Rep. Robyn Gabel

Filed: 5/23/2014

 

 


 

 


 
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1
AMENDMENT TO SENATE BILL 2799

2    AMENDMENT NO. ______. Amend Senate Bill 2799 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Personnel Code is amended by changing
5Section 4c as follows:
 
6    (20 ILCS 415/4c)  (from Ch. 127, par. 63b104c)
7    Sec. 4c. General exemptions. The following positions in
8State service shall be exempt from jurisdictions A, B, and C,
9unless the jurisdictions shall be extended as provided in this
10Act:
11        (1) All officers elected by the people.
12        (2) All positions under the Lieutenant Governor,
13    Secretary of State, State Treasurer, State Comptroller,
14    State Board of Education, Clerk of the Supreme Court,
15    Attorney General, and State Board of Elections.
16        (3) Judges, and officers and employees of the courts,

 

 

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

 

 

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1    University Retirement System of Illinois, and the
2    administrative officers and scientific and technical staff
3    of the Illinois State Museum.
4        (9) All other employees except the presidents, other
5    principal administrative officers, and teaching, research
6    and extension faculties of the universities under the
7    jurisdiction of the Board of Regents and the colleges and
8    universities under the jurisdiction of the Board of
9    Governors of State Colleges and Universities, Illinois
10    Community College Board, Southern Illinois University,
11    Illinois Board of Higher Education, Board of Governors of
12    State Colleges and Universities, the Board of Regents,
13    University of Illinois, State Universities Civil Service
14    System, University Retirement System of Illinois, so long
15    as these are subject to the provisions of the State
16    Universities Civil Service Act.
17        (10) The State Police so long as they are subject to
18    the merit provisions of the State Police Act.
19        (11) (Blank).
20        (12) The technical and engineering staffs of the
21    Department of Transportation, the Department of Nuclear
22    Safety, the Pollution Control Board, and the Illinois
23    Commerce Commission, and the technical and engineering
24    staff providing architectural and engineering services in
25    the Department of Central Management Services.
26        (13) All employees of the Illinois State Toll Highway

 

 

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1    Authority.
2        (14) The Secretary of the Illinois Workers'
3    Compensation Commission.
4        (15) All persons who are appointed or employed by the
5    Director of Insurance under authority of Section 202 of the
6    Illinois Insurance Code to assist the Director of Insurance
7    in discharging his responsibilities relating to the
8    rehabilitation, liquidation, conservation, and dissolution
9    of companies that are subject to the jurisdiction of the
10    Illinois Insurance Code.
11        (16) All employees of the St. Louis Metropolitan Area
12    Airport Authority.
13        (17) All investment officers employed by the Illinois
14    State Board of Investment.
15        (18) Employees of the Illinois Young Adult
16    Conservation Corps program, administered by the Illinois
17    Department of Natural Resources, authorized grantee under
18    Title VIII of the Comprehensive Employment and Training Act
19    of 1973, 29 USC 993.
20        (19) Seasonal employees of the Department of
21    Agriculture for the operation of the Illinois State Fair
22    and the DuQuoin State Fair, no one person receiving more
23    than 29 days of such employment in any calendar year.
24        (20) All "temporary" employees hired under the
25    Department of Natural Resources' Illinois Conservation
26    Service, a youth employment program that hires young people

 

 

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1    to work in State parks for a period of one year or less.
2        (21) All hearing officers of the Human Rights
3    Commission.
4        (22) All employees of the Illinois Mathematics and
5    Science Academy.
6        (23) All employees of the Kankakee River Valley Area
7    Airport Authority.
8        (24) The commissioners and employees of the Executive
9    Ethics Commission.
10        (25) The Executive Inspectors General, including
11    special Executive Inspectors General, and employees of
12    each Office of an Executive Inspector General.
13        (26) The commissioners and employees of the
14    Legislative Ethics Commission.
15        (27) The Legislative Inspector General, including
16    special Legislative Inspectors General, and employees of
17    the Office of the Legislative Inspector General.
18        (28) The Auditor General's Inspector General and
19    employees of the Office of the Auditor General's Inspector
20    General.
21        (29) All employees of the Illinois Power Agency.
22        (30) Employees having demonstrable, defined advanced
23    skills in accounting, financial reporting, or technical
24    expertise who are employed within executive branch
25    agencies and whose duties are directly related to the
26    submission to the Office of the Comptroller of financial

 

 

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1    information for the publication of the Comprehensive
2    Annual Financial Report (CAFR).
3        (31) All employees of the Illinois Sentencing Policy
4    Advisory Council.
5        (32) The employees of the Illinois Health Benefits
6    Exchange.
7(Source: P.A. 97-618, eff. 10-26-11; 97-1055, eff. 8-23-12;
898-65, eff. 7-15-13.)
 
9    Section 10. The Department of Insurance Law of the Civil
10Administrative Code of Illinois is amended by adding Section
111405-40 as follows:
 
12    (20 ILCS 1405/1405-40 new)
13    Sec. 1405-40. Transfer of the Comprehensive Health
14Insurance Plan.
15    (a) On January 1, 2015, all powers, duties, rights, and
16responsibilities of the Comprehensive Health Insurance Plan
17and the Illinois Comprehensive Health Insurance Board shall be
18transferred to the Department of Insurance.
19    (b) The Department of Insurance shall act on behalf of the
20Comprehensive Health Insurance Plan and the Illinois
21Comprehensive Health Insurance Board and shall have the power
22and duty to receive and answer correspondence, pay claims due
23and owing to the Department of Central Management Services
24revolving fund from any unencumbered funds, refer unpaid

 

 

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1vendors to the court of claims, and arrange for the orderly
2termination of any affairs of the Comprehensive Health
3Insurance Plan and the Illinois Comprehensive Health Insurance
4Board that remain unresolved on or after January 1, 2015.
5    (c) All books, records, papers, documents, property (real
6and personal), contracts, causes of action, and pending
7business pertaining to the powers, duties, rights, and
8responsibilities transferred by this amendatory Act of the 98th
9General Assembly from the Comprehensive Health Insurance Plan
10and the Illinois Comprehensive Health Insurance Board to the
11Department of Insurance, including, but not limited to,
12material in electronic or magnetic format and necessary
13computer hardware and software, shall be transferred to the
14Department of Insurance. Records shall remain intact as
15regulated by the federal Health Insurance Portability and
16Accountability Act of 1996.
17    (d) The personnel of the Comprehensive Health Insurance
18Plan and the Illinois Comprehensive Health Insurance Board
19shall be transferred to the Department of Insurance. The status
20and rights of those employees under the Personnel Code shall
21not be affected by the transfer. The rights of the employees
22and the State of Illinois and its agencies under the Personnel
23Code and applicable collective bargaining agreements or under
24any pension, retirement, or annuity plan shall not be affected
25by this amendatory Act of the 98th General Assembly.
26    (e) All unexpended appropriations and balances and other

