Bill Text: IL SB1556 | 2011-2012 | 97th General Assembly | Engrossed

NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Amends the State Employees Group Insurance Act of 1971. Provides that in order to be eligible for group insurance benefits under a retirement system: (i) each annuitant or retired employee must meet the vesting requirements of the applicable retirement system and (ii) each survivor must establish that the deceased employee, annuitant, or retired employee upon whom the annuity is based was eligible to participate in the group insurance system under the applicable retirement system. Specifies that certain persons do not qualify as community college dependent beneficiaries or TRS dependent beneficiaries. Provides that only employees (rather than employees, annuitants, retired employees, and survivors) and their elected dependents are eligible and covered for all benefits available under the Act's programs. Provides that annuitants, survivors, and retired employees and their elected dependents are immediately eligible for the group health benefits program and that the coverage of those persons is effective immediately upon the completion of the required forms. Requires, however, each survivor who is seeking coverage under that program to establish that he or she would have been eligible for coverage under the deceased member upon whom the survivor's annuity is based.

Status: (Enrolled - Dead) 2013-02-06 - Sent to the Governor [SB1556 Detail]

Download: Illinois-2011-SB1556-Engrossed.html



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1 AN ACT concerning government.
2 Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4 Section 5. The State Employees Group Insurance Act of 1971
5is amended by changing Sections 3 and 8 as follows:
6 (5 ILCS 375/3) (from Ch. 127, par. 523)
7 Sec. 3. Definitions. Unless the context otherwise
8requires, the following words and phrases as used in this Act
9shall have the following meanings. The Department may define
10these and other words and phrases separately for the purpose of
11implementing specific programs providing benefits under this
12Act.
13 (a) "Administrative service organization" means any
14person, firm or corporation experienced in the handling of
15claims which is fully qualified, financially sound and capable
16of meeting the service requirements of a contract of
17administration executed with the Department.
18 (b) "Annuitant" means (1) an employee who retires, or has
19retired, on or after January 1, 1966 on an immediate annuity
20under the provisions of Articles 2, 14 (including an employee
21who has elected to receive an alternative retirement
22cancellation payment under Section 14-108.5 of the Illinois
23Pension Code in lieu of an annuity), 15 (including an employee

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1who has retired under the optional retirement program
2established under Section 15-158.2), paragraphs (2), (3), or
3(5) of Section 16-106, or Article 18 of the Illinois Pension
4Code; (2) any person who was receiving group insurance coverage
5under this Act as of March 31, 1978 by reason of his status as
6an annuitant, even though the annuity in relation to which such
7coverage was provided is a proportional annuity based on less
8than the minimum period of service required for a retirement
9annuity in the system involved; (3) any person not otherwise
10covered by this Act who has retired as a participating member
11under Article 2 of the Illinois Pension Code but is ineligible
12for the retirement annuity under Section 2-119 of the Illinois
13Pension Code; (4) the spouse of any person who is receiving a
14retirement annuity under Article 18 of the Illinois Pension
15Code and who is covered under a group health insurance program
16sponsored by a governmental employer other than the State of
17Illinois and who has irrevocably elected to waive his or her
18coverage under this Act and to have his or her spouse
19considered as the "annuitant" under this Act and not as a
20"dependent"; or (5) an employee who retires, or has retired,
21from a qualified position, as determined according to rules
22promulgated by the Director, under a qualified local
23government, a qualified rehabilitation facility, a qualified
24domestic violence shelter or service, or a qualified child
25advocacy center. (For definition of "retired employee", see (p)
26post).

