HB3441 EngrossedLRB097 06367 RPM 46449 b

1    AN ACT concerning insurance.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Comprehensive Health Insurance Plan Act is
5amended by changing Section 5 as follows:
 
6    (215 ILCS 105/5)  (from Ch. 73, par. 1305)
7    Sec. 5. Plan administrator.
8    a. The board shall select a plan administrator through a
9competitive bidding process to administer the plan. The board
10shall evaluate bids submitted under this Section based on
11criteria established by the board which shall include:
12        (1) The plan administrator's proven ability to handle
13    other large group accident and health benefit plans.
14        (2) The efficiency and timeliness of the plan
15    administrator's claim processing procedures.
16        (3) An estimate of total net cost for administering the
17    plan, including any discounts or income the Plan could
18    expect to receive or benefit from.
19        (4) The plan administrator's ability to apply
20    effective cost containment programs and procedures and to
21    administer the plan in a cost-efficient manner.
22        (5) The financial condition and stability of the plan
23    administrator.

 

 

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1    b. The plan administrator shall serve for a period of 5
2years subject to removal for cause and subject to the terms,
3conditions and limitations of the contract between the board
4and the plan administrator. At least one year prior to the
5expiration of each 5 year period of service by the current plan
6administrator, the board shall begin to advertise for bids to
7serve as the plan administrator for the succeeding 5 year
8period. Selection of the plan administrator for the succeeding
9period shall be made at least 6 months prior to the end of the
10current 5 year period. Notwithstanding any other provision of
11this subsection, the Board at its option may extend the term of
12a plan administrator contract for a period not to exceed 3
13years.
14    c. The plan administrator shall perform such functions
15relating to the plan as may be assigned to it including:
16        (1) establishment of a premium billing procedure for
17    collection of premiums from plan participants. Billings
18    shall be made on a periodic basis as determined by the
19    board;
20        (2) payment and processing of claims and various cost
21    containment functions; and
22        (3) other functions to assure timely payment of
23    benefits to participants under the plan, including:
24            (a) making available information relating to the
25        proper manner of submitting a claim for benefits under
26        the plan and distributing forms upon which submissions

 

 

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1        shall be made, and
2            (b) evaluating the eligibility of each claim for
3        payment under the plan.
4     The plan administrator shall be governed by the
5requirements of Part 919 of Title 50 of the Illinois
6Administrative Code, promulgated by the Department of
7Insurance, regarding the handling of claims under this Act.
8    d. The plan administrator shall submit regular reports to
9the board regarding the operation of the plan. The frequency,
10content and form of the report shall be as determined by the
11board.
12    e. The plan administrator shall pay or be reimbursed for
13claims expenses from the premium payments received from or on
14behalf of plan participants. If the plan administrator's
15payments or reimbursements for claims expenses exceed the
16portion of premiums allocated by the board for payment of
17claims expenses, the board shall provide additional funds to
18the plan administrator for payment or reimbursement of such
19claims expenses.
20    f. The plan administrator shall be paid as provided in the
21contract between the Board and the plan administrator.
22(Source: P.A. 90-30, eff. 7-1-97; 90-567, eff. 1-23-98; 91-357,
23eff. 7-29-99.)
 
24    Section 99. Effective date. This Act takes effect upon
25becoming law.