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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 356f.1, | |||||||||||||||||||||||||||||||||||
14 | 356g.5,
356u, 356w, 356x, 356z.2, 356z.4, 356z.6, 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 |
| |||||||
| |||||||
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 356f.1, | ||||||
6 | 356g.5,
356u, 356w, 356x, 356z.2, 356z.4, 356z.6, 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 356f.1, 356g.5, 356u,
356w, 356x, 356z.6, |
| |||||||
| |||||||
1 | 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 356f.1, 356g.5, 356u,
356w, 356x, 356z.6, | ||||||
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.
|
| |||||||
| |||||||
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 356f.1, 356g.5, 356u, | ||||||
16 | 356w, 356x, 356z.6, 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. |
| |||||||
| |||||||
1 | 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 356f.1, 356g.5, 356u, | ||||||
10 | 356w, 356x, 356z.6, 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: |
| |||||||
| |||||||
1 | (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 356f.1, 356g.5, 356u, | ||||||
8 | 356w, 356x,
356z.6, 356z.9, 356z.13
and 356z.11 , and 356z.14 of
| ||||||
9 | the
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 356f.1, 356g.5, 356u, | ||||||
19 | 356w, 356x,
356z.6, 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 |
| |||||||
| |||||||
1 | adding Section 356f.1 as follows: | ||||||
2 | (215 ILCS 5/356f.1 new) | ||||||
3 | Sec. 356f.1. Health care services appeals,
complaints, and
| ||||||
4 | external independent reviews. | ||||||
5 | (a) A policy of accident or health insurance or managed | ||||||
6 | care plan shall establish and maintain an appeals procedure as
| ||||||
7 | outlined in this Section. Compliance with this Section's | ||||||
8 | appeals procedures shall
satisfy a policy or plan's obligation | ||||||
9 | to provide appeal procedures under any
other State law or | ||||||
10 | rules. | ||||||
11 | (b) When an appeal concerns a decision or action by a | ||||||
12 | policy of accident or health insurance or managed care plan,
| ||||||
13 | its
employees, or its subcontractors that relates to (i) health | ||||||
14 | care services,
including, but not limited to, procedures or
| ||||||
15 | treatments
for an enrollee with an ongoing course of treatment | ||||||
16 | ordered
by a health care provider,
the denial of which could | ||||||
17 | significantly
increase the risk to an
enrollee's health,
or | ||||||
18 | (ii) a treatment referral, service,
procedure, or other health | ||||||
19 | care service,
the denial of which could significantly
increase | ||||||
20 | the risk to an
enrollee's health, or (iii) the non-renewal or | ||||||
21 | termination of a plan,
the policy or plan must allow for the | ||||||
22 | filing of an appeal
either orally or in writing. Upon | ||||||
23 | submission of the appeal, a policy or plan
must notify the | ||||||
24 | party filing the appeal, as soon as possible, but in no event
| ||||||
25 | more than 24 hours after the submission of the appeal, of all |
| |||||||
| |||||||
1 | information
that the plan requires to evaluate the appeal.
The | ||||||
2 | policy or plan shall render a decision on the appeal within
24 | ||||||
3 | hours after receipt of the required information. The policy or | ||||||
4 | plan shall
notify the party filing the
appeal and the enrollee, | ||||||
5 | enrollee's primary care physician, and any health care
provider | ||||||
6 | who recommended the health care service involved in the appeal | ||||||
7 | of its
decision orally
followed-up by a written notice of the | ||||||
8 | determination. | ||||||
9 | (c) For all appeals related to health care services | ||||||
10 | including, but not
limited to, procedures or treatments for an | ||||||
11 | enrollee and not covered by
subsection (b) above, the policy or | ||||||
12 | plan shall establish a procedure for the filing of such | ||||||
13 | appeals. Upon
submission of an appeal under this subsection, a | ||||||
14 | policy or plan must notify
the party filing an appeal, within 3 | ||||||
15 | business days, of all information that the
policy or plan | ||||||
16 | requires to evaluate the appeal.
The policy or plan shall | ||||||
17 | render a decision on the appeal within 15 business
days after | ||||||
18 | receipt of the required information. The policy or plan shall
| ||||||
19 | notify the party filing the appeal,
the enrollee, the | ||||||
20 | enrollee's primary care physician, and any health care
provider
| ||||||
21 | who recommended the health care service involved in the appeal | ||||||
22 | orally of its
decision followed-up by a written notice of the | ||||||
23 | determination. | ||||||
24 | (d) An appeal under subsection (b) or (c) may be filed by | ||||||
25 | the
enrollee, the enrollee's designee or guardian, the | ||||||
26 | enrollee's primary care
physician, or the enrollee's health |
| |||||||
| |||||||
1 | care provider. A policy or plan shall
designate a clinical peer | ||||||
2 | to review
appeals, because these appeals pertain to medical or | ||||||
3 | clinical matters
and such an appeal must be reviewed by an | ||||||
4 | appropriate
health care professional. No one reviewing an | ||||||
5 | appeal may have had any
involvement
in the initial | ||||||
6 | determination that is the subject of the appeal. The written
| ||||||
7 | notice of determination required under subsections (b) and (c) | ||||||
8 | shall
include (i) clear and detailed reasons for the | ||||||
9 | determination, (ii)
the medical or
clinical criteria for the | ||||||
10 | determination, which shall be based upon sound
clinical | ||||||
11 | evidence and reviewed on a periodic basis, and (iii) in the | ||||||
12 | case of an
adverse determination, the
procedures for requesting | ||||||
13 | an external independent review under subsection (f). | ||||||
14 | (e) If an appeal filed under subsection (b) or (c) is | ||||||
15 | denied for a reason
including, but not limited to, the
service, | ||||||
16 | procedure, or treatment is not viewed as medically necessary,
| ||||||
17 | denial of specific tests or procedures, denial of referral
to | ||||||
18 | specialist physicians or denial of hospitalization requests or | ||||||
19 | length of
stay requests, any involved party may request an | ||||||
20 | external independent review
under subsection (f) of the adverse | ||||||
21 | determination. | ||||||
22 | (f) The party seeking an external independent review shall | ||||||
23 | so notify the
policy or plan.
