Bill Text: IL HB1309 | 2021-2022 | 102nd General Assembly | Introduced
Bill Title: Amends the State Employees Group Insurance Act of 1971. Makes a technical change in a Section concerning retired teacher benefits.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2021-04-23 - Rule 19(a) / Re-referred to Rules Committee [HB1309 Detail]
Download: Illinois-2021-HB1309-Introduced.html
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1 | AN ACT concerning government.
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2 | Be it enacted by the People of the State of Illinois, | |||||||||||||||||||
3 | represented in the General Assembly:
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4 | Section 5. The State Employees Group Insurance Act of 1971 | |||||||||||||||||||
5 | is amended by changing Section 6.5 as follows:
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6 | (5 ILCS 375/6.5)
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7 | Sec. 6.5. Health benefits for TRS benefit recipients and | |||||||||||||||||||
8 | TRS dependent
beneficiaries. | |||||||||||||||||||
9 | (a) Purpose. It is the
the purpose of this amendatory Act | |||||||||||||||||||
10 | of 1995 to transfer
the administration of the program of | |||||||||||||||||||
11 | health benefits established for benefit
recipients and their | |||||||||||||||||||
12 | dependent beneficiaries under Article 16 of the Illinois
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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 | |||||||||||||||||||
17 | Illinois Pension Code through December 31,
1995. Beginning | |||||||||||||||||||
18 | January 1, 1996, the Department of Central Management Services
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19 | shall be responsible for administering a program of health | |||||||||||||||||||
20 | benefits for TRS
benefit recipients and TRS dependent | |||||||||||||||||||
21 | beneficiaries under this Section.
The Department of Central | |||||||||||||||||||
22 | Management Services and the Teachers' Retirement
System shall | |||||||||||||||||||
23 | cooperate in this endeavor and shall coordinate their |
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1 | activities
so as to ensure a smooth transition and | ||||||
2 | uninterrupted health benefit coverage.
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3 | (c) Eligibility. All persons who were enrolled in the | ||||||
4 | Article 16 program at
the time of the transfer shall be | ||||||
5 | eligible to participate in the program
established under this | ||||||
6 | Section without any interruption or delay in coverage
or | ||||||
7 | limitation as to pre-existing medical conditions. Eligibility | ||||||
8 | to
participate shall be determined by the Teachers' Retirement | ||||||
9 | System.
Eligibility information shall be communicated to the | ||||||
10 | Department of Central
Management Services in a format | ||||||
11 | acceptable to the Department.
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12 | Eligible TRS benefit recipients may enroll or re-enroll in | ||||||
13 | the program of health benefits established under this Section | ||||||
14 | during any applicable annual open enrollment period and as | ||||||
15 | otherwise permitted by the Department of Central Management | ||||||
16 | Services. A TRS benefit recipient shall not be deemed | ||||||
17 | ineligible to participate solely by reason of the TRS benefit | ||||||
18 | recipient having made a previous election to disenroll or | ||||||
19 | otherwise not participate in the program of health benefits. | ||||||
20 | A TRS dependent beneficiary who is a child age 19 or over | ||||||
21 | and
mentally or physically disabled does not become ineligible | ||||||
22 | to participate
by reason of (i) becoming ineligible to be | ||||||
23 | claimed as a dependent for Illinois
or federal income tax | ||||||
24 | purposes or (ii) receiving earned income, so long as
those | ||||||
25 | earnings are insufficient for the child to be fully | ||||||
26 | self-sufficient.
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1 | (d) Coverage. The level of health benefits provided under | ||||||
2 | this Section
shall be similar to the level of benefits | ||||||
3 | provided by the
program previously established under Article | ||||||
4 | 16 of the Illinois Pension Code.
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5 | Group life insurance benefits are not included in the | ||||||
6 | benefits
to be provided to TRS benefit recipients and TRS | ||||||
7 | dependent beneficiaries under
this Act.
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8 | The program of health benefits under this Section may | ||||||
9 | include any or all of
the benefit limitations, including but | ||||||
10 | not limited to a reduction in benefits
based on eligibility | ||||||
11 | for federal Medicare benefits, that are provided under
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12 | subsection (a) of Section 6 of this Act for other health | ||||||
13 | benefit programs under
this Act.
