Full Text of SB1999 96th General Assembly
SB1999 96TH GENERAL ASSEMBLY
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96TH GENERAL ASSEMBLY
State of Illinois
2009 and 2010 SB1999
Introduced 2/20/2009, by Sen. Carole Pankau SYNOPSIS AS INTRODUCED: |
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215 ILCS 5/367e |
from Ch. 73, par. 979e |
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Amends the Illinois Insurance Code. Makes a technical change in a Section
concerning continuation of group hospital, surgical and major medical
coverage after termination of employment or membership. |
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A BILL FOR
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SB1999 |
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LRB096 11335 RPM 21783 b |
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| AN ACT concerning regulation.
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| Be it enacted by the People of the State of Illinois, | 3 |
| represented in the General Assembly:
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| Section 5. The Illinois Insurance Code is amended by | 5 |
| changing Section 367e as follows:
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| (215 ILCS 5/367e) (from Ch. 73, par. 979e)
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| Sec. 367e.
Continuation of Group Hospital, Surgical and and | 8 |
| Major Medical
Coverage After Termination of Employment or | 9 |
| Membership.
A group policy delivered, issued for delivery, | 10 |
| renewed or amended in this
state which insures employees or | 11 |
| members
for hospital, surgical or major medical insurance on an | 12 |
| expense incurred
or service basis, other than for specific | 13 |
| diseases or for accidental injuries
only, shall provide that | 14 |
| employees or members whose insurance under the
group policy | 15 |
| would otherwise terminate because of termination of employment
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| or membership or because of a reduction in hours below the | 17 |
| minimum required
by the group plan shall be entitled to | 18 |
| continue their hospital, surgical and
major medical insurance | 19 |
| under that group policy, for themselves and their
eligible | 20 |
| dependents, subject to all of the group policy's terms and | 21 |
| conditions
applicable to those forms of insurance and to the | 22 |
| following conditions:
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| 1. Continuation shall only be available to an employee |
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| or member who has
been continuously insured under the group | 2 |
| policy (and for similar benefits
under any group policy | 3 |
| which it replaced) during the entire 3 months period
ending | 4 |
| with such termination
or reduction in hours below the | 5 |
| minimum required by the group plan.
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| 2. Continuation shall not be available for any person | 7 |
| who is covered by
Medicare, except for those individuals | 8 |
| who have been covered under a
group Medicare supplement | 9 |
| policy. Neither shall continuation be
available for any | 10 |
| person who is
covered by any other insured or uninsured | 11 |
| plan
which provides hospital, surgical or medical coverage | 12 |
| for individuals in
a group and under which the person was | 13 |
| not
covered immediately prior to such termination
or | 14 |
| reduction in hours below the minimum required by the group | 15 |
| plan
or who exercises his conversion
privilege under the | 16 |
| group policy.
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| 3. Continuation need not include dental, vision care, | 18 |
| prescription drug
benefits, disability income, specified | 19 |
| disease, or similar supplementary
benefits which are | 20 |
| provided under the group policy in addition to its | 21 |
| hospital,
surgical or major medical benefits.
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| 4. Upon termination
or reduction in hours below the | 23 |
| minimum required by the group plan
written notice of | 24 |
| continuation shall be presented
to the employee or member | 25 |
| by the employer or mailed by the employer to the
last known | 26 |
| address of the employee. An employee or member who wishes
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| continuation
of coverage must request such continuation in | 2 |
| writing within the ten-day
period following the later of: | 3 |
| (i) the date of such termination
or reduction in hours | 4 |
| below the minimum required by the group plan, or (ii)
the | 5 |
| date the employee is given written notice of the right of | 6 |
| continuation
by either the employer or the
group | 7 |
| policyholder. In no event, however, may the employee or | 8 |
| member elect
continuation more than 60 days after the date | 9 |
| of such termination
or reduction in hours below the minimum | 10 |
| required by the group plan.
Written notice of continuation | 11 |
| presented to the employee or member by the
policyholder, or | 12 |
| mailed by the policyholder to the last known address of
the | 13 |
| employee, shall constitute the giving of notice for the | 14 |
| purpose of this
provision.
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| 5. An employee or member electing continuation must pay | 16 |
| to the group
policyholder
or his employer, on a monthly | 17 |
| basis in advance, the total amount of premium
required by | 18 |
| the insurer, including that portion of the premium | 19 |
| contributed
by the policyholder or employer, if any, but | 20 |
| not more than the group rate
for the insurance being | 21 |
| continued with appropriate reduction in premium
for any | 22 |
| supplementary benefits which have been discontinued under | 23 |
| paragraph
(3) of this Section. The premium rate required by | 24 |
| the insurer shall be
the applicable premium required on the | 25 |
| due date of each payment.
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| 6. Continuation of insurance under the group policy for
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| any person shall terminate when he becomes eligible for | 2 |
| Medicare or is covered
by any other insured or uninsured | 3 |
| plan which provides hospital, surgical
or medical coverage | 4 |
| for individuals in a group and under which
the person was | 5 |
| not covered immediately prior to such termination
or | 6 |
| reduction in hours below the minimum required by the group | 7 |
| plan
as provided
in condition
2 above or, if earlier, at | 8 |
| the first to occur of the following:
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| (a) The date 9 months after the date the employee's | 10 |
| or member's
insurance
under the policy would otherwise | 11 |
| have terminated because of termination
of employment | 12 |
| or membership
or reduction in hours below the minimum | 13 |
| required by the group plan.
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| (b) If the employee or member fails to make timely | 15 |
| payment of a required
contribution, the end of the | 16 |
| period for which contributions were made.
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| (c) The date on which the group policy is | 18 |
| terminated or, in the case of
an employee, the date his | 19 |
| employer terminates participation under the group
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| policy. However, if this (c) applies and the coverage | 21 |
| ceasing by reason of
such
termination is replaced by | 22 |
| similar coverage under another group policy,
the | 23 |
| following shall apply:
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| (i) The employee or member shall have the right | 25 |
| to become covered
under
that other group policy, | 26 |
| for the balance of the period that he would have
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| remained covered under the prior group policy in | 2 |
| accordance with condition
6 had a termination | 3 |
| described in this (c) not occurred.
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| (ii) The prior group policy shall continue to | 5 |
| provide benefits to the
extent of its accrued | 6 |
| liabilities and extensions of benefits as if the
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| replacement
had not occurred.
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| 7. A notification of the continuation privilege shall | 9 |
| be included in each
certificate of coverage.
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| 8. Continuation shall not be available for any employee | 11 |
| who was
discharged because of the commission of a felony in | 12 |
| connection with his
work, or because of theft in connection | 13 |
| with his work, for which the
employer was in no way | 14 |
| responsible; provided the employee admitted his
commission | 15 |
| of the felony or theft or such act has resulted in a | 16 |
| conviction
or order of supervision by a court of competent | 17 |
| jurisdiction.
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| The requirements of this amendatory Act of 1983 shall apply | 19 |
| to any group
policy as defined in this Section, delivered or | 20 |
| issued for delivery on or after
180 days following the | 21 |
| effective date of this amendatory Act of 1983.
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| The requirements of this amendatory Act of 1985 shall apply | 23 |
| to any
group policy as defined in this Section, delivered, | 24 |
| issued for delivery,
renewed or amended on or after 180 days | 25 |
| following the effective date of
this amendatory Act of 1985.
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| (Source: P.A. 93-477, eff. 1-1-04.)
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