093_SB0783enr

 
SB783 Enrolled                       LRB093 03237 JLS 03254 b

 1        AN ACT in relation to insurance.

 2        Be it  enacted  by  the  People  of  the  State  of  Illinois,
 3    represented in the General Assembly:

 4        Section  5.   The Comprehensive Health Insurance Plan Act
 5    is amended by changing Sections 2, 3, and 15 as follows:

 6        (215 ILCS 105/2) (from Ch. 73, par. 1302)
 7        Sec. 2.  Definitions.  As used in this  Act,  unless  the
 8    context otherwise requires:
 9        "Plan  administrator"  means  the  insurer or third party
10    administrator designated under Section 5 of this Act.
11        "Benefits plan" means the coverage to be offered  by  the
12    Plan  to  eligible persons and federally eligible individuals
13    pursuant to this Act.
14        "Board" means the Illinois Comprehensive Health Insurance
15    Board.
16        "Church plan" has the same meaning given that term in the
17    federal Health Insurance Portability and  Accountability  Act
18    of 1996.
19        "Continuation  coverage"  means  continuation of coverage
20    under a group health plan or other health insurance  coverage
21    for  former  employees or dependents of former employees that
22    would otherwise have  terminated  under  the  terms  of  that
23    coverage   pursuant  to  any  continuation  provisions  under
24    federal or State  law,  including  the  Consolidated  Omnibus
25    Budget  Reconciliation  Act  of  1985  (COBRA),  as  amended,
26    Sections  367.2,  367e,  and 367e.1 of the Illinois Insurance
27    Code, or any other similar requirement in another State.
28        "Covered person" means a person who is and  continues  to
29    remain eligible for Plan coverage and is covered under one of
30    the benefit plans offered by the Plan.
31        "Creditable  coverage" means, with respect to a federally
 
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 1    eligible individual, coverage of the individual under any  of
 2    the following:
 3             (A)  A group health plan.
 4             (B)  Health   insurance  coverage  (including  group
 5        health insurance coverage).
 6             (C)  Medicare.
 7             (D)  Medical assistance.
 8             (E)  Chapter 55 of title 10, United States Code.
 9             (F)  A medical care program  of  the  Indian  Health
10        Service or of a tribal organization.
11             (G)  A state health benefits risk pool.
12             (H)  A health plan offered under Chapter 89 of title
13        5, United States Code.
14             (I)  A public health plan (as defined in regulations
15        consistent   with   Section   104   of  the  Health  Care
16        Portability and Accountability Act of 1996  that  may  be
17        promulgated  by  the  Secretary of the U.S. Department of
18        Health and Human Services).
19             (J)  A health benefit plan under Section 5(e) of the
20        Peace Corps Act (22 U.S.C. 2504(e)).
21             (K)  Any other qualifying coverage required  by  the
22        federal  Health  Insurance Portability and Accountability
23        Act of 1996, as it may be amended, or  regulations  under
24        that Act.
25        "Creditable   coverage"   does   not   include   coverage
26    consisting  solely  of  coverage  of  excepted  benefits,  as
27    defined  in  Section  2791(c)  of  title  XXVII of the Public
28    Health Service Act (42 U.S.C. 300 gg-91), nor does it include
29    any period of coverage under any of  items  (A)  through  (K)
30    that  occurred  before  a  break  of more than 90 days or, if
31    after September 30, 2003,  the  individual  has  either  been
32    certified  as  eligible  pursuant to the federal Trade Act of
33    2002 or initially been paid a benefit by the Pension  Benefit
34    Guaranty Corporation, a break of more than 63 days during all
 
