Sen. Kimberly A. Lightford

Filed: 5/19/2011

 

 


 

 


 
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1
AMENDMENT TO HOUSE BILL 3039

2    AMENDMENT NO. ______. Amend House Bill 3039 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 of the Illinois Insurance Code.
16The program of health benefits must comply with Sections

 

 

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1Section 155.37 and 356z.19 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 of the Illinois Insurance Code. The
2coverage shall comply with Section 356z.19 of the Illinois
3Insurance Code. The requirement that health benefits be covered
4as provided in this Section is an exclusive power and function
5of the State and is a denial and limitation under Article VII,
6Section 6, subsection (h) of the Illinois Constitution. A home
7rule county to which this Section applies must comply with
8every provision of this Section.
9    Rulemaking authority to implement Public Act 95-1045, if
10any, is conditioned on the rules being adopted in accordance
11with all provisions of the Illinois Administrative Procedure
12Act and all rules and procedures of the Joint Committee on
13Administrative Rules; any purported rule not so adopted, for
14whatever reason, is unauthorized.
15(Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07;
1695-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff.
176-1-09; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; 95-1045,
18eff. 3-27-09; 95-1049, eff. 1-1-10; 96-139, eff. 1-1-10;
1996-328, eff. 8-11-09; 96-1000, eff. 7-2-10.)
 
20    Section 15. The Illinois Municipal Code is amended by
21changing Section 10-4-2.3 as follows:
 
22    (65 ILCS 5/10-4-2.3)
23    Sec. 10-4-2.3. Required health benefits. If a
24municipality, including a home rule municipality, is a

 

 

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1self-insurer for purposes of providing health insurance
2coverage for its employees, the coverage shall include coverage
3for the post-mastectomy care benefits required to be covered by
4a policy of accident and health insurance under Section 356t
5and the coverage required under Sections 356g, 356g.5,
6356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10,
7356z.11, 356z.12, 356z.13, 356z.14, and 356z.15 of the Illinois
8Insurance Code. The coverage shall comply with Section 356z.19
9of the Illinois Insurance Code. The requirement that health
10benefits be covered as provided in this is an exclusive power
11and function of the State and is a denial and limitation under
12Article VII, Section 6, subsection (h) of the Illinois
13Constitution. A home rule municipality to which this Section
14applies must comply with every provision of this Section.
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; 95-422, eff. 8-24-07;
2295-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff.
236-1-09; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; 95-1045,
24eff. 3-27-09; 95-1049, eff. 1-1-10; 96-139, eff. 1-1-10;
2596-328, eff. 8-11-09; 96-1000, eff. 7-2-10.)
 

 

 

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1    Section 20. The School Code is amended by changing Section
210-22.3f as follows:
 
3    (105 ILCS 5/10-22.3f)
4    Sec. 10-22.3f. Required health benefits. Insurance
5protection and benefits for employees shall provide the
6post-mastectomy care benefits required to be covered by a
7policy of accident and health insurance under Section 356t and
8the coverage required under Sections 356g, 356g.5, 356g.5-1,
9356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11, 356z.12,
10356z.13, 356z.14, and 356z.15 of the Illinois Insurance Code.
11Insurance policies shall comply with Section 356z.19 of the
12Illinois Insurance Code.
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;
2095-876, eff. 8-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09;
2195-1005, 12-12-08; 95-1045, eff. 3-27-09; 95-1049, eff.
221-1-10; 96-139, eff. 1-1-10; 96-328, eff. 8-11-09; 96-1000,
23eff. 7-2-10.)
 
24    Section 25. The Illinois Insurance Code is amended by

 

 

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1adding Section 356z.19 as follows:
 
2    (215 ILCS 5/356z.19 new)
3    Sec. 356z.19. Cardiovascular disease. Because
4cardiovascular disease is a leading cause of death and
5disability, entities providing group or individual policies of
6accident and health insurance or managed care plans shall
7annually notify adult enrollees about the importance and value
8of early detection and proactive management of cardiovascular
9disease; advise these enrollees about personal behavior that
10can affect cardiovascular health outcomes; and further advise
11these enrollees that they should consult with their personal
12physician about their health status and any symptoms that may
13cause the personal physician to prescribe screening,
14diagnostic testing, or referral to specialty care related to
15cardiovascular disease. The notice required by this Section may
16be included as an attachment to the plan or policy issued to
17the enrollee, as an attachment to a renewal or any amendment of
18the plan or policy, or in a separate notice delivered by
19personal mail. Nothing in this Section affects any change in
20the terms, conditions, or benefits of the policies and plans,
21nor the criteria, standards, and procedures related to the
22application for, enrollment in, or renewal of coverage or
23conditions of participation of enrollees in the health plans or
24policies subject to this Code.
 

