093_SB0783ham001

 










                                     LRB093 03237 SAS 19617 a

 1                    AMENDMENT TO SENATE BILL 783

 2        AMENDMENT NO.     .  Amend Senate Bill 783  by  replacing
 3    everything after the enacting clause with the following:

 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
 
                            -2-      LRB093 03237 SAS 19617 a
 1    coverage   pursuant  to  any  continuation  provisions  under
 2    federal or State  law,  including  the  Consolidated  Omnibus
 3    Budget  Reconciliation  Act  of  1985  (COBRA),  as  amended,
 4    Sections  367.2,  367e,  and 367e.1 of the Illinois Insurance
 5    Code, or any other similar requirement in another State.
 6        "Covered person" means a person who is and  continues  to
 7    remain eligible for Plan coverage and is covered under one of
 8    the benefit plans offered by the Plan.
 9        "Creditable  coverage" means, with respect to a federally
10    eligible individual, coverage of the individual under any  of
11    the following:
12             (A)  A group health plan.
13             (B)  Health   insurance  coverage  (including  group
14        health insurance coverage).
15             (C)  Medicare.
16             (D)  Medical assistance.
17             (E)  Chapter 55 of title 10, United States Code.
18             (F)  A medical care program  of  the  Indian  Health
19        Service or of a tribal organization.
20             (G)  A state health benefits risk pool.
21             (H)  A health plan offered under Chapter 89 of title
22        5, United States Code.
23             (I)  A public health plan (as defined in regulations
24        consistent   with   Section   104   of  the  Health  Care
25        Portability and Accountability Act of 1996  that  may  be
26        promulgated  by  the  Secretary of the U.S. Department of
27        Health and Human Services).
28             (J)  A health benefit plan under Section 5(e) of the
29        Peace Corps Act (22 U.S.C. 2504(e)).
30             (K)  Any other qualifying coverage required  by  the
31        federal  Health  Insurance Portability and Accountability
32        Act of 1996, as it may be amended, or  regulations  under
33        that Act.
34        "Creditable   coverage"   does   not   include   coverage
 
                            -3-      LRB093 03237 SAS 19617 a
 1    consisting  solely  of  coverage  of  excepted  benefits,  as
 2    defined  in  Section  2791(c)  of  title  XXVII of the Public
 3    Health Service Act (42 U.S.C. 300 gg-91), nor does it include
 4    any period of coverage under any of  items  (A)  through  (K)
 5    that  occurred  before  a  break  of more than 90 days or, if
 6    after September 30, 2003,  the  individual  has  either  been
 7    certified  as  eligible  pursuant to the federal Trade Act of
 8    2002 or initially been paid a benefit by the Pension  Benefit
 9    Guaranty Corporation, a break of more than 63 days during all
10    of  which  the  individual was not covered under any of items
11    (A) through (K) above.
12        For an  individual  who  between  December  1,  2002  and
13    September  30, 2003 has either (1) been certified as eligible
14    pursuant to the federal Trade Act of 2002, (2) initially been
15    paid a benefit by the Pension Benefit  Guaranty  Corporation,
16    or  (3)  as of December 1, 2002, been receiving benefits from
17    the  Pension  Benefit  Guaranty  Corporation  and   who   has
18    qualified  health  insurance, as defined by the federal Trade
19    Act of 2002, "creditable coverage"  includes  any  period  of
20    coverage  aggregating 3 or more months under any of items (A)
21    through (K), irrespective of the length of a break during all
22    of which the individual was not covered under  any  of  items
23    (A) through (K).
24        Any  period that an individual is in a waiting period for
25    any coverage under a group health plan (or for  group  health
26    insurance  coverage) or is in an affiliation period under the
27    terms of  health  insurance  coverage  offered  by  a  health
28    maintenance  organization  shall not be taken into account in
29    determining if there has been a break of more than 90 days in
30    any creditable coverage.
31        "Department" means the Illinois Department of Insurance.
32        "Dependent" means an Illinois resident: who is a  spouse;
33    or who is claimed as a dependent by the principal insured for
34    purposes of filing a federal income tax return and resides in
 
