SB1087 EnrolledLRB102 04910 CPF 14929 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Department of Insurance Law of the Civil
5Administrative Code of Illinois is amended by adding Section
61405-40 as follows:
 
7    (20 ILCS 1405/1405-40 new)
8    Sec. 1405-40. Transfer of the Illinois Comprehensive
9Health Insurance Plan. Upon entry of an Order of
10Rehabilitation or Liquidation against the Comprehensive Health
11Insurance Plan in accordance with Article XIII of the Illinois
12Insurance Code, all powers, duties, rights, and
13responsibilities of the Illinois Comprehensive Health
14Insurance Plan and the Illinois Comprehensive Health Insurance
15Board under the Comprehensive Health Insurance Plan Act shall
16be transferred to and vested in the Director of Insurance as
17rehabilitator or liquidator as provided in the provisions of
18this amendatory Act of the 102nd General Assembly.
 
19    Section 10. The Comprehensive Health Insurance Plan Act is
20amended by changing Sections 1.1, 3, and 15 and by adding
21Sections 16 and 17 as follows:
 

 

 

SB1087 Enrolled- 2 -LRB102 04910 CPF 14929 b

1    (215 ILCS 105/1.1)  (from Ch. 73, par. 1301.1)
2    Sec. 1.1. The General Assembly hereby makes the following
3findings and declarations:
4        (a) The Comprehensive Health Insurance Plan is
5    established as a State program that is intended to provide
6    an alternate market for health insurance for certain
7    uninsurable Illinois residents, and further is intended to
8    provide an acceptable alternative mechanism as described
9    in the federal Health Insurance Portability and
10    Accountability Act of 1996 for providing portable and
11    accessible individual health insurance coverage for
12    federally eligible individuals as defined in this Act.
13        (b) The State of Illinois may subsidize the cost of
14    health insurance coverage offered by the Plan. However,
15    since the State has only a limited amount of resources,
16    the General Assembly declares that it intends for this
17    program to provide portable and accessible individual
18    health insurance coverage for every federally eligible
19    individual who qualifies for coverage in accordance with
20    Section 15 of this Act, but does not intend for every
21    eligible person who qualifies for Plan coverage in
22    accordance with Section 7 of this Act to be guaranteed a
23    right to be issued a policy under this Plan as a matter of
24    entitlement.
25        (c) The Comprehensive Health Insurance Plan Board
26    shall operate the Plan in a manner so that the estimated

 

 

SB1087 Enrolled- 3 -LRB102 04910 CPF 14929 b

1    cost of the program during any fiscal year will not exceed
2    the total income it expects to receive from policy
3    premiums, investment income, assessments, or fees
4    collected or received by the Board and other funds which
5    are made available from appropriations for the Plan by the
6    General Assembly for that fiscal year.
7    With the implementation of the federal Patient Protection
8and Affordable Care Act, the Plan shall discontinue as the
9alternative market for health insurance for certain Illinois
10residents and discontinue as the alternative mechanism, as
11described in the federal Health Insurance Portability and
12Accountability Act of 1996, effective no later than January 1,
132022.
14(Source: P.A. 90-30, eff. 7-1-97.)
 
15    (215 ILCS 105/3)  (from Ch. 73, par. 1303)
16    Sec. 3. Operation of the Plan.
17    a. There is hereby created an Illinois Comprehensive
18Health Insurance Plan.
19    b. The Plan shall operate subject to the supervision and
20control of the Board. The Board is created as a political
21subdivision and body politic and corporate and, as such, is
22not a State agency. The Board shall consist of 10 public
23members, appointed by the Governor with the advice and consent
24of the Senate.
25    Initial members shall be appointed to the Board by the

 

 

