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1 | AN ACT concerning insurance.
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2 | Be it enacted by the People of the State of Illinois,
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3 | represented in the General Assembly:
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4 | Section 5. The Illinois Health Benefits Exchange Law is | ||||||||||||||||||||||||||||||||||||||
5 | amended by changing Sections 5-3, 5-5, and 5-15 and by adding | ||||||||||||||||||||||||||||||||||||||
6 | Sections 5-4, 5-6, 5-16, 5-17, and 5-21 as follows: | ||||||||||||||||||||||||||||||||||||||
7 | (215 ILCS 122/5-3)
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8 | Sec. 5-3. Legislative intent. The General Assembly finds | ||||||||||||||||||||||||||||||||||||||
9 | the health benefits exchanges authorized by the federal Patient | ||||||||||||||||||||||||||||||||||||||
10 | Protection and Affordable Care Act represent one of a number of | ||||||||||||||||||||||||||||||||||||||
11 | ways in which the State can address coverage gaps and provide | ||||||||||||||||||||||||||||||||||||||
12 | individual consumers and small employers access to greater | ||||||||||||||||||||||||||||||||||||||
13 | coverage options. The General Assembly also finds that the | ||||||||||||||||||||||||||||||||||||||
14 | State is best positioned to implement an exchange that is | ||||||||||||||||||||||||||||||||||||||
15 | sensitive to the coverage gaps and market landscape unique to | ||||||||||||||||||||||||||||||||||||||
16 | this State. | ||||||||||||||||||||||||||||||||||||||
17 | The purpose of this Law is to provide for the establishment | ||||||||||||||||||||||||||||||||||||||
18 | of an Illinois Health Benefits Exchange (the Exchange) to | ||||||||||||||||||||||||||||||||||||||
19 | facilitate the purchase and sale of qualified health plans and | ||||||||||||||||||||||||||||||||||||||
20 | qualified dental plans in the individual market in this State | ||||||||||||||||||||||||||||||||||||||
21 | and to provide for the establishment of a Small Business Health | ||||||||||||||||||||||||||||||||||||||
22 | Options Program (SHOP Exchange) to assist qualified small | ||||||||||||||||||||||||||||||||||||||
23 | employers in this State in facilitating the enrollment of their |
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1 | employees in qualified health plans and qualified dental plans | ||||||
2 | offered in the small group market. The intent of the Exchange | ||||||
3 | is to supplement the existing health insurance market to | ||||||
4 | simplify shopping for individual and small employers by | ||||||
5 | increasing access to benefit options, encouraging a robust and | ||||||
6 | competitive market both inside and outside the Exchange, | ||||||
7 | reducing the number of uninsured, and providing a transparent | ||||||
8 | marketplace and effective consumer education and programmatic | ||||||
9 | assistance tools. The purpose of this Law is to ensure that the | ||||||
10 | State is making sufficient progress towards establishing an | ||||||
11 | exchange within the guidelines outlined by the federal law and | ||||||
12 | to protect Illinoisans from undue federal regulation. Although | ||||||
13 | the federal law imposes a number of core requirements on | ||||||
14 | state-level exchanges, the State has significant flexibility | ||||||
15 | in the design and operation of a State exchange that make it | ||||||
16 | prudent for the State to carefully analyze, plan, and prepare | ||||||
17 | for the exchange. The General Assembly finds that in order for | ||||||
18 | the State to craft a tenable exchange that meets the | ||||||
19 | fundamental goals outlined by the Patient Protection and | ||||||
20 | Affordable Care Act of expanding access to affordable coverage | ||||||
21 | and improving the quality of care, the implementation process | ||||||
22 | should (1) provide for broad stakeholder representation; (2) | ||||||
23 | foster a robust and competitive marketplace, both inside and | ||||||
24 | outside of the exchange; and (3) provide for a broad-based | ||||||
25 | approach to the fiscal solvency of the exchange.
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26 | (Source: P.A. 97-142, eff. 7-14-11.) |
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1 | (215 ILCS 122/5-4 new) | ||||||
2 | Sec. 5-4. Definitions. In this Law: | ||||||
3 | "Board" means the Illinois Health Benefits Exchange Board | ||||||
4 | established pursuant to this Law. | ||||||
5 | "Director" means the Director of Insurance. | ||||||
6 | "Educated health care consumer" means an individual who is | ||||||
7 | knowledgeable about the health care system, and has background | ||||||
8 | or experience in making informed decisions regarding health, | ||||||
9 | medical, and scientific matters. | ||||||
10 | "Essential health benefits" has the meaning provided under | ||||||
11 | Section 1302(b) of the Federal Act. | ||||||
12 | "Exchange" means the Illinois Health Benefits Exchange | ||||||
13 | established by this Law and includes the Individual Exchange | ||||||
14 | and the SHOP Exchange, unless otherwise specified. | ||||||
15 | "Executive Director" means the Executive Director of the | ||||||
16 | Illinois Health Benefits Exchange. | ||||||
17 | "Federal Act" means the federal Patient Protection and | ||||||
18 | Affordable Care Act (Public Law 111-148), as amended by the | ||||||
19 | federal Health Care and Education Reconciliation Act of 2010 | ||||||
20 | (Public Law 111-152), and any amendments thereto, or | ||||||
21 | regulations or guidance issued under, those Acts. | ||||||
22 | "Health benefit plan" means a policy, contract, | ||||||
23 | certificate, or agreement offered or issued by a health carrier | ||||||
24 | to provide, deliver, arrange for, pay for, or reimburse any of | ||||||
25 | the costs of health care services.
