Illinois General Assembly - Full Text of SB2969
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Full Text of SB2969  102nd General Assembly

SB2969enr 102ND GENERAL ASSEMBLY

  
  
  

 


 
SB2969 EnrolledLRB102 20623 BMS 29494 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, 356q, 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, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
18and 356z.53 and 356z.43 of the Illinois Insurance Code. The
19program of health benefits must comply with Sections 155.22a,
20155.37, 355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of
21the Illinois Insurance Code. The Department of Insurance shall
22enforce the requirements of this Section with respect to
23Sections 370c and 370c.1 of the Illinois Insurance Code; all

 

 

SB2969 Enrolled- 2 -LRB102 20623 BMS 29494 b

1other requirements of this Section shall be enforced by the
2Department of Central Management Services.
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. 101-13, eff. 6-12-19; 101-281, eff. 1-1-20;
10101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
111-1-20; 101-625, eff. 1-1-21; 102-30, eff. 1-1-22; 102-103,
12eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
13102-642, eff. 1-1-22; 102-665, eff. 10-8-21; revised
1410-26-21.)
 
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
20of providing 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, 356q, 356u, 356w, 356x,

 

 

SB2969 Enrolled- 3 -LRB102 20623 BMS 29494 b

1356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
2356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
3356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
4356z.45, 356z.46, 356z.47, 356z.48, 356z.51, and 356z.53 and
5356z.43 of the Illinois Insurance Code. The coverage shall
6comply with Sections 155.22a, 355b, 356z.19, and 370c of the
7Illinois Insurance Code. The Department of Insurance shall
8enforce the requirements of this Section. The requirement that
9health benefits be covered as provided in this Section is an
10exclusive power and function of the State and is a denial and
11limitation under Article VII, Section 6, subsection (h) of the
12Illinois Constitution. A home rule county to which this
13Section applies must comply with every provision of this
14Section.
15    Rulemaking authority to implement Public Act 95-1045, if
16any, is conditioned on the rules being adopted in accordance
17with all provisions of the Illinois Administrative Procedure
18Act and all rules and procedures of the Joint Committee on
19Administrative Rules; any purported rule not so adopted, for
20whatever reason, is unauthorized.
21(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
22101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
231-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
24eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22;
25102-642, eff. 1-1-22; 102-665, eff. 10-8-21; revised
2610-26-21.)
 

 

 

SB2969 Enrolled- 4 -LRB102 20623 BMS 29494 b

1    Section 15. The Illinois Municipal Code is amended by
2changing Section 10-4-2.3 as follows:
 
3    (65 ILCS 5/10-4-2.3)
4    Sec. 10-4-2.3. Required health benefits. If a
5municipality, including a home rule municipality, is a
6self-insurer for purposes of providing health insurance
7coverage for its employees, the coverage shall include
8coverage for the post-mastectomy care benefits required to be
9covered by a policy of accident and health insurance under
10Section 356t and the coverage required under Sections 356g,
11356g.5, 356g.5-1, 356q, 356u, 356w, 356x, 356z.6, 356z.8,
12356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
13356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32,
14356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
15356z.48, 356z.51, and 356z.53 and 356z.43 of the Illinois
16Insurance Code. The coverage shall comply with Sections
17155.22a, 355b, 356z.19, and 370c of the Illinois Insurance
18Code. The Department of Insurance shall enforce the
19requirements of this Section. The requirement that health
20benefits be covered as provided in this is an exclusive power
21and function of the State and is a denial and limitation under
22Article VII, Section 6, subsection (h) of the Illinois
23Constitution. A home rule municipality to which this Section
24applies must comply with every provision of this Section.

 

 

SB2969 Enrolled- 5 -LRB102 20623 BMS 29494 b

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. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
8101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
91-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
10eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22;
11102-642, eff. 1-1-22; 102-665, eff. 10-8-21; revised
1210-26-21.)
 
