Sen. David Koehler

Filed: 5/13/2013





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2    AMENDMENT NO. ______. Amend House Bill 3227 by replacing
3everything after the enacting clause with the following:
4    "Section 5. The Personnel Code is amended by changing
5Section 4c as follows:
6    (20 ILCS 415/4c)  (from Ch. 127, par. 63b104c)
7    Sec. 4c. General exemptions. The following positions in
8State service shall be exempt from jurisdictions A, B, and C,
9unless the jurisdictions shall be extended as provided in this
11        (1) All officers elected by the people.
12        (2) All positions under the Lieutenant Governor,
13    Secretary of State, State Treasurer, State Comptroller,
14    State Board of Education, Clerk of the Supreme Court,
15    Attorney General, and State Board of Elections.
16        (3) Judges, and officers and employees of the courts,



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1    and notaries public.
2        (4) All officers and employees of the Illinois General
3    Assembly, all employees of legislative commissions, all
4    officers and employees of the Illinois Legislative
5    Reference Bureau, the Legislative Research Unit, and the
6    Legislative Printing Unit.
7        (5) All positions in the Illinois National Guard and
8    Illinois State Guard, paid from federal funds or positions
9    in the State Military Service filled by enlistment and paid
10    from State funds.
11        (6) All employees of the Governor at the executive
12    mansion and on his immediate personal staff.
13        (7) Directors of Departments, the Adjutant General,
14    the Assistant Adjutant General, the Director of the
15    Illinois Emergency Management Agency, members of boards
16    and commissions, and all other positions appointed by the
17    Governor by and with the consent of the Senate.
18        (8) The presidents, other principal administrative
19    officers, and teaching, research and extension faculties
20    of Chicago State University, Eastern Illinois University,
21    Governors State University, Illinois State University,
22    Northeastern Illinois University, Northern Illinois
23    University, Western Illinois University, the Illinois
24    Community College Board, Southern Illinois University,
25    Illinois Board of Higher Education, University of
26    Illinois, State Universities Civil Service System,



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1    University Retirement System of Illinois, and the
2    administrative officers and scientific and technical staff
3    of the Illinois State Museum.
4        (9) All other employees except the presidents, other
5    principal administrative officers, and teaching, research
6    and extension faculties of the universities under the
7    jurisdiction of the Board of Regents and the colleges and
8    universities under the jurisdiction of the Board of
9    Governors of State Colleges and Universities, Illinois
10    Community College Board, Southern Illinois University,
11    Illinois Board of Higher Education, Board of Governors of
12    State Colleges and Universities, the Board of Regents,
13    University of Illinois, State Universities Civil Service
14    System, University Retirement System of Illinois, so long
15    as these are subject to the provisions of the State
16    Universities Civil Service Act.
17        (10) The State Police so long as they are subject to
18    the merit provisions of the State Police Act.
19        (11) (Blank).
20        (12) The technical and engineering staffs of the
21    Department of Transportation, the Department of Nuclear
22    Safety, the Pollution Control Board, and the Illinois
23    Commerce Commission, and the technical and engineering
24    staff providing architectural and engineering services in
25    the Department of Central Management Services.
26        (13) All employees of the Illinois State Toll Highway



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1    Authority.
2        (14) The Secretary of the Illinois Workers'
3    Compensation Commission.
4        (15) All persons who are appointed or employed by the
5    Director of Insurance under authority of Section 202 of the
6    Illinois Insurance Code to assist the Director of Insurance
7    in discharging his responsibilities relating to the
8    rehabilitation, liquidation, conservation, and dissolution
9    of companies that are subject to the jurisdiction of the
10    Illinois Insurance Code.
11        (16) All employees of the St. Louis Metropolitan Area
12    Airport Authority.
13        (17) All investment officers employed by the Illinois
14    State Board of Investment.
15        (18) Employees of the Illinois Young Adult
16    Conservation Corps program, administered by the Illinois
17    Department of Natural Resources, authorized grantee under
18    Title VIII of the Comprehensive Employment and Training Act
19    of 1973, 29 USC 993.
20        (19) Seasonal employees of the Department of
21    Agriculture for the operation of the Illinois State Fair
22    and the DuQuoin State Fair, no one person receiving more
23    than 29 days of such employment in any calendar year.
24        (20) All "temporary" employees hired under the
25    Department of Natural Resources' Illinois Conservation
26    Service, a youth employment program that hires young people



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1    to work in State parks for a period of one year or less.
2        (21) All hearing officers of the Human Rights
3    Commission.
4        (22) All employees of the Illinois Mathematics and
5    Science Academy.
6        (23) All employees of the Kankakee River Valley Area
7    Airport Authority.
8        (24) The commissioners and employees of the Executive
9    Ethics Commission.
10        (25) The Executive Inspectors General, including
11    special Executive Inspectors General, and employees of
12    each Office of an Executive Inspector General.
13        (26) The commissioners and employees of the
14    Legislative Ethics Commission.
15        (27) The Legislative Inspector General, including
16    special Legislative Inspectors General, and employees of
17    the Office of the Legislative Inspector General.
18        (28) The Auditor General's Inspector General and
19    employees of the Office of the Auditor General's Inspector
20    General.
21        (29) All employees of the Illinois Power Agency.
22        (30) Employees having demonstrable, defined advanced
23    skills in accounting, financial reporting, or technical
24    expertise who are employed within executive branch
25    agencies and whose duties are directly related to the
26    submission to the Office of the Comptroller of financial



