Full Text of SB0034 98th General Assembly
SB0034sam001 98TH GENERAL ASSEMBLY | Sen. David Koehler Filed: 3/7/2013
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| 1 | | AMENDMENT TO SENATE BILL 34
| 2 | | AMENDMENT NO. ______. Amend Senate Bill 34 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 5. The Personnel Code is amended by changing | 5 | | Section 4c as follows: | 6 | | (20 ILCS 415/4c) (from Ch. 127, par. 63b104c) | 7 | | Sec. 4c. General exemptions. The following positions in | 8 | | State
service shall be exempt from jurisdictions A, B, and C, | 9 | | unless the
jurisdictions shall be extended as provided in this | 10 | | Act:
| 11 | | (1) All officers elected by the people.
| 12 | | (2) All positions under the Lieutenant Governor, | 13 | | Secretary of State,
State Treasurer, State Comptroller, | 14 | | State Board of Education, Clerk of
the Supreme Court,
| 15 | | Attorney General, and State Board of Elections.
| 16 | | (3) Judges, and officers and employees of the courts, |
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| 1 | | and notaries
public.
| 2 | | (4) All officers and employees of the Illinois General | 3 | | Assembly, all
employees of legislative commissions, all | 4 | | officers and employees of the
Illinois Legislative | 5 | | Reference Bureau, the Legislative
Research Unit, and the | 6 | | Legislative Printing Unit.
| 7 | | (5) All positions in the Illinois National Guard and | 8 | | Illinois State
Guard, paid from federal funds or positions
| 9 | | in the State Military Service filled by enlistment and paid | 10 | | from State
funds.
| 11 | | (6) All employees of the Governor at the executive | 12 | | mansion and on
his immediate personal staff.
| 13 | | (7) Directors of Departments, the Adjutant General, | 14 | | the Assistant
Adjutant General, the Director of the | 15 | | Illinois Emergency
Management Agency, members of boards | 16 | | and commissions, and all other
positions appointed by the | 17 | | Governor by and with the consent of the
Senate.
| 18 | | (8) The presidents, other principal administrative | 19 | | officers, and
teaching, research and extension faculties | 20 | | of
Chicago State University, Eastern Illinois University, | 21 | | Governors State
University, Illinois State University, | 22 | | Northeastern Illinois University,
Northern Illinois | 23 | | University, Western Illinois University, the Illinois
| 24 | | Community College Board, Southern Illinois
University, | 25 | | Illinois Board of Higher Education, University of
| 26 | | Illinois, State Universities Civil Service System, |
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| 1 | | University Retirement
System of Illinois, and the | 2 | | administrative officers and scientific and
technical staff | 3 | | of the Illinois State Museum.
| 4 | | (9) All other employees except the presidents, other | 5 | | principal
administrative officers, and teaching, research | 6 | | and extension faculties
of the universities under the | 7 | | jurisdiction of the Board of Regents and
the colleges and | 8 | | universities under the jurisdiction of the Board of
| 9 | | Governors of State Colleges and Universities, Illinois | 10 | | Community College
Board, Southern Illinois University, | 11 | | Illinois Board of Higher Education,
Board of Governors of | 12 | | State Colleges and Universities, the Board of
Regents, | 13 | | University of Illinois, State Universities Civil Service
| 14 | | System, University Retirement System of Illinois, so long | 15 | | as these are
subject to the provisions of the State | 16 | | Universities Civil Service Act.
| 17 | | (10) The State Police so long as they are subject to | 18 | | the merit
provisions of the State Police Act.
| 19 | | (11) (Blank).
| 20 | | (12) The technical and engineering staffs of the | 21 | | Department of
Transportation, the Department of Nuclear | 22 | | Safety, the Pollution Control
Board, and the Illinois | 23 | | Commerce Commission, and the technical and engineering
| 24 | | staff providing architectural and engineering services in | 25 | | the Department of
Central Management Services.
| 26 | | (13) All employees of the Illinois State Toll Highway |
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| 1 | | Authority.
| 2 | | (14) The Secretary of the Illinois Workers' | 3 | | Compensation Commission.
| 4 | | (15) All persons who are appointed or employed by the | 5 | | Director of
Insurance under authority of Section 202 of the | 6 | | Illinois Insurance Code
to assist the Director of Insurance | 7 | | in discharging his responsibilities
relating to the | 8 | | rehabilitation, liquidation, conservation, and
dissolution | 9 | | of companies that are subject to the jurisdiction of the
| 10 | | Illinois Insurance Code.
| 11 | | (16) All employees of the St. Louis Metropolitan Area | 12 | | Airport
Authority.
| 13 | | (17) All investment officers employed by the Illinois | 14 | | State Board of
Investment.
| 15 | | (18) Employees of the Illinois Young Adult | 16 | | Conservation Corps program,
administered by the Illinois | 17 | | Department of Natural Resources, authorized
grantee under | 18 | | Title VIII of the Comprehensive
Employment and Training Act | 19 | | of 1973, 29 USC 993.
| 20 | | (19) Seasonal employees of the Department of | 21 | | Agriculture for the
operation of the Illinois State Fair | 22 | | and the DuQuoin State Fair, no one
person receiving more | 23 | | than 29 days of such employment in any calendar year.
| 24 | | (20) All "temporary" employees hired under the | 25 | | Department of Natural
Resources' Illinois Conservation | 26 | | Service, a youth
employment program that hires young people |
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| 1 | | to work in State parks for a period
of one year or less.
| 2 | | (21) All hearing officers of the Human Rights | 3 | | Commission.
| 4 | | (22) All employees of the Illinois Mathematics and | 5 | | Science Academy.
| 6 | | (23) All employees of the Kankakee River Valley Area
| 7 | | Airport Authority.
| 8 | | (24) The commissioners and employees of the Executive | 9 | | Ethics
Commission.
| 10 | | (25) The Executive Inspectors General, including | 11 | | special Executive
Inspectors General, and employees of | 12 | | each Office of an
Executive Inspector General.
| 13 | | (26) The commissioners and employees of the | 14 | | Legislative Ethics
Commission.
| 15 | | (27) The Legislative Inspector General, including | 16 | | special Legislative
Inspectors General, and employees of | 17 | | the Office of
the Legislative Inspector General.
| 18 | | (28) The Auditor General's Inspector General and | 19 | | employees of the Office
of the Auditor General's Inspector | 20 | | General.
| 21 | | (29) All employees of the Illinois Power Agency. | 22 | | (30) Employees having demonstrable, defined advanced | 23 | | skills in accounting, financial reporting, or technical | 24 | | expertise who are employed within executive branch | 25 | | agencies and whose duties are directly related to the | 26 | | submission to the Office of the Comptroller of financial |
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| 1 | | information for the publication of the Comprehensive | 2 | | Annual Financial Report (CAFR). | 3 | | (31) The employees of the Illinois Health Benefits | 4 | | Exchange. | 5 | | (Source: P.A. 97-618, eff. 10-26-11; 97-1055, eff. 8-23-12 .)
