Public Act 90-0736 of the 90th General Assembly

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Public Act 90-0736

HB0705 Enrolled                                LRB9002464JScc

    AN ACT regarding health insurance for children.

    Be it enacted by the People of  the  State  of  Illinois,
represented in the General Assembly:

    Section  1.   Short  title.  This Act may be cited as the
Children's Health Insurance Program Act.

    Section 5.  Legislative  intent.   The  General  Assembly
finds  that,  for  the  economic  and  social  benefit of all
citizens of the State, it is important to  enable  low-income
children  of  this  State,  to the extent funding permits, to
access health benefits coverage, especially preventive health
care.  The General Assembly  recognizes  that  assistance  to
help   families   purchase  health  benefits  for  low-income
children must be provided in a fair and equitable fashion and
must treat all children at the same income level in a similar
fashion.   The  State  of  Illinois  should  help  low-income
families  transition  from  a  health   care   system   where
government  partners with families to provide health benefits
to low-income children to a system where families with higher
incomes eventually transition into private or employer  based
health  plans.   This  Act  is  not  intended  to  create  an
entitlement.

    Section 10.  Definitions.  As used in this Act:
    "Benchmarking"  means health benefits coverage as defined
in Section 2103 of the Social Security Act.
    "Child" means a person under the age of 19.
    "Department" means the Department of Public Aid.
    "Medical assistance" means health care benefits  provided
under Article V of the Illinois Public Aid Code.
    "Medical  visit"  means  a  hospital,  dental, physician,
optical, or  other  health  care  visit  where  services  are
provided pursuant to this Act.
    "Program"  means the Children's Health Insurance Program,
which includes subsidizing the cost  of  privately  sponsored
health  insurance  and  purchasing  or  providing health care
benefits for eligible children.
    "Resident"  means  a  person  who  meets  the   residency
requirements as defined in Section 5-3 of the Illinois Public
Aid Code.

    Section  15.   Operation of the Program.  There is hereby
created a Children's Health Insurance Program.   The  Program
shall   operate   subject   to  appropriation  and  shall  be
administered by the Department of Public Aid.  The Department
shall have the powers and authority granted to the Department
under the Illinois  Public  Aid  Code.   The  Department  may
contract  with  a Third Party Administrator or other entities
to administer and oversee any portion of this Program.

    Section 20.  Eligibility.
    (a)  To be eligible for this Program, a person must be  a
person  who  has  a  child eligible under this Act and who is
eligible under a waiver of federal requirements  pursuant  to
an application made pursuant to subdivision (a)(1) of Section
40 of this Act or who is a child who:
         (1)  is  a  child  who  is  not eligible for medical
    assistance;
         (2)  is a child whose annual  household  income,  as
    determined  by  the  Department,  is  above  133%  of the
    federal poverty level and at or below 185% of the federal
    poverty level;
         (3)  is a  resident of the State of Illinois; and
         (4)  is a  child  who  is  either  a  United  States
    citizen or included in one of the following categories of
    non-citizens:
              (A)  unmarried  dependent  children of either a
         United States  Veteran  honorably  discharged  or  a
         person on active military duty;
              (B)  refugees   under   Section   207   of  the
         Immigration and Nationality Act;
              (C)  asylees   under   Section   208   of   the
         Immigration and Nationality Act;
              (D)  persons  for  whom  deportation  has  been
         withheld under Section  243(h)  of  the  Immigration
         and Nationality Act;
              (E)  persons  granted  conditional  entry under
         Section 203(a)(7) of the Immigration and Nationality
         Act as in effect prior to April 1, 1980;
              (F)  persons lawfully  admitted  for  permanent
         residence under the Immigration and Nationality Act;
         and
              (G)  parolees,  for  at  least  one year, under
         Section 212(d)(5) of the Immigration and Nationality
         Act.
    Those children who are in the  categories  set  forth  in
subdivisions  (4)(F) and (4)(G) of this subsection, who enter
the United States on or after August 22, 1996, shall  not  be
eligible  for 5 years beginning on the date the child entered
the United States.
    (b)  A  child  who  is  determined  to  be  eligible  for
assistance shall remain eligible for 12 months, provided  the
child  maintains  his  or her residence in the State, has not
yet attained 19 years of age, and is not excluded pursuant to
subsection (c).  Eligibility shall be  re-determined  by  the
Department at least annually.
    (c)  A  child  shall  not  be eligible for coverage under
this Program if:
         (1)  the premium required pursuant to Section 30  of
    this Act has not been paid.  If the required premiums are
    not paid the liability of the Program shall be limited to
    benefits  incurred  under the Program for the time period
    for which  premiums  had  been  paid.   If  the  required
    monthly   premium   is  not  paid,  the  child  shall  be
    ineligible for re-enrollment for a minimum  period  of  3
    months.   Re-enrollment  shall  be completed prior to the
    next covered medical visit and the first month's required
    premium shall be paid in  advance  of  the  next  covered
    medical  visit.   The  Department  shall promulgate rules
    regarding grace periods, notice requirements, and hearing
    procedures pursuant to this subsection;
         (2)  the child is an inmate of a public  institution
    or a patient in an institution for mental diseases; or
         (3)  the  child  is  a  member  of  a family that is
    eligible for health benefits covered under the  State  of
    Illinois  health benefits plan on the basis of a member's
    employment with a public agency.

