Full Text of SB1555 97th General Assembly
SB1555ham001 97TH GENERAL ASSEMBLY | Rep. Frank J. Mautino Filed: 5/20/2011
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| 1 | | AMENDMENT TO SENATE BILL 1555
| 2 | | AMENDMENT NO. ______. Amend Senate Bill 1555 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "ARTICLE 5. | 5 | | ILLINOIS HEALTH BENEFITS EXCHANGE | 6 | | Section 5-1. Short title. This Article may be cited as the | 7 | | Illinois Health Benefits Exchange Law. | 8 | | Section 5-3. Legislative intent. The General Assembly | 9 | | finds the health benefits exchanges authorized by the federal | 10 | | Patient Protection and Affordable Care Act represent one of a | 11 | | number of ways in which the State can address coverage gaps and | 12 | | provide individual consumers and small employers access to | 13 | | greater coverage options. The General Assembly also finds that | 14 | | the State is best-positioned to implement an exchange that is | 15 | | sensitive to the coverage gaps and market landscape unique to |
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| 1 | | this State. | 2 | | The purpose of this Law is to ensure that the State is | 3 | | making sufficient progress towards establishing an exchange | 4 | | within the guidelines outlined by the federal law and to | 5 | | protect Illinoisans from undue federal regulation. Although | 6 | | the federal law imposes a number of core requirements on | 7 | | state-level exchanges, the State has significant flexibility | 8 | | in the design and operation of a State exchange that make it | 9 | | prudent for the State to carefully analyze, plan, and prepare | 10 | | for the exchange. The General Assembly finds that in order for | 11 | | the State to craft a tenable exchange that meets the | 12 | | fundamental goals outlined by the Patient Protection and | 13 | | Affordable Care Act of expanding access to affordable coverage | 14 | | and improving the quality of care, the implementation process | 15 | | should (1) provide for broad stakeholder representation; (2) | 16 | | foster a robust and competitive marketplace, both inside and | 17 | | outside of the exchange; and (3) provide for a broad-based | 18 | | approach to the fiscal solvency of the exchange. | 19 | | Section 5-5. State health benefits exchange. It is | 20 | | declared that this State, beginning October 1, 2013, in | 21 | | accordance with Section 1311 of the federal Patient Protection | 22 | | and Affordable Care Act, shall establish a State health | 23 | | benefits exchange to be known as the Illinois Health Benefits | 24 | | Exchange in order to help individuals and small employers with | 25 | | no more than 50 employees shop for, select, and enroll in |
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| 1 | | qualified, affordable private health plans that fit their needs | 2 | | at competitive prices. The Exchange shall separate coverage | 3 | | pools for individuals and small employers and shall supplement | 4 | | and not supplant any existing private health insurance market | 5 | | for individuals and small employers. | 6 | | Section 5-10. Exchange functions. | 7 | | (a) The Illinois Health Benefits Exchange shall meet the | 8 | | core functions identified by Section 1311 of the Patient | 9 | | Protection and Affordable Care Act and subsequent federal | 10 | | guidance and regulations. | 11 | | (b) In order to meet the deadline of October 1, 2013 | 12 | | established by federal law to have operational a State | 13 | | exchange, the Department of Insurance
and the Commission on | 14 | | Governmental Forecasting and Accountability is authorized to | 15 | | apply for, accept, receive, and use as appropriate
for and on | 16 | | behalf of the State any grant money provided by the
federal | 17 | | government and to share federal grant funding with, give | 18 | | support to,
and coordinate with other agencies of the State and | 19 | | federal government
or third parties as determined by the | 20 | | Governor. | 21 | | Section 5-15. Illinois Health Benefits Exchange | 22 | | Legislative Study Committee. | 23 | | (a) There is created an Illinois Health Benefits Exchange | 24 | | Legislative Study Committee to conduct a study regarding State |
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| 1 | | implementation and establishment of the Illinois Health | 2 | | Benefits Exchange. | 3 | | (b) Members of the Legislative Study Committee shall be | 4 | | appointed as follows: 3 members of the Senate shall be | 5 | | appointed by the President of the Senate; 3 members of the | 6 | | Senate shall be appointed by the Minority Leader of the Senate; | 7 | | 3 members of the House of Representatives shall be appointed by | 8 | | the Speaker of the House of Representatives; and 3 members of | 9 | | the House of Representatives shall be appointed by the Minority | 10 | | Leader of the House of Representatives. Each legislative leader | 11 | | shall select one member to serve as co-chair of the committee. | 12 | | (c) Members of the Legislative Study Committee shall be | 13 | | appointed within 30 days after the effective date of this Law. | 14 | | The co-chairs shall convene the first meeting of the committee | 15 | | no later than 45 days after the effective date of this Law. | 16 | | Section 5-20. Committee study. No later than September 30, | 17 | | 2011, the Committee shall report all findings concerning the | 18 | | implementation and establishment of the Illinois Health | 19 | | Benefits Exchange to the executive and legislative branches, | 20 | | including, but not limited to, (1) the governance and
structure | 21 | | of the Exchange, (2) financial sustainability of the
Exchange, | 22 | | and (3) stakeholder engagement, including an ongoing role
for | 23 | | the Legislative Study Committee or other legislative oversight | 24 | | of the
Exchange. The Committee shall report its findings with | 25 | | regard to (A) the operating model of
the Exchange, (B) the size |
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| 1 | | of the small employers to be offered
coverage through the | 2 | | Exchange, (C) coverage pools for
individuals and businesses | 3 | | within the Exchange, and (D) the development of standards for | 4 | | the coverage of full-time and part-time employees and their | 5 | | dependents. The Committee study shall also include | 6 | | recommendations concerning prospective action on behalf of the | 7 | | General Assembly as it relates to the establishment of the | 8 | | Exchange in 2011, 2012, 2013, and 2014. | 9 | | Section 5-25. Federal action. This Law shall be null and | 10 | | void if Congress and the President take action to repeal or | 11 | | replace, or both, Section 1311 of the Affordable Care Act. | 12 | | ARTICLE 10. | 13 | | HEALTH SAVINGS ACCOUNT | 14 | | Section 10-1. Short title. This Article may be cited as | 15 | | the State Employee Health Savings Account Law. | 16 | | Section 10-5. Definitions. As used in this Law: | 17 | | (a) "Deductible" means the total deductible of a high | 18 | | deductible health plan for an eligible individual and all the | 19 | | dependents of that eligible individual for a calendar year. | 20 | | (b) "Dependent" means an eligible individual's spouse or | 21 | | child, as defined in Section 152 of the Internal Revenue Code | 22 | | of 1986.
