Sen. Julie A. Morrison

Filed: 3/8/2024

 

 


 

 


 
10300SB2697sam001LRB103 35895 RPS 70819 a

1
AMENDMENT TO SENATE BILL 2697

2    AMENDMENT NO. ______. Amend Senate Bill 2697 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The State Employees Group Insurance Act of
51971 is 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, 356q, 356u, 356u.10,
14356w, 356x, 356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9,
15356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17,
16356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32,

 

 

10300SB2697sam001- 2 -LRB103 35895 RPS 70819 a

1356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
2356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59,
3356z.60, and 356z.61, and 356z.62, 356z.64, 356z.67, 356z.68,
4and 356z.70 of the Illinois Insurance Code. The program of
5health benefits must comply with Sections 155.22a, 155.37,
6355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of the
7Illinois Insurance Code. The program of health benefits shall
8provide the coverage required under Section 356m of the
9Illinois Insurance Code and, for the employees of the State
10Employee Group Insurance Program only, the coverage as also
11provided in Section 6.11B of this Act. The Department of
12Insurance shall enforce the requirements of this Section with
13respect to Sections 370c and 370c.1 of the Illinois Insurance
14Code; all other requirements of this Section shall be enforced
15by the Department of Central Management Services.
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. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
23102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
241-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-768,
25eff. 1-1-24; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
26102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.

 

 

10300SB2697sam001- 3 -LRB103 35895 RPS 70819 a

11-1-23; 102-1117, eff. 1-13-23; 103-8, eff. 1-1-24; 103-84,
2eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, eff. 1-1-24;
3103-445, eff. 1-1-24; 103-535, eff. 8-11-23; 103-551, eff.
48-11-23; revised 8-29-23.)
 
5    Section 10. The Counties Code is amended by changing
6Section 5-1069.3 as follows:
 
7    (55 ILCS 5/5-1069.3)
8    Sec. 5-1069.3. Required health benefits. If a county,
9including a home rule county, is a self-insurer for purposes
10of providing health insurance coverage for its employees, the
11coverage shall include coverage for the post-mastectomy care
12benefits required to be covered by a policy of accident and
13health insurance under Section 356t and the coverage required
14under Sections 356g, 356g.5, 356g.5-1, 356q, 356u, 356u.10,
15356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
16356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25,
17356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, 356z.36,
18356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51,
19356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and
20356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, and 356z.70
21of the Illinois Insurance Code. The coverage shall comply with
22Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
23Insurance Code. The Department of Insurance shall enforce the
24requirements of this Section. The requirement that health

 

 

10300SB2697sam001- 4 -LRB103 35895 RPS 70819 a

1benefits be covered as provided in this Section is an
2exclusive power and function of the State and is a denial and
3limitation under Article VII, Section 6, subsection (h) of the
4Illinois Constitution. A home rule county to which this
5Section applies must comply with every provision of this
6Section.
7    Rulemaking authority to implement Public Act 95-1045, if
8any, is conditioned on the rules being adopted in accordance
9with all provisions of the Illinois Administrative Procedure
10Act and all rules and procedures of the Joint Committee on
11Administrative Rules; any purported rule not so adopted, for
12whatever reason, is unauthorized.
13(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
14102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
151-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
16eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
17102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
181-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
19eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
20103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised
218-29-23.)
 
22    Section 15. The Illinois Municipal Code is amended by
23changing Section 10-4-2.3 as follows:
 
24    (65 ILCS 5/10-4-2.3)

 

 

10300SB2697sam001- 5 -LRB103 35895 RPS 70819 a

1    Sec. 10-4-2.3. Required health benefits. If a
2municipality, including a home rule municipality, is a
3self-insurer for purposes of providing health insurance
4coverage for its employees, the coverage shall include
5coverage for the post-mastectomy care benefits required to be
6covered by a policy of accident and health insurance under
7Section 356t and the coverage required under Sections 356g,
8356g.5, 356g.5-1, 356q, 356u, 356u.10, 356w, 356x, 356z.4,
9356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
10356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
11356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
12356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
13356z.56, 356z.57, 356z.59, 356z.60, and 356z.61, and 356z.62,
14356z.64, 356z.67, 356z.68, and 356z.70 of the Illinois
15Insurance Code. The coverage shall comply with Sections
16155.22a, 355b, 356z.19, and 370c of the Illinois Insurance
17Code. The Department of Insurance shall enforce the
18requirements of this Section. The requirement that health
19benefits be covered as provided in this is an exclusive power
20and function of the State and is a denial and limitation under
21Article VII, Section 6, subsection (h) of the Illinois
22Constitution. A home rule municipality to which this Section
23applies must 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
26with all provisions of the Illinois Administrative Procedure

