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1 | AN ACT concerning insurance.
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2 | Be it enacted by the People of the State of Illinois,
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3 | represented in the General Assembly:
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4 | Section 5. The Comprehensive Health Insurance Plan Act is | ||||||
5 | amended by changing Section 7 as follows:
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6 | (215 ILCS 105/7) (from Ch. 73, par. 1307)
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7 | Sec. 7. Eligibility.
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8 | a. Except as provided in subsection (e) of this Section or | ||||||
9 | in Section
15 of this Act, any person who is either a citizen | ||||||
10 | of the United States or an
alien lawfully admitted for | ||||||
11 | permanent residence and who has been for a period
of at least | ||||||
12 | 180 days and continues to be a resident of this State shall be
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13 | eligible for Plan coverage under this Section if evidence is | ||||||
14 | provided of:
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15 | (1) A notice of rejection or refusal to issue | ||||||
16 | substantially
similar individual health insurance coverage | ||||||
17 | for health reasons by a
health insurance issuer; or
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18 | (2) A refusal by a health insurance issuer to issue | ||||||
19 | individual
health insurance coverage except at a rate | ||||||
20 | exceeding the
applicable Plan rate for which the person is | ||||||
21 | responsible.
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22 | A rejection or refusal by a group health plan or health | ||||||
23 | insurance issuer
offering only
stop-loss or excess of loss | ||||||
24 | insurance or contracts,
agreements, or other arrangements for | ||||||
25 | reinsurance coverage with respect
to the applicant shall not be | ||||||
26 | sufficient evidence under this subsection.
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27 | b. The board shall promulgate a list of medical or health | ||||||
28 | conditions for
which a person who is either a citizen of the | ||||||
29 | United States or an
alien lawfully admitted for permanent | ||||||
30 | residence and a resident of this State
would be eligible for | ||||||
31 | Plan coverage without applying for
health insurance coverage | ||||||
32 | pursuant to subsection a. of this Section.
Persons who
can |
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1 | demonstrate the existence or history of any medical or health
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2 | conditions on the list promulgated by the board shall not be | ||||||
3 | required to
provide the evidence specified in subsection a. of | ||||||
4 | this Section. The list
shall be effective
on the first day of | ||||||
5 | the operation of the Plan and may be amended from time
to time | ||||||
6 | as appropriate.
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7 | c. Family members of the same household who each are | ||||||
8 | covered
persons are
eligible for optional family coverage under | ||||||
9 | the Plan.
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10 | d. For persons qualifying for coverage in accordance with | ||||||
11 | Section 7 of
this Act, the board shall, if it determines that | ||||||
12 | such appropriations as are
made pursuant to Section 12 of this | ||||||
13 | Act are insufficient to allow the board
to accept all of the | ||||||
14 | eligible persons which it projects will apply for
enrollment | ||||||
15 | under the Plan, limit or close enrollment to ensure that the
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16 | Plan is not over-subscribed and that it has sufficient | ||||||
17 | resources to meet
its obligations to existing enrollees. The | ||||||
18 | board shall not limit or close
enrollment for federally | ||||||
19 | eligible individuals.
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20 | e. A person shall not be eligible for coverage under the | ||||||
21 | Plan if:
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22 | (1) He or she has or obtains other coverage under a | ||||||
23 | group health plan
or health insurance coverage
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24 | substantially similar to or better than a Plan policy as an | ||||||
25 | insured or
covered dependent or would be eligible to have | ||||||
26 | that coverage if he or she
elected to obtain it. Persons | ||||||
27 | otherwise eligible for Plan coverage may,
however, solely | ||||||
28 | for the purpose of having coverage for a pre-existing
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29 | condition, maintain other coverage only while satisfying | ||||||
30 | any pre-existing
condition waiting period under a Plan | ||||||
31 | policy or a subsequent replacement
policy of a Plan policy.
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32 | (1.1) His or her prior coverage under a group health | ||||||
33 | plan or health
insurance coverage, provided or arranged by | ||||||
34 | an employer of more than 10 employees was discontinued
for | ||||||
35 | any reason without the entire group or plan being | ||||||
36 | discontinued and not
replaced, provided he or she remains |
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1 | an employee, or dependent thereof, of the
same employer.