 

 

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1funds available for use by the Comprehensive Health Insurance
2Plan and the Illinois Comprehensive Health Insurance Board
3shall be transferred for use by the Department of Insurance.
4Unexpended balances so transferred shall be expended only for
5the purpose for which the appropriations were originally made.
6    (f) The powers, duties, rights, and responsibilities
7transferred from the Comprehensive Health Insurance Plan and
8the Illinois Comprehensive Health Insurance Board shall be
9vested in and shall be exercised by the Department of
10Insurance.
11    (g) Whenever reports or notices are now required to be made
12or given or papers or documents furnished or served by any
13person to or upon the Comprehensive Health Insurance Plan or
14the Illinois Comprehensive Health Insurance Board in
15connection with any of the powers, duties, rights, and
16responsibilities transferred by this amendatory Act of the 98th
17General Assembly, the same shall be made, given, furnished, or
18served in the same manner to or upon the Department of
19Insurance.
20    (h) This amendatory Act of the 98th General Assembly does
21not affect any act done, ratified, or canceled or any right
22occurring or established or any action or proceeding had or
23commenced in an administrative, civil, or criminal cause by the
24Comprehensive Health Insurance Plan or the Illinois
25Comprehensive Health Insurance Board prior to January 1, 2015;
26such actions or proceedings may be prosecuted and continued by

 

 

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1the Department of Insurance.
 
2    Section 15. The Illinois State Auditing Act is amended by
3changing Section 3-1 as follows:
 
4    (30 ILCS 5/3-1)  (from Ch. 15, par. 303-1)
5    Sec. 3-1. Jurisdiction of Auditor General. The Auditor
6General has jurisdiction over all State agencies to make post
7audits and investigations authorized by or under this Act or
8the Constitution.
9    The Auditor General has jurisdiction over local government
10agencies and private agencies only:
11        (a) to make such post audits authorized by or under
12    this Act as are necessary and incidental to a post audit of
13    a State agency or of a program administered by a State
14    agency involving public funds of the State, but this
15    jurisdiction does not include any authority to review local
16    governmental agencies in the obligation, receipt,
17    expenditure or use of public funds of the State that are
18    granted without limitation or condition imposed by law,
19    other than the general limitation that such funds be used
20    for public purposes;
21        (b) to make investigations authorized by or under this
22    Act or the Constitution; and
23        (c) to make audits of the records of local government
24    agencies to verify actual costs of state-mandated programs

 

 

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1    when directed to do so by the Legislative Audit Commission
2    at the request of the State Board of Appeals under the
3    State Mandates Act.
4    In addition to the foregoing, the Auditor General may
5conduct an audit of the Metropolitan Pier and Exposition
6Authority, the Regional Transportation Authority, the Suburban
7Bus Division, the Commuter Rail Division and the Chicago
8Transit Authority and any other subsidized carrier when
9authorized by the Legislative Audit Commission. Such audit may
10be a financial, management or program audit, or any combination
11thereof.
12    The audit shall determine whether they are operating in
13accordance with all applicable laws and regulations. Subject to
14the limitations of this Act, the Legislative Audit Commission
15may by resolution specify additional determinations to be
16included in the scope of the audit.
17    In addition to the foregoing, the Auditor General must also
18conduct a financial audit of the Illinois Sports Facilities
19Authority's expenditures of public funds in connection with the
20reconstruction, renovation, remodeling, extension, or
21improvement of all or substantially all of any existing
22"facility", as that term is defined in the Illinois Sports
23Facilities Authority Act.
24    The Auditor General may also conduct an audit, when
25authorized by the Legislative Audit Commission, of any hospital
26which receives 10% or more of its gross revenues from payments

 

 

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1from the State of Illinois, Department of Healthcare and Family
2Services (formerly Department of Public Aid), Medical
3Assistance Program.
4    The Auditor General is authorized to conduct financial and
5compliance audits of the Illinois Distance Learning Foundation
6and the Illinois Conservation Foundation.
7    As soon as practical after the effective date of this
8amendatory Act of 1995, the Auditor General shall conduct a
9compliance and management audit of the City of Chicago and any
10other entity with regard to the operation of Chicago O'Hare
11International Airport, Chicago Midway Airport and Merrill C.
12Meigs Field. The audit shall include, but not be limited to, an
13examination of revenues, expenses, and transfers of funds;
14purchasing and contracting policies and practices; staffing
15levels; and hiring practices and procedures. When completed,
16the audit required by this paragraph shall be distributed in
17accordance with Section 3-14.
18    The Auditor General shall conduct a financial and
19compliance and program audit of distributions from the
20Municipal Economic Development Fund during the immediately
21preceding calendar year pursuant to Section 8-403.1 of the
22Public Utilities Act at no cost to the city, village, or
23incorporated town that received the distributions.
24    The Auditor General must conduct an audit of the Health
25Facilities and Services Review Board pursuant to Section 19.5
26of the Illinois Health Facilities Planning Act.

 

 

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1    The Auditor General of the State of Illinois shall annually
2conduct or cause to be conducted a financial and compliance
3audit of the books and records of any county water commission
4organized pursuant to the Water Commission Act of 1985 and
5shall file a copy of the report of that audit with the Governor
6and the Legislative Audit Commission. The filed audit shall be
7open to the public for inspection. The cost of the audit shall
8be charged to the county water commission in accordance with
9Section 6z-27 of the State Finance Act. The county water
10commission shall make available to the Auditor General its
11books and records and any other documentation, whether in the
12possession of its trustees or other parties, necessary to
13conduct the audit required. These audit requirements apply only
14through July 1, 2007.
15    The Auditor General must conduct audits of the Rend Lake
16Conservancy District as provided in Section 25.5 of the River
17Conservancy Districts Act.
18    The Auditor General must conduct financial audits of the
19Southeastern Illinois Economic Development Authority as
20provided in Section 70 of the Southeastern Illinois Economic
21Development Authority Act.
22    The Auditor General shall conduct a compliance audit in
23accordance with subsections (d) and (f) of Section 30 of the
24Innovation Development and Economy Act.
25    The Auditor General shall have the authority to conduct an
26audit of the Illinois Health Benefits Exchange. The audit may

 

 

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1be a financial audit, a management audit, a program audit, or
2any combination thereof.
3(Source: P.A. 95-331, eff. 8-21-07; 96-31, eff. 6-30-09;
496-939, eff. 6-24-10.)
 
