Rep. Karen May
Filed: 3/2/2012
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1 | AMENDMENT TO HOUSE BILL 3976
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2 | AMENDMENT NO. ______. Amend House Bill 3976 by replacing | ||||||
3 | everything after the enacting clause with the following:
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4 | "Section 5. The Illinois Insurance Code is amended by | ||||||
5 | adding Section 44.1 as follows: | ||||||
6 | (215 ILCS 5/44.1 new) | ||||||
7 | Sec. 44.1. Health care cooperatives. | ||||||
8 | (a) In addition to all other provisions of this Article not | ||||||
9 | in conflict with this Section, a company seeking to organize | ||||||
10 | under this Article as a health care cooperative shall meet all | ||||||
11 | of the following requirements: | ||||||
12 | (1) The company shall comply with all provisions | ||||||
13 | applicable to domestic mutual insurance companies under | ||||||
14 | this Code. | ||||||
15 | (2) The articles of incorporation of the company shall | ||||||
16 | demonstrate that the company is to be organized as a |
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1 | nonprofit member corporation and that the governance of the | ||||||
2 | company shall be subject to a majority vote of all members. | ||||||
3 | (3) The activities of the company shall be limited to | ||||||
4 | the issuance of health care plans in the individual and | ||||||
5 | small group markets. | ||||||
6 | (4) Either the articles of incorporation or the bylaws | ||||||
7 | of the company shall incorporate ethics and conflict of | ||||||
8 | interest standards and the governance requirements set | ||||||
9 | forth in Section 1322(c)(3)(C) of the federal Patient | ||||||
10 | Protection and Affordable Care Act. | ||||||
11 | (5) The company or a related entity or any predecessor | ||||||
12 | of either shall not have been a health insurance issuer on | ||||||
13 | July 16, 2009. | ||||||
14 | (6) The company shall not be sponsored by a State or | ||||||
15 | local government, any political subdivision thereof, or | ||||||
16 | any instrumentality of such government or political | ||||||
17 | subdivision. | ||||||
18 | (7) Excess surplus shall be used to lower premiums, to | ||||||
19 | improve benefits, or for other programs intended to improve | ||||||
20 | the quality of health care delivered to its members. | ||||||
21 | (8) No representative of a federal, State, or local | ||||||
22 | government, or any political instrumentality thereof, and | ||||||
23 | no representative of a company described in paragraph (5) | ||||||
24 | of subsection (a) of this Section may serve on the board of | ||||||
25 | directors of the company. | ||||||
26 | (b) Notwithstanding Section 37 of this Article, the |
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1 | corporate name of any organization seeking to organize under | ||||||
2 | this Article as a health care cooperative need not contain the | ||||||
3 | word "Mutual" but shall contain the phrase "Health Care | ||||||
4 | Cooperative". The corporate name shall not be the same as, or | ||||||
5 | deceptively similar to, the name of any domestic organization | ||||||
6 | or of any foreign or alien organization authorized to transact | ||||||
7 | business in this State. | ||||||
8 | (c) A company seeking to be organized as a health care | ||||||
9 | cooperative shall submit an application to the Director | ||||||
10 | according to procedures and meeting such requirements as the | ||||||
11 | Director shall adopt by rule. No company shall transact any | ||||||
12 | business of insurance until it has received a certificate of | ||||||
13 | authority as set forth in Section 51 of this Article. | ||||||
14 | Section 10. The Co-operative Act is amended by changing | ||||||
15 | Section 22 and by adding Section 30 as follows:
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16 | (805 ILCS 310/22) (from Ch. 32, par. 326)
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17 | Sec. 22. No corporation or association hereafter organized | ||||||
18 | or doing
business for profit in this State shall be entitled to | ||||||
19 | use the term
"Co-operative" as a part of its corporate or other | ||||||
20 | business name or title
unless it has complied with the | ||||||
21 | provisions of this Act, except (1) a corporation
organized | ||||||
22 | under the Business Corporation Act of 1983 for the purpose of | ||||||
23 | ownership or administration of residential property on
a | ||||||
24 | cooperative basis, or (2) a cooperative corporation organized |
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1 | under the General Not For Profit Corporation Act of 1986 or its | ||||||
2 | predecessor or successor statutes , or (3) a domestic mutual | ||||||
3 | insurance company licensed as a health care cooperative by the | ||||||
4 | Director of Insurance under Article III of the Illinois | ||||||
5 | Insurance Code . Any corporation
or association violating the | ||||||
6 | provision of this Section may be enjoined from
doing business | ||||||
7 | under such name at the instance of any shareholder of any
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8 | association or corporation organized under this Act.
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9 | (Source: P.A. 95-368, eff. 8-23-07.)
