103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
SB0311

 

Introduced 2/2/2023, 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.61 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.


LRB103 26159 BMS 52517 b

STATE MANDATES ACT MAY REQUIRE REIMBURSEMENT
MAY APPLY

 

 

A BILL FOR

 

SB0311LRB103 26159 BMS 52517 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. 102-768)
8    Sec. 6.11. Required health benefits; Illinois Insurance
9Code requirements. The program of health benefits shall
10provide the post-mastectomy care benefits required to be
11covered by a policy of accident and health insurance under
12Section 356t of the Illinois Insurance Code. The program of
13health benefits shall provide the coverage required under
14Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x,
15356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
16356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,
17356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
18356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
19356z.53, 356z.54, 356z.56, 356z.57, 356z.59, and 356z.60 of
20the Illinois Insurance Code. The program of health benefits
21must comply with Sections 155.22a, 155.37, 355b, 356z.19,
22370c, and 370c.1 and Article XXXIIB of the Illinois Insurance
23Code. The Department of Insurance shall enforce the

 

 

SB0311- 2 -LRB103 26159 BMS 52517 b

1requirements of this Section with respect to Sections 370c and
2370c.1 of the Illinois Insurance Code; all other requirements
3of this Section shall be enforced by the Department of Central
4Management Services.
5    Rulemaking authority to implement Public Act 95-1045, if
6any, is conditioned on the rules being adopted in accordance
7with all provisions of the Illinois Administrative Procedure
8Act and all rules and procedures of the Joint Committee on
9Administrative Rules; any purported rule not so adopted, for
10whatever reason, is unauthorized.
11(Source: P.A. 101-13, eff. 6-12-19; 101-281, eff. 1-1-20;
12101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
131-1-20; 101-625, eff. 1-1-21; 102-30, eff. 1-1-22; 102-103,
14eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
15102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff.
161-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816,
17eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
18revised 12-13-22.)
 
19    (Text of Section after amendment by P.A. 102-768)
20    Sec. 6.11. Required health benefits; Illinois Insurance
21Code requirements. The program of health benefits shall
22provide the post-mastectomy care benefits required to be
23covered by a policy of accident and health insurance under
24Section 356t of the Illinois Insurance Code. The program of
25health benefits shall provide the coverage required under

 

 

SB0311- 3 -LRB103 26159 BMS 52517 b

1Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x,
2356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
3356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,
4356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
5356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
6356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59, and
7356z.60, and 356z.61 of the Illinois Insurance Code. The
8program of health benefits must comply with Sections 155.22a,
9155.37, 355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of
10the Illinois Insurance Code. The Department of Insurance shall
11enforce the requirements of this Section with respect to
12Sections 370c and 370c.1 of the Illinois Insurance Code; all
13other requirements of this Section shall be enforced by the
14Department of Central Management Services.
15    Rulemaking authority to implement Public Act 95-1045, if
16any, is conditioned on the rules being adopted in accordance
17with all provisions of the Illinois Administrative Procedure
18Act and all rules and procedures of the Joint Committee on
19Administrative Rules; any purported rule not so adopted, for
20whatever reason, is unauthorized.
21(Source: P.A. 101-13, eff. 6-12-19; 101-281, eff. 1-1-20;
22101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
231-1-20; 101-625, eff. 1-1-21; 102-30, eff. 1-1-22; 102-103,
24eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
25102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff.
261-1-23; 102-768, eff. 1-1-24; 102-804, eff. 1-1-23; 102-813,

 

 

SB0311- 4 -LRB103 26159 BMS 52517 b

1eff. 5-13-22; 102-816, eff. 1-1-23; 102-860, eff. 1-1-23;
2102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23.)
 
3    Section 10. The Counties Code is amended by changing
4Section 5-1069.3 as follows:
 
5    (55 ILCS 5/5-1069.3)
6    Sec. 5-1069.3. Required health benefits. If a county,
7including a home rule county, is a self-insurer for purposes
8of providing health insurance coverage for its employees, the
9coverage shall include coverage for the post-mastectomy care
10benefits required to be covered by a policy of accident and
11health insurance under Section 356t and the coverage required
12under Sections 356g, 356g.5, 356g.5-1, 356q, 356u, 356w, 356x,
13356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11,
14356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26,
15356z.29, 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40,
16356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53,
17356z.54, 356z.56, 356z.57, 356z.59, and 356z.60, and 356z.61
18of the Illinois Insurance Code. The coverage shall comply with
19Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
20Insurance Code. The Department of Insurance shall enforce the
21requirements of this Section. The requirement that health
22benefits be covered as provided in this Section is an
23exclusive power and function of the State and is a denial and
24limitation under Article VII, Section 6, subsection (h) of the

 

 

SB0311- 5 -LRB103 26159 BMS 52517 b

1Illinois Constitution. A home rule county to which this
2Section applies must comply with every provision of this
3Section.
4    Rulemaking authority to implement Public Act 95-1045, if
5any, is conditioned on the rules being adopted in accordance
6with all provisions of the Illinois Administrative Procedure
7Act and all rules and procedures of the Joint Committee on
8Administrative Rules; any purported rule not so adopted, for
9whatever reason, is unauthorized.
10(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
11101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
121-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
13eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22;
14102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff.
151-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816,
16eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
17102-1117, eff. 1-13-23.)
 
