HB 5036

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Full Text of HB5036
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	HB5036 - 104th General Assembly
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104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
HB5036
Introduced 2/10/2026, by Rep. Bradley Fritts
SYNOPSIS AS INTRODUCED:
5 ILCS 375/3	  from Ch. 127, par. 523
5 ILCS 375/8	  from Ch. 127, par. 528
5 ILCS 375/9	  from Ch. 127, par. 529
5 ILCS 375/10	  from Ch. 127, par. 530
Amends the State Employees Group Insurance Act of 1971. Provides that if both spouses are eligible covered members and are employees under the State Employees Article of the Illinois Pension Code, then one spouse may enroll the other spouse as an eligible dependent if: (1) both spouses provide to the Department of Central Management Services, upon the request of the Department of Central Management Services, an attestation that the member and the member's spouse have elected for the spouse to be enrolled as a dependent; and (2) the spouses continue to be married. Provides that upon electing to enroll in the program of group health benefits as an eligible dependent under the amendatory provisions, a member forfeits his or her rights as a member under the Act with respect to the program of group health benefits during the period when that election is in effect. Makes conforming changes to the definition of "dependent" and provisions concerning contributions.
LRB104 17785 RPS 31217 b
A BILL FOR
		HB5036		LRB104 17785 RPS 31217 b
1    AN ACT concerning government.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4    Section 5. The State Employees Group Insurance Act of 1971
5is amended by changing Sections 3, 8, 9, and 10 as follows:
6    (5 ILCS 375/3)  (from Ch. 127, par. 523)
7    Sec. 3. Definitions. Unless the context otherwise
8requires, the following words and phrases as used in this Act
9shall have the following meanings. The Department may define
10these and other words and phrases separately for the purpose
11of implementing specific programs providing benefits under
12this Act.
13    (a) "Administrative service organization" means any
14person, firm, or corporation experienced in the handling of
15claims which is fully qualified, financially sound, and
16capable of meeting the service requirements of a contract of
17administration executed with the Department.
18    (b) "Annuitant" means (1) an employee who retires, or has
19retired, on or after January 1, 1966 on an immediate annuity
20under the provisions of Articles 2, 14 (including an employee
21who has elected to receive an alternative retirement
22cancellation payment under Section 14-108.5 of the Illinois
23Pension Code in lieu of an annuity or who meets the criteria
		HB5036	- 2 -	LRB104 17785 RPS 31217 b
1for retirement, but in lieu of receiving an annuity under that
2Article has elected to receive an accelerated pension benefit
3payment under Section 14-147.5 of that Article), 15 (including
4an employee who has retired under the optional retirement
5program established under Section 15-158.2 or who meets the
6criteria for retirement but in lieu of receiving an annuity
7under that Article has elected to receive an accelerated
8pension benefit payment under Section 15-185.5 of the
9Article), paragraph (2), (3), or (5) of Section 16-106
10(including an employee who meets the criteria for retirement,
11but in lieu of receiving an annuity under that Article has
12elected to receive an accelerated pension benefit payment
13under Section 16-190.5 of the Illinois Pension Code), or
14Article 18 of the Illinois Pension Code; (2) any person who was
15receiving group insurance coverage under this Act as of March
1631, 1978 by reason of his status as an annuitant, even though
17the annuity in relation to which such coverage was provided is
18a proportional annuity based on less than the minimum period
19of service required for a retirement annuity in the system
20involved; (3) any person not otherwise covered by this Act who
21has retired as a participating member under Article 2 of the
22Illinois Pension Code but is ineligible for the retirement
23annuity under Section 2-119 of the Illinois Pension Code; (4)
24the spouse of any person who is receiving a retirement annuity
25under Article 18 of the Illinois Pension Code and who is
26covered under a group health insurance program sponsored by a
		HB5036	- 3 -	LRB104 17785 RPS 31217 b
1governmental employer other than the State of Illinois and who
2has irrevocably elected to waive his or her coverage under
3this Act and to have his or her spouse considered as the
4"annuitant" under this Act and not as a "dependent"; or (5) an
5employee who retires, or has retired, from a qualified
6position, as determined according to rules promulgated by the
7Director, under a qualified local government, a qualified
8rehabilitation facility, a qualified domestic violence shelter
9or service, or a qualified child advocacy center. (For
10definition of "retired employee", see subsection (p)).
11    (b-5) (Blank).
12    (b-6) (Blank).
13    (b-7) (Blank).
14    (c) "Carrier" means (1) an insurance company, a
15corporation organized under the Limited Health Service
16Organization Act or the Voluntary Health Services Plans Act, a
17partnership, or other nongovernmental organization, which is
18authorized to do group life or group health insurance business
19in Illinois, or (2) the State of Illinois as a self-insurer.
20    (d) "Compensation" means salary or wages payable on a
21regular payroll by the State Treasurer on a warrant of the
22State Comptroller out of any State, trust or federal fund, or
23by the Governor of the State through a disbursing officer of
24the State out of a trust or out of federal funds, or by any
25Department out of State, trust, federal, or other funds held
26by the State Treasurer or the Department, to any person for
		HB5036	- 4 -	LRB104 17785 RPS 31217 b
1personal services currently performed, and ordinary or
2accidental disability benefits under Articles 2, 14, 15
3(including ordinary or accidental disability benefits under
4the optional retirement program established under Section
515-158.2), paragraph (2), (3), or (5) of Section 16-106, or
6Article 18 of the Illinois Pension Code, for disability
7incurred after January 1, 1966, or benefits payable under the
8Workers' Compensation Act or the Workers' Occupational
9Diseases Act or benefits payable under a sick pay plan
10established in accordance with Section 36 of the State Finance
11Act. "Compensation" also means salary or wages paid to an
12employee of any qualified local government, qualified
13rehabilitation facility, qualified domestic violence shelter
14or service, or qualified child advocacy center.
15    (e) "Commission" means the State Employees Group Insurance
16Advisory Commission authorized by this Act. Commencing July 1,
171984, "Commission" as used in this Act means the Commission on
18Government Forecasting and Accountability as established by
19the Legislative Commission Reorganization Act of 1984.
20    (f) "Contributory", when referred to as contributory
21coverage, shall mean optional coverages or benefits elected by
22the member toward the cost of which such member makes
23contribution, or which are funded in whole or in part through
24the acceptance of a reduction in earnings or the foregoing of
25an increase in earnings by an employee, as distinguished from
26noncontributory coverage or benefits which are paid entirely
		HB5036	- 5 -	LRB104 17785 RPS 31217 b
1by the State of Illinois without reduction of the member's
2salary.
3    (g) "Department" means any department, institution, board,
4commission, officer, court, or any agency of the State
5government receiving appropriations and having power to
6certify payrolls to the Comptroller authorizing payments of
7salary and wages against such appropriations as are made by
8the General Assembly from any State fund, or against trust
9funds held by the State Treasurer and includes boards of
10trustees of the retirement systems created by Articles 2, 14,
1115, 16, and 18 of the Illinois Pension Code. "Department" also
12includes the Illinois Comprehensive Health Insurance Board,
13the Board of Examiners established under the Illinois Public
14Accounting Act, and the Illinois Finance Authority.
