Sen. William R. Haine

Filed: 3/23/2012

 

 


 

 


 
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1
AMENDMENT TO SENATE BILL 2876

2    AMENDMENT NO. ______. Amend Senate Bill 2876 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. If and only if House Bill 3443 of the 97th
5General Assembly becomes law in the form in which it left the
6House, then the Illinois Insurance Code is amended by changing
7Section 4 as follows:
 
8    (215 ILCS 5/4)  (from Ch. 73, par. 616)
9    Sec. 4. Classes of insurance. Insurance and insurance
10business shall be classified as follows:
11    Class 1. Life, Accident and Health.
12    (a) Life. Insurance on the lives of persons and every
13insurance appertaining thereto or connected therewith and
14granting, purchasing or disposing of annuities. Policies of
15life or endowment insurance or annuity contracts or contracts
16supplemental thereto which contain provisions for additional

 

 

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1benefits in case of death by accidental means and provisions
2operating to safeguard such policies or contracts against
3lapse, to give a special surrender value, or special benefit,
4or an annuity, in the event, that the insured or annuitant
5shall become totally and permanently disabled as defined by the
6policy or contract, or which contain benefits providing
7acceleration of life or endowment or annuity benefits in
8advance of the time they would otherwise be payable, as an
9indemnity for long term care which is certified or ordered by a
10physician, including but not limited to, professional nursing
11care, medical care expenses, custodial nursing care,
12non-nursing custodial care provided in a nursing home or at a
13residence of the insured, or which contain benefits providing
14acceleration of life or endowment or annuity benefits in
15advance of the time they would otherwise be payable, at any
16time during the insured's lifetime, as an indemnity for a
17terminal illness shall be deemed to be policies of life or
18endowment insurance or annuity contracts within the intent of
19this clause.
20    Also to be deemed as policies of life or endowment
21insurance or annuity contracts within the intent of this clause
22shall be those policies or riders that provide for the payment
23of up to 75% of the face amount of benefits in advance of the
24time they would otherwise be payable upon a diagnosis by a
25physician licensed to practice medicine in all of its branches
26that the insured has incurred a covered condition listed in the

 

 

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1policy or rider.
2    "Covered condition", as used in this clause, means: heart
3attack, stroke, coronary artery surgery, life threatening
4cancer, renal failure, alzheimer's disease, paraplegia, major
5organ transplantation, total and permanent disability, and any
6other medical condition that the Department may approve for any
7particular filing.
8    The Director may issue rules that specify prohibited policy
9provisions, not otherwise specifically prohibited by law,
10which in the opinion of the Director are unjust, unfair, or
11unfairly discriminatory to the policyholder, any person
12insured under the policy, or beneficiary.
13    (b) Accident and health. Insurance against bodily injury,
14disablement or death by accident and against disablement
15resulting from sickness or old age and every insurance
16appertaining thereto, including stop-loss insurance. Stop-loss
17insurance is insurance against the risk of economic loss issued
18to a single employer self-funded employee disability benefit
19plan or an employee welfare benefit plan as described in 29
20U.S.C. 100 et seq. The insurance laws of this State, including
21this Code, do not apply to arrangements between a religious
22organization and the organization's members or participants
23when the arrangement and organization meet all of the following
24criteria:
25        (i) the organization is described in Section 501(c)(3)
26    of the Internal Revenue Code and is exempt from taxation

 

 

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1    under Section 501(a) of the Internal Revenue Code;
2        (ii) members of the organization share a common set of
3    ethical or religious beliefs and share medical expenses
4    among members in accordance with those beliefs and without
5    regard to the state in which a member resides or is
6    employed;
7        (iii) no funds that have been given for the purpose of
8    the sharing of medical expenses among members described in
9    paragraph (ii) of this subsection (b) are held by the
10    organization in an off-shore trust or bank account;
11        (iv) the organization provides at least monthly to all
12    of its members a written statement listing the dollar
13    amount of qualified medical expenses that members have
14    submitted for sharing, as well as the amount of expenses
15    actually shared among the members;
16        (v) (iii) members of the organization retain
17    membership even after they develop a medical condition;
18        (vi) (iv) the organization or a predecessor
19    organization has been in existence at all times since
20    December 31, 1999, and medical expenses of its members have
21    been shared continuously and without interruption since at
22    least December 31, 1999;
23        (vii) (v) the organization conducts an annual audit
24    that is performed by an independent certified public
25    accounting firm in accordance with generally accepted
26    accounting principles and is made available to the public