The policy or plan shall seek to | ||||||
24 | resolve all
external independent
reviews in the most | ||||||
25 | expeditious manner and shall make a determination and
provide | ||||||
26 | notice of the determination no more
than 24 hours after the |
| |||||||
| |||||||
1 | receipt of all necessary information when a delay would
| ||||||
2 | significantly increase
the risk to an enrollee's health or when | ||||||
3 | extended health care services for an
enrollee undergoing a
| ||||||
4 | course of treatment prescribed by a health care provider are at | ||||||
5 | issue. | ||||||
6 | (1) Within 30 days after the enrollee receives written | ||||||
7 | notice of an
adverse
determination,
if the enrollee decides | ||||||
8 | to initiate an external independent review, the
enrollee | ||||||
9 | shall send to the policy or plan a written request for an | ||||||
10 | external independent review, including any
information or
| ||||||
11 | documentation to support the enrollee's request for the | ||||||
12 | covered service or
claim for a covered
service. | ||||||
13 | (2) Within 30 days after the policy or plan receives a | ||||||
14 | request for an
external
independent review from an enrollee | ||||||
15 | or, within 24 hours after the receipt of a request if a | ||||||
16 | delay would significantly increase the risk to the | ||||||
17 | enrollee's health, the policy or plan shall: | ||||||
18 | (a) provide a mechanism for joint selection of an | ||||||
19 | external independent
reviewer by the enrollee, the | ||||||
20 | enrollee's physician or other health care
provider,
| ||||||
21 | and the policy or plan; and | ||||||
22 | (b) forward to the independent reviewer all | ||||||
23 | medical records and
supporting
documentation | ||||||
24 | pertaining to the case, a summary description of the | ||||||
25 | applicable
issues including a
statement of the | ||||||
26 | decision made by, the criteria used, and the
medical |
| |||||||
| |||||||
1 | and clinical reasons
for that decision. | ||||||
2 | (3) Within 5 days after receipt of all necessary | ||||||
3 | information or within 24 hours when a delay would
| ||||||
4 | significantly increase
the risk to an enrollee's health, | ||||||
5 | the
independent
reviewer
shall evaluate and analyze the | ||||||
6 | case and render a decision that is based on
whether or not | ||||||
7 | the health
care service or claim for the health care | ||||||
8 | service is medically appropriate. The
decision by the
| ||||||
9 | independent reviewer is final. If the external independent | ||||||
10 | reviewer determines
the health care
service to be medically
| ||||||
11 | appropriate, the policy or plan shall pay for the health | ||||||
12 | care service. | ||||||
13 | (4) The policy or plan shall be solely responsible for | ||||||
14 | paying the fees
of the external
independent reviewer who is | ||||||
15 | selected to perform the review. | ||||||
16 | (5) An external independent reviewer who acts in good | ||||||
17 | faith shall have
immunity
from any civil or criminal | ||||||
18 | liability or professional discipline as a result of
acts or | ||||||
19 | omissions with
respect to any external independent review, | ||||||
20 | unless the acts or omissions
constitute wilful and wanton
| ||||||
21 | misconduct. For purposes of any proceeding, the good faith | ||||||
22 | of the person
participating shall be
presumed. | ||||||
23 | (6) Future contractual or employment action by the | ||||||
24 | policy or plan
regarding the
patient's physician or other | ||||||
25 | health care provider shall not be based solely on
the | ||||||
26 | physician's or other
health care provider's participation |
| |||||||
| |||||||
1 | in this procedure. | ||||||
2 | (7) For the purposes of this Section, an external | ||||||
3 | independent reviewer
shall: | ||||||
4 | (a) be a clinical peer; | ||||||
5 | (b) have no direct financial interest in | ||||||
6 | connection with the case; and | ||||||
7 | (c) have not been informed of the specific identity | ||||||
8 | of the enrollee. | ||||||
9 | (g) Nothing in this Section shall be construed to require a | ||||||
10 | policy or
plan to pay for a health care service not covered | ||||||
11 | under the enrollee's
certificate of coverage or policy. | ||||||
12 | (h) A policy of accident or health insurance or managed | ||||||
13 | care plan shall provide each enrollee, prospective enrollee, | ||||||
14 | and enrollee representative with written notification of the | ||||||
15 | policy's or plan's appeal process and any external review | ||||||
16 | appeals process that is available to the enrollee. This | ||||||
17 | notification shall be provided at the time the insured enrolls | ||||||
18 | in the health insurance or managed care plan, renews such | ||||||
19 | enrollment, or requests to reverse or modify an adverse | ||||||
20 | determination made by the insurer or managed care plan.
