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Public Act 096-0013 |
HB2325 Enrolled |
LRB096 09782 RPM 19945 b |
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AN ACT concerning insurance.
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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 Illinois Insurance Code is amended by |
changing Section 367e as follows:
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(215 ILCS 5/367e) (from Ch. 73, par. 979e)
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Sec. 367e. Continuation of Group Hospital, Surgical and |
Major Medical
Coverage After Termination of Employment or |
Membership.
A group policy delivered, issued for delivery, |
renewed or amended in this
state which insures employees or |
members
for hospital, surgical or major medical insurance on an |
expense incurred
or service basis, other than for specific |
diseases or for accidental injuries
only, shall provide that |
employees or members whose insurance under the
group policy |
would otherwise terminate because of termination of employment
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or membership or because of a reduction in hours below the |
minimum required
by the group plan shall be entitled to |
continue their hospital, surgical and
major medical insurance |
under that group policy, for themselves and their
eligible |
dependents, subject to all of the group policy's terms and |
conditions
applicable to those forms of insurance and to the |
following conditions:
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1. Continuation shall only be available to an employee |
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or member who has
been continuously insured under the group |
policy (and for similar benefits
under any group policy |
which it replaced) during the entire 3 months period
ending |
with such termination
or reduction in hours below the |
minimum required by the group plan. With respect to an |
employee or member who is involuntarily terminated between |
September 1, 2008 and December 31, 2009, continuation shall |
be available if the employee or member was insured under |
the group policy on the day prior to the termination.
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2. Continuation shall not be available for any person |
who is covered by
Medicare, except for those individuals |
who have been covered under a
group Medicare supplement |
policy. Neither shall continuation be
available for any |
person who is
covered by any other insured or uninsured |
plan
which provides hospital, surgical or medical coverage |
for individuals in
a group and under which the person was |
not
covered immediately prior to such termination
or |
reduction in hours below the minimum required by the group |
plan
or who exercises his conversion
privilege under the |
group policy.
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3. Continuation need not include dental, vision care, |
prescription drug
benefits, disability income, specified |
disease, or similar supplementary
benefits which are |
provided under the group policy in addition to its |
hospital,
surgical or major medical benefits.
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4. Within 10 days after the employee's or member's Upon |
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termination
or reduction in hours below the minimum |
required by the group plan
written notice of continuation |
shall be presented
to the employee or member by the |
employer . If the employee or member is unavailable, written |
notice shall be or mailed by the employer to the
last known |
address of the employee or member within 10 days after the |
employee's or member's termination or reduction in hours |
below the minimum required by the group plan . The employer |
shall also send a copy of the notice to the insurer. An |
employee or member who wishes
continuation
of coverage must |
request such continuation in writing within the 30 day |
ten-day
period following the later of: (i) the date of such |
termination
or reduction in hours below the minimum |
required by the group plan, or (ii)
the date the employee |
is presented or mailed given written notice of the right of |
continuation
by either the employer or the
group |
policyholder. In no event, however, may the employee or |
member elect
continuation more than 60 days after the date |
of such termination
or reduction in hours below the minimum |
required by the group plan.
Written notice of continuation |
presented to the employee or member by the
policyholder, or |
mailed by the policyholder to the last known address of
the |
employee, shall constitute the giving of notice for the |
purpose of this
provision.
