Public Act 093-0034
Public Act 93-0034 of the 93rd General Assembly
Public Act 93-0034
HB0707 Enrolled LRB093 05485 MKM 05576 b
AN ACT concerning the Comprehensive Health Insurance
Plan.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. If and only if House Bill 3298 of the 93rd
General Assembly becomes law, the Comprehensive Health
Insurance Plan Act is amended by changing Sections 2, 4, 7,
and 15 as follows:
(215 ILCS 105/2) (from Ch. 73, par. 1302)
Sec. 2. Definitions. As used in this Act, unless the
context otherwise requires:
"Plan administrator" means the insurer or third party
administrator designated under Section 5 of this Act.
"Benefits plan" means the coverage to be offered by the
Plan to eligible persons and federally eligible individuals
pursuant to this Act.
"Board" means the Illinois Comprehensive Health Insurance
Board.
"Church plan" has the same meaning given that term in the
federal Health Insurance Portability and Accountability Act
of 1996.
"Continuation coverage" means continuation of coverage
under a group health plan or other health insurance coverage
for former employees or dependents of former employees that
would otherwise have terminated under the terms of that
coverage pursuant to any continuation provisions under
federal or State law, including the Consolidated Omnibus
Budget Reconciliation Act of 1985 (COBRA), as amended,
Sections 367.2 and 367e of the Illinois Insurance Code, or
any other similar requirement in another State.
"Covered person" means a person who is and continues to
remain eligible for Plan coverage and is covered under one of
the benefit plans offered by the Plan.
"Creditable coverage" means, with respect to a federally
eligible individual, coverage of the individual under any of
the following:
(A) A group health plan.
(B) Health insurance coverage (including group
health insurance coverage).
(C) Medicare.
(D) Medical assistance.
(E) Chapter 55 of title 10, United States Code.
(F) A medical care program of the Indian Health
Service or of a tribal organization.
(G) A state health benefits risk pool.
(H) A health plan offered under Chapter 89 of title
5, United States Code.
(I) A public health plan (as defined in regulations
consistent with Section 104 of the Health Care
Portability and Accountability Act of 1996 that may be
promulgated by the Secretary of the U.S. Department of
Health and Human Services).
(J) A health benefit plan under Section 5(e) of the
Peace Corps Act (22 U.S.C. 2504(e)).
(K) Any other qualifying coverage required by the
federal Health Insurance Portability and Accountability
Act of 1996, as it may be amended, or regulations under
that Act.
"Creditable coverage" does not include coverage
consisting solely of coverage of excepted benefits, as
defined in Section 2791(c) of title XXVII of the Public
Health Service Act (42 U.S.C. 300 gg-91), nor does it include
any period of coverage under any of items (A) through (K)
that occurred before a break of more than 90 days or, if
after September 30, 2003, the individual has either been
certified as an eligible person pursuant to the federal Trade
Adjustment Act of 2002 or initially been paid a benefit by
the Pension Benefit Guaranty Corporation, a break of more
than 63 days during all of which the individual was not
covered under any of items (A) through (K) above.
For an individual who between December 1, 2002 and
September 30, 2003 has either (1) been certified as eligible
pursuant to the federal Trade Act of 2002, (2) initially been
paid a benefit by the Pension Benefit Guaranty Corporation,
or (3) as of December 1, 2002, been receiving benefits from
the Pension Benefit Guaranty Corporation and who has
qualified health insurance, as defined by the federal Trade
Act of 2002, "creditable coverage" includes any period of
coverage aggregating 3 or more months under any of items (A)
through (K), irrespective of the length of a break during all
of which the individual was not covered under any of items
(A) through (K).
Any period that an individual is in a waiting period for
any coverage under a group health plan (or for group health
insurance coverage) or is in an affiliation period under the
terms of health insurance coverage offered by a health
maintenance organization shall not be taken into account in
determining if there has been a break of more than 90 days in
any creditable coverage.
"Department" means the Illinois Department of Insurance.
"Dependent" means an Illinois resident: who is a spouse;
or who is claimed as a dependent by the principal insured for
purposes of filing a federal income tax return and resides in
the principal insured's household, and is a resident
unmarried child under the age of 19 years; or who is an
unmarried child who also is a full-time student under the age
of 23 years and who is financially dependent upon the
principal insured; or who is a child of any age and who is
disabled and financially dependent upon the principal
insured.
