STATE GROUP INS-DEPENDENTS

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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,
3
represented in the General Assembly:

4

Section 5.
The State Employees Group Insurance Act of 1971
5
is 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
8
requires, the following words and phrases as used in this Act
9
shall have the following meanings. The Department may define
10
these and other words and phrases separately for the purpose
11
of implementing specific programs providing benefits under
12
this Act.
13

(a) "Administrative service organization" means any
14
person, firm, or corporation experienced in the handling of
15
claims which is fully qualified, financially sound, and
16
capable of meeting the service requirements of a contract of
17
administration executed with the Department.
18

(b) "Annuitant" means (1) an employee who retires, or has
19
retired, on or after January 1, 1966 on an immediate annuity
20
under the provisions of Articles 2, 14 (including an employee
21
who has elected to receive an alternative retirement
22
cancellation payment under Section 14-108.5 of the Illinois
23
Pension Code in lieu of an annuity or who meets the criteria

HB5036
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LRB104 17785 RPS 31217 b
1
for retirement, but in lieu of receiving an annuity under that
2
Article has elected to receive an accelerated pension benefit
3
payment under Section 14-147.5 of that Article), 15 (including
4
an employee who has retired under the optional retirement
5
program established under Section 15-158.2 or who meets the
6
criteria for retirement but in lieu of receiving an annuity
7
under that Article has elected to receive an accelerated
8
pension benefit payment under Section 15-185.5 of the
9
Article), paragraph (2), (3), or (5) of Section 16-106
10
(including an employee who meets the criteria for retirement,
11
but in lieu of receiving an annuity under that Article has
12
elected to receive an accelerated pension benefit payment
13
under Section 16-190.5 of the Illinois Pension Code), or
14
Article 18 of the Illinois Pension Code; (2) any person who was
15
receiving group insurance coverage under this Act as of March
16
31, 1978 by reason of his status as an annuitant, even though
17
the annuity in relation to which such coverage was provided is
18
a proportional annuity based on less than the minimum period
19
of service required for a retirement annuity in the system
20
involved; (3) any person not otherwise covered by this Act who
21
has retired as a participating member under Article 2 of the
22
Illinois Pension Code but is ineligible for the retirement
23
annuity under Section 2-119 of the Illinois Pension Code; (4)
24
the spouse of any person who is receiving a retirement annuity
25
under Article 18 of the Illinois Pension Code and who is
26
covered under a group health insurance program sponsored by a

HB5036
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LRB104 17785 RPS 31217 b
1
governmental employer other than the State of Illinois and who
2
has irrevocably elected to waive his or her coverage under
3
this Act and to have his or her spouse considered as the
4
"annuitant" under this Act and not as a "dependent"; or (5) an
5
employee who retires, or has retired, from a qualified
6
position, as determined according to rules promulgated by the
7
Director, under a qualified local government, a qualified
8
rehabilitation facility, a qualified domestic violence shelter
9
or service, or a qualified child advocacy center. (For
10
definition 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
15
corporation organized under the Limited Health Service
16
Organization Act or the Voluntary Health Services Plans Act, a
17
partnership, or other nongovernmental organization, which is
18
authorized to do group life or group health insurance business
19
in Illinois, or (2) the State of Illinois as a self-insurer.
20

(d) "Compensation" means salary or wages payable on a
21
regular payroll by the State Treasurer on a warrant of the
22
State Comptroller out of any State, trust or federal fund, or
23
by the Governor of the State through a disbursing officer of
24
the State out of a trust or out of federal funds, or by any
25
Department out of State, trust, federal, or other funds held
26
by the State Treasurer or the Department, to any person for

HB5036
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LRB104 17785 RPS 31217 b
1
personal services currently performed, and ordinary or
2
accidental disability benefits under Articles 2, 14, 15
3
(including ordinary or accidental disability benefits under
4
the optional retirement program established under Section
5
15-158.2), paragraph (2), (3), or (5) of Section 16-106, or
6
Article 18 of the Illinois Pension Code, for disability
7
incurred after January 1, 1966, or benefits payable under the
8
Workers' Compensation Act or the Workers' Occupational
9
Diseases Act or benefits payable under a sick pay plan
10
established in accordance with Section 36 of the State Finance
11
Act. "Compensation" also means salary or wages paid to an
12
employee of any qualified local government, qualified
13
rehabilitation facility, qualified domestic violence shelter
14
or service, or qualified child advocacy center.
15

(e) "Commission" means the State Employees Group Insurance
16
Advisory Commission authorized by this Act. Commencing July 1,
17
1984, "Commission" as used in this Act means the Commission on
18
Government Forecasting and Accountability as established by
19
the Legislative Commission Reorganization Act of 1984.
20

(f) "Contributory", when referred to as contributory
21
coverage, shall mean optional coverages or benefits elected by
22
the member toward the cost of which such member makes
23
contribution, or which are funded in whole or in part through
24
the acceptance of a reduction in earnings or the foregoing of
25
an increase in earnings by an employee, as distinguished from
26
noncontributory coverage or benefits which are paid entirely

HB5036
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LRB104 17785 RPS 31217 b
1
by the State of Illinois without reduction of the member's
2
salary.
3

(g) "Department" means any department, institution, board,
4
commission, officer, court, or any agency of the State
5
government receiving appropriations and having power to
6
certify payrolls to the Comptroller authorizing payments of
7
salary and wages against such appropriations as are made by
8
the General Assembly from any State fund, or against trust
9
funds held by the State Treasurer and includes boards of
10
trustees of the retirement systems created by Articles 2, 14,
11
15, 16, and 18 of the Illinois Pension Code. "Department" also
12
includes the Illinois Comprehensive Health Insurance Board,
13
the Board of Examiners established under the Illinois Public
14
Accounting Act, and the Illinois Finance Authority.
15

