Illinois General Assembly - Full Text of SB0968
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Full Text of SB0968  102nd General Assembly

SB0968sam002 102ND GENERAL ASSEMBLY

Sen. Adriane Johnson

Filed: 4/16/2021

 

 


 

 


 
10200SB0968sam002LRB102 04882 BMS 25380 a

1
AMENDMENT TO SENATE BILL 968

2    AMENDMENT NO. ______. Amend Senate Bill 968 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The State Employees Group Insurance Act of
51971 is amended by changing Section 6.11 as follows:
 
6    (5 ILCS 375/6.11)
7    Sec. 6.11. Required health benefits; Illinois Insurance
8Code requirements. The program of health benefits shall
9provide the post-mastectomy care benefits required to be
10covered by a policy of accident and health insurance under
11Section 356t of the Illinois Insurance Code. The program of
12health benefits shall provide the coverage required under
13Sections 356g, 356g.5, 356g.5-1, 356m, 356u, 356w, 356x,
14356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
15356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,
16356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,

 

 

10200SB0968sam002- 2 -LRB102 04882 BMS 25380 a

1356z.36, and 356z.41, and 356z.43 of the Illinois Insurance
2Code. The program of health benefits must comply with Sections
3155.22a, 155.37, 355b, 356z.19, 370c, and 370c.1 and Article
4XXXIIB of the Illinois Insurance Code. The Department of
5Insurance shall enforce the requirements of this Section with
6respect to Sections 370c and 370c.1 of the Illinois Insurance
7Code; all other requirements of this Section shall be enforced
8by the Department of Central Management Services.
9    Rulemaking authority to implement Public Act 95-1045, if
10any, is conditioned on the rules being adopted in accordance
11with all provisions of the Illinois Administrative Procedure
12Act and all rules and procedures of the Joint Committee on
13Administrative Rules; any purported rule not so adopted, for
14whatever reason, is unauthorized.
15(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
16100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
171-1-19; 100-1102, eff. 1-1-19; 100-1170, eff. 6-1-19; 101-13,
18eff. 6-12-19; 101-281, eff. 1-1-20; 101-393, eff. 1-1-20;
19101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
201-1-21.)
 
21    Section 10. The Counties Code is amended by changing
22Section 5-1069.3 as follows:
 
23    (55 ILCS 5/5-1069.3)
24    Sec. 5-1069.3. Required health benefits. If a county,

 

 

10200SB0968sam002- 3 -LRB102 04882 BMS 25380 a

1including a home rule county, is a self-insurer for purposes
2of providing health insurance coverage for its employees, the
3coverage shall include coverage for the post-mastectomy care
4benefits required to be covered by a policy of accident and
5health insurance under Section 356t and the coverage required
6under Sections 356g, 356g.5, 356g.5-1, 356u, 356w, 356x,
7356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
8356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
9356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41, and 356z.43
10of the Illinois Insurance Code. The coverage shall comply with
11Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
12Insurance Code. The Department of Insurance shall enforce the
13requirements of this Section. The requirement that health
14benefits be covered as provided in this Section is an
15exclusive power and function of the State and is a denial and
16limitation under Article VII, Section 6, subsection (h) of the
17Illinois Constitution. A home rule county to which this
18Section applies must comply with every provision of this
19Section.
20    Rulemaking authority to implement Public Act 95-1045, if
21any, is conditioned on the rules being adopted in accordance
22with all provisions of the Illinois Administrative Procedure
23Act and all rules and procedures of the Joint Committee on
24Administrative Rules; any purported rule not so adopted, for
25whatever reason, is unauthorized.
26(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;

 

 

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1100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
21-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
3eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
4101-625, eff. 1-1-21.)
 
5    Section 15. The Illinois Municipal Code is amended by
6changing Section 10-4-2.3 as follows:
 
7    (65 ILCS 5/10-4-2.3)
8    Sec. 10-4-2.3. Required health benefits. If a
9municipality, including a home rule municipality, is a
10self-insurer for purposes of providing health insurance
11coverage for its employees, the coverage shall include
12coverage for the post-mastectomy care benefits required to be
13covered by a policy of accident and health insurance under
14Section 356t and the coverage required under Sections 356g,
15356g.5, 356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9,
16356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
17356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
18356z.36, and 356z.41, and 356z.43 of the Illinois Insurance
19Code. The coverage shall comply with Sections 155.22a, 355b,
20356z.19, and 370c of the Illinois Insurance Code. The
21Department of Insurance shall enforce the requirements of this
22Section. The requirement that health benefits be covered as
23provided in this is an exclusive power and function of the
24State and is a denial and limitation under Article VII,

