Sen. David Koehler

Filed: 4/15/2013

 

 


 

 


 
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1
AMENDMENT TO SENATE BILL 34

2    AMENDMENT NO. ______. Amend Senate Bill 34 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
10Act:
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 Health Benefits Exchange Law is
7amended by changing Sections 5-3, 5-5, and 5-15 and by adding
8Sections 5-4, 5-6, 5-16, 5-17, 5-18, 5-21, and 5-23 as follows:
 
9    (215 ILCS 122/5-3)
10    Sec. 5-3. Legislative intent. The General Assembly finds
11the health benefits exchanges authorized by the federal Patient
12Protection and Affordable Care Act represent one of a number of
13ways in which the State can address coverage gaps and provide
14individual consumers and small employers access to greater
15coverage options. The General Assembly also finds that the
16State is best positioned to implement an exchange that is
17sensitive to the coverage gaps and market landscape unique to
18this State.
19    The purpose of this Law is to provide for the establishment
20of an Illinois Health Benefits Exchange (the Exchange) to
21facilitate the purchase and sale of qualified health plans and
22qualified dental plans in the individual market in this State
23and to provide for the establishment of a Small Business Health
24Options Program (SHOP Exchange) to assist qualified small

 

 

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1employers in this State in facilitating the enrollment of their
2employees in qualified health plans and qualified dental plans
3offered in the small group market. The intent of the Exchange
4is to supplement the existing health insurance market to
5simplify shopping for individual and small employers by
6increasing access to benefit options, encouraging a
7competitive market both inside and outside the Exchange,
8reducing the number of uninsured, and providing a transparent
9marketplace and effective consumer education and programmatic
10assistance tools. The purpose of this Law is to ensure that the
11State is making sufficient progress towards establishing an
12exchange within the guidelines outlined by the federal law and
13to protect Illinoisans from undue federal regulation. Although
14the federal law imposes a number of core requirements on
15state-level exchanges, the State has significant flexibility
16in the design and operation of a State exchange that make it
17prudent for the State to carefully analyze, plan, and prepare
18for the exchange. The General Assembly finds that in order for
19the State to craft a tenable exchange that meets the
20fundamental goals outlined by the Patient Protection and
21Affordable Care Act of expanding access to affordable coverage
22and improving the quality of care, the implementation process
23should (1) provide for broad stakeholder representation; (2)
24foster a robust and competitive marketplace, both inside and
25outside of the exchange; and (3) provide for a broad-based
26approach to the fiscal solvency of the exchange.

 

 

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1(Source: P.A. 97-142, eff. 7-14-11.)
 
2    (215 ILCS 122/5-4 new)
3    Sec. 5-4. Definitions. In this Law:
4    "Board" means the Illinois Health Benefits Exchange Board
5established pursuant to this Law.
6    "Department" means the Department of Insurance.
7    "Director" means the Director of Insurance.
8    "Educated health care consumer" means an individual who is
9knowledgeable about the health care system, and has background
10or experience in making informed decisions regarding health,
11medical, and public health matters.
12    "Essential health benefits" has the meaning provided under
13Section 1302(b) of the Federal Act.
14    "Exchange" means the Illinois Health Benefits Exchange
15established by this Law and includes the Individual Exchange
16and the SHOP Exchange, unless otherwise specified.
17    "Executive Director" means the Executive Director of the
18Illinois Health Benefits Exchange.
19    "Federal Act" means the federal Patient Protection and
20Affordable Care Act (Public Law 111-148), as amended by the
21federal Health Care and Education Reconciliation Act of 2010
22(Public Law 111-152), and any amendments thereto, or
23regulations or guidance issued under, those Acts.
24    "Health benefit plan" means a policy, contract,
25certificate, or agreement offered or issued by a health carrier

 

 

