Illinois General Assembly - Full Text of SB0968
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Full Text of SB0968  102nd General Assembly

SB0968enr 102ND GENERAL ASSEMBLY

  
  
  

 


 
SB0968 EnrolledLRB102 04882 CPF 14901 b

1    AN ACT concerning health.
 
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, and 356z.43 of the Illinois Insurance
18Code. The program of health benefits must comply with Sections
19155.22a, 155.37, 355b, 356z.19, 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

 

 

SB0968 Enrolled- 2 -LRB102 04882 CPF 14901 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,

 

 

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1356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
2356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41, and 356z.43
3of the Illinois Insurance Code. The coverage shall comply with
4Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
5Insurance Code. The Department of Insurance shall enforce the
6requirements of this Section. The requirement that health
7benefits 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:
 

 

 

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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, and 356z.43 of the Illinois Insurance
13Code. The coverage shall comply with Sections 155.22a, 355b,
14356z.19, 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

 

 

SB0968 Enrolled- 5 -LRB102 04882 CPF 14901 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, and 356z.43
19of the Illinois Insurance Code. Insurance policies shall
20comply with Section 356z.19 of the Illinois Insurance Code.
21The coverage shall comply with Sections 155.22a, 355b, and
22370c of the Illinois Insurance Code. The Department of
23Insurance shall enforce the requirements of this Section.
24    Rulemaking authority to implement Public Act 95-1045, if

 

 

SB0968 Enrolled- 6 -LRB102 04882 CPF 14901 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. Coverage for pancreatic cancer screening. A
15group or individual policy of accident and health insurance or
16a managed care plan that is amended, delivered, issued, or
17renewed on or after January 1, 2022 shall provide coverage for
18medically necessary pancreatic cancer screening.
 
19    Section 30. 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.

 

 

SB0968 Enrolled- 7 -LRB102 04882 CPF 14901 b

1    (a) Health Maintenance Organizations shall be subject to
2the provisions of Sections 133, 134, 136, 137, 139, 140,
3141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
4154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2,
5355.3, 355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2,
6356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10,
7356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.18,
8356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30,
9356z.30a, 356z.32, 356z.33, 356z.35, 356z.36, 356z.41,
10356z.43, 364, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c,
11368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A, 408,
12408.2, 409, 412, 444, and 444.1, paragraph (c) of subsection
13(2) of Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2,
14XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the Illinois
15Insurance Code.
16    (b) For purposes of the Illinois Insurance Code, except
17for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
18Health Maintenance Organizations in the following categories
19are deemed to be "domestic companies":
20        (1) a corporation authorized under the Dental Service
21    Plan Act or the Voluntary Health Services Plans Act;
22        (2) a corporation organized under the laws of this
23    State; or
24        (3) a corporation organized under the laws of another
25    state, 30% or more of the enrollees of which are residents
26    of this State, except a corporation subject to

 

 

SB0968 Enrolled- 8 -LRB102 04882 CPF 14901 b

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

 

 

SB0968 Enrolled- 9 -LRB102 04882 CPF 14901 b

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

 

 

SB0968 Enrolled- 10 -LRB102 04882 CPF 14901 b

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

 

 

SB0968 Enrolled- 11 -LRB102 04882 CPF 14901 b

1    account the refund period and the immediately preceding 2
2    plan years.
3    The Health Maintenance Organization shall include a
4statement in the evidence of coverage issued to each enrollee
5describing the possibility of a refund or additional premium,
6and upon request of any group or enrollment unit, provide to
7the group or enrollment unit a description of the method used
8to calculate (1) the Health Maintenance Organization's
9profitable experience with respect to the group or enrollment
10unit and the resulting refund to the group or enrollment unit
11or (2) the Health Maintenance Organization's unprofitable
12experience with respect to the group or enrollment unit and
13the resulting additional premium to be paid by the group or
14enrollment unit.
15    In no event shall the Illinois Health Maintenance
16Organization Guaranty Association be liable to pay any
17contractual obligation of an insolvent organization to pay any
18refund authorized under this Section.
19    (g) Rulemaking authority to implement Public Act 95-1045,
20if any, is conditioned on the rules being adopted in
21accordance with all provisions of the Illinois Administrative
22Procedure Act and all rules and procedures of the Joint
23Committee on Administrative Rules; any purported rule not so
24adopted, for whatever reason, is unauthorized.
25(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
26100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff.