"Health benefit plan" does |
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1 | not include: | ||||||
2 | (1) coverage for accident only or disability income | ||||||
3 | insurance or any combination thereof; | ||||||
4 | (2) coverage issued as a supplement to liability | ||||||
5 | insurance; | ||||||
6 | (3) liability insurance, including general liability | ||||||
7 | insurance and automobile liability insurance; | ||||||
8 | (4) workers' compensation or similar insurance; | ||||||
9 | (5) automobile medical payment insurance; | ||||||
10 | (6) credit-only insurance; | ||||||
11 | (7) coverage for on-site medical clinics; or | ||||||
12 | (8) other similar insurance coverage, specified in | ||||||
13 | federal regulations issued pursuant to Public Law 104-191, | ||||||
14 | under which benefits for health care services are secondary | ||||||
15 | or incidental to other insurance benefits. | ||||||
16 | "Health benefit plan" does not include the following | ||||||
17 | benefits if they are provided under a separate policy, | ||||||
18 | certificate, or contract of insurance or are otherwise not an | ||||||
19 | integral part of the plan: | ||||||
20 | (a) limited scope dental or vision benefits; | ||||||
21 | (b) benefits for long-term care, nursing home care, | ||||||
22 | home health care, community-based care, or any combination | ||||||
23 | thereof; or | ||||||
24 | (c) other similar, limited benefits specified in | ||||||
25 | federal regulations issued pursuant to Public Law 104-191. | ||||||
26 | "Health benefit plan" does not include the following |
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1 | benefits if the benefits are provided under a separate policy, | ||||||
2 | certificate, or contract of insurance, there is no coordination | ||||||
3 | between the provision of the benefits and any exclusion of | ||||||
4 | benefits under any group health plan maintained by the same | ||||||
5 | plan sponsor, and the benefits are paid with respect to an | ||||||
6 | event without regard to whether benefits are provided with | ||||||
7 | respect to such an event under any group health plan maintained | ||||||
8 | by the same plan sponsor: | ||||||
9 | (i) coverage only for a specified disease or illness; | ||||||
10 | or | ||||||
11 | (ii) hospital indemnity or other fixed indemnity | ||||||
12 | insurance. | ||||||
13 | "Health benefit plan" does not include the following if | ||||||
14 | offered as a separate policy, certificate, or contract of | ||||||
15 | insurance: | ||||||
16 | (A) Medicare supplemental health insurance as defined | ||||||
17 | under Section 1882(g)(1) of the federal Social Security | ||||||
18 | Act; | ||||||
19 | (B) coverage supplemental to the coverage provided | ||||||
20 | under Chapter 55 of Title 10, United States Code (Civilian | ||||||
21 | Health and Medical Program of the Uniformed Services | ||||||
22 | (CHAMPUS)); or | ||||||
23 | (C) similar supplemental coverage provided to coverage | ||||||
24 | under a group health plan. | ||||||
25 | "Health benefit plan" does not include a group health plan | ||||||
26 | or multiple employer welfare arrangement to the extent the plan |
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1 | or arrangement is not subject to State insurance regulation | ||||||
2 | under Section 514 of the federal Employee Retirement Income | ||||||
3 | Security Act of 1974. | ||||||
4 | "Health carrier" or "carrier" means an entity subject to | ||||||
5 | the insurance laws and regulations of this State, or subject to | ||||||
6 | the jurisdiction of the Director, that contracts or offers to | ||||||
7 | contract to provide, deliver, arrange for, pay for, or | ||||||
8 | reimburse any of the costs of health care services, including a | ||||||
9 | sickness and accident insurance company, a health maintenance | ||||||
10 | organization, a nonprofit hospital and health service | ||||||
11 | corporation, or any other entity providing a plan of health | ||||||
12 | insurance, health benefits or health services. | ||||||
13 | "Individual Exchange" means the exchange marketplace | ||||||
14 | established by this Law through which qualified individuals may | ||||||
15 | obtain coverage through an individual market qualified health | ||||||
16 | plan. | ||||||
17 | "Principal place of business" means the location in a state | ||||||
18 | where an employer has its headquarters or significant place of | ||||||
19 | business and where the persons with direction and control | ||||||
20 | authority over the business are employed. | ||||||
21 | "Qualified dental plan" means a limited scope dental plan | ||||||
22 | that has been certified in accordance with this Law. | ||||||
23 | "Qualified employee" means an eligible individual employed | ||||||
24 | by a qualified employer who has been offered health insurance | ||||||
25 | coverage by that qualified employer through the SHOP on the | ||||||
26 | Exchange. |
