Illinois General Assembly - Full Text of SB2969
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Full Text of SB2969  102nd General Assembly

SB2969sam001 102ND GENERAL ASSEMBLY

Sen. Julie A. Morrison

Filed: 2/17/2022

 

 


 

 


 
10200SB2969sam001LRB102 20623 BMS 36498 a

1
AMENDMENT TO SENATE BILL 2969

2    AMENDMENT NO. ______. Amend Senate Bill 2969 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, 356q, 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,

 

 

10200SB2969sam001- 2 -LRB102 20623 BMS 36498 a

1356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
2and 356z.53 and 356z.43 of the Illinois Insurance Code. The
3program of health benefits must comply with Sections 155.22a,
4155.37, 355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of
5the Illinois Insurance Code. The Department of Insurance shall
6enforce the requirements of this Section with respect to
7Sections 370c and 370c.1 of the Illinois Insurance Code; all
8other requirements of this Section shall be enforced by the
9Department of Central Management Services.
10    Rulemaking authority to implement Public Act 95-1045, if
11any, is conditioned on the rules being adopted in accordance
12with all provisions of the Illinois Administrative Procedure
13Act and all rules and procedures of the Joint Committee on
14Administrative Rules; any purported rule not so adopted, for
15whatever reason, is unauthorized.
16(Source: P.A. 101-13, eff. 6-12-19; 101-281, 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; 102-30, eff. 1-1-22; 102-103,
19eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
20102-642, eff. 1-1-22; 102-665, eff. 10-8-21; revised
2110-26-21.)
 
22    Section 10. The Counties Code is amended by changing
23Section 5-1069.3 as follows:
 
24    (55 ILCS 5/5-1069.3)

 

 

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1    Sec. 5-1069.3. Required health benefits. If a county,
2including a home rule county, is a self-insurer for purposes
3of providing health insurance coverage for its employees, the
4coverage shall include coverage for the post-mastectomy care
5benefits required to be covered by a policy of accident and
6health insurance under Section 356t and the coverage required
7under Sections 356g, 356g.5, 356g.5-1, 356q, 356u, 356w, 356x,
8356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
9356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
10356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
11356z.45, 356z.46, 356z.47, 356z.48, 356z.51, and 356z.53 and
12356z.43 of the Illinois Insurance Code. The coverage shall
13comply with Sections 155.22a, 355b, 356z.19, and 370c of the
14Illinois Insurance Code. The Department of Insurance shall
15enforce the requirements of this Section. The requirement that
16health benefits be covered as provided in this Section is an
17exclusive power and function of the State and is a denial and
18limitation under Article VII, Section 6, subsection (h) of the
19Illinois Constitution. A home rule county to which this
20Section applies must comply with every provision of this
21Section.
22    Rulemaking authority to implement Public Act 95-1045, if
23any, is conditioned on the rules being adopted in accordance
24with all provisions of the Illinois Administrative Procedure
25Act and all rules and procedures of the Joint Committee on
26Administrative Rules; any purported rule not so adopted, for

 

 

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1whatever reason, is unauthorized.
2(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
3101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
41-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
5eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22;
6102-642, eff. 1-1-22; 102-665, eff. 10-8-21; revised
710-26-21.)
 
8    Section 15. The Illinois Municipal Code is amended by
9changing Section 10-4-2.3 as follows:
 
10    (65 ILCS 5/10-4-2.3)
11    Sec. 10-4-2.3. Required health benefits. If a
12municipality, including a home rule municipality, is a
13self-insurer for purposes of providing health insurance
14coverage for its employees, the coverage shall include
15coverage for the post-mastectomy care benefits required to be
16covered by a policy of accident and health insurance under
17Section 356t and the coverage required under Sections 356g,
18356g.5, 356g.5-1, 356q, 356u, 356w, 356x, 356z.6, 356z.8,
19356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
20356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32,
21356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
22356z.48, 356z.51, and 356z.53 and 356z.43 of the Illinois
23Insurance Code. The coverage shall comply with Sections
24155.22a, 355b, 356z.19, and 370c of the Illinois Insurance

 

 

10200SB2969sam001- 5 -LRB102 20623 BMS 36498 a

1Code. The Department of Insurance shall enforce the
2requirements of this Section. The requirement that health
3benefits be covered as provided in this is an exclusive power
4and function of the State and is a denial and limitation under
5Article VII, Section 6, subsection (h) of the Illinois
6Constitution. A home rule municipality to which this Section
7applies must comply with every provision of this Section.
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. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
15101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
161-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
17eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22;
18102-642, eff. 1-1-22; 102-665, eff. 10-8-21; revised
1910-26-21.)
 
