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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,
| |||||||||||||||||||||
3 | represented in the General Assembly:
| |||||||||||||||||||||
4 | Section 5. The Illinois Insurance Code is amended by | |||||||||||||||||||||
5 | changing Section 356v as follows:
| |||||||||||||||||||||
6 | (215 ILCS 5/356v)
| |||||||||||||||||||||
7 | Sec. 356v. Use of information derived from genetic testing.
| |||||||||||||||||||||
8 | After the effective date of this amendatory Act of 1997, an | |||||||||||||||||||||
9 | insurer must comply
with the provisions of the Genetic | |||||||||||||||||||||
10 | Information Privacy Act in connection with
the amendment, | |||||||||||||||||||||
11 | delivery, issuance, or renewal of, or claims for or denial of
| |||||||||||||||||||||
12 | coverage under, an individual or group policy of accident and | |||||||||||||||||||||
13 | health insurance.
Additionally, genetic information shall not | |||||||||||||||||||||
14 | be treated as a condition
described in item (1) of subsection | |||||||||||||||||||||
15 | (A) of Section 20 of the Illinois Health
Insurance Portability | |||||||||||||||||||||
16 | and Accountability Act in the absence of a diagnosis of
the | |||||||||||||||||||||
17 | condition related to that genetic information.
| |||||||||||||||||||||
18 | (Source: P.A. 90-25, eff. 1-1-98; 90-655, eff. 7-30-98; 91-549, | |||||||||||||||||||||
19 | eff. 8-14-99.)
| |||||||||||||||||||||
20 | Section 10. The Illinois Health Insurance Portability and | |||||||||||||||||||||
21 | Accountability Act is amended by changing Section 20 as | |||||||||||||||||||||
22 | follows:
|
| |||||||
| |||||||
1 | (215 ILCS 97/20)
| ||||||
2 | Sec. 20. Increased portability through limitation on | ||||||
3 | preexisting
condition exclusions. | ||||||
4 | (A) Notwithstanding any law to the contrary, a group health | ||||||
5 | plan or a health insurance issuer offering group or individual | ||||||
6 | health insurance coverage may not impose any preexisting | ||||||
7 | condition exclusion. Limitation of preexisting condition | ||||||
8 | exclusion period;
crediting for periods of previous coverage. | ||||||
9 | Subject
to subsection (D), a group health plan, and a health
| ||||||
10 | insurance issuer offering group health insurance
coverage, | ||||||
11 | may, with respect to a participant or
beneficiary, impose a | ||||||
12 | preexisting condition exclusion
only if:
| ||||||
13 | (1) the exclusion relates to a condition (whether
| ||||||
14 | physical or mental), regardless of the cause of
the | ||||||
15 | condition, for which medical advice,
diagnosis, care, or | ||||||
16 | treatment was recommended or
received
within the 6-month | ||||||
17 | period ending on the enrollment
date;
| ||||||
18 | (2) the exclusion extends for a period of not more
than | ||||||
19 | 12 months (or 18 months in the case of a late
enrollee) | ||||||
20 | after the enrollment date; and
| ||||||
21 | (3) the period of any such preexisting condition
| ||||||
22 | exclusion is reduced by the aggregate of the periods
of | ||||||
23 | creditable coverage (if any, as defined in
subsection | ||||||
24 | (C)(1)) applicable to the participant or
beneficiary as of | ||||||
25 | the enrollment date.
|
| |||||||
| |||||||
1 | (B) (Blank). Preexisting condition exclusion. A group
| ||||||
2 | health plan, and health insurance issuer offering
group health | ||||||
3 | insurance coverage, may not impose
any preexisting condition | ||||||
4 | exclusion relating to
pregnancy as a preexisting condition.
| ||||||
5 | Genetic information shall not be treated as a condition
| ||||||
6 | described in subsection (A)(1) in the absence of a
diagnosis of | ||||||
7 | the condition related to such
information.
| ||||||
8 | (C) Rules relating to crediting previous coverage.