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1    information for the publication of the Comprehensive
2    Annual Financial Report (CAFR).
3        (31) The employees of the Illinois Health Benefits
4    Exchange.
5(Source: P.A. 97-618, eff. 10-26-11; 97-1055, eff. 8-23-12.)
6    Section 10. The Illinois State Auditing Act is amended by
7changing Section 3-1 as follows:
8    (30 ILCS 5/3-1)  (from Ch. 15, par. 303-1)
9    Sec. 3-1. Jurisdiction of Auditor General. The Auditor
10General has jurisdiction over all State agencies to make post
11audits and investigations authorized by or under this Act or
12the Constitution.
13    The Auditor General has jurisdiction over local government
14agencies and private agencies only:
15        (a) to make such post audits authorized by or under
16    this Act as are necessary and incidental to a post audit of
17    a State agency or of a program administered by a State
18    agency involving public funds of the State, but this
19    jurisdiction does not include any authority to review local
20    governmental agencies in the obligation, receipt,
21    expenditure or use of public funds of the State that are
22    granted without limitation or condition imposed by law,
23    other than the general limitation that such funds be used
24    for public purposes;



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1        (b) to make investigations authorized by or under this
2    Act or the Constitution; and
3        (c) to make audits of the records of local government
4    agencies to verify actual costs of state-mandated programs
5    when directed to do so by the Legislative Audit Commission
6    at the request of the State Board of Appeals under the
7    State Mandates Act.
8    In addition to the foregoing, the Auditor General may
9conduct an audit of the Metropolitan Pier and Exposition
10Authority, the Regional Transportation Authority, the Suburban
11Bus Division, the Commuter Rail Division and the Chicago
12Transit Authority and any other subsidized carrier when
13authorized by the Legislative Audit Commission. Such audit may
14be a financial, management or program audit, or any combination
16    The audit shall determine whether they are operating in
17accordance with all applicable laws and regulations. Subject to
18the limitations of this Act, the Legislative Audit Commission
19may by resolution specify additional determinations to be
20included in the scope of the audit.
21    In addition to the foregoing, the Auditor General must also
22conduct a financial audit of the Illinois Sports Facilities
23Authority's expenditures of public funds in connection with the
24reconstruction, renovation, remodeling, extension, or
25improvement of all or substantially all of any existing
26"facility", as that term is defined in the Illinois Sports



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1Facilities Authority Act.
2    The Auditor General may also conduct an audit, when
3authorized by the Legislative Audit Commission, of any hospital
4which receives 10% or more of its gross revenues from payments
5from the State of Illinois, Department of Healthcare and Family
6Services (formerly Department of Public Aid), Medical
7Assistance Program.
8    The Auditor General is authorized to conduct financial and
9compliance audits of the Illinois Distance Learning Foundation
10and the Illinois Conservation Foundation.
11    As soon as practical after the effective date of this
12amendatory Act of 1995, the Auditor General shall conduct a
13compliance and management audit of the City of Chicago and any
14other entity with regard to the operation of Chicago O'Hare
15International Airport, Chicago Midway Airport and Merrill C.
16Meigs Field. The audit shall include, but not be limited to, an
17examination of revenues, expenses, and transfers of funds;
18purchasing and contracting policies and practices; staffing
19levels; and hiring practices and procedures. When completed,
20the audit required by this paragraph shall be distributed in
21accordance with Section 3-14.
22    The Auditor General shall conduct a financial and
23compliance and program audit of distributions from the
24Municipal Economic Development Fund during the immediately
25preceding calendar year pursuant to Section 8-403.1 of the
26Public Utilities Act at no cost to the city, village, or



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1incorporated town that received the distributions.
2    The Auditor General must conduct an audit of the Health
3Facilities and Services Review Board pursuant to Section 19.5
4of the Illinois Health Facilities Planning Act.
5    The Auditor General of the State of Illinois shall annually
6conduct or cause to be conducted a financial and compliance
7audit of the books and records of any county water commission
8organized pursuant to the Water Commission Act of 1985 and
9shall file a copy of the report of that audit with the Governor
10and the Legislative Audit Commission. The filed audit shall be
11open to the public for inspection. The cost of the audit shall
12be charged to the county water commission in accordance with
13Section 6z-27 of the State Finance Act. The county water
14commission shall make available to the Auditor General its
15books and records and any other documentation, whether in the
16possession of its trustees or other parties, necessary to
17conduct the audit required. These audit requirements apply only
18through July 1, 2007.
19    The Auditor General must conduct audits of the Rend Lake
20Conservancy District as provided in Section 25.5 of the River
21Conservancy Districts Act.
22    The Auditor General must conduct financial audits of the
23Southeastern Illinois Economic Development Authority as
24provided in Section 70 of the Southeastern Illinois Economic
25Development Authority Act.
26    The Auditor General shall conduct a compliance audit in



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1accordance with subsections (d) and (f) of Section 30 of the
2Innovation Development and Economy Act.
3    The Auditor General shall have the authority to conduct an
4audit of the Illinois Health Benefits Exchange. The audit may
5be a financial audit, a management audit, a program audit, or
6any combination thereof.
7(Source: P.A. 95-331, eff. 8-21-07; 96-31, eff. 6-30-09;
896-939, eff. 6-24-10.)
9    Section 15. The Comprehensive Health Insurance Plan Act is
10amended by adding Sections 16 and 17 as follows:
11    (215 ILCS 105/16 new)
12    Sec. 16. Cessation of operations. Notwithstanding any
13other provision of this Act, the insurance operations of the
14Plan authorized by this Act shall cease on January 1, 2014 in
15accordance with Section 5-30 of the Illinois Health Benefits
16Exchange Law. Plan coverage does not apply to service provided
17on or after January 1, 2014 in accordance with Section 5-30 of
18the Illinois Health Benefits Exchange Law.
19    (215 ILCS 105/17 new)
20    Sec. 17. Repealer. This Act is repealed on January 1, 2015.
21    Section 20. The Illinois Health Benefits Exchange Law is
22amended by changing Sections 5-3, 5-5, and 5-15 and by adding