(h) "Dependent", when the term is used in the context of
16
the 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
18
who lives with the member from the time of the placement for
19
adoption until entry of an order of adoption, a stepchild or
20
adjudicated child, or a child who lives with the member if such
21
member is a court appointed guardian of the child or (2) age 19
22
or over who has a mental or physical disability from a cause
23
originating prior to the age of 19 (age 26 if enrolled as an
24
adult child dependent). For the health plan only, the term
25
"dependent" also includes
:
(1) any person enrolled prior to
26
the effective date of this Section who is dependent upon the

HB5036
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LRB104 17785 RPS 31217 b
1
member to the extent that the member may claim such person as a
2
dependent for income tax deduction purposes
;

and
(2) any
3
person who has received after June 30, 2000 an organ
4
transplant and who is financially dependent upon the member
5
and eligible to be claimed as a dependent for income tax
6
purposes
; and (3) any employee who is authorized to elect and
7
has elected dependent status under subsection (c) of Section 8
8
during the period when that election is in effect
. A member
9
requesting to cover any dependent must provide documentation
10
as requested by the Department of Central Management Services
11
and file with the Department any and all forms required by the
12
Department.
13

(i) "Director" means the Director of the Illinois
14
Department of Central Management Services.
15

(j) "Eligibility period" means the period of time a member
16
has to elect enrollment in programs or to select benefits
17
without regard to age, sex, or health.
18

(k) "Employee" means and includes each officer or employee
19
in the service of a department who (1) receives his
20
compensation for service rendered to the department on a
21
warrant issued pursuant to a payroll certified by a department
22
or on a warrant or check issued and drawn by a department upon
23
a trust, federal or other fund or on a warrant issued pursuant
24
to a payroll certified by an elected or duly appointed officer
25
of the State or who receives payment of the performance of
26
personal services on a warrant issued pursuant to a payroll

HB5036
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LRB104 17785 RPS 31217 b
1
certified by a Department and drawn by the Comptroller upon
2
the State Treasurer against appropriations made by the General
3
Assembly from any fund or against trust funds held by the State
4
Treasurer, and (2) is employed full-time or part-time in a
5
position normally requiring actual performance of duty during
6
not less than 1/2 of a normal work period, as established by
7
the Director in cooperation with each department, except that
8
persons elected by popular vote will be considered employees
9
during the entire term for which they are elected regardless
10
of hours devoted to the service of the State, and (3) except
11
that "employee" does not include any person who is not
12
eligible by reason of such person's employment to participate
13
in one of the State retirement systems under Articles 2, 14, 15
14
(either the regular Article 15 system or the optional
15
retirement program established under Section 15-158.2), or 18,
16
or under paragraph (2), (3), or (5) of Section 16-106, of the
17
Illinois Pension Code, but such term does include persons who
18
are employed during the 6-month qualifying period under
19
Article 14 of the Illinois Pension Code. Such term also
20
includes any person who (1) after January 1, 1966, is
21
receiving ordinary or accidental disability benefits under
22
Articles 2, 14, 15 (including ordinary or accidental
23
disability benefits under the optional retirement program
24
established under Section 15-158.2), paragraph (2), (3), or
25
(5) of Section 16-106, or Article 18 of the Illinois Pension
26
Code, for disability incurred after January 1, 1966, (2)

HB5036
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LRB104 17785 RPS 31217 b
1
receives total permanent or total temporary disability under
2
the Workers' Compensation Act or the Workers' Occupational
3
Diseases Act as a result of injuries sustained or illness
4
contracted in the course of employment with the State of
5
Illinois, or (3) is not otherwise covered under this Act and
6
has retired as a participating member under Article 2 of the
7
Illinois Pension Code but is ineligible for the retirement
8
annuity under Section 2-119 of the Illinois Pension Code.
9
However, a person who satisfies the criteria of the foregoing
10
definition of "employee" except that such person is made
11
ineligible to participate in the State Universities Retirement
12
System by clause (4) of subsection (a) of Section 15-107 of the
13
Illinois Pension Code is also an "employee" for the purposes
14
of this Act. "Employee" also includes any person receiving or
15
eligible for benefits under a sick pay plan established in
16
accordance with Section 36 of the State Finance Act.
17
"Employee" also includes (i) each officer or employee in the
18
service of a qualified local government, including persons
19
appointed as trustees of sanitary districts regardless of
20
hours devoted to the service of the sanitary district, (ii)
21
each employee in the service of a qualified rehabilitation
22
facility, (iii) each full-time employee in the service of a
23
qualified domestic violence shelter or service, and (iv) each
24
full-time employee in the service of a qualified child
25
advocacy center, as determined according to rules promulgated
26
by the Director.

HB5036
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LRB104 17785 RPS 31217 b
1

(l) "Member" means an employee, annuitant, retired
2
employee, or survivor. In the case of an annuitant or retired
3
employee who first becomes an annuitant or retired employee on
4
or after January 13, 2012 (the effective date of Public Act
5
97-668), the individual must meet the minimum vesting
6
requirements of the applicable retirement system in order to
7
be eligible for group insurance benefits under that system. In
8
the case of a survivor who is not entitled to occupational
9
death benefits pursuant to an applicable retirement system or
10
death benefits pursuant to the Workers' Compensation Act, and
11
who first becomes a survivor on or after January 13, 2012 (the
12
effective date of Public Act 97-668), the deceased employee,
13
annuitant, or retired employee upon whom the annuity is based
14
must have been eligible to participate in the group insurance
15
system under the applicable retirement system in order for the
16
survivor to be eligible for group insurance benefits under
17
that system.
18

For purposes of coverage under the program of group health
19
benefits, "member" does not include any employee who is
20
authorized to elect and has elected dependent status under
21
subsection (c) of Section 8 during the period when that
22
election is in effect.

