Sen. Laura Fine

Filed: 3/25/2022

 

 


 

 


 
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1
AMENDMENT TO SENATE BILL 3926

2    AMENDMENT NO. ______. Amend Senate Bill 3926 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Illinois Insurance Code is amended by
5changing Sections 121-2.05, 356z.18, 367.3, 367a, 368f, 424,
6425, and 500-70 as follows:
 
7    (215 ILCS 5/121-2.05)  (from Ch. 73, par. 733-2.05)
8    Sec. 121-2.05. Group insurance policies issued and
9delivered in other State-Transactions in this State. With the
10exception of insurance transactions authorized under Sections
11230.2 or 367.3 of this Code and transactions subject to the
12requirements of the Short-Term, Limited-Duration Health
13Insurance Coverage Act, transactions in this State involving
14group legal, group life and group accident and health or
15blanket accident and health insurance or group annuities where
16the master policy of such groups was lawfully issued and

 

 

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1delivered in, and under the laws of, a State in which the
2insurer was authorized to do an insurance business, to a group
3properly established pursuant to law or regulation, and where
4the policyholder is domiciled or otherwise has a bona fide
5situs.
6(Source: P.A. 86-753.)
 
7    (215 ILCS 5/356z.18)
8    Sec. 356z.18. Prosthetic and customized orthotic devices.
9    (a) For the purposes of this Section:
10    "Customized orthotic device" means a supportive device for
11the body or a part of the body, the head, neck, or extremities,
12and includes the replacement or repair of the device based on
13the patient's physical condition as medically necessary,
14excluding foot orthotics defined as an in-shoe device designed
15to support the structural components of the foot during
16weight-bearing activities.
17    "Licensed provider" means a prosthetist, orthotist, or
18pedorthist licensed to practice in this State.
19    "Prosthetic device" means an artificial device to replace,
20in whole or in part, an arm or leg and includes accessories
21essential to the effective use of the device and the
22replacement or repair of the device based on the patient's
23physical condition as medically necessary.
24    (b) This amendatory Act of the 96th General Assembly shall
25provide benefits to any person covered thereunder for expenses

 

 

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1incurred in obtaining a prosthetic or custom orthotic device
2from any Illinois licensed prosthetist, licensed orthotist, or
3licensed pedorthist as required under the Orthotics,
4Prosthetics, and Pedorthics Practice Act.
5    (c) A group or individual major medical policy of accident
6or health insurance or managed care plan or medical, health,
7or hospital service corporation contract that provides
8coverage for prosthetic or custom orthotic care and is
9amended, delivered, issued, or renewed 6 months after the
10effective date of this amendatory Act of the 96th General
11Assembly must provide coverage for prosthetic and orthotic
12devices in accordance with this subsection (c). The coverage
13required under this Section shall be subject to the other
14general exclusions, limitations, and financial requirements of
15the policy, including coordination of benefits, participating
16provider requirements, utilization review of health care
17services, including review of medical necessity, case
18management, and experimental and investigational treatments,
19and other managed care provisions under terms and conditions
20that are no less favorable than the terms and conditions that
21apply to substantially all medical and surgical benefits
22provided under the plan or coverage.
23    (d) The policy or plan or contract may require prior
24authorization for the prosthetic or orthotic devices in the
25same manner that prior authorization is required for any other
26covered benefit.

 

 

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1    (e) Repairs and replacements of prosthetic and orthotic
2devices are also covered, subject to the co-payments and
3deductibles, unless necessitated by misuse or loss.
4    (f) A policy or plan or contract may require that, if
5coverage is provided through a managed care plan, the benefits
6mandated pursuant to this Section shall be covered benefits
7only if the prosthetic or orthotic devices are provided by a
8licensed provider employed by a provider service who contracts
9with or is designated by the carrier, to the extent that the
10carrier provides in-network and out-of-network service, the
11coverage for the prosthetic or orthotic device shall be
12offered no less extensively.
13    (g) The policy or plan or contract shall also meet
14adequacy requirements as established by the Health Care
15Reimbursement Reform Act of 1985 of the Illinois Insurance
16Code.
17    (h) This Section shall not apply to accident only,
18specified disease, short-term travel hospital or medical,
19hospital confinement indemnity, credit, dental, vision,
20Medicare supplement, long-term care, basic hospital and
21medical-surgical expense coverage, disability income insurance
22coverage, coverage issued as a supplement to liability
23insurance, workers' compensation insurance, or automobile
24medical payment insurance.
25(Source: P.A. 96-833, eff. 6-1-10.)
 

 

 

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1    (215 ILCS 5/367.3)  (from Ch. 73, par. 979.3)
2    Sec. 367.3. Group accident and health insurance;
3discretionary groups.
4    (a) No group health insurance offered to a resident of
5this State under a policy issued to a group, other than one
6specifically described in Section 367(1), shall be delivered
7or issued for delivery in this State unless the Director
8determines that:
9        (1) the issuance of the policy is not contrary to the
10    public interest;
11        (2) the issuance of the policy will result in
12    economies of acquisition and administration; and
13        (3) the benefits under the policy are reasonable in
14    relation to the premium charged.
15    (b) No such group health insurance may be offered in this
16State under a policy issued in another state unless this State
17or the state in which the group policy is issued has made a
18determination that the requirements of subsection (a) have
19been met.
20    Where insurance is to be offered in this State under a
21policy described in this subsection, the insurer shall file
22for informational review purposes:
23        (1) a copy of the group master contract;
24        (2) a copy of the statute authorizing the issuance of
25    the group policy in the state of situs, which statute has
26    the same or similar requirements as this State, or in the