15    (h) "Dependent", when the term is used in the context of
16the health and life plan, means a member's spouse and any child
17(1) from birth to age 26, including an adopted child, a child
18who lives with the member from the time of the placement for
19adoption until entry of an order of adoption, a stepchild or
20adjudicated child, or a child who lives with the member if such
21member is a court appointed guardian of the child or (2) age 19
22or over who has a mental or physical disability from a cause
23originating prior to the age of 19 (age 26 if enrolled as an
24adult child dependent). For the health plan only, the term
25"dependent" also includes: (1) any person enrolled prior to
26the effective date of this Section who is dependent upon the
		HB5036	- 6 -	LRB104 17785 RPS 31217 b
1member to the extent that the member may claim such person as a
2dependent for income tax deduction purposes; [and] (2) any
3person who has received after June 30, 2000 an organ
4transplant and who is financially dependent upon the member
5and eligible to be claimed as a dependent for income tax
6purposes; and (3) any employee who is authorized to elect and 
7has elected dependent status under subsection (c) of Section 8 
8during the period when that election is in effect. A member
9requesting to cover any dependent must provide documentation
10as requested by the Department of Central Management Services
11and file with the Department any and all forms required by the
12Department.
13    (i) "Director" means the Director of the Illinois
14Department of Central Management Services.
15    (j) "Eligibility period" means the period of time a member
16has to elect enrollment in programs or to select benefits
17without regard to age, sex, or health.
18    (k) "Employee" means and includes each officer or employee
19in the service of a department who (1) receives his
20compensation for service rendered to the department on a
21warrant issued pursuant to a payroll certified by a department
22or on a warrant or check issued and drawn by a department upon
23a trust, federal or other fund or on a warrant issued pursuant
24to a payroll certified by an elected or duly appointed officer
25of the State or who receives payment of the performance of
26personal services on a warrant issued pursuant to a payroll
		HB5036	- 7 -	LRB104 17785 RPS 31217 b
1certified by a Department and drawn by the Comptroller upon
2the State Treasurer against appropriations made by the General
3Assembly from any fund or against trust funds held by the State
4Treasurer, and (2) is employed full-time or part-time in a
5position normally requiring actual performance of duty during
6not less than 1/2 of a normal work period, as established by
7the Director in cooperation with each department, except that
8persons elected by popular vote will be considered employees
9during the entire term for which they are elected regardless
10of hours devoted to the service of the State, and (3) except
11that "employee" does not include any person who is not
12eligible by reason of such person's employment to participate
13in one of the State retirement systems under Articles 2, 14, 15
14(either the regular Article 15 system or the optional
15retirement program established under Section 15-158.2), or 18,
16or under paragraph (2), (3), or (5) of Section 16-106, of the
17Illinois Pension Code, but such term does include persons who
18are employed during the 6-month qualifying period under
19Article 14 of the Illinois Pension Code. Such term also
20includes any person who (1) after January 1, 1966, is
21receiving ordinary or accidental disability benefits under
22Articles 2, 14, 15 (including ordinary or accidental
23disability benefits under the optional retirement program
24established under Section 15-158.2), paragraph (2), (3), or
25(5) of Section 16-106, or Article 18 of the Illinois Pension
26Code, for disability incurred after January 1, 1966, (2)
		HB5036	- 8 -	LRB104 17785 RPS 31217 b
1receives total permanent or total temporary disability under
2the Workers' Compensation Act or the Workers' Occupational
3Diseases Act as a result of injuries sustained or illness
4contracted in the course of employment with the State of
5Illinois, or (3) is not otherwise covered under this Act and
6has retired as a participating member under Article 2 of the
7Illinois Pension Code but is ineligible for the retirement
8annuity under Section 2-119 of the Illinois Pension Code.
9However, a person who satisfies the criteria of the foregoing
10definition of "employee" except that such person is made
11ineligible to participate in the State Universities Retirement
12System by clause (4) of subsection (a) of Section 15-107 of the
13Illinois Pension Code is also an "employee" for the purposes
14of this Act. "Employee" also includes any person receiving or
15eligible for benefits under a sick pay plan established in
16accordance with Section 36 of the State Finance Act.
17"Employee" also includes (i) each officer or employee in the
18service of a qualified local government, including persons
19appointed as trustees of sanitary districts regardless of
20hours devoted to the service of the sanitary district, (ii)
21each employee in the service of a qualified rehabilitation
22facility, (iii) each full-time employee in the service of a
23qualified domestic violence shelter or service, and (iv) each
24full-time employee in the service of a qualified child
25advocacy center, as determined according to rules promulgated
26by the Director.
		HB5036	- 9 -	LRB104 17785 RPS 31217 b
1    (l) "Member" means an employee, annuitant, retired
2employee, or survivor. In the case of an annuitant or retired
3employee who first becomes an annuitant or retired employee on
4or after January 13, 2012 (the effective date of Public Act
597-668), the individual must meet the minimum vesting
6requirements of the applicable retirement system in order to
7be eligible for group insurance benefits under that system. In
8the case of a survivor who is not entitled to occupational
9death benefits pursuant to an applicable retirement system or
10death benefits pursuant to the Workers' Compensation Act, and
11who first becomes a survivor on or after January 13, 2012 (the
12effective date of Public Act 97-668), the deceased employee,
13annuitant, or retired employee upon whom the annuity is based
14must have been eligible to participate in the group insurance
15system under the applicable retirement system in order for the
16survivor to be eligible for group insurance benefits under
17that system.
18    For purposes of coverage under the program of group health 
19benefits, "member" does not include any employee who is 
20authorized to elect and has elected dependent status under 
21subsection (c) of Section 8 during the period when that 
22election is in effect.
23    In the case of a survivor who is entitled to occupational
24death benefits pursuant to the deceased employee's applicable
25retirement system or death benefits pursuant to the Workers'
26Compensation Act, and first becomes a survivor on or after
		HB5036	- 10 -	LRB104 17785 RPS 31217 b
1January 1, 2022, the survivor is eligible for group health
2insurance benefits regardless of the deceased employee's
3minimum vesting requirements under the applicable retirement
4system, with a State contribution rate of 100%, until an
5unmarried child dependent reaches the age of 18, or the age of
622 if the dependent child is a full-time student, or until the
7adult survivor becomes eligible for benefits under the federal
8Medicare health insurance program (Title XVIII of the Social
9Security Act, as added by Public Law 89-97). In the case of a
10survivor currently receiving occupational death benefits
11pursuant to the deceased employee's applicable retirement
12system or has received death benefits pursuant to the Workers'
13Compensation Act, who first became a survivor prior to January
141, 2022, the survivor is eligible for group health insurance
15benefits regardless of the deceased employee's minimum vesting
16requirements under the applicable retirement system, with a
17State contribution rate of 100%, until an unmarried child
18dependent reaches the age of 18, or the age of 22 if the
19dependent child is a full-time student, or until the adult
20survivor becomes eligible for benefits under the federal
21Medicare health insurance program (Title XVIII of the Social
22Security Act, as added by Public Law 89-97). The changes made
23by Public Act 102-714 with respect to survivors who first
24became survivors prior to January 1, 2022 shall apply upon
25request of the survivor on or after April 29, 2022 (the
26effective date of Public Act 102-714).
