There is a newer version of the Illinois Compiled Statutes
2005 Illinois Code - Chapter 5 General Provisions 5 ILCS 375/ State Employees Group Insurance Act of 1971.
(5 ILCS 375/1) (from Ch. 127, par. 521)
Sec. 1.
This Act shall be known and may be cited as the "State Employees Group
Insurance Act of 1971".
(Source: P. A. 77‑476.)
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(3) either (i) has at least 8 years of creditable | ||
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(w) "TRS dependent beneficiary" means a person who:
(1) is not a "member" or "dependent" as defined in | ||
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(2) is a TRS benefit recipient's: (A) spouse, (B) | ||
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(x) "Military leave with pay and benefits" refers to individuals in basic
training for reserves, special/advanced training, annual training, emergency
call up, or activation by the President of the United States with approved pay
and benefits.
(y) "Military leave without pay and benefits" refers to
individuals who enlist for active duty in a regular component of the U.S. Armed
Forces or other duty not specified or authorized under military leave with pay
and benefits.
(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 | ||
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(3) either (i) was a full‑time employee of a | ||
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(aa) "Community college dependent beneficiary" means a person who:
(1) is not a "member" or "dependent" as defined in | ||
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(2) is a community college benefit recipient's: (A) | ||
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(Source: P.A. 93‑205, eff. 1‑1‑04; 93‑839, eff. 7‑30‑04; 94‑32, eff. 6‑15‑05.)
(Text of Section from P.A. 94‑82)
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.
(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 or a qualified rehabilitation
facility or a qualified domestic violence shelter or service. (For definition
of "retired employee", see (p) post).
(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.
(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.
(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
annuitants under this Act.
(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 or qualified rehabilitation facility or a
qualified domestic violence shelter or service.
(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.
(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 unmarried child (1) from
birth to age 19 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 recognized child who lives with the
member in a parent‑child relationship, or a child who lives with the member
if such member is a court appointed guardian of the child, or (2)
age 19 to 23 enrolled as a full‑time student in any accredited school,
financially dependent upon the member, and eligible to be claimed as a
dependent for income tax purposes, or (3) age 19 or over who is mentally
or physically handicapped. For
the health plan only, the term "dependent" also includes 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; no other such
person may be enrolled.
For the health plan only, the term "dependent" also includes 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.
(i) "Director" means the Director of the Illinois Department of Central
Management Services.
(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.
(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 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, and each employee in the service of a qualified
rehabilitation facility and each full‑time employee in the service of a
qualified domestic violence shelter or service, as determined according to
rules promulgated by the Director.
(l) "Member" means an employee, annuitant, retired employee or survivor.
(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 for by the Director under this Act.
(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 | ||
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(3) either (i) has at least 8 years of creditable | ||
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(w) "TRS dependent beneficiary" means a person who:
(1) is not a "member" or "dependent" as defined in | ||
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(2) is a TRS benefit recipient's: (A) spouse, (B) | ||
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(x) "Military leave with pay and benefits" refers to individuals in basic
training for reserves, special/advanced training, annual training, emergency
call up, or activation by the President of the United States with approved pay
and benefits.
(y) "Military leave without pay and benefits" refers to
individuals who enlist for active duty in a regular component of the U.S. Armed
Forces or other duty not specified or authorized under military leave with pay
and benefits.
(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 | ||
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(3) either (i) was a full‑time employee of a | ||
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(aa) "Community college dependent beneficiary" means a person who:
(1) is not a "member" or "dependent" as defined in | ||
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(2) is a community college benefit recipient's: (A) | ||
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(Source: P.A. 93‑205, eff. 1‑1‑04; 93‑839, eff. 7‑30‑04; 93‑1067, eff. 1‑15‑05; 94‑82, eff. 1‑1‑06.)
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(5 ILCS 375/4) (from Ch. 127, par. 524)
Sec. 4.
The Commission shall meet with the Department of
Central Management Services and advise the Department of Central Management
Services on all matters relating to policy and the administration of this Act.
(Source: P.A. 85‑848.)
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(ii) Within 30 days after notice of the awarding or | ||
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(iii) No contract subject to this Section may be | ||
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(iv) If the Director seeks to make any substantive | ||
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(v) By the date of the beginning of the annual | ||
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(vi) The Director must provide the reports, | ||
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All contracts entered into under this Section are subject to appropriation and shall comply with Section 20‑60(b) of the Illinois Procurement Code (30 ILCS 500/20‑60(b)).
The Director shall contract or otherwise make available group
life insurance, health benefits and other
employee benefits to eligible members and, where elected,
their eligible dependents. Any contract or, if
applicable, contracts or other arrangement for provision of benefits
shall be on terms consistent with State policy and
based on, but not limited to, such
criteria as administrative cost, service capabilities of the carrier
or other contractor and premiums, fees or charges as related to benefits.