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14 | (e) Insurance rates and premiums. The Director shall | ||||||
15 | determine the
insurance rates and premiums for TRS benefit | ||||||
16 | recipients and TRS dependent
beneficiaries,
and shall present | ||||||
17 | to the Teachers' Retirement System of
the State of Illinois, | ||||||
18 | by April 15 of each calendar year, the rate-setting
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19 | methodology (including but not limited to utilization levels | ||||||
20 | and costs) used
to determine the amount of the health care | ||||||
21 | premiums.
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22 | For Fiscal Year 1996, the premium shall be equal to | ||||||
23 | the premium actually
charged in Fiscal Year 1995; in | ||||||
24 | subsequent years, the premium shall
never be lower than | ||||||
25 | the premium charged in Fiscal Year 1995. | ||||||
26 | For Fiscal Year
2003, the premium shall not exceed |
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1 | 110% of the premium actually charged in
Fiscal Year 2002. | ||||||
2 | For Fiscal Year 2004, the premium shall not exceed | ||||||
3 | 112% of
the premium actually charged in Fiscal Year 2003.
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4 | For Fiscal Year 2005, the premium shall not exceed a | ||||||
5 | weighted average of 106.6% of
the premium actually charged | ||||||
6 | in Fiscal Year 2004.
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7 | For Fiscal Year 2006, the premium shall not exceed a | ||||||
8 | weighted average of 109.1% of
the premium actually charged | ||||||
9 | in Fiscal Year 2005.
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10 | For Fiscal Year 2007, the premium shall not exceed a | ||||||
11 | weighted average of 103.9% of
the premium actually charged | ||||||
12 | in Fiscal Year 2006.
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13 | For Fiscal Year 2008 and thereafter, the premium in | ||||||
14 | each fiscal year shall not exceed 105% of
the premium | ||||||
15 | actually charged in the previous fiscal year.
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16 | Rates and premiums may be based in part on age and | ||||||
17 | eligibility for federal
medicare coverage. However, the cost | ||||||
18 | of participation for a TRS dependent
beneficiary who is an | ||||||
19 | unmarried child age 19 or over and mentally or physically
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20 | disabled shall not exceed the cost for a TRS dependent | ||||||
21 | beneficiary who is
an unmarried child under age 19 and | ||||||
22 | participates in the same major medical or
managed care | ||||||
23 | program.
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24 | The cost of health benefits under the program shall be | ||||||
25 | paid as follows:
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26 | (1) For a TRS benefit recipient selecting a managed |
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1 | care program, up to
75% of the total insurance rate shall | ||||||
2 | be paid from the Teacher Health Insurance
Security Fund. | ||||||
3 | Effective with Fiscal Year 2007 and thereafter, for a TRS | ||||||
4 | benefit recipient selecting a managed care program, 75% of | ||||||
5 | the total insurance rate shall be paid from the Teacher | ||||||
6 | Health Insurance
Security Fund.
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7 | (2) For a TRS benefit recipient selecting the major | ||||||
8 | medical coverage
program, up to 50% of the total insurance | ||||||
9 | rate shall be paid from the Teacher
Health Insurance | ||||||
10 | Security Fund if a managed care program is accessible, as
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11 | determined by the Teachers' Retirement System. Effective | ||||||
12 | with Fiscal Year 2007 and thereafter, for a TRS benefit | ||||||
13 | recipient selecting the major medical coverage
program, | ||||||
14 | 50% of the total insurance rate shall be paid from the | ||||||
15 | Teacher
Health Insurance Security Fund if a managed care | ||||||
16 | program is accessible, as
determined by the Department of | ||||||
17 | Central Management Services.
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18 | (3) For a TRS benefit recipient selecting the major | ||||||
19 | medical coverage
program, up to 75% of the total insurance | ||||||
20 | rate shall be paid from the Teacher
Health Insurance | ||||||
21 | Security Fund if a managed care program is not accessible, | ||||||
22 | as
determined by the Teachers' Retirement System. | ||||||
23 | Effective with Fiscal Year 2007 and thereafter, for a TRS | ||||||
24 | benefit recipient selecting the major medical coverage
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25 | program, 75% of the total insurance rate shall be paid | ||||||
26 | from the Teacher
Health Insurance Security Fund if a |
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1 | managed care program is not accessible, as
determined by | ||||||
2 | the Department of Central Management Services.