 

 

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1    absence of such statute, a certification by an officer of
2    the company that the policy meets the Illinois minimum
3    standards required for individual accident and health
4    policies under authority of Section 401 of this Code, as
5    now or hereafter amended, as promulgated by rule at 50
6    Illinois Administrative Code, Ch. I, Sec. 2007, et seq.,
7    as now or hereafter amended, or under the Short-Term,
8    Limited-Duration Health Insurance Coverage Act and rules
9    thereunder, as applicable, or by a successor rule;
10        (3) evidence of approval by the state of situs of the
11    group master policy; and
12        (4) copies of all supportive material furnished to the
13    state of situs to satisfy the criteria for approval.
14    (c) The Director may, at any time after receipt of the
15information required under subsection (b) and after finding
16that the standards of subsection (a) have not been met, order
17the insurer to cease the issuance or marketing of that
18coverage in this State.
19    (d) Notwithstanding subsections (a) and (b), group Group
20accident and health insurance subject to the provisions of
21this Section is also subject to the provisions of Section 367i
22of this Code or the Short-Term, Limited-Duration Health
23Insurance Coverage Act, as applicable, and rules thereunder
24that pertain to group accident and health insurance.
25(Source: P.A. 90-655, eff. 7-30-98.)
 

 

 

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1    (215 ILCS 5/367a)  (from Ch. 73, par. 979a)
2    Sec. 367a. Blanket accident and health insurance.
3    (1) Blanket accident and health insurance is that form of
4accident and health insurance covering special groups of
5persons as enumerated in one of the following paragraphs (a)
6to (g), inclusive:
7    (a) Under a policy or contract issued to any carrier for
8hire, which shall be deemed the policyholder, covering a group
9defined as all persons who may become passengers on such
10carrier.
11    (b) Under a policy or contract issued to an employer, who
12shall be deemed the policyholder, covering all employees or
13any group of employees defined by reference to exceptional
14hazards incident to such employment.
15    (c) Under a policy or contract issued to a college,
16school, or other institution of learning or to the head or
17principal thereof, who or which shall be deemed the
18policyholder, covering students or teachers. However, except
19where inconsistent with 45 CFR 147.145, student health
20insurance coverage other than excepted benefits or short-term,
21limited-duration health insurance coverage that is provided
22pursuant to a written agreement with an institution of higher
23education for the benefit of its enrolled students and their
24dependents shall remain subject to the standards and
25requirements for individual health insurance coverage.
26    (d) Under a policy or contract issued in the name of any

 

 

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1volunteer fire department, first aid, or other such volunteer
2group, which shall be deemed the policyholder, covering all of
3the members of such department or group.
4    (e) Under a policy or contract issued to a creditor, who
5shall be deemed the policyholder, to insure debtors of the
6creditors; Provided, however, that in the case of a loan which
7is subject to the Small Loans Act, no insurance premium or
8other cost shall be directly or indirectly charged or assessed
9against, or collected or received from the borrower.
10    (f) Under a policy or contract issued to a sports team or
11to a camp, which team or camp sponsor shall be deemed the
12policyholder, covering members or campers.
13    (g) Under a policy or contract issued to any other
14substantially similar group which, in the discretion of the
15Director, may be subject to the issuance of a blanket accident
16and health policy or contract.
17    (2) Any insurance company authorized to write accident and
18health insurance in this state shall have the power to issue
19blanket accident and health insurance. No such blanket policy
20may be issued or delivered in this State unless a copy of the
21form thereof shall have been filed in accordance with Section
22355, and it contains in substance such of those provisions
23contained in Sections 357.1 through 357.30 as may be
24applicable to blanket accident and health insurance and the
25following provisions:
26    (a) A provision that the policy and the application shall

 

 

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1constitute the entire contract between the parties, and that
2all statements made by the policyholder shall, in absence of
3fraud, be deemed representations and not warranties, and that
4no such statements shall be used in defense to a claim under
5the policy, unless it is contained in a written application.
6    (b) A provision that to the group or class thereof
7originally insured shall be added from time to time all new
8persons or individuals eligible for coverage.
9    (3) An individual application shall not be required from a
10person covered under a blanket accident or health policy or
11contract, nor shall it be necessary for the insurer to furnish
12each person a certificate.
13    (4) All benefits under any blanket accident and health
14policy shall be payable to the person insured, or to his
15designated beneficiary or beneficiaries, or to his or her
16estate, except that if the person insured be a minor or person
17under legal disability, such benefits may be made payable to
18his or her parent, guardian, or other person actually
19supporting him or her. Provided further, however, that the
20policy may provide that all or any portion of any indemnities
21provided by any such policy on account of hospital, nursing,
22medical or surgical services may, at the insurer's option, be
23paid directly to the hospital or person rendering such
24services; but the policy may not require that the service be
25rendered by a particular hospital or person. Payment so made
26shall discharge the insurer's obligation with respect to the

 

 

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1amount of insurance so paid.
2    (5) Nothing contained in this section shall be deemed to
3affect the legal liability of policyholders for the death of
4or injury to, any such member of such group.
5(Source: P.A. 83-1362.)
 