 

 

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1Section 6, subsection (h) of the Illinois Constitution. A home
2rule municipality to which this Section applies must comply
3with every provision of this Section.
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 20. The School Code is amended by changing Section
1610-22.3f as follows:
 
17    (105 ILCS 5/10-22.3f)
18    Sec. 10-22.3f. Required health benefits. Insurance
19protection and benefits for employees shall provide the
20post-mastectomy care benefits required to be covered by a
21policy of accident and health insurance under Section 356t and
22the coverage required under Sections 356g, 356g.5, 356g.5-1,
23356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11, 356z.12,
24356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,

 

 

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1356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41, and 356z.43
2of the Illinois Insurance Code. Insurance policies shall
3comply with Section 356z.19 of the Illinois Insurance Code.
4The coverage shall comply with Sections 155.22a, 355b, and
5370c of the Illinois Insurance Code. The Department of
6Insurance shall enforce the requirements of this Section.
7    Rulemaking authority to implement Public Act 95-1045, if
8any, is conditioned on the rules being adopted in accordance
9with all provisions of the Illinois Administrative Procedure
10Act and all rules and procedures of the Joint Committee on
11Administrative Rules; any purported rule not so adopted, for
12whatever 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; 100-1024, eff. 1-1-19; 100-1057, eff.
151-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
16eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
17101-625, eff. 1-1-21.)
 
18    Section 25. The Illinois Insurance Code is amended by
19adding Section 356z.43 as follows:
 
20    (215 ILCS 5/356z.43 new)
21    Sec. 356z.43. Coverage for pancreatic cancer screening. A
22group or individual policy of accident and health insurance or
23a managed care plan that is amended, delivered, issued, or
24renewed on or after January 1, 2022 shall provide coverage for

 

 

10200SB0968sam002- 7 -LRB102 04882 BMS 25380 a

1medically necessary pancreatic cancer screening.
 
2    Section 30. The Health Maintenance Organization Act is
3amended by changing Section 5-3 as follows:
 
4    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
5    Sec. 5-3. Insurance Code provisions.
6    (a) Health Maintenance Organizations shall be subject to
7the provisions of Sections 133, 134, 136, 137, 139, 140,
8141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
9154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2,
10355.3, 355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2,
11356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10,
12356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.18,
13356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30,
14356z.30a, 356z.32, 356z.33, 356z.35, 356z.36, 356z.41,
15356z.43, 364, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c,
16368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A, 408,
17408.2, 409, 412, 444, and 444.1, paragraph (c) of subsection
18(2) of Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2,
19XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the Illinois
20Insurance Code.
21    (b) For purposes of the Illinois Insurance Code, except
22for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
23Health Maintenance Organizations in the following categories
24are deemed to be "domestic companies":

 

 

10200SB0968sam002- 8 -LRB102 04882 BMS 25380 a

1        (1) a corporation authorized under the Dental Service
2    Plan Act or the Voluntary Health Services Plans Act;
3        (2) a corporation organized under the laws of this
4    State; or
5        (3) a corporation organized under the laws of another
6    state, 30% or more of the enrollees of which are residents
7    of this State, except a corporation subject to
8    substantially the same requirements in its state of
9    organization as is a "domestic company" under Article VIII
10    1/2 of the Illinois Insurance Code.
11    (c) In considering the merger, consolidation, or other
12acquisition of control of a Health Maintenance Organization
13pursuant to Article VIII 1/2 of the Illinois Insurance Code,
14        (1) the Director shall give primary consideration to
15    the continuation of benefits to enrollees and the
16    financial conditions of the acquired Health Maintenance
17    Organization after the merger, consolidation, or other
18    acquisition of control takes effect;
19        (2)(i) the criteria specified in subsection (1)(b) of
20    Section 131.8 of the Illinois Insurance Code shall not
21    apply and (ii) the Director, in making his determination
22    with respect to the merger, consolidation, or other
23    acquisition of control, need not take into account the
24    effect on competition of the merger, consolidation, or
25    other acquisition of control;
26        (3) the Director shall have the power to require the

 