		HB5036	- 11 -	LRB104 17785 RPS 31217 b
1    (m) "Optional coverages or benefits" means those coverages
2or benefits available to the member on his or her voluntary
3election, and at his or her own expense.
4    (n) "Program" means the group life insurance, health
5benefits, and other employee benefits designed and contracted
6for by the Director under this Act.
7    (o) "Health plan" means a health benefits program offered
8by the State of Illinois for persons eligible for the plan.
9    (p) "Retired employee" means any person who would be an
10annuitant as that term is defined herein but for the fact that
11such person retired prior to January 1, 1966. Such term also
12includes any person formerly employed by the University of
13Illinois in the Cooperative Extension Service who would be an
14annuitant but for the fact that such person was made
15ineligible to participate in the State Universities Retirement
16System by clause (4) of subsection (a) of Section 15-107 of the
17Illinois Pension Code.
18    (q) "Survivor" means a person receiving an annuity as a
19survivor of an employee or of an annuitant. "Survivor" also
20includes: (1) the surviving dependent of a person who
21satisfies the definition of "employee" except that such person
22is made ineligible to participate in the State Universities
23Retirement System by clause (4) of subsection (a) of Section
2415-107 of the Illinois Pension Code; (2) the surviving
25dependent of any person formerly employed by the University of
26Illinois in the Cooperative Extension Service who would be an
		HB5036	- 12 -	LRB104 17785 RPS 31217 b
1annuitant except for the fact that such person was made
2ineligible to participate in the State Universities Retirement
3System by clause (4) of subsection (a) of Section 15-107 of the
4Illinois Pension Code; (3) the surviving dependent of a person
5who was an annuitant under this Act by virtue of receiving an
6alternative retirement cancellation payment under Section
714-108.5 of the Illinois Pension Code; and (4) a person who
8would be receiving an annuity as a survivor of an annuitant
9except that the annuitant elected on or after June 4, 2018 to
10receive an accelerated pension benefit payment under Section
1114-147.5, 15-185.5, or 16-190.5 of the Illinois Pension Code
12in lieu of receiving an annuity.
13    (q-2) "SERS" means the State Employees' Retirement System
14of Illinois, created under Article 14 of the Illinois Pension
15Code.
16    (q-3) "SURS" means the State Universities Retirement
17System, created under Article 15 of the Illinois Pension Code.
18    (q-4) "TRS" means the Teachers' Retirement System of the
19State of Illinois, created under Article 16 of the Illinois
20Pension Code.
21    (q-5) (Blank).
22    (q-6) (Blank).
23    (q-7) (Blank).
24    (r) "Medical services" means the services provided within
25the scope of their licenses by practitioners in all categories
26licensed under the Medical Practice Act of 1987.
		HB5036	- 13 -	LRB104 17785 RPS 31217 b
1    (s) "Unit of local government" means any county,
2municipality, township, school district (including a
3combination of school districts under the Intergovernmental
4Cooperation Act), special district or other unit, designated
5as a unit of local government by law, which exercises limited
6governmental powers or powers in respect to limited
7governmental subjects, any not-for-profit association with a
8membership that primarily includes townships and township
9officials, that has duties that include provision of research
10service, dissemination of information, and other acts for the
11purpose of improving township government, and that is funded
12wholly or partly in accordance with Section 85-15 of the
13Township Code; any not-for-profit corporation or association,
14with a membership consisting primarily of municipalities, that
15operates its own utility system, and provides research,
16training, dissemination of information, or other acts to
17promote cooperation between and among municipalities that
18provide utility services and for the advancement of the goals
19and purposes of its membership; the Southern Illinois
20Collegiate Common Market, which is a consortium of higher
21education institutions in Southern Illinois; the Illinois
22Association of Park Districts; and any hospital provider that
23is owned by a county that has 100 or fewer hospital beds and
24has not already joined the program. "Qualified local
25government" means a unit of local government approved by the
26Director and participating in a program created under
		HB5036	- 14 -	LRB104 17785 RPS 31217 b
1subsection (i) of Section 10 of this Act.
2    (t) "Qualified rehabilitation facility" means any
3not-for-profit organization that is accredited by the
4Commission on Accreditation of Rehabilitation Facilities or
5certified by the Department of Human Services (as successor to
6the Department of Mental Health and Developmental
7Disabilities) to provide services to persons with disabilities
8and which receives funds from the State of Illinois for
9providing those services, approved by the Director and
10participating in a program created under subsection (j) of
11Section 10 of this Act.
12    (u) "Qualified domestic violence shelter or service" means
13any Illinois domestic violence shelter or service and its
14administrative offices funded by the Department of Human
15Services (as successor to the Illinois Department of Public
16Aid), approved by the Director and participating in a program
17created under subsection (k) of Section 10.
18    (v) "TRS benefit recipient" means a person who:
19        (1) is not a "member" as defined in this Section; and
20        (2) is receiving a monthly benefit or retirement
21    annuity under Article 16 of the Illinois Pension Code or
22    would be receiving such monthly benefit or retirement
23    annuity except that the benefit recipient elected on or
24    after June 4, 2018 to receive an accelerated pension
25    benefit payment under Section 16-190.5 of the Illinois
26    Pension Code in lieu of receiving an annuity; and
		HB5036	- 15 -	LRB104 17785 RPS 31217 b
1        (3) either (i) has at least 8 years of creditable
2    service under Article 16 of the Illinois Pension Code, or
3    (ii) was enrolled in the health insurance program offered
4    under that Article on January 1, 1996, or (iii) is the
5    survivor of a benefit recipient who had at least 8 years of
6    creditable service under Article 16 of the Illinois
7    Pension Code or was enrolled in the health insurance
8    program offered under that Article on June 21, 1995 (the
9    effective date of Public Act 89-25), or (iv) is a
10    recipient or survivor of a recipient of a disability
11    benefit under Article 16 of the Illinois Pension Code.
12    (w) "TRS dependent beneficiary" means a person who:
13        (1) is not a "member" or "dependent" as defined in
14    this Section; and
15        (2) is a TRS benefit recipient's: (A) spouse, (B)
16    dependent parent who is receiving at least half of his or
17    her support from the TRS benefit recipient, or (C)
18    natural, step, adjudicated, or adopted child who is (i)
19    under age 26, (ii) was, on January 1, 1996, participating
20    as a dependent beneficiary in the health insurance program
21    offered under Article 16 of the Illinois Pension Code, or
22    (iii) age 19 or over who has a mental or physical
23    disability from a cause originating prior to the age of 19
24    (age 26 if enrolled as an adult child).
25    "TRS dependent beneficiary" does not include, as indicated
26under paragraph (2) of this subsection (w), a dependent of the
		HB5036	- 16 -	LRB104 17785 RPS 31217 b
1survivor of a TRS benefit recipient who first becomes a
2dependent of a survivor of a TRS benefit recipient on or after
3January 13, 2012 (the effective date of Public Act 97-668)
4unless that dependent would have been eligible for coverage as
5a dependent of the deceased TRS benefit recipient upon whom
6the survivor benefit is based.
7    (x) "Military leave" refers to individuals in basic
8training for reserves, special/advanced training, annual
9training, emergency call up, activation by the President of
10the United States, or any other training or duty in service to
11the United States Armed Forces.
