093_SB0783enr
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1 AN ACT in relation to insurance.
2 Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
4 Section 5. The Comprehensive Health Insurance Plan Act
5 is amended by changing Sections 2, 3, and 15 as follows:
6 (215 ILCS 105/2) (from Ch. 73, par. 1302)
7 Sec. 2. Definitions. As used in this Act, unless the
8 context otherwise requires:
9 "Plan administrator" means the insurer or third party
10 administrator designated under Section 5 of this Act.
11 "Benefits plan" means the coverage to be offered by the
12 Plan to eligible persons and federally eligible individuals
13 pursuant to this Act.
14 "Board" means the Illinois Comprehensive Health Insurance
15 Board.
16 "Church plan" has the same meaning given that term in the
17 federal Health Insurance Portability and Accountability Act
18 of 1996.
19 "Continuation coverage" means continuation of coverage
20 under a group health plan or other health insurance coverage
21 for former employees or dependents of former employees that
22 would otherwise have terminated under the terms of that
23 coverage pursuant to any continuation provisions under
24 federal or State law, including the Consolidated Omnibus
25 Budget Reconciliation Act of 1985 (COBRA), as amended,
26 Sections 367.2, 367e, and 367e.1 of the Illinois Insurance
27 Code, or any other similar requirement in another State.
28 "Covered person" means a person who is and continues to
29 remain eligible for Plan coverage and is covered under one of
30 the benefit plans offered by the Plan.
31 "Creditable coverage" means, with respect to a federally
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1 eligible individual, coverage of the individual under any of
2 the following:
3 (A) A group health plan.
4 (B) Health insurance coverage (including group
5 health insurance coverage).
6 (C) Medicare.
7 (D) Medical assistance.
8 (E) Chapter 55 of title 10, United States Code.
9 (F) A medical care program of the Indian Health
10 Service or of a tribal organization.
11 (G) A state health benefits risk pool.
12 (H) A health plan offered under Chapter 89 of title
13 5, United States Code.
14 (I) A public health plan (as defined in regulations
15 consistent with Section 104 of the Health Care
16 Portability and Accountability Act of 1996 that may be
17 promulgated by the Secretary of the U.S. Department of
18 Health and Human Services).
19 (J) A health benefit plan under Section 5(e) of the
20 Peace Corps Act (22 U.S.C. 2504(e)).
21 (K) Any other qualifying coverage required by the
22 federal Health Insurance Portability and Accountability
23 Act of 1996, as it may be amended, or regulations under
24 that Act.
25 "Creditable coverage" does not include coverage
26 consisting solely of coverage of excepted benefits, as
27 defined in Section 2791(c) of title XXVII of the Public
28 Health Service Act (42 U.S.C. 300 gg-91), nor does it include
29 any period of coverage under any of items (A) through (K)
30 that occurred before a break of more than 90 days or, if
31 after September 30, 2003, the individual has either been
32 certified as eligible pursuant to the federal Trade Act of
33 2002 or initially been paid a benefit by the Pension Benefit
34 Guaranty Corporation, a break of more than 63 days during all
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1 of which the individual was not covered under any of items
2 (A) through (K) above.
3 For an individual who between December 1, 2002 and
4 September 30, 2003 has either (1) been certified as eligible
5 pursuant to the federal Trade Act of 2002, (2) initially been
6 paid a benefit by the Pension Benefit Guaranty Corporation,
7 or (3) as of December 1, 2002, been receiving benefits from
8 the Pension Benefit Guaranty Corporation and who has
9 qualified health insurance, as defined by the federal Trade
10 Act of 2002, "creditable coverage" includes any period of
11 coverage aggregating 3 or more months under any of items (A)
12 through (K), irrespective of the length of a break during all
13 of which the individual was not covered under any of items
14 (A) through (K).
15 Any period that an individual is in a waiting period for
16 any coverage under a group health plan (or for group health
17 insurance coverage) or is in an affiliation period under the
18 terms of health insurance coverage offered by a health
19 maintenance organization shall not be taken into account in
20 determining if there has been a break of more than 90 days in
21 any creditable coverage.
