Full Text of SB2294 102nd General Assembly
SB2294eng 102ND GENERAL ASSEMBLY |
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| 1 | | AN ACT concerning regulation.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | Section 5. The Illinois Insurance Code is amended by | 5 | | changing Section 356z.17 as follows: | 6 | | (215 ILCS 5/356z.17) | 7 | | Sec. 356z.17. Wellness coverage. | 8 | | (a) A group or individual policy of accident and health | 9 | | insurance or managed care plan amended, delivered, issued, or | 10 | | renewed after January 1, 2010 (the effective date of Public | 11 | | Act 96-639) that provides coverage for hospital or medical | 12 | | treatment on an expense incurred basis may offer a reasonably | 13 | | designed program for wellness coverage that allows for a | 14 | | reward, a contribution, a reduction in premiums or reduced | 15 | | medical, prescription drug, or equipment copayments, | 16 | | coinsurance, or deductibles, or a combination of these | 17 | | incentives, for participation in any health behavior wellness, | 18 | | maintenance, or improvement program approved or offered by the | 19 | | insurer or managed care plan. The insured or enrollee may be | 20 | | required to provide evidence of participation in a program. | 21 | | Individuals unable to participate in these incentives due to | 22 | | an adverse health factor shall not be penalized based upon an | 23 | | adverse health status. |
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| 1 | | (b) For purposes of this Section, "wellness coverage" | 2 | | means health care coverage with the primary purpose to engage | 3 | | and motivate the insured or enrollee through: incentives; | 4 | | provision of health education, counseling, and self-management | 5 | | skills; identification of modifiable health risks; and other | 6 | | activities to influence health behavior changes. | 7 | | For the purposes of this Section, "reasonably designed | 8 | | program" means a program of wellness coverage that has a | 9 | | reasonable chance of improving health or preventing disease; | 10 | | is not overly burdensome; does not discriminate based upon | 11 | | factors of health; and is not otherwise contrary to law. | 12 | | (c) Incentives as outlined in this Section are specific | 13 | | and unique to the offering of wellness coverage and have no | 14 | | application to any other required or optional health care | 15 | | benefit. | 16 | | (d) Such wellness coverage must satisfy the requirements | 17 | | for an exception from the general prohibition against | 18 | | discrimination based on a health factor under the federal | 19 | | Health Insurance Portability and Accountability Act of 1996 | 20 | | (P.L. 104-191; 110 Stat. 1936), including any federal | 21 | | regulations that are adopted pursuant to that Act. | 22 | | (e) A plan offering wellness coverage must do the | 23 | | following: | 24 | | (i) give participants the opportunity to qualify for | 25 | | offered incentives at least once a year; | 26 | | (ii) allow a reasonable alternative to any individual |
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| 1 | | for whom it is unreasonably difficult, due to a medical | 2 | | condition, to satisfy otherwise applicable wellness | 3 | | program standards. Plans may seek physician verification | 4 | | that health factors make it unreasonably difficult or | 5 | | medically inadvisable for the participant to satisfy the | 6 | | standards; and | 7 | | (iii) not provide a total incentive that exceeds 30% | 8 | | 20% of the cost of self-only or employee-only coverage , | 9 | | except that the incentive may be increased by up to an | 10 | | additional 20%, for a total incentive of 50%, to the | 11 | | extent that the additional percentage is in connection | 12 | | with a program designed to prevent or reduce tobacco use . | 13 | | The cost of employee-only or family coverage provided | 14 | | through group health insurance coverage includes both | 15 | | employer and employee contributions. For group or | 16 | | individual plans offering family coverage, the 20% | 17 | | limitation applies to cost of family coverage and applies | 18 | | to the entire family. | 19 | | (f) A reward, contribution, or reduction established under | 20 | | this Section and included in the policy or certificate does | 21 | | not violate Section 151 of this Code.
| 22 | | (Source: P.A. 96-639, eff. 1-1-10; 96-833, eff. 6-1-10 .) | 23 | | Section 10. The Navigator Certification Act is amended by | 24 | | changing Sections 5, 10, 15, 30, 35, and 45 as follows: |
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| 1 | | (215 ILCS 121/5)
| 2 | | Sec. 5. Definitions.
