96TH GENERAL ASSEMBLY
State of Illinois
2009 and 2010
HB0626


 
Introduced 2/6/2009, by Rep. Mary E. Flowers
 
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.15 new






215 ILCS 5/356z.16 new






215 ILCS 5/356z.17 new





215 ILCS 125/5-3
  from Ch. 111 1/2, par. 1411.2


215 ILCS 165/10
  from Ch. 32, par. 604



30 ILCS 805/8.33 new











    Amends the State Employees Group Insurance Act of 1971, the Counties Code,
the
Illinois Municipal Code, the School Code, the Illinois Insurance Code, the
Health Maintenance Organization Act,
and the Voluntary Health Services Plans Act. Provides that an individual or group policy of accident and health insurance or managed care plan must provide coverage for intravenous feeding, prescription
nutritional supplements, and physician prescribed or ordered pain medication.  Amends the State Mandates Act to require implementation
without reimbursement by the State.
















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FISCAL NOTE ACT MAY APPLY


STATE MANDATES ACT MAY REQUIRE REIMBURSEMENT
















 


 


A BILL FOR









 











HB0626

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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.9, 356z.10, 
15
356z.13
356z.11, and 356z.14, 356z.15, 356z.16, and 356z.17
of 
16
the
Illinois Insurance Code.
The program of health benefits 
17
must comply with Section 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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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.9, 356z.10, 
7
356z.11, and 356z.12, 356z.13
356z.11, and 356z.14, 356z.15, 
8
356z.16, and 356z.17 of the
Illinois Insurance Code.
The 
9
program of health benefits must comply with Section 155.37 of 
10
the
Illinois Insurance Code.

11
(Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; 
12
95-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff. 
13
6-1-09; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; revised 
14
12-15-08.)

 
15
    Section 10. The Counties Code is amended by changing 
16
Section 5-1069.3 as
follows:


 
17
    (55 ILCS 5/5-1069.3)

18
    (Text of Section before amendment by P.A. 95-958)

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


 






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1
under Sections 356g.5, 356u,
356w, 356x, 356z.6, 356z.9, 
2
356z.10, 356z.13
356z.11, and 356z.14, 356z.15, 356z.16, and 
3
356z.17 of
the Illinois Insurance Code.  The requirement that 
4
health benefits be covered
as provided in this Section is an

5
exclusive power and function of the State and is a denial and 
6
limitation under
Article VII, Section 6, subsection (h) of the 
7
Illinois Constitution.  A home
rule county to which this Section 
8
applies must comply with every provision of
this Section.


9
(Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; 
10
95-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-978, eff. 
11
1-1-09; 95-1005, eff. 12-12-08; revised 12-15-08.)

 
12
    (Text of Section after amendment by P.A. 95-958)
13
    Sec. 5-1069.3. Required health benefits.   If a county, 
14
including a home
rule
county, is a self-insurer for purposes of 
15
providing health insurance coverage
for its employees, the 
16
coverage shall include coverage for the post-mastectomy
care 
17
benefits required to be covered by a policy of accident and 
18
health
insurance under Section 356t and the coverage required 
19
under Sections 356g.5, 356u,
356w, 356x, 356z.6, 356z.9, 
20
356z.10, 356z.11, and 356z.12, 356z.13
356z.11, and 356z.14, 
21
356z.15, 356z.16, and 356z.17 of
the Illinois Insurance Code.  
22
The requirement that health benefits be covered
as provided in 
23
this Section is an
exclusive power and function of the State 
24
and is a denial and limitation under
Article VII, Section 6, 
25
subsection (h) of the Illinois Constitution.  A home
rule county 
 


 






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to which this Section applies must comply with every provision 
2
of
this Section.


3
(Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; 
4
95-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff. 
5
6-1-09; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; revised 
6
12-15-08.)

