101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
SB1420

 

Introduced 2/13/2019, by Sen. Laura M. Murphy

 

SYNOPSIS AS INTRODUCED:
 
5 ILCS 375/6.11
55 ILCS 5/5-1069.3
65 ILCS 5/10-4-2.3
105 ILCS 5/10-22.3f
215 ILCS 5/356z.33 new
215 ILCS 125/5-3  from Ch. 111 1/2, par. 1411.2

    Amends the Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance or managed care plan that is amended, delivered, issued, or renewed after the effective date of the amendatory Act shall provide coverage for hippotherapy and other forms of therapeutic riding. Makes conforming changes in the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, and the Health Maintenance Organization Act.


LRB101 08598 RAB 53677 b

FISCAL NOTE ACT MAY APPLY
STATE MANDATES ACT MAY REQUIRE REIMBURSEMENT

 

 

A BILL FOR

 

SB1420LRB101 08598 RAB 53677 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
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
17356z.29, 356z.32, and 356z.33 of the Illinois Insurance Code.
18The program of health benefits must comply with Sections
19155.22a, 155.37, 355b, 356z.19, 370c, and 370c.1 of the
20Illinois Insurance Code. The Department of Insurance shall
21enforce the requirements of this Section.
22    Rulemaking authority to implement Public Act 95-1045, if
23any, is conditioned on the rules being adopted in accordance

 

 

SB1420- 2 -LRB101 08598 RAB 53677 b

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
81-8-19.)
 
9    (Text of Section after amendment by P.A. 100-1170)
10    Sec. 6.11. Required health benefits; Illinois Insurance
11Code requirements. The program of health benefits shall provide
12the post-mastectomy care benefits required to be covered by a
13policy of accident and health insurance under Section 356t of
14the Illinois Insurance Code. The program of health benefits
15shall provide the coverage required under Sections 356g,
16356g.5, 356g.5-1, 356m, 356u, 356w, 356x, 356z.2, 356z.4,
17356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
18356z.14, 356z.15, 356z.17, 356z.22, 356z.25, 356z.26, 356z.29,
19and 356z.32, and 356z.33 of the Illinois Insurance Code. The
20program of health benefits must comply with Sections 155.22a,
21155.37, 355b, 356z.19, 370c, and 370c.1 of the Illinois
22Insurance Code. The Department of Insurance shall enforce the
23requirements of this Section with respect to Sections 370c and
24370c.1 of the Illinois Insurance Code; all other requirements
25of this Section shall be enforced by the Department of Central

 

 

SB1420- 3 -LRB101 08598 RAB 53677 b

1Management Services.
2    Rulemaking authority to implement Public Act 95-1045, if
3any, is conditioned on the rules being adopted in accordance
4with all provisions of the Illinois Administrative Procedure
5Act and all rules and procedures of the Joint Committee on
6Administrative Rules; any purported rule not so adopted, for
7whatever reason, is unauthorized.
8(Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17;
9100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1024, eff.
101-1-19; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19;
11100-1170, eff. 6-1-19.)
 
12    Section 10. The Counties Code is amended by changing
13Section 5-1069.3 as follows:
 
14    (55 ILCS 5/5-1069.3)
15    Sec. 5-1069.3. Required health benefits. If a county,
16including a home rule county, is a self-insurer for purposes of
17providing health insurance coverage for its employees, the
18coverage shall include coverage for the post-mastectomy care
19benefits required to be covered by a policy of accident and
20health insurance under Section 356t and the coverage required
21under Sections 356g, 356g.5, 356g.5-1, 356u, 356w, 356x,
22356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
23356z.14, 356z.15, 356z.22, 356z.25, and 356z.26, and 356z.29,
24356z.32, and 356z.33 of the Illinois Insurance Code. The

 

 

SB1420- 4 -LRB101 08598 RAB 53677 b

1coverage shall comply with Sections 155.22a, 355b, 356z.19, and
2370c of the Illinois Insurance Code. The Department of
3Insurance shall enforce the requirements of this Section. The
4requirement that health benefits be covered as provided in this
5Section is an exclusive power and function of the State and is
6a denial and limitation under Article VII, Section 6,
7subsection (h) of the Illinois Constitution. A home rule county
8to which this Section applies must comply with every provision
9of this Section.
10    Rulemaking authority to implement Public Act 95-1045, if
11any, is conditioned on the rules being adopted in accordance
12with all provisions of the Illinois Administrative Procedure
13Act and all rules and procedures of the Joint Committee on
14Administrative Rules; any purported rule not so adopted, for
15whatever reason, is unauthorized.
16(Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17;
17100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1024, eff.
181-1-19; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised
1910-3-18.)
 
