Illinois General Assembly - Full Text of HB2653
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Full Text of HB2653  102nd General Assembly

HB2653eng 102ND GENERAL ASSEMBLY

  
  
  

 


 
HB2653 EngrossedLRB102 03848 BMS 13862 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 Counties Code is amended by changing
5Section 5-1069.3 as follows:
 
6    (55 ILCS 5/5-1069.3)
7    Sec. 5-1069.3. Required health benefits. If a county,
8including a home rule county, is a self-insurer for purposes
9of providing health insurance coverage for its employees, the
10coverage shall include coverage for the post-mastectomy care
11benefits required to be covered by a policy of accident and
12health insurance under Section 356t and the coverage required
13under Sections 356g, 356g.5, 356g.5-1, 356u, 356w, 356x,
14356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
15356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
16356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41, and 356z.43
17of the Illinois Insurance Code. The coverage shall comply with
18Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
19Insurance Code. The Department of Insurance shall enforce the
20requirements of this Section. The requirement that health
21benefits be covered as provided in this Section is an
22exclusive power and function of the State and is a denial and
23limitation under Article VII, Section 6, subsection (h) of the

 

 

HB2653 Engrossed- 2 -LRB102 03848 BMS 13862 b

1Illinois Constitution. A home rule county to which this
2Section applies must comply with every provision of this
3Section.
4    Rulemaking authority to implement Public Act 95-1045, if
5any, is conditioned on the rules being adopted in accordance
6with all provisions of the Illinois Administrative Procedure
7Act and all rules and procedures of the Joint Committee on
8Administrative Rules; any purported rule not so adopted, for
9whatever reason, is unauthorized.
10(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
11100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
121-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
13eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
14101-625, eff. 1-1-21.)
 
15    Section 10. The Illinois Municipal Code is amended by
16changing Section 10-4-2.3 as follows:
 
17    (65 ILCS 5/10-4-2.3)
18    Sec. 10-4-2.3. Required health benefits. If a
19municipality, including a home rule municipality, is a
20self-insurer for purposes of providing health insurance
21coverage for its employees, the coverage shall include
22coverage for the post-mastectomy care benefits required to be
23covered by a policy of accident and health insurance under
24Section 356t and the coverage required under Sections 356g,

 

 

HB2653 Engrossed- 3 -LRB102 03848 BMS 13862 b

1356g.5, 356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9,
2356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
3356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
4356z.36, and 356z.41, and 356z.43 of the Illinois Insurance
5Code. The coverage shall comply with Sections 155.22a, 355b,
6356z.19, and 370c of the Illinois Insurance Code. The
7Department of Insurance shall enforce the requirements of this
8Section. The requirement that health benefits be covered as
9provided in this is an exclusive power and function of the
10State and is a denial and limitation under Article VII,
11Section 6, subsection (h) of the Illinois Constitution. A home
12rule municipality to which this Section applies must comply
13with every provision of this Section.
14    Rulemaking authority to implement Public Act 95-1045, if
15any, is conditioned on the rules being adopted in accordance
16with all provisions of the Illinois Administrative Procedure
17Act and all rules and procedures of the Joint Committee on
18Administrative Rules; any purported rule not so adopted, for
19whatever 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; 100-1024, eff. 1-1-19; 100-1057, eff.
221-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
23eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
24101-625, eff. 1-1-21.)
 
25    Section 15. The Illinois Insurance Code is amended by

 

 

HB2653 Engrossed- 4 -LRB102 03848 BMS 13862 b

1adding Section 356z.43 as follows:
 
2    (215 ILCS 5/356z.43 new)
3    Sec. 356z.43. Colonoscopy coverage.
4    (a) A group policy of accident and health insurance that
5is amended, delivered, issued, or renewed on or after January
61, 2022 shall provide coverage for a colonoscopy that is a
7follow-up exam based on an initial screen where the
8colonoscopy was determined to be medically necessary by a
9physician licensed to practice medicine in all its branches,
10an advanced practice registered nurse, or a physician
11assistant.
12    (b) A policy subject to this Section shall not impose a
13deductible, coinsurance, copayment, or any other cost-sharing
14requirement on the coverage provided; except that this
15subsection does not apply to coverage of colonoscopies to the
16extent such coverage would disqualify a high-deductible health
17plan from eligibility for a health savings account pursuant to
18Section 223 of the Internal Revenue Code.
 
