Full Text of SB1313 97th General Assembly
SB1313ham002 97TH GENERAL ASSEMBLY | Rep. Frank J. Mautino Filed: 10/26/2011
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| 1 | | AMENDMENT TO SENATE BILL 1313
| 2 | | AMENDMENT NO. ______. Amend Senate Bill 1313 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 5. The State Employee Health Savings Account Law | 5 | | is amended by changing Sections 10-5 and 10-10 as follows: | 6 | | (5 ILCS 377/10-5)
| 7 | | Sec. 10-5. Definitions. As used in this Law: | 8 | | (a) "Deductible" means the total deductible of a high | 9 | | deductible health plan for an eligible individual and all the | 10 | | dependents of that eligible individual for a calendar year. | 11 | | (b) "Dependent" means a dependent as defined in Section 3 | 12 | | of the State Employee Group Insurance Act of 1971, provided | 13 | | that any dependent age 26 or above, as defined under that | 14 | | Section, is eligible to be claimed by the eligible individual | 15 | | as a tax dependent under Section 152(a) of the Internal Revenue | 16 | | Code of 1986 an eligible individual's spouse or child, as |
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| 1 | | defined in Section 152 of the Internal Revenue Code of 1986 .
| 2 | | "Dependent" also includes a party to or the child of a party to | 3 | | a civil union, as defined under Section 10 of the Illinois | 4 | | Religious Freedom Protection and Civil Union Act , provided that | 5 | | the party to, or the child of a party to, the civil union is | 6 | | eligible to be claimed by the eligible individual as a tax | 7 | | dependent under Section 152(a) of the Internal Revenue Code of | 8 | | 1986 . | 9 | | (c) "Eligible individual" means an employee, as defined in | 10 | | Section 3 of the State Employees Group Insurance Act of 1971, | 11 | | who contributes to health savings accounts on the employees' | 12 | | behalf, who: | 13 | | (1) is covered by a high deductible health plan | 14 | | individually or with dependents; and | 15 | | (2) is not covered under any health plan that is not a | 16 | | high deductible health plan, except for: | 17 | | (i) coverage for accidents; | 18 | | (ii) workers' compensation insurance; | 19 | | (iii) insurance for a specified disease or | 20 | | illness; | 21 | | (iv) insurance paying a fixed amount per day per | 22 | | hospitalization; and | 23 | | (v) tort liabilities; and | 24 | | (3) establishes a health savings account or on whose | 25 | | behalf the health savings account is
established ; . | 26 | | (4) is not entitled to Medicare; and |
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| 1 | | (5) cannot be claimed as a dependent on another | 2 | | person's tax return. | 3 | | (d) "Employer" means a State agency, department, or other | 4 | | entity that employs an eligible individual. | 5 | | (e) "Health savings account" or "account" means a trust or | 6 | | custodial account established under a State program | 7 | | exclusively to pay the qualified medical expenses of an | 8 | | eligible individual, or his or her dependents, that meets all | 9 | | of the following requirements:
| 10 | | (1) Except in the case of a rollover contribution, no | 11 | | contribution may be accepted: | 12 | | (A) unless it is in cash; or
| 13 | | (B) to the extent that the contribution, when added | 14 | | to the previous contributions to the Account for the | 15 | | calendar year, exceeds the lesser of (i) 100% of the | 16 | | eligible individual's deductible or (ii) the | 17 | | contribution level set for that year by the Internal | 18 | | Revenue Service. | 19 | | (2)
The trustee or custodian is a bank, an insurance | 20 | | company, or another person approved by the Director of | 21 | | Insurance.
| 22 | | (3) No part of the trust assets shall be invested in | 23 | | life insurance contracts. | 24 | | (4) The assets of the account shall not be commingled | 25 | | with other property except as allowed for under Individual | 26 | | Retirement Accounts. |
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| 1 | | (5) Eligible individual's interest in the account is | 2 | | nonforfeitable. | 3 | | (f) "Health savings account program" or "program" means a | 4 | | program that includes all of the following:
| 5 | | (1) Participation The purchase by an eligible | 6 | | individual in an employer-sponsored or by an employer of a | 7 | | high deductible health plan. | 8 | | (2) The contribution into a health savings account by | 9 | | an eligible individual or on behalf of an employee or by | 10 | | his or her employer. The total annual contribution may not | 11 | | exceed the amount of the deductible or the amounts listed | 12 | | in sub-item (B) of item (1) of subsection (e) (f) of this | 13 | | Section. | 14 | | (g) "High deductible" means: | 15 | | (1) In the case of self-only coverage, an annual | 16 | | deductible that is not less than the level set by the | 17 | | Internal Revenue Service and that, when added to the other | 18 | | annual out-of-pocket expenses required to be paid under the | 19 | | plan for covered benefits, does not exceed the maximum | 20 | | level set by the Internal Revenue Service $5,000 ; and
| 21 | | (2) In the case of family coverage, an annual | 22 | | deductible of not less than the level set by the Internal | 23 | | Revenue Service and that, when added to the other annual | 24 | | out-of-pocket expenses required to be paid under the plan | 25 | | for covered benefits, does not exceed the maximum level set | 26 | | by the Internal Revenue Service $10,000 .