13    Section 20. The School Code is amended by changing Section
1410-22.3f as follows:
 
15    (105 ILCS 5/10-22.3f)
16    Sec. 10-22.3f. Required health benefits. Insurance
17protection and benefits for employees shall provide the
18post-mastectomy care benefits required to be covered by a
19policy of accident and health insurance under Section 356t and
20the coverage required under Sections 356g, 356g.5, 356g.5-1,
21356q, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11,
22356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26,
23356z.29, 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40,
24356z.41, 356z.45, 356z.46, 356z.47, 356z.51, and 356z.53 and

 

 

SB2969 Enrolled- 6 -LRB102 20623 BMS 29494 b

1356z.43 of the Illinois Insurance Code. Insurance policies
2shall comply with Section 356z.19 of the Illinois Insurance
3Code. The coverage shall comply with Sections 155.22a, 355b,
4and 370c of the Illinois Insurance Code. The Department of
5Insurance shall enforce the requirements of this Section.
6    Rulemaking authority to implement Public Act 95-1045, if
7any, is conditioned on the rules being adopted in accordance
8with all provisions of the Illinois Administrative Procedure
9Act and all rules and procedures of the Joint Committee on
10Administrative Rules; any purported rule not so adopted, for
11whatever reason, is unauthorized.
12(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
13101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
141-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
15eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. 1-1-22;
16102-665, eff. 10-8-21; revised 10-27-21.)
 
17    Section 25. The Illinois Insurance Code is amended by
18adding Section 356z.53 as follows:
 
19    (215 ILCS 5/356z.53 new)
20    Sec. 356z.53. Coverage for continuous glucose monitors. A
21group or individual policy of accident and health insurance or
22a managed care plan that is amended, delivered, issued, or
23renewed on or after January 1, 2024 shall provide coverage for
24medically necessary continuous glucose monitors for

 

 

SB2969 Enrolled- 7 -LRB102 20623 BMS 29494 b

1individuals who are diagnosed with type 1 or type 2 diabetes
2and require insulin for the management of their diabetes.
 
3    Section 30. The Health Maintenance Organization Act is
4amended by changing Section 5-3 as follows:
 
5    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
6    Sec. 5-3. Insurance Code provisions.
7    (a) Health Maintenance Organizations shall be subject to
8the provisions of Sections 133, 134, 136, 137, 139, 140,
9141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
10154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2,
11355.3, 355b, 356g.5-1, 356m, 356q, 356v, 356w, 356x, 356y,
12356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9,
13356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17,
14356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29,
15356z.30, 356z.30a, 356z.32, 356z.33, 356z.35, 356z.36,
16356z.40, 356z.41, 356z.43, 356z.46, 356z.47, 356z.48, 356z.50,
17356z.51, 356z.53, 364, 364.01, 367.2, 367.2-5, 367i, 368a,
18368b, 368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403,
19403A, 408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of
20subsection (2) of Section 367, and Articles IIA, VIII 1/2,
21XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the
22Illinois Insurance Code.
23    (b) For purposes of the Illinois Insurance Code, except
24for Sections 444 and 444.1 and Articles XIII and XIII 1/2,

 

 

SB2969 Enrolled- 8 -LRB102 20623 BMS 29494 b

1Health Maintenance Organizations in the following categories
2are deemed 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
18    financial conditions of the acquired Health Maintenance
19    Organization after the merger, consolidation, or other
20    acquisition of 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

 

 

SB2969 Enrolled- 9 -LRB102 20623 BMS 29494 b

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
25to its health care certificates).
26    (e) In considering any management contract or service

 

 

SB2969 Enrolled- 10 -LRB102 20623 BMS 29494 b

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,
4take into account the effect of the management contract or
5service agreement on the continuation of benefits to enrollees
6and the financial condition of the health maintenance
7organization to be managed or serviced, and (ii) need not take
8into account the effect of the management contract or service
9agreement on competition.
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
14Health Maintenance Organization may by contract agree with a
15group or other enrollment unit to effect refunds or charge
16additional premiums 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
22    not 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

 

 

SB2969 Enrolled- 11 -LRB102 20623 BMS 29494 b

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
22the resulting 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

 

 

SB2969 Enrolled- 12 -LRB102 20623 BMS 29494 b

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
4accordance with all provisions of the Illinois Administrative
5Procedure Act and all rules and procedures of the Joint
6Committee on Administrative Rules; any purported rule not so
7adopted, for whatever reason, is unauthorized.
8(Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19;
9101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-393, eff.
101-1-20; 101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625,
11eff. 1-1-21; 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
12102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
131-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
14eff. 10-8-21; revised 10-27-21.)
 
