Illinois General Assembly - Full Text of HB3183
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Full Text of HB3183  103rd General Assembly

HB3183 103RD GENERAL ASSEMBLY

  
  

 


 
103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
HB3183

 

Introduced 2/17/2023, by Rep. Tom Weber

 

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.61 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 Accident and Health Article of the Illinois Insurance Code. Provides that an individual or group policy of accident and health insurance that is amended, delivered, issued, or renewed on or after January 1, 2025 shall cover a medically necessary coronary calcium scan and scoring every 24 months for individuals over the age of 40. Defines "coronary calcium scan and scoring". 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 Medical Assistance Article of the Illinois Public Aid Code. Effective January 1, 2024.


LRB103 27685 BMS 54062 b

STATE MANDATES ACT MAY REQUIRE REIMBURSEMENT
MAY APPLY

 

 

A BILL FOR

 

HB3183LRB103 27685 BMS 54062 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    (Text of Section before amendment by P.A. 102-768)
8    Sec. 6.11. Required health benefits; Illinois Insurance
9Code requirements. The program of health benefits shall
10provide the post-mastectomy care benefits required to be
11covered by a policy of accident and health insurance under
12Section 356t of the Illinois Insurance Code. The program of
13health benefits shall provide the coverage required under
14Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x,
15356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
16356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,
17356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
18356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
19356z.53, 356z.54, 356z.56, 356z.57, 356z.59, and 356z.60 of
20the Illinois Insurance Code. The program of health benefits
21must comply with Sections 155.22a, 155.37, 355b, 356z.19,
22370c, and 370c.1 and Article XXXIIB of the Illinois Insurance
23Code. The Department of Insurance shall enforce the

 

 

HB3183- 2 -LRB103 27685 BMS 54062 b

1requirements of this Section with respect to Sections 370c and
2370c.1 of the Illinois Insurance Code; all other requirements
3of this Section shall be enforced by the Department of Central
4Management Services.
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. 101-13, eff. 6-12-19; 101-281, eff. 1-1-20;
12101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
131-1-20; 101-625, eff. 1-1-21; 102-30, eff. 1-1-22; 102-103,
14eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
15102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff.
161-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816,
17eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
18revised 12-13-22.)
 
19    (Text of Section after amendment by P.A. 102-768)
20    Sec. 6.11. Required health benefits; Illinois Insurance
21Code requirements. The program of health benefits shall
22provide the post-mastectomy care benefits required to be
23covered by a policy of accident and health insurance under
24Section 356t of the Illinois Insurance Code. The program of
25health benefits shall provide the coverage required under

 

 

HB3183- 3 -LRB103 27685 BMS 54062 b

1Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x,
2356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
3356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,
4356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
5356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
6356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59, and
7356z.60, and 356z.61 of the Illinois Insurance Code. The
8program of health benefits must comply with Sections 155.22a,
9155.37, 355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of
10the Illinois Insurance Code. The Department of Insurance shall
11enforce the requirements of this Section with respect to
12Sections 370c and 370c.1 of the Illinois Insurance Code; all
13other requirements of this Section shall be enforced by the
14Department of Central Management Services.
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. 101-13, eff. 6-12-19; 101-281, eff. 1-1-20;
22101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
231-1-20; 101-625, eff. 1-1-21; 102-30, eff. 1-1-22; 102-103,
24eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
25102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff.
261-1-23; 102-768, eff. 1-1-24; 102-804, eff. 1-1-23; 102-813,

 

 

HB3183- 4 -LRB103 27685 BMS 54062 b

1eff. 5-13-22; 102-816, eff. 1-1-23; 102-860, eff. 1-1-23;
2102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23.)
 