 

10200SB0968sam002- 9 -LRB102 04882 BMS 25380 a

1    following information:
2            (A) certification by an independent actuary of the
3        adequacy of the reserves of the Health Maintenance
4        Organization sought to be acquired;
5            (B) pro forma financial statements reflecting the
6        combined balance sheets of the acquiring company and
7        the Health Maintenance Organization sought to be
8        acquired as of the end of the preceding year and as of
9        a date 90 days prior to the acquisition, as well as pro
10        forma financial statements reflecting projected
11        combined operation for a period of 2 years;
12            (C) a pro forma business plan detailing an
13        acquiring party's plans with respect to the operation
14        of the Health Maintenance Organization sought to be
15        acquired for a period of not less than 3 years; and
16            (D) such other information as the Director shall
17        require.
18    (d) The provisions of Article VIII 1/2 of the Illinois
19Insurance Code and this Section 5-3 shall apply to the sale by
20any health maintenance organization of greater than 10% of its
21enrollee population (including without limitation the health
22maintenance organization's right, title, and interest in and
23to its health care certificates).
24    (e) In considering any management contract or service
25agreement subject to Section 141.1 of the Illinois Insurance
26Code, the Director (i) shall, in addition to the criteria

 

 

10200SB0968sam002- 10 -LRB102 04882 BMS 25380 a

1specified in Section 141.2 of the Illinois Insurance Code,
2take into account the effect of the management contract or
3service agreement on the continuation of benefits to enrollees
4and the financial condition of the health maintenance
5organization to be managed or serviced, and (ii) need not take
6into account the effect of the management contract or service
7agreement on competition.
8    (f) Except for small employer groups as defined in the
9Small Employer Rating, Renewability and Portability Health
10Insurance Act and except for medicare supplement policies as
11defined in Section 363 of the Illinois Insurance Code, a
12Health Maintenance Organization may by contract agree with a
13group or other enrollment unit to effect refunds or charge
14additional premiums under the following terms and conditions:
15        (i) the amount of, and other terms and conditions with
16    respect to, the refund or additional premium are set forth
17    in the group or enrollment unit contract agreed in advance
18    of the period for which a refund is to be paid or
19    additional premium is to be charged (which period shall
20    not be less than one year); and
21        (ii) the amount of the refund or additional premium
22    shall not exceed 20% of the Health Maintenance
23    Organization's profitable or unprofitable experience with
24    respect to the group or other enrollment unit for the
25    period (and, for purposes of a refund or additional
26    premium, the profitable or unprofitable experience shall

 

 

10200SB0968sam002- 11 -LRB102 04882 BMS 25380 a

1    be calculated taking into account a pro rata share of the
2    Health Maintenance Organization's administrative and
3    marketing expenses, but shall not include any refund to be
4    made or additional premium to be paid pursuant to this
5    subsection (f)). The Health Maintenance Organization and
6    the group or enrollment unit may agree that the profitable
7    or unprofitable experience may be calculated taking into
8    account the refund period and the immediately preceding 2
9    plan years.
10    The Health Maintenance Organization shall include a
11statement in the evidence of coverage issued to each enrollee
12describing the possibility of a refund or additional premium,
13and upon request of any group or enrollment unit, provide to
14the group or enrollment unit a description of the method used
15to calculate (1) the Health Maintenance Organization's
16profitable experience with respect to the group or enrollment
17unit and the resulting refund to the group or enrollment unit
18or (2) the Health Maintenance Organization's unprofitable
19experience with respect to the group or enrollment unit and
20the resulting additional premium to be paid by the group or
21enrollment unit.
22    In no event shall the Illinois Health Maintenance
23Organization Guaranty Association be liable to pay any
24contractual obligation of an insolvent organization to pay any
25refund authorized under this Section.
26    (g) Rulemaking authority to implement Public Act 95-1045,

 

 

10200SB0968sam002- 12 -LRB102 04882 BMS 25380 a

1if any, is conditioned on the rules being adopted in
2accordance with all provisions of the Illinois Administrative
3Procedure Act and all rules and procedures of the Joint
4Committee on Administrative Rules; any purported rule not so
5adopted, for whatever reason, is unauthorized.
6(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
7100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff.
81-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81,
9eff. 7-12-19; 101-281, eff. 1-1-20; 101-371, eff. 1-1-20;
10101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
111-1-20; 101-625, eff. 1-1-21.)
 
