100TH GENERAL ASSEMBLY
State of Illinois
2017 and 2018
HB4577

 

Introduced , by Rep. Jay Hoffman

 

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.29 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

    Amends the Illinois Insurance Code. Requires a group or individual policy of accident and health insurance that is amended, delivered, issued, or renewed after the effective date of the amendatory Act to provide coverage for the treatment of Neurofibromatosis Type 1, including surgical procedures. Makes conforming changes in 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. Effective immediately.


LRB100 18153 SMS 33348 b

FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

HB4577LRB100 18153 SMS 33348 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 State Employees Group Insurance Act of 1971
5is 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 provide
9the post-mastectomy care benefits required to be covered by a
10policy of accident and health insurance under Section 356t of
11the Illinois Insurance Code. The program of health benefits
12shall provide the coverage required under Sections 356g,
13356g.5, 356g.5-1, 356m, 356u, 356w, 356x, 356z.2, 356z.4,
14356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
15356z.14, 356z.15, 356z.17, 356z.22, and 356z.25, 356z.26, and
16356z.29 of the Illinois Insurance Code. The program of health
17benefits must comply with Sections 155.22a, 155.37, 355b,
18356z.19, 370c, and 370c.1 of the Illinois Insurance Code.
19    Rulemaking authority to implement Public Act 95-1045, if
20any, is conditioned on the rules being adopted in accordance
21with all provisions of the Illinois Administrative Procedure
22Act and all rules and procedures of the Joint Committee on
23Administrative Rules; any purported rule not so adopted, for

 

 

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1whatever reason, is unauthorized.
2(Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17;
3100-138, eff. 8-18-17; revised 10-3-17.)
 
4    Section 10. 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 of
9providing 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, and 356z.25, 356z.26, and 356z.29 of
16the Illinois Insurance Code. The coverage shall comply with
17Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
18Insurance Code. The requirement that health benefits be covered
19as provided in this Section is an exclusive power and function
20of the State and is a denial and limitation under Article VII,
21Section 6, subsection (h) of the Illinois Constitution. A home
22rule county to which this Section applies must comply with
23every provision of this Section.
24    Rulemaking authority to implement Public Act 95-1045, if

 

 

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1any, is conditioned on the rules being adopted in accordance
2with all provisions of the Illinois Administrative Procedure
3Act and all rules and procedures of the Joint Committee on
4Administrative Rules; any purported rule not so adopted, for
5whatever reason, is unauthorized.
6(Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17;
7100-138, eff. 8-18-17; revised 10-5-17.)
 
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 coverage
15for the post-mastectomy care benefits required to be covered by
16a policy of accident and health insurance under Section 356t
17and the coverage required under Sections 356g, 356g.5,
18356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10,
19356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, and
20356z.25, 356z.26, and 356z.29 of the Illinois Insurance Code.
21The coverage shall comply with Sections 155.22a, 355b, 356z.19,
22and 370c of the Illinois Insurance Code. The requirement that
23health benefits be covered as provided in this is an exclusive
24power and function of the State and is a denial and limitation

 

 

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1under Article VII, Section 6, subsection (h) of the Illinois
2Constitution. A home rule municipality to which this Section
3applies must comply with 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. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17;
11100-138, eff. 8-18-17; revised 10-5-17.)
 
12    Section 20. The School Code is amended by changing Section
1310-22.3f as follows:
 
14    (105 ILCS 5/10-22.3f)
15    Sec. 10-22.3f. Required health benefits. Insurance
16protection and benefits for employees shall provide the
17post-mastectomy care benefits required to be covered by a
18policy of accident and health insurance under Section 356t and
19the coverage required under Sections 356g, 356g.5, 356g.5-1,
20356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11, 356z.12,
21356z.13, 356z.14, 356z.15, 356z.22, and 356z.25, 356z.26, and
22356z.29 of the Illinois Insurance Code. Insurance policies
23shall comply with Section 356z.19 of the Illinois Insurance
24Code. The coverage shall comply with Sections 155.22a and 355b

 

 

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1of the Illinois Insurance Code.
2    Rulemaking authority to implement Public Act 95-1045, if
3any, is conditioned on the rules being adopted in accordance
4with all provisions of the Illinois Administrative Procedure
5Act and all rules and procedures of the Joint Committee on
6Administrative Rules; any purported rule not so adopted, for
7whatever reason, is unauthorized.
8(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
9revised 9-25-17.)
 
