Illinois 2023-2024 Regular Session

Illinois Senate Bill SB0056 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	Public Act 103-0747
2	1		SB0056 EnrolledLRB103 04998 BMS 50010 b SB0056 Enrolled LRB103 04998 BMS 50010 b
3	2		SB0056 Enrolled LRB103 04998 BMS 50010 b
4		-	AN ACT concerning regulation.
5		-	Be it enacted by the People of the State of Illinois,
6		-	represented in the General Assembly:
7		-	Section 5. The Illinois Insurance Code is amended by
8		-	changing Section 363 as follows:
9		-	(215 ILCS 5/363) (from Ch. 73, par. 975)
10		-	Sec. 363. Medicare supplement policies; minimum standards.
11		-	(1) Except as otherwise specifically provided therein,
12		-	this Section and Section 363a of this Code shall apply to:
13		-	(a) all Medicare supplement policies and subscriber
14		-	contracts delivered or issued for delivery in this State
15		-	on and after January 1, 1989; and
16		-	(b) all certificates issued under group Medicare
17		-	supplement policies or subscriber contracts, which
18		-	certificates are issued or issued for delivery in this
19		-	State on and after January 1, 1989.
20		-	This Section shall not apply to "Accident Only" or
21		-	"Specified Disease" types of policies. The provisions of this
22		-	Section are not intended to prohibit or apply to policies or
23		-	health care benefit plans, including group conversion
24		-	policies, provided to Medicare eligible persons, which
25		-	policies or plans are not marketed or purported or held to be
26		-	Medicare supplement policies or benefit plans.
	3	+	1 AN ACT concerning regulation.
	4	+	2 Be it enacted by the People of the State of Illinois,
	5	+	3 represented in the General Assembly:
	6	+	4 Section 5. The Illinois Insurance Code is amended by
	7	+	5 changing Section 363 as follows:
	8	+	6 (215 ILCS 5/363) (from Ch. 73, par. 975)
	9	+	7 Sec. 363. Medicare supplement policies; minimum standards.
	10	+	8 (1) Except as otherwise specifically provided therein,
	11	+	9 this Section and Section 363a of this Code shall apply to:
	12	+	10 (a) all Medicare supplement policies and subscriber
	13	+	11 contracts delivered or issued for delivery in this State
	14	+	12 on and after January 1, 1989; and
	15	+	13 (b) all certificates issued under group Medicare
	16	+	14 supplement policies or subscriber contracts, which
	17	+	15 certificates are issued or issued for delivery in this
	18	+	16 State on and after January 1, 1989.
	19	+	17 This Section shall not apply to "Accident Only" or
	20	+	18 "Specified Disease" types of policies. The provisions of this
	21	+	19 Section are not intended to prohibit or apply to policies or
	22	+	20 health care benefit plans, including group conversion
	23	+	21 policies, provided to Medicare eligible persons, which
	24	+	22 policies or plans are not marketed or purported or held to be
	25	+	23 Medicare supplement policies or benefit plans.
27	26
28	27
29	28
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32	31
33		-	(2) For the purposes of this Section and Section 363a, the
34		-	following terms have the following meanings:
35		-	(a) "Applicant" means:
36		-	(i) in the case of individual Medicare supplement
37		-	policy, the person who seeks to contract for insurance
38		-	benefits, and
39		-	(ii) in the case of a group Medicare policy or
40		-	subscriber contract, the proposed certificate holder.
41		-	(b) "Certificate" means any certificate delivered or
42		-	issued for delivery in this State under a group Medicare
43		-	supplement policy.