5    Section 20. The Comprehensive Health Insurance Plan Act is
6amended by adding Sections 16 and 17 as follows:
 
7    (215 ILCS 105/16 new)
8    Sec. 16. Cessation of operations.
9    (a) Except as otherwise provided in this Section, the
10insurance operations of the Plan authorized by this Act shall
11cease on January 1, 2015.
12    (b) Coverage under the Plan does not apply to service
13provided on or after January 1, 2015.
14    (c) The Plan shall cease enrolling new participants on
15December 31, 2014.
16    (d) The Plan shall cease providing coverage for
17participants enrolled prior to January 1, 2015 at 11:59 p.m. on
18December 31, 2014. Except as otherwise provided in this
19subsection (d), the Board shall provide at least 90 days
20written notice to all Plan participants of the cessation of
21coverage under this Section. For participants enrolled less
22than 90 days before January 1, 2015, notice of the cessation of
23coverage under this Section shall be provided to all applicants
24and to all participants upon enrollment.

 

 

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1    (e) Any claim for payment under the Plan must be submitted
2no later than 90 days after January 1, 2015, and any valid
3claim submitted on or after January 1, 2015 must be paid within
490 days after receipt.
5    (f) Any grievance shall be resolved by the Board not later
6than October 31, 2015.
7    (g) Balance billing under this Section by a health care
8provider that is not a member of the provider network
9arrangement used by the Plan is prohibited.
10    (h) The Board shall, not later than June 30, 2014, submit
11to the Director a plan of dissolution, which must provide for,
12but not be limited to, the following:
13        (1) Continuity of care for an individual who is covered
14    under the Plan and is an inpatient on at the time the Plan
15    ceases.
16        (2) A final accounting of assessments.
17        (3) Resolution of any net asset deficiency.
18        (4) Cessation of all liability of the Plan.
19        (5) Final dissolution of the Plan.
20    (i) No legal action by or against the Plan may be filed on
21or after January 1, 2016.
22    (j) General Revenue Fund funds remaining in the Plan after
23satisfaction of all of the Plan's liabilities shall be
24transferred back into the General Revenue Fund.
25    (k) The Board shall cease charging insurer assessments on
26January 1, 2015; however, the Board may charge and collect

 

 

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1insurer assessments pursuant to Section 12 of this Act as
2necessary to satisfy any remaining liabilities of the Plan.
3Insurer assessments remaining in the Plan after satisfaction of
4all of the Plan's liabilities shall be returned to insurers
5based on subsection (e) of Section 12 of this Act.
 
6    (215 ILCS 105/17 new)
7    Sec. 17. Repealer. This Act is repealed on July 1, 2016.
 
8    Section 25. The Illinois Health Benefits Exchange Law is
9amended by changing Sections 5-3, 5-5, 5-10, and 5-15 and by
10adding Sections 5-4, 5-11, 5-16, 5-17, 5-18, 5-21, 5-23, and
115-30 as follows:
 
12    (215 ILCS 122/5-3)
13    Sec. 5-3. Legislative intent. The General Assembly finds
14the health benefits exchanges authorized by the federal Patient
15Protection and Affordable Care Act represent one of a number of
16ways in which the State can address coverage gaps and provide
17individual consumers and small employers access to greater
18coverage options. The General Assembly also finds that the
19State is best positioned to implement an exchange that is
20sensitive to the coverage gaps and market landscape unique to
21this State.
22    The purpose of this Law is to provide for the establishment
23of an Illinois Health Benefits Exchange (the Exchange) to

 

 

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1facilitate the purchase and sale of qualified health plans and
2qualified dental plans in the individual market in this State
3and to provide for the establishment of a Small Business Health
4Options Program (SHOP Exchange) to assist qualified small
5employers in this State in facilitating the enrollment of their
6employees in qualified health plans and qualified dental plans
7offered in the small group market. The intent of the Exchange
8is to supplement the existing health insurance market to
9simplify shopping for individual and small employers by
10increasing access to benefit options, encouraging a
11competitive market both inside and outside the Exchange,
12reducing the number of uninsured, and providing a transparent
13marketplace and effective consumer education and programmatic
14assistance tools. The purpose of this Law is to ensure that the
15State is making sufficient progress towards establishing an
16exchange within the guidelines outlined by the federal law and
17to protect Illinoisans from undue federal regulation. Although
18the federal law imposes a number of core requirements on
19state-level exchanges, the State has significant flexibility
20in the design and operation of a State exchange that make it
21prudent for the State to carefully analyze, plan, and prepare
22for the exchange. The General Assembly finds that in order for
23the State to craft a tenable exchange that meets the
24fundamental goals outlined by the Patient Protection and
25Affordable Care Act of expanding access to affordable coverage
26and improving the quality of care, the implementation process

 

 

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1should (1) provide for broad stakeholder representation; (2)
2foster a robust and competitive marketplace, both inside and
3outside of the exchange; and (3) provide for a broad-based
4approach to the fiscal solvency of the exchange.
5(Source: P.A. 97-142, eff. 7-14-11.)
 
6    (215 ILCS 122/5-4 new)
7    Sec. 5-4. Definitions. In this Law:
8    "Board" means the Illinois Health Benefits Exchange Board
9established pursuant to this Law.
10    "Department" means the Department of Insurance.
11    "Director" means the Director of Insurance.
12    "Educated health care consumer" means an individual who is
13knowledgeable about the health care system, and has background
14or experience in making informed decisions regarding health,
15medical, and public health matters.
16    "Essential health benefits" has the meaning provided under
17Section 1302(b) of the Federal Act.
18    "Exchange" means the Illinois Health Benefits Exchange
19established by this Law and includes the Individual Exchange
20and the SHOP Exchange, unless otherwise specified.
21    "Executive Director" means the Executive Director of the
22Illinois Health Benefits Exchange.
23    "Federal Act" means the federal Patient Protection and
24Affordable Care Act (Public Law 111-148), as amended by the
25federal Health Care and Education Reconciliation Act of 2010

 

 

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1(Public Law 111-152), and any amendments thereto, or
2regulations or guidance issued under, those Acts.
3    "Health benefit plan" means a policy, contract,
4certificate, or agreement offered or issued by a health carrier
5to provide, deliver, arrange for, pay for, or reimburse any of
6the costs of health care services. "Health benefit plan" does
7not include:
8        (1) coverage for accident only or disability income
9    insurance or any combination thereof;
10        (2) coverage issued as a supplement to liability
11    insurance;
12        (3) liability insurance, including general liability
13    insurance and automobile liability insurance;
14        (4) workers' compensation or similar insurance;
15        (5) automobile medical payment insurance;
16        (6) credit-only insurance;
17        (7) coverage for on-site medical clinics; or
18        (8) other similar insurance coverage, specified in
19    federal regulations issued pursuant to the federal Health
20    Information Portability and Accountability Act of 1996,
21    Public Law 104-191, under which benefits for health care
22    services are secondary or incidental to other insurance
23    benefits.
24    "Health benefit plan" does not include the following
25benefits if they are provided under a separate policy,
26certificate, or contract of insurance or are otherwise not an

 

 

