Full Text of HB3039 97th General Assembly
HB3039enr 97TH GENERAL ASSEMBLY |
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| 1 | | AN ACT concerning insurance.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | Section 5. The State Employees Group Insurance Act of 1971 | 5 | | is amended by changing Section 6.11 as follows:
| 6 | | (5 ILCS 375/6.11)
| 7 | | Sec. 6.11. Required health benefits; Illinois Insurance | 8 | | Code
requirements. The program of health
benefits shall provide | 9 | | the post-mastectomy care benefits required to be covered
by a | 10 | | policy of accident and health insurance under Section 356t of | 11 | | the Illinois
Insurance Code. The program of health benefits | 12 | | shall provide the coverage
required under Sections 356g, | 13 | | 356g.5, 356g.5-1, 356m,
356u, 356w, 356x, 356z.2, 356z.4, | 14 | | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, | 15 | | 356z.14, 356z.15, and 356z.17 of the
Illinois Insurance Code.
| 16 | | The program of health benefits must comply with Sections | 17 | | Section 155.37 and 356z.19 of the
Illinois Insurance Code.
| 18 | | Rulemaking authority to implement Public Act 95-1045, if | 19 | | any, is conditioned on the rules being adopted in accordance | 20 | | with all provisions of the Illinois Administrative Procedure | 21 | | Act and all rules and procedures of the Joint Committee on | 22 | | Administrative Rules; any purported rule not so adopted, for | 23 | | whatever reason, is unauthorized. |
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| 1 | | (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; | 2 | | 95-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff. | 3 | | 6-1-09; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; 95-1044, | 4 | | eff. 3-26-09; 95-1045, eff. 3-27-09; 95-1049, eff. 1-1-10; | 5 | | 96-139, eff. 1-1-10; 96-328, eff. 8-11-09; 96-639, eff. 1-1-10; | 6 | | 96-1000, eff. 7-2-10.) | 7 | | Section 10. The Counties Code is amended by changing | 8 | | Section 5-1069.3 as follows: | 9 | | (55 ILCS 5/5-1069.3)
| 10 | | Sec. 5-1069.3. Required health benefits. If a county, | 11 | | including a home
rule
county, is a self-insurer for purposes of | 12 | | providing health insurance coverage
for its employees, the | 13 | | coverage shall include coverage for the post-mastectomy
care | 14 | | benefits required to be covered by a policy of accident and | 15 | | health
insurance under Section 356t and the coverage required | 16 | | under Sections 356g, 356g.5, 356g.5-1, 356u,
356w, 356x, | 17 | | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, | 18 | | 356z.14, and 356z.15 of
the Illinois Insurance Code. The | 19 | | coverage shall comply with Section 356z.19 of the Illinois | 20 | | Insurance Code. The requirement that health benefits be covered
| 21 | | as provided in this Section is an
exclusive power and function | 22 | | of the State and is a denial and limitation under
Article VII, | 23 | | Section 6, subsection (h) of the Illinois Constitution. A home
| 24 | | rule county to which this Section applies must comply with |
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| 1 | | every provision of
this Section.
