Illinois General Assembly - Full Text of HB3462
Illinois General Assembly

Previous General Assemblies

Full Text of HB3462  97th General Assembly


Sen. Heather A. Steans

Filed: 10/27/2011





09700HB3462sam001LRB097 10590 AMC 59151 a


2    AMENDMENT NO. ______. Amend House Bill 3462 by replacing
3everything after the enacting clause with the following:
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



09700HB3462sam001- 2 -LRB097 10590 AMC 59151 a

1    for health reasons by a health insurance issuer; or
2        (2) A refusal by a health insurance issuer to issue
3    individual health insurance coverage except at a rate
4    exceeding the applicable Plan rate for which the person is
5    responsible; or .
6        (3) The absence of available health insurance coverage
7    for a person under 19 years of age.
8    A rejection or refusal by a group health plan or health
9insurance issuer offering only stop-loss or excess of loss
10insurance or contracts, agreements, or other arrangements for
11reinsurance coverage with respect to the applicant shall not be
12sufficient evidence under this subsection.
13    b. The board shall promulgate a list of medical or health
14conditions for which a person who is either a citizen of the
15United States or an alien lawfully admitted for permanent
16residence and a resident of this State would be eligible for
17Plan coverage without applying for health insurance coverage
18pursuant to subsection a. of this Section. Persons who can
19demonstrate the existence or history of any medical or health
20conditions on the list promulgated by the board shall not be
21required to provide the evidence specified in subsection a. of
22this Section. The list shall be effective on the first day of
23the operation of the Plan and may be amended from time to time
24as appropriate.
25    c. Family members of the same household who each are
26covered persons are eligible for optional family coverage under



09700HB3462sam001- 3 -LRB097 10590 AMC 59151 a

1the Plan.
2    d. For persons qualifying for coverage in accordance with
3Section 7 of this Act, the board shall, if it determines that
4such appropriations as are made pursuant to Section 12 of this
5Act are insufficient to allow the board to accept all of the
6eligible persons which it projects will apply for enrollment
7under the Plan, limit or close enrollment to ensure that the
8Plan is not over-subscribed and that it has sufficient
9resources to meet its obligations to existing enrollees. The
10board shall not limit or close enrollment for federally
11eligible individuals.
12    e. A person shall not be eligible for coverage under the
13Plan if:
14        (1) He or she has or obtains other coverage under a
15    group health plan or health insurance coverage
16    substantially similar to or better than a Plan policy as an
17    insured or covered dependent or would be eligible to have
18    that coverage if he or she elected to obtain it. Persons
19    otherwise eligible for Plan coverage may, however, solely
20    for the purpose of having coverage for a pre-existing
21    condition, maintain other coverage only while satisfying
22    any pre-existing condition waiting period under a Plan
23    policy or a subsequent replacement policy of a Plan policy.
24        (1.1) His or her prior coverage under a group health
25    plan or health insurance coverage, provided or arranged by
26    an employer of more than 10 employees was discontinued for



09700HB3462sam001- 4 -LRB097 10590 AMC 59151 a

1    any reason without the entire group or plan being
2    discontinued and not replaced, provided he or she remains
3    an employee, or dependent thereof, of the same employer.
4        (2) He or she is a recipient of or is approved to
5    receive medical assistance, except that a person may
6    continue to receive medical assistance through the medical
7    assistance no grant program, but only while satisfying the
8    requirements for a preexisting condition under Section 8,
9    subsection f. of this Act. Payment of premiums pursuant to
10    this Act shall be allocable to the person's spenddown for
11    purposes of the medical assistance no grant program, but
12    that person shall not be eligible for any Plan benefits
13    while that person remains eligible for medical assistance.
14    If the person continues to receive or be approved to
15    receive medical assistance through the medical assistance
16    no grant program at or after the time that requirements for
17    a preexisting condition are satisfied, the person shall not
18    be eligible for coverage under the Plan. In that
19    circumstance, coverage under the plan shall terminate as of
20    the expiration of the preexisting condition limitation
21    period. Under all other circumstances, coverage under the
22    Plan shall automatically terminate as of the effective date
23    of any medical assistance.
24        (3) Except as provided in Section 15, the person has
25    previously participated in the Plan and voluntarily
26    terminated Plan coverage, unless 12 months have elapsed



09700HB3462sam001- 5 -LRB097 10590 AMC 59151 a

1    since the person's latest voluntary termination of
2    coverage.
3        (4) The person fails to pay the required premium under
4    the covered person's terms of enrollment and
5    participation, in which event the liability of the Plan
6    shall be limited to benefits incurred under the Plan for
7    the time period for which premiums had been paid and the
8    covered person remained eligible for Plan coverage.
9        (5) The Plan has paid a total of $5,000,000 in benefits
10    on behalf of the covered person.
11        (6) The person is a resident of a public institution.
12        (7) The person's premium is paid for or reimbursed
13    under any government sponsored program or by any government
14    agency or health care provider, except as an otherwise
15    qualifying full-time employee, or dependent of such
16    employee, of a government agency or health care provider
17    or, except when a person's premium is paid by the U.S.
18    Treasury Department pursuant to the federal Trade Act of
19    2002.
20        (8) The person has or later receives other benefits or
21    funds from any settlement, judgement, or award resulting
22    from any accident or injury, regardless of the date of the
23    accident or injury, or any other circumstances creating a
24    legal liability for damages due that person by a third
25    party, whether the settlement, judgment, or award is in the
26    form of a contract, agreement, or trust on behalf of a



09700HB3462sam001- 6 -LRB097 10590 AMC 59151 a

1    minor or otherwise and whether the settlement, judgment, or
2    award is payable to the person, his or her dependent,
3    estate, personal representative, or guardian in a lump sum
4    or over time, so long as there continues to be benefits or
5    assets remaining from those sources in an amount in excess
6    of $300,000.
7        (9) Within the 5 years prior to the date a person's
8    Plan application is received by the Board, the person's
9    coverage under any health care benefit program as defined
10    in 18 U.S.C. 24, including any public or private plan or
11    contract under which any medical benefit, item, or service
12    is provided, was terminated as a result of any act or
13    practice that constitutes fraud under State or federal law
14    or as a result of an intentional misrepresentation of
15    material fact; or if that person knowingly and willfully
16    obtained or attempted to obtain, or fraudulently aided or
17    attempted to aid any other person in obtaining, any
18    coverage or benefits under the Plan to which that person
19    was not entitled.
20    f. The board or the administrator shall require
21verification of residency and may require any additional
22information or documentation, or statements under oath, when
23necessary to determine residency upon initial application and
24for the entire term of the policy.
25    g. Coverage shall cease (i) on the date a person is no
26longer a resident of Illinois, (ii) on the date a person



09700HB3462sam001- 7 -LRB097 10590 AMC 59151 a

1requests coverage to end, (iii) upon the death of the covered
2person, (iv) on the date State law requires cancellation of the
3policy, or (v) at the Plan's option, 30 days after the Plan
4makes any inquiry concerning a person's eligibility or place of
5residence to which the person does not reply.
6    h. Except under the conditions set forth in subsection g of
7this Section, the coverage of any person who ceases to meet the
8eligibility requirements of this Section shall be terminated at
9the end of the current policy period for which the necessary
10premiums have been paid.
11(Source: P.A. 95-547, eff. 8-29-07; 96-938, eff. 6-24-10.)
12    Section 99. Effective date. This Act takes effect upon
13becoming law.".