Bill Amendment: IL HB4972 | 2023-2024 | 103rd General Assembly
NOTE: For additional amemendments please see the Bill Drafting List
Bill Title: CMS POSTING REQUIREMENTS
Status: 2024-04-30 - Chief Senate Sponsor Sen. Chapin Rose [HB4972 Detail]
Download: Illinois-2023-HB4972-House_Amendment_001.html
Bill Title: CMS POSTING REQUIREMENTS
Status: 2024-04-30 - Chief Senate Sponsor Sen. Chapin Rose [HB4972 Detail]
Download: Illinois-2023-HB4972-House_Amendment_001.html
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1 | AMENDMENT TO HOUSE BILL 4972 | ||||||
2 | AMENDMENT NO. ______. Amend House Bill 4972 by replacing | ||||||
3 | everything after the enacting clause with the following:
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4 | "Section 5. The State Employees Group Insurance Act of | ||||||
5 | 1971 is amended by changing Section 6.5 as follows:
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6 | (5 ILCS 375/6.5) | ||||||
7 | Sec. 6.5. Health benefits for TRS benefit recipients and | ||||||
8 | TRS dependent beneficiaries. | ||||||
9 | (a) Purpose. It is the purpose of this amendatory Act of | ||||||
10 | 1995 to transfer the administration of the program of health | ||||||
11 | benefits established for benefit recipients and their | ||||||
12 | dependent beneficiaries under Article 16 of the Illinois | ||||||
13 | Pension Code to the Department of Central Management Services. | ||||||
14 | (b) Transition provisions. The Board of Trustees of the | ||||||
15 | Teachers' Retirement System shall continue to administer the | ||||||
16 | health benefit program established under Article 16 of the |
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1 | Illinois Pension Code through December 31, 1995. Beginning | ||||||
2 | January 1, 1996, the Department of Central Management Services | ||||||
3 | shall be responsible for administering a program of health | ||||||
4 | benefits for TRS benefit recipients and TRS dependent | ||||||
5 | beneficiaries under this Section. The Department of Central | ||||||
6 | Management Services and the Teachers' Retirement System shall | ||||||
7 | cooperate in this endeavor and shall coordinate their | ||||||
8 | activities so as to ensure a smooth transition and | ||||||
9 | uninterrupted health benefit coverage. | ||||||
10 | (c) Eligibility. All persons who were enrolled in the | ||||||
11 | Article 16 program at the time of the transfer shall be | ||||||
12 | eligible to participate in the program established under this | ||||||
13 | Section without any interruption or delay in coverage or | ||||||
14 | limitation as to pre-existing medical conditions. Eligibility | ||||||
15 | to participate shall be determined by the Teachers' Retirement | ||||||
16 | System. Eligibility information shall be communicated to the | ||||||
17 | Department of Central Management Services in a format | ||||||
18 | acceptable to the Department. | ||||||
19 | Eligible TRS benefit recipients may enroll or re-enroll in | ||||||
20 | the program of health benefits established under this Section | ||||||
21 | during any applicable annual open enrollment period and as | ||||||
22 | otherwise permitted by the Department of Central Management | ||||||
23 | Services. A TRS benefit recipient shall not be deemed | ||||||
24 | ineligible to participate solely by reason of the TRS benefit | ||||||
25 | recipient having made a previous election to disenroll or | ||||||
26 | otherwise not participate in the program of health benefits. |
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1 | A TRS dependent beneficiary who is a child age 19 or over | ||||||
2 | and mentally or physically disabled does not become ineligible | ||||||
3 | to participate by reason of (i) becoming ineligible to be | ||||||
4 | claimed as a dependent for Illinois or federal income tax | ||||||
5 | purposes or (ii) receiving earned income, so long as those | ||||||
6 | earnings are insufficient for the child to be fully | ||||||
7 | self-sufficient. | ||||||
8 | (d) Coverage. The level of health benefits provided under | ||||||
9 | this Section shall be similar to the level of benefits | ||||||
10 | provided by the program previously established under Article | ||||||
11 | 16 of the Illinois Pension Code. | ||||||
12 | Group life insurance benefits are not included in the | ||||||
13 | benefits to be provided to TRS benefit recipients and TRS | ||||||
14 | dependent beneficiaries under this Act. | ||||||
15 | The program of health benefits under this Section may | ||||||
