093_HB0707sam001











                                     LRB093 05485 LRD 17109 a

 1                     AMENDMENT TO HOUSE BILL 707

 2        AMENDMENT NO.     .  Amend House Bill  707  by  replacing
 3    everything after the enacting clause with the following:

 4        "Section  5.  If  and only if House Bill 3298 of the 93rd
 5    General  Assembly  becomes  law,  the  Comprehensive   Health
 6    Insurance  Plan  Act is amended by changing Sections 2, 4, 7,
 7    and 15 as follows:

 8        (215 ILCS 105/2) (from Ch. 73, par. 1302)
 9        Sec. 2.  Definitions.  As used in this  Act,  unless  the
10    context otherwise requires:
11        "Plan  administrator"  means  the  insurer or third party
12    administrator designated under Section 5 of this Act.
13        "Benefits plan" means the coverage to be offered  by  the
14    Plan  to  eligible persons and federally eligible individuals
15    pursuant to this Act.
16        "Board" means the Illinois Comprehensive Health Insurance
17    Board.
18        "Church plan" has the same meaning given that term in the
19    federal Health Insurance Portability and  Accountability  Act
20    of 1996.
21        "Continuation  coverage"  means  continuation of coverage
22    under a group health plan or other health insurance  coverage
 
                            -2-      LRB093 05485 LRD 17109 a
 1    for  former  employees or dependents of former employees that
 2    would otherwise have  terminated  under  the  terms  of  that
 3    coverage   pursuant  to  any  continuation  provisions  under
 4    federal or State  law,  including  the  Consolidated  Omnibus
 5    Budget  Reconciliation  Act  of  1985  (COBRA),  as  amended,
 6    Sections  367.2  and  367e of the Illinois Insurance Code, or
 7    any other similar requirement in another State.
 8        "Covered person" means a person who is and  continues  to
 9    remain eligible for Plan coverage and is covered under one of
10    the benefit plans offered by the Plan.
11        "Creditable  coverage" means, with respect to a federally
12    eligible individual, coverage of the individual under any  of
13    the following:
14             (A)  A group health plan.
15             (B)  Health   insurance  coverage  (including  group
16        health insurance coverage).
17             (C)  Medicare.
18             (D)  Medical assistance.
19             (E)  Chapter 55 of title 10, United States Code.
20             (F)  A medical care program  of  the  Indian  Health
21        Service or of a tribal organization.
22             (G)  A state health benefits risk pool.
23             (H)  A health plan offered under Chapter 89 of title
24        5, United States Code.
25             (I)  A public health plan (as defined in regulations
26        consistent   with   Section   104   of  the  Health  Care
27        Portability and Accountability Act of 1996  that  may  be
28        promulgated  by  the  Secretary of the U.S. Department of
29        Health and Human Services).
30             (J)  A health benefit plan under Section 5(e) of the
31        Peace Corps Act (22 U.S.C. 2504(e)).
32             (K)  Any other qualifying coverage required  by  the
33        federal  Health  Insurance Portability and Accountability
34        Act of 1996, as it may be amended, or  regulations  under
 
                            -3-      LRB093 05485 LRD 17109 a
 1        that Act.
 2        "Creditable   coverage"   does   not   include   coverage
 3    consisting  solely  of  coverage  of  excepted  benefits,  as
 4    defined  in  Section  2791(c)  of  title  XXVII of the Public
 5    Health Service Act (42 U.S.C. 300 gg-91), nor does it include
 6    any period of coverage under any of  items  (A)  through  (K)
 7    that  occurred  before  a  break  of more than 90 days or, if
 8    after September 30, 2003,  the  individual  has  either  been
 9    certified as an eligible person pursuant to the federal Trade
10    Adjustment  Act  of  2002 or initially been paid a benefit by
11    the Pension Benefit Guaranty Corporation,  a  break  of  more
12    than  63  days  during  all  of  which the individual was not
13    covered under any of items (A) through (K) above.
14        For an  individual  who  between  December  1,  2002  and
15    September  30, 2003 has either (1) been certified as eligible
16    pursuant to the federal Trade Act of 2002, (2) initially been
17    paid a benefit by the Pension Benefit  Guaranty  Corporation,
18    or  (3)  as of December 1, 2002, been receiving benefits from
19    the  Pension  Benefit  Guaranty  Corporation  and   who   has
20    qualified  health  insurance, as defined by the federal Trade
21    Act of 2002, "creditable coverage"  includes  any  period  of
22    coverage  aggregating 3 or more months under any of items (A)
23    through (K), irrespective of the length of a break during all
24    of which the individual was not covered under  any  of  items
25    (A) through (K).
26        Any  period that an individual is in a waiting period for
27    any coverage under a group health plan (or for  group  health
28    insurance  coverage) or is in an affiliation period under the
29    terms of  health  insurance  coverage  offered  by  a  health
30    maintenance  organization  shall not be taken into account in
31    determining if there has been a break of more than 90 days in
32    any creditable coverage.
33        "Department" means the Illinois Department of Insurance.
34        "Dependent" means an Illinois resident: who is a  spouse;
 
