Full Text of HB0678 93rd General Assembly
HB0678sam001 93RD GENERAL ASSEMBLY
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Sen. Denny Jacobs
Filed: 11/16/2004
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| AMENDMENT TO HOUSE BILL 678
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| AMENDMENT NO. ______. Amend House Bill 678 by replacing | 3 |
| everything after the enacting clause with the following:
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| "Section 1. Short title. This Act may be cited as the | 5 |
| Illinois Consumer Choice of Benefits Health Insurance Plan Act.
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| Section 5. Purpose. The legislature recognizes the need for | 7 |
| individuals, employers, and other purchasers of coverage in | 8 |
| this State to have the opportunity to choose health insurance | 9 |
| plans that are more affordable and flexible than existing | 10 |
| market policies offering accident and health insurance | 11 |
| coverage. The legislature, therefore, seeks to increase the | 12 |
| availability of health insurance coverage by allowing insurers | 13 |
| authorized to engage in the business of insurance in this state | 14 |
| to issue accident and health policies that, in whole or in | 15 |
| part, do not offer or provide state-mandated health benefits. | 16 |
| Section 10. Definitions. For purposes of this Act: | 17 |
| (a) "Consumer Choice of Benefits Health Insurance Plan" | 18 |
| means an accident or health insurance policy that, in whole or | 19 |
| in part, does not offer and provide state-mandated health | 20 |
| benefits, but that provides creditable coverage as defined by | 21 |
| Section 20 of the Illinois Health Insurance Portability and | 22 |
| Accountability Act. | 23 |
| (b) "Department" means the Department of Financial and |
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| Professional Regulation. | 2 |
| (c) "Secretary" means the Secretary of the Department of | 3 |
| Financial and Professional Regulation. | 4 |
| (d) "Insurer" means an insurance company actively engaged | 5 |
| in issuing approved policies of accident and health insurance | 6 |
| in Illinois prior to the effective date of this Act.
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| Section 15. State-mandated health benefits. | 8 |
| (a) For purposes of this Act, "state-mandated health | 9 |
| benefits" means coverage required under this Act or other laws | 10 |
| of this State to be provided in an individual major medical, | 11 |
| blanket, or group major medical policy for accident and health | 12 |
| insurance or a contract for a health-related condition that:
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| (1) includes coverage for specific health care | 14 |
| services or benefits; or | 15 |
| (2) includes coverage for a specific category of | 16 |
| licensed health care practitioner from whom an insured is | 17 |
| entitled to receive care. | 18 |
| (b) For purposes of this Act, "state-mandated health | 19 |
| benefits" does not include benefits that are mandated by | 20 |
| federal law or standard provisions or rights required under | 21 |
| this Act or other laws of this State to be provided in a group | 22 |
| major medical policy for accident and health insurance that are | 23 |
| unrelated to specific health illnesses, injuries, or | 24 |
| conditions of an insured, including provisions related to: | 25 |
| (1) continuation of coverage under Sections 367e, | 26 |
| 367f, 367g, 367h, 367j, 367.2, and 367.2-5 of the Illinois | 27 |
| Insurance Code; | 28 |
| (2) conversion coverage under Sections 356d and | 29 |
| 367e(A) of the Illinois Insurance Code; | 30 |
| (3) preexisting conditions under: | 31 |
| (A) Section 20 of the Illinois Health Insurance | 32 |
| Portability and Accountability Act; | 33 |
| (B) Section 367i of the Illinois Insurance Code; |
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| and | 2 |
| (C) Part 2005 of Chapter 1 of Title 50 of the | 3 |
| Illinois Administrative Code; | 4 |
| (4) coverage for children, including newborn or | 5 |
| adopted children, under Sections 356c, 356h, and 367b of | 6 |
| the Illinois Insurance Code; | 7 |
| (5) timely payment of claims under Section 368a of the | 8 |
