Full Text of SB2364 99th General Assembly
SB2364eng 99TH 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 Personnel Code is amended by adding Section | 5 | | 26 as follows: | 6 | | (20 ILCS 415/26 new) | 7 | | Sec. 26. Transfers. Personnel employed by the Illinois | 8 | | Comprehensive Health Insurance Plan transferred to the | 9 | | Department of Insurance on January 1, 2017 pursuant to this | 10 | | amendatory Act of the 99th General Assembly, upon completion of | 11 | | the probationary period, shall receive certified status under | 12 | | this Code. | 13 | | Section 10. The Department of Insurance Law of the
Civil | 14 | | Administrative Code of Illinois is amended by adding Section | 15 | | 1405-40 as follows: | 16 | | (20 ILCS 1405/1405-40 new) | 17 | | Sec. 1405-40. Transfer of the Illinois Comprehensive | 18 | | Health Insurance Plan. On January 1, 2017, all powers, duties, | 19 | | rights, and responsibilities of the Illinois Comprehensive | 20 | | Health Insurance Plan and the Illinois Comprehensive Health | 21 | | Insurance Board under the Comprehensive Health Insurance Plan |
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| 1 | | Act shall be transferred to the Director of Insurance as | 2 | | provided in Section 17 of the Comprehensive Health Insurance | 3 | | Plan Act. | 4 | | Section 15. The Comprehensive Health Insurance Plan Act is | 5 | | amended by changing Sections 1.1, 3, and 15 and by adding | 6 | | Sections 16, 17, and 18 as follows:
| 7 | | (215 ILCS 105/1.1) (from Ch. 73, par. 1301.1)
| 8 | | Sec. 1.1.
The General Assembly hereby makes the following | 9 | | findings and
declarations:
| 10 | | (a) The Comprehensive Health Insurance Plan is | 11 | | established as a State
program that is intended to provide
| 12 | | an alternate market for health insurance for certain | 13 | | uninsurable Illinois
residents, and further is intended to | 14 | | provide an
acceptable alternative mechanism as described | 15 | | in the federal Health Insurance
Portability and | 16 | | Accountability Act of 1996 for providing portable and
| 17 | | accessible individual health insurance coverage for | 18 | | federally eligible
individuals as defined in this Act.
| 19 | | (b) The State of Illinois may subsidize the cost of | 20 | | health insurance
coverage offered by the Plan. However, | 21 | | since the State
has only a limited amount of
resources, the | 22 | | General Assembly declares that it intends for this program | 23 | | to
provide portable and accessible individual health | 24 | | insurance coverage for every
federally eligible individual |
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| 1 | | who qualifies for coverage in accordance with
Section 15 of | 2 | | this Act, but does not intend for every
eligible person who | 3 | | qualifies for Plan coverage in accordance with Section 7
of | 4 | | this Act to be guaranteed a right to be issued a policy | 5 | | under
this
Plan as a matter of entitlement.
| 6 | | (c) The Comprehensive Health Insurance Plan Board | 7 | | shall operate the Plan
in a manner so that the estimated | 8 | | cost of the program during
any fiscal year will not exceed | 9 | | the total income it expects to receive from
policy | 10 | | premiums, investment income, assessments, or fees | 11 | | collected or
received
by the Board and other funds which | 12 | | are made available from
appropriations for the Plan by
the | 13 | | General Assembly for that fiscal year. | 14 | | With the implementation of the federal Patient Protection | 15 | | and Affordable Care Act, the Plan shall discontinue as the | 16 | | alternative market for health insurance for certain | 17 | | uninsurable Illinois residents and discontinue as the | 18 | | alternative mechanism, as described in the federal Health | 19 | | Insurance Portability and Accountability Act of 1996, | 20 | | effective no later than January 1, 2017.
| 21 | | (Source: P.A. 90-30, eff. 7-1-97.)
| 22 | | (215 ILCS 105/3) (from Ch. 73, par. 1303)
| 23 | | Sec. 3. Operation of the Plan.
| 24 | | a. There is hereby created an Illinois Comprehensive Health | 25 | | Insurance Plan.
