Full Text of SB1555 97th General Assembly
SB1555enr 97TH GENERAL ASSEMBLY |
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| 1 | | AN ACT concerning insurance.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | ARTICLE 5. | 5 | | ILLINOIS HEALTH BENEFITS EXCHANGE | 6 | | Section 5-1. Short title. This Article may be cited as the | 7 | | Illinois Health Benefits Exchange Law. | 8 | | Section 5-3. Legislative intent. The General Assembly | 9 | | finds the health benefits exchanges authorized by the federal | 10 | | Patient Protection and Affordable Care Act represent one of a | 11 | | number of ways in which the State can address coverage gaps and | 12 | | provide individual consumers and small employers access to | 13 | | greater coverage options. The General Assembly also finds that | 14 | | the State is best positioned to implement an exchange that is | 15 | | sensitive to the coverage gaps and market landscape unique to | 16 | | this State. | 17 | | The purpose of this Law is to ensure that the State is | 18 | | making sufficient progress towards establishing an exchange | 19 | | within the guidelines outlined by the federal law and to | 20 | | protect Illinoisans from undue federal regulation. Although | 21 | | the federal law imposes a number of core requirements on | 22 | | state-level exchanges, the State has significant flexibility |
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| 1 | | in the design and operation of a State exchange that make it | 2 | | prudent for the State to carefully analyze, plan, and prepare | 3 | | for the exchange. The General Assembly finds that in order for | 4 | | the State to craft a tenable exchange that meets the | 5 | | fundamental goals outlined by the Patient Protection and | 6 | | Affordable Care Act of expanding access to affordable coverage | 7 | | and improving the quality of care, the implementation process | 8 | | should (1) provide for broad stakeholder representation; (2) | 9 | | foster a robust and competitive marketplace, both inside and | 10 | | outside of the exchange; and (3) provide for a broad-based | 11 | | approach to the fiscal solvency of the exchange. | 12 | | Section 5-5. State health benefits exchange. It is | 13 | | declared that this State, beginning October 1, 2013, in | 14 | | accordance with Section 1311 of the federal Patient Protection | 15 | | and Affordable Care Act, shall establish a State health | 16 | | benefits exchange to be known as the Illinois Health Benefits | 17 | | Exchange in order to help individuals and small employers with | 18 | | no more than 50 employees shop for, select, and enroll in | 19 | | qualified, affordable private health plans that fit their needs | 20 | | at competitive prices. The Exchange shall separate coverage | 21 | | pools for individuals and small employers and shall supplement | 22 | | and not supplant any existing private health insurance market | 23 | | for individuals and small employers. | 24 | | Section 5-10. Exchange functions. |
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| 1 | | (a) The Illinois Health Benefits Exchange shall meet the | 2 | | core functions identified by Section 1311 of the Patient | 3 | | Protection and Affordable Care Act and subsequent federal | 4 | | guidance and regulations. | 5 | | (b) In order to meet the deadline of October 1, 2013 | 6 | | established by federal law to have operational a State | 7 | | exchange, the Department of Insurance
and the Commission on | 8 | | Governmental Forecasting and Accountability is authorized to | 9 | | apply for, accept, receive, and use as appropriate
for and on | 10 | | behalf of the State any grant money provided by the
federal | 11 | | government and to share federal grant funding with, give | 12 | | support to,
and coordinate with other agencies of the State and | 13 | | federal government
or third parties as determined by the | 14 | | Governor. | 15 | | Section 5-15. Illinois Health Benefits Exchange | 16 | | Legislative Study Committee. | 17 | | (a) There is created an Illinois Health Benefits Exchange | 18 | | Legislative Study Committee to conduct a study regarding State | 19 | | implementation and establishment of the Illinois Health | 20 | | Benefits Exchange. | 21 | | (b) Members of the Legislative Study Committee shall be | 22 | | appointed as follows: 3 members of the Senate shall be | 23 | | appointed by the President of the Senate; 3 members of the | 24 | | Senate shall be appointed by the Minority Leader of the Senate; | 25 | | 3 members of the House of Representatives shall be appointed by |
