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1 | AN ACT concerning insurance.
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2 | Be it enacted by the People of the State of Illinois,
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3 | represented in the General Assembly:
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4 | Section 5. The Illinois Insurance Code is amended by adding | |||||||||||||||||||||||
5 | Section 356z.15 as follows: | |||||||||||||||||||||||
6 | (215 ILCS 5/356z.15 new)
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7 | Sec. 356z.15. Cochlear implants; audiological services. | |||||||||||||||||||||||
8 | (a) A group or individual policy of accident and health | |||||||||||||||||||||||
9 | insurance or managed care plan amended, delivered, issued, or | |||||||||||||||||||||||
10 | renewed after the effective date of this amendatory Act of the | |||||||||||||||||||||||
11 | 96th General Assembly must provide coverage for an operation to | |||||||||||||||||||||||
12 | implant cochlear implants and post-treatment services for | |||||||||||||||||||||||
13 | children identified within one year of birth as being deaf or | |||||||||||||||||||||||
14 | hearing impaired. | |||||||||||||||||||||||
15 | (b) A group or individual
policy of accident and health | |||||||||||||||||||||||
16 | insurance or managed care plan
amended, delivered, issued, or | |||||||||||||||||||||||
17 | renewed after the effective date
of this amendatory Act of the | |||||||||||||||||||||||
18 | 96th General Assembly must
provide coverage for audiological | |||||||||||||||||||||||
19 | services and hearing aids for
children up to 18 years of age. | |||||||||||||||||||||||
20 | This coverage shall only apply
to hearing aids that are | |||||||||||||||||||||||
21 | prescribed, filled, and dispensed by a
licensed audiologist. A | |||||||||||||||||||||||
22 | policy or plan may limit the hearing
aid benefit payable for | |||||||||||||||||||||||
23 | each hearing-impaired ear to every 38
months. A policy or plan |
| |||||||
| |||||||
1 | may provide for up to 4 additional ear
molds per year for | ||||||
2 | children up to 2 years of age. | ||||||
3 | Section 10. The Health Maintenance Organization Act is | ||||||
4 | amended by changing Section 5-3 as follows:
| ||||||
5 | (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
| ||||||
6 | (Text of Section before amendment by P.A. 95-958 )
| ||||||
7 | Sec. 5-3. Insurance Code provisions.
| ||||||
8 | (a) Health Maintenance Organizations
shall be subject to | ||||||
9 | the provisions of Sections 133, 134, 137, 140, 141.1,
141.2, | ||||||
10 | 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, 154, 154.5, | ||||||
11 | 154.6,
154.7, 154.8, 155.04, 355.2, 356m, 356v, 356w, 356x, | ||||||
12 | 356y,
356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10, | ||||||
13 | 356z.13
356z.11 , 356z.14, 356z.15,
364.01, 367.2, 367.2-5, | ||||||
14 | 367i, 368a, 368b, 368c, 368d, 368e, 370c,
401, 401.1, 402, 403, | ||||||
15 | 403A,
408, 408.2, 409, 412, 444,
and
444.1,
paragraph (c) of | ||||||
16 | subsection (2) of Section 367, and Articles IIA, VIII 1/2,
XII,
| ||||||
17 | XII 1/2, XIII, XIII 1/2, XXV, and XXVI of the Illinois | ||||||
18 | Insurance Code.
| ||||||
19 | (b) For purposes of the Illinois Insurance Code, except for | ||||||
20 | Sections 444
and 444.1 and Articles XIII and XIII 1/2, Health | ||||||
21 | Maintenance Organizations in
the following categories are | ||||||
22 | deemed to be "domestic companies":
| ||||||
23 | (1) a corporation authorized under the
Dental Service | ||||||
24 | Plan Act or the Voluntary Health Services Plans Act;
|
| |||||||
| |||||||
1 | (2) a corporation organized under the laws of this | ||||||
2 | State; or
| ||||||
3 | (3) a corporation organized under the laws of another | ||||||
4 | state, 30% or more
of the enrollees of which are residents | ||||||
5 | of this State, except a
corporation subject to | ||||||
6 | substantially the same requirements in its state of
| ||||||
7 | organization as is a "domestic company" under Article VIII | ||||||
8 | 1/2 of the
Illinois Insurance Code.
