HB2109 EnrolledLRB102 12330 BMS 17667 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 1. This Act may be referred to as Cal's Law.
5    Section 5. The Illinois Insurance Code is amended by
6adding Section 356z.43 as follows:
7    (215 ILCS 5/356z.43 new)
8    Sec. 356z.43. Comprehensive cancer testing.
9    (a) As used in this Section:
10    "Comprehensive cancer testing" includes, but is not
11limited to, the following forms of testing:
12        (1) Targeted cancer gene panels.
13        (2) Whole-exome genome testing.
14        (3) Whole-genome sequencing.
15        (4) RNA sequencing.
16        (5) Tumor mutation burden.
17    "Testing of blood or constitutional tissue for cancer
18predisposition testing" includes, but is not limited to, the
19following forms of testing:
20        (1) Targeted cancer gene panels.
21        (2) Whole-exome genome testing.
22        (3) Whole-genome sequencing.



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1    (b) An individual or group policy of accident and health
2insurance or managed care plan that is amended, delivered,
3issued, or renewed on or after the effective date of this
4amendatory Act of the 102nd General Assembly shall provide
5coverage for medically necessary comprehensive cancer testing
6and testing of blood or constitutional tissue for cancer
7predisposition testing as determined by a physician licensed
8to practice medicine in all of its branches.
9    Section 10. The Health Maintenance Organization Act is
10amended by changing Section 5-3 as follows:
11    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
12    Sec. 5-3. Insurance Code provisions.
13    (a) Health Maintenance Organizations shall be subject to
14the provisions of Sections 133, 134, 136, 137, 139, 140,
15141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
16154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2,
17355.3, 355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2,
18356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10,
19356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.18,
20356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30,
21356z.30a, 356z.32, 356z.33, 356z.35, 356z.36, 356z.41,
22356z.43, 364, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c,
23368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A, 408,
24408.2, 409, 412, 444, and 444.1, paragraph (c) of subsection



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1(2) of Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2,
2XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the Illinois
3Insurance Code.
4    (b) For purposes of the Illinois Insurance Code, except
5for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
6Health Maintenance Organizations in the following categories
7are deemed to be "domestic companies":
8        (1) a corporation authorized under the Dental Service
9    Plan Act or the Voluntary Health Services Plans Act;
10        (2) a corporation organized under the laws of this
11    State; or
12        (3) a corporation organized under the laws of another
13    state, 30% or more of the enrollees of which are residents
14    of this State, except a corporation subject to
15    substantially the same requirements in its state of
16    organization as is a "domestic company" under Article VIII
17    1/2 of the Illinois Insurance Code.
18    (c) In considering the merger, consolidation, or other
19acquisition of control of a Health Maintenance Organization
20pursuant to Article VIII 1/2 of the Illinois Insurance Code,
21        (1) the Director shall give primary consideration to
22    the continuation of benefits to enrollees and the
23    financial conditions of the acquired Health Maintenance
24    Organization after the merger, consolidation, or other
25    acquisition of control takes effect;
26        (2)(i) the criteria specified in subsection (1)(b) of



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1    Section 131.8 of the Illinois Insurance Code shall not
2    apply and (ii) the Director, in making his determination
3    with respect to the merger, consolidation, or other
4    acquisition of control, need not take into account the
5    effect on competition of the merger, consolidation, or
6    other acquisition of control;
7        (3) the Director shall have the power to require the
8    following information:
9            (A) certification by an independent actuary of the
10        adequacy of the reserves of the Health Maintenance
11        Organization sought to be acquired;
12            (B) pro forma financial statements reflecting the
13        combined balance sheets of the acquiring company and
14        the Health Maintenance Organization sought to be
15        acquired as of the end of the preceding year and as of
16        a date 90 days prior to the acquisition, as well as pro
17        forma financial statements reflecting projected
18        combined operation for a period of 2 years;
19            (C) a pro forma business plan detailing an
20        acquiring party's plans with respect to the operation
21        of the Health Maintenance Organization sought to be
22        acquired for a period of not less than 3 years; and
23            (D) such other information as the Director shall
24        require.
25    (d) The provisions of Article VIII 1/2 of the Illinois
26Insurance Code and this Section 5-3 shall apply to the sale by



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1any health maintenance organization of greater than 10% of its
2enrollee population (including without limitation the health
3maintenance organization's right, title, and interest in and
4to its health care certificates).
5    (e) In considering any management contract or service
6agreement subject to Section 141.1 of the Illinois Insurance
7Code, the Director (i) shall, in addition to the criteria
8specified in Section 141.2 of the Illinois Insurance Code,
9take into account the effect of the management contract or
10service agreement on the continuation of benefits to enrollees
11and the financial condition of the health maintenance
12organization to be managed or serviced, and (ii) need not take
13into account the effect of the management contract or service
14agreement on competition.
15    (f) Except for small employer groups as defined in the
16Small Employer Rating, Renewability and Portability Health
17Insurance Act and except for medicare supplement policies as
18defined in Section 363 of the Illinois Insurance Code, a
19Health Maintenance Organization may by contract agree with a
20group or other enrollment unit to effect refunds or charge
21additional premiums under the following terms and conditions:
22        (i) the amount of, and other terms and conditions with
23    respect to, the refund or additional premium are set forth
24    in the group or enrollment unit contract agreed in advance
25    of the period for which a refund is to be paid or
26    additional premium is to be charged (which period shall



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1    not be less than one year); and
2        (ii) the amount of the refund or additional premium
3    shall not exceed 20% of the Health Maintenance
4    Organization's profitable or unprofitable experience with
5    respect to the group or other enrollment unit for the
6    period (and, for purposes of a refund or additional
7    premium, the profitable or unprofitable experience shall
8    be calculated taking into account a pro rata share of the
9    Health Maintenance Organization's administrative and
10    marketing expenses, but shall not include any refund to be
11    made or additional premium to be paid pursuant to this
12    subsection (f)). The Health Maintenance Organization and
13    the group or enrollment unit may agree that the profitable
14    or unprofitable experience may be calculated taking into
15    account the refund period and the immediately preceding 2
16    plan years.
17    The Health Maintenance Organization shall include a
18statement in the evidence of coverage issued to each enrollee
19describing the possibility of a refund or additional premium,
20and upon request of any group or enrollment unit, provide to
21the group or enrollment unit a description of the method used
22to calculate (1) the Health Maintenance Organization's
23profitable experience with respect to the group or enrollment
24unit and the resulting refund to the group or enrollment unit
25or (2) the Health Maintenance Organization's unprofitable
26experience with respect to the group or enrollment unit and



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1the resulting additional premium to be paid by the group or
2enrollment unit.
3    In no event shall the Illinois Health Maintenance
4Organization Guaranty Association be liable to pay any
5contractual obligation of an insolvent organization to pay any
6refund authorized under this Section.
7    (g) Rulemaking authority to implement Public Act 95-1045,
8if any, is conditioned on the rules being adopted in
9accordance with all provisions of the Illinois Administrative
10Procedure Act and all rules and procedures of the Joint
11Committee on Administrative Rules; any purported rule not so
12adopted, for whatever reason, is unauthorized.
13(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
14100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff.
151-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81,
16eff. 7-12-19; 101-281, eff. 1-1-20; 101-371, eff. 1-1-20;
17101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
181-1-20; 101-625, eff. 1-1-21.)