6    (215 ILCS 5/368f)
7    Sec. 368f. Military service member insurance
8reinstatement.
9    (a) No Illinois resident activated for military service
10and no spouse or dependent of the resident who becomes
11eligible for a federal government-sponsored health insurance
12program, including the TriCare program providing coverage for
13civilian dependents of military personnel, as a result of the
14activation shall be denied reinstatement into the same
15individual health insurance coverage with the health insurer
16that the resident lapsed as a result of activation or becoming
17covered by the federal government-sponsored health insurance
18program. The resident shall have the right to reinstatement in
19the same individual health insurance coverage without medical
20underwriting, subject to payment of the current premium
21charged to other persons of the same age and gender that are
22covered under the same individual health coverage. Except in
23the case of birth or adoption that occurs during the period of
24activation, reinstatement must be into the same coverage type
25as the resident held prior to lapsing the individual health

 

 

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1insurance coverage and at the same or, at the option of the
2resident, higher deductible level. The reinstatement rights
3provided under this subsection (a) are not available to a
4resident or dependents if the activated person is discharged
5from the military under other than honorable conditions.
6    (b) The health insurer with which the reinstatement is
7being requested must receive a request for reinstatement no
8later than 63 days following the later of (i) deactivation or
9(ii) loss of coverage under the federal government-sponsored
10health insurance program. The health insurer may request proof
11of loss of coverage and the timing of the loss of coverage of
12the government-sponsored coverage in order to determine
13eligibility for reinstatement into the individual coverage.
14The effective date of the reinstatement of individual health
15coverage shall be the first of the month following receipt of
16the notice requesting reinstatement.
17    (c) All insurers must provide written notice to the
18policyholder of individual health coverage of the rights
19described in subsection (a) of this Section. In lieu of the
20inclusion of the notice in the individual health insurance
21policy, an insurance company may satisfy the notification
22requirement by providing a single written notice:
23        (1) in conjunction with the enrollment process for a
24    policyholder initially enrolling in the individual
25    coverage on or after the effective date of this amendatory
26    Act of the 94th General Assembly; or

 

 

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1        (2) by mailing written notice to policyholders whose
2    coverage was effective prior to the effective date of this
3    amendatory Act of the 94th General Assembly no later than
4    90 days following the effective date of this amendatory
5    Act of the 94th General Assembly.
6    (d) The provisions of subsection (a) of this Section do
7not apply to any policy or certificate providing coverage for
8any specified disease, specified accident or accident-only
9coverage, credit, dental, disability income, hospital
10indemnity, long-term care, Medicare supplement, vision care,
11or short-term travel nonrenewable health policy or other
12limited-benefit supplemental insurance, or any coverage issued
13as a supplement to any liability insurance, workers'
14compensation or similar insurance, or any insurance under
15which benefits are payable with or without regard to fault,
16whether written on a group, blanket, or individual basis.
17    (e) Nothing in this Section shall require an insurer to
18reinstate the resident if the insurer requires residency in an
19enrollment area and those residency requirements are not met
20after deactivation or loss of coverage under the
21government-sponsored health insurance program.
22    (f) All terms, conditions, and limitations of the
23individual coverage into which reinstatement is made apply
24equally to all insureds enrolled in the coverage.
25    (g) The Secretary may adopt rules as may be necessary to
26carry out the provisions of this Section.

 

 

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1(Source: P.A. 94-1037, eff. 7-20-06.)
 
2    (215 ILCS 5/424)  (from Ch. 73, par. 1031)
3    Sec. 424. Unfair methods of competition and unfair or
4deceptive acts or practices defined. The following are hereby
5defined as unfair methods of competition and unfair and
6deceptive acts or practices in the business of insurance:
7        (1) The commission by any person of any one or more of
8    the acts defined or prohibited by Sections 134, 143.24c,
9    147, 148, 149, 151, 155.22, 155.22a, 155.42, 236, 237,
10    364, and 469 of this Code.
11        (2) Entering into any agreement to commit, or by any
12    concerted action committing, any act of boycott, coercion
13    or intimidation resulting in or tending to result in
14    unreasonable restraint of, or monopoly in, the business of
15    insurance.
16        (3) Making or permitting, in the case of insurance of
17    the types enumerated in Classes 1, 2, and 3 of Section 4,
18    any unfair discrimination between individuals or risks of
19    the same class or of essentially the same hazard and
20    expense element because of the race, color, religion, or
21    national origin of such insurance risks or applicants. The
22    application of this Article to the types of insurance
23    enumerated in Class 1 of Section 4 shall in no way limit,
24    reduce, or impair the protections and remedies already
25    provided for by Sections 236 and 364 of this Code or any

 

 

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1    other provision of this Code.
2        (4) Engaging in any of the acts or practices defined
3    in or prohibited by Sections 154.5 through 154.8 of this
4    Code.
5        (5) Making or charging any rate for insurance against
6    losses arising from the use or ownership of a motor
7    vehicle which requires a higher premium of any person by
8    reason of his physical disability, race, color, religion,
9    or national origin.
10        (6) Failing to meet any requirement of the Unclaimed
11    Life Insurance Benefits Act with such frequency as to
12    constitute a general business practice.
13        (7) Failing to make a disclosure or obtain a signed
14    confirmation required under Section 15 of the Short-Term,
15    Limited-Duration Health Insurance Coverage Act or any
16    unlawful practice described in Section 30 of the
17    Short-Term, Limited-Duration Health Insurance Coverage
18    Act.
19(Source: P.A. 99-143, eff. 7-27-15; 99-893, eff. 1-1-17.)
 
