Illinois General Assembly - Full Text of HB2370
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Full Text of HB2370  102nd General Assembly

HB2370 102ND GENERAL ASSEMBLY

  
  

 


 
102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
HB2370

 

Introduced 2/17/2021, by Rep. Dagmara Avelar

 

SYNOPSIS AS INTRODUCED:
 
5 ILCS 375/6.11
55 ILCS 5/5-1069.3
65 ILCS 5/10-4-2.3
105 ILCS 5/10-22.3f
215 ILCS 5/356z.43 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
305 ILCS 5/5-16.8

    Amends the Illinois Insurance Code to provide that a group or individual policy of accident and health insurance amended, delivered, issued, or renewed on or after the effective date of the amendatory Act that provides coverage for prescription drugs shall limit the total amount that an insured is required to pay for a 30-day supply of covered prescription drugs at an amount not to exceed $100. Makes conforming changes in the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, the Limited Health Service Organization Act, the Voluntary Health Services Plans Act, and the Illinois Public Aid Code.


LRB102 13403 BMS 18747 b

 

 

A BILL FOR

 

HB2370LRB102 13403 BMS 18747 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
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
9provide the post-mastectomy care benefits required to be
10covered by a policy of accident and health insurance under
11Section 356t of the Illinois Insurance Code. The program of
12health benefits shall provide the coverage required under
13Sections 356g, 356g.5, 356g.5-1, 356m, 356u, 356w, 356x,
14356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
15356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,
16356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
17356z.36, and 356z.41 of the Illinois Insurance Code. The
18program of health benefits must comply with Sections 155.22a,
19155.37, 355b, 356z.19, 356z.43, 370c, and 370c.1 and Article
20XXXIIB of the Illinois Insurance Code. The Department of
21Insurance shall enforce the requirements of this Section with
22respect to Sections 370c and 370c.1 of the Illinois Insurance
23Code; all other requirements of this Section shall be enforced

 

 

HB2370- 2 -LRB102 13403 BMS 18747 b

1by the Department of Central Management Services.
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. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
9100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
101-1-19; 100-1102, eff. 1-1-19; 100-1170, eff. 6-1-19; 101-13,
11eff. 6-12-19; 101-281, eff. 1-1-20; 101-393, eff. 1-1-20;
12101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
131-1-21.)
 
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
19of providing 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,

 

 

HB2370- 3 -LRB102 13403 BMS 18747 b

1356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
2356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41 of the
3Illinois Insurance Code. The coverage shall comply with
4Sections 155.22a, 355b, 356z.19, 356z.43, and 370c of the
5Illinois Insurance Code. The Department of Insurance shall
6enforce the requirements of this Section. The requirement that
7health benefits be covered as provided in this Section is an
8exclusive power and function of the State and is a denial and
9limitation under Article VII, Section 6, subsection (h) of the
10Illinois Constitution. A home rule county to which this
11Section applies must comply with every provision of this
12Section.
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. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
20100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
211-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
22eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
23101-625, eff. 1-1-21.)
 
24    Section 15. The Illinois Municipal Code is amended by
25changing Section 10-4-2.3 as follows:
 

 

 

HB2370- 4 -LRB102 13403 BMS 18747 b

1    (65 ILCS 5/10-4-2.3)
2    Sec. 10-4-2.3. Required health benefits. If a
3municipality, including a home rule municipality, is a
4self-insurer for purposes of providing health insurance
5coverage for its employees, the coverage shall include
6coverage for the post-mastectomy care benefits required to be
7covered by a policy of accident and health insurance under
8Section 356t and the coverage required under Sections 356g,
9356g.5, 356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9,
10356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
11356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
12356z.36, and 356z.41 of the Illinois Insurance Code. The
13coverage shall comply with Sections 155.22a, 355b, 356z.19,
14356z.43, and 370c of the Illinois Insurance Code. The
15Department of Insurance shall enforce the requirements of this
16Section. The requirement that health benefits be covered as
17provided in this is an exclusive power and function of the
18State and is a denial and limitation under Article VII,
19Section 6, subsection (h) of the Illinois Constitution. A home
20rule municipality to which this Section applies must comply
21with every provision of this Section.
22    Rulemaking authority to implement Public Act 95-1045, if
23any, is conditioned on the rules being adopted in accordance
24with all provisions of the Illinois Administrative Procedure
25Act and all rules and procedures of the Joint Committee on

 

 

HB2370- 5 -LRB102 13403 BMS 18747 b

1Administrative Rules; any purported rule not so adopted, for
2whatever reason, is unauthorized.
3(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
4100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
51-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
6eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
7101-625, eff. 1-1-21.)
 
