Rep. Sara Feigenholtz

Filed: 5/12/2014

 

 


 

 


 
09800SB0647ham001LRB098 04426 AMC 59279 a

1
AMENDMENT TO SENATE BILL 647

2    AMENDMENT NO. ______. Amend Senate Bill 647 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, and 356z.22 of the Illinois
16Insurance Code. The program of health benefits must comply with

 

 

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1Sections 155.22a, 155.37, 355b, and 356z.19 of the Illinois
2Insurance 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. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-813,
10eff. 7-13-12; 98-189, eff. 1-1-14.)
 
11    Section 10. The Counties Code is amended by changing
12Section 5-1069.3 as follows:
 
13    (55 ILCS 5/5-1069.3)
14    Sec. 5-1069.3. Required health benefits. If a county,
15including a home rule county, is a self-insurer for purposes of
16providing health insurance coverage for its employees, the
17coverage shall include coverage for the post-mastectomy care
18benefits required to be covered by a policy of accident and
19health insurance under Section 356t and the coverage required
20under Sections 356g, 356g.5, 356g.5-1, 356u, 356w, 356x,
21356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
22356z.14, and 356z.15, and 356z.22 of the Illinois Insurance
23Code. The coverage shall comply with Sections 155.22a, 355b,
24and 356z.19 of the Illinois Insurance Code. The requirement

 

 

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1that health benefits be covered as provided in this Section is
2an exclusive power and function of the State and is a denial
3and limitation under Article VII, Section 6, subsection (h) of
4the Illinois Constitution. A home rule county to which this
5Section applies must comply with every provision of this
6Section.
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. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-813,
14eff. 7-13-12; 98-189, eff. 1-1-14.)
 
15    Section 15. The Illinois Municipal Code is amended by
16changing Section 10-4-2.3 as follows:
 
17    (65 ILCS 5/10-4-2.3)
18    Sec. 10-4-2.3. Required health benefits. If a
19municipality, including a home rule municipality, is a
20self-insurer for purposes of providing health insurance
21coverage for its employees, the coverage shall include coverage
22for the post-mastectomy care benefits required to be covered by
23a policy of accident and health insurance under Section 356t
24and the coverage required under Sections 356g, 356g.5,

 

 

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1356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10,
2356z.11, 356z.12, 356z.13, 356z.14, and 356z.15, and 356z.22 of
3the Illinois Insurance Code. The coverage shall comply with
4Sections 155.22a, 355b, and 356z.19 of the Illinois Insurance
5Code. The requirement that health benefits be covered as
6provided in this is an exclusive power and function of the
7State and is a denial and limitation under Article VII, Section
86, subsection (h) of the Illinois Constitution. A home rule
9municipality to which this Section applies must comply with
10every provision of this Section.
11    Rulemaking authority to implement Public Act 95-1045, if
12any, is conditioned on the rules being adopted in accordance
13with all provisions of the Illinois Administrative Procedure
14Act and all rules and procedures of the Joint Committee on
15Administrative Rules; any purported rule not so adopted, for
16whatever reason, is unauthorized.
17(Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-813,
18eff. 7-13-12; 98-189, eff. 1-1-14.)
 
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, and 356z.22 of the Illinois
5Insurance Code. Insurance policies shall comply with Section
6356z.19 of the Illinois Insurance Code. The coverage shall
7comply with Sections 155.22a and 355b of the Illinois Insurance
8Code.
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. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-813,
16eff. 7-13-12; 98-189, eff. 1-1-14.)
 
17    Section 25. The Illinois Insurance Code is amended by
18adding Section 356z.22 as follows:
 
19    (215 ILCS 5/356z.22 new)
20    Sec. 356z.22. Coverage for telehealth services.
21    (a) For purposes of this Section:
22        "Distant site" means the location at which the health
23    care provider rendering the telehealth service is located.
24        "Interactive telecommunications system" means an audio

 

 

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1    and video system permitting 2-way, live interactive
2    communication between the patient and the distant site
3    health care provider.
4        "Telehealth services" means the delivery of covered
5    health care services by way of an interactive
6    telecommunications system.
7    (b) If an individual or group policy of accident or health
8insurance provides coverage for telehealth services, then it
9must comply with the following:
10        (1) An individual or group policy of accident or health
11    insurance providing telehealth services may not:
12            (A) require that in-person contact occur between a
13        health care provider and a patient;
14            (B) require the health care provider to document a
15        barrier to an in-person consultation for coverage of
16        services to be provided through telehealth;
17            (C) require the use of telehealth when the health
18        care provider has determined that it is not
19        appropriate; or
20            (D) require the use of telehealth when a patient
21        chooses an in-person consultation.
22        (2) Deductibles, copayments, or coinsurance applicable
23    to services provided through telehealth shall not exceed
24    the deductibles, copayments, or coinsurance required by
25    the individual or group policy of accident or health
26    insurance for the same services provided through in-person