19    Section 20. The Health Maintenance Organization Act is
20amended by changing Section 5-3 as follows:
 
21    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
22    Sec. 5-3. Insurance Code provisions.
23    (a) Health Maintenance Organizations shall be subject to

 

 

HB2653 Engrossed- 5 -LRB102 03848 BMS 13862 b

1the provisions of Sections 133, 134, 136, 137, 139, 140,
2141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
3154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2,
4355.3, 355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2,
5356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10,
6356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.18,
7356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30,
8356z.30a, 356z.32, 356z.33, 356z.35, 356z.36, 356z.41,
9356z.43, 364, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c,
10368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A, 408,
11408.2, 409, 412, 444, and 444.1, paragraph (c) of subsection
12(2) of Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2,
13XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the Illinois
14Insurance Code.
15    (b) For purposes of the Illinois Insurance Code, except
16for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
17Health Maintenance Organizations in the following categories
18are deemed to be "domestic companies":
19        (1) a corporation authorized under the Dental Service
20    Plan Act or the Voluntary Health Services Plans Act;
21        (2) a corporation organized under the laws of this
22    State; or
23        (3) a corporation organized under the laws of another
24    state, 30% or more of the enrollees of which are residents
25    of this State, except a corporation subject to
26    substantially the same requirements in its state of

 

 

HB2653 Engrossed- 6 -LRB102 03848 BMS 13862 b

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

 

 

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1        a date 90 days prior to the acquisition, as well as pro
2        forma financial statements reflecting projected
3        combined operation for a period of 2 years;
4            (C) a pro forma business plan detailing an
5        acquiring party's plans with respect to the operation
6        of the Health Maintenance Organization sought to be
7        acquired for a period of not less than 3 years; and
8            (D) such other information as the Director shall
9        require.
10    (d) The provisions of Article VIII 1/2 of the Illinois
11Insurance Code and this Section 5-3 shall apply to the sale by
12any health maintenance organization of greater than 10% of its
13enrollee population (including without limitation the health
14maintenance organization's right, title, and interest in and
15to its health care certificates).
16    (e) In considering any management contract or service
17agreement subject to Section 141.1 of the Illinois Insurance
18Code, the Director (i) shall, in addition to the criteria
19specified in Section 141.2 of the Illinois Insurance Code,
20take into account the effect of the management contract or
21service agreement on the continuation of benefits to enrollees
22and the financial condition of the health maintenance
23organization to be managed or serviced, and (ii) need not take
24into account the effect of the management contract or service
25agreement on competition.
26    (f) Except for small employer groups as defined in the

 

 

HB2653 Engrossed- 8 -LRB102 03848 BMS 13862 b

1Small Employer Rating, Renewability and Portability Health
2Insurance Act and except for medicare supplement policies as
3defined in Section 363 of the Illinois Insurance Code, a
4Health Maintenance Organization may by contract agree with a
5group or other enrollment unit to effect refunds or charge
6additional premiums under the following terms and conditions:
7        (i) the amount of, and other terms and conditions with
8    respect to, the refund or additional premium are set forth
9    in the group or enrollment unit contract agreed in advance
10    of the period for which a refund is to be paid or
11    additional premium is to be charged (which period shall
12    not be less than one year); and
13        (ii) the amount of the refund or additional premium
14    shall not exceed 20% of the Health Maintenance
15    Organization's profitable or unprofitable experience with
16    respect to the group or other enrollment unit for the
17    period (and, for purposes of a refund or additional
18    premium, the profitable or unprofitable experience shall
19    be calculated taking into account a pro rata share of the
20    Health Maintenance Organization's administrative and
21    marketing expenses, but shall not include any refund to be
22    made or additional premium to be paid pursuant to this
23    subsection (f)). The Health Maintenance Organization and
24    the group or enrollment unit may agree that the profitable
25    or unprofitable experience may be calculated taking into
26    account the refund period and the immediately preceding 2

 

 

HB2653 Engrossed- 9 -LRB102 03848 BMS 13862 b

1    plan years.
2    The Health Maintenance Organization shall include a
3statement in the evidence of coverage issued to each enrollee
4describing the possibility of a refund or additional premium,
5and upon request of any group or enrollment unit, provide to
6the group or enrollment unit a description of the method used
7to calculate (1) the Health Maintenance Organization's
8profitable experience with respect to the group or enrollment
9unit and the resulting refund to the group or enrollment unit
10or (2) the Health Maintenance Organization's unprofitable
11experience with respect to the group or enrollment unit and
12the resulting additional premium to be paid by the group or
13enrollment unit.
14    In no event shall the Illinois Health Maintenance
15Organization Guaranty Association be liable to pay any
16contractual obligation of an insolvent organization to pay any
17refund authorized under this Section.
18    (g) Rulemaking authority to implement Public Act 95-1045,
19if any, is conditioned on the rules being adopted in
20accordance with all provisions of the Illinois Administrative
21Procedure Act and all rules and procedures of the Joint
22Committee on Administrative Rules; any purported rule not so
23adopted, for whatever reason, is unauthorized.
24(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
25100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff.
261-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81,

 

 

HB2653 Engrossed- 10 -LRB102 03848 BMS 13862 b

1eff. 7-12-19; 101-281, eff. 1-1-20; 101-371, eff. 1-1-20;
2101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
31-1-20; 101-625, eff. 1-1-21.)
 
4    Section 99. Effective date. This Act takes effect January
51, 2022.