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| Public Act 102-0019
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| HB0706 Enrolled | LRB102 11853 RJF 17189 b |
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AN ACT concerning government.
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Be it enacted by the People of the State of Illinois,
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represented in the General Assembly:
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Section 5. The State Employees Group Insurance Act of 1971 |
is amended by changing Sections 2, 6.1, 6.2, 7, 8, 10, 13, and |
13.1 as follows:
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(5 ILCS 375/2) (from Ch. 127, par. 522)
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Sec. 2. Purpose. The purpose of this Act is to provide a |
program of
group life insurance, a program of health benefits |
and other employee benefits
for persons in the service of the |
State of Illinois, employees of local
governments, employees |
of rehabilitation facilities, employees of
domestic violence |
shelters and services, and employees of child advocacy |
centers, and certain of their dependents.
It is also the |
purpose of this Act to provide a program of health benefits
(i) |
for certain benefit recipients of the Teachers' Retirement |
System of
the State of Illinois and their dependent |
beneficiaries, and (ii) for certain
eligible retired community |
college employees and their dependent
beneficiaries, and (iii) |
for employees of local governments, employees of |
rehabilitation facilities, employees of domestic violence |
shelters and services, and employees of child advocacy |
centers, and certain of their dependents.
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(Source: P.A. 94-860, eff. 6-16-06.)
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(5 ILCS 375/6.1) (from Ch. 127, par. 526.1)
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Sec. 6.1.
The program of health benefits may offer as an |
alternative,
available on an optional basis, coverage through
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health maintenance organizations or other managed care |
programs. That part of the premium for
such coverage which is |
in excess of the amount which would
otherwise be paid by the |
State for the program of health benefits shall
be paid by the |
member who elects such alternative coverage and shall
be |
collected as provided for premiums for other optional |
coverages.
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(Source: P.A. 100-538, eff. 1-1-18.)
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(5 ILCS 375/6.2) (from Ch. 127, par. 526.2)
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Sec. 6.2.
When the Director, with the advice and consent |
of the
Commission, determines that it would be in the best |
interests of the State
and its employees, any the program of |
health benefits under this Act may be
administered with the |
State as a self-insurer in whole or in part. The
State assumes |
the risks of any such the program. The State may provide the
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administrative services in connection with any the |
self-insurance health plan
or purchase administrative services |
from an administrative service
organization. A plan of |
self-insurance may combine forms of re-insurance or
stop-loss |
insurance which limits the amount of State liability.
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The program of health benefits shall provide a |
continuation and
conversion privilege for persons whose State |
employment is terminated and
a continuation privilege for |
members' spouses and dependent children who
are covered under |
the provisions of the program, consistent with the
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requirements of federal law and Sections 367.2, 367e, and
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367e.1 of the Illinois
Insurance Code.
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(Source: P.A. 93-477, eff. 1-1-04.)
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(5 ILCS 375/7) (from Ch. 127, par. 527)
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Sec. 7. Group life insurance program.
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(a) The basic noncontributory group life insurance program |
shall
provide coverage as follows:
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(1) employees shall be insured in an amount equal to |
the basic annual
salary rate, exclusive of overtime, |
bonus, or other cumulative additional
income factors, |
raised to the next round hundred dollar
amount if it is not |
already a round hundred dollar amount;
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(2) annuitants shall be insured in the same manner as |
described for
active employees, based on the salary in |
force immediately before
retirement, with coverage |
becoming effective on the effective date of
retirement |
benefits or the first day of the month of application, |
whichever
occurs later, except that at age 60 the amount |
of coverage for the
annuitant shall be reduced to $5,000;
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(3) survivors whose coverage became effective prior to |
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September 22,
1979 shall be insured for $2,000;
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(4) retired employees shall not be eligible under the |
group life insurance
program contracted to begin or |
continue after June 30, 1973.