 

 

10300SB2697sam001- 6 -LRB103 35895 RPS 70819 a

1Act and all rules and procedures of the Joint Committee on
2Administrative Rules; any purported rule not so adopted, for
3whatever reason, is unauthorized.
4(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
5102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
61-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
7eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
8102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
91-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
10eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
11103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised
128-29-23.)
 
13    Section 20. The School Code is amended by changing Section
1410-22.3f as follows:
 
15    (105 ILCS 5/10-22.3f)
16    Sec. 10-22.3f. Required health benefits. Insurance
17protection and benefits for employees shall provide the
18post-mastectomy care benefits required to be covered by a
19policy of accident and health insurance under Section 356t and
20the coverage required under Sections 356g, 356g.5, 356g.5-1,
21356q, 356u, 356u.10, 356w, 356x, 356z.4, 356z.4a, 356z.6,
22356z.8, 356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
23356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32,
24356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,

 

 

10300SB2697sam001- 7 -LRB103 35895 RPS 70819 a

1356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60,
2and 356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, and
3356z.70 of the Illinois Insurance Code. Insurance policies
4shall comply with Section 356z.19 of the Illinois Insurance
5Code. The coverage shall comply with Sections 155.22a, 355b,
6and 370c of the Illinois Insurance Code. The Department of
7Insurance shall enforce the requirements of this Section.
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. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
15102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
161-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804,
17eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
18102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff.
191-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420,
20eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. 8-11-23;
21103-551, eff. 8-11-23; revised 8-29-23.)
 
22    Section 25. The Illinois Insurance Code is amended by
23adding Section 356u.10 as follows:
 
24    (215 ILCS 5/356u.10 new)

 

 

10300SB2697sam001- 8 -LRB103 35895 RPS 70819 a

1    Sec. 356u.10. Genetic testing and cancer risk management
2for an inherited gene mutation.
3    (a) In this Section, "genetic testing for an inherited
4mutation" means germline multi-gene testing for an inherited
5mutation associated with an increased risk of cancer in
6accordance with evidence-based, clinical practice guidelines.
7    (b) A group policy of accident and health insurance or
8managed care plan that is amended, delivered, issued, or
9renewed after January 1, 2026 shall provide coverage for
10clinical genetic testing for an inherited gene mutation for
11individuals with a personal or family history of cancer as
12recommended by a health care professional in accordance with
13current evidence-based clinical practice guidelines,
14including, but not limited to, the most recent version of the
15National Comprehensive Cancer Network clinical practice
16guidelines. The coverage shall limit the total amount that a
17covered person is required to pay for a clinical genetic test
18under this subsection to an amount not to exceed $50. This
19subsection (b) shall not apply to coverage of genetic testing
20to the extent such coverage would disqualify a high-deductible
21health plan from eligibility for a health savings account
22pursuant to Section 223 of the Internal Revenue Code.
23    (c) For individuals with a genetic test that is positive
24for an inherited mutation associated with an increased risk of
25cancer, coverage required under this Section shall include any
26cancer risk management strategy as recommended by a health

 

 

10300SB2697sam001- 9 -LRB103 35895 RPS 70819 a

1care professional in accordance with current evidence-based
2clinical practice guidelines to the extent that the management
3recommendation is not already covered by the policy, except
4that coverage for risk management under this subsection (c)
5may be subject to a deductible, coinsurance, or other
6cost-sharing limitation so long as such limitation is not
7greater than that required for other related cancer risk
8management benefits covered under the policy.
 
