il-v50i40-50-ill-adm-code-4500: 50 Ill. Adm. Code 4500 — Illinois Health Benefits Exchange

1) Heading of the Part: Illinois Health Benefits Exchange 2) Code Citation: 50 Ill. Adm. Code 4500 3) Section Number: Proposed Action: 4500.140 Amendment 4) Statutory Authority: Implementing Sections 5-5, 5-10, 5-21, and 5-23 of the Illinois Health Benefits Exchange Law [215 ILCS 122], Sections 50 and 90 of the Grant Accountability and Transparency Act [30 ILCS 708], and 42 U.S.C. 18031, and authorized by Section 50 of the Grant Accountability and Transparency Act, Section 401 of the Illinois Insurance Code [215 ILCS 5], Section 10-10 of the Illinois Administrative Procedure Act [5 ILCS 100] and Section 5-23 of the Illinois Health Benefits Exchange Law. 5) A Complete Description of the Subjects and Issues Involved: This rulemaking is filed pursuant to Section 5-15 of the Illinois Administrative Procedure Act and is only changing the address of the Department's Springfield Office to reflect the fact that the office is moving on September 23, 2026. Section 5-15 of the Illinois Administrative Procedure Act requires agencies to include a statement of how the proposed rule made under this Section satisfies the criteria established by subsections (a) and (b). The Department's address is used by the public to obtain information from the Department and/or make submissions or requests of the Department. These members of the public may include insurance companies, persons licensed by the Department, and Illinois insurance consumers. The address provided in the rules should be accurate, otherwise such persons may go to or send correspondence to the wrong address. The decision to relocate the Springfield office was an internal management decision. The private rights of individuals are not affected by Department rules containing the accurate address, although having the incorrect address in rule will cause unnecessary confusion and delay for people seeking information from and/or making submissions to the Department in person or via mail. It is in the public interest to have the Department's office address published in the Illinois Administrative Code be correct. 6) Published studies or reports, and sources of underlying data, used to compose this rulemaking: Not required for Section 5-15 notices. 7) Will this proposed rulemaking replace an emergency rule currently in effect? Not required for Section 5-15 notices. 8) Does this rulemaking contain an automatic repeal date? Not required for Section 5-15 notices. 9) Does this proposed amendment contain incorporations by reference? Not required for Section 5-15 notices. 10) Are there any other proposed rulemakings pending on this Part? No 11) Statement of Statewide Policy Objectives: Not required for Section 5-15 notices. 12) Time, Place, and Manner in which interested persons may comment on this proposed rulemaking: Persons who wish to comment on this proposed rulemaking may submit written comments no later than 14 days after the publication of this Notice to: Kathryn Williams Department of Insurance th 115 S. LaSalle Street, 13 Floor Chicago IL, 60603 (312) 814-8212 Kathryn.A.Williams@illinois.gov 13) Initial Regulatory Flexibility Analysis: Not required for Section 5-15 notices. A) Description of the type of small business, not for profit corporations or small municipalities subject to the proposed amendment: None B) Description of the proposed reporting, bookkeeping and other procedures required for compliance with the amendment: None C) Description of the types of professional skills necessary for compliance: None 14) Small Business Economic Impact Analysis: Not required for Section 5-15 notices. 15) Regulatory Agenda on which this rulemaking was summarized: Not required for Section 5-15 notices. DEPARTMENT OF INSURANCE NOTICE OF PROPOSED AMENDMENT 16) Any other information or justification for the proposed rule or amendment that the agency believes would be helpful to the public regarding the proposed rule or amendment. For example, a discussion or analysis of the benefits of the proposed rule or amendment is projected to have on the Illinois public, consumers, investors or other similar groups. Not required for Section 5-15 notices. The full text of the Proposed Amendment begins on the next page: DEPARTMENT OF INSURANCE NOTICE OF PROPOSED AMENDMENT TITLE 50: INSURANCE CHAPTER I: DEPARTMENT OF INSURANCE SUBCHAPTER ww: HEALTH CARE SERVICE PLANS PART 4500 ILLINOIS HEALTH BENEFITS EXCHANGE Section 4500.10 Purpose 4500.20 Applicability 4500.30 Definitions 4500.40 QHP Issuer Certification 4500.50 QHP Recertification 4500.60 Non-certification of QHPs 4500.70 QHP Decertification 4500.80 Plan Suppression 4500.90 Minimum QHP Certification Standards 4500.100 Illinois SHOP 4500.110 Compliance Reviews of QHP Issuers 4500.120 Standards for QHP Issuers in Specific Types of Exchanges 4500.130 Casework Standards 4500.140 State Awards for Navigators and In-Person Counselor Organizations, and Certifications for Certified Application Counselor Organizations and Certified Application Counselors 