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| 1 | | A plan shall not fail to be treated as a high deductible | 2 | | plan by reason of a failure to have a deductible for preventive | 3 | | care or, in the case of network plans, for having out-of-pocket | 4 | | expenses that exceed these limits on an annual deductible for | 5 | | services that are provided outside the network.
| 6 | | (h) "High deductible health plan" means a health coverage | 7 | | policy, certificate, or contract that provides for payments for | 8 | | covered benefits that exceed the high deductible. | 9 | | (i) "Qualified medical expense" means an expense paid by | 10 | | the eligible individual for medical care described in Section | 11 | | 213(d) of the Internal Revenue Code of 1986.
| 12 | | (Source: P.A. 97-142, eff. 7-14-11.) | 13 | | (5 ILCS 377/10-10)
| 14 | | Sec. 10-10. Application; authorized contributions. | 15 | | (a) Beginning in calendar taxable year 2012 2011 , each | 16 | | employer shall make available to each eligible individual a | 17 | | health savings account program, if that individual chooses to | 18 | | enroll in the program except that, for an employer who provides | 19 | | coverage pursuant to any one or more of subsections (i) through | 20 | | (n) of Section 10 of the State Employee Group Insurance Act, | 21 | | that employer may make available a health savings account | 22 | | program . An employer who makes a health savings account program | 23 | | available shall annually deposit an amount equal to one-third | 24 | | of the annual deductible $2,750 annually into an eligible | 25 | | individual's health savings account. Unused funds in a health |
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| 1 | | savings account shall become the property of the account holder | 2 | | at the end of a taxable year. | 3 | | (b) Beginning in calendar taxable year 2012 2011 , an | 4 | | eligible individual may deposit contributions into a health | 5 | | savings account in accordance with the restrictions set forth | 6 | | in subsection (e) of Section 10-5 . The amount of deposit may | 7 | | not exceed the amount of the deductible for the policy.
| 8 | | (Source: P.A. 97-142, eff. 7-14-11.) | 9 | | Section 10. The Illinois Insurance Code is amended by | 10 | | adding Section 500-123 as follows: | 11 | | (215 ILCS 5/500-123 new) | 12 | | Sec. 500-123. Consulting. A producer shall be prohibited | 13 | | from selling, soliciting, or negotiating insurance or limited | 14 | | lines insurance after the producer or an employee or contractor | 15 | | of the producer has been hired by the purchaser or prospective | 16 | | purchaser within the previous 5 years as a consultant | 17 | | concerning the insurance or limited lines insurance being sold, | 18 | | solicited, or negotiated. For the purposes of this Section, | 19 | | "producer" means an insurance producer, limited line producer, | 20 | | or temporary insurance producer. | 21 | | Section 15. The Illinois Health Benefits Exchange Law is | 22 | | amended by adding Sections 5-4, 5-8, 5-11, 5-12, 5-13, 5-14, | 23 | | and 5-18 and by changing Section 5-10 as follows: |
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| 1 | | (215 ILCS 122/5-4 new) | 2 | | Sec. 5-4. Definitions. For purposes of this Law: | 3 | | "Board" means the Illinois Health Benefits Exchange Board | 4 | | established pursuant to this Law. | 5 | | "Director" means the Director of Insurance. | 6 | | "Essential health benefits" has the meaning provided under | 7 | | Section 1302(b) of the Federal Act. | 8 | | "Exchange" means the Illinois Health Benefits Exchange | 9 | | established by this Law and includes the Individual Exchange | 10 | | and the SHOP Exchange, unless otherwise specified. | 11 | | "Executive Director" means the Executive Director of the | 12 | | Illinois Health Benefits Exchange. | 13 | | "Federal Act" means the federal Patient Protection and | 14 | | Affordable Care Act (Public Law 111-148), as amended by the | 15 | | federal Health Care and Education Reconciliation Act of 2010 | 16 | | (Public Law 111-152), and any amendments thereto or regulations | 17 | | or guidance issued under those Acts. | 18 | | "Health benefit plan" means a policy, contract, | 19 | | certificate, or agreement offered or issued by a health carrier | 20 | | to provide, deliver, arrange for, pay for, or reimburse any of | 21 | | the costs of health care services. "Health benefit plan" does | 22 | | not include: | 23 | | (a) coverage for accident only or disability income | 24 | | insurance or any combination thereof; | 25 | | (b) coverage issued as a supplement to liability |
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| 1 | | insurance; | 2 | | (c) liability insurance, including general liability | 3 | | insurance and automobile liability insurance; | 4 | | (d) workers' compensation or similar insurance; | 5 | | (e) automobile medical payment insurance; | 6 | | (f) credit-only insurance; | 7 | | (g) coverage for on-site medical clinics; or | 8 | | (h) other similar insurance coverage, specified in | 9 | | federal regulations issued pursuant to Pub. L. No. 104-191, | 10 | | under which benefits for health care services are secondary | 11 | | or incidental to other insurance benefits. | 12 | | "Health carrier" or "carrier" means an entity subject to | 13 | | the insurance laws and regulations of this State, or subject to | 14 | | the jurisdiction of the Director, that contracts or offers to | 15 | | contract to provide, deliver, arrange for, pay for, or | 16 | | reimburse any of the costs of health care services, including a | 17 | | sickness and accident insurance company, a health maintenance | 18 | | organization, a non-profit hospital and health service | 19 | | corporation, or any other entity providing a plan of health | 20 | | insurance, health benefits, or health services. | 21 | | "Individual Exchange" means the exchange marketplace | 22 | | established by this Law through which qualified individuals may | 23 | | obtain coverage through an individual market qualified health | 24 | | plan. | 25 | | "Qualified dental plan" means a limited scope dental plan | 26 | | that has been certified in accordance with this Law. |