| Illinois Insurance Code; | 9 |
| (6) a consumer's right to an adequate and accessible | 10 |
| network under Section 370i of the Illinois Insurance Code. | 11 |
| These rights shall not be waived under a Consumer Choice of | 12 |
| Benefits Health Insurance Plan product; | 13 |
| (7) coverage for mental health services and mental | 14 |
| illness rehabilitation services under Sections 367c and | 15 |
| 367d of the Illinois Insurance Code. | 16 |
| (c) For purposes of this Act, "state-mandated health | 17 |
| benefits" does not include benefits that are mandated by | 18 |
| federal law or standard provisions or rights required under | 19 |
| this Act or other laws of this state to be provided in an | 20 |
| individual major medical or, blanket, policy for accident and | 21 |
| health insurance that are unrelated to specific health | 22 |
| illnesses, injuries, or conditions of an insured, including | 23 |
| provisions related to: | 24 |
| (1) preexisting conditions under Part 2005 of Chapter 1 | 25 |
| of Title 50 of the Illinois Administrative Code; | 26 |
| (2) coverage for children, including newborn or | 27 |
| adopted children, under Sections 356b, 356c, and 356h of | 28 |
| the Illinois Insurance Code; | 29 |
| (3) timely payment of claims under Section 368a of the | 30 |
| Illinois Insurance Code; | 31 |
| (4) a consumer's right to an adequate and accessible | 32 |
| network under Section 370i of the Illinois Insurance Code; | 33 |
| (5) coverage requirements for individual policies | 34 |
| outlined in Section 2007.70 of Title 50 of the Illinois |
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| Administrative Code. These rights shall not be waived under | 2 |
| a Consumer Choice of Benefits Health Insurance Plan | 3 |
| product.
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| Section 20. Consumer choice of benefits health insurance | 5 |
| plans authorized; minimum requirement. An insurer may offer one | 6 |
| or more Consumer Choice of Benefits Health Insurance plans. | 7 |
| Section 25. Notice to policyholder and enrollees. | 8 |
| (a) Each written application for enrollment, including any | 9 |
| application for enrollment under a group policy, in a Consumer | 10 |
| Choice of Benefits Health Insurance Plan must contain the | 11 |
| following language at the beginning of the application in bold | 12 |
| type: | 13 |
| "You have the option to choose this Consumer Choice of | 14 |
| Benefits Health Insurance Plan that, either in whole or in | 15 |
| part, does not provide state-mandated health insurance | 16 |
| benefits normally required in accident and health | 17 |
| insurance policies in Illinois. This Consumer Choice of | 18 |
| Benefits Health Insurance Plan may provide a more | 19 |
| affordable health insurance policy for you although, at the | 20 |
| same time, it may provide you with fewer health insurance | 21 |
| benefits than those normally included as state-mandated | 22 |
| health insurance benefits in policies in Illinois. If you | 23 |
| choose this Consumer Choice of Benefits Health Insurance | 24 |
| Plan, please consult the insurance company or your | 25 |
| employer's benefits department to determine which | 26 |
| state-mandated health benefits are not included in this | 27 |
| policy."
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| (b) Each Consumer Choice of Benefits Health Insurance Plan | 29 |
| must contain the following language at or near the beginning of | 30 |
| the policy in bold type: | 31 |
| "This Consumer Choice of Benefits Health Insurance Plan, | 32 |
| either in whole or in part, does not provide state-mandated |
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| health benefits normally required in accident and health | 2 |
| insurance policies in Illinois. This Consumer Choice of | 3 |
| Benefits Health Insurance Plan may provide a more | 4 |
| affordable health insurance policy for you although, at the | 5 |
| same time, it may provide you with fewer health benefits | 6 |
| than those normally included as state-mandated health | 7 |
| benefits in policies in Illinois. Please consult with the | 8 |
| insurance company or your employer's benefits department | 9 |
| to discover which state-mandated health benefits are not | 10 |
| included in this policy."