20    Section 15. The Illinois Municipal Code is amended by
21changing Section 10-4-2.3 as follows:
 
22    (65 ILCS 5/10-4-2.3)
23    Sec. 10-4-2.3. Required health benefits. If a
24municipality, including a home rule municipality, is a

 

 

SB1420- 5 -LRB101 08598 RAB 53677 b

1self-insurer for purposes of providing health insurance
2coverage for its employees, the coverage shall include coverage
3for the post-mastectomy care benefits required to be covered by
4a policy of accident and health insurance under Section 356t
5and the coverage required under Sections 356g, 356g.5,
6356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10,
7356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25,
8and 356z.26, and 356z.29, 356z.32, and 356z.33 of the Illinois
9Insurance Code. The coverage shall comply with Sections
10155.22a, 355b, 356z.19, and 370c of the Illinois Insurance
11Code. The Department of Insurance shall enforce the
12requirements of this Section. The requirement that health
13benefits be covered as provided in this is an exclusive power
14and function of the State and is a denial and limitation under
15Article VII, Section 6, subsection (h) of the Illinois
16Constitution. A home rule municipality to which this Section
17applies must comply with every provision of this Section.
18    Rulemaking authority to implement Public Act 95-1045, if
19any, is conditioned on the rules being adopted in accordance
20with all provisions of the Illinois Administrative Procedure
21Act and all rules and procedures of the Joint Committee on
22Administrative Rules; any purported rule not so adopted, for
23whatever reason, is unauthorized.
24(Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17;
25100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1024, eff.
261-1-19; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised

 

 

SB1420- 6 -LRB101 08598 RAB 53677 b

110-4-18.)
 
2    Section 20. The School Code is amended by changing Section
310-22.3f as follows:
 
4    (105 ILCS 5/10-22.3f)
5    Sec. 10-22.3f. Required health benefits. Insurance
6protection and benefits for employees shall provide the
7post-mastectomy care benefits required to be covered by a
8policy of accident and health insurance under Section 356t and
9the coverage required under Sections 356g, 356g.5, 356g.5-1,
10356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11, 356z.12,
11356z.13, 356z.14, 356z.15, 356z.22, 356z.25, and 356z.26, and
12356z.29, 356z.32, and 356z.33 of the Illinois Insurance Code.
13Insurance policies shall comply with Section 356z.19 of the
14Illinois Insurance Code. The coverage shall comply with
15Sections 155.22a, 355b, and 370c of the Illinois Insurance
16Code. The Department of Insurance shall enforce the
17requirements of this Section.
18    Rulemaking authority to implement Public Act 95-1045, if
19any, is conditioned on the rules being adopted in accordance
20with all provisions of the Illinois Administrative Procedure
21Act and all rules and procedures of the Joint Committee on
22Administrative Rules; any purported rule not so adopted, for
23whatever reason, is unauthorized.
24(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;

 

 

SB1420- 7 -LRB101 08598 RAB 53677 b

1100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
21-1-19; 100-1102, eff. 1-1-19; revised 10-4-18.)
 
3    Section 25. The Illinois Insurance Code is amended by
4adding Section 356z.33 as follows:
 
5    (215 ILCS 5/356z.33 new)
6    Sec. 356z.33. Coverage for hippotherapy and therapeutic
7riding.
8    (a) As used in this Section:
9    "Disability" means a determinable physical or mental
10characteristic of a person, including, but not limited to, a
11determinable physical characteristic that necessitates the
12person's use of a guide, hearing, or support dog, that may
13result from a disease, injury, or congenital condition of birth
14or a functional disorder.
15    "Hippotherapy" means physical, occupational, or speech
16therapy, prescribed by a physician and delivered by a licensed
17occupational therapist, physical therapist, or speech-language
18pathologist, in conjunction with a professional horse handler
19and a therapy horse.
20    "Therapeutic riding" means horseback riding lessons
21adapted to individuals with a disability, delivered by a
22professional horse handler and a therapy horse.
23    (b) A group or individual policy of accident and health
24insurance or managed care plan that is amended, delivered,

 

 

SB1420- 8 -LRB101 08598 RAB 53677 b

1issued, or renewed after the effective date of this amendatory
2Act of the 101st General Assembly shall provide coverage for
3hippotherapy and other forms of therapeutic riding.
 