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The insurer shall not deny coverage to the employee or |
member due to the employer's failure to provide notice |
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pursuant to this Section to the employee or member. Until |
January 1, 2010, in the event the employee or member |
contacts the insurer regarding continuation rights and |
advises that notice has not been provided by the employer |
or group policyholder, the insurer shall provide a written |
explanation to the employee or member of the employee's or |
member's continuation rights pursuant to this Section. |
4a. Unless contrary to the provisions of, or any rules |
promulgated pursuant to, Section 3001(a)(7) of Title III of |
Division B of the federal American Recovery and |
Reinvestment Act of 2009, with respect to employees or |
members of health plans that are subject solely to State |
continuation coverage and who are terminated or whose |
reduction in hours below the minimum required by the group |
occurs between the effective date of this amendatory Act of |
the 96th General Assembly and December 31, 2009, the notice |
requirements of this Section are not satisfied unless |
notice is presented or mailed to the employee or member by |
the insurer informing the employee or member of the |
availability of premium reduction with respect to such |
coverage under the American Recovery and Reinvestment Act |
of 2009. Such written notice shall conform to all |
applicable requirements set forth in Section 3001(a)(7) of |
Title III of Division B of the federal American Recovery |
and Reinvestment Act of 2009. The Department shall publish |
models for the notification that shall be provided by |
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insurers pursuant to this paragraph 4a. |
4b. Unless contrary to the provisions of, or any rules |
promulgated pursuant to, Section 3001(a)(7) of Title III of |
Division B of the federal American Recovery and |
Reinvestment Act of 2009, with respect to employees or |
members of health plans that are subject solely to State |
continuation coverage who were terminated or whose |
reduction in hours below the minimum required by the group |
occurred between September 1, 2008 and the effective date |
of this amendatory Act of the 96th General Assembly and who |
have an election of continuation of coverage pursuant to |
this Section in effect, notice shall be presented or mailed |
to the employee or member by the insurer informing the |
employee or member of the availability of premium reduction |
with respect to such coverage under the federal American |
Recovery and Reinvestment Act of 2009. Such written notice |
shall conform to all applicable requirements set forth in |
Section 3001(a)(7) of Title III of Division B of the |
federal American Recovery and Reinvestment Act of 2009 and |
shall be presented or mailed to the employee or member |
within 14 days of the effective date of this amendatory Act |
of the 96th General Assembly. The Department shall publish |
models for the notification that shall be provided by |
insurers pursuant to this paragraph 4b.
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5. An employee or member electing continuation must pay |
to the group
policyholder
or his employer, on a monthly |
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basis in advance, the total amount of premium
required by |
the insurer, including that portion of the premium |
contributed
by the policyholder or employer, if any, but |
not more than the group rate
for the insurance being |
continued with appropriate reduction in premium
for any |
supplementary benefits which have been discontinued under |
paragraph
(3) of this Section. The premium rate required by |
the insurer shall be
the applicable premium required on the |
due date of each payment.
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6. Continuation of insurance under the group policy for
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any person shall terminate when he becomes eligible for |
Medicare or is covered
by any other insured or uninsured |
plan which provides hospital, surgical
or medical coverage |
for individuals in a group and under which
the person was |
not covered immediately prior to such termination
or |
reduction in hours below the minimum required by the group |
plan
as provided
in condition
2 above or, if earlier, at |
the first to occur of the following:
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(a) The date 12 9 months after the date the |
employee's or member's
insurance
under the policy |
would otherwise have terminated because of termination
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of employment or membership
or reduction in hours below |
the minimum required by the group plan.
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(b) If the employee or member fails to make timely |
payment of a required
contribution, the end of the |
period for which contributions were made.
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(c) The date on which the group policy is |
terminated or, in the case of
an employee, the date his |
employer terminates participation under the group
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policy. However, if this (c) applies and the coverage |
ceasing by reason of
such
termination is replaced by |
similar coverage under another group policy,
the |
following shall apply:
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(i) The employee or member shall have the right |
to become covered
under
that other group policy, |
for the balance of the period that he would have
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remained covered under the prior group policy in |
accordance with condition
6 had a termination |
described in this (c) not occurred.
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(ii) The prior group policy shall continue to |
provide benefits to the
extent of its accrued |
liabilities and extensions of benefits as if the
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replacement
had not occurred.
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7. A notification of the continuation privilege shall |
be included in each
certificate of coverage.
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8. Continuation shall not be available for any employee |
who was
discharged because of the commission of a felony in |
connection with his
work, or because of theft in connection |
with his work, for which the
employer was in no way |
responsible; provided the employee admitted his
commission |
of the felony or theft or such act has resulted in a |
conviction
or order of supervision by a court of competent |
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jurisdiction.