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3 | (3.1) For a TRS dependent beneficiary who is Medicare | ||||||
4 | primary and enrolled in a managed care plan, or the major | ||||||
5 | medical coverage program if a managed care plan is not | ||||||
6 | available, 25% of the total insurance rate shall be paid | ||||||
7 | from the Teacher Health Security Fund as determined by the | ||||||
8 | Department of Central Management Services. For the purpose | ||||||
9 | of this item (3.1), the term "TRS dependent beneficiary | ||||||
10 | who is Medicare primary" means a TRS dependent beneficiary | ||||||
11 | who is participating in Medicare Parts A and B.
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12 | (4) Except as otherwise provided in item (3.1), the
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13 | balance of the rate of insurance, including the entire | ||||||
14 | premium of
any coverage for TRS dependent beneficiaries | ||||||
15 | that has been elected, shall be
paid
by deductions | ||||||
16 | authorized by the TRS benefit recipient to be withheld | ||||||
17 | from his
or her monthly annuity or benefit payment from | ||||||
18 | the Teachers' Retirement System;
except that (i) if the | ||||||
19 | balance of the cost of coverage exceeds the amount of
the | ||||||
20 | monthly annuity or benefit payment, the difference shall | ||||||
21 | be paid directly
to the Teachers' Retirement System by the | ||||||
22 | TRS benefit recipient, and (ii) all
or part of the balance | ||||||
23 | of the cost of coverage may, at the school board's
option, | ||||||
24 | be paid to the Teachers' Retirement System by the school | ||||||
25 | board of the
school district from which the TRS benefit | ||||||
26 | recipient retired, in accordance
with Section 10-22.3b of |
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1 | the School Code. The Teachers' Retirement System
shall | ||||||
2 | promptly deposit all moneys withheld by or paid to it | ||||||
3 | under this
subdivision (e)(4) into the Teacher Health | ||||||
4 | Insurance Security Fund. These
moneys shall not be | ||||||
5 | considered assets of the Retirement System.
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6 | (5) If in any case an error is made in billing a TRS | ||||||
7 | benefit recipient under this Section, the Department shall | ||||||
8 | identify the error and refund the overpaid amount as soon | ||||||
9 | as practicable. A TRS benefit recipient who has overpaid | ||||||
10 | under this Section shall be entitled to a refund of | ||||||
11 | overpayments for up to 7 years of past payments. | ||||||
12 | (f) Financing. Beginning July 1, 1995, all revenues | ||||||
13 | arising from the
administration of the health benefit programs | ||||||
14 | established under Article 16 of
the Illinois Pension Code or | ||||||
15 | this Section shall be deposited into the
Teacher Health | ||||||
16 | Insurance Security Fund, which is hereby created as a
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17 | nonappropriated trust fund to be held outside the State | ||||||
18 | Treasury, with the
State Treasurer as custodian. Any interest | ||||||
19 | earned on moneys in the Teacher
Health Insurance Security Fund | ||||||
20 | shall be deposited into the Fund.
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21 | Moneys in the Teacher Health Insurance Security
Fund shall | ||||||
22 | be used only to pay the costs of the health benefit program
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23 | established under this Section, including associated | ||||||
24 | administrative costs, and
the costs associated with the health | ||||||
25 | benefit program established under Article
16 of the Illinois | ||||||
26 | Pension Code, as authorized in this Section. Beginning
July 1, |
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1 | 1995, the Department of Central Management Services may make
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2 | expenditures from the Teacher Health Insurance Security Fund | ||||||
3 | for those costs.
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4 | After other funds authorized for the payment of the costs | ||||||
5 | of the health
benefit program established under Article 16 of | ||||||
6 | the Illinois Pension Code are
exhausted and until January 1, | ||||||
7 | 1996 (or such later date as may be agreed upon
by the Director | ||||||
8 | of Central Management Services and the Secretary of the
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9 | Teachers' Retirement System), the Secretary of the Teachers' | ||||||
10 | Retirement System
may make expenditures from the Teacher | ||||||
11 | Health Insurance Security Fund as
necessary to pay up to 75% of | ||||||
12 | the cost of providing health coverage to eligible
benefit | ||||||
13 | recipients (as defined in Sections 16-153.1 and 16-153.3 of | ||||||
14 | the
Illinois Pension Code) who are enrolled in the Article 16 | ||||||
15 | health benefit
program and to facilitate the transfer of | ||||||
16 | administration of the health benefit
program to the Department | ||||||
17 | of Central Management Services.