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1Sections 5-4, 5-6, 5-16, 5-17, 5-18, 5-21, 5-23, and 5-30 as
3    (215 ILCS 122/5-3)
4    Sec. 5-3. Legislative intent. The General Assembly finds
5the health benefits exchanges authorized by the federal Patient
6Protection and Affordable Care Act represent one of a number of
7ways in which the State can address coverage gaps and provide
8individual consumers and small employers access to greater
9coverage options. The General Assembly also finds that the
10State is best positioned to implement an exchange that is
11sensitive to the coverage gaps and market landscape unique to
12this State.
13    The purpose of this Law is to provide for the establishment
14of an Illinois Health Benefits Exchange (the Exchange) to
15facilitate the purchase and sale of qualified health plans and
16qualified dental plans in the individual market in this State
17and to provide for the establishment of a Small Business Health
18Options Program (SHOP Exchange) to assist qualified small
19employers in this State in facilitating the enrollment of their
20employees in qualified health plans and qualified dental plans
21offered in the small group market. The intent of the Exchange
22is to supplement the existing health insurance market to
23simplify shopping for individual and small employers by
24increasing access to benefit options, encouraging a
25competitive market both inside and outside the Exchange,



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1reducing the number of uninsured, and providing a transparent
2marketplace and effective consumer education and programmatic
3assistance tools. The purpose of this Law is to ensure that the
4State is making sufficient progress towards establishing an
5exchange within the guidelines outlined by the federal law and
6to protect Illinoisans from undue federal regulation. Although
7the federal law imposes a number of core requirements on
8state-level exchanges, the State has significant flexibility
9in the design and operation of a State exchange that make it
10prudent for the State to carefully analyze, plan, and prepare
11for the exchange. The General Assembly finds that in order for
12the State to craft a tenable exchange that meets the
13fundamental goals outlined by the Patient Protection and
14Affordable Care Act of expanding access to affordable coverage
15and improving the quality of care, the implementation process
16should (1) provide for broad stakeholder representation; (2)
17foster a robust and competitive marketplace, both inside and
18outside of the exchange; and (3) provide for a broad-based
19approach to the fiscal solvency of the exchange.
20(Source: P.A. 97-142, eff. 7-14-11.)
21    (215 ILCS 122/5-4 new)
22    Sec. 5-4. Definitions. In this Law:
23    "Board" means the Illinois Health Benefits Exchange Board
24established pursuant to this Law.
25    "Department" means the Department of Insurance.



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1    "Director" means the Director of Insurance.
2    "Educated health care consumer" means an individual who is
3knowledgeable about the health care system, and has background
4or experience in making informed decisions regarding health,
5medical, and public health matters.
6    "Essential health benefits" has the meaning provided under
7Section 1302(b) of the Federal Act.
8    "Exchange" means the Illinois Health Benefits Exchange
9established by this Law and includes the Individual Exchange
10and the SHOP Exchange, unless otherwise specified.
11    "Executive Director" means the Executive Director of the
12Illinois Health Benefits Exchange.
13    "Federal Act" means the federal Patient Protection and
14Affordable Care Act (Public Law 111-148), as amended by the
15federal Health Care and Education Reconciliation Act of 2010
16(Public Law 111-152), and any amendments thereto, or
17regulations or guidance issued under, those Acts.
18    "Health benefit plan" means a policy, contract,
19certificate, or agreement offered or issued by a health carrier
20to provide, deliver, arrange for, pay for, or reimburse any of
21the costs of health care services. "Health benefit plan" does
22not include:
23        (1) coverage for accident only or disability income
24    insurance or any combination thereof;
25        (2) coverage issued as a supplement to liability
26    insurance;



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1        (3) liability insurance, including general liability
2    insurance and automobile liability insurance;
3        (4) workers' compensation or similar insurance;
4        (5) automobile medical payment insurance;
5        (6) credit-only insurance;
6        (7) coverage for on-site medical clinics; or
7        (8) other similar insurance coverage, specified in
8    federal regulations issued pursuant to the federal Health
9    Information Portability and Accountability Act of 1996,
10    Public Law 104-191, under which benefits for health care
11    services are secondary or incidental to other insurance
12    benefits.
13    "Health benefit plan" does not include the following
14benefits if they are provided under a separate policy,
15certificate, or contract of insurance or are otherwise not an
16integral part of the plan:
17        (a) limited scope dental or vision benefits;
18        (b) benefits for long-term care, nursing home care,
19    home health care, community-based care, or any combination
20    thereof; or
21        (c) other similar, limited benefits specified in
22    federal regulations issued pursuant to Public Law 104-191.
23    "Health benefit plan" does not include the following
24benefits if the benefits are provided under a separate policy,
25certificate, or contract of insurance, there is no coordination
26between the provision of the benefits and any exclusion of



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1benefits under any group health plan maintained by the same
2plan sponsor, and the benefits are paid with respect to an
3event without regard to whether benefits are provided with
4respect to such an event under any group health plan maintained
5by the same plan sponsor:
6        (i) coverage only for a specified disease or illness;
7    or
8        (ii) hospital indemnity or other fixed indemnity
9    insurance.
10    "Health benefit plan" does not include the following if
11offered as a separate policy, certificate, or contract of
13        (A) Medicare supplemental health insurance as defined
14    under Section 1882(g)(1) of the federal Social Security
15    Act;
16        (B) coverage supplemental to the coverage provided
17    under Chapter 55 of Title 10, United States Code (Civilian
18    Health and Medical Program of the Uniformed Services
19    (CHAMPUS)); or
20        (C) similar supplemental coverage provided to coverage
21    under a group health plan.
22    "Health benefit plan" does not include a group health plan
23or multiple employer welfare arrangement to the extent the plan
24or arrangement is not subject to State insurance regulation
25under Section 514 of the federal Employee Retirement Income
26Security Act of 1974.



