093_HB3298eng HB3298 Engrossed LRB093 11158 JLS 12059 b 1 AN ACT concerning the Comprehensive Health Insurance 2 Plan. 3 Be it enacted by the People of the State of Illinois, 4 represented in the General Assembly: 5 Section 5. The Comprehensive Health Insurance Plan Act 6 is amended by changing Sections 2, 4, 7, and 15 as follows: 7 (215 ILCS 105/2) (from Ch. 73, par. 1302) 8 Sec. 2. Definitions. As used in this Act, unless the 9 context otherwise requires: 10 "Plan administrator" means the insurer or third party 11 administrator designated under Section 5 of this Act. 12 "Benefits plan" means the coverage to be offered by the 13 Plan to eligible persons and federally eligible individuals 14 pursuant to this Act. 15 "Board" means the Illinois Comprehensive Health Insurance 16 Board. 17 "Church plan" has the same meaning given that term in the 18 federal Health Insurance Portability and Accountability Act 19 of 1996. 20 "Continuation coverage" means continuation of coverage 21 under a group health plan or other health insurance coverage 22 for former employees or dependents of former employees that 23 would otherwise have terminated under the terms of that 24 coverage pursuant to any continuation provisions under 25 federal or State law, including the Consolidated Omnibus 26 Budget Reconciliation Act of 1985 (COBRA), as amended, 27 Sections 367.2 and 367e of the Illinois Insurance Code, or 28 any other similar requirement in another State. 29 "Covered person" means a person who is and continues to 30 remain eligible for Plan coverage and is covered under one of 31 the benefit plans offered by the Plan. HB3298 Engrossed -2- LRB093 11158 JLS 12059 b 1 "Creditable coverage" means, with respect to a federally 2 eligible individual, coverage of the individual under any of 3 the following: 4 (A) A group health plan. 5 (B) Health insurance coverage (including group 6 health insurance coverage). 7 (C) Medicare. 8 (D) Medical assistance. 9 (E) Chapter 55 of title 10, United States Code. 10 (F) A medical care program of the Indian Health 11 Service or of a tribal organization. 12 (G) A state health benefits risk pool. 13 (H) A health plan offered under Chapter 89 of title 14 5, United States Code. 15 (I) A public health plan (as defined in regulations 16 consistent with Section 104 of the Health Care 17 Portability and Accountability Act of 1996 that may be 18 promulgated by the Secretary of the U.S. Department of 19 Health and Human Services). 20 (J) A health benefit plan under Section 5(e) of the 21 Peace Corps Act (22 U.S.C. 2504(e)). 22 (K) Any other qualifying coverage required by the 23 federal Health Insurance Portability and Accountability 24 Act of 1996, as it may be amended, or regulations under 25 that Act. 26 "Creditable coverage" does not include coverage 27 consisting solely of coverage of excepted benefits, as 28 defined in Section 2791(c) of title XXVII of the Public 29 Health Service Act (42 U.S.C. 300 gg-91), nor does it include 30 any period of coverage under any of items (A) through (K) 31 that occurred before a break of more than 90 days or, if the 32 individual has been certified as an eligible person pursuant 33 to the federal Trade Adjustment Act of 2002, a break of more 34 than 63 days during all of which the individual was not HB3298 Engrossed -3- LRB093 11158 JLS 12059 b 1 covered under any of items (A) through (K) above. Any period 2 that an individual is in a waiting period for any coverage 3 under a group health plan (or for group health insurance 4 coverage) or is in an affiliation period under the terms of 5 health insurance coverage offered by a health maintenance 6 organization shall not be taken into account in determining 7 if there has been a break of more than 90 days in any 8 creditable coverage. 9 "Department" means the Illinois Department of Insurance. 10 "Dependent" means an Illinois resident: who is a spouse; 11 or who is claimed as a dependent by the principal insured for 12 purposes of filing a federal income tax return and resides in 13 the principal insured's household, and is a resident 14 unmarried child under the age of 19 years; or who is an 15 unmarried child who also is a full-time student under the age 16 of 23 years and who is financially dependent upon the 17 principal insured; or who is a child of any age and who is 18 disabled and financially dependent upon the principal 19 insured. 