Full Text of SB3972 103rd General Assembly
SB3972 103RD GENERAL ASSEMBLY | | | 103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024 SB3972 Introduced 10/11/2024, by Sen. Willie Preston SYNOPSIS AS INTRODUCED: | | 5 ILCS 375/6.11 | | 55 ILCS 5/5-1069.3 | | 65 ILCS 5/10-4-2.3 | | 105 ILCS 5/10-22.3f | | 215 ILCS 5/356z.80 new | | 215 ILCS 125/5-3 | from Ch. 111 1/2, par. 1411.2 | 215 ILCS 130/4003 | from Ch. 73, par. 1504-3 | 215 ILCS 165/10 | from Ch. 32, par. 604 | 305 ILCS 5/5-16.8 | | 30 ILCS 805/8.48 new | |
| Amends the Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2026 that provides coverage for: habilitative services shall provide coverage for habilitative speech therapy as a treatment for stuttering, regardless of whether the stuttering is classified as developmental; rehabilitative services shall provide coverage for rehabilitative speech therapy as a treatment for stuttering; or habilitative services and rehabilitative services shall provide coverage for habilitative speech therapy as a treatment for stuttering, regardless of whether the stuttering is classified as developmental, and shall provide coverage for rehabilitative speech therapy as a treatment for stuttering. Sets forth requirements and limitations for the coverage. Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, the Limited Health Service Organization Act, the Voluntary Health Services Plans Act, and the Illinois Public Aid Code to require coverage under those provisions. Amends the State Mandates Act to require implementation without reimbursement. Effective January 1, 2026. |
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| | A BILL FOR |
| | | | SB3972 | | LRB103 42708 RPS 75944 b |
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| 1 | | AN ACT concerning regulation. | 2 | | Be it enacted by the People of the State of Illinois, | 3 | | represented in the General Assembly: | 4 | | Section 5. The State Employees Group Insurance Act of 1971 | 5 | | is amended by changing Section 6.11 as follows: | 6 | | (5 ILCS 375/6.11) | 7 | | Sec. 6.11. Required health benefits; Illinois Insurance | 8 | | Code requirements. The program of health benefits shall | 9 | | provide the post-mastectomy care benefits required to be | 10 | | covered by a policy of accident and health insurance under | 11 | | Section 356t of the Illinois Insurance Code. The program of | 12 | | health benefits shall provide the coverage required under | 13 | | Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x, | 14 | | 356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, | 15 | | 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22, | 16 | | 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, | 17 | | 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51, | 18 | | 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59, 356z.60, | 19 | | and 356z.61, and 356z.62 , 356z.64, 356z.67, 356z.68, 356z.70, | 20 | | and 356z.80 of the Illinois Insurance Code. The program of | 21 | | health benefits must comply with Sections 155.22a, 155.37, | 22 | | 355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of the | 23 | | Illinois Insurance Code. The program of health benefits shall |
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| 1 | | provide the coverage required under Section 356m of the | 2 | | Illinois Insurance Code and, for the employees of the State | 3 | | Employee Group Insurance Program only, the coverage as also | 4 | | provided in Section 6.11B of this Act. The Department of | 5 | | Insurance shall enforce the requirements of this Section with | 6 | | respect to Sections 370c and 370c.1 of the Illinois Insurance | 7 | | Code; all other requirements of this Section shall be enforced | 8 | | by the Department of Central Management Services. | 9 | | Rulemaking authority to implement Public Act 95-1045, if | 10 | | any, is conditioned on the rules being adopted in accordance | 11 | | with all provisions of the Illinois Administrative Procedure | 12 | | Act and all rules and procedures of the Joint Committee on | 13 | | Administrative Rules; any purported rule not so adopted, for | 14 | | whatever reason, is unauthorized. | 15 | | (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; | 16 | | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. | 17 | | 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-768, | 18 | | eff. 1-1-24; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; | 19 | | 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. | 20 | | 1-1-23; 102-1117, eff. 1-13-23; 103-8, eff. 1-1-24; 103-84, | 21 | | eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, eff. 1-1-24; | 22 | | 103-445, eff. 1-1-24; 103-535, eff. 8-11-23; 103-551, eff. | 23 | | 8-11-23; revised 8-29-23.) | 24 | | Section 10. The Counties Code is amended by changing | 25 | | Section 5-1069.3 as follows: |
