the
    Department of Central Management Services.
        (3.1) For a TRS dependent beneficiary who is Medicare
    primary and enrolled in a managed care plan, or the major
    medical coverage program if a managed care plan is not
    available, 25% of the total insurance rate shall be paid
    from the Teacher Health Security Fund as determined by the
    Department of Central Management Services. For the purpose
    of this item (3.1), the term "TRS dependent beneficiary who
    is Medicare primary" means a TRS dependent beneficiary who
    is participating in Medicare Parts A and B.
        (4) Except as otherwise provided in item (3.1), the
    balance of the rate of insurance, including the entire
    premium of any coverage for TRS dependent beneficiaries
    that has been elected, shall be paid by deductions
    authorized by the TRS benefit recipient to be withheld from
    his or her monthly annuity or benefit payment from the
    Teachers' Retirement System; except that (i) if the balance
    of the cost of coverage exceeds the amount of the monthly
    annuity or benefit payment, the difference shall be paid
    directly to the Teachers' Retirement System by the TRS
    benefit recipient, and (ii) all or part of the balance of
    the cost of coverage may, at the school board's option, be
    paid to the Teachers' Retirement System by the school board
    of the school district from which the TRS benefit recipient
    retired, in accordance with Section 10-22.3b of the School
    Code. The Teachers' Retirement System shall promptly
    deposit all moneys withheld by or paid to it under this
    subdivision (e)(4) into the Teacher Health Insurance
    Security Fund. These moneys shall not be considered assets
    of the Retirement System.
    (f) Financing. Beginning July 1, 1995, all revenues arising
from the administration of the health benefit programs
established under Article 16 of the Illinois Pension Code or
this Section shall be deposited into the Teacher Health
Insurance Security Fund, which is hereby created as a
nonappropriated trust fund to be held outside the State
Treasury, with the State Treasurer as custodian. Any interest
earned on moneys in the Teacher Health Insurance Security Fund
shall be deposited into the Fund.
    Moneys in the Teacher Health Insurance Security Fund shall
be used only to pay the costs of the health benefit program
established under this Section, including associated
administrative costs, and the costs associated with the health
benefit program established under Article 16 of the Illinois
Pension Code, as authorized in this Section. Beginning July 1,
1995, the Department of Central Management Services may make
expenditures from the Teacher Health Insurance Security Fund
for those costs.
    After other funds authorized for the payment of the costs
of the health benefit program established under Article 16 of
the Illinois Pension Code are exhausted and until January 1,
1996 (or such later date as may be agreed upon by the Director
of Central Management Services and the Secretary of the
Teachers' Retirement System), the Secretary of the Teachers'
Retirement System may make expenditures from the Teacher Health
Insurance Security Fund as necessary to pay up to 75% of the
cost of providing health coverage to eligible benefit
recipients (as defined in Sections 16-153.1 and 16-153.3 of the
Illinois Pension Code) who are enrolled in the Article 16
health benefit program and to facilitate the transfer of
administration of the health benefit program to the Department
of Central Management Services.
    The Department of Healthcare and Family Services, or any
successor agency designated to procure healthcare contracts
pursuant to this Act, is authorized to establish funds,
separate accounts provided by any bank or banks as defined by
the Illinois Banking Act, or separate accounts provided by any
savings and loan association or associations as defined by the
Illinois Savings and Loan Act of 1985 to be held by the
Director, outside the State treasury, for the purpose of
receiving the transfer of moneys from the Teacher Health
Insurance Security Fund. The Department may promulgate rules
further defining the methodology for the transfers. Any
interest earned by moneys in the funds or accounts shall inure
to the Teacher Health Insurance Security Fund. The transferred
moneys, and interest accrued thereon, shall be used exclusively
for transfers to administrative service organizations or their
financial institutions for payments of claims to claimants and
providers under the self-insurance health plan. The
transferred moneys, and interest accrued thereon, shall not be
used for any other purpose including, but not limited to,
reimbursement of administration fees due the administrative
service organization pursuant to its contract or contracts with
the Department.
    (g) Contract for benefits. The Director shall by contract,
self-insurance, or otherwise make available the program of
health benefits for TRS benefit recipients and their TRS
dependent beneficiaries that is provided for in this Section.
The contract or other arrangement for the provision of these
health benefits shall be on terms deemed by the Director to be
in the best interest of the State of Illinois and the TRS
benefit recipients based on, but not limited to, such criteria
as administrative cost, service capabilities of the carrier or
other contractor, and the costs of the benefits.
    (g-5) Committee. A Teacher Retirement Insurance Program
Committee shall be established, to consist of 10 persons
appointed by the Governor.
    The Committee shall convene at least 4 times each year, and
shall consider and make recommendations on issues affecting the
program of health benefits provided under this Section.
Recommendations of the Committee shall be based on a consensus
of the members of the Committee.
    If the Teacher Health Insurance Security Fund experiences a
deficit balance based upon the contribution and subsidy rates
established in this Section and Section 6.6 for Fiscal Year
2008 or thereafter, the Committee shall make recommendations
for adjustments to the funding sources established under these
Sections.
    (h) Continuation of program. It is the intention of the
General Assembly that the program of health benefits provided
under this Section be maintained on an ongoing, affordable
basis.