 

 

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1    consultation.
2    (c) Nothing in this Section shall be deemed as precluding a
3health insurer from providing benefits for other services,
4including, but not limited to, remote monitoring services,
5other monitoring services, or oral communications otherwise
6covered under the policy.
 
7    Section 30. The Health Maintenance Organization Act is
8amended by changing Section 5-3 as follows:
 
9    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
10    Sec. 5-3. Insurance Code provisions.
11    (a) Health Maintenance Organizations shall be subject to
12the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
13141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
14154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2, 355.3,
15355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2, 356z.4,
16356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
17356z.13, 356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.21,
18356z.22, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c, 368d,
19368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A, 408, 408.2,
20409, 412, 444, and 444.1, paragraph (c) of subsection (2) of
21Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2, XIII,
22XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.
23    (b) For purposes of the Illinois Insurance Code, except for
24Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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1refund authorized under this Section.
2    (g) Rulemaking authority to implement Public Act 95-1045,
3if any, 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. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-437,
9eff. 8-18-11; 97-486, eff. 1-1-12; 97-592, eff. 1-1-12; 97-805,
10eff. 1-1-13; 97-813, eff. 7-13-12; 98-189, eff. 1-1-14.)
 
11    Section 35. The Limited Health Service Organization Act is
12amended by changing Section 4003 as follows:
 
13    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
14    Sec. 4003. Illinois Insurance Code provisions. Limited
15health service organizations shall be subject to the provisions
16of Sections 133, 134, 136, 137, 139, 140, 141.1, 141.2, 141.3,
17143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5, 154.6,
18154.7, 154.8, 155.04, 155.37, 355.2, 355.3, 355b, 356v,
19356z.10, 356z.21, 356z.22, 368a, 401, 401.1, 402, 403, 403A,
20408, 408.2, 409, 412, 444, and 444.1 and Articles IIA, VIII
211/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and XXVI of the
22Illinois Insurance Code. For purposes of the Illinois Insurance
23Code, except for Sections 444 and 444.1 and Articles XIII and
24XIII 1/2, limited health service organizations in the following

 

 

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1categories are deemed to be domestic companies:
2        (1) a corporation under the laws of this State; or
3        (2) a corporation organized under the laws of another
4    state, 30% of more of the enrollees of which are residents
5    of this State, except a corporation subject to
6    substantially the same requirements in its state of
7    organization as is a domestic company under Article VIII
8    1/2 of the Illinois Insurance Code.
9(Source: P.A. 97-486, eff. 1-1-12; 97-592, 1-1-12; 97-805, eff.
101-1-13; 97-813, eff. 7-13-12; 98-189, eff. 1-1-14.)
 
11    Section 40. The Voluntary Health Services Plans Act is
12amended by changing Section 10 as follows:
 
13    (215 ILCS 165/10)  (from Ch. 32, par. 604)
14    Sec. 10. Application of Insurance Code provisions. Health
15services plan corporations and all persons interested therein
16or dealing therewith shall be subject to the provisions of
17Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
18143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, 356g,
19356g.5, 356g.5-1, 356r, 356t, 356u, 356v, 356w, 356x, 356y,
20356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9,
21356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18,
22356z.19, 356z.21, 356z.22, 364.01, 367.2, 368a, 401, 401.1,
23402, 403, 403A, 408, 408.2, and 412, and paragraphs (7) and
24(15) of Section 367 of the Illinois Insurance Code.

 

 

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1    Rulemaking authority to implement Public Act 95-1045, if
2any, is conditioned on the rules being adopted in accordance
3with all provisions of the Illinois Administrative Procedure
4Act and all rules and procedures of the Joint Committee on
5Administrative Rules; any purported rule not so adopted, for
6whatever reason, is unauthorized.
7(Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-486,
8eff. 1-1-12; 97-592, eff. 1-1-12; 97-805, eff. 1-1-13; 97-813,
9eff. 7-13-12; 98-189, eff. 1-1-14.)".