Rep. Thaddeus Jones

Filed: 4/20/2021

 

 


 

 


 
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1
AMENDMENT TO HOUSE BILL 1471

2    AMENDMENT NO. ______. Amend House Bill 1471 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Department of Insurance Law of the Civil
5Administrative Code of Illinois is amended by adding Section
61405-40 as follows:
 
7    (20 ILCS 1405/1405-40 new)
8    Sec. 1405-40. Transfer of the Illinois Comprehensive
9Health Insurance Plan. Upon entry of an Order of
10Rehabilitation or Liquidation against the Comprehensive Health
11Insurance Plan in accordance with Article XIII of the Illinois
12Insurance Code, all powers, duties, rights, and
13responsibilities of the Illinois Comprehensive Health
14Insurance Plan and the Illinois Comprehensive Health Insurance
15Board under the Comprehensive Health Insurance Plan Act shall
16be transferred to and vested in the Director of Insurance as

 

 

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1rehabilitator or liquidator as provided in the provisions of
2this amendatory Act of the 102nd General Assembly.
 
3    Section 10. The Comprehensive Health Insurance Plan Act is
4amended by changing Sections 1.1, 3, and 15 and by adding
5Sections 16 and 17 as follows:
 
6    (215 ILCS 105/1.1)  (from Ch. 73, par. 1301.1)
7    Sec. 1.1. The General Assembly hereby makes the following
8findings and declarations:
9        (a) The Comprehensive Health Insurance Plan is
10    established as a State program that is intended to provide
11    an alternate market for health insurance for certain
12    uninsurable Illinois residents, and further is intended to
13    provide an acceptable alternative mechanism as described
14    in the federal Health Insurance Portability and
15    Accountability Act of 1996 for providing portable and
16    accessible individual health insurance coverage for
17    federally eligible individuals as defined in this Act.
18        (b) The State of Illinois may subsidize the cost of
19    health insurance coverage offered by the Plan. However,
20    since the State has only a limited amount of resources,
21    the General Assembly declares that it intends for this
22    program to provide portable and accessible individual
23    health insurance coverage for every federally eligible
24    individual who qualifies for coverage in accordance with

 

 

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1    Section 15 of this Act, but does not intend for every
2    eligible person who qualifies for Plan coverage in
3    accordance with Section 7 of this Act to be guaranteed a
4    right to be issued a policy under this Plan as a matter of
5    entitlement.
6        (c) The Comprehensive Health Insurance Plan Board
7    shall operate the Plan in a manner so that the estimated
8    cost of the program during any fiscal year will not exceed
9    the total income it expects to receive from policy
10    premiums, investment income, assessments, or fees
11    collected or received by the Board and other funds which
12    are made available from appropriations for the Plan by the
13    General Assembly for that fiscal year.
14    With the implementation of the federal Patient Protection
15and Affordable Care Act, the Plan shall discontinue as the
16alternative market for health insurance for certain Illinois
17residents and discontinue as the alternative mechanism, as
18described in the federal Health Insurance Portability and
19Accountability Act of 1996, effective no later than January 1,
202022.
21(Source: P.A. 90-30, eff. 7-1-97.)
 
22    (215 ILCS 105/3)  (from Ch. 73, par. 1303)
23    Sec. 3. Operation of the Plan.
24    a. There is hereby created an Illinois Comprehensive
25Health Insurance Plan.

 

 

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1    b. The Plan shall operate subject to the supervision and
2control of the Board. The Board is created as a political
3subdivision and body politic and corporate and, as such, is
4not a State agency. The Board shall consist of 10 public
5members, appointed by the Governor with the advice and consent
6of the Senate.
7    Initial members shall be appointed to the Board by the
8Governor as follows: 2 members to serve until July 1, 1988, and
9until their successors are appointed and qualified; 2 members
10to serve until July 1, 1989, and until their successors are
11appointed and qualified; 3 members to serve until July 1,
121990, and until their successors are appointed and qualified;
13and 3 members to serve until July 1, 1991, and until their
14successors are appointed and qualified. As terms of initial
15members expire, their successors shall be appointed for terms
16to expire the first day in July 3 years thereafter, and until
17their successors are appointed and qualified.
18    Any vacancy in the Board occurring for any reason other
19than the expiration of a term shall be filled for the unexpired
20term in the same manner as the original appointment.
21    Any member of the Board may be removed by the Governor for
22neglect of duty, misfeasance, malfeasance, or nonfeasance in
23office.
24    In addition, a representative of the Governor's Office of
25Management and Budget, a representative of the Office of the
26Attorney General and the Director or the Director's designated

