Public Act 097-0661
HB3462 EnrolledLRB097 10590 RPM 50951 b

    AN ACT concerning insurance.
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
    Section 5. The Comprehensive Health Insurance Plan Act is
amended by changing Section 7 as follows:
    (215 ILCS 105/7)  (from Ch. 73, par. 1307)
    Sec. 7. Eligibility.
    a. Except as provided in subsection (e) of this Section or
in Section 15 of this Act, any person who is either a citizen
of the United States or an alien lawfully admitted for
permanent residence and who has been for a period of at least
180 days and continues to be a resident of this State shall be
eligible for Plan coverage under this Section if evidence is
provided of:
        (1) A notice of rejection or refusal to issue
    substantially similar individual health insurance coverage
    for health reasons by a health insurance issuer; or
        (2) A refusal by a health insurance issuer to issue
    individual health insurance coverage except at a rate
    exceeding the applicable Plan rate for which the person is
    responsible; or .
        (3) The absence of available health insurance coverage
    for a person under 19 years of age.
    A rejection or refusal by a group health plan or health
insurance issuer offering only stop-loss or excess of loss
insurance or contracts, agreements, or other arrangements for
reinsurance coverage with respect to the applicant shall not be
sufficient evidence under this subsection.
    b. The board shall promulgate a list of medical or health
conditions for which a person who is either a citizen of the
United States or an alien lawfully admitted for permanent
residence and a resident of this State would be eligible for
Plan coverage without applying for health insurance coverage
pursuant to subsection a. of this Section. Persons who can
demonstrate the existence or history of any medical or health
conditions on the list promulgated by the board shall not be
required to provide the evidence specified in subsection a. of
this Section. The list shall be effective on the first day of
the operation of the Plan and may be amended from time to time
as appropriate.
    c. Family members of the same household who each are
covered persons are eligible for optional family coverage under
the Plan.
    d. For persons qualifying for coverage in accordance with
Section 7 of this Act, the board shall, if it determines that
such appropriations as are made pursuant to Section 12 of this
Act are insufficient to allow the board to accept all of the
eligible persons which it projects will apply for enrollment
under the Plan, limit or close enrollment to ensure that the
Plan is not over-subscribed and that it has sufficient
resources to meet its obligations to existing enrollees. The
board shall not limit or close enrollment for federally
eligible individuals.
    e. A person shall not be eligible for coverage under the
Plan if:
        (1) He or she has or obtains other coverage under a
    group health plan or health insurance coverage
    substantially similar to or better than a Plan policy as an
    insured or covered dependent or would be eligible to have
    that coverage if he or she elected to obtain it. Persons
    otherwise eligible for Plan coverage may, however, solely
    for the purpose of having coverage for a pre-existing
    condition, maintain other coverage only while satisfying
    any pre-existing condition waiting period under a Plan
    policy or a subsequent replacement policy of a Plan policy.
        (1.1) His or her prior coverage under a group health
    plan or health insurance coverage, provided or arranged by
    an employer of more than 10 employees was discontinued for
    any reason without the entire group or plan being
    discontinued and not replaced, provided he or she remains
    an employee, or dependent thereof, of the same employer.
        (2) He or she is a recipient of or is approved to
    receive medical assistance, except that a person may
    continue to receive medical assistance through the medical
    assistance no grant program, but only while satisfying the
    requirements for a preexisting condition under Section 8,
    subsection f. of this Act. Payment of premiums pursuant to
    this Act shall be allocable to the person's spenddown for
    purposes of the medical assistance no grant program, but
    that person shall not be eligible for any Plan benefits
    while that person remains eligible for medical assistance.
    If the person continues to receive or be approved to
    receive medical assistance through the medical assistance
    no grant program at or after the time that requirements for
    a preexisting condition are satisfied, the person shall not
    be eligible for coverage under the Plan. In that
    circumstance, coverage under the plan shall terminate as of
    the expiration of the preexisting condition limitation
    period. Under all other circumstances, coverage under the
    Plan shall automatically terminate as of the effective date
    of any medical assistance.
        (3) Except as provided in Section 15, the person has
    previously participated in the Plan and voluntarily
    terminated Plan coverage, unless 12 months have elapsed
    since the person's latest voluntary termination of
        (4) The person fails to pay the required premium under
    the covered person's terms of enrollment and
    participation, in which event the liability of the Plan
    shall be limited to benefits incurred under the Plan for
    the time period for which premiums had been paid and the
    covered person remained eligible for Plan coverage.
        (5) The Plan has paid a total of $5,000,000 in benefits
    on behalf of the covered person.
        (6) The person is a resident of a public institution.
        (7) The person's premium is paid for or reimbursed
    under any government sponsored program or by any government
    agency or health care provider, except as an otherwise
    qualifying full-time employee, or dependent of such
    employee, of a government agency or health care provider
    or, except when a person's premium is paid by the U.S.
    Treasury Department pursuant to the federal Trade Act of
        (8) The person has or later receives other benefits or
    funds from any settlement, judgement, or award resulting
    from any accident or injury, regardless of the date of the
    accident or injury, or any other circumstances creating a
    legal liability for damages due that person by a third
    party, whether the settlement, judgment, or award is in the
    form of a contract, agreement, or trust on behalf of a
    minor or otherwise and whether the settlement, judgment, or
    award is payable to the person, his or her dependent,
    estate, personal representative, or guardian in a lump sum
    or over time, so long as there continues to be benefits or
    assets remaining from those sources in an amount in excess
    of $300,000.
        (9) Within the 5 years prior to the date a person's
    Plan application is received by the Board, the person's
    coverage under any health care benefit program as defined
    in 18 U.S.C. 24, including any public or private plan or
    contract under which any medical benefit, item, or service
    is provided, was terminated as a result of any act or
    practice that constitutes fraud under State or federal law
    or as a result of an intentional misrepresentation of
    material fact; or if that person knowingly and willfully
    obtained or attempted to obtain, or fraudulently aided or
    attempted to aid any other person in obtaining, any
    coverage or benefits under the Plan to which that person
    was not entitled.
    f. The board or the administrator shall require
verification of residency and may require any additional
information or documentation, or statements under oath, when
necessary to determine residency upon initial application and
for the entire term of the policy.
    g. Coverage shall cease (i) on the date a person is no
longer a resident of Illinois, (ii) on the date a person
requests coverage to end, (iii) upon the death of the covered
person, (iv) on the date State law requires cancellation of the
policy, or (v) at the Plan's option, 30 days after the Plan
makes any inquiry concerning a person's eligibility or place of
residence to which the person does not reply.
    h. Except under the conditions set forth in subsection g of
this Section, the coverage of any person who ceases to meet the
eligibility requirements of this Section shall be terminated at
the end of the current policy period for which the necessary
premiums have been paid.
(Source: P.A. 95-547, eff. 8-29-07; 96-938, eff. 6-24-10.)
    Section 99. Effective date. This Act takes effect upon
becoming law.

Effective Date: 01/13/2012