The Director may prepare and issue specifications
for group life insurance, health benefits, other employee benefits
and administrative services for the purpose of receiving proposals
from interested parties.
The Director is authorized to execute a contract, or
contracts, for the programs of group life insurance, health
benefits, other employee benefits and administrative services
authorized by this Act (including, without limitation, prescription drug benefits). All of the benefits provided under this Act may be
included in one or more contracts, or the benefits may be classified into
different types with each type included under one or more similar contracts
with the same or different companies.
The term of any contract may not extend beyond 5 fiscal years.
Upon recommendation of the Commission, the Director may exercise renewal
options of the same contract for up to a period of 5 years. Any
increases in premiums, fees or charges requested by a contractor whose
contract may be renewed pursuant to a renewal option contained therein,
must be justified on the basis of (1) audited experience data, (2)
increases in the costs of health care services provided under the contract,
(3) contractor performance, (4) increases in contractor responsibilities,
or (5) any combination thereof.
Any contractor shall agree to abide by all
requirements of this Act and Rules and Regulations promulgated and adopted
thereto; to submit such information and data as may from time to time be
deemed necessary by the Director for effective administration of the
provisions of this Act and the programs established
hereunder, and to fully cooperate in any audit.
(Source: P.A. 93‑839, eff. 7‑30‑04.)
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(5 ILCS 375/6) (from Ch. 127, par. 526)
Sec. 6.
Program of health benefits.
(a) The program of health benefits shall provide for protection
against the financial costs of health care expenses incurred in and out
of hospital including basic hospital‑surgical‑medical coverages. The program
may include, but shall not be limited to, such supplemental coverages as
out‑patient diagnostic X‑ray and laboratory expenses, prescription drugs,
dental services, hearing evaluations, hearing aids, the dispensing and
fitting
of hearing aids, and similar group benefits
as are now or may become available. However, nothing in this Act shall
be construed to permit, on or after July 1, 1980, the non‑contributory portion
of any such program to include the expenses of obtaining an abortion, induced
miscarriage or induced premature birth unless, in the opinion of a physician,
such procedures are necessary for the preservation of the life of the woman
seeking such treatment, or except an induced premature birth intended to
produce a live viable child and such procedure is necessary for the health
of the mother or the unborn child. The program may also include
coverage for those who rely on treatment by prayer or spiritual means
alone for healing in accordance with the tenets and practice of a
recognized religious denomination.
The program of health benefits shall be designed by the Director
(1) to provide a reasonable relationship between the benefits to be
included and the expected distribution of expenses of each such type to
be incurred by the covered members and dependents,
(2) to specify, as covered benefits and as optional benefits, the
medical services of practitioners in all categories licensed under the
Medical Practice Act of 1987, (3) to include
reasonable controls, which may include deductible and co‑insurance
provisions, applicable to some or all of the benefits, or a coordination
of benefits provision, to prevent or minimize unnecessary utilization of
the various hospital, surgical and medical expenses to be provided and
to provide reasonable assurance of stability of the program, and (4) to
provide benefits to the extent possible to members throughout the
State, wherever located, on an equitable basis.
Notwithstanding any other provision of this Section or Act,
for all members or dependents who are eligible for benefits under Social
Security or the
Railroad Retirement system or who had sufficient Medicare‑covered government
employment,
the
Department shall reduce benefits
which would otherwise be paid by Medicare, by the amount of benefits for
which the member or dependents are eligible
under Medicare, except that such reduction in benefits shall apply only to
those members or dependents who (1) first become
eligible for such medicare coverage on or after the effective date of this
amendatory Act of 1992; or (2) are 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
Medicare coverage which they had been receiving on or after the effective date
of this amendatory Act of 1992.
Notwithstanding any other provisions of this Act, where a covered member or
dependents are eligible for benefits under the federal Medicare health
insurance program (Title XVIII of the Social Security Act as added by
Public Law 89‑97, 89th Congress), benefits paid under the State of Illinois
program or plan will be reduced by the amount of benefits paid by Medicare.
For members or dependents
who are eligible for benefits under Social Security
or the Railroad Retirement system or who had sufficient Medicare‑covered
government employment, benefits shall be reduced by the amount for which
the member or dependent is eligible under Medicare,
except that such reduction in benefits shall apply only to those
members or dependents who (1) first become eligible for such
Medicare coverage on or after the effective date of this amendatory Act
of 1992; or (2) are 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 Medicare
coverage which they had been receiving on or after the effective date of this
amendatory Act of 1992. Premiums may be adjusted, where applicable, to an
amount deemed by the Director to be reasonably consistent with any reduction
of benefits.
(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, not
exceeding the amount paid by the State for the non‑contributory coverage for
other members, under the group health benefits program under this Act. The
Director shall determine the premiums to be paid
by a member under this subsection (b).
