Bill Text: IL SB3210 | 2009-2010 | 96th General Assembly | Introduced

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Bill Title: Amends the Comprehensive Health Insurance Plan Act. Deletes language that provides that the State may subsidize the cost of health insurance coverage offered by the Comprehensive Health Insurance Plan. Makes changes to the definition of "dependent". In the provisions concerning powers and authority of the board and eligibility, changes references of "appropriated funds" to "assessments". Deletes language that provides that any deficit incurred or expected to be incurred on behalf of eligible persons who qualify for plan coverage shall be recouped by an appropriation made by the General Assembly. Makes technical changes to update Section numbering. Makes other changes. Effective immediately.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2010-03-08 - Rule 3-9(a) / Re-referred to Assignments [SB3210 Detail]

Download: Illinois-2009-SB3210-Introduced.html

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96TH GENERAL ASSEMBLY State of Illinois 2009 and 2010 SB3210 Introduced 2/9/2010, by Sen. Jeffrey M. Schoenberg SYNOPSIS AS INTRODUCED:
215 ILCS 105/1.1 from Ch. 73, par. 1301.1
215 ILCS 105/2 from Ch. 73, par. 1302
215 ILCS 105/4 from Ch. 73, par. 1304
215 ILCS 105/7 from Ch. 73, par. 1307
215 ILCS 105/12 from Ch. 73, par. 1312
Amends the Comprehensive Health Insurance Plan Act. Deletes language that provides that the State may subsidize the cost of health insurance coverage offered by the Comprehensive Health Insurance Plan. Makes changes to the definition of "dependent". In the provisions concerning powers and authority of the board and eligibility, changes references of "appropriated funds" to "assessments". Deletes language that provides that any deficit incurred or expected to be incurred on behalf of eligible persons who qualify for plan coverage shall be recouped by an appropriation made by the General Assembly. Makes technical changes to update Section numbering. Makes other changes. Effective immediately.
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FISCAL NOTE ACT MAY APPLY
A BILL FOR
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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 Sections 1.1, 2, 4, 7, and 12 as follows:
(215 ILCS 105/1.1) (from Ch. 73, par. 1301.1)
Sec. 1.1. The General Assembly hereby makes the following
findings and declarations:
(a) The Comprehensive Health Insurance Plan is established
as a State program that is intended to provide an alternate
market for health insurance for certain uninsurable Illinois
residents, and further is intended to provide an acceptable
alternative mechanism as described in the federal Health
Insurance Portability and Accountability Act of 1996 for
providing portable and accessible individual health insurance
coverage for federally eligible individuals as defined in this
Act.
(b) The State of Illinois may subsidize the cost of health
insurance coverage offered by the Plan. However, since the
State has only a limited amount of resources, the General
Assembly declares that it intends for this program to provide
portable and accessible individual health insurance coverage
for every federally eligible individual who qualifies for

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coverage in accordance with Section 14.05 15 of this Act, but
does not intend for every eligible person who qualifies for
Plan coverage in accordance with Section 7 of this Act to be
guaranteed a right to be issued a policy under this Plan as a
matter of entitlement.
(c) The Comprehensive Health Insurance Plan Board shall
operate the Plan in a manner so that the estimated cost of the
program during any fiscal year will not exceed the total income
it expects to receive from policy premiums, investment income,
assessments, or fees collected or received by the Board and
other funds which are made available from appropriations for
the Plan by the General Assembly for that fiscal year.
(Source: P.A. 90-30, eff. 7-1-97.)
(215 ILCS 105/2) (from Ch. 73, par. 1302)
Sec. 2. Definitions. As used in this Act, unless the
context otherwise requires:
"Plan administrator" means the insurer or third party
administrator designated under Section 5 of this Act.
"Benefits plan" means the coverage to be offered by the
Plan to eligible persons and federally eligible individuals
pursuant to this Act.
"Board" means the Illinois Comprehensive Health Insurance
Board.
"Church plan" has the same meaning given that term in the
federal Health Insurance Portability and Accountability Act of

