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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,
| |||||||||||||||||||||||||||||||||
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 | Sec. 6.11. Required health benefits; Illinois Insurance | |||||||||||||||||||||||||||||||||
8 | Code
requirements. The program of health
benefits shall provide | |||||||||||||||||||||||||||||||||
9 | the post-mastectomy care benefits required to be covered
by a | |||||||||||||||||||||||||||||||||
10 | policy of accident and health insurance under Section 356t of | |||||||||||||||||||||||||||||||||
11 | the Illinois
Insurance Code. The program of health benefits | |||||||||||||||||||||||||||||||||
12 | shall provide the coverage
required under Sections 356g, | |||||||||||||||||||||||||||||||||
13 | 356g.5, 356g.5-1, 356m,
356u, 356w, 356x, 356z.2, 356z.4, | |||||||||||||||||||||||||||||||||
14 | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, and | |||||||||||||||||||||||||||||||||
15 | 356z.13, and 356z.14, 356z.15 and 356z.14 , and 356z.17 356z.15 | |||||||||||||||||||||||||||||||||
16 | of the
Illinois Insurance Code.
The program of health benefits | |||||||||||||||||||||||||||||||||
17 | must comply with Sections Section 155.37 and 359d of the
| |||||||||||||||||||||||||||||||||
18 | Illinois Insurance Code.
| |||||||||||||||||||||||||||||||||
19 | Rulemaking authority to implement Public Act 95-1045 this | |||||||||||||||||||||||||||||||||
20 | amendatory Act of the 95th General Assembly , if any, is | |||||||||||||||||||||||||||||||||
21 | conditioned on the rules being adopted in accordance with all | |||||||||||||||||||||||||||||||||
22 | provisions of the Illinois Administrative Procedure Act and all | |||||||||||||||||||||||||||||||||
23 | rules and procedures of the Joint Committee on Administrative |
| |||||||
| |||||||
1 | Rules; any purported rule not so adopted, for whatever reason, | ||||||
2 | is unauthorized. | ||||||
3 | (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; | ||||||
4 | 95-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff. | ||||||
5 | 6-1-09; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; 95-1044, | ||||||
6 | eff. 3-26-09; 95-1045, eff. 3-27-09; 95-1049, eff. 1-1-10; | ||||||
7 | 96-139, eff. 1-1-10; 96-328, eff. 8-11-09; 96-639, eff. 1-1-10; | ||||||
8 | revised 10-22-09.) | ||||||
9 | Section 10. The Counties Code is amended by changing | ||||||
10 | Section 5-1069.3 as follows: | ||||||
11 | (55 ILCS 5/5-1069.3)
| ||||||
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, 356g.5, 356g.5-1, 356u,
356w, 356x, | ||||||
19 | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, and | ||||||
20 | 356z.13, and 356z.14, and 356z.15 356z.14 of
the Illinois | ||||||
21 | Insurance Code and shall comply with Section 359d of
the | ||||||
22 | Illinois Insurance Code . The requirement that health benefits | ||||||
23 | be covered
as provided in this Section is an
exclusive power | ||||||
24 | and function of the State and is a denial and limitation under
|
| |||||||
| |||||||
1 | Article VII, Section 6, subsection (h) of the Illinois | ||||||
2 | Constitution. A home
rule county to which this Section applies | ||||||
3 | must comply with every provision of
this Section.