12    (y) (Blank).
13    (z) "Community college benefit recipient" means a person
14who:
15        (1) is not a "member" as defined in this Section; and
16        (2) is receiving a monthly survivor's annuity or
17    retirement annuity under Article 15 of the Illinois
18    Pension Code or would be receiving such monthly survivor's
19    annuity or retirement annuity except that the benefit
20    recipient elected on or after June 4, 2018 to receive an
21    accelerated pension benefit payment under Section 15-185.5
22    of the Illinois Pension Code in lieu of receiving an
23    annuity; and
24        (3) either (i) was a full-time employee of a community
25    college district or an association of community college
26    boards created under the Public Community College Act
		HB5036	- 17 -	LRB104 17785 RPS 31217 b
1    (other than an employee whose last employer under Article
2    15 of the Illinois Pension Code was a community college
3    district subject to Article VII of the Public Community
4    College Act) and was eligible to participate in a group
5    health benefit plan as an employee during the time of
6    employment with a community college district (other than a
7    community college district subject to Article VII of the
8    Public Community College Act) or an association of
9    community college boards, or (ii) is the survivor of a
10    person described in item (i).
11    (aa) "Community college dependent beneficiary" means a
12person who:
13        (1) is not a "member" or "dependent" as defined in
14    this Section; and
15        (2) is a community college benefit recipient's: (A)
16    spouse, (B) dependent parent who is receiving at least
17    half of his or her support from the community college
18    benefit recipient, or (C) natural, step, adjudicated, or
19    adopted child who is (i) under age 26, or (ii) age 19 or
20    over and has a mental or physical disability from a cause
21    originating prior to the age of 19 (age 26 if enrolled as
22    an adult child).
23    "Community college dependent beneficiary" does not
24include, as indicated under paragraph (2) of this subsection
25(aa), a dependent of the survivor of a community college
26benefit recipient who first becomes a dependent of a survivor
		HB5036	- 18 -	LRB104 17785 RPS 31217 b
1of a community college benefit recipient on or after January
213, 2012 (the effective date of Public Act 97-668) unless that
3dependent would have been eligible for coverage as a dependent
4of the deceased community college benefit recipient upon whom
5the survivor annuity is based.
6    (bb) "Qualified child advocacy center" means any Illinois
7child advocacy center and its administrative offices funded by
8the Department of Children and Family Services, as defined by
9the Children's Advocacy Center Act, approved by the Director
10and participating in a program created under subsection (n) of
11Section 10.
12    (cc) "Placement for adoption" means the assumption and
13retention by a member of a legal obligation for total or
14partial support of a child in anticipation of adoption of the
15child. The child's placement with the member terminates upon
16the termination of such legal obligation.
17(Source: P.A. 104-417, eff. 8-15-25.)
18    (5 ILCS 375/8)  (from Ch. 127, par. 528)
19    Sec. 8. Eligibility.
20    (a) Each employee eligible under the provisions of this
21Act and any rules and regulations promulgated and adopted
22hereunder by the Director shall become immediately eligible
23and covered for all benefits available under the programs.
24Employees electing coverage for eligible dependents shall have
25the coverage effective immediately, provided that the election
		HB5036	- 19 -	LRB104 17785 RPS 31217 b
1is properly filed in accordance with required filing dates and
2procedures specified by the Director, including the completion
3and submission of all documentation and forms required by the
4Director.
5        (1) Every member originally eligible to elect
6    dependent coverage, but not electing it during the
7    original eligibility period, may subsequently obtain
8    dependent coverage only in the event of a qualifying
9    change in status, special enrollment, special circumstance
10    as defined by the Director, or during the annual Benefit
11    Choice Period.
12        (2) Members described above being transferred from
13    previous coverage towards which the State has been
14    contributing shall be transferred regardless of
15    preexisting conditions, waiting periods, or other
16    requirements that might jeopardize claim payments to which
17    they would otherwise have been entitled.
18        (3) Eligible and covered members that are eligible for
19    coverage as dependents except for the fact of being
20    members shall be transferred to, and covered under,
21    dependent status regardless of preexisting conditions,
22    waiting periods, or other requirements that might
23    jeopardize claim payments to which they would otherwise
24    have been entitled upon cessation of member status and the
25    election of dependent coverage by a member eligible to
26    elect that coverage.
		HB5036	- 20 -	LRB104 17785 RPS 31217 b
1    (b) New employees shall be immediately insured for the
2basic group life insurance and covered by the program of
3health benefits on the first day of active State service.
4Optional life insurance coverage one to 4 times the basic
5amount, if elected during the relevant eligibility period,
6will become effective on the date of employment. Optional life
7insurance coverage exceeding 4 times the basic amount and all
8life insurance amounts applied for after the eligibility
9period will be effective, subject to satisfactory evidence of
10insurability when applicable, or other necessary
11qualifications, pursuant to the requirements of the applicable
12benefit program, unless there is a change in status that would
13confer new eligibility for change of enrollment under rules
14established supplementing this Act, in which event application
15must be made within the new eligibility period.
16    (c) As to the group health benefits program contracted to
17begin or continue after June 30, 1973, each annuitant,
18survivor, and retired employee shall become immediately
19eligible for all benefits available under that program. Each
20annuitant, survivor, and retired employee shall have coverage
21effective immediately, provided that the election is properly
22filed in accordance with the required filing dates and
23procedures specified by the Director, including the completion
24and submission of all documentation and forms required by the
25Director. Annuitants, survivors, and retired employees may
26elect coverage for eligible dependents and shall have the
		HB5036	- 21 -	LRB104 17785 RPS 31217 b
1coverage effective immediately, provided that the election is
2properly filed in accordance with required filing dates and
3procedures specified by the Director, except that, for a
4survivor, the dependent sought to be added on or after the
5effective date of this amendatory Act of the 97th General
6Assembly must have been eligible for coverage as a dependent
7under the deceased member upon whom the survivor's annuity is
8based in order to be eligible for coverage under the survivor.
9    Except as otherwise provided in this Act, where spouses
10[husband and wife] are both eligible members, each shall be
11enrolled as a member and coverage on their eligible dependent
12children, if any, may be under the enrollment and election of
13either. However, if both spouses are eligible members and are 
14also employees under Article 14 of the Illinois Pension Code, 
15then one spouse and only one spouse may elect to enroll the 
16other spouse in the program of group health benefits as an 
17eligible dependent if:
18        (1) both spouses provide to the Department of Central 
19    Management Services, upon the request of the Department of 
20    Central Management Services, an attestation that the 
21    member and the member's spouse have elected for the spouse 
22    to be enrolled as a dependent; and
23        (2) the spouses continue to be married.
24Upon electing to enroll in the program of group health 
25benefits as an eligible dependent under this paragraph, a 
26member forfeits his or her rights as a member under this Act 
		HB5036	- 22 -	LRB104 17785 RPS 31217 b
1with respect to the program of group health benefits during 
2the period when that election is in effect.
3    Regardless of other provisions herein regarding late
4enrollment or other qualifications, as appropriate, the
5Director may periodically authorize open enrollment periods
6for each of the benefit programs at which time each member may
7elect enrollment or change of enrollment without regard to
8age, sex, health, or other qualification under the conditions
9as may be prescribed in rules and regulations supplementing
10this Act. Special open enrollment periods may be declared by
11the Director for certain members only when special
12circumstances occur that affect only those members.
