Full Text of HB2617 100th General Assembly
HB2617eng 100TH GENERAL ASSEMBLY |
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| 1 | | AN ACT concerning regulation.
| 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, 356z.17, 356z.22, and 356z.25 , 356z.26, and | 16 | | 356z.29 of the
Illinois Insurance Code.
The program of health | 17 | | benefits must comply with Sections 155.22a, 155.37, 355b, | 18 | | 356z.19, 370c, and 370c.1 of the
Illinois Insurance Code.
| 19 | | Rulemaking authority to implement Public Act 95-1045, if | 20 | | any, is conditioned on the rules being adopted in accordance | 21 | | with all provisions of the Illinois Administrative Procedure | 22 | | Act and all rules and procedures of the Joint Committee on | 23 | | Administrative Rules; any purported rule not so adopted, for |
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| 1 | | whatever reason, is unauthorized. | 2 | | (Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17; | 3 | | 100-138, eff. 8-18-17; revised 10-3-17.) | 4 | | Section 10. The Counties Code is amended by changing | 5 | | Section 5-1069.3 as follows: | 6 | | (55 ILCS 5/5-1069.3)
| 7 | | Sec. 5-1069.3. Required health benefits. If a county, | 8 | | including a home
rule
county, is a self-insurer for purposes of | 9 | | providing health insurance coverage
for its employees, the | 10 | | coverage shall include coverage for the post-mastectomy
care | 11 | | benefits required to be covered by a policy of accident and | 12 | | health
insurance under Section 356t and the coverage required | 13 | | under Sections 356g, 356g.5, 356g.5-1, 356u,
356w, 356x, | 14 | | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, | 15 | | 356z.14, 356z.15, 356z.22, and 356z.25 , 356z.26, and 356z.29 of
| 16 | | the Illinois Insurance Code. The coverage shall comply with | 17 | | Sections 155.22a, 355b, 356z.19, and 370c of
the Illinois | 18 | | Insurance Code. The requirement that health benefits be covered
| 19 | | as provided in this Section is an
exclusive power and function | 20 | | of the State and is a denial and limitation under
Article VII, | 21 | | Section 6, subsection (h) of the Illinois Constitution. A home
| 22 | | rule county to which this Section applies must comply with | 23 | | every provision of
this Section.
| 24 | | Rulemaking authority to implement Public Act 95-1045, if |
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| 1 | | any, is conditioned on the rules being adopted in accordance | 2 | | with all provisions of the Illinois Administrative Procedure | 3 | | Act and all rules and procedures of the Joint Committee on | 4 | | Administrative Rules; any purported rule not so adopted, for | 5 | | whatever reason, is unauthorized. | 6 | | (Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17; | 7 | | 100-138, eff. 8-18-17; revised 10-5-17.) | 8 | | Section 15. The Illinois Municipal Code is amended by | 9 | | changing Section 10-4-2.3 as follows: | 10 | | (65 ILCS 5/10-4-2.3)
| 11 | | Sec. 10-4-2.3. Required health benefits. If a | 12 | | municipality, including a
home rule municipality, is a | 13 | | self-insurer for purposes of providing health
insurance | 14 | | coverage for its employees, the coverage shall include coverage | 15 | | for
the post-mastectomy care benefits required to be covered by | 16 | | a policy of
accident and health insurance under Section 356t | 17 | | and the coverage required
under Sections 356g, 356g.5, | 18 | | 356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10, | 19 | | 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, and | 20 | | 356z.25 , 356z.26, and 356z.29 of the Illinois
Insurance
Code. | 21 | | The coverage shall comply with Sections 155.22a, 355b, 356z.19, | 22 | | and 370c of
the Illinois Insurance Code. The requirement that | 23 | | health
benefits be covered as provided in this is an exclusive | 24 | | power and function of
the State and is a denial and limitation |
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| 1 | | under Article VII, Section 6,
subsection (h) of the Illinois | 2 | | Constitution. A home rule municipality to which
this Section | 3 | | applies must comply with every provision of this Section.
