Rep. Laura Fine

Filed: 4/12/2018

 

 


 

 


 
10000HB2617ham001LRB100 08150 SMS 37835 a

1
AMENDMENT TO HOUSE BILL 2617

2    AMENDMENT NO. ______. Amend House Bill 2617 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, 356z.22, and 356z.25, 356z.26, and
16356z.29 of the Illinois Insurance Code. The program of health

 

 

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1benefits must comply with Sections 155.22a, 155.37, 355b,
2356z.19, 370c, and 370c.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. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17;
10100-138, eff. 8-18-17; revised 10-3-17.)
 
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, 356z.22, and 356z.25, 356z.26, and 356z.29 of
23the Illinois Insurance Code. The coverage shall comply with
24Sections 155.22a, 355b, 356z.19, and 370c of the Illinois

 

 

10000HB2617ham001- 3 -LRB100 08150 SMS 37835 a

1Insurance Code. The requirement that health benefits be covered
2as provided in this Section is an exclusive power and function
3of the 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. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17;
14100-138, eff. 8-18-17; revised 10-5-17.)
 
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, 356z.22, and
3356z.25, 356z.26, and 356z.29 of the Illinois Insurance Code.
4The coverage shall comply with Sections 155.22a, 355b, 356z.19,
5and 370c of the Illinois Insurance Code. The requirement that
6health benefits be covered as provided in this is an exclusive
7power and function of the State and is a denial and limitation
8under Article 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. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17;
18100-138, eff. 8-18-17; revised 10-5-17.)
 
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, 356z.22, and 356z.25, 356z.26, and
5356z.29 of the Illinois Insurance Code. Insurance policies
6shall comply with Section 356z.19 of the Illinois Insurance
7Code. The coverage shall comply with Sections 155.22a and 355b
8of the Illinois Insurance 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. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
16revised 9-25-17.)
 
17    Section 25. The Illinois Insurance Code is amended by
18adding Section 356z.29 as follows:
 
19    (215 ILCS 5/356z.29 new)
20    Sec. 356z.29. Coverage for fertility preservation
21treatments.
22    (a) As used in this Section:
23        "Iatrogenic infertility" means in impairment of
24    fertility by surgery, radiation, chemotherapy, or other

 

 

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1    medical treatment affecting reproductive organs or
2    processes.
3        "May directly or indirectly cause" means the likely
4    possibility that treatment will cause a side effect of
5    infertility, based upon current evidence-based standards
6    of care established by the American Society for
7    Reproductive Medicine, the American Society of Clinical
8    Oncology, or other national medical associations that
9    follow current evidence-based standards of care.
10        "Standard fertility preservation services" means
11    procedures based upon current evidence-based standards of
12    care established by the American Society for Reproductive
13    Medicine, the American Society of Clinical Oncology, or
14    other national medical associations that follow current
15    evidence-based standards of care.
16    (b) An individual or group policy of accident and health
17insurance amended, delivered, issued, or renewed in this State
18after the effective date of this amendatory Act of the 100th
19General Assembly must provide coverage for medically necessary
20expenses for standard fertility preservation services when a
21necessary medical treatment may directly or indirectly cause
22iatrogenic infertility to an enrollee.
23    (c) In determining coverage pursuant to this Section, an
24insurer shall not discriminate based on an individuals expected
25length of life, present or predicted disability, degree of
26medical dependency, quality of life, or other health

 

 

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1conditions, nor based on personal characteristics, including
2age, sex, sexual orientation, or marital status.
 
3    Section 30. The Health Maintenance Organization Act is
4amended by changing Section 5-3 as follows:
 
5    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
6    Sec. 5-3. Insurance Code provisions.
7    (a) Health Maintenance Organizations shall be subject to
8the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
9141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
10154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2, 355.3,
11355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2, 356z.4,
12356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
13356z.13, 356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.21,
14356z.22, 356z.25, 356z.26, 356z.29, 364, 364.01, 367.2,
15367.2-5, 367i, 368a, 368b, 368c, 368d, 368e, 370c, 370c.1, 401,
16401.1, 402, 403, 403A, 408, 408.2, 409, 412, 444, and 444.1,
17paragraph (c) of subsection (2) of Section 367, and Articles
18IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and XXVI of
19the Illinois Insurance Code.
20    (b) For purposes of the Illinois Insurance Code, except for
21Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health
22Maintenance Organizations in the following categories are
23deemed to be "domestic companies":
24        (1) a corporation authorized under the Dental Service

