Sen. Heather Steans

Filed: 4/23/2010

 

 


 

 


 
09600HB5018sam001 LRB096 18816 ASK 40609 a

1
AMENDMENT TO HOUSE BILL 5018

2     AMENDMENT NO. ______. Amend House Bill 5018 by replacing
3 everything after the enacting clause with the following:
 
4     "Section 5. The Illinois Insurance Code is amended by
5 renumbering and changing Section 356z.15, as added by Public
6 Act 96-180, and adding Section 356z.19 as follows:
 
7     (215 ILCS 5/356z.16)
8     Sec. 356z.16 356z.15. Applicability of mandated benefits
9 to supplemental policies. Unless specified otherwise, the
10 following Sections of the Illinois Insurance Code do not apply
11 to short-term travel, disability income, long-term care,
12 accident only, or limited or specified disease policies: 356b,
13 356c, 356d, 356g, 356k, 356m, 356n, 356p, 356q, 356r, 356t,
14 356u, 356w, 356x, 356z.1, 356z.2, 356z.4, 356z.5, 356z.6,
15 356z.8, 356z.19, 367.2-5, and 367e.
16 (Source: P.A. 96-180, eff. 1-1-10; revised 10-21-09.)".
 

 

 

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1     (215 ILCS 5/356z.19 new)
2     Sec. 356z.19. Tobacco use cessation programs.
3     (a) This Section may be referred to as the Tobacco
4 Dependence Coverage Law.
5     (b) Tobacco use is the number one cause of preventable
6 disease and death in Illinois, costing $4.1 billion annually in
7 direct health care costs and an additional $4.35 billion in
8 lost productivity. In Illinois, the smoking rates are highest
9 among African Americans (25.8%). Smoking rates among lesbian,
10 gay, and bisexual adults range from 25% to 44%. The U.S. Public
11 Health Service Clinical Practice Guideline 2008 Update found
12 that tobacco dependence treatments are both clinically
13 effective and highly cost effective. A study in the Journal of
14 Preventive Medicine concluded that comprehensive smoking
15 cessation treatment is one of the 3 most important and cost
16 effective preventive services that can be provided in medical
17 practice. Greater efforts are needed to achieve more of this
18 potential value by increasing current low levels of
19 performance.
20     (c) In this Section, "tobacco use cessation program" means
21 a program recommended by a physician that follows
22 evidence-based treatment, such as is outlined in the United
23 States Public Health Service guidelines for tobacco use
24 cessation. "Tobacco use cessation program" includes education
25 and medical treatment components designed to assist a person in

 

 

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1 ceasing the use of tobacco products. "Tobacco use cessation
2 program" includes education and counseling by physicians or
3 associated medical personnel and all FDA approved medications
4 for the treatment of tobacco dependence irrespective of whether
5 they are available only over the counter, only by prescription,
6 or both over the counter and by prescription.
7     (d) A group or individual policy of accident and health
8 insurance or managed care plan amended, delivered, issued, or
9 renewed after the effective date of this amendatory Act of the
10 96th General Assembly to a resident of this State must provide
11 coverage or reimbursement of up to $500 annually for a tobacco
12 use cessation program for a person enrolled in the plan who is
13 18 years of age or older.
14     (e) Written notice of the availability of coverage under
15 this Section shall be delivered to the insured upon enrollment
16 and annually thereafter. An insurer may not deny to an insured
17 eligibility or continued eligibility to enroll or to renew
18 coverage under the terms of the plan solely for the purpose of
19 avoiding the requirements of this Section. An insurer may not
20 penalize or reduce or limit the reimbursement of an attending
21 provider or provide incentives, monetary or otherwise, to an
22 attending provider to induce the provider to provide care to an
23 insured in a manner inconsistent with this Section.
 