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1996.
"Continuation coverage" means continuation of coverage
under a group health plan or other health insurance coverage
for former employees or dependents of former employees that
would otherwise have terminated under the terms of that
coverage pursuant to any continuation provisions under federal
or State law, including the Consolidated Omnibus Budget
Reconciliation Act of 1985 (COBRA), as amended, Sections 367.2,
367e, and 367e.1 of the Illinois Insurance Code, or any other
similar requirement in another State.
"Covered person" means a person who is and continues to
remain eligible for Plan coverage and is covered under one of
the benefit plans offered by the Plan.
"Creditable coverage" means, with respect to a federally
eligible individual, coverage of the individual under any of
the following:
(A) A group health plan.
(B) Health insurance coverage (including group health
insurance coverage).
(C) Medicare.
(D) Medical assistance.
(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,

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United States Code.
(I) A public health plan (as defined in regulations
consistent with Section 104 of the Health Care Portability
and Accountability Act of 1996 that may be promulgated by
the Secretary of the U.S. Department of Health and Human
Services).
(J) A health benefit plan under Section 5(e) of the
Peace Corps Act (22 U.S.C. 2504(e)).
(K) Any other qualifying coverage required by the
federal Health Insurance Portability and Accountability
Act of 1996, as it may be amended, or regulations under
that Act.
"Creditable coverage" does not include coverage consisting
solely of coverage of excepted benefits, as defined in Section
2791(c) of title XXVII of the Public Health Service Act (42
U.S.C. 300 gg-91), nor does it include any period of coverage
under any of items (A) through (K) that occurred before a break
of more than 90 days or, if the individual has been certified
as eligible pursuant to the federal Trade Act of 2002, a break
of more than 63 days during all of which the individual was not
covered under any of items (A) through (K) above.
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 under the
terms of health insurance coverage offered by a health
maintenance organization shall not be taken into account in

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determining if there has been a break of more than 90 days in
any creditable coverage.
"Department" means the Illinois Department of Insurance.
"Dependent" means an Illinois resident: who is a spouse; or
who is an claimed as a dependent by the principal insured for
purposes of filing a federal income tax return and resides in
the principal insured's household, and is a resident unmarried
child under the age of 26 19 years; or who is an unmarried
child who also is a full-time student under the age of 23 years
and who is financially dependent upon the principal insured; or
who is an unmarried child under the age of 30 years if the
child (i) is an Illinois resident, (ii) served as a member of
the active or reserve components of any of the branches of the
Armed Forces of the United States, and (iii) has received a
release or discharge other than a dishonorable discharge; or
who is a child of any age and who is disabled and financially
dependent upon the principal insured.
"Direct Illinois premiums" means, for Illinois business,
an insurer's direct premium income for the kinds of business
described in clause (b) of Class 1 or clause (a) of Class 2 of
Section 4 of the Illinois Insurance Code, and direct premium
income of a health maintenance organization or a voluntary
health services plan, except it shall not include credit health
insurance as defined in Article IX 1/2 of the Illinois
Insurance Code.
"Director" means the Director of the Illinois Department of

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Insurance.
"Effective date of medical assistance" means the date that
eligibility for medical assistance for a person is approved by
the Department of Human Services or the Department of
Healthcare and Family Services, except when the Department of
Human Services or the Department of Healthcare and Family
Services determines eligibility retroactively. In such
circumstances, the effective date of the medical assistance is
the date the Department of Human Services or the Department of
Healthcare and Family Services determines the person to be
eligible for medical assistance.
"Eligible person" means a resident of this State who
qualifies for Plan coverage under Section 7 of this Act.
"Employee" means a resident of this State who is employed
by an employer or has entered into the employment of or works
under contract or service of an employer including the
officers, managers and employees of subsidiary or affiliated
corporations and the individual proprietors, partners and
employees of affiliated individuals and firms when the business
of the subsidiary or affiliated corporations, firms or
individuals is controlled by a common employer through stock
ownership, contract, or otherwise.
"Employer" means any individual, partnership, association,
corporation, business trust, or any person or group of persons
acting directly or indirectly in the interest of an employer in
relation to an employee, for which one or more persons is

