Bill Title: Amends the Department of Human Services Act. Requires the Governor to create a Management Improvement Initiative Committee that shall include the Management Improvement Initiative Departmental Leadership Team to implement the recommendations made in the report submitted to the General Assembly on January 1, 2011 as required under Public Act 96-1141. Provides that the Team shall be comprised of a representative from the Department on Aging and the Departments of Children and Family Services, Healthcare and Family Services, Human Services, and Public Health, and that the Team members shall integrate the Committee's objectives into their respective departmental operations and shall submit a progress report to the General Assembly by May 1, 2011 on the progress made in implementing the recommendations made in the report submitted to the General Assembly on January 1, 2011 as required under Public Act 96-1141. Provides that additional duties of the Committee shall include reviewing contracts held with community health and human service providers on the regulations and work processes required by the departments and their divisions; and describing how improved regulations, reporting, monitoring, compliance, auditing, certification, licensing, and work processes are measured at the community vendor, contractor, and departmental levels, and how they have reduced redundant regulations, reporting, monitoring, compliance, auditing, certification, licensing, and work processes. Contains provisions concerning the composition of the Committee. Effective immediately.
Spectrum: Moderate Partisan Bill (Democrat 8-1)
Status: (Passed) 2012-01-13 - Public Act . . . . . . . . . 97-0668
[SB1538 Detail]Download: Illinois-2011-SB1538-Chaptered.html
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| Public Act 097-0668
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| SB1538 Enrolled | LRB097 07771 KTG 47883 b |
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AN ACT concerning State 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 3 and 8 as follows:
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(5 ILCS 375/3) (from Ch. 127, par. 523)
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Sec. 3. Definitions. Unless the context otherwise |
requires, the
following words and phrases as used in this Act |
shall have the following
meanings. The Department may define |
these and other words and phrases
separately for the purpose of |
implementing specific programs providing benefits
under this |
Act.
|
(a) "Administrative service organization" means any |
person, firm or
corporation experienced in the handling of |
claims which is
fully qualified, financially sound and capable |
of meeting the service
requirements of a contract of |
administration executed with the Department.
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(b) "Annuitant" means (1) an employee who retires, or has |
retired,
on or after January 1, 1966 on an immediate annuity |
under the provisions
of Articles 2, 14 (including an employee |
who has elected to receive an alternative retirement |
cancellation payment under Section 14-108.5 of the Illinois |
Pension Code in lieu of an annuity), 15 (including an employee |
|
who has retired under the optional
retirement program |
established under Section 15-158.2),
paragraphs (2), (3), or |
(5) of Section 16-106, or
Article 18 of the Illinois Pension |
Code; (2) any person who was receiving
group insurance coverage |
under this Act as of March 31, 1978 by
reason of his status as |
an annuitant, even though the annuity in relation
to which such |
coverage was provided is a proportional annuity based on less
|
than the minimum period of service required for a retirement |
annuity in
the system involved; (3) any person 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; (4) the spouse of any person who
is receiving a |
retirement annuity under Article 18 of the Illinois Pension
|
Code and who is covered under a group health insurance program |
sponsored
by a governmental employer other than the State of |
Illinois and who has
irrevocably elected to waive his or her |
coverage under this Act and to have
his or her spouse |
considered as the "annuitant" under this Act and not as
a |
"dependent"; or (5) an employee who retires, or has retired, |
from a
qualified position, as determined according to rules |
promulgated by the
Director, under a qualified local |
government, a qualified rehabilitation
facility, a qualified |
domestic violence shelter or service, or a qualified child |
advocacy center. (For definition
of "retired employee", see (p) |
post).
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(b-5) "New SERS annuitant" means a person who, on or after |
January 1,
1998, becomes an annuitant, as defined in subsection |
(b), by virtue of
beginning to receive a retirement annuity |
under Article 14 of the Illinois
Pension Code (including an |
employee who has elected to receive an alternative retirement |
cancellation payment under Section 14-108.5 of that Code in |
lieu of an annuity), and is eligible to participate in the |
basic program of group
health benefits provided for annuitants |
under this Act.
