102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
SB2241

 

Introduced 2/26/2021, by Sen. Laura M. Murphy

 

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 5/356z.43 new
215 ILCS 125/5-3  from Ch. 111 1/2, par. 1411.2

    Amends the Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance or managed care plan that is amended, delivered, issued, or renewed after the effective date of the amendatory Act shall provide coverage for hippotherapy and other forms of therapeutic riding. Makes conforming changes in the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, and the Health Maintenance Organization Act.


LRB102 17215 BMS 22673 b

FISCAL NOTE ACT MAY APPLY
STATE MANDATES ACT MAY REQUIRE REIMBURSEMENT

 

 

A BILL FOR

 

SB2241LRB102 17215 BMS 22673 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    Sec. 6.11. Required health benefits; Illinois Insurance
8Code requirements. The program of health benefits shall
9provide the post-mastectomy care benefits required to be
10covered by a policy of accident and health insurance under
11Section 356t of the Illinois Insurance Code. The program of
12health benefits shall provide the coverage required under
13Sections 356g, 356g.5, 356g.5-1, 356m, 356u, 356w, 356x,
14356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
15356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,
16356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
17356z.36, and 356z.41, and 356z.43 of the Illinois Insurance
18Code. The program of health benefits must comply with Sections
19155.22a, 155.37, 355b, 356z.19, 370c, and 370c.1 and Article
20XXXIIB of the Illinois Insurance Code. The Department of
21Insurance shall enforce the requirements of this Section with
22respect to Sections 370c and 370c.1 of the Illinois Insurance
23Code; all other requirements of this Section shall be enforced

 

 

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1by the Department of Central Management Services.
2    Rulemaking authority to implement Public Act 95-1045, if
3any, is conditioned on the rules being adopted in accordance
4with all provisions of the Illinois Administrative Procedure
5Act and all rules and procedures of the Joint Committee on
6Administrative Rules; any purported rule not so adopted, for
7whatever reason, is unauthorized.
8(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
9100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
101-1-19; 100-1102, eff. 1-1-19; 100-1170, eff. 6-1-19; 101-13,
11eff. 6-12-19; 101-281, eff. 1-1-20; 101-393, eff. 1-1-20;
12101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
131-1-21.)
 
14    Section 10. The Counties Code is amended by changing
15Section 5-1069.3 as follows:
 
16    (55 ILCS 5/5-1069.3)
17    Sec. 5-1069.3. Required health benefits. If a county,
18including a home rule county, is a self-insurer for purposes
19of providing health insurance coverage for its employees, the
20coverage shall include coverage for the post-mastectomy care
21benefits required to be covered by a policy of accident and
22health insurance under Section 356t and the coverage required
23under Sections 356g, 356g.5, 356g.5-1, 356u, 356w, 356x,
24356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,

 

 

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1356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
2356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41, and 356z.43
3of the Illinois Insurance Code. The coverage shall comply with
4Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
5Insurance Code. The Department of Insurance shall enforce the
6requirements of this Section. The requirement that health
7benefits be covered as provided in this Section is an
8exclusive power and function of the State and is a denial and
9limitation under Article VII, Section 6, subsection (h) of the
10Illinois Constitution. A home rule county to which this
11Section applies must comply with every provision of this
12Section.
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; 100-1024, eff. 1-1-19; 100-1057, eff.
211-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
22eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
23101-625, eff. 1-1-21.)
 
24    Section 15. The Illinois Municipal Code is amended by
25changing Section 10-4-2.3 as follows:
 

 

 

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1    (65 ILCS 5/10-4-2.3)
2    Sec. 10-4-2.3. Required health benefits. If a
3municipality, including a home rule municipality, is a
4self-insurer for purposes of providing health insurance
5coverage for its employees, the coverage shall include
6coverage for the post-mastectomy care benefits required to be
7covered by a policy of accident and health insurance under
8Section 356t and the coverage required under Sections 356g,
9356g.5, 356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9,
10356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
11356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
12356z.36, and 356z.41, and 356z.43 of the Illinois Insurance
13Code. The coverage shall comply with Sections 155.22a, 355b,
14356z.19, and 370c of the Illinois Insurance Code. The
15Department of Insurance shall enforce the requirements of this
16Section. The requirement that health benefits be covered as
17provided in this is an exclusive power and function of the
18State and is a denial and limitation under Article VII,
19Section 6, subsection (h) of the Illinois Constitution. A home
20rule municipality to which this Section applies must comply
21with every provision of this Section.
22    Rulemaking authority to implement Public Act 95-1045, if
23any, 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

 

 

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1Administrative Rules; any purported rule not so adopted, for
2whatever reason, is unauthorized.
3(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
4100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
51-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
6eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
7101-625, eff. 1-1-21.)
 