 

 

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1    Section 30. The Health Maintenance Organization Act is
2amended by changing Section 5-3 as follows:
 
3    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
4    Sec. 5-3. Insurance Code provisions.
5    (a) Health Maintenance Organizations shall be subject to
6the provisions of Sections 133, 134, 137, 140, 141.1, 141.2,
7141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5,
8154.6, 154.7, 154.8, 155.04, 355.2, 356g.5-1, 356m, 356v, 356w,
9356x, 356y, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9,
10356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17,
11356z.18, 356z.19, 364.01, 367.2, 367.2-5, 367i, 368a, 368b,
12368c, 368d, 368e, 370c, 401, 401.1, 402, 403, 403A, 408, 408.2,
13409, 412, 444, and 444.1, paragraph (c) of subsection (2) of
14Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2, XIII,
15XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.
16    (b) For purposes of the Illinois Insurance Code, except for
17Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health
18Maintenance Organizations in the following categories are
19deemed to be "domestic companies":
20        (1) a corporation authorized under the Dental Service
21    Plan Act or the Voluntary Health Services Plans Act;
22        (2) a corporation organized under the laws of this
23    State; or
24        (3) a corporation organized under the laws of another
25    state, 30% or more of the enrollees of which are residents

 

 

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

 

 

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

 

 

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

 

 

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1    or unprofitable experience may be calculated taking into
2    account the refund period and the immediately preceding 2
3    plan years.
4    The Health Maintenance Organization shall include a
5statement in the evidence of coverage issued to each enrollee
6describing the possibility of a refund or additional premium,
7and upon request of any group or enrollment unit, provide to
8the group or enrollment unit a description of the method used
9to calculate (1) the Health Maintenance Organization's
10profitable experience with respect to the group or enrollment
11unit and the resulting refund to the group or enrollment unit
12or (2) the Health Maintenance Organization's unprofitable
13experience with respect to the group or enrollment unit and the
14resulting additional premium to be paid by the group or
15enrollment unit.
16    In no event shall the Illinois Health Maintenance
17Organization Guaranty Association be liable to pay any
18contractual obligation of an insolvent organization to pay any
19refund authorized under this Section.
20    (g) Rulemaking authority to implement Public Act 95-1045,
21if any, 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
25whatever reason, is unauthorized.
26(Source: P.A. 95-422, eff. 8-24-07; 95-520, eff. 8-28-07;

 

 

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195-876, eff. 8-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09;
295-1005, eff. 12-12-08; 95-1045, eff. 3-27-09; 95-1049, eff.
31-1-10; 96-328, eff. 8-11-09; 96-639, eff. 1-1-10; 96-833, eff.
46-1-10; 96-1000, eff. 7-2-10.)
 
5    Section 35. The Voluntary Health Services Plans Act is
6amended by changing Section 10 as follows:
 
7    (215 ILCS 165/10)  (from Ch. 32, par. 604)
8    Sec. 10. Application of Insurance Code provisions. Health
9services plan corporations and all persons interested therein
10or dealing therewith shall be subject to the provisions of
11Articles IIA and XII 1/2 and Sections 3.1, 133, 140, 143, 143c,
12149, 155.37, 354, 355.2, 356g, 356g.5, 356g.5-1, 356r, 356t,
13356u, 356v, 356w, 356x, 356y, 356z.1, 356z.2, 356z.4, 356z.5,
14356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
15356z.14, 356z.15, 356z.18, 356z.19, 364.01, 367.2, 368a, 401,
16401.1, 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7)
17and (15) of Section 367 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.
24(Source: P.A. 95-189, eff. 8-16-07; 95-331, eff. 8-21-07;

 

 

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195-422, eff. 8-24-07; 95-520, eff. 8-28-07; 95-876, eff.
28-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09; 95-1005,
3eff. 12-12-08; 95-1045, eff. 3-27-09; 95-1049, eff. 1-1-10;
496-328, eff. 8-11-09; 96-833, eff. 6-1-10; 96-1000, eff.
57-2-10.)
 
6    Section 40. The Illinois Public Aid Code is amended by
7changing Section 5-16.8 as follows:
 
8    (305 ILCS 5/5-16.8)
9    Sec. 5-16.8. Required health benefits. The medical
10assistance program shall (i) provide the post-mastectomy care
11benefits required to be covered by a policy of accident and
12health insurance under Section 356t and the coverage required
13under Sections 356g.5, 356u, 356w, 356x, and 356z.6 of the
14Illinois Insurance Code and (ii) be subject to the provisions
15of Sections 356z.19 and Section 364.01 of the Illinois
16Insurance Code.
17(Source: P.A. 95-189, eff. 8-16-07; 95-331, eff. 8-21-07.)
 
18    Section 99. Effective date. This Act takes effect upon
19becoming law.".