"Dependent" includes a party to a civil union, as |
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| 1 | | defined under Section 10 of the Illinois Religious Freedom | 2 | | Protection and Civil Union Act. | 3 | | (c) "Eligible individual" means an employee, as defined in | 4 | | Section 3 of the State Employees Group Insurance Act of 1971, | 5 | | who contributes to health savings accounts on the employees' | 6 | | behalf, who: | 7 | | (1) is covered by a high deductible health plan | 8 | | individually or with dependents; and | 9 | | (2) is not covered under any health plan that is not a | 10 | | high deductible health plan, except for: | 11 | | (i) coverage for accidents; | 12 | | (ii) workers' compensation insurance; | 13 | | (iii) insurance for a specified disease or | 14 | | illness; | 15 | | (iv) insurance paying a fixed amount per day per | 16 | | hospitalization; and | 17 | | (v) tort liabilities; and | 18 | | (3) establishes a health savings account or on whose | 19 | | behalf the health savings account is
established. | 20 | | (d) "Employer" means a State agency, department, or other | 21 | | entity that employs an eligible individual. | 22 | | (e) "Health savings account" or "account" means a trust or | 23 | | custodial account established under a State program | 24 | | exclusively to pay the qualified medical expenses of an | 25 | | eligible individual, or his or her dependents, that meets the | 26 | | all of the following requirements:
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| 1 | | (1) Except in the case of a rollover contribution, no | 2 | | contribution may be accepted: | 3 | | (A) unless it is in cash; or
| 4 | | (B) to the extent that the contribution, when added | 5 | | to the previous contributions to the Account for the | 6 | | calendar year, exceeds the lesser of (i) 100% of the | 7 | | eligible individual's deductible or (ii) the | 8 | | contribution level set for that year by the Internal | 9 | | Revenue Service. | 10 | | (2)
The trustee or custodian is a bank, an insurance | 11 | | company, or another person approved by the Director of | 12 | | Insurance.
| 13 | | (3) No part of the trust assets shall be invested in | 14 | | life insurance contracts. | 15 | | (4) The assets of the account shall not be commingled | 16 | | with other property except as allowed for under Individual | 17 | | Retirement Accounts. | 18 | | (5) Eligible individual's interest in the account is | 19 | | nonforfeitable. | 20 | | (f) "Health savings account program" or "program" means a | 21 | | program that includes all of the following:
| 22 | | (1) The purchase by an eligible individual or by an | 23 | | employer of a high deductible health plan. | 24 | | (2) The contribution into a health savings account by | 25 | | an eligible individual or on behalf of an employee or by | 26 | | his or her employer. The total annual contribution may not |
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| 1 | | exceed the amount of the deductible or the amounts listed | 2 | | in sub-item (B) of item (1) of subsection (f) of this | 3 | | Section. | 4 | | (g) "High deductible" means: | 5 | | (1) In the case of self-only coverage, an annual | 6 | | deductible that is not less than the level set by the | 7 | | Internal Revenue Service and that, when added to the other | 8 | | annual out-of-pocket expenses required to be paid under the | 9 | | plan for covered benefits, does not exceed $5,000; and
| 10 | | (2) In the case of family coverage, an annual | 11 | | deductible of not less than the level set by the Internal | 12 | | Revenue Service and that, when added to the other annual | 13 | | out-of-pocket expenses required to be paid under the plan | 14 | | for covered benefits, does not exceed $10,000.
| 15 | | A plan shall not fail to be treated as a high deductible | 16 | | plan by reason of a failure to have a deductible for preventive | 17 | | care or, in the case of network plans, for having out-of-pocket | 18 | | expenses that exceed these limits on an annual deductible for | 19 | | services that are provided outside the network.
| 20 | | (h) "High deductible health plan" means a health coverage | 21 | | policy, certificate, or contract that provides for payments for | 22 | | covered benefits that exceed the high deductible. | 23 | | (i) "Qualified medical expense" means an expense paid by | 24 | | the eligible individual for medical care described in Section | 25 | | 213(d) of the Internal Revenue Code of 1986. |
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| 1 | | Section 10-10. Application; authorized contributions. | 2 | | (a) Beginning in taxable year 2011, each employer may make | 3 | | available to each eligible individual a health savings account | 4 | | program, if that individual chooses to enroll in the program. | 5 | | An employer shall deposit $2,750 annually into an eligible | 6 | | individual's health savings account. Unused funds in a health | 7 | | savings account shall become the property of the account holder | 8 | | at the end of a taxable year. | 9 | | (b) Beginning in taxable year 2011, an eligible individual | 10 | | may deposit contributions into a health savings account. The | 11 | | amount of deposit may not exceed the amount of the deductible | 12 | | for the policy. | 13 | | Section 10-15. Use of funds. | 14 | | (a) The trustee or custodian must use the funds held in a | 15 | | health savings account solely (i) for the purpose of paying the | 16 | | qualified medical expenses of the eligible individual or his or | 17 | | her dependents, (ii) to purchase a health coverage policy, | 18 | | certificate, or contract, or (iii) to pay for health insurance | 19 | | other than a Medicare supplemental policy for those who are | 20 | | Medicare eligible. | 21 | | (b) Funds held in a health savings account may not be used | 22 | | to cover expenses of the eligible individual or his or her | 23 | | dependents that are otherwise covered, including, but not | 24 | | limited to, medical expense covered under an automobile | 25 | | insurance policy, worker's compensation insurance policy or |
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| 1 | | self-insured plan, or another employer-funded health coverage | 2 | | policy, certificate, or contract. | 3 | | ARTICLE 90. | 4 | | AMENDATORY PROVISIONS | 5 | | Section 90-5. The Comprehensive Health Insurance Plan Act | 6 | | is amended by changing Sections 1.1, 2, 4, 7, 7.1, and 12 and | 7 | | by adding Section 20 as follows:
| 8 | | (215 ILCS 105/1.1) (from Ch. 73, par. 1301.1)
| 9 | | Sec. 1.1.
The General Assembly hereby makes the following | 10 | | findings and
declarations:
| 11 | | (a) The Comprehensive Health Insurance Plan is established | 12 | | as a State
program that is intended to provide
an alternate | 13 | | market for health insurance for certain uninsurable Illinois
| 14 | | residents, and further is intended to provide an
acceptable | 15 | | alternative mechanism as described in the federal Health | 16 | | Insurance
Portability and Accountability Act of 1996 for | 17 | | providing portable and
accessible individual health insurance | 18 | | coverage for federally eligible
individuals as defined in this | 19 | | Act.
| 20 | | (b) The State of Illinois may subsidize the cost of health | 21 | | insurance
coverage offered by the Plan. However, since the | 22 | | State
has only a limited amount of
resources, the General | 23 | | Assembly declares that it intends for this program to
provide |
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| 1 | | portable and accessible individual health insurance coverage | 2 | | for every
federally eligible individual who qualifies for | 3 | | coverage in accordance with
Section 15 of this Act, but does | 4 | | not intend for every
eligible person who qualifies for Plan | 5 | | coverage in accordance with Section 7
of this Act to be | 6 | | guaranteed a right to be issued a policy under
this
Plan as a | 7 | | matter of entitlement.
| 8 | | (c) The Comprehensive Health Insurance Plan Board shall | 9 | | operate the Plan
in a manner so that the estimated cost of the | 10 | | program during
any fiscal year will not exceed the total income | 11 | | it expects to receive from
policy premiums, investment income, | 12 | | assessments, or fees collected or
received
by the Board and | 13 | | other funds which are made available from
appropriations for | 14 | | the Plan by
the General Assembly for that fiscal year .
| 15 | | (Source: P.A. 90-30, eff. 7-1-97.)
| 16 | | (215 ILCS 105/2) (from Ch. 73, par. 1302)
| 17 | | Sec. 2. Definitions. As used in this Act, unless the | 18 | | context otherwise
requires:
| 19 | | "Plan administrator" means the insurer or third party
| 20 | | administrator designated under Section 5 of this Act.
| 21 | | "Benefits plan" means the coverage to be offered by the | 22 | | Plan to
eligible persons and federally eligible individuals | 23 | | pursuant to this Act.
| 24 | | "Board" means the Illinois Comprehensive Health Insurance | 25 | | Board.