| ||||||
9 | (1) Creditable coverage defined. For purposes of this
| ||||||
10 | Act, the term "creditable coverage" means, with
respect to | ||||||
11 | an individual, coverage of the individual
under any of the | ||||||
12 | following:
| ||||||
13 | (a) A group health plan.
| ||||||
14 | (b) Health insurance coverage.
| ||||||
15 | (c) Part A or part B of title XVIII of the Social | ||||||
16 | Security
Act.
| ||||||
17 | (d) Title XIX of the Social Security Act, other | ||||||
18 | than coverage
consisting solely of benefits under | ||||||
19 | Section 1928.
| ||||||
20 | (e) Chapter 55 of title 10, United States Code.
| ||||||
21 | (f) A medical care program of the Indian Health | ||||||
22 | Service or of
a tribal organization.
| ||||||
23 | (g) A State health benefits risk pool.
| ||||||
24 | (h) A health plan offered under chapter 89 of title | ||||||
25 | 5, United
States Code.
| ||||||
26 | (i) A public health plan (as defined in |
| |||||||
| |||||||
1 | regulations).
| ||||||
2 | (j) A health benefit plan under Section 5(e) of the | ||||||
3 | Peace
Corps Act (22 U.S.C. 2504(e)).
| ||||||
4 | (k) Title XXI of the federal Social Security Act, | ||||||
5 | State Children's
Health Insurance Program.
| ||||||
6 | Such term does not include coverage consisting solely | ||||||
7 | of
coverage of excepted benefits.
| ||||||
8 | (2) Excepted benefits. For purposes of this Act, the | ||||||
9 | term "excepted
benefits" means benefits under one or more | ||||||
10 | of the following:
| ||||||
11 | (a) Benefits not subject to requirements:
| ||||||
12 | (i) Coverage only for accident, or disability | ||||||
13 | income
insurance, or any combination thereof.
| ||||||
14 | (ii) Coverage issued as a supplement to | ||||||
15 | liability insurance.
| ||||||
16 | (iii) Liability insurance, including general | ||||||
17 | liability
insurance and automobile liability | ||||||
18 | insurance.
| ||||||
19 | (iv) Workers' compensation or similar | ||||||
20 | insurance.
| ||||||
21 | (v) Automobile medical payment insurance.
| ||||||
22 | (vi) Credit-only insurance.
| ||||||
23 | (vii) Coverage for on-site medical clinics.
| ||||||
24 | (viii) Other similar insurance coverage, | ||||||
25 | specified
in regulations, under which benefits for | ||||||
26 | medical
care are secondary or incidental to other |
| |||||||
| |||||||
1 | insurance
benefits.
| ||||||
2 | (b) Benefits not subject to requirements if | ||||||
3 | offered separately:
| ||||||
4 | (i) Limited scope dental or vision benefits.
| ||||||
5 | (ii) Benefits for long-term care, nursing home | ||||||
6 | care, home
health care, community-based care, or | ||||||
7 | any combination
thereof.
| ||||||
8 | (iii) Such other similar, limited benefits as | ||||||
9 | are
specified in rules.
| ||||||
10 | (c) Benefits not subject to requirements if | ||||||
11 | offered, as
independent, noncoordinated benefits:
| ||||||
12 | (i) Coverage only for a specified disease or
| ||||||
13 | illness.
| ||||||
14 | (ii) Hospital indemnity or other fixed | ||||||
15 | indemnity
insurance.
| ||||||
16 | (d) Benefits not subject to requirements if | ||||||
17 | offered as
separate insurance policy. Medicare | ||||||
18 | supplemental health
insurance (as defined under | ||||||
19 | Section 1882(g)(1) of the
Social Security Act), | ||||||
20 | coverage supplemental to the
coverage provided under | ||||||
21 | chapter 55 of title 10, United
States Code, and similar | ||||||
22 | supplemental coverage provided to
coverage under a | ||||||
23 | group health plan.
| ||||||
24 | (3) Not counting periods before significant breaks in | ||||||
25 | coverage.