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| Section 30. Disclosure statement. | 12 |
| (a) When a Consumer Choice of Benefits Health Insurance | 13 |
| Plan policy is issued, an insurer providing a Consumer Choice | 14 |
| of Benefits Health Insurance Plan must provide an applicant or | 15 |
| subscriber with a written disclosure statement that: | 16 |
| (1) acknowledges that the Consumer Choice of Benefits | 17 |
| Health Insurance Plan being purchased does not provide some | 18 |
| or all state-mandated health benefits; | 19 |
| (2) lists those state-mandated health benefits not | 20 |
| included under the Consumer Choice of Benefits Health | 21 |
| Insurance Plan; | 22 |
| (3) provides a notice, if the Consumer Choice of | 23 |
| Benefits Health Insurance Plan is issued to an individual | 24 |
| policyholder, that purchasing a plan may limit the | 25 |
| policyholder's future coverage options in the event the | 26 |
| policyholder's health changes and needed benefits are not | 27 |
| available under the Consumer Choice of Benefits Health | 28 |
| Insurance Plan; and | 29 |
| (4) includes a section that allows for a signature by | 30 |
| the applicant or subscriber attesting to the fact that the | 31 |
| applicant has read and understood the disclosure statement | 32 |
| and attesting to the fact that the applicant or subscriber | 33 |
| has in fact been given a choice between the Consumer Choice |
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| of Benefits Health Insurance Plan that they have chosen and | 2 |
| a health insurance plan that includes all state-mandated | 3 |
| health benefits. | 4 |
| (b) Each applicant and subscriber for initial coverage must | 5 |
| sign the disclosure statement provided by the insurer under | 6 |
| subsection (a) of this Section and return the statement to the | 7 |
| insurer. Under a group policy or contract, the term "applicant" | 8 |
| means the employer and the term "subscriber" means employee. | 9 |
| Under an individual policy or contract "applicant" means the | 10 |
| individual purchasing the policy. | 11 |
| (c) An insurer must: | 12 |
| (1) retain the signed disclosure statement in the | 13 |
| insurer's records; and | 14 |
| (2) provide the signed disclosure statement to the | 15 |
| Department upon request from the Secretary.
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| Section 35. Rules. The Secretary shall adopt rules as | 17 |
| necessary to implement this Act.
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| Section 40. Additional policies.
An insurer that offers | 19 |
| one or more Consumer Choice of Benefits Health Insurance Plans | 20 |
| under this Act to an employer group must also offer to all | 21 |
| eligible employees in the group at least one accident and | 22 |
| health insurance policy that has been filed and approved with | 23 |
| the Department and includes coverage for all state-mandated | 24 |
| health benefits. An employer that offers a Consumer Choice of | 25 |
| Benefits Health Insurance Plan to its eligible employees must | 26 |
| offer at least one accident and health insurance policy that | 27 |
| includes coverage for all state-mandated health benefits that | 28 |
| has been filed and approved by the Department. | 29 |
| Section 45. Rates; rating and underwriting records. | 30 |
| (a) An insurer offering a Consumer Choice of Benefits | 31 |
| Health Insurance Plan under this Act shall maintain at its |
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| principal place of business a complete and detailed description | 2 |
| of its rating practices and renewal underwriting practices, | 3 |
| including information and documentation that demonstrates that | 4 |
| its rating methods and practices are based upon commonly | 5 |
| accepted actuarial assumptions and are in accordance with sound | 6 |
| actuarial principles and that the rates for the Consumer Choice | 7 |
| of Benefits Health Insurance Plan reflect the difference in its | 8 |
| benefit package from a non-Consumer Choice of Benefits Health | 9 |
| Insurance Plan. | 10 |
| (b) Upon request, an insurer shall provide to the | 11 |
| Department an actuarial certification certifying that the | 12 |
| insurer is in compliance with this Act, and that the rating | 13 |
| methods of the insurer are actuarially sound. Such | 14 |
| certification shall be in a form and manner, and shall contain | 15 |
| such information, as specified by the Secretary. A copy of the | 16 |
| certification shall be retained by the insurer at its principal | 17 |
| place of business for a period of 3 years from the date of | 18 |
| certification. This shall include any work papers prepared in | 19 |
| support of the actuarial certification. | 20 |
| (c) Nothing in this Section shall be construed as granting | 21 |
| the Secretary any power or authority to determine, fix, | 22 |
| prescribe, or promulgate the rates to be charged for any | 23 |
| individual or group accident and health insurance policy or | 24 |
| policies issued under this Act.
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| Section 50. Applicability of Illinois Insurance Code | 26 |
| provisions. All policies of accident and health insurance | 27 |
| issued under this Act shall be subject to the provisions of | 28 |
| Section 356c, subsection (a) of Sections 356g, 356n, 370, 370a, | 29 |
| 370e, and 370o of the Illinois Insurance Code.
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| (215 ILCS 5/Art. XIXB rep.)
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| Section 55. The Illinois Insurance Code is amended by | 32 |
| repealing Article XIXB.".
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