Insurance Committee
Adopted in House Comm. on Mar 03, 2004
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1 | AMENDMENT TO HOUSE BILL 5925
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2 | AMENDMENT NO. ______. Amend House Bill 5925 by replacing | ||||||
3 | everything after the enacting clause with the following:
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4 | "Section 1. Short title. This Act may be cited as the | ||||||
5 | Illinois Consumer Choice of Benefits Health Insurance Plan Act. | ||||||
6 | Section 5. Purpose. The legislature recognizes the need for | ||||||
7 | individuals, employers, and other purchasers of coverage in | ||||||
8 | this State to have the opportunity to choose health insurance | ||||||
9 | plans that are more affordable and flexible than existing | ||||||
10 | market policies offering accident and health insurance | ||||||
11 | coverage. The legislature, therefore, seeks to increase the | ||||||
12 | availability of health insurance coverage by allowing insurers | ||||||
13 | authorized to engage in the business of insurance in this state | ||||||
14 | to issue accident and health policies that, in whole or in | ||||||
15 | part, do not offer or provide state-mandated health benefits. | ||||||
16 | Section 10. Definitions. For purposes of this Act: | ||||||
17 | (a) "Consumer Choice of Benefits Health Insurance Plan" | ||||||
18 | means an accident or health insurance policy that, in whole or | ||||||
19 | in part, does not offer and provide state-mandated health | ||||||
20 | benefits, but that provides creditable coverage as defined by | ||||||
21 | Section 20 of the Illinois Health Insurance Portability and | ||||||
22 | Accountability Act. | ||||||
23 | (b) "Department" means the Department of Insurance. |
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1 | (c) "Director" means the Director of Insurance. | ||||||
2 | (d) "Insurer" means an insurance company actively engaged | ||||||
3 | in issuing approved policies of accident and health insurance | ||||||
4 | in Illinois prior to the effective date of this Act.
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5 | Section 15. State-mandated health benefits. | ||||||
6 | (a) For purposes of this Act, "state-mandated health | ||||||
7 | benefits" means coverage required under this Act or other laws | ||||||
8 | of this State to be provided in an individual major medical, | ||||||
9 | blanket, or group major medical policy for accident and health | ||||||
10 | insurance or a contract for a health-related condition that:
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11 | (1) includes coverage for specific health care | ||||||
12 | services or benefits; | ||||||
13 | (2) places limitations of restrictions on deductibles, | ||||||
14 | coinsurance, copayments, or any annual or lifetime maximum | ||||||
15 | benefit amounts; or | ||||||
16 | (3) includes coverage for a specific category of | ||||||
17 | licensed health care practitioner from whom an insured is | ||||||
18 | entitled to receive care. | ||||||
19 | (b) For purposes of this Act, "state-mandated health | ||||||
20 | benefits" does not include benefits that are mandated by | ||||||
21 | federal law or standard provisions or rights required under | ||||||
22 | this Act or other laws of this State to be provided in a group | ||||||
23 | major medical policy for accident and health insurance that are | ||||||
24 | unrelated to specific health illnesses, injuries, or | ||||||
25 | conditions of an insured, including provisions related to: | ||||||
26 | (1) continuation of coverage under Sections 367e, | ||||||
27 | 367f, 367g, 367h, 367j, 367.2, and 367.2-5 of the Illinois | ||||||
28 | Insurance Code; | ||||||
29 | (2) conversion coverage under Sections 356d and | ||||||
30 | 367e(A) of the Illinois Insurance Code; | ||||||
31 | (3) preexisting conditions under: | ||||||
32 | (A) Section 20 of the Illinois Health Insurance | ||||||
33 | Portability and Accountability Act; |
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1 | (B) Sections 367i of the Illinois Insurance Code; | ||||||
2 | and | ||||||
3 | (C) Part 2005 of Chapter 1 of Title 50 of the | ||||||
4 | Illinois Administrative Code; | ||||||
5 | (4) coverage for children, including newborn or | ||||||
6 | adopted children, under Sections 356c, 356h, and 367b of | ||||||
7 | the Illinois Insurance Code; | ||||||
8 | (5) timely payment of claims under Section 368a of the | ||||||
9 | Illinois Insurance Code; | ||||||
10 | (6) a consumer's right to an adequate and accessible | ||||||
11 | network under Section 370i of the Illinois Insurance Code. | ||||||
12 | These rights shall not be waived under a Consumer Choice of | ||||||
13 | Benefits Health Insurance Plan product; | ||||||
14 | (7) coverage for mental health services and mental | ||||||
15 | illness rehabilitation services under Sections 367c and | ||||||
16 | 367d of the Illinois Insurance Code. | ||||||
17 | (c) For purposes of this Act, "state-mandated health | ||||||
18 | benefits" does not include benefits that are mandated by | ||||||
19 | federal law or standard provisions or rights required under | ||||||
20 | this Act or other laws of this state to be provided in an | ||||||
21 | individual major medical or, blanket, policy for accident and | ||||||
22 | health insurance that are unrelated to specific health | ||||||
23 | illnesses, injuries, or conditions of an insured, including | ||||||
24 | provisions related to: | ||||||
25 | (1) preexisting conditions under Part 2005 of Chapter 1 | ||||||
26 | of Title 50 of the Illinois Administrative Code; | ||||||
27 | (2) coverage for children, including newborn or | ||||||
28 | adopted children, under Sections 356b, 356c, 356h of the | ||||||
29 | Illinois Insurance Code; | ||||||
30 | (3) timely payment of claims under Section 368a of the | ||||||
31 | Illinois Insurance Code; | ||||||
32 | (4) a consumer's right to an adequate and accessible | ||||||
33 | network under Section 370i of the Illinois Insurance Code. | ||||||
34 | These rights shall not be waived under a Consumer Choice of |
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1 | Benefits Health Insurance Plan product.