(Source: P.A. 93‑47, eff. 7‑1‑03.)
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(5 ILCS 375/6.1) (from Ch. 127, par. 526.1)
Sec. 6.1.
The program of health benefits may offer as an alternative,
available on an optional basis, coverage through
health maintenance organizations. 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.
However, nothing in this Act shall be construed to permit, after
the effective date of this amendatory Act of 1983, the noncontributory portion
of any such program to include the expenses of obtaining an abortion, induced
miscarriage or induced premature birth unless, in the opinion of a physician,
such procedures are necessary for the preservation of the life of the woman
seeking such treatment, or except an induced premature birth intended to
produce a live viable child and such procedure is necessary for the health
of the mother or her unborn child.
(Source: P.A. 85‑848.)
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(5 ILCS 375/6.2) (from Ch. 127, par. 526.2)
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, 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 the program. The State may provide the
administrative services in connection with 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.
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
requirements of federal law and Sections 367.2, 367e, and
367e.1 of the Illinois
Insurance Code.
(Source: P.A. 93‑477, eff. 1‑1‑04.)
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(5 ILCS 375/6.4) (from Ch. 127, par. 526.4)
Sec. 6.4.
Prescription drugs; cancer treatment.
If the program of
health benefits provides coverage for prescribed drugs approved by the
federal Food and Drug Administration for the treatment of certain types of
cancer, it may not exclude coverage of any drug on the basis that the drug
has been prescribed for the treatment of a type of cancer for which the
drug has not been approved by the federal Food and Drug Administration.
The drug, however, must be approved by the federal Food and Drug
Administration and must be recognized for the treatment of the specific
type of cancer for which the drug has been prescribed in
any one of the following established reference compendia:
(a) the American Medical Association Drug Evaluations;
(b) the American Hospital Formulary Service Drug Information; or
(c) the United States Pharmacopeia Drug Information; or
if not in the compendia, recommended for that particular type of cancer
in formal clinical studies, the results of which have been published in at
least two peer reviewed professional medical journals published in the
United States or Great Britain.
Any coverage required by this Section shall also include those medically
necessary services associated with the administration of a drug.
Despite the provisions of this Section, coverage shall
not be required for any experimental or investigational drugs or any drug
that the federal Food and Drug Administration has determined to be
contraindicated for treatment of the specific type of cancer for which the
drug has been prescribed. This Section shall apply only to cancer drugs.
Nothing in this Section shall be construed, expressly or by implication, to
create, impair, alter, limit, notify, enlarge, abrogate or prohibit
reimbursement for drugs used in the treatment of any other disease or
condition.
(Source: P.A. 87‑980.)
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(5 ILCS 375/6.5)
Sec. 6.5. Health benefits for TRS benefit recipients and TRS dependent
beneficiaries.
(a) Purpose. It is the purpose of this amendatory Act of 1995 to transfer
the administration of the program of health benefits established for benefit
recipients and their dependent beneficiaries under Article 16 of the Illinois
Pension Code to the Department of Central Management Services.
(b) Transition provisions. The Board of Trustees of the Teachers'
Retirement System shall continue to administer the health benefit program
established under Article 16 of the Illinois Pension Code through December 31,
1995. Beginning January 1, 1996, the Department of Central Management Services
shall be responsible for administering a program of health benefits for TRS
benefit recipients and TRS dependent beneficiaries under this Section.
The Department of Central Management Services and the Teachers' Retirement
System shall cooperate in this endeavor and shall coordinate their activities
so as to ensure a smooth transition and uninterrupted health benefit coverage.
(c) Eligibility. All persons who were enrolled in the Article 16 program at
the time of the transfer shall be eligible to participate in the program
established under this Section without any interruption or delay in coverage
or limitation as to pre‑existing medical conditions. Eligibility to
participate shall be determined by the Teachers' Retirement System.
Eligibility information shall be communicated to the Department of Central
Management Services in a format acceptable to the Department.
A TRS dependent beneficiary who is an unmarried child age 19 or over and
mentally or physically disabled does not become ineligible to participate
by reason of (i) becoming ineligible to be claimed as a dependent for Illinois
or federal income tax purposes or (ii) receiving earned income, so long as
those earnings are insufficient for the child to be fully self‑sufficient.
(d) Coverage. The level of health benefits provided under this Section
shall be similar to the level of benefits provided by the
program previously established under Article 16 of the Illinois Pension Code.
Group life insurance benefits are not included in the benefits
to be provided to TRS benefit recipients and TRS dependent beneficiaries under
this Act.
The program of health benefits under this Section may include any or all of
the benefit limitations, including but not limited to a reduction in benefits
based on eligibility for federal medicare benefits, that are provided under
subsection (a) of Section 6 of this Act for other health benefit programs under
this Act.