3    Section 10. The Counties Code is amended by changing
4Section 5-1069.3 as follows:
 
5    (55 ILCS 5/5-1069.3)
6    Sec. 5-1069.3. Required health benefits. If a county,
7including a home rule county, is a self-insurer for purposes
8of providing health insurance coverage for its employees, the
9coverage shall include coverage for the post-mastectomy care
10benefits required to be covered by a policy of accident and
11health insurance under Section 356t and the coverage required
12under Sections 356g, 356g.5, 356g.5-1, 356q, 356u, 356w, 356x,
13356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11,
14356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26,
15356z.29, 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40,
16356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53,
17356z.54, 356z.56, 356z.57, 356z.59, and 356z.60, and 356z.61
18of the Illinois Insurance Code. The coverage shall comply with
19Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
20Insurance Code. The Department of Insurance shall enforce the
21requirements of this Section. The requirement that health
22benefits be covered as provided in this Section is an
23exclusive power and function of the State and is a denial and
24limitation under Article VII, Section 6, subsection (h) of the

 

 

HB3183- 5 -LRB103 27685 BMS 54062 b

1Illinois Constitution. A home rule county to which this
2Section applies must comply with every provision of this
3Section.
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. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
11101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
121-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
13eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22;
14102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff.
151-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816,
16eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
17102-1117, eff. 1-13-23.)
 
18    Section 15. The Illinois Municipal Code is amended by
19changing Section 10-4-2.3 as follows:
 
20    (65 ILCS 5/10-4-2.3)
21    Sec. 10-4-2.3. Required health benefits. If a
22municipality, including a home rule municipality, is a
23self-insurer for purposes of providing health insurance
24coverage for its employees, the coverage shall include

 

 

HB3183- 6 -LRB103 27685 BMS 54062 b

1coverage for the post-mastectomy care benefits required to be
2covered by a policy of accident and health insurance under
3Section 356t and the coverage required under Sections 356g,
4356g.5, 356g.5-1, 356q, 356u, 356w, 356x, 356z.4, 356z.4a,
5356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
6356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
7356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
8356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
9356z.56, 356z.57, 356z.59, and 356z.60, and 356z.61 of the
10Illinois Insurance Code. The coverage shall comply with
11Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
12Insurance Code. The Department of Insurance shall enforce the
13requirements of this Section. The requirement that health
14benefits be covered as provided in this is an exclusive power
15and function of the State and is a denial and limitation under
16Article VII, Section 6, subsection (h) of the Illinois
17Constitution. A home rule municipality to which this Section
18applies must comply with every provision of this Section.
19    Rulemaking authority to implement Public Act 95-1045, if
20any, is conditioned on the rules being adopted in accordance
21with all provisions of the Illinois Administrative Procedure
22Act and all rules and procedures of the Joint Committee on
23Administrative Rules; any purported rule not so adopted, for
24whatever reason, is unauthorized.
25(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
26101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.

 

 

HB3183- 7 -LRB103 27685 BMS 54062 b

11-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
2eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22;
3102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff.
41-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816,
5eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
6102-1117, eff. 1-13-23.)
 
7    Section 20. The School Code is amended by changing Section
810-22.3f as follows:
 
9    (105 ILCS 5/10-22.3f)
10    Sec. 10-22.3f. Required health benefits. Insurance
11protection and benefits for employees shall provide the
12post-mastectomy care benefits required to be covered by a
13policy of accident and health insurance under Section 356t and
14the coverage required under Sections 356g, 356g.5, 356g.5-1,
15356q, 356u, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8,
16356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
17356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
18356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
19356z.53, 356z.54, 356z.56, 356z.57, 356z.59, and 356z.60, and
20356z.61 of the Illinois Insurance Code. Insurance policies
21shall comply with Section 356z.19 of the Illinois Insurance
22Code. The coverage shall comply with Sections 155.22a, 355b,
23and 370c of the Illinois Insurance Code. The Department of
24Insurance shall enforce the requirements of this Section.

 

 

HB3183- 8 -LRB103 27685 BMS 54062 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; 102-642, eff. 1-1-22;
11102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804, eff.
121-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860,
13eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23.)
 