| 2 | | Rulemaking authority to implement Public Act 95-1045, if | 3 | | any, is conditioned on the rules being adopted in accordance | 4 | | with all provisions of the Illinois Administrative Procedure | 5 | | Act and all rules and procedures of the Joint Committee on | 6 | | Administrative Rules; any purported rule not so adopted, for | 7 | | whatever reason, is unauthorized. | 8 | | (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; | 9 | | 95-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff. | 10 | | 6-1-09; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; 95-1045, | 11 | | eff. 3-27-09; 95-1049, eff. 1-1-10; 96-139, eff. 1-1-10; | 12 | | 96-328, eff. 8-11-09; 96-1000, eff. 7-2-10.) | 13 | | Section 15. The Illinois Municipal Code is amended by | 14 | | changing Section 10-4-2.3 as follows: | 15 | | (65 ILCS 5/10-4-2.3)
| 16 | | Sec. 10-4-2.3. Required health benefits. If a | 17 | | municipality, including a
home rule municipality, is a | 18 | | self-insurer for purposes of providing health
insurance | 19 | | coverage for its employees, the coverage shall include coverage | 20 | | for
the post-mastectomy care benefits required to be covered by | 21 | | a policy of
accident and health insurance under Section 356t | 22 | | and the coverage required
under Sections 356g, 356g.5, | 23 | | 356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10, | 24 | | 356z.11, 356z.12, 356z.13, 356z.14, and 356z.15 of the Illinois
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| 1 | | Insurance
Code. The coverage shall comply with Section 356z.19 | 2 | | of the Illinois Insurance Code. The requirement that health
| 3 | | benefits be covered as provided in this is an exclusive power | 4 | | and function of
the State and is a denial and limitation under | 5 | | Article VII, Section 6,
subsection (h) of the Illinois | 6 | | Constitution. A home rule municipality to which
this Section | 7 | | applies must comply with every provision of this Section.
| 8 | | Rulemaking authority to implement Public Act 95-1045, if | 9 | | any, is conditioned on the rules being adopted in accordance | 10 | | with all provisions of the Illinois Administrative Procedure | 11 | | Act and all rules and procedures of the Joint Committee on | 12 | | Administrative Rules; any purported rule not so adopted, for | 13 | | whatever reason, is unauthorized. | 14 | | (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; | 15 | | 95-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff. | 16 | | 6-1-09; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; 95-1045, | 17 | | eff. 3-27-09; 95-1049, eff. 1-1-10; 96-139, eff. 1-1-10; | 18 | | 96-328, eff. 8-11-09; 96-1000, eff. 7-2-10.) | 19 | | Section 20. The School Code is amended by changing Section | 20 | | 10-22.3f as follows: | 21 | | (105 ILCS 5/10-22.3f)
| 22 | | Sec. 10-22.3f. Required health benefits. Insurance | 23 | | protection and
benefits
for employees shall provide the | 24 | | post-mastectomy care benefits required to be
covered by a |
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| 1 | | policy of accident and health insurance under Section 356t and | 2 | | the
coverage required under Sections 356g, 356g.5, 356g.5-1, | 3 | | 356u, 356w, 356x,
356z.6, 356z.8, 356z.9, 356z.11, 356z.12, | 4 | | 356z.13, 356z.14, and 356z.15 of
the
Illinois Insurance Code.
| 5 | | Insurance policies shall comply with Section 356z.19 of the | 6 | | Illinois Insurance Code.
| 7 | | Rulemaking authority to implement Public Act 95-1045, if | 8 | | any, is conditioned on the rules being adopted in accordance | 9 | | with all provisions of the Illinois Administrative Procedure | 10 | | Act and all rules and procedures of the Joint Committee on | 11 | | Administrative Rules; any purported rule not so adopted, for | 12 | | whatever reason, is unauthorized. | 13 | | (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; | 14 | | 95-876, eff. 8-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09; | 15 | | 95-1005, 12-12-08; 95-1045, eff. 3-27-09; 95-1049, eff. | 16 | | 1-1-10; 96-139, eff. 1-1-10; 96-328, eff. 8-11-09; 96-1000, | 17 | | eff. 7-2-10.)
| 18 | | Section 25. The Illinois Insurance Code is amended by | 19 | | changing Section 356z.16 and by adding Section 356z.19 as | 20 | | follows: | 21 | | (215 ILCS 5/356z.16) | 22 | | Sec. 356z.16. Applicability of mandated benefits to | 23 | | supplemental policies. Unless specified otherwise, the | 24 | | following Sections of the Illinois Insurance Code do not apply |
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| 1 | | to short-term travel, disability income, long-term care, | 2 | | accident only, or limited or specified disease policies: 356b, | 3 | | 356c, 356d, 356g, 356k, 356m, 356n, 356p, 356q, 356r, 356t, | 4 | | 356u, 356w, 356x, 356z.1, 356z.2, 356z.4, 356z.5, 356z.6, | 5 | | 356z.8, 356z.12, 356z.19, 367.2-5, and 367e.