                            -4-      LRB093 05485 LRD 17109 a
 1    or who is claimed as a dependent by the principal insured for
 2    purposes of filing a federal income tax return and resides in
 3    the   principal   insured's  household,  and  is  a  resident
 4    unmarried child under the age of  19  years;  or  who  is  an
 5    unmarried child who also is a full-time student under the age
 6    of  23  years  and  who  is  financially  dependent  upon the
 7    principal insured; or who is a child of any age  and  who  is
 8    disabled   and   financially  dependent  upon  the  principal
 9    insured.
10        "Direct Illinois premiums" means, for Illinois  business,
11    an  insurer's direct premium income for the kinds of business
12    described in clause (b) of Class 1 or clause (a) of  Class  2
13    of  Section  4  of  the  Illinois  Insurance Code, and direct
14    premium income of a  health  maintenance  organization  or  a
15    voluntary  health  services plan, except it shall not include
16    credit health insurance as defined in Article IX 1/2  of  the
17    Illinois Insurance Code.
18        "Director"  means the Director of the Illinois Department
19    of Insurance.
20        "Eligible person" means a  resident  of  this  State  who
21    qualifies for Plan coverage under Section 7 of this Act.
22        "Employee" means a resident of this State who is employed
23    by an employer or has entered into the employment of or works
24    under  contract  or  service  of  an  employer  including the
25    officers, managers and employees of subsidiary or  affiliated
26    corporations  and  the  individual  proprietors, partners and
27    employees  of  affiliated  individuals  and  firms  when  the
28    business of the subsidiary or affiliated corporations,  firms
29    or  individuals  is  controlled  by a common employer through
30    stock ownership, contract, or otherwise.
31        "Employer"    means    any    individual,    partnership,
32    association, corporation, business trust, or  any  person  or
33    group  of  persons  acting  directly  or  indirectly  in  the
34    interest of an employer in relation to an employee, for which
 
                            -5-      LRB093 05485 LRD 17109 a
 1    one or more persons is gainfully employed.
 2        "Family" coverage means the coverage provided by the Plan
 3    for the covered person and his or her eligible dependents who
 4    also are covered persons.
 5        "Federally   eligible  individual"  means  an  individual
 6    resident of this State:
 7             (1)(A)  for whom,  as  of  the  date  on  which  the
 8        individual  seeks  Plan coverage under Section 15 of this
 9        Act, the aggregate of the periods of creditable  coverage
10        is 18 or more months or, if the individual has either (i)
11        been  certified  as  an  eligible  person pursuant to the
12        federal Trade Adjustment Act of 2002, (ii) initially been
13        paid  a  benefit  by   the   Pension   Benefit   Guaranty
14        Corporation,  or  (iii)  as  of  December  1,  2002, been
15        receiving benefits  from  the  Pension  Benefit  Guaranty
16        Corporation   and  has  qualified  health  insurance,  as
17        defined by the federal Trade  Act  of  2002,  3  or  more
18        months,  and  (B)  whose  most  recent  prior  creditable
19        coverage   was  under  group  health  insurance  coverage
20        offered by a health  insurance  issuer,  a  group  health
21        plan,  a  governmental  plan, or a church plan (or health
22        insurance coverage offered in connection  with  any  such
23        plans)  or any other type of creditable coverage that may
24        be required by the federal Health  Insurance  Portability
25        and  Accountability Act of 1996, as it may be amended, or
26        the regulations under that Act;
27             (2)  who is not eligible for coverage  under  (A)  a
28        group  health  plan, (B) part A or part B of Medicare due
29        to age, or (C) medical  assistance,  and  does  not  have
30        other health insurance coverage;
31             (3)  with  respect  to whom the most recent coverage
32        within the coverage period described in paragraph  (1)(A)
33        of this definition was not terminated based upon a factor
34        relating to nonpayment of premiums or fraud;
 
