Illinois General Assembly

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Full Text of SB1729  97th General Assembly


Sen. David Koehler

Filed: 3/17/2011





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2    AMENDMENT NO. ______. Amend Senate Bill 1729 by replacing
3everything after the enacting clause with the following:
4    "Section 1. Short title. This Act may be cited as the
5Illinois Health Coverage Exchange Establishment Act of 2011.
6    Section 5. Purpose and intent; application.
7    (a) The General Assembly hereby declares as follows:
8        (1) The purpose of this Act is to provide for the
9    establishment of an Illinois Health Coverage Exchange to
10    facilitate the purchase and sale of qualified health plans
11    in the individual market in this State, to provide for the
12    establishment of the Small Business Health Options Program
13    to assist qualified small employers in this State in
14    facilitating the enrollment of employees and their family
15    members in qualified health plans, and to provide an
16    efficient, cost-effective process to test eligibility and



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1    enroll eligible individuals in public health care coverage
2    such as Medicaid or the Children's Health Insurance
3    Program.
4        (2) The intent of the Exchange is to offer private
5    health plans that provide financial security and
6    appropriate access to health care for individuals,
7    families, and employers in this State and in a manner that
8    is in the best interest of such individuals, reduce the
9    number of uninsured, provide a transparent marketplace and
10    consumer education, assist eligible individuals with
11    enrollment in public health care programs such as Medicaid
12    or the Children's Health Insurance Program, premium
13    assistance tax credits, cost-sharing reductions, and to
14    promote an innovative delivery system and payment reforms
15    referring to lower cost and improve quality.
16        (3) The federal Patient Protection and Affordable Care
17    Act (ACA) requires states to establish an operational
18    Exchange on or before January 1, 2014. In the event a state
19    does not demonstrate significant progress in the
20    implementation of an Exchange by January 1, 2013, then the
21    federal government will establish an Exchange for the
22    non-compliant state. Pursuant to the ACA, an Exchange will
23    determine eligibility and facilitate enrollment in public
24    health programs, including Medicaid and the Children's
25    Health Insurance Program. The Exchange will also provide a
26    marketplace for individuals, families, and employers to



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1    shop for and purchase private health plans. The State of
2    Illinois finds that it is in the State's best interest to
3    establish an Exchange rather than defer to the federal
4    government.
5    (b) This Act shall be null and void if Congress and the
6President take action to repeal or replace, or both, Section
71311 of the Affordable Care Act.
8    Section 10. Definitions. As used in this Act:
9    "Board" means the Illinois Health Benefits Exchange Board
10established pursuant to this Act.
11    "Director" means the Director of Insurance.
12    "Educated health care consumer" means an individual who is
13knowledgeable about the health care system and has background
14or experience in making informed decisions regarding health,
15medical, and scientific matters.
16    "Employee" has the meaning given that term in the Illinois
17Health Insurance Portability and Accountability Act.
18    "Exchange" means the Illinois Health Benefits Exchange
19established pursuant to this Act.
20    "Federal Act" means the federal Patient Protection and
21Affordable Care Act (Public Law 111-148), as amended by the
22federal Health Care and Education Reconciliation Act of 2010
23(Public Law 111-152), and any amendments thereto or regulations
24or guidance issued under those Acts.
25    "Health benefit plan" means a policy, contract,



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1certificate, or agreement offered or issued by a health carrier
2to provide, deliver, arrange for, pay for, or reimburse any of
3the costs of health care services. "Health benefit plan" does
4not include:
5        (1) coverage only for accident or disability income
6    insurance or any combination thereof;
7        (2) coverage issued as a supplement to liability
8    insurance;
9        (3) liability insurance, including general liability
10    insurance and automobile liability insurance;
11        (4) workers' compensation or similar insurance;
12        (5) automobile medical payment insurance;
13        (6) credit-only insurance;
14        (7) coverage for only on-site medical clinics; or
15        (8) other similar insurance coverage specified in
16    federal regulations issued pursuant to Pub. L. No. 104-191,
17    under which benefits for health care services are secondary
18    or incidental to other insurance benefits.
19"Health benefit plan" does not include the following benefits
20if they are provided under a separate policy, certificate, or
21contract of insurance or are otherwise not an integral part of
22the plan:
23        (a) limited scope dental or vision benefits;
24        (b) benefits for long-term care, nursing home care,
25    home health care, community-based care, or any combination
26    thereof; or



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1        (c) other similar, limited benefits specified in
2    federal regulations issued pursuant to Pub. L. No. 104-191.
3"Health benefit plan" does not include the following benefits
4if the benefits are provided under a separate policy,
5certificate, or contract of insurance, there is no coordination
6between the provision of the benefits and any exclusion of
7benefits under any group health plan maintained by the same
8plan sponsor, and the benefits are paid with respect to an
9event without regard to whether benefits are provided with
10respect to such an event under any group health plan maintained
11by the same plan sponsor:
12        (i) coverage only for a specified disease or illness;
13    or
14        (ii) hospital indemnity or other fixed indemnity
15    insurance.
16"Health benefit plan" does not include the following if offered
17as a separate policy, certificate, or contract of insurance:
18        (A) medicare supplemental health insurance as defined
19    under Section 1882(g)(1) of the Social Security Act;
20        (B) coverage supplemental to the coverage provided
21    under Chapter 55 of Title 10, United States Code (Civilian
22    Health and Medical Program of the Uniformed Services
23    (CHAMPUS)); or
24        (C) similar supplemental coverage provided as coverage
25    under a group health plan.
26    "Health carrier" or "carrier" means an entity subject to



