Bill Text: IL SB2493 | 2009-2010 | 96th General Assembly | Introduced

---

Bill Title: Amends the Illinois Health Insurance Portability and Accountability Act. Provides that a group health plan or a health insurance issuer offering group or individual health insurance coverage may not impose any preexisting condition exclusion. Makes conforming changes, including removing a cross-reference in the Illinois Insurance Code. Effective immediately.

Spectrum: Partisan Bill (Democrat 10-0)

Status: (Introduced - Dead) 2010-06-27 - Pursuant to Senate Rule 3-9(b) / Referred to Assignments [SB2493 Detail]

Download: Illinois-2009-SB2493-Introduced.html

---

96TH GENERAL ASSEMBLY State of Illinois 2009 and 2010 SB2493 Introduced 10/29/2009, by Sen. Terry Link SYNOPSIS AS INTRODUCED:
215 ILCS 5/356v
215 ILCS 97/20
Amends the Illinois Health Insurance Portability and Accountability Act. Provides that a group health plan or a health insurance issuer offering group or individual health insurance coverage may not impose any preexisting condition exclusion. Makes conforming changes, including removing a cross-reference in the Illinois Insurance Code. Effective immediately.
LRB096 15298 AMC 30410 b
A BILL FOR
SB2493 LRB096 15298 AMC 30410 b
AN ACT concerning insurance.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Illinois Insurance Code is amended by
changing Section 356v as follows:
(215 ILCS 5/356v)
Sec. 356v. Use of information derived from genetic testing.
After the effective date of this amendatory Act of 1997, an
insurer must comply with the provisions of the Genetic
Information Privacy Act in connection with the amendment,
delivery, issuance, or renewal of, or claims for or denial of
coverage under, an individual or group policy of accident and
health insurance. Additionally, genetic information shall not
be treated as a condition described in item (1) of subsection
(A) of Section 20 of the Illinois Health Insurance Portability
and Accountability Act in the absence of a diagnosis of the
condition related to that genetic information.
(Source: P.A. 90-25, eff. 1-1-98; 90-655, eff. 7-30-98; 91-549,
eff. 8-14-99.)
Section 10. The Illinois Health Insurance Portability and
Accountability Act is amended by changing Section 20 as
follows:

SB2493 - 2 - LRB096 15298 AMC 30410 b
(215 ILCS 97/20)
Sec. 20. Increased portability through limitation on
preexisting condition exclusions.
(A) Notwithstanding any law to the contrary, a group health
plan or a health insurance issuer offering group or individual
health insurance coverage may not impose any preexisting
condition exclusion. Limitation of preexisting condition
exclusion period; crediting for periods of previous coverage.
Subject to subsection (D), a group health plan, and a health
insurance issuer offering group health insurance coverage,
may, with respect to a participant or beneficiary, impose a
preexisting condition exclusion only if:
(1) the exclusion relates to a condition (whether
physical or mental), regardless of the cause of the
condition, for which medical advice, diagnosis, care, or
treatment was recommended or received within the 6-month
period ending on the enrollment date;
(2) the exclusion extends for a period of not more than
12 months (or 18 months in the case of a late enrollee)
after the enrollment date; and
(3) the period of any such preexisting condition
exclusion is reduced by the aggregate of the periods of
creditable coverage (if any, as defined in subsection
(C)(1)) applicable to the participant or beneficiary as of
the enrollment date.

SB2493 - 3 - LRB096 15298 AMC 30410 b
(B) (Blank). Preexisting condition exclusion. A group
health plan, and health insurance issuer offering group health
insurance coverage, may not impose any preexisting condition
exclusion relating to pregnancy as a preexisting condition.
Genetic information shall not be treated as a condition
described in subsection (A)(1) in the absence of a diagnosis of
the condition related to such information.
(C) Rules relating to crediting previous coverage.
(1) Creditable coverage defined. For purposes of this
Act, the term "creditable coverage" means, with respect to
an individual, coverage of the individual under any of the
following:
(a) A group health plan.
(b) Health insurance coverage.
(c) Part A or part B of title XVIII of the Social
Security Act.
(d) Title XIX of the Social Security Act, other
than coverage consisting solely of benefits under
Section 1928.
(e) Chapter 55 of title 10, United States Code.
(f) A medical care program of the Indian Health
Service or of a tribal organization.
(g) A State health benefits risk pool.
(h) A health plan offered under chapter 89 of title
5, United States Code.
(i) A public health plan (as defined in