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| 1 | | the Speaker of the House of Representatives; and 3 members of | 2 | | the House of Representatives shall be appointed by the Minority | 3 | | Leader of the House of Representatives. Each legislative leader | 4 | | shall select one member to serve as co-chair of the committee. | 5 | | (c) Members of the Legislative Study Committee shall be | 6 | | appointed within 30 days after the effective date of this Law. | 7 | | The co-chairs shall convene the first meeting of the committee | 8 | | no later than 45 days after the effective date of this Law. | 9 | | Section 5-20. Committee study. No later than September 30, | 10 | | 2011, the Committee shall report all findings concerning the | 11 | | implementation and establishment of the Illinois Health | 12 | | Benefits Exchange to the executive and legislative branches, | 13 | | including, but not limited to, (1) the governance and
structure | 14 | | of the Exchange, (2) financial sustainability of the
Exchange, | 15 | | and (3) stakeholder engagement, including an ongoing role
for | 16 | | the Legislative Study Committee or other legislative oversight | 17 | | of the
Exchange. The Committee shall report its findings with | 18 | | regard to (A) the operating model of
the Exchange, (B) the size | 19 | | of the employers to be offered
coverage through the Exchange, | 20 | | (C) coverage pools for
individuals and businesses within the | 21 | | Exchange, and (D) the development of standards for the coverage | 22 | | of full-time and part-time employees and their dependents. The | 23 | | Committee study shall also include recommendations concerning | 24 | | prospective action on behalf of the General Assembly as it | 25 | | relates to the establishment of the Exchange in 2011, 2012, |
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| 1 | | 2013, and 2014. | 2 | | Section 5-25. Federal action. This Law shall be null and | 3 | | void if Congress and the President take action to repeal or | 4 | | replace, or both, Section 1311 of the Affordable Care Act. | 5 | | ARTICLE 10. | 6 | | HEALTH SAVINGS ACCOUNT | 7 | | Section 10-1. Short title. This Article may be cited as | 8 | | the State Employee Health Savings Account Law. | 9 | | Section 10-5. Definitions. As used in this Law: | 10 | | (a) "Deductible" means the total deductible of a high | 11 | | deductible health plan for an eligible individual and all the | 12 | | dependents of that eligible individual for a calendar year. | 13 | | (b) "Dependent" means an eligible individual's spouse or | 14 | | child, as defined in Section 152 of the Internal Revenue Code | 15 | | of 1986.
"Dependent" includes a party to a civil union, as | 16 | | defined under Section 10 of the Illinois Religious Freedom | 17 | | Protection and Civil Union Act. | 18 | | (c) "Eligible individual" means an employee, as defined in | 19 | | Section 3 of the State Employees Group Insurance Act of 1971, | 20 | | who contributes to health savings accounts on the employees' | 21 | | behalf, who: | 22 | | (1) is covered by a high deductible health plan |
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| 1 | | individually or with dependents; and | 2 | | (2) is not covered under any health plan that is not a | 3 | | high deductible health plan, except for: | 4 | | (i) coverage for accidents; | 5 | | (ii) workers' compensation insurance; | 6 | | (iii) insurance for a specified disease or | 7 | | illness; | 8 | | (iv) insurance paying a fixed amount per day per | 9 | | hospitalization; and | 10 | | (v) tort liabilities; and | 11 | | (3) establishes a health savings account or on whose | 12 | | behalf the health savings account is
established. | 13 | | (d) "Employer" means a State agency, department, or other | 14 | | entity that employs an eligible individual. | 15 | | (e) "Health savings account" or "account" means a trust or | 16 | | custodial account established under a State program | 17 | | exclusively to pay the qualified medical expenses of an | 18 | | eligible individual, or his or her dependents, that meets all | 19 | | of the following requirements:
| 20 | | (1) Except in the case of a rollover contribution, no | 21 | | contribution may be accepted: | 22 | | (A) unless it is in cash; or
| 23 | | (B) to the extent that the contribution, when added | 24 | | to the previous contributions to the Account for the | 25 | | calendar year, exceeds the lesser of (i) 100% of the | 26 | | eligible individual's deductible or (ii) the |
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| 1 | | contribution level set for that year by the Internal | 2 | | Revenue Service. | 3 | | (2)
The trustee or custodian is a bank, an insurance | 4 | | company, or another person approved by the Director of | 5 | | Insurance.
