093_SB0783ham001
LRB093 03237 SAS 19617 a
1 AMENDMENT TO SENATE BILL 783
2 AMENDMENT NO. . Amend Senate Bill 783 by replacing
3 everything after the enacting clause with the following:
4 "Section 5. The Comprehensive Health Insurance Plan Act
5 is amended by changing Sections 2, 3, and 15 as follows:
6 (215 ILCS 105/2) (from Ch. 73, par. 1302)
7 Sec. 2. Definitions. As used in this Act, unless the
8 context otherwise requires:
9 "Plan administrator" means the insurer or third party
10 administrator designated under Section 5 of this Act.
11 "Benefits plan" means the coverage to be offered by the
12 Plan to eligible persons and federally eligible individuals
13 pursuant to this Act.
14 "Board" means the Illinois Comprehensive Health Insurance
15 Board.
16 "Church plan" has the same meaning given that term in the
17 federal Health Insurance Portability and Accountability Act
18 of 1996.
19 "Continuation coverage" means continuation of coverage
20 under a group health plan or other health insurance coverage
21 for former employees or dependents of former employees that
22 would otherwise have terminated under the terms of that
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1 coverage pursuant to any continuation provisions under
2 federal or State law, including the Consolidated Omnibus
3 Budget Reconciliation Act of 1985 (COBRA), as amended,
4 Sections 367.2, 367e, and 367e.1 of the Illinois Insurance
5 Code, or any other similar requirement in another State.
6 "Covered person" means a person who is and continues to
7 remain eligible for Plan coverage and is covered under one of
8 the benefit plans offered by the Plan.
9 "Creditable coverage" means, with respect to a federally
10 eligible individual, coverage of the individual under any of
11 the following:
12 (A) A group health plan.
13 (B) Health insurance coverage (including group
14 health insurance coverage).
15 (C) Medicare.
16 (D) Medical assistance.
17 (E) Chapter 55 of title 10, United States Code.
18 (F) A medical care program of the Indian Health
19 Service or of a tribal organization.
20 (G) A state health benefits risk pool.
21 (H) A health plan offered under Chapter 89 of title
22 5, United States Code.
23 (I) A public health plan (as defined in regulations
24 consistent with Section 104 of the Health Care
25 Portability and Accountability Act of 1996 that may be
26 promulgated by the Secretary of the U.S. Department of
27 Health and Human Services).
28 (J) A health benefit plan under Section 5(e) of the
29 Peace Corps Act (22 U.S.C. 2504(e)).
30 (K) Any other qualifying coverage required by the
31 federal Health Insurance Portability and Accountability
32 Act of 1996, as it may be amended, or regulations under
33 that Act.
34 "Creditable coverage" does not include coverage
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1 consisting solely of coverage of excepted benefits, as
2 defined in Section 2791(c) of title XXVII of the Public
3 Health Service Act (42 U.S.C. 300 gg-91), nor does it include
4 any period of coverage under any of items (A) through (K)
5 that occurred before a break of more than 90 days or, if
6 after September 30, 2003, the individual has either been
7 certified as eligible pursuant to the federal Trade Act of
8 2002 or initially been paid a benefit by the Pension Benefit
9 Guaranty Corporation, a break of more than 63 days during all
10 of which the individual was not covered under any of items
11 (A) through (K) above.
12 For an individual who between December 1, 2002 and
13 September 30, 2003 has either (1) been certified as eligible
14 pursuant to the federal Trade Act of 2002, (2) initially been
15 paid a benefit by the Pension Benefit Guaranty Corporation,
16 or (3) as of December 1, 2002, been receiving benefits from
17 the Pension Benefit Guaranty Corporation and who has
18 qualified health insurance, as defined by the federal Trade
19 Act of 2002, "creditable coverage" includes any period of
20 coverage aggregating 3 or more months under any of items (A)
21 through (K), irrespective of the length of a break during all
22 of which the individual was not covered under any of items
23 (A) through (K).