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1to provide, deliver, arrange for, pay for, or reimburse any of
2the costs of health care services. "Health benefit plan" does
3not include:
4        (1) coverage for accident only or disability income
5    insurance or any combination thereof;
6        (2) coverage issued as a supplement to liability
7    insurance;
8        (3) liability insurance, including general liability
9    insurance and automobile liability insurance;
10        (4) workers' compensation or similar insurance;
11        (5) automobile medical payment insurance;
12        (6) credit-only insurance;
13        (7) coverage for on-site medical clinics; or
14        (8) other similar insurance coverage, specified in
15    federal regulations issued pursuant to the federal Health
16    Information Portability and Accountability Act of 1996,
17    Public Law 104-191, under which benefits for health care
18    services are secondary or incidental to other insurance
19    benefits.
20    "Health benefit plan" does not include the following
21benefits if they are provided under a separate policy,
22certificate, or contract of insurance or are otherwise not an
23integral part of the plan:
24        (a) limited scope dental or vision benefits;
25        (b) benefits for long-term care, nursing home care,
26    home health care, community-based care, or any combination

 

 

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1    thereof; or
2        (c) other similar, limited benefits specified in
3    federal regulations issued pursuant to Public Law 104-191.
4    "Health benefit plan" does not include the following
5benefits if the benefits are provided under a separate policy,
6certificate, or contract of insurance, there is no coordination
7between the provision of the benefits and any exclusion of
8benefits under any group health plan maintained by the same
9plan sponsor, and the benefits are paid with respect to an
10event without regard to whether benefits are provided with
11respect to such an event under any group health plan maintained
12by the same plan sponsor:
13        (i) coverage only for a specified disease or illness;
14    or
15        (ii) hospital indemnity or other fixed indemnity
16    insurance.
17    "Health benefit plan" does not include the following if
18offered as a separate policy, certificate, or contract of
19insurance:
20        (A) Medicare supplemental health insurance as defined
21    under Section 1882(g)(1) of the federal Social Security
22    Act;
23        (B) coverage supplemental to the coverage provided
24    under Chapter 55 of Title 10, United States Code (Civilian
25    Health and Medical Program of the Uniformed Services
26    (CHAMPUS)); or

 

 

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1        (C) similar supplemental coverage provided to coverage
2    under a group health plan.
3    "Health benefit plan" does not include a group health plan
4or multiple employer welfare arrangement to the extent the plan
5or arrangement is not subject to State insurance regulation
6under Section 514 of the federal Employee Retirement Income
7Security Act of 1974.
8    "Health insurance carrier" or "carrier" means an entity
9subject to the insurance laws and regulations of this State, or
10subject to the jurisdiction of the Director, that contracts or
11offers to contract to provide, deliver, arrange for, pay for,
12or reimburse any of the costs of health care services,
13including a sickness and accident insurance company, a health
14maintenance organization, or any other entity providing a plan
15of health insurance, health benefits, or health services.
16"Health insurance carrier" does not include short term,
17accident only, disability income, hospital confinement or
18fixed indemnity, vision only, limited benefit, or credit
19insurance, coverage issued as a supplement to liability
20insurance, insurance arising out of a workers' compensation or
21similar law, automobile medical-payment insurance, insurance
22under which benefits are payable with or without regard to
23fault and which is statutorily required to be contained in any
24liability insurance policy or equivalent self-insurance, or a
25Consumer Operated and Oriented Plan.
26    "Illinois Health Benefits Exchange Fund" means the fund

 

 

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1created outside of the State treasury to be used exclusively to
2provide funding for the operation and administration of the
3Exchange in carrying out the purposes authorized by this Law.
4    "Individual Exchange" means the exchange marketplace
5established by this Law through which qualified individuals may
6obtain coverage through an individual market qualified health
7plan.
8    "Principal place of business" means the location in a state
9where an employer has its headquarters or significant place of
10business and where the persons with direction and control
11authority over the business are employed.
12    "Qualified dental plan" means a limited scope dental plan
13that has been certified in accordance with this Law.
14    "Qualified employee" means an eligible individual employed
15by a qualified employer who has been offered health insurance
16coverage by that qualified employer through the SHOP on the
17Exchange.
18    "Qualified employer" means a small employer that elects to
19make its full-time employees eligible for one or more qualified
20health plans or qualified dental plans offered through the SHOP
21Exchange, and at the option of the employer, some or all of its
22part-time employees, provided that the employer has its
23principal place of business in this State and elects to provide
24coverage through the SHOP Exchange to all of its eligible
25employees, wherever employed.
26    "Qualified health plan" or "QHP" means a health benefit