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 1    of  which  the  individual was not covered under any of items
 2    (A) through (K) above.
 3        For an  individual  who  between  December  1,  2002  and
 4    September  30, 2003 has either (1) been certified as eligible
 5    pursuant to the federal Trade Act of 2002, (2) initially been
 6    paid a benefit by the Pension Benefit  Guaranty  Corporation,
 7    or  (3)  as of December 1, 2002, been receiving benefits from
 8    the  Pension  Benefit  Guaranty  Corporation  and   who   has
 9    qualified  health  insurance, as defined by the federal Trade
10    Act of 2002, "creditable coverage"  includes  any  period  of
11    coverage  aggregating 3 or more months under any of items (A)
12    through (K), irrespective of the length of a break during all
13    of which the individual was not covered under  any  of  items
14    (A) through (K).
15        Any  period that an individual is in a waiting period for
16    any coverage under a group health plan (or for  group  health
17    insurance  coverage) or is in an affiliation period under the
18    terms of  health  insurance  coverage  offered  by  a  health
19    maintenance  organization  shall not be taken into account in
20    determining if there has been a break of more than 90 days in
21    any creditable coverage.
22        "Department" means the Illinois Department of Insurance.
23        "Dependent" means an Illinois resident: who is a  spouse;
24    or who is claimed as a dependent by the principal insured for
25    purposes of filing a federal income tax return and resides in
26    the   principal   insured's  household,  and  is  a  resident
27    unmarried child under the age of  19  years;  or  who  is  an
28    unmarried child who also is a full-time student under the age
29    of  23  years  and  who  is  financially  dependent  upon the
30    principal insured; or who is a child of any age  and  who  is
31    disabled   and   financially  dependent  upon  the  principal
32    insured.
33        "Direct Illinois premiums" means, for Illinois  business,
34    an  insurer's direct premium income for the kinds of business
 
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 1    described in clause (b) of Class 1 or clause (a) of  Class  2
 2    of  Section  4  of  the  Illinois  Insurance Code, and direct
 3    premium income of a  health  maintenance  organization  or  a
 4    voluntary  health  services plan, except it shall not include
 5    credit health insurance as defined in Article IX 1/2  of  the
 6    Illinois Insurance Code.
 7        "Director"  means the Director of the Illinois Department
 8    of Insurance.
 9        "Eligible person" means a  resident  of  this  State  who
10    qualifies for Plan coverage under Section 7 of this Act.
11        "Employee" means a resident of this State who is employed
12    by an employer or has entered into the employment of or works
13    under  contract  or  service  of  an  employer  including the
14    officers, managers and employees of subsidiary or  affiliated
15    corporations  and  the  individual  proprietors, partners and
16    employees  of  affiliated  individuals  and  firms  when  the
17    business of the subsidiary or affiliated corporations,  firms
18    or  individuals  is  controlled  by a common employer through
19    stock ownership, contract, or otherwise.
20        "Employer"    means    any    individual,    partnership,
21    association, corporation, business trust, or  any  person  or
22    group  of  persons  acting  directly  or  indirectly  in  the
23    interest of an employer in relation to an employee, for which
24    one or more persons is gainfully employed.
25        "Family" coverage means the coverage provided by the Plan
26    for the covered person and his or her eligible dependents who
27    also are covered persons.
28        "Federally   eligible  individual"  means  an  individual
29    resident of this State:
30             (1)(A)  for whom,  as  of  the  date  on  which  the
31        individual  seeks  Plan coverage under Section 15 of this
32        Act, the aggregate of the periods of creditable  coverage
33        is 18 or more months or, if the individual has either (i)
34        been  certified as eligible pursuant to the federal Trade
 
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 1        Act of 2002, (ii) initially been paid a  benefit  by  the
 2        Pension  Benefit  Guaranty  Corporation,  or  (iii) as of
 3        December  1,  2002,  been  receiving  benefits  from  the
 4        Pension Benefit Guaranty Corporation  and  has  qualified
 5        health  insurance, as defined by the federal Trade Act of
 6        2002, 3 or more months, and (B) whose most  recent  prior
 7        creditable  coverage  was  under  group  health insurance
 8        coverage offered by a health insurance  issuer,  a  group
 9        health  plan,  a  governmental plan, or a church plan (or
10        health insurance coverage offered in connection with  any
11        such plans) or any other type of creditable coverage that
12        may   be   required   by  the  federal  Health  Insurance
13        Portability and Accountability Act of 1996, as it may  be
14        amended, or the regulations under that Act;
15             (2)  who  is  not  eligible for coverage under (A) a
16        group health plan (other than an individual who has  been
17        certified  as  eligible pursuant to the federal Trade Act
18        of 2002), (B) part A or part B of  Medicare  due  to  age
19        (other  than  an  individual  who  has  been certified as
20        eligible pursuant to the federal Trade Act of  2002),  or
21        (C)  medical  assistance,  and does not have other health
22        insurance coverage (other than an individual who has been
23        certified as eligible pursuant to the federal  Trade  Act
24        of 2002);
25             (3)  with  respect to whom (other than an individual
26        who has  been  certified  as  eligible  pursuant  to  the
27        federal  Trade  Act  of  2002)  the  most recent coverage
28        within the coverage period described in paragraph  (1)(A)
29        of this definition was not terminated based upon a factor
30        relating to nonpayment of premiums or fraud;
31             (4)  if the individual (other than an individual who
32        has either (A) been certified as eligible pursuant to the
33        federal  Trade  Act  of  2002,  (B) initially been paid a
34        benefit by the Pension Benefit Guaranty  Corporation,  or
 