                            -6-      LRB093 05485 LRD 17109 a
 1             (4)  if  the  individual (, other than an individual
 2        who has either (A) been certified as an  eligible  person
 3        pursuant to the federal Trade Adjustment Act of 2002, (B)
 4        initially  been  paid  a  benefit  by the Pension Benefit
 5        Guaranty Corporation, or (C) as of December 1, 2002, been
 6        receiving benefits  from  the  Pension  Benefit  Guaranty
 7        Corporation  and  who  has qualified health insurance, as
 8        defined by the federal  Trade  Act  of  2002),  had  been
 9        offered the option of continuation coverage under a COBRA
10        continuation  provision or under a similar State program,
11        who elected such coverage; and
12             (5)  who,   if   the   individual    elected    such
13        continuation  coverage,  has  exhausted such continuation
14        coverage under such provision or program.
15        An  individual  who  has  either  been  certified  as  an
16    eligible person pursuant to the federal Trade Adjustment  Act
17    of  2002  or  initially  been  paid  a benefit by the Pension
18    Benefit Guaranty Corporation shall not be required  to  elect
19    continuation coverage under a COBRA continuation provision or
20    under a similar state program.
21        "Group  health  insurance  coverage" means, in connection
22    with a group health plan, health insurance  coverage  offered
23    in connection with that plan.
24        "Group  health plan" has the same meaning given that term
25    in   the   federal   Health   Insurance    Portability    and
26    Accountability Act of 1996.
27        "Governmental  plan" has the same meaning given that term
28    in   the   federal   Health   Insurance    Portability    and
29    Accountability Act of 1996.
30        "Health  insurance coverage" means benefits consisting of
31    medical  care  (provided  directly,  through   insurance   or
32    reimbursement,  or otherwise and including items and services
33    paid for as medical care)  under  any  hospital  and  medical
34    expense-incurred policy, certificate, or contract provided by
 
                            -7-      LRB093 05485 LRD 17109 a
 1    an  insurer,  non-profit  health  care service plan contract,
 2    health maintenance organization or other subscriber contract,
 3    or any other health care plan or arrangement that pays for or
 4    furnishes  medical  or  health  care  services   whether   by
 5    insurance  or otherwise.  Health insurance coverage shall not
 6    include  short  term,  accident  only,   disability   income,
 7    hospital  confinement or fixed indemnity, dental only, vision
 8    only, limited benefit, or credit insurance,  coverage  issued
 9    as a supplement to liability insurance, insurance arising out
10    of   a  workers'  compensation  or  similar  law,  automobile
11    medical-payment insurance, or insurance under which  benefits
12    are  payable  with  or  without  regard to fault and which is
13    statutorily  required  to  be  contained  in  any   liability
14    insurance policy or equivalent self-insurance.
15        "Health  insurance  issuer"  means  an insurance company,
16    insurance service, or  insurance  organization  (including  a
17    health   maintenance  organization  and  a  voluntary  health
18    services  plan)  that  is  authorized  to   transact   health
19    insurance business in this State.  Such term does not include
20    a group health plan.
21        "Health  Maintenance  Organization" means an organization
22    as defined in the Health Maintenance Organization Act.
23        "Hospice" means a program  as  defined  in  and  licensed
24    under the Hospice Program Licensing Act.
25        "Hospital"  means  a duly licensed institution as defined
26    in the Hospital Licensing Act, an institution that meets  all
27    comparable conditions and requirements in effect in the state
28    in  which  it  is  located,  or  the  University  of Illinois
29    Hospital as defined in the University  of  Illinois  Hospital
30    Act.
31        "Individual   health  insurance  coverage"  means  health
32    insurance coverage offered to individuals in  the  individual
33    market,  but  does  not  include short-term, limited-duration
34    insurance.
 
                            -8-      LRB093 05485 LRD 17109 a
 1        "Insured" means any individual resident of this State who
 2    is eligible to receive benefits from any  insurer  (including
 3    health  insurance coverage offered in connection with a group
 4    health plan) or health insurance issuer as  defined  in  this
 5    Section.
 6        "Insurer"  means  any  insurance  company  authorized  to
 7    transact  health  insurance  business  in  this State and any
 8    corporation that provides medical services and  is  organized
 9    under  the  Voluntary Health Services Plans Act or the Health
10    Maintenance Organization Act.
11        "Medical assistance" means the State  medical  assistance
12    or medical assistance no grant (MANG) programs provided under
13    Title  XIX of the Social Security Act and Articles V (Medical
14    Assistance) and  VI  (General  Assistance)  of  the  Illinois
15    Public  Aid  Code  (or  any  successor  program) or under any
16    similar program of health care benefits in a state other than
17    Illinois.
18        "Medically necessary" means  that  a  service,  drug,  or
19    supply  is  necessary  and  appropriate  for the diagnosis or
20    treatment of an illness or injury in  accord  with  generally
21    accepted  standards  of  medical  practice  at  the  time the
22    service, drug,  or  supply  is  provided.  When  specifically
23    applied  to a confinement it further means that the diagnosis
24    or treatment of the  covered  person's  medical  symptoms  or
25    condition  cannot  be  safely  provided  to that person as an
26    outpatient. A service, drug, or supply shall not be medically
27    necessary if it: (i) is investigational, experimental, or for
28    research  purposes;  or  (ii)  is  provided  solely  for  the
29    convenience of the patient, the patient's family,  physician,
30    hospital,  or  any other provider; or (iii) exceeds in scope,
31    duration, or intensity that level of care that is  needed  to
32    provide   safe,   adequate,   and  appropriate  diagnosis  or
33    treatment; or (iv) could have been omitted without  adversely
34    affecting  the  covered  person's condition or the quality of
 
