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1 | AN ACT concerning regulation.
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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 1. Short title. This Act may be cited as the Health | ||||||||||||||||||||||||||||
5 | Insurance Choice Act. | ||||||||||||||||||||||||||||
6 | Section 5. Purpose. The General Assembly recognizes the | ||||||||||||||||||||||||||||
7 | need for individuals and small employers in this State to have | ||||||||||||||||||||||||||||
8 | access to health insurance policies that are more affordable | ||||||||||||||||||||||||||||
9 | and flexible than those currently available in the small group | ||||||||||||||||||||||||||||
10 | market. The General Assembly, therefore, seeks to increase the | ||||||||||||||||||||||||||||
11 | availability of health insurance coverage by requiring small | ||||||||||||||||||||||||||||
12 | employer carriers in this State to issue policies that are more | ||||||||||||||||||||||||||||
13 | affordable for employees of eligible employers. To accomplish | ||||||||||||||||||||||||||||
14 | its objective, the General Assembly also requires eligible | ||||||||||||||||||||||||||||
15 | employers to facilitate the offering of these policies to their | ||||||||||||||||||||||||||||
16 | employees. | ||||||||||||||||||||||||||||
17 | Section 10. Definitions. For purposes of this Act: | ||||||||||||||||||||||||||||
18 | "Department" means the Department of Financial and | ||||||||||||||||||||||||||||
19 | Professional Regulation. | ||||||||||||||||||||||||||||
20 | "Eligible employer" means a small employer (1) that has not | ||||||||||||||||||||||||||||
21 | offered group health plans to its employees for at least 12 | ||||||||||||||||||||||||||||
22 | months before the employee applies for such coverage under a |
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1 | health insurance choice policy; and (2) whose average annual | ||||||
2 | compensation paid to employees is less than 250% of the Federal | ||||||
3 | poverty level. | ||||||
4 | "Employee" means an employee who is scheduled to work not | ||||||
5 | less than 20 hours per week on a regular basis. | ||||||
6 | "Enrollee" means an individual covered under a health | ||||||
7 | insurance choice policy, including both an employee and his or | ||||||
8 | her dependents. | ||||||
9 | "Facilitate" means, with respect to an eligible employer, | ||||||
10 | permitting one or more insurers to, without endorsement, | ||||||
11 | publicize their health insurance choice policy or policies and | ||||||
12 | alternative accident and health insurance policy or policies | ||||||
13 | with all mandated benefits to the eligible employer's employees | ||||||
14 | and collecting premiums through payroll deduction and | ||||||
15 | remitting such premiums to the insurer. | ||||||
16 | "Federal poverty level" means the federal poverty level | ||||||
17 | guidelines published annually by the United States Department | ||||||
18 | of Health and Human Services. | ||||||
19 | "Group health plan" has the meaning given to such term in | ||||||
20 | the Illinois Health Insurance Portability and Accountability | ||||||
21 | Act. | ||||||
22 | "Health insurance choice policy" or "policy" means a policy | ||||||
23 | of accident and health insurance that provides standard | ||||||
24 | required benefits as described in Section 20 of this Act and | ||||||
25 | satisfies the additional requirements set forth in Section 25 | ||||||
26 | of this Act. |
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1 | "Insurer" means a small employer carrier as such term is | ||||||
2 | defined in the Small Employer Health Insurer Rating Act. | ||||||
3 | "Secretary" means the Secretary of the Financial and | ||||||
4 | Professional Regulation. | ||||||
5 | "Small employer" has the meaning given that term in the | ||||||
6 | Illinois Health Insurance Portability and Accountability Act. | ||||||
7 | "State-mandated health benefits" means coverage required | ||||||
8 | under the laws of this State to be provided in a group major | ||||||
9 | medical policy for accident and health insurance or a contract | ||||||
10 | for a health-related condition that:
(1) includes coverage for | ||||||
11 | specific health care services or benefits;
(2) places | ||||||
12 | limitations or restrictions on deductibles, coinsurance, | ||||||
13 | co-payments, or any annual or lifetime maximum benefit amounts; | ||||||
14 | or
(3) includes coverage for a specific category of licensed | ||||||
15 | health practitioner from whom an insured is entitled to receive | ||||||