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 1        (C)  as of December 1, 2002, been receiving benefits from
 2        the Pension Benefit  Guaranty  Corporation  and  who  has
 3        qualified  health  insurance,  as  defined by the federal
 4        Trade Act  of  2002)  had  been  offered  the  option  of
 5        continuation   coverage   under   a   COBRA  continuation
 6        provision or under a similar State program,  who  elected
 7        such coverage; and
 8             (5)  who,    if    the   individual   elected   such
 9        continuation coverage, has  exhausted  such  continuation
10        coverage under such provision or program.
11        However,  an  individual who has either been certified as
12    eligible pursuant  to  the  federal  Trade  Act  of  2002  or
13    initially been paid a benefit by the Pension Benefit Guaranty
14    Corporation  shall  not  be  required  to  elect continuation
15    coverage under a COBRA  continuation  provision  or  under  a
16    similar state program.
17        "Group  health  insurance  coverage" means, in connection
18    with a group health plan, health insurance  coverage  offered
19    in connection with that plan.
20        "Group  health plan" has the same meaning given that term
21    in   the   federal   Health   Insurance    Portability    and
22    Accountability Act of 1996.
23        "Governmental  plan" has the same meaning given that term
24    in   the   federal   Health   Insurance    Portability    and
25    Accountability Act of 1996.
26        "Health  insurance coverage" means benefits consisting of
27    medical  care  (provided  directly,  through   insurance   or
28    reimbursement,  or otherwise and including items and services
29    paid for as medical care)  under  any  hospital  and  medical
30    expense-incurred policy, certificate, or contract provided by
31    an  insurer,  non-profit  health  care service plan contract,
32    health maintenance organization or other subscriber contract,
33    or any other health care plan or arrangement that pays for or
34    furnishes  medical  or  health  care  services   whether   by
 
SB783 Enrolled             -7-       LRB093 03237 JLS 03254 b
 1    insurance  or otherwise.  Health insurance coverage shall not
 2    include  short  term,  accident  only,   disability   income,
 3    hospital  confinement or fixed indemnity, dental only, vision
 4    only, limited benefit, or credit insurance,  coverage  issued
 5    as a supplement to liability insurance, insurance arising out
 6    of   a  workers'  compensation  or  similar  law,  automobile
 7    medical-payment insurance, or insurance under which  benefits
 8    are  payable  with  or  without  regard to fault and which is
 9    statutorily  required  to  be  contained  in  any   liability
10    insurance policy or equivalent self-insurance.
11        "Health  insurance  issuer"  means  an insurance company,
12    insurance service, or  insurance  organization  (including  a
13    health   maintenance  organization  and  a  voluntary  health
14    services  plan)  that  is  authorized  to   transact   health
15    insurance business in this State.  Such term does not include
16    a group health plan.
17        "Health  Maintenance  Organization" means an organization
18    as defined in the Health Maintenance Organization Act.
19        "Hospice" means a program  as  defined  in  and  licensed
20    under the Hospice Program Licensing Act.
21        "Hospital"  means  a duly licensed institution as defined
22    in the Hospital Licensing Act, an institution that meets  all
23    comparable conditions and requirements in effect in the state
24    in  which  it  is  located,  or  the  University  of Illinois
25    Hospital as defined in the University  of  Illinois  Hospital
26    Act.
27        "Individual   health  insurance  coverage"  means  health
28    insurance coverage offered to individuals in  the  individual
29    market,  but  does  not  include short-term, limited-duration
30    insurance.
31        "Insured" means any individual resident of this State who
32    is eligible to receive benefits from any  insurer  (including
33    health  insurance coverage offered in connection with a group
34    health plan) or health insurance issuer as  defined  in  this
 