13    (d) Eligible members may elect not to participate in the
14program of health benefits as defined in this Act. The
15election must be made during the annual benefit choice period
16or upon showing a qualifying change in status as defined in the
17U.S. Internal Revenue Code, subject to the conditions in this
18subsection.
19        (1) (Blank).
20        (2) Members may re-enroll in the Department of Central
21    Management Services program of health benefits upon
22    showing a qualifying change in status, as defined in the
23    U.S. Internal Revenue Code, without evidence of
24    insurability and with no limitations on coverage for
25    pre-existing conditions.
26        (3) Members may also re-enroll in the program of
		HB5036	- 23 -	LRB104 17785 RPS 31217 b
1    health benefits during any annual benefit choice period,
2    without evidence of insurability.
3        (4) Members who elect not to participate in the
4    program of health benefits shall be furnished a written
5    explanation of the requirements and limitations for the
6    election not to participate in the program and for
7    re-enrolling in the program. The explanation shall also be
8    included in the annual benefit choice options booklets
9    furnished to members.
10    (d-5) Beginning July 1, 2005, the Director may establish a
11program of financial incentives to encourage annuitants
12receiving a retirement annuity, but who are not eligible for
13benefits under the federal Medicare health insurance program
14(Title XVIII of the Social Security Act, as added by Public Law
1589-97) to elect not to participate in the program of health
16benefits provided under this Act. The election by an annuitant
17not to participate under this program must be made in
18accordance with the requirements set forth under subsection
19(d). The financial incentives provided to these annuitants
20under the program may not exceed $150 per month for each
21annuitant electing not to participate in the program of health
22benefits provided under this Act.
23    (d-6) Beginning July 1, 2013, the Director may establish a
24program of financial incentives to encourage annuitants with
2520 or more years of creditable service but who are not eligible
26for benefits under the federal Medicare health insurance
		HB5036	- 24 -	LRB104 17785 RPS 31217 b
1program (Title XVIII of the Social Security Act, as added by
2Public Law 89-97) to elect not to participate in the program of
3health benefits provided under this Act. The election by an
4annuitant not to participate under this program must be made
5in accordance with the requirements set forth under subsection
6(d). The program established under this subsection (d-6) may
7include a prorated incentive for annuitants with fewer than 20
8years of creditable service, as determined by the Director.
9The financial incentives provided to these annuitants under
10this program may not exceed $500 per month for each annuitant
11electing not to participate in the program of health benefits
12provided under this Act.
13    (e) Notwithstanding any other provision of this Act or the
14rules adopted under this Act, if a person participating in the
15program of health benefits as the dependent spouse of an
16eligible member becomes an annuitant, the person may elect, at
17the time of becoming an annuitant or during any subsequent
18annual benefit choice period, to continue participation as a
19dependent rather than as an eligible member for as long as the
20person continues to be an eligible dependent. In order to be
21eligible to make such an election, the person must have been
22enrolled as a dependent under the program of health benefits
23for no less than one year prior to becoming an annuitant.
24    An eligible member who has elected to participate as a
25dependent may re-enroll in the program of health benefits as
26an eligible member (i) during any subsequent annual benefit
		HB5036	- 25 -	LRB104 17785 RPS 31217 b
1choice period or (ii) upon showing a qualifying change in
2status, as defined in the U.S. Internal Revenue Code, without
3evidence of insurability and with no limitations on coverage
4for pre-existing conditions.
5    A person who elects to participate in the program of
6health benefits as a dependent rather than as an eligible
7member shall be furnished a written explanation of the
8consequences of electing to participate as a dependent and the
9conditions and procedures for re-enrolling as an eligible
10member. The explanation shall also be included in the annual
11benefit choice options booklet furnished to members.
12(Source: P.A. 102-19, eff. 7-1-21.)
13    (5 ILCS 375/9)  (from Ch. 127, par. 529)
14    Sec. 9. (a) The eligible member shall be responsible for
15his or her portion of the premiums, charges or other fees for
16all elected coverages or benefits, which shall be paid by
17means of the acceptance of a reduction in earnings or the
18foregoing of an increase in earnings by an employee; provided,
19however, subject to rules and regulations promulgated by the
20Department, the eligible member may make personal payment of
21the premium, charge or fee for any wellness programs
22implemented under the program of health benefits. All
23contributions and payments by the eligible members and the
24State for all elected coverages and benefits shall be
25deposited in the Health Insurance Reserve Fund. The Department
		HB5036	- 26 -	LRB104 17785 RPS 31217 b
1may determine the aggregate level of contribution required
2under this Section on the basis of actual cost of services
3adjusted for age, sex or the geographical or other demographic
4characteristics which affect costs of the benefit.
5    (b) If a member is not entitled to receive any salary,
6wages or other compensation during a period in which premiums,
7charges or other fees are due or does not receive compensation
8sufficient to allow deduction of the required payment of the
9premium, charge or other fee, such member may continue the
10contributory benefit in effect by making personal payment of
11the premium, charge or other fee for the period in such manner,
12in such amount, and for such duration, as may be prescribed in
13rules and regulations promulgated for the administration of
14this Act.
15    (c) If an eligible member elects coverage as a dependent 
16under subsection (c) of Section 8, the premium or charge 
17applicable to dependent coverage shall apply rather than the 
18premium or charge applicable to a member. The Department shall 
19ensure that the State's aggregate contribution for such 
20individual does not exceed the contribution that would have 
21applied had the individual enrolled as a member.
22(Source: P.A. 91-390, eff. 7-30-99.)
23    (5 ILCS 375/10)  (from Ch. 127, par. 530)
24    Sec. 10. Contributions by the State and members.
25    (a) The State shall pay the cost of basic non-contributory
		HB5036	- 27 -	LRB104 17785 RPS 31217 b
1group life insurance and, subject to member paid contributions
2set by the Department or required by this Section and except as
3provided in this Section, the basic program of group health
4benefits on each eligible member, except a member, not
5otherwise covered by this Act, who has retired as a
6participating member under Article 2 of the Illinois Pension
7Code but is ineligible for the retirement annuity under
8Section 2-119 of the Illinois Pension Code, and part of each
9eligible member's and retired member's premiums for health
10insurance coverage for enrolled dependents as provided by
11Section 9. The State shall pay the cost of the basic program of
12group health benefits only after benefits are reduced by the
13amount of benefits covered by Medicare for all members and
14dependents who are eligible for benefits under Social Security
15or the Railroad Retirement system or who had sufficient
16Medicare-covered government employment, except that such
17reduction in benefits shall apply only to those members and
18dependents who (1) first become eligible for such Medicare
19coverage on or after July 1, 1992; or (2) are
20Medicare-eligible members or dependents of a local government
21unit which began participation in the program on or after July
221, 1992; or (3) remain eligible for, but no longer receive
23Medicare coverage which they had been receiving on or after
24July 1, 1992. The Department may determine the aggregate level
25of the State's contribution on the basis of actual cost of
26medical services adjusted for age, sex or geographic or other
		HB5036	- 28 -	LRB104 17785 RPS 31217 b
1demographic characteristics which affect the costs of such
2programs.