SB1087 Enrolled- 4 -LRB102 04910 CPF 14929 b

1Governor as follows: 2 members to serve until July 1, 1988, and
2until their successors are appointed and qualified; 2 members
3to serve until July 1, 1989, and until their successors are
4appointed and qualified; 3 members to serve until July 1,
51990, and until their successors are appointed and qualified;
6and 3 members to serve until July 1, 1991, and until their
7successors are appointed and qualified. As terms of initial
8members expire, their successors shall be appointed for terms
9to expire the first day in July 3 years thereafter, and until
10their successors are appointed and qualified.
11    Any vacancy in the Board occurring for any reason other
12than the expiration of a term shall be filled for the unexpired
13term in the same manner as the original appointment.
14    Any member of the Board may be removed by the Governor for
15neglect of duty, misfeasance, malfeasance, or nonfeasance in
16office.
17    In addition, a representative of the Governor's Office of
18Management and Budget, a representative of the Office of the
19Attorney General and the Director or the Director's designated
20representative shall be members of the Board. Four members of
21the General Assembly, one each appointed by the President and
22Minority Leader of the Senate and by the Speaker and Minority
23Leader of the House of Representatives, shall serve as
24nonvoting members of the Board. At least 2 of the public
25members shall be individuals reasonably expected to qualify
26for coverage under the Plan, the parent or spouse of such an

 

 

SB1087 Enrolled- 5 -LRB102 04910 CPF 14929 b

1individual, or a surviving family member of an individual who
2could have qualified for the Plan during his lifetime. The
3Director or Director's representative shall be the chairperson
4of the Board. Members of the Board shall receive no
5compensation, but shall be reimbursed for reasonable expenses
6incurred in the necessary performance of their duties.
7    c. The Board shall make an annual report in September and
8shall file the report with the Secretary of the Senate and the
9Clerk of the House of Representatives. The report shall
10summarize the activities of the Plan in the preceding calendar
11year, including net written and earned premiums, the expense
12of administration, the paid and incurred losses for the year
13and other information as may be requested by the General
14Assembly. The report shall also include analysis and
15recommendations regarding utilization review, quality
16assurance and access to cost effective quality health care.
17    d. In its plan of operation the Board shall:
18        (1) Establish procedures for selecting a Plan
19    administrator in accordance with Section 5 of this Act.
20        (2) Establish procedures for the operation of the
21    Board.
22        (3) Create a Plan fund, under management of the Board,
23    to fund administrative, claim, and other expenses of the
24    Plan.
25        (4) Establish procedures for the handling and
26    accounting of assets and monies of the Plan.

 

 

SB1087 Enrolled- 6 -LRB102 04910 CPF 14929 b

1        (5) Develop and implement a program to publicize the
2    existence of the Plan, the eligibility requirements and
3    procedures for enrollment and to maintain public awareness
4    of the Plan.
5        (6) Establish procedures under which applicants and
6    participants may have grievances reviewed by a grievance
7    committee appointed by the Board. The grievances shall be
8    reported to the Board immediately after completion of the
9    review. The Department and the Board shall retain all
10    written complaints regarding the Plan for at least 3
11    years. Oral complaints shall be reduced to written form
12    and maintained for at least 3 years.
13        (7) Provide for other matters as may be necessary and
14    proper for the execution of its powers, duties and
15    obligations under the Plan.
16    e. No later than 5 years after the Plan is operative the
17Board and the Department shall conduct cooperatively a study
18of the Plan and the persons insured by the Plan to determine:
19(1) claims experience including a breakdown of medical
20conditions for which claims were paid; (2) whether
21availability of the Plan affected employment opportunities for
22participants; (3) whether availability of the Plan affected
23the receipt of medical assistance benefits by Plan
24participants; (4) whether a change occurred in the number of
25personal bankruptcies due to medical or other health related
26costs; (5) data regarding all complaints received about the

 

 

SB1087 Enrolled- 7 -LRB102 04910 CPF 14929 b

1Plan including its operation and services; (6) and any other
2significant observations regarding utilization of the Plan.
3The study shall culminate in a written report to be presented
4to the Governor, the President of the Senate, the Speaker of
5the House and the chairpersons of the House and Senate
6Insurance Committees. The report shall be filed with the
7Secretary of the Senate and the Clerk of the House of
8Representatives. The report shall also be available to members
9of the general public upon request.
10    (e-5) The Board shall conduct a feasibility study of
11establishing a small employer health insurance pool in which
12employers may provide affordable health insurance coverage to
13their employees. The Board may contract with a private entity
14or enter into intergovernmental agreements with State agencies
15for the completion of all or part of the study. The study
16shall:
17        (i) Analyze other states' experience in establishing
18    small employer health insurance pools;
19        (ii) Assess the need for a small employer health
20    insurance pool, including the number of individuals who
21    might benefit from it;
22        (iii) Recommend means of establishing a small employer
23    health insurance pool; and
24        (iv) Estimate the cost of providing a small employer
25    health insurance pool through the Illinois Comprehensive
26    Health Insurance Plan or another, public or private