18    Section 15. The Illinois Municipal Code is amended by
19changing Section 10-4-2.3 as follows:
 
20    (65 ILCS 5/10-4-2.3)
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

 

 

SB0311- 6 -LRB103 26159 BMS 52517 b

1coverage for the post-mastectomy care benefits required to be
2covered by a policy of accident and health insurance under
3Section 356t and the coverage required under Sections 356g,
4356g.5, 356g.5-1, 356q, 356u, 356w, 356x, 356z.4, 356z.4a,
5356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
6356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
7356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
8356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
9356z.56, 356z.57, 356z.59, and 356z.60, and 356z.61 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 is an exclusive power
15and function of the State and is a denial and limitation under
16Article VII, Section 6, subsection (h) of the Illinois
17Constitution. A home rule municipality to which this Section
18applies must 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. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
26101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.

 

 

SB0311- 7 -LRB103 26159 BMS 52517 b

11-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
2eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22;
3102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff.
41-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816,
5eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
6102-1117, eff. 1-13-23.)
 
7    Section 20. The School Code is amended by changing Section
810-22.3f as follows:
 
9    (105 ILCS 5/10-22.3f)
10    Sec. 10-22.3f. Required health benefits. Insurance
11protection and benefits for employees shall provide the
12post-mastectomy care benefits required to be covered by a
13policy of accident and health insurance under Section 356t and
14the coverage required under Sections 356g, 356g.5, 356g.5-1,
15356q, 356u, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8,
16356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
17356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
18356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
19356z.53, 356z.54, 356z.56, 356z.57, 356z.59, and 356z.60, and
20356z.61 of the Illinois Insurance Code. Insurance policies
21shall comply with Section 356z.19 of the Illinois Insurance
22Code. The coverage shall comply with Sections 155.22a, 355b,
23and 370c of the Illinois Insurance Code. The Department of
24Insurance shall enforce the requirements of this Section.

 

 

SB0311- 8 -LRB103 26159 BMS 52517 b

1    Rulemaking authority to implement Public Act 95-1045, if
2any, is conditioned on the rules being adopted in accordance
3with all provisions of the Illinois Administrative Procedure
4Act and all rules and procedures of the Joint Committee on
5Administrative Rules; any purported rule not so adopted, for
6whatever reason, is unauthorized.
7(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
8101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
91-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
10eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. 1-1-22;
11102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804, eff.
121-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860,
13eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23.)
 
14    Section 25. The Illinois Insurance Code is amended by
15adding Section 356z.61 as follows:
 
16    (215 ILCS 5/356z.61 new)
17    Sec. 356z.61. Coverage for hippotherapy and therapeutic
18riding.
19    (a) As used in this Section:
20    "Disability" means a determinable physical or mental
21characteristic of a person, including, but not limited to, a
22determinable physical characteristic that necessitates the
23person's use of a guide, hearing, or support dog, that may
24result from a disease, injury, or congenital condition of

 

 

SB0311- 9 -LRB103 26159 BMS 52517 b

1birth or a functional disorder.
2    "Hippotherapy" means physical, occupational, or speech
3therapy, prescribed by a physician and delivered by a licensed
4occupational therapist, physical therapist, or speech-language
5pathologist, in conjunction with a professional horse handler
6and a therapy horse.
7    "Therapeutic riding" means horseback riding lessons
8adapted to an individual with a disability, delivered by a
9professional horse handler and a therapy horse.
10    (b) A group or individual policy of accident and health
11insurance or managed care plan that is amended, delivered,
12issued, or renewed after the effective date of this amendatory
13Act of the 103rd General Assembly shall provide coverage for
14hippotherapy and other forms of therapeutic riding.
 
