101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
HB4847

 

Introduced 2/18/2020, by Rep. Deanne M. Mazzochi

 

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 5/356u
215 ILCS 5/356x
215 ILCS 5/356z.43 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
305 ILCS 5/5-16.8

    Amends the Illinois Insurance Code. In provisions requiring insurance coverage for prostate-specific antigen tests and for colorectal cancer examination and screening, removes provisions requiring the testing be recommended or prescribed by a physician. 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, the Voluntary Health Services Plans Act, and the Illinois Public Aid Code to require insurance policies to provide coverage for testing to establish the presence or absence of sexually transmitted diseases or infections. Effective immediately.


LRB101 19329 BMS 68798 b

FISCAL NOTE ACT MAY APPLY
STATE MANDATES ACT MAY REQUIRE REIMBURSEMENT

 

 

A BILL FOR

 

HB4847LRB101 19329 BMS 68798 b

1    AN ACT concerning regulation.
 
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    (Text of Section before amendment by P.A. 101-625)
8    Sec. 6.11. Required health benefits; Illinois Insurance
9Code requirements. The program of health benefits shall provide
10the post-mastectomy care benefits required to be covered by a
11policy of accident and health insurance under Section 356t of
12the Illinois Insurance Code. The program of health benefits
13shall provide the coverage required under Sections 356g,
14356g.5, 356g.5-1, 356m, 356u, 356w, 356x, 356z.2, 356z.4,
15356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
16356z.13, 356z.14, 356z.15, 356z.17, 356z.22, 356z.25, 356z.26,
17356z.29, 356z.30a, 356z.32, and 356z.33, 356z.36, and 356z.43
18of the Illinois Insurance Code. The program of health benefits
19must comply with Sections 155.22a, 155.37, 355b, 356z.19, 370c,
20and 370c.1, and Article XXXIIB of the Illinois Insurance Code.
21The Department of Insurance shall enforce the requirements of
22this Section with respect to Sections 370c and 370c.1 of the
23Illinois Insurance Code; all other requirements of this Section

 

 

HB4847- 2 -LRB101 19329 BMS 68798 b

1shall be enforced by the Department of Central Management
2Services.
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. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
10100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
111-1-19; 100-1102, eff. 1-1-19; 100-1170, eff. 6-1-19; 101-13,
12eff. 6-12-19; 101-281, eff. 1-1-20; 101-393, eff. 1-1-20;
13101-452, eff. 1-1-20; 101-461, eff. 1-1-20; revised 10-16-19.)
 
14    (Text of Section after amendment by P.A. 101-625)
15    Sec. 6.11. Required health benefits; Illinois Insurance
16Code requirements. The program of health benefits shall provide
17the post-mastectomy care benefits required to be covered by a
18policy of accident and health insurance under Section 356t of
19the Illinois Insurance Code. The program of health benefits
20shall provide the coverage required under Sections 356g,
21356g.5, 356g.5-1, 356m, 356u, 356w, 356x, 356z.2, 356z.4,
22356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
23356z.13, 356z.14, 356z.15, 356z.17, 356z.22, 356z.25, 356z.26,
24356z.29, 356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41, and
25356z.43 of the Illinois Insurance Code. The program of health

 

 

HB4847- 3 -LRB101 19329 BMS 68798 b

1benefits must comply with Sections 155.22a, 155.37, 355b,
2356z.19, 370c, and 370c.1 and Article XXXIIB of the Illinois
3Insurance Code. The Department of Insurance shall enforce the
4requirements of this Section with respect to Sections 370c and
5370c.1 of the Illinois Insurance Code; all other requirements
6of this Section shall be enforced by the Department of Central
7Management Services.
8    Rulemaking authority to implement Public Act 95-1045, if
9any, is conditioned on the rules being adopted in accordance
10with all provisions of the Illinois Administrative Procedure
11Act and all rules and procedures of the Joint Committee on
12Administrative Rules; any purported rule not so adopted, for
13whatever reason, is unauthorized.
14(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
15100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
161-1-19; 100-1102, eff. 1-1-19; 100-1170, eff. 6-1-19; 101-13,
17eff. 6-12-19; 101-281, eff. 1-1-20; 101-393, eff. 1-1-20;
18101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
191-1-21.)
 