23

In the case of a survivor who is entitled to occupational
24
death benefits pursuant to the deceased employee's applicable
25
retirement system or death benefits pursuant to the Workers'
26
Compensation Act, and first becomes a survivor on or after

HB5036
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LRB104 17785 RPS 31217 b
1
January 1, 2022, the survivor is eligible for group health
2
insurance benefits regardless of the deceased employee's
3
minimum vesting requirements under the applicable retirement
4
system, with a State contribution rate of 100%, until an
5
unmarried child dependent reaches the age of 18, or the age of
6
22 if the dependent child is a full-time student, or until the
7
adult survivor becomes eligible for benefits under the federal
8
Medicare health insurance program (Title XVIII of the Social
9
Security Act, as added by Public Law 89-97). In the case of a
10
survivor currently receiving occupational death benefits
11
pursuant to the deceased employee's applicable retirement
12
system or has received death benefits pursuant to the Workers'
13
Compensation Act, who first became a survivor prior to January
14
1, 2022, the survivor is eligible for group health insurance
15
benefits regardless of the deceased employee's minimum vesting
16
requirements under the applicable retirement system, with a
17
State contribution rate of 100%, until an unmarried child
18
dependent reaches the age of 18, or the age of 22 if the
19
dependent child is a full-time student, or until the adult
20
survivor becomes eligible for benefits under the federal
21
Medicare health insurance program (Title XVIII of the Social
22
Security Act, as added by Public Law 89-97). The changes made
23
by Public Act 102-714 with respect to survivors who first
24
became survivors prior to January 1, 2022 shall apply upon
25
request of the survivor on or after April 29, 2022 (the
26
effective date of Public Act 102-714).

HB5036
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LRB104 17785 RPS 31217 b
1

(m) "Optional coverages or benefits" means those coverages
2
or benefits available to the member on his or her voluntary
3
election, and at his or her own expense.
4

(n) "Program" means the group life insurance, health
5
benefits, and other employee benefits designed and contracted
6
for by the Director under this Act.
7

(o) "Health plan" means a health benefits program offered
8
by the State of Illinois for persons eligible for the plan.
9

(p) "Retired employee" means any person who would be an
10
annuitant as that term is defined herein but for the fact that
11
such person retired prior to January 1, 1966. Such term also
12
includes any person formerly employed by the University of
13
Illinois in the Cooperative Extension Service who would be an
14
annuitant but for the fact that such person was made
15
ineligible to participate in the State Universities Retirement
16
System by clause (4) of subsection (a) of Section 15-107 of the
17
Illinois Pension Code.
18

(q) "Survivor" means a person receiving an annuity as a
19
survivor of an employee or of an annuitant. "Survivor" also
20
includes: (1) the surviving dependent of a person who
21
satisfies the definition of "employee" except that such person
22
is made ineligible to participate in the State Universities
23
Retirement System by clause (4) of subsection (a) of Section
24
15-107 of the Illinois Pension Code; (2) the surviving
25
dependent of any person formerly employed by the University of
26
Illinois in the Cooperative Extension Service who would be an

HB5036
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LRB104 17785 RPS 31217 b
1
annuitant except for the fact that such person was made
2
ineligible to participate in the State Universities Retirement
3
System by clause (4) of subsection (a) of Section 15-107 of the
4
Illinois Pension Code; (3) the surviving dependent of a person
5
who was an annuitant under this Act by virtue of receiving an
6
alternative retirement cancellation payment under Section
7
14-108.5 of the Illinois Pension Code; and (4) a person who
8
would be receiving an annuity as a survivor of an annuitant
9
except that the annuitant elected on or after June 4, 2018 to
10
receive an accelerated pension benefit payment under Section
11
14-147.5, 15-185.5, or 16-190.5 of the Illinois Pension Code
12
in lieu of receiving an annuity.
13

(q-2) "SERS" means the State Employees' Retirement System
14
of Illinois, created under Article 14 of the Illinois Pension
15
Code.
16

(q-3) "SURS" means the State Universities Retirement
17
System, created under Article 15 of the Illinois Pension Code.
18

(q-4) "TRS" means the Teachers' Retirement System of the
19
State of Illinois, created under Article 16 of the Illinois
20
Pension Code.
21

(q-5) (Blank).
22

(q-6) (Blank).
23

(q-7) (Blank).
24

(r) "Medical services" means the services provided within
25
the scope of their licenses by practitioners in all categories
26
licensed under the Medical Practice Act of 1987.

HB5036
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LRB104 17785 RPS 31217 b
1

(s) "Unit of local government" means any county,
2
municipality, township, school district (including a
3
combination of school districts under the Intergovernmental
4
Cooperation Act), special district or other unit, designated
5
as a unit of local government by law, which exercises limited
6
governmental powers or powers in respect to limited
7
governmental subjects, any not-for-profit association with a
8
membership that primarily includes townships and township
9
officials, that has duties that include provision of research
10
service, dissemination of information, and other acts for the
11
purpose of improving township government, and that is funded
12
wholly or partly in accordance with Section 85-15 of the
13
Township Code; any not-for-profit corporation or association,
14
with a membership consisting primarily of municipalities, that
15
operates its own utility system, and provides research,
16
training, dissemination of information, or other acts to
17
promote cooperation between and among municipalities that
18
provide utility services and for the advancement of the goals
19
and purposes of its membership; the Southern Illinois
20
Collegiate Common Market, which is a consortium of higher
21
education institutions in Southern Illinois; the Illinois
22
Association of Park Districts; and any hospital provider that
23
is owned by a county that has 100 or fewer hospital beds and
24
has not already joined the program. "Qualified local
25
government" means a unit of local government approved by the
26
Director and participating in a program created under

HB5036
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LRB104 17785 RPS 31217 b
1
subsection (i) of Section 10 of this Act.
2

(t) "Qualified rehabilitation facility" means any
3
not-for-profit organization that is accredited by the
4
Commission on Accreditation of Rehabilitation Facilities or
5
certified by the Department of Human Services (as successor to
6
the Department of Mental Health and Developmental
7
Disabilities) to provide services to persons with disabilities
8
and which receives funds from the State of Illinois for
9
providing those services, approved by the Director and
10
participating in a program created under subsection (j) of
11
Section 10 of this Act.
12

