SB2364 EngrossedLRB099 19287 EGJ 43679 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Personnel Code is amended by adding Section
526 as follows:
 
6    (20 ILCS 415/26 new)
7    Sec. 26. Transfers. Personnel employed by the Illinois
8Comprehensive Health Insurance Plan transferred to the
9Department of Insurance on January 1, 2017 pursuant to this
10amendatory Act of the 99th General Assembly, upon completion of
11the probationary period, shall receive certified status under
12this Code.
 
13    Section 10. The Department of Insurance Law of the Civil
14Administrative Code of Illinois is amended by adding Section
151405-40 as follows:
 
16    (20 ILCS 1405/1405-40 new)
17    Sec. 1405-40. Transfer of the Illinois Comprehensive
18Health Insurance Plan. On January 1, 2017, all powers, duties,
19rights, and responsibilities of the Illinois Comprehensive
20Health Insurance Plan and the Illinois Comprehensive Health
21Insurance Board under the Comprehensive Health Insurance Plan

 

 

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1Act shall be transferred to the Director of Insurance as
2provided in Section 17 of the Comprehensive Health Insurance
3Plan Act.
 
4    Section 15. The Comprehensive Health Insurance Plan Act is
5amended by changing Sections 1.1, 3, and 15 and by adding
6Sections 16, 17, and 18 as follows:
 
7    (215 ILCS 105/1.1)  (from Ch. 73, par. 1301.1)
8    Sec. 1.1. The General Assembly hereby makes the following
9findings and declarations:
10        (a) The Comprehensive Health Insurance Plan is
11    established as a State program that is intended to provide
12    an alternate market for health insurance for certain
13    uninsurable Illinois residents, and further is intended to
14    provide an acceptable alternative mechanism as described
15    in the federal Health Insurance Portability and
16    Accountability Act of 1996 for providing portable and
17    accessible individual health insurance coverage for
18    federally eligible individuals as defined in this Act.
19        (b) The State of Illinois may subsidize the cost of
20    health insurance coverage offered by the Plan. However,
21    since the State has only a limited amount of resources, the
22    General Assembly declares that it intends for this program
23    to provide portable and accessible individual health
24    insurance coverage for every federally eligible individual

 

 

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1    who qualifies for coverage in accordance with Section 15 of
2    this Act, but does not intend for every eligible person who
3    qualifies for Plan coverage in accordance with Section 7 of
4    this Act to be guaranteed a right to be issued a policy
5    under this Plan as a matter of entitlement.
6        (c) The Comprehensive Health Insurance Plan Board
7    shall operate the Plan in a manner so that the estimated
8    cost of the program during any fiscal year will not exceed
9    the total income it expects to receive from policy
10    premiums, investment income, assessments, or fees
11    collected or received by the Board and other funds which
12    are made available from appropriations for the Plan by the
13    General Assembly for that fiscal year.
14    With the implementation of the federal Patient Protection
15and Affordable Care Act, the Plan shall discontinue as the
16alternative market for health insurance for certain
17uninsurable Illinois residents and discontinue as the
18alternative mechanism, as described in the federal Health
19Insurance Portability and Accountability Act of 1996,
20effective no later than January 1, 2017.
21(Source: P.A. 90-30, eff. 7-1-97.)
 
22    (215 ILCS 105/3)  (from Ch. 73, par. 1303)
23    Sec. 3. Operation of the Plan.
24    a. There is hereby created an Illinois Comprehensive Health
25Insurance Plan.

 

 

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1    b. The Plan shall operate subject to the supervision and
2control of the board. The board is created as a political
3subdivision and body politic and corporate and, as such, is not
4a State agency. The board shall consist of 10 public members,
5appointed by the Governor with the advice and consent of the
6Senate.
7    Initial members shall be appointed to the Board by the
8Governor as follows: 2 members to serve until July 1, 1988, and
9until their successors are appointed and qualified; 2 members
10to serve until July 1, 1989, and until their successors are
11appointed and qualified; 3 members to serve until July 1, 1990,
12and until their successors are appointed and qualified; and 3
13members to serve until July 1, 1991, and until their successors
14are appointed and qualified. As terms of initial members
15expire, their successors shall be appointed for terms to expire
16the first day in July 3 years thereafter, and until their
17successors are appointed and qualified.
18    Any vacancy in the Board occurring for any reason other
19than the expiration of a term shall be filled for the unexpired
20term in the same manner as the original appointment.
21    Any member of the Board may be removed by the Governor for
22neglect of duty, misfeasance, malfeasance, or nonfeasance in
23office.
24    In addition, a representative of the Governor's Office of
25Management and Budget, a representative of the Office of the
26Attorney General and the Director or the Director's designated