44		-	(c) "Medicare supplement policy" means an individual
45		-	policy of accident and health insurance, as defined in
46		-	paragraph (a) of subsection (2) of Section 355a of this
47		-	Code, or a group policy or certificate delivered or issued
48		-	for delivery in this State by an insurer, fraternal
49		-	benefit society, voluntary health service plan, or health
50		-	maintenance organization, other than a policy issued
51		-	pursuant to a contract under Section 1876 of the federal
52		-	Social Security Act (42 U.S.C. Section 1395 et seq.) or a
53		-	policy issued under a demonstration project specified in
54		-	42 U.S.C. Section 1395ss(g)(1), or any similar
55		-	organization, that is advertised, marketed, or designed
56		-	primarily as a supplement to reimbursements under Medicare
57		-	for the hospital, medical, or surgical expenses of persons
58		-	eligible for Medicare.
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	33	+	SB0056 Enrolled - 2 - LRB103 04998 BMS 50010 b
	34	+	1 (2) For the purposes of this Section and Section 363a, the
	35	+	2 following terms have the following meanings:
	36	+	3 (a) "Applicant" means:
	37	+	4 (i) in the case of individual Medicare supplement
	38	+	5 policy, the person who seeks to contract for insurance
	39	+	6 benefits, and
	40	+	7 (ii) in the case of a group Medicare policy or
	41	+	8 subscriber contract, the proposed certificate holder.
	42	+	9 (b) "Certificate" means any certificate delivered or
	43	+	10 issued for delivery in this State under a group Medicare
	44	+	11 supplement policy.
	45	+	12 (c) "Medicare supplement policy" means an individual
	46	+	13 policy of accident and health insurance, as defined in
	47	+	14 paragraph (a) of subsection (2) of Section 355a of this
	48	+	15 Code, or a group policy or certificate delivered or issued
	49	+	16 for delivery in this State by an insurer, fraternal
	50	+	17 benefit society, voluntary health service plan, or health
	51	+	18 maintenance organization, other than a policy issued
	52	+	19 pursuant to a contract under Section 1876 of the federal
	53	+	20 Social Security Act (42 U.S.C. Section 1395 et seq.) or a
	54	+	21 policy issued under a demonstration project specified in
	55	+	22 42 U.S.C. Section 1395ss(g)(1), or any similar
	56	+	23 organization, that is advertised, marketed, or designed
	57	+	24 primarily as a supplement to reimbursements under Medicare
	58	+	25 for the hospital, medical, or surgical expenses of persons
	59	+	26 eligible for Medicare.
59	60
60	61
61		-	(d) "Issuer" includes insurance companies, fraternal
62		-	benefit societies, voluntary health service plans, health
63		-	maintenance organizations, or any other entity providing
64		-	Medicare supplement insurance, unless the context clearly
65		-	indicates otherwise.
66		-	(e) "Medicare" means the Health Insurance for the Aged
67		-	Act, Title XVIII of the Social Security Amendments of
68		-	1965.
69		-	(3) No Medicare supplement insurance policy, contract, or
70		-	certificate, that provides benefits that duplicate benefits
71		-	provided by Medicare, shall be issued or issued for delivery
72		-	in this State after December 31, 1988. No such policy,
73		-	contract, or certificate shall provide lesser benefits than
74		-	those required under this Section or the existing Medicare
75		-	Supplement Minimum Standards Regulation, except where
76		-	duplication of Medicare benefits would result.
77		-	(4) Medicare supplement policies or certificates shall
78		-	have a notice prominently printed on the first page of the
79		-	policy or attached thereto stating in substance that the
80		-	policyholder or certificate holder shall have the right to
81		-	return the policy or certificate within 30 days of its
82		-	delivery and to have the premium refunded directly to him or
83		-	her in a timely manner if, after examination of the policy or
84		-	certificate, the insured person is not satisfied for any
85		-	reason.
86		-	(5) A Medicare supplement policy or certificate may not
87	62
88	63
89		-	deny a claim for losses incurred more than 6 months from the
90		-	effective date of coverage for a preexisting condition. The
91		-	policy may not define a preexisting condition more
92		-	restrictively than a condition for which medical advice was
93		-	given or treatment was recommended by or received from a
94		-	physician within 6 months before the effective date of
95		-	coverage.
