Full Text of SB3172 93rd General Assembly
SB3172 93RD GENERAL ASSEMBLY
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93RD GENERAL ASSEMBLY
State of Illinois
2003 and 2004 SB3172
Introduced 2/6/2004, by Ira I. Silverstein SYNOPSIS AS INTRODUCED: |
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215 ILCS 5/363 |
from Ch. 73, par. 975 |
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Amends the Illinois Insurance Code. Prohibits issuers of Medicare supplemental policies or certificates available for sale in this State from discriminating in the pricing of a policy or certificate because of the health status, claims experience, receipt of health care, or medical condition of an applicant in the case of an application for a policy or certificate that is submitted within 6 months of the first day on which the person enrolls for benefits under Medicare Part B or within a 6 month period beginning with the month in which the person received notice of retroactive eligibility to enroll. Requires issuers to: make available to persons eligible for Medicare without regard to age each type of Medicare supplement policy the issuer currently makes available in this State; and provide the rights granted by the new provisions to any person who had enrolled for benefits under Medicare Part B prior to this amendatory Act who otherwise would have been eligible for coverage under the new provisions.
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A BILL FOR
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SB3172 |
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LRB093 16343 SAS 41981 b |
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| AN ACT concerning insurance.
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| Be it enacted by the People of the State of Illinois,
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| represented in the General Assembly:
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| Section 5. The Illinois Insurance Code is amended by | 5 |
| changing Section 363 as follows:
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| (215 ILCS 5/363) (from Ch. 73, par. 975)
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| Sec. 363. Medicare supplement policies; minimum standards.
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| (1) Except as otherwise specifically provided therein, | 9 |
| this
Section and Section 363a of this Code shall apply to:
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| (a) all Medicare supplement policies and subscriber | 11 |
| contracts delivered
or issued for delivery in this State on | 12 |
| and after January 1, 1989; and
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| (b) all certificates issued under group Medicare | 14 |
| supplement policies or
subscriber contracts, which | 15 |
| certificates are issued or issued for delivery
in this | 16 |
| State on and after January 1, 1989.
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| This Section shall not apply to "Accident Only" or | 18 |
| "Specified Disease"
types of policies. The provisions of this | 19 |
| Section are not intended to prohibit
or apply to policies or | 20 |
| health care benefit plans, including group
conversion | 21 |
| policies, provided to Medicare eligible persons, which | 22 |
| policies
or plans are not marketed or purported or held to be | 23 |
| Medicare supplement
policies or benefit plans.
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| (2) For the purposes of this Section and Section 363a, the | 25 |
| following
terms have the following meanings:
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| (a) "Applicant" means:
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| (i) in the case of individual Medicare supplement | 28 |
| policy, the person
who seeks to contract for insurance | 29 |
| benefits, and
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| (ii) in the case of a group Medicare policy or | 31 |
| subscriber contract, the
proposed certificate holder.
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| (b) "Certificate" means any certificate delivered or |
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LRB093 16343 SAS 41981 b |
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| issued for
delivery in this State under a group Medicare
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| supplement policy.
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| (c) "Medicare supplement policy" means an individual
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| policy of
accident and health insurance, as defined in | 5 |
| paragraph (a) of subsection (2)
of Section 355a of this | 6 |
| Code, or a group policy or certificate delivered or
issued | 7 |
| for
delivery in this State by an insurer, fraternal benefit | 8 |
| society, voluntary
health service plan, or health | 9 |
| maintenance organization, other than a policy
issued | 10 |
| pursuant to a contract under Section 1876 of the
federal
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| Social Security Act (42 U.S.C. Section 1395 et seq.) or a | 12 |
| policy
issued under
a
demonstration project specified in 42 | 13 |
| U.S.C. Section 1395ss(g)(1), or
any similar organization, | 14 |
| that is advertised, marketed, or designed
primarily as a | 15 |
| supplement to reimbursements under Medicare for the
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| hospital, medical, or surgical expenses of persons | 17 |
| eligible for Medicare.
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| (d) "Issuer" includes insurance companies, fraternal | 19 |
| benefit
societies, voluntary health service plans, health | 20 |
| maintenance
organizations, or any other entity providing | 21 |
| Medicare supplement insurance,
unless the context clearly | 22 |
| indicates otherwise.
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| (e) "Medicare" means the Health Insurance for the Aged | 24 |
| Act, Title
XVIII of the Social Security Amendments of 1965.
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| (3) No medicare supplement insurance policy, contract, or
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| certificate,
that provides benefits that duplicate benefits | 27 |
| provided by Medicare, shall
be issued or issued for delivery in | 28 |
| this State after December 31, 1988. No
such policy, contract, | 29 |
| or certificate shall provide lesser benefits than
those | 30 |
| required under this Section or the existing Medicare Supplement
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| Minimum Standards Regulation, except where duplication of | 32 |
| Medicare benefits
would result.