 
7
    Section 15. The Illinois Municipal Code is amended by 
8
changing Section
10-4-2.3 as follows:


 
9
    (65 ILCS 5/10-4-2.3)

10
    (Text of Section before amendment by P.A. 95-958)

11
    Sec. 10-4-2.3. Required health benefits.   If a 
12
municipality, including a
home rule municipality, is a 
13
self-insurer for purposes of providing health
insurance 
14
coverage for its employees, the coverage shall include coverage 
15
for
the post-mastectomy care benefits required to be covered by 
16
a policy of
accident and health insurance under Section 356t 
17
and the coverage required
under Sections 356g.5, 356u, 356w, 
18
356x, 356z.6, 356z.9, 356z.10, 356z.13
356z.11, and 356z.14, 
19
356z.15, 356z.16, and 356z.17 of the Illinois
Insurance
Code.  
20
The requirement that health
benefits be covered as provided in 
21
this is an exclusive power and function of
the State and is a 
22
denial and limitation under Article VII, Section 6,
subsection 
23
(h) of the Illinois Constitution.  A home rule municipality to 
24
which
this Section applies must comply with every provision of 
 


 






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this Section.


2
(Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; 
3
95-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-978, eff. 
4
1-1-09; 95-1005, eff. 12-12-08; revised 12-15-08.)

 
5
    (Text of Section after amendment by P.A. 95-958)
6
    Sec. 10-4-2.3. Required health benefits.   If a 
7
municipality, including a
home rule municipality, is a 
8
self-insurer for purposes of providing health
insurance 
9
coverage for its employees, the coverage shall include coverage 
10
for
the post-mastectomy care benefits required to be covered by 
11
a policy of
accident and health insurance under Section 356t 
12
and the coverage required
under Sections 356g.5, 356u, 356w, 
13
356x, 356z.6, 356z.9, 356z.10, 356z.11, and 356z.12, 356z.13

14
356z.11, and 356z.14, 356z.15, 356z.16, and 356z.17 of the 
15
Illinois
Insurance
Code.  The requirement that health
benefits 
16
be covered as provided in this is an exclusive power and 
17
function of
the State and is a denial and limitation under 
18
Article VII, Section 6,
subsection (h) of the Illinois 
19
Constitution.  A home rule municipality to which
this Section 
20
applies must comply with every provision of this Section.


21
(Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; 
22
95-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff. 
23
6-1-09; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; revised 
24
12-15-08.)

 
 


 






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    Section 20. The School Code is amended by changing Section 
2
10-22.3f as
follows:


 
3
    (105 ILCS 5/10-22.3f)

4
    (Text of Section before amendment by P.A. 95-958)

5
    Sec. 10-22.3f. Required health benefits.   Insurance 
6
protection and
benefits
for employees shall provide the 
7
post-mastectomy care benefits required to be
covered by a 
8
policy of accident and health insurance under Section 356t and 
9
the
coverage required under Sections 356g.5, 356u, 356w, 356x,


10
356z.6, 356z.9, 356z.13
and 356z.11, and 356z.14, 356z.15, 
11
356z.16, and 356z.17 of
the
Illinois Insurance Code.


12
(Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; 
13
95-876, eff. 8-21-08; 95-978, eff. 1-1-09; 95-1005, eff. 
14
12-12-08; revised 12-15-08.)

 
15
    (Text of Section after amendment by P.A. 95-958)
16
    Sec. 10-22.3f. Required health benefits.   Insurance 
17
protection and
benefits
for employees shall provide the 
18
post-mastectomy care benefits required to be
covered by a 
19
policy of accident and health insurance under Section 356t and 
20
the
coverage required under Sections 356g.5, 356u, 356w, 356x,


21
356z.6, 356z.9, 356z.11, and 356z.12, 356z.13
and 356z.11, and 
22
356z.14, 356z.15, 356z.16, and 356z.17 of
the
Illinois 
23
Insurance Code.


24
(Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; 
 


 






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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, 12-12-08; revised 12-15-08.)

