Rep. Emily McAsey

Filed: 5/18/2016

 

 


 

 


 
09900HB2743ham003LRB099 03614 RPS 48871 a

1
AMENDMENT TO HOUSE BILL 2743

2    AMENDMENT NO. ______. Amend House Bill 2743 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    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, 356z.17, and 356z.22, and 356z.24 of the
16Illinois Insurance Code. The program of health benefits must

 

 

09900HB2743ham003- 2 -LRB099 03614 RPS 48871 a

1comply with Sections 155.22a, 155.37, 355b, 356z.19, 370c, and
2370c.1 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. 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15;
1099-480, eff. 9-9-15.)
 
11    Section 10. The Counties Code is amended by changing
12Section 5-1069.3 as follows:
 
13    (55 ILCS 5/5-1069.3)
14    Sec. 5-1069.3. Required health benefits. If a county,
15including a home rule county, is a self-insurer for purposes of
16providing health insurance coverage for its employees, the
17coverage shall include coverage for the post-mastectomy care
18benefits required to be covered by a policy of accident and
19health insurance under Section 356t and the coverage required
20under Sections 356g, 356g.5, 356g.5-1, 356u, 356w, 356x,
21356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
22356z.14, 356z.15, and 356z.22, and 356z.24 of the Illinois
23Insurance Code. The coverage shall comply with Sections
24155.22a, 355b, 356z.19, and 370c of the Illinois Insurance

 

 

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1Code. The requirement that health benefits be covered as
2provided in this Section is an exclusive power and function of
3the State and is a denial and limitation under Article VII,
4Section 6, subsection (h) of the Illinois Constitution. A home
5rule county to which this Section applies must comply with
6every provision of this Section.
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. 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15;
1499-480, eff. 9-9-15.)
 
15    Section 15. The Illinois Municipal Code is amended by
16changing Section 10-4-2.3 as follows:
 
17    (65 ILCS 5/10-4-2.3)
18    Sec. 10-4-2.3. Required health benefits. If a
19municipality, including a home rule municipality, is a
20self-insurer for purposes of providing health insurance
21coverage for its employees, the coverage shall include coverage
22for the post-mastectomy care benefits required to be covered by
23a policy of accident and health insurance under Section 356t
24and the coverage required under Sections 356g, 356g.5,

 

 

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1356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10,
2356z.11, 356z.12, 356z.13, 356z.14, 356z.15, and 356z.22, and
3356z.24 of the Illinois Insurance Code. The coverage shall
4comply with Sections 155.22a, 355b, 356z.19, and 370c of the
5Illinois Insurance Code. The requirement that health benefits
6be covered as provided in this is an exclusive power and
7function of the State and is a denial and limitation under
8Article VII, Section 6, subsection (h) of the Illinois
9Constitution. A home rule municipality to which this Section
10applies must comply with every provision of this Section.
11    Rulemaking authority to implement Public Act 95-1045, if
12any, is conditioned on the rules being adopted in accordance
13with all provisions of the Illinois Administrative Procedure
14Act and all rules and procedures of the Joint Committee on
15Administrative Rules; any purported rule not so adopted, for
16whatever reason, is unauthorized.
17(Source: P.A. 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15;
1899-480, eff. 9-9-15.)
 
19    Section 20. The School Code is amended by changing Section
2010-22.3f as follows:
 
21    (105 ILCS 5/10-22.3f)
22    Sec. 10-22.3f. Required health benefits. Insurance
23protection and benefits for employees shall provide the
24post-mastectomy care benefits required to be covered by a

 

 

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1policy of accident and health insurance under Section 356t and
2the coverage required under Sections 356g, 356g.5, 356g.5-1,
3356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11, 356z.12,
4356z.13, 356z.14, 356z.15, and 356z.22, and 356z.24 of the
5Illinois Insurance Code. Insurance policies shall comply with
6Section 356z.19 of the Illinois Insurance Code. The coverage
7shall comply with Sections 155.22a and 355b of the Illinois
8Insurance Code.
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. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-813,
16eff. 7-13-12; 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15.)
 