 

 

SB1087 Enrolled- 8 -LRB102 04910 CPF 14929 b

1    entity.
2    The Board may accept donations, in trust, from any legal
3source, public or private, for deposit into a trust account
4specifically created for expenditure, without the necessity of
5being appropriated, solely for the purpose of conducting all
6or part of the study. The Board shall issue a report with
7recommendations to the Governor and the General Assembly by
8January 1, 2005. As used in this subsection e-5, "small
9employer" means an employer having between one and 50
10employees.
11    f. The Board may:
12        (1) Prepare and distribute certificate of eligibility
13    forms and enrollment instruction forms to insurance
14    producers and to the general public in this State.
15        (2) Provide for reinsurance of risks incurred by the
16    Plan and enter into reinsurance agreements with insurers
17    to establish a reinsurance plan for risks of coverage
18    described in the Plan, or obtain commercial reinsurance to
19    reduce the risk of loss through the Plan.
20        (3) Issue additional types of health insurance
21    policies to provide optional coverages as are otherwise
22    permitted by this Act including a Medicare supplement
23    policy designed to supplement Medicare.
24        (4) Provide for and employ cost containment measures
25    and requirements including, but not limited to,
26    preadmission certification, second surgical opinion,

 

 

SB1087 Enrolled- 9 -LRB102 04910 CPF 14929 b

1    concurrent utilization review programs, and individual
2    case management for the purpose of making the pool more
3    cost effective.
4        (5) Design, utilize, contract, or otherwise arrange
5    for the delivery of cost effective health care services,
6    including establishing or contracting with preferred
7    provider organizations, health maintenance organizations,
8    and other limited network provider arrangements.
9        (6) Adopt bylaws, rules, regulations, policies and
10    procedures as may be necessary or convenient for the
11    implementation of the Act and the operation of the Plan.
12        (7) Administer separate pools, separate accounts, or
13    other plans or arrangements as required by this Act to
14    separate federally eligible individuals or groups of
15    federally eligible individuals who qualify for Plan
16    coverage under Section 15 of this Act from eligible
17    persons or groups of eligible persons who qualify for Plan
18    coverage under Section 7 of this Act and apportion the
19    costs of the administration among such separate pools,
20    separate accounts, or other plans or arrangements.
21    g. The Director may, by rule, establish additional powers
22and duties of the Board and may adopt rules for any other
23purposes, including the operation of the Plan, as are
24necessary or proper to implement this Act.
25    h. The Board is not liable for any obligation of the Plan.
26There is no liability on the part of any member or employee of

 

 

SB1087 Enrolled- 10 -LRB102 04910 CPF 14929 b

1the Board, or the Department, or the Director, both as
2regulator and as rehabilitator or liquidator, and no cause of
3action of any nature may arise against them, for any action
4taken or omission made by them in the performance of their
5powers and duties under this Act, unless the action or
6omission constitutes willful or wanton misconduct. The Board
7may provide in its bylaws or rules for indemnification of, and
8legal representation for, its members and employees.
9    i. There is no liability on the part of any insurance
10producer for the failure of any applicant to be accepted by the
11Plan unless the failure of the applicant to be accepted by the
12Plan is due to an act or omission by the insurance producer
13which constitutes willful or wanton misconduct.
14    j. Not later than 60 days after the effective date of this
15amendatory Act of the 102nd General Assembly, the Board shall
16develop a plan of rehabilitation or liquidation and
17dissolution, including the consent of a majority of the Board
18to the entry of an order of rehabilitation or liquidation, to
19wind down the affairs of the Plan, including details for the
20transition to other health plans of any persons currently
21enrolled in the Plan, for presentation to and approval by the
22Director. Upon the Director's approval of the plan of
23rehabilitation or liquidation and dissolution, the Director
24shall thereafter report to the Attorney General of this State,
25whose duty it shall be to file a complaint for rehabilitation
26or liquidation of the Plan pursuant to the provisions of

 

 

SB1087 Enrolled- 11 -LRB102 04910 CPF 14929 b

1Article XIII of the Illinois Insurance Code. Upon entry of a
2final Order of Rehabilitation or Liquidation and the
3Director's appointment as statutory rehabilitator or
4liquidator, the Director shall begin to administer and oversee
5the wind-down and dissolution of the Plan in accordance with
6the provisions of Article XIII.
7(Source: P.A. 92-597, eff. 6-28-02; 93-622, eff. 12-18-03;
893-824, eff. 7-28-04.)
 