(u) "Qualified domestic violence shelter or service" means
13
any Illinois domestic violence shelter or service and its
14
administrative offices funded by the Department of Human
15
Services (as successor to the Illinois Department of Public
16
Aid), approved by the Director and participating in a program
17
created 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
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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
26
under paragraph (2) of this subsection (w), a dependent of the

HB5036
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LRB104 17785 RPS 31217 b
1
survivor of a TRS benefit recipient who first becomes a
2
dependent of a survivor of a TRS benefit recipient on or after
3
January 13, 2012 (the effective date of Public Act 97-668)
4
unless that dependent would have been eligible for coverage as
5
a dependent of the deceased TRS benefit recipient upon whom
6
the survivor benefit is based.
7

(x) "Military leave" refers to individuals in basic
8
training for reserves, special/advanced training, annual
9
training, emergency call up, activation by the President of
10
the United States, or any other training or duty in service to
11
the United States Armed Forces.
12

(y) (Blank).
13

(z) "Community college benefit recipient" means a person
14
who:
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

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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
12
person 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
24
include, as indicated under paragraph (2) of this subsection
25
(aa), a dependent of the survivor of a community college
26
benefit recipient who first becomes a dependent of a survivor

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1
of a community college benefit recipient on or after January
2
13, 2012 (the effective date of Public Act 97-668) unless that
3
dependent would have been eligible for coverage as a dependent
4
of the deceased community college benefit recipient upon whom
5
the survivor annuity is based.
6

(bb) "Qualified child advocacy center" means any Illinois
7
child advocacy center and its administrative offices funded by
8
the Department of Children and Family Services, as defined by
9
the Children's Advocacy Center Act, approved by the Director
10
and participating in a program created under subsection (n) of
11
Section 10.
12

(cc) "Placement for adoption" means the assumption and
13
retention by a member of a legal obligation for total or
14
partial support of a child in anticipation of adoption of the
15
child. The child's placement with the member terminates upon
16
the 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
21
Act and any rules and regulations promulgated and adopted
22
hereunder by the Director shall become immediately eligible
23
and covered for all benefits available under the programs.
24
Employees electing coverage for eligible dependents shall have
25
the coverage effective immediately, provided that the election

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1
is properly filed in accordance with required filing dates and
2
procedures specified by the Director, including the completion
3
and submission of all documentation and forms required by the
4
Director.
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.

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1

(b) New employees shall be immediately insured for the
2
basic group life insurance and covered by the program of
3
health benefits on the first day of active State service.
4
Optional life insurance coverage one to 4 times the basic
5
amount, if elected during the relevant eligibility period,
6
will become effective on the date of employment. Optional life
7
insurance coverage exceeding 4 times the basic amount and all
8
life insurance amounts applied for after the eligibility
9
period will be effective, subject to satisfactory evidence of
10
insurability when applicable, or other necessary
11
qualifications, pursuant to the requirements of the applicable
12
benefit program, unless there is a change in status that would
13
confer new eligibility for change of enrollment under rules
14
established supplementing this Act, in which event application
15
must be made within the new eligibility period.
16

(c) As to the group health benefits program contracted to
17
begin or continue after June 30, 1973, each annuitant,
18
survivor, and retired employee shall become immediately
19
eligible for all benefits available under that program. Each
20
annuitant, survivor, and retired employee shall have coverage
21
effective immediately, provided that the election is properly
22
filed in accordance with the required filing dates and
23
procedures specified by the Director, including the completion
24
and submission of all documentation and forms required by the
25
Director. Annuitants, survivors, and retired employees may
26
elect coverage for eligible dependents and shall have the

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1
coverage effective immediately, provided that the election is
2
properly filed in accordance with required filing dates and
3
procedures specified by the Director, except that, for a
4
survivor, the dependent sought to be added on or after the
5
effective date of this amendatory Act of the 97th General
6
Assembly must have been eligible for coverage as a dependent
7
under the deceased member upon whom the survivor's annuity is
8
based 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
11
enrolled as a member and coverage on their eligible dependent
12
children, if any, may be under the enrollment and election of
13
either.
However, if both spouses are eligible members and are
14
also employees under Article 14 of the Illinois Pension Code,
15
then one spouse and only one spouse may elect to enroll the
16
other spouse in the program of group health benefits as an
17
eligible 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.

24
Upon electing to enroll in the program of group health
25
benefits as an eligible dependent under this paragraph, a
26
member forfeits his or her rights as a member under this Act

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1
with respect to the program of group health benefits during
2
the period when that election is in effect.

3

Regardless of other provisions herein regarding late
4
enrollment or other qualifications, as appropriate, the
5
Director may periodically authorize open enrollment periods
6
for each of the benefit programs at which time each member may
7
elect enrollment or change of enrollment without regard to
8
age, sex, health, or other qualification under the conditions
9
as may be prescribed in rules and regulations supplementing
10
this Act. Special open enrollment periods may be declared by
11
the Director for certain members only when special
12
circumstances occur that affect only those members.
13

(d) Eligible members may elect not to participate in the
14
program of health benefits as defined in this Act. The
15
election must be made during the annual benefit choice period
16
or upon showing a qualifying change in status as defined in the
17
U.S. Internal Revenue Code, subject to the conditions in this
18
subsection.
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

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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
11
program of financial incentives to encourage annuitants
12
receiving a retirement annuity, but who are not eligible for
13
benefits under the federal Medicare health insurance program
14
(Title XVIII of the Social Security Act, as added by Public Law
15
89-97) to elect not to participate in the program of health
16
benefits provided under this Act. The election by an annuitant
17
not to participate under this program must be made in
18
accordance with the requirements set forth under subsection
19
(d). The financial incentives provided to these annuitants
20
under the program may not exceed $150 per month for each
21
annuitant electing not to participate in the program of health
22
benefits provided under this Act.
23

