94TH GENERAL ASSEMBLY
State of Illinois
2005 and 2006
HB0985

 

Introduced 2/3/2005, by Rep. Brandon W. Phelps

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 97/25

    Amends the Illinois Health Insurance Portability and Accountability Act. Makes a technical change in a Section prohibiting discrimination against individual participants.


LRB094 07927 LJB 38108 b

 

 

A BILL FOR

 

HB0985 LRB094 07927 LJB 38108 b

1     AN ACT concerning regulation.
 
2     Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
 
4     Section 5. The Illinois Health Insurance Portability and
5 Accountability Act is amended by changing Section 25 as
6 follows:
 
7     (215 ILCS 97/25)
8     Sec. 25. Prohibiting discrimination against individual
9 participants.
10     (A) In eligibility to enroll.
11         (1) In general. Subject to paragraph (2), a group
12     health plan, and a health insurance issuer offering group
13     health insurance coverage in connection with a group health
14     plan, may not establish rules for eligibility (including
15     continued eligibility) of any individual to enroll under
16     the the terms of the plan based on any of the following
17     health status-related factors in relation to the
18     individual or a dependent of the individual:
19             (a) Health status.
20             (b) Medical condition (including both physical and
21         mental illnesses).
22             (c) Claims experience.
23             (d) Receipt of health care.
24             (e) Medical history.
25             (f) Genetic information.
26             (g) Evidence of insurability (including conditions
27         arising out of acts of domestic violence).
28             (h) Disability.
29         (2) No application to benefits or exclusions. To the
30     extent consistent with Section 20, the provisions of
31     paragraph (1) shall not be construed:
32             (a) to require a group health plan, or group health

 

 

HB0985 - 2 - LRB094 07927 LJB 38108 b

1         insurance coverage, to provide particular benefits
2         other than those provided under the terms of such plan
3         or coverage; or
4             (b) to prevent such a plan or coverage from
5         establishing limitations or restrictions on the
6         amount, level, extent, or nature of the benefits or
7         coverage for similarly situated individuals enrolled
8         in the plan or coverage.
9         (3) Construction. For purposes of paragraph (1), rules
10     for eligibility to enroll under a plan include rules
11     defining any applicable waiting periods for such
12     enrollment.
13     (B) In premium contributions.
14         (1) In general. A group health plan, and a health
15     insurance issuer offering health insurance coverage in
16     connection with a group health plan, may not require any
17     individual (as a condition of enrollment or continued
18     enrollment under the plan) to pay a premium or contribution
19     which is greater than such premium or contribution for a
20     similarly situated individual enrolled in the plan on the
21     basis of any health status-related factor in relation to
22     the individual or to an individual enrolled under the plan
23     as a dependent of the individual.
24         (2) Construction. Nothing in paragraph (1) shall be
25     construed:
26             (a) to restrict the amount that an employer may be
27         charged for coverage under a group health plan; or
28             (b) to prevent a group health plan, and a health
29         insurance issuer offering group health insurance
30         coverage, from establishing premium discounts or
31         rebates or modifying otherwise applicable copayments
32         or deductibles in return for adherence to programs of
33         health promotion and disease prevention.
34 (Source: P.A. 90-30, eff. 7-1-97.)