(e) Insurance rates and premiums. The Director shall determine the
insurance rates and premiums for TRS benefit recipients and TRS dependent
beneficiaries,
and shall present to the Teachers' Retirement System of
the State of Illinois, by April 15 of each calendar year, the rate‑setting
methodology (including but not limited to utilization levels and costs) used
to determine the amount of the health care premiums.
For Fiscal Year 1996, the premium shall be equal to | ||
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For Fiscal Year 2003, the premium shall not exceed | ||
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For Fiscal Year 2004, the premium shall not exceed | ||
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For Fiscal Year 2005, the premium shall not exceed a | ||
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For Fiscal Year 2006, the premium shall not exceed a | ||
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For Fiscal Year 2007, the premium shall not exceed a | ||
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For Fiscal Year 2008 and thereafter, the premium in | ||
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Rates and premiums may be based in part on age and eligibility for federal
medicare coverage. However, the cost of participation for a TRS dependent
beneficiary who is an unmarried child age 19 or over and mentally or physically
disabled shall not exceed the cost for a TRS dependent beneficiary who is
an unmarried child under age 19 and participates in the same major medical or
managed care program.
The cost of health benefits under the program shall be paid as follows:
(1) For a TRS benefit recipient selecting a managed | ||
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(2) For a TRS benefit recipient selecting the major | ||
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(3) For a TRS benefit recipient selecting the major | ||
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(3.1) For a TRS dependent beneficiary who is Medicare | ||
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(4) Except as otherwise provided in item (3.1), the | ||
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(f) Financing. Beginning July 1, 1995, all revenues arising from the
administration of the health benefit programs established under Article 16 of
the Illinois Pension Code or this Section shall be deposited into the
Teacher Health Insurance Security Fund, which is hereby created as a
nonappropriated trust fund to be held outside the State Treasury, with the
State Treasurer as custodian. Any interest earned on moneys in the Teacher
Health Insurance Security Fund shall be deposited into the Fund.
Moneys in the Teacher Health Insurance Security
Fund shall be used only to pay the costs of the health benefit program
established under this Section, including associated administrative costs, and
the costs associated with the health benefit program established under Article
16 of the Illinois Pension Code, as authorized in this Section. Beginning
July 1, 1995, the Department of Central Management Services may make
expenditures from the Teacher Health Insurance Security Fund for those costs.
After other funds authorized for the payment of the costs of the health
benefit program established under Article 16 of the Illinois Pension Code are
exhausted and until January 1, 1996 (or such later date as may be agreed upon
by the Director of Central Management Services and the Secretary of the
Teachers' Retirement System), the Secretary of the Teachers' Retirement System
may make expenditures from the Teacher Health Insurance Security Fund as
necessary to pay up to 75% of the cost of providing health coverage to eligible
benefit recipients (as defined in Sections 16‑153.1 and 16‑153.3 of the
Illinois Pension Code) who are enrolled in the Article 16 health benefit
program and to facilitate the transfer of administration of the health benefit
program to the Department of Central Management Services.
(g) Contract for benefits. The Director shall by contract, self‑insurance,
or otherwise make available the program of health benefits for TRS benefit
recipients and their TRS dependent beneficiaries that is provided for in this
Section. The contract or other arrangement for the provision of these health
benefits shall be on terms deemed by the Director to be in the best interest of
the State of Illinois and the TRS benefit recipients based on, but not limited
to, such criteria as administrative cost, service capabilities of the carrier
or other contractor, and the costs of the benefits.
(g‑5) Committee. A Teacher Retirement Insurance Program Committee shall be established, to consist of 10 persons appointed by the Governor.
The Committee shall convene at least 4 times each year, and shall consider and make recommendations on issues affecting the program of health benefits provided under this
Section. Recommendations of the Committee shall be based on a consensus of the members of the Committee.
If the Teacher
Health Insurance Security Fund experiences a deficit balance based upon the contribution and subsidy rates established in this Section and Section 6.6 for Fiscal Year 2008 or thereafter, the Committee shall make recommendations for adjustments to the funding sources established under these Sections. (h) Continuation of program. It is the intention of
the General Assembly that the program of health benefits provided under this
Section be maintained on an ongoing, affordable basis.
The program of health benefits provided under this Section may be amended by
the State and is not intended to be a pension or retirement benefit subject to
protection under Article XIII, Section 5 of the Illinois Constitution.
(i) Repeal. (Blank).
(Source: P.A. 92‑505, eff. 12‑20‑01; 92‑862, eff. 1‑3‑03; 93‑679, eff. 6‑30‑04.)
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(5 ILCS 375/6.6)
Sec. 6.6. Contributions to the Teacher Health Insurance Security Fund.
