Sen. Susan Garrett
Filed: 5/5/2009
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1 | AMENDMENT TO HOUSE BILL 2325
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2 | AMENDMENT NO. ______. Amend House Bill 2325 by replacing | ||||||
3 | everything after the enacting clause with the following:
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4 | "Section 5. The Illinois Insurance Code is amended by | ||||||
5 | changing Section 367e as follows:
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6 | (215 ILCS 5/367e) (from Ch. 73, par. 979e)
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7 | Sec. 367e. Continuation of Group Hospital, Surgical and | ||||||
8 | Major Medical
Coverage After Termination of Employment or | ||||||
9 | Membership.
A group policy delivered, issued for delivery, | ||||||
10 | renewed or amended in this
state which insures employees or | ||||||
11 | members
for hospital, surgical or major medical insurance on an | ||||||
12 | expense incurred
or service basis, other than for specific | ||||||
13 | diseases or for accidental injuries
only, shall provide that | ||||||
14 | employees or members whose insurance under the
group policy | ||||||
15 | would otherwise terminate because of termination of employment
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16 | or membership or because of a reduction in hours below the |
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1 | minimum required
by the group plan shall be entitled to | ||||||
2 | continue their hospital, surgical and
major medical insurance | ||||||
3 | under that group policy, for themselves and their
eligible | ||||||
4 | dependents, subject to all of the group policy's terms and | ||||||
5 | conditions
applicable to those forms of insurance and to the | ||||||
6 | following conditions:
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7 | 1. Continuation shall only be available to an employee | ||||||
8 | or member who has
been continuously insured under the group | ||||||
9 | policy (and for similar benefits
under any group policy | ||||||
10 | which it replaced) during the entire 3 months period
ending | ||||||
11 | with such termination
or reduction in hours below the | ||||||
12 | minimum required by the group plan. With respect to an | ||||||
13 | employee or member who is involuntarily terminated between | ||||||
14 | September 1, 2008 and December 31, 2009, continuation shall | ||||||
15 | be available if the employee or member was insured under | ||||||
16 | the group policy on the day prior to the termination.
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17 | 2. Continuation shall not be available for any person | ||||||
18 | who is covered by
Medicare, except for those individuals | ||||||
19 | who have been covered under a
group Medicare supplement | ||||||
20 | policy. Neither shall continuation be
available for any | ||||||
21 | person who is
covered by any other insured or uninsured | ||||||
22 | plan
which provides hospital, surgical or medical coverage | ||||||
23 | for individuals in
a group and under which the person was | ||||||
24 | not
covered immediately prior to such termination
or | ||||||
25 | reduction in hours below the minimum required by the group | ||||||
26 | plan
or who exercises his conversion
privilege under the |
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1 | group policy.
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2 | 3. Continuation need not include dental, vision care, | ||||||
3 | prescription drug
benefits, disability income, specified | ||||||
4 | disease, or similar supplementary
benefits which are | ||||||
5 | provided under the group policy in addition to its | ||||||
6 | hospital,
surgical or major medical benefits.
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7 | 4. Upon termination
or reduction in hours below the | ||||||
8 | minimum required by the group plan
written notice of | ||||||
9 | continuation shall be presented
to the employee or member | ||||||
10 | and the insurer by the employer or mailed by the employer | ||||||
11 | to the
last known address of the employee. With respect to | ||||||
12 | an employee or member who is terminated or whose reduction | ||||||
13 | in hours below the minimum required by the group occurs | ||||||
14 | after the effective date of this amendatory Act of the 96th | ||||||
15 | General Assembly, this written notice must be given | ||||||
16 | directly to the employee or member or sent via certified | ||||||
17 | mail within 10 days after the employee's or member's | ||||||
18 | termination or reduction in hours below the minimum | ||||||
19 | required by the group plan. An employee or member who | ||||||
20 | wishes
continuation
of coverage must request such | ||||||
21 | continuation in writing within the 30 day ten-day
period | ||||||
22 | following the later of: (i) the date of such termination
or | ||||||
23 | reduction in hours below the minimum required by the group | ||||||
24 | plan, or (ii)
the date the employee is given written notice | ||||||
25 | of the right of continuation
by either the employer , or the
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26 | group policyholder , or insurer. The written notice |
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1 | provided to an employee or member who is terminated or | ||||||
2 | whose reduction in hours below the minimum required by the | ||||||
3 | group occurs after the effective date of this amendatory | ||||||
4 | Act of the 96th General Assembly must include an | ||||||
5 | explanation that his or her option for continuation | ||||||
6 | coverage will expire within the 30 day period following the | ||||||
7 | later of (i) the date of such termination of employment or | ||||||
8 | reduction in hours below the minimum required by the group | ||||||
9 | plan, or (ii) the date the employee is given written notice | ||||||
10 | of the right of continuation by either the employer, group | ||||||
11 | policyholder, or insurer . In no event, however, may the | ||||||
12 | employee or member elect
continuation more than 60 days | ||||||
13 | after the date of such termination
or reduction in hours | ||||||
14 | below the minimum required by the group plan.