 

 

SB0968 Enrolled- 12 -LRB102 04882 CPF 14901 b

11-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81,
2eff. 7-12-19; 101-281, eff. 1-1-20; 101-371, eff. 1-1-20;
3101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
41-1-20; 101-625, eff. 1-1-21.)
 
5    Section 35. The Limited Health Service Organization Act is
6amended by changing Section 4003 as follows:
 
7    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
8    Sec. 4003. Illinois Insurance Code provisions. Limited
9health service organizations shall be subject to the
10provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
11141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
12154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 355.2, 355.3,
13355b, 356v, 356z.10, 356z.21, 356z.22, 356z.25, 356z.26,
14356z.29, 356z.30a, 356z.32, 356z.33, 356z.41, 356z.43, 368a,
15401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412, 444, and
16444.1 and Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2,
17XXV, and XXVI of the Illinois Insurance Code. For purposes of
18the Illinois Insurance Code, except for Sections 444 and 444.1
19and Articles XIII and XIII 1/2, limited health service
20organizations in the following categories are deemed to be
21domestic companies:
22        (1) a corporation under the laws of this State; or
23        (2) a corporation organized under the laws of another
24    state, 30% or more of the enrollees of which are residents

 

 

SB0968 Enrolled- 13 -LRB102 04882 CPF 14901 b

1    of this State, except a corporation subject to
2    substantially the same requirements in its state of
3    organization as is a domestic company under Article VIII
4    1/2 of the Illinois Insurance Code.
5(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
6100-201, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1057, eff.
71-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
8eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff. 1-1-21.)
 
9    Section 40. The Voluntary Health Services Plans Act is
10amended by changing Section 10 as follows:
 
11    (215 ILCS 165/10)  (from Ch. 32, par. 604)
12    Sec. 10. Application of Insurance Code provisions. Health
13services plan corporations and all persons interested therein
14or dealing therewith shall be subject to the provisions of
15Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
16143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
17356g, 356g.5, 356g.5-1, 356r, 356t, 356u, 356v, 356w, 356x,
18356y, 356z.1, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8,
19356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
20356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29,
21356z.30, 356z.30a, 356z.32, 356z.33, 356z.41, 356z.43, 364.01,
22367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412,
23and paragraphs (7) and (15) of Section 367 of the Illinois
24Insurance Code.

 

 

SB0968 Enrolled- 14 -LRB102 04882 CPF 14901 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. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
8100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff.
91-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81,
10eff. 7-12-19; 101-281, eff. 1-1-20; 101-393, eff. 1-1-20;
11101-625, eff. 1-1-21.)
 
12    Section 45. The Illinois Public Aid Code is amended by
13changing Section 5-16.8 as follows:
 
14    (305 ILCS 5/5-16.8)
15    Sec. 5-16.8. Required health benefits. The medical
16assistance program shall (i) provide the post-mastectomy care
17benefits required to be covered by a policy of accident and
18health insurance under Section 356t and the coverage required
19under Sections 356g.5, 356u, 356w, 356x, 356z.6, 356z.26,
20356z.29, 356z.32, 356z.33, 356z.34, and 356z.35, and 356z.43
21of the Illinois Insurance Code and (ii) be subject to the
22provisions of Sections 356z.19, 364.01, 370c, and 370c.1 of
23the Illinois Insurance Code.
24    The Department, by rule, shall adopt a model similar to

 

 

SB0968 Enrolled- 15 -LRB102 04882 CPF 14901 b

1the requirements of Section 356z.39 of the Illinois Insurance
2Code.
3    On and after July 1, 2012, the Department shall reduce any
4rate of reimbursement for services or other payments or alter
5any methodologies authorized by this Code to reduce any rate
6of reimbursement for services or other payments in accordance
7with Section 5-5e.
8    To ensure full access to the benefits set forth in this
9Section, on and after January 1, 2016, the Department shall
10ensure that provider and hospital reimbursement for
11post-mastectomy care benefits required under this Section are
12no lower than the Medicare reimbursement rate.
13(Source: P.A. 100-138, eff. 8-18-17; 100-863, eff. 8-14-18;
14100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff.
157-12-19; 101-218, eff. 1-1-20; 101-281, eff. 1-1-20; 101-371,
16eff. 1-1-20; 101-574, eff. 1-1-20; 101-649, eff. 7-7-20.)