 

 

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

 

 

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

 

 

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

 

 

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1    Health Maintenance Organization's administrative and
2    marketing expenses, but shall not include any refund to be
3    made or additional premium to be paid pursuant to this
4    subsection (f)). The Health Maintenance Organization and
5    the group or enrollment unit may agree that the profitable
6    or unprofitable experience may be calculated taking into
7    account the refund period and the immediately preceding 2
8    plan years.
9    The Health Maintenance Organization shall include a
10statement in the evidence of coverage issued to each enrollee
11describing the possibility of a refund or additional premium,
12and upon request of any group or enrollment unit, provide to
13the group or enrollment unit a description of the method used
14to calculate (1) the Health Maintenance Organization's
15profitable experience with respect to the group or enrollment
16unit and the resulting refund to the group or enrollment unit
17or (2) the Health Maintenance Organization's unprofitable
18experience with respect to the group or enrollment unit and the
19resulting additional premium to be paid by the group or
20enrollment unit.
21    In no event shall the Illinois Health Maintenance
22Organization Guaranty Association be liable to pay any
23contractual obligation of an insolvent organization to pay any
24refund authorized under this Section.
25    (g) Rulemaking authority to implement Public Act 95-1045,
26if any, 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. 99-761, eff. 1-1-18; 100-24, eff. 7-18-17;
6100-138, eff. 8-18-17; revised 10-5-17.)
 
7    Section 35. The Limited Health Service Organization Act is
8amended by changing Section 4003 as follows:
 
9    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
10    Sec. 4003. Illinois Insurance Code provisions. Limited
11health service organizations shall be subject to the provisions
12of Sections 133, 134, 136, 137, 139, 140, 141.1, 141.2, 141.3,
13143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5, 154.6,
14154.7, 154.8, 155.04, 155.37, 355.2, 355.3, 355b, 356v,
15356z.10, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 368a,
16401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412, 444, and
17444.1 and Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2,
18XXV, and XXVI of the Illinois Insurance Code. For purposes of
19the Illinois Insurance Code, except for Sections 444 and 444.1
20and Articles XIII and XIII 1/2, limited health service
21organizations in the following categories are deemed to be
22domestic companies:
23        (1) a corporation under the laws of this State; or
24        (2) a corporation organized under the laws of another

 

 

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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(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
7100-201, eff. 8-18-17; revised 10-5-17.)
 
8    Section 40. The Voluntary Health Services Plans Act is
9amended by changing Section 10 as follows:
 
10    (215 ILCS 165/10)  (from Ch. 32, par. 604)
11    Sec. 10. Application of Insurance Code provisions. Health
12services plan corporations and all persons interested therein
13or dealing therewith shall be subject to the provisions of
14Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
15143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, 356g,
16356g.5, 356g.5-1, 356r, 356t, 356u, 356v, 356w, 356x, 356y,
17356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9,
18356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18,
19356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 364.01,
20367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412,
21and paragraphs (7) and (15) of Section 367 of the Illinois
22Insurance Code.
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. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
6revised 10-5-17.)
 
7    Section 45. The Illinois Public Aid Code is amended by
8changing Section 5-16.8 as follows:
 
9    (305 ILCS 5/5-16.8)
10    Sec. 5-16.8. Required health benefits. The medical
11assistance program shall (i) provide 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.5, 356u, 356w, 356x, 356z.6, 356z.26, and
15356z.29 and 356z.25 of the Illinois Insurance Code and (ii) be
16subject to the provisions of Sections 356z.19, 364.01, 370c,
17and 370c.1 of the Illinois Insurance Code.
18    On and after July 1, 2012, the Department shall reduce any
19rate of reimbursement for services or other payments or alter
20any methodologies authorized by this Code to reduce any rate of
21reimbursement for services or other payments in accordance with
22Section 5-5e.
23    To ensure full access to the benefits set forth in this
24Section, on and after January 1, 2016, the Department shall

 

 

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1ensure that provider and hospital reimbursement for
2post-mastectomy care benefits required under this Section are
3no lower than the Medicare reimbursement rate.
4(Source: P.A. 99-433, eff. 8-21-15; 99-480, eff. 9-9-15;
599-642, eff. 7-28-16; 100-138, eff. 8-18-17; revised
61-29-18.)".