Full Text of SB0147 102nd General Assembly
SB0147sam001 102ND GENERAL ASSEMBLY | Sen. Laura M. Murphy Filed: 4/27/2021
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| 1 | | AMENDMENT TO SENATE BILL 147
| 2 | | AMENDMENT NO. ______. Amend Senate Bill 147 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 5. The Illinois Insurance Code is amended by | 5 | | changing Section 363 as follows: | 6 | | (215 ILCS 5/363) (from Ch. 73, par. 975)
| 7 | | Sec. 363. Medicare supplement policies; minimum standards.
| 8 | | (1) Except as otherwise specifically provided therein, | 9 | | this
Section and Section 363a of this Code shall apply to:
| 10 | | (a) all Medicare supplement policies and subscriber | 11 | | contracts delivered
or issued for delivery in this State | 12 | | on and after January 1, 1989; and
| 13 | | (b) all certificates issued under group Medicare | 14 | | supplement policies or
subscriber contracts, which | 15 | | certificates are issued or issued for delivery
in this | 16 | | State on and after January 1, 1989.
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| 1 | | This Section shall not apply to "Accident Only" or | 2 | | "Specified Disease"
types of policies. The provisions of this | 3 | | Section are not intended to prohibit
or apply to policies or | 4 | | health care benefit plans, including group
conversion | 5 | | policies, provided to Medicare eligible persons, which | 6 | | policies
or plans are not marketed or purported or held to be | 7 | | Medicare supplement
policies or benefit plans.
| 8 | | (2) For the purposes of this Section and Section 363a, the | 9 | | following
terms have the following meanings:
| 10 | | (a) "Applicant" means:
| 11 | | (i) in the case of individual Medicare supplement | 12 | | policy, the person
who seeks to contract for insurance | 13 | | benefits, and
| 14 | | (ii) in the case of a group Medicare policy or | 15 | | subscriber contract, the
proposed certificate holder.
| 16 | | (b) "Certificate" means any certificate delivered or | 17 | | issued for
delivery in this State under a group Medicare
| 18 | | supplement policy.
| 19 | | (c) "Medicare supplement policy" means an individual
| 20 | | policy of
accident and health insurance, as defined in | 21 | | paragraph (a) of subsection (2)
of Section 355a of this | 22 | | Code, or a group policy or certificate delivered or
issued | 23 | | for
delivery in this State by an insurer, fraternal | 24 | | benefit society, voluntary
health service plan, or health | 25 | | maintenance organization, other than a policy
issued | 26 | | pursuant to a contract under Section 1876 of the
federal
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| 1 | | Social Security Act (42 U.S.C. Section 1395 et seq.) or a | 2 | | policy
issued under
a
demonstration project specified in | 3 | | 42 U.S.C. Section 1395ss(g)(1), or
any similar | 4 | | organization, that is advertised, marketed, or designed
| 5 | | primarily as a supplement to reimbursements under Medicare | 6 | | for the
hospital, medical, or surgical expenses of persons | 7 | | eligible for Medicare.
| 8 | | (d) "Issuer" includes insurance companies, fraternal | 9 | | benefit
societies, voluntary health service plans, health | 10 | | maintenance
organizations, or any other entity providing | 11 | | Medicare supplement insurance,
unless the context clearly | 12 | | indicates otherwise.
| 13 | | (e) "Medicare" means the Health Insurance for the Aged | 14 | | Act, Title
XVIII of the Social Security Amendments of | 15 | | 1965.
| 16 | | (3) No Medicare supplement insurance policy, contract, or
| 17 | | certificate,
that provides benefits that duplicate benefits | 18 | | provided by Medicare, shall
be issued or issued for delivery | 19 | | in this State after December 31, 1988. No
such policy, | 20 | | contract, or certificate shall provide lesser benefits than
| 21 | | those required under this Section or the existing Medicare | 22 | | Supplement
Minimum Standards Regulation, except where | 23 | | duplication of Medicare benefits
would result.
| 24 | | (4) Medicare supplement policies or certificates shall | 25 | | have a
notice
prominently printed on the first page of the | 26 | | policy or attached thereto
stating in substance that the |
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| 1 | | policyholder or certificate holder shall have
the right to | 2 | | return the policy or certificate within 30 days of its
| 3 | | delivery and to have the premium refunded directly to him or | 4 | | her in a
timely manner if, after examination of the policy or | 5 | | certificate, the
insured person is not satisfied for any | 6 | | reason.
| 7 | | (5) A Medicare supplement policy or certificate may not | 8 | | deny a
claim
for losses incurred more than 6 months from the | 9 | | effective date of coverage
for a preexisting condition. The | 10 | | policy may not define a preexisting
condition more | 11 | | restrictively than a condition for which medical advice was
| 12 | | given or treatment was recommended by or received from a | 13 | | physician within 6
months before the effective date of | 14 | | coverage.