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1the insurance laws and regulations of this State, or subject to
2the jurisdiction of the Director, that contracts or offers to
3contract to provide, deliver, arrange for, pay for, or
4reimburse any of the costs of health care services, including a
5sickness and accident insurance company, a health maintenance
6organization, or any other entity providing a plan of health
7insurance, health benefits, or health services.
8    "Qualified dental plan" means a limited scope dental plan
9that has been certified in accordance with this Act.
10    "Qualified employer" means a small employer that elects to
11make its full-time employees eligible for one or more qualified
12health plans offered through the SHOP Exchange, and at the
13option of the employer, some or all of its part-time employees,
14provided that the employer:
15        (1) has its principal place of business in this State
16    and elects to provide coverage through the SHOP Exchange to
17    all of its eligible employees, wherever employed; or
18        (2) elects to provide coverage through the SHOP
19    Exchange to all of its eligible employees who are
20    principally employed in this State.
21    "Qualified health plan" means a health benefit plan that
22has in effect a certification that the plan meets the criteria
23for certification described in Section 1311(c) of the Federal
24Act and this Act.
25    "Qualified individual" means an individual, including a
26minor, who:



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1        (1) is seeking to enroll in a qualified health plan
2    offered to individuals through the Exchange;
3        (2) resides in this State;
4        (3) At the time of enrollment, is not incarcerated,
5    other than incarceration pending the disposition of
6    charges; and
7        (4) is and is reasonably expected to be for the entire
8    period for which enrollment is sought a citizen or national
9    of the United States or an alien lawfully present in the
10    United States.
11    "Secretary" means the Secretary of the federal Department
12of Health and Human Services.
13    "SHOP Exchange" means the Small Business Health Options
14Program established under Section 30 of this Act.
15    "Small employer" has the meaning given that term in the
16Illinois Health Insurance Portability and Accountability Act.
17An employer that makes enrollment in qualified health plans
18available to its employees through the SHOP Exchange and would
19cease to be a small employer by reason of an increase in the
20number of its employees shall continue to be treated as a small
21employer for purposes of this Act as long as it continuously
22makes enrollment through the SHOP Exchange available to its
24    Section 15. Creation of the Exchange.
25    (a) There is hereby created a political subdivision, body



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1politic, and corporate, that is not a State entity, named the
2Illinois Health Benefits Exchange. The governing and
3administrative powers of the Exchange shall be vested in a body
4known as the Illinois Health Benefits Exchange Board. The Board
5shall consist of 9 voting members, 7 of whom shall be appointed
6by the Governor with the advice and consent of the Senate and 2
7of whom shall be appointed by the Attorney General with the
8advice and consent of the Senate. The members appointed by the
9Governor shall include:
10        (1) one consumer representative who is or has in the
11    preceding 2 years been insured in the individual health
12    insurance market in this State;
13        (2) one small employer representative with experience
14    operating a small business in this State;
15        (3) one employee representative of a small employer in
16    this State;
17        (4) one Illinois-licensed insurance producer with
18    experience facilitating the purchase of health insurance
19    coverage in the individual or small group market in this
20    State;
21        (5) one certified health actuary; and
22        (6) one Illinois-licensed health care provider or
23    other qualified representative with experience serving
24    underserved populations, including but not limited to the
25    uninsured and those receiving coverage through public
26    health care programs such as Medicaid or the Children's



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1    Health Insurance Program, in both the community-based
2    health care setting and a hospital-based setting in this
3    State; and
4        (7) one representative of the organized labor
5    community in this State.
6The members appointed by the Attorney General shall include:
7        (i) one health lawyer with experience in public
8    programs, such as Medicaid or the Children's Health
9    Insurance Program, and private health insurance coverage;
10    and
11        (ii) One health lawyer with experience working in
12    collaboration with the Attorney General's Health Care
13    Bureau.
14    (b) The Director of Insurance, the Director of the
15Healthcare and Family Services, the Director of Human Services,
16and the Director of Public Health shall serve as ex officio,
17non-voting members of the Board.
18    (c) Four members of the General Assembly, one each
19appointed by the President of the Senate, the Minority Leader
20of the Senate, the Speaker of the House of Representatives, and
21the Minority Leader of the House of Representatives, shall
22serve as ex officio, nonvoting members of the Board.
23    (d) In making appointments to the Board, the appointing
24authorities shall take into consideration the cultural,
25ethnic, and geographic diversity of the State so that the
26Board's composition reflects the communities of this State.



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1    (e) The Board shall appoint one of its members as
2chairperson of the Board. Members of the Board shall receive no
3compensation, but shall be reimbursed for reasonable expenses
4incurred in the necessary performance of their duties,
5including travel.
6    (f) The Exchange shall procure necessary services and terms
7using a process with integrity and transparency and that is
8free of conflicts of interest and serves the best interest of
9individuals, families, and employers purchasing coverage
10through the Exchange.
11    (g) The meetings of the Board shall be subject to the Open
12Meetings Act, except that the Board may hold closed sessions
13when considering matters related to litigation, personnel,
14contracting, and rates.
15    (h) Notwithstanding subsections (8) and (12) of Section
1610-15 of the State Officials and Employees Ethics Act, no
17member of the Board or its employees shall accept food or
18refreshments or any item or items from any prohibited source.
19    (i) Board members shall have the responsibility and duty to
20meet the requirements of this Act and all applicable State and
21federal laws and regulations, to serve the public interest of
22the individuals and small businesses seeking health insurance
23coverage through the Exchange, and to ensure the operational
24well-being and fiscal solvency of the Exchange.
25    (j) No member of the Board nor employees of the Board may
26be an employee of any licensed carrier authorized to do



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1business in this State.
2    (k) No member of the Board nor employees of the Board shall
3make, participate in making, or in any way attempt to use his
4or her official position to influence the making of any
5decision that he or she knows or has any reason to know will
6have a reasonably foreseeable material financial effect,
7distinguishable from its effect on the public generally, on him
8or her or a member of his or her family or on either of the
10        (1) any source of income provided to, received by, or
11    promised to a member within 12 months prior to the time
12    when a decision is made; or
13        (2) any business entity in which the member is a
14    director, officer, partner, trustee, employee, or holds
15    any position of management.
16    (l) The Director, or any person he or she may appoint, may,
17in the same manner as authorized for examination of domestic,
18foreign, or alien insurance companies, investigate the affairs
19of the Exchange and examine the properties and records of the
20Exchange and shall, at least annually, require the Exchange to
21provide periodic reporting to the Governor and the General
22Assembly in relation to the activities undertaken by the
23Exchange under this Act.
24    (m) The Office of the Executive Inspector General shall
25have jurisdiction over the Exchange and all individuals
26supervising, directing, contracting, or working for the