96		-	(6) An issuer of a Medicare supplement policy shall:
97		-	(a) not deny coverage to an applicant under 65 years
98		-	of age who meets any of the following criteria:
99		-	(i) becomes eligible for Medicare by reason of
100		-	disability if the person makes application for a
101		-	Medicare supplement policy within 6 months of the
102		-	first day on which the person enrolls for benefits
103		-	under Medicare Part B; for a person who is
104		-	retroactively enrolled in Medicare Part B due to a
105		-	retroactive eligibility decision made by the Social
106		-	Security Administration, the application must be
107		-	submitted within a 6-month period beginning with the
108		-	month in which the person received notice of
109		-	retroactive eligibility to enroll;
110		-	(ii) has Medicare and an employer group health
111		-	plan (either primary or secondary to Medicare) that
112		-	terminates or ceases to provide all such supplemental
113		-	health benefits;
114		-	(iii) is insured by a Medicare Advantage plan that
	64	+
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116	67
117		-	includes a Health Maintenance Organization, a
118		-	Preferred Provider Organization, and a Private
119		-	Fee-For-Service or Medicare Select plan and the
120		-	applicant moves out of the plan's service area; the
121		-	insurer goes out of business, withdraws from the
122		-	market, or has its Medicare contract terminated; or
123		-	the plan violates its contract provisions or is
124		-	misrepresented in its marketing; or
125		-	(iv) is insured by a Medicare supplement policy
126		-	and the insurer goes out of business, withdraws from
127		-	the market, or the insurance company or agents
128		-	misrepresent the plan and the applicant is without
129		-	coverage;
130		-	(b) make available to persons eligible for Medicare by
131		-	reason of disability each type of Medicare supplement
132		-	policy the issuer makes available to persons eligible for
133		-	Medicare by reason of age;
134		-	(c) not charge individuals who become eligible for
135		-	Medicare by reason of disability and who are under the age
136		-	of 65 premium rates for any medical supplemental insurance
137		-	benefit plan offered by the issuer that exceed the
138		-	issuer's highest rate on the current rate schedule filed
139		-	with the Division of Insurance for that plan to
140		-	individuals who are age 65 or older; and
141		-	(d) provide the rights granted by items (a) through
142		-	(d), for 6 months after the effective date of this
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	70	+	1 (d) "Issuer" includes insurance companies, fraternal
	71	+	2 benefit societies, voluntary health service plans, health
	72	+	3 maintenance organizations, or any other entity providing
	73	+	4 Medicare supplement insurance, unless the context clearly
	74	+	5 indicates otherwise.
	75	+	6 (e) "Medicare" means the Health Insurance for the Aged
	76	+	7 Act, Title XVIII of the Social Security Amendments of
	77	+	8 1965.
	78	+	9 (3) No Medicare supplement insurance policy, contract, or
	79	+	10 certificate, that provides benefits that duplicate benefits
	80	+	11 provided by Medicare, shall be issued or issued for delivery
	81	+	12 in this State after December 31, 1988. No such policy,
	82	+	13 contract, or certificate shall provide lesser benefits than
	83	+	14 those required under this Section or the existing Medicare
	84	+	15 Supplement Minimum Standards Regulation, except where
	85	+	16 duplication of Medicare benefits would result.
	86	+	17 (4) Medicare supplement policies or certificates shall
	87	+	18 have a notice prominently printed on the first page of the
	88	+	19 policy or attached thereto stating in substance that the
	89	+	20 policyholder or certificate holder shall have the right to
	90	+	21 return the policy or certificate within 30 days of its
	91	+	22 delivery and to have the premium refunded directly to him or
	92	+	23 her in a timely manner if, after examination of the policy or
	93	+	24 certificate, the insured person is not satisfied for any
	94	+	25 reason.