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 1    Section.
 2        "Insurer"  means  any  insurance  company  authorized  to
 3    transact  health  insurance  business  in  this State and any
 4    corporation that provides medical services and  is  organized
 5    under  the  Voluntary Health Services Plans Act or the Health
 6    Maintenance Organization Act.
 7        "Medical assistance" means the State  medical  assistance
 8    or medical assistance no grant (MANG) programs provided under
 9    Title  XIX of the Social Security Act and Articles V (Medical
10    Assistance) and  VI  (General  Assistance)  of  the  Illinois
11    Public  Aid  Code  (or  any  successor  program) or under any
12    similar program of health care benefits in a state other than
13    Illinois.
14        "Medically necessary" means  that  a  service,  drug,  or
15    supply  is  necessary  and  appropriate  for the diagnosis or
16    treatment of an illness or injury in  accord  with  generally
17    accepted  standards  of  medical  practice  at  the  time the
18    service, drug,  or  supply  is  provided.  When  specifically
19    applied  to a confinement it further means that the diagnosis
20    or treatment of the  covered  person's  medical  symptoms  or
21    condition  cannot  be  safely  provided  to that person as an
22    outpatient. A service, drug, or supply shall not be medically
23    necessary if it: (i) is investigational, experimental, or for
24    research  purposes;  or  (ii)  is  provided  solely  for  the
25    convenience of the patient, the patient's family,  physician,
26    hospital,  or  any other provider; or (iii) exceeds in scope,
27    duration, or intensity that level of care that is  needed  to
28    provide   safe,   adequate,   and  appropriate  diagnosis  or
29    treatment; or (iv) could have been omitted without  adversely
30    affecting  the  covered  person's condition or the quality of
31    medical care; or (v) involves the use of  a  medical  device,
32    drug, or substance not formally approved by the United States
33    Food and Drug Administration.
34        "Medical  care" means the ordinary and usual professional
 
SB783 Enrolled             -9-       LRB093 03237 JLS 03254 b
 1    services rendered by a physician or other specified  provider
 2    during  a  professional  visit for treatment of an illness or
 3    injury.
 4        "Medicare" means coverage under both Part A and Part B of
 5    Title XVIII of the Social Security Act, 42 U.S.C. Sec.  1395,
 6    et seq.
 7        "Minimum  premium  plan"  means  an arrangement whereby a
 8    specified amount of health care claims  is  self-funded,  but
 9    the  insurance  company  assumes  the  risk  that claims will
10    exceed that amount.
11        "Participating  transplant  center"  means   a   hospital
12    designated  by the Board as a preferred or exclusive provider
13    of services for one or more specified human organ  or  tissue
14    transplants  for  which  the hospital has signed an agreement
15    with the Board to accept a transplant payment  allowance  for
16    all  expenses  related  to the transplant during a transplant
17    benefit period.
18        "Physician" means a person licensed to practice  medicine
19    pursuant to the Medical Practice Act of 1987.
20        "Plan"  means  the  Comprehensive  Health  Insurance Plan
21    established by this Act.
22        "Plan of operation" means the plan of  operation  of  the
23    Plan, including articles, bylaws and operating rules, adopted
24    by the board pursuant to this Act.
25        "Provider"  means any hospital, skilled nursing facility,
26    hospice, home health agency, physician, registered pharmacist
27    acting within the scope of that registration,  or  any  other
28    person  or  entity  licensed  in  Illinois to furnish medical
29    care.
30        "Qualified high risk pool" has  the  same  meaning  given
31    that  term  in  the  federal Health Insurance Portability and
32    Accountability Act of 1996.
33        "Resident" means a person who  is  and  continues  to  be
34    legally  domiciled and physically residing on a permanent and
 