20    Section 10. The Counties Code is amended by changing
21Section 5-1069.3 as follows:
 
22    (55 ILCS 5/5-1069.3)
23    (Text of Section before amendment by P.A. 101-625)
24    Sec. 5-1069.3. Required health benefits. If a county,

 

 

HB4847- 4 -LRB101 19329 BMS 68798 b

1including a home rule county, is a self-insurer for purposes of
2providing health insurance coverage for its employees, the
3coverage shall include coverage for the post-mastectomy care
4benefits required to be covered by a policy of accident and
5health insurance under Section 356t and the coverage required
6under Sections 356g, 356g.5, 356g.5-1, 356u, 356w, 356x,
7356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
8356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
9356z.30a, and 356z.32, and 356z.33, 356z.36, and 356z.43 of the
10Illinois Insurance Code. The coverage shall comply with
11Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
12Insurance Code. The Department of Insurance shall enforce the
13requirements of this Section. The requirement that health
14benefits be covered as provided in this Section is an exclusive
15power and function of the State and is a denial and limitation
16under Article VII, Section 6, subsection (h) of the Illinois
17Constitution. A home rule county to which this Section applies
18must comply with every provision of this Section.
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.
25(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
26100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.

 

 

HB4847- 5 -LRB101 19329 BMS 68798 b

11-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
2eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
3revised 10-16-19.)
 
4    (Text of Section after amendment by P.A. 101-625)
5    Sec. 5-1069.3. Required health benefits. If a county,
6including a home rule county, is a self-insurer for purposes of
7providing health insurance coverage for its employees, the
8coverage shall include coverage for the post-mastectomy care
9benefits required to be covered by a policy of accident and
10health insurance under Section 356t and the coverage required
11under Sections 356g, 356g.5, 356g.5-1, 356u, 356w, 356x,
12356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
13356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
14356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41, and 356z.43
15of the Illinois Insurance Code. The coverage shall comply with
16Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
17Insurance Code. The Department of Insurance shall enforce the
18requirements of this Section. The requirement that health
19benefits be covered as provided in this Section is an exclusive
20power and function of the State and is a denial and limitation
21under Article VII, Section 6, subsection (h) of the Illinois
22Constitution. A home rule county to which this Section applies
23must comply with every provision of this Section.
24    Rulemaking authority to implement Public Act 95-1045, if
25any, is conditioned on the rules being adopted in accordance

 

 

HB4847- 6 -LRB101 19329 BMS 68798 b

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;
6100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
71-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
8eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
9101-625, eff. 1-1-21.)
 
10    Section 15. The Illinois Municipal Code is amended by
11changing Section 10-4-2.3 as follows:
 
12    (65 ILCS 5/10-4-2.3)
13    (Text of Section before amendment by P.A. 101-625)
14    Sec. 10-4-2.3. Required health benefits. If a
15municipality, including a home rule municipality, is a
16self-insurer for purposes of providing health insurance
17coverage for its employees, the coverage shall include coverage
18for the post-mastectomy care benefits required to be covered by
19a policy of accident and health insurance under Section 356t
20and the coverage required under Sections 356g, 356g.5,
21356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10,
22356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25,
23356z.26, 356z.29, 356z.30a, and 356z.32, and 356z.33, 356z.36,
24and 356z.43 of the Illinois Insurance Code. The coverage shall

 

 

HB4847- 7 -LRB101 19329 BMS 68798 b

1comply with Sections 155.22a, 355b, 356z.19, and 370c of the
2Illinois Insurance Code. The Department of Insurance shall
3enforce the requirements of this Section. The requirement that
4health benefits be covered as provided in this is an exclusive
5power and function of the State and is a denial and limitation
6under Article VII, Section 6, subsection (h) of the Illinois
7Constitution. A home rule municipality to which this Section
8applies must comply with every provision of this Section.
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;
16100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
171-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
18eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
19revised 10-16-19.)
 