24 Any period that an individual is in a waiting period for
25 any coverage under a group health plan (or for group health
26 insurance coverage) or is in an affiliation period under the
27 terms of health insurance coverage offered by a health
28 maintenance organization shall not be taken into account in
29 determining if there has been a break of more than 90 days in
30 any creditable coverage.
31 "Department" means the Illinois Department of Insurance.
32 "Dependent" means an Illinois resident: who is a spouse;
33 or who is claimed as a dependent by the principal insured for
34 purposes of filing a federal income tax return and resides in
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1 the principal insured's household, and is a resident
2 unmarried child under the age of 19 years; or who is an
3 unmarried child who also is a full-time student under the age
4 of 23 years and who is financially dependent upon the
5 principal insured; or who is a child of any age and who is
6 disabled and financially dependent upon the principal
7 insured.
8 "Direct Illinois premiums" means, for Illinois business,
9 an insurer's direct premium income for the kinds of business
10 described in clause (b) of Class 1 or clause (a) of Class 2
11 of Section 4 of the Illinois Insurance Code, and direct
12 premium income of a health maintenance organization or a
13 voluntary health services plan, except it shall not include
14 credit health insurance as defined in Article IX 1/2 of the
15 Illinois Insurance Code.
16 "Director" means the Director of the Illinois Department
17 of Insurance.
18 "Eligible person" means a resident of this State who
19 qualifies for Plan coverage under Section 7 of this Act.
20 "Employee" means a resident of this State who is employed
21 by an employer or has entered into the employment of or works
22 under contract or service of an employer including the
23 officers, managers and employees of subsidiary or affiliated
24 corporations and the individual proprietors, partners and
25 employees of affiliated individuals and firms when the
26 business of the subsidiary or affiliated corporations, firms
27 or individuals is controlled by a common employer through
28 stock ownership, contract, or otherwise.
29 "Employer" means any individual, partnership,
30 association, corporation, business trust, or any person or
31 group of persons acting directly or indirectly in the
32 interest of an employer in relation to an employee, for which
33 one or more persons is gainfully employed.
34 "Family" coverage means the coverage provided by the Plan
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1 for the covered person and his or her eligible dependents who
2 also are covered persons.
3 "Federally eligible individual" means an individual
4 resident of this State:
5 (1)(A) for whom, as of the date on which the
6 individual seeks Plan coverage under Section 15 of this
7 Act, the aggregate of the periods of creditable coverage
8 is 18 or more months or, if the individual has either (i)
9 been certified as eligible pursuant to the federal Trade
10 Act of 2002, (ii) initially been paid a benefit by the
11 Pension Benefit Guaranty Corporation, or (iii) as of
12 December 1, 2002, been receiving benefits from the
13 Pension Benefit Guaranty Corporation and has qualified
14 health insurance, as defined by the federal Trade Act of
15 2002, 3 or more months, and (B) whose most recent prior
16 creditable coverage was under group health insurance
17 coverage offered by a health insurance issuer, a group
18 health plan, a governmental plan, or a church plan (or
19 health insurance coverage offered in connection with any
20 such plans) or any other type of creditable coverage that
21 may be required by the federal Health Insurance
22 Portability and Accountability Act of 1996, as it may be
23 amended, or the regulations under that Act;
24 (2) who is not eligible for coverage under (A) a
25 group health plan (other than an individual who has been
26 certified as eligible pursuant to the federal Trade Act
27 of 2002), (B) part A or part B of Medicare due to age
28 (other than an individual who has been certified as
29 eligible pursuant to the federal Trade Act of 2002), or
30 (C) medical assistance, and does not have other health
31 insurance coverage (other than an individual who has been
32 certified as eligible pursuant to the Federal Trade Act
33 of 2002);
34 (3) with respect to whom (other than an individual
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1 who has been certified as eligible pursuant to the
2 federal Trade Act of 2002) the most recent coverage
3 within the coverage period described in paragraph (1)(A)
4 of this definition was not terminated based upon a factor
5 relating to nonpayment of premiums or fraud;
6 (4) if the individual (other than an individual who
7 has either (A) been certified as eligible pursuant to the
8 federal Trade Act of 2002, (B) initially been paid a
9 benefit by the Pension Benefit Guaranty Corporation, or
10 (C) as of December 1, 2002, been receiving benefits from
11 the Pension Benefit Guaranty Corporation and who has
12 qualified health insurance, as defined by the federal
13 Trade Act of 2002) had been offered the option of
14 continuation coverage under a COBRA continuation
15 provision or under a similar State program, who elected
16 such coverage; and
17 (5) who, if the individual elected such
18 continuation coverage, has exhausted such continuation
19 coverage under such provision or program.
