HB3462enr 97TH GENERAL ASSEMBLY

  
  
  

 


 
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1    AN ACT concerning insurance.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Comprehensive Health Insurance Plan Act is
5amended by changing Section 7 as follows:
 
6    (215 ILCS 105/7)  (from Ch. 73, par. 1307)
7    Sec. 7. Eligibility.
8    a. Except as provided in subsection (e) of this Section or
9in Section 15 of this Act, any person who is either a citizen
10of the United States or an alien lawfully admitted for
11permanent residence and who has been for a period of at least
12180 days and continues to be a resident of this State shall be
13eligible for Plan coverage under this Section if evidence is
14provided of:
15        (1) A notice of rejection or refusal to issue
16    substantially similar individual health insurance coverage
17    for health reasons by a health insurance issuer; or
18        (2) A refusal by a health insurance issuer to issue
19    individual health insurance coverage except at a rate
20    exceeding the applicable Plan rate for which the person is
21    responsible; or .
22        (3) The absence of available health insurance coverage
23    for a person under 19 years of age.

 

 

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1    A rejection or refusal by a group health plan or health
2insurance issuer offering only stop-loss or excess of loss
3insurance or contracts, agreements, or other arrangements for
4reinsurance coverage with respect to the applicant shall not be
5sufficient evidence under this subsection.
6    b. The board shall promulgate a list of medical or health
7conditions for which a person who is either a citizen of the
8United States or an alien lawfully admitted for permanent
9residence and a resident of this State would be eligible for
10Plan coverage without applying for health insurance coverage
11pursuant to subsection a. of this Section. Persons who can
12demonstrate the existence or history of any medical or health
13conditions on the list promulgated by the board shall not be
14required to provide the evidence specified in subsection a. of
15this Section. The list shall be effective on the first day of
16the operation of the Plan and may be amended from time to time
17as appropriate.
18    c. Family members of the same household who each are
19covered persons are eligible for optional family coverage under
20the Plan.
21    d. For persons qualifying for coverage in accordance with
22Section 7 of this Act, the board shall, if it determines that
23such appropriations as are made pursuant to Section 12 of this
24Act are insufficient to allow the board to accept all of the
25eligible persons which it projects will apply for enrollment
26under the Plan, limit or close enrollment to ensure that the

 

 

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1Plan is not over-subscribed and that it has sufficient
2resources to meet its obligations to existing enrollees. The
3board shall not limit or close enrollment for federally
4eligible individuals.
5    e. A person shall not be eligible for coverage under the
6Plan if:
7        (1) He or she has or obtains other coverage under a
8    group health plan or health insurance coverage
9    substantially similar to or better than a Plan policy as an
10    insured or covered dependent or would be eligible to have
11    that coverage if he or she elected to obtain it. Persons
12    otherwise eligible for Plan coverage may, however, solely
13    for the purpose of having coverage for a pre-existing
14    condition, maintain other coverage only while satisfying
15    any pre-existing condition waiting period under a Plan
16    policy or a subsequent replacement policy of a Plan policy.
17        (1.1) His or her prior coverage under a group health
18    plan or health insurance coverage, provided or arranged by
19    an employer of more than 10 employees was discontinued for
20    any reason without the entire group or plan being
21    discontinued and not replaced, provided he or she remains
22    an employee, or dependent thereof, of the same employer.
23        (2) He or she is a recipient of or is approved to
24    receive medical assistance, except that a person may
25    continue to receive medical assistance through the medical
26    assistance no grant program, but only while satisfying the

 

 

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1    requirements for a preexisting condition under Section 8,
2    subsection f. of this Act. Payment of premiums pursuant to
3    this Act shall be allocable to the person's spenddown for
4    purposes of the medical assistance no grant program, but
5    that person shall not be eligible for any Plan benefits
6    while that person remains eligible for medical assistance.
7    If the person continues to receive or be approved to
8    receive medical assistance through the medical assistance
9    no grant program at or after the time that requirements for
10    a preexisting condition are satisfied, the person shall not
11    be eligible for coverage under the Plan. In that
12    circumstance, coverage under the plan shall terminate as of
13    the expiration of the preexisting condition limitation
14    period. Under all other circumstances, coverage under the
15    Plan shall automatically terminate as of the effective date
16    of any medical assistance.
17        (3) Except as provided in Section 15, the person has
18    previously participated in the Plan and voluntarily
19    terminated Plan coverage, unless 12 months have elapsed
20    since the person's latest voluntary termination of
21    coverage.
22        (4) The person fails to pay the required premium under
23    the covered person's terms of enrollment and
24    participation, in which event the liability of the Plan
25    shall be limited to benefits incurred under the Plan for
26    the time period for which premiums had been paid and the

 

 

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1    covered person remained eligible for Plan coverage.
2        (5) The Plan has paid a total of $5,000,000 in benefits
3    on behalf of the covered person.
4        (6) The person is a resident of a public institution.
5        (7) The person's premium is paid for or reimbursed
6    under any government sponsored program or by any government
7    agency or health care provider, except as an otherwise
8    qualifying full-time employee, or dependent of such
9    employee, of a government agency or health care provider
10    or, except when a person's premium is paid by the U.S.
11    Treasury Department pursuant to the federal Trade Act of
12    2002.
13        (8) The person has or later receives other benefits or
14    funds from any settlement, judgement, or award resulting
15    from any accident or injury, regardless of the date of the
16    accident or injury, or any other circumstances creating a
17    legal liability for damages due that person by a third
18    party, whether the settlement, judgment, or award is in the
19    form of a contract, agreement, or trust on behalf of a
20    minor or otherwise and whether the settlement, judgment, or
21    award is payable to the person, his or her dependent,
22    estate, personal representative, or guardian in a lump sum
23    or over time, so long as there continues to be benefits or
24    assets remaining from those sources in an amount in excess
25    of $300,000.
26        (9) Within the 5 years prior to the date a person's

 

 

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1    Plan application is received by the Board, the person's
2    coverage under any health care benefit program as defined
3    in 18 U.S.C. 24, including any public or private plan or
4    contract under which any medical benefit, item, or service
5    is provided, was terminated as a result of any act or
6    practice that constitutes fraud under State or federal law
7    or as a result of an intentional misrepresentation of
8    material fact; or if that person knowingly and willfully
9    obtained or attempted to obtain, or fraudulently aided or
10    attempted to aid any other person in obtaining, any
11    coverage or benefits under the Plan to which that person
12    was not entitled.
13    f. The board or the administrator shall require
14verification of residency and may require any additional
15information or documentation, or statements under oath, when
16necessary to determine residency upon initial application and
17for the entire term of the policy.
18    g. Coverage shall cease (i) on the date a person is no
19longer a resident of Illinois, (ii) on the date a person
20requests coverage to end, (iii) upon the death of the covered
21person, (iv) on the date State law requires cancellation of the
22policy, or (v) at the Plan's option, 30 days after the Plan
23makes any inquiry concerning a person's eligibility or place of
24residence to which the person does not reply.
25    h. Except under the conditions set forth in subsection g of
26this Section, the coverage of any person who ceases to meet the

 

 

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1eligibility requirements of this Section shall be terminated at
2the end of the current policy period for which the necessary
3premiums have been paid.
4(Source: P.A. 95-547, eff. 8-29-07; 96-938, eff. 6-24-10.)
 
5    Section 99. Effective date. This Act takes effect upon
6becoming law.