HB3039 EngrossedLRB097 06869 RPM 46962 b

1    AN ACT concerning insurance.
 
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    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, and 356z.19 of the Illinois
16Insurance Code. The program of health benefits must comply with
17Section 155.37 of the Illinois Insurance Code.
18    Rulemaking authority to implement Public Act 95-1045, if
19any, is conditioned on the rules being adopted in accordance
20with all provisions of the Illinois Administrative Procedure
21Act and all rules and procedures of the Joint Committee on
22Administrative Rules; any purported rule not so adopted, for
23whatever reason, is unauthorized.

 

 

HB3039 Engrossed- 2 -LRB097 06869 RPM 46962 b

1(Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07;
295-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff.
36-1-09; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; 95-1044,
4eff. 3-26-09; 95-1045, eff. 3-27-09; 95-1049, eff. 1-1-10;
596-139, eff. 1-1-10; 96-328, eff. 8-11-09; 96-639, eff. 1-1-10;
696-1000, eff. 7-2-10.)
 
7    Section 10. The Counties Code is amended by changing
8Section 5-1069.3 as follows:
 
9    (55 ILCS 5/5-1069.3)
10    Sec. 5-1069.3. Required health benefits. If a county,
11including a home rule county, is a self-insurer for purposes of
12providing health insurance coverage for its employees, the
13coverage shall include coverage for the post-mastectomy care
14benefits required to be covered by a policy of accident and
15health insurance under Section 356t and the coverage required
16under Sections 356g, 356g.5, 356g.5-1, 356u, 356w, 356x,
17356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
18356z.14, and 356z.15, and 356z.19 of the Illinois Insurance
19Code. The requirement that health benefits be covered as
20provided in this Section is an exclusive power and function of
21the State and is a denial and limitation under Article VII,
22Section 6, subsection (h) of the Illinois Constitution. A home
23rule county to which this Section applies must comply with
24every provision of this Section.

 

 

HB3039 Engrossed- 3 -LRB097 06869 RPM 46962 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. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07;
895-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff.
96-1-09; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; 95-1045,
10eff. 3-27-09; 95-1049, eff. 1-1-10; 96-139, eff. 1-1-10;
1196-328, eff. 8-11-09; 96-1000, eff. 7-2-10.)
 
12    Section 15. The Illinois Municipal Code is amended by
13changing Section 10-4-2.3 as follows:
 
14    (65 ILCS 5/10-4-2.3)
15    Sec. 10-4-2.3. Required health benefits. If a
16municipality, including a home rule municipality, is a
17self-insurer for purposes of providing health insurance
18coverage for its employees, the coverage shall include coverage
19for the post-mastectomy care benefits required to be covered by
20a policy of accident and health insurance under Section 356t
21and the coverage required under Sections 356g, 356g.5,
22356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10,
23356z.11, 356z.12, 356z.13, 356z.14, and 356z.15, and 356z.19 of
24the Illinois Insurance Code. The requirement that health

 

 

HB3039 Engrossed- 4 -LRB097 06869 RPM 46962 b

1benefits be covered as provided in this is an exclusive power
2and function of the State and is a denial and limitation under
3Article VII, Section 6, subsection (h) of the Illinois
4Constitution. A home rule municipality to which this Section
5applies must comply with every provision of this Section.
6    Rulemaking authority to implement Public Act 95-1045, if
7any, is conditioned on the rules being adopted in accordance
8with all provisions of the Illinois Administrative Procedure
9Act and all rules and procedures of the Joint Committee on
10Administrative Rules; any purported rule not so adopted, for
11whatever reason, is unauthorized.
12(Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07;
1395-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff.
146-1-09; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; 95-1045,
15eff. 3-27-09; 95-1049, eff. 1-1-10; 96-139, eff. 1-1-10;
1696-328, eff. 8-11-09; 96-1000, eff. 7-2-10.)
 
