101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
HB5181

 

Introduced , by Rep. Sam Yingling

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 97/5

    Amends the Illinois Health Insurance Portability and Accountability Act. Revises the definition of "small employer" to mean an employer who employs an average of at least one but not more than 50 employees on business days during the preceding calendar year and who employs at least one employee on the first day of the plan year (rather than an employer who employs an average of at least 2 employees on business days during the preceding calendar year and who employs at least 2 employees on the first day of the plan year). Effective immediately.


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A BILL FOR

 

HB5181LRB101 16648 BMS 66035 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Health Insurance Portability and
5Accountability Act is amended by changing Section 5 as follows:
 
6    (215 ILCS 97/5)
7    Sec. 5. Definitions.
8    "Affiliate" means a person that directly, or indirectly
9through one or more intermediaries, controls, is controlled by,
10or is under common control with the person specified.
11    "Beneficiary" has the meaning given such term under Section
123(8) of the Employee Retirement Income Security Act of 1974.
13    "Bona fide association" means, with respect to health
14insurance coverage offered in a State, an association which:
15        (1) has been actively in existence for at least 5
16    years;
17        (2) has been formed and maintained in good faith for
18    purposes other than obtaining insurance;
19        (3) does not condition membership in the association on
20    any health status-related factor relating to an individual
21    (including an employee of an employer or a dependent of an
22    employee);
23        (4) makes health insurance coverage offered through

 

 

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1    the association available to all members regardless of any
2    health status-related factor relating to such members (or
3    individuals eligible for coverage through a member);
4        (5) does not make health insurance coverage offered
5    through the association available other than in connection
6    with a member of the association; and
7        (6) meets such additional requirements as may be
8    imposed under State law.
9    "Church plan" has the meaning given that term under Section
103(33) of the Employee Retirement Income Security Act of 1974.
11    "COBRA continuation provision" means any of the following:
12        (1) Section 4980B of the Internal Revenue Code of 1986,
13    other than subsection (f)(1) of that Section insofar as it
14    relates to pediatric vaccines.
15        (2) Part 6 of subtitle B of title I of the Employee
16    Retirement Income Security Act of 1974, other than Section
17    609 of that Act.
18        (3) Title XXII of federal Public Health Service Act.
19    "Control" means the possession, direct or indirect, of the
20power to direct or cause the direction of the management and
21policies of a person, whether through the ownership of voting
22securities, the holding of policyholders' proxies by contract
23other than a commercial contract for goods or non-management
24services, or otherwise, unless the power is solely the result
25of an official position with or corporate office held by the
26person. Control is presumed to exist if any person, directly or

 

 

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1indirectly, owns, controls, holds with the power to vote, or
2holds shareholders' proxies representing 10% or more of the
3voting securities of any other person or holds or controls
4sufficient policyholders' proxies to elect the majority of the
5board of directors of the domestic company. This presumption
6may be rebutted by a showing made in a manner as the Secretary
7may provide by rule. The Secretary may determine, after
8furnishing all persons in interest notice and opportunity to be
9heard and making specific findings of fact to support such
10determination, that control exists in fact, notwithstanding
11the absence of a presumption to that effect.
12    "Department" means the Department of Insurance.
13    "Employee" has the meaning given that term under Section
143(6) of the Employee Retirement Income Security Act of 1974.
15    "Employer" has the meaning given that term under Section
163(5) of the Employee Retirement Income Security Act of 1974,
17except that the term shall include only employers of 2 or more
18employees.
19    "Enrollment date" means, with respect to an individual
20covered under a group health plan or group health insurance
21coverage, the date of enrollment of the individual in the plan
22or coverage, or if earlier, the first day of the waiting period
23for enrollment.
24    "Federal governmental plan" means a governmental plan
25established or maintained for its employees by the government
26of the United States or by any agency or instrumentality of

 

 

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1that government.
2    "Governmental plan" has the meaning given that term under
3Section 3(32) of the Employee Retirement Income Security Act of
41974 and any federal governmental plan.
5    "Group health insurance coverage" means, in connection
6with a group health plan, health insurance coverage offered in
7connection with the plan.
8    "Group health plan" means an employee welfare benefit plan
9(as defined in Section 3(1) of the Employee Retirement Income
10Security Act of 1974) to the extent that the plan provides
11medical care (as defined in paragraph (2) of that Section and
12including items and services paid for as medical care) to
13employees or their dependents (as defined under the terms of
14the plan) directly or through insurance, reimbursement, or
15otherwise.
16    "Health insurance coverage" means benefits consisting of
17medical care (provided directly, through insurance or
18reimbursement, or otherwise and including items and services
19paid for as medical care) under any hospital or medical service
20policy or certificate, hospital or medical service plan
21contract, or health maintenance organization contract offered
22by a health insurance issuer.
23    "Health insurance issuer" means an insurance company,
24insurance service, or insurance organization (including a
25health maintenance organization, as defined herein) which is
26licensed to engage in the business of insurance in a state and

 

 