 

 

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1representative shall be members of the board. Four members of
2the General Assembly, one each appointed by the President and
3Minority Leader of the Senate and by the Speaker and Minority
4Leader of the House of Representatives, shall serve as
5nonvoting members of the board. At least 2 of the public
6members shall be individuals reasonably expected to qualify for
7coverage under the Plan, the parent or spouse of such an
8individual, or a surviving family member of an individual who
9could have qualified for the plan during his lifetime. The
10Director or Director's representative shall be the chairperson
11of the board. Members of the board shall receive no
12compensation, but shall be reimbursed for reasonable expenses
13incurred in the necessary performance of their duties.
14    c. The board shall make an annual report in September and
15shall file the report with the Secretary of the Senate and the
16Clerk of the House of Representatives. The report shall
17summarize the activities of the Plan in the preceding calendar
18year, including net written and earned premiums, the expense of
19administration, the paid and incurred losses for the year and
20other information as may be requested by the General Assembly.
21The report shall also include analysis and recommendations
22regarding utilization review, quality assurance and access to
23cost effective quality health care.
24    d. In its plan of operation the board shall:
25        (1) Establish procedures for selecting a plan
26    administrator in accordance with Section 5 of this Act.

 

 

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1        (2) Establish procedures for the operation of the
2    board.
3        (3) Create a Plan fund, under management of the board,
4    to fund administrative, claim, and other expenses of the
5    Plan.
6        (4) Establish procedures for the handling and
7    accounting of assets and monies of the Plan.
8        (5) Develop and implement a program to publicize the
9    existence of the Plan, the eligibility requirements and
10    procedures for enrollment and to maintain public awareness
11    of the Plan.
12        (6) Establish procedures under which applicants and
13    participants may have grievances reviewed by a grievance
14    committee appointed by the board. The grievances shall be
15    reported to the board immediately after completion of the
16    review. The Department and the board shall retain all
17    written complaints regarding the Plan for at least 3 years.
18    Oral complaints shall be reduced to written form and
19    maintained for at least 3 years.
20        (7) Provide for other matters as may be necessary and
21    proper for the execution of its powers, duties and
22    obligations under the Plan.
23    e. No later than 5 years after the Plan is operative the
24board and the Department shall conduct cooperatively a study of
25the Plan and the persons insured by the Plan to determine: (1)
26claims experience including a breakdown of medical conditions

 

 

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1for which claims were paid; (2) whether availability of the
2Plan affected employment opportunities for participants; (3)
3whether availability of the Plan affected the receipt of
4medical assistance benefits by Plan participants; (4) whether a
5change occurred in the number of personal bankruptcies due to
6medical or other health related costs; (5) data regarding all
7complaints received about the Plan including its operation and
8services; (6) and any other significant observations regarding
9utilization of the Plan. The study shall culminate in a written
10report to be presented to the Governor, the President of the
11Senate, the Speaker of the House and the chairpersons of the
12House and Senate Insurance Committees. The report shall be
13filed with the Secretary of the Senate and the Clerk of the
14House of Representatives. The report shall also be available to
15members of the general public upon request.
16    (e-5) The board shall conduct a feasibility study of
17establishing a small employer health insurance pool in which
18employers may provide affordable health insurance coverage to
19their employees. The board may contract with a private entity
20or enter into intergovernmental agreements with State agencies
21for the completion of all or part of the study. The study
22shall:
23        (i) Analyze other states' experience in establishing
24    small employer health insurance pools;
25        (ii) Assess the need for a small employer health
26    insurance pool, including the number of individuals who

 

 