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gainfully employed.
"Family" coverage means the coverage provided by the Plan
for the covered person and his or her eligible dependents who
also are covered persons.
"Federally eligible individual" means an individual
resident of this State:
(1)(A) for whom, as of the date on which the individual
seeks Plan coverage under Section 14.05 15 of this Act, the
aggregate of the periods of creditable coverage is 18 or
more months or, if the individual has been certified as
eligible pursuant to the federal Trade Act of 2002, 3 or
more months, and (B) whose most recent prior creditable
coverage was under group health insurance coverage offered
by a health insurance issuer, a group health plan, a
governmental plan, or a church plan (or health insurance
coverage offered in connection with any such plans) or any
other type of creditable coverage that may be required by
the federal Health Insurance Portability and
Accountability Act of 1996, as it may be amended, or the
regulations under that Act;
(2) who is not eligible for coverage under (A) a group
health plan (other than an individual who has been
certified as eligible pursuant to the federal Trade Act of
2002), (B) part A or part B of Medicare due to age (other
than an individual who has been certified as eligible
pursuant to the federal Trade Act of 2002), or (C) medical

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assistance, and does not have other health insurance
coverage (other than an individual who has been certified
as eligible pursuant to the federal Trade Act of 2002);
(3) with respect to whom (other than an individual who
has been certified as eligible pursuant to the federal
Trade Act of 2002) the most recent coverage within the
coverage period described in paragraph (1)(A) of this
definition was not terminated based upon a factor relating
to nonpayment of premiums or fraud;
(4) if the individual (other than an individual who has
been certified as eligible pursuant to the federal Trade
Act of 2002) had been offered the option of continuation
coverage under a COBRA continuation provision or under a
similar State program, who elected such coverage; and
(5) who, if the individual elected such continuation
coverage, has exhausted such continuation coverage under
such provision or program.
However, an individual who has been certified as eligible
pursuant to the federal Trade Act of 2002 shall not be required
to elect continuation coverage under a COBRA continuation
provision or under a similar state program.
"Group health insurance coverage" means, in connection
with a group health plan, health insurance coverage offered in
connection with that plan.
"Group health plan" has the same meaning given that term in
the federal Health Insurance Portability and Accountability

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Act of 1996.
"Governmental plan" has the same meaning given that term in
the federal Health Insurance Portability and Accountability
Act of 1996.
"Health insurance coverage" means benefits consisting of
medical care (provided directly, through insurance or
reimbursement, or otherwise and including items and services
paid for as medical care) under any hospital and medical
expense-incurred policy, certificate, or contract provided by
an insurer, non-profit health care service plan contract,
health maintenance organization or other subscriber contract,
or any other health care plan or arrangement that pays for or
furnishes medical or health care services whether by insurance
or otherwise. Health insurance coverage shall not include short
term, accident only, disability income, hospital confinement
or fixed indemnity, dental only, vision only, limited benefit,
or credit insurance, coverage issued as a supplement to
liability insurance, insurance arising out of a workers'
compensation or similar law, automobile medical-payment
insurance, or insurance under which benefits are payable with
or without regard to fault and which is statutorily required to
be contained in any liability insurance policy or equivalent
self-insurance.
"Health insurance issuer" means an insurance company,
insurance service, or insurance organization (including a
health maintenance organization and a voluntary health

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services plan) that is authorized to transact health insurance
business in this State. Such term does not include a group
health plan.
"Health Maintenance Organization" means an organization as
defined in the Health Maintenance Organization Act.
"Hospice" means a program as defined in and licensed under
the Hospice Program Licensing Act.
"Hospital" means a duly licensed institution as defined in
the Hospital Licensing Act, an institution that meets all
comparable conditions and requirements in effect in the state
in which it is located, or the University of Illinois Hospital
as defined in the University of Illinois Hospital Act.
"Individual health insurance coverage" means health
insurance coverage offered to individuals in the individual
market, but does not include short-term, limited-duration
insurance.
"Insured" means any individual resident of this State who
is eligible to receive benefits from any insurer (including
health insurance coverage offered in connection with a group
health plan) or health insurance issuer as defined in this
Section.
"Insurer" means any insurance company authorized to
transact health insurance business in this State and any
corporation that provides medical services and is organized
under the Voluntary Health Services Plans Act or the Health
Maintenance Organization Act.