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| 1 | | "Qualified employee" means an eligible individual employed | 2 | | by a qualified employer who has been offered health insurance | 3 | | coverage by that qualified employer through the SHOP on the | 4 | | Exchange. | 5 | | "Qualified employer" means a small employer that elects to | 6 | | make its full-time employees eligible for one or more qualified | 7 | | health plans or qualified dental plans offered through the SHOP | 8 | | Exchange, and at the option of the employer, some or all of its | 9 | | part-time employees, provided that the employer has its | 10 | | principal place of business in this State and elects to provide | 11 | | coverage through the SHOP Exchange to all of its eligible | 12 | | employees, wherever employed. | 13 | | "Qualified health plan" or "QHP" means a health benefit | 14 | | plan that has in effect a certification that the plan meets the | 15 | | criteria for certification described in Section 1311(c) of the | 16 | | Federal Act. | 17 | | "Qualified health plan issuer" or "QHP issuer" means a | 18 | | health insurance issuer that offers a health plan that the | 19 | | Exchange has certified as a qualified health plan. | 20 | | "Qualified individual" means an individual, including a | 21 | | minor, who: | 22 | | (1) is seeking to enroll in a qualified health plan or | 23 | | qualified dental plan offered to individuals through the | 24 | | Exchange; | 25 | | (2) resides in this State; | 26 | | (3) at the time of enrollment, is not incarcerated, |
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| 1 | | other than incarceration pending the disposition of | 2 | | charges; and | 3 | | (4) is, and is reasonably expected to be, for the | 4 | | entire period for which enrollment is sought, a citizen or | 5 | | national of the United States or an alien lawfully present | 6 | | in the United States. | 7 | | "Secretary" means the Secretary of the federal Department | 8 | | of Health and Human Services. | 9 | | "SHOP Exchange" means the Small Business Health Options | 10 | | Program established under this Law through which a qualified | 11 | | employer can provide small group qualified health plans to its | 12 | | qualified employees. | 13 | | "Small employer" means, in connection with a group health | 14 | | plan with respect to a calendar year and a plan year, an | 15 | | employer who employed an average of at least 2 but not more | 16 | | than 50 employees on business days during the preceding | 17 | | calendar year and who employs at least one employee on the | 18 | | first day of the plan year. Beginning January 1, 2016, the | 19 | | definition of a "small employer" shall mean, in connection with | 20 | | a group health plan with respect to a calendar year and a plan | 21 | | year, an employer who employed an average of at least 2 but not | 22 | | more than 100 employees on business days during the preceding | 23 | | calendar year and who employs at least one employee on the | 24 | | first day of the plan year. | 25 | | (215 ILCS 122/5-8 new) |
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| 1 | | Sec. 5-8. Exchange Board. There is created the Illinois | 2 | | Health Benefits Exchange Board. The purpose of the Board is to | 3 | | administer the State health benefits exchange created pursuant | 4 | | to this Law and to conduct such other business as may further | 5 | | the administration of the State health benefits exchange. The | 6 | | Exchange shall operate subject to the supervision and control | 7 | | of the Board. The Exchange is created as a quasigovernmental | 8 | | agency and as such is not a State agency. | 9 | | (215 ILCS 122/5-10)
| 10 | | Sec. 5-10. Exchange functions. On or before January 1, | 11 | | 2014, in compliance with paragraph (4) of subdivision (d) of | 12 | | Section 1311 of the federal Patient Protection and Affordable | 13 | | Care Act, the Exchange shall, at a minimum, do all of the | 14 | | following to implement Section 1311 of the federal Patient | 15 | | Protection and Affordable Care Act: | 16 | | (1) Make qualified health plans available to qualified | 17 | | individuals and qualified employers. | 18 | | (2) Implement procedures for the certification, | 19 | | recertification, and decertification, consistent with | 20 | | guidelines established by the U.S. Secretary of Health and | 21 | | Human Services, of health plans as qualified health plans. | 22 | | The Board shall require health plans seeking certification | 23 | | as qualified health plans to do all of the following: | 24 | | (A) Submit a justification for any premium | 25 | | increase prior to the implementation of the increase. |