| 4 | | Rulemaking authority to implement Public Act 95-1045, if | 5 | | any, is conditioned on the rules being adopted in accordance | 6 | | with all provisions of the Illinois Administrative Procedure | 7 | | Act and all rules and procedures of the Joint Committee on | 8 | | Administrative Rules; any purported rule not so adopted, for | 9 | | whatever reason, is unauthorized. | 10 | | (Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17; | 11 | | 100-138, eff. 8-18-17; revised 10-5-17.) | 12 | | Section 20. The School Code is amended by changing Section | 13 | | 10-22.3f as follows: | 14 | | (105 ILCS 5/10-22.3f)
| 15 | | Sec. 10-22.3f. Required health benefits. Insurance | 16 | | protection and
benefits
for employees shall provide the | 17 | | post-mastectomy care benefits required to be
covered by a | 18 | | policy of accident and health insurance under Section 356t and | 19 | | the
coverage required under Sections 356g, 356g.5, 356g.5-1, | 20 | | 356u, 356w, 356x,
356z.6, 356z.8, 356z.9, 356z.11, 356z.12, | 21 | | 356z.13, 356z.14, 356z.15, 356z.22, and 356z.25 , 356z.26, and | 22 | | 356z.29 of
the
Illinois Insurance Code.
Insurance policies | 23 | | shall comply with Section 356z.19 of the Illinois Insurance | 24 | | Code. The coverage shall comply with Sections 155.22a and 355b |
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| 1 | | of
the Illinois Insurance Code.
| 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. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; | 9 | | revised 9-25-17.) | 10 | | Section 25. The Illinois Insurance Code is amended by | 11 | | changing Section 356z.4 and adding Section 356z.29 as follows:
| 12 | | (215 ILCS 5/356z.4)
| 13 | | Sec. 356z.4. Coverage for contraceptives. | 14 | | (a)(1) The General Assembly hereby finds and declares all | 15 | | of the following: | 16 | | (A) Illinois has a long history of expanding timely | 17 | | access to birth control to prevent unintended pregnancy. | 18 | | (B) The federal Patient Protection and Affordable Care | 19 | | Act includes a contraceptive coverage guarantee as part of | 20 | | a broader requirement for health insurance to cover key | 21 | | preventive care services without out-of-pocket costs for | 22 | | patients. | 23 | | (C) The General Assembly intends to build on existing | 24 | | State and federal law to promote gender equity and women's |
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| 1 | | health and to ensure greater contraceptive coverage equity | 2 | | and timely access to all federal Food and Drug | 3 | | Administration approved methods of birth control for all | 4 | | individuals covered by an individual or group health | 5 | | insurance policy in Illinois. | 6 | | (D) Medical management techniques such as denials, | 7 | | step therapy, or prior authorization in public and private | 8 | | health care coverage can impede access to the most | 9 | | effective contraceptive methods. | 10 | | (2) As used in this subsection (a): | 11 | | "Contraceptive services" includes consultations, | 12 | | examinations, procedures, and medical services related to the | 13 | | use of contraceptive methods (including natural family | 14 | | planning) to prevent an unintended pregnancy. | 15 | | "Medical necessity", for the purposes of this subsection | 16 | | (a), includes, but is not limited to, considerations such as | 17 | | severity of side effects, differences in permanence and | 18 | | reversibility of contraceptive, and ability to adhere to the | 19 | | appropriate use of the item or service, as determined by the | 20 | | attending provider. | 21 | | "Therapeutic equivalent version" means drugs, devices, or | 22 | | products that can be expected to have the same clinical effect | 23 | | and safety profile when administered to patients under the | 24 | | conditions specified in the labeling and satisfy the following | 25 | | general criteria: | 26 | | (i) they are approved as safe and effective; |
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| 1 | | (ii) they are pharmaceutical equivalents in that they | 2 | | (A) contain identical amounts of the same active drug | 3 | | ingredient in the same dosage form and route of | 4 | | administration and (B) meet compendial or other applicable | 5 | | standards of strength, quality, purity, and identity; | 6 | | (iii) they are bioequivalent in that (A) they do not | 7 | | present a known or potential bioequivalence problem and | 8 | | they meet an acceptable in vitro standard or (B) if they do | 9 | | present such a known or potential problem, they are shown | 10 | | to meet an appropriate bioequivalence standard; | 11 | | (iv) they are adequately labeled; and | 12 | | (v) they are manufactured in compliance with Current | 13 | | Good Manufacturing Practice regulations. | 14 | | (3) An individual or group policy of accident and health | 15 | | insurance amended,
