SB1812sam001 97TH GENERAL ASSEMBLY

Sen. Terry Link

Filed: 3/10/2011

09700SB1812sam001 LRB097 09496 RPM 52372 a

AMENDMENT TO SENATE BILL 1812

AMENDMENT NO. ______. Amend Senate Bill 1812 by replacing line 2 on page 29 through line 12 on page 33 with the following:

"(215 ILCS 5/356z.25 new)

Sec. 356z.25. Coverage for children with preexisting conditions.

(a) A health insurance issuer offering group or individual health insurance shall not limit or exclude coverage for an individual under the age of 19 by imposing a preexisting condition exclusion on that individual.

(b) Notwithstanding any other provision of law, a health insurance issuer offering individual health insurance must offer a child-only plan and, except as set forth in subsection (g) of this Section, shall accept applications for child-only plans and offer coverage without any limitations or riders based on health status according to the following provisions:

(1) during the open enrollment periods outlined in subsection (c) of this Section; and

(2) within 30 days after a qualifying event.

(c) Beginning January 1, 2012, each January and July a health insurance issuer offering a child-only plan shall hold an open enrollment period for child-only plan applicants for the duration of the entire month. During these open enrollment periods, all child-only plan applicants under the age of 19 shall be offered coverage without any limitations or riders based on health status.

(d) Notice of the open enrollment opportunity and open enrollment dates for new applicants, as well as the opportunity to enroll due to a qualifying event, must be displayed prominently on the health insurance issuer's web site throughout the year.

(e) Applications for coverage during a January open enrollment period shall become effective no later than March 1 following the open enrollment during which the application is received. Applications for coverage during a July open enrollment period shall become effective no later than September 1 following the open enrollment during which the application is received.

(f) Except during an open enrollment period, a health insurance issuer need not offer coverage to a child-only applicant who had a child-only plan with a health insurance issuer during the 12 months prior to the application for child-only coverage where such coverage was voluntarily terminated.

(g) A health insurance issuer is not required to accept applications from eligible individuals applying for child-only plan coverage during an open enrollment period if such individuals have comprehensive medical coverage available to be purchased by them at the time that the child-only plan would become effective.

(h) Health insurance issuers are not precluded from applying non-health related eligibility rules to individuals applying for child-only plan coverage so long as such rules are uniformly applied to all individuals applying for child-only plan coverage.

(i) For the purposes of this Section:

"Child-only plan" means renewable individual health insurance coverage (as defined in 42 U.S.C. 300gg-91) issued with an effective date on or after September 23, 2010, that provides coverage to an individual under the age of 19. This shall not include individual health insurance coverage that covers children under age 19 as dependents.

"Qualifying event" shall occur only when:

(1) an individual's major medical coverage is involuntarily terminated, whether or not such coverage is provided to the individual directly as a policyholder or as a dependent; and

(2) that individual does not have other comprehensive major medical coverage available to be purchased, whether or not such coverage is available to be purchased by that individual as a policyholder or as a dependent. A qualifying event shall be considered to have occurred on the later of the date that the individual's previous major medical coverage was involuntarily terminated or notice of such termination was provided.

"Preexisting condition" means a limitation or exclusion of benefits, including a denial of coverage, based on the fact that the condition was present before the effective date of coverage, or if the coverage is denied, the date of denial, under a health benefit plan whether or not any medical advice, diagnosis, care, or treatment was recommended or received before the effective date of coverage.

"Preexisting condition exclusion" includes any limitation or exclusion of benefits, including a denial of coverage, applicable to an individual as a result of information relating to an individual's health status before the individual's effective date of coverage or, if the coverage is denied, the date of denial under the health benefit plan, such as a condition identified as a result of a pre-enrollment questionnaire or physical examination given to the individual or review of medical records relating to the pre-enrollment period.".