| 6 | | Section 10. The Illinois Insurance Code is amended by | 7 | | changing Section 500-100 as follows:
| 8 | | (215 ILCS 5/500-100)
| 9 | | (Section scheduled to be repealed on January 1, 2017)
| 10 | | Sec. 500-100. Limited lines producer license.
| 11 | | (a) An individual who is at least 18 years of age and whom | 12 | | the Director
considers to
be competent, trustworthy, and of | 13 | | good business reputation may obtain a limited
lines producer
| 14 | | license for one or more of the following classes:
| 15 | | (1) insurance on baggage or limited travel health, | 16 | | accident, or trip
cancellation
insurance sold in | 17 | | connection with transportation provided by a common | 18 | | carrier;
| 19 | | (2) industrial life insurance, as defined in Section | 20 | | 228 of this Code;
| 21 | | (3) industrial accident and health insurance, as | 22 | | defined in
Section 368 of this
Code;
| 23 | | (4) insurance issued by a company organized under the | 24 | | Farm Mutual
Insurance Company Act of 1986;
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| 1 | | (5) legal expense insurance;
| 2 | | (6) enrollment of recipients of public aid or medicare | 3 | | in a health
maintenance
organization;
| 4 | | (7) a limited health care plan issued by an | 5 | | organization having a
certificate of
authority under the | 6 | | Limited Health Service Organization Act.
| 7 | | (a-5) An insurance navigator shall obtain a limited lines | 8 | | producer license for the purpose of advising qualified | 9 | | individuals under the federal Patient Protection and | 10 | | Affordable Care Act, as amended by the federal Health Care and | 11 | | Education Reconciliation Act of 2010, and any amendments | 12 | | thereto, about health plans offered through the Illinois Health | 13 | | Benefits Exchange and other State and federal health programs | 14 | | as may be available. Insurance navigators must complete a | 15 | | training program in basic instruction about the Illinois Health | 16 | | Benefits Exchange, accident and health insurance business, and | 17 | | State and federal programs with which they will be assisting | 18 | | individuals. | 19 | | Insurance navigators may not receive any direct | 20 | | compensation or personal economic benefit for assisting | 21 | | individuals with respect to any particular health benefits | 22 | | plan. | 23 | | (b) The application for a limited lines producer license | 24 | | must be submitted
on a form
prescribed by the Director by a | 25 | | designee of the insurance company, health
maintenance
| 26 | | organization, or limited health service organization |
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| 1 | | appointing the limited
insurance
representative. The insurance | 2 | | company, health maintenance organization, or
limited health
| 3 | | service organization must pay the fee required by Section | 4 | | 500-135.
| 5 | | (c) A limited lines producer may represent more than one | 6 | | insurance company,
health
maintenance organization, or limited | 7 | | health service organization.
| 8 | | (d) An applicant who has met the requirements of this | 9 | | Section shall be
issued a
perpetual limited lines producer | 10 | | license.
| 11 | | (e) A limited lines producer license shall remain in effect | 12 | | as long as the
appointing
insurance company pays the respective | 13 | | fee required by Section 500-135 prior to
January 1 of
each | 14 | | year, unless the license is revoked or suspended pursuant to
| 15 | | Section 500-70. Failure of the
insurance company to pay the | 16 | | license fee or to submit the required documents
shall cause
| 17 | | immediate termination of the limited line insurance producer | 18 | | license with
respect to which the
failure occurs.
| 19 | | (f) A limited lines producer license may be terminated by | 20 | | the insurance
company or
the licensee.
| 21 | | (g) A person whom the Director considers to be competent, | 22 | | trustworthy, and
of
good
business reputation may be issued a | 23 | | car rental limited line license. A car
rental limited line
| 24 | | license for a rental company shall remain in effect as long as | 25 | | the car rental
limited line licensee
pays the respective fee | 26 | | required by Section 500-135 prior to the next fee date
unless |
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| 1 | | the car rental
license is revoked or suspended pursuant to | 2 | | Section 500-70. Failure of the car
rental limited line
licensee | 3 | | to pay the license fee or to submit the required documents | 4 | | shall cause
immediate
suspension of the car rental limited line | 5 | | license. A car rental limited line
license for rental
companies | 6 | | may be voluntarily
terminated by the car rental limited line | 7 | | licensee. The license fee
shall not be refunded upon | 8 | | termination of the car rental limited line license
by the car | 9 | | rental
limited line licensee.
| 10 | | (h) A limited lines producer issued a license pursuant to | 11 | | this Section is
not
subject to
the requirements of Section | 12 | | 500-30.
| 13 | | (i) A limited lines producer license must contain the name, | 14 | | address and
personal
identification number of the licensee, the | 15 | | date the license was issued,
general conditions relative
to the | 16 | | license's expiration or termination, and any other information | 17 | | the
Director considers
proper. A limited line producer license, | 18 | | if applicable, must also contain the
name and address of
the | 19 | | appointing insurance company.
| 20 | | (Source: P.A. 92-386, eff. 1-1-02 .)
| 21 | | Section 15. The Comprehensive Health Insurance Plan Act is | 22 | | amended by adding Sections 16 and 17 as follows: | 23 | | (215 ILCS 105/16 new) | 24 | | Sec. 16. Cessation of operations. Notwithstanding any |
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| 1 | | other provision of this Act, the insurance operations of the | 2 | | Plan authorized by this Act shall cease on January 1, 2014 in | 3 | | accordance with Section 5-30 of the Illinois Health Benefits | 4 | | Exchange Law. Plan coverage does not apply to service provided | 5 | | on or after January 1, 2014 in accordance with Section 5-30 of | 6 | | the Illinois Health Benefits Exchange Law. | 7 | | (215 ILCS 105/17 new) | 8 | | Sec. 17. Repealer. This Act is repealed on January 1, 2015. | 9 | | Section 20. The Illinois Health Benefits Exchange Law is | 10 | | amended by changing Sections 5-3, 5-5, and 5-15 and by adding | 11 | | Sections 5-4, 5-6, 5-16, 5-17, 5-18, 5-21, 5-23, and 5-30 as | 12 | | follows: | 13 | | (215 ILCS 122/5-3)
| 14 | | Sec. 5-3. Legislative intent. The General Assembly finds | 15 | | the health benefits exchanges authorized by the federal Patient | 16 | | Protection and Affordable Care Act represent one of a number of | 17 | | ways in which the State can address coverage gaps and provide | 18 | | individual consumers and small employers access to greater | 19 | | coverage options. The General Assembly also finds that the | 20 | | State is best positioned to implement an exchange that is | 21 | | sensitive to the coverage gaps and market landscape unique to | 22 | | this State. | 23 | | The purpose of this Law is to provide for the establishment |
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| 1 | | of an Illinois Health Benefits Exchange (the Exchange) to | 2 | | facilitate the purchase and sale of qualified health plans and | 3 | | qualified dental plans in the individual market in this State | 4 | | and to provide for the establishment of a Small Business Health | 5 | | Options Program (SHOP Exchange) to assist qualified small | 6 | | employers in this State in facilitating the enrollment of their | 7 | | employees in qualified health plans and qualified dental plans | 8 | | offered in the small group market. The intent of the Exchange | 9 | | is to supplement the existing health insurance market to | 10 | | simplify shopping for individual and small employers by | 11 | | increasing access to benefit options, encouraging a | 12 | | competitive market both inside and outside the Exchange, | 13 | | reducing the number of uninsured, and providing a transparent | 14 | | marketplace and effective consumer education and programmatic | 15 | | assistance tools. The purpose of this Law is to ensure that the | 16 | | State is making sufficient progress towards establishing an | 17 | | exchange within the guidelines outlined by the federal law and | 18 | | to protect Illinoisans from undue federal regulation. Although | 19 | | the federal law imposes a number of core requirements on | 20 | | state-level exchanges, the State has significant flexibility | 21 | | in the design and operation of a State exchange that make it | 22 | | prudent for the State to carefully analyze, plan, and prepare | 23 | | for the exchange. The General Assembly finds that in order for | 24 | | the State to craft a tenable exchange that meets the | 25 | | fundamental goals outlined by the Patient Protection and | 26 | | Affordable Care Act of expanding access to affordable coverage |
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| 1 | | and improving the quality of care, the implementation process | 2 | | should (1) provide for broad stakeholder representation; (2) | 3 | | foster a robust and competitive marketplace, both inside and | 4 | | outside of the exchange; and (3) provide for a broad-based | 5 | | approach to the fiscal solvency of the exchange.
