Sen. Kimberly A. Lightford

Filed: 5/13/2021





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2    AMENDMENT NO. ______. Amend House Bill 2109 by replacing
3everything after the enacting clause with the following:
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.



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1        (5) Tumor mutation burden.
2    "Testing of blood or constitutional tissue for cancer
3predisposition testing" includes, but is not limited to, the
4following forms of testing:
5        (1) Targeted cancer gene panels.
6        (2) Whole-exome genome testing.
7        (3) Whole-genome sequencing.
8    (b) An individual or group policy of accident and health
9insurance or managed care plan that is amended, delivered,
10issued, or renewed on or after the effective date of this
11amendatory Act of the 102nd General Assembly shall provide
12coverage for medically necessary comprehensive cancer testing
13and testing of blood or constitutional tissue for cancer
14predisposition testing as determined by a physician licensed
15to practice medicine in all of its branches.
16    Section 10. The Health Maintenance Organization Act is
17amended by changing Section 5-3 as follows:
18    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
19    Sec. 5-3. Insurance Code provisions.
20    (a) Health Maintenance Organizations shall be subject to
21the provisions of Sections 133, 134, 136, 137, 139, 140,
22141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
23154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2,
24355.3, 355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2,



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1356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10,
2356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.18,
3356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30,
4356z.30a, 356z.32, 356z.33, 356z.35, 356z.36, 356z.41,
5356z.43, 364, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c,
6368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A, 408,
7408.2, 409, 412, 444, and 444.1, paragraph (c) of subsection
8(2) of Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2,
9XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the Illinois
10Insurance Code.
11    (b) For purposes of the Illinois Insurance Code, except
12for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
13Health Maintenance Organizations in the following categories
14are deemed to be "domestic companies":
15        (1) a corporation authorized under the Dental Service
16    Plan Act or the Voluntary Health Services Plans Act;
17        (2) a corporation organized under the laws of this
18    State; or
19        (3) a corporation organized under the laws of another
20    state, 30% or more of the enrollees of which are residents
21    of this State, except a corporation subject to
22    substantially the same requirements in its state of
23    organization as is a "domestic company" under Article VIII
24    1/2 of the Illinois Insurance Code.
25    (c) In considering the merger, consolidation, or other
26acquisition of control of a Health Maintenance Organization



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1pursuant to Article VIII 1/2 of the Illinois Insurance Code,
2        (1) the Director shall give primary consideration to
3    the continuation of benefits to enrollees and the
4    financial conditions of the acquired Health Maintenance
5    Organization after the merger, consolidation, or other
6    acquisition of control takes effect;
7        (2)(i) the criteria specified in subsection (1)(b) of
8    Section 131.8 of the Illinois Insurance Code shall not
9    apply and (ii) the Director, in making his determination
10    with respect to the merger, consolidation, or other
11    acquisition of control, need not take into account the
12    effect on competition of the merger, consolidation, or
13    other acquisition of control;
14        (3) the Director shall have the power to require the
15    following information:
16            (A) certification by an independent actuary of the
17        adequacy of the reserves of the Health Maintenance
18        Organization sought to be acquired;
19            (B) pro forma financial statements reflecting the
20        combined balance sheets of the acquiring company and
21        the Health Maintenance Organization sought to be
22        acquired as of the end of the preceding year and as of
23        a date 90 days prior to the acquisition, as well as pro
24        forma financial statements reflecting projected
25        combined operation for a period of 2 years;
26            (C) a pro forma business plan detailing an



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1        acquiring party's plans with respect to the operation
2        of the Health Maintenance Organization sought to be
3        acquired for a period of not less than 3 years; and
4            (D) such other information as the Director shall
5        require.
6    (d) The provisions of Article VIII 1/2 of the Illinois
7Insurance Code and this Section 5-3 shall apply to the sale by
8any health maintenance organization of greater than 10% of its
9enrollee population (including without limitation the health
10maintenance organization's right, title, and interest in and
11to its health care certificates).
12    (e) In considering any management contract or service
13agreement subject to Section 141.1 of the Illinois Insurance
14Code, the Director (i) shall, in addition to the criteria
15specified in Section 141.2 of the Illinois Insurance Code,
16take into account the effect of the management contract or
17service agreement on the continuation of benefits to enrollees
18and the financial condition of the health maintenance
19organization to be managed or serviced, and (ii) need not take
20into account the effect of the management contract or service
21agreement on competition.
22    (f) Except for small employer groups as defined in the
23Small Employer Rating, Renewability and Portability Health
24Insurance Act and except for medicare supplement policies as
25defined in Section 363 of the Illinois Insurance Code, a
26Health Maintenance Organization may by contract agree with a



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1group or other enrollment unit to effect refunds or charge
2additional premiums under the following terms and conditions:
3        (i) the amount of, and other terms and conditions with
4    respect to, the refund or additional premium are set forth
5    in the group or enrollment unit contract agreed in advance
6    of the period for which a refund is to be paid or
7    additional premium is to be charged (which period shall
8    not be less than one year); and
9        (ii) the amount of the refund or additional premium
10    shall not exceed 20% of the Health Maintenance
11    Organization's profitable or unprofitable experience with
12    respect to the group or other enrollment unit for the
13    period (and, for purposes of a refund or additional
14    premium, the profitable or unprofitable experience shall
15    be calculated taking into account a pro rata share of the
16    Health Maintenance Organization's administrative and
17    marketing expenses, but shall not include any refund to be
18    made or additional premium to be paid pursuant to this
19    subsection (f)). The Health Maintenance Organization and
20    the group or enrollment unit may agree that the profitable
21    or unprofitable experience may be calculated taking into
22    account the refund period and the immediately preceding 2
23    plan years.
24    The Health Maintenance Organization shall include a
25statement in the evidence of coverage issued to each enrollee
26describing the possibility of a refund or additional premium,



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1and upon request of any group or enrollment unit, provide to
2the group or enrollment unit a description of the method used
3to calculate (1) the Health Maintenance Organization's
4profitable experience with respect to the group or enrollment
5unit and the resulting refund to the group or enrollment unit
6or (2) the Health Maintenance Organization's unprofitable
7experience with respect to the group or enrollment unit and
8the resulting additional premium to be paid by the group or
9enrollment unit.
10    In no event shall the Illinois Health Maintenance
11Organization Guaranty Association be liable to pay any
12contractual obligation of an insolvent organization to pay any
13refund authorized under this Section.
14    (g) Rulemaking authority to implement Public Act 95-1045,
15if any, is conditioned on the rules being adopted in
16accordance with all provisions of the Illinois Administrative
17Procedure Act and all rules and procedures of the Joint
18Committee on Administrative Rules; any purported rule not so
19adopted, for whatever reason, is unauthorized.
20(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
21100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff.
221-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81,
23eff. 7-12-19; 101-281, eff. 1-1-20; 101-371, eff. 1-1-20;
24101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
251-1-20; 101-625, eff. 1-1-21.)".