20 "Direct Illinois premiums" means, for Illinois business, 21 an insurer's direct premium income for the kinds of business 22 described in clause (b) of Class 1 or clause (a) of Class 2 23 of Section 4 of the Illinois Insurance Code, and direct 24 premium income of a health maintenance organization or a 25 voluntary health services plan, except it shall not include 26 credit health insurance as defined in Article IX 1/2 of the 27 Illinois Insurance Code. 28 "Director" means the Director of the Illinois Department 29 of Insurance. 30 "Eligible person" means a resident of this State who 31 qualifies for Plan coverage under Section 7 of this Act. 32 "Employee" means a resident of this State who is employed 33 by an employer or has entered into the employment of or works 34 under contract or service of an employer including the HB3298 Engrossed -4- LRB093 11158 JLS 12059 b 1 officers, managers and employees of subsidiary or affiliated 2 corporations and the individual proprietors, partners and 3 employees of affiliated individuals and firms when the 4 business of the subsidiary or affiliated corporations, firms 5 or individuals is controlled by a common employer through 6 stock ownership, contract, or otherwise. 7 "Employer" means any individual, partnership, 8 association, corporation, business trust, or any person or 9 group of persons acting directly or indirectly in the 10 interest of an employer in relation to an employee, for which 11 one or more persons is gainfully employed. 12 "Family" coverage means the coverage provided by the Plan 13 for the covered person and his or her eligible dependents who 14 also are covered persons. 15 "Federally eligible individual" means an individual 16 resident of this State: 17 (1)(A) for whom, as of the date on which the 18 individual seeks Plan coverage under Section 15 of this 19 Act, the aggregate of the periods of creditable coverage 20 is 18 or more months or, if the individual has been 21 certified as an eligible person pursuant to the federal 22 Trade Adjustment Act of 2002, 3 or more months, and (B) 23 whose most recent prior creditable coverage was under 24 group health insurance coverage offered by a health 25 insurance issuer, a group health plan, a governmental 26 plan, or a church plan (or health insurance coverage 27 offered in connection with any such plans) or any other 28 type of creditable coverage that may be required by the 29 federal Health Insurance Portability and Accountability 30 Act of 1996, as it may be amended, or the regulations 31 under that Act; 32 (2) who is not eligible for coverage under (A) a 33 group health plan, (B) part A or part B of Medicare due 34 to age, or (C) medical assistance, and does not have HB3298 Engrossed -5- LRB093 11158 JLS 12059 b 1 other health insurance coverage; 2 (3) with respect to whom the most recent coverage 3 within the coverage period described in paragraph (1)(A) 4 of this definition was not terminated based upon a factor 5 relating to nonpayment of premiums or fraud; 6 (4) if the individual, other than an individual who 7 has been certified as an eligible person pursuant to the 8 federal Trade Adjustment Act of 2002, had been offered 9 the option of continuation coverage under a COBRA 10 continuation provision or under a similar State program, 11 who elected such coverage; and 12 (5) who, if the individual elected such 13 continuation coverage, has exhausted such continuation 14 coverage under such provision or program. 15 An individual who has been certified as an eligible 16 person pursuant to the federal Trade Adjustment Act of 2002 17 shall not be required to elect continuation coverage under a 18 COBRA continuation provision or under a similar state 19 program. 20 "Group health insurance coverage" means, in connection 21 with a group health plan, health insurance coverage offered 22 in connection with that plan. 23 "Group health plan" has the same meaning given that term 24 in the federal Health Insurance Portability and 25 Accountability Act of 1996. 26 "Governmental plan" has the same meaning given that term 27 in the federal Health Insurance Portability and 28 Accountability Act of 1996. 