	95	+	26 (5) A Medicare supplement policy or certificate may not
143	96
144	97
145		-	amendatory Act of the 95th General Assembly, to any person
146		-	who had enrolled for benefits under Medicare Part B prior
147		-	to this amendatory Act of the 95th General Assembly who
148		-	otherwise would have been eligible for coverage under item
149		-	(a).
150		-	(7) The Director shall issue reasonable rules and
151		-	regulations for the following purposes:
152		-	(a) To establish specific standards for policy
153		-	provisions of Medicare policies and certificates. The
154		-	standards shall be in accordance with the requirements of
155		-	this Code. No requirement of this Code relating to minimum
156		-	required policy benefits, other than the minimum standards
157		-	contained in this Section and Section 363a, shall apply to
158		-	Medicare supplement policies and certificates. The
159		-	standards may cover, but are not limited to the following:
160		-	(A) Terms of renewability.
161		-	(B) Initial and subsequent terms of eligibility.
162		-	(C) Non-duplication of coverage.
163		-	(D) Probationary and elimination periods.
164		-	(E) Benefit limitations, exceptions and
165		-	reductions.
166		-	(F) Requirements for replacement.
167		-	(G) Recurrent conditions.
168		-	(H) Definition of terms.
169		-	(I) Requirements for issuing rebates or credits to
170		-	policyholders if the policy's loss ratio does not
171	98
172	99
173		-	comply with subsection (7) of Section 363a.
174		-	(J) Uniform methodology for the calculating and
175		-	reporting of loss ratio information.
176		-	(K) Assuring public access to loss ratio
177		-	information of an issuer of Medicare supplement
178		-	insurance.
179		-	(L) Establishing a process for approving or
180		-	disapproving proposed premium increases.
181		-	(M) Establishing a policy for holding public
182		-	hearings prior to approval of premium increases.
183		-	(N) Establishing standards for Medicare Select
184		-	policies.
185		-	(O) Prohibited policy provisions not otherwise
186		-	specifically authorized by statute that, in the
187		-	opinion of the Director, are unjust, unfair, or
188		-	unfairly discriminatory to any person insured or
189		-	proposed for coverage under a medicare supplement
190		-	policy or certificate.
191		-	(b) To establish minimum standards for benefits and
192		-	claims payments, marketing practices, compensation
193		-	arrangements, and reporting practices for Medicare
194		-	supplement policies.
195		-	(c) To implement transitional requirements of Medicare
196		-	supplement insurance benefits and premiums of Medicare
197		-	supplement policies and certificates to conform to
198		-	Medicare program revisions.
	100	+
	101	+	SB0056 Enrolled - 3 - LRB103 04998 BMS 50010 b
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200	103
201		-	(8) If an individual is at least 65 years of age but no
202		-	more than 75 years of age and has an existing Medicare
203		-	supplement policy, the individual is entitled to an annual
204		-	open enrollment period lasting 45 days, commencing with the
205		-	individual's birthday, and the individual may purchase any
206		-	Medicare supplement policy with the same issuer or any
207		-	affiliate authorized to transact business in this State that
208		-	offers benefits equal to or lesser than those provided by the
209		-	previous coverage. During this open enrollment period, an
210		-	issuer of a Medicare supplement policy shall not deny or
211		-	condition the issuance or effectiveness of Medicare
212		-	supplemental coverage, nor discriminate in the pricing of
213		-	coverage, because of health status, claims experience, receipt
214		-	of health care, or a medical condition of the individual. An
215		-	issuer shall provide notice of this annual open enrollment
216		-	period for eligible Medicare supplement policyholders at the
217		-	time that the application is made for a Medicare supplement
218		-	policy or certificate. The notice shall be in a form that may
219		-	be prescribed by the Department.
220		-	(Source: P.A. 102-142, eff. 1-1-22.)