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1 | "Qualified employer" means a small employer that elects to | ||||||
2 | make its full-time employees eligible for one or more qualified | ||||||
3 | health plans or qualified dental plans offered through the SHOP | ||||||
4 | Exchange, and at the option of the employer, some or all of its | ||||||
5 | part-time employees, provided that the employer has its | ||||||
6 | principal place of business in this State and elects to provide | ||||||
7 | coverage through the SHOP Exchange to all of its eligible | ||||||
8 | employees, wherever employed. | ||||||
9 | "Qualified health plan" or "QHP" means a health benefit | ||||||
10 | plan that has in effect a certification that the plan meets the | ||||||
11 | criteria for certification described in Section 1311(c) of the | ||||||
12 | Federal Act. | ||||||
13 | "Qualified health plan issuer" or "QHP issuer" means a | ||||||
14 | health insurance issuer that offers a health plan that the | ||||||
15 | Exchange has certified as a qualified health plan. | ||||||
16 | "Qualified individual" means an individual, including a | ||||||
17 | minor, who: | ||||||
18 | (1) is seeking to enroll in a qualified health plan or | ||||||
19 | qualified dental plan offered to individuals through the | ||||||
20 | Exchange; | ||||||
21 | (2) resides in this State; | ||||||
22 | (3) at the time of enrollment, is not incarcerated, | ||||||
23 | other than incarceration pending the disposition of | ||||||
24 | charges; and | ||||||
25 | (4) is, and is reasonably expected to be, for the | ||||||
26 | entire period for which enrollment is sought, a citizen or |
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1 | national of the United States or an alien lawfully present | ||||||
2 | in the United States. | ||||||
3 | "Secretary" means the Secretary of the federal Department | ||||||
4 | of Health and Human Services. | ||||||
5 | "SHOP Exchange" means the Small Business Health Options | ||||||
6 | Program established under this Law through which a qualified | ||||||
7 | employer can provide small group qualified health plans to its | ||||||
8 | qualified employees. | ||||||
9 | "Small employer" means, in connection with a group health | ||||||
10 | plan with respect to a calendar year and a plan year, an | ||||||
11 | employer who employed an average of at least 2 but not more | ||||||
12 | than 100 employees on business days during the preceding | ||||||
13 | calendar year and who employs at least one employee on the | ||||||
14 | first day of the plan year.
For purposes of this definition: | ||||||
15 | (a) all persons treated as a single employer under | ||||||
16 | subsection (b), (c), (m) or (o) of Section 414 of the | ||||||
17 | federal Internal Revenue Code of 1986 shall be treated as a | ||||||
18 | single employer; | ||||||
19 | (b) an employer and any predecessor employer shall be | ||||||
20 | treated as a single employer; | ||||||
21 | (c) employees shall be counted in accordance with | ||||||
22 | federal law and regulations and State law and regulations; | ||||||
23 | (d) if an employer was not in existence throughout the | ||||||
24 | preceding calendar year, then the determination of whether | ||||||
25 | that employer is a small employer shall be based on the | ||||||
26 | average number of employees that is reasonably expected |
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1 | that employer will employ on business days in the current | ||||||
2 | calendar year; and | ||||||
3 | (e) an employer that makes enrollment in qualified | ||||||
4 | health plans or qualified dental plans available to its | ||||||
5 | employees through the SHOP Exchange, and would cease to be | ||||||
6 | a small employer by reason of an increase in the number of | ||||||
7 | its employees, shall continue to be treated as a small | ||||||
8 | employer for purposes of this Law as long as it | ||||||
9 | continuously makes enrollment through the SHOP Exchange | ||||||
10 | available to its employees. | ||||||
11 | (215 ILCS 122/5-5)
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12 | Sec. 5-5. Establishment of the Exchange State health | ||||||
13 | benefits exchange . | ||||||
14 | (a) It is declared that this State, beginning October 1, | ||||||
15 | 2014 2013 , in accordance with Section 1311 of the federal | ||||||
16 | Patient Protection and Affordable Care Act, shall establish a | ||||||
17 | State health benefits exchange to be known as the Illinois | ||||||
18 | Health Benefits Exchange in order to help individuals and small | ||||||
19 | employers with no more than 50 employees shop for, select, and | ||||||
20 | enroll in qualified, affordable private health plans that fit | ||||||
21 | their needs at competitive prices. The Exchange shall separate | ||||||
22 | coverage pools for individuals and small employers and shall | ||||||
23 | supplement and not supplant any existing private health | ||||||
24 | insurance market for individuals and small employers.
