Rep. Camille Y. Lilly

Filed: 3/12/2024

 

 


 

 


 
10300HB4562ham001LRB103 37130 RPS 70700 a

1
AMENDMENT TO HOUSE BILL 4562

2    AMENDMENT NO. ______. Amend House Bill 4562 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, 356u.10,
14356w, 356x, 356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9,
15356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17,
16356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32,

 

 

10300HB4562ham001- 2 -LRB103 37130 RPS 70700 a

1356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
2356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59,
3356z.60, and 356z.61, and 356z.62, 356z.64, 356z.67, 356z.68,
4and 356z.70 of the Illinois Insurance Code. The program of
5health benefits must comply with Sections 155.22a, 155.37,
6355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of the
7Illinois Insurance Code. The program of health benefits shall
8provide the coverage required under Section 356m of the
9Illinois Insurance Code and, for the employees of the State
10Employee Group Insurance Program only, the coverage as also
11provided in Section 6.11B of this Act. The Department of
12Insurance shall enforce the requirements of this Section with
13respect to Sections 370c and 370c.1 of the Illinois Insurance
14Code; all other requirements of this Section shall be enforced
15by the Department of Central Management Services.
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. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
23102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
241-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-768,
25eff. 1-1-24; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
26102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.

 

 

10300HB4562ham001- 3 -LRB103 37130 RPS 70700 a

11-1-23; 102-1117, eff. 1-13-23; 103-8, eff. 1-1-24; 103-84,
2eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, eff. 1-1-24;
3103-445, eff. 1-1-24; 103-535, eff. 8-11-23; 103-551, eff.
48-11-23; revised 8-29-23.)
 
5    Section 10. The Counties Code is amended by changing
6Section 5-1069.3 as follows:
 
7    (55 ILCS 5/5-1069.3)
8    Sec. 5-1069.3. Required health benefits. If a county,
9including a home rule county, is a self-insurer for purposes
10of providing health insurance coverage for its employees, the
11coverage shall include coverage for the post-mastectomy care
12benefits required to be covered by a policy of accident and
13health insurance under Section 356t and the coverage required
14under Sections 356g, 356g.5, 356g.5-1, 356q, 356u, 356u.10,
15356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
16356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25,
17356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, 356z.36,
18356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51,
19356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and
20356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, and 356z.70
21of the Illinois Insurance Code. The coverage shall comply with
22Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
23Insurance Code. The Department of Insurance shall enforce the
24requirements of this Section. The requirement that health

 

 

10300HB4562ham001- 4 -LRB103 37130 RPS 70700 a

1benefits be covered as provided in this Section is an
2exclusive power and function of the State and is a denial and
3limitation under Article VII, Section 6, subsection (h) of the
4Illinois Constitution. A home rule county to which this
5Section applies must comply with every provision of this
6Section.
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. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
14102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
151-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
16eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
17102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
181-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
19eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
20103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised
218-29-23.)
 
22    Section 15. The Illinois Municipal Code is amended by
23changing Section 10-4-2.3 as follows:
 
24    (65 ILCS 5/10-4-2.3)

 

 

10300HB4562ham001- 5 -LRB103 37130 RPS 70700 a

1    Sec. 10-4-2.3. Required health benefits. If a
2municipality, including a home rule municipality, is a
3self-insurer for purposes of providing health insurance
4coverage for its employees, the coverage shall include
5coverage for the post-mastectomy care benefits required to be
6covered by a policy of accident and health insurance under
7Section 356t and the coverage required under Sections 356g,
8356g.5, 356g.5-1, 356q, 356u, 356u.10, 356w, 356x, 356z.4,
9356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
10356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
11356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
12356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
13356z.56, 356z.57, 356z.59, 356z.60, and 356z.61, and 356z.62,
14356z.64, 356z.67, 356z.68, and 356z.70 of the Illinois
15Insurance Code. The coverage shall comply with Sections
16155.22a, 355b, 356z.19, and 370c of the Illinois Insurance
17Code. The Department of Insurance shall enforce the
18requirements of this Section. The requirement that health
19benefits be covered as provided in this is an exclusive power
20and function of the State and is a denial and limitation under
21Article VII, Section 6, subsection (h) of the Illinois
22Constitution. A home rule municipality to which this Section
23applies must comply with every provision of this Section.
24    Rulemaking authority to implement Public Act 95-1045, if
25any, is conditioned on the rules being adopted in accordance
26with all provisions of the Illinois Administrative Procedure

