Public Act 93-0033

HB3298 Enrolled                      LRB093 11158 JLS 12059 b

    AN ACT  concerning  the  Comprehensive  Health  Insurance
Plan.

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

    Section 5.  The Comprehensive Health Insurance  Plan  Act
is amended by changing Sections 2, 4, 7, and 15 as follows:

    (215 ILCS 105/2) (from Ch. 73, par. 1302)
    Sec.  2.  Definitions.   As  used in this Act, unless the
context otherwise requires:
    "Plan administrator" means the  insurer  or  third  party
administrator designated under Section 5 of this Act.
    "Benefits  plan"  means the coverage to be offered by the
Plan to eligible persons and federally  eligible  individuals
pursuant to this Act.
    "Board" means the Illinois Comprehensive Health Insurance
Board.
    "Church plan" has the same meaning given that term in the
federal  Health  Insurance Portability and Accountability Act
of 1996.
    "Continuation coverage" means  continuation  of  coverage
under  a group health plan or other health insurance coverage
for former employees or dependents of former  employees  that
would  otherwise  have  terminated  under  the  terms of that
coverage  pursuant  to  any  continuation  provisions   under
federal  or  State  law,  including  the Consolidated Omnibus
Budget  Reconciliation  Act  of  1985  (COBRA),  as  amended,
Sections 367.2 and 367e of the Illinois  Insurance  Code,  or
any other similar requirement in another State.
    "Covered  person"  means a person who is and continues to
remain eligible for Plan coverage and is covered under one of
the benefit plans offered by the Plan.
    "Creditable coverage" means, with respect to a  federally
eligible  individual, coverage of the individual under any of
the following:
         (A)  A group health plan.
         (B)  Health  insurance  coverage  (including   group
    health insurance coverage).
         (C)  Medicare.
         (D)  Medical assistance.
         (E)  Chapter 55 of title 10, United States Code.
         (F)  A  medical  care  program  of the Indian Health
    Service or of a tribal organization.
         (G)  A state health benefits risk pool.
         (H)  A health plan offered under Chapter 89 of title
    5, United States Code.
         (I)  A public health plan (as defined in regulations
    consistent  with  Section  104   of   the   Health   Care
    Portability  and  Accountability  Act of 1996 that may be
    promulgated by the Secretary of the  U.S.  Department  of
    Health and Human Services).
         (J)  A health benefit plan under Section 5(e) of the
    Peace Corps Act (22 U.S.C. 2504(e)).
         (K)  Any  other  qualifying coverage required by the
    federal Health Insurance Portability  and  Accountability
    Act  of  1996, as it may be amended, or regulations under
    that Act.
    "Creditable   coverage"   does   not   include   coverage
consisting  solely  of  coverage  of  excepted  benefits,  as
defined in Section 2791(c)  of  title  XXVII  of  the  Public
Health Service Act (42 U.S.C. 300 gg-91), nor does it include
any  period  of  coverage  under any of items (A) through (K)
that occurred before a break of more than 90 days or, if  the
individual  has been certified as an eligible person pursuant
to the federal Trade Adjustment Act of 2002, a break of  more
than  63  days  during  all  of  which the individual was not
covered under any of items (A) through (K) above.  Any period
that an individual is in a waiting period  for  any  coverage
under  a  group  health  plan  (or for group health insurance
coverage) or is in an affiliation period under the  terms  of
health  insurance  coverage  offered  by a health maintenance
organization shall not be taken into account  in  determining
if  there  has  been  a  break  of  more  than 90 days in any
creditable coverage.
    "Department" means the Illinois Department of Insurance.
    "Dependent" means an Illinois resident: who is a  spouse;
or who is claimed as a dependent by the principal insured for
purposes of filing a federal income tax return and resides in
the   principal   insured's  household,  and  is  a  resident
unmarried child under the age of  19  years;  or  who  is  an
unmarried child who also is a full-time student under the age
of  23  years  and  who  is  financially  dependent  upon the
principal insured; or who is a child of any age  and  who  is
disabled   and   financially  dependent  upon  the  principal
insured.
    "Direct Illinois premiums" means, for Illinois  business,
an  insurer's direct premium income for the kinds of business
described in clause (b) of Class 1 or clause (a) of  Class  2
of  Section  4  of  the  Illinois  Insurance Code, and direct
premium income of a  health  maintenance  organization  or  a
voluntary  health  services plan, except it shall not include
credit health insurance as defined in Article IX 1/2  of  the
Illinois Insurance Code.