                            -9-      LRB093 05485 LRD 17109 a
 1    medical care; or (v) involves the use of  a  medical  device,
 2    drug, or substance not formally approved by the United States
 3    Food and Drug Administration.
 4        "Medical  care" means the ordinary and usual professional
 5    services rendered by a physician or other specified  provider
 6    during  a  professional  visit for treatment of an illness or
 7    injury.
 8        "Medicare" means coverage under both Part A and Part B of
 9    Title XVIII of the Social Security Act, 42 U.S.C. Sec.  1395,
10    et seq.
11        "Minimum  premium  plan"  means  an arrangement whereby a
12    specified amount of health care claims  is  self-funded,  but
13    the  insurance  company  assumes  the  risk  that claims will
14    exceed that amount.
15        "Participating  transplant  center"  means   a   hospital
16    designated  by the Board as a preferred or exclusive provider
17    of services for one or more specified human organ  or  tissue
18    transplants  for  which  the hospital has signed an agreement
19    with the Board to accept a transplant payment  allowance  for
20    all  expenses  related  to the transplant during a transplant
21    benefit period.
22        "Physician" means a person licensed to practice  medicine
23    pursuant to the Medical Practice Act of 1987.
24        "Plan"  means  the  Comprehensive  Health  Insurance Plan
25    established by this Act.
26        "Plan of operation" means the plan of  operation  of  the
27    Plan, including articles, bylaws and operating rules, adopted
28    by the board pursuant to this Act.
29        "Provider"  means any hospital, skilled nursing facility,
30    hospice, home health agency, physician, registered pharmacist
31    acting within the scope of that registration,  or  any  other
32    person  or  entity  licensed  in  Illinois to furnish medical
33    care.
34        "Qualified high risk pool" has  the  same  meaning  given
 
                            -10-     LRB093 05485 LRD 17109 a
 1    that  term  in  the  federal Health Insurance Portability and
 2    Accountability Act of 1996.
 3        "Resident" means a person who  is  and  continues  to  be
 4    legally  domiciled and physically residing on a permanent and
 5    full-time basis in a place of permanent  habitation  in  this
 6    State that remains that person's principal residence and from
 7    which  that person is absent only for temporary or transitory
 8    purpose.
 9        "Skilled nursing  facility"  means  a  facility  or  that
10    portion  of  a  facility  that  is  licensed  by the Illinois
11    Department of Public Health under the Nursing Home  Care  Act
12    or  a  comparable  licensing  authority  in  another state to
13    provide skilled nursing care.
14        "Stop-loss coverage"  means  an  arrangement  whereby  an
15    insurer  insures  against  the  risk  that any one claim will
16    exceed a specific dollar amount or that the entire loss of  a
17    self-insurance plan will exceed a specific amount.
18        "Third  party  administrator"  means  an administrator as
19    defined in Section 511.101 of the Illinois Insurance Code who
20    is licensed under Article XXXI 1/4 of that Code.
21    (Source: P.A. 91-357,  eff.  7-29-99;  91-735,  eff.  6-2-00;
22    92-153, eff. 7-25-01; 93HB3298enr.)

23        (215 ILCS 105/4) (from Ch. 73, par. 1304)
24        Sec.  4.  Powers  and  authority of the board.  The board
25    shall have the general powers and authority granted under the
26    laws  of  this  State  to  insurance  companies  licensed  to
27    transact  health  and  accident  insurance  and  in  addition
28    thereto, the specific authority to:
29        a.  Enter into contracts as are necessary  or  proper  to
30    carry  out the provisions and purposes of this Act, including
31    the authority, with the approval of the  Director,  to  enter
32    into  contracts  with  similar  plans of other states for the
33    joint performance of common administrative functions, or with
 
                            -11-     LRB093 05485 LRD 17109 a
 1    persons  or  other  organizations  for  the  performance   of
 2    administrative   functions   including,  without  limitation,
 3    utilization review and quality assurance  programs,  or  with
 4    health   maintenance   organizations  or  preferred  provider
 5    organizations for the provision of health care services.
 6        b.  Sue or be sued, including taking  any  legal  actions
 7    necessary or proper.
 8        c.  Take such legal action as necessary to:
 9             (1)  avoid  the  payment  of improper claims against
10        the plan or the coverage provided by or through the plan;
11             (2)  to   recover   any   amounts   erroneously   or
12        improperly paid by the plan;
13             (3)  to recover any amounts paid by the  plan  as  a
14        result of a mistake of fact or law; or
15             (4)  to   recover  or  collect  any  other  amounts,
16        including assessments, that are due or owed the  Plan  or
17        have been billed on its or the Plan's behalf.
18        d.  Establish  appropriate  rates,  rate  schedules, rate
19    adjustments, expense allowances, agents' referral fees, claim
20    reserves, and  formulas  and  any  other  actuarial  function
21    appropriate  to  the  operation  of the plan.  Rates and rate
22    schedules may be adjusted for appropriate risk  factors  such
23    as  age and area variation in claim costs and shall take into
24    consideration appropriate risk  factors  in  accordance  with
25    established actuarial and underwriting practices.
26        e.  Issue  policies  of  insurance in accordance with the
27    requirements of this Act.
28        f.  Appoint  appropriate  legal,  actuarial   and   other
29    committees  as  necessary  to provide technical assistance in
30    the operation of the plan, policy and other contract  design,
31    and any other function within the authority of the plan.
32        g.  Borrow  money  to effect the purposes of the Illinois
33    Comprehensive Health Insurance  Plan.   Any  notes  or  other
34    evidence  of indebtedness of the plan not in default shall be
 
