Illinois General Assembly - Full Text of HB3707
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Full Text of HB3707  102nd General Assembly

HB3707 102ND GENERAL ASSEMBLY

  
  

 


 
102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
HB3707

 

Introduced 2/22/2021, by Rep. Sam Yingling

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 97/5

    Amends the Illinois Health Insurance Portability and Accountability Act. Revises the definition of "small employer" to mean an employer who employs an average of at least one but not more than 50 employees on business days during the preceding calendar year and who employs at least one employee on the first day of the plan year (rather than an employer who employs an average of at least 2 employees on business days during the preceding calendar year and who employs at least 2 employees on the first day of the plan year). Effective immediately.


LRB102 10033 BMS 15353 b

 

 

A BILL FOR

 

HB3707LRB102 10033 BMS 15353 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Health Insurance Portability and
5Accountability Act is amended by changing Section 5 as
6follows:
 
7    (215 ILCS 97/5)
8    Sec. 5. Definitions.
9    "Affiliate" means a person that directly, or indirectly
10through one or more intermediaries, controls, is controlled
11by, or is under common control with the person specified.
12    "Beneficiary" has the meaning given such term under
13Section 3(8) of the Employee Retirement Income Security Act of
141974.
15    "Bona fide association" means, with respect to health
16insurance coverage offered in a State, an association which:
17        (1) has been actively in existence for at least 5
18    years;
19        (2) has been formed and maintained in good faith for
20    purposes other than obtaining insurance;
21        (3) does not condition membership in the association
22    on any health status-related factor relating to an
23    individual (including an employee of an employer or a

 

 

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1    dependent of an employee);
2        (4) makes health insurance coverage offered through
3    the association available to all members regardless of any
4    health status-related factor relating to such members (or
5    individuals eligible for coverage through a member);
6        (5) does not make health insurance coverage offered
7    through the association available other than in connection
8    with a member of the association; and
9        (6) meets such additional requirements as may be
10    imposed under State law.
11    "Church plan" has the meaning given that term under
12Section 3(33) of the Employee Retirement Income Security Act
13of 1974.
14    "COBRA continuation provision" means any of the following:
15        (1) Section 4980B of the Internal Revenue Code of
16    1986, other than subsection (f)(1) of that Section insofar
17    as it relates to pediatric vaccines.
18        (2) Part 6 of subtitle B of title I of the Employee
19    Retirement Income Security Act of 1974, other than Section
20    609 of that Act.
21        (3) Title XXII of federal Public Health Service Act.
22    "Control" means the possession, direct or indirect, of the
23power to direct or cause the direction of the management and
24policies of a person, whether through the ownership of voting
25securities, the holding of policyholders' proxies by contract
26other than a commercial contract for goods or non-management

 

 

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1services, or otherwise, unless the power is solely the result
2of an official position with or corporate office held by the
3person. Control is presumed to exist if any person, directly
4or indirectly, owns, controls, holds with the power to vote,
5or holds shareholders' proxies representing 10% or more of the
6voting securities of any other person or holds or controls
7sufficient policyholders' proxies to elect the majority of the
8board of directors of the domestic company. This presumption
9may be rebutted by a showing made in a manner as the Secretary
10may provide by rule. The Secretary may determine, after
11furnishing all persons in interest notice and opportunity to
12be heard and making specific findings of fact to support such
13determination, that control exists in fact, notwithstanding
14the absence of a presumption to that effect.
15    "Department" means the Department of Insurance.
16    "Employee" has the meaning given that term under Section
173(6) of the Employee Retirement Income Security Act of 1974.
18    "Employer" has the meaning given that term under Section
193(5) of the Employee Retirement Income Security Act of 1974,
20except that the term shall include only employers of 2 or more
21employees.
22    "Enrollment date" means, with respect to an individual
23covered under a group health plan or group health insurance
24coverage, the date of enrollment of the individual in the plan
25or coverage, or if earlier, the first day of the waiting period
26for enrollment.

 

 

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1    "Federal governmental plan" means a governmental plan
2established or maintained for its employees by the government
3of the United States or by any agency or instrumentality of
4that government.
5    "Governmental plan" has the meaning given that term under
6Section 3(32) of the Employee Retirement Income Security Act
7of 1974 and any federal governmental plan.
8    "Group health insurance coverage" means, in connection
9with a group health plan, health insurance coverage offered in
10connection with the plan.
11    "Group health plan" means an employee welfare benefit plan
12(as defined in Section 3(1) of the Employee Retirement Income
13Security Act of 1974) to the extent that the plan provides
14medical care (as defined in paragraph (2) of that Section and
15including items and services paid for as medical care) to
16employees or their dependents (as defined under the terms of
17the plan) directly or through insurance, reimbursement, or
18otherwise.
19    "Health insurance coverage" means benefits consisting of
20medical care (provided directly, through insurance or
21reimbursement, or otherwise and including items and services
22paid for as medical care) under any hospital or medical
23service policy or certificate, hospital or medical service
24plan contract, or health maintenance organization contract
25offered by a health insurance issuer.
26    "Health insurance issuer" means an insurance company,

 

 