22 "Department" means the Illinois Department of Insurance.
23 "Dependent" means an Illinois resident: who is a spouse;
24 or who is claimed as a dependent by the principal insured for
25 purposes of filing a federal income tax return and resides in
26 the principal insured's household, and is a resident
27 unmarried child under the age of 19 years; or who is an
28 unmarried child who also is a full-time student under the age
29 of 23 years and who is financially dependent upon the
30 principal insured; or who is a child of any age and who is
31 disabled and financially dependent upon the principal
32 insured.
33 "Direct Illinois premiums" means, for Illinois business,
34 an insurer's direct premium income for the kinds of business
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1 described in clause (b) of Class 1 or clause (a) of Class 2
2 of Section 4 of the Illinois Insurance Code, and direct
3 premium income of a health maintenance organization or a
4 voluntary health services plan, except it shall not include
5 credit health insurance as defined in Article IX 1/2 of the
6 Illinois Insurance Code.
7 "Director" means the Director of the Illinois Department
8 of Insurance.
9 "Eligible person" means a resident of this State who
10 qualifies for Plan coverage under Section 7 of this Act.
11 "Employee" means a resident of this State who is employed
12 by an employer or has entered into the employment of or works
13 under contract or service of an employer including the
14 officers, managers and employees of subsidiary or affiliated
15 corporations and the individual proprietors, partners and
16 employees of affiliated individuals and firms when the
17 business of the subsidiary or affiliated corporations, firms
18 or individuals is controlled by a common employer through
19 stock ownership, contract, or otherwise.
20 "Employer" means any individual, partnership,
21 association, corporation, business trust, or any person or
22 group of persons acting directly or indirectly in the
23 interest of an employer in relation to an employee, for which
24 one or more persons is gainfully employed.
25 "Family" coverage means the coverage provided by the Plan
26 for the covered person and his or her eligible dependents who
27 also are covered persons.
28 "Federally eligible individual" means an individual
29 resident of this State:
30 (1)(A) for whom, as of the date on which the
31 individual seeks Plan coverage under Section 15 of this
32 Act, the aggregate of the periods of creditable coverage
33 is 18 or more months or, if the individual has either (i)
34 been certified as eligible pursuant to the federal Trade
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1 Act of 2002, (ii) initially been paid a benefit by the
2 Pension Benefit Guaranty Corporation, or (iii) as of
3 December 1, 2002, been receiving benefits from the
4 Pension Benefit Guaranty Corporation and has qualified
5 health insurance, as defined by the federal Trade Act of
6 2002, 3 or more months, and (B) whose most recent prior
7 creditable coverage was under group health insurance
8 coverage offered by a health insurance issuer, a group
9 health plan, a governmental plan, or a church plan (or
10 health insurance coverage offered in connection with any
11 such plans) or any other type of creditable coverage that
12 may be required by the federal Health Insurance
13 Portability and Accountability Act of 1996, as it may be
14 amended, or the regulations under that Act;
15 (2) who is not eligible for coverage under (A) a
16 group health plan (other than an individual who has been
17 certified as eligible pursuant to the federal Trade Act
18 of 2002), (B) part A or part B of Medicare due to age
19 (other than an individual who has been certified as
20 eligible pursuant to the federal Trade Act of 2002), or
21 (C) medical assistance, and does not have other health
22 insurance coverage (other than an individual who has been
23 certified as eligible pursuant to the federal Trade Act
24 of 2002);
25 (3) with respect to whom (other than an individual
26 who has been certified as eligible pursuant to the
27 federal Trade Act of 2002) the most recent coverage
28 within the coverage period described in paragraph (1)(A)
29 of this definition was not terminated based upon a factor
30 relating to nonpayment of premiums or fraud;
31 (4) if the individual (other than an individual who
32 has either (A) been certified as eligible pursuant to the
33 federal Trade Act of 2002, (B) initially been paid a
34 benefit by the Pension Benefit Guaranty Corporation, or
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1 (C) as of December 1, 2002, been receiving benefits from
2 the Pension Benefit Guaranty Corporation and who has
3 qualified health insurance, as defined by the federal
4 Trade Act of 2002) had been offered the option of
5 continuation coverage under a COBRA continuation
6 provision or under a similar State program, who elected
7 such coverage; and
8 (5) who, if the individual elected such
9 continuation coverage, has exhausted such continuation
10 coverage under such provision or program.
