Rep. Natalie A. Manley

Filed: 3/14/2019

 

 


 

 


 
10100HB3503ham001LRB101 09822 AMC 57414 a

1
AMENDMENT TO HOUSE BILL 3503

2    AMENDMENT NO. ______. Amend House Bill 3503 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The State Employees Group Insurance Act of 1971
5is amended by changing Section 6.11 as follows:
 
6    (5 ILCS 375/6.11)
7    (Text of Section before amendment by P.A. 100-1170)
8    Sec. 6.11. Required health benefits; Illinois Insurance
9Code requirements. The program of health benefits shall provide
10the post-mastectomy care benefits required to be covered by a
11policy of accident and health insurance under Section 356t of
12the Illinois Insurance Code. The program of health benefits
13shall provide the coverage required under Sections 356g,
14356g.5, 356g.5-1, 356m, 356u, 356w, 356x, 356z.2, 356z.4,
15356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
16356z.14, 356z.15, 356z.17, 356z.22, 356z.25, and 356z.26, and

 

 

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1356z.29, and 356z.32 of the Illinois Insurance Code. The
2program of health benefits must comply with Sections 155.22a,
3155.37, 355b, 356z.19, 370c, and 370c.1 of the Illinois
4Insurance Code. The Department of Insurance shall enforce the
5requirements of this Section.
6    Rulemaking authority to implement Public Act 95-1045, if
7any, is conditioned on the rules being adopted in accordance
8with all provisions of the Illinois Administrative Procedure
9Act and all rules and procedures of the Joint Committee on
10Administrative Rules; any purported rule not so adopted, for
11whatever reason, is unauthorized.
12(Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17;
13100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1024, eff.
141-1-19; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised
151-8-19.)
 
16    (Text of Section after amendment by P.A. 100-1170)
17    Sec. 6.11. Required health benefits; Illinois Insurance
18Code requirements. The program of health benefits shall provide
19the post-mastectomy care benefits required to be covered by a
20policy of accident and health insurance under Section 356t of
21the Illinois Insurance Code. The program of health benefits
22shall provide the coverage required under Sections 356g,
23356g.5, 356g.5-1, 356m, 356u, 356w, 356x, 356z.2, 356z.4,
24356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
25356z.14, 356z.15, 356z.17, 356z.22, 356z.25, 356z.26, 356z.29,

 

 

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1356z.30a, and 356z.32 of the Illinois Insurance Code. The
2program of health benefits must comply with Sections 155.22a,
3155.37, 355b, 356z.19, 370c, and 370c.1 of the Illinois
4Insurance Code. The Department of Insurance shall enforce the
5requirements of this Section with respect to Sections 370c and
6370c.1 of the Illinois Insurance Code; all other requirements
7of this Section shall be enforced by the Department of Central
8Management Services.
9    Rulemaking authority to implement Public Act 95-1045, if
10any, is conditioned on the rules being adopted in accordance
11with all provisions of the Illinois Administrative Procedure
12Act and all rules and procedures of the Joint Committee on
13Administrative Rules; any purported rule not so adopted, for
14whatever reason, is unauthorized.
15(Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17;
16100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1024, eff.
171-1-19; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19;
18100-1170, eff. 6-1-19.)
 
19    Section 10. The Counties Code is amended by changing
20Section 5-1069.3 as follows:
 
21    (55 ILCS 5/5-1069.3)
22    Sec. 5-1069.3. Required health benefits. If a county,
23including a home rule county, is a self-insurer for purposes of
24providing health insurance coverage for its employees, the

 

 