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9. An employee or member without an election of |
continuation of coverage pursuant to this Section in effect |
on the effective date of this amendatory Act of the 96th |
General Assembly may elect continuation pursuant to this |
paragraph 9 if the employee or member: (i) would be an |
assistance eligible individual as defined in Section |
3001(a)(3) of Title III of Division B of the federal |
American Recovery and Reinvestment Act of 2009, if such an |
election were in effect and (ii) at the time of termination |
was eligible for continuation pursuant to paragraphs 1 and |
2 of this Section. |
Unless contrary to the provisions of, or any rules |
promulgated pursuant to, Section 3001(a)(7) of Title III of |
Division B of the federal American Recovery and |
Reinvestment Act of 2009, written notice of continuation |
pursuant to this paragraph 9 shall be presented to the |
employee or member by the insurer or mailed by the insurer |
to the last known address of the employee or member within |
30 days after the effective date of this amendatory Act of |
the 96th General Assembly. Such written notice shall |
conform to all applicable requirements set forth in Section |
3001(a)(7) of Title III of Division B of the federal |
American Recovery and Reinvestment Act of 2009. The |
Department shall publish models for the notification that |
shall be provided by insurers pursuant to this paragraph 9. |
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An employee or member electing continuation of |
coverage under this paragraph 9 must request such |
continuation in writing within 60 days after the date the |
employee or member receives written notice of the right of |
continuation by the insurer. |
Continuation of coverage elected pursuant to this |
paragraph 9 shall commence with the first period of |
coverage beginning on or after February 17, 2009, the |
effective date of the federal American Recovery and |
Reinvestment Act of 2009, and shall not extend beyond the |
period of continuation that would have been required if the |
coverage had been elected pursuant to paragraph 4 of this |
Section. |
With respect to an employee or member who elects |
continuation of coverage under this paragraph 9, the period |
beginning on the date of the employee's or member's |
involuntary termination of employment and ending on the |
date of the first period of coverage on or after February |
17, 2009 shall be disregarded for purposes of determining |
the 63-day period referred to in Section 20 of the Illinois |
Health Insurance Portability and Accountability Act. |
The requirements of this amendatory Act of 1983 shall apply |
to any group
policy as defined in this Section, delivered or |
issued for delivery on or after
180 days following the |
effective date of this amendatory Act of 1983.
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The requirements of this amendatory Act of 1985 shall apply |
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to any
group policy as defined in this Section, delivered, |
issued for delivery,
renewed or amended on or after 180 days |
following the effective date of
this amendatory Act of 1985.
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(Source: P.A. 93-477, eff. 1-1-04.)
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Section 10. The Health Maintenance Organization Act is |
amended by changing Section 4-9.2 as follows:
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(215 ILCS 125/4-9.2) (from Ch. 111 1/2, par. 1409.2-2)
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Sec. 4-9.2. Continuation of group HMO coverage after |
termination of
employee or membership. A group contract |
delivered, issued for delivery,
renewed, or amended in this |
State that covers employees or members for health
care services |
shall provide that employees or members whose coverage under
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the group contract would otherwise terminate because of |
termination of
employment or membership or because of a |
reduction in hours below the minimum
required by the group |
contract shall be entitled to continue their coverage
under
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that group contract, for themselves and their eligible |
dependents, subject
to all of the group contract's terms and |
conditions applicable to those
forms of coverage and to the |
following conditions:
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(1) Continuation shall only be available to an employee |
or member who has
been continuously covered under the group |
contract (and for similar
benefits under any group contract |
that it replaced) during the entire 3
month period ending |
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with the termination of employment or membership or
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reduction in hours below the minimum required by the group |
contract. With respect to an employee or member who is |
involuntarily terminated between September 1, 2008 and |
December 31, 2009, continuation shall be available if the |
employee or member was covered under the group contract the |
day prior to such termination.
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(2) Continuation shall not be available for any |
enrollee who is
covered by Medicare, except for those |
individuals who have been covered
under a group Medicare |
supplement policy. Continuation shall not be
available for |
any enrollee who is covered by any other insured or |
uninsured
plan that provides hospital, surgical, or |
medical coverage for individuals
in a group and under which |
the enrollee was not covered immediately
before |
termination or reduction in hours below the minimum |
required by the
group contract or who exercises his or her |
conversion privilege under
the group policy.
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(3) Continuation need not include dental, vision care, |
prescription
drug, or similar supplementary benefits that |
are provided under
the group contract in addition to its |
basic health care services.