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1    "Health insurance carrier" or "carrier" means an entity
2subject to the insurance laws and regulations of this State, or
3subject to the jurisdiction of the Director, that contracts or
4offers to contract to provide, deliver, arrange for, pay for,
5or reimburse any of the costs of health care services,
6including a sickness and accident insurance company, a health
7maintenance organization, or any other entity providing a plan
8of health insurance, or health benefits.
9    "Illinois Health Benefits Exchange Fund" means the fund
10created outside of the State treasury to be used exclusively to
11provide funding for the operation and administration of the
12Exchange in carrying out the purposes authorized by this Law.
13    "Individual Exchange" means the exchange marketplace
14established by this Law through which qualified individuals may
15obtain coverage through an individual market qualified health
17    "Principal place of business" means the location in a state
18where an employer has its headquarters or significant place of
19business and where the persons with direction and control
20authority over the business are employed.
21    "Qualified dental plan" means a limited scope dental plan
22that has been certified in accordance with this Law.
23    "Qualified employee" means an eligible individual employed
24by a qualified employer who has been offered health insurance
25coverage by that qualified employer through the SHOP on the



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1    "Qualified employer" means a small employer that elects to
2make its full-time employees eligible for one or more qualified
3health plans or qualified dental plans offered through the SHOP
4Exchange, and at the option of the employer, some or all of its
5part-time employees, provided that the employer has its
6principal place of business in this State and elects to provide
7coverage through the SHOP Exchange to all of its eligible
8employees, wherever employed.
9    "Qualified health plan" or "QHP" means a health benefit
10plan that has in effect a certification that the plan meets the
11criteria for certification described in Section 1311(c) of the
12Federal Act.
13    "Qualified health plan issuer" or "QHP issuer" means a
14health insurance issuer that offers a health plan that the
15Exchange has certified as a qualified health plan.
16    "Qualified individual" means an individual, including a
17minor, 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
4of Health and Human Services.
5    "SHOP Exchange" means the Small Business Health Options
6Program established under this Law through which a qualified
7employer can provide small group qualified health plans to its
8qualified employees through various options available to the
9employer, including, but not limited to: (a) offering one
10qualified health plan to employees, (b) offering multiple
11qualified health plans to employees, or (c) offering an
12employee-directed choice of a qualified health plan within an
13employer-selected coverage tier.
14    "Small employer" means, in connection with a group health
15plan with respect to a calendar year and a plan year, an
16employer who employed an average of at least 2 but not more
17than 50 employees before January 1, 2016 and no more than 100
18employees on and after January 1, 2016 on business days during
19the preceding calendar year and who employs at least one
20employee on the first day of the plan year. For purposes of
21this definition:
22        (a) all persons treated as a single employer under
23    subsection (b), (c), (m) or (o) of Section 414 of the
24    federal Internal Revenue Code of 1986 shall be treated as a
25    single employer;
26        (b) an employer and any predecessor employer shall be



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1    treated as a single employer;
2        (c) employees shall be counted in accordance with
3    federal law and regulations and State law and regulations;
4    provided however, that in the event of a conflict between
5    the federal law and regulations and the State law and
6    regulations, the federal law and regulations shall
7    prevail;
8        (d) if an employer was not in existence throughout the
9    preceding calendar year, then the determination of whether
10    that employer is a small employer shall be based on the
11    average number of employees that is reasonably expected
12    that employer will employ on business days in the current
13    calendar year; and
14        (e) an employer that makes enrollment in qualified
15    health plans or qualified dental plans available to its
16    employees through the SHOP Exchange, and would cease to be
17    a small employer by reason of an increase in the number of
18    its employees, shall continue to be treated as a small
19    employer for purposes of this Law as long as it
20    continuously makes enrollment through the SHOP Exchange
21    available to its employees.
22    (215 ILCS 122/5-5)
23    Sec. 5-5. Establishment of the Exchange State health
24benefits exchange.
25    (a) It is declared that this State, beginning on the



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1effective date of this amendatory Act of the 98th General
2Assembly October 1, 2013, in accordance with Section 1311 of
3the federal Patient Protection and Affordable Care Act, shall
4establish a State health benefits exchange to be known as the
5Illinois Health Benefits Exchange in order to help individuals
6and small employers with no more than 50 employees shop for,
7select, and enroll in qualified, affordable private health
8plans that fit their needs at competitive prices. The Exchange
9shall separate coverage pools for individuals and small
10employers and shall supplement and not supplant any existing
11private health insurance market for individuals and small
12employers. These health plans shall be available to individuals
13and small employers for enrollment by October 1, 2014.
14    (b) There is hereby created a political subdivision, body
15politic and corporate, named the Illinois Health Benefits
16Exchange. The Exchange shall be a public entity, but shall not
17be considered a department, institution, or agency of the
19    (c) The Exchange shall be comprised of an individual and a
20small business health options (SHOP) exchange. Pursuant to
21Section 1311(b)(2) of the Federal Act, the Exchange shall
22provide individual exchange services to qualified individuals
23and SHOP Exchange services to qualified employers under a
24single governance and administrative structure. The Board
25shall produce an assessment, which must include a premium
26impact study, by July 1, 2016 to determine the viability of



