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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 1. Short title. This Act may be cited as the | ||||||||||||||||||||||||
5 | Consumer Choice of Benefits Health Insurance Plan Act.
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6 | Section 5. Purpose. The legislature recognizes the need for | ||||||||||||||||||||||||
7 | individuals in this State to have the opportunity to choose | ||||||||||||||||||||||||
8 | health insurance plans that are more affordable and flexible | ||||||||||||||||||||||||
9 | than existing market policies offering accident and health | ||||||||||||||||||||||||
10 | insurance coverage. The legislature, therefore, seeks to | ||||||||||||||||||||||||
11 | increase the availability of health insurance coverage by | ||||||||||||||||||||||||
12 | allowing insurers authorized to engage in the business of | ||||||||||||||||||||||||
13 | insurance in this State to issue accident and health policies | ||||||||||||||||||||||||
14 | that, in whole or in part, do not offer or provide | ||||||||||||||||||||||||
15 | state-mandated health benefits. | ||||||||||||||||||||||||
16 | Section 10. Definitions. For purposes of this Act: | ||||||||||||||||||||||||
17 | "Consumer Choice of Benefits Health Insurance Plan" means | ||||||||||||||||||||||||
18 | individual health insurance coverage offered to individuals in | ||||||||||||||||||||||||
19 | the individual market, as those terms are defined in Section 5 | ||||||||||||||||||||||||
20 | of the Illinois Health Insurance Portability and | ||||||||||||||||||||||||
21 | Accountability Act, that, in whole or in part, does not offer | ||||||||||||||||||||||||
22 | and provide state-mandated health benefits, but that provides |
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1 | creditable coverage as defined by Section 20 of the Illinois | ||||||
2 | Health Insurance Portability and Accountability Act. | ||||||
3 | "Department" means the Department of Financial and | ||||||
4 | Professional Regulation. | ||||||
5 | "Insurer" means an insurance company actively engaged in | ||||||
6 | issuing approved policies of accident and health insurance in | ||||||
7 | Illinois prior to the effective date of this Act.
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8 | "Secretary" means the Secretary of Financial and | ||||||
9 | Professional Regulation. | ||||||
10 | Section 15. State-mandated health benefits defined. | ||||||
11 | (a) For purposes of this Act, "state-mandated health | ||||||
12 | benefits" means coverage required under this Act or other laws | ||||||
13 | of this State to be provided in an individual major medical or | ||||||
14 | blanket policy for accident and health insurance or an | ||||||
15 | individual contract for a health-related condition that does | ||||||
16 | the following:
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17 | (1) includes coverage for specific health care | ||||||
18 | services or benefits; or | ||||||
19 | (2) includes coverage for a specific category of | ||||||
20 | licensed health care practitioner from whom an insured is | ||||||
21 | entitled to receive care. | ||||||
22 | (b) For purposes of this Act, "state-mandated health | ||||||
23 | benefits" does not include benefits that are mandated by | ||||||
24 | federal law or standard provisions or rights required under | ||||||
25 | this Act or other laws of this State to be provided in an |
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1 | individual major medical or blanket policy for accident and | ||||||
2 | health insurance that are unrelated to specific health | ||||||
3 | illnesses, injuries, or conditions of an insured, including | ||||||
4 | provisions related to the following: | ||||||
5 | (1) preexisting conditions under Part 2005 of Chapter 1 | ||||||
6 | of Title 50 of the Illinois Administrative Code; | ||||||
7 | (2) coverage for children, including newborn or | ||||||
8 | adopted children, under Sections 356b, 356c, and 356h of | ||||||
9 | the Illinois Insurance Code; | ||||||
10 | (3) timely payment of claims under Section 368a of the | ||||||
11 | Illinois Insurance Code; | ||||||
12 | (4) a consumer's right to an adequate and accessible | ||||||
13 | network under Section 370i of the Illinois Insurance Code; | ||||||
14 | and | ||||||
15 | (5) coverage requirements for individual policies | ||||||
16 | outlined in Section 2007.70 of Title 50 of the Illinois | ||||||
17 | Administrative Code. | ||||||
18 | These rights shall not be waived under a Consumer Choice of | ||||||
19 | Benefits Health Insurance Plan product.
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20 | Section 20. Consumer choice of benefits health insurance | ||||||
21 | plans authorized. An insurer may offer one or more Consumer | ||||||
22 | Choice of Benefits Health Insurance Plans. | ||||||
23 | Section 25. Notice to policyholder and enrollees. | ||||||
24 | (a) Each written application for enrollment in a Consumer |
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1 | Choice of Benefits Health Insurance Plan must contain the | ||||||
2 | following language at the beginning of the application in bold | ||||||
3 | type: | ||||||
4 | "You have the option to choose this Consumer Choice of | ||||||
5 | Benefits Health Insurance Plan that, either in whole or in | ||||||
6 | part, does not provide state-mandated health insurance | ||||||
7 | benefits normally required in accident and health | ||||||
8 | insurance policies in Illinois. This Consumer Choice of | ||||||
9 | Benefits Health Insurance Plan may provide a more | ||||||
10 | affordable health insurance policy for you, although, at | ||||||
11 | the same time, it may provide you with fewer health | ||||||
12 | insurance benefits than those normally included as | ||||||
13 | state-mandated health insurance benefits in policies in | ||||||
14 | Illinois. If you choose this Consumer Choice of Benefits | ||||||
15 | Health Insurance Plan, please consult the insurance | ||||||
16 | company to determine which state-mandated health benefits | ||||||
17 | are not included in this policy."