4500.150 Agent and Broker Standards for Assisting with Enrollment in QHPs 4500.160 Cultural, Linguistic, and Accessibility Standards 4500.170 QHP Eligibility and Enrollment 4500.180 Annual Open Enrollment and Special Enrollment Periods 4500.190 Eligibility and Special Rules on Advanced Payments of the Premium Tax Credit and Cost-Sharing Reductions 4500.200 Termination of Coverage and Grace Periods 4500.210 Plan Formulary Information 4500.220 Illinois Exchange User Fee 4500.230 Eligibility Appeals AUTHORITY: Implementing Sections 5-5, 5-10, 5-21, and 5-23 of the Illinois Health Benefits Exchange Law [215 ILCS 122], Sections 50 and 90 of the Grant Accountability and Transparency Act [30 ILCS 708], and 42 U.S.C. 18031, and authorized by Section 50 of the Grant Accountability and Transparency Act, Section 401 of the Illinois Insurance Code [215 DEPARTMENT OF INSURANCE NOTICE OF PROPOSED AMENDMENT ILCS 5], Section 10-10 of the Illinois Administrative Procedure Act [5 ILCS 100] and Section 5- 23 of the Illinois Health Benefits Exchange Law. SOURCE: Adopted at 48 Ill. Reg. 12312, effective August 1, 2024; amended at 49 Ill. Reg. 420, effective December 26, 2024; amended at 49 Ill. Reg. 14672, effective October 28, 2025; amended at 50 Ill. Reg. ______, effective ____________. Section 4500.140 State Awards for Navigators and In-Person Counselor Organizations, and Certifications for Certified Application Counselor Organizations and Certified Application Counselors a) The Exchange will offer State awards for Navigators and certifications to Certified Application Counselor Organizations. The Exchange may elect to offer State awards for In-Person Counselors. The Exchange may delegate the administration of its agreements, certifications, or State awards under this Section to an eligible entity as allowed under 45 CFR 155.110(a) through (b) (Mar. 27, 2012) (no later editions or amendments). b) As required by Section 50 of GATA, for all State awards under this Part, the Exchange hereby incorporates by reference 2 CFR 200, Subparts A through F and Appendices I through XII as those provisions of the Code of Federal Regulations were in effect on July 1, 2025 (no later editions or amendments). 1) The terminology equivalences listed at 44 Ill. Adm. Code 7000.200(b)(1) apply to the incorporation of 2 CFR 200. 2) Copies of the materials incorporated by reference are available for inspection at the Illinois Department of Insurance, 4800 Wabash Ave.320 West Washington Street, Floor 4, Springfield, Illinois 6271162767 and online via the U.S. Government Publishing Office at http://www.ecfr.gov. 3) The Exchange or its designee may submit a request for specific exceptions or exemptions from GATA. Those exceptions or exemptions granted by the Grant Accountability and Transparency Unit within the Illinois Governor's Office of Management and Budget will be recorded in the Catalog of State Financial Assistance. This subsection (b)(3) does not apply when different provisions are required by State or federal law. DEPARTMENT OF INSURANCE NOTICE OF PROPOSED AMENDMENT c) To receive, renew, or maintain a State award as a Navigator or In-Person Counselor, an entity or individual must: 1) for Navigators, meet the criteria in 45 CFR 155.210(c)(1) (Apr. 27, 2023) (no later editions or amendments), including having an active certification from the Department under 50 Ill. Adm. Code 4515; 2) for In-Person Counselors, have an active certification from the Department under 50 Ill. Adm. Code 4515; 3) comply with the applicable conflict-of-interest standards in 45 CFR 155.215(a) (Apr. 25, 2019) (no later editions or amendments); 4) not engage in any conduct or hold any status prohibited under 45 CFR 155.210(d); 5) comply with the applicable cultural, linguistic, and accessibility standards in Section 4500.160(b); 6) enter an agreement to perform and in fact perform the duties described in 45 CFR 155.210(e); 7) comply with any other requirements or standards specified in the NOFO, grant agreement, or cooperative agreement, as applicable; and 8) for new and renewed grants, satisfactorily complete the following application process: A) pursuant to 44 Ill. Adm. Code 7000.320, registration with the State of Illinois, prequalification, and being determined "qualified" as described in 44 Ill. Adm. Code 7000.70; B) pursuant to 44 Ill. Adm. Code 7000.330, submission of the uniform grant application and uniform budget template; C) pursuant to 44 Ill. Adm. Code 7000.350, receipt of a successful determination under the merit review process; and DEPARTMENT OF INSURANCE NOTICE OF PROPOSED AMENDMENT D) any other applicable requirements under the GATA and 44 Ill. Adm. Code 7000. d) To receive, renew, or maintain certification by the Exchange as a Certified Application Counselor Organization, an entity must: 1) comply with 45 CFR 155.225(b)(1) (Apr. 27, 2023) (no later editions or amendments); 2) enforce the standards of certification for its own Certified Application Counselors specified in 45 CFR 155.225(d), including the requirement that the Certified Application