"Direct Illinois premiums" means, for Illinois business,
an insurer's direct premium income for the kinds of business
described in clause (b) of Class 1 or clause (a) of Class 2
of Section 4 of the Illinois Insurance Code, and direct
premium income of a health maintenance organization or a
voluntary health services plan, except it shall not include
credit health insurance as defined in Article IX 1/2 of the
Illinois Insurance Code.
"Director" means the Director of the Illinois Department
of Insurance.
"Eligible person" means a resident of this State who
qualifies for Plan coverage under Section 7 of this Act.
"Employee" means a resident of this State who is employed
by an employer or has entered into the employment of or works
under contract or service of an employer including the
officers, managers and employees of subsidiary or affiliated
corporations and the individual proprietors, partners and
employees of affiliated individuals and firms when the
business of the subsidiary or affiliated corporations, firms
or individuals is controlled by a common employer through
stock ownership, contract, or otherwise.
"Employer" means any individual, partnership,
association, corporation, business trust, or any person or
group of persons acting directly or indirectly in the
interest of an employer in relation to an employee, for which
one or more persons is gainfully employed.
"Family" coverage means the coverage provided by the Plan
for the covered person and his or her eligible dependents who
also are covered persons.
"Federally eligible individual" means an individual
resident of this State:
(1)(A) for whom, as of the date on which the
individual seeks Plan coverage under Section 15 of this
Act, the aggregate of the periods of creditable coverage
is 18 or more months or, if the individual has either (i)
been certified as an eligible person pursuant to the
federal Trade Adjustment Act of 2002, (ii) initially been
paid a benefit by the Pension Benefit Guaranty
Corporation, or (iii) as of December 1, 2002, been
receiving benefits from the Pension Benefit Guaranty
Corporation and has qualified health insurance, as
defined by the federal Trade Act of 2002, 3 or more
months, and (B) whose most recent prior creditable
coverage was under group health insurance coverage
offered by a health insurance issuer, a group health
plan, a governmental plan, or a church plan (or health
insurance coverage offered in connection with any such
plans) or any other type of creditable coverage that may
be required by the federal Health Insurance Portability
and Accountability Act of 1996, as it may be amended, or
the regulations under that Act;
(2) who is not eligible for coverage under (A) a
group health plan, (B) part A or part B of Medicare due
to age, or (C) medical assistance, and does not have
other health insurance coverage;
(3) with respect to whom the most recent coverage
within the coverage period described in paragraph (1)(A)
of this definition was not terminated based upon a factor
relating to nonpayment of premiums or fraud;
(4) if the individual (, other than an individual
who has either (A) been certified as an eligible person
pursuant to the federal Trade Adjustment Act of 2002, (B)
initially been paid a benefit by the Pension Benefit
Guaranty Corporation, or (C) as of December 1, 2002, been
receiving benefits from the Pension Benefit Guaranty
Corporation and who has qualified health insurance, as
defined by the federal Trade Act of 2002), had been
offered the option of continuation coverage under a COBRA
continuation provision or under a similar State program,
who elected such coverage; and
(5) who, if the individual elected such
continuation coverage, has exhausted such continuation
coverage under such provision or program.
An individual who has either been certified as an
eligible person pursuant to the federal Trade Adjustment Act
of 2002 or initially been paid a benefit by the Pension
Benefit Guaranty Corporation shall not be required to elect
continuation coverage under a COBRA continuation provision or
under a similar state program.
"Group health insurance coverage" means, in connection
with a group health plan, health insurance coverage offered
in connection with that plan.
"Group health plan" has the same meaning given that term
in the federal Health Insurance Portability and
Accountability Act of 1996.
"Governmental plan" has the same meaning given that term
in the federal Health Insurance Portability and
Accountability Act of 1996.