16 | care. | ||||||
17 | Section 15. Authorization of health insurance choice | ||||||
18 | policies. | ||||||
19 | (a) All insurers, as defined in Section 10 of this Act, | ||||||
20 | shall offer one or more health insurance choice policies to | ||||||
21 | employees of eligible employers in this State. | ||||||
22 | (b) An insurer that offers one or more health insurance | ||||||
23 | choice policies under this Act to the employees of an eligible | ||||||
24 | employer must also offer to all employees of such eligible | ||||||
25 | employer at least one accident and health insurance policy that |
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1 | has been filed with and approved by the Department and includes | ||||||
2 | coverage for all state-mandated health benefits. | ||||||
3 | (c) All eligible employers in this State shall facilitate | ||||||
4 | insurers offering coverage under one or more health insurance | ||||||
5 | choice policies for employees of such eligible employers and | ||||||
6 | their dependents. Each employee may elect whether he or she | ||||||
7 | wants to apply for coverage. | ||||||
8 | (d) All eligible employers in the State shall also offer to | ||||||
9 | their employees at least one insured group health plan under a | ||||||
10 | policy that has been filed with and approved by the Department | ||||||
11 | and includes coverage for all state-mandated health benefits. | ||||||
12 | (e) An eligible employer whose employees elect coverage | ||||||
13 | under a health insurance choice policy or group health plan | ||||||
14 | under subsections (c) or (d) of this Section for themselves or | ||||||
15 | their dependents is not required to make contributions to the | ||||||
16 | cost of any policy or group health plan on behalf of its | ||||||
17 | employees or their dependents. | ||||||
18 | (f) An insurer is not required to issue or renew coverage | ||||||
19 | to the employees of an eligible employer under a health | ||||||
20 | insurance choice policy or group health plan unless (i) 75% of | ||||||
21 | the eligible employer's employees, excluding employees covered | ||||||
22 | by a group health plan of another employer, elect coverage | ||||||
23 | under a health insurance choice policy or a group health plan | ||||||
24 | of the small employer offered by the insurer and (ii) 50% of | ||||||
25 | the eligible employer's total employees elect coverage under a | ||||||
26 | health insurance choice policy or group health plan of the |
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1 | eligible employer offered by the insurer. | ||||||
2 | (g) This Act must not be interpreted to restrict the | ||||||
3 | ability of any insurer or small employer to offer any health | ||||||
4 | insurance coverage permitted by law.
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5 | Section 20. Standard required benefits. A health insurance | ||||||
6 | choice policy must include a maximum aggregate benefit of not | ||||||
7 | less than $50,000 per year for each enrollee and the policy | ||||||
8 | must contain the following standard required benefits: | ||||||
9 | (1) physician services, including, primary care, | ||||||
10 | consultation, referral, surgical, anesthesia, or other, as | ||||||
11 | needed by the enrollee in any level of service delivery. | ||||||
12 | Such services need not include organ transplants unless | ||||||
13 | specifically authorized by a physician; | ||||||
14 | (2) outpatient diagnostic, imaging, and pathology | ||||||
15 | services and radiation therapy; | ||||||
16 | (3) 120 days of non-mental-health inpatient services | ||||||
17 | per year, including all professional services, | ||||||
18 | medications, surgically implanted devices, and supplies | ||||||
19 | used by the enrollee while an inpatient; | ||||||
20 | (4) 45 days of inpatient serious mental illness | ||||||
21 | treatment services per year and 60 office visits per year | ||||||
22 | for outpatient serious mental illness treatment services, | ||||||
23 | with the copayment to apply to the cost of treatment if the | ||||||
24 | treatment occurs during the office visit; | ||||||
25 | (5) 30 days of other inpatient mental health and |
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1 | chemical dependency treatment services per year and 30 days | ||||||
2 | of other outpatient mental health and chemical dependency | ||||||
3 | treatment services per year, with a lifetime maximum of 100 | ||||||
4 | visits; | ||||||
5 | (6) emergency services for accidental injury or | ||||||
6 | emergency illness 24 hours per day and 7 days per week. | ||||||
