Full Text of HB1603 94th General Assembly
HB1603ham001 94TH GENERAL ASSEMBLY
|
Rep. Karen May
Filed: 3/15/2005
|
|
09400HB1603ham001 |
|
LRB094 02952 LJB 43885 a |
|
| 1 |
| AMENDMENT TO HOUSE BILL 1603
| 2 |
| AMENDMENT NO. ______. Amend House Bill 1603 by replacing | 3 |
| everything after the enacting clause with the following:
| 4 |
| "Section 5. The Comprehensive Health Insurance Plan Act is | 5 |
| amended by changing Sections 2 and 4 and by adding Section 16 | 6 |
| as follows: | 7 |
| (215 ILCS 105/2) (from Ch. 73, par. 1302)
| 8 |
| Sec. 2. Definitions. As used in this Act, unless the | 9 |
| context otherwise
requires:
| 10 |
| "Plan administrator" means the insurer or third party
| 11 |
| administrator designated under Section 5 of this Act.
| 12 |
| "Benefits plan" means the coverage to be offered by the | 13 |
| Plan to
eligible persons and federally eligible individuals | 14 |
| pursuant to this Act.
| 15 |
| "Board" means the Illinois Comprehensive Health Insurance | 16 |
| Board.
| 17 |
| "Church plan" has the same meaning given that term in the | 18 |
| federal Health
Insurance Portability and Accountability Act of | 19 |
| 1996.
| 20 |
| "Continuation coverage" means continuation of coverage | 21 |
| under a group health
plan or other health insurance coverage | 22 |
| for former employees or dependents of
former employees that | 23 |
| would otherwise have terminated under the terms of that
| 24 |
| coverage pursuant to any continuation provisions under federal |
|
|
|
09400HB1603ham001 |
- 2 - |
LRB094 02952 LJB 43885 a |
|
| 1 |
| or State law,
including the Consolidated Omnibus Budget | 2 |
| Reconciliation Act of 1985 (COBRA),
as amended, Sections 367.2, | 3 |
| 367e, and 367e.1 of the Illinois Insurance Code, or
any
other | 4 |
| similar requirement in another State.
| 5 |
| "Covered person" means a person who is and continues to | 6 |
| remain eligible for
Plan coverage and is covered under one of | 7 |
| the benefit plans offered by the
Plan.
| 8 |
| "Creditable coverage" means, with respect to a federally | 9 |
| eligible
individual, coverage of the individual under any of | 10 |
| the following:
| 11 |
| (A) A group health plan.
| 12 |
| (B) Health insurance coverage (including group health | 13 |
| insurance coverage).
| 14 |
| (C) Medicare.
| 15 |
| (D) Medical assistance.
| 16 |
| (E) Chapter 55 of title 10, United States Code.
| 17 |
| (F) A medical care program of the Indian Health Service | 18 |
| or of a tribal
organization.
| 19 |
| (G) A state health benefits risk pool.
| 20 |
| (H) A health plan offered under Chapter 89 of title 5, | 21 |
| United States Code.
| 22 |
| (I) A public health plan (as defined in regulations | 23 |
| consistent with
Section
104 of the Health Care Portability | 24 |
| and Accountability Act of 1996 that may be
promulgated by | 25 |
| the Secretary of the U.S. Department of Health and Human
| 26 |
| Services).
| 27 |
| (J) A health benefit plan under Section 5(e) of the | 28 |
| Peace Corps Act (22
U.S.C. 2504(e)).
| 29 |
| (K) Any other qualifying coverage required by the | 30 |
| federal Health Insurance
Portability and Accountability | 31 |
| Act of 1996, as it may be amended, or
regulations under | 32 |
| that
Act.
| 33 |
| "Creditable coverage" does not include coverage consisting | 34 |
| solely of coverage
of excepted benefits, as defined in Section |
|
|
|
09400HB1603ham001 |
- 3 - |
LRB094 02952 LJB 43885 a |
|
| 1 |
| 2791(c) of title XXVII of
the
Public Health Service Act (42 | 2 |
| U.S.C. 300 gg-91), nor does it include any
period
of coverage | 3 |
| under any of items (A) through (K) that occurred before a break | 4 |
| of
more than 90 days or, if the individual has
been certified | 5 |
| as eligible pursuant to the federal Trade Act
of 2002, a
break | 6 |
| of more than 63 days during all of which the individual was not | 7 |
| covered
under any of items (A) through (K) above.