29 "Health insurance coverage" means benefits consisting of 30 medical care (provided directly, through insurance or 31 reimbursement, or otherwise and including items and services 32 paid for as medical care) under any hospital and medical 33 expense-incurred policy, certificate, or contract provided by 34 an insurer, non-profit health care service plan contract, HB3298 Engrossed -6- LRB093 11158 JLS 12059 b 1 health maintenance organization or other subscriber contract, 2 or any other health care plan or arrangement that pays for or 3 furnishes medical or health care services whether by 4 insurance or otherwise. Health insurance coverage shall not 5 include short term, accident only, disability income, 6 hospital confinement or fixed indemnity, dental only, vision 7 only, limited benefit, or credit insurance, coverage issued 8 as a supplement to liability insurance, insurance arising out 9 of a workers' compensation or similar law, automobile 10 medical-payment insurance, or insurance under which benefits 11 are payable with or without regard to fault and which is 12 statutorily required to be contained in any liability 13 insurance policy or equivalent self-insurance. 14 "Health insurance issuer" means an insurance company, 15 insurance service, or insurance organization (including a 16 health maintenance organization and a voluntary health 17 services plan) that is authorized to transact health 18 insurance business in this State. Such term does not include 19 a group health plan. 20 "Health Maintenance Organization" means an organization 21 as defined in the Health Maintenance Organization Act. 22 "Hospice" means a program as defined in and licensed 23 under the Hospice Program Licensing Act. 24 "Hospital" means a duly licensed institution as defined 25 in the Hospital Licensing Act, an institution that meets all 26 comparable conditions and requirements in effect in the state 27 in which it is located, or the University of Illinois 28 Hospital as defined in the University of Illinois Hospital 29 Act. 30 "Individual health insurance coverage" means health 31 insurance coverage offered to individuals in the individual 32 market, but does not include short-term, limited-duration 33 insurance. 34 "Insured" means any individual resident of this State who HB3298 Engrossed -7- LRB093 11158 JLS 12059 b 1 is eligible to receive benefits from any insurer (including 2 health insurance coverage offered in connection with a group 3 health plan) or health insurance issuer as defined in this 4 Section. 5 "Insurer" means any insurance company authorized to 6 transact health insurance business in this State and any 7 corporation that provides medical services and is organized 8 under the Voluntary Health Services Plans Act or the Health 9 Maintenance Organization Act. 10 "Medical assistance" means the State medical assistance 11 or medical assistance no grant (MANG) programs provided under 12 Title XIX of the Social Security Act and Articles V (Medical 13 Assistance) and VI (General Assistance) of the Illinois 14 Public Aid Code (or any successor program) or under any 15 similar program of health care benefits in a state other than 16 Illinois. 17 "Medically necessary" means that a service, drug, or 18 supply is necessary and appropriate for the diagnosis or 19 treatment of an illness or injury in accord with generally 20 accepted standards of medical practice at the time the 21 service, drug, or supply is provided. When specifically 22 applied to a confinement it further means that the diagnosis 23 or treatment of the covered person's medical symptoms or 24 condition cannot be safely provided to that person as an 25 outpatient. A service, drug, or supply shall not be medically 26 necessary if it: (i) is investigational, experimental, or for 27 research purposes; or (ii) is provided solely for the 28 convenience of the patient, the patient's family, physician, 29 hospital, or any other provider; or (iii) exceeds in scope, 30 duration, or intensity that level of care that is needed to 31 provide safe, adequate, and appropriate diagnosis or 32 treatment; or (iv) could have been omitted without adversely 33 affecting the covered person's condition or the quality of 34 medical care; or (v) involves the use of a medical device, HB3298 Engrossed -8- LRB093 11158 JLS 12059 b 1 drug, or substance not formally approved by the United States 2 Food and Drug Administration. 