| ||||||
9 | (c) In considering the merger, consolidation, or other | ||||||
10 | acquisition of
control of a Health Maintenance Organization | ||||||
11 | pursuant to Article VIII 1/2
of the Illinois Insurance Code,
| ||||||
12 | (1) the Director shall give primary consideration to | ||||||
13 | the continuation of
benefits to enrollees and the financial | ||||||
14 | conditions of the acquired Health
Maintenance Organization | ||||||
15 | after the merger, consolidation, or other
acquisition of | ||||||
16 | control takes effect;
| ||||||
17 | (2)(i) the criteria specified in subsection (1)(b) of | ||||||
18 | Section 131.8 of
the Illinois Insurance Code shall not | ||||||
19 | apply and (ii) the Director, in making
his determination | ||||||
20 | with respect to the merger, consolidation, or other
| ||||||
21 | acquisition of control, need not take into account the | ||||||
22 | effect on
competition of the merger, consolidation, or | ||||||
23 | other acquisition of control;
| ||||||
24 | (3) the Director shall have the power to require the | ||||||
25 | following
information:
| ||||||
26 | (A) certification by an independent actuary of the |
| |||||||
| |||||||
1 | adequacy
of the reserves of the Health Maintenance | ||||||
2 | Organization sought to be acquired;
| ||||||
3 | (B) pro forma financial statements reflecting the | ||||||
4 | combined balance
sheets of the acquiring company and | ||||||
5 | the Health Maintenance Organization sought
to be | ||||||
6 | acquired as of the end of the preceding year and as of | ||||||
7 | a date 90 days
prior to the acquisition, as well as pro | ||||||
8 | forma financial statements
reflecting projected | ||||||
9 | combined operation for a period of 2 years;
| ||||||
10 | (C) a pro forma business plan detailing an | ||||||
11 | acquiring party's plans with
respect to the operation | ||||||
12 | of the Health Maintenance Organization sought to
be | ||||||
13 | acquired for a period of not less than 3 years; and
| ||||||
14 | (D) such other information as the Director shall | ||||||
15 | require.
| ||||||
16 | (d) The provisions of Article VIII 1/2 of the Illinois | ||||||
17 | Insurance Code
and this Section 5-3 shall apply to the sale by | ||||||
18 | any health maintenance
organization of greater than 10% of its
| ||||||
19 | enrollee population (including without limitation the health | ||||||
20 | maintenance
organization's right, title, and interest in and to | ||||||
21 | its health care
certificates).
| ||||||
22 | (e) In considering any management contract or service | ||||||
23 | agreement subject
to Section 141.1 of the Illinois Insurance | ||||||
24 | Code, the Director (i) shall, in
addition to the criteria | ||||||
25 | specified in Section 141.2 of the Illinois
Insurance Code, take | ||||||
26 | into account the effect of the management contract or
service |
| |||||||
| |||||||
1 | agreement on the continuation of benefits to enrollees and the
| ||||||
2 | financial condition of the health maintenance organization to | ||||||
3 | be managed or
serviced, and (ii) need not take into account the | ||||||
4 | effect of the management
contract or service agreement on | ||||||
5 | competition.
| ||||||
6 | (f) Except for small employer groups as defined in the | ||||||
7 | Small Employer
Rating, Renewability and Portability Health | ||||||
8 | Insurance Act and except for
medicare supplement policies as | ||||||
9 | defined in Section 363 of the Illinois
Insurance Code, a Health | ||||||
10 | Maintenance Organization may by contract agree with a
group or | ||||||
11 | other enrollment unit to effect refunds or charge additional | ||||||
12 | premiums
under the following terms and conditions:
| ||||||
13 | (i) the amount of, and other terms and conditions with | ||||||
14 | respect to, the
refund or additional premium are set forth | ||||||
15 | in the group or enrollment unit
contract agreed in advance | ||||||
16 | of the period for which a refund is to be paid or
| ||||||
17 | additional premium is to be charged (which period shall not | ||||||
18 | be less than one
year); and
| ||||||
19 | (ii) the amount of the refund or additional premium | ||||||
20 | shall not exceed 20%
of the Health Maintenance | ||||||
21 | Organization's profitable or unprofitable experience
with | ||||||
22 | respect to the group or other enrollment unit for the | ||||||
23 | period (and, for
purposes of a refund or additional | ||||||
24 | premium, the profitable or unprofitable
experience shall | ||||||
25 | be calculated taking into account a pro rata share of the
| ||||||
26 | Health Maintenance Organization's administrative and |
| |||||||
| |||||||
1 | marketing expenses, but
shall not include any refund to be | ||||||
2 | made or additional premium to be paid
pursuant to this | ||||||
3 | subsection (f)). The Health Maintenance Organization and | ||||||
4 | the
group or enrollment unit may agree that the profitable | ||||||
5 | or unprofitable
experience may be calculated taking into | ||||||
6 | account the refund period and the
immediately preceding 2 | ||||||
7 | plan years.