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(b-6) "New SURS annuitant" means a person who (1) on or |
after January 1,
1998, becomes an annuitant, as defined in |
subsection (b), by virtue of
beginning to receive a retirement |
annuity under Article 15 of the Illinois
Pension Code, (2) has |
not made the election authorized under Section 15-135.1
of the |
Illinois Pension Code, and (3) is eligible to participate in |
the basic
program of group
health benefits provided for |
annuitants under this Act.
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(b-7) "New TRS State annuitant" means a person who, on or |
after July
1, 1998, becomes an annuitant, as defined in |
subsection (b), by virtue of
beginning to receive a retirement |
annuity under Article 16 of the Illinois
Pension Code based on |
service as a teacher as defined in
paragraph (2), (3), or (5) |
of Section 16-106 of that Code, and is eligible
to participate |
in the basic program of group health benefits provided for
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annuitants under this Act.
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(c) "Carrier" means (1) an insurance company, a corporation |
|
organized
under the Limited Health Service Organization Act or |
the Voluntary Health
Services Plan Act, a partnership, or other |
nongovernmental organization,
which is authorized to do group |
life or group health insurance business in
Illinois, or (2) the |
State of Illinois as a self-insurer.
|
(d) "Compensation" means salary or wages payable on a |
regular
payroll by the State Treasurer on a warrant of the |
State Comptroller out
of any State, trust or federal fund, or |
by the Governor of the State
through a disbursing officer of |
the State out of a trust or out of
federal funds, or by any |
Department out of State, trust, federal or
other funds held by |
the State Treasurer or the Department, to any person
for |
personal services currently performed, and ordinary or |
accidental
disability benefits under Articles 2, 14, 15 |
(including ordinary or accidental
disability benefits under |
the optional retirement program established under
Section |
15-158.2), paragraphs (2), (3), or (5) of
Section 16-106, or |
Article 18 of the Illinois Pension Code, for disability
|
incurred after January 1, 1966, or benefits payable under the |
Workers'
Compensation or Occupational Diseases Act or benefits |
payable under a sick
pay plan established in accordance with |
Section 36 of the State Finance Act.
"Compensation" also means |
salary or wages paid to an employee of any
qualified local |
government, qualified rehabilitation facility,
qualified |
domestic violence shelter or service, or qualified child |
advocacy center.
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(e) "Commission" means the State Employees Group Insurance |
Advisory
Commission authorized by this Act. Commencing July 1, |
1984, "Commission"
as used in this Act means the Commission on |
Government Forecasting and Accountability as
established by |
the Legislative Commission Reorganization Act of 1984.
|
(f) "Contributory", when referred to as contributory |
coverage, shall
mean optional coverages or benefits elected by |
the member toward the cost of
which such member makes |
contribution, or which are funded in whole or in part
through |
the acceptance of a reduction in earnings or the foregoing of |
an
increase in earnings by an employee, as distinguished from |
noncontributory
coverage or benefits which are paid entirely by |
the State of Illinois
without reduction of the member's salary.
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(g) "Department" means any department, institution, board,
|
commission, officer, court or any agency of the State |
government
receiving appropriations and having power to |
certify payrolls to the
Comptroller authorizing payments of |
salary and wages against such
appropriations as are made by the |
General Assembly from any State fund, or
against trust funds |
held by the State Treasurer and includes boards of
trustees of |
the retirement systems created by Articles 2, 14, 15, 16 and
18 |
of the Illinois Pension Code. "Department" also includes the |
Illinois
Comprehensive Health Insurance Board, the Board of |
Examiners established under
the Illinois Public Accounting |
Act, and the Illinois Finance Authority.