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1coverage shall include coverage for the post-mastectomy care
2benefits required to be covered by a policy of accident and
3health insurance under Section 356t and the coverage required
4under Sections 356g, 356g.5, 356g.5-1, 356u, 356w, 356x,
5356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
6356z.14, 356z.15, 356z.22, 356z.25, and 356z.26, and 356z.29,
7356z.30a, and 356z.32 of the Illinois Insurance Code. The
8coverage shall comply with Sections 155.22a, 355b, 356z.19, and
9370c of the Illinois Insurance Code. The Department of
10Insurance shall enforce the requirements of this Section. The
11requirement that health benefits be covered as provided in this
12Section is an exclusive power and function of the State and is
13a denial and limitation under Article VII, Section 6,
14subsection (h) of the Illinois Constitution. A home rule county
15to which this Section applies must comply with every provision
16of this Section.
17    Rulemaking authority to implement Public Act 95-1045, if
18any, is conditioned on the rules being adopted in accordance
19with all provisions of the Illinois Administrative Procedure
20Act and all rules and procedures of the Joint Committee on
21Administrative Rules; any purported rule not so adopted, for
22whatever reason, is unauthorized.
23(Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17;
24100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1024, eff.
251-1-19; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised
2610-3-18.)
 

 

 

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1    Section 15. The Illinois Municipal Code is amended by
2changing Section 10-4-2.3 as follows:
 
3    (65 ILCS 5/10-4-2.3)
4    Sec. 10-4-2.3. Required health benefits. If a
5municipality, including a home rule municipality, is a
6self-insurer for purposes of providing health insurance
7coverage for its employees, the coverage shall include coverage
8for the post-mastectomy care benefits required to be covered by
9a policy of accident and health insurance under Section 356t
10and the coverage required under Sections 356g, 356g.5,
11356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10,
12356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25,
13and 356z.26, and 356z.29, 356z.30a, and 356z.32 of the Illinois
14Insurance Code. The coverage shall comply with Sections
15155.22a, 355b, 356z.19, and 370c of the Illinois Insurance
16Code. The Department of Insurance shall enforce the
17requirements of this Section. The requirement that health
18benefits be covered as provided in this is an exclusive power
19and function of the State and is a denial and limitation under
20Article VII, Section 6, subsection (h) of the Illinois
21Constitution. A home rule municipality to which this Section
22applies must comply with every provision of this Section.
23    Rulemaking authority to implement Public Act 95-1045, if
24any, is conditioned on the rules being adopted in accordance

 

 

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1with all provisions of the Illinois Administrative Procedure
2Act and all rules and procedures of the Joint Committee on
3Administrative Rules; any purported rule not so adopted, for
4whatever reason, is unauthorized.
5(Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17;
6100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1024, eff.
71-1-19; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised
810-4-18.)
 
9    Section 20. The School Code is amended by changing Section
1010-22.3f as follows:
 
11    (105 ILCS 5/10-22.3f)
12    Sec. 10-22.3f. Required health benefits. Insurance
13protection and benefits for employees shall provide the
14post-mastectomy care benefits required to be covered by a
15policy of accident and health insurance under Section 356t and
16the coverage required under Sections 356g, 356g.5, 356g.5-1,
17356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11, 356z.12,
18356z.13, 356z.14, 356z.15, 356z.22, 356z.25, and 356z.26, and
19356z.29, 356z.30a, and 356z.32 of the Illinois Insurance Code.
20Insurance policies shall comply with Section 356z.19 of the
21Illinois Insurance Code. The coverage shall comply with
22Sections 155.22a, 355b, and 370c of the Illinois Insurance
23Code. The Department of Insurance shall enforce the
24requirements of this Section.

 

 

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1    Rulemaking authority to implement Public Act 95-1045, if
2any, is conditioned on the rules being adopted in accordance
3with all provisions of the Illinois Administrative Procedure
4Act and all rules and procedures of the Joint Committee on
5Administrative Rules; any purported rule not so adopted, for
6whatever reason, is unauthorized.
7(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
8100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
91-1-19; 100-1102, eff. 1-1-19; revised 10-4-18.)
 
