Full Text of SB2799 98th General Assembly
SB2799ham001 98TH GENERAL ASSEMBLY | Rep. Robyn Gabel Filed: 5/23/2014
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| 1 | | AMENDMENT TO SENATE BILL 2799
| 2 | | AMENDMENT NO. ______. Amend Senate Bill 2799 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) All employees of the Illinois Sentencing Policy | 4 | | Advisory Council. | 5 | | (32) The employees of the Illinois Health Benefits | 6 | | Exchange. | 7 | | (Source: P.A. 97-618, eff. 10-26-11; 97-1055, eff. 8-23-12; | 8 | | 98-65, eff. 7-15-13.)
| 9 | | Section 10. The Department of Insurance Law of the
Civil | 10 | | Administrative Code of Illinois is amended by adding Section | 11 | | 1405-40 as follows: | 12 | | (20 ILCS 1405/1405-40 new) | 13 | | Sec. 1405-40. Transfer of the Comprehensive Health | 14 | | Insurance Plan. | 15 | | (a) On January 1, 2015, all powers, duties, rights, and | 16 | | responsibilities of the Comprehensive Health Insurance Plan | 17 | | and the Illinois Comprehensive Health Insurance Board shall be | 18 | | transferred to the Department of Insurance. | 19 | | (b) The Department of Insurance shall act on behalf of the | 20 | | Comprehensive Health Insurance Plan and the Illinois | 21 | | Comprehensive Health Insurance Board and shall have the power | 22 | | and duty to receive and answer correspondence, pay claims due | 23 | | and owing to the Department of Central Management Services | 24 | | revolving fund from any unencumbered funds, refer unpaid |
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| 1 | | vendors to the court of claims, and arrange for the orderly | 2 | | termination of any affairs of the Comprehensive Health | 3 | | Insurance Plan and the Illinois Comprehensive Health Insurance | 4 | | Board that remain unresolved on or after January 1, 2015. | 5 | | (c) All books, records, papers, documents, property (real | 6 | | and personal), contracts, causes of action, and pending | 7 | | business pertaining to the powers, duties, rights, and | 8 | | responsibilities transferred by this amendatory Act of the 98th | 9 | | General Assembly from the Comprehensive Health Insurance Plan | 10 | | and the Illinois Comprehensive Health Insurance Board to the | 11 | | Department of Insurance, including, but not limited to, | 12 | | material in electronic or magnetic format and necessary | 13 | | computer hardware and software, shall be transferred to the | 14 | | Department of Insurance. Records shall remain intact as | 15 | | regulated by the federal Health Insurance Portability and | 16 | | Accountability Act of 1996. | 17 | | (d) The personnel of the Comprehensive Health Insurance | 18 | | Plan and the Illinois Comprehensive Health Insurance Board | 19 | | shall be transferred to the Department of Insurance. The status | 20 | | and rights of those employees under the Personnel Code shall | 21 | | not be affected by the transfer. The rights of the employees | 22 | | and the State of Illinois and its agencies under the Personnel | 23 | | Code and applicable collective bargaining agreements or under | 24 | | any pension, retirement, or annuity plan shall not be affected | 25 | | by this amendatory Act of the 98th General Assembly. | 26 | | (e) All unexpended appropriations and balances and other |
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| 1 | | funds available for use by the Comprehensive Health Insurance | 2 | | Plan and the Illinois Comprehensive Health Insurance Board | 3 | | shall be transferred for use by the Department of Insurance. | 4 | | Unexpended balances so transferred shall be expended only for | 5 | | the purpose for which the appropriations were originally made. | 6 | | (f) The powers, duties, rights, and responsibilities | 7 | | transferred from the Comprehensive Health Insurance Plan and | 8 | | the Illinois Comprehensive Health Insurance Board shall be | 9 | | vested in and shall be exercised by the Department of | 10 | | Insurance. | 11 | | (g) Whenever reports or notices are now required to be made | 12 | | or given or papers or documents furnished or served by any | 13 | | person to or upon the Comprehensive Health Insurance Plan or | 14 | | the Illinois Comprehensive Health Insurance Board in | 15 | | connection with any of the powers, duties, rights, and | 16 | | responsibilities transferred by this amendatory Act of the 98th | 17 | | General Assembly, the same shall be made, given, furnished, or | 18 | | served in the same manner to or upon the Department of | 19 | | Insurance. | 20 | | (h) This amendatory Act of the 98th General Assembly does | 21 | | not affect any act done, ratified, or canceled or any right | 22 | | occurring or established or any action or proceeding had or | 23 | | commenced in an administrative, civil, or criminal cause by the | 24 | | Comprehensive Health Insurance Plan or the Illinois | 25 | | Comprehensive Health Insurance Board prior to January 1, 2015; | 26 | | such actions or proceedings may be prosecuted and continued by |
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| 1 | | the Department of Insurance. | 2 | | Section 15. The Illinois State Auditing Act is amended by | 3 | | changing Section 3-1 as follows:
| 4 | | (30 ILCS 5/3-1) (from Ch. 15, par. 303-1)
| 5 | | Sec. 3-1. Jurisdiction of Auditor General. The Auditor | 6 | | General has
jurisdiction over all State agencies to make post | 7 | | audits and investigations
authorized by or under this Act or | 8 | | the Constitution.
| 9 | | The Auditor General has jurisdiction over local government | 10 | | agencies
and private agencies only:
| 11 | | (a) to make such post audits authorized by or under | 12 | | this Act as are
necessary and incidental to a post audit of | 13 | | a State agency or of a
program administered by a State | 14 | | agency involving public funds of the
State, but this | 15 | | jurisdiction does not include any authority to review
local | 16 | | governmental agencies in the obligation, receipt, | 17 | | expenditure or
use of public funds of the State that are | 18 | | granted without limitation or
condition imposed by law, | 19 | | other than the general limitation that such
funds be used | 20 | | for public purposes;
| 21 | | (b) to make investigations authorized by or under this | 22 | | Act or the
Constitution; and
| 23 | | (c) to make audits of the records of local government | 24 | | agencies to verify
actual costs of state-mandated programs |
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| 1 | | when directed to do so by the
Legislative Audit Commission | 2 | | at the request of the State Board of Appeals
under the | 3 | | State Mandates Act.
| 4 | | In addition to the foregoing, the Auditor General may | 5 | | conduct an
audit of the Metropolitan Pier and Exposition | 6 | | Authority, the
Regional Transportation Authority, the Suburban | 7 | | Bus Division, the Commuter
Rail Division and the Chicago | 8 | | Transit Authority and any other subsidized
carrier when | 9 | | authorized by the Legislative Audit Commission. Such audit
may | 10 | | be a financial, management or program audit, or any combination | 11 | | thereof.
| 12 | | The audit shall determine whether they are operating in | 13 | | accordance with
all applicable laws and regulations. Subject to | 14 | | the limitations of this
Act, the Legislative Audit Commission | 15 | | may by resolution specify additional
determinations to be | 16 | | included in the scope of the audit.
| 17 | | In addition to the foregoing, the Auditor General must also | 18 | | conduct a
financial audit of
the Illinois Sports Facilities | 19 | | Authority's expenditures of public funds in
connection with the | 20 | | reconstruction, renovation, remodeling, extension, or
| 21 | | improvement of all or substantially all of any existing | 22 | | "facility", as that
term is defined in the Illinois Sports | 23 | | Facilities Authority Act.
| 24 | | The Auditor General may also conduct an audit, when | 25 | | authorized by
the Legislative Audit Commission, of any hospital | 26 | | which receives 10% or
more of its gross revenues from payments |
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| 1 | | from the State of Illinois,
Department of Healthcare and Family | 2 | | Services (formerly Department of Public Aid), Medical | 3 | | Assistance Program.