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1    might benefit from it;
2        (iii) Recommend means of establishing a small employer
3    health insurance pool; and
4        (iv) Estimate the cost of providing a small employer
5    health insurance pool through the Illinois Comprehensive
6    Health Insurance Plan or another, public or private entity.
7    The board may accept donations, in trust, from any legal
8source, public or private, for deposit into a trust account
9specifically created for expenditure, without the necessity of
10being appropriated, solely for the purpose of conducting all or
11part of the study. The board shall issue a report with
12recommendations to the Governor and the General Assembly by
13January 1, 2005. As used in this subsection e-5, "small
14employer" means an employer having between one and 50
15employees.
16    f. The board may:
17        (1) Prepare and distribute certificate of eligibility
18    forms and enrollment instruction forms to insurance
19    producers and to the general public in this State.
20        (2) Provide for reinsurance of risks incurred by the
21    Plan and enter into reinsurance agreements with insurers to
22    establish a reinsurance plan for risks of coverage
23    described in the Plan, or obtain commercial reinsurance to
24    reduce the risk of loss through the Plan.
25        (3) Issue additional types of health insurance
26    policies to provide optional coverages as are otherwise

 

 

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1    permitted by this Act including a Medicare supplement
2    policy designed to supplement Medicare.
3        (4) Provide for and employ cost containment measures
4    and requirements including, but not limited to,
5    preadmission certification, second surgical opinion,
6    concurrent utilization review programs, and individual
7    case management for the purpose of making the pool more
8    cost effective.
9        (5) Design, utilize, contract, or otherwise arrange
10    for the delivery of cost effective health care services,
11    including establishing or contracting with preferred
12    provider organizations, health maintenance organizations,
13    and other limited network provider arrangements.
14        (6) Adopt bylaws, rules, regulations, policies and
15    procedures as may be necessary or convenient for the
16    implementation of the Act and the operation of the Plan.
17        (7) Administer separate pools, separate accounts, or
18    other plans or arrangements as required by this Act to
19    separate federally eligible individuals or groups of
20    federally eligible individuals who qualify for plan
21    coverage under Section 15 of this Act from eligible persons
22    or groups of eligible persons who qualify for plan coverage
23    under Section 7 of this Act and apportion the costs of the
24    administration among such separate pools, separate
25    accounts, or other plans or arrangements.
26    g. The Director may, by rule, establish additional powers

 

 

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1and duties of the board and may adopt rules for any other
2purposes, including the operation of the Plan, as are necessary
3or proper to implement this Act.
4    h. The board is not liable for any obligation of the Plan.
5There is no liability on the part of any member or employee of
6the board or the Department, and no cause of action of any
7nature may arise against them, for any action taken or omission
8made by them in the performance of their powers and duties
9under this Act, unless the action or omission constitutes
10willful or wanton misconduct. The board may provide in its
11bylaws or rules for indemnification of, and legal
12representation for, its members and employees.
13    i. There is no liability on the part of any insurance
14producer for the failure of any applicant to be accepted by the
15Plan unless the failure of the applicant to be accepted by the
16Plan is due to an act or omission by the insurance producer
17which constitutes willful or wanton misconduct.
18    j. On or before June 30, 2016, the Board shall develop a
19dissolution plan to wind down the affairs of the Plan for
20presentation to and approval by the Director, who shall begin
21to administer and oversee the dissolution and wind-down plan on
22the effective date of this amendatory Act of the 99th General
23Assembly in accordance with Article XIII of the Illinois
24Insurance Code.
25(Source: P.A. 92-597, eff. 6-28-02; 93-622, eff. 12-18-03;
2693-824, eff. 7-28-04.)
 

 

 

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1    (215 ILCS 105/15)
2    Sec. 15. Alternative portable coverage for federally
3eligible individuals.
4    (a) Notwithstanding the requirements of subsection a. of
5Section 7 and except as otherwise provided in this Section, any
6federally eligible individual for whom a Plan application, and
7such enclosures and supporting documentation as the Board may
8require, is received by the Board within 90 days after the
9termination of prior creditable coverage shall qualify to
10enroll in the Plan under the portability provisions of this
11Section.
12    A federally eligible person who has been certified as
13eligible pursuant to the federal Trade Act of 2002 and whose
14Plan application and enclosures and supporting documentation
15as the Board may require is received by the Board within 63
16days after the termination of previous creditable coverage
17shall qualify to enroll in the Plan under the portability
18provisions of this Section.
19    (b) Any federally eligible individual seeking Plan
20coverage under this Section must submit with his or her
21application evidence, including acceptable written
22certification of previous creditable coverage, that will
23establish to the Board's satisfaction, that he or she meets all
24of the requirements to be a federally eligible individual and
25is currently and permanently residing in this State (as of the