8    Section 20. The School Code is amended by changing Section
910-22.3f as follows:
 
10    (105 ILCS 5/10-22.3f)
11    Sec. 10-22.3f. Required health benefits. Insurance
12protection and benefits for employees shall provide the
13post-mastectomy care benefits required to be covered by a
14policy of accident and health insurance under Section 356t and
15the coverage required under Sections 356g, 356g.5, 356g.5-1,
16356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11, 356z.12,
17356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
18356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41, and 356z.43
19of the Illinois Insurance Code. Insurance policies shall
20comply with Section 356z.19 of the Illinois Insurance Code.
21The coverage shall comply with Sections 155.22a, 355b, and
22370c of the Illinois Insurance Code. The Department of
23Insurance shall enforce the requirements of this Section.
24    Rulemaking authority to implement Public Act 95-1045, if

 

 

SB2241- 6 -LRB102 17215 BMS 22673 b

1any, is conditioned on the rules being adopted in accordance
2with all provisions of the Illinois Administrative Procedure
3Act and all rules and procedures of the Joint Committee on
4Administrative Rules; any purported rule not so adopted, for
5whatever reason, is unauthorized.
6(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
7100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
81-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
9eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
10101-625, eff. 1-1-21.)
 
11    Section 25. The Illinois Insurance Code is amended by
12adding Section 356z.43 as follows:
 
13    (215 ILCS 5/356z.43 new)
14    Sec. 356z.43. Coverage for hippotherapy and therapeutic
15riding.
16    (a) As used in this Section:
17    "Disability" means a determinable physical or mental
18characteristic of a person, including, but not limited to, a
19determinable physical characteristic that necessitates the
20person's use of a guide, hearing, or support dog, that may
21result from a disease, injury, or congenital condition of
22birth or a functional disorder.
23    "Hippotherapy" means physical, occupational, or speech
24therapy, prescribed by a physician and delivered by a licensed

 

 

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1occupational therapist, physical therapist, or speech-language
2pathologist, in conjunction with a professional horse handler
3and a therapy horse.
4    "Therapeutic riding" means horseback riding lessons
5adapted to an individual with a disability, delivered by a
6professional horse handler and a therapy horse.
7    (b) A group or individual policy of accident and health
8insurance or managed care plan that is amended, delivered,
9issued, or renewed after the effective date of this amendatory
10Act of the 102nd General Assembly shall provide coverage for
11hippotherapy and other forms of therapeutic riding.
 
12    Section 30. The Health Maintenance Organization Act is
13amended by changing Section 5-3 as follows:
 
14    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
15    Sec. 5-3. Insurance Code provisions.
16    (a) Health Maintenance Organizations shall be subject to
17the provisions of Sections 133, 134, 136, 137, 139, 140,
18141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
19154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2,
20355.3, 355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2,
21356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10,
22356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.18,
23356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30,
24356z.30a, 356z.32, 356z.33, 356z.35, 356z.36, 356z.41,

 

 

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1356z.43, 364, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c,
2368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A, 408,
3408.2, 409, 412, 444, and 444.1, paragraph (c) of subsection
4(2) of Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2,
5XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the Illinois
6Insurance Code.
7    (b) For purposes of the Illinois Insurance Code, except
8for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
9Health Maintenance Organizations in the following categories
10are deemed to be "domestic companies":
11        (1) a corporation authorized under the Dental Service
12    Plan Act or the Voluntary Health Services Plans Act;
13        (2) a corporation organized under the laws of this
14    State; or
15        (3) a corporation organized under the laws of another
16    state, 30% or more of the enrollees of which are residents
17    of this State, except a corporation subject to
18    substantially the same requirements in its state of
19    organization as is a "domestic company" under Article VIII
20    1/2 of the Illinois Insurance Code.
21    (c) In considering the merger, consolidation, or other
22acquisition of control of a Health Maintenance Organization
23pursuant to Article VIII 1/2 of the Illinois Insurance Code,
24        (1) the Director shall give primary consideration to
25    the continuation of benefits to enrollees and the
26    financial conditions of the acquired Health Maintenance

 

 