3 "Medical care" means the ordinary and usual professional 4 services rendered by a physician or other specified provider 5 during a professional visit for treatment of an illness or 6 injury. 7 "Medicare" means coverage under both Part A and Part B of 8 Title XVIII of the Social Security Act, 42 U.S.C. Sec. 1395, 9 et seq. 10 "Minimum premium plan" means an arrangement whereby a 11 specified amount of health care claims is self-funded, but 12 the insurance company assumes the risk that claims will 13 exceed that amount. 14 "Participating transplant center" means a hospital 15 designated by the Board as a preferred or exclusive provider 16 of services for one or more specified human organ or tissue 17 transplants for which the hospital has signed an agreement 18 with the Board to accept a transplant payment allowance for 19 all expenses related to the transplant during a transplant 20 benefit period. 21 "Physician" means a person licensed to practice medicine 22 pursuant to the Medical Practice Act of 1987. 23 "Plan" means the Comprehensive Health Insurance Plan 24 established by this Act. 25 "Plan of operation" means the plan of operation of the 26 Plan, including articles, bylaws and operating rules, adopted 27 by the board pursuant to this Act. 28 "Provider" means any hospital, skilled nursing facility, 29 hospice, home health agency, physician, registered pharmacist 30 acting within the scope of that registration, or any other 31 person or entity licensed in Illinois to furnish medical 32 care. 33 "Qualified high risk pool" has the same meaning given 34 that term in the federal Health Insurance Portability and HB3298 Engrossed -9- LRB093 11158 JLS 12059 b 1 Accountability Act of 1996. 2 "Resident" means a person who is and continues to be 3 legally domiciled and physically residing on a permanent and 4 full-time basis in a place of permanent habitation in this 5 State that remains that person's principal residence and from 6 which that person is absent only for temporary or transitory 7 purpose. 8 "Skilled nursing facility" means a facility or that 9 portion of a facility that is licensed by the Illinois 10 Department of Public Health under the Nursing Home Care Act 11 or a comparable licensing authority in another state to 12 provide skilled nursing care. 13 "Stop-loss coverage" means an arrangement whereby an 14 insurer insures against the risk that any one claim will 15 exceed a specific dollar amount or that the entire loss of a 16 self-insurance plan will exceed a specific amount. 17 "Third party administrator" means an administrator as 18 defined in Section 511.101 of the Illinois Insurance Code who 19 is licensed under Article XXXI 1/4 of that Code. 20 (Source: P.A. 91-357, eff. 7-29-99; 91-735, eff. 6-2-00; 21 92-153, eff. 7-25-01.) 22 (215 ILCS 105/4) (from Ch. 73, par. 1304) 23 Sec. 4. Powers and authority of the board. The board 24 shall have the general powers and authority granted under the 25 laws of this State to insurance companies licensed to 26 transact health and accident insurance and in addition 27 thereto, the specific authority to: 28 a. Enter into contracts as are necessary or proper to 29 carry out the provisions and purposes of this Act, including 30 the authority, with the approval of the Director, to enter 31 into contracts with similar plans of other states for the 32 joint performance of common administrative functions, or with 33 persons or other organizations for the performance of HB3298 Engrossed -10- LRB093 11158 JLS 12059 b 1 administrative functions including, without limitation, 2 utilization review and quality assurance programs, or with 3 health maintenance organizations or preferred provider 4 organizations for the provision of health care services. 5 b. Sue or be sued, including taking any legal actions 6 necessary or proper. 7 c. Take such legal action as necessary to: 8 (1) avoid the payment of improper claims against 9 the plan or the coverage provided by or through the plan; 10 (2) to recover any amounts erroneously or 11 improperly paid by the plan; 12 (3) to recover any amounts paid by the plan as a 13 result of a mistake of fact or law; or 14 (4) to recover or collect any other amounts, 15 including assessments, that are due or owed the Plan or 16 have been billed on its or the Plan's behalf. 