Bill Text: IL SB1245 | 2013-2014 | 98th General Assembly | Amended
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Amends the Public Safety Employee Benefits Act. Defines "catastrophic injury" to mean the consequences of an injury that permanently prevent an individual from performing any gainful work. Effective immediately.
Spectrum: Bipartisan Bill
Status: (Passed) 2013-08-27 - Public Act . . . . . . . . . 98-0561 [SB1245 Detail]
Download: Illinois-2013-SB1245-Amended.html
Bill Title: Amends the Public Safety Employee Benefits Act. Defines "catastrophic injury" to mean the consequences of an injury that permanently prevent an individual from performing any gainful work. Effective immediately.
Spectrum: Bipartisan Bill
Status: (Passed) 2013-08-27 - Public Act . . . . . . . . . 98-0561 [SB1245 Detail]
Download: Illinois-2013-SB1245-Amended.html
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1 | AMENDMENT TO SENATE BILL 1245
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2 | AMENDMENT NO. ______. Amend Senate Bill 1245, AS AMENDED, | ||||||
3 | by replacing the enacting clause with the following:
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4 | "Section 5. The Public Safety Employee Benefits Act is | ||||||
5 | amended by changing Section 10 and adding Section 17 as | ||||||
6 | follows:
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7 | (820 ILCS 320/10)
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8 | Sec. 10. Required health coverage benefits.
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9 | (a) An employer who employs a full-time law enforcement, | ||||||
10 | correctional or
correctional probation officer, or firefighter | ||||||
11 | (hereinafter referred to as "injured employee") , who, on or | ||||||
12 | after the effective
date of this Act suffers a catastrophic | ||||||
13 | injury or is killed in the line of duty
shall pay the entire | ||||||
14 | premium of the employer's health insurance plan for the
injured | ||||||
15 | employee, the injured employee's spouse, and for each dependent | ||||||
16 | child
of the injured employee until the child reaches the age |
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1 | of majority or until
the end of the calendar year in which the | ||||||
2 | child reaches the age of 25 if the
child continues to be | ||||||
3 | dependent for support or the child is a full-time or
part-time | ||||||
4 | student and is dependent for support. The term "health | ||||||
5 | insurance
plan" does not include supplemental benefits that are | ||||||
6 | not part of the basic
group health insurance plan.
If the
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7 | injured employee subsequently dies, the employer shall | ||||||
8 | continue to pay the
entire health insurance premium for the | ||||||
9 | surviving spouse until remarried and
for the dependent children | ||||||
10 | under the conditions established in this Section.
An employer | ||||||
11 | shall not be required to pay the premium of the health | ||||||
12 | insurance plan as provided in this Section if the employee or | ||||||
13 | employee's spouse: (1) is granted disability income benefits | ||||||
14 | under Title II (42 U.S.C. 401 et seq.) or supplemental security | ||||||
15 | income benefits under Title XVI (42 U.S.C. 1381 et seq.) of the | ||||||
16 | Social Security Act, (2) accepts health insurance benefits from | ||||||
17 | another source, or (3) becomes eligible for federal Medicare | ||||||
18 | benefits. However:
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19 | (1) Health insurance benefits payable from any other | ||||||
20 | source shall reduce
benefits payable under this Section.
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21 | (2) It is unlawful for a person to willfully and | ||||||
22 | knowingly make, or cause
to be made, or to assist, conspire | ||||||
23 | with, or urge another to make, or cause to
be made, any | ||||||
24 | false, fraudulent, or misleading oral or written statement | ||||||
25 | to
obtain health insurance coverage as provided under this | ||||||
26 | Section. A violation
of this item is a Class A misdemeanor.
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1 | (3) Upon conviction for a violation described in item | ||||||
2 | (2), a law
enforcement, correctional or correctional | ||||||
3 | probation officer, or other
beneficiary who receives or | ||||||
4 | seeks to receive health insurance benefits under
this | ||||||
5 | Section shall forfeit the right to receive health insurance | ||||||
6 | benefits and
shall reimburse the employer for all benefits | ||||||
7 | paid due to the fraud or other
prohibited activity. For | ||||||
8 | purposes of this item, "conviction" means a
determination | ||||||
9 | of guilt that is the result of a plea or trial, regardless | ||||||
10 | of
whether adjudication is withheld.
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11 | (b) In order for the law enforcement, correctional or | ||||||
12 | correctional probation
officer, firefighter, spouse, or | ||||||
13 | dependent children to be eligible for
insurance coverage under | ||||||
14 | this Act, the injury or death must have occurred as
the result | ||||||
15 | of the officer's response to fresh pursuit, the officer or
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16 | firefighter's response to what is reasonably believed to be an | ||||||
17 | emergency, an
unlawful act perpetrated by another, or during | ||||||
18 | the investigation of a criminal
act. Nothing in this Section | ||||||
19 | shall be construed to limit health insurance
coverage or | ||||||
20 | pension benefits for which the officer, firefighter, spouse, or
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21 | dependent children may otherwise be eligible.