| ||||||
4 | Rulemaking authority to implement Public Act 95-1045 this | ||||||
5 | amendatory Act of the 95th General Assembly , if any, is | ||||||
6 | conditioned on the rules being adopted in accordance with all | ||||||
7 | provisions of the Illinois Administrative Procedure Act and all | ||||||
8 | rules and procedures of the Joint Committee on Administrative | ||||||
9 | Rules; any purported rule not so adopted, for whatever reason, | ||||||
10 | is unauthorized. | ||||||
11 | (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; | ||||||
12 | 95-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff. | ||||||
13 | 6-1-09; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; 95-1045, | ||||||
14 | eff. 3-27-09; 95-1049, eff. 1-1-10; 96-139, eff. 1-1-10; | ||||||
15 | 96-328, eff. 8-11-09; revised 10-22-09.) | ||||||
16 | Section 15. The Illinois Municipal Code is amended by | ||||||
17 | changing Section 10-4-2.3 as follows: | ||||||
18 | (65 ILCS 5/10-4-2.3)
| ||||||
19 | Sec. 10-4-2.3. Required health benefits. If a | ||||||
20 | municipality, including a
home rule municipality, is a | ||||||
21 | self-insurer for purposes of providing health
insurance | ||||||
22 | coverage for its employees, the coverage shall include coverage | ||||||
23 | for
the post-mastectomy care benefits required to be covered by | ||||||
24 | a policy of
accident and health insurance under Section 356t |
| |||||||
| |||||||
1 | and the coverage required
under Sections 356g, 356g.5, | ||||||
2 | 356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10, | ||||||
3 | 356z.11, 356z.12, and 356z.13, and 356z.14, and 356z.15 356z.14 | ||||||
4 | of the Illinois
Insurance
Code and shall comply with Section | ||||||
5 | 359d of
the Illinois Insurance Code . The requirement that | ||||||
6 | health
benefits be covered as provided in this is an exclusive | ||||||
7 | power and function of
the State and is a denial and limitation | ||||||
8 | under Article VII, Section 6,
subsection (h) of the Illinois | ||||||
9 | Constitution. A home rule municipality to which
this Section | ||||||
10 | applies must comply with every provision of this Section.
| ||||||
11 | Rulemaking authority to implement Public Act 95-1045 this | ||||||
12 | amendatory Act of the 95th General Assembly , if any, is | ||||||
13 | conditioned on the rules being adopted in accordance with all | ||||||
14 | provisions of the Illinois Administrative Procedure Act and all | ||||||
15 | rules and procedures of the Joint Committee on Administrative | ||||||
16 | Rules; any purported rule not so adopted, for whatever reason, | ||||||
17 | is unauthorized. | ||||||
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; 95-1045, | ||||||
21 | eff. 3-27-09; 95-1049, eff. 1-1-10; 96-139, eff. 1-1-10; | ||||||
22 | 96-328, eff. 8-11-09; revised 10-23-09.) | ||||||
23 | Section 20. The School Code is amended by changing Section | ||||||
24 | 10-22.3f as follows: |
| |||||||
| |||||||
1 | (105 ILCS 5/10-22.3f)
| ||||||
2 | Sec. 10-22.3f. Required health benefits. Insurance | ||||||
3 | protection and
benefits
for employees shall provide the | ||||||
4 | post-mastectomy care benefits required to be
covered by a | ||||||
5 | policy of accident and health insurance under Section 356t and | ||||||
6 | the
coverage required under Sections 356g, 356g.5, 356g.5-1, | ||||||
7 | 356u, 356w, 356x,
356z.6, 356z.8, 356z.9, 356z.11, 356z.12, | ||||||
8 | 356z.13, and 356z.14, and 356z.15 356z.14 of
the
Illinois | ||||||
9 | Insurance Code and shall comply with Section 359d of
the | ||||||
10 | Illinois Insurance Code .
| ||||||
11 | Rulemaking authority to implement Public Act 95-1045 this | ||||||
12 | amendatory Act of the 95th General Assembly , if any, is | ||||||
13 | conditioned on the rules being adopted in accordance with all | ||||||
14 | provisions of the Illinois Administrative Procedure Act and all | ||||||
15 | rules and procedures of the Joint Committee on Administrative | ||||||
16 | Rules; any purported rule not so adopted, for whatever reason, | ||||||
17 | is unauthorized. | ||||||
18 | (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; | ||||||
19 | 95-876, eff. 8-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09; | ||||||
20 | 95-1005, 12-12-08; 95-1045, eff. 3-27-09; 95-1049, eff. | ||||||
21 | 1-1-10; 96-139, eff. 1-1-10; 96-328, eff. 8-11-09; revised | ||||||
22 | 10-23-09.) | ||||||
23 | Section 25. The Illinois Insurance Code is amended by | ||||||
24 | adding Section 359d as follows: |
| |||||||
| |||||||
1 | (215 ILCS 5/359d new) | ||||||
2 | Sec. 359d. Refunds. If an insured is owed any amount of | ||||||
3 | money by an insurer, then the insurer shall provide the insured | ||||||
4 | with the option of having the amount owed payed to the insured | ||||||
5 | or applied to the insured's future premiums.
