State of Illinois
92nd General Assembly
Legislation

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[ Introduced ][ Engrossed ][ House Amendment 002 ]


92_HB0023ham001

 










                                           LRB9200767DJmgam04

 1                     AMENDMENT TO HOUSE BILL 23

 2        AMENDMENT NO.     .  Amend House Bill 23 by replacing the
 3    title of the bill with the following:
 4        "AN ACT in relation to health."; and

 5    by replacing everything after the enacting  clause  with  the
 6    following:

 7        "Section  1.   Short title.  This Act may be cited as the
 8    Family Health Insurance Program Act.

 9        Section 5.  Legislative  intent.   The  General  Assembly
10    finds  that,  for  the  economic  and  social  benefit of all
11    citizens of this State, it is important to enable  low-income
12    families  with  children  to access health benefits coverage,
13    especially for preventive and maintenance health care.   This
14    helps  these  families  to maintain and succeed in their work
15    efforts.  Coverage of the entire  family  also  promotes  the
16    goals  of  the  Children's  Health  Insurance  Program.   The
17    General  Assembly recognizes that assistance to help families
18    purchase health benefits must  be  provided  in  a  fair  and
19    equitable  fashion and must treat families at the same income
20    level in a similar fashion.  The  State  of  Illinois  should
21    also  help  low-income  families transition from a program in
 
                            -2-            LRB9200767DJmgam04
 1    which the State helps  the  family  to  secure  the  family's
 2    health  coverage  to a program in which the family is covered
 3    by private or employer-based insurance without  help  from  a
 4    State program.

 5        Section 10.  Definitions.
 6        "Children's  Health  Insurance Program" means the program
 7    of health insurance  provided  under  the  Children's  Health
 8    Insurance Program Act.
 9        "Department" means the Department of Public Aid.
10        "Family"  means  a  group of people who live together and
11    who  include  minor  children  and  their  parents  or  other
12    blood-related  adults  who  are  the   children's   caretaker
13    relatives,  and  the  spouses  of  those parents or caretaker
14    relatives.  "Family" also includes any other persons who  are
15    defined  as covered family members under employer-provided or
16    private health insurance for which a single "family coverage"
17    premium is paid.
18        "Medical Assistance Program" is the health  care  benefit
19    program  provided  under Article V of the Illinois Public Aid
20    Code.
21        "Non-spend-down" Medical Assistance means benefits  under
22    the  Medical  Assistance  Program  for  which the beneficiary
23    qualifies without any required financial contribution.
24        "Program" means the Family Health Insurance Program.

25        Section 15.  Operation of the program.  The Family Health
26    Insurance Program is created.    The  program  shall  operate
27    subject  to  appropriation  and  shall be administered by the
28    Department. Except as otherwise provided  in  this  Act,  the
29    program  is subject to the same rules and requirements as the
30    Children's  Health  Insurance  Program.   Families  have  the
31    option to participate only in the Children's Health Insurance
32    Program, even if they are eligible for  coverage  under  this
 
                            -3-            LRB9200767DJmgam04
 1    Act.

 2        Section 20.  Eligibility.
 3        (a)  The  Department  shall  make  all  determinations of
 4    eligibility for the program.
 5        (b) To be eligible for health  insurance  coverage  under
 6    the  program,  a  family  must  include a child who meets the
 7    non-financial  and  financial  eligibility  requirements  for
 8    health coverage under the Children's Health Insurance Program
 9    or  non-spend-down  coverage  under  the  Medical  Assistance
10    Program.
11        (c) A family determined eligible for the program  remains
12    eligible  for  12  months,  as long as it meets the following
13    criteria:
14             (1)  The  family  maintains   a   residence   within
15        Illinois.
16             (2)  At  least one child in the family remains under
17        the age of 19.
18             (3) The family is not excluded under subsection (d).
19        The Department shall determine each family's  eligibility
20    at least once each year.
21        (d)  A  family  is  not  eligible  for coverage under the
22    program if it meets any of the following criteria:
23             (1) A premium required  under  the  program  is  not
24        paid.  The Department shall adopt rules governing periods
25        of  coverage  in  the event of loss of eligibility due to
26        unpaid  premiums,  waiting  periods  and  conditions  for
27        re-enrollment,  grace  periods,  notices,   and   hearing
28        procedures relevant to this subsection.
29             (2)  There  is  no  longer  a  child  in  the family
30        eligible under the Children's Health Insurance Program or
31        non-spend-down Medical Assistance.
32             (3) The family  is  eligible  for  health  insurance
33        under  the  State of Illinois health benefits plan on the
 
                            -4-            LRB9200767DJmgam04
 1        basis of a  family  member's  employment  with  a  public
 2        agency,   or   the   whole   family   is   eligible   for
 3        non-spend-down Medical Assistance.

