Sen. Kimberly A. Lightford

Filed: 5/26/2011

 

 


 

 


 
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1
AMENDMENT TO HOUSE BILL 3039

2    AMENDMENT NO. ______. Amend House Bill 3039, AS AMENDED, by
3replacing everything after the enacting clause with the
4following:
 
5    "Section 5. The State Employees Group Insurance Act of 1971
6is amended by changing Section 6.11 as follows:
 
7    (5 ILCS 375/6.11)
8    Sec. 6.11. Required health benefits; Illinois Insurance
9Code requirements. The program of health benefits shall provide
10the post-mastectomy care benefits required to be covered by a
11policy of accident and health insurance under Section 356t of
12the Illinois Insurance Code. The program of health benefits
13shall provide the coverage required under Sections 356g,
14356g.5, 356g.5-1, 356m, 356u, 356w, 356x, 356z.2, 356z.4,
15356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
16356z.14, 356z.15, and 356z.17 of the Illinois Insurance Code.

 

 

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1The program of health benefits must comply with Sections
2Section 155.37 and 356z.19 of the Illinois Insurance Code.
3    Rulemaking authority to implement Public Act 95-1045, if
4any, is conditioned on the rules being adopted in accordance
5with all provisions of the Illinois Administrative Procedure
6Act and all rules and procedures of the Joint Committee on
7Administrative Rules; any purported rule not so adopted, for
8whatever reason, is unauthorized.
9(Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07;
1095-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff.
116-1-09; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; 95-1044,
12eff. 3-26-09; 95-1045, eff. 3-27-09; 95-1049, eff. 1-1-10;
1396-139, eff. 1-1-10; 96-328, eff. 8-11-09; 96-639, eff. 1-1-10;
1496-1000, eff. 7-2-10.)
 
15    Section 10. The Counties Code is amended by changing
16Section 5-1069.3 as follows:
 
17    (55 ILCS 5/5-1069.3)
18    Sec. 5-1069.3. Required health benefits. If a county,
19including a home rule county, is a self-insurer for purposes of
20providing health insurance coverage for its employees, the
21coverage shall include coverage for the post-mastectomy care
22benefits required to be covered by a policy of accident and
23health insurance under Section 356t and the coverage required
24under Sections 356g, 356g.5, 356g.5-1, 356u, 356w, 356x,

 

 

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1356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
2356z.14, and 356z.15 of the Illinois Insurance Code. The
3coverage shall comply with Section 356z.19 of the Illinois
4Insurance Code. The requirement that health benefits be covered
5as provided in this Section is an exclusive power and function
6of the State and is a denial and limitation under Article VII,
7Section 6, subsection (h) of the Illinois Constitution. A home
8rule county to which this Section applies must comply with
9every provision of this Section.
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;
1795-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff.
186-1-09; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; 95-1045,
19eff. 3-27-09; 95-1049, eff. 1-1-10; 96-139, eff. 1-1-10;
2096-328, eff. 8-11-09; 96-1000, eff. 7-2-10.)
 
21    Section 15. The Illinois Municipal Code is amended by
22changing Section 10-4-2.3 as follows:
 
23    (65 ILCS 5/10-4-2.3)
24    Sec. 10-4-2.3. Required health benefits. If a

 

 

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1municipality, including a home rule municipality, is a
2self-insurer for purposes of providing health insurance
3coverage for its employees, the coverage shall include coverage
4for the post-mastectomy care benefits required to be covered by
5a policy of accident and health insurance under Section 356t
6and the coverage required under Sections 356g, 356g.5,
7356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10,
8356z.11, 356z.12, 356z.13, 356z.14, and 356z.15 of the Illinois
9Insurance Code. The coverage shall comply with Section 356z.19
10of the Illinois Insurance Code. The requirement that health
11benefits be covered as provided in this is an exclusive power
12and function of the State and is a denial and limitation under
13Article VII, Section 6, subsection (h) of the Illinois
14Constitution. A home rule municipality to which this Section
15applies must comply with every provision of this Section.
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; 95-422, eff. 8-24-07;
2395-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff.
246-1-09; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; 95-1045,
25eff. 3-27-09; 95-1049, eff. 1-1-10; 96-139, eff. 1-1-10;
2696-328, 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.)
 

 

 

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1    Section 25. The Illinois Insurance Code is amended by
2changing Section 356z.16 and by adding Section 356z.19 as
3follows:
 
4    (215 ILCS 5/356z.16)
5    Sec. 356z.16. Applicability of mandated benefits to
6supplemental policies. Unless specified otherwise, the
7following Sections of the Illinois Insurance Code do not apply
8to short-term travel, disability income, long-term care,
9accident only, or limited or specified disease policies: 356b,
10356c, 356d, 356g, 356k, 356m, 356n, 356p, 356q, 356r, 356t,
11356u, 356w, 356x, 356z.1, 356z.2, 356z.4, 356z.5, 356z.6,
12356z.8, 356z.12, 356z.19, 367.2-5, and 367e.
13(Source: P.A. 96-180, eff. 1-1-10; 96-1000, eff. 7-2-10;
1496-1034, eff. 1-1-11.)
 