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| 1 | | (55 ILCS 5/5-1069.3) | 2 | | Sec. 5-1069.3. Required health benefits. If a county, | 3 | | including a home rule county, is a self-insurer for purposes | 4 | | of providing health insurance coverage for its employees, the | 5 | | coverage shall include coverage for the post-mastectomy care | 6 | | benefits required to be covered by a policy of accident and | 7 | | health insurance under Section 356t and the coverage required | 8 | | under Sections 356g, 356g.5, 356g.5-1, 356q, 356u, 356w, 356x, | 9 | | 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, | 10 | | 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, | 11 | | 356z.29, 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, | 12 | | 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, | 13 | | 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and 356z.61, and | 14 | | 356z.62 , 356z.64, 356z.67, 356z.68, 356z.70, and 356z.80 of | 15 | | the Illinois Insurance Code. The coverage shall comply with | 16 | | Sections 155.22a, 355b, 356z.19, and 370c of the Illinois | 17 | | Insurance Code. The Department of Insurance shall enforce the | 18 | | requirements of this Section. The requirement that health | 19 | | benefits be covered as provided in this Section is an | 20 | | exclusive power and function of the State and is a denial and | 21 | | limitation under Article VII, Section 6, subsection (h) of the | 22 | | Illinois Constitution. A home rule county to which this | 23 | | Section applies must comply with every provision of this | 24 | | Section. | 25 | | Rulemaking authority to implement Public Act 95-1045, if |
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| 1 | | any, is conditioned on the rules being adopted in accordance | 2 | | with all provisions of the Illinois Administrative Procedure | 3 | | Act and all rules and procedures of the Joint Committee on | 4 | | Administrative Rules; any purported rule not so adopted, for | 5 | | whatever reason, is unauthorized. | 6 | | (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; | 7 | | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. | 8 | | 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, | 9 | | eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; | 10 | | 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. | 11 | | 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, | 12 | | eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24; | 13 | | 103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised | 14 | | 8-29-23.) | 15 | | Section 15. The Illinois Municipal Code is amended by | 16 | | changing 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 | 19 | | municipality, including a home rule municipality, is a | 20 | | self-insurer for purposes of providing health insurance | 21 | | coverage for its employees, the coverage shall include | 22 | | coverage for the post-mastectomy care benefits required to be | 23 | | covered by a policy of accident and health insurance under | 24 | | Section 356t and the coverage required under Sections 356g, |
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| 1 | | 356g.5, 356g.5-1, 356q, 356u, 356w, 356x, 356z.4, 356z.4a, | 2 | | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, | 3 | | 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29, | 4 | | 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41, | 5 | | 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54, | 6 | | 356z.56, 356z.57, 356z.59, 356z.60, and 356z.61, and 356z.62 , | 7 | | 356z.64, 356z.67, 356z.68, 356z.70, and 356z.80 of the | 8 | | Illinois Insurance Code. The coverage shall comply with | 9 | | Sections 155.22a, 355b, 356z.19, and 370c of the Illinois | 10 | | Insurance Code. The Department of Insurance shall enforce the | 11 | | requirements of this Section. The requirement that health | 12 | | benefits be covered as provided in this is an exclusive power | 13 | | and function of the State and is a denial and limitation under | 14 | | Article VII, Section 6, subsection (h) of the Illinois | 15 | | Constitution. A home rule municipality to which this Section | 16 | | applies must comply with every provision of this Section. | 17 | | Rulemaking authority to implement Public Act 95-1045, if | 18 | | any, is conditioned on the rules being adopted in accordance | 19 | | with all provisions of the Illinois Administrative Procedure | 20 | | Act and all rules and procedures of the Joint Committee on | 21 | | Administrative Rules; any purported rule not so adopted, for | 22 | | whatever reason, is unauthorized. | 23 | | (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; | 24 | | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. | 25 | | 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, | 26 | | eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; |