 4        Section 25.  Health benefits for families.
 5        (a)   Subject  to  appropriation,  the  Department  shall
 6    provide health benefits  coverage  to  eligible  families  by
 7    doing either of the following:
 8             (1) Subsidizing the cost of a family's coverage, for
 9        families    with    a    member   who   has   access   to
10        employer-provided family health coverage.
11             (2) Providing the family with health benefits  that,
12        subject  to  appropriation  and  without  regard  to  any
13        applicable  cost-sharing  under Section 30, are identical
14        to the benefits provided under the State's approved  plan
15        under Title XIX of the Social Security Act or any waivers
16        granted    by   the   federal   Health   Care   Financing
17        Administration, for families that do not have  access  to
18        employer-provided  family  health  coverage  or  for whom
19        subsidization of that coverage under paragraph (1) is not
20        cost-effective  for  the  State,  as  determined  by  the
21        Department  pursuant  to  rules.   Providers  of   health
22        benefits under this paragraph (2) must be approved by the
23        Department  to  provide  health  care  under the Illinois
24        Public Aid Code and shall be reimbursed at the same  rate
25        as  providers under the State's approved plan under Title
26        XIX of the Social Security Act.  Any copayments  required
27        under  Section  30  may  be  paid  to  the  Department or
28        retained by the provider, as provided by rule.
29        (b) The Department may provide the  subsidy  pursuant  to
30    subdivision  (a)(1)  directly  to  an insurance company, as a
31    rebate to  the  family  for  premiums  paid  through  payroll
32    deduction,  or  in  any  other  manner  the  Department deems
33    cost-effective and accurate and best suited to accomplish the
 
                            -5-            LRB9200767DJmgam04
 1    purposes of  the  program.   The  Department  may  also  take
 2    appropriate  measures  to  ensure  that employers do not take
 3    unfair advantage of the subsidies provided under  subdivision
 4    (a)(1)  by  increasing the subsidized employees' share of the
 5    premium for health insurance by amounts out-of-proportion  to
 6    any increase in the actual total cost of the insurance.
 7        (c) The Department may not deny subsidization of coverage
 8    to   a   family   with   a   member  who  has  access  to  an
 9    employer-provided  health  plan  under   subdivision   (a)(1)
10    because the plan does not meet federal benchmarking standards
11    or   cost-sharing   and  contribution  requirements.   To  be
12    eligible for inclusion in the program, the plan must  contain
13    comprehensive   major   medical  coverage  of  physician  and
14    hospital inpatient services.  The  Department  may  not  deny
15    subsidization  of  coverage  for  a  family under subdivision
16    (a)(1) because the employer-based  plan  offers  benefits  in
17    addition  to  coverage  of  physician  and hospital inpatient
18    services. The Department may deny subsidization  of  coverage
19    for   a  family  under  subdivision  (a)(1)  if  it  is  more
20    cost-effective to  provide  coverage  for  the  family  under
21    subdivision (a)(2).
22        (d)  The  monthly dollar amount of the subsidy for family
23    coverage under subdivision (a)(1) shall  be  an  amount  that
24    allows  the  family to pay no more than 2% of its average net
25    income per month toward its share  of  the  premium  for  the
26    health insurance.
27        The Department, however, may limit the monthly subsidy to
28    an  amount  equal  to  the  average monthly cost of providing
29    coverage to identically configured families under subdivision
30    (a)(2), or a larger amount established by the  Department  by
31    rule.    The  Department,  to  the  extent  it  imposes  this
32    limitation,    must   set   this   "average   monthly   cost"
33    prospectively based on the  prior  fiscal  year's  experience
34    adjusted  for  incurred-but-not-reported claims and estimated
 
                            -6-            LRB9200767DJmgam04
 1    increases or decreases in the  cost  of  medical  care.   The
 2    subsidy  may  not  exceed the amount of the family's share of
 3    the premium for the health insurance.

