Full Text of SB2592 94th General Assembly
SB2592 94TH GENERAL ASSEMBLY
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94TH GENERAL ASSEMBLY
State of Illinois
2005 and 2006 SB2592
Introduced 1/20/2006, by Sen. Jeffrey M. Schoenberg SYNOPSIS AS INTRODUCED: |
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215 ILCS 105/12 |
from Ch. 73, par. 1312 |
215 ILCS 105/16 new |
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215 ILCS 105/17 new |
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215 ILCS 105/18 new |
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765 ILCS 1025/18 |
from Ch. 141, par. 118 |
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Amends the Comprehensive Health Insurance Plan Act. Changes the funding sources for deficits for both federally eligible individuals and all other eligible individuals to the Plan fund and assessments on insurance companies, including stop-loss insurers (now, assessments only for federally eligible individuals and General Assembly appropriation for other eligible individuals). Provides that assessments of stop-loss insurers shall be made on the basis of the number of covered lives. Requires the Comprehensive Health Insurance Board to develop baseline statistics for asthma, diabetes, coronary artery disease, and congestive heart failure as part of any disease management program instituted by the Board. Requires participation in a disease management program established by the Board by any covered person diagnosed with one or more of these diseases and provides penalties for refusal to participate. Requires the Board to contract with the Plan administrator to provide 24-hour telephone access to trained nurses in order to facilitate better patient self-care and to reduce avoidable care and emergency room visits. Requires an amount of money representing the total net receipt of moneys from health insurers by the State as unclaimed property to be deposited into the Plan fund as provided in the Uniform Disposition of Unclaimed Property Act. Amends the Uniform Disposition of Unclaimed Property Act to require the State Treasurer to deposit 95% of the amount in the trust fund exceeding $2,500,000 into the State Pensions Fund, and to deposit 5% of that amount into the Plan fund. Effective immediately.
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A BILL FOR
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SB2592 |
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LRB094 18970 LJB 54436 b |
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| AN ACT concerning insurance.
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| Be it enacted by the People of the State of Illinois,
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| represented in the General Assembly:
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| Section 5. The Comprehensive Health Insurance Plan Act is | 5 |
| amended by changing Section 12 and by adding Sections 16, 17, | 6 |
| and 18 as follows:
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| (215 ILCS 105/12) (from Ch. 73, par. 1312)
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| Sec. 12. Deficit or surplus.
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| a. If premiums or other receipts by the
Board exceed the | 10 |
| amount required for the
operation
of the Plan, including actual | 11 |
| losses and administrative
expenses of the Plan, the Board shall | 12 |
| direct that the excess be held at
interest, in a bank | 13 |
| designated by the Board, or used to offset future
losses or to | 14 |
| reduce Plan premiums. In this
subsection, the term "future | 15 |
| losses" includes reserves for incurred but not
reported claims.
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| b. Any deficit incurred or expected to be incurred on | 17 |
| behalf of eligible
persons who qualify for Plan
plan coverage | 18 |
| under Section 7 of this Act or federally
eligible individuals | 19 |
| who qualify for Plan coverage under Section 15 of this Act | 20 |
| shall be
recouped from the Plan fund
by an
appropriation made | 21 |
| by the General Assembly .
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| c. For the purposes of this Section, a deficit shall be | 23 |
| incurred when
anticipated losses and incurred but not reported | 24 |
| claims expenses exceed
anticipated income from earned premiums | 25 |
| net of administrative expenses.
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| d. Any deficit incurred or expected to be incurred on | 27 |
| behalf of eligible
persons who qualify for Plan coverage under | 28 |
| Section 7 of this Act or federally
eligible individuals who | 29 |
| qualify for Plan coverage under Section 15 of this Act
that | 30 |
| exceeds the amount of funds in the Plan fund shall be recouped | 31 |
| by an assessment of all insurers , as defined in Section 2 of | 32 |
| this Act and including stop-loss insurers, made in accordance |
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| with the
provisions of this Section. The Board shall within 90 | 2 |
| days of the effective
date of this amendatory Act of 1997 and | 3 |
| within the first quarter of each fiscal
year thereafter assess | 4 |
| all insurers for the anticipated deficit in accordance
with the | 5 |
| provisions of this Section. The board may also make additional
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| assessments no more than 4 times a year to fund unanticipated | 7 |
| deficits,
implementation expenses, and cash flow needs.
