Full Text of HB4478 93rd General Assembly
HB4478 93RD GENERAL ASSEMBLY
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93RD GENERAL ASSEMBLY
State of Illinois
2003 and 2004 HB4478
Introduced 02/03/04, by Karen May SYNOPSIS AS INTRODUCED: |
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215 ILCS 105/3 |
from Ch. 73, par. 1303 |
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Amends the Comprehensive Health Insurance Plan Act. Requires the Illinois Comprehensive Health Insurance Board to conduct a study pertaining to the feasability of establishing a small employer health insurance pool in which employers may provide affordable health insurance coverage to their employees. Effective immediately.
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| FISCAL NOTE ACT MAY APPLY | |
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A BILL FOR
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HB4478 |
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LRB093 19548 SAS 45288 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 3 as follows: | 6 |
| (215 ILCS 105/3) (from Ch. 73, par. 1303)
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| Sec. 3. Operation of the Plan.
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| a. There is hereby created an Illinois Comprehensive Health | 9 |
| Insurance Plan.
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| b. The Plan shall operate subject to the supervision and | 11 |
| control of
the board. The board is created as a political | 12 |
| subdivision and body
politic and corporate and, as such, is not | 13 |
| a State agency. The board shall
consist of 10 public members, | 14 |
| appointed by the Governor with the
advice and consent of the | 15 |
| Senate.
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| Initial members shall be appointed to the Board by the | 17 |
| Governor as
follows: 2 members to serve until July 1, 1988, and | 18 |
| until their successors
are appointed and qualified; 2 members | 19 |
| to serve until July 1, 1989, and
until their successors are | 20 |
| appointed and qualified; 3 members to serve
until July 1, 1990, | 21 |
| and until their successors are appointed and qualified;
and 3 | 22 |
| members to serve until July 1, 1991, and until their successors | 23 |
| are
appointed and qualified. As terms of initial members | 24 |
| expire, their
successors shall be appointed for terms to expire | 25 |
| the first day in July 3
years thereafter, and until their | 26 |
| successors are appointed and qualified.
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| Any vacancy in the Board occurring for any reason other | 28 |
| than the
expiration of a term shall be filled for the unexpired | 29 |
| term in the same
manner as the original appointment.
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| Any member of the Board may be removed by the Governor for | 31 |
| neglect of
duty, misfeasance, malfeasance, or nonfeasance in | 32 |
| office.
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HB4478 |
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LRB093 19548 SAS 45288 b |
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| In addition, a representative of the
Governor's Office of | 2 |
| Management and Budget, a representative of the Office
of the | 3 |
| Attorney General and the Director or the Director's designated
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| representative shall be members of the board. Four members of | 5 |
| the General
Assembly, one each appointed by the President and | 6 |
| Minority Leader of the
Senate and by the Speaker and Minority | 7 |
| Leader of the House of
Representatives, shall serve as | 8 |
| nonvoting members of the board. At least
2 of the public | 9 |
| members shall be individuals reasonably expected to qualify
for | 10 |
| coverage under the Plan, the parent or spouse of such an
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| individual, or a surviving family member of an individual who | 12 |
| could have
qualified for the plan during his lifetime. The | 13 |
| Director or Director's
representative shall be the chairperson | 14 |
| of the board. Members of the board
shall receive no | 15 |
| compensation, but shall be reimbursed for reasonable
expenses | 16 |
| incurred in the necessary performance of their duties.
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| c. The board shall make an annual report in September and
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| shall file the report with the Secretary of the Senate and the | 19 |
| Clerk of
the House of Representatives. The report shall | 20 |
| summarize the activities of
the Plan in the preceding calendar | 21 |
| year, including net written and earned
premiums, the expense of | 22 |
| administration, the paid and incurred
losses for the year and | 23 |
| other information as may be requested by the
General Assembly. | 24 |
| The report shall also include analysis and
recommendations | 25 |
| regarding utilization review, quality assurance and access
to | 26 |
| cost effective quality health care.
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| d. In its plan of operation the board shall:
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| (1) Establish procedures for selecting a plan | 29 |
| administrator in
accordance with Section 5 of this Act.
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| (2) Establish procedures for the operation of the | 31 |
| board.
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| (3) Create a Plan fund, under management of the board, | 33 |
| to fund
administrative, claim, and other expenses of the | 34 |
| Plan.
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| (4) Establish procedures for the handling and | 36 |
| accounting of assets and
monies of the Plan.
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HB4478 |
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LRB093 19548 SAS 45288 b |
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| (5) Develop and implement a program to publicize the | 2 |
| existence of the
Plan, the eligibility requirements and | 3 |
| procedures for enrollment and to
maintain public awareness | 4 |
| of the Plan.
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| (6) Establish procedures under which applicants and | 6 |
| participants may have
grievances reviewed by a grievance | 7 |
| committee appointed by the board. The
grievances shall be | 8 |
| reported to the board immediately after completion of
the | 9 |
| review. The Department and the board shall retain all | 10 |
| written
complaints regarding the Plan for at least 3 years. | 11 |
| Oral complaints
shall be reduced to written form and | 12 |
| maintained for at least 3 years.
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| (7) Provide for other matters as may be necessary and | 14 |
| proper for
the execution of its powers, duties and | 15 |
| obligations under the Plan.