| 4 | | The Auditor General is authorized to conduct financial and | 5 | | compliance
audits of the Illinois Distance Learning Foundation | 6 | | and the Illinois
Conservation Foundation.
| 7 | | As soon as practical after the effective date of this | 8 | | amendatory Act of
1995, the Auditor General shall conduct a | 9 | | compliance and management audit of
the City of
Chicago and any | 10 | | other entity with regard to the operation of Chicago O'Hare
| 11 | | International Airport, Chicago Midway Airport and Merrill C. | 12 | | Meigs Field. The
audit shall include, but not be limited to, an | 13 | | examination of revenues,
expenses, and transfers of funds; | 14 | | purchasing and contracting policies and
practices; staffing | 15 | | levels; and hiring practices and procedures. When
completed, | 16 | | the audit required by this paragraph shall be distributed in
| 17 | | accordance with Section 3-14.
| 18 | | The Auditor General shall conduct a financial and | 19 | | compliance and program
audit of distributions from the | 20 | | Municipal Economic Development Fund
during the immediately | 21 | | preceding calendar year pursuant to Section 8-403.1 of
the | 22 | | Public Utilities Act at no cost to the city, village, or | 23 | | incorporated town
that received the distributions.
| 24 | | The Auditor General must conduct an audit of the Health | 25 | | Facilities and Services Review Board pursuant to Section 19.5 | 26 | | of the Illinois Health Facilities Planning
Act.
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| 1 | | The Auditor General of the State of Illinois shall annually | 2 | | conduct or
cause to be conducted a financial and compliance | 3 | | audit of the books and records
of any county water commission | 4 | | organized pursuant to the Water Commission Act
of 1985 and | 5 | | shall file a copy of the report of that audit with the Governor | 6 | | and
the Legislative Audit Commission. The filed audit shall be | 7 | | open to the public
for inspection. The cost of the audit shall | 8 | | be charged to the county water
commission in accordance with | 9 | | Section 6z-27 of the State Finance Act. The
county water | 10 | | commission shall make available to the Auditor General its | 11 | | books
and records and any other documentation, whether in the | 12 | | possession of its
trustees or other parties, necessary to | 13 | | conduct the audit required. These
audit requirements apply only | 14 | | through July 1, 2007.
| 15 | | The Auditor General must conduct audits of the Rend Lake | 16 | | Conservancy
District as provided in Section 25.5 of the River | 17 | | Conservancy Districts Act.
| 18 | | The Auditor General must conduct financial audits of the | 19 | | Southeastern Illinois Economic Development Authority as | 20 | | provided in Section 70 of the Southeastern Illinois Economic | 21 | | Development Authority Act.
| 22 | | The Auditor General shall conduct a compliance audit in | 23 | | accordance with subsections (d) and (f) of Section 30 of the | 24 | | Innovation Development and Economy Act. | 25 | | The Auditor General shall have the authority to conduct an | 26 | | audit of the Illinois Health Benefits Exchange. The audit may |
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| 1 | | be a financial audit, a management audit, a program audit, or | 2 | | any combination thereof. | 3 | | (Source: P.A. 95-331, eff. 8-21-07; 96-31, eff. 6-30-09; | 4 | | 96-939, eff. 6-24-10.)
| 5 | | Section 20. The Comprehensive Health Insurance Plan Act is | 6 | | amended by adding Sections 16 and 17 as follows: | 7 | | (215 ILCS 105/16 new) | 8 | | Sec. 16. Cessation of operations. | 9 | | (a) Except as otherwise provided in this Section, the | 10 | | insurance operations of the Plan authorized by this Act shall | 11 | | cease on January 1, 2015. | 12 | | (b) Coverage under the Plan does not apply to service | 13 | | provided on or after January 1, 2015. | 14 | | (c) The Plan shall cease enrolling new participants on | 15 | | December 31, 2014. | 16 | | (d) The Plan shall cease providing coverage for | 17 | | participants enrolled prior to January 1, 2015 at 11:59 p.m. on | 18 | | December 31, 2014. Except as otherwise provided in this | 19 | | subsection (d), the Board shall provide at least 90 days | 20 | | written notice to all Plan participants of the cessation of | 21 | | coverage under this Section. For participants enrolled less | 22 | | than 90 days before January 1, 2015, notice of the cessation of | 23 | | coverage under this Section shall be provided to all applicants | 24 | | and to all participants upon enrollment. |
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| 1 | | (e) Any claim for payment under the Plan must be submitted | 2 | | no later than 90 days after January 1, 2015, and any valid | 3 | | claim submitted on or after January 1, 2015 must be paid within | 4 | | 90 days after receipt. | 5 | | (f) Any grievance shall be resolved by the Board not later | 6 | | than October 31, 2015. | 7 | | (g) Balance billing under this Section by a health care | 8 | | provider that is not a member of the provider network | 9 | | arrangement used by the Plan is prohibited. | 10 | | (h) The Board shall, not later than June 30, 2014, submit | 11 | | to the Director a plan of dissolution, which must provide for, | 12 | | but not be limited to, the following: | 13 | | (1) Continuity of care for an individual who is covered | 14 | | under the Plan and is an inpatient on at the time the Plan | 15 | | ceases. | 16 | | (2) A final accounting of assessments. | 17 | | (3) Resolution of any net asset deficiency. | 18 | | (4) Cessation of all liability of the Plan. | 19 | | (5) Final dissolution of the Plan. | 20 | | (i) No legal action by or against the Plan may be filed on | 21 | | or after January 1, 2016. | 22 | | (j) General Revenue Fund funds remaining in the Plan after | 23 | | satisfaction of all of the Plan's liabilities shall be | 24 | | transferred back into the General Revenue Fund. | 25 | | (k) The Board shall cease charging insurer assessments on | 26 | | January 1, 2015; however, the Board may charge and collect |
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| 1 | | insurer assessments pursuant to Section 12 of this Act as | 2 | | necessary to satisfy any remaining liabilities of the Plan. | 3 | | Insurer assessments remaining in the Plan after satisfaction of | 4 | | all of the Plan's liabilities shall be returned to insurers | 5 | | based on subsection (e) of Section 12 of this Act. | 6 | | (215 ILCS 105/17 new) | 7 | | Sec. 17. Repealer. This Act is repealed on July 1, 2016. | 8 | | Section 25. The Illinois Health Benefits Exchange Law is | 9 | | amended by changing Sections 5-3, 5-5, 5-10, and 5-15 and by | 10 | | adding Sections 5-4, 5-11, 5-16, 5-17, 5-18, 5-21, 5-23, and | 11 | | 5-30 as follows: | 12 | | (215 ILCS 122/5-3)
| 13 | | Sec. 5-3. Legislative intent. The General Assembly finds | 14 | | the health benefits exchanges authorized by the federal Patient | 15 | | Protection and Affordable Care Act represent one of a number of | 16 | | ways in which the State can address coverage gaps and provide | 17 | | individual consumers and small employers access to greater | 18 | | coverage options. The General Assembly also finds that the | 19 | | State is best positioned to implement an exchange that is | 20 | | sensitive to the coverage gaps and market landscape unique to | 21 | | this State. | 22 | | The purpose of this Law is to provide for the establishment | 23 | | of an Illinois Health Benefits Exchange (the Exchange) to |
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| 1 | | facilitate the purchase and sale of qualified health plans and | 2 | | qualified dental plans in the individual market in this State | 3 | | and to provide for the establishment of a Small Business Health | 4 | | Options Program (SHOP Exchange) to assist qualified small | 5 | | employers in this State in facilitating the enrollment of their | 6 | | employees in qualified health plans and qualified dental plans | 7 | | offered in the small group market. The intent of the Exchange | 8 | | is to supplement the existing health insurance market to | 9 | | simplify shopping for individual and small employers by | 10 | | increasing access to benefit options, encouraging a | 11 | | competitive market both inside and outside the Exchange, | 12 | | reducing the number of uninsured, and providing a transparent | 13 | | marketplace and effective consumer education and programmatic | 14 | | assistance tools. The purpose of this Law is to ensure that the | 15 | | State is making sufficient progress towards establishing an | 16 | | exchange within the guidelines outlined by the federal law and | 17 | | to protect Illinoisans from undue federal regulation. Although | 18 | | the federal law imposes a number of core requirements on | 19 | | state-level exchanges, the State has significant flexibility | 20 | | in the design and operation of a State exchange that make it | 21 | | prudent for the State to carefully analyze, plan, and prepare | 22 | | for the exchange. The General Assembly finds that in order for | 23 | | the State to craft a tenable exchange that meets the | 24 | | fundamental goals outlined by the Patient Protection and | 25 | | Affordable Care Act of expanding access to affordable coverage | 26 | | and improving the quality of care, the implementation process |
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| 1 | | should (1) provide for broad stakeholder representation; (2) | 2 | | foster a robust and competitive marketplace, both inside and | 3 | | outside of the exchange; and (3) provide for a broad-based | 4 | | approach to the fiscal solvency of the exchange.
