100TH GENERAL ASSEMBLY
State of Illinois
2017 and 2018
HB4516

 

Introduced , by Rep. Laura Fine

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 5/356z.29 new
215 ILCS 125/5-3  from Ch. 111 1/2, par. 1411.2
215 ILCS 165/10  from Ch. 32, par. 604

    Amends the Illinois Insurance Code, the Voluntary Health Services Plans Act, and the Voluntary Health Services Plans Act to require coverage for hearing instruments and related services for all individuals under the age of 18 when a hearing care professional prescribes a hearing instrument. Provides that an insurer shall provide coverage for hearing aids subject to certain restrictions. Provides that an insurer shall not be required to pay a claim if the insured filed such a claim 12 months prior to the date of filing the claim with the insurer and the claim was paid by any insurer. Effective immediately.


LRB100 17336 SMS 32500 b

 

 

A BILL FOR

 

HB4516LRB100 17336 SMS 32500 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 Illinois Insurance Code is amended by adding
5Section 356z.29 as follows:
 
6    (215 ILCS 5/356z.29 new)
7    Sec. 356z.29. Coverage for hearing aids for individuals
8under the age of 18.
9    (a) As used in this Section:
10    "Hearing care professional" means a person who is a
11licensed hearing instrument dispenser, licensed audiologist,
12or licensed physician.
13    "Hearing instrument" or "hearing aid" means any wearable
14non-disposable instrument or device designed to aid or
15compensate for impaired human hearing and any parts,
16attachments, or accessories for the instrument or device,
17including an ear mold but excluding batteries and cords.
18    "Related services" means those services necessary to
19assess, select, and adjust or fit the hearing instrument to
20ensure optimal performance, including, but not limited to:
21audiological exams, replacement ear molds, and repairs to the
22hearing instrument.
23    (b) An individual or group policy of accident and health

 

 

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1insurance or managed care plan that is amended, delivered,
2issued, or renewed after the effective date of this amendatory
3Act of the 100th General Assembly must provide coverage for
4hearing instruments and related services for all individuals
5under the age of 18 when a hearing care professional prescribes
6a hearing instrument to augment communication.
7    (c) An insurer shall provide coverage, subject to all
8applicable co-payments, co-insurance, deductibles, and
9out-of-pocket limits, subject to the following restrictions:
10        (1) for all insured individuals, hearing aids may be
11    replaced up to once every 12 months as prescribed and
12    dispensed by a hearing care professional;
13        (2) for all insured individuals, any hearing aid may be
14    replaced at any time regardless of the above restrictions
15    if there is a significant change in the insured
16    individual's hearing status; and
17        (3) for all insured individuals, related services,
18    such as audiological exams, ear molds, and hearing aid
19    repairs, shall be covered at all times when prescribed by a
20    hearing care professional.
21    (d) An insurer shall not be required to pay a claim filed
22by its insured for the payment of the cost of a hearing aid
23covered by this Section if less than 12 months prior to the
24date of the claim its insured filed a claim for payment of the
25cost of the hearing aid and the claim was paid by any insurer.
 

 

 

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1    Section 10. The Health Maintenance Organization Act is
2amended by changing Section 5-3 as follows:
 
3    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
4    Sec. 5-3. Insurance Code provisions.
5    (a) Health Maintenance Organizations shall be subject to
6the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
7141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
8154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2, 355.3,
9355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2, 356z.4,
10356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
11356z.13, 356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.21,
12356z.22, 356z.25, 356z.26, 356z.29, 364, 364.01, 367.2,
13367.2-5, 367i, 368a, 368b, 368c, 368d, 368e, 370c, 370c.1, 401,
14401.1, 402, 403, 403A, 408, 408.2, 409, 412, 444, and 444.1,
15paragraph (c) of subsection (2) of Section 367, and Articles
16IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and XXVI of
17the Illinois Insurance Code.
18    (b) For purposes of the Illinois Insurance Code, except for
19Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health
20Maintenance Organizations in the following categories are
21deemed to be "domestic companies":
22        (1) a corporation authorized under the Dental Service
23    Plan Act or the Voluntary Health Services Plans Act;
24        (2) a corporation organized under the laws of this
25    State; or

 

 

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

 

 

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

 

 

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

 

 

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1    subsection (f)). The Health Maintenance Organization and
2    the group or enrollment unit may agree that the profitable
3    or unprofitable experience may be calculated taking into
4    account the refund period and the immediately preceding 2
5    plan years.
6    The Health Maintenance Organization shall include a
7statement in the evidence of coverage issued to each enrollee
8describing the possibility of a refund or additional premium,
9and upon request of any group or enrollment unit, provide to
10the group or enrollment unit a description of the method used
11to calculate (1) the Health Maintenance Organization's
12profitable experience with respect to the group or enrollment
13unit and the resulting refund to the group or enrollment unit
14or (2) the Health Maintenance Organization's unprofitable
15experience with respect to the group or enrollment unit and the
16resulting additional premium to be paid by the group or
17enrollment unit.
18    In no event shall the Illinois Health Maintenance
19Organization Guaranty Association be liable to pay any
20contractual obligation of an insolvent organization to pay any
21refund authorized under this Section.
22    (g) Rulemaking authority to implement Public Act 95-1045,
23if any, is conditioned on the rules being adopted in accordance
24with all provisions of the Illinois Administrative Procedure
25Act and all rules and procedures of the Joint Committee on
26Administrative Rules; any purported rule not so adopted, for

 

 

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1whatever reason, is unauthorized.
2(Source: P.A. 99-761, eff. 1-1-18; 100-24, eff. 7-18-17;
3100-138, eff. 8-18-17; revised 10-5-17.)
 
4    Section 15. The Voluntary Health Services Plans Act is
5amended by changing Section 10 as follows:
 
6    (215 ILCS 165/10)  (from Ch. 32, par. 604)
7    Sec. 10. Application of Insurance Code provisions. Health
8services plan corporations and all persons interested therein
9or dealing therewith shall be subject to the provisions of
10Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
11143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, 356g,
12356g.5, 356g.5-1, 356r, 356t, 356u, 356v, 356w, 356x, 356y,
13356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9,
14356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18,
15356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 364.01,
16367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412,
17and paragraphs (7) and (15) of Section 367 of the Illinois
18Insurance 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
24whatever reason, is unauthorized.

 

 

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1(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
2revised 10-5-17.)
 
3    Section 99. Effective date. This Act takes effect upon
4becoming law.