| ||||||
8 | The Health Maintenance Organization shall include a | ||||||
9 | statement in the
evidence of coverage issued to each enrollee | ||||||
10 | describing the possibility of a
refund or additional premium, | ||||||
11 | and upon request of any group or enrollment unit,
provide to | ||||||
12 | the group or enrollment unit a description of the method used | ||||||
13 | to
calculate (1) the Health Maintenance Organization's | ||||||
14 | profitable experience with
respect to the group or enrollment | ||||||
15 | unit and the resulting refund to the group
or enrollment unit | ||||||
16 | or (2) the Health Maintenance Organization's unprofitable
| ||||||
17 | experience with respect to the group or enrollment unit and the | ||||||
18 | resulting
additional premium to be paid by the group or | ||||||
19 | enrollment unit.
| ||||||
20 | In no event shall the Illinois Health Maintenance | ||||||
21 | Organization
Guaranty Association be liable to pay any | ||||||
22 | contractual obligation of an
insolvent organization to pay any | ||||||
23 | refund authorized under this Section.
| ||||||
24 | (Source: P.A. 94-906, eff. 1-1-07; 94-1076, eff. 12-29-06; | ||||||
25 | 95-422, eff. 8-24-07; 95-520, eff. 8-28-07; 95-876, eff. | ||||||
26 | 8-21-08; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; revised |
| |||||||
| |||||||
1 | 12-15-08.)
| ||||||
2 | (Text of Section after amendment by P.A. 95-958 ) | ||||||
3 | Sec. 5-3. Insurance Code provisions.
| ||||||
4 | (a) Health Maintenance Organizations
shall be subject to | ||||||
5 | the provisions of Sections 133, 134, 137, 140, 141.1,
141.2, | ||||||
6 | 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, 154, 154.5, | ||||||
7 | 154.6,
154.7, 154.8, 155.04, 355.2, 356m, 356v, 356w, 356x, | ||||||
8 | 356y,
356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10, | ||||||
9 | 356z.11, 356z.12 , 356z.13
356z.11 , 356z.14, 356z.15, 364.01, | ||||||
10 | 367.2, 367.2-5, 367i, 368a, 368b, 368c, 368d, 368e, 370c,
401, | ||||||
11 | 401.1, 402, 403, 403A,
408, 408.2, 409, 412, 444,
and
444.1,
| ||||||
12 | paragraph (c) of subsection (2) of Section 367, and Articles | ||||||
13 | IIA, VIII 1/2,
XII,
XII 1/2, XIII, XIII 1/2, XXV, and XXVI of | ||||||
14 | the Illinois Insurance Code.
| ||||||
15 | (b) For purposes of the Illinois Insurance Code, except for | ||||||
16 | Sections 444
and 444.1 and Articles XIII and XIII 1/2, Health | ||||||
17 | Maintenance Organizations in
the following categories are | ||||||
18 | deemed to be "domestic companies":
| ||||||
19 | (1) a corporation authorized under the
Dental Service | ||||||
20 | Plan Act or the Voluntary Health Services Plans Act;
| ||||||
21 | (2) a corporation organized under the laws of this | ||||||
22 | State; or
| ||||||
23 | (3) a corporation organized under the laws of another | ||||||
24 | state, 30% or more
of the enrollees of which are residents | ||||||
25 | of this State, except a
corporation subject to |
| |||||||
| |||||||
1 | substantially the same requirements in its state of
| ||||||
2 | organization as is a "domestic company" under Article VIII | ||||||
3 | 1/2 of the
Illinois Insurance Code.