7 | Such emergency treatment shall include outpatient visits | ||||||
8 | and referrals for emergency mental health problems; | ||||||
9 | (7) maternity care, including prenatal and post-natal | ||||||
10 | care, care for complications of pregnancy of the mother, | ||||||
11 | and care with respect to a newborn child from the moment of | ||||||
12 | birth, which shall include the necessary care and treatment | ||||||
13 | of an illness, an injury, congenital defects, birth | ||||||
14 | abnormalities, and a premature birth; | ||||||
15 | (8) blood transfusion services, processing, and the | ||||||
16 | administration of whole blood and blood components and | ||||||
17 | derivatives; | ||||||
18 | (9) preventive health services as appropriate for the | ||||||
19 | patient population, including a health evaluation program | ||||||
20 | and immunizations to prevent or arrest the further | ||||||
21 | manifestation of human illness or injury, including, but | ||||||
22 | not limited to, allergy infections and allergy serum. Such | ||||||
23 | health evaluation program shall include at least periodic | ||||||
24 | physical examinations and medical history, hearing and | ||||||
25 | vision testing or screening, routine laboratory testing or | ||||||
26 | screening, blood pressure testing, uterine |
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1 | cervical-cytological testing, and low-dose mammography | ||||||
2 | testing as required by Section 356g of the Illinois | ||||||
3 | Insurance Code; and | ||||||
4 | (10) outpatient rehabilitative therapy (including, but | ||||||
5 | not limited to, speech therapy, physical therapy, and | ||||||
6 | occupational therapy directed at improving physical | ||||||
7 | functioning of the member), up to 60 treatments per year | ||||||
8 | for conditions that are expected to result in significant | ||||||
9 | improvement within 2 months, as determined by the primary | ||||||
10 | care physician. | ||||||
11 | The benefits under a health insurance choice policy may | ||||||
12 | contain reasonable deductibles and co-payments subject to such | ||||||
13 | limitations as the Department may prescribe pursuant to rule. | ||||||
14 | Section 25. Health insurance choice policy requirements. | ||||||
15 | (a) Any insurer, as defined in Section 10 of this Act, | ||||||
16 | shall have the power to issue health insurance choice policies. | ||||||
17 | No such policy may be issued or delivered in this State unless | ||||||
18 | a copy of the form thereof has been filed with the Department | ||||||
19 | and approved by it in accordance with Section 355 of the | ||||||
20 | Illinois Insurance Code, unless it contains in substance those | ||||||
21 | provisions contained in Sections 357.1 through 357.30 of the | ||||||
22 | Illinois Insurance Code as may be applicable to this Act and | ||||||
23 | the provisions set forth in this Section. | ||||||
24 | (b) The policy must provide that the policy and the | ||||||
25 | individual applications of the employees of the eligible |
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1 | employer shall constitute the entire contract between the | ||||||
2 | parties, that all statements made by the employer or by the | ||||||
3 | individual employees shall (in the absence of fraud) be deemed | ||||||
4 | representations and not warranties, and that none of those | ||||||
5 | statements may be used in defense to a claim under the policy | ||||||
6 | unless it is contained in a written application. | ||||||
7 | (c) The policy must provide that the insurer will issue to | ||||||
8 | the eligible employer, for delivery to the employee who is | ||||||
9 | insured under the policy, an individual certificate setting | ||||||
10 | forth a statement as to the insurance protection to which the | ||||||
11 | employee is entitled and to whom payable. | ||||||
12 | (d) The policy must provide that all new employees of the | ||||||
13 | eligible employer shall be eligible to apply for coverage under | ||||||
14 | any health insurance choice policies facilitated by such | ||||||
15 | employer or the group health plan of the employer. | ||||||
16 | (e) Any health insurance choice policy may provide that all | ||||||
17 | or any portion of any indemnities provided by the policy on | ||||||
18 | account of hospital, nursing, medical, or surgical services | ||||||
19 | may, at the insurer's option, be paid directly to the health | ||||||
20 | care professional, health care provider, or the insured; but | ||||||
21 | the policy may not require that the service be rendered by a | ||||||