    "Director"  means the Director of the Illinois Department
of Insurance.
    "Eligible person" means a  resident  of  this  State  who
qualifies for Plan coverage under Section 7 of this Act.
    "Employee" means a resident of this State who is employed
by an employer or has entered into the employment of or works
under  contract  or  service  of  an  employer  including the
officers, managers and employees of subsidiary or  affiliated
corporations  and  the  individual  proprietors, partners and
employees  of  affiliated  individuals  and  firms  when  the
business of the subsidiary or affiliated corporations,  firms
or  individuals  is  controlled  by a common employer through
stock ownership, contract, or otherwise.
    "Employer"    means    any    individual,    partnership,
association, corporation, business trust, or  any  person  or
group  of  persons  acting  directly  or  indirectly  in  the
interest of an employer in relation to an employee, for which
one or more persons is gainfully employed.
    "Family" coverage means the coverage provided by the Plan
for the covered person and his or her eligible dependents who
also are covered persons.
    "Federally   eligible  individual"  means  an  individual
resident of this State:
         (1)(A)  for whom,  as  of  the  date  on  which  the
    individual  seeks  Plan coverage under Section 15 of this
    Act, the aggregate of the periods of creditable  coverage
    is  18  or  more  months  or,  if the individual has been
    certified as an eligible person pursuant to  the  federal
    Trade  Adjustment  Act of 2002, 3 or more months, and (B)
    whose most recent prior  creditable  coverage  was  under
    group  health  insurance  coverage  offered  by  a health
    insurance issuer, a group  health  plan,  a  governmental
    plan,  or  a  church  plan  (or health insurance coverage
    offered in connection with any such plans) or  any  other
    type  of  creditable coverage that may be required by the
    federal Health Insurance Portability  and  Accountability
    Act  of  1996,  as  it may be amended, or the regulations
    under that Act;
         (2)  who is not eligible for coverage  under  (A)  a
    group  health  plan, (B) part A or part B of Medicare due
    to age, or (C) medical  assistance,  and  does  not  have
    other health insurance coverage;
         (3)  with  respect  to whom the most recent coverage
    within the coverage period described in paragraph  (1)(A)
    of this definition was not terminated based upon a factor
    relating to nonpayment of premiums or fraud;
         (4)  if the individual, other than an individual who
    has  been certified as an eligible person pursuant to the
    federal Trade Adjustment Act of 2002,  had  been  offered
    the   option  of  continuation  coverage  under  a  COBRA
    continuation provision or under a similar State  program,
    who elected such coverage; and
         (5)  who,    if    the   individual   elected   such
    continuation coverage, has  exhausted  such  continuation
    coverage under such provision or program.
    An  individual  who  has  been  certified  as an eligible
person pursuant to the federal Trade Adjustment Act  of  2002
shall  not be required to elect continuation coverage under a
COBRA  continuation  provision  or  under  a  similar   state
program.
    "Group  health  insurance  coverage" means, in connection
with a group health plan, health insurance  coverage  offered
in connection with that plan.
    "Group  health plan" has the same meaning given that term
in   the   federal   Health   Insurance    Portability    and
Accountability Act of 1996.
    "Governmental  plan" has the same meaning given that term
in   the   federal   Health   Insurance    Portability    and
Accountability Act of 1996.
    "Health  insurance coverage" means benefits consisting of
medical  care  (provided  directly,  through   insurance   or
reimbursement,  or otherwise and including items and services
paid for as medical care)  under  any  hospital  and  medical
expense-incurred policy, certificate, or contract provided by
an  insurer,  non-profit  health  care service plan contract,
health maintenance organization or other subscriber contract,
or any other health care plan or arrangement that pays for or
furnishes  medical  or  health  care  services   whether   by
insurance  or otherwise.  Health insurance coverage shall not
include  short  term,  accident  only,   disability   income,
hospital  confinement or fixed indemnity, dental only, vision
only, limited benefit, or credit insurance,  coverage  issued
as a supplement to liability insurance, insurance arising out
of   a  workers'  compensation  or  similar  law,  automobile
medical-payment insurance, or insurance under which  benefits
are  payable  with  or  without  regard to fault and which is
statutorily  required  to  be  contained  in  any   liability
insurance policy or equivalent self-insurance.
    "Health  insurance  issuer"  means  an insurance company,
insurance service, or  insurance  organization  (including  a
health   maintenance  organization  and  a  voluntary  health
services  plan)  that  is  authorized  to   transact   health
insurance business in this State.  Such term does not include
a group health plan.