24     Section 10. The Health Maintenance Organization Act is
25 amended by changing Section 5-3 as follows:
 

 

 

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1     (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
2     (Text of Section before amendment by P.A. 96-833)
3     Sec. 5-3. Insurance Code provisions.
4     (a) Health Maintenance Organizations shall be subject to
5 the provisions of Sections 133, 134, 137, 140, 141.1, 141.2,
6 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5,
7 154.6, 154.7, 154.8, 155.04, 355.2, 356g.5-1, 356m, 356v, 356w,
8 356x, 356y, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9,
9 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15 356z.14,
10 356z.17 356z.15, 356z.19, 364.01, 367.2, 367.2-5, 367i, 368a,
11 368b, 368c, 368d, 368e, 370c, 401, 401.1, 402, 403, 403A, 408,
12 408.2, 409, 412, 444, and 444.1, paragraph (c) of subsection
13 (2) of Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2,
14 XIII, XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.
15     (b) For purposes of the Illinois Insurance Code, except for
16 Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health
17 Maintenance Organizations in the following categories are
18 deemed to be "domestic companies":
19         (1) a corporation authorized under the Dental Service
20     Plan Act or the Voluntary Health Services Plans Act;
21         (2) a corporation organized under the laws of this
22     State; or
23         (3) a corporation organized under the laws of another
24     state, 30% or more of the enrollees of which are residents
25     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 financial
9     conditions of the acquired Health Maintenance Organization
10     after the merger, consolidation, or other acquisition of
11     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 to
16 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, take
21 into account the effect of the management contract or service
22 agreement on the continuation of benefits to enrollees and the
23 financial condition of the health maintenance organization to
24 be managed or serviced, and (ii) need not take into account the
25 effect of the management contract or service agreement on
26 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 Health
5 Maintenance Organization may by contract agree with a group or
6 other enrollment unit to effect refunds or charge additional
7 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 not
13     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 the
13 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 this amendatory Act of the 95th General Assembly, if any, is
21 conditioned on the rules being adopted in accordance with all
22 provisions of the Illinois Administrative Procedure Act and all
23 rules and procedures of the Joint Committee on Administrative
24 Rules; any purported rule not so adopted, for whatever reason,
25 is unauthorized.
26 (Source: P.A. 95-422, eff. 8-24-07; 95-520, eff. 8-28-07;

 

 

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1 95-876, eff. 8-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09;
2 95-1005, eff. 12-12-08; 95-1045, eff. 3-27-09; 95-1049, eff.
3 1-1-10; 96-328, eff. 8-11-09; 96-639, eff. 1-1-10; revised
4 10-23-09.)
 
5     (Text of Section after amendment by P.A. 96-833)
6     Sec. 5-3. Insurance Code provisions.
7     (a) Health Maintenance Organizations shall be subject to
8 the provisions of Sections 133, 134, 137, 140, 141.1, 141.2,
9 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5,
10 154.6, 154.7, 154.8, 155.04, 355.2, 356g.5-1, 356m, 356v, 356w,
11 356x, 356y, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9,
12 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17,
13 356z.18, 356z.19, 364.01, 367.2, 367.2-5, 367i, 368a, 368b,
14 368c, 368d, 368e, 370c, 401, 401.1, 402, 403, 403A, 408, 408.2,
15 409, 412, 444, and 444.1, paragraph (c) of subsection (2) of
16 Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2, XIII,
17 XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.
18     (b) For purposes of the Illinois Insurance Code, except for
19 Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health
20 Maintenance Organizations in the following categories are
21 deemed to be "domestic companies":
22         (1) a corporation authorized under the Dental Service
23     Plan Act or the Voluntary Health Services Plans Act;
24         (2) a corporation organized under the laws of this
25     State; or

 

 

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1         (3) a corporation organized under the laws of another
2     state, 30% or more of the enrollees of which are residents
3     of this State, except a corporation subject to
4     substantially the same requirements in its state of
5     organization as is a "domestic company" under Article VIII
6     1/2 of the Illinois Insurance Code.
7     (c) In considering the merger, consolidation, or other
8 acquisition of control of a Health Maintenance Organization
9 pursuant to Article VIII 1/2 of the Illinois Insurance Code,
10         (1) the Director shall give primary consideration to
11     the continuation of benefits to enrollees and the financial
12     conditions of the acquired Health Maintenance Organization
13     after the merger, consolidation, or other acquisition of
14     control takes effect;
15         (2)(i) the criteria specified in subsection (1)(b) of
16     Section 131.8 of the Illinois Insurance Code shall not
17     apply and (ii) the Director, in making his determination
18     with respect to the merger, consolidation, or other
19     acquisition of control, need not take into account the
20     effect on competition of the merger, consolidation, or
21     other acquisition of control;
22         (3) the Director shall have the power to require the
23     following information:
24             (A) certification by an independent actuary of the
25         adequacy of the reserves of the Health Maintenance
26         Organization sought to be acquired;

