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Public Act 102-0159


 

Public Act 0159 102ND GENERAL ASSEMBLY



 


 
Public Act 102-0159
 
SB1087 EnrolledLRB102 04910 CPF 14929 b

    AN ACT concerning regulation.
 
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
 
    Section 5. The Department of Insurance Law of the Civil
Administrative Code of Illinois is amended by adding Section
1405-40 as follows:
 
    (20 ILCS 1405/1405-40 new)
    Sec. 1405-40. Transfer of the Illinois Comprehensive
Health Insurance Plan. Upon entry of an Order of
Rehabilitation or Liquidation against the Comprehensive Health
Insurance Plan in accordance with Article XIII of the Illinois
Insurance Code, all powers, duties, rights, and
responsibilities of the Illinois Comprehensive Health
Insurance Plan and the Illinois Comprehensive Health Insurance
Board under the Comprehensive Health Insurance Plan Act shall
be transferred to and vested in the Director of Insurance as
rehabilitator or liquidator as provided in the provisions of
this amendatory Act of the 102nd General Assembly.
 
    Section 10. The Comprehensive Health Insurance Plan Act is
amended by changing Sections 1.1, 3, and 15 and by adding
Sections 16 and 17 as follows:
 
    (215 ILCS 105/1.1)  (from Ch. 73, par. 1301.1)
    Sec. 1.1. The General Assembly hereby makes the following
findings and declarations:
        (a) The Comprehensive Health Insurance Plan is
    established as a State program that is intended to provide
    an alternate market for health insurance for certain
    uninsurable Illinois residents, and further is intended to
    provide an acceptable alternative mechanism as described
    in the federal Health Insurance Portability and
    Accountability Act of 1996 for providing portable and
    accessible individual health insurance coverage for
    federally eligible individuals as defined in this Act.
        (b) The State of Illinois may subsidize the cost of
    health insurance coverage offered by the Plan. However,
    since the State has only a limited amount of resources,
    the General Assembly declares that it intends for this
    program to provide portable and accessible individual
    health insurance coverage for every federally eligible
    individual who qualifies for coverage in accordance with
    Section 15 of this Act, but does not intend for every
    eligible person who qualifies for Plan coverage in
    accordance with Section 7 of this Act to be guaranteed a
    right to be issued a policy under this Plan as a matter of
    entitlement.
        (c) The Comprehensive Health Insurance Plan Board
    shall operate the Plan in a manner so that the estimated
    cost of the program during any fiscal year will not exceed
    the total income it expects to receive from policy
    premiums, investment income, assessments, or fees
    collected or received by the Board and other funds which
    are made available from appropriations for the Plan by the
    General Assembly for that fiscal year.
    With the implementation of the federal Patient Protection
and Affordable Care Act, the Plan shall discontinue as the
alternative market for health insurance for certain Illinois
residents and discontinue as the alternative mechanism, as
described in the federal Health Insurance Portability and
Accountability Act of 1996, effective no later than January 1,
2022.
(Source: P.A. 90-30, eff. 7-1-97.)
 
