Rep. Mary E. Flowers

Filed: 3/2/2011

 

 


 

 


 
09700HB1267ham001LRB097 07252 RPM 51897 a

1
AMENDMENT TO HOUSE BILL 1267

2    AMENDMENT NO. ______. Amend House Bill 1267 by replacing
3everything after the enacting clause with the following:
 
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 provide
9the post-mastectomy care benefits required to be covered by a
10policy of accident and health insurance under Section 356t of
11the Illinois Insurance Code. The program of health benefits
12shall provide the coverage required under Sections 356g,
13356g.5, 356g.5-1, 356m, 356u, 356w, 356x, 356z.2, 356z.4,
14356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
15356z.14, 356z.15, and 356z.17, 356z.19, and 356z.20 of the
16Illinois Insurance Code. The program of health benefits must

 

 

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1comply with Section 155.37 of the Illinois Insurance 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. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07;
995-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff.
106-1-09; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; 95-1044,
11eff. 3-26-09; 95-1045, eff. 3-27-09; 95-1049, eff. 1-1-10;
1296-139, eff. 1-1-10; 96-328, eff. 8-11-09; 96-639, eff. 1-1-10;
1396-1000, eff. 7-2-10.)
 
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 of
19providing 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, and 356z.15, 356z.19, and 356z.20 of the Illinois
2Insurance Code. The requirement that health benefits be covered
3as provided in this Section is an exclusive power and function
4of the State and is a denial and limitation under Article VII,
5Section 6, subsection (h) of the Illinois Constitution. A home
6rule county to which this Section applies must comply with
7every provision 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. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07;
1595-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff.
166-1-09; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; 95-1045,
17eff. 3-27-09; 95-1049, eff. 1-1-10; 96-139, eff. 1-1-10;
1896-328, eff. 8-11-09; 96-1000, eff. 7-2-10.)
 
19    Section 15. The Illinois Municipal Code is amended by
20changing Section 10-4-2.3 as follows:
 
21    (65 ILCS 5/10-4-2.3)
22    Sec. 10-4-2.3. Required health benefits. If a
23municipality, including a home rule municipality, is a
24self-insurer for purposes of providing health insurance

 

 

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1coverage for its employees, the coverage shall include coverage
2for the post-mastectomy care benefits required to be covered by
3a policy of accident and health insurance under Section 356t
4and the coverage required under Sections 356g, 356g.5,
5356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10,
6356z.11, 356z.12, 356z.13, 356z.14, and 356z.15, 356z.19, and
7356z.20 of the Illinois Insurance Code. The requirement that
8health benefits be covered as provided in this is an exclusive
9power and function of the State and is a denial and limitation
10under Article VII, Section 6, subsection (h) of the Illinois
11Constitution. A home rule municipality to which this Section
12applies must comply with every provision of this Section.
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. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07;
2095-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff.
216-1-09; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; 95-1045,
22eff. 3-27-09; 95-1049, eff. 1-1-10; 96-139, eff. 1-1-10;
2396-328, eff. 8-11-09; 96-1000, eff. 7-2-10.)
 
24    Section 20. The School Code is amended by changing Section
2510-22.3f as follows:
 

 

 

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1    (105 ILCS 5/10-22.3f)
2    Sec. 10-22.3f. Required health benefits. Insurance
3protection and benefits for employees shall provide the
4post-mastectomy care benefits required to be covered by a
5policy of accident and health insurance under Section 356t and
6the coverage required under Sections 356g, 356g.5, 356g.5-1,
7356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11, 356z.12,
8356z.13, 356z.14, and 356z.15, 356z.19, and 356z.20 of the
9Illinois Insurance Code.
10    Rulemaking authority to implement Public Act 95-1045, if
11any, is conditioned on the rules being adopted in accordance
12with all provisions of the Illinois Administrative Procedure
13Act and all rules and procedures of the Joint Committee on
14Administrative Rules; any purported rule not so adopted, for
15whatever reason, is unauthorized.
16(Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07;
1795-876, eff. 8-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09;
1895-1005, 12-12-08; 95-1045, eff. 3-27-09; 95-1049, eff.
191-1-10; 96-139, eff. 1-1-10; 96-328, eff. 8-11-09; 96-1000,
20eff. 7-2-10.)
 
21    Section 25. The Illinois Insurance Code is amended by
22adding Sections 356z.19 and 356z.20 as follows:
 
23    (215 ILCS 5/356z.19 new)

 

 

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1    Sec. 356z.19. Intravenous feeding. A group or individual
2policy of accident and health insurance or managed care plan
3amended, delivered, issued, or renewed after the effective date
4of this amendatory Act of the 97th General Assembly must
5provide coverage for intravenous feeding. The benefits under
6this Section shall be at least as favorable as for other
7coverages under the policy and may be subject to the same
8dollar amount limits, deductibles, and co-insurance
9requirements applicable generally to other coverages under the
10policy.
 