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2 | Section 20. Consumer choice of benefits health insurance | ||||||
3 | plans authorized; minimum requirement. An insurer may offer one | ||||||
4 | or more Consumer Choice of Benefits Health Insurance plans. | ||||||
5 | Section 25. Notice to policyholder and enrollees. | ||||||
6 | (a) Each written application for enrollment, including any | ||||||
7 | application for enrollment under a group policy, in a Consumer | ||||||
8 | Choice of Benefits Health Insurance Plan must contain the | ||||||
9 | following language at the beginning of the application in bold | ||||||
10 | type: | ||||||
11 | "You have the option to choose this Consumer Choice of | ||||||
12 | Benefits Health Insurance Plan that, either in whole or in | ||||||
13 | part, does not provide state-mandated health insurance | ||||||
14 | benefits normally required in accident and sickness | ||||||
15 | insurance policies in Illinois. This Consumer Choice of | ||||||
16 | Benefits Health Insurance Plan may provide a more | ||||||
17 | affordable health insurance policy for you although, at the | ||||||
18 | same time, it may provide you with fewer health insurance | ||||||
19 | benefits than those normally included as state-mandated | ||||||
20 | health insurance benefits in policies in Illinois. If you | ||||||
21 | choose this Consumer Choice of Benefits Health Insurance | ||||||
22 | Plan, please consult the insurance company or your | ||||||
23 | employer's benefits department to determine which | ||||||
24 | state-mandated health benefits are not included in this | ||||||
25 | policy."
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26 | (b) Each Consumer Choice of Benefits Health Insurance Plan | ||||||
27 | must contain the following language at or near the beginning of | ||||||
28 | the policy in bold type: | ||||||
29 | "This Consumer Choice of Benefits Health Insurance Plan, | ||||||
30 | either in whole or in part, does not provide state-mandated | ||||||
31 | health benefits normally required in accident and health | ||||||
32 | insurance policies in Illinois. This Consumer Choice of |
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1 | Benefits Health Insurance Plan may provide a more | ||||||
2 | affordable health insurance policy for you although, at the | ||||||
3 | same time, it may provide you with fewer health benefits | ||||||
4 | than those normally included as state-mandated health | ||||||
5 | benefits in policies in Illinois. Please consult with your | ||||||
6 | the insurance company or your employer's benefits | ||||||
7 | department to discover which state-mandated health | ||||||
8 | benefits are not included in this policy."