    The program of health benefits provided under this Section
may be amended by the State and is not intended to be a pension
or retirement benefit subject to protection under Article XIII,
Section 5 of the Illinois Constitution.
    (i) Repeal. (Blank).
(Source: P.A. 92-505, eff. 12-20-01; 92-862, eff. 1-3-03;
93-679, eff. 6-30-04.)
 
    (5 ILCS 375/6.10)
    Sec. 6.10. Contributions to the Community College Health
Insurance Security Fund.
    (a) Beginning January 1, 1999, every active contributor of
the State Universities Retirement System (established under
Article 15 of the Illinois Pension Code) who (1) is a full-time
employee of 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 and (2) is not an employee as defined in Section 3 of
this Act shall make contributions toward the cost of community
college annuitant and survivor health benefits at the rate of
0.50% of salary.
    These contributions shall be deducted by the employer and
paid to the State Universities Retirement System as service
agent for the Department of Central Management Services. The
System may use the same processes for collecting the
contributions required by this subsection that it uses to
collect the contributions received from those employees under
Section 15-157 of the Illinois Pension Code. An employer may
agree to pick up or pay the contributions required under this
subsection on behalf of the employee; such contributions shall
be deemed to have been paid by the employee.
    The State Universities Retirement System shall promptly
deposit all moneys collected under this subsection (a) into the
Community College Health Insurance Security Fund created in
Section 6.9 of this Act. The moneys collected under this
Section shall be used only for the purposes authorized in
Section 6.9 of this Act and shall not be considered to be
assets of the State Universities Retirement System.
Contributions made under this Section are not transferable to
other pension funds or retirement systems and are not
refundable upon termination of service.
    (b) Beginning January 1, 1999, every community college
district (other than a community college district subject to
Article VII of the Public Community College Act) or association
of community college boards that is an employer under the State
Universities Retirement System shall contribute toward the
cost of the community college health benefits provided under
Section 6.9 of this Act an amount equal to 0.50% of the salary
paid to its full-time employees who participate in the State
Universities Retirement System and are not members as defined
in Section 3 of this Act.
    These contributions shall be paid by the employer to the
State Universities Retirement System as service agent for the
Department of Central Management Services. The System may use
the same processes for collecting the contributions required by
this subsection that it uses to collect the contributions
received from those employers under Section 15-155 of the
Illinois Pension Code.
    The State Universities Retirement System shall promptly
deposit all moneys collected under this subsection (b) into the
Community College Health Insurance Security Fund created in
Section 6.9 of this Act. The moneys collected under this
Section shall be used only for the purposes authorized in
Section 6.9 of this Act and shall not be considered to be
assets of the State Universities Retirement System.
Contributions made under this Section are not transferable to
other pension funds or retirement systems and are not
refundable upon termination of service.
    The Department of Healthcare and Family Services, or any
successor agency designated to procure healthcare contracts
pursuant to this Act, is authorized to establish funds,
separate accounts provided by any bank or banks as defined by
the Illinois Banking Act, or separate accounts provided by any
savings and loan association or associations as defined by the
Illinois Savings and Loan Act of 1985 to be held by the
Director, outside the State treasury, for the purpose of
receiving the transfer of moneys from the Community College
Health Insurance Security Fund. The Department may promulgate
rules further defining the methodology for the transfers. Any
interest earned by moneys in the funds or accounts shall inure
to the Community College Health Insurance Security Fund. The
transferred moneys, and interest accrued thereon, shall be used
exclusively for transfers to administrative service
organizations or their financial institutions for payments of
claims to claimants and providers under the self-insurance
health plan. The transferred moneys, and interest accrued
thereon, shall not be used for any other purpose including, but
not limited to, reimbursement of administration fees due the
administrative service organization pursuant to its contract
or contracts with the Department.
    (c) On or before November 15 of each year, the Board of
Trustees of the State Universities Retirement System shall
certify to the Governor, the Director of Central Management
Services, and the State Comptroller its estimate of the total
amount of contributions to be paid under subsection (a) of this
Section for the next fiscal year. Beginning in fiscal year
2008, the amount certified shall be decreased or increased each
year by the amount that the actual active employee
contributions either fell short of or exceeded the estimate
used by the Board in making the certification for the previous
fiscal year. The State Universities Retirement System shall
calculate the amount of actual active employee contributions in
fiscal years 1999 through 2005. Based upon this calculation,
the fiscal year 2008 certification shall include an amount
equal to the cumulative amount that the actual active employee
contributions either fell short of or exceeded the estimate
used by the Board in making the certification for those fiscal
years. The certification shall include a detailed explanation
of the methods and information that the Board relied upon in
preparing its estimate. As soon as possible after the effective
date of this Section, the Board shall submit its estimate for
fiscal year 1999.
    (d) Beginning in fiscal year 1999, on the first day of each
month, or as soon thereafter as may be practical, the State
Treasurer and the State Comptroller shall transfer from the
General Revenue Fund to the Community College Health Insurance
Security Fund 1/12 of the annual amount appropriated for that
fiscal year to the State Comptroller for deposit into the
Community College Health Insurance Security Fund under Section
1.4 of the State Pension Funds Continuing Appropriation Act.