| 5 | | (Source: P.A. 97-142, eff. 7-14-11.) | 6 | | (215 ILCS 122/5-4 new) | 7 | | Sec. 5-4. Definitions. In this Law: | 8 | | "Board" means the Illinois Health Benefits Exchange Board | 9 | | established pursuant to this Law. | 10 | | "Department" means the Department of Insurance. | 11 | | "Director" means the Director of Insurance. | 12 | | "Educated health care consumer" means an individual who is | 13 | | knowledgeable about the health care system, and has background | 14 | | or experience in making informed decisions regarding health, | 15 | | medical, and public health matters. | 16 | | "Essential health benefits" has the meaning provided under | 17 | | Section 1302(b) of the Federal Act. | 18 | | "Exchange" means the Illinois Health Benefits Exchange | 19 | | established by this Law and includes the Individual Exchange | 20 | | and the SHOP Exchange, unless otherwise specified. | 21 | | "Executive Director" means the Executive Director of the | 22 | | Illinois Health Benefits Exchange. | 23 | | "Federal Act" means the federal Patient Protection and | 24 | | Affordable Care Act (Public Law 111-148), as amended by the | 25 | | federal Health Care and Education Reconciliation Act of 2010 |
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| 1 | | (Public Law 111-152), and any amendments thereto, or | 2 | | regulations or guidance issued under, those Acts. | 3 | | "Health benefit plan" means a policy, contract, | 4 | | certificate, or agreement offered or issued by a health carrier | 5 | | to provide, deliver, arrange for, pay for, or reimburse any of | 6 | | the costs of health care services.
"Health benefit plan" does | 7 | | not include: | 8 | | (1) coverage for accident only or disability income | 9 | | insurance or any combination thereof; | 10 | | (2) coverage issued as a supplement to liability | 11 | | insurance; | 12 | | (3) liability insurance, including general liability | 13 | | insurance and automobile liability insurance; | 14 | | (4) workers' compensation or similar insurance; | 15 | | (5) automobile medical payment insurance; | 16 | | (6) credit-only insurance; | 17 | | (7) coverage for on-site medical clinics; or | 18 | | (8) other similar insurance coverage, specified in | 19 | | federal regulations issued pursuant to the federal Health | 20 | | Information Portability and Accountability Act of 1996, | 21 | | Public Law 104-191, under which benefits for health care | 22 | | services are secondary or incidental to other insurance | 23 | | benefits. | 24 | | "Health benefit plan" does not include the following | 25 | | benefits if they are provided under a separate policy, | 26 | | certificate, or contract of insurance or are otherwise not an |
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| 1 | | integral part of the plan: | 2 | | (a) limited scope dental or vision benefits; | 3 | | (b) benefits for long-term care, nursing home care, | 4 | | home health care, community-based care, or any combination | 5 | | thereof; or | 6 | | (c) other similar, limited benefits specified in | 7 | | federal regulations issued pursuant to Public Law 104-191. | 8 | | "Health benefit plan" does not include the following | 9 | | benefits if the benefits are provided under a separate policy, | 10 | | certificate, or contract of insurance, there is no coordination | 11 | | between the provision of the benefits and any exclusion of | 12 | | benefits under any group health plan maintained by the same | 13 | | plan sponsor, and the benefits are paid with respect to an | 14 | | event without regard to whether benefits are provided with | 15 | | respect to such an event under any group health plan maintained | 16 | | by the same plan sponsor: | 17 | | (i) coverage only for a specified disease or illness; | 18 | | or | 19 | | (ii) hospital indemnity or other fixed indemnity | 20 | | insurance. | 21 | | "Health benefit plan" does not include the following if | 22 | | offered as a separate policy, certificate, or contract of | 23 | | insurance: | 24 | | (A) Medicare supplemental health insurance as defined | 25 | | under Section 1882(g)(1) of the federal Social Security | 26 | | Act; |
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| 1 | | (B) coverage supplemental to the coverage provided | 2 | | under Chapter 55 of Title 10, United States Code (Civilian | 3 | | Health and Medical Program of the Uniformed Services | 4 | | (CHAMPUS)); or | 5 | | (C) similar supplemental coverage provided to coverage | 6 | | under a group health plan. | 7 | | "Health benefit plan" does not include a group health plan | 8 | | or multiple employer welfare arrangement to the extent the plan | 9 | | or arrangement is not subject to State insurance regulation | 10 | | under Section 514 of the federal Employee Retirement Income | 11 | | Security Act of 1974. | 12 | | "Health insurance carrier" or "carrier" means an entity | 13 | | subject to the insurance laws and regulations of this State, or | 14 | | subject to the jurisdiction of the Director, that contracts or | 15 | | offers to contract to provide, deliver, arrange for, pay for, | 16 | | or reimburse any of the costs of health care services, | 17 | | including a sickness and accident insurance company, a health | 18 | | maintenance organization, or any other entity providing a plan | 19 | | of health insurance, or health benefits. "Health insurance | 20 | | carrier" does not include short term, accident only, disability | 21 | | income, hospital confinement or fixed indemnity, vision only, | 22 | | limited benefit, or credit insurance, coverage issued as a | 23 | | supplement to liability insurance, insurance arising out of a | 24 | | workers' compensation or similar law, automobile | 25 | | medical-payment insurance, insurance under which benefits are | 26 | | payable with or without regard to fault and which is |
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| 1 | | statutorily required to be contained in any liability insurance | 2 | | policy or equivalent self-insurance, or a Consumer Operated and | 3 | | Oriented Plan. | 4 | | "Illinois Health Benefits Exchange Fund" means the fund | 5 | | created outside of the State treasury to be used exclusively to | 6 | | provide funding for the operation and administration of the | 7 | | Exchange in carrying out the purposes authorized by this Law. | 8 | | "Individual Exchange" means the exchange marketplace | 9 | | established by this Law through which qualified individuals may | 10 | | obtain coverage through an individual market qualified health | 11 | | plan. | 12 | | "Principal place of business" means the location in a state | 13 | | where an employer has its headquarters or significant place of | 14 | | business and where the persons with direction and control | 15 | | authority over the business are employed. | 16 | | "Qualified dental plan" means a limited scope dental plan | 17 | | that has been certified in accordance with this Law. | 18 | | "Qualified employee" means an eligible individual employed | 19 | | by a qualified employer who has been offered health insurance | 20 | | coverage by that qualified employer through the SHOP on the | 21 | | Exchange. | 22 | | "Qualified employer" means a small employer that elects to | 23 | | make its full-time employees eligible for one or more qualified | 24 | | health plans or qualified dental plans offered through the SHOP | 25 | | Exchange, and at the option of the employer, some or all of its | 26 | | part-time employees, provided that the employer has its |
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| 1 | | principal place of business in this State and elects to provide | 2 | | coverage through the SHOP Exchange to all of its eligible | 3 | | employees, wherever employed. | 4 | | "Qualified health plan" or "QHP" means a health benefit | 5 | | plan that has in effect a certification that the plan meets the | 6 | | criteria for certification described in Section 1311(c) of the | 7 | | Federal Act. | 8 | | "Qualified health plan issuer" or "QHP issuer" means a | 9 | | health insurance issuer that offers a health plan that the | 10 | | Exchange has certified as a qualified health plan. | 11 | | "Qualified individual" means an individual, including a | 12 | | minor, who: | 13 | | (1) is seeking to enroll in a qualified health plan or | 14 | | qualified dental plan offered to individuals through the | 15 | | Exchange; | 16 | | (2) resides in this State; | 17 | | (3) at the time of enrollment, is not incarcerated, | 18 | | other than incarceration pending the disposition of | 19 | | charges; and | 20 | | (4) is, and is reasonably expected to be, for the | 21 | | entire period for which enrollment is sought, a citizen or | 22 | | national of the United States or an alien lawfully present | 23 | | in the United States. | 24 | | "Secretary" means the Secretary of the federal Department | 25 | | of Health and Human Services. | 26 | | "SHOP Exchange" means the Small Business Health Options |