| ||||||
26 | (a) In general. A period of creditable coverage |
| |||||||
| |||||||
1 | shall not
be counted, with respect to enrollment of an
| ||||||
2 | individual under a group health plan, if, after such
| ||||||
3 | period and before the enrollment date, there was a | ||||||
4 | 63-day period during all of
which the individual was | ||||||
5 | not
covered under any creditable coverage.
| ||||||
6 | (b) Waiting period not treated as a break in
| ||||||
7 | coverage. For purposes of subparagraph (a) and
| ||||||
8 | subsection (D)(3) , any period that an individual is in
| ||||||
9 | a waiting period for any coverage under a group health
| ||||||
10 | plan (or for group health insurance coverage) or is in
| ||||||
11 | an affiliation period (as defined in subsection
| ||||||
12 | (G)(2)) shall not be taken into account in determining
| ||||||
13 | the continuous period under subparagraph (a).
| ||||||
14 | (4) Method of crediting coverage.
(a) Standard method. | ||||||
15 | A Except as otherwise provided under
subparagraph (b), for | ||||||
16 | purposes of applying subsection
(A)(3), a group health | ||||||
17 | plan, and a health insurance
issuer offering group health | ||||||
18 | insurance coverage, shall
count a period of creditable | ||||||
19 | coverage without regard
to the specific benefits covered | ||||||
20 | during the period.
| ||||||
21 | (b) Election of alternative method. A group health | ||||||
22 | plan,
or a health insurance issuer offering group | ||||||
23 | health
insurance, may elect to apply subsection (A)(3) | ||||||
24 | based
on coverage of benefits within each of several | ||||||
25 | classes
or categories of benefits specified in | ||||||
26 | regulations
rather than as provided under subparagraph |
| |||||||
| |||||||
1 | (a). Such
election shall be made on a uniform basis for | ||||||
2 | all
participants and beneficiaries. Under such | ||||||
3 | election a
group health plan or issuer shall count a | ||||||
4 | period of
creditable coverage with respect to any class | ||||||
5 | or
category of benefits if any level of benefits is
| ||||||
6 | covered within such class or category.
| ||||||
7 | (c) Plan notice. In the case of an election with | ||||||
8 | respect
to a group health plan under subparagraph (b) | ||||||
9 | (whether
or not health insurance coverage is provided | ||||||
10 | in
connection with such plan), the plan shall:
| ||||||
11 | (i) prominently state in any disclosure | ||||||
12 | statements
concerning the plan, and state to each | ||||||
13 | enrollee at
the time of enrollment under the plan, | ||||||
14 | that the
plan has made such election; and
| ||||||
15 | (ii) include in such statements a description | ||||||
16 | of
the effect of this election.
| ||||||
17 | (d) Issuer notice. In the case of an election
under | ||||||
18 | subparagraph (b) with respect to health
insurance | ||||||
19 | coverage offered by an issuer in the small
or large | ||||||
20 | group market, the issuer:
| ||||||
21 | (i) shall prominently state in any disclosure
| ||||||
22 | statements concerning the coverage, and to each
| ||||||
23 | employer at the time of the offer or sale of the
| ||||||
24 | coverage, that the issuer has made such election;
| ||||||
25 | and
| ||||||
26 | (ii) shall include in such statements a
|
| |||||||
| |||||||
1 | description of the effect of such election.
| ||||||
2 | (5) Establishment of period. Periods of creditable | ||||||
3 | coverage
with respect to an individual shall be established | ||||||
4 | through
presentation or certifications described in | ||||||
5 | subsection (E)
or in such other manner as may be specified | ||||||
6 | in
regulations.
| ||||||
7 | (D) (Blank). Exceptions:
| ||||||
8 | (1) Exclusion not applicable to certain newborns.
| ||||||
9 | Subject to paragraph (3), a group health plan, and
a health | ||||||
10 | insurance issuer offering group health
insurance coverage, | ||||||
11 | may not impose any preexisting
condition exclusion in the | ||||||
12 | case of an
individual who, as of the last day of the 30-day
| ||||||
13 | period beginning with the date of birth, is
covered under | ||||||
14 | creditable coverage.