10    Section 25. The Illinois Insurance Code is amended by
11adding Section 356z.29 as follows:
 
12    (215 ILCS 5/356z.29 new)
13    Sec. 356z.29. Coverage for treatment of Neurofibromatosis
14Type 1. A group or individual policy of accident and health
15insurance that is amended, delivered, issued, or renewed after
16the effective date of this amendatory Act of the 100th General
17Assembly shall cover treatment of Neurofibromatosis Type 1,
18including surgical procedures.
 
19    Section 30. 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.

 

 

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1    (a) Health Maintenance Organizations shall be subject to
2the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
3141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
4154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2, 355.3,
5355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2, 356z.4,
6356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
7356z.13, 356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.21,
8356z.22, 356z.25, 356z.26, 356z.29, 364, 364.01, 367.2,
9367.2-5, 367i, 368a, 368b, 368c, 368d, 368e, 370c, 370c.1, 401,
10401.1, 402, 403, 403A, 408, 408.2, 409, 412, 444, and 444.1,
11paragraph (c) of subsection (2) of Section 367, and Articles
12IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and XXVI of
13the Illinois Insurance Code.
14    (b) For purposes of the Illinois Insurance Code, except for
15Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health
16Maintenance Organizations in the following categories are
17deemed to be "domestic companies":
18        (1) a corporation authorized under the Dental Service
19    Plan Act or the Voluntary Health Services Plans Act;
20        (2) a corporation organized under the laws of this
21    State; or
22        (3) a corporation organized under the laws of another
23    state, 30% or more of the enrollees of which are residents
24    of this State, except a corporation subject to
25    substantially the same requirements in its state of
26    organization as is a "domestic company" under Article VIII

 

 

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1    1/2 of the Illinois Insurance Code.
2    (c) In considering the merger, consolidation, or other
3acquisition of control of a Health Maintenance Organization
4pursuant to Article VIII 1/2 of the Illinois Insurance Code,
5        (1) the Director shall give primary consideration to
6    the continuation of benefits to enrollees and the financial
7    conditions of the acquired Health Maintenance Organization
8    after the merger, consolidation, or other acquisition of
9    control takes effect;
10        (2)(i) the criteria specified in subsection (1)(b) of
11    Section 131.8 of the Illinois Insurance Code shall not
12    apply and (ii) the Director, in making his determination
13    with respect to the merger, consolidation, or other
14    acquisition of control, need not take into account the
15    effect on competition of the merger, consolidation, or
16    other acquisition of control;
17        (3) the Director shall have the power to require the
18    following information:
19            (A) certification by an independent actuary of the
20        adequacy of the reserves of the Health Maintenance
21        Organization sought to be acquired;
22            (B) pro forma financial statements reflecting the
23        combined balance sheets of the acquiring company and
24        the Health Maintenance Organization sought to be
25        acquired as of the end of the preceding year and as of
26        a date 90 days prior to the acquisition, as well as pro

 

 

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

 

 

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

 

 