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| 1 | | b. The Plan shall operate subject to the supervision and | 2 | | control of
the board. The board is created as a political | 3 | | subdivision and body
politic and corporate and, as such, is not | 4 | | a State agency. The board shall
consist of 10 public members, | 5 | | appointed by the Governor with the
advice and consent of the | 6 | | Senate.
| 7 | | Initial members shall be appointed to the Board by the | 8 | | Governor as
follows: 2 members to serve until July 1, 1988, and | 9 | | until their successors
are appointed and qualified; 2 members | 10 | | to serve until July 1, 1989, and
until their successors are | 11 | | appointed and qualified; 3 members to serve
until July 1, 1990, | 12 | | and until their successors are appointed and qualified;
and 3 | 13 | | members to serve until July 1, 1991, and until their successors | 14 | | are
appointed and qualified. As terms of initial members | 15 | | expire, their
successors shall be appointed for terms to expire | 16 | | the first day in July 3
years thereafter, and until their | 17 | | successors are appointed and qualified.
| 18 | | Any vacancy in the Board occurring for any reason other | 19 | | than the
expiration of a term shall be filled for the unexpired | 20 | | term in the same
manner as the original appointment.
| 21 | | Any member of the Board may be removed by the Governor for | 22 | | neglect of
duty, misfeasance, malfeasance, or nonfeasance in | 23 | | office.
| 24 | | In addition, a representative of the
Governor's Office of | 25 | | Management and Budget, a representative of the Office
of the | 26 | | Attorney General and the Director or the Director's designated
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| 1 | | representative shall be members of the board. Four members of | 2 | | the General
Assembly, one each appointed by the President and | 3 | | Minority Leader of the
Senate and by the Speaker and Minority | 4 | | Leader of the House of
Representatives, shall serve as | 5 | | nonvoting members of the board. At least
2 of the public | 6 | | members shall be individuals reasonably expected to qualify
for | 7 | | coverage under the Plan, the parent or spouse of such an
| 8 | | individual, or a surviving family member of an individual who | 9 | | could have
qualified for the plan during his lifetime. The | 10 | | Director or Director's
representative shall be the chairperson | 11 | | of the board. Members of the board
shall receive no | 12 | | compensation, but shall be reimbursed for reasonable
expenses | 13 | | incurred in the necessary performance of their duties.
| 14 | | c. The board shall make an annual report in September and
| 15 | | shall file the report with the Secretary of the Senate and the | 16 | | Clerk of
the House of Representatives. The report shall | 17 | | summarize the activities of
the Plan in the preceding calendar | 18 | | year, including net written and earned
premiums, the expense of | 19 | | administration, the paid and incurred
losses for the year and | 20 | | other information as may be requested by the
General Assembly. | 21 | | The report shall also include analysis and
recommendations | 22 | | regarding utilization review, quality assurance and access
to | 23 | | cost effective quality health care.
| 24 | | d. In its plan of operation the board shall:
| 25 | | (1) Establish procedures for selecting a plan | 26 | | administrator in
accordance with Section 5 of this Act.
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| 1 | | (2) Establish procedures for the operation of the | 2 | | board.
| 3 | | (3) Create a Plan fund, under management of the board, | 4 | | to fund
administrative, claim, and other expenses of the | 5 | | Plan.
| 6 | | (4) Establish procedures for the handling and | 7 | | accounting of assets and
monies of the Plan.
| 8 | | (5) Develop and implement a program to publicize the | 9 | | existence of the
Plan, the eligibility requirements and | 10 | | procedures for enrollment and to
maintain public awareness | 11 | | of the Plan.
| 12 | | (6) Establish procedures under which applicants and | 13 | | participants may have
grievances reviewed by a grievance | 14 | | committee appointed by the board. The
grievances shall be | 15 | | reported to the board immediately after completion of
the | 16 | | review. The Department and the board shall retain all | 17 | | written
complaints regarding the Plan for at least 3 years. | 18 | | Oral complaints
shall be reduced to written form and | 19 | | maintained for at least 3 years.
| 20 | | (7) Provide for other matters as may be necessary and | 21 | | proper for
the execution of its powers, duties and | 22 | | obligations under the Plan.