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(a-5) There shall also be available on an optional basis |
to employees,
annuitants whose retirement benefits begin |
within one year of their receipt of
final compensation, and |
survivors whose coverage became effective prior to
September |
22, 1979, a contributory program of:
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(1) supplemental life insurance in an amount not |
exceeding 8 times the
basic life benefits for active |
employees and annuitants under age 60 and not exceeding 4 |
times the basic life benefits for annuitants age 60 and |
over, as described above, except that (a) amounts selected
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by employees and annuitants must be in full multiples of |
the basic amount,
and (b) premiums may be adjusted by age |
bracket established in rules
supplementing this Act; |
beginning July 1, 1981, survivors whose coverage
becomes |
effective on or after September 22, 1979, shall have the |
option of
participating in the contributory program of |
life insurance in an amount of
$5,000 coverage;
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(2) accidental death and dismemberment, with the |
employee and annuitant
having the option of electing an |
amount equal to the basic noncontributory
life benefits |
only, or an amount equaling the combined total of basic |
plus
optional life benefits not exceeding 5 times basic |
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life benefits, or $3,000,000, whichever is less;
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(3) dependent life insurance in an amount of $10,000 |
coverage on the
spouse; however, coverage reduces to |
$5,000 when the eligible spouse annuitant turns 60; and
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(4) dependent life insurance in an amount of $10,000
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coverage on each
dependent other than the spouse.
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(b) 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, |
shall pay the premiums for coverage under
the group life |
insurance program under this Act. The Director shall |
promulgate
rules and regulations to determine the premiums to |
be paid by a member
under this subsection (b).
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(Source: P.A. 94-95, eff. 7-1-05.)
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(5 ILCS 375/8) (from Ch. 127, par. 528)
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Sec. 8. Eligibility.
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(a) Each employee 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. |
Employees electing coverage for eligible dependents shall have
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the coverage effective immediately, provided that the election |
is properly
filed in accordance with required filing dates and |
procedures specified by
the Director, including the completion |
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and submission of all documentation and forms required by the |
Director.
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(1) Every member originally eligible to elect |
dependent coverage, but not
electing it during the |
original eligibility period, may subsequently obtain
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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.
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(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.
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(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,
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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.
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(b) New employees shall be immediately insured for the |
basic group
life insurance and covered by the program of |
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health benefits on the first
day of active State service. |
Optional life insurance coverage one to 4 times the basic |
amount, if elected
during the relevant eligibility period, |
will become effective on the date
of employment. Optional life |
insurance coverage exceeding 4 times the basic amount and all |
life insurance amounts applied for after the
eligibility |
period will be effective, subject to satisfactory evidence of
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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
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established supplementing this Act, in which event application |
must be made
within the new eligibility period.
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(c) As to the group health benefits program contracted to |
begin or
continue after June 30, 1973, each annuitant, |
survivor, and retired employee shall become immediately
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eligible for all benefits available under that program. Each |
annuitant, survivor, and retired employee shall have coverage |
effective immediately, provided that the election is properly |
filed in accordance with the required filing dates and |
procedures specified by the Director, including the completion |
and submission of all documentation and forms required by the |
Director. Annuitants, survivors, and retired
employees may |
elect coverage for eligible dependents and shall have the
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coverage effective immediately, provided that the election is |
properly
filed in accordance with required filing dates and |
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procedures specified
by the Director, except that, for a |
survivor, the dependent sought to be added on or after the |
effective date of this amendatory Act of the 97th General |
Assembly must have been eligible for coverage as a dependent |
under the deceased member upon whom the survivor's annuity is |
based in order to be eligible for coverage under the survivor.
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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.
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Regardless of other provisions herein regarding late |
enrollment or other
qualifications, as appropriate, the
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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
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the Director for certain members only when special |
circumstances occur that
affect only those members.
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(d) Eligible 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
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choice period or upon showing a qualifying change in status as |
defined in the U.S. Internal Revenue Code, subject to the |
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conditions in this subsection.
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(1) (Blank). 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.
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(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.
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(3) Members may also re-enroll in the program of |
health benefits during
any annual benefit choice period, |
without evidence of insurability.
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(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.
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(d-5) Beginning July 1, 2005, the Director may establish a |
program of financial incentives to encourage annuitants |
receiving a retirement annuity, but who are not eligible for |
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benefits under the federal Medicare health insurance program |
(Title XVIII of the Social Security Act, as added by Public Law |
89-97) to elect not to participate in the program of health |
benefits provided under this Act. The election by an annuitant |
not to participate under this program must be made in |
accordance with the requirements set forth under subsection |
(d). The financial incentives provided to these annuitants |
under the program may not exceed $150 per month for each |
annuitant electing not to participate in the program of health |
benefits provided under this Act.