 4        Section 30.  Cost-sharing.
 5        (a) A family enrolled in a health benefits program  under
 6    subdivision  (a)(2) of Section 25 is subject to the following
 7    cost-sharing requirements to the extent permitted by  federal
 8    requirements in waivers governing the funding of the program:
 9             (1) A copayment may not be required for well-baby or
10        well-child  care, including age-appropriate immunizations
11        as required under federal law.
12             (2) Health insurance premiums  for  a  family  whose
13        household  income is equal to or greater than 150% of the
14        poverty  guidelines  updated  annually  in  the   Federal
15        Register  by  the  U.S.  Department  of  Health and Human
16        Services under authority of 42  U.S.C.  9902(2)  must  be
17        payable   monthly,   subject  to  rules  adopted  by  the
18        Department for grace periods and  advance  payments,  and
19        must be as follows:
20                  (A)  $25  for a family composed of an adult and
21             one dependent.
22                  (B) $30 for a family composed of an adult and 2
23             dependents.
24                  (C) $35 for a family composed of an adult and 3
25             or more dependents.
26             (3) Copayments for a family  whose  income  is  less
27        than  150%  of the poverty guidelines updated annually in
28        the Federal Register by the U.S. Department of Health and
29        Human Services under authority of 42 U.S.C. 9902(2), at a
30        minimum and to the extent permitted  under  federal  law,
31        must  be  $2 for each medical visit and each prescription
32        provided under this Act.
33             (4) Copayments for a family whose income is equal to
 
                            -7-            LRB9200767DJmgam04
 1        or greater than 150% of the poverty   guidelines  updated
 2        annually  in  the Federal Register by the U.S. Department
 3        of Health and Human Services under authority of 42 U.S.C.
 4        9902(2), at a minimum and to the extent  permitted  under
 5        federal law, must be as follows:
 6                  (A) $5 for each medical visit.
 7                  (B) $3 for each generic prescription and $5 for
 8             each brand-name prescription.
 9                  (C)  $25  for  each  emergency  room  use for a
10        non-emergency situation as defined by the  Department  by
11        rule.
12             (5)  The  maximum  allowable amount of out-of-pocket
13        expenses for copayments is $100 per family per year.
14        (b) A family whose health benefits coverage is subsidized
15    under subdivision (a)(1) of Section 25 is subject to (i)  the
16    cost-sharing   provisions  of  the  employer-provided  family
17    health coverage to which a family member has access, (ii) the
18    requirements imposed by  the  federal  government  under  any
19    waivers  governing  federal  funding of the program, or (iii)
20    both.

21        Section 35.  Funding.
22        (a) The program is not an entitlement and  shall  not  be
23    construed  to  create  an  entitlement.   Eligibility for the
24    program is subject to appropriation of moneys  by  the  State
25    and federal governments to fund the program.
26        (b)  Any  requirement  imposed  under  this  Act  and any
27    implementation of this Act by the Department shall  cease  in
28    the event that moneys are not available for those purposes.

29        Section  40.  Medical Assistance Plan amendments; federal
30    waivers.
31        (a)  The  Department  shall  amend  the  State's  Medical
32    Assistance Plan to the extent permitted  by  federal  law  in
 
                            -8-            LRB9200767DJmgam04
 1    order  to  secure  federal  matching  funds  for  the  health
 2    coverages provided and administrative expenses incurred under
 3    this Act.
 4        (b)  Promptly  after  the effective date of this Act, the
 5    Department shall request any  necessary  waivers  of  federal
 6    requirements in order to allow receipt of federal funding for
 7    the    health    coverages   subsidized   or   provided   and
 8    administrative  expenses  incurred  under  this   Act.    The
 9    Department  must  implement the program, however, even if the
10    federal government  denies  all  or  some  of  the  requested
11    waivers, to the extent that State appropriations permit.

12        Section 45.  Contracts with non-governmental bodies.  All
13    contracts with non-governmental bodies that are determined by
14    the Department to be necessary for the implementation of this
15    Act  are  deemed  to  be  purchase  of care as defined in the
16    Illinois Procurement Code.

17        Section 50.  Implementation date.   The  Department  must
18    begin  implementing  this  Act  on the effective date of this
19    Act.  Health benefits  coverage  may  not  be  subsidized  or
20    provided  under  the program, and applications for enrollment
21    in the program may not be taken, until January 1, 2002 at the
22    earliest.  Portions of the program as to which the Department
23    is awaiting  federal  action  on  a  waiver  request  may  be
24    implemented  upon  learning  of  the  federal decision on the
25    request.