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"Medical assistance" means the State medical assistance or
medical assistance no grant (MANG) programs provided under
Title XIX of the Social Security Act and Articles V (Medical
Assistance) and VI (General Assistance) of the Illinois Public
Aid Code (or any successor program) or under any similar
program of health care benefits in a state other than Illinois.
"Medically necessary" means that a service, drug, or supply
is necessary and appropriate for the diagnosis or treatment of
an illness or injury in accord with generally accepted
standards of medical practice at the time the service, drug, or
supply is provided. When specifically applied to a confinement
it further means that the diagnosis or treatment of the covered
person's medical symptoms or condition cannot be safely
provided to that person as an outpatient. A service, drug, or
supply shall not be medically necessary if it: (i) is
investigational, experimental, or for research purposes; or
(ii) is provided solely for the convenience of the patient, the
patient's family, physician, hospital, or any other provider;
or (iii) exceeds in scope, duration, or intensity that level of
care that is needed to provide safe, adequate, and appropriate
diagnosis or treatment; or (iv) could have been omitted without
adversely affecting the covered person's condition or the
quality of medical care; or (v) involves the use of a medical
device, drug, or substance not formally approved by the United
States Food and Drug Administration.
"Medical care" means the ordinary and usual professional

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services rendered by a physician or other specified provider
during a professional visit for treatment of an illness or
injury.
"Medicare" means coverage under both Part A and Part B of
Title XVIII of the Social Security Act, 42 U.S.C. Sec. 1395, et
seq.
"Minimum premium plan" means an arrangement whereby a
specified amount of health care claims is self-funded, but the
insurance company assumes the risk that claims will exceed that
amount.
"Participating transplant center" means a hospital
designated by the Board as a preferred or exclusive provider of
services for one or more specified human organ or tissue
transplants for which the hospital has signed an agreement with
the Board to accept a transplant payment allowance for all
expenses related to the transplant during a transplant benefit
period.
"Physician" means a person licensed to practice medicine
pursuant to the Medical Practice Act of 1987.
"Plan" means the Comprehensive Health Insurance Plan
established by this Act.
"Plan of operation" means the plan of operation of the
Plan, including articles, bylaws and operating rules, adopted
by the board pursuant to this Act.
"Provider" means any hospital, skilled nursing facility,
hospice, home health agency, physician, registered pharmacist

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acting within the scope of that registration, or any other
person or entity licensed in Illinois to furnish medical care.
"Qualified high risk pool" has the same meaning given that
term in the federal Health Insurance Portability and
Accountability Act of 1996.
"Resident" means a person who is and continues to be
legally domiciled and physically residing on a permanent and
full-time basis in a place of permanent habitation in this
State that remains that person's principal residence and from
which that person is absent only for temporary or transitory
purpose.
"Skilled nursing facility" means a facility or that portion
of a facility that is licensed by the Illinois Department of
Public Health under the Nursing Home Care Act or a comparable
licensing authority in another state to provide skilled nursing
care.
"Stop-loss coverage" means an arrangement whereby an
insurer insures against the risk that any one claim will exceed
a specific dollar amount or that the entire loss of a
self-insurance plan will exceed a specific amount.
"Third party administrator" means an administrator as
defined in Section 511.101 of the Illinois Insurance Code who
is licensed under Article XXXI 1/4 of that Code.
(Source: P.A. 95-965, eff. 9-23-08.)
(215 ILCS 105/4) (from Ch. 73, par. 1304)

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Sec. 4. Powers and authority of the board. The board shall
have the general powers and authority granted under the laws of
this State to insurance companies licensed to transact health
and accident insurance and in addition thereto, the specific
authority to:
a. Enter into contracts as are necessary or proper to carry
out the provisions and purposes of this Act, including the
authority, with the approval of the Director, to enter into
contracts with similar plans of other states for the joint
performance of common administrative functions, or with
persons or other organizations for the performance of
administrative functions including, without limitation,
utilization review and quality assurance programs, or with
health maintenance organizations or preferred provider
organizations for the provision of health care services.
b. Sue or be sued, including taking any legal actions
necessary or proper.
c. Take such legal action as necessary to:
(1) avoid the payment of improper claims against the
plan or the coverage provided by or through the plan;
(2) to recover any amounts erroneously or improperly
paid by the plan;
(3) to recover any amounts paid by the plan as a result
of a mistake of fact or law; or
(4) to recover or collect any other amounts, including
assessments, that are due or owed the Plan or have been