"Health insurance coverage" means benefits consisting of
medical care (provided directly, through insurance or
reimbursement, or otherwise and including items and services
paid for as medical care) under any hospital and medical
expense-incurred policy, certificate, or contract provided by
an insurer, non-profit health care service plan contract,
health maintenance organization or other subscriber contract,
or any other health care plan or arrangement that pays for or
furnishes medical or health care services whether by
insurance or otherwise. Health insurance coverage shall not
include short term, accident only, disability income,
hospital confinement or fixed indemnity, dental only, vision
only, limited benefit, or credit insurance, coverage issued
as a supplement to liability insurance, insurance arising out
of a workers' compensation or similar law, automobile
medical-payment insurance, or insurance under which benefits
are payable with or without regard to fault and which is
statutorily required to be contained in any liability
insurance policy or equivalent self-insurance.
"Health insurance issuer" means an insurance company,
insurance service, or insurance organization (including a
health maintenance organization and a voluntary health
services plan) that is authorized to transact health
insurance business in this State. Such term does not include
a group health plan.
"Health Maintenance Organization" means an organization
as defined in the Health Maintenance Organization Act.
"Hospice" means a program as defined in and licensed
under the Hospice Program Licensing Act.
"Hospital" means a duly licensed institution as defined
in the Hospital Licensing Act, an institution that meets all
comparable conditions and requirements in effect in the state
in which it is located, or the University of Illinois
Hospital as defined in the University of Illinois Hospital
Act.
"Individual health insurance coverage" means health
insurance coverage offered to individuals in the individual
market, but does not include short-term, limited-duration
insurance.
"Insured" means any individual resident of this State who
is eligible to receive benefits from any insurer (including
health insurance coverage offered in connection with a group
health plan) or health insurance issuer as defined in this
Section.
"Insurer" means any insurance company authorized to
transact health insurance business in this State and any
corporation that provides medical services and is organized
under the Voluntary Health Services Plans Act or the Health
Maintenance Organization Act.
"Medical assistance" means the State medical assistance
or medical assistance no grant (MANG) programs provided under
Title XIX of the Social Security Act and Articles V (Medical
Assistance) and VI (General Assistance) of the Illinois
Public Aid Code (or any successor program) or under any
similar program of health care benefits in a state other than
Illinois.
"Medically necessary" means that a service, drug, or
supply is necessary and appropriate for the diagnosis or
treatment of an illness or injury in accord with generally
accepted standards of medical practice at the time the
service, drug, or supply is provided. When specifically
applied to a confinement it further means that the diagnosis
or treatment of the covered person's medical symptoms or
condition cannot be safely provided to that person as an
outpatient. A service, drug, or supply shall not be medically
necessary if it: (i) is investigational, experimental, or for
research purposes; or (ii) is provided solely for the
convenience of the patient, the patient's family, physician,
hospital, or any other provider; or (iii) exceeds in scope,
duration, or intensity that level of care that is needed to
provide safe, adequate, and appropriate diagnosis or
treatment; or (iv) could have been omitted without adversely
affecting the covered person's condition or the quality of
medical care; or (v) involves the use of a medical device,
drug, or substance not formally approved by the United States
Food and Drug Administration.
"Medical care" means the ordinary and usual professional
services rendered by a physician or other specified provider
during a professional visit for treatment of an illness or
injury.
"Medicare" means coverage under both Part A and Part B of
Title XVIII of the Social Security Act, 42 U.S.C. Sec. 1395,
et seq.
"Minimum premium plan" means an arrangement whereby a
specified amount of health care claims is self-funded, but
the insurance company assumes the risk that claims will
exceed that amount.
"Participating transplant center" means a hospital
designated by the Board as a preferred or exclusive provider
of services for one or more specified human organ or tissue
transplants for which the hospital has signed an agreement
with the Board to accept a transplant payment allowance for
all expenses related to the transplant during a transplant
benefit period.
"Physician" means a person licensed to practice medicine
pursuant to the Medical Practice Act of 1987.
"Plan" means the Comprehensive Health Insurance Plan
established by this Act.
"Plan of operation" means the plan of operation of the
Plan, including articles, bylaws and operating rules, adopted
by the board pursuant to this Act.
"Provider" means any hospital, skilled nursing facility,
hospice, home health agency, physician, registered pharmacist
acting within the scope of that registration, or any other
person or entity licensed in Illinois to furnish medical
care.
"Qualified high risk pool" has the same meaning given
that term in the federal Health Insurance Portability and
Accountability Act of 1996.