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22 | (c) "Catastrophic injury" means an injury that is one of | ||||||
23 | the following: | ||||||
24 | (1) spinal cord injury involving severe paralysis of an | ||||||
25 | arm, a leg, or the trunk; | ||||||
26 | (2) any amputation of an arm, a hand, a foot, or a leg |
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1 | that involves the effective loss of use of that appendage; | ||||||
2 | (3) severe brain or closed head injury as evidenced by: | ||||||
3 | (A) severe sensory or motor disturbances; | ||||||
4 | (B) severe communication disturbances; | ||||||
5 | (C) severe complex integrated disturbances of | ||||||
6 | cerebral function; | ||||||
7 | (D) severe disturbances of consciousness; | ||||||
8 | (E) severe episodic neurological disorders; or | ||||||
9 | (F) other conditions at least as severe in nature | ||||||
10 | as any condition provided in items (A) through (E); | ||||||
11 | (4) second or third degree burns over 50% of the body | ||||||
12 | as a whole or third degree burns to 50% or more of the face | ||||||
13 | or hands; | ||||||
14 | (5) total vision loss; or | ||||||
15 | (6) any other injury, the direct and proximate cause of | ||||||
16 | which permanently prevents an individual from performing | ||||||
17 | any gainful work. | ||||||
18 | (d) An injured employee who on or after the effective date | ||||||
19 | of this amendatory Act of the 98th General Assembly suffers an | ||||||
20 | injury that is not considered catastrophic under subsection (c) | ||||||
21 | of this Section, but would otherwise qualify the individual to | ||||||
22 | receive a line-of-duty disability pension that was awarded as a | ||||||
23 | consequence of the officer's response to fresh pursuit, the | ||||||
24 | officer's or firefighter's response to what is reasonably | ||||||
25 | believed to be an emergency, an unlawful act perpetrated by | ||||||
26 | another, or during the investigation of a criminal act or under |
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1 | Section 3-114.1 or 4-110 of the Illinois Pension Code or a duty | ||||||
2 | death benefit under Section 3 of the Line of Duty Compensation | ||||||
3 | Act, shall be considered to have suffered a qualifying | ||||||
4 | disability and shall be entitled to receive health insurance | ||||||
5 | benefits as provided in this subsection. | ||||||
6 | An injured employee who has suffered a qualifying | ||||||
7 | disability is entitled to purchase or continue to purchase the | ||||||
8 | same health insurance benefits provided by the unit of | ||||||
9 | government at the time that the injured employee was injured | ||||||
10 | for a period of 5 years following the qualifying disability. | ||||||
11 | The employer shall pay not less than 50% of the total insurance | ||||||
12 | premium. | ||||||
13 | The injured employee is entitled to purchase or continue to | ||||||
14 | purchase health insurance coverage until the earlier of: (1) a | ||||||
15 | decision being rendered granting disability income benefits | ||||||
16 | under Title II (42 U.S.C. 401 et seq.) or supplemental security | ||||||
17 | income benefits under Title XVI (42 U.S.C. 1381 et seq.) of the | ||||||
18 | Social Security Act, (2) the injured employee accepting health | ||||||
19 | insurance benefits from another source, or (3) the date the | ||||||
20 | injured employee becomes eligible for federal Medicare | ||||||
21 | benefits. | ||||||
22 | (e) By July 1 of every year, a person receiving benefits | ||||||
23 | under this Act shall be required to submit to the employer, on | ||||||
24 | a form provided by the employer, a report that shall include | ||||||
25 | the following: | ||||||
26 | (1) gainful employment by the beneficiary within the |
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1 | reporting period; | ||||||
2 | (2) compensation earned by the beneficiary as a result | ||||||
3 | of the employment; | ||||||
4 | (3) current annual household income; | ||||||
5 | (4) whether the injured employee, or his or her spouse, | ||||||
6 | has been offered any insurance from another source; and | ||||||
7 | (5) whether the injured employee, or his or her spouse, | ||||||
8 | is currently enrolled in any insurance plan from another | ||||||
9 | source. | ||||||
10 | Any information collected by the employer under this | ||||||
11 | Section shall be exempt from the requirements of the Freedom of | ||||||
12 | Information Act except data collected in the aggregate that | ||||||
13 | does not reveal any personal information of the injured | ||||||
14 | employee. | ||||||
15 | (f) The employer may cancel benefits being provided under | ||||||
16 | this Act for any beneficiary (1) whose household income exceeds | ||||||
17 | 800% of the poverty level; (2) who has rejected an offer of | ||||||
18 | insurance coverage from another source; or (3) who is currently | ||||||
19 | enrolled in an insurance plan from another source. Benefits may | ||||||
20 | be denied any individual who fails to timely file a completed | ||||||
21 | report under this Section. Not less than 60 days prior to July | ||||||
22 | 1, an employer shall notify any employee receiving benefits | ||||||
23 | under this Act of that employee's obligation to file a report | ||||||
24 | under this Section. Any employee that fails to timely file a | ||||||
25 | report under this Section by July 1 shall be notified that he | ||||||
26 | or she has 30 days to submit the report. Any employee who fails |
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1 | to file 30 days after receiving this notice may be denied | ||||||
2 | benefits. | ||||||
3 | (Source: P.A. 90-535, eff. 11-14-97.)