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billed on its or the Plan's behalf.
d. Establish appropriate rates, rate schedules, rate
adjustments, expense allowances, agents' referral fees, claim
reserves, and formulas and any other actuarial function
appropriate to the operation of the plan. Rates and rate
schedules may be adjusted for appropriate risk factors such as
age and area variation in claim costs and shall take into
consideration appropriate risk factors in accordance with
established actuarial and underwriting practices.
e. Issue policies of insurance in accordance with the
requirements of this Act.
f. Appoint appropriate legal, actuarial and other
committees as necessary to provide technical assistance in the
operation of the plan, policy and other contract design, and
any other function within the authority of the plan.
g. Borrow money to effect the purposes of the Illinois
Comprehensive Health Insurance Plan. Any notes or other
evidence of indebtedness of the plan not in default shall be
legal investments for insurers and may be carried as admitted
assets.
h. Establish rules, conditions and procedures for
reinsuring risks under this Act.
i. Employ and fix the compensation of employees. Such
employees may be paid on a warrant issued by the State
Treasurer pursuant to a payroll voucher certified by the Board
and drawn by the Comptroller against appropriations or trust

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funds held by the State Treasurer.
j. Enter into intergovernmental cooperation agreements
with other agencies or entities of State government for the
purpose of sharing the cost of providing health care services
that are otherwise authorized by this Act for children who are
both plan participants and eligible for financial assistance
from the Division of Specialized Care for Children of the
University of Illinois.
k. Establish conditions and procedures under which the plan
may, if funds permit, discount or subsidize premium rates that
are paid directly by senior citizens, as defined by the Board,
and other plan participants, who are retired or unemployed and
meet other qualifications.
l. Establish and maintain the Plan Fund authorized in
Section 3 of this Act, which shall be divided into separate
accounts, as follows:
(1) accounts to fund the administrative, claim, and
other expenses of the Plan associated with eligible persons
who qualify for Plan coverage under Section 7 of this Act,
which shall consist of:
(A) premiums paid on behalf of covered persons;
(B) assessments appropriated funds and other
revenues collected or received by the Board;
(C) reserves for future losses maintained by the
Board; and
(D) interest earnings from investment of the funds

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in the Plan Fund or any of its accounts other than the
funds in the account established under item 2 of this
subsection;
(2) an account, to be denominated the federally
eligible individuals account, to fund the administrative,
claim, and other expenses of the Plan associated with
federally eligible individuals who qualify for Plan
coverage under Section 14.05 15 of this Act, which shall
consist of:
(A) premiums paid on behalf of covered persons;
(B) assessments and other revenues collected or
received by the Board;
(C) reserves for future losses maintained by the
Board; and
(D) interest earnings from investment of the
federally eligible individuals account funds; and
(E) grants provided pursuant to the federal Trade
Act of 2002; and
(3) such other accounts as may be appropriate.
m. Charge and collect assessments paid by insurers pursuant
to Section 12 of this Act and recover any assessments for, on
behalf of, or against those insurers.
(Source: P.A. 93-33, eff. 6-23-03; 93-34, eff. 6-23-03.)
(215 ILCS 105/7) (from Ch. 73, par. 1307)
Sec. 7. Eligibility.

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a. Except as provided in subsection (e) of this Section or
in Section 14.05 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.
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

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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 assessments 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

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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

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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 14.05 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
coverage.
(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 (i) until 3 years after the effective date
of this amendatory Act of the 95th General Assembly has
paid a total of $2,000,000 in benefits on behalf of the
covered person or (ii) 3 years or more after the effective
date of this amendatory Act of the 95th General Assembly
has paid a total of $1,500,000 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

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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
2002.
(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

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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. 94-17, eff. 1-1-06; 94-737, eff. 5-3-06; 95-547,
eff. 8-29-07.)
(215 ILCS 105/12) (from Ch. 73, par. 1312)

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Sec. 12. Deficit or surplus.
a. If premiums or other receipts by the Board exceed the
amount required for the operation of the Plan, including actual
losses and administrative expenses of the Plan, the Board shall
direct that the excess be held at interest, in a bank
designated by the Board, or used to offset future losses or to
reduce Plan premiums. In this subsection, the term "future
losses" includes reserves for incurred but not reported claims.
b. (Blank). Any deficit incurred or expected to be incurred
on behalf of eligible persons who qualify for plan coverage
under Section 7 of this Act shall be recouped by an
appropriation made by the General Assembly.
c. For the purposes of this Section, a deficit shall be
incurred when anticipated losses and incurred but not reported
claims expenses exceed anticipated income from earned premiums
net of administrative expenses.
d. Any deficit incurred or expected to be incurred on
behalf of covered persons federally eligible individuals who
qualify for Plan coverage under Section 7 or Section 14.05 15
of this Act shall be recouped by an assessment of all insurers
made in accordance with the provisions of this Section. The
Board shall within 90 days of the effective date of this
amendatory Act of 1997 and within the first quarter of each
fiscal year thereafter assess all insurers for the anticipated
deficit in accordance with the provisions of this Section. The
board may also make additional assessments no more than 4 times

