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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 , and 356z.15
of the
Illinois | ||||||||||||||||||||||||||||||||||||||
16 | Insurance Code.
The program of health benefits must comply with | ||||||||||||||||||||||||||||||||||||||
17 | 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 |
| |||||||
| |||||||
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.9, 356z.10, | ||||||
7 | 356z.11, and 356z.12 , 356z.13
356z.11 , and 356z.14 , and 356z.15 | ||||||
8 | of 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.9, |
| |||||||
| |||||||
1 | 356z.10, 356z.13
356z.11 , and 356z.14 , and 356z.15 of
the | ||||||
2 | Illinois Insurance Code. The requirement that health benefits | ||||||
3 | be covered
as provided in this Section is an
exclusive power | ||||||
4 | and function of the State and is a denial and limitation under
| ||||||
5 | Article VII, Section 6, subsection (h) of the Illinois | ||||||
6 | Constitution. A home
rule county to which this Section applies | ||||||
7 | must comply with 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.9, | ||||||
19 | 356z.10, 356z.11, and 356z.12 , 356z.13
356z.11 , and 356z.14 , | ||||||
20 | and 356z.15 of
the Illinois Insurance Code. The requirement | ||||||
21 | that health benefits be covered
as provided in this Section is | ||||||
22 | an
exclusive power and function of the State and is a denial | ||||||
23 | and limitation under
Article VII, Section 6, subsection (h) of | ||||||
24 | the Illinois Constitution. A home
rule county to which this | ||||||
25 | Section applies must comply with every provision of
this |
| |||||||
| |||||||
1 | 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; 95-958, eff. | ||||||
4 | 6-1-09; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; revised | ||||||
5 | 12-15-08.)
| ||||||
6 | Section 15. The Illinois Municipal Code is amended by | ||||||
7 | changing Section 10-4-2.3 as follows: | ||||||
8 | (65 ILCS 5/10-4-2.3)
| ||||||
9 | (Text of Section before amendment by P.A. 95-958 )
| ||||||
10 | Sec. 10-4-2.3. Required health benefits. If a | ||||||
11 | municipality, including a
home rule municipality, is a | ||||||
12 | self-insurer for purposes of providing health
insurance | ||||||
13 | coverage for its employees, the coverage shall include coverage | ||||||
14 | for
the post-mastectomy care benefits required to be covered by | ||||||
15 | a policy of
accident and health insurance under Section 356t | ||||||
16 | and the coverage required
under Sections 356g.5, 356u, 356w, | ||||||
17 | 356x, 356z.6, 356z.9, 356z.10, 356z.13
356z.11 , and 356z.14 , | ||||||
18 | and 356z.15 of the Illinois
Insurance
Code. The requirement | ||||||
19 | that health
benefits be covered as provided in this is an | ||||||
20 | exclusive power and function of
the State and is a denial and | ||||||
21 | limitation under Article VII, Section 6,
subsection (h) of the | ||||||
22 | Illinois Constitution. A home rule municipality to which
this | ||||||
23 | Section applies must comply with every provision of this | ||||||
24 | Section.
|
| |||||||
| |||||||
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; 95-978, eff. | ||||||
3 | 1-1-09; 95-1005, eff. 12-12-08; revised 12-15-08.)
| ||||||
4 | (Text of Section after amendment by P.A. 95-958 ) | ||||||
5 | Sec. 10-4-2.3. Required health benefits. If a | ||||||
6 | municipality, including a
home rule municipality, is a | ||||||
7 | self-insurer for purposes of providing health
insurance | ||||||
8 | coverage for its employees, the coverage shall include coverage | ||||||
9 | for
the post-mastectomy care benefits required to be covered by | ||||||
10 | a policy of
accident and health insurance under Section 356t | ||||||
11 | and the coverage required
under Sections 356g.5, 356u, 356w, | ||||||
12 | 356x, 356z.6, 356z.9, 356z.10, 356z.11, and 356z.12 , 356z.13
| ||||||
13 | 356z.11 , and 356z.14 , and 356z.15 of the Illinois
Insurance
| ||||||
14 | Code. The requirement that health
benefits be covered as | ||||||
15 | provided in this is an exclusive power and function of
the | ||||||
16 | State and is a denial and limitation under Article VII, Section | ||||||
17 | 6,
subsection (h) of the Illinois Constitution. A home rule | ||||||
18 | municipality to which
this Section applies must comply with | ||||||
19 | every provision of this Section.
