State of Illinois
92nd General Assembly
Legislation

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92_HB0944

 
                                               LRB9205827JSpc

 1        AN ACT concerning insurance coverage.

 2        Be it enacted by the People of  the  State  of  Illinois,
 3    represented in the General Assembly:

 4        Section  5.  The  Illinois  Insurance  Code is amended by
 5    adding Section 356z.1 as follows:

 6        (215 ILCS 5/356z.1 new)
 7        Sec. 356z.1.  Coverage for contraceptives.
 8        (a)  An individual or group policy of accident and health
 9    insurance amended, delivered,  issued,  or  renewed  in  this
10    State  after the effective date of this amendatory Act of the
11    92nd General Assembly that provides coverage  for  outpatient
12    services  and  outpatient  prescription drugs or devices must
13    provide coverage for the insured and  any  dependent  of  the
14    insured  covered  by  the policy for outpatient contraceptive
15    services  and  outpatient  contraceptive  drugs  or   devices
16    approved  by  the  Food  and  Drug  Administration.  Coverage
17    required under this Section may not  impose  any  deductible,
18    coinsurance,   waiting   period,  or  other  cost-sharing  or
19    limitation  that  is  greater  than  that  required  for  any
20    outpatient service or outpatient prescription drug or  device
21    otherwise covered by the policy.
22        (b)  As  used  in this Section, "outpatient contraceptive
23    service" means consultations, examinations,  procedures,  and
24    medical services, provided on an outpatient basis and related
25    to the use of contraceptive methods (including natural family
26    planning) to prevent an unintended pregnancy.

27        Section  10.  The  Health Maintenance Organization Act is
28    amended by changing Section 5-3 as follows:

29        (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
 
                            -2-                LRB9205827JSpc
 1        Sec. 5-3.  Insurance Code provisions.
 2        (a)  Health Maintenance Organizations shall be subject to
 3    the provisions of Sections 133, 134, 137, 140, 141.1,  141.2,
 4    141.3,  143,  143c, 147, 148, 149, 151, 152, 153, 154, 154.5,
 5    154.6, 154.7, 154.8, 155.04, 355.2, 356m, 356v,  356w,  356x,
 6    356y,  356z.1,  367i,  368a, 401, 401.1, 402, 403, 403A, 408,
 7    408.2, 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,
 9    XIII, XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.
10        (b)  For  purposes of the Illinois Insurance Code, except
11    for Sections 444 and 444.1 and Articles XIII  and  XIII  1/2,
12    Health  Maintenance Organizations in the following categories
13    are deemed to be "domestic companies":
14             (1)  a  corporation  authorized  under  the   Dental
15        Service  Plan  Act or the Voluntary Health Services Plans
16        Act;
17             (2)  a corporation organized under the laws of  this
18        State; or
19             (3)  a  corporation  organized  under  the  laws  of
20        another  state, 30% or more of the enrollees of which are
21        residents 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
24        VIII 1/2 of the Illinois Insurance Code.
25        (c)  In  considering  the merger, consolidation, or other
26    acquisition of control of a Health  Maintenance  Organization
27    pursuant to Article VIII 1/2 of the Illinois Insurance Code,
28             (1)  the  Director  shall give primary consideration
29        to the continuation of  benefits  to  enrollees  and  the
30        financial  conditions  of the acquired Health Maintenance
31        Organization after the merger,  consolidation,  or  other
32        acquisition of control takes effect;
33             (2)(i)  the  criteria specified in subsection (1)(b)
34        of Section 131.8 of the Illinois Insurance Code shall not
 
                            -3-                LRB9205827JSpc
 1        apply and (ii) the Director, in making his  determination
 2        with  respect  to  the  merger,  consolidation,  or other
 3        acquisition of control, need not take  into  account  the
 4        effect  on  competition  of the merger, consolidation, or
 5        other acquisition of control;
 6             (3)  the Director shall have the  power  to  require
 7        the following information:
 8                  (A)  certification by an independent actuary of
 9             the   adequacy   of   the  reserves  of  the  Health
10             Maintenance Organization sought to be acquired;
11                  (B)  pro forma financial statements  reflecting
12             the combined balance sheets of the acquiring company
13             and the Health Maintenance Organization sought to be
14             acquired  as of the end of the preceding year and as
15             of a date 90 days prior to the acquisition, as  well
16             as   pro   forma   financial  statements  reflecting
17             projected combined  operation  for  a  period  of  2
18             years;
19                  (C)  a  pro  forma  business  plan detailing an
20             acquiring  party's  plans  with   respect   to   the
21             operation  of  the  Health  Maintenance Organization
22             sought to be acquired for a period of not less  than
23             3 years; and
24                  (D)  such  other  information  as  the Director
25             shall require.
26        (d)  The provisions of Article VIII 1/2 of  the  Illinois
27    Insurance  Code  and this Section 5-3 shall apply to the sale
28    by any health maintenance organization of greater than 10% of
29    its enrollee population  (including  without  limitation  the
30    health  maintenance organization's right, title, and interest
31    in and to its health care certificates).
32        (e)  In considering any management  contract  or  service
33    agreement  subject to Section 141.1 of the Illinois Insurance
34    Code, the Director (i) shall, in  addition  to  the  criteria
 