 

 

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1representative shall be members of the Board. Four members of
2the General Assembly, one each appointed by the President and
3Minority Leader of the Senate and by the Speaker and Minority
4Leader of the House of Representatives, shall serve as
5nonvoting members of the Board. At least 2 of the public
6members shall be individuals reasonably expected to qualify
7for coverage under the Plan, the parent or spouse of such an
8individual, or a surviving family member of an individual who
9could have qualified for the Plan during his lifetime. The
10Director or Director's representative shall be the chairperson
11of the Board. Members of the Board shall receive no
12compensation, but shall be reimbursed for reasonable expenses
13incurred in the necessary performance of their duties.
14    c. The Board shall make an annual report in September and
15shall file the report with the Secretary of the Senate and the
16Clerk of the House of Representatives. The report shall
17summarize the activities of the Plan in the preceding calendar
18year, including net written and earned premiums, the expense
19of administration, the paid and incurred losses for the year
20and other information as may be requested by the General
21Assembly. The report shall also include analysis and
22recommendations regarding utilization review, quality
23assurance and access to cost effective quality health care.
24    d. In its plan of operation the Board shall:
25        (1) Establish procedures for selecting a Plan
26    administrator in accordance with Section 5 of this Act.

 

 

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1        (2) Establish procedures for the operation of the
2    Board.
3        (3) Create a Plan fund, under management of the Board,
4    to fund administrative, claim, and other expenses of the
5    Plan.
6        (4) Establish procedures for the handling and
7    accounting of assets and monies of the Plan.
8        (5) Develop and implement a program to publicize the
9    existence of the Plan, the eligibility requirements and
10    procedures for enrollment and to maintain public awareness
11    of the Plan.
12        (6) Establish procedures under which applicants and
13    participants may have grievances reviewed by a grievance
14    committee appointed by the Board. The grievances shall be
15    reported to the Board immediately after completion of the
16    review. The Department and the Board shall retain all
17    written complaints regarding the Plan for at least 3
18    years. Oral complaints shall be reduced to written form
19    and maintained for at least 3 years.
20        (7) Provide for other matters as may be necessary and
21    proper for the execution of its powers, duties and
22    obligations under the Plan.
23    e. No later than 5 years after the Plan is operative the
24Board and the Department shall conduct cooperatively a study
25of the Plan and the persons insured by the Plan to determine:
26(1) claims experience including a breakdown of medical

 

 

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1conditions for which claims were paid; (2) whether
2availability of the Plan affected employment opportunities for
3participants; (3) whether availability of the Plan affected
4the receipt of medical assistance benefits by Plan
5participants; (4) whether a change occurred in the number of
6personal bankruptcies due to medical or other health related
7costs; (5) data regarding all complaints received about the
8Plan including its operation and services; (6) and any other
9significant observations regarding utilization of the Plan.
10The study shall culminate in a written report to be presented
11to the Governor, the President of the Senate, the Speaker of
12the House and the chairpersons of the House and Senate
13Insurance Committees. The report shall be filed with the
14Secretary of the Senate and the Clerk of the House of
15Representatives. The report shall also be available to members
16of the general public upon request.
17    (e-5) The Board shall conduct a feasibility study of
18establishing a small employer health insurance pool in which
19employers may provide affordable health insurance coverage to
20their employees. The Board may contract with a private entity
21or enter into intergovernmental agreements with State agencies
22for the completion of all or part of the study. The study
23shall:
24        (i) Analyze other states' experience in establishing
25    small employer health insurance pools;
26        (ii) Assess the need for a small employer health