14    Section 25. The Illinois Insurance Code is amended by
15adding Section 356z.61 as follows:
 
16    (215 ILCS 5/356z.61 new)
17    Sec. 356z.61. Coronary calcium scan and scoring.
18    (a) As used in this Section, "coronary calcium scan and
19scoring" means the use of computed tomography equipment to
20produce pictures of the coronary arteries to locate blockages
21or narrowing.
22    (b) An individual or group policy of accident and health
23insurance that is amended, delivered, issued, or renewed on or
24after January 1, 2025 shall cover a medically necessary

 

 

HB3183- 9 -LRB103 27685 BMS 54062 b

1coronary calcium scan and scoring every 24 months for
2individuals over the age of 40.
 
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, 355c, 356g.5-1, 356m, 356q, 356v, 356w, 356x,
12356y, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6,
13356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14,
14356z.15, 356z.17, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25,
15356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33,
16356z.35, 356z.36, 356z.40, 356z.41, 356z.46, 356z.47, 356z.48,
17356z.50, 356z.51, 356z.53 256z.53, 356z.54, 356z.56, 356z.57,
18356z.59, 356z.60, 356z.61, 364, 364.01, 364.3, 367.2, 367.2-5,
19367i, 368a, 368b, 368c, 368d, 368e, 370c, 370c.1, 401, 401.1,
20402, 403, 403A, 408, 408.2, 409, 412, 444, and 444.1,
21paragraph (c) of subsection (2) of Section 367, and Articles
22IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and
23XXXIIB of the Illinois Insurance Code.
24    (b) For purposes of the Illinois Insurance Code, except

 

 

HB3183- 10 -LRB103 27685 BMS 54062 b

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

 

 

HB3183- 11 -LRB103 27685 BMS 54062 b

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

 

 

HB3183- 12 -LRB103 27685 BMS 54062 b

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

 

 

HB3183- 13 -LRB103 27685 BMS 54062 b

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

 

 

HB3183- 14 -LRB103 27685 BMS 54062 b

1contractual obligation of an insolvent organization to pay any
2refund authorized under this Section.
3    (g) Rulemaking authority to implement Public Act 95-1045,
4if any, is conditioned on the rules being adopted in
5accordance with all provisions of the Illinois Administrative
6Procedure Act and all rules and procedures of the Joint
7Committee on Administrative Rules; any purported rule not so
8adopted, for whatever reason, is unauthorized.
9(Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19;
10101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-393, eff.
111-1-20; 101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625,
12eff. 1-1-21; 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
13102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
141-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
15eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
16102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
171-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
18eff. 1-1-23; 102-1117, eff. 1-13-23; revised 1-22-23.)
 
19    Section 35. The Limited Health Service Organization Act is
20amended by changing Section 4003 as follows:
 
21    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
22    Sec. 4003. Illinois Insurance Code provisions. Limited
23health service organizations shall be subject to the
24provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,

 

 

HB3183- 15 -LRB103 27685 BMS 54062 b

1141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
2154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 355.2, 355.3,
3355b, 356q, 356v, 356z.4, 356z.4a, 356z.10, 356z.21, 356z.22,
4356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
5356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54, 356z.57,
6356z.59, 356z.61, 364.3, 368a, 401, 401.1, 402, 403, 403A,
7408, 408.2, 409, 412, 444, and 444.1 and Articles IIA, VIII
81/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and XXVI of the
9Illinois Insurance Code. Nothing in this Section shall require
10a limited health care plan to cover any service that is not a
11limited health service. For purposes of the Illinois Insurance
12Code, except for Sections 444 and 444.1 and Articles XIII and
13XIII 1/2, limited health service organizations in the
14following categories are deemed to be domestic companies:
15        (1) a corporation under the laws of this State; or
16        (2) a corporation organized under the laws of another
17    state, 30% or more of the enrollees of which are residents
18    of this State, except a corporation subject to
19    substantially the same requirements in its state of
20    organization as is a domestic company under Article VIII
21    1/2 of the Illinois Insurance Code.
22(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
23101-393, eff. 1-1-20; 101-625, eff. 1-1-21; 102-30, eff.
241-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642,
25eff. 1-1-22; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
26102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860, eff.

