093_SB0908eng SB908 Engrossed LRB093 07205 JLS 07361 b 1 AN ACT concerning health benefit plans. 2 Be it enacted by the People of the State of Illinois, 3 represented in the General Assembly: 4 Section 5. The Illinois Insurance Code is amended by 5 adding Section 352b as follows: 6 (215 ILCS 5/352b new) 7 Sec. 352b. Flexible health plans. 8 (a) The Illinois General Assembly finds that a 9 significant proportion of the residents of this State are 10 unable to obtain affordable health insurance coverage. The 11 General Assembly recognizes the need for individuals and 12 employers in this State to have the opportunity to choose 13 health insurance plans that are more affordable and flexible 14 than standard market policies of accident and health 15 insurance and the need to increase the availability of health 16 insurance coverage by authorizing the transaction of this 17 type of plan or policy by carriers licensed to provide health 18 insurance in this State. Therefore, it is the intent of the 19 Illinois General Assembly to expand the availability of 20 affordable and flexible health insurance options for 21 individuals and employers by allowing health insurance 22 carriers to develop alternative approaches to traditional 23 accident and health insurance policies currently offered in 24 this State. This Section shall in no way prevent carriers 25 from offering or any individual or employer from choosing in 26 whole or in part any health insurance coverages that are 27 offered or mandated under this Code. 28 (b) As used in this Section: 29 "Carrier" means any entity authorized by the Department 30 to provide a health insurance plan, including a licensed 31 insurance company, a prepaid hospital or medical service SB908 Engrossed -2- LRB093 07205 JLS 07361 b 1 plan, or a health maintenance organization. 2 "Health benefit plan" means any hospital or medical 3 expense-incurred policy, hospital or medical service plan 4 contract, or health maintenance organization subscriber 5 contract. 6 "Health flex plan" means a health benefit plan offered by 7 a carrier authorized to transact business in this State that, 8 either in whole or in part, does not provide State mandated 9 health benefits. 10 "State mandated health benefits" means coverage for 11 specific health care services, benefits, or treatment 12 required by State law or rule, limitations or restrictions on 13 deductibles, coinsurance, copayments, or any annual or 14 lifetime maximum benefit amounts, or inclusion of a specific 15 health care provider to be provided to a person covered under 16 a health benefit plan issued in the State of Illinois. "State 17 mandated health benefits" does not mean standard provisions 18 or rights required to be present in a health benefit plan 19 pursuant to State law or regulations including, but not 20 limited to, those contained in Article IV of the Health 21 Maintenance Organization Act, Sections 356b through 356L, 22 Sections 356n through 356z.2, Section 367b, Section 367e, 23 Section 367i, Section 367.2, and Section 370c of the Illinois 24 Insurance Code. 25 (c) In addition to offering within this State health 26 benefit plans that must contain State mandated health 27 benefits, any carrier authorized to transact business in this 28 State shall be authorized to offer, as an option, a health 29 flex plan beginning on January 1, 2004. 30 (d) In each sale of a health benefit plan in which the 31 proposed group has chosen a health flex plan, the carrier 32 shall: 33 (1) provide notice that identifies to the 34 policyholder the State mandated benefits not included in SB908 Engrossed -3- LRB093 07205 JLS 07361 b 1 the health flex plan. Such notice shall be provided by 2 the employer to each employee participating in the health 3 flex plan; 4 (2) provide to the policy holder a notice with the 5 following language in bold type: 6 "This health flex plan, either in whole or in part, 7 does not provide State mandated health benefits normally 8 required in accident and health insurance policies in 9 Illinois. This health flex plan may provide a more 10 affordable health insurance policy for you, although, at 11 the same time, it may provide you with fewer health 12 benefits than those normally included as State mandated 13 health benefits in policies in Illinois."; 14 (3) provide to the policyholder a statement to be 15 signed acknowledging that the health flex plan being 16 purchased does not provide the State mandated health 17 benefits listed on the form; and 18 (4) maintain the signed notice to provide 19 information as may be needed by the Director of 20 Insurance. 21 (e) The Director may promulgate rules as necessary to 22 implement the provisions of this Section. 23 Section 99. Effective date. This Act takes effect upon 24 becoming law.