    "Health  Maintenance  Organization" means an organization
as defined in the Health Maintenance Organization Act.
    "Hospice" means a program  as  defined  in  and  licensed
under the Hospice Program Licensing Act.
    "Hospital"  means  a duly licensed institution as defined
in the Hospital Licensing Act, an institution that meets  all
comparable conditions and requirements in effect in the state
in  which  it  is  located,  or  the  University  of Illinois
Hospital as defined in the University  of  Illinois  Hospital
Act.
    "Individual   health  insurance  coverage"  means  health
insurance coverage offered to individuals in  the  individual
market,  but  does  not  include short-term, limited-duration
insurance.
    "Insured" means any individual resident of this State who
is eligible to receive benefits from any  insurer  (including
health  insurance coverage offered in connection with a group
health plan) or health insurance issuer as  defined  in  this
Section.
    "Insurer"  means  any  insurance  company  authorized  to
transact  health  insurance  business  in  this State and any
corporation that provides medical services and  is  organized
under  the  Voluntary Health Services Plans Act or the Health
Maintenance Organization Act.
    "Medical assistance" means the State  medical  assistance
or medical assistance no grant (MANG) programs provided under
Title  XIX of the Social Security Act and Articles V (Medical
Assistance) and  VI  (General  Assistance)  of  the  Illinois
Public  Aid  Code  (or  any  successor  program) or under any
similar program of health care benefits in a state other than
Illinois.
    "Medically necessary" means  that  a  service,  drug,  or
supply  is  necessary  and  appropriate  for the diagnosis or
treatment of an illness or injury in  accord  with  generally
accepted  standards  of  medical  practice  at  the  time the
service, drug,  or  supply  is  provided.  When  specifically
applied  to a confinement it further means that the diagnosis
or treatment of the  covered  person's  medical  symptoms  or
condition  cannot  be  safely  provided  to that person as an
outpatient. A service, drug, or supply shall not be medically
necessary if it: (i) is investigational, experimental, or for
research  purposes;  or  (ii)  is  provided  solely  for  the
convenience of the patient, the patient's family,  physician,
hospital,  or  any other provider; or (iii) exceeds in scope,
duration, or intensity that level of care that is  needed  to
provide   safe,   adequate,   and  appropriate  diagnosis  or
treatment; or (iv) could have been omitted without  adversely
affecting  the  covered  person's condition or the quality of
medical care; or (v) involves the use of  a  medical  device,
drug, or substance not formally approved by the United States
Food and Drug Administration.
    "Medical  care" means the ordinary and usual professional
services rendered by a physician or other specified  provider
during  a  professional  visit for treatment of an illness or
injury.
    "Medicare" means coverage under both Part A and Part B of
Title XVIII of the Social Security Act, 42 U.S.C. Sec.  1395,
et seq.
    "Minimum  premium  plan"  means  an arrangement whereby a
specified amount of health care claims  is  self-funded,  but
the  insurance  company  assumes  the  risk  that claims will
exceed that amount.
    "Participating  transplant  center"  means   a   hospital
designated  by the Board as a preferred or exclusive provider
of services for one or more specified human organ  or  tissue
transplants  for  which  the hospital has signed an agreement
with the Board to accept a transplant payment  allowance  for
all  expenses  related  to the transplant during a transplant
benefit period.
    "Physician" means a person licensed to practice  medicine
pursuant to the Medical Practice Act of 1987.
    "Plan"  means  the  Comprehensive  Health  Insurance Plan
established by this Act.
    "Plan of operation" means the plan of  operation  of  the
Plan, including articles, bylaws and operating rules, adopted
by the board pursuant to this Act.
    "Provider"  means any hospital, skilled nursing facility,
hospice, home health agency, physician, registered pharmacist
acting within the scope of that registration,  or  any  other
person  or  entity  licensed  in  Illinois to furnish medical
care.
    "Qualified high risk pool" has  the  same  meaning  given
that  term  in  the  federal Health Insurance Portability and
Accountability Act of 1996.
    "Resident" means a person who  is  and  continues  to  be
legally  domiciled and physically residing on a permanent and
full-time basis in a place of permanent  habitation  in  this
State that remains that person's principal residence and from
which  that person is absent only for temporary or transitory
purpose.
    "Skilled nursing  facility"  means  a  facility  or  that
portion  of  a  facility  that  is  licensed  by the Illinois
Department of Public Health under the Nursing Home  Care  Act
or  a  comparable  licensing  authority  in  another state to
provide skilled nursing care.