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| 1 | | 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. | 2 | | 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, | 3 | | eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24; | 4 | | 103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised | 5 | | 8-29-23.) | 6 | | Section 20. The School Code is amended by changing Section | 7 | | 10-22.3f as follows: | 8 | | (105 ILCS 5/10-22.3f) | 9 | | Sec. 10-22.3f. Required health benefits. Insurance | 10 | | protection and benefits for employees shall provide the | 11 | | post-mastectomy care benefits required to be covered by a | 12 | | policy of accident and health insurance under Section 356t and | 13 | | the coverage required under Sections 356g, 356g.5, 356g.5-1, | 14 | | 356q, 356u, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8, | 15 | | 356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, | 16 | | 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, | 17 | | 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51, | 18 | | 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and | 19 | | 356z.61, and 356z.62 , 356z.64, 356z.67, 356z.68, 356z.70, and | 20 | | 356z.80 of the Illinois Insurance Code. Insurance policies | 21 | | shall comply with Section 356z.19 of the Illinois Insurance | 22 | | Code. The coverage shall comply with Sections 155.22a, 355b, | 23 | | and 370c of the Illinois Insurance Code. The Department of | 24 | | Insurance shall enforce the requirements of this Section. |
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| 1 | | Rulemaking authority to implement Public Act 95-1045, if | 2 | | any, is conditioned on the rules being adopted in accordance | 3 | | with all provisions of the Illinois Administrative Procedure | 4 | | Act and all rules and procedures of the Joint Committee on | 5 | | Administrative Rules; any purported rule not so adopted, for | 6 | | whatever reason, is unauthorized. | 7 | | (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; | 8 | | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. | 9 | | 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804, | 10 | | eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; | 11 | | 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff. | 12 | | 1-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, | 13 | | eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. 8-11-23; | 14 | | 103-551, eff. 8-11-23; revised 8-29-23.) | 15 | | Section 25. The Illinois Insurance Code is amended by | 16 | | adding Section 356z.80 as follows: | 17 | | (215 ILCS 5/356z.80 new) | 18 | | Sec. 356z.80. Coverage of treatment for stuttering. | 19 | | (a) As used in this Section: | 20 | | "Habilitative services" means health care services that | 21 | | help a person keep, learn, or improve skills and functioning | 22 | | for daily living. | 23 | | "Habilitative speech therapy" means speech therapy that | 24 | | helps a person keep, learn, or improve skills and functioning |
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| 1 | | for daily living. | 2 | | "Rehabilitative services" means health care services that | 3 | | help a person restore or improve skills and functioning for | 4 | | daily living that have been lost or impaired. | 5 | | "Rehabilitative speech therapy" means speech therapy that | 6 | | helps a person restore or improve skills and functioning for | 7 | | daily living that have been lost or impaired. | 8 | | (b) Except as provided in subsection (d) of this Section, | 9 | | a group or individual policy of accident and health insurance | 10 | | or a managed care plan that is amended, delivered, issued, or | 11 | | renewed on or after January 1, 2026 that provides coverage | 12 | | for: | 13 | | (1) habilitative services shall provide coverage for | 14 | | habilitative speech therapy as a treatment for stuttering, | 15 | | regardless of whether the stuttering is classified as | 16 | | developmental; | 17 | | (2) rehabilitative services shall provide coverage for | 18 | | rehabilitative speech therapy as a treatment for | 19 | | stuttering; or | 20 | | (3) both habilitative services and rehabilitative | 21 | | services shall provide the coverage required under | 22 | | paragraphs (1) and (2) of this subsection. | 23 | | (c) The coverage required under subsection (b) of this | 24 | | Section shall: | 25 | | (1) not be: | 26 | | (A) subject to any maximum annual benefit limit, |