 

 

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1    insurance pool, including the number of individuals who
2    might benefit from it;
3        (iii) Recommend means of establishing a small employer
4    health insurance pool; and
5        (iv) Estimate the cost of providing a small employer
6    health insurance pool through the Illinois Comprehensive
7    Health Insurance Plan or another, public or private
8    entity.
9    The Board may accept donations, in trust, from any legal
10source, public or private, for deposit into a trust account
11specifically created for expenditure, without the necessity of
12being appropriated, solely for the purpose of conducting all
13or part of the study. The Board shall issue a report with
14recommendations to the Governor and the General Assembly by
15January 1, 2005. As used in this subsection e-5, "small
16employer" means an employer having between one and 50
17employees.
18    f. The Board may:
19        (1) Prepare and distribute certificate of eligibility
20    forms and enrollment instruction forms to insurance
21    producers and to the general public in this State.
22        (2) Provide for reinsurance of risks incurred by the
23    Plan and enter into reinsurance agreements with insurers
24    to establish a reinsurance plan for risks of coverage
25    described in the Plan, or obtain commercial reinsurance to
26    reduce the risk of loss through the Plan.

 

 

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1        (3) Issue additional types of health insurance
2    policies to provide optional coverages as are otherwise
3    permitted by this Act including a Medicare supplement
4    policy designed to supplement Medicare.
5        (4) Provide for and employ cost containment measures
6    and requirements including, but not limited to,
7    preadmission certification, second surgical opinion,
8    concurrent utilization review programs, and individual
9    case management for the purpose of making the pool more
10    cost effective.
11        (5) Design, utilize, contract, or otherwise arrange
12    for the delivery of cost effective health care services,
13    including establishing or contracting with preferred
14    provider organizations, health maintenance organizations,
15    and other limited network provider arrangements.
16        (6) Adopt bylaws, rules, regulations, policies and
17    procedures as may be necessary or convenient for the
18    implementation of the Act and the operation of the Plan.
19        (7) Administer separate pools, separate accounts, or
20    other plans or arrangements as required by this Act to
21    separate federally eligible individuals or groups of
22    federally eligible individuals who qualify for Plan
23    coverage under Section 15 of this Act from eligible
24    persons or groups of eligible persons who qualify for Plan
25    coverage under Section 7 of this Act and apportion the
26    costs of the administration among such separate pools,

 

 

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1    separate accounts, or other plans or arrangements.
2    g. The Director may, by rule, establish additional powers
3and duties of the Board and may adopt rules for any other
4purposes, including the operation of the Plan, as are
5necessary or proper to implement this Act.
6    h. The Board is not liable for any obligation of the Plan.
7There is no liability on the part of any member or employee of
8the Board, or the Department, or the Director, both as
9regulator and as rehabilitator or liquidator, and no cause of
10action of any nature may arise against them, for any action
11taken or omission made by them in the performance of their
12powers and duties under this Act, unless the action or
13omission constitutes willful or wanton misconduct. The Board
14may provide in its bylaws or rules for indemnification of, and
15legal representation for, its members and employees.
16    i. There is no liability on the part of any insurance
17producer for the failure of any applicant to be accepted by the
18Plan unless the failure of the applicant to be accepted by the
19Plan is due to an act or omission by the insurance producer
20which constitutes willful or wanton misconduct.
21    j. Not later than 60 days after the effective date of this
22amendatory Act of the 102nd General Assembly, the Board shall
23develop a plan of rehabilitation or liquidation and
24dissolution, including the consent of a majority of the Board
25to the entry of an order of rehabilitation or liquidation, to
26wind down the affairs of the Plan, including details for the

 

 

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1transition to other health plans of any persons currently
2enrolled in the Plan, for presentation to and approval by the
3Director. Upon the Director's approval of the plan of
4rehabilitation or liquidation and dissolution, the Director
5shall thereafter report to the Attorney General of this State,
6whose duty it shall be to file a complaint for rehabilitation
7or liquidation of the Plan pursuant to the provisions of
8Article XIII of the Illinois Insurance Code. Upon entry of a
9final Order of Rehabilitation or Liquidation and the
10Director's appointment as statutory rehabilitator or
11liquidator, the Director shall begin to administer and oversee
12the wind-down and dissolution of the Plan in accordance with
13the provisions of Article XIII.
14(Source: P.A. 92-597, eff. 6-28-02; 93-622, eff. 12-18-03;
1593-824, eff. 7-28-04.)
 