|
(h) "Dependent", when the term is used in the context of |
|
the health
and life plan, means a member's spouse and any child |
(1) from
birth to age 26 including an adopted child, a child |
who lives with the
member from the time of the filing of a |
petition for adoption until entry
of an order of adoption, a |
stepchild or adjudicated child, or a child who lives with the |
member
if such member is a court appointed guardian of the |
child or (2)
age 19 or over who is mentally
or physically |
disabled from a cause originating prior to the age of 19 (age |
26 if enrolled as an adult child dependent). For
the health |
plan only, the term "dependent" also includes (1) any person
|
enrolled prior to the effective date of this Section who is |
dependent upon
the member to the extent that the member may |
claim such person as a
dependent for income tax deduction |
purposes and (2) any person who
has received after June 30, |
2000 an organ transplant and who is financially
dependent upon |
the member and eligible to be claimed as a dependent for income
|
tax purposes. A member requesting to cover any dependent must |
provide documentation as requested by the Department of Central |
Management Services and file with the Department any and all |
forms required by the Department.
|
(i) "Director" means the Director of the Illinois |
Department of Central
Management Services or of any successor |
agency designated to administer this Act.
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(j) "Eligibility period" means the period of time a member |
has to
elect enrollment in programs or to select benefits |
without regard to
age, sex or health.
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(k) "Employee" means and includes each officer or employee |
in the
service of a department who (1) receives his |
compensation for
service rendered to the department on a |
warrant issued pursuant to a payroll
certified by a department |
or on a warrant or check issued and drawn by a
department upon |
a trust, federal or other fund or on a warrant issued
pursuant |
to a payroll certified by an elected or duly appointed officer
|
of the State or who receives payment of the performance of |
personal
services on a warrant issued pursuant to a payroll |
certified by a
Department and drawn by the Comptroller upon the |
State Treasurer against
appropriations made by the General |
Assembly from any fund or against
trust funds held by the State |
Treasurer, and (2) is employed full-time or
part-time in a |
position normally requiring actual performance of duty
during |
not less than 1/2 of a normal work period, as established by |
the
Director in cooperation with each department, except that |
persons elected
by popular vote will be considered employees |
during the entire
term for which they are elected regardless of |
hours devoted to the
service of the State, and (3) except that |
"employee" does not include any
person who is not eligible by |
reason of such person's employment to
participate in one of the |
State retirement systems under Articles 2, 14, 15
(either the |
regular Article 15 system or the optional retirement program
|
established under Section 15-158.2) or 18, or under paragraph |
(2), (3), or
(5) of Section 16-106, of the Illinois
Pension |
Code, but such term does include persons who are employed |
|
during
the 6 month qualifying period under Article 14 of the |
Illinois Pension
Code. Such term also includes any person who |
(1) after January 1, 1966,
is receiving ordinary or accidental |
disability benefits under Articles
2, 14, 15 (including |
ordinary or accidental disability benefits under the
optional |
retirement program established under Section 15-158.2), |
paragraphs
(2), (3), or (5) of Section 16-106, or Article 18 of |
the
Illinois Pension Code, for disability incurred after |
January 1, 1966, (2)
receives total permanent or total |
temporary disability under the Workers'
Compensation Act or |
Occupational Disease Act as a result of injuries
sustained or |
illness contracted in the course of employment with the
State |
of Illinois, or (3) is not otherwise covered under this Act and |
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. |
However, a person who satisfies the criteria
of the foregoing |
definition of "employee" except that such person is 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 is also an "employee" for the purposes of |
this Act. "Employee" also
includes any person receiving or |
eligible for benefits under a sick pay
plan established in |
accordance with Section 36 of the State Finance Act.
