98TH GENERAL ASSEMBLY
State of Illinois
2013 and 2014
HB0024

 

Introduced 1/9/2013, by Rep. Mary E. Flowers

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 5/351B-4  from Ch. 73, par. 963B-4
215 ILCS 5/364  from Ch. 73, par. 976

    Amends the Illinois Insurance Code. Provides that no company, in any policy of accident or health insurance, shall make or permit any distinction or discrimination against individuals solely because of handicaps or disabilities in specified provisions of the contract it makes or permit any distinction or discrimination against individuals solely because of handicaps or disabilities in the specified provisions of the contract it makes (instead of including an exception for those who meet specified criteria). Provides that no company shall refuse to insure or refuse to continue to insure, limit the amount or extent or kind of coverage available to an individual, or charge an individual a different rate for the same coverage solely because of health status or disability (instead of only because of blindness or partial blindness).


LRB098 00171 RPM 30172 b

 

 

A BILL FOR

 

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1    AN ACT concerning insurance.
 
2    WHEREAS, It is a fundamental right not to be discriminated
3against because of health status or disabilities; therefore
 
4    Be it enacted by the People of the State of Illinois,
5represented in the General Assembly:
 
6    Section 5. The Illinois Insurance Code is amended by
7changing Sections 351B-4 and 364 as follows:
 
8    (215 ILCS 5/351B-4)  (from Ch. 73, par. 963B-4)
9    Sec. 351B-4. Small employer group accident and health
10insurance policy requirements.
11    (a) Any insurance company authorized to write accident and
12health insurance in this State shall have power to issue small
13employer group accident and health policies. No policy of small
14employer group accident and health insurance may be issued or
15delivered in this State unless a copy of the form thereof has
16been filed with the Department and approved by it in accordance
17with Section 355, unless it contains in substance those
18provisions contained in Sections 357.1 through 357.30 as may be
19applicable to small employer group accident and health
20insurance and unless it contains the provisions set forth in
21this Section.
22    (b) The policy must provide that the policy, the

 

 

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1application of the employer or the executive officer or trustee
2of any association and the individual applications, if any, of
3the employees, members, or employees of members insured shall
4constitute the entire contract between the parties, and that
5all statements made by the employer or executive officer or
6trustee, or by the individual employees, members, or employees
7of members shall (in the absence of fraud) be deemed
8representations and not warranties, and that none of those
9statements may be used in defense to a claim under the policy
10unless it is contained in a written application.
11    (c) The policy must provide that the insurer will issue to
12the employer or to the executive officer or trustee of the
13association, for delivery to the employee, member, or employee
14of a member who is insured under the policy, an individual
15certificate setting forth a statement as to the insurance
16protection to which he is entitled and to whom payable.
17    (d) The policy must provide that all new employees of the
18employer, new members of the association, or new employees of
19members eligible and applying for insurance in the group or
20class shall be added periodically to the group or class
21originally insured.
22    (e) Anything in this Code to the contrary notwithstanding,
23any small employer group accident and health insurance policy
24may provide that all or any portion of any indemnities provided
25by the policy on account of hospital, nursing, medical, or
26surgical services may, at the insurer's option, be paid

 

 

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1directly to the hospital or person rendering the services; but
2the policy may not require that the service be rendered by a
3particular hospital or person. Payment so made shall discharge
4the insurer's obligation with respect to the amount of
5insurance so paid. Nothing in this subsection shall prohibit an
6insurer from providing incentives for insureds to utilize the
7services of a particular hospital or person.
8    (f) Whenever the Department of Public Health finds that it
9has paid all or part of any hospital or medical expenses that
10an insurance carrier is obligated to pay under this Article,
11the Department of Public Health shall be entitled to receive
12reimbursement for its payments from the insurance carrier,
13provided that the Department of Public Health has notified the
14insurance carrier of its claim before the carrier has paid the
15benefits to its insureds or the insureds' assignees.
16    (g) No group hospital, medical, or surgical expense policy
17under this Article shall contain any provision whereby benefits
18otherwise payable thereunder are subject to reduction solely on
19account of the existence of similar benefits provided under
20other group or group type accident and sickness insurance
21policies where the reduction would operate to reduce total
22benefits payable under the policies below an amount equal to
23100% of total allowable expenses provided under the policies.
24    (h) When dependents of insureds are covered under 2
25policies, both of which contain coordination of benefits
26provisions, benefits of the policy of the insured whose

