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| | 103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
SB1557 Introduced 2/8/2023, by Sen. Laura M. Murphy SYNOPSIS AS INTRODUCED:
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| 215 ILCS 5/356z.61 new | | 305 ILCS 5/5-16.8 | |
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Amends the Illinois Insurance Code. Provides that no individual or group policy of accident and health insurance or managed care organization shall change an insured's eligibility or coverage during a contract period. Provides that during a contract period, insureds shall have the protection and continuity of their providers, medication, covered benefits, and formulary during the contract period. Amends the Illinois Public Aid Code making conforming changes.
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| | A BILL FOR |
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| | SB1557 | | LRB103 27648 BMS 54024 b |
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| 1 | | AN ACT concerning regulation.
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| 2 | | Be it enacted by the People of the State of Illinois,
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| 3 | | represented in the General Assembly:
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| 4 | | Section 5. The Illinois Insurance Code is amended by |
| 5 | | adding Section 356z.61 as follows:
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| 6 | | (215 ILCS 5/356z.61 new) |
| 7 | | Sec. 356z.61. Contract terms; coverage. No individual or |
| 8 | | group policy of accident and health insurance or managed care |
| 9 | | organization shall amend, deliver, issue, or renew a policy in |
| 10 | | a way that changes an insured's eligibility or coverage during |
| 11 | | a contract period. During a contract period, an insured shall |
| 12 | | have the protection and continuity of his or her providers, |
| 13 | | his or her medication, his or her covered benefits, and the |
| 14 | | formulary during the contract period.
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| 15 | | Section 10. The Illinois Public Aid Code is amended by |
| 16 | | changing Section 5-16.8 as follows:
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| 17 | | (305 ILCS 5/5-16.8)
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| 18 | | Sec. 5-16.8. Required health benefits. The medical |
| 19 | | assistance program
shall
(i) provide the post-mastectomy care |
| 20 | | benefits required to be covered by a policy of
accident and |
| 21 | | health insurance under Section 356t and the coverage required
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| | SB1557 | - 2 - | LRB103 27648 BMS 54024 b |
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| 1 | | under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6, |
| 2 | | 356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46, |
| 3 | | 356z.47, 356z.51, 356z.53, 356z.56, 356z.59, and 356z.60, and |
| 4 | | 356z.61 of the Illinois
Insurance Code, (ii) be subject to the |
| 5 | | provisions of Sections 356z.19, 356z.44, 356z.49, 364.01, |
| 6 | | 370c, and 370c.1 of the Illinois
Insurance Code, and (iii) be |
| 7 | | subject to the provisions of subsection (d-5) of Section 10 of |
| 8 | | the Network Adequacy and Transparency Act.
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| 9 | | The Department, by rule, shall adopt a model similar to |
| 10 | | the requirements of Section 356z.39 of the Illinois Insurance |
| 11 | | Code. |
| 12 | | On and after July 1, 2012, the Department shall reduce any |
| 13 | | rate of reimbursement for services or other payments or alter |
| 14 | | any methodologies authorized by this Code to reduce any rate |
| 15 | | of reimbursement for services or other payments in accordance |
| 16 | | with Section 5-5e. |
| 17 | | To ensure full access to the benefits set forth in this |
| 18 | | Section, on and after January 1, 2016, the Department shall |
| 19 | | ensure that provider and hospital reimbursement for |
| 20 | | post-mastectomy care benefits required under this Section are |
| 21 | | no lower than the Medicare reimbursement rate. |
| 22 | | (Source: P.A. 101-81, eff. 7-12-19; 101-218, eff. 1-1-20; |
| 23 | | 101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-574, eff. |
| 24 | | 1-1-20; 101-649, eff. 7-7-20; 102-30, eff. 1-1-22; 102-144, |
| 25 | | eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; |
| 26 | | 102-530, eff. 1-1-22; 102-642, eff. 1-1-22; 102-804, eff. |