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| 1 | | including any limits on the number of visits an | 2 | | insured may make to a speech-language pathologist; | 3 | | (B) limited based on the type of disease, injury, | 4 | | disorder, or other medical condition that resulted in | 5 | | the stuttering; or | 6 | | (C) subject to utilization review or utilization | 7 | | management requirements, including prior | 8 | | authorization; | 9 | | (2) be considered medically necessary if the patient's | 10 | | treating provider determines, in his or her clinical | 11 | | judgment, that such speech therapy services for stuttering | 12 | | are medically appropriate to help the patient keep, learn, | 13 | | improve, or restore skills or functioning for daily | 14 | | living; and | 15 | | (3) include coverage for speech therapy provided in | 16 | | person and via telehealth, which shall: | 17 | | (A) not be less than the coverage required for | 18 | | health benefit plans under Section 356z.22; and | 19 | | (B) include the use of any communication | 20 | | technology, application, or platform to deliver | 21 | | telehealth services, except coverage may be restricted | 22 | | to technology, applications, or platforms that are | 23 | | compliant with any applicable privacy provisions of | 24 | | the federal Health Insurance Portability and | 25 | | Accountability Act of 1996, 42 U.S.C. 1320d et seq., | 26 | | as amended. |
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| 1 | | (d) If, at any time, the Secretary of the United States | 2 | | Department of Health and Human Services, or its successor | 3 | | agency, promulgates rules or regulations to be published in | 4 | | the Federal Register or publishes a comment in the Federal | 5 | | Register or issues an opinion, guidance, or other action that | 6 | | would require the State, pursuant to any provision of the | 7 | | Patient Protection and Affordable Care Act (Public Law | 8 | | 111-148), including, but not limited to, 42 U.S.C. | 9 | | 18031(d)(3)(B) or any successor provision, to defray the cost | 10 | | of any coverage outlined in this Section, then this Section is | 11 | | inoperative with respect to all coverage outlined in this | 12 | | Section other than that authorized under Section 1902 of the | 13 | | Social Security Act, 42 U.S.C. 1396a, and the State shall not | 14 | | assume any obligation for the cost of the coverage set forth in | 15 | | this Section. | 16 | | Section 30. The Health Maintenance Organization Act is | 17 | | amended 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 | 21 | | the provisions of Sections 133, 134, 136, 137, 139, 140, | 22 | | 141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, | 23 | | 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 155.49, | 24 | | 355.2, 355.3, 355b, 355c, 356f, 356g.5-1, 356m, 356q, 356v, |
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| 1 | | 356w, 356x, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, | 2 | | 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, | 3 | | 356z.15, 356z.17, 356z.18, 356z.19, 356z.20, 356z.21, 356z.22, | 4 | | 356z.23, 356z.24, 356z.25, 356z.26, 356z.28, 356z.29, 356z.30, | 5 | | 356z.30a, 356z.31, 356z.32, 356z.33, 356z.34, 356z.35, | 6 | | 356z.36, 356z.37, 356z.38, 356z.39, 356z.40, 356z.41, 356z.44, | 7 | | 356z.45, 356z.46, 356z.47, 356z.48, 356z.49, 356z.50, 356z.51, | 8 | | 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.58, 356z.59, | 9 | | 356z.60, 356z.61, 356z.62, 356z.64, 356z.65, 356z.67, 356z.68, | 10 | | 356z.80, 364, 364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b, | 11 | | 368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A, | 12 | | 408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of | 13 | | subsection (2) of Section 367, and Articles IIA, VIII 1/2, | 14 | | XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the | 15 | | Illinois Insurance Code. | 16 | | (b) For purposes of the Illinois Insurance Code, except | 17 | | for Sections 444 and 444.1 and Articles XIII and XIII 1/2, | 18 | | Health Maintenance Organizations in the following categories | 19 | | are deemed to be "domestic companies": | 20 | | (1) a corporation authorized under the Dental Service | 21 | | Plan Act or the Voluntary Health Services Plans Act; | 22 | | (2) a corporation organized under the laws of this | 23 | | State; or | 24 | | (3) a corporation organized under the laws of another | 25 | | state, 30% or more of the enrollees of which are residents | 26 | | of this State, except a corporation subject to |