 

 

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1             (B) pro forma financial statements reflecting the
2         combined balance sheets of the acquiring company and
3         the Health Maintenance Organization sought to be
4         acquired as of the end of the preceding year and as of
5         a date 90 days prior to the acquisition, as well as pro
6         forma financial statements reflecting projected
7         combined operation for a period of 2 years;
8             (C) a pro forma business plan detailing an
9         acquiring party's plans with respect to the operation
10         of the Health Maintenance Organization sought to be
11         acquired for a period of not less than 3 years; and
12             (D) such other information as the Director shall
13         require.
14     (d) The provisions of Article VIII 1/2 of the Illinois
15 Insurance Code and this Section 5-3 shall apply to the sale by
16 any health maintenance organization of greater than 10% of its
17 enrollee population (including without limitation the health
18 maintenance organization's right, title, and interest in and to
19 its health care certificates).
20     (e) In considering any management contract or service
21 agreement subject to Section 141.1 of the Illinois Insurance
22 Code, the Director (i) shall, in addition to the criteria
23 specified in Section 141.2 of the Illinois Insurance Code, take
24 into account the effect of the management contract or service
25 agreement on the continuation of benefits to enrollees and the
26 financial condition of the health maintenance organization to

 

 

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

 

 

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1     subsection (f)). The Health Maintenance Organization and
2     the group or enrollment unit may agree that the profitable
3     or unprofitable experience may be calculated taking into
4     account the refund period and the immediately preceding 2
5     plan years.
6     The Health Maintenance Organization shall include a
7 statement in the evidence of coverage issued to each enrollee
8 describing the possibility of a refund or additional premium,
9 and upon request of any group or enrollment unit, provide to
10 the group or enrollment unit a description of the method used
11 to calculate (1) the Health Maintenance Organization's
12 profitable experience with respect to the group or enrollment
13 unit and the resulting refund to the group or enrollment unit
14 or (2) the Health Maintenance Organization's unprofitable
15 experience with respect to the group or enrollment unit and the
16 resulting additional premium to be paid by the group or
17 enrollment unit.
18     In no event shall the Illinois Health Maintenance
19 Organization Guaranty Association be liable to pay any
20 contractual obligation of an insolvent organization to pay any
21 refund authorized under this Section.
22     (g) Rulemaking authority to implement Public Act 95-1045,
23 if any, is conditioned on the rules being adopted in accordance
24 with all provisions of the Illinois Administrative Procedure
25 Act and all rules and procedures of the Joint Committee on
26 Administrative Rules; any purported rule not so adopted, for

 

 

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1 whatever reason, is unauthorized.
2 (Source: P.A. 95-422, eff. 8-24-07; 95-520, eff. 8-28-07;
3 95-876, eff. 8-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09;
4 95-1005, eff. 12-12-08; 95-1045, eff. 3-27-09; 95-1049, eff.
5 1-1-10; 96-328, eff. 8-11-09; 96-639, eff. 1-1-10; 96-833, eff.
6 6-1-10.)
 
7     Section 15. The Limited Health Service Organization Act is
8 amended by changing Section 4003 as follows:
 
9     (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
10     Sec. 4003. Illinois Insurance Code provisions. Limited
11 health service organizations shall be subject to the provisions
12 of Sections 133, 134, 137, 140, 141.1, 141.2, 141.3, 143, 143c,
13 147, 148, 149, 151, 152, 153, 154, 154.5, 154.6, 154.7, 154.8,
14 155.04, 155.37, 355.2, 356v, 356z.10, 356z.19, 368a, 401,
15 401.1, 402, 403, 403A, 408, 408.2, 409, 412, 444, and 444.1 and
16 Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and
17 XXVI of the Illinois Insurance Code. For purposes of the
18 Illinois Insurance Code, except for Sections 444 and 444.1 and
19 Articles XIII and XIII 1/2, limited health service
20 organizations in the following categories are deemed to be
21 domestic companies:
22         (1) a corporation under the laws of this State; or
23         (2) a corporation organized under the laws of another
24     state, 30% of more of the enrollees of which are residents

 

 

09600HB5018sam001 - 15 - LRB096 18816 ASK 40609 a

1     of this State, except a corporation subject to
2     substantially the same requirements in its state of
3     organization as is a domestic company under Article VIII
4     1/2 of the Illinois Insurance Code.
5 (Source: P.A. 95-520, eff. 8-28-07; 95-876, eff. 8-21-08.)
 
