215 ILCS 122/ Illinois Health Benefits Exchange Law.

(215 ILCS 122/Art. 5 heading) ARTICLE 5. ILLINOIS HEALTH BENEFITS EXCHANGE (Source: P.A. 97-142, eff. 7-14-11.)

(215 ILCS 122/5-1)

Sec. 5-1. Short title. This Article may be cited as the Illinois Health Benefits Exchange Law.

(Source: P.A. 97-142, eff. 7-14-11.)

(215 ILCS 122/5-3)

Sec. 5-3. Legislative intent. The General Assembly finds the health benefits exchanges authorized by the federal Patient Protection and Affordable Care Act represent one of a number of ways in which the State can address coverage gaps and provide individual consumers and small employers access to greater coverage options. The General Assembly also finds that the State is best positioned to implement an exchange that is sensitive to the coverage gaps and market landscape unique to this State.

The purpose of this Law is to ensure that the State is making sufficient progress towards establishing an exchange within the guidelines outlined by the federal law and to protect Illinoisans from undue federal regulation. Although the federal law imposes a number of core requirements on state-level exchanges, the State has significant flexibility in the design and operation of a State exchange that make it prudent for the State to carefully analyze, plan, and prepare for the exchange. The General Assembly finds that in order for the State to craft a tenable exchange that meets the fundamental goals outlined by the Patient Protection and Affordable Care Act of expanding access to affordable coverage and improving the quality of care, the implementation process should (1) provide for broad stakeholder representation; (2) foster a robust and competitive marketplace, both inside and outside of the exchange; and (3) provide for a broad-based approach to the fiscal solvency of the exchange.

(Source: P.A. 97-142, eff. 7-14-11.)

(215 ILCS 122/5-5)

(Text of Section before amendment by P.A. 103-650)

Sec. 5-5. State health benefits exchange. It is declared that this State, beginning October 1, 2013, in accordance with Section 1311 of the federal Patient Protection and Affordable Care Act, shall establish a State health benefits exchange to be known as the Illinois Health Benefits Exchange in order to help individuals and small employers with no more than 50 employees shop for, select, and enroll in qualified, affordable private health plans that fit their needs at competitive prices. The Exchange shall separate coverage pools for individuals and small employers and shall supplement and not supplant any existing private health insurance market for individuals and small employers. The Department of Insurance shall operate the Illinois Health Benefits Exchange as a State-based exchange using the federal platform by plan year 2025 and as a State-based exchange by plan year 2026. The Director of Insurance may require that all plans in the individual and small group markets, other than grandfathered health plans, be made available for comparison on the Illinois Health Benefits Exchange, but may not require that all plans in the individual and small group markets be purchased exclusively on the Illinois Health Benefits Exchange. Through the adoption of rules, the Director of Insurance may require that plans offered on the exchange conform with standardized plan designs that provide for standardized cost sharing for covered health services. Except when it is inconsistent with State law, the Department of Insurance shall enforce the coverage requirements under the federal Patient Protection and Affordable Care Act, including the coverage of all United States Preventive Services Task Force Grade A and B preventive services without cost sharing notwithstanding any federal overturning or repeal of 42 U.S.C. 300gg-13(a)(1), that apply to the individual and small group markets. The Director of Insurance may elect to add a small business health options program to the Illinois Health Benefits Exchange to help small employers enroll their employees in qualified health plans in the small group market. The General Assembly shall appropriate funds to establish the Illinois Health Benefits Exchange.

(Source: P.A. 103-103, eff. 6-27-23.)

(Text of Section after amendment by P.A. 103-650)

