093_SB0908sam001
LRB093 07205 JLS 13790 a
1 AMENDMENT TO SENATE BILL 908
2 AMENDMENT NO. . Amend Senate Bill 908 by replacing
3 everything after the enacting clause with the following:
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
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1 accident and health insurance policies currently offered in
2 this State. This Section shall in no way prevent carriers
3 from offering or any individual or employer from choosing in
4 whole or in part any health insurance coverages that are
5 offered or mandated under this Code.
6 (b) As used in this Section:
7 "Carrier" means any entity authorized by the Department
8 to provide a health insurance plan, including a licensed
9 insurance company, a prepaid hospital or medical service
10 plan, or a health maintenance organization.
11 "Health benefit plan" means any hospital or medical
12 expense-incurred policy, hospital or medical service plan
13 contract, or health maintenance organization subscriber
14 contract.
15 "Health flex plan" means a health benefit plan offered by
16 a carrier authorized to transact business in this State that,
17 either in whole or in part, does not provide State mandated
18 health benefits.
19 "State mandated health benefits" means coverage for
20 specific health care services, benefits, or treatment
21 required by State law or rule, limitations or restrictions on
22 deductibles, coinsurance, copayments, or any annual or
23 lifetime maximum benefit amounts, or inclusion of a specific
24 health care provider to be provided to a person covered under
25 a health benefit plan issued in the State of Illinois. "State
26 mandated health benefits" does not mean standard provisions
27 or rights required to be present in a health benefit plan
28 pursuant to state law or regulations including, but not
29 limited to, those contained in Article IV of the Health
30 Maintenance Organization Act, Sections 356b through 356L,
31 Sections 356n through 356z.2, Section 367b, Section 367e,
32 Section 367i, Section 367.2, and Section 370c of the Illinois
33 Insurance Code.
34 (c)In addition to offering within this State health
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1 benefit plans that must contain State mandated health
2 benefits, any carrier authorized to transact business in this
3 State shall be authorized to offer, as an option, a health
4 flex plan beginning on January 1, 2004.
5 (d) In each sale of a health benefit plan in which the
6 proposed group has chosen a health flex plan, the carrier
7 shall:
8 (1) provide notice that identifies to the
9 policyholder the State mandated benefits not included in
10 the health flex plan. Such notice shall be provided by
11 the employer to each employee participating in the health
12 flex plan;
13 (2) provide to the policy holder a notice with the
14 following language in bold type:
15 "This health flex plan, either in whole or in part,
16 does not provide State mandated health benefits normally
17 required in accident and health insurance policies in
18 Illinois. This health flex plan may provide a more
19 affordable health insurance policy for you, although, at
20 the same time, it may provide you with fewer health
21 benefits than those normally included as State mandated
22 health benefits in policies in Illinois.";
23 (3) provide to the policyholder a statement to be
24 signed acknowledging that the health flex plan being
25 purchased does not provide the State mandated health
26 benefits listed on the form; and
27 (4) maintain the signed notice to provide
28 information as may be needed by the Director of
29 Insurance.
30 (e) The Director may promulgate rules as necessary to
31 implement the provisions of this Section.
32 Section 99. Effective date. This Act takes effect upon
33 becoming law.".