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1 (b-5) "New SERS annuitant" means a person who, on or after
2January 1, 1998, becomes an annuitant, as defined in subsection
3(b), by virtue of beginning to receive a retirement annuity
4under Article 14 of the Illinois Pension Code (including an
5employee who has elected to receive an alternative retirement
6cancellation payment under Section 14-108.5 of that Code in
7lieu of an annuity), and is eligible to participate in the
8basic program of group health benefits provided for annuitants
9under this Act.
10 (b-6) "New SURS annuitant" means a person who (1) on or
11after January 1, 1998, becomes an annuitant, as defined in
12subsection (b), by virtue of beginning to receive a retirement
13annuity under Article 15 of the Illinois Pension Code, (2) has
14not made the election authorized under Section 15-135.1 of the
15Illinois Pension Code, and (3) is eligible to participate in
16the basic program of group health benefits provided for
17annuitants under this Act.
18 (b-7) "New TRS State annuitant" means a person who, on or
19after July 1, 1998, becomes an annuitant, as defined in
20subsection (b), by virtue of beginning to receive a retirement
21annuity under Article 16 of the Illinois Pension Code based on
22service as a teacher as defined in paragraph (2), (3), or (5)
23of Section 16-106 of that Code, and is eligible to participate
24in the basic program of group health benefits provided for
25annuitants under this Act.
26 (c) "Carrier" means (1) an insurance company, a corporation

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1organized under the Limited Health Service Organization Act or
2the Voluntary Health Services Plan Act, a partnership, or other
3nongovernmental organization, which is authorized to do group
4life or group health insurance business in Illinois, or (2) the
5State of Illinois as a self-insurer.
6 (d) "Compensation" means salary or wages payable on a
7regular payroll by the State Treasurer on a warrant of the
8State Comptroller out of any State, trust or federal fund, or
9by the Governor of the State through a disbursing officer of
10the State out of a trust or out of federal funds, or by any
11Department out of State, trust, federal or other funds held by
12the State Treasurer or the Department, to any person for
13personal services currently performed, and ordinary or
14accidental disability benefits under Articles 2, 14, 15
15(including ordinary or accidental disability benefits under
16the optional retirement program established under Section
1715-158.2), paragraphs (2), (3), or (5) of Section 16-106, or
18Article 18 of the Illinois Pension Code, for disability
19incurred after January 1, 1966, or benefits payable under the
20Workers' Compensation or Occupational Diseases Act or benefits
21payable under a sick pay plan established in accordance with
22Section 36 of the State Finance Act. "Compensation" also means
23salary or wages paid to an employee of any qualified local
24government, qualified rehabilitation facility, qualified
25domestic violence shelter or service, or qualified child
26advocacy center.

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1 (e) "Commission" means the State Employees Group Insurance
2Advisory Commission authorized by this Act. Commencing July 1,
31984, "Commission" as used in this Act means the Commission on
4Government Forecasting and Accountability as established by
5the Legislative Commission Reorganization Act of 1984.
6 (f) "Contributory", when referred to as contributory
7coverage, shall mean optional coverages or benefits elected by
8the member toward the cost of which such member makes
9contribution, or which are funded in whole or in part through
10the acceptance of a reduction in earnings or the foregoing of
11an increase in earnings by an employee, as distinguished from
12noncontributory coverage or benefits which are paid entirely by
13the State of Illinois without reduction of the member's salary.
14 (g) "Department" means any department, institution, board,
15commission, officer, court or any agency of the State
16government receiving appropriations and having power to
17certify payrolls to the Comptroller authorizing payments of
18salary and wages against such appropriations as are made by the
19General Assembly from any State fund, or against trust funds
20held by the State Treasurer and includes boards of trustees of
21the retirement systems created by Articles 2, 14, 15, 16 and 18
22of the Illinois Pension Code. "Department" also includes the
23Illinois Comprehensive Health Insurance Board, the Board of
24Examiners established under the Illinois Public Accounting
25Act, and the Illinois Finance Authority.
26 (h) "Dependent", when the term is used in the context of

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1the health and life plan, means a member's spouse and any child
2(1) from birth to age 26 including an adopted child, a child
3who lives with the member from the time of the filing of a
4petition for adoption until entry of an order of adoption, a
5stepchild or adjudicated child, or a child who lives with the
6member if such member is a court appointed guardian of the
7child or (2) age 19 or over who is mentally or physically
8disabled from a cause originating prior to the age of 19 (age
926 if enrolled as an adult child dependent). For the health
10plan only, the term "dependent" also includes (1) any person
11enrolled prior to the effective date of this Section who is
12dependent upon the member to the extent that the member may
13claim such person as a dependent for income tax deduction
14purposes and (2) any person who has received after June 30,
152000 an organ transplant and who is financially dependent upon
16the member and eligible to be claimed as a dependent for income
17tax purposes. A member requesting to cover any dependent must
18provide documentation as requested by the Department of Central
19Management Services and file with the Department any and all
20forms required by the Department.
21 (i) "Director" means the Director of the Illinois
22Department of Central Management Services or of any successor
23agency designated to administer this Act.
24 (j) "Eligibility period" means the period of time a member
25has to elect enrollment in programs or to select benefits
26without regard to age, sex or health.