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| 1 | | "Church plan" has the same meaning given that term in the | 2 | | federal Health
Insurance Portability and Accountability Act of | 3 | | 1996.
| 4 | | "Continuation coverage" means continuation of coverage | 5 | | under a group health
plan or other health insurance coverage | 6 | | for former employees or dependents of
former employees that | 7 | | would otherwise have terminated under the terms of that
| 8 | | coverage pursuant to any continuation provisions under federal | 9 | | or State law,
including the Consolidated Omnibus Budget | 10 | | Reconciliation Act of 1985 (COBRA),
as amended, Sections 367.2, | 11 | | 367e, and 367e.1 of the Illinois Insurance Code, or
any
other | 12 | | similar requirement in another State.
| 13 | | "Covered person" means a person who is and continues to | 14 | | remain eligible for
Plan coverage and is covered under one of | 15 | | the benefit plans offered by the
Plan.
| 16 | | "Creditable coverage" means, with respect to a federally | 17 | | eligible
individual, coverage of the individual under any of | 18 | | the following:
| 19 | | (A) A group health plan.
| 20 | | (B) Health insurance coverage (including group health | 21 | | insurance coverage).
| 22 | | (C) Medicare.
| 23 | | (D) Medical assistance.
| 24 | | (E) Chapter 55 of title 10, United States Code.
| 25 | | (F) A medical care program of the Indian Health Service | 26 | | or of a tribal
organization.
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| 1 | | (G) A state health benefits risk pool.
| 2 | | (H) A health plan offered under Chapter 89 of title 5, | 3 | | United States Code.
| 4 | | (I) A public health plan (as defined in regulations | 5 | | consistent with
Section
104 of the Health Care Portability | 6 | | and Accountability Act of 1996 that may be
promulgated by | 7 | | the Secretary of the U.S. Department of Health and Human
| 8 | | Services).
| 9 | | (J) A health benefit plan under Section 5(e) of the | 10 | | Peace Corps Act (22
U.S.C. 2504(e)).
| 11 | | (K) Any other qualifying coverage required by the | 12 | | federal Health Insurance
Portability and Accountability | 13 | | Act of 1996, as it may be amended, or
regulations under | 14 | | that
Act.
| 15 | | "Creditable coverage" does not include coverage consisting | 16 | | solely of coverage
of excepted benefits, as defined in Section | 17 | | 2791(c) of title XXVII of
the
Public Health Service Act (42 | 18 | | U.S.C. 300 gg-91), nor does it include any
period
of coverage | 19 | | under any of items (A) through (K) that occurred before a break | 20 | | of
more than 90 days or, if the individual has
been certified | 21 | | as eligible pursuant to the federal Trade Act
of 2002, a
break | 22 | | of more than 63 days during all of which the individual was not | 23 | | covered
under any of items (A) through (K) above.
| 24 | | Any period that an individual is in a waiting period for
| 25 | | any coverage under a group health plan (or for group health | 26 | | insurance
coverage) or is in an affiliation period under the |
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| 1 | | terms of health insurance
coverage offered by a health | 2 | | maintenance organization shall not be taken into
account in | 3 | | determining if there has been a break of more than 90
days in | 4 | | any
creditable coverage.
| 5 | | "Department" means the Illinois Department of Insurance.
| 6 | | "Dependent" means an Illinois resident: who is a spouse; or | 7 | | who is an claimed
as a dependent by the principal insured for | 8 | | purposes of filing a federal income
tax return and resides in | 9 | | the principal insured's household, and is a resident
unmarried | 10 | | child under the age of 26 19 years; or who is an unmarried | 11 | | child who
also is a full-time student under the age of 23 years | 12 | | and who is financially
dependent upon the principal insured; or | 13 | | who is an unmarried child under the age of 30 years if the | 14 | | child (i) is an Illinois resident, (ii) served as a member of | 15 | | the active or reserve components of any of the branches of the | 16 | | Armed Forces of the United States, and (iii) has received a | 17 | | release or discharge other than a dishonorable discharge; or | 18 | | who is a child of any age and who is
disabled and financially | 19 | | dependent upon the
principal insured.
| 20 | | "Direct Illinois premiums" means, for Illinois business, | 21 | | an insurer's direct
premium income for the kinds of business | 22 | | described in clause (b) of Class 1 or
clause (a) of Class 2 of | 23 | | Section 4 of the Illinois Insurance Code, and direct
premium | 24 | | income of a health maintenance organization or a voluntary | 25 | | health
services plan, except it shall not include credit health | 26 | | insurance as defined
in Article IX 1/2 of the Illinois |
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| 1 | | Insurance Code.
| 2 | | "Director" means the Director of the Illinois Department of | 3 | | Insurance.
| 4 | | "Effective date of medical assistance" means the date that | 5 | | eligibility for medical assistance for a person is approved by | 6 | | the Department of Human Services or the Department of | 7 | | Healthcare and Family Services, except when the Department of | 8 | | Human Services or the Department of Healthcare and Family | 9 | | Services determines eligibility retroactively. In such | 10 | | circumstances, the effective date of the medical assistance is | 11 | | the date the Department of Human Services or the Department of | 12 | | Healthcare and Family Services determines the person to be | 13 | | eligible for medical assistance. | 14 | | "Eligible person" means a resident of this State who | 15 | | qualifies
for Plan coverage under Section 7 of this Act.
| 16 | | "Employee" means a resident of this State who is employed | 17 | | by an employer
or has entered into
the employment of or works | 18 | | under contract or service of an employer
including the | 19 | | officers, managers and employees of subsidiary or affiliated
| 20 | | corporations and the individual proprietors, partners and | 21 | | employees of
affiliated individuals and firms when the business | 22 | | of the subsidiary or
affiliated corporations, firms or | 23 | | individuals is controlled by a common
employer through stock | 24 | | ownership, contract, or otherwise.
| 25 | | "Employer" means any individual, partnership, association, | 26 | | corporation,
business trust, or any person or group of persons |
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| 1 | | acting directly or indirectly
in the interest of an employer in | 2 | | relation to an employee, for which one or
more
persons is | 3 | | gainfully employed.