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| e. An insurer's assessment , other than an assessment of a | 9 |
| stop-loss insurer, shall be determined by multiplying the total
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| assessment, as determined in subsection d. of this Section, by | 11 |
| a fraction, the
numerator of which equals that insurer's direct | 12 |
| Illinois premiums during the
preceding calendar year and the | 13 |
| denominator of which equals the total of all
insurers' direct | 14 |
| Illinois premiums. Assessments of stop-loss insurers shall be | 15 |
| made on the basis of the number of covered lives of that | 16 |
| insurer. The Board may exempt those insurers whose
share as | 17 |
| determined under this subsection would be so minimal as to not | 18 |
| exceed
the estimated cost of levying the assessment.
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| f. The Board shall charge and collect from each insurer the | 20 |
| amounts
determined to be due under this Section. The assessment | 21 |
| shall be billed by
Board invoice based upon the insurer's | 22 |
| direct Illinois premium income as shown
in its annual
statement | 23 |
| for the preceding calendar year as filed with the Director. The
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| invoice shall be due upon
receipt and must be paid no later | 25 |
| than 30 days after receipt by the insurer.
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| g. When an insurer fails to pay the full amount of any | 27 |
| assessment of $100 or
more
due under this Section there shall | 28 |
| be added to the amount due as a penalty the
greater of $50 or an | 29 |
| amount equal to 5% of the deficiency for each month or
part of | 30 |
| a month that the deficiency remains unpaid.
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| h. Amounts collected under this Section shall be paid to | 32 |
| the Board for
deposit into the Plan Fund authorized by Section | 33 |
| 3 of this Act.
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| i. An insurer may petition the Director for an abatement or | 35 |
| deferment of
all or part of an assessment imposed by the Board. | 36 |
| The Director may abate or
defer, in whole or in part, the |
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| assessment if, in the opinion of the Director,
payment of the | 2 |
| assessment would endanger the ability of the insurer to fulfill
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| its contractual obligations. In the event an assessment against | 4 |
| an insurer is
abated or deferred in whole or in part, the | 5 |
| amount by which the assessment is
abated or deferred shall be | 6 |
| assessed against the other insurers in a manner
consistent with | 7 |
| the basis for assessments set forth in this subsection. The
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| insurer receiving a deferment shall remain liable to the plan | 9 |
| for the
deficiency for 4 years.
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| j. The board shall establish procedures for appeal by any | 11 |
| insurer subject
to assessment pursuant to this
Section. Such | 12 |
| procedures shall require that:
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| (1) Any insurer that wishes to appeal all or any part | 14 |
| of an assessment
made pursuant to this Section shall first | 15 |
| pay the amount of the assessment as
set forth in the | 16 |
| invoice provided by the board within the time provided in
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| subsection f. of this Section.
The board shall hold such | 18 |
| payments
in a separate interest-bearing account.
The | 19 |
| payments shall be accompanied by a
statement in writing | 20 |
| that the payment is made under appeal.
The statement
shall | 21 |
| specify the grounds for the appeal.
The insurer may be | 22 |
| represented in its appeal by counsel or other | 23 |
| representative
of its choosing.
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| (2) Within 90 days following the payment of an | 25 |
| assessment under appeal by
any insurer, the board shall | 26 |
| notify the insurer or representative designated by
the | 27 |
| insurer in writing of its determination with respect to the | 28 |
| appeal
and the basis or bases for that determination unless
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| the Board notifies the insurer that
a reasonable amount of | 30 |
| additional
time is required to resolve the issues raised by | 31 |
| the appeal.
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| (3) The board shall refer to the Director any question | 33 |
| concerning the
amount of direct Illinois premium income as | 34 |
| shown in an insurer's annual
statement for the preceding | 35 |
| calendar year on file with the Director on the
invoice date | 36 |
| of the assessment. Unless additional time is required to |
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| resolve
the question, the Director shall within 60 days | 2 |
| report to the board in writing
his determination respecting | 3 |
| the amount of direct Illinois premium income on
file on the | 4 |
| invoice date of the assessment.
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| (4) In the event the board determines that the insurer | 6 |
| is entitled to a
refund, the refund shall be paid within 30 | 7 |
| days following the date upon which
the board makes its | 8 |
| determination, together with the accrued interest.
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| Interest on any
refund due an insurer shall be paid at the | 10 |
| rate actually earned by the Board on
the separate account.