10    Section 25. The Illinois Insurance Code is amended by
11adding Section 356z.30a as follows:
 
12    (215 ILCS 5/356z.30a new)
13    Sec. 356z.30a. Coverage for hearing instruments.
14    (a) As used in this Section:
15    "Hearing care professional" means a person who is a
16licensed audiologist or a licensed physician.
17    "Hearing instrument" means any wearable non-disposable
18instrument or device designed to aid or compensate for impaired
19human hearing and any parts, attachments, or accessories for
20the instrument or device, including an ear mold but excluding
21batteries and cords.
22    "Related services" means those services necessary to
23assess, select, and adjust or fit the hearing instrument to
24ensure optimal performance, including, but not limited to:

 

 

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1audiological exams, replacement ear molds, and repairs to the
2hearing instrument.
3    (b) An individual or group policy of accident and health
4insurance or managed care plan that is amended, delivered,
5issued, or renewed after the effective date of this amendatory
6Act of the 101st General Assembly shall offer, for an
7additional premium and subject to the insurer's standard of
8insurability, optional coverage or optional reimbursement for
9hearing instruments and related services for all individuals
10when a hearing care professional prescribes a hearing
11instrument to augment communication.
12    (c) This optional coverage shall be subject to all
13applicable copayments, coinsurance, deductibles, and
14out-of-pocket limits for the cost of a hearing instrument for
15each ear, as needed, as well as related services, with a
16maximum for the hearing instrument and related services of no
17more than $2,500 per hearing instrument every 24 months.
18    (d) An insurer shall not be required to pay a claim filed
19by its insured for the payment of the cost of a hearing
20instrument covered by this Section if less than 24 months
21before the date of the claim its insured filed a claim for
22payment of the cost of the hearing instrument and the claim was
23paid by the insurer.
 
24    Section 30. The Health Maintenance Organization Act is
25amended by changing Section 5-3 as follows:
 

 

 

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1    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
2    Sec. 5-3. Insurance Code provisions.
3    (a) Health Maintenance Organizations shall be subject to
4the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
5141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
6154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2, 355.3,
7355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2, 356z.4,
8356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
9356z.13, 356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.21,
10356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.30a,
11356z.32, 364, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c,
12368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A, 408,
13408.2, 409, 412, 444, and 444.1, paragraph (c) of subsection
14(2) of Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2,
15XIII, XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.
16    (b) For purposes of the Illinois Insurance Code, except for
17Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health
18Maintenance Organizations in the following categories are
19deemed to be "domestic companies":
20        (1) a corporation authorized under the Dental Service
21    Plan Act or the Voluntary Health Services Plans Act;
22        (2) a corporation organized under the laws of this
23    State; or
24        (3) a corporation organized under the laws of another
25    state, 30% or more of the enrollees of which are residents

 

 

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1    of this State, except a corporation subject to
2    substantially the same requirements in its state of
3    organization as is a "domestic company" under Article VIII
4    1/2 of the Illinois Insurance Code.
5    (c) In considering the merger, consolidation, or other
6acquisition of control of a Health Maintenance Organization
7pursuant to Article VIII 1/2 of the Illinois Insurance Code,
8        (1) the Director shall give primary consideration to
9    the continuation of benefits to enrollees and the financial
10    conditions of the acquired Health Maintenance Organization
11    after the merger, consolidation, or other acquisition of
12    control takes effect;
13        (2)(i) the criteria specified in subsection (1)(b) of
14    Section 131.8 of the Illinois Insurance Code shall not
15    apply and (ii) the Director, in making his determination
16    with respect to the merger, consolidation, or other
17    acquisition of control, need not take into account the
18    effect on competition of the merger, consolidation, or
19    other acquisition of control;
20        (3) the Director shall have the power to require the
21    following information:
22            (A) certification by an independent actuary of the
23        adequacy of the reserves of the Health Maintenance
24        Organization sought to be acquired;
25            (B) pro forma financial statements reflecting the
26        combined balance sheets of the acquiring company and

 

 