"Resident" means a person who is and continues to be
legally domiciled and physically residing on a permanent and
full-time basis in a place of permanent habitation in this
State that remains that person's principal residence and from
which that person is absent only for temporary or transitory
purpose.
"Skilled nursing facility" means a facility or that
portion of a facility that is licensed by the Illinois
Department of Public Health under the Nursing Home Care Act
or a comparable licensing authority in another state to
provide skilled nursing care.
"Stop-loss coverage" means an arrangement whereby an
insurer insures against the risk that any one claim will
exceed a specific dollar amount or that the entire loss of a
self-insurance plan will exceed a specific amount.
"Third party administrator" means an administrator as
defined in Section 511.101 of the Illinois Insurance Code who
is licensed under Article XXXI 1/4 of that Code.
(Source: P.A. 91-357, eff. 7-29-99; 91-735, eff. 6-2-00;
92-153, eff. 7-25-01; 93HB3298enr.)
(215 ILCS 105/4) (from Ch. 73, par. 1304)
Sec. 4. Powers and authority of the board. The board
shall have the general powers and authority granted under the
laws of this State to insurance companies licensed to
transact health and accident insurance and in addition
thereto, the specific authority to:
a. Enter into contracts as are necessary or proper to
carry out the provisions and purposes of this Act, including
the authority, with the approval of the Director, to enter
into contracts with similar plans of other states for the
joint performance of common administrative functions, or with
persons or other organizations for the performance of
administrative functions including, without limitation,
utilization review and quality assurance programs, or with
health maintenance organizations or preferred provider
organizations for the provision of health care services.
b. Sue or be sued, including taking any legal actions
necessary or proper.
c. Take such legal action as necessary to:
(1) avoid the payment of improper claims against
the plan or the coverage provided by or through the plan;
(2) to recover any amounts erroneously or
improperly paid by the plan;
(3) to recover any amounts paid by the plan as a
result of a mistake of fact or law; or
(4) to recover or collect any other amounts,
including assessments, that are due or owed the Plan or
have been billed on its or the Plan's behalf.
d. Establish appropriate rates, rate schedules, rate
adjustments, expense allowances, agents' referral fees, claim
reserves, and formulas and any other actuarial function
appropriate to the operation of the plan. Rates and rate
schedules may be adjusted for appropriate risk factors such
as age and area variation in claim costs and shall take into
consideration appropriate risk factors in accordance with
established actuarial and underwriting practices.
e. Issue policies of insurance in accordance with the
requirements of this Act.
f. Appoint appropriate legal, actuarial and other
committees as necessary to provide technical assistance in
the operation of the plan, policy and other contract design,
and any other function within the authority of the plan.
g. Borrow money to effect the purposes of the Illinois
Comprehensive Health Insurance Plan. Any notes or other
evidence of indebtedness of the plan not in default shall be
legal investments for insurers and may be carried as admitted
assets.
h. Establish rules, conditions and procedures for
reinsuring risks under this Act.
i. Employ and fix the compensation of employees. Such
employees may be paid on a warrant issued by the State
Treasurer pursuant to a payroll voucher certified by the
Board and drawn by the Comptroller against appropriations or
trust funds held by the State Treasurer.
j. Enter into intergovernmental cooperation agreements
with other agencies or entities of State government for the
purpose of sharing the cost of providing health care services
that are otherwise authorized by this Act for children who
are both plan participants and eligible for financial
assistance from the Division of Specialized Care for Children
of the University of Illinois.
k. Establish conditions and procedures under which the
plan may, if funds permit, discount or subsidize premium
rates that are paid directly by senior citizens, as defined
by the Board, and other plan participants, who are retired or
unemployed and meet other qualifications.