 
3
    Section 25. The Illinois Insurance Code is amended by 
4
adding Sections
356z.15,
356z.16,
and 356z.17
as
follows:


 
5
    (215 ILCS 5/356z.15 new)

6
    Sec. 356z.15. Intravenous feeding.   A group or individual 
7
policy of
accident and health insurance or managed care plan 
8
amended, delivered, issued,
or renewed after the effective date 
9
of this amendatory Act of the 96th General
Assembly must 
10
provide coverage for intravenous feeding.  The benefits under

11
this Section shall be at least as favorable as for other 
12
coverages under the
policy and may be subject to the same 
13
dollar amount limits, deductibles, and
co-insurance 
14
requirements applicable generally to other coverages under the

15
policy.
 
16
    (215 ILCS 5/356z.16 new)

17
    Sec. 356z.16. Prescription nutritional supplements. A 
18
group or individual
policy of
accident and health insurance or 
19
managed care plan amended, delivered, issued,
or renewed
after 
20
the effective date of this amendatory Act of the 96th General 
21
Assembly
that provides
coverage for prescription drugs must 
22
provide coverage for reimbursement for
medically
appropriate 
23
prescription nutritional supplements when ordered by a 
 


 






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1
physician
licensed to
practice medicine in all its branches and 
2
the insured suffers from a condition
that prevents
him or her 
3
from taking sufficient oral nourishment to sustain life.
 
4
    (215 ILCS 5/356z.17 new)

5
    Sec. 356z.17. Pain medication coverage. A group or 
6
individual policy
of accident and health insurance or managed 
7
care plan amended, delivered,
issued, or renewed after the 
8
effective date of this amendatory Act of the
96th General 
9
Assembly that provides coverage for prescription drugs must

10
provide coverage for any pain medication prescribed or ordered 
11
by the
insured's treating physician licensed to practice 
12
medicine in all its branches.

 
13
    Section 30. The Health Maintenance Organization Act is 
14
amended by changing
Section 5-3 as follows:


 


15
    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)

16
    (Text of Section before amendment by P.A. 95-958)

17
    Sec. 5-3. Insurance Code provisions. 

18
    (a) Health Maintenance Organizations
shall be subject to 
19
the provisions of Sections 133, 134, 137, 140, 141.1,
141.2, 
20
141.3, 143, 143c, 147, 148, 149, 151,
152, 153, 154, 154.5, 
21
154.6,
154.7, 154.8, 155.04, 355.2, 356m, 356v, 356w, 356x, 
22
356y,
356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 
23
356z.13
356z.11, 356z.14, 356z.15, 356z.16, 356z.17,
 364.01, 
 


 






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1
367.2, 367.2-5, 367i, 368a, 368b, 368c, 368d, 368e, 370c,
401, 
2
401.1, 402, 403, 403A,
408, 408.2, 409, 412, 444,
and
444.1,

3
paragraph (c) of subsection (2) of Section 367, and Articles 
4
IIA, VIII 1/2,
XII,
XII 1/2, XIII, XIII 1/2, XXV, and XXVI of 
5
the Illinois Insurance Code.

6
    (b) For purposes of the Illinois Insurance Code, except for 
7
Sections 444
and 444.1 and Articles XIII and XIII 1/2, Health 
8
Maintenance Organizations in
the following categories are 
9
deemed to be "domestic companies":


10
        (1) a corporation authorized under the
Dental Service 
11
    Plan Act or the Voluntary Health Services Plans Act;


12
        (2) a corporation organized under the laws of this 
13
    State; or


14
        (3) a corporation organized under the laws of another 
15
    state, 30% or more
of the enrollees of which are residents 
16
    of this State, except a
corporation subject to 
17
    substantially the same requirements in its state of

18
    organization as is a "domestic company" under Article VIII 
19
    1/2 of the
Illinois Insurance Code.