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| 1 | | Program established under this Law through which a qualified | 2 | | employer can provide small group qualified health plans to its | 3 | | qualified employees through various options available to the | 4 | | employer, including, but not limited to: (a) offering one | 5 | | qualified health plan to employees, (b) offering multiple | 6 | | qualified health plans to employees, or (c) offering an | 7 | | employee-directed choice of a qualified health plan within an | 8 | | employer-selected coverage tier. | 9 | | "Small employer" means, in connection with a group health | 10 | | plan with respect to a calendar year and a plan year, an | 11 | | employer who employed an average of at least 2 but not more | 12 | | than 50 employees before January 1, 2016 and no more than 100 | 13 | | employees on and after January 1, 2016 on business days during | 14 | | the preceding calendar year and who employs at least one | 15 | | employee on the first day of the plan year.
For purposes of | 16 | | this definition: | 17 | | (a) all persons treated as a single employer under | 18 | | subsection (b), (c), (m) or (o) of Section 414 of the | 19 | | federal Internal Revenue Code of 1986 shall be treated as a | 20 | | single employer; | 21 | | (b) an employer and any predecessor employer shall be | 22 | | treated as a single employer; | 23 | | (c) employees shall be counted in accordance with | 24 | | federal law and regulations and State law and regulations; | 25 | | provided however, that in the event of a conflict between | 26 | | the federal law and regulations and the State law and |
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| 1 | | regulations, the federal law and regulations shall | 2 | | prevail; | 3 | | (d) if an employer was not in existence throughout the | 4 | | preceding calendar year, then the determination of whether | 5 | | that employer is a small employer shall be based on the | 6 | | average number of employees that is reasonably expected | 7 | | that employer will employ on business days in the current | 8 | | calendar year; and | 9 | | (e) an employer that makes enrollment in qualified | 10 | | health plans or qualified dental plans available to its | 11 | | employees through the SHOP Exchange, and would cease to be | 12 | | a small employer by reason of an increase in the number of | 13 | | its employees, shall continue to be treated as a small | 14 | | employer for purposes of this Law as long as it | 15 | | continuously makes enrollment through the SHOP Exchange | 16 | | available to its employees. | 17 | | (215 ILCS 122/5-5)
| 18 | | Sec. 5-5. Establishment of the Exchange State health | 19 | | benefits exchange . | 20 | | (a) It is declared that this State, beginning on the | 21 | | effective date of this amendatory Act of the 98th General | 22 | | Assembly October 1, 2013 , in accordance with Section 1311 of | 23 | | the federal Patient Protection and Affordable Care Act, shall | 24 | | establish a State health benefits exchange to be known as the | 25 | | Illinois Health Benefits Exchange in order to help individuals |
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| 1 | | and small employers with no more than 50 employees shop for, | 2 | | select, and enroll in qualified, affordable private health | 3 | | plans that fit their needs at competitive prices. The Exchange | 4 | | shall separate coverage pools for individuals and small | 5 | | employers and shall supplement and not supplant any existing | 6 | | private health insurance market for individuals and small | 7 | | employers. These health plans shall be available to individuals | 8 | | and small employers for enrollment by October 1, 2015.
| 9 | | (b) There is hereby created a political subdivision, body | 10 | | politic and corporate, named the Illinois Health Benefits | 11 | | Exchange. The Exchange shall be a public entity, but shall not | 12 | | be considered a department, institution, or agency of the | 13 | | State. | 14 | | (c) The Exchange shall be comprised of an individual and a | 15 | | small business health options (SHOP) exchange. Pursuant to | 16 | | Section 1311(b)(2) of the Federal Act, the Exchange shall | 17 | | provide individual exchange services to qualified individuals | 18 | | and SHOP Exchange services to qualified employers under a | 19 | | single governance and administrative structure. The Board | 20 | | shall produce an assessment, which must include a premium | 21 | | impact study, by July 1, 2017 to determine the viability of | 22 | | merging the SHOP Exchange and Individual Exchange functions | 23 | | into a single exchange by January 1, 2018. Any recommended | 24 | | merger of the SHOP Exchange and Individual Exchange functions | 25 | | shall be subject to legislative approval. | 26 | | (d) The Exchange shall promote a competitive marketplace |
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| 1 | | for consumer access to affordable health coverage options. The | 2 | | Department shall review and recommend that the Board certify | 3 | | health benefit plans on the individual and SHOP Exchange, as | 4 | | applicable, provided that any such health benefit plan meets | 5 | | the requirements set forth in Section 1311(c) of the Federal | 6 | | Act and any other requirements of the Illinois Insurance Code. | 7 | | The Board shall certify health benefit plans that the | 8 | | Department recommends for certification. | 9 | | (e) The Exchange shall not supersede the provisions of the | 10 | | Illinois Insurance Code, nor the functions of the Department of | 11 | | Insurance, the Department of Healthcare and Family Services, or | 12 | | the Department of Public Health. | 13 | | (Source: P.A. 97-142, eff. 7-14-11.) | 14 | | (215 ILCS 122/5-10)
| 15 | | Sec. 5-10. Exchange functions. | 16 | | (a) On or before January 1, 2016, in compliance with | 17 | | paragraph (4) of subdivision (d) of Section 1311 of the federal | 18 | | Patient Protection and Affordable Care Act, the Exchange shall, | 19 | | at a minimum, do all of the following to implement Section 1311 | 20 | | of the federal Patient Protection and Affordable Care Act: | 21 | | (1) Make qualified health plans available to qualified | 22 | | individuals and qualified employers. | 23 | | (2) Implement procedures for the certification, | 24 | | recertification, and decertification, consistent with | 25 | | Section 5-11 of this Act and the guidelines established by |
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| 1 | | the U.S. Secretary of Health and Human Services, of health | 2 | | plans as qualified health plans. | 3 | | (3) Provide for the operation of a toll-free telephone | 4 | | hotline and call center to respond to requests for | 5 | | assistance. | 6 | | (4) Maintain an Internet website through which | 7 | | enrollees and prospective enrollees of qualified health | 8 | | plans may obtain standardized comparative information on | 9 | | those plans. | 10 | | (5) With respect to each qualified health plan offered | 11 | | through the Exchange, do both of the following: | 12 | | (A) assign a rating to each qualified health plan | 13 | | offered through the Exchange in accordance with the | 14 | | criteria developed by the U.S. Secretary of Health and | 15 | | Human Services; and | 16 | | (B) determine each qualified health plan's level | 17 | | of coverage in accordance with regulations adopted by | 18 | | the U.S. Secretary of Health and Human Services under | 19 | | paragraph (A) of subdivision (2) of Section 1302(d) of | 20 | | the federal Patient Protection and Affordable Care Act | 21 | | and any additional regulations adopted by the Exchange | 22 | | under this Law. | 23 | | (6) Utilize a standardized format for presenting | 24 | | health benefits plan options in the Exchange, including the | 25 | | use of the uniform outline of coverage established under | 26 | | Section 2715 of the federal Public Health Service Act. |
