The national guide covers the general group concepts: group underwriting, the master contract and certificates, contributory plans, COBRA and coordination of benefits. Illinois adds three sets of rules:

• state continuation (215 ILCS 5/367e);
• spousal continuation (215 ILCS 5/367.2);
• protections when a group plan is discontinued or replaced (215 ILCS 5/367i), plus the Illinois Health Insurance Portability and Accountability Act (215 ILCS 97).

National concepts in brief

• The employer holds the master contract, and members get certificates.
• Federal COBRA lets eligible people continue group coverage for a limited time at their own expense.
• Experience rating prices a group on its own claims history.

State continuation (215 ILCS 5/367e)

Spousal continuation (215 ILCS 5/367.2)

• Who can continue: a spouse may continue group coverage after the employee's death or a divorce. After the employee's retirement, the spouse qualifies if they are at least 55.
• Deadline: the spouse gives written notice within 30 days of the judgment, death or retirement.
• When it ends: coverage for a former spouse 55 or older ends on events such as remarriage, other group coverage, or Medicare eligibility.

Discontinued or replaced plans

• Extension of benefits: people totally disabled when a group policy ends get a reasonable extension of benefits (215 ILCS 5/367i). It lasts until the earliest of these (50 Ill. Adm. Code 2013.60):
  • 12 months;
  • the date the maximum benefit is reached;
  • the end of the disability.
• Discontinuance notice: it tells the group policyholder to notify enrolled members within 10 working days (50 Ill. Adm. Code 2013.50).
• Replacement plans: a succeeding plan must cover everyone covered under the old plan, including people who are disabled and away from work (215 ILCS 5/367i).

Illinois HIPAA (215 ILCS 97)

• Eligibility: eligibility rules can't be based on health status factors, including medical condition, claims experience, genetic information and disability.
• Pricing: no individual may be charged more than similarly situated members because of a health status factor.
• Disclosure: carriers disclose:
  • rate-change rights and rating factors;
  • renewability;
  • preexisting condition provisions;
  • available benefits and premiums.

Other group rules

• Dependents may stay on a parent's coverage to at least 26 (215 ILCS 5/356z.12).
• Licensing exemption: employers that administer their own benefit plan without insurer compensation need no producer license (215 ILCS 5/500-20(b)(3)).

Common exam traps

• Illinois continuation lasts 12 months, after 3 months of prior coverage.
• The employer gives notice within 10 days. The employee elects within 30 days, and never more than 60 after termination.
• Spousal continuation at retirement requires the spouse to be at least 55.
• The disability extension when a plan ends runs up to 12 months.