17 d. Establish appropriate rates, rate schedules, rate 18 adjustments, expense allowances, agents' referral fees, claim 19 reserves, and formulas and any other actuarial function 20 appropriate to the operation of the plan. Rates and rate 21 schedules may be adjusted for appropriate risk factors such 22 as age and area variation in claim costs and shall take into 23 consideration appropriate risk factors in accordance with 24 established actuarial and underwriting practices. 25 e. Issue policies of insurance in accordance with the 26 requirements of this Act. 27 f. Appoint appropriate legal, actuarial and other 28 committees as necessary to provide technical assistance in 29 the operation of the plan, policy and other contract design, 30 and any other function within the authority of the plan. 31 g. Borrow money to effect the purposes of the Illinois 32 Comprehensive Health Insurance Plan. Any notes or other 33 evidence of indebtedness of the plan not in default shall be 34 legal investments for insurers and may be carried as admitted HB3298 Engrossed -11- LRB093 11158 JLS 12059 b 1 assets. 2 h. Establish rules, conditions and procedures for 3 reinsuring risks under this Act. 4 i. Employ and fix the compensation of employees. Such 5 employees may be paid on a warrant issued by the State 6 Treasurer pursuant to a payroll voucher certified by the 7 Board and drawn by the Comptroller against appropriations or 8 trust funds held by the State Treasurer. 9 j. Enter into intergovernmental cooperation agreements 10 with other agencies or entities of State government for the 11 purpose of sharing the cost of providing health care services 12 that are otherwise authorized by this Act for children who 13 are both plan participants and eligible for financial 14 assistance from the Division of Specialized Care for Children 15 of the University of Illinois. 16 k. Establish conditions and procedures under which the 17 plan may, if funds permit, discount or subsidize premium 18 rates that are paid directly by senior citizens, as defined 19 by the Board, and other plan participants, who are retired or 20 unemployed and meet other qualifications. 21 l. Establish and maintain the Plan Fund authorized in 22 Section 3 of this Act, which shall be divided into separate 23 accounts, as follows: 24 (1) accounts to fund the administrative, claim, and 25 other expenses of the Plan associated with eligible 26 persons who qualify for Plan coverage under Section 7 of 27 this Act, which shall consist of: 28 (A) premiums paid on behalf of covered 29 persons; 30 (B) appropriated funds and other revenues 31 collected or received by the Board; 32 (C) reserves for future losses maintained by 33 the Board; and 34 (D) interest earnings from investment of the HB3298 Engrossed -12- LRB093 11158 JLS 12059 b 1 funds in the Plan Fund or any of its accounts other 2 than the funds in the account established under item 3 2 of this subsection; 4 (2) an account, to be denominated the federally 5 eligible individuals account, to fund the administrative, 6 claim, and other expenses of the Plan associated with 7 federally eligible individuals who qualify for Plan 8 coverage under Section 15 of this Act, which shall 9 consist of: 10 (A) premiums paid on behalf of covered 11 persons; 12 (B) assessments and other revenues collected 13 or received by the Board; 14 (C) reserves for future losses maintained by 15 the Board;and16 (D) interest earnings from investment of the 17 federally eligible individuals account funds; and 18 (E) grants provided pursuant to the federal 19 Trade Adjustment Act of 2002; and 20 (3) such other accounts as may be appropriate. 21 m. Charge and collect assessments paid by insurers 22 pursuant to Section 12 of this Act and recover any 23 assessments for, on behalf of, or against those insurers. 24 (Source: P.A. 90-30, eff. 7-1-97; 91-357, eff. 7-29-99.) 25 (215 ILCS 105/7) (from Ch. 73, par. 1307) 26 Sec. 7. Eligibility. 27 a. Except as provided in subsection (e) of this Section 28 or in Section 15 of this Act, any person who is either a 29 citizen of the United States or an alien lawfully admitted 30 for permanent residence and who has been for a period of at 31 least 180 days and continues to be a resident of this State 32 shall be eligible for Plan coverage under this Section if 33 evidence is provided of: HB3298 Engrossed -13- LRB093 11158 JLS 12059 b 1 (1) A notice of rejection or refusal to issue 2 substantially similar individual health insurance 3 coverage for health reasons by a health insurance issuer; 4 or 5 (2) A refusal by a health insurance issuer to issue 6 individual health insurance coverage except at a rate 7 exceeding the applicable Plan rate for which the person 8 is responsible. 