Public Act 93-0553
HB0943 Enrolled LRB093 05764 RCE 05857 b
AN ACT in relation to public employee benefits.
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 8 as follows:
(5 ILCS 375/8) (from Ch. 127, par. 528)
Sec. 8. Eligibility.
(a) Each member eligible under the provisions of this
Act and any rules and regulations promulgated and adopted
hereunder by the Director shall become immediately eligible
and covered for all benefits available under the programs.
Members electing coverage for eligible dependents shall have
the coverage effective immediately, provided that the
election is properly filed in accordance with required filing
dates and procedures specified by the Director.
(1) Every member originally eligible to elect
dependent coverage, but not electing it during the
original eligibility period, may subsequently obtain
dependent coverage only 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.
(2) Members described above being transferred from
previous coverage towards which the State has been
contributing shall be transferred regardless of
preexisting conditions, waiting periods, or other
requirements that might jeopardize claim payments to
which they would otherwise have been entitled.
(3) Eligible and covered members that are eligible
for coverage as dependents except for the fact of being
members shall be transferred to, and covered under,
dependent status regardless of preexisting conditions,
waiting periods, or other requirements that might
jeopardize claim payments to which they would otherwise
have been entitled upon cessation of member status and
the election of dependent coverage by a member eligible
to elect that coverage.
(b) New employees shall be immediately insured for the
basic group life insurance and covered by the program of
health benefits on the first day of active State service.
Optional coverages or benefits, if elected during the
relevant eligibility period, will become effective on the
date of employment. Optional coverages or benefits applied
for after the eligibility period will be effective, subject
to satisfactory evidence of insurability when applicable, or
other necessary qualifications, pursuant to the requirements
of the applicable benefit program, unless there is a change
in status that would confer new eligibility for change of
enrollment under rules established supplementing this Act, in
which event application must be made within the new
eligibility period.
(c) As to the group health benefits program contracted
to begin or continue after June 30, 1973, each retired
employee shall become immediately eligible and covered for
all benefits available under that program. Retired employees
may elect coverage for eligible dependents and shall have the
coverage effective immediately, provided that the election is
properly filed in accordance with required filing dates and
procedures specified by the Director.
Except as otherwise provided in this Act, where husband
and wife are both eligible members, each shall be enrolled as
a member and coverage on their eligible dependent children,
if any, may be under the enrollment and election of either.
Regardless of other provisions herein regarding late
enrollment or other qualifications, as appropriate, the
Director may periodically authorize open enrollment periods
for each of the benefit programs at which time each member
may elect enrollment or change of enrollment without regard
to age, sex, health, or other qualification under the
conditions as may be prescribed in rules and regulations
supplementing this Act. Special open enrollment periods may
be declared by the Director for certain members only when
special circumstances occur that affect only those members.
(d) Beginning with fiscal year 2003 and for all
subsequent years, eligible members may elect not to
participate in the program of health benefits as defined in
this Act. The election must be made during the annual
benefit choice period, subject to the conditions in this
subsection.
(1) Members must furnish proof of health benefit
coverage, either comprehensive major medical coverage or
comprehensive managed care plan, from a source other than
the Department of Central Management Services in order to
elect not to participate in the program.
(2) Members may re-enroll in the Department of
Central Management Services program of health benefits
upon showing a qualifying change in status, as defined in
the U.S. Internal Revenue Code, without evidence of
insurability and with no limitations on coverage for
pre-existing conditions, provided that there was not a
break in coverage of more than 63 days.
(3) Members may also re-enroll in the program of
health benefits during any annual benefit choice period,
without evidence of insurability.
(4) Members who elect not to participate in the
program of health benefits shall be furnished a written
explanation of the requirements and limitations for the
election not to participate in the program and for
re-enrolling in the program. The explanation shall also
be included in the annual benefit choice options booklets
furnished to members.
(e) Notwithstanding any other provision of this Act or
the rules adopted under this Act, if a person participating
in the program of health benefits as the dependent spouse of
an eligible member becomes an annuitant, the person may
elect, at the time of becoming an annuitant or during any
subsequent annual benefit choice period, to continue
participation as a dependent rather than as an eligible
member for as long as the person continues to be an eligible
dependent.
An eligible member who has elected to participate as a
dependent may re-enroll in the program of health benefits as
an eligible member (i) during any subsequent annual benefit
choice period or (ii) upon showing a qualifying change in
status, as defined in the U.S. Internal Revenue Code, without
evidence of insurability and with no limitations on coverage
for pre-existing conditions.
A person who elects to participate in the program of
health benefits as a dependent rather than as an eligible
member shall be furnished a written explanation of the
consequences of electing to participate as a dependent and
the conditions and procedures for re-enrolling as an eligible
member. The explanation shall also be included in the annual
benefit choice options booklet furnished to members.
(Source: P.A. 91-390, eff. 7-30-99; 92-600, eff. 6-28-02.)
Section 99. Effective date. This Act takes effect upon
becoming law.