98TH GENERAL ASSEMBLY
State of Illinois
2013 and 2014
SB1422

 

Introduced 2/6/2013, by Sen. Mattie Hunter

 

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.22 new
215 ILCS 125/5-3  from Ch. 111 1/2, par. 1411.2
215 ILCS 130/4003  from Ch. 73, par. 1504-3
215 ILCS 165/10  from Ch. 32, par. 604

    Amends the Illinois Insurance Code, the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, the Limited Health Service Organization Act, and the Voluntary Health Services Plans Act to provide that accident and health insurance policies and managed care plans must provide coverage for telemedicine services. Provides that the required coverage for telemedicine services shall be subject to the same deductible, coinsurance, and copayment as if the telemedicine services were provided through face-to-face interactions between patients and their providers.


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FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

SB1422LRB098 08144 RPM 38237 b

1    AN ACT concerning insurance.
 
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    Sec. 6.11. Required health benefits; Illinois Insurance
8Code requirements. The program of health benefits shall provide
9the post-mastectomy care benefits required to be covered by a
10policy of accident and health insurance under Section 356t of
11the Illinois Insurance Code. The program of health benefits
12shall provide the coverage required under Sections 356g,
13356g.5, 356g.5-1, 356m, 356u, 356w, 356x, 356z.2, 356z.4,
14356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
15356z.14, 356z.15, and 356z.17, and 356z.22 and 356z.19 of the
16Illinois Insurance Code. The program of health benefits must
17comply with Sections 155.22a, 155.37, and 356z.19 of the
18Illinois Insurance Code.
19    Rulemaking authority to implement Public Act 95-1045, if
20any, is conditioned on the rules being adopted in accordance
21with all provisions of the Illinois Administrative Procedure
22Act and all rules and procedures of the Joint Committee on
23Administrative Rules; any purported rule not so adopted, for

 

 

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1whatever reason, is unauthorized.
2(Source: P.A. 96-139, eff. 1-1-10; 96-328, eff. 8-11-09;
396-639, eff. 1-1-10; 96-1000, eff. 7-2-10; 97-282, eff. 8-9-11;
497-343, eff. 1-1-12; 97-813, eff. 7-13-12.)
 
5    Section 10. The Counties Code is amended by changing
6Section 5-1069.3 as follows:
 
7    (55 ILCS 5/5-1069.3)
8    Sec. 5-1069.3. Required health benefits. If a county,
9including a home rule county, is a self-insurer for purposes of
10providing health insurance coverage for its employees, the
11coverage shall include coverage for the post-mastectomy care
12benefits required to be covered by a policy of accident and
13health insurance under Section 356t and the coverage required
14under Sections 356g, 356g.5, 356g.5-1, 356u, 356w, 356x,
15356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
16356z.14, and 356z.15, and 356z.22 of the Illinois Insurance
17Code. The coverage shall comply with Sections 155.22a and
18356z.19 of the Illinois Insurance Code. The requirement that
19health benefits be covered as provided in this Section is an
20exclusive power and function of the State and is a denial and
21limitation under Article VII, Section 6, subsection (h) of the
22Illinois Constitution. A home rule county to which this Section
23applies must comply with every provision of this Section.
24    Rulemaking authority to implement Public Act 95-1045, if

 

 

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1any, 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. 96-139, eff. 1-1-10; 96-328, eff. 8-11-09;
796-1000, eff. 7-2-10; 97-282, eff. 8-9-11; 97-343, eff. 1-1-12;
897-813, eff. 7-13-12.)
 
