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Public Act 102-0462


 

Public Act 0462 102ND GENERAL ASSEMBLY

  
  
  

 


 
Public Act 102-0462
 
HB3175 EnrolledLRB102 16868 BMS 22274 b

    AN ACT concerning regulation.
 
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
 
    Section 5. The Illinois Insurance Code is amended by
changing Section 356z.17 as follows:
 
    (215 ILCS 5/356z.17)
    Sec. 356z.17. Wellness coverage.
    (a) A group or individual policy of accident and health
insurance or managed care plan amended, delivered, issued, or
renewed after January 1, 2010 (the effective date of Public
Act 96-639) that provides coverage for hospital or medical
treatment on an expense incurred basis may offer a reasonably
designed program for wellness coverage that allows for a
reward, a contribution, a reduction in premiums or reduced
medical, prescription drug, or equipment copayments,
coinsurance, or deductibles, or a combination of these
incentives, for participation in any health behavior wellness,
maintenance, or improvement program approved or offered by the
insurer or managed care plan. The insured or enrollee may be
required to provide evidence of participation in a program.
Individuals unable to participate in these incentives due to
an adverse health factor shall not be penalized based upon an
adverse health status.
    (b) For purposes of this Section, "wellness coverage"
means health care coverage with the primary purpose to engage
and motivate the insured or enrollee through: incentives;
provision of health education, counseling, and self-management
skills; identification of modifiable health risks; and other
activities to influence health behavior changes.
    For the purposes of this Section, "reasonably designed
program" means a program of wellness coverage that has a
reasonable chance of improving health or preventing disease;
is not overly burdensome; does not discriminate based upon
factors of health; and is not otherwise contrary to law.
    (c) Incentives as outlined in this Section are specific
and unique to the offering of wellness coverage and have no
application to any other required or optional health care
benefit.
    (d) Such wellness coverage must satisfy the requirements
for an exception from the general prohibition against
discrimination based on a health factor under the federal
Health Insurance Portability and Accountability Act of 1996
(P.L. 104-191; 110 Stat. 1936), including any federal
regulations that are adopted pursuant to that Act.
    (e) A plan offering wellness coverage must do the
following:
        (i) give participants the opportunity to qualify for
    offered incentives at least once a year;
        (ii) allow a reasonable alternative to any individual
    for whom it is unreasonably difficult, due to a medical
    condition, to satisfy otherwise applicable wellness
    program standards. Plans may seek physician verification
    that health factors make it unreasonably difficult or
    medically inadvisable for the participant to satisfy the
    standards; and
        (iii) not provide a total incentive that exceeds 30%
    20% of the cost of self-only or employee-only coverage,
    except that the incentive may be increased by up to an
    additional 20%, for a total incentive of 50%, to the
    extent that the additional percentage is in connection
    with a program designed to prevent or reduce tobacco use.
    The cost of employee-only or family coverage provided
    through group health insurance coverage includes both
    employer and employee contributions. For group or
    individual plans offering family coverage, the 20%
    limitation applies to cost of family coverage and applies
    to the entire family.
    (f) A reward, contribution, or reduction established under
this Section and included in the policy or certificate does
not violate Section 151 of this Code.
(Source: P.A. 96-639, eff. 1-1-10; 96-833, eff. 6-1-10.)
 
    Section 10. The Navigator Certification Act is amended by
changing Sections 5, 10, 15, 30, 35, and 45 as follows:
 
    (215 ILCS 121/5)
    Sec. 5. Definitions. As used in this Act:
    "Certified application counselor" has the same meaning as
in federal regulations and guidelines, including 45 CFR
155.225.
    "Director" means the Director of Insurance.
    "Exchange" means any health benefit exchange established
or operating in this State, including any exchange established
or operated by the United States Department of Health and
Human Services.
    "Navigator" means a person or entity selected to perform
the activities and duties identified in 42 U.S.C. 18031(i) in
this State. "Navigator" includes any person or entity who
receives grant funds from the United States Department of
Health and Human Services, the State of Illinois, or an
exchange or private funds to perform any of the activities and
duties identified in 42 U.S.C. 18031(i), including, but not
limited to, in-person assisters as defined by federal
regulations or guidelines.
(Source: P.A. 98-524, eff. 8-23-13.)
 