 

 

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1date his or her application was received by the Board).
2    (c) Except as otherwise provided in this Section, a period
3of creditable coverage shall not be counted, with respect to
4qualifying an applicant for Plan coverage as a federally
5eligible individual under this Section, if after such period
6and before the application for Plan coverage was received by
7the Board, there was at least a 90 day period during all of
8which the individual was not covered under any creditable
9coverage.
10    For a federally eligible person who has been certified as
11eligible pursuant to the federal Trade Act of 2002, a period of
12creditable coverage shall not be counted, with respect to
13qualifying an applicant for Plan coverage as a federally
14eligible individual under this Section, if after such period
15and before the application for Plan coverage was received by
16the Board, there was at least a 63 day period during all of
17which the individual was not covered under any creditable
18coverage.
19    (d) Any federally eligible individual who the Board
20determines qualifies for Plan coverage under this Section shall
21be offered his or her choice of enrolling in one of alternative
22portability health benefit plans which the Board is authorized
23under this Section to establish for these federally eligible
24individuals and their dependents.
25    (e) The Board shall offer a choice of health care coverages
26consistent with major medical coverage under the alternative

 

 

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1health benefit plans authorized by this Section to every
2federally eligible individual. The coverages to be offered
3under the plans, the schedule of benefits, deductibles,
4co-payments, exclusions, and other limitations shall be
5approved by the Board. One optional form of coverage shall be
6comparable to comprehensive health insurance coverage offered
7in the individual market in this State or a standard option of
8coverage available under the group or individual health
9insurance laws of the State. The standard benefit plan that is
10authorized by Section 8 of this Act may be used for this
11purpose. The Board may also offer a preferred provider option
12and such other options as the Board determines may be
13appropriate for these federally eligible individuals who
14qualify for Plan coverage pursuant to this Section.
15    (f) Notwithstanding the requirements of subsection f. of
16Section 8, any plan coverage that is issued to federally
17eligible individuals who qualify for the Plan pursuant to the
18portability provisions of this Section shall not be subject to
19any preexisting conditions exclusion, waiting period, or other
20similar limitation on coverage.
21    (g) Federally eligible individuals who qualify and enroll
22in the Plan pursuant to this Section shall be required to pay
23such premium rates as the Board shall establish and approve in
24accordance with the requirements of Section 7.1 of this Act.
25    (h) A federally eligible individual who qualifies and
26enrolls in the Plan pursuant to this Section must satisfy on an

 

 

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1ongoing basis all of the other eligibility requirements of this
2Act to the extent not inconsistent with the federal Health
3Insurance Portability and Accountability Act of 1996 in order
4to maintain continued eligibility for coverage under the Plan.
5    (i) New enrollment and policy renewals are discontinued on
6December 31, 2016.
7(Source: P.A. 97-333, eff. 8-12-11.)
 
8    (215 ILCS 105/16 new)
9    Sec. 16. Cessation of operations.
10    (a) Except as otherwise provided in this Section, the
11insurance operations of the Plan authorized by this Act shall
12cease on December 31, 2016.
13    (b) Coverage under the Plan does not apply to services
14provided on or after January 1, 2017.
15    (c) The Plan shall cease providing coverage for
16participants enrolled prior to January 1, 2017 at 11:59 p.m. on
17December 31, 2016.
18    (d) A claim for payment under the Plan must be submitted
19within 180 days after January 1, 2017 and paid within 180 days
20after receipt.
21    (e) Any grievance shall be resolved by the Board not later
22than October 31, 2017.
23    (f) Balance billing by a health care provider that is not a
24member of the provider network used by the Plan is prohibited.
25    (g) The Board shall, not later than June 30, 2016, submit

 

 

