SB0005sam004 95TH GENERAL ASSEMBLY

Sen. Carol Ronen

Filed: 5/24/2007

09500SB0005sam004 LRB095 08883 DRJ 36949 a

AMENDMENT TO SENATE BILL 5

AMENDMENT NO. ______. Amend Senate Bill 5, AS AMENDED, with reference to page and line numbers of Senate Amendment No. 1, on page 68, after line 23, by inserting the following:

"Section 15-15. The State Employees Group Insurance Act of 1971 is amended by adding Section 6.16 as follows:

(5 ILCS 375/6.16 new)

Sec. 6.16. Coverage of dependents until age 30.

(a) A group health insurance policy that provides coverage for a dependent of a State member, as defined in this Act, under which coverage of a dependent terminates at a specific age before the dependent's 30th birthday, and is delivered, issued, executed, or renewed in this State after January 1, 2008, shall, upon application of the dependent as set forth in subsection (c) of this Section, provide health insurance coverage, excluding dental, life, and vision coverage, to the dependent after that specific age until the dependent's 30th birthday. As used in this Section, "dependent" means any State member's child by blood or by law who:

(1) is less than 30 years of age;

(2) is unmarried;

(3) is a resident of this State or is enrolled as a full-time student at an accredited public or private institution of higher education; and

(4) is not actually provided coverage as a named subscriber, insured, enrollee, or covered person under any other group or individual health benefits plan, group health plan, church plan, or health benefits plan, or entitled to benefits under Title XVIII of the Social Security Act, Pub.L. 89-97 (42 U.S.C. 1395 et seq.).

(b) Nothing in this Section shall be construed to require that:

(1) coverage for services be provided to dependents before January 1, 2008; or

(2) an insurer pay all or part of the cost of coverage for dependents as provided pursuant to this Section.

(c) Application for dependent coverage.

(1) A dependent covered by any health insurance policy, which coverage under the policy terminates at a specific age before the dependent's 30th birthday, may make a written election for coverage as a dependent pursuant to this Section, until the dependent's 30th birthday, at any of the following times:

(A) within 30 days prior to the termination of coverage at the specific age provided in the policy;

(B) within 30 days after meeting the requirements for dependent status as set forth in subsection (a) of this Section, when coverage for the dependent under the policy previously terminated; or

(C) during an open enrollment period, as provided pursuant to the policy, if the dependent meets the requirements for dependent status as set forth in subsection (a) of this Section during the open enrollment period.

(2) For 12 months after January 1, 2008, a dependent who qualifies for dependent status as set forth in subsection (a) of this Section, but whose coverage as a dependent terminated under the terms of the policy prior to January 1, 2008, may make a written election to reinstate coverage under the policy as a dependent pursuant to this subsection.

(3) Coverage for a dependent who makes a written election for coverage pursuant to this subsection shall consist of coverage that is identical to the health insurance coverage provided to that dependent prior to the termination of coverage at the specific age provided in the policy. If the health insurance coverage was modified under the policy for any similarly situated dependents prior to their termination of coverage at the specific age provided in the policy, the health insurance coverage shall also be modified in the same manner for the dependent seeking reinstatement.

(4) Coverage for a dependent who makes a written election for coverage pursuant to this subsection shall not be conditioned upon, or discriminate on the basis of, lack of evidence of insurability.

(d) Premium payments.

(1) The policy of insurance pursuant to this Section shall require payment of a premium by the State member or dependent, as appropriate, for any period of coverage relating to a dependent's written election for coverage pursuant to subsection (c). The premium shall be no less than 100% and shall not exceed 105% of the cost of such coverage as determined by the Department of Healthcare and Family Services.

(2) Payments of the premium may, at the election of the State member, be made in monthly or semi-monthly installments through payroll deduction or direct payment.

(e) Coverage for a dependent provided pursuant to this Section shall be provided until the earlier of the following:

(1) the dependent is disqualified for dependent status as set forth in subsection (a) of this Section;

(2) the date on which coverage ceases under the policy by reason of a failure to make a timely payment of any premium required under the policy by the State member or dependent for coverage provided pursuant to this Section; the payment of any premium shall be considered to be timely if made within 30 days after the due date or within a longer period as may be provided for by the policy; or

(3) the date upon which the insurer ceases to provide coverage to the State member.

Nothing in this subsection (e) shall be construed to permit the insurer to refuse a written election for coverage by a dependent pursuant to subsection (c) of this Section, based upon the dependent's prior disqualification pursuant to paragraph (1) of this subsection (e).

(f) Notice regarding coverage for a dependent as provided pursuant to this Section shall be provided by the insurer:

(1) on or before the coverage of a State member's dependent terminates at the specific age as provided in the policy;

(2) at the time coverage of the dependent is no longer provided pursuant to this Section because the dependent is disqualified for dependent status as set forth in subsection (a) of this Section, except that this notice shall not be required when a dependent no longer qualifies based upon paragraph (1) or (3) of subsection (a) of this Section;

(3) before any open enrollment period permitting a dependent to make a written election for coverage pursuant to subsection (c) of this Section; and

(4) immediately following January 1, 2008, prior to any subsequent open enrollment period, as provided for by the policy, to make a written election to reinstate coverage under the policy pursuant to paragraph (2) of subsection (c) of this Section.".