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a year to fund unanticipated deficits, implementation
expenses, and cash flow needs.
e. An insurer's assessment shall be determined by
multiplying the total assessment, as determined in subsection
d. of this Section, by a fraction, the numerator of which
equals that insurer's direct Illinois premiums during the
preceding calendar year and the denominator of which equals the
total of all insurers' direct Illinois premiums. The Board may
exempt those insurers whose share as determined under this
subsection would be so minimal as to not exceed the estimated
cost of levying the assessment.
f. The Board shall charge and collect from each insurer the
amounts determined to be due under this Section. The assessment
shall be billed by Board invoice based upon the insurer's
direct Illinois premium income as shown in its annual statement
for the preceding calendar year as filed with the Director. The
invoice shall be due upon receipt and must be paid no later
than 30 days after receipt by the insurer.
g. When an insurer fails to pay the full amount of any
assessment of $100 or more due under this Section there shall
be added to the amount due as a penalty the greater of $50 or an
amount equal to 5% of the deficiency for each month or part of
a month that the deficiency remains unpaid.
h. Amounts collected under this Section shall be paid to
the Board for deposit into the Plan Fund authorized by Section
3 of this Act.

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i. An insurer may petition the Director for an abatement or
deferment of all or part of an assessment imposed by the Board.
The Director may abate or defer, in whole or in part, the
assessment if, in the opinion of the Director, payment of the
assessment would endanger the ability of the insurer to fulfill
its contractual obligations. In the event an assessment against
an insurer is abated or deferred in whole or in part, the
amount by which the assessment is abated or deferred shall be
assessed against the other insurers in a manner consistent with
the basis for assessments set forth in this subsection. The
insurer receiving a deferment shall remain liable to the plan
for the deficiency for 4 years.
j. The board shall establish procedures for appeal by any
insurer subject to assessment pursuant to this Section. Such
procedures shall require that:
(1) Any insurer that wishes to appeal all or any part
of an assessment made pursuant to this Section shall first
pay the amount of the assessment as set forth in the
invoice provided by the board within the time provided in
subsection f. of this Section. The board shall hold such
payments in a separate interest-bearing account. The
payments shall be accompanied by a statement in writing
that the payment is made under appeal. The statement shall
specify the grounds for the appeal. The insurer may be
represented in its appeal by counsel or other
representative of its choosing.

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(2) Within 90 days following the payment of an
assessment under appeal by any insurer, the board shall
notify the insurer or representative designated by the
insurer in writing of its determination with respect to the
appeal and the basis or bases for that determination unless
the Board notifies the insurer that a reasonable amount of
additional time is required to resolve the issues raised by
the appeal.
(3) The board shall refer to the Director any question
concerning the amount of direct Illinois premium income as
shown in an insurer's annual statement for the preceding
calendar year on file with the Director on the invoice date
of the assessment. Unless additional time is required to
resolve the question, the Director shall within 60 days
report to the board in writing his determination respecting
the amount of direct Illinois premium income on file on the
invoice date of the assessment.
(4) In the event the board determines that the insurer
is entitled to a refund, the refund shall be paid within 30
days following the date upon which the board makes its
determination, together with the accrued interest.
Interest on any refund due an insurer shall be paid at the
rate actually earned by the Board on the separate account.
(5) The amount of any such refund shall then be
assessed against all insurers in a manner consistent with
the basis for assessment as otherwise authorized by this

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Section.
(6) The board's determination with respect to any
appeal received pursuant to this subsection shall be a
final administrative decision as defined in Section 3-101
of the Code of Civil Procedure. The provisions of the
Administrative Review Law shall apply to and govern all
proceedings for the judicial review of final
administrative decisions of the board.
(7) If an insurer fails to appeal an assessment in
accordance with the provisions of this subsection, the
insurer shall be deemed to have waived its right of appeal.
The provisions of this subsection apply to all assessments
made in any calendar year ending on or after December 31, 1997.
(Source: P.A. 90-30, eff. 7-1-97; 90-567, eff. 1-23-98.)
Section 99. Effective date. This Act takes effect upon
becoming law.