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1integral part of the plan:
2        (a) limited scope dental or vision benefits;
3        (b) benefits for long-term care, nursing home care,
4    home health care, community-based care, or any combination
5    thereof; or
6        (c) other similar, limited benefits specified in
7    federal regulations issued pursuant to Public Law 104-191.
8    "Health benefit plan" does not include the following
9benefits if the benefits are provided under a separate policy,
10certificate, or contract of insurance, there is no coordination
11between the provision of the benefits and any exclusion of
12benefits under any group health plan maintained by the same
13plan sponsor, and the benefits are paid with respect to an
14event without regard to whether benefits are provided with
15respect to such an event under any group health plan maintained
16by the same plan sponsor:
17        (i) coverage only for a specified disease or illness;
18    or
19        (ii) hospital indemnity or other fixed indemnity
20    insurance.
21    "Health benefit plan" does not include the following if
22offered as a separate policy, certificate, or contract of
23insurance:
24        (A) Medicare supplemental health insurance as defined
25    under Section 1882(g)(1) of the federal Social Security
26    Act;

 

 

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1        (B) coverage supplemental to the coverage provided
2    under Chapter 55 of Title 10, United States Code (Civilian
3    Health and Medical Program of the Uniformed Services
4    (CHAMPUS)); or
5        (C) similar supplemental coverage provided to coverage
6    under a group health plan.
7    "Health benefit plan" does not include a group health plan
8or multiple employer welfare arrangement to the extent the plan
9or arrangement is not subject to State insurance regulation
10under Section 514 of the federal Employee Retirement Income
11Security Act of 1974.
12    "Health insurance carrier" or "carrier" means an entity
13subject to the insurance laws and regulations of this State, or
14subject to the jurisdiction of the Director, that contracts or
15offers to contract to provide, deliver, arrange for, pay for,
16or reimburse any of the costs of health care services,
17including a sickness and accident insurance company, a health
18maintenance organization, or any other entity providing a plan
19of health insurance, or health benefits. "Health insurance
20carrier" does not include short term, accident only, disability
21income, hospital confinement or fixed indemnity, vision only,
22limited benefit, or credit insurance, coverage issued as a
23supplement to liability insurance, insurance arising out of a
24workers' compensation or similar law, automobile
25medical-payment insurance, insurance under which benefits are
26payable with or without regard to fault and which is

 

 

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1statutorily required to be contained in any liability insurance
2policy or equivalent self-insurance, or a Consumer Operated and
3Oriented Plan.
4    "Illinois Health Benefits Exchange Fund" means the fund
5created outside of the State treasury to be used exclusively to
6provide funding for the operation and administration of the
7Exchange in carrying out the purposes authorized by this Law.
8    "Individual Exchange" means the exchange marketplace
9established by this Law through which qualified individuals may
10obtain coverage through an individual market qualified health
11plan.
12    "Principal place of business" means the location in a state
13where an employer has its headquarters or significant place of
14business and where the persons with direction and control
15authority over the business are employed.
16    "Qualified dental plan" means a limited scope dental plan
17that has been certified in accordance with this Law.
18    "Qualified employee" means an eligible individual employed
19by a qualified employer who has been offered health insurance
20coverage by that qualified employer through the SHOP on the
21Exchange.
22    "Qualified employer" means a small employer that elects to
23make its full-time employees eligible for one or more qualified
24health plans or qualified dental plans offered through the SHOP
25Exchange, and at the option of the employer, some or all of its
26part-time employees, provided that the employer has its

 

 

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1principal place of business in this State and elects to provide
2coverage through the SHOP Exchange to all of its eligible
3employees, wherever employed.
4    "Qualified health plan" or "QHP" means a health benefit
5plan that has in effect a certification that the plan meets the
6criteria for certification described in Section 1311(c) of the
7Federal Act.
8    "Qualified health plan issuer" or "QHP issuer" means a
9health insurance issuer that offers a health plan that the
10Exchange has certified as a qualified health plan.
11    "Qualified individual" means an individual, including a
12minor, who:
13        (1) is seeking to enroll in a qualified health plan or
14    qualified dental plan offered to individuals through the
15    Exchange;
16        (2) resides in this State;
17        (3) at the time of enrollment, is not incarcerated,
18    other than incarceration pending the disposition of
19    charges; and
20        (4) is, and is reasonably expected to be, for the
21    entire period for which enrollment is sought, a citizen or
22    national of the United States or an alien lawfully present
23    in the United States.
24    "Secretary" means the Secretary of the federal Department
25of Health and Human Services.
26    "SHOP Exchange" means the Small Business Health Options

 

 

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1Program established under this Law through which a qualified
2employer can provide small group qualified health plans to its
3qualified employees through various options available to the
4employer, including, but not limited to: (a) offering one
5qualified health plan to employees, (b) offering multiple
6qualified health plans to employees, or (c) offering an
7employee-directed choice of a qualified health plan within an
8employer-selected coverage tier.
9    "Small employer" means, in connection with a group health
10plan with respect to a calendar year and a plan year, an
11employer who employed an average of at least 2 but not more
12than 50 employees before January 1, 2016 and no more than 100
13employees on and after January 1, 2016 on business days during
14the preceding calendar year and who employs at least one
15employee on the first day of the plan year. For purposes of
16this definition:
17        (a) all persons treated as a single employer under
18    subsection (b), (c), (m) or (o) of Section 414 of the
19    federal Internal Revenue Code of 1986 shall be treated as a
20    single employer;
21        (b) an employer and any predecessor employer shall be
22    treated as a single employer;
23        (c) employees shall be counted in accordance with
24    federal law and regulations and State law and regulations;
25    provided however, that in the event of a conflict between
26    the federal law and regulations and the State law and

 

 

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1    regulations, the federal law and regulations shall
2    prevail;
3        (d) if an employer was not in existence throughout the
4    preceding calendar year, then the determination of whether
5    that employer is a small employer shall be based on the
6    average number of employees that is reasonably expected
7    that employer will employ on business days in the current
8    calendar year; and
9        (e) an employer that makes enrollment in qualified
10    health plans or qualified dental plans available to its
11    employees through the SHOP Exchange, and would cease to be
12    a small employer by reason of an increase in the number of
13    its employees, shall continue to be treated as a small
14    employer for purposes of this Law as long as it
15    continuously makes enrollment through the SHOP Exchange
16    available to its employees.
 