20
    (c) In considering the merger, consolidation, or other 
21
acquisition of
control of a Health Maintenance Organization 
22
pursuant to Article VIII 1/2
of the Illinois Insurance Code,


23
        (1) the Director shall give primary consideration to 
24
    the continuation of
benefits to enrollees and the financial 
25
    conditions of the acquired Health
Maintenance Organization 
26
    after the merger, consolidation, or other
acquisition of 
 


 






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    control takes effect;


2
        (2)(i) the criteria specified in subsection (1)(b) of 
3
    Section 131.8 of
the Illinois Insurance Code shall not 
4
    apply and (ii) the Director, in making
his determination 
5
    with respect to the merger, consolidation, or other

6
    acquisition of control, need not take into account the 
7
    effect on
competition of the merger, consolidation, or 
8
    other acquisition of control;


9
        (3) the Director shall have the power to require the 
10
    following
information:


11
            (A) certification by an independent actuary of the 
12
        adequacy
of the reserves of the Health Maintenance 
13
        Organization sought to be acquired;


14
            (B) pro forma financial statements reflecting the 
15
        combined balance
sheets of the acquiring company and 
16
        the Health Maintenance Organization sought
to be 
17
        acquired as of the end of the preceding year and as of 
18
        a date 90 days
prior to the acquisition, as well as pro 
19
        forma financial statements
reflecting projected 
20
        combined operation for a period of 2 years;


21
            (C) a pro forma business plan detailing an 
22
        acquiring party's plans with
respect to the operation 
23
        of the Health Maintenance Organization sought to
be 
24
        acquired for a period of not less than 3 years; and


25
            (D) such other information as the Director shall 
26
        require.

 


 






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    (d) The provisions of Article VIII 1/2 of the Illinois 
2
Insurance Code
and this Section 5-3 shall apply to the sale by 
3
any health maintenance
organization of greater than 10% of its

4
enrollee population (including without limitation the health 
5
maintenance
organization's right, title, and interest in and to 
6
its health care
certificates).

7
    (e) In considering any management contract or service 
8
agreement subject
to Section 141.1 of the Illinois Insurance 
9
Code, the Director (i) shall, in
addition to the criteria 
10
specified in Section 141.2 of the Illinois
Insurance Code, take 
11
into account the effect of the management contract or
service 
12
agreement on the continuation of benefits to enrollees and the

13
financial condition of the health maintenance organization to 
14
be managed or
serviced, and (ii) need not take into account the 
15
effect of the management
contract or service agreement on 
16
competition.

17
    (f) Except for small employer groups as defined in the 
18
Small Employer
Rating, Renewability and Portability Health 
19
Insurance Act and except for
medicare supplement policies as 
20
defined in Section 363 of the Illinois
Insurance Code, a Health 
21
Maintenance Organization may by contract agree with a
group or 
22
other enrollment unit to effect refunds or charge additional 
23
premiums
under the following terms and conditions:


24
        (i) the amount of, and other terms and conditions with 
25
    respect to, the
refund or additional premium are set forth 
26
    in the group or enrollment unit
contract agreed in advance 
 


 






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    of the period for which a refund is to be paid or

2
    additional premium is to be charged (which period shall not 
3
    be less than one
year); and


4
        (ii) the amount of the refund or additional premium 
5
    shall not exceed 20%
of the Health Maintenance 
6
    Organization's profitable or unprofitable experience
with 
7
    respect to the group or other enrollment unit for the 
8
    period (and, for
purposes of a refund or additional 
9
    premium, the profitable or unprofitable
experience shall 
10
    be calculated taking into account a pro rata share of the

11
    Health Maintenance Organization's administrative and 
12
    marketing expenses, but
shall not include any refund to be 
13
    made or additional premium to be paid
pursuant to this 
14
    subsection (f)).  The Health Maintenance Organization and 
15
    the
group or enrollment unit may agree that the profitable 
16
    or unprofitable
experience may be calculated taking into 
17
    account the refund period and the
immediately preceding 2 
18
    plan years.

