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