 

 

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1plan that has in effect a certification that the plan meets the
2criteria for certification described in Section 1311(c) of the
3Federal Act.
4    "Qualified health plan issuer" or "QHP issuer" means a
5health insurance issuer that offers a health plan that the
6Exchange has certified as a qualified health plan.
7    "Qualified individual" means an individual, including a
8minor, who:
9        (1) is seeking to enroll in a qualified health plan or
10    qualified dental plan offered to individuals through the
11    Exchange;
12        (2) resides in this State;
13        (3) at the time of enrollment, is not incarcerated,
14    other than incarceration pending the disposition of
15    charges; and
16        (4) is, and is reasonably expected to be, for the
17    entire period for which enrollment is sought, a citizen or
18    national of the United States or an alien lawfully present
19    in the United States.
20    "Secretary" means the Secretary of the federal Department
21of Health and Human Services.
22    "SHOP Exchange" means the Small Business Health Options
23Program established under this Law through which a qualified
24employer can provide small group qualified health plans to its
25qualified employees.
26    "Small employer" means, in connection with a group health

 

 

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1plan with respect to a calendar year and a plan year, an
2employer who employed an average of at least 2 but not more
3than 50 employees before January 1, 2016 and no more than 100
4employees on and after January 1, 2016 on business days during
5the preceding calendar year and who employs at least one
6employee on the first day of the plan year. For purposes of
7this definition:
8        (a) all persons treated as a single employer under
9    subsection (b), (c), (m) or (o) of Section 414 of the
10    federal Internal Revenue Code of 1986 shall be treated as a
11    single employer;
12        (b) an employer and any predecessor employer shall be
13    treated as a single employer;
14        (c) employees shall be counted in accordance with
15    federal law and regulations and State law and regulations;
16    provided however, that in the event of a conflict between
17    the federal law and regulations and the State law and
18    regulations, the federal law and regulations shall
19    prevail;
20        (d) if an employer was not in existence throughout the
21    preceding calendar year, then the determination of whether
22    that employer is a small employer shall be based on the
23    average number of employees that is reasonably expected
24    that employer will employ on business days in the current
25    calendar year; and
26        (e) an employer that makes enrollment in qualified

 

 

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1    health plans or qualified dental plans available to its
2    employees through the SHOP Exchange, and would cease to be
3    a small employer by reason of an increase in the number of
4    its employees, shall continue to be treated as a small
5    employer for purposes of this Law as long as it
6    continuously makes enrollment through the SHOP Exchange
7    available to its employees.
 
8    (215 ILCS 122/5-5)
9    Sec. 5-5. Establishment of the Exchange State health
10benefits exchange.
11    (a) It is declared that this State, beginning on the
12effective date of this amendatory Act of the 98th General
13Assembly October 1, 2013, in accordance with Section 1311 of
14the federal Patient Protection and Affordable Care Act, shall
15establish a State health benefits exchange to be known as the
16Illinois Health Benefits Exchange in order to help individuals
17and small employers with no more than 50 employees shop for,
18select, and enroll in qualified, affordable private health
19plans that fit their needs at competitive prices. The Exchange
20shall separate coverage pools for individuals and small
21employers and shall supplement and not supplant any existing
22private health insurance market for individuals and small
23employers. These health plans shall be available to individuals
24and small employers for enrollment by October 1, 2014.
25    (b) There is hereby created a political subdivision, body

 

 

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1politic and corporate, named the Illinois Health Benefits
2Exchange. The Exchange shall be a public entity, but shall not
3be considered a department, institution, or agency of the
4State.
5    (c) The Exchange shall be comprised of an individual and a
6small business health options (SHOP) exchange. Pursuant to
7Section 1311(b)(2) of the Federal Act, the Exchange shall
8provide individual exchange services to qualified individuals
9and SHOP Exchange services to qualified employers under a
10single governance and administrative structure. The Board
11shall produce an assessment by July 1, 2016 to determine the
12viability of merging the SHOP Exchange and Individual Exchange
13functions into a single exchange by January 1, 2017.
14    (d) The Exchange shall promote a competitive marketplace
15for consumer access to affordable health coverage options. The
16Department shall review and recommend that the Board certify
17health benefit plans on the individual and SHOP Exchange, as
18applicable, provided that any such health benefit plan meets
19the requirements set forth in Section 1311(c) of the Federal
20Act and any other requirements of the Illinois Insurance Code.
21The Board shall certify health benefit plans that the
22Department recommends for certification.
23    (e) The Exchange shall not supersede the provisions of the
24Illinois Insurance Code, nor the functions of the Department of
25Insurance, the Department of Healthcare and Family Services, or
26the Department of Public Health.