                            -4-      LRB093 03237 SAS 19617 a
 1    the   principal   insured's  household,  and  is  a  resident
 2    unmarried child under the age of  19  years;  or  who  is  an
 3    unmarried child who also is a full-time student under the age
 4    of  23  years  and  who  is  financially  dependent  upon the
 5    principal insured; or who is a child of any age  and  who  is
 6    disabled   and   financially  dependent  upon  the  principal
 7    insured.
 8        "Direct Illinois premiums" means, for Illinois  business,
 9    an  insurer's direct premium income for the kinds of business
10    described in clause (b) of Class 1 or clause (a) of  Class  2
11    of  Section  4  of  the  Illinois  Insurance Code, and direct
12    premium income of a  health  maintenance  organization  or  a
13    voluntary  health  services plan, except it shall not include
14    credit health insurance as defined in Article IX 1/2  of  the
15    Illinois Insurance Code.
16        "Director"  means the Director of the Illinois Department
17    of Insurance.
18        "Eligible person" means a  resident  of  this  State  who
19    qualifies for Plan coverage under Section 7 of this Act.
20        "Employee" means a resident of this State who is employed
21    by an employer or has entered into the employment of or works
22    under  contract  or  service  of  an  employer  including the
23    officers, managers and employees of subsidiary or  affiliated
24    corporations  and  the  individual  proprietors, partners and
25    employees  of  affiliated  individuals  and  firms  when  the
26    business of the subsidiary or affiliated corporations,  firms
27    or  individuals  is  controlled  by a common employer through
28    stock ownership, contract, or otherwise.
29        "Employer"    means    any    individual,    partnership,
30    association, corporation, business trust, or  any  person  or
31    group  of  persons  acting  directly  or  indirectly  in  the
32    interest of an employer in relation to an employee, for which
33    one or more persons is gainfully employed.
34        "Family" coverage means the coverage provided by the Plan
 
                            -5-      LRB093 03237 SAS 19617 a
 1    for the covered person and his or her eligible dependents who
 2    also are covered persons.
 3        "Federally   eligible  individual"  means  an  individual
 4    resident of this State:
 5             (1)(A)  for whom,  as  of  the  date  on  which  the
 6        individual  seeks  Plan coverage under Section 15 of this
 7        Act, the aggregate of the periods of creditable  coverage
 8        is 18 or more months or, if the individual has either (i)
 9        been  certified as eligible pursuant to the federal Trade
10        Act of 2002, (ii) initially been paid a  benefit  by  the
11        Pension  Benefit  Guaranty  Corporation,  or  (iii) as of
12        December  1,  2002,  been  receiving  benefits  from  the
13        Pension Benefit Guaranty Corporation  and  has  qualified
14        health  insurance, as defined by the federal Trade Act of
15        2002, 3 or more months, and (B) whose most  recent  prior
16        creditable  coverage  was  under  group  health insurance
17        coverage offered by a health insurance  issuer,  a  group
18        health  plan,  a  governmental plan, or a church plan (or
19        health insurance coverage offered in connection with  any
20        such plans) or any other type of creditable coverage that
21        may   be   required   by  the  federal  Health  Insurance
22        Portability and Accountability Act of 1996, as it may  be
23        amended, or the regulations under that Act;
24             (2)  who  is  not  eligible for coverage under (A) a
25        group health plan (other than an individual who has  been
26        certified  as  eligible pursuant to the federal Trade Act
27        of 2002), (B) part A or part B of  Medicare  due  to  age
28        (other  than  an  individual  who  has  been certified as
29        eligible pursuant to the federal Trade Act of  2002),  or
30        (C)  medical  assistance,  and does not have other health
31        insurance coverage (other than an individual who has been
32        certified as eligible pursuant to the Federal  Trade  Act
33        of 2002);
34             (3)  with  respect to whom (other than an individual
 
