Illinois General Assembly - Full Text of SB0034
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Full Text of SB0034  98th General Assembly




State of Illinois
2013 and 2014


Introduced 1/10/2013, by Sen. David Koehler


215 ILCS 122/5-3
215 ILCS 122/5-4 new
215 ILCS 122/5-5
215 ILCS 122/5-6 new
215 ILCS 122/5-15
215 ILCS 122/5-16 new
215 ILCS 122/5-17 new
215 ILCS 122/5-21 new

    Amends the Illinois Health Benefits Exchange Law. Makes changes concerning the legislative intent of the Law. Sets forth definitions. Establishes the Illinois Health Benefits Exchange as a political subdivision, body politic and corporate beginning October 1, 2014 (instead of 2013). Provides that the Exchange shall be a public entity, but shall not be considered a department, institution, or agency of the State. Sets forth provisions concerning health benefit plan certification. Deletes references to the Illinois Health Benefits Exchange Legislative Study Committee and establishes instead the Illinois Health Benefits Exchange Legislative Oversight Committee within the Commission on Government Forecasting and Accountability. Provides that the governing and administrative powers of the Exchange shall be vested in a body known as the Illinois Health Benefits Exchange Board and sets forth provisions concerning appointments, terms, meetings, the Board's structure, recusal, a budget, a revenue generating plan, and the Board's purpose. Establishes the Illinois Health Benefits Exchange Fund. Sets forth provisions concerning enrollment through brokers and agents and producer compensation. Makes other changes. Effective immediately.

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1    AN ACT concerning insurance.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4    Section 5. The Illinois Health Benefits Exchange Law is
5amended by changing Sections 5-3, 5-5, and 5-15 and by adding
6Sections 5-4, 5-6, 5-16, 5-17, and 5-21 as follows:
7    (215 ILCS 122/5-3)
8    Sec. 5-3. Legislative intent. The General Assembly finds
9the health benefits exchanges authorized by the federal Patient
10Protection and Affordable Care Act represent one of a number of
11ways in which the State can address coverage gaps and provide
12individual consumers and small employers access to greater
13coverage options. The General Assembly also finds that the
14State is best positioned to implement an exchange that is
15sensitive to the coverage gaps and market landscape unique to
16this State.
17    The purpose of this Law is to provide for the establishment
18of an Illinois Health Benefits Exchange (the Exchange) to
19facilitate the purchase and sale of qualified health plans and
20qualified dental plans in the individual market in this State
21and to provide for the establishment of a Small Business Health
22Options Program (SHOP Exchange) to assist qualified small
23employers in this State in facilitating the enrollment of their



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1employees in qualified health plans and qualified dental plans
2offered in the small group market. The intent of the Exchange
3is to supplement the existing health insurance market to
4simplify shopping for individual and small employers by
5increasing access to benefit options, encouraging a robust and
6competitive market both inside and outside the Exchange,
7reducing the number of uninsured, and providing a transparent
8marketplace and effective consumer education and programmatic
9assistance tools. The purpose of this Law is to ensure that the
10State is making sufficient progress towards establishing an
11exchange within the guidelines outlined by the federal law and
12to protect Illinoisans from undue federal regulation. Although
13the federal law imposes a number of core requirements on
14state-level exchanges, the State has significant flexibility
15in the design and operation of a State exchange that make it
16prudent for the State to carefully analyze, plan, and prepare
17for the exchange. The General Assembly finds that in order for
18the State to craft a tenable exchange that meets the
19fundamental goals outlined by the Patient Protection and
20Affordable Care Act of expanding access to affordable coverage
21and improving the quality of care, the implementation process
22should (1) provide for broad stakeholder representation; (2)
23foster a robust and competitive marketplace, both inside and
24outside of the exchange; and (3) provide for a broad-based
25approach to the fiscal solvency of the exchange.
26(Source: P.A. 97-142, eff. 7-14-11.)