22 | particular hospital or person. Payment so made shall discharge | ||||||
23 | the insurer's obligation with respect to the amount of | ||||||
24 | insurance so paid. Nothing in this subsection (e) shall | ||||||
25 | prohibit an insurer from providing incentives for insureds to | ||||||
26 | utilize the services of a particular hospital or person. |
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1 | (f) Whenever the Department of Public Health finds that it | ||||||
2 | has paid all or part of any hospital or medical expenses that | ||||||
3 | an insurer is obligated to pay under a policy issued under this | ||||||
4 | Act, the Department of Public Health shall be entitled to | ||||||
5 | receive reimbursement for its payments from the insurer, | ||||||
6 | provided that the Department of Public Health has notified the | ||||||
7 | insurer of its claim before the carrier has paid the benefits | ||||||
8 | to its insureds or the insureds' assignees. | ||||||
9 | (g) No group hospital, medical, or surgical expense policy | ||||||
10 | under this Act may contain any provision whereby benefits | ||||||
11 | otherwise payable thereunder are subject to reduction solely on | ||||||
12 | account of the existence of similar benefits provided under | ||||||
13 | other group or group-type accident and sickness insurance | ||||||
14 | policies if the reduction would operate to reduce total | ||||||
15 | benefits payable under the policies below an amount equal to | ||||||
16 | 100% of total allowable expenses provided under the policies. | ||||||
17 | (h) If dependents of insureds are covered under 2 policies, | ||||||
18 | both of which contain coordination of benefit provisions, | ||||||
19 | benefits of the policy of the insured whose birthday falls | ||||||
20 | earlier in the year are determined before those of the policy | ||||||
21 | of the insured whose birthday falls later in the year. | ||||||
22 | "Birthday", as used in this subsection (h), refers only to the | ||||||
23 | month and day in a calendar year, not the year in which the | ||||||
24 | person was born. The Department shall promulgate rules defining | ||||||
25 | the order of benefit determination under this subsection (h). | ||||||
26 | (i) Discrimination between individuals of the same class of |
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1 | risk in the issuance of policies, in the amount of premiums or | ||||||
2 | rates charged for any insurance covered by this Act, in | ||||||
3 | benefits payable thereon, in any of the terms or conditions of | ||||||
4 | the policy, or in any other manner whatsoever is prohibited. | ||||||
5 | Nothing in this subsection (i) prohibits an insurer from | ||||||
6 | providing incentives for insureds to utilize the services of a | ||||||
7 | particular hospital or person. | ||||||
8 | (j) No insurer may make or permit any distinction or | ||||||
9 | discrimination against individuals solely because of handicaps | ||||||
10 | or disabilities in (i) the amount of payment of premiums or | ||||||
11 | rates charged for policies of insurance, (ii) the amount of any | ||||||
12 | dividends or other benefits payable thereon, or (iii) any other | ||||||
13 | terms and conditions of the contract it makes, except if the | ||||||
14 | distinction or discrimination is based on sound actuarial | ||||||
15 | principles or is related to actual or reasonably anticipated | ||||||
16 | experience.
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17 | (k) No insurer may refuse to insure or refuse to continue | ||||||
18 | to insure, limit the amount, extent, or kind of coverage | ||||||
19 | available to an individual, or charge an individual a different | ||||||
20 | rate for the same coverage solely because of blindness or | ||||||
21 | partial blindness. With respect to all other conditions, | ||||||
22 | including the underlying cause of the blindness or partial | ||||||
23 | blindness, persons who are blind or partially blind shall be | ||||||
24 | subject to the same standards of sound actuarial principles or | ||||||
25 | actual or reasonably anticipated experience as are sighted | ||||||
26 | persons. Refusal to insure includes denial by an insurer of |
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1 | disability insurance coverage on the grounds that the policy | ||||||
2 | defines "disability" as being presumed in the event that the | ||||||
3 | insured loses his or her eyesight. However, an insurer may | ||||||
4 | exclude from coverage disability consisting solely of | ||||||
5 | blindness or partial blindness when the condition existed at | ||||||
6 | the time the policy was issued.
