HB3039 EnrolledLRB097 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 of the Illinois Insurance Code.
16The program of health benefits must comply with Sections
17Section 155.37 and 356z.19 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.

 

 

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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 of the Illinois Insurance Code. The
19coverage shall comply with Section 356z.19 of the Illinois
20Insurance Code. The requirement that health benefits be covered
21as provided in this Section is an exclusive power and function
22of the State and is a denial and limitation under Article VII,
23Section 6, subsection (h) of the Illinois Constitution. A home
24rule county to which this Section applies must comply with

 

 

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1every provision of this Section.
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; 95-1045,
11eff. 3-27-09; 95-1049, eff. 1-1-10; 96-139, eff. 1-1-10;
1296-328, eff. 8-11-09; 96-1000, eff. 7-2-10.)
 
13    Section 15. The Illinois Municipal Code is amended by
14changing Section 10-4-2.3 as follows:
 
15    (65 ILCS 5/10-4-2.3)
16    Sec. 10-4-2.3. Required health benefits. If a
17municipality, including a home rule municipality, is a
18self-insurer for purposes of providing health insurance
19coverage for its employees, the coverage shall include coverage
20for the post-mastectomy care benefits required to be covered by
21a policy of accident and health insurance under Section 356t
22and the coverage required under Sections 356g, 356g.5,
23356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10,
24356z.11, 356z.12, 356z.13, 356z.14, and 356z.15 of the Illinois

 

 

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1Insurance Code. The coverage shall comply with Section 356z.19
2of the Illinois Insurance Code. The requirement that health
3benefits be covered as provided in this is an exclusive power
4and function of the State and is a denial and limitation under
5Article VII, Section 6, subsection (h) of the Illinois
6Constitution. A home rule municipality to which this Section
7applies must comply with every 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 20. The School Code is amended by changing Section
2010-22.3f as follows:
 
21    (105 ILCS 5/10-22.3f)
22    Sec. 10-22.3f. Required health benefits. Insurance
23protection and benefits for employees shall provide the
24post-mastectomy care benefits required to be covered by a

 

 

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1policy of accident and health insurance under Section 356t and
2the coverage required under Sections 356g, 356g.5, 356g.5-1,
3356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11, 356z.12,
4356z.13, 356z.14, and 356z.15 of the Illinois Insurance Code.
5Insurance policies shall comply with Section 356z.19 of the
6Illinois Insurance Code.
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. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07;
1495-876, eff. 8-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09;
1595-1005, 12-12-08; 95-1045, eff. 3-27-09; 95-1049, eff.
161-1-10; 96-139, eff. 1-1-10; 96-328, eff. 8-11-09; 96-1000,
17eff. 7-2-10.)
 
18    Section 25. The Illinois Insurance Code is amended by
19changing Section 356z.16 and by adding Section 356z.19 as
20follows:
 
21    (215 ILCS 5/356z.16)
22    Sec. 356z.16. Applicability of mandated benefits to
23supplemental policies. Unless specified otherwise, the
24following Sections of the Illinois Insurance Code do not apply

 

 

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1to short-term travel, disability income, long-term care,
2accident only, or limited or specified disease policies: 356b,
3356c, 356d, 356g, 356k, 356m, 356n, 356p, 356q, 356r, 356t,
4356u, 356w, 356x, 356z.1, 356z.2, 356z.4, 356z.5, 356z.6,
5356z.8, 356z.12, 356z.19, 367.2-5, and 367e.
6(Source: P.A. 96-180, eff. 1-1-10; 96-1000, eff. 7-2-10;
796-1034, eff. 1-1-11.)
 
8    (215 ILCS 5/356z.19 new)
9    Sec. 356z.19. Cardiovascular disease. Because
10cardiovascular disease is a leading cause of death and
11disability, an insurer providing group or individual policies
12of accident and health insurance or a managed care plan shall
13develop and implement a process to communicate with their adult
14enrollees on an annual basis regarding the importance and value
15of early detection and proactive management of cardiovascular
16disease. Nothing in this Section affects any change in the
17terms, conditions, or benefits of the policies and plans, nor
18the criteria, standards, and procedures related to the
19application for, enrollment in, or renewal of coverage or
20conditions of participation of enrollees in the health plans or
21policies subject to this Code.
 
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, 364.01, 367.2, 367.2-5, 367i, 368a, 368b,
10368c, 368d, 368e, 370c, 401, 401.1, 402, 403, 403A, 408, 408.2,
11409, 412, 444, and 444.1, paragraph (c) of subsection (2) of
12Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2, XIII,
13XIII 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, 364.01, 367.2, 368a, 401,
13401.1, 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7)
14and (15) of Section 367 of the Illinois Insurance Code.
15    Rulemaking authority to implement Public Act 95-1045, if
16any, is conditioned on the rules being adopted in accordance
17with all provisions of the Illinois Administrative Procedure
18Act and all rules and procedures of the Joint Committee on
19Administrative Rules; any purported rule not so adopted, for
20whatever reason, is unauthorized.
21(Source: P.A. 95-189, eff. 8-16-07; 95-331, eff. 8-21-07;
2295-422, eff. 8-24-07; 95-520, eff. 8-28-07; 95-876, eff.
238-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09; 95-1005,
24eff. 12-12-08; 95-1045, eff. 3-27-09; 95-1049, eff. 1-1-10;

 

 

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196-328, eff. 8-11-09; 96-833, eff. 6-1-10; 96-1000, eff.
27-2-10.)
 
3    Section 40. The Illinois Public Aid Code is amended by
4changing Section 5-16.8 as follows:
 
5    (305 ILCS 5/5-16.8)
6    Sec. 5-16.8. Required health benefits. The medical
7assistance program shall (i) provide the post-mastectomy care
8benefits required to be covered by a policy of accident and
9health insurance under Section 356t and the coverage required
10under Sections 356g.5, 356u, 356w, 356x, and 356z.6 of the
11Illinois Insurance Code and (ii) be subject to the provisions
12of Sections 356z.19 and Section 364.01 of the Illinois
13Insurance Code.
14(Source: P.A. 95-189, eff. 8-16-07; 95-331, eff. 8-21-07.)
 
15    Section 99. Effective date. This Act takes effect upon
16becoming law.