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1    (215 ILCS 122/5-4 new)
2    Sec. 5-4. Definitions. In this Law:
3    "Board" means the Illinois Health Benefits Exchange Board
4established pursuant to this Law.
5    "Director" means the Director of Insurance.
6    "Educated health care consumer" means an individual who is
7knowledgeable about the health care system, and has background
8or experience in making informed decisions regarding health,
9medical, and scientific matters.
10    "Essential health benefits" has the meaning provided under
11Section 1302(b) of the Federal Act.
12    "Exchange" means the Illinois Health Benefits Exchange
13established by this Law and includes the Individual Exchange
14and the SHOP Exchange, unless otherwise specified.
15    "Executive Director" means the Executive Director of the
16Illinois Health Benefits Exchange.
17    "Federal Act" means the federal Patient Protection and
18Affordable Care Act (Public Law 111-148), as amended by the
19federal Health Care and Education Reconciliation Act of 2010
20(Public Law 111-152), and any amendments thereto, or
21regulations or guidance issued under, those Acts.
22    "Health benefit plan" means a policy, contract,
23certificate, or agreement offered or issued by a health carrier
24to provide, deliver, arrange for, pay for, or reimburse any of
25the costs of health care services. "Health benefit plan" does



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1not include:
2        (1) coverage for accident only or disability income
3    insurance or any combination thereof;
4        (2) coverage issued as a supplement to liability
5    insurance;
6        (3) liability insurance, including general liability
7    insurance and automobile liability insurance;
8        (4) workers' compensation or similar insurance;
9        (5) automobile medical payment insurance;
10        (6) credit-only insurance;
11        (7) coverage for on-site medical clinics; or
12        (8) other similar insurance coverage, specified in
13    federal regulations issued pursuant to Public Law 104-191,
14    under which benefits for health care services are secondary
15    or incidental to other insurance benefits.
16    "Health benefit plan" does not include the following
17benefits if they are provided under a separate policy,
18certificate, or contract of insurance or are otherwise not an
19integral part of the plan:
20        (a) limited scope dental or vision benefits;
21        (b) benefits for long-term care, nursing home care,
22    home health care, community-based care, or any combination
23    thereof; or
24        (c) other similar, limited benefits specified in
25    federal regulations issued pursuant to Public Law 104-191.
26    "Health benefit plan" does not include the following



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



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1or arrangement is not subject to State insurance regulation
2under Section 514 of the federal Employee Retirement Income
3Security Act of 1974.
4    "Health carrier" or "carrier" means an entity subject to
5the insurance laws and regulations of this State, or subject to
6the jurisdiction of the Director, that contracts or offers to
7contract to provide, deliver, arrange for, pay for, or
8reimburse any of the costs of health care services, including a
9sickness and accident insurance company, a health maintenance
10organization, a nonprofit hospital and health service
11corporation, or any other entity providing a plan of health
12insurance, health benefits or health services.
13    "Individual Exchange" means the exchange marketplace
14established by this Law through which qualified individuals may
15obtain coverage through an individual market qualified health
17    "Principal place of business" means the location in a state
18where an employer has its headquarters or significant place of
19business and where the persons with direction and control
20authority over the business are employed.
21    "Qualified dental plan" means a limited scope dental plan
22that has been certified in accordance with this Law.
23    "Qualified employee" means an eligible individual employed
24by a qualified employer who has been offered health insurance
25coverage by that qualified employer through the SHOP on the



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



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1    national of the United States or an alien lawfully present
2    in the United States.
3    "Secretary" means the Secretary of the federal Department
4of Health and Human Services.
5    "SHOP Exchange" means the Small Business Health Options
6Program established under this Law through which a qualified
7employer can provide small group qualified health plans to its
8qualified employees.
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 100 employees on business days during the preceding
13calendar year and who employs at least one employee on the
14first day of the plan year. For purposes of this definition:
15        (a) all persons treated as a single employer under
16    subsection (b), (c), (m) or (o) of Section 414 of the
17    federal Internal Revenue Code of 1986 shall be treated as a
18    single employer;
19        (b) an employer and any predecessor employer shall be
20    treated as a single employer;
21        (c) employees shall be counted in accordance with
22    federal law and regulations and State law and regulations;
23        (d) if an employer was not in existence throughout the
24    preceding calendar year, then the determination of whether
25    that employer is a small employer shall be based on the
26    average number of employees that is reasonably expected