| 4 | | "Family" coverage means the coverage provided by the Plan | 5 | | for the
covered person and his or her eligible dependents who | 6 | | also are
covered persons.
| 7 | | "Federally eligible individual" means an individual | 8 | | resident of this State:
| 9 | | (1)(A) for whom, as of the date on which the individual | 10 | | seeks Plan
coverage
under Section 15 of this Act, the | 11 | | aggregate of the periods of creditable
coverage is 18 or | 12 | | more months or, if the individual has been
certified as
| 13 | | eligible pursuant to the federal Trade Act of 2002,
3 or | 14 | | more
months, and (B) whose most recent prior creditable
| 15 | | coverage was under group health insurance coverage offered | 16 | | by a health
insurance issuer, a group health plan, a | 17 | | governmental plan, or a church plan
(or
health insurance | 18 | | coverage offered in connection with any such plans) or any
| 19 | | other type of creditable coverage that may be required by | 20 | | the federal Health
Insurance Portability
and | 21 | | Accountability Act of 1996, as it may be amended, or the | 22 | | regulations
under that Act;
| 23 | | (2) who
is not eligible for coverage under
(A) a group | 24 | | health plan
(other than an individual who has been | 25 | | certified as eligible
pursuant to the federal Trade Act of | 26 | | 2002), (B)
part
A or part B of Medicare due to age
(other |
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| 1 | | than an individual who has been certified as eligible
| 2 | | pursuant to the federal Trade Act of 2002), or (C) medical | 3 | | assistance, and
does not
have other
health insurance | 4 | | coverage (other than an individual who has been certified | 5 | | as
eligible pursuant to the federal Trade Act of 2002);
| 6 | | (3) with respect to whom (other than an individual who | 7 | | has been
certified as eligible pursuant to the federal | 8 | | Trade Act of 2002) the most
recent coverage within the | 9 | | coverage
period
described in paragraph (1)(A) of this | 10 | | definition was not terminated
based upon a factor relating | 11 | | to nonpayment of premiums or fraud;
| 12 | | (4) if the individual (other than an individual who has
| 13 | | been certified
as eligible pursuant to the federal Trade | 14 | | Act
of 2002)
had been offered the option of continuation
| 15 | | coverage
under a COBRA continuation provision or under a | 16 | | similar State program, who
elected such coverage; and
| 17 | | (5) who, if the individual elected such continuation | 18 | | coverage, has
exhausted
such continuation coverage under | 19 | | such provision or program.
| 20 | | However, an individual who has been certified as
eligible
| 21 | | pursuant to the
federal Trade Act of 2002
shall not be required | 22 | | to elect
continuation
coverage under a COBRA continuation | 23 | | provision or under a similar state
program.
| 24 | | "Group health insurance coverage" means, in connection | 25 | | with a group health
plan, health insurance coverage offered in | 26 | | connection with that plan.
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| 1 | | "Group health plan" has the same meaning given that term in | 2 | | the federal
Health
Insurance Portability and Accountability | 3 | | Act of 1996.
| 4 | | "Governmental plan" has the same meaning given that term in | 5 | | the federal
Health
Insurance Portability and Accountability | 6 | | Act of 1996.
| 7 | | "Health insurance coverage" means benefits consisting of | 8 | | medical care
(provided directly, through insurance or | 9 | | reimbursement, or otherwise and
including items and services | 10 | | paid for as medical care) under any hospital and
medical | 11 | | expense-incurred policy,
certificate, or
contract provided by | 12 | | an insurer, non-profit health care service plan
contract, | 13 | | health maintenance organization or other subscriber contract, | 14 | | or
any other health care plan or arrangement that pays for or | 15 | | furnishes
medical or health care services whether by
insurance | 16 | | or otherwise. Health insurance coverage shall not include short
| 17 | | term,
accident only,
disability income, hospital confinement | 18 | | or fixed indemnity, dental only,
vision only, limited benefit, | 19 | | or credit
insurance, coverage issued as a supplement to | 20 | | liability insurance,
insurance arising out of a workers' | 21 | | compensation or similar law, automobile
medical-payment | 22 | | insurance, or insurance under which benefits are payable
with | 23 | | or without regard to fault and which is statutorily required to | 24 | | be
contained in any liability insurance policy or equivalent | 25 | | self-insurance.
| 26 | | "Health insurance issuer" means an insurance company, |
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| 1 | | insurance service,
or insurance organization (including a | 2 | | health maintenance organization and a
voluntary health | 3 | | services plan) that is authorized to transact health
insurance
| 4 | | business in this State. Such term does not include a group | 5 | | health plan.
| 6 | | "Health Maintenance Organization" means an organization as
| 7 | | defined in the Health Maintenance Organization Act.
| 8 | | "Hospice" means a program as defined in and licensed under | 9 | | the
Hospice Program Licensing Act.
| 10 | | "Hospital" means a duly licensed institution as defined in | 11 | | the
Hospital Licensing Act,
an institution that meets all | 12 | | comparable conditions and requirements in
effect in the state | 13 | | in which it is located, or the University of Illinois
Hospital | 14 | | as defined in the University of Illinois Hospital Act.
| 15 | | "Individual health insurance coverage" means health | 16 | | insurance coverage
offered to individuals in the individual | 17 | | market, but does not include
short-term, limited-duration | 18 | | insurance.
| 19 | | "Insured" means any individual resident of this State who | 20 | | is
eligible to receive benefits from any insurer (including | 21 | | health insurance
coverage offered in connection with a group | 22 | | health plan) or health
insurance issuer as
defined in this | 23 | | Section.
| 24 | | "Insurer" means any insurance company authorized to | 25 | | transact health
insurance business in this State and any | 26 | | corporation that provides medical
services and is organized |
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| 1 | | under the Voluntary Health Services Plans Act or
the Health | 2 | | Maintenance Organization
Act.
| 3 | | "Medical assistance" means the State medical assistance or | 4 | | medical
assistance no grant (MANG) programs provided under
| 5 | | Title XIX of the Social Security Act and
Articles V (Medical | 6 | | Assistance) and VI (General Assistance) of the Illinois
Public | 7 | | Aid Code (or any successor program) or under any
similar | 8 | | program of health care benefits in a state other than Illinois.
| 9 | | "Medically necessary" means that a service, drug, or supply | 10 | | is
necessary and appropriate for the diagnosis or treatment of | 11 | | an illness or
injury in accord with generally accepted | 12 | | standards of medical practice at
the time the service, drug, or | 13 | | supply is provided. When specifically
applied to a confinement | 14 | | it further means that the diagnosis or treatment
of the covered | 15 | | person's medical symptoms or condition cannot be
safely
| 16 | | provided to that person as an outpatient. A service, drug, or | 17 | | supply shall
not be medically necessary if it: (i) is | 18 | | investigational, experimental, or
for research purposes; or | 19 | | (ii) is provided solely for the convenience of
the patient, the | 20 | | patient's family, physician, hospital, or any other
provider; | 21 | | or (iii) exceeds in scope, duration, or intensity that level of
| 22 | | care that is needed to provide safe, adequate, and appropriate | 23 | | diagnosis or
treatment; or (iv) could have been omitted without | 24 | | adversely affecting the
covered person's condition or the | 25 | | quality of medical care; or
(v) involves
the use of a medical | 26 | | device, drug, or substance not formally approved by
the United |
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| 1 | | States Food and Drug Administration.