17    (215 ILCS 122/5-5)
18    Sec. 5-5. Establishment of the Exchange State health
19benefits exchange.
20    (a) It is declared that this State, beginning on the
21effective date of this amendatory Act of the 98th General
22Assembly October 1, 2013, in accordance with Section 1311 of
23the federal Patient Protection and Affordable Care Act, shall
24establish a State health benefits exchange to be known as the
25Illinois Health Benefits Exchange in order to help individuals

 

 

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1and small employers with no more than 50 employees shop for,
2select, and enroll in qualified, affordable private health
3plans that fit their needs at competitive prices. The Exchange
4shall separate coverage pools for individuals and small
5employers and shall supplement and not supplant any existing
6private health insurance market for individuals and small
7employers. These health plans shall be available to individuals
8and small employers for enrollment by October 1, 2015.
9    (b) There is hereby created a political subdivision, body
10politic and corporate, named the Illinois Health Benefits
11Exchange. The Exchange shall be a public entity, but shall not
12be considered a department, institution, or agency of the
13State.
14    (c) The Exchange shall be comprised of an individual and a
15small business health options (SHOP) exchange. Pursuant to
16Section 1311(b)(2) of the Federal Act, the Exchange shall
17provide individual exchange services to qualified individuals
18and SHOP Exchange services to qualified employers under a
19single governance and administrative structure. The Board
20shall produce an assessment, which must include a premium
21impact study, by July 1, 2017 to determine the viability of
22merging the SHOP Exchange and Individual Exchange functions
23into a single exchange by January 1, 2018. Any recommended
24merger of the SHOP Exchange and Individual Exchange functions
25shall be subject to legislative approval.
26    (d) The Exchange shall promote a competitive marketplace

 

 

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1for consumer access to affordable health coverage options. The
2Department shall review and recommend that the Board certify
3health benefit plans on the individual and SHOP Exchange, as
4applicable, provided that any such health benefit plan meets
5the requirements set forth in Section 1311(c) of the Federal
6Act and any other requirements of the Illinois Insurance Code.
7The Board shall certify health benefit plans that the
8Department recommends for certification.
9    (e) The Exchange shall not supersede the provisions of the
10Illinois Insurance Code, nor the functions of the Department of
11Insurance, the Department of Healthcare and Family Services, or
12the Department of Public Health.
13(Source: P.A. 97-142, eff. 7-14-11.)
 
14    (215 ILCS 122/5-10)
15    Sec. 5-10. Exchange functions.
16    (a) On or before January 1, 2016, in compliance with
17paragraph (4) of subdivision (d) of Section 1311 of the federal
18Patient Protection and Affordable Care Act, the Exchange shall,
19at a minimum, do all of the following to implement Section 1311
20of the federal Patient Protection and Affordable Care Act:
21        (1) Make qualified health plans available to qualified
22    individuals and qualified employers.
23        (2) Implement procedures for the certification,
24    recertification, and decertification, consistent with
25    Section 5-11 of this Act and the guidelines established by

 

 

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1    the U.S. Secretary of Health and Human Services, of health
2    plans as qualified health plans.
3        (3) Provide for the operation of a toll-free telephone
4    hotline and call center to respond to requests for
5    assistance.
6        (4) Maintain an Internet website through which
7    enrollees and prospective enrollees of qualified health
8    plans may obtain standardized comparative information on
9    those plans.
10        (5) With respect to each qualified health plan offered
11    through the Exchange, do both of the following:
12            (A) assign a rating to each qualified health plan
13        offered through the Exchange in accordance with the
14        criteria developed by the U.S. Secretary of Health and
15        Human Services; and
16            (B) determine each qualified health plan's level
17        of coverage in accordance with regulations adopted by
18        the U.S. Secretary of Health and Human Services under
19        paragraph (A) of subdivision (2) of Section 1302(d) of
20        the federal Patient Protection and Affordable Care Act
21        and any additional regulations adopted by the Exchange
22        under this Law.
23        (6) Utilize a standardized format for presenting
24    health benefits plan options in the Exchange, including the
25    use of the uniform outline of coverage established under
26    Section 2715 of the federal Public Health Service Act.

 

 

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1        (7) Inform individuals of eligibility requirements for
2    the Medicaid program, the Covering ALL KIDS Health
3    Insurance Program, or any applicable State or local public
4    program and, if through screening of the application by the
5    Exchange the Exchange determines that an individual is
6    eligible for any such program, enroll that individual in
7    the program.
8        (8) Establish and make available by electronic means a
9    calculator to determine the actual cost of coverage after
10    the application of any premium tax credit under Section 36B
11    of the Internal Revenue Code of 1986 and any cost sharing
12    reduction under Section 1402 of the federal Patient
13    Protection and Affordable Care Act.
14        (9) Coordinate with other State and county agencies.
15        (10) Grant a certification attesting that, for
16    purposes of the individual responsibility penalty under
17    Section 5000A of the Internal Revenue Code of 1986, an
18    individual is exempt from the individual requirement or
19    from the penalty imposed by that Section because of either
20    of the following:
21            (A) There is no affordable qualified health plan
22        available through the Exchange or the individual's
23        employer covering the individual.
24            (B) The individual meets the requirements for any
25        other exemption from the individual responsibility
26        requirement or penalty.

 

 

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

 

 

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1        (12) Provide to each employer the name of each employee
2    of the employer described in subdivision (i) of Section
3    1311 of the federal Patient Protection and Affordable Care
4    Act who ceases coverage under a qualified health plan
5    during a plan year and the effective date of that
6    cessation.
7        (13) Perform duties required of, or delegated to, the
8    Exchange by the U.S. Secretary of Health and Human Services
9    or the Secretary of the Treasury of the United States
10    related to the following:
11            (A) Determining eligibility for premium tax
12        credits, reduced cost sharing, or individual
13        responsibility exemptions.
14            (B) Establishing procedures necessary for the
15        operation of the program, including, but not limited
16        to, procedures for application, enrollment, risk
17        assessment, risk adjustment, plan administration,
18        performance monitoring, and consumer education.
19            (C) Arranging for collection of contributions from
20        participating employers and individuals.
21            (D) Arranging for payment of premiums and other
22        appropriate disbursements based on the selections of
23        products and services by the individual participants.
24            (E) Establishing criteria for disenrollment of
25        participating individuals based on failure to pay the
26        individual's share of any contribution required to

 

 

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1        maintain enrollment in selected products.
2            (F) Establishing criteria for exclusion of
3        vendors.
4            (G) Developing and implementing a plan for
5        promoting public awareness of and participation in the
6        program.
7            (H) Evaluating options for employer participation
8        which may conform with common insurance practices.
9        (14) Providing for initial, annual, and special
10    enrollment periods, in accordance with guidelines adopted
11    by the U.S. Secretary of Health and Human Services under
12    paragraph (6) of subdivision (c) of Section 1311 of the
13    federal Patient Protection and Affordable Care Act.
14        (15) Establish the Navigator Program in accordance
15    with subdivision (i) of Section 1311 of the federal Patient
16    Protection and Affordable Care Act. The Exchange shall
17    award grants to certain entities to do the following:
18            (A) Conduct public education activities to raise
19        awareness of the availability of qualified health
20        plans.
21            (B) Distribute fair and impartial information
22        concerning enrollment in qualified health plans and
23        the availability of premium tax credits under Section
24        36B of the Internal Revenue Code of 1986 and
25        cost-sharing reductions under Section 1402 of the
26        federal Patient Protection and Affordable Care Act.

