Bill Text: IL SB0034 | 2013-2014 | 98th General Assembly | Amended
Bill Title: Amends the Illinois Health Benefits Exchange Law. Makes changes concerning the legislative intent of the Law. Sets forth definitions. Establishes the Illinois Health Benefits Exchange as a political subdivision, body politic and corporate beginning October 1, 2014 (instead of 2013). Provides that the Exchange shall be a public entity, but shall not be considered a department, institution, or agency of the State. Sets forth provisions concerning health benefit plan certification. Deletes references to the Illinois Health Benefits Exchange Legislative Study Committee and establishes instead the Illinois Health Benefits Exchange Legislative Oversight Committee within the Commission on Government Forecasting and Accountability. Provides that the governing and administrative powers of the Exchange shall be vested in a body known as the Illinois Health Benefits Exchange Board and sets forth provisions concerning appointments, terms, meetings, the Board's structure, recusal, a budget, a revenue generating plan, and the Board's purpose. Establishes the Illinois Health Benefits Exchange Fund. Sets forth provisions concerning enrollment through brokers and agents and producer compensation. Makes other changes. Effective immediately.
Spectrum: Partisan Bill (Democrat 31-0)
Status: (Failed) 2015-01-13 - Session Sine Die [SB0034 Detail]
Download: Illinois-2013-SB0034-Amended.html
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1 | AMENDMENT TO SENATE BILL 34
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2 | AMENDMENT NO. ______. Amend Senate Bill 34 by replacing | ||||||
3 | everything after the enacting clause with the following:
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4 | "Section 5. The Personnel Code is amended by changing | ||||||
5 | Section 4c as follows:
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6 | (20 ILCS 415/4c) (from Ch. 127, par. 63b104c) | ||||||
7 | Sec. 4c. General exemptions. The following positions in | ||||||
8 | State
service shall be exempt from jurisdictions A, B, and C, | ||||||
9 | unless the
jurisdictions shall be extended as provided in this | ||||||
10 | Act:
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11 | (1) All officers elected by the people.
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12 | (2) All positions under the Lieutenant Governor, | ||||||
13 | Secretary of State,
State Treasurer, State Comptroller, | ||||||
14 | State Board of Education, Clerk of
the Supreme Court,
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15 | Attorney General, and State Board of Elections.
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16 | (3) Judges, and officers and employees of the courts, |
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1 | and notaries
public.
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2 | (4) All officers and employees of the Illinois General | ||||||
3 | Assembly, all
employees of legislative commissions, all | ||||||
4 | officers and employees of the
Illinois Legislative | ||||||
5 | Reference Bureau, the Legislative
Research Unit, and the | ||||||
6 | Legislative Printing Unit.
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7 | (5) All positions in the Illinois National Guard and | ||||||
8 | Illinois State
Guard, paid from federal funds or positions
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9 | in the State Military Service filled by enlistment and paid | ||||||
10 | from State
funds.
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11 | (6) All employees of the Governor at the executive | ||||||
12 | mansion and on
his immediate personal staff.
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13 | (7) Directors of Departments, the Adjutant General, | ||||||
14 | the Assistant
Adjutant General, the Director of the | ||||||
15 | Illinois Emergency
Management Agency, members of boards | ||||||
16 | and commissions, and all other
positions appointed by the | ||||||
17 | Governor by and with the consent of the
Senate.
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18 | (8) The presidents, other principal administrative | ||||||
19 | officers, and
teaching, research and extension faculties | ||||||
20 | of
Chicago State University, Eastern Illinois University, | ||||||
21 | Governors State
University, Illinois State University, | ||||||
22 | Northeastern Illinois University,
Northern Illinois | ||||||
23 | University, Western Illinois University, the Illinois
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24 | Community College Board, Southern Illinois
University, | ||||||
25 | Illinois Board of Higher Education, University of
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26 | Illinois, State Universities Civil Service System, |
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1 | University Retirement
System of Illinois, and the | ||||||
2 | administrative officers and scientific and
technical staff | ||||||
3 | of the Illinois State Museum.
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4 | (9) All other employees except the presidents, other | ||||||
5 | principal
administrative officers, and teaching, research | ||||||
6 | and extension faculties
of the universities under the | ||||||
7 | jurisdiction of the Board of Regents and
the colleges and | ||||||
8 | universities under the jurisdiction of the Board of
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9 | Governors of State Colleges and Universities, Illinois | ||||||
10 | Community College
Board, Southern Illinois University, | ||||||
11 | Illinois Board of Higher Education,
Board of Governors of | ||||||
12 | State Colleges and Universities, the Board of
Regents, | ||||||
13 | University of Illinois, State Universities Civil Service
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14 | System, University Retirement System of Illinois, so long | ||||||
15 | as these are
subject to the provisions of the State | ||||||
16 | Universities Civil Service Act.
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17 | (10) The State Police so long as they are subject to | ||||||
18 | the merit
provisions of the State Police Act.
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19 | (11) (Blank).
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20 | (12) The technical and engineering staffs of the | ||||||
21 | Department of
Transportation, the Department of Nuclear | ||||||
22 | Safety, the Pollution Control
Board, and the Illinois | ||||||
23 | Commerce Commission, and the technical and engineering
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24 | staff providing architectural and engineering services in | ||||||
25 | the Department of
Central Management Services.
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26 | (13) All employees of the Illinois State Toll Highway |
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1 | Authority.
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2 | (14) The Secretary of the Illinois Workers' | ||||||
3 | Compensation Commission.
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4 | (15) All persons who are appointed or employed by the | ||||||
5 | Director of
Insurance under authority of Section 202 of the | ||||||
6 | Illinois Insurance Code
to assist the Director of Insurance | ||||||
7 | in discharging his responsibilities
relating to the | ||||||
8 | rehabilitation, liquidation, conservation, and
dissolution | ||||||
9 | of companies that are subject to the jurisdiction of the
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10 | Illinois Insurance Code.
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11 | (16) All employees of the St. Louis Metropolitan Area | ||||||
12 | Airport
Authority.
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13 | (17) All investment officers employed by the Illinois | ||||||
14 | State Board of
Investment.
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15 | (18) Employees of the Illinois Young Adult | ||||||
16 | Conservation Corps program,
administered by the Illinois | ||||||
17 | Department of Natural Resources, authorized
grantee under | ||||||
18 | Title VIII of the Comprehensive
Employment and Training Act | ||||||
19 | of 1973, 29 USC 993.
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20 | (19) Seasonal employees of the Department of | ||||||
21 | Agriculture for the
operation of the Illinois State Fair | ||||||
22 | and the DuQuoin State Fair, no one
person receiving more | ||||||
23 | than 29 days of such employment in any calendar year.
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24 | (20) All "temporary" employees hired under the | ||||||
25 | Department of Natural
Resources' Illinois Conservation | ||||||
26 | Service, a youth
employment program that hires young people |
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1 | to work in State parks for a period
of one year or less.
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2 | (21) All hearing officers of the Human Rights | ||||||
3 | Commission.
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4 | (22) All employees of the Illinois Mathematics and | ||||||
5 | Science Academy.
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6 | (23) All employees of the Kankakee River Valley Area
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7 | Airport Authority.
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8 | (24) The commissioners and employees of the Executive | ||||||
9 | Ethics
Commission.
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10 | (25) The Executive Inspectors General, including | ||||||
11 | special Executive
Inspectors General, and employees of | ||||||
12 | each Office of an
Executive Inspector General.
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13 | (26) The commissioners and employees of the | ||||||
14 | Legislative Ethics
Commission.
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15 | (27) The Legislative Inspector General, including | ||||||
16 | special Legislative
Inspectors General, and employees of | ||||||
17 | the Office of
the Legislative Inspector General.
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18 | (28) The Auditor General's Inspector General and | ||||||
19 | employees of the Office
of the Auditor General's Inspector | ||||||
20 | General.