| ||||||
4 | (c) In considering the merger, consolidation, or other | ||||||
5 | acquisition of
control of a Health Maintenance Organization | ||||||
6 | pursuant to Article VIII 1/2
of the Illinois Insurance Code,
| ||||||
7 | (1) the Director shall give primary consideration to | ||||||
8 | the continuation of
benefits to enrollees and the financial | ||||||
9 | conditions of the acquired Health
Maintenance Organization | ||||||
10 | after the merger, consolidation, or other
acquisition of | ||||||
11 | control takes effect;
| ||||||
12 | (2)(i) the criteria specified in subsection (1)(b) of | ||||||
13 | Section 131.8 of
the Illinois Insurance Code shall not | ||||||
14 | apply and (ii) the Director, in making
his determination | ||||||
15 | with respect to the merger, consolidation, or other
| ||||||
16 | acquisition of control, need not take into account the | ||||||
17 | effect on
competition of the merger, consolidation, or | ||||||
18 | other acquisition of control;
| ||||||
19 | (3) the Director shall have the power to require the | ||||||
20 | following
information:
| ||||||
21 | (A) certification by an independent actuary of the | ||||||
22 | adequacy
of the reserves of the Health Maintenance | ||||||
23 | Organization sought to be acquired;
| ||||||
24 | (B) pro forma financial statements reflecting the | ||||||
25 | combined balance
sheets of the acquiring company and | ||||||
26 | the Health Maintenance Organization sought
to be |
| |||||||
| |||||||
1 | acquired as of the end of the preceding year and as of | ||||||
2 | a date 90 days
prior to the acquisition, as well as pro | ||||||
3 | forma financial statements
reflecting projected | ||||||
4 | combined operation for a period of 2 years;
| ||||||
5 | (C) a pro forma business plan detailing an | ||||||
6 | acquiring party's plans with
respect to the operation | ||||||
7 | of the Health Maintenance Organization sought to
be | ||||||
8 | acquired for a period of not less than 3 years; and
| ||||||
9 | (D) such other information as the Director shall | ||||||
10 | require.
| ||||||
11 | (d) The provisions of Article VIII 1/2 of the Illinois | ||||||
12 | Insurance Code
and this Section 5-3 shall apply to the sale by | ||||||
13 | any health maintenance
organization of greater than 10% of its
| ||||||
14 | enrollee population (including without limitation the health | ||||||
15 | maintenance
organization's right, title, and interest in and to | ||||||
16 | its health care
certificates).
| ||||||
17 | (e) In considering any management contract or service | ||||||
18 | agreement subject
to Section 141.1 of the Illinois Insurance | ||||||
19 | Code, the Director (i) shall, in
addition to the criteria | ||||||
20 | specified in Section 141.2 of the Illinois
Insurance Code, take | ||||||
21 | into account the effect of the management contract or
service | ||||||
22 | agreement on the continuation of benefits to enrollees and the
| ||||||
23 | financial condition of the health maintenance organization to | ||||||
24 | be managed or
serviced, and (ii) need not take into account the | ||||||
25 | effect of the management
contract or service agreement on | ||||||
26 | competition.
|
| |||||||
| |||||||
1 | (f) Except for small employer groups as defined in the | ||||||
2 | Small Employer
Rating, Renewability and Portability Health | ||||||
3 | Insurance Act and except for
medicare supplement policies as | ||||||
4 | defined in Section 363 of the Illinois
Insurance Code, a Health | ||||||
5 | Maintenance Organization may by contract agree with a
group or | ||||||
6 | other enrollment unit to effect refunds or charge additional | ||||||
7 | premiums
under the following terms and conditions:
| ||||||
8 | (i) the amount of, and other terms and conditions with | ||||||
9 | respect to, the
refund or additional premium are set forth | ||||||
10 | in the group or enrollment unit
contract agreed in advance | ||||||
11 | of the period for which a refund is to be paid or
| ||||||
12 | additional premium is to be charged (which period shall not | ||||||
13 | be less than one
year); and
| ||||||
14 | (ii) the amount of the refund or additional premium | ||||||
15 | shall not exceed 20%
of the Health Maintenance | ||||||
16 | Organization's profitable or unprofitable experience
with | ||||||
17 | respect to the group or other enrollment unit for the | ||||||
18 | period (and, for
purposes of a refund or additional | ||||||
19 | premium, the profitable or unprofitable
experience shall | ||||||
20 | be calculated taking into account a pro rata share of the
| ||||||
21 | Health Maintenance Organization's administrative and | ||||||
22 | marketing expenses, but
shall not include any refund to be | ||||||
23 | made or additional premium to be paid
pursuant to this | ||||||
24 | subsection (f)). The Health Maintenance Organization and | ||||||
25 | the
group or enrollment unit may agree that the profitable | ||||||
26 | or unprofitable
experience may be calculated taking into |
| |||||||
| |||||||
1 | account the refund period and the
immediately preceding 2 | ||||||
2 | plan years.