26        Section 55. Repealer.  This Act is repealed on  June  30,
27    2007.

28        Section  90.   The  Illinois Health Insurance Portability
29    and Accountability Act is amended by changing Section  20  as
30    follows:
 
                            -9-            LRB9200767DJmgam04
 1        (215 ILCS 97/20)
 2        Sec.  20.   Increased  portability  through limitation on
 3    preexisting condition exclusions.
 4        (A)  Limitation  of   preexisting   condition   exclusion
 5    period;  crediting for periods of previous coverage.  Subject
 6    to  subsection  (D),  a  group  health  plan,  and  a  health
 7    insurance issuer offering group  health  insurance  coverage,
 8    may,  with  respect to a participant or beneficiary, impose a
 9    preexisting condition exclusion only if:
10             (1)  the exclusion relates to a  condition  (whether
11        physical  or  mental),  regardless  of  the  cause of the
12        condition, for which medical advice, diagnosis, care,  or
13        treatment  was recommended or received within the 6-month
14        period ending on the enrollment date;
15             (2)  the exclusion extends for a period of not  more
16        than  12  months  (or  18  months  in  the case of a late
17        enrollee) after the enrollment date; and
18             (3)  the period of any  such  preexisting  condition
19        exclusion  is  reduced by the aggregate of the periods of
20        creditable coverage (if any,  as  defined  in  subsection
21        (C)(1))  applicable  to the participant or beneficiary as
22        of the enrollment date.
23        (B)  Preexisting condition  exclusion.   A  group  health
24    plan,  and  health  insurance  issuer  offering  group health
25    insurance coverage, may not impose any preexisting  condition
26    exclusion relating to pregnancy as a preexisting condition.
27        Genetic  information  shall not be treated as a condition
28    described in subsection (A)(1) in the absence of a  diagnosis
29    of the condition related to such information.
30        (C)  Rules relating to crediting previous coverage.
31             (1)  Creditable  coverage  defined.  For purposes of
32        this Act, the  term  "creditable  coverage"  means,  with
33        respect  to  an  individual,  coverage  of the individual
34        under any of the following:
 
                            -10-           LRB9200767DJmgam04
 1                  (a)  A group health plan.
 2                  (b)  Health insurance coverage.
 3                  (c)  Part A or part B of  title  XVIII  of  the
 4             Social Security Act.
 5                  (d)  Title  XIX  of  the  Social  Security Act,
 6             other than coverage consisting  solely  of  benefits
 7             under Section 1928.
 8                  (e)  Chapter  55  of  title  10,  United States
 9             Code.
10                  (f)  A  medical  care  program  of  the  Indian
11             Health Service or of a tribal organization.
12                  (g)  A State health benefits risk pool.
13                  (h)  A health plan offered under chapter 89  of
14             title 5, United States Code.
15                  (i)  A   public  health  plan  (as  defined  in
16             regulations).
17                  (j)  A health benefit plan under  Section  5(e)
18             of the Peace Corps Act (22 U.S.C. 2504(e)).
19                  (k)  Title  XXI  of the federal Social Security
20             Act, State Children's Health Insurance Program.
21                  (l)  Coverage under the Family Health Insurance
22             Program Act.
23             Such  term  does  not  include  coverage  consisting
24        solely of coverage of excepted benefits.
25             (2)  Excepted benefits.  For purposes of  this  Act,
26        the  term "excepted benefits" means benefits under one or
27        more of the following:
28                  (a)  Benefits not subject to requirements:
29                       (i)  Coverage  only   for   accident,   or
30                  disability income insurance, or any combination
31                  thereof.
32                       (ii)  Coverage  issued  as a supplement to
33                  liability insurance.
34                       (iii)  Liability   insurance,    including
 
                            -11-           LRB9200767DJmgam04
 1                  general   liability  insurance  and  automobile
 2                  liability insurance.
 3                       (iv)  Workers'  compensation  or   similar
 4                  insurance.
 5                       (v)  Automobile medical payment insurance.
 6                       (vi)  Credit-only insurance.
 7                       (vii)  Coverage    for   on-site   medical
 8                  clinics.
 9                       (viii)  Other similar insurance  coverage,
10                  specified  in regulations, under which benefits
11                  for medical care are secondary or incidental to
12                  other insurance benefits.
13                  (b)  Benefits not subject  to  requirements  if
14             offered separately:
15                       (i)  Limited   scope   dental   or  vision
16                  benefits.
17                       (ii)  Benefits for long-term care, nursing
18                  home care, home  health  care,  community-based
19                  care, or any combination thereof.
20                       (iii)  Such    other    similar,   limited
21                  benefits as are specified in rules.
22                  (c)  Benefits not subject  to  requirements  if
23             offered, as independent, noncoordinated benefits:
24                       (i)  Coverage only for a specified disease
25                  or illness.
26                       (ii)  Hospital  indemnity  or  other fixed
27                  indemnity insurance.
28                  (d)  Benefits not subject  to  requirements  if
29             offered  as  separate  insurance  policy.   Medicare
30             supplemental  health  insurance  (as  defined  under
31             Section  1882(g)(1)  of  the  Social  Security Act),
32             coverage supplemental to the coverage provided under
33             chapter 55 of title  10,  United  States  Code,  and
34             similar  supplemental  coverage provided to coverage
 