20    (Text of Section after amendment by P.A. 101-625)
21    Sec. 10-4-2.3. Required health benefits. If a
22municipality, including a home rule municipality, is a
23self-insurer for purposes of providing health insurance
24coverage for its employees, the coverage shall include coverage
25for the post-mastectomy care benefits required to be covered by

 

 

HB4847- 8 -LRB101 19329 BMS 68798 b

1a policy of accident and health insurance under Section 356t
2and the coverage required under Sections 356g, 356g.5,
3356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10,
4356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25,
5356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, 356z.36, and
6356z.41, and 356z.43 of the Illinois Insurance Code. The
7coverage shall comply with Sections 155.22a, 355b, 356z.19, and
8370c of the Illinois Insurance Code. The Department of
9Insurance shall enforce the requirements of this Section. The
10requirement that health benefits be covered as provided in this
11is an exclusive power and function of the State and is a denial
12and limitation under Article VII, Section 6, subsection (h) of
13the Illinois Constitution. A home rule municipality to which
14this Section applies must comply with every provision of this
15Section.
16    Rulemaking authority to implement Public Act 95-1045, if
17any, is conditioned on the rules being adopted in accordance
18with all provisions of the Illinois Administrative Procedure
19Act and all rules and procedures of the Joint Committee on
20Administrative Rules; any purported rule not so adopted, for
21whatever reason, is unauthorized.
22(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
23100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
241-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
25eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
26101-625, eff. 1-1-21.)
 

 

 

HB4847- 9 -LRB101 19329 BMS 68798 b

1    Section 20. The School Code is amended by changing Section
210-22.3f as follows:
 
3    (105 ILCS 5/10-22.3f)
4    (Text of Section before amendment by P.A. 101-625)
5    Sec. 10-22.3f. Required health benefits. Insurance
6protection and benefits for employees shall provide the
7post-mastectomy care benefits required to be covered by a
8policy of accident and health insurance under Section 356t and
9the coverage required under Sections 356g, 356g.5, 356g.5-1,
10356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11, 356z.12,
11356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
12356z.30a, and 356z.32, and 356z.33, 356z.36, and 356z.43 of the
13Illinois Insurance Code. Insurance policies shall comply with
14Section 356z.19 of the Illinois Insurance Code. The coverage
15shall comply with Sections 155.22a, 355b, and 370c of the
16Illinois Insurance Code. The Department of Insurance shall
17enforce the requirements of this Section.
18    Rulemaking authority to implement Public Act 95-1045, if
19any, is conditioned on the rules being adopted in accordance
20with all provisions of the Illinois Administrative Procedure
21Act and all rules and procedures of the Joint Committee on
22Administrative Rules; any purported rule not so adopted, for
23whatever reason, is unauthorized.
24(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;

 

 

HB4847- 10 -LRB101 19329 BMS 68798 b

1100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
21-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
3eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
4revised 10-16-19.)
 
5    (Text of Section after amendment by P.A. 101-625)
6    Sec. 10-22.3f. Required health benefits. Insurance
7protection and benefits for employees shall provide the
8post-mastectomy care benefits required to be covered by a
9policy of accident and health insurance under Section 356t and
10the coverage required under Sections 356g, 356g.5, 356g.5-1,
11356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11, 356z.12,
12356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
13356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41, and 356z.43
14of the Illinois Insurance Code. Insurance policies shall comply
15with Section 356z.19 of the Illinois Insurance Code. The
16coverage shall comply with Sections 155.22a, 355b, and 370c of
17the Illinois Insurance Code. The Department of Insurance shall
18enforce the requirements of this Section.
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.
25(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;

 

 

HB4847- 11 -LRB101 19329 BMS 68798 b

1100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
21-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
3eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
4101-625, eff. 1-1-21.)
 