    (215 ILCS 105/3)  (from Ch. 73, par. 1303)
    Sec. 3. Operation of the Plan.
    a. There is hereby created an Illinois Comprehensive
Health Insurance Plan.
    b. The Plan shall operate subject to the supervision and
control of the Board. The Board is created as a political
subdivision and body politic and corporate and, as such, is
not a State agency. The Board shall consist of 10 public
members, appointed by the Governor with the advice and consent
of the Senate.
    Initial members shall be appointed to the Board by the
Governor as follows: 2 members to serve until July 1, 1988, and
until their successors are appointed and qualified; 2 members
to serve until July 1, 1989, and until their successors are
appointed and qualified; 3 members to serve until July 1,
1990, and until their successors are appointed and qualified;
and 3 members to serve until July 1, 1991, and until their
successors are appointed and qualified. As terms of initial
members expire, their successors shall be appointed for terms
to expire the first day in July 3 years thereafter, and until
their successors are appointed and qualified.
    Any vacancy in the Board occurring for any reason other
than the expiration of a term shall be filled for the unexpired
term in the same manner as the original appointment.
    Any member of the Board may be removed by the Governor for
neglect of duty, misfeasance, malfeasance, or nonfeasance in
office.
    In addition, a representative of the Governor's Office of
Management and Budget, a representative of the Office of the
Attorney General and the Director or the Director's designated
representative shall be members of the Board. Four members of
the General Assembly, one each appointed by the President and
Minority Leader of the Senate and by the Speaker and Minority
Leader of the House of Representatives, shall serve as
nonvoting members of the Board. At least 2 of the public
members shall be individuals reasonably expected to qualify
for coverage under the Plan, the parent or spouse of such an
individual, or a surviving family member of an individual who
could have qualified for the Plan during his lifetime. The
Director or Director's representative shall be the chairperson
of the Board. Members of the Board shall receive no
compensation, but shall be reimbursed for reasonable expenses
incurred in the necessary performance of their duties.
    c. The Board shall make an annual report in September and
shall file the report with the Secretary of the Senate and the
Clerk of the House of Representatives. The report shall
summarize the activities of the Plan in the preceding calendar
year, including net written and earned premiums, the expense
of administration, the paid and incurred losses for the year
and other information as may be requested by the General
Assembly. The report shall also include analysis and
recommendations regarding utilization review, quality
assurance and access to cost effective quality health care.
    d. In its plan of operation the Board shall:
        (1) Establish procedures for selecting a Plan
    administrator in accordance with Section 5 of this Act.
        (2) Establish procedures for the operation of the
    Board.
        (3) Create a Plan fund, under management of the Board,
    to fund administrative, claim, and other expenses of the
    Plan.
        (4) Establish procedures for the handling and
    accounting of assets and monies of the Plan.
        (5) Develop and implement a program to publicize the
    existence of the Plan, the eligibility requirements and
    procedures for enrollment and to maintain public awareness
    of the Plan.
        (6) Establish procedures under which applicants and
    participants may have grievances reviewed by a grievance
    committee appointed by the Board. The grievances shall be
    reported to the Board immediately after completion of the
    review. The Department and the Board shall retain all
    written complaints regarding the Plan for at least 3
    years. Oral complaints shall be reduced to written form
    and maintained for at least 3 years.
        (7) Provide for other matters as may be necessary and
    proper for the execution of its powers, duties and
    obligations under the Plan.
    e. No later than 5 years after the Plan is operative the
Board and the Department shall conduct cooperatively a study
of the Plan and the persons insured by the Plan to determine:
(1) claims experience including a breakdown of medical
conditions for which claims were paid; (2) whether
availability of the Plan affected employment opportunities for
participants; (3) whether availability of the Plan affected
the receipt of medical assistance benefits by Plan
participants; (4) whether a change occurred in the number of
personal bankruptcies due to medical or other health related
costs; (5) data regarding all complaints received about the
Plan including its operation and services; (6) and any other
significant observations regarding utilization of the Plan.
The study shall culminate in a written report to be presented
to the Governor, the President of the Senate, the Speaker of
the House and the chairpersons of the House and Senate
Insurance Committees. The report shall be filed with the
Secretary of the Senate and the Clerk of the House of
Representatives. The report shall also be available to members
of the general public upon request.
    (e-5) The Board shall conduct a feasibility study of
establishing a small employer health insurance pool in which
employers may provide affordable health insurance coverage to
their employees. The Board may contract with a private entity
or enter into intergovernmental agreements with State agencies
for the completion of all or part of the study. The study
shall:
        (i) Analyze other states' experience in establishing
    small employer health insurance pools;
        (ii) Assess the need for a small employer health
    insurance pool, including the number of individuals who
    might benefit from it;
        (iii) Recommend means of establishing a small employer
    health insurance pool; and
        (iv) Estimate the cost of providing a small employer
    health insurance pool through the Illinois Comprehensive
    Health Insurance Plan or another, public or private
    entity.
    The Board may accept donations, in trust, from any legal
source, public or private, for deposit into a trust account
specifically created for expenditure, without the necessity of
being appropriated, solely for the purpose of conducting all
or part of the study. The Board shall issue a report with
recommendations to the Governor and the General Assembly by
January 1, 2005. As used in this subsection e-5, "small
employer" means an employer having between one and 50
employees.
    f. The Board may:
        (1) Prepare and distribute certificate of eligibility
    forms and enrollment instruction forms to insurance
    producers and to the general public in this State.
        (2) Provide for reinsurance of risks incurred by the
    Plan and enter into reinsurance agreements with insurers
    to establish a reinsurance plan for risks of coverage
    described in the Plan, or obtain commercial reinsurance to
    reduce the risk of loss through the Plan.
        (3) Issue additional types of health insurance
    policies to provide optional coverages as are otherwise
    permitted by this Act including a Medicare supplement
    policy designed to supplement Medicare.
        (4) Provide for and employ cost containment measures
    and requirements including, but not limited to,
    preadmission certification, second surgical opinion,
    concurrent utilization review programs, and individual
    case management for the purpose of making the pool more
    cost effective.
        (5) Design, utilize, contract, or otherwise arrange
    for the delivery of cost effective health care services,
    including establishing or contracting with preferred
    provider organizations, health maintenance organizations,
    and other limited network provider arrangements.
        (6) Adopt bylaws, rules, regulations, policies and
    procedures as may be necessary or convenient for the
    implementation of the Act and the operation of the Plan.
        (7) Administer separate pools, separate accounts, or
    other plans or arrangements as required by this Act to
    separate federally eligible individuals or groups of
    federally eligible individuals who qualify for Plan
    coverage under Section 15 of this Act from eligible
    persons or groups of eligible persons who qualify for Plan
    coverage under Section 7 of this Act and apportion the
    costs of the administration among such separate pools,
    separate accounts, or other plans or arrangements.
    g. The Director may, by rule, establish additional powers
and duties of the Board and may adopt rules for any other
purposes, including the operation of the Plan, as are
necessary or proper to implement this Act.
    h. The Board is not liable for any obligation of the Plan.
There is no liability on the part of any member or employee of
the Board, or the Department, or the Director, both as
regulator and as rehabilitator or liquidator, and no cause of
action of any nature may arise against them, for any action
taken or omission made by them in the performance of their
powers and duties under this Act, unless the action or
omission constitutes willful or wanton misconduct. The Board
may provide in its bylaws or rules for indemnification of, and
legal representation for, its members and employees.
    i. There is no liability on the part of any insurance
producer for the failure of any applicant to be accepted by the
Plan unless the failure of the applicant to be accepted by the
Plan is due to an act or omission by the insurance producer
which constitutes willful or wanton misconduct.
    j. Not later than 60 days after the effective date of this
amendatory Act of the 102nd General Assembly, the Board shall
develop a plan of rehabilitation or liquidation and
dissolution, including the consent of a majority of the Board
to the entry of an order of rehabilitation or liquidation, to
wind down the affairs of the Plan, including details for the
transition to other health plans of any persons currently
enrolled in the Plan, for presentation to and approval by the
Director. Upon the Director's approval of the plan of
rehabilitation or liquidation and dissolution, the Director
shall thereafter report to the Attorney General of this State,
whose duty it shall be to file a complaint for rehabilitation
or liquidation of the Plan pursuant to the provisions of
Article XIII of the Illinois Insurance Code. Upon entry of a
final Order of Rehabilitation or Liquidation and the
Director's appointment as statutory rehabilitator or
liquidator, the Director shall begin to administer and oversee
the wind-down and dissolution of the Plan in accordance with
the provisions of Article XIII.
(Source: P.A. 92-597, eff. 6-28-02; 93-622, eff. 12-18-03;
93-824, eff. 7-28-04.)
 