 

 

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1(Source: P.A. 97-142, eff. 7-14-11.)
 
2    (215 ILCS 122/5-6 new)
3    Sec. 5-6. Health benefit plan certification.
4    (a) To be certified as a qualified health plan, a health
5benefit plan shall, at a minimum:
6        (1) provide the essential health benefits package
7    described in Section 1302(a) of the Federal Act; except
8    that the plan is not required to provide essential benefits
9    that duplicate the minimum benefits of qualified dental
10    plans, as provided in subsection (e) of this Section if:
11            (A) the Board, in cooperation with the Department,
12        has determined that at least one qualified dental plan
13        is available to supplement the plan's coverage; and
14            (B) the health carrier makes prominent disclosure
15        at the time it offers the plan, in a form approved by
16        the Board, that the plan does not provide the full
17        range of essential pediatric dental benefits and that
18        qualified dental plans providing those benefits and
19        other dental benefits not covered by the plan are
20        offered through the Exchange;
21        (2) fulfill all premium rate and contract filing
22    requirements and ensure that no contract language has been
23    disapproved by the Director;
24        (3) provide at least the minimum level of coverage
25    prescribed by the Federal Act;

 

 

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1        (4) ensure that the cost-sharing requirements of the
2    plan do not exceed the limits established under Section
3    1302(c)(l) of the Federal Act, and if the plan is offered
4    through the SHOP Exchange, the plan's deductible does not
5    exceed the limits established under Section 1302(c)(2) of
6    the Federal Act;
7        (5) be offered by a health carrier that:
8            (A) is authorized and in good standing to offer
9        health insurance coverage;
10            (B) offers at least one qualified health plan at
11        the silver level and at least one plan at the gold
12        level, as described in the Federal Act, through each
13        component of the Board in which the health carrier
14        participates; for the purposes of this subparagraph
15        (B), "component" means the SHOP Exchange and the
16        exchange for individual coverage within the American
17        Health Benefit Exchange;
18            (C) charges the same premium rate for each
19        qualified health plan without regard to whether the
20        plan is offered through the Exchange and without regard
21        to whether the plan is offered directly from the health
22        carrier or through an insurance producer;
23            (D) does not charge any cancellation fees or
24        penalties; and
25            (E) complies with the regulations established by
26        the Secretary under Section 1311 (d) of the Federal Act

 

 

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1        and any other requirements of the Illinois Insurance
2        Code and the Department;
3        (6) meet the requirements of certification pursuant to
4    the requirements of the Department and the Illinois
5    Insurance Code provided in this Law and the requirements
6    issued by the Secretary under Section 1311(c) of the
7    Federal Act and rules promulgated or adopted pursuant to
8    this Law or the Federal Act, which shall include:
9            (A) minimum standards in the areas of marketing
10        practices;
11            (B) network adequacy;
12            (C) essential community providers in underserved
13        areas;
14            (D) accreditation;
15            (E) quality improvement;
16            (F) uniform enrollment forms and descriptions of
17        coverage; and
18            (G) information on quality measures for health
19        benefit plan performance; and
20        (7) include outpatient clinics in the health plan's
21    region that are controlled by an entity that also controls
22    a 340B eligible provider as defined by Section 340B(a)(4)
23    of the federal Public Health Service Act such that the
24    outpatient clinics are subject to the same mission,
25    policies, and medical standards related to the provision of
26    health care services as the 340B eligible provider.