"Employee" |
also includes (i) each officer or employee in the service of a
|
qualified local government, including persons appointed as |
|
trustees of
sanitary districts regardless of hours devoted to |
the service of the
sanitary district, (ii) each employee in the |
service of a qualified
rehabilitation facility, (iii) each |
full-time employee in the service of a
qualified domestic |
violence shelter or service, and (iv) each full-time employee |
in the service of a qualified child advocacy center, as |
determined according to
rules promulgated by the Director.
|
(l) "Member" means an employee, annuitant, retired |
employee or survivor. In the case of an annuitant or retired |
employee who first becomes an annuitant or retired employee on |
or after the effective date of this amendatory Act of the 97th |
General Assembly, the individual must meet the minimum vesting |
requirements of the applicable retirement system in order to be |
eligible for group insurance benefits under that system. In the |
case of a survivor who first becomes a survivor on or after the |
effective date of this amendatory Act of the 97th General |
Assembly, the deceased employee, annuitant, or retired |
employee upon whom the annuity is based must have been eligible |
to participate in the group insurance system under the |
applicable retirement system in order for the survivor to be |
eligible for group insurance benefits under that system.
|
(m) "Optional coverages or benefits" means those coverages |
or
benefits available to the member on his or her voluntary |
election, and at
his or her own expense.
|
(n) "Program" means the group life insurance, health |
benefits and other
employee benefits designed and contracted |
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for by the Director under this Act.
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(o) "Health plan" means a health benefits
program offered
|
by the State of Illinois for persons eligible for the plan.
|
(p) "Retired employee" means any person who would be an |
annuitant as
that term is defined herein but for the fact that |
such person retired prior to
January 1, 1966. Such term also |
includes any person formerly employed by
the University of |
Illinois in the Cooperative Extension Service who would
be an |
annuitant but for the fact that such person 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.
|
(q) "Survivor" means a person receiving an annuity as a |
survivor of an
employee or of an annuitant. "Survivor" also |
includes: (1) the surviving
dependent of a person who satisfies |
the definition of "employee" except that
such person is 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; (2) the surviving
dependent of any |
person formerly employed by the University of Illinois in
the |
Cooperative Extension Service who would be an annuitant except |
for the
fact that such person 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; and (3) the surviving dependent of a person who |
was an annuitant under this Act by virtue of receiving an |
|
alternative retirement cancellation payment under Section |
14-108.5 of the Illinois Pension Code.
|
(q-2) "SERS" means the State Employees' Retirement System |
of Illinois, created under Article 14 of the Illinois Pension |
Code.
|
(q-3) "SURS" means the State Universities Retirement |
System, created under Article 15 of the Illinois Pension Code.
|
(q-4) "TRS" means the Teachers' Retirement System of the |
State of Illinois, created under Article 16 of the Illinois |
Pension Code.
|
(q-5) "New SERS survivor" means a survivor, as defined in |
subsection (q),
whose annuity is paid under Article 14 of the |
Illinois Pension Code and is
based on the death of (i) an |
employee whose death occurs on or after January 1,
1998, or |
(ii) a new SERS annuitant as defined in subsection (b-5). "New |
SERS survivor" includes the surviving dependent of a person who |
was an annuitant under this Act by virtue of receiving an |
alternative retirement cancellation payment under Section |
14-108.5 of the Illinois Pension Code.
|
(q-6) "New SURS survivor" means a survivor, as defined in |
subsection (q),
whose annuity is paid under Article 15 of the |
Illinois Pension Code and is
based on the death of (i) an |
employee whose death occurs on or after January 1,
1998, or |
(ii) a new SURS annuitant as defined in subsection (b-6).
|
(q-7) "New TRS State survivor" means a survivor, as defined |
in subsection
(q), whose annuity is paid under Article 16 of |
|
the Illinois Pension Code and is
based on the death of (i) an |
employee who is a teacher as defined in paragraph
(2), (3), or |
(5) of Section 16-106 of that Code and whose death occurs on or
|
after July 1, 1998, or (ii) a new TRS State annuitant as |
defined in subsection
(b-7).
|
(r) "Medical services" means the services provided within |
the scope
of their licenses by practitioners in all categories |
licensed under the
Medical Practice Act of 1987.