15    (215 ILCS 5/356z.19 new)
16    Sec. 356z.19. Cardiovascular disease. Because
17cardiovascular disease is a leading cause of death and
18disability, an insurer providing group or individual policies
19of accident and health insurance or a managed care plan shall
20develop and implement a process to communicate with their adult
21enrollees on an annual basis regarding the importance and value
22of early detection and proactive management of cardiovascular
23disease. Nothing in this Section affects any change in the
24terms, conditions, or benefits of the policies and plans, nor

 

 

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1the criteria, standards, and procedures related to the
2application for, enrollment in, or renewal of coverage or
3conditions of participation of enrollees in the health plans or
4policies subject to this Code.
 
5    Section 30. The Health Maintenance Organization Act is
6amended by changing Section 5-3 as follows:
 
7    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
8    Sec. 5-3. Insurance Code provisions.
9    (a) Health Maintenance Organizations shall be subject to
10the provisions of Sections 133, 134, 137, 140, 141.1, 141.2,
11141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5,
12154.6, 154.7, 154.8, 155.04, 355.2, 356g.5-1, 356m, 356v, 356w,
13356x, 356y, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9,
14356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17,
15356z.18, 356z.19, 364.01, 367.2, 367.2-5, 367i, 368a, 368b,
16368c, 368d, 368e, 370c, 401, 401.1, 402, 403, 403A, 408, 408.2,
17409, 412, 444, and 444.1, paragraph (c) of subsection (2) of
18Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2, XIII,
19XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.
20    (b) For purposes of the Illinois Insurance Code, except for
21Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health
22Maintenance Organizations in the following categories are
23deemed to be "domestic companies":
24        (1) a corporation authorized under the Dental Service

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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1with all provisions of the Illinois Administrative Procedure
2Act and all rules and procedures of the Joint Committee on
3Administrative Rules; any purported rule not so adopted, for
4whatever reason, is unauthorized.
5(Source: P.A. 95-422, eff. 8-24-07; 95-520, eff. 8-28-07;
695-876, eff. 8-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09;
795-1005, eff. 12-12-08; 95-1045, eff. 3-27-09; 95-1049, eff.
81-1-10; 96-328, eff. 8-11-09; 96-639, eff. 1-1-10; 96-833, eff.
96-1-10; 96-1000, eff. 7-2-10.)
 
10    Section 35. The Voluntary Health Services Plans Act is
11amended by changing Section 10 as follows:
 
12    (215 ILCS 165/10)  (from Ch. 32, par. 604)
13    Sec. 10. Application of Insurance Code provisions. Health
14services plan corporations and all persons interested therein
15or dealing therewith shall be subject to the provisions of
16Articles IIA and XII 1/2 and Sections 3.1, 133, 140, 143, 143c,
17149, 155.37, 354, 355.2, 356g, 356g.5, 356g.5-1, 356r, 356t,
18356u, 356v, 356w, 356x, 356y, 356z.1, 356z.2, 356z.4, 356z.5,
19356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
20356z.14, 356z.15, 356z.18, 356z.19, 364.01, 367.2, 368a, 401,
21401.1, 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7)
22and (15) of Section 367 of the Illinois Insurance Code.
23    Rulemaking authority to implement Public Act 95-1045, if
24any, is conditioned on the rules being adopted in accordance

 

 

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1with all provisions of the Illinois Administrative Procedure
2Act and all rules and procedures of the Joint Committee on
3Administrative Rules; any purported rule not so adopted, for
4whatever reason, is unauthorized.
5(Source: P.A. 95-189, eff. 8-16-07; 95-331, eff. 8-21-07;
695-422, eff. 8-24-07; 95-520, eff. 8-28-07; 95-876, eff.
78-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09; 95-1005,
8eff. 12-12-08; 95-1045, eff. 3-27-09; 95-1049, eff. 1-1-10;
996-328, eff. 8-11-09; 96-833, eff. 6-1-10; 96-1000, eff.
107-2-10.)
 
11    Section 40. The Illinois Public Aid Code is amended by
12changing Section 5-16.8 as follows:
 
13    (305 ILCS 5/5-16.8)
14    Sec. 5-16.8. Required health benefits. The medical
15assistance program shall (i) provide the post-mastectomy care
16benefits required to be covered by a policy of accident and
17health insurance under Section 356t and the coverage required
18under Sections 356g.5, 356u, 356w, 356x, and 356z.6 of the
19Illinois Insurance Code and (ii) be subject to the provisions
20of Sections 356z.19 and Section 364.01 of the Illinois
21Insurance Code.
22(Source: P.A. 95-189, eff. 8-16-07; 95-331, eff. 8-21-07.)
 
23    Section 99. Effective date. This Act takes effect upon

 

 

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1becoming law.".