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2    Section 20. Terms of appointments. Within 60 days after the
3effective date of this Act, the Governor shall appoint 3 voting
4members of the Board for initial terms expiring June 30, 2015;
5the Governor shall appoint 2 public members and the Attorney
6General shall appoint one voting member of the Board for
7initial terms expiring June 30, 2014; and the Governor shall
8appoint 2 voting members and the Attorney General shall appoint
9one voting member of the Board for initial terms expiring June
1030, 2013. All successors shall hold office for a term of 3
11years from the first day of July in the year of appointment and
12running through June 30 of the third year, except in case of an
13appointment to fill a vacancy. A Board member shall hold office
14until the expiration of that member's term and until that
15member's successor is appointed and qualified. Board members
16may be appointed to subsequent terms. Vacancies shall be filled
17in the same manner as original appointments for the balance of
18the unexpired term. In case of vacancy when the Senate is not
19in session, the Governor may make a temporary appointment until
20the next meeting of the Senate, when the Governor or Attorney
21General shall nominate such person to fill the open Board
22position and any person so nominated who is confirmed by the
23Senate shall hold his or her office during the remainder of the
24term and until his or her successor is appointed and qualified.



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1    Section 25. Executive Director. The Board shall appoint an
2Executive Director who shall be the chief executive officer of
3the Exchange. The Executive Director shall have at least 5
4years of experience in health care policy, management, service,
5delivery, or coverage. In addition to any other duties set
6forth in this Act, the Executive Director shall:
7        (1) employ such staff as may be necessary to carry out
8    the provisions of this Act;
9        (2) direct and supervise the administrative affairs
10    and activities of the Exchange in accordance with its
11    rules, regulations, and policies;
12        (3) attend meetings of the Board;
13        (4) keep minutes of all proceedings of the Board;
14        (5) approve all accounts for salaries, per diem
15    payments, and allowable expenses of the Exchange and its
16    employees and consultants and approve all expenses
17    incidental to the operation of the Exchange; and
18        (6) perform any other duty that the Board requires for
19    carrying out the provisions of this Act.
20    Section 30. Quorum; voting; meetings.
21    (a) Five members of the Board constitute a quorum for the
22purpose of conducting business.
23    (b) Actions of the Board must receive the affirmative vote
24of at least 5 members of the Board.
25    (c) The Board shall meet at least quarterly or more often



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1if necessary.
2    Section 35. Powers and authority of the Board.
3    (a) In addition to powers set forth elsewhere in this Act,
4the Board may do the following:
5        (1) Adopt bylaws, rules, and regulations to carry out
6    the provisions of this Act.
7        (2) Authorize the Exchange to enter into contracts as
8    are necessary or proper to carry out the provisions and
9    purposes or perform any of the functions described in this
10    Act.
11        (3) Take or defend any legal actions necessary to
12    effectuate the purposes of this Act.
13        (4) Appoint appropriate legal, actuarial, and other
14    committees as necessary to provide technical assistance in
15    the operation of the Exchange, contract design, and any
16    other function described in this Act.
17        (5) Authorize commercial, banking, and financial
18    arrangements as needed to manage the day-to-day operations
19    of the Exchange.
20        (6) Appoint and fix the compensation of an Executive
21    Director.
22        (7) Enter into intergovernmental cooperation
23    agreements with governmental entities for the purpose of
24    sharing the cost of providing access to health care
25    coverage that are otherwise authorized by this Act or to



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1    carry out other responsibilities under this Act provided
2    such agreements adequately protect the confidentiality of
3    information to be shared and comply with applicable State
4    and federal laws and regulations.
5        (8) Establish conditions and procedures under which
6    the exchange may, if charitable or other funds are
7    provided, discount or subsidize premium rates and
8    cost-sharing or prescription drug costs that are paid
9    directly by other public or private entities, as defined by
10    the Board.
11        (9) Apply for, accept, and spend as appropriate any
12    federal or State grant money made available through or
13    pursuant to the Affordable Care Act or any other federal or
14    State-related opportunity in order to assist the Board as
15    it implements the provisions of this Act.
16        (10) Create an administration fund under direction of
17    the Board and management by the Executive Director to:
18            (A) fund administrative and any other expenses of
19        the Exchange; and
20            (B) receive and deposit into the administration
21        fund any money collected or received by the Board
22        pursuant to this Act.
23    (b) The Board shall create an Exchange that shall:
24        (1) facilitate the purchase and sale of qualified
25    health plans;
26        (2) assist qualified small employers in this State in



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1    facilitating the enrollment of employees in qualified
2    health plans;
3        (3) develop a process to certify plans eligible to
4    participate in the Exchange; and
5        (4) facilitate enrollment in Medicaid or the
6    Children's Health Insurance Program for eligible
7    individuals;
8        (5) inform individuals of the potential for
9    overpayments of advance premium tax credits and of
10    procedures by which individuals can report a change of
11    income that may affect the subsequent level of premium tax
12    credits, including the availability of any safe harbor from
13    recoupment of any overpayment, to the extent permissible
14    under the Federal Act or any federal regulations
15    promulgated thereunder; and
16        (6) meet the requirements of this Act and any
17    regulations implemented under this Act.
18    (c) In addition to powers set forth elsewhere in this Act,
19the Board shall do all of the following:
20        (1) Make qualified health plans available to qualified
21    individuals and qualified employers beginning with
22    effective dates on or before January 1, 2014.
23        (2) Not make available any health benefit plan that is
24    not a qualified health plan.
25        (3) Allow a health carrier to offer a plan that
26    provides limited scope dental benefits meeting the