19
    The Health Maintenance Organization shall include a 
20
statement in the
evidence of coverage issued to each enrollee 
21
describing the possibility of a
refund or additional premium, 
22
and upon request of any group or enrollment unit,
provide to 
23
the group or enrollment unit a description of the method used 
24
to
calculate (1) the Health Maintenance Organization's 
25
profitable experience with
respect to the group or enrollment 
26
unit and the resulting refund to the group
or enrollment unit 
 


 






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or (2) the Health Maintenance Organization's unprofitable

2
experience with respect to the group or enrollment unit and the 
3
resulting
additional premium to be paid by the group or 
4
enrollment unit.

5
    In no event shall the Illinois Health Maintenance 
6
Organization
Guaranty Association be liable to pay any 
7
contractual obligation of an
insolvent organization to pay any 
8
refund authorized under this Section.

9
(Source: P.A. 94-906, eff. 1-1-07; 94-1076, eff. 12-29-06; 
10
95-422, eff. 8-24-07; 95-520, eff. 8-28-07; 95-876, eff. 
11
8-21-08; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; revised 
12
12-15-08.)

 
13
    (Text of Section after amendment by P.A. 95-958)
14
    Sec. 5-3. Insurance Code provisions. 

15
    (a) Health Maintenance Organizations
shall be subject to 
16
the provisions of Sections 133, 134, 137, 140, 141.1,
141.2, 
17
141.3, 143, 143c, 147, 148, 149, 151,
152, 153, 154, 154.5, 
18
154.6,
154.7, 154.8, 155.04, 355.2, 356m, 356v, 356w, 356x, 
19
356y,
356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 
20
356z.11, 356z.12, 356z.13
356z.11, 356z.14, 356z.15, 356z.16, 
21
356z.17, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c, 368d, 
22
368e, 370c,
401, 401.1, 402, 403, 403A,
408, 408.2, 409, 412, 
23
444,
and
444.1,
paragraph (c) of subsection (2) of Section 367, 
24
and Articles IIA, VIII 1/2,
XII,
XII 1/2, XIII, XIII 1/2, XXV, 
25
and XXVI of the Illinois Insurance Code.

 


 






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    (b) For purposes of the Illinois Insurance Code, except for 
2
Sections 444
and 444.1 and Articles XIII and XIII 1/2, Health 
3
Maintenance Organizations in
the following categories are 
4
deemed to be "domestic companies":


5
        (1) a corporation authorized under the
Dental Service 
6
    Plan Act or the Voluntary Health Services Plans Act;


7
        (2) a corporation organized under the laws of this 
8
    State; or


9
        (3) a corporation organized under the laws of another 
10
    state, 30% or more
of the enrollees of which are residents 
11
    of this State, except a
corporation subject to 
12
    substantially the same requirements in its state of

13
    organization as is a "domestic company" under Article VIII 
14
    1/2 of the
Illinois Insurance Code.

15
    (c) In considering the merger, consolidation, or other 
16
acquisition of
control of a Health Maintenance Organization 
17
pursuant to Article VIII 1/2
of the Illinois Insurance Code,


18
        (1) the Director shall give primary consideration to 
19
    the continuation of
benefits to enrollees and the financial 
20
    conditions of the acquired Health
Maintenance Organization 
21
    after the merger, consolidation, or other
acquisition of 
22
    control takes effect;


23
        (2)(i) the criteria specified in subsection (1)(b) of 
24
    Section 131.8 of
the Illinois Insurance Code shall not 
25
    apply and (ii) the Director, in making
his determination 
26
    with respect to the merger, consolidation, or other

 


 






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    acquisition of control, need not take into account the 
2
    effect on
competition of the merger, consolidation, or 
3
    other acquisition of control;


4
        (3) the Director shall have the power to require the 
5
    following
information:


6
            (A) certification by an independent actuary of the 
7
        adequacy
of the reserves of the Health Maintenance 
8
        Organization sought to be acquired;


9
            (B) pro forma financial statements reflecting the 
10
        combined balance
sheets of the acquiring company and 
11
        the Health Maintenance Organization sought
to be 
12
        acquired as of the end of the preceding year and as of 
13
        a date 90 days
prior to the acquisition, as well as pro 
14
        forma financial statements
reflecting projected 
15
        combined operation for a period of 2 years;


16
            (C) a pro forma business plan detailing an 
17
        acquiring party's plans with
respect to the operation 
18
        of the Health Maintenance Organization sought to
be 
19
        acquired for a period of not less than 3 years; and


20
            (D) such other information as the Director shall 
21
        require.

22
    (d) The provisions of Article VIII 1/2 of the Illinois 
23
Insurance Code
and this Section 5-3 shall apply to the sale by 
24
any health maintenance
organization of greater than 10% of its

25
enrollee population (including without limitation the health 
26
maintenance
organization's right, title, and interest in and to 
 


 






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its health care
certificates).

2
    (e) In considering any management contract or service 
3
agreement subject
to Section 141.1 of the Illinois Insurance 
4
Code, the Director (i) shall, in
addition to the criteria 
5
specified in Section 141.2 of the Illinois
Insurance Code, take 
6
into account the effect of the management contract or
service 
7
agreement on the continuation of benefits to enrollees and the

8
financial condition of the health maintenance organization to 
9
be managed or
serviced, and (ii) need not take into account the 
10
effect of the management
contract or service agreement on 
11
competition.

12
    (f) Except for small employer groups as defined in the 
13
Small Employer
Rating, Renewability and Portability Health 
14
Insurance Act and except for
medicare supplement policies as 
15
defined in Section 363 of the Illinois
Insurance Code, a Health 
16
Maintenance Organization may by contract agree with a
group or 
17
other enrollment unit to effect refunds or charge additional 
18
premiums
under the following terms and conditions:


19
        (i) the amount of, and other terms and conditions with 
20
    respect to, the
refund or additional premium are set forth 
21
    in the group or enrollment unit
contract agreed in advance 
22
    of the period for which a refund is to be paid or

23
    additional premium is to be charged (which period shall not 
24
    be less than one
year); and


25
        (ii) the amount of the refund or additional premium 
26
    shall not exceed 20%
of the Health Maintenance 
 


 






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    Organization's profitable or unprofitable experience
with 
2
    respect to the group or other enrollment unit for the 
3
    period (and, for
purposes of a refund or additional 
4
    premium, the profitable or unprofitable
experience shall 
5
    be calculated taking into account a pro rata share of the

6
    Health Maintenance Organization's administrative and 
7
    marketing expenses, but
shall not include any refund to be 
8
    made or additional premium to be paid
pursuant to this 
9
    subsection (f)).  The Health Maintenance Organization and 
10
    the
group or enrollment unit may agree that the profitable 
11
    or unprofitable
experience may be calculated taking into 
12
    account the refund period and the
immediately preceding 2 
13
    plan years.

14
    The Health Maintenance Organization shall include a 
15
statement in the
evidence of coverage issued to each enrollee 
16
describing the possibility of a
refund or additional premium, 
17
and upon request of any group or enrollment unit,
provide to 
18
the group or enrollment unit a description of the method used 
19
to
calculate (1) the Health Maintenance Organization's 
20
profitable experience with
respect to the group or enrollment 
21
unit and the resulting refund to the group
or enrollment unit 
22
or (2) the Health Maintenance Organization's unprofitable

23
experience with respect to the group or enrollment unit and the 
24
resulting
additional premium to be paid by the group or 
25
enrollment unit.