The | ||||||
21 | notice outlined in this subsection (h) shall describe the | ||||||
22 | policy's or plan's appeals process, any applicable forms, and | ||||||
23 | the time frames for appeals, complaints, and external review | ||||||
24 | appeals and shall include a phone number to call for more | ||||||
25 | information from the policy or plan concerning the appeals | ||||||
26 | process.
|
| |||||||
| |||||||
1 | Section 30. The Health Maintenance Organization Act is | ||||||
2 | amended by changing Section 5-3 as follows:
| ||||||
3 | (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
| ||||||
4 | (Text of Section before amendment by P.A. 95-958 )
| ||||||
5 | Sec. 5-3. Insurance Code provisions.
| ||||||
6 | (a) Health Maintenance Organizations
shall be subject to | ||||||
7 | the provisions of Sections 133, 134, 137, 140, 141.1,
141.2, | ||||||
8 | 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, 154, 154.5, | ||||||
9 | 154.6,
154.7, 154.8, 155.04, 355.2, 356f.1, 356m, 356v, 356w, | ||||||
10 | 356x, 356y,
356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9, | ||||||
11 | 356z.10, 356z.13
356z.11 , 356z.14,
364.01, 367.2, 367.2-5, | ||||||
12 | 367i, 368a, 368b, 368c, 368d, 368e, 370c,
401, 401.1, 402, 403, | ||||||
13 | 403A,
408, 408.2, 409, 412, 444,
and
444.1,
paragraph (c) of | ||||||
14 | subsection (2) of Section 367, and Articles IIA, VIII 1/2,
XII,
| ||||||
15 | XII 1/2, XIII, XIII 1/2, XXV, and XXVI of the Illinois | ||||||
16 | Insurance Code.
| ||||||
17 | (b) For purposes of the Illinois Insurance Code, except for | ||||||
18 | Sections 444
and 444.1 and Articles XIII and XIII 1/2, Health | ||||||
19 | Maintenance Organizations in
the following categories are | ||||||
20 | deemed to be "domestic companies":
| ||||||
21 | (1) a corporation authorized under the
Dental Service | ||||||
22 | Plan Act or the Voluntary Health Services Plans Act;
| ||||||
23 | (2) a corporation organized under the laws of this | ||||||
24 | State; or
|
| |||||||
| |||||||
1 | (3) a corporation organized under the laws of another | ||||||
2 | state, 30% or more
of the enrollees of which are residents | ||||||
3 | of this State, except a
corporation subject to | ||||||
4 | substantially the same requirements in its state of
| ||||||
5 | organization as is a "domestic company" under Article VIII | ||||||
6 | 1/2 of the
Illinois Insurance Code.
| ||||||
7 | (c) In considering the merger, consolidation, or other | ||||||
8 | acquisition of
control of a Health Maintenance Organization | ||||||
9 | pursuant to Article VIII 1/2
of the Illinois Insurance Code,
| ||||||
10 | (1) the Director shall give primary consideration to | ||||||
11 | the continuation of
benefits to enrollees and the financial | ||||||
12 | conditions of the acquired Health
Maintenance Organization | ||||||
13 | after the merger, consolidation, or other
acquisition of | ||||||
14 | control takes effect;
| ||||||
15 | (2)(i) the criteria specified in subsection (1)(b) of | ||||||
16 | Section 131.8 of
the Illinois Insurance Code shall not | ||||||
17 | apply and (ii) the Director, in making
his determination | ||||||
18 | with respect to the merger, consolidation, or other
| ||||||
19 | acquisition of control, need not take into account the | ||||||
20 | effect on
competition of the merger, consolidation, or | ||||||
21 | other acquisition of control;
| ||||||
22 | (3) the Director shall have the power to require the | ||||||
23 | following
information:
| ||||||
24 | (A) certification by an independent actuary of the | ||||||
25 | adequacy
of the reserves of the Health Maintenance | ||||||
26 | Organization sought to be acquired;
|
| |||||||
| |||||||
1 | (B) pro forma financial statements reflecting the | ||||||
2 | combined balance
sheets of the acquiring company and | ||||||
3 | the Health Maintenance Organization sought
to be | ||||||
4 | acquired as of the end of the preceding year and as of | ||||||
5 | a date 90 days
prior to the acquisition, as well as pro | ||||||
6 | forma financial statements
reflecting projected | ||||||
7 | combined operation for a period of 2 years;
| ||||||
8 | (C) a pro forma business plan detailing an | ||||||
9 | acquiring party's plans with
respect to the operation | ||||||
10 | of the Health Maintenance Organization sought to
be | ||||||
11 | acquired for a period of not less than 3 years; and
| ||||||
12 | (D) such other information as the Director shall | ||||||
13 | require.
| ||||||
14 | (d) The provisions of Article VIII 1/2 of the Illinois | ||||||
15 | Insurance Code
and this Section 5-3 shall apply to the sale by | ||||||
16 | any health maintenance
organization of greater than 10% of its
| ||||||
17 | enrollee population (including without limitation the health | ||||||
18 | maintenance
organization's right, title, and interest in and to | ||||||
19 | its health care
certificates).