9    Section 30. The Health Maintenance Organization Act is
10amended by changing Section 5-3 as follows:
 
11    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
12    Sec. 5-3. Insurance Code provisions.
13    (a) Health Maintenance Organizations shall be subject to
14the provisions of Sections 133, 134, 136, 137, 139, 140,
15141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
16154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 155.49,
17355.2, 355.3, 355b, 355c, 356f, 356g.5-1, 356m, 356q, 356u.10,
18356v, 356w, 356x, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5,
19356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
20356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.20, 356z.21,
21356z.22, 356z.23, 356z.24, 356z.25, 356z.26, 356z.28, 356z.29,
22356z.30, 356z.30a, 356z.31, 356z.32, 356z.33, 356z.34,
23356z.35, 356z.36, 356z.37, 356z.38, 356z.39, 356z.40, 356z.41,
24356z.44, 356z.45, 356z.46, 356z.47, 356z.48, 356z.49, 356z.50,

 

 

10300SB2697sam001- 10 -LRB103 35895 RPS 70819 a

1356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.58,
2356z.59, 356z.60, 356z.61, 356z.62, 356z.64, 356z.65, 356z.67,
3356z.68, 364, 364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b,
4368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A,
5408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of
6subsection (2) of Section 367, and Articles IIA, VIII 1/2,
7XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the
8Illinois Insurance Code.
9    (b) For purposes of the Illinois Insurance Code, except
10for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
11Health Maintenance Organizations in the following categories
12are deemed to be "domestic companies":
13        (1) a corporation authorized under the Dental Service
14    Plan Act or the Voluntary Health Services Plans Act;
15        (2) a corporation organized under the laws of this
16    State; or
17        (3) a corporation organized under the laws of another
18    state, 30% or more of the enrollees of which are residents
19    of this State, except a corporation subject to
20    substantially the same requirements in its state of
21    organization as is a "domestic company" under Article VIII
22    1/2 of the Illinois Insurance Code.
23    (c) In considering the merger, consolidation, or other
24acquisition of control of a Health Maintenance Organization
25pursuant to Article VIII 1/2 of the Illinois Insurance Code,
26        (1) the Director shall give primary consideration to

 

 

10300SB2697sam001- 11 -LRB103 35895 RPS 70819 a

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

 

 

10300SB2697sam001- 12 -LRB103 35895 RPS 70819 a

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

 

 

10300SB2697sam001- 13 -LRB103 35895 RPS 70819 a

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

 

 

10300SB2697sam001- 14 -LRB103 35895 RPS 70819 a

1to calculate (1) the Health Maintenance Organization's
2profitable experience with respect to the group or enrollment
3unit and the resulting refund to the group or enrollment unit
4or (2) the Health Maintenance Organization's unprofitable
5experience with respect to the group or enrollment unit and
6the resulting additional premium to be paid by the group or
7enrollment unit.
8    In no event shall the Illinois Health Maintenance
9Organization Guaranty Association be liable to pay any
10contractual obligation of an insolvent organization to pay any
11refund authorized under this Section.
12    (g) Rulemaking authority to implement Public Act 95-1045,
13if any, is conditioned on the rules being adopted in
14accordance with all provisions of the Illinois Administrative
15Procedure Act and all rules and procedures of the Joint
16Committee on Administrative Rules; any purported rule not so
17adopted, for whatever reason, is unauthorized.
18(Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
19102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
201-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
21eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
22102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
231-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
24eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;
25103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.
266-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,

 

 

10300SB2697sam001- 15 -LRB103 35895 RPS 70819 a

1eff. 1-1-24; 103-551, eff. 8-11-23; revised 8-29-23.)
 
2    Section 35. The Voluntary Health Services Plans Act is
3amended by changing Section 10 as follows:
 
4    (215 ILCS 165/10)  (from Ch. 32, par. 604)
5    Sec. 10. Application of Insurance Code provisions. Health
6services plan corporations and all persons interested therein
7or dealing therewith shall be subject to the provisions of
8Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
9143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
10356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356u.10, 356v,
11356w, 356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a,
12356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
13356z.13, 356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22,
14356z.25, 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32,
15356z.33, 356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53,
16356z.54, 356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62,
17356z.64, 356z.67, 356z.68, 364.01, 364.3, 367.2, 368a, 401,
18401.1, 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7)
19and (15) of Section 367 of the Illinois Insurance Code.
20    Rulemaking authority to implement Public Act 95-1045, if
21any, is conditioned on the rules being adopted in accordance
22with all provisions of the Illinois Administrative Procedure
23Act and all rules and procedures of the Joint Committee on
24Administrative Rules; any purported rule not so adopted, for

 

 

10300SB2697sam001- 16 -LRB103 35895 RPS 70819 a

1whatever reason, is unauthorized.
2(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
3102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff.
410-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804,
5eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
6102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff.
71-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
8eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
9103-551, eff. 8-11-23; revised 8-29-23.)".