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(4) Within 10 days after the employee's or member's |
Upon termination or reduction in hours below the minimum |
required by
the group contract, written notice of |
continuation shall be presented
to the employee or member |
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by the employer . If the employee or member is unavailable, |
written notice shall be or mailed by the employer to the |
last
known address of the employee or member within 10 days |
after the employee's or member's termination or reduction |
in hours below the minimum required by the group plan . The |
employer shall also send a copy of the notice to the HMO. |
An employee or member who wishes
continuation of coverage |
must request continuation in writing within
the 30 10 day |
period following the later of (i) the date of termination |
or
reduction in hours below the minimum required by the |
group contract or (ii)
the date the employee is presented |
or mailed given written notice of the right of continuation |
by
either the employer or the group policyholder. In no |
event, however, shall the
employee or member elect |
continuation more than 60 days after the date of
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termination
or reduction in hours below the minimum |
required by the group contract.
Written notice of |
continuation presented to the employee or member
by the |
policyholder, or mailed by the policyholder to the last |
known address of
the employee, shall constitute the giving |
of notice for the purpose of this
paragraph. |
The HMO shall not deny coverage to the employee or |
member due to the employer's failure to provide notice |
pursuant to this Section to the employee or member. Until |
January 1, 2010, in the event the employee or member |
contacts the HMO regarding continuation rights and advises |
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that notice has not been provided by the employer or group |
policyholder, the HMO shall provide a written explanation |
to the employee or member of the employee's or member's |
continuation rights pursuant to this Section. |
(4a) Unless contrary to the provisions of, or any rules |
promulgated pursuant to, Section 3001(a)(7) of Title III of |
Division B of the federal American Recovery and |
Reinvestment Act of 2009, with respect to employees or |
members of health plans that are subject solely to State |
continuation coverage and who are terminated or whose |
reduction in hours below the minimum required by the group |
occurs between the effective date of this amendatory Act of |
the 96th General Assembly and December 31, 2009, the notice |
requirements of this Section are not satisfied unless |
notice is presented or mailed to the employee or member by |
the HMO informing the employee or member of the |
availability of premium reduction with respect to such |
coverage under the federal American Recovery and |
Reinvestment Act of 2009. Such written notice shall conform |
to all applicable requirements set forth in Section |
3001(a)(7) of Title III of Division B of the federal |
American Recovery and Reinvestment Act of 2009. The |
Department shall publish models for the notification that |
shall be provided by HMOs pursuant to this paragraph (4a). |
(4b) Unless contrary to the provisions of, or any rules |
promulgated pursuant to, Section 3001(a)(7) of Title III of |
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Division B of the federal American Recovery and |
Reinvestment Act of 2009, with respect to employees or |
members of health plans that are subject solely to State |
continuation coverage who were terminated or whose |
reduction in hours below the minimum required by the group |
occurred between September 1, 2008, and the effective date |
of this amendatory Act of the 96th General Assembly and who |
have an election of continuation of coverage pursuant to |
this Section in effect, notice shall be presented or mailed |
to the employee or member by the HMO informing the employee |
or member of the availability of premium reduction with |
respect to such coverage under the federal American |
Recovery and Reinvestment Act of 2009. Such written notice |
shall conform to all applicable requirements set forth in |
Section 3001(a)(7) of Title III of Division B of the |
federal American Recovery and Reinvestment Act of 2009 and |
shall be presented or mailed to the employee or member |
within 14 days of the effective date of this amendatory Act |
of the 96th General Assembly. The Department shall publish |
models for the notification that shall be provided by HMOs |
pursuant to this paragraph (4b).
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(5) An employee or member electing continuation must |
pay to the group
policyholder or his employer, on a monthly |
basis in advance, the total
amount of premium required by |
the HMO, including that portion of the
premium contributed |
by the policyholder or employer, if any, but not more
than |
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the group rate for the coverage being continued with |
appropriate
reduction in premium for any supplementary |
benefits that have been
discontinued under paragraph (3) of |
this Section. The premium rate required
by the HMO shall be |
the applicable premium required on the due date of each
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payment.