 

 

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11-1-23; 102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23.)
 
2    Section 40. The Voluntary Health Services Plans Act is
3amended by changing Section 10 as follows:
 
4    (215 ILCS 165/10)  (from Ch. 32, par. 604)
5    Sec. 10. Application of Insurance Code provisions. Health
6services plan corporations and all persons interested therein
7or dealing therewith shall be subject to the provisions of
8Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
9143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
10356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356v, 356w,
11356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5,
12356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
13356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25,
14356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33,
15356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
16356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 364.01, 364.3,
17367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412,
18and paragraphs (7) and (15) of Section 367 of the Illinois
19Insurance Code.
20    Rulemaking authority to implement Public Act 95-1045, if
21any, is conditioned on the rules being adopted in accordance
22with all provisions of the Illinois Administrative Procedure
23Act and all rules and procedures of the Joint Committee on
24Administrative Rules; any purported rule not so adopted, for

 

 

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1whatever reason, is unauthorized.
2(Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19;
3101-281, eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff.
41-1-21; 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; 102-306,
5eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21;
6102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804, eff.
71-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860,
8eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff. 1-1-23;
9102-1117, eff. 1-13-23.)
 
10    Section 45. The Illinois Public Aid Code is amended by
11changing Section 5-16.8 as follows:
 
12    (305 ILCS 5/5-16.8)
13    Sec. 5-16.8. Required health benefits. The medical
14assistance program shall (i) provide the post-mastectomy care
15benefits required to be covered by a policy of accident and
16health insurance under Section 356t and the coverage required
17under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6,
18356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,
19356z.47, 356z.51, 356z.53, 356z.56, 356z.59, and 356z.60, and
20356z.61 of the Illinois Insurance Code, (ii) be subject to the
21provisions of Sections 356z.19, 356z.44, 356z.49, 364.01,
22370c, and 370c.1 of the Illinois Insurance Code, and (iii) be
23subject to the provisions of subsection (d-5) of Section 10 of
24the Network Adequacy and Transparency Act.

 

 

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1    The Department, by rule, shall adopt a model similar to
2the requirements of Section 356z.39 of the Illinois Insurance
3Code.
4    On and after July 1, 2012, the Department shall reduce any
5rate of reimbursement for services or other payments or alter
6any methodologies authorized by this Code to reduce any rate
7of reimbursement for services or other payments in accordance
8with Section 5-5e.
9    To ensure full access to the benefits set forth in this
10Section, on and after January 1, 2016, the Department shall
11ensure that provider and hospital reimbursement for
12post-mastectomy care benefits required under this Section are
13no lower than the Medicare reimbursement rate.
14(Source: P.A. 101-81, eff. 7-12-19; 101-218, eff. 1-1-20;
15101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-574, eff.
161-1-20; 101-649, eff. 7-7-20; 102-30, eff. 1-1-22; 102-144,
17eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
18102-530, eff. 1-1-22; 102-642, eff. 1-1-22; 102-804, eff.
191-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093,
20eff. 1-1-23; 102-1117, eff. 1-13-23.)
 
21    Section 95. No acceleration or delay. Where this Act makes
22changes in a statute that is represented in this Act by text
23that is not yet or no longer in effect (for example, a Section
24represented by multiple versions), the use of that text does
25not accelerate or delay the taking effect of (i) the changes

 

 

HB3183- 19 -LRB103 27685 BMS 54062 b

1made by this Act or (ii) provisions derived from any other
2Public Act.
 
3    Section 99. Effective date. This Act takes effect January
41, 2024.