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1    requirements of Section 9832(c)(2)(A) of the Internal
2    Revenue Code of 1986 through the Exchange, either
3    separately or in conjunction with a qualified health plan,
4    if the plan provides pediatric dental benefits meeting the
5    requirements of Section 1302(b)(1)(J) of the Federal Act.
6        (4) Not charge, or allow a health carrier offering
7    health benefit plans though the Exchange to charge, an
8    individual a fee or penalty for termination of coverage if
9    the individual enrolls in another type of minimum essential
10    coverage because the individual has become newly eligible
11    for that coverage or because the individual's
12    employer-sponsored coverage has become affordable under
13    the standards of Section 36B(c)(2)(C) of the Internal
14    Revenue Code of 1986.
15        (5) Implement procedures for the certification,
16    recertification, and decertification, consistent with
17    guidelines developed by the Secretary under Section
18    1311(c) of the Federal Act and Section 35 of this Act, of
19    health benefit plans as qualified health plans.
20        (6) Provide for the operation of a toll-free telephone
21    hotline to respond to requests for assistance.
22        (7) Provide for enrollment periods as provided under
23    Section 1311(c)(6) of the Federal Act.
24        (8) Maintain an Internet website through which
25    enrollees and prospective enrollees of qualified health
26    plans may obtain standardized comparative information on



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1    such plans.
2        (9) Assign a rating to each qualified health plan
3    offered through the Exchange in accordance with the
4    criteria developed by the Secretary under Section
5    1311(c)(3) of the Federal Act, and determine each qualified
6    health plan's level of coverage in accordance with
7    regulations issued by the Secretary under Section
8    1302(d)(2)(A) of the Federal Act. The Exchange shall make
9    this information public in a manner consistent with
10    subparagraph (B) of paragraph (18) of subsection (c) of
11    this Section and paragraph (3) of subsection (c) of Section
12    50 of this Act.
13        (10) Use a standardized format for presenting health
14    benefit options in the Exchange, including the use of the
15    uniform outline of coverage established under Section 2715
16    of the Public Health Service Act.
17        (11) In accordance with Section 1413 of the Federal
18    Act, inform individuals of eligibility requirements for
19    the Medicaid program under title XIX of the Social Security
20    Act, the Children's Health Insurance Program under title
21    XXI of the Social Security Act or any applicable State or
22    local public program and if through screening of the
23    application by the Exchange the Exchange determines that
24    any individual is eligible for any such program, then
25    enroll that individual in that program.
26        (12) Establish and make available by electronic means a



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1    calculator to determine the actual cost of coverage after
2    application of any premium tax credit under Section 36B of
3    the Internal Revenue Code of 1986 and any cost-sharing
4    reduction under Section 1402 of the Federal Act.
5        (13) Establish a SHOP Exchange, separate from the
6    activities related to the individual market, through which
7    qualified employers may access coverage for their
8    employees. The SHOP Exchange shall enable any qualified
9    employer to specify a level of coverage so that any of its
10    employees may enroll in any qualified health plan offered
11    through the SHOP Exchange at the specified level of
12    coverage.
13         (14) Subject to Section 1411 of the Federal Act, grant
14    a certification attesting that, for purposes of the
15    individual responsibility penalty under Section 5000A of
16    the Internal Revenue Code of 1986, an individual is exempt
17    from the individual responsibility requirement or from the
18    penalty imposed by that Section because:
19             (A) there is no affordable qualified health plan
20        available through the Exchange or the individual's
21        employer covering the individual; or
22             (B) the individual meets the requirements for any
23        other such exemption from the individual
24        responsibility requirement or penalty;
25         (15) Transfer to the federal Secretary of the Treasury
26    the following:



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1            (A) a list of the individuals who are issued a
2        certification under paragraph (14) of this subsection
3        (c), including the name and taxpayer identification
4        number of each individual;
5            (B) the name and taxpayer identification number of
6        each individual who was an employee of an employer but
7        who was determined to be eligible for the premium tax
8        credit under Section 36B of the Internal Revenue Code
9        of 1986 because:
10                (i) the employer did not provide minimum
11            essential coverage; or
12                (ii) the employer provided the minimum
13            essential coverage, but it was determined under
14            Section 36B(c)(2)(C) of the Internal Revenue Code
15            to either be unaffordable to the employee or not
16            provide the required minimum actuarial value; and
17            (C) the name and taxpayer identification number
18        of:
19                (i) each individual who notifies the Exchange
20            under Section 1411(b)(4) of the Federal Act that he
21            or she has changed employers; and
22                (ii) each individual who ceases coverage under
23            a qualified health plan during a plan year and the
24            effective date of that cessation.
25        (16) Provide to each employer the name of each employee
26    of the employer described in item (ii) of subparagraph (C)



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1    of paragraph (15) of this subsection (c) who ceases
2    coverage under a qualified health plan during a plan year
3    and the effective date of the cessation.
4        (17) Perform duties required of the Exchange by the
5    Secretary or the Secretary of the Treasury related to
6    determining eligibility for premium tax credits, reduced
7    cost-sharing or individual responsibility requirement
8    exemptions.
9        (18) Select entities qualified to serve as Navigators
10    in accordance with Section 1311(i) of the Federal Act, and
11    standards developed by the Secretary, and award grants to
12    enable Navigators to:
13            (A) conduct public education activities to raise
14        awareness of the availability of qualified health
15        plans, premium assistance tax credits, cost sharing
16        reductions, Medicaid and Children's Health Insurance
17        Program eligibility, and related consumer protections;
18            (B) distribute fair and impartial information
19        concerning enrollment in qualified health plans and
20        the availability of premium tax credits under Section
21        36B of the Internal Revenue Code of 1986 and
22        cost-sharing reductions under Section 1402 of the
23        Federal Act;
24            (C) facilitate enrollment in qualified health
25        plans and public health care programs, such as Medicaid
26        and the Children Health Insurance Program, where



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1        permitted by State and federal law;
2            (D) provide referrals to the Office of Consumer
3        Health Insurance in the Department for any enrollee
4        with a grievance, complaint, or question regarding
5        their health benefit plan, coverage, or a
6        determination under that plan or coverage; and
7            (E) provide information in a manner that is
8        culturally and linguistically appropriate to the needs
9        of the population being served by the Exchange.
10        (19) Within 30 days after issuance of federal guidance
11    regarding the Navigator function in the Exchange, the
12    Board, in collaboration with the advisory committees,
13    shall establish an open process to explore the design and
14    operation of the Exchange's Navigator Program and any other
15    appropriate consumer assistance mechanisms. Within 6
16    months after the effective date of this Act or by February
17    1, 2012, whichever occurs first, the Board shall provide
18    recommendations related to the functions of the Exchange or
19    the role of navigators to the Governor and the General
20    Assembly for their consideration, including:
21            (A) the infrastructure of the existing private
22        sector health insurance distribution system in this
23        State to determine whether private sector resources
24        may be available and suitable for use by the Exchange;
25            (B) the effect the Exchange may have on private
26        sector employment in the health insurance distribution