| ||||||
20 | (e) In considering any management contract or service | ||||||
21 | agreement subject
to Section 141.1 of the Illinois Insurance | ||||||
22 | Code, the Director (i) shall, in
addition to the criteria | ||||||
23 | specified in Section 141.2 of the Illinois
Insurance Code, take | ||||||
24 | into account the effect of the management contract or
service | ||||||
25 | agreement on the continuation of benefits to enrollees and the
| ||||||
26 | financial condition of the health maintenance organization to |
| |||||||
| |||||||
1 | be managed or
serviced, and (ii) need not take into account the | ||||||
2 | effect of the management
contract or service agreement on | ||||||
3 | competition.
| ||||||
4 | (f) Except for small employer groups as defined in the | ||||||
5 | Small Employer
Rating, Renewability and Portability Health | ||||||
6 | Insurance Act and except for
medicare supplement policies as | ||||||
7 | defined in Section 363 of the Illinois
Insurance Code, a Health | ||||||
8 | Maintenance Organization may by contract agree with a
group or | ||||||
9 | other enrollment unit to effect refunds or charge additional | ||||||
10 | premiums
under the following terms and conditions:
| ||||||
11 | (i) the amount of, and other terms and conditions with | ||||||
12 | respect to, the
refund or additional premium are set forth | ||||||
13 | in the group or enrollment unit
contract agreed in advance | ||||||
14 | of the period for which a refund is to be paid or
| ||||||
15 | additional premium is to be charged (which period shall not | ||||||
16 | be less than one
year); and
| ||||||
17 | (ii) the amount of the refund or additional premium | ||||||
18 | shall not exceed 20%
of the Health Maintenance | ||||||
19 | Organization's profitable or unprofitable experience
with | ||||||
20 | respect to the group or other enrollment unit for the | ||||||
21 | period (and, for
purposes of a refund or additional | ||||||
22 | premium, the profitable or unprofitable
experience shall | ||||||
23 | be calculated taking into account a pro rata share of the
| ||||||
24 | Health Maintenance Organization's administrative and | ||||||
25 | marketing expenses, but
shall not include any refund to be | ||||||
26 | made or additional premium to be paid
pursuant to this |
| |||||||
| |||||||
1 | subsection (f)). The Health Maintenance Organization and | ||||||
2 | the
group or enrollment unit may agree that the profitable | ||||||
3 | or unprofitable
experience may be calculated taking into | ||||||
4 | account the refund period and the
immediately preceding 2 | ||||||
5 | plan years.
| ||||||
6 | The Health Maintenance Organization shall include a | ||||||
7 | statement in the
evidence of coverage issued to each enrollee | ||||||
8 | describing the possibility of a
refund or additional premium, | ||||||
9 | and upon request of any group or enrollment unit,
provide to | ||||||
10 | the group or enrollment unit a description of the method used | ||||||
11 | to
calculate (1) the Health Maintenance Organization's | ||||||
12 | profitable experience with
respect to the group or enrollment | ||||||
13 | unit and the resulting refund to the group
or enrollment unit | ||||||
14 | or (2) the Health Maintenance Organization's unprofitable
| ||||||
15 | experience with respect to the group or enrollment unit and the | ||||||
16 | resulting
additional premium to be paid by the group or | ||||||
17 | enrollment unit.
| ||||||
18 | In no event shall the Illinois Health Maintenance | ||||||
19 | Organization
Guaranty Association be liable to pay any | ||||||
20 | contractual obligation of an
insolvent organization to pay any | ||||||
21 | refund authorized under this Section.
| ||||||
22 | (Source: P.A. 94-906, eff. 1-1-07; 94-1076, eff. 12-29-06; | ||||||
23 | 95-422, eff. 8-24-07; 95-520, eff. 8-28-07; 95-876, eff. | ||||||
24 | 8-21-08; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; revised | ||||||
25 | 12-15-08.)
|
| |||||||
| |||||||
1 | (Text of Section after amendment by P.A. 95-958 ) | ||||||
2 | Sec. 5-3. Insurance Code provisions.
| ||||||
3 | (a) Health Maintenance Organizations
shall be subject to | ||||||
4 | the provisions of Sections 133, 134, 137, 140, 141.1,
141.2, | ||||||
5 | 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, 154, 154.5, | ||||||
6 | 154.6,
154.7, 154.8, 155.04, 355.2, 356f.1, 356m, 356v, 356w, | ||||||
7 | 356x, 356y,
356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9, | ||||||
8 | 356z.10, 356z.11, 356z.12 , 356z.13
356z.11 , 356z.14, 364.01, | ||||||
9 | 367.2, 367.2-5, 367i, 368a, 368b, 368c, 368d, 368e, 370c,
401, | ||||||
10 | 401.1, 402, 403, 403A,
408, 408.2, 409, 412, 444,
and
444.1,
| ||||||
11 | paragraph (c) of subsection (2) of Section 367, and Articles | ||||||
12 | IIA, VIII 1/2,
XII,
XII 1/2, XIII, XIII 1/2, XXV, and XXVI of | ||||||
13 | the Illinois Insurance Code.