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1    The Health Maintenance Organization shall include a
2statement in the evidence of coverage issued to each enrollee
3describing the possibility of a refund or additional premium,
4and upon request of any group or enrollment unit, provide to
5the group or enrollment unit a description of the method used
6to calculate (1) the Health Maintenance Organization's
7profitable experience with respect to the group or enrollment
8unit and the resulting refund to the group or enrollment unit
9or (2) the Health Maintenance Organization's unprofitable
10experience with respect to the group or enrollment unit and the
11resulting additional premium to be paid by the group or
12enrollment unit.
13    In no event shall the Illinois Health Maintenance
14Organization Guaranty Association be liable to pay any
15contractual obligation of an insolvent organization to pay any
16refund authorized under this Section.
17    (g) Rulemaking authority to implement Public Act 95-1045,
18if any, is conditioned on the rules being adopted in accordance
19with all provisions of the Illinois Administrative Procedure
20Act and all rules and procedures of the Joint Committee on
21Administrative Rules; any purported rule not so adopted, for
22whatever reason, is unauthorized.
23(Source: P.A. 99-761, eff. 1-1-18; 100-24, eff. 7-18-17;
24100-138, eff. 8-18-17; revised 10-5-17.)
 
25    Section 35. The Limited Health Service Organization Act is

 

 

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1amended by changing Section 4003 as follows:
 
2    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
3    Sec. 4003. Illinois Insurance Code provisions. Limited
4health service organizations shall be subject to the provisions
5of Sections 133, 134, 136, 137, 139, 140, 141.1, 141.2, 141.3,
6143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5, 154.6,
7154.7, 154.8, 155.04, 155.37, 355.2, 355.3, 355b, 356v,
8356z.10, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 368a,
9401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412, 444, and
10444.1 and Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2,
11XXV, and XXVI of the Illinois Insurance Code. For purposes of
12the Illinois Insurance Code, except for Sections 444 and 444.1
13and Articles XIII and XIII 1/2, limited health service
14organizations in the following categories are deemed to be
15domestic companies:
16        (1) a corporation under the laws of this State; or
17        (2) a corporation organized under the laws of another
18    state, 30% or more of the enrollees of which are residents
19    of this State, except a corporation subject to
20    substantially the same requirements in its state of
21    organization as is a domestic company under Article VIII
22    1/2 of the Illinois Insurance Code.
23(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
24100-201, eff. 8-18-17; revised 10-5-17.)
 

 

 

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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, 356g,
9356g.5, 356g.5-1, 356r, 356t, 356u, 356v, 356w, 356x, 356y,
10356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9,
11356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18,
12356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 364.01,
13367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412,
14and paragraphs (7) and (15) of Section 367 of the Illinois
15Insurance Code.
16    Rulemaking authority to implement Public Act 95-1045, if
17any, is conditioned on the rules being adopted in accordance
18with all provisions of the Illinois Administrative Procedure
19Act and all rules and procedures of the Joint Committee on
20Administrative Rules; any purported rule not so adopted, for
21whatever reason, is unauthorized.
22(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
23revised 10-5-17.)
 
24    Section 45. The Illinois Public Aid Code is amended by

 

 

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1changing Section 5-16.8 as follows:
 
2    (305 ILCS 5/5-16.8)
3    Sec. 5-16.8. Required health benefits. The medical
4assistance program shall (i) provide 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.5, 356u, 356w, 356x, 356z.6, 356z.26, and
8356z.29 and 356z.25 of the Illinois Insurance Code and (ii) be
9subject to the provisions of Sections 356z.19, 364.01, 370c,
10and 370c.1 of the Illinois Insurance Code.
11    On and after July 1, 2012, the Department shall reduce any
12rate of reimbursement for services or other payments or alter
13any methodologies authorized by this Code to reduce any rate of
14reimbursement for services or other payments in accordance with
15Section 5-5e.
16    To ensure full access to the benefits set forth in this
17Section, on and after January 1, 2016, the Department shall
18ensure that provider and hospital reimbursement for
19post-mastectomy care benefits required under this Section are
20no lower than the Medicare reimbursement rate.
21(Source: P.A. 99-433, eff. 8-21-15; 99-480, eff. 9-9-15;
2299-642, eff. 7-28-16; 100-138, eff. 8-18-17; revised 1-29-18.)
 
23    Section 99. Effective date. This Act takes effect upon
24becoming law.