| 8 |
| Any period that an individual is in a waiting period for
| 9 |
| any coverage under a group health plan (or for group health | 10 |
| insurance
coverage) or is in an affiliation period under the | 11 |
| terms of health insurance
coverage offered by a health | 12 |
| maintenance organization shall not be taken into
account in | 13 |
| determining if there has been a break of more than 90
days in | 14 |
| any
creditable coverage.
| 15 |
| "Department" means the Illinois Department of Insurance.
| 16 |
| "Dependent" means an Illinois resident: who is a spouse; or | 17 |
| who is claimed
as a dependent by the principal insured for | 18 |
| purposes of filing a federal income
tax return and resides in | 19 |
| the principal insured's household, and is a resident
unmarried | 20 |
| child under the age of 19 years; or who is an unmarried child | 21 |
| who
also is a full-time student under the age of 23 years and | 22 |
| who is financially
dependent upon the principal insured; or who | 23 |
| is a child of any age and who is
disabled and financially | 24 |
| dependent upon the
principal insured.
| 25 |
| "Direct Illinois premiums" means, for Illinois business, | 26 |
| an insurer's direct
premium income for the kinds of business | 27 |
| described in clause (b) of Class 1 or
clause (a) of Class 2 of | 28 |
| Section 4 of the Illinois Insurance Code, and direct
premium | 29 |
| income of a health maintenance organization or a voluntary | 30 |
| health
services plan, except it shall not include credit health | 31 |
| insurance as defined
in Article IX 1/2 of the Illinois | 32 |
| Insurance Code.
| 33 |
| "Director" means the Director of the Illinois Department of | 34 |
| Insurance.
|
|
|
|
09400HB1603ham001 |
- 4 - |
LRB094 02952 LJB 43885 a |
|
| 1 |
| "Eligible person" means a resident of this State who | 2 |
| qualifies
for Plan coverage under Section 7 of this Act.
| 3 |
| "Employee" means a resident of this State who is employed | 4 |
| by an employer
or has entered into
the employment of or works | 5 |
| under contract or service of an employer
including the | 6 |
| officers, managers and employees of subsidiary or affiliated
| 7 |
| corporations and the individual proprietors, partners and | 8 |
| employees of
affiliated individuals and firms when the business | 9 |
| of the subsidiary or
affiliated corporations, firms or | 10 |
| individuals is controlled by a common
employer through stock | 11 |
| ownership, contract, or otherwise.
| 12 |
| "Employer" means any individual, partnership, association, | 13 |
| corporation,
business trust, or any person or group of persons | 14 |
| acting directly or indirectly
in the interest of an employer in | 15 |
| relation to an employee, for which one or
more
persons is | 16 |
| gainfully employed.
| 17 |
| "Family" coverage means the coverage provided by the Plan | 18 |
| for the
covered person and his or her eligible dependents who | 19 |
| also are
covered persons.