    Section 25.  Health benefits for children.
    (a)  The  Department  shall,  subject  to  appropriation,
provide health benefits coverage to eligible children by:
         (1)  Subsidizing the  cost  of  privately  sponsored
    health   insurance,   including   employer  based  health
    insurance,  to  assist  families  to  take  advantage  of
    available privately sponsored health insurance for  their
    eligible children; and
         (2)  Purchasing  or  providing  health care benefits
    for eligible  children.   The  health  benefits  provided
    under   this   subdivision   (a)(2)   shall,  subject  to
    appropriation and without regard to any  applicable  cost
    sharing  under  Section  30, be identical to the benefits
    provided for children under  the  State's  approved  plan
    under  Title  XIX  of the Social Security Act.  Providers
    under  this  subdivision  (a)(2)  shall  be  subject   to
    approval  by  the Department to provide health care under
    the Illinois Public Aid Code and shall be  reimbursed  at
    the  same  rate  as  providers under the State's approved
    plan under Title XIX  of  the  Social  Security  Act.  In
    addition,   providers   may   retain   co-payments   when
    determined appropriate by the Department.
    (b)  The  subsidization  provided pursuant to subdivision
(a)(1) shall be credited to the family of the eligible child.
    (c)  The Department is prohibited from  denying  coverage
to  a  child  who is enrolled in a privately sponsored health
insurance plan pursuant to  subdivision  (a)(1)  because  the
plan  does  not  meet  federal benchmarking standards or cost
sharing and contribution requirements.  To  be  eligible  for
inclusion   in   the   Program,   the   plan   shall  contain
comprehensive major medical coverage which shall  consist  of
physician  and hospital inpatient services. The Department is
prohibited from denying coverage to a child who  is  enrolled
in  a  privately  sponsored health insurance plan pursuant to
subdivision  (a)(1)  because  the  plan  offers  benefits  in
addition to physician and hospital inpatient services.
    (d)  The total dollar amount of subsidizing coverage  per
child per month pursuant to subdivision (a)(1) shall be equal
to  the  average dollar payments, less premiums incurred, per
child  per  month  pursuant  to  subdivision  (a)(2).     The
Department shall set this amount prospectively based upon the
prior  fiscal year's experience adjusted for incurred but not
reported claims and estimated increases or decreases  in  the
cost  of  medical  care.   Payments  obligated before July 1,
1999, will be computed using State Fiscal Year 1996  payments
for  children  eligible  for  Medical  Assistance  and income
assistance under the Aid to Families with Dependent  Children
Program,   with   appropriate   adjustments   for   cost  and
utilization changes through January 1, 1999.  The  Department
is   prohibited   from   providing   a  subsidy  pursuant  to
subdivision (a)(1) that is more than the individual's monthly
portion of the premium.
    (e)  An eligible  child  may  obtain  immediate  coverage
under  this  Program  only  once  during a medical visit.  If
coverage lapses, re-enrollment shall be completed in  advance
of  the  next  covered  medical  visit  and the first month's
required premium shall be paid  in  advance  of  any  covered
medical visit.
    (f)  In   order   to   accelerate   and   facilitate  the
development of networks to deliver services  to  children  in
areas   outside   counties  with  populations  in  excess  of
3,000,000, in  the  event  less  than  25%  of  the  eligible
children in a county or contiguous counties has enrolled with
a Health Maintenance Organization pursuant to Section 5-11 of
the  Illinois Public Aid Code, the Department may develop and
implement  demonstration  projects  to   create   alternative
networks  designed to enhance enrollment and participation in
the program.  The Department  shall  prescribe  by  rule  the
criteria,    standards,    and   procedures   for   effecting
demonstration projects under this Section.

    Section 30.  Cost sharing.
    (a)  Children  enrolled  in  a  health  benefits  program
pursuant to subdivision (a)(2) of Section 25 shall be subject
to the following cost sharing requirements:
         (1)  There  shall  be  no  co-payment  required  for
    well-baby or well-child care,  including  age-appropriate
    immunizations as required under federal law.
         (2)  Health   insurance  premiums  for  children  in
    families whose household income is at or  above  150%  of
    the  federal  poverty  level  shall  be  payable monthly,
    subject to rules promulgated by the Department for  grace
    periods and advance payments, and shall be as follows:
              (A)  $15 per month for one child.
              (B)  $25 per month for 2 children.
              (C)  $30 per month for 3 or more children.
         (3)  Co-payments  for  children  in  families  whose
    income  is  below 150% of the federal poverty level, at a
    minimum and to the extent permitted  under  federal  law,
    shall  be  $2  for  all  medical visits and prescriptions
    provided under this Act.
         (4)  Co-payments  for  children  in  families  whose
    income is at or above 150% of the federal poverty  level,
    at  a  minimum  and to the extent permitted under federal
    law shall be as follows:
              (A)  $5 for medical visits.
              (B)  $3 for generic prescriptions  and  $5  for
         brand name prescriptions.
              (C)  $25   for   emergency   room   use  for  a
         non-emergency situation as defined by the Department
         by rule.
         (5)  The maximum amount  of  out-of-pocket  expenses
    for co-payments shall be $100 per family per year.
    (b)  Individuals enrolled in a privately sponsored health
insurance  plan  pursuant to subdivision (a)(1) of Section 25
shall be subject to the cost sharing provisions as stated  in
the privately sponsored health insurance plan.