    (215 ILCS 121/10)
    Sec. 10. Certificate required.
    (a) No individual or entity shall perform, offer to
perform, or advertise any service as a navigator or certified
application counselor in this State or receive navigator grant
funding from the United States Department of Health and Human
Services, the State of Illinois, or an exchange or private
funds unless certified as a navigator or certified application
counselor by the Director under this Act.
    (b) The Director may establish exemptions from
certification by rule. A navigator who complies with the
requirements of this Act shall do the following:
        (1) conduct public education activities to raise
    awareness of the availability of qualified health plans;
        (2) distribute fair and impartial information
    concerning enrollment in qualified health plans offered
    within the exchange and the availability of the premium
    tax credits under Section 36B of the Internal Revenue Code
    of 1986, 26 U.S.C. 36B, and cost-sharing reductions under
    Section 1402 of the federal Patient Protection and
    Affordable Care Act;
        (3) facilitate enrollment in qualified health plans;
        (4) provide referrals to appropriate federal and State
    agencies for any enrollee with a grievance, complaint, or
    question regarding their health plan or coverage or a
    determination under such plan or coverage;
        (5) provide information in a manner that is culturally
    and linguistically appropriate to the needs of the
    population being served by the exchange.
    (c) A navigator or certified application counselor may
not:
        (1) sell, solicit, or negotiate, as these terms are
    defined in Section 500-10 of the Illinois Insurance Code,
    any of the classes of insurance enumerated in Section 4 of
    the Illinois Insurance Code;
        (2) offer advice about which health plan is better or
    worse for a particular individual or employer;
        (3) recommend or endorse a particular health plan or
    advise consumers about which health plan to choose;
        (4) provide any information or services related to
    health benefit plans or other insurance products not
    offered in the exchange, except for health care providers
    when furnishing information or services related to a
    patient's existing health benefit plan or other existing
    health insurance coverage; or
        (5) accept any compensation or consideration, directly
    or indirectly, from any issuer of accident and health
    insurance or stop-loss insurance that is dependent, in
    whole or in part, on whether a person enrolls in or
    purchases a particular private health benefit plan; or .
        (6) engage in an unfair method of competition or a
    fraudulent, deceptive, or dishonest act or practice with
    respect to the health insurance marketplace or with
    respect to that individual's or entity's absence of a
    conflict of interest in connection with the enrollment of
    an individual or employee in a particular private health
    benefit plan.
    (d) Items (1), (2), (3), (4), and (5) of subsection (c) of
this Section do not apply to navigators or certified
application counselors when assisting individuals with the
enrollment process in the State Medicaid program or other
public programs.
(Source: P.A. 98-524, eff. 8-23-13.)
 
    (215 ILCS 121/15)
    Sec. 15. Application for certificate.
    (a) An entity or individual applying for an initial or
renewal a navigator or certified application counselor
certificate shall make application to the Director on a form
developed by the Director and declare under penalty of
refusal, suspension, or revocation of the certificate that the
statements made in the application are true, correct, and
complete to the best of the individual's or entity's knowledge
and belief. Before approving the application, the Director
shall find that the individual:
        (1) is at least 18 years of age;
        (2) resides in this State or maintains his or her
    principal place of business in this State;
        (3) is not disqualified due to having committed any
    act that would be grounds for denial, suspension, or
    revocation of a navigator certification in accordance with
    Section 30 of this Act;
        (4) has successfully completed the federal and State
    training provided by the exchange or equivalent State
    requirements as determined by the Department; and
        (5) when applicable, has the written consent of the
    Director pursuant to 18 U.S.C. 1033, or any successor
    statute regulating crimes by or affecting persons engaged
    in the business of insurance whose activities affect
    interstate commerce.
    (b) The Director shall establish certification terms and
requirements for completed applications, including educational
requirements, by rule. An entity that acts as a navigator,
supervises the activities of individual navigators, or
receives funding to perform such activities shall obtain a
navigator entity certificate. An entity applying for a
navigator entity certificate shall make application on a form
containing the information prescribed by the Director and
shall list the individuals acting as navigators under the
entity certificate.
        (1) The entity shall designate a certified navigator
    responsible for the navigator entity's compliance with the
    laws of this State and the exchange.
        (2) The entity, under penalty of revocation,
    suspension, or other discipline prescribed by the
    Director, shall certify that each individual completes the
    mandatory training required by item (4) of subsection (a)
    of Section 15 of this Act.
    (c) The Director may require any documents deemed
necessary to verify the information contained in an
application submitted in accordance with subsections (a) and
(b) of this Section.
    (d) Any navigator or certified application counselor who
fails to timely file for certificate renewal shall be charged
a late fee in an amount prescribed by the Director Entities
certified as navigators shall provide the Director with a list
of all individual navigators that it employs, supervises, or
is affiliated with at renewal.
    (e) The Director may require, in a manner determined by
the Director, that each entity that acts as a navigator or
certified application counselor demonstrate a level of
financial responsibility capable of protecting all persons
against the wrongful acts, misrepresentations, or negligence
of the navigator or certified application counselor.
    (f) Prior to any exchange becoming operational in this
State, the Director, in coordination with the exchange, shall
prescribe the initial training and continuing education
requirements for navigators and certified application
counselors.
    (g) Certificate holders must inform the Director, in
writing, of a change of address within 30 days after the
change.
    (h) In order to assist in the performance of the
Director's duties, the Director may contract with the National
Association of Insurance Commissioners (NAIC), or any
affiliates or subsidiaries that the NAIC oversees, to perform
any ministerial functions, including the collection of fees,
related to certification that the Director and the
nongovernmental entity may deem appropriate.
(Source: P.A. 98-524, eff. 8-23-13.)
 