9 A rejection or refusal by a group health plan or health 10 insurance issuer offering only stop-loss or excess of loss 11 insurance or contracts, agreements, or other arrangements for 12 reinsurance coverage with respect to the applicant shall not 13 be sufficient evidence under this subsection. 14 b. The board shall promulgate a list of medical or 15 health conditions for which a person who is either a citizen 16 of the United States or an alien lawfully admitted for 17 permanent residence and a resident of this State would be 18 eligible for Plan coverage without applying for health 19 insurance coverage pursuant to subsection a. of this Section. 20 Persons who can demonstrate the existence or history of any 21 medical or health conditions on the list promulgated by the 22 board shall not be required to provide the evidence specified 23 in subsection a. of this Section. The list shall be 24 effective on the first day of the operation of the Plan and 25 may be amended from time to time as appropriate. 26 c. Family members of the same household who each are 27 covered persons are eligible for optional family coverage 28 under the Plan. 29 d. For persons qualifying for coverage in accordance 30 with Section 7 of this Act, the board shall, if it determines 31 that such appropriations as are made pursuant to Section 12 32 of this Act are insufficient to allow the board to accept all 33 of the eligible persons which it projects will apply for 34 enrollment under the Plan, limit or close enrollment to HB3298 Engrossed -14- LRB093 11158 JLS 12059 b 1 ensure that the Plan is not over-subscribed and that it has 2 sufficient resources to meet its obligations to existing 3 enrollees. The board shall not limit or close enrollment for 4 federally eligible individuals. 5 e. A person shall not be eligible for coverage under the 6 Plan if: 7 (1) He or she has or obtains other coverage under a 8 group health plan or health insurance coverage 9 substantially similar to or better than a Plan policy as 10 an insured or covered dependent or would be eligible to 11 have that coverage if he or she elected to obtain it. 12 Persons otherwise eligible for Plan coverage may, 13 however, solely for the purpose of having coverage for a 14 pre-existing condition, maintain other coverage only 15 while satisfying any pre-existing condition waiting 16 period under a Plan policy or a subsequent replacement 17 policy of a Plan policy. 18 (1.1) His or her prior coverage under a group 19 health plan or health insurance coverage, provided or 20 arranged by an employer of more than 10 employees was 21 discontinued for any reason without the entire group or 22 plan being discontinued and not replaced, provided he or 23 she remains an employee, or dependent thereof, of the 24 same employer. 25 (2) He or she is a recipient of or is approved to 26 receive medical assistance, except that a person may 27 continue to receive medical assistance through the 28 medical assistance no grant program, but only while 29 satisfying the requirements for a preexisting condition 30 under Section 8, subsection f. of this Act. Payment of 31 premiums pursuant to this Act shall be allocable to the 32 person's spenddown for purposes of the medical assistance 33 no grant program, but that person shall not be eligible 34 for any Plan benefits while that person remains eligible HB3298 Engrossed -15- LRB093 11158 JLS 12059 b 1 for medical assistance. If the person continues to 2 receive or be approved to receive medical assistance 3 through the medical assistance no grant program at or 4 after the time that requirements for a preexisting 5 condition are satisfied, the person shall not be eligible 6 for coverage under the Plan. In that circumstance, 7 coverage under the plan shall terminate as of the 8 expiration of the preexisting condition limitation 9 period. Under all other circumstances, coverage under 10 the Plan shall automatically terminate as of the 11 effective date of any medical assistance. 