Rep. Mary E. Flowers

Filed: 3/18/2013

 

 


 

 


 
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1
AMENDMENT TO HOUSE BILL 566

2    AMENDMENT NO. ______. Amend House Bill 566 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Counties Code is amended by changing
5Section 5-1069.3 as follows:
 
6    (55 ILCS 5/5-1069.3)
7    Sec. 5-1069.3. Required health benefits. If a county,
8including a home rule county, is a self-insurer for purposes of
9providing health insurance coverage for its employees, the
10coverage shall include coverage for 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, 356g.5, 356g.5-1, 356u, 356w, 356x,
14356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
15356z.14, and 356z.15, 356z.22, and 356z.23 of the Illinois
16Insurance Code. The coverage shall comply with Sections 155.22a

 

 

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1and 356z.19 of the Illinois Insurance Code. The requirement
2that health benefits be covered as provided in this Section is
3an exclusive power and function of the State and is a denial
4and limitation under Article VII, Section 6, subsection (h) of
5the Illinois Constitution. A home rule county to which this
6Section applies must comply with every provision of this
7Section.
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. 96-139, eff. 1-1-10; 96-328, eff. 8-11-09;
1596-1000, eff. 7-2-10; 97-282, eff. 8-9-11; 97-343, eff. 1-1-12;
1697-813, eff. 7-13-12.)
 
17    Section 10. The Illinois Municipal Code is amended by
18changing Section 10-4-2.3 as follows:
 
19    (65 ILCS 5/10-4-2.3)
20    Sec. 10-4-2.3. Required health benefits. If a
21municipality, including a home rule municipality, is a
22self-insurer for purposes of providing health insurance
23coverage for its employees, the coverage shall include coverage
24for the post-mastectomy care benefits required to be covered by

 

 

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1a policy of accident and health insurance under Section 356t
2and the coverage required under Sections 356g, 356g.5,
3356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10,
4356z.11, 356z.12, 356z.13, 356z.14, and 356z.15, 356z.22, and
5356z.23 of the Illinois Insurance Code. The coverage shall
6comply with Sections 155.22a and 356z.19 of the Illinois
7Insurance Code. The requirement that health benefits be covered
8as provided in this is an exclusive power and function of the
9State and is a denial and limitation under Article VII, Section
106, subsection (h) of the Illinois Constitution. A home rule
11municipality to which this Section applies must comply with
12every provision of this Section.
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. 96-139, eff. 1-1-10; 96-328, eff. 8-11-09;
2096-1000, eff. 7-2-10; 97-282, eff. 8-9-11; 97-343, eff. 1-1-12;
2197-813, eff. 7-13-12.)
 
22    Section 15. The School Code is amended by changing Section
2310-22.3f as follows:
 
24    (105 ILCS 5/10-22.3f)

 

 

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1    Sec. 10-22.3f. Required health benefits. Insurance
2protection and benefits for employees shall provide the
3post-mastectomy care benefits required to be covered by a
4policy of accident and health insurance under Section 356t and
5the coverage required under Sections 356g, 356g.5, 356g.5-1,
6356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11, 356z.12,
7356z.13, 356z.14, and 356z.15, 356z.22, and 356z.23 of the
8Illinois Insurance Code. Insurance policies shall comply with
9Section 356z.19 of the Illinois Insurance Code. The coverage
10shall comply with Section 155.22a of the Illinois Insurance
11Code.
12    Rulemaking authority to implement Public Act 95-1045, if
13any, is conditioned on the rules being adopted in accordance
14with all provisions of the Illinois Administrative Procedure
15Act and all rules and procedures of the Joint Committee on
16Administrative Rules; any purported rule not so adopted, for
17whatever reason, is unauthorized.
18(Source: P.A. 96-139, eff. 1-1-10; 96-328, eff. 8-11-09;
1996-1000, eff. 7-2-10; 97-282, eff. 8-9-11; 97-343, eff. 1-1-12;
2097-813, eff. 7-13-12.)
 
21    Section 20. The Illinois Insurance Code is amended by
22adding Sections 356z.22 and 356z.23 as follows:
 
23    (215 ILCS 5/356z.22 new)
24    Sec. 356z.22. Nutritional support and hydration.