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 1    full-time basis in a place of permanent  habitation  in  this
 2    State that remains that person's principal residence and from
 3    which  that person is absent only for temporary or transitory
 4    purpose.
 5        "Skilled nursing  facility"  means  a  facility  or  that
 6    portion  of  a  facility  that  is  licensed  by the Illinois
 7    Department of Public Health under the Nursing Home  Care  Act
 8    or  a  comparable  licensing  authority  in  another state to
 9    provide skilled nursing care.
10        "Stop-loss coverage"  means  an  arrangement  whereby  an
11    insurer  insures  against  the  risk  that any one claim will
12    exceed a specific dollar amount or that the entire loss of  a
13    self-insurance plan will exceed a specific amount.
14        "Third  party  administrator"  means  an administrator as
15    defined in Section 511.101 of the Illinois Insurance Code who
16    is licensed under Article XXXI 1/4 of that Code.
17    (Source: P.A. 92-153,  eff.  7-25-01;  93-33,  eff.  6-23-03;
18    93-34, eff. 6-23-03; 93-477, eff. 8-8-03; revised 8-21-03.)

19        (215 ILCS 105/3) (from Ch. 73, par. 1303)
20        Sec. 3.  Operation of the Plan.
21        a.  There  is  hereby  created  an Illinois Comprehensive
22    Health Insurance Plan.
23        b.  The Plan shall operate subject to the supervision and
24    control of the board.  The board is created  as  a  political
25    subdivision  and  body politic and corporate and, as such, is
26    not a State agency.  The board shall  consist  of  10  public
27    members,  appointed  by  the  Governor  with  the  advice and
28    consent of the Senate.
29        Initial members shall be appointed to the  Board  by  the
30    Governor  as  follows: 2 members to serve until July 1, 1988,
31    and until their successors are  appointed  and  qualified;  2
32    members  to  serve  until  July  1,  1989,  and  until  their
33    successors  are  appointed  and qualified; 3 members to serve
 
SB783 Enrolled             -11-      LRB093 03237 JLS 03254 b
 1    until July 1, 1990, and until their successors are  appointed
 2    and qualified; and 3 members to serve until July 1, 1991, and
 3    until  their successors are appointed and qualified. As terms
 4    of  initial  members  expire,  their  successors   shall   be
 5    appointed  for  terms to expire the first day in July 3 years
 6    thereafter, and until  their  successors  are  appointed  and
 7    qualified.
 8        Any  vacancy  in the Board occurring for any reason other
 9    than the expiration  of  a  term  shall  be  filled  for  the
10    unexpired   term   in   the   same  manner  as  the  original
11    appointment.
12        Any member of the Board may be removed  by  the  Governor
13    for neglect of duty, misfeasance, malfeasance, or nonfeasance
14    in office.
15        In addition, a representative of the Governor's Office of
16    Management  and Budget Bureau of the Budget, a representative
17    of the Office of the Attorney General and the Director or the
18    Director's designated representative shall be members of  the
19    board.   Four  members  of  the  General  Assembly,  one each
20    appointed by the President and Minority Leader of the  Senate
21    and  by  the  Speaker  and  Minority  Leader  of the House of
22    Representatives, shall serve  as  nonvoting  members  of  the
23    board.  At least 2 of the public members shall be individuals
24    reasonably  expected  to qualify for coverage under the Plan,
25    the parent or spouse of such an individual,  or  a  surviving
26    family  member  of an individual who could have qualified for
27    the plan during his  lifetime.  The  Director  or  Director's
28    representative   shall  be  the  chairperson  of  the  board.
29    Members of the board shall receive no compensation, but shall
30    be  reimbursed  for  reasonable  expenses  incurred  in   the
31    necessary performance of their duties.
32        c.  The  board  shall  make an annual report in September
33    and shall file the report with the Secretary  of  the  Senate
34    and  the  Clerk  of the House of Representatives.  The report
 