| ||||||
14 | (b) For purposes of the Illinois Insurance Code, except for | ||||||
15 | Sections 444
and 444.1 and Articles XIII and XIII 1/2, Health | ||||||
16 | Maintenance Organizations in
the following categories are | ||||||
17 | deemed to be "domestic companies":
| ||||||
18 | (1) a corporation authorized under the
Dental Service | ||||||
19 | Plan Act or the Voluntary Health Services Plans Act;
| ||||||
20 | (2) a corporation organized under the laws of this | ||||||
21 | State; or
| ||||||
22 | (3) a corporation organized under the laws of another | ||||||
23 | state, 30% or more
of the enrollees of which are residents | ||||||
24 | of this State, except a
corporation subject to | ||||||
25 | substantially the same requirements in its state of
| ||||||
26 | organization as is a "domestic company" under Article VIII |
| |||||||
| |||||||
1 | 1/2 of the
Illinois Insurance Code.
| ||||||
2 | (c) In considering the merger, consolidation, or other | ||||||
3 | acquisition of
control of a Health Maintenance Organization | ||||||
4 | pursuant to Article VIII 1/2
of the Illinois Insurance Code,
| ||||||
5 | (1) the Director shall give primary consideration to | ||||||
6 | the continuation of
benefits to enrollees and the financial | ||||||
7 | conditions of the acquired Health
Maintenance Organization | ||||||
8 | after the merger, consolidation, or other
acquisition of | ||||||
9 | control takes effect;
| ||||||
10 | (2)(i) the criteria specified in subsection (1)(b) of | ||||||
11 | Section 131.8 of
the Illinois Insurance Code shall not | ||||||
12 | apply and (ii) the Director, in making
his determination | ||||||
13 | with respect to the merger, consolidation, or other
| ||||||
14 | acquisition of control, need not take into account the | ||||||
15 | effect on
competition of the merger, consolidation, or | ||||||
16 | other acquisition of control;
| ||||||
17 | (3) the Director shall have the power to require the | ||||||
18 | following
information:
| ||||||
19 | (A) certification by an independent actuary of the | ||||||
20 | adequacy
of the reserves of the Health Maintenance | ||||||
21 | Organization sought to be acquired;
| ||||||
22 | (B) pro forma financial statements reflecting the | ||||||
23 | combined balance
sheets of the acquiring company and | ||||||
24 | the Health Maintenance Organization sought
to be | ||||||
25 | acquired as of the end of the preceding year and as of | ||||||
26 | a date 90 days
prior to the acquisition, as well as pro |
| |||||||
| |||||||
1 | forma financial statements
reflecting projected | ||||||
2 | combined operation for a period of 2 years;
| ||||||
3 | (C) a pro forma business plan detailing an | ||||||
4 | acquiring party's plans with
respect to the operation | ||||||
5 | of the Health Maintenance Organization sought to
be | ||||||
6 | acquired for a period of not less than 3 years; and
| ||||||
7 | (D) such other information as the Director shall | ||||||
8 | require.
| ||||||
9 | (d) The provisions of Article VIII 1/2 of the Illinois | ||||||
10 | Insurance Code
and this Section 5-3 shall apply to the sale by | ||||||
11 | any health maintenance
organization of greater than 10% of its
| ||||||
12 | enrollee population (including without limitation the health | ||||||
13 | maintenance
organization's right, title, and interest in and to | ||||||
14 | its health care
certificates).
| ||||||
15 | (e) In considering any management contract or service | ||||||
16 | agreement subject
to Section 141.1 of the Illinois Insurance | ||||||
17 | Code, the Director (i) shall, in
addition to the criteria | ||||||
18 | specified in Section 141.2 of the Illinois
Insurance Code, take | ||||||
19 | into account the effect of the management contract or
service | ||||||
20 | agreement on the continuation of benefits to enrollees and the
| ||||||
21 | financial condition of the health maintenance organization to | ||||||
22 | be managed or
serviced, and (ii) need not take into account the | ||||||
23 | effect of the management
contract or service agreement on | ||||||
24 | competition.
| ||||||
25 | (f) Except for small employer groups as defined in the | ||||||
26 | Small Employer
Rating, Renewability and Portability Health |
| |||||||
| |||||||
1 | Insurance Act and except for
medicare supplement policies as | ||||||
2 | defined in Section 363 of the Illinois
Insurance Code, a Health | ||||||
3 | Maintenance Organization may by contract agree with a
group or | ||||||
4 | other enrollment unit to effect refunds or charge additional | ||||||
5 | premiums
under the following terms and conditions:
| ||||||
6 | (i) the amount of, and other terms and conditions with | ||||||
7 | respect to, the
refund or additional premium are set forth | ||||||
8 | in the group or enrollment unit
contract agreed in advance | ||||||
9 | of the period for which a refund is to be paid or
| ||||||
10 | additional premium is to be charged (which period shall not | ||||||
11 | be less than one
year); and
| ||||||
12 | (ii) the amount of the refund or additional premium | ||||||
13 | shall not exceed 20%
of the Health Maintenance | ||||||
14 | Organization's profitable or unprofitable experience
with | ||||||
15 | respect to the group or other enrollment unit for the | ||||||
16 | period (and, for
purposes of a refund or additional | ||||||
17 | premium, the profitable or unprofitable
experience shall | ||||||
18 | be calculated taking into account a pro rata share of the
| ||||||
19 | Health Maintenance Organization's administrative and | ||||||
20 | marketing expenses, but
shall not include any refund to be | ||||||
21 | made or additional premium to be paid
pursuant to this | ||||||
22 | subsection (f)). The Health Maintenance Organization and | ||||||
23 | the
group or enrollment unit may agree that the profitable | ||||||
24 | or unprofitable
experience may be calculated taking into | ||||||
25 | account the refund period and the
immediately preceding 2 | ||||||
26 | plan years.