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1merging the SHOP Exchange and Individual Exchange functions
2into a single exchange by January 1, 2017. Any recommended
3merger of the SHOP Exchange and Individual Exchange functions
4shall be subject to legislative approval.
5    (d) The Exchange shall promote a competitive marketplace
6for consumer access to affordable health coverage options. The
7Department shall review and recommend that the Board certify
8health benefit plans on the individual and SHOP Exchange, as
9applicable, provided that any such health benefit plan meets
10the requirements set forth in Section 1311(c) of the Federal
11Act and any other requirements of the Illinois Insurance Code.
12The Board shall certify health benefit plans that the
13Department recommends for certification.
14    (e) The Exchange shall not supersede the provisions of the
15Illinois Insurance Code, nor the functions of the Department of
16Insurance, the Department of Healthcare and Family Services, or
17the Department of Public Health.
18(Source: P.A. 97-142, eff. 7-14-11.)
19    (215 ILCS 122/5-6 new)
20    Sec. 5-6. Health benefit plan certification.
21    (a) To be certified as a qualified health plan, a health
22benefit plan shall, at a minimum:
23        (1) provide the essential health benefits package
24    described in Section 1302(a) of the Federal Act; except
25    that the plan is not required to provide essential benefits



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1    that duplicate the minimum benefits of qualified dental
2    plans, as provided in subsection (e) of this Section if:
3            (A) the Board, in cooperation with the Department,
4        has determined that at least one qualified dental plan
5        is available to supplement the plan's coverage; and
6            (B) the health carrier makes prominent disclosure
7        at the time it offers the plan, in a form approved by
8        the Board, that the plan does not provide the full
9        range of essential pediatric dental benefits and that
10        qualified dental plans providing those benefits and
11        other dental benefits not covered by the plan are
12        offered through the Exchange;
13        (2) fulfill all premium rate and contract filing
14    requirements and ensure that no contract language has been
15    disapproved by the Director;
16        (3) provide at least the minimum level of coverage
17    prescribed by the Federal Act;
18        (4) ensure that the cost-sharing requirements of the
19    plan do not exceed the limits established under Section
20    1302(c)(l) of the Federal Act, and if the plan is offered
21    through the SHOP Exchange, the plan's deductible does not
22    exceed the limits established under Section 1302(c)(2) of
23    the Federal Act;
24        (5) be offered by a health carrier that:
25            (A) is authorized and in good standing to offer
26        health insurance coverage;



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1            (B) offers at least one qualified health plan at
2        the silver level and at least one plan at the gold
3        level, as described in the Federal Act, through each
4        component of the Board in which the health carrier
5        participates; for the purposes of this subparagraph
6        (B), "component" means the SHOP Exchange and the
7        exchange for individual coverage within the American
8        Health Benefit Exchange;
9            (C) charges the same premium rate for each
10        qualified health plan without regard to whether the
11        plan is offered through the Exchange and without regard
12        to whether the plan is offered directly from the health
13        carrier or through an insurance producer;
14            (D) does not charge any cancellation fees or
15        penalties; and
16            (E) complies with the regulations established by
17        the Secretary under Section 1311 (d) of the Federal Act
18        and any other requirements of the Illinois Insurance
19        Code and the Department;
20        (6) meet the requirements of certification pursuant to
21    the requirements of the Department and the Illinois
22    Insurance Code provided in this Law and the requirements
23    issued by the Secretary under Section 1311(c) of the
24    Federal Act and rules promulgated or adopted pursuant to
25    this Law or the Federal Act, which shall include:
26            (A) minimum standards in the areas of marketing



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1        practices;
2            (B) network adequacy;
3            (C) essential community providers in underserved
4        areas;
5            (D) accreditation;
6            (E) quality improvement;
7            (F) uniform enrollment forms and descriptions of
8        coverage; and
9            (G) information on quality measures for health
10        benefit plan performance; and
11        (7) include outpatient clinics in the health plan's
12    region that are controlled by an entity that also controls
13    a 340B eligible provider as defined by Section 340B(a)(4)
14    of the federal Public Health Service Act such that the
15    outpatient clinics are subject to the same mission,
16    policies, and medical standards related to the provision of
17    health care services as the 340B eligible provider.
18    (b) The Department shall require each health carrier
19seeking certification of a plan as a qualified health plan to:
20        (1) make available to the public, in plain language as
21    defined in Section 1311(e)(3)(B) of the Federal Act, and
22    submit to the Board, the Secretary, and the Department
23    accurate and timely disclosure of the following:
24                (i) claims payment policies and practices;
25                (ii) periodic financial disclosures;
26                (iii) data on enrollment;



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1                (iv) data on disenrollment;
2                (v) data on the number of claims that are
3            denied;
4                (vi) data on rating practices;
5                (vii) information on cost-sharing and payments
6            with respect to any out-of-network coverage;
7                (viii) information on enrollee and participant
8            rights under Title I of the Federal Act; and
9                (ix) other information as determined
10            appropriate by the Secretary, including, but not
11            limited to, accredited clinical quality measures;
12            and
13        (2) permit individuals to learn, in a timely manner
14    upon the request of the individual, the comparative quality
15    standards of the plans along established clinical
16    data-based standards and the amount of cost-sharing,
17    including deductibles, copayments, and coinsurance, under
18    the individual's plan or coverage that the individual would
19    be responsible for paying with respect to the furnishing of
20    a specific item or service by a participating provider and
21    make this information available to the individual through
22    an Internet website that is publicly accessible and through
23    other means for individuals without access to the Internet.
24    (c) The Department shall not exempt any health carrier
25seeking certification as a qualified health plan, regardless of
26the type or size of the health carrier, from licensure or



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1solvency requirements and shall apply the criteria of this
2Section in a manner that ensures a level playing field between
3or among health carriers participating in the Exchange.
4    (d) The provisions of this Law that are applicable to
5qualified health plans shall also apply, to the extent
6relevant, to qualified dental plans, except as modified in
7accordance with the provisions of paragraphs (1), (2), and (3)
8of this subsection (d) or by rules adopted by the Board.
9        (1) The health carrier shall be licensed to offer
10    dental coverage, but need not be licensed to offer other
11    health benefits.
12        (2) The plan shall be limited to dental and oral health
13    benefits, without substantially duplicating the benefits
14    typically offered by health benefit plans without dental
15    coverage and shall include, at a minimum, the essential
16    pediatric dental benefits prescribed by the Secretary
17    pursuant to Section 1302(b)(l)(J) of the Federal Act and
18    such other dental benefits as the Board or the Secretary
19    may specify by rule.
20        (3) Health carriers may jointly offer a comprehensive
21    plan through the Exchange in which the dental benefits are
22    provided by a health carrier through a qualified dental
23    plan and the other benefits are provided by a health
24    carrier through a qualified health plan, provided that the
25    plans are priced separately and are also made available for
26    purchase separately at the same price.



