Bill Text: IL SB1999 | 2009-2010 | 96th General Assembly | Introduced

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Bill Title: Amends the Illinois Insurance Code. Makes a technical change in a Section concerning continuation of group hospital, surgical and major medical coverage after termination of employment or membership.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced - Dead) 2009-02-20 - Referred to Assignments [SB1999 Detail]

Download: Illinois-2009-SB1999-Introduced.html

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96TH GENERAL ASSEMBLY State of Illinois 2009 and 2010 SB1999 Introduced 2/20/2009, by Sen. Carole Pankau SYNOPSIS AS INTRODUCED:
215 ILCS 5/367e from Ch. 73, par. 979e
Amends the Illinois Insurance Code. Makes a technical change in a Section concerning continuation of group hospital, surgical and major medical coverage after termination of employment or membership.
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A BILL FOR
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AN ACT concerning regulation.
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 367e as follows:
(215 ILCS 5/367e) (from Ch. 73, par. 979e)
Sec. 367e. Continuation of Group Hospital, Surgical and and
Major Medical Coverage After Termination of Employment or
Membership. A group policy delivered, issued for delivery,
renewed or amended in this state which insures employees or
members for hospital, surgical or major medical insurance on an
expense incurred or service basis, other than for specific
diseases or for accidental injuries only, shall provide that
employees or members whose insurance under the group policy
would otherwise terminate because of termination of employment
or membership or because of a reduction in hours below the
minimum required by the group plan shall be entitled to
continue their hospital, surgical and major medical insurance
under that group policy, for themselves and their eligible
dependents, subject to all of the group policy's terms and
conditions applicable to those forms of insurance and to the
following conditions:
1. Continuation shall only be available to an employee

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or member who has been continuously insured under the group
policy (and for similar benefits under any group policy
which it replaced) during the entire 3 months period ending
with such termination or reduction in hours below the
minimum required by the group plan.
2. Continuation shall not be available for any person
who is covered by Medicare, except for those individuals
who have been covered under a group Medicare supplement
policy. Neither shall continuation be available for any
person who is covered by any other insured or uninsured
plan which provides hospital, surgical or medical coverage
for individuals in a group and under which the person was
not covered immediately prior to such termination or
reduction in hours below the minimum required by the group
plan or who exercises his conversion privilege under the
group policy.
3. Continuation need not include dental, vision care,
prescription drug benefits, disability income, specified
disease, or similar supplementary benefits which are
provided under the group policy in addition to its
hospital, surgical or major medical benefits.
4. Upon termination or reduction in hours below the
minimum required by the group plan written notice of
continuation shall be presented to the employee or member
by the employer or mailed by the employer to the last known
address of the employee. An employee or member who wishes

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continuation of coverage must request such continuation in
writing within the ten-day period following the later of:
(i) the date of such termination or reduction in hours
below the minimum required by the group plan, or (ii) the
date the employee is given written notice of the right of
continuation by either the employer or the group
policyholder. In no event, however, may the employee or
member elect continuation more than 60 days after the date
of such termination or reduction in hours below the minimum
required by the group plan. Written notice of continuation
presented to the employee or member by the policyholder, or
mailed by the policyholder to the last known address of the
employee, shall constitute the giving of notice for the
purpose of this provision.
5. An employee or member electing continuation must pay
to the group policyholder or his employer, on a monthly
basis in advance, the total amount of premium required by
the insurer, including that portion of the premium
contributed by the policyholder or employer, if any, but
not more than the group rate for the insurance being
continued with appropriate reduction in premium for any
supplementary benefits which have been discontinued under
paragraph (3) of this Section. The premium rate required by
the insurer shall be the applicable premium required on the
due date of each payment.
6. Continuation of insurance under the group policy for

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any person shall terminate when he becomes eligible for
Medicare or is covered by any other insured or uninsured
plan which provides hospital, surgical or medical coverage
for individuals in a group and under which the person was
not covered immediately prior to such termination or
reduction in hours below the minimum required by the group
plan as provided in condition 2 above or, if earlier, at
the first to occur of the following:
(a) The date 9 months after the date the employee's
or member's insurance under the policy would otherwise
have terminated because of termination of employment
or membership or reduction in hours below the minimum
required by the group plan.
(b) If the employee or member fails to make timely
payment of a required contribution, the end of the
period for which contributions were made.
(c) The date on which the group policy is
terminated or, in the case of an employee, the date his
employer terminates participation under the group
policy. However, if this (c) applies and the coverage
ceasing by reason of such termination is replaced by
similar coverage under another group policy, the
following shall apply:
(i) The employee or member shall have the right
to become covered under that other group policy,
for the balance of the period that he would have

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remained covered under the prior group policy in
accordance with condition 6 had a termination
described in this (c) not occurred.
(ii) The prior group policy shall continue to
provide benefits to the extent of its accrued
liabilities and extensions of benefits as if the
replacement had not occurred.
7. A notification of the continuation privilege shall
be included in each certificate of coverage.
8. Continuation shall not be available for any employee
who was discharged because of the commission of a felony in
connection with his work, or because of theft in connection
with his work, for which the employer was in no way
responsible; provided the employee admitted his commission
of the felony or theft or such act has resulted in a
conviction or order of supervision by a court of competent
jurisdiction.
The requirements of this amendatory Act of 1983 shall apply
to any group policy as defined in this Section, delivered or
issued for delivery on or after 180 days following the
effective date of this amendatory Act of 1983.
The requirements of this amendatory Act of 1985 shall apply
to any group policy as defined in this Section, delivered,
issued for delivery, renewed or amended on or after 180 days
following the effective date of this amendatory Act of 1985.
(Source: P.A. 93-477, eff. 1-1-04.)