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7 | Section 30. Applicability of other Insurance Code | ||||||
8 | provisions. All health insurance choice policies issued under | ||||||
9 | this Act shall be subject to the provisions of Sections 356c, | ||||||
10 | 356d, 356g, 356h, 356n, 367.2, 367.2-5, 367c, 367d, 367e, | ||||||
11 | 367e.1, 367i, 368a, 370, 370a, and 370e of the Illinois | ||||||
12 | Insurance Code even though such policies do not constitute | ||||||
13 | group health plans. | ||||||
14 | Section 35. Means testing; authorized. For purposes of this | ||||||
15 | Act, an employer shall perform means testing to determine | ||||||
16 | eligibility requirements for the health insurance choice | ||||||
17 | policy and shall provide a certification to the insurer | ||||||
18 | respecting the results of the means testing. A health insurance | ||||||
19 | choice policy based on those eligibility requirements shall not | ||||||
20 | be in violation of Section 364 of the Illinois Insurance Code | ||||||
21 | or subsection (i) or (j) of Section 25 of this Act. | ||||||
22 | Section 40. Guaranteed renewability and availability. | ||||||
23 | (a) Subject to subsection (f) of Section 15 of this Act and |
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1 | subsections (b) and (c) of this Section, an insurer (i) must | ||||||
2 | accept the application of every employee of an eligible | ||||||
3 | employer that applies for coverage under subsections (c) or (d) | ||||||
4 | of Section 15 of this Act and (ii) must renew or continue in | ||||||
5 | force such coverage at the option of the covered employee as | ||||||
6 | long as the employee continues as an employee of the eligible | ||||||
7 | employer. | ||||||
8 | (b) An insurer is not obligated to renew or continue in | ||||||
9 | force coverage under subsection (a) of this Section (i) if the | ||||||
10 | coverage requirements of subsection (f) of Section 15 of this | ||||||
11 | Act are not satisfied, (ii) if the insurer would not be | ||||||
12 | obligated to renew or continue in force such coverage had | ||||||
13 | subdivision (2), (4), or (5) of subsection (B) Section 30 of | ||||||
14 | the Illinois Health Insurance Portability and Accountability | ||||||
15 | Act applied to such policies, or (iii) with respect to an | ||||||
16 | employee who has failed to pay premiums in accordance with the | ||||||
17 | applicable policy or the insurer has not received timely | ||||||
18 | premium payments from the employee. | ||||||
19 | (c) An insurer may modify the coverage offered under this | ||||||
20 | Act only at the time of coverage renewal and only if the | ||||||
21 | modification is consistent with State law and effective on a | ||||||
22 | uniform basis with respect to all employees of eligible | ||||||
23 | employers. | ||||||
24 | (d) Subsection (a) of Section 15 of this Act and this | ||||||
25 | Section shall apply with respect to an insurer as long as the | ||||||
26 | insurer offers any health benefit plan to small employers in |
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1 | this State that is subject to the Small Employer Health | ||||||
2 | Insurance Rating Act. | ||||||
3 | Section 45. Notice to policyholders and enrollees. | ||||||
4 | (a) Each written application for enrollment under a health | ||||||
5 | insurance choice policy must contain the following language at | ||||||
6 | the beginning of the application in bold type:
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7 | "You have the option to choose this health insurance | ||||||
8 | choice policy that, either in whole or in part, does not | ||||||
9 | provide state-mandated health insurance benefits normally | ||||||
10 | required in accident and health insurance policies in | ||||||
11 | Illinois. This health insurance choice policy may provide a | ||||||
12 | more affordable health insurance policy for you, although, | ||||||
13 | at the same time, it may provide you with fewer health | ||||||
14 | insurance benefits than those normally included as | ||||||
15 | state-mandated health insurance benefits in policies in | ||||||
16 | Illinois." | ||||||
17 | (b) Each health insurance choice policy must contain the | ||||||
18 | following language at or near the beginning of the policy in | ||||||
19 | bold type:
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20 | "This health insurance choice policy, either in whole | ||||||
21 | or in part, does not provide state-mandated health benefits | ||||||
22 | normally required in accident and health insurance | ||||||
23 | policies in Illinois. This health insurance choice policy | ||||||
24 | may provide a more affordable health insurance policy for | ||||||
