Illinois General Assembly - Full Text of SB0918
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Full Text of SB0918  94th General Assembly


Sen. Deanna Demuzio

Filed: 2/28/2006





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2     AMENDMENT NO. ______. Amend Senate Bill 918 by replacing
3 everything after the enacting clause with the following:
4     "Section 5. The Comprehensive Health Insurance Plan Act is
5 amended by changing Sections 7 and 8 as follows:
6     (215 ILCS 105/7)  (from Ch. 73, par. 1307)
7     Sec. 7. Eligibility.
8     a. Except as provided in subsection (e) of this Section or
9 in Section 15 of this Act, any person who is either a citizen
10 of the United States or an alien lawfully admitted for
11 permanent residence and who has been for a period of at least
12 180 days and continues to be a resident of this State shall be
13 eligible for Plan coverage under this Section if evidence is
14 provided of:
15         (1) A notice of rejection or refusal to issue
16     substantially similar individual health insurance coverage
17     for health reasons by a health insurance issuer; or
18         (2) A refusal by a health insurance issuer to issue
19     individual health insurance coverage except at a rate
20     exceeding the applicable Plan rate for which the person is
21     responsible.
22     A rejection or refusal by a group health plan or health
23 insurance issuer offering only stop-loss or excess of loss
24 insurance or contracts, agreements, or other arrangements for



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



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



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1     since the person's latest voluntary termination of
2     coverage.
3         (4) The person fails to pay the required premium under
4     the covered person's terms of enrollment and
5     participation, in which event the liability of the Plan
6     shall be limited to benefits incurred under the Plan for
7     the time period for which premiums had been paid and the
8     covered person remained eligible for Plan coverage.
9         (5) The Plan has paid a total of $1,500,000 $1,000,000
10     in benefits on behalf of the covered person.
11         (6) The person is a resident of a public institution.
12         (7) The person's premium is paid for or reimbursed
13     under any government sponsored program or by any government
14     agency or health care provider, except as an otherwise
15     qualifying full-time employee, or dependent of such
16     employee, of a government agency or health care provider
17     or, except when a person's premium is paid by the U.S.
18     Treasury Department pursuant to the federal Trade Act of
19     2002.
20         (8) The person has or later receives other benefits or
21     funds from any settlement, judgement, or award resulting
22     from any accident or injury, regardless of the date of the
23     accident or injury, or any other circumstances creating a
24     legal liability for damages due that person by a third
25     party, whether the settlement, judgment, or award is in the
26     form of a contract, agreement, or trust on behalf of a
27     minor or otherwise and whether the settlement, judgment, or
28     award is payable to the person, his or her dependent,
29     estate, personal representative, or guardian in a lump sum
30     or over time, so long as there continues to be benefits or
31     assets remaining from those sources in an amount in excess
32     of $300,000.
33         (9) Within the 5 years prior to the date a person's
34     Plan application is received by the Board, the person's



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1     coverage under any health care benefit program as defined
2     in 18 U.S.C. 24, including any public or private plan or
3     contract under which any medical benefit, item, or service
4     is provided, was terminated as a result of any act or
5     practice that constitutes fraud under State or federal law
6     or as a result of an intentional misrepresentation of
7     material fact; or if that person knowingly and willfully
8     obtained or attempted to obtain, or fraudulently aided or
9     attempted to aid any other person in obtaining, any
10     coverage or benefits under the Plan to which that person
11     was not entitled.
12     f. The board or the administrator shall require
13 verification of residency and may require any additional
14 information or documentation, or statements under oath, when
15 necessary to determine residency upon initial application and
16 for the entire term of the policy.
17     g. Coverage shall cease (i) on the date a person is no
18 longer a resident of Illinois, (ii) on the date a person
19 requests coverage to end, (iii) upon the death of the covered
20 person, (iv) on the date State law requires cancellation of the
21 policy, or (v) at the Plan's option, 30 days after the Plan
22 makes any inquiry concerning a person's eligibility or place of
23 residence to which the person does not reply.
24     h. Except under the conditions set forth in subsection g of
25 this Section, the coverage of any person who ceases to meet the
26 eligibility requirements of this Section shall be terminated at
27 the end of the current policy period for which the necessary
28 premiums have been paid.
29 (Source: P.A. 93-33, eff. 6-23-03; 93-34, eff. 6-23-03; 94-17,
30 eff. 1-1-06.)
31     (215 ILCS 105/8)  (from Ch. 73, par. 1308)
32     Sec. 8. Minimum benefits.
33     a. Availability. The Plan shall offer in an annually