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	106	+	1 deny a claim for losses incurred more than 6 months from the
	107	+	2 effective date of coverage for a preexisting condition. The
	108	+	3 policy may not define a preexisting condition more
	109	+	4 restrictively than a condition for which medical advice was
	110	+	5 given or treatment was recommended by or received from a
	111	+	6 physician within 6 months before the effective date of
	112	+	7 coverage.
	113	+	8 (6) An issuer of a Medicare supplement policy shall:
	114	+	9 (a) not deny coverage to an applicant under 65 years
	115	+	10 of age who meets any of the following criteria:
	116	+	11 (i) becomes eligible for Medicare by reason of
	117	+	12 disability if the person makes application for a
	118	+	13 Medicare supplement policy within 6 months of the
	119	+	14 first day on which the person enrolls for benefits
	120	+	15 under Medicare Part B; for a person who is
	121	+	16 retroactively enrolled in Medicare Part B due to a
	122	+	17 retroactive eligibility decision made by the Social
	123	+	18 Security Administration, the application must be
	124	+	19 submitted within a 6-month period beginning with the
	125	+	20 month in which the person received notice of
	126	+	21 retroactive eligibility to enroll;
	127	+	22 (ii) has Medicare and an employer group health
	128	+	23 plan (either primary or secondary to Medicare) that
	129	+	24 terminates or ceases to provide all such supplemental
	130	+	25 health benefits;
	131	+	26 (iii) is insured by a Medicare Advantage plan that
	132	+
	133	+
	134	+
	135	+
	136	+
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	139	+
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	142	+	1 includes a Health Maintenance Organization, a
	143	+	2 Preferred Provider Organization, and a Private
	144	+	3 Fee-For-Service or Medicare Select plan and the
	145	+	4 applicant moves out of the plan's service area; the
	146	+	5 insurer goes out of business, withdraws from the
	147	+	6 market, or has its Medicare contract terminated; or
	148	+	7 the plan violates its contract provisions or is
	149	+	8 misrepresented in its marketing; or
	150	+	9 (iv) is insured by a Medicare supplement policy
	151	+	10 and the insurer goes out of business, withdraws from
	152	+	11 the market, or the insurance company or agents
	153	+	12 misrepresent the plan and the applicant is without
	154	+	13 coverage;
	155	+	14 (b) make available to persons eligible for Medicare by
	156	+	15 reason of disability each type of Medicare supplement
	157	+	16 policy the issuer makes available to persons eligible for
	158	+	17 Medicare by reason of age;
	159	+	18 (c) not charge individuals who become eligible for
	160	+	19 Medicare by reason of disability and who are under the age
	161	+	20 of 65 premium rates for any medical supplemental insurance
	162	+	21 benefit plan offered by the issuer that exceed the
	163	+	22 issuer's highest rate on the current rate schedule filed
	164	+	23 with the Division of Insurance for that plan to
	165	+	24 individuals who are age 65 or older; and
	166	+	25 (d) provide the rights granted by items (a) through
	167	+	26 (d), for 6 months after the effective date of this
	168	+
	169	+
	170	+
	171	+
	172	+
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	174	+
	175	+
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	177	+	SB0056 Enrolled - 6 - LRB103 04998 BMS 50010 b
	178	+	1 amendatory Act of the 95th General Assembly, to any person
	179	+	2 who had enrolled for benefits under Medicare Part B prior
	180	+	3 to this amendatory Act of the 95th General Assembly who
	181	+	4 otherwise would have been eligible for coverage under item
	182	+	5 (a).
	183	+	6 (7) The Director shall issue reasonable rules and
	184	+	7 regulations for the following purposes:
	185	+	8 (a) To establish specific standards for policy
	186	+	9 provisions of Medicare policies and certificates. The
	187	+	10 standards shall be in accordance with the requirements of
	188	+	11 this Code. No requirement of this Code relating to minimum
	189	+	12 required policy benefits, other than the minimum standards
	190	+	13 contained in this Section and Section 363a, shall apply to
	191	+	14 Medicare supplement policies and certificates. The
	192	+	15 standards may cover, but are not limited to the following:
	193	+	16 (A) Terms of renewability.