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| 1 | | substantially the same requirements in its state of | 2 | | organization as is a "domestic company" under Article VIII | 3 | | 1/2 of the Illinois Insurance Code. | 4 | | (c) In considering the merger, consolidation, or other | 5 | | acquisition of control of a Health Maintenance Organization | 6 | | pursuant to Article VIII 1/2 of the Illinois Insurance Code, | 7 | | (1) the Director shall give primary consideration to | 8 | | the continuation of benefits to enrollees and the | 9 | | financial conditions of the acquired Health Maintenance | 10 | | Organization after the merger, consolidation, or other | 11 | | acquisition of control takes effect; | 12 | | (2)(i) the criteria specified in subsection (1)(b) of | 13 | | Section 131.8 of the Illinois Insurance Code shall not | 14 | | apply and (ii) the Director, in making his determination | 15 | | with respect to the merger, consolidation, or other | 16 | | acquisition of control, need not take into account the | 17 | | effect on competition of the merger, consolidation, or | 18 | | other acquisition of control; | 19 | | (3) the Director shall have the power to require the | 20 | | following information: | 21 | | (A) certification by an independent actuary of the | 22 | | adequacy of the reserves of the Health Maintenance | 23 | | Organization sought to be acquired; | 24 | | (B) pro forma financial statements reflecting the | 25 | | combined balance sheets of the acquiring company and | 26 | | the Health Maintenance Organization sought to be |
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| 1 | | acquired as of the end of the preceding year and as of | 2 | | a date 90 days prior to the acquisition, as well as pro | 3 | | forma financial statements reflecting projected | 4 | | combined operation for a period of 2 years; | 5 | | (C) a pro forma business plan detailing an | 6 | | acquiring party's plans with respect to the operation | 7 | | of the Health Maintenance Organization sought to be | 8 | | acquired for a period of not less than 3 years; and | 9 | | (D) such other information as the Director shall | 10 | | require. | 11 | | (d) The provisions of Article VIII 1/2 of the Illinois | 12 | | Insurance Code and this Section 5-3 shall apply to the sale by | 13 | | any health maintenance organization of greater than 10% of its | 14 | | enrollee population (including , without limitation , the health | 15 | | maintenance organization's right, title, and interest in and | 16 | | to its health care certificates). | 17 | | (e) In considering any management contract or service | 18 | | agreement subject to Section 141.1 of the Illinois Insurance | 19 | | Code, the Director (i) shall, in addition to the criteria | 20 | | specified in Section 141.2 of the Illinois Insurance Code, | 21 | | take into account the effect of the management contract or | 22 | | service agreement on the continuation of benefits to enrollees | 23 | | and the financial condition of the health maintenance | 24 | | organization to be managed or serviced, and (ii) need not take | 25 | | into account the effect of the management contract or service | 26 | | agreement on competition. |
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| 1 | | (f) Except for small employer groups as defined in the | 2 | | Small Employer Rating, Renewability and Portability Health | 3 | | Insurance Act and except for medicare supplement policies as | 4 | | defined in Section 363 of the Illinois Insurance Code, a | 5 | | Health Maintenance Organization may by contract agree with a | 6 | | group or other enrollment unit to effect refunds or charge | 7 | | additional premiums under the following terms and conditions: | 8 | | (i) the amount of, and other terms and conditions with | 9 | | respect to, the refund or additional premium are set forth | 10 | | in the group or enrollment unit contract agreed in advance | 11 | | of the period for which a refund is to be paid or | 12 | | additional premium is to be charged (which period shall | 13 | | not be less than one year); and | 14 | | (ii) the amount of the refund or additional premium | 15 | | shall not exceed 20% of the Health Maintenance | 16 | | Organization's profitable or unprofitable experience with | 17 | | respect to the group or other enrollment unit for the | 18 | | period (and, for purposes of a refund or additional | 19 | | premium, the profitable or unprofitable experience shall | 20 | | be calculated taking into account a pro rata share of the | 21 | | Health Maintenance Organization's administrative and | 22 | | marketing expenses, but shall not include any refund to be | 23 | | made or additional premium to be paid pursuant to this | 24 | | subsection (f)). The Health Maintenance Organization and | 25 | | the group or enrollment unit may agree that the profitable | 26 | | or unprofitable experience may be calculated taking into |