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21 | (29) All employees of the Illinois Power Agency. | ||||||
22 | (30) Employees having demonstrable, defined advanced | ||||||
23 | skills in accounting, financial reporting, or technical | ||||||
24 | expertise who are employed within executive branch | ||||||
25 | agencies and whose duties are directly related to the | ||||||
26 | submission to the Office of the Comptroller of financial |
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1 | information for the publication of the Comprehensive | ||||||
2 | Annual Financial Report (CAFR). | ||||||
3 | (31) The employees of the Illinois Health Benefits | ||||||
4 | Exchange. | ||||||
5 | (Source: P.A. 97-618, eff. 10-26-11; 97-1055, eff. 8-23-12 .)
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6 | Section 10. The Illinois State Auditing Act is amended by | ||||||
7 | changing Section 3-1 as follows:
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8 | (30 ILCS 5/3-1) (from Ch. 15, par. 303-1)
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9 | Sec. 3-1. Jurisdiction of Auditor General. The Auditor | ||||||
10 | General has
jurisdiction over all State agencies to make post | ||||||
11 | audits and investigations
authorized by or under this Act or | ||||||
12 | the Constitution.
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13 | The Auditor General has jurisdiction over local government | ||||||
14 | agencies
and private agencies only:
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15 | (a) to make such post audits authorized by or under | ||||||
16 | this Act as are
necessary and incidental to a post audit of | ||||||
17 | a State agency or of a
program administered by a State | ||||||
18 | agency involving public funds of the
State, but this | ||||||
19 | jurisdiction does not include any authority to review
local | ||||||
20 | governmental agencies in the obligation, receipt, | ||||||
21 | expenditure or
use of public funds of the State that are | ||||||
22 | granted without limitation or
condition imposed by law, | ||||||
23 | other than the general limitation that such
funds be used | ||||||
24 | for public purposes;
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1 | (b) to make investigations authorized by or under this | ||||||
2 | Act or the
Constitution; and
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3 | (c) to make audits of the records of local government | ||||||
4 | agencies to verify
actual costs of state-mandated programs | ||||||
5 | when directed to do so by the
Legislative Audit Commission | ||||||
6 | at the request of the State Board of Appeals
under the | ||||||
7 | State Mandates Act.
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8 | In addition to the foregoing, the Auditor General may | ||||||
9 | conduct an
audit of the Metropolitan Pier and Exposition | ||||||
10 | Authority, the
Regional Transportation Authority, the Suburban | ||||||
11 | Bus Division, the Commuter
Rail Division and the Chicago | ||||||
12 | Transit Authority and any other subsidized
carrier when | ||||||
13 | authorized by the Legislative Audit Commission. Such audit
may | ||||||
14 | be a financial, management or program audit, or any combination | ||||||
15 | thereof.
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16 | The audit shall determine whether they are operating in | ||||||
17 | accordance with
all applicable laws and regulations. Subject to | ||||||
18 | the limitations of this
Act, the Legislative Audit Commission | ||||||
19 | may by resolution specify additional
determinations to be | ||||||
20 | included in the scope of the audit.
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21 | In addition to the foregoing, the Auditor General must also | ||||||
22 | conduct a
financial audit of
the Illinois Sports Facilities | ||||||
23 | Authority's expenditures of public funds in
connection with the | ||||||
24 | reconstruction, renovation, remodeling, extension, or
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25 | improvement of all or substantially all of any existing | ||||||
26 | "facility", as that
term is defined in the Illinois Sports |
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1 | Facilities Authority Act.
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2 | The Auditor General may also conduct an audit, when | ||||||
3 | authorized by
the Legislative Audit Commission, of any hospital | ||||||
4 | which receives 10% or
more of its gross revenues from payments | ||||||
5 | from the State of Illinois,
Department of Healthcare and Family | ||||||
6 | Services (formerly Department of Public Aid), Medical | ||||||
7 | Assistance Program.
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8 | The Auditor General is authorized to conduct financial and | ||||||
9 | compliance
audits of the Illinois Distance Learning Foundation | ||||||
10 | and the Illinois
Conservation Foundation.
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11 | As soon as practical after the effective date of this | ||||||
12 | amendatory Act of
1995, the Auditor General shall conduct a | ||||||
13 | compliance and management audit of
the City of
Chicago and any | ||||||
14 | other entity with regard to the operation of Chicago O'Hare
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15 | International Airport, Chicago Midway Airport and Merrill C. | ||||||
16 | Meigs Field. The
audit shall include, but not be limited to, an | ||||||
17 | examination of revenues,
expenses, and transfers of funds; | ||||||
18 | purchasing and contracting policies and
practices; staffing | ||||||
19 | levels; and hiring practices and procedures. When
completed, | ||||||
20 | the audit required by this paragraph shall be distributed in
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21 | accordance with Section 3-14.
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22 | The Auditor General shall conduct a financial and | ||||||
23 | compliance and program
audit of distributions from the | ||||||
24 | Municipal Economic Development Fund
during the immediately | ||||||
25 | preceding calendar year pursuant to Section 8-403.1 of
the | ||||||
26 | Public Utilities Act at no cost to the city, village, or |
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1 | incorporated town
that received the distributions.
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2 | The Auditor General must conduct an audit of the Health | ||||||
3 | Facilities and Services Review Board pursuant to Section 19.5 | ||||||
4 | of the Illinois Health Facilities Planning
Act.
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5 | The Auditor General of the State of Illinois shall annually | ||||||
6 | conduct or
cause to be conducted a financial and compliance | ||||||
7 | audit of the books and records
of any county water commission | ||||||
8 | organized pursuant to the Water Commission Act
of 1985 and | ||||||
9 | shall file a copy of the report of that audit with the Governor | ||||||
10 | and
the Legislative Audit Commission. The filed audit shall be | ||||||
11 | open to the public
for inspection. The cost of the audit shall | ||||||
12 | be charged to the county water
commission in accordance with | ||||||
13 | Section 6z-27 of the State Finance Act. The
county water | ||||||
14 | commission shall make available to the Auditor General its | ||||||
15 | books
and records and any other documentation, whether in the | ||||||
16 | possession of its
trustees or other parties, necessary to | ||||||
17 | conduct the audit required. These
audit requirements apply only | ||||||
18 | through July 1, 2007.
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19 | The Auditor General must conduct audits of the Rend Lake | ||||||
20 | Conservancy
District as provided in Section 25.5 of the River | ||||||
21 | Conservancy Districts Act.
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22 | The Auditor General must conduct financial audits of the | ||||||
23 | Southeastern Illinois Economic Development Authority as | ||||||
24 | provided in Section 70 of the Southeastern Illinois Economic | ||||||
25 | Development Authority Act.
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26 | The Auditor General shall conduct a compliance audit in |
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1 | accordance with subsections (d) and (f) of Section 30 of the | ||||||
2 | Innovation Development and Economy Act. | ||||||
3 | The Auditor General shall have the authority to conduct an | ||||||
4 | audit of the Illinois Health Benefits Exchange. The audit may | ||||||
5 | be a financial audit, a management audit, a program audit, or | ||||||
6 | any combination thereof. | ||||||
7 | (Source: P.A. 95-331, eff. 8-21-07; 96-31, eff. 6-30-09; | ||||||
8 | 96-939, eff. 6-24-10.)
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9 | Section 15. The Comprehensive Health Insurance Plan Act is | ||||||
10 | amended by adding Sections 16 and 17 as follows:
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11 | (215 ILCS 105/16 new) | ||||||
12 | Sec. 16. Cessation of operations. Notwithstanding any | ||||||
13 | other provision of this Act, the insurance operations of the | ||||||
14 | Plan authorized by this Act shall cease on January 1, 2014 in | ||||||
15 | accordance with Section 5-30 of the Illinois Health Benefits | ||||||
16 | Exchange Law. Plan coverage does not apply to service provided | ||||||
17 | on or after January 1, 2014 in accordance with Section 5-30 of | ||||||
18 | the Illinois Health Benefits Exchange Law.
