SB2748 93RD GENERAL ASSEMBLY

LRB093 20228 RAS 45986 b

93RD GENERAL ASSEMBLY
State of Illinois
2003 and 2004
SB2748

Introduced 2/5/2004, by Mattie Hunter

SYNOPSIS AS INTRODUCED:

5 ILCS 375/6.16 new
55 ILCS 5/5-1069.9 new
65 ILCS 5/10-4-2.6 new
30 ILCS 805/8.28 new

Amends the State Employees Group Insurance Act of 1971, the Counties Code, and the Illinois Municipal Code. Provides that health benefits provided to employees under those Acts must include coverage for surgical treatment for morbid obesity. Amends the State Mandates Act to require implementation without reimbursement.

FISCAL NOTE ACT MAY APPLY

HOME RULE NOTE ACT MAY APPLY

STATE MANDATES ACT MAY REQUIRE REIMBURSEMENT

A BILL FOR

AN ACT concerning public employee health benefits.

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

Section 5. The State Employees Group Insurance Act of 1971 is amended by adding Section 6.16 as follows:

(5 ILCS 375/6.16 new)

Sec. 6.16. Morbid obesity.

(a) Beginning on January 1, 2005, the program of health benefits must provide benefits for the expenses of the surgical treatment of morbid obesity for the following individuals:

(1) individuals with a body-mass index equal to or greater than 40 kilograms per meter squared;

(2) individuals with a body-mass index equal to or greater than 35 kilograms per meter squared, with comorbidities or coexisting medical conditions, such as hypertension, cardiopulmonary conditions, sleep apnea, or diabetes; and

(3) individuals who meet the guidelines for the surgical treatment of morbid obesity as set forth by the national institutes of health.

(b) The benefits provided under subsection (a) shall include benefits for examinations and laboratory tests performed in accordance with the guidelines of the national institutes of health for the surgical treatment of morbid obesity.

(c) The benefits provided under subsection (a) shall be no less extensive than those provided for any other medically necessary surgical procedure under the program of health benefits and shall be subject to the same terms and conditions, including copayment charges.

Section 10. The Counties Code is amended by adding Section 5-1069.9 as follows:

(55 ILCS 5/5-1069.9 new)

Sec. 5-1069.9. Morbid obesity.

(a) If a county, including a home rule county, is a self-insurer for purposes of providing health insurance coverage for its employees, the coverage must provide benefits for the expenses of the surgical treatment of morbid obesity for the following individuals:

(1) individuals with a body-mass index equal to or greater than 40 kilograms per meter squared;

(2) individuals with a body-mass index equal to or greater than 35 kilograms per meter squared, with comorbidities or coexisting medical conditions, such as hypertension, cardiopulmonary conditions, sleep apnea, or diabetes; and

(3) individuals who meet the guidelines for the surgical treatment of morbid obesity as set forth by the national institutes of health.

(b) The benefits provided under subsection (a) shall include benefits for examinations and laboratory tests performed in accordance with the guidelines of the national institutes of health for the surgical treatment of morbid obesity.

(c) The benefits provided under subsection (a) shall be no less extensive than those provided for any other medically necessary surgical procedure under the coverage and shall be subject to the same terms and conditions, including copayment charges.

(d) The requirement that health benefits be covered as provided in this Section is an exclusive power and function of the State and is a denial and limitation under Article VII, Section 6, subsection (h) of the Illinois Constitution. A home rule county to which this Section applies must comply with every provision of this Section.

Section 15. The Illinois Municipal Code is amended by adding Section 10-4-2.6 as follows:

(65 ILCS 5/10-4-2.6 new)

Sec. 10-4-2.6. Morbid obesity.

(a) If a municipality, including a home rule municipality, is a self-insurer for purposes of providing health insurance coverage for its employees, the coverage must provide benefits for the expenses of the surgical treatment of morbid obesity for the following individuals:

(1) individuals with a body-mass index equal to or greater than 40 kilograms per meter squared;

(2) individuals with a body-mass index equal to or greater than 35 kilograms per meter squared, with comorbidities or coexisting medical conditions, such as hypertension, cardiopulmonary conditions, sleep apnea, or diabetes; and

(3) individuals who meet the guidelines for the surgical treatment of morbid obesity as set forth by the national institutes of health.

(b) The benefits provided under subsection (a) shall include benefits for examinations and laboratory tests performed in accordance with the guidelines of the national institutes of health for the surgical treatment of morbid obesity.

(c) The benefits provided under subsection (a) shall be no less extensive than those provided for any other medically necessary surgical procedure under the coverage and shall be subject to the same terms and conditions, including copayment charges.

(d) The requirement that health benefits be covered as provided in this Section is an exclusive power and function of the State and is a denial and limitation under Article VII, Section 6, subsection (h) of the Illinois Constitution. A home rule municipality to which this Section applies must comply with every provision of this Section.

Section 90. The State Mandates Act is amended by adding Section 8.28 as follows:

(30 ILCS 805/8.28 new)

Sec. 8.28. Exempt mandate. Notwithstanding Sections 6 and 8 of this Act, no reimbursement by the State is required for the implementation of any mandate created by this amendatory Act of the 93rd General Assembly.