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| 1 | | (7) Inform individuals of eligibility requirements for | 2 | | the Medicaid program, the Covering ALL KIDS Health | 3 | | Insurance Program, or any applicable State or local public | 4 | | program and, if through screening of the application by the | 5 | | Exchange the Exchange determines that an individual is | 6 | | eligible for any such program, enroll that individual in | 7 | | the program. | 8 | | (8) Establish and make available by electronic means a | 9 | | calculator to determine the actual cost of coverage after | 10 | | the application of any premium tax credit under Section 36B | 11 | | of the Internal Revenue Code of 1986 and any cost sharing | 12 | | reduction under Section 1402 of the federal Patient | 13 | | Protection and Affordable Care Act. | 14 | | (9) Coordinate with other State and county agencies. | 15 | | (10) Grant a certification attesting that, for | 16 | | purposes of the individual responsibility penalty under | 17 | | Section 5000A of the Internal Revenue Code of 1986, an | 18 | | individual is exempt from the individual requirement or | 19 | | from the penalty imposed by that Section because of either | 20 | | of the following: | 21 | | (A) There is no affordable qualified health plan | 22 | | available through the Exchange or the individual's | 23 | | employer covering the individual. | 24 | | (B) The individual meets the requirements for any | 25 | | other exemption from the individual responsibility | 26 | | requirement or penalty. |
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| 1 | | (11) Transfer to the Secretary of the Treasury of the | 2 | | United States all of the following: | 3 | | (A) a list of the individuals who are issued a | 4 | | certification, including the name and taxpayer | 5 | | identification number of each individual; | 6 | | (B) the name and taxpayer identification number of | 7 | | each individual who was an employee of an employer, but | 8 | | who was determined to be eligible for the premium tax | 9 | | credit under Section 36B of the Internal Revenue Code | 10 | | of 1986 because: | 11 | | (i) the employer did not provide the minimum | 12 | | essential coverage or the employer provided the | 13 | | minimum essential coverage but it was determined | 14 | | under item (C) of paragraph (2) of subdivision (c) | 15 | | of Section 36B of the Internal Revenue Code to | 16 | | either be unaffordable to the employee or not | 17 | | provide the required minimum actuarial value; and | 18 | | (ii) the name and taxpayer identification | 19 | | number of each individual who notifies the | 20 | | Exchange under paragraph (4) of subdivision (b) of | 21 | | Section 1411 of the federal Patient Protection and | 22 | | Affordable Care Act that they have changed | 23 | | employers and of each individual who ceases | 24 | | coverage under a qualified health plan during a | 25 | | plan year, and the effective date of such | 26 | | cessation. |
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| 1 | | (12) Provide to each employer the name of each employee | 2 | | of the employer described in subdivision (i) of Section | 3 | | 1311 of the federal Patient Protection and Affordable Care | 4 | | Act who ceases coverage under a qualified health plan | 5 | | during a plan year and the effective date of that | 6 | | cessation. | 7 | | (13) Perform duties required of, or delegated to, the | 8 | | Exchange by the U.S. Secretary of Health and Human Services | 9 | | or the Secretary of the Treasury of the United States | 10 | | related to the following: | 11 | | (A) Determining eligibility for premium tax | 12 | | credits, reduced cost sharing, or individual | 13 | | responsibility exemptions. | 14 | | (B) Establishing procedures necessary for the | 15 | | operation of the program, including, but not limited | 16 | | to, procedures for application, enrollment, risk | 17 | | assessment, risk adjustment, plan administration, | 18 | | performance monitoring, and consumer education. | 19 | | (C) Arranging for collection of contributions from | 20 | | participating employers and individuals. | 21 | | (D) Arranging for payment of premiums and other | 22 | | appropriate disbursements based on the selections of | 23 | | products and services by the individual participants. | 24 | | (E) Establishing criteria for disenrollment of | 25 | | participating individuals based on failure to pay the | 26 | | individual's share of any contribution required to |
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| 1 | | maintain enrollment in selected products. | 2 | | (F) Establishing criteria for exclusion of | 3 | | vendors. | 4 | | (G) Developing and implementing a plan for | 5 | | promoting public awareness of and participation in the | 6 | | program. | 7 | | (H) Evaluating options for employer participation | 8 | | which may conform with common insurance practices. | 9 | | (14) Providing for initial, annual, and special | 10 | | enrollment periods, in accordance with guidelines adopted | 11 | | by the U.S. Secretary of Health and Human Services under | 12 | | paragraph (6) of subdivision (c) of Section 1311 of the | 13 | | federal Patient Protection and Affordable Care Act. | 14 | | (15) Establish the Navigator Program in accordance | 15 | | with subdivision (i) of Section 1311 of the federal Patient | 16 | | Protection and Affordable Care Act. The Exchange shall | 17 | | award grants to certain entities to do the following: | 18 | | (A) Conduct public education activities to raise | 19 | | awareness of the availability of qualified health | 20 | | plans. | 21 | | (B) Distribute fair and impartial information | 22 | | concerning enrollment in qualified health plans and | 23 | | the availability of premium tax credits under Section | 24 | | 36B of the Internal Revenue Code of 1986 and | 25 | | cost-sharing reductions under Section 1402 of the | 26 | | federal Patient Protection and Affordable Care Act. |
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| 1 | | (C) Facilitate enrollment in qualified health | 2 | | plans. | 3 | | (D) Provide referrals to any applicable office of | 4 | | health insurance consumer assistance or health | 5 | | insurance ombudsman established under Section 2793 of | 6 | | the federal Public Health Service Act, or any other | 7 | | appropriate State agency or agencies, for any enrollee | 8 | | with a grievance, complaint, or question regarding his | 9 | | or her health plan, coverage, or a determination under | 10 | | that plan or coverage. | 11 | | (E) Refer individuals with a grievance, complaint, | 12 | | or question regarding a plan, a plan's coverage, or a | 13 | | determination under a plan's coverage to a customer | 14 | | relations unit established by the Exchange. | 15 | | (F) Provide information in a manner that is | 16 | | culturally and linguistically appropriate to the needs | 17 | | of the population being served by the Exchange. | 18 | | (16) Establish the Small Business Health Options | 19 | | Program, separate from the activities of the Board related | 20 | | to the individual market, to assist qualified small | 21 | | employers in facilitating the enrollment of their | 22 | | employees in qualified health plans offered through the | 23 | | Exchange in the small employer market in a manner | 24 | | consistent with paragraph (2) of subdivision (a) of Section | 25 | | 1312 of the Federal Act. The Illinois Health Benefits | 26 | | Exchange shall meet the core functions identified by |
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| 1 | | Section 1311 of the Patient Protection and Affordable Care | 2 | | Act and subsequent federal guidance and regulations. | 3 | | (b) The In order to meet the deadline of October 1, 2013 | 4 | | established by federal law to have operational a State | 5 | | exchange, the Department of Insurance
and the Commission on | 6 | | Government Governmental Forecasting and Accountability is | 7 | | authorized to apply for, accept, receive, and use as | 8 | | appropriate
for and on behalf of the State any grant money | 9 | | provided by the
federal government and to share federal grant | 10 | | funding with, give support to,
and coordinate with other | 11 | | agencies of the State and federal government
or third parties | 12 | | as determined by the Governor , until the Board has the ability | 13 | | to do so, at which time the Board is authorized to apply for, | 14 | | accept, receive, and use as appropriate for and on behalf of | 15 | | the State any grant money provided by the federal government | 16 | | and to share federal grant funding with, give support to, and | 17 | | coordinate with other agencies of the State and federal | 18 | | government or third parties pursuant to Section 5-11 of this | 19 | | Law .
