Illinois Compiled Statutes 215 ILCS 97/25 – Prohibiting discrimination against individual participants
Current as of: 2024 | Check for updates
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(A) In eligibility to enroll.
(1) In general. Subject to paragraph (2), a group
(1) In general. Subject to paragraph (2), a group
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health plan, and a health insurance issuer offering group health insurance coverage in connection with a group health plan, may not establish rules for eligibility (including continued eligibility) of any individual to enroll under the terms of the plan based on any of the following health status-related factors in relation to the individual or a dependent of the individual:
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(a) Health status.
(b) Medical condition (including both physical
Terms Used In Illinois Compiled Statutes 215 ILCS 97/25
- Dependent: A person dependent for support upon another.
- Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
- individual: shall include every infant member of the species homo sapiens who is born alive at any stage of development. See Illinois Compiled Statutes 5 ILCS 70/1.36
(b) Medical condition (including both physical
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and mental illnesses).
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(c) Claims experience.
(d) Receipt of health care.
(e) Medical history.
(f) Genetic information.
(g) Evidence of insurability (including
(d) Receipt of health care.
(e) Medical history.
(f) Genetic information.
(g) Evidence of insurability (including
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conditions arising out of acts of domestic violence).
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(h) Disability.
(2) No application to benefits or exclusions. To the
(2) No application to benefits or exclusions. To the
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extent consistent with Section 20, the provisions of paragraph (1) shall not be construed:
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(a) to require a group health plan, or group
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health insurance coverage, to provide particular benefits other than those provided under the terms of such plan or coverage; or
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(b) to prevent such a plan or coverage from
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establishing limitations or restrictions on the amount, level, extent, or nature of the benefits or coverage for similarly situated individuals enrolled in the plan or coverage.
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(3) Construction. For purposes of paragraph (1),
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rules for eligibility to enroll under a plan include rules defining any applicable waiting periods for such enrollment.
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(B) In premium contributions.
(1) In general. A group health plan, and a health
(1) In general. A group health plan, and a health
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insurance issuer offering health insurance coverage in connection with a group health plan, may not require any individual (as a condition of enrollment or continued enrollment under the plan) to pay a premium or contribution which is greater than such premium or contribution for a similarly situated individual enrolled in the plan on the basis of any health status-related factor in relation to the individual or to an individual enrolled under the plan as a dependent of the individual.
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(2) Construction. Nothing in paragraph (1) shall be
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construed:
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(a) to restrict the amount that an employer may
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be charged for coverage under a group health plan; or
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(b) to prevent a group health plan, and a health
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insurance issuer offering group health insurance coverage, from establishing premium discounts or rebates or modifying otherwise applicable copayments or deductibles in return for adherence to programs of health promotion and disease prevention.
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