|
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.
|
Eligible TRS benefit recipients may enroll or re-enroll in |
the program of health benefits established under this Section |
during any applicable annual open enrollment period and as |
otherwise permitted by the Department of Central Management |
Services. A TRS benefit recipient shall not be deemed |
ineligible to participate solely by reason of the TRS benefit |
recipient having made a previous election to disenroll or |
otherwise not participate in the program of health benefits. |
A TRS dependent beneficiary who is a 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.
|
(5) If in any case an error is made in billing a TRS |
benefit recipient under this Section, the Department shall |
identify the error and refund the overpaid amount as soon |
as practicable. A TRS benefit recipient who has overpaid |
under this Section shall be entitled to a refund of |
overpayments for up to 7 years of past payments. |
(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 Central Management 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. |
In addition, the Committee shall identify proposed |
solutions to the funding shortfalls that are affecting the |
Teacher Health Insurance Security Fund, and it shall report |
those solutions to the Governor and the General Assembly within |
6 months after August 15, 2011 (the effective date of Public |
Act 97-386). |
(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. 100-1017, eff. 8-21-18.)
|