| ||||||
20 | (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; | ||||||
21 | 95-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff. | ||||||
22 | 6-1-09; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; revised | ||||||
23 | 12-15-08.)
| ||||||
24 | Section 20. The School Code is amended by changing Section |
| |||||||
| |||||||
1 | 10-22.3f as follows: | ||||||
2 | (105 ILCS 5/10-22.3f)
| ||||||
3 | (Text of Section before amendment by P.A. 95-958 )
| ||||||
4 | Sec. 10-22.3f. Required health benefits. Insurance | ||||||
5 | protection and
benefits
for employees shall provide the | ||||||
6 | post-mastectomy care benefits required to be
covered by a | ||||||
7 | policy of accident and health insurance under Section 356t and | ||||||
8 | the
coverage required under Sections 356g.5, 356u, 356w, 356x,
| ||||||
9 | 356z.6, 356z.9, 356z.13 and 356z.11 , and 356z.14 , and 356z.15 | ||||||
10 | of
the
Illinois Insurance Code.
| ||||||
11 | (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; | ||||||
12 | 95-876, eff. 8-21-08; 95-978, eff. 1-1-09; 95-1005, eff. | ||||||
13 | 12-12-08; revised 12-15-08.)
| ||||||
14 | (Text of Section after amendment by P.A. 95-958 ) | ||||||
15 | Sec. 10-22.3f. Required health benefits. Insurance | ||||||
16 | protection and
benefits
for employees shall provide the | ||||||
17 | post-mastectomy care benefits required to be
covered by a | ||||||
18 | policy of accident and health insurance under Section 356t and | ||||||
19 | the
coverage required under Sections 356g.5, 356u, 356w, 356x,
| ||||||
20 | 356z.6, 356z.9, 356z.11, and 356z.12, 356z.13 and 356z.11 , and | ||||||
21 | 356z.14 , and 356z.15 of
the
Illinois Insurance Code.
| ||||||
22 | (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; | ||||||
23 | 95-876, eff. 8-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09; | ||||||
24 | 95-1005, 12-12-08; revised 12-15-08.)
|
| |||||||
| |||||||
1 | Section 25. The Illinois Insurance Code is amended by | ||||||
2 | adding Section 356z.15 as follows: | ||||||
3 | (215 ILCS 5/356z.15 new)
| ||||||
4 | Sec. 356z.15. Gestational surrogate coverage. A group or | ||||||
5 | individual policy of accident and health insurance or managed | ||||||
6 | care plan that provides maternity coverage and is amended, | ||||||
7 | delivered, issued, or renewed after the effective date of this | ||||||
8 | amendatory Act of the 96th General Assembly must, upon request | ||||||
9 | of an insured intended parent, provide maternity coverage for a | ||||||
10 | gestational surrogate as a dependent for a term that extends | ||||||
11 | throughout the duration of the expected pregnancy and for 8 | ||||||
12 | weeks after the birth of the child. | ||||||
13 | For the purposes of this Section, "intended parent" and | ||||||
14 | "gestational surrogate" shall have the meanings given to those | ||||||
15 | terms under the Gestational Surrogacy Act.
| ||||||
16 | Section 30. The Health Maintenance Organization Act is | ||||||
17 | amended by changing Section 5-3 as follows:
| ||||||
18 | (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
| ||||||
19 | (Text of Section before amendment by P.A. 95-958 )
| ||||||
20 | Sec. 5-3. Insurance Code provisions.