| ||||||
15 | (2) Exclusion not applicable to certain adopted
| ||||||
16 | children. Subject to paragraph (3), a group
health plan, | ||||||
17 | and a health insurance issuer
offering group health | ||||||
18 | insurance coverage, may not
impose any preexisting | ||||||
19 | condition exclusion in the
case of a child who is adopted | ||||||
20 | or placed for
adoption before attaining 18 years of age and | ||||||
21 | who,
as of the last day of the 30-day period beginning
on | ||||||
22 | the date of the adoption or placement for
adoption, is | ||||||
23 | covered under creditable coverage.
| ||||||
24 | The previous sentence
shall not apply to coverage | ||||||
25 | before the date of
such adoption or placement for adoption.
| ||||||
26 | (3) Loss if break in coverage. Paragraphs (1) and
(2) |
| |||||||
| |||||||
1 | shall no longer apply to an individual
after the end of the | ||||||
2 | first 63-day period
during all of which the individual was | ||||||
3 | not
covered under any creditable coverage.
| ||||||
4 | (E) Certifications and disclosure of coverage.
| ||||||
5 | (1) Requirement for Certification of Period of | ||||||
6 | Creditable
Coverage.
| ||||||
7 | (a) A group health plan, and a
health insurance | ||||||
8 | issuer offering group health
insurance coverage, shall | ||||||
9 | provide the certification described in subparagraph
| ||||||
10 | (b):
| ||||||
11 | (i) at the time an individual ceases to be | ||||||
12 | covered
under the plan or otherwise becomes | ||||||
13 | covered
under a COBRA continuation provision;
| ||||||
14 | (ii) in the case of an individual becoming | ||||||
15 | covered
under such a provision, at the time the
| ||||||
16 | individual ceases to be covered under such
| ||||||
17 | provision; and
| ||||||
18 | (iii) on the request on behalf of an individual
| ||||||
19 | made not later than 24 months after the date
of | ||||||
20 | cessation of the coverage described in
clause (i) | ||||||
21 | or (ii), whichever is later.
| ||||||
22 | The certification under clause (i) may be provided, to
| ||||||
23 | the extent practicable, at a time consistent with
| ||||||
24 | notices required under any applicable COBRA
| ||||||
25 | continuation provision.
| ||||||
26 | (b) The certification described in
this |
| |||||||
| |||||||
1 | subparagraph is a written certification of:
| ||||||
2 | (i) the period of creditable coverage of the
| ||||||
3 | individual under such plan and the coverage (if
| ||||||
4 | any) under such COBRA continuation provision; and
| ||||||
5 | (ii) the waiting period (if any) (and
| ||||||
6 | affiliation period, if applicable) imposed with
| ||||||
7 | respect to the individual for any coverage under
| ||||||
8 | such plan.
| ||||||
9 | (c) To the extent that medical care
under a group | ||||||
10 | health plan consists of group health
insurance | ||||||
11 | coverage, the plan is deemed to have
satisfied the | ||||||
12 | certification requirement under this
paragraph if the | ||||||
13 | health insurance issuer offering the
coverage provides | ||||||
14 | for such certification in accordance
with this | ||||||
15 | paragraph.
| ||||||
16 | (2) Disclosure of information on previous benefits. In | ||||||
17 | the
case of an election described in subsection (C)(4)(b) | ||||||
18 | by a
group health plan or health insurance issuer, if the | ||||||
19 | plan
or issuer enrolls an individual for coverage under the
| ||||||
20 | plan and the individual provides a certification of
| ||||||
21 | coverage of the individual under paragraph (1):
| ||||||
22 | (a) upon request of such plan or issuer, the entity | ||||||
23 | which
issued the certification provided by the | ||||||
24 | individual
shall promptly disclose to such requesting | ||||||
25 | plan or
issuer information on coverage of classes and
| ||||||
26 | categories of health benefits available under such
|
| |||||||
| |||||||
1 | entity's plan or coverage; and
| ||||||
2 | (b) such entity may charge the requesting plan or | ||||||
3 | issuer
for the reasonable cost of disclosing such
| ||||||
4 | information.