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1        system in this State;
2            (C) what functions, in addition to those required
3        by the Patient Protection and Affordable Care Act,
4        should be performed by Navigators;
5            (D) what training and expertise should be required
6        of Navigators, and whether different markets and
7        populations require Navigators with different
8        qualifications;
9            (E) how Navigators should be retained and
10        compensated, and how disparities between Navigator
11        compensation and the compensation of insurance
12        producers outside the Exchange can be minimized or
13        avoided;
14            (F) how to ensure that Navigators provide
15        information in a manner culturally, linguistically,
16        and otherwise appropriate to the needs of the diverse
17        populations served by the Exchange, and that
18        Navigators have the capacity to meet these needs; and
19            (G) what other means of consumer assistance may be
20        appropriate and feasible, and how they should be
21        designed and implemented.
22        (20) Review the rate of premium growth within the
23    Exchange and outside the Exchange and consider the
24    information in developing recommendations to the Board
25    about whether to continue limiting qualified employer
26    status to small employers.



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1         (21) Credit the amount of any free choice voucher to
2    the monthly premium of the plan in which a qualified
3    employee is enrolled, in accordance with Section 10108 of
4    the Federal Act, and collect the amount credited from the
5    offering employer.
6         (22) Consult with stakeholders relevant to carrying
7    out the activities required under this Act, including, but
8    not limited to:
9            (A) health care consumers who are enrollees in
10        qualified health plans;
11            (B) individuals and entities with experience in
12        facilitating enrollment in qualified health plans and
13        public health care programs, such as Medicaid or the
14        Children's Health Insurance Program;
15            (C) representatives of the employer community,
16        including small businesses, self-employed individuals,
17        and large self-insured plans;
18            (D) providers, including physicians, nurses,
19        behavioral health professionals, other allied health
20        professionals, and hospitals;
21            (E) representatives of union-administered health
22        benefit plans;
23            (F) entities or individuals with experience in
24        designing, managing, and purchasing health benefit
25        plans;
26            (G) the Department of Healthcare and Family



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1        Services;
2            (H) the President of the Senate, the Minority
3        Leader of the Senate, the Speaker of the House of
4        Representatives, and the Minority Leader of the House
5        of Representatives;
6            (I) the Department of Human Services;
7            (J) the Department of Public Health; and
8            (K) advocates for enrolling hard to reach
9        populations.
10        (23) The Board, in collaboration with the advisory
11    committees, shall establish an open process to explore
12    several aspects of Exchange policy and provide
13    recommendations to the General Assembly about future
14    legislative action regarding:
15            (A) expanding the definition of small employer to
16        include employers with up to 100 employees, including
17        an analysis of the impact of such a policy on premiums
18        and access to health insurance coverage for
19        individuals and small businesses in this State;
20            (B) permitting employers with more than 100
21        employees to purchase coverage through the Exchange
22        beginning in 2017, including an analysis of the impact
23        of such a policy on premiums and access to health
24        insurance coverage for individuals and small
25        businesses in this State; and
26            (C) additional mechanisms to minimize the risk of



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1        adverse selection in the Exchange.
2        In close cooperation with the Department of Healthcare
3    and Family Services and other impacted agencies and stake
4    holders, the Board shall make a recommendation as to
5    whether Illinois should adopt a Basic Health Plan as
6    allowed under Section 1331 of the ACA. Such a
7    recommendation should take into account, among other
8    things the potential impact on individuals who would be
9    covered under the Basic Health Plan, the potential cost to
10    the State, and the overall impact on the Exchange. Such a
11    recommendation must be made within 6 months after the final
12    rules for states by the Secretary regarding the
13    establishment of Basic Health Plans.
14        (25) Meet the following financial integrity
15    requirements:
16            (A) keep an accurate accounting of all activities,
17        receipts, and expenditures and annually submit to the
18        Secretary, the Governor, the Director, and the General
19        Assembly a report concerning such accountings;
20            (B) fully cooperate with any investigation
21        conducted by the Secretary pursuant to the Secretary's
22        authority under the Federal Act and allow the
23        Secretary, in coordination with the Inspector General
24        of the U.S. Department of Health and Human Services, to
25        do the following:
26                (i) investigate the affairs of the Exchange;



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1                (ii) examine the properties and records of the
2            Exchange; and
3                (iii) require periodic reports in relation to
4            the activities undertaken by the Exchange; and
5            (C) in carrying out its activities under this Act,
6        not use any funds intended for the administrative and
7        operational expenses of the Exchange for staff
8        retreats, promotional giveaways, excessive executive
9        compensation, or promotion of federal or State
10        legislative and regulatory modifications.
11    (d) Unless authorized by law, the Board and any Exchange
12employee or representative are not authorized to act in any
13manner that implies or asserts that the Board or the Exchange
14in and of itself can add to or impose any fiscal liability on
15the State.
16    (e) The Board shall recognize waivers approved by the
17Secretary pursuant to the Federal Act, recognizing that these
18waivers may change over time and be of limited scope or
20    Section 40. Advisory committees.
21    (a) Within 60 days after the effective date of this Act,
22the Board shall appoint a Technical Advisory Committee composed
23of no more than 20 individuals responsible for developing the
24standards and criteria for selecting qualified health plans to
25be offered through the Exchange. Such standards and criteria



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1shall be developed based upon the tenets of value, quality, and
2service and in a manner that serves the best interests of
3qualified individuals and qualified small employers. The
4Committee shall meet no less than once every 3 months and shall
5provide recommendations to the Board regarding standards and
6criteria for qualified health plans no later than 6 months
7after its establishment. The Technical Advisory Committee
8shall consult with the Stakeholder Advisory Committee
9described in this Section regarding its draft recommendations
10and provide time for substantive comment no less than once
11prior to issuing any final recommendations for review by the
13    (b) Each person appointed to the Committee shall serve a
142-year term, and have demonstrated and acknowledged expertise
15in at least 2 of the following areas:
16        (1) Individual health care coverage.
17        (2) Employer health care coverage.
18        (3) Health benefits plan administration, including
19    revenue cycle billing and collections.
20        (4) The health coverage needs of populations with
21    low-income limited health literacy and limited English
22    language proficiency.
23        (5) Health care finance.
24        (6) Administering a public or private health care
25    delivery system.
26        (7) Purchasing health plan coverage.