| 20 |
| "Federally eligible individual" means an individual | 21 |
| resident of this State:
| 22 |
| (1)(A) for whom, as of the date on which the individual | 23 |
| seeks Plan
coverage
under Section 15 of this Act, the | 24 |
| aggregate of the periods of creditable
coverage is 18 or | 25 |
| more months or, if the individual has been
certified as
| 26 |
| eligible pursuant to the federal Trade Act of 2002,
3 or | 27 |
| more
months, and (B) whose most recent prior creditable
| 28 |
| coverage was under group health insurance coverage offered | 29 |
| by a health
insurance issuer, a group health plan, a | 30 |
| governmental plan, or a church plan
(or
health insurance | 31 |
| coverage offered in connection with any such plans) or any
| 32 |
| other type of creditable coverage that may be required by | 33 |
| the federal Health
Insurance Portability
and | 34 |
| Accountability Act of 1996, as it may be amended, or the |
|
|
|
09400HB1603ham001 |
- 5 - |
LRB094 02952 LJB 43885 a |
|
| 1 |
| regulations
under that Act;
| 2 |
| (2) who
is not eligible for coverage under
(A) a group | 3 |
| health plan
(other than an individual who has been | 4 |
| certified as eligible
pursuant to the federal Trade Act of | 5 |
| 2002), (B)
part
A or part B of Medicare due to age
(other | 6 |
| than an individual who has been certified as eligible
| 7 |
| pursuant to the federal Trade Act of 2002), or (C) medical | 8 |
| assistance, and
does not
have other
health insurance | 9 |
| coverage (other than an individual who has been certified | 10 |
| as
eligible pursuant to the federal Trade Act of 2002);
| 11 |
| (3) with respect to whom (other than an individual who | 12 |
| has been
certified as eligible pursuant to the federal | 13 |
| Trade Act of 2002) the most
recent coverage within the | 14 |
| coverage
period
described in paragraph (1)(A) of this | 15 |
| definition was not terminated
based upon a factor relating | 16 |
| to nonpayment of premiums or fraud;
| 17 |
| (4) if the individual (other than an individual who has
| 18 |
| been certified
as eligible pursuant to the federal Trade | 19 |
| Act
of 2002)
had been offered the option of continuation
| 20 |
| coverage
under a COBRA continuation provision or under a | 21 |
| similar State program, who
elected such coverage; and
| 22 |
| (5) who, if the individual elected such continuation | 23 |
| coverage, has
exhausted
such continuation coverage under | 24 |
| such provision or program.
| 25 |
| However, an individual who has been certified as
eligible
| 26 |
| pursuant to the
federal Trade Act of 2002
shall not be required | 27 |
| to elect
continuation
coverage under a COBRA continuation | 28 |
| provision or under a similar state
program.
| 29 |
| "Group health insurance coverage" means, in connection | 30 |
| with a group health
plan, health insurance coverage offered in | 31 |
| connection with that plan.
| 32 |
| "Group health plan" has the same meaning given that term in | 33 |
| the federal
Health
Insurance Portability and Accountability | 34 |
| Act of 1996.
|
|
|
|
09400HB1603ham001 |
- 6 - |
LRB094 02952 LJB 43885 a |
|
| 1 |
| "Governmental plan" has the same meaning given that term in | 2 |
| the federal
Health
Insurance Portability and Accountability | 3 |
| Act of 1996.
| 4 |
| "Health insurance coverage" means benefits consisting of | 5 |
| medical care
(provided directly, through insurance or | 6 |
| reimbursement, or otherwise and
including items and services | 7 |
| paid for as medical care) under any hospital and
medical | 8 |
| expense-incurred policy,
certificate, or
contract provided by | 9 |
| an insurer, non-profit health care service plan
contract, | 10 |
| health maintenance organization or other subscriber contract, | 11 |
| or
any other health care plan or arrangement that pays for or | 12 |
| furnishes
medical or health care services whether by
insurance | 13 |
| or otherwise. Health insurance coverage shall not include short
| 14 |
| term,
accident only,
disability income, hospital confinement | 15 |
| or fixed indemnity, dental only,
vision only, limited benefit, | 16 |
| or credit
insurance, coverage issued as a supplement to | 17 |
| liability insurance,
insurance arising out of a workers' | 18 |
| compensation or similar law, automobile
medical-payment | 19 |
| insurance, or insurance under which benefits are payable
with | 20 |
| or without regard to fault and which is statutorily required to | 21 |
| be
contained in any liability insurance policy or equivalent | 22 |
| self-insurance.
| 23 |
| "Health insurance issuer" means an insurance company, | 24 |
| insurance service,
or insurance organization (including a | 25 |
| health maintenance organization and a
voluntary health | 26 |
| services plan) that is authorized to transact health
insurance
| 27 |
| business in this State. Such term does not include a group | 28 |
| health plan.
| 29 |
| "Health Maintenance Organization" means an organization as
| 30 |
| defined in the Health Maintenance Organization Act.
| 31 |
| "Hospice" means a program as defined in and licensed under | 32 |
| the
Hospice Program Licensing Act.