| 20 | | (Source: P.A. 97-142, eff. 7-14-11; revised 9-11-13.) | 21 | | (215 ILCS 122/5-11 new) | 22 | | Sec. 5-11. Health benefit plan certification. | 23 | | (a) To be certified as a qualified health plan, a health | 24 | | benefit plan shall, at a minimum: | 25 | | (1) provide the essential health benefits package |
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| 1 | | described in Section 1302(a) of
the Federal Act; except | 2 | | that the plan is not required to provide essential benefits | 3 | | that duplicate
the minimum benefits of qualified dental | 4 | | plans, as provided in subsection (e) of this Section if: | 5 | | (A) the Board, in cooperation with the Department, | 6 | | has determined that at least one qualified dental plan | 7 | | is
available to supplement the plan's coverage; and | 8 | | (B) the health carrier makes prominent disclosure | 9 | | at the time it offers the
plan, in a form approved by | 10 | | the Board, that the plan does not provide the full | 11 | | range of
essential pediatric dental benefits and that | 12 | | qualified dental plans providing those benefits and
| 13 | | other dental benefits not covered by the plan are | 14 | | offered through the Exchange; | 15 | | (2) fulfill all premium rate and contract filing | 16 | | requirements and ensure that no contract language has been | 17 | | disapproved by the Director; | 18 | | (3) provide at least the minimum level of coverage | 19 | | prescribed by the Federal Act; | 20 | | (4) ensure that the cost-sharing requirements of the | 21 | | plan do not exceed the limits
established under Section | 22 | | 1302(c)(l) of the Federal Act, and if the plan is offered | 23 | | through the
SHOP Exchange, the plan's deductible does not | 24 | | exceed the limits established under Section
1302(c)(2) of | 25 | | the Federal Act; | 26 | | (5) be offered by a health carrier that: |
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| 1 | | (A) is authorized and in good standing to offer | 2 | | health insurance coverage; | 3 | | (B) offers at least one qualified health plan at | 4 | | the silver level and at
least one plan at the gold | 5 | | level, as described in the Federal Act, through each | 6 | | component of the Board in which the health
carrier | 7 | | participates; for the purposes of this subparagraph | 8 | | (B), "component"
means the SHOP Exchange and the | 9 | | exchange for individual coverage within the American
| 10 | | Health Benefit Exchange; | 11 | | (C) charges the same premium rate for each | 12 | | qualified health plan without
regard to whether the | 13 | | plan is offered through the Exchange and without regard | 14 | | to whether the
plan is offered directly from the health | 15 | | carrier or through an insurance producer; | 16 | | (D) does not charge any cancellation fees or | 17 | | penalties; and | 18 | | (E) complies with the regulations established by | 19 | | the Secretary under
Section 1311 (d) of the Federal Act | 20 | | and any other requirements of the Illinois Insurance | 21 | | Code and the Department; | 22 | | (6) meet the requirements of certification pursuant to | 23 | | the requirements of the Department and the Illinois | 24 | | Insurance Code provided in
this Law and the requirements | 25 | | issued by the Secretary under Section 1311(c) of the | 26 | | Federal Act and rules promulgated or adopted
pursuant to |
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| 1 | | this Law or the Federal Act, which shall include: | 2 | | (A) minimum standards in the areas of marketing | 3 | | practices; | 4 | | (B) network adequacy; | 5 | | (C) essential community providers in underserved | 6 | | areas; | 7 | | (D) accreditation; | 8 | | (E) quality improvement; | 9 | | (F) uniform enrollment forms and descriptions of | 10 | | coverage; and | 11 | | (G) information on quality measures for health | 12 | | benefit plan performance; | 13 | | (7) include outpatient clinics in the health plan's | 14 | | region that are controlled by an entity that also controls | 15 | | a 340B eligible provider as defined by Section 340B(a)(4) | 16 | | of the federal Public Health Service Act such that the | 17 | | outpatient clinics are subject to the same mission, | 18 | | policies, and medical standards related to the provision of | 19 | | health care services as the 340B eligible provider; and | 20 | | (8) submit a justification for any premium increase | 21 | | prior to the implementation of the increase; the plans | 22 | | shall prominently post that information on their Internet | 23 | | websites; the Board shall take this information, and the | 24 | | information and the recommendations provided to the Board | 25 | | by the Department of Insurance or the Department of Managed | 26 | | Health Care under paragraph (1) of subdivision (b) of |
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| 1 | | Section 2794 of the federal Public Health Service Act, into | 2 | | consideration when determining whether to make the health | 3 | | plan available through the Exchange; the Board shall take | 4 | | into account any excess of premium growth outside the | 5 | | Exchange as compared to the rate of that growth inside the | 6 | | Exchange, including information reported by the Department | 7 | | of Insurance and the Department of Managed Health Care. | 8 | | (b) The Department shall require each health carrier | 9 | | seeking certification of a plan as a
qualified health plan to: | 10 | | (1) make available to the public, in plain language as | 11 | | defined in Section 1311(e)(3)(B) of the Federal Act, and | 12 | | submit to the Board, the Secretary, and the Department | 13 | | accurate
and timely disclosure of the following: | 14 | | (i) claims payment policies and practices; | 15 | | (ii) periodic financial disclosures; | 16 | | (iii) data on enrollment; | 17 | | (iv) data on disenrollment; | 18 | | (v) data on the number of claims that are | 19 | | denied; | 20 | | (vi) data on rating practices; | 21 | | (vii) information on cost-sharing and payments | 22 | | with respect to any
out-of-network coverage; | 23 | | (viii) information on enrollee and participant | 24 | | rights under Title I of
the Federal Act; and | 25 | | (ix) other information as determined | 26 | | appropriate by the Secretary, including, but not |
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| 1 | | limited to, accredited clinical quality measures; | 2 | | and | 3 | | (2) permit individuals to learn, in a timely manner | 4 | | upon the request of the
individual, the comparative quality | 5 | | standards of the plans along established clinical | 6 | | data-based standards and the amount of cost-sharing, | 7 | | including deductibles, copayments, and coinsurance,
under | 8 | | the individual's plan or coverage that the individual would | 9 | | be responsible for paying with
respect to the furnishing of | 10 | | a specific item or service by a participating provider and | 11 | | make this
information available to the individual through | 12 | | an Internet website that is publicly accessible and
through | 13 | | other means for individuals without access to the Internet. | 14 | | (c) The Department shall not exempt any health carrier | 15 | | seeking certification as a qualified
health plan, regardless of | 16 | | the type or size of the health carrier, from licensure or | 17 | | solvency
requirements and shall apply the criteria of this | 18 | | Section in a manner that ensures a level playing
field between | 19 | | or among health carriers participating in the Exchange. | 20 | | (d) The provisions of this Law that are applicable to | 21 | | qualified health plans shall also
apply, to the extent | 22 | | relevant, to qualified dental plans, except as modified in | 23 | | accordance with the
provisions of paragraphs (1), (2), and (3) | 24 | | of this subsection (d) or by rules adopted by the
Board. | 25 | | (1) The health carrier shall be licensed to offer | 26 | | dental coverage, but need not be
licensed to offer other |