3    The cost of participation in the basic program of group
4health benefits for the dependent or survivor of a living or
5deceased retired employee who was formerly employed by the
6University of Illinois in the Cooperative Extension Service
7and would be an annuitant but for the fact that he or she was
8made ineligible to participate in the State Universities
9Retirement System by clause (4) of subsection (a) of Section
1015-107 of the Illinois Pension Code shall not be greater than
11the cost of participation that would otherwise apply to that
12dependent or survivor if he or she were the dependent or
13survivor of an annuitant under the State Universities
14Retirement System.
15    (a-1) (Blank).
16    (a-2) (Blank).
17    (a-3) (Blank).
18    (a-4) (Blank).
19    (a-5) (Blank).
20    (a-6) (Blank).
21    (a-7) (Blank).
22    (a-8) Any annuitant, survivor, or retired employee may
23waive or terminate coverage in the program of group health
24benefits. Any such annuitant, survivor, or retired employee
25who has waived or terminated coverage may enroll or re-enroll
26in the program of group health benefits only during the annual
		HB5036	- 29 -	LRB104 17785 RPS 31217 b
1benefit choice period, as determined by the Director; except
2that in the event of termination of coverage due to nonpayment
3of premiums, the annuitant, survivor, or retired employee may
4not re-enroll in the program.
5    (a-8.3) Notwithstanding any other provision of this 
6Section, the Department shall not require an employee who is 
7authorized to elect and has elected to become a dependent 
8under subsection (c) of Section 8 to make contributions as a 
9member under this Section during the period when that election 
10is in effect.
11    (a-8.5) Beginning on July 1, 2012 (the effective date of
12Public Act 97-695), the Director of Central Management
13Services shall, on an annual basis, determine the amount that
14the State shall contribute toward the basic program of group
15health benefits on behalf of annuitants (including individuals
16who (i) participated in the General Assembly Retirement
17System, the State Employees' Retirement System of Illinois,
18the State Universities Retirement System, the Teachers'
19Retirement System of the State of Illinois, or the Judges
20Retirement System of Illinois and (ii) qualify as annuitants
21under subsection (b) of Section 3 of this Act), survivors
22(including individuals who (i) receive an annuity as a
23survivor of an individual who participated in the General
24Assembly Retirement System, the State Employees' Retirement
25System of Illinois, the State Universities Retirement System,
26the Teachers' Retirement System of the State of Illinois, or
		HB5036	- 30 -	LRB104 17785 RPS 31217 b
1the Judges Retirement System of Illinois and (ii) qualify as
2survivors under subsection (q) of Section 3 of this Act), and
3retired employees (as defined in subsection (p) of Section 3
4of this Act). The remainder of the cost of coverage for each
5annuitant, survivor, or retired employee, as determined by the
6Director of Central Management Services, shall be the
7responsibility of that annuitant, survivor, or retired
8employee.
9    Contributions required of annuitants, survivors, and
10retired employees shall be the same for all retirement systems
11and shall also be based on whether an individual has made an
12election under Section 15-135.1 of the Illinois Pension Code.
13Contributions may be based on annuitants', survivors', or
14retired employees' Medicare eligibility, but may not be based
15on Social Security eligibility.
16    (a-9) No later than May 1 of each calendar year, the
17Director of Central Management Services shall certify in
18writing to the Executive Secretary of the State Employees'
19Retirement System of Illinois the amounts of the Medicare
20supplement health care premiums and the amounts of the health
21care premiums for all other retirees who are not Medicare
22eligible.
23    A separate calculation of the premiums based upon the
24actual cost of each health care plan shall be so certified.
25    The Director of Central Management Services shall provide
26to the Executive Secretary of the State Employees' Retirement
		HB5036	- 31 -	LRB104 17785 RPS 31217 b
1System of Illinois such information, statistics, and other
2data as he or she may require to review the premium amounts
3certified by the Director of Central Management Services.
4    The Department of Central Management Services, or any
5successor agency designated to procure health care contracts
6pursuant to this Act, is authorized to establish funds,
7separate accounts provided by any bank or banks as defined by
8the Illinois Banking Act, or separate accounts provided by any
9savings and loan association or associations as defined by the
10Illinois Savings and Loan Act of 1985 to be held by the
11Director, outside the State treasury, for the purpose of
12receiving the transfer of moneys from the Local Government
13Health Insurance Reserve Fund. The Department may promulgate
14rules further defining the methodology for the transfers. Any
15interest earned by moneys in the funds or accounts shall inure
16to the Local Government Health Insurance Reserve Fund. The
17transferred moneys, and interest accrued thereon, shall be
18used exclusively for transfers to administrative service
19organizations or their financial institutions for payments of
20claims to claimants and providers under the self-insurance
21health plan. The transferred moneys, and interest accrued
22thereon, shall not be used for any other purpose including,
23but not limited to, reimbursement of administration fees due
24the administrative service organization pursuant to its
25contract or contracts with the Department.
26    (a-10) To the extent that participation, benefits, or
		HB5036	- 32 -	LRB104 17785 RPS 31217 b
1premiums under this Act are based on a person's service credit
2under an Article of the Illinois Pension Code, service credit
3terminated in exchange for an accelerated pension benefit
4payment under Section 14-147.5, 15-185.5, or 16-190.5 of that
5Code shall be included in determining a person's service
6credit for the purposes of this Act.
7    (b) State employees who become eligible for this program
8on or after January 1, 1980 in positions normally requiring
9actual performance of duty not less than 1/2 of a normal work
10period but not equal to that of a normal work period, shall be
11given the option of participating in the available program. If
12the employee elects coverage, the State shall contribute on
13behalf of such employee to the cost of the employee's benefit
14and any applicable dependent supplement, that sum which bears
15the same percentage as that percentage of time the employee
16regularly works when compared to normal work period.
17    (c) The basic non-contributory coverage from the basic
18program of group health benefits shall be continued for each
19employee not in pay status or on active service by reason of
20(1) leave of absence due to illness or injury, (2) authorized
21educational leave of absence or sabbatical leave, or (3)
22military leave. This coverage shall continue until expiration
23of authorized leave and return to active service, but not to
24exceed 24 months for leaves under item (1) or (2). This
2524-month limitation and the requirement of returning to active
26service shall not apply to persons receiving ordinary or
		HB5036	- 33 -	LRB104 17785 RPS 31217 b
1accidental disability benefits or retirement benefits through
2the appropriate State retirement system or benefits under the
3Workers' Compensation Act or the Workers' Occupational
4Diseases Act.
5    (d) The basic group life insurance coverage shall
6continue, with full State contribution, where such person is
7(1) absent from active service by reason of disability arising
8from any cause other than self-inflicted, (2) on authorized
9educational leave of absence or sabbatical leave, or (3) on
10military leave.
11    (e) Where the person is in non-pay status for a period in
12excess of 30 days or on leave of absence, other than by reason
13of disability, educational or sabbatical leave, or military
14leave, such person may continue coverage only by making
15personal payment equal to the amount normally contributed by
16the State on such person's behalf. Such payments and coverage
17may be continued: (1) until such time as the person returns to
18a status eligible for coverage at State expense, but not to
19exceed 24 months or (2) until such person's employment or
20annuitant status with the State is terminated (exclusive of
21any additional service imposed pursuant to law).