| ||||||
21 | (a) Health Maintenance Organizations
shall be subject to | ||||||
22 | the provisions of Sections 133, 134, 137, 140, 141.1,
141.2, |
| |||||||
| |||||||
1 | 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, 154, 154.5, | ||||||
2 | 154.6,
154.7, 154.8, 155.04, 355.2, 356m, 356v, 356w, 356x, | ||||||
3 | 356y,
356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10, | ||||||
4 | 356z.13
356z.11 , 356z.14, 356z.15,
364.01, 367.2, 367.2-5, | ||||||
5 | 367i, 368a, 368b, 368c, 368d, 368e, 370c,
401, 401.1, 402, 403, | ||||||
6 | 403A,
408, 408.2, 409, 412, 444,
and
444.1,
paragraph (c) of | ||||||
7 | subsection (2) of Section 367, and Articles IIA, VIII 1/2,
XII,
| ||||||
8 | XII 1/2, XIII, XIII 1/2, XXV, and XXVI of the Illinois | ||||||
9 | Insurance Code.
| ||||||
10 | (b) For purposes of the Illinois Insurance Code, except for | ||||||
11 | Sections 444
and 444.1 and Articles XIII and XIII 1/2, Health | ||||||
12 | Maintenance Organizations in
the following categories are | ||||||
13 | deemed to be "domestic companies":
| ||||||
14 | (1) a corporation authorized under the
Dental Service | ||||||
15 | Plan Act or the Voluntary Health Services Plans Act;
| ||||||
16 | (2) a corporation organized under the laws of this | ||||||
17 | State; or
| ||||||
18 | (3) a corporation organized under the laws of another | ||||||
19 | state, 30% or more
of the enrollees of which are residents | ||||||
20 | of this State, except a
corporation subject to | ||||||
21 | substantially the same requirements in its state of
| ||||||
22 | organization as is a "domestic company" under Article VIII | ||||||
23 | 1/2 of the
Illinois Insurance Code.
| ||||||
24 | (c) In considering the merger, consolidation, or other | ||||||
25 | acquisition of
control of a Health Maintenance Organization | ||||||
26 | pursuant to Article VIII 1/2
of the Illinois Insurance Code,
|
| |||||||
| |||||||
1 | (1) the Director shall give primary consideration to | ||||||
2 | the continuation of
benefits to enrollees and the financial | ||||||
3 | conditions of the acquired Health
Maintenance Organization | ||||||
4 | after the merger, consolidation, or other
acquisition of | ||||||
5 | control takes effect;
| ||||||
6 | (2)(i) the criteria specified in subsection (1)(b) of | ||||||
7 | Section 131.8 of
the Illinois Insurance Code shall not | ||||||
8 | apply and (ii) the Director, in making
his determination | ||||||
9 | with respect to the merger, consolidation, or other
| ||||||
10 | acquisition of control, need not take into account the | ||||||
11 | effect on
competition of the merger, consolidation, or | ||||||
12 | other acquisition of control;
| ||||||
13 | (3) the Director shall have the power to require the | ||||||
14 | following
information:
| ||||||
15 | (A) certification by an independent actuary of the | ||||||
16 | adequacy
of the reserves of the Health Maintenance | ||||||
17 | Organization sought to be acquired;
| ||||||
18 | (B) pro forma financial statements reflecting the | ||||||
19 | combined balance
sheets of the acquiring company and | ||||||
20 | the Health Maintenance Organization sought
to be | ||||||
21 | acquired as of the end of the preceding year and as of | ||||||
22 | a date 90 days
prior to the acquisition, as well as pro | ||||||
23 | forma financial statements
reflecting projected | ||||||
24 | combined operation for a period of 2 years;
| ||||||
25 | (C) a pro forma business plan detailing an | ||||||
26 | acquiring party's plans with
respect to the operation |
| |||||||
| |||||||
1 | of the Health Maintenance Organization sought to
be | ||||||
2 | acquired for a period of not less than 3 years; and
| ||||||
3 | (D) such other information as the Director shall | ||||||
4 | require.
| ||||||
5 | (d) The provisions of Article VIII 1/2 of the Illinois | ||||||
6 | Insurance Code
and this Section 5-3 shall apply to the sale by | ||||||
7 | any health maintenance
organization of greater than 10% of its
| ||||||
8 | enrollee population (including without limitation the health | ||||||
9 | maintenance
organization's right, title, and interest in and to | ||||||
10 | its health care
certificates).
