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Health Care Availability and Access Committee
Filed: 3/11/2008
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09500HB4830ham001 |
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LRB095 17861 AMC 48096 a |
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| AMENDMENT TO HOUSE BILL 4830
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| AMENDMENT NO. ______. Amend House Bill 4830 by replacing |
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| everything after the enacting clause with the following: |
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| "Section 5. The Illinois Insurance Code is amended by |
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| changing Section 367e as follows:
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| (215 ILCS 5/367e) (from Ch. 73, par. 979e)
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| Sec. 367e. Continuation of Group Hospital, Surgical and |
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| Major Medical
Coverage After Termination of Employment or |
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| Membership.
A group policy delivered, issued for delivery, |
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| renewed or amended in this
state which insures employees or |
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| members
for hospital, surgical or major medical insurance on an |
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| expense incurred
or service basis, other than for specific |
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| diseases or for accidental injuries
only, shall provide that |
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| employees or members whose insurance under the
group policy |
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| would otherwise terminate because of termination of employment
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| or membership or because of a reduction in hours below the |
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09500HB4830ham001 |
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LRB095 17861 AMC 48096 a |
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| minimum required
by the group plan shall be entitled to |
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| continue their hospital, surgical and
major medical insurance |
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| under that group policy, for themselves and their
eligible |
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| dependents, subject to all of the group policy's terms and |
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| conditions
applicable to those forms of insurance and to the |
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| following conditions:
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| 1. Continuation shall only be available to an employee |
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| or member who has
been continuously insured under the group |
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| policy (and for similar benefits
under any group policy |
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| which it replaced) during the entire 3 months period
ending |
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| with such termination
or reduction in hours below the |
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| minimum required by the group plan.
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| 2. Continuation shall not be available for any person |
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| who is covered by
Medicare, except for those individuals |
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| who have been covered under a
group Medicare supplement |
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| policy. Neither shall continuation be
available for any |
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| person who is
covered by any other insured or uninsured |
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| plan
which provides hospital, surgical or medical coverage |
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| for individuals in
a group and under which the person was |
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| not
covered immediately prior to such termination
or |
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| reduction in hours below the minimum required by the group |
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| plan
or who exercises his conversion
privilege under the |
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| group policy.
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| 3. Continuation need not include dental, vision care, |
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| prescription drug
benefits, disability income, specified |
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| disease, or similar supplementary
benefits which are |
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09500HB4830ham001 |
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LRB095 17861 AMC 48096 a |
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| provided under the group policy in addition to its |
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| hospital,
surgical or major medical benefits.
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| 4. Upon termination
or reduction in hours below the |
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| minimum required by the group plan
written notice of |
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| continuation shall be presented
to the employee or member |
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| and the insurer by the employer or mailed by the employer |
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| to the
last known address of the employee. This written |
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| notice must be given directly to the employee or sent via |
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| certified mail within 10 days after the employee's |
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| termination or reduction in hours below the minimum |
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| required by the group plan. An employee or member who |
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| wishes
continuation
of coverage must request such |
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| continuation in writing within the 30 day ten-day
period |
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| following the later of: (i) the date of such termination
or |
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| reduction in hours below the minimum required by the group |
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| plan, or (ii)
the date the employee is given written notice |
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| of the right of continuation
by either the employer , or the
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| group policyholder , or insurer. The written notice |
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| provided to an employee must include an explanation that |
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| his or her option for continuation coverage will expire |
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| within the 30 day period following the later of (i) the |
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| date of such termination of employment or reduction in |
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| hours below the minimum required by the group plan, or (ii) |
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| the date the employee is given written notice of the right |
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| of continuation by either the employer, group |
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| policyholder, or insurer . In no event, however, may the |
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09500HB4830ham001 |
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LRB095 17861 AMC 48096 a |
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| employee or member elect
continuation more than 60 days |
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| after the date of such termination
or reduction in hours |
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| below the minimum required by the group plan.
Written |
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| notice of continuation presented to the employee or member |
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| by the
policyholder, or mailed by the policyholder to the |
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| last known address of
the employee, shall constitute the |
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| giving of notice for the purpose of this
provision.
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| In the event the employer fails or refuses to provide |
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| notice of continuation rights to the employee or member, |
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| the insurer is required to mail notice of the continuation |
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| rights to the employee or member at the last known address |
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| of the employee. In the event the employee or member |
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| contacts the insurer regarding continuation rights and |
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| advises that notice has not been provided by the employer |
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| or group policyholder, the insurer shall mail out notice to |
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| that individual. An employee or member shall have 30 days |
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| from receipt of the notice to elect continuation. |
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| Any employer who fails to provide the notice required |
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| in this subsection 4. is guilty of a petty offense and |
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| shall be fined $500.