    (215 ILCS 105/15)
    Sec. 15. Alternative portable coverage for federally
eligible individuals.
    (a) Notwithstanding the requirements of subsection a of
Section 7 and except as otherwise provided in this Section,
any federally eligible individual for whom a Plan application,
and such enclosures and supporting documentation as the Board
may require, is received by the Board within 90 days after the
termination of prior creditable coverage shall qualify to
enroll in the Plan under the portability provisions of this
Section.
    A federally eligible person who has been certified as
eligible pursuant to the federal Trade Act of 2002 and whose
Plan application and enclosures and supporting documentation
as the Board may require is received by the Board within 63
days after the termination of previous creditable coverage
shall qualify to enroll in the Plan under the portability
provisions of this Section.
    (b) Any federally eligible individual seeking Plan
coverage under this Section must submit with his or her
application evidence, including acceptable written
certification of previous creditable coverage, that will
establish to the Board's satisfaction, that he or she meets
all of the requirements to be a federally eligible individual
and is currently and permanently residing in this State (as of
the date his or her application was received by the Board).
    (c) Except as otherwise provided in this Section, a period
of creditable coverage shall not be counted, with respect to
qualifying an applicant for Plan coverage as a federally
eligible individual under this Section, if after such period
and before the application for Plan coverage was received by
the Board, there was at least a 90-day period during all of
which the individual was not covered under any creditable
coverage.
    For a federally eligible person who has been certified as
eligible pursuant to the federal Trade Act of 2002, a period of
creditable coverage shall not be counted, with respect to
qualifying an applicant for Plan coverage as a federally
eligible individual under this Section, if after such period
and before the application for Plan coverage was received by
the Board, there was at least a 63-day period during all of
which the individual was not covered under any creditable
coverage.
    (d) Any federally eligible individual who the Board
determines qualifies for Plan coverage under this Section
shall be offered his or her choice of enrolling in one of
alternative portability health benefit plans which the Board
is authorized under this Section to establish for these
federally eligible individuals and their dependents.
    (e) The Board shall offer a choice of health care
coverages consistent with major medical coverage under the
alternative health benefit plans authorized by this Section to
every federally eligible individual. The coverages to be
offered under the plans, the schedule of benefits,
deductibles, co-payments, exclusions, and other limitations
shall be approved by the Board. One optional form of coverage
shall be comparable to comprehensive health insurance coverage
offered in the individual market in this State or a standard
option of coverage available under the group or individual
health insurance laws of the State. The standard benefit plan
that is authorized by Section 8 of this Act may be used for
this purpose. The Board may also offer a preferred provider
option and such other options as the Board determines may be
appropriate for these federally eligible individuals who
qualify for Plan coverage pursuant to this Section.
    (f) Notwithstanding the requirements of subsection f of
Section 8, any Plan coverage that is issued to federally
eligible individuals who qualify for the Plan pursuant to the
portability provisions of this Section shall not be subject to
any preexisting conditions exclusion, waiting period, or other
similar limitation on coverage.
    (g) Federally eligible individuals who qualify and enroll
in the Plan pursuant to this Section shall be required to pay
such premium rates as the Board shall establish and approve in
accordance with the requirements of Section 7.1 of this Act.
    (h) A federally eligible individual who qualifies and
enrolls in the Plan pursuant to this Section must satisfy on an
ongoing basis all of the other eligibility requirements of
this Act to the extent not inconsistent with the federal
Health Insurance Portability and Accountability Act of 1996 in
order to maintain continued eligibility for coverage under the
Plan.
    (i) New enrollment and policy renewals are discontinued on
December 31, 2021.
(Source: P.A. 100-201, eff. 8-18-17.)
 