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1 renewable policy major medical expense coverage to every
2 eligible person who is not eligible for Medicare. Major medical
3 expense coverage offered by the Plan shall pay an eligible
4 person's covered expenses, subject to limit on the deductible
5 and coinsurance payments authorized under paragraph (4) of
6 subsection d of this Section, up to a lifetime benefit limit of
7 $1,500,000 $1,000,000 per covered individual. The maximum
8 limit under this subsection shall not be altered by the Board,
9 and no actuarial equivalent benefit may be substituted by the
10 Board. Any person who otherwise would qualify for coverage
11 under the Plan, but is excluded because he or she is eligible
12 for Medicare, shall be eligible for any separate Medicare
13 supplement policy or policies which the Board may offer.
14     b. Outline of benefits. Covered expenses shall be limited
15 to the usual and customary charge, including negotiated fees,
16 in the locality for the following services and articles when
17 prescribed by a physician and determined by the Plan to be
18 medically necessary for the following areas of services,
19 subject to such separate deductibles, co-payments, exclusions,
20 and other limitations on benefits as the Board shall establish
21 and approve, and the other provisions of this Section:
22         (1) Hospital services, except that any services
23     provided by a hospital that is located more than 75 miles
24     outside the State of Illinois shall be covered only for a
25     maximum of 45 days in any calendar year. With respect to
26     covered expenses incurred during any calendar year ending
27     on or after December 31, 1999, inpatient hospitalization of
28     an eligible person for the treatment of mental illness at a
29     hospital located within the State of Illinois shall be
30     subject to the same terms and conditions as for any other
31     illness.
32         (2) Professional services for the diagnosis or
33     treatment of injuries, illnesses or conditions, other than
34     dental and mental and nervous disorders as described in



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1     paragraph (17), which are rendered by a physician, or by
2     other licensed professionals at the physician's direction.
3     This includes reconstruction of the breast on which a
4     mastectomy was performed; surgery and reconstruction of
5     the other breast to produce a symmetrical appearance; and
6     prostheses and treatment of physical complications at all
7     stages of the mastectomy, including lymphedemas.
8         (2.5) Professional services provided by a physician to
9     children under the age of 16 years for physical
10     examinations and age appropriate immunizations ordered by
11     a physician licensed to practice medicine in all its
12     branches.
13         (3) (Blank).
14         (4) Outpatient prescription drugs that by law require a
15     prescription written by a physician licensed to practice
16     medicine in all its branches subject to such separate
17     deductible, copayment, and other limitations or
18     restrictions as the Board shall approve, including the use
19     of a prescription drug card or any other program, or both.
20         (5) Skilled nursing services of a licensed skilled
21     nursing facility for not more than 120 days during a policy
22     year.
23         (6) Services of a home health agency in accord with a
24     home health care plan, up to a maximum of 270 visits per
25     year.
26         (7) Services of a licensed hospice for not more than
27     180 days during a policy year.
28         (8) Use of radium or other radioactive materials.
29         (9) Oxygen.
30         (10) Anesthetics.
31         (11) Orthoses and prostheses other than dental.
32         (12) Rental or purchase in accordance with Board
33     policies or procedures of durable medical equipment, other
34     than eyeglasses or hearing aids, for which there is no