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| 1 | | health benefits. | 2 | | (2) The plan shall be limited to dental and oral health | 3 | | benefits, without
substantially duplicating the benefits | 4 | | typically offered by health benefit plans without dental
| 5 | | coverage and shall include, at a minimum, the essential | 6 | | pediatric dental benefits prescribed by
the Secretary | 7 | | pursuant to Section 1302(b)(l)(J) of the Federal Act and | 8 | | such other dental benefits
as the Board or the Secretary | 9 | | may specify by rule. | 10 | | (3) Health carriers may jointly offer a comprehensive | 11 | | plan through the Exchange
in which the dental benefits are | 12 | | provided by a health carrier through a qualified dental | 13 | | plan and
the other benefits are provided by a health | 14 | | carrier through a qualified health plan, provided that
the | 15 | | plans are priced separately and are also made available for | 16 | | purchase separately at the same
price. | 17 | | (215 ILCS 122/5-15)
| 18 | | Sec. 5-15. Illinois Health Benefits Exchange Legislative | 19 | | Oversight Study Committee. | 20 | | (a) There is created an Illinois Health Benefits Exchange | 21 | | Legislative Oversight Study Committee within the Commission on | 22 | | Government Forecasting and Accountability to provide | 23 | | accountability for conduct a study regarding State | 24 | | implementation and establishment of the Illinois Health | 25 | | Benefits Exchange and to ensure Exchange operations and |
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| 1 | | functions align with the goals and duties outlined by this Law . | 2 | | The Committee shall also be responsible for providing policy | 3 | | recommendations to ensure the Exchange aligns with the Federal | 4 | | Act, amendments to the Federal Act, and regulations promulgated | 5 | | pursuant to the Federal Act. | 6 | | (b) Members of the Legislative Oversight Study Committee | 7 | | shall be appointed as follows: 3 members of the Senate shall be | 8 | | appointed by the President of the Senate; 3 members of the | 9 | | Senate shall be appointed by the Minority Leader of the Senate; | 10 | | 3 members of the House of Representatives shall be appointed by | 11 | | the Speaker of the House of Representatives; and 3 members of | 12 | | the House of Representatives shall be appointed by the Minority | 13 | | Leader of the House of Representatives. Each legislative leader | 14 | | shall select one member to serve as co-chair of the committee. | 15 | | (c) Members of the Legislative Oversight Study Committee | 16 | | shall be appointed no later than September 1, 2014 within 30 | 17 | | days after the effective date of this Law. The co-chairs shall | 18 | | convene the first meeting of the committee no later than 45 | 19 | | days after the effective date of this Law .
| 20 | | (Source: P.A. 97-142, eff. 7-14-11.) | 21 | | (215 ILCS 122/5-16 new) | 22 | | Sec. 5-16. Exchange governance. The governing and | 23 | | administrative powers of the Exchange shall be vested in a body | 24 | | known as the Illinois Health Benefits Exchange Board. The | 25 | | following provisions shall apply: |
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| 1 | | (1) The Board shall consist of 11 voting members | 2 | | appointed by the Governor with the advice and consent of a | 3 | | majority of the members elected to the Senate. In addition, | 4 | | the Director of Healthcare and Family Services, and the | 5 | | Executive Director of the Exchange shall serve as | 6 | | non-voting, ex-officio members of the Board. The Governor | 7 | | shall also appoint as non-voting, ex-officio members one | 8 | | economist with experience in the health care markets and | 9 | | one educated health care consumer advocate. All Board | 10 | | members shall be appointed no later than September 1, 2014. | 11 | | (2) The Governor shall make the appointments so as to | 12 | | reflect no less than proportional representation of the | 13 | | geographic, gender, cultural, racial, and ethnic | 14 | | composition of this State and in accordance with | 15 | | subparagraphs (A), (B), and (C) of this paragraph, as | 16 | | follows: | 17 | | (A) No more than 4 voting members may represent the | 18 | | following interests, of which no more than 2 may | 19 | | represent any one interest: | 20 | | (1) the insurance industry; | 21 | | (2) health care administrators; and | 22 | | (3) licensed health care professionals. | 23 | | (B) At least 7 voting members shall represent the | 24 | | following interest groups, with each interest group | 25 | | represented by at least one voting member: | 26 | | (1) a labor interest group; |
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| 1 | | (2) a women's interest group; | 2 | | (3) a minorities' interest group; | 3 | | (4) a disabled persons' interest group; | 4 | | (5) a small business interest group; and | 5 | | (6) a public health interest group. | 6 | | (C) Each person appointed to the Board should have | 7 | | demonstrated experience in at least one of the | 8 | | following areas: | 9 | | (1) individual health insurance coverage; | 10 | | (2) small employer health insurance; | 11 | | (3) health benefits administration; | 12 | | (4) health care finance; | 13 | | (5) administration of a public or private | 14 | | health care delivery system; | 15 | | (6) the provision of health care services; | 16 | | (7) the purchase of health insurance coverage; | 17 | | (8) health care consumer navigation or | 18 | | assistance; | 19 | | (9) health care economics or health care | 20 | | actuarial sciences; | 21 | | (10) information technology; or | 22 | | (11) starting a small business with 50 or fewer | 23 | | employees. | 24 | | (3) The Board shall elect one voting member of the | 25 | | Board to serve as chairperson and one voting member to | 26 | | serve as vice-chairperson, upon approval of a majority of |
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| 1 | | the Board. | 2 | | (4) The Exchange shall be administered by an Executive | 3 | | Director, who shall be appointed, and may be removed, by a | 4 | | majority of the Board. The Board shall have the power to | 5 | | determine compensation for the Executive Director. | 6 | | (5) The terms of the non-voting, ex-officio members of | 7 | | the Board shall run concurrent with their terms of | 8 | | appointment to office, or in the case of the Executive | 9 | | Director, his or her term of appointment to that position, | 10 | | subject to the determination of the Board. The terms of the | 11 | | members, including those non-voting, ex-officio members | 12 | | appointed by the Governor, shall be 4 years. Upon | 13 | | conclusion of the initial term, the next term and every | 14 | | term subsequent to it shall run for 3 years. Voting members | 15 | | shall serve no more than 3 consecutive terms. | 16 | | A person appointed to fill a vacancy and complete the | 17 | | unexpired term of a member of the Board shall only be | 18 | | appointed to serve out the unexpired term by the individual | 19 | | who made the original appointment within 45 days after the | 20 | | initial vacancy. A person appointed to fill a vacancy and | 21 | | complete the unexpired term of a member of the Board may be | 22 | | re-appointed to the Board for another term, but shall not | 23 | | serve than more than 2 consecutive terms following their | 24 | | completion of the unexpired term of a member of the Board. | 25 | | If a voting Board member's qualifications change due to | 26 | | a change in employment during the term of their |