5    Section 25. The Illinois Insurance Code is amended by
6changing Sections 356u and 356x and by adding Section 356z.43
7as follows:
 
8    (215 ILCS 5/356u)
9    Sec. 356u. Pap tests and prostate-specific antigen tests.
10    (a) A group policy of accident and health insurance that
11provides coverage for hospital or medical treatment or services
12for illness on an expense-incurred basis and is amended,
13delivered, issued, or renewed after the effective date of this
14amendatory Act of 1997 shall provide coverage for all of the
15following:
16        (1) An annual cervical smear or Pap smear test for
17    female insureds.
18        (2) An annual digital rectal examination and a
19    prostate-specific antigen test, for male insureds upon the
20    recommendation of a physician licensed to practice
21    medicine in all its branches for:
22            (A) asymptomatic men age 50 and over;
23            (B) African-American men age 40 and over; and
24            (C) men age 40 and over with a family history of

 

 

HB4847- 12 -LRB101 19329 BMS 68798 b

1        prostate cancer.
2        (3) Surveillance tests for ovarian cancer for female
3    insureds who are at risk for ovarian cancer.
4    (b) This Section shall not apply to agreements, contracts,
5or policies that provide coverage for a specified disease or
6other limited benefit coverage.
7    (c) For the purposes of this Section:
8    "At risk for ovarian cancer" means:
9        (1) having a family history (i) with one or more
10    first-degree relatives with ovarian cancer, (ii) of
11    clusters of women relatives with breast cancer, or (iii) of
12    nonpolyposis colorectal cancer; or
13        (2) testing positive for BRCA1 or BRCA2 mutations.
14    "Surveillance tests for ovarian cancer" means annual
15screening using (i) CA-125 serum tumor marker testing, (ii)
16transvaginal ultrasound, (iii) pelvic examination.
17(Source: P.A. 94-122, eff. 1-1-06.)
 
18    (215 ILCS 5/356x)
19    Sec. 356x. Coverage for colorectal cancer examination and
20screening.
21    (a) An individual or group policy of accident and health
22insurance or a managed care plan that is amended, delivered,
23issued, or renewed on or after the effective date of this
24amendatory Act of the 93rd General Assembly that provides
25coverage to a resident of this State must provide benefits or

 

 

HB4847- 13 -LRB101 19329 BMS 68798 b

1coverage for all colorectal cancer examinations and laboratory
2tests for colorectal cancer as prescribed by a physician, in
3accordance with the published American Cancer Society
4guidelines on colorectal cancer screening or other existing
5colorectal cancer screening guidelines issued by nationally
6recognized professional medical societies or federal
7government agencies, including the National Cancer Institute,
8the Centers for Disease Control and Prevention, and the
9American College of Gastroenterology.
10    (b) Coverage required under this Section may not impose any
11deductible, coinsurance, waiting period, or other cost-sharing
12limitation that is greater than that required for other
13coverage under the policy.
14(Source: P.A. 93-568, eff. 1-1-04.)
 
15    (215 ILCS 5/356z.43 new)
16    Sec. 356z.43. Coverage for sexually transmitted disease
17testing. A group or individual policy of accident and health
18insurance amended, delivered, issued, or renewed after the
19effective date of this amendatory Act of the 101st General
20Assembly shall provide coverage for testing to establish the
21presence or absence of sexually transmitted diseases or
22infections.
 