                            -12-     LRB093 05485 LRD 17109 a
 1    legal investments for insurers and may be carried as admitted
 2    assets.
 3        h.  Establish  rules,  conditions  and   procedures   for
 4    reinsuring risks under this Act.
 5        i.  Employ  and  fix  the compensation of employees. Such
 6    employees may be paid  on  a  warrant  issued  by  the  State
 7    Treasurer  pursuant  to  a  payroll  voucher certified by the
 8    Board and drawn by the Comptroller against appropriations  or
 9    trust funds held by the State Treasurer.
10        j.  Enter  into  intergovernmental cooperation agreements
11    with other agencies or entities of State government  for  the
12    purpose of sharing the cost of providing health care services
13    that  are  otherwise  authorized by this Act for children who
14    are  both  plan  participants  and  eligible  for   financial
15    assistance from the Division of Specialized Care for Children
16    of the University of Illinois.
17        k.  Establish  conditions  and procedures under which the
18    plan may, if funds  permit,  discount  or  subsidize  premium
19    rates  that  are paid directly by senior citizens, as defined
20    by the Board, and other plan participants, who are retired or
21    unemployed and meet other qualifications.
22        l.  Establish and maintain the Plan  Fund  authorized  in
23    Section  3  of this Act, which shall be divided into separate
24    accounts, as follows:
25             (1)  accounts to fund the administrative, claim, and
26        other expenses  of  the  Plan  associated  with  eligible
27        persons  who qualify for Plan coverage under Section 7 of
28        this Act, which shall consist of:
29                  (A)  premiums  paid  on   behalf   of   covered
30             persons;
31                  (B)  appropriated   funds  and  other  revenues
32             collected or received by the Board;
33                  (C)  reserves for future losses  maintained  by
34             the Board; and
 
                            -13-     LRB093 05485 LRD 17109 a
 1                  (D)  interest  earnings  from investment of the
 2             funds in the Plan Fund or any of its accounts  other
 3             than the funds in the account established under item
 4             2 of this subsection;
 5             (2)  an  account,  to  be  denominated the federally
 6        eligible individuals account, to fund the administrative,
 7        claim, and other expenses of  the  Plan  associated  with
 8        federally  eligible  individuals  who  qualify  for  Plan
 9        coverage  under  Section  15  of  this  Act,  which shall
10        consist of:
11                  (A)  premiums  paid  on   behalf   of   covered
12             persons;
13                  (B)  assessments  and  other revenues collected
14             or received by the Board;
15                  (C)  reserves for future losses  maintained  by
16             the Board; and
17                  (D)  interest  earnings  from investment of the
18             federally eligible individuals account funds; and
19                  (E)  grants provided pursuant  to  the  federal
20             Trade Adjustment Act of 2002; and
21             (3)  such other accounts as may be appropriate.
22        m.  Charge  and  collect  assessments  paid  by  insurers
23    pursuant   to   Section  12  of  this  Act  and  recover  any
24    assessments for, on behalf of, or against those insurers.
25    (Source: P.A.  90-30,  eff.  7-1-97;  91-357,  eff.  7-29-99;
26    93HB3298enr.)

27        (215 ILCS 105/7) (from Ch. 73, par. 1307)
28        Sec. 7.  Eligibility.
29        a.  Except  as provided in subsection (e) of this Section
30    or in Section 15 of this Act, any  person  who  is  either  a
31    citizen  of  the  United States or an alien lawfully admitted
32    for permanent residence and who has been for a period  of  at
33    least  180  days and continues to be a resident of this State
 
