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LRB093 17899 SAS 43582 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 1. Short title. This Act may be cited as the |
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| Illinois Consumer Choice of Benefits Health Insurance Plan Act. |
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| Section 5. Purpose. The legislature recognizes the need for |
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| individuals, employers, and other purchasers of coverage in |
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| this State to have the opportunity to choose health insurance |
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| plans that are more affordable and flexible than existing |
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| market policies offering accident and health insurance |
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| coverage. The legislature, therefore, seeks to increase the |
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| availability of health insurance coverage by allowing insurers |
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| authorized to engage in the business of insurance in this state |
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| to issue accident and health policies that, in whole or in |
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| part, do not offer or provide state-mandated health benefits. |
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| Section 10. Definitions. For purposes of this Act: |
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| (a) "Consumer Choice of Benefits Health Insurance Plan" |
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| means an accident or health insurance policy that, in whole or |
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| in part, does not offer and provide state-mandated health |
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| benefits, but that provides creditable coverage as defined by |
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| Section 20 of the Illinois Health Insurance Portability and |
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| Accountability Act. |
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| (b) "Department" means the Department of Insurance. |
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| (c) "Director" means the Director of Insurance. |
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| (d) "Insurer" means an insurance company actively engaged |
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| in issuing approved policies of accident and health insurance |
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| in Illinois prior to the effective date of this Act.
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| Section 15. State-mandated health benefits. |
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| (a) For purposes of this Act, "state-mandated health |
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| benefits" means coverage required under this Act or other laws |
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LRB093 17899 SAS 43582 b |
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| of this State to be provided in an individual major medical, |
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| blanket, or group major medical policy for accident and health |
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| insurance or a contract for a health-related condition that:
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| (1) includes coverage for specific health care |
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| services or benefits; |
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| (2) places limitations of restrictions on deductibles, |
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| coinsurance, copayments, or any annual or lifetime maximum |
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| benefit amounts; or |
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| (3) includes coverage for a specific category of |
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| licensed health care practitioner from whom an insured is |
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| entitled to receive care. |
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| (b) For purposes of this Act, "state-mandated health |
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| benefits" does not include benefits that are mandated by |
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| federal law or standard provisions or rights required under |
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| this Act or other laws of this State to be provided in a group |
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| major medical policy for accident and health insurance that are |
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| unrelated to specific health illnesses, injuries, or |
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| conditions of an insured, including provisions related to: |
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| (1) continuation of coverage under Sections 367e, |
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| 367f, 367g, 367h, 367j, 367.2, and 367.2-5 of the Illinois |
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| Insurance Code; |
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| (2) conversion coverage under Sections 356d and |
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| 367e(A) of the Illinois Insurance Code; |
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| (3) preexisting conditions under: |
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| (A) Section 20 of the Illinois Health Insurance |
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| Portability and Accountability Act; |
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| (B) Section 367i of the Illinois Insurance Code; |
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| and |
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| (C) Part 2005 of Chapter 1 of Title 50 of the |
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| Illinois Administrative Code; |
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| (4) coverage for children, including newborn or |
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| adopted children, under Sections 356c, 356h, and 367b of |
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| the Illinois Insurance Code; |
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| (5) timely payment of claims under Section 368a of the |
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| Illinois Insurance Code; |
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| (6) a consumer's right to an adequate and accessible |
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LRB093 17899 SAS 43582 b |
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| network under Section 370i of the Illinois Insurance Code. |
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| These rights shall not be waived under a Consumer Choice of |
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| Benefits Health Insurance Plan product; |
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| (7) coverage for mental health services and mental |
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| illness rehabilitation services under Sections 367c and |
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| 367d of the Illinois Insurance Code. |
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| (c) For purposes of this Act, "state-mandated health |
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| benefits" does not include benefits that are mandated by |
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| federal law or standard provisions or rights required under |
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| this Act or other laws of this state to be provided in an |
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| individual major medical or, blanket, policy for accident and |
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| health insurance that are unrelated to specific health |
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| illnesses, injuries, or conditions of an insured, including |
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| provisions related to: |
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| (1) preexisting conditions under Part 2005 of Chapter 1 |
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| of Title 50 of the Illinois Administrative Code; |
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| (2) coverage for children, including newborn or |
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| adopted children, under Sections 356b, 356c, and 356h of |
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| the Illinois Insurance Code; |
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| (3) timely payment of claims under Section 368a of the |
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| Illinois Insurance Code; |
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| (4) a consumer's right to an adequate and accessible |
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| network under Section 370i of the Illinois Insurance Code; |
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| (5) coverage requirements for individual policies |
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| outlined in Section 2007.70 of Title 50 of the Illinois |
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| Administrative Code. These rights shall not be waived under |
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| a Consumer Choice of Benefits Health Insurance Plan |
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| product.
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| Section 20. Consumer choice of benefits health insurance |
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| plans authorized; minimum requirement. An insurer may offer one |
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| or more Consumer Choice of Benefits Health Insurance plans. |
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| Section 25. Notice to policyholder and enrollees. |
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| (a) Each written application for enrollment, including any |
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| application for enrollment under a group policy, in a Consumer |
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LRB093 17899 SAS 43582 b |
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| Choice of Benefits Health Insurance Plan must contain the |
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| following language at the beginning of the application in bold |
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| type: |
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| "You have the option to choose this Consumer Choice of |
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| Benefits Health Insurance Plan that, either in whole or in |
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| part, does not provide state-mandated health insurance |
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| benefits normally required in accident and health |
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| insurance policies in Illinois. This Consumer Choice of |
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| Benefits Health Insurance Plan may provide a more |
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| affordable health insurance policy for you although, at the |
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| same time, it may provide you with fewer health insurance |
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| benefits than those normally included as state-mandated |
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| health insurance benefits in policies in Illinois. If you |
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| choose this Consumer Choice of Benefits Health Insurance |
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| Plan, please consult the insurance company or your |
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| employer's benefits department to determine which |
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| state-mandated health benefits are not included in this |
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| policy."