l. Establish and maintain the Plan Fund authorized in
Section 3 of this Act, which shall be divided into separate
accounts, as follows:
(1) accounts to fund the administrative, claim, and
other expenses of the Plan associated with eligible
persons who qualify for Plan coverage under Section 7 of
this Act, which shall consist of:
(A) premiums paid on behalf of covered
persons;
(B) appropriated funds and other revenues
collected or received by the Board;
(C) reserves for future losses maintained by
the Board; and
(D) interest earnings from investment of the
funds in the Plan Fund or any of its accounts other
than the funds in the account established under item
2 of this subsection;
(2) an account, to be denominated the federally
eligible individuals account, to fund the administrative,
claim, and other expenses of the Plan associated with
federally eligible individuals who qualify for Plan
coverage under Section 15 of this Act, which shall
consist of:
(A) premiums paid on behalf of covered
persons;
(B) assessments and other revenues collected
or received by the Board;
(C) reserves for future losses maintained by
the Board; and
(D) interest earnings from investment of the
federally eligible individuals account funds; and
(E) grants provided pursuant to the federal
Trade Adjustment Act of 2002; and
(3) such other accounts as may be appropriate.
m. Charge and collect assessments paid by insurers
pursuant to Section 12 of this Act and recover any
assessments for, on behalf of, or against those insurers.
(Source: P.A. 90-30, eff. 7-1-97; 91-357, eff. 7-29-99;
93HB3298enr.)
(215 ILCS 105/7) (from Ch. 73, par. 1307)
Sec. 7. Eligibility.
a. Except as provided in subsection (e) of this Section
or in Section 15 of this Act, any person who is either a
citizen of the United States or an alien lawfully admitted
for permanent residence and who has been for a period of at
least 180 days and continues to be a resident of this State
shall be eligible for Plan coverage under this Section if
evidence is provided of:
(1) A notice of rejection or refusal to issue
substantially similar individual health insurance
coverage for health reasons by a health insurance issuer;
or
(2) A refusal by a health insurance issuer to issue
individual health insurance coverage except at a rate
exceeding the applicable Plan rate for which the person
is responsible.
A rejection or refusal by a group health plan or health
insurance issuer offering only stop-loss or excess of loss
insurance or contracts, agreements, or other arrangements for
reinsurance coverage with respect to the applicant shall not
be sufficient evidence under this subsection.
b. The board shall promulgate a list of medical or
health conditions for which a person who is either a citizen
of the United States or an alien lawfully admitted for
permanent residence and a resident of this State would be
eligible for Plan coverage without applying for health
insurance coverage pursuant to subsection a. of this Section.
Persons who can demonstrate the existence or history of any
medical or health conditions on the list promulgated by the
board shall not be required to provide the evidence specified
in subsection a. of this Section. The list shall be
effective on the first day of the operation of the Plan and
may be amended from time to time as appropriate.
c. Family members of the same household who each are
covered persons are eligible for optional family coverage
under the Plan.
d. For persons qualifying for coverage in accordance
with Section 7 of this Act, the board shall, if it determines
that such appropriations as are made pursuant to Section 12
of this Act are insufficient to allow the board to accept all
of the eligible persons which it projects will apply for
enrollment under the Plan, limit or close enrollment to
ensure that the Plan is not over-subscribed and that it has
sufficient resources to meet its obligations to existing
enrollees. The board shall not limit or close enrollment for
federally eligible individuals.
e. A person shall not be eligible for coverage under the
Plan if:
(1) He or she has or obtains other coverage under a
group health plan or health insurance coverage
substantially similar to or better than a Plan policy as
an insured or covered dependent or would be eligible to
have that coverage if he or she elected to obtain it.
Persons otherwise eligible for Plan coverage may,
however, solely for the purpose of having coverage for a
pre-existing condition, maintain other coverage only
while satisfying any pre-existing condition waiting
period under a Plan policy or a subsequent replacement
policy of a Plan policy.
(1.1) His or her prior coverage under a group
health plan or health insurance coverage, provided or
arranged by an employer of more than 10 employees was
discontinued for any reason without the entire group or
plan being discontinued and not replaced, provided he or
she remains an employee, or dependent thereof, of the
same employer.
(2) He or she is a recipient of or is approved to
receive medical assistance, except that a person may
continue to receive medical assistance through the
medical assistance no grant program, but only while
satisfying the requirements for a preexisting condition
under Section 8, subsection f. of this Act. Payment of
premiums pursuant to this Act shall be allocable to the
person's spenddown for purposes of the medical assistance
no grant program, but that person shall not be eligible
for any Plan benefits while that person remains eligible
for medical assistance. If the person continues to
receive or be approved to receive medical assistance
through the medical assistance no grant program at or
after the time that requirements for a preexisting
condition are satisfied, the person shall not be eligible
for coverage under the Plan. In that circumstance,
coverage under the plan shall terminate as of the
expiration of the preexisting condition limitation
period. Under all other circumstances, coverage under
the Plan shall automatically terminate as of the
effective date of any medical assistance.