 

 

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1    upon request;
2        (viii) (vi) the organization includes the following
3    statement, in writing, on or accompanying all applications
4    and guideline materials:
5        "Notice: The organization facilitating the sharing of
6        medical expenses is not an insurance company, and
7        neither its guidelines nor plan of operation
8        constitute or create an insurance policy. Any
9        assistance you receive with your medical bills will be
10        totally voluntary. Neither the organization nor any
11        other participant can be compelled by law to contribute
12        toward your medical bills. As such, participation in
13        the organization or a subscription to any of its
14        documents should never be considered to be insurance.
15        Whether or not you receive any payments for medical
16        expenses and whether or not this organization
17        continues to operate, you are always personally
18        responsible for the payment of your own medical
19        bills."; and
20        (ix) (vii) any membership card or similar document
21    issued by the organization and any written communication
22    sent by the organization to a hospital, physician, or other
23    health care provider shall include a statement that the
24    organization does not issue health insurance and that the
25    member or participant is personally liable for payment of
26    his or her medical bills; .

 

 

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1        (x) the organization provides to a participant, within
2    30 days after the participant joins, a complete set of its
3    rules for the sharing of medical expenses, appeals of
4    decisions made by the organization, and the filing of
5    complaints;
6        (xi) the organization does not offer any other services
7    that are regulated under any provision of the Illinois
8    Insurance Code or other insurance laws of this State; and
9        (xii) the organization does not amass funds as reserves
10    intended for payment of medical services, rather the
11    organization facilitates the payments provided for in this
12    subsection (b) through payments made directly from one
13    participant to another.
14    (c) Legal Expense Insurance. Insurance which involves the
15assumption of a contractual obligation to reimburse the
16beneficiary against or pay on behalf of the beneficiary, all or
17a portion of his fees, costs, or expenses related to or arising
18out of services performed by or under the supervision of an
19attorney licensed to practice in the jurisdiction wherein the
20services are performed, regardless of whether the payment is
21made by the beneficiaries individually or by a third person for
22them, but does not include the provision of or reimbursement
23for legal services incidental to other insurance coverages. The
24insurance laws of this State, including this Act do not apply
25to:
26        (i) Retainer contracts made by attorneys at law with

 

 

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1    individual clients with fees based on estimates of the
2    nature and amount of services to be provided to the
3    specific client, and similar contracts made with a group of
4    clients involved in the same or closely related legal
5    matters;
6        (ii) Plans owned or operated by attorneys who are the
7    providers of legal services to the plan;
8        (iii) Plans providing legal service benefits to groups
9    where such plans are owned or operated by authority of a
10    state, county, local or other bar association;
11        (iv) Any lawyer referral service authorized or
12    operated by a state, county, local or other bar
13    association;
14        (v) The furnishing of legal assistance by labor unions
15    and other employee organizations to their members in
16    matters relating to employment or occupation;
17        (vi) The furnishing of legal assistance to members or
18    dependents, by churches, consumer organizations,
19    cooperatives, educational institutions, credit unions, or
20    organizations of employees, where such organizations
21    contract directly with lawyers or law firms for the
22    provision of legal services, and the administration and
23    marketing of such legal services is wholly conducted by the
24    organization or its subsidiary;
25        (vii) Legal services provided by an employee welfare
26    benefit plan defined by the Employee Retirement Income

 

 