Sec. 5-5. State health benefits exchange. It is declared that this State, beginning October 1, 2013, in accordance with Section 1311 of the federal Patient Protection and Affordable Care Act, shall establish a State health benefits exchange to be known as the Illinois Health Benefits Exchange in order to help individuals and small employers with no more than 50 employees shop for, select, and enroll in qualified, affordable private health plans that fit their needs at competitive prices. The Exchange shall separate coverage pools for individuals and small employers and shall supplement and not supplant any existing private health insurance market for individuals and small employers. The Department of Insurance shall operate the Illinois Health Benefits Exchange as a State-based exchange using the federal platform by plan year 2025 and as a State-based exchange by plan year 2026. The Director of Insurance may require that all plans in the individual and small group markets, other than grandfathered health plans, be made available for comparison on the Illinois Health Benefits Exchange, but may not require that all plans in the individual and small group markets be purchased exclusively on the Illinois Health Benefits Exchange. Through the adoption of rules, the Director of Insurance may require that plans offered on the exchange conform with standardized plan designs that provide for standardized cost sharing for covered health services. Except when it is inconsistent with State law, the Department of Insurance shall enforce the coverage requirements under the federal Patient Protection and Affordable Care Act, including the coverage of all United States Preventive Services Task Force Grade A and B preventive services without cost sharing notwithstanding any federal overturning or repeal of 42 U.S.C. 300gg-13(a)(1), that apply to the individual and small group markets. Beginning for plan year 2026, if a health insurance issuer offers a product as defined under 45 CFR 144.103 at the gold or silver level through the Illinois Health Benefits Exchange, the issuer must offer that product at both the gold and silver levels. The Director of Insurance may elect to add a small business health options program to the Illinois Health Benefits Exchange to help small employers enroll their employees in qualified health plans in the small group market. The General Assembly shall appropriate funds to establish the Illinois Health Benefits Exchange.

(Source: P.A. 103-103, eff. 6-27-23; 103-650, eff. 1-1-25.)

(215 ILCS 122/5-10)

Sec. 5-10. Exchange functions.

(a) The Illinois Health Benefits Exchange shall meet the core functions identified by Section 1311 of the Patient Protection and Affordable Care Act and subsequent federal guidance and regulations.

(b) In order to meet the deadline of October 1, 2013 established by federal law to have operational a State exchange, the Department of Insurance and the Commission on Government Forecasting and Accountability is authorized to apply for, accept, receive, and use as appropriate for and on behalf of the State any grant money provided by the federal government and to share federal grant funding with, give support to, and coordinate with other agencies of the State and federal government or third parties as determined by the Governor.

(Source: P.A. 97-142, eff. 7-14-11; 98-756, eff. 7-16-14.)

(215 ILCS 122/5-15)

Sec. 5-15. Illinois Health Benefits Exchange Legislative Study Committee.

(a) There is created an Illinois Health Benefits Exchange Legislative Study Committee to conduct a study regarding State implementation and establishment of the Illinois Health Benefits Exchange.

(b) Members of the Legislative Study Committee shall be appointed as follows: 3 members of the Senate shall be appointed by the President of the Senate; 3 members of the Senate shall be appointed by the Minority Leader of the Senate; 3 members of the House of Representatives shall be appointed by the Speaker of the House of Representatives; and 3 members of the House of Representatives shall be appointed by the Minority Leader of the House of Representatives. Each legislative leader shall select one member to serve as co-chair of the committee.

(c) Members of the Legislative Study Committee shall be appointed within 30 days after the effective date of this Law. The co-chairs shall convene the first meeting of the committee no later than 45 days after the effective date of this Law.

(Source: P.A. 97-142, eff. 7-14-11.)

(215 ILCS 122/5-20)

Sec. 5-20. Committee study. No later than September 30, 2011, the Committee shall report all findings concerning the implementation and establishment of the Illinois Health Benefits Exchange to the executive and legislative branches, including, but not limited to, (1) the governance and structure of the Exchange, (2) financial sustainability of the Exchange, and (3) stakeholder engagement, including an ongoing role for the Legislative Study Committee or other legislative oversight of the Exchange. The Committee shall report its findings with regard to (A) the operating model of the Exchange, (B) the size of the employers to be offered coverage through the Exchange, (C) coverage pools for individuals and businesses within the Exchange, and (D) the development of standards for the coverage of full-time and part-time employees and their dependents. The Committee study shall also include recommendations concerning prospective action on behalf of the General Assembly as it relates to the establishment of the Exchange in 2011, 2012, 2013, and 2014.

(Source: P.A. 97-142, eff. 7-14-11.)

(215 ILCS 122/5-21)

Sec. 5-21. Monthly assessments.