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| 1 | | The plans shall prominently post that information on | 2 | | their Internet web sites. The Board shall take this | 3 | | information, and the information and the | 4 | | recommendations provided to the Board by the | 5 | | Department of Insurance or the Department of Managed | 6 | | Health Care under paragraph (1) of subdivision (b) of | 7 | | Section 2794 of the federal Public Health Service Act, | 8 | | into consideration when determining whether to make | 9 | | the health plan available through the Exchange. The | 10 | | Board shall take into account any excess of premium | 11 | | growth outside the Exchange as compared to the rate of | 12 | | that growth inside the Exchange, including information | 13 | | reported by the Department of Insurance and the | 14 | | Department of Managed Health Care. | 15 | | (B) Make available to the public and submit to the | 16 | | Board, the U.S. Secretary of Health and Human Services, | 17 | | and the Department of Insurance or the Department of | 18 | | Public Health, as applicable, accurate and timely | 19 | | disclosure of the following information: | 20 | | (i) Claims payment policies and practices. | 21 | | (ii) Periodic financial disclosures. | 22 | | (iii) Data on enrollment. | 23 | | (iv) Data on disenrollment. | 24 | | (v) Data on the number of claims that are | 25 | | denied. | 26 | | (vi) Data on rating practices. |
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| 1 | | (vii) Information on cost sharing and payments | 2 | | with respect to any out-of-network coverage. | 3 | | (viii) Information on enrollee and participant | 4 | | rights under Title I of the federal Patient | 5 | | Protection and Affordable Care Act. | 6 | | (ix) Other information as determined | 7 | | appropriate by the U.S. Secretary of Health and | 8 | | Human Services. | 9 | | The information required under this paragraph (b) | 10 | | shall be provided in plain language, as defined in | 11 | | subparagraph (B) of paragraph (3) of subdivision (e) of | 12 | | Section 1311 of the federal Patient Protection and | 13 | | Affordable Care Act. | 14 | | (C) Permit individuals to learn, in a timely manner | 15 | | upon the request of the individual, the amount of cost | 16 | | sharing, including, but not limited to, deductibles, | 17 | | copayments, and coinsurance, under the individual's | 18 | | plan or coverage that the individual would be | 19 | | responsible for paying with respect to the furnishing | 20 | | of a specific item or service by a participating | 21 | | provider. At a minimum, this information shall be made | 22 | | available to the individual through an Internet web | 23 | | site and through other means for individuals without | 24 | | access to the Internet. | 25 | | (3) Provide for the operation of a toll-free telephone | 26 | | hotline to respond to requests for assistance. |
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| 1 | | (4) Maintain an Internet web site through which | 2 | | enrollees and prospective enrollees of qualified health | 3 | | plans may obtain standardized comparative information on | 4 | | those plans. | 5 | | (5) With respect to each qualified health plan offered | 6 | | through the Exchange, do both of the following: | 7 | | (A) assign a rating to each qualified health plan | 8 | | offered through the
Exchange in accordance with the | 9 | | criteria developed by the U.S. Secretary of Health and | 10 | | Human Services; and | 11 | | (B) determine each qualified health plan's level | 12 | | of coverage in accordance with regulations adopted by | 13 | | the Secretary under paragraph (A) of subdivision (2) of | 14 | | Section 1302(d) of the federal Patient Protection and | 15 | | Affordable Care Act and any additional regulations | 16 | | adopted by the Exchange under this Law. | 17 | | (6) Utilize a standardized format for presenting | 18 | | health benefits plan
options in the Exchange, including the | 19 | | use of the uniform outline of coverage established under | 20 | | Section 2715 of the federal Public Health Service Act. | 21 | | (7) Inform individuals of eligibility requirements for | 22 | | the Medicaid program, the Covering ALL KIDS Health | 23 | | Insurance Program, or any applicable State or local public | 24 | | program and, if through screening of the application by the | 25 | | Exchange the Exchange determines that an individual is | 26 | | eligible for any such program, enroll that individual in |
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| 1 | | the program. | 2 | | (8) Establish and make available by electronic means a | 3 | | calculator to determine the actual cost of coverage after | 4 | | the application of any premium tax credit under Section 36B | 5 | | of the Internal Revenue Code of 1986 and any cost sharing | 6 | | reduction under Section 1402 of the federal Patient | 7 | | Protection and Affordable Care Act. | 8 | | (9) Grant a certification attesting that, for purposes | 9 | | of the individual responsibility penalty under Section | 10 | | 5000A of the Internal Revenue Code of 1986, an individual | 11 | | is exempt from the individual requirement or from the | 12 | | penalty imposed by that Section because of either of the | 13 | | following: | 14 | | (A) There is no affordable qualified health plan | 15 | | available through the Exchange or the individual's | 16 | | employer covering the individual. | 17 | | (B) The individual meets the requirements for any | 18 | | other exemption from the individual responsibility | 19 | | requirement or penalty. | 20 | | (10) Transfer to the Secretary of the Treasury all of | 21 | | the following: | 22 | | (A) a list of the individuals who are issued a | 23 | | certification, including the name and taxpayer | 24 | | identification number of each individual; | 25 | | (B) the name and taxpayer identification number of | 26 | | each individual who was an employee of an employer but |