| 6 | | (Source: P.A. 96-180, eff. 1-1-10; 96-1000, eff. 7-2-10; | 7 | | 96-1034, eff. 1-1-11.) | 8 | | (215 ILCS 5/356z.19 new) | 9 | | Sec. 356z.19. Cardiovascular disease. Because | 10 | | cardiovascular disease is a leading cause of death and | 11 | | disability, an insurer providing group or individual policies | 12 | | of accident and health insurance or a managed care plan shall | 13 | | develop and implement a process to communicate with their adult | 14 | | enrollees on an annual basis regarding the importance and value | 15 | | of early detection and proactive management of cardiovascular | 16 | | disease. Nothing in this Section affects any change in the | 17 | | terms, conditions, or benefits of the policies and plans, nor | 18 | | the criteria, standards, and procedures related to the | 19 | | application for, enrollment in, or renewal of coverage or | 20 | | conditions of participation of enrollees in the health plans or | 21 | | policies subject to this Code. | 22 | | Section 30. The Health Maintenance Organization Act is | 23 | | amended by changing Section 5-3 as follows:
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| 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 | 4 | | the provisions of Sections 133, 134, 137, 140, 141.1,
141.2, | 5 | | 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, 154, 154.5, | 6 | | 154.6,
154.7, 154.8, 155.04, 355.2, 356g.5-1, 356m, 356v, 356w, | 7 | | 356x, 356y,
356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9, | 8 | | 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, | 9 | | 356z.18, 356z.19, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, | 10 | | 368c, 368d, 368e, 370c,
401, 401.1, 402, 403, 403A,
408, 408.2, | 11 | | 409, 412, 444,
and
444.1,
paragraph (c) of subsection (2) of | 12 | | Section 367, and Articles IIA, VIII 1/2,
XII,
XII 1/2, XIII, | 13 | | XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.
| 14 | | (b) For purposes of the Illinois Insurance Code, except for | 15 | | Sections 444
and 444.1 and Articles XIII and XIII 1/2, Health | 16 | | Maintenance Organizations in
the following categories are | 17 | | deemed to be "domestic companies":
| 18 | | (1) a corporation authorized under the
Dental Service | 19 | | Plan Act or the Voluntary Health Services Plans Act;
| 20 | | (2) a corporation organized under the laws of this | 21 | | State; or
| 22 | | (3) a corporation organized under the laws of another | 23 | | state, 30% or more
of the enrollees of which are residents | 24 | | of this State, except a
corporation subject to | 25 | | substantially the same requirements in its state of
| 26 | | organization as is a "domestic company" under Article VIII |
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| 1 | | 1/2 of the
Illinois Insurance Code.
| 2 | | (c) In considering the merger, consolidation, or other | 3 | | acquisition of
control of a Health Maintenance Organization | 4 | | pursuant to Article VIII 1/2
of the Illinois Insurance Code,
| 5 | | (1) the Director shall give primary consideration to | 6 | | the continuation of
benefits to enrollees and the financial | 7 | | conditions of the acquired Health
Maintenance Organization | 8 | | after the merger, consolidation, or other
acquisition of | 9 | | control takes effect;
| 10 | | (2)(i) the criteria specified in subsection (1)(b) of | 11 | | Section 131.8 of
the Illinois Insurance Code shall not | 12 | | apply and (ii) the Director, in making
his determination | 13 | | with respect to the merger, consolidation, or other
| 14 | | acquisition of control, need not take into account the | 15 | | effect on
competition of the merger, consolidation, or | 16 | | other acquisition of control;
| 17 | | (3) the Director shall have the power to require the | 18 | | following
information:
| 19 | | (A) certification by an independent actuary of the | 20 | | adequacy
of the reserves of the Health Maintenance | 21 | | Organization sought to be acquired;
| 22 | | (B) pro forma financial statements reflecting the | 23 | | combined balance
sheets of the acquiring company and | 24 | | the Health Maintenance Organization sought
to be | 25 | | acquired as of the end of the preceding year and as of | 26 | | a date 90 days
prior to the acquisition, as well as pro |
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| 1 | | forma financial statements
reflecting projected | 2 | | combined operation for a period of 2 years;
| 3 | | (C) a pro forma business plan detailing an | 4 | | acquiring party's plans with
respect to the operation | 5 | | of the Health Maintenance Organization sought to
be | 6 | | acquired for a period of not less than 3 years; and
| 7 | | (D) such other information as the Director shall | 8 | | require.