| 23 | | e. No later than 5 years after the Plan is operative the | 24 | | board and
the Department shall conduct cooperatively a study of | 25 | | the Plan and the
persons insured by the Plan to determine: (1) | 26 | | claims experience including a
breakdown of medical conditions |
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| 1 | | for which claims were paid; (2) whether
availability of the | 2 | | Plan affected employment opportunities for
participants; (3) | 3 | | whether availability of the Plan affected the receipt of
| 4 | | medical assistance benefits by Plan participants; (4) whether a | 5 | | change
occurred in the number of personal bankruptcies due to | 6 | | medical or other
health related costs; (5) data regarding all | 7 | | complaints received about the
Plan including its operation and | 8 | | services; (6) and any other significant
observations regarding | 9 | | utilization of the Plan. The study shall culminate
in a written | 10 | | report to be presented to the Governor, the President of the
| 11 | | Senate, the Speaker of the House and the chairpersons of the | 12 | | House and
Senate Insurance Committees. The report shall be | 13 | | filed with the
Secretary of the Senate and the Clerk of the | 14 | | House of Representatives. The
report shall also be available to | 15 | | members of the general public upon request.
| 16 | | (e-5) The board shall conduct a feasibility study of | 17 | | establishing a small employer health insurance pool in which | 18 | | employers may provide affordable health insurance coverage to | 19 | | their employees. The board may contract with a private entity | 20 | | or enter into intergovernmental agreements with State agencies | 21 | | for the completion of all or part of the study. The study | 22 | | shall: | 23 | | (i) Analyze other states' experience in establishing | 24 | | small employer health
insurance pools; | 25 | | (ii) Assess the need for a small employer health | 26 | | insurance pool, including the number of individuals who |
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| 1 | | might benefit from it; | 2 | | (iii) Recommend means of establishing a small employer | 3 | | health insurance pool; and | 4 | | (iv) Estimate the cost of providing a small employer | 5 | | health insurance pool through the Illinois Comprehensive | 6 | | Health Insurance Plan or another, public or private entity. | 7 | | The board may accept donations, in trust, from any legal | 8 | | source, public or private, for deposit into a trust account | 9 | | specifically created for expenditure, without the necessity of | 10 | | being appropriated, solely for the purpose of conducting all or | 11 | | part of the study.
The board shall issue a report with | 12 | | recommendations to the Governor and the General Assembly by | 13 | | January 1, 2005.
As used in this subsection e-5, "small | 14 | | employer" means an employer having between one and 50 | 15 | | employees.
| 16 | | f. The board may:
| 17 | | (1) Prepare and distribute certificate of eligibility | 18 | | forms and
enrollment instruction forms to insurance | 19 | | producers and to the general
public in this State.
| 20 | | (2) Provide for reinsurance of risks incurred by the | 21 | | Plan and enter into
reinsurance agreements with insurers to | 22 | | establish a reinsurance plan for
risks of coverage | 23 | | described in the Plan, or obtain commercial reinsurance
to | 24 | | reduce the risk of loss through the Plan.
| 25 | | (3) Issue additional types of health insurance | 26 | | policies to provide
optional coverages as are otherwise |
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| 1 | | permitted by this Act including a
Medicare supplement | 2 | | policy designed to supplement Medicare.
| 3 | | (4) Provide for and employ cost containment measures | 4 | | and requirements
including, but not limited to, | 5 | | preadmission certification, second surgical
opinion, | 6 | | concurrent utilization review programs, and individual | 7 | | case
management for the purpose of making the pool more | 8 | | cost effective.
| 9 | | (5) Design, utilize, contract, or otherwise arrange | 10 | | for the
delivery of cost effective health care services, | 11 | | including establishing or
contracting with preferred | 12 | | provider organizations, health maintenance organizations, | 13 | | and other limited network
provider
arrangements.
| 14 | | (6) Adopt bylaws, rules, regulations, policies and | 15 | | procedures as
may be necessary or convenient for the | 16 | | implementation of the Act and the
operation of the Plan.
| 17 | | (7) Administer separate pools, separate accounts, or | 18 | | other plans or
arrangements as required by this Act to | 19 | | separate federally eligible
individuals or groups of | 20 | | federally eligible individuals who qualify for plan
| 21 | | coverage under Section 15 of this Act from eligible persons | 22 | | or groups of
eligible persons who qualify for plan coverage | 23 | | under Section 7 of this Act and
apportion the costs of the
| 24 | | administration among such separate pools, separate | 25 | | accounts, or other plans or
arrangements.