22    (f) The Department shall establish by rule the extent to
23which other employee benefits will continue for persons in
24non-pay status or who are not in active service.
25    (g) The State shall not pay the cost of the basic
26non-contributory group life insurance, program of health
		HB5036	- 34 -	LRB104 17785 RPS 31217 b
1benefits and other employee benefits for members who are
2survivors as defined by paragraphs (1) and (2) of subsection
3(q) of Section 3 of this Act. The costs of benefits for these
4survivors shall be paid by the survivors or by the University
5of Illinois Cooperative Extension Service, or any combination
6thereof. However, the State shall pay the amount of the
7reduction in the cost of participation, if any, resulting from
8the amendment to subsection (a) made by Public Act 91-617.
9    (h) Those persons occupying positions with any department
10as a result of emergency appointments pursuant to Section 8b.8
11of the Personnel Code who are not considered employees under
12this Act shall be given the option of participating in the
13programs of group life insurance, health benefits and other
14employee benefits. Such persons electing coverage may
15participate only by making payment equal to the amount
16normally contributed by the State for similarly situated
17employees. Such amounts shall be determined by the Director.
18Such payments and coverage may be continued until such time as
19the person becomes an employee pursuant to this Act or such
20person's appointment is terminated.
21    (i) Any unit of local government within the State of
22Illinois may apply to the Director to have its employees,
23annuitants, and their dependents provided group health
24coverage under this Act on a non-insured basis. To
25participate, a unit of local government must agree to enroll
26all of its employees, who may select coverage under any group
		HB5036	- 35 -	LRB104 17785 RPS 31217 b
1health benefits plan made available by the Department under
2the health benefits program established under this Section or
3a health maintenance organization that has contracted with the
4State to be available as a health care provider for employees
5as defined in this Act. A unit of local government must remit
6the entire cost of providing coverage under the health
7benefits program established under this Section or, for
8coverage under a health maintenance organization, an amount
9determined by the Director based on an analysis of the sex,
10age, geographic location, or other relevant demographic
11variables for its employees, except that the unit of local
12government shall not be required to enroll those of its
13employees who are covered spouses or dependents under the
14State group health benefits plan or another group policy or
15plan providing health benefits as long as (1) an appropriate
16official from the unit of local government attests that each
17employee not enrolled is a covered spouse or dependent under
18this plan or another group policy or plan, and (2) at least 50%
19of the employees are enrolled and the unit of local government
20remits the entire cost of providing coverage to those
21employees, except that a participating school district must
22have enrolled at least 50% of its full-time employees who have
23not waived coverage under the district's group health plan by
24participating in a component of the district's cafeteria plan.
25A participating school district is not required to enroll a
26full-time employee who has waived coverage under the
		HB5036	- 36 -	LRB104 17785 RPS 31217 b
1district's health plan, provided that an appropriate official
2from the participating school district attests that the
3full-time employee has waived coverage by participating in a
4component of the district's cafeteria plan. For the purposes
5of this subsection, "participating school district" includes a
6unit of local government whose primary purpose is education as
7defined by the Department's rules.
8    Employees of a participating unit of local government who
9are not enrolled due to coverage under another group health
10policy or plan may enroll in the event of a qualifying change
11in status, special enrollment, special circumstance as defined
12by the Director, or during the annual benefit choice period. A
13participating unit of local government may also elect to cover
14its annuitants. Dependent coverage shall be offered on an
15optional basis, with the costs paid by the unit of local
16government, its employees, or some combination of the two as
17determined by the unit of local government. The unit of local
18government shall be responsible for timely collection and
19transmission of dependent premiums.
20    The Director shall annually determine monthly rates of
21payment, subject to the following constraints:
22        (1) In the first year of coverage, the rates shall be
23    equal to the amount normally charged to State employees
24    for elected optional coverages or for enrolled dependents
25    coverages or other contributory coverages, or contributed
26    by the State for basic insurance coverages on behalf of
		HB5036	- 37 -	LRB104 17785 RPS 31217 b
1    its employees, adjusted for differences between State
2    employees and employees of the local government in age,
3    sex, geographic location or other relevant demographic
4    variables, plus an amount sufficient to pay for the
5    additional administrative costs of providing coverage to
6    employees of the unit of local government and their
7    dependents.
8        (2) In subsequent years, a further adjustment shall be
9    made to reflect the actual prior years' claims experience
10    of the employees of the unit of local government.
11    In the case of coverage of local government employees
12under a health maintenance organization, the Director shall
13annually determine for each participating unit of local
14government the maximum monthly amount the unit may contribute
15toward that coverage, based on an analysis of (i) the age, sex,
16geographic location, and other relevant demographic variables
17of the unit's employees and (ii) the cost to cover those
18employees under the State group health benefits plan. The
19Director may similarly determine the maximum monthly amount
20each unit of local government may contribute toward coverage
21of its employees' dependents under a health maintenance
22organization.
23    Monthly payments by the unit of local government or its
24employees for group health benefits plan or health maintenance
25organization coverage shall be deposited into the Local
26Government Health Insurance Reserve Fund.
		HB5036	- 38 -	LRB104 17785 RPS 31217 b
1    The Local Government Health Insurance Reserve Fund is
2hereby created as a nonappropriated trust fund to be held
3outside the State treasury, with the State Treasurer as
4custodian. The Local Government Health Insurance Reserve Fund
5shall be a continuing fund not subject to fiscal year
6limitations. The Local Government Health Insurance Reserve
7Fund is not subject to administrative charges or charge-backs,
8including, but not limited to, those authorized under Section
98h of the State Finance Act. All revenues arising from the
10administration of the health benefits program established
11under this Section shall be deposited into the Local
12Government Health Insurance Reserve Fund. Any interest earned
13on moneys in the Local Government Health Insurance Reserve
14Fund shall be deposited into the Fund. All expenditures from
15this Fund shall be used for payments for health care benefits
16for local government and rehabilitation facility employees,
17annuitants, and dependents, and to reimburse the Department or
18its administrative service organization for all expenses
19incurred in the administration of benefits. No other State
20funds may be used for these purposes.
21    A local government employer's participation or desire to
22participate in a program created under this subsection shall
23not limit that employer's duty to bargain with the
24representative of any collective bargaining unit of its
25employees.
26    (j) Any rehabilitation facility within the State of
		HB5036	- 39 -	LRB104 17785 RPS 31217 b
1Illinois may apply to the Director to have its employees,
2annuitants, and their eligible dependents provided group
3health coverage under this Act on a non-insured basis. To
4participate, a rehabilitation facility must agree to enroll
5all of its employees and remit the entire cost of providing
6such coverage for its employees, except that the
7rehabilitation facility shall not be required to enroll those
8of its employees who are covered spouses or dependents under
9this plan or another group policy or plan providing health
10benefits as long as (1) an appropriate official from the
11rehabilitation facility attests that each employee not
12enrolled is a covered spouse or dependent under this plan or
13another group policy or plan, and (2) at least 50% of the
14employees are enrolled and the rehabilitation facility remits
15the entire cost of providing coverage to those employees.