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9 | Section 30. Disclosure statement. | ||||||
10 | (a) When a Consumer Choice of Benefits Health Insurance | ||||||
11 | Plan policy is issued, an insurer providing a Consumer Choice | ||||||
12 | of Benefits Health Insurance Plan must provide an applicant or | ||||||
13 | subscriber with a written disclosure statement that: | ||||||
14 | (1) acknowledges that the Consumer Choice of Benefits | ||||||
15 | Health Insurance Plan being purchased does not provide some | ||||||
16 | or all state-mandated health benefits; | ||||||
17 | (2) lists those state-mandated health benefits not | ||||||
18 | included under the Consumer Choice of Benefits Health | ||||||
19 | Insurance Plan; and | ||||||
20 | (3) provides a notice, if the Consumer Choice of | ||||||
21 | Benefits Health Insurance Plan is issued to an individual | ||||||
22 | policyholder, that purchasing a plan may limit the | ||||||
23 | policyholder's future coverage options in the event the | ||||||
24 | policyholder's health changes and needed benefits are not | ||||||
25 | available under the Consumer Choice of Benefits Health | ||||||
26 | Insurance Plan. | ||||||
27 | (4) includes a section that allows for a signature by | ||||||
28 | the applicant or subscriber attesting to the fact that the | ||||||
29 | applicant has read and understood the disclosure statement | ||||||
30 | and attesting to the fact that the applicant or subscriber | ||||||
31 | has in fact been given a choice between the Consumer Choice | ||||||
32 | of Benefits Health Insurance Plan that they have chosen and | ||||||
33 | a health insurance plan that includes all state-mandated |
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1 | health benefits. | ||||||
2 | (b) Each applicant and subscriber for initial coverage must | ||||||
3 | sign the disclosure statement provided by the insurer under | ||||||
4 | subsection (a) of this Section and return the statement to the | ||||||
5 | insurer. Under a group policy or contract, the term "applicant" | ||||||
6 | means the employer and term "subscriber" means employee. Under | ||||||
7 | an individual policy or contract "applicant" means the | ||||||
8 | individual purchasing the policy. | ||||||
9 | (c) An insurer must: | ||||||
10 | (1) retain the signed disclosure statement in the | ||||||
11 | insurer's records; and | ||||||
12 | (2) provide the signed disclosure statement to the | ||||||
13 | Department upon request from the Director.
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14 | Section 35. Rules. The Director shall adopt rules as | ||||||
15 | necessary to implement this Act.
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16 | Section 40. Additional policies.
An insurer that offers | ||||||
17 | one or more Consumer Choice of Benefits Health Insurance Plans | ||||||
18 | under this Act to an employer group must also offer to all | ||||||
19 | eligible employees in the group at least one accident and | ||||||
20 | health insurance policy that has been filed and approved with | ||||||
21 | the Department and includes coverage for all state-mandated | ||||||
22 | health benefits. An employer that offers a Consumer Choice of | ||||||
23 | Benefits Health Insurance Plan to its eligible employees must | ||||||
24 | offer at least one accident and health insurance policy that | ||||||
25 | includes coverage for all state-mandated health benefits that | ||||||
26 | has been filed and approved by the Department. | ||||||
27 | Section 45. Rates; rating and underwriting records. | ||||||
28 | (a) An insurer offering a Consumer Choice of Benefits | ||||||
29 | Health Insurance Plan under this Act shall maintain at its | ||||||
30 | principal place of business a complete and detailed description | ||||||
31 | of its rating practices and renewal underwriting practices, |
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1 | including information and documentation that demonstrates that | ||||||
2 | its rating methods and practices are based upon commonly | ||||||
3 | accepted actuarial assumptions and are in accordance with sound | ||||||
4 | actuarial principles and that the rates for the Consumer Choice | ||||||
5 | of Benefits Health Insurance Plan reflect the difference in its | ||||||
6 | benefit package from a non-Consumer Choice of Benefits Health | ||||||
7 | Insurance Plan. | ||||||
8 | (b) Upon request, an insurer shall provide to the | ||||||
9 | Department an actuarial certification certifying that the | ||||||
10 | insurer is in compliance with this Act, and that the rating | ||||||
11 | methods of the insurer are actuarially sound. Such | ||||||
12 | certification shall be in a form and manner, and shall contain | ||||||
13 | such information, as specified by the Director. A copy of the | ||||||
14 | certification shall be retained by the insurer at its principal | ||||||
15 | place of business for a period of 3 years from the date of | ||||||
16 | certification. This shall include any work papers prepared in | ||||||
17 | support of the actuarial certification. | ||||||
18 | (c) Nothing in this Section shall be construed as granting | ||||||
19 | the Director any power or authority to determine, fix, | ||||||
20 | prescribe, or promulgate the rates to be charged for any | ||||||
21 | individual or group accident and health insurance policy or | ||||||
22 | policies issued under this Act.
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23 | Section 50. Applicability of Illinois Insurance Code | ||||||
24 | provisions. All policies of accident and health insurance | ||||||
25 | issued under this Act shall be subject to the provisions of | ||||||
26 | Sections 356c, subsection (a) of Section 356g, 356n, 370, 370a, | ||||||
27 | 370e, and 370o of the Illinois Insurance Code. | ||||||
28 | (215 ILCS 5/Art. XIXB rep.) | ||||||
29 | Section 55. The Illinois Insurance Code is amended by | ||||||
30 | repealing Article XIXB.
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31 | Section 99. Effective date. This Act takes effect upon |
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1 | becoming law.".
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