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95TH GENERAL ASSEMBLY
State of Illinois
2007 and 2008 SB2380
Introduced 2/14/2008, by Sen. Deanna Demuzio SYNOPSIS AS INTRODUCED: |
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215 ILCS 105/7 |
from Ch. 73, par. 1307 |
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Amends the Comprehensive Health Insurance Plan Act. Provides that coverage under the Plan
shall automatically terminate as of the effective date of any medical
assistance, except in cases where the effective date of the medical assistance is the date that the application for medical assistance was submitted to the Department of Human Services and that date is different than the date that the applicant is determined to be eligible for medical assistance. Provides that in that circumstance, coverage under the plan shall terminate on the date that the applicant was determined to be eligible for medical assistance. Effective immediately.
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A BILL FOR
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SB2380 |
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LRB095 19723 KBJ 46088 b |
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| AN ACT concerning regulation.
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| Be it enacted by the People of the State of Illinois,
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| represented in the General Assembly:
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| Section 5. The Comprehensive Health Insurance Plan Act is |
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| amended by changing Section 7 as follows:
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| (215 ILCS 105/7) (from Ch. 73, par. 1307)
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| Sec. 7. Eligibility.
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| a. Except as provided in subsection (e) of this Section or |
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| in Section
15 of this Act, any person who is either a citizen |
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| of the United States or an
alien lawfully admitted for |
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| permanent residence and who has been for a period
of at least |
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| 180 days and continues to be a resident of this State shall be
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| eligible for Plan coverage under this Section if evidence is |
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| provided of:
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| (1) A notice of rejection or refusal to issue |
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| substantially
similar individual health insurance coverage |
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| for health reasons by a
health insurance issuer; or
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| (2) A refusal by a health insurance issuer to issue |
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| individual
health insurance coverage except at a rate |
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| exceeding the
applicable Plan rate for which the person is |
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| responsible.
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| A rejection or refusal by a group health plan or health |
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| insurance issuer
offering only
stop-loss or excess of loss |
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SB2380 |
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LRB095 19723 KBJ 46088 b |
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| insurance or contracts,
agreements, or other arrangements for |
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| reinsurance coverage with respect
to the applicant shall not be |
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| sufficient evidence under this subsection.
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| b. The board shall promulgate a list of medical or health |
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| conditions for
which a person who is either a citizen of the |
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| United States or an
alien lawfully admitted for permanent |
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| residence and a resident of this State
would be eligible for |
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| Plan coverage without applying for
health insurance coverage |
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| pursuant to subsection a. of this Section.
Persons who
can |
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| demonstrate the existence or history of any medical or health
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| conditions on the list promulgated by the board shall not be |
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| required to
provide the evidence specified in subsection a. of |
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| this Section. The list
shall be effective
on the first day of |
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| the operation of the Plan and may be amended from time
to time |
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| as appropriate.
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| c. Family members of the same household who each are |
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| covered
persons are
eligible for optional family coverage under |
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| the Plan.
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| d. For persons qualifying for coverage in accordance with |
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| Section 7 of
this Act, the board shall, if it determines that |
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| such appropriations as are
made pursuant to Section 12 of this |
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| Act are insufficient to allow the board
to accept all of the |
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| eligible persons which it projects will apply for
enrollment |
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| under the Plan, limit or close enrollment to ensure that the
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| Plan is not over-subscribed and that it has sufficient |
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| resources to meet
its obligations to existing enrollees. The |
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SB2380 |
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LRB095 19723 KBJ 46088 b |
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| board shall not limit or close
enrollment for federally |
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| eligible individuals.
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| e. A person shall not be eligible for coverage under the |
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| Plan if:
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| (1) He or she has or obtains other coverage under a |
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| group health plan
or health insurance coverage
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| substantially similar to or better than a Plan policy as an |
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| insured or
covered dependent or would be eligible to have |
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| that coverage if he or she
elected to obtain it. Persons |
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| otherwise eligible for Plan coverage may,
however, solely |
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| for the purpose of having coverage for a pre-existing
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| condition, maintain other coverage only while satisfying |
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| any pre-existing
condition waiting period under a Plan |
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| policy or a subsequent replacement
policy of a Plan policy.
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| (1.1) His or her prior coverage under a group health |
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| plan or health
insurance coverage, provided or arranged by |
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| an employer of more than 10 employees was discontinued
for |
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| any reason without the entire group or plan being |
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| discontinued and not
replaced, provided he or she remains |
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| an employee, or dependent thereof, of the
same employer.
