94TH GENERAL ASSEMBLY
State of Illinois
2005 and 2006
SB3006

 

Introduced 1/20/2006, by Sen. Christine Radogno - Dale A. Righter - Kirk W. Dillard - Peter J. Roskam - Adeline Jay Geo-Karis

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 105/7   from Ch. 73, par. 1307
215 ILCS 105/7.2 new

    Amends the Comprehensive Health Insurance Plan Act. Provides that employers employing less than 50 employees that provide health insurance coverage to employees may enroll an employee in the Comprehensive Health Insurance Plan if certain conditions are met. Requires the rates for Plan coverage to be 200% of rates established as applicable for individual standard risks. Requires the employee and the employer to contribute to the cost of premiums. Effective immediately.


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FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

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1     AN ACT concerning insurance.
 
2     Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
 
4     Section 5. The Comprehensive Health Insurance Plan Act is
5 amended by changing Section 7 and by adding Section 7.2 as
6 follows:
 
7     (215 ILCS 105/7)  (from Ch. 73, par. 1307)
8     Sec. 7. Eligibility.
9     a. Except as provided in subsection (e) of this Section, in
10 Section 7.2 of this Act, or in Section 15 of this Act, any
11 person who is either a citizen of the United States or an alien
12 lawfully admitted for permanent residence and who has been for
13 a period of at least 180 days and continues to be a resident of
14 this State shall be eligible for Plan coverage under this
15 Section if evidence is provided of:
16         (1) A notice of rejection or refusal to issue
17     substantially similar individual health insurance coverage
18     for health reasons by a health insurance issuer; or
19         (2) A refusal by a health insurance issuer to issue
20     individual health insurance coverage except at a rate
21     exceeding the applicable Plan rate for which the person is
22     responsible.
23     A rejection or refusal by a group health plan or health
24 insurance issuer offering only stop-loss or excess of loss
25 insurance or contracts, agreements, or other arrangements for
26 reinsurance coverage with respect to the applicant shall not be
27 sufficient evidence under this subsection.
28     b. The board shall promulgate a list of medical or health
29 conditions for which a person who is either a citizen of the
30 United States or an alien lawfully admitted for permanent
31 residence and a resident of this State would be eligible for
32 Plan coverage without applying for health insurance coverage

 

 

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1 pursuant to subsection a. of this Section. Persons who can
2 demonstrate the existence or history of any medical or health
3 conditions on the list promulgated by the board shall not be
4 required to provide the evidence specified in subsection a. of
5 this Section. The list shall be effective on the first day of
6 the operation of the Plan and may be amended from time to time
7 as appropriate.
8     c. Family members of the same household who each are
9 covered persons are eligible for optional family coverage under
10 the Plan.
11     d. For persons qualifying for coverage in accordance with
12 Section 7 of this Act, the board shall, if it determines that
13 such appropriations as are made pursuant to Section 12 of this
14 Act are insufficient to allow the board to accept all of the
15 eligible persons which it projects will apply for enrollment
16 under the Plan, limit or close enrollment to ensure that the
17 Plan is not over-subscribed and that it has sufficient
18 resources to meet its obligations to existing enrollees. The
19 board shall not limit or close enrollment for federally
20 eligible individuals.
21     e. A person shall not be eligible for coverage under the
22 Plan if:
23         (1) He or she has or obtains other coverage under a
24     group health plan or health insurance coverage
25     substantially similar to or better than a Plan policy as an
26     insured or covered dependent or would be eligible to have
27     that coverage if he or she elected to obtain it. Persons
28     otherwise eligible for Plan coverage may, however, solely
29     for the purpose of having coverage for a pre-existing
30     condition, maintain other coverage only while satisfying
31     any pre-existing condition waiting period under a Plan
32     policy or a subsequent replacement policy of a Plan policy.
33         (1.1) His or her prior coverage under a group health
34     plan or health insurance coverage, provided or arranged by
35     an employer of more than 10 employees was discontinued for
36     any reason without the entire group or plan being

 

 