11 However, an individual who has either been certified as
12 eligible pursuant to the federal Trade Act of 2002 or
13 initially been paid a benefit by the Pension Benefit Guaranty
14 Corporation shall not be required to elect continuation
15 coverage under a COBRA continuation provision or under a
16 similar state program.
17 "Group health insurance coverage" means, in connection
18 with a group health plan, health insurance coverage offered
19 in connection with that plan.
20 "Group health plan" has the same meaning given that term
21 in the federal Health Insurance Portability and
22 Accountability Act of 1996.
23 "Governmental plan" has the same meaning given that term
24 in the federal Health Insurance Portability and
25 Accountability Act of 1996.
26 "Health insurance coverage" means benefits consisting of
27 medical care (provided directly, through insurance or
28 reimbursement, or otherwise and including items and services
29 paid for as medical care) under any hospital and medical
30 expense-incurred policy, certificate, or contract provided by
31 an insurer, non-profit health care service plan contract,
32 health maintenance organization or other subscriber contract,
33 or any other health care plan or arrangement that pays for or
34 furnishes medical or health care services whether by
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1 insurance or otherwise. Health insurance coverage shall not
2 include short term, accident only, disability income,
3 hospital confinement or fixed indemnity, dental only, vision
4 only, limited benefit, or credit insurance, coverage issued
5 as a supplement to liability insurance, insurance arising out
6 of a workers' compensation or similar law, automobile
7 medical-payment insurance, or insurance under which benefits
8 are payable with or without regard to fault and which is
9 statutorily required to be contained in any liability
10 insurance policy or equivalent self-insurance.
11 "Health insurance issuer" means an insurance company,
12 insurance service, or insurance organization (including a
13 health maintenance organization and a voluntary health
14 services plan) that is authorized to transact health
15 insurance business in this State. Such term does not include
16 a group health plan.
17 "Health Maintenance Organization" means an organization
18 as defined in the Health Maintenance Organization Act.
19 "Hospice" means a program as defined in and licensed
20 under the Hospice Program Licensing Act.
21 "Hospital" means a duly licensed institution as defined
22 in the Hospital Licensing Act, an institution that meets all
23 comparable conditions and requirements in effect in the state
24 in which it is located, or the University of Illinois
25 Hospital as defined in the University of Illinois Hospital
26 Act.
27 "Individual health insurance coverage" means health
28 insurance coverage offered to individuals in the individual
29 market, but does not include short-term, limited-duration
30 insurance.
31 "Insured" means any individual resident of this State who
32 is eligible to receive benefits from any insurer (including
33 health insurance coverage offered in connection with a group
34 health plan) or health insurance issuer as defined in this
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1 Section.