                            -6-      LRB093 03237 SAS 19617 a
 1        who has  been  certified  as  eligible  pursuant  to  the
 2        federal  Trade  Act  of  2002)  the  most recent coverage
 3        within the coverage period described in paragraph  (1)(A)
 4        of this definition was not terminated based upon a factor
 5        relating to nonpayment of premiums or fraud;
 6             (4)  if the individual (other than an individual who
 7        has either (A) been certified as eligible pursuant to the
 8        federal  Trade  Act  of  2002,  (B) initially been paid a
 9        benefit by the Pension Benefit Guaranty  Corporation,  or
10        (C)  as of December 1, 2002, been receiving benefits from
11        the Pension Benefit  Guaranty  Corporation  and  who  has
12        qualified  health  insurance,  as  defined by the federal
13        Trade Act  of  2002)  had  been  offered  the  option  of
14        continuation   coverage   under   a   COBRA  continuation
15        provision or under a similar State program,  who  elected
16        such coverage; and
17             (5)  who,    if    the   individual   elected   such
18        continuation coverage, has  exhausted  such  continuation
19        coverage under such provision or program.
20        However,  an  individual who has either been certified as
21    eligible pursuant  to  the  federal  Trade  Act  of  2002  or
22    initially been paid a benefit by the Pension Benefit Guaranty
23    Corporation  shall  not  be  required  to  elect continuation
24    coverage under a COBRA  continuation  provision  or  under  a
25    similar state program.
26        "Group  health  insurance  coverage" means, in connection
27    with a group health plan, health insurance  coverage  offered
28    in connection with that plan.
29        "Group  health plan" has the same meaning given that term
30    in   the   federal   Health   Insurance    Portability    and
31    Accountability Act of 1996.
32        "Governmental  plan" has the same meaning given that term
33    in   the   federal   Health   Insurance    Portability    and
34    Accountability Act of 1996.
 
                            -7-      LRB093 03237 SAS 19617 a
 1        "Health  insurance coverage" means benefits consisting of
 2    medical  care  (provided  directly,  through   insurance   or
 3    reimbursement,  or otherwise and including items and services
 4    paid for as medical care)  under  any  hospital  and  medical
 5    expense-incurred policy, certificate, or contract provided by
 6    an  insurer,  non-profit  health  care service plan contract,
 7    health maintenance organization or other subscriber contract,
 8    or any other health care plan or arrangement that pays for or
 9    furnishes  medical  or  health  care  services   whether   by
10    insurance  or otherwise.  Health insurance coverage shall not
11    include  short  term,  accident  only,   disability   income,
12    hospital  confinement or fixed indemnity, dental only, vision
13    only, limited benefit, or credit insurance,  coverage  issued
14    as a supplement to liability insurance, insurance arising out
15    of   a  workers'  compensation  or  similar  law,  automobile
16    medical-payment insurance, or insurance under which  benefits
17    are  payable  with  or  without  regard to fault and which is
18    statutorily  required  to  be  contained  in  any   liability
19    insurance policy or equivalent self-insurance.
20        "Health  insurance  issuer"  means  an insurance company,
21    insurance service, or  insurance  organization  (including  a
22    health   maintenance  organization  and  a  voluntary  health
23    services  plan)  that  is  authorized  to   transact   health
24    insurance business in this State.  Such term does not include
25    a group health plan.
26        "Health  Maintenance  Organization" means an organization
27    as defined in the Health Maintenance Organization Act.
28        "Hospice" means a program  as  defined  in  and  licensed
29    under the Hospice Program Licensing Act.
30        "Hospital"  means  a duly licensed institution as defined
31    in the Hospital Licensing Act, an institution that meets  all
32    comparable conditions and requirements in effect in the state
33    in  which  it  is  located,  or  the  University  of Illinois
34    Hospital as defined in the University  of  Illinois  Hospital
 