| ||||||
3 | The Health Maintenance Organization shall include a | ||||||
4 | statement in the
evidence of coverage issued to each enrollee | ||||||
5 | describing the possibility of a
refund or additional premium, | ||||||
6 | and upon request of any group or enrollment unit,
provide to | ||||||
7 | the group or enrollment unit a description of the method used | ||||||
8 | to
calculate (1) the Health Maintenance Organization's | ||||||
9 | profitable experience with
respect to the group or enrollment | ||||||
10 | unit and the resulting refund to the group
or enrollment unit | ||||||
11 | or (2) the Health Maintenance Organization's unprofitable
| ||||||
12 | experience with respect to the group or enrollment unit and the | ||||||
13 | resulting
additional premium to be paid by the group or | ||||||
14 | enrollment unit.
| ||||||
15 | In no event shall the Illinois Health Maintenance | ||||||
16 | Organization
Guaranty Association be liable to pay any | ||||||
17 | contractual obligation of an
insolvent organization to pay any | ||||||
18 | refund authorized under this Section.
| ||||||
19 | (Source: P.A. 94-906, eff. 1-1-07; 94-1076, eff. 12-29-06; | ||||||
20 | 95-422, eff. 8-24-07; 95-520, eff. 8-28-07; 95-876, eff. | ||||||
21 | 8-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09; 95-1005, | ||||||
22 | eff. 12-12-08; revised 12-15-08.) | ||||||
23 | Section 15. The Voluntary Health Services Plans Act is | ||||||
24 | amended by changing Section 10 as follows:
|
| |||||||
| |||||||
1 | (215 ILCS 165/10) (from Ch. 32, par. 604)
| ||||||
2 | (Text of Section before 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.13
356z.11 , 356z.14, 356z.15,
364.01, | ||||||
10 | 367.2, 368a, 401, 401.1,
402,
403, 403A, 408,
408.2, and 412, | ||||||
11 | and paragraphs (7) and (15) of Section 367 of the Illinois
| ||||||
12 | 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; 95-978, eff. 1-1-09; 95-1005, | ||||||
16 | eff. 12-12-08; revised 12-15-08.)
| ||||||
17 | (Text of Section after amendment by P.A. 95-958 ) | ||||||
18 | Sec. 10. Application of Insurance Code provisions. Health | ||||||
19 | services
plan corporations and all persons interested therein | ||||||
20 | or dealing therewith
shall be subject to the provisions of | ||||||
21 | Articles IIA and XII 1/2 and Sections
3.1, 133, 140, 143, 143c, | ||||||
22 | 149, 155.37, 354, 355.2, 356g.5, 356r, 356t, 356u, 356v,
356w, | ||||||
23 | 356x, 356y, 356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, | ||||||
24 | 356z.9,
356z.10, 356z.11, 356z.12 , 356z.13
356z.11 , 356z.14, | ||||||
25 | 356z.15, 364.01, 367.2, 368a, 401, 401.1,
402,
403, 403A, 408,
|
| |||||||
| |||||||
1 | 408.2, and 412, and paragraphs (7) and (15) of Section 367 of | ||||||
2 | the Illinois
Insurance Code.
| ||||||
3 | (Source: P.A. 94-1076, eff. 12-29-06; 95-189, eff. 8-16-07; | ||||||
4 | 95-331, eff. 8-21-07; 95-422, eff. 8-24-07; 95-520, eff. | ||||||
5 | 8-28-07; 95-876, eff. 8-21-08; 95-958, eff. 6-1-09; 95-978, | ||||||
6 | eff. 1-1-09; 95-1005, eff. 12-12-08; revised 12-15-08.)
| ||||||
7 | Section 95. No acceleration or delay. Where this Act makes | ||||||
8 | changes in a statute that is represented in this Act by text | ||||||
9 | that is not yet or no longer in effect (for example, a Section | ||||||
10 | represented by multiple versions), the use of that text does | ||||||
11 | not accelerate or delay the taking effect of (i) the changes | ||||||
12 | made by this Act or (ii) provisions derived from any other | ||||||
13 | Public Act.
|