96TH GENERAL ASSEMBLY
State of Illinois
2009 and 2010
HB0244


 
Introduced 1/20/2009, by Rep. Robert W. Pritchard
 
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.8






30 ILCS 805/8.33 new










    Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, and the School Code to require coverage for medically necessary preventative physical therapy for insureds diagnosed with multiple sclerosis. Amends the Illinois Insurance Code. In the provisions concerning multiple sclerosis preventative physical therapy, provides a definition for "medically necessary". Amends the State Mandates Act to require implementation without reimbursement.
















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FISCAL NOTE ACT MAY APPLY


STATE MANDATES ACT MAY REQUIRE REIMBURSEMENT
















 


 


A BILL FOR









 











HB0244

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1
    AN ACT concerning insurance.

 
2
    Be it enacted by the People of the State of Illinois,
 
3
represented in the General Assembly:


 
4
    Section 5. The State Employees Group Insurance Act of 1971 
5
is amended  by changing Section 6.11 as follows:
 


6
    (5 ILCS 375/6.11)

7
    (Text of Section before amendment by P.A. 95-958)
8
    Sec. 6.11. Required health benefits; Illinois Insurance 
9
Code
requirements.  The program of health
benefits shall provide 
10
the post-mastectomy care benefits required to be covered
by a 
11
policy of accident and health insurance under Section 356t of 
12
the Illinois
Insurance Code.  The program of health benefits 
13
shall provide the coverage
required under Sections 356g.5,

14
356u, 356w, 356x, 356z.2, 356z.4, 356z.6, 356z.8, 356z.9, 
15
356z.10, 356z.13
356z.11, and 356z.14
of the
Illinois Insurance 
16
Code.
The program of health benefits must comply with Section 
17
155.37 of the
Illinois Insurance Code.

18
(Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; 
19
95-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-978, eff. 
20
1-1-09; 95-1005, eff. 12-12-08; revised 12-15-08.)

 
21
    (Text of Section after amendment by P.A. 95-958)

22
    Sec. 6.11. Required health benefits; Illinois Insurance 
 


 






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1
Code
requirements.  The program of health
benefits shall provide 
2
the post-mastectomy care benefits required to be covered
by a 
3
policy of accident and health insurance under Section 356t of 
4
the Illinois
Insurance Code.  The program of health benefits 
5
shall provide the coverage
required under Sections 356g.5,

6
356u, 356w, 356x, 356z.2, 356z.4, 356z.6, 356z.8, 356z.9, 
7
356z.10, 356z.11, and 356z.12, 356z.13
356z.11, and 356z.14 of 
8
the
Illinois Insurance Code.
The program of health benefits 
9
must comply with Section 155.37 of the
Illinois Insurance Code.

10
(Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; 
11
95-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff. 
12
6-1-09; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; revised 
13
12-15-08.)
 
14
    Section 10. The Counties Code is amended  by changing 
15
Section 5-1069.3 as follows:
 
16
    (55 ILCS 5/5-1069.3)

17
    (Text of Section before amendment by P.A. 95-958)

18
    Sec. 5-1069.3. Required health benefits.   If a county, 
19
including a home
rule
county, is a self-insurer for purposes of 
20
providing health insurance coverage
for its employees, the 
21
coverage shall include coverage for the post-mastectomy
care 
22
benefits required to be covered by a policy of accident and 
23
health
insurance under Section 356t and the coverage required 
24
under Sections 356g.5, 356u,
356w, 356x, 356z.6, 356z.8, 
 


 






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356z.9, 356z.10, 356z.13
356z.11, and 356z.14 of
the Illinois 
2
Insurance Code.  The requirement that health benefits be covered

3
as provided in this Section is an
exclusive power and function 
4
of the State and is a denial and limitation under
Article VII, 
5
Section 6, subsection (h) of the Illinois Constitution.  A home

6
rule county to which this Section applies must comply with 
7
every provision of
this Section.


8
(Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; 
9
95-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-978, eff. 
10
1-1-09; 95-1005, eff. 12-12-08; revised 12-15-08.)

 
11
    (Text of Section after amendment by P.A. 95-958)
12
    Sec. 5-1069.3. Required health benefits.   If a county, 
13
including a home
rule
county, is a self-insurer for purposes of 
14
providing health insurance coverage
for its employees, the 
15
coverage shall include coverage for the post-mastectomy
care 
16
benefits required to be covered by a policy of accident and 
17
health
insurance under Section 356t and the coverage required 
18
under Sections 356g.5, 356u,
356w, 356x, 356z.6, 356z.8, 
19
356z.9, 356z.10, 356z.11, and 356z.12, 356z.13
356z.11, and 
20
356z.14 of
the Illinois Insurance Code.  The requirement that 
21
health benefits be covered
as provided in this Section is an

22
exclusive power and function of the State and is a denial and 
23
limitation under
Article VII, Section 6, subsection (h) of the 
24
Illinois Constitution.  A home
rule county to which this Section 
25
applies must comply with every provision of
this Section.


 


 






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1
(Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; 
2
95-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff. 
3
6-1-09; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; revised 
4
12-15-08.)
 
5
    Section 15. The Illinois Municipal Code is amended  by 
6
changing Section 10-4-2.3 as follows:
 
7
    (65 ILCS 5/10-4-2.3)

8
    (Text of Section before amendment by P.A. 95-958)

9
    Sec. 10-4-2.3. Required health benefits.   If a 
10
municipality, including a
home rule municipality, is a 
11
self-insurer for purposes of providing health
insurance 
12
coverage for its employees, the coverage shall include coverage 
13
for
the post-mastectomy care benefits required to be covered by 
14
a policy of
accident and health insurance under Section 356t 
15
and the coverage required
under Sections 356g.5, 356u, 356w, 
16
356x, 356z.6, 356z.8, 356z.9, 356z.10, 356z.13
356z.11, and 
17
356z.14 of the Illinois
Insurance
Code.  The requirement that 
18
health
benefits be covered as provided in this is an exclusive 
19
power and function of
the State and is a denial and limitation 
20
under Article VII, Section 6,
subsection (h) of the Illinois 
21
Constitution.  A home rule municipality to which
this Section 
22
applies must comply with every provision of this Section.