As used in this Act: | 3 | | "Certified application counselor" has the same meaning as | 4 | | in federal regulations and guidelines , including 45 CFR | 5 | | 155.225 . | 6 | | "Director" means the Director of Insurance. | 7 | | "Exchange" means any health benefit exchange established | 8 | | or operating in this State, including any exchange established | 9 | | or operated by the United States Department of Health and | 10 | | Human Services. | 11 | | "Navigator" means a person or entity selected to perform | 12 | | the activities and duties identified in 42 U.S.C. 18031(i) in | 13 | | this State. "Navigator" includes any person or entity who | 14 | | receives grant funds from the United States Department of | 15 | | Health and Human Services, the State of Illinois, or an | 16 | | exchange or private funds to perform any of the activities and | 17 | | duties identified in 42 U.S.C. 18031(i), including, but not | 18 | | limited to, in-person assisters as defined by federal | 19 | | regulations or guidelines.
| 20 | | (Source: P.A. 98-524, eff. 8-23-13.) | 21 | | (215 ILCS 121/10)
| 22 | | Sec. 10. Certificate required.
| 23 | | (a) No individual or entity shall perform, offer to | 24 | | perform, or advertise any service as a navigator or certified | 25 | | application counselor in this State or receive navigator grant |
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| 1 | | funding from the United States Department of Health and Human | 2 | | Services, the State of Illinois, or an exchange or private | 3 | | funds unless certified as a navigator or certified application | 4 | | counselor by the Director under this Act. | 5 | | (b) The Director may establish exemptions from | 6 | | certification by rule. A navigator who complies with the | 7 | | requirements of this Act
shall do the following: | 8 | | (1) conduct public education activities to raise | 9 | | awareness of the availability of qualified health plans; | 10 | | (2) distribute fair and impartial information | 11 | | concerning enrollment in qualified health plans offered | 12 | | within the exchange and the availability of the premium | 13 | | tax credits under Section 36B of the Internal Revenue Code | 14 | | of 1986, 26 U.S.C. 36B, and cost-sharing reductions under | 15 | | Section 1402 of the federal Patient Protection and | 16 | | Affordable Care Act; | 17 | | (3) facilitate enrollment in qualified health plans; | 18 | | (4) provide referrals to appropriate federal and State | 19 | | agencies for any enrollee with a grievance, complaint, or | 20 | | question regarding their health plan or coverage or a | 21 | | determination under such plan or coverage; | 22 | | (5) provide information in a manner that is culturally | 23 | | and linguistically appropriate to the needs of the | 24 | | population being served by the exchange. | 25 | | (c) A navigator or certified application counselor may | 26 | | not: |
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| 1 | | (1) sell, solicit, or negotiate, as these terms are | 2 | | defined in Section 500-10 of the Illinois Insurance Code, | 3 | | any of the classes of insurance enumerated in Section 4 of | 4 | | the Illinois Insurance Code; | 5 | | (2) offer advice about which health plan is better or | 6 | | worse for a particular individual or employer; | 7 | | (3) recommend or endorse a particular health plan or | 8 | | advise consumers about which health plan to choose; | 9 | | (4) provide any information or services related to | 10 | | health benefit plans or other insurance products not | 11 | | offered in the exchange, except for health care providers | 12 | | when furnishing information or services related to a | 13 | | patient's existing health benefit plan or other existing | 14 | | health insurance coverage; or | 15 | | (5) accept any compensation or consideration, directly | 16 | | or indirectly, from any issuer of accident and health | 17 | | insurance or stop-loss insurance that is dependent, in | 18 | | whole or in part, on whether a person enrolls in or | 19 | | purchases a particular private health benefit plan ; or . | 20 | | (6) engage in an unfair method of competition or a | 21 | | fraudulent, deceptive, or dishonest act or practice with | 22 | | respect to the health insurance marketplace or with | 23 | | respect to that individual's or entity's absence of a | 24 | | conflict of interest in connection with the enrollment of | 25 | | an individual or employee in a particular private health | 26 | | benefit plan. |
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| 1 | | (d) Items (1), (2), (3), (4), and (5) of subsection (c) of | 2 | | this Section do not apply to navigators or certified | 3 | | application counselors when assisting individuals with the | 4 | | enrollment process in the State Medicaid program or other | 5 | | public programs.
| 6 | | (Source: P.A. 98-524, eff. 8-23-13.) | 7 | | (215 ILCS 121/15)
| 8 | | Sec. 15. Application for certificate.