9    (215 ILCS 105/15)
10    Sec. 15. Alternative portable coverage for federally
11eligible individuals.
12    (a) Notwithstanding the requirements of subsection a of
13Section 7 and except as otherwise provided in this Section,
14any federally eligible individual for whom a Plan application,
15and such enclosures and supporting documentation as the Board
16may require, is received by the Board within 90 days after the
17termination of prior creditable coverage shall qualify to
18enroll in the Plan under the portability provisions of this
19Section.
20    A federally eligible person who has been certified as
21eligible pursuant to the federal Trade Act of 2002 and whose
22Plan application and enclosures and supporting documentation
23as the Board may require is received by the Board within 63
24days after the termination of previous creditable coverage
25shall qualify to enroll in the Plan under the portability

 

 

SB1087 Enrolled- 12 -LRB102 04910 CPF 14929 b

1provisions of this Section.
2    (b) Any federally eligible individual seeking Plan
3coverage under this Section must submit with his or her
4application evidence, including acceptable written
5certification of previous creditable coverage, that will
6establish to the Board's satisfaction, that he or she meets
7all of the requirements to be a federally eligible individual
8and is currently and permanently residing in this State (as of
9the date his or her application was received by the Board).
10    (c) Except as otherwise provided in this Section, a period
11of creditable coverage shall not be counted, with respect to
12qualifying an applicant for Plan coverage as a federally
13eligible individual under this Section, if after such period
14and before the application for Plan coverage was received by
15the Board, there was at least a 90-day period during all of
16which the individual was not covered under any creditable
17coverage.
18    For a federally eligible person who has been certified as
19eligible pursuant to the federal Trade Act of 2002, a period of
20creditable coverage shall not be counted, with respect to
21qualifying an applicant for Plan coverage as a federally
22eligible individual under this Section, if after such period
23and before the application for Plan coverage was received by
24the Board, there was at least a 63-day period during all of
25which the individual was not covered under any creditable
26coverage.

 

 

SB1087 Enrolled- 13 -LRB102 04910 CPF 14929 b

1    (d) Any federally eligible individual who the Board
2determines qualifies for Plan coverage under this Section
3shall be offered his or her choice of enrolling in one of
4alternative portability health benefit plans which the Board
5is authorized under this Section to establish for these
6federally eligible individuals and their dependents.
7    (e) The Board shall offer a choice of health care
8coverages consistent with major medical coverage under the
9alternative health benefit plans authorized by this Section to
10every federally eligible individual. The coverages to be
11offered under the plans, the schedule of benefits,
12deductibles, co-payments, exclusions, and other limitations
13shall be approved by the Board. One optional form of coverage
14shall be comparable to comprehensive health insurance coverage
15offered in the individual market in this State or a standard
16option of coverage available under the group or individual
17health insurance laws of the State. The standard benefit plan
18that is authorized by Section 8 of this Act may be used for
19this purpose. The Board may also offer a preferred provider
20option and such other options as the Board determines may be
21appropriate for these federally eligible individuals who
22qualify for Plan coverage pursuant to this Section.
23    (f) Notwithstanding the requirements of subsection f of
24Section 8, any Plan coverage that is issued to federally
25eligible individuals who qualify for the Plan pursuant to the
26portability provisions of this Section shall not be subject to

 

 

SB1087 Enrolled- 14 -LRB102 04910 CPF 14929 b

1any preexisting conditions exclusion, waiting period, or other
2similar limitation on coverage.
3    (g) Federally eligible individuals who qualify and enroll
4in the Plan pursuant to this Section shall be required to pay
5such premium rates as the Board shall establish and approve in
6accordance with the requirements of Section 7.1 of this Act.
7    (h) A federally eligible individual who qualifies and
8enrolls in the Plan pursuant to this Section must satisfy on an
9ongoing basis all of the other eligibility requirements of
10this Act to the extent not inconsistent with the federal
11Health Insurance Portability and Accountability Act of 1996 in
12order to maintain continued eligibility for coverage under the
13Plan.
14    (i) New enrollment and policy renewals are discontinued on
15December 31, 2021.
16(Source: P.A. 100-201, eff. 8-18-17.)
 