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| 1 | | account the refund period and the immediately preceding 2 | 2 | | plan years. | 3 | | The Health Maintenance Organization shall include a | 4 | | statement in the evidence of coverage issued to each enrollee | 5 | | describing the possibility of a refund or additional premium, | 6 | | and upon request of any group or enrollment unit, provide to | 7 | | the group or enrollment unit a description of the method used | 8 | | to calculate (1) the Health Maintenance Organization's | 9 | | profitable experience with respect to the group or enrollment | 10 | | unit and the resulting refund to the group or enrollment unit | 11 | | or (2) the Health Maintenance Organization's unprofitable | 12 | | experience with respect to the group or enrollment unit and | 13 | | the resulting additional premium to be paid by the group or | 14 | | enrollment unit. | 15 | | In no event shall the Illinois Health Maintenance | 16 | | Organization Guaranty Association be liable to pay any | 17 | | contractual obligation of an insolvent organization to pay any | 18 | | refund authorized under this Section. | 19 | | (g) Rulemaking authority to implement Public Act 95-1045, | 20 | | if any, is conditioned on the rules being adopted in | 21 | | accordance with all provisions of the Illinois Administrative | 22 | | Procedure Act and all rules and procedures of the Joint | 23 | | Committee on Administrative Rules; any purported rule not so | 24 | | adopted, for whatever reason, is unauthorized. | 25 | | (Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21; | 26 | | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. |
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| 1 | | 1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, | 2 | | eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; | 3 | | 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. | 4 | | 1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, | 5 | | eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; | 6 | | 103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff. | 7 | | 6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445, | 8 | | eff. 1-1-24; 103-551, eff. 8-11-23; revised 8-29-23.) | 9 | | Section 35. The Limited Health Service Organization Act is | 10 | | amended by changing Section 4003 as follows: | 11 | | (215 ILCS 130/4003) (from Ch. 73, par. 1504-3) | 12 | | Sec. 4003. Illinois Insurance Code provisions. Limited | 13 | | health service organizations shall be subject to the | 14 | | provisions of Sections 133, 134, 136, 137, 139, 140, 141.1, | 15 | | 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154, | 16 | | 154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 355.2, | 17 | | 355.3, 355b, 356q, 356v, 356z.4, 356z.4a, 356z.10, 356z.21, | 18 | | 356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, | 19 | | 356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54, | 20 | | 356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68, 356z.80, | 21 | | 364.3, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412, | 22 | | 444, and 444.1 and Articles IIA, VIII 1/2, XII, XII 1/2, XIII, | 23 | | XIII 1/2, XXV, and XXVI of the Illinois Insurance Code. | 24 | | Nothing in this Section shall require a limited health care |
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| 1 | | plan to cover any service that is not a limited health service. | 2 | | For purposes of the Illinois Insurance Code, except for | 3 | | Sections 444 and 444.1 and Articles XIII and XIII 1/2, limited | 4 | | health service organizations in the following categories are | 5 | | deemed to be domestic companies: | 6 | | (1) a corporation under the laws of this State; or | 7 | | (2) a corporation organized under the laws of another | 8 | | state, 30% or more of the enrollees of which are residents | 9 | | of this State, except a corporation subject to | 10 | | substantially the same requirements in its state of | 11 | | organization as is a domestic company under Article VIII | 12 | | 1/2 of the Illinois Insurance Code. | 13 | | (Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; | 14 | | 102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-731, eff. | 15 | | 1-1-23; 102-775, eff. 5-13-22; 102-813, eff. 5-13-22; 102-816, | 16 | | eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; | 17 | | 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff. | 18 | | 1-1-24; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445, | 19 | | eff. 1-1-24; revised 8-29-23.) | 20 | | Section 40. The Voluntary Health Services Plans Act is | 21 | | amended by changing Section 10 as follows: | 22 | | (215 ILCS 165/10) (from Ch. 32, par. 604) | 23 | | Sec. 10. Application of Insurance Code provisions. Health | 24 | | services plan corporations and all persons interested therein |