6     Section 20. The Voluntary Health Services Plans Act is
7 amended by changing Section 10 as follows:
 
8     (215 ILCS 165/10)  (from Ch. 32, par. 604)
9     (Text of Section before amendment by P.A. 96-833)
10     Sec. 10. Application of Insurance Code provisions. Health
11 services plan corporations and all persons interested therein
12 or dealing therewith shall be subject to the provisions of
13 Articles IIA and XII 1/2 and Sections 3.1, 133, 140, 143, 143c,
14 149, 155.37, 354, 355.2, 356g, 356g.5, 356g.5-1, 356r, 356t,
15 356u, 356v, 356w, 356x, 356y, 356z.1, 356z.2, 356z.4, 356z.5,
16 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
17 356z.14, 356z.15 356z.14, 356z.19, 364.01, 367.2, 368a, 401,
18 401.1, 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7)
19 and (15) of Section 367 of the Illinois Insurance Code.
20     Rulemaking authority to implement Public Act 95-1045 this
21 amendatory Act of the 95th General Assembly, if any, is
22 conditioned on the rules being adopted in accordance with all
23 provisions of the Illinois Administrative Procedure Act and all
24 rules and procedures of the Joint Committee on Administrative

 

 

09600HB5018sam001 - 16 - LRB096 18816 ASK 40609 a

1 Rules; any purported rule not so adopted, for whatever reason,
2 is unauthorized.
3 (Source: P.A. 95-189, eff. 8-16-07; 95-331, eff. 8-21-07;
4 95-422, eff. 8-24-07; 95-520, eff. 8-28-07; 95-876, eff.
5 8-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09; 95-1005,
6 eff. 12-12-08; 95-1045, eff. 3-27-09; 95-1049, eff. 1-1-10;
7 96-328, eff. 8-11-09; revised 9-25-09.)
 
8     (Text of Section after amendment by P.A. 96-833)
9     Sec. 10. Application of Insurance Code provisions. Health
10 services plan corporations and all persons interested therein
11 or dealing therewith shall be subject to the provisions of
12 Articles IIA and XII 1/2 and Sections 3.1, 133, 140, 143, 143c,
13 149, 155.37, 354, 355.2, 356g, 356g.5, 356g.5-1, 356r, 356t,
14 356u, 356v, 356w, 356x, 356y, 356z.1, 356z.2, 356z.4, 356z.5,
15 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
16 356z.14, 356z.15, 356z.18, 356z.19, 364.01, 367.2, 368a, 401,
17 401.1, 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7)
18 and (15) of Section 367 of the Illinois Insurance Code.
19     Rulemaking authority to implement Public Act 95-1045, if
20 any, is conditioned on the rules being adopted in accordance
21 with all provisions of the Illinois Administrative Procedure
22 Act and all rules and procedures of the Joint Committee on
23 Administrative Rules; any purported rule not so adopted, for
24 whatever reason, is unauthorized.
25 (Source: P.A. 95-189, eff. 8-16-07; 95-331, eff. 8-21-07;

 

 

09600HB5018sam001 - 17 - LRB096 18816 ASK 40609 a

1 95-422, eff. 8-24-07; 95-520, eff. 8-28-07; 95-876, eff.
2 8-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09; 95-1005,
3 eff. 12-12-08; 95-1045, eff. 3-27-09; 95-1049, eff. 1-1-10;
4 96-328, eff. 8-11-09; 96-833, eff. 6-1-10.)
 
5     Section 95. No acceleration or delay. Where this Act makes
6 changes in a statute that is represented in this Act by text
7 that is not yet or no longer in effect (for example, a Section
8 represented by multiple versions), the use of that text does
9 not accelerate or delay the taking effect of (i) the changes
10 made by this Act or (ii) provisions derived from any other
11 Public Act.".