HB0317 EngrossedLRB102 09996 BMS 15314 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 Illinois Insurance Code is amended by
5changing Section 352 as follows:
6    (215 ILCS 5/352)  (from Ch. 73, par. 964)
7    Sec. 352. Scope of Article.
8    (a) Except as provided in subsections (b), (c), (d), and
9(e), this Article shall apply to all companies transacting in
10this State the kinds of business enumerated in clause (b) of
11Class 1 and clause (a) of Class 2 of Section 4. Nothing in this
12Article shall apply to, or in any way affect policies or
13contracts described in clause (a) of Class 1 of Section 4;
14however, this Article shall apply to policies and contracts
15which contain benefits providing reimbursement for the
16expenses of long term health care which are certified or
17ordered by a physician including but not limited to
18professional nursing care, custodial nursing care, and
19non-nursing custodial care provided in a nursing home or at a
20residence of the insured.
21    (a-5) An air ambulance service or other entity that
22directly or indirectly, whether through an affiliated entity,
23agreement with a third-party entity, or otherwise, is engaging



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1in the business of insurance as an insurer if the service or
2other entity, for the purpose of covering the copayments,
3deductibles, or cost-sharing amounts of a patient or
4post-service payments of costs to third parties, solicits air
5ambulance membership subscriptions, accepts membership
6applications, or charges membership fees. An air ambulance
7membership that covers the copayments, deductibles, or other
8cost-sharing amounts of a patient or provides for post-service
9payments of costs to third parties shall be considered
10insurance and an insurance product and may be considered
11secondary insurance coverage or a supplement to any insurance
12coverage and shall be regulated accordingly by the Department
13of Insurance.
14    (b) (Blank).
15    (c) A policy issued and delivered in this State that
16provides coverage under that policy for certificate holders
17who are neither residents of nor employed in this State does
18not need to provide to those nonresident certificate holders
19who are not employed in this State the coverages or services
20mandated by this Article.
21    (d) Stop-loss insurance is exempt from all Sections of
22this Article, except this Section and Sections 353a, 354,
23357.30, and 370. For purposes of this exemption, stop-loss
24insurance is further defined as follows:
25        (1) The policy must be issued to and insure an
26    employer, trustee, or other sponsor of the plan, or the



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1    plan itself, but not employees, members, or participants.
2        (2) Payments by the insurer must be made to the
3    employer, trustee, or other sponsors of the plan, or the
4    plan itself, but not to the employees, members,
5    participants, or health care providers.
6    (e) A policy issued or delivered in this State to the
7Department of Healthcare and Family Services (formerly
8Illinois Department of Public Aid) and providing coverage,
9under clause (b) of Class 1 or clause (a) of Class 2 as
10described in Section 4, to persons who are enrolled under
11Article V of the Illinois Public Aid Code or under the
12Children's Health Insurance Program Act is exempt from all
13restrictions, limitations, standards, rules, or regulations
14respecting benefits imposed by or under authority of this
15Code, except those specified by subsection (1) of Section 143,
16Section 370c, and Section 370c.1. Nothing in this subsection,
17however, affects the total medical services available to
18persons eligible for medical assistance under the Illinois
19Public Aid Code.
20    (f) An in-office membership care agreement provided under
21the In-Office Membership Care Act is not insurance for the
22purposes of this Code.
23(Source: P.A. 101-190, eff. 8-2-19.)
24    Section 99. Effective date. This Act takes effect upon
25becoming law.