16 | include any or all of the benefit limitations, including but | ||||||
17 | not limited to a reduction in benefits based on eligibility | ||||||
18 | for federal Medicare benefits, that are provided under | ||||||
19 | subsection (a) of Section 6 of this Act for other health | ||||||
20 | benefit programs under this Act. | ||||||
21 | (e) Insurance rates and premiums. The Director shall | ||||||
22 | determine the insurance rates and premiums for TRS benefit | ||||||
23 | recipients and TRS dependent beneficiaries, and shall present | ||||||
24 | to the Teachers' Retirement System of the State of Illinois, | ||||||
25 | by April 15 of each calendar year, the rate-setting | ||||||
26 | methodology (including but not limited to utilization levels |
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1 | and costs) used to determine the amount of the health care | ||||||
2 | premiums. | ||||||
3 | For Fiscal Year 1996, the premium shall be equal to | ||||||
4 | the premium actually charged in Fiscal Year 1995; in | ||||||
5 | subsequent years, the premium shall never be lower than | ||||||
6 | the premium charged in Fiscal Year 1995. | ||||||
7 | For Fiscal Year 2003, the premium shall not exceed | ||||||
8 | 110% of the premium actually charged in Fiscal Year 2002. | ||||||
9 | For Fiscal Year 2004, the premium shall not exceed | ||||||
10 | 112% of the premium actually charged in Fiscal Year 2003. | ||||||
11 | For Fiscal Year 2005, the premium shall not exceed a | ||||||
12 | weighted average of 106.6% of the premium actually charged | ||||||
13 | in Fiscal Year 2004. | ||||||
14 | For Fiscal Year 2006, the premium shall not exceed a | ||||||
15 | weighted average of 109.1% of the premium actually charged | ||||||
16 | in Fiscal Year 2005. | ||||||
17 | For Fiscal Year 2007, the premium shall not exceed a | ||||||
18 | weighted average of 103.9% of the premium actually charged | ||||||
19 | in Fiscal Year 2006. | ||||||
20 | For Fiscal Year 2008 and thereafter, the premium in | ||||||
21 | each fiscal year shall not exceed 105% of the premium | ||||||
22 | actually charged in the previous fiscal year. | ||||||
23 | Rates and premiums may be based in part on age and | ||||||
24 | eligibility for federal medicare coverage. However, the cost | ||||||
25 | of participation for a TRS dependent beneficiary who is an | ||||||
26 | unmarried child age 19 or over and mentally or physically |
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1 | disabled shall not exceed the cost for a TRS dependent | ||||||
2 | beneficiary who is an unmarried child under age 19 and | ||||||
3 | participates in the same major medical or managed care | ||||||
4 | program. | ||||||
5 | The cost of health benefits under the program shall be | ||||||
6 | paid as follows: | ||||||
7 | (1) For a TRS benefit recipient selecting a managed | ||||||
8 | care program, up to 75% of the total insurance rate shall | ||||||
9 | be paid from the Teacher Health Insurance Security Fund. | ||||||
10 | Effective with Fiscal Year 2007 and thereafter, for a TRS | ||||||
11 | benefit recipient selecting a managed care program, 75% of | ||||||
12 | the total insurance rate shall be paid from the Teacher | ||||||
13 | Health Insurance Security Fund. | ||||||
14 | (2) For a TRS benefit recipient selecting the major | ||||||
15 | medical coverage program, up to 50% of the total insurance | ||||||
16 | rate shall be paid from the Teacher Health Insurance | ||||||
17 | Security Fund if a managed care program is accessible, as | ||||||
18 | determined by the Teachers' Retirement System. Effective | ||||||
19 | with Fiscal Year 2007 and thereafter, for a TRS benefit | ||||||
20 | recipient selecting the major medical coverage program, | ||||||
21 | 50% of the total insurance rate shall be paid from the | ||||||
22 | Teacher Health Insurance Security Fund if a managed care | ||||||
23 | program is accessible, as determined by the Department of | ||||||
24 | Central Management Services. | ||||||
25 | (3) For a TRS benefit recipient selecting the major | ||||||
26 | medical coverage program, up to 75% of the total insurance |
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1 | rate shall be paid from the Teacher Health Insurance | ||||||
2 | Security Fund if a managed care program is not accessible, | ||||||
3 | as determined by the Teachers' Retirement System. | ||||||
4 | Effective with Fiscal Year 2007 and thereafter, for a TRS | ||||||