    (e) Except where otherwise specified in this Section, the
definitions that apply to Article 15 of the Illinois Pension
Code apply to this Section.
(Source: P.A. 94-839, eff. 6-6-06.)
 
    (5 ILCS 375/10)  (from Ch. 127, par. 530)
    Sec. 10. Payments by State; premiums.
    (a) The State shall pay the cost of basic non-contributory
group life insurance and, subject to member paid contributions
set by the Department or required by this Section, the basic
program of group health benefits on each eligible member,
except a member, 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, and
part of each eligible member's and retired member's premiums
for health insurance coverage for enrolled dependents as
provided by Section 9. The State shall pay the cost of the
basic program of group health benefits only after benefits are
reduced by the amount of benefits covered by Medicare for all
members and dependents who are eligible for benefits under
Social Security or the Railroad Retirement system or who had
sufficient Medicare-covered government employment, except that
such reduction in benefits shall apply only to those members
and dependents who (1) first become eligible for such Medicare
coverage on or after July 1, 1992; or (2) are Medicare-eligible
members or dependents of a local government unit which began
participation in the program on or after July 1, 1992; or (3)
remain eligible for, but no longer receive Medicare coverage
which they had been receiving on or after July 1, 1992. The
Department may determine the aggregate level of the State's
contribution on the basis of actual cost of medical services
adjusted for age, sex or geographic or other demographic
characteristics which affect the costs of such programs.
    The cost of participation in the basic program of group
health benefits for the dependent or survivor of a living or
deceased retired employee who was formerly employed by the
University of Illinois in the Cooperative Extension Service and
would be an annuitant but for the fact that he or she 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 shall not be greater than the cost of
participation that would otherwise apply to that dependent or
survivor if he or she were the dependent or survivor of an
annuitant under the State Universities Retirement System.
    (a-1) Beginning January 1, 1998, for each person who
becomes a new SERS annuitant and participates in the basic
program of group health benefits, the State shall contribute
toward the cost of the annuitant's coverage under the basic
program of group health benefits an amount equal to 5% of that
cost for each full year of creditable service upon which the
annuitant's retirement annuity is based, up to a maximum of
100% for an annuitant with 20 or more years of creditable
service. The remainder of the cost of a new SERS annuitant's
coverage under the basic program of group health benefits shall
be the responsibility of the annuitant. In the case of a new
SERS annuitant 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, for the purposes
of this subsection the annuitant shall be deemed to be
receiving a retirement annuity based on the number of years of
creditable service that the annuitant had established at the
time of his or her termination of service under SERS.
    (a-2) Beginning January 1, 1998, for each person who
becomes a new SERS survivor and participates in the basic
program of group health benefits, the State shall contribute
toward the cost of the survivor's coverage under the basic
program of group health benefits an amount equal to 5% of that
cost for each full year of the deceased employee's or deceased
annuitant's creditable service in the State Employees'
Retirement System of Illinois on the date of death, up to a
maximum of 100% for a survivor of an employee or annuitant with
20 or more years of creditable service. The remainder of the
cost of the new SERS survivor's coverage under the basic
program of group health benefits shall be the responsibility of
the survivor. In the case of a new SERS survivor who was the
dependent of an annuitant who elected to receive an alternative
retirement cancellation payment under Section 14-108.5 of the
Illinois Pension Code in lieu of an annuity, for the purposes
of this subsection the deceased annuitant's creditable service
shall be determined as of the date of termination of service
rather than the date of death.
    (a-3) Beginning January 1, 1998, for each person who
becomes a new SURS annuitant and participates in the basic
program of group health benefits, the State shall contribute
toward the cost of the annuitant's coverage under the basic
program of group health benefits an amount equal to 5% of that
cost for each full year of creditable service upon which the
annuitant's retirement annuity is based, up to a maximum of
100% for an annuitant with 20 or more years of creditable
service. The remainder of the cost of a new SURS annuitant's
coverage under the basic program of group health benefits shall
be the responsibility of the annuitant.
    (a-4) (Blank).
    (a-5) Beginning January 1, 1998, for each person who
becomes a new SURS survivor and participates in the basic
program of group health benefits, the State shall contribute
toward the cost of the survivor's coverage under the basic
program of group health benefits an amount equal to 5% of that
cost for each full year of the deceased employee's or deceased
annuitant's creditable service in the State Universities
Retirement System on the date of death, up to a maximum of 100%
for a survivor of an employee or annuitant with 20 or more
years of creditable service. The remainder of the cost of the
new SURS survivor's coverage under the basic program of group
health benefits shall be the responsibility of the survivor.
    (a-6) Beginning July 1, 1998, for each person who becomes a
new TRS State annuitant and participates in the basic program
of group health benefits, the State shall contribute toward the
cost of the annuitant's coverage under the basic program of
group health benefits an amount equal to 5% of that cost for
each full year of creditable service as a teacher as defined in
paragraph (2), (3), or (5) of Section 16-106 of the Illinois
Pension Code upon which the annuitant's retirement annuity is
based, up to a maximum of 100%; except that the State
contribution shall be 12.5% per year (rather than 5%) for each
full year of creditable service as a regional superintendent or
assistant regional superintendent of schools. The remainder of
the cost of a new TRS State annuitant's coverage under the
basic program of group health benefits shall be the
responsibility of the annuitant.