SB2493 - 4 - LRB096 15298 AMC 30410 b
regulations).
(j) A health benefit plan under Section 5(e) of the
Peace Corps Act (22 U.S.C. 2504(e)).
(k) Title XXI of the federal Social Security Act,
State Children's Health Insurance Program.
Such term does not include coverage consisting solely
of coverage of excepted benefits.
(2) Excepted benefits. For purposes of this Act, the
term "excepted benefits" means benefits under one or more
of the following:
(a) Benefits not subject to requirements:
(i) Coverage only for accident, or disability
income insurance, or any combination thereof.
(ii) Coverage issued as a supplement to
liability insurance.
(iii) Liability insurance, including general
liability insurance and automobile liability
insurance.
(iv) Workers' compensation or similar
insurance.
(v) Automobile medical payment insurance.
(vi) Credit-only insurance.
(vii) Coverage for on-site medical clinics.
(viii) Other similar insurance coverage,
specified in regulations, under which benefits for
medical care are secondary or incidental to other

SB2493 - 5 - LRB096 15298 AMC 30410 b
insurance benefits.
(b) Benefits not subject to requirements if
offered separately:
(i) Limited scope dental or vision benefits.
(ii) Benefits for long-term care, nursing home
care, home health care, community-based care, or
any combination thereof.
(iii) Such other similar, limited benefits as
are specified in rules.
(c) Benefits not subject to requirements if
offered, as independent, noncoordinated benefits:
(i) Coverage only for a specified disease or
illness.
(ii) Hospital indemnity or other fixed
indemnity insurance.
(d) Benefits not subject to requirements if
offered as separate insurance policy. Medicare
supplemental health insurance (as defined under
Section 1882(g)(1) of the Social Security Act),
coverage supplemental to the coverage provided under
chapter 55 of title 10, United States Code, and similar
supplemental coverage provided to coverage under a
group health plan.
(3) Not counting periods before significant breaks in
coverage.
(a) In general. A period of creditable coverage

SB2493 - 6 - LRB096 15298 AMC 30410 b
shall not be counted, with respect to enrollment of an
individual under a group health plan, if, after such
period and before the enrollment date, there was a
63-day period during all of which the individual was
not covered under any creditable coverage.
(b) Waiting period not treated as a break in
coverage. For purposes of subparagraph (a) and
subsection (D)(3), any period that an individual is in
a waiting period for any coverage under a group health
plan (or for group health insurance coverage) or is in
an affiliation period (as defined in subsection
(G)(2)) shall not be taken into account in determining
the continuous period under subparagraph (a).
(4) Method of crediting coverage. (a) Standard method.
A Except as otherwise provided under subparagraph (b), for
purposes of applying subsection (A)(3), a group health
plan, and a health insurance issuer offering group health
insurance coverage, shall count a period of creditable
coverage without regard to the specific benefits covered
during the period.
(b) Election of alternative method. A group health
plan, or a health insurance issuer offering group
health insurance, may elect to apply subsection (A)(3)
based on coverage of benefits within each of several
classes or categories of benefits specified in
regulations rather than as provided under subparagraph

SB2493 - 7 - LRB096 15298 AMC 30410 b
(a). Such election shall be made on a uniform basis for
all participants and beneficiaries. Under such
election a group health plan or issuer shall count a
period of creditable coverage with respect to any class
or category of benefits if any level of benefits is
covered within such class or category.
(c) Plan notice. In the case of an election with
respect to a group health plan under subparagraph (b)
(whether or not health insurance coverage is provided
in connection with such plan), the plan shall:
(i) prominently state in any disclosure
statements concerning the plan, and state to each
enrollee at the time of enrollment under the plan,
that the plan has made such election; and
(ii) include in such statements a description
of the effect of this election.
(d) Issuer notice. In the case of an election under
subparagraph (b) with respect to health insurance
coverage offered by an issuer in the small or large
group market, the issuer:
(i) shall prominently state in any disclosure
statements concerning the coverage, and to each
employer at the time of the offer or sale of the
coverage, that the issuer has made such election;
and
(ii) shall include in such statements a