23    Section 30. The Health Maintenance Organization Act is
24amended by changing Section 5-3 as follows:
 

 

 

HB4847- 14 -LRB101 19329 BMS 68798 b

1    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
2    (Text of Section before amendment by P.A. 101-625)
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.4a, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11,
10356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.18, 356z.19,
11356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30,
12356z.30a, 356z.32, 356z.33, 356z.35, 356z.36, 356z.43, 364,
13364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c, 368d, 368e,
14370c, 370c.1, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412,
15444, and 444.1, paragraph (c) of subsection (2) of Section 367,
16and Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV,
17XXVI, and XXXIIB of the 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

 

 

HB4847- 15 -LRB101 19329 BMS 68798 b

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;

 

 

HB4847- 16 -LRB101 19329 BMS 68798 b

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

 

 

HB4847- 17 -LRB101 19329 BMS 68798 b

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

 

 

HB4847- 18 -LRB101 19329 BMS 68798 b

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

 

 

HB4847- 19 -LRB101 19329 BMS 68798 b

1whatever reason, is unauthorized.
2(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
3100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff.
41-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81,
5eff. 7-12-19; 101-281, eff. 1-1-20; 101-371, eff. 1-1-20;
6101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
71-1-20; revised 10-16-19.)
 
8    (Text of Section after amendment by P.A. 101-625)
9    Sec. 5-3. Insurance Code provisions.
10    (a) Health Maintenance Organizations shall be subject to
11the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
12141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
13154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2, 355.3,
14355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2, 356z.4,
15356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11,
16356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.18, 356z.19,
17356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30,
18356z.30a, 356z.32, 356z.33, 356z.35, 356z.36, 356z.41,
19356z.43, 364, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c,
20368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A, 408,
21408.2, 409, 412, 444, and 444.1, paragraph (c) of subsection
22(2) of Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2,
23XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the Illinois Insurance
24Code.
25    (b) For purposes of the Illinois Insurance Code, except for

 

 

HB4847- 20 -LRB101 19329 BMS 68798 b

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

 

 

HB4847- 21 -LRB101 19329 BMS 68798 b

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

 

 

HB4847- 22 -LRB101 19329 BMS 68798 b

1    (e) In considering any management contract or service
2agreement subject to Section 141.1 of the Illinois Insurance
3Code, the Director (i) shall, in addition to the criteria
4specified in Section 141.2 of the Illinois Insurance Code, take
5into account the effect of the management contract or service
6agreement on the continuation of benefits to enrollees and the
7financial condition of the health maintenance organization to
8be managed or serviced, and (ii) need not take into account the
9effect of the management contract or service agreement on
10competition.
11    (f) Except for small employer groups as defined in the
12Small Employer Rating, Renewability and Portability Health
13Insurance Act and except for medicare supplement policies as
14defined in Section 363 of the Illinois Insurance Code, a Health
15Maintenance Organization may by contract agree with a group or
16other enrollment unit to effect refunds or charge additional
17premiums under the following terms and conditions:
18        (i) the amount of, and other terms and conditions with
19    respect to, the refund or additional premium are set forth
20    in the group or enrollment unit contract agreed in advance
21    of the period for which a refund is to be paid or
22    additional premium is to be charged (which period shall not
23    be less than one year); and
24        (ii) the amount of the refund or additional premium
25    shall not exceed 20% of the Health Maintenance
26    Organization's profitable or unprofitable experience with

 

 

HB4847- 23 -LRB101 19329 BMS 68798 b

1    respect to the group or other enrollment unit for the
2    period (and, for purposes of a refund or additional
3    premium, the profitable or unprofitable experience shall
4    be calculated taking into account a pro rata share of the
5    Health Maintenance Organization's administrative and
6    marketing expenses, but shall not include any refund to be
7    made or additional premium to be paid pursuant to this
8    subsection (f)). The Health Maintenance Organization and
9    the group or enrollment unit may agree that the profitable
10    or unprofitable experience may be calculated taking into
11    account the refund period and the immediately preceding 2
12    plan years.
13    The Health Maintenance Organization shall include a
14statement in the evidence of coverage issued to each enrollee
15describing the possibility of a refund or additional premium,
16and upon request of any group or enrollment unit, provide to
17the group or enrollment unit a description of the method used
18to calculate (1) the Health Maintenance Organization's
19profitable experience with respect to the group or enrollment
20unit and the resulting refund to the group or enrollment unit
21or (2) the Health Maintenance Organization's unprofitable
22experience with respect to the group or enrollment unit and the
23resulting additional premium to be paid by the group or
24enrollment unit.
25    In no event shall the Illinois Health Maintenance
26Organization Guaranty Association be liable to pay any