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1    (215 ILCS 122/5-15)
2    Sec. 5-15. Illinois Health Benefits Exchange Legislative
3Oversight Study Committee.
4    (a) There is created an Illinois Health Benefits Exchange
5Legislative Oversight Study Committee within the Commission on
6Government Forecasting and Accountability to provide
7accountability for conduct a study regarding State
8implementation and establishment of the Illinois Health
9Benefits Exchange and to ensure Exchange operations and
10functions align with the goals and duties outlined by this Law.
11The Committee shall also be responsible for providing policy
12recommendations to ensure the Exchange aligns with the Federal
13Act, amendments to the Federal Act, and regulations promulgated
14pursuant to the Federal Act.
15    (b) Members of the Legislative Oversight Study Committee
16shall be appointed as follows: 3 members of the Senate shall be
17appointed by the President of the Senate; 3 members of the
18Senate shall be appointed by the Minority Leader of the Senate;
193 members of the House of Representatives shall be appointed by
20the Speaker of the House of Representatives; and 3 members of
21the House of Representatives shall be appointed by the Minority
22Leader of the House of Representatives. Each legislative leader
23shall select one member to serve as co-chair of the committee.
24    (c) Members of the Legislative Oversight Study Committee
25shall be appointed no later than June 1, 2013 within 30 days



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1after the effective date of this Law. The co-chairs shall
2convene the first meeting of the committee no later than 45
3days after the effective date of this Law.
4(Source: P.A. 97-142, eff. 7-14-11.)
5    (215 ILCS 122/5-16 new)
6    Sec. 5-16. Exchange governance. The governing and
7administrative powers of the Exchange shall be vested in a body
8known as the Illinois Health Benefits Exchange Board. The
9following provisions shall apply:
10        (1) The Board shall consist of 11 voting members
11    appointed by the Governor with the advice and consent of a
12    majority of the members elected to the Senate. In addition,
13    the Director of Healthcare and Family Services, and the
14    Executive Director of the Exchange shall serve as
15    non-voting, ex-officio members of the Board. The Governor
16    shall also appoint as non-voting, ex-officio members one
17    economist with experience in the health care markets and
18    one educated health care consumer advocate. All Board
19    members shall be appointed no later than January 1, 2014.
20        (2) The Governor shall make the appointments so as to
21    reflect no less than proportional representation of the
22    geographic, gender, cultural, racial, and ethnic
23    composition of this State and in accordance with
24    subparagraphs (A), (B), and (C) of this paragraph, as
25    follows:



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1            (A) No more than 4 voting members may represent the
2        following interests, of which no more than 2 may
3        represent any one interest:
4                (1) the insurance industry;
5                (2) health care administrators; and
6                (3) licensed health care professionals.
7            (B) At least 7 voting members shall represent the
8        following interest groups, with each interest group
9        represented by at least one voting member:
10                (1) a labor interest group;
11                (2) a women's interest group;
12                (3) a minorities' interest group;
13                (4) a disabled persons' interest group;
14                (5) a small business interest group; and
15                (6) a public health interest group.
16            (C) Each person appointed to the Board should have
17        demonstrated experience in at least one of the
18        following areas:
19                (1) individual health insurance coverage;
20                (2) small employer health insurance;
21                (3) health benefits administration;
22                (4) health care finance;
23                (5) administration of a public or private
24            health care delivery system;
25                (6) the provision of health care services;
26                (7) the purchase of health insurance coverage;



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1                (8) health care consumer navigation or
2        assistance;
3                (9) health care economics or health care
4        actuarial sciences;
5                (10) information technology; or
6                (11) starting a small business with 50 or fewer
7        employees.
8        (3) The Board shall elect one voting member of the
9    Board to serve as chairperson and one voting member to
10    serve as vice-chairperson, upon approval of a majority of
11    the Board.
12        (4) The Exchange shall be administered by an Executive
13    Director, who shall be appointed, and may be removed, by a
14    majority of the Board. The Board shall have the power to
15    determine compensation for the Executive Director.
16        (5) The terms of the non-voting, ex-officio members of
17    the Board shall run concurrent with their terms of
18    appointment to office, or in the case of the Executive
19    Director, his or her term of appointment to that position,
20    subject to the determination of the Board. The terms of the
21    members, including those non-voting, ex-officio members
22    appointed by the Governor, shall be 4 years. Upon
23    conclusion of the initial term, the next term and every
24    term subsequent to it shall run for 3 years. Voting members
25    shall serve no more than 3 consecutive terms.
26        A person appointed to fill a vacancy and complete the