9    Section 15. The Illinois Municipal Code is amended by
10changing Section 10-4-2.3 as follows:
 
11    (65 ILCS 5/10-4-2.3)
12    Sec. 10-4-2.3. Required health benefits. If a
13municipality, including a home rule municipality, is a
14self-insurer for purposes of providing health insurance
15coverage for its employees, the coverage shall include coverage
16for the post-mastectomy care benefits required to be covered by
17a policy of accident and health insurance under Section 356t
18and the coverage required under Sections 356g, 356g.5,
19356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10,
20356z.11, 356z.12, 356z.13, 356z.14, and 356z.15, and 356z.22 of
21the Illinois Insurance Code. The coverage shall comply with
22Sections 155.22a and 356z.19 of the Illinois Insurance Code.
23The requirement that health benefits be covered as provided in
24this is an exclusive power and function of the State and is a

 

 

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1denial and limitation under Article VII, Section 6, subsection
2(h) of the Illinois Constitution. A home rule municipality to
3which this Section applies must comply with every provision of
4this Section.
5    Rulemaking authority to implement Public Act 95-1045, if
6any, is conditioned on the rules being adopted in accordance
7with all provisions of the Illinois Administrative Procedure
8Act and all rules and procedures of the Joint Committee on
9Administrative Rules; any purported rule not so adopted, for
10whatever reason, is unauthorized.
11(Source: P.A. 96-139, eff. 1-1-10; 96-328, eff. 8-11-09;
1296-1000, eff. 7-2-10; 97-282, eff. 8-9-11; 97-343, eff. 1-1-12;
1397-813, eff. 7-13-12.)
 
14    Section 20. The School Code is amended by changing Section
1510-22.3f as follows:
 
16    (105 ILCS 5/10-22.3f)
17    Sec. 10-22.3f. Required health benefits. Insurance
18protection and benefits for employees shall provide the
19post-mastectomy care benefits required to be covered by a
20policy of accident and health insurance under Section 356t and
21the coverage required under Sections 356g, 356g.5, 356g.5-1,
22356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11, 356z.12,
23356z.13, 356z.14, and 356z.15, and 356z.22 of the Illinois
24Insurance Code. Insurance policies shall comply with Section

 

 

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1356z.19 of the Illinois Insurance Code. The coverage shall
2comply with Section 155.22a of the Illinois Insurance Code.
3    Rulemaking authority to implement Public Act 95-1045, if
4any, is conditioned on the rules being adopted in accordance
5with all provisions of the Illinois Administrative Procedure
6Act and all rules and procedures of the Joint Committee on
7Administrative Rules; any purported rule not so adopted, for
8whatever reason, is unauthorized.
9(Source: P.A. 96-139, eff. 1-1-10; 96-328, eff. 8-11-09;
1096-1000, eff. 7-2-10; 97-282, eff. 8-9-11; 97-343, eff. 1-1-12;
1197-813, eff. 7-13-12.)
 
12    Section 25. The Illinois Insurance Code is amended by
13adding Section 356z.22 as follows:
 
14    (215 ILCS 5/356z.22 new)
15    Sec. 356z.22. Coverage for telemedicine services.
16    (a) As used in this Section, "telemedicine services" means
17the delivery of health care services by a physician or advanced
18practice nurse to his or her patient through remote video
19conferencing, remote patient monitoring, or other
20telecommunications and electronic technology for the purpose
21of diagnosing, consulting with, or treating the patient at a
22location other than where the physician is located.
23"Telemedicine services" does not include audio-only telephone
24calls, e-mail messages, or facsimile transmissions.

 

 

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1    (b) An individual or group policy of accident and health
2insurance or a managed care plan that is amended, delivered,
3issued, or renewed on or after the effective date of this
4amendatory Act of the 98th General Assembly must provide
5coverage for telemedicine services.
6    (c) Coverage for telemedicine services required under this
7Section shall be subject to the same deductible, coinsurance,
8and copayment as if the telemedicine services were provided
9through face-to-face interactions between patients and their
10providers.
 
11    Section 30. The Health Maintenance Organization Act is
12amended by changing Section 5-3 as follows:
 
13    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
14    Sec. 5-3. Insurance Code provisions.
15    (a) Health Maintenance Organizations shall be subject to
16the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
17141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
18154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2, 355.3,
19356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2, 356z.4, 356z.5,
20356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
21356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.21, 356z.22,
22364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c, 368d, 368e,
23370c, 370c.1, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412,
24444, and 444.1, paragraph (c) of subsection (2) of Section 367,

 

 