    "Stop-loss coverage"  means  an  arrangement  whereby  an
insurer  insures  against  the  risk  that any one claim will
exceed a specific dollar amount or that the entire loss of  a
self-insurance plan will exceed a specific amount.
    "Third  party  administrator"  means  an administrator as
defined in Section 511.101 of the Illinois Insurance Code who
is licensed under Article XXXI 1/4 of that Code.
(Source: P.A. 91-357,  eff.  7-29-99;  91-735,  eff.  6-2-00;
92-153, eff. 7-25-01.)

    (215 ILCS 105/4) (from Ch. 73, par. 1304)
    Sec.  4.  Powers  and  authority of the board.  The board
shall have the general powers and authority granted under the
laws  of  this  State  to  insurance  companies  licensed  to
transact  health  and  accident  insurance  and  in  addition
thereto, the specific authority to:
    a.  Enter into contracts as are necessary  or  proper  to
carry  out the provisions and purposes of this Act, including
the authority, with the approval of the  Director,  to  enter
into  contracts  with  similar  plans of other states for the
joint performance of common administrative functions, or with
persons  or  other  organizations  for  the  performance   of
administrative   functions   including,  without  limitation,
utilization review and quality assurance  programs,  or  with
health   maintenance   organizations  or  preferred  provider
organizations for the provision of health care services.
    b.  Sue or be sued, including taking  any  legal  actions
necessary or proper.
    c.  Take such legal action as necessary to:
         (1)  avoid  the  payment  of improper claims against
    the plan or the coverage provided by or through the plan;
         (2)  to   recover   any   amounts   erroneously   or
    improperly paid by the plan;
         (3)  to recover any amounts paid by the  plan  as  a
    result of a mistake of fact or law; or
         (4)  to   recover  or  collect  any  other  amounts,
    including assessments, that are due or owed the  Plan  or
    have been billed on its or the Plan's behalf.
    d.  Establish  appropriate  rates,  rate  schedules, rate
adjustments, expense allowances, agents' referral fees, claim
reserves, and  formulas  and  any  other  actuarial  function
appropriate  to  the  operation  of the plan.  Rates and rate
schedules may be adjusted for appropriate risk  factors  such
as  age and area variation in claim costs and shall take into
consideration appropriate risk  factors  in  accordance  with
established actuarial and underwriting practices.
    e.  Issue  policies  of  insurance in accordance with the
requirements of this Act.
    f.  Appoint  appropriate  legal,  actuarial   and   other
committees  as  necessary  to provide technical assistance in
the operation of the plan, policy and other contract  design,
and any other function within the authority of the plan.
    g.  Borrow  money  to effect the purposes of the Illinois
Comprehensive Health Insurance  Plan.   Any  notes  or  other
evidence  of indebtedness of the plan not in default shall be
legal investments for insurers and may be carried as admitted
assets.
    h.  Establish  rules,  conditions  and   procedures   for
reinsuring risks under this Act.
    i.  Employ  and  fix  the compensation of employees. Such
employees may be paid  on  a  warrant  issued  by  the  State
Treasurer  pursuant  to  a  payroll  voucher certified by the
Board and drawn by the Comptroller against appropriations  or
trust funds held by the State Treasurer.
    j.  Enter  into  intergovernmental cooperation agreements
with other agencies or entities of State government  for  the
purpose of sharing the cost of providing health care services
that  are  otherwise  authorized by this Act for children who
are  both  plan  participants  and  eligible  for   financial
assistance from the Division of Specialized Care for Children
of the University of Illinois.
    k.  Establish  conditions  and procedures under which the
plan may, if funds  permit,  discount  or  subsidize  premium
rates  that  are paid directly by senior citizens, as defined
by the Board, and other plan participants, who are retired or
unemployed and meet other qualifications.