	194	+	17 (B) Initial and subsequent terms of eligibility.
	195	+	18 (C) Non-duplication of coverage.
	196	+	19 (D) Probationary and elimination periods.
	197	+	20 (E) Benefit limitations, exceptions and
	198	+	21 reductions.
	199	+	22 (F) Requirements for replacement.
	200	+	23 (G) Recurrent conditions.
	201	+	24 (H) Definition of terms.
	202	+	25 (I) Requirements for issuing rebates or credits to
	203	+	26 policyholders if the policy's loss ratio does not
	204	+
	205	+
	206	+
	207	+
	208	+
	209	+	SB0056 Enrolled - 6 - LRB103 04998 BMS 50010 b
	210	+
	211	+
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	213	+	SB0056 Enrolled - 7 - LRB103 04998 BMS 50010 b
	214	+	1 comply with subsection (7) of Section 363a.
	215	+	2 (J) Uniform methodology for the calculating and
	216	+	3 reporting of loss ratio information.
	217	+	4 (K) Assuring public access to loss ratio
	218	+	5 information of an issuer of Medicare supplement
	219	+	6 insurance.
	220	+	7 (L) Establishing a process for approving or
	221	+	8 disapproving proposed premium increases.
	222	+	9 (M) Establishing a policy for holding public
	223	+	10 hearings prior to approval of premium increases.
	224	+	11 (N) Establishing standards for Medicare Select
	225	+	12 policies.
	226	+	13 (O) Prohibited policy provisions not otherwise
	227	+	14 specifically authorized by statute that, in the
	228	+	15 opinion of the Director, are unjust, unfair, or
	229	+	16 unfairly discriminatory to any person insured or
	230	+	17 proposed for coverage under a medicare supplement
	231	+	18 policy or certificate.
	232	+	19 (b) To establish minimum standards for benefits and
	233	+	20 claims payments, marketing practices, compensation
	234	+	21 arrangements, and reporting practices for Medicare
	235	+	22 supplement policies.
	236	+	23 (c) To implement transitional requirements of Medicare
	237	+	24 supplement insurance benefits and premiums of Medicare
	238	+	25 supplement policies and certificates to conform to
	239	+	26 Medicare program revisions.
	240	+
	241	+
	242	+
	243	+
	244	+
	245	+	SB0056 Enrolled - 7 - LRB103 04998 BMS 50010 b
	246	+
	247	+
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	249	+	SB0056 Enrolled - 8 - LRB103 04998 BMS 50010 b
	250	+	1 (8) If an individual is at least 65 years of age but no
	251	+	2 more than 75 years of age and has an existing Medicare
	252	+	3 supplement policy, the individual is entitled to an annual
	253	+	4 open enrollment period lasting 45 days, commencing with the
	254	+	5 individual's birthday, and the individual may purchase any
	255	+	6 Medicare supplement policy with the same issuer or any
	256	+	7 affiliate authorized to transact business in this State that
	257	+	8 offers benefits equal to or lesser than those provided by the
	258	+	9 previous coverage. During this open enrollment period, an
	259	+	10 issuer of a Medicare supplement policy shall not deny or
	260	+	11 condition the issuance or effectiveness of Medicare
	261	+	12 supplemental coverage, nor discriminate in the pricing of
	262	+	13 coverage, because of health status, claims experience, receipt
	263	+	14 of health care, or a medical condition of the individual. An
	264	+	15 issuer shall provide notice of this annual open enrollment
	265	+	16 period for eligible Medicare supplement policyholders at the
	266	+	17 time that the application is made for a Medicare supplement
	267	+	18 policy or certificate. The notice shall be in a form that may
	268	+	19 be prescribed by the Department.
	269	+	20 (Source: P.A. 102-142, eff. 1-1-22.)
	270	+
	271	+
	272	+
	273	+
	274	+
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