2 "Insurer" means any insurance company authorized to
3 transact health insurance business in this State and any
4 corporation that provides medical services and is organized
5 under the Voluntary Health Services Plans Act or the Health
6 Maintenance Organization Act.
7 "Medical assistance" means the State medical assistance
8 or medical assistance no grant (MANG) programs provided under
9 Title XIX of the Social Security Act and Articles V (Medical
10 Assistance) and VI (General Assistance) of the Illinois
11 Public Aid Code (or any successor program) or under any
12 similar program of health care benefits in a state other than
13 Illinois.
14 "Medically necessary" means that a service, drug, or
15 supply is necessary and appropriate for the diagnosis or
16 treatment of an illness or injury in accord with generally
17 accepted standards of medical practice at the time the
18 service, drug, or supply is provided. When specifically
19 applied to a confinement it further means that the diagnosis
20 or treatment of the covered person's medical symptoms or
21 condition cannot be safely provided to that person as an
22 outpatient. A service, drug, or supply shall not be medically
23 necessary if it: (i) is investigational, experimental, or for
24 research purposes; or (ii) is provided solely for the
25 convenience of the patient, the patient's family, physician,
26 hospital, or any other provider; or (iii) exceeds in scope,
27 duration, or intensity that level of care that is needed to
28 provide safe, adequate, and appropriate diagnosis or
29 treatment; or (iv) could have been omitted without adversely
30 affecting the covered person's condition or the quality of
31 medical care; or (v) involves the use of a medical device,
32 drug, or substance not formally approved by the United States
33 Food and Drug Administration.
34 "Medical care" means the ordinary and usual professional
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1 services rendered by a physician or other specified provider
2 during a professional visit for treatment of an illness or
3 injury.
4 "Medicare" means coverage under both Part A and Part B of
5 Title XVIII of the Social Security Act, 42 U.S.C. Sec. 1395,
6 et seq.
7 "Minimum premium plan" means an arrangement whereby a
8 specified amount of health care claims is self-funded, but
9 the insurance company assumes the risk that claims will
10 exceed that amount.
11 "Participating transplant center" means a hospital
12 designated by the Board as a preferred or exclusive provider
13 of services for one or more specified human organ or tissue
14 transplants for which the hospital has signed an agreement
15 with the Board to accept a transplant payment allowance for
16 all expenses related to the transplant during a transplant
17 benefit period.
18 "Physician" means a person licensed to practice medicine
19 pursuant to the Medical Practice Act of 1987.
20 "Plan" means the Comprehensive Health Insurance Plan
21 established by this Act.
22 "Plan of operation" means the plan of operation of the
23 Plan, including articles, bylaws and operating rules, adopted
24 by the board pursuant to this Act.
25 "Provider" means any hospital, skilled nursing facility,
26 hospice, home health agency, physician, registered pharmacist
27 acting within the scope of that registration, or any other
28 person or entity licensed in Illinois to furnish medical
29 care.
30 "Qualified high risk pool" has the same meaning given
31 that term in the federal Health Insurance Portability and
32 Accountability Act of 1996.
33 "Resident" means a person who is and continues to be
34 legally domiciled and physically residing on a permanent and
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1 full-time basis in a place of permanent habitation in this
2 State that remains that person's principal residence and from
3 which that person is absent only for temporary or transitory
4 purpose.
5 "Skilled nursing facility" means a facility or that
6 portion of a facility that is licensed by the Illinois
7 Department of Public Health under the Nursing Home Care Act
8 or a comparable licensing authority in another state to
9 provide skilled nursing care.
10 "Stop-loss coverage" means an arrangement whereby an
11 insurer insures against the risk that any one claim will
12 exceed a specific dollar amount or that the entire loss of a
13 self-insurance plan will exceed a specific amount.
14 "Third party administrator" means an administrator as
15 defined in Section 511.101 of the Illinois Insurance Code who
16 is licensed under Article XXXI 1/4 of that Code.
17 (Source: P.A. 92-153, eff. 7-25-01; 93-33, eff. 6-23-03;
18 93-34, eff. 6-23-03; 93-477, eff. 8-8-03; revised 8-21-03.)
19 (215 ILCS 105/3) (from Ch. 73, par. 1303)
20 Sec. 3. Operation of the Plan.
21 a. There is hereby created an Illinois Comprehensive
22 Health Insurance Plan.
23 b. The Plan shall operate subject to the supervision and
24 control of the board. The board is created as a political
25 subdivision and body politic and corporate and, as such, is
26 not a State agency. The board shall consist of 10 public
27 members, appointed by the Governor with the advice and
28 consent of the Senate.
29 Initial members shall be appointed to the Board by the
30 Governor as follows: 2 members to serve until July 1, 1988,
31 and until their successors are appointed and qualified; 2
32 members to serve until July 1, 1989, and until their
33 successors are appointed and qualified; 3 members to serve
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1 until July 1, 1990, and until their successors are appointed
2 and qualified; and 3 members to serve until July 1, 1991, and
3 until their successors are appointed and qualified. As terms
4 of initial members expire, their successors shall be
5 appointed for terms to expire the first day in July 3 years
6 thereafter, and until their successors are appointed and
7 qualified.