                            -12-           LRB9200767DJmgam04
 1             under a group health plan.
 2             (3)  Not counting periods before significant  breaks
 3        in coverage.
 4                  (a)  In   general.    A  period  of  creditable
 5             coverage shall  not  be  counted,  with  respect  to
 6             enrollment  of  an  individual  under a group health
 7             plan,  if,  after  such  period   and   before   the
 8             enrollment  date,  there  was a 63-day period during
 9             all of which the individual was  not  covered  under
10             any creditable coverage.
11                  (b)  Waiting  period  not treated as a break in
12             coverage.  For  purposes  of  subparagraph  (a)  and
13             subsection  (D)(3), any period that an individual is
14             in a waiting period for any coverage under  a  group
15             health plan (or for group health insurance coverage)
16             or  is  in  an  affiliation  period  (as  defined in
17             subsection (G)(2)) shall not be taken  into  account
18             in   determining   the   continuous   period   under
19             subparagraph (a).
20             (4)  Method of crediting coverage.
21                  (a)  Standard   method.   Except  as  otherwise
22             provided under subparagraph  (b),  for  purposes  of
23             applying subsection (A)(3), a group health plan, and
24             a  health  insurance  issuer  offering  group health
25             insurance  coverage,  shall  count   a   period   of
26             creditable  coverage  without regard to the specific
27             benefits covered during the period.
28                  (b)  Election of alternative method.   A  group
29             health  plan,  or a health insurance issuer offering
30             group  health  insurance,   may   elect   to   apply
31             subsection  (A)(3)  based  on  coverage  of benefits
32             within each of  several  classes  or  categories  of
33             benefits  specified  in  regulations  rather than as
34             provided  under  subparagraph  (a).   Such  election
 
                            -13-           LRB9200767DJmgam04
 1             shall  be  made  on  a   uniform   basis   for   all
 2             participants and beneficiaries.  Under such election
 3             a  group  health plan or issuer shall count a period
 4             of creditable coverage with respect to any class  or
 5             category  of  benefits  if  any level of benefits is
 6             covered within such class or category.
 7                  (c)  Plan notice.  In the case of  an  election
 8             with   respect   to   a   group  health  plan  under
 9             subparagraph (b) (whether or  not  health  insurance
10             coverage  is provided in connection with such plan),
11             the plan shall:
12                       (i)  prominently state in  any  disclosure
13                  statements  concerning  the  plan, and state to
14                  each enrollee at the time of  enrollment  under
15                  the plan, that the plan has made such election;
16                  and
17                       (ii)  include   in   such   statements   a
18                  description of the effect of this election.
19                  (d)  Issuer notice.  In the case of an election
20             under   subparagraph  (b)  with  respect  to  health
21             insurance coverage offered by an issuer in the small
22             or large group market, the issuer:
23                       (i)  shall  prominently   state   in   any
24                  disclosure  statements concerning the coverage,
25                  and to each employer at the time of  the  offer
26                  or  sale  of  the coverage, that the issuer has
27                  made such election; and
28                       (ii)  shall include in such  statements  a
29                  description of the effect of such election.
30             (5)  Establishment of period.  Periods of creditable
31        coverage   with   respect   to  an  individual  shall  be
32        established  through   presentation   or   certifications
33        described  in  subsection  (E) or in such other manner as
34        may be specified in regulations.
 
                            -14-           LRB9200767DJmgam04
 1        (D)  Exceptions:
 2             (1)  Exclusion not applicable to  certain  newborns.
 3        Subject  to  paragraph  (3),  a  group health plan, and a
 4        health insurance issuer offering group  health  insurance
 5        coverage,   may  not  impose  any  preexisting  condition
 6        exclusion in the case of an individual  who,  as  of  the
 7        last  day of the 30-day period beginning with the date of
 8        birth, is covered under creditable coverage.
 9             (2)  Exclusion not  applicable  to  certain  adopted
10        children.  Subject to paragraph (3), a group health plan,
11        and  a  health  insurance  issuer  offering  group health
12        insurance  coverage,  may  not  impose  any   preexisting
13        condition exclusion in the case of a child who is adopted
14        or  placed  for adoption before attaining 18 years of age
15        and who,  as  of  the  last  day  of  the  30-day  period
16        beginning  on  the  date of the adoption or placement for
17        adoption, is covered under creditable coverage.
18             The previous sentence shall not  apply  to  coverage
19        before  the  date  of  such  adoption  or  placement  for
20        adoption.
21             (3)  Loss  if break in coverage.  Paragraphs (1) and
22        (2) shall no longer apply to an individual after the  end
23        of  the  first  63-day  period  during  all  of which the
24        individual was not covered under any creditable coverage.
25        (E)  Certifications and disclosure of coverage.
26             (1)  Requirement  for  Certification  of  Period  of
27        Creditable Coverage.
28                  (a)  A  group  health  plan,   and   a   health
29             insurance  issuer  offering  group  health insurance
30             coverage, shall provide the certification  described
31             in subparagraph (b):
32                       (i)  at  the  time an individual ceases to
33                  be covered under the plan or otherwise  becomes
34                  covered under a COBRA continuation provision;
 