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1        the Health Maintenance Organization sought to be
2        acquired as of the end of the preceding year and as of
3        a date 90 days prior to the acquisition, as well as pro
4        forma financial statements reflecting projected
5        combined operation for a period of 2 years;
6            (C) a pro forma business plan detailing an
7        acquiring party's plans with respect to the operation
8        of the Health Maintenance Organization sought to be
9        acquired for a period of not less than 3 years; and
10            (D) such other information as the Director shall
11        require.
12    (d) The provisions of Article VIII 1/2 of the Illinois
13Insurance Code and this Section 5-3 shall apply to the sale by
14any health maintenance organization of greater than 10% of its
15enrollee population (including without limitation the health
16maintenance organization's right, title, and interest in and to
17its health care certificates).
18    (e) In considering any management contract or service
19agreement subject to Section 141.1 of the Illinois Insurance
20Code, the Director (i) shall, in addition to the criteria
21specified in Section 141.2 of the Illinois Insurance Code, take
22into account the effect of the management contract or service
23agreement on the continuation of benefits to enrollees and the
24financial condition of the health maintenance organization to
25be managed or serviced, and (ii) need not take into account the
26effect of the management contract or service agreement on

 

 

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1competition.
2    (f) Except for small employer groups as defined in the
3Small Employer Rating, Renewability and Portability Health
4Insurance Act and except for medicare supplement policies as
5defined in Section 363 of the Illinois Insurance Code, a Health
6Maintenance Organization may by contract agree with a group or
7other enrollment unit to effect refunds or charge additional
8premiums under the following terms and conditions:
9        (i) the amount of, and other terms and conditions with
10    respect to, the refund or additional premium are set forth
11    in the group or enrollment unit contract agreed in advance
12    of the period for which a refund is to be paid or
13    additional premium is to be charged (which period shall not
14    be less than one year); and
15        (ii) the amount of the refund or additional premium
16    shall not exceed 20% of the Health Maintenance
17    Organization's profitable or unprofitable experience with
18    respect to the group or other enrollment unit for the
19    period (and, for purposes of a refund or additional
20    premium, the profitable or unprofitable experience shall
21    be calculated taking into account a pro rata share of the
22    Health Maintenance Organization's administrative and
23    marketing expenses, but shall not include any refund to be
24    made or additional premium to be paid pursuant to this
25    subsection (f)). The Health Maintenance Organization and
26    the group or enrollment unit may agree that the profitable

 

 

10100HB3503ham001- 13 -LRB101 09822 AMC 57414 a

1    or unprofitable experience may be calculated taking into
2    account the refund period and the immediately preceding 2
3    plan years.
4    The Health Maintenance Organization shall include a
5statement in the evidence of coverage issued to each enrollee
6describing the possibility of a refund or additional premium,
7and upon request of any group or enrollment unit, provide to
8the group or enrollment unit a description of the method used
9to calculate (1) the Health Maintenance Organization's
10profitable experience with respect to the group or enrollment
11unit and the resulting refund to the group or enrollment unit
12or (2) the Health Maintenance Organization's unprofitable
13experience with respect to the group or enrollment unit and the
14resulting additional premium to be paid by the group or
15enrollment unit.
16    In no event shall the Illinois Health Maintenance
17Organization Guaranty Association be liable to pay any
18contractual obligation of an insolvent organization to pay any
19refund authorized under this Section.
20    (g) Rulemaking authority to implement Public Act 95-1045,
21if any, is conditioned on the rules being adopted in accordance
22with all provisions of the Illinois Administrative Procedure
23Act and all rules and procedures of the Joint Committee on
24Administrative Rules; any purported rule not so adopted, for
25whatever reason, is unauthorized.
26(Source: P.A. 99-761, eff. 1-1-18; 100-24, eff. 7-18-17;

 

 

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1100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1026, eff.
28-22-18; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised
310-4-18.)
 