| ||||||
5 | (3) Rules. The Department shall establish rules to
| ||||||
6 | prevent an entity's failure to provide information under
| ||||||
7 | paragraph (1) or (2) with respect to previous coverage of
| ||||||
8 | an individual from adversely affecting any subsequent
| ||||||
9 | coverage of the individual under another group health plan
| ||||||
10 | or health insurance coverage.
| ||||||
11 | (4) Treatment of certain plans as group health plan for
| ||||||
12 | notice provision. A program under which creditable
| ||||||
13 | coverage described in subparagraph (c), (d), (e), or
(f) of | ||||||
14 | Section 20(C)(1) is provided shall be treated
as a group | ||||||
15 | health plan for purposes of this Section.
| ||||||
16 | (F) Special enrollment periods.
| ||||||
17 | (1) Individuals losing other coverage. A group health
| ||||||
18 | plan, and a health insurance issuer offering group
health | ||||||
19 | insurance coverage in connection with a group health
plan, | ||||||
20 | shall permit an employee who is eligible, but not
enrolled, | ||||||
21 | for coverage under the terms of the plan (or a
dependent of | ||||||
22 | such an employee if the dependent is eligible,
but not | ||||||
23 | enrolled, for coverage under such terms) to enroll for
| ||||||
24 | coverage under the terms of the plan if each of the | ||||||
25 | following
conditions is met:
| ||||||
26 | (a) The employee or dependent was covered under a
|
| |||||||
| |||||||
1 | group health plan or had health insurance coverage
at | ||||||
2 | the time coverage was previously offered to the
| ||||||
3 | employee or dependent.
| ||||||
4 | (b) The employee stated in writing at such time
| ||||||
5 | that coverage under a group health plan or health
| ||||||
6 | insurance coverage was the reason for declining
| ||||||
7 | enrollment, but only if the plan sponsor or issuer
(if | ||||||
8 | applicable) required such a statement at such
time and | ||||||
9 | provided the employee with notice of such
requirement | ||||||
10 | (and the consequences of such
requirement) at such | ||||||
11 | time.
| ||||||
12 | (c) The employee's or dependent's coverage
| ||||||
13 | described in subparagraph (a):
| ||||||
14 | (i) was under a COBRA continuation provision | ||||||
15 | and the
coverage under such provision was | ||||||
16 | exhausted; or
| ||||||
17 | (ii) was not under such a provision and either | ||||||
18 | the
coverage was terminated as a result of loss of
| ||||||
19 | eligibility for the coverage (including as a
| ||||||
20 | result of legal separation, divorce, death,
| ||||||
21 | termination of employment, or reduction in the
| ||||||
22 | number of hours of
employment) or employer | ||||||
23 | contributions towards such
coverage were | ||||||
24 | terminated.
| ||||||
25 | (d) Under the terms of the plan, the employee
| ||||||
26 | requests such enrollment not later than 30 days after
|
| |||||||
| |||||||
1 | the date of exhaustion of coverage described in
| ||||||
2 | subparagraph (c)(i) or termination of coverage or
| ||||||
3 | employer contributions described in subparagraph
| ||||||
4 | (c)(ii).
| ||||||
5 | (2) For dependent beneficiaries.
| ||||||
6 | (a) In general. If:
| ||||||
7 | (i) a group health plan makes coverage
| ||||||
8 | available with respect to a dependent of an
| ||||||
9 | individual,
| ||||||
10 | (ii) the individual is a participant under the | ||||||
11 | plan (or
has met any waiting period applicable to | ||||||
12 | becoming a
participant under the plan and is | ||||||
13 | eligible to be
enrolled under the plan but for a | ||||||
14 | failure to enroll
during a previous enrollment | ||||||
15 | period), and
| ||||||
16 | (iii) a person becomes such a dependent of the | ||||||
17 | individual
through marriage, birth, or adoption or | ||||||
18 | placement
for adoption,
| ||||||
19 | then the group health plan shall provide
for a | ||||||
20 | dependent special enrollment period described
in | ||||||
21 | subparagraph (b) during which the person (or, if
not | ||||||
22 | otherwise enrolled, the individual) may be
enrolled | ||||||
23 | under the plan as a dependent of the
individual, and in | ||||||
24 | the case of the birth or
adoption of a child, the | ||||||
25 | spouse of the individual
may be enrolled as a dependent | ||||||
26 | of the individual if
such spouse is otherwise eligible |
| |||||||
| |||||||
1 | for coverage.