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(d-6) Beginning July 1, 2013, the Director may establish a |
program of financial incentives to encourage annuitants with |
20 or more years of creditable service but who are not eligible |
for benefits under the federal Medicare health insurance |
program (Title XVIII of the Social Security Act, as added by |
Public Law 89-97) to elect not to participate in the program of |
health benefits provided under this Act. The election by an |
annuitant not to participate under this program must be made |
in accordance with the requirements set forth under subsection |
(d). The program established under this subsection (d-6) may |
include a prorated incentive for annuitants with fewer than 20 |
years of creditable service, as determined by the Director. |
The financial incentives provided to these annuitants under |
this program may not exceed $500 per month for each annuitant |
electing not to participate in the program of health benefits |
provided under this Act. |
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(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. In order to be |
eligible to make such an election, the person must have been |
enrolled as a dependent under the program of health benefits |
for no less than one year prior to becoming an annuitant.
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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.
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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.
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(Source: P.A. 97-668, eff. 1-13-12; 98-19, eff. 6-10-13.)
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(5 ILCS 375/10) (from Ch. 127, par. 530)
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Sec. 10. Contributions by the State and members.
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(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 and except as |
provided in 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
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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
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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 |
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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.
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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
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dependent or survivor if he or she were the dependent or |
survivor of an
annuitant under the State Universities |
Retirement System.
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(a-1) (Blank).
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(a-2) (Blank).
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(a-3) (Blank).
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(a-4) (Blank).
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(a-5) (Blank).
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(a-6) (Blank).
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(a-7) (Blank).
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(a-8) Any annuitant, survivor, or retired employee may |
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waive or terminate coverage in
the program of group health |
benefits. Any such annuitant, survivor, or retired employee
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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, survivor, or retired employee
may |
not re-enroll in the program.
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(a-8.5) Beginning on the effective date of this amendatory |
Act of the 97th General Assembly, the Director of Central |
Management Services shall, on an annual basis, determine the |
amount that the State shall contribute toward the basic |
program of group health benefits on behalf of annuitants |
(including individuals who (i) participated in the General |
Assembly Retirement System, the State Employees' Retirement |
System of Illinois, the State Universities Retirement System, |
the Teachers' Retirement System of the State of Illinois, or |
the Judges Retirement System of Illinois and (ii) qualify as |
annuitants under subsection (b) of Section 3 of this Act), |
survivors (including individuals who (i) receive an annuity as |
a survivor of an individual who participated in the General |
Assembly Retirement System, the State Employees' Retirement |
System of Illinois, the State Universities Retirement System, |
the Teachers' Retirement System of the State of Illinois, or |
the Judges Retirement System of Illinois and (ii) qualify as |
survivors under subsection (q) of Section 3 of this Act), and |
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retired employees (as defined in subsection (p) of Section 3 |
of this Act). The remainder of the cost of coverage for each |
annuitant, survivor, or retired employee, as determined by the |
Director of Central Management Services, shall be the |
responsibility of that annuitant, survivor, or retired |
employee. |
Contributions required of annuitants, survivors, and |
retired employees shall be the same for all retirement systems |
and shall also be based on whether an individual has made an |
election under Section 15-135.1 of the Illinois Pension Code. |
Contributions may be based on annuitants', survivors', or |
retired employees' Medicare eligibility, but may not be based |
on Social Security eligibility. |
(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.
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A separate calculation of the premiums based upon the |
actual cost of each
health care plan shall be so certified.
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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 |
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certified by the Director
of Central Management Services.
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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 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.
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(a-10) To the extent that participation, benefits, or |
premiums under this Act are based on a person's service credit |
under an Article of the Illinois Pension Code, service credit |
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terminated in exchange for an accelerated pension benefit |
payment under Section 14-147.5, 15-185.5, or 16-190.5 of that |
Code shall be included in determining a person's service |
credit for the purposes of this Act. |
(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.
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(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. 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 |
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Workers' Compensation
or Occupational Disease Act.
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(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.
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(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, 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 or (2) until such person's employment or |
annuitant status
with the State is terminated (exclusive of |
any additional service imposed pursuant to law).
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(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.
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(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
|
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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.
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(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.