20 However, an individual who has either been certified as
21 eligible pursuant to the federal Trade Act of 2002 or
22 initially been paid a benefit by the Pension Benefit Guaranty
23 Corporation shall not be required to elect continuation
24 coverage under a COBRA continuation provision or under a
25 similar state program.
26 "Group health insurance coverage" means, in connection
27 with a group health plan, health insurance coverage offered
28 in connection with that plan.
29 "Group health plan" has the same meaning given that term
30 in the federal Health Insurance Portability and
31 Accountability Act of 1996.
32 "Governmental plan" has the same meaning given that term
33 in the federal Health Insurance Portability and
34 Accountability Act of 1996.
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1 "Health insurance coverage" means benefits consisting of
2 medical care (provided directly, through insurance or
3 reimbursement, or otherwise and including items and services
4 paid for as medical care) under any hospital and medical
5 expense-incurred policy, certificate, or contract provided by
6 an insurer, non-profit health care service plan contract,
7 health maintenance organization or other subscriber contract,
8 or any other health care plan or arrangement that pays for or
9 furnishes medical or health care services whether by
10 insurance or otherwise. Health insurance coverage shall not
11 include short term, accident only, disability income,
12 hospital confinement or fixed indemnity, dental only, vision
13 only, limited benefit, or credit insurance, coverage issued
14 as a supplement to liability insurance, insurance arising out
15 of a workers' compensation or similar law, automobile
16 medical-payment insurance, or insurance under which benefits
17 are payable with or without regard to fault and which is
18 statutorily required to be contained in any liability
19 insurance policy or equivalent self-insurance.
20 "Health insurance issuer" means an insurance company,
21 insurance service, or insurance organization (including a
22 health maintenance organization and a voluntary health
23 services plan) that is authorized to transact health
24 insurance business in this State. Such term does not include
25 a group health plan.
26 "Health Maintenance Organization" means an organization
27 as defined in the Health Maintenance Organization Act.
28 "Hospice" means a program as defined in and licensed
29 under the Hospice Program Licensing Act.
30 "Hospital" means a duly licensed institution as defined
31 in the Hospital Licensing Act, an institution that meets all
32 comparable conditions and requirements in effect in the state
33 in which it is located, or the University of Illinois
34 Hospital as defined in the University of Illinois Hospital
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1 Act.
2 "Individual health insurance coverage" means health
3 insurance coverage offered to individuals in the individual
4 market, but does not include short-term, limited-duration
5 insurance.