| 26 | | g. The Director may, by rule, establish additional powers |
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| 1 | | and duties of
the board and may adopt rules for any other | 2 | | purposes, including the
operation of the Plan, as are necessary | 3 | | or proper to implement this Act.
| 4 | | h. The board is not liable for any obligation of the Plan. | 5 | | There is no
liability on the part of any member or employee of | 6 | | the board or the
Department, and no cause of action of any | 7 | | nature may arise against them,
for any action taken or omission | 8 | | made by them in the performance of their
powers and duties | 9 | | under this Act, unless the action or omission
constitutes | 10 | | willful or wanton misconduct. The board may provide in its
| 11 | | bylaws or rules for indemnification of, and legal | 12 | | representation for, its
members and employees.
| 13 | | i. There is no liability on the part of any insurance | 14 | | producer for the
failure of any applicant to be accepted by the | 15 | | Plan unless the failure of
the applicant to be accepted by the | 16 | | Plan is due to an act or omission by
the insurance producer | 17 | | which constitutes willful or wanton misconduct.
| 18 | | j. On or before June 30, 2016, the Board shall develop a | 19 | | dissolution plan to wind down the affairs of the Plan for | 20 | | presentation to and approval by the Director, who shall begin | 21 | | to administer and oversee the dissolution and wind-down plan on | 22 | | the effective date of this amendatory Act of the 99th General | 23 | | Assembly in accordance with Article XIII of the Illinois | 24 | | Insurance Code. | 25 | | (Source: P.A. 92-597, eff. 6-28-02; 93-622, eff. 12-18-03; | 26 | | 93-824, eff. 7-28-04.)
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| 1 | | (215 ILCS 105/15)
| 2 | | Sec. 15. Alternative portable coverage for federally | 3 | | eligible individuals.
| 4 | | (a) Notwithstanding the requirements of subsection a. of | 5 | | Section 7 and
except as otherwise provided in this Section, any
| 6 | | federally eligible individual for whom a Plan
application, and | 7 | | such enclosures and supporting documentation as the Board may
| 8 | | require, is received by the Board within 90 days after the
| 9 | | termination of prior
creditable coverage shall qualify to | 10 | | enroll in the Plan under the
portability provisions of this | 11 | | Section.
| 12 | | A federally eligible person who has
been certified as | 13 | | eligible pursuant to the federal Trade
Act of 2002
and whose | 14 | | Plan application and enclosures and supporting
documentation | 15 | | as the Board may require is received by the Board within 63 | 16 | | days
after the termination of previous creditable coverage | 17 | | shall qualify to enroll
in the Plan under the portability | 18 | | provisions of this Section.
| 19 | | (b) Any federally eligible individual seeking Plan | 20 | | coverage under this
Section must submit with his or her | 21 | | application evidence, including acceptable
written | 22 | | certification of previous creditable coverage, that will | 23 | | establish to
the Board's satisfaction, that he or she meets all | 24 | | of the requirements to be a
federally eligible individual and | 25 | | is currently and
permanently residing in this State (as of the |
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| 1 | | date his or her application was
received by the Board).
| 2 | | (c) Except as otherwise provided in this Section, a period | 3 | | of creditable
coverage shall not be counted, with respect to
| 4 | | qualifying an applicant for Plan coverage as a federally | 5 | | eligible individual
under this Section, if after such period | 6 | | and before the application for Plan
coverage was received by | 7 | | the Board, there was at least a 90 day
period during
all of | 8 | | which the individual was not covered under any creditable | 9 | | coverage.
| 10 | | For a federally eligible person who has
been certified as | 11 | | eligible
pursuant to the federal Trade Act of 2002, a period of | 12 | | creditable
coverage shall not be counted, with respect to | 13 | | qualifying an applicant for Plan
coverage as a federally | 14 | | eligible individual under this Section, if after such
period | 15 | | and before the application for Plan coverage was received by | 16 | | the Board,
there was at
least a 63 day period during all of | 17 | | which the individual was not covered under
any creditable | 18 | | coverage.
| 19 | | (d) Any federally eligible individual who the Board | 20 | | determines qualifies for
Plan coverage under this Section shall | 21 | | be offered his or her choice of
enrolling in one of alternative | 22 | | portability health benefit plans which the
Board
is authorized | 23 | | under this Section to establish for these federally eligible
| 24 | | individuals
and their dependents.
| 25 | | (e) The Board shall offer a choice of health care coverages | 26 | | consistent with
major medical coverage under the alternative |
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| 1 | | health benefit plans authorized by
this Section to every | 2 | | federally eligible individual.