delivered, issued, or renewed in this State | 16 | | after the effective date of this amendatory Act of the 99th | 17 | | General Assembly shall provide coverage for all of the | 18 | | following services and contraceptive methods: | 19 | | (A) All contraceptive drugs, devices, and other | 20 | | products approved by the United States Food and Drug | 21 | | Administration. This includes all over-the-counter | 22 | | contraceptive drugs, devices, and products approved by the | 23 | | United States Food and Drug Administration, excluding male | 24 | | condoms. The following apply: | 25 | | (i) If the United States Food and Drug | 26 | | Administration has approved one or more therapeutic |
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| 1 | | equivalent versions of a contraceptive drug, device, | 2 | | or product, a policy is not required to include all | 3 | | such therapeutic equivalent versions in its formulary, | 4 | | so long as at least one is included and covered without | 5 | | cost-sharing and in accordance with this Section. | 6 | | (ii) If an individual's attending provider | 7 | | recommends a particular service or item approved by the | 8 | | United States Food and Drug Administration based on a | 9 | | determination of medical necessity with respect to | 10 | | that individual, the plan or issuer must cover that | 11 | | service or item without cost sharing. The plan or | 12 | | issuer must defer to the determination of the attending | 13 | | provider. | 14 | | (iii) If a drug, device, or product is not covered, | 15 | | plans and issuers must have an easily accessible, | 16 | | transparent, and sufficiently expedient process that | 17 | | is not unduly burdensome on the individual or a | 18 | | provider or other individual acting as a patient's | 19 | | authorized representative to ensure coverage without | 20 | | cost sharing. | 21 | | (iv) This coverage must provide for the dispensing | 22 | | of 12 months' worth of contraception at one time. | 23 | | (B) Voluntary sterilization procedures. | 24 | | (C) Contraceptive services, patient education, and | 25 | | counseling on contraception. | 26 | | (D) Follow-up services related to the drugs, devices, |
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| 1 | | products, and procedures covered under this Section, | 2 | | including, but not limited to, management of side effects, | 3 | | counseling for continued adherence, and device insertion | 4 | | and removal. | 5 | | (4) Except as otherwise provided in this subsection (a), a | 6 | | policy subject to this subsection (a) shall not impose a | 7 | | deductible, coinsurance, copayment, or any other cost-sharing | 8 | | requirement on the coverage provided. The provisions of this | 9 | | paragraph do not apply to coverage of voluntary male | 10 | | sterilization procedures to the extent such coverage would | 11 | | disqualify a high-deductible health plan from eligibility for a | 12 | | health savings account pursuant to the federal Internal Revenue | 13 | | Code, 26 U.S.C. 223. | 14 | | (5) Except as otherwise authorized under this subsection | 15 | | (a), a policy shall not impose any restrictions or delays on | 16 | | the coverage required under this subsection (a). | 17 | | (6) If, at any time, the Secretary of the United States | 18 | | Department of Health and Human Services, or its successor | 19 | | agency, promulgates rules or regulations to be published in the | 20 | | Federal Register or publishes a comment in the Federal Register | 21 | | or issues an opinion, guidance, or other action that would | 22 | | require the State, pursuant to any provision of the Patient | 23 | | Protection and Affordable Care Act (Public Law 111-148), | 24 | | including, but not limited to, 42 U.S.C. 18031(d)(3)(B) or any | 25 | | successor provision, to defray the cost of any coverage | 26 | | outlined in this subsection (a), then this subsection (a) is |
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| 1 | | inoperative with respect to all coverage outlined in this | 2 | | subsection (a) other than that authorized under Section 1902 of | 3 | | the Social Security Act, 42 U.S.C. 1396a, and the State shall | 4 | | not assume any obligation for the cost of the coverage set | 5 | | forth in this subsection (a). | 6 | | (b) This subsection (b) shall become operative if and only | 7 | | if subsection (a) becomes inoperative. | 8 | | An individual or group policy of accident and health | 9 | | insurance amended,
delivered, issued, or renewed in this State | 10 | | after the date this subsection (b) becomes operative that | 11 | | provides coverage for
outpatient services and outpatient | 12 | | prescription drugs or devices must provide
coverage for the | 13 | | insured and any
dependent of the
insured covered by the policy | 14 | | for all outpatient contraceptive services and
all outpatient | 15 | | contraceptive drugs and devices approved by the Food and
Drug | 16 | | Administration. Coverage required under this Section may not | 17 | | impose any
deductible, coinsurance, waiting period, or other | 18 | | cost-sharing or limitation
that is greater than that required | 19 | | for any outpatient service or outpatient
prescription drug or | 20 | | device otherwise covered by the policy.