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| 1 | | appointment, then the Board member shall resign their | 2 | | position, subject to reappointment by the individual who | 3 | | made the original appointment. | 4 | | (6) The Board shall, as necessary, create and appoint | 5 | | qualified persons with requisite expertise to Exchange | 6 | | technical advisory groups. These Exchange technical | 7 | | advisory groups shall meet in a manner and frequency | 8 | | determined by the Board to discuss exchange-related issues | 9 | | and to provide exchange-related guidance, advice, and | 10 | | recommendations to the Board and the Exchange. There shall | 11 | | be at a minimum, 6 technical advisory groups, including the | 12 | | following: | 13 | | (1) an insurer advisory group; | 14 | | (2) a business advisory group; | 15 | | (3) a consumer advisory group; | 16 | | (4) a provider advisory group; | 17 | | (5) an insurance producer advisory group; and | 18 | | (6) a dentist advisory group. | 19 | | (7) The Board shall meet no less than quarterly on a | 20 | | schedule established by the chairperson. Meetings shall be | 21 | | public and public records shall be maintained, subject to | 22 | | the Open Meetings Act. A majority of the Board shall | 23 | | constitute a quorum and the affirmative vote of a majority | 24 | | is necessary for any action of the Board. No vacancy shall | 25 | | impair the ability of the Board to act provided a quorum is | 26 | | reached. Members shall serve without pay, but shall be |
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| 1 | | reimbursed for their actual and reasonable expenses | 2 | | incurred in the performance of their duties. The | 3 | | chairperson of the Board shall file a written report | 4 | | regarding the activities of the Board and the Exchange to | 5 | | the Governor and General Assembly annually, and the | 6 | | Legislative Oversight Committee established in Section | 7 | | 5-15 quarterly, beginning on January 1, 2015 through | 8 | | December 31, 2016. | 9 | | (8) The Board shall adopt conflict of interest rules | 10 | | and recusal procedures. Such rules and procedures shall (i) | 11 | | prohibit a member of the Board from performing an official | 12 | | act that may have a direct economic benefit on a business | 13 | | or other endeavor in which that member has a direct or | 14 | | substantial financial interest and (ii) require a member of | 15 | | the Board to recuse himself or herself from an official | 16 | | matter, whether direct or indirect. All recusals must be in | 17 | | writing and specify the reason and date of the recusal. All | 18 | | recusals shall be maintained by the Executive Director and | 19 | | shall be disclosed to any person upon written request. | 20 | | (9) The Board shall develop a budget, to be submitted | 21 | | to the General Assembly along with the Governor's annual | 22 | | budget proposal and approved by the General Assembly, for | 23 | | the implementation and operation of the Exchange for | 24 | | operating expenses, including, but not limited to: | 25 | | (A) proposed compensation levels for the Executive | 26 | | Director and shall identify personnel and staffing |
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| 1 | | needs for the implementation and operation of the | 2 | | Exchange; | 3 | | (B) disclosure of funds received or expected to be | 4 | | received from the federal government for the | 5 | | infrastructure and systems of the Exchange and those | 6 | | funds received or expected to be received for program | 7 | | administration and operations; | 8 | | (C) delineation of those functions of the Exchange | 9 | | that are to be paid by State and federal programs that | 10 | | are allocable to the State's General Revenue Fund; and | 11 | | (D) beginning January 1, 2016, insurer assessments | 12 | | contingent upon the use of federal funds for the first | 13 | | year of operation of the Exchange and upon the review | 14 | | and recommendations of the Commission on Government | 15 | | Forecasting and Accountability. | 16 | | (10) The Board shall, in consultation with the Health | 17 | | Benefits Exchange Legislative Oversight Committee, produce | 18 | | a cost-benefit analysis of the State's essential health | 19 | | benefits no later than August 1, 2015 for the purposes of | 20 | | informing the U.S. Department of Health and Human Services | 21 | | in their re-evaluation of the essential health benefits for | 22 | | plan years 2016 and beyond. | 23 | | (11) The purpose of the Board shall be to implement the | 24 | | Exchange in accordance with this Section and shall be | 25 | | authorized to establish procedures for the operation of the | 26 | | Exchange, subject to legislative approval. |
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| 1 | | (215 ILCS 122/5-17 new) | 2 | | Sec. 5-17. Insurer's assessment. Every carrier licensed to | 3 | | issue, and that issues for delivery, policies of accident and | 4 | | health insurance in this State shall be assessed. An insurer's | 5 | | assessment shall be determined by multiplying the total | 6 | | assessment, as determined in this Section, by a fraction, the | 7 | | numerator of which equals that insurer's direct Illinois | 8 | | premiums, excluding those premiums from limited lines policies | 9 | | and supplemental insurance policies, during the preceding | 10 | | calendar year and the denominator of which equals the total of | 11 | | all insurers' direct Illinois premiums, excluding those | 12 | | premiums from limited lines policies and supplemental | 13 | | insurance policies. The Board may exempt those insurers whose | 14 | | share as determined under this Section would be so minimal as | 15 | | to not exceed the estimated cost of levying the assessment. The | 16 | | Board shall charge and collect from each insurer the amounts | 17 | | determined to be due under this Section. The assessment shall | 18 | | be billed by Board invoice based upon the insurer's direct | 19 | | Illinois premium income, excluding premium income from limited | 20 | | lines policies and supplemental insurance policies, as shown in | 21 | | its annual statement for the preceding calendar year as filed | 22 | | with the Director. The invoice shall be due upon receipt and | 23 | | must be paid no later than 30 days after receipt by the | 24 | | insurer. | 25 | | When a carrier fails to pay the full amount of any |
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| 1 | | assessment of $100 or more due under this Section there shall | 2 | | be added to the amount due as a penalty the greater of $50 or an | 3 | | amount equal to 5% of the deficiency for each month or part of | 4 | | a month that the deficiency remains unpaid. All moneys | 5 | | collected by the Board shall be placed in the Illinois Health | 6 | | Benefits Exchange Fund. | 7 | | Insurers shall be assessed only an amount not exceeding the | 8 | | General Assembly's approved Board budget. No assessment shall | 9 | | be made on insurers while assessments are being made pursuant | 10 | | to Section 12 of the Comprehensive Health Insurance Plan Act. | 11 | | The assessment shall also take into consideration any unspent | 12 | | federal funds remaining and shall be reduced accordingly. | 13 | | The Board shall prepare annually a complete and detailed | 14 | | written report accounting for all funds received and dispensed | 15 | | during the preceding fiscal year. | 16 | | (215 ILCS 122/5-18 new) | 17 | | Sec. 5-18. Illinois Health Benefits Exchange Fund. There | 18 | | is hereby created as a fund outside of the State treasury the | 19 | | Illinois Health Benefits Exchange Fund to be used, subject to | 20 | | appropriation, exclusively by the Exchange to provide funding | 21 | | for the operation and administration of the Exchange in | 22 | | carrying out the purposes authorized in this Law. | 23 | | (215 ILCS 122/5-23 new) | 24 | | Sec. 5-23. Examination or investigation of the Exchange. |
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| 1 | | The Director shall have the ability to examine or investigate | 2 | | the Exchange pursuant to his or her authority under Article | 3 | | XXIV of the Illinois Insurance Code.
| 4 | | Section 99. Effective date. This Act takes effect upon | 5 | | becoming law.".
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