20    (215 ILCS 5/425)  (from Ch. 73, par. 1032)
21    Sec. 425. Power of Director.
22    The Director shall have power to examine and investigate
23into the affairs of every person engaged in the business of
24insurance in this State, or otherwise subject to the
25provisions of Section 30 of the Short-Term, Limited-Duration

 

 

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1Health Insurance Coverage Act, and to examine and investigate
2into the affairs of any person domiciled in or resident of this
3State engaged in the business of insurance in any other State,
4Territory, Province, Possession, Country or District in which
5he is not licensed or otherwise authorized to transact
6business in order to determine whether such person has been or
7is engaged in any unfair method of competition or in any unfair
8or deceptive act or practice prohibited by Section 424.
9(Source: Laws 1967, p. 990.)
 
10    (215 ILCS 5/500-70)
11    (Section scheduled to be repealed on January 1, 2027)
12    Sec. 500-70. License denial, nonrenewal, or revocation.
13    (a) The Director may place on probation, suspend, revoke,
14or refuse to issue or renew an insurance producer's license or
15may levy a civil penalty in accordance with this Section or
16take any combination of actions, for any one or more of the
17following causes:
18        (1) providing incorrect, misleading, incomplete, or
19    materially untrue information in the license application;
20        (2) violating any insurance laws, or violating any
21    rule, subpoena, or order of the Director or of another
22    state's insurance commissioner;
23        (3) obtaining or attempting to obtain a license
24    through misrepresentation or fraud;
25        (4) improperly withholding, misappropriating or

 

 

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1    converting any moneys or properties received in the course
2    of doing insurance business;
3        (5) intentionally misrepresenting the terms of an
4    actual or proposed insurance contract or application for
5    insurance;
6        (6) having been convicted of a felony, unless the
7    individual demonstrates to the Director sufficient
8    rehabilitation to warrant the public trust; consideration
9    of such conviction of an applicant shall be in accordance
10    with Section 500-76;
11        (7) having admitted or been found to have committed
12    any insurance unfair trade practice or fraud;
13        (8) using fraudulent, coercive, or dishonest
14    practices, or demonstrating incompetence,
15    untrustworthiness or financial irresponsibility in the
16    conduct of business in this State or elsewhere;
17        (9) having an insurance producer license, or its
18    equivalent, denied, suspended, or revoked in any other
19    state, province, district or territory;
20        (10) forging a name to an application for insurance or
21    to a document related to an insurance transaction;
22        (11) improperly using notes or any other reference
23    material to complete an examination for an insurance
24    license;
25        (12) knowingly accepting insurance business from an
26    individual who is not licensed;

 

 

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1        (13) failing to comply with an administrative or court
2    order imposing a child support obligation;
3        (14) failing to pay state income tax or penalty or
4    interest or comply with any administrative or court order
5    directing payment of state income tax or failed to file a
6    return or to pay any final assessment of any tax due to the
7    Department of Revenue;
8        (15) (blank); or
9        (16) failing to comply with any provision of the
10    Viatical Settlements Act of 2009; or .
11        (17) failing to make a disclosure or obtain a signed
12    confirmation required under Section 15 of the Short-Term,
13    Limited-Duration Health Insurance Coverage Act or any
14    unlawful practice described in Section 30 of the
15    Short-Term, Limited-Duration Health Insurance Coverage
16    Act.
17    (b) If the action by the Director is to nonrenew, suspend,
18or revoke a license or to deny an application for a license,
19the Director shall notify the applicant or licensee and
20advise, in writing, the applicant or licensee of the reason
21for the suspension, revocation, denial or nonrenewal of the
22applicant's or licensee's license. The applicant or licensee
23may make written demand upon the Director within 30 days after
24the date of mailing for a hearing before the Director to
25determine the reasonableness of the Director's action. The
26hearing must be held within not fewer than 20 days nor more

 

 

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1than 30 days after the mailing of the notice of hearing and
2shall be held pursuant to 50 Ill. Adm. Code 2402.
3    (c) The license of a business entity may be suspended,
4revoked, or refused if the Director finds, after hearing, that
5an individual licensee's violation was known or should have
6been known by one or more of the partners, officers, or
7managers acting on behalf of the partnership, corporation,
8limited liability company, or limited liability partnership
9and the violation was neither reported to the Director nor
10corrective action taken.
11    (d) In addition to or instead of any applicable denial,
12suspension, or revocation of a license, a person may, after
13hearing, be subject to a civil penalty of up to $10,000 for
14each cause for denial, suspension, or revocation, however, the
15civil penalty may total no more than $100,000.
16    (e) The Director has the authority to enforce the
17provisions of and impose any penalty or remedy authorized by
18this Article against any person who is under investigation for
19or charged with a violation of this Code or rules even if the
20person's license or registration has been surrendered or has
21lapsed by operation of law.
22    (f) Upon the suspension, denial, or revocation of a
23license, the licensee or other person having possession or
24custody of the license shall promptly deliver it to the
25Director in person or by mail. The Director shall publish all
26suspensions, denials, or revocations after the suspensions,

 

 

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1denials, or revocations become final in a manner designed to
2notify interested insurance companies and other persons.
3    (g) A person whose license is revoked or whose application
4is denied pursuant to this Section is ineligible to apply for
5any license for 3 years after the revocation or denial. A
6person whose license as an insurance producer has been
7revoked, suspended, or denied may not be employed, contracted,
8or engaged in any insurance related capacity during the time
9the revocation, suspension, or denial is in effect.
10(Source: P.A. 100-286, eff. 1-1-18; 100-872, eff. 8-14-18.)
 