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| 1 | | who was determined to be eligible for the premium tax | 2 | | credit under Section 36B of the Internal Revenue Code | 3 | | of 1986 because: | 4 | | (i) the employer did not provide the minimum | 5 | | essential coverage or the employer provided the | 6 | | minimum essential coverage but it was determined | 7 | | under item (C) of paragraph (2) of subdivision (c) | 8 | | of Section 36B of the Code to either be | 9 | | unaffordable to the employee or not provide the | 10 | | required minimum actuarial value; and | 11 | | (ii) the name and taxpayer identification | 12 | | number of each individual who notifies the | 13 | | Exchange under paragraph (4) of subdivision (b) of | 14 | | Section 1411 of the federal Patient Protection and | 15 | | Affordable Care Act that they have changed | 16 | | employers and of each individual who ceases | 17 | | coverage under a qualified health plan during a | 18 | | plan year, and the effective date of such | 19 | | cessation; | 20 | | (11) Provide to each employer the name of each employee | 21 | | of the employer described in subdivision (i) of Section | 22 | | 1311 of the federal Patient Protection and Affordable Care | 23 | | Act who ceases coverage under a qualified health plan | 24 | | during a plan year and the effective date of that | 25 | | cessation. | 26 | | (12) Perform duties required of, or delegated to, the |
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| 1 | | Exchange by the U.S. Secretary of Health and Human Services | 2 | | or the Secretary of the Treasury related to the following: | 3 | | (A) Determining eligibility for premium tax | 4 | | credits, reduced cost sharing, or individual | 5 | | responsibility exemptions. | 6 | | (B) Establishing procedures necessary for the | 7 | | operation of the program, including, but not limited | 8 | | to, procedures for application, enrollment, risk | 9 | | assessment, risk adjustment, plan administration, | 10 | | performance monitoring, and consumer education. | 11 | | (C) Arranging for collection of contributions from | 12 | | participating employers and individuals. | 13 | | (D) Arranging for payment of premiums and other | 14 | | appropriate disbursements based on the selections of | 15 | | products and services by the individual participants. | 16 | | (E) Establishing criteria for disenrollment of | 17 | | participating individuals based on failure to pay the | 18 | | individual's share of any contribution required to | 19 | | maintain enrollment in selected products. | 20 | | (F) Establishing criteria for exclusion of | 21 | | vendors. | 22 | | (G) Developing and implementing a plan for | 23 | | promoting public awareness of and participation in the | 24 | | program. | 25 | | (H) Evaluating options for employer participation | 26 | | which may conform with common insurance practices. |
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| 1 | | (I) Providing for initial, annual, and special | 2 | | enrollment periods, in accordance with guidelines | 3 | | adopted by the Secretary under paragraph (6) of | 4 | | subdivision (c) of Section 1311 of the federal Patient | 5 | | Protection and Affordable Care Act. | 6 | | (13) Establish the Navigator Program in accordance | 7 | | with subdivision (i) of Section 1311 of the federal Patient | 8 | | Protection and Affordable Care Act. The Exchange shall | 9 | | award grants to certain entities to do the following: | 10 | | (A) Conduct public education activities to raise | 11 | | awareness of the availability of qualified health | 12 | | plans. | 13 | | (B) Distribute fair and impartial information | 14 | | concerning enrollment in qualified health plans and | 15 | | the availability of premium tax credits under Section | 16 | | 36B of the Internal Revenue Code of 1986 and | 17 | | cost-sharing reductions under Section 1402 of the | 18 | | federal Patient Protection and Affordable Care Act. | 19 | | (C) Facilitate enrollment in qualified health | 20 | | plans. | 21 | | (D) Provide referrals to any applicable office of | 22 | | health insurance consumer assistance or health | 23 | | insurance ombudsman established under Section 2793 of | 24 | | the federal Public Health Service Act, or any other | 25 | | appropriate State agency or agencies, for any enrollee | 26 | | with a grievance, complaint, or question regarding his |
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| 1 | | or her health plan, coverage, or a determination under | 2 | | that plan or coverage. | 3 | | (E) Refer individuals with a grievance, complaint, | 4 | | or question regarding a plan, a plan's coverage, or a | 5 | | determination under a plan's coverage to a customer | 6 | | relations unit established by the Exchange. | 7 | | (F) Provide information in a manner that is | 8 | | culturally and linguistically appropriate to the needs | 9 | | of the population being served by the Exchange. | 10 | | (14) Establish the Small Business Health Options | 11 | | Program, separate from the activities of the Board related | 12 | | to the individual market, to assist qualified small | 13 | | employers in facilitating the enrollment of their | 14 | | employees in qualified health plans offered through the | 15 | | Exchange in the small employer market in a manner | 16 | | consistent with paragraph (2) of subdivision (a) of Section | 17 | | 1312 of the Federal Act. (a) The Illinois Health Benefits | 18 | | Exchange shall meet the core functions identified by | 19 | | Section 1311 of the Patient Protection and Affordable Care | 20 | | Act and subsequent federal guidance and regulations. | 21 | | (b) In order to meet the deadline of October 1, 2013 | 22 | | established by federal law to have operational a State | 23 | | exchange, the Department of Insurance
and the Commission on | 24 | | Governmental Forecasting and Accountability is authorized to | 25 | | apply for, accept, receive, and use as appropriate
for and on | 26 | | behalf of the State any grant money provided by the
federal |
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| 1 | | government and to share federal grant funding with, give | 2 | | support to,
and coordinate with other agencies of the State and | 3 | | federal government
or third parties as determined by the | 4 | | Governor.
