95TH GENERAL ASSEMBLY
State of Illinois
2007 and 2008
HB4620

 

Introduced , by Rep. Michael K. Smith

 

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.11 new
215 ILCS 125/5-3   from Ch. 111 1/2, par. 1411.2
215 ILCS 165/10   from Ch. 32, par. 604
305 ILCS 5/5-16.8

    Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Illinois Insurance Code, the Health Maintenance Organization Act, the Voluntary Health Services Plans Act, and the Public Aid Code to provide coverage for heart disease prevention tests for women. Effective immediately.


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FISCAL NOTE ACT MAY APPLY
STATE MANDATES ACT MAY REQUIRE REIMBURSEMENT

 

 

A BILL FOR

 

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1     AN ACT concerning regulation.
 
2     Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
 
4     Section 5. The State Employees Group Insurance Act of 1971
5 is amended by changing Section 6.11 as follows:
 
6     (5 ILCS 375/6.11)
7     Sec. 6.11. Required health benefits; Illinois Insurance
8 Code requirements. The program of health benefits shall provide
9 the post-mastectomy care benefits required to be covered by a
10 policy of accident and health insurance under Section 356t of
11 the Illinois Insurance Code. The program of health benefits
12 shall provide the coverage required under Sections 356g.5,
13 356u, 356w, 356x, 356z.2, 356z.4, 356z.6, and 356z.9, 356z.10,
14 and 356z.11 and 356z.9 of the Illinois Insurance Code. The
15 program of health benefits must comply with Section 155.37 of
16 the Illinois Insurance Code.
17 (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07;
18 95-520, eff. 8-28-07; revised 12-4-07.)
 
19     Section 10. The Counties Code is amended by changing
20 Section 5-1069.3 as follows:
 
21     (55 ILCS 5/5-1069.3)

 

 

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1     Sec. 5-1069.3. Required health benefits. If a county,
2 including a home rule county, is a self-insurer for purposes of
3 providing health insurance coverage for its employees, the
4 coverage shall include coverage for the post-mastectomy care
5 benefits required to be covered by a policy of accident and
6 health insurance under Section 356t and the coverage required
7 under Sections 356g.5, 356u, 356w, 356x, 356z.6, and 356z.9,
8 356z.10, and 356z.11 and 356z.9 of the Illinois Insurance Code.
9 The requirement that health benefits be covered as provided in
10 this Section is an exclusive power and function of the State
11 and is a denial and limitation under Article VII, Section 6,
12 subsection (h) of the Illinois Constitution. A home rule county
13 to which this Section applies must comply with every provision
14 of this Section.
15 (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07;
16 95-520, eff. 8-28-07; revised 12-4-07.)
 
17     Section 15. The Illinois Municipal Code is amended by
18 changing Section 10-4-2.3 as follows:
 
19     (65 ILCS 5/10-4-2.3)
20     Sec. 10-4-2.3. Required health benefits. If a
21 municipality, including a home rule municipality, is a
22 self-insurer for purposes of providing health insurance
23 coverage for its employees, the coverage shall include coverage
24 for the post-mastectomy care benefits required to be covered by

 

 

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1 a policy of accident and health insurance under Section 356t
2 and the coverage required under Sections 356g.5, 356u, 356w,
3 356x, 356z.6, and 356z.9, 356z.10, and 356z.11 and 356z.9 of
4 the Illinois Insurance Code. The requirement that health
5 benefits be covered as provided in this is an exclusive power
6 and function of the State and is a denial and limitation under
7 Article VII, Section 6, subsection (h) of the Illinois
8 Constitution. A home rule municipality to which this Section
9 applies must comply with every provision of this Section.
10 (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07;
11 95-520, eff. 8-28-07; revised 12-4-07.)
 
12     Section 20. The School Code is amended by changing Section
13 10-22.3f as follows:
 
14     (105 ILCS 5/10-22.3f)
15     Sec. 10-22.3f. Required health benefits. Insurance
16 protection and benefits for employees shall provide the
17 post-mastectomy care benefits required to be covered by a
18 policy of accident and health insurance under Section 356t and
19 the coverage required under Sections 356g.5, 356u, 356w, 356x,
20 356z.6, and 356z.9, and 356z.11 of the Illinois Insurance Code.
21 (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07;
22 revised 12-4-07.)
 