8 Any vacancy in the Board occurring for any reason other
9 than the expiration of a term shall be filled for the
10 unexpired term in the same manner as the original
11 appointment.
12 Any member of the Board may be removed by the Governor
13 for neglect of duty, misfeasance, malfeasance, or nonfeasance
14 in office.
15 In addition, a representative of the Governor's Office of
16 Management and Budget Bureau of the Budget, a representative
17 of the Office of the Attorney General and the Director or the
18 Director's designated representative shall be members of the
19 board. Four members of the General Assembly, one each
20 appointed by the President and Minority Leader of the Senate
21 and by the Speaker and Minority Leader of the House of
22 Representatives, shall serve as nonvoting members of the
23 board. At least 2 of the public members shall be individuals
24 reasonably expected to qualify for coverage under the Plan,
25 the parent or spouse of such an individual, or a surviving
26 family member of an individual who could have qualified for
27 the plan during his lifetime. The Director or Director's
28 representative shall be the chairperson of the board.
29 Members of the board shall receive no compensation, but shall
30 be reimbursed for reasonable expenses incurred in the
31 necessary performance of their duties.
32 c. The board shall make an annual report in September
33 and shall file the report with the Secretary of the Senate
34 and the Clerk of the House of Representatives. The report
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1 shall summarize the activities of the Plan in the preceding
2 calendar year, including net written and earned premiums, the
3 expense of administration, the paid and incurred losses for
4 the year and other information as may be requested by the
5 General Assembly. The report shall also include analysis and
6 recommendations regarding utilization review, quality
7 assurance and access to cost effective quality health care.
8 d. In its plan of operation the board shall:
9 (1) Establish procedures for selecting a plan
10 administrator in accordance with Section 5 of this Act.
11 (2) Establish procedures for the operation of the
12 board.
13 (3) Create a Plan fund, under management of the
14 board, to fund administrative, claim, and other expenses
15 of the Plan.
16 (4) Establish procedures for the handling and
17 accounting of assets and monies of the Plan.
18 (5) Develop and implement a program to publicize
19 the existence of the Plan, the eligibility requirements
20 and procedures for enrollment and to maintain public
21 awareness of the Plan.
22 (6) Establish procedures under which applicants and
23 participants may have grievances reviewed by a grievance
24 committee appointed by the board. The grievances shall
25 be reported to the board immediately after completion of
26 the review. The Department and the board shall retain
27 all written complaints regarding the Plan for at least 3
28 years. Oral complaints shall be reduced to written form
29 and maintained for at least 3 years.
30 (7) Provide for other matters as may be necessary
31 and proper for the execution of its powers, duties and
32 obligations under the Plan.
33 e. No later than 5 years after the Plan is operative the
34 board and the Department shall conduct cooperatively a study
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1 of the Plan and the persons insured by the Plan to determine:
2 (1) claims experience including a breakdown of medical
3 conditions for which claims were paid; (2) whether
4 availability of the Plan affected employment opportunities
5 for participants; (3) whether availability of the Plan
6 affected the receipt of medical assistance benefits by Plan
7 participants; (4) whether a change occurred in the number of
8 personal bankruptcies due to medical or other health related
9 costs; (5) data regarding all complaints received about the
10 Plan including its operation and services; (6) and any other
11 significant observations regarding utilization of the Plan.
12 The study shall culminate in a written report to be presented
13 to the Governor, the President of the Senate, the Speaker of
14 the House and the chairpersons of the House and Senate
15 Insurance Committees. The report shall be filed with the
16 Secretary of the Senate and the Clerk of the House of
17 Representatives. The report shall also be available to
18 members of the general public upon request.
19 f. The board may:
20 (1) Prepare and distribute certificate of
21 eligibility forms and enrollment instruction forms to
22 insurance producers and to the general public in this
23 State.
24 (2) Provide for reinsurance of risks incurred by
25 the Plan and enter into reinsurance agreements with
26 insurers to establish a reinsurance plan for risks of
27 coverage described in the Plan, or obtain commercial
28 reinsurance to reduce the risk of loss through the Plan.