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1 (k) "Employee" means and includes each officer or employee
2in the service of a department who (1) receives his
3compensation for service rendered to the department on a
4warrant issued pursuant to a payroll certified by a department
5or on a warrant or check issued and drawn by a department upon
6a trust, federal or other fund or on a warrant issued pursuant
7to a payroll certified by an elected or duly appointed officer
8of the State or who receives payment of the performance of
9personal services on a warrant issued pursuant to a payroll
10certified by a Department and drawn by the Comptroller upon the
11State Treasurer against appropriations made by the General
12Assembly from any fund or against trust funds held by the State
13Treasurer, and (2) is employed full-time or part-time in a
14position normally requiring actual performance of duty during
15not less than 1/2 of a normal work period, as established by
16the Director in cooperation with each department, except that
17persons elected by popular vote will be considered employees
18during the entire term for which they are elected regardless of
19hours devoted to the service of the State, and (3) except that
20"employee" does not include any person who is not eligible by
21reason of such person's employment to participate in one of the
22State retirement systems under Articles 2, 14, 15 (either the
23regular Article 15 system or the optional retirement program
24established under Section 15-158.2) or 18, or under paragraph
25(2), (3), or (5) of Section 16-106, of the Illinois Pension
26Code, but such term does include persons who are employed

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1during the 6 month qualifying period under Article 14 of the
2Illinois Pension Code. Such term also includes any person who
3(1) after January 1, 1966, is receiving ordinary or accidental
4disability benefits under Articles 2, 14, 15 (including
5ordinary or accidental disability benefits under the optional
6retirement program established under Section 15-158.2),
7paragraphs (2), (3), or (5) of Section 16-106, or Article 18 of
8the Illinois Pension Code, for disability incurred after
9January 1, 1966, (2) receives total permanent or total
10temporary disability under the Workers' Compensation Act or
11Occupational Disease Act as a result of injuries sustained or
12illness contracted in the course of employment with the State
13of Illinois, or (3) is not otherwise covered under this Act and
14has retired as a participating member under Article 2 of the
15Illinois Pension Code but is ineligible for the retirement
16annuity under Section 2-119 of the Illinois Pension Code.
17However, a person who satisfies the criteria of the foregoing
18definition of "employee" except that such person is made
19ineligible to participate in the State Universities Retirement
20System by clause (4) of subsection (a) of Section 15-107 of the
21Illinois Pension Code is also an "employee" for the purposes of
22this Act. "Employee" also includes any person receiving or
23eligible for benefits under a sick pay plan established in
24accordance with Section 36 of the State Finance Act. "Employee"
25also includes (i) each officer or employee in the service of a
26qualified local government, including persons appointed as

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1trustees of sanitary districts regardless of hours devoted to
2the service of the sanitary district, (ii) each employee in the
3service of a qualified rehabilitation facility, (iii) each
4full-time employee in the service of a qualified domestic
5violence shelter or service, and (iv) each full-time employee
6in the service of a qualified child advocacy center, as
7determined according to rules promulgated by the Director.
8 (l) "Member" means an employee, annuitant, retired
9employee or survivor. In the case of an annuitant or retired
10employee who first becomes an annuitant or retired employee on
11or after the effective date of this amendatory Act of the 97th
12General Assembly, the individual must meet the minimum vesting
13requirements of the applicable retirement system in order to be
14eligible for group insurance benefits under that system. In the
15case of a survivor who first becomes a survivor on or after the
16effective date of this amendatory Act of the 97th General
17Assembly, the deceased employee, annuitant, or retired
18employee upon whom the annuity is based must have been eligible
19to participate in the group insurance system under the
20applicable retirement system in order for the survivor to be
21eligible for group insurance benefits under that system.
22 (m) "Optional coverages or benefits" means those coverages
23or benefits available to the member on his or her voluntary
24election, and at his or her own expense.
25 (n) "Program" means the group life insurance, health
26benefits and other employee benefits designed and contracted