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25 | (b) There is hereby created a political subdivision, body |
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1 | politic and corporate, named the Illinois Health Benefits | ||||||
2 | Exchange. The Exchange shall be a public entity, but shall not | ||||||
3 | be considered a department, institution, or agency of the | ||||||
4 | State. | ||||||
5 | (c) The Exchange shall be comprised of an individual and a | ||||||
6 | small business health options (SHOP) exchange. Pursuant to | ||||||
7 | Section 1311(b)(2) of the Federal Act, the Exchange shall | ||||||
8 | provide individual exchange services to qualified individuals | ||||||
9 | and SHOP Exchange services to qualified employers under a | ||||||
10 | single governance and administrative structure. The Board | ||||||
11 | shall produce an assessment by July 1, 2016 to determine the | ||||||
12 | viability of merging the SHOP Exchange and Individual Exchange | ||||||
13 | functions into a single exchange by January 1, 2017. | ||||||
14 | (d) The Exchange shall promote a competitive and robust | ||||||
15 | marketplace that allows consumer access to affordable health | ||||||
16 | coverage options. The Exchange shall certify health benefit | ||||||
17 | plans on the individual and SHOP exchange, as applicable, | ||||||
18 | provided that any such health benefit plan meets the | ||||||
19 | requirements set forth in Section 1311(c) of the Federal Act. | ||||||
20 | (e) The Exchange shall not duplicate or replace the | ||||||
21 | functions of the Department of Insurance. | ||||||
22 | (Source: P.A. 97-142, eff. 7-14-11.) | ||||||
23 | (215 ILCS 122/5-6 new) | ||||||
24 | Sec. 5-6. Health benefit plan certification. | ||||||
25 | (a) To be certified as a qualified health plan, a health |
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1 | benefit plan shall, at a minimum: | ||||||
2 | (1) provide the essential health benefits package | ||||||
3 | described in Section 1302(a) of
the Federal Act; except | ||||||
4 | that the plan is not required to provide essential benefits | ||||||
5 | that duplicate
the minimum benefits of qualified dental | ||||||
6 | plans, as provided in subsection (e) of this Section if: | ||||||
7 | (A) the Board has determined that at least one | ||||||
8 | qualified dental plan is
available to supplement the | ||||||
9 | plan's coverage; and | ||||||
10 | (B) the health carrier makes prominent disclosure | ||||||
11 | at the time it offers the
plan, in a form approved by | ||||||
12 | the Board, that the plan does not provide the full | ||||||
13 | range of
essential pediatric dental benefits and that | ||||||
14 | qualified dental plans providing those benefits and
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15 | other dental benefits not covered by the plan are | ||||||
16 | offered through the Exchange; | ||||||
17 | (2) obtain prior approval of premium rates and contract | ||||||
18 | language from the
Department; | ||||||
19 | (3) provide at least the minimum level of coverage | ||||||
20 | prescribed by the Federal Act; | ||||||
21 | (4) ensure that the cost-sharing requirements of the | ||||||
22 | plan do not exceed the limits
established under Section | ||||||
23 | 1302(c)(l) of the Federal Act, and if the plan is offered | ||||||
24 | through the
SHOP Exchange, the plan's deductible does not | ||||||
25 | exceed the limits established under Section
1302(c)(2) of | ||||||
26 | the Federal Act; |
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1 | (5) be offered by a health carrier that: | ||||||
2 | (A) is authorized and in good standing to offer | ||||||
3 | health insurance coverage; | ||||||
4 | (B) offers at least one qualified health plan at | ||||||
5 | the silver level and at
least one plan at the gold | ||||||
6 | level, as described in the Federal Act, through each | ||||||
7 | component of the Board in which the health
carrier | ||||||
8 | participates; for the purposes of this subparagraph | ||||||
9 | (B), "component"
means the SHOP Exchange and the | ||||||
10 | exchange for individual coverage within the American
| ||||||
11 | Health Benefit Exchange; | ||||||
12 | (C) charges the same premium rate for each | ||||||
13 | qualified health plan without
regard to whether the | ||||||
14 | plan is offered through the Exchange and without regard | ||||||
15 | to whether the
plan is offered directly from the health | ||||||
16 | carrier or through an insurance producer; | ||||||
17 | (D) does not charge any cancellation fees or | ||||||
18 | penalties; and | ||||||
19 | (E) complies with the regulations established by | ||||||
20 | the Secretary under
Section 1311 (d) of the Federal Act | ||||||
21 | and any other requirements as the Board may establish; | ||||||
22 | (6) meet the requirements of certification pursuant to | ||||||
23 | the Board provided in
this Law and by the Secretary under | ||||||
24 | Section 1311(c) of the Federal Act and rules promulgated
| ||||||
25 | pursuant to this Law or the Federal Act, which shall | ||||||
26 | include: |
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1 | (A) minimum standards in the areas of marketing | ||||||