 

 

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1    (a) The General Assembly finds that people who are
2physically unable to swallow, digest, or absorb food and fluids
3taken by mouth are at risk of malnutrition and dehydration.
4Without nutritional support and hydration, such individuals
5will become increasingly weakened. As their immune system
6functioning is reduced, they may die from infections before
7death can occur from malnutrition or dehydration.
8    (b) A group or individual policy of accident and health
9insurance or managed care plan amended, delivered, issued, or
10renewed after the effective date of this amendatory Act of the
1198th General Assembly must provide coverage for intravenous
12feeding and for enteral or tube feeding. The benefits under
13this Section shall be at least as favorable as for other
14coverages under the policy and may be subject to the same
15dollar amount limits, deductibles, and co-insurance
16requirements applicable generally to other coverages under the
17policy.
18    (c) For the purpose of this Section, "enteral or tube
19feeding" means the process by which nutritional formulas are
20delivered via a tube into the digestive tract.
 
21    (215 ILCS 5/356z.23 new)
22    Sec. 356z.23. Prescription nutritional supplements. A
23group or individual policy of accident and health insurance or
24managed care plan amended, delivered, issued, or renewed after
25the effective date of this amendatory Act of the 98th General

 

 

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1Assembly that provides coverage for prescription drugs must
2provide coverage for reimbursement for medically appropriate
3prescription nutritional supplements, limited to those
4products that are issued only by a physician's written order,
5when ordered by a physician licensed to practice medicine in
6all its branches and the insured suffers from a condition that
7prevents him or her from taking sufficient oral nourishment to
8sustain life.
 
9    Section 25. The Health Maintenance Organization Act is
10amended by changing Section 5-3 as follows:
 
11    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
12    Sec. 5-3. Insurance Code provisions.
13    (a) Health Maintenance Organizations shall be subject to
14the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
15141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
16154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2, 355.3,
17356g.5-1, 356m, 356v, 356w, 356x, 356y, 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.17, 356z.18, 356z.19, 356z.21, 356z.22,
20356z.23, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c, 368d,
21368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A, 408, 408.2,
22409, 412, 444, and 444.1, paragraph (c) of subsection (2) of
23Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2, XIII,
24XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.

 

 

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1    (b) For purposes of the Illinois Insurance Code, except for
2Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health
3Maintenance Organizations in the following categories are
4deemed to be "domestic companies":
5        (1) a corporation authorized under the Dental Service
6    Plan Act or the Voluntary Health Services Plans Act;
7        (2) a corporation organized under the laws of this
8    State; or
9        (3) a corporation organized under the laws of another
10    state, 30% or more of the enrollees of which are residents
11    of this State, except a corporation subject to
12    substantially the same requirements in its state of
13    organization as is a "domestic company" under Article VIII
14    1/2 of the Illinois Insurance Code.
15    (c) In considering the merger, consolidation, or other
16acquisition of control of a Health Maintenance Organization
17pursuant to Article VIII 1/2 of the Illinois Insurance Code,
18        (1) the Director shall give primary consideration to
19    the continuation of benefits to enrollees and the financial
20    conditions of the acquired Health Maintenance Organization
21    after the merger, consolidation, or other acquisition of
22    control takes effect;
23        (2)(i) the criteria specified in subsection (1)(b) of
24    Section 131.8 of the Illinois Insurance Code shall not
25    apply and (ii) the Director, in making his determination
26    with respect to the merger, consolidation, or other

 

 

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

 

 

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1its health care certificates).
2    (e) In considering any management contract or service
3agreement subject to Section 141.1 of the Illinois Insurance
4Code, the Director (i) shall, in addition to the criteria
5specified in Section 141.2 of the Illinois Insurance Code, take
6into account the effect of the management contract or service
7agreement on the continuation of benefits to enrollees and the
8financial condition of the health maintenance organization to
9be managed or serviced, and (ii) need not take into account the
10effect of the management contract or service agreement on
11competition.
12    (f) Except for small employer groups as defined in the
13Small Employer Rating, Renewability and Portability Health
14Insurance Act and except for medicare supplement policies as
15defined in Section 363 of the Illinois Insurance Code, a Health
16Maintenance Organization may by contract agree with a group or
17other enrollment unit to effect refunds or charge additional
18premiums under the following terms and conditions:
19        (i) the amount of, and other terms and conditions with
20    respect to, the refund or additional premium are set forth
21    in the group or enrollment unit contract agreed in advance
22    of the period for which a refund is to be paid or
23    additional premium is to be charged (which period shall not
24    be less than one year); and
25        (ii) the amount of the refund or additional premium
26    shall not exceed 20% of the Health Maintenance

