97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
HB5658

 

Introduced 2/16/2012, by Rep. Robyn Gabel

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 5/356z.16
215 ILCS 5/356z.22 new
215 ILCS 125/5-3  from Ch. 111 1/2, par. 1411.2
215 ILCS 130/4003  from Ch. 73, par. 1504-3
215 ILCS 165/10  from Ch. 32, par. 604

    Amends the Illinois Insurance Code. Provides that the provision concerning tobacco use cessation programs does not apply to short-term travel, disability income, long-term care, accident only, or limited or specified disease policies. Creates the Tobacco Dependence Coverage Law. Provides that group and individual accident and health policies and managed care plans issued to a resident of the State must provide coverage or reimbursement of up to $500 annually for a tobacco use cessation program for insureds who are 18 years of age or older. Provides that notice of the availability of coverage shall be delivered to the insured. Provides that an insurer may not deny eligibility or continued eligibility to enroll or renew coverage solely for the purpose of avoiding the requirements of the Law. Provides that an insurer may not penalize or reduce or limit the reimbursement of an attending provider or provide incentives to induce the provider to provide care that is inconsistent with the Law. Amends the Health Maintenance Organization Act, Limited Health Service Organization Act, and Voluntary Health Services Plans Act to provide that those Acts shall be subject to the provisions of the Illinois Insurance Code concerning tobacco use cessation programs.


LRB097 17546 RPM 62751 b

 

 

A BILL FOR

 

HB5658LRB097 17546 RPM 62751 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 Illinois Insurance Code is amended by
5changing Section 356z.16 and adding Section 356z.22 as follows:
 
6    (215 ILCS 5/356z.16)
7    Sec. 356z.16. Applicability of mandated benefits to
8supplemental policies. Unless specified otherwise, the
9following Sections of the Illinois Insurance Code do not apply
10to short-term travel, disability income, long-term care,
11accident only, or limited or specified disease policies: 356b,
12356c, 356d, 356g, 356k, 356m, 356n, 356p, 356q, 356r, 356t,
13356u, 356w, 356x, 356z.1, 356z.2, 356z.4, 356z.5, 356z.6,
14356z.8, 356z.12, 356z.19, 356z.21 356z.19, 356z.22, 364.01,
15367.2-5, and 367e.
16(Source: P.A. 96-180, eff. 1-1-10; 96-1000, eff. 7-2-10;
1796-1034, eff. 1-1-11; 97-91, eff. 1-1-12; 97-282, eff. 8-9-11;
1897-592, eff. 1-1-12; revised 10-13-11.)
 
19    (215 ILCS 5/356z.22 new)
20    Sec. 356z.22. Tobacco use cessation programs.
21    (a) This Section may be referred to as the Tobacco
22Dependence Coverage Law.

 

 

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1    (b) Tobacco use is the number one cause of preventable
2disease and death in Illinois, costing $4.1 billion annually in
3direct health care costs and an additional $4.35 billion in
4lost productivity. In Illinois, the smoking rates are highest
5among African Americans (25.8%). Smoking rates among lesbian,
6gay, and bisexual adults range from 25% to 44%. The U.S. Public
7Health Service Clinical Practice Guideline 2008 Update found
8that tobacco dependence treatments are both clinically
9effective and highly cost effective. A study in the Journal of
10Preventive Medicine concluded that comprehensive smoking
11cessation treatment is one of the 3 most important and cost
12effective preventive services that can be provided in medical
13practice. Greater efforts are needed to achieve more of this
14potential value by increasing current low levels of
15performance.
16    (c) In this Section, "tobacco use cessation program" means
17a program recommended by a physician that follows
18evidence-based treatment, such as is outlined in the United
19States Public Health Service guidelines for tobacco use
20cessation. "Tobacco use cessation program" includes education
21and medical treatment components designed to assist a person in
22ceasing the use of tobacco products. "Tobacco use cessation
23program" includes education and counseling by physicians or
24associated medical personnel and all FDA approved medications
25for the treatment of tobacco dependence irrespective of whether
26they are available only over the counter, only by prescription,

 

 

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1or both over the counter and by prescription.
2    (d) A group or individual policy of accident and health
3insurance or managed care plan amended, delivered, issued, or
4renewed after the effective date of this amendatory Act of the
597th General Assembly to a resident of this State must provide
6coverage or reimbursement of up to $500 annually for a tobacco
7use cessation program for a person enrolled in the plan who is
818 years of age or older.
9    (e) Written notice of the availability of coverage under
10this Section shall be delivered to the insured upon enrollment
11and annually thereafter. An insurer may not deny to an insured
12eligibility or continued eligibility to enroll or to renew
13coverage under the terms of the plan solely for the purpose of
14avoiding the requirements of this Section. An insurer may not
15penalize or reduce or limit the reimbursement of an attending
16provider or provide incentives, monetary or otherwise, to an
17attending provider to induce the provider to provide care to an
18insured in a manner inconsistent with this Section.
 