2 | practices; | ||||||
3 | (B) network adequacy; | ||||||
4 | (C) essential community providers in underserved | ||||||
5 | areas; | ||||||
6 | (D) accreditation; | ||||||
7 | (E) quality improvement; | ||||||
8 | (F) uniform enrollment forms and descriptions of | ||||||
9 | coverage; and | ||||||
10 | (G) information on quality measures for health | ||||||
11 | benefit plan performance; | ||||||
12 | (7) be determined by the Board that making the plan | ||||||
13 | available through the
Exchange is in the interest of | ||||||
14 | qualified individuals and qualified employers; and | ||||||
15 | (8) include all outpatient clinics in the health plan's | ||||||
16 | region that are controlled by an entity that also controls | ||||||
17 | a 340B eligible provider as defined by Section 340B(a)(4) | ||||||
18 | of the federal Public Health Service Act such that the | ||||||
19 | outpatient clinics are subject to the same mission, | ||||||
20 | policies, and medical standards related to the provision of | ||||||
21 | health care services as the 340B eligible provider. | ||||||
22 | (b) The Board shall not withhold certification from a | ||||||
23 | health benefit plan: | ||||||
24 | (1) on the basis that the plan is a fee-for-service | ||||||
25 | plan; | ||||||
26 | (2) through the imposition of premium price controls by |
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1 | the Board; or | ||||||
2 | (3) on the basis that the health benefit plan provides | ||||||
3 | treatments necessary to
prevent patients' deaths in | ||||||
4 | circumstances the Board determines are inappropriate or | ||||||
5 | too
costly. | ||||||
6 | (c) The Board shall require each health carrier seeking | ||||||
7 | certification of a plan as a
qualified health plan to: | ||||||
8 | (1) submit a justification for any premium increase | ||||||
9 | before implementation of that
increase, and prominently | ||||||
10 | post the information on its publicly accessible Internet | ||||||
11 | website; | ||||||
12 | (2) make available to the public, in plain language as | ||||||
13 | defined in Section 1311(e)(3)(B) of the Federal Act, and | ||||||
14 | submit to the Board, the Secretary, and the Department | ||||||
15 | accurate
and timely disclosure of the following: | ||||||
16 | (i) claims payment policies and practices; | ||||||
17 | (ii) periodic financial disclosures; | ||||||
18 | (iii) data on enrollment; | ||||||
19 | (iv) data on disenrollment; | ||||||
20 | (v) data on the number of claims that are | ||||||
21 | denied; | ||||||
22 | (vi) data on rating practices; | ||||||
23 | (vii) information on cost-sharing and payments | ||||||
24 | with respect to any
out-of-network coverage; | ||||||
25 | (viii) information on enrollee and participant | ||||||
26 | rights under Title I of
the Federal Act; and |
| |||||||
| |||||||
1 | (ix) other information as determined | ||||||
2 | appropriate by the Secretary; | ||||||
3 | (3) permit individuals to learn, in a timely manner | ||||||
4 | upon the request of the
individual, the amount of | ||||||
5 | cost-sharing, including deductibles, copayments, and | ||||||
6 | coinsurance,
under the individual's plan or coverage that | ||||||
7 | the individual would be responsible for paying with
respect | ||||||
8 | to the furnishing of a specific item or service by a | ||||||
9 | participating provider and make this
information available | ||||||
10 | to the individual through an Internet website that is | ||||||
11 | publicly accessible and
through other means for | ||||||
12 | individuals without access to the Internet; and | ||||||
13 | (4) promptly notify affected individuals of price and | ||||||
14 | benefit changes or other
changes in circumstances that | ||||||
15 | could materially impact enrollment or coverage. | ||||||
16 | (d) The Board shall not exempt any health carrier seeking | ||||||
17 | certification as a qualified
health plan, regardless of the | ||||||
18 | type or size of the health carrier, from licensure or solvency
| ||||||
19 | requirements and shall apply the criteria of this Section in a | ||||||
20 | manner that ensures a level playing
field between or among | ||||||
21 | health carriers participating in the Exchange. | ||||||
22 | (e) The provisions of this Law that are applicable to | ||||||
23 | qualified health plans shall also
apply, to the extent | ||||||
24 | relevant, to qualified dental plans, except as modified in | ||||||
25 | accordance with the
provisions of paragraphs (1), (2), and (3) | ||||||
26 | of this subsection (e) or by rules adopted by the
Board. |
| |||||||
| |||||||
1 | (1) The health carrier shall be licensed to offer | ||||||
2 | dental coverage, but need not be
licensed to offer other | ||||||
3 | health benefits. | ||||||
4 | (2) The plan shall be limited to dental and oral health | ||||||
5 | benefits, without
substantially duplicating the benefits | ||||||
6 | typically offered by health benefit plans without dental
| ||||||
7 | coverage and shall include, at a minimum, the essential | ||||||
8 | pediatric dental benefits prescribed by
the Secretary | ||||||
9 | pursuant to Section 1302(b)(l)(J) of the Federal Act and | ||||||
10 | such other dental benefits
as the Board or the Secretary | ||||||