    l.  Establish and maintain the Plan  Fund  authorized  in
Section  3  of this Act, which shall be divided into separate
accounts, as follows:
         (1)  accounts to fund the administrative, claim, and
    other expenses  of  the  Plan  associated  with  eligible
    persons  who qualify for Plan coverage under Section 7 of
    this Act, which shall consist of:
              (A)  premiums  paid  on   behalf   of   covered
         persons;
              (B)  appropriated   funds  and  other  revenues
         collected or received by the Board;
              (C)  reserves for future losses  maintained  by
         the Board; and
              (D)  interest  earnings  from investment of the
         funds in the Plan Fund or any of its accounts  other
         than the funds in the account established under item
         2 of this subsection;
         (2)  an  account,  to  be  denominated the federally
    eligible individuals account, to fund the administrative,
    claim, and other expenses of  the  Plan  associated  with
    federally  eligible  individuals  who  qualify  for  Plan
    coverage  under  Section  15  of  this  Act,  which shall
    consist of:
              (A)  premiums  paid  on   behalf   of   covered
         persons;
              (B)  assessments  and  other revenues collected
         or received by the Board;
              (C)  reserves for future losses  maintained  by
         the Board; and
              (D)  interest  earnings  from investment of the
         federally eligible individuals account funds; and
              (E)  grants provided pursuant  to  the  federal
         Trade Adjustment Act of 2002; and
         (3)  such other accounts as may be appropriate.
    m.  Charge  and  collect  assessments  paid  by  insurers
pursuant   to   Section  12  of  this  Act  and  recover  any
assessments for, on behalf of, or against those insurers.
(Source: P.A. 90-30, eff. 7-1-97; 91-357, eff. 7-29-99.)

    (215 ILCS 105/7) (from Ch. 73, par. 1307)
    Sec. 7.  Eligibility.
    a.  Except as provided in subsection (e) of this  Section
or  in  Section  15  of  this Act, any person who is either a
citizen of the United States or an  alien  lawfully  admitted
for  permanent  residence and who has been for a period of at
least 180 days and continues to be a resident of  this  State
shall  be  eligible  for  Plan coverage under this Section if
evidence is provided of:
         (1)  A notice  of  rejection  or  refusal  to  issue
    substantially   similar   individual   health   insurance
    coverage for health reasons by a health insurance issuer;
    or
         (2)  A refusal by a health insurance issuer to issue
    individual  health  insurance  coverage  except at a rate
    exceeding the applicable Plan rate for which  the  person
    is responsible.
    A  rejection  or refusal by a group health plan or health
insurance issuer offering only stop-loss or  excess  of  loss
insurance or contracts, agreements, or other arrangements for
reinsurance  coverage with respect to the applicant shall not
be sufficient evidence under this subsection.
    b.  The board shall  promulgate  a  list  of  medical  or
health  conditions for which a person who is either a citizen
of the United  States  or  an  alien  lawfully  admitted  for
permanent  residence  and  a  resident of this State would be
eligible  for  Plan  coverage  without  applying  for  health
insurance coverage pursuant to subsection a. of this Section.
Persons who can demonstrate the existence or history  of  any
medical  or  health conditions on the list promulgated by the
board shall not be required to provide the evidence specified
in  subsection  a.  of  this  Section.   The  list  shall  be
effective on the first day of the operation of the  Plan  and
may be amended from time to time as appropriate.
    c.  Family  members  of  the  same household who each are
covered persons are eligible  for  optional  family  coverage
under the Plan.
    d.  For  persons  qualifying  for  coverage in accordance
with Section 7 of this Act, the board shall, if it determines
that such appropriations as are made pursuant to  Section  12
of this Act are insufficient to allow the board to accept all
of  the  eligible  persons  which  it projects will apply for
enrollment under the  Plan,  limit  or  close  enrollment  to
ensure  that  the Plan is not over-subscribed and that it has
sufficient resources to  meet  its  obligations  to  existing
enrollees.  The board shall not limit or close enrollment for
federally eligible individuals.
    e.  A person shall not be eligible for coverage under the
Plan if:
         (1)  He or she has or obtains other coverage under a
    group   health   plan   or   health   insurance  coverage
    substantially similar to or better than a Plan policy  as
    an  insured  or covered dependent or would be eligible to
    have that coverage if he or she  elected  to  obtain  it.
    Persons   otherwise   eligible  for  Plan  coverage  may,
    however, solely for the purpose of having coverage for  a
    pre-existing  condition,  maintain  other  coverage  only
    while   satisfying  any  pre-existing  condition  waiting
    period under a Plan policy or  a  subsequent  replacement
    policy of a Plan policy.
         (1.1)  His  or  her  prior  coverage  under  a group
    health plan or health  insurance  coverage,  provided  or
    arranged  by  an  employer  of more than 10 employees was
    discontinued for any reason without the entire  group  or
    plan  being discontinued and not replaced, provided he or
    she remains an employee, or  dependent  thereof,  of  the
    same employer.