16    (215 ILCS 105/15)
17    Sec. 15. Alternative portable coverage for federally
18eligible individuals.
19    (a) Notwithstanding the requirements of subsection a of
20Section 7 and except as otherwise provided in this Section,
21any federally eligible individual for whom a Plan application,
22and such enclosures and supporting documentation as the Board
23may require, is received by the Board within 90 days after the
24termination of prior creditable coverage shall qualify to
25enroll in the Plan under the portability provisions of this

 

 

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1Section.
2    A federally eligible person who has been certified as
3eligible pursuant to the federal Trade Act of 2002 and whose
4Plan application and enclosures and supporting documentation
5as the Board may require is received by the Board within 63
6days after the termination of previous creditable coverage
7shall qualify to enroll in the Plan under the portability
8provisions of this Section.
9    (b) Any federally eligible individual seeking Plan
10coverage under this Section must submit with his or her
11application evidence, including acceptable written
12certification of previous creditable coverage, that will
13establish to the Board's satisfaction, that he or she meets
14all of the requirements to be a federally eligible individual
15and is currently and permanently residing in this State (as of
16the date his or her application was received by the Board).
17    (c) Except as otherwise provided in this Section, a period
18of creditable coverage shall not be counted, with respect to
19qualifying an applicant for Plan coverage as a federally
20eligible individual under this Section, if after such period
21and before the application for Plan coverage was received by
22the Board, there was at least a 90-day period during all of
23which the individual was not covered under any creditable
24coverage.
25    For a federally eligible person who has been certified as
26eligible pursuant to the federal Trade Act of 2002, a period of

 

 

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1creditable coverage shall not be counted, with respect to
2qualifying an applicant for Plan coverage as a federally
3eligible individual under this Section, if after such period
4and before the application for Plan coverage was received by
5the Board, there was at least a 63-day period during all of
6which the individual was not covered under any creditable
7coverage.
8    (d) Any federally eligible individual who the Board
9determines qualifies for Plan coverage under this Section
10shall be offered his or her choice of enrolling in one of
11alternative portability health benefit plans which the Board
12is authorized under this Section to establish for these
13federally eligible individuals and their dependents.
14    (e) The Board shall offer a choice of health care
15coverages consistent with major medical coverage under the
16alternative health benefit plans authorized by this Section to
17every federally eligible individual. The coverages to be
18offered under the plans, the schedule of benefits,
19deductibles, co-payments, exclusions, and other limitations
20shall be approved by the Board. One optional form of coverage
21shall be comparable to comprehensive health insurance coverage
22offered in the individual market in this State or a standard
23option of coverage available under the group or individual
24health insurance laws of the State. The standard benefit plan
25that is authorized by Section 8 of this Act may be used for
26this purpose. The Board may also offer a preferred provider

 

 

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1option and such other options as the Board determines may be
2appropriate for these federally eligible individuals who
3qualify for Plan coverage pursuant to this Section.
4    (f) Notwithstanding the requirements of subsection f of
5Section 8, any Plan coverage that is issued to federally
6eligible individuals who qualify for the Plan pursuant to the
7portability provisions of this Section shall not be subject to
8any preexisting conditions exclusion, waiting period, or other
9similar limitation on coverage.
10    (g) Federally eligible individuals who qualify and enroll
11in the Plan pursuant to this Section shall be required to pay
12such premium rates as the Board shall establish and approve in
13accordance with the requirements of Section 7.1 of this Act.
14    (h) A federally eligible individual who qualifies and
15enrolls in the Plan pursuant to this Section must satisfy on an
16ongoing basis all of the other eligibility requirements of
17this Act to the extent not inconsistent with the federal
18Health Insurance Portability and Accountability Act of 1996 in
19order to maintain continued eligibility for coverage under the
20Plan.
21    (i) New enrollment and policy renewals are discontinued on
22December 31, 2021.
23(Source: P.A. 100-201, eff. 8-18-17.)
 