Written | ||||||
15 | notice of continuation presented to the employee or member | ||||||
16 | by the
policyholder, or mailed by the policyholder to the | ||||||
17 | last known address of
the employee, shall constitute the | ||||||
18 | giving of notice for the purpose of this
provision.
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19 | In the event the employer fails or refuses to provide | ||||||
20 | notice of continuation rights to the employee or member, | ||||||
21 | the insurer is required to mail notice of the continuation | ||||||
22 | rights to the employee or member at the last known address | ||||||
23 | of the employee. In the event the employee or member | ||||||
24 | contacts the insurer regarding continuation rights and | ||||||
25 | advises that notice has not been provided by the employer | ||||||
26 | or group policyholder, the insurer shall mail out notice to |
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1 | that individual. An employee or member shall have 30 days | ||||||
2 | from receipt of the notice to elect continuation. | ||||||
3 | 4a. Unless contrary to the provisions of, or any rules | ||||||
4 | promulgated pursuant to, Section 3001(a)(7) of Title III of | ||||||
5 | Division B of the federal American Recovery and | ||||||
6 | Reinvestment Act of 2009, with respect to employees or | ||||||
7 | members of health plans that are subject solely to State | ||||||
8 | continuation coverage and who are terminated or whose | ||||||
9 | reduction in hours below the minimum required by the group | ||||||
10 | occurs between the effective date of this amendatory Act of | ||||||
11 | the 96th General Assembly and December 31, 2009, the notice | ||||||
12 | requirements of this Section are not satisfied unless | ||||||
13 | notice is presented to the employee or member by the | ||||||
14 | insurer informing the employee or member of the | ||||||
15 | availability of premium reduction with respect to such | ||||||
16 | coverage under the American Recovery and Reinvestment Act | ||||||
17 | of 2009. Such written notice shall conform to all | ||||||
18 | applicable requirements set forth in Section 3001(a)(7) of | ||||||
19 | Title III of Division B of the federal American Recovery | ||||||
20 | and Reinvestment Act of 2009. The Department shall publish | ||||||
21 | models for the notification that shall be provided by | ||||||
22 | insurers pursuant to this paragraph 4a. | ||||||
23 | 4b. Unless contrary to the provisions of, or any rules | ||||||
24 | promulgated pursuant to, Section 3001(a)(7) of Title III of | ||||||
25 | Division B of the federal American Recovery and | ||||||
26 | Reinvestment Act of 2009, with respect to employees or |
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1 | members of health plans that are subject solely to State | ||||||
2 | continuation coverage who were terminated or whose | ||||||
3 | reduction in hours below the minimum required by the group | ||||||
4 | occurred between September 1, 2008 and the effective date | ||||||
5 | of this amendatory Act of the 96th General Assembly and who | ||||||
6 | have an election of continuation of coverage pursuant to | ||||||
7 | this Section in effect, notice shall be presented to the | ||||||
8 | employee or member by the insurer informing the employee or | ||||||
9 | member of the availability of premium reduction with | ||||||
10 | respect to such coverage under the American Recovery and | ||||||
11 | Reinvestment Act of 2009. Such written notice shall conform | ||||||
12 | to all applicable requirements set forth in Section | ||||||
13 | 3001(a)(7) of Title III of Division B of the federal | ||||||
14 | American Recovery and Reinvestment Act of 2009 and shall be | ||||||
15 | sent to the employee or member within 14 days of the | ||||||
16 | effective date of this amendatory Act of the 96th General | ||||||
17 | Assembly. The Department shall publish models for the | ||||||
18 | notification that shall be provided by insurers pursuant to | ||||||
19 | this paragraph 4b.
