093_SB0908eng
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1 AN ACT concerning health benefit plans.
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 adding Section 352b as follows:
6 (215 ILCS 5/352b new)
7 Sec. 352b. Flexible health plans.
8 (a) The Illinois General Assembly finds that a
9 significant proportion of the residents of this State are
10 unable to obtain affordable health insurance coverage. The
11 General Assembly recognizes the need for individuals and
12 employers in this State to have the opportunity to choose
13 health insurance plans that are more affordable and flexible
14 than standard market policies of accident and health
15 insurance and the need to increase the availability of health
16 insurance coverage by authorizing the transaction of this
17 type of plan or policy by carriers licensed to provide health
18 insurance in this State. Therefore, it is the intent of the
19 Illinois General Assembly to expand the availability of
20 affordable and flexible health insurance options for
21 individuals and employers by allowing health insurance
22 carriers to develop alternative approaches to traditional
23 accident and health insurance policies currently offered in
24 this State. This Section shall in no way prevent carriers
25 from offering or any individual or employer from choosing in
26 whole or in part any health insurance coverages that are
27 offered or mandated under this Code.
28 (b) As used in this Section:
29 "Carrier" means any entity authorized by the Department
30 to provide a health insurance plan, including a licensed
31 insurance company, a prepaid hospital or medical service
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1 plan, or a health maintenance organization.
2 "Health benefit plan" means any hospital or medical
3 expense-incurred policy, hospital or medical service plan
4 contract, or health maintenance organization subscriber
5 contract.
6 "Health flex plan" means a health benefit plan offered by
7 a carrier authorized to transact business in this State that,
8 either in whole or in part, does not provide State mandated
9 health benefits.
10 "State mandated health benefits" means coverage for
11 specific health care services, benefits, or treatment
12 required by State law or rule, limitations or restrictions on
13 deductibles, coinsurance, copayments, or any annual or
14 lifetime maximum benefit amounts, or inclusion of a specific
15 health care provider to be provided to a person covered under
16 a health benefit plan issued in the State of Illinois. "State
17 mandated health benefits" does not mean standard provisions
18 or rights required to be present in a health benefit plan
19 pursuant to State law or regulations including, but not
20 limited to, those contained in Article IV of the Health
21 Maintenance Organization Act, Sections 356b through 356L,
22 Sections 356n through 356z.2, Section 367b, Section 367e,
23 Section 367i, Section 367.2, and Section 370c of the Illinois
24 Insurance Code.
25 (c) In addition to offering within this State health
26 benefit plans that must contain State mandated health
27 benefits, any carrier authorized to transact business in this
28 State shall be authorized to offer, as an option, a health
29 flex plan beginning on January 1, 2004.
30 (d) In each sale of a health benefit plan in which the
31 proposed group has chosen a health flex plan, the carrier
32 shall:
33 (1) provide notice that identifies to the
34 policyholder the State mandated benefits not included in
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1 the health flex plan. Such notice shall be provided by
2 the employer to each employee participating in the health
3 flex plan;
4 (2) provide to the policy holder a notice with the
5 following language in bold type:
6 "This health flex plan, either in whole or in part,
7 does not provide State mandated health benefits normally
8 required in accident and health insurance policies in
9 Illinois. This health flex 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 benefits than those normally included as State mandated
13 health benefits in policies in Illinois.";
14 (3) provide to the policyholder a statement to be
15 signed acknowledging that the health flex plan being
16 purchased does not provide the State mandated health
17 benefits listed on the form; and
18 (4) maintain the signed notice to provide
19 information as may be needed by the Director of
20 Insurance.
21 (e) The Director may promulgate rules as necessary to
22 implement the provisions of this Section.
23 Section 99. Effective date. This Act takes effect upon
24 becoming law.