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1     personal use in the absence of the condition for which it
2     is prescribed.
3         (13) Diagnostic x-rays and laboratory tests.
4         (14) Oral surgery (i) for excision of partially or
5     completely unerupted impacted teeth when not performed in
6     connection with the routine extraction or repair of teeth;
7     (ii) for excision of tumors or cysts of the jaws, cheeks,
8     lips, tongue, and roof and floor of the mouth; (iii)
9     required for correction of cleft lip and palate and other
10     craniofacial and maxillofacial birth defects; or (iv) for
11     treatment of injuries to natural teeth or a fractured jaw
12     due to an accident.
13         (15) Physical, speech, and functional occupational
14     therapy as medically necessary and provided by appropriate
15     licensed professionals.
16         (16) Emergency and other medically necessary
17     transportation provided by a licensed ambulance service to
18     the nearest health care facility qualified to treat a
19     covered illness, injury, or condition, subject to the
20     provisions of the Emergency Medical Systems (EMS) Act.
21         (17) Outpatient services for diagnosis and treatment
22     of mental and nervous disorders provided that a covered
23     person shall be required to make a copayment not to exceed
24     50% and that the Plan's payment shall not exceed such
25     amounts as are established by the Board.
26         (18) Human organ or tissue transplants specified by the
27     Board that are performed at a hospital designated by the
28     Board as a participating transplant center for that
29     specific organ or tissue transplant.
30         (19) Naprapathic services, as appropriate, provided by
31     a licensed naprapathic practitioner.
32     c. Exclusions. Covered expenses of the Plan shall not
33 include the following:
34         (1) Any charge for treatment for cosmetic purposes



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1     other than for reconstructive surgery when the service is
2     incidental to or follows surgery resulting from injury,
3     sickness or other diseases of the involved part or surgery
4     for the repair or treatment of a congenital bodily defect
5     to restore normal bodily functions.
6         (2) Any charge for care that is primarily for rest,
7     custodial, educational, or domiciliary purposes.
8         (3) Any charge for services in a private room to the
9     extent it is in excess of the institution's charge for its
10     most common semiprivate room, unless a private room is
11     prescribed as medically necessary by a physician.
12         (4) That part of any charge for room and board or for
13     services rendered or articles prescribed by a physician,
14     dentist, or other health care personnel that exceeds the
15     reasonable and customary charge in the locality or for any
16     services or supplies not medically necessary for the
17     diagnosed injury or illness.
18         (5) Any charge for services or articles the provision
19     of which is not within the scope of licensure of the
20     institution or individual providing the services or
21     articles.
22         (6) Any expense incurred prior to the effective date of
23     coverage by the Plan for the person on whose behalf the
24     expense is incurred.
25         (7) Dental care, dental surgery, dental treatment, any
26     other dental procedure involving the teeth or
27     periodontium, or any dental appliances, including crowns,
28     bridges, implants, or partial or complete dentures, except
29     as specifically provided in paragraph (14) of subsection b
30     of this Section.
31         (8) Eyeglasses, contact lenses, hearing aids or their
32     fitting.
33         (9) Illness or injury due to acts of war.
34         (10) Services of blood donors and any fee for failure



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1     to replace the first 3 pints of blood provided to a covered
2     person each policy year.
3         (11) Personal supplies or services provided by a
4     hospital or nursing home, or any other nonmedical or
5     nonprescribed supply or service.
6         (12) Routine maternity charges for a pregnancy, except
7     where added as optional coverage with payment of an
8     additional premium for pregnancy resulting from conception
9     occurring after the effective date of the optional
10     coverage.
11         (13) (Blank).
12         (14) Any expense or charge for services, drugs, or
13     supplies that are: (i) not provided in accord with
14     generally accepted standards of current medical practice;
15     (ii) for procedures, treatments, equipment, transplants,
16     or implants, any of which are investigational,
17     experimental, or for research purposes; (iii)
18     investigative and not proven safe and effective; or (iv)
19     for, or resulting from, a gender transformation operation.
20         (15) Any expense or charge for routine physical
21     examinations or tests except as provided in item (2.5) of
22     subsection b of this Section.
23         (16) Any expense for which a charge is not made in the
24     absence of insurance or for which there is no legal
25     obligation on the part of the patient to pay.
26         (17) Any expense incurred for benefits provided under
27     the laws of the United States and this State, including
28     Medicare, Medicaid, and other medical assistance, maternal
29     and child health services and any other program that is
30     administered or funded by the Department of Human Services,
31     Department of Healthcare and Family Services Public Aid, or
32     Department of Public Health, military service-connected
33     disability payments, medical services provided for members
34     of the armed forces and their dependents or employees of