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| (2) He or she is a recipient of or is approved to |
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| receive medical
assistance, except that a person may |
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| continue to receive medical
assistance through the medical |
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| assistance no grant program, but only
while satisfying the |
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| requirements for a preexisting condition under
Section 8, |
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| subsection f. of this Act. Payment of premiums pursuant to |
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SB2380 |
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LRB095 19723 KBJ 46088 b |
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| this
Act shall be allocable to the person's spenddown for |
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| purposes of the
medical assistance no grant program, but |
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| that person shall not be
eligible for any Plan benefits |
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| while that person remains eligible for
medical assistance. |
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| If the person continues to receive
or be approved to |
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| receive medical assistance through the medical
assistance |
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| no grant program at or after the time that requirements for |
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| a
preexisting condition are satisfied, the person shall not |
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| be eligible for
coverage under the Plan. In that |
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| circumstance, coverage under the plan
shall terminate as of |
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| the expiration of the preexisting condition
limitation |
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| period. Under all other circumstances, coverage under the |
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| Plan
shall automatically terminate as of the effective date |
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| of any medical
assistance , except in cases where the |
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| effective date of the medical assistance is the date that |
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| the application for medical assistance was submitted to the |
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| Department of Human Services and that date is different |
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| than the date that the applicant is determined to be |
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| eligible for medical assistance. In that circumstance, |
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| coverage under the plan shall terminate on the date that |
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| the applicant was determined to be eligible for medical |
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| assistance .
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| (3) Except as provided in Section 15, the person has |
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| previously
participated in the Plan and voluntarily
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| terminated Plan coverage, unless 12 months have elapsed
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| since the person's
latest voluntary termination of |
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SB2380 |
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LRB095 19723 KBJ 46088 b |
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| coverage.
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| (4) The person fails to pay the required premium under |
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| the covered
person's
terms of enrollment and |
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| participation, in which event the liability of the
Plan |
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| shall be limited to benefits incurred under the Plan for |
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| the time
period for which premiums had been paid and the |
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| covered person remained
eligible for Plan coverage.
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| (5) The Plan (i) until 3 years after the effective date |
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| of this amendatory Act of the 95th General Assembly has |
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| paid a total of
$2,000,000
in benefits
on behalf of the |
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| covered person or (ii) 3 years or more after the effective |
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| date of this amendatory Act of the 95th General Assembly |
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| has paid a total of $1,500,000 in benefits on behalf of the |
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| covered person.
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| (6) The person is a resident of a public institution.
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| (7) The person's premium is paid for or reimbursed |
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| under any
government sponsored program or by any government |
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| agency or health
care provider, except as an otherwise |
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| qualifying full-time employee, or
dependent of such |
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| employee, of a government agency or health care provider
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| or, except when a person's premium is paid by the U.S. |
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| Treasury Department
pursuant to the federal Trade Act of |
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| 2002.
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| (8) The person has or later receives other benefits or |
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| funds from
any settlement, judgement, or award resulting |
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| from any accident or injury,
regardless of the date of the |
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SB2380 |
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LRB095 19723 KBJ 46088 b |
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| accident or injury, or any other
circumstances creating a |
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| legal liability for damages due that person by a
third |
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| party, whether the settlement, judgment, or award is in the |
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| form of a
contract, agreement, or trust on behalf of a |
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| minor or otherwise and whether
the settlement, judgment, or |
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| award is payable to the person, his or her
dependent, |
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| estate, personal representative, or guardian in a lump sum |
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| or
over time, so long as there continues to be benefits or |
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| assets remaining
from those sources in an amount in excess |
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| of $300,000.
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| (9) Within the 5 years prior to the date a person's |
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| Plan application is
received by the Board, the person's |
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| coverage under any health care benefit
program as defined |
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| in 18 U.S.C. 24, including any public or private plan or
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| contract under which any
medical benefit, item, or service |
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| is provided, was terminated as a result of
any act or |
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| practice that constitutes fraud under State or federal law |
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| or as a
result of an intentional misrepresentation of |
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| material fact; or if that person
knowingly and willfully |
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| obtained or attempted to obtain, or fraudulently aided
or |
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| attempted to aid any other person in obtaining, any |
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| coverage or benefits
under the Plan to which that person |
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| was not entitled.
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| f. The board or the administrator shall require |
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| verification of
residency and may require any additional |
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| information or documentation, or
statements under oath, when |
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SB2380 |
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LRB095 19723 KBJ 46088 b |
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| necessary to determine residency upon initial
application and |
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| for the entire term of the policy.
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| g. Coverage shall cease (i) on the date a person is no |
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| longer a
resident of Illinois, (ii) on the date a person |
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| requests coverage to end,
(iii) upon the death of the covered |
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| person, (iv) on the date State law
requires cancellation of the |
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| policy, or (v) at the Plan's option, 30 days
after the Plan |
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| makes any inquiry concerning a person's eligibility or place
of |
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| residence to which the person does not reply.
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| h. Except under the conditions set forth in subsection g of |
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| this
Section, the coverage of any person who ceases to meet the
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| eligibility requirements of this Section shall be terminated at |
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| the end of
the current policy period for which the necessary |
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| premiums have been paid.
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| (Source: P.A. 94-17, eff. 1-1-06; 94-737, eff. 5-3-06; 95-547, |
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| eff. 8-29-07.)
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| Section 99. Effective date. This Act takes effect upon |
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| becoming law.
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