| 9 | | (d) The provisions of Article VIII 1/2 of the Illinois | 10 | | Insurance Code
and this Section 5-3 shall apply to the sale by | 11 | | any health maintenance
organization of greater than 10% of its
| 12 | | enrollee population (including without limitation the health | 13 | | maintenance
organization's right, title, and interest in and to | 14 | | its health care
certificates).
| 15 | | (e) In considering any management contract or service | 16 | | agreement subject
to Section 141.1 of the Illinois Insurance | 17 | | Code, the Director (i) shall, in
addition to the criteria | 18 | | specified in Section 141.2 of the Illinois
Insurance Code, take | 19 | | into account the effect of the management contract or
service | 20 | | agreement on the continuation of benefits to enrollees and the
| 21 | | financial condition of the health maintenance organization to | 22 | | be managed or
serviced, and (ii) need not take into account the | 23 | | effect of the management
contract or service agreement on | 24 | | competition.
| 25 | | (f) Except for small employer groups as defined in the | 26 | | Small Employer
Rating, Renewability and Portability Health |
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| 1 | | Insurance Act and except for
medicare supplement policies as | 2 | | defined in Section 363 of the Illinois
Insurance Code, a Health | 3 | | Maintenance Organization may by contract agree with a
group or | 4 | | other enrollment unit to effect refunds or charge additional | 5 | | premiums
under the following terms and conditions:
| 6 | | (i) the amount of, and other terms and conditions with | 7 | | respect to, the
refund or additional premium are set forth | 8 | | in the group or enrollment unit
contract agreed in advance | 9 | | of the period for which a refund is to be paid or
| 10 | | additional premium is to be charged (which period shall not | 11 | | be less than one
year); and
| 12 | | (ii) the amount of the refund or additional premium | 13 | | shall not exceed 20%
of the Health Maintenance | 14 | | Organization's profitable or unprofitable experience
with | 15 | | respect to the group or other enrollment unit for the | 16 | | period (and, for
purposes of a refund or additional | 17 | | premium, the profitable or unprofitable
experience shall | 18 | | be calculated taking into account a pro rata share of the
| 19 | | Health Maintenance Organization's administrative and | 20 | | marketing expenses, but
shall not include any refund to be | 21 | | made or additional premium to be paid
pursuant to this | 22 | | subsection (f)). The Health Maintenance Organization and | 23 | | the
group or enrollment unit may agree that the profitable | 24 | | or unprofitable
experience may be calculated taking into | 25 | | account the refund period and the
immediately preceding 2 | 26 | | plan years.
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| 1 | | The Health Maintenance Organization shall include a | 2 | | statement in the
evidence of coverage issued to each enrollee | 3 | | describing the possibility of a
refund or additional premium, | 4 | | and upon request of any group or enrollment unit,
provide to | 5 | | the group or enrollment unit a description of the method used | 6 | | to
calculate (1) the Health Maintenance Organization's | 7 | | profitable experience with
respect to the group or enrollment | 8 | | unit and the resulting refund to the group
or enrollment unit | 9 | | or (2) the Health Maintenance Organization's unprofitable
| 10 | | experience with respect to the group or enrollment unit and the | 11 | | resulting
additional premium to be paid by the group or | 12 | | enrollment unit.