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| (b) Each Consumer Choice of Benefits Health Insurance Plan |
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| must contain the following language at or near the beginning of |
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| the policy in bold type: |
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| "This Consumer Choice of Benefits Health Insurance Plan, |
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| either in whole or in part, does not provide state-mandated |
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| health benefits normally required in accident and health |
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| insurance policies in Illinois. This Consumer Choice of |
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| Benefits Health Insurance Plan may provide a more |
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| affordable health insurance policy for you although, at the |
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| same time, it may provide you with fewer health benefits |
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| than those normally included as state-mandated health |
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| benefits in policies in Illinois. Please consult with the |
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| insurance company or your employer's benefits department |
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| to discover which state-mandated health benefits are not |
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| included in this policy."
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| Section 30. Disclosure statement. |
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| (a) When a Consumer Choice of Benefits Health Insurance |
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LRB093 17899 SAS 43582 b |
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| Plan policy is issued, an insurer providing a Consumer Choice |
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| of Benefits Health Insurance Plan must provide an applicant or |
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| subscriber with a written disclosure statement that: |
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| (1) acknowledges that the Consumer Choice of Benefits |
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| Health Insurance Plan being purchased does not provide some |
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| or all state-mandated health benefits; |
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| (2) lists those state-mandated health benefits not |
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| included under the Consumer Choice of Benefits Health |
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| Insurance Plan; |
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| (3) provides a notice, if the Consumer Choice of |
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| Benefits Health Insurance Plan is issued to an individual |
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| policyholder, that purchasing a plan may limit the |
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| policyholder's future coverage options in the event the |
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| policyholder's health changes and needed benefits are not |
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| available under the Consumer Choice of Benefits Health |
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| Insurance Plan; and |
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| (4) includes a section that allows for a signature by |
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| the applicant or subscriber attesting to the fact that the |
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| applicant has read and understood the disclosure statement |
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| and attesting to the fact that the applicant or subscriber |
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| has in fact been given a choice between the Consumer Choice |
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| of Benefits Health Insurance Plan that they have chosen and |
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| a health insurance plan that includes all state-mandated |
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| health benefits. |
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| (b) Each applicant and subscriber for initial coverage must |
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| sign the disclosure statement provided by the insurer under |
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| subsection (a) of this Section and return the statement to the |
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| insurer. Under a group policy or contract, the term "applicant" |
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| means the employer and the term "subscriber" means employee. |
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| Under an individual policy or contract "applicant" means the |
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| individual purchasing the policy. |
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| (c) An insurer must: |
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| (1) retain the signed disclosure statement in the |
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| insurer's records; and |
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| (2) provide the signed disclosure statement to the |
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| Department upon request from the Director.
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LRB093 17899 SAS 43582 b |
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| Section 35. Rules. The Director shall adopt rules as |
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| necessary to implement this Act.
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| Section 40. Additional policies.
An insurer that offers |
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| one or more Consumer Choice of Benefits Health Insurance Plans |
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| under this Act to an employer group must also offer to all |
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| eligible employees in the group at least one accident and |
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| health insurance policy that has been filed and approved with |
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| the Department and includes coverage for all state-mandated |
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| health benefits. An employer that offers a Consumer Choice of |
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| Benefits Health Insurance Plan to its eligible employees must |
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| offer at least one accident and health insurance policy that |
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| includes coverage for all state-mandated health benefits that |
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| has been filed and approved by the Department. |
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| Section 45. Rates; rating and underwriting records. |
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| (a) An insurer offering a Consumer Choice of Benefits |
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| Health Insurance Plan under this Act shall maintain at its |
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| principal place of business a complete and detailed description |
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| of its rating practices and renewal underwriting practices, |
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| including information and documentation that demonstrates that |
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| its rating methods and practices are based upon commonly |
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| accepted actuarial assumptions and are in accordance with sound |
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| actuarial principles and that the rates for the Consumer Choice |
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| of Benefits Health Insurance Plan reflect the difference in its |
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| benefit package from a non-Consumer Choice of Benefits Health |
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| Insurance Plan. |
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| (b) Upon request, an insurer shall provide to the |
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| Department an actuarial certification certifying that the |
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| insurer is in compliance with this Act, and that the rating |
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| methods of the insurer are actuarially sound. Such |
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| certification shall be in a form and manner, and shall contain |
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| such information, as specified by the Director. A copy of the |
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| certification shall be retained by the insurer at its principal |
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| place of business for a period of 3 years from the date of |
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LRB093 17899 SAS 43582 b |
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| certification. This shall include any work papers prepared in |
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| support of the actuarial certification. |
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| (c) Nothing in this Section shall be construed as granting |
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| the Director any power or authority to determine, fix, |
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| prescribe, or promulgate the rates to be charged for any |
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| individual or group accident and health insurance policy or |
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| policies issued under this Act.
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| Section 50. Applicability of Illinois Insurance Code |
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| provisions. All policies of accident and health insurance |
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| issued under this Act shall be subject to the provisions of |
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| Section 356c, subsection (a) of Sections 356g, 356n, 370, 370a, |
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| 370e, and 370o of the Illinois Insurance Code. |
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| (215 ILCS 5/Art. XIXB rep.) |
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| Section 55. The Illinois Insurance Code is amended by |
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| repealing Article XIXB.
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| Section 99. Effective date. This Act takes effect upon |
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| becoming law.
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