| 33 |
| "Hospital" means a duly licensed institution as defined in | 34 |
| the
Hospital Licensing Act,
an institution that meets all |
|
|
|
09400HB1603ham001 |
- 7 - |
LRB094 02952 LJB 43885 a |
|
| 1 |
| comparable conditions and requirements in
effect in the state | 2 |
| in which it is located, or the University of Illinois
Hospital | 3 |
| as defined in the University of Illinois Hospital Act.
| 4 |
| "Individual health insurance coverage" means health | 5 |
| insurance coverage
offered to individuals in the individual | 6 |
| market, but does not include
short-term, limited-duration | 7 |
| insurance.
| 8 |
| "Insured" means any individual resident of this State who | 9 |
| is
eligible to receive benefits from any insurer (including | 10 |
| health insurance
coverage offered in connection with a group | 11 |
| health plan) or health
insurance issuer as
defined in this | 12 |
| Section.
| 13 |
| "Insurer" means any insurance company authorized to | 14 |
| transact health
insurance business in this State and any | 15 |
| corporation that provides medical
services and is organized | 16 |
| under the Voluntary Health Services Plans Act or
the Health | 17 |
| Maintenance Organization
Act.
| 18 |
| "Medical assistance" means the State medical assistance or | 19 |
| medical
assistance no grant (MANG) programs provided under
| 20 |
| Title XIX of the Social Security Act and
Articles V (Medical | 21 |
| Assistance) and VI (General Assistance) of the Illinois
Public | 22 |
| Aid Code (or any successor program) or under any
similar | 23 |
| program of health care benefits in a state other than Illinois.
| 24 |
| "Medically necessary" means that a service, drug, or supply | 25 |
| is
necessary and appropriate for the diagnosis or treatment of | 26 |
| an illness or
injury in accord with generally accepted | 27 |
| standards of medical practice at
the time the service, drug, or | 28 |
| supply is provided. When specifically
applied to a confinement | 29 |
| it further means that the diagnosis or treatment
of the covered | 30 |
| person's medical symptoms or condition cannot be
safely
| 31 |
| provided to that person as an outpatient. A service, drug, or | 32 |
| supply shall
not be medically necessary if it: (i) is | 33 |
| investigational, experimental, or
for research purposes; or | 34 |
| (ii) is provided solely for the convenience of
the patient, the |
|
|
|
09400HB1603ham001 |
- 8 - |
LRB094 02952 LJB 43885 a |
|
| 1 |
| patient's family, physician, hospital, or any other
provider; | 2 |
| or (iii) exceeds in scope, duration, or intensity that level of
| 3 |
| care that is needed to provide safe, adequate, and appropriate | 4 |
| diagnosis or
treatment; or (iv) could have been omitted without | 5 |
| adversely affecting the
covered person's condition or the | 6 |
| quality of medical care; or
(v) involves
the use of a medical | 7 |
| device, drug, or substance not formally approved by
the United | 8 |
| States Food and Drug Administration.
| 9 |
| "Medical care" means the ordinary and usual professional | 10 |
| services rendered
by a physician or other specified provider | 11 |
| during a professional visit for
treatment of an illness or | 12 |
| injury.
| 13 |
| "Medicare" means coverage under both Part A and Part B of | 14 |
| Title XVIII of
the Social Security
Act, 42 U.S.C. Sec. 1395, et | 15 |
| seq.
| 16 |
| "Minimum premium plan" means an arrangement whereby a | 17 |
| specified
amount of health care claims is self-funded, but the | 18 |
| insurance company
assumes the risk that claims will exceed that | 19 |
| amount.
| 20 |
| "Participating transplant center" means a hospital | 21 |
| designated by the
Board as a preferred or exclusive provider of | 22 |
| services for one or more
specified human organ or tissue | 23 |
| transplants for which the hospital has
signed an agreement with | 24 |
| the Board to accept a transplant payment allowance
for all | 25 |
| expenses related to the transplant during a transplant benefit | 26 |
| period.
| 27 |
| "Physician" means a person licensed to practice medicine | 28 |
| pursuant to
the Medical Practice Act of 1987.
| 29 |
| "Plan" means the Comprehensive Health Insurance Plan
| 30 |
| established by this Act.