| ||||||
11 | (e) In considering any management contract or service | ||||||
12 | agreement subject
to Section 141.1 of the Illinois Insurance | ||||||
13 | Code, the Director (i) shall, in
addition to the criteria | ||||||
14 | specified in Section 141.2 of the Illinois
Insurance Code, take | ||||||
15 | into account the effect of the management contract or
service | ||||||
16 | agreement on the continuation of benefits to enrollees and the
| ||||||
17 | financial condition of the health maintenance organization to | ||||||
18 | be managed or
serviced, and (ii) need not take into account the | ||||||
19 | effect of the management
contract or service agreement on | ||||||
20 | competition.
| ||||||
21 | (f) Except for small employer groups as defined in the | ||||||
22 | Small Employer
Rating, Renewability and Portability Health | ||||||
23 | Insurance Act and except for
medicare supplement policies as | ||||||
24 | defined in Section 363 of the Illinois
Insurance Code, a Health | ||||||
25 | Maintenance Organization may by contract agree with a
group or | ||||||
26 | other enrollment unit to effect refunds or charge additional |
| |||||||
| |||||||
1 | premiums
under the following terms and conditions:
| ||||||
2 | (i) the amount of, and other terms and conditions with | ||||||
3 | respect to, the
refund or additional premium are set forth | ||||||
4 | in the group or enrollment unit
contract agreed in advance | ||||||
5 | of the period for which a refund is to be paid or
| ||||||
6 | additional premium is to be charged (which period shall not | ||||||
7 | be less than one
year); and
| ||||||
8 | (ii) the amount of the refund or additional premium | ||||||
9 | shall not exceed 20%
of the Health Maintenance | ||||||
10 | Organization's profitable or unprofitable experience
with | ||||||
11 | respect to the group or other enrollment unit for the | ||||||
12 | period (and, for
purposes of a refund or additional | ||||||
13 | premium, the profitable or unprofitable
experience shall | ||||||
14 | be calculated taking into account a pro rata share of the
| ||||||
15 | Health Maintenance Organization's administrative and | ||||||
16 | marketing expenses, but
shall not include any refund to be | ||||||
17 | made or additional premium to be paid
pursuant to this | ||||||
18 | subsection (f)). The Health Maintenance Organization and | ||||||
19 | the
group or enrollment unit may agree that the profitable | ||||||
20 | or unprofitable
experience may be calculated taking into | ||||||
21 | account the refund period and the
immediately preceding 2 | ||||||
22 | plan years.
| ||||||
23 | The Health Maintenance Organization shall include a | ||||||
24 | statement in the
evidence of coverage issued to each enrollee | ||||||
25 | describing the possibility of a
refund or additional premium, | ||||||
26 | and upon request of any group or enrollment unit,
provide to |
| |||||||
| |||||||
1 | the group or enrollment unit a description of the method used | ||||||
2 | to
calculate (1) the Health Maintenance Organization's | ||||||
3 | profitable experience with
respect to the group or enrollment | ||||||
4 | unit and the resulting refund to the group
or enrollment unit | ||||||
5 | or (2) the Health Maintenance Organization's unprofitable
| ||||||
6 | experience with respect to the group or enrollment unit and the | ||||||
7 | resulting
additional premium to be paid by the group or | ||||||
8 | enrollment unit.
| ||||||
9 | In no event shall the Illinois Health Maintenance | ||||||
10 | Organization
Guaranty Association be liable to pay any | ||||||
11 | contractual obligation of an
insolvent organization to pay any | ||||||
12 | refund authorized under this Section.
| ||||||
13 | (Source: P.A. 94-906, eff. 1-1-07; 94-1076, eff. 12-29-06; | ||||||
14 | 95-422, eff. 8-24-07; 95-520, eff. 8-28-07; 95-876, eff. | ||||||
15 | 8-21-08; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; revised | ||||||
16 | 12-15-08.)
| ||||||
17 | (Text of Section after amendment by P.A. 95-958 ) | ||||||
18 | Sec. 5-3. Insurance Code provisions.