12 (3) Except as provided in Section 15, the person 13 has previously participated in the Plan and voluntarily 14 terminated Plan coverage, unless 12 months have elapsed 15 since the person's latest voluntary termination of 16 coverage. 17 (4) The person fails to pay the required premium 18 under the covered person's terms of enrollment and 19 participation, in which event the liability of the Plan 20 shall be limited to benefits incurred under the Plan for 21 the time period for which premiums had been paid and the 22 covered person remained eligible for Plan coverage. 23 (5) The Plan has paid a total of $1,000,000 in 24 benefits on behalf of the covered person. 25 (6) The person is a resident of a public 26 institution. 27 (7) The person's premium is paid for or reimbursed 28 under any government sponsored program or by any 29 government agency or health care provider, except as an 30 otherwise qualifying full-time employee, or dependent of 31 such employee, of a government agency or health care 32 provider or, except when a person's premium is paid by 33 the U.S. Treasury Department pursuant to the federal 34 Trade Adjustment Act of 2002. HB3298 Engrossed -16- LRB093 11158 JLS 12059 b 1 (8) The person has or later receives other benefits 2 or funds from any settlement, judgement, or award 3 resulting from any accident or injury, regardless of the 4 date of the accident or injury, or any other 5 circumstances creating a legal liability for damages due 6 that person by a third party, whether the settlement, 7 judgment, or award is in the form of a contract, 8 agreement, or trust on behalf of a minor or otherwise and 9 whether the settlement, judgment, or award is payable to 10 the person, his or her dependent, estate, personal 11 representative, or guardian in a lump sum or over time, 12 so long as there continues to be benefits or assets 13 remaining from those sources in an amount in excess of 14 $100,000. 15 (9) Within the 5 years prior to the date a person's 16 Plan application is received by the Board, the person's 17 coverage under any health care benefit program as defined 18 in 18 U.S.C. 24, including any public or private plan or 19 contract under which any medical benefit, item, or 20 service is provided, was terminated as a result of any 21 act or practice that constitutes fraud under State or 22 federal law or as a result of an intentional 23 misrepresentation of material fact; or if that person 24 knowingly and willfully obtained or attempted to obtain, 25 or fraudulently aided or attempted to aid any other 26 person in obtaining, any coverage or benefits under the 27 Plan to which that person was not entitled. 28 f. The board or the administrator shall require 29 verification of residency and may require any additional 30 information or documentation, or statements under oath, when 31 necessary to determine residency upon initial application and 32 for the entire term of the policy. 33 g. Coverage shall cease (i) on the date a person is no 34 longer a resident of Illinois, (ii) on the date a person HB3298 Engrossed -17- LRB093 11158 JLS 12059 b 1 requests coverage to end, (iii) upon the death of the covered 2 person, (iv) on the date State law requires cancellation of 3 the policy, or (v) at the Plan's option, 30 days after the 4 Plan makes any inquiry concerning a person's eligibility or 5 place of residence to which the person does not reply. 6 h. Except under the conditions set forth in subsection g 7 of this Section, the coverage of any person who ceases to 8 meet the eligibility requirements of this Section shall be 9 terminated at the end of the current policy period for which 10 the necessary premiums have been paid. 11 (Source: P.A. 90-30, eff. 7-1-97; 91-639, eff. 8-20-99; 12 91-735, eff. 6-2-00.) 13 (215 ILCS 105/15) 14 Sec. 15. Alternative portable coverage for federally 15 eligible individuals. 16 (a) Notwithstanding the requirements of subsection a. of 17 Section 7 and except as otherwise provided in this Section, 18 any federally eligible individual for whom a Plan 19 application, and such enclosures and supporting documentation 20 as the Board may require, is received by the Board within 90 21 days after the termination of prior creditable coverage shall 22 qualify to enroll in the Plan under the portability 23 provisions of this Section. A federally eligible person who 24 has been certified as an eligible person pursuant to the 25 federal Trade Adjustment Act of 2002 and whose Plan 26 application and enclosures and supporting documentation as 27 the Board may require is received by the Board within 63 days 28 after the termination of previous creditable coverage shall 29 qualify to enroll in the Plan under the portability 30 provisions of this Section. 