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1to the Director a plan of dissolution, which must provide for,
2but shall not be limited to, the following:
3        (1) Continuity of care for an individual who is covered
4    under the Plan and is an inpatient on January 1, 2017.
5        (2) A final accounting of assessments.
6        (3) Resolution of any net asset deficiency.
7        (4) Cessation of all liability of the Plan.
8        (5) Final dissolution of the Plan.
9    (h) The plan of dissolution may provide that, with the
10approval of the Director, a power or duty of the Plan may be
11delegated to a person that is to perform functions similar to
12the functions of the Plan.
13    (i) An action by or against the Plan must be filed no later
14than January 1, 2019.
15    (j) Upon completion of the dissolution plan and final
16satisfaction of all claims under and administrative expenses of
17the dissolution plan, a proportional share of any remaining
18General Revenue Fund and insurer assessments contributed to the
19Plan shall be returned to the General Revenue Fund and assessed
20insurers in accordance with the distribution provisions
21contained in Section 210 of the Illinois Insurance Code.
 
22    (215 ILCS 105/17 new)
23    Sec. 17. Transfer of the Illinois Comprehensive Health
24Insurance Plan.
25    (a) On January 1, 2017, all powers, duties, rights, and

 

 

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1responsibilities of the Plan and the Board shall be transferred
2to the Director, who is authorized to wind down the affairs of
3the Plan in accordance with Article XIII of the Illinois
4Insurance Code.
5    (b) The Director shall act on behalf of the Plan and the
6Board and shall have the power and duty to receive and answer
7correspondence and pay any claims due and owing from any
8unencumbered funds, including refunds, and, for claims
9remaining unpaid as of July 1, 2018, refer unpaid vendors to
10the Court of Claims and arrange for the orderly termination of
11any affairs of the Plan and the Board that remain unresolved.
12    (c) All books, records, papers, documents, property (real
13and personal), contracts, causes of action, and pending
14business pertaining to the powers, duties, rights, and
15responsibilities transferred by this amendatory Act of the 99th
16General Assembly from the Plan and the Board to the Director,
17including, but not limited to, material in electronic or
18magnetic format and necessary computer hardware and software,
19shall be transferred to the Director. Records shall be
20maintained as required by the federal Health Insurance
21Portability and Accountability Act, as now or hereafter
22amended.
23    (d) The personnel of the Plan and the Board shall be
24transferred to the Department. The rights of the employees in
25the State of Illinois and its agencies under the Personnel Code
26and applicable collective bargaining agreements or under any

 

 

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1pension, retirement, or annuity plan shall not be affected by
2this amendatory Act of the 99th General Assembly.
3    (e) All unexpended appropriations and balances and other
4funds available for use by the Plan and the Board shall be
5transferred for use by the Director. Unexpended balances so
6transferred shall be expended for the purpose for which the
7appropriations were originally made or for paying the
8Director's administrative expenses incurred in connection with
9winding down the affairs of the Plan in accordance with Article
10XIII of the Illinois Insurance Code.
11    (f) Whenever reports or notices are, on the effective date
12of this amendatory Act of the 99th General Assembly, required
13to be made or given or papers or documents furnished or served
14by any person to or upon the Plan or the Board in connection
15with any of the powers, duties, rights, and responsibilities
16transferred by this amendatory Act of the 99th General
17Assembly, the same shall be made, given, furnished, or served
18in the same manner to or upon the Director.
19    (g) This amendatory Act of the 99th General Assembly does
20not affect any act done, ratified, or canceled or any right
21occurring or established or any action or proceeding had or
22commenced in the administrative, civil, or criminal cause by
23the Plan or the Board prior to January 1, 2017; such actions or
24proceedings may be prosecuted and continued by the Director.
25    (h) The Board shall continue to exist within the Department
26to provide guidance and recommendations to the Director

 

 

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1relating to the wind down of operations and affairs of the Plan
2and shall retain the power and responsibility to review
3grievances pursuant to this Act. The Board shall cease to exist
4upon final dissolution of the Plan or December 31, 2018,
5whichever occurs first.
 
6    (215 ILCS 105/18 new)
7    Sec. 18. Repealer. This Act is repealed on January 1, 2019.
 
8    Section 99. Effective date. This Act takes effect upon
9becoming law.