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1for by the Director under this Act.
2 (o) "Health plan" means a health benefits program offered
3by the State of Illinois for persons eligible for the plan.
4 (p) "Retired employee" means any person who would be an
5annuitant as that term is defined herein but for the fact that
6such person retired prior to January 1, 1966. Such term also
7includes any person formerly employed by the University of
8Illinois in the Cooperative Extension Service who would be an
9annuitant but for the fact that such person was made ineligible
10to participate in the State Universities Retirement System by
11clause (4) of subsection (a) of Section 15-107 of the Illinois
12Pension Code.
13 (q) "Survivor" means a person receiving an annuity as a
14survivor of an employee or of an annuitant. "Survivor" also
15includes: (1) the surviving dependent of a person who satisfies
16the definition of "employee" except that such person is made
17ineligible to participate in the State Universities Retirement
18System by clause (4) of subsection (a) of Section 15-107 of the
19Illinois Pension Code; (2) the surviving dependent of any
20person formerly employed by the University of Illinois in the
21Cooperative Extension Service who would be an annuitant except
22for the fact that such person was made ineligible to
23participate in the State Universities Retirement System by
24clause (4) of subsection (a) of Section 15-107 of the Illinois
25Pension Code; and (3) the surviving dependent of a person who
26was an annuitant under this Act by virtue of receiving an

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1alternative retirement cancellation payment under Section
214-108.5 of the Illinois Pension Code.
3 (q-2) "SERS" means the State Employees' Retirement System
4of Illinois, created under Article 14 of the Illinois Pension
5Code.
6 (q-3) "SURS" means the State Universities Retirement
7System, created under Article 15 of the Illinois Pension Code.
8 (q-4) "TRS" means the Teachers' Retirement System of the
9State of Illinois, created under Article 16 of the Illinois
10Pension Code.
11 (q-5) "New SERS survivor" means a survivor, as defined in
12subsection (q), whose annuity is paid under Article 14 of the
13Illinois Pension Code and is based on the death of (i) an
14employee whose death occurs on or after January 1, 1998, or
15(ii) a new SERS annuitant as defined in subsection (b-5). "New
16SERS survivor" includes the surviving dependent of a person who
17was an annuitant under this Act by virtue of receiving an
18alternative retirement cancellation payment under Section
1914-108.5 of the Illinois Pension Code.
20 (q-6) "New SURS survivor" means a survivor, as defined in
21subsection (q), whose annuity is paid under Article 15 of the
22Illinois Pension Code and is based on the death of (i) an
23employee whose death occurs on or after January 1, 1998, or
24(ii) a new SURS annuitant as defined in subsection (b-6).
25 (q-7) "New TRS State survivor" means a survivor, as defined
26in subsection (q), whose annuity is paid under Article 16 of

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1the Illinois Pension Code and is based on the death of (i) an
2employee who is a teacher as defined in paragraph (2), (3), or
3(5) of Section 16-106 of that Code and whose death occurs on or
4after July 1, 1998, or (ii) a new TRS State annuitant as
5defined in subsection (b-7).
6 (r) "Medical services" means the services provided within
7the scope of their licenses by practitioners in all categories
8licensed under the Medical Practice Act of 1987.
9 (s) "Unit of local government" means any county,
10municipality, township, school district (including a
11combination of school districts under the Intergovernmental
12Cooperation Act), special district or other unit, designated as
13a unit of local government by law, which exercises limited
14governmental powers or powers in respect to limited
15governmental subjects, any not-for-profit association with a
16membership that primarily includes townships and township
17officials, that has duties that include provision of research
18service, dissemination of information, and other acts for the
19purpose of improving township government, and that is funded
20wholly or partly in accordance with Section 85-15 of the
21Township Code; any not-for-profit corporation or association,
22with a membership consisting primarily of municipalities, that
23operates its own utility system, and provides research,
24training, dissemination of information, or other acts to
25promote cooperation between and among municipalities that
26provide utility services and for the advancement of the goals