 

 

HB4847- 24 -LRB101 19329 BMS 68798 b

1contractual obligation of an insolvent organization to pay any
2refund authorized under this Section.
3    (g) Rulemaking authority to implement Public Act 95-1045,
4if any, 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. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
10100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff.
111-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81,
12eff. 7-12-19; 101-281, eff. 1-1-20; 101-371, eff. 1-1-20;
13101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
141-1-20; 101-625, eff. 1-1-21.)
 
15    Section 35. The Limited Health Service Organization Act is
16amended by changing Section 4003 as follows:
 
17    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
18    (Text of Section before amendment by P.A. 101-625)
19    Sec. 4003. Illinois Insurance Code provisions. Limited
20health service organizations shall be subject to the provisions
21of Sections 133, 134, 136, 137, 139, 140, 141.1, 141.2, 141.3,
22143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5, 154.6,
23154.7, 154.8, 155.04, 155.37, 355.2, 355.3, 355b, 356v,
24356z.10, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29,

 

 

HB4847- 25 -LRB101 19329 BMS 68798 b

1356z.30a, 356z.32, 356z.33, 356z.43, 368a, 401, 401.1, 402,
2403, 403A, 408, 408.2, 409, 412, 444, and 444.1 and Articles
3IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and XXVI of
4the Illinois Insurance Code. For purposes of the Illinois
5Insurance Code, except for Sections 444 and 444.1 and Articles
6XIII and XIII 1/2, limited health service organizations in the
7following categories are deemed 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% or 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. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
16100-201, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1057, eff.
171-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
18eff. 1-1-20; 101-393, eff. 1-1-20; revised 10-16-19.)
 
19    (Text of Section after amendment by P.A. 101-625)
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, 355b, 356v,
25356z.10, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29,

 

 

HB4847- 26 -LRB101 19329 BMS 68798 b

1356z.30a, 356z.32, 356z.33, 356z.41, 356z.43, 368a, 401,
2401.1, 402, 403, 403A, 408, 408.2, 409, 412, 444, and 444.1 and
3Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and
4XXVI of the Illinois Insurance Code. For purposes of the
5Illinois Insurance Code, except for Sections 444 and 444.1 and
6Articles XIII and XIII 1/2, limited health service
7organizations in the following categories are deemed to be
8domestic companies:
9        (1) a corporation under the laws of this State; or
10        (2) a corporation organized under the laws of another
11    state, 30% or more of the enrollees of which are residents
12    of this State, except a corporation subject to
13    substantially the same requirements in its state of
14    organization as is a domestic company under Article VIII
15    1/2 of the Illinois Insurance Code.
16(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
17100-201, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1057, eff.
181-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
19eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff. 1-1-21.)
 
20    Section 40. The Voluntary Health Services Plans Act is
21amended by changing Section 10 as follows:
 
22    (215 ILCS 165/10)  (from Ch. 32, par. 604)
23    (Text of Section before amendment by P.A. 101-625)
24    Sec. 10. Application of Insurance Code provisions. Health

 

 