17    Section 20. The School Code is amended by changing Section
1810-22.3f as follows:
 
19    (105 ILCS 5/10-22.3f)
20    Sec. 10-22.3f. Required health benefits. Insurance
21protection and benefits for employees shall provide the
22post-mastectomy care benefits required to be covered by a
23policy of accident and health insurance under Section 356t and
24the coverage required under Sections 356g, 356g.5, 356g.5-1,

 

 

HB3039 Engrossed- 5 -LRB097 06869 RPM 46962 b

1356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11, 356z.12,
2356z.13, 356z.14, and 356z.15, and 356z.19 of the Illinois
3Insurance Code.
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. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07;
1195-876, eff. 8-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09;
1295-1005, 12-12-08; 95-1045, eff. 3-27-09; 95-1049, eff.
131-1-10; 96-139, eff. 1-1-10; 96-328, eff. 8-11-09; 96-1000,
14eff. 7-2-10.)
 
15    Section 25. The Illinois Insurance Code is amended by
16adding Section 356z.19 as follows:
 
17    (215 ILCS 5/356z.19 new)
18    Sec. 356z.19. Cardiovascular disease testing. A group or
19individual policy of accident and health insurance or managed
20care plan amended, delivered, issued, or renewed after the
21effective date of this amendatory Act of the 97th General
22Assembly must provide coverage for diagnostic testing for
23cardiovascular disease if the diagnostic testing is ordered by
24a physician licensed pursuant to the Medical Practice Act of

 

 

HB3039 Engrossed- 6 -LRB097 06869 RPM 46962 b

11987 based on guidelines for preventative cardiovascular
2services issued by a nationally recognized medical society or
3federal government agency.
 
4    Section 30. The Health Maintenance Organization Act is
5amended by changing Section 5-3 as follows:
 
6    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
7    Sec. 5-3. Insurance Code provisions.
8    (a) Health Maintenance Organizations shall be subject to
9the provisions of Sections 133, 134, 137, 140, 141.1, 141.2,
10141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5,
11154.6, 154.7, 154.8, 155.04, 355.2, 356g.5-1, 356m, 356v, 356w,
12356x, 356y, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9,
13356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17,
14356z.18, 356z.19, 364.01, 367.2, 367.2-5, 367i, 368a, 368b,
15368c, 368d, 368e, 370c, 401, 401.1, 402, 403, 403A, 408, 408.2,
16409, 412, 444, and 444.1, paragraph (c) of subsection (2) of
17Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2, XIII,
18XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.
19    (b) For purposes of the Illinois Insurance Code, except for
20Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health
21Maintenance Organizations in the following categories are
22deemed to be "domestic companies":
23        (1) a corporation authorized under the Dental Service
24    Plan Act or the Voluntary Health Services Plans Act;

 

 

HB3039 Engrossed- 7 -LRB097 06869 RPM 46962 b

1        (2) a corporation organized under the laws of this
2    State; or
3        (3) a corporation organized under the laws of another
4    state, 30% or more of the enrollees of which are residents
5    of this State, except a corporation subject to
6    substantially the same requirements in its state of
7    organization as is a "domestic company" under Article VIII
8    1/2 of the Illinois Insurance Code.
9    (c) In considering the merger, consolidation, or other
10acquisition of control of a Health Maintenance Organization
11pursuant to Article VIII 1/2 of the Illinois Insurance Code,
12        (1) the Director shall give primary consideration to
13    the continuation of benefits to enrollees and the financial
14    conditions of the acquired Health Maintenance Organization
15    after the merger, consolidation, or other acquisition of
16    control takes effect;
17        (2)(i) the criteria specified in subsection (1)(b) of
18    Section 131.8 of the Illinois Insurance Code shall not
19    apply and (ii) the Director, in making his determination
20    with respect to the merger, consolidation, or other
21    acquisition of control, need not take into account the
22    effect on competition of the merger, consolidation, or
23    other acquisition of control;
24        (3) the Director shall have the power to require the
25    following information:
26            (A) certification by an independent actuary of the

 

 

HB3039 Engrossed- 8 -LRB097 06869 RPM 46962 b

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

 

 

HB3039 Engrossed- 9 -LRB097 06869 RPM 46962 b

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

 

 