11    Section 10. The Short-Term, Limited-Duration Health
12Insurance Coverage Act is amended by changing Sections 5, 10,
1315, and 20 and by adding Sections 2, 25, 30, and 35 as follows:
 
14    (215 ILCS 190/2 new)
15    Sec. 2. Purpose and scope. This Act is intended to
16regulate the sale, solicitation, and marketing of short-term,
17limited-duration health insurance coverage to insurance
18consumers, and the referral of insurance consumers to
19short-term, limited-duration health insurance coverage, and to
20protect consumers from confusing or deceptive marketing
21practices. This Act applies to health insurance issuers and
22insurance producers. Additionally, except as provided therein,
23Section 30 applies to any other person whose business
24transactions include advertising, referring, or directing

 

 

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1prospective insurance purchasers or enrollees to health
2insurance coverage even when such persons are not otherwise
3required to obtain a license, certificate, or registration
4from the Department.
 
5    (215 ILCS 190/5)
6    Sec. 5. Definitions. In this Act:
7    "Department" means the Department of Insurance.
8    "Excepted benefits" has the meaning given to that term in
942 U.S.C. 300gg-91(c) and regulations thereunder.
10    "Health insurance coverage" has the meaning given to that
11term in Section 5 of the Illinois Health Insurance Portability
12and Accountability Act.
13    "Health insurance issuer" has the meaning given to that
14term in Section 5 of the Illinois Health Insurance Portability
15and Accountability Act.
16    "Health insurance issuer doing direct sales" means a
17health insurance issuer that provides a means to accept a
18completed application or enrollment form for a policy or
19certificate of health insurance coverage directly from an
20individual or group without any prior live interaction or
21written correspondence between that individual or group and an
22insurance producer. A "health insurance issuer doing direct
23sales" includes a health insurance issuer that accepts an
24application for health insurance coverage through its own
25website. A "health insurance issuer doing direct sales" does

 

 

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1not include the enrollment of individuals under a group policy
2by a non-producer representative of the group or the group's
3own website.
4    "Fraud" means an intentional misrepresentation of a
5material fact in connection with the coverage.
6    "Person" means any natural or legal person, organization,
7body, association, corporation, company, partnership, society,
8order, aggregation of individuals, or other entity described
9under any State or federal law.
10    "Short-term, limited-duration health insurance coverage"
11means health insurance coverage, other than excepted benefits,
12provided pursuant to a policy or certificate with an issuer,
13regardless of the situs of the delivery of the policy, that has
14an expiration date of is less than 365 days after the effective
15date of the policy or certificate.
16(Source: P.A. 100-1118, eff. 11-27-18.)
 
17    (215 ILCS 190/10)
18    Sec. 10. Application; scope; duration of coverage.
19    (a) This Act applies to health insurance issuers that
20offer short-term, limited-duration health insurance coverage
21to groups and individuals in this State and to short-term,
22limited-duration health insurance coverage that is delivered
23or issued for delivery in this State, including group coverage
24issued outside of this State that covers individuals in this
25State.

 

 

10200SB3926sam001- 22 -LRB102 24061 BMS 38138 a

1    (b) A short-term, limited-duration health insurance
2coverage policy or certificate may not be issued or delivered
3to any natural or legal person residing in this State unless
4the policy or certificate, when delivered or issued for
5delivery in this State, complies with the provisions of this
6Act.
7    (b-5) In addition to the entities recognized under Section
8230.1 or 367 of the Illinois Insurance Code or under the Health
9Maintenance Organization Act as eligible for group coverage, a
10group policy of short-term, limited-duration health insurance
11coverage may be issued to an institution of higher education
12for the benefit of its enrolled students and their dependents
13for purposes of this Act.
14    (c) Any short-term, limited-duration health insurance
15coverage policy or certificate that is delivered or issued for
16delivery in this State must have an expiration date in the
17policy that is less than the lesser of 181 days after the
18effective date or any applicable time limitation provided in
19federal law or regulation and shall not be renewable or
20extendable within a period of 365 days after the individual's
21coverage under the policy ends, either at the option of the
22issuer or the individual. Renewal of a short-term,
23limited-duration health insurance coverage policy or
24certificate includes the issuance of a new or different
25short-term, limited-duration health insurance policy or
26certificate by an issuer to a policyholder within 60 days

 

 

10200SB3926sam001- 23 -LRB102 24061 BMS 38138 a

1after the expiration of a policy or certificate previously
2issued by the issuer to the policyholder.
3    (d) An issuer may not rescind any Any short-term,
4limited-duration health insurance coverage policy or
5certificate that is delivered or issued for delivery in this
6State may not be rescinded before the expiration date in the
7policy, except as provided in Section 154 of the Illinois
8Insurance Code. An issuer may not cancel any such policy or
9certificate except for nonpayment of premiums or for fraud in
10the making of a claim or an application for the policy or
11certificate. Notwithstanding Section 357.22 of the Illinois
12Insurance Code, cancellations for nonpayment of premiums shall
13not be valid except upon 10 days' notice but may be effectuated
14retroactively back to the last date of coverage for which
15premiums were paid in cases of nonpayment of premiums, fraud,
16or as provided in subsection (e).
17    (e) Any short-term, limited-duration health insurance
18coverage policy or certificate that is delivered or issued for
19delivery in this State shall contain an option for an
20individual to cancel coverage after any 30-day interval during
21the term of the plan, counting such intervals from the
22effective date of coverage.
23(Source: P.A. 100-1118, eff. 11-27-18.)
 