| ||||||
6 | Section 30. The Health Maintenance Organization Act is | ||||||
7 | amended by changing Section 5-3 as follows:
| ||||||
8 | (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
| ||||||
9 | (Text of Section before amendment by P.A. 96-833 ) | ||||||
10 | Sec. 5-3. Insurance Code provisions.
| ||||||
11 | (a) Health Maintenance Organizations
shall be subject to | ||||||
12 | the provisions of Sections 133, 134, 137, 140, 141.1,
141.2, | ||||||
13 | 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, 154, 154.5, | ||||||
14 | 154.6,
154.7, 154.8, 155.04, 355.2, 356g.5-1, 356m, 356v, 356w, | ||||||
15 | 356x, 356y,
356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9, | ||||||
16 | 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15 356z.14 , | ||||||
17 | 356z.17 356z.15 , 359d, 364.01, 367.2, 367.2-5, 367i, 368a, | ||||||
18 | 368b, 368c, 368d, 368e, 370c,
401, 401.1, 402, 403, 403A,
408, | ||||||
19 | 408.2, 409, 412, 444,
and
444.1,
paragraph (c) of subsection | ||||||
20 | (2) of Section 367, and Articles IIA, VIII 1/2,
XII,
XII 1/2, | ||||||
21 | XIII, XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.
| ||||||
22 | (b) For purposes of the Illinois Insurance Code, except for | ||||||
23 | Sections 444
and 444.1 and Articles XIII and XIII 1/2, Health | ||||||
24 | Maintenance Organizations in
the following categories are |
| |||||||
| |||||||
1 | deemed to be "domestic companies":
| ||||||
2 | (1) a corporation authorized under the
Dental Service | ||||||
3 | Plan Act or the Voluntary Health Services Plans Act;
| ||||||
4 | (2) a corporation organized under the laws of this | ||||||
5 | State; or
| ||||||
6 | (3) a corporation organized under the laws of another | ||||||
7 | state, 30% or more
of the enrollees of which are residents | ||||||
8 | of this State, except a
corporation subject to | ||||||
9 | substantially the same requirements in its state of
| ||||||
10 | organization as is a "domestic company" under Article VIII | ||||||
11 | 1/2 of the
Illinois Insurance Code.
| ||||||
12 | (c) In considering the merger, consolidation, or other | ||||||
13 | acquisition of
control of a Health Maintenance Organization | ||||||
14 | pursuant to Article VIII 1/2
of the Illinois Insurance Code,
| ||||||
15 | (1) the Director shall give primary consideration to | ||||||
16 | the continuation of
benefits to enrollees and the financial | ||||||
17 | conditions of the acquired Health
Maintenance Organization | ||||||
18 | after the merger, consolidation, or other
acquisition of | ||||||
19 | control takes effect;
| ||||||
20 | (2)(i) the criteria specified in subsection (1)(b) of | ||||||
21 | Section 131.8 of
the Illinois Insurance Code shall not | ||||||
22 | apply and (ii) the Director, in making
his determination | ||||||
23 | with respect to the merger, consolidation, or other
| ||||||
24 | acquisition of control, need not take into account the | ||||||
25 | effect on
competition of the merger, consolidation, or | ||||||
26 | other acquisition of control;
|
| |||||||
| |||||||
1 | (3) the Director shall have the power to require the | ||||||
2 | following
information:
| ||||||
3 | (A) certification by an independent actuary of the | ||||||
4 | adequacy
of the reserves of the Health Maintenance | ||||||
5 | Organization sought to be acquired;
| ||||||
6 | (B) pro forma financial statements reflecting the | ||||||
7 | combined balance
sheets of the acquiring company and | ||||||
8 | the Health Maintenance Organization sought
to be | ||||||
9 | acquired as of the end of the preceding year and as of | ||||||
10 | a date 90 days
prior to the acquisition, as well as pro | ||||||
11 | forma financial statements
reflecting projected | ||||||
12 | combined operation for a period of 2 years;
| ||||||
13 | (C) a pro forma business plan detailing an | ||||||
14 | acquiring party's plans with
respect to the operation | ||||||
15 | of the Health Maintenance Organization sought to
be | ||||||
16 | acquired for a period of not less than 3 years; and
| ||||||
17 | (D) such other information as the Director shall | ||||||
18 | require.