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1    Security Act of 1974;
2        (viii) Any collectively bargained plan for legal
3    services between a labor union and an employer negotiated
4    pursuant to Section 302 of the Labor Management Relations
5    Act as now or hereafter amended, under which plan legal
6    services will be provided for employees of the employer
7    whether or not payments for such services are funded to or
8    through an insurance company.
9    Class 2. Casualty, Fidelity and Surety.
10    (a) Accident and health. Insurance against bodily injury,
11disablement or death by accident and against disablement
12resulting from sickness or old age and every insurance
13appertaining thereto, including stop-loss insurance. Stop-loss
14insurance is insurance against the risk of economic loss issued
15to a single employer self-funded employee disability benefit
16plan or an employee welfare benefit plan as described in 29
17U.S.C. 1001 et seq.
18    (b) Vehicle. Insurance against any loss or liability
19resulting from or incident to the ownership, maintenance or use
20of any vehicle (motor or otherwise), draft animal or aircraft.
21Any policy insuring against any loss or liability on account of
22the bodily injury or death of any person may contain a
23provision for payment of disability benefits to injured persons
24and death benefits to dependents, beneficiaries or personal
25representatives of persons who are killed, including the named
26insured, irrespective of legal liability of the insured, if the

 

 

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1injury or death for which benefits are provided is caused by
2accident and sustained while in or upon or while entering into
3or alighting from or through being struck by a vehicle (motor
4or otherwise), draft animal or aircraft, and such provision
5shall not be deemed to be accident insurance.
6    (c) Liability. Insurance against the liability of the
7insured for the death, injury or disability of an employee or
8other person, and insurance against the liability of the
9insured for damage to or destruction of another person's
10property.
11    (d) Workers' compensation. Insurance of the obligations
12accepted by or imposed upon employers under laws for workers'
13compensation.
14    (e) Burglary and forgery. Insurance against loss or damage
15by burglary, theft, larceny, robbery, forgery, fraud or
16otherwise; including all householders' personal property
17floater risks.
18    (f) Glass. Insurance against loss or damage to glass
19including lettering, ornamentation and fittings from any
20cause.
21    (g) Fidelity and surety. Become surety or guarantor for any
22person, copartnership or corporation in any position or place
23of trust or as custodian of money or property, public or
24private; or, becoming a surety or guarantor for the performance
25of any person, copartnership or corporation of any lawful
26obligation, undertaking, agreement or contract of any kind,

 

 

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1except contracts or policies of insurance; and underwriting
2blanket bonds. Such obligations shall be known and treated as
3suretyship obligations and such business shall be known as
4surety business.
5    (h) Miscellaneous. Insurance against loss or damage to
6property and any liability of the insured caused by accidents
7to boilers, pipes, pressure containers, machinery and
8apparatus of any kind and any apparatus connected thereto, or
9used for creating, transmitting or applying power, light, heat,
10steam or refrigeration, making inspection of and issuing
11certificates of inspection upon elevators, boilers, machinery
12and apparatus of any kind and all mechanical apparatus and
13appliances appertaining thereto; insurance against loss or
14damage by water entering through leaks or openings in
15buildings, or from the breakage or leakage of a sprinkler,
16pumps, water pipes, plumbing and all tanks, apparatus, conduits
17and containers designed to bring water into buildings or for
18its storage or utilization therein, or caused by the falling of
19a tank, tank platform or supports, or against loss or damage
20from any cause (other than causes specifically enumerated under
21Class 3 of this Section) to such sprinkler, pumps, water pipes,
22plumbing, tanks, apparatus, conduits or containers; insurance
23against loss or damage which may result from the failure of
24debtors to pay their obligations to the insured; and insurance
25of the payment of money for personal services under contracts
26of hiring.

 

 

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1    (i) Other casualty risks. Insurance against any other
2casualty risk not otherwise specified under Classes 1 or 3,
3which may lawfully be the subject of insurance and may properly
4be classified under Class 2.
5    (j) Contingent losses. Contingent, consequential and
6indirect coverages wherein the proximate cause of the loss is
7attributable to any one of the causes enumerated under Class 2.
8Such coverages shall, for the purpose of classification, be
9included in the specific grouping of the kinds of insurance
10wherein such cause is specified.
11    (k) Livestock and domestic animals. Insurance against
12mortality, accident and health of livestock and domestic
13animals.
14    (l) Legal expense insurance. Insurance against risk
15resulting from the cost of legal services as defined under
16Class 1(c).
17    Class 3. Fire and Marine, etc.
18    (a) Fire. Insurance against loss or damage by fire, smoke
19and smudge, lightning or other electrical disturbances.
20    (b) Elements. Insurance against loss or damage by
21earthquake, windstorms, cyclone, tornado, tempests, hail,
22frost, snow, ice, sleet, flood, rain, drought or other weather
23or climatic conditions including excess or deficiency of
24moisture, rising of the waters of the ocean or its tributaries.
25    (c) War, riot and explosion. Insurance against loss or
26damage by bombardment, invasion, insurrection, riot, strikes,