25 | you, although, at the same time, it may provide you with |
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1 | fewer health insurance benefits than those normally | ||||||
2 | included as state-mandated health insurance benefits in | ||||||
3 | policies in Illinois." | ||||||
4 | Section 50. Disclosure statement. | ||||||
5 | (a) When a health insurance choice policy is issued, the | ||||||
6 | insurer providing such policy must provide an applicant with a | ||||||
7 | written disclosure statement that does the following: | ||||||
8 | (1) acknowledges that the health insurance choice | ||||||
9 | policy being purchased does not provide some or all | ||||||
10 | state-mandated health benefits; | ||||||
11 | (2) lists those state-mandated health benefits not | ||||||
12 | included under the health insurance choice policy; and | ||||||
13 | (3) includes a section that allows for a signature by | ||||||
14 | the applicant attesting to the fact that the applicant has | ||||||
15 | read and understands the disclosure statement and | ||||||
16 | attesting to the fact that the applicant has in fact been | ||||||
17 | given a choice between the health insurance choice policy | ||||||
18 | that he or she has chosen and a health insurance policy | ||||||
19 | that includes all state-mandated health benefits. | ||||||
20 | (b) Each applicant for initial coverage must sign the | ||||||
21 | disclosure statement provided by the insurer under subsection | ||||||
22 | (a) of this Section and return the statement to the insurer. | ||||||
23 | (c) An insurer must: | ||||||
24 | (1) retain the signed disclosure statement in the | ||||||
25 | insurer's records; and |
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1 | (2) provide the signed disclosure statement to the | ||||||
2 | Department upon request from the Secretary. | ||||||
3 | Section 55. Rates. | ||||||
4 | (a) Except as expressly provided in paragraphs (b) and (c) | ||||||
5 | of this Section, the Small Employer Health Insurance Rating Act | ||||||
6 | shall apply to each health insurance choice policy that is | ||||||
7 | delivered, issued for delivery, renewed, or continued in this | ||||||
8 | State. | ||||||
9 | (b) An insurer may establish one or more separate classes | ||||||
10 | of business for purposes of the Small Employer Health Insurance | ||||||
11 | Rating Act for health insurance choice policies delivered, | ||||||
12 | issued for delivery, renewed, or continued in this State, and | ||||||
13 | any such separate classes of business so established and | ||||||
14 | including only health insurance choice policies shall not | ||||||
15 | reduce the number of classes of business that an insurer may | ||||||
16 | otherwise establish under the Small Employer Health Insurance | ||||||
17 | Rating Act. | ||||||
18 | (c) Premium rates for health insurance choice policies | ||||||
19 | included in a separate class of business shall not be subject | ||||||
20 | to subdivision (1) of subsection (a) of Section 25 of the Small | ||||||
21 | Employer Health Insurance Rating Act. | ||||||
22 | Section 60. Rules. The Secretary shall adopt rules as | ||||||
23 | necessary to implement this Act.
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1 | Section 900. The Illinois Income Tax Act is amended by | ||||||
2 | adding Section 218 as follows: | ||||||
3 | (35 ILCS 5/218 new) | ||||||
4 | Sec. 218. Health insurance choice contribution credit. | ||||||
5 | (a) For those taxable years ending on or after December 31, | ||||||
6 | 2007 and ending on or before December 30, 2012, each taxpayer | ||||||
7 | that is an eligible employer under the Health Insurance Choice | ||||||
8 | Act is entitled to a credit against the tax imposed by | ||||||
9 | subsections (a) and (b) of Section 201 in an amount equal to | ||||||
10 | 33% of the amount of any contribution made by the taxpayer | ||||||
11 | during the taxable year towards the premium of a health | ||||||
12 | insurance choice policy under the Health Insurance Choice Act. | ||||||
13 | (b) For partners, shareholders of Subchapter S | ||||||
14 | corporations, and owners of limited liability companies, if the | ||||||
15 | liability company is treated as a partnership for purposes of | ||||||
16 | federal and State income taxation, there shall be allowed a | ||||||
17 | credit under this Section to be determined in accordance with | ||||||
18 | the determination of income and distributive share of income | ||||||
19 | under Sections 702 and 704 and Subchapter S of the Internal | ||||||
20 | Revenue Code. | ||||||
21 | (c) The credit under this Section may not be carried | ||||||
22 | forward or back and may not reduce the taxpayer's liability to | ||||||
23 | less than zero.