8    Section 20. The School Code is amended by changing Section
910-22.3f as follows:
 
10    (105 ILCS 5/10-22.3f)
11    Sec. 10-22.3f. Required health benefits. Insurance
12protection and benefits for employees shall provide the
13post-mastectomy care benefits required to be covered by a
14policy of accident and health insurance under Section 356t and
15the coverage required under Sections 356g, 356g.5, 356g.5-1,
16356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11, 356z.12,
17356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
18356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41 of the
19Illinois Insurance Code. Insurance policies shall comply with
20Section 356z.19 of the Illinois Insurance Code. The coverage
21shall comply with Sections 155.22a, 355b, 356z.43, and 370c of
22the Illinois Insurance Code. The Department of Insurance shall
23enforce the requirements of this Section.
24    Rulemaking authority to implement Public Act 95-1045, if

 

 

HB2370- 6 -LRB102 13403 BMS 18747 b

1any, is conditioned on the rules being adopted in accordance
2with all provisions of the Illinois Administrative Procedure
3Act and all rules and procedures of the Joint Committee on
4Administrative Rules; any purported rule not so adopted, for
5whatever reason, is unauthorized.
6(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
7100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
81-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
9eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
10101-625, eff. 1-1-21.)
 
11    Section 25. The Illinois Insurance Code is amended by
12adding Section 356z.43 as follows:
 
13    (215 ILCS 5/356z.43 new)
14    Sec. 356z.43. Cost sharing for prescription drugs; limits.
15A group or individual policy of accident and health insurance
16amended, delivered, issued, or renewed on or after the
17effective date of this amendatory Act of the 102nd General
18Assembly that provides coverage for prescription drugs shall
19limit the total amount that an insured is required to pay for a
2030-day supply of covered prescription drugs at an amount not
21to exceed $100.
 
22    Section 30. The Health Maintenance Organization Act is
23amended by changing Section 5-3 as follows:
 

 

 

HB2370- 7 -LRB102 13403 BMS 18747 b

1    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
2    Sec. 5-3. Insurance Code provisions.
3    (a) Health Maintenance Organizations shall be subject to
4the provisions of Sections 133, 134, 136, 137, 139, 140,
5141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
6154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2,
7355.3, 355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2,
8356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10,
9356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.18,
10356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30,
11356z.30a, 356z.32, 356z.33, 356z.35, 356z.36, 356z.41,
12356z.43, 364, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c,
13368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A, 408,
14408.2, 409, 412, 444, and 444.1, paragraph (c) of subsection
15(2) of Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2,
16XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the Illinois
17Insurance Code.
18    (b) For purposes of the Illinois Insurance Code, except
19for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
20Health Maintenance Organizations in the following categories
21are deemed to be "domestic companies":
22        (1) a corporation authorized under the Dental Service
23    Plan Act or the Voluntary Health Services Plans Act;
24        (2) a corporation organized under the laws of this
25    State; or

 

 

HB2370- 8 -LRB102 13403 BMS 18747 b

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

 

 

HB2370- 9 -LRB102 13403 BMS 18747 b

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

 

 

HB2370- 10 -LRB102 13403 BMS 18747 b

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

 

 

HB2370- 11 -LRB102 13403 BMS 18747 b

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

 

 

HB2370- 12 -LRB102 13403 BMS 18747 b

1adopted, for whatever reason, is unauthorized.
2(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
3100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff.
41-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81,
5eff. 7-12-19; 101-281, eff. 1-1-20; 101-371, eff. 1-1-20;
6101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
71-1-20; 101-625, eff. 1-1-21.)
 