    (a-7) Beginning July 1, 1998, for each person who becomes a
new TRS State survivor and participates in the basic program of
group health benefits, the State shall contribute toward the
cost of the survivor's coverage under the basic program of
group health benefits an amount equal to 5% of that cost for
each full year of the deceased employee's or deceased
annuitant's creditable service as a teacher as defined in
paragraph (2), (3), or (5) of Section 16-106 of the Illinois
Pension Code on the date of death, up to a maximum of 100%;
except that the State contribution shall be 12.5% per year
(rather than 5%) for each full year of the deceased employee's
or deceased annuitant's creditable service as a regional
superintendent or assistant regional superintendent of
schools. The remainder of the cost of the new TRS State
survivor's coverage under the basic program of group health
benefits shall be the responsibility of the survivor.
    (a-8) A new SERS annuitant, new SERS survivor, new SURS
annuitant, new SURS survivor, new TRS State annuitant, or new
TRS State survivor may waive or terminate coverage in the
program of group health benefits. Any such annuitant or
survivor who has waived or terminated coverage may enroll or
re-enroll in the program of group health benefits only during
the annual benefit choice period, as determined by the
Director; except that in the event of termination of coverage
due to nonpayment of premiums, the annuitant or survivor may
not re-enroll in the program.
    (a-9) No later than May 1 of each calendar year, the
Director of Central Management Services shall certify in
writing to the Executive Secretary of the State Employees'
Retirement System of Illinois the amounts of the Medicare
supplement health care premiums and the amounts of the health
care premiums for all other retirees who are not Medicare
eligible.
    A separate calculation of the premiums based upon the
actual cost of each health care plan shall be so certified.
    The Director of Central Management Services shall provide
to the Executive Secretary of the State Employees' Retirement
System of Illinois such information, statistics, and other data
as he or she may require to review the premium amounts
certified by the Director of Central Management Services.
    The Department of Healthcare and Family Services, or any
successor agency designated to procure healthcare contracts
pursuant to this Act, is authorized to establish funds,
separate accounts provided by any bank or banks as defined by
the Illinois Banking Act, or separate accounts provided by any
savings and loan association or associations as defined by the
Illinois Savings and Loan Act of 1985 to be held by the
Director, outside the State treasury, for the purpose of
receiving the transfer of moneys from the Local Government
Health Insurance Reserve Fund. The Department may promulgate
rules further defining the methodology for the transfers. Any
interest earned by moneys in the funds or accounts shall inure
to the Local Government Health Insurance Reserve Fund. The
transferred moneys, and interest accrued thereon, shall be used
exclusively for transfers to administrative service
organizations or their financial institutions for payments of
claims to claimants and providers under the self-insurance
health plan. The transferred moneys, and interest accrued
thereon, shall not be used for any other purpose including, but
not limited to, reimbursement of administration fees due the
administrative service organization pursuant to its contract
or contracts with the Department.
    (b) State employees who become eligible for this program on
or after January 1, 1980 in positions normally requiring actual
performance of duty not less than 1/2 of a normal work period
but not equal to that of a normal work period, shall be given
the option of participating in the available program. If the
employee elects coverage, the State shall contribute on behalf
of such employee to the cost of the employee's benefit and any
applicable dependent supplement, that sum which bears the same
percentage as that percentage of time the employee regularly
works when compared to normal work period.
    (c) The basic non-contributory coverage from the basic
program of group health benefits shall be continued for each
employee not in pay status or on active service by reason of
(1) leave of absence due to illness or injury, (2) authorized
educational leave of absence or sabbatical leave, or (3)
military leave with pay and benefits. This coverage shall
continue until expiration of authorized leave and return to
active service, but not to exceed 24 months for leaves under
item (1) or (2). This 24-month limitation and the requirement
of returning to active service shall not apply to persons
receiving ordinary or accidental disability benefits or
retirement benefits through the appropriate State retirement
system or benefits under the Workers' Compensation or
Occupational Disease Act.
    (d) The basic group life insurance coverage shall continue,
with full State contribution, where such person is (1) absent
from active service by reason of disability arising from any
cause other than self-inflicted, (2) on authorized educational
leave of absence or sabbatical leave, or (3) on military leave
with pay and benefits.
    (e) Where the person is in non-pay status for a period in
excess of 30 days or on leave of absence, other than by reason
of disability, educational or sabbatical leave, or military
leave with pay and benefits, such person may continue coverage
only by making personal payment equal to the amount normally
contributed by the State on such person's behalf. Such payments
and coverage may be continued: (1) until such time as the
person returns to a status eligible for coverage at State
expense, but not to exceed 24 months, (2) until such person's
employment or annuitant status with the State is terminated, or
(3) for a maximum period of 4 years for members on military
leave with pay and benefits and military leave without pay and
benefits (exclusive of any additional service imposed pursuant
to law).
    (f) The Department shall establish by rule the extent to
which other employee benefits will continue for persons in
non-pay status or who are not in active service.
