Rep. Karen May
Filed: 3/30/2012
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1 | AMENDMENT TO HOUSE BILL 3976
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2 | AMENDMENT NO. ______. Amend House Bill 3976, AS AMENDED, by | ||||||
3 | replacing everything after the enacting clause with the | ||||||
4 | following:
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5 | "Section 5. The Health Care Purchasing Group Act is amended | ||||||
6 | by changing Sections 10 and 15 as follows:
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7 | (215 ILCS 123/10)
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8 | Sec. 10. Definitions. Words and phrases used in this
Act, | ||||||
9 | unless defined in this Section, have the meanings attributed to | ||||||
10 | them in
Section 5 of the Illinois Health Insurance Portability | ||||||
11 | and Accountability
Act.
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12 | "Director" means the Director of
Insurance.
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13 | "Employer" means an individual, sole proprietorship,
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14 | partnership, firm, corporation, association, or any other | ||||||
15 | legal entity that has
one or more employees and is legally | ||||||
16 | doing business in this State. |
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1 | "Health insurance contract", "group or master health
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2 | insurance contract" and "insurance" refer to the forms of
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3 | insurance obligations which a "risk-bearer" as defined in this
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4 | Section has been authorized to issue.
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5 | "Risk-bearer" means an insurance company licensed in
this | ||||||
6 | State and authorized to transact the kinds of business
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7 | described in clause (b) of Class 1 and clause (a) of Class 2 of
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8 | Section 4 of the Illinois Insurance Code and
entities | ||||||
9 | authorized under the Health Maintenance Organization
Act.
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10 | (Source: P.A. 90-337, eff. 1-1-98; 90-567, eff. 1-23-98.)
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11 | (215 ILCS 123/15)
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12 | Sec. 15. Health care purchasing groups; membership; | ||||||
13 | formation.
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14 | (a) An HPG may be an organization formed by 2 or more
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15 | employers with no more than 2,500
500 covered employees each, | ||||||
16 | an HPG sponsor or a
risk-bearer for purposes of
contracting for | ||||||
17 | health insurance under this Act to cover
employees and | ||||||
18 | dependents of HPG members. An HPG shall not be
prevented from | ||||||
19 | supplementing health insurance coverage purchased
under this | ||||||
20 | Act by contracting for services from entities licensed
and | ||||||
21 | authorized in Illinois to provide those services under the
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22 | Dental Service Plan Act, the Limited Health Service | ||||||
23 | Organization
Act, or Voluntary Health Services Plans Act.
An | ||||||
24 | HPG may be a separate legal entity or simply a group of 2 or | ||||||
25 | more employers
with no more than 2,500
500 covered employees |
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1 | each aggregated under this Act by an HPG
sponsor or risk-bearer | ||||||
2 | for insurance purposes. There shall be no limit as to
the | ||||||
3 | number of HPGs that may operate in any geographic area of the | ||||||
4 | State. No
insurance risk may be borne or retained by the HPG. | ||||||
5 | All health insurance
contracts issued to the HPG must be | ||||||
6 | delivered or issued for delivery in
Illinois.
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7 | (b) Members of an HPG must be Illinois domiciled employers, | ||||||
8 | except that an
employer domiciled elsewhere may become a member | ||||||
9 | of an Illinois HPG for the
sole purpose of insuring its | ||||||
10 | employees whose place of employment is located
within this | ||||||
11 | State. HPG membership may include employers having no more than | ||||||
12 | 2,500
500 covered employees each.
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13 | (c) If an HPG is formed by any 2 or more employers with no | ||||||
14 | more than 2,500
500 covered employees each, it is authorized to | ||||||
15 | negotiate, solicit, market, obtain
proposals for, and enter | ||||||
16 | into group or master health insurance contracts on
behalf of | ||||||
17 | its members and their employees and employee dependents so long | ||||||
18 | as
it meets all of the following requirements:
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19 | (1) The HPG must be an organization having the legal
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20 | capacity to contract and having its legal situs in | ||||||
21 | Illinois.
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22 | (2) The principal persons responsible for the conduct | ||||||
23 | of
the HPG must perform their HPG related functions in | ||||||
24 | Illinois.
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25 | (3) No HPG may collect premium in its name or hold or | ||||||
26 | manage premium or
claim fund accounts unless duly licensed |
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1 | and qualified as a managing general
agent pursuant to | ||||||
2 | Section 141a of the Illinois Insurance Code or a third | ||||||
3 | party
administrator pursuant to Section 511.105 of the | ||||||
4 | Illinois Insurance Code.
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5 | (4) If the HPG gives an offer, application, notice, or | ||||||
6 | proposal of
insurance to an employer, it must disclose to | ||||||
7 | that employer the total cost of
the insurance. Dues, fees, | ||||||
8 | or charges to be paid to the HPG, HPG sponsor, or
any other | ||||||
9 | entity as a condition to purchasing the insurance must be | ||||||
10 | itemized.
The HPG shall also disclose to its members the | ||||||
11 | amount of any dividends,
experience refunds, or other such | ||||||
12 | payments it receives from the risk-bearer.
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13 | (5) An HPG must register with the Director before | ||||||
14 | entering
into a group or master health insurance contract | ||||||
15 | on behalf of
its members and must renew the registration | ||||||
16 | annually on forms
and at times prescribed by the Director | ||||||
17 | in rules
specifying, at minimum, (i) the identity of the | ||||||
18 | officers and
directors, trustees, or attorney-in-fact of | ||||||
19 | the HPG; (ii) a
certification that those persons have not | ||||||
20 | been convicted of any
felony offense involving a breach of | ||||||
21 | fiduciary duty or
improper manipulation of accounts; and | ||||||
22 | (iii) the number of employer
members then enrolled in the | ||||||
23 | HPG, together with any other
information that may be needed | ||||||
24 | to carry out the purposes of
this Act.
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25 | (6) At the time of initial registration and each | ||||||
26 | renewal
thereof an HPG shall pay a fee of $100 to the |
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1 | Director.
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2 | (d) If an HPG is formed by an HPG sponsor or risk-bearer
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3 | and the HPG performs
no marketing, negotiation, solicitation, | ||||||
4 | or proposing of insurance to HPG
members, exclusive of | ||||||
5 | ministerial acts performed by individual employers to
service | ||||||
6 | their own employees, then a group or master health insurance | ||||||
7 | contract
may be issued in the name of the HPG and held by an HPG | ||||||
8 | sponsor, risk-bearer,
or designated employer member within the | ||||||
9 | State. In these cases the HPG
requirements specified in | ||||||
10 | subsection (c) shall not be applicable, however:
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11 | (1) the group or master health insurance contract must
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12 | contain a provision permitting the contract to be enforced
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13 | through legal action initiated by any employer member or by
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14 | an employee of an HPG member who has paid premium for the
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15 | coverage provided;
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16 | (2) the group or master health insurance contract must | ||||||
17 | be
available for inspection and copying by any HPG member,
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18 | employee, or insured dependent at a designated location
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19 | within the State at all normal business hours; and
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20 | (3) any information concerning HPG membership required | ||||||
21 | by rule under item
(5) of subsection (c) must be provided | ||||||
22 | by the HPG sponsor in its registration
and renewal forms or | ||||||
23 | by the risk-bearer in its annual reports.
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24 | (Source: P.A. 90-337, eff. 1-1-98; 90-655, eff. 7-30-98; | ||||||
25 | 91-617, eff. 1-1-00.)".
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