24    (215 ILCS 105/16 new)
25    Sec. 16. Cessation of operations.

 

 

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1    (a) Except as otherwise provided in this Section, the
2insurance operations of the Plan authorized by this Act shall
3cease on December 31, 2021.
4    (b) Coverage under the Plan does not apply to services
5provided on or after January 1, 2022.
6    (c) The Plan shall cease providing coverage for
7participants enrolled prior to January 1, 2022 at 11:59 p.m.
8on December 31, 2021.
9    (d) A claim for payment under the Plan must be submitted
10within 180 days after January 1, 2022 and paid in accordance
11with the provisions of Article XIII of the Illinois Insurance
12Code.
13    (e) Any claim or grievance shall be resolved by the court
14supervising the Plan's Article XIII rehabilitation or
15liquidation proceedings.
16    (f) Balance billing by a health care provider that is not a
17member of the provider network used by the Plan is prohibited.
18    (g) The Board shall, not later than 60 days after the
19effective date of this amendatory Act of the 102nd General
20Assembly, submit to the Director a plan of rehabilitation or
21liquidation and dissolution, which must provide for, but shall
22not be limited to, the following:
23        (1) continuity of care for an individual who is
24    covered under the Plan and is an inpatient on January 1,
25    2022;
26        (2) a final accounting of assessments;

 

 

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1        (3) resolution of any net asset deficiency;
2        (4) cessation of all liability of the Plan; and
3        (5) final dissolution of the Plan.
4    (h) The plan of rehabilitation or liquidation and
5dissolution may provide that, with the approval of the
6Director, a power or duty of the Plan may be delegated to a
7person that is to perform functions similar to the functions
8of the Plan.
9    (i) Upon entry of an Order of Rehabilitation or
10Liquidation against the Plan, the court supervising the
11rehabilitation or liquidation proceedings shall have the
12jurisdiction to issue injunctions as set forth in Section 189
13of the Illinois Insurance Code, including, but not limited to,
14the restraining of all persons, companies, and entities from
15bringing or further prosecuting all actions and proceedings at
16law or in equity or otherwise, whether in this State or
17elsewhere, against the Plan or its assets or property or the
18Director except insofar as those actions or proceedings arise
19in or are brought in the rehabilitation or liquidation
20proceedings.
21    (j) Upon the entry of an order of rehabilitation or
22liquidation, the rights and liabilities of the Plan and of its
23policyholders and all other persons interested in its assets
24shall be fixed as of the date of entry of the order directing
25rehabilitation or liquidation, or such later date as may be
26provided by order of the court supervising the rehabilitation

 

 

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1or liquidation proceedings.
2    (k) Upon the satisfaction of all claims allowed in the
3rehabilitation or liquidation proceedings, including the costs
4and expenses of administering the rehabilitation or
5liquidation, any remaining funds shall be distributed as
6follows:
7        (1) for the accounts described in paragraph (2) of
8    subsection (l) of Section 4, all funds shall be refunded
9    on a pro rata basis to the insurers that were assessed
10    based on the most recent deficit projections of the Plan's
11    operation pursuant to Section 12 and to covered persons
12    where appropriate; and
13        (2) for all other accounts, all remaining funds shall
14    be released and deposited into the Insurance Producer
15    Administration Fund for use by the Department for
16    initiatives to support the Illinois Health Benefits
17    Exchange.
18    (l) Upon the entry of an Order of Rehabilitation or
19Liquidation against the Plan, if the Director determines the
20Plan is holding any surplus funds in a segregated account
21associated with persons who qualified for coverage under
22Section 7 that are no longer required for the purposes for
23which they were acquired and are restricted from any other
24use, the Director may petition the court for such funds to be
25released and placed as follows:
26        (1) the first $10,000,000 shall be deposited into the

 

 

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1    Insurance Producer Administration Fund for use by the
2    Department for initiatives to support the Illinois Health
3    Benefits Exchange; and
4        (2) the remainder shall be deposited into the Parity
5    Advancement Fund.
 
