Full Text of HB4679 096th General Assembly
HB4679eng 96TH GENERAL ASSEMBLY
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| AN ACT concerning insurance.
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| WHEREAS, It is a fundamental right not to be discriminated | 3 |
| against because of health status or disabilities; therefore | 4 |
| 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 Insurance Code is amended by | 7 |
| changing Sections 351B-4 and 364 as follows:
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| (215 ILCS 5/351B-4) (from Ch. 73, par. 963B-4)
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| Sec. 351B-4.
Small employer group accident and health | 10 |
| insurance
policy requirements.
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| (a) Any insurance company authorized to write accident and | 12 |
| health
insurance in this State shall have power to issue small | 13 |
| employer group
accident and health policies. No policy of small | 14 |
| employer group accident
and health insurance may be issued or | 15 |
| delivered in this State unless a copy
of the form thereof has | 16 |
| been filed with the Department and approved by it
in accordance | 17 |
| with Section 355, unless it contains in substance those
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| provisions contained in Sections 357.1 through 357.30 as may be | 19 |
| applicable
to small employer group accident and health | 20 |
| insurance and unless it
contains the provisions set forth in | 21 |
| this Section.
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| (b) The policy must provide that the policy, the |
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| application of the
employer or the executive officer or trustee | 2 |
| of any association and the
individual applications, if any, of | 3 |
| the employees, members, or employees of
members insured shall | 4 |
| constitute the entire contract between the parties,
and that | 5 |
| all statements made by the employer or executive officer or
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| trustee, or by the individual employees, members, or employees | 7 |
| of members
shall (in the absence of fraud) be deemed | 8 |
| representations and not
warranties, and that none of those | 9 |
| statements may be used in defense to a
claim under the policy | 10 |
| unless it is contained in a written application.
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| (c) The policy must provide that the insurer will issue to | 12 |
| the employer
or to the executive officer or trustee of the | 13 |
| association, for delivery to
the employee, member, or employee | 14 |
| of a member who is insured under the
policy, an individual | 15 |
| certificate setting forth a statement as to the
insurance | 16 |
| protection to which he is entitled and to whom payable.
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| (d) The policy must provide that all new employees of the | 18 |
| employer, new
members of the association, or new employees of | 19 |
| members eligible and
applying for insurance in the group or | 20 |
| class shall be added periodically to
the group or class | 21 |
| originally insured.
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| (e) Anything in this Code to the contrary notwithstanding, | 23 |
| any small
employer group accident and health insurance policy | 24 |
| may provide that all or
any portion of any indemnities provided | 25 |
| by the policy on account of
hospital, nursing, medical, or | 26 |
| surgical services may, at the insurer's
option, be paid |
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| directly to the hospital or person rendering the services;
but | 2 |
| the policy may not require that the service be rendered by a | 3 |
| particular
hospital or person. Payment so made shall discharge | 4 |
| the insurer's
obligation with respect to the amount of | 5 |
| insurance so paid. Nothing in
this subsection shall prohibit an | 6 |
| insurer from providing incentives for
insureds to utilize the | 7 |
| services of a particular hospital or person.
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| (f) Whenever the Department of Public Health finds that it | 9 |
| has paid all
or part of any hospital or medical expenses that | 10 |
| an insurance carrier is
obligated to pay under this Article, | 11 |
| the Department of Public Health shall
be entitled to receive | 12 |
| reimbursement for its payments from the insurance
carrier, | 13 |
| provided that the Department of Public Health has notified the
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| insurance carrier of its claim before the carrier has paid the | 15 |
| benefits to
its insureds or the insureds' assignees.
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| (g) No group hospital, medical, or surgical expense policy | 17 |
| under this
Article shall contain any provision whereby benefits | 18 |
| otherwise payable
thereunder are subject to reduction solely on | 19 |
| account of the existence of
similar benefits provided under | 20 |
| other group or group type accident and
sickness insurance | 21 |
| policies where the reduction would operate to reduce
total | 22 |
| benefits payable under the policies below an amount equal to | 23 |
| 100% of
total allowable expenses provided under the policies.
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| (h) When dependents of insureds are covered under 2 | 25 |
| policies, both of
which contain coordination of benefits | 26 |
| provisions, benefits of the policy
of the insured whose |
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| birthday falls earlier in the year are determined
before those | 2 |
| of the policy of the insured whose birthday falls later in the
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| year. "Birthday", as used herein, refers only to the month and | 4 |
| day in a
calendar year, not the year in which the person was | 5 |
| born. The Department
shall promulgate rules defining the order | 6 |
| of benefit determination under this subsection.
