Full Text of SB2885 97th General Assembly
SB2885enr 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 | | Section 5. The Health Care Purchasing Group Act is amended | 5 | | by changing Sections 10 and 15 as follows:
| 6 | | (215 ILCS 123/10)
| 7 | | Sec. 10. Definitions. Words and phrases used in this
Act, | 8 | | unless defined in this Section, have the meanings attributed to | 9 | | them in
Section 5 of the Illinois Health Insurance Portability | 10 | | and Accountability
Act.
| 11 | | "Director" means the Director of
Insurance.
| 12 | | "Employer" means an individual, sole proprietorship,
| 13 | | partnership, firm, corporation, association, or any other | 14 | | legal entity that has
one or more employees and is legally | 15 | | doing business in this State. "Employer" includes employers as | 16 | | defined in the Illinois Health Insurance Portability and | 17 | | Accountability Act. | 18 | | "Health insurance contract", "group or master health
| 19 | | insurance contract" and "insurance" refer to the forms of
| 20 | | insurance obligations which a "risk-bearer" as defined in this
| 21 | | Section has been authorized to issue.
| 22 | | "Risk-bearer" means an insurance company licensed in
this | 23 | | State and authorized to transact the kinds of business
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| 1 | | described in clause (b) of Class 1 and clause (a) of Class 2 of
| 2 | | Section 4 of the Illinois Insurance Code and
entities | 3 | | authorized under the Health Maintenance Organization
Act.
| 4 | | (Source: P.A. 90-337, eff. 1-1-98; 90-567, eff. 1-23-98.)
| 5 | | (215 ILCS 123/15)
| 6 | | Sec. 15. Health care purchasing groups; membership; | 7 | | formation.
| 8 | | (a) An HPG may be an organization formed by 2 or more
| 9 | | employers with no more than 2,500
500 covered employees each, | 10 | | an HPG sponsor or a
risk-bearer for purposes of
contracting for | 11 | | health insurance under this Act to cover
employees and | 12 | | dependents of HPG members. An HPG shall not be
prevented from | 13 | | supplementing health insurance coverage purchased
under this | 14 | | Act by contracting for services from entities licensed
and | 15 | | authorized in Illinois to provide those services under the
| 16 | | Dental Service Plan Act, the Limited Health Service | 17 | | Organization
Act, or Voluntary Health Services Plans Act.
An | 18 | | HPG may be a separate legal entity or simply a group of 2 or | 19 | | more employers
with no more than 2,500
500 covered employees | 20 | | each aggregated under this Act by an HPG
sponsor or risk-bearer | 21 | | for insurance purposes. There shall be no limit as to
the | 22 | | number of HPGs that may operate in any geographic area of the | 23 | | State. No
insurance risk may be borne or retained by the HPG. | 24 | | All health insurance
contracts issued to the HPG must be | 25 | | delivered or issued for delivery in
Illinois.
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| 1 | | (b) Members of an HPG must be Illinois domiciled employers, | 2 | | except that an
employer domiciled elsewhere may become a member | 3 | | of an Illinois HPG for the
sole purpose of insuring its | 4 | | employees whose place of employment is located
within this | 5 | | State. HPG membership may include employers having no more than | 6 | | 2,500
500 covered employees each.
| 7 | | (c) If an HPG is formed by any 2 or more employers with no | 8 | | more than 2,500
500 covered employees each, it shall utilize a | 9 | | licensed insurance producer is authorized to negotiate, | 10 | | solicit, market, obtain
proposals for, and enter into group or | 11 | | master health insurance contracts on
behalf of its members and | 12 | | their employees and employee dependents so long as
it meets all | 13 | | of the following requirements:
| 14 | | (1) The HPG must be an organization having the legal
| 15 | | capacity to contract and having its legal situs in | 16 | | Illinois.
| 17 | | (2) The principal persons responsible for the conduct | 18 | | of
the HPG must perform their HPG related functions in | 19 | | Illinois.
| 20 | | (3) No HPG may collect premium in its name or hold or | 21 | | manage premium or
claim fund accounts unless duly licensed | 22 | | and qualified as a managing general
agent pursuant to | 23 | | Section 141a of the Illinois Insurance Code or a third | 24 | | party
administrator pursuant to Section 511.105 of the | 25 | | Illinois Insurance Code.
| 26 | | (4) If the HPG gives an offer, application, notice, or |
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| 1 | | proposal of
insurance to an employer, it must disclose to | 2 | | that employer the total cost of
the insurance. Dues, fees, | 3 | | or charges to be paid to the HPG, HPG sponsor, or
any other | 4 | | entity as a condition to purchasing the insurance must be | 5 | | itemized.
The HPG shall also disclose to its members the | 6 | | amount of any dividends,
experience refunds, or other such | 7 | | payments it receives from the risk-bearer.
| 8 | | (5) An HPG must register with the Director before | 9 | | entering
into a group or master health insurance contract | 10 | | on behalf of
its members and must renew the registration | 11 | | annually on forms
and at times prescribed by the Director | 12 | | in rules
specifying, at minimum, (i) the identity of the | 13 | | officers and
directors, trustees, or attorney-in-fact of | 14 | | the HPG; (ii) a
certification that those persons have not | 15 | | been convicted of any
felony offense involving a breach of | 16 | | fiduciary duty or
improper manipulation of accounts; and | 17 | | (iii) the number of employer
members then enrolled in the | 18 | | HPG, together with any other
information that may be needed | 19 | | to carry out the purposes of
this Act.
| 20 | | (6) At the time of initial registration and each | 21 | | renewal
thereof an HPG shall pay a fee of $100 to the | 22 | | Director.
| 23 | | (d) If an HPG is formed by an HPG sponsor or risk-bearer
| 24 | | and the HPG performs
no marketing, negotiation, solicitation, | 25 | | or proposing of insurance to HPG
members, exclusive of | 26 | | ministerial acts performed by individual employers to
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| 1 | | their own employees, then a group or master health insurance | 2 | | contract
may be issued in the name of the HPG and held by an HPG | 3 | | sponsor, risk-bearer,
or designated employer member within the | 4 | | State. In these cases the HPG
requirements specified in | 5 | | subsection (c) shall not be applicable, however:
| 6 | | (1) the group or master health insurance contract must
| 7 | | contain a provision permitting the contract to be enforced
| 8 | | through legal action initiated by any employer member or by
| 9 | | an employee of an HPG member who has paid premium for the
| 10 | | coverage provided;
| 11 | | (2) the group or master health insurance contract must | 12 | | be
available for inspection and copying by any HPG member,
| 13 | | employee, or insured dependent at a designated location
| 14 | | within the State at all normal business hours; and
| 15 | | (3) any information concerning HPG membership required | 16 | | by rule under item
(5) of subsection (c) must be provided | 17 | | by the HPG sponsor in its registration
and renewal forms or | 18 | | by the risk-bearer in its annual reports.
| 19 | | (Source: P.A. 90-337, eff. 1-1-98; 90-655, eff. 7-30-98; | 20 | | 91-617, eff. 1-1-00.)
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