                            -8-      LRB093 03237 SAS 19617 a
 1    Act.
 2        "Individual   health  insurance  coverage"  means  health
 3    insurance coverage offered to individuals in  the  individual
 4    market,  but  does  not  include short-term, limited-duration
 5    insurance.
 6        "Insured" means any individual resident of this State who
 7    is eligible to receive benefits from any  insurer  (including
 8    health  insurance coverage offered in connection with a group
 9    health plan) or health insurance issuer as  defined  in  this
10    Section.
11        "Insurer"  means  any  insurance  company  authorized  to
12    transact  health  insurance  business  in  this State and any
13    corporation that provides medical services and  is  organized
14    under  the  Voluntary Health Services Plans Act or the Health
15    Maintenance Organization Act.
16        "Medical assistance" means the State  medical  assistance
17    or medical assistance no grant (MANG) programs provided under
18    Title  XIX of the Social Security Act and Articles V (Medical
19    Assistance) and  VI  (General  Assistance)  of  the  Illinois
20    Public  Aid  Code  (or  any  successor  program) or under any
21    similar program of health care benefits in a state other than
22    Illinois.
23        "Medically necessary" means  that  a  service,  drug,  or
24    supply  is  necessary  and  appropriate  for the diagnosis or
25    treatment of an illness or injury in  accord  with  generally
26    accepted  standards  of  medical  practice  at  the  time the
27    service, drug,  or  supply  is  provided.  When  specifically
28    applied  to a confinement it further means that the diagnosis
29    or treatment of the  covered  person's  medical  symptoms  or
30    condition  cannot  be  safely  provided  to that person as an
31    outpatient. A service, drug, or supply shall not be medically
32    necessary if it: (i) is investigational, experimental, or for
33    research  purposes;  or  (ii)  is  provided  solely  for  the
34    convenience of the patient, the patient's family,  physician,
 
                            -9-      LRB093 03237 SAS 19617 a
 1    hospital,  or  any other provider; or (iii) exceeds in scope,
 2    duration, or intensity that level of care that is  needed  to
 3    provide   safe,   adequate,   and  appropriate  diagnosis  or
 4    treatment; or (iv) could have been omitted without  adversely
 5    affecting  the  covered  person's condition or the quality of
 6    medical care; or (v) involves the use of  a  medical  device,
 7    drug, or substance not formally approved by the United States
 8    Food and Drug Administration.
 9        "Medical  care" means the ordinary and usual professional
10    services rendered by a physician or other specified  provider
11    during  a  professional  visit for treatment of an illness or
12    injury.
13        "Medicare" means coverage under both Part A and Part B of
14    Title XVIII of the Social Security Act, 42 U.S.C. Sec.  1395,
15    et seq.
16        "Minimum  premium  plan"  means  an arrangement whereby a
17    specified amount of health care claims  is  self-funded,  but
18    the  insurance  company  assumes  the  risk  that claims will
19    exceed that amount.
20        "Participating  transplant  center"  means   a   hospital
21    designated  by the Board as a preferred or exclusive provider
22    of services for one or more specified human organ  or  tissue
23    transplants  for  which  the hospital has signed an agreement
24    with the Board to accept a transplant payment  allowance  for
25    all  expenses  related  to the transplant during a transplant
26    benefit period.
27        "Physician" means a person licensed to practice  medicine
28    pursuant to the Medical Practice Act of 1987.
29        "Plan"  means  the  Comprehensive  Health  Insurance Plan
30    established by this Act.
31        "Plan of operation" means the plan of  operation  of  the
32    Plan, including articles, bylaws and operating rules, adopted
33    by the board pursuant to this Act.
34        "Provider"  means any hospital, skilled nursing facility,
 