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1and Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV,
2and XXVI of the Illinois Insurance Code.
3    (b) For purposes of the Illinois Insurance Code, except for
4Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health
5Maintenance Organizations in the following categories are
6deemed to be "domestic companies":
7        (1) a corporation authorized under the Dental Service
8    Plan Act or the Voluntary Health Services Plans Act;
9        (2) a corporation organized under the laws of this
10    State; or
11        (3) a corporation organized under the laws of another
12    state, 30% or more of the enrollees of which are residents
13    of this State, except a corporation subject to
14    substantially the same requirements in its state of
15    organization as is a "domestic company" under Article VIII
16    1/2 of the Illinois Insurance Code.
17    (c) In considering the merger, consolidation, or other
18acquisition of control of a Health Maintenance Organization
19pursuant to Article VIII 1/2 of the Illinois Insurance Code,
20        (1) the Director shall give primary consideration to
21    the continuation of benefits to enrollees and the financial
22    conditions of the acquired Health Maintenance Organization
23    after the merger, consolidation, or other acquisition of
24    control takes effect;
25        (2)(i) the criteria specified in subsection (1)(b) of
26    Section 131.8 of the Illinois Insurance Code shall not

 

 

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1    apply and (ii) the Director, in making his determination
2    with respect to the merger, consolidation, or other
3    acquisition of control, need not take into account the
4    effect on competition of the merger, consolidation, or
5    other acquisition of control;
6        (3) the Director shall have the power to require the
7    following information:
8            (A) certification by an independent actuary of the
9        adequacy of the reserves of the Health Maintenance
10        Organization sought to be acquired;
11            (B) pro forma financial statements reflecting the
12        combined balance sheets of the acquiring company and
13        the Health Maintenance Organization sought to be
14        acquired as of the end of the preceding year and as of
15        a date 90 days prior to the acquisition, as well as pro
16        forma financial statements reflecting projected
17        combined operation for a period of 2 years;
18            (C) a pro forma business plan detailing an
19        acquiring party's plans with respect to the operation
20        of the Health Maintenance Organization sought to be
21        acquired for a period of not less than 3 years; and
22            (D) such other information as the Director shall
23        require.
24    (d) The provisions of Article VIII 1/2 of the Illinois
25Insurance Code and this Section 5-3 shall apply to the sale by
26any health maintenance organization of greater than 10% of its

 

 

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1enrollee population (including without limitation the health
2maintenance organization's right, title, and interest in and to
3its health care certificates).
4    (e) In considering any management contract or service
5agreement subject to Section 141.1 of the Illinois Insurance
6Code, the Director (i) shall, in addition to the criteria
7specified in Section 141.2 of the Illinois Insurance Code, take
8into account the effect of the management contract or service
9agreement on the continuation of benefits to enrollees and the
10financial condition of the health maintenance organization to
11be managed or serviced, and (ii) need not take into account the
12effect of the management contract or service agreement on
13competition.
14    (f) Except for small employer groups as defined in the
15Small Employer Rating, Renewability and Portability Health
16Insurance Act and except for medicare supplement policies as
17defined in Section 363 of the Illinois Insurance Code, a Health
18Maintenance Organization may by contract agree with a group or
19other enrollment unit to effect refunds or charge additional
20premiums under the following terms and conditions:
21        (i) the amount of, and other terms and conditions with
22    respect to, the refund or additional premium are set forth
23    in the group or enrollment unit contract agreed in advance
24    of the period for which a refund is to be paid or
25    additional premium is to be charged (which period shall not
26    be less than one year); and

 

 

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1        (ii) the amount of the refund or additional premium
2    shall not exceed 20% of the Health Maintenance
3    Organization's profitable or unprofitable experience with
4    respect to the group or other enrollment unit for the
5    period (and, for purposes of a refund or additional
6    premium, the profitable or unprofitable experience shall
7    be calculated taking into account a pro rata share of the
8    Health Maintenance Organization's administrative and
9    marketing expenses, but shall not include any refund to be
10    made or additional premium to be paid pursuant to this
11    subsection (f)). The Health Maintenance Organization and
12    the group or enrollment unit may agree that the profitable
13    or unprofitable experience may be calculated taking into
14    account the refund period and the immediately preceding 2
15    plan years.
16    The Health Maintenance Organization shall include a
17statement in the evidence of coverage issued to each enrollee
18describing the possibility of a refund or additional premium,
19and upon request of any group or enrollment unit, provide to
20the group or enrollment unit a description of the method used
21to calculate (1) the Health Maintenance Organization's
22profitable experience with respect to the group or enrollment
23unit and the resulting refund to the group or enrollment unit
24or (2) the Health Maintenance Organization's unprofitable
25experience with respect to the group or enrollment unit and the
26resulting additional premium to be paid by the group or

