Full Text of SB2008 95th General Assembly
SB2008 95TH GENERAL ASSEMBLY
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95TH GENERAL ASSEMBLY
State of Illinois
2007 and 2008 SB2008
Introduced 2/7/2008, by Sen. Jeffrey M. Schoenberg SYNOPSIS AS INTRODUCED: |
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Amends the Health Insurance Portability and Accountability Act. In a provision involving the guaranteed renewability of individual health insurance, provides that the changes made to the provision by Public Act 94-502 apply to discontinuances of coverage occurring before, on, or after August 8, 2005 (the effective date of Public Act 94-502). Effective immediately.
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A BILL FOR
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SB2008 |
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LRB095 18651 KBJ 44738 b |
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| AN ACT concerning regulation.
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| Be it enacted by the People of the State of Illinois,
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| represented in the General Assembly:
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| Section 5. The Illinois Health Insurance Portability and | 5 |
| Accountability Act is amended by changing Section 50 as | 6 |
| follows:
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| (215 ILCS 97/50)
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| Sec. 50. Guaranteed renewability of individual health | 9 |
| insurance coverage.
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| (A) In general. Except as provided in this Section, a | 11 |
| health insurance
issuer that provides individual health | 12 |
| insurance coverage to an individual
shall renew or continue in | 13 |
| force such coverage at the option of the individual.
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| (B) General exceptions. A health insurance issuer may | 15 |
| nonrenew or
discontinue health insurance coverage of an | 16 |
| individual in the individual market
based
only on one or more | 17 |
| of the following:
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| (1) Nonpayment of premiums. The individual has failed | 19 |
| to pay premiums or
contributions in accordance with the | 20 |
| terms of the health insurance coverage or
the issuer has | 21 |
| not received timely premium payments.
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| (2) Fraud. The individual has performed an act or | 23 |
| practice that
constitutes fraud or made an intentional |
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| misrepresentation of material fact
under the terms of the | 2 |
| coverage.
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| (3) Termination of plan. The issuer is ceasing to offer | 4 |
| coverage in the
individual market in accordance with | 5 |
| subsection (C) of this Section and
applicable Illinois law.
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| (4) Movement outside the service area. In the case of a | 7 |
| health insurance
issuer that offers health insurance
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| coverage in the market through a network plan, the | 9 |
| individual no longer
resides, lives, or works in the | 10 |
| service area (or in an area for which the
issuer is | 11 |
| authorized to do business), but only if such coverage is | 12 |
| terminated
under this paragraph uniformly without regard | 13 |
| to any health status-related
factor of covered | 14 |
| individuals.
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| (5) Association membership ceases. In the case of | 16 |
| health insurance
coverage that is made available in the | 17 |
| individual market only through one or
more bona fide | 18 |
| associations, the membership of the individual in the
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| association (on the basis of which the coverage is | 20 |
| provided) ceases, but only
if
such coverage is terminated | 21 |
| under this paragraph uniformly without regard to
any health | 22 |
| status-related factor of covered individuals.
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| (C) Requirements for uniform termination of coverage.
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| (1) Particular type of coverage not offered. In any | 25 |
| case in which an
issuer decides to discontinue offering a | 26 |
| particular type of health insurance
coverage offered in the |
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| individual market, coverage of such type may be
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| discontinued by
the issuer only if:
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| (a) the issuer provides notice to each covered | 4 |
| individual provided
coverage of this type in such | 5 |
| market of such discontinuation at least 90 days
prior | 6 |
| to the date of the discontinuation of such coverage;
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| (b) the issuer offers, to each individual in the | 8 |
| individual market
provided coverage of this type, the | 9 |
| option to purchase any other individual
health | 10 |
| insurance coverage currently being offered by the | 11 |
| issuer for individuals
in such market; and
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| (c) in exercising the option to discontinue | 13 |
| coverage of that type and in
offering the option of | 14 |
| coverage under subparagraph (b), the issuer acts
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| uniformly without regard to any health status-related | 16 |
| factor of enrolled
individuals or individuals who may | 17 |
| become eligible for such coverage.
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| (2) Discontinuance of all coverage.