(d-6) Beginning July 1, 2013, the Director may establish a
24
program of financial incentives to encourage annuitants with
25
20 or more years of creditable service but who are not eligible
26
for benefits under the federal Medicare health insurance

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LRB104 17785 RPS 31217 b
1
program (Title XVIII of the Social Security Act, as added by
2
Public Law 89-97) to elect not to participate in the program of
3
health benefits provided under this Act. The election by an
4
annuitant not to participate under this program must be made
5
in accordance with the requirements set forth under subsection
6
(d). The program established under this subsection (d-6) may
7
include a prorated incentive for annuitants with fewer than 20
8
years of creditable service, as determined by the Director.
9
The financial incentives provided to these annuitants under
10
this program may not exceed $500 per month for each annuitant
11
electing not to participate in the program of health benefits
12
provided under this Act.
13

(e) Notwithstanding any other provision of this Act or the
14
rules adopted under this Act, if a person participating in the
15
program of health benefits as the dependent spouse of an
16
eligible member becomes an annuitant, the person may elect, at
17
the time of becoming an annuitant or during any subsequent
18
annual benefit choice period, to continue participation as a
19
dependent rather than as an eligible member for as long as the
20
person continues to be an eligible dependent. In order to be
21
eligible to make such an election, the person must have been
22
enrolled as a dependent under the program of health benefits
23
for no less than one year prior to becoming an annuitant.
24

An eligible member who has elected to participate as a
25
dependent may re-enroll in the program of health benefits as
26
an eligible member (i) during any subsequent annual benefit

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1
choice period or (ii) upon showing a qualifying change in
2
status, as defined in the U.S. Internal Revenue Code, without
3
evidence of insurability and with no limitations on coverage
4
for pre-existing conditions.
5

A person who elects to participate in the program of
6
health benefits as a dependent rather than as an eligible
7
member shall be furnished a written explanation of the
8
consequences of electing to participate as a dependent and the
9
conditions and procedures for re-enrolling as an eligible
10
member. The explanation shall also be included in the annual
11
benefit 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
15
his or her portion of the premiums, charges or other fees for
16
all elected coverages or benefits, which shall be paid by
17
means of the acceptance of a reduction in earnings or the
18
foregoing of an increase in earnings by an employee; provided,
19
however, subject to rules and regulations promulgated by the
20
Department, the eligible member may make personal payment of
21
the premium, charge or fee for any wellness programs
22
implemented under the program of health benefits. All
23
contributions and payments by the eligible members and the
24
State for all elected coverages and benefits shall be
25
deposited in the Health Insurance Reserve Fund. The Department

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1
may determine the aggregate level of contribution required
2
under this Section on the basis of actual cost of services
3
adjusted for age, sex or the geographical or other demographic
4
characteristics which affect costs of the benefit.
5

(b) If a member is not entitled to receive any salary,
6
wages or other compensation during a period in which premiums,
7
charges or other fees are due or does not receive compensation
8
sufficient to allow deduction of the required payment of the
9
premium, charge or other fee, such member may continue the
10
contributory benefit in effect by making personal payment of
11
the premium, charge or other fee for the period in such manner,
12
in such amount, and for such duration, as may be prescribed in
13
rules and regulations promulgated for the administration of
14
this Act.
15

(c) If an eligible member elects coverage as a dependent
16
under subsection (c) of Section 8, the premium or charge
17
applicable to dependent coverage shall apply rather than the
18
premium or charge applicable to a member. The Department shall
19
ensure that the State's aggregate contribution for such
20
individual does not exceed the contribution that would have
21
applied 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

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LRB104 17785 RPS 31217 b
1
group life insurance and, subject to member paid contributions
2
set by the Department or required by this Section and except as
3
provided in this Section, the basic program of group health
4
benefits on each eligible member, except a member, not
5
otherwise covered by this Act, who has retired as a
6
participating member under Article 2 of the Illinois Pension
7
Code but is ineligible for the retirement annuity under
8
Section 2-119 of the Illinois Pension Code, and part of each
9
eligible member's and retired member's premiums for health
10
insurance coverage for enrolled dependents as provided by
11
Section 9. The State shall pay the cost of the basic program of
12
group health benefits only after benefits are reduced by the
13
amount of benefits covered by Medicare for all members and
14
dependents who are eligible for benefits under Social Security
15
or the Railroad Retirement system or who had sufficient
16
Medicare-covered government employment, except that such
17
reduction in benefits shall apply only to those members and
18
dependents who (1) first become eligible for such Medicare
19
coverage on or after July 1, 1992; or (2) are
20
Medicare-eligible members or dependents of a local government
21
unit which began participation in the program on or after July
22
1, 1992; or (3) remain eligible for, but no longer receive
23
Medicare coverage which they had been receiving on or after
24
July 1, 1992. The Department may determine the aggregate level
25
of the State's contribution on the basis of actual cost of
26
medical services adjusted for age, sex or geographic or other

HB5036
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LRB104 17785 RPS 31217 b
1
demographic characteristics which affect the costs of such
2
programs.
3

The cost of participation in the basic program of group
4
health benefits for the dependent or survivor of a living or
5
deceased retired employee who was formerly employed by the
6
University of Illinois in the Cooperative Extension Service
7
and would be an annuitant but for the fact that he or she was
8
made ineligible to participate in the State Universities
9
Retirement System by clause (4) of subsection (a) of Section
10
15-107 of the Illinois Pension Code shall not be greater than
11
the cost of participation that would otherwise apply to that
12
dependent or survivor if he or she were the dependent or
13
survivor of an annuitant under the State Universities
14
Retirement 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
23
waive or terminate coverage in the program of group health
24
benefits. Any such annuitant, survivor, or retired employee
25
who has waived or terminated coverage may enroll or re-enroll
26
in the program of group health benefits only during the annual

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1
benefit choice period, as determined by the Director; except
2
that in the event of termination of coverage due to nonpayment
3
of premiums, the annuitant, survivor, or retired employee may
4
not re-enroll in the program.
5

(a-8.3) Notwithstanding any other provision of this
6
Section, the Department shall not require an employee who is
7
authorized to elect and has elected to become a dependent
8
under subsection (c) of Section 8 to make contributions as a
9
member under this Section during the period when that election
10
is in effect.