23     Section 25. The Illinois Insurance Code is amended by

 

 

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1 adding Section 356z.11 as follows:
 
2     (215 ILCS 5/356z.11 new)
3     Sec. 356z.11. Heart disease prevention testing for women. A
4 group or individual policy of accident and health insurance or
5 managed care plan amended, delivered, issued, or renewed after
6 the effective date of this amendatory Act of the 95th General
7 Assembly must provide coverage for heart disease prevention
8 tests for women including, but not limited to testing for
9 cholesterol and blood sugar.
 
10     Section 30. The Health Maintenance Organization Act is
11 amended by changing Section 5-3 as follows:
 
12     (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
13     Sec. 5-3. Insurance Code provisions.
14     (a) Health Maintenance Organizations shall be subject to
15 the provisions of Sections 133, 134, 137, 140, 141.1, 141.2,
16 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5,
17 154.6, 154.7, 154.8, 155.04, 355.2, 356m, 356v, 356w, 356x,
18 356y, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10,
19 356z.11 356z.9, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c,
20 368d, 368e, 370c, 401, 401.1, 402, 403, 403A, 408, 408.2, 409,
21 412, 444, and 444.1, paragraph (c) of subsection (2) of Section
22 367, and Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2,
23 XXV, and XXVI of the Illinois Insurance Code.

 

 

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1     (b) For purposes of the Illinois Insurance Code, except for
2 Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health
3 Maintenance Organizations in the following categories are
4 deemed to be "domestic companies":
5         (1) a corporation authorized under the Dental Service
6     Plan Act or the Voluntary Health Services Plans Act;
7         (2) a corporation organized under the laws of this
8     State; or
9         (3) 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     (c) In considering the merger, consolidation, or other
16 acquisition of control of a Health Maintenance Organization
17 pursuant to Article VIII 1/2 of the Illinois Insurance Code,
18         (1) the Director shall give primary consideration to
19     the continuation of benefits to enrollees and the financial
20     conditions of the acquired Health Maintenance Organization
21     after the merger, consolidation, or other acquisition of
22     control takes effect;
23         (2)(i) the criteria specified in subsection (1)(b) of
24     Section 131.8 of the Illinois Insurance Code shall not
25     apply and (ii) the Director, in making his determination
26     with respect to the merger, consolidation, or other

 

 

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

 

 

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

 

 

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

 

 

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1 Organization Guaranty Association be liable to pay any
2 contractual obligation of an insolvent organization to pay any
3 refund authorized under this Section.
4 (Source: P.A. 94-906, eff. 1-1-07; 94-1076, eff. 12-29-06;
5 95-422, eff. 8-24-07; 95-520, eff. 8-28-07; revised 12-4-07.)
 
6     Section 35. The Voluntary Health Services Plans Act is
7 amended by changing Section 10 as follows:
 
8     (215 ILCS 165/10)  (from Ch. 32, par. 604)
9     Sec. 10. Application of Insurance Code provisions. Health
10 services plan corporations and all persons interested therein
11 or dealing therewith shall be subject to the provisions of
12 Articles IIA and XII 1/2 and Sections 3.1, 133, 140, 143, 143c,
13 149, 155.37, 354, 355.2, 356g.5, 356r, 356t, 356u, 356v, 356w,
14 356x, 356y, 356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8,
15 356z.9, 356z.10, 356z.11 356z.9, 364.01, 367.2, 368a, 401,
16 401.1, 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7)
17 and (15) of Section 367 of the Illinois Insurance Code.
18 (Source: P.A. 94-1076, eff. 12-29-06; 95-189, eff. 8-16-07;
19 95-331, eff. 8-21-07; 95-422, eff. 8-24-07; 95-520, eff.
20 8-28-07; revised 12-5-07.)
 
21     Section 40. The Illinois Public Aid Code is amended by
22 changing Section 5-16.8 as follows:
 

 

 

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1     (305 ILCS 5/5-16.8)
2     Sec. 5-16.8. Required health benefits. The medical
3 assistance program shall (i) provide the post-mastectomy care
4 benefits required to be covered by a policy of accident and
5 health insurance under Section 356t and the coverage required
6 under Sections 356g.5, 356u, 356w, 356x, and 356z.6, and
7 356z.11 of the Illinois Insurance Code and (ii) be subject to
8 the provisions of Section 364.01 of the Illinois Insurance
9 Code.
10 (Source: P.A. 95-189, eff. 8-16-07; 95-331, eff. 8-21-07.)
 
11     Section 99. Effective date. This Act takes effect upon
12 becoming law.