31 (b) Any federally eligible individual seeking Plan 32 coverage under this Section must submit with his or her 33 application evidence, including acceptable written HB3298 Engrossed -18- LRB093 11158 JLS 12059 b 1 certification of previous creditable coverage, that will 2 establish to the Board's satisfaction, that he or she meets 3 all of the requirements to be a federally eligible individual 4 and is currently and permanently residing in this State (as 5 of the date his or her application was received by the 6 Board). 7 (c) Except as otherwise provided in this Section, a 8 period of creditable coverage shall not be counted, with 9 respect to qualifying an applicant for Plan coverage as a 10 federally eligible individual under this Section, if after 11 such period and before the application for Plan coverage was 12 received by the Board, there was at least a 90 day period 13 during all of which the individual was not covered under any 14 creditable coverage. For a federally eligible person who has 15 been certified as an eligible person pursuant to the federal 16 Trade Adjustment Act of 2002, a period of creditable coverage 17 shall not be counted, with respect to qualifying an applicant 18 for Plan coverage as a federally eligible individual under 19 this Section, if after such period and before the application 20 for Plan coverage was received by the Board, there was at 21 least a 63 day period during all of which the individual was 22 not covered under any creditable coverage. 23 (d) Any federally eligible individual who the Board 24 determines qualifies for Plan coverage under this Section 25 shall be offered his or her choice of enrolling in one of 26 alternative portability health benefit plans which the Board 27 is authorized under this Section to establish for these 28 federally eligible individuals and their dependents. 29 (e) The Board shall offer a choice of health care 30 coverages consistent with major medical coverage under the 31 alternative health benefit plans authorized by this Section 32 to every federally eligible individual. The coverages to be 33 offered under the plans, the schedule of benefits, 34 deductibles, co-payments, exclusions, and other limitations HB3298 Engrossed -19- LRB093 11158 JLS 12059 b 1 shall be approved by the Board. One optional form of 2 coverage shall be comparable to comprehensive health 3 insurance coverage offered in the individual market in this 4 State or a standard option of coverage available under the 5 group or individual health insurance laws of the State. The 6 standard benefit plan that is authorized by Section 8 of this 7 Act may be used for this purpose. The Board may also offer a 8 preferred provider option and such other options as the Board 9 determines may be appropriate for these federally eligible 10 individuals who qualify for Plan coverage pursuant to this 11 Section. 12 (f) Notwithstanding the requirements of subsection f. of 13 Section 8, any plan coverage that is issued to federally 14 eligible individuals who qualify for the Plan pursuant to the 15 portability provisions of this Section shall not be subject 16 to any preexisting conditions exclusion, waiting period, or 17 other similar limitation on coverage. 18 (g) Federally eligible individuals who qualify and 19 enroll in the Plan pursuant to this Section shall be required 20 to pay such premium rates as the Board shall establish and 21 approve in accordance with the requirements of Section 7.1 of 22 this Act. 23 (h) A federally eligible individual who qualifies and 24 enrolls in the Plan pursuant to this Section must satisfy on 25 an ongoing basis all of the other eligibility requirements of 26 this Act to the extent not inconsistent with the federal 27 Health Insurance Portability and Accountability Act of 1996 28 in order to maintain continued eligibility for coverage under 29 the Plan. 30 (Source: P.A. 92-153, eff. 7-25-01.) 31 Section 99. Effective date. This Act takes effect upon 32 becoming law.