| 2 | | "Medical care" means the ordinary and usual professional | 3 | | services rendered
by a physician or other specified provider | 4 | | during a professional visit for
treatment of an illness or | 5 | | injury.
| 6 | | "Medicare" means coverage under both Part A and Part B of | 7 | | Title XVIII of
the Social Security
Act, 42 U.S.C. Sec. 1395, et | 8 | | seq.
| 9 | | "Minimum premium plan" means an arrangement whereby a | 10 | | specified
amount of health care claims is self-funded, but the | 11 | | insurance company
assumes the risk that claims will exceed that | 12 | | amount.
| 13 | | "Participating transplant center" means a hospital | 14 | | designated by the
Board as a preferred or exclusive provider of | 15 | | services for one or more
specified human organ or tissue | 16 | | transplants for which the hospital has
signed an agreement with | 17 | | the Board to accept a transplant payment allowance
for all | 18 | | expenses related to the transplant during a transplant benefit | 19 | | period.
| 20 | | "Physician" means a person licensed to practice medicine | 21 | | pursuant to
the Medical Practice Act of 1987.
| 22 | | "Plan" means the Comprehensive Health Insurance Plan
| 23 | | established by this Act.
| 24 | | "Plan of operation" means the plan of operation of the
| 25 | | Plan, including articles, bylaws and operating rules, adopted | 26 | | by the board
pursuant to this Act.
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| 1 | | "Provider" means any hospital, skilled nursing facility, | 2 | | hospice, home
health agency, physician, registered pharmacist | 3 | | acting within the scope of that
registration, or any other | 4 | | person or entity licensed in Illinois to furnish
medical care.
| 5 | | "Qualified high risk pool" has the same meaning given that | 6 | | term in the
federal Health
Insurance Portability and | 7 | | Accountability Act of 1996.
| 8 | | "Resident" means a person who is and continues to be | 9 | | legally domiciled
and physically residing on a permanent and | 10 | | full-time basis in a
place of permanent habitation
in this | 11 | | State
that remains that person's principal residence and from | 12 | | which that person is
absent only for temporary or transitory | 13 | | purpose.
| 14 | | "Skilled nursing facility" means a facility or that portion | 15 | | of a facility
that is licensed by the Illinois Department of | 16 | | Public Health under the
Nursing Home Care Act or a comparable | 17 | | licensing authority in another state
to provide skilled nursing | 18 | | care.
| 19 | | "Stop-loss coverage" means an arrangement whereby an | 20 | | insurer
insures against the risk that any one claim will exceed | 21 | | a specific dollar
amount or that the entire loss of a | 22 | | self-insurance plan will exceed
a specific amount.
| 23 | | "Third party administrator" means an administrator as | 24 | | defined in
Section 511.101 of the Illinois Insurance Code who | 25 | | is licensed under
Article XXXI 1/4 of that Code.
| 26 | | (Source: P.A. 95-965, eff. 9-23-08.)
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| 1 | | (215 ILCS 105/4) (from Ch. 73, par. 1304)
| 2 | | Sec. 4. Powers and authority of the board. The board shall | 3 | | have the
general powers and authority granted under the laws of | 4 | | this State to
insurance companies licensed to transact health | 5 | | and accident insurance and
in addition thereto, the specific | 6 | | authority to:
| 7 | | a. Enter into contracts as are necessary or proper to carry | 8 | | out the
provisions and purposes of this Act, including the | 9 | | authority, with the
approval of the Director, to enter into | 10 | | contracts with similar plans of
other states for the joint | 11 | | performance of common administrative functions,
or with | 12 | | persons or other organizations for the performance of
| 13 | | administrative functions including, without limitation, | 14 | | utilization review
and quality assurance programs, or with | 15 | | health maintenance organizations or
preferred provider | 16 | | organizations for the provision of health care services.
| 17 | | b. Sue or be sued, including taking any legal actions | 18 | | necessary or
proper.
| 19 | | c. Take such legal action as necessary to:
| 20 | | (1) avoid the payment of improper
claims against the | 21 | | plan or the coverage provided by or through the plan;
| 22 | | (2) to recover any amounts erroneously or improperly | 23 | | paid by the plan;
| 24 | | (3) to recover any amounts paid by the plan as a result | 25 | | of a mistake of
fact or law; or
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| 1 | | (4) to recover or collect any other amounts, including | 2 | | assessments, that
are due or owed the Plan or have been | 3 | | billed on its or the Plan's behalf.
| 4 | | d. Establish appropriate rates, rate schedules, rate | 5 | | adjustments,
expense allowances, agents' referral fees, claim | 6 | | reserves, and formulas and
any other actuarial function | 7 | | appropriate to the operation of the plan.
Rates and rate | 8 | | schedules may be adjusted for appropriate risk factors
such as | 9 | | age and area variation in claim costs and shall take into
| 10 | | consideration appropriate risk factors in accordance with | 11 | | established
actuarial and underwriting practices.
| 12 | | e. Issue policies of insurance in accordance with the | 13 | | requirements of
this Act.
| 14 | | f. Appoint appropriate legal, actuarial and other | 15 | | committees as
necessary to provide technical assistance in the | 16 | | operation of the plan,
policy and other contract design, and | 17 | | any other function within
the authority of the plan.
| 18 | | g. Borrow money to effect the purposes of the Illinois | 19 | | Comprehensive
Health Insurance Plan. Any notes or other | 20 | | evidence of indebtedness of the
plan not in default shall be | 21 | | legal investments for insurers and may be
carried as admitted | 22 | | assets.
| 23 | | h. Establish rules, conditions and procedures for | 24 | | reinsuring risks
under this Act.
| 25 | | i. Employ and fix the compensation of employees. Such | 26 | | employees
may be
paid on a warrant issued by the State |
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| 1 | | Treasurer pursuant to a payroll
voucher certified by the Board | 2 | | and drawn by the Comptroller against
appropriations or trust | 3 | | funds held by the State Treasurer.
| 4 | | j. Enter into intergovernmental cooperation agreements | 5 | | with other agencies
or entities of State government for the | 6 | | purpose of sharing the cost of
providing health care services | 7 | | that are otherwise authorized by this Act for
children who are | 8 | | both plan participants and eligible for financial assistance
| 9 | | from the Division of Specialized Care for Children of the | 10 | | University of
Illinois.
| 11 | | k. Establish conditions and procedures under which the plan | 12 | | may, if funds
permit, discount or subsidize premium rates that | 13 | | are paid directly by senior
citizens, as defined by the Board, | 14 | | and other
plan participants, who are retired or unemployed and | 15 | | meet other
qualifications.