 

 

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1    Organization's profitable or unprofitable experience with
2    respect to the group or other enrollment unit for the
3    period (and, for purposes of a refund or additional
4    premium, the profitable or unprofitable experience shall
5    be calculated taking into account a pro rata share of the
6    Health Maintenance Organization's administrative and
7    marketing expenses, but shall not include any refund to be
8    made or additional premium to be paid pursuant to this
9    subsection (f)). The Health Maintenance Organization and
10    the group or enrollment unit may agree that the profitable
11    or unprofitable experience may be calculated taking into
12    account the refund period and the immediately preceding 2
13    plan years.
14    The Health Maintenance Organization shall include a
15statement in the evidence of coverage issued to each enrollee
16describing the possibility of a refund or additional premium,
17and upon request of any group or enrollment unit, provide to
18the group or enrollment unit a description of the method used
19to calculate (1) the Health Maintenance Organization's
20profitable experience with respect to the group or enrollment
21unit and the resulting refund to the group or enrollment unit
22or (2) the Health Maintenance Organization's unprofitable
23experience with respect to the group or enrollment unit and the
24resulting additional premium to be paid by the group or
25enrollment unit.
26    In no event shall the Illinois Health Maintenance

 

 

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1Organization Guaranty Association be liable to pay any
2contractual obligation of an insolvent organization to pay any
3refund authorized under this Section.
4    (g) Rulemaking authority to implement Public Act 95-1045,
5if any, 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. 96-328, eff. 8-11-09; 96-639, eff. 1-1-10;
1196-833, eff. 6-1-10; 96-1000, eff. 7-2-10; 97-282, eff. 8-9-11;
1297-343, eff. 1-1-12; 97-437, eff. 8-18-11; 97-486, eff. 1-1-12;
1397-592, eff. 1-1-12; 97-805, eff. 1-1-13; 97-813, eff.
147-13-12.)
 
15    Section 30. The Voluntary Health Services Plans Act is
16amended by changing Section 10 as follows:
 
17    (215 ILCS 165/10)  (from Ch. 32, par. 604)
18    Sec. 10. Application of Insurance Code provisions. Health
19services plan corporations and all persons interested therein
20or dealing therewith shall be subject to the provisions of
21Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
22143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 356g,
23356g.5, 356g.5-1, 356r, 356t, 356u, 356v, 356w, 356x, 356y,
24356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9,

 

 

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1356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18,
2356z.19, 356z.21, 356z.22, 356z.23, 364.01, 367.2, 368a, 401,
3401.1, 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7)
4and (15) of Section 367 of the Illinois Insurance Code.
5    Rulemaking authority to implement Public Act 95-1045, if
6any, is conditioned on the rules being adopted in accordance
7with all provisions of the Illinois Administrative Procedure
8Act and all rules and procedures of the Joint Committee on
9Administrative Rules; any purported rule not so adopted, for
10whatever reason, is unauthorized.
11(Source: P.A. 96-328, eff. 8-11-09; 96-833, eff. 6-1-10;
1296-1000, eff. 7-2-10; 97-282, eff. 8-9-11; 97-343, eff. 1-1-12;
1397-486, eff. 1-1-12; 97-592, eff. 1-1-12; 97-805, eff. 1-1-13;
1497-813, eff. 7-13-12.)
 
15    Section 90. The State Mandates Act is amended by adding
16Section 8.37 as follows:
 
17    (30 ILCS 805/8.37 new)
18    Sec. 8.37. Exempt mandate. Notwithstanding Sections 6 and 8
19of this Act, no reimbursement by the State is required for the
20implementation of any mandate created by this amendatory Act of
21the 98th General Assembly.".