|
| |||||||
| |||||||
1 | The Health Maintenance Organization shall include a | ||||||
2 | statement in the
evidence of coverage issued to each enrollee | ||||||
3 | describing the possibility of a
refund or additional premium, | ||||||
4 | and upon request of any group or enrollment unit,
provide to | ||||||
5 | the group or enrollment unit a description of the method used | ||||||
6 | to
calculate (1) the Health Maintenance Organization's | ||||||
7 | profitable experience with
respect to the group or enrollment | ||||||
8 | unit and the resulting refund to the group
or enrollment unit | ||||||
9 | or (2) the Health Maintenance Organization's unprofitable
| ||||||
10 | experience with respect to the group or enrollment unit and the | ||||||
11 | resulting
additional premium to be paid by the group or | ||||||
12 | enrollment unit.
| ||||||
13 | In no event shall the Illinois Health Maintenance | ||||||
14 | Organization
Guaranty Association be liable to pay any | ||||||
15 | contractual obligation of an
insolvent organization to pay any | ||||||
16 | refund authorized under this Section.
| ||||||
17 | (Source: P.A. 94-906, eff. 1-1-07; 94-1076, eff. 12-29-06; | ||||||
18 | 95-422, eff. 8-24-07; 95-520, eff. 8-28-07; 95-876, eff. | ||||||
19 | 8-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09; 95-1005, | ||||||
20 | eff. 12-12-08; revised 12-15-08.) | ||||||
21 | Section 35. The Limited Health Service Organization Act is | ||||||
22 | amended by changing Section 4003 as follows:
| ||||||
23 | (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
| ||||||
24 | Sec. 4003. Illinois Insurance Code provisions. Limited |
| |||||||
| |||||||
1 | health service
organizations shall be subject to the provisions | ||||||
2 | of Sections 133, 134, 137,
140, 141.1, 141.2, 141.3, 143, 143c, | ||||||
3 | 147, 148, 149, 151, 152, 153, 154, 154.5,
154.6, 154.7, 154.8, | ||||||
4 | 155.04, 155.37, 355.2, 356f.1, 356v, 356z.10, 368a, 401, 401.1,
| ||||||
5 | 402,
403, 403A, 408,
408.2, 409, 412, 444, and 444.1 and | ||||||
6 | Articles IIA, VIII 1/2, XII, XII 1/2,
XIII,
XIII 1/2, XXV, and | ||||||
7 | XXVI of the Illinois Insurance Code. For purposes of the
| ||||||
8 | Illinois Insurance Code, except for Sections 444 and 444.1 and | ||||||
9 | Articles XIII
and XIII 1/2, limited health service | ||||||
10 | organizations in the following categories
are deemed to be | ||||||
11 | domestic companies:
| ||||||
12 | (1) a corporation under the laws of this State; or
| ||||||
13 | (2) a corporation organized under the laws of another | ||||||
14 | state, 30% of 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 | (Source: P.A. 95-520, eff. 8-28-07; 95-876, eff. 8-21-08.)
| ||||||
20 | Section 40. The Managed Care Reform and Patient Rights Act | ||||||
21 | is amended by changing Section 45 as follows:
| ||||||
22 | (215 ILCS 134/45)
| ||||||
23 | Sec. 45.
Health care services appeals,
complaints, and
| ||||||
24 | external independent reviews.
|
| |||||||
| |||||||
1 | (a) A health care plan shall establish and maintain an | ||||||
2 | appeals procedure as
outlined in this Act. Compliance with this | ||||||
3 | Act's appeals procedures shall
satisfy a health care plan's | ||||||
4 | obligation to provide appeal procedures under any
other State | ||||||
5 | law or rules.
All appeals of a health care plan's | ||||||
6 | administrative determinations and
complaints regarding its | ||||||
7 | administrative decisions shall be handled as required
under | ||||||
8 | Section 50.
| ||||||
9 | (b) When an appeal concerns a decision or action by a | ||||||
10 | health care plan,
its
employees, or its subcontractors that | ||||||
11 | relates to (i) health care services,
including, but not limited | ||||||
12 | to, procedures or
treatments,
for an enrollee with an ongoing | ||||||
13 | course of treatment ordered
by a health care provider,
the | ||||||
14 | denial of which could significantly
increase the risk to an
| ||||||
15 | enrollee's health,
or (ii) a treatment referral, service,
| ||||||
16 | procedure, or other health care service,
the denial of which | ||||||
17 | could significantly
increase the risk to an
enrollee's health, | ||||||
18 | or (iii) the nonrenewal or termination of a plan,
the health | ||||||
19 | care plan must allow for the filing of an appeal
either orally | ||||||
20 | or in writing. Upon submission of the appeal, a health care | ||||||
21 | plan
must notify the party filing the appeal, as soon as | ||||||
22 | possible, but in no event
more than 24 hours after the | ||||||
23 | submission of the appeal, of all information
that the plan | ||||||
24 | requires to evaluate the appeal.