| ||||||
19 | (a) Health Maintenance Organizations
shall be subject to | ||||||
20 | the provisions of Sections 133, 134, 137, 140, 141.1,
141.2, | ||||||
21 | 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, 154, 154.5, | ||||||
22 | 154.6,
154.7, 154.8, 155.04, 355.2, 356m, 356v, 356w, 356x, | ||||||
23 | 356y,
356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10, | ||||||
24 | 356z.11, 356z.12 , 356z.13
356z.11 , 356z.14, 356z.15, 364.01, | ||||||
25 | 367.2, 367.2-5, 367i, 368a, 368b, 368c, 368d, 368e, 370c,
401, |
| |||||||
| |||||||
1 | 401.1, 402, 403, 403A,
408, 408.2, 409, 412, 444,
and
444.1,
| ||||||
2 | paragraph (c) of subsection (2) of Section 367, and Articles | ||||||
3 | IIA, VIII 1/2,
XII,
XII 1/2, XIII, XIII 1/2, XXV, and XXVI of | ||||||
4 | the Illinois Insurance Code.
| ||||||
5 | (b) For purposes of the Illinois Insurance Code, except for | ||||||
6 | Sections 444
and 444.1 and Articles XIII and XIII 1/2, Health | ||||||
7 | Maintenance Organizations in
the following categories are | ||||||
8 | deemed to be "domestic companies":
| ||||||
9 | (1) a corporation authorized under the
Dental Service | ||||||
10 | Plan Act or the Voluntary Health Services Plans Act;
| ||||||
11 | (2) a corporation organized under the laws of this | ||||||
12 | State; or
| ||||||
13 | (3) a corporation organized under the laws of another | ||||||
14 | state, 30% or more
of the enrollees of which are residents | ||||||
15 | of this State, except a
corporation subject to | ||||||
16 | substantially the same requirements in its state of
| ||||||
17 | organization as is a "domestic company" under Article VIII | ||||||
18 | 1/2 of the
Illinois Insurance Code.
| ||||||
19 | (c) In considering the merger, consolidation, or other | ||||||
20 | acquisition of
control of a Health Maintenance Organization | ||||||
21 | pursuant to Article VIII 1/2
of the Illinois Insurance Code,
| ||||||
22 | (1) the Director shall give primary consideration to | ||||||
23 | the continuation of
benefits to enrollees and the financial | ||||||
24 | conditions of the acquired Health
Maintenance Organization | ||||||
25 | after the merger, consolidation, or other
acquisition of | ||||||
26 | control takes effect;
|
| |||||||
| |||||||
1 | (2)(i) the criteria specified in subsection (1)(b) of | ||||||
2 | Section 131.8 of
the Illinois Insurance Code shall not | ||||||
3 | apply and (ii) the Director, in making
his determination | ||||||
4 | with respect to the merger, consolidation, or other
| ||||||
5 | acquisition of control, need not take into account the | ||||||
6 | effect on
competition of the merger, consolidation, or | ||||||
7 | other acquisition of control;
| ||||||
8 | (3) the Director shall have the power to require the | ||||||
9 | following
information:
| ||||||
10 | (A) certification by an independent actuary of the | ||||||
11 | adequacy
of the reserves of the Health Maintenance | ||||||
12 | Organization sought to be acquired;
| ||||||
13 | (B) pro forma financial statements reflecting the | ||||||
14 | combined balance
sheets of the acquiring company and | ||||||
15 | the Health Maintenance Organization sought
to be | ||||||
16 | acquired as of the end of the preceding year and as of | ||||||
17 | a date 90 days
prior to the acquisition, as well as pro | ||||||
18 | forma financial statements
reflecting projected | ||||||
19 | combined operation for a period of 2 years;
| ||||||
20 | (C) a pro forma business plan detailing an | ||||||
21 | acquiring party's plans with
respect to the operation | ||||||
22 | of the Health Maintenance Organization sought to
be | ||||||
23 | acquired for a period of not less than 3 years; and
| ||||||
24 | (D) such other information as the Director shall | ||||||
25 | require.
| ||||||
26 | (d) The provisions of Article VIII 1/2 of the Illinois |
| |||||||
| |||||||
1 | Insurance Code
and this Section 5-3 shall apply to the sale by | ||||||
2 | any health maintenance
organization of greater than 10% of its
| ||||||
3 | enrollee population (including without limitation the health | ||||||
4 | maintenance
organization's right, title, and interest in and to | ||||||
5 | its health care
certificates).