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2 | (2) He or she is a recipient of or is approved to | ||||||
3 | receive medical
assistance, except that a person may | ||||||
4 | continue to receive medical
assistance through the medical | ||||||
5 | assistance no grant program, but only
while satisfying the | ||||||
6 | requirements for a preexisting condition under
Section 8, | ||||||
7 | subsection f. of this Act. Payment of premiums pursuant to | ||||||
8 | this
Act shall be allocable to the person's spenddown for | ||||||
9 | purposes of the
medical assistance no grant program, but | ||||||
10 | that person shall not be
eligible for any Plan benefits | ||||||
11 | while that person remains eligible for
medical assistance. | ||||||
12 | If the person continues to receive
or be approved to | ||||||
13 | receive medical assistance through the medical
assistance | ||||||
14 | no grant program at or after the time that requirements for | ||||||
15 | a
preexisting condition are satisfied, the person shall not | ||||||
16 | be eligible for
coverage under the Plan. In that | ||||||
17 | circumstance, coverage under the plan
shall terminate as of | ||||||
18 | the expiration of the preexisting condition
limitation | ||||||
19 | period. Under all other circumstances, coverage under the | ||||||
20 | Plan
shall automatically terminate as of the effective date | ||||||
21 | of any medical
assistance.
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22 | (3) Except as provided in Section 15, the person has | ||||||
23 | previously
participated in the Plan and voluntarily
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24 | terminated Plan coverage, unless 12 months have elapsed
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25 | since the person's
latest voluntary termination of | ||||||
26 | coverage.
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27 | (4) The person fails to pay the required premium under | ||||||
28 | the covered
person's
terms of enrollment and | ||||||
29 | participation, in which event the liability of the
Plan | ||||||
30 | shall be limited to benefits incurred under the Plan for | ||||||
31 | the time
period for which premiums had been paid and the | ||||||
32 | covered person remained
eligible for Plan coverage.
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33 | (5) The Plan has paid a total of $1,000,000 in benefits
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34 | on behalf of the covered person.
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35 | (6) The person is a resident of a public institution.
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36 | (7) The person's premium is paid for or reimbursed |
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1 | under any
government sponsored program or by any government | ||||||
2 | agency or health
care provider, except as an otherwise | ||||||
3 | qualifying full-time employee, or
dependent of such | ||||||
4 | employee, of a government agency or health care provider
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5 | or, except when a person's premium is paid by the U.S. | ||||||
6 | Treasury Department
pursuant to the federal Trade Act of | ||||||
7 | 2002.
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8 | (8) The person has or later receives other benefits or | ||||||
9 | funds from
any settlement, judgement, or award resulting | ||||||
10 | from any accident or injury,
regardless of the date of the | ||||||
11 | accident or injury, or any other
circumstances creating a | ||||||
12 | legal liability for damages due that person by a
third | ||||||
13 | party, whether the settlement, judgment, or award is in the | ||||||
14 | form of a
contract, agreement, or trust on behalf of a | ||||||
15 | minor or otherwise and whether
the settlement, judgment, or | ||||||
16 | award is payable to the person, his or her
dependent, | ||||||
17 | estate, personal representative, or guardian in a lump sum | ||||||
18 | or
over time, so long as there continues to be benefits or | ||||||
19 | assets remaining
from those sources in an amount in excess | ||||||
20 | of $300,000
$100,000 .
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21 | (9) Within the 5 years prior to the date a person's | ||||||
22 | Plan application is
received by the Board, the person's | ||||||
23 | coverage under any health care benefit
program as defined | ||||||
24 | in 18 U.S.C. 24, including any public or private plan or
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25 | contract under which any
medical benefit, item, or service | ||||||
26 | is provided, was terminated as a result of
any act or | ||||||
27 | practice that constitutes fraud under State or federal law | ||||||
28 | or as a
result of an intentional misrepresentation of | ||||||
29 | material fact; or if that person
knowingly and willfully | ||||||
30 | obtained or attempted to obtain, or fraudulently aided
or | ||||||
31 | attempted to aid any other person in obtaining, any | ||||||
32 | coverage or benefits
under the Plan to which that person | ||||||
33 | was not entitled.
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34 | f. The board or the administrator shall require | ||||||
35 | verification of
residency and may require any additional | ||||||
36 | information or documentation, or
statements under oath, when |
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1 | necessary to determine residency upon initial
application and | ||||||
2 | for the entire term of the policy.
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3 | g. Coverage shall cease (i) on the date a person is no | ||||||
4 | longer a
resident of Illinois, (ii) on the date a person | ||||||
5 | requests coverage to end,
(iii) upon the death of the covered | ||||||
6 | person, (iv) on the date State law
requires cancellation of the | ||||||
7 | policy, or (v) at the Plan's option, 30 days
after the Plan | ||||||
8 | makes any inquiry concerning a person's eligibility or place
of | ||||||
9 | residence to which the person does not reply.
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10 | h. Except under the conditions set forth in subsection g of | ||||||
11 | this
Section, the coverage of any person who ceases to meet the
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12 | eligibility requirements of this Section shall be terminated at | ||||||
13 | the end of
the current policy period for which the necessary | ||||||
14 | premiums have been paid.
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15 | (Source: P.A. 93-33, eff. 6-23-03; 93-34, eff. 6-23-03.)
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