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| (i) Discrimination between individuals of the same class of | 8 |
| risk in the
issuance of policies, in the amount of premiums or | 9 |
| rates charged for
any insurance covered by this Article, in | 10 |
| benefits payable thereon,
in any of the terms or conditions of | 11 |
| the policy, or in any other manner
whatsoever is prohibited. | 12 |
| Nothing in this subsection shall prohibit an
insurer from | 13 |
| providing incentives for insureds to utilize the services of a
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| particular hospital or person.
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| (j) No company shall make or permit any distinction or | 16 |
| discrimination
against individuals solely because of handicaps | 17 |
| or disabilities in (i) the
amount of payment of premiums or | 18 |
| rates charged for policies of insurance,
(ii) the amount of any | 19 |
| dividends or other benefits payable thereon, or
(iii) any other | 20 |
| terms and conditions of the contract it makes , except where
the | 21 |
| distinction or discrimination is based on sound actuarial | 22 |
| principles or
is related to actual or reasonably anticipated | 23 |
| experience .
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| (k) No company shall refuse to insure or refuse to continue | 25 |
| to insure,
limit the amount or extent or kind of coverage | 26 |
| available to an individual,
or charge an individual a different |
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| rate for the same coverage solely
because of health status or | 2 |
| disability blindness or partial blindness . With respect to all | 3 |
| other
conditions, including the underlying cause of the | 4 |
| blindness or partial
blindness, persons who are blind or | 5 |
| partially blind shall be subject to the
same standards of sound | 6 |
| actuarial principles or actual or reasonably
anticipated | 7 |
| experience as are sighted persons. Refusal to insure includes
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| denial by an insurer of disability insurance coverage on the | 9 |
| grounds that
the policy defines "disability" as being presumed | 10 |
| in the event that the
insured loses his or her eyesight. | 11 |
| However, an insurer may exclude from
coverage disability | 12 |
| consisting solely of blindness or partial blindness
when the | 13 |
| condition existed at the time the policy was issued.
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| (Source: P.A. 86-1407.)
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| (215 ILCS 5/364) (from Ch. 73, par. 976)
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| Sec. 364. Discrimination prohibited. Discrimination | 17 |
| between
individuals of the same class of risk in the issuance | 18 |
| of its policies
or in the amount of premiums or rates charged
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| for any insurance covered by this article, or in the benefits
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| payable thereon, or in any of the terms or conditions of such | 21 |
| policy, or
in any other manner whatsoever is prohibited. | 22 |
| Nothing in this provision
shall prohibit an insurer from | 23 |
| providing incentives for insureds to utilize
the services of a | 24 |
| particular hospital or person. It is hereby expressly
provided | 25 |
| that whenever the terms "physician" or "doctor" appear or are
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| used in any way in any policy of accident or health insurance | 2 |
| issued in
this state, said terms shall include within their | 3 |
| meaning persons
licensed to practice dentistry under the | 4 |
| Illinois Dental Practice Act with
regard to benefits payable | 5 |
| for services performed by a person so
licensed, which such | 6 |
| services are within the coverage provided by the
particular | 7 |
| policy or contract of insurance and are within the
professional | 8 |
| services authorized to be performed by such person under
and in | 9 |
| accordance with the said Act.
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| No company, in any policy of accident or health insurance | 11 |
| issued in this
State, shall make or permit any distinction or | 12 |
| discrimination against
individuals solely because of handicaps | 13 |
| or disabilities in the amount of
payment of premiums or rates | 14 |
| charged for policies of insurance, in the
amount of any | 15 |
| dividends or other benefits payable thereon, or in any other
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| terms and conditions of the contract it makes , except where the | 17 |
| distinction
or discrimination is based on sound actuarial | 18 |
| principles or is related to
actual or reasonably anticipated | 19 |
| experience .
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| No company shall refuse to insure, or refuse to continue to | 21 |
| insure,
or limit the amount or extent or kind of coverage | 22 |
| available to an
individual, or charge an individual a different | 23 |
| rate for the same coverage
solely because of health status or | 24 |
| disability blindness or partial blindness . With respect to all
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| other conditions, including the underlying cause of the | 26 |
| blindness or
partial blindness, persons who are blind or |
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| partially blind shall be
subject to the same standards of sound | 2 |
| actuarial principles or actual or
reasonably anticipated | 3 |
| experience as are sighted persons. Refusal to
insure includes | 4 |
| denial by an insurer of disability insurance coverage on
the | 5 |
| grounds that the policy defines "disability" as being presumed | 6 |
| in the
event that the insured loses his or her eyesight.
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| (Source: P.A. 91-549, eff. 8-14-99.)
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