 

 

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1    (b) The Department shall require each health carrier
2seeking certification of a plan as a qualified health plan to:
3        (1) make available to the public, in plain language as
4    defined in Section 1311(e)(3)(B) of the Federal Act, and
5    submit to the Board, the Secretary, and the Department
6    accurate and timely disclosure of the following:
7                (i) claims payment policies and practices;
8                (ii) periodic financial disclosures;
9                (iii) data on enrollment;
10                (iv) data on disenrollment;
11                (v) data on the number of claims that are
12            denied;
13                (vi) data on rating practices;
14                (vii) information on cost-sharing and payments
15            with respect to any out-of-network coverage;
16                (viii) information on enrollee and participant
17            rights under Title I of the Federal Act; and
18                (ix) other information as determined
19            appropriate by the Secretary, including, but not
20            limited to, accredited clinical quality measures;
21            and
22        (2) permit individuals to learn, in a timely manner
23    upon the request of the individual, the comparative quality
24    standards of the plans along established clinical
25    data-based standards and the amount of cost-sharing,
26    including deductibles, copayments, and coinsurance, under

 

 

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1    the individual's plan or coverage that the individual would
2    be responsible for paying with respect to the furnishing of
3    a specific item or service by a participating provider and
4    make this information available to the individual through
5    an Internet website that is publicly accessible and through
6    other means for individuals without access to the Internet.
7    (c) The Department shall not exempt any health carrier
8seeking certification as a qualified health plan, regardless of
9the type or size of the health carrier, from licensure or
10solvency requirements and shall apply the criteria of this
11Section in a manner that ensures a level playing field between
12or among health carriers participating in the Exchange.
13    (d) The provisions of this Law that are applicable to
14qualified health plans shall also apply, to the extent
15relevant, to qualified dental plans, except as modified in
16accordance with the provisions of paragraphs (1), (2), and (3)
17of this subsection (d) or by rules adopted by the Board.
18        (1) The health carrier shall be licensed to offer
19    dental coverage, but need not be licensed to offer other
20    health benefits.
21        (2) The plan shall be limited to dental and oral health
22    benefits, without substantially duplicating the benefits
23    typically offered by health benefit plans without dental
24    coverage and shall include, at a minimum, the essential
25    pediatric dental benefits prescribed by the Secretary
26    pursuant to Section 1302(b)(l)(J) of the Federal Act and

 

 

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1    such other dental benefits as the Board or the Secretary
2    may specify by rule.
3        (3) Health carriers may jointly offer a comprehensive
4    plan through the Exchange in which the dental benefits are
5    provided by a health carrier through a qualified dental
6    plan and the other benefits are provided by a health
7    carrier through a qualified health plan, provided that the
8    plans are priced separately and are also made available for
9    purchase separately at the same price.
 
10    (215 ILCS 122/5-15)
11    Sec. 5-15. Illinois Health Benefits Exchange Legislative
12Oversight Study Committee.
13    (a) There is created an Illinois Health Benefits Exchange
14Legislative Oversight Study Committee within the Commission on
15Government Forecasting and Accountability to provide
16accountability for conduct a study regarding State
17implementation and establishment of the Illinois Health
18Benefits Exchange and to ensure Exchange operations and
19functions align with the goals and duties outlined by this Law.
20The Committee shall also be responsible for providing policy
21recommendations to ensure the Exchange aligns with the Federal
22Act, amendments to the Federal Act, and regulations promulgated
23pursuant to the Federal Act.
24    (b) Members of the Legislative Oversight Study Committee
25shall be appointed as follows: 3 members of the Senate shall be

 

 

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1appointed by the President of the Senate; 3 members of the
2Senate shall be appointed by the Minority Leader of the Senate;
33 members of the House of Representatives shall be appointed by
4the Speaker of the House of Representatives; and 3 members of
5the House of Representatives shall be appointed by the Minority
6Leader of the House of Representatives. Each legislative leader
7shall select one member to serve as co-chair of the committee.
8    (c) Members of the Legislative Oversight Study Committee
9shall be appointed no later than June 1, 2013 within 30 days
10after the effective date of this Law. The co-chairs shall
11convene the first meeting of the committee no later than 45
12days after the effective date of this Law.
13(Source: P.A. 97-142, eff. 7-14-11.)
 