                            -15-           LRB9200767DJmgam04
 1                       (ii)  in   the   case   of  an  individual
 2                  becoming covered under such a provision, at the
 3                  time the individual ceases to be covered  under
 4                  such provision; and
 5                       (iii)  on  the  request  on  behalf  of an
 6                  individual made not later than 24 months  after
 7                  the date of cessation of the coverage described
 8                  in clause (i) or (ii), whichever is later.
 9             The  certification under clause (i) may be provided,
10             to the extent practicable, at a time consistent with
11             notices  required   under   any   applicable   COBRA
12             continuation provision.
13                  (b)  The   certification   described   in  this
14             subparagraph is a written certification  of:
15                       (i)  the period of creditable coverage  of
16                  the individual under such plan and the coverage
17                  (if   any)   under   such   COBRA  continuation
18                  provision; and
19                       (ii)  the waiting  period  (if  any)  (and
20                  affiliation period, if applicable) imposed with
21                  respect  to  the  individual  for  any coverage
22                  under such plan.
23                  (c)  To the extent that medical  care  under  a
24             group health plan consists of group health insurance
25             coverage,  the  plan is deemed to have satisfied the
26             certification requirement under  this  paragraph  if
27             the  health  insurance  issuer offering the coverage
28             provides for such certification in  accordance  with
29             this paragraph.
30             (2)  Disclosure of information on previous benefits.
31        In  the  case  of  an  election  described  in subsection
32        (C)(4)(b) by a group  health  plan  or  health  insurance
33        issuer,  if  the plan or issuer enrolls an individual for
34        coverage under the plan and  the  individual  provides  a
 
                            -16-           LRB9200767DJmgam04
 1        certification   of   coverage  of  the  individual  under
 2        paragraph (1):
 3                  (a)  upon request of such plan or  issuer,  the
 4             entity  which  issued  the certification provided by
 5             the  individual  shall  promptly  disclose  to  such
 6             requesting plan or issuer information on coverage of
 7             classes and categories of health benefits  available
 8             under such entity's plan or coverage; and
 9                  (b)  such entity may charge the requesting plan
10             or issuer for the reasonable cost of disclosing such
11             information.
12             (3)  Rules.  The Department shall establish rules to
13        prevent  an entity's failure to provide information under
14        paragraph (1) or (2) with respect to previous coverage of
15        an individual from  adversely  affecting  any  subsequent
16        coverage  of  the  individual  under another group health
17        plan or health insurance coverage.
18             (4)  Treatment of certain plans as group health plan
19        for notice provision.  A program under  which  creditable
20        coverage  described in subparagraph (c), (d), (e), or (f)
21        of Section 20(C)(1) is provided shall  be  treated  as  a
22        group health plan for purposes of this Section.
23        (F)  Special enrollment periods.
24             (1)  Individuals  losing  other  coverage.   A group
25        health plan, and a health insurance issuer offering group
26        health insurance coverage  in  connection  with  a  group
27        health  plan,  shall  permit an employee who is eligible,
28        but not enrolled, for coverage under  the  terms  of  the
29        plan (or a dependent of such an employee if the dependent
30        is  eligible,  but  not enrolled, for coverage under such
31        terms) to enroll for coverage under the terms of the plan
32        if each of the following conditions is met:
33                  (a)  The  employee  or  dependent  was  covered
34             under a group health plan or  had  health  insurance
 