(3) Except as provided in Section 15, the person
has previously participated in the Plan and voluntarily
terminated Plan coverage, unless 12 months have elapsed
since the person's latest voluntary termination of
coverage.
(4) The person fails to pay the required premium
under the covered person's terms of enrollment and
participation, in which event the liability of the Plan
shall be limited to benefits incurred under the Plan for
the time period for which premiums had been paid and the
covered person remained eligible for Plan coverage.
(5) The Plan has paid a total of $1,000,000 in
benefits on behalf of the covered person.
(6) The person is a resident of a public
institution.
(7) The person's premium is paid for or reimbursed
under any government sponsored program or by any
government agency or health care provider, except as an
otherwise qualifying full-time employee, or dependent of
such employee, of a government agency or health care
provider or, except when a person's premium is paid by
the U.S. Treasury Department pursuant to the federal
Trade Adjustment Act of 2002.
(8) The person has or later receives other benefits
or funds from any settlement, judgement, or award
resulting from any accident or injury, regardless of the
date of the accident or injury, or any other
circumstances creating a legal liability for damages due
that person by a third party, whether the settlement,
judgment, or award is in the form of a contract,
agreement, or trust on behalf of a minor or otherwise and
whether the settlement, judgment, or award is payable to
the person, his or her dependent, estate, personal
representative, or guardian in a lump sum or over time,
so long as there continues to be benefits or assets
remaining from those sources in an amount in excess of
$100,000.
(9) Within the 5 years prior to the date a person's
Plan application is received by the Board, the person's
coverage under any health care benefit program as defined
in 18 U.S.C. 24, including any public or private plan or
contract under which any medical benefit, item, or
service is provided, was terminated as a result of any
act or practice that constitutes fraud under State or
federal law or as a result of an intentional
misrepresentation of material fact; or if that person
knowingly and willfully obtained or attempted to obtain,
or fraudulently aided or attempted to aid any other
person in obtaining, any coverage or benefits under the
Plan to which that person was not entitled.
f. The board or the administrator shall require
verification of residency and may require any additional
information or documentation, or statements under oath, when
necessary to determine residency upon initial application and
for the entire term of the policy.
g. Coverage shall cease (i) on the date a person is no
longer a resident of Illinois, (ii) on the date a person
requests coverage to end, (iii) upon the death of the covered
person, (iv) on the date State law requires cancellation of
the policy, or (v) at the Plan's option, 30 days after the
Plan makes any inquiry concerning a person's eligibility or
place of residence to which the person does not reply.
h. Except under the conditions set forth in subsection g
of this Section, the coverage of any person who ceases to
meet the eligibility requirements of this Section shall be
terminated at the end of the current policy period for which
the necessary premiums have been paid.
(Source: P.A. 90-30, eff. 7-1-97; 91-639, eff. 8-20-99;
91-735, eff. 6-2-00; 93HB3298enr.)
(215 ILCS 105/15)
Sec. 15. Alternative portable coverage for federally
eligible individuals.
(a) Notwithstanding the requirements of subsection a. of
Section 7 and except as otherwise provided in this Section,
any federally eligible individual for whom a Plan
application, and such enclosures and supporting documentation
as the Board may require, is received by the Board within 90
days after the termination of prior creditable coverage shall
qualify to enroll in the Plan under the portability
provisions of this Section.
A federally eligible person who between December 1, 2002
and September 30, 2003 has either (1) been certified as
eligible pursuant to the federal Trade Act of 2002, (2)
initially been paid a benefit by the Pension Benefit Guaranty
Corporation, or (3) as of December 1, 2002, been receiving
benefits from the Pension Benefit Guaranty Corporation, who
has qualified health insurance, as defined by the federal
Trade Act of 2002, and whose Plan application and enclosures
and supporting documentation, as the Board may require, is
received by the Board after the termination of previous
creditable coverage shall qualify to enroll in the Plan under
the portability provisions of this Section.