14    (215 ILCS 122/5-16 new)
15    Sec. 5-16. Exchange governance. The governing and
16administrative powers of the Exchange shall be vested in a body
17known as the Illinois Health Benefits Exchange Board. The
18following provisions shall apply:
19        (1) The Board shall consist of 11 voting members
20    appointed by the Governor with the advice and consent of a
21    majority of the members elected to the Senate. In addition,
22    the Director of Healthcare and Family Services, and the
23    Executive Director of the Exchange shall serve as
24    non-voting, ex-officio members of the Board. The Governor
25    shall also appoint as non-voting, ex-officio members one

 

 

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1    economist with experience in the health care markets and
2    one educated health care consumer advocate. All Board
3    members shall be appointed no later than January 1, 2014.
4        (2) The Governor shall make the appointments so as to
5    reflect no less than proportional representation of the
6    geographic, gender, cultural, racial, and ethnic
7    composition of this State and in accordance with
8    subparagraphs (A), (B), and (C) of this paragraph, as
9    follows:
10            (A) No more than 4 voting members may represent the
11        following interests, of which no more than 2 may
12        represent any one interest:
13                (1) the insurance industry;
14                (2) health care administrators; and
15                (3) licensed health care professionals.
16            (B) At least 7 voting members shall represent the
17        following interest groups, with each interest group
18        represented by at least one voting member:
19                (1) a labor interest group;
20                (2) a women's interest group;
21                (3) a minorities' interest group;
22                (4) a disabled persons' interest group;
23                (5) a small business interest group; and
24                (6) a public health interest group.
25            (C) Each person appointed to the Board should have
26        demonstrated experience in at least one of the

 

 

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1        following areas:
2                (1) individual health insurance coverage;
3                (2) small employer health insurance;
4                (3) health benefits administration;
5                (4) health care finance;
6                (5) administration of a public or private
7            health care delivery system;
8                (6) the provision of health care services;
9                (7) the purchase of health insurance coverage;
10                (8) health care consumer navigation or
11        assistance;
12                (9) health care economics or health care
13        actuarial sciences;
14                (10) information technology; or
15                (11) starting a small business with 50 or fewer
16        employees.
17        (3) The Board shall elect one voting member of the
18    Board to serve as chairperson and one voting member to
19    serve as vice-chairperson, upon approval of a majority of
20    the Board.
21        (4) The Exchange shall be administered by an Executive
22    Director, who shall be appointed, and may be removed, by a
23    majority of the Board. The Board shall have the power to
24    determine compensation for the Executive Director.
25        (5) The terms of the non-voting, ex-officio members of
26    the Board shall run concurrent with their terms of

 

 

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1    appointment to office, or in the case of the Executive
2    Director, his or her term of appointment to that position,
3    subject to the determination of the Board. The terms of the
4    members, including those non-voting, ex-officio members
5    appointed by the Governor, shall be 4 years. Upon
6    conclusion of the initial term, the next term and every
7    term subsequent to it shall run for 3 years. Voting members
8    shall serve no more than 3 consecutive terms.
9        A person appointed to fill a vacancy and complete the
10    unexpired term of a member of the Board shall only be
11    appointed to serve out the unexpired term by the individual
12    who made the original appointment within 45 days after the
13    initial vacancy. A person appointed to fill a vacancy and
14    complete the unexpired term of a member of the Board may be
15    re-appointed to the Board for another term, but shall not
16    serve than more than 2 consecutive terms following their
17    completion of the unexpired term of a member of the Board.
18        If a voting Board member's qualifications change due to
19    a change in employment during the term of their
20    appointment, then the Board member shall resign their
21    position, subject to reappointment by the individual who
22    made the original appointment.
23        (6) The Board shall, as necessary, create and appoint
24    qualified persons with requisite expertise to Exchange
25    technical advisory groups. These Exchange technical
26    advisory groups shall meet in a manner and frequency

 

 