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1     discontinued and not replaced, provided he or she remains
2     an employee, or dependent thereof, of the same employer.
3         (2) He or she is a recipient of or is approved to
4     receive medical assistance, except that a person may
5     continue to receive medical assistance through the medical
6     assistance no grant program, but only while satisfying the
7     requirements for a preexisting condition under Section 8,
8     subsection f. of this Act. Payment of premiums pursuant to
9     this Act shall be allocable to the person's spenddown for
10     purposes of the medical assistance no grant program, but
11     that person shall not be eligible for any Plan benefits
12     while that person remains eligible for medical assistance.
13     If the person continues to receive or be approved to
14     receive medical assistance through the medical assistance
15     no grant program at or after the time that requirements for
16     a preexisting condition are satisfied, the person shall not
17     be eligible for coverage under the Plan. In that
18     circumstance, coverage under the plan shall terminate as of
19     the expiration of the preexisting condition limitation
20     period. Under all other circumstances, coverage under the
21     Plan shall automatically terminate as of the effective date
22     of any medical assistance.
23         (3) Except as provided in Section 15, the person has
24     previously participated in the Plan and voluntarily
25     terminated Plan coverage, unless 12 months have elapsed
26     since the person's latest voluntary termination of
27     coverage.
28         (4) The person fails to pay the required premium under
29     the covered person's terms of enrollment and
30     participation, in which event the liability of the Plan
31     shall be limited to benefits incurred under the Plan for
32     the time period for which premiums had been paid and the
33     covered person remained eligible for Plan coverage.
34         (5) The Plan has paid a total of $1,000,000 in benefits
35     on behalf of the covered person.
36         (6) The person is a resident of a public institution.

 

 

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1         (7) The person's premium is paid for or reimbursed
2     under any government sponsored program or by any government
3     agency or health care provider, except as an otherwise
4     qualifying full-time employee, or dependent of such
5     employee, of a government agency or health care provider
6     or, except when a person's premium is paid by the U.S.
7     Treasury Department pursuant to the federal Trade Act of
8     2002.
9         (8) The person has or later receives other benefits or
10     funds from any settlement, judgement, or award resulting
11     from any accident or injury, regardless of the date of the
12     accident or injury, or any other circumstances creating a
13     legal liability for damages due that person by a third
14     party, whether the settlement, judgment, or award is in the
15     form of a contract, agreement, or trust on behalf of a
16     minor or otherwise and whether the settlement, judgment, or
17     award is payable to the person, his or her dependent,
18     estate, personal representative, or guardian in a lump sum
19     or over time, so long as there continues to be benefits or
20     assets remaining from those sources in an amount in excess
21     of $300,000.
22         (9) Within the 5 years prior to the date a person's
23     Plan application is received by the Board, the person's
24     coverage under any health care benefit program as defined
25     in 18 U.S.C. 24, including any public or private plan or
26     contract under which any medical benefit, item, or service
27     is provided, was terminated as a result of any act or
28     practice that constitutes fraud under State or federal law
29     or as a result of an intentional misrepresentation of
30     material fact; or if that person knowingly and willfully
31     obtained or attempted to obtain, or fraudulently aided or
32     attempted to aid any other person in obtaining, any
33     coverage or benefits under the Plan to which that person
34     was not entitled.
35     f. The board or the administrator shall require
36 verification of residency and may require any additional

 

 

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1 information or documentation, or statements under oath, when
2 necessary to determine residency upon initial application and
3 for the entire term of the policy.
4     g. Coverage shall cease (i) on the date a person is no
5 longer a resident of Illinois, (ii) on the date a person
6 requests coverage to end, (iii) upon the death of the covered
7 person, (iv) on the date State law requires cancellation of the
8 policy, or (v) at the Plan's option, 30 days after the Plan
9 makes any inquiry concerning a person's eligibility or place of
10 residence to which the person does not reply.
11     h. Except under the conditions set forth in subsection g of
12 this Section, the coverage of any person who ceases to meet the
13 eligibility requirements of this Section shall be terminated at
14 the end of the current policy period for which the necessary
15 premiums have been paid.
16 (Source: P.A. 93-33, eff. 6-23-03; 93-34, eff. 6-23-03; 94-17,
17 eff. 1-1-06.)
 
18     (215 ILCS 105/7.2 new)
19     Sec. 7.2. Small employer employee eligibility.
20     (a) An employer employing less than 50 employees that
21 provides health insurance coverage to its employees may enroll
22 an employee in the Plan if that employee does not otherwise
23 meet the requirements for eligibility set forth in this Act and
24 the insurance coverage for that employee becomes too expensive
25 to maintain while continuing to provide coverage to the
26 employer's other employees.
27     (b) Rates for Plan coverage under this Section shall be
28 200% of rates established as applicable for individual standard
29 risks pursuant to subsection (d) of Section 7.1 of this Act.
30     (c) Payment of premiums required under this Act shall be as
31 follows:
32         (1) the employee shall contribute to the cost of
33     premiums in the amount that the employee would have to pay
34     if covered under the employer's health insurance plan; and
35         (2) the employer shall pay the remaining cost of

 

 

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1     premiums if the employee's contribution does not satisfy
2     the cost of premiums.
 
3     Section 99. Effective date. This Act takes effect upon
4 becoming law.