Commission on Government Forecasting and Accountability
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Robert Pritchard, Co-Chair
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Heather Steans, Co-Chair
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Public Safety Employee Benefits Act (PSEBA)

PUBLIC SAFETY EMPLOYEE BENEFITS ACT

Letter to Employers Under the PSEBA Act

EXPLANATION

Pursuant to P.A. 98-0561, these forms are being sent to all units of government throughout Illinois which fall under the purview of the Public Safety Employee Benefits Act (820 ILCS 320/) (hereinafter referred to as "PSEBA", which is commonly known as "catastrophic injury insurance"). Under P.A. 98-0561, the Commission on Government Forecasting and Accountability (hereinafter referred to as "CGFA") is required to collect certain data pertaining to the cost of health insurance under PSEBA. Under Section 17 of PSEBA, CGFA is charged with creating and submitting a report to the Governor and General Assembly setting forth information regarding recipients and benefits payable under the Public Safety Employee Benefits Act (Act). The Act requires employers to assist CGFA in the collection of data needed to fulfill this reporting requirement.

Public Safety Employee Benefits Act

FORMS AND TIMELINE

Employers subject to PSEBA have two separate responsibilities under P.A. 98-0561.

Responsibility One: Employers are required to send the Recipient Form to current PSEBA recipients for completion during the time frame allowed and to gather these forms and send originals back to the Commission by the submission date. The Act requires employers providing PSEBA benefits to distribute this form to any former peace officer, firefighter, or correctional officer currently in receipt of PSEBA benefits. P.A. 98-0561 requires the PSEBA recipient to complete the PSEBA Recipient Form and submit it to the employer providing PSEBA benefits within 60 days of receipt by the PSEBA recipient. If the PSEBA recipient fails to submit this form within 60 days of receipt, the employer is required to notify the PSEBA recipient of non-compliance and provide an additional 30 days to submit the required form. Failure to submit the form in a timely manner may result in the PSEBA recipient incurring responsibility for reimbursing the employer for premiums paid during the period the form is due and not filed.

There are a few ways employers may choose to distribute the Recipient Form (below) to recipients:

1.       Click on the Recipient Form to open it. Choose "File" and then "Save" to save the PDF on your computer to attach in an e-mail to each recipient; or

2.       Click on the Recipient Form to open its location on this website. Highlight and copy the web address and paste it into an e-mail to send to each recipient; or

3.       Refer each recipient to this webpage and ask them to click on the Recipient Form to fill it out; or

4.       Click on the Recipient Form to open it. Choose "File" and then "Print" to distribute by hand or to mail to each recipient.

The Commission prefers to receive a digital copy of the completed form. If possible, please use method 1, 2 or 3 for Recipient Form distribution. Instructions for recipients to fill out the form and return it are included on the Recipient Form.

PSEBA Recipient Reporting Form 2018  To open forms use Internet Explorer or Mozilla Firefox. If the form does not load, check the upper right hand corner and choose "Open With Different Viewer". This should allow you to open or save the pdf file. Once saved, the pdf file can be opened in Adobe Reader. To use Google Chrome you have to disable its pdf viewer.

Responsibility Two: The second responsibility for employers under P.A. 98-0561 is to fill out the Employer Form based on data derived from the PSEBA Benefit Recipient Forms and any other available sources of information as necessary, such as employment records, minutes and transcripts of pension board meetings, physician reports, disability records, etc., to which the employer has access. The Act requires all employers subject to the PSEBA Act to submit the Recipient Forms and the Employer Form to CGFA within 120 days after the initial receipt of these forms.

PSEBA Employer Reporting Form 2018  To open forms use Internet Explorer or Mozilla Firefox. If the form does not load, check the upper right hand corner and choose "Open With Different Viewer". This should allow you to open or save the pdf file. Once saved, the pdf file can be opened in Adobe Reader. To use Google Chrome you have to disable its pdf viewer.

Pursuant to P.A. 98-0561, the responses to the questions from both forms will be used by CGFA to compile information regarding the PSEBA benefit for its report. The Act prohibits the release of any personal information concerning the PSEBA recipient and exempts the reported information from the requirements of the Freedom of Information Act (FOIA).

NOTE: All employers subject to the PSEBA Act who do not have any PSEBA Recipients are still required to send a copy of the PSEBA Employer Reporting Form 2018 to CGFA within 120 days after receipt of the PSEBA Employer Reporting Form 2018, though you should write "none" or "N/A" on the form in regards to the number of recipients within your jurisdiction.

 INSTRUCTIONS

Forms can be opened using Adobe Acrobat Reader version 8 or higher. If you do not have Adobe Acrobat Reader, you may download the free software at the following link.

Latest Version of Acrobat Reader (Free Download)

After forms are filled out, they should be saved in Adobe Acrobat Reader, using the form name but including the Recipients name or Employer name, depending on the form. Specific instructions are included at the end of each form. These forms should be e-mailed to the Commission within the time frame prescribed above, using the following e-mail address:

AnthonyB@ilga.gov

If you receive Recipient Forms on paper, either scan and e-mail the forms (preferable) or mail the forms to the address below under CONTACT.

 

CONTACT

If any questions should arise in the completion of these forms, or if you encounter any difficulties, please contact Anthony Bolton at CGFA at 217-785-3014, or via e-mail at AnthonyB@ilga.gov, during the hours of 9:00 AM to 4:30 PM, Monday through Friday. Below is the Commission's address.

Commission on Government Forecasting and Accountability

c/o Anthony Bolton

703 Stratton Building

401 S. Spring Street

Springfield, IL 62706