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| 1 | | or dealing therewith shall be subject to the provisions of | 2 | | Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140, | 3 | | 143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, | 4 | | 356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356v, 356w, | 5 | | 356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, | 6 | | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, | 7 | | 356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25, | 8 | | 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33, | 9 | | 356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54, | 10 | | 356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64, | 11 | | 356z.67, 356z.68, 356z.80, 364.01, 364.3, 367.2, 368a, 401, | 12 | | 401.1, 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7) | 13 | | and (15) of Section 367 of the Illinois Insurance Code. | 14 | | Rulemaking authority to implement Public Act 95-1045, if | 15 | | any, is conditioned on the rules being adopted in accordance | 16 | | with all provisions of the Illinois Administrative Procedure | 17 | | Act and all rules and procedures of the Joint Committee on | 18 | | Administrative Rules; any purported rule not so adopted, for | 19 | | whatever reason, is unauthorized. | 20 | | (Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; | 21 | | 102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. | 22 | | 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804, | 23 | | eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; | 24 | | 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff. | 25 | | 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, | 26 | | eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24; |
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| 1 | | 103-551, eff. 8-11-23; revised 8-29-23.) | 2 | | Section 45. The Illinois Public Aid Code is amended by | 3 | | changing Section 5-16.8 as follows: | 4 | | (305 ILCS 5/5-16.8) | 5 | | Sec. 5-16.8. Required health benefits. The medical | 6 | | assistance program shall (i) provide the post-mastectomy care | 7 | | benefits required to be covered by a policy of accident and | 8 | | health insurance under Section 356t and the coverage required | 9 | | under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6, | 10 | | 356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46, | 11 | | 356z.47, 356z.51, 356z.53, 356z.56, 356z.59, 356z.60, and | 12 | | 356z.61 , 356z.64, 356z.67, and 356z.80 of the Illinois | 13 | | Insurance Code, (ii) be subject to the provisions of Sections | 14 | | 356z.19, 356z.44, 356z.49, 364.01, 370c, and 370c.1 of the | 15 | | Illinois Insurance Code, and (iii) be subject to the | 16 | | provisions of subsection (d-5) of Section 10 of the Network | 17 | | Adequacy and Transparency Act. | 18 | | The Department, by rule, shall adopt a model similar to | 19 | | the requirements of Section 356z.39 of the Illinois Insurance | 20 | | Code. | 21 | | On and after July 1, 2012, the Department shall reduce any | 22 | | rate of reimbursement for services or other payments or alter | 23 | | any methodologies authorized by this Code to reduce any rate | 24 | | of reimbursement for services or other payments in accordance |
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| 1 | | with Section 5-5e. | 2 | | To ensure full access to the benefits set forth in this | 3 | | Section, on and after January 1, 2016, the Department shall | 4 | | ensure that provider and hospital reimbursement for | 5 | | post-mastectomy care benefits required under this Section are | 6 | | no lower than the Medicare reimbursement rate. | 7 | | (Source: P.A. 102-30, eff. 1-1-22; 102-144, eff. 1-1-22; | 8 | | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-530, eff. | 9 | | 1-1-22; 102-642, eff. 1-1-22; 102-804, eff. 1-1-23; 102-813, | 10 | | eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093, eff. 1-1-23; | 11 | | 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff. | 12 | | 1-1-24; 103-420, eff. 1-1-24; revised 12-15-23.) | 13 | | Section 90. The State Mandates Act is amended by adding | 14 | | Section 8.48 as follows: | 15 | | (30 ILCS 805/8.48 new) | 16 | | Sec. 8.48. Exempt mandate. Notwithstanding Sections 6 and | 17 | | 8 of this Act, no reimbursement by the State is required for | 18 | | the implementation of any mandate created by this amendatory | 19 | | Act of the 103rd General Assembly. | 20 | | Section 99. Effective date. This Act takes effect January | 21 | | 1, 2026. |
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