Full Text of HB3976 97th General Assembly
HB3976ham002 97TH GENERAL ASSEMBLY | Rep. Karen May Filed: 3/2/2012
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| 1 | | AMENDMENT TO HOUSE BILL 3976
| 2 | | AMENDMENT NO. ______. Amend House Bill 3976 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 5. The Illinois Insurance Code is amended by | 5 | | adding Section 44.1 as follows: | 6 | | (215 ILCS 5/44.1 new) | 7 | | Sec. 44.1. Health care cooperatives. | 8 | | (a) In addition to all other provisions of this Article not | 9 | | in conflict with this Section, a company seeking to organize | 10 | | under this Article as a health care cooperative shall meet all | 11 | | of the following requirements: | 12 | | (1) The company shall comply with all provisions | 13 | | applicable to domestic mutual insurance companies under | 14 | | this Code. | 15 | | (2) The articles of incorporation of the company shall | 16 | | demonstrate that the company is to be organized as a |
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| 1 | | nonprofit member corporation and that the governance of the | 2 | | company shall be subject to a majority vote of all members. | 3 | | (3) The activities of the company shall be limited to | 4 | | the issuance of health care plans in the individual and | 5 | | small group markets. | 6 | | (4) Either the articles of incorporation or the bylaws | 7 | | of the company shall incorporate ethics and conflict of | 8 | | interest standards and the governance requirements set | 9 | | forth in Section 1322(c)(3)(C) of the federal Patient | 10 | | Protection and Affordable Care Act. | 11 | | (5) The company or a related entity or any predecessor | 12 | | of either shall not have been a health insurance issuer on | 13 | | July 16, 2009. | 14 | | (6) The company shall not be sponsored by a State or | 15 | | local government, any political subdivision thereof, or | 16 | | any instrumentality of such government or political | 17 | | subdivision. | 18 | | (7) Excess surplus shall be used to lower premiums, to | 19 | | improve benefits, or for other programs intended to improve | 20 | | the quality of health care delivered to its members. | 21 | | (8) No representative of a federal, State, or local | 22 | | government, or any political instrumentality thereof, and | 23 | | no representative of a company described in paragraph (5) | 24 | | of subsection (a) of this Section may serve on the board of | 25 | | directors of the company. | 26 | | (b) Notwithstanding Section 37 of this Article, the |
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| 1 | | corporate name of any organization seeking to organize under | 2 | | this Article as a health care cooperative need not contain the | 3 | | word "Mutual" but shall contain the phrase "Health Care | 4 | | Cooperative". The corporate name shall not be the same as, or | 5 | | deceptively similar to, the name of any domestic organization | 6 | | or of any foreign or alien organization authorized to transact | 7 | | business in this State. | 8 | | (c) A company seeking to be organized as a health care | 9 | | cooperative shall submit an application to the Director | 10 | | according to procedures and meeting such requirements as the | 11 | | Director shall adopt by rule. No company shall transact any | 12 | | business of insurance until it has received a certificate of | 13 | | authority as set forth in Section 51 of this Article. | 14 | | Section 10. The Co-operative Act is amended by changing | 15 | | Section 22 and by adding Section 30 as follows:
| 16 | | (805 ILCS 310/22) (from Ch. 32, par. 326)
| 17 | | Sec. 22. No corporation or association hereafter organized | 18 | | or doing
business for profit in this State shall be entitled to | 19 | | use the term
"Co-operative" as a part of its corporate or other | 20 | | business name or title
unless it has complied with the | 21 | | provisions of this Act, except (1) a corporation
organized | 22 | | under the Business Corporation Act of 1983 for the purpose of | 23 | | ownership or administration of residential property on
a | 24 | | cooperative basis, or (2) a cooperative corporation organized |
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| 1 | | under the General Not For Profit Corporation Act of 1986 or its | 2 | | predecessor or successor statutes , or (3) a domestic mutual | 3 | | insurance company licensed as a health care cooperative by the | 4 | | Director of Insurance under Article III of the Illinois | 5 | | Insurance Code . Any corporation
or association violating the | 6 | | provision of this Section may be enjoined from
doing business | 7 | | under such name at the instance of any shareholder of any
| 8 | | association or corporation organized under this Act.
| 9 | | (Source: P.A. 95-368, eff. 8-23-07.)