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20 | 5. An employee or member electing continuation must pay | ||||||
21 | to the group
policyholder
or his employer, on a monthly | ||||||
22 | basis in advance, the total amount of premium
required by | ||||||
23 | the insurer, including that portion of the premium | ||||||
24 | contributed
by the policyholder or employer, if any, but | ||||||
25 | not more than the group rate
for the insurance being | ||||||
26 | continued with appropriate reduction in premium
for any |
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1 | supplementary benefits which have been discontinued under | ||||||
2 | paragraph
(3) of this Section. The premium rate required by | ||||||
3 | the insurer shall be
the applicable premium required on the | ||||||
4 | due date of each payment.
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5 | 6. Continuation of insurance under the group policy for
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6 | any person shall terminate when he becomes eligible for | ||||||
7 | Medicare or is covered
by any other insured or uninsured | ||||||
8 | plan which provides hospital, surgical
or medical coverage | ||||||
9 | for individuals in a group and under which
the person was | ||||||
10 | not covered immediately prior to such termination
or | ||||||
11 | reduction in hours below the minimum required by the group | ||||||
12 | plan
as provided
in condition
2 above or, if earlier, at | ||||||
13 | the first to occur of the following:
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14 | (a) The date 12 9 months after the date the | ||||||
15 | employee's or member's
insurance
under the policy | ||||||
16 | would otherwise have terminated because of termination
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17 | of employment or membership
or reduction in hours below | ||||||
18 | the minimum required by the group plan.
| ||||||
19 | (b) If the employee or member fails to make timely | ||||||
20 | payment of a required
contribution, the end of the | ||||||
21 | period for which contributions were made.
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22 | (c) The date on which the group policy is | ||||||
23 | terminated or, in the case of
an employee, the date his | ||||||
24 | employer terminates participation under the group
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25 | policy. However, if this (c) applies and the coverage | ||||||
26 | ceasing by reason of
such
termination is replaced by |
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1 | similar coverage under another group policy,
the | ||||||
2 | following shall apply:
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3 | (i) The employee or member shall have the right | ||||||
4 | to become covered
under
that other group policy, | ||||||
5 | for the balance of the period that he would have
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6 | remained covered under the prior group policy in | ||||||
7 | accordance with condition
6 had a termination | ||||||
8 | described in this (c) not occurred.
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9 | (ii) The prior group policy shall continue to | ||||||
10 | provide benefits to the
extent of its accrued | ||||||
11 | liabilities and extensions of benefits as if the
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12 | replacement
had not occurred.
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13 | 7. A notification of the continuation privilege shall | ||||||
14 | be included in each
certificate of coverage.
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15 | 8. Continuation shall not be available for any employee | ||||||
16 | who was
discharged because of the commission of a felony in | ||||||
17 | connection with his
work, or because of theft in connection | ||||||
18 | with his work, for which the
employer was in no way | ||||||
19 | responsible; provided the employee admitted his
commission | ||||||
20 | of the felony or theft or such act has resulted in a | ||||||
21 | conviction
or order of supervision by a court of competent | ||||||
22 | jurisdiction.