SB2493 - 8 - LRB096 15298 AMC 30410 b
description of the effect of such election.
(5) Establishment of period. Periods of creditable
coverage with respect to an individual shall be established
through presentation or certifications described in
subsection (E) or in such other manner as may be specified
in regulations.
(D) (Blank). Exceptions:
(1) Exclusion not applicable to certain newborns.
Subject to paragraph (3), a group health plan, and a health
insurance issuer offering group health insurance coverage,
may not impose any preexisting condition exclusion in the
case of an individual who, as of the last day of the 30-day
period beginning with the date of birth, is covered under
creditable coverage.
(2) Exclusion not applicable to certain adopted
children. Subject to paragraph (3), a group health plan,
and a health insurance issuer offering group health
insurance coverage, may not impose any preexisting
condition exclusion in the case of a child who is adopted
or placed for adoption before attaining 18 years of age and
who, as of the last day of the 30-day period beginning on
the date of the adoption or placement for adoption, is
covered under creditable coverage.
The previous sentence shall not apply to coverage
before the date of such adoption or placement for adoption.
(3) Loss if break in coverage. Paragraphs (1) and (2)

SB2493 - 9 - LRB096 15298 AMC 30410 b
shall no longer apply to an individual after the end of the
first 63-day period during all of which the individual was
not covered under any creditable coverage.
(E) Certifications and disclosure of coverage.
(1) Requirement for Certification of Period of
Creditable Coverage.
(a) A group health plan, and a health insurance
issuer offering group health insurance coverage, shall
provide the certification described in subparagraph
(b):
(i) at the time an individual ceases to be
covered under the plan or otherwise becomes
covered under a COBRA continuation provision;
(ii) in the case of an individual becoming
covered under such a provision, at the time the
individual ceases to be covered under such
provision; and
(iii) on the request on behalf of an individual
made not later than 24 months after the date of
cessation of the coverage described in clause (i)
or (ii), whichever is later.
The certification under clause (i) may be provided, to
the extent practicable, at a time consistent with
notices required under any applicable COBRA
continuation provision.
(b) The certification described in this

SB2493 - 10 - LRB096 15298 AMC 30410 b
subparagraph is a written certification of:
(i) the period of creditable coverage of the
individual under such plan and the coverage (if
any) under such COBRA continuation provision; and
(ii) the waiting period (if any) (and
affiliation period, if applicable) imposed with
respect to the individual for any coverage under
such plan.
(c) To the extent that medical care under a group
health plan consists of group health insurance
coverage, the plan is deemed to have satisfied the
certification requirement under this paragraph if the
health insurance issuer offering the coverage provides
for such certification in accordance with this
paragraph.
(2) Disclosure of information on previous benefits. In
the case of an election described in subsection (C)(4)(b)
by a group health plan or health insurance issuer, if the
plan or issuer enrolls an individual for coverage under the
plan and the individual provides a certification of
coverage of the individual under paragraph (1):
(a) upon request of such plan or issuer, the entity
which issued the certification provided by the
individual shall promptly disclose to such requesting
plan or issuer information on coverage of classes and
categories of health benefits available under such

SB2493 - 11 - LRB096 15298 AMC 30410 b
entity's plan or coverage; and
(b) such entity may charge the requesting plan or
issuer for the reasonable cost of disclosing such
information.
(3) Rules. The Department shall establish rules to
prevent an entity's failure to provide information under
paragraph (1) or (2) with respect to previous coverage of
an individual from adversely affecting any subsequent
coverage of the individual under another group health plan
or health insurance coverage.
(4) Treatment of certain plans as group health plan for
notice provision. A program under which creditable
coverage described in subparagraph (c), (d), (e), or (f) of
Section 20(C)(1) is provided shall be treated as a group
health plan for purposes of this Section.
(F) Special enrollment periods.
(1) Individuals losing other coverage. A group health
plan, and a health insurance issuer offering group health
insurance coverage in connection with a group health plan,
shall permit an employee who is eligible, but not enrolled,
for coverage under the terms of the plan (or a dependent of
such an employee if the dependent is eligible, but not
enrolled, for coverage under such terms) to enroll for
coverage under the terms of the plan if each of the
following conditions is met:
(a) The employee or dependent was covered under a