| 21 | | Nothing in this subsection (b) shall be construed to | 22 | | require an insurance
company to cover services related to | 23 | | permanent sterilization that requires a
surgical procedure. | 24 | | As used in this subsection (b), "outpatient contraceptive | 25 | | service" means
consultations, examinations, procedures, and | 26 | | medical services, provided on an
outpatient basis and related |
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| 1 | | to the use of contraceptive methods (including
natural family | 2 | | planning) to prevent an unintended pregnancy.
| 3 | | (c) Nothing in this Section shall be construed to require | 4 | | an insurance
company to cover services related to an abortion | 5 | | as the term "abortion" is
defined in the Illinois Abortion Law | 6 | | of 1975.
| 7 | | (d) If a plan or issuer utilizes a network of providers, | 8 | | nothing in this Section shall be construed to require coverage | 9 | | or to prohibit the plan or issuer from imposing cost-sharing | 10 | | for items or services described in this Section that are | 11 | | provided or delivered by an out-of-network provider, unless the | 12 | | plan or issuer does not have in its network a provider who is | 13 | | able to or is willing to provide the applicable items or | 14 | | services.
| 15 | | (Source: P.A. 99-672, eff. 1-1-17 .)
| 16 | | (215 ILCS 5/356z.29 new) | 17 | | Sec. 356z.29. Coverage for fertility preservation | 18 | | treatments. | 19 | | (a) As used in this Section: | 20 | | "Iatrogenic infertility" means in impairment of | 21 | | fertility by surgery, radiation, chemotherapy, or other | 22 | | medical treatment affecting reproductive organs or | 23 | | processes. | 24 | | "May directly or indirectly cause" means the likely | 25 | | possibility that treatment will cause a side effect of |
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| 1 | | infertility, based upon current evidence-based standards | 2 | | of care established by the American Society for | 3 | | Reproductive Medicine, the American Society of Clinical | 4 | | Oncology, or other national medical associations that | 5 | | follow current evidence-based standards of care. | 6 | | "Standard fertility preservation services" means | 7 | | procedures based upon current evidence-based standards of | 8 | | care established by the American Society for Reproductive | 9 | | Medicine, the American Society of Clinical Oncology, or | 10 | | other national medical associations that follow current | 11 | | evidence-based standards of care. | 12 | | (b) An individual or group policy of accident and health | 13 | | insurance amended, delivered, issued, or renewed in this State | 14 | | after the effective date of this amendatory Act of the 100th | 15 | | General Assembly must provide coverage for medically necessary | 16 | | expenses for standard fertility preservation services when a | 17 | | necessary medical treatment may directly or indirectly cause | 18 | | iatrogenic infertility to an enrollee. | 19 | | (c) In determining coverage pursuant to this Section, an | 20 | | insurer shall not discriminate based on an individuals expected | 21 | | length of life, present or predicted disability, degree of | 22 | | medical dependency, quality of life, or other health | 23 | | conditions, nor based on personal characteristics, including | 24 | | age, sex, sexual orientation, or marital status. | 25 | | Section 30. The Health Maintenance Organization Act is |
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| 1 | | amended by changing Section 5-3 as follows:
| 2 | | (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
| 3 | | Sec. 5-3. Insurance Code provisions.
