Full Text of HB4830 95th General Assembly
HB4830eng 95TH GENERAL ASSEMBLY
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HB4830 Engrossed |
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LRB095 17861 KBJ 43941 b |
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| AN ACT concerning insurance.
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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 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 | 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 |
| and the insurer by the employer or mailed by the employer | 26 |
| to the
last known address of the employee. This written |
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LRB095 17861 KBJ 43941 b |
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| notice must be given directly to the employee or sent via | 2 |
| certified mail within 10 days after the employee's | 3 |
| termination or reduction in hours below the minimum | 4 |
| required by the group plan. An employee or member who | 5 |
| wishes
continuation
of coverage must request such | 6 |
| continuation in writing within the 30 day ten-day
period | 7 |
| following the later of: (i) the date of such termination
or | 8 |
| reduction in hours below the minimum required by the group | 9 |
| plan, or (ii)
the date the employee is given written notice | 10 |
| of the right of continuation
by either the employer , or the
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| group policyholder , or insurer. The written notice | 12 |
| provided to an employee must include an explanation that | 13 |
| his or her option for continuation coverage will expire | 14 |
| within the 30 day period following the later of (i) the | 15 |
| date of such termination of employment or reduction in | 16 |
| hours below the minimum required by the group plan, or (ii) | 17 |
| the date the employee is given written notice of the right | 18 |
| of continuation by either the employer, group | 19 |
| policyholder, or insurer . In no event, however, may the | 20 |
| employee or member elect
continuation more than 60 days | 21 |
| after the date of such termination
or reduction in hours | 22 |
| below the minimum required by the group plan.
Written | 23 |
| notice of continuation presented to the employee or member | 24 |
| by the
policyholder, or mailed by the policyholder to the | 25 |
| last known address of
the employee, shall constitute the | 26 |
| giving of notice for the purpose of this
provision.
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| In the event the employer fails or refuses to provide | 2 |
| notice of continuation rights to the employee or member, | 3 |
| the insurer is required to mail notice of the continuation | 4 |
| rights to the employee or member at the last known address | 5 |
| of the employee. In the event the employee or member | 6 |
| contacts the insurer regarding continuation rights and | 7 |
| advises that notice has not been provided by the employer | 8 |
| or group policyholder, the insurer shall mail out notice to | 9 |
| that individual. An employee or member shall have 30 days | 10 |
| from receipt of the notice to elect continuation. | 11 |
| Any employer who fails to provide the notice required | 12 |
| in this subsection 4. is guilty of a petty offense and | 13 |
| shall be fined $500.
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| 5. An employee or member electing continuation must pay | 15 |
| to the group
policyholder
or his employer, on a monthly | 16 |
| basis in advance, the total amount of premium
required by | 17 |
| the insurer, including that portion of the premium | 18 |
| contributed
by the policyholder or employer, if any, but | 19 |
| not more than the group rate
for the insurance being | 20 |
| continued with appropriate reduction in premium
for any | 21 |
| supplementary benefits which have been discontinued under | 22 |
| paragraph
(3) of this Section. The premium rate required by | 23 |
| the insurer shall be
the applicable premium required on the | 24 |
| 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 |
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| Medicare or is covered
by any other insured or uninsured | 2 |
| plan which provides hospital, surgical
or medical coverage | 3 |
| for individuals in a group and under which
the person was | 4 |
| not covered immediately prior to such termination
or | 5 |
| reduction in hours below the minimum required by the group | 6 |
| plan
as provided
in condition
2 above or, if earlier, at | 7 |
| the first to occur of the following:
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| (a) The date 18 9 months after the date the | 9 |
| employee's or member's
insurance
under the policy | 10 |
| would otherwise have terminated because of termination
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| of employment or membership
or reduction in hours below | 12 |
| the minimum required by the group plan.
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| (b) If the employee or member fails to make timely | 14 |
| payment of a required
contribution, the end of the | 15 |
| period for which contributions were made.
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| (c) The date on which the group policy is | 17 |
| terminated or, in the case of
an employee, the date his | 18 |
| employer terminates participation under the group
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| policy. However, if this (c) applies and the coverage | 20 |
| ceasing by reason of
such
termination is replaced by | 21 |
| similar coverage under another group policy,
the | 22 |
| following shall apply:
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| (i) The employee or member shall have the right | 24 |
| to become covered
under
that other group policy, | 25 |
| for the balance of the period that he would have
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| remained covered under the prior group policy in |
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| accordance with condition
6 had a termination | 2 |
| described in this (c) not occurred.