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| (5) The amount of any such refund shall then be | 12 |
| assessed against all
insurers in a manner consistent with | 13 |
| the basis for assessment as otherwise
authorized
by this | 14 |
| Section.
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| (6) The board's determination with respect to any | 16 |
| appeal received pursuant
to this subsection shall be a | 17 |
| final administrative decision as defined in
Section 3-101 | 18 |
| of the Code of Civil Procedure. The provisions of the
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| Administrative
Review Law shall apply to and govern all
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| proceedings for the judicial review of final | 21 |
| administrative decisions of the
board.
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| (7) If an insurer fails to appeal an assessment in | 23 |
| accordance with the
provisions of this subsection, the | 24 |
| insurer shall be deemed
to have waived its right of appeal.
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| The provisions of this subsection apply to all assessments | 26 |
| made in any
calendar year ending on or after December 31, 1997.
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| (Source: P.A. 90-30, eff. 7-1-97; 90-567, eff. 1-23-98.)
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| (215 ILCS 105/16 new) | 29 |
| Sec. 16. Disease management program; required | 30 |
| participation. | 31 |
| (a) The Board shall develop baseline statistics for asthma, | 32 |
| diabetes, coronary artery disease, and congestive heart | 33 |
| failure and the co-morbidity of these and other commonly | 34 |
| occurring peripheral diseases among covered persons as part of | 35 |
| any disease management program instituted by the Board. |
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| (b) All covered persons diagnosed with any of the diseases | 2 |
| listed in subsection (a) of this Section shall participate in | 3 |
| any disease management program instituted by the Board. A | 4 |
| covered person who refuses to participate in a disease | 5 |
| management program as required by this subsection (b) shall (i) | 6 |
| have his benefits reduced or (ii) be terminated from the Plan, | 7 |
| at the discretion of the Board.
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| (215 ILCS 105/17 new)
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| Sec. 17. Patient hotline. The Board shall contract with the | 10 |
| Plan administrator to provide 24-hour telephone access for | 11 |
| covered persons to a trained nurse in order to facilitate | 12 |
| better patient self-care and to reduce avoidable care and | 13 |
| emergency room visits. | 14 |
| (215 ILCS 105/18 new)
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| Sec. 18. Unclaimed insurance moneys. An amount of money | 16 |
| representing the total net receipt of moneys from health | 17 |
| insurers by the State as unclaimed property shall be deposited | 18 |
| into the Plan fund as provided in Section 18 of the Uniform | 19 |
| Disposition of Unclaimed Property Act.
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| Section 10. The Uniform Disposition of Unclaimed Property | 21 |
| Act is amended by changing Section 18 as follows:
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| (765 ILCS 1025/18) (from Ch. 141, par. 118)
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| Sec. 18. Deposit of funds received under the Act.
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| (a) The State Treasurer shall retain all funds received | 25 |
| under this Act,
including the proceeds from
the sale of | 26 |
| abandoned property under Section 17, in a trust fund and shall,
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| on April 15 and October 15 of each year, deposit any amount in | 28 |
| the trust fund
exceeding $2,500,000 as follows: 95% of that | 29 |
| amount shall be deposited into the State Pensions Fund , and 5% | 30 |
| of that amount shall be deposited into the Plan fund | 31 |
| established under Section 3 of the Comprehensive Health | 32 |
| Insurance Plan Act . He or she shall make prompt payment of |
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| claims he or she
duly allows as provided for in this Act for | 2 |
| the trust fund.
Before making the deposit the State Treasurer
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| shall record the name and last known address of each person | 4 |
| appearing from the
holders' reports to be entitled to the | 5 |
| abandoned property. The record shall be
available for public | 6 |
| inspection during reasonable business
hours.
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| (b) Before making any deposit to the credit of the State | 8 |
| Pensions Fund or the Plan fund established under Section 3 of | 9 |
| the Comprehensive Health Insurance Plan Act ,
the State | 10 |
| Treasurer may deduct: (1) any costs in connection with sale of
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| abandoned property, (2) any costs of mailing and publication in | 12 |
| connection with
any abandoned property, and (3) any costs in | 13 |
| connection with the maintenance of
records or disposition of | 14 |
| claims made pursuant to this Act. The State
Treasurer shall | 15 |
| semiannually file an itemized report of all such expenses with
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| the Legislative Audit Commission.
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| (Source: P.A. 93-531, eff. 8-14-03.)
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| Section 99. Effective date. This Act takes effect upon | 19 |
| becoming law.
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