29 (3) Issue additional types of health insurance
30 policies to provide optional coverages as are otherwise
31 permitted by this Act including a Medicare supplement
32 policy designed to supplement Medicare.
33 (4) Provide for and employ cost containment
34 measures and requirements including, but not limited to,
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1 preadmission certification, second surgical opinion,
2 concurrent utilization review programs, and individual
3 case management for the purpose of making the pool more
4 cost effective.
5 (5) Design, utilize, contract, or otherwise arrange
6 for the delivery of cost effective health care services,
7 including establishing or contracting with preferred
8 provider organizations, health maintenance organizations,
9 and other limited network provider arrangements.
10 (6) Adopt bylaws, rules, regulations, policies and
11 procedures as may be necessary or convenient for the
12 implementation of the Act and the operation of the Plan.
13 (7) Administer separate pools, separate accounts,
14 or other plans or arrangements as required by this Act to
15 separate federally eligible individuals or groups of
16 federally eligible individuals who qualify for plan
17 coverage under Section 15 of this Act from eligible
18 persons or groups of eligible persons who qualify for
19 plan coverage under Section 7 of this Act and apportion
20 the costs of the administration among such separate
21 pools, separate accounts, or other plans or arrangements.
22 g. The Director may, by rule, establish additional
23 powers and duties of the board and may adopt rules for any
24 other purposes, including the operation of the Plan, as are
25 necessary or proper to implement this Act.
26 h. The board is not liable for any obligation of the
27 Plan. There is no liability on the part of any member or
28 employee of the board or the Department, and no cause of
29 action of any nature may arise against them, for any action
30 taken or omission made by them in the performance of their
31 powers and duties under this Act, unless the action or
32 omission constitutes willful or wanton misconduct. The board
33 may provide in its bylaws or rules for indemnification of,
34 and legal representation for, its members and employees.
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1 i. There is no liability on the part of any insurance
2 producer for the failure of any applicant to be accepted by
3 the Plan unless the failure of the applicant to be accepted
4 by the Plan is due to an act or omission by the insurance
5 producer which constitutes willful or wanton misconduct.
6 (Source: P.A. 92-597, eff. 6-28-02; revised 8-23-03.)
7 (215 ILCS 105/15)
8 Sec. 15. Alternative portable coverage for federally
9 eligible individuals.
10 (a) Notwithstanding the requirements of subsection a. of
11 Section 7 and except as otherwise provided in this Section,
12 any federally eligible individual for whom a Plan
13 application, and such enclosures and supporting documentation
14 as the Board may require, is received by the Board within 90
15 days after the termination of prior creditable coverage shall
16 qualify to enroll in the Plan under the portability
17 provisions of this Section.
18 A federally eligible person who between December 1, 2002
19 and September 30, 2003 has either (1) been certified as
20 eligible pursuant to the federal Trade Act of 2002, (2)
21 initially been paid a benefit by the Pension Benefit Guaranty
22 Corporation, or (3) as of December 1, 2002, been receiving
23 benefits from the Pension Benefit Guaranty Corporation, who
24 has qualified health insurance, as defined by the federal
25 Trade Act of 2002, and whose Plan application and enclosures
26 and supporting documentation, as the Board may require, is
27 received by the Board after the termination of previous
28 creditable coverage shall qualify to enroll in the Plan under
29 the portability provisions of this Section.
30 A federally eligible person who, after September 30,
31 2003, has either been certified as eligible pursuant to the
32 federal Trade Act of 2002 or initially been paid a benefit by
33 the Pension Benefit Guaranty Corporation and whose Plan
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1 application and enclosures and supporting documentation as
2 the Board may require is received by the Board within 63 days
3 after the termination of previous creditable coverage shall
4 qualify to enroll in the Plan under the portability
5 provisions of this Section.