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1    determined by the Board to discuss exchange-related issues
2    and to provide exchange-related guidance, advice, and
3    recommendations to the Board and the Exchange. There shall
4    be at a minimum, 4 technical advisory groups, including the
5    following:
6            (1) an insurer advisory group;
7            (2) a business advisory group;
8            (3) a consumer advisory group; and
9            (4) a provider advisory group.
10        (7) The Board shall meet no less than quarterly on a
11    schedule established by the chairperson. Meetings shall be
12    public and public records shall be maintained, subject to
13    the Open Meetings Act. A majority of the Board shall
14    constitute a quorum and the affirmative vote of a majority
15    is necessary for any action of the Board. No vacancy shall
16    impair the ability of the Board to act provided a quorum is
17    reached. Members shall serve without pay, but shall be
18    reimbursed for their actual and reasonable expenses
19    incurred in the performance of their duties. The
20    chairperson of the Board shall file a written report
21    regarding the activities of the Board and the Exchange to
22    the Governor and General Assembly annually, and the
23    Legislative Oversight Committee established in Section
24    5-15 quarterly, beginning on September 1, 2013 through
25    December 31, 2014.
26        (8) The Board shall adopt conflict of interest rules

 

 

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1    and recusal procedures. Such rules and procedures shall (i)
2    prohibit a member of the Board from performing an official
3    act that may have a direct economic benefit on a business
4    or other endeavor in which that member has a direct or
5    substantial financial interest and (ii) require a member of
6    the Board to recuse himself or herself from an official
7    matter, whether direct or indirect. All recusals must be in
8    writing and specify the reason and date of the recusal. All
9    recusals shall be maintained by the Executive Director and
10    shall be disclosed to any person upon written request.
11        (9) The Board shall develop a budget, to be submitted
12    and approved by the General Assembly, for the
13    implementation and operation of the Exchange for operating
14    expenses, including, but not limited to:
15            (A) proposed compensation levels for the Executive
16        Director and shall identify personnel and staffing
17        needs for the implementation and operation of the
18        Exchange;
19            (B) disclosure of funds received or expected to be
20        received from the federal government for the
21        infrastructure and systems of the Exchange and those
22        funds received or expected to be received for program
23        administration and operations; and
24            (C) delineation of those functions of the Exchange
25        that are to be paid by State and federal programs that
26        are allocable to the State's General Revenue Fund.

 

 

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1        (10) The purpose of the Board shall be to implement the
2    Exchange in accordance with this Section and shall be
3    authorized to establish procedures for the operation of the
4    Exchange, subject to legislative approval.
 
5    (215 ILCS 122/5-17 new)
6    Sec. 5-17. Insurer's assessment. Every carrier licensed to
7issue, and that issues for delivery, policies of accident and
8health insurance in this State, excluding those carriers that
9issue only limited lines or supplemental insurance policies not
10eligible to be offered on the Exchange, shall be assessed. The
11Board shall within 90 days after the effective date of this
12amendatory Act of the 98th General Assembly and within the
13first quarter of each fiscal year thereafter, assess all
14insurers for the anticipated deficit in accordance with the
15provisions of this Section. The Board may also make additional
16assessments no more than 4 times a year to fund unanticipated
17deficits, implementation expenses, and cash flow needs. An
18insurer's assessment shall be determined by multiplying the
19total assessment, as determined in this Section, by a fraction,
20the numerator of which equals that insurer's direct Illinois
21premiums during the preceding calendar year and the denominator
22of which equals the total of all insurers' direct Illinois
23premiums. The Board may exempt those insurers whose share as
24determined under this Section would be so minimal as to not
25exceed the estimated cost of levying the assessment. The Board

 

 

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1shall charge and collect from each insurer the amounts
2determined to be due under this Section. The assessment shall
3be billed by Board invoice based upon the insurer's direct
4Illinois premium income as shown in its annual statement for
5the preceding calendar year as filed with the Director. The
6invoice shall be due upon receipt and must be paid no later
7than 30 days after receipt by the insurer.
8    When a carrier fails to pay the full amount of any
9assessment of $100 or more due under this Section there shall
10be added to the amount due as a penalty the greater of $50 or an
11amount equal to 5% of the deficiency for each month or part of
12a month that the deficiency remains unpaid. All moneys
13collected by the Board shall be placed in the Illinois Health
14Benefits Exchange Fund.
15    The Board shall prepare annually a complete and detailed
16written report accounting for all funds received and dispensed
17during the preceding fiscal year.
 