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19 | (215 ILCS 105/17 new) | ||||||
20 | Sec. 17. Repealer. This Act is repealed on January 1, 2015.
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21 | Section 20. The Illinois Health Benefits Exchange Law is | ||||||
22 | amended by changing Sections 5-3, 5-5, and 5-15 and by adding |
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1 | Sections 5-4, 5-6, 5-16, 5-17, 5-18, 5-21, 5-23, and 5-30 as | ||||||
2 | follows:
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3 | (215 ILCS 122/5-3)
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4 | Sec. 5-3. Legislative intent. The General Assembly finds | ||||||
5 | the health benefits exchanges authorized by the federal Patient | ||||||
6 | Protection and Affordable Care Act represent one of a number of | ||||||
7 | ways in which the State can address coverage gaps and provide | ||||||
8 | individual consumers and small employers access to greater | ||||||
9 | coverage options. The General Assembly also finds that the | ||||||
10 | State is best positioned to implement an exchange that is | ||||||
11 | sensitive to the coverage gaps and market landscape unique to | ||||||
12 | this State. | ||||||
13 | The purpose of this Law is to provide for the establishment | ||||||
14 | of an Illinois Health Benefits Exchange (the Exchange) to | ||||||
15 | facilitate the purchase and sale of qualified health plans and | ||||||
16 | qualified dental plans in the individual market in this State | ||||||
17 | and to provide for the establishment of a Small Business Health | ||||||
18 | Options Program (SHOP Exchange) to assist qualified small | ||||||
19 | employers in this State in facilitating the enrollment of their | ||||||
20 | employees in qualified health plans and qualified dental plans | ||||||
21 | offered in the small group market. The intent of the Exchange | ||||||
22 | is to supplement the existing health insurance market to | ||||||
23 | simplify shopping for individual and small employers by | ||||||
24 | increasing access to benefit options, encouraging a | ||||||
25 | competitive market both inside and outside the Exchange, |
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1 | reducing the number of uninsured, and providing a transparent | ||||||
2 | marketplace and effective consumer education and programmatic | ||||||
3 | assistance tools. The purpose of this Law is to ensure that the | ||||||
4 | State is making sufficient progress towards establishing an | ||||||
5 | exchange within the guidelines outlined by the federal law and | ||||||
6 | to protect Illinoisans from undue federal regulation. Although | ||||||
7 | the federal law imposes a number of core requirements on | ||||||
8 | state-level exchanges, the State has significant flexibility | ||||||
9 | in the design and operation of a State exchange that make it | ||||||
10 | prudent for the State to carefully analyze, plan, and prepare | ||||||
11 | for the exchange. The General Assembly finds that in order for | ||||||
12 | the State to craft a tenable exchange that meets the | ||||||
13 | fundamental goals outlined by the Patient Protection and | ||||||
14 | Affordable Care Act of expanding access to affordable coverage | ||||||
15 | and improving the quality of care, the implementation process | ||||||
16 | should (1) provide for broad stakeholder representation; (2) | ||||||
17 | foster a robust and competitive marketplace, both inside and | ||||||
18 | outside of the exchange; and (3) provide for a broad-based | ||||||
19 | approach to the fiscal solvency of the exchange.
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20 | (Source: P.A. 97-142, eff. 7-14-11.)
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21 | (215 ILCS 122/5-4 new) | ||||||
22 | Sec. 5-4. Definitions. In this Law: | ||||||
23 | "Board" means the Illinois Health Benefits Exchange Board | ||||||
24 | established pursuant to this Law. | ||||||
25 | "Department" means the Department of Insurance. |
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1 | "Director" means the Director of Insurance. | ||||||
2 | "Educated health care consumer" means an individual who is | ||||||
3 | knowledgeable about the health care system, and has background | ||||||
4 | or experience in making informed decisions regarding health, | ||||||
5 | medical, and public health matters. | ||||||
6 | "Essential health benefits" has the meaning provided under | ||||||
7 | Section 1302(b) of the Federal Act. | ||||||
8 | "Exchange" means the Illinois Health Benefits Exchange | ||||||
9 | established by this Law and includes the Individual Exchange | ||||||
10 | and the SHOP Exchange, unless otherwise specified. | ||||||
11 | "Executive Director" means the Executive Director of the | ||||||
12 | Illinois Health Benefits Exchange. | ||||||
13 | "Federal Act" means the federal Patient Protection and | ||||||
14 | Affordable Care Act (Public Law 111-148), as amended by the | ||||||
15 | federal Health Care and Education Reconciliation Act of 2010 | ||||||
16 | (Public Law 111-152), and any amendments thereto, or | ||||||
17 | regulations or guidance issued under, those Acts. | ||||||
18 | "Health benefit plan" means a policy, contract, | ||||||
19 | certificate, or agreement offered or issued by a health carrier | ||||||
20 | to provide, deliver, arrange for, pay for, or reimburse any of | ||||||
21 | the costs of health care services.
"Health benefit plan" does | ||||||
22 | not include: | ||||||
23 | (1) coverage for accident only or disability income | ||||||
24 | insurance or any combination thereof; | ||||||
25 | (2) coverage issued as a supplement to liability | ||||||
26 | insurance; |
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1 | (3) liability insurance, including general liability | ||||||
2 | insurance and automobile liability insurance; | ||||||
3 | (4) workers' compensation or similar insurance; | ||||||
4 | (5) automobile medical payment insurance; | ||||||
5 | (6) credit-only insurance; | ||||||
6 | (7) coverage for on-site medical clinics; or | ||||||
7 | (8) other similar insurance coverage, specified in | ||||||
8 | federal regulations issued pursuant to the federal Health | ||||||
9 | Information Portability and Accountability Act of 1996, | ||||||
10 | Public Law 104-191, under which benefits for health care | ||||||
11 | services are secondary or incidental to other insurance | ||||||
12 | benefits. | ||||||
13 | "Health benefit plan" does not include the following | ||||||
14 | benefits if they are provided under a separate policy, | ||||||
15 | certificate, or contract of insurance or are otherwise not an | ||||||
16 | integral part of the plan: | ||||||
17 | (a) limited scope dental or vision benefits; | ||||||
18 | (b) benefits for long-term care, nursing home care, | ||||||
19 | home health care, community-based care, or any combination | ||||||
20 | thereof; or | ||||||
21 | (c) other similar, limited benefits specified in | ||||||
22 | federal regulations issued pursuant to Public Law 104-191. | ||||||
23 | "Health benefit plan" does not include the following | ||||||
24 | benefits if the benefits are provided under a separate policy, | ||||||
25 | certificate, or contract of insurance, there is no coordination | ||||||
26 | between the provision of the benefits and any exclusion of |
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1 | benefits under any group health plan maintained by the same | ||||||
2 | plan sponsor, and the benefits are paid with respect to an | ||||||
3 | event without regard to whether benefits are provided with | ||||||
4 | respect to such an event under any group health plan maintained | ||||||
5 | by the same plan sponsor: | ||||||
6 | (i) coverage only for a specified disease or illness; | ||||||
7 | or | ||||||
8 | (ii) hospital indemnity or other fixed indemnity | ||||||
9 | insurance. | ||||||
10 | "Health benefit plan" does not include the following if | ||||||
11 | offered as a separate policy, certificate, or contract of | ||||||
12 | insurance: | ||||||
13 | (A) Medicare supplemental health insurance as defined | ||||||
14 | under Section 1882(g)(1) of the federal Social Security | ||||||
15 | Act; | ||||||
16 | (B) coverage supplemental to the coverage provided | ||||||
17 | under Chapter 55 of Title 10, United States Code (Civilian | ||||||
18 | Health and Medical Program of the Uniformed Services | ||||||
19 | (CHAMPUS)); or | ||||||
20 | (C) similar supplemental coverage provided to coverage | ||||||
21 | under a group health plan. | ||||||
22 | "Health benefit plan" does not include a group health plan | ||||||