The health care plan shall | ||||||
25 | render a decision on the appeal within
24 hours after receipt | ||||||
26 | of the required information. The health care plan shall
notify |
| |||||||
| |||||||
1 | the party filing the
appeal and the enrollee, enrollee's | ||||||
2 | primary care physician, and any health care
provider who | ||||||
3 | recommended the health care service involved in the appeal of | ||||||
4 | its
decision orally
followed-up by a written notice of the | ||||||
5 | determination.
| ||||||
6 | (c) For all appeals related to health care services | ||||||
7 | including, but not
limited to, procedures or treatments for an | ||||||
8 | enrollee and not covered by
subsection (b) above, the health | ||||||
9 | care
plan shall establish a procedure for the filing of such | ||||||
10 | appeals. Upon
submission of an appeal under this subsection, a | ||||||
11 | health care plan must notify
the party filing an appeal, within | ||||||
12 | 3 business days, of all information that the
plan requires to | ||||||
13 | evaluate the appeal.
The health care plan shall render a | ||||||
14 | decision on the appeal within 15 business
days after receipt of | ||||||
15 | the required information. The health care plan shall
notify the | ||||||
16 | party filing the appeal,
the enrollee, the enrollee's primary | ||||||
17 | care physician, and any health care
provider
who recommended | ||||||
18 | the health care service involved in the appeal orally of its
| ||||||
19 | decision followed-up by a written notice of the determination.
| ||||||
20 | (d) An appeal under subsection (b) or (c) may be filed by | ||||||
21 | the
enrollee, the enrollee's designee or guardian, the | ||||||
22 | enrollee's primary care
physician, or the enrollee's health | ||||||
23 | care provider. A health care plan shall
designate a clinical | ||||||
24 | peer to review
appeals, because these appeals pertain to | ||||||
25 | medical or clinical matters
and such an appeal must be reviewed | ||||||
26 | by an appropriate
health care professional. No one reviewing an |
| |||||||
| |||||||
1 | appeal may have had any
involvement
in the initial | ||||||
2 | determination that is the subject of the appeal. The written
| ||||||
3 | notice of determination required under subsections (b) and (c) | ||||||
4 | shall
include (i) clear and detailed reasons for the | ||||||
5 | determination, (ii)
the medical or
clinical criteria for the | ||||||
6 | determination, which shall be based upon sound
clinical | ||||||
7 | evidence and reviewed on a periodic basis, and (iii) in the | ||||||
8 | case of an
adverse determination, the
procedures for requesting | ||||||
9 | an external independent review under subsection (f).
| ||||||
10 | (e) If an appeal filed under subsection (b) or (c) is | ||||||
11 | denied for a reason
including, but not limited to, the
service, | ||||||
12 | procedure, or treatment is not viewed as medically necessary,
| ||||||
13 | denial of specific tests or procedures, denial of referral
to | ||||||
14 | specialist physicians or denial of hospitalization requests or | ||||||
15 | length of
stay requests, any involved party may request an | ||||||
16 | external independent review
under subsection (f) of the adverse | ||||||
17 | determination.
| ||||||
18 | (f) External independent review.
| ||||||
19 | (1) The party seeking an external independent review | ||||||
20 | shall so notify the
health care plan.
The health care plan | ||||||
21 | shall seek to resolve all
external independent
reviews in | ||||||
22 | the most expeditious manner and shall make a determination | ||||||
23 | and
provide notice of the determination no more
than 24 | ||||||
24 | hours after the receipt of all necessary information when a | ||||||
25 | delay would
significantly increase
the risk to an | ||||||
26 | enrollee's health or when extended health care services for |
| |||||||
| |||||||
1 | an
enrollee undergoing a
course of treatment prescribed by | ||||||
2 | a health care provider are at issue.
| ||||||
3 | (2) Within 30 days after the enrollee receives written | ||||||
4 | notice of an
adverse
determination,
if the enrollee decides | ||||||
5 | to initiate an external independent review, the
enrollee | ||||||
6 | shall send to the health
care plan a written request for an | ||||||
7 | external independent review, including any
information or
| ||||||
8 | documentation to support the enrollee's request for the | ||||||
9 | covered service or
claim for a covered
service.
| ||||||
10 | (3) Within 30 days after the health care plan receives | ||||||
11 | a request for an
external
independent review from an | ||||||
12 | enrollee, the health care plan shall:
| ||||||
13 | (A) provide a mechanism for joint selection of an | ||||||
14 | external independent
reviewer by the enrollee, the | ||||||
15 | enrollee's physician or other health care
provider,
| ||||||
16 | and the health care plan; and
| ||||||
17 | (B) forward to the independent reviewer all | ||||||
18 | medical records and
supporting
documentation | ||||||
19 | pertaining to the case, a summary description of the | ||||||
20 | applicable
issues including a
statement of the health | ||||||
21 | care plan's decision, the criteria used, and the
| ||||||
22 | medical and clinical reasons
for that decision.