SB783 Enrolled             -12-      LRB093 03237 JLS 03254 b
 1    shall summarize the activities of the Plan in  the  preceding
 2    calendar year, including net written and earned premiums, the
 3    expense  of  administration, the paid and incurred losses for
 4    the year and other information as may  be  requested  by  the
 5    General  Assembly. The report shall also include analysis and
 6    recommendations   regarding   utilization   review,   quality
 7    assurance and access to cost effective quality health care.
 8        d.  In its plan of operation the board shall:
 9             (1)  Establish  procedures  for  selecting  a   plan
10        administrator in accordance with Section 5 of this Act.
11             (2)  Establish  procedures  for the operation of the
12        board.
13             (3)  Create a Plan fund,  under  management  of  the
14        board,  to fund administrative, claim, and other expenses
15        of the Plan.
16             (4)  Establish  procedures  for  the  handling   and
17        accounting of assets and monies of the Plan.
18             (5)  Develop  and  implement  a program to publicize
19        the existence of the Plan, the  eligibility  requirements
20        and  procedures  for  enrollment  and  to maintain public
21        awareness of the Plan.
22             (6)  Establish procedures under which applicants and
23        participants may have grievances reviewed by a  grievance
24        committee  appointed  by the board.  The grievances shall
25        be reported to the board immediately after completion  of
26        the  review.   The  Department and the board shall retain
27        all written complaints regarding the Plan for at least  3
28        years.   Oral complaints shall be reduced to written form
29        and maintained for at least 3 years.
30             (7)  Provide for other matters as may  be  necessary
31        and  proper  for  the execution of its powers, duties and
32        obligations under the Plan.
33        e.  No later than 5 years after the Plan is operative the
34    board and the Department shall conduct cooperatively a  study
 
SB783 Enrolled             -13-      LRB093 03237 JLS 03254 b
 1    of the Plan and the persons insured by the Plan to determine:
 2    (1)  claims  experience  including  a  breakdown  of  medical
 3    conditions   for   which   claims   were  paid;  (2)  whether
 4    availability of the Plan  affected  employment  opportunities
 5    for  participants;  (3)  whether  availability  of  the  Plan
 6    affected  the  receipt of medical assistance benefits by Plan
 7    participants; (4) whether a change occurred in the number  of
 8    personal  bankruptcies due to medical or other health related
 9    costs; (5) data regarding all complaints received  about  the
10    Plan  including its operation and services; (6) and any other
11    significant observations regarding utilization of  the  Plan.
12    The study shall culminate in a written report to be presented
13    to  the Governor, the President of the Senate, the Speaker of
14    the House and  the  chairpersons  of  the  House  and  Senate
15    Insurance  Committees.   The  report  shall be filed with the
16    Secretary of the  Senate  and  the  Clerk  of  the  House  of
17    Representatives.   The  report  shall  also  be  available to
18    members of the general public upon request.
19        f.  The board may:
20             (1)  Prepare   and   distribute    certificate    of
21        eligibility  forms  and  enrollment  instruction forms to
22        insurance producers and to the  general  public  in  this
23        State.
24             (2)  Provide  for  reinsurance  of risks incurred by
25        the Plan  and  enter  into  reinsurance  agreements  with
26        insurers  to  establish  a  reinsurance plan for risks of
27        coverage described in  the  Plan,  or  obtain  commercial
28        reinsurance to reduce the risk of loss through the Plan.
29             (3)  Issue  additional  types  of  health  insurance
30        policies  to  provide optional coverages as are otherwise
31        permitted by this Act  including  a  Medicare  supplement
32        policy designed to supplement Medicare.
33             (4)  Provide   for   and   employ  cost  containment
34        measures and requirements including, but not limited  to,
 
