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Public Act 093-1000
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| SB2339 Enrolled |
LRB093 17610 SAS 43280 b |
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AN ACT concerning insurance.
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Be it enacted by the People of the State of Illinois,
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represented in the General Assembly:
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Section 5. The Illinois Insurance Code is amended by adding |
Section 364.01 as follows:
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(215 ILCS 5/364.01 new) |
Sec. 364.01. Qualified cancer trials. |
(a) No individual or group policy of accident and health |
insurance issued or renewed in this State may be cancelled or |
non-renewed for any individual based on that individual's |
participation in a qualified clinical trial. |
(b) Qualified cancer trials must meet the following |
criteria: |
(1) the effectiveness of the treatment has not been |
determined relative to established therapies; |
(2) the trial is under clinical investigation as part |
of an approved cancer research trial in Phase II, Phase |
III, or Phase IV of investigation; |
(3) the trial is: |
(A) approved by the Food and Drug Administration; |
or |
(B) approved and funded by the National Institutes |
of Health, the Centers for Disease Control and |
Prevention, the Agency for Healthcare Research and |
Quality, the United States Department of Defense, the |
United States Department of Veterans Affairs, or the |
United States Department of Energy in the form of an |
investigational new drug application, or a cooperative |
group or center of any entity described in this |
subdivision (B); and
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(4) the patient's primary care physician, if any, is |
involved in the coordination of care.
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Section 10. The Health Maintenance Organization Act is |
amended by changing Section 5-3 as follows:
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(215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
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Sec. 5-3. Insurance Code provisions.
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(a) Health Maintenance Organizations
shall be subject to |
the provisions of Sections 133, 134, 137, 140, 141.1,
141.2, |
141.3, 143, 143c, 147, 148, 149, 151,
152, 153, 154, 154.5, |
154.6,
154.7, 154.8, 155.04, 355.2, 356m, 356v, 356w, 356x, |
356y,
356z.2, 356z.4, 356z.5, 364.01, 367.2, 367.2-5, 367i, |
368a, 368b, 368c, 368d, 368e,
401, 401.1, 402, 403, 403A,
408, |
408.2, 409, 412, 444,
and
444.1,
paragraph (c) of subsection |
(2) of Section 367, and Articles IIA, VIII 1/2,
XII,
XII 1/2, |
XIII, XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.
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(b) For purposes of the Illinois Insurance Code, except for |
Sections 444
and 444.1 and Articles XIII and XIII 1/2, Health |
Maintenance Organizations in
the following categories are |
deemed to be "domestic companies":
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(1) a corporation authorized under the
Dental Service |
Plan Act or the Voluntary Health Services Plans Act;
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(2) a corporation organized under the laws of this |
State; or
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(3) a corporation organized under the laws of another |
state, 30% or more
of the enrollees of which are residents |
of this State, except a
corporation subject to |
substantially the same requirements in its state of
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organization as is a "domestic company" under Article VIII |
1/2 of the
Illinois Insurance Code.
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(c) In considering the merger, consolidation, or other |
acquisition of
control of a Health Maintenance Organization |
pursuant to Article VIII 1/2
of the Illinois Insurance Code,
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(1) the Director shall give primary consideration to |
the continuation of
benefits to enrollees and the financial |
conditions of the acquired Health
Maintenance Organization |
after the merger, consolidation, or other
acquisition of |
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control takes effect;
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(2)(i) the criteria specified in subsection (1)(b) of |
Section 131.8 of
the Illinois Insurance Code shall not |
apply and (ii) the Director, in making
his determination |
with respect to the merger, consolidation, or other
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acquisition of control, need not take into account the |
effect on
competition of the merger, consolidation, or |
other acquisition of control;
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(3) the Director shall have the power to require the |
following
information:
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(A) certification by an independent actuary of the |
adequacy
of the reserves of the Health Maintenance |
Organization sought to be acquired;
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(B) pro forma financial statements reflecting the |
combined balance
sheets of the acquiring company and |
the Health Maintenance Organization sought
to be |
acquired as of the end of the preceding year and as of |
a date 90 days
prior to the acquisition, as well as pro |
forma financial statements
reflecting projected |
combined operation for a period of 2 years;
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(C) a pro forma business plan detailing an |
acquiring party's plans with
respect to the operation |
of the Health Maintenance Organization sought to
be |
acquired for a period of not less than 3 years; and
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(D) such other information as the Director shall |
require.