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| e. No later than 5 years after the Plan is operative the | 17 |
| board and
the Department shall conduct cooperatively a study of | 18 |
| the Plan and the
persons insured by the Plan to determine: (1) | 19 |
| claims experience including a
breakdown of medical conditions | 20 |
| for which claims were paid; (2) whether
availability of the | 21 |
| Plan affected employment opportunities for
participants; (3) | 22 |
| whether availability of the Plan affected the receipt of
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| medical assistance benefits by Plan participants; (4) whether a | 24 |
| change
occurred in the number of personal bankruptcies due to | 25 |
| medical or other
health related costs; (5) data regarding all | 26 |
| complaints received about the
Plan including its operation and | 27 |
| services; (6) and any other significant
observations regarding | 28 |
| utilization of the Plan. The study shall culminate
in a written | 29 |
| report to be presented to the Governor, the President of the
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| Senate, the Speaker of the House and the chairpersons of the | 31 |
| House and
Senate Insurance Committees. The report shall be | 32 |
| filed with the
Secretary of the Senate and the Clerk of the | 33 |
| House of Representatives. The
report shall also be available to | 34 |
| members of the general public upon request.
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| (e-5) The board shall conduct a feasibility study of | 36 |
| establishing a small employer health insurance pool in which |
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HB4478 |
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LRB093 19548 SAS 45288 b |
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| employers may provide affordable health insurance coverage to | 2 |
| their employees. The board may contract with a private entity | 3 |
| or enter into intergovernmental agreements with State agencies | 4 |
| for the completion of all or part of the study. The study | 5 |
| shall: | 6 |
| (i) Analyze other states' experience in establishing | 7 |
| small employer health
insurance pools; | 8 |
| (ii) Assess the need for a small employer health | 9 |
| insurance pool, including the number of individuals who | 10 |
| might benefit from it; | 11 |
| (iii) Recommend means of establishing a small employer | 12 |
| health insurance pool; and | 13 |
| (iv) Estimate the cost of providing a small employer | 14 |
| health insurance pool through the Illinois Comprehensive | 15 |
| Health Insurance Plan or another, public or private entity. | 16 |
| The board may accept donations, in trust, from any legal | 17 |
| source, public or private, for deposit into a trust account | 18 |
| specifically created for expenditure, without the necessity of | 19 |
| being appropriated, solely for the purpose of conducting all or | 20 |
| part of the study.
The board shall issue a report with | 21 |
| recommendations to the Governor and the General Assembly by | 22 |
| January 1, 2005.
As used in this subsection e-5, "small | 23 |
| employer" means an employer having between one and 50 | 24 |
| employees.
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| f. The board may:
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| (1) Prepare and distribute certificate of eligibility | 27 |
| forms and
enrollment instruction forms to insurance | 28 |
| producers and to the general
public in this State.
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| (2) Provide for reinsurance of risks incurred by the | 30 |
| Plan and enter into
reinsurance agreements with insurers to | 31 |
| establish a reinsurance plan for
risks of coverage | 32 |
| described in the Plan, or obtain commercial reinsurance
to | 33 |
| reduce the risk of loss through the Plan.
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| (3) Issue additional types of health insurance | 35 |
| policies to provide
optional coverages as are otherwise | 36 |
| permitted by this Act including a
Medicare supplement |
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LRB093 19548 SAS 45288 b |
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| policy designed to supplement Medicare.
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| (4) Provide for and employ cost containment measures | 3 |
| and requirements
including, but not limited to, | 4 |
| preadmission certification, second surgical
opinion, | 5 |
| concurrent utilization review programs, and individual | 6 |
| case
management for the purpose of making the pool more | 7 |
| cost effective.
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| (5) Design, utilize, contract, or otherwise arrange | 9 |
| for the
delivery of cost effective health care services, | 10 |
| including establishing or
contracting with preferred | 11 |
| provider organizations, health maintenance organizations, | 12 |
| and other limited network
provider
arrangements.
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| (6) Adopt bylaws, rules, regulations, policies and | 14 |
| procedures as
may be necessary or convenient for the | 15 |
| implementation of the Act and the
operation of the Plan.
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| (7) Administer separate pools, separate accounts, or | 17 |
| other plans or
arrangements as required by this Act to | 18 |
| separate federally eligible
individuals or groups of | 19 |
| federally eligible individuals who qualify for plan
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| coverage under Section 15 of this Act from eligible persons | 21 |
| or groups of
eligible persons who qualify for plan coverage | 22 |
| under Section 7 of this Act and
apportion the costs of the
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| administration among such separate pools, separate | 24 |
| accounts, or other plans or
arrangements.
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| g. The Director may, by rule, establish additional powers | 26 |
| and duties of
the board and may adopt rules for any other | 27 |
| purposes, including the
operation of the Plan, as are necessary | 28 |
| or proper to implement this Act.
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| h. The board is not liable for any obligation of the Plan. | 30 |
| There is no
liability on the part of any member or employee of | 31 |
| the board or the
Department, and no cause of action of any | 32 |
| nature may arise against them,
for any action taken or omission | 33 |
| made by them in the performance of their
powers and duties | 34 |
| under this Act, unless the action or omission
constitutes | 35 |
| willful or wanton misconduct. The board may provide in its
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| bylaws or rules for indemnification of, and legal |
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HB4478 |
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LRB093 19548 SAS 45288 b |
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| representation for, its
members and employees.
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| i. There is no liability on the part of any insurance | 3 |
| producer for the
failure of any applicant to be accepted by the | 4 |
| Plan unless the failure of
the applicant to be accepted by the | 5 |
| Plan is due to an act or omission by
the insurance producer | 6 |
| which constitutes willful or wanton misconduct.
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| (Source: P.A. 92-597, eff. 6-28-02; 93-622, eff. 12-18-03.)
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| Section 99. Effective date. This Act takes effect upon | 9 |
| becoming law.
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