17    (215 ILCS 105/16 new)
18    Sec. 16. Cessation of operations.
19    (a) Except as otherwise provided in this Section, the
20insurance operations of the Plan authorized by this Act shall
21cease on December 31, 2021.
22    (b) Coverage under the Plan does not apply to services
23provided on or after January 1, 2022.
24    (c) The Plan shall cease providing coverage for
25participants enrolled prior to January 1, 2022 at 11:59 p.m.

 

 

SB1087 Enrolled- 15 -LRB102 04910 CPF 14929 b

1on December 31, 2021.
2    (d) A claim for payment under the Plan must be submitted
3within 180 days after January 1, 2022 and paid in accordance
4with the provisions of Article XIII of the Illinois Insurance
5Code.
6    (e) Any claim or grievance shall be resolved by the court
7supervising the Plan's Article XIII rehabilitation or
8liquidation proceedings.
9    (f) Balance billing by a health care provider that is not a
10member of the provider network used by the Plan is prohibited.
11    (g) The Board shall, not later than 60 days after the
12effective date of this amendatory Act of the 102nd General
13Assembly, submit to the Director a plan of rehabilitation or
14liquidation and dissolution, which must provide for, but shall
15not be limited to, the following:
16        (1) continuity of care for an individual who is
17    covered under the Plan and is an inpatient on January 1,
18    2022;
19        (2) a final accounting of assessments;
20        (3) resolution of any net asset deficiency;
21        (4) cessation of all liability of the Plan; and
22        (5) final dissolution of the Plan.
23    (h) The plan of rehabilitation or liquidation and
24dissolution may provide that, with the approval of the
25Director, a power or duty of the Plan may be delegated to a
26person that is to perform functions similar to the functions

 

 

SB1087 Enrolled- 16 -LRB102 04910 CPF 14929 b

1of the Plan.
2    (i) Upon entry of an Order of Rehabilitation or
3Liquidation against the Plan, the court supervising the
4rehabilitation or liquidation proceedings shall have the
5jurisdiction to issue injunctions as set forth in Section 189
6of the Illinois Insurance Code, including, but not limited to,
7the restraining of all persons, companies, and entities from
8bringing or further prosecuting all actions and proceedings at
9law or in equity or otherwise, whether in this State or
10elsewhere, against the Plan or its assets or property or the
11Director except insofar as those actions or proceedings arise
12in or are brought in the rehabilitation or liquidation
13proceedings.
14    (j) Upon the entry of an order of rehabilitation or
15liquidation, the rights and liabilities of the Plan and of its
16policyholders and all other persons interested in its assets
17shall be fixed as of the date of entry of the order directing
18rehabilitation or liquidation, or such later date as may be
19provided by order of the court supervising the rehabilitation
20or liquidation proceedings.
21    (k) Upon the satisfaction of all claims allowed in the
22rehabilitation or liquidation proceedings, including the costs
23and expenses of administering the rehabilitation or
24liquidation, any remaining funds shall be distributed as
25follows:
26        (1) for the accounts described in paragraph (2) of

 

 

SB1087 Enrolled- 17 -LRB102 04910 CPF 14929 b

1    subsection (l) of Section 4, all funds shall be refunded
2    on a pro rata basis to the insurers that were assessed
3    based on the most recent deficit projections of the Plan's
4    operation pursuant to Section 12 and to covered persons
5    where appropriate; and
6        (2) for all other accounts, all remaining funds shall
7    be released and deposited into the Insurance Producer
8    Administration Fund for use by the Department for
9    initiatives to support the Illinois Health Benefits
10    Exchange.
11    (l) Upon the entry of an Order of Rehabilitation or
12Liquidation against the Plan, if the Director determines the
13Plan is holding any surplus funds in a segregated account
14associated with persons who qualified for coverage under
15Section 7 that are no longer required for the purposes for
16which they were acquired and are restricted from any other
17use, the Director may petition the court for such funds to be
18released and placed as follows:
19        (1) the first $10,000,000 shall be deposited into the
20    Insurance Producer Administration Fund for use by the
21    Department for initiatives to support the Illinois Health
22    Benefits Exchange; and
23        (2) the remainder shall be deposited into the Parity
24    Advancement Fund.
 