15    Section 30. The Health Maintenance Organization Act is
16amended by changing Section 5-3 as follows:
 
17    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
18    Sec. 5-3. Insurance Code provisions.
19    (a) Health Maintenance Organizations shall be subject to
20the provisions of Sections 133, 134, 136, 137, 139, 140,
21141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
22154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2,
23355.3, 355b, 355c, 356g.5-1, 356m, 356q, 356v, 356w, 356x,
24356y, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6,

 

 

SB0311- 10 -LRB103 26159 BMS 52517 b

1356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14,
2356z.15, 356z.17, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25,
3356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33,
4356z.35, 356z.36, 356z.40, 356z.41, 356z.46, 356z.47, 356z.48,
5356z.50, 356z.51, 356z.53 256z.53, 356z.54, 356z.56, 356z.57,
6356z.59, 356z.60, 356z.61, 364, 364.01, 364.3, 367.2, 367.2-5,
7367i, 368a, 368b, 368c, 368d, 368e, 370c, 370c.1, 401, 401.1,
8402, 403, 403A, 408, 408.2, 409, 412, 444, and 444.1,
9paragraph (c) of subsection (2) of Section 367, and Articles
10IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and
11XXXIIB of the Illinois Insurance Code.
12    (b) For purposes of the Illinois Insurance Code, except
13for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
14Health Maintenance Organizations in the following categories
15are deemed to be "domestic companies":
16        (1) a corporation authorized under the Dental Service
17    Plan Act or the Voluntary Health Services Plans Act;
18        (2) a corporation organized under the laws of this
19    State; or
20        (3) a corporation organized under the laws of another
21    state, 30% or more of the enrollees of which are residents
22    of this State, except a corporation subject to
23    substantially the same requirements in its state of
24    organization as is a "domestic company" under Article VIII
25    1/2 of the Illinois Insurance Code.
26    (c) In considering the merger, consolidation, or other

 

 

SB0311- 11 -LRB103 26159 BMS 52517 b

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

 

 

SB0311- 12 -LRB103 26159 BMS 52517 b

1            (C) a pro forma business plan detailing an
2        acquiring party's plans with respect to the operation
3        of the Health Maintenance Organization sought to be
4        acquired for a period of not less than 3 years; and
5            (D) such other information as the Director shall
6        require.
7    (d) The provisions of Article VIII 1/2 of the Illinois
8Insurance Code and this Section 5-3 shall apply to the sale by
9any health maintenance organization of greater than 10% of its
10enrollee population (including without limitation the health
11maintenance organization's right, title, and interest in and
12to its health care certificates).
13    (e) In considering any management contract or service
14agreement subject to Section 141.1 of the Illinois Insurance
15Code, the Director (i) shall, in addition to the criteria
16specified in Section 141.2 of the Illinois Insurance Code,
17take into account the effect of the management contract or
18service agreement on the continuation of benefits to enrollees
19and the financial condition of the health maintenance
20organization to be managed or serviced, and (ii) need not take
21into account the effect of the management contract or service
22agreement on competition.
23    (f) Except for small employer groups as defined in the
24Small Employer Rating, Renewability and Portability Health
25Insurance Act and except for medicare supplement policies as
26defined in Section 363 of the Illinois Insurance Code, a

 

 

SB0311- 13 -LRB103 26159 BMS 52517 b

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

 

 

SB0311- 14 -LRB103 26159 BMS 52517 b

1describing the possibility of a refund or additional premium,
2and upon request of any group or enrollment unit, provide to
3the group or enrollment unit a description of the method used
4to calculate (1) the Health Maintenance Organization's
5profitable experience with respect to the group or enrollment
6unit and the resulting refund to the group or enrollment unit
7or (2) the Health Maintenance Organization's unprofitable
8experience with respect to the group or enrollment unit and
9the resulting additional premium to be paid by the group or
10enrollment unit.
11    In no event shall the Illinois Health Maintenance
12Organization Guaranty Association be liable to pay any
13contractual obligation of an insolvent organization to pay any
14refund authorized under this Section.
15    (g) Rulemaking authority to implement Public Act 95-1045,
16if any, is conditioned on the rules being adopted in
17accordance with all provisions of the Illinois Administrative
18Procedure Act and all rules and procedures of the Joint
19Committee on Administrative Rules; any purported rule not so
20adopted, for whatever reason, is unauthorized.
21(Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19;
22101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-393, eff.
231-1-20; 101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625,
24eff. 1-1-21; 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
25102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
261-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,

 

 

SB0311- 15 -LRB103 26159 BMS 52517 b

1eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
2102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
31-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
4eff. 1-1-23; 102-1117, eff. 1-13-23; revised 1-22-23.)
 
5    Section 95. No acceleration or delay. Where this Act makes
6changes in a statute that is represented in this Act by text
7that is not yet or no longer in effect (for example, a Section
8represented by multiple versions), the use of that text does
9not accelerate or delay the taking effect of (i) the changes
10made by this Act or (ii) provisions derived from any other
11Public Act.