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1    that employer will employ on business days in the current
2    calendar year; and
3        (e) an employer that makes enrollment in qualified
4    health plans or qualified dental plans available to its
5    employees through the SHOP Exchange, and would cease to be
6    a small employer by reason of an increase in the number of
7    its employees, shall continue to be treated as a small
8    employer for purposes of this Law as long as it
9    continuously makes enrollment through the SHOP Exchange
10    available to its employees.
11    (215 ILCS 122/5-5)
12    Sec. 5-5. Establishment of the Exchange State health
13benefits exchange.
14    (a) It is declared that this State, beginning October 1,
152014 2013, in accordance with Section 1311 of the federal
16Patient Protection and Affordable Care Act, shall establish a
17State health benefits exchange to be known as the Illinois
18Health Benefits Exchange in order to help individuals and small
19employers with no more than 50 employees shop for, select, and
20enroll in qualified, affordable private health plans that fit
21their needs at competitive prices. The Exchange shall separate
22coverage pools for individuals and small employers and shall
23supplement and not supplant any existing private health
24insurance market for individuals and small employers.
25    (b) There is hereby created a political subdivision, body



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1politic and corporate, named the Illinois Health Benefits
2Exchange. The Exchange shall be a public entity, but shall not
3be considered a department, institution, or agency of the
5    (c) The Exchange shall be comprised of an individual and a
6small business health options (SHOP) exchange. Pursuant to
7Section 1311(b)(2) of the Federal Act, the Exchange shall
8provide individual exchange services to qualified individuals
9and SHOP Exchange services to qualified employers under a
10single governance and administrative structure. The Board
11shall produce an assessment by July 1, 2016 to determine the
12viability of merging the SHOP Exchange and Individual Exchange
13functions into a single exchange by January 1, 2017.
14    (d) The Exchange shall promote a competitive and robust
15marketplace that allows consumer access to affordable health
16coverage options. The Exchange shall certify health benefit
17plans on the individual and SHOP exchange, as applicable,
18provided that any such health benefit plan meets the
19requirements set forth in Section 1311(c) of the Federal Act.
20    (e) The Exchange shall not duplicate or replace the
21functions of the Department of Insurance.
22(Source: P.A. 97-142, eff. 7-14-11.)
23    (215 ILCS 122/5-6 new)
24    Sec. 5-6. Health benefit plan certification.
25    (a) To be certified as a qualified health plan, a health



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1benefit plan shall, at a minimum:
2        (1) provide the essential health benefits package
3    described in Section 1302(a) of the Federal Act; except
4    that the plan is not required to provide essential benefits
5    that duplicate the minimum benefits of qualified dental
6    plans, as provided in subsection (e) of this Section if:
7            (A) the Board has determined that at least one
8        qualified dental plan is available to supplement the
9        plan's coverage; and
10            (B) the health carrier makes prominent disclosure
11        at the time it offers the plan, in a form approved by
12        the Board, that the plan does not provide the full
13        range of essential pediatric dental benefits and that
14        qualified dental plans providing those benefits and
15        other dental benefits not covered by the plan are
16        offered through the Exchange;
17        (2) obtain prior approval of premium rates and contract
18    language from the Department;
19        (3) provide at least the minimum level of coverage
20    prescribed by the Federal Act;
21        (4) ensure that the cost-sharing requirements of the
22    plan do not exceed the limits established under Section
23    1302(c)(l) of the Federal Act, and if the plan is offered
24    through the SHOP Exchange, the plan's deductible does not
25    exceed the limits established under Section 1302(c)(2) of
26    the Federal Act;



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



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1            (A) minimum standards in the areas of marketing
2        practices;
3            (B) network adequacy;
4            (C) essential community providers in underserved
5        areas;
6            (D) accreditation;
7            (E) quality improvement;
8            (F) uniform enrollment forms and descriptions of
9        coverage; and
10            (G) information on quality measures for health
11        benefit plan performance;
12        (7) be determined by the Board that making the plan
13    available through the Exchange is in the interest of
14    qualified individuals and qualified employers; and
15        (8) include all outpatient clinics in the health plan's
16    region that are controlled by an entity that also controls
17    a 340B eligible provider as defined by Section 340B(a)(4)
18    of the federal Public Health Service Act such that the
19    outpatient clinics are subject to the same mission,
20    policies, and medical standards related to the provision of
21    health care services as the 340B eligible provider.
22    (b) The Board shall not withhold certification from a
23health benefit plan:
24        (1) on the basis that the plan is a fee-for-service
25    plan;
26        (2) through the imposition of premium price controls by



