Public Act 097-0011
 
HB3441 EnrolledLRB097 06367 RPM 46449 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 5 as follows:
 



    (215 ILCS 105/5)  (from Ch. 73, par. 1305)



    Sec. 5. Plan administrator. 

    a. The board shall select a plan administrator through a 
competitive bidding
process to administer the plan.  The board 
shall evaluate bids submitted under
this Section based on 
criteria established by the board which shall include:


        (1) The plan administrator's proven ability to handle 
    other large group
accident and health benefit plans.


        (2) The efficiency and timeliness of the plan 
    administrator's claim
processing procedures.


        (3) An estimate of total net cost for administering the 
    plan, including
any discounts or income the Plan could 
    expect to receive or benefit from.


        (4) The plan administrator's ability to apply 
    effective cost containment
programs and procedures and to 
    administer the plan in a cost-efficient manner.


        (5) The financial condition and stability of the plan 
    administrator.

    b. The plan administrator shall serve for a period of 5 
years subject to
removal for cause and subject to the terms, 
conditions and limitations of the
contract between the board 
and the plan administrator.  At least one year
prior to the 
expiration of each 5 year period of service by the current plan

administrator, the board shall begin to advertise for bids to 
serve as the
plan administrator for the succeeding 5 year 
period.  Selection of the plan
administrator for the succeeding 
period shall be made at least 6 months prior
to the end of the 
current 5 year period. Notwithstanding any other provision of 
this subsection, the Board at its option may extend the term of 
a plan administrator contract for a period not to exceed 3 
years.

    c. The plan administrator shall perform such functions 
relating to the plan
as may be assigned to it including:


        (1) establishment of a premium billing procedure for 
    collection of
premiums from plan participants.  Billings 
    shall be made on a periodic basis as
determined by the 
    board;


        (2) payment and processing of claims and various cost 
    containment
functions; and


        (3) other functions to assure timely payment of 
    benefits to participants
under the plan, including:


            (a) making available information relating to the 
        proper manner of
submitting a claim for benefits under 
        the plan and distributing forms upon
which submissions 
        shall be made, and


            (b) evaluating the eligibility of each claim for 
        payment under the plan.

     The plan administrator shall be governed by the 
requirements of
Part 919 of Title 50 of the Illinois 
Administrative Code, promulgated by
the Department of 
Insurance, regarding the handling of claims under this
Act.

    d. The plan administrator shall submit regular reports to 
the board
regarding the operation of the plan.  The frequency, 
content and form of the
report shall be as determined by the 
board.

    e. The plan administrator shall pay or be reimbursed for 
claims expenses
from the premium payments received from or on 
behalf of plan participants.  If
the plan administrator's 
payments or reimbursements for claims expenses exceed
the 
portion of premiums allocated by the board for payment of 
claims expenses,
the board shall provide additional funds to 
the plan administrator for payment
or reimbursement of such 
claims expenses.

    f. The plan administrator shall be paid as provided in the

contract between the Board and the plan administrator.

(Source: P.A. 90-30, eff. 7-1-97; 90-567, eff. 1-23-98; 91-357, 
eff.
7-29-99.)

 
 
    Section 99. Effective date. This Act takes effect upon 
becoming law.