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1        (8) Education and outreach.
2    The Board shall consider the expertise of the other members
3of the Committee and attempt to make appointments so that the
4Committee's composition reflects a diversity of expertise.
5    (c) Within 30 days after the Board's establishment, it
6shall appoint a Stakeholder Advisory Committee composed of no
7fewer than 5 Illinois health care consumers, 5 Illinois small
8business owners, 5 Illinois-licensed health care providers
9from a variety of provider types, including, but not limited
10to, hospitals, private practice medical groups, community
11health centers, and safety net providers that have experience
12providing medical care to underserved populations, and 5 health
13plans that rank among the 10 largest in this State for premium
14volume. Committee members shall serve one-year terms.
15    (d) The Board may establish additional advisory committees
16to assist in carrying out its duties under the Act.
17    (e) Members of committees shall receive no compensation,
18but shall be reimbursed for reasonable expenses incurred in the
19necessary performance of their duties, including travel.
20    (f) The meetings of all advisory committees shall be
21subject to the Open Meetings Act.
22    Section 45. Annual report. The Board shall report in
23writing to the Governor, the Clerk of the House of
24Representatives, and the Clerk of the Senate by the 30th day of
25June, annually, the details and results of its administration



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1of this Act. The Board's report shall include an audited
2financial report, and may include any recommendation intended
3to improve the value of health coverage sold through the
4Exchange to patients, families, and employers. The Board shall
5make such report publicly available on the Exchange website.
6    Section 50. Health benefit plan certification.
7    (a) The Exchange may certify a health benefit plan as a
8qualified health plan if:
9        (1) the plan provides the essential health benefits
10    package described in Section 1302(a) of the Federal Act,
11    except that the plan is not required to provide essential
12    benefits that duplicate the minimum benefits of qualified
13    dental plans, as provided in subsection (e) of this
14    Section, if:
15            (A) the Exchange has determined that at least one
16        qualified dental plan is available to supplement the
17        plan's coverage; and
18            (B) the carrier makes prominent disclosure at the
19        time it offers the plan, in a form approved by the
20        Exchange, that the plan does not provide the full range
21        of essential pediatric benefits, and that qualified
22        dental plans providing those benefits and other dental
23        benefits not covered by the plan are offered through
24        the Exchange;
25        (2) the premium rates and contract language have been



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1    approved by the Director;
2        (3) the plan provides at least a bronze level of
3    coverage, as determined pursuant to paragraph (9) of
4    subsection (c) of Section 35 of this Act, unless the plan
5    is certified as a qualified catastrophic plan, meets the
6    requirements of the Federal Act for catastrophic plans, and
7    will only be offered to individuals eligible for
8    catastrophic coverage;
9        (4) the plan's cost-sharing requirements do not exceed
10    the limits established under Section 1302(c)(1) of the
11    Federal Act and if the plan is offered through the SHOP
12    Exchange, then the plan's deductible does not exceed the
13    limits established under Section 1302(c)(2) of the Federal
14    Act;
15        (5) the health carrier offering the plan:
16            (A) is licensed and in good standing to offer
17        health insurance coverage in this State;
18            (B) offers at least one qualified health plan in
19        the silver level and at least one plan in the gold
20        level through each component of the Exchange in which
21        the carrier participates, where "component" refers to
22        the SHOP Exchange and the Exchange for individual
23        coverage;
24            (C) charges the same premium rate for each
25        qualified health plan without regard to whether the
26        plan is offered through the Exchange and without regard



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1        to whether the plan is offered directly from the
2        carrier or through an insurance producer;
3            (D) does not charge any cancellation fees or
4        penalties in violation of paragraph (4) of subsection
5        (c) of Section 35 of this Act; and
6            (E) complies with the regulations developed by the
7        Secretary under Section 1311(d) of the Federal Act and
8        such other requirements as the Exchange may establish.
9        Should the qualified health plan offer the benefits of
10    qualified dental plans, the health and dental benefits
11    shall be placed separately.
12        (6) the plan meets the requirements of certification as
13    set forth by the Board, in collaboration with the Technical
14    Advisory Committee, and by the Secretary under Section
15    1311(c) of the Federal Act, which include, but are not
16    limited to, minimum standards in the areas of marketing
17    practices, network adequacy, essential community providers
18    in underserved areas, accreditation, quality improvement,
19    uniform enrollment forms, and descriptions of coverage and
20    information on quality measures for health benefit plan
21    performance; and
22        (7) the Exchange determines that making the plan
23    available through the Exchange is in the interest of
24    qualified individuals and qualified employers in this
25    State.
26    (b) The Exchange shall not exclude a health benefit plan:



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1        (1) on the basis that the plan is a fee-for-service
2    plan;
3        (2) through the imposition of premium price controls by
4    the Exchange; or
5        (3) on the basis that the health benefit plan provides
6    treatments necessary to prevent patients' deaths in
7    circumstances the Exchange determines are inappropriate or
8    too costly.
9    (c) The Exchange shall require each health carrier seeking
10certification of a plan as a qualified health plan to:
11        (1) submit a justification for any premium increase
12    before implementation of that increase; the carrier shall
13    prominently post the information on its Internet website;
14    the Exchange shall take this information, along with the
15    information and the recommendations provided to the
16    Exchange by the Director under Section 2794(b) of the
17    Public Health Service Act, into consideration when
18    determining whether to allow the carrier to make plans
19    available through the Exchange;
20        (2) make available to the public, in the format
21    described in paragraph (3) of subsection (c) of this
22    Section, and submit to the Exchange, the Secretary, and the
23    Director, accurate and timely disclosure of current data
24    relating to the following:
25            (A) claims payment policies and practices;
26            (B) periodic financial disclosures;