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1insurance service, or insurance organization (including a
2health maintenance organization, as defined herein) which is
3licensed to engage in the business of insurance in a state and
4which is subject to Illinois law which regulates insurance
5(within the meaning of Section 514(b)(2) of the Employee
6Retirement Income Security Act of 1974). The term does not
7include a group health plan.
8    "Health maintenance organization (HMO)" means:
9        (1) a Federally qualified health maintenance
10    organization (as defined in Section 1301(a) of the Public
11    Health Service Act.);
12        (2) an organization recognized under State law as a
13    health maintenance organization; or
14        (3) a similar organization regulated under State law
15    for solvency in the same manner and to the same extent as
16    such a health maintenance organization.
17    "Individual health insurance coverage" means health
18insurance coverage offered to individuals in the individual
19market, but does not include short-term limited duration
20insurance.
21    "Individual market" means the market for health insurance
22coverage offered to individuals other than in connection with
23a group health plan.
24    "Large employer" means, in connection with a group health
25plan with respect to a calendar year and a plan year, an
26employer who employed an average of at least 51 employees on

 

 

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1business days during the preceding calendar year and who
2employs at least 2 employees on the first day of the plan year.
3        (1) Application of aggregation rule for large
4    employers. All persons treated as a single employer under
5    subsection (b), (c), (m), or (o) of Section 414 of the
6    Internal Revenue Code of 1986 shall be treated as one
7    employer.
8        (2) Employers not in existence in preceding year. In
9    the case of an employer which was not in existence
10    throughout the preceding calendar year, the determination
11    of whether the employer is a large employer shall be based
12    on the average number of employees that it is reasonably
13    expected the employer will employ on business days in the
14    current calendar year.
15        (3) Predecessors. Any reference in this Act to an
16    employer shall include a reference to any predecessor of
17    such employer.
18    "Large group market" means the health insurance market
19under which individuals obtain health insurance coverage
20(directly or through any arrangement) on behalf of themselves
21(and their dependents) through a group health plan maintained
22by a large employer.
23    "Late enrollee" means with respect to coverage under a
24group health plan, a participant or beneficiary who enrolls
25under the plan other than during:
26        (1) the first period in which the individual is

 

 

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1    eligible to enroll under the plan; or
2        (2) a special enrollment period under subsection (F)
3    of Section 20.
4    "Medical care" means amounts paid for:
5        (1) the diagnosis, cure, mitigation, treatment, or
6    prevention of disease, or amounts paid for the purpose of
7    affecting any structure or function of the body;
8        (2) amounts paid for transportation primarily for and
9    essential to medical care referred to in item (1); and
10        (3) amounts paid for insurance covering medical care
11    referred to in items (1) and (2).
12    "Nonfederal governmental plan" means a governmental plan
13that is not a federal governmental plan.
14    "Network plan" means health insurance coverage of a health
15insurance issuer under which the financing and delivery of
16medical care (including items and services paid for as medical
17care) are provided, in whole or in part, through a defined set
18of providers under contract with the issuer.
19    "Participant" has the meaning given that term under
20Section 3(7) of the Employee Retirement Income Security Act of
211974.
22    "Person" means an individual, a corporation, a
23partnership, an association, a joint stock company, a trust,
24an unincorporated organization, any similar entity, or any
25combination of the foregoing acting in concert, but does not
26include any securities broker performing no more than the

 

 

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1usual and customary broker's function or joint venture
2partnership exclusively engaged in owning, managing, leasing,
3or developing real or tangible personal property other than
4capital stock.
5    "Placement" or being "placed" for adoption, in connection
6with any placement for adoption of a child with any person,
7means the assumption and retention by the person of a legal
8obligation for total or partial support of the child in
9anticipation of adoption of the child. The child's placement
10with the person terminates upon the termination of the legal
11obligation.
12    "Plan sponsor" has the meaning given that term under
13Section 3(16)(B) of the Employee Retirement Income Security
14Act of 1974.
15    "Preexisting condition exclusion" means, with respect to
16coverage, a limitation or exclusion of benefits relating to a
17condition based on the fact that the condition was present
18before the date of enrollment for such coverage, whether or
19not any medical advice, diagnosis, care, or treatment was
20recommended or received before such date.
21    "Small employer" means, in connection with a group health
22plan with respect to a calendar year and a plan year, an
23employer who employed an average of at least one 2 but not more
24than 50 employees on business days during the preceding
25calendar year and who employs at least one employee 2
26employees on the first day of the plan year.

 

 

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1        (1) Application of aggregation rule for small
2    employers. All persons treated as a single employer under
3    subsection (b), (c), (m), or (o) of Section 414 of the
4    Internal Revenue Code of 1986 shall be treated as one
5    employer.
6        (2) Employers not in existence in preceding year. In
7    the case of an employer which was not in existence
8    throughout the preceding calendar year, the determination
9    of whether the employer is a small employer shall be based
10    on the average number of employees that it is reasonably
11    expected the employer will employ on business days in the
12    current calendar year.
13        (3) Predecessors. Any reference in this Act to a small
14    employer shall include a reference to any predecessor of
15    that employer.
16    "Small group market" means the health insurance market
17under which individuals obtain health insurance coverage
18(directly or through any arrangement) on behalf of themselves
19(and their dependents) through a group health plan maintained
20by a small employer.
21    "State" means each of the several States, the District of
22Columbia, Puerto Rico, the Virgin Islands, Guam, American
23Samoa, and the Northern Mariana Islands.
24    "Waiting period" means with respect to a group health plan
25and an individual who is a potential participant or
26beneficiary in the plan, the period of time that must pass with

 

 

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1respect to the individual before the individual is eligible to
2be covered for benefits under the terms of the plan.
3(Source: P.A. 94-502, eff. 8-8-05.)
 
4    Section 99. Effective date. This Act takes effect upon
5becoming law.