| ||||||
19 | (d) The provisions of Article VIII 1/2 of the Illinois | ||||||
20 | Insurance Code
and this Section 5-3 shall apply to the sale by | ||||||
21 | any health maintenance
organization of greater than 10% of its
| ||||||
22 | enrollee population (including without limitation the health | ||||||
23 | maintenance
organization's right, title, and interest in and to | ||||||
24 | its health care
certificates).
| ||||||
25 | (e) In considering any management contract or service | ||||||
26 | agreement subject
to Section 141.1 of the Illinois Insurance |
| |||||||
| |||||||
1 | Code, the Director (i) shall, in
addition to the criteria | ||||||
2 | specified in Section 141.2 of the Illinois
Insurance Code, take | ||||||
3 | into account the effect of the management contract or
service | ||||||
4 | agreement on the continuation of benefits to enrollees and the
| ||||||
5 | financial condition of the health maintenance organization to | ||||||
6 | be managed or
serviced, and (ii) need not take into account the | ||||||
7 | effect of the management
contract or service agreement on | ||||||
8 | competition.
| ||||||
9 | (f) Except for small employer groups as defined in the | ||||||
10 | Small Employer
Rating, Renewability and Portability Health | ||||||
11 | Insurance Act and except for
medicare supplement policies as | ||||||
12 | defined in Section 363 of the Illinois
Insurance Code, a Health | ||||||
13 | Maintenance Organization may by contract agree with a
group or | ||||||
14 | other enrollment unit to effect refunds or charge additional | ||||||
15 | premiums
under the following terms and conditions:
| ||||||
16 | (i) the amount of, and other terms and conditions with | ||||||
17 | respect to, the
refund or additional premium are set forth | ||||||
18 | in the group or enrollment unit
contract agreed in advance | ||||||
19 | of the period for which a refund is to be paid or
| ||||||
20 | additional premium is to be charged (which period shall not | ||||||
21 | be less than one
year); and
| ||||||
22 | (ii) the amount of the refund or additional premium | ||||||
23 | shall not exceed 20%
of the Health Maintenance | ||||||
24 | Organization's profitable or unprofitable experience
with | ||||||
25 | respect to the group or other enrollment unit for the | ||||||
26 | period (and, for
purposes of a refund or additional |
| |||||||
| |||||||
1 | premium, the profitable or unprofitable
experience shall | ||||||
2 | be calculated taking into account a pro rata share of the
| ||||||
3 | Health Maintenance Organization's administrative and | ||||||
4 | marketing expenses, but
shall not include any refund to be | ||||||
5 | made or additional premium to be paid
pursuant to this | ||||||
6 | subsection (f)). The Health Maintenance Organization and | ||||||
7 | the
group or enrollment unit may agree that the profitable | ||||||
8 | or unprofitable
experience may be calculated taking into | ||||||
9 | account the refund period and the
immediately preceding 2 | ||||||
10 | plan years.
| ||||||
11 | The Health Maintenance Organization shall include a | ||||||
12 | statement in the
evidence of coverage issued to each enrollee | ||||||
13 | describing the possibility of a
refund or additional premium, | ||||||
14 | and upon request of any group or enrollment unit,
provide to | ||||||
15 | the group or enrollment unit a description of the method used | ||||||
16 | to
calculate (1) the Health Maintenance Organization's | ||||||
17 | profitable experience with
respect to the group or enrollment | ||||||
18 | unit and the resulting refund to the group
or enrollment unit | ||||||
19 | or (2) the Health Maintenance Organization's unprofitable
| ||||||
20 | experience with respect to the group or enrollment unit and the | ||||||
21 | resulting
additional premium to be paid by the group or | ||||||
22 | enrollment unit.
| ||||||
23 | In no event shall the Illinois Health Maintenance | ||||||
24 | Organization
Guaranty Association be liable to pay any | ||||||
25 | contractual obligation of an
insolvent organization to pay any | ||||||
26 | refund authorized under this Section.
