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