| 16 | | l. Establish and maintain the Plan Fund authorized in
| 17 | | Section 3 of this Act, which shall be divided into separate | 18 | | accounts, as
follows:
| 19 | | (1) accounts to fund the administrative, claim, and | 20 | | other expenses of the
Plan associated with eligible persons | 21 | | who qualify for Plan coverage under
Section 7 of this Act, | 22 | | which shall consist of:
| 23 | | (A) premiums paid on behalf of covered persons;
| 24 | | (B) assessments appropriated funds and other | 25 | | revenues collected or received by the
Board;
| 26 | | (C) reserves for future losses maintained by the |
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| 1 | | Board; and
| 2 | | (D) interest earnings from investment of the funds | 3 | | in the Plan
Fund or any of its accounts other than the | 4 | | funds in the account established
under item 2 of this | 5 | | subsection;
| 6 | | (2) an account, to be denominated the federally | 7 | | eligible individuals
account, to fund the administrative, | 8 | | claim, and other expenses of the Plan
associated with | 9 | | federally eligible individuals who qualify for Plan | 10 | | coverage
under Section 15 of this Act, which shall consist | 11 | | of:
| 12 | | (A) premiums paid on behalf of covered persons;
| 13 | | (B) assessments and other revenues collected or | 14 | | received by the Board;
| 15 | | (C) reserves for future losses maintained by the | 16 | | Board; and
| 17 | | (D) interest earnings from investment of the | 18 | | federally eligible
individuals account funds; and
| 19 | | (E) grants provided pursuant to the federal Trade | 20 | | Act of
2002; and
| 21 | | (3) such other accounts as may be appropriate.
| 22 | | m. Charge and collect assessments paid by insurers pursuant | 23 | | to
Section 12 of this Act and recover any assessments for, on | 24 | | behalf of, or
against those insurers.
| 25 | | (Source: P.A. 93-33, eff. 6-23-03; 93-34, eff. 6-23-03.)
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| 1 | | (215 ILCS 105/7) (from Ch. 73, par. 1307) | 2 | | Sec. 7. Eligibility. | 3 | | a. Except as provided in subsection (e) of this Section or | 4 | | in Section
15 of this Act, any person who is either a citizen | 5 | | of the United States or an
alien lawfully admitted for | 6 | | permanent residence and who has been for a period
of at least | 7 | | 180 days and continues to be a resident of this State shall be
| 8 | | eligible for Plan coverage under this Section if evidence is | 9 | | provided of: | 10 | | (1) A notice of rejection or refusal to issue | 11 | | substantially
similar individual health insurance coverage | 12 | | for health reasons by a
health insurance issuer; or | 13 | | (2) A refusal by a health insurance issuer to issue | 14 | | individual
health insurance coverage except at a rate | 15 | | exceeding the
applicable Plan rate for which the person is | 16 | | responsible. | 17 | | A rejection or refusal by a group health plan or health | 18 | | insurance issuer
offering only
stop-loss or excess of loss | 19 | | insurance or contracts,
agreements, or other arrangements for | 20 | | reinsurance coverage with respect
to the applicant shall not be | 21 | | sufficient evidence under this subsection. | 22 | | b. The board shall promulgate a list of medical or health | 23 | | conditions for
which a person who is either a citizen of the | 24 | | United States or an
alien lawfully admitted for permanent | 25 | | residence and a resident of this State
would be eligible for | 26 | | Plan coverage without applying for
health insurance coverage |
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| 1 | | pursuant to subsection a. of this Section.
Persons who
can | 2 | | demonstrate the existence or history of any medical or health
| 3 | | conditions on the list promulgated by the board shall not be | 4 | | required to
provide the evidence specified in subsection a. of | 5 | | this Section. The list
shall be effective
on the first day of | 6 | | the operation of the Plan and may be amended from time
to time | 7 | | as appropriate. | 8 | | c. Family members of the same household who each are | 9 | | covered
persons are
eligible for optional family coverage under | 10 | | the Plan. | 11 | | d. For persons qualifying for coverage in accordance with | 12 | | Section 7 of
this Act, the board shall, if it determines that | 13 | | such assessments appropriations as are
made pursuant to Section | 14 | | 12 of this Act are insufficient to allow the board
to accept | 15 | | all of the eligible persons which it projects will apply for
| 16 | | enrollment under the Plan, limit or close enrollment to ensure | 17 | | that the
Plan is not over-subscribed and that it has sufficient | 18 | | resources to meet
its obligations to existing enrollees. The | 19 | | board shall not limit or close
enrollment for federally | 20 | | eligible individuals. | 21 | | e. A person shall not be eligible for coverage under the | 22 | | Plan if: | 23 | | (1) He or she has or obtains other coverage under a | 24 | | group health plan
or health insurance coverage
| 25 | | substantially similar to or better than a Plan policy as an | 26 | | insured or
covered dependent or would be eligible to have |
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| 1 | | that coverage if he or she
elected to obtain it. Persons | 2 | | otherwise eligible for Plan coverage may,
however, solely | 3 | | for the purpose of having coverage for a pre-existing
| 4 | | condition, maintain other coverage only while satisfying | 5 | | any pre-existing
condition waiting period under a Plan | 6 | | policy or a subsequent replacement
policy of a Plan policy. | 7 | | (1.1) His or her prior coverage under a group health | 8 | | plan or health
insurance coverage, provided or arranged by | 9 | | an employer of more than 10 employees was discontinued
for | 10 | | any reason without the entire group or plan being | 11 | | discontinued and not
replaced, provided he or she remains | 12 | | an employee, or dependent thereof, of the
same employer. | 13 | | (2) He or she is a recipient of or is approved to | 14 | | receive medical
assistance, except that a person may | 15 | | continue to receive medical
assistance through the medical | 16 | | assistance no grant program, but only
while satisfying the | 17 | | requirements for a preexisting condition under
Section 8, | 18 | | subsection f. of this Act. Payment of premiums pursuant to | 19 | | this
Act shall be allocable to the person's spenddown for | 20 | | purposes of the
medical assistance no grant program, but | 21 | | that person shall not be
eligible for any Plan benefits | 22 | | while that person remains eligible for
medical assistance. | 23 | | If the person continues to receive
or be approved to | 24 | | receive medical assistance through the medical
assistance | 25 | | no grant program at or after the time that requirements for | 26 | | a
preexisting condition are satisfied, the person shall not |
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| 1 | | be eligible for
coverage under the Plan. In that | 2 | | circumstance, coverage under the plan
shall terminate as of | 3 | | the expiration of the preexisting condition
limitation | 4 | | period. Under all other circumstances, coverage under the | 5 | | Plan
shall automatically terminate as of the effective date | 6 | | of any medical
assistance. | 7 | | (3) Except as provided in Section 15, the person has | 8 | | previously
participated in the Plan and voluntarily
| 9 | | terminated Plan coverage, unless 12 months have elapsed
| 10 | | since the person's