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23 | 9. An employee or member without an election of | ||||||
24 | continuation of coverage pursuant to this Section in effect | ||||||
25 | on the effective date of this amendatory Act of the 96th | ||||||
26 | General Assembly may elect continuation pursuant to this |
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1 | paragraph 9 if the employee or member: (i) would be an | ||||||
2 | assistance eligible individual as defined in Section | ||||||
3 | 3001(a)(3) of Title III of Division B of the federal | ||||||
4 | American Recovery and Reinvestment Act of 2009, if such an | ||||||
5 | election were in effect and (ii) at the time of termination | ||||||
6 | was eligible for continuation pursuant to paragraphs 1 and | ||||||
7 | 2 of this Section. | ||||||
8 | Unless contrary to the provisions of, or any rules | ||||||
9 | promulgated pursuant to, Section 3001(a)(7) of Title III of | ||||||
10 | Division B of the federal American Recovery and | ||||||
11 | Reinvestment Act of 2009, written notice of continuation | ||||||
12 | pursuant to this paragraph 9 shall be presented to the | ||||||
13 | employee or member by the insurer or mailed by the insurer | ||||||
14 | to the last known address of the employee or member within | ||||||
15 | 30 days after the effective date of this amendatory Act of | ||||||
16 | the 96th General Assembly. Such written notice shall | ||||||
17 | conform to all applicable requirements set forth in section | ||||||
18 | 3001(a)(7) of Title III of Division B of the federal | ||||||
19 | American Recovery and Reinvestment Act of 2009. The | ||||||
20 | Department shall publish models for the notification that | ||||||
21 | shall be provided by insurers pursuant to this paragraph 9. | ||||||
22 | An employee or member electing continuation of | ||||||
23 | coverage under this paragraph 9 must request such | ||||||
24 | continuation in writing within 60 days after the date the | ||||||
25 | employee or member receives written notice of the right of | ||||||
26 | continuation by the insurer. |
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1 | Continuation of coverage elected pursuant to this | ||||||
2 | paragraph 9 shall commence with the first period of | ||||||
3 | coverage beginning on or after February 17, 2009, the | ||||||
4 | effective date of the federal American Recovery and | ||||||
5 | Reinvestment Act of 2009, and shall not extend beyond the | ||||||
6 | period of continuation that would have been required if the | ||||||
7 | coverage had been elected pursuant to paragraph 4 of this | ||||||
8 | Section. | ||||||
9 | With respect to an employee or member who elects | ||||||
10 | continuation of coverage under this paragraph 9, the period | ||||||
11 | beginning on the date of the employee's or member's | ||||||
12 | involuntary termination of employment and ending on the | ||||||
13 | date of the first period of coverage on or after February | ||||||
14 | 17, 2009 shall be disregarded for purposes of determining | ||||||
15 | the 63-day period referred to in Section 20 of the Illinois | ||||||
16 | Health Insurance Portability and Accountability Act. | ||||||
17 | The requirements of this amendatory Act of 1983 shall apply | ||||||
18 | to any group
policy as defined in this Section, delivered or | ||||||
19 | issued for delivery on or after
180 days following the | ||||||
20 | effective date of this amendatory Act of 1983.
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21 | The requirements of this amendatory Act of 1985 shall apply | ||||||
22 | to any
group policy as defined in this Section, delivered, | ||||||
23 | issued for delivery,
renewed or amended on or after 180 days | ||||||
24 | following the effective date of
this amendatory Act of 1985.
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25 | (Source: P.A. 93-477, eff. 1-1-04.)
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1 | Section 10. The Health Maintenance Organization Act is | ||||||
2 | amended by changing Section 4-9.2 as follows:
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3 | (215 ILCS 125/4-9.2) (from Ch. 111 1/2, par. 1409.2-2)
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4 | Sec. 4-9.2. Continuation of group HMO coverage after | ||||||
5 | termination of
employee or membership. A group contract | ||||||
6 | delivered, issued for delivery,
renewed, or amended in this | ||||||
7 | State that covers employees or members for health
care services | ||||||
8 | shall provide that employees or members whose coverage under
| ||||||
9 | the group contract would otherwise terminate because of | ||||||
10 | termination of
employment or membership or because of a | ||||||
11 | reduction in hours below the minimum
required by the group | ||||||
12 | contract shall be entitled to continue their coverage
under
| ||||||
13 | that group contract, for themselves and their eligible | ||||||
14 | dependents, subject
to all of the group contract's terms and | ||||||
15 | conditions applicable to those
forms of coverage and to the | ||||||
16 | following conditions:
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17 | (1) Continuation shall only be available to an employee | ||||||
18 | or member who has
been continuously covered under the group | ||||||
19 | contract (and for similar
benefits under any group contract | ||||||
20 | that it replaced) during the entire 3
month period ending | ||||||
21 | with the termination of employment or membership or
| ||||||
22 | reduction in hours below the minimum required by the group | ||||||
23 | contract. With respect to an employee or member who is | ||||||
24 | involuntarily terminated between September 1, 2008 and | ||||||
25 | December 31, 2009, continuation shall be available if the |
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| |||||||
1 | employee or member was insured under the group policy on | ||||||
2 | the day prior to such termination.
