HB5830: STATE EMPLOYEES MEDICARE PLANS

104TH GENERAL ASSEMBLY
 State of Illinois
 2025 and 2026 HB5830 Introduced , by Rep. Katie Stuart SYNOPSIS AS INTRODUCED: 5 ILCS 375/5 from Ch. 127, par. 525 Amends the State Employees Group Insurance Act of 1971. Provides that, notwithstanding any other provisions of the Act, the Department of Central Management Services, in consultation with and subject to the approval of the Chief Procurement Officer, shall contract or make otherwise available a Medicare plan to supplement Medicare Parts A and B and to provide coverage compliant with Medicare Part D for Medicare-primary members and their Medicare-primary dependents. On January 1, 2027, requires the Department to begin procurement of supplemental Medicare plans to be effective on January 1, 2028. Provides that the Department shall award contracts to provide a minimum of 2 supplemental Medicare plan options if 2 or more responsive bidders submit bids. Effective immediately. LRB104 23661 BAB 40164 b A BILL FOR HB5830 LRB104 23661 BAB 40164 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 Section 5 as follows: 6 (5 ILCS 375/5) (from Ch. 127, par. 525) 7 Sec. 5. Employee benefits; declaration of State policy. 8 The General Assembly declares that it is the policy of the 9 State and in the best interest of the State to assure quality 10 benefits to members and their dependents under this Act. The 11 implementation of this policy depends upon, among other 12 things, stability and continuity of coverage, care, and 13 services under benefit programs for members and their 14 dependents. Specifically, but without limitation, members 15 should have continued access, on substantially similar terms 16 and conditions, to trusted family health care providers with 17 whom they have developed long-term relationships through a 18 benefit program under this Act. Therefore, the Director must 19 administer this Act consistent with that State policy, but may 20 consider affordability, cost of coverage and care, and 21 competition among health insurers and providers. All contracts 22 for provision of employee benefits, including those portions 23 of any proposed collective bargaining agreement that would HB5830 - 2 - LRB104 23661 BAB 40164 b 1 require implementation through contracts entered into under 2 this Act, are subject to the following requirements: 3 (i) By April 1 of each year, the Director must report 4 and provide information to the Commission concerning the 5 status of the employee benefits program to be offered for 6 the next fiscal year. Information includes, but is not 7 limited to, documents, reports of negotiations, bid 8 invitations, requests for proposals, specifications, 9 copies of proposed and final contracts or agreements, and 10 any other materials concerning contracts or agreements for 11 the employee benefits program. By the first of each month 12 thereafter, the Director must provide updated, and any 13 new, information to the Commission until the employee 14 benefits program for the next fiscal year is determined. 15 In addition to these monthly reporting requirements, at 16 any time the Commission makes a written request, the 17 Director must promptly, but in no event later than 5 18 business days after receipt of the request, provide to the 19 Commission any additional requested information in the 20 possession of the Director concerning employee benefits 21 programs. The Commission may waive any of the reporting 22 requirements of this item (i) upon the written request by 23 the Director. Any waiver granted under this item (i) must 24 be in writing. Nothing in this item is intended to 25 abrogate any attorney-client privilege. 26 (ii) Within 30 days after notice of the awarding or HB5830 - 3 - LRB104 23661 BAB 40164 b 1 letting of a contract has appeared in the Illinois 2 Procurement Bulletin in accordance with subsection (b) of 3 Section 15-25 of the Illinois Procurement Code, the 4 Commission may request in writing from the Director and 5 the Director shall promptly, but in no event later than 5 6 business days after receipt of the request, provide to the 7 Commission information in the possession of the Director 8 concerning the proposed contract. Nothing in this item is 9 intended to waive or abrogate any privilege or right of 10 confidentiality authorized by law. 11 (iii) Except as otherwise provided in this item (iii), 12 no contract subject to this Section may be entered into 13 until the 30-day period described in item (ii) has 14 expired, unless the Director requests in writing that the 15 Commission waive the period and the Commission grants the 16 waiver in writing. This item (iii) does not apply to any 17 contract entered into after the effective date of this 18 amendatory Act of the 98th General Assembly and through 19 January 1, 2014 to provide a program of group health 20 benefits for Medicare-primary members and their 21 Medicare-primary dependents that is comparable in 22 stability and continuity of coverage, care, and services 23 to the program of health benefits offered to other members 24 and their dependents under this Act. 25 (iv) If the Director seeks to make any substantive 26 modification to any provision of a proposed contract after HB5830 - 4 - LRB104 23661 BAB 40164 b 1 it is submitted to the Commission in accordance with item 2 (ii), the modified contract shall be subject to the 3 requirements of items (ii) and (iii) unless the Commission 4 agrees, in writing, to a waiver of those requirements with 5 respect to the modified contract. 