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4 | (820 ILCS 320/17 new) | ||||||
5 | Sec. 17. Claims report. | ||||||
6 | (a) An employer subject to this Act shall file a claims | ||||||
7 | report with the Public Pension Division of the Department of | ||||||
8 | Insurance in the format prepared by the Division. The Division | ||||||
9 | shall design the form and prescribe the content of the report. | ||||||
10 | At least 60 days before the filing deadline, the Division shall | ||||||
11 | provide the form to the employers subject to this Act. The | ||||||
12 | claims report shall be filed no later than December 31 of each | ||||||
13 | year. The claims report shall set forth the required | ||||||
14 | information for the 12-month period ending on June 30 preceding | ||||||
15 | the deadline date for filing the report. The claims report | ||||||
16 | shall, at a minimum, contain the following information: | ||||||
17 | (1) the number of claims filed under this Act during | ||||||
18 | the reporting period; | ||||||
19 | (2) the number of claims awarded under this Act during | ||||||
20 | the reporting period; | ||||||
21 | (3) the dollar amount of all claims awarded under this | ||||||
22 | Act during the reporting period; | ||||||
23 | (4) the number of claims paid under this Act during the | ||||||
24 | reporting period regardless of when the claim was awarded; | ||||||
25 | (5) the dollar amount of all claims paid under this Act |
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1 | during the reporting period regardless of when the claim | ||||||
2 | was awarded; | ||||||
3 | (6) the annual cost of the benefit and any available | ||||||
4 | long-term cost projections; | ||||||
5 | (7) the nature of the injury; | ||||||
6 | (8) any gainful employment during the annual reporting | ||||||
7 | period; | ||||||
8 | (9) the compensation earned as a result of that | ||||||
9 | employment; and | ||||||
10 | (10) any accessible insurance options. | ||||||
11 | The claims report shall redact any information as required by | ||||||
12 | the Health Insurance Portability and Accountability Act of 1996 | ||||||
13 | (HIPAA). | ||||||
14 | (b) On or before July 1 of each year, the Public Pension | ||||||
15 | Division of the Department of Insurance shall submit a report | ||||||
16 | to the Governor and General Assembly setting forth the | ||||||
17 | information received under subsection (a) with respect to the | ||||||
18 | most recently completed reporting period. The requirement for | ||||||
19 | reporting to the General Assembly shall be satisfied by filing | ||||||
20 | copies of the report with the Speaker, Minority Leader, and | ||||||
21 | Clerk of the House of Representatives, the President, Minority | ||||||
22 | Leader, and Secretary of the Senate, the Legislative Research | ||||||
23 | Unit as required under Section 3.1 of the General Assembly | ||||||
24 | Organization Act, and the State Government Report Distribution | ||||||
25 | Center for the General Assembly as required under paragraph (t) | ||||||
26 | of Section 7 of the State Library Act. Upon request, the |
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1 | Division shall provide copies of the report at no charge to | ||||||
2 | employers subject to this Act, to public libraries, and to | ||||||
3 | State agencies. | ||||||
4 | (c) By July 1 of every year, a person receiving benefits | ||||||
5 | under this Act shall be required to file, on a form provided by | ||||||
6 | the employer, a report that shall include the following: | ||||||
7 | (1) gainful employment by the beneficiary within the | ||||||
8 | reporting period; | ||||||
9 | (2) compensation earned by the beneficiary as a result | ||||||
10 | of the employment; | ||||||
11 | (3) current annual household income; | ||||||
12 | (4) whether the injured employee, or his or her spouse, | ||||||
13 | has been offered comparable insurance from another source; | ||||||
14 | and | ||||||
15 | (5) whether the injured employee, or his or her spouse, | ||||||
16 | is currently enrolled in a comparable insurance plan from | ||||||
17 | another source. | ||||||
18 | Benefits may be denied any individual who fails to timely | ||||||
19 | file a report under this subsection.
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20 | Section 99. Effective date. This Act takes effect upon | ||||||
21 | becoming law.".
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