103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
SB2573

 

Introduced 5/3/2023, by Sen. Napoleon Harris, III

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 5/356z.61 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 Accident and Health Article of the Illinois Insurance Code. Provides that a group or individual plan of accident and health insurance or managed care plan amended, delivered, issued, or renewed after the effective date of the amendatory Act must provide coverage for wigs or other scalp prostheses worn for hair loss caused by alopecia, chemotherapy, or radiation treatment for cancer or other conditions. Makes a conforming change in the Health Maintenance Organization Act and the Voluntary Health Services Plans Act. Effective immediately.


LRB103 31822 BMS 60443 b

 

 

A BILL FOR

 

SB2573LRB103 31822 BMS 60443 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 Illinois Insurance Code is amended by
5adding Section 356z.61 as follows:
 
6    (215 ILCS 5/356z.61 new)
7    Sec. 356z.61. Wigs and hair prostheses. A group or
8individual plan of accident and health insurance or managed
9care plan amended, delivered, issued, or renewed after the
10effective date of this amendatory Act of the 103rd General
11Assembly must provide coverage for wigs or other scalp
12prostheses worn for hair loss caused by alopecia,
13chemotherapy, or radiation treatment for cancer or other
14conditions.
 
15    Section 10. 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,

 

 

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1154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2,
2355.3, 355b, 355c, 356g.5-1, 356m, 356q, 356v, 356w, 356x,
3356y, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6,
4356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14,
5356z.15, 356z.17, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25,
6356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33,
7356z.35, 356z.36, 356z.40, 356z.41, 356z.46, 356z.47, 356z.48,
8356z.50, 356z.51, 356z.53 256z.53, 356z.54, 356z.56, 356z.57,
9356z.59, 356z.60, 356z.61, 364, 364.01, 364.3, 367.2, 367.2-5,
10367i, 368a, 368b, 368c, 368d, 368e, 370c, 370c.1, 401, 401.1,
11402, 403, 403A, 408, 408.2, 409, 412, 444, and 444.1,
12paragraph (c) of subsection (2) of Section 367, and Articles
13IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and
14XXXIIB of the Illinois Insurance Code.
15    (b) For purposes of the Illinois Insurance Code, except
16for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
17Health Maintenance Organizations in the following categories
18are deemed to be "domestic companies":
19        (1) a corporation authorized under the Dental Service
20    Plan Act or the Voluntary Health Services Plans Act;
21        (2) a corporation organized under the laws of this
22    State; or
23        (3) a corporation organized under the laws of another
24    state, 30% or more of the enrollees of which are residents
25    of this State, except a corporation subject to
26    substantially the same requirements in its state of

 

 

SB2573- 3 -LRB103 31822 BMS 60443 b

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

 

 

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

 

 

SB2573- 5 -LRB103 31822 BMS 60443 b

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

 

 

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1    plan years.
2    The Health Maintenance Organization shall include a
3statement in the evidence of coverage issued to each enrollee
4describing the possibility of a refund or additional premium,
5and upon request of any group or enrollment unit, provide to
6the group or enrollment unit a description of the method used
7to calculate (1) the Health Maintenance Organization's
8profitable experience with respect to the group or enrollment
9unit and the resulting refund to the group or enrollment unit
10or (2) the Health Maintenance Organization's unprofitable
11experience with respect to the group or enrollment unit and
12the resulting additional premium to be paid by the group or
13enrollment unit.
14    In no event shall the Illinois Health Maintenance
15Organization Guaranty Association be liable to pay any
16contractual obligation of an insolvent organization to pay any
17refund authorized under this Section.
18    (g) Rulemaking authority to implement Public Act 95-1045,
19if any, is conditioned on the rules being adopted in
20accordance with all provisions of the Illinois Administrative
21Procedure Act and all rules and procedures of the Joint
22Committee on Administrative Rules; any purported rule not so
23adopted, for whatever reason, is unauthorized.
24(Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19;
25101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-393, eff.
261-1-20; 101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625,

 

 

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1eff. 1-1-21; 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
2102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
31-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
4eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
5102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
61-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
7eff. 1-1-23; 102-1117, eff. 1-13-23; revised 1-22-23.)
 
8    Section 15. The Voluntary Health Services Plans Act is
9amended by changing Section 10 as follows:
 
10    (215 ILCS 165/10)  (from Ch. 32, par. 604)
11    Sec. 10. Application of Insurance Code provisions. Health
12services plan corporations and all persons interested therein
13or dealing therewith shall be subject to the provisions of
14Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
15143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
16356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356v, 356w,
17356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5,
18356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
19356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25,
20356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33,
21356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
22356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 364.01, 364.3,
23367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412,
24and paragraphs (7) and (15) of Section 367 of the Illinois

 

 

SB2573- 8 -LRB103 31822 BMS 60443 b

1Insurance Code.
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. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19;
9101-281, eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff.
101-1-21; 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; 102-306,
11eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21;
12102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804, eff.
131-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860,
14eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff. 1-1-23;
15102-1117, eff. 1-13-23.)
 
16    Section 99. Effective date. This Act takes effect upon
17becoming law.