                            -10-     LRB093 03237 SAS 19617 a
 1    hospice, home health agency, physician, registered pharmacist
 2    acting within the scope of that registration,  or  any  other
 3    person  or  entity  licensed  in  Illinois to furnish medical
 4    care.
 5        "Qualified high risk pool" has  the  same  meaning  given
 6    that  term  in  the  federal Health Insurance Portability and
 7    Accountability Act of 1996.
 8        "Resident" means a person who  is  and  continues  to  be
 9    legally  domiciled and physically residing on a permanent and
10    full-time basis in a place of permanent  habitation  in  this
11    State that remains that person's principal residence and from
12    which  that person is absent only for temporary or transitory
13    purpose.
14        "Skilled nursing  facility"  means  a  facility  or  that
15    portion  of  a  facility  that  is  licensed  by the Illinois
16    Department of Public Health under the Nursing Home  Care  Act
17    or  a  comparable  licensing  authority  in  another state to
18    provide skilled nursing care.
19        "Stop-loss coverage"  means  an  arrangement  whereby  an
20    insurer  insures  against  the  risk  that any one claim will
21    exceed a specific dollar amount or that the entire loss of  a
22    self-insurance plan will exceed a specific amount.
23        "Third  party  administrator"  means  an administrator as
24    defined in Section 511.101 of the Illinois Insurance Code who
25    is licensed under Article XXXI 1/4 of that Code.
26    (Source: P.A. 92-153,  eff.  7-25-01;  93-33,  eff.  6-23-03;
27    93-34, eff. 6-23-03; 93-477, eff. 8-8-03; revised 8-21-03.)

28        (215 ILCS 105/3) (from Ch. 73, par. 1303)
29        Sec. 3.  Operation of the Plan.
30        a.  There  is  hereby  created  an Illinois Comprehensive
31    Health Insurance Plan.
32        b.  The Plan shall operate subject to the supervision and
33    control of the board.  The board is created  as  a  political
 
                            -11-     LRB093 03237 SAS 19617 a
 1    subdivision  and  body politic and corporate and, as such, is
 2    not a State agency.  The board shall  consist  of  10  public
 3    members,  appointed  by  the  Governor  with  the  advice and
 4    consent of the Senate.
 5        Initial members shall be appointed to the  Board  by  the
 6    Governor  as  follows: 2 members to serve until July 1, 1988,
 7    and until their successors are  appointed  and  qualified;  2
 8    members  to  serve  until  July  1,  1989,  and  until  their
 9    successors  are  appointed  and qualified; 3 members to serve
10    until July 1, 1990, and until their successors are  appointed
11    and qualified; and 3 members to serve until July 1, 1991, and
12    until  their successors are appointed and qualified. As terms
13    of  initial  members  expire,  their  successors   shall   be
14    appointed  for  terms to expire the first day in July 3 years
15    thereafter, and until  their  successors  are  appointed  and
16    qualified.
17        Any  vacancy  in the Board occurring for any reason other
18    than the expiration  of  a  term  shall  be  filled  for  the
19    unexpired   term   in   the   same  manner  as  the  original
20    appointment.
21        Any member of the Board may be removed  by  the  Governor
22    for neglect of duty, misfeasance, malfeasance, or nonfeasance
23    in office.
24        In addition, a representative of the Governor's Office of
25    Management  and Budget Bureau of the Budget, a representative
26    of the Office of the Attorney General and the Director or the
27    Director's designated representative shall be members of  the
28    board.   Four  members  of  the  General  Assembly,  one each
29    appointed by the President and Minority Leader of the  Senate
30    and  by  the  Speaker  and  Minority  Leader  of the House of
31    Representatives, shall serve  as  nonvoting  members  of  the
32    board.  At least 2 of the public members shall be individuals
33    reasonably  expected  to qualify for coverage under the Plan,
34    the parent or spouse of such an individual,  or  a  surviving
 
                            -12-     LRB093 03237 SAS 19617 a
 1    family  member  of an individual who could have qualified for
 2    the plan during his  lifetime.  The  Director  or  Director's
 3    representative   shall  be  the  chairperson  of  the  board.
 4    Members of the board shall receive no compensation, but shall
 5    be  reimbursed  for  reasonable  expenses  incurred  in   the
 6    necessary performance of their duties.
 7        c.  The  board  shall  make an annual report in September
 8    and shall file the report with the Secretary  of  the  Senate
 9    and  the  Clerk  of the House of Representatives.  The report
10    shall summarize the activities of the Plan in  the  preceding
11    calendar year, including net written and earned premiums, the
12    expense  of  administration, the paid and incurred losses for
13    the year and other information as may  be  requested  by  the
14    General  Assembly. The report shall also include analysis and
15    recommendations   regarding   utilization   review,   quality
16    assurance and access to cost effective quality health care.
17        d.  In its plan of operation the board shall:
18             (1)  Establish  procedures  for  selecting  a   plan
19        administrator in accordance with Section 5 of this Act.
20             (2)  Establish  procedures  for the operation of the
21        board.
22             (3)  Create a Plan fund,  under  management  of  the
23        board,  to fund administrative, claim, and other expenses
24        of the Plan.
25             (4)  Establish  procedures  for  the  handling   and
26        accounting of assets and monies of the Plan.
27             (5)  Develop  and  implement  a program to publicize
28        the existence of the Plan, the  eligibility  requirements
29        and  procedures  for  enrollment  and  to maintain public
30        awareness of the Plan.
31             (6)  Establish procedures under which applicants and
32        participants may have grievances reviewed by a  grievance
33        committee  appointed  by the board.  The grievances shall
34        be reported to the board immediately after completion  of
 