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(d) The provisions of Article VIII 1/2 of the Illinois |
Insurance Code
and this Section 5-3 shall apply to the sale by |
any health maintenance
organization of greater than 10% of its
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enrollee population (including without limitation the health |
maintenance
organization's right, title, and interest in and to |
its health care
certificates).
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(e) In considering any management contract or service |
agreement subject
to Section 141.1 of the Illinois Insurance |
Code, the Director (i) shall, in
addition to the criteria |
specified in Section 141.2 of the Illinois
Insurance Code, take |
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into account the effect of the management contract or
service |
agreement on the continuation of benefits to enrollees and the
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financial condition of the health maintenance organization to |
be managed or
serviced, and (ii) need not take into account the |
effect of the management
contract or service agreement on |
competition.
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(f) Except for small employer groups as defined in the |
Small Employer
Rating, Renewability and Portability Health |
Insurance Act and except for
medicare supplement policies as |
defined in Section 363 of the Illinois
Insurance Code, a Health |
Maintenance Organization may by contract agree with a
group or |
other enrollment unit to effect refunds or charge additional |
premiums
under the following terms and conditions:
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(i) the amount of, and other terms and conditions with |
respect to, the
refund or additional premium are set forth |
in the group or enrollment unit
contract agreed in advance |
of the period for which a refund is to be paid or
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additional premium is to be charged (which period shall not |
be less than one
year); and
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(ii) the amount of the refund or additional premium |
shall not exceed 20%
of the Health Maintenance |
Organization's profitable or unprofitable experience
with |
respect to the group or other enrollment unit for the |
period (and, for
purposes of a refund or additional |
premium, the profitable or unprofitable
experience shall |
be calculated taking into account a pro rata share of the
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Health Maintenance Organization's administrative and |
marketing expenses, but
shall not include any refund to be |
made or additional premium to be paid
pursuant to this |
subsection (f)). The Health Maintenance Organization and |
the
group or enrollment unit may agree that the profitable |
or unprofitable
experience may be calculated taking into |
account the refund period and the
immediately preceding 2 |
plan years.
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The Health Maintenance Organization shall include a |
statement in the
evidence of coverage issued to each enrollee |
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describing the possibility of a
refund or additional premium, |
and upon request of any group or enrollment unit,
provide to |
the group or enrollment unit a description of the method used |
to
calculate (1) the Health Maintenance Organization's |
profitable experience with
respect to the group or enrollment |
unit and the resulting refund to the group
or enrollment unit |
or (2) the Health Maintenance Organization's unprofitable
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experience with respect to the group or enrollment unit and the |
resulting
additional premium to be paid by the group or |
enrollment unit.
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In no event shall the Illinois Health Maintenance |
Organization
Guaranty Association be liable to pay any |
contractual obligation of an
insolvent organization to pay any |
refund authorized under this Section.
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(Source: P.A. 92-764, eff. 1-1-03; 93-102, eff. 1-1-04; 93-261, |
eff. 1-1-04;
93-477, eff. 8-8-03; 93-529, eff. 8-14-03; revised |
9-25-03.)
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Section 15. The Voluntary Health Services Plans Act is |
amended by changing Section 10 as follows:
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(215 ILCS 165/10) (from Ch. 32, par. 604)
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Sec. 10. Application of Insurance Code provisions. Health |
services
plan corporations and all persons interested therein |
or dealing therewith
shall be subject to the provisions of |
Articles IIA and XII 1/2 and Sections
3.1, 133, 140, 143, 143c, |
149, 155.37, 354, 355.2, 356r, 356t, 356u, 356v,
356w, 356x, |
356y, 356z.1, 356z.2, 356z.4, 356z.5, 364.01, 367.2, 368a, 401, |
401.1,
402,
403, 403A, 408,
408.2, and 412, and paragraphs (7) |
and (15) of Section 367 of the Illinois
Insurance Code.
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(Source: P.A. 92-130, eff. 7-20-01; 92-440, eff. 8-17-01;
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92-651, eff. 7-11-02; 92-764, eff. 1-1-03; 93-102, eff. 1-1-04; |
93-529, eff.
8-14-03; revised 9-25-03.)
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Section 20. The Illinois Public Aid Code is amended by |
changing Section 5-16.8 as follows:
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