17    Section 25. The Illinois Insurance Code is amended by
18adding Section 356z.24 as follows:
 
19    (215 ILCS 5/356z.24 new)
20    Sec. 356z.24. Access to opioid analgesics with
21abuse-deterrent properties.
22    (a) For purposes of this Section:
23    "Abuse-deterrent opioid analgesic drug product" means a
24brand or generic opioid analgesic drug product approved by the

 

 

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1U.S. Food and Drug Administration with abuse-deterrence
2labeling claims that indicate the drug product's
3abuse-deterrent properties are expected to deter or reduce its
4abuse.
5    "Covered individual" means an individual covered by an
6individual or group policy of accident and health insurance.
7    "Health insurer" means an entity or company licensed or
8authorized by the State to sell health insurance policies or
9that provides health care coverage, including pharmacy benefit
10managers that administer the pharmacy benefit for an entity or
11company.
12    "Opioid analgesic drug product" means a drug product that
13contains an opioid agonist and that is indicated by the U.S.
14Food and Drug Administration for the treatment of pain, whether
15in an immediate-release or extended-release formulation and
16whether or not the drug product contains other drug substances.
17    (b) On or after the effective date of this amendatory Act
18of the 99th General Assembly, a health insurer that amends,
19delivers, issues, or renews a group accident and health policy
20that provides coverage for prescription drugs shall not require
21that a covered individual first use an opioid analgesic drug
22product without abuse-deterrence labeling claims before
23providing coverage for an abuse-deterrent opioid analgesic
24drug product.
 
25    Section 30. The Health Maintenance Organization Act is

 

 

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1amended by changing Section 5-3 as follows:
 
2    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
3    Sec. 5-3. Insurance Code provisions.
4    (a) Health Maintenance Organizations shall be subject to
5the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
6141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
7154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2, 355.3,
8355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2, 356z.4,
9356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
10356z.13, 356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.21,
11356z.22, 356z.24, 364.01, 367.2, 367.2-5, 367i, 368a, 368b,
12368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A,
13408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of
14subsection (2) of Section 367, and Articles IIA, VIII 1/2, XII,
15XII 1/2, XIII, XIII 1/2, XXV, and XXVI of the Illinois
16Insurance Code.
17    (b) For purposes of the Illinois Insurance Code, except for
18Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health
19Maintenance Organizations in the following categories are
20deemed to be "domestic companies":
21        (1) a corporation authorized under the Dental Service
22    Plan Act or the Voluntary Health Services Plans Act;
23        (2) a corporation organized under the laws of this
24    State; or
25        (3) a corporation organized under the laws of another

 

 

09900HB2743ham003- 8 -LRB099 03614 RPS 48871 a

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

 

 

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

 

 

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

 

 

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

 

 

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1(Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-437,
2eff. 8-18-11; 97-486, eff. 1-1-12; 97-592, eff. 1-1-12; 97-805,
3eff. 1-1-13; 97-813, eff. 7-13-12; 98-189, eff. 1-1-14;
498-1091, eff. 1-1-15.)
 
5    Section 35. The Limited Health Service Organization Act is
6amended by changing Section 4003 as follows:
 
7    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
8    Sec. 4003. Illinois Insurance Code provisions. Limited
9health service organizations shall be subject to the provisions
10of Sections 133, 134, 136, 137, 139, 140, 141.1, 141.2, 141.3,
11143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5, 154.6,
12154.7, 154.8, 155.04, 155.37, 355.2, 355.3, 355b, 356v,
13356z.10, 356z.21, 356z.22, 356z.24, 368a, 401, 401.1, 402, 403,
14403A, 408, 408.2, 409, 412, 444, and 444.1 and Articles IIA,
15VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and XXVI of the
16Illinois Insurance Code. For purposes of the Illinois Insurance
17Code, except for Sections 444 and 444.1 and Articles XIII and
18XIII 1/2, 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% of 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. 97-486, eff. 1-1-12; 97-592, 1-1-12; 97-805, eff.
41-1-13; 97-813, eff. 7-13-12; 98-189, eff. 1-1-14; 98-1091,
5eff. 1-1-15.)
 
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.24, 364.01, 367.2, 368a, 401,
18401.1, 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7)
19and (15) of Section 367 of the Illinois Insurance Code.
20    Rulemaking authority to implement Public Act 95-1045, if
21any, 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

 

 

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1whatever reason, is unauthorized.
2(Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-486,
3eff. 1-1-12; 97-592, eff. 1-1-12; 97-805, eff. 1-1-13; 97-813,
4eff. 7-13-12; 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15.)".