23 | or multiple employer welfare arrangement to the extent the plan | ||||||
24 | or arrangement is not subject to State insurance regulation | ||||||
25 | under Section 514 of the federal Employee Retirement Income | ||||||
26 | Security Act of 1974. |
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1 | "Health insurance carrier" or "carrier" means an entity | ||||||
2 | subject to the insurance laws and regulations of this State, or | ||||||
3 | subject to the jurisdiction of the Director, that contracts or | ||||||
4 | offers to contract to provide, deliver, arrange for, pay for, | ||||||
5 | or reimburse any of the costs of health care services, | ||||||
6 | including a sickness and accident insurance company, a health | ||||||
7 | maintenance organization, or any other entity providing a plan | ||||||
8 | of health insurance, or health benefits. "Health insurance | ||||||
9 | carrier" does not include short term, accident only, disability | ||||||
10 | income, hospital confinement or fixed indemnity, vision only, | ||||||
11 | limited benefit, or credit insurance, coverage issued as a | ||||||
12 | supplement to liability insurance, insurance arising out of a | ||||||
13 | workers' compensation or similar law, automobile | ||||||
14 | medical-payment insurance, insurance under which benefits are | ||||||
15 | payable with or without regard to fault and which is | ||||||
16 | statutorily required to be contained in any liability insurance | ||||||
17 | policy or equivalent self-insurance, or a Consumer Operated and | ||||||
18 | Oriented Plan. | ||||||
19 | "Illinois Health Benefits Exchange Fund" means the fund | ||||||
20 | created outside of the State treasury to be used exclusively to | ||||||
21 | provide funding for the operation and administration of the | ||||||
22 | Exchange in carrying out the purposes authorized by this Law. | ||||||
23 | "Individual Exchange" means the exchange marketplace | ||||||
24 | established by this Law through which qualified individuals may | ||||||
25 | obtain coverage through an individual market qualified health | ||||||
26 | plan. |
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1 | "Principal place of business" means the location in a state | ||||||
2 | where an employer has its headquarters or significant place of | ||||||
3 | business and where the persons with direction and control | ||||||
4 | authority over the business are employed. | ||||||
5 | "Qualified dental plan" means a limited scope dental plan | ||||||
6 | that has been certified in accordance with this Law. | ||||||
7 | "Qualified employee" means an eligible individual employed | ||||||
8 | by a qualified employer who has been offered health insurance | ||||||
9 | coverage by that qualified employer through the SHOP on the | ||||||
10 | Exchange. | ||||||
11 | "Qualified employer" means a small employer that elects to | ||||||
12 | make its full-time employees eligible for one or more qualified | ||||||
13 | health plans or qualified dental plans offered through the SHOP | ||||||
14 | Exchange, and at the option of the employer, some or all of its | ||||||
15 | part-time employees, provided that the employer has its | ||||||
16 | principal place of business in this State and elects to provide | ||||||
17 | coverage through the SHOP Exchange to all of its eligible | ||||||
18 | employees, wherever employed. | ||||||
19 | "Qualified health plan" or "QHP" means a health benefit | ||||||
20 | plan that has in effect a certification that the plan meets the | ||||||
21 | criteria for certification described in Section 1311(c) of the | ||||||
22 | Federal Act. | ||||||
23 | "Qualified health plan issuer" or "QHP issuer" means a | ||||||
24 | health insurance issuer that offers a health plan that the | ||||||
25 | Exchange has certified as a qualified health plan. | ||||||
26 | "Qualified individual" means an individual, including a |
| |||||||
| |||||||
1 | minor, who: | ||||||
2 | (1) is seeking to enroll in a qualified health plan or | ||||||
3 | qualified dental plan offered to individuals through the | ||||||
4 | Exchange; | ||||||
5 | (2) resides in this State; | ||||||
6 | (3) at the time of enrollment, is not incarcerated, | ||||||
7 | other than incarceration pending the disposition of | ||||||
8 | charges; and | ||||||
9 | (4) is, and is reasonably expected to be, for the | ||||||
10 | entire period for which enrollment is sought, a citizen or | ||||||
11 | national of the United States or an alien lawfully present | ||||||
12 | in the United States. | ||||||
13 | "Secretary" means the Secretary of the federal Department | ||||||
14 | of Health and Human Services. | ||||||
15 | "SHOP Exchange" means the Small Business Health Options | ||||||
16 | Program established under this Law through which a qualified | ||||||
17 | employer can provide small group qualified health plans to its | ||||||
18 | qualified employees through various options available to the | ||||||
19 | employer, including, but not limited to: (a) offering one | ||||||
20 | qualified health plan to employees, (b) offering multiple | ||||||
21 | qualified health plans to employees, or (c) offering an | ||||||
22 | employee-directed choice of a qualified health plan within an | ||||||
23 | employer-selected coverage tier. | ||||||
24 | "Small employer" means, in connection with a group health | ||||||
25 | plan with respect to a calendar year and a plan year, an | ||||||
26 | employer who employed an average of at least 2 but not more |
| |||||||
| |||||||
1 | than 50 employees before January 1, 2016 and no more than 100 | ||||||
2 | employees on and after January 1, 2016 on business days during | ||||||
3 | the preceding calendar year and who employs at least one | ||||||
4 | employee on the first day of the plan year.
For purposes of | ||||||
5 | this definition: | ||||||
6 | (a) all persons treated as a single employer under | ||||||
7 | subsection (b), (c), (m) or (o) of Section 414 of the | ||||||
8 | federal Internal Revenue Code of 1986 shall be treated as a | ||||||
9 | single employer; | ||||||
10 | (b) an employer and any predecessor employer shall be | ||||||
11 | treated as a single employer; | ||||||
12 | (c) employees shall be counted in accordance with | ||||||
13 | federal law and regulations and State law and regulations; | ||||||
14 | provided however, that in the event of a conflict between | ||||||
15 | the federal law and regulations and the State law and | ||||||
16 | regulations, the federal law and regulations shall | ||||||
17 | prevail; | ||||||
18 | (d) if an employer was not in existence throughout the | ||||||
19 | preceding calendar year, then the determination of whether | ||||||
20 | that employer is a small employer shall be based on the | ||||||
21 | average number of employees that is reasonably expected | ||||||
22 | that employer will employ on business days in the current | ||||||
23 | calendar year; and | ||||||
24 | (e) an employer that makes enrollment in qualified | ||||||
25 | health plans or qualified dental plans available to its | ||||||
26 | employees through the SHOP Exchange, and would cease to be |
| |||||||
| |||||||
1 | a small employer by reason of an increase in the number of | ||||||
2 | its employees, shall continue to be treated as a small | ||||||
3 | employer for purposes of this Law as long as it | ||||||
4 | continuously makes enrollment through the SHOP Exchange | ||||||
5 | available to its employees.
| ||||||
6 | (215 ILCS 122/5-5)
| ||||||
7 | Sec. 5-5. Establishment of the Exchange State health | ||||||
8 | benefits exchange . | ||||||
9 | (a) It is declared that this State, beginning on the | ||||||
10 | effective date of this amendatory Act of the 98th General | ||||||
11 | Assembly October 1, 2013 , in accordance with Section 1311 of | ||||||
12 | the federal Patient Protection and Affordable Care Act, shall | ||||||
13 | establish a State health benefits exchange to be known as the | ||||||
14 | Illinois Health Benefits Exchange in order to help individuals | ||||||
15 | and small employers with no more than 50 employees shop for, | ||||||
16 | select, and enroll in qualified, affordable private health | ||||||
17 | plans that fit their needs at competitive prices. The Exchange | ||||||
18 | shall separate coverage pools for individuals and small | ||||||
19 | employers and shall supplement and not supplant any existing | ||||||
20 | private health insurance market for individuals and small | ||||||
21 | employers. These health plans shall be available to individuals | ||||||
22 | and small employers for enrollment by October 1, 2014.