 

 

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1            (C) Facilitate enrollment in qualified health
2        plans.
3            (D) Provide referrals to any applicable office of
4        health insurance consumer assistance or health
5        insurance ombudsman established under Section 2793 of
6        the federal Public Health Service Act, or any other
7        appropriate State agency or agencies, for any enrollee
8        with a grievance, complaint, or question regarding his
9        or her health plan, coverage, or a determination under
10        that plan or coverage.
11            (E) Refer individuals with a grievance, complaint,
12        or question regarding a plan, a plan's coverage, or a
13        determination under a plan's coverage to a customer
14        relations unit established by the Exchange.
15            (F) Provide information in a manner that is
16        culturally and linguistically appropriate to the needs
17        of the population being served by the Exchange.
18        (16) Establish the Small Business Health Options
19    Program, separate from the activities of the Board related
20    to the individual market, to assist qualified small
21    employers in facilitating the enrollment of their
22    employees in qualified health plans offered through the
23    Exchange in the small employer market in a manner
24    consistent with paragraph (2) of subdivision (a) of Section
25    1312 of the Federal Act. The Illinois Health Benefits
26    Exchange shall meet the core functions identified by

 

 

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1    Section 1311 of the Patient Protection and Affordable Care
2    Act and subsequent federal guidance and regulations.
3    (b) The In order to meet the deadline of October 1, 2013
4established by federal law to have operational a State
5exchange, the Department of Insurance and the Commission on
6Government Governmental Forecasting and Accountability is
7authorized to apply for, accept, receive, and use as
8appropriate for and on behalf of the State any grant money
9provided by the federal government and to share federal grant
10funding with, give support to, and coordinate with other
11agencies of the State and federal government or third parties
12as determined by the Governor, until the Board has the ability
13to do so, at which time the Board is authorized to apply for,
14accept, receive, and use as appropriate for and on behalf of
15the State any grant money provided by the federal government
16and to share federal grant funding with, give support to, and
17coordinate with other agencies of the State and federal
18government or third parties pursuant to Section 5-11 of this
19Law.
20(Source: P.A. 97-142, eff. 7-14-11; revised 9-11-13.)
 
21    (215 ILCS 122/5-11 new)
22    Sec. 5-11. Health benefit plan certification.
23    (a) To be certified as a qualified health plan, a health
24benefit plan shall, at a minimum:
25        (1) provide the essential health benefits package

 

 

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1    described in Section 1302(a) of the Federal Act; except
2    that the plan is not required to provide essential benefits
3    that duplicate the minimum benefits of qualified dental
4    plans, as provided in subsection (e) of this Section if:
5            (A) the Board, in cooperation with the Department,
6        has determined that at least one qualified dental plan
7        is available to supplement the plan's coverage; and
8            (B) the health carrier makes prominent disclosure
9        at the time it offers the plan, in a form approved by
10        the Board, that the plan does not provide the full
11        range of essential pediatric dental benefits and that
12        qualified dental plans providing those benefits and
13        other dental benefits not covered by the plan are
14        offered through the Exchange;
15        (2) fulfill all premium rate and contract filing
16    requirements and ensure that no contract language has been
17    disapproved by the Director;
18        (3) provide at least the minimum level of coverage
19    prescribed by the Federal Act;
20        (4) ensure that the cost-sharing requirements of the
21    plan do not exceed the limits established under Section
22    1302(c)(l) of the Federal Act, and if the plan is offered
23    through the SHOP Exchange, the plan's deductible does not
24    exceed the limits established under Section 1302(c)(2) of
25    the Federal Act;
26        (5) be offered by a health carrier that:

 

 

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1            (A) is authorized and in good standing to offer
2        health insurance coverage;
3            (B) offers at least one qualified health plan at
4        the silver level and at least one plan at the gold
5        level, as described in the Federal Act, through each
6        component of the Board in which the health carrier
7        participates; for the purposes of this subparagraph
8        (B), "component" means the SHOP Exchange and the
9        exchange for individual coverage within the American
10        Health Benefit Exchange;
11            (C) charges the same premium rate for each
12        qualified health plan without regard to whether the
13        plan is offered through the Exchange and without regard
14        to whether the plan is offered directly from the health
15        carrier or through an insurance producer;
16            (D) does not charge any cancellation fees or
17        penalties; and
18            (E) complies with the regulations established by
19        the Secretary under Section 1311 (d) of the Federal Act
20        and any other requirements of the Illinois Insurance
21        Code and the Department;
22        (6) meet the requirements of certification pursuant to
23    the requirements of the Department and the Illinois
24    Insurance Code provided in this Law and the requirements
25    issued by the Secretary under Section 1311(c) of the
26    Federal Act and rules promulgated or adopted pursuant to

 

 

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1    this Law or the Federal Act, which shall include:
2            (A) minimum standards in the areas of marketing
3        practices;
4            (B) network adequacy;
5            (C) essential community providers in underserved
6        areas;
7            (D) accreditation;
8            (E) quality improvement;
9            (F) uniform enrollment forms and descriptions of
10        coverage; and
11            (G) information on quality measures for health
12        benefit plan performance;
13        (7) include outpatient clinics in the health plan's
14    region that are controlled by an entity that also controls
15    a 340B eligible provider as defined by Section 340B(a)(4)
16    of the federal Public Health Service Act such that the
17    outpatient clinics are subject to the same mission,
18    policies, and medical standards related to the provision of
19    health care services as the 340B eligible provider; and
20        (8) submit a justification for any premium increase
21    prior to the implementation of the increase; the plans
22    shall prominently post that information on their Internet
23    websites; the Board shall take this information, and the
24    information and the recommendations provided to the Board
25    by the Department of Insurance or the Department of Managed
26    Health Care under paragraph (1) of subdivision (b) of

 

 

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1    Section 2794 of the federal Public Health Service Act, into
2    consideration when determining whether to make the health
3    plan available through the Exchange; the Board shall take
4    into account any excess of premium growth outside the
5    Exchange as compared to the rate of that growth inside the
6    Exchange, including information reported by the Department
7    of Insurance and the Department of Managed Health Care.
8    (b) The Department shall require each health carrier
9seeking certification of a plan as a qualified health plan to:
10        (1) make available to the public, in plain language as
11    defined in Section 1311(e)(3)(B) of the Federal Act, and
12    submit to the Board, the Secretary, and the Department
13    accurate and timely disclosure of the following:
14                (i) claims payment policies and practices;
15                (ii) periodic financial disclosures;
16                (iii) data on enrollment;
17                (iv) data on disenrollment;
18                (v) data on the number of claims that are
19            denied;
20                (vi) data on rating practices;
21                (vii) information on cost-sharing and payments
22            with respect to any out-of-network coverage;
23                (viii) information on enrollee and participant
24            rights under Title I of the Federal Act; and
25                (ix) other information as determined
26            appropriate by the Secretary, including, but not