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1    the Board; or
2        (3) on the basis that the health benefit plan provides
3    treatments necessary to prevent patients' deaths in
4    circumstances the Board determines are inappropriate or
5    too costly.
6    (c) The Board shall require each health carrier seeking
7certification of a plan as a qualified health plan to:
8        (1) submit a justification for any premium increase
9    before implementation of that increase, and prominently
10    post the information on its publicly accessible Internet
11    website;
12        (2) make available to the public, in plain language as
13    defined in Section 1311(e)(3)(B) of the Federal Act, and
14    submit to the Board, the Secretary, and the Department
15    accurate and timely disclosure of the following:
16                (i) claims payment policies and practices;
17                (ii) periodic financial disclosures;
18                (iii) data on enrollment;
19                (iv) data on disenrollment;
20                (v) data on the number of claims that are
21            denied;
22                (vi) data on rating practices;
23                (vii) information on cost-sharing and payments
24            with respect to any out-of-network coverage;
25                (viii) information on enrollee and participant
26            rights under Title I of the Federal Act; and



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



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1        (1) The health carrier shall be licensed to offer
2    dental coverage, but need not be licensed to offer other
3    health benefits.
4        (2) The plan shall be limited to dental and oral health
5    benefits, without substantially duplicating the benefits
6    typically offered by health benefit plans without dental
7    coverage and shall include, at a minimum, the essential
8    pediatric dental benefits prescribed by the Secretary
9    pursuant to Section 1302(b)(l)(J) of the Federal Act and
10    such other dental benefits as the Board or the Secretary
11    may specify by rule.
12        (3) Health carriers may jointly offer a comprehensive
13    plan through the Exchange in which the dental benefits are
14    provided by a health carrier through a qualified dental
15    plan and the other benefits are provided by a health
16    carrier through a qualified health plan, provided that the
17    plans are priced separately and are also made available for
18    purchase separately at the same price.
19    (215 ILCS 122/5-15)
20    Sec. 5-15. Illinois Health Benefits Exchange Legislative
21Oversight Study Committee.
22    (a) There is created an Illinois Health Benefits Exchange
23Legislative Oversight Study Committee within the Commission on
24Government Forecasting and Accountability to provide
25accountability for conduct a study regarding State



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1implementation and establishment of the Illinois Health
2Benefits Exchange and to ensure Exchange operations and
3functions align with the goals and duties outlined by this Law.
4The Committee shall also be responsible for providing policy
5recommendations to ensure the Exchange aligns with the Federal
6Act, amendments to the Federal Act, and regulations promulgated
7pursuant to the Federal Act.
8    (b) Members of the Legislative Oversight Study Committee
9shall be appointed as follows: 3 members of the Senate shall be
10appointed by the President of the Senate; 3 members of the
11Senate shall be appointed by the Minority Leader of the Senate;
123 members of the House of Representatives shall be appointed by
13the Speaker of the House of Representatives; and 3 members of
14the House of Representatives shall be appointed by the Minority
15Leader of the House of Representatives. Each legislative leader
16shall select one member to serve as co-chair of the committee.
17    (c) Members of the Legislative Oversight Study Committee
18shall be appointed no later than June 1, 2012 within 30 days
19after the effective date of this Law. The co-chairs shall
20convene the first meeting of the committee no later than 45
21days after the effective date of this Law.
22(Source: P.A. 97-142, eff. 7-14-11.)
23    (215 ILCS 122/5-16 new)
24    Sec. 5-16. Exchange governance. The governing and
25administrative powers of the Exchange shall be vested in a body