23
(Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; 
24
95-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-978, eff. 
 


 






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1-1-09; 95-1005, eff. 12-12-08; revised 12-15-08.)

 
2
    (Text of Section after amendment by P.A. 95-958)
3
    Sec. 10-4-2.3. Required health benefits.   If a 
4
municipality, including a
home rule municipality, is a 
5
self-insurer for purposes of providing health
insurance 
6
coverage for its employees, the coverage shall include coverage 
7
for
the post-mastectomy care benefits required to be covered by 
8
a policy of
accident and health insurance under Section 356t 
9
and the coverage required
under Sections 356g.5, 356u, 356w, 
10
356x, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, and 356z.12, 
11
356z.13
356z.11, and 356z.14 of the Illinois
Insurance
Code.  
12
The requirement that health
benefits be covered as provided in 
13
this is an exclusive power and function of
the State and is a 
14
denial and limitation under Article VII, Section 6,
subsection 
15
(h) of the Illinois Constitution.  A home rule municipality to 
16
which
this Section applies must comply with every provision of 
17
this Section.


18
(Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; 
19
95-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff. 
20
6-1-09; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; revised 
21
12-15-08.)
 
22
    Section 20. The School Code is amended  by changing Section 
23
10-22.3f as follows:
 
 


 






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    (105 ILCS 5/10-22.3f)

2
    (Text of Section before amendment by P.A. 95-958)

3
    Sec. 10-22.3f. Required health benefits.   Insurance 
4
protection and
benefits
for employees shall provide the 
5
post-mastectomy care benefits required to be
covered by a 
6
policy of accident and health insurance under Section 356t and 
7
the
coverage required under Sections 356g.5, 356u, 356w, 356x,


8
356z.6, 356z.8, 356z.9, 356z.13
and 356z.11, and 356z.14 of
the

9
Illinois Insurance Code.


10
(Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; 
11
95-876, eff. 8-21-08; 95-978, eff. 1-1-09; 95-1005, eff. 
12
12-12-08; revised 12-15-08.)

 
13
    (Text of Section after amendment by P.A. 95-958)
14
    Sec. 10-22.3f. Required health benefits.   Insurance 
15
protection and
benefits
for employees shall provide the 
16
post-mastectomy care benefits required to be
covered by a 
17
policy of accident and health insurance under Section 356t and 
18
the
coverage required under Sections 356g.5, 356u, 356w, 356x,


19
356z.6, 356z.8, 356z.9, 356z.11, and 356z.12, 356z.13
and 
20
356z.11, and 356z.14 of
the
Illinois Insurance Code.


21
(Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; 
22
95-876, eff. 8-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09; 
23
95-1005, 12-12-08; revised 12-15-08.)

 
24
    Section 25. The Illinois Insurance Code is amended  by 
 


 






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1
changing Section 356z.8 as follows:
 
2
    (215 ILCS 5/356z.8)

3
    Sec. 356z.8. Multiple sclerosis preventative physical 
4
therapy. 
5
    (a) A group or individual policy of accident and health 
6
insurance or managed care plan amended, delivered, issued, or 
7
renewed after the effective date of this amendatory Act of the 
8
94th General Assembly must provide coverage for medically 
9
necessary preventative physical therapy for insureds diagnosed 
10
with multiple sclerosis.
11
    (b) For the purposes of this Section: ,
12
    "Preventative preventative physical therapy" means 
13
physical therapy that is prescribed by a physician licensed to 
14
practice medicine in all of its branches for the purpose of 
15
treating parts of the body affected by multiple sclerosis, but 
16
only where the physical therapy includes reasonably defined 
17
goals, including, but not limited to, sustaining the level of 
18
function the person has achieved, with periodic evaluation of 
19
the efficacy of the physical therapy against those goals. The 
20
coverage required under this Section shall be subject to the 
21
same deductible, coinsurance, waiting period, cost sharing 
22
limitation, treatment limitation, calendar year maximum, or  
23
other limitations as provided for
other physical or 
24
rehabilitative therapy benefits covered by the policy.

25
    "Medically necessary" means any care, treatment, 
 


 






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intervention, service, or item that will or is reasonably 
2
expected to do any of the following: (i) prevent the onset of 
3
an illness, condition, injury, disease, or disability; (ii) 
4
reduce or ameliorate the physical, mental, or developmental 
5
effects of an illness, condition, injury, disease, or 
6
disability; or (iii) assist in achieving or maintaining maximum 
7
functional activity in performing daily activities. 
8
(Source: P.A. 94-1076, eff. 12-29-06.)

 
9
    Section 90. The State Mandates Act is amended by adding 
10
Section 8.33 as follows:
 
11
    (30 ILCS 805/8.33 new)
12
    Sec. 8.33. Exempt mandate. Notwithstanding Sections 6 and 8 
13
of this Act, no reimbursement by the State is required for the 
14
implementation of any mandate created by this amendatory Act of 
15
the 96th General Assembly.
 
16
    Section 95. No acceleration or delay. Where this Act makes 
17
changes in a statute that is represented in this Act by text 
18
that is not yet or no longer in effect (for example, a Section 
19
represented by multiple versions), the use of that text does 
20
not accelerate or delay the taking effect of (i) the changes 
21
made by this Act or (ii) provisions derived from any other 
22
Public Act.