SB783 Enrolled             -14-      LRB093 03237 JLS 03254 b
 1        preadmission   certification,  second  surgical  opinion,
 2        concurrent utilization review  programs,  and  individual
 3        case  management  for the purpose of making the pool more
 4        cost effective.
 5             (5)  Design, utilize, contract, or otherwise arrange
 6        for the delivery of cost effective health care  services,
 7        including  establishing  or  contracting  with  preferred
 8        provider organizations, health maintenance organizations,
 9        and other limited network provider arrangements.
10             (6)  Adopt  bylaws, rules, regulations, policies and
11        procedures as may be  necessary  or  convenient  for  the
12        implementation of the Act and the operation of the Plan.
13             (7)  Administer  separate  pools, separate accounts,
14        or other plans or arrangements as required by this Act to
15        separate federally  eligible  individuals  or  groups  of
16        federally  eligible  individuals  who  qualify  for  plan
17        coverage  under  Section  15  of  this  Act from eligible
18        persons or groups of eligible  persons  who  qualify  for
19        plan  coverage  under Section 7 of this Act and apportion
20        the costs  of  the  administration  among  such  separate
21        pools, separate accounts, or other plans or arrangements.
22        g.  The  Director  may,  by  rule,  establish  additional
23    powers  and  duties  of the board and may adopt rules for any
24    other purposes, including the operation of the Plan,  as  are
25    necessary or proper to implement this Act.
26        h.  The  board  is  not  liable for any obligation of the
27    Plan.  There is no liability on the part  of  any  member  or
28    employee  of  the  board  or  the Department, and no cause of
29    action of any nature may arise against them, for  any  action
30    taken  or  omission  made by them in the performance of their
31    powers and duties  under  this  Act,  unless  the  action  or
32    omission  constitutes willful or wanton misconduct. The board
33    may provide in its bylaws or rules  for  indemnification  of,
34    and legal representation for, its members and employees.
 
SB783 Enrolled             -15-      LRB093 03237 JLS 03254 b
 1        i.  There  is  no  liability on the part of any insurance
 2    producer for the failure of any applicant to be  accepted  by
 3    the  Plan  unless the failure of the applicant to be accepted
 4    by the Plan is due to an act or  omission  by  the  insurance
 5    producer which constitutes willful or wanton misconduct.
 6    (Source: P.A. 92-597, eff. 6-28-02; revised 8-23-03.)

 7        (215 ILCS 105/15)
 8        Sec.  15.  Alternative  portable  coverage  for federally
 9    eligible individuals.
10        (a)  Notwithstanding the requirements of subsection a. of
11    Section 7 and except as otherwise provided in  this  Section,
12    any   federally   eligible   individual   for   whom  a  Plan
13    application, and such enclosures and supporting documentation
14    as the Board may require, is received by the Board within  90
15    days after the termination of prior creditable coverage shall
16    qualify   to   enroll  in  the  Plan  under  the  portability
17    provisions of this Section.
18        A federally eligible person who between December 1,  2002
19    and  September  30,  2003  has  either  (1) been certified as
20    eligible pursuant to the  federal  Trade  Act  of  2002,  (2)
21    initially been paid a benefit by the Pension Benefit Guaranty
22    Corporation,  or  (3)  as of December 1, 2002, been receiving
23    benefits from the Pension Benefit Guaranty  Corporation,  who
24    has  qualified  health  insurance,  as defined by the federal
25    Trade Act of 2002, and whose Plan application and  enclosures
26    and  supporting  documentation,  as the Board may require, is
27    received by the  Board  after  the  termination  of  previous
28    creditable coverage shall qualify to enroll in the Plan under
29    the portability provisions of this Section.
30        A  federally  eligible  person  who,  after September 30,
31    2003, has either been certified as eligible pursuant  to  the
32    federal Trade Act of 2002 or initially been paid a benefit by
33    the  Pension  Benefit  Guaranty  Corporation  and  whose Plan
 
SB783 Enrolled             -16-      LRB093 03237 JLS 03254 b
 1    application and enclosures and  supporting  documentation  as
 2    the Board may require is received by the Board within 63 days
 3    after  the  termination of previous creditable coverage shall
 4    qualify  to  enroll  in  the  Plan  under   the   portability
 5    provisions of this Section.
 6        (b)  Any   federally  eligible  individual  seeking  Plan
 7    coverage under this Section  must  submit  with  his  or  her
 8    application    evidence,    including    acceptable   written
 9    certification of  previous  creditable  coverage,  that  will
10    establish  to  the Board's satisfaction, that he or she meets
11    all of the requirements to be a federally eligible individual
12    and is currently and permanently residing in this  State  (as
13    of  the  date  his  or  her  application  was received by the
14    Board).
15        (c)  Except as otherwise  provided  in  this  Section,  a
16    period  of  creditable  coverage  shall  not be counted, with
17    respect to qualifying an applicant for  Plan  coverage  as  a
18    federally  eligible  individual  under this Section, if after
19    such period and before the application for Plan coverage  was
20    received  by  the  Board,  there was at least a 90 day period
21    during all of which the individual was not covered under  any
22    creditable coverage.
23        For  a  federally eligible person who between December 1,
24    2002 and September 30, 2003 has either (1) been certified  as
25    eligible  pursuant  to  the  federal  Trade  Act of 2002, (2)
26    initially been paid a benefit by the Pension Benefit Guaranty
27    Corporation, or (3) as of December 1,  2002,  been  receiving
28    benefits  from  the  Pension Benefit Guaranty Corporation and
29    who has qualified health insurance, as defined by the federal
30    Trade Act of 2002, a period of creditable coverage  shall  be
31    counted,  with  respect  to  qualifying an applicant for Plan
32    coverage  as  a  federally  eligible  individual  under  this
33    Section, when the application for Plan coverage was  received
34    by the Board.
 