| ||||||
23 | (b) There is hereby created a political subdivision, body | ||||||
24 | politic and corporate, named the Illinois Health Benefits | ||||||
25 | Exchange. The Exchange shall be a public entity, but shall not |
| |||||||
| |||||||
1 | be considered a department, institution, or agency of the | ||||||
2 | State. | ||||||
3 | (c) The Exchange shall be comprised of an individual and a | ||||||
4 | small business health options (SHOP) exchange. Pursuant to | ||||||
5 | Section 1311(b)(2) of the Federal Act, the Exchange shall | ||||||
6 | provide individual exchange services to qualified individuals | ||||||
7 | and SHOP Exchange services to qualified employers under a | ||||||
8 | single governance and administrative structure. The Board | ||||||
9 | shall produce an assessment, which must include a premium | ||||||
10 | impact study, by July 1, 2016 to determine the viability of | ||||||
11 | merging the SHOP Exchange and Individual Exchange functions | ||||||
12 | into a single exchange by January 1, 2017. Any recommended | ||||||
13 | merger of the SHOP Exchange and Individual Exchange functions | ||||||
14 | shall be subject to legislative approval. | ||||||
15 | (d) The Exchange shall promote a competitive marketplace | ||||||
16 | for consumer access to affordable health coverage options. The | ||||||
17 | Department shall review and recommend that the Board certify | ||||||
18 | health benefit plans on the individual and SHOP Exchange, as | ||||||
19 | applicable, provided that any such health benefit plan meets | ||||||
20 | the requirements set forth in Section 1311(c) of the Federal | ||||||
21 | Act and any other requirements of the Illinois Insurance Code. | ||||||
22 | The Board shall certify health benefit plans that the | ||||||
23 | Department recommends for certification. | ||||||
24 | (e) The Exchange shall not supersede the provisions of the | ||||||
25 | Illinois Insurance Code, nor the functions of the Department of | ||||||
26 | Insurance, the Department of Healthcare and Family Services, or |
| |||||||
| |||||||
1 | the Department of Public Health. | ||||||
2 | (Source: P.A. 97-142, eff. 7-14-11.)
| ||||||
3 | (215 ILCS 122/5-6 new) | ||||||
4 | Sec. 5-6. Health benefit plan certification. | ||||||
5 | (a) To be certified as a qualified health plan, a health | ||||||
6 | benefit plan shall, at a minimum: | ||||||
7 | (1) provide the essential health benefits package | ||||||
8 | described in Section 1302(a) of
the Federal Act; except | ||||||
9 | that the plan is not required to provide essential benefits | ||||||
10 | that duplicate
the minimum benefits of qualified dental | ||||||
11 | plans, as provided in subsection (e) of this Section if: | ||||||
12 | (A) the Board, in cooperation with the Department, | ||||||
13 | has determined that at least one qualified dental plan | ||||||
14 | is
available to supplement the plan's coverage; and | ||||||
15 | (B) the health carrier makes prominent disclosure | ||||||
16 | at the time it offers the
plan, in a form approved by | ||||||
17 | the Board, that the plan does not provide the full | ||||||
18 | range of
essential pediatric dental benefits and that | ||||||
19 | qualified dental plans providing those benefits and
| ||||||
20 | other dental benefits not covered by the plan are | ||||||
21 | offered through the Exchange; | ||||||
22 | (2) fulfill all premium rate and contract filing | ||||||
23 | requirements and ensure that no contract language has been | ||||||
24 | disapproved by the Director; | ||||||
25 | (3) provide at least the minimum level of coverage |
| |||||||
| |||||||
1 | prescribed by the Federal Act; | ||||||
2 | (4) ensure that the cost-sharing requirements of the | ||||||
3 | plan do not exceed the limits
established under Section | ||||||
4 | 1302(c)(l) of the Federal Act, and if the plan is offered | ||||||
5 | through the
SHOP Exchange, the plan's deductible does not | ||||||
6 | exceed the limits established under Section
1302(c)(2) of | ||||||
7 | the Federal Act; | ||||||
8 | (5) be offered by a health carrier that: | ||||||
9 | (A) is authorized and in good standing to offer | ||||||
10 | health insurance coverage; | ||||||
11 | (B) offers at least one qualified health plan at | ||||||
12 | the silver level and at
least one plan at the gold | ||||||
13 | level, as described in the Federal Act, through each | ||||||
14 | component of the Board in which the health
carrier | ||||||
15 | participates; for the purposes of this subparagraph | ||||||
16 | (B), "component"
means the SHOP Exchange and the | ||||||
17 | exchange for individual coverage within the American
| ||||||
18 | Health Benefit Exchange; | ||||||
19 | (C) charges the same premium rate for each | ||||||
20 | qualified health plan without
regard to whether the | ||||||
21 | plan is offered through the Exchange and without regard | ||||||
22 | to whether the
plan is offered directly from the health | ||||||
23 | carrier or through an insurance producer; | ||||||
24 | (D) does not charge any cancellation fees or | ||||||
25 | penalties; and | ||||||
26 | (E) complies with the regulations established by |
| |||||||
| |||||||
1 | the Secretary under
Section 1311 (d) of the Federal Act | ||||||
2 | and any other requirements of the Illinois Insurance | ||||||
3 | Code and the Department; | ||||||
4 | (6) meet the requirements of certification pursuant to | ||||||
5 | the requirements of the Department and the Illinois | ||||||
6 | Insurance Code provided in
this Law and the requirements | ||||||
7 | issued by the Secretary under Section 1311(c) of the | ||||||
8 | Federal Act and rules promulgated or adopted
pursuant to | ||||||
9 | this Law or the Federal Act, which shall include: | ||||||
10 | (A) minimum standards in the areas of marketing | ||||||
11 | practices; | ||||||
12 | (B) network adequacy; | ||||||
13 | (C) essential community providers in underserved | ||||||
14 | areas; | ||||||
15 | (D) accreditation; | ||||||
16 | (E) quality improvement; | ||||||
17 | (F) uniform enrollment forms and descriptions of | ||||||
18 | coverage; and | ||||||
19 | (G) information on quality measures for health | ||||||
20 | benefit plan performance; and | ||||||
21 | (7) include outpatient clinics in the health plan's | ||||||
22 | region that are controlled by an entity that also controls | ||||||
23 | a 340B eligible provider as defined by Section 340B(a)(4) | ||||||
24 | of the federal Public Health Service Act such that the | ||||||
25 | outpatient clinics are subject to the same mission, | ||||||
26 | policies, and medical standards related to the provision of |
| |||||||
| |||||||
1 | health care services as the 340B eligible provider. | ||||||
2 | (b) The Department shall require each health carrier | ||||||
3 | seeking certification of a plan as a
qualified health plan to: | ||||||
4 | (1) make available to the public, in plain language as | ||||||
5 | defined in Section 1311(e)(3)(B) of the Federal Act, and | ||||||
6 | submit to the Board, the Secretary, and the Department | ||||||
7 | accurate
and timely disclosure of the following: | ||||||
8 | (i) claims payment policies and practices; | ||||||
9 | (ii) periodic financial disclosures; | ||||||
10 | (iii) data on enrollment; | ||||||
11 | (iv) data on disenrollment; | ||||||
12 | (v) data on the number of claims that are | ||||||
13 | denied; | ||||||
14 | (vi) data on rating practices; | ||||||
15 | (vii) information on cost-sharing and payments | ||||||
16 | with respect to any
out-of-network coverage; | ||||||
17 | (viii) information on enrollee and participant | ||||||
18 | rights under Title I of
the Federal Act; and | ||||||
19 | (ix) other information as determined | ||||||
20 | appropriate by the Secretary, including, but not | ||||||
21 | limited to, accredited clinical quality measures; | ||||||
22 | and | ||||||
23 | (2) permit individuals to learn, in a timely manner | ||||||
24 | upon the request of the
individual, the comparative quality | ||||||
25 | standards of the plans along established clinical | ||||||
26 | data-based standards and the amount of cost-sharing, |
| |||||||
| |||||||
1 | including deductibles, copayments, and coinsurance,
under | ||||||
2 | the individual's plan or coverage that the individual would | ||||||
3 | be responsible for paying with
respect to the furnishing of | ||||||
4 | a specific item or service by a participating provider and | ||||||
5 | make this
information available to the individual through | ||||||