The coverages to be offered | 3 | | under the plans, the schedule of
benefits, deductibles, | 4 | | co-payments, exclusions, and other limitations shall be
| 5 | | approved by the Board. One optional form of coverage shall be | 6 | | comparable to
comprehensive health insurance coverage offered | 7 | | in the individual market in
this State or a standard option of | 8 | | coverage available under the group or
individual health | 9 | | insurance laws of the State. The standard benefit plan that
is
| 10 | | authorized by Section 8 of this Act may be used for this | 11 | | purpose. The Board
may also offer a preferred provider option | 12 | | and such other options as the Board
determines may be | 13 | | appropriate for these federally eligible individuals who
| 14 | | qualify for Plan coverage pursuant to this Section.
| 15 | | (f) Notwithstanding the requirements of subsection f. of | 16 | | Section 8, any
plan coverage
that is issued to federally | 17 | | eligible individuals who qualify for the Plan
pursuant
to the | 18 | | portability provisions of this Section shall not be subject to | 19 | | any
preexisting conditions exclusion, waiting period, or other | 20 | | similar limitation
on coverage.
| 21 | | (g) Federally eligible individuals who qualify and enroll | 22 | | in the Plan
pursuant
to this Section shall be required to pay | 23 | | such premium rates as the Board shall
establish and approve in | 24 | | accordance with the requirements of Section 7.1 of
this Act.
| 25 | | (h) A federally eligible individual who qualifies and | 26 | | enrolls in the Plan
pursuant to this Section must satisfy on an |
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| 1 | | ongoing basis all of the other
eligibility requirements of this | 2 | | Act to the extent not inconsistent with the
federal Health | 3 | | Insurance Portability and Accountability Act of 1996 in order | 4 | | to
maintain continued eligibility
for coverage under the Plan.
| 5 | | (i) New enrollment and policy renewals are discontinued on | 6 | | December 31, 2016. | 7 | | (Source: P.A. 97-333, eff. 8-12-11.)
| 8 | | (215 ILCS 105/16 new) | 9 | | Sec. 16. Cessation of operations. | 10 | | (a) Except as otherwise provided in this Section, the | 11 | | insurance operations of the Plan authorized by this Act shall | 12 | | cease on December 31, 2016. | 13 | | (b) Coverage under the Plan does not apply to services
| 14 | | provided on or after January 1, 2017. | 15 | | (c) The Plan shall cease providing coverage for | 16 | | participants enrolled prior to January 1, 2017 at 11:59 p.m. on | 17 | | December 31, 2016. | 18 | | (d) A claim for payment under the Plan must be submitted
| 19 | | within 180 days after January 1, 2017 and paid within 180 days
| 20 | | after receipt. | 21 | | (e) Any grievance shall be resolved by the Board not
later | 22 | | than October 31, 2017. | 23 | | (f) Balance billing by a health care
provider that is not a | 24 | | member of the provider network
used by the Plan is prohibited. | 25 | | (g) The Board shall, not later than June 30, 2016,
submit |
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| 1 | | to the Director a plan of dissolution,
which must provide for, | 2 | | but shall not be limited to, the following: | 3 | | (1) Continuity of care for an individual who is covered
| 4 | | under the Plan and is an inpatient on January 1, 2017. | 5 | | (2) A final accounting of assessments. | 6 | | (3) Resolution of any net asset deficiency. | 7 | | (4) Cessation of all liability of the Plan. | 8 | | (5) Final dissolution of the Plan. | 9 | | (h) The plan of dissolution may provide that, with the
| 10 | | approval of the Director, a power or duty of the Plan may be | 11 | | delegated to a person that is to perform functions similar to | 12 | | the functions of the Plan. | 13 | | (i) An action by or against the Plan must be filed no later | 14 | | than January 1, 2019. | 15 | | (j) Upon completion of the dissolution plan and final | 16 | | satisfaction of all claims under and administrative expenses of | 17 | | the dissolution plan, a proportional share of any remaining | 18 | | General Revenue Fund and insurer assessments contributed to the | 19 | | Plan shall be returned to the General Revenue Fund and assessed | 20 | | insurers in accordance with the distribution provisions | 21 | | contained in Section 210 of the Illinois Insurance Code. | 22 | | (215 ILCS 105/17 new) | 23 | | Sec. 17. Transfer of the Illinois Comprehensive Health | 24 | | Insurance Plan. | 25 | | (a) On January 1, 2017, all powers, duties, rights, and |