| 6 | | (Source: P.A. 97-142, eff. 7-14-11.) | 7 | | (215 ILCS 122/5-4 new) | 8 | | Sec. 5-4. Definitions. In this Law: | 9 | | "Board" means the Illinois Health Benefits Exchange Board | 10 | | established pursuant to this Law. | 11 | | "Department" means the Department of Insurance. | 12 | | "Director" means the Director of Insurance. | 13 | | "Educated health care consumer" means an individual who is | 14 | | knowledgeable about the health care system, and has background | 15 | | or experience in making informed decisions regarding health, | 16 | | medical, and public health matters. | 17 | | "Essential health benefits" has the meaning provided under | 18 | | Section 1302(b) of the Federal Act. | 19 | | "Exchange" means the Illinois Health Benefits Exchange | 20 | | established by this Law and includes the Individual Exchange | 21 | | and the SHOP Exchange, unless otherwise specified. | 22 | | "Executive Director" means the Executive Director of the | 23 | | Illinois Health Benefits Exchange. | 24 | | "Federal Act" means the federal Patient Protection and | 25 | | Affordable Care Act (Public Law 111-148), as amended by the |
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| 1 | | federal Health Care and Education Reconciliation Act of 2010 | 2 | | (Public Law 111-152), and any amendments thereto, or | 3 | | regulations or guidance issued under, those Acts. | 4 | | "Health benefit plan" means a policy, contract, | 5 | | certificate, or agreement offered or issued by a health carrier | 6 | | to provide, deliver, arrange for, pay for, or reimburse any of | 7 | | the costs of health care services.
"Health benefit plan" does | 8 | | not include: | 9 | | (1) coverage for accident only or disability income | 10 | | insurance or any combination thereof; | 11 | | (2) coverage issued as a supplement to liability | 12 | | insurance; | 13 | | (3) liability insurance, including general liability | 14 | | insurance and automobile liability insurance; | 15 | | (4) workers' compensation or similar insurance; | 16 | | (5) automobile medical payment insurance; | 17 | | (6) credit-only insurance; | 18 | | (7) coverage for on-site medical clinics; or | 19 | | (8) other similar insurance coverage, specified in | 20 | | federal regulations issued pursuant to the federal Health | 21 | | Information Portability and Accountability Act of 1996, | 22 | | Public Law 104-191, under which benefits for health care | 23 | | services are secondary or incidental to other insurance | 24 | | benefits. | 25 | | "Health benefit plan" does not include the following | 26 | | benefits if they are provided under a separate policy, |
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| 1 | | certificate, or contract of insurance or are otherwise not an | 2 | | integral part of the plan: | 3 | | (a) limited scope dental or vision benefits; | 4 | | (b) benefits for long-term care, nursing home care, | 5 | | home health care, community-based care, or any combination | 6 | | thereof; or | 7 | | (c) other similar, limited benefits specified in | 8 | | federal regulations issued pursuant to Public Law 104-191. | 9 | | "Health benefit plan" does not include the following | 10 | | benefits if the benefits are provided under a separate policy, | 11 | | certificate, or contract of insurance, there is no coordination | 12 | | between the provision of the benefits and any exclusion of | 13 | | benefits under any group health plan maintained by the same | 14 | | plan sponsor, and the benefits are paid with respect to an | 15 | | event without regard to whether benefits are provided with | 16 | | respect to such an event under any group health plan maintained | 17 | | by the same plan sponsor: | 18 | | (i) coverage only for a specified disease or illness; | 19 | | or | 20 | | (ii) hospital indemnity or other fixed indemnity | 21 | | insurance. | 22 | | "Health benefit plan" does not include the following if | 23 | | offered as a separate policy, certificate, or contract of | 24 | | insurance: | 25 | | (A) Medicare supplemental health insurance as defined | 26 | | under Section 1882(g)(1) of the federal Social Security |
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| 1 | | Act; | 2 | | (B) coverage supplemental to the coverage provided | 3 | | under Chapter 55 of Title 10, United States Code (Civilian | 4 | | Health and Medical Program of the Uniformed Services | 5 | | (CHAMPUS)); or | 6 | | (C) similar supplemental coverage provided to coverage | 7 | | under a group health plan. | 8 | | "Health benefit plan" does not include a group health plan | 9 | | or multiple employer welfare arrangement to the extent the plan | 10 | | or arrangement is not subject to State insurance regulation | 11 | | under Section 514 of the federal Employee Retirement Income | 12 | | Security Act of 1974. | 13 | | "Health insurance carrier" or "carrier" means an entity | 14 | | subject to the insurance laws and regulations of this State, or | 15 | | subject to the jurisdiction of the Director, that contracts or | 16 | | offers to contract to provide, deliver, arrange for, pay for, | 17 | | or reimburse any of the costs of health care services, | 18 | | including a sickness and accident insurance company, a health | 19 | | maintenance organization, or any other entity providing a plan | 20 | | of health insurance, health benefits, or health services. | 21 | | "Health insurance carrier" does not include short term, | 22 | | accident only, disability income, hospital confinement or | 23 | | fixed indemnity, vision only, limited benefit, or credit | 24 | | insurance, coverage issued as a supplement to liability | 25 | | insurance, insurance arising out of a workers' compensation or | 26 | | similar law, automobile medical-payment insurance, insurance |