| 31 |
| "Plan of operation" means the plan of operation of the
| 32 |
| Plan, including articles, bylaws and operating rules, adopted | 33 |
| by the board
pursuant to this Act.
| 34 |
| "Provider" means any hospital, skilled nursing facility, |
|
|
|
09400HB1603ham001 |
- 9 - |
LRB094 02952 LJB 43885 a |
|
| 1 |
| hospice, home
health agency, physician, registered pharmacist | 2 |
| acting within the scope of that
registration, or any other | 3 |
| person or entity licensed in Illinois to furnish
medical care.
| 4 |
| "Qualified high risk pool" has the same meaning given that | 5 |
| term in the
federal Health
Insurance Portability and | 6 |
| Accountability Act of 1996.
| 7 |
| "Qualifying small employer" means an employer with at least | 8 |
| 2 but not more than 50 employees. A qualifying small employer | 9 |
| (i) shall not have had group health insurance coverage in | 10 |
| effect during the 12-month period prior to application for a | 11 |
| qualifying group health insurance contract and (ii) shall have | 12 |
| at least 30% of its eligible employees receiving annual wages | 13 |
| from the employer at a level equal to or less than $30,000. The | 14 |
| wage requirement set forth in item (ii) shall be adjusted | 15 |
| periodically by the board. | 16 |
| "Qualifying group health insurance contract" means a group | 17 |
| health insurance contract purchased from a health insurance | 18 |
| issuer by a qualifying small employer. The contract shall cover | 19 |
| the benefits determined by the board in accordance with | 20 |
| subsection (b) of Section 16 of this Act and shall insure not | 21 |
| fewer than 75% of the employees eligible for coverage. At the | 22 |
| option of the qualifying small employer, the benefits of the | 23 |
| qualifying group health insurance contract may exclude | 24 |
| outpatient prescription drugs that by law require a | 25 |
| prescription written by a physician licensed to practice | 26 |
| medicine in all its branches.
| 27 |
| "Resident" means a person who is and continues to be | 28 |
| legally domiciled
and physically residing on a permanent and | 29 |
| full-time basis in a
place of permanent habitation
in this | 30 |
| State
that remains that person's principal residence and from | 31 |
| which that person is
absent only for temporary or transitory | 32 |
| purpose.
| 33 |
| "Skilled nursing facility" means a facility or that portion | 34 |
| of a facility
that is licensed by the Illinois Department of |
|
|
|
09400HB1603ham001 |
- 10 - |
LRB094 02952 LJB 43885 a |
|
| 1 |
| Public Health under the
Nursing Home Care Act or a comparable | 2 |
| licensing authority in another state
to provide skilled nursing | 3 |
| care.
| 4 |
| "Stop-loss coverage" means an arrangement whereby an | 5 |
| insurer
insures against the risk that any one claim will exceed | 6 |
| a specific dollar
amount or that the entire loss of a | 7 |
| self-insurance plan will exceed
a specific amount.
| 8 |
| "Third party administrator" means an administrator as | 9 |
| defined in
Section 511.101 of the Illinois Insurance Code who | 10 |
| is licensed under
Article XXXI 1/4 of that Code.
| 11 |
| (Source: P.A. 92-153, eff. 7-25-01; 93-33, eff. 6-23-03; 93-34, | 12 |
| eff. 6-23-03; 93-477, eff. 8-8-03; 93-622, eff. 12-18-03.)
| 13 |
| (215 ILCS 105/4) (from Ch. 73, par. 1304)
| 14 |
| Sec. 4. Powers and authority of the board. The board shall | 15 |
| have the
general powers and authority granted under the laws of | 16 |
| this State to
insurance companies licensed to transact health | 17 |
| and accident insurance and
in addition thereto, the specific | 18 |
| authority to:
| 19 |
| a. Enter into contracts as are necessary or proper to carry | 20 |
| out the
provisions and purposes of this Act, including the | 21 |
| authority, with the
approval of the Director, to enter into | 22 |
| contracts with similar plans of
other states for the joint | 23 |
| performance of common administrative functions,
or with | 24 |
| persons or other organizations for the performance of
| 25 |
| administrative functions including, without limitation, | 26 |
| utilization review
and quality assurance programs, or with | 27 |
| health maintenance organizations or
preferred provider | 28 |
| organizations for the provision of health care services.