24    (215 ILCS 190/15)
25    Sec. 15. Disclosure requirements.

 

 

10200SB3926sam001- 24 -LRB102 24061 BMS 38138 a

1    (a) A health insurance issuer that offers short-term,
2limited-duration health insurance coverage to be delivered or
3issued for delivery in this State shall, in addition to all
4other documents required, including, but not limited to, the
5policy, the certificate, the membership booklet, the completed
6and signed application or enrollment form, all signed
7confirmations required by this Section, and a description of
8appeal and external review rights, deliver an outline of
9coverage to an applicant for or an enrollee in short-term,
10limited-duration health insurance coverage delivered or issued
11for delivery in this State.
12    (b) Any short-term, limited-duration health insurance
13coverage policy that is delivered or issued for delivery in
14the State shall display prominently in the policy, any
15application, sales, and marketing materials provided in
16connection with enrollment in such coverage, and the outline
17of coverage for such coverage, in at least 14-point, bold
18type, the following: "NOTICE: THE SHORT-TERM, LIMITED-DURATION
19INSURANCE BENEFITS UNDER THIS COVERAGE DO NOT MEET ALL FEDERAL
20REQUIREMENTS TO QUALIFY AS "MINIMUM ESSENTIAL COVERAGE" FOR
21HEALTH INSURANCE UNDER THE AFFORDABLE CARE ACT. THIS PLAN OF
22COVERAGE DOES NOT INCLUDE ALL ESSENTIAL HEALTH BENEFITS AS
23REQUIRED BY THE AFFORDABLE CARE ACT. PREEXISTING CONDITIONS
24ARE NOT COVERED UNDER THIS PLAN OF COVERAGE. BE SURE TO CHECK
25YOUR POLICY CAREFULLY TO MAKE SURE YOU UNDERSTAND WHAT THE
26POLICY DOES AND DOES NOT COVER. IF THIS COVERAGE EXPIRES OR YOU

 

 

10200SB3926sam001- 25 -LRB102 24061 BMS 38138 a

1LOSE ELIGIBILITY FOR THIS COVERAGE, YOU MIGHT HAVE TO WAIT
2UNTIL THE NEXT OPEN ENROLLMENT PERIOD TO GET OTHER HEALTH
3INSURANCE COVERAGE. YOU MAY BE ABLE TO GET LONGER TERM
4INSURANCE THAT QUALIFIES AS "MINIMUM ESSENTIAL COVERAGE" FOR
5HEALTH INSURANCE UNDER THE AFFORDABLE CARE ACT NOW AND HELP TO
6PAY FOR IT AT WWW.HEALTHCARE.GOV.".
7    (c)(1) Before enrolling any individual or accepting any
8application for group or individual short-term,
9limited-duration health insurance coverage to be delivered or
10issued for delivery in this State, an insurance producer or a
11health insurance issuer doing direct sales shall review with
12the prospective purchaser or enrollee each essential health
13benefit in the State of Illinois, identify whether the policy
14or certificate covers that benefit, and obtain the prospective
15purchaser or enrollee's signed confirmation of receipt of this
16disclosure. The signed confirmation document must be in at
17least 12-point type and must include the complete list of
18essential health benefits and an indication for each benefit
19as to whether the policy or certificate covers it to the extent
20provided in the Illinois Essential Health Benefits Benchmark
21Plan. An insurance producer or other representative of an
22issuer or its administrator may not sign on the prospective
23purchaser or enrollee's behalf.
24    (2) For coverage offered to an individual in this State
25under a group policy by a representative of the group
26policyholder or its administrator, if the issuer does not

 

 

10200SB3926sam001- 26 -LRB102 24061 BMS 38138 a

1receive the signed confirmation with the individual's
2completed and signed application or enrollment form, the
3issuer must provide this disclosure to the individual and
4obtain the individual's signed confirmation before enrolling
5the individual under the coverage.
6    (d)(1) Before enrolling any individual or accepting any
7individual application for short-term, limited-duration health
8insurance coverage, an insurance producer or a health
9insurance issuer doing direct sales must review the complete
10list of qualifying events for special enrollment with the
11prospective purchaser or enrollee, verify whether the
12individual qualifies for special enrollment on the date the
13short-term, limited-duration health insurance coverage is
14offered, and obtain the prospective purchaser or enrollee's
15signed confirmation as to whether the individual has
16experienced a qualifying event within the time frames provided
17under the Patient Protection and Affordable Care Act. The
18signed confirmation must be in at least 12-point type and must
19include the complete list of qualifying events, the relevant
20time frames for each, and an indication for each qualifying
21event as to whether it applies to the individual. An insurance
22producer or other representative of the issuer or its
23administrator may not sign the confirmation on the
24individual's behalf.
25    (2) If the individual qualifies for special enrollment, or
26during an open enrollment period described in 42 U.S.C.