| 5 | | (Source: P.A. 97-142, eff. 7-14-11.) | 6 | | (215 ILCS 122/5-11 new) | 7 | | Sec. 5-11. Exchange powers. The Exchange shall have the | 8 | | power to do the following acts. | 9 | | (1) Have perpetual successions as a body politic and | 10 | | corporate and to adopt bylaws for the regulation of its | 11 | | affairs and the conduct of its business. | 12 | | (2) Adopt an official seal and alter the same at | 13 | | pleasure. | 14 | | (3) Maintain an office in the State at such place or | 15 | | places as it may designate. | 16 | | (4) Employ such assistants, agents, managers, and | 17 | | other employees as may be necessary or desirable. | 18 | | (5) Acquire, lease, purchase, own, manage, hold, and | 19 | | dispose of real and personal property. | 20 | | (6) Receive and accept, from any source, aid or | 21 | | contributions, including money, property, labor, and other | 22 | | things of value. | 23 | | (7) Charge assessments or user fees to generate funding | 24 | | necessary to support the operations of the Exchange. | 25 | | (8) Exclude plans that fail to deliver robust consumer |
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| 1 | | protections, quality care, and reasonable costs, | 2 | | particularly if the plan has a history of unreasonable rate | 3 | | increases. | 4 | | (9) Procure insurance against loss in connection with | 5 | | its property and other assets in such amounts and from such | 6 | | insurers as it deems desirable. | 7 | | (10) Invest any funds not needed for immediate use or | 8 | | disbursement in obligations issued or guaranteed by the | 9 | | U.S. of America or the State and in obligations that are | 10 | | legal investments for savings banks in the State. | 11 | | (11) Issue bonds, bond anticipation notes, and other | 12 | | obligations of the Exchange for any of its corporate | 13 | | purposes, and to fund or refund the same and provide for | 14 | | the rights of the holders thereof, and to secure the same | 15 | | by pledge of revenues, notes, and mortgages of others. | 16 | | (12) Borrow money for the purpose of obtaining working | 17 | | capital. | 18 | | (13) Account for and audit funds of the Exchange and | 19 | | any recipients of funds from the Exchange. | 20 | | (14) Make and enter into any contract or agreement | 21 | | necessary or
incidental to the performance of its duties | 22 | | and execution of its powers (copies of all contracts of the | 23 | | Exchange shall be maintained by the Exchange as public | 24 | | records, subject to the proprietary rights of any party to | 25 | | the contract). | 26 | | (15) To the extent permitted under its contract with |
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| 1 | | other persons, consent to any termination, modification, | 2 | | forgiveness, or other change of agreement of any kind to | 3 | | which the Exchange is a party. | 4 | | (16) Award grants to Navigators (applications for | 5 | | grants from the Exchange shall be made on a form prescribed | 6 | | by the Board). | 7 | | (17) Limit the number of plans offered, and use | 8 | | selective criteria in determining which plans to offer, | 9 | | through the Exchange, provided
individuals and employers | 10 | | have an adequate number and selection of choices. | 11 | | (18) Sue and be sued, plead and be impleaded. | 12 | | (19) Adopt regular procedures that are not in conflict | 13 | | with other provisions of the general statutes, for | 14 | | exercising the power of the
Exchange. | 15 | | (20) Apply for federal grants to cover the cost | 16 | | associated with setting up the Exchange. | 17 | | (21) Do all acts and things necessary and convenient to | 18 | | carry out the purposes of the Exchange, provided such acts | 19 | | or things shall not conflict with the provisions of the | 20 | | federal Patient Protection and Affordable Care Act, | 21 | | regulations adopted there under, or federal guidance | 22 | | issued pursuant to the federal Patient Protection and | 23 | | Affordable Care Act. | 24 | | (215 ILCS 122/5-12 new) | 25 | | Sec. 5-12. Composition of the Board. |
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| 1 | | (a) The Exchange shall be governed by a Board of Directors | 2 | | comprised as follows: | 3 | | (1) Four ex officio, non-voting members to include: | 4 | | (A) the Director of Insurance or his or her | 5 | | designee with expertise in insurance regulation; | 6 | | (B) the Director of Healthcare and Family Services | 7 | | or his or her designee; | 8 | | (C) the Director of Human Services or his or her | 9 | | designee; and | 10 | | (D) the Director of Public Health or his or her | 11 | | designee. | 12 | | (2) Two members appointed by the Attorney General to | 13 | | include: | 14 | | (A) one attorney with experience with public | 15 | | programs such as Medicaid; and | 16 | | (B) one attorney with experience working with the | 17 | | Attorney General's Health Care Bureau. | 18 | | (3) Seven members appointed by the Governor with the | 19 | | advice and confirmation of the Senate pursuant to | 20 | | subsection (b) of this Section to include: | 21 | | (A) one consumer representative; | 22 | | (B) one small employer representative; | 23 | | (C) one employee representative of a small | 24 | | employer in this State; | 25 | | (D) one certified health actuary or health | 26 | | economist; |
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| 1 | | (E) one representative of the organized labor | 2 | | community in this State; | 3 | | (F) one individual who qualifies for Medicaid | 4 | | under current or expanded Medicaid eligibility rules; | 5 | | and | 6 | | (G) one community-based provider that mainly | 7 | | serves vulnerable individuals living under 200% of the | 8 | | federal poverty level. | 9 | | The Governor shall make the appointments so as to reflect | 10 | | no less than proportional representation of the minority racial | 11 | | composition of the State. | 12 | | (b) All appointments of members to the Board shall be | 13 | | subject to the advice and consent of the Senate pursuant to | 14 | | this Section. Appointments by the Governor pursuant to | 15 | | paragraph (3) of subsection (a) of this Section shall require | 16 | | the advice and consent of a 2/3 vote of the members elected to | 17 | | the Senate. | 18 | | The Senate shall confirm or reject appointments within 30 | 19 | | session days or 60 calendar days after they are submitted by | 20 | | the Governor, whichever occurs first. Except in the case of | 21 | | appointments to fill vacancies, the confirmation time period | 22 | | specified in this Section shall not commence until all | 23 | | appointments required to be made in that year have been | 24 | | submitted by the Governor. | 25 | | (215 ILCS 122/5-13 new) |