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| 1 | | responsibilities of the Plan and the Board shall be transferred | 2 | | to the Director, who is authorized to wind down the affairs of | 3 | | the Plan in accordance with Article XIII of the Illinois | 4 | | Insurance Code. | 5 | | (b) The Director shall act on behalf of the Plan and the | 6 | | Board and shall have the power and duty to receive and answer | 7 | | correspondence and pay any claims due and owing from any | 8 | | unencumbered funds, including refunds, and, for claims | 9 | | remaining unpaid as of July 1, 2018, refer unpaid vendors to | 10 | | the Court of Claims and arrange for the orderly termination of | 11 | | any affairs of the Plan and the Board that remain unresolved. | 12 | | (c) All books, records, papers, documents, property (real | 13 | | and personal), contracts, causes of action, and pending | 14 | | business pertaining to the powers, duties, rights, and | 15 | | responsibilities transferred by this amendatory Act of the 99th | 16 | | General Assembly from the Plan and the Board to the Director, | 17 | | including, but not limited to, material in electronic or | 18 | | magnetic format and necessary computer hardware and software, | 19 | | shall be transferred to the Director. Records shall be | 20 | | maintained as required by the federal Health Insurance | 21 | | Portability and Accountability Act, as now or hereafter | 22 | | amended. | 23 | | (d) The personnel of the Plan and the Board shall be | 24 | | transferred to the Department. The rights of the employees in | 25 | | the State of Illinois and its agencies under the Personnel Code | 26 | | and applicable collective bargaining agreements or under any |
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| 1 | | pension, retirement, or annuity plan shall not be affected by | 2 | | this amendatory Act of the 99th General Assembly. | 3 | | (e) All unexpended appropriations and balances and other | 4 | | funds available for use by the Plan and the Board shall be | 5 | | transferred for use by the Director. Unexpended balances so | 6 | | transferred shall be expended for the purpose for which the | 7 | | appropriations were originally made or for paying the | 8 | | Director's administrative expenses incurred in connection with | 9 | | winding down the affairs of the Plan in accordance with Article | 10 | | XIII of the Illinois Insurance Code. | 11 | | (f) Whenever reports or notices are, on the effective date | 12 | | of this amendatory Act of the 99th General Assembly, required | 13 | | to be made or given or papers or documents furnished or served | 14 | | by any person to or upon the Plan or the Board in connection | 15 | | with any of the powers,
duties, rights, and responsibilities | 16 | | transferred by this amendatory Act of the 99th General | 17 | | Assembly, the same shall be made, given, furnished, or served | 18 | | in the same manner to or upon the Director. | 19 | | (g) This amendatory Act of the 99th General Assembly does | 20 | | not affect any act done, ratified, or canceled or any right | 21 | | occurring or established or any action or proceeding had or | 22 | | commenced in the administrative, civil, or criminal cause by | 23 | | the Plan or the Board prior to January 1, 2017; such actions or | 24 | | proceedings may be prosecuted and continued by the Director. | 25 | | (h) The Board shall continue to exist within the Department | 26 | | to provide guidance and recommendations to the Director |
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| 1 | | relating to the wind down of operations and affairs of the Plan | 2 | | and shall retain the power and responsibility to review | 3 | | grievances pursuant to this Act. The Board shall cease to exist | 4 | | upon final dissolution of the Plan or December 31, 2018, | 5 | | whichever occurs first. | 6 | | (215 ILCS 105/18 new) | 7 | | Sec. 18. Repealer. This Act is repealed on January 1, 2019.
| 8 | | Section 99. Effective date. This Act takes effect upon | 9 | | becoming law. |
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