11 | may specify by rule. | ||||||
12 | (3) Health carriers may jointly offer a comprehensive | ||||||
13 | plan through the Exchange
in which the dental benefits are | ||||||
14 | provided by a health carrier through a qualified dental | ||||||
15 | plan and
the other benefits are provided by a health | ||||||
16 | carrier through a qualified health plan, provided that
the | ||||||
17 | plans are priced separately and are also made available for | ||||||
18 | purchase separately at the same
price. | ||||||
19 | (215 ILCS 122/5-15)
| ||||||
20 | Sec. 5-15. Illinois Health Benefits Exchange Legislative | ||||||
21 | Oversight Study Committee. | ||||||
22 | (a) There is created an Illinois Health Benefits Exchange | ||||||
23 | Legislative Oversight Study Committee within the Commission on | ||||||
24 | Government Forecasting and Accountability to provide | ||||||
25 | accountability for conduct a study regarding State |
| |||||||
| |||||||
1 | implementation and establishment of the Illinois Health | ||||||
2 | Benefits Exchange and to ensure Exchange operations and | ||||||
3 | functions align with the goals and duties outlined by this Law . | ||||||
4 | The Committee shall also be responsible for providing policy | ||||||
5 | recommendations to ensure the Exchange aligns with the Federal | ||||||
6 | Act, amendments to the Federal Act, and regulations promulgated | ||||||
7 | pursuant to the Federal Act. | ||||||
8 | (b) Members of the Legislative Oversight Study Committee | ||||||
9 | shall be appointed as follows: 3 members of the Senate shall be | ||||||
10 | appointed by the President of the Senate; 3 members of the | ||||||
11 | Senate shall be appointed by the Minority Leader of the Senate; | ||||||
12 | 3 members of the House of Representatives shall be appointed by | ||||||
13 | the Speaker of the House of Representatives; and 3 members of | ||||||
14 | the House of Representatives shall be appointed by the Minority | ||||||
15 | Leader of the House of Representatives. Each legislative leader | ||||||
16 | shall select one member to serve as co-chair of the committee. | ||||||
17 | (c) Members of the Legislative Oversight Study Committee | ||||||
18 | shall be appointed no later than June 1, 2012 within 30 days | ||||||
19 | after the effective date of this Law. The co-chairs shall | ||||||
20 | convene the first meeting of the committee no later than 45 | ||||||
21 | days after the effective date of this Law .
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22 | (Source: P.A. 97-142, eff. 7-14-11.) | ||||||
23 | (215 ILCS 122/5-16 new) | ||||||
24 | Sec. 5-16. Exchange governance. The governing and | ||||||
25 | administrative powers of the Exchange shall be vested in a body |
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1 | known as the Illinois Health Benefits Exchange Board. The | ||||||
2 | following provisions shall apply: | ||||||
3 | (1) The Board shall consist of 11 voting members | ||||||
4 | appointed by the Governor with the advice and consent of a | ||||||
5 | majority of the members elected to the Senate. In addition, | ||||||
6 | the Director of Insurance, the Director of Healthcare and | ||||||
7 | Family Services, and the Executive Director of the Exchange | ||||||
8 | shall serve as non-voting, ex-officio members of the Board. | ||||||
9 | The Governor shall also appoint as non-voting, ex-officio | ||||||
10 | members one economist with experience in the health care | ||||||
11 | markets and one educated health care consumer advocate. All | ||||||
12 | Board members shall be appointed no later than January 1, | ||||||
13 | 2013. | ||||||
14 | (2) The Governor shall make the appointments so as to | ||||||
15 | reflect no less than proportional representation of the | ||||||
16 | geographic, gender, cultural, racial, and ethnic | ||||||
17 | composition of this State and in accordance with | ||||||
18 | subparagraphs (A), (B), and (C) of this paragraph, as | ||||||
19 | follows: | ||||||
20 | (A) No more than one voting member may be an | ||||||
21 | individual who is employed by, a consultant to, or a | ||||||
22 | member of a board of directors of an insurer, a | ||||||
23 | third-party administrator, or an insurance producer. | ||||||
24 | No more than one voting member may be an individual who | ||||||
25 | is a member of a board of directors of a health care | ||||||
26 | provider, health care facility, or health clinic. |
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1 | (B) At least one board member must represent each | ||||||
2 | of the following interest groups: | ||||||
3 | (1) a labor interest group; | ||||||
4 | (2) a women's interest group; | ||||||
5 | (3) a minorities' interest group; | ||||||
6 | (4) a disabled persons' interest group; | ||||||
7 | (5) a small business interest group; and | ||||||
8 | (6) a public health interest group. | ||||||
9 | (C) Each person appointed to the Board should have | ||||||
10 | demonstrated expertise in no less than 2 of the | ||||||
11 | following areas: | ||||||
12 | (1) individual health insurance coverage; | ||||||
13 | (2) small employer health insurance; | ||||||
14 | (3) health benefits administration; | ||||||