6 "Insured" means any individual resident of this State who
7 is eligible to receive benefits from any insurer (including
8 health insurance coverage offered in connection with a group
9 health plan) or health insurance issuer as defined in this
10 Section.
11 "Insurer" means any insurance company authorized to
12 transact health insurance business in this State and any
13 corporation that provides medical services and is organized
14 under the Voluntary Health Services Plans Act or the Health
15 Maintenance Organization Act.
16 "Medical assistance" means the State medical assistance
17 or medical assistance no grant (MANG) programs provided under
18 Title XIX of the Social Security Act and Articles V (Medical
19 Assistance) and VI (General Assistance) of the Illinois
20 Public Aid Code (or any successor program) or under any
21 similar program of health care benefits in a state other than
22 Illinois.
23 "Medically necessary" means that a service, drug, or
24 supply is necessary and appropriate for the diagnosis or
25 treatment of an illness or injury in accord with generally
26 accepted standards of medical practice at the time the
27 service, drug, or supply is provided. When specifically
28 applied to a confinement it further means that the diagnosis
29 or treatment of the covered person's medical symptoms or
30 condition cannot be safely provided to that person as an
31 outpatient. A service, drug, or supply shall not be medically
32 necessary if it: (i) is investigational, experimental, or for
33 research purposes; or (ii) is provided solely for the
34 convenience of the patient, the patient's family, physician,
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1 hospital, or any other provider; or (iii) exceeds in scope,
2 duration, or intensity that level of care that is needed to
3 provide safe, adequate, and appropriate diagnosis or
4 treatment; or (iv) could have been omitted without adversely
5 affecting the covered person's condition or the quality of
6 medical care; or (v) involves the use of a medical device,
7 drug, or substance not formally approved by the United States
8 Food and Drug Administration.
9 "Medical care" means the ordinary and usual professional
10 services rendered by a physician or other specified provider
11 during a professional visit for treatment of an illness or
12 injury.
13 "Medicare" means coverage under both Part A and Part B of
14 Title XVIII of the Social Security Act, 42 U.S.C. Sec. 1395,
15 et seq.
16 "Minimum premium plan" means an arrangement whereby a
17 specified amount of health care claims is self-funded, but
18 the insurance company assumes the risk that claims will
19 exceed that amount.
20 "Participating transplant center" means a hospital
21 designated by the Board as a preferred or exclusive provider
22 of services for one or more specified human organ or tissue
23 transplants for which the hospital has signed an agreement
24 with the Board to accept a transplant payment allowance for
25 all expenses related to the transplant during a transplant
26 benefit period.
27 "Physician" means a person licensed to practice medicine
28 pursuant to the Medical Practice Act of 1987.
29 "Plan" means the Comprehensive Health Insurance Plan
30 established by this Act.
31 "Plan of operation" means the plan of operation of the
32 Plan, including articles, bylaws and operating rules, adopted
33 by the board pursuant to this Act.
34 "Provider" means any hospital, skilled nursing facility,
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1 hospice, home health agency, physician, registered pharmacist
2 acting within the scope of that registration, or any other
3 person or entity licensed in Illinois to furnish medical
4 care.
5 "Qualified high risk pool" has the same meaning given
6 that term in the federal Health Insurance Portability and
7 Accountability Act of 1996.
8 "Resident" means a person who is and continues to be
9 legally domiciled and physically residing on a permanent and
10 full-time basis in a place of permanent habitation in this
11 State that remains that person's principal residence and from
12 which that person is absent only for temporary or transitory
13 purpose.
14 "Skilled nursing facility" means a facility or that
15 portion of a facility that is licensed by the Illinois
16 Department of Public Health under the Nursing Home Care Act
17 or a comparable licensing authority in another state to
18 provide skilled nursing care.
19 "Stop-loss coverage" means an arrangement whereby an
20 insurer insures against the risk that any one claim will
21 exceed a specific dollar amount or that the entire loss of a
22 self-insurance plan will exceed a specific amount.
23 "Third party administrator" means an administrator as
24 defined in Section 511.101 of the Illinois Insurance Code who
25 is licensed under Article XXXI 1/4 of that Code.
26 (Source: P.A. 92-153, eff. 7-25-01; 93-33, eff. 6-23-03;
27 93-34, eff. 6-23-03; 93-477, eff. 8-8-03; revised 8-21-03.)
28 (215 ILCS 105/3) (from Ch. 73, par. 1303)
29 Sec. 3. Operation of the Plan.
30 a. There is hereby created an Illinois Comprehensive
31 Health Insurance Plan.
32 b. The Plan shall operate subject to the supervision and
33 control of the board. The board is created as a political
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1 subdivision and body politic and corporate and, as such, is
2 not a State agency. The board shall consist of 10 public
3 members, appointed by the Governor with the advice and
4 consent of the Senate.
5 Initial members shall be appointed to the Board by the
6 Governor as follows: 2 members to serve until July 1, 1988,
7 and until their successors are appointed and qualified; 2
8 members to serve until July 1, 1989, and until their
9 successors are appointed and qualified; 3 members to serve
10 until July 1, 1990, and until their successors are appointed
11 and qualified; and 3 members to serve until July 1, 1991, and
12 until their successors are appointed and qualified. As terms
13 of initial members expire, their successors shall be
14 appointed for terms to expire the first day in July 3 years
15 thereafter, and until their successors are appointed and
16 qualified.