    (g) The State shall not pay the cost of the basic
non-contributory group life insurance, program of health
benefits and other employee benefits for members who are
survivors as defined by paragraphs (1) and (2) of subsection
(q) of Section 3 of this Act. The costs of benefits for these
survivors shall be paid by the survivors or by the University
of Illinois Cooperative Extension Service, or any combination
thereof. However, the State shall pay the amount of the
reduction in the cost of participation, if any, resulting from
the amendment to subsection (a) made by this amendatory Act of
the 91st General Assembly.
    (h) Those persons occupying positions with any department
as a result of emergency appointments pursuant to Section 8b.8
of the Personnel Code who are not considered employees under
this Act shall be given the option of participating in the
programs of group life insurance, health benefits and other
employee benefits. Such persons electing coverage may
participate only by making payment equal to the amount normally
contributed by the State for similarly situated employees. Such
amounts shall be determined by the Director. Such payments and
coverage may be continued until such time as the person becomes
an employee pursuant to this Act or such person's appointment
is terminated.
    (i) Any unit of local government within the State of
Illinois may apply to the Director to have its employees,
annuitants, and their dependents provided group health
coverage under this Act on a non-insured basis. To participate,
a unit of local government must agree to enroll all of its
employees, who may select coverage under either the State group
health benefits plan or a health maintenance organization that
has contracted with the State to be available as a health care
provider for employees as defined in this Act. A unit of local
government must remit the entire cost of providing coverage
under the State group health benefits plan or, for coverage
under a health maintenance organization, an amount determined
by the Director based on an analysis of the sex, age,
geographic location, or other relevant demographic variables
for its employees, except that the unit of local government
shall not be required to enroll those of its employees who are
covered spouses or dependents under this plan or another group
policy or plan providing health benefits as long as (1) an
appropriate official from the unit of local government attests
that each employee not enrolled is a covered spouse or
dependent under this plan or another group policy or plan, and
(2) at least 85% of the employees are enrolled and the unit of
local government remits the entire cost of providing coverage
to those employees, except that a participating school district
must have enrolled at least 85% of its full-time employees who
have not waived coverage under the district's group health plan
by participating in a component of the district's cafeteria
plan. A participating school district is not required to enroll
a full-time employee who has waived coverage under the
district's health plan, provided that an appropriate official
from the participating school district attests that the
full-time employee has waived coverage by participating in a
component of the district's cafeteria plan. For the purposes of
this subsection, "participating school district" includes a
unit of local government whose primary purpose is education as
defined by the Department's rules.
    Employees of a participating unit of local government who
are not enrolled due to coverage under another group health
policy or plan may enroll in the event of a qualifying change
in status, special enrollment, special circumstance as defined
by the Director, or during the annual Benefit Choice Period. A
participating unit of local government may also elect to cover
its annuitants. Dependent coverage shall be offered on an
optional basis, with the costs paid by the unit of local
government, its employees, or some combination of the two as
determined by the unit of local government. The unit of local
government shall be responsible for timely collection and
transmission of dependent premiums.
    The Director shall annually determine monthly rates of
payment, subject to the following constraints:
        (1) In the first year of coverage, the rates shall be
    equal to the amount normally charged to State employees for
    elected optional coverages or for enrolled dependents
    coverages or other contributory coverages, or contributed
    by the State for basic insurance coverages on behalf of its
    employees, adjusted for differences between State
    employees and employees of the local government in age,
    sex, geographic location or other relevant demographic
    variables, plus an amount sufficient to pay for the
    additional administrative costs of providing coverage to
    employees of the unit of local government and their
    dependents.
        (2) In subsequent years, a further adjustment shall be
    made to reflect the actual prior years' claims experience
    of the employees of the unit of local government.
    In the case of coverage of local government employees under
a health maintenance organization, the Director shall annually
determine for each participating unit of local government the
maximum monthly amount the unit may contribute toward that
coverage, based on an analysis of (i) the age, sex, geographic
location, and other relevant demographic variables of the
unit's employees and (ii) the cost to cover those employees
under the State group health benefits plan. The Director may
similarly determine the maximum monthly amount each unit of
local government may contribute toward coverage of its
employees' dependents under a health maintenance organization.
    Monthly payments by the unit of local government or its
employees for group health benefits plan or health maintenance
organization coverage shall be deposited in the Local
Government Health Insurance Reserve Fund.
    The Local Government Health Insurance Reserve Fund shall be
a continuing fund not subject to fiscal year limitations. All
revenues arising from the administration of the health benefits
program established under this Section shall be deposited into
the Local Government Health Insurance Reserve Fund. All
expenditures from this Fund shall be used for payments for
health care benefits for local government and rehabilitation
facility employees, annuitants, and dependents, and to
reimburse the Department or its administrative service
organization for all expenses incurred in the administration of
benefits. No other State funds may be used for these purposes.
    A local government employer's participation or desire to
participate in a program created under this subsection shall
not limit that employer's duty to bargain with the
representative of any collective bargaining unit of its
employees.