(a) The Director of Insurance may apply a monthly assessment to each health benefits plan sold on the Illinois Health Benefits Exchange. The assessment shall be paid by the issuer and to the Department of Insurance and shall be used only for the purpose of supporting the exchange through exchange operations, outreach, and enrollment, including any efforts that may result in a benefit to policyholders. The assessment may be applied at a rate of:

(1) 0.5% of the total monthly premium charged by an issuer for each health benefits plan during any period that the State is on a State-based exchange using the federal platform; or

(2) 2.75% of the total monthly premium charged by an issuer for each health benefits plan during any period that the State is on the State-based exchange. The Director of Insurance shall adjust this rate to ensure that the Illinois Health Benefits Exchange is fully funded, but in no case shall the assessment be applied at a rate that exceeds 3.5% of the total monthly premium charged by a carrier. If the Director determines it is necessary to adjust the rate pursuant to this paragraph, the Director shall, in advance of the adjustment, post on the Department's website a report describing the reasons and justifications for the adjustment, which shall be consistent with the purposes of supporting the Illinois Health Benefits Exchange as provided in this Section, at least 120 days before the implementation of the rate adjustment.

(b) The Director of Insurance shall notify an issuer 120 days before the implementation of its assessment rate for the subsequent year. Issuers must remit the assessment due in monthly installments to the Department of Insurance.

(c) The assessment described in this Section shall be considered a special purpose obligation and may not be applied by issuers to vary premium rates at the plan level.

(d) There is created a special fund within the State treasury to be known as the Illinois Health Benefits Exchange Fund. The Illinois Health Benefits Exchange Fund shall be the repository for moneys collected pursuant to fees or assessments on exchange issuers, federal financial participation as appropriate, and other moneys received as grants or otherwise appropriated for the purposes of supporting health insurance outreach, enrollment efforts, and plan management operations through an exchange. All moneys in the Fund shall be used, subject to appropriation, only for the purpose of supporting the exchange through exchange operations, outreach, enrollment, and other means of supporting the exchange, including any efforts that may result in a benefit to policyholders.

(Source: P.A. 103-103, eff. 6-27-23.)

(215 ILCS 122/5-22)

Sec. 5-22. State medical assistance program coordination.

(a) The Department of Insurance and the Department of Healthcare and Family Services shall coordinate the operations of the exchange with the operations of State medical assistance programs. The Department of Healthcare and Family Services shall oversee and operate the exchange eligibility rules engine to ensure accurate assessments and determinations of exchange and State medical assistance program eligibility.

(b) The exchange may determine eligibility for State medical assistance programs that use the modified adjusted gross income methodology.

(c) The exchange may be used for enrollment into State medical assistance program health plans.

(d) The Department of Healthcare and Family Services shall request federal financial participation funds from the Centers for Medicare and Medicaid Services for any integrated eligibility and enrollment functions of the exchange.

(Source: P.A. 103-103, eff. 6-27-23.)

(215 ILCS 122/5-23)

Sec. 5-23. Department of Insurance and Department of Healthcare and Family Services authority.

(a) The Department of Insurance and the Department of Healthcare and Family Services, in addition to the powers granted under the Illinois Insurance Code and the Illinois Public Aid Code, have the power necessary to establish and operate the Illinois Health Benefits Exchange, including, but not limited to, the authority to:

(1) adopt rules deemed necessary by the departments to implement this Law;

(2) employ or retain sufficient personnel to provide administration, staffing, and necessary related support required to adequately discharge the duties described in this Law from funds held in the Illinois Health Benefits Exchange Fund;

(3) procure services, including a call center, and goods for the purpose of establishing the Illinois Health Benefits Exchange, including, but not limited to, procurements in conformance with paragraph (22) of subsection (b) of Section 1-10 of the Illinois Procurement Code; and

(4) require any exchange vendor to have experience operating a State-based exchange in another state.

(b) The Department of Insurance has the authority to employ a Marketplace Director of the Illinois Health Benefits Exchange.

(Source: P.A. 103-103, eff. 6-27-23.)

(215 ILCS 122/5-24)

Sec. 5-24. Illinois Health Benefits Exchange Advisory Committee.

(a) The Director of Insurance shall establish the Illinois Health Benefits Exchange Advisory Committee no later than December 31, 2023. The Illinois Health Benefits Exchange Advisory Committee shall be tasked with making recommendations to the Marketplace Director of the Illinois Health Benefits Exchange concerning the operation of the exchange, and the Committee shall hold its first meeting no later than 90 days following the establishment of the Committee and shall meet quarterly thereafter. The Marketplace Director shall make a quarterly report to the Committee.