                            -13-     LRB093 03237 SAS 19617 a
 1        the  review.   The  Department and the board shall retain
 2        all written complaints regarding the Plan for at least  3
 3        years.   Oral complaints shall be reduced to written form
 4        and maintained for at least 3 years.
 5             (7)  Provide for other matters as may  be  necessary
 6        and  proper  for  the execution of its powers, duties and
 7        obligations under the Plan.
 8        e.  No later than 5 years after the Plan is operative the
 9    board and the Department shall conduct cooperatively a  study
10    of the Plan and the persons insured by the Plan to determine:
11    (1)  claims  experience  including  a  breakdown  of  medical
12    conditions   for   which   claims   were  paid;  (2)  whether
13    availability of the Plan  affected  employment  opportunities
14    for  participants;  (3)  whether  availability  of  the  Plan
15    affected  the  receipt of medical assistance benefits by Plan
16    participants; (4) whether a change occurred in the number  of
17    personal  bankruptcies due to medical or other health related
18    costs; (5) data regarding all complaints received  about  the
19    Plan  including its operation and services; (6) and any other
20    significant observations regarding utilization of  the  Plan.
21    The study shall culminate in a written report to be presented
22    to  the Governor, the President of the Senate, the Speaker of
23    the House and  the  chairpersons  of  the  House  and  Senate
24    Insurance  Committees.   The  report  shall be filed with the
25    Secretary of the  Senate  and  the  Clerk  of  the  House  of
26    Representatives.   The  report  shall  also  be  available to
27    members of the general public upon request.
28        f.  The board may:
29             (1)  Prepare   and   distribute    certificate    of
30        eligibility  forms  and  enrollment  instruction forms to
31        insurance producers and to the  general  public  in  this
32        State.
33             (2)  Provide  for  reinsurance  of risks incurred by
34        the Plan  and  enter  into  reinsurance  agreements  with
 
                            -14-     LRB093 03237 SAS 19617 a
 1        insurers  to  establish  a  reinsurance plan for risks of
 2        coverage described in  the  Plan,  or  obtain  commercial
 3        reinsurance to reduce the risk of loss through the Plan.
 4             (3)  Issue  additional  types  of  health  insurance
 5        policies  to  provide optional coverages as are otherwise
 6        permitted by this Act  including  a  Medicare  supplement
 7        policy designed to supplement Medicare.
 8             (4)  Provide   for   and   employ  cost  containment
 9        measures and requirements including, but not limited  to,
10        preadmission   certification,  second  surgical  opinion,
11        concurrent utilization review  programs,  and  individual
12        case  management  for the purpose of making the pool more
13        cost effective.
14             (5)  Design, utilize, contract, or otherwise arrange
15        for the delivery of cost effective health care  services,
16        including  establishing  or  contracting  with  preferred
17        provider organizations, health maintenance organizations,
18        and other limited network provider arrangements.
19             (6)  Adopt  bylaws, rules, regulations, policies and
20        procedures as may be  necessary  or  convenient  for  the
21        implementation of the Act and the operation of the Plan.
22             (7)  Administer  separate  pools, separate accounts,
23        or other plans or arrangements as required by this Act to
24        separate federally  eligible  individuals  or  groups  of
25        federally  eligible  individuals  who  qualify  for  plan
26        coverage  under  Section  15  of  this  Act from eligible
27        persons or groups of eligible  persons  who  qualify  for
28        plan  coverage  under Section 7 of this Act and apportion
29        the costs  of  the  administration  among  such  separate
30        pools, separate accounts, or other plans or arrangements.
31        g.  The  Director  may,  by  rule,  establish  additional
32    powers  and  duties  of the board and may adopt rules for any
33    other purposes, including the operation of the Plan,  as  are
34    necessary or proper to implement this Act.
 