    (215 ILCS 105/16 new)
    Sec. 16. Cessation of operations.
    (a) Except as otherwise provided in this Section, the
insurance operations of the Plan authorized by this Act shall
cease on December 31, 2021.
    (b) Coverage under the Plan does not apply to services
provided on or after January 1, 2022.
    (c) The Plan shall cease providing coverage for
participants enrolled prior to January 1, 2022 at 11:59 p.m.
on December 31, 2021.
    (d) A claim for payment under the Plan must be submitted
within 180 days after January 1, 2022 and paid in accordance
with the provisions of Article XIII of the Illinois Insurance
Code.
    (e) Any claim or grievance shall be resolved by the court
supervising the Plan's Article XIII rehabilitation or
liquidation proceedings.
    (f) Balance billing by a health care provider that is not a
member of the provider network used by the Plan is prohibited.
    (g) The Board shall, not later than 60 days after the
effective date of this amendatory Act of the 102nd General
Assembly, submit to the Director a plan of rehabilitation or
liquidation and dissolution, which must provide for, but shall
not be limited to, the following:
        (1) continuity of care for an individual who is
    covered under the Plan and is an inpatient on January 1,
    2022;
        (2) a final accounting of assessments;
        (3) resolution of any net asset deficiency;
        (4) cessation of all liability of the Plan; and
        (5) final dissolution of the Plan.
    (h) The plan of rehabilitation or liquidation and
dissolution may provide that, with the approval of the
Director, a power or duty of the Plan may be delegated to a
person that is to perform functions similar to the functions
of the Plan.
    (i) Upon entry of an Order of Rehabilitation or
Liquidation against the Plan, the court supervising the
rehabilitation or liquidation proceedings shall have the
jurisdiction to issue injunctions as set forth in Section 189
of the Illinois Insurance Code, including, but not limited to,
the restraining of all persons, companies, and entities from
bringing or further prosecuting all actions and proceedings at
law or in equity or otherwise, whether in this State or
elsewhere, against the Plan or its assets or property or the
Director except insofar as those actions or proceedings arise
in or are brought in the rehabilitation or liquidation
proceedings.
    (j) Upon the entry of an order of rehabilitation or
liquidation, the rights and liabilities of the Plan and of its
policyholders and all other persons interested in its assets
shall be fixed as of the date of entry of the order directing
rehabilitation or liquidation, or such later date as may be
provided by order of the court supervising the rehabilitation
or liquidation proceedings.
    (k) Upon the satisfaction of all claims allowed in the
rehabilitation or liquidation proceedings, including the costs
and expenses of administering the rehabilitation or
liquidation, any remaining funds shall be distributed as
follows:
        (1) for the accounts described in paragraph (2) of
    subsection (l) of Section 4, all funds shall be refunded
    on a pro rata basis to the insurers that were assessed
    based on the most recent deficit projections of the Plan's
    operation pursuant to Section 12 and to covered persons
    where appropriate; and
        (2) for all other accounts, all remaining funds shall
    be released and deposited into the Insurance Producer
    Administration Fund for use by the Department for
    initiatives to support the Illinois Health Benefits
    Exchange.
    (l) Upon the entry of an Order of Rehabilitation or
Liquidation against the Plan, if the Director determines the
Plan is holding any surplus funds in a segregated account
associated with persons who qualified for coverage under
Section 7 that are no longer required for the purposes for
which they were acquired and are restricted from any other
use, the Director may petition the court for such funds to be
released and placed as follows:
        (1) the first $10,000,000 shall be deposited into the
    Insurance Producer Administration Fund for use by the
    Department for initiatives to support the Illinois Health
    Benefits Exchange; and
        (2) the remainder shall be deposited into the Parity
    Advancement Fund.
 