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| 1 | | under which benefits are payable with or without regard to | 2 | | fault and which is statutorily required to be contained in any | 3 | | liability insurance policy or equivalent self-insurance, or a | 4 | | Consumer Operated and Oriented Plan. | 5 | | "Illinois Health Benefits Exchange Fund" means the fund | 6 | | created outside of the State treasury to be used exclusively to | 7 | | provide funding for the operation and administration of the | 8 | | Exchange in carrying out the purposes authorized by this Law. | 9 | | "Individual Exchange" means the exchange marketplace | 10 | | established by this Law through which qualified individuals may | 11 | | obtain coverage through an individual market qualified health | 12 | | plan. | 13 | | "Principal place of business" means the location in a state | 14 | | where an employer has its headquarters or significant place of | 15 | | business and where the persons with direction and control | 16 | | authority over the business are employed. | 17 | | "Qualified dental plan" means a limited scope dental plan | 18 | | that has been certified in accordance with this Law. | 19 | | "Qualified employee" means an eligible individual employed | 20 | | by a qualified employer who has been offered health insurance | 21 | | coverage by that qualified employer through the SHOP on the | 22 | | Exchange. | 23 | | "Qualified employer" means a small employer that elects to | 24 | | make its full-time employees eligible for one or more qualified | 25 | | health plans or qualified dental plans offered through the SHOP | 26 | | Exchange, and at the option of the employer, some or all of its |
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| 1 | | part-time employees, provided that the employer has its | 2 | | principal place of business in this State and elects to provide | 3 | | coverage through the SHOP Exchange to all of its eligible | 4 | | employees, wherever employed. | 5 | | "Qualified health plan" or "QHP" means a health benefit | 6 | | plan that has in effect a certification that the plan meets the | 7 | | criteria for certification described in Section 1311(c) of the | 8 | | Federal Act and any additional requirements provided for under | 9 | | this Law. | 10 | | "Qualified health plan issuer" or "QHP issuer" means a | 11 | | health insurance issuer that offers a health plan that the | 12 | | Exchange has certified as a qualified health plan. | 13 | | "Qualified individual" means an individual, including a | 14 | | minor, who: | 15 | | (1) is seeking to enroll in a qualified health plan or | 16 | | qualified dental plan offered to individuals through the | 17 | | Exchange; | 18 | | (2) resides in this State; | 19 | | (3) at the time of enrollment, is not incarcerated, | 20 | | other than incarceration pending the disposition of | 21 | | charges; and | 22 | | (4) is, and is reasonably expected to be, for the | 23 | | entire period for which enrollment is sought, a citizen or | 24 | | national of the United States or an alien lawfully present | 25 | | in the United States. | 26 | | "Secretary" means the Secretary of the federal Department |
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| 1 | | of Health and Human Services. | 2 | | "SHOP Exchange" means the Small Business Health Options | 3 | | Program established under this Law through which a qualified | 4 | | employer can provide small group qualified health plans to its | 5 | | qualified employees. | 6 | | "Small employer" means, in connection with a group health | 7 | | plan with respect to a calendar year and a plan year, an | 8 | | employer who employed an average of at least 2 but not more | 9 | | than 50 employees before January 1, 2016 and no more than 100 | 10 | | employees on and after January 1, 2016 on business days during | 11 | | the preceding calendar year and who employs at least one | 12 | | employee on the first day of the plan year.
For purposes of | 13 | | this definition: | 14 | | (a) all persons treated as a single employer under | 15 | | subsection (b), (c), (m) or (o) of Section 414 of the | 16 | | federal Internal Revenue Code of 1986 shall be treated as a | 17 | | single employer; | 18 | | (b) an employer and any predecessor employer shall be | 19 | | treated as a single employer; | 20 | | (c) employees shall be counted in accordance with | 21 | | federal law and regulations and State law and regulations; | 22 | | provided however, that in the event of a conflict between | 23 | | the federal law and regulations and the State law and | 24 | | regulations, the federal law and regulations shall | 25 | | prevail; | 26 | | (d) if an employer was not in existence throughout the |
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| 1 | | preceding calendar year, then the determination of whether | 2 | | that employer is a small employer shall be based on the | 3 | | average number of employees that is reasonably expected | 4 | | that employer will employ on business days in the current | 5 | | calendar year; and | 6 | | (e) an employer that makes enrollment in qualified | 7 | | health plans or qualified dental plans available to its | 8 | | employees through the SHOP Exchange, and would cease to be | 9 | | a small employer by reason of an increase in the number of | 10 | | its employees, shall continue to be treated as a small | 11 | | employer for purposes of this Law as long as it | 12 | | continuously makes enrollment through the SHOP Exchange | 13 | | available to its employees. | 14 | | (215 ILCS 122/5-5)
| 15 | | Sec. 5-5. Establishment of the Exchange State health | 16 | | benefits exchange . | 17 | | (a) It is declared that this State, beginning on the | 18 | | effective date of this amendatory Act of the 98th General | 19 | | Assembly October 1, 2013 , in accordance with Section 1311 of | 20 | | the federal Patient Protection and Affordable Care Act, shall | 21 | | establish a State health benefits exchange to be known as the | 22 | | Illinois Health Benefits Exchange in order to help individuals | 23 | | and small employers with no more than 50 employees shop for, | 24 | | select, and enroll in qualified, affordable private health | 25 | | plans that fit their needs at competitive prices. The Exchange |
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| 1 | | shall separate coverage pools for individuals and small | 2 | | employers and shall supplement and not supplant any existing | 3 | | private health insurance market for individuals and small | 4 | | employers. These health plans shall be available to individuals | 5 | | and small employers for enrollment by October 1, 2014.