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(6) Continuation of coverage under the group contract |
for any person
shall terminate when the person becomes |
eligible for Medicare or is covered by
any other insured or |
uninsured plan that provides hospital, surgical, or
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medical coverage for individuals in a group and under which |
the person was not
covered immediately before termination
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or reduction in hours below the minimum required by the |
group contract
as provided in paragraph (2) of this
Section |
or, if earlier, at the first to occur of the following:
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(a) The expiration of 12 9 months after the |
employee's or member's coverage
because of termination |
of employment or membership
or reduction in hours below |
the minimum required by the group contract.
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(b) If the employee or member fails to make timely |
payment of a
required contribution, the end of the |
period for which contributions were made.
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(c) The date on which the group contract is |
terminated or, in the
case of an employee, the date his |
or her employer terminates participation
under the |
group contract. If, however, this paragraph applies |
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and the coverage
ceasing by reason of termination is |
replaced by similar coverage under another
group |
contract, then (i) the employee or member shall have |
the right to become
covered under the replacement group |
contract for the balance of the period that
he or she |
would have remained covered under the prior group |
contract in
accordance with paragraph (6) had a |
termination described in this item (c) not
occurred and |
(ii) the prior group contract shall continue to provide |
benefits
to the extent of its accrued liabilities and |
extensions of benefits as if the
replacement had not |
occurred.
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(7) A notification of the continuation privilege shall |
be included in
each evidence of coverage.
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(8) Continuation shall not be available for any |
employee who was
discharged because of the commission of a |
felony in connection with his or her
work, or because of |
theft in connection with his or her work, for which the
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employer was in no way responsible if the employee (i) |
admitted to
committing the felony or theft or (ii) was |
convicted or placed under
supervision by a court of |
competent jurisdiction.
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(9) An employee or member without an election of |
continuation of coverage pursuant to this Section in effect |
on the effective date of this amendatory Act of the 96th |
General Assembly may elect continuation pursuant to this |
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paragraph (9) if the employee or member: (i) would be an |
assistance eligible individual as defined in Section |
3001(a)(3) of Title III of Division B of the federal |
American Recovery and Reinvestment Act of 2009 if such an |
election were in effect and (ii) at the time of termination |
was eligible for continuation pursuant to paragraphs (1) |
and (2) of this Section. |
Unless contrary to the provisions of, or any rules |
promulgated pursuant to, Section 3001(a)(7) of Title III of |
Division B of the federal American Recovery and |
Reinvestment Act of 2009, written notice of continuation |
pursuant to this paragraph (9) shall be presented to the |
employee or member by the HMO or mailed by the HMO to the |
last known address of the employee or member within 30 days |
after the effective date of this amendatory Act of the 96th |
General Assembly. The written notice shall conform to all |
applicable requirements set forth in Section 3001(a)(7) of |
Title III of Division B of the federal American Recovery |
and Reinvestment Act of 2009. The Department shall publish |
models for the notification that shall be provided by HMOs |
pursuant to this paragraph (9). |
An employee or member electing continuation of |
coverage under this paragraph (9) must request such |
continuation in writing within 60 days after the date the |
employee or member receives written notice of the right of |
continuation by the HMO. |
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Continuation of coverage elected pursuant to this |
paragraph (9) shall commence with the first period of |
coverage beginning on or after February 17, 2009, the |
effective date of the federal American Recovery and |
Reinvestment Act of 2009, and shall not extend beyond the |
period of continuation that would have been required if the |
coverage had been elected pursuant to paragraph (4) of this |
Section. |
With respect to an employee or member who elects |
continuation of coverage under this paragraph (9), the |
period beginning on the date of the employee or member's |
involuntary termination of employment and ending on the |
date of the first period of coverage on or after February |
17, 2009 shall be disregarded for purposes of determining |
the 63-day period referred to in Section 20 of the Illinois |
Health Insurance Portability and Accountability Act. |
The requirements of this amendatory Act of 1992 shall apply |
to any
group contract, as defined in this Section, delivered or |
issued for
delivery on or after 180 days following the |
effective date of this
amendatory Act of 1992.
|
(Source: P.A. 93-477, eff. 1-1-04.)
|
Section 99. Effective date. This Act takes effect upon |
becoming law.
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