| 9 | | (a) An entity or individual applying for an initial or | 10 | | renewal a navigator or certified application counselor | 11 | | certificate shall make application to the Director on a form | 12 | | developed by the Director and declare under penalty of | 13 | | refusal, suspension, or revocation of the certificate that the | 14 | | statements made in the application are true, correct, and | 15 | | complete to the best of the individual's or entity's knowledge | 16 | | and belief. Before approving the application, the Director | 17 | | shall find that the individual: | 18 | | (1) is at least 18 years of age; | 19 | | (2) resides in this State or maintains his or her | 20 | | principal place of business in this State; | 21 | | (3) is not disqualified due to having committed any | 22 | | act that would be grounds for denial, suspension, or | 23 | | revocation of a navigator certification in accordance with | 24 | | Section 30 of this Act; | 25 | | (4) has successfully completed the federal and State |
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| 1 | | training provided by the exchange or equivalent State | 2 | | requirements as determined by the Department; and | 3 | | (5) when applicable, has the written consent of the | 4 | | Director pursuant to 18 U.S.C. 1033, or any successor | 5 | | statute regulating crimes by or affecting persons engaged | 6 | | in the business of insurance whose activities affect | 7 | | interstate commerce. | 8 | | (b) The Director shall establish certification terms and | 9 | | requirements for completed applications, including educational | 10 | | requirements, by rule. An entity that acts as a navigator, | 11 | | supervises the activities of individual navigators, or | 12 | | receives funding to perform such activities shall obtain a | 13 | | navigator entity certificate. An entity applying for a | 14 | | navigator entity certificate shall make application on a form | 15 | | containing the information prescribed by the Director and | 16 | | shall list the individuals acting as navigators under the | 17 | | entity certificate. | 18 | | (1) The entity shall designate a certified navigator | 19 | | responsible for the navigator entity's compliance with the | 20 | | laws of this State and the exchange. | 21 | | (2) The entity, under penalty of revocation, | 22 | | suspension, or other discipline prescribed by the | 23 | | Director, shall certify that each individual completes the | 24 | | mandatory training required by item (4) of subsection (a) | 25 | | of Section 15 of this Act. | 26 | | (c) The Director may require any documents deemed |
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| 1 | | necessary to verify the information contained in an | 2 | | application submitted in accordance with subsections (a) and | 3 | | (b) of this Section. | 4 | | (d) Any navigator or certified application counselor who | 5 | | fails to timely file for certificate renewal shall be charged | 6 | | a late fee in an amount prescribed by the Director Entities | 7 | | certified as navigators shall provide the Director with a list | 8 | | of all individual navigators that it employs, supervises, or | 9 | | is affiliated with at renewal . | 10 | | (e) The Director may require, in a manner determined by | 11 | | the Director, that each entity that acts as a navigator or | 12 | | certified application counselor demonstrate a level of | 13 | | financial responsibility capable of protecting all persons | 14 | | against the wrongful acts, misrepresentations, or negligence | 15 | | of the navigator or certified application counselor . | 16 | | (f) Prior to any exchange becoming operational in this | 17 | | State, the Director, in coordination with the exchange, shall | 18 | | prescribe the initial training and continuing education | 19 | | requirements for navigators and certified application | 20 | | counselors .
| 21 | | (g) Certificate holders must inform the Director, in | 22 | | writing, of a change of address within 30 days after the | 23 | | change. | 24 | | (h) In order to assist in the performance of the | 25 | | Director's duties, the Director may contract with the National | 26 | | Association of Insurance Commissioners (NAIC), or any |
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| 1 | | affiliates or subsidiaries that the NAIC oversees, to perform | 2 | | any ministerial functions, including the collection of fees, | 3 | | related to certification that the Director and the | 4 | | nongovernmental entity may deem appropriate.
| 5 | | (Source: P.A. 98-524, eff. 8-23-13.) | 6 | | (215 ILCS 121/30)
| 7 | | Sec. 30. Certificate denial, nonrenewal, or revocation.
| 8 | | (a) The Director may place on probation, suspend, revoke, | 9 | | or refuse to issue or renew a navigator or certified | 10 | | application counselor navigator's certificate or may levy a | 11 | | civil penalty as established by rule. | 12 | | (b) If an action by the Director is to nonrenew, suspend, | 13 | | or revoke a certificate or to deny an application for a | 14 | | certificate, then the Director shall notify the applicant or | 15 | | certificate holder and advise, in writing, the applicant or | 16 | | certificate holder of the reason for the suspension, | 17 | | revocation, or denial or nonrenewal of the applicant's or | 18 | | certificate holder's certificate. The applicant or certificate | 19 | | holder may make written demand upon the Director within 30 | 20 | | days after the date of mailing for a hearing before the | 21 | | Director to determine the reasonableness of the Director's | 22 | | action. The hearing must be held within not fewer than 20 days | 23 | | nor more than 30 days after the mailing of the notice of | 24 | | hearing and shall be held pursuant to Part 2402 of Title 50 of | 25 | | the Illinois Administrative Code . |
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| 1 | | (c) A navigator or certified application counselor entity | 2 | | certificate may be suspended, revoked, or refused or | 3 | | information turned over to the U.S. Department of Health and | 4 | | Human Services and applicable state agencies if the Director | 5 | | finds, after hearing, that a certified individual's violation | 6 | | was known or should have been known by one or more of the | 7 | | partners, officers, or managers acting on behalf of the | 8 | | navigator entity. | 9 | | (d) In addition to or instead of any applicable denial, | 10 | | suspension, or revocation of a certificate, a person may, | 11 | | after hearing, be subject to a civil penalty in accordance | 12 | | with emergency rules issued by the Director. | 13 | | (e) The Director has the authority to enforce the | 14 | | provisions of and impose any penalty or remedy authorized by | 15 | | this Act against any person who is under investigation of or | 16 | | charged with a violation of this Act or rules, even if the | 17 | | person's certificate has been surrendered or has lapsed by | 18 | | operation of law. | 19 | | (f) Upon the suspension, denial, or revocation of a | 20 | | certificate, the certificate holder or other person having | 21 | | possession or custody of the certificate shall promptly | 22 | | deliver it to the Director in person or by mail. The Director | 23 | | shall publish all suspensions, denials, or revocations after | 24 | | the suspensions, denials, or revocations become final in a | 25 | | manner designed to notify the public. | 26 | | (g) A person whose certificate is revoked or whose |
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| 1 | | application is denied pursuant to this Section is ineligible | 2 | | to apply for any certificate for 3 years after the revocation | 3 | | or denial. A person whose certificate as a navigator or | 4 | | certified application counselor has been revoked, suspended, | 5 | | or denied may not be employed, contracted, or engaged in an | 6 | | exchange-related capacity during the time the revocation, | 7 | | suspension, or denial is in effect.