6 | an Internet website that is publicly accessible and
through | ||||||
7 | other means for individuals without access to the Internet. | ||||||
8 | (c) The Department shall not exempt any health carrier | ||||||
9 | seeking certification as a qualified
health plan, regardless of | ||||||
10 | the type or size of the health carrier, from licensure or | ||||||
11 | solvency
requirements and shall apply the criteria of this | ||||||
12 | Section in a manner that ensures a level playing
field between | ||||||
13 | or among health carriers participating in the Exchange. | ||||||
14 | (d) The provisions of this Law that are applicable to | ||||||
15 | qualified health plans shall also
apply, to the extent | ||||||
16 | relevant, to qualified dental plans, except as modified in | ||||||
17 | accordance with the
provisions of paragraphs (1), (2), and (3) | ||||||
18 | of this subsection (d) or by rules adopted by the
Board. | ||||||
19 | (1) The health carrier shall be licensed to offer | ||||||
20 | dental coverage, but need not be
licensed to offer other | ||||||
21 | health benefits. | ||||||
22 | (2) The plan shall be limited to dental and oral health | ||||||
23 | benefits, without
substantially duplicating the benefits | ||||||
24 | typically offered by health benefit plans without dental
| ||||||
25 | coverage and shall include, at a minimum, the essential | ||||||
26 | pediatric dental benefits prescribed by
the Secretary |
| |||||||
| |||||||
1 | pursuant to Section 1302(b)(l)(J) of the Federal Act and | ||||||
2 | such other dental benefits
as the Board or the Secretary | ||||||
3 | may specify by rule. | ||||||
4 | (3) Health carriers may jointly offer a comprehensive | ||||||
5 | plan through the Exchange
in which the dental benefits are | ||||||
6 | provided by a health carrier through a qualified dental | ||||||
7 | plan and
the other benefits are provided by a health | ||||||
8 | carrier through a qualified health plan, provided that
the | ||||||
9 | plans are priced separately and are also made available for | ||||||
10 | purchase separately at the same
price.
| ||||||
11 | (215 ILCS 122/5-15)
| ||||||
12 | Sec. 5-15. Illinois Health Benefits Exchange Legislative | ||||||
13 | Oversight Study Committee. | ||||||
14 | (a) There is created an Illinois Health Benefits Exchange | ||||||
15 | Legislative Oversight Study Committee within the Commission on | ||||||
16 | Government Forecasting and Accountability to provide | ||||||
17 | accountability for conduct a study regarding State | ||||||
18 | implementation and establishment of the Illinois Health | ||||||
19 | Benefits Exchange and to ensure Exchange operations and | ||||||
20 | functions align with the goals and duties outlined by this Law . | ||||||
21 | The Committee shall also be responsible for providing policy | ||||||
22 | recommendations to ensure the Exchange aligns with the Federal | ||||||
23 | Act, amendments to the Federal Act, and regulations promulgated | ||||||
24 | pursuant to the Federal Act. | ||||||
25 | (b) Members of the Legislative Oversight Study Committee |
| |||||||
| |||||||
1 | shall be appointed as follows: 3 members of the Senate shall be | ||||||
2 | appointed by the President of the Senate; 3 members of the | ||||||
3 | Senate shall be appointed by the Minority Leader of the Senate; | ||||||
4 | 3 members of the House of Representatives shall be appointed by | ||||||
5 | the Speaker of the House of Representatives; and 3 members of | ||||||
6 | the House of Representatives shall be appointed by the Minority | ||||||
7 | Leader of the House of Representatives. Each legislative leader | ||||||
8 | shall select one member to serve as co-chair of the committee. | ||||||
9 | (c) Members of the Legislative Oversight Study Committee | ||||||
10 | shall be appointed no later than June 1, 2013 within 30 days | ||||||
11 | after the effective date of this Law. The co-chairs shall | ||||||
12 | convene the first meeting of the committee no later than 45 | ||||||
13 | days after the effective date of this Law .
| ||||||
14 | (Source: P.A. 97-142, eff. 7-14-11.)
| ||||||
15 | (215 ILCS 122/5-16 new) | ||||||
16 | Sec. 5-16. Exchange governance. The governing and | ||||||
17 | administrative powers of the Exchange shall be vested in a body | ||||||
18 | known as the Illinois Health Benefits Exchange Board. The | ||||||
19 | following provisions shall apply: | ||||||
20 | (1) The Board shall consist of 11 voting members | ||||||
21 | appointed by the Governor with the advice and consent of a | ||||||
22 | majority of the members elected to the Senate. In addition, | ||||||
23 | the Director of Healthcare and Family Services, and the | ||||||
24 | Executive Director of the Exchange shall serve as | ||||||
25 | non-voting, ex-officio members of the Board. The Governor |
| |||||||
| |||||||
1 | shall also appoint as non-voting, ex-officio members one | ||||||
2 | economist with experience in the health care markets and | ||||||
3 | one educated health care consumer advocate. All Board | ||||||
4 | members shall be appointed no later than January 1, 2014. | ||||||
5 | (2) The Governor shall make the appointments so as to | ||||||
6 | reflect no less than proportional representation of the | ||||||
7 | geographic, gender, cultural, racial, and ethnic | ||||||
8 | composition of this State and in accordance with | ||||||
9 | subparagraphs (A), (B), and (C) of this paragraph, as | ||||||
10 | follows: | ||||||
11 | (A) No more than 4 voting members may represent the | ||||||
12 | following interests, of which no more than 2 may | ||||||
13 | represent any one interest: | ||||||
14 | (1) the insurance industry; | ||||||
15 | (2) health care administrators; and | ||||||
16 | (3) licensed health care professionals. | ||||||
17 | (B) At least 7 voting members shall represent the | ||||||
18 | following interest groups, with each interest group | ||||||
19 | represented by at least one voting member: | ||||||
20 | (1) a labor interest group; | ||||||
21 | (2) a women's interest group; | ||||||
22 | (3) a minorities' interest group; | ||||||
23 | (4) a disabled persons' interest group; | ||||||
24 | (5) a small business interest group; and | ||||||
25 | (6) a public health interest group. | ||||||
26 | (C) Each person appointed to the Board should have |
| |||||||
| |||||||
1 | demonstrated experience in at least one of the | ||||||
2 | following areas: | ||||||
3 | (1) individual health insurance coverage; | ||||||
4 | (2) small employer health insurance; | ||||||
5 | (3) health benefits administration; | ||||||
6 | (4) health care finance; | ||||||
7 | (5) administration of a public or private | ||||||
8 | health care delivery system; | ||||||
9 | (6) the provision of health care services; | ||||||
10 | (7) the purchase of health insurance coverage; | ||||||
11 | (8) health care consumer navigation or | ||||||
12 | assistance; | ||||||
13 | (9) health care economics or health care | ||||||
14 | actuarial sciences; | ||||||
15 | (10) information technology; or | ||||||
16 | (11) starting a small business with 50 or fewer | ||||||
17 | employees. | ||||||
18 | (3) The Board shall elect one voting member of the | ||||||
19 | Board to serve as chairperson and one voting member to | ||||||
20 | serve as vice-chairperson, upon approval of a majority of | ||||||
21 | the Board. | ||||||
22 | (4) The Exchange shall be administered by an Executive | ||||||
23 | Director, who shall be appointed, and may be removed, by a | ||||||
24 | majority of the Board. The Board shall have the power to | ||||||
25 | determine compensation for the Executive Director. | ||||||
26 | (5) The terms of the non-voting, ex-officio members of |
| |||||||
| |||||||
1 | the Board shall run concurrent with their terms of | ||||||
2 | appointment to office, or in the case of the Executive | ||||||
3 | Director, his or her term of appointment to that position, | ||||||
4 | subject to the determination of the Board. The terms of the | ||||||
5 | members, including those non-voting, ex-officio members | ||||||
6 | appointed by the Governor, shall be 4 years. Upon | ||||||
7 | conclusion of the initial term, the next term and every | ||||||
8 | term subsequent to it shall run for 3 years. Voting members | ||||||
9 | shall serve no more than 3 consecutive terms. | ||||||
10 | A person appointed to fill a vacancy and complete the | ||||||
11 | unexpired term of a member of the Board shall only be | ||||||
12 | appointed to serve out the unexpired term by the individual | ||||||