SB2493 - 12 - LRB096 15298 AMC 30410 b
group health plan or had health insurance coverage at
the time coverage was previously offered to the
employee or dependent.
(b) The employee stated in writing at such time
that coverage under a group health plan or health
insurance coverage was the reason for declining
enrollment, but only if the plan sponsor or issuer (if
applicable) required such a statement at such time and
provided the employee with notice of such requirement
(and the consequences of such requirement) at such
time.
(c) The employee's or dependent's coverage
described in subparagraph (a):
(i) was under a COBRA continuation provision
and the coverage under such provision was
exhausted; or
(ii) was not under such a provision and either
the coverage was terminated as a result of loss of
eligibility for the coverage (including as a
result of legal separation, divorce, death,
termination of employment, or reduction in the
number of hours of employment) or employer
contributions towards such coverage were
terminated.
(d) Under the terms of the plan, the employee
requests such enrollment not later than 30 days after

SB2493 - 13 - LRB096 15298 AMC 30410 b
the date of exhaustion of coverage described in
subparagraph (c)(i) or termination of coverage or
employer contributions described in subparagraph
(c)(ii).
(2) For dependent beneficiaries.
(a) In general. If:
(i) a group health plan makes coverage
available with respect to a dependent of an
individual,
(ii) the individual is a participant under the
plan (or has met any waiting period applicable to
becoming a participant under the plan and is
eligible to be enrolled under the plan but for a
failure to enroll during a previous enrollment
period), and
(iii) a person becomes such a dependent of the
individual through marriage, birth, or adoption or
placement for adoption,
then the group health plan shall provide for a
dependent special enrollment period described in
subparagraph (b) during which the person (or, if not
otherwise enrolled, the individual) may be enrolled
under the plan as a dependent of the individual, and in
the case of the birth or adoption of a child, the
spouse of the individual may be enrolled as a dependent
of the individual if such spouse is otherwise eligible

SB2493 - 14 - LRB096 15298 AMC 30410 b
for coverage.
(b) Dependent special enrollment period. A
dependent special enrollment period under this
subparagraph shall be a period of not less than 30 days
and shall begin on the later of:
(i) the date dependent coverage is made
available; or
(ii) the date of the marriage, birth, or
adoption or placement for adoption (as the case may
be) described in subparagraph (a)(iii).
(c) No waiting period. If an individual seeks to
enroll a dependent during the first 30 days of such a
dependent special enrollment period, the coverage of
the dependent shall become effective:
(i) in the case of marriage, not later than the
first day of the first month beginning after the
date the completed request for enrollment is
received;
(ii) in the case of a dependent's birth, as of
the date of such birth; or
(iii) in the case of a dependent's adoption or
placement for adoption, the date of such adoption
or placement for adoption.
(G) Use of affiliation period by HMOs as alternative to
preexisting condition exclusion.
(1) In general. A health maintenance organization

SB2493 - 15 - LRB096 15298 AMC 30410 b
which offers health insurance coverage in connection with a
group health plan and which does not impose any
pre-existing condition exclusion allowed under subsection
(A) with respect to any particular coverage option may
impose an affiliation period for such coverage option, but
only if:
(a) such period is applied uniformly without
regard to any health status-related factors; and
(b) such period does not exceed 2 months (or 3
months in the case of a late enrollee).
(2) Affiliation period.
(a) Defined. For purposes of this Act, the term
"affiliation period" means a period which, under the
terms of the health insurance coverage offered by the
health maintenance organization, must expire before
the health insurance coverage becomes effective. The
organization is not required to provide health care
services or benefits during such period and no premium
shall be charged to the participant or beneficiary for
any coverage during the period.
(b) Beginning. Such period shall begin on the
enrollment date.
(c) Runs concurrently with waiting periods. An
affiliation period under a plan shall run concurrently
with any waiting period under the plan.
(3) Alternative methods. A health maintenance

SB2493 - 16 - LRB096 15298 AMC 30410 b
organization described in paragraph (1) may use
alternative methods, from those described in such
paragraph, to address adverse selection as approved by the
Department.
(Source: P.A. 90-30, eff. 7-1-97; 90-736, eff. 8-12-98.)
Section 99. Effective date. This Act takes effect upon
becoming law.