         (2)  He  or  she is a recipient of or is approved to
    receive medical assistance, except  that   a  person  may
    continue   to  receive  medical  assistance  through  the
    medical assistance  no  grant  program,  but  only  while
    satisfying  the  requirements for a preexisting condition
    under Section 8, subsection f. of this Act.   Payment  of
    premiums  pursuant  to this Act shall be allocable to the
    person's spenddown for purposes of the medical assistance
    no grant program, but that person shall not  be  eligible
    for  any Plan benefits while that person remains eligible
    for medical  assistance.   If  the  person  continues  to
    receive  or  be  approved  to  receive medical assistance
    through the medical assistance no  grant  program  at  or
    after  the  time  that  requirements  for  a  preexisting
    condition are satisfied, the person shall not be eligible
    for  coverage  under  the  Plan.  In  that  circumstance,
    coverage  under  the  plan  shall  terminate  as  of  the
    expiration   of   the  preexisting  condition  limitation
    period.  Under all other  circumstances,  coverage  under
    the   Plan   shall  automatically  terminate  as  of  the
    effective date of any medical assistance.
         (3)  Except as provided in Section  15,  the  person
    has  previously  participated in the Plan and voluntarily
    terminated Plan coverage, unless 12 months  have  elapsed
    since   the  person's  latest  voluntary  termination  of
    coverage.
         (4)  The person fails to pay  the  required  premium
    under  the  covered  person's  terms  of  enrollment  and
    participation,  in  which event the liability of the Plan
    shall be limited to benefits incurred under the Plan  for
    the  time period for which premiums had been paid and the
    covered person remained eligible for Plan coverage.
         (5)  The Plan has paid  a  total  of  $1,000,000  in
    benefits on behalf of the covered person.
         (6)  The   person   is   a   resident  of  a  public
    institution.
         (7)  The person's premium is paid for or  reimbursed
    under   any   government  sponsored  program  or  by  any
    government agency or health care provider, except  as  an
    otherwise  qualifying full-time employee, or dependent of
    such employee, of a  government  agency  or  health  care
    provider  or,  except  when a person's premium is paid by
    the U.S. Treasury  Department  pursuant  to  the  federal
    Trade Adjustment Act of 2002.
         (8)  The person has or later receives other benefits
    or   funds  from  any  settlement,  judgement,  or  award
    resulting from any accident or injury, regardless of  the
    date   of   the   accident   or   injury,  or  any  other
    circumstances creating a legal liability for damages  due
    that  person  by  a  third party, whether the settlement,
    judgment,  or  award  is  in  the  form  of  a  contract,
    agreement, or trust on behalf of a minor or otherwise and
    whether the settlement, judgment, or award is payable  to
    the  person,  his  or  her  dependent,  estate,  personal
    representative,  or  guardian in a lump sum or over time,
    so long as there  continues  to  be  benefits  or  assets
    remaining  from  those  sources in an amount in excess of
    $100,000.
         (9)  Within the 5 years prior to the date a person's
    Plan application is received by the Board,  the  person's
    coverage under any health care benefit program as defined
    in  18 U.S.C. 24, including any public or private plan or
    contract  under  which  any  medical  benefit,  item,  or
    service is provided, was terminated as a  result  of  any
    act  or  practice  that  constitutes fraud under State or
    federal  law  or  as   a   result   of   an   intentional
    misrepresentation  of  material  fact;  or if that person
    knowingly and willfully obtained or attempted to  obtain,
    or  fraudulently  aided  or  attempted  to  aid any other
    person in obtaining, any coverage or benefits  under  the
    Plan to which that person was not entitled.
    f.  The   board   or   the  administrator  shall  require
verification of residency  and  may  require  any  additional
information  or documentation, or statements under oath, when
necessary to determine residency upon initial application and
for the entire term of the policy.
    g.  Coverage shall cease (i) on the date a person  is  no
longer  a  resident  of  Illinois,  (ii) on the date a person
requests coverage to end, (iii) upon the death of the covered
person, (iv) on the date State law requires  cancellation  of
the  policy,  or  (v) at the Plan's option, 30 days after the
Plan makes any inquiry concerning a person's  eligibility  or
place of residence to which the person does not reply.
    h.  Except under the conditions set forth in subsection g
of  this  Section,  the  coverage of any person who ceases to
meet the eligibility requirements of this  Section  shall  be
terminated  at the end of the current policy period for which
the necessary premiums have been paid.
(Source: P.A.  90-30,  eff.  7-1-97;  91-639,  eff.  8-20-99;
91-735, eff. 6-2-00.)

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

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

Effective Date: 06/23/03