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| (4) Medicare supplement policies or certificates shall | 34 |
| have a
notice
prominently printed on the first page of the | 35 |
| policy or attached thereto
stating in substance that the | 36 |
| policyholder or certificate holder shall have
the right to |
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LRB093 16343 SAS 41981 b |
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| return the policy or certificate within 30 days of its
delivery | 2 |
| and to have the premium refunded directly to him or her in a
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| timely manner if, after examination of the policy or | 4 |
| certificate, the
insured person is not satisfied for any | 5 |
| reason.
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| (5) A Medicare supplement policy or certificate may not | 7 |
| deny a
claim
for losses incurred more than 6 months from the | 8 |
| effective date of coverage
for a preexisting condition. The | 9 |
| policy may not define a preexisting
condition more | 10 |
| restrictively than a condition for which medical advice was
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| given or treatment was recommended by or received from a | 12 |
| physician within 6
months before the effective date of | 13 |
| coverage.
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| (5.5) An issuer of a Medicare supplement policy shall:
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| (a) not deny coverage or condition the issuance or | 16 |
| effectiveness of any Medicare supplement policy or | 17 |
| certificate available for sale in this State, nor | 18 |
| discriminate in the pricing of a policy or certificate | 19 |
| because of the health status, claims experience, receipt of | 20 |
| health care, or medical condition of an applicant in the | 21 |
| case of an application for a policy or certificate that is | 22 |
| submitted within 6 months of the first day on which the | 23 |
| person enrolls for benefits under Medicare Part B; for a | 24 |
| person who is retroactively enrolled in Medicare Part B due | 25 |
| to a retroactive eligibility decision made by the Social | 26 |
| Security Administration, the application must be submitted | 27 |
| within a 6-month period beginning with the month in which | 28 |
| the person received notice of retroactive eligibility to | 29 |
| enroll; | 30 |
| (b) make available to persons eligible for Medicare | 31 |
| without regard to age each type of Medicare supplement | 32 |
| policy the issuer currently makes available in this State; | 33 |
| (c) provide the rights granted by items (a) through (c) | 34 |
| for 6 months after the effective date of this amendatory | 35 |
| Act of the 93rd General Assembly, to any person who had | 36 |
| enrolled for benefits under Medicare Part B prior to this |
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| amendatory Act of the 93rd General Assembly who otherwise | 2 |
| would have been eligible for coverage under item (a).
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| (6) The Director shall issue reasonable rules and | 4 |
| regulations
for the
following purposes:
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| (a) To establish specific standards for policy | 6 |
| provisions of Medicare
policies and certificates. The | 7 |
| standards shall be in
accordance with the requirements of | 8 |
| this Code. No requirement of this Code
relating to minimum | 9 |
| required policy benefits, other than the minimum
standards | 10 |
| contained in this Section and Section 363a, shall apply to
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| medicare supplement policies and certificates. The | 12 |
| standards may
cover, but are not limited to the following:
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| (A) Terms of renewability.
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| (B) Initial and subsequent terms of eligibility.
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| (C) Non-duplication of coverage.
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| (D) Probationary and elimination periods.
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| (E) Benefit limitations, exceptions and | 18 |
| reductions.
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| (F) Requirements for replacement.
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| (G) Recurrent conditions.
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| (H) Definition of terms.
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| (I) Requirements for issuing rebates or credits to | 23 |
| policyholders
if the policy's loss ratio does not | 24 |
| comply with subsection (7) of
Section 363a.
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| (J) Uniform methodology for the calculating and | 26 |
| reporting of loss
ratio information.
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| (K) Assuring public access to loss ratio | 28 |
| information of an issuer of
Medicare supplement | 29 |
| insurance.
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| (L) Establishing a process for approving or | 31 |
| disapproving proposed
premium increases.
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| (M) Establishing a policy for holding public | 33 |
| hearings prior to
approval of premium increases.
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| (N) Establishing standards for Medicare Select | 35 |
| policies.
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| (O) Prohibited policy provisions not otherwise |
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| specifically authorized
by statute that, in the | 2 |
| opinion of the Director, are unjust, unfair, or
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| unfairly discriminatory to any person insured or | 4 |
| proposed for coverage
under a medicare supplement | 5 |
| policy or certificate.
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| (b) To establish minimum standards for benefits and | 7 |
| claims payments,
marketing practices, compensation | 8 |
| arrangements, and reporting practices
for Medicare | 9 |
| supplement policies.
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| (c) To implement transitional requirements of Medicare | 11 |
| supplement
insurance benefits and premiums of Medicare | 12 |
| supplement policies and
certificates to conform to | 13 |
| Medicare program revisions.
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| (Source: P.A. 88-313; 89-484, eff. 6-21-96.)
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