    (j) Any rehabilitation facility within the State of
Illinois may apply to the Director to have its employees,
annuitants, and their eligible dependents provided group
health coverage under this Act on a non-insured basis. To
participate, a rehabilitation facility must agree to enroll all
of its employees and remit the entire cost of providing such
coverage for its employees, except that the rehabilitation
facility shall not be required to enroll those of its employees
who are covered spouses or dependents under this plan or
another group policy or plan providing health benefits as long
as (1) an appropriate official from the rehabilitation facility
attests that each employee not enrolled is a covered spouse or
dependent under this plan or another group policy or plan, and
(2) at least 85% of the employees are enrolled and the
rehabilitation facility remits the entire cost of providing
coverage to those employees. Employees of a participating
rehabilitation facility who are not enrolled due to coverage
under another group health policy or plan may enroll in the
event of a qualifying change in status, special enrollment,
special circumstance as defined by the Director, or during the
annual Benefit Choice Period. A participating rehabilitation
facility may also elect to cover its annuitants. Dependent
coverage shall be offered on an optional basis, with the costs
paid by the rehabilitation facility, its employees, or some
combination of the 2 as determined by the rehabilitation
facility. The rehabilitation facility shall be responsible for
timely collection and transmission of dependent premiums.
    The Director shall annually determine quarterly rates of
payment, subject to the following constraints:
        (1) In the first year of coverage, the rates shall be
    equal to the amount normally charged to State employees for
    elected optional coverages or for enrolled dependents
    coverages or other contributory coverages on behalf of its
    employees, adjusted for differences between State
    employees and employees of the rehabilitation facility in
    age, sex, geographic location or other relevant
    demographic variables, plus an amount sufficient to pay for
    the additional administrative costs of providing coverage
    to employees of the rehabilitation facility and their
    dependents.
        (2) In subsequent years, a further adjustment shall be
    made to reflect the actual prior years' claims experience
    of the employees of the rehabilitation facility.
    Monthly payments by the rehabilitation facility or its
employees for group health benefits shall be deposited in the
Local Government Health Insurance Reserve Fund.
    (k) Any domestic violence shelter or service within the
State of Illinois may apply to the Director to have its
employees, annuitants, and their dependents provided group
health coverage under this Act on a non-insured basis. To
participate, a domestic violence shelter or service must agree
to enroll all of its employees and pay the entire cost of
providing such coverage for its employees. A participating
domestic violence shelter may also elect to cover its
annuitants. Dependent coverage shall be offered on an optional
basis, with employees, or some combination of the 2 as
determined by the domestic violence shelter or service. The
domestic violence shelter or service shall be responsible for
timely collection and transmission of dependent premiums.
    The Director shall annually determine rates of payment,
subject to the following constraints:
        (1) In the first year of coverage, the rates shall be
    equal to the amount normally charged to State employees for
    elected optional coverages or for enrolled dependents
    coverages or other contributory coverages on behalf of its
    employees, adjusted for differences between State
    employees and employees of the domestic violence shelter or
    service in age, sex, geographic location or other relevant
    demographic variables, plus an amount sufficient to pay for
    the additional administrative costs of providing coverage
    to employees of the domestic violence shelter or service
    and their dependents.
        (2) In subsequent years, a further adjustment shall be
    made to reflect the actual prior years' claims experience
    of the employees of the domestic violence shelter or
    service.
    Monthly payments by the domestic violence shelter or
service or its employees for group health insurance shall be
deposited in the Local Government Health Insurance Reserve
Fund.
    (l) A public community college or entity organized pursuant
to the Public Community College Act may apply to the Director
initially to have only annuitants not covered prior to July 1,
1992 by the district's health plan provided health coverage
under this Act on a non-insured basis. The community college
must execute a 2-year contract to participate in the Local
Government Health Plan. Any annuitant may enroll in the event
of a qualifying change in status, special enrollment, special
circumstance as defined by the Director, or during the annual
Benefit Choice Period.
    The Director shall annually determine monthly rates of
payment subject to the following constraints: for those
community colleges with annuitants only enrolled, first year
rates shall be equal to the average cost to cover claims for a
State member adjusted for demographics, Medicare
participation, and other factors; and in the second year, a
further adjustment of rates shall be made to reflect the actual
first year's claims experience of the covered annuitants.
    (l-5) The provisions of subsection (l) become inoperative
on July 1, 1999.
    (m) The Director shall adopt any rules deemed necessary for
implementation of this amendatory Act of 1989 (Public Act
86-978).
    (n) Any child advocacy center within the State of Illinois
may apply to the Director to have its employees, annuitants,
and their dependents dependants provided group health coverage
under this Act on a non-insured basis. To participate, a child
advocacy center must agree to enroll all of its employees and
pay the entire cost of providing coverage for its employees. A
participating child advocacy center may also elect to cover its
annuitants. Dependent coverage shall be offered on an optional
basis, with the costs paid by the child advocacy center, its
employees, or some combination of the 2 as determined by the
child advocacy center. The child advocacy center shall be
responsible for timely collection and transmission of
dependent premiums.
    The Director shall annually determine rates of payment,
subject to the following constraints:
        (1) In the first year of coverage, the rates shall be
    equal to the amount normally charged to State employees for
    elected optional coverages or for enrolled dependents
    coverages or other contributory coverages on behalf of its
    employees, adjusted for differences between State
    employees and employees of the child advocacy center in
    age, sex, geographic location, or other relevant
    demographic variables, plus an amount sufficient to pay for
    the additional administrative costs of providing coverage
    to employees of the child advocacy center and their
    dependents.