4    Section 30. The Health Maintenance Organization Act is
5amended by changing Section 5-3 as follows:
 
6    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
7    Sec. 5-3. Insurance Code provisions.
8    (a) Health Maintenance Organizations shall be subject to
9the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
10141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
11154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2, 355.3,
12355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2, 356z.4,
13356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
14356z.13, 356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.21,
15356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32, 356z.33,
16364, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c, 368d,
17368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A, 408, 408.2,
18409, 412, 444, and 444.1, paragraph (c) of subsection (2) of
19Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2, XIII,
20XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.
21    (b) For purposes of the Illinois Insurance Code, except for
22Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health
23Maintenance Organizations in the following categories are
24deemed to be "domestic companies":

 

 

SB1420- 9 -LRB101 08598 RAB 53677 b

1        (1) a corporation authorized under the Dental Service
2    Plan Act or the Voluntary Health Services Plans Act;
3        (2) a corporation organized under the laws of this
4    State; or
5        (3) a corporation organized under the laws of another
6    state, 30% or more of the enrollees of which are residents
7    of this State, except a corporation subject to
8    substantially the same requirements in its state of
9    organization as is a "domestic company" under Article VIII
10    1/2 of the Illinois Insurance Code.
11    (c) In considering the merger, consolidation, or other
12acquisition of control of a Health Maintenance Organization
13pursuant to Article VIII 1/2 of the Illinois Insurance Code,
14        (1) the Director shall give primary consideration to
15    the continuation of benefits to enrollees and the financial
16    conditions of the acquired Health Maintenance Organization
17    after the merger, consolidation, or other acquisition of
18    control takes effect;
19        (2)(i) the criteria specified in subsection (1)(b) of
20    Section 131.8 of the Illinois Insurance Code shall not
21    apply and (ii) the Director, in making his determination
22    with respect to the merger, consolidation, or other
23    acquisition of control, need not take into account the
24    effect on competition of the merger, consolidation, or
25    other acquisition of control;
26        (3) the Director shall have the power to require the

 

 

SB1420- 10 -LRB101 08598 RAB 53677 b

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

 

 

SB1420- 11 -LRB101 08598 RAB 53677 b

1specified in Section 141.2 of the Illinois Insurance Code, take
2into account the effect of the management contract or service
3agreement on the continuation of benefits to enrollees and the
4financial condition of the health maintenance organization to
5be managed or serviced, and (ii) need not take into account the
6effect of the management contract or service agreement on
7competition.
8    (f) Except for small employer groups as defined in the
9Small Employer Rating, Renewability and Portability Health
10Insurance Act and except for medicare supplement policies as
11defined in Section 363 of the Illinois Insurance Code, a Health
12Maintenance Organization may by contract agree with a group or
13other enrollment unit to effect refunds or charge additional
14premiums under the following terms and conditions:
15        (i) the amount of, and other terms and conditions with
16    respect to, the refund or additional premium are set forth
17    in the group or enrollment unit contract agreed in advance
18    of the period for which a refund is to be paid or
19    additional premium is to be charged (which period shall not
20    be less than one year); and
21        (ii) the amount of the refund or additional premium
22    shall not exceed 20% of the Health Maintenance
23    Organization's profitable or unprofitable experience with
24    respect to the group or other enrollment unit for the
25    period (and, for purposes of a refund or additional
26    premium, the profitable or unprofitable experience shall

 

 

SB1420- 12 -LRB101 08598 RAB 53677 b

1    be calculated taking into account a pro rata share of the
2    Health Maintenance Organization's administrative and
3    marketing expenses, but shall not include any refund to be
4    made or additional premium to be paid pursuant to this
5    subsection (f)). The Health Maintenance Organization and
6    the group or enrollment unit may agree that the profitable
7    or unprofitable experience may be calculated taking into
8    account the refund period and the immediately preceding 2
9    plan years.
10    The Health Maintenance Organization shall include a
11statement in the evidence of coverage issued to each enrollee
12describing the possibility of a refund or additional premium,
13and upon request of any group or enrollment unit, provide to
14the group or enrollment unit a description of the method used
15to calculate (1) the Health Maintenance Organization's
16profitable experience with respect to the group or enrollment
17unit and the resulting refund to the group or enrollment unit
18or (2) the Health Maintenance Organization's unprofitable
19experience with respect to the group or enrollment unit and the
20resulting additional premium to be paid by the group or
21enrollment unit.
22    In no event shall the Illinois Health Maintenance
23Organization Guaranty Association be liable to pay any
24contractual obligation of an insolvent organization to pay any
25refund authorized under this Section.
26    (g) Rulemaking authority to implement Public Act 95-1045,

 

 

SB1420- 13 -LRB101 08598 RAB 53677 b

1if any, is conditioned on the rules being adopted in accordance
2with all provisions of the Illinois Administrative Procedure
3Act and all rules and procedures of the Joint Committee on
4Administrative Rules; any purported rule not so adopted, for
5whatever reason, is unauthorized.
6(Source: P.A. 99-761, eff. 1-1-18; 100-24, eff. 7-18-17;
7100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1026, eff.
88-22-18; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised
910-4-18.)
 
10    Section 95. No acceleration or delay. Where this Act makes
11changes in a statute that is represented in this Act by text
12that is not yet or no longer in effect (for example, a Section
13represented by multiple versions), the use of that text does
14not accelerate or delay the taking effect of (i) the changes
15made by this Act or (ii) provisions derived from any other
16Public Act.