| 13 | | In no event shall the Illinois Health Maintenance | 14 | | Organization
Guaranty Association be liable to pay any | 15 | | contractual obligation of an
insolvent organization to pay any | 16 | | refund authorized under this Section.
| 17 | | (g) Rulemaking authority to implement Public Act 95-1045, | 18 | | if any, is conditioned on the rules being adopted in accordance | 19 | | with all provisions of the Illinois Administrative Procedure | 20 | | Act and all rules and procedures of the Joint Committee on | 21 | | Administrative Rules; any purported rule not so adopted, for | 22 | | whatever reason, is unauthorized. | 23 | | (Source: P.A. 95-422, eff. 8-24-07; 95-520, eff. 8-28-07; | 24 | | 95-876, eff. 8-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09; | 25 | | 95-1005, eff. 12-12-08; 95-1045, eff. 3-27-09; 95-1049, eff. | 26 | | 1-1-10; 96-328, eff. 8-11-09; 96-639, eff. 1-1-10; 96-833, eff. |
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| 1 | | 6-1-10; 96-1000, eff. 7-2-10.) | 2 | | Section 35. The Voluntary Health Services Plans Act is | 3 | | amended 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 | 6 | | services
plan corporations and all persons interested therein | 7 | | or dealing therewith
shall be subject to the provisions of | 8 | | Articles IIA and XII 1/2 and Sections
3.1, 133, 140, 143, 143c, | 9 | | 149, 155.37, 354, 355.2, 356g, 356g.5, 356g.5-1, 356r, 356t, | 10 | | 356u, 356v,
356w, 356x, 356y, 356z.1, 356z.2, 356z.4, 356z.5, | 11 | | 356z.6, 356z.8, 356z.9,
356z.10, 356z.11, 356z.12, 356z.13, | 12 | | 356z.14, 356z.15, 356z.18, 356z.19, 364.01, 367.2, 368a, 401, | 13 | | 401.1,
402,
403, 403A, 408,
408.2, and 412, and paragraphs (7) | 14 | | and (15) of Section 367 of the Illinois
Insurance Code.
| 15 | | Rulemaking authority to implement Public Act 95-1045, if | 16 | | any, is conditioned on the rules being adopted in accordance | 17 | | with all provisions of the Illinois Administrative Procedure | 18 | | Act and all rules and procedures of the Joint Committee on | 19 | | Administrative Rules; any purported rule not so adopted, for | 20 | | whatever reason, is unauthorized. | 21 | | (Source: P.A. 95-189, eff. 8-16-07; 95-331, eff. 8-21-07; | 22 | | 95-422, eff. 8-24-07; 95-520, eff. 8-28-07; 95-876, eff. | 23 | | 8-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09; 95-1005, | 24 | | eff. 12-12-08; 95-1045, eff. 3-27-09; 95-1049, eff. 1-1-10; |
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| 1 | | 96-328, eff. 8-11-09; 96-833, eff. 6-1-10; 96-1000, eff. | 2 | | 7-2-10.) | 3 | | Section 40. The Illinois Public Aid Code is amended by | 4 | | changing Section 5-16.8 as follows:
| 5 | | (305 ILCS 5/5-16.8)
| 6 | | Sec. 5-16.8. Required health benefits. The medical | 7 | | assistance program
shall
(i) provide the post-mastectomy care | 8 | | benefits required to be covered by a policy of
accident and | 9 | | health insurance under Section 356t and the coverage required
| 10 | | under Sections 356g.5, 356u, 356w, 356x, and 356z.6 of the | 11 | | Illinois
Insurance Code and (ii) be subject to the provisions | 12 | | of Sections 356z.19 and Section 364.01 of the Illinois
| 13 | | Insurance Code.
| 14 | | (Source: P.A. 95-189, eff. 8-16-07; 95-331, eff. 8-21-07.)
| 15 | | Section 99. Effective date. This Act takes effect upon | 16 | | becoming law.
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