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| 5. An employee or member electing continuation must pay |
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| to the group
policyholder
or his employer, on a monthly |
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| basis in advance, the total amount of premium
required by |
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| the insurer, including that portion of the premium |
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| contributed
by the policyholder or employer, if any, but |
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| not more than the group rate
for the insurance being |
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09500HB4830ham001 |
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LRB095 17861 AMC 48096 a |
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| continued with appropriate reduction in premium
for any |
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| supplementary benefits which have been discontinued under |
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| paragraph
(3) of this Section. The premium rate required by |
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| the insurer shall be
the applicable premium required on the |
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| due date of each payment.
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| 6. Continuation of insurance under the group policy for
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| any person shall terminate when he becomes eligible for |
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| Medicare or is covered
by any other insured or uninsured |
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| plan which provides hospital, surgical
or medical coverage |
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| for individuals in a group and under which
the person was |
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| not covered immediately prior to such termination
or |
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| reduction in hours below the minimum required by the group |
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| plan
as provided
in condition
2 above or, if earlier, at |
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| the first to occur of the following:
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| (a) The date 18 9 months after the date the |
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| employee's or member's
insurance
under the policy |
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| would otherwise have terminated because of termination
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| of employment or membership
or reduction in hours below |
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| the minimum required by the group plan.
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| (b) If the employee or member fails to make timely |
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| payment of a required
contribution, the end of the |
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| period for which contributions were made.
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| (c) The date on which the group policy is |
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| terminated or, in the case of
an employee, the date his |
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| employer terminates participation under the group
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| policy. However, if this (c) applies and the coverage |
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09500HB4830ham001 |
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LRB095 17861 AMC 48096 a |
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| ceasing by reason of
such
termination is replaced by |
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| similar coverage under another group policy,
the |
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| following shall apply:
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| (i) The employee or member shall have the right |
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| to become covered
under
that other group policy, |
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| for the balance of the period that he would have
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| remained covered under the prior group policy in |
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| accordance with condition
6 had a termination |
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| described in this (c) not occurred.
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| (ii) The prior group policy shall continue to |
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| provide benefits to the
extent of its accrued |
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| liabilities and extensions of benefits as if the
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| replacement
had not occurred.
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| 7. A notification of the continuation privilege shall |
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| be included in each
certificate of coverage.
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| 8. Continuation shall not be available for any employee |
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| who was
discharged because of the commission of a felony in |
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| connection with his
work, or because of theft in connection |
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| with his work, for which the
employer was in no way |
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| responsible; provided the employee admitted his
commission |
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| of the felony or theft or such act has resulted in a |
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| conviction
or order of supervision by a court of competent |
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| jurisdiction.
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| The requirements of this amendatory Act of 1983 shall apply |
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| to any group
policy as defined in this Section, delivered or |
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| issued for delivery on or after
180 days following the |
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09500HB4830ham001 |
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LRB095 17861 AMC 48096 a |
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| effective date of this amendatory Act of 1983.
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| The requirements of this amendatory Act of 1985 shall apply |
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| to any
group policy as defined in this Section, delivered, |
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| issued for delivery,
renewed or amended on or after 180 days |
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| following the effective date of
this amendatory Act of 1985.
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| Notwithstanding any other rulemaking authority that may |
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| exist, neither the Governor nor any agency or agency head under |
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| the jurisdiction of the Governor has any authority to make or |
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| promulgate rules to implement or enforce the provisions of this |
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| amendatory Act of the 95th General Assembly. If, however, the |
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| Governor believes that rules are necessary to implement or |
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| enforce the provisions of this amendatory Act of the 95th |
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| General Assembly, the Governor may suggest rules to the General |
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| Assembly by filing them with the Clerk of the House and the |
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| Secretary of the Senate and by requesting that the General |
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| Assembly authorize such rulemaking by law, enact those |
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| suggested rules into law, or take any other appropriate action |
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| in the General Assembly's discretion. Nothing contained in this |
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| amendatory Act of the 95th General Assembly shall be |
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| interpreted to grant rulemaking authority under any other |
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| Illinois statute where such authority is not otherwise |
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| explicitly given. For the purposes of this amendatory Act of |
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| the 95th General Assembly, "rules" is given the meaning |
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| contained in Section 1-70 of the Illinois Administrative |
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| Procedure Act, and "agency" and "agency head" are given the |
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| meanings contained in Sections 1-20 and 1-25 of the Illinois |
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09500HB4830ham001 |
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LRB095 17861 AMC 48096 a |
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| Administrative Procedure Act to the extent that such |
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| definitions apply to agencies or agency heads under the |
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| jurisdiction of the Governor. |
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| (Source: P.A. 93-477, eff. 1-1-04.)
