94TH GENERAL ASSEMBLY
State of Illinois
2005 and 2006
HB0985


 
Introduced 2/3/2005, by Rep. Brandon W. Phelps
 
SYNOPSIS AS INTRODUCED:
 		














215 ILCS 97/25









    Amends the Illinois Health Insurance Portability and Accountability Act. Makes a technical change in a Section prohibiting discrimination against individual participants.
















LRB094 07927 LJB 38108 b

















 


 


A BILL FOR









 











HB0985

LRB094 07927 LJB 38108 b






1
    AN ACT concerning regulation.

 
2
    Be it enacted by the People of the State of Illinois,
 
3
represented in the General Assembly:


 
4
    Section 5. The Illinois Health Insurance Portability and 
5
Accountability Act is amended  by changing Section 25 as 
6
follows:
 



7
    (215 ILCS 97/25)



8
    Sec. 25. Prohibiting discrimination against individual

9
participants.

10
    (A) In eligibility to enroll.


11
        (1) In general.  Subject to paragraph (2), a group

12
    health plan, and a health insurance issuer offering
group 
13
    health insurance coverage in connection with a
group health 
14
    plan, may not establish rules for
eligibility (including 
15
    continued eligibility) of any
individual to enroll under 
16
    the
the terms of the plan
based on any of the following 
17
    health status-related
factors in relation to the 
18
    individual or a dependent
of the individual:


19
            (a) Health status.


20
            (b) Medical condition (including both physical and

21
        mental illnesses).


22
            (c) Claims experience.


23
            (d) Receipt of health care.


24
            (e) Medical history.


25
            (f) Genetic information.


26
            (g) Evidence of insurability (including conditions

27
        arising out of acts of domestic violence).


28
            (h) Disability.


29
        (2) No application to benefits or exclusions.  To the 
30
    extent
consistent with Section 20, the provisions of 
31
    paragraph (1) shall not be
construed:


32
            (a) to require a group health plan, or group health

 


 






HB0985
- 2 -
LRB094 07927 LJB 38108 b




1
        insurance coverage, to provide particular benefits

2
        other than those provided under the terms of such
plan 
3
        or coverage; or


4
            (b) to prevent such a plan or coverage from 
5
        establishing
limitations or restrictions on the 
6
        amount, level,
extent, or nature of the benefits or 
7
        coverage for
similarly situated individuals enrolled 
8
        in the plan
or coverage.


9
        (3) Construction.  For purposes of paragraph (1), rules 
10
    for
eligibility to enroll under a plan include rules

11
    defining any applicable waiting periods for such

12
    enrollment.

13
    (B) In premium contributions.


14
        (1) In general.  A group health plan, and a health 
15
    insurance
issuer offering health insurance coverage in 
16
    connection
with a group health plan, may not require any 
17
    individual
(as a condition of enrollment or continued 
18
    enrollment
under the plan) to pay a premium or contribution 
19
    which
is greater than such premium or contribution for a

20
    similarly situated individual enrolled in the plan on
the 
21
    basis of any health status-related factor in
relation to 
22
    the individual or to an individual enrolled
under the plan 
23
    as a dependent of the individual.


24
        (2) Construction.  Nothing in paragraph (1) shall be

25
    construed:


26
            (a) to restrict the amount that an employer may be

27
        charged for coverage under a group health plan; or


28
            (b) to prevent a group health plan, and a health

29
        insurance issuer offering group health insurance

30
        coverage, from establishing premium discounts or

31
        rebates or modifying otherwise applicable
copayments 
32
        or deductibles in return for
adherence to programs of 
33
        health promotion and
disease prevention.

34
(Source: P.A. 90-30, eff. 7-1-97.)