(a) Beginning July 1, 1995, all active contributors of the Teachers'
Retirement System (established under Article 16 of the Illinois Pension Code)
who are not employees of a department as defined in Section 3 of this Act
shall make contributions toward the cost of annuitant and survivor health
benefits. These contributions shall be at the following rates:
until January 1, 2002, 0.5% of salary;
beginning January 1, 2002, 0.65% of salary;
beginning July 1, 2003, 0.75% of salary; beginning July 1, 2005, 0.80% of salary;
beginning July 1, 2007, a percentage of salary to be determined by the Department of Central Management Services by rule, which in each fiscal year shall not exceed 105% of the percentage of salary actually required to be paid in the previous fiscal year.
These contributions shall be deducted by the employer and paid to the System
as service agent for the Department of Central Management Services. The System
may use the same processes for collecting the contributions required by this
subsection that it uses to collect contributions received from school districts
and other covered employers under Sections 16‑154 and 16‑155 of the Illinois
Pension Code.
An employer may agree to pick up or pay the contributions required under
this subsection on behalf of the teacher; such contributions shall be deemed
to have to have been paid by the teacher. Beginning January 1, 2002, if
the employer does not directly pay the required member contribution, then the
employer shall reduce the member's salary by an amount equal to the required
contribution and shall then pay the contribution on behalf of the member.
This reduction shall not change the amounts reported as creditable earnings
to the Teachers' Retirement System.
A person who purchases optional service credit under Article 16 of the
Illinois Pension Code for a period after June 30, 1995 must also make a
contribution under this subsection for that optional credit, at the rate
provided in subsection (a), based on the salary used in
computing the optional service credit, plus interest on this employee
contribution. This contribution shall be collected by the System as service
agent for the Department of Central Management Services. The contribution
required under this subsection for the optional service credit must be paid
in full before any annuity based on that credit begins.
(a‑5) Beginning January 1, 2002, every employer of a teacher (other than
an employer that is a department as defined in Section 3 of this Act) shall
pay an employer contribution toward the cost of annuitant and survivor health
benefits. These contributions shall be computed as follows:
(1) Beginning January 1, 2002 through June 30, 2003, | ||
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(2) Beginning July 1, 2003, the employer | ||
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(3) Beginning July 1, 2005, the employer contribution | ||
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(4) Beginning July 1, 2007, the employer contribution | ||
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These contributions shall be paid by the employer to the System as service
agent for the Department of Central Management Services. The System may use
the same processes for collecting the contributions required by this subsection
that it uses to collect contributions received from school districts and other
covered employers under the Illinois Pension Code.
The school district or other employing unit may pay these employer
contributions out of any source of funding available for that purpose and
shall forward the contributions to the System on the schedule established
for the payment of member contributions.
(b) The Teachers' Retirement System shall promptly deposit all moneys
collected under subsections (a) and (a‑5) of this
Section into the Teacher Health Insurance Security Fund created in Section 6.5
of this Act. The moneys collected under this Section shall be used only for
the purposes authorized in Section 6.5 of this Act and shall not be considered
to be assets of the Teachers' Retirement System. Contributions made under this
Section are not transferable to other pension funds or retirement systems and
are not refundable upon termination of service.
(c) On or before November 15 of each year, the Board of Trustees of the
Teachers' Retirement System shall certify to the Governor, the Director of
Central Management Services, and the State Comptroller its estimate of the
total amount of contributions to be paid under subsection (a) of this Section
6.6 for the next fiscal year. The amount certified shall be decreased or
increased each year by the amount that the actual active teacher contributions
either fell short of or exceeded the estimate used by the Board in making the
certification for the previous fiscal year. The certification shall include
a detailed explanation of the methods and information that the Board relied
upon in preparing its estimate. As soon as possible after the effective date
of this amendatory Act of the 92nd General Assembly, the Board
shall recalculate and recertify its certifications for fiscal years 2002 and
2003.
(d) Beginning in fiscal year 1996, on the first day of each month, or
as soon thereafter as may be practical, the State Treasurer and the State
Comptroller shall transfer from the General Revenue Fund to the Teacher Health
Insurance Security Fund 1/12 of the annual amount appropriated for that fiscal
year to the State Comptroller for deposit into the Teacher Health Insurance
Security Fund under Section 1.3 of the State Pension Funds Continuing
Appropriation Act.
(e) Except where otherwise specified in this Section, the definitions
that apply to Article 16 of the Illinois Pension Code apply to this Section.
(f) (Blank).
(Source: P.A. 92‑505, eff. 12‑20‑01; 93‑679, eff. 6‑30‑04.)
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(5 ILCS 375/6.7)
Sec. 6.7.
Woman's health care provider.
The program of health benefits is
subject to the provisions of Section 356r of the Illinois Insurance Code.
(Source: P.A. 89‑514, eff. 7‑17‑96; 90‑14, eff. 7‑1‑97.)
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(5 ILCS 375/6.8)
Sec. 6.8.