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| Section 10. The Health Maintenance Organization Act is |
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| amended by changing Section 4-9.2 as follows:
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| (215 ILCS 125/4-9.2) (from Ch. 111 1/2, par. 1409.2-2)
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| Sec. 4-9.2. Continuation of group HMO coverage after |
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| termination of
employee or membership. A group contract |
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| delivered, issued for delivery,
renewed, or amended in this |
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| State that covers employees or members for health
care services |
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| shall provide that employees or members whose coverage under
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| the group contract would otherwise terminate because of |
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| termination of
employment or membership or because of a |
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| reduction in hours below the minimum
required by the group |
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| contract shall be entitled to continue their coverage
under
|
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| that group contract, for themselves and their eligible |
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| dependents, subject
to all of the group contract's terms and |
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| conditions applicable to those
forms of coverage and to the |
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| following conditions:
|
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| (1) Continuation shall only be available to an employee |
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| or member who has
been continuously covered under the group |
23 |
| contract (and for similar
benefits under any group contract |
24 |
| that it replaced) during the entire 3
month period ending |
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LRB095 17861 AMC 48096 a |
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| with the termination of employment or membership or
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| reduction in hours below the minimum required by the group |
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| contract.
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| (2) Continuation shall not be available for any |
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| enrollee who is
covered by Medicare, except for those |
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| individuals who have been covered
under a group Medicare |
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| supplement policy. Continuation shall not be
available for |
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| any enrollee who is covered by any other insured or |
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| uninsured
plan that provides hospital, surgical, or |
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| medical coverage for individuals
in a group and under which |
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| the enrollee was not covered immediately
before |
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| termination or reduction in hours below the minimum |
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| required by the
group contract or who exercises his or her |
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| conversion privilege under
the group policy.
|
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| (3) Continuation need not include dental, vision care, |
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| prescription
drug, or similar supplementary benefits that |
17 |
| are provided under
the group contract in addition to its |
18 |
| basic health care services.
|
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| (4) Upon termination or reduction in hours below the |
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| minimum required by
the group contract, written notice of |
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| continuation shall be presented
to the employee or member |
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| and the HMO by the employer or mailed by the employer to |
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| the last
known address of the employee. This written notice |
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| must be given directly to the employee or sent via |
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| certified mail within 10 days after the employee's |
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| termination or reduction in hours below the minimum |
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09500HB4830ham001 |
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LRB095 17861 AMC 48096 a |
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| required by the group plan. An employee or member who |
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| wishes
continuation of coverage must request continuation |
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| in writing within
the 30 10 day period following the later |
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| of (i) the date of termination or
reduction in hours below |
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| the minimum required by the group contract or (ii)
the date |
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| the employee is given written notice of the right of |
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| continuation by
either the employer , or the group |
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| policyholder , or HMO . In no event, however, shall the
|
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| employee or member elect continuation more than 60 days |
10 |
| after the date of
termination
or reduction in hours below |
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| the minimum required by the group contract.
Written notice |
12 |
| of continuation presented to the employee or member
by the |
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| policyholder or HMO , or mailed by the policyholder or HMO |
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| to the last known address of
the employee, shall constitute |
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| the giving of notice for the purpose of this
paragraph. |
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| The written notice provided to an employee must include |
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| an explanation that his or her option for continuation |
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| coverage will expire within the 30 day period following the |
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| later of (i) the date of such termination of employment or |
20 |
| reduction in hours below the minimum required by the group |
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| plan, or (ii) the date the employee is given written notice |
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| of the right of continuation by either the employer, group |
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| policyholder, or HMO. |
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| In the event the employer fails or refuses to provide |
25 |
| notice of continuation rights to the employee or member, |
26 |
| the HMO is required to mail notice of the continuation |
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09500HB4830ham001 |
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LRB095 17861 AMC 48096 a |
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| rights to the employee or member at the last known address |
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| of the employee. In the event the employee or member |
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| contacts the HMO regarding continuation rights and advises |
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| that notice has not been provided by the employer or group |
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| policyholder, the HMO shall mail out notice to that |
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| individual. An employee or member shall have 30 days from |
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| receipt of the notice to elect continuation. |
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| Any employer who fails to provide the notice required |
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| in this subsection (4) is guilty of a petty offense and |
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| shall be fined $500.