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1and purposes of its membership; the Southern Illinois
2Collegiate Common Market, which is a consortium of higher
3education institutions in Southern Illinois; the Illinois
4Association of Park Districts; and any hospital provider that
5is owned by a county that has 100 or fewer hospital beds and
6has not already joined the program. "Qualified local
7government" means a unit of local government approved by the
8Director and participating in a program created under
9subsection (i) of Section 10 of this Act.
10 (t) "Qualified rehabilitation facility" means any
11not-for-profit organization that is accredited by the
12Commission on Accreditation of Rehabilitation Facilities or
13certified by the Department of Human Services (as successor to
14the Department of Mental Health and Developmental
15Disabilities) to provide services to persons with disabilities
16and which receives funds from the State of Illinois for
17providing those services, approved by the Director and
18participating in a program created under subsection (j) of
19Section 10 of this Act.
20 (u) "Qualified domestic violence shelter or service" means
21any Illinois domestic violence shelter or service and its
22administrative offices funded by the Department of Human
23Services (as successor to the Illinois Department of Public
24Aid), approved by the Director and participating in a program
25created under subsection (k) of Section 10.
26 (v) "TRS benefit recipient" means a person who:

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1 (1) is not a "member" as defined in this Section; and
2 (2) is receiving a monthly benefit or retirement
3 annuity under Article 16 of the Illinois Pension Code; and
4 (3) either (i) has at least 8 years of creditable
5 service under Article 16 of the Illinois Pension Code, or
6 (ii) was enrolled in the health insurance program offered
7 under that Article on January 1, 1996, or (iii) is the
8 survivor of a benefit recipient who had at least 8 years of
9 creditable service under Article 16 of the Illinois Pension
10 Code or was enrolled in the health insurance program
11 offered under that Article on the effective date of this
12 amendatory Act of 1995, or (iv) is a recipient or survivor
13 of a recipient of a disability benefit under Article 16 of
14 the Illinois Pension Code.
15 (w) "TRS dependent beneficiary" means a person who:
16 (1) is not a "member" or "dependent" as defined in this
17 Section; and
18 (2) is a TRS benefit recipient's: (A) spouse, (B)
19 dependent parent who is receiving at least half of his or
20 her support from the TRS benefit recipient, or (C) natural,
21 step, adjudicated, or adopted child who is (i) under age
22 26, (ii) was, on January 1, 1996, participating as a
23 dependent beneficiary in the health insurance program
24 offered under Article 16 of the Illinois Pension Code, or
25 (iii) age 19 or over who is mentally or physically disabled
26 from a cause originating prior to the age of 19 (age 26 if

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1 enrolled as an adult child).
2 "TRS dependent beneficiary" does not include, as indicated
3under paragraph (2) of this subsection (w), a dependent of the
4survivor of a TRS benefit recipient who first becomes a
5dependent of a survivor of a TRS benefit recipient on or after
6the effective date of this amendatory Act of the 97th General
7Assembly unless that dependent would have been eligible for
8coverage as a dependent of the deceased TRS benefit recipient
9upon whom the survivor benefit is based.
10 (x) "Military leave" refers to individuals in basic
11training for reserves, special/advanced training, annual
12training, emergency call up, activation by the President of the
13United States, or any other training or duty in service to the
14United States Armed Forces.
15 (y) (Blank).
16 (z) "Community college benefit recipient" means a person
17who:
18 (1) is not a "member" as defined in this Section; and
19 (2) is receiving a monthly survivor's annuity or
20 retirement annuity under Article 15 of the Illinois Pension
21 Code; and
22 (3) either (i) was a full-time employee of a community
23 college district or an association of community college
24 boards created under the Public Community College Act
25 (other than an employee whose last employer under Article
26 15 of the Illinois Pension Code was a community college