| 6 | | (3) No part of the trust assets shall be invested in | 7 | | life insurance contracts. | 8 | | (4) The assets of the account shall not be commingled | 9 | | with other property except as allowed for under Individual | 10 | | Retirement Accounts. | 11 | | (5) Eligible individual's interest in the account is | 12 | | nonforfeitable. | 13 | | (f) "Health savings account program" or "program" means a | 14 | | program that includes all of the following:
| 15 | | (1) The purchase by an eligible individual or by an | 16 | | employer of a high deductible health plan. | 17 | | (2) The contribution into a health savings account by | 18 | | an eligible individual or on behalf of an employee or by | 19 | | his or her employer. The total annual contribution may not | 20 | | exceed the amount of the deductible or the amounts listed | 21 | | in sub-item (B) of item (1) of subsection (f) of this | 22 | | Section. | 23 | | (g) "High deductible" means: | 24 | | (1) In the case of self-only coverage, an annual | 25 | | deductible that is not less than the level set by the | 26 | | Internal Revenue Service and that, when added to the other |
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| 1 | | annual out-of-pocket expenses required to be paid under the | 2 | | plan for covered benefits, does not exceed $5,000; and
| 3 | | (2) In the case of family coverage, an annual | 4 | | deductible of not less than the level set by the Internal | 5 | | Revenue Service and that, when added to the other annual | 6 | | out-of-pocket expenses required to be paid under the plan | 7 | | for covered benefits, does not exceed $10,000.
| 8 | | A plan shall not fail to be treated as a high deductible | 9 | | plan by reason of a failure to have a deductible for preventive | 10 | | care or, in the case of network plans, for having out-of-pocket | 11 | | expenses that exceed these limits on an annual deductible for | 12 | | services that are provided outside the network.
| 13 | | (h) "High deductible health plan" means a health coverage | 14 | | policy, certificate, or contract that provides for payments for | 15 | | covered benefits that exceed the high deductible. | 16 | | (i) "Qualified medical expense" means an expense paid by | 17 | | the eligible individual for medical care described in Section | 18 | | 213(d) of the Internal Revenue Code of 1986. | 19 | | Section 10-10. Application; authorized contributions. | 20 | | (a) Beginning in taxable year 2011, each employer shall | 21 | | make available to each eligible individual a health savings | 22 | | account program, if that individual chooses to enroll in the | 23 | | program. An employer shall deposit $2,750 annually into an | 24 | | eligible individual's health savings account. Unused funds in a | 25 | | health savings account shall become the property of the account |
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| 1 | | holder at the end of a taxable year. | 2 | | (b) Beginning in taxable year 2011, an eligible individual | 3 | | may deposit contributions into a health savings account. The | 4 | | amount of deposit may not exceed the amount of the deductible | 5 | | for the policy. | 6 | | Section 10-15. Use of funds. | 7 | | (a) The trustee or custodian must use the funds held in a | 8 | | health savings account solely (i) for the purpose of paying the | 9 | | qualified medical expenses of the eligible individual or his or | 10 | | her dependents, (ii) to purchase a health coverage policy, | 11 | | certificate, or contract, or (iii) to pay for health insurance | 12 | | other than a Medicare supplemental policy for those who are | 13 | | Medicare eligible. | 14 | | (b) Funds held in a health savings account may not be used | 15 | | to cover expenses of the eligible individual or his or her | 16 | | dependents that are otherwise covered, including, but not | 17 | | limited to, medical expense covered under an automobile | 18 | | insurance policy, worker's compensation insurance policy or | 19 | | self-insured plan, or another employer-funded health coverage | 20 | | policy, certificate, or contract. | 21 | | ARTICLE 90. | 22 | | AMENDATORY PROVISIONS | 23 | | (20 ILCS 4045/Act rep.) |
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| 1 | | Section 90-10. The Health Care
Justice Act is repealed. | 2 | | ARTICLE 99. | 3 | | EFFECTIVE DATE | 4 | | Section 99. Effective date. This Act takes effect upon | 5 | | becoming law.
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