20    Section 20. The School Code is amended by changing Section
2110-22.3f as follows:
 
22    (105 ILCS 5/10-22.3f)
23    Sec. 10-22.3f. Required health benefits. Insurance
24protection and benefits for employees shall provide the

 

 

10200SB2969sam001- 6 -LRB102 20623 BMS 36498 a

1post-mastectomy care benefits required to be covered by a
2policy of accident and health insurance under Section 356t and
3the coverage required under Sections 356g, 356g.5, 356g.5-1,
4356q, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11,
5356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26,
6356z.29, 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40,
7356z.41, 356z.45, 356z.46, 356z.47, 356z.51, and 356z.53 and
8356z.43 of the Illinois Insurance Code. Insurance policies
9shall comply with Section 356z.19 of the Illinois Insurance
10Code. The coverage shall comply with Sections 155.22a, 355b,
11and 370c of the Illinois Insurance Code. The Department of
12Insurance shall enforce the requirements of this Section.
13    Rulemaking authority to implement Public Act 95-1045, if
14any, is conditioned on the rules being adopted in accordance
15with all provisions of the Illinois Administrative Procedure
16Act and all rules and procedures of the Joint Committee on
17Administrative Rules; any purported rule not so adopted, for
18whatever reason, is unauthorized.
19(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
20101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
211-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
22eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. 1-1-22;
23102-665, eff. 10-8-21; revised 10-27-21.)
 
24    Section 25. The Illinois Insurance Code is amended by
25adding Section 356z.53 as follows:
 

 

 

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1    (215 ILCS 5/356z.53 new)
2    Sec. 356z.53. Coverage for continuous glucose monitors. A
3group or individual policy of accident and health insurance or
4a managed care plan that is amended, delivered, issued, or
5renewed on or after January 1, 2024 shall provide coverage for
6medically necessary continuous glucose monitors for
7individuals who are diagnosed with type 1 or type 2 diabetes
8and require insulin for the management of their diabetes.
 
9    Section 30. 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, 356q, 356v, 356w, 356x, 356y,
18356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9,
19356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17,
20356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29,
21356z.30, 356z.30a, 356z.32, 356z.33, 356z.35, 356z.36,
22356z.40, 356z.41, 356z.43, 356z.46, 356z.47, 356z.48, 356z.50,
23356z.51, 356z.53, 364, 364.01, 367.2, 367.2-5, 367i, 368a,

 

 

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1368b, 368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403,
2403A, 408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of
3subsection (2) of Section 367, and Articles IIA, VIII 1/2,
4XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the
5Illinois Insurance Code.
6    (b) For purposes of the Illinois Insurance Code, except
7for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
8Health Maintenance Organizations in the following categories
9are deemed to be "domestic companies":
10        (1) a corporation authorized under the Dental Service
11    Plan Act or the Voluntary Health Services Plans Act;
12        (2) a corporation organized under the laws of this
13    State; or
14        (3) a corporation organized under the laws of another
15    state, 30% or more of the enrollees of which are residents
16    of this State, except a corporation subject to
17    substantially the same requirements in its state of
18    organization as is a "domestic company" under Article VIII
19    1/2 of the Illinois Insurance Code.
20    (c) In considering the merger, consolidation, or other
21acquisition of control of a Health Maintenance Organization
22pursuant to Article VIII 1/2 of the Illinois Insurance Code,
23        (1) the Director shall give primary consideration to
24    the continuation of benefits to enrollees and the
25    financial conditions of the acquired Health Maintenance
26    Organization after the merger, consolidation, or other

 

 

10200SB2969sam001- 9 -LRB102 20623 BMS 36498 a

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

 

 

10200SB2969sam001- 10 -LRB102 20623 BMS 36498 a

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

 

 

10200SB2969sam001- 11 -LRB102 20623 BMS 36498 a

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

 

 

10200SB2969sam001- 12 -LRB102 20623 BMS 36498 a

1or (2) the Health Maintenance Organization's unprofitable
2experience with respect to the group or enrollment unit and
3the resulting additional premium to be paid by the group or
4enrollment unit.
5    In no event shall the Illinois Health Maintenance
6Organization Guaranty Association be liable to pay any
7contractual obligation of an insolvent organization to pay any
8refund authorized under this Section.
9    (g) Rulemaking authority to implement Public Act 95-1045,
10if any, is conditioned on the rules being adopted in
11accordance with all provisions of the Illinois Administrative
12Procedure Act and all rules and procedures of the Joint
13Committee on Administrative Rules; any purported rule not so
14adopted, for whatever reason, is unauthorized.
15(Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19;
16101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-393, eff.
171-1-20; 101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625,
18eff. 1-1-21; 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
19102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
201-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
21eff. 10-8-21; revised 10-27-21.)
 
