Illinois General Assembly - Full Text of HB0197
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Full Text of HB0197  94th General Assembly

HB0197ham001 94TH GENERAL ASSEMBLY

Insurance Committee

Adopted in House Comm. on Feb 01, 2005

 

 


 

 


 
09400HB0197ham001 LRB094 05352 LJB 37428 a

1
AMENDMENT TO HOUSE BILL 197

2     AMENDMENT NO. ______. Amend House Bill 197 by replacing the
3 title with the following:
4     "AN ACT concerning insurance."; and
 
5 by replacing everything after the enacting clause with the
6 following:
 
7     "Section 5. The Comprehensive Health Insurance Plan Act is
8 amended by changing Section 7 as follows:
 
9     (215 ILCS 105/7)  (from Ch. 73, par. 1307)
10     Sec. 7. Eligibility.
11     a. Except as provided in subsection (e) of this Section or
12 in Section 15 of this Act, any person who is either a citizen
13 of the United States or an alien lawfully admitted for
14 permanent residence and who has been for a period of at least
15 180 days and continues to be a resident of this State shall be
16 eligible for Plan coverage under this Section if evidence is
17 provided of:
18         (1) A notice of rejection or refusal to issue
19     substantially similar individual health insurance coverage
20     for health reasons by a health insurance issuer; or
21         (2) A refusal by a health insurance issuer to issue
22     individual health insurance coverage except at a rate
23     exceeding the applicable Plan rate for which the person is

 

 

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1     responsible.
2     A rejection or refusal by a group health plan or health
3 insurance issuer offering only stop-loss or excess of loss
4 insurance or contracts, agreements, or other arrangements for
5 reinsurance coverage with respect to the applicant shall not be
6 sufficient evidence under this subsection.
7     b. The board shall promulgate a list of medical or health
8 conditions for which a person who is either a citizen of the
9 United States or an alien lawfully admitted for permanent
10 residence and a resident of this State would be eligible for
11 Plan coverage without applying for health insurance coverage
12 pursuant to subsection a. of this Section. Persons who can
13 demonstrate the existence or history of any medical or health
14 conditions on the list promulgated by the board shall not be
15 required to provide the evidence specified in subsection a. of
16 this Section. The list shall be effective on the first day of
17 the operation of the Plan and may be amended from time to time
18 as appropriate.
19     c. Family members of the same household who each are
20 covered persons are eligible for optional family coverage under
21 the Plan.
22     d. For persons qualifying for coverage in accordance with
23 Section 7 of this Act, the board shall, if it determines that
24 such appropriations as are made pursuant to Section 12 of this
25 Act are insufficient to allow the board to accept all of the
26 eligible persons which it projects will apply for enrollment
27 under the Plan, limit or close enrollment to ensure that the
28 Plan is not over-subscribed and that it has sufficient
29 resources to meet its obligations to existing enrollees. The
30 board shall not limit or close enrollment for federally
31 eligible individuals.
32     e. A person shall not be eligible for coverage under the
33 Plan if:
34         (1) He or she has or obtains other coverage under a

 

 

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1     group health plan or health insurance coverage
2     substantially similar to or better than a Plan policy as an
3     insured or covered dependent or would be eligible to have
4     that coverage if he or she elected to obtain it. Persons
5     otherwise eligible for Plan coverage may, however, solely
6     for the purpose of having coverage for a pre-existing
7     condition, maintain other coverage only while satisfying
8     any pre-existing condition waiting period under a Plan
9     policy or a subsequent replacement policy of a Plan policy.
10         (1.1) His or her prior coverage under a group health
11     plan or health insurance coverage, provided or arranged by
12     an employer of more than 10 employees was discontinued for
13     any reason without the entire group or plan being
14     discontinued and not replaced, provided he or she remains
15     an employee, or dependent thereof, of the same employer.
16         (2) He or she is a recipient of or is approved to
17     receive medical assistance, except that a person may
18     continue to receive medical assistance through the medical
19     assistance no grant program, but only while satisfying the
20     requirements for a preexisting condition under Section 8,
21     subsection f. of this Act. Payment of premiums pursuant to
22     this Act shall be allocable to the person's spenddown for
23     purposes of the medical assistance no grant program, but
24     that person shall not be eligible for any Plan benefits
25     while that person remains eligible for medical assistance.
26     If the person continues to receive or be approved to
27     receive medical assistance through the medical assistance
28     no grant program at or after the time that requirements for
29     a preexisting condition are satisfied, the person shall not
30     be eligible for coverage under the Plan. In that
31     circumstance, coverage under the plan shall terminate as of
32     the expiration of the preexisting condition limitation
33     period. Under all other circumstances, coverage under the
34     Plan shall automatically terminate as of the effective date