| 6 | | (b) There is hereby created a political subdivision, body | 7 | | politic and corporate, named the Illinois Health Benefits | 8 | | Exchange. The Exchange shall be a public entity, but shall not | 9 | | be considered a department, institution, or agency of the | 10 | | State. | 11 | | (c) The Exchange shall be comprised of an individual and a | 12 | | small business health options (SHOP) exchange. Pursuant to | 13 | | Section 1311(b)(2) of the Federal Act, the Exchange shall | 14 | | provide individual exchange services to qualified individuals | 15 | | and SHOP Exchange services to qualified employers under a | 16 | | single governance and administrative structure. The Board | 17 | | shall produce an assessment by July 1, 2016 to determine the | 18 | | viability of merging the SHOP Exchange and Individual Exchange | 19 | | functions into a single exchange by January 1, 2017. | 20 | | (d) The Exchange shall promote a competitive marketplace | 21 | | that allows consumer access to affordable health coverage | 22 | | options. The Department shall review and recommend that the | 23 | | Board certify health benefit plans on the individual and SHOP | 24 | | Exchange, as applicable, provided that any such health benefit | 25 | | plan meets the requirements set forth in Section 1311(c) of the | 26 | | Federal Act and any other requirements of the Illinois |
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| 1 | | Insurance Code. The Board shall certify health benefit plans | 2 | | that the Department recommends for certification. If the Board | 3 | | fails to certify a health benefit plan that has been | 4 | | recommended by the Department, then the issuing insurer may | 5 | | file a mandamus action in a court of proper jurisdiction in a | 6 | | county where the principle place of business of the Board is | 7 | | located. | 8 | | (e) The Exchange shall not supersede the provisions of the | 9 | | Illinois Insurance Code. | 10 | | (Source: P.A. 97-142, eff. 7-14-11.) | 11 | | (215 ILCS 122/5-6 new) | 12 | | Sec. 5-6. Health benefit plan certification. | 13 | | (a) To be certified as a qualified health plan, a health | 14 | | benefit plan shall, at a minimum: | 15 | | (1) provide the essential health benefits package | 16 | | described in Section 1302(a) of
the Federal Act; except | 17 | | that the plan is not required to provide essential benefits | 18 | | that duplicate
the minimum benefits of qualified dental | 19 | | plans, as provided in subsection (e) of this Section if: | 20 | | (A) the Board, in cooperation with the Department, | 21 | | has determined that at least one qualified dental plan | 22 | | is
available to supplement the plan's coverage; and | 23 | | (B) the health carrier makes prominent disclosure | 24 | | at the time it offers the
plan, in a form approved by | 25 | | the Board, that the plan does not provide the full |
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| 1 | | range of
essential pediatric dental benefits and that | 2 | | qualified dental plans providing those benefits and
| 3 | | other dental benefits not covered by the plan are | 4 | | offered through the Exchange; | 5 | | (2) obtain prior approval of premium rates and contract | 6 | | language from the
Department; | 7 | | (3) provide at least the minimum level of coverage | 8 | | prescribed by the Federal Act; | 9 | | (4) ensure that the cost-sharing requirements of the | 10 | | plan do not exceed the limits
established under Section | 11 | | 1302(c)(l) of the Federal Act, and if the plan is offered | 12 | | through the
SHOP Exchange, the plan's deductible does not | 13 | | exceed the limits established under Section
1302(c)(2) of | 14 | | the Federal Act; | 15 | | (5) be offered by a health carrier that: | 16 | | (A) is authorized and in good standing to offer | 17 | | health insurance coverage; | 18 | | (B) offers at least one qualified health plan at | 19 | | the silver level and at
least one plan at the gold | 20 | | level, as described in the Federal Act, through each | 21 | | component of the Board in which the health
carrier | 22 | | participates; for the purposes of this subparagraph | 23 | | (B), "component"
means the SHOP Exchange and the | 24 | | exchange for individual coverage within the American
| 25 | | Health Benefit Exchange; | 26 | | (C) charges the same premium rate for each |
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| 1 | | qualified health plan without
regard to whether the | 2 | | plan is offered through the Exchange and without regard | 3 | | to whether the
plan is offered directly from the health | 4 | | carrier or through an insurance producer; | 5 | | (D) does not charge any cancellation fees or | 6 | | penalties; and | 7 | | (E) complies with the regulations established by | 8 | | the Secretary under
Section 1311 (d) of the Federal Act | 9 | | and any other requirements as the Board may establish; | 10 | | (6) meet the requirements of certification pursuant to | 11 | | the Board and the requirements of the Illinois Insurance | 12 | | Code provided in
this Law and the requirements issued by | 13 | | the Secretary under Section 1311(c) of the Federal Act and | 14 | | rules promulgated or adopted
pursuant to this Law or the | 15 | | Federal Act, which shall include: | 16 | | (A) minimum standards in the areas of marketing | 17 | | practices; | 18 | | (B) network adequacy; | 19 | | (C) essential community providers in underserved | 20 | | areas; | 21 | | (D) accreditation; | 22 | | (E) quality improvement; | 23 | | (F) uniform enrollment forms and descriptions of | 24 | | coverage; and | 25 | | (G) information on quality measures for health | 26 | | benefit plan performance; |
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| 1 | | (7) be determined by the Board that making the plan | 2 | | available through the
Exchange is in the interest of | 3 | | qualified individuals and qualified employers; and | 4 | | (8) include all outpatient clinics in the health plan's | 5 | | region that are controlled by an entity that also controls | 6 | | a 340B eligible provider as defined by Section 340B(a)(4) | 7 | | of the federal Public Health Service Act such that the | 8 | | outpatient clinics are subject to the same mission, | 9 | | policies, and medical standards related to the provision of | 10 | | health care services as the 340B eligible provider. | 11 | | (b) The Board shall not withhold certification from a | 12 | | health benefit plan: | 13 | | (1) on the basis that the plan is a fee-for-service | 14 | | plan; | 15 | | (2) through the imposition of premium price controls by | 16 | | the Board; or | 17 | | (3) on the basis that the health benefit plan provides | 18 | | treatments necessary to
prevent patients' deaths in | 19 | | circumstances the Board determines are inappropriate or | 20 | | too
costly. | 21 | | (c) The Board shall require each health carrier seeking | 22 | | certification of a plan as a
qualified health plan to: | 23 | | (1) submit a justification for any premium increase | 24 | | before implementation of that
increase, and prominently | 25 | | post the information on its publicly accessible Internet | 26 | | website; |
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| 1 | | (2) make available to the public, in plain language as | 2 | | defined in Section 1311(e)(3)(B) of the Federal Act, and | 3 | | submit to the Board, the Secretary, and the Department | 4 | | accurate
and timely disclosure of the following: | 5 | | (i) claims payment policies and practices; | 6 | | (ii) periodic financial disclosures; | 7 | | (iii) data on enrollment; | 8 | | (iv) data on disenrollment; | 9 | | (v) data on the number of claims that are | 10 | | denied; | 11 | | (vi) data on rating practices; | 12 | | (vii) information on cost-sharing and payments | 13 | | with respect to any
out-of-network coverage; | 14 | | (viii) information on enrollee and participant | 15 | | rights under Title I of
the Federal Act; and | 16 | | (ix) other information as determined | 17 | | appropriate by the Secretary; | 18 | | (3) permit individuals to learn, in a timely manner | 19 | | upon the request of the
individual, the amount of | 20 | | cost-sharing, including deductibles, copayments, and | 21 | | coinsurance,
under the individual's plan or coverage that | 22 | | the individual would be responsible for paying with