latest voluntary termination of | 11 | | coverage. | 12 | | (4) The person fails to pay the required premium under | 13 | | the covered
person's
terms of enrollment and | 14 | | participation, in which event the liability of the
Plan | 15 | | shall be limited to benefits incurred under the Plan for | 16 | | the time
period for which premiums had been paid and the | 17 | | covered person remained
eligible for Plan coverage. | 18 | | (5) The Plan has paid a total of
$5,000,000
in benefits
| 19 | | on behalf of the covered person. | 20 | | (6) The person is a resident of a public institution. | 21 | | (7) The person's premium is paid for or reimbursed | 22 | | under any
government sponsored program or by any government | 23 | | agency or health
care provider, except as an otherwise | 24 | | qualifying full-time employee, or
dependent of such | 25 | | employee, of a government agency or health care provider
| 26 | | or, except when a person's premium is paid by the U.S. |
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| 1 | | Treasury Department
pursuant to the federal Trade Act of | 2 | | 2002. | 3 | | (8) The person has or later receives other benefits or | 4 | | funds from
any settlement, judgement, or award resulting | 5 | | from any accident or injury,
regardless of the date of the | 6 | | accident or injury, or any other
circumstances creating a | 7 | | legal liability for damages due that person by a
third | 8 | | party, whether the settlement, judgment, or award is in the | 9 | | form of a
contract, agreement, or trust on behalf of a | 10 | | minor or otherwise and whether
the settlement, judgment, or | 11 | | award is payable to the person, his or her
dependent, | 12 | | estate, personal representative, or guardian in a lump sum | 13 | | or
over time, so long as there continues to be benefits or | 14 | | assets remaining
from those sources in an amount in excess | 15 | | of $300,000. | 16 | | (9) Within the 5 years prior to the date a person's | 17 | | Plan application is
received by the Board, the person's | 18 | | coverage under any health care benefit
program as defined | 19 | | in 18 U.S.C. 24, including any public or private plan or
| 20 | | contract under which any
medical benefit, item, or service | 21 | | is provided, was terminated as a result of
any act or | 22 | | practice that constitutes fraud under State or federal law | 23 | | or as a
result of an intentional misrepresentation of | 24 | | material fact; or if that person
knowingly and willfully | 25 | | obtained or attempted to obtain, or fraudulently aided
or | 26 | | attempted to aid any other person in obtaining, any |
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| 1 | | coverage or benefits
under the Plan to which that person | 2 | | was not entitled. | 3 | | f. The board or the administrator shall require | 4 | | verification of
residency and may require any additional | 5 | | information or documentation, or
statements under oath, when | 6 | | necessary to determine residency upon initial
application and | 7 | | for the entire term of the policy. | 8 | | g. Coverage shall cease (i) on the date a person is no | 9 | | longer a
resident of Illinois, (ii) on the date a person | 10 | | requests coverage to end,
(iii) upon the death of the covered | 11 | | person, (iv) on the date State law
requires cancellation of the | 12 | | policy, or (v) at the Plan's option, 30 days
after the Plan | 13 | | makes any inquiry concerning a person's eligibility or place
of | 14 | | residence to which the person does not reply. | 15 | | h. Except under the conditions set forth in subsection g of | 16 | | this
Section, the coverage of any person who ceases to meet the
| 17 | | eligibility requirements of this Section shall be terminated at | 18 | | the end of
the current policy period for which the necessary | 19 | | premiums have been paid. | 20 | | (Source: P.A. 95-547, eff. 8-29-07; 96-938, eff. 6-24-10.)
| 21 | | (215 ILCS 105/7.1)
| 22 | | Sec. 7.1. Premiums.
| 23 | | (a) The Board shall establish premium rates for coverage as | 24 | | provided in
subsection (d) of this Section.
| 25 | | (b) Separate schedules of premium rates based on sex, age, |
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| 1 | | geographical
location, and benefit plan shall apply for | 2 | | individual risks.
| 3 | | (c) The Board may provide for separate premium rates for | 4 | | optional family
coverage for the spouse or one or more | 5 | | dependents who reside together in any
eligible individual's or | 6 | | eligible person's household. The rates for each
spouse or | 7 | | dependent who
qualifies to be covered under this optional | 8 | | family coverage shall be such
percentage of the applicable | 9 | | individual Plan rate as the Board, in accordance
with | 10 | | appropriate actuarial principles, shall establish.
| 11 | | (d) The Board, with the assistance of the Director and in | 12 | | accordance with
appropriate actuarial principles, shall | 13 | | determine a standard risk rate by using
the average rates that | 14 | | individual standard risks in this State are charged by
at least | 15 | | 5 of the largest health insurance issuers providing individual | 16 | | health
insurance coverage to residents of Illinois that is | 17 | | substantially similar to
the coverage offered by the Plan. In | 18 | | determining the average rate or charges
of those health | 19 | | insurance issuers, the rates charged by those issuers
shall be | 20 | | actuarially adjusted to determine the rate or charge that would | 21 | | have
been charged for benefits similar to those provided by the | 22 | | Plan. The standard
risk rates
shall be established using | 23 | | reasonable actuarial techniques and shall reflect
anticipated | 24 | | claims experience, expenses, and other appropriate risk | 25 | | factors for
such coverage.
| 26 | | (e) Rates for Plan coverage shall not be less than 125% nor |
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| 1 | | more than 150%
of
rates established as applicable for | 2 | | individual standard risks pursuant to
subsection (d). Rates for | 3 | | Plan coverages for Section 7 enrollees shall remain no less | 4 | | than 150% of rates established as applicable and for Section 15 | 5 | | enrollees shall remain no less than 125% of rates established | 6 | | as applicable until January 1, 2014, unless a different | 7 | | percentage is established by law of the State of Illinois after | 8 | | January 1, 2014.
| 9 | | (Source: P.A. 90-30, eff. 7-1-97.)
| 10 | | (215 ILCS 105/12) (from Ch. 73, par. 1312)
| 11 | | Sec. 12. Deficit or surplus.
| 12 | | a. If premiums or other receipts by the
Board exceed the | 13 | | amount required for the
operation
of the Plan, including actual | 14 | | losses and administrative
expenses of the Plan, the Board shall | 15 | | direct that the excess be held at
interest, in a bank | 16 | | designated by the Board, or used to offset future
losses or to | 17 | | reduce Plan premiums. In this
subsection, the term "future | 18 | | losses" includes reserves for incurred but not
reported claims.
| 19 | | b. (Blank). Any deficit incurred or expected to be incurred | 20 | | on behalf of eligible
persons who qualify for plan coverage | 21 | | under Section 7 of this Act shall be
recouped by an
| 22 | | appropriation made by the General Assembly.
| 23 | | c. For the purposes of this Section, a deficit shall be | 24 | | incurred when
anticipated losses and incurred but not reported | 25 | | claims expenses exceed
anticipated income from earned premiums |
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| 1 | | net of administrative expenses.