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1known as the Illinois Health Benefits Exchange Board. The
2following provisions shall apply:
3        (1) The Board shall consist of 11 voting members
4    appointed by the Governor with the advice and consent of a
5    majority of the members elected to the Senate. In addition,
6    the Director of Insurance, the Director of Healthcare and
7    Family Services, and the Executive Director of the Exchange
8    shall serve as non-voting, ex-officio members of the Board.
9    The Governor shall also appoint as non-voting, ex-officio
10    members one economist with experience in the health care
11    markets and one educated health care consumer advocate. All
12    Board members shall be appointed no later than January 1,
13    2013.
14        (2) The Governor shall make the appointments so as to
15    reflect no less than proportional representation of the
16    geographic, gender, cultural, racial, and ethnic
17    composition of this State and in accordance with
18    subparagraphs (A), (B), and (C) of this paragraph, as
19    follows:
20            (A) No more than one voting member may be an
21        individual who is employed by, a consultant to, or a
22        member of a board of directors of an insurer, a
23        third-party administrator, or an insurance producer.
24        No more than one voting member may be an individual who
25        is a member of a board of directors of a health care
26        provider, health care facility, or health clinic.



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1            (B) At least one board member must represent each
2        of the following interest groups:
3                (1) a labor interest group;
4                (2) a women's interest group;
5                (3) a minorities' interest group;
6                (4) a disabled persons' interest group;
7                (5) a small business interest group; and
8                (6) a public health interest group.
9            (C) Each person appointed to the Board should have
10        demonstrated expertise in no less than 2 of the
11        following areas:
12                (1) individual health insurance coverage;
13                (2) small employer health insurance;
14                (3) health benefits administration;
15                (4) health care finance;
16                (5) administration of a public or private
17            health care delivery system;
18                (6) the provision of health care services;
19                (7) the purchase of health insurance coverage;
20                (8) health care consumer navigation or
21        assistance;
22                (9) health care economics or health care
23        actuarial sciences;
24                (10) information technology; or
25                (11) starting a small business with 50 or fewer
26        employees.



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1        (3) The Board shall elect one voting member of the
2    Board to serve as chairperson and one voting member to
3    serve as vice-chairperson, upon approval of a majority of
4    the Board.
5        (4) The Exchange shall be administered by an Executive
6    Director, who shall be appointed, and may be removed, by a
7    majority of the Board. The Board shall have the power to
8    determine compensation for the Executive Director. The
9    Executive Director may not be a State employee or have been
10    employed by or have had a contract with the State in the 3
11    years prior to his or her appointment. The Executive
12    Director may not be nor have been an employee of an
13    insurance company.
14        (5) The terms of the non-voting, ex-officio members of
15    the Board shall run concurrent with their terms of
16    appointment to office, or in the case of the Executive
17    Director, his or her term of appointment to that position,
18    subject to the determination of the Board. The terms of the
19    members, including those non-voting, ex-officio members
20    appointed by the Governor, shall be 4 years. Each member of
21    the General Assembly identified in paragraph (1) of this
22    Section shall initially appoint one member to a 3-year
23    term, and one member to a 4-year term. Upon conclusion of
24    the initial term, the next term and every term subsequent
25    to it shall run for 3 years. Voting members shall serve no
26    more than 3 consecutive terms.



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1        A person appointed to fill a vacancy and complete the
2    unexpired term of a member of the Board shall only be
3    appointed to serve out the unexpired term by the individual
4    who made the original appointment within 45 days after the
5    initial vacancy. A person appointed to fill a vacancy and
6    complete the unexpired term of a member of the Board may be
7    re-appointed to the Board for another term, but shall not
8    serve than more than 2 consecutive terms following their
9    completion of the unexpired term of a member of the Board.
10        If a voting Board member's qualifications change due to
11    a change in employment during the term of their
12    appointment, then the Board member shall resign their
13    position, subject to reappointment by the individual who
14    made the original appointment.
15        (6) The Board shall, as necessary, create and appoint
16    qualified persons with requisite expertise to Exchange
17    technical advisory groups. These Exchange technical
18    advisory groups shall meet in a manner and frequency
19    determined by the Board to discuss exchange-related issues
20    and to provide exchange-related guidance, advice, and
21    recommendations to the Board and the Exchange. There shall
22    be at a minimum, 4 technical advisory groups, including the
23    following:
24            (1) an insurer advisory group;
25            (2) a business advisory group;
26            (3) a consumer advisory group; and