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1     the armed forces of the United States, and medical services
2     financed on behalf of all citizens by the United States.
3         (18) Any expense or charge for in vitro fertilization,
4     artificial insemination, or any other artificial means
5     used to cause pregnancy.
6         (19) Any expense or charge for oral contraceptives used
7     for birth control or any other temporary birth control
8     measures.
9         (20) Any expense or charge for sterilization or
10     sterilization reversals.
11         (21) Any expense or charge for weight loss programs,
12     exercise equipment, or treatment of obesity, except when
13     certified by a physician as morbid obesity (at least 2
14     times normal body weight).
15         (22) Any expense or charge for acupuncture treatment
16     unless used as an anesthetic agent for a covered surgery.
17         (23) Any expense or charge for or related to organ or
18     tissue transplants other than those performed at a hospital
19     with a Board approved organ transplant program that has
20     been designated by the Board as a preferred or exclusive
21     provider organization for that specific organ or tissue
22     transplant.
23         (24) Any expense or charge for procedures, treatments,
24     equipment, or services that are provided in special
25     settings for research purposes or in a controlled
26     environment, are being studied for safety, efficiency, and
27     effectiveness, and are awaiting endorsement by the
28     appropriate national medical speciality college for
29     general use within the medical community.
30     d. Deductibles and coinsurance.
31     The Plan coverage defined in Section 6 shall provide for a
32 choice of deductibles per individual as authorized by the
33 Board. If 2 individual members of the same family household,
34 who are both covered persons under the Plan, satisfy the same



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1 applicable deductibles, no other member of that family who is
2 also a covered person under the Plan shall be required to meet
3 any deductibles for the balance of that calendar year. The
4 deductibles must be applied first to the authorized amount of
5 covered expenses incurred by the covered person. A mandatory
6 coinsurance requirement shall be imposed at the rate authorized
7 by the Board in excess of the mandatory deductible, the
8 coinsurance in the aggregate not to exceed such amounts as are
9 authorized by the Board per annum. At its discretion the Board
10 may, however, offer catastrophic coverages or other policies
11 that provide for larger deductibles with or without coinsurance
12 requirements. The deductibles and coinsurance factors may be
13 adjusted annually according to the Medical Component of the
14 Consumer Price Index.
15     e. Scope of coverage.
16         (1) In approving any of the benefit plans to be offered
17     by the Plan, the Board shall establish such benefit levels,
18     deductibles, coinsurance factors, exclusions, and
19     limitations as it may deem appropriate and that it believes
20     to be generally reflective of and commensurate with health
21     insurance coverage that is provided in the individual
22     market in this State.
23         (2) The benefit plans approved by the Board may also
24     provide for and employ various cost containment measures
25     and other requirements including, but not limited to,
26     preadmission certification, prior approval, second
27     surgical opinions, concurrent utilization review programs,
28     individual case management, preferred provider
29     organizations, health maintenance organizations, and other
30     cost effective arrangements for paying for covered
31     expenses.
32     f. Preexisting conditions.
33         (1) Except for federally eligible individuals
34     qualifying for Plan coverage under Section 15 of this Act



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1     or eligible persons who qualify for the waiver authorized
2     in paragraph (3) of this subsection, plan coverage shall
3     exclude charges or expenses incurred during the first 6
4     months following the effective date of coverage as to any
5     condition for which medical advice, care or treatment was
6     recommended or received during the 6 month period
7     immediately preceding the effective date of coverage.
8         (2) (Blank).
9         (3) Waiver: The preexisting condition exclusions as
10     set forth in paragraph (1) of this subsection shall be
11     waived to the extent to which the eligible person (a) has
12     satisfied similar exclusions under any prior individual
13     health insurance policy that was involuntarily terminated
14     because of the insolvency of the issuer of the policy and
15     (b) has applied for Plan coverage within 90 days following
16     the involuntary termination of that individual health
17     insurance coverage.
18     g. Other sources primary; nonduplication of benefits.
19         (1) The Plan shall be the last payor of benefits
20     whenever any other benefit or source of third party payment
21     is available. Subject to the provisions of subsection e of
22     Section 7, benefits otherwise payable under Plan coverage
23     shall be reduced by all amounts paid or payable by Medicare
24     or any other government program or through any health
25     insurance coverage or group health plan, whether by
26     insurance, reimbursement, or otherwise, or through any
27     third party liability, settlement, judgment, or award,
28     regardless of the date of the settlement, judgment, or
29     award, 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 covered person, his or her
33     dependent, estate, personal representative, or guardian in
34     a lump sum or over time, and by all hospital or medical