                            -14-     LRB093 05485 LRD 17109 a
 1    shall be eligible for Plan coverage  under  this  Section  if
 2    evidence is provided of:
 3             (1)  A  notice  of  rejection  or  refusal  to issue
 4        substantially   similar   individual   health   insurance
 5        coverage for health reasons by a health insurance issuer;
 6        or
 7             (2)  A refusal by a health insurance issuer to issue
 8        individual health insurance coverage  except  at  a  rate
 9        exceeding  the  applicable Plan rate for which the person
10        is responsible.
11        A rejection or refusal by a group health plan  or  health
12    insurance  issuer  offering  only stop-loss or excess of loss
13    insurance or contracts, agreements, or other arrangements for
14    reinsurance coverage with respect to the applicant shall  not
15    be sufficient evidence under this subsection.
16        b.  The  board  shall  promulgate  a  list  of medical or
17    health conditions for which a person who is either a  citizen
18    of  the  United  States  or  an  alien  lawfully admitted for
19    permanent residence and a resident of  this  State  would  be
20    eligible  for  Plan  coverage  without  applying  for  health
21    insurance coverage pursuant to subsection a. of this Section.
22    Persons  who  can demonstrate the existence or history of any
23    medical or health conditions on the list promulgated  by  the
24    board shall not be required to provide the evidence specified
25    in  subsection  a.  of  this  Section.   The  list  shall  be
26    effective  on  the first day of the operation of the Plan and
27    may be amended from time to time as appropriate.
28        c.  Family members of the same  household  who  each  are
29    covered  persons  are  eligible  for optional family coverage
30    under the Plan.
31        d.  For persons qualifying  for  coverage  in  accordance
32    with Section 7 of this Act, the board shall, if it determines
33    that  such  appropriations as are made pursuant to Section 12
34    of this Act are insufficient to allow the board to accept all
 
                            -15-     LRB093 05485 LRD 17109 a
 1    of the eligible persons which  it  projects  will  apply  for
 2    enrollment  under  the  Plan,  limit  or  close enrollment to
 3    ensure that the Plan is not over-subscribed and that  it  has
 4    sufficient  resources  to  meet  its  obligations to existing
 5    enrollees.  The board shall not limit or close enrollment for
 6    federally eligible individuals.
 7        e.  A person shall not be eligible for coverage under the
 8    Plan if:
 9             (1)  He or she has or obtains other coverage under a
10        group  health   plan   or   health   insurance   coverage
11        substantially  similar to or better than a Plan policy as
12        an insured or covered dependent or would be  eligible  to
13        have  that  coverage  if  he or she elected to obtain it.
14        Persons  otherwise  eligible  for  Plan   coverage   may,
15        however,  solely for the purpose of having coverage for a
16        pre-existing  condition,  maintain  other  coverage  only
17        while  satisfying  any  pre-existing  condition   waiting
18        period  under  a  Plan policy or a subsequent replacement
19        policy of a Plan policy.
20             (1.1)  His or  her  prior  coverage  under  a  group
21        health  plan  or  health  insurance coverage, provided or
22        arranged by an employer of more  than  10  employees  was
23        discontinued  for  any reason without the entire group or
24        plan being discontinued and not replaced, provided he  or
25        she  remains  an  employee,  or dependent thereof, of the
26        same employer.
27             (2)  He or she is a recipient of or is  approved  to
28        receive  medical  assistance,  except  that  a person may
29        continue  to  receive  medical  assistance  through   the
30        medical  assistance  no  grant  program,  but  only while
31        satisfying the requirements for a  preexisting  condition
32        under  Section  8, subsection f. of this Act.  Payment of
33        premiums pursuant to this Act shall be allocable  to  the
34        person's spenddown for purposes of the medical assistance
 
                            -16-     LRB093 05485 LRD 17109 a
 1        no  grant  program, but that person shall not be eligible
 2        for any Plan benefits while that person remains  eligible
 3        for  medical  assistance.   If  the  person  continues to
 4        receive or be  approved  to  receive  medical  assistance
 5        through  the  medical  assistance  no grant program at or
 6        after  the  time  that  requirements  for  a  preexisting
 7        condition are satisfied, the person shall not be eligible
 8        for  coverage  under  the  Plan.  In  that  circumstance,
 9        coverage  under  the  plan  shall  terminate  as  of  the
10        expiration  of  the  preexisting   condition   limitation
11        period.   Under  all  other circumstances, coverage under
12        the  Plan  shall  automatically  terminate  as   of   the
13        effective date of any medical assistance.
14             (3)  Except  as  provided  in Section 15, the person
15        has previously participated in the Plan  and  voluntarily
16        terminated  Plan  coverage, unless 12 months have elapsed
17        since  the  person's  latest  voluntary  termination   of
18        coverage.
19             (4)  The  person  fails  to pay the required premium
20        under  the  covered  person's  terms  of  enrollment  and
21        participation, in which event the liability of  the  Plan
22        shall  be limited to benefits incurred under the Plan for
23        the time period for which premiums had been paid and  the
24        covered person remained eligible for Plan coverage.
25             (5)  The  Plan  has  paid  a  total of $1,000,000 in
26        benefits on behalf of the covered person.
27             (6)  The  person  is  a   resident   of   a   public
28        institution.
29             (7)  The  person's premium is paid for or reimbursed
30        under  any  government  sponsored  program  or   by   any
31        government  agency  or health care provider, except as an
32        otherwise qualifying full-time employee, or dependent  of
33        such  employee,  of  a  government  agency or health care
34        provider or, except when a person's premium  is  paid  by
 