| 29 |
| b. Sue or be sued, including taking any legal actions | 30 |
| necessary or
proper.
| 31 |
| c. Take such legal action as necessary to:
| 32 |
| (1) avoid the payment of improper
claims against the | 33 |
| plan or the coverage provided by or through the plan;
|
|
|
|
09400HB1603ham001 |
- 11 - |
LRB094 02952 LJB 43885 a |
|
| 1 |
| (2) to recover any amounts erroneously or improperly | 2 |
| paid by the plan;
| 3 |
| (3) to recover any amounts paid by the plan as a result | 4 |
| of a mistake of
fact or law; or
| 5 |
| (4) to recover or collect any other amounts, including | 6 |
| assessments, that
are due or owed the Plan or have been | 7 |
| billed on its or the Plan's behalf.
| 8 |
| d. Establish appropriate rates, rate schedules, rate | 9 |
| adjustments,
expense allowances, agents' referral fees, claim | 10 |
| reserves, and formulas and
any other actuarial function | 11 |
| appropriate to the operation of the plan.
Rates and rate | 12 |
| schedules may be adjusted for appropriate risk factors
such as | 13 |
| age and area variation in claim costs and shall take into
| 14 |
| consideration appropriate risk factors in accordance with | 15 |
| established
actuarial and underwriting practices.
| 16 |
| e. Issue policies of insurance in accordance with the | 17 |
| requirements of
this Act.
| 18 |
| f. Appoint appropriate legal, actuarial and other | 19 |
| committees as
necessary to provide technical assistance in the | 20 |
| operation of the plan,
policy and other contract design, and | 21 |
| any other function within
the authority of the plan.
| 22 |
| g. Borrow money to effect the purposes of the Illinois | 23 |
| Comprehensive
Health Insurance Plan. Any notes or other | 24 |
| evidence of indebtedness of the
plan not in default shall be | 25 |
| legal investments for insurers and may be
carried as admitted | 26 |
| assets.
| 27 |
| h. Establish rules, conditions and procedures for | 28 |
| reinsuring risks
under this Act.
| 29 |
| i. Employ and fix the compensation of employees. Such | 30 |
| employees
may be
paid on a warrant issued by the State | 31 |
| Treasurer pursuant to a payroll
voucher certified by the Board | 32 |
| and drawn by the Comptroller against
appropriations or trust | 33 |
| funds held by the State Treasurer.
| 34 |
| j. Enter into intergovernmental cooperation agreements |
|
|
|
09400HB1603ham001 |
- 12 - |
LRB094 02952 LJB 43885 a |
|
| 1 |
| with other agencies
or entities of State government for the | 2 |
| purpose of sharing the cost of
providing health care services | 3 |
| that are otherwise authorized by this Act for
children who are | 4 |
| both plan participants and eligible for financial assistance
| 5 |
| from the Division of Specialized Care for Children of the | 6 |
| University of
Illinois.
| 7 |
| k. Establish conditions and procedures under which the plan | 8 |
| may, if funds
permit, discount or subsidize premium rates that | 9 |
| are paid directly by senior
citizens, as defined by the Board, | 10 |
| and other
plan participants, who are retired or unemployed and | 11 |
| meet other
qualifications.