                            -15-     LRB093 03237 SAS 19617 a
 1        h.  The  board  is  not  liable for any obligation of the
 2    Plan.  There is no liability on the part  of  any  member  or
 3    employee  of  the  board  or  the Department, and no cause of
 4    action of any nature may arise against them, for  any  action
 5    taken  or  omission  made by them in the performance of their
 6    powers and duties  under  this  Act,  unless  the  action  or
 7    omission  constitutes willful or wanton misconduct. The board
 8    may provide in its bylaws or rules  for  indemnification  of,
 9    and legal representation for, its members and employees.
10        i.  There  is  no  liability on the part of any insurance
11    producer for the failure of any applicant to be  accepted  by
12    the  Plan  unless the failure of the applicant to be accepted
13    by the Plan is due to an act or  omission  by  the  insurance
14    producer which constitutes willful or wanton misconduct.
15    (Source: P.A. 92-597, eff. 6-28-02; revised 8-23-03.)

16        (215 ILCS 105/15)
17        Sec.  15.  Alternative  portable  coverage  for federally
18    eligible individuals.
19        (a)  Notwithstanding the requirements of subsection a. of
20    Section 7 and except as otherwise provided in  this  Section,
21    any   federally   eligible   individual   for   whom  a  Plan
22    application, and such enclosures and supporting documentation
23    as the Board may require, is received by the Board within  90
24    days after the termination of prior creditable coverage shall
25    qualify   to   enroll  in  the  Plan  under  the  portability
26    provisions of this Section.
27        A federally eligible person who between December 1,  2002
28    and  September  30,  2003  has  either  (1) been certified as
29    eligible pursuant to the  federal  Trade  Act  of  2002,  (2)
30    initially been paid a benefit by the Pension Benefit Guaranty
31    Corporation,  or  (3)  as of December 1, 2002, been receiving
32    benefits from the Pension Benefit Guaranty  Corporation,  who
33    has  qualified  health  insurance,  as defined by the federal
 
                            -16-     LRB093 03237 SAS 19617 a
 1    Trade Act of 2002, and whose Plan application and  enclosures
 2    and  supporting  documentation,  as the Board may require, is
 3    received by the  Board  after  the  termination  of  previous
 4    creditable coverage shall qualify to enroll in the Plan under
 5    the portability provisions of this Section.
 6        A  federally  eligible  person  who,  after September 30,
 7    2003, has either been certified as eligible pursuant  to  the
 8    federal Trade Act of 2002 or initially been paid a benefit by
 9    the  Pension  Benefit  Guaranty  Corporation  and  whose Plan
10    application and enclosures and  supporting  documentation  as
11    the Board may require is received by the Board within 63 days
12    after  the  termination of previous creditable coverage shall
13    qualify  to  enroll  in  the  Plan  under   the   portability
14    provisions of this Section.
15        (b)  Any   federally  eligible  individual  seeking  Plan
16    coverage under this Section  must  submit  with  his  or  her
17    application    evidence,    including    acceptable   written
18    certification of  previous  creditable  coverage,  that  will
19    establish  to  the Board's satisfaction, that he or she meets
20    all of the requirements to be a federally eligible individual
21    and is currently and permanently residing in this  State  (as
22    of  the  date  his  or  her  application  was received by the
23    Board).
24        (c)  Except as otherwise  provided  in  this  Section,  a
25    period  of  creditable  coverage  shall  not be counted, with
26    respect to qualifying an applicant for  Plan  coverage  as  a
27    federally  eligible  individual  under this Section, if after
28    such period and before the application for Plan coverage  was
29    received  by  the  Board,  there was at least a 90 day period
30    during all of which the individual was not covered under  any
31    creditable coverage.
32        For  a  federally eligible person who between December 1,
33    2002 and September 30, 2003 has either (1) been certified  as
34    eligible  pursuant  to  the  federal  Trade  Act of 2002, (2)
 