19    Section 10. The Health Maintenance Organization Act is
20amended by changing Section 5-3 as follows:
 
21    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
22    Sec. 5-3. Insurance Code provisions.
23    (a) Health Maintenance Organizations shall be subject to
24the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,

 

 

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1141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
2154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2, 356g.5-1,
3356m, 356v, 356w, 356x, 356y, 356z.2, 356z.4, 356z.5, 356z.6,
4356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14,
5356z.15, 356z.17, 356z.18, 356z.19, 356z.21 356z.19, 356z.22,
6364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c, 368d, 368e,
7370c, 370c.1, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412,
8444, and 444.1, paragraph (c) of subsection (2) of Section 367,
9and Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV,
10and XXVI of the Illinois Insurance Code.
11    (b) For purposes of the Illinois Insurance Code, except for
12Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health
13Maintenance Organizations in the following categories are
14deemed to be "domestic companies":
15        (1) a corporation authorized under the Dental Service
16    Plan Act or the Voluntary Health Services Plans Act;
17        (2) a corporation organized under the laws of this
18    State; or
19        (3) a corporation organized under the laws of another
20    state, 30% or more of the enrollees of which are residents
21    of this State, except a corporation subject to
22    substantially the same requirements in its state of
23    organization as is a "domestic company" under Article VIII
24    1/2 of the Illinois Insurance Code.
25    (c) In considering the merger, consolidation, or other
26acquisition of control of a Health Maintenance Organization

 

 

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

 

 

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1        acquiring party's plans with respect to the operation
2        of the Health Maintenance Organization sought to be
3        acquired for a period of not less than 3 years; and
4            (D) such other information as the Director shall
5        require.
6    (d) The provisions of Article VIII 1/2 of the Illinois
7Insurance Code and this Section 5-3 shall apply to the sale by
8any health maintenance organization of greater than 10% of its
9enrollee population (including without limitation the health
10maintenance organization's right, title, and interest in and to
11its health care certificates).
12    (e) In considering any management contract or service
13agreement subject to Section 141.1 of the Illinois Insurance
14Code, the Director (i) shall, in addition to the criteria
15specified in Section 141.2 of the Illinois Insurance Code, take
16into account the effect of the management contract or service
17agreement on the continuation of benefits to enrollees and the
18financial condition of the health maintenance organization to
19be managed or serviced, and (ii) need not take into account the
20effect of the management contract or service agreement on
21competition.
22    (f) Except for small employer groups as defined in the
23Small Employer Rating, Renewability and Portability Health
24Insurance Act and except for medicare supplement policies as
25defined in Section 363 of the Illinois Insurance Code, a Health
26Maintenance Organization may by contract agree with a group or

 

 

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

 

 

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1and upon request of any group or enrollment unit, provide to
2the group or enrollment unit a description of the method used
3to calculate (1) the Health Maintenance Organization's
4profitable experience with respect to the group or enrollment
5unit and the resulting refund to the group or enrollment unit
6or (2) the Health Maintenance Organization's unprofitable
7experience with respect to the group or enrollment unit and the
8resulting additional premium to be paid by the group or
9enrollment unit.
10    In no event shall the Illinois Health Maintenance
11Organization Guaranty Association be liable to pay any
12contractual obligation of an insolvent organization to pay any
13refund authorized under this Section.
14    (g) Rulemaking authority to implement Public Act 95-1045,
15if any, is conditioned on the rules being adopted in accordance
16with all provisions of the Illinois Administrative Procedure
17Act and all rules and procedures of the Joint Committee on
18Administrative Rules; any purported rule not so adopted, for
19whatever reason, is unauthorized.
20(Source: P.A. 96-328, eff. 8-11-09; 96-639, eff. 1-1-10;
2196-833, eff. 6-1-10; 96-1000, eff. 7-2-10; 97-282, eff. 8-9-11;
2297-343, eff. 1-1-12; 97-437, eff. 8-18-11; 97-486, eff. 1-1-12;
2397-592, eff. 1-1-12; revised 10-13-11.)
 
24    Section 15. The Limited Health Service Organization Act is
25amended by changing Section 4003 as follows:
 

 

 

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1    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
2    Sec. 4003. Illinois Insurance Code provisions. Limited
3health service organizations shall be subject to the provisions
4of Sections 133, 134, 136, 137, 139, 140, 141.1, 141.2, 141.3,
5143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5, 154.6,
6154.7, 154.8, 155.04, 155.37, 355.2, 356v, 356z.10, 356z.21
7356z.19, 356z.22, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2,
8409, 412, 444, and 444.1 and Articles IIA, VIII 1/2, XII, XII
91/2, XIII, XIII 1/2, XXV, and XXVI of the Illinois Insurance
10Code. For purposes of the Illinois Insurance Code, except for
11Sections 444 and 444.1 and Articles XIII and XIII 1/2, limited
12health service organizations in the following categories are
13deemed to be domestic companies:
14        (1) a corporation under the laws of this State; or
15        (2) a corporation organized under the laws of another
16    state, 30% of more of the enrollees of which are residents
17    of this State, except a corporation subject to
18    substantially the same requirements in its state of
19    organization as is a domestic company under Article VIII
20    1/2 of the Illinois Insurance Code.
21(Source: P.A. 97-486, eff. 1-1-12; 97-592, 1-1-12; revised
2210-13-11.)
 
23    Section 20. The Voluntary Health Services Plans Act is
24amended by changing Section 10 as follows:
 

 

 

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1    (215 ILCS 165/10)  (from Ch. 32, par. 604)
2    Sec. 10. Application of Insurance Code provisions. Health
3services plan corporations and all persons interested therein
4or dealing therewith shall be subject to the provisions of
5Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
6143, 143c, 149, 155.22a, 155.37, 354, 355.2, 356g, 356g.5,
7356g.5-1, 356r, 356t, 356u, 356v, 356w, 356x, 356y, 356z.1,
8356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10,
9356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18, 356z.19,
10356z.21 356z.19, 356z.22, 364.01, 367.2, 368a, 401, 401.1, 402,
11403, 403A, 408, 408.2, and 412, and paragraphs (7) and (15) of
12Section 367 of the Illinois 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. 96-328, eff. 8-11-09; 96-833, eff. 6-1-10;
2096-1000, eff. 7-2-10; 97-282, eff. 8-9-11; 97-343, eff. 1-1-12;
2197-486, eff. 1-1-12; 97-592, eff. 1-1-12; revised 10-13-11.)