17 Any vacancy in the Board occurring for any reason other
18 than the expiration of a term shall be filled for the
19 unexpired term in the same manner as the original
20 appointment.
21 Any member of the Board may be removed by the Governor
22 for neglect of duty, misfeasance, malfeasance, or nonfeasance
23 in office.
24 In addition, a representative of the Governor's Office of
25 Management and Budget Bureau of the Budget, a representative
26 of the Office of the Attorney General and the Director or the
27 Director's designated representative shall be members of the
28 board. Four members of the General Assembly, one each
29 appointed by the President and Minority Leader of the Senate
30 and by the Speaker and Minority Leader of the House of
31 Representatives, shall serve as nonvoting members of the
32 board. At least 2 of the public members shall be individuals
33 reasonably expected to qualify for coverage under the Plan,
34 the parent or spouse of such an individual, or a surviving
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1 family member of an individual who could have qualified for
2 the plan during his lifetime. The Director or Director's
3 representative shall be the chairperson of the board.
4 Members of the board shall receive no compensation, but shall
5 be reimbursed for reasonable expenses incurred in the
6 necessary performance of their duties.
7 c. The board shall make an annual report in September
8 and shall file the report with the Secretary of the Senate
9 and the Clerk of the House of Representatives. The report
10 shall summarize the activities of the Plan in the preceding
11 calendar year, including net written and earned premiums, the
12 expense of administration, the paid and incurred losses for
13 the year and other information as may be requested by the
14 General Assembly. The report shall also include analysis and
15 recommendations regarding utilization review, quality
16 assurance and access to cost effective quality health care.
17 d. In its plan of operation the board shall:
18 (1) Establish procedures for selecting a plan
19 administrator in accordance with Section 5 of this Act.
20 (2) Establish procedures for the operation of the
21 board.
22 (3) Create a Plan fund, under management of the
23 board, to fund administrative, claim, and other expenses
24 of the Plan.
25 (4) Establish procedures for the handling and
26 accounting of assets and monies of the Plan.
27 (5) Develop and implement a program to publicize
28 the existence of the Plan, the eligibility requirements
29 and procedures for enrollment and to maintain public
30 awareness of the Plan.
31 (6) Establish procedures under which applicants and
32 participants may have grievances reviewed by a grievance
33 committee appointed by the board. The grievances shall
34 be reported to the board immediately after completion of
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1 the review. The Department and the board shall retain
2 all written complaints regarding the Plan for at least 3
3 years. Oral complaints shall be reduced to written form
4 and maintained for at least 3 years.
5 (7) Provide for other matters as may be necessary
6 and proper for the execution of its powers, duties and
7 obligations under the Plan.
8 e. No later than 5 years after the Plan is operative the
9 board and the Department shall conduct cooperatively a study
10 of the Plan and the persons insured by the Plan to determine:
11 (1) claims experience including a breakdown of medical
12 conditions for which claims were paid; (2) whether
13 availability of the Plan affected employment opportunities
14 for participants; (3) whether availability of the Plan
15 affected the receipt of medical assistance benefits by Plan
16 participants; (4) whether a change occurred in the number of
17 personal bankruptcies due to medical or other health related
18 costs; (5) data regarding all complaints received about the
19 Plan including its operation and services; (6) and any other
20 significant observations regarding utilization of the Plan.
21 The study shall culminate in a written report to be presented
22 to the Governor, the President of the Senate, the Speaker of
23 the House and the chairpersons of the House and Senate
24 Insurance Committees. The report shall be filed with the
25 Secretary of the Senate and the Clerk of the House of
26 Representatives. The report shall also be available to
27 members of the general public upon request.