8    Section 35. The Limited Health Service Organization Act is
9amended by changing Section 4003 as follows:
 
10    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
11    Sec. 4003. Illinois Insurance Code provisions. Limited
12health service organizations shall be subject to the
13provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
14141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
15154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 355.2, 355.3,
16355b, 356v, 356z.10, 356z.21, 356z.22, 356z.25, 356z.26,
17356z.29, 356z.30a, 356z.32, 356z.33, 356z.41, 356z.43, 368a,
18401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412, 444, and
19444.1 and Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2,
20XXV, and XXVI of the Illinois Insurance Code. For purposes of
21the Illinois Insurance Code, except for Sections 444 and 444.1
22and Articles XIII and XIII 1/2, limited health service
23organizations in the following categories are deemed to be
24domestic companies:

 

 

HB2370- 13 -LRB102 13403 BMS 18747 b

1        (1) a corporation under the laws of this State; or
2        (2) a corporation organized under the laws of another
3    state, 30% or more of the enrollees of which are residents
4    of this State, except a corporation subject to
5    substantially the same requirements in its state of
6    organization as is a domestic company under Article VIII
7    1/2 of the Illinois Insurance Code.
8(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
9100-201, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1057, eff.
101-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
11eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff. 1-1-21.)
 
12    Section 40. The Voluntary Health Services Plans Act is
13amended by changing Section 10 as follows:
 
14    (215 ILCS 165/10)  (from Ch. 32, par. 604)
15    Sec. 10. Application of Insurance Code provisions. Health
16services plan corporations and all persons interested therein
17or dealing therewith shall be subject to the provisions of
18Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
19143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
20356g, 356g.5, 356g.5-1, 356r, 356t, 356u, 356v, 356w, 356x,
21356y, 356z.1, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8,
22356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
23356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29,
24356z.30, 356z.30a, 356z.32, 356z.33, 356z.41, 356z.43, 364.01,

 

 

HB2370- 14 -LRB102 13403 BMS 18747 b

1367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412,
2and paragraphs (7) and (15) of Section 367 of the Illinois
3Insurance Code.
4    Rulemaking authority to implement Public Act 95-1045, if
5any, 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. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
11100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff.
121-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81,
13eff. 7-12-19; 101-281, eff. 1-1-20; 101-393, eff. 1-1-20;
14101-625, eff. 1-1-21.)
 
15    Section 45. The Illinois Public Aid Code is amended by
16changing Section 5-16.8 as follows:
 
17    (305 ILCS 5/5-16.8)
18    Sec. 5-16.8. Required health benefits. The medical
19assistance program shall (i) provide the post-mastectomy care
20benefits required to be covered by a policy of accident and
21health insurance under Section 356t and the coverage required
22under Sections 356g.5, 356u, 356w, 356x, 356z.6, 356z.26,
23356z.29, 356z.32, 356z.33, 356z.34, and 356z.35 of the
24Illinois Insurance Code and (ii) be subject to the provisions

 

 

HB2370- 15 -LRB102 13403 BMS 18747 b

1of Sections 356z.19, 356z.43, 364.01, 370c, and 370c.1 of the
2Illinois Insurance Code.
3    The Department, by rule, shall adopt a model similar to
4the requirements of Section 356z.39 of the Illinois Insurance
5Code.
6    On and after July 1, 2012, the Department shall reduce any
7rate of reimbursement for services or other payments or alter
8any methodologies authorized by this Code to reduce any rate
9of reimbursement for services or other payments in accordance
10with Section 5-5e.
11    To ensure full access to the benefits set forth in this
12Section, on and after January 1, 2016, the Department shall
13ensure that provider and hospital reimbursement for
14post-mastectomy care benefits required under this Section are
15no lower than the Medicare reimbursement rate.
16(Source: P.A. 100-138, eff. 8-18-17; 100-863, eff. 8-14-18;
17100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff.
187-12-19; 101-218, eff. 1-1-20; 101-281, eff. 1-1-20; 101-371,
19eff. 1-1-20; 101-574, eff. 1-1-20; 101-649, eff. 7-7-20.)