Public Act 097-0011
 
HB3441 EnrolledLRB097 06367 RPM 46449 b

    AN ACT concerning insurance.
 
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
 
    Section 5. The Comprehensive Health Insurance Plan Act is
amended by changing Section 5 as follows:
 
    (215 ILCS 105/5)  (from Ch. 73, par. 1305)
    Sec. 5. Plan administrator.
    a. The board shall select a plan administrator through a
competitive bidding process to administer the plan. The board
shall evaluate bids submitted under this Section based on
criteria established by the board which shall include:
        (1) The plan administrator's proven ability to handle
    other large group accident and health benefit plans.
        (2) The efficiency and timeliness of the plan
    administrator's claim processing procedures.
        (3) An estimate of total net cost for administering the
    plan, including any discounts or income the Plan could
    expect to receive or benefit from.
        (4) The plan administrator's ability to apply
    effective cost containment programs and procedures and to
    administer the plan in a cost-efficient manner.
        (5) The financial condition and stability of the plan
    administrator.
    b. The plan administrator shall serve for a period of 5
years subject to removal for cause and subject to the terms,
conditions and limitations of the contract between the board
and the plan administrator. At least one year prior to the
expiration of each 5 year period of service by the current plan
administrator, the board shall begin to advertise for bids to
serve as the plan administrator for the succeeding 5 year
period. Selection of the plan administrator for the succeeding
period shall be made at least 6 months prior to the end of the
current 5 year period. Notwithstanding any other provision of
this subsection, the Board at its option may extend the term of
a plan administrator contract for a period not to exceed 3
years.
    c. The plan administrator shall perform such functions
relating to the plan as may be assigned to it including:
        (1) establishment of a premium billing procedure for
    collection of premiums from plan participants. Billings
    shall be made on a periodic basis as determined by the
    board;
        (2) payment and processing of claims and various cost
    containment functions; and
        (3) other functions to assure timely payment of
    benefits to participants under the plan, including:
            (a) making available information relating to the
        proper manner of submitting a claim for benefits under
        the plan and distributing forms upon which submissions
        shall be made, and
            (b) evaluating the eligibility of each claim for
        payment under the plan.
     The plan administrator shall be governed by the
requirements of Part 919 of Title 50 of the Illinois
Administrative Code, promulgated by the Department of
Insurance, regarding the handling of claims under this Act.
    d. The plan administrator shall submit regular reports to
the board regarding the operation of the plan. The frequency,
content and form of the report shall be as determined by the
board.
    e. The plan administrator shall pay or be reimbursed for
claims expenses from the premium payments received from or on
behalf of plan participants. If the plan administrator's
payments or reimbursements for claims expenses exceed the
portion of premiums allocated by the board for payment of
claims expenses, the board shall provide additional funds to
the plan administrator for payment or reimbursement of such
claims expenses.
    f. The plan administrator shall be paid as provided in the
contract between the Board and the plan administrator.
(Source: P.A. 90-30, eff. 7-1-97; 90-567, eff. 1-23-98; 91-357,
eff. 7-29-99.)
 
    Section 99. Effective date. This Act takes effect upon
becoming law.

Effective Date: 6/14/2011