                            -17-     LRB093 05485 LRD 17109 a
 1        the  U.S.  Treasury  Department  pursuant  to the federal
 2        Trade Adjustment Act of 2002.
 3             (8)  The person has or later receives other benefits
 4        or  funds  from  any  settlement,  judgement,  or   award
 5        resulting  from any accident or injury, regardless of the
 6        date  of  the  accident   or   injury,   or   any   other
 7        circumstances  creating a legal liability for damages due
 8        that person by a third  party,  whether  the  settlement,
 9        judgment,  or  award  is  in  the  form  of  a  contract,
10        agreement, or trust on behalf of a minor or otherwise and
11        whether  the settlement, judgment, or award is payable to
12        the  person,  his  or  her  dependent,  estate,  personal
13        representative, or guardian in a lump sum or  over  time,
14        so  long  as  there  continues  to  be benefits or assets
15        remaining from those sources in an amount  in  excess  of
16        $100,000.
17             (9)  Within the 5 years prior to the date a person's
18        Plan  application  is received by the Board, the person's
19        coverage under any health care benefit program as defined
20        in 18 U.S.C. 24, including any public or private plan  or
21        contract  under  which  any  medical  benefit,  item,  or
22        service  is  provided,  was terminated as a result of any
23        act or practice that constitutes  fraud  under  State  or
24        federal   law   or   as   a   result  of  an  intentional
25        misrepresentation of material fact;  or  if  that  person
26        knowingly  and willfully obtained or attempted to obtain,
27        or fraudulently aided  or  attempted  to  aid  any  other
28        person  in  obtaining, any coverage or benefits under the
29        Plan to which that person was not entitled.
30        f.  The  board  or  the   administrator   shall   require
31    verification  of  residency  and  may  require any additional
32    information or documentation, or statements under oath,  when
33    necessary to determine residency upon initial application and
34    for the entire term of the policy.
 
                            -18-     LRB093 05485 LRD 17109 a
 1        g.  Coverage  shall  cease (i) on the date a person is no
 2    longer a resident of Illinois, (ii)  on  the  date  a  person
 3    requests coverage to end, (iii) upon the death of the covered
 4    person,  (iv)  on the date State law requires cancellation of
 5    the policy, or (v) at the Plan's option, 30  days  after  the
 6    Plan  makes  any inquiry concerning a person's eligibility or
 7    place of residence to which the person does not reply.
 8        h.  Except under the conditions set forth in subsection g
 9    of this Section, the coverage of any  person  who  ceases  to
10    meet  the  eligibility  requirements of this Section shall be
11    terminated at the end of the current policy period for  which
12    the necessary premiums have been paid.
13    (Source: P.A.  90-30,  eff.  7-1-97;  91-639,  eff.  8-20-99;
14    91-735, eff. 6-2-00; 93HB3298enr.)

15        (215 ILCS 105/15)
16        Sec.  15.  Alternative  portable  coverage  for federally
17    eligible individuals.
18        (a)  Notwithstanding the requirements of subsection a. of
19    Section 7 and except as otherwise provided in  this  Section,
20    any   federally   eligible   individual   for   whom  a  Plan
21    application, and such enclosures and supporting documentation
22    as the Board may require, is received by the Board within  90
23    days after the termination of prior creditable coverage shall
24    qualify   to   enroll  in  the  Plan  under  the  portability
25    provisions of this Section.
26        A federally eligible person who between December 1,  2002
27    and  September  30,  2003  has  either  (1) been certified as
28    eligible pursuant to the  federal  Trade  Act  of  2002,  (2)
29    initially been paid a benefit by the Pension Benefit Guaranty
30    Corporation,  or  (3)  as of December 1, 2002, been receiving
31    benefits from the Pension Benefit Guaranty  Corporation,  who
32    has  qualified  health  insurance,  as defined by the federal
33    Trade Act of 2002, and whose Plan application and  enclosures
 