HB3039 Engrossed- 10 -LRB097 06869 RPM 46962 b

1    marketing expenses, but shall not include any refund to be
2    made or additional premium to be paid pursuant to this
3    subsection (f)). The Health Maintenance Organization and
4    the group or enrollment unit may agree that the profitable
5    or unprofitable experience may be calculated taking into
6    account the refund period and the immediately preceding 2
7    plan years.
8    The Health Maintenance Organization shall include a
9statement in the evidence of coverage issued to each enrollee
10describing the possibility of a refund or additional premium,
11and upon request of any group or enrollment unit, provide to
12the group or enrollment unit a description of the method used
13to calculate (1) the Health Maintenance Organization's
14profitable experience with respect to the group or enrollment
15unit and the resulting refund to the group or enrollment unit
16or (2) the Health Maintenance Organization's unprofitable
17experience with respect to the group or enrollment unit and the
18resulting additional premium to be paid by the group or
19enrollment unit.
20    In no event shall the Illinois Health Maintenance
21Organization Guaranty Association be liable to pay any
22contractual obligation of an insolvent organization to pay any
23refund authorized under this Section.
24    (g) Rulemaking authority to implement Public Act 95-1045,
25if any, is conditioned on the rules being adopted in accordance
26with all provisions of the Illinois Administrative Procedure

 

 

HB3039 Engrossed- 11 -LRB097 06869 RPM 46962 b

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. 95-422, eff. 8-24-07; 95-520, eff. 8-28-07;
595-876, eff. 8-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09;
695-1005, eff. 12-12-08; 95-1045, eff. 3-27-09; 95-1049, eff.
71-1-10; 96-328, eff. 8-11-09; 96-639, eff. 1-1-10; 96-833, eff.
86-1-10; 96-1000, eff. 7-2-10.)
 
9    Section 35. The Voluntary Health Services Plans Act is
10amended by changing Section 10 as follows:
 
11    (215 ILCS 165/10)  (from Ch. 32, par. 604)
12    Sec. 10. Application of Insurance Code provisions. Health
13services plan corporations and all persons interested therein
14or dealing therewith shall be subject to the provisions of
15Articles IIA and XII 1/2 and Sections 3.1, 133, 140, 143, 143c,
16149, 155.37, 354, 355.2, 356g, 356g.5, 356g.5-1, 356r, 356t,
17356u, 356v, 356w, 356x, 356y, 356z.1, 356z.2, 356z.4, 356z.5,
18356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
19356z.14, 356z.15, 356z.18, 356z.19, 364.01, 367.2, 368a, 401,
20401.1, 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7)
21and (15) of Section 367 of the Illinois Insurance Code.
22    Rulemaking authority to implement Public Act 95-1045, if
23any, is conditioned on the rules being adopted in accordance
24with all provisions of the Illinois Administrative Procedure

 

 

HB3039 Engrossed- 12 -LRB097 06869 RPM 46962 b

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. 95-189, eff. 8-16-07; 95-331, eff. 8-21-07;
595-422, eff. 8-24-07; 95-520, eff. 8-28-07; 95-876, eff.
68-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09; 95-1005,
7eff. 12-12-08; 95-1045, eff. 3-27-09; 95-1049, eff. 1-1-10;
896-328, eff. 8-11-09; 96-833, eff. 6-1-10; 96-1000, eff.
97-2-10.)
 
10    Section 40. The Illinois Public Aid Code is amended by
11changing Section 5-16.8 as follows:
 
12    (305 ILCS 5/5-16.8)
13    Sec. 5-16.8. Required health benefits. The medical
14assistance program shall (i) provide the post-mastectomy care
15benefits required to be covered by a policy of accident and
16health insurance under Section 356t and the coverage required
17under Sections 356g.5, 356u, 356w, 356x, and 356z.6, and
18356z.19 of the Illinois Insurance Code and (ii) be subject to
19the provisions of Section 364.01 of the Illinois Insurance
20Code.
21(Source: P.A. 95-189, eff. 8-16-07; 95-331, eff. 8-21-07.)
 
22    Section 99. Effective date. This Act takes effect upon
23becoming law.