11    (215 ILCS 5/356z.20 new)
12    Sec. 356z.20. Prescription nutritional supplements. A
13group or individual policy of accident and health insurance or
14managed care plan amended, delivered, issued, or renewed after
15the effective date of this amendatory Act of the 97th General
16Assembly that provides coverage for prescription drugs must
17provide coverage for reimbursement for medically appropriate
18prescription nutritional supplements when ordered by a
19physician licensed to practice medicine in all its branches and
20the insured suffers from a condition that prevents him or her
21from taking sufficient oral nourishment to sustain life.
 
22    Section 30. The Health Maintenance Organization Act is
23amended by changing Section 5-3 as follows:
 

 

 

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1    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
2    Sec. 5-3. Insurance Code provisions.
3    (a) Health Maintenance Organizations shall be subject to
4the provisions of Sections 133, 134, 137, 140, 141.1, 141.2,
5141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5,
6154.6, 154.7, 154.8, 155.04, 355.2, 356g.5-1, 356m, 356v, 356w,
7356x, 356y, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9,
8356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17,
9356z.18, 356z.19, 356z.20, 364.01, 367.2, 367.2-5, 367i, 368a,
10368b, 368c, 368d, 368e, 370c, 401, 401.1, 402, 403, 403A, 408,
11408.2, 409, 412, 444, and 444.1, paragraph (c) of subsection
12(2) of Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2,
13XIII, XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.
14    (b) For purposes of the Illinois Insurance Code, except for
15Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health
16Maintenance Organizations in the following categories are
17deemed to be "domestic companies":
18        (1) a corporation authorized under the Dental Service
19    Plan Act or the Voluntary Health Services Plans Act;
20        (2) a corporation organized under the laws of this
21    State; or
22        (3) a corporation organized under the laws of another
23    state, 30% or more of the enrollees of which are residents
24    of this State, except a corporation subject to
25    substantially the same requirements in its state of
26    organization as is a "domestic company" under Article VIII

 

 

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

 

 

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

 

 

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

 

 

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1    The Health Maintenance Organization shall include a
2statement in the evidence of coverage issued to each enrollee
3describing the possibility of a refund or additional premium,
4and upon request of any group or enrollment unit, provide to
5the group or enrollment unit a description of the method used
6to calculate (1) the Health Maintenance Organization's
7profitable experience with respect to the group or enrollment
8unit and the resulting refund to the group or enrollment unit
9or (2) the Health Maintenance Organization's unprofitable
10experience with respect to the group or enrollment unit and the
11resulting additional premium to be paid by the group or
12enrollment unit.
13    In no event shall the Illinois Health Maintenance
14Organization Guaranty Association be liable to pay any
15contractual obligation of an insolvent organization to pay any
16refund authorized under this Section.
17    (g) Rulemaking authority to implement Public Act 95-1045,
18if any, is conditioned on the rules being adopted in accordance
19with all provisions of the Illinois Administrative Procedure
20Act and all rules and procedures of the Joint Committee on
21Administrative Rules; any purported rule not so adopted, for
22whatever reason, is unauthorized.
23(Source: P.A. 95-422, eff. 8-24-07; 95-520, eff. 8-28-07;
2495-876, eff. 8-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09;
2595-1005, eff. 12-12-08; 95-1045, eff. 3-27-09; 95-1049, eff.
261-1-10; 96-328, eff. 8-11-09; 96-639, eff. 1-1-10; 96-833, eff.

 

 

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16-1-10; 96-1000, eff. 7-2-10.)
 
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, 140, 143, 143c,
9149, 155.37, 354, 355.2, 356g, 356g.5, 356g.5-1, 356r, 356t,
10356u, 356v, 356w, 356x, 356y, 356z.1, 356z.2, 356z.4, 356z.5,
11356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
12356z.14, 356z.15, 356z.18, 356z.19, 356z.20, 364.01, 367.2,
13368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412, and
14paragraphs (7) and (15) of Section 367 of the Illinois
15Insurance Code.
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. 95-189, eff. 8-16-07; 95-331, eff. 8-21-07;
2395-422, eff. 8-24-07; 95-520, eff. 8-28-07; 95-876, eff.
248-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09; 95-1005,

 

 

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1eff. 12-12-08; 95-1045, eff. 3-27-09; 95-1049, eff. 1-1-10;
296-328, eff. 8-11-09; 96-833, eff. 6-1-10; 96-1000, eff.
37-2-10.)
 
4    Section 90. The State Mandates Act is amended by adding
5Section 8.35 as follows:
 
6    (30 ILCS 805/8.35 new)
7    Sec. 8.35. Exempt mandate. Notwithstanding Sections 6 and 8
8of this Act, no reimbursement by the State is required for the
9implementation of any mandate created by this amendatory Act of
10the 97th General Assembly.".