SB783 Enrolled             -17-      LRB093 03237 JLS 03254 b
 1        For  a federally eligible person who, after September 30,
 2    2003, has either been certified as eligible pursuant  to  the
 3    federal Trade Act of 2002 or initially been paid a benefit by
 4    the   Pension  Benefit  Guaranty  Corporation,  a  period  of
 5    creditable coverage shall not be  counted,  with  respect  to
 6    qualifying  an  applicant  for  Plan  coverage as a federally
 7    eligible individual under this Section, if after such  period
 8    and  before the application for Plan coverage was received by
 9    the Board, there was at least a 63 day period during  all  of
10    which  the  individual  was  not covered under any creditable
11    coverage.
12        (d)  Any federally  eligible  individual  who  the  Board
13    determines  qualifies  for  Plan  coverage under this Section
14    shall be offered his or her choice of  enrolling  in  one  of
15    alternative  portability health benefit plans which the Board
16    is authorized under  this  Section  to  establish  for  these
17    federally eligible individuals and their dependents.
18        (e)  The  Board  shall  offer  a  choice  of  health care
19    coverages consistent with major medical  coverage  under  the
20    alternative  health  benefit plans authorized by this Section
21    to every federally eligible individual. The coverages  to  be
22    offered   under   the   plans,   the  schedule  of  benefits,
23    deductibles, co-payments, exclusions, and  other  limitations
24    shall  be  approved  by  the  Board.   One  optional  form of
25    coverage  shall  be  comparable   to   comprehensive   health
26    insurance  coverage  offered in the individual market in this
27    State or a standard option of coverage  available  under  the
28    group  or individual health insurance laws of the State.  The
29    standard benefit plan that is authorized by Section 8 of this
30    Act may be used for this purpose.  The Board may also offer a
31    preferred provider option and such other options as the Board
32    determines may be appropriate for  these  federally  eligible
33    individuals  who  qualify  for Plan coverage pursuant to this
34    Section.
 
SB783 Enrolled             -18-      LRB093 03237 JLS 03254 b
 1        (f)  Notwithstanding the requirements of subsection f. of
 2    Section 8, any plan coverage  that  is  issued  to  federally
 3    eligible individuals who qualify for the Plan pursuant to the
 4    portability  provisions  of this Section shall not be subject
 5    to any preexisting conditions exclusion, waiting  period,  or
 6    other similar limitation on coverage.
 7        (g)  Federally   eligible  individuals  who  qualify  and
 8    enroll in the Plan pursuant to this Section shall be required
 9    to pay such premium rates as the Board  shall  establish  and
10    approve in accordance with the requirements of Section 7.1 of
11    this Act.
12        (h)  A  federally  eligible  individual who qualifies and
13    enrolls in the Plan pursuant to this Section must satisfy  on
14    an ongoing basis all of the other eligibility requirements of
15    this  Act  to  the  extent  not inconsistent with the federal
16    Health Insurance Portability and Accountability Act  of  1996
17    in order to maintain continued eligibility for coverage under
18    the Plan.
19    (Source:  P.A.  92-153,  eff.  7-25-01;  93-33, eff. 6-23-03;
20    93-34, eff. 6-23-03.)

21        Section 99.  Effective date.  This Act takes effect  upon
22    becoming law.