| 4 | | (a) Health Maintenance Organizations
shall be subject to | 5 | | the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
| 6 | | 141.2, 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, 154, | 7 | | 154.5, 154.6,
154.7, 154.8, 155.04, 155.22a, 355.2, 355.3, | 8 | | 355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y,
356z.2, 356z.4, | 9 | | 356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, | 10 | | 356z.13, 356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.21, | 11 | | 356z.22, 356z.25, 356z.26, 356z.29, 364, 364.01, 367.2, | 12 | | 367.2-5, 367i, 368a, 368b, 368c, 368d, 368e, 370c,
370c.1, 401, | 13 | | 401.1, 402, 403, 403A,
408, 408.2, 409, 412, 444,
and
444.1,
| 14 | | paragraph (c) of subsection (2) of Section 367, and Articles | 15 | | IIA, VIII 1/2,
XII,
XII 1/2, XIII, XIII 1/2, XXV, and XXVI of | 16 | | the Illinois Insurance Code.
| 17 | | (b) For purposes of the Illinois Insurance Code, except for | 18 | | Sections 444
and 444.1 and Articles XIII and XIII 1/2, Health | 19 | | Maintenance Organizations in
the following categories are | 20 | | deemed to be "domestic companies":
| 21 | | (1) a corporation authorized under the
Dental Service | 22 | | Plan Act or the Voluntary Health Services Plans Act;
| 23 | | (2) a corporation organized under the laws of this | 24 | | State; or
| 25 | | (3) a corporation organized under the laws of another |
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| 1 | | state, 30% or more
of the enrollees of which are residents | 2 | | of this State, except a
corporation subject to | 3 | | substantially the same requirements in its state of
| 4 | | organization as is a "domestic company" under Article VIII | 5 | | 1/2 of the
Illinois Insurance Code.
| 6 | | (c) In considering the merger, consolidation, or other | 7 | | acquisition of
control of a Health Maintenance Organization | 8 | | pursuant to Article VIII 1/2
of the Illinois Insurance Code,
| 9 | | (1) the Director shall give primary consideration to | 10 | | the continuation of
benefits to enrollees and the financial | 11 | | conditions of the acquired Health
Maintenance Organization | 12 | | after the merger, consolidation, or other
acquisition of | 13 | | control takes effect;
| 14 | | (2)(i) the criteria specified in subsection (1)(b) of | 15 | | Section 131.8 of
the Illinois Insurance Code shall not | 16 | | apply and (ii) the Director, in making
his determination | 17 | | with respect to the merger, consolidation, or other
| 18 | | acquisition of control, need not take into account the | 19 | | effect on
competition of the merger, consolidation, or | 20 | | other acquisition of control;
| 21 | | (3) the Director shall have the power to require the | 22 | | following
information:
| 23 | | (A) certification by an independent actuary of the | 24 | | adequacy
of the reserves of the Health Maintenance | 25 | | Organization sought to be acquired;
| 26 | | (B) pro forma financial statements reflecting the |
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| 1 | | combined balance
sheets of the acquiring company and | 2 | | the Health Maintenance Organization sought
to be | 3 | | acquired as of the end of the preceding year and as of | 4 | | a date 90 days
prior to the acquisition, as well as pro | 5 | | forma financial statements
reflecting projected | 6 | | combined operation for a period of 2 years;
| 7 | | (C) a pro forma business plan detailing an | 8 | | acquiring party's plans with
respect to the operation | 9 | | of the Health Maintenance Organization sought to
be | 10 | | acquired for a period of not less than 3 years; and
| 11 | | (D) such other information as the Director shall | 12 | | require.
