Public Act 093-0824
 
HB4478 Enrolled LRB093 19548 SAS 45288 b

    AN ACT concerning insurance.
 
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
 
    Section 5. The Comprehensive Health Insurance Plan Act is
amended by changing Section 3 as follows:
 
    (215 ILCS 105/3)  (from Ch. 73, par. 1303)
    Sec. 3. Operation of the Plan.
    a. There is hereby created an Illinois Comprehensive Health
Insurance Plan.
    b. The Plan shall operate subject to the supervision and
control of the board. The board is created as a political
subdivision and body politic and corporate and, as such, is not
a State agency. The board shall consist of 10 public members,
appointed by the Governor with the advice and consent of the
Senate.
    Initial members shall be appointed to the Board by the
Governor as follows: 2 members to serve until July 1, 1988, and
until their successors are appointed and qualified; 2 members
to serve until July 1, 1989, and until their successors are
appointed and qualified; 3 members to serve until July 1, 1990,
and until their successors are appointed and qualified; and 3
members to serve until July 1, 1991, and until their successors
are appointed and qualified. As terms of initial members
expire, their successors shall be appointed for terms to expire
the first day in July 3 years thereafter, and until their
successors are appointed and qualified.
    Any vacancy in the Board occurring for any reason other
than the expiration of a term shall be filled for the unexpired
term in the same manner as the original appointment.
    Any member of the Board may be removed by the Governor for
neglect of duty, misfeasance, malfeasance, or nonfeasance in
office.
    In addition, a representative of the Governor's Office of
Management and Budget, a representative of the Office of the
Attorney General and the Director or the Director's designated
representative shall be members of the board. Four members of
the General Assembly, one each appointed by the President and
Minority Leader of the Senate and by the Speaker and Minority
Leader of the House of Representatives, shall serve as
nonvoting members of the board. At least 2 of the public
members shall be individuals reasonably expected to qualify for
coverage under the Plan, the parent or spouse of such an
individual, or a surviving family member of an individual who
could have qualified for the plan during his lifetime. The
Director or Director's representative shall be the chairperson
of the board. Members of the board shall receive no
compensation, but shall be reimbursed for reasonable expenses
incurred in the necessary performance of their duties.
    c. The board shall make an annual report in September and
shall file the report with the Secretary of the Senate and the
Clerk of the House of Representatives. The report shall
summarize the activities of the Plan in the preceding calendar
year, including net written and earned premiums, the expense of
administration, the paid and incurred losses for the year and
other information as may be requested by the General Assembly.
The report shall also include analysis and recommendations
regarding utilization review, quality assurance and access to
cost effective quality health care.
    d. In its plan of operation the board shall:
        (1) Establish procedures for selecting a plan
    administrator in accordance with Section 5 of this Act.
        (2) Establish procedures for the operation of the
    board.
        (3) Create a Plan fund, under management of the board,
    to fund administrative, claim, and other expenses of the
    Plan.
        (4) Establish procedures for the handling and
    accounting of assets and monies of the Plan.
        (5) Develop and implement a program to publicize the
    existence of the Plan, the eligibility requirements and
    procedures for enrollment and to maintain public awareness
    of the Plan.
        (6) Establish procedures under which applicants and
    participants may have grievances reviewed by a grievance
    committee appointed by the board. The grievances shall be
    reported to the board immediately after completion of the
    review. The Department and the board shall retain all
    written complaints regarding the Plan for at least 3 years.
    Oral complaints shall be reduced to written form and
    maintained for at least 3 years.
        (7) Provide for other matters as may be necessary and
    proper for the execution of its powers, duties and
    obligations under the Plan.
    e. No later than 5 years after the Plan is operative the
board and the Department shall conduct cooperatively a study of
the Plan and the persons insured by the Plan to determine: (1)
claims experience including a breakdown of medical conditions
for which claims were paid; (2) whether availability of the
Plan affected employment opportunities for participants; (3)
whether availability of the Plan affected the receipt of
medical assistance benefits by Plan participants; (4) whether a
change occurred in the number of personal bankruptcies due to
medical or other health related costs; (5) data regarding all