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1            (C) data on enrollment;
2            (D) data on disenrollment;
3            (E) data on the number of claims that are denied,
4        including pre-certification denials and limitations on
5        requested services;
6            (F) data on rating practices;
7            (G) information on cost-sharing and payments with
8        respect to any out-of-network coverage;
9            (H) information on enrollee and participant rights
10        under title I of the Federal Act;
11            (I) data on how the plan's quality scores, consumer
12        satisfaction levels, and performance levels compare to
13        national metrics and others in the Exchange; and
14            (J) other information as determined appropriate by
15        the Secretary; and
16        (3) enable individuals to learn, in a timely manner
17    upon the request of the individual, the amount of
18    cost-sharing, including deductibles, copayments, and
19    coinsurance, under the individual's plan or coverage that
20    the individual would be responsible for paying with respect
21    to the furnishing of a specific item or service by a
22    participating provider; at a minimum, this information
23    shall be made available to the individual through an
24    Internet website and through other means for individuals
25    without access to the Internet, and in a manner consistent
26    with subparagraph (E) of paragraph (18) of subsection (c)



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1    of Section 35 of this Act and this paragraph (3).
2    The information required in paragraph (2) of this
3subsection (c) shall be provided in plain language, as that
4term is defined in Section 1311(e)(3)(B) of the Federal Act.
5    (d) The Exchange shall not exempt any health carrier
6seeking certification of a qualified health plan, regardless of
7the type or size of the carrier, from State licensure or
8solvency requirements and shall apply the criteria of this
9Section in a manner that assures a level playing field between
10or among health carriers participating in the Exchange.
11    (e) Application to dental plans shall comport with all of
12the following provisions:
13        (1) The provisions of this Act that are applicable to
14    qualified health plans shall also apply to the extent
15    relevant to qualified dental plans except as modified in
16    accordance with the provisions of paragraphs (2), (3), and
17    (4) of this subsection (e) or by regulations adopted by the
18    Exchange.
19        (2) The carrier shall be licensed to offer dental
20    coverage, but need not be licensed to offer other health
21    benefits.
22        (3) The plan shall be limited to dental and oral health
23    benefits, without substantially duplicating the benefits
24    typically offered by health benefit plans without dental
25    coverage and shall include, at a minimum, the essential
26    pediatric dental benefits prescribed by the Secretary



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1    pursuant to Section 1302(b)(1)(J) of the Federal Act, and
2    such other dental benefits as the Exchange or the Secretary
3    may specify by regulation.
4        (4) Carriers may jointly offer a comprehensive plan
5    through the Exchange in which the dental benefits are
6    provided by a carrier through a qualified dental plan and
7    the other benefits are provided by a carrier through a
8    qualified health plan, provided that the plans are priced
9    separately and are also made available for purchase
10    separately at the same price.
11    Section 55. Funding; publication of costs.
12    (a) The Exchange shall be financed in a manner independent
13of general revenue funds, but that shall preclude any
14allocations of identifiable costs to State entities for
15specific services.
16    (b) The Exchange shall publish the average costs of
17licensing, regulatory fees and any other payments required by
18the Exchange and the administrative costs of the Exchange, on
19an Internet website to educate consumers on such costs. This
20information shall include information on money lost to waste,
21fraud, and abuse.
22    Section 60. Relation to other laws. Nothing in this Act and
23no action taken by the Exchange pursuant to this Act shall be
24construed to preempt or supersede the authority of the Director



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1to regulate the business of insurance. Except as expressly
2provided to the contrary in this Act, all health carriers
3offering qualified health plans in this State shall comply
4fully with all applicable health insurance laws of this State
5and regulations adopted and orders issued by the Director.
6    Section 65. Health insurance coverage survey. The
7Department of Insurance shall conduct an annual household and
8employer survey regarding health insurance coverage in this
9State, the cost of which shall be incorporated into the
10operation costs of the Exchange. This purpose of this report is
11to measure the current state of health insurance coverage in
12this State, and such information shall inform the Exchange in
13its pursuit to achieve the goals put forth in this Act. The
14Department of Revenue and other relevant State departments and
15agencies shall provide the Department with any and all relevant
16information for the purposes of successfully completing this
17survey. The Department shall deliver this report to the Board,
18the Governor, the Clerk of the House of Representatives, and
19the Clerk of the Senate by November 1, 2012, and the first day
20of July annually thereafter. The Department of Insurance shall
21make such report publicly available on its website. At a
22minimum, the report shall include:
23        (1) primary and secondary sources of health insurance
24    coverage for individuals and families in this State;
25        (2) demographic characteristics of insured and



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1    uninsured individuals in this State, including, but not
2    limited to:
3            (A) household income and size;
4            (B) age;
5            (C) gender;
6            (D) race;
7            (E) sexual orientation;
8            (F) geographic location;
9            (G) employment status; and
10            (H) disability status;
11        (3) barriers to health insurance coverage including,
12    but not limited to:
13            (A) financial;
14            (B) physical;
15            (C) religious or other personal restrictions;
16            (D) administrative barriers, including barriers
17        resulting from the operation of the Exchange; and
18            (E) language barriers; and
19        (4) survey of Employer-based coverage in this State,
20    including, but not limited to:
21            (A) health benefits offer rates;
22            (B) health benefits take-up rates among employees;
23            (C) scope of benefits provided (including, but not
24        limited to, comprehensive, scheduled, high-deductible,
25        catastrophic, or hospital-only coverage), including
26        the types of health plans;