25    (215 ILCS 105/17 new)

 

 

SB1087 Enrolled- 18 -LRB102 04910 CPF 14929 b

1    Sec. 17. Transfer of the Illinois Comprehensive Health
2Insurance Plan.
3    (a) Upon entry of an Order of Rehabilitation or
4Liquidation against the Plan all powers, duties, rights, and
5responsibilities of the Plan and the Board shall be
6transferred to and vested in the Director, as rehabilitator or
7liquidator, who is authorized to wind down the affairs of the
8Plan in accordance with Article XIII of the Illinois Insurance
9Code.
10    (b) The Director, as rehabilitator or liquidator, shall
11act on behalf of the Plan and the Board and shall have the
12power and duty to receive and answer correspondence, and shall
13evaluate all claims that are timely filed in the
14rehabilitation or liquidation proceedings and is authorized to
15make distribution from any unencumbered funds of the Plan's
16rehabilitation or liquidation estate upon all such claims as
17are allowed in the proceedings consistent with subsection (1)
18of Section 205 of the Illinois Insurance Code. Timely filed
19claims of vendors allowed in the rehabilitation or liquidation
20proceedings that are not capable of being discharged, in full,
21from the assets of the rehabilitation or liquidation estate
22may be presented to the Court of Claims.
23    (c) All books, records, papers, documents, property (real
24and personal), contracts, causes of action, and pending
25business pertaining to the powers, duties, rights, and
26responsibilities transferred by this amendatory Act of the

 

 

SB1087 Enrolled- 19 -LRB102 04910 CPF 14929 b

1102nd General Assembly from the Plan and the Board to the
2Director, as rehabilitator or liquidator, including, but not
3limited to, material in electronic or magnetic format and
4necessary computer hardware and software, shall be transferred
5to the Director, as rehabilitator or liquidator. Records shall
6be maintained as required by the federal Health Insurance
7Portability and Accountability Act of 1996, as now or
8hereafter amended, unless otherwise ordered by the court
9supervising the rehabilitation or liquidation proceedings.
10    (d) The rights of the employees in the State of Illinois
11and its agencies under the Personnel Code and applicable
12collective bargaining agreements or under any pension,
13retirement, or annuity plan shall not be affected by this
14amendatory Act of the 102nd General Assembly.
15    (e) Upon entry of an Order of Rehabilitation or
16Liquidation against the Plan, all unexpended appropriations
17and balances and other funds available for use by the Plan and
18the Board shall be transferred to and vested in the Director,
19as rehabilitator or liquidator. Except as provided in
20subsection (l) of Section 16, unexpended balances so
21transferred shall be distributed in accordance with Article
22XIII of the Illinois Insurance Code for paying the Director's
23administrative expenses incurred in connection with winding
24down the affairs of the Plan.
25    (f) Whenever reports or notices are, on the effective date
26of this amendatory Act of the 102nd General Assembly, required

 

 

SB1087 Enrolled- 20 -LRB102 04910 CPF 14929 b

1to be made or given or papers or documents furnished or served
2by any person to or upon the Plan or the Board in connection
3with any of the powers, duties, rights, and responsibilities
4transferred by this amendatory Act of the 102nd General
5Assembly, the same shall be made, given, furnished, or served
6in the same manner to or upon the Director, as rehabilitator or
7liquidator.
8    (g) This amendatory Act of the 102nd General Assembly does
9not affect any act done, ratified, or canceled or any right
10occurring or established or any action or proceeding had or
11commenced in the administrative, civil, or criminal cause by
12the Plan or the Board prior to the entry of an Order of
13Rehabilitation or Liquidation against the Plan; such actions
14or proceedings may be prosecuted and continued by the
15Director, as rehabilitator or liquidator.
 
16    Section 99. Effective date. This Act takes effect upon
17becoming law.