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| 1 | | Sec. 5-13. Terms of Board members. | 2 | | (a) Initial members shall be appointed to the Board as | 3 | | follows: 4 members to serve one year, and until their | 4 | | successors are appointed and qualified; 4 members to serve 2 | 5 | | years, and until their successors are appointed and qualified; | 6 | | 6 members to serve 3 years, and until their successors are | 7 | | appointed and qualified; and 3 members to serve 4 years, and | 8 | | until their successors are appointed and qualified. As terms of | 9 | | initial members expire, their successors shall be appointed for | 10 | | terms to expire the first day in July 4 years thereafter, and | 11 | | until their successors are appointed and qualified. Any member | 12 | | is eligible for reappointment. A vacancy on the Board shall be | 13 | | filled for the unexpired portion of the term in the same manner | 14 | | as the original appointment. | 15 | | (b) The Board shall elect a chairperson and a vice | 16 | | chairperson on an annual basis. | 17 | | (c) Appointed Board members may not designate a | 18 | | representative to perform in their absence their respective | 19 | | duties. Meetings of the Board shall be held at such times as | 20 | | shall be specified in the bylaws adopted by the Board and at | 21 | | such other time or times as the chairperson deems necessary. | 22 | | All meetings of the Board shall be conducted in accordance with | 23 | | the Open Meetings Act. The Board must afford an opportunity for | 24 | | public comment at each of its meetings. | 25 | | (d) Any Board member who fails to attend more than 50% of | 26 | | all meetings held during any calendar year shall be deemed to |
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| 1 | | have resigned from the Board. | 2 | | (e) A majority of members appointed shall constitute a | 3 | | quorum for the transaction of any business or the exercise of | 4 | | any power of the Exchange. | 5 | | (f) For the transaction of any business or the exercise of | 6 | | any power of the Exchange, the Exchange may act by a majority | 7 | | of the Board members present at any meeting at which a quorum | 8 | | is in attendance. No vacancy in the membership of the Board | 9 | | shall impair the right of the Board members to exercise all the | 10 | | rights and perform all the duties of the Board. Any action | 11 | | taken by the Board may be authorized by resolution approved by | 12 | | a majority of the Board members present at any regular or | 13 | | special meeting, which resolution shall take effect | 14 | | immediately unless otherwise provided in the resolution. | 15 | | (g) Board members are entitled to receive, from funds of | 16 | | the Board, reimbursement for per diem and travel expenses. No | 17 | | other compensation is authorized. | 18 | | (h) There is no liability on the part of, and no cause of | 19 | | action shall arise against, any member of the Board or its | 20 | | employees or agents for any action taken by them in the | 21 | | performance of their powers and duties under this Law. | 22 | | (i) No Board member shall, for one year after the end of | 23 | | the member's service on the Board, accept employment with any | 24 | | health carrier that offers a qualified health benefit plan | 25 | | through the Exchange. | 26 | | (j) The Board may exercise all powers granted to it |
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| 1 | | necessary to carry out the purposes of this Section, including, | 2 | | but not limited to, the power to receive and accept grants, | 3 | | loans, or advances of funds from any public or private agency | 4 | | and to receive and accept from any source contributions of | 5 | | money, property, labor, or any other thing of value to be held, | 6 | | used, and applied for the purposes of this Section. | 7 | | (k) A member of the Board or of the staff of the Exchange | 8 | | shall not be employed by or be affiliated with a health care | 9 | | provider, a health care facility, a medical clinic, or an | 10 | | insurer, with the exception of health care providers not | 11 | | receiving compensation for rendering services as a provider who | 12 | | do not have an ownership interest in a professional health care | 13 | | practice. | 14 | | (l) The Board shall hire an Executive Director to organize, | 15 | | administer, and manage the operations of the Exchange. The | 16 | | Executive Director shall be responsible for the selection of | 17 | | such other staff as may be authorized by the Board's operating | 18 | | budget as adopted by the Board. The Executive Director shall be | 19 | | exempt from civil service and shall serve at the pleasure of | 20 | | the Board. | 21 | | (m) No employee of the Exchange shall be a member of the | 22 | | Board or an employee of a trade association of (i) insurers, | 23 | | (ii) insurance producers or brokers, (iii) health care | 24 | | providers, or (iv) health care facilities or health or medical | 25 | | clinics while serving on the Board or on the staff of the | 26 | | Exchange. |