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1 district subject to Article VII of the Public Community
2 College Act) and was eligible to participate in a group
3 health benefit plan as an employee during the time of
4 employment with a community college district (other than a
5 community college district subject to Article VII of the
6 Public Community College Act) or an association of
7 community college boards, or (ii) is the survivor of a
8 person described in item (i).
9 (aa) "Community college dependent beneficiary" means a
10person who:
11 (1) is not a "member" or "dependent" as defined in this
12 Section; and
13 (2) is a community college benefit recipient's: (A)
14 spouse, (B) dependent parent who is receiving at least half
15 of his or her support from the community college benefit
16 recipient, or (C) natural, step, adjudicated, or adopted
17 child who is (i) under age 26, or (ii) age 19 or over and
18 mentally or physically disabled from a cause originating
19 prior to the age of 19 (age 26 if enrolled as an adult
20 child).
21 "Community college dependent beneficiary" does not
22include, as indicated under paragraph (2) of this subsection
23(aa), a dependent of the survivor of a community college
24benefit recipient who first becomes a dependent of a survivor
25of a community college benefit recipient on or after the
26effective date of this amendatory Act of the 97th General

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1Assembly unless that dependent would have been eligible for
2coverage as a dependent of the deceased community college
3benefit recipient upon whom the survivor annuity is based.
4 (bb) "Qualified child advocacy center" means any Illinois
5child advocacy center and its administrative offices funded by
6the Department of Children and Family Services, as defined by
7the Children's Advocacy Center Act (55 ILCS 80/), approved by
8the Director and participating in a program created under
9subsection (n) of Section 10.
10(Source: P.A. 95-331, eff. 8-21-07; 95-632, eff. 9-25-07;
1196-756, eff. 1-1-10; 96-1519, eff. 2-4-11.)
12 (5 ILCS 375/8) (from Ch. 127, par. 528)
13 Sec. 8. Eligibility.
14 (a) Each employee member eligible under the provisions of
15this Act and any rules and regulations promulgated and adopted
16hereunder by the Director shall become immediately eligible and
17covered for all benefits available under the programs.
18Employees Members electing coverage for eligible dependents
19shall have the coverage effective immediately, provided that
20the election is properly filed in accordance with required
21filing dates and procedures specified by the Director,
22including the completion and submission of all documentation
23and forms required by the Director.
24 (1) Every member originally eligible to elect
25 dependent coverage, but not electing it during the original

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1 eligibility period, may subsequently obtain dependent
2 coverage only in the event of a qualifying change in
3 status, special enrollment, special circumstance as
4 defined by the Director, or during the annual Benefit
5 Choice Period.
6 (2) Members described above being transferred from
7 previous coverage towards which the State has been
8 contributing shall be transferred regardless of
9 preexisting conditions, waiting periods, or other
10 requirements that might jeopardize claim payments to which
11 they would otherwise have been entitled.
12 (3) Eligible and covered members that are eligible for
13 coverage as dependents except for the fact of being members
14 shall be transferred to, and covered under, dependent
15 status regardless of preexisting conditions, waiting
16 periods, or other requirements that might jeopardize claim
17 payments to which they would otherwise have been entitled
18 upon cessation of member status and the election of
19 dependent coverage by a member eligible to elect that
20 coverage.
21 (b) New employees shall be immediately insured for the
22basic group life insurance and covered by the program of health
23benefits on the first day of active State service. Optional
24life insurance coverage one to 4 times the basic amount, if
25elected during the relevant eligibility period, will become
26effective on the date of employment. Optional life insurance

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1coverage exceeding 4 times the basic amount and all life
2insurance amounts applied for after the eligibility period will
3be effective, subject to satisfactory evidence of insurability
4when applicable, or other necessary qualifications, pursuant
5to the requirements of the applicable benefit program, unless
6there is a change in status that would confer new eligibility
7for change of enrollment under rules established supplementing
8this Act, in which event application must be made within the
9new eligibility period.
10 (c) As to the group health benefits program contracted to
11begin or continue after June 30, 1973, each annuitant,
12survivor, and retired employee shall become immediately
13eligible and covered for all benefits available under that
14program. Each annuitant, survivor, and retired employee shall
15have coverage effective immediately, provided that the
16election is properly filed in accordance with the required
17filing dates and procedures specified by the Director,
18including the completion and submission of all documentation
19and forms required by the Director. Annuitants, survivors, and
20retired Retired employees may elect coverage for eligible
21dependents and shall have the coverage effective immediately,
22provided that the election is properly filed in accordance with
23required filing dates and procedures specified by the Director,
24except that, for a survivor, the dependent sought to be added
25on or after the effective date of this amendatory Act of the
2697th General Assembly must have been eligible for coverage as a