22    Section 35. The Limited Health Service Organization Act is
23amended by changing Section 4003 as follows:
 
24    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)

 

 

10200SB2969sam001- 13 -LRB102 20623 BMS 36498 a

1    Sec. 4003. Illinois Insurance Code provisions. Limited
2health service organizations shall be subject to the
3provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
4141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
5154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 355.2, 355.3,
6355b, 356q, 356v, 356z.10, 356z.21, 356z.22, 356z.25, 356z.26,
7356z.29, 356z.30a, 356z.32, 356z.33, 356z.41, 356z.46,
8356z.47, 356z.51, 356z.53, 356z.43, 368a, 401, 401.1, 402,
9403, 403A, 408, 408.2, 409, 412, 444, and 444.1 and Articles
10IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and XXVI of
11the Illinois Insurance Code. For purposes of the Illinois
12Insurance Code, except for Sections 444 and 444.1 and Articles
13XIII and XIII 1/2, limited health service organizations in the
14following categories are deemed to be domestic companies:
15        (1) a corporation under the laws of this State; or
16        (2) a corporation organized under the laws of another
17    state, 30% or more of the enrollees of which are residents
18    of this State, except a corporation subject to
19    substantially the same requirements in its state of
20    organization as is a domestic company under Article VIII
21    1/2 of the Illinois Insurance Code.
22(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
23101-393, eff. 1-1-20; 101-625, eff. 1-1-21; 102-30, eff.
241-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642,
25eff. 1-1-22; revised 10-27-21.)
 

 

 

10200SB2969sam001- 14 -LRB102 20623 BMS 36498 a

1    Section 40. The Voluntary Health Services Plans Act is
2amended by changing Section 10 as follows:
 
3    (215 ILCS 165/10)  (from Ch. 32, par. 604)
4    Sec. 10. Application of Insurance Code provisions. Health
5services plan corporations and all persons interested therein
6or dealing therewith shall be subject to the provisions of
7Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
8143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
9356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356v, 356w,
10356x, 356y, 356z.1, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6,
11356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14,
12356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26,
13356z.29, 356z.30, 356z.30a, 356z.32, 356z.33, 356z.40,
14356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.43, 364.01,
15367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412,
16and paragraphs (7) and (15) of Section 367 of the Illinois
17Insurance Code.
18    Rulemaking authority to implement Public Act 95-1045, if
19any, is conditioned on the rules being adopted in accordance
20with all provisions of the Illinois Administrative Procedure
21Act and all rules and procedures of the Joint Committee on
22Administrative Rules; any purported rule not so adopted, for
23whatever reason, is unauthorized.
24(Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19;
25101-281, eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff.

 

 

10200SB2969sam001- 15 -LRB102 20623 BMS 36498 a

11-1-21; 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; 102-306,
2eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21;
3revised 10-27-21.)
 
4    Section 45. The Illinois Public Aid Code is amended by
5changing Section 5-16.8 as follows:
 
6    (305 ILCS 5/5-16.8)
7    Sec. 5-16.8. Required health benefits. The medical
8assistance program shall (i) provide the post-mastectomy care
9benefits required to be covered by a policy of accident and
10health insurance under Section 356t and the coverage required
11under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6,
12356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,
13356z.47, 356z.51, and 356z.53, and 356z.43 of the Illinois
14Insurance Code, (ii) be subject to the provisions of Sections
15356z.19, 356z.43, 356z.44, 356z.49, 364.01, 370c, and 370c.1
16of the Illinois Insurance Code, and (iii) be subject to the
17provisions of subsection (d-5) of Section 10 of the Network
18Adequacy and Transparency Act.
19    The Department, by rule, shall adopt a model similar to
20the requirements of Section 356z.39 of the Illinois Insurance
21Code.
22    On and after July 1, 2012, the Department shall reduce any
23rate of reimbursement for services or other payments or alter
24any methodologies authorized by this Code to reduce any rate

 

 

10200SB2969sam001- 16 -LRB102 20623 BMS 36498 a

1of reimbursement for services or other payments in accordance
2with Section 5-5e.
3    To ensure full access to the benefits set forth in this
4Section, on and after January 1, 2016, the Department shall
5ensure that provider and hospital reimbursement for
6post-mastectomy care benefits required under this Section are
7no lower than the Medicare reimbursement rate.
8(Source: P.A. 101-81, eff. 7-12-19; 101-218, eff. 1-1-20;
9101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-574, eff.
101-1-20; 101-649, eff. 7-7-20; 102-30, eff. 1-1-22; 102-144,
11eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
12102-530, eff. 1-1-22; 102-642, eff. 1-1-22; revised
1310-27-21.)".