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1            (D) exclusions, restrictions, and waiting periods;
2            (E) worker and employer premium contributions in
3        accordance with the following provisions;
4                (i) employer size (under 20; 20-99; 100-499;
5            and over 500);
6                (ii) part-time, full-time, and seasonal
7            employee;
8                (iii) salaried, hourly employees, or exempt
9            and non-exempt employees; and
10                (iv) employee and dependent coverage available
11            and take-up rate;
12            (F) organizational characteristics of the
13        employer, including, but not limited to:
14                (i) employer size (under 20; 20-99; 100-499;
15            and over 500);
16                (ii) part-time, full-time, and seasonal
17            employee;
18                (iii) salaried, hourly employees, or exempt
19            and non-exempt employees; and
20                (iv) employee and dependent coverage available
21            and take-up rate; and
22            (G) for employers not offering coverage, reasons
23        for not offering.
24    Section 70. Illinois Administrative Procedures Act. The
25provisions of the Illinois Administrative Procedures Act as now



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1or hereafter amended are hereby expressly adopted and
2incorporated herein as though a part of this Act and shall
3apply to all administrative rules and procedures of the
4Exchange under this Act.
5    Section 900. The Personnel Code is amended by changing
6Section 4c as follows:
7    (20 ILCS 415/4c)  (from Ch. 127, par. 63b104c)
8    Sec. 4c. General exemptions. The following positions in
9State service shall be exempt from jurisdictions A, B, and C,
10unless the jurisdictions shall be extended as provided in this
12        (1) All officers elected by the people.
13        (2) All positions under the Lieutenant Governor,
14    Secretary of State, State Treasurer, State Comptroller,
15    State Board of Education, Clerk of the Supreme Court,
16    Attorney General, and State Board of Elections.
17        (3) Judges, and officers and employees of the courts,
18    and notaries public.
19        (4) All officers and employees of the Illinois General
20    Assembly, all employees of legislative commissions, all
21    officers and employees of the Illinois Legislative
22    Reference Bureau, the Legislative Research Unit, and the
23    Legislative Printing Unit.
24        (5) All positions in the Illinois National Guard and



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1    Illinois State Guard, paid from federal funds or positions
2    in the State Military Service filled by enlistment and paid
3    from State funds.
4        (6) All employees of the Governor at the executive
5    mansion and on his immediate personal staff.
6        (7) Directors of Departments, the Adjutant General,
7    the Assistant Adjutant General, the Director of the
8    Illinois Emergency Management Agency, members of boards
9    and commissions, and all other positions appointed by the
10    Governor by and with the consent of the Senate.
11        (8) The presidents, other principal administrative
12    officers, and teaching, research and extension faculties
13    of Chicago State University, Eastern Illinois University,
14    Governors State University, Illinois State University,
15    Northeastern Illinois University, Northern Illinois
16    University, Western Illinois University, the Illinois
17    Community College Board, Southern Illinois University,
18    Illinois Board of Higher Education, University of
19    Illinois, State Universities Civil Service System,
20    University Retirement System of Illinois, and the
21    administrative officers and scientific and technical staff
22    of the Illinois State Museum.
23        (9) All other employees except the presidents, other
24    principal administrative officers, and teaching, research
25    and extension faculties of the universities under the
26    jurisdiction of the Board of Regents and the colleges and



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1    universities under the jurisdiction of the Board of
2    Governors of State Colleges and Universities, Illinois
3    Community College Board, Southern Illinois University,
4    Illinois Board of Higher Education, Board of Governors of
5    State Colleges and Universities, the Board of Regents,
6    University of Illinois, State Universities Civil Service
7    System, University Retirement System of Illinois, so long
8    as these are subject to the provisions of the State
9    Universities Civil Service Act.
10        (10) The State Police so long as they are subject to
11    the merit provisions of the State Police Act.
12        (11) (Blank).
13        (12) The technical and engineering staffs of the
14    Department of Transportation, the Department of Nuclear
15    Safety, the Pollution Control Board, and the Illinois
16    Commerce Commission, and the technical and engineering
17    staff providing architectural and engineering services in
18    the Department of Central Management Services.
19        (13) All employees of the Illinois State Toll Highway
20    Authority.
21        (14) The Secretary of the Illinois Workers'
22    Compensation Commission.
23        (15) All persons who are appointed or employed by the
24    Director of Insurance under authority of Section 202 of the
25    Illinois Insurance Code to assist the Director of Insurance
26    in discharging his responsibilities relating to the



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1    rehabilitation, liquidation, conservation, and dissolution
2    of companies that are subject to the jurisdiction of the
3    Illinois Insurance Code.
4        (16) All employees of the St. Louis Metropolitan Area
5    Airport Authority.
6        (17) All investment officers employed by the Illinois
7    State Board of Investment.
8        (18) Employees of the Illinois Young Adult
9    Conservation Corps program, administered by the Illinois
10    Department of Natural Resources, authorized grantee under
11    Title VIII of the Comprehensive Employment and Training Act
12    of 1973, 29 USC 993.
13        (19) Seasonal employees of the Department of
14    Agriculture for the operation of the Illinois State Fair
15    and the DuQuoin State Fair, no one person receiving more
16    than 29 days of such employment in any calendar year.
17        (20) All "temporary" employees hired under the
18    Department of Natural Resources' Illinois Conservation
19    Service, a youth employment program that hires young people
20    to work in State parks for a period of one year or less.
21        (21) All hearing officers of the Human Rights
22    Commission.
23        (22) All employees of the Illinois Mathematics and
24    Science Academy.
25        (23) All employees of the Kankakee River Valley Area
26    Airport Authority.



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1        (24) The commissioners and employees of the Executive
2    Ethics Commission.
3        (25) The Executive Inspectors General, including
4    special Executive Inspectors General, and employees of
5    each Office of an Executive Inspector General.
6        (26) The commissioners and employees of the
7    Legislative Ethics Commission.
8        (27) The Legislative Inspector General, including
9    special Legislative Inspectors General, and employees of
10    the Office of the Legislative Inspector General.
11        (28) The Auditor General's Inspector General and
12    employees of the Office of the Auditor General's Inspector
13    General.
14        (29) The Board members and employees of the Illinois
15    Health Benefits Exchange.
16(Source: P.A. 95-728, eff. 7-1-08 - See Sec. 999.)
17    Section 999. Effective date. This Act takes effect upon
18becoming law.".