        (2) In subsequent years, a further adjustment shall be
    made to reflect the actual prior years' claims experience
    of the employees of the child advocacy center.
    Monthly payments by the child advocacy center or its
employees for group health insurance shall be deposited into
the Local Government Health Insurance Reserve Fund.
(Source: P.A. 93-839, eff. 7-30-04; 94-839, eff. 6-6-06;
94-860, eff. 6-16-06; revised 8-3-06.)
 
    (5 ILCS 375/12)  (from Ch. 127, par. 532)
    Sec. 12. (a) Any surplus resulting from favorable
experience of those portions of the group life insurance and
group health program shall be refunded to the State of Illinois
for deposit, respectively, in the Group Insurance Premium Fund
or Health Insurance Reserve Fund established under this Act.
Such funds may be applied to reduce member premiums, charges or
fees or increase benefits, or both, in accordance with
Subsection (b) of this Section.
    (b) Surplus resulting from favorable experience may be
applied to any current or future contract made under authority
of this Act. With respect to any surplus relating to the Group
Insurance Premium Fund, the surplus shall be deposited into the
Group Insurance Premium Fund and may be applied either towards
toward the reduction of the cost of optional life insurance or
the provision of additional life insurance as determined by the
Director. With respect to any surplus relating to the Health
Insurance Reserve Fund, the surplus shall be deposited into the
Health Insurance Reserve Fund and may be applied towards
contributions to the program of health benefits or other
employee benefits or towards toward providing additional life
insurance or health or other benefits, or both, as determined
by the Director.
(Source: P.A. 85-848.)
 
    (5 ILCS 375/13)  (from Ch. 127, par. 533)
    Sec. 13. There is established a Group Insurance Premium
Fund administered by the Director which shall include: (1)
amounts paid by covered members for optional life insurance or
health benefits coverages, and (2) refunds which may be
received from (a) the group carrier or carriers which may
result from favorable experience as described in Section 12
herein or (b) from any other source from which the State is
reasonably and properly entitled to refund as a result of the
life insurance group health benefits program. The Group
Insurance Premium Fund shall be a continuing fund not subject
to fiscal year limitations.
    The State of Illinois shall at least once each month make
payment on behalf of each member, except one who is a member by
virtue of participation in a program created under subsection
(i), (j), (k), or (l) of Section 10 of this Act, to the
appropriate carrier or, if applicable, carriers insuring State
members under the contracted group life insurance and group
health benefits program authorized by this Act.
    Refunds to members for premiums paid for coverage may be
paid from the Group Insurance Premium Fund without regard to
the fact that the premium being refunded may have been paid in
a different fiscal year.
(Source: P.A. 91-390, eff. 7-30-99.)
 
    (5 ILCS 375/13.1)  (from Ch. 127, par. 533.1)
    Sec. 13.1. (a) All contributions, appropriations,
interest, and dividend payments to fund the program of health
benefits and other employee benefits, and all other revenues
arising from the administration of any employee health benefits
program, shall be deposited in a trust fund outside the State
Treasury, with the State Treasurer as ex-officio custodian, to
be known as the Health Insurance Reserve Fund.
    (b) Upon the adoption of a self-insurance health plan, any
monies attributable to the group health insurance program shall
be deposited in or transferred to the Health Insurance Reserve
Fund for use by the Department. As of the effective date of
this amendatory Act of 1986, the Department shall certify to
the Comptroller the amount of money in the Group Insurance
Premium Fund attributable to the State group health insurance
program and the Comptroller shall transfer such money from the
Group Insurance Premium Fund to the Health Insurance Reserve
Fund. Contributions by the State to the Health Insurance
Reserve Fund to meet the requirements of this Act, as
established by the Director, from the General Revenue Fund and
the Road Fund to the Health Insurance Reserve Fund shall be by
annual appropriations, and all other contributions to meet the
requirements of the programs of health benefits or other
employee benefits shall be deposited in the Health Insurance
Reserve Fund. The Department shall draw the appropriation from
the General Revenue Fund and the Road Fund from time to time as
necessary to make expenditures authorized under this Act.
    The Director may employ such assistance and services and
may purchase such goods as may be necessary for the proper
development and administration of any of the benefit programs
authorized by this Act. The Director may promulgate rules and
regulations in regard to the administration of these programs.
    All monies received by the Department for deposit in or
transfer to the Health Insurance Reserve Fund, through
appropriation or otherwise, shall be used to provide for the
making of payments to claimants and providers and to reimburse
the Department for all expenses directly incurred relating to
Department development and administration of the program of
health benefits and other employee benefits.
    Any administrative service organization administering any
self-insurance health plan and paying claims and benefits under
authority of this Act may receive, pursuant to written
authorization and direction of the Director, an initial
transfer and periodic transfers of funds from the Health
Insurance Reserve Fund in amounts determined by the Director
who may consider the amount recommended by the administrative
service organization. Notwithstanding any other statute, such
transferred funds shall be retained by the administrative
service organization in a separate account provided by any bank
as defined by the Illinois Banking Act. The Department may
promulgate regulations further defining the banks authorized
to accept such funds and all methodology for transfer of such
funds. Any interest earned by monies in such account shall
inure to the Health Insurance Reserve Fund, shall remain in
such account and shall be used exclusively to pay claims and
benefits under this Act. Such transferred funds shall be used
exclusively for administrative service organization payment of
claims to claimants and providers under the self-insurance
health plan by the drawing of checks against such account. The
administrative service organization may not use such
transferred funds, or interest accrued thereon, for any other
purpose including, but not limited to, reimbursement of
administrative expenses or payments of administration fees due
the organization pursuant to its contract or contracts with the
Department of Central Management Services.