                            -17-     LRB093 03237 SAS 19617 a
 1    initially been paid a benefit by the Pension Benefit Guaranty
 2    Corporation, or (3) as of December 1,  2002,  been  receiving
 3    benefits  from  the  Pension Benefit Guaranty Corporation and
 4    who has qualified health insurance, as defined by the federal
 5    Trade Act of 2002, a period of creditable coverage  shall  be
 6    counted,  with  respect  to  qualifying an applicant for Plan
 7    coverage  as  a  federally  eligible  individual  under  this
 8    Section, when the application for Plan coverage was  received
 9    by the Board.
10        For  a federally eligible person who, after September 30,
11    2003, has either been certified as eligible pursuant  to  the
12    federal Trade Act of 2002 or initially been paid a benefit by
13    the   Pension  Benefit  Guaranty  Corporation,  a  period  of
14    creditable coverage shall not be  counted,  with  respect  to
15    qualifying  an  applicant  for  Plan  coverage as a federally
16    eligible individual under this Section, if after such  period
17    and  before the application for Plan coverage was received by
18    the Board, there was at least a 63 day period during  all  of
19    which  the  individual  was  not covered under any creditable
20    coverage.
21        (d)  Any federally  eligible  individual  who  the  Board
22    determines  qualifies  for  Plan  coverage under this Section
23    shall be offered his or her choice of  enrolling  in  one  of
24    alternative  portability health benefit plans which the Board
25    is authorized under  this  Section  to  establish  for  these
26    federally eligible individuals and their dependents.
27        (e)  The  Board  shall  offer  a  choice  of  health care
28    coverages consistent with major medical  coverage  under  the
29    alternative  health  benefit plans authorized by this Section
30    to every federally eligible individual. The coverages  to  be
31    offered   under   the   plans,   the  schedule  of  benefits,
32    deductibles, co-payments, exclusions, and  other  limitations
33    shall  be  approved  by  the  Board.   One  optional  form of
34    coverage  shall  be  comparable   to   comprehensive   health
 
                            -18-     LRB093 03237 SAS 19617 a
 1    insurance  coverage  offered in the individual market in this
 2    State or a standard option of coverage  available  under  the
 3    group  or individual health insurance laws of the State.  The
 4    standard benefit plan that is authorized by Section 8 of this
 5    Act may be used for this purpose.  The Board may also offer a
 6    preferred provider option and such other options as the Board
 7    determines may be appropriate for  these  federally  eligible
 8    individuals  who  qualify  for Plan coverage pursuant to this
 9    Section.
10        (f)  Notwithstanding the requirements of subsection f. of
11    Section 8, any plan coverage  that  is  issued  to  federally
12    eligible individuals who qualify for the Plan pursuant to the
13    portability  provisions  of this Section shall not be subject
14    to any preexisting conditions exclusion, waiting  period,  or
15    other similar limitation on coverage.
16        (g)  Federally   eligible  individuals  who  qualify  and
17    enroll in the Plan pursuant to this Section shall be required
18    to pay such premium rates as the Board  shall  establish  and
19    approve in accordance with the requirements of Section 7.1 of
20    this Act.
21        (h)  A  federally  eligible  individual who qualifies and
22    enrolls in the Plan pursuant to this Section must satisfy  on
23    an ongoing basis all of the other eligibility requirements of
24    this  Act  to  the  extent  not inconsistent with the federal
25    Health Insurance Portability and Accountability Act  of  1996
26    in order to maintain continued eligibility for coverage under
27    the Plan.
28    (Source:  P.A.  92-153,  eff.  7-25-01;  93-33, eff. 6-23-03;
29    93-34, eff. 6-23-03.)

30        Section 99.  Effective date.  This Act takes effect  upon
31    becoming law.".