Post‑parturition care.
The program of health
benefits shall provide the post‑parturition care benefits required to be
covered by a policy of accident and health insurance under Section 356s of the
Illinois Insurance Code.
(Source: P.A. 89‑513, eff. 7‑17‑96; 90‑14, eff. 7‑1‑97.)
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(5 ILCS 375/6.9)
Sec. 6.9.
Health benefits for community college benefit recipients and
community college dependent beneficiaries.
(a) Purpose. It is the purpose of this amendatory Act of 1997 to establish
a uniform program of health benefits for community college benefit recipients
and their dependent beneficiaries under the administration of the Department of
Central Management Services.
(b) Creation of program. Beginning July 1, 1999, the Department of
Central Management Services shall be responsible for administering a program of
health benefits for community college benefit recipients and community college
dependent beneficiaries under this Section. The State Universities Retirement
System and the boards of trustees of the various community college districts
shall cooperate with the Department in this endeavor.
(c) Eligibility. All community college benefit recipients and community
college dependent beneficiaries shall be eligible to participate in the program
established under this Section, without any interruption or delay in coverage
or limitation as to pre‑existing medical conditions. Eligibility to
participate shall be determined by the State Universities Retirement System.
Eligibility information shall be communicated to the Department of Central
Management Services in a format acceptable to the Department.
(d) Coverage. The health benefit coverage provided under this Section
shall be a program of health, dental, and vision benefits.
The program of health benefits under this Section may include any or all of
the benefit limitations, including but not limited to a reduction in benefits
based on eligibility for federal medicare benefits, that are provided under
subsection (a) of Section 6 of this Act for other health benefit programs under
this Act.
(e) Insurance rates and premiums. The Director shall determine the
insurance rates and premiums for community college benefit recipients and
community college dependent beneficiaries. Rates and premiums may be based
in part on age and eligibility for federal Medicare coverage.
The Director shall also determine premiums that will allow for the
establishment of an actuarially sound reserve for this program.
The cost of health benefits under the program shall be paid as follows:
(1) For a community college benefit recipient, up to | ||
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(2) The balance of the rate of insurance, including | ||
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(f) Financing. All revenues arising from the administration of the health
benefit program established under this Section shall be deposited into the
Community College Health Insurance Security Fund, which is hereby created as a
nonappropriated trust fund to be held outside the State Treasury, with the
State Treasurer as custodian. Any interest earned on moneys in the Community
College Health Insurance Security Fund shall be deposited into the Fund.
Moneys in the Community College Health Insurance Security Fund shall be used
only to pay the costs of the health benefit program established under this
Section, including associated administrative costs and the establishment of a
program reserve. Beginning January 1, 1999,
the Department of Central Management Services may make expenditures from the
Community College Health Insurance Security Fund for those costs.
(g) Contract for benefits. The Director shall by contract, self‑insurance,
or otherwise make available the program of health benefits for community
college benefit recipients and their community college dependent beneficiaries
that is provided for in this Section. The contract or other arrangement for
the provision of these health benefits shall be on terms deemed by the Director
to be in the best interest of the State of Illinois and the community college
benefit recipients based on, but not limited to, such criteria as
administrative cost, service capabilities of the carrier or other contractor,
and the costs of the benefits.
(h) Continuation of program. It is the intention of the General Assembly
that the program of health benefits provided under this Section be maintained
on an ongoing, affordable basis. The program of health benefits provided under
this Section may be amended by the State and is not intended to be a pension or
retirement benefit subject to protection under Article XIII, Section 5 of the
Illinois Constitution.
(i) Other health benefit plans. A health benefit plan provided by a
community college district (other than a community college district subject to
Article VII of the Public Community College Act) under the terms of a
collective bargaining agreement in effect on or prior to the effective date of
this amendatory Act of 1997 shall continue in force according to the terms of
that agreement, unless otherwise mutually agreed by the parties to that
agreement and the affected retiree.
A community college benefit recipient or community college dependent
beneficiary whose coverage under such a plan expires shall be eligible to begin
participating in the program established under this Section without any
interruption or delay in coverage or limitation as to pre‑existing medical
conditions.
This Act does not prohibit any community college district from offering
additional health benefits for its retirees or their dependents or survivors.
(Source: P.A. 90‑497, eff. 8‑18‑97; 90‑655, eff. 7‑30‑98.)
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(5 ILCS 375/6.11)
Sec. 6.11. Required health benefits; Illinois Insurance Code
requirements. The program of health
benefits shall provide the post‑mastectomy care benefits required to be covered
by a policy of accident and health insurance under Section 356t of the Illinois
Insurance Code. The program of health benefits shall provide the coverage
required under Sections 356u, 356w, 356x, 356z.2, 356z.4, and 356z.6 of the
Illinois Insurance Code.