11

(a-8.5) Beginning on July 1, 2012 (the effective date of
12
Public Act 97-695), the Director of Central Management
13
Services shall, on an annual basis, determine the amount that
14
the State shall contribute toward the basic program of group
15
health benefits on behalf of annuitants (including individuals
16
who (i) participated in the General Assembly Retirement
17
System, the State Employees' Retirement System of Illinois,
18
the State Universities Retirement System, the Teachers'
19
Retirement System of the State of Illinois, or the Judges
20
Retirement System of Illinois and (ii) qualify as annuitants
21
under subsection (b) of Section 3 of this Act), survivors
22
(including individuals who (i) receive an annuity as a
23
survivor of an individual who participated in the General
24
Assembly Retirement System, the State Employees' Retirement
25
System of Illinois, the State Universities Retirement System,
26
the Teachers' Retirement System of the State of Illinois, or

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LRB104 17785 RPS 31217 b
1
the Judges Retirement System of Illinois and (ii) qualify as
2
survivors under subsection (q) of Section 3 of this Act), and
3
retired employees (as defined in subsection (p) of Section 3
4
of this Act). The remainder of the cost of coverage for each
5
annuitant, survivor, or retired employee, as determined by the
6
Director of Central Management Services, shall be the
7
responsibility of that annuitant, survivor, or retired
8
employee.
9

Contributions required of annuitants, survivors, and
10
retired employees shall be the same for all retirement systems
11
and shall also be based on whether an individual has made an
12
election under Section 15-135.1 of the Illinois Pension Code.
13
Contributions may be based on annuitants', survivors', or
14
retired employees' Medicare eligibility, but may not be based
15
on Social Security eligibility.
16

(a-9) No later than May 1 of each calendar year, the
17
Director of Central Management Services shall certify in
18
writing to the Executive Secretary of the State Employees'
19
Retirement System of Illinois the amounts of the Medicare
20
supplement health care premiums and the amounts of the health
21
care premiums for all other retirees who are not Medicare
22
eligible.
23

A separate calculation of the premiums based upon the
24
actual cost of each health care plan shall be so certified.
25

The Director of Central Management Services shall provide
26
to the Executive Secretary of the State Employees' Retirement

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LRB104 17785 RPS 31217 b
1
System of Illinois such information, statistics, and other
2
data as he or she may require to review the premium amounts
3
certified by the Director of Central Management Services.
4

The Department of Central Management Services, or any
5
successor agency designated to procure health care contracts
6
pursuant to this Act, is authorized to establish funds,
7
separate accounts provided by any bank or banks as defined by
8
the Illinois Banking Act, or separate accounts provided by any
9
savings and loan association or associations as defined by the
10
Illinois Savings and Loan Act of 1985 to be held by the
11
Director, outside the State treasury, for the purpose of
12
receiving the transfer of moneys from the Local Government
13
Health Insurance Reserve Fund. The Department may promulgate
14
rules further defining the methodology for the transfers. Any
15
interest earned by moneys in the funds or accounts shall inure
16
to the Local Government Health Insurance Reserve Fund. The
17
transferred moneys, and interest accrued thereon, shall be
18
used exclusively for transfers to administrative service
19
organizations or their financial institutions for payments of
20
claims to claimants and providers under the self-insurance
21
health plan. The transferred moneys, and interest accrued
22
thereon, shall not be used for any other purpose including,
23
but not limited to, reimbursement of administration fees due
24
the administrative service organization pursuant to its
25
contract or contracts with the Department.
26

(a-10) To the extent that participation, benefits, or

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LRB104 17785 RPS 31217 b
1
premiums under this Act are based on a person's service credit
2
under an Article of the Illinois Pension Code, service credit
3
terminated in exchange for an accelerated pension benefit
4
payment under Section 14-147.5, 15-185.5, or 16-190.5 of that
5
Code shall be included in determining a person's service
6
credit for the purposes of this Act.
7

(b) State employees who become eligible for this program
8
on or after January 1, 1980 in positions normally requiring
9
actual performance of duty not less than 1/2 of a normal work
10
period but not equal to that of a normal work period, shall be
11
given the option of participating in the available program. If
12
the employee elects coverage, the State shall contribute on
13
behalf of such employee to the cost of the employee's benefit
14
and any applicable dependent supplement, that sum which bears
15
the same percentage as that percentage of time the employee
16
regularly works when compared to normal work period.
17

(c) The basic non-contributory coverage from the basic
18
program of group health benefits shall be continued for each
19
employee not in pay status or on active service by reason of
20
(1) leave of absence due to illness or injury, (2) authorized
21
educational leave of absence or sabbatical leave, or (3)
22
military leave. This coverage shall continue until expiration
23
of authorized leave and return to active service, but not to
24
exceed 24 months for leaves under item (1) or (2). This
25
24-month limitation and the requirement of returning to active
26
service shall not apply to persons receiving ordinary or

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LRB104 17785 RPS 31217 b
1
accidental disability benefits or retirement benefits through
2
the appropriate State retirement system or benefits under the
3
Workers' Compensation Act or the Workers' Occupational
4
Diseases Act.
5

(d) The basic group life insurance coverage shall
6
continue, with full State contribution, where such person is
7
(1) absent from active service by reason of disability arising
8
from any cause other than self-inflicted, (2) on authorized
9
educational leave of absence or sabbatical leave, or (3) on
10
military leave.
11

(e) Where the person is in non-pay status for a period in
12
excess of 30 days or on leave of absence, other than by reason
13
of disability, educational or sabbatical leave, or military
14
leave, such person may continue coverage only by making
15
personal payment equal to the amount normally contributed by
16
the State on such person's behalf. Such payments and coverage
17
may be continued: (1) until such time as the person returns to
18
a status eligible for coverage at State expense, but not to
19
exceed 24 months or (2) until such person's employment or
20
annuitant status with the State is terminated (exclusive of
21
any additional service imposed pursuant to law).
22