 

 

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1     of any medical assistance.
2         (3) Except as provided in Section 15, the person has
3     previously participated in the Plan and voluntarily
4     terminated Plan coverage, unless 12 months have elapsed
5     since the person's latest voluntary termination of
6     coverage.
7         (4) The person fails to pay the required premium under
8     the covered person's terms of enrollment and
9     participation, in which event the liability of the Plan
10     shall be limited to benefits incurred under the Plan for
11     the time period for which premiums had been paid and the
12     covered person remained eligible for Plan coverage.
13         (5) The Plan has paid a total of $1,000,000 in benefits
14     on behalf of the covered person.
15         (6) The person is a resident of a public institution.
16         (7) The person's premium is paid for or reimbursed
17     under any government sponsored program or by any government
18     agency or health care provider, except as an otherwise
19     qualifying full-time employee, or dependent of such
20     employee, of a government agency or health care provider
21     or, except when a person's premium is paid by the U.S.
22     Treasury Department pursuant to the federal Trade Act of
23     2002.
24         (8) The person has or later receives other benefits or
25     funds from any settlement, judgement, or award resulting
26     from any accident or injury, regardless of the date of the
27     accident or injury, or any other circumstances creating a
28     legal liability for damages due that person by a third
29     party, whether the settlement, judgment, or award is in the
30     form of a contract, agreement, or trust on behalf of a
31     minor or otherwise and whether the settlement, judgment, or
32     award is payable to the person, his or her dependent,
33     estate, personal representative, or guardian in a lump sum
34     or over time, so long as there continues to be benefits or

 

 

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1     assets remaining from those sources in an amount in excess
2     of $300,000 $100,000.
3         (9) Within the 5 years prior to the date a person's
4     Plan application is received by the Board, the person's
5     coverage under any health care benefit program as defined
6     in 18 U.S.C. 24, including any public or private plan or
7     contract under which any medical benefit, item, or service
8     is provided, was terminated as a result of any act or
9     practice that constitutes fraud under State or federal law
10     or as a result of an intentional misrepresentation of
11     material fact; or if that person knowingly and willfully
12     obtained or attempted to obtain, or fraudulently aided or
13     attempted to aid any other person in obtaining, any
14     coverage or benefits under the Plan to which that person
15     was not entitled.
16     f. The board or the administrator shall require
17 verification of residency and may require any additional
18 information or documentation, or statements under oath, when
19 necessary to determine residency upon initial application and
20 for the entire term of the policy.
21     g. Coverage shall cease (i) on the date a person is no
22 longer a resident of Illinois, (ii) on the date a person
23 requests coverage to end, (iii) upon the death of the covered
24 person, (iv) on the date State law requires cancellation of the
25 policy, or (v) at the Plan's option, 30 days after the Plan
26 makes any inquiry concerning a person's eligibility or place of
27 residence to which the person does not reply.
28     h. Except under the conditions set forth in subsection g of
29 this Section, the coverage of any person who ceases to meet the
30 eligibility requirements of this Section shall be terminated at
31 the end of the current policy period for which the necessary
32 premiums have been paid.
33 (Source: P.A. 93-33, eff. 6-23-03; 93-34, eff. 6-23-03.)".