Counselor have an active certification from the Department under 50 Ill. Adm. Code 4515; 3) comply with the availability of information and authorization requirements in 45 CFR 155.225(f); 4) comply with the applicable accessibility standards in Section 4500.160(b); 5) meet the terms and conditions of the agreement entered with the Exchange or its designee; 6) not engage in the conduct described in 45 CFR 155.225(g). The Illinois Exchange adopts the provisions applicable to Federally-facilitated Exchanges; and 7) for new and renewal certifications, successfully make an application on a form prescribed by the Exchange addressing the requirements of this subsection (d). e) To receive, renew, or maintain certification to perform the duties in 45 CFR 155.225(c) as a Certified Application Counselor, an individual must: 1) meet the standards provided in 45 CFR 155.225(d), including the requirement that the Certified Application Counselor have an active certification from the Department under 50 Ill. Adm. Code 4515; 2) comply with the availability of information and authorization requirements in 45 CFR 155.225(f); 3) meet the terms and conditions of the agreement entered with the Certified Application Counselor Organization; and 4) not engage in the conduct described in 45 CFR 155.225(g). The Illinois Exchange adopts the provisions applicable to Federally-facilitated Exchanges. f) Denials, suspensions, terminations, withdrawals, and appeals 1) For Navigator and In-Person Counselor award applications, nothing in this subsection (f) supersedes the requirements for the merit review and appeals process described in 44 Ill. Adm. Code 7700.350. 2) The Exchange may deny, suspend, or terminate a Navigator or In-Person Counselor award, or deny, suspend, or withdraw a Certified Application Counselor Organization certification, if the applicant, certificate holder, or recipient: A) provides incorrect, misleading, incomplete, or materially untrue information in the award or certificate application; B) violates any insurance law, or violates any rule, subpoena, or order of the Director or of another state's insurance Director; C) obtains or attempts to obtain an award or certificate through misrepresentation or fraud; D) obtains or attempts to obtain any monies or property from Illinois consumers while conducting business under this Section; E) intentionally misrepresents the terms of an actual or proposed insurance contract; F) has been convicted of a felony, unless the applicant, certificate holder, or recipient demonstrates to the Director sufficient rehabilitation to warrant the public trust in accordance with Section 4515.140; DEPARTMENT OF INSURANCE NOTICE OF PROPOSED AMENDMENT G) has admitted or been found to have committed any insurance unfair trade practice or fraud; H) uses fraudulent, coercive, or dishonest practices, or demonstrating incompetence, untrustworthiness or financial irresponsibility in the conduct of business in this State or elsewhere; I) has a Navigator or In-Person Counselor award or Certified Application Counselor Organization certificate, or its equivalent, denied, suspended, terminated, or withdrawn by HHS or by the American Health Benefit Exchange for any other state, province, district, or territory; J) forges a name to an application for insurance or a document related to an insurance transaction; K) fails to comply with an administrative or court order imposing a child support obligation; L) fails to pay Illinois State income tax or penalty or interest, or to comply with any administrative or court order directing payment of Illinois state income tax, or fails to file a return or to pay any final assessment of any tax due to the Illinois Department of Revenue; or M) fails to make satisfactory repayment to the Illinois Student Assistance Commission for a delinquent or defaulted student loan. 3) If the Exchange determines that any of the grounds listed in subsection (f)(2) exists, the Exchange or its designee will send a written notice to the entity or individual identifying the nature of the disciplinary action to be taken, the specific reasons for the action, an effective date 10 days from the date the notice is issued, and information about how to request a hearing on the decision. The entity or individual may appeal by submitting a request for hearing to the Department within 10 days. The appeal will stay the effective date of the disciplinary action pending the outcome of the hearing and any further administrative review. The hearing will be conducted in accordance with 50 Ill. Adm. Code 2402. An entity or DEPARTMENT OF INSURANCE NOTICE OF PROPOSED AMENDMENT individual may reapply for certification or an award one calendar year after certification has been withdrawn or the award has been terminated. 4) A Certified Application Counselor Organization must have procedures to withdraw a certification it has issued to a Certified Application Counselor when the individual does not comply with the requirements of this Section. (Source: Amended at 50 Ill. Reg. ______, effective ____________)