respect | 23 | | to the furnishing of a specific item or service by a | 24 | | participating provider and make this
information available | 25 | | to the individual through an Internet website that is | 26 | | publicly accessible and
through other means for |
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| 1 | | individuals without access to the Internet; and | 2 | | (4) promptly notify affected individuals of price and | 3 | | benefit changes or other
changes in circumstances that | 4 | | could materially impact enrollment or coverage. | 5 | | (d) The Board shall not exempt any health carrier seeking | 6 | | certification as a qualified
health plan, regardless of the | 7 | | type or size of the health carrier, from licensure or solvency
| 8 | | requirements and shall apply the criteria of this Section in a | 9 | | manner that ensures a level playing
field between or among | 10 | | health carriers participating in the Exchange. | 11 | | (e) The provisions of this Law that are applicable to | 12 | | qualified health plans shall also
apply, to the extent | 13 | | relevant, to qualified dental plans, except as modified in | 14 | | accordance with the
provisions of paragraphs (1), (2), and (3) | 15 | | of this subsection (e) or by rules adopted by the
Board. | 16 | | (1) The health carrier shall be licensed to offer | 17 | | dental coverage, but need not be
licensed to offer other | 18 | | health benefits. | 19 | | (2) The plan shall be limited to dental and oral health | 20 | | benefits, without
substantially duplicating the benefits | 21 | | typically offered by health benefit plans without dental
| 22 | | coverage and shall include, at a minimum, the essential | 23 | | pediatric dental benefits prescribed by
the Secretary | 24 | | pursuant to Section 1302(b)(l)(J) of the Federal Act and | 25 | | such other dental benefits
as the Board or the Secretary | 26 | | may specify by rule. |
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| 1 | | (3) Health carriers may jointly offer a comprehensive | 2 | | plan through the Exchange
in which the dental benefits are | 3 | | provided by a health carrier through a qualified dental | 4 | | plan and
the other benefits are provided by a health | 5 | | carrier through a qualified health plan, provided that
the | 6 | | plans are priced separately and are also made available for | 7 | | purchase separately at the same
price. | 8 | | (215 ILCS 122/5-15)
| 9 | | Sec. 5-15. Illinois Health Benefits Exchange Legislative | 10 | | Oversight Study Committee. | 11 | | (a) There is created an Illinois Health Benefits Exchange | 12 | | Legislative Oversight Study Committee within the Commission on | 13 | | Government Forecasting and Accountability to provide | 14 | | accountability for conduct a study regarding State | 15 | | implementation and establishment of the Illinois Health | 16 | | Benefits Exchange and to ensure Exchange operations and | 17 | | functions align with the goals and duties outlined by this Law . | 18 | | The Committee shall also be responsible for providing policy | 19 | | recommendations to ensure the Exchange aligns with the Federal | 20 | | Act, amendments to the Federal Act, and regulations promulgated | 21 | | pursuant to the Federal Act. | 22 | | (b) Members of the Legislative Oversight Study Committee | 23 | | shall be appointed as follows: 3 members of the Senate shall be | 24 | | appointed by the President of the Senate; 3 members of the | 25 | | Senate shall be appointed by the Minority Leader of the Senate; |
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| 1 | | 3 members of the House of Representatives shall be appointed by | 2 | | the Speaker of the House of Representatives; and 3 members of | 3 | | the House of Representatives shall be appointed by the Minority | 4 | | Leader of the House of Representatives. Each legislative leader | 5 | | shall select one member to serve as co-chair of the committee. | 6 | | (c) Members of the Legislative Oversight Study Committee | 7 | | shall be appointed no later than June 1, 2013 within 30 days | 8 | | after the effective date of this Law. The co-chairs shall | 9 | | convene the first meeting of the committee no later than 45 | 10 | | days after the effective date of this Law .
| 11 | | (Source: P.A. 97-142, eff. 7-14-11.) | 12 | | (215 ILCS 122/5-16 new) | 13 | | Sec. 5-16. Exchange governance. The governing and | 14 | | administrative powers of the Exchange shall be vested in a body | 15 | | known as the Illinois Health Benefits Exchange Board. The | 16 | | following provisions shall apply: | 17 | | (1) The Board shall consist of 11 voting members | 18 | | appointed by the Governor with the advice and consent of a | 19 | | majority of the members elected to the Senate. In addition, | 20 | | the Director of Healthcare and Family Services, and the | 21 | | Executive Director of the Exchange shall serve as | 22 | | non-voting, ex-officio members of the Board. The Governor | 23 | | shall also appoint as non-voting, ex-officio members one | 24 | | economist with experience in the health care markets and | 25 | | one educated health care consumer advocate. All Board |
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| 1 | | members shall be appointed no later than January 1, 2014. | 2 | | (2) The Governor shall make the appointments so as to | 3 | | reflect no less than proportional representation of the | 4 | | geographic, gender, cultural, racial, and ethnic | 5 | | composition of this State and in accordance with | 6 | | subparagraphs (A), (B), and (C) of this paragraph, as | 7 | | follows: | 8 | | (A) No more than one voting member may be an | 9 | | individual who is employed by, a consultant to, or a | 10 | | member of a board of directors of an insurer, a | 11 | | third-party administrator, or an insurance producer. | 12 | | No more than one voting member may be an individual who | 13 | | is a member of a board of directors of a health care | 14 | | provider, health care facility, or health clinic. | 15 | | (B) At least one board member must represent each | 16 | | of the following interest groups: | 17 | | (1) a labor interest group; | 18 | | (2) a women's interest group; | 19 | | (3) a minorities' interest group; | 20 | | (4) a disabled persons' interest group; | 21 | | (5) a small business interest group; and | 22 | | (6) a public health interest group. | 23 | | (C) Each person appointed to the Board should have | 24 | | demonstrated experience in at least one of the | 25 | | following areas: | 26 | | (1) individual health insurance coverage; |
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| 1 | | (2) small employer health insurance; | 2 | | (3) health benefits administration; | 3 | | (4) health care finance; | 4 | | (5) administration of a public or private | 5 | | health care delivery system; | 6 | | (6) the provision of health care services; | 7 | | (7) the purchase of health insurance coverage; | 8 | | (8) health care consumer navigation or | 9 | | assistance; | 10 | | (9) health care economics or health care | 11 | | actuarial sciences; | 12 | | (10) information technology; or | 13 | | (11) starting a small business with 50 or fewer | 14 | | employees. | 15 | | (3) The Board shall elect one voting member of the | 16 | | Board to serve as chairperson and one voting member to | 17 | | serve as vice-chairperson, upon approval of a majority of | 18 | | the Board. | 19 | | (4) The Exchange shall be administered by an Executive | 20 | | Director, who shall be appointed, and may be removed, by a | 21 | | majority of the Board. The Board shall have the power to | 22 | | determine compensation for the Executive Director. | 23 | | (5) The terms of the non-voting, ex-officio members of | 24 | | the Board shall run concurrent with their terms of | 25 | | appointment to office, or in the case of the Executive | 26 | | Director, his or her term of appointment to that position, |