    (215 ILCS 105/17 new)
    Sec. 17. Transfer of the Illinois Comprehensive Health
Insurance Plan.
    (a) Upon entry of an Order of Rehabilitation or
Liquidation against the Plan all powers, duties, rights, and
responsibilities of the Plan and the Board shall be
transferred to and vested in the Director, as rehabilitator or
liquidator, who is authorized to wind down the affairs of the
Plan in accordance with Article XIII of the Illinois Insurance
Code.
    (b) The Director, as rehabilitator or liquidator, shall
act on behalf of the Plan and the Board and shall have the
power and duty to receive and answer correspondence, and shall
evaluate all claims that are timely filed in the
rehabilitation or liquidation proceedings and is authorized to
make distribution from any unencumbered funds of the Plan's
rehabilitation or liquidation estate upon all such claims as
are allowed in the proceedings consistent with subsection (1)
of Section 205 of the Illinois Insurance Code. Timely filed
claims of vendors allowed in the rehabilitation or liquidation
proceedings that are not capable of being discharged, in full,
from the assets of the rehabilitation or liquidation estate
may be presented to the Court of Claims.
    (c) All books, records, papers, documents, property (real
and personal), contracts, causes of action, and pending
business pertaining to the powers, duties, rights, and
responsibilities transferred by this amendatory Act of the
102nd General Assembly from the Plan and the Board to the
Director, as rehabilitator or liquidator, including, but not
limited to, material in electronic or magnetic format and
necessary computer hardware and software, shall be transferred
to the Director, as rehabilitator or liquidator. Records shall
be maintained as required by the federal Health Insurance
Portability and Accountability Act of 1996, as now or
hereafter amended, unless otherwise ordered by the court
supervising the rehabilitation or liquidation proceedings.
    (d) The rights of the employees in the State of Illinois
and its agencies under the Personnel Code and applicable
collective bargaining agreements or under any pension,
retirement, or annuity plan shall not be affected by this
amendatory Act of the 102nd General Assembly.
    (e) Upon entry of an Order of Rehabilitation or
Liquidation against the Plan, all unexpended appropriations
and balances and other funds available for use by the Plan and
the Board shall be transferred to and vested in the Director,
as rehabilitator or liquidator. Except as provided in
subsection (l) of Section 16, unexpended balances so
transferred shall be distributed in accordance with Article
XIII of the Illinois Insurance Code for paying the Director's
administrative expenses incurred in connection with winding
down the affairs of the Plan.
    (f) Whenever reports or notices are, on the effective date
of this amendatory Act of the 102nd General Assembly, required
to be made or given or papers or documents furnished or served
by any person to or upon the Plan or the Board in connection
with any of the powers, duties, rights, and responsibilities
transferred by this amendatory Act of the 102nd General
Assembly, the same shall be made, given, furnished, or served
in the same manner to or upon the Director, as rehabilitator or
liquidator.
    (g) This amendatory Act of the 102nd General Assembly does
not affect any act done, ratified, or canceled or any right
occurring or established or any action or proceeding had or
commenced in the administrative, civil, or criminal cause by
the Plan or the Board prior to the entry of an Order of
Rehabilitation or Liquidation against the Plan; such actions
or proceedings may be prosecuted and continued by the
Director, as rehabilitator or liquidator.
 
    Section 99. Effective date. This Act takes effect upon
becoming law.

Effective Date: 7/23/2021