 

 

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1civil war or commotion, military or usurped power, or explosion
2(other than explosion of steam boilers and the breaking of fly
3wheels on premises owned, controlled, managed, or maintained by
4the insured.)
5    (d) Marine and transportation. Insurance against loss or
6damage to vessels, craft, aircraft, vehicles of every kind,
7(excluding vehicles operating under their own power or while in
8storage not incidental to transportation) as well as all goods,
9freights, cargoes, merchandise, effects, disbursements,
10profits, moneys, bullion, precious stones, securities, chooses
11in action, evidences of debt, valuable papers, bottomry and
12respondentia interests and all other kinds of property and
13interests therein, in respect to, appertaining to or in
14connection with any or all risks or perils of navigation,
15transit, or transportation, including war risks, on or under
16any seas or other waters, on land or in the air, or while being
17assembled, packed, crated, baled, compressed or similarly
18prepared for shipment or while awaiting the same or during any
19delays, storage, transshipment, or reshipment incident
20thereto, including marine builder's risks and all personal
21property floater risks; and for loss or damage to persons or
22property in connection with or appertaining to marine, inland
23marine, transit or transportation insurance, including
24liability for loss of or damage to either arising out of or in
25connection with the construction, repair, operation,
26maintenance, or use of the subject matter of such insurance,

 

 

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1(but not including life insurance or surety bonds); but, except
2as herein specified, shall not mean insurances against loss by
3reason of bodily injury to the person; and insurance against
4loss or damage to precious stones, jewels, jewelry, gold,
5silver and other precious metals whether used in business or
6trade or otherwise and whether the same be in course of
7transportation or otherwise, which shall include jewelers'
8block insurance; and insurance against loss or damage to
9bridges, tunnels and other instrumentalities of transportation
10and communication (excluding buildings, their furniture and
11furnishings, fixed contents and supplies held in storage)
12unless fire, tornado, sprinkler leakage, hail, explosion,
13earthquake, riot and civil commotion are the only hazards to be
14covered; and to piers, wharves, docks and slips, excluding the
15risks of fire, tornado, sprinkler leakage, hail, explosion,
16earthquake, riot and civil commotion; and to other aids to
17navigation and transportation, including dry docks and marine
18railways, against all risk.
19    (e) Vehicle. Insurance against loss or liability resulting
20from or incident to the ownership, maintenance or use of any
21vehicle (motor or otherwise), draft animal or aircraft,
22excluding the liability of the insured for the death, injury or
23disability of another person.
24    (f) Property damage, sprinkler leakage and crop. Insurance
25against the liability of the insured for loss or damage to
26another person's property or property interests from any cause

 

 

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1enumerated in this class; insurance against loss or damage by
2water entering through leaks or openings in buildings, or from
3the breakage or leakage of a sprinkler, pumps, water pipes,
4plumbing and all tanks, apparatus, conduits and containers
5designed to bring water into buildings or for its storage or
6utilization therein, or caused by the falling of a tank, tank
7platform or supports or against loss or damage from any cause
8to such sprinklers, pumps, water pipes, plumbing, tanks,
9apparatus, conduits or containers; insurance against loss or
10damage from insects, diseases or other causes to trees, crops
11or other products of the soil.
12    (g) Other fire and marine risks. Insurance against any
13other property risk not otherwise specified under Classes 1 or
142, which may lawfully be the subject of insurance and may
15properly be classified under Class 3.
16    (h) Contingent losses. Contingent, consequential and
17indirect coverages wherein the proximate cause of the loss is
18attributable to any of the causes enumerated under Class 3.
19Such coverages shall, for the purpose of classification, be
20included in the specific grouping of the kinds of insurance
21wherein such cause is specified.
22    (i) Legal expense insurance. Insurance against risk
23resulting from the cost of legal services as defined under
24Class 1(c).
25(Source: 09700HB3443eng.)".