215 ILCS 97/40 — what it says, and how the exam tests it

215 ILCS 97/40. Sec. 40. Guaranteed availability of coverage for employers in the group market. (A) Issuance of coverage in the small group market. (1) In general. Subject to subsections (C) through (F), each health insurance issuer that offers health insurance coverage in the small group market in a State: (a) must accept every small employer (as defined in Section 10) in the State that applies for such coverage; and (b) must accept for enrollment under such coverage every eligible individual (as defined in paragraph (2)) who applies for enrollment during the period in which the individual first becomes eligible to enroll under the terms of the group health plan and may not place any restriction which is inconsistent with Section 25 on an eligible individual being a participant or beneficiary. (2) Eligible individual defined. For purposes of this Section, the term "eligible individual" means, with respect to a health insurance issuer that offers health insurance coverage to a small employer in connection with a group health plan in the small group market, such an individual in relation to the employer as shall be determined: (a) in accordance with the terms of such plan; (b) as provided by the issuer under rules of the issuer which are uniformly applicable in a State to small employers in the small group market; and (c) in accordance with all applicable State laws governing such issuer and such market. (B) Special rules for network plans. (1) In general. In the case of a health insurance issuer that offers health insurance coverage in the small group market through a network plan, the issuer may: (a) limit the employers that may apply for such coverage to those with eligible individuals who live, work, or reside in the service area for such network plan; and (b) within the service area of such plan, deny such coverage to such employers if the issuer has demonstrated, if required, to the Department that: (i) it will not have the capacity to deliver services adequately to enrollees of any additional groups because of its obligations to existing group contract holders and enrollees; and (ii) it is applying this paragraph uniformly to all employers without regard to the claims experience of those employers and their employees (and their dependents) or any health status-related factor relating to such employees and dependents. (2) 180-day suspension upon denial…