26
    In no event shall the Illinois Health Maintenance 
 


 






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Organization
Guaranty Association be liable to pay any 
2
contractual obligation of an
insolvent organization to pay any 
3
refund authorized under this Section.

4
(Source: P.A. 94-906, eff. 1-1-07; 94-1076, eff. 12-29-06; 
5
95-422, eff. 8-24-07; 95-520, eff. 8-28-07; 95-876, eff. 
6
8-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09; 95-1005, 
7
eff. 12-12-08; revised 12-15-08.)


 
8
    Section 35. The Voluntary Health Services Plans Act is 
9
amended by changing
Section 10 as follows:


 


10
    (215 ILCS 165/10)  (from Ch. 32, par. 604)

11
    (Text of Section before amendment by P.A. 95-958)

12
    Sec. 10. Application of Insurance Code provisions. Health 
13
services
plan corporations and all persons interested therein 
14
or dealing therewith
shall be subject to the provisions of 
15
Articles IIA and XII 1/2 and Sections
3.1, 133, 140, 143, 143c, 
16
149, 155.37, 354, 355.2, 356g.5, 356r, 356t, 356u, 356v,
356w, 
17
356x, 356y, 356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 
18
356z.9,
356z.10, 356z.13
356z.11, 356z.14, 356z.15, 356z.16, 
19
356z.17,
 364.01, 367.2, 368a, 401, 401.1,
402,
403, 403A, 408,

20
408.2, and 412, and paragraphs (7) and (15) of Section 367 of 
21
the Illinois
Insurance Code.

22
(Source: P.A. 94-1076, eff. 12-29-06; 95-189, eff. 8-16-07; 
23
95-331, eff. 8-21-07; 95-422, eff. 8-24-07; 95-520, eff. 
24
8-28-07; 95-876, eff. 8-21-08; 95-978, eff. 1-1-09; 95-1005, 
 


 






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eff. 12-12-08; revised 12-15-08.)

 
2
    (Text of Section after amendment by P.A. 95-958)
3
    Sec. 10. Application of Insurance Code provisions. Health 
4
services
plan corporations and all persons interested therein 
5
or dealing therewith
shall be subject to the provisions of 
6
Articles IIA and XII 1/2 and Sections
3.1, 133, 140, 143, 143c, 
7
149, 155.37, 354, 355.2, 356g.5, 356r, 356t, 356u, 356v,
356w, 
8
356x, 356y, 356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 
9
356z.9,
356z.10, 356z.11, 356z.12, 356z.13
356z.11, 356z.14, 
10
356z.15, 356z.16, 356z.17, 364.01, 367.2, 368a, 401, 401.1,

11
402,
403, 403A, 408,
408.2, and 412, and paragraphs (7) and 
12
(15) of Section 367 of the Illinois
Insurance Code.

13
(Source: P.A. 94-1076, eff. 12-29-06; 95-189, eff. 8-16-07; 
14
95-331, eff. 8-21-07; 95-422, eff. 8-24-07; 95-520, eff. 
15
8-28-07; 95-876, eff. 8-21-08; 95-958, eff. 6-1-09; 95-978, 
16
eff. 1-1-09; 95-1005, eff. 12-12-08; revised 12-15-08.)


 
17
    Section 90. The State Mandates Act is amended by adding 
18
Section 8.33 as follows:
 
19
    (30 ILCS 805/8.33 new)
20
    Sec. 8.33. Exempt mandate. Notwithstanding Sections 6 and 8 
21
of this Act, no reimbursement by the State is required for the 
22
implementation of any mandate created by this amendatory Act of 
23
the 96th General Assembly.
 
 


 






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    Section 95. No acceleration or delay. Where this Act makes 
2
changes in a statute that is represented in this Act by text 
3
that is not yet or no longer in effect (for example, a Section 
4
represented by multiple versions), the use of that text does 
5
not accelerate or delay the taking effect of (i) the changes 
6
made by this Act or (ii) provisions derived from any other 
7
Public Act.