 

 

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1enrollment unit.
2    In no event shall the Illinois Health Maintenance
3Organization Guaranty Association be liable to pay any
4contractual obligation of an insolvent organization to pay any
5refund authorized under this Section.
6    (g) Rulemaking authority to implement Public Act 95-1045,
7if any, 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. 96-328, eff. 8-11-09; 96-639, eff. 1-1-10;
1396-833, eff. 6-1-10; 96-1000, eff. 7-2-10; 97-282, eff. 8-9-11;
1497-343, eff. 1-1-12; 97-437, eff. 8-18-11; 97-486, eff. 1-1-12;
1597-592, eff. 1-1-12; 97-805, eff. 1-1-13; 97-813, eff.
167-13-12.)
 
17    Section 35. The Limited Health Service Organization Act is
18amended by changing Section 4003 as follows:
 
19    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
20    Sec. 4003. Illinois Insurance Code provisions. Limited
21health service organizations shall be subject to the provisions
22of Sections 133, 134, 136, 137, 139, 140, 141.1, 141.2, 141.3,
23143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5, 154.6,
24154.7, 154.8, 155.04, 155.37, 355.2, 355.3, 356v, 356z.10,

 

 

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1356z.21, 356z.22, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2,
2409, 412, 444, and 444.1 and Articles IIA, VIII 1/2, XII, XII
31/2, XIII, XIII 1/2, XXV, and XXVI of the Illinois Insurance
4Code. For purposes of the Illinois Insurance Code, except for
5Sections 444 and 444.1 and Articles XIII and XIII 1/2, limited
6health service organizations in the following categories are
7deemed to be domestic companies:
8        (1) a corporation under the laws of this State; or
9        (2) a corporation organized under the laws of another
10    state, 30% of more of the enrollees of which are residents
11    of this State, except a corporation subject to
12    substantially the same requirements in its state of
13    organization as is a domestic company under Article VIII
14    1/2 of the Illinois Insurance Code.
15(Source: P.A. 97-486, eff. 1-1-12; 97-592, 1-1-12; 97-805, eff.
161-1-13; 97-813, eff. 7-13-12.)
 
17    Section 40. The Voluntary Health Services Plans Act is
18amended by changing Section 10 as follows:
 
19    (215 ILCS 165/10)  (from Ch. 32, par. 604)
20    Sec. 10. Application of Insurance Code provisions. Health
21services plan corporations and all persons interested therein
22or dealing therewith shall be subject to the provisions of
23Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
24143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 356g,

 

 

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1356g.5, 356g.5-1, 356r, 356t, 356u, 356v, 356w, 356x, 356y,
2356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9,
3356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18,
4356z.19, 356z.21, 356z.22, 364.01, 367.2, 368a, 401, 401.1,
5402, 403, 403A, 408, 408.2, and 412, and paragraphs (7) and
6(15) of Section 367 of the Illinois Insurance Code.
7    Rulemaking authority to implement Public Act 95-1045, if
8any, is conditioned on the rules being adopted in accordance
9with all provisions of the Illinois Administrative Procedure
10Act and all rules and procedures of the Joint Committee on
11Administrative Rules; any purported rule not so adopted, for
12whatever reason, is unauthorized.
13(Source: P.A. 96-328, eff. 8-11-09; 96-833, eff. 6-1-10;
1496-1000, eff. 7-2-10; 97-282, eff. 8-9-11; 97-343, eff. 1-1-12;
1597-486, eff. 1-1-12; 97-592, eff. 1-1-12; 97-805, eff. 1-1-13;
1697-813, eff. 7-13-12.)