| ||||||
2 | (b) Dependent special enrollment period. A
| ||||||
3 | dependent special enrollment period under this
| ||||||
4 | subparagraph shall be a period of not less than 30 days
| ||||||
5 | and shall begin on the later of:
| ||||||
6 | (i) the date dependent coverage is made
| ||||||
7 | available; or
| ||||||
8 | (ii) the date of the marriage, birth, or | ||||||
9 | adoption or
placement for adoption (as the case may | ||||||
10 | be)
described in subparagraph (a)(iii).
| ||||||
11 | (c) No waiting period. If an individual seeks to | ||||||
12 | enroll
a dependent during the first 30 days of such a
| ||||||
13 | dependent special enrollment period, the coverage of
| ||||||
14 | the dependent shall become effective:
| ||||||
15 | (i) in the case of marriage, not later than the
| ||||||
16 | first day of the first month beginning after the
| ||||||
17 | date the completed request for enrollment is
| ||||||
18 | received;
| ||||||
19 | (ii) in the case of a dependent's birth, as of | ||||||
20 | the
date of such birth; or
| ||||||
21 | (iii) in the case of a dependent's adoption or
| ||||||
22 | placement for adoption, the date of such
adoption | ||||||
23 | or placement for adoption.
| ||||||
24 | (G) Use of affiliation period by HMOs as alternative to | ||||||
25 | preexisting
condition exclusion.
| ||||||
26 | (1) In general. A health maintenance organization
|
| |||||||
| |||||||
1 | which offers health insurance coverage in connection
with a | ||||||
2 | group health plan and which does not impose any
| ||||||
3 | pre-existing condition exclusion allowed under
subsection | ||||||
4 | (A) with respect to any particular coverage
option may | ||||||
5 | impose an affiliation period for such
coverage option, but | ||||||
6 | only if:
| ||||||
7 | (a) such period is applied uniformly without | ||||||
8 | regard to
any health status-related factors; and
| ||||||
9 | (b) such period does not exceed 2 months (or 3 | ||||||
10 | months in
the case of a late enrollee).
| ||||||
11 | (2) Affiliation period.
| ||||||
12 | (a) Defined. For purposes of this Act, the term
| ||||||
13 | "affiliation period" means a period which, under the
| ||||||
14 | terms of the health insurance coverage offered by the
| ||||||
15 | health maintenance organization, must expire before | ||||||
16 | the
health insurance coverage becomes
effective. The | ||||||
17 | organization is not required to
provide health care | ||||||
18 | services or benefits during such
period and no premium | ||||||
19 | shall be charged to the
participant or beneficiary for | ||||||
20 | any coverage during
the period.
| ||||||
21 | (b) Beginning. Such period shall begin on the
| ||||||
22 | enrollment date.
| ||||||
23 | (c) Runs concurrently with waiting periods. An
| ||||||
24 | affiliation period under a plan shall run concurrently | ||||||
25 | with any waiting period
under the plan.
| ||||||
26 | (3) Alternative methods. A health maintenance |
| |||||||
| |||||||
1 | organization
described in paragraph (1) may use | ||||||
2 | alternative methods,
from those described in such | ||||||
3 | paragraph, to address
adverse selection as approved by the | ||||||
4 | Department.
| ||||||
5 | (Source: P.A. 90-30, eff. 7-1-97; 90-736, eff. 8-12-98.)
| ||||||
6 | Section 99. Effective date. This Act takes effect upon | ||||||
7 | becoming law.
|