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18 | (b) Each Consumer Choice of Benefits Health Insurance Plan | ||||||
19 | must contain the following language at or near the beginning of | ||||||
20 | the policy in bold type: | ||||||
21 | "This Consumer Choice of Benefits Health Insurance Plan, | ||||||
22 | either in whole or in part, does not provide state-mandated | ||||||
23 | health benefits normally required in accident and health | ||||||
24 | insurance policies in Illinois. This Consumer Choice of | ||||||
25 | Benefits Health Insurance Plan may provide a more | ||||||
26 | affordable health insurance policy for you, although, at |
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1 | the same time, it may provide you with fewer health | ||||||
2 | benefits than those normally included as state-mandated | ||||||
3 | health benefits in policies in Illinois. Please consult | ||||||
4 | with the insurance company to discover which | ||||||
5 | state-mandated health benefits are not included in this | ||||||
6 | policy."
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7 | Section 30. Disclosure statement. | ||||||
8 | (a) When a Consumer Choice of Benefits Health Insurance | ||||||
9 | Plan policy is issued, an insurer providing a Consumer Choice | ||||||
10 | of Benefits Health Insurance Plan must provide an applicant or | ||||||
11 | subscriber with a written disclosure statement that does the | ||||||
12 | following: | ||||||
13 | (1) acknowledges that the Consumer Choice of Benefits | ||||||
14 | Health Insurance Plan being purchased does not provide some | ||||||
15 | or all state-mandated health benefits; | ||||||
16 | (2) lists those state-mandated health benefits not | ||||||
17 | included under the Consumer Choice of Benefits Health | ||||||
18 | Insurance Plan; | ||||||
19 | (3) provides a notice that purchasing a plan may limit | ||||||
20 | the policyholder's future coverage options in the event the | ||||||
21 | policyholder's health changes and needed benefits are not | ||||||
22 | available under the Consumer Choice of Benefits Health | ||||||
23 | Insurance Plan; and | ||||||
24 | (4) includes a section that allows for a signature by | ||||||
25 | the applicant or subscriber attesting to the fact that the |
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1 | applicant has read and understood the disclosure statement | ||||||
2 | and attesting to the fact that the applicant or subscriber | ||||||
3 | has in fact been given a choice between the Consumer Choice | ||||||
4 | of Benefits Health Insurance Plan that he or she has chosen | ||||||
5 | and a health insurance plan that includes all | ||||||
6 | state-mandated health benefits. | ||||||
7 | (b) Each applicant and subscriber for initial coverage must | ||||||
8 | sign the disclosure statement provided by the insurer under | ||||||
9 | subsection (a) of this Section and return the statement to the | ||||||
10 | insurer. Under an individual policy or contract, "applicant" | ||||||
11 | means the individual purchasing the policy. | ||||||
12 | (c) An insurer must do the following: | ||||||
13 | (1) retain the signed disclosure statement in the | ||||||
14 | insurer's records; and | ||||||
15 | (2) provide the signed disclosure statement to the | ||||||
16 | Department upon request from the Secretary.
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17 | Section 35. Rules. The Secretary shall adopt rules as | ||||||
18 | necessary to implement this Act. | ||||||
19 | Section 40. Additional policies.
An insurer that offers | ||||||
20 | one or more Consumer Choice of Benefits Health Insurance Plans | ||||||
21 | under this Act must also offer at least one accident and health | ||||||
22 | insurance policy that has been filed and approved with the | ||||||
23 | Department and includes coverage for all state-mandated health | ||||||
24 | benefits. |
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1 | Section 45. Rating and underwriting records. | ||||||
2 | (a) An insurer offering a Consumer Choice of Benefits | ||||||
3 | Health Insurance Plan under this Act shall maintain at its | ||||||
4 | principal place of business a complete and detailed description | ||||||
5 | of its rating practices and renewal underwriting practices, | ||||||
6 | including information and documentation that demonstrates that | ||||||
7 | its rating methods and practices are based upon commonly | ||||||
8 | accepted actuarial assumptions and are in accordance with sound | ||||||
9 | actuarial principles and that the rates for the Consumer Choice | ||||||
10 | of Benefits Health Insurance Plan reflect the difference in its | ||||||
11 | benefit package from a non-Consumer Choice of Benefits Health | ||||||
12 | Insurance Plan. | ||||||
13 | (b) Upon request, an insurer shall provide to the | ||||||
14 | Department an actuarial certification certifying that the | ||||||
15 | insurer is in compliance with this Act and that the rating | ||||||
16 | methods of the insurer are actuarially sound. Such | ||||||
17 | certification shall be in a form and manner and shall contain | ||||||
18 | such information as specified by the Secretary. A copy of the | ||||||
19 | certification shall be retained by the insurer at its principal | ||||||
20 | place of business for a period of 3 years from the date of | ||||||
21 | certification. This shall include any work papers prepared in | ||||||
22 | support of the actuarial certification. | ||||||
23 | (c) Nothing in this Section shall be construed as granting | ||||||
24 | the Secretary any power or authority to determine, fix, | ||||||
25 | prescribe, or promulgate the rates to be charged for any |
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1 | individual or group accident and health insurance policy or | ||||||
2 | policies issued under this Act.
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3 | Section 50. Applicability of Illinois Insurance Code | ||||||
4 | provisions. All policies of accident and health insurance | ||||||
5 | issued under this Act shall be subject to the provisions of | ||||||
6 | Section 356c, subsection (a) of Sections 356g, 356n, 370, 370a, | ||||||
7 | 370e, and 370o of the Illinois Insurance Code.
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