 

 

10200SB3926sam001- 27 -LRB102 24061 BMS 38138 a

1300gg-1, the issuer or producer, before accepting the
2application or enrollment, must inform the individual in
3writing and via either face-to-face interaction or telephone
4call or voicemail about the availability of qualified health
5plans on the healthcare.gov website. If the issuer or producer
6also offers policies in the individual market, the issuer or
7producer may also inform the individual of the availability of
8such plans.
9    (3) For coverage offered to an individual in this State
10under a group policy by a representative of the group
11policyholder or its administrator, if the issuer does not
12receive the signed confirmation regarding qualifying events
13with the individual's completed and signed application or
14enrollment form, the issuer must provide this disclosure to
15the individual and obtain the individual's signed confirmation
16regarding qualifying events before enrolling the individual
17under the coverage. If the individual indicates that a
18qualifying event has occurred within the relevant time frame,
19the issuer must comply with paragraph (2).
20    (e) A health insurance issuer shall provide a website
21where prospective purchasers or enrollees can review the
22complete policy or certificate and the outline of coverage
23before submitting their application or enrollment form. The
24availability of this website shall be disclosed on the
25application or enrollment form and in any sales or marketing
26materials for the coverage.

 

 

10200SB3926sam001- 28 -LRB102 24061 BMS 38138 a

1    (f) The policy or certificate and any application or
2enrollment form must contain a provision stating that, during
3a period of 10 days from the date the policy or certificate is
4delivered, the group or individual may submit a written
5request for retroactive cancellation of coverage and that in
6such event the issuer will refund any premium paid for the
7policy or certificate, including any contract fees or other
8charges.
9    (g) In addition to the written disclosures, any insurance
10producer (c) Any individual selling a short-term,
11limited-duration health insurance coverage policy in this
12State in face-to-face or telephonic sales interactions must
13read out loud the disclosures disclosure in subsections
14subsection (b), (c), (d), (e), and (f) to a prospective
15purchaser or enrollee. An issuer entity selling a short-term,
16limited-duration health insurance coverage policy or
17certificate in Illinois must display the disclosures
18disclosure in subsections subsection (b), (c), (d), (e), and
19(f) on the webpage where a prospective purchaser or enrollee
20would purchase or enroll in coverage. For sales conducted by
21an insurance producer in face-to-face or telephonic
22interactions, the application or enrollment form shall contain
23an attestation to be initialed by the applicant that the
24producer read each disclosure out loud, that the applicant
25understood each disclosure, and that the applicant was given
26opportunities to ask the producer questions about each

 

 

10200SB3926sam001- 29 -LRB102 24061 BMS 38138 a

1disclosure and to review the policy or certificate and the
2outline of coverage.
3    (h) (d) Nothing in this Section precludes an issuer
4insurer from providing disclosures in addition to those
5required in subsections (b), and (c), (d), (e), and (f).
6Nothing in this Section precludes an insurer from providing
7disclosures intended to clarify those required in subsections
8(b), and (c), (d), (e), and (f) if approved by the Department.
9Nothing in this Section precludes an issuer from including the
10written disclosures required in subsections (c) and (d) on the
11application or enrollment form.
12    (i) No policy or certificate of short-term,
13limited-duration health insurance coverage shall be delivered
14or issued for delivery in this State unless the prospective
15purchaser or enrollee reviews and signs the completed written
16application or enrollment form. Any application or enrollment
17form submitted by an insurance producer to a health insurance
18issuer shall contain an attestation clause signed by the
19producer stating that the producer received the signed form
20from the applicant, that no alterations have been made to any
21of the applicant's personal information appearing on the
22signed form at the time the producer received it, and that the
23applicant received and signed all disclosures described in
24this Section.
25    (j) Nothing in this Act shall preclude a prospective
26purchaser or enrollee from designating an authorized

 

 

10200SB3926sam001- 30 -LRB102 24061 BMS 38138 a

1representative to act on his or her behalf in relation to the
2purchase or enrollment. However, no designation of an
3insurance producer, a health insurance issuer, or an agent or
4employee of either shall be valid with respect to the
5disclosures, applications, enrollment forms, and signed
6confirmations under this Section.
7(Source: P.A. 100-1118, eff. 11-27-18.)
 
8    (215 ILCS 190/20)
9    Sec. 20. Filing and approval.
10    (a) Coverage subject to this Act may not be delivered or
11issued for delivery in this State unless the health insurance
12issuer has complied with the policy form and rate filing
13requirements of Sections 143 and 355 of the Illinois Insurance
14Code or Sections 4-12 and 4-13 of the Health Maintenance
15Organization Act, as applicable, including rules thereunder
16policy evidencing such coverage has been filed with and been
17approved by the Department.
18    (b) A health insurance issuer that who intends to deliver
19or issue for delivery a short-term, limited-duration health
20insurance coverage policy or certificate in this State shall
21file with the Department: (1) all paperwork required for
22individual health insurance coverage pursuant to 50 Ill. Adm.
23Code 916; and (2) all sales and marketing materials provided
24in connection with enrollment in such coverage for
25informational purposes.

 

 

10200SB3926sam001- 31 -LRB102 24061 BMS 38138 a

1    (c) (Blank). The Department shall adopt any rules
2necessary to carry out the provisions of this Act.
3(Source: P.A. 100-1118, eff. 11-27-18.)
 