15    Section 35. The Limited Health Service Organization Act is
16amended by changing Section 4003 as follows:
 
17    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
18    Sec. 4003. Illinois Insurance Code provisions. Limited
19health service organizations shall be subject to the
20provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
21141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
22154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 355.2, 355.3,
23355b, 356q, 356v, 356z.10, 356z.21, 356z.22, 356z.25, 356z.26,
24356z.29, 356z.30a, 356z.32, 356z.33, 356z.41, 356z.46,

 

 

SB2969 Enrolled- 13 -LRB102 20623 BMS 29494 b

1356z.47, 356z.51, 356z.53, 356z.43, 368a, 401, 401.1, 402,
2403, 403A, 408, 408.2, 409, 412, 444, and 444.1 and Articles
3IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and XXVI of
4the Illinois Insurance Code. For purposes of the Illinois
5Insurance Code, except for Sections 444 and 444.1 and Articles
6XIII and XIII 1/2, limited health service organizations in the
7following categories are deemed to be domestic companies:
8        (1) a corporation under the laws of this State; or
9        (2) 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(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
16101-393, eff. 1-1-20; 101-625, eff. 1-1-21; 102-30, eff.
171-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642,
18eff. 1-1-22; revised 10-27-21.)
 
19    Section 40. The Voluntary Health Services Plans Act is
20amended by changing Section 10 as follows:
 
21    (215 ILCS 165/10)  (from Ch. 32, par. 604)
22    Sec. 10. Application of Insurance Code provisions. Health
23services plan corporations and all persons interested therein
24or dealing therewith shall be subject to the provisions of

 

 

SB2969 Enrolled- 14 -LRB102 20623 BMS 29494 b

1Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
2143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
3356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356v, 356w,
4356x, 356y, 356z.1, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6,
5356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14,
6356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26,
7356z.29, 356z.30, 356z.30a, 356z.32, 356z.33, 356z.40,
8356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.43, 364.01,
9367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412,
10and paragraphs (7) and (15) of Section 367 of the Illinois
11Insurance Code.
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. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19;
19101-281, eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff.
201-1-21; 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; 102-306,
21eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21;
22revised 10-27-21.)
 
23    Section 45. The Illinois Public Aid Code is amended by
24changing Section 5-16.8 as follows:
 

 

 

SB2969 Enrolled- 15 -LRB102 20623 BMS 29494 b

1    (305 ILCS 5/5-16.8)
2    Sec. 5-16.8. Required health benefits. The medical
3assistance program shall (i) provide the post-mastectomy care
4benefits required to be covered by a policy of accident and
5health insurance under Section 356t and the coverage required
6under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6,
7356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,
8356z.47, 356z.51, and 356z.53, and 356z.43 of the Illinois
9Insurance Code, (ii) be subject to the provisions of Sections
10356z.19, 356z.43, 356z.44, 356z.49, 364.01, 370c, and 370c.1
11of the Illinois Insurance Code, and (iii) be subject to the
12provisions of subsection (d-5) of Section 10 of the Network
13Adequacy and Transparency Act.
14    The Department, by rule, shall adopt a model similar to
15the requirements of Section 356z.39 of the Illinois Insurance
16Code.
17    On and after July 1, 2012, the Department shall reduce any
18rate of reimbursement for services or other payments or alter
19any methodologies authorized by this Code to reduce any rate
20of reimbursement for services or other payments in accordance
21with Section 5-5e.
22    To ensure full access to the benefits set forth in this
23Section, on and after January 1, 2016, the Department shall
24ensure that provider and hospital reimbursement for
25post-mastectomy care benefits required under this Section are
26no lower than the Medicare reimbursement rate.

 

 

SB2969 Enrolled- 16 -LRB102 20623 BMS 29494 b

1(Source: P.A. 101-81, eff. 7-12-19; 101-218, eff. 1-1-20;
2101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-574, eff.
31-1-20; 101-649, eff. 7-7-20; 102-30, eff. 1-1-22; 102-144,
4eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
5102-530, eff. 1-1-22; 102-642, eff. 1-1-22; revised 10-27-21.)