    The account of the administrative service organization
established under this Section, any transfers from the Health
Insurance Reserve Fund to such account and the use of such
account and funds shall be subject to (1) audit by the
Department or private contractor authorized by the Department
to conduct audits, and (2) post audit pursuant to the Illinois
State Auditing Act.
    The Department of Healthcare and Family Services, or any
successor agency designated to procure healthcare contracts
pursuant to this Act, is authorized to establish funds,
separate accounts provided by any bank or banks as defined by
the Illinois Banking Act, or separate accounts provided by any
savings and loan association or associations as defined by the
Illinois Savings and Loan Act of 1985 to be held by the
Director, outside the State treasury, for the purpose of
receiving the transfer of moneys from the Health Insurance
Reserve Fund. The Department may promulgate rules further
defining the methodology for the transfers. Any interest earned
by monies in the funds or accounts shall inure to the Health
Insurance Reserve Fund. The transferred moneys, and interest
accrued thereon, shall be used exclusively for transfers to
administrative service organizations or their financial
institutions for payments of claims to claimants and providers
under the self-insurance health plan. The transferred moneys,
and interest accrued thereon, shall not be used for any other
purpose including, but not limited to, reimbursement of
administration fees due the administrative service
organization pursuant to its contract or contracts with the
Department.
    (c) The Director, with the advice and consent of the
Commission, shall establish premiums for optional coverage for
dependents of eligible members for the health plans. The
eligible members shall be responsible for their portion of such
optional premium. The State shall contribute an amount per
month for each eligible member who has enrolled one or more
dependents under the health plans. Such contribution shall be
made directly to the Health Insurance Reserve Fund. Those
employees described in subsection (b) of Section 9 of this Act
shall be allowed to continue in the health plan by making
personal payments with the premiums to be deposited in the
Health Insurance Reserve Fund.
    (d) The Health Insurance Reserve Fund shall be a continuing
fund not subject to fiscal year limitations. All expenditures
from that fund shall be at the direction of the Director and
shall be only for the purpose of:
        (1) the payment of administrative expenses incurred by
    the Department for the program of health benefits or other
    employee benefit programs, including but not limited to the
    costs of audits or actuarial consultations, professional
    and contractual services, electronic data processing
    systems and services, and expenses in connection with the
    development and administration of such programs;
        (2) the payment of administrative expenses incurred by
    the Administrative Service Organization;
        (3) the payment of health benefits;
        (4) refunds to employees for erroneous payments of
    their selected dependent coverage;
        (5) payment of premium for stop-loss or re-insurance;
        (6) payment of premium to health maintenance
    organizations pursuant to Section 6.1 of this Act;
        (7) payment of adoption program benefits; and
        (8) payment of other benefits offered to members and
    dependents under this Act.
(Source: P.A. 94-839, eff. 6-6-06.)
 
    Section 10. The Illinois Insurance Code is amended by
adding Section 5.5 as follows:
 
    (215 ILCS 5/5.5 new)
    Sec. 5.5. Compliance with the Department of Healthcare and
Family Services. A company authorized to do business in this
State or accredited by the State to issue policies of health
insurance, including but not limited to, self-insured plans,
group health plans (as defined in Section 607(1) of the
Employee Retirement Income Security Act of 1974), service
benefit plans, managed care organizations, pharmacy benefit
managers, or other parties that are by statute, contract, or
agreement legally responsible for payment of a claim for a
health care item or service as a condition of doing business in
the State must:
        (1) provide to the Department of Healthcare and Family
    Services, or any successor agency, upon request
    information to determine during what period any individual
    may be, or may have been, covered by a health insurer and
    the nature of the coverage that is or was provided by the
    health insurer, including the name, address, and
    identifying number of the plan;
        (2) accept the State's right of recovery and the
    assignment to the State of any right of an individual or
    other entity to payment from the party for an item or
    service for which payment has been made under the medical
    programs of the Department of Healthcare and Family
    Services, or any successor agency, under this Code or the
    Illinois Public Aid Code;
        (3) respond to any inquiry by the Department of
    Healthcare and Family Services regarding a claim for
    payment for any health care item or service that is
    submitted not later than 3 years after the date of the
    provision of such health care item or service; and
        (4) agree not to deny a claim submitted by the
    Department of Healthcare and Family Services solely on the
    basis of the date of submission of the claim, the type or
    format of the claim form, or a failure to present proper
    documentation at the point-of-sale that is the basis of the
    claim if (i) the claim is submitted by the Department of
    Healthcare and Family Services within the 3-year period
    beginning on the date on which the item or service was
    furnished and (ii) any action by the Department of
    Healthcare and Family Services to enforce its rights with
    respect to such claim is commenced within 6 years of its
    submission of such claim.
 
    Section 99. Effective date. This Act takes effect upon
becoming law.