13 | who made the original appointment within 45 days after the | ||||||
14 | initial vacancy. A person appointed to fill a vacancy and | ||||||
15 | complete the unexpired term of a member of the Board may be | ||||||
16 | re-appointed to the Board for another term, but shall not | ||||||
17 | serve than more than 2 consecutive terms following their | ||||||
18 | completion of the unexpired term of a member of the Board. | ||||||
19 | If a voting Board member's qualifications change due to | ||||||
20 | a change in employment during the term of their | ||||||
21 | appointment, then the Board member shall resign their | ||||||
22 | position, subject to reappointment by the individual who | ||||||
23 | made the original appointment. | ||||||
24 | (6) The Board shall, as necessary, create and appoint | ||||||
25 | qualified persons with requisite expertise to Exchange | ||||||
26 | technical advisory groups. These Exchange technical |
| |||||||
| |||||||
1 | advisory groups shall meet in a manner and frequency | ||||||
2 | determined by the Board to discuss exchange-related issues | ||||||
3 | and to provide exchange-related guidance, advice, and | ||||||
4 | recommendations to the Board and the Exchange. There shall | ||||||
5 | be at a minimum, 6 technical advisory groups, including the | ||||||
6 | following: | ||||||
7 | (1) an insurer advisory group; | ||||||
8 | (2) a business advisory group; | ||||||
9 | (3) a consumer advisory group; | ||||||
10 | (4) a provider advisory group; | ||||||
11 | (5) an insurance producer advisory group; and | ||||||
12 | (6) a dentist advisory group. | ||||||
13 | (7) The Board shall meet no less than quarterly on a | ||||||
14 | schedule established by the chairperson. Meetings shall be | ||||||
15 | public and public records shall be maintained, subject to | ||||||
16 | the Open Meetings Act. A majority of the Board shall | ||||||
17 | constitute a quorum and the affirmative vote of a majority | ||||||
18 | is necessary for any action of the Board. No vacancy shall | ||||||
19 | impair the ability of the Board to act provided a quorum is | ||||||
20 | reached. Members shall serve without pay, but shall be | ||||||
21 | reimbursed for their actual and reasonable expenses | ||||||
22 | incurred in the performance of their duties. The | ||||||
23 | chairperson of the Board shall file a written report | ||||||
24 | regarding the activities of the Board and the Exchange to | ||||||
25 | the Governor and General Assembly annually, and the | ||||||
26 | Legislative Oversight Committee established in Section |
| |||||||
| |||||||
1 | 5-15 quarterly, beginning on September 1, 2013 through | ||||||
2 | December 31, 2014. | ||||||
3 | (8) The Board shall adopt conflict of interest rules | ||||||
4 | and recusal procedures. Such rules and procedures shall (i) | ||||||
5 | prohibit a member of the Board from performing an official | ||||||
6 | act that may have a direct economic benefit on a business | ||||||
7 | or other endeavor in which that member has a direct or | ||||||
8 | substantial financial interest and (ii) require a member of | ||||||
9 | the Board to recuse himself or herself from an official | ||||||
10 | matter, whether direct or indirect. All recusals must be in | ||||||
11 | writing and specify the reason and date of the recusal. All | ||||||
12 | recusals shall be maintained by the Executive Director and | ||||||
13 | shall be disclosed to any person upon written request. | ||||||
14 | (9) The Board shall develop a budget, to be submitted | ||||||
15 | to the General Assembly along with the Governor's annual | ||||||
16 | budget proposal and approved by the General Assembly, for | ||||||
17 | the implementation and operation of the Exchange for | ||||||
18 | operating expenses, including, but not limited to: | ||||||
19 | (A) proposed compensation levels for the Executive | ||||||
20 | Director and shall identify personnel and staffing | ||||||
21 | needs for the implementation and operation of the | ||||||
22 | Exchange; | ||||||
23 | (B) disclosure of funds received or expected to be | ||||||
24 | received from the federal government for the | ||||||
25 | infrastructure and systems of the Exchange and those | ||||||
26 | funds received or expected to be received for program |
| |||||||
| |||||||
1 | administration and operations; | ||||||
2 | (C) delineation of those functions of the Exchange | ||||||
3 | that are to be paid by State and federal programs that | ||||||
4 | are allocable to the State's General Revenue Fund; and | ||||||
5 | (D) beginning January 1, 2015, insurer assessments | ||||||
6 | contingent upon the use of federal funds for the first | ||||||
7 | year of operation of the Exchange and upon the review | ||||||
8 | and recommendations of the Commission on Government | ||||||
9 | Forecasting and Accountability. | ||||||
10 | (10) The Board shall, in consultation with the Health | ||||||
11 | Benefits Exchange Legislative Oversight Committee, produce | ||||||
12 | a cost-benefit analysis of the State's essential health | ||||||
13 | benefits no later than August 1, 2015 for the purposes of | ||||||
14 | informing the U.S. Department of Health and Human Services | ||||||
15 | in their re-evaluation of the essential health benefits for | ||||||
16 | plan years 2016 and beyond. | ||||||
17 | (11) The purpose of the Board shall be to implement the | ||||||
18 | Exchange in accordance with this Section and shall be | ||||||
19 | authorized to establish procedures for the operation of the | ||||||
20 | Exchange, subject to legislative approval.
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21 | (215 ILCS 122/5-17 new) | ||||||
22 | Sec. 5-17. Insurer's assessment. Every carrier licensed to | ||||||
23 | issue, and that issues for delivery, policies of accident and | ||||||
24 | health insurance in this State shall be assessed. An insurer's | ||||||
25 | assessment shall be determined by multiplying the total |
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1 | assessment, as determined in this Section, by a fraction, the | ||||||
2 | numerator of which equals that insurer's direct Illinois | ||||||
3 | premiums, excluding those premiums from limited lines policies | ||||||
4 | and supplemental insurance policies, during the preceding | ||||||
5 | calendar year and the denominator of which equals the total of | ||||||
6 | all insurers' direct Illinois premiums, excluding those | ||||||
7 | premiums from limited lines policies and supplemental | ||||||
8 | insurance policies. The Board may exempt those insurers whose | ||||||
9 | share as determined under this Section would be so minimal as | ||||||
10 | to not exceed the estimated cost of levying the assessment. The | ||||||
11 | Board shall charge and collect from each insurer the amounts | ||||||
12 | determined to be due under this Section. The assessment shall | ||||||
13 | be billed by Board invoice based upon the insurer's direct | ||||||
14 | Illinois premium income, excluding premium income from limited | ||||||
15 | lines policies and supplemental insurance policies, as shown in | ||||||
16 | its annual statement for the preceding calendar year as filed | ||||||
17 | with the Director. The invoice shall be due upon receipt and | ||||||
18 | must be paid no later than 30 days after receipt by the | ||||||
19 | insurer. | ||||||
20 | When a carrier fails to pay the full amount of any | ||||||
21 | assessment of $100 or more due under this Section there shall | ||||||
22 | be added to the amount due as a penalty the greater of $50 or an | ||||||
23 | amount equal to 5% of the deficiency for each month or part of | ||||||
24 | a month that the deficiency remains unpaid. All moneys | ||||||
25 | collected by the Board shall be placed in the Illinois Health | ||||||
26 | Benefits Exchange Fund. |
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1 | Insurers shall be assessed only an amount not exceeding the | ||||||
2 | General Assembly's approved Board budget. No assessment shall | ||||||
3 | be made on insurers while assessments are being made pursuant | ||||||
4 | to Section 12 of the Comprehensive Health Insurance Plan Act. | ||||||
5 | The assessment shall also take into consideration any unspent | ||||||
6 | federal funds remaining and shall be reduced accordingly. | ||||||
7 | The Board shall prepare annually a complete and detailed | ||||||
8 | written report accounting for all funds received and dispensed | ||||||
9 | during the preceding fiscal year.