15 | (4) health care finance; | ||||||
16 | (5) administration of a public or private | ||||||
17 | health care delivery system; | ||||||
18 | (6) the provision of health care services; | ||||||
19 | (7) the purchase of health insurance coverage; | ||||||
20 | (8) health care consumer navigation or | ||||||
21 | assistance; | ||||||
22 | (9) health care economics or health care | ||||||
23 | actuarial sciences; | ||||||
24 | (10) information technology; or | ||||||
25 | (11) starting a small business with 50 or fewer | ||||||
26 | employees. |
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1 | (3) The Board shall elect one voting member of the | ||||||
2 | Board to serve as chairperson and one voting member to | ||||||
3 | serve as vice-chairperson, upon approval of a majority of | ||||||
4 | the Board. | ||||||
5 | (4) The Exchange shall be administered by an Executive | ||||||
6 | Director, who shall be appointed, and may be removed, by a | ||||||
7 | majority of the Board. The Board shall have the power to | ||||||
8 | determine compensation for the Executive Director. The | ||||||
9 | Executive Director may not be a State employee or have been | ||||||
10 | employed by or have had a contract with the State in the 3 | ||||||
11 | years prior to his or her appointment. The Executive | ||||||
12 | Director may not be nor have been an employee of an | ||||||
13 | insurance company. | ||||||
14 | (5) The terms of the non-voting, ex-officio members of | ||||||
15 | the Board shall run concurrent with their terms of | ||||||
16 | appointment to office, or in the case of the Executive | ||||||
17 | Director, his or her term of appointment to that position, | ||||||
18 | subject to the determination of the Board. The terms of the | ||||||
19 | members, including those non-voting, ex-officio members | ||||||
20 | appointed by the Governor, shall be 4 years. Each member of | ||||||
21 | the General Assembly identified in paragraph (1) of this | ||||||
22 | Section shall initially appoint one member to a 3-year | ||||||
23 | term, and one member to a 4-year term. Upon conclusion of | ||||||
24 | the initial term, the next term and every term subsequent | ||||||
25 | to it shall run for 3 years. Voting members shall serve no | ||||||
26 | more than 3 consecutive terms. |
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1 | A person appointed to fill a vacancy and complete the | ||||||
2 | unexpired term of a member of the Board shall only be | ||||||
3 | appointed to serve out the unexpired term by the individual | ||||||
4 | who made the original appointment within 45 days after the | ||||||
5 | initial vacancy. A person appointed to fill a vacancy and | ||||||
6 | complete the unexpired term of a member of the Board may be | ||||||
7 | re-appointed to the Board for another term, but shall not | ||||||
8 | serve than more than 2 consecutive terms following their | ||||||
9 | completion of the unexpired term of a member of the Board. | ||||||
10 | If a voting Board member's qualifications change due to | ||||||
11 | a change in employment during the term of their | ||||||
12 | appointment, then the Board member shall resign their | ||||||
13 | position, subject to reappointment by the individual who | ||||||
14 | made the original appointment. | ||||||
15 | (6) The Board shall, as necessary, create and appoint | ||||||
16 | qualified persons with requisite expertise to Exchange | ||||||
17 | technical advisory groups. These Exchange technical | ||||||
18 | advisory groups shall meet in a manner and frequency | ||||||
19 | determined by the Board to discuss exchange-related issues | ||||||
20 | and to provide exchange-related guidance, advice, and | ||||||
21 | recommendations to the Board and the Exchange. There shall | ||||||
22 | be at a minimum, 4 technical advisory groups, including the | ||||||
23 | following: | ||||||
24 | (1) an insurer advisory group; | ||||||
25 | (2) a business advisory group; | ||||||
26 | (3) a consumer advisory group; and |
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1 | (4) a provider advisory group. | ||||||
2 | (7) The Board shall meet no less than quarterly on a | ||||||
3 | schedule established by the chairperson. Meetings shall be | ||||||
4 | public and public records shall be maintained, subject to | ||||||
5 | the Open Meetings Act. A majority of the Board shall | ||||||
6 | constitute a quorum and the affirmative vote of a majority | ||||||
7 | is necessary for any action of the Board. No vacancy shall | ||||||
8 | impair the ability of the Board to act provided a quorum is | ||||||
9 | reached. Members shall serve without pay, but shall be | ||||||
10 | reimbursed for their actual and reasonable expenses | ||||||
11 | incurred in the performance of their duties. The | ||||||
12 | chairperson of the Board shall file a written report | ||||||
13 | regarding the activities of the Board and the Exchange to | ||||||
14 | the Governor and General Assembly annually, and the | ||||||
15 | Legislative Oversight Committee established in Section | ||||||
16 | 5-15 quarterly, beginning on July 1, 2012 through December | ||||||
17 | 31, 2014. | ||||||
18 | (8) The Board shall adopt conflict of interest rules | ||||||