|
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| (5) An employee or member electing continuation must |
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| pay to the group
policyholder or his employer, on a monthly |
13 |
| basis in advance, the total
amount of premium required by |
14 |
| the HMO, including that portion of the
premium contributed |
15 |
| by the policyholder or employer, if any, but not more
than |
16 |
| the group rate for the coverage being continued with |
17 |
| appropriate
reduction in premium for any supplementary |
18 |
| benefits that have been
discontinued under paragraph (3) of |
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| this Section. The premium rate required
by the HMO shall be |
20 |
| the applicable premium required on the due date of each
|
21 |
| payment.
|
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| (6) Continuation of coverage under the group contract |
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| for any person
shall terminate when the person becomes |
24 |
| eligible for Medicare or is covered by
any other insured or |
25 |
| uninsured plan that provides hospital, surgical, or
|
26 |
| medical coverage for individuals in a group and under which |
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09500HB4830ham001 |
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LRB095 17861 AMC 48096 a |
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| the person was not
covered immediately before termination
|
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| or reduction in hours below the minimum required by the |
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| group contract
as provided in paragraph (2) of this
Section |
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| or, if earlier, at the first to occur of the following:
|
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| (a) The expiration of 18 9 months after the |
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| employee's or member's coverage
because of termination |
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| of employment or membership
or reduction in hours below |
8 |
| the minimum required by the group contract.
|
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| (b) If the employee or member fails to make timely |
10 |
| payment of a
required contribution, the end of the |
11 |
| period for which contributions were made.
|
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| (c) The date on which the group contract is |
13 |
| terminated or, in the
case of an employee, the date his |
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| or her employer terminates participation
under the |
15 |
| group contract. If, however, this paragraph applies |
16 |
| and the coverage
ceasing by reason of termination is |
17 |
| replaced by similar coverage under another
group |
18 |
| contract, then (i) the employee or member shall have |
19 |
| the right to become
covered under the replacement group |
20 |
| contract for the balance of the period that
he or she |
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| would have remained covered under the prior group |
22 |
| contract in
accordance with paragraph (6) had a |
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| termination described in this item (c) not
occurred and |
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| (ii) the prior group contract shall continue to provide |
25 |
| benefits
to the extent of its accrued liabilities and |
26 |
| extensions of benefits as if the
replacement had not |
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LRB095 17861 AMC 48096 a |
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| occurred.
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| (7) A notification of the continuation privilege shall |
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| be included in
each evidence of coverage.
|
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| (8) Continuation shall not be available for any |
5 |
| employee who was
discharged because of the commission of a |
6 |
| felony in connection with his or her
work, or because of |
7 |
| theft in connection with his or her work, for which the
|
8 |
| employer was in no way responsible if the employee (i) |
9 |
| admitted to
committing the felony or theft or (ii) was |
10 |
| convicted or placed under
supervision by a court of |
11 |
| competent jurisdiction.
|
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| The requirements of this amendatory Act of 1992 shall apply |
13 |
| to any
group contract, as defined in this Section, delivered or |
14 |
| issued for
delivery on or after 180 days following the |
15 |
| effective date of this
amendatory Act of 1992.
|
16 |
| Notwithstanding any other rulemaking authority that may |
17 |
| exist, neither the Governor nor any agency or agency head under |
18 |
| the jurisdiction of the Governor has any authority to make or |
19 |
| promulgate rules to implement or enforce the provisions of this |
20 |
| amendatory Act of the 95th General Assembly. If, however, the |
21 |
| Governor believes that rules are necessary to implement or |
22 |
| enforce the provisions of this amendatory Act of the 95th |
23 |
| General Assembly, the Governor may suggest rules to the General |
24 |
| Assembly by filing them with the Clerk of the House and the |
25 |
| Secretary of the Senate and by requesting that the General |
26 |
| Assembly authorize such rulemaking by law, enact those |
|
|
|
09500HB4830ham001 |
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LRB095 17861 AMC 48096 a |
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|
1 |
| suggested rules into law, or take any other appropriate action |
2 |
| in the General Assembly's discretion. Nothing contained in this |
3 |
| amendatory Act of the 95th General Assembly shall be |
4 |
| interpreted to grant rulemaking authority under any other |
5 |
| Illinois statute where such authority is not otherwise |
6 |
| explicitly given. For the purposes of this amendatory Act of |
7 |
| the 95th General Assembly, "rules" is given the meaning |
8 |
| contained in Section 1-70 of the Illinois Administrative |
9 |
| Procedure Act, and "agency" and "agency head" are given the |
10 |
| meanings contained in Sections 1-20 and 1-25 of the Illinois |
11 |
| Administrative Procedure Act to the extent that such |
12 |
| definitions apply to agencies or agency heads under the |
13 |
| jurisdiction of the Governor. |
14 |
| (Source: P.A. 93-477, eff. 1-1-04.)
|
15 |
| Section 99. Effective date. This Act takes effect upon |
16 |
| becoming law.".
|