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10 | (215 ILCS 122/5-18 new) | ||||||
11 | Sec. 5-18. Illinois Health Benefits Exchange Fund. There | ||||||
12 | is hereby created as a fund outside of the State treasury the | ||||||
13 | Illinois Health Benefits Exchange Fund to be used, subject to | ||||||
14 | appropriation, exclusively by the Exchange to provide funding | ||||||
15 | for the operation and administration of the Exchange in | ||||||
16 | carrying out the purposes authorized in this Law.
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17 | (215 ILCS 122/5-21 new) | ||||||
18 | Sec. 5-21. Enrollment through brokers and agents; producer | ||||||
19 | compensation. | ||||||
20 | (a) In accordance with Section 1312(e) of the Federal Act, | ||||||
21 | the Exchange shall allow licensed insurance producers to (1) | ||||||
22 | enroll qualified individuals in any qualified health plan, for | ||||||
23 | which the individual is eligible, in the individual exchange, | ||||||
24 | (2) assist qualified individuals in applying for premium tax |
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1 | credits and cost-sharing reductions for qualified health plans | ||||||
2 | purchased through the individual exchange, and (3) enroll | ||||||
3 | qualified employers in any qualified health plan, for which the | ||||||
4 | employer is eligible, offered through the SHOP exchange. | ||||||
5 | Nothing in this subsection (a) shall be construed as to require | ||||||
6 | a qualified individual or qualified employer to utilize a | ||||||
7 | licensed insurance producer for any of the purposes outlined in | ||||||
8 | this subsection (a). | ||||||
9 | (b) In order to enroll individuals and small employers in | ||||||
10 | qualified health plans on the Exchange, licensed producers must | ||||||
11 | complete a certification program. The Department of Insurance | ||||||
12 | may develop and implement a certification program for licensed | ||||||
13 | insurance producers who enroll individuals and employers in the | ||||||
14 | exchange. The Department of Insurance may charge a reasonable | ||||||
15 | fee, by regulation, to producers for the certification program. | ||||||
16 | The Department of Insurance may approve certification programs | ||||||
17 | developed and instructed by others, charging a reasonable fee, | ||||||
18 | by regulation, for approval. | ||||||
19 | (c) The Exchange shall include on its Internet website a | ||||||
20 | producer locator section, featured prominently, through which | ||||||
21 | individuals and small employers can find exchange-certified | ||||||
22 | producers. | ||||||
23 | (d) The Exchange shall take no role in developing or | ||||||
24 | determining the manner or amount of compensation producers | ||||||
25 | receive from qualified health plans for individuals or | ||||||
26 | employers enrolled in health plans through the Exchange.
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1 | (215 ILCS 122/5-23 new) | ||||||
2 | Sec. 5-23. Examination or investigation of the Exchange. | ||||||
3 | The Director shall have the ability to examine or investigate | ||||||
4 | the Exchange pursuant to his or her authority under Article | ||||||
5 | XXIV of the Illinois Insurance Code.
| ||||||
6 | (215 ILCS 122/5-30 new) | ||||||
7 | Sec. 5-30. Dissolution of Comprehensive Health Insurance | ||||||
8 | Plan. | ||||||
9 | (a) Except as otherwise provided in this Section, the | ||||||
10 | insurance operations of the Comprehensive Health Insurance | ||||||
11 | Plan authorized by the Comprehensive Health Insurance Plan Act | ||||||
12 | shall cease on January 1, 2014. As used in this Section, "Plan" | ||||||
13 | means the Comprehensive Health Insurance plan. | ||||||
14 | (b) Coverage under the Plan does not apply to service | ||||||
15 | provided on or after January 1, 2014. | ||||||
16 | (c) A claim for payment under the Plan must be submitted | ||||||
17 | within 180 days after January 1, 2014 and paid within 60 days | ||||||
18 | after receipt. | ||||||
19 | (d) Any grievance shall be resolved by the Plan Board not | ||||||
20 | later than 360 days after January 1, 2014. In this Section, | ||||||
21 | "Plan Board" means the Illinois Comprehensive Health Insurance | ||||||
22 | Board. | ||||||
23 | (e) The Plan Board shall, not later than June 30, 2013, | ||||||
24 | submit to the Director of Insurance a plan of dissolution, |
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1 | which must provide for, but not be limited to, the following: | ||||||
2 | (1) Continuity of care for an individual who is covered | ||||||
3 | under the Plan and is an inpatient on January 1, 2014. | ||||||
4 | (2) A final accounting of assessments. | ||||||
5 | (3) Resolution of any net asset deficiency. | ||||||
6 | (4) Cessation of all liability of the Plan. | ||||||
7 | (5) Final dissolution of the Plan. | ||||||
8 | (f) The plan of dissolution may provide that, with the | ||||||
9 | approval of the Plan Board and the Director, a power or duty of | ||||||
10 | the association may be delegated to a person that is to perform | ||||||
11 | functions similar to the functions of the Plan. | ||||||
12 | (g) The Director shall, after notice and hearing, approve a | ||||||
13 | plan of dissolution submitted under subsection (e) of this | ||||||
14 | Section if the Director determines that the plan of dissolution | ||||||
15 | is suitable to ensure the fair, reasonable, and equitable | ||||||
16 | dissolution of the Plan and complies with subsection (e) of | ||||||
17 | this Section. If the Director does not find that the plan of | ||||||
18 | dissolution is suitable to ensure the fair, reasonable, and | ||||||
19 | equitable dissolution of the Plan, he or she may by order | ||||||
20 | require changes to the plan that cure the deficiencies | ||||||
21 | identified in his or her findings. | ||||||
22 | (h) A plan of dissolution submitted under subsection (e) of | ||||||
23 | this Section is effective upon the written approval of the | ||||||
24 | Director. | ||||||
25 | (i) An action by or against the Plan must be filed not more | ||||||
26 | than one year after January 1, 2014. |
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1 | (j) General Revenue Fund funds remaining in the Plan on the | ||||||
2 | date on which final dissolution of the Plan occurs must be | ||||||
3 | transferred back into the General Revenue Fund. | ||||||
4 | (k) Insurer assessments remaining in the Plan on the date | ||||||
5 | on which dissolution of the Plan occurs must be returned to | ||||||
6 | insurers based on subsection e of Section 12 of the | ||||||
7 | Comprehensive Health Insurance Plan Act. | ||||||
8 | (l) The Plan, or the person or entity to which the Plan | ||||||
9 | delegates powers under subsection (f) of this Section, may | ||||||
10 | implement this Section in accordance with the plan of | ||||||
11 | dissolution approved by the Director under subsection (g) of | ||||||
12 | this Section.
| ||||||
13 | Section 99. Effective date. This Act takes effect upon | ||||||
14 | becoming law.".
|