| 13 | | (d) The provisions of Article VIII 1/2 of the Illinois | 14 | | Insurance Code
and this Section 5-3 shall apply to the sale by | 15 | | any health maintenance
organization of greater than 10% of its
| 16 | | enrollee population (including without limitation the health | 17 | | maintenance
organization's right, title, and interest in and to | 18 | | its health care
certificates).
| 19 | | (e) In considering any management contract or service | 20 | | agreement subject
to Section 141.1 of the Illinois Insurance | 21 | | Code, the Director (i) shall, in
addition to the criteria | 22 | | specified in Section 141.2 of the Illinois
Insurance Code, take | 23 | | into account the effect of the management contract or
service | 24 | | agreement on the continuation of benefits to enrollees and the
| 25 | | financial condition of the health maintenance organization to | 26 | | be managed or
serviced, and (ii) need not take into account the |
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| 1 | | effect of the management
contract or service agreement on | 2 | | competition.
| 3 | | (f) Except for small employer groups as defined in the | 4 | | Small Employer
Rating, Renewability and Portability Health | 5 | | Insurance Act and except for
medicare supplement policies as | 6 | | defined in Section 363 of the Illinois
Insurance Code, a Health | 7 | | Maintenance Organization may by contract agree with a
group or | 8 | | other enrollment unit to effect refunds or charge additional | 9 | | premiums
under the following terms and conditions:
| 10 | | (i) the amount of, and other terms and conditions with | 11 | | respect to, the
refund or additional premium are set forth | 12 | | in the group or enrollment unit
contract agreed in advance | 13 | | of the period for which a refund is to be paid or
| 14 | | additional premium is to be charged (which period shall not | 15 | | be less than one
year); and
| 16 | | (ii) the amount of the refund or additional premium | 17 | | shall not exceed 20%
of the Health Maintenance | 18 | | Organization's profitable or unprofitable experience
with | 19 | | respect to the group or other enrollment unit for the | 20 | | period (and, for
purposes of a refund or additional | 21 | | premium, the profitable or unprofitable
experience shall | 22 | | be calculated taking into account a pro rata share of the
| 23 | | Health Maintenance Organization's administrative and | 24 | | marketing expenses, but
shall not include any refund to be | 25 | | made or additional premium to be paid
pursuant to this | 26 | | subsection (f)). The Health Maintenance Organization and |
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| 1 | | the
group or enrollment unit may agree that the profitable | 2 | | or unprofitable
experience may be calculated taking into | 3 | | account the refund period and the
immediately preceding 2 | 4 | | plan years.
| 5 | | The Health Maintenance Organization shall include a | 6 | | statement in the
evidence of coverage issued to each enrollee | 7 | | describing the possibility of a
refund or additional premium, | 8 | | and upon request of any group or enrollment unit,
provide to | 9 | | the group or enrollment unit a description of the method used | 10 | | to
calculate (1) the Health Maintenance Organization's | 11 | | profitable experience with
respect to the group or enrollment | 12 | | unit and the resulting refund to the group
or enrollment unit | 13 | | or (2) the Health Maintenance Organization's unprofitable
| 14 | | experience with respect to the group or enrollment unit and the | 15 | | resulting
additional premium to be paid by the group or | 16 | | enrollment unit.
| 17 | | In no event shall the Illinois Health Maintenance | 18 | | Organization
Guaranty Association be liable to pay any | 19 | | contractual obligation of an
insolvent organization to pay any | 20 | | refund authorized under this Section.