5 | benefit recipient selecting the major medical coverage | ||||||
6 | program, 75% of the total insurance rate shall be paid | ||||||
7 | from the Teacher Health Insurance Security Fund if a | ||||||
8 | managed care program is not accessible, as determined by | ||||||
9 | the Department of Central Management Services. | ||||||
10 | (3.1) For a TRS dependent beneficiary who is Medicare | ||||||
11 | primary and enrolled in a managed care plan, or the major | ||||||
12 | medical coverage program if a managed care plan is not | ||||||
13 | available, 25% of the total insurance rate shall be paid | ||||||
14 | from the Teacher Health Security Fund as determined by the | ||||||
15 | Department of Central Management Services. For the purpose | ||||||
16 | of this item (3.1), the term "TRS dependent beneficiary | ||||||
17 | who is Medicare primary" means a TRS dependent beneficiary | ||||||
18 | who is participating in Medicare Parts A and B. | ||||||
19 | (4) Except as otherwise provided in item (3.1), the | ||||||
20 | balance of the rate of insurance, including the entire | ||||||
21 | premium of any coverage for TRS dependent beneficiaries | ||||||
22 | that has been elected, shall be paid by deductions | ||||||
23 | authorized by the TRS benefit recipient to be withheld | ||||||
24 | from his or her monthly annuity or benefit payment from | ||||||
25 | the Teachers' Retirement System; except that (i) if the | ||||||
26 | balance of the cost of coverage exceeds the amount of the |
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1 | monthly annuity or benefit payment, the difference shall | ||||||
2 | be paid directly to the Teachers' Retirement System by the | ||||||
3 | TRS benefit recipient, and (ii) all or part of the balance | ||||||
4 | of the cost of coverage may, at the school board's option, | ||||||
5 | be paid to the Teachers' Retirement System by the school | ||||||
6 | board of the school district from which the TRS benefit | ||||||
7 | recipient retired, in accordance with Section 10-22.3b of | ||||||
8 | the School Code. The Teachers' Retirement System shall | ||||||
9 | promptly deposit all moneys withheld by or paid to it | ||||||
10 | under this subdivision (e)(4) into the Teacher Health | ||||||
11 | Insurance Security Fund. These moneys shall not be | ||||||
12 | considered assets of the Retirement System. | ||||||
13 | (5) If, for any month beginning on or after January 1, | ||||||
14 | 2013, a TRS benefit recipient or TRS dependent beneficiary | ||||||
15 | was enrolled in Medicare Parts A and B and such Medicare | ||||||
16 | coverage was primary to coverage under this Section but | ||||||
17 | payment for coverage under this Section was made at a rate | ||||||
18 | greater than the Medicare primary rate published by the | ||||||
19 | Department of Central Management Services, the TRS benefit | ||||||
20 | recipient or TRS dependent beneficiary shall be eligible | ||||||
21 | for a refund equal to the difference between the amount | ||||||
22 | paid by the TRS benefit recipient or TRS dependent | ||||||
23 | beneficiary and the published Medicare primary rate. To | ||||||
24 | receive a refund pursuant to this subsection, the TRS | ||||||
25 | benefit recipient or TRS dependent beneficiary must | ||||||
26 | provide documentation to the Department of Central |
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1 | Management Services evidencing the TRS benefit recipient's | ||||||
2 | or TRS dependent beneficiary's Medicare coverage and the | ||||||
3 | amount paid by the TRS benefit recipient or TRS dependent | ||||||
4 | beneficiary during the applicable time period. | ||||||
5 | (f) Financing. Beginning July 1, 1995, all revenues | ||||||
6 | arising from the administration of the health benefit programs | ||||||
7 | established under Article 16 of the Illinois Pension Code or | ||||||
8 | this Section shall be deposited into the Teacher Health | ||||||
9 | Insurance Security Fund, which is hereby created as a | ||||||
10 | nonappropriated trust fund to be held outside the State | ||||||
11 | Treasury, with the State Treasurer as custodian. Any interest | ||||||
12 | earned on moneys in the Teacher Health Insurance Security Fund | ||||||
13 | shall be deposited into the Fund. | ||||||
14 | Moneys in the Teacher Health Insurance Security Fund shall | ||||||
15 | be used only to pay the costs of the health benefit program | ||||||
16 | established under this Section, including associated | ||||||