|
(s) "Unit of local government" means any county, |
municipality,
township, school district (including a |
combination of school districts under
the Intergovernmental |
Cooperation Act), special district or other unit,
designated as |
a
unit of local government by law, which exercises limited |
governmental
powers or powers in respect to limited |
governmental subjects, any
not-for-profit association with a |
membership that primarily includes
townships and township |
officials, that has duties that include provision of
research |
service, dissemination of information, and other acts for the
|
purpose of improving township government, and that is funded |
wholly or
partly in accordance with Section 85-15 of the |
Township Code; any
not-for-profit corporation or association, |
with a membership consisting
primarily of municipalities, that |
operates its own utility system, and
provides research, |
training, dissemination of information, or other acts to
|
promote cooperation between and among municipalities that |
provide utility
services and for the advancement of the goals |
|
and purposes of its
membership;
the Southern Illinois |
Collegiate Common Market, which is a consortium of higher
|
education institutions in Southern Illinois; the Illinois |
Association of
Park Districts; and any hospital provider that |
is owned by a county that has 100 or fewer hospital beds and |
has not already joined the program. "Qualified
local |
government" means a unit of local government approved by the |
Director and
participating in a program created under |
subsection (i) of Section 10 of this
Act.
|
(t) "Qualified rehabilitation facility" means any |
not-for-profit
organization that is accredited by the |
Commission on Accreditation of
Rehabilitation Facilities or |
certified by the Department
of Human Services (as successor to |
the Department of Mental Health
and Developmental |
Disabilities) to provide services to persons with
disabilities
|
and which receives funds from the State of Illinois for |
providing those
services, approved by the Director and |
participating in a program created
under subsection (j) of |
Section 10 of this Act.
|
(u) "Qualified domestic violence shelter or service" means |
any Illinois
domestic violence shelter or service and its |
administrative offices funded
by the Department of Human |
Services (as successor to the Illinois Department of
Public |
Aid),
approved by the Director and
participating in a program |
created under subsection (k) of Section 10.
|
(v) "TRS benefit recipient" means a person who:
|
|
(1) is not a "member" as defined in this Section; and
|
(2) is receiving a monthly benefit or retirement |
annuity
under Article 16 of the Illinois Pension Code; and
|
(3) either (i) has at least 8 years of creditable |
service under Article
16 of the Illinois Pension Code, or |
(ii) was enrolled in the health insurance
program offered |
under that Article on January 1, 1996, or (iii) is the |
survivor
of a benefit recipient who had at least 8
years of |
creditable service under Article 16 of the Illinois Pension |
Code or
was enrolled in the health insurance program |
offered under that Article on
the effective date of this |
amendatory Act of 1995, or (iv) is a recipient or
survivor |
of a recipient of a disability benefit under Article 16 of |
the
Illinois Pension Code.
|
(w) "TRS dependent beneficiary" means a person who:
|
(1) is not a "member" or "dependent" as defined in this |
Section; and
|
(2) is a TRS benefit recipient's: (A) spouse, (B) |
dependent parent who
is receiving at least half of his or |
her support from the TRS benefit
recipient, or (C) natural, |
step, adjudicated, or adopted child who is (i) under age |
26, (ii) was, on January 1, 1996, participating as a |
dependent
beneficiary in the health insurance program |
offered under Article 16 of the
Illinois Pension Code, or |
(iii) age 19 or over who is mentally or physically disabled |
from a cause originating prior to the age of 19 (age 26 if |
|
enrolled as an adult child).
|
"TRS dependent beneficiary" does not include, as indicated |
under paragraph (2) of this subsection (w), a dependent of the |
survivor of a TRS benefit recipient who first becomes a |
dependent of a survivor of a TRS benefit recipient on or after |
the effective date of this amendatory Act of the 97th General |
Assembly unless that dependent would have been eligible for |
coverage as a dependent of the deceased TRS benefit recipient |
upon whom the survivor benefit is based. |
(x) "Military leave" refers to individuals in basic
|
training for reserves, special/advanced training, annual |
training, emergency
call up, activation by the President of the |
United States, or any other training or duty in service to the |
United States Armed Forces.