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| 1 | | (n) No employee of the Exchange shall, for one year after | 2 | | terminating employment with the Exchange, accept employment | 3 | | with any health carrier that offers a qualified health benefit | 4 | | plan through the Exchange. | 5 | | (o) Any employee of the Exchange who sells, solicits, or | 6 | | negotiates insurance or will sell, solicit, or negotiate | 7 | | insurance to individuals and small employers shall be licensed | 8 | | not later than one year after such employee begins employment | 9 | | with the Exchange. | 10 | | (p) The Exchange has the authority to enter into an | 11 | | agreement with an eligible entity to carry out responsibilities | 12 | | of the Exchange. | 13 | | (q) The Board may establish advisory panels consisting of | 14 | | interested parties, including consumers, health care | 15 | | providers, individuals with expertise in insurance regulation, | 16 | | and insurers. | 17 | | (r) No member of the Board nor employee of the Exchange | 18 | | shall make, participate in making, or in any way attempt to use | 19 | | his or her official position to influence the making of any | 20 | | decision that he or she knows or has any reason to know will | 21 | | have a reasonably foreseeable material financial effect, | 22 | | distinguishable from its effect on the public generally, on him | 23 | | or her or a member of his or her family or on either of the | 24 | | following: | 25 | | (1) any source of income provided to, received by, or | 26 | | promised to a member within 12 months prior to the time |
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| 1 | | when a decision is made; or | 2 | | (2) any business entity in which the member is a | 3 | | director, officer, partner, trustee, or employee or holds | 4 | | any position of management. | 5 | | (s) The Board shall develop and adopt bylaws and other | 6 | | corporate procedures as necessary for the operation of the | 7 | | Board and carrying out the purposes of this Section. The bylaws | 8 | | shall do the following: | 9 | | (1) specify procedures for selection of officers and | 10 | | qualifications for reappointment, provided that no Board | 11 | | member shall serve more than 9 consecutive years; | 12 | | (2) require an annual membership meeting that provides | 13 | | an opportunity for input and interaction with individual | 14 | | participants in the program; and | 15 | | (3) specify policies and procedures regarding | 16 | | conflicts of interest; the policies and procedures shall | 17 | | also require public disclosure of the interest that | 18 | | prevents the member from participating in a decision on a | 19 | | particular matter. | 20 | | (215 ILCS 122/5-14 new) | 21 | | Sec. 5-14. Illinois Health Benefits Exchange Legislative | 22 | | Oversight Committee. | 23 | | (a) There is created an Illinois Health Benefits Exchange | 24 | | Legislative Oversight Committee within the Commission on | 25 | | Government Forecasting and Accountability to provide |
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| 1 | | accountability for the Illinois Health Benefits Exchange and to | 2 | | ensure that Exchange operations and functions align with the | 3 | | goals and duties outlined by this Law. The Committee shall also | 4 | | be responsible for providing policy recommendations to ensure | 5 | | that the Exchange aligns with the Federal Act, amendments to | 6 | | the Federal Act, and regulations promulgated pursuant to the | 7 | | Federal Act. | 8 | | (b) Members of the Legislative Oversight Committee shall be | 9 | | appointed as follows: 3 members of the Senate shall be | 10 | | appointed by the President of the Senate; 3 members of the | 11 | | Senate shall be appointed by the Minority Leader of the Senate; | 12 | | 3 members of the House of Representatives shall be appointed by | 13 | | the Speaker of the House of Representatives; and 3 members of | 14 | | the House of Representatives shall be appointed by the Minority | 15 | | Leader of the House of Representatives. Each legislative leader | 16 | | shall select one member to serve as co-chair of the Committee. | 17 | | (c) Members of the Legislative Oversight Committee shall be | 18 | | appointed within 30 days after the effective date of this | 19 | | amendatory Act of the 97th General Assembly. The co-chairs | 20 | | shall convene the first meeting of the Committee no later than | 21 | | 45 days after the effective date of this Law. | 22 | | (d) The Executive Director of the Exchange must provide | 23 | | updates to the Legislative Oversight Committee in person about | 24 | | the Exchange's progress every quarter for the first 2 years | 25 | | beginning at the start of employment on the Exchange. |
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| 1 | | (215 ILCS 122/5-18 new) | 2 | | Sec. 5-18. Illinois Health Benefit Exchange Fund. There is | 3 | | hereby created as a special fund outside of the State treasury | 4 | | the Illinois Health Benefit Exchange Fund to be used, subject | 5 | | to appropriation, exclusively by the Exchange to provide | 6 | | funding for the operation and administration of the Exchange in | 7 | | carrying out the purposes authorized in this Law.
The Fund | 8 | | shall consist of the following: | 9 | | (1) any user fees or other assessment collected by the | 10 | | Exchange; | 11 | | (2) income from investments made on behalf of the Fund; | 12 | | (3) interest on deposits or investments of money in the | 13 | | Fund; | 14 | | (4) money collected by the Board as a result of legal | 15 | | or other action taken by the Board on behalf of the | 16 | | Exchange or the Fund; | 17 | | (5) money donated to the Fund; | 18 | | (6) money awarded to the Fund through grants; and | 19 | | (7) any other money from any other source accepted for | 20 | | the benefit of the Fund. | 21 | | Any investment earnings of the Fund shall be credited to | 22 | | the Fund. No part of the Fund may revert or be credited to the | 23 | | General Revenue Fund or any special fund in the State Treasury. | 24 | | A debt or an obligation of the Fund is not a debt of the State | 25 | | or a pledge of credit of the State.
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| 1 | | Section 90. The State Finance Act is amended by adding | 2 | | Section 5.809 as follows: | 3 | | (30 ILCS 105/5.809 new) | 4 | | Sec. 5.809. The Illinois Health Benefit Exchange Fund. | 5 | | (215 ILCS 122/5-15 rep.) | 6 | | (215 ILCS 122/5-20 rep.) | 7 | | Section 95. The Illinois Health Benefits Exchange Law is | 8 | | amended by repealing Sections 5-15 and 5-20. | 9 | | Section 97. Severability. The provisions of this Act are | 10 | | severable under Section 1.31 of the Statute on Statutes.
| 11 | | Section 99. Effective date. This Act takes effect upon | 12 | | becoming law.".
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