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1which is subject to Illinois law which regulates insurance
2(within the meaning of Section 514(b)(2) of the Employee
3Retirement Income Security Act of 1974). The term does not
4include a group health plan.
5    "Health maintenance organization (HMO)" means:
6        (1) a Federally qualified health maintenance
7    organization (as defined in Section 1301(a) of the Public
8    Health Service Act.);
9        (2) an organization recognized under State law as a
10    health maintenance organization; or
11        (3) a similar organization regulated under State law
12    for solvency in the same manner and to the same extent as
13    such a health maintenance organization.
14    "Individual health insurance coverage" means health
15insurance coverage offered to individuals in the individual
16market, but does not include short-term limited duration
17insurance.
18    "Individual market" means the market for health insurance
19coverage offered to individuals other than in connection with a
20group health plan.
21    "Large employer" means, in connection with a group health
22plan with respect to a calendar year and a plan year, an
23employer who employed an average of at least 51 employees on
24business days during the preceding calendar year and who
25employs at least 2 employees on the first day of the plan year.
26        (1) Application of aggregation rule for large

 

 

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1    employers. All persons treated as a single employer under
2    subsection (b), (c), (m), or (o) of Section 414 of the
3    Internal Revenue Code of 1986 shall be treated as one
4    employer.
5        (2) Employers not in existence in preceding year. In
6    the case of an employer which was not in existence
7    throughout the preceding calendar year, the determination
8    of whether the employer is a large employer shall be based
9    on the average number of employees that it is reasonably
10    expected the employer will employ on business days in the
11    current calendar year.
12        (3) Predecessors. Any reference in this Act to an
13    employer shall include a reference to any predecessor of
14    such employer.
15    "Large group market" means the health insurance market
16under which individuals obtain health insurance coverage
17(directly or through any arrangement) on behalf of themselves
18(and their dependents) through a group health plan maintained
19by a large employer.
20    "Late enrollee" means with respect to coverage under a
21group health plan, a participant or beneficiary who enrolls
22under the plan other than during:
23        (1) the first period in which the individual is
24    eligible to enroll under the plan; or
25        (2) a special enrollment period under subsection (F) of
26    Section 20.

 

 

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1    "Medical care" means amounts paid for:
2        (1) the diagnosis, cure, mitigation, treatment, or
3    prevention of disease, or amounts paid for the purpose of
4    affecting any structure or function of the body;
5        (2) amounts paid for transportation primarily for and
6    essential to medical care referred to in item (1); and
7        (3) amounts paid for insurance covering medical care
8    referred to in items (1) and (2).
9    "Nonfederal governmental plan" means a governmental plan
10that is not a federal governmental plan.
11    "Network plan" means health insurance coverage of a health
12insurance issuer under which the financing and delivery of
13medical care (including items and services paid for as medical
14care) are provided, in whole or in part, through a defined set
15of providers under contract with the issuer.
16    "Participant" has the meaning given that term under Section
173(7) of the Employee Retirement Income Security Act of 1974.
18    "Person" means an individual, a corporation, a
19partnership, an association, a joint stock company, a trust, an
20unincorporated organization, any similar entity, or any
21combination of the foregoing acting in concert, but does not
22include any securities broker performing no more than the usual
23and customary broker's function or joint venture partnership
24exclusively engaged in owning, managing, leasing, or
25developing real or tangible personal property other than
26capital stock.

 

 

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1    "Placement" or being "placed" for adoption, in connection
2with any placement for adoption of a child with any person,
3means the assumption and retention by the person of a legal
4obligation for total or partial support of the child in
5anticipation of adoption of the child. The child's placement
6with the person terminates upon the termination of the legal
7obligation.
8    "Plan sponsor" has the meaning given that term under
9Section 3(16)(B) of the Employee Retirement Income Security Act
10of 1974.
11    "Preexisting condition exclusion" means, with respect to
12coverage, a limitation or exclusion of benefits relating to a
13condition based on the fact that the condition was present
14before the date of enrollment for such coverage, whether or not
15any medical advice, diagnosis, care, or treatment was
16recommended or received before such date.
17    "Small employer" means, in connection with a group health
18plan with respect to a calendar year and a plan year, an
19employer who employed an average of at least one 2 but not more
20than 50 employees on business days during the preceding
21calendar year and who employs at least one employee 2 employees
22on the first day of the plan year.
23        (1) Application of aggregation rule for small
24    employers. All persons treated as a single employer under
25    subsection (b), (c), (m), or (o) of Section 414 of the
26    Internal Revenue Code of 1986 shall be treated as one

 

 

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1    employer.
2        (2) Employers not in existence in preceding year. In
3    the case of an employer which was not in existence
4    throughout the preceding calendar year, the determination
5    of whether the employer is a small employer shall be based
6    on the average number of employees that it is reasonably
7    expected the employer will employ on business days in the
8    current calendar year.
9        (3) Predecessors. Any reference in this Act to a small
10    employer shall include a reference to any predecessor of
11    that employer.
12    "Small group market" means the health insurance market
13under which individuals obtain health insurance coverage
14(directly or through any arrangement) on behalf of themselves
15(and their dependents) through a group health plan maintained
16by a small employer.
17    "State" means each of the several States, the District of
18Columbia, Puerto Rico, the Virgin Islands, Guam, American
19Samoa, and the Northern Mariana Islands.
20    "Waiting period" means with respect to a group health plan
21and an individual who is a potential participant or beneficiary
22in the plan, the period of time that must pass with respect to
23the individual before the individual is eligible to be covered
24for benefits under the terms of the plan.
25(Source: P.A. 94-502, eff. 8-8-05.)
 
26    Section 99. Effective date. This Act takes effect upon

 

 

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1becoming law.