|
(y) (Blank).
|
(z) "Community college benefit recipient" means a person |
who:
|
(1) is not a "member" as defined in this Section; and
|
(2) is receiving a monthly survivor's annuity or |
retirement annuity
under Article 15 of the Illinois Pension |
Code; and
|
(3) either (i) was a full-time employee of a community |
college district or
an association of community college |
boards created under the Public Community
College Act |
(other than an employee whose last employer under Article |
15 of the
Illinois Pension Code was a community college |
|
district subject to Article VII
of the Public Community |
College Act) and was eligible to participate in a group
|
health benefit plan as an employee during the time of |
employment with a
community college district (other than a |
community college district subject to
Article VII of the |
Public Community College Act) or an association of |
community
college boards, or (ii) is the survivor of a |
person described in item (i).
|
(aa) "Community college dependent beneficiary" means a |
person who:
|
(1) is not a "member" or "dependent" as defined in this |
Section; and
|
(2) is a community college benefit recipient's: (A) |
spouse, (B) dependent
parent who is receiving at least half |
of his or her support from the community
college benefit |
recipient, or (C) natural, step, adjudicated, or adopted |
child who is (i)
under age 26, or (ii)
age 19 or over and |
mentally or physically disabled from a cause originating |
prior to the age of 19 (age 26 if enrolled as an adult |
child).
|
"Community college dependent beneficiary" does not |
include, as indicated under paragraph (2) of this subsection |
(aa), a dependent of the survivor of a community college |
benefit recipient who first becomes a dependent of a survivor |
of a community college benefit recipient on or after the |
effective date of this amendatory Act of the 97th General |
|
Assembly unless that dependent would have been eligible for |
coverage as a dependent of the deceased community college |
benefit recipient upon whom the survivor annuity is based. |
(bb) "Qualified child advocacy center" means any Illinois |
child advocacy center and its administrative offices funded by |
the Department of Children and Family Services, as defined by |
the Children's Advocacy Center Act (55 ILCS 80/), approved by |
the Director and participating in a program created under |
subsection (n) of Section 10.
|
(Source: P.A. 95-331, eff. 8-21-07; 95-632, eff. 9-25-07; |
96-756, eff. 1-1-10; 96-1519, eff. 2-4-11.)
|
(5 ILCS 375/8) (from Ch. 127, par. 528)
|
Sec. 8. Eligibility.
|
(a) Each employee member 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 Members electing coverage for eligible dependents |
shall have
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 and submission of all documentation |
and forms required by the Director.
|
(1) Every member originally eligible to elect |
dependent coverage, but not
electing it during the original |
|
eligibility period, may subsequently obtain
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.
|
(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.
|
(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,
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.
|
(b) New employees shall be immediately insured for the |
basic group
life insurance and covered by the program of 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
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
established supplementing |
this Act, in which event application must be made
within the |
new eligibility period.
|
(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
|
eligible and covered 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 Retired
employees may elect coverage for eligible |
dependents and shall have the
coverage effective immediately, |
provided that the election is properly
filed in accordance with |
required filing dates and 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.
|
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.
|
Regardless of other provisions herein regarding late |
enrollment or other
qualifications, as appropriate, the
|
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
the Director |
for certain members only when special circumstances occur that
|
affect only those members.
|
(d) 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
choice period, subject |
to the conditions in this subsection.
|
(1) 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.
|
(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.
|
(3) Members may also re-enroll in the program of health |
benefits during
any annual benefit choice period, without |
evidence of insurability.
|
(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.
|
(d-5) Beginning July 1, 2005, the Director may establish a |
program of financial incentives to encourage annuitants |
receiving a retirement annuity from the State Employees |
Retirement System, 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 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.
|
(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.
|
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.
|
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.
|
(Source: P.A. 94-95, eff. 7-1-05; 94-109, eff. 7-1-05; 95-331, |
eff. 8-21-07.)
|
Section 99. Effective date. This Act takes effect upon |
becoming law.
|