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3 | (2) Continuation shall not be available for any | ||||||
4 | enrollee who is
covered by Medicare, except for those | ||||||
5 | individuals who have been covered
under a group Medicare | ||||||
6 | supplement policy. Continuation shall not be
available for | ||||||
7 | any enrollee who is covered by any other insured or | ||||||
8 | uninsured
plan that provides hospital, surgical, or | ||||||
9 | medical coverage for individuals
in a group and under which | ||||||
10 | the enrollee was not covered immediately
before | ||||||
11 | termination or reduction in hours below the minimum | ||||||
12 | required by the
group contract or who exercises his or her | ||||||
13 | conversion privilege under
the group policy.
| ||||||
14 | (3) Continuation need not include dental, vision care, | ||||||
15 | prescription
drug, or similar supplementary benefits that | ||||||
16 | are provided under
the group contract in addition to its | ||||||
17 | basic health care services.
| ||||||
18 | (4) Upon termination or reduction in hours below the | ||||||
19 | minimum required by
the group contract, written notice of | ||||||
20 | continuation shall be presented
to the employee or member | ||||||
21 | and the HMO by the employer or mailed by the employer to | ||||||
22 | the last
known address of the employee. With respect to an | ||||||
23 | employee or member who is terminated or whose reduction in | ||||||
24 | hours below the minimum required by the group occurs after | ||||||
25 | the effective date of this amendatory Act of the 96th | ||||||
26 | General Assembly, this written notice must be given |
| |||||||
| |||||||
1 | directly to the employee or member or sent via certified | ||||||
2 | mail within 10 days after the employee's or member's | ||||||
3 | termination or reduction in hours below the minimum | ||||||
4 | required by the group plan. An employee or member who | ||||||
5 | wishes
continuation of coverage must request continuation | ||||||
6 | in writing within
the 30 10 day period following the later | ||||||
7 | of (i) the date of termination or
reduction in hours below | ||||||
8 | the minimum required by the group contract or (ii)
the date | ||||||
9 | the employee is given written notice of the right of | ||||||
10 | continuation by
either the employer , or the group | ||||||
11 | policyholder , or HMO . The written notice provided to an | ||||||
12 | employee or member who is terminated or whose reduction in | ||||||
13 | hours below the minimum required by the group occurs after | ||||||
14 | the effective date of this amendatory Act of the 96th | ||||||
15 | General Assembly must include an explanation that his or | ||||||
16 | her option for continuation coverage will expire within the | ||||||
17 | 30 day period following the later of (i) the date of such | ||||||
18 | termination of employment or reduction in hours below the | ||||||
19 | minimum required by the group plan or (ii) the date the | ||||||
20 | employee is given written notice of the right of | ||||||
21 | continuation by either the employer, group policyholder, | ||||||
22 | or HMO. In no event, however, shall the
employee or member | ||||||
23 | elect continuation more than 60 days after the date of
| ||||||
24 | termination
or reduction in hours below the minimum | ||||||
25 | required by the group contract.
Written notice of | ||||||
26 | continuation presented to the employee or member
by the |
| |||||||
| |||||||
1 | policyholder or HMO , or mailed by the policyholder or HMO | ||||||
2 | to the last known address of
the employee, shall constitute | ||||||
3 | the giving of notice for the purpose of this
paragraph. | ||||||
4 | | ||||||
5 | In the event the employer fails or refuses to provide | ||||||
6 | notice of continuation rights to the employee or member, | ||||||
7 | the HMO is required to mail notice of the continuation | ||||||
8 | rights to the employee or member at the last known address | ||||||
9 | of the employee. In the event the employee or member | ||||||
10 | contacts the HMO regarding continuation rights and advises | ||||||
11 | that notice has not been provided by the employer or group | ||||||
12 | policyholder, the HMO shall mail out notice to that | ||||||
13 | individual. An employee or member shall have 30 days from | ||||||
14 | receipt of the notice to elect continuation. | ||||||
15 | (4a) Unless contrary to the provisions of, or any rules | ||||||
16 | promulgated pursuant to, Section 3001(a)(7) of Title III of | ||||||
17 | Division B of the federal American Recovery and | ||||||
18 | Reinvestment Act of 2009, with respect to employees or | ||||||
19 | members of health plans that are subject solely to State | ||||||
20 | continuation coverage and who are terminated or whose | ||||||
21 | reduction in hours below the minimum required by the group | ||||||
22 | occurs between the effective date of this amendatory Act of | ||||||
23 | the 96th General Assembly and December 31, 2009, the notice | ||||||
24 | requirements of this Section are not satisfied unless | ||||||