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18 | The Department of Central Management Services, or any | ||||||
19 | successor agency designated to procure healthcare contracts | ||||||
20 | pursuant to this Act, is authorized to establish funds, | ||||||
21 | separate accounts provided by any bank or banks as defined by | ||||||
22 | the Illinois Banking Act, or separate accounts provided by any | ||||||
23 | savings and loan association or associations as defined by the | ||||||
24 | Illinois Savings and Loan Act of 1985 to be held by the | ||||||
25 | Director, outside the State treasury, for the purpose of | ||||||
26 | receiving the transfer of moneys from the Teacher Health |
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1 | Insurance Security Fund. The Department may promulgate rules | ||||||
2 | further defining the methodology for the transfers. Any | ||||||
3 | interest earned by moneys in the funds or accounts shall inure | ||||||
4 | to the Teacher Health Insurance Security Fund. The transferred | ||||||
5 | moneys, and interest accrued thereon, shall be used | ||||||
6 | exclusively for transfers to administrative service | ||||||
7 | organizations or their financial institutions for payments of | ||||||
8 | claims to claimants and providers under the self-insurance | ||||||
9 | health plan. The transferred moneys, and interest accrued | ||||||
10 | thereon, shall not be used for any other purpose including, | ||||||
11 | but not limited to, reimbursement of administration fees due | ||||||
12 | the administrative service organization pursuant to its | ||||||
13 | contract or contracts with the Department.
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14 | (g) Contract for benefits. The Director shall by contract, | ||||||
15 | self-insurance,
or otherwise make available the program of | ||||||
16 | health benefits for TRS benefit
recipients and their TRS | ||||||
17 | dependent beneficiaries that is provided for in this
Section. | ||||||
18 | The contract or other arrangement for the provision of these | ||||||
19 | health
benefits shall be on terms deemed by the Director to be | ||||||
20 | in the best interest of
the State of Illinois and the TRS | ||||||
21 | benefit recipients based on, but not limited
to, such criteria | ||||||
22 | as administrative cost, service capabilities of the carrier
or | ||||||
23 | other contractor, and the costs of the benefits.
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24 | (g-5) Committee. A Teacher Retirement Insurance Program | ||||||
25 | Committee shall be established, to consist of 10 persons | ||||||
26 | appointed by the Governor.
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1 | The Committee shall convene at least 4 times each year, | ||||||
2 | and shall consider and make recommendations on issues | ||||||
3 | affecting the program of health benefits provided under this
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4 | Section. Recommendations of the Committee shall be based on a | ||||||
5 | consensus of the members of the Committee.
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6 | If the Teacher
Health Insurance Security Fund experiences | ||||||
7 | a deficit balance based upon the contribution and subsidy | ||||||
8 | rates established in this Section and Section 6.6 for Fiscal | ||||||
9 | Year 2008 or thereafter, the Committee shall make | ||||||
10 | recommendations for adjustments to the funding sources | ||||||
11 | established under these Sections. | ||||||
12 | In addition, the Committee shall identify proposed | ||||||
13 | solutions to the funding shortfalls that are affecting the | ||||||
14 | Teacher Health Insurance Security Fund, and it shall report | ||||||
15 | those solutions to the Governor and the General Assembly | ||||||
16 | within 6 months after August 15, 2011 (the effective date of | ||||||
17 | Public Act 97-386). | ||||||
18 | (h) Continuation of program. It is the intention of
the | ||||||
19 | General Assembly that the program of health benefits provided | ||||||
20 | under this
Section be maintained on an ongoing, affordable | ||||||
21 | basis.
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22 | The program of health benefits provided under this Section | ||||||
23 | may be amended by
the State and is not intended to be a pension | ||||||
24 | or retirement benefit subject to
protection under Article | ||||||
25 | XIII, Section 5 of the Illinois Constitution.
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26 | (i) Repeal. (Blank).
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1 | (Source: P.A. 100-1017, eff. 8-21-18; 101-483, eff. 1-1-20 .)
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