    (215 ILCS 121/30)
    Sec. 30. Certificate denial, nonrenewal, or revocation.
    (a) The Director may place on probation, suspend, revoke,
or refuse to issue or renew a navigator or certified
application counselor navigator's certificate or may levy a
civil penalty as established by rule.
    (b) If an action by the Director is to nonrenew, suspend,
or revoke a certificate or to deny an application for a
certificate, then the Director shall notify the applicant or
certificate holder and advise, in writing, the applicant or
certificate holder of the reason for the suspension,
revocation, or denial or nonrenewal of the applicant's or
certificate holder's certificate. The applicant or certificate
holder may make written demand upon the Director within 30
days after the date of mailing for a hearing before the
Director to determine the reasonableness of the Director's
action. The hearing must be held within not fewer than 20 days
nor more than 30 days after the mailing of the notice of
hearing and shall be held pursuant to Part 2402 of Title 50 of
the Illinois Administrative Code.
    (c) A navigator or certified application counselor entity
certificate may be suspended, revoked, or refused or
information turned over to the U.S. Department of Health and
Human Services and applicable state agencies if the Director
finds, after hearing, that a certified individual's violation
was known or should have been known by one or more of the
partners, officers, or managers acting on behalf of the
navigator entity.
    (d) In addition to or instead of any applicable denial,
suspension, or revocation of a certificate, a person may,
after hearing, be subject to a civil penalty in accordance
with emergency rules issued by the Director.
    (e) The Director has the authority to enforce the
provisions of and impose any penalty or remedy authorized by
this Act against any person who is under investigation of or
charged with a violation of this Act or rules, even if the
person's certificate has been surrendered or has lapsed by
operation of law.
    (f) Upon the suspension, denial, or revocation of a
certificate, the certificate holder or other person having
possession or custody of the certificate shall promptly
deliver it to the Director in person or by mail. The Director
shall publish all suspensions, denials, or revocations after
the suspensions, denials, or revocations become final in a
manner designed to notify the public.
    (g) A person whose certificate is revoked or whose
application is denied pursuant to this Section is ineligible
to apply for any certificate for 3 years after the revocation
or denial. A person whose certificate as a navigator or
certified application counselor has been revoked, suspended,
or denied may not be employed, contracted, or engaged in an
exchange-related capacity during the time the revocation,
suspension, or denial is in effect.
(Source: P.A. 98-524, eff. 8-23-13.)
 
    (215 ILCS 121/35)
    Sec. 35. Reporting to the Director.
    (a) Each navigator or certified application counselor
shall report to the Director within 30 calendar days after the
final disposition of a matter that violates the provisions set
forth in this Act that results in any administrative action
taken against the navigator or certified application counselor
him in another jurisdiction or by another governmental agency
in this State. The report shall include a copy of the order,
consent to order, or other relevant legal documents.
    (b) Within 30 days after the initial pretrial hearing
date, a navigator or certified application counselor shall
report to the Director any criminal prosecution of the
navigator or certified application counselor of a matter that
violates the provisions set forth in this Act taken in any
jurisdiction. The report shall include a copy of the initial
complaint filed, the order resulting from the hearing, and any
other relevant legal documents.
    (c) An entity that is certified acts as a navigator or
certified application counselor that terminates the
employment, engagement, affiliation, or other relationship
with an individual navigator or certified application
counselor shall notify the Director within 30 days following
the effective date of the termination, using a format
prescribed by the Director, if the reason for termination is
related to the requirements or standards one of the reasons
set forth in this Act or the rules adopted by the Director
pursuant to this Act, or the entity has knowledge the
navigator or certified application counselor was found by a
court or government body to have engaged in any of the
activities prohibited by this Act or the rules adopted by the
Director pursuant to this Act. Upon the written request of the
Director, the entity shall provide additional information,
documents, records, or other data pertaining to the
termination or activity of the individual.
(Source: P.A. 98-524, eff. 8-23-13.)
 
    (215 ILCS 121/45)
    Sec. 45. Other laws; rulemaking authority.
    (a) The requirements of this Act shall not apply to any
individual or entity licensed as an insurance producer in this
State.
    (b) Pursuant to the authority granted by this Act, the
Director may adopt rules as may be necessary or appropriate
for the administration and enforcement of this Act. Such rules
may not conflict with or prevent the application of the
provisions of Title I of the Patient Protection and Affordable
Care Act or the federal regulations promulgated under such
provisions.
(Source: P.A. 98-524, eff. 8-23-13.)
 
    (215 ILCS 121/20 rep.)
    (215 ILCS 121/25 rep.)
    (215 ILCS 121/40 rep.)
    Section 15. The Navigator Certification Act is amended by
repealing Sections 20, 25, and 40.
 
    Section 99. Effective date. This Act takes effect upon
becoming law.
INDEX
Statutes amended in order of appearance
    215 ILCS 5/356z.17
    215 ILCS 121/5
    215 ILCS 121/10
    215 ILCS 121/15
    215 ILCS 121/30
    215 ILCS 121/35
    215 ILCS 121/45
    215 ILCS 121/20 rep.
    215 ILCS 121/25 rep.
    215 ILCS 121/40 rep.

Effective Date: 8/20/2021