Public Act 093-0824
 		





HB4478 Enrolled
LRB093 19548 SAS 45288 b






    AN ACT concerning insurance.

 
    Be it enacted by the People of the State of Illinois,
 
represented in the General Assembly:


 
    Section 5. The Comprehensive Health Insurance Plan Act is 
amended  by changing Section 3 as follows:
 
    (215 ILCS 105/3)  (from Ch. 73, par. 1303)

    Sec. 3. Operation of the Plan.


    a. There is hereby created an Illinois Comprehensive Health 
Insurance Plan.


    b. The Plan shall operate subject to the supervision and 
control of
the board.  The board is created as a political 
subdivision and body
politic and corporate and, as such, is not 
a State agency.  The board shall
consist of 10 public members, 
appointed by the Governor with the
advice and consent of the 
Senate.


    Initial members shall be appointed to the Board by the 
Governor as
follows: 2 members to serve until July 1, 1988, and 
until their successors
are appointed and qualified; 2 members 
to serve until July 1, 1989, and
until their successors are 
appointed and qualified; 3 members to serve
until July 1, 1990, 
and until their successors are appointed and qualified;
and 3 
members to serve until July 1, 1991, and until their successors 
are
appointed and qualified. As terms of initial members 
expire, their
successors shall be appointed for terms to expire 
the first day in July 3
years thereafter, and until their 
successors are appointed and qualified.


    Any vacancy in the Board occurring for any reason other 
than the
expiration of a term shall be filled for the unexpired 
term in the same
manner as the original appointment.


    Any member of the Board may be removed by the Governor for 
neglect of
duty, misfeasance, malfeasance, or nonfeasance in 
office.


    In addition, a representative of the
Governor's Office of 
Management and Budget, a representative of the Office
of the 
Attorney General and the Director or the Director's designated

representative shall be members of the board.  Four members of 
the General
Assembly, one each appointed by the President and 
Minority Leader of the
Senate and by the Speaker and Minority 
Leader of the House of
Representatives, shall serve as 
nonvoting members of the board.  At least
2 of the public 
members shall be individuals reasonably expected to qualify
for 
coverage under the Plan, the parent or spouse of such an

individual, or a surviving family member of an individual who 
could have
qualified for the plan during his lifetime. The 
Director or Director's
representative shall be the chairperson 
of the board.  Members of the board
shall receive no 
compensation, but shall be reimbursed for reasonable
expenses 
incurred in the necessary performance of their duties.


    c. The board shall make an annual report in September and

shall file the report with the Secretary of the Senate and the 
Clerk of
the House of Representatives.  The report shall 
summarize the activities of
the Plan in the preceding calendar 
year, including net written and earned
premiums, the expense of 
administration, the paid and incurred
losses for the year and 
other information as may be requested by the
General Assembly. 
The report shall also include analysis and
recommendations 
regarding utilization review, quality assurance and access
to 
cost effective quality health care.


    d. In its plan of operation the board shall:


        (1) Establish procedures for selecting a plan 
    administrator in
accordance with Section 5 of this Act.


        (2) Establish procedures for the operation of the 
    board.


        (3) Create a Plan fund, under management of the board, 
    to fund
administrative, claim, and other expenses of the 
    Plan.


        (4) Establish procedures for the handling and 
    accounting of assets and
monies of the Plan.


        (5) Develop and implement a program to publicize the 
    existence of the
Plan, the eligibility requirements and 
    procedures for enrollment and to
maintain public awareness 
    of the Plan.


        (6) Establish procedures under which applicants and 
    participants may have
grievances reviewed by a grievance 
    committee appointed by the board.  The
grievances shall be 
    reported to the board immediately after completion of
the 
    review.  The Department and the board shall retain all 
    written
complaints regarding the Plan for at least 3 years.  
    Oral complaints
shall be reduced to written form and 
    maintained for at least 3 years.