 

 

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1            limited to, accredited clinical quality measures;
2            and
3        (2) permit individuals to learn, in a timely manner
4    upon the request of the individual, the comparative quality
5    standards of the plans along established clinical
6    data-based standards and the amount of cost-sharing,
7    including deductibles, copayments, and coinsurance, under
8    the individual's plan or coverage that the individual would
9    be responsible for paying with respect to the furnishing of
10    a specific item or service by a participating provider and
11    make this information available to the individual through
12    an Internet website that is publicly accessible and through
13    other means for individuals without access to the Internet.
14    (c) The Department shall not exempt any health carrier
15seeking certification as a qualified health plan, regardless of
16the type or size of the health carrier, from licensure or
17solvency requirements and shall apply the criteria of this
18Section in a manner that ensures a level playing field between
19or among health carriers participating in the Exchange.
20    (d) The provisions of this Law that are applicable to
21qualified health plans shall also apply, to the extent
22relevant, to qualified dental plans, except as modified in
23accordance with the provisions of paragraphs (1), (2), and (3)
24of this subsection (d) or by rules adopted by the Board.
25        (1) The health carrier shall be licensed to offer
26    dental coverage, but need not be licensed to offer other

 

 

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1    health benefits.
2        (2) The plan shall be limited to dental and oral health
3    benefits, without substantially duplicating the benefits
4    typically offered by health benefit plans without dental
5    coverage and shall include, at a minimum, the essential
6    pediatric dental benefits prescribed by the Secretary
7    pursuant to Section 1302(b)(l)(J) of the Federal Act and
8    such other dental benefits as the Board or the Secretary
9    may specify by rule.
10        (3) Health carriers may jointly offer a comprehensive
11    plan through the Exchange in which the dental benefits are
12    provided by a health carrier through a qualified dental
13    plan and the other benefits are provided by a health
14    carrier through a qualified health plan, provided that the
15    plans are priced separately and are also made available for
16    purchase separately at the same price.
 
17    (215 ILCS 122/5-15)
18    Sec. 5-15. Illinois Health Benefits Exchange Legislative
19Oversight Study Committee.
20    (a) There is created an Illinois Health Benefits Exchange
21Legislative Oversight Study Committee within the Commission on
22Government Forecasting and Accountability to provide
23accountability for conduct a study regarding State
24implementation and establishment of the Illinois Health
25Benefits Exchange and to ensure Exchange operations and

 

 

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1functions align with the goals and duties outlined by this Law.
2The Committee shall also be responsible for providing policy
3recommendations to ensure the Exchange aligns with the Federal
4Act, amendments to the Federal Act, and regulations promulgated
5pursuant to the Federal Act.
6    (b) Members of the Legislative Oversight Study Committee
7shall be appointed as follows: 3 members of the Senate shall be
8appointed by the President of the Senate; 3 members of the
9Senate shall be appointed by the Minority Leader of the Senate;
103 members of the House of Representatives shall be appointed by
11the Speaker of the House of Representatives; and 3 members of
12the House of Representatives shall be appointed by the Minority
13Leader of the House of Representatives. Each legislative leader
14shall select one member to serve as co-chair of the committee.
15    (c) Members of the Legislative Oversight Study Committee
16shall be appointed no later than September 1, 2014 within 30
17days after the effective date of this Law. The co-chairs shall
18convene the first meeting of the committee no later than 45
19days after the effective date of this Law.
20(Source: P.A. 97-142, eff. 7-14-11.)
 
21    (215 ILCS 122/5-16 new)
22    Sec. 5-16. Exchange governance. The governing and
23administrative powers of the Exchange shall be vested in a body
24known as the Illinois Health Benefits Exchange Board. The
25following provisions shall apply:

 

 

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1        (1) The Board shall consist of 11 voting members
2    appointed by the Governor with the advice and consent of a
3    majority of the members elected to the Senate. In addition,
4    the Director of Healthcare and Family Services, and the
5    Executive Director of the Exchange shall serve as
6    non-voting, ex-officio members of the Board. The Governor
7    shall also appoint as non-voting, ex-officio members one
8    economist with experience in the health care markets and
9    one educated health care consumer advocate. All Board
10    members shall be appointed no later than September 1, 2014.
11        (2) The Governor shall make the appointments so as to
12    reflect no less than proportional representation of the
13    geographic, gender, cultural, racial, and ethnic
14    composition of this State and in accordance with
15    subparagraphs (A), (B), and (C) of this paragraph, as
16    follows:
17            (A) No more than 4 voting members may represent the
18        following interests, of which no more than 2 may
19        represent any one interest:
20                (1) the insurance industry;
21                (2) health care administrators; and
22                (3) licensed health care professionals.
23            (B) At least 7 voting members shall represent the
24        following interest groups, with each interest group
25        represented by at least one voting member:
26                (1) a labor interest group;

 

 

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1                (2) a women's interest group;
2                (3) a minorities' interest group;
3                (4) a disabled persons' interest group;
4                (5) a small business interest group; and
5                (6) a public health interest group.
6            (C) Each person appointed to the Board should have
7        demonstrated experience in at least one of the
8        following areas:
9                (1) individual health insurance coverage;
10                (2) small employer health insurance;
11                (3) health benefits administration;
12                (4) health care finance;
13                (5) administration of a public or private
14            health care delivery system;
15                (6) the provision of health care services;
16                (7) the purchase of health insurance coverage;
17                (8) health care consumer navigation or
18        assistance;
19                (9) health care economics or health care
20        actuarial sciences;
21                (10) information technology; or
22                (11) starting a small business with 50 or fewer
23        employees.
24        (3) The Board shall elect one voting member of the
25    Board to serve as chairperson and one voting member to
26    serve as vice-chairperson, upon approval of a majority of

 

 

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1    the Board.
2        (4) The Exchange shall be administered by an Executive
3    Director, who shall be appointed, and may be removed, by a
4    majority of the Board. The Board shall have the power to
5    determine compensation for the Executive Director.
6        (5) The terms of the non-voting, ex-officio members of
7    the Board shall run concurrent with their terms of
8    appointment to office, or in the case of the Executive
9    Director, his or her term of appointment to that position,
10    subject to the determination of the Board. The terms of the
11    members, including those non-voting, ex-officio members
12    appointed by the Governor, shall be 4 years. Upon
13    conclusion of the initial term, the next term and every
14    term subsequent to it shall run for 3 years. Voting members
15    shall serve no more than 3 consecutive terms.
16        A person appointed to fill a vacancy and complete the
17    unexpired term of a member of the Board shall only be
18    appointed to serve out the unexpired term by the individual
19    who made the original appointment within 45 days after the
20    initial vacancy. A person appointed to fill a vacancy and
21    complete the unexpired term of a member of the Board may be
22    re-appointed to the Board for another term, but shall not
23    serve than more than 2 consecutive terms following their
24    completion of the unexpired term of a member of the Board.
25        If a voting Board member's qualifications change due to
26    a change in employment during the term of their