6 (b) Any federally eligible individual seeking Plan
7 coverage under this Section must submit with his or her
8 application evidence, including acceptable written
9 certification of previous creditable coverage, that will
10 establish to the Board's satisfaction, that he or she meets
11 all of the requirements to be a federally eligible individual
12 and is currently and permanently residing in this State (as
13 of the date his or her application was received by the
14 Board).
15 (c) Except as otherwise provided in this Section, a
16 period of creditable coverage shall not be counted, with
17 respect to qualifying an applicant for Plan coverage as a
18 federally eligible individual under this Section, if after
19 such period and before the application for Plan coverage was
20 received by the Board, there was at least a 90 day period
21 during all of which the individual was not covered under any
22 creditable coverage.
23 For a federally eligible person who between December 1,
24 2002 and September 30, 2003 has either (1) been certified as
25 eligible pursuant to the federal Trade Act of 2002, (2)
26 initially been paid a benefit by the Pension Benefit Guaranty
27 Corporation, or (3) as of December 1, 2002, been receiving
28 benefits from the Pension Benefit Guaranty Corporation and
29 who has qualified health insurance, as defined by the federal
30 Trade Act of 2002, a period of creditable coverage shall be
31 counted, with respect to qualifying an applicant for Plan
32 coverage as a federally eligible individual under this
33 Section, when the application for Plan coverage was received
34 by the Board.
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1 For a federally eligible person who, after September 30,
2 2003, has either been certified as eligible pursuant to the
3 federal Trade Act of 2002 or initially been paid a benefit by
4 the Pension Benefit Guaranty Corporation, a period of
5 creditable coverage shall not be counted, with respect to
6 qualifying an applicant for Plan coverage as a federally
7 eligible individual under this Section, if after such period
8 and before the application for Plan coverage was received by
9 the Board, there was at least a 63 day period during all of
10 which the individual was not covered under any creditable
11 coverage.
12 (d) Any federally eligible individual who the Board
13 determines qualifies for Plan coverage under this Section
14 shall be offered his or her choice of enrolling in one of
15 alternative portability health benefit plans which the Board
16 is authorized under this Section to establish for these
17 federally eligible individuals and their dependents.
18 (e) The Board shall offer a choice of health care
19 coverages consistent with major medical coverage under the
20 alternative health benefit plans authorized by this Section
21 to every federally eligible individual. The coverages to be
22 offered under the plans, the schedule of benefits,
23 deductibles, co-payments, exclusions, and other limitations
24 shall be approved by the Board. One optional form of
25 coverage shall be comparable to comprehensive health
26 insurance coverage offered in the individual market in this
27 State or a standard option of coverage available under the
28 group or individual health insurance laws of the State. The
29 standard benefit plan that is authorized by Section 8 of this
30 Act may be used for this purpose. The Board may also offer a
31 preferred provider option and such other options as the Board
32 determines may be appropriate for these federally eligible
33 individuals who qualify for Plan coverage pursuant to this
34 Section.
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1 (f) Notwithstanding the requirements of subsection f. of
2 Section 8, any plan coverage that is issued to federally
3 eligible individuals who qualify for the Plan pursuant to the
4 portability provisions of this Section shall not be subject
5 to any preexisting conditions exclusion, waiting period, or
6 other similar limitation on coverage.
7 (g) Federally eligible individuals who qualify and
8 enroll in the Plan pursuant to this Section shall be required
9 to pay such premium rates as the Board shall establish and
10 approve in accordance with the requirements of Section 7.1 of
11 this Act.
12 (h) A federally eligible individual who qualifies and
13 enrolls in the Plan pursuant to this Section must satisfy on
14 an ongoing basis all of the other eligibility requirements of
15 this Act to the extent not inconsistent with the federal
16 Health Insurance Portability and Accountability Act of 1996
17 in order to maintain continued eligibility for coverage under
18 the Plan.
19 (Source: P.A. 92-153, eff. 7-25-01; 93-33, eff. 6-23-03;
20 93-34, eff. 6-23-03.)
21 Section 99. Effective date. This Act takes effect upon
22 becoming law.