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| (ii) The prior group policy shall continue to | 4 |
| provide benefits to the
extent of its accrued | 5 |
| 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 | 8 |
| be included in each
certificate of coverage.
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| 8. Continuation shall not be available for any employee | 10 |
| who was
discharged because of the commission of a felony in | 11 |
| connection with his
work, or because of theft in connection | 12 |
| with his work, for which the
employer was in no way | 13 |
| responsible; provided the employee admitted his
commission | 14 |
| of the felony or theft or such act has resulted in a | 15 |
| conviction
or order of supervision by a court of competent | 16 |
| jurisdiction.
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| The requirements of this amendatory Act of 1983 shall apply | 18 |
| to any group
policy as defined in this Section, delivered or | 19 |
| issued for delivery on or after
180 days following the | 20 |
| effective date of this amendatory Act of 1983.
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| The requirements of this amendatory Act of 1985 shall apply | 22 |
| to any
group policy as defined in this Section, delivered, | 23 |
| issued for delivery,
renewed or amended on or after 180 days | 24 |
| following the effective date of
this amendatory Act of 1985.
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| Notwithstanding any other rulemaking authority that may | 26 |
| exist, neither the Governor nor any agency or agency head under |
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HB4830 Engrossed |
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LRB095 17861 KBJ 43941 b |
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| the jurisdiction of the Governor has any authority to make or | 2 |
| promulgate rules to implement or enforce the provisions of this | 3 |
| amendatory Act of the 95th General Assembly. If, however, the | 4 |
| Governor believes that rules are necessary to implement or | 5 |
| enforce the provisions of this amendatory Act of the 95th | 6 |
| General Assembly, the Governor may suggest rules to the General | 7 |
| Assembly by filing them with the Clerk of the House and the | 8 |
| Secretary of the Senate and by requesting that the General | 9 |
| Assembly authorize such rulemaking by law, enact those | 10 |
| suggested rules into law, or take any other appropriate action | 11 |
| in the General Assembly's discretion. Nothing contained in this | 12 |
| amendatory Act of the 95th General Assembly shall be | 13 |
| interpreted to grant rulemaking authority under any other | 14 |
| Illinois statute where such authority is not otherwise | 15 |
| explicitly given. For the purposes of this amendatory Act of | 16 |
| the 95th General Assembly, "rules" is given the meaning | 17 |
| contained in Section 1-70 of the Illinois Administrative | 18 |
| Procedure Act, and "agency" and "agency head" are given the | 19 |
| meanings contained in Sections 1-20 and 1-25 of the Illinois | 20 |
| Administrative Procedure Act to the extent that such | 21 |
| definitions apply to agencies or agency heads under the | 22 |
| jurisdiction of the Governor. | 23 |
| (Source: P.A. 93-477, eff. 1-1-04.)
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| Section 10. The Health Maintenance Organization Act is | 25 |
| amended by changing Section 4-9.2 as follows:
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| (215 ILCS 125/4-9.2) (from Ch. 111 1/2, par. 1409.2-2)
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| Sec. 4-9.2. Continuation of group HMO coverage after | 3 |
| termination of
employee or membership. A group contract | 4 |
| delivered, issued for delivery,
renewed, or amended in this | 5 |
| State that covers employees or members for health
care services | 6 |
| shall provide that employees or members whose coverage under
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| the group contract would otherwise terminate because of | 8 |
| termination of
employment or membership or because of a | 9 |
| reduction in hours below the minimum
required by the group | 10 |
| contract shall be entitled to continue their coverage
under
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| that group contract, for themselves and their eligible | 12 |
| dependents, subject
to all of the group contract's terms and | 13 |
| conditions applicable to those
forms of coverage and to the | 14 |
| following conditions:
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| (1) Continuation shall only be available to an employee | 16 |
| or member who has
been continuously covered under the group | 17 |
| contract (and for similar
benefits under any group contract | 18 |
| that it replaced) during the entire 3
month period ending | 19 |
| with the termination of employment or membership or
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| reduction in hours below the minimum required by the group | 21 |
| contract.