28 f. The board may:
29 (1) Prepare and distribute certificate of
30 eligibility forms and enrollment instruction forms to
31 insurance producers and to the general public in this
32 State.
33 (2) Provide for reinsurance of risks incurred by
34 the Plan and enter into reinsurance agreements with
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1 insurers to establish a reinsurance plan for risks of
2 coverage described in the Plan, or obtain commercial
3 reinsurance to reduce the risk of loss through the Plan.
4 (3) Issue additional types of health insurance
5 policies to provide optional coverages as are otherwise
6 permitted by this Act including a Medicare supplement
7 policy designed to supplement Medicare.
8 (4) Provide for and employ cost containment
9 measures and requirements including, but not limited to,
10 preadmission certification, second surgical opinion,
11 concurrent utilization review programs, and individual
12 case management for the purpose of making the pool more
13 cost effective.
14 (5) Design, utilize, contract, or otherwise arrange
15 for the delivery of cost effective health care services,
16 including establishing or contracting with preferred
17 provider organizations, health maintenance organizations,
18 and other limited network provider arrangements.
19 (6) Adopt bylaws, rules, regulations, policies and
20 procedures as may be necessary or convenient for the
21 implementation of the Act and the operation of the Plan.
22 (7) Administer separate pools, separate accounts,
23 or other plans or arrangements as required by this Act to
24 separate federally eligible individuals or groups of
25 federally eligible individuals who qualify for plan
26 coverage under Section 15 of this Act from eligible
27 persons or groups of eligible persons who qualify for
28 plan coverage under Section 7 of this Act and apportion
29 the costs of the administration among such separate
30 pools, separate accounts, or other plans or arrangements.
31 g. The Director may, by rule, establish additional
32 powers and duties of the board and may adopt rules for any
33 other purposes, including the operation of the Plan, as are
34 necessary or proper to implement this Act.
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1 h. The board is not liable for any obligation of the
2 Plan. There is no liability on the part of any member or
3 employee of the board or the Department, and no cause of
4 action of any nature may arise against them, for any action
5 taken or omission made by them in the performance of their
6 powers and duties under this Act, unless the action or
7 omission constitutes willful or wanton misconduct. The board
8 may provide in its bylaws or rules for indemnification of,
9 and legal representation for, its members and employees.
10 i. There is no liability on the part of any insurance
11 producer for the failure of any applicant to be accepted by
12 the Plan unless the failure of the applicant to be accepted
13 by the Plan is due to an act or omission by the insurance
14 producer which constitutes willful or wanton misconduct.
15 (Source: P.A. 92-597, eff. 6-28-02; revised 8-23-03.)
16 (215 ILCS 105/15)
17 Sec. 15. Alternative portable coverage for federally
18 eligible individuals.
19 (a) Notwithstanding the requirements of subsection a. of
20 Section 7 and except as otherwise provided in this Section,
21 any federally eligible individual for whom a Plan
22 application, and such enclosures and supporting documentation
23 as the Board may require, is received by the Board within 90
24 days after the termination of prior creditable coverage shall
25 qualify to enroll in the Plan under the portability
26 provisions of this Section.
27 A federally eligible person who between December 1, 2002
28 and September 30, 2003 has either (1) been certified as
29 eligible pursuant to the federal Trade Act of 2002, (2)
30 initially been paid a benefit by the Pension Benefit Guaranty
31 Corporation, or (3) as of December 1, 2002, been receiving
32 benefits from the Pension Benefit Guaranty Corporation, who
33 has qualified health insurance, as defined by the federal
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1 Trade Act of 2002, and whose Plan application and enclosures
2 and supporting documentation, as the Board may require, is
3 received by the Board after the termination of previous
4 creditable coverage shall qualify to enroll in the Plan under
5 the portability provisions of this Section.
6 A federally eligible person who, after September 30,
7 2003, has either been certified as eligible pursuant to the
8 federal Trade Act of 2002 or initially been paid a benefit by
9 the Pension Benefit Guaranty Corporation and whose Plan
10 application and enclosures and supporting documentation as
11 the Board may require is received by the Board within 63 days
12 after the termination of previous creditable coverage shall
13 qualify to enroll in the Plan under the portability
14 provisions of this Section.