6 (v) By the date of the beginning of the annual benefit 7 choice period, the Director must transmit to the 8 Commission a copy of each final contract or agreement for 9 the employee benefits program to be offered for the next 10 fiscal year. The annual benefit choice period for an 11 employee benefits program must begin on May 1 of the 12 fiscal year preceding the year for which the program is to 13 be offered. If, however, in any such preceding fiscal year 14 collective bargaining over employee benefit programs for 15 the next fiscal year remains pending on April 15, the 16 beginning date of the annual benefit choice period shall 17 be not later than 15 days after ratification of the 18 collective bargaining agreement. 19 (vi) The Director must provide the reports, 20 information, and contracts required under items (i), (ii), 21 (iv), and (v) by electronic or other means satisfactory to 22 the Commission. Reports, information, and contracts in the 23 possession of the Commission pursuant to items (i), (ii), 24 (iv), and (v) are exempt from disclosure by the Commission 25 and its members and employees under the Freedom of 26 Information Act. Reports, information, and contracts HB5830 - 5 - LRB104 23661 BAB 40164 b 1 received by the Commission pursuant to items (i), (ii), 2 (iv), and (v) must be kept confidential by and may not be 3 disclosed or used by the Commission or its members or 4 employees if such disclosure or use could compromise the 5 fairness or integrity of the procurement, bidding, or 6 contract process. Commission meetings, or portions of 7 Commission meetings, in which reports, information, and 8 contracts received by the Commission pursuant to items 9 (i), (ii), (iv), and (v) are discussed must be closed if 10 disclosure or use of the report or information could 11 compromise the fairness or integrity of the procurement, 12 bidding, or contract process. 13 All contracts entered into under this Section are subject 14 to appropriation and shall comply with Section 20-60(b) of the 15 Illinois Procurement Code (30 ILCS 500/20-60(b)). 16 The Director shall contract or otherwise make available 17 group life insurance, health benefits and other employee 18 benefits to eligible members and, where elected, their 19 eligible dependents. Any contract or, if applicable, contracts 20 or other arrangement for provision of benefits shall be on 21 terms consistent with State policy and based on, but not 22 limited to, such criteria as administrative cost, service 23 capabilities of the carrier or other contractor and premiums, 24 fees or charges as related to benefits. 25 Notwithstanding any other provisions of this Act, by 26 January 1, 2014, the Department of Central Management HB5830 - 6 - LRB104 23661 BAB 40164 b 1 Services, in consultation with and subject to the approval of 2 the Chief Procurement Officer, shall contract or make 3 otherwise available a Medicare plan to supplement Medicare 4 Parts A and B and to provide coverage compliant with Medicare 5 Part D program of group health benefits for Medicare-primary 6 members and their Medicare-primary dependents. The Director 7 may procure a single contract or multiple contracts that 8 provide a supplemental Medicare plan program of group health 9 benefits that is comparable in stability and continuity of 10 coverage, care, and services to the program of health benefits 11 offered to other members and their dependents under this Act. 12 The initial procurement of a contract or contracts under this 13 paragraph is not subject to the provisions of the Illinois 14 Procurement Code, except for Sections 20-60, 20-65, 20-70, and 15 20-160 and Article 50 of that Code, provided that the Chief 16 Procurement Officer may, in writing with justification, waive 17 any certification required under Article 50. On January 1, 18 2027, the Department shall begin procurement of supplemental 19 Medicare plans to be effective on January 1, 2028. Should 20 there be 2 or more responsive bidders, as defined in Section 21 1-15.85 of the Illinois Procurement Code, to this or any 22 future procurement of supplemental Medicare plans, the 23 Department shall award contracts to provide a minimum of 2 24 supplemental Medicare plan options to Medicare-primary members 25 and their Medicare-primary dependents. 26 The Director may prepare and issue specifications for HB5830 - 7 - LRB104 23661 BAB 40164 b 1 group life insurance, health benefits, other employee benefits 2 and administrative services for the purpose of receiving 3 proposals from interested parties. 4 The Director is authorized to execute a contract, or 5 contracts, for the programs of group life insurance, health 6 benefits, other employee benefits and administrative services 7 authorized by this Act (including, without limitation, 8 prescription drug benefits). All of the benefits provided 9 under this Act may be included in one or more contracts, or the 10 benefits may be classified into different types with each type 11 included under one or more similar contracts with the same or 12 different companies. 13 The term of any contract may not extend beyond 5 fiscal 14 years. Upon recommendation of the Commission, the Director may 15 exercise renewal options of the same contract for up to a 16 period of 5 years. Any increases in premiums, fees or charges 17 requested by a contractor whose contract may be renewed 18 pursuant to a renewal option contained therein, must be 19 justified on the basis of (1) audited experience data, (2) 20 increases in the costs of health care services provided under 21 the contract, (3) contractor performance, (4) increases in 22 contractor responsibilities, or (5) any combination thereof. 23 Any contractor shall agree to abide by all requirements of 24 this Act and Rules and Regulations promulgated and adopted 25 thereto; to submit such information and data as may from time 26 to time be deemed necessary by the Director for effective HB5830 - 8 - LRB104 23661 BAB 40164 b 1 administration of the provisions of this Act and the programs 2 established hereunder, and to fully cooperate in any audit. 3 (Source: P.A. 98-19, eff. 6-10-13.) 4 Section 99. Effective date. This Act takes effect upon 5 becoming law.