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| 1 | | subject to the determination of the Board. The terms of the | 2 | | members, including those non-voting, ex-officio members | 3 | | appointed by the Governor, shall be 4 years. Each member of | 4 | | the General Assembly identified in paragraph (1) of this | 5 | | Section shall initially appoint one member to a 3-year | 6 | | term, and one member to a 4-year term. Upon conclusion of | 7 | | the initial term, the next term and every term subsequent | 8 | | to it shall run for 3 years. Voting members shall serve no | 9 | | more than 3 consecutive terms. | 10 | | A person appointed to fill a vacancy and complete the | 11 | | unexpired term of a member of the Board shall only be | 12 | | appointed to serve out the unexpired term by the individual | 13 | | who made the original appointment within 45 days after the | 14 | | initial vacancy. A person appointed to fill a vacancy and | 15 | | complete the unexpired term of a member of the Board may be | 16 | | re-appointed to the Board for another term, but shall not | 17 | | serve than more than 2 consecutive terms following their | 18 | | completion of the unexpired term of a member of the Board. | 19 | | If a voting Board member's qualifications change due to | 20 | | a change in employment during the term of their | 21 | | appointment, then the Board member shall resign their | 22 | | position, subject to reappointment by the individual who | 23 | | made the original appointment. | 24 | | (6) The Board shall, as necessary, create and appoint | 25 | | qualified persons with requisite expertise to Exchange | 26 | | technical advisory groups. These Exchange technical |
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| 1 | | advisory groups shall meet in a manner and frequency | 2 | | determined by the Board to discuss exchange-related issues | 3 | | and to provide exchange-related guidance, advice, and | 4 | | recommendations to the Board and the Exchange. There shall | 5 | | be at a minimum, 4 technical advisory groups, including the | 6 | | following: | 7 | | (1) an insurer advisory group; | 8 | | (2) a business advisory group; | 9 | | (3) a consumer advisory group; and | 10 | | (4) a provider advisory group. | 11 | | (7) The Board shall meet no less than quarterly on a | 12 | | schedule established by the chairperson. Meetings shall be | 13 | | public and public records shall be maintained, subject to | 14 | | the Open Meetings Act. A majority of the Board shall | 15 | | constitute a quorum and the affirmative vote of a majority | 16 | | is necessary for any action of the Board. No vacancy shall | 17 | | impair the ability of the Board to act provided a quorum is | 18 | | reached. Members shall serve without pay, but shall be | 19 | | reimbursed for their actual and reasonable expenses | 20 | | incurred in the performance of their duties. The | 21 | | chairperson of the Board shall file a written report | 22 | | regarding the activities of the Board and the Exchange to | 23 | | the Governor and General Assembly annually, and the | 24 | | Legislative Oversight Committee established in Section | 25 | | 5-15 quarterly, beginning on September 1, 2013 through | 26 | | December 31, 2014. |
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| 1 | | (8) The Board shall adopt conflict of interest rules | 2 | | and recusal procedures. Such rules and procedures shall (i) | 3 | | prohibit a member of the Board from performing an official | 4 | | act that may have a direct economic benefit on a business | 5 | | or other endeavor in which that member has a direct or | 6 | | substantial financial interest and (ii) require a member of | 7 | | the Board to recuse himself or herself from an official | 8 | | matter, whether direct or indirect. All recusals must be in | 9 | | writing and specify the reason and date of the recusal. All | 10 | | recusals shall be maintained by the Executive Director and | 11 | | shall be disclosed to any person upon written request. | 12 | | (9) The Board shall develop a budget for the | 13 | | implementation and operation of the Exchange for operating | 14 | | expenses, including, but not limited to: | 15 | | (A) proposed compensation levels for the Executive | 16 | | Director and shall identify personnel and staffing | 17 | | needs for the implementation and operation of the | 18 | | Exchange; | 19 | | (B) disclosure of funds received or expected to be | 20 | | received from the federal government for the | 21 | | infrastructure and systems of the Exchange and those | 22 | | funds received or expected to be received for program | 23 | | administration and operations; and | 24 | | (C) delineation of those functions of the Exchange | 25 | | that are to be paid by State and federal programs that | 26 | | are allocable to the State's General Revenue Fund. |
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| 1 | | (10) The purpose of the Board shall be to implement the | 2 | | Exchange in accordance with this Section and shall be | 3 | | authorized to establish procedures for the operation of the | 4 | | Exchange, subject to legislative approval. | 5 | | (215 ILCS 122/5-17 new) | 6 | | Sec. 5-17. Insurer's assessment. Every carrier licensed to | 7 | | issue, and that issues for delivery, policies of accident and | 8 | | health insurance in this State shall be assessed. The Board | 9 | | shall within 90 days after the effective date of this | 10 | | amendatory Act of the 98th General Assembly and within the | 11 | | first quarter of each fiscal year thereafter, assess all | 12 | | insurers for the anticipated deficit in accordance with the | 13 | | provisions of this Section. The Board may also make additional | 14 | | assessments no more than 4 times a year to fund unanticipated | 15 | | deficits, implementation expenses, and cash flow needs. An | 16 | | insurer's assessment shall be determined by multiplying the | 17 | | total assessment, as determined in this Section, by a fraction, | 18 | | the numerator of which equals that insurer's direct Illinois | 19 | | premiums during the preceding calendar year and the denominator | 20 | | of which equals the total of all insurers' direct Illinois | 21 | | premiums. The Board may exempt those insurers whose share as | 22 | | determined under this Section would be so minimal as to not | 23 | | exceed the estimated cost of levying the assessment. The Board | 24 | | shall charge and collect from each insurer the amounts | 25 | | determined to be due under this Section. The assessment shall |
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| 1 | | be billed by Board invoice based upon the insurer's direct | 2 | | Illinois premium income as shown in its annual statement for | 3 | | the preceding calendar year as filed with the Director. The | 4 | | invoice shall be due upon receipt and must be paid no later | 5 | | than 30 days after receipt by the insurer. | 6 | | When a carrier fails to pay the full amount of any | 7 | | assessment of $100 or more due under this Section there shall | 8 | | be added to the amount due as a penalty the greater of $50 or an | 9 | | amount equal to 5% of the deficiency for each month or part of | 10 | | a month that the deficiency remains unpaid. All moneys | 11 | | collected by the Board shall be placed in the Illinois Health | 12 | | Benefits Exchange Fund. | 13 | | (215 ILCS 122/5-18 new) | 14 | | Sec. 5-18. Illinois Health Benefits Exchange Fund. There | 15 | | is hereby created as a fund outside of the State treasury the | 16 | | Illinois Health Benefits Exchange Fund to be used, subject to | 17 | | appropriation, exclusively by the Exchange to provide funding | 18 | | for the operation and administration of the Exchange in | 19 | | carrying out the purposes authorized in this Law. | 20 | | (215 ILCS 122/5-21 new) | 21 | | Sec. 5-21. Enrollment through brokers and agents; producer | 22 | | compensation. | 23 | | (a) In accordance with Section 1312(e) of the Federal Act, | 24 | | the Exchange shall allow licensed insurance producers to (1) |