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1            (4) a provider advisory group.
2        (7) The Board shall meet no less than quarterly on a
3    schedule established by the chairperson. Meetings shall be
4    public and public records shall be maintained, subject to
5    the Open Meetings Act. A majority of the Board shall
6    constitute a quorum and the affirmative vote of a majority
7    is necessary for any action of the Board. No vacancy shall
8    impair the ability of the Board to act provided a quorum is
9    reached. Members shall serve without pay, but shall be
10    reimbursed for their actual and reasonable expenses
11    incurred in the performance of their duties. The
12    chairperson of the Board shall file a written report
13    regarding the activities of the Board and the Exchange to
14    the Governor and General Assembly annually, and the
15    Legislative Oversight Committee established in Section
16    5-15 quarterly, beginning on July 1, 2012 through December
17    31, 2014.
18        (8) The Board shall adopt conflict of interest rules
19    and recusal procedures. Such rules and procedures shall (i)
20    prohibit a member of the Board from performing an official
21    act that may have a direct economic benefit on a business
22    or other endeavor in which that member has a direct or
23    substantial financial interest and (ii) require a member of
24    the Board to recuse himself or herself from an official
25    matter, whether direct or indirect. All recusals must be in
26    advance, in writing, and specify the reason and date of the



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1    recusal. All recusals shall be maintained by the Executive
2    Director and shall be disclosed to any person upon written
3    request.
4        (9) The Board shall develop an initial budget for the
5    implementation and operation of the Exchange for fiscal
6    year 2014, fiscal year 2015, and fiscal year 2016 for
7    review and approval by the Governor and the General
8    Assembly. The initial budget shall include, but not be
9    limited to:
10            (A) proposed compensation levels for the Executive
11        Director and shall identify personnel and staffing
12        needs for the implementation and operation of the
13        Exchange;
14            (B) disclosure of funds received or expected to be
15        received from the federal government for the
16        infrastructure and systems of the Exchange and those
17        funds received or expected to be received for program
18        administration and operations; and
19            (C) delineation of those functions of the Exchange
20        that are to be paid by State and federal programs that
21        are allocable to the State's General Revenue Fund.
22        (10) The Board shall establish a revenue generating
23    plan that shall include annual assessments of all entities
24    authorized in this State to transact the types of insurance
25    enumerated in Class 1 of Section 4 of the Illinois
26    Insurance Code.



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1        (11) The purpose of the Board shall be to implement the
2    Exchange in accordance with this Section and shall be
3    authorized to establish procedures for the operation of the
4    Exchange, subject to legislative approval.
5    (215 ILCS 122/5-17 new)
6    Sec. 5-17. Illinois Health Benefits Exchange Fund. There
7is hereby created as a special fund outside of the State
8treasury the Illinois Health Benefits Exchange Fund to be used,
9subject to appropriation, exclusively by the Exchange to
10provide funding for the operation and administration of the
11Exchange in carrying out the purposes authorized in this Law.
12    (215 ILCS 122/5-21 new)
13    Sec. 5-21. Enrollment through brokers and agents; producer
15    (a) In accordance with Section 1312(e) of the Federal Act,
16the Exchange shall allow licensed insurance producers to (1)
17enroll qualified individuals in any qualified health plan, for
18which the individual is eligible, in the individual exchange,
19(2) assist qualified individuals in applying for premium tax
20credits and cost-sharing reductions for qualified health plans
21purchased through the individual exchange, and (3) enroll
22qualified employers in any qualified health plan, for which the
23employer is eligible, offered through the SHOP exchange.
24Nothing in this subsection (a) shall be construed as to require



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1a qualified individual or qualified employer to utilize a
2licensed insurance producer for any of the purposes outlined in
3this subsection (a).
4    (b) In order to enroll individuals and small employers in
5qualified health plans on the Exchange, licensed producers must
6complete a certification program. The Department of Insurance
7may develop and implement a certification program for licensed
8insurance producers who enroll individuals and employers in the
9exchange. The Department of Insurance may charge a reasonable
10fee, by regulation, to producers for the certification program.
11The Department of Insurance may approve certification programs
12developed and instructed by others, charging a reasonable fee,
13by regulation, for approval.
14    (c) The Exchange shall include on its Internet website a
15producer locator section, featured prominently, through which
16individuals and small employers can find exchange-certified
18    Section 99. Effective date. This Act takes effect upon
19becoming law.