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
 
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 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
 
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 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.