                            -17-           LRB9200767DJmgam04
 1             coverage at the time coverage was previously offered
 2             to the employee or dependent.
 3                  (b)  The  employee  stated  in  writing at such
 4             time that coverage under  a  group  health  plan  or
 5             health   insurance   coverage  was  the  reason  for
 6             declining enrollment, but only if the  plan  sponsor
 7             or  issuer (if applicable) required such a statement
 8             at such time and provided the employee  with  notice
 9             of  such  requirement  (and the consequences of such
10             requirement) at such time.
11                  (c)  The  employee's  or  dependent's  coverage
12             described in subparagraph (a):
13                       (i)  was  under   a   COBRA   continuation
14                  provision and the coverage under such provision
15                  was exhausted; or
16                       (ii)  was  not  under such a provision and
17                  either the coverage was terminated as a  result
18                  of   loss   of  eligibility  for  the  coverage
19                  (including as a  result  of  legal  separation,
20                  divorce,  death,  termination of employment, or
21                  reduction in the number of hours of employment)
22                  or employer contributions towards such coverage
23                  were terminated.
24                  (d)  Under the terms of the plan, the  employee
25             requests  such  enrollment  not  later  than 30 days
26             after the date of exhaustion of  coverage  described
27             in subparagraph (c)(i) or termination of coverage or
28             employer  contributions  described  in  subparagraph
29             (c)(ii).
30             (2)  For dependent beneficiaries.
31                  (a)  In general.  If:
32                       (i)  a  group  health  plan makes coverage
33                  available with respect to  a  dependent  of  an
34                  individual,
 
                            -18-           LRB9200767DJmgam04
 1                       (ii)  the   individual  is  a  participant
 2                  under the plan (or has met any  waiting  period
 3                  applicable  to becoming a participant under the
 4                  plan and is eligible to be enrolled  under  the
 5                  plan  but  for  a  failure  to  enroll during a
 6                  previous enrollment period), and
 7                       (iii)  a person becomes such  a  dependent
 8                  of  the  individual through marriage, birth, or
 9                  adoption or placement for adoption,
10             then the group  health  plan  shall  provide  for  a
11             dependent  special  enrollment  period  described in
12             subparagraph (b) during which the person (or, if not
13             otherwise enrolled, the individual) may be  enrolled
14             under the plan as a dependent of the individual, and
15             in the case of the birth or adoption of a child, the
16             spouse  of  the  individual  may  be  enrolled  as a
17             dependent  of  the  individual  if  such  spouse  is
18             otherwise eligible for coverage.
19                  (b)  Dependent special  enrollment  period.   A
20             dependent   special  enrollment  period  under  this
21             subparagraph shall be a period of not less  than  30
22             days and shall begin on the later of:
23                       (i)  the  date  dependent coverage is made
24                  available; or
25                       (ii)  the date of the marriage, birth,  or
26                  adoption or placement for adoption (as the case
27                  may be) described in subparagraph (a)(iii).
28                  (c)  No waiting period.  If an individual seeks
29             to  enroll  a  dependent during the first 30 days of
30             such a  dependent  special  enrollment  period,  the
31             coverage of the dependent shall become effective:
32                       (i)  in  the  case  of marriage, not later
33                  than the first day of the first month beginning
34                  after  the  date  the  completed  request   for
 
                            -19-           LRB9200767DJmgam04
 1                  enrollment is received;
 2                       (ii)  in  the case of a dependent's birth,
 3                  as of the date of such birth; or
 4                       (iii)  in  the  case  of   a   dependent's
 5                  adoption or placement for adoption, the date of
 6                  such adoption or placement for adoption.
 7        (G)  Use  of affiliation period by HMOs as alternative to
 8    preexisting condition exclusion.
 9             (1)  In general.  A health maintenance  organization
10        which offers health insurance coverage in connection with
11        a  group  health  plan  and  which  does  not  impose any
12        pre-existing condition exclusion allowed under subsection
13        (A) with respect to any particular  coverage  option  may
14        impose  an  affiliation  period for such coverage option,
15        but only if:
16                  (a)  such period is applied  uniformly  without
17             regard to any health status-related factors; and
18                  (b)  such period does not exceed 2 months (or 3
19             months in the case of a late enrollee).
20             (2)  Affiliation period.
21                  (a)  Defined.   For  purposes  of this Act, the
22             term "affiliation  period"  means  a  period  which,
23             under  the  terms  of  the health insurance coverage
24             offered by the health maintenance organization, must
25             expire before the health insurance coverage  becomes
26             effective.   The  organization  is  not  required to
27             provide health care services or benefits during such
28             period and  no  premium  shall  be  charged  to  the
29             participant  or  beneficiary for any coverage during
30             the period.
31                  (b)  Beginning.  Such period shall begin on the
32             enrollment date.
33                  (c)  Runs concurrently  with  waiting  periods.
34             An   affiliation  period  under  a  plan  shall  run
 
                            -20-           LRB9200767DJmgam04
 1             concurrently with any waiting period under the plan.
 2             (3)  Alternative  methods.   A  health   maintenance
 3        organization   described   in   paragraph   (1)  may  use
 4        alternative  methods,  from  those  described   in   such
 5        paragraph,  to  address  adverse selection as approved by
 6        the Department.
 7    (Source: P.A. 90-30, eff. 7-1-97; 90-736, eff. 8-12-98.)