| ||||||
6 | (e) In considering any management contract or service | ||||||
7 | agreement subject
to Section 141.1 of the Illinois Insurance | ||||||
8 | Code, the Director (i) shall, in
addition to the criteria | ||||||
9 | specified in Section 141.2 of the Illinois
Insurance Code, take | ||||||
10 | into account the effect of the management contract or
service | ||||||
11 | agreement on the continuation of benefits to enrollees and the
| ||||||
12 | financial condition of the health maintenance organization to | ||||||
13 | be managed or
serviced, and (ii) need not take into account the | ||||||
14 | effect of the management
contract or service agreement on | ||||||
15 | competition.
| ||||||
16 | (f) Except for small employer groups as defined in the | ||||||
17 | Small Employer
Rating, Renewability and Portability Health | ||||||
18 | Insurance Act and except for
medicare supplement policies as | ||||||
19 | defined in Section 363 of the Illinois
Insurance Code, a Health | ||||||
20 | Maintenance Organization may by contract agree with a
group or | ||||||
21 | other enrollment unit to effect refunds or charge additional | ||||||
22 | premiums
under the following terms and conditions:
| ||||||
23 | (i) the amount of, and other terms and conditions with | ||||||
24 | respect to, the
refund or additional premium are set forth | ||||||
25 | in the group or enrollment unit
contract agreed in advance | ||||||
26 | of the period for which a refund is to be paid or
|
| |||||||
| |||||||
1 | additional premium is to be charged (which period shall not | ||||||
2 | be less than one
year); and
| ||||||
3 | (ii) the amount of the refund or additional premium | ||||||
4 | shall not exceed 20%
of the Health Maintenance | ||||||
5 | Organization's profitable or unprofitable experience
with | ||||||
6 | respect to the group or other enrollment unit for the | ||||||
7 | period (and, for
purposes of a refund or additional | ||||||
8 | premium, the profitable or unprofitable
experience shall | ||||||
9 | be calculated taking into account a pro rata share of the
| ||||||
10 | Health Maintenance Organization's administrative and | ||||||
11 | marketing expenses, but
shall not include any refund to be | ||||||
12 | made or additional premium to be paid
pursuant to this | ||||||
13 | subsection (f)). The Health Maintenance Organization and | ||||||
14 | the
group or enrollment unit may agree that the profitable | ||||||
15 | or unprofitable
experience may be calculated taking into | ||||||
16 | account the refund period and the
immediately preceding 2 | ||||||
17 | plan years.
| ||||||
18 | The Health Maintenance Organization shall include a | ||||||
19 | statement in the
evidence of coverage issued to each enrollee | ||||||
20 | describing the possibility of a
refund or additional premium, | ||||||
21 | and upon request of any group or enrollment unit,
provide to | ||||||
22 | the group or enrollment unit a description of the method used | ||||||
23 | to
calculate (1) the Health Maintenance Organization's | ||||||
24 | profitable experience with
respect to the group or enrollment | ||||||
25 | unit and the resulting refund to the group
or enrollment unit | ||||||
26 | or (2) the Health Maintenance Organization's unprofitable
|
| |||||||
| |||||||
1 | experience with respect to the group or enrollment unit and the | ||||||
2 | resulting
additional premium to be paid by the group or | ||||||
3 | enrollment unit.
| ||||||
4 | In no event shall the Illinois Health Maintenance | ||||||
5 | Organization
Guaranty Association be liable to pay any | ||||||
6 | contractual obligation of an
insolvent organization to pay any | ||||||
7 | refund authorized under this Section.
| ||||||
8 | (Source: P.A. 94-906, eff. 1-1-07; 94-1076, eff. 12-29-06; | ||||||
9 | 95-422, eff. 8-24-07; 95-520, eff. 8-28-07; 95-876, eff. | ||||||
10 | 8-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09; 95-1005, | ||||||
11 | eff. 12-12-08; revised 12-15-08.)