 

 

10300HB4562ham001- 6 -LRB103 37130 RPS 70700 a

1Act and all rules and procedures of the Joint Committee on
2Administrative Rules; any purported rule not so adopted, for
3whatever reason, is unauthorized.
4(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
5102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
61-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
7eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
8102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
91-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
10eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
11103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised
128-29-23.)
 
13    Section 20. The School Code is amended by changing Section
1410-22.3f as follows:
 
15    (105 ILCS 5/10-22.3f)
16    Sec. 10-22.3f. Required health benefits. Insurance
17protection and benefits for employees shall provide the
18post-mastectomy care benefits required to be covered by a
19policy of accident and health insurance under Section 356t and
20the coverage required under Sections 356g, 356g.5, 356g.5-1,
21356q, 356u, 356u.10, 356w, 356x, 356z.4, 356z.4a, 356z.6,
22356z.8, 356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
23356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32,
24356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,

 

 

10300HB4562ham001- 7 -LRB103 37130 RPS 70700 a

1356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60,
2and 356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, and
3356z.70 of the Illinois Insurance Code. Insurance policies
4shall comply with Section 356z.19 of the Illinois Insurance
5Code. The coverage shall comply with Sections 155.22a, 355b,
6and 370c of the Illinois Insurance Code. The Department of
7Insurance shall enforce the requirements 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. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
15102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
161-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804,
17eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
18102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff.
191-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420,
20eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. 8-11-23;
21103-551, eff. 8-11-23; revised 8-29-23.)
 
22    Section 25. The Illinois Insurance Code is amended by
23adding Section 356u.10 as follows:
 
24    (215 ILCS 5/356u.10 new)

 

 

10300HB4562ham001- 8 -LRB103 37130 RPS 70700 a

1    Sec. 356u.10. Genetic testing and cancer risk management
2for an inherited gene mutation.
3    (a) In this Section, "genetic testing for an inherited
4mutation" means germline multi-gene testing for an inherited
5mutation associated with an increased risk of cancer in
6accordance with evidence-based, clinical practice guidelines.
7    (b) A group policy of accident and health insurance or
8managed care plan that is amended, delivered, issued, or
9renewed after January 1, 2026 shall provide coverage, without
10imposing a deductible, coinsurance, copayment, or any other
11cost-sharing requirement, for clinical genetic testing for an
12inherited gene mutation for individuals with a personal or
13family history of cancer as recommended by a health care
14professional in accordance with current evidence-based
15clinical practice guidelines, including, but not limited to,
16the most recent version of the National Comprehensive Cancer
17Network clinical practice guidelines. This subsection (b)
18shall not apply to coverage of genetic testing to the extent
19such coverage would disqualify a high-deductible health plan
20from eligibility for a health savings account pursuant to
21Section 223 of the Internal Revenue Code.
22    (c) For individuals with a genetic test that is positive
23for an inherited mutation associated with an increased risk of
24cancer, coverage required under this Section shall include any
25cancer risk management strategy as recommended by a health
26care professional in accordance with current evidence-based

 

 

10300HB4562ham001- 9 -LRB103 37130 RPS 70700 a

1clinical practice guidelines to the extent that the management
2recommendation is not already covered by the policy, except
3that coverage for risk management under this subsection (c)
4may be subject to a deductible, coinsurance, or other
5cost-sharing limitation so long as such limitation is not
6greater than that required for other related cancer risk
7management benefits covered under the policy.
 