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24 | Section 905. The Illinois Insurance Code is amended by |
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| |||||||
1 | changing Section 352 as follows:
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2 | (215 ILCS 5/352) (from Ch. 73, par. 964)
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3 | Sec. 352. Scope of Article.
| ||||||
4 | (a) Except as provided in subsections (b), (c), (d), and | ||||||
5 | (e),
this Article shall
apply to all companies transacting in | ||||||
6 | this State the kinds of business
enumerated in clause (b) of | ||||||
7 | Class 1 and clause (a) of Class 2 of section 4.
Nothing in this | ||||||
8 | Article shall apply to, or in any way affect policies or
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9 | contracts described in clause (a) of Class 1 of Section 4; | ||||||
10 | however, this
Article shall apply to policies and contracts | ||||||
11 | which contain benefits
providing reimbursement for the | ||||||
12 | expenses of long term health care which are
certified or | ||||||
13 | ordered by a physician including but not limited to
| ||||||
14 | professional nursing care, custodial nursing care, and | ||||||
15 | non-nursing
custodial care provided in a nursing home or at a | ||||||
16 | residence of the insured.
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17 | (b) This Article does not apply to policies of accident and | ||||||
18 | health
insurance issued in compliance with Article XIXB of this | ||||||
19 | Code or the Health Insurance Choice Act .
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20 | (c) A policy issued and delivered in this State
that | ||||||
21 | provides coverage under that policy for
certificate holders who | ||||||
22 | are neither residents of nor employed in this State
does not | ||||||
23 | need to provide to those nonresident
certificate holders who | ||||||
24 | are not employed in this State the coverages or
services | ||||||
25 | mandated by this Article.
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1 | (d) Stop-loss insurance is exempt from all Sections
of this | ||||||
2 | Article, except this Section and Sections 353a, 354, 357.30, | ||||||
3 | and
370. For purposes of this exemption, stop-loss insurance is | ||||||
4 | further defined as
follows:
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5 | (1) The policy must be issued to and insure an | ||||||
6 | employer, trustee, or other
sponsor of the plan, or the | ||||||
7 | plan itself, but not employees, members, or
participants.
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8 | (2) Payments by the insurer must be made to the | ||||||
9 | employer, trustee, or
other sponsors of the plan, or the | ||||||
10 | plan itself, but not to the employees,
members, | ||||||
11 | participants, or health care providers.
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12 | (e) A policy issued or delivered in this State to the | ||||||
13 | Department of Healthcare and Family Services (formerly
| ||||||
14 | Illinois Department
of Public Aid ) and providing coverage, | ||||||
15 | under clause (b) of Class 1 or clause (a)
of Class 2 as | ||||||
16 | described in Section 4, to persons who are enrolled under | ||||||
17 | Article V of the Illinois
Public Aid Code or under the | ||||||
18 | Children's Health Insurance Program Act is
exempt from all | ||||||
19 | restrictions, limitations,
standards, rules, or regulations | ||||||
20 | respecting benefits imposed by or under
authority of this Code, | ||||||
21 | except those specified by subsection (1) of Section
143. | ||||||
22 | Nothing in this subsection, however, affects the total medical | ||||||
23 | services
available to persons eligible for medical assistance | ||||||
24 | under the Illinois Public
Aid Code.
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25 | (Source: P.A. 92-370, eff. 8-15-01; revised 12-15-05.)
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26 | Section 999. Effective date. This Act takes effect upon |
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| |||||||
1 | becoming law.
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