HB1229eng 103RD GENERAL ASSEMBLY

HB1229 Engrossed LRB103 24799 BMS 51128 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 Health Benefits Exchange Law is amended by changing Section 5-5 and by adding Sections 5-30, 5-35, 5-40, and 5-45 as follows:

(215 ILCS 122/5-5)

Sec. 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. The Department of Insurance has the authority to operate the Illinois Health Benefits Exchange. The Director of Insurance may require that all plans in the individual market be made available for comparison on the Illinois Health Benefits Exchange, but may not require that all plans in the individual market be purchased exclusively on the Illinois Health Benefits Exchange. The Director of Insurance has the authority to require that plans offered on the exchange conform with standardized plan designs that provide for standardized cost-sharing for covered health services.

(Source: P.A. 97-142, eff. 7-14-11.)

(215 ILCS 122/5-30 new)

Sec. 5-30. Monthly assessments.

(a) The Director of Insurance may apply a monthly assessment to each health benefits plan sold in the Illinois Health Benefits Exchange. The assessment shall be paid by the insurer and to the Department of Insurance and shall be used only for the purpose of supporting the exchange through exchange operations, outreach, enrollment, and other means of supporting the exchange, including any efforts that can increase market stabilization and that may result in a net benefit to policyholders. The assessment may be applied at a rate of:

(1) 1% of the total monthly premium charged by an insurer for each health benefits plan during any period that the State is on a State-based exchange using the federal platform; or

(2) 2.75% of the total monthly premium charged by an insurer for each health benefits plan during any period that the State is on the Illinois Health Benefits Exchange. The Director of Insurance may adjust this rate to ensure that the Illinois Health Benefits Exchange is fully funded, but shall not apply the assessment at a rate that exceeds 4% of the total monthly premium charged by an insurer. If the Director of Insurance determines it is necessary to adjust the rate above 2.75% pursuant to this paragraph (2), the Director of Insurance shall, in advance of the adjustment, post on the Department of Insurance's website a report describing the reasons and justifications for the adjustment, which shall be consistent with the purposes of supporting the exchange as provided in this Section.

(b) The Director of Insurance shall notify an insurer of its assessment rate for the subsequent year at least 20 days before the date the insurer is required to file its rate filing with the Department of Insurance. In the case of an assessment for the 2023 plan year, the Director of Insurance shall notify insurers as soon as is practicable of the assessment amount.

(c) The Director of Insurance shall consider any amount of assessments unexpended from a previous year when calculating the monthly assessment.

(215 ILCS 122/5-35 new)

Sec. 5-35. Health benefits exchange advisory committee. The Director of Insurance shall establish an advisory committee to provide advice to the Director of Insurance concerning the operation of the exchange. The advisory committee shall include at least 9 members, as follows:

(1) The Director of Insurance, or a designee, who shall serve ex officio.

(2) The Director of Healthcare and Family Services, or a designee, who shall serve ex officio.

(3) The Director of Public Health, or a designee, who shall serve ex officio.

(4) Six public members, who shall be residents of the State, appointed by the Director of Insurance. Each public member shall have demonstrated experience in one or more of the following areas: health insurance consumer advocacy, individual health insurance coverage, health benefits plan marketing, the provision of health care services, or academic or professional research relating to health insurance.

(215 ILCS 122/5-40 new)

Sec. 5-40. State Medicaid program coordination. The Department of Insurance shall also have the authority to coordinate the operations of the exchange with the operations of the State Medicaid program and the FamilyCare Program to determine eligibility for those programs as soon as practicable.

(215 ILCS 122/5-45 new)

Sec. 5-45. Rulemaking. The Department of Insurance shall adopt rules implementing this Law.

Section 99. Effective date. This Act takes effect January 1, 2024.