The program of health benefits must comply with Section 155.37 of the
Illinois Insurance Code.
(Source: P.A. 92‑440, eff. 8‑17‑01; 92‑764, eff. 1‑1‑03; 93‑102, eff. 1‑1‑04; 93‑853, eff. 1‑1‑05.)
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(5 ILCS 375/6.12)
Sec. 6.12.
Payment for services.
The program of health benefits
is subject to the provisions of Section 368a of the Illinois
Insurance Code.
(Source: P.A. 91‑605, eff. 12‑14‑99; 91‑788, eff. 6‑9‑00; 92‑16, eff.
6‑28‑01.)
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(5 ILCS 375/6.13)
Sec. 6.13.
Managed Care Reform and Patient Rights Act.
The
program of
health
benefits
is subject to the provisions of the Managed Care Reform and Patient Rights
Act, except the fee for service program shall only be required to comply with
Section 85 and the definition of "emergency medical condition" in Section 10 of
the Managed Care Reform and Patient Rights Act.
(Source: P.A. 91‑617, eff. 8‑19‑99; 92‑16, eff. 6‑28‑01.)
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(5 ILCS 375/6.14)
Sec. 6.14.
Organ donor costs.
With respect to organ transplants occurring
after
June 30, 2000 when both a donor and donee are members of the same family and
are
both covered by the program of health benefits, the program of health benefits
shall pay
100% of the donor's expenses without the imposition of any deductible or
copayment.
(Source: P.A. 92‑204, eff. 8‑1‑01.)
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(5 ILCS 375/6.15)
Sec. 6.15.
Retired teacher returning to service in shortage area.
Notwithstanding any other provision of this Act, the eligibility of an
annuitant or TRS benefit recipient to participate in the program of health
benefits established under Section 6 or 6.5 of this Act is suspended for any
period during which he or she is covered under a plan of group health benefits
for active teachers due to eligible employment as defined in Section 16‑150.1
of the Illinois Pension Code. Upon termination of that coverage, eligibility
to participate in the program of health benefits established under Section 6 or
6.5 shall be immediately restored, without any interruption or delay in
coverage or limitation as to pre‑existing medical condition.
(Source: P.A. 93‑320, eff. 7‑23‑03.)
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(2) annuitants shall be insured in the same manner | ||
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(3) survivors whose coverage became effective prior | ||
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(4) retired employees shall not be eligible under | ||
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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:
(1) supplemental life insurance in an amount not | ||
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(2) accidental death and dismemberment, with the | ||
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(3) dependent life insurance in an amount of $10,000 | ||
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(4) dependent life insurance in an amount of $10,000 | ||
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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).
(Source: P.A. 94‑95, eff. 7‑1‑05.)
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(5 ILCS 375/7.1) (from Ch. 127, par. 527.1)
Sec. 7.1.
Any benefit received by an employee under this
Act pursuant to a collective bargaining agreement may be
extended by the Director to employees whose wages, hours and
other conditions of employment with the State are not subject
to a collective bargaining agreement. In addition, if any benefit
is offered by the Department of Central Management Services to
employees who are not members of a recognized bargaining unit,
then that benefit shall also be offered to all bargaining unit
members through their certified exclusive representative.
(Source: P.A. 85‑848.)
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(2) Members described above being transferred from | ||
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(3) Eligible and covered members that are eligible | ||
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(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 retired employee shall become immediately
eligible and covered for all benefits available under that program. 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 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 | ||
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(2) Members may re‑enroll in the Department of | ||
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(3) Members may also re‑enroll in the program of | ||
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(4) Members who elect not to participate in the | ||
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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.
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. 93‑553, eff. 8‑20‑03; 94‑95, eff. 7‑1‑05.)
(Text of Section from P.A. 94‑109)
Sec. 8. Eligibility.
(a) Each 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. 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.
(1) Every member originally eligible to elect | ||
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(2) Members described above being transferred from | ||
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(3) Eligible and covered members that are eligible | ||
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(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 coverages or benefits, if elected
during the relevant eligibility period, will become effective on the date
of employment. Optional coverages or benefits 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 retired employee shall become immediately
eligible and covered for all benefits available under that program. 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 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 | ||
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(2) Members may re‑enroll in the Department of | ||
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(3) Members may also re‑enroll in the program of | ||
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(4) Members who elect not to participate in the | ||
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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 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.
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. 93‑553, eff. 8‑20‑03; 94‑109, eff. 7‑1‑05.)
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(5 ILCS 375/9) (from Ch. 127, par. 529)
Sec. 9.
(a) The eligible member shall be responsible for his or her
portion of the
premiums, charges or other fees for all elected coverages
or benefits, which shall be paid by means of the acceptance of a reduction
in earnings or the foregoing of an increase in earnings by an employee;
provided, however, subject to rules and regulations promulgated by the
Department, the eligible member may make personal payment of the premium,
charge or fee for any wellness programs implemented under the program of
health benefits.