| 12 |
| l. Establish and maintain the Plan Fund authorized in
| 13 |
| Section 3 of this Act, which shall be divided into separate | 14 |
| accounts, as
follows:
| 15 |
| (1) accounts to fund the administrative, claim, and | 16 |
| other expenses of the
Plan associated with eligible persons | 17 |
| who qualify for Plan coverage under
Section 7 of this Act, | 18 |
| which shall consist of:
| 19 |
| (A) premiums paid on behalf of covered persons;
| 20 |
| (B) appropriated funds and other revenues | 21 |
| collected or received by the
Board;
| 22 |
| (C) reserves for future losses maintained by the | 23 |
| Board; and
| 24 |
| (D) interest earnings from investment of the funds | 25 |
| in the Plan
Fund or any of its accounts other than the | 26 |
| funds in the account established
under item 2 of this | 27 |
| subsection;
| 28 |
| (2) an account, to be denominated the federally | 29 |
| eligible individuals
account, to fund the administrative, | 30 |
| claim, and other expenses of the Plan
associated with | 31 |
| federally eligible individuals who qualify for Plan | 32 |
| coverage
under Section 15 of this Act, which shall consist | 33 |
| of:
| 34 |
| (A) premiums paid on behalf of covered persons;
|
|
|
|
09400HB1603ham001 |
- 13 - |
LRB094 02952 LJB 43885 a |
|
| 1 |
| (B) assessments and other revenues collected or | 2 |
| received by the Board;
| 3 |
| (C) reserves for future losses maintained by the | 4 |
| Board; and
| 5 |
| (D) interest earnings from investment of the | 6 |
| federally eligible
individuals account funds; and
| 7 |
| (E) grants provided pursuant to the federal Trade | 8 |
| Act of
2002; and
| 9 |
| (3) such other accounts as may be appropriate , | 10 |
| including, but not limited to, accounts to fund the | 11 |
| administrative, claim, and other expenses of the Plan | 12 |
| associated with the Small Employer Group Health Insurance | 13 |
| Program established in accordance with Section 16 of this | 14 |
| Act .
| 15 |
| m. Charge and collect assessments paid by insurers pursuant | 16 |
| to
Section 12 of this Act and recover any assessments for, on | 17 |
| behalf of, or
against those insurers.
| 18 |
| (Source: P.A. 93-33, eff. 6-23-03; 93-34, eff. 6-23-03.)
| 19 |
| (215 ILCS 105/16 new) | 20 |
| Sec. 16. Small Employer Group Health Insurance Program. | 21 |
| (a) On or after July 1, 2007 and subject to appropriation, | 22 |
| the board shall establish the Small Employer Group Health | 23 |
| Insurance Program. The purpose of the Program is to make | 24 |
| qualifying group health insurance contracts available to | 25 |
| qualifying small employers. The Program is designed to | 26 |
| encourage small employers to offer health insurance coverage to | 27 |
| their employees. | 28 |
| Participation in the Program by insurers is limited to | 29 |
| health insurance issuers offering qualifying group health | 30 |
| insurance contracts. Agents for health insurance issuers shall | 31 |
| receive a referral fee of $50 for each qualifying group health | 32 |
| insurance contract issued. | 33 |
| (b) For qualifying group health insurance contracts made |
|
|
|
09400HB1603ham001 |
- 14 - |
LRB094 02952 LJB 43885 a |
|
| 1 |
| available under the Program, the board shall determine | 2 |
| benefits, limitations, exclusions, deductibles, coinsurance | 3 |
| payments, and other policy terms and conditions in accordance | 4 |
| with appropriate actuarial principles and the requirements of | 5 |
| this Act. | 6 |
| (c) The board shall establish a fund from which a health | 7 |
| insurance issuer may receive reimbursement for claims paid by | 8 |
| the health insurance issuer for persons covered under | 9 |
| qualifying group health insurance contracts to the extent funds | 10 |
| are available therefor. The fund shall be known as the "small | 11 |
| employer stop loss fund". | 12 |
| (d) Beginning on July 1, 2007, health insurance issuers | 13 |
| shall be eligible to receive reimbursement for 90% of the value | 14 |
| of claims paid between $30,000 and $100,000 in a calendar year | 15 |
| for any person covered under a qualifying group health | 16 |
| insurance contract to the extent funds are available therefor. | 17 |
| Claims paid for persons covered under qualifying group | 18 |
| health insurance contracts shall be reimbursable from the small | 19 |
| employer stop loss fund. Claims shall be reported and funds | 20 |
| shall be distributed from the small employer stop loss fund on | 21 |
| a calendar year basis. Claims shall be eligible for | 22 |
| reimbursement only for the calendar year in which the claims | 23 |
| are paid. Once claims paid on behalf of a claimant reach or | 24 |
| exceed $100,000 in a given calendar year, no further claims | 25 |
| paid on behalf of the claimant in that calendar year shall be | 26 |
| eligible for reimbursement. | 27 |
| (e) The board shall adopt rules that set forth procedures | 28 |
| for the operation of the small employer stop loss fund. ".
|
|