16Employees of a participating rehabilitation facility who are
17not enrolled due to coverage under another group health policy
18or plan may enroll in the event of a qualifying change in
19status, special enrollment, special circumstance as defined by
20the Director, or during the annual benefit choice period. A
21participating rehabilitation facility may also elect to cover
22its annuitants. Dependent coverage shall be offered on an
23optional basis, with the costs paid by the rehabilitation
24facility, its employees, or some combination of the 2 as
25determined by the rehabilitation facility. The rehabilitation
26facility shall be responsible for timely collection and
		HB5036	- 40 -	LRB104 17785 RPS 31217 b
1transmission of dependent premiums.
2    The Director shall annually determine quarterly rates of
3payment, subject to the following constraints:
4        (1) In the first year of coverage, the rates shall be
5    equal to the amount normally charged to State employees
6    for elected optional coverages or for enrolled dependents
7    coverages or other contributory coverages on behalf of its
8    employees, adjusted for differences between State
9    employees and employees of the rehabilitation facility in
10    age, sex, geographic location or other relevant
11    demographic variables, plus an amount sufficient to pay
12    for the additional administrative costs of providing
13    coverage to employees of the rehabilitation facility and
14    their dependents.
15        (2) In subsequent years, a further adjustment shall be
16    made to reflect the actual prior years' claims experience
17    of the employees of the rehabilitation facility.
18    Monthly payments by the rehabilitation facility or its
19employees for group health benefits shall be deposited into
20the Local Government Health Insurance Reserve Fund.
21    (k) Any domestic violence shelter or service within the
22State of Illinois may apply to the Director to have its
23employees, annuitants, and their dependents provided group
24health coverage under this Act on a non-insured basis. To
25participate, a domestic violence shelter or service must agree
26to enroll all of its employees and pay the entire cost of
		HB5036	- 41 -	LRB104 17785 RPS 31217 b
1providing such coverage for its employees. The domestic
2violence shelter shall not be required to enroll those of its
3employees who are covered spouses or dependents under this
4plan or another group policy or plan providing health benefits
5as long as (1) an appropriate official from the domestic
6violence shelter attests that each employee not enrolled is a
7covered spouse or dependent under this plan or another group
8policy or plan and (2) at least 50% of the employees are
9enrolled and the domestic violence shelter remits the entire
10cost of providing coverage to those employees. Employees of a
11participating domestic violence shelter who are not enrolled
12due to coverage under another group health policy or plan may
13enroll in the event of a qualifying change in status, special
14enrollment, or special circumstance as defined by the Director
15or during the annual benefit choice period. A participating
16domestic violence shelter may also elect to cover its
17annuitants. Dependent coverage shall be offered on an optional
18basis, with employees, or some combination of the 2 as
19determined by the domestic violence shelter or service. The
20domestic violence shelter or service shall be responsible for
21timely collection and transmission of dependent premiums.
22    The Director shall annually determine rates of payment,
23subject to the following constraints:
24        (1) In the first year of coverage, the rates shall be
25    equal to the amount normally charged to State employees
26    for elected optional coverages or for enrolled dependents
		HB5036	- 42 -	LRB104 17785 RPS 31217 b
1    coverages or other contributory coverages on behalf of its
2    employees, adjusted for differences between State
3    employees and employees of the domestic violence shelter
4    or service in age, sex, geographic location or other
5    relevant demographic variables, plus an amount sufficient
6    to pay for the additional administrative costs of
7    providing coverage to employees of the domestic violence
8    shelter or service and their dependents.
9        (2) In subsequent years, a further adjustment shall be
10    made to reflect the actual prior years' claims experience
11    of the employees of the domestic violence shelter or
12    service.
13    Monthly payments by the domestic violence shelter or
14service or its employees for group health insurance shall be
15deposited into the Local Government Health Insurance Reserve
16Fund.
17    (l) A public community college or entity organized
18pursuant to the Public Community College Act may apply to the
19Director initially to have only annuitants not covered prior
20to July 1, 1992 by the district's health plan provided health
21coverage under this Act on a non-insured basis. The community
22college must execute a 2-year contract to participate in the
23Local Government Health Plan. Any annuitant may enroll in the
24event of a qualifying change in status, special enrollment,
25special circumstance as defined by the Director, or during the
26annual benefit choice period.
		HB5036	- 43 -	LRB104 17785 RPS 31217 b
1    The Director shall annually determine monthly rates of
2payment subject to the following constraints: for those
3community colleges with annuitants only enrolled, first year
4rates shall be equal to the average cost to cover claims for a
5State member adjusted for demographics, Medicare
6participation, and other factors; and in the second year, a
7further adjustment of rates shall be made to reflect the
8actual first year's claims experience of the covered
9annuitants.
10    (l-5) The provisions of subsection (l) become inoperative
11on July 1, 1999.
12    (m) The Director shall adopt any rules deemed necessary
13for implementation of this amendatory Act of 1989 (Public Act
1486-978).
15    (n) Any child advocacy center within the State of Illinois
16may apply to the Director to have its employees, annuitants,
17and their dependents provided group health coverage under this
18Act on a non-insured basis. To participate, a child advocacy
19center must agree to enroll all of its employees and pay the
20entire cost of providing coverage for its employees. The child
21advocacy center shall not be required to enroll those of its
22employees who are covered spouses or dependents under this
23plan or another group policy or plan providing health benefits
24as long as (1) an appropriate official from the child advocacy
25center attests that each employee not enrolled is a covered
26spouse or dependent under this plan or another group policy or
		HB5036	- 44 -	LRB104 17785 RPS 31217 b
1plan and (2) at least 50% of the employees are enrolled and the
2child advocacy center remits the entire cost of providing
3coverage to those employees. Employees of a participating
4child advocacy center who are not enrolled due to coverage
5under another group health policy or plan may enroll in the
6event of a qualifying change in status, special enrollment, or
7special circumstance as defined by the Director or during the
8annual benefit choice period. A participating child advocacy
9center may also elect to cover its annuitants. Dependent
10coverage shall be offered on an optional basis, with the costs
11paid by the child advocacy center, its employees, or some
12combination of the 2 as determined by the child advocacy
13center. The child advocacy center shall be responsible for
14timely collection and transmission of dependent premiums.
15    The Director shall annually determine rates of payment,
16subject to the following constraints:
17        (1) In the first year of coverage, the rates shall be
18    equal to the amount normally charged to State employees
19    for elected optional coverages or for enrolled dependents
20    coverages or other contributory coverages on behalf of its
21    employees, adjusted for differences between State
22    employees and employees of the child advocacy center in
23    age, sex, geographic location, or other relevant
24    demographic variables, plus an amount sufficient to pay
25    for the additional administrative costs of providing
26    coverage to employees of the child advocacy center and
		HB5036	- 45 -	LRB104 17785 RPS 31217 b
1    their dependents.
2        (2) In subsequent years, a further adjustment shall be
3    made to reflect the actual prior years' claims experience
4    of the employees of the child advocacy center.
5    Monthly payments by the child advocacy center or its
6employees for group health insurance shall be deposited into
7the Local Government Health Insurance Reserve Fund.
8(Source: P.A. 104-417, eff. 8-15-25.)