(b) The Department of Insurance shall present regular and timely reports to the Illinois Health Benefits Exchange Advisory Committee regarding the progress in the development and ongoing operations of the Illinois Health Benefits Exchange before its establishment by plan year 2026. The reports shall be posted to the Department of Insurance's website and include information on the Department of Insurance's progress toward establishing and maintaining the Illinois Health Benefits Exchange with the goal of ensuring an effective and efficient transition from the federal platform to the State-based exchange for individuals, employers, and health insurance issuers while mitigating loss of health insurance coverage for any potential consumer. The Department of Insurance's progress reports shall provide information including, but not limited to, transparency, user understandability, plan compliance, outreach and education, systems operations, and annual fiscal projections. The Department of Insurance shall gather stakeholder input in developing operational plans and preparing the reports for the Illinois Health Benefits Exchange Advisory Committee.

(c) The Illinois Health Benefits Exchange Advisory Committee shall include the following members:

(1) the Director of Insurance, or the Director's designee, who shall serve ex officio and as co-chair;

(2) the Director of Healthcare and Family Services, or the Director's designee, who shall serve ex officio and as co-chair;

(3) the Secretary of Human Services, or the Secretary's designee, who shall serve ex officio; and

(4) 10 public members, who shall be residents of this State, appointed by the Governor with the advice and consent of the Senate. The Governor may make temporary appointments until the next meeting of the Senate. The Governor shall consider the diversity of this State in the selection of the committee members. The public members shall include:

(A) one representative of a statewide organization representing a majority of Illinois hospitals;

(B) one representative of a statewide insurance producer professional trade association whose membership is primarily composed of individuals licensed under the Illinois Insurance Code;

(C) 2 representatives of a health insurance consumer advocacy group;

(D) one representative with expertise in enrollment and consumer assistance;

(E) 2 representatives of health insurance issuers or issuer trade associations, at least one of which represents a State-domiciled mutual health insurance company, with a demonstrated expertise in the business of health insurance or health benefits administration;

(F) one representative of a statewide association representing small business owners;

(G) one representative of a statewide organization representing physicians; and

(H) one academic or research professional with expertise in health insurance.

(d) Members of the Illinois Health Benefits Exchange Advisory Committee shall serve for a term of 2 years, shall serve without compensation, and shall not be entitled to reimbursement. The Department of Insurance shall provide administrative support to the Illinois Health Benefits Exchange Advisory Committee.

(e) The Committee's quarterly meetings shall be open to the public and subject to the Open Meetings Act.

(Source: P.A. 103-103, eff. 6-27-23.)

(215 ILCS 122/5-25)

Sec. 5-25. Federal action. This Law shall be null and void if Congress and the President take action to repeal or replace, or both, Section 1311 of the Affordable Care Act.

(Source: P.A. 97-142, eff. 7-14-11.)

(215 ILCS 122/5-30)

(Section scheduled to be repealed on January 1, 2026)

Sec. 5-30. Transfers from Insurance Producer Administration Fund.

(a) During fiscal year 2024 only, at the direction of and upon notification from the Director of Insurance, the State Comptroller shall direct and the State Treasurer shall transfer up to a total of $10,000,000 from the Insurance Producer Administration Fund to the Illinois Health Benefits Exchange Fund.

(b) During fiscal year 2025 only, at the direction of and upon notification from the Director of Insurance, the State Comptroller shall direct and the State Treasurer shall transfer up to a total of $15,500,000 from the Insurance Producer Administration Fund to the Illinois Health Benefits Exchange Fund.

(c) This Section is repealed on January 1, 2026.

(Source: P.A. 103-8, eff. 6-7-23; 103-588, eff. 6-5-24.)

(215 ILCS 122/Art. 10 heading) ARTICLE 10. HEALTH SAVINGS ACCOUNT (The State Employee Health Savings Account Law is compiled at 5 ILCS 377/)(Source: P.A. 97-142, eff. 7-14-11.)

(215 ILCS 122/Art. 90 heading) ARTICLE 90. AMENDATORY PROVISIONS (Amendatory provisions; text omitted)(Source: P.A. 97-142, eff. 7-14-11; text omitted.)

(215 ILCS 122/Art. 99 heading) ARTICLE 99. EFFECTIVE DATE (Source: P.A. 97-142, eff. 7-14-11.)

(215 ILCS 122/99)

Section 99. Effective date. This Act takes effect upon becoming law.

(Source: P.A. 97-142, eff. 7-14-11.)