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1     expense benefits paid or payable under any worker's
2     compensation coverage, automobile medical payment, or
3     liability insurance, whether provided on the basis of fault
4     or nonfault, and by any hospital or medical benefits paid
5     or payable under or provided pursuant to any State or
6     federal law or program.
7         (2) The Plan shall have a cause of action against any
8     covered person or any other person or entity for the
9     recovery of any amount paid to the extent the amount was
10     for treatment, services, or supplies not covered in this
11     Section or in excess of benefits as set forth in this
12     Section.
13         (3) Whenever benefits are due from the Plan because of
14     sickness or an injury to a covered person resulting from a
15     third party's wrongful act or negligence and the covered
16     person has recovered or may recover damages from a third
17     party or its insurer, the Plan shall have the right to
18     reduce benefits or to refuse to pay benefits that otherwise
19     may be payable by the amount of damages that the covered
20     person has recovered or may recover regardless of the date
21     of the sickness or injury or the date of any settlement,
22     judgment, or award resulting from that sickness or injury.
23         During the pendency of any action or claim that is
24     brought by or on behalf of a covered person against a third
25     party or its insurer, any benefits that would otherwise be
26     payable except for the provisions of this paragraph (3)
27     shall be paid if payment by or for the third party has not
28     yet been made and the covered person or, if incapable, that
29     person's legal representative agrees in writing to pay back
30     promptly the benefits paid as a result of the sickness or
31     injury to the extent of any future payments made by or for
32     the third party for the sickness or injury. This agreement
33     is to apply whether or not liability for the payments is
34     established or admitted by the third party or whether those



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1     payments are itemized.
2         Any amounts due the plan to repay benefits may be
3     deducted from other benefits payable by the Plan after
4     payments by or for the third party are made.
5         (4) Benefits due from the Plan may be reduced or
6     refused as an offset against any amount otherwise
7     recoverable under this Section.
8     h. Right of subrogation; recoveries.
9         (1) Whenever the Plan has paid benefits because of
10     sickness or an injury to any covered person resulting from
11     a third party's wrongful act or negligence, or for which an
12     insurer is liable in accordance with the provisions of any
13     policy of insurance, and the covered person has recovered
14     or may recover damages from a third party that is liable
15     for the damages, the Plan shall have the right to recover
16     the benefits it paid from any amounts that the covered
17     person has received or may receive regardless of the date
18     of the sickness or injury or the date of any settlement,
19     judgment, or award resulting from that sickness or injury.
20     The Plan shall be subrogated to any right of recovery the
21     covered person may have under the terms of any private or
22     public health care coverage or liability coverage,
23     including coverage under the Workers' Compensation Act or
24     the Workers' Occupational Diseases Act, without the
25     necessity of assignment of claim or other authorization to
26     secure the right of recovery. To enforce its subrogation
27     right, the Plan may (i) intervene or join in an action or
28     proceeding brought by the covered person or his personal
29     representative, including his guardian, conservator,
30     estate, dependents, or survivors, against any third party
31     or the third party's insurer that may be liable or (ii)
32     institute and prosecute legal proceedings against any
33     third party or the third party's insurer that may be liable
34     for the sickness or injury in an appropriate court either