12    Section 35. The Limited Health Service Organization Act is
13amended by changing Section 4003 as follows:
 
14    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
15    Sec. 4003. Illinois Insurance Code provisions. Limited
16health service organizations shall be subject to the
17provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
18141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
19154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 355.2, 355.3,
20355b, 356v, 356z.10, 356z.21, 356z.22, 356z.25, 356z.26,
21356z.29, 356z.30a, 356z.32, 356z.33, 356z.41, 356z.43, 368a,
22401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412, 444, and
23444.1 and Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2,
24XXV, and XXVI of the Illinois Insurance Code. For purposes of

 

 

10200SB0968sam002- 13 -LRB102 04882 BMS 25380 a

1the Illinois Insurance Code, except for Sections 444 and 444.1
2and Articles XIII and XIII 1/2, limited health service
3organizations in the following categories are deemed to be
4domestic companies:
5        (1) a corporation under the laws of this State; or
6        (2) a corporation organized under the laws of another
7    state, 30% or more of the enrollees of which are residents
8    of this State, except a corporation subject to
9    substantially the same requirements in its state of
10    organization as is a domestic company under Article VIII
11    1/2 of the Illinois Insurance Code.
12(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
13100-201, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1057, eff.
141-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
15eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff. 1-1-21.)
 
16    Section 40. The Voluntary Health Services Plans Act is
17amended by changing Section 10 as follows:
 
18    (215 ILCS 165/10)  (from Ch. 32, par. 604)
19    Sec. 10. Application of Insurance Code provisions. Health
20services plan corporations and all persons interested therein
21or dealing therewith shall be subject to the provisions of
22Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
23143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
24356g, 356g.5, 356g.5-1, 356r, 356t, 356u, 356v, 356w, 356x,

 

 

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1356y, 356z.1, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8,
2356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
3356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29,
4356z.30, 356z.30a, 356z.32, 356z.33, 356z.41, 356z.43, 364.01,
5367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412,
6and paragraphs (7) and (15) of Section 367 of the Illinois
7Insurance Code.
8    Rulemaking authority to implement Public Act 95-1045, if
9any, is conditioned on the rules being adopted in accordance
10with all provisions of the Illinois Administrative Procedure
11Act and all rules and procedures of the Joint Committee on
12Administrative Rules; any purported rule not so adopted, for
13whatever reason, is unauthorized.
14(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
15100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff.
161-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81,
17eff. 7-12-19; 101-281, eff. 1-1-20; 101-393, eff. 1-1-20;
18101-625, eff. 1-1-21.)
 
19    Section 45. The Illinois Public Aid Code is amended by
20changing Section 5-16.8 as follows:
 
21    (305 ILCS 5/5-16.8)
22    Sec. 5-16.8. Required health benefits. The medical
23assistance program shall (i) provide the post-mastectomy care
24benefits required to be covered by a policy of accident and

 

 

10200SB0968sam002- 15 -LRB102 04882 BMS 25380 a

1health insurance under Section 356t and the coverage required
2under Sections 356g.5, 356u, 356w, 356x, 356z.6, 356z.26,
3356z.29, 356z.32, 356z.33, 356z.34, and 356z.35, and 356z.43
4of the Illinois Insurance Code and (ii) be subject to the
5provisions of Sections 356z.19, 364.01, 370c, and 370c.1 of
6the Illinois Insurance Code.
7    The Department, by rule, shall adopt a model similar to
8the requirements of Section 356z.39 of the Illinois Insurance
9Code.
10    On and after July 1, 2012, the Department shall reduce any
11rate of reimbursement for services or other payments or alter
12any methodologies authorized by this Code to reduce any rate
13of reimbursement for services or other payments in accordance
14with Section 5-5e.
15    To ensure full access to the benefits set forth in this
16Section, on and after January 1, 2016, the Department shall
17ensure that provider and hospital reimbursement for
18post-mastectomy care benefits required under this Section are
19no lower than the Medicare reimbursement rate.
20(Source: P.A. 100-138, eff. 8-18-17; 100-863, eff. 8-14-18;
21100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff.
227-12-19; 101-218, eff. 1-1-20; 101-281, eff. 1-1-20; 101-371,
23eff. 1-1-20; 101-574, eff. 1-1-20; 101-649, eff. 7-7-20.)".