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1    unexpired term of a member of the Board shall only be
2    appointed to serve out the unexpired term by the individual
3    who made the original appointment within 45 days after the
4    initial vacancy. A person appointed to fill a vacancy and
5    complete the unexpired term of a member of the Board may be
6    re-appointed to the Board for another term, but shall not
7    serve than more than 2 consecutive terms following their
8    completion of the unexpired term of a member of the Board.
9        If a voting Board member's qualifications change due to
10    a change in employment during the term of their
11    appointment, then the Board member shall resign their
12    position, subject to reappointment by the individual who
13    made the original appointment.
14        (6) The Board shall, as necessary, create and appoint
15    qualified persons with requisite expertise to Exchange
16    technical advisory groups. These Exchange technical
17    advisory groups shall meet in a manner and frequency
18    determined by the Board to discuss exchange-related issues
19    and to provide exchange-related guidance, advice, and
20    recommendations to the Board and the Exchange. There shall
21    be at a minimum, 6 technical advisory groups, including the
22    following:
23            (1) an insurer advisory group;
24            (2) a business advisory group;
25            (3) a consumer advisory group;
26            (4) a provider advisory group;



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1            (5) an insurance producer advisory group; and
2            (6) a dentist advisory group.
3        (7) The Board shall meet no less than quarterly on a
4    schedule established by the chairperson. Meetings shall be
5    public and public records shall be maintained, subject to
6    the Open Meetings Act. A majority of the Board shall
7    constitute a quorum and the affirmative vote of a majority
8    is necessary for any action of the Board. No vacancy shall
9    impair the ability of the Board to act provided a quorum is
10    reached. Members shall serve without pay, but shall be
11    reimbursed for their actual and reasonable expenses
12    incurred in the performance of their duties. The
13    chairperson of the Board shall file a written report
14    regarding the activities of the Board and the Exchange to
15    the Governor and General Assembly annually, and the
16    Legislative Oversight Committee established in Section
17    5-15 quarterly, beginning on September 1, 2013 through
18    December 31, 2014.
19        (8) The Board shall adopt conflict of interest rules
20    and recusal procedures. Such rules and procedures shall (i)
21    prohibit a member of the Board from performing an official
22    act that may have a direct economic benefit on a business
23    or other endeavor in which that member has a direct or
24    substantial financial interest and (ii) require a member of
25    the Board to recuse himself or herself from an official
26    matter, whether direct or indirect. All recusals must be in



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1    writing and specify the reason and date of the recusal. All
2    recusals shall be maintained by the Executive Director and
3    shall be disclosed to any person upon written request.
4        (9) The Board shall develop a budget, to be submitted
5    to the General Assembly along with the Governor's annual
6    budget proposal and approved by the General Assembly, for
7    the implementation and operation of the Exchange for
8    operating expenses, including, but not limited to:
9            (A) proposed compensation levels for the Executive
10        Director and shall identify personnel and staffing
11        needs for the implementation and operation of the
12        Exchange;
13            (B) disclosure of funds received or expected to be
14        received from the federal government for the
15        infrastructure and systems of the Exchange and those
16        funds received or expected to be received for program
17        administration and operations;
18            (C) delineation of those functions of the Exchange
19        that are to be paid by State and federal programs that
20        are allocable to the State's General Revenue Fund; and
21            (D) beginning January 1, 2015, insurer assessments
22        contingent upon the use of federal funds for the first
23        year of operation of the Exchange and upon the review
24        and recommendations of the Commission on Government
25        Forecasting and Accountability.
26        (10) The Board shall, in consultation with the Health



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1    Benefits Exchange Legislative Oversight Committee, produce
2    a cost-benefit analysis of the State's essential health
3    benefits no later than August 1, 2015 for the purposes of
4    informing the U.S. Department of Health and Human Services
5    in their re-evaluation of the essential health benefits for
6    plan years 2016 and beyond.
7        (11) The purpose of the Board shall be to implement the
8    Exchange in accordance with this Section and shall be
9    authorized to establish procedures for the operation of the
10    Exchange, subject to legislative approval.
11    (215 ILCS 122/5-17 new)
12    Sec. 5-17. Insurer's assessment. Every carrier licensed to
13issue, and that issues for delivery, policies of accident and
14health insurance in this State shall be assessed. An insurer's
15assessment shall be determined by multiplying the total
16assessment, as determined in this Section, by a fraction, the
17numerator of which equals that insurer's direct Illinois
18premiums (excluding those premiums from short term, accident
19only, disability income, hospital confinement or fixed
20indemnity, vision only, limited benefit, Medicare supplement,
21long-term care, or credit insurance, coverage issued as a
22supplement to liability insurance, insurance arising out of a
23workers' compensation or similar law, automobile
24medical-payment insurance, insurance under which benefits are
25payable with or without regard to fault and which is



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1statutorily required to be contained in any liability insurance
2policy or equivalent self-insurance, or a Consumer Operated and
3Oriented Plan), during the preceding calendar year and the
4denominator of which equals the total of all insurers' direct
5Illinois premiums (excluding those premiums from short term,
6accident only, disability income, hospital confinement or
7fixed indemnity, vision only, limited benefit, Medicare
8supplement, long-term care, or credit insurance, coverage
9issued as a supplement to liability insurance, insurance
10arising out of a workers' compensation or similar law,
11automobile medical-payment insurance, insurance under which
12benefits are payable with or without regard to fault and which
13is statutorily required to be contained in any liability
14insurance policy or equivalent self-insurance, or a Consumer
15Operated and Oriented Plan). The Board may exempt those
16insurers whose share as determined under this Section would be
17so minimal as to not exceed the estimated cost of levying the
18assessment. The Board shall charge and collect from each
19insurer the amounts determined to be due under this Section.
20The assessment shall be billed by Board invoice based upon the
21insurer's direct Illinois premium income, excluding premium
22income from limited lines policies and supplemental insurance
23policies, as shown in its annual statement for the preceding
24calendar year as filed with the Director. The invoice shall be
25due upon receipt and must be paid no later than 30 days after
26receipt by the insurer.



