96TH GENERAL ASSEMBLY
State of Illinois
2009 and 2010
SB3419

 

Introduced 2/10/2010, by Sen. Dan Kotowski

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 97/40

    Amends the Illinois Health Insurance Portability and Accountability Act. Includes large group markets in the provision concerning guaranteed availability of coverage for employers in the group market. Effective July 1, 2010.


LRB096 19501 RPM 34893 b

 

 

A BILL FOR

 

SB3419 LRB096 19501 RPM 34893 b

1     AN ACT concerning insurance.
 
2     Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
 
4     Section 5. The Illinois Health Insurance Portability and
5 Accountability Act is amended by changing Section 40 as
6 follows:
 
7     (215 ILCS 97/40)
8     Sec. 40. Guaranteed availability of coverage for employers
9 in the group market.
10     (A) Issuance of coverage in the small and large group
11 markets market.
12         (1) In general. Subject to subsections (C) through (F),
13     each health insurance issuer that offers health insurance
14     coverage in the small group market or the large group
15     market or both markets in the a State:
16             (a) must accept every small or large employer (as
17         defined in Section 5 10) in the State that applies for
18         such coverage; and
19             (b) must accept for enrollment under such coverage
20         every eligible individual (as defined in paragraph
21         (2)) who applies for enrollment during the period in
22         which the individual first becomes eligible to enroll
23         under the terms of the group health plan and may not

 

 

SB3419 - 2 - LRB096 19501 RPM 34893 b

1         place any restriction which is inconsistent with
2         Section 25 on an eligible individual being a
3         participant or beneficiary.
4         (2) Eligible individual defined. For purposes of this
5     Section, the term "eligible individual" means, with
6     respect to a health insurance issuer that offers health
7     insurance coverage to a small employer in connection with a
8     group health plan in the small group market or to a large
9     employer in connection with a group health plan in the
10     large group market, such an individual in relation to the
11     employer as shall be determined:
12             (a) in accordance with the terms of such plan;
13             (b) as provided by the issuer under rules of the
14         issuer which are uniformly applicable in the a State to
15         all small employers in such the small group market or
16         markets; and
17             (c) in accordance with all applicable State laws
18         governing such issuer and such market or markets.
19     (B) Special rules for network plans.
20         (1) In general. In the case of a health insurance
21     issuer that offers health insurance coverage in the small
22     group market or the large group market or both markets
23     through a network plan, the issuer may:
24             (a) limit the employers that may apply for such
25         coverage to those with eligible individuals who live,
26         work, or reside in the service area for such network

 

 

SB3419 - 3 - LRB096 19501 RPM 34893 b

1         plan; and
2             (b) within the service area of such plan, deny such
3         coverage to such employers if the issuer has
4         demonstrated, if required, to the Department that:
5                 (i) it will not have the capacity to deliver
6             services adequately to enrollees of any additional
7             groups in such market or markets because of its
8             obligations to existing group contract holders and
9             enrollees; and
10                 (ii) it is applying this paragraph uniformly
11             to all employers in such market or markets without
12             regard to the claims experience of those employers
13             and their employees (and their dependents) or any
14             health status-related factor relating to such
15             employees and dependents.
16         (2) 180-day suspension upon denial of coverage. An
17     issuer, upon denying health insurance coverage in any
18     service area in accordance with paragraph (1)(b), may not
19     offer coverage in such the small group market or markets
20     within such service area for a period of 180 days after the
21     date such coverage is denied.
22     (C) Application of financial capacity limits.
23         (1) In general. A health insurance issuer may deny
24     health insurance coverage in the small group market if the
25     issuer has demonstrated, if required, to the Department:
26             (a) it does not have the financial capacity

 

 

SB3419 - 4 - LRB096 19501 RPM 34893 b

1         necessary to underwrite additional coverage in such
2         market or markets; and
3             (b) it is applying this paragraph uniformly to all
4         employers in such the small group market or markets in
5         the State and without regard to the claims experience
6         of those employers and their employees (and their
7         dependents) or any health status-related factor
8         relating to such employees and dependents.
9         (2) 180-day suspension upon denial of coverage. A
10     health insurance issuer upon denying health insurance
11     coverage in connection with group health plans in
12     accordance with paragraph (1) may not offer coverage in
13     connection with group health plans in such the small group
14     market or markets for a period of 180 days after the date
15     such coverage is denied or until the issuer has
16     demonstrated to the Department that the issuer has
17     sufficient financial capacity to underwrite additional
18     coverage in such market or markets, whichever is later. The
19     Department may provide for the application of this
20     subsection on a service-area-specific basis.
21     (D) Exception to requirement for failure to meet certain
22 minimum participation or contribution rules.
23         (1) In general. Subsection (A) shall not be construed
24     to preclude a health insurance issuer from establishing
25     employer contribution rules or group participation rules
26     for the offering of health insurance coverage in connection

 

 

SB3419 - 5 - LRB096 19501 RPM 34893 b

1     with a group health plan in the small or large group
2     market.
3         (2) Rules defined. For purposes of paragraph (1):
4             (a) the term "employer contribution rule" means a
5         requirement relating to the minimum level or amount of
6         employer contribution toward the premium for
7         enrollment of participants and beneficiaries; and
8             (b) the term "group participation rule" means a
9         requirement relating to the minimum number of
10         participants or beneficiaries that must be enrolled in
11         relation to a specified percentage or number of
12         eligible individuals or employees of an employer.
13     (E) Exception for coverage offered only to bona fide
14 association members. Subsection (A) shall not apply to health
15 insurance coverage offered by a health insurance issuer if such
16 coverage is made available in the small or large group market
17 only through one or more bona fide associations (as defined in
18 Section 5 10).
19 (Source: P.A. 90-30, eff. 7-1-97.)
 
20     Section 99. Effective date. This Act takes effect July 1,
21 2010.