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1    Organization after the merger, consolidation, or other
2    acquisition of control takes effect;
3        (2)(i) the criteria specified in subsection (1)(b) of
4    Section 131.8 of the Illinois Insurance Code shall not
5    apply and (ii) the Director, in making his determination
6    with respect to the merger, consolidation, or other
7    acquisition of control, need not take into account the
8    effect on competition of the merger, consolidation, or
9    other acquisition of control;
10        (3) the Director shall have the power to require the
11    following information:
12            (A) certification by an independent actuary of the
13        adequacy of the reserves of the Health Maintenance
14        Organization sought to be acquired;
15            (B) pro forma financial statements reflecting the
16        combined balance sheets of the acquiring company and
17        the Health Maintenance Organization sought to be
18        acquired as of the end of the preceding year and as of
19        a date 90 days prior to the acquisition, as well as pro
20        forma financial statements reflecting projected
21        combined operation for a period of 2 years;
22            (C) a pro forma business plan detailing an
23        acquiring party's plans with respect to the operation
24        of the Health Maintenance Organization sought to be
25        acquired for a period of not less than 3 years; and
26            (D) such other information as the Director shall

 

 

SB2241- 10 -LRB102 17215 BMS 22673 b

1        require.
2    (d) The provisions of Article VIII 1/2 of the Illinois
3Insurance Code and this Section 5-3 shall apply to the sale by
4any health maintenance organization of greater than 10% of its
5enrollee population (including without limitation the health
6maintenance organization's right, title, and interest in and
7to its health care certificates).
8    (e) In considering any management contract or service
9agreement subject to Section 141.1 of the Illinois Insurance
10Code, the Director (i) shall, in addition to the criteria
11specified in Section 141.2 of the Illinois Insurance Code,
12take into account the effect of the management contract or
13service agreement on the continuation of benefits to enrollees
14and the financial condition of the health maintenance
15organization to be managed or serviced, and (ii) need not take
16into account the effect of the management contract or service
17agreement on competition.
18    (f) Except for small employer groups as defined in the
19Small Employer Rating, Renewability and Portability Health
20Insurance Act and except for medicare supplement policies as
21defined in Section 363 of the Illinois Insurance Code, a
22Health Maintenance Organization may by contract agree with a
23group or other enrollment unit to effect refunds or charge
24additional premiums under the following terms and conditions:
25        (i) the amount of, and other terms and conditions with
26    respect to, the refund or additional premium are set forth

 

 

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1    in the group or enrollment unit contract agreed in advance
2    of the period for which a refund is to be paid or
3    additional premium is to be charged (which period shall
4    not be less than one year); and
5        (ii) the amount of the refund or additional premium
6    shall not exceed 20% of the Health Maintenance
7    Organization's profitable or unprofitable experience with
8    respect to the group or other enrollment unit for the
9    period (and, for purposes of a refund or additional
10    premium, the profitable or unprofitable experience shall
11    be calculated taking into account a pro rata share of the
12    Health Maintenance Organization's administrative and
13    marketing expenses, but shall not include any refund to be
14    made or additional premium to be paid pursuant to this
15    subsection (f)). The Health Maintenance Organization and
16    the group or enrollment unit may agree that the profitable
17    or unprofitable experience may be calculated taking into
18    account the refund period and the immediately preceding 2
19    plan years.
20    The Health Maintenance Organization shall include a
21statement in the evidence of coverage issued to each enrollee
22describing the possibility of a refund or additional premium,
23and upon request of any group or enrollment unit, provide to
24the group or enrollment unit a description of the method used
25to calculate (1) the Health Maintenance Organization's
26profitable experience with respect to the group or enrollment

 

 

SB2241- 12 -LRB102 17215 BMS 22673 b

1unit and the resulting refund to the group or enrollment unit
2or (2) the Health Maintenance Organization's unprofitable
3experience with respect to the group or enrollment unit and
4the resulting additional premium to be paid by the group or
5enrollment unit.
6    In no event shall the Illinois Health Maintenance
7Organization Guaranty Association be liable to pay any
8contractual obligation of an insolvent organization to pay any
9refund authorized under this Section.
10    (g) Rulemaking authority to implement Public Act 95-1045,
11if any, is conditioned on the rules being adopted in
12accordance with all provisions of the Illinois Administrative
13Procedure Act and all rules and procedures of the Joint
14Committee on Administrative Rules; any purported rule not so
15adopted, for whatever reason, is unauthorized.
16(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
17100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff.
181-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81,
19eff. 7-12-19; 101-281, eff. 1-1-20; 101-371, eff. 1-1-20;
20101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
211-1-20; 101-625, eff. 1-1-21.)