25 | notice is presented to the employee or member by the HMO | ||||||
26 | informing the employee or member of the availability of |
| |||||||
| |||||||
1 | premium reduction with respect to such coverage under the | ||||||
2 | American Recovery and Reinvestment Act of 2009. Such | ||||||
3 | written notice shall conform to all applicable | ||||||
4 | requirements set forth in Section 3001(a)(7) of Title III | ||||||
5 | of Division B of the federal American Recovery and | ||||||
6 | Reinvestment Act of 2009. The Department shall publish | ||||||
7 | models for the notification that shall be provided by HMOs | ||||||
8 | pursuant to this paragraph (4a). | ||||||
9 | (4b) Unless contrary to the provisions of, or any rules | ||||||
10 | promulgated pursuant to, Section 3001(a)(7) of Title III of | ||||||
11 | Division B of the federal American Recovery and | ||||||
12 | Reinvestment Act of 2009, with respect to employees or | ||||||
13 | members of health plans that are subject solely to State | ||||||
14 | continuation coverage who were terminated or whose | ||||||
15 | reduction in hours below the minimum required by the group | ||||||
16 | occurred between September 1, 2008, and the effective date | ||||||
17 | of this amendatory Act of the 96th General Assembly and who | ||||||
18 | have an election of continuation of coverage pursuant to | ||||||
19 | this Section in effect, notice shall be presented to the | ||||||
20 | employee or member by the HMO informing the employee or | ||||||
21 | member of the availability of premium reduction with | ||||||
22 | respect to such coverage under the American Recovery and | ||||||
23 | Reinvestment Act of 2009. Such written notice shall conform | ||||||
24 | to all applicable requirements set forth in Section | ||||||
25 | 3001(a)(7) of Title III of Division B of the federal | ||||||
26 | American Recovery and Reinvestment Act of 2009 and shall be |
| |||||||
| |||||||
1 | sent to the employee or member within 14 days of the | ||||||
2 | effective date of this amendatory Act of the 96th General | ||||||
3 | Assembly. The Department shall publish models for the | ||||||
4 | notification that shall be provided by HMOs pursuant to | ||||||
5 | this paragraph (4b).
| ||||||
6 | (5) An employee or member electing continuation must | ||||||
7 | pay to the group
policyholder or his employer, on a monthly | ||||||
8 | basis in advance, the total
amount of premium required by | ||||||
9 | the HMO, including that portion of the
premium contributed | ||||||
10 | by the policyholder or employer, if any, but not more
than | ||||||
11 | the group rate for the coverage being continued with | ||||||
12 | appropriate
reduction in premium for any supplementary | ||||||
13 | benefits that have been
discontinued under paragraph (3) of | ||||||
14 | this Section. The premium rate required
by the HMO shall be | ||||||
15 | the applicable premium required on the due date of each
| ||||||
16 | payment.
| ||||||
17 | (6) Continuation of coverage under the group contract | ||||||
18 | for any person
shall terminate when the person becomes | ||||||
19 | eligible for Medicare or is covered by
any other insured or | ||||||
20 | uninsured plan that provides hospital, surgical, or
| ||||||
21 | medical coverage for individuals in a group and under which | ||||||
22 | the person was not
covered immediately before termination
| ||||||
23 | or reduction in hours below the minimum required by the | ||||||
24 | group contract
as provided in paragraph (2) of this
Section | ||||||
25 | or, if earlier, at the first to occur of the following:
| ||||||
26 | (a) The expiration of 12 9 months after the |
| |||||||
| |||||||
1 | employee's or member's coverage
because of termination | ||||||
2 | of employment or membership
or reduction in hours below | ||||||
3 | the minimum required by the group contract.
| ||||||
4 | (b) If the employee or member fails to make timely | ||||||
5 | payment of a
required contribution, the end of the | ||||||
6 | period for which contributions were made.
| ||||||
7 | (c) The date on which the group contract is | ||||||
8 | terminated or, in the
case of an employee, the date his | ||||||
9 | or her employer terminates participation
under the | ||||||
10 | group contract. If, however, this paragraph applies | ||||||
11 | and the coverage
ceasing by reason of termination is | ||||||
12 | replaced by similar coverage under another
group | ||||||
13 | contract, then (i) the employee or member shall have | ||||||
14 | the right to become
covered under the replacement group | ||||||
15 | contract for the balance of the period that
he or she | ||||||
16 | would have remained covered under the prior group | ||||||
17 | contract in
accordance with paragraph (6) had a | ||||||
18 | termination described in this item (c) not
occurred and | ||||||
19 | (ii) the prior group contract shall continue to provide | ||||||
20 | benefits
to the extent of its accrued liabilities and | ||||||
21 | extensions of benefits as if the
replacement had not | ||||||
22 | occurred.