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| (2) Continuation shall not be available for any | 23 |
| enrollee who is
covered by Medicare, except for those | 24 |
| individuals who have been covered
under a group Medicare | 25 |
| supplement policy. Continuation shall not be
available for |
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HB4830 Engrossed |
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LRB095 17861 KBJ 43941 b |
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| any enrollee who is covered by any other insured or | 2 |
| uninsured
plan that provides hospital, surgical, or | 3 |
| medical coverage for individuals
in a group and under which | 4 |
| the enrollee was not covered immediately
before | 5 |
| termination or reduction in hours below the minimum | 6 |
| required by the
group contract or who exercises his or her | 7 |
| conversion privilege under
the group policy.
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| (3) Continuation need not include dental, vision care, | 9 |
| prescription
drug, or similar supplementary benefits that | 10 |
| are provided under
the group contract in addition to its | 11 |
| basic health care services.
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| (4) Upon termination or reduction in hours below the | 13 |
| minimum required by
the group contract, written notice of | 14 |
| continuation shall be presented
to the employee or member | 15 |
| and the HMO by the employer or mailed by the employer to | 16 |
| the last
known address of the employee. This written notice | 17 |
| must be given directly to the employee or sent via | 18 |
| certified mail within 10 days after the employee's | 19 |
| termination or reduction in hours below the minimum | 20 |
| required by the group plan. An employee or member who | 21 |
| wishes
continuation of coverage must request continuation | 22 |
| in writing within
the 30 10 day period following the later | 23 |
| of (i) the date of termination or
reduction in hours below | 24 |
| the minimum required by the group contract or (ii)
the date | 25 |
| the employee is given written notice of the right of | 26 |
| continuation by
either the employer , or the group |
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HB4830 Engrossed |
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LRB095 17861 KBJ 43941 b |
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| policyholder , or HMO . In no event, however, shall the
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| employee or member elect continuation more than 60 days | 3 |
| after the date of
termination
or reduction in hours below | 4 |
| the minimum required by the group contract.
Written notice | 5 |
| of continuation presented to the employee or member
by the | 6 |
| policyholder or HMO , or mailed by the policyholder or HMO | 7 |
| to the last known address of
the employee, shall constitute | 8 |
| the giving of notice for the purpose of this
paragraph. | 9 |
| The written notice provided to an employee must include | 10 |
| an explanation that his or her option for continuation | 11 |
| coverage will expire within the 30 day period following the | 12 |
| later of (i) the date of such termination of employment or | 13 |
| reduction in hours below the minimum required by the group | 14 |
| plan, or (ii) the date the employee is given written notice | 15 |
| of the right of continuation by either the employer, group | 16 |
| policyholder, or HMO. | 17 |
| In the event the employer fails or refuses to provide | 18 |
| notice of continuation rights to the employee or member, | 19 |
| the HMO is required to mail notice of the continuation | 20 |
| rights to the employee or member at the last known address | 21 |
| of the employee. In the event the employee or member | 22 |
| contacts the HMO regarding continuation rights and advises | 23 |
| that notice has not been provided by the employer or group | 24 |
| policyholder, the HMO shall mail out notice to that | 25 |
| individual. An employee or member shall have 30 days from | 26 |
| receipt of the notice to elect continuation. |
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HB4830 Engrossed |
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LRB095 17861 KBJ 43941 b |
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| Any employer who fails to provide the notice required | 2 |
| in this subsection (4) is guilty of a petty offense and | 3 |
| shall be fined $500.
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| (5) An employee or member electing continuation must | 5 |
| pay to the group
policyholder or his employer, on a monthly | 6 |
| basis in advance, the total
amount of premium required by | 7 |
| the HMO, including that portion of the
premium contributed | 8 |
| by the policyholder or employer, if any, but not more
than | 9 |
| the group rate for the coverage being continued with | 10 |
| appropriate
reduction in premium for any supplementary | 11 |
| benefits that have been
discontinued under paragraph (3) of | 12 |
| this Section. The premium rate required
by the HMO shall be | 13 |
| the applicable premium required on the due date of each
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| payment.