| 2 | | d. Any deficit incurred or expected to be incurred on | 3 | | behalf of covered persons federally
eligible individuals who | 4 | | qualify for Plan coverage under Section 7 or Section 15 of this | 5 | | Act
shall be recouped by an assessment of all insurers made in | 6 | | accordance with the
provisions of this Section. The Board shall | 7 | | within 90 days of the effective
date of this amendatory Act of | 8 | | 1997 and within the first quarter of each fiscal
year | 9 | | thereafter assess all insurers for the anticipated deficit in | 10 | | accordance
with the provisions of this Section. The board may | 11 | | also make additional
assessments no more than 4 times a year to | 12 | | fund unanticipated deficits,
implementation expenses, and cash | 13 | | flow needs.
| 14 | | e. An insurer's assessment shall be determined by | 15 | | multiplying the total
assessment, as determined in subsection | 16 | | d. of this Section, by a fraction, the
numerator of which | 17 | | equals that insurer's direct Illinois premiums during the
| 18 | | preceding calendar year and the denominator of which equals the | 19 | | total of all
insurers' direct Illinois premiums. The Board may | 20 | | exempt those insurers whose
share as determined under this | 21 | | subsection would be so minimal as to not exceed
the estimated | 22 | | cost of levying the assessment.
| 23 | | f. The Board shall charge and collect from each insurer the | 24 | | amounts
determined to be due under this Section. The assessment | 25 | | shall be billed by
Board invoice based upon the insurer's | 26 | | direct Illinois premium income as shown
in its annual
statement |
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| 1 | | for the preceding calendar year as filed with the Director. The
| 2 | | invoice shall be due upon
receipt and must be paid no later | 3 | | than 30 days after receipt by the insurer.
| 4 | | g. When an insurer fails to pay the full amount of any | 5 | | assessment of $100 or
more
due under this Section there shall | 6 | | be added to the amount due as a penalty the
greater of $50 or an | 7 | | amount equal to 5% of the deficiency for each month or
part of | 8 | | a month that the deficiency remains unpaid.
| 9 | | h. Amounts collected under this Section shall be paid to | 10 | | the Board for
deposit into the Plan Fund authorized by Section | 11 | | 3 of this Act.
| 12 | | i. An insurer may petition the Director for an abatement or | 13 | | deferment of
all or part of an assessment imposed by the Board. | 14 | | The Director may abate or
defer, in whole or in part, the | 15 | | assessment if, in the opinion of the Director,
payment of the | 16 | | assessment would endanger the ability of the insurer to fulfill
| 17 | | its contractual obligations. In the event an assessment against | 18 | | an insurer is
abated or deferred in whole or in part, the | 19 | | amount by which the assessment is
abated or deferred shall be | 20 | | assessed against the other insurers in a manner
consistent with | 21 | | the basis for assessments set forth in this subsection. The
| 22 | | insurer receiving a deferment shall remain liable to the plan | 23 | | for the
deficiency for 4 years.
| 24 | | j. The board shall establish procedures for appeal by any | 25 | | insurer subject
to assessment pursuant to this
Section. Such | 26 | | procedures shall require that:
|
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| 1 | | (1) Any insurer that wishes to appeal all or any part | 2 | | of an assessment
made pursuant to this Section shall first | 3 | | pay the amount of the assessment as
set forth in the | 4 | | invoice provided by the board within the time provided in
| 5 | | subsection f. of this Section.
The board shall hold such | 6 | | payments
in a separate interest-bearing account.
The | 7 | | payments shall be accompanied by a
statement in writing | 8 | | that the payment is made under appeal.
The statement
shall | 9 | | specify the grounds for the appeal.
The insurer may be | 10 | | represented in its appeal by counsel or other | 11 | | representative
of its choosing.
| 12 | | (2) Within 90 days following the payment of an | 13 | | assessment under appeal by
any insurer, the board shall | 14 | | notify the insurer or representative designated by
the | 15 | | insurer in writing of its determination with respect to the | 16 | | appeal
and the basis or bases for that determination unless
| 17 | | the Board notifies the insurer that
a reasonable amount of | 18 | | additional
time is required to resolve the issues raised by | 19 | | the appeal.
| 20 | | (3) The board shall refer to the Director any question | 21 | | concerning the
amount of direct Illinois premium income as | 22 | | shown in an insurer's annual
statement for the preceding | 23 | | calendar year on file with the Director on the
invoice date | 24 | | of the assessment. Unless additional time is required to | 25 | | resolve
the question, the Director shall within 60 days | 26 | | report to the board in writing
his determination respecting |
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| 1 | | the amount of direct Illinois premium income on
file on the | 2 | | invoice date of the assessment.
| 3 | | (4) In the event the board determines that the insurer | 4 | | is entitled to a
refund, the refund shall be paid within 30 | 5 | | days following the date upon which
the board makes its | 6 | | determination, together with the accrued interest.
| 7 | | Interest on any
refund due an insurer shall be paid at the | 8 | | rate actually earned by the Board on
the separate account.
| 9 | | (5) The amount of any such refund shall then be | 10 | | assessed against all
insurers in a manner consistent with | 11 | | the basis for assessment as otherwise
authorized
by this | 12 | | Section.
| 13 | | (6) The board's determination with respect to any | 14 | | appeal received pursuant
to this subsection shall be a | 15 | | final administrative decision as defined in
Section 3-101 | 16 | | of the Code of Civil Procedure. The provisions of the
| 17 | | Administrative
Review Law shall apply to and govern all
| 18 | | proceedings for the judicial review of final | 19 | | administrative decisions of the
board.
| 20 | | (7) If an insurer fails to appeal an assessment in | 21 | | accordance with the
provisions of this subsection, the | 22 | | insurer shall be deemed
to have waived its right of appeal.
| 23 | | The provisions of this subsection apply to all assessments | 24 | | made in any
calendar year ending on or after December 31, 1997.
| 25 | | k. The total balance of funds newly appropriated into the | 26 | | Comprehensive Health Insurance Plan shall be used to pay down |
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| 1 | | accrued State debt. | 2 | | (Source: P.A. 90-30, eff. 7-1-97; 90-567, eff. 1-23-98.)
| 3 | | (215 ILCS 105/20 new) | 4 | | Sec. 20. Illinois Health Benefits Exchange. Beginning on | 5 | | the date that the Illinois Health Benefits Exchange becomes | 6 | | operational in that the Exchange meets the core functions | 7 | | identified in Section 1311 of the federal Patient Protection | 8 | | and Affordable Care Act and subsequent guidelines and | 9 | | regulations, the Board shall examine the feasibility of | 10 | | operating the Plan concomitantly with the Illinois Health | 11 | | Benefits Exchange and shall report its findings to the General | 12 | | Assembly no later than 90 days after the date that the Illinois | 13 | | Health Benefits Exchange becomes operational. | 14 | | (20 ILCS 4045/Act rep.) | 15 | | Section 90-10. The Health Care
Justice Act is repealed. | 16 | | ARTICLE 99. | 17 | | EFFECTIVE DATE | 18 | | Section 99. Effective date. This Act takes effect upon | 19 | | becoming law.".
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