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(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 any either |
the State group
health benefits plan made available by the |
Department under the health benefits program established under |
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this Section 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 health benefits program established under this |
Section the State group health benefits plan
or, for coverage |
under a health maintenance organization, an amount determined
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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 the State group health |
benefits 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
50% 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 50% 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 |
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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 is |
|
hereby created as a nonappropriated trust fund to be held |
outside the State Treasury, with the State Treasurer as |
custodian. The Local Government Health Insurance Reserve Fund |
shall be a continuing
fund not subject to fiscal year |
limitations. The Local Government Health Insurance Reserve |
Fund is not subject to administrative charges or charge-backs, |
including but not limited to those authorized under Section 8h |
of the State Finance Act. 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. Any interest earned |
on moneys in the Local Government Health Insurance Reserve |
Fund shall be deposited into the 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
50% 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. The domestic |
|
violence shelter 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 domestic |
violence shelter 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 50% of the employees are |
enrolled and the domestic violence shelter remits the entire |
cost of providing coverage to those employees. Employees of a |
participating domestic violence shelter 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, or special circumstance as defined by the Director |
or during the annual Benefit Choice Period. 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 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. The child
|
advocacy center 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 child advocacy
|
center 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 50% of the employees are enrolled and the |
|
child advocacy center remits the entire cost of providing |
coverage to those employees. Employees of a participating |
child advocacy center 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, or |
special circumstance as defined by the Director or during the |
annual Benefit Choice Period. 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. 100-587, eff. 6-4-18.)
|
(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 |
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
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 program |
authorized by this Act.
|
|
Refunds to members for premiums paid for optional life |
insurance 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. 95-632, eff. 9-25-07.)
|
(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 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 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 |
an the Administrative
Service Organization;
|
(3) the payment of health benefits;
|
(3.5) the payment of medical expenses incurred by the |
|
Department for the treatment of employees who suffer |
accidental injury or death within the scope of their |
employment; |
(4) refunds to employees for erroneous payments of |
their selected health insurance
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. 98-488, eff. 8-16-13.)
|
Section 10. The Illinois Pension Code is amended by |
changing Section 15-158.3 as follows:
|
(40 ILCS 5/15-158.3)
|
Sec. 15-158.3. Reports on cost reduction; effect on |
retirement at any age
with 30 years of service.
|
(a)
On or before November 15, 2001 and on or before |
November 15th of each
year thereafter, the Board shall have |
the System's actuary prepare a report
showing, on a fiscal |
year by fiscal year basis, the actual rate of
participation in |
the self-managed plan
authorized by Section
15-158.2, (i) by |
employees of the System's covered higher educational
|
institutions who were hired on or after the implementation |
|
date of the
self-managed plan and (ii) by other System
|
participants.
|
(b) On or before November 15th of 2001 and on or before |
November 15th of
each year thereafter, the Illinois Board of |
Higher Education, in conjunction
with the
Bureau of the
Budget |
(now Governor's Office of Management and Budget) shall prepare |
a
report showing, on a
fiscal year by fiscal year basis, the |
amount by which the costs associated with
compensable sick |
leave have been reduced as a result of the termination of
|
compensable sick leave accrual on and after January 1, 1998 by |
employees of
higher education institutions who are |
participants in the System.
|
(c) (Blank). On or before November 15 of 2001 and on or |
before November 15th of each
year thereafter, the Department |
of Central Management Services shall prepare a
report showing, |
on
a fiscal year by fiscal year basis, the amount by which the |
State's cost for
health insurance coverage under the State |
Employees Group Insurance Act
of 1971 for retirees of the |
State's universities and their survivors has
declined as a |
result of requiring some of those retirees and survivors to
|
contribute to the cost of their basic health insurance. These |
year-by-year
reductions in cost must be quantified both in |
dollars and as a level percentage
of payroll covered by the |
System.
|
(d) The report reports required under subsection |
subsections (b) and (c) shall be
disseminated to the Board, |
|
the Pension Laws
Commission (until it ceases to exist), the |
Commission on Government Forecasting and Accountability, the |
Illinois Board of Higher Education, and the
Governor.
|
(e) The report reports required under subsection |
subsections (b) and (c) shall be
taken into account by the |
Pension
Laws Commission (or its successor, the Commission on |
Government Forecasting and Accountability) in
making any |
recommendation to extend by legislation beyond
December 31, |
2002 the provision that allows a System participant to retire |
at
any age with 30 or more years of service as authorized in |
Section 15-135.
|
(Source: P.A. 95-83, eff. 8-13-07.)
|
Section 99. Effective date. This Act takes effect July 1, |
2021.
|