6    (215 ILCS 105/17 new)
7    Sec. 17. Transfer of the Illinois Comprehensive Health
8Insurance Plan.
9    (a) Upon entry of an Order of Rehabilitation or
10Liquidation against the Plan all powers, duties, rights, and
11responsibilities of the Plan and the Board shall be
12transferred to and vested in the Director, as rehabilitator or
13liquidator, who is authorized to wind down the affairs of the
14Plan in accordance with Article XIII of the Illinois Insurance
15Code.
16    (b) The Director, as rehabilitator or liquidator, shall
17act on behalf of the Plan and the Board and shall have the
18power and duty to receive and answer correspondence, and shall
19evaluate all claims that are timely filed in the
20rehabilitation or liquidation proceedings and is authorized to
21make distribution from any unencumbered funds of the Plan's
22rehabilitation or liquidation estate upon all such claims as
23are allowed in the proceedings consistent with subsection (1)
24of Section 205 of the Illinois Insurance Code. Timely filed
25claims of vendors allowed in the rehabilitation or liquidation

 

 

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1proceedings that are not capable of being discharged, in full,
2from the assets of the rehabilitation or liquidation estate
3may be presented to the Court of Claims.
4    (c) All books, records, papers, documents, property (real
5and personal), contracts, causes of action, and pending
6business pertaining to the powers, duties, rights, and
7responsibilities transferred by this amendatory Act of the
8102nd General Assembly from the Plan and the Board to the
9Director, as rehabilitator or liquidator, including, but not
10limited to, material in electronic or magnetic format and
11necessary computer hardware and software, shall be transferred
12to the Director, as rehabilitator or liquidator. Records shall
13be maintained as required by the federal Health Insurance
14Portability and Accountability Act of 1996, as now or
15hereafter amended, unless otherwise ordered by the court
16supervising the rehabilitation or liquidation proceedings.
17    (d) The rights of the employees in the State of Illinois
18and its agencies under the Personnel Code and applicable
19collective bargaining agreements or under any pension,
20retirement, or annuity plan shall not be affected by this
21amendatory Act of the 102nd General Assembly.
22    (e) Upon entry of an Order of Rehabilitation or
23Liquidation against the Plan, all unexpended appropriations
24and balances and other funds available for use by the Plan and
25the Board shall be transferred to and vested in the Director,
26as rehabilitator or liquidator. Except as provided in

 

 

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1subsection (l) of Section 16, unexpended balances so
2transferred shall be distributed in accordance with Article
3XIII of the Illinois Insurance Code for paying the Director's
4administrative expenses incurred in connection with winding
5down the affairs of the Plan.
6    (f) Whenever reports or notices are, on the effective date
7of this amendatory Act of the 102nd General Assembly, required
8to be made or given or papers or documents furnished or served
9by any person to or upon the Plan or the Board in connection
10with any of the powers, duties, rights, and responsibilities
11transferred by this amendatory Act of the 102nd General
12Assembly, the same shall be made, given, furnished, or served
13in the same manner to or upon the Director, as rehabilitator or
14liquidator.
15    (g) This amendatory Act of the 102nd General Assembly does
16not affect any act done, ratified, or canceled or any right
17occurring or established or any action or proceeding had or
18commenced in the administrative, civil, or criminal cause by
19the Plan or the Board prior to the entry of an Order of
20Rehabilitation or Liquidation against the Plan; such actions
21or proceedings may be prosecuted and continued by the
22Director, as rehabilitator or liquidator.
 
23    Section 99. Effective date. This Act takes effect upon
24becoming law.".