All contributions and payments by the eligible members and the State for
all elected coverages and benefits shall be deposited in the
Health Insurance Reserve Fund. The Department may determine the aggregate
level of contribution required under this Section on the basis of actual
cost of services adjusted for age, sex or the geographical or other
demographic characteristics which affect costs of the benefit.
(b) If a member is not entitled to receive any salary, wages or other
compensation during a period in which premiums,
charges or other fees are due or does not receive compensation
sufficient to allow deduction of the required payment of the
premium, charge or other fee, such member may continue the contributory
benefit in effect by making personal payment of the premium, charge or
other fee for the period in such manner, in such amount, and
for such duration, as may be prescribed in rules and regulations promulgated
for the administration of this Act.
(Source: P.A. 91‑390, eff. 7‑30‑99.)
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(2) In subsequent years, a further adjustment shall | ||
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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 shall be a continuing
fund not subject to fiscal year limitations. 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
85% 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 | ||
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(2) In subsequent years, a further adjustment shall | ||
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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. 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 | ||
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(2) In subsequent years, a further adjustment shall | ||
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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).
(Source: P.A. 92‑16, eff. 6‑28‑01; 93‑839, eff. 7‑30‑04.)
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(5 ILCS 375/12) (from Ch. 127, par. 532)
Sec. 12.
(a) Any surplus resulting from favorable experience of those
portions of the group life insurance and group health program shall be
refunded to the State of Illinois for deposit in the Group Insurance
Premium Fund or Health Insurance Reserve Fund established under this Act.
Such funds may be applied to reduce member premiums, charges or fees or
increase benefits, or both, in accordance with Subsection (b) of this Section.
(b) Surplus resulting from favorable experience may be applied to
any current or future contract made under authority of this Act either
toward the reduction of optional life insurance or contributions to the
program of health benefits or other employee benefits or toward providing
additional life insurance or health or other benefits or both as determined
by the Director.
(Source: P.A. 85‑848.)
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(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 or health benefits
coverages, 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 group health benefits
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 and group health
benefits program authorized by this Act.
Refunds to members for premiums paid for 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. 91‑390, eff. 7‑30‑99.)
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(2) the payment of administrative expenses incurred | ||
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(3) the payment of health benefits;
(4) refunds to employees for erroneous payments of | ||
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(5) payment of premium for stop‑loss or re‑insurance;
(6) payment of premium to health maintenance | ||
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(7) payment of adoption program benefits; and
(8) payment of other benefits offered to members and | ||
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(Source: P.A. 94‑839, eff. 6‑6‑06.)
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(5 ILCS 375/13.2) (from Ch. 127, par. 533.2)
Sec. 13.2.
Insurance reserve funds; investments.
All amounts held in
the Health Insurance Reserve Fund, the Group Insurance Premium Fund, and
the Local Government Health
Insurance Reserve Fund shall be invested, at interest, by the State
Treasurer. The investments shall be subject to terms, conditions, and
limitations imposed by the laws of Illinois on State funds. All income
derived from the investments shall accrue and be deposited to the
respective funds no less frequently than quarterly. The Health Insurance
Reserve Fund and the Local Government Health Insurance Reserve Fund shall
be administered by the Director.
(Source: P.A. 91‑390, eff. 7‑30‑99.)
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(5 ILCS 375/15.1) (from Ch. 127, par. 535.1)
Sec. 15.1.
Every group health insurance program or self‑insurance health
plan which provides coverage for services coming within
the practice of optometry as defined in the Illinois Optometric
Practice Act of 1987, as now or hereafter amended, shall provide to each member a
written notice that such member may elect for optometric services received
to be reimbursed to either a physician licensed to practice medicine in all
its branches or to an optometrist licensed in this State.
This Section applies only to persons who become covered by such group insurance
program or self‑insurance health plan after the effective date of this
amendatory Act of 1979.
(Source: P.A. 85‑1440.)
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(5 ILCS 375/16) (from Ch. 127, par. 536)
Sec. 16.
If any provision of this Act or application thereof to any person or
circumstance is held invalid, such invalidity does not affect other
provisions or applications of this Act which can be given effect without
the invalid application or provision, and to this end the provisions of
this Act are declared to be severable.
The Department is authorized to interpret and implement this Act so as
not to conflict with required provisions of the federal Medicare law
and rules.
(Source: P.A. 87‑860.)
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(5 ILCS 375/17) (from Ch. 127, par. 537)
Sec. 17.
The provisions of this Act with regard to the initiation of planning
and other provisions in respect to the administration of this Act shall
become effective July 1, 1971. Provisions regarding initiation of the program
of group life and group health insurance and State contributions authorized
herein shall become effective January 1, 1972.
(Source: P.A. 77‑476.)
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