 

 

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1    appointment, then the Board member shall resign their
2    position, subject to reappointment by the individual who
3    made the original appointment.
4        (6) The Board shall, as necessary, create and appoint
5    qualified persons with requisite expertise to Exchange
6    technical advisory groups. These Exchange technical
7    advisory groups shall meet in a manner and frequency
8    determined by the Board to discuss exchange-related issues
9    and to provide exchange-related guidance, advice, and
10    recommendations to the Board and the Exchange. There shall
11    be at a minimum, 6 technical advisory groups, including the
12    following:
13            (1) an insurer advisory group;
14            (2) a business advisory group;
15            (3) a consumer advisory group;
16            (4) a provider advisory group;
17            (5) an insurance producer advisory group; and
18            (6) a dentist advisory group.
19        (7) The Board shall meet no less than quarterly on a
20    schedule established by the chairperson. Meetings shall be
21    public and public records shall be maintained, subject to
22    the Open Meetings Act. A majority of the Board shall
23    constitute a quorum and the affirmative vote of a majority
24    is necessary for any action of the Board. No vacancy shall
25    impair the ability of the Board to act provided a quorum is
26    reached. Members shall serve without pay, but shall be

 

 

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1    reimbursed for their actual and reasonable expenses
2    incurred in the performance of their duties. The
3    chairperson of the Board shall file a written report
4    regarding the activities of the Board and the Exchange to
5    the Governor and General Assembly annually, and the
6    Legislative Oversight Committee established in Section
7    5-15 quarterly, beginning on January 1, 2015 through
8    December 31, 2016.
9        (8) The Board shall adopt conflict of interest rules
10    and recusal procedures. Such rules and procedures shall (i)
11    prohibit a member of the Board from performing an official
12    act that may have a direct economic benefit on a business
13    or other endeavor in which that member has a direct or
14    substantial financial interest and (ii) require a member of
15    the Board to recuse himself or herself from an official
16    matter, whether direct or indirect. All recusals must be in
17    writing and specify the reason and date of the recusal. All
18    recusals shall be maintained by the Executive Director and
19    shall be disclosed to any person upon written request.
20        (9) The Board shall develop a budget, to be submitted
21    to the General Assembly along with the Governor's annual
22    budget proposal and approved by the General Assembly, for
23    the implementation and operation of the Exchange for
24    operating expenses, including, but not limited to:
25            (A) proposed compensation levels for the Executive
26        Director and shall identify personnel and staffing

 

 

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1        needs for the implementation and operation of the
2        Exchange;
3            (B) disclosure of funds received or expected to be
4        received from the federal government for the
5        infrastructure and systems of the Exchange and those
6        funds received or expected to be received for program
7        administration and operations;
8            (C) delineation of those functions of the Exchange
9        that are to be paid by State and federal programs that
10        are allocable to the State's General Revenue Fund; and
11            (D) beginning January 1, 2016, insurer assessments
12        contingent upon the use of federal funds for the first
13        year of operation of the Exchange and upon the review
14        and recommendations of the Commission on Government
15        Forecasting and Accountability.
16        (10) The Board shall, in consultation with the Health
17    Benefits Exchange Legislative Oversight Committee, produce
18    a cost-benefit analysis of the State's essential health
19    benefits no later than August 1, 2015 for the purposes of
20    informing the U.S. Department of Health and Human Services
21    in their re-evaluation of the essential health benefits for
22    plan years 2016 and beyond.
23        (11) The purpose of the Board shall be to implement the
24    Exchange in accordance with this Section and shall be
25    authorized to establish procedures for the operation of the
26    Exchange, subject to legislative approval.
 

 

 

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1    (215 ILCS 122/5-17 new)
2    Sec. 5-17. Insurer's assessment. Every carrier licensed to
3issue, and that issues for delivery, policies of accident and
4health insurance in this State shall be assessed. An insurer's
5assessment shall be determined by multiplying the total
6assessment, as determined in this Section, by a fraction, the
7numerator of which equals that insurer's direct Illinois
8premiums, excluding those premiums from limited lines policies
9and supplemental insurance policies, during the preceding
10calendar year and the denominator of which equals the total of
11all insurers' direct Illinois premiums, excluding those
12premiums from limited lines policies and supplemental
13insurance policies. The Board may exempt those insurers whose
14share as determined under this Section would be so minimal as
15to not exceed the estimated cost of levying the assessment. The
16Board shall charge and collect from each insurer the amounts
17determined to be due under this Section. The assessment shall
18be billed by Board invoice based upon the insurer's direct
19Illinois premium income, excluding premium income from limited
20lines policies and supplemental insurance policies, as shown in
21its annual statement for the preceding calendar year as filed
22with the Director. The invoice shall be due upon receipt and
23must be paid no later than 30 days after receipt by the
24insurer.
25    When a carrier fails to pay the full amount of any

 

 

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1assessment of $100 or more due under this Section there shall
2be added to the amount due as a penalty the greater of $50 or an
3amount equal to 5% of the deficiency for each month or part of
4a month that the deficiency remains unpaid. All moneys
5collected by the Board shall be placed in the Illinois Health
6Benefits Exchange Fund.
7    Insurers shall be assessed only an amount not exceeding the
8General Assembly's approved Board budget. No assessment shall
9be made on insurers while assessments are being made pursuant
10to Section 12 of the Comprehensive Health Insurance Plan Act.
11The assessment shall also take into consideration any unspent
12federal funds remaining and shall be reduced accordingly.
13    The Board shall prepare annually a complete and detailed
14written report accounting for all funds received and dispensed
15during the preceding fiscal year.
 
16    (215 ILCS 122/5-18 new)
17    Sec. 5-18. Illinois Health Benefits Exchange Fund. There
18is hereby created as a fund outside of the State treasury the
19Illinois Health Benefits Exchange Fund to be used, subject to
20appropriation, exclusively by the Exchange to provide funding
21for the operation and administration of the Exchange in
22carrying out the purposes authorized in this Law.
 
23    (215 ILCS 122/5-23 new)
24    Sec. 5-23. Examination or investigation of the Exchange.

 

 

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1The Director shall have the ability to examine or investigate
2the Exchange pursuant to his or her authority under Article
3XXIV of the Illinois Insurance Code.
 
4    Section 99. Effective date. This Act takes effect upon
5becoming law.".