                            -19-     LRB093 05485 LRD 17109 a
 1    and  supporting  documentation,  as the Board may require, is
 2    received by the  Board  after  the  termination  of  previous
 3    creditable coverage shall qualify to enroll in the Plan under
 4    the portability provisions of this Section.
 5        A  federally  eligible  person  who,  after September 30,
 6    2003,  has  either  been  certified  as  an  eligible  person
 7    pursuant to the federal  Trade  Adjustment  Act  of  2002  or
 8    initially been paid a benefit by the Pension Benefit Guaranty
 9    Corporation  and  whose  Plan  application and enclosures and
10    supporting documentation as the Board may require is received
11    by the Board within 63 days after the termination of previous
12    creditable coverage shall qualify to enroll in the Plan under
13    the portability provisions of this Section.
14        (b)  Any  federally  eligible  individual  seeking   Plan
15    coverage  under  this  Section  must  submit  with his or her
16    application   evidence,    including    acceptable    written
17    certification  of  previous  creditable  coverage,  that will
18    establish to the Board's satisfaction, that he or  she  meets
19    all of the requirements to be a federally eligible individual
20    and  is  currently and permanently residing in this State (as
21    of the date his  or  her  application  was  received  by  the
22    Board).
23        (c)  Except  as  otherwise  provided  in  this Section, a
24    period of creditable coverage  shall  not  be  counted,  with
25    respect  to  qualifying  an  applicant for Plan coverage as a
26    federally eligible individual under this  Section,  if  after
27    such  period and before the application for Plan coverage was
28    received by the Board, there was at least  a  90  day  period
29    during  all of which the individual was not covered under any
30    creditable coverage.
31        For a federally eligible person who between  December  1,
32    2002  and September 30, 2003 has either (1) been certified as
33    eligible pursuant to the  federal  Trade  Act  of  2002,  (2)
34    initially been paid a benefit by the Pension Benefit Guaranty
 
                            -20-     LRB093 05485 LRD 17109 a
 1    Corporation,  or  (3)  as of December 1, 2002, been receiving
 2    benefits from the Pension Benefit  Guaranty  Corporation  and
 3    who has qualified health insurance, as defined by the federal
 4    Trade  Act  of 2002, a period of creditable coverage shall be
 5    counted, with respect to qualifying  an  applicant  for  Plan
 6    coverage  as  a  federally  eligible  individual  under  this
 7    Section,  when the application for Plan coverage was received
 8    by the Board.
 9        For a federally eligible person who, after September  30,
10    2003,  has  either  been  certified  as  an  eligible  person
11    pursuant  to  the  federal  Trade  Adjustment  Act of 2002 or
12    initially been paid a benefit by the Pension Benefit Guaranty
13    Corporation, a period of creditable  coverage  shall  not  be
14    counted,  with  respect  to  qualifying an applicant for Plan
15    coverage  as  a  federally  eligible  individual  under  this
16    Section, if after such period and before the application  for
17    Plan coverage was received by the Board, there was at least a
18    63  day  period  during  all  of which the individual was not
19    covered under any creditable coverage.
20        (d)  Any federally  eligible  individual  who  the  Board
21    determines  qualifies  for  Plan  coverage under this Section
22    shall be offered his or her choice of  enrolling  in  one  of
23    alternative  portability health benefit plans which the Board
24    is authorized under  this  Section  to  establish  for  these
25    federally eligible individuals and their dependents.
26        (e)  The  Board  shall  offer  a  choice  of  health care
27    coverages consistent with major medical  coverage  under  the
28    alternative  health  benefit plans authorized by this Section
29    to every federally eligible individual. The coverages  to  be
30    offered   under   the   plans,   the  schedule  of  benefits,
31    deductibles, co-payments, exclusions, and  other  limitations
32    shall  be  approved  by  the  Board.   One  optional  form of
33    coverage  shall  be  comparable   to   comprehensive   health
34    insurance  coverage  offered in the individual market in this
 
                            -21-     LRB093 05485 LRD 17109 a
 1    State or a standard option of coverage  available  under  the
 2    group  or individual health insurance laws of the State.  The
 3    standard benefit plan that is authorized by Section 8 of this
 4    Act may be used for this purpose.  The Board may also offer a
 5    preferred provider option and such other options as the Board
 6    determines may be appropriate for  these  federally  eligible
 7    individuals  who  qualify  for Plan coverage pursuant to this
 8    Section.
 9        (f)  Notwithstanding the requirements of subsection f. of
10    Section 8, any plan coverage  that  is  issued  to  federally
11    eligible individuals who qualify for the Plan pursuant to the
12    portability  provisions  of this Section shall not be subject
13    to any preexisting conditions exclusion, waiting  period,  or
14    other similar limitation on coverage.
15        (g)  Federally   eligible  individuals  who  qualify  and
16    enroll in the Plan pursuant to this Section shall be required
17    to pay such premium rates as the Board  shall  establish  and
18    approve in accordance with the requirements of Section 7.1 of
19    this Act.
20        (h)  A  federally  eligible  individual who qualifies and
21    enrolls in the Plan pursuant to this Section must satisfy  on
22    an ongoing basis all of the other eligibility requirements of
23    this  Act  to  the  extent  not inconsistent with the federal
24    Health Insurance Portability and Accountability Act  of  1996
25    in order to maintain continued eligibility for coverage under
26    the Plan.
27    (Source: P.A. 92-153, eff. 7-25-01; 93HB3298enr.)

28        Section  99.  Effective date.  This Act takes effect upon
29    becoming law.".