| ||||||
23 | (4) Within 5 days after receipt of all necessary | ||||||
24 | information, the
independent
reviewer
shall evaluate and | ||||||
25 | analyze the case and render a decision that is based on
| ||||||
26 | whether or not the health
care service or claim for the |
| |||||||
| |||||||
1 | health care service is medically appropriate. The
decision | ||||||
2 | by the
independent reviewer is final. If the external | ||||||
3 | independent reviewer determines
the health care
service to | ||||||
4 | be medically
appropriate, the health
care plan shall pay | ||||||
5 | for the health care service.
| ||||||
6 | (5) The health care plan shall be solely responsible | ||||||
7 | for paying the fees
of the external
independent reviewer | ||||||
8 | who is selected to perform the review.
| ||||||
9 | (6) An external independent reviewer who acts in good | ||||||
10 | faith shall have
immunity
from any civil or criminal | ||||||
11 | liability or professional discipline as a result of
acts or | ||||||
12 | omissions with
respect to any external independent review, | ||||||
13 | unless the acts or omissions
constitute wilful and wanton
| ||||||
14 | misconduct. For purposes of any proceeding, the good faith | ||||||
15 | of the person
participating shall be
presumed.
| ||||||
16 | (7) Future contractual or employment action by the | ||||||
17 | health care plan
regarding the
patient's physician or other | ||||||
18 | health care provider shall not be based solely on
the | ||||||
19 | physician's or other
health care provider's participation | ||||||
20 | in this procedure.
| ||||||
21 | (8) For the purposes of this Section, an external | ||||||
22 | independent reviewer
shall:
| ||||||
23 | (A) be a clinical peer;
| ||||||
24 | (B) have no direct financial interest in | ||||||
25 | connection with the case; and
| ||||||
26 | (C) have not been informed of the specific identity |
| |||||||
| |||||||
1 | of the enrollee.
| ||||||
2 | (g) Nothing in this Section shall be construed to require a | ||||||
3 | health care
plan to pay for a health care service not covered | ||||||
4 | under the enrollee's
certificate of coverage or policy.
| ||||||
5 | (Source: P.A. 91-617, eff. 1-1-00.)
| ||||||
6 | Section 45. The Voluntary Health Services Plans Act is | ||||||
7 | amended by changing Section 10 as follows:
| ||||||
8 | (215 ILCS 165/10) (from Ch. 32, par. 604)
| ||||||
9 | (Text of Section before amendment by P.A. 95-958 )
| ||||||
10 | Sec. 10. Application of Insurance Code provisions. Health | ||||||
11 | services
plan corporations and all persons interested therein | ||||||
12 | or dealing therewith
shall be subject to the provisions of | ||||||
13 | Articles IIA and XII 1/2 and Sections
3.1, 133, 140, 143, 143c, | ||||||
14 | 149, 155.37, 354, 355.2, 356f.1, 356g.5, 356r, 356t, 356u, | ||||||
15 | 356v,
356w, 356x, 356y, 356z.1, 356z.2, 356z.4, 356z.5, 356z.6, | ||||||
16 | 356z.8, 356z.9,
356z.10, 356z.13
356z.11 , 356z.14,
364.01, | ||||||
17 | 367.2, 368a, 401, 401.1,
402,
403, 403A, 408,
408.2, and 412, | ||||||
18 | and paragraphs (7) and (15) of Section 367 of the Illinois
| ||||||
19 | Insurance Code.
| ||||||
20 | (Source: P.A. 94-1076, eff. 12-29-06; 95-189, eff. 8-16-07; | ||||||
21 | 95-331, eff. 8-21-07; 95-422, eff. 8-24-07; 95-520, eff. | ||||||
22 | 8-28-07; 95-876, eff. 8-21-08; 95-978, eff. 1-1-09; 95-1005, | ||||||
23 | eff. 12-12-08; revised 12-15-08.)
|
| |||||||
| |||||||
1 | (Text of Section after amendment by P.A. 95-958 ) | ||||||
2 | Sec. 10. Application of Insurance Code provisions. Health | ||||||
3 | services
plan corporations and all persons interested therein | ||||||
4 | or dealing therewith
shall be subject to the provisions of | ||||||
5 | Articles IIA and XII 1/2 and Sections
3.1, 133, 140, 143, 143c, | ||||||
6 | 149, 155.37, 354, 355.2, 356f.1, 356g.5, 356r, 356t, 356u, | ||||||
7 | 356v,
356w, 356x, 356y, 356z.1, 356z.2, 356z.4, 356z.5, 356z.6, | ||||||
8 | 356z.8, 356z.9,
356z.10, 356z.11, 356z.12 , 356z.13
356z.11 , | ||||||
9 | 356z.14, 364.01, 367.2, 368a, 401, 401.1,
402,
403, 403A, 408,
| ||||||
10 | 408.2, and 412, and paragraphs (7) and (15) of Section 367 of | ||||||
11 | the Illinois
Insurance Code.
| ||||||
12 | (Source: P.A. 94-1076, eff. 12-29-06; 95-189, eff. 8-16-07; | ||||||
13 | 95-331, eff. 8-21-07; 95-422, eff. 8-24-07; 95-520, eff. | ||||||
14 | 8-28-07; 95-876, eff. 8-21-08; 95-958, eff. 6-1-09; 95-978, | ||||||
15 | eff. 1-1-09; 95-1005, eff. 12-12-08; revised 12-15-08.)
| ||||||
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. |