                            -4-                LRB9205827JSpc
 1    specified  in  Section  141.2 of the Illinois Insurance Code,
 2    take into account the effect of the  management  contract  or
 3    service   agreement   on  the  continuation  of  benefits  to
 4    enrollees  and  the  financial  condition   of   the   health
 5    maintenance  organization to be managed or serviced, and (ii)
 6    need not take into  account  the  effect  of  the  management
 7    contract or service agreement on competition.
 8        (f)  Except  for  small employer groups as defined in the
 9    Small Employer Rating, Renewability  and  Portability  Health
10    Insurance  Act and except for medicare supplement policies as
11    defined in Section 363 of  the  Illinois  Insurance  Code,  a
12    Health  Maintenance Organization may by contract agree with a
13    group or other enrollment unit to effect  refunds  or  charge
14    additional premiums under the following terms and conditions:
15             (i)  the  amount  of, and other terms and conditions
16        with respect to, the refund or additional premium are set
17        forth in the group or enrollment unit contract agreed  in
18        advance 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
27        be calculated taking into account a pro rata share of the
28        Health  Maintenance  Organization's  administrative   and
29        marketing  expenses,  but shall not include any refund to
30        be made or additional premium to be paid pursuant to this
31        subsection (f)).  The Health Maintenance Organization and
32        the  group  or  enrollment  unit  may  agree   that   the
33        profitable  or  unprofitable experience may be calculated
34        taking into account the refund period and the immediately
 
                            -5-                LRB9205827JSpc
 1        preceding 2 plan years.
 2        The  Health  Maintenance  Organization  shall  include  a
 3    statement in the evidence of coverage issued to each enrollee
 4    describing the possibility of a refund or additional premium,
 5    and upon request of any group or enrollment unit, provide  to
 6    the group or enrollment unit a description of the method used
 7    to   calculate  (1)  the  Health  Maintenance  Organization's
 8    profitable experience with respect to the group or enrollment
 9    unit and the resulting refund to the group or enrollment unit
10    or (2) the  Health  Maintenance  Organization's  unprofitable
11    experience  with  respect to the group or enrollment unit and
12    the resulting additional premium to be paid by the  group  or
13    enrollment unit.
14        In   no  event  shall  the  Illinois  Health  Maintenance
15    Organization  Guaranty  Association  be  liable  to  pay  any
16    contractual obligation of an insolvent  organization  to  pay
17    any refund authorized under this Section.
18    (Source: P.A.  90-25,  eff.  1-1-98;  90-177,  eff.  7-23-97;
19    90-372,  eff.  7-1-98;  90-583,  eff.  5-29-98;  90-655, eff.
20    7-30-98; 90-741, eff. 1-1-99; 91-357, eff.  7-29-99;  91-406,
21    eff.  1-1-00;  91-549,  eff.  8-14-99; 91-605, eff. 12-14-99;
22    91-788, eff. 6-9-00.)

23        Section 15.  The Voluntary Health Services Plans  Act  is
24    amended by changing Section 10 as follows:

25        (215 ILCS 165/10) (from Ch. 32, par. 604)
26        Sec.   10.  Application  of  Insurance  Code  provisions.
27    Health services plan corporations and all persons  interested
28    therein   or  dealing  therewith  shall  be  subject  to  the
29    provisions of Articles IIA and XII 1/2 and Sections 3.1, 133,
30    140, 143, 143c, 149, 354,  355.2,  356r,  356t,  356u,  356v,
31    356w,  356x, 356y, 356z.1, 367.2, 368a, 401, 401.1, 402, 403,
32    403A, 408, 408.2, and 412, and paragraphs  (7)  and  (15)  of
 
                            -6-                LRB9205827JSpc
 1    Section 367 of the Illinois Insurance Code.
 2    (Source: P.A. 90-7, eff. 6-10-97; 90-25, eff. 1-1-98; 90-655,
 3    eff.  7-30-98;  90-741,  eff.  1-1-99;  91-406,  eff. 1-1-00;
 4    91-549, eff. 8-14-99; 91-605,  eff.  12-14-99;  91-788,  eff.
 5    6-9-00.)

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