(f) The Department shall establish by rule the extent to
23
which other employee benefits will continue for persons in
24
non-pay status or who are not in active service.
25

(g) The State shall not pay the cost of the basic
26
non-contributory group life insurance, program of health

HB5036
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LRB104 17785 RPS 31217 b
1
benefits and other employee benefits for members who are
2
survivors as defined by paragraphs (1) and (2) of subsection
3
(q) of Section 3 of this Act. The costs of benefits for these
4
survivors shall be paid by the survivors or by the University
5
of Illinois Cooperative Extension Service, or any combination
6
thereof. However, the State shall pay the amount of the
7
reduction in the cost of participation, if any, resulting from
8
the amendment to subsection (a) made by Public Act 91-617.
9

(h) Those persons occupying positions with any department
10
as a result of emergency appointments pursuant to Section 8b.8
11
of the Personnel Code who are not considered employees under
12
this Act shall be given the option of participating in the
13
programs of group life insurance, health benefits and other
14
employee benefits. Such persons electing coverage may
15
participate only by making payment equal to the amount
16
normally contributed by the State for similarly situated
17
employees. Such amounts shall be determined by the Director.
18
Such payments and coverage may be continued until such time as
19
the person becomes an employee pursuant to this Act or such
20
person's appointment is terminated.
21

(i) Any unit of local government within the State of
22
Illinois may apply to the Director to have its employees,
23
annuitants, and their dependents provided group health
24
coverage under this Act on a non-insured basis. To
25
participate, a unit of local government must agree to enroll
26
all of its employees, who may select coverage under any group

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LRB104 17785 RPS 31217 b
1
health benefits plan made available by the Department under
2
the health benefits program established under this Section or
3
a health maintenance organization that has contracted with the
4
State to be available as a health care provider for employees
5
as defined in this Act. A unit of local government must remit
6
the entire cost of providing coverage under the health
7
benefits program established under this Section or, for
8
coverage under a health maintenance organization, an amount
9
determined by the Director based on an analysis of the sex,
10
age, geographic location, or other relevant demographic
11
variables for its employees, except that the unit of local
12
government shall not be required to enroll those of its
13
employees who are covered spouses or dependents under the
14
State group health benefits plan or another group policy or
15
plan providing health benefits as long as (1) an appropriate
16
official from the unit of local government attests that each
17
employee not enrolled is a covered spouse or dependent under
18
this plan or another group policy or plan, and (2) at least 50%
19
of the employees are enrolled and the unit of local government
20
remits the entire cost of providing coverage to those
21
employees, except that a participating school district must
22
have enrolled at least 50% of its full-time employees who have
23
not waived coverage under the district's group health plan by
24
participating in a component of the district's cafeteria plan.
25
A participating school district is not required to enroll a
26
full-time employee who has waived coverage under the

HB5036
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LRB104 17785 RPS 31217 b
1
district's health plan, provided that an appropriate official
2
from the participating school district attests that the
3
full-time employee has waived coverage by participating in a
4
component of the district's cafeteria plan. For the purposes
5
of this subsection, "participating school district" includes a
6
unit of local government whose primary purpose is education as
7
defined by the Department's rules.
8

Employees of a participating unit of local government who
9
are not enrolled due to coverage under another group health
10
policy or plan may enroll in the event of a qualifying change
11
in status, special enrollment, special circumstance as defined
12
by the Director, or during the annual benefit choice period. A
13
participating unit of local government may also elect to cover
14
its annuitants. Dependent coverage shall be offered on an
15
optional basis, with the costs paid by the unit of local
16
government, its employees, or some combination of the two as
17
determined by the unit of local government. The unit of local
18
government shall be responsible for timely collection and
19
transmission of dependent premiums.
20

The Director shall annually determine monthly rates of
21
payment, 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
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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
12
under a health maintenance organization, the Director shall
13
annually determine for each participating unit of local
14
government the maximum monthly amount the unit may contribute
15
toward that coverage, based on an analysis of (i) the age, sex,
16
geographic location, and other relevant demographic variables
17
of the unit's employees and (ii) the cost to cover those
18
employees under the State group health benefits plan. The
19
Director may similarly determine the maximum monthly amount
20
each unit of local government may contribute toward coverage
21
of its employees' dependents under a health maintenance
22
organization.
23

Monthly payments by the unit of local government or its
24
employees for group health benefits plan or health maintenance
25
organization coverage shall be deposited into the Local
26
Government Health Insurance Reserve Fund.

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LRB104 17785 RPS 31217 b
1

The Local Government Health Insurance Reserve Fund is
2
hereby created as a nonappropriated trust fund to be held
3
outside the State treasury, with the State Treasurer as
4
custodian. The Local Government Health Insurance Reserve Fund
5
shall be a continuing fund not subject to fiscal year
6
limitations. The Local Government Health Insurance Reserve
7
Fund is not subject to administrative charges or charge-backs,
8
including, but not limited to, those authorized under Section
9
8h of the State Finance Act. All revenues arising from the
10
administration of the health benefits program established
11
under this Section shall be deposited into the Local
12
Government Health Insurance Reserve Fund. Any interest earned
13
on moneys in the Local Government Health Insurance Reserve
14
Fund shall be deposited into the Fund. All expenditures from
15
this Fund shall be used for payments for health care benefits
16
for local government and rehabilitation facility employees,
17
annuitants, and dependents, and to reimburse the Department or
18
its administrative service organization for all expenses
19
incurred in the administration of benefits. No other State
20
funds may be used for these purposes.
21

A local government employer's participation or desire to
22
participate in a program created under this subsection shall
23
not limit that employer's duty to bargain with the
24
representative of any collective bargaining unit of its
25
employees.
26