4    Section 35. The Limited Health Service Organization Act is
5amended by changing Section 4003 as follows:
 
6    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
7    Sec. 4003. Illinois Insurance Code provisions. Limited
8health service organizations shall be subject to the provisions
9of Sections 133, 134, 136, 137, 139, 140, 141.1, 141.2, 141.3,
10143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5, 154.6,
11154.7, 154.8, 155.04, 155.37, 355.2, 355.3, 355b, 356v,
12356z.10, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29,
13356z.30a, 356z.32, 368a, 401, 401.1, 402, 403, 403A, 408,
14408.2, 409, 412, 444, and 444.1 and Articles IIA, VIII 1/2,
15XII, XII 1/2, XIII, XIII 1/2, XXV, and XXVI of the Illinois
16Insurance Code. For purposes of the Illinois Insurance Code,
17except for Sections 444 and 444.1 and Articles XIII and XIII
181/2, limited health service organizations in the following
19categories are deemed to be domestic companies:
20        (1) a corporation under the laws of this State; or
21        (2) a corporation organized under the laws of another
22    state, 30% or more of the enrollees of which are residents
23    of this State, except a corporation subject to
24    substantially the same requirements in its state of

 

 

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1    organization as is a domestic company under Article VIII
2    1/2 of the Illinois Insurance Code.
3(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
4100-201, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1057, eff.
51-1-19; 100-1102, eff. 1-1-19; revised 10-4-18.)
 
6    Section 40. The Voluntary Health Services Plans Act is
7amended by changing Section 10 as follows:
 
8    (215 ILCS 165/10)  (from Ch. 32, par. 604)
9    Sec. 10. Application of Insurance Code provisions. Health
10services plan corporations and all persons interested therein
11or dealing therewith shall be subject to the provisions of
12Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
13143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, 356g,
14356g.5, 356g.5-1, 356r, 356t, 356u, 356v, 356w, 356x, 356y,
15356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9,
16356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18,
17356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29,
18356z.30a, 356z.32, 364.01, 367.2, 368a, 401, 401.1, 402, 403,
19403A, 408, 408.2, and 412, and paragraphs (7) and (15) of
20Section 367 of the Illinois Insurance Code.
21    Rulemaking authority to implement Public Act 95-1045, if
22any, is conditioned on the rules being adopted in accordance
23with all provisions of the Illinois Administrative Procedure
24Act and all rules and procedures of the Joint Committee on

 

 

10100HB3503ham001- 16 -LRB101 09822 AMC 57414 a

1Administrative Rules; any purported rule not so adopted, for
2whatever reason, is unauthorized.
3(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
4100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff.
51-1-19; 100-1102, eff. 1-1-19; revised 10-4-18.)
 
6    Section 45. The Illinois Public Aid Code is amended by
7changing Section 5-16.8 as follows:
 
8    (305 ILCS 5/5-16.8)
9    Sec. 5-16.8. Required health benefits. The medical
10assistance program shall (i) provide the post-mastectomy care
11benefits required to be covered by a policy of accident and
12health insurance under Section 356t and the coverage required
13under Sections 356g.5, 356u, 356w, 356x, 356z.6, 356z.26, and
14356z.29, 356z.30a, and 356z.32 of the Illinois Insurance Code
15and (ii) be subject to the provisions of Sections 356z.19,
16364.01, 370c, and 370c.1 of the Illinois Insurance Code.
17    On and after July 1, 2012, the Department shall reduce any
18rate of reimbursement for services or other payments or alter
19any methodologies authorized by this Code to reduce any rate of
20reimbursement for services or other payments in accordance with
21Section 5-5e.
22    To ensure full access to the benefits set forth in this
23Section, on and after January 1, 2016, the Department shall
24ensure that provider and hospital reimbursement for

 

 

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1post-mastectomy care benefits required under this Section are
2no lower than the Medicare reimbursement rate.
3(Source: P.A. 99-433, eff. 8-21-15; 99-480, eff. 9-9-15;
499-642, eff. 7-28-16; 100-138, eff. 8-18-17; 100-863, eff.
58-14-18; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised
610-4-18.)
 
7    Section 95. No acceleration or delay. Where this Act makes
8changes in a statute that is represented in this Act by text
9that is not yet or no longer in effect (for example, a Section
10represented by multiple versions), the use of that text does
11not accelerate or delay the taking effect of (i) the changes
12made by this Act or (ii) provisions derived from any other
13Public Act.".