17 | administrative costs, and the costs associated with the health | ||||||
18 | benefit program established under Article 16 of the Illinois | ||||||
19 | Pension Code, as authorized in this Section. Beginning July 1, | ||||||
20 | 1995, the Department of Central Management Services may make | ||||||
21 | expenditures from the Teacher Health Insurance Security Fund | ||||||
22 | for those costs. | ||||||
23 | After other funds authorized for the payment of the costs | ||||||
24 | of the health benefit program established under Article 16 of | ||||||
25 | the Illinois Pension Code are exhausted and until January 1, | ||||||
26 | 1996 (or such later date as may be agreed upon by the Director |
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1 | of Central Management Services and the Secretary of the | ||||||
2 | Teachers' Retirement System), the Secretary of the Teachers' | ||||||
3 | Retirement System may make expenditures from the Teacher | ||||||
4 | Health Insurance Security Fund as necessary to pay up to 75% of | ||||||
5 | the cost of providing health coverage to eligible benefit | ||||||
6 | recipients (as defined in Sections 16-153.1 and 16-153.3 of | ||||||
7 | the Illinois Pension Code) who are enrolled in the Article 16 | ||||||
8 | health benefit program and to facilitate the transfer of | ||||||
9 | administration of the health benefit program to the Department | ||||||
10 | of Central Management Services. | ||||||
11 | The Department of Central Management Services, or any | ||||||
12 | successor agency designated to procure healthcare contracts | ||||||
13 | pursuant to this Act, is authorized to establish funds, | ||||||
14 | separate accounts provided by any bank or banks as defined by | ||||||
15 | the Illinois Banking Act, or separate accounts provided by any | ||||||
16 | savings and loan association or associations as defined by the | ||||||
17 | Illinois Savings and Loan Act of 1985 to be held by the | ||||||
18 | Director, outside the State treasury, for the purpose of | ||||||
19 | receiving the transfer of moneys from the Teacher Health | ||||||
20 | Insurance Security Fund. The Department may promulgate rules | ||||||
21 | further defining the methodology for the transfers. Any | ||||||
22 | interest earned by moneys in the funds or accounts shall inure | ||||||
23 | to the Teacher Health Insurance Security Fund. The transferred | ||||||
24 | moneys, and interest accrued thereon, shall be used | ||||||
25 | exclusively for transfers to administrative service | ||||||
26 | organizations or their financial institutions for payments of |
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1 | claims to claimants and providers under the self-insurance | ||||||
2 | health plan. The transferred moneys, and interest accrued | ||||||
3 | thereon, shall not be used for any other purpose including, | ||||||
4 | but not limited to, reimbursement of administration fees due | ||||||
5 | the administrative service organization pursuant to its | ||||||
6 | contract or contracts with the Department. | ||||||
7 | (g) Contract for benefits. The Director shall by contract, | ||||||
8 | self-insurance, or otherwise make available the program of | ||||||
9 | health benefits for TRS benefit recipients and their TRS | ||||||
10 | dependent beneficiaries that is provided for in this Section. | ||||||
11 | The contract or other arrangement for the provision of these | ||||||
12 | health benefits shall be on terms deemed by the Director to be | ||||||
13 | in the best interest of the State of Illinois and the TRS | ||||||
14 | benefit recipients based on, but not limited to, such criteria | ||||||
15 | as administrative cost, service capabilities of the carrier or | ||||||
16 | other contractor, and the costs of the benefits. | ||||||
17 | (g-5) Committee. A Teacher Retirement Insurance Program | ||||||
18 | Committee shall be established, to consist of 10 persons | ||||||
19 | appointed by the Governor. | ||||||
20 | The Committee shall convene at least 4 times each year, | ||||||
21 | and shall consider and make recommendations on issues | ||||||
22 | affecting the program of health benefits provided under this | ||||||
23 | Section. Recommendations of the Committee shall be based on a | ||||||
24 | consensus of the members of the Committee. | ||||||
25 | If the Teacher Health Insurance Security Fund experiences | ||||||
26 | a deficit balance based upon the contribution and subsidy |
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