HB4847- 27 -LRB101 19329 BMS 68798 b

1services plan corporations and all persons interested therein
2or dealing therewith shall be subject to the provisions of
3Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
4143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, 356g,
5356g.5, 356g.5-1, 356r, 356t, 356u, 356v, 356w, 356x, 356y,
6356z.1, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8,
7356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
8356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29,
9356z.30, 356z.30a, 356z.32, 356z.33, 356z.43, 364.01, 367.2,
10368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412, and
11paragraphs (7) and (15) of Section 367 of the Illinois
12Insurance Code.
13    Rulemaking authority to implement Public Act 95-1045, if
14any, is conditioned on the rules being adopted in accordance
15with all provisions of the Illinois Administrative Procedure
16Act and all rules and procedures of the Joint Committee on
17Administrative Rules; any purported rule not so adopted, for
18whatever reason, is unauthorized.
19(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
20100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff.
211-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81,
22eff. 7-12-19; 101-281, eff. 1-1-20; 101-393, eff. 1-1-20;
23revised 10-16-19.)
 
24    (Text of Section after amendment by P.A. 101-625)
25    Sec. 10. Application of Insurance Code provisions. Health

 

 

HB4847- 28 -LRB101 19329 BMS 68798 b

1services plan corporations and all persons interested therein
2or dealing therewith shall be subject to the provisions of
3Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
4143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, 356g,
5356g.5, 356g.5-1, 356r, 356t, 356u, 356v, 356w, 356x, 356y,
6356z.1, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8,
7356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
8356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29,
9356z.30, 356z.30a, 356z.32, 356z.33, 356z.41, 356z.43, 364.01,
10367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412,
11and paragraphs (7) and (15) of Section 367 of the Illinois
12Insurance Code.
13    Rulemaking authority to implement Public Act 95-1045, if
14any, is conditioned on the rules being adopted in accordance
15with all provisions of the Illinois Administrative Procedure
16Act and all rules and procedures of the Joint Committee on
17Administrative Rules; any purported rule not so adopted, for
18whatever reason, is unauthorized.
19(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
20100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff.
211-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81,
22eff. 7-12-19; 101-281, eff. 1-1-20; 101-393, eff. 1-1-20;
23101-625, eff. 1-1-21.)
 
24    Section 45. The Illinois Public Aid Code is amended by
25changing Section 5-16.8 as follows:
 

 

 

HB4847- 29 -LRB101 19329 BMS 68798 b

1    (305 ILCS 5/5-16.8)
2    Sec. 5-16.8. Required health benefits. The medical
3assistance program shall (i) provide the post-mastectomy care
4benefits required to be covered by a policy of accident and
5health insurance under Section 356t and the coverage required
6under Sections 356g.5, 356u, 356w, 356x, 356z.6, 356z.26,
7356z.29, and 356z.32, and 356z.33, 356z.34, 356z.35, 356z.39,
8and 356z.43 of the Illinois Insurance Code and (ii) be subject
9to the provisions of Sections 356z.19, 364.01, 370c, and 370c.1
10of the Illinois Insurance Code.
11    On and after July 1, 2012, the Department shall reduce any
12rate of reimbursement for services or other payments or alter
13any methodologies authorized by this Code to reduce any rate of
14reimbursement for services or other payments in accordance with
15Section 5-5e.
16    To ensure full access to the benefits set forth in this
17Section, on and after January 1, 2016, the Department shall
18ensure that provider and hospital reimbursement for
19post-mastectomy care benefits required under this Section are
20no lower than the Medicare reimbursement rate.
21(Source: P.A. 100-138, eff. 8-18-17; 100-863, eff. 8-14-18;
22100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff.
237-12-19; 101-218, eff. 1-1-20; 101-281, eff. 1-1-20; 101-371,
24eff. 1-1-20; 101-574, eff. 1-1-20; revised 10-16-19.)
 

 

 

HB4847- 30 -LRB101 19329 BMS 68798 b

1    Section 95. No acceleration or delay. Where this Act makes
2changes in a statute that is represented in this Act by text
3that is not yet or no longer in effect (for example, a Section
4represented by multiple versions), the use of that text does
5not accelerate or delay the taking effect of (i) the changes
6made by this Act or (ii) provisions derived from any other
7Public Act.
 
8    Section 999. Effective date. This Act takes effect upon
9becoming law.