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1dependent under the deceased member upon whom the survivor's
2annuity is based in order to be eligible for coverage under the
3survivor.
4 Except as otherwise provided in this Act, where husband and
5wife are both eligible members, each shall be enrolled as a
6member and coverage on their eligible dependent children, if
7any, may be under the enrollment and election of either.
8 Regardless of other provisions herein regarding late
9enrollment or other qualifications, as appropriate, the
10Director may periodically authorize open enrollment periods
11for each of the benefit programs at which time each member may
12elect enrollment or change of enrollment without regard to age,
13sex, health, or other qualification under the conditions as may
14be prescribed in rules and regulations supplementing this Act.
15Special open enrollment periods may be declared by the Director
16for certain members only when special circumstances occur that
17affect only those members.
18 (d) Beginning with fiscal year 2003 and for all subsequent
19years, eligible members may elect not to participate in the
20program of health benefits as defined in this Act. The election
21must be made during the annual benefit choice period, subject
22to the conditions in this subsection.
23 (1) Members must furnish proof of health benefit
24 coverage, either comprehensive major medical coverage or
25 comprehensive managed care plan, from a source other than
26 the Department of Central Management Services in order to

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1 elect not to participate in the program.
2 (2) Members may re-enroll in the Department of Central
3 Management Services program of health benefits upon
4 showing a qualifying change in status, as defined in the
5 U.S. Internal Revenue Code, without evidence of
6 insurability and with no limitations on coverage for
7 pre-existing conditions, provided that there was not a
8 break in coverage of more than 63 days.
9 (3) Members may also re-enroll in the program of health
10 benefits during any annual benefit choice period, without
11 evidence of insurability.
12 (4) Members who elect not to participate in the program
13 of health benefits shall be furnished a written explanation
14 of the requirements and limitations for the election not to
15 participate in the program and for re-enrolling in the
16 program. The explanation shall also be included in the
17 annual benefit choice options booklets furnished to
18 members.
19 (d-5) Beginning July 1, 2005, the Director may establish a
20program of financial incentives to encourage annuitants
21receiving a retirement annuity from the State Employees
22Retirement System, but who are not eligible for benefits under
23the federal Medicare health insurance program (Title XVIII of
24the Social Security Act, as added by Public Law 89-97) to elect
25not to participate in the program of health benefits provided
26under this Act. The election by an annuitant not to participate

SB1556 Engrossed- 22 -LRB097 09499 JDS 49636 b
1under this program must be made in accordance with the
2requirements set forth under subsection (d). The financial
3incentives provided to these annuitants under the program may
4not exceed $150 per month for each annuitant electing not to
5participate in the program of health benefits provided under
6this Act.
7 (e) Notwithstanding any other provision of this Act or the
8rules adopted under this Act, if a person participating in the
9program of health benefits as the dependent spouse of an
10eligible member becomes an annuitant, the person may elect, at
11the time of becoming an annuitant or during any subsequent
12annual benefit choice period, to continue participation as a
13dependent rather than as an eligible member for as long as the
14person continues to be an eligible dependent.
15 An eligible member who has elected to participate as a
16dependent may re-enroll in the program of health benefits as an
17eligible member (i) during any subsequent annual benefit choice
18period or (ii) upon showing a qualifying change in status, as
19defined in the U.S. Internal Revenue Code, without evidence of
20insurability and with no limitations on coverage for
21pre-existing conditions.
22 A person who elects to participate in the program of health
23benefits as a dependent rather than as an eligible member shall
24be furnished a written explanation of the consequences of
25electing to participate as a dependent and the conditions and
26procedures for re-enrolling as an eligible member. The

SB1556 Engrossed- 23 -LRB097 09499 JDS 49636 b
1explanation shall also be included in the annual benefit choice
2options booklet furnished to members.
3(Source: P.A. 94-95, eff. 7-1-05; 94-109, eff. 7-1-05; 95-331,
4eff. 8-21-07.)
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