18    (215 ILCS 122/5-18 new)
19    Sec. 5-18. Illinois Health Benefits Exchange Fund. There
20is hereby created as a fund outside of the State treasury the
21Illinois Health Benefits Exchange Fund to be used, subject to
22appropriation, exclusively by the Exchange to provide funding
23for the operation and administration of the Exchange in
24carrying out the purposes authorized in this Law.
 

 

 

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1    (215 ILCS 122/5-21 new)
2    Sec. 5-21. Enrollment through brokers and agents; producer
3compensation.
4    (a) In accordance with Section 1312(e) of the Federal Act,
5the Exchange shall allow licensed insurance producers to (1)
6enroll qualified individuals in any qualified health plan, for
7which the individual is eligible, in the individual exchange,
8(2) assist qualified individuals in applying for premium tax
9credits and cost-sharing reductions for qualified health plans
10purchased through the individual exchange, and (3) enroll
11qualified employers in any qualified health plan, for which the
12employer is eligible, offered through the SHOP exchange.
13Nothing in this subsection (a) shall be construed as to require
14a qualified individual or qualified employer to utilize a
15licensed insurance producer for any of the purposes outlined in
16this subsection (a).
17    (b) In order to enroll individuals and small employers in
18qualified health plans on the Exchange, licensed producers must
19complete a certification program. The Department of Insurance
20may develop and implement a certification program for licensed
21insurance producers who enroll individuals and employers in the
22exchange. The Department of Insurance may charge a reasonable
23fee, by regulation, to producers for the certification program.
24The Department of Insurance may approve certification programs
25developed and instructed by others, charging a reasonable fee,
26by regulation, for approval.

 

 

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1    (c) The Exchange shall include on its Internet website a
2producer locator section, featured prominently, through which
3individuals and small employers can find exchange-certified
4producers.
 
5    (215 ILCS 122/5-23 new)
6    Sec. 5-23. Examination or investigation of the Exchange;
7hearing.
8    (a) In addition to any powers conferred upon him or her by
9this or any other law, including Article XXIV of the Illinois
10Insurance Code, the Director or any person designated by him or
11her has the power to:
12        (1) at the expense of the Exchange, examine or
13    investigate any and all aspects regarding the operation and
14    finances of the Exchange and the Illinois Health Benefits
15    Exchange Fund through free access to all books, records,
16    files, papers, and documents relating to their operation
17    and finances and may summon, subpoena, qualify, and examine
18    as witnesses all persons having knowledge of such
19    operation, including directors, officers, agents, or
20    employees thereof; and
21        (2) require such reports as the Director may deem
22    necessary.
23    (b) The examiners designated by the Director pursuant to
24this Section may make reports to the Director. Any report
25alleging substantive violations of this Law, any applicable

 

 

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1provisions of the Illinois Insurance Code, any applicable Part
2of Title 50 of the Illinois Administrative Code, or federal law
3shall be in writing and be based upon facts obtained by the
4examiners. The report shall be verified by the examiners.
5    (c) If a report is made, the Director shall deliver a
6duplicate thereof to the Exchange or persons examined and
7afford the Exchange or such persons examined an opportunity to
8request a hearing to object to the report. The Exchange or such
9persons examined may request a hearing within 30 days after
10receipt of the duplicate of the examination report by giving
11the Director written notice of such request together with
12written objections to the report. Any hearing shall be
13conducted in accordance with Sections 402 and 403 of the
14Illinois Insurance Code. The right to hearing is waived if the
15delivery of the report is refused or the report is otherwise
16undeliverable or the Exchange or such persons examined do not
17timely request a hearing.
18    After the hearing or upon expiration of the time period
19during which the Exchange or such persons may request a
20hearing, if the examination reveals that the Exchange or such
21persons examined are operating in violation of any applicable
22provision of this Article, the Illinois Insurance Code, any
23applicable Part of Title 50 of the Illinois Administrative
24Code, prior order, or federal law, the Director, in the written
25order, may require the Exchange or such persons examined to
26take any action the Director considers necessary or appropriate

 

 

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1in accordance with the report or examination hearing. If the
2Director issues an order, it shall be issued within 90 days
3after the report is filed, or if there is a hearing, within 90
4days after the conclusion of the hearing. The order is subject
5to review under the Administrative Review Law.
 
6    Section 99. Effective date. This Act takes effect upon
7becoming law.".