4    (215 ILCS 190/25 new)
5    Sec. 25. Coverage requirements; other laws.
6    (a) Except where inconsistent with this Act, a health
7insurance issuer that offers any policy or certificate of
8short-term, limited-duration health insurance coverage shall
9be subject to all Illinois insurance laws or rules not
10specifically referenced in this Act that apply to major
11medical accident and health insurance or health maintenance
12organization health care plans, as applicable to the
13certificate of authority under which the short-term,
14limited-duration health insurance coverage is offered or
15issued, and that do not:
16        (1) require the policy or certificate to cover
17    essential health benefits or other specified health care
18    services or to maintain parity between certain types of
19    benefits;
20        (2) prescribe standards for continuation coverage or
21    conversion privileges;
22        (3) prohibit or prescribe standards for allowable
23    cost-sharing amounts; or
24        (4) require an issuer to satisfy standards for the
25    adequacy and transparency of any provider network through

 

 

10200SB3926sam001- 32 -LRB102 24061 BMS 38138 a

1    which the insured or enrollee is required or incentivized
2    to obtain covered health care services.
3    (b) Notwithstanding subsection (a), no State law or rule
4shall apply to the extent that it would require a policy or
5certificate of short-term, limited-duration health insurance
6coverage to provide coverage for at least 3 calendar months or
7to renew, extend, or reinstate coverage within 365 days of the
8date that coverage terminates.
9    (c) Nothing in this Act shall exempt a health maintenance
10organization offering short-term, limited-duration health
11insurance coverage from the requirements for coverage of basic
12health care services or other requirements to maintain and
13restrictions on a certificate of authority under Sections 2-1
14through 2-3 of the Health Maintenance Organization Act.
 
15    (215 ILCS 190/30 new)
16    Sec. 30. Unfair or deceptive practices relating to the
17sale of supplemental or short-term, limited-duration health
18insurance coverage.
19    (a) It is an unlawful method, act, or practice within the
20meaning of this Act for any person who solicits, negotiates,
21sells, offers, offers to enroll, issues, or delivers
22short-term, limited-duration health insurance coverage or
23excepted benefits within this State, or advertisers for such
24persons, or persons whose business transactions include
25referring or directing prospective purchasers or enrollees of

 

 

10200SB3926sam001- 33 -LRB102 24061 BMS 38138 a

1health insurance coverage that reside or are domiciled in this
2State to health insurance issuers or insurance producers
3transacting business in this State, to do any of the
4following:
5        (1) represent or warrant to any prospective purchaser
6    or enrollee, or use language or imagery in speech or
7    published content that is suggestive, that a policy or
8    certificate of excepted benefits or short-term,
9    limited-duration health insurance coverage, or any
10    combination of such policies or certificates, constitutes
11    minimum essential coverage;
12        (2) represent or warrant to any prospective purchaser
13    or enrollee, or use language or imagery in speech or
14    published content that is suggestive, that a policy or
15    certificate of excepted benefits or short-term,
16    limited-duration health insurance coverage, or any
17    combination of such policies or certificates, is similar
18    to, is almost as beneficial as, can be used for similar
19    purposes as, or may be better for the prospective
20    purchaser or enrollee than minimum essential coverage,
21    major medical coverage that complies with all Illinois
22    requirements, a health maintenance organization health
23    care plan that complies with all Illinois requirements, a
24    voluntary health services plan, comprehensive health
25    insurance coverage, a qualified health plan, or any other
26    description of coverage indicating such policies or

 

 

10200SB3926sam001- 34 -LRB102 24061 BMS 38138 a

1    certificates. An application or enrollment form for
2    specified disease or accident-only excepted benefits that
3    allows an individual prospective purchaser or enrollee to
4    choose coverage for a majority of the diseases, health
5    conditions, or accidents typically covered under major
6    medical accident health insurance or a health maintenance
7    organization health care plan, or that covers a majority
8    of the health care services constituting preventive care
9    under 42 U.S.C. 300gg-13, shall be deemed an unlawful
10    practice within the meaning of this Act; or
11        (3) use any logo, brand, trademark, service mark,
12    mark, device, name, tagline, slogan, descriptor, or
13    website domain that is deceptively similar to those used
14    for Get Covered Illinois or the healthcare.gov website,
15    including those that do not expressly mention Illinois or
16    its political subdivisions. This paragraph expressly
17    includes circumstances that would not violate the
18    Counterfeit Trademark Act.
19    (b) This Section does not apply to Internet search
20engines, Internet service providers, website domain
21registrars, Internet network hardware providers, or other
22natural or legal persons insofar as they do not propose,
23approve, or submit the content published by an insurance
24producer, health insurance issuer, or their advertisers, or
25propose, approve, or submit the content published by persons
26whose business transactions include referring prospective

 

 

10200SB3926sam001- 35 -LRB102 24061 BMS 38138 a

1purchasers or enrollees resident or domiciled in this State to
2health insurance issuers or insurance producers transacting
3business in this State.
 
4    (215 ILCS 190/35 new)
5    Sec. 35. Department administration and enforcement. The
6Department may adopt any rules necessary to carry out the
7provisions of this Act. The Department shall have all
8enforcement powers granted to it by law with respect to
9accident and health insurance and health maintenance
10organization health care plans and all persons otherwise under
11the Director's jurisdiction.
 
12    Section 99. Effective date. This Act takes effect January
131, 2023.".