| 21 | | (g) Rulemaking authority to implement Public Act 95-1045, | 22 | | if any, is conditioned on the rules being adopted in accordance | 23 | | with all provisions of the Illinois Administrative Procedure | 24 | | Act and all rules and procedures of the Joint Committee on | 25 | | Administrative Rules; any purported rule not so adopted, for | 26 | | whatever reason, is unauthorized. |
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| 1 | | (Source: P.A. 99-761, eff. 1-1-18; 100-24, eff. 7-18-17; | 2 | | 100-138, eff. 8-18-17; revised 10-5-17.) | 3 | | Section 35. The Limited Health Service Organization Act is | 4 | | amended by changing Section 4003 as follows:
| 5 | | (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
| 6 | | Sec. 4003. Illinois Insurance Code provisions. Limited | 7 | | health service
organizations shall be subject to the provisions | 8 | | of Sections 133, 134, 136, 137, 139,
140, 141.1, 141.2, 141.3, | 9 | | 143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5,
154.6, | 10 | | 154.7, 154.8, 155.04, 155.37, 355.2, 355.3, 355b, 356v, | 11 | | 356z.10, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 368a, | 12 | | 401, 401.1,
402,
403, 403A, 408,
408.2, 409, 412, 444, and | 13 | | 444.1 and Articles IIA, VIII 1/2, XII, XII 1/2,
XIII,
XIII 1/2, | 14 | | XXV, and XXVI of the Illinois Insurance Code. For purposes of | 15 | | the
Illinois Insurance Code, except for Sections 444 and 444.1 | 16 | | and Articles XIII
and XIII 1/2, limited health service | 17 | | organizations in the following categories
are deemed to be | 18 | | domestic companies:
| 19 | | (1) a corporation under the laws of this State; or
| 20 | | (2) a corporation organized under the laws of another | 21 | | state, 30% or more
of the enrollees of which are residents | 22 | | of this State, except a corporation
subject to | 23 | | substantially the same requirements in its state of | 24 | | organization as
is a domestic company under Article VIII |
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| 1 | | 1/2 of the Illinois Insurance Code.
| 2 | | (Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; | 3 | | 100-201, eff. 8-18-17; revised 10-5-17.)
| 4 | | Section 40. The Voluntary Health Services Plans Act is | 5 | | amended by changing Section 10 as follows:
| 6 | | (215 ILCS 165/10) (from Ch. 32, par. 604)
| 7 | | Sec. 10. Application of Insurance Code provisions. Health | 8 | | services
plan corporations and all persons interested therein | 9 | | or dealing therewith
shall be subject to the provisions of | 10 | | Articles IIA and XII 1/2 and Sections
3.1, 133, 136, 139, 140, | 11 | | 143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, 356g, | 12 | | 356g.5, 356g.5-1, 356r, 356t, 356u, 356v,
356w, 356x, 356y, | 13 | | 356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9,
| 14 | | 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18, | 15 | | 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 364.01, | 16 | | 367.2, 368a, 401, 401.1,
402,
403, 403A, 408,
408.2, and 412, | 17 | | and paragraphs (7) and (15) of Section 367 of the Illinois
| 18 | | Insurance Code.
| 19 | | Rulemaking authority to implement Public Act 95-1045, if | 20 | | any, is conditioned on the rules being adopted in accordance | 21 | | with all provisions of the Illinois Administrative Procedure | 22 | | Act and all rules and procedures of the Joint Committee on | 23 | | Administrative Rules; any purported rule not so adopted, for | 24 | | whatever reason, is unauthorized. |
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| 1 | | (Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; | 2 | | revised 10-5-17.) | 3 | | Section 45. 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, 356z.6, 356z.26, and | 11 | | 356z.29 and 356z.25 of the Illinois
Insurance Code and (ii) be | 12 | | subject to the provisions of Sections 356z.19, 364.01, 370c, | 13 | | and 370c.1 of the Illinois
Insurance Code.
| 14 | | On and after July 1, 2012, the Department shall reduce any | 15 | | rate of reimbursement for services or other payments or alter | 16 | | any methodologies authorized by this Code to reduce any rate of | 17 | | reimbursement for services or other payments in accordance with | 18 | | Section 5-5e. | 19 | | To ensure full access to the benefits set forth in this | 20 | | Section, on and after January 1, 2016, the Department shall | 21 | | ensure that provider and hospital reimbursement for | 22 | | post-mastectomy care benefits required under this Section are | 23 | | no lower than the Medicare reimbursement rate. | 24 | | (Source: P.A. 99-433, eff. 8-21-15; 99-480, eff. 9-9-15; |
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| 1 | | 99-642, eff. 7-28-16; 100-138, eff. 8-18-17; revised 1-29-18.)
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