| 8 | | (Source: P.A. 98-524, eff. 8-23-13.) | 9 | | (215 ILCS 121/35)
| 10 | | Sec. 35. Reporting to the Director.
| 11 | | (a) Each navigator or certified application counselor | 12 | | shall report to the Director within 30 calendar days after the | 13 | | final disposition of a matter that violates the provisions set | 14 | | forth in this Act that results in any administrative action | 15 | | taken against the navigator or certified application counselor | 16 | | him in another jurisdiction or by another governmental agency | 17 | | in this State. The report shall include a copy of the order, | 18 | | consent to order, or other relevant legal documents. | 19 | | (b) Within 30 days after the initial pretrial hearing | 20 | | date, a navigator or certified application counselor shall | 21 | | report to the Director any criminal prosecution of the | 22 | | navigator or certified application counselor of a matter that | 23 | | violates the provisions set forth in this Act taken in any | 24 | | jurisdiction. The report shall include a copy of the initial | 25 | | complaint filed, the order resulting from the hearing, and any |
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| 1 | | other relevant legal documents. | 2 | | (c) An entity that is certified acts as a navigator or | 3 | | certified application counselor that terminates the | 4 | | employment, engagement, affiliation, or other relationship | 5 | | with an individual navigator or certified application | 6 | | counselor shall notify the Director within 30 days following | 7 | | the effective date of the termination, using a format | 8 | | prescribed by the Director, if the reason for termination is | 9 | | related to the requirements or standards one of the reasons | 10 | | set forth in this Act or the rules adopted by the Director | 11 | | pursuant to this Act, or the entity has knowledge the | 12 | | navigator or certified application counselor was found by a | 13 | | court or government body to have engaged in any of the | 14 | | activities prohibited by this Act or the rules adopted by the | 15 | | Director pursuant to this Act . Upon the written request of the | 16 | | Director, the entity shall provide additional information, | 17 | | documents, records, or other data pertaining to the | 18 | | termination or activity of the individual.
| 19 | | (Source: P.A. 98-524, eff. 8-23-13.) | 20 | | (215 ILCS 121/45)
| 21 | | Sec. 45. Other laws; rulemaking authority.
| 22 | | (a) The requirements of this Act shall not apply to any | 23 | | individual or entity licensed as an insurance producer in this | 24 | | State. | 25 | | (b) Pursuant to the authority granted by this Act, the |
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| 1 | | Director may adopt rules as may be necessary or appropriate | 2 | | for the administration and enforcement of this Act.
Such rules | 3 | | may not conflict with or prevent the application of the | 4 | | provisions of Title I of the Patient Protection and Affordable | 5 | | Care Act or the federal regulations promulgated under such | 6 | | provisions.
| 7 | | (Source: P.A. 98-524, eff. 8-23-13.) | 8 | | (215 ILCS 121/20 rep.) | 9 | | (215 ILCS 121/25 rep.) | 10 | | (215 ILCS 121/40 rep.) | 11 | | Section 15. The Navigator Certification Act is amended by | 12 | | repealing Sections 20, 25, and 40.
| 13 | | Section 99. Effective date. This Act takes effect upon | 14 | | becoming law.
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| 1 | |
INDEX
| 2 | |
Statutes amended in order of appearance
| | 3 | | 215 ILCS 5/356z.17 | | | 4 | | 215 ILCS 121/5 | | | 5 | | 215 ILCS 121/10 | | | 6 | | 215 ILCS 121/15 | | | 7 | | 215 ILCS 121/30 | | | 8 | | 215 ILCS 121/35 | | | 9 | | 215 ILCS 121/45 | | | 10 | | 215 ILCS 121/20 rep. | | | 11 | | 215 ILCS 121/25 rep. | | | 12 | | 215 ILCS 121/40 rep. | |
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