| 10 | | (805 ILCS 310/30 new) | 11 | | Sec. 30. Health benefit purchasing cooperative. | 12 | | (a) Notwithstanding any other provisions of this Act, | 13 | | health benefit purchasing cooperatives may be organized by one | 14 | | or more persons under this Section in each of the geographic | 15 | | areas identified in subsection (l) of this Section. | 16 | | (b) The purpose of a health benefit purchasing cooperative | 17 | | is to provide health care benefits for the individuals | 18 | | specified in subsection (i) of this Section, under a single | 19 | | group health care policy or plan through a contract between the | 20 | | health benefit purchasing cooperative and an insurer | 21 | | authorized to do health insurance business in this State. | 22 | | (c) A health benefit purchasing cooperative shall be | 23 | | designed so that all of the following are accomplished: | 24 | | (1) The members become better informed about health | 25 | | care trends and cost increases. |
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| 1 | | (2) All members receive their health care benefits | 2 | | under the group health care policy or plan negotiated under | 3 | | subsection (i) of this Section. | 4 | | (3) The members are actively engaged in designing | 5 | | health care benefit options that are offered by the insurer | 6 | | and that meet the needs of their community. | 7 | | (4) The health insurance risk of all of the members is | 8 | | pooled. | 9 | | (5) The members actively participate in health | 10 | | improvement decisions for their community. | 11 | | (d) The articles of a health benefit purchasing cooperative | 12 | | shall set forth the name and address of at least one | 13 | | incorporator who will act as the temporary board. | 14 | | (e) Each health benefit purchasing cooperative shall be | 15 | | organized on a membership basis with no capital stock. | 16 | | (f) Subject to subsection (g) of this Section, any person | 17 | | that does business in, is located in, has a principal office | 18 | | in, or resides in the geographic area in which a health benefit | 19 | | purchasing cooperative is organized, that meets the membership | 20 | | criteria established by the health benefit purchasing | 21 | | cooperative in its bylaws, and that pays the membership fee may | 22 | | be a member of the health benefit purchasing cooperative. | 23 | | (g) A health benefit cooperative may limit membership of | 24 | | self-employed individuals through its membership criteria, but | 25 | | such criteria must be applied in the same manner to all | 26 | | self-employed individuals. |
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| 1 | | (h) Each health benefit purchasing cooperative shall file | 2 | | its membership criteria, as well as any amendments to the | 3 | | criteria, with the Director. | 4 | | (i) The health care benefits offered by a health benefit | 5 | | purchasing cooperative shall be negotiated between the health | 6 | | benefit purchasing cooperative and the insurer and shall be | 7 | | offered in a single group health care policy or plan. The | 8 | | insurer must offer coverage under the group health care policy | 9 | | or plan to all of the following: | 10 | | (1) An individual who is a member, officer, or eligible | 11 | | employee of a member of the health benefit purchasing | 12 | | cooperative. | 13 | | (2) A self-employed individual who is a member of the | 14 | | health benefit purchasing cooperative. | 15 | | (3) A dependent of an individual under subdivisions | 16 | | (i)(1) and (2) who receives coverage. | 17 | | (j) The contract between the health benefit purchasing | 18 | | cooperative and an insurer shall be for a term of 3 years. Upon | 19 | | enrollment in the insurer's group health care policy or plan, | 20 | | each member shall pay to the health benefit purchasing | 21 | | cooperative an amount determined by the health benefit | 22 | | purchasing cooperative that is not less than the member's | 23 | | applicable premium for the 36th month of coverage under the | 24 | | contract. If a member withdraws from the health benefit | 25 | | purchasing cooperative before the end of the contract term, the | 26 | | health benefit purchasing cooperative may retain, as a penalty, |
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| 1 | | an amount specified by the health benefit purchasing | 2 | | cooperative that is not less than the premium that the member | 3 | | paid for the 36th month of coverage. | 4 | | (k) Each health benefit purchasing cooperative shall | 5 | | submit to the Director all of the following: | 6 | | (1) Annually, no later than September 30, a report on | 7 | | the progress of the health benefit purchasing arrangement | 8 | | described in this Section and, to the extent possible, any | 9 | | significant findings in the criteria under subdivision | 10 | | (k)(2) of this Section. | 11 | | (2) Within one year after the end of the term of the | 12 | | contract under subsection (j) of this Section, a final | 13 | | report that details significant findings from the project | 14 | | and that includes, at a minimum, to the extent available, | 15 | | information on all of the following: | 16 | | (A) The extent to which the health benefit | 17 | | purchasing arrangement had an impact on the number of | 18 | | uninsured in the geographic area in which it operated. | 19 | | (B) The effect on health care coverage premiums for | 20 | | groups in the geographic area in which the health | 21 | | benefit purchasing arrangement operated, including | 22 | | groups other than the health benefit purchasing | 23 | | cooperative. | 24 | | (C) The degree to which health care consumers were | 25 | | involved in the development and implementation of the | 26 | | health benefit purchasing arrangement. |
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| 1 | | (l) The Director shall designate, by order, the geographic | 2 | | areas of the State in which health benefit purchasing | 3 | | cooperatives may be organized. A geographic area may overlap | 4 | | with one or more other geographic areas. | 5 | | (m) As used in this Section, "Director" means the Director | 6 | | of the Department of Insurance.
| 7 | | Section 99. Effective date. This Act takes effect upon | 8 | | becoming law.".
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