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10 | (805 ILCS 310/30 new) | ||||||
11 | Sec. 30. Health benefit purchasing cooperative. | ||||||
12 | (a) Notwithstanding any other provisions of this Act, | ||||||
13 | health benefit purchasing cooperatives may be organized by one | ||||||
14 | or more persons under this Section in each of the geographic | ||||||
15 | areas identified in subsection (l) of this Section. | ||||||
16 | (b) The purpose of a health benefit purchasing cooperative | ||||||
17 | is to provide health care benefits for the individuals | ||||||
18 | specified in subsection (i) of this Section, under a single | ||||||
19 | group health care policy or plan through a contract between the | ||||||
20 | health benefit purchasing cooperative and an insurer | ||||||
21 | authorized to do health insurance business in this State. | ||||||
22 | (c) A health benefit purchasing cooperative shall be | ||||||
23 | designed so that all of the following are accomplished: | ||||||
24 | (1) The members become better informed about health | ||||||
25 | care trends and cost increases. |
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1 | (2) All members receive their health care benefits | ||||||
2 | under the group health care policy or plan negotiated under | ||||||
3 | subsection (i) of this Section. | ||||||
4 | (3) The members are actively engaged in designing | ||||||
5 | health care benefit options that are offered by the insurer | ||||||
6 | and that meet the needs of their community. | ||||||
7 | (4) The health insurance risk of all of the members is | ||||||
8 | pooled. | ||||||
9 | (5) The members actively participate in health | ||||||
10 | improvement decisions for their community. | ||||||
11 | (d) The articles of a health benefit purchasing cooperative | ||||||
12 | shall set forth the name and address of at least one | ||||||
13 | incorporator who will act as the temporary board. | ||||||
14 | (e) Each health benefit purchasing cooperative shall be | ||||||
15 | organized on a membership basis with no capital stock. | ||||||
16 | (f) Subject to subsection (g) of this Section, any person | ||||||
17 | that does business in, is located in, has a principal office | ||||||
18 | in, or resides in the geographic area in which a health benefit | ||||||
19 | purchasing cooperative is organized, that meets the membership | ||||||
20 | criteria established by the health benefit purchasing | ||||||
21 | cooperative in its bylaws, and that pays the membership fee may | ||||||
22 | be a member of the health benefit purchasing cooperative. | ||||||
23 | (g) A health benefit cooperative may limit membership of | ||||||
24 | self-employed individuals through its membership criteria, but | ||||||
25 | such criteria must be applied in the same manner to all | ||||||
26 | self-employed individuals. |
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1 | (h) Each health benefit purchasing cooperative shall file | ||||||
2 | its membership criteria, as well as any amendments to the | ||||||
3 | criteria, with the Director. | ||||||
4 | (i) The health care benefits offered by a health benefit | ||||||
5 | purchasing cooperative shall be negotiated between the health | ||||||
6 | benefit purchasing cooperative and the insurer and shall be | ||||||
7 | offered in a single group health care policy or plan. The | ||||||
8 | insurer must offer coverage under the group health care policy | ||||||
9 | or plan to all of the following: | ||||||
10 | (1) An individual who is a member, officer, or eligible | ||||||
11 | employee of a member of the health benefit purchasing | ||||||
12 | cooperative. | ||||||
13 | (2) A self-employed individual who is a member of the | ||||||
14 | health benefit purchasing cooperative. | ||||||
15 | (3) A dependent of an individual under subdivisions | ||||||
16 | (i)(1) and (2) who receives coverage. | ||||||
17 | (j) The contract between the health benefit purchasing | ||||||
18 | cooperative and an insurer shall be for a term of 3 years. Upon | ||||||
19 | enrollment in the insurer's group health care policy or plan, | ||||||
20 | each member shall pay to the health benefit purchasing | ||||||
21 | cooperative an amount determined by the health benefit | ||||||
22 | purchasing cooperative that is not less than the member's | ||||||
23 | applicable premium for the 36th month of coverage under the | ||||||
24 | contract. If a member withdraws from the health benefit | ||||||
25 | purchasing cooperative before the end of the contract term, the | ||||||
26 | health benefit purchasing cooperative may retain, as a penalty, |
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1 | an amount specified by the health benefit purchasing | ||||||
2 | cooperative that is not less than the premium that the member | ||||||
3 | paid for the 36th month of coverage. | ||||||
4 | (k) Each health benefit purchasing cooperative shall | ||||||
5 | submit to the Director all of the following: | ||||||
6 | (1) Annually, no later than September 30, a report on | ||||||
7 | the progress of the health benefit purchasing arrangement | ||||||
8 | described in this Section and, to the extent possible, any | ||||||
9 | significant findings in the criteria under subdivision | ||||||
10 | (k)(2) of this Section. | ||||||
11 | (2) Within one year after the end of the term of the | ||||||
12 | contract under subsection (j) of this Section, a final | ||||||
13 | report that details significant findings from the project | ||||||
14 | and that includes, at a minimum, to the extent available, | ||||||
15 | information on all of the following: | ||||||
16 | (A) The extent to which the health benefit | ||||||
17 | purchasing arrangement had an impact on the number of | ||||||
18 | uninsured in the geographic area in which it operated. | ||||||
19 | (B) The effect on health care coverage premiums for | ||||||
20 | groups in the geographic area in which the health | ||||||
21 | benefit purchasing arrangement operated, including | ||||||
22 | groups other than the health benefit purchasing | ||||||
23 | cooperative. | ||||||
24 | (C) The degree to which health care consumers were | ||||||
25 | involved in the development and implementation of the | ||||||
26 | health benefit purchasing arrangement. |
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1 | (l) The Director shall designate, by order, the geographic | ||||||
2 | areas of the State in which health benefit purchasing | ||||||
3 | cooperatives may be organized. A geographic area may overlap | ||||||
4 | with one or more other geographic areas. | ||||||
5 | (m) As used in this Section, "Director" means the Director | ||||||
6 | of the Department of Insurance.
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7 | Section 99. Effective date. This Act takes effect upon | ||||||
8 | becoming law.".
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