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