A federally eligible person who, after September 30,
2003, has either been certified as an eligible person
pursuant to the federal Trade Adjustment Act of 2002 or
initially been paid a benefit by the Pension Benefit Guaranty
Corporation and whose Plan application and enclosures and
supporting documentation as the Board may require is received
by the Board within 63 days after the termination of previous
creditable coverage shall qualify to enroll in the Plan under
the portability provisions of this Section.
(b) Any federally eligible individual seeking Plan
coverage under this Section must submit with his or her
application evidence, including acceptable written
certification of previous creditable coverage, that will
establish to the Board's satisfaction, that he or she meets
all of the requirements to be a federally eligible individual
and is currently and permanently residing in this State (as
of the date his or her application was received by the
Board).
(c) Except as otherwise provided in this Section, a
period of creditable coverage shall not be counted, with
respect to qualifying an applicant for Plan coverage as a
federally eligible individual under this Section, if after
such period and before the application for Plan coverage was
received by the Board, there was at least a 90 day period
during all of which the individual was not covered under any
creditable coverage.
For a federally eligible person who between December 1,
2002 and September 30, 2003 has either (1) been certified as
eligible pursuant to the federal Trade Act of 2002, (2)
initially been paid a benefit by the Pension Benefit Guaranty
Corporation, or (3) as of December 1, 2002, been receiving
benefits from the Pension Benefit Guaranty Corporation and
who has qualified health insurance, as defined by the federal
Trade Act of 2002, a period of creditable coverage shall be
counted, with respect to qualifying an applicant for Plan
coverage as a federally eligible individual under this
Section, when the application for Plan coverage was received
by the Board.
For a federally eligible person who, after September 30,
2003, has either been certified as an eligible person
pursuant to the federal Trade Adjustment Act of 2002 or
initially been paid a benefit by the Pension Benefit Guaranty
Corporation, a period of creditable coverage shall not be
counted, with respect to qualifying an applicant for Plan
coverage as a federally eligible individual under this
Section, if after such period and before the application for
Plan coverage was received by the Board, there was at least a
63 day period during all of which the individual was not
covered under any creditable coverage.
(d) Any federally eligible individual who the Board
determines qualifies for Plan coverage under this Section
shall be offered his or her choice of enrolling in one of
alternative portability health benefit plans which the Board
is authorized under this Section to establish for these
federally eligible individuals and their dependents.
(e) The Board shall offer a choice of health care
coverages consistent with major medical coverage under the
alternative health benefit plans authorized by this Section
to every federally eligible individual. The coverages to be
offered under the plans, the schedule of benefits,
deductibles, co-payments, exclusions, and other limitations
shall be approved by the Board. One optional form of
coverage shall be comparable to comprehensive health
insurance coverage offered in the individual market in this
State or a standard option of coverage available under the
group or individual health insurance laws of the State. The
standard benefit plan that is authorized by Section 8 of this
Act may be used for this purpose. The Board may also offer a
preferred provider option and such other options as the Board
determines may be appropriate for these federally eligible
individuals who qualify for Plan coverage pursuant to this
Section.
(f) Notwithstanding the requirements of subsection f. of
Section 8, any plan coverage that is issued to federally
eligible individuals who qualify for the Plan pursuant to the
portability provisions of this Section shall not be subject
to any preexisting conditions exclusion, waiting period, or
other similar limitation on coverage.
(g) Federally eligible individuals who qualify and
enroll in the Plan pursuant to this Section shall be required
to pay such premium rates as the Board shall establish and
approve in accordance with the requirements of Section 7.1 of
this Act.
(h) A federally eligible individual who qualifies and
enrolls in the Plan pursuant to this Section must satisfy on
an ongoing basis all of the other eligibility requirements of
this Act to the extent not inconsistent with the federal
Health Insurance Portability and Accountability Act of 1996
in order to maintain continued eligibility for coverage under
the Plan.
(Source: P.A. 92-153, eff. 7-25-01; 93HB3298enr.)
Section 99. Effective date. This Act takes effect upon
becoming law.
Effective Date: 06/23/03
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