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| 1 | | enroll qualified individuals in any qualified health plan, for | 2 | | which the individual is eligible, in the individual exchange, | 3 | | (2) assist qualified individuals in applying for premium tax | 4 | | credits and cost-sharing reductions for qualified health plans | 5 | | purchased through the individual exchange, and (3) enroll | 6 | | qualified employers in any qualified health plan, for which the | 7 | | employer is eligible, offered through the SHOP exchange. | 8 | | Nothing in this subsection (a) shall be construed as to require | 9 | | a qualified individual or qualified employer to utilize a | 10 | | licensed insurance producer for any of the purposes outlined in | 11 | | this subsection (a). | 12 | | (b) In order to enroll individuals and small employers in | 13 | | qualified health plans on the Exchange, licensed producers must | 14 | | complete a certification program. The Department of Insurance | 15 | | may develop and implement a certification program for licensed | 16 | | insurance producers who enroll individuals and employers in the | 17 | | exchange. The Department of Insurance may charge a reasonable | 18 | | fee, by regulation, to producers for the certification program. | 19 | | The Department of Insurance may approve certification programs | 20 | | developed and instructed by others, charging a reasonable fee, | 21 | | by regulation, for approval. | 22 | | (c) The Exchange shall include on its Internet website a | 23 | | producer locator section, featured prominently, through which | 24 | | individuals and small employers can find exchange-certified | 25 | | producers. |
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| 1 | | (215 ILCS 122/5-23 new) | 2 | | Sec. 5-23. Examination or investigation of the Exchange; | 3 | | hearing. | 4 | | (a) In addition to any powers conferred upon him or her by | 5 | | this or any other law, including Article XXIV of the Illinois | 6 | | Insurance Code, the Director or any person designated by him or | 7 | | her has the power to: | 8 | | (1) at the expense of the Exchange, examine or | 9 | | investigate any and all aspects regarding the operation and | 10 | | finances of the Exchange and the Illinois Health Benefits | 11 | | Exchange Fund through free access to all books, records, | 12 | | files, papers, and documents relating to their operation | 13 | | and finances and may summon, subpoena, qualify, and examine | 14 | | as witnesses all persons having knowledge of such | 15 | | operation, including directors, officers, agents, or | 16 | | employees thereof; and | 17 | | (2) require such reports as the Director may deem | 18 | | necessary. | 19 | | (b) The examiners designated by the Director pursuant to | 20 | | this Section may make reports to the Director. Any report | 21 | | alleging substantive violations of this Law, any applicable | 22 | | provisions of the Illinois Insurance Code, any applicable Part | 23 | | of Title 50 of the Illinois Administrative Code, or federal law | 24 | | shall be in writing and be based upon facts obtained by the | 25 | | examiners. The report shall be verified by the examiners. | 26 | | (c) If a report is made, the Director shall deliver a |
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| 1 | | duplicate thereof to the Exchange or persons examined and | 2 | | afford the Exchange or such persons examined an opportunity to | 3 | | request a hearing to object to the report. The Exchange or such | 4 | | persons examined may request a hearing within 30 days after | 5 | | receipt of the duplicate of the examination report by giving | 6 | | the Director written notice of such request together with | 7 | | written objections to the report. Any hearing shall be | 8 | | conducted in accordance with Sections 402 and 403 of the | 9 | | Illinois Insurance Code. The right to hearing is waived if the | 10 | | delivery of the report is refused or the report is otherwise | 11 | | undeliverable or the Exchange or such persons examined do not | 12 | | timely request a hearing. | 13 | | After the hearing or upon expiration of the time period | 14 | | during which the Exchange or such persons may request a | 15 | | hearing, if the examination reveals that the Exchange or such | 16 | | persons examined are operating in violation of any applicable | 17 | | provision of this Article, the Illinois Insurance Code, any | 18 | | applicable Part of Title 50 of the Illinois Administrative | 19 | | Code, prior order, or federal law, the Director, in the written | 20 | | order, may require the Exchange or such persons examined to | 21 | | take any action the Director considers necessary or appropriate | 22 | | in accordance with the report or examination hearing. If the | 23 | | Director issues an order, it shall be issued within 90 days | 24 | | after the report is filed, or if there is a hearing, within 90 | 25 | | days after the conclusion of the hearing. The order is subject | 26 | | to review under the Administrative Review Law. |
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| 1 | | (215 ILCS 122/5-30 new) | 2 | | Sec. 5-30. Dissolution of Comprehensive Health Insurance | 3 | | Plan. | 4 | | (a) Except as otherwise provided in this Section, the | 5 | | insurance operations of the Comprehensive Health Insurance | 6 | | Plan authorized by the Comprehensive Health Insurance Plan Act | 7 | | shall cease on January 1, 2014. As used in this Section, "Plan" | 8 | | means the Comprehensive Health Insurance plan. | 9 | | (b) Coverage under the Plan does not apply to service | 10 | | provided on or after January 1, 2014. | 11 | | (c) A claim for payment under the Plan must be submitted | 12 | | within 180 days after January 1, 2014 and paid within 60 days | 13 | | after receipt. | 14 | | (d) Any grievance shall be resolved by the Plan Board not | 15 | | later than 360 days after January 1, 2014. In this Section, | 16 | | "Plan Board" means the Illinois Comprehensive Health Insurance | 17 | | Board. | 18 | | (e) Balance billing under this Section by a health care | 19 | | provider that is not a member of the provider network | 20 | | arrangement used by the Plan is prohibited. | 21 | | (f) The Plan Board shall, not later than June 30, 2013, | 22 | | submit to the Director of Insurance a plan of dissolution, | 23 | | which must provide for, but not be limited to, the following: | 24 | | (1) Continuity of care for an individual who is covered | 25 | | under the Plan and is an inpatient on January 1, 2014. |
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| 1 | | (2) A final accounting of assessments. | 2 | | (3) Resolution of any net asset deficiency. | 3 | | (4) Cessation of all liability of the Plan. | 4 | | (5) Final dissolution of the Plan. | 5 | | (g) The plan of dissolution may provide that, with the | 6 | | approval of the Plan Board and the Director, a power or duty of | 7 | | the association may be delegated to a person that is to perform | 8 | | functions similar to the functions of the Plan. | 9 | | (h) The Director shall, after notice and hearing, approve a | 10 | | plan of dissolution submitted under subsection (f) of this | 11 | | Section if the Director determines that the plan of dissolution | 12 | | is suitable to ensure the fair, reasonable, and equitable | 13 | | dissolution of the Plan and complies with subsection (f) of | 14 | | this Section. If the Director does not find that the plan of | 15 | | dissolution is suitable to ensure the fair, reasonable, and | 16 | | equitable dissolution of the Plan, he or she may by order | 17 | | require changes to the plan that cure the deficiencies | 18 | | identified in his or her findings. | 19 | | (i) A plan of dissolution submitted under subsection (f) of | 20 | | this Section is effective upon the written approval of the | 21 | | Director. | 22 | | (j) An action by or against the Plan must be filed not more | 23 | | than one year after January 1, 2014. | 24 | | (k) General Revenue Fund funds remaining in the Plan on the | 25 | | date on which final dissolution of the Plan occurs must be | 26 | | transferred back into the General Revenue Fund. |
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| 1 | | (l) Insurer assessments remaining in the Plan on the date | 2 | | on which dissolution of the Plan occurs must be returned to | 3 | | insurers based on subsection e of Section 12 of the | 4 | | Comprehensive Health Insurance Plan Act. | 5 | | (m) The Plan, or the person or entity to which the Plan | 6 | | delegates powers under subsection (g) of this Section, may | 7 | | implement this Section in accordance with the plan of | 8 | | dissolution approved by the Director under subsection (h) of | 9 | | this Section.
| 10 | | Section 99. Effective date. This Act takes effect upon | 11 | | becoming law.".
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