 

 

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1birthday falls earlier in the year are determined before those
2of the policy of the insured whose birthday falls later in the
3year. "Birthday", as used herein, refers only to the month and
4day in a calendar year, not the year in which the person was
5born. The Department shall promulgate rules defining the order
6of benefit determination under this subsection.
7    (i) Discrimination between individuals of the same class of
8risk in the issuance of policies, in the amount of premiums or
9rates charged for any insurance covered by this Article, in
10benefits payable thereon, in any of the terms or conditions of
11the policy, or in any other manner whatsoever is prohibited.
12Nothing in this subsection shall prohibit an insurer from
13providing incentives for insureds to utilize the services of a
14particular hospital or person.
15    (j) No company shall make or permit any distinction or
16discrimination against individuals solely because of handicaps
17or disabilities in (i) the amount of payment of premiums or
18rates charged for policies of insurance, (ii) the amount of any
19dividends or other benefits payable thereon, or (iii) any other
20terms and conditions of the contract it makes, except where the
21distinction or discrimination is based on sound actuarial
22principles or is related to actual or reasonably anticipated
23experience.
24    (k) No company shall refuse to insure or refuse to continue
25to insure, limit the amount or extent or kind of coverage
26available to an individual, or charge an individual a different

 

 

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1rate for the same coverage solely because of health status or
2disability blindness or partial blindness. With respect to all
3other conditions, including the underlying cause of the
4blindness or partial blindness, persons who are blind or
5partially blind shall be subject to the same standards of sound
6actuarial principles or actual or reasonably anticipated
7experience as are sighted persons. Refusal to insure includes
8denial by an insurer of disability insurance coverage on the
9grounds that the policy defines "disability" as being presumed
10in the event that the insured loses his or her eyesight.
11However, an insurer may exclude from coverage disability
12consisting solely of blindness or partial blindness when the
13condition existed at the time the policy was issued.
14(Source: P.A. 86-1407.)
 
15    (215 ILCS 5/364)  (from Ch. 73, par. 976)
16    Sec. 364. Discrimination prohibited. Discrimination
17between individuals of the same class of risk in the issuance
18of its policies or in the amount of premiums or rates charged
19for any insurance covered by this article, or in the benefits
20payable thereon, or in any of the terms or conditions of such
21policy, or in any other manner whatsoever is prohibited.
22Nothing in this provision shall prohibit an insurer from
23providing incentives for insureds to utilize the services of a
24particular hospital or person. It is hereby expressly provided
25that whenever the terms "physician" or "doctor" appear or are

 

 

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1used in any way in any policy of accident or health insurance
2issued in this state, said terms shall include within their
3meaning persons licensed to practice dentistry under the
4Illinois Dental Practice Act with regard to benefits payable
5for services performed by a person so licensed, which such
6services are within the coverage provided by the particular
7policy or contract of insurance and are within the professional
8services authorized to be performed by such person under and in
9accordance with the said Act.
10    No company, in any policy of accident or health insurance
11issued in this State, shall make or permit any distinction or
12discrimination against individuals solely because of handicaps
13or disabilities in the amount of payment of premiums or rates
14charged for policies of insurance, in the amount of any
15dividends or other benefits payable thereon, or in any other
16terms and conditions of the contract it makes, except where the
17distinction or discrimination is based on sound actuarial
18principles or is related to actual or reasonably anticipated
19experience.
20    No company shall refuse to insure, or refuse to continue to
21insure, or limit the amount or extent or kind of coverage
22available to an individual, or charge an individual a different
23rate for the same coverage solely because of health status or
24disability blindness or partial blindness. With respect to all
25other conditions, including the underlying cause of the
26blindness or partial blindness, persons who are blind or

 

 

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1partially blind shall be subject to the same standards of sound
2actuarial principles or actual or reasonably anticipated
3experience as are sighted persons. Refusal to insure includes
4denial by an insurer of disability insurance coverage on the
5grounds that the policy defines "disability" as being presumed
6in the event that the insured loses his or her eyesight.
7(Source: P.A. 91-549, eff. 8-14-99.)