| ||||||
12 | Section 35. The Voluntary Health Services Plans Act is | ||||||
13 | amended by changing Section 10 as follows:
| ||||||
14 | (215 ILCS 165/10) (from Ch. 32, par. 604)
| ||||||
15 | (Text of Section before amendment by P.A. 95-958 )
| ||||||
16 | Sec. 10. Application of Insurance Code provisions. Health | ||||||
17 | services
plan corporations and all persons interested therein | ||||||
18 | or dealing therewith
shall be subject to the provisions of | ||||||
19 | Articles IIA and XII 1/2 and Sections
3.1, 133, 140, 143, 143c, | ||||||
20 | 149, 155.37, 354, 355.2, 356g.5, 356r, 356t, 356u, 356v,
356w, | ||||||
21 | 356x, 356y, 356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, | ||||||
22 | 356z.9,
356z.10, 356z.13
356z.11 , 356z.14, 356z.15,
364.01, | ||||||
23 | 367.2, 368a, 401, 401.1,
402,
403, 403A, 408,
408.2, and 412, | ||||||
24 | and paragraphs (7) and (15) of Section 367 of the Illinois
|
| |||||||
| |||||||
1 | Insurance Code.
| ||||||
2 | (Source: P.A. 94-1076, eff. 12-29-06; 95-189, eff. 8-16-07; | ||||||
3 | 95-331, eff. 8-21-07; 95-422, eff. 8-24-07; 95-520, eff. | ||||||
4 | 8-28-07; 95-876, eff. 8-21-08; 95-978, eff. 1-1-09; 95-1005, | ||||||
5 | eff. 12-12-08; revised 12-15-08.)
| ||||||
6 | (Text of Section after amendment by P.A. 95-958 ) | ||||||
7 | Sec. 10. Application of Insurance Code provisions. Health | ||||||
8 | services
plan corporations and all persons interested therein | ||||||
9 | or dealing therewith
shall be subject to the provisions of | ||||||
10 | Articles IIA and XII 1/2 and Sections
3.1, 133, 140, 143, 143c, | ||||||
11 | 149, 155.37, 354, 355.2, 356g.5, 356r, 356t, 356u, 356v,
356w, | ||||||
12 | 356x, 356y, 356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, | ||||||
13 | 356z.9,
356z.10, 356z.11, 356z.12 , 356z.13
356z.11 , 356z.14, | ||||||
14 | 356z.15, 364.01, 367.2, 368a, 401, 401.1,
402,
403, 403A, 408,
| ||||||
15 | 408.2, and 412, and paragraphs (7) and (15) of Section 367 of | ||||||
16 | the Illinois
Insurance Code.
| ||||||
17 | (Source: P.A. 94-1076, eff. 12-29-06; 95-189, eff. 8-16-07; | ||||||
18 | 95-331, eff. 8-21-07; 95-422, eff. 8-24-07; 95-520, eff. | ||||||
19 | 8-28-07; 95-876, eff. 8-21-08; 95-958, eff. 6-1-09; 95-978, | ||||||
20 | eff. 1-1-09; 95-1005, eff. 12-12-08; revised 12-15-08.)
| ||||||
21 | Section 40. The Illinois Public Aid Code is amended by | ||||||
22 | changing Section 5-16.8 as follows:
| ||||||
23 | (305 ILCS 5/5-16.8)
|
| |||||||
| |||||||
1 | Sec. 5-16.8. Required health benefits. The medical | ||||||
2 | assistance program
shall
(i) provide the post-mastectomy care | ||||||
3 | benefits required to be covered by a policy of
accident and | ||||||
4 | health insurance under Section 356t and the coverage required
| ||||||
5 | under Sections 356g.5, 356u, 356w, 356x, and 356z.6 , and | ||||||
6 | 356z.15 of the Illinois
Insurance Code and (ii) be subject to | ||||||
7 | the provisions of Section 364.01 of the Illinois
Insurance | ||||||
8 | Code.
| ||||||
9 | (Source: P.A. 95-189, eff. 8-16-07; 95-331, eff. 8-21-07.)
| ||||||
10 | Section 95. No acceleration or delay. Where this Act makes | ||||||
11 | changes in a statute that is represented in this Act by text | ||||||
12 | that is not yet or no longer in effect (for example, a Section | ||||||
13 | represented by multiple versions), the use of that text does | ||||||
14 | not accelerate or delay the taking effect of (i) the changes | ||||||
15 | made by this Act or (ii) provisions derived from any other | ||||||
16 | Public Act.
| ||||||
17 | Section 99. Effective date. This Act takes effect upon | ||||||
18 | becoming law.
|