| ||||||
23 | (7) A notification of the continuation privilege shall | ||||||
24 | be included in
each evidence of coverage.
| ||||||
25 | (8) Continuation shall not be available for any | ||||||
26 | employee who was
discharged because of the commission of a |
| |||||||
| |||||||
1 | felony in connection with his or her
work, or because of | ||||||
2 | theft in connection with his or her work, for which the
| ||||||
3 | employer was in no way responsible if the employee (i) | ||||||
4 | admitted to
committing the felony or theft or (ii) was | ||||||
5 | convicted or placed under
supervision by a court of | ||||||
6 | competent jurisdiction.
| ||||||
7 | (9) An employee or member without an election of | ||||||
8 | continuation of coverage pursuant to this Section in effect | ||||||
9 | on the effective date of this amendatory Act of the 96th | ||||||
10 | General Assembly may elect continuation pursuant to this | ||||||
11 | paragraph (9) if the employee or member: (i) would be an | ||||||
12 | assistance eligible individual as defined in Section | ||||||
13 | 3001(a)(3) of Title III of Division B of the federal | ||||||
14 | American Recovery and Reinvestment Act of 2009 if such an | ||||||
15 | election were in effect and (ii) at the time of termination | ||||||
16 | was eligible for continuation pursuant to paragraphs (1) | ||||||
17 | and (2) of this Section. | ||||||
18 | Unless contrary to the provisions of, or any rules | ||||||
19 | promulgated pursuant to, Section 3001(a)(7) of Title III of | ||||||
20 | Division B of the federal American Recovery and | ||||||
21 | Reinvestment Act of 2009, written notice of continuation | ||||||
22 | pursuant to this paragraph (9) shall be presented to the | ||||||
23 | employee or member by the HMO or mailed by the HMO to the | ||||||
24 | last known address of the employee or member within 30 days | ||||||
25 | after effective date of this amendatory Act of the 96th | ||||||
26 | General Assembly. The written notice shall conform to all |
| |||||||
| |||||||
1 | applicable requirements set forth in section 3001(a)(7) of | ||||||
2 | Title III of Division B of the federal American Recovery | ||||||
3 | and Reinvestment Act of 2009. The Department shall publish | ||||||
4 | models for the notification that shall be provided by HMOs | ||||||
5 | pursuant to this paragraph (9). | ||||||
6 | An employee or member electing continuation of | ||||||
7 | coverage under this paragraph (9) must request such | ||||||
8 | continuation in writing within 60 days after the date the | ||||||
9 | employee or member receives written notice of the right of | ||||||
10 | continuation by the HMO. | ||||||
11 | Continuation of coverage elected pursuant to this | ||||||
12 | paragraph (9) shall commence with the first period of | ||||||
13 | coverage beginning on or after February 17, 2009, the | ||||||
14 | effective date of the federal American Recovery and | ||||||
15 | Reinvestment Act of 2009, and shall not extend beyond the | ||||||
16 | period of continuation that would have been required if the | ||||||
17 | coverage had been elected pursuant to paragraph (4) of this | ||||||
18 | Section. | ||||||
19 | With respect to an employee or member who elects | ||||||
20 | continuation of coverage under this paragraph (9), the | ||||||
21 | period beginning on the date of the employee or member's | ||||||
22 | involuntary termination of employment and ending on the | ||||||
23 | date of the first period of coverage on or after February | ||||||
24 | 17, 2009 shall be disregarded for purposes of determining | ||||||
25 | the 63-day period referred to in Section 20 of the Illinois | ||||||
26 | Health Insurance Portability and Accountability Act. |
| |||||||
| |||||||
1 | The requirements of this amendatory Act of 1992 shall apply | ||||||
2 | to any
group contract, as defined in this Section, delivered or | ||||||
3 | issued for
delivery on or after 180 days following the | ||||||
4 | effective date of this
amendatory Act of 1992.
| ||||||
5 | (Source: P.A. 93-477, eff. 1-1-04.)
| ||||||
6 | Section 99. Effective date. This Act takes effect upon | ||||||
7 | becoming law.".
|