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| (6) Continuation of coverage under the group contract | 16 |
| for any person
shall terminate when the person becomes | 17 |
| eligible for Medicare or is covered by
any other insured or | 18 |
| uninsured plan that provides hospital, surgical, or
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| medical coverage for individuals in a group and under which | 20 |
| the person was not
covered immediately before termination
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| or reduction in hours below the minimum required by the | 22 |
| group contract
as provided in paragraph (2) of this
Section | 23 |
| or, if earlier, at the first to occur of the following:
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| (a) The expiration of 18 9 months after the | 25 |
| employee's or member's coverage
because of termination | 26 |
| of employment or membership
or reduction in hours below |
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HB4830 Engrossed |
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LRB095 17861 KBJ 43941 b |
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| the minimum required by the group contract.
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| (b) If the employee or member fails to make timely | 3 |
| payment of a
required contribution, the end of the | 4 |
| period for which contributions were made.
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| (c) The date on which the group contract is | 6 |
| terminated or, in the
case of an employee, the date his | 7 |
| or her employer terminates participation
under the | 8 |
| group contract. If, however, this paragraph applies | 9 |
| and the coverage
ceasing by reason of termination is | 10 |
| replaced by similar coverage under another
group | 11 |
| contract, then (i) the employee or member shall have | 12 |
| the right to become
covered under the replacement group | 13 |
| contract for the balance of the period that
he or she | 14 |
| would have remained covered under the prior group | 15 |
| contract in
accordance with paragraph (6) had a | 16 |
| termination described in this item (c) not
occurred and | 17 |
| (ii) the prior group contract shall continue to provide | 18 |
| benefits
to the extent of its accrued liabilities and | 19 |
| extensions of benefits as if the
replacement had not | 20 |
| occurred.
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| (7) A notification of the continuation privilege shall | 22 |
| be included in
each evidence of coverage.
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| (8) Continuation shall not be available for any | 24 |
| employee who was
discharged because of the commission of a | 25 |
| felony in connection with his or her
work, or because of | 26 |
| theft in connection with his or her work, for which the
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HB4830 Engrossed |
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LRB095 17861 KBJ 43941 b |
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| employer was in no way responsible if the employee (i) | 2 |
| admitted to
committing the felony or theft or (ii) was | 3 |
| convicted or placed under
supervision by a court of | 4 |
| competent jurisdiction.
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| The requirements of this amendatory Act of 1992 shall apply | 6 |
| to any
group contract, as defined in this Section, delivered or | 7 |
| issued for
delivery on or after 180 days following the | 8 |
| effective date of this
amendatory Act of 1992.
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| Notwithstanding any other rulemaking authority that may | 10 |
| exist, neither the Governor nor any agency or agency head under | 11 |
| the jurisdiction of the Governor has any authority to make or | 12 |
| promulgate rules to implement or enforce the provisions of this | 13 |
| amendatory Act of the 95th General Assembly. If, however, the | 14 |
| Governor believes that rules are necessary to implement or | 15 |
| enforce the provisions of this amendatory Act of the 95th | 16 |
| General Assembly, the Governor may suggest rules to the General | 17 |
| Assembly by filing them with the Clerk of the House and the | 18 |
| Secretary of the Senate and by requesting that the General | 19 |
| Assembly authorize such rulemaking by law, enact those | 20 |
| suggested rules into law, or take any other appropriate action | 21 |
| in the General Assembly's discretion. Nothing contained in this | 22 |
| amendatory Act of the 95th General Assembly shall be | 23 |
| interpreted to grant rulemaking authority under any other | 24 |
| Illinois statute where such authority is not otherwise | 25 |
| explicitly given. For the purposes of this amendatory Act of | 26 |
| the 95th General Assembly, "rules" is given the meaning |
|
|
|
HB4830 Engrossed |
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LRB095 17861 KBJ 43941 b |
|
| 1 |
| contained in Section 1-70 of the Illinois Administrative | 2 |
| Procedure Act, and "agency" and "agency head" are given the | 3 |
| meanings contained in Sections 1-20 and 1-25 of the Illinois | 4 |
| Administrative Procedure Act to the extent that such | 5 |
| definitions apply to agencies or agency heads under the | 6 |
| jurisdiction of the Governor. | 7 |
| (Source: P.A. 93-477, eff. 1-1-04.)
| 8 |
| Section 99. Effective date. This Act takes effect upon | 9 |
| becoming law.
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