8    Section 30. The Health Maintenance Organization Act is
9amended by changing Section 5-3 as follows:
 
10    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
11    Sec. 5-3. Insurance Code provisions.
12    (a) Health Maintenance Organizations shall be subject to
13the provisions of Sections 133, 134, 136, 137, 139, 140,
14141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
15154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 155.49,
16355.2, 355.3, 355b, 355c, 356f, 356g.5-1, 356m, 356q, 356u.10,
17356v, 356w, 356x, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5,
18356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
19356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.20, 356z.21,
20356z.22, 356z.23, 356z.24, 356z.25, 356z.26, 356z.28, 356z.29,
21356z.30, 356z.30a, 356z.31, 356z.32, 356z.33, 356z.34,
22356z.35, 356z.36, 356z.37, 356z.38, 356z.39, 356z.40, 356z.41,
23356z.44, 356z.45, 356z.46, 356z.47, 356z.48, 356z.49, 356z.50,
24356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.58,

 

 

10300HB4562ham001- 10 -LRB103 37130 RPS 70700 a

1356z.59, 356z.60, 356z.61, 356z.62, 356z.64, 356z.65, 356z.67,
2356z.68, 364, 364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b,
3368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A,
4408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of
5subsection (2) of Section 367, and Articles IIA, VIII 1/2,
6XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the
7Illinois Insurance Code.
8    (b) For purposes of the Illinois Insurance Code, except
9for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
10Health Maintenance Organizations in the following categories
11are deemed to be "domestic companies":
12        (1) a corporation authorized under the Dental Service
13    Plan Act or the Voluntary Health Services Plans Act;
14        (2) a corporation organized under the laws of this
15    State; or
16        (3) 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    (c) In considering the merger, consolidation, or other
23acquisition of control of a Health Maintenance Organization
24pursuant to Article VIII 1/2 of the Illinois Insurance Code,
25        (1) the Director shall give primary consideration to
26    the continuation of benefits to enrollees and the

 

 

10300HB4562ham001- 11 -LRB103 37130 RPS 70700 a

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

 

 

10300HB4562ham001- 12 -LRB103 37130 RPS 70700 a

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

 

 

10300HB4562ham001- 13 -LRB103 37130 RPS 70700 a

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

 

 

10300HB4562ham001- 14 -LRB103 37130 RPS 70700 a

1profitable experience with respect to the group or enrollment
2unit and the resulting refund to the group or enrollment unit
3or (2) the Health Maintenance Organization's unprofitable
4experience with respect to the group or enrollment unit and
5the resulting additional premium to be paid by the group or
6enrollment unit.
7    In no event shall the Illinois Health Maintenance
8Organization Guaranty Association be liable to pay any
9contractual obligation of an insolvent organization to pay any
10refund authorized under this Section.
11    (g) Rulemaking authority to implement Public Act 95-1045,
12if any, is conditioned on the rules being adopted in
13accordance with all provisions of the Illinois Administrative
14Procedure Act and all rules and procedures of the Joint
15Committee on Administrative Rules; any purported rule not so
16adopted, for whatever reason, is unauthorized.
17(Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
18102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
191-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
20eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
21102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
221-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
23eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;
24103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.
256-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
26eff. 1-1-24; 103-551, eff. 8-11-23; revised 8-29-23.)
 

 

 

10300HB4562ham001- 15 -LRB103 37130 RPS 70700 a

1    Section 35. 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, 356u.10, 356v,
10356w, 356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a,
11356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
12356z.13, 356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22,
13356z.25, 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32,
14356z.33, 356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53,
15356z.54, 356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62,
16356z.64, 356z.67, 356z.68, 364.01, 364.3, 367.2, 368a, 401,
17401.1, 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7)
18and (15) of Section 367 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
24whatever reason, is unauthorized.

 

 

10300HB4562ham001- 16 -LRB103 37130 RPS 70700 a

1(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
2102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff.
310-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804,
4eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
5102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff.
61-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
7eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
8103-551, eff. 8-11-23; revised 8-29-23.)".