    Section 35.  Funding.
    (a)  This  Program is not an entitlement and shall not be
construed to create  an  entitlement.   Eligibility  for  the
Program is subject to appropriation of funds by the State and
federal  governments.  Subdivision (a)(2) of Section 25 shall
operate and be funded only if subdivision (a)(1)  of  Section
25  is  operational and funded. The estimated net State share
of appropriated funds for subdivision (a)(2)  of  Section  25
shall   be   equal  to  the  estimated  net  State  share  of
appropriated funds for subdivision (a)(1) of Section 25.



    (b)  Any requirement  imposed  under  this  Act  and  any
implementation  of  this Act by the Department shall cease in
the  event  (1)  continued  receipt  of  federal  funds   for
implementation of this Act requires an amendment to this Act,
or  (2)  federal  funds for implementation of the Act are not
otherwise available.
    (c)  Payments under this Act shall be  appropriated  from
the General Revenue Fund.
    (d)  Benefits  under  this Act shall be available only as
long as the intergovernmental  agreements  made  pursuant  to
Section 12-4.7 and Article XV of the Illinois Public Aid Code
and  entered  into between the Department and the Cook County
Board of Commissioners continue to exist.

    Section 40.  Waivers.
    (a)  The Department shall request any  necessary  waivers
of  federal requirements in order to allow receipt of federal
funding for:
         (1)  the coverage of families with eligible children
    under this Act; and
         (2)  for  the  coverage  of   children   who   would
    otherwise be eligible under this Act, but who have health
    insurance.
    (b)  The  failure  of  the  responsible federal agency to
approve a waiver for children who would otherwise be eligible
under this Act  but  who  have  health  insurance  shall  not
prevent  the  implementation  of  any  Section  of  this  Act
provided that there are sufficient appropriated funds.

    Section 45.  Study.
    (a)  The Department shall conduct a study which includes,
but is not limited to, the following:
         (1)  Establishes  estimates,  broken down by regions
    of the State, of  the  number  of  children  with  health
    insurance coverage and without health insurance coverage;
    the number of children who are eligible for Medicaid, and
    of  that number, the number who are enrolled in Medicaid;
    the number of children with access to dependent  coverage
    through  an  employer, and of that number, the number who
    are enrolled in dependent coverage through an employer.
         (2)  Ascertains,  for  the  population  of  children
    potentially eligible for coverage under any component  of
    the  Program, the extent of access to dependent coverage,
    how many children are enrolled in dependent coverage, the
    comprehensiveness of dependent coverage benefit  packages
    available,  and the amount of cost sharing currently paid
    by the employees.
    (b)  The Department shall submit the preliminary  results
of  the  study  to  the  Governor and the General Assembly by
December 1, 1998 and shall submit the final  results  to  the
Governor and the General Assembly by May 1, 1999.

    Section  50.   Program  evaluation.  The Department shall
conduct 2 evaluations of the  effectiveness  of  the  program
implemented  under  this  Act.  The first evaluation shall be
for the first  6  full  months  of  implementation,  and  the
evaluation  shall  be  completed  within  90  days after that
period.  The second evaluation shall be for the first 12 full
months of implementation and shall  be  completed  within  90
days after that period.

    Section 55.  Contracts with non-governmental bodies.  All
contracts with non-governmental bodies that are determined by
the Department to be necessary for the implementation of this
Section  are  deemed to be purchase of care as defined in the
Illinois Procurement Code.

    Section 60.  Emergency rulemaking.   Prior  to  June  30,
1999,  the  Department may adopt rules necessary to establish
and implement this  Section  through  the  use  of  emergency
rulemaking  in  accordance  with Section 5-45 of the Illinois
Administrative Procedure Act.  For purposes of that Act,  the
General   Assembly  finds  that  the  adoption  of  rules  to
implement this Section is deemed an emergency  and  necessary
for the public interest, safety, and welfare.

    Section  96.  Inseverability.  The provisions of this Act
are mutually dependent and inseverable.  If any provision  or
its  application  to  any  person  or  circumstance  is  held
invalid, then this entire Act is invalid.

    Section  97.  Repealer.  This Act is repealed on June 30,
2001.

    Section 98.  The Illinois  Health  Insurance  Portability
and  Accountability  Act is amended by changing Section 20 as
follows:

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

    Section  99.  Effective Date.  This Act takes effect upon
becoming law.

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