| 15 | | (6) An issuer of a Medicare supplement policy shall:
| 16 | | (a) not deny coverage to an applicant under 65 years | 17 | | of age who meets any of the following criteria: | 18 | | (i) becomes eligible for Medicare by reason of | 19 | | disability if the person makes
application for a | 20 | | Medicare supplement policy within 6 months of the | 21 | | first day
on
which the person enrolls for benefits | 22 | | under Medicare Part B; for a person who
is | 23 | | retroactively enrolled in Medicare Part B due to a | 24 | | retroactive eligibility
decision made by the Social | 25 | | Security Administration, the application must be
| 26 | | submitted within a 6-month period beginning with the |
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| 1 | | month in which the person
received notice of | 2 | | retroactive eligibility to enroll; | 3 | | (ii) has Medicare and an employer group health | 4 | | plan (either primary or secondary to Medicare) that | 5 | | terminates or ceases to provide all such supplemental | 6 | | health benefits; | 7 | | (iii) is insured by a Medicare Advantage plan that | 8 | | includes a Health Maintenance Organization, a | 9 | | Preferred Provider Organization, and a Private | 10 | | Fee-For-Service or Medicare Select plan and the | 11 | | applicant moves out of the plan's service area; the | 12 | | insurer goes out of business, withdraws from the | 13 | | market, or has its Medicare contract terminated; or | 14 | | the plan violates its contract provisions or is | 15 | | misrepresented in its marketing; or | 16 | | (iv) is insured by a Medicare supplement policy | 17 | | and the insurer goes out of business, withdraws from | 18 | | the market, or the insurance company or agents | 19 | | misrepresent the plan and the applicant is without | 20 | | coverage;
| 21 | | (b) make available to persons eligible for Medicare by | 22 | | reason of
disability each type of Medicare supplement | 23 | | policy the issuer makes available
to persons eligible for | 24 | | Medicare by reason of age;
| 25 | | (c) not charge individuals who become eligible for | 26 | | Medicare by
reason of disability and who are under the age |
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| 1 | | of 65 premium rates for any
medical supplemental insurance | 2 | | benefit plan offered by the issuer that exceed
the | 3 | | issuer's highest rate on the current rate schedule filed | 4 | | with the Division of Insurance for that plan to | 5 | | individuals who are age 65
or older;
and
| 6 | | (d) provide the rights granted by items (a) through | 7 | | (d), for 6 months
after the effective date of this | 8 | | amendatory Act of the 95th General
Assembly, to any person | 9 | | who had enrolled for benefits under Medicare Part B
prior | 10 | | to this amendatory Act of the 95th General Assembly who | 11 | | otherwise would
have been eligible for coverage under item | 12 | | (a).
| 13 | | (7) The Director shall issue reasonable rules and | 14 | | regulations
for the
following purposes:
| 15 | | (a) To establish specific standards for policy | 16 | | provisions of Medicare
policies and certificates. The | 17 | | standards shall be in
accordance with the requirements of | 18 | | this Code. No requirement of this Code
relating to minimum | 19 | | required policy benefits, other than the minimum
standards | 20 | | contained in this Section and Section 363a, shall apply to | 21 | | Medicare
medicare supplement policies and certificates. | 22 | | The standards may
cover, but are not limited to the | 23 | | following:
| 24 | | (A) Terms of renewability.
| 25 | | (B) Initial and subsequent terms of eligibility.
| 26 | | (C) Non-duplication of coverage.
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| 1 | | (D) Probationary and elimination periods.
| 2 | | (E) Benefit limitations, exceptions and | 3 | | reductions.
| 4 | | (F) Requirements for replacement.
| 5 | | (G) Recurrent conditions.
| 6 | | (H) Definition of terms.
| 7 | | (I) Requirements for issuing rebates or credits to | 8 | | policyholders
if the policy's loss ratio does not | 9 | | comply with subsection (7) of
Section 363a.
| 10 | | (J) Uniform methodology for the calculating and | 11 | | reporting of loss
ratio information.
| 12 | | (K) Assuring public access to loss ratio | 13 | | information of an issuer of
Medicare supplement | 14 | | insurance.
| 15 | | (L) Establishing a process for approving or | 16 | | disapproving proposed
premium increases.
| 17 | | (M) Establishing a policy for holding public | 18 | | hearings prior to
approval of premium increases.
| 19 | | (N) Establishing standards for Medicare Select | 20 | | policies.
| 21 | | (O) Prohibited policy provisions not otherwise | 22 | | specifically authorized
by statute that, in the | 23 | | opinion of the Director, are unjust, unfair, or
| 24 | | unfairly discriminatory to any person insured or | 25 | | proposed for coverage
under a medicare supplement | 26 | | policy or certificate.
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| 1 | | (b) To establish minimum standards for benefits and | 2 | | claims payments,
marketing practices, compensation | 3 | | arrangements, and reporting practices
for Medicare | 4 | | supplement policies.
| 5 | | (c) To implement transitional requirements of Medicare | 6 | | supplement
insurance benefits and premiums of Medicare | 7 | | supplement policies and
certificates to conform to | 8 | | Medicare program revisions.
| 9 | | (8) If an individual is at least 65 years of age but no | 10 | | more than 75 years of age and has an existing Medicare | 11 | | supplement policy, the individual is entitled to an annual | 12 | | open enrollment period lasting 45 days, commencing with the | 13 | | individual's birthday, and the individual may purchase any | 14 | | Medicare supplement policy with the same issuer that offers | 15 | | benefits equal to or lesser than those provided by the | 16 | | previous coverage. During this open enrollment period, an | 17 | | issuer of a Medicare supplement policy shall not deny or | 18 | | condition the issuance or effectiveness of Medicare | 19 | | supplemental coverage, nor discriminate in the pricing of | 20 | | coverage, because of health status, claims experience, receipt | 21 | | of health care, or a medical condition of the individual. An | 22 | | issuer shall provide notice of this annual open enrollment | 23 | | period for eligible Medicare supplement policyholders at the | 24 | | time that the application is made for a Medicare supplement | 25 | | policy or certificate. The notice shall be in a form that may | 26 | | be prescribed by the Department. |
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| 1 | | (Source: P.A. 95-436, eff. 6-1-08 .)
| 2 | | Section 99. Effective date. This Act takes effect on | 3 | | January 1, 2022.".
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