19 | and recusal procedures. Such rules and procedures shall (i) | ||||||
20 | prohibit a member of the Board from performing an official | ||||||
21 | act that may have a direct economic benefit on a business | ||||||
22 | or other endeavor in which that member has a direct or | ||||||
23 | substantial financial interest and (ii) require a member of | ||||||
24 | the Board to recuse himself or herself from an official | ||||||
25 | matter, whether direct or indirect. All recusals must be in | ||||||
26 | advance, in writing, and specify the reason and date of the |
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1 | recusal. All recusals shall be maintained by the Executive | ||||||
2 | Director and shall be disclosed to any person upon written | ||||||
3 | request. | ||||||
4 | (9) The Board shall develop an initial budget for the | ||||||
5 | implementation and operation of the Exchange for fiscal | ||||||
6 | year 2014, fiscal year 2015, and fiscal year 2016 for | ||||||
7 | review and approval by the Governor and the General | ||||||
8 | Assembly. The initial budget shall include, but not be | ||||||
9 | limited to: | ||||||
10 | (A) proposed compensation levels for the Executive | ||||||
11 | Director and shall identify personnel and staffing | ||||||
12 | needs for the implementation and operation of the | ||||||
13 | Exchange; | ||||||
14 | (B) disclosure of funds received or expected to be | ||||||
15 | received from the federal government for the | ||||||
16 | infrastructure and systems of the Exchange and those | ||||||
17 | funds received or expected to be received for program | ||||||
18 | administration and operations; and | ||||||
19 | (C) delineation of those functions of the Exchange | ||||||
20 | that are to be paid by State and federal programs that | ||||||
21 | are allocable to the State's General Revenue Fund. | ||||||
22 | (10) The Board shall establish a revenue generating | ||||||
23 | plan that shall include annual assessments of all entities | ||||||
24 | authorized in this State to transact the types of insurance | ||||||
25 | enumerated in Class 1 of Section 4 of the Illinois | ||||||
26 | Insurance Code. |
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1 | (11) The purpose of the Board shall be to implement the | ||||||
2 | Exchange in accordance with this Section and shall be | ||||||
3 | authorized to establish procedures for the operation of the | ||||||
4 | Exchange, subject to legislative approval. | ||||||
5 | (215 ILCS 122/5-17 new) | ||||||
6 | Sec. 5-17. Illinois Health Benefits Exchange Fund. There | ||||||
7 | is hereby created as a special fund outside of the State | ||||||
8 | treasury the Illinois Health Benefits Exchange Fund to be used, | ||||||
9 | subject to appropriation, exclusively by the Exchange to | ||||||
10 | provide funding for the operation and administration of the | ||||||
11 | Exchange in carrying out the purposes authorized in this Law. | ||||||
12 | (215 ILCS 122/5-21 new) | ||||||
13 | Sec. 5-21. Enrollment through brokers and agents; producer | ||||||
14 | compensation. | ||||||
15 | (a) In accordance with Section 1312(e) of the Federal Act, | ||||||
16 | the Exchange shall allow licensed insurance producers to (1) | ||||||
17 | enroll qualified individuals in any qualified health plan, for | ||||||
18 | which the individual is eligible, in the individual exchange, | ||||||
19 | (2) assist qualified individuals in applying for premium tax | ||||||
20 | credits and cost-sharing reductions for qualified health plans | ||||||
21 | purchased through the individual exchange, and (3) enroll | ||||||
22 | qualified employers in any qualified health plan, for which the | ||||||
23 | employer is eligible, offered through the SHOP exchange. | ||||||
24 | Nothing in this subsection (a) shall be construed as to require |
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1 | a qualified individual or qualified employer to utilize a | ||||||
2 | licensed insurance producer for any of the purposes outlined in | ||||||
3 | this subsection (a). | ||||||
4 | (b) In order to enroll individuals and small employers in | ||||||
5 | qualified health plans on the Exchange, licensed producers must | ||||||
6 | complete a certification program. The Department of Insurance | ||||||
7 | may develop and implement a certification program for licensed | ||||||
8 | insurance producers who enroll individuals and employers in the | ||||||
9 | exchange. The Department of Insurance may charge a reasonable | ||||||
10 | fee, by regulation, to producers for the certification program. | ||||||
11 | The Department of Insurance may approve certification programs | ||||||
12 | developed and instructed by others, charging a reasonable fee, | ||||||
13 | by regulation, for approval. | ||||||
14 | (c) The Exchange shall include on its Internet website a | ||||||
15 | producer locator section, featured prominently, through which | ||||||
16 | individuals and small employers can find exchange-certified | ||||||
17 | producers.
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18 | Section 99. Effective date. This Act takes effect upon | ||||||
19 | becoming law.
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