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1    When a carrier fails to pay the full amount of any
2assessment of $100 or more due under this Section there shall
3be added to the amount due as a penalty the greater of $50 or an
4amount equal to 5% of the deficiency for each month or part of
5a month that the deficiency remains unpaid. All moneys
6collected by the Board shall be placed in the Illinois Health
7Benefits Exchange Fund.
8    Insurers shall be assessed only an amount not exceeding the
9General Assembly's approved Board budget. No assessment shall
10be made on insurers while assessments are being made pursuant
11to Section 12 of the Comprehensive Health Insurance Plan Act.
12The assessment shall also take into consideration any unspent
13federal funds remaining and shall be reduced accordingly.
14    The Board shall prepare annually a complete and detailed
15written report accounting for all funds received and dispensed
16during the preceding fiscal year.
17    (215 ILCS 122/5-18 new)
18    Sec. 5-18. Illinois Health Benefits Exchange Fund. There
19is hereby created as a fund outside of the State treasury the
20Illinois Health Benefits Exchange Fund to be used, subject to
21appropriation, exclusively by the Exchange to provide funding
22for the operation and administration of the Exchange in
23carrying out the purposes authorized in this Law.
24    (215 ILCS 122/5-21 new)



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1    Sec. 5-21. Enrollment through brokers and agents; producer
3    (a) In accordance with Section 1312(e) of the Federal Act,
4the Exchange shall allow licensed insurance producers to (1)
5enroll qualified individuals in any qualified health plan, for
6which the individual is eligible, in the individual exchange,
7(2) assist qualified individuals in applying for premium tax
8credits and cost-sharing reductions for qualified health plans
9purchased through the individual exchange, and (3) enroll
10qualified employers in any qualified health plan, for which the
11employer is eligible, offered through the SHOP exchange.
12Nothing in this subsection (a) shall be construed as to require
13a qualified individual or qualified employer to utilize a
14licensed insurance producer for any of the purposes outlined in
15this subsection (a).
16    (b) In order to enroll individuals and small employers in
17qualified health plans on the Exchange, licensed producers must
18complete a certification program. The Department of Insurance
19may develop and implement a certification program for licensed
20insurance producers who enroll individuals and employers in the
21exchange. The Department of Insurance may charge a reasonable
22fee, by regulation, to producers for the certification program.
23The Department of Insurance may approve certification programs
24developed and instructed by others, charging a reasonable fee,
25by regulation, for approval.
26    (c) The Exchange shall include on its Internet website a



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1producer locator section, featured prominently, through which
2individuals and small employers can find exchange-certified
4    (d) The Exchange shall take no role in developing or
5determining the manner or amount of compensation producers
6receive from qualified health plans for individuals or
7employers enrolled in health plans through the Exchange.
8    (215 ILCS 122/5-23 new)
9    Sec. 5-23. Examination or investigation of the Exchange.
10The Director shall have the ability to examine or investigate
11the Exchange pursuant to his or her authority under Article
12XXIV of the Illinois Insurance Code.
13    (215 ILCS 122/5-30 new)
14    Sec. 5-30. Dissolution of Comprehensive Health Insurance
16    (a) Except as otherwise provided in this Section, the
17insurance operations of the Comprehensive Health Insurance
18Plan authorized by the Comprehensive Health Insurance Plan Act
19shall cease on January 1, 2014. As used in this Section, "Plan"
20means the Comprehensive Health Insurance plan.
21    (b) Coverage under the Plan does not apply to service
22provided on or after January 1, 2014.
23    (c) A claim for payment under the Plan must be submitted
24within 180 days after January 1, 2014 and paid within 60 days



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1after receipt.
2    (d) Any grievance shall be resolved by the Plan Board not
3later than 360 days after January 1, 2014. In this Section,
4"Plan Board" means the Illinois Comprehensive Health Insurance
6    (e) The Plan Board shall, not later than June 30, 2013,
7submit to the Director of Insurance a plan of dissolution,
8which must provide for, but not be limited to, the following:
9        (1) Continuity of care for an individual who is covered
10    under the Plan and is an inpatient on January 1, 2014.
11        (2) A final accounting of assessments.
12        (3) Resolution of any net asset deficiency.
13        (4) Cessation of all liability of the Plan.
14        (5) Final dissolution of the Plan.
15    (f) The plan of dissolution may provide that, with the
16approval of the Plan Board and the Director, a power or duty of
17the association may be delegated to a person that is to perform
18functions similar to the functions of the Plan.
19    (g) The Director shall, after notice and hearing, approve a
20plan of dissolution submitted under subsection (e) of this
21Section if the Director determines that the plan of dissolution
22is suitable to ensure the fair, reasonable, and equitable
23dissolution of the Plan and complies with subsection (e) of
24this Section. If the Director does not find that the plan of
25dissolution is suitable to ensure the fair, reasonable, and
26equitable dissolution of the Plan, he or she may by order



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1require changes to the plan that cure the deficiencies
2identified in his or her findings.
3    (h) A plan of dissolution submitted under subsection (e) of
4this Section is effective upon the written approval of the
6    (i) An action by or against the Plan must be filed not more
7than one year after January 1, 2014.
8    (j) General Revenue Fund funds remaining in the Plan on the
9date on which final dissolution of the Plan occurs must be
10transferred back into the General Revenue Fund.
11    (k) Insurer assessments remaining in the Plan on the date
12on which dissolution of the Plan occurs must be returned to
13insurers based on subsection e of Section 12 of the
14Comprehensive Health Insurance Plan Act.
15    (l) The Plan, or the person or entity to which the Plan
16delegates powers under subsection (f) of this Section, may
17implement this Section in accordance with the plan of
18dissolution approved by the Director under subsection (g) of
19this Section.
20    Section 99. Effective date. This Act takes effect upon
21becoming law.".