        (7) Provide for other matters as may be necessary and 
    proper for
the execution of its powers, duties and 
    obligations under the Plan.


    e. No later than 5 years after the Plan is operative the 
board and
the Department shall conduct cooperatively a study of 
the Plan and the
persons insured by the Plan to determine: (1) 
claims experience including a
breakdown of medical conditions 
for which claims were paid; (2) whether
availability of the 
Plan affected employment opportunities for
participants; (3) 
whether availability of the Plan affected the receipt of

medical assistance benefits by Plan participants; (4) whether a 
change
occurred in the number of personal bankruptcies due to 
medical or other
health related costs; (5) data regarding all 
complaints received about the
Plan including its operation and 
services; (6) and any other significant
observations regarding 
utilization of the Plan.  The study shall culminate
in a written 
report to be presented to the Governor, the President of the

Senate, the Speaker of the House and the chairpersons of the 
House and
Senate Insurance Committees.  The report shall be 
filed with the
Secretary of the Senate and the Clerk of the 
House of Representatives.  The
report shall also be available to 
members of the general public upon request.


    (e-5) The board shall conduct a feasibility study of 
establishing a small employer health insurance pool in which 
employers may provide affordable health insurance coverage to 
their employees. The board may contract with a private entity 
or enter into intergovernmental agreements with State agencies 
for the completion of all or part of the study. The study 
shall:
        (i) Analyze other states' experience in establishing 
    small employer health
insurance pools;
        (ii) Assess the need for a small employer health 
    insurance pool, including the number of individuals who 
    might benefit from it;
        (iii) Recommend means of establishing a small employer 
    health insurance pool; and
        (iv) Estimate the cost of providing a small employer 
    health insurance pool through the Illinois Comprehensive 
    Health Insurance Plan or another, public or private entity.
    The board may accept donations, in trust, from any legal 
source, public or private, for deposit into a trust account 
specifically created for expenditure, without the necessity of 
being appropriated, solely for the purpose of conducting all or 
part of the study.
The board shall issue a report with 
recommendations to the Governor and the General Assembly by 
January 1, 2005.
As used in this subsection e-5, "small 
employer" means an employer having between one and 50 
employees.

    f. The board may:


        (1) Prepare and distribute certificate of eligibility 
    forms and
enrollment instruction forms to insurance 
    producers and to the general
public in this State.


        (2) Provide for reinsurance of risks incurred by the 
    Plan and enter into
reinsurance agreements with insurers to 
    establish a reinsurance plan for
risks of coverage 
    described in the Plan, or obtain commercial reinsurance
to 
    reduce the risk of loss through the Plan.


        (3) Issue additional types of health insurance 
    policies to provide
optional coverages as are otherwise 
    permitted by this Act including a
Medicare supplement 
    policy designed to supplement Medicare.


        (4) Provide for and employ cost containment measures 
    and requirements
including, but not limited to, 
    preadmission certification, second surgical
opinion, 
    concurrent utilization review programs, and individual 
    case
management for the purpose of making the pool more 
    cost effective.


        (5) Design, utilize, contract, or otherwise arrange 
    for the
delivery of cost effective health care services, 
    including establishing or
contracting with preferred 
    provider organizations, health maintenance organizations, 
    and other limited network
provider
arrangements.


        (6) Adopt bylaws, rules, regulations, policies and 
    procedures as
may be necessary or convenient for the 
    implementation of the Act and the
operation of the Plan.


        (7) Administer separate pools, separate accounts, or 
    other plans or
arrangements as required by this Act to 
    separate federally eligible
individuals or groups of 
    federally eligible individuals who qualify for plan

    coverage under Section 15 of this Act from eligible persons 
    or groups of
eligible persons who qualify for plan coverage 
    under Section 7 of this Act and
apportion the costs of the

    administration among such separate pools, separate 
    accounts, or other plans or
arrangements.


    g. The Director may, by rule, establish additional powers 
and duties of
the board and may adopt rules for any other 
purposes, including the
operation of the Plan, as are necessary 
or proper to implement this Act.


    h. The board is not liable for any obligation of the Plan.  
There is no
liability on the part of any member or employee of 
the board or the
Department, and no cause of action of any 
nature may arise against them,
for any action taken or omission 
made by them in the performance of their
powers and duties 
under this Act, unless the action or omission
constitutes 
willful or wanton misconduct. The board may provide in its

bylaws or rules for indemnification of, and legal 
representation for, its
members and employees.


    i. There is no liability on the part of any insurance 
producer for the
failure of any applicant to be accepted by the 
Plan unless the failure of
the applicant to be accepted by the 
Plan is due to an act or omission by
the insurance producer 
which constitutes willful or wanton misconduct.


(Source: P.A. 92-597, eff. 6-28-02; 93-622, eff. 12-18-03.)

 

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