complaints received about the Plan including its operation and
services; (6) and any other significant observations regarding
utilization of the Plan. The study shall culminate in a written
report to be presented to the Governor, the President of the
Senate, the Speaker of the House and the chairpersons of the
House and Senate Insurance Committees. The report shall be
filed with the Secretary of the Senate and the Clerk of the
House of Representatives. The report shall also be available to
members of the general public upon request.
    (e-5) The board shall conduct a feasibility study of
establishing a small employer health insurance pool in which
employers may provide affordable health insurance coverage to
their employees. The board may contract with a private entity
or enter into intergovernmental agreements with State agencies
for the completion of all or part of the study. The study
shall:
        (i) Analyze other states' experience in establishing
    small employer health insurance pools;
        (ii) Assess the need for a small employer health
    insurance pool, including the number of individuals who
    might benefit from it;
        (iii) Recommend means of establishing a small employer
    health insurance pool; and
        (iv) Estimate the cost of providing a small employer
    health insurance pool through the Illinois Comprehensive
    Health Insurance Plan or another, public or private entity.
    The board may accept donations, in trust, from any legal
source, public or private, for deposit into a trust account
specifically created for expenditure, without the necessity of
being appropriated, solely for the purpose of conducting all or
part of the study. The board shall issue a report with
recommendations to the Governor and the General Assembly by
January 1, 2005. As used in this subsection e-5, "small
employer" means an employer having between one and 50
employees.
    f. The board may:
        (1) Prepare and distribute certificate of eligibility
    forms and enrollment instruction forms to insurance
    producers and to the general public in this State.
        (2) Provide for reinsurance of risks incurred by the
    Plan and enter into reinsurance agreements with insurers to
    establish a reinsurance plan for risks of coverage
    described in the Plan, or obtain commercial reinsurance to
    reduce the risk of loss through the Plan.
        (3) Issue additional types of health insurance
    policies to provide optional coverages as are otherwise
    permitted by this Act including a Medicare supplement
    policy designed to supplement Medicare.
        (4) Provide for and employ cost containment measures
    and requirements including, but not limited to,
    preadmission certification, second surgical opinion,
    concurrent utilization review programs, and individual
    case management for the purpose of making the pool more
    cost effective.
        (5) Design, utilize, contract, or otherwise arrange
    for the delivery of cost effective health care services,
    including establishing or contracting with preferred
    provider organizations, health maintenance organizations,
    and other limited network provider arrangements.
        (6) Adopt bylaws, rules, regulations, policies and
    procedures as may be necessary or convenient for the
    implementation of the Act and the operation of the Plan.
        (7) Administer separate pools, separate accounts, or
    other plans or arrangements as required by this Act to
    separate federally eligible individuals or groups of
    federally eligible individuals who qualify for plan
    coverage under Section 15 of this Act from eligible persons
    or groups of eligible persons who qualify for plan coverage
    under Section 7 of this Act and apportion the costs of the
    administration among such separate pools, separate
    accounts, or other plans or arrangements.
    g. The Director may, by rule, establish additional powers
and duties of the board and may adopt rules for any other
purposes, including the operation of the Plan, as are necessary
or proper to implement this Act.
    h. The board is not liable for any obligation of the Plan.
There is no liability on the part of any member or employee of
the board or the Department, and no cause of action of any
nature may arise against them, for any action taken or omission
made by them in the performance of their powers and duties
under this Act, unless the action or omission constitutes
willful or wanton misconduct. The board may provide in its
bylaws or rules for indemnification of, and legal
representation for, its members and employees.
    i. There is no liability on the part of any insurance
producer for the failure of any applicant to be accepted by the
Plan unless the failure of the applicant to be accepted by the
Plan is due to an act or omission by the insurance producer
which constitutes willful or wanton misconduct.
(Source: P.A. 92-597, eff. 6-28-02; 93-622, eff. 12-18-03.)
 
    Section 99. Effective date. This Act takes effect upon
becoming law.