State RegulationsIL specificDifficulty 3/5
A group health plan in Illinois is being discontinued. One employee wants to keep individual coverage in force through the same carrier, while another will enroll in a new employer's plan and wants credit for the prior coverage. How does Illinois law assign these protections?
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
Illinois separates the two protections. The discontinuance-and-replacement provision at 215 ILCS 5/367i, with the conversion rules at 50 Ill. Adm. Code 2013, governs what the existing carrier must offer when group coverage ends. Portability, meaning carrying credit for prior group coverage to a new plan, is the domain of the Illinois Health Insurance Portability and Accountability Act at 215 ILCS 97/20. Knowing which statute answers which question is a practical necessity when advising terminated group members.
Why the other options are wrong
- B) 215 ILCS 97/20 addresses portability and continuation, but it does not eliminate the conversion and replacement duties created by 215 ILCS 5/367i and 50 Ill. Adm. Code 2013.
- C) 50 Ill. Adm. Code 5421 contains the HMO rules and does not govern conversion or portability for group health policies generally.
- D) The citations are reversed: 215 ILCS 130/1002 et seq. covers limited health service organizations, while 215 ILCS 5/367i supplies the discontinuance and replacement duties rather than portability credit.
Memory hook
Conversion stays put (367i/2013); portability travels (215 ILCS 97/20).