15 (b) Any federally eligible individual seeking Plan
16 coverage under this Section must submit with his or her
17 application evidence, including acceptable written
18 certification of previous creditable coverage, that will
19 establish to the Board's satisfaction, that he or she meets
20 all of the requirements to be a federally eligible individual
21 and is currently and permanently residing in this State (as
22 of the date his or her application was received by the
23 Board).
24 (c) Except as otherwise provided in this Section, a
25 period of creditable coverage shall not be counted, with
26 respect to qualifying an applicant for Plan coverage as a
27 federally eligible individual under this Section, if after
28 such period and before the application for Plan coverage was
29 received by the Board, there was at least a 90 day period
30 during all of which the individual was not covered under any
31 creditable coverage.
32 For a federally eligible person who between December 1,
33 2002 and September 30, 2003 has either (1) been certified as
34 eligible pursuant to the federal Trade Act of 2002, (2)
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1 initially been paid a benefit by the Pension Benefit Guaranty
2 Corporation, or (3) as of December 1, 2002, been receiving
3 benefits from the Pension Benefit Guaranty Corporation and
4 who has qualified health insurance, as defined by the federal
5 Trade Act of 2002, a period of creditable coverage shall be
6 counted, with respect to qualifying an applicant for Plan
7 coverage as a federally eligible individual under this
8 Section, when the application for Plan coverage was received
9 by the Board.
10 For a federally eligible person who, after September 30,
11 2003, has either been certified as eligible pursuant to the
12 federal Trade Act of 2002 or initially been paid a benefit by
13 the Pension Benefit Guaranty Corporation, a period of
14 creditable coverage shall not be counted, with respect to
15 qualifying an applicant for Plan coverage as a federally
16 eligible individual under this Section, if after such period
17 and before the application for Plan coverage was received by
18 the Board, there was at least a 63 day period during all of
19 which the individual was not covered under any creditable
20 coverage.
21 (d) Any federally eligible individual who the Board
22 determines qualifies for Plan coverage under this Section
23 shall be offered his or her choice of enrolling in one of
24 alternative portability health benefit plans which the Board
25 is authorized under this Section to establish for these
26 federally eligible individuals and their dependents.
27 (e) The Board shall offer a choice of health care
28 coverages consistent with major medical coverage under the
29 alternative health benefit plans authorized by this Section
30 to every federally eligible individual. The coverages to be
31 offered under the plans, the schedule of benefits,
32 deductibles, co-payments, exclusions, and other limitations
33 shall be approved by the Board. One optional form of
34 coverage shall be comparable to comprehensive health
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1 insurance coverage offered in the individual market in this
2 State or a standard option of coverage available under the
3 group or individual health insurance laws of the State. The
4 standard benefit plan that is authorized by Section 8 of this
5 Act may be used for this purpose. The Board may also offer a
6 preferred provider option and such other options as the Board
7 determines may be appropriate for these federally eligible
8 individuals who qualify for Plan coverage pursuant to this
9 Section.
10 (f) Notwithstanding the requirements of subsection f. of
11 Section 8, any plan coverage that is issued to federally
12 eligible individuals who qualify for the Plan pursuant to the
13 portability provisions of this Section shall not be subject
14 to any preexisting conditions exclusion, waiting period, or
15 other similar limitation on coverage.
16 (g) Federally eligible individuals who qualify and
17 enroll in the Plan pursuant to this Section shall be required
18 to pay such premium rates as the Board shall establish and
19 approve in accordance with the requirements of Section 7.1 of
20 this Act.
21 (h) A federally eligible individual who qualifies and
22 enrolls in the Plan pursuant to this Section must satisfy on
23 an ongoing basis all of the other eligibility requirements of
24 this Act to the extent not inconsistent with the federal
25 Health Insurance Portability and Accountability Act of 1996
26 in order to maintain continued eligibility for coverage under
27 the Plan.
28 (Source: P.A. 92-153, eff. 7-25-01; 93-33, eff. 6-23-03;
29 93-34, eff. 6-23-03.)
30 Section 99. Effective date. This Act takes effect upon
31 becoming law.".