 8        Section 95.  The Children's Health Insurance Program  Act
 9    is amended by changing Section 20 as follows:

10        (215 ILCS 106/20)
11        (Section scheduled to be repealed on July 1, 2002)
12        Sec. 20.  Eligibility.
13        (a)  To  be eligible for this Program, a person must be a
14    person who has a child eligible under this  Act  and  who  is
15    eligible under this Act and who is eligible under a waiver of
16    federal requirements pursuant to an application made pursuant
17    to  subdivision  (a)(1) of Section 40 of this Act or who is a
18    child who:
19             (1)  is a child who  is  not  eligible  for  medical
20        assistance;
21             (2)  is  a  child  whose annual household income, as
22        determined by  the  Department,  is  above  133%  of  the
23        federal poverty level and at or below 185% of the federal
24        poverty   level;   provided,   that  the  Department  may
25        establish the upper limit of eligibility at 200%  of  the
26        federal  poverty  level  as  part  of  acquiring  federal
27        waivers   from   the   federal   Health   Care  Financing
28        Administration  allowing  Illinois  to  claim   favorable
29        levels  of  federal  matching  funds  to  provide  health
30        insurance  to  families under the Family Health Insurance
31        Program Act;
32             (3)  is a  resident of the State of Illinois; and
 
                            -21-           LRB9200767DJmgam04
 1             (4)  is a  child  who  is  either  a  United  States
 2        citizen or included in one of the following categories of
 3        non-citizens:
 4                  (A)  unmarried  dependent  children of either a
 5             United States  Veteran  honorably  discharged  or  a
 6             person on active military duty;
 7                  (B)  refugees   under   Section   207   of  the
 8             Immigration and Nationality Act;
 9                  (C)  asylees   under   Section   208   of   the
10             Immigration and Nationality Act;
11                  (D)  persons  for  whom  deportation  has  been
12             withheld under Section  243(h)  of  the  Immigration
13             and Nationality Act;
14                  (E)  persons  granted  conditional  entry under
15             Section 203(a)(7) of the Immigration and Nationality
16             Act as in effect prior to April 1, 1980;
17                  (F)  persons lawfully  admitted  for  permanent
18             residence under the Immigration and Nationality Act;
19             and
20                  (G)  parolees,  for  at  least  one year, under
21             Section 212(d)(5) of the Immigration and Nationality
22             Act.
23        Those children who are in the  categories  set  forth  in
24    subdivisions  (4)(F) and (4)(G) of this subsection, who enter
25    the United States on or after August 22, 1996, shall  not  be
26    eligible  for 5 years beginning on the date the child entered
27    the United States.
28        (b)  A  child  who  is  determined  to  be  eligible  for
29    assistance shall remain eligible for 12 months, provided  the
30    child  maintains  his  or her residence in the State, has not
31    yet attained 19 years of age, and is not excluded pursuant to
32    subsection (c).  Eligibility shall be  re-determined  by  the
33    Department at least annually.
34        (c)  A  child  shall  not  be eligible for coverage under
 
                            -22-           LRB9200767DJmgam04
 1    this Program if:
 2             (1)  the premium required pursuant to Section 30  of
 3        this Act has not been paid.  If the required premiums are
 4        not paid the liability of the Program shall be limited to
 5        benefits  incurred  under the Program for the time period
 6        for which  premiums  had  been  paid.   If  the  required
 7        monthly   premium   is  not  paid,  the  child  shall  be
 8        ineligible for re-enrollment for a minimum  period  of  3
 9        months.   Re-enrollment  shall  be completed prior to the
10        next covered medical visit and the first month's required
11        premium shall be paid in  advance  of  the  next  covered
12        medical  visit.   The  Department  shall promulgate rules
13        regarding grace periods, notice requirements, and hearing
14        procedures pursuant to this subsection;
15             (2)  the child is an inmate of a public  institution
16        or a patient in an institution for mental diseases; or
17             (3)  the  child  is  a  member  of  a family that is
18        eligible for health benefits covered under the  State  of
19        Illinois  health benefits plan on the basis of a member's
20        employment with a public agency.
21    (Source: P.A. 90-736, eff. 8-12-98.)".

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