(j) Any rehabilitation facility within the State of

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LRB104 17785 RPS 31217 b
1
Illinois may apply to the Director to have its employees,
2
annuitants, and their eligible dependents provided group
3
health coverage under this Act on a non-insured basis. To
4
participate, a rehabilitation facility must agree to enroll
5
all of its employees and remit the entire cost of providing
6
such coverage for its employees, except that the
7
rehabilitation facility shall not be required to enroll those
8
of its employees who are covered spouses or dependents under
9
this plan or another group policy or plan providing health
10
benefits as long as (1) an appropriate official from the
11
rehabilitation facility attests that each employee not
12
enrolled is a covered spouse or dependent under this plan or
13
another group policy or plan, and (2) at least 50% of the
14
employees are enrolled and the rehabilitation facility remits
15
the entire cost of providing coverage to those employees.
16
Employees of a participating rehabilitation facility who are
17
not enrolled due to coverage under another group health policy
18
or plan may enroll in the event of a qualifying change in
19
status, special enrollment, special circumstance as defined by
20
the Director, or during the annual benefit choice period. A
21
participating rehabilitation facility may also elect to cover
22
its annuitants. Dependent coverage shall be offered on an
23
optional basis, with the costs paid by the rehabilitation
24
facility, its employees, or some combination of the 2 as
25
determined by the rehabilitation facility. The rehabilitation
26
facility shall be responsible for timely collection and

HB5036
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LRB104 17785 RPS 31217 b
1
transmission of dependent premiums.
2

The Director shall annually determine quarterly rates of
3
payment, 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
19
employees for group health benefits shall be deposited into
20
the Local Government Health Insurance Reserve Fund.
21

(k) Any domestic violence shelter or service within the
22
State of Illinois may apply to the Director to have its
23
employees, annuitants, and their dependents provided group
24
health coverage under this Act on a non-insured basis. To
25
participate, a domestic violence shelter or service must agree
26
to enroll all of its employees and pay the entire cost of

HB5036
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LRB104 17785 RPS 31217 b
1
providing such coverage for its employees. The domestic
2
violence shelter shall not be required to enroll those of its
3
employees who are covered spouses or dependents under this
4
plan or another group policy or plan providing health benefits
5
as long as (1) an appropriate official from the domestic
6
violence shelter attests that each employee not enrolled is a
7
covered spouse or dependent under this plan or another group
8
policy or plan and (2) at least 50% of the employees are
9
enrolled and the domestic violence shelter remits the entire
10
cost of providing coverage to those employees. Employees of a
11
participating domestic violence shelter who are not enrolled
12
due to coverage under another group health policy or plan may
13
enroll in the event of a qualifying change in status, special
14
enrollment, or special circumstance as defined by the Director
15
or during the annual benefit choice period. A participating
16
domestic violence shelter may also elect to cover its
17
annuitants. Dependent coverage shall be offered on an optional
18
basis, with employees, or some combination of the 2 as
19
determined by the domestic violence shelter or service. The
20
domestic violence shelter or service shall be responsible for
21
timely collection and transmission of dependent premiums.
22

The Director shall annually determine rates of payment,
23
subject 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
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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
14
service or its employees for group health insurance shall be
15
deposited into the Local Government Health Insurance Reserve
16
Fund.
17

(l) A public community college or entity organized
18
pursuant to the Public Community College Act may apply to the
19
Director initially to have only annuitants not covered prior
20
to July 1, 1992 by the district's health plan provided health
21
coverage under this Act on a non-insured basis. The community
22
college must execute a 2-year contract to participate in the
23
Local Government Health Plan. Any annuitant may enroll in the
24
event of a qualifying change in status, special enrollment,
25
special circumstance as defined by the Director, or during the
26
annual benefit choice period.

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LRB104 17785 RPS 31217 b
1

The Director shall annually determine monthly rates of
2
payment subject to the following constraints: for those
3
community colleges with annuitants only enrolled, first year
4
rates shall be equal to the average cost to cover claims for a
5
State member adjusted for demographics, Medicare
6
participation, and other factors; and in the second year, a
7
further adjustment of rates shall be made to reflect the
8
actual first year's claims experience of the covered
9
annuitants.
10

(l-5) The provisions of subsection (l) become inoperative
11
on July 1, 1999.
12

(m) The Director shall adopt any rules deemed necessary
13
for implementation of this amendatory Act of 1989 (Public Act
14
86-978).
15

(n) Any child advocacy center within the State of Illinois
16
may apply to the Director to have its employees, annuitants,
17
and their dependents provided group health coverage under this
18
Act on a non-insured basis. To participate, a child advocacy
19
center must agree to enroll all of its employees and pay the
20
entire cost of providing coverage for its employees. The child
21
advocacy center shall not be required to enroll those of its
22
employees who are covered spouses or dependents under this
23
plan or another group policy or plan providing health benefits
24
as long as (1) an appropriate official from the child advocacy
25
center attests that each employee not enrolled is a covered
26
spouse or dependent under this plan or another group policy or

HB5036
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LRB104 17785 RPS 31217 b
1
plan and (2) at least 50% of the employees are enrolled and the
2
child advocacy center remits the entire cost of providing
3
coverage to those employees. Employees of a participating
4
child advocacy center who are not enrolled due to coverage
5
under another group health policy or plan may enroll in the
6
event of a qualifying change in status, special enrollment, or
7
special circumstance as defined by the Director or during the
8
annual benefit choice period. A participating child advocacy
9
center may also elect to cover its annuitants. Dependent
10
coverage shall be offered on an optional basis, with the costs
11
paid by the child advocacy center, its employees, or some
12
combination of the 2 as determined by the child advocacy
13
center. The child advocacy center shall be responsible for
14
timely collection and transmission of dependent premiums.
15

The Director shall annually determine rates of payment,
16
subject 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
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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
6
employees for group health insurance shall be deposited into
7
the Local Government Health Insurance Reserve Fund.
8
(Source: P.A. 104-417, eff. 8-15-25.)

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