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1     in the name of the Plan or in the name of the covered
2     person or his personal representative, including his
3     guardian, conservator, estate, dependents, or survivors.
4         (2) If any action or claim is brought by or on behalf
5     of a covered person against a third party or the third
6     party's insurer, the covered person or his personal
7     representative, including his guardian, conservator,
8     estate, dependents, or survivors, shall notify the Plan by
9     personal service or registered mail of the action or claim
10     and of the name of the court in which the action or claim
11     is brought, filing proof thereof in the action or claim.
12     The Plan may, at any time thereafter, join in the action or
13     claim upon its motion so that all orders of court after
14     hearing and judgment shall be made for its protection. No
15     release or settlement of a claim for damages and no
16     satisfaction of judgment in the action shall be valid
17     without the written consent of the Plan to the extent of
18     its interest in the settlement or judgment and of the
19     covered person or his personal representative.
20         (3) In the event that the covered person or his
21     personal representative fails to institute a proceeding
22     against any appropriate third party before the fifth month
23     before the action would be barred, the Plan may, in its own
24     name or in the name of the covered person or personal
25     representative, commence a proceeding against any
26     appropriate third party for the recovery of damages on
27     account of any sickness, injury, or death to the covered
28     person. The covered person shall cooperate in doing what is
29     reasonably necessary to assist the Plan in any recovery and
30     shall not take any action that would prejudice the Plan's
31     right to recovery. The Plan shall pay to the covered person
32     or his personal representative all sums collected from any
33     third party by judgment or otherwise in excess of amounts
34     paid in benefits under the Plan and amounts paid or to be



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1     paid as costs, attorneys fees, and reasonable expenses
2     incurred by the Plan in making the collection or enforcing
3     the judgment.
4         (4) In the event that a covered person or his personal
5     representative, including his guardian, conservator,
6     estate, dependents, or survivors, recovers damages from a
7     third party for sickness or injury caused to the covered
8     person, the covered person or the personal representative
9     shall pay to the Plan from the damages recovered the amount
10     of benefits paid or to be paid on behalf of the covered
11     person.
12         (5) When the action or claim is brought by the covered
13     person alone and the covered person incurs a personal
14     liability to pay attorney's fees and costs of litigation,
15     the Plan's claim for reimbursement of the benefits provided
16     to the covered person shall be the full amount of benefits
17     paid to or on behalf of the covered person under this Act
18     less a pro rata share that represents the Plan's reasonable
19     share of attorney's fees paid by the covered person and
20     that portion of the cost of litigation expenses determined
21     by multiplying by the ratio of the full amount of the
22     expenditures to the full amount of the judgement, award, or
23     settlement.
24         (6) In the event of judgment or award in a suit or
25     claim against a third party or insurer, the court shall
26     first order paid from any judgement or award the reasonable
27     litigation expenses incurred in preparation and
28     prosecution of the action or claim, together with
29     reasonable attorney's fees. After payment of those
30     expenses and attorney's fees, the court shall apply out of
31     the balance of the judgment or award an amount sufficient
32     to reimburse the Plan the full amount of benefits paid on
33     behalf of the covered person under this Act, provided the
34     court may reduce and apportion the Plan's portion of the



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1     judgement proportionate to the recovery of the covered
2     person. The burden of producing evidence sufficient to
3     support the exercise by the court of its discretion to
4     reduce the amount of a proven charge sought to be enforced
5     against the recovery shall rest with the party seeking the
6     reduction. The court may consider the nature and extent of
7     the injury, economic and non-economic loss, settlement
8     offers, comparative negligence as it applies to the case at
9     hand, hospital costs, physician costs, and all other
10     appropriate costs. The Plan shall pay its pro rata share of
11     the attorney fees based on the Plan's recovery as it
12     compares to the total judgment. Any reimbursement rights of
13     the Plan shall take priority over all other liens and
14     charges existing under the laws of this State with the
15     exception of any attorney liens filed under the Attorneys
16     Lien Act.
17         (7) The Plan may compromise or settle and release any
18     claim for benefits provided under this Act or waive any
19     claims for benefits, in whole or in part, for the
20     convenience of the Plan or if the Plan determines that
21     collection would result in undue hardship upon the covered
22     person.
23 (Source: P.A. 91-639, eff. 8-20-99; 91-735, eff. 6-2-00; 92-2,
24 eff. 5-1-01; 92-630, eff. 7-11-02; revised 12-15-05.)
25     Section 99. Effective date. This Act takes effect upon
26 becoming law.".