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| (a) In general. Subject to subparagraph (c), in any | 20 |
| case in which a
health insurance issuer elects
to | 21 |
| discontinue offering all health insurance coverage in | 22 |
| the individual market
in Illinois, health insurance | 23 |
| coverage may be discontinued by the issuer only
if:
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| (i) the issuer provides notice to the Director | 25 |
| and to each individual
of the discontinuation at | 26 |
| least 180 days prior to the date of the expiration
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| of such coverage;
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| (ii) all health insurance issued or delivered | 3 |
| for issuance in Illinois
in such market is | 4 |
| discontinued and coverage under such health | 5 |
| insurance
coverage in such market is not renewed; | 6 |
| and
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| (iii) in the case where the issuer has | 8 |
| affiliates in the individual market, the issuer | 9 |
| gives notice to each affected individual at least | 10 |
| 180 days prior to the date of the expiration of the | 11 |
| coverage of the individual's option to purchase | 12 |
| all other individual health benefit plans | 13 |
| currently offered by any affiliate of the carrier.
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| (b) Prohibition on market reentry. In the case of a | 15 |
| discontinuation
under subparagraph (a) in the | 16 |
| individual market, the issuer may not provide for
the | 17 |
| issuance of any health insurance coverage in Illinois | 18 |
| involved during the
5-year period beginning on the date | 19 |
| of the discontinuation of the last health
insurance | 20 |
| coverage not so renewed.
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| (c) If an issuer elects to discontinue offering all | 22 |
| health insurance coverage in the individual market | 23 |
| under subparagraph (a), its affiliates that offer | 24 |
| health insurance coverage in the individual market in | 25 |
| Illinois shall offer individual health insurance | 26 |
| coverage to all individuals who were covered by the |
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| discontinued health insurance coverage on the date of | 2 |
| the notice provided to affected individuals under | 3 |
| subdivision (iii) of subparagraph (a) of this item (2) | 4 |
| if the individual applies for coverage no later than 63 | 5 |
| days after the discontinuation of coverage. | 6 |
| (d) Subject to subparagraph (e) of this item (2), | 7 |
| an affiliate that issues coverage under subparagraph | 8 |
| (c) shall waive the preexisting condition exclusion | 9 |
| period to the extent that the individual has satisfied | 10 |
| the preexisting condition exclusion period under the | 11 |
| individual's prior contract or policy. | 12 |
| (e) An affiliate that issues coverage under | 13 |
| subparagraph (c) may require the individual to satisfy | 14 |
| the remaining part of the preexisting condition | 15 |
| exclusion period, if any, under the individual's prior | 16 |
| contract or policy that has not been satisfied, unless | 17 |
| the coverage has a shorter preexisting condition | 18 |
| exclusion period, and may include in any coverage | 19 |
| issued under subparagraph (c) any waivers or | 20 |
| limitations of coverage that were included in the | 21 |
| individual's prior contract or policy.
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| (D) Exception for uniform modification of coverage. At the | 23 |
| time of coverage
renewal, a health insurance issuer may modify | 24 |
| the health insurance coverage for
a policy form offered to | 25 |
| individuals in the individual market so long as the
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| modification is consistent with Illinois law and effective on a |
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| uniform basis
among all individuals with that policy form.
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| (E) Application to coverage offered only through | 3 |
| associations. In applying
this Section in the case of health | 4 |
| insurance coverage that is made available by
a health insurance | 5 |
| issuer in the individual market to individuals only through
one | 6 |
| or more associations, a reference to an "individual" is deemed | 7 |
| to include a
reference to such an association (of which the | 8 |
| individual is a member).
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| The changes to this Section made by Public Act 94-502 apply | 10 |
| to discontinuances of coverage occurring before, on, or after | 11 |
| August 8, 2008. The changes to this Section made by this | 12 |
| amendatory Act of the 94th General Assembly apply only to | 13 |
| discontinuances of coverage occurring on or after the effective | 14 |
| date of this amendatory Act of the 94th General Assembly.
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| (Source: P.A. 94-502, eff. 8-8-05.)
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| Section 99. Effective date. This Act takes effect upon | 17 |
| becoming law.
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