|
| |||||||
| |||||||
1 | (g) Rulemaking authority to implement Public Act 95-1045 | ||||||
2 | this amendatory Act of the 95th General Assembly , if any, is | ||||||
3 | conditioned on the rules being adopted in accordance with all | ||||||
4 | provisions of the Illinois Administrative Procedure Act and all | ||||||
5 | rules and procedures of the Joint Committee on Administrative | ||||||
6 | Rules; any purported rule not so adopted, for whatever reason, | ||||||
7 | is unauthorized. | ||||||
8 | (Source: P.A. 95-422, eff. 8-24-07; 95-520, eff. 8-28-07; | ||||||
9 | 95-876, eff. 8-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09; | ||||||
10 | 95-1005, eff. 12-12-08; 95-1045, eff. 3-27-09; 95-1049, eff. | ||||||
11 | 1-1-10; 96-328, eff. 8-11-09; 96-639, eff. 1-1-10; revised | ||||||
12 | 10-23-09.) | ||||||
13 | (Text of Section after amendment by P.A. 96-833 ) | ||||||
14 | Sec. 5-3. Insurance Code provisions.
| ||||||
15 | (a) Health Maintenance Organizations
shall be subject to | ||||||
16 | the provisions of Sections 133, 134, 137, 140, 141.1,
141.2, | ||||||
17 | 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, 154, 154.5, | ||||||
18 | 154.6,
154.7, 154.8, 155.04, 355.2, 356g.5-1, 356m, 356v, 356w, | ||||||
19 | 356x, 356y,
356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9, | ||||||
20 | 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, | ||||||
21 | 356z.18, 359d, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c, | ||||||
22 | 368d, 368e, 370c,
401, 401.1, 402, 403, 403A,
408, 408.2, 409, | ||||||
23 | 412, 444,
and
444.1,
paragraph (c) of subsection (2) of Section | ||||||
24 | 367, and Articles IIA, VIII 1/2,
XII,
XII 1/2, XIII, XIII 1/2, | ||||||
25 | XXV, and XXVI of the Illinois Insurance Code.
|
| |||||||
| |||||||
1 | (b) For purposes of the Illinois Insurance Code, except for | ||||||
2 | Sections 444
and 444.1 and Articles XIII and XIII 1/2, Health | ||||||
3 | Maintenance Organizations in
the following categories are | ||||||
4 | deemed to be "domestic companies":
| ||||||
5 | (1) a corporation authorized under the
Dental Service | ||||||
6 | Plan Act or the Voluntary Health Services Plans Act;
| ||||||
7 | (2) a corporation organized under the laws of this | ||||||
8 | State; or
| ||||||
9 | (3) a corporation organized under the laws of another | ||||||
10 | state, 30% or more
of the enrollees of which are residents | ||||||
11 | of this State, except a
corporation subject to | ||||||
12 | substantially the same requirements in its state of
| ||||||
13 | organization as is a "domestic company" under Article VIII | ||||||
14 | 1/2 of the
Illinois Insurance Code.
| ||||||
15 | (c) In considering the merger, consolidation, or other | ||||||
16 | acquisition of
control of a Health Maintenance Organization | ||||||
17 | pursuant to Article VIII 1/2
of the Illinois Insurance Code,
| ||||||
18 | (1) the Director shall give primary consideration to | ||||||
19 | the continuation of
benefits to enrollees and the financial | ||||||
20 | conditions of the acquired Health
Maintenance Organization | ||||||
21 | after the merger, consolidation, or other
acquisition of | ||||||
22 | control takes effect;
| ||||||
23 | (2)(i) the criteria specified in subsection (1)(b) of | ||||||
24 | Section 131.8 of
the Illinois Insurance Code shall not | ||||||
25 | apply and (ii) the Director, in making
his determination | ||||||
26 | with respect to the merger, consolidation, or other
|
| |||||||
| |||||||
1 | acquisition of control, need not take into account the | ||||||
2 | effect on
competition of the merger, consolidation, or | ||||||
3 | other acquisition of control;
| ||||||
4 | (3) the Director shall have the power to require the | ||||||
5 | following
information:
| ||||||
6 | (A) certification by an independent actuary of the | ||||||
7 | adequacy
of the reserves of the Health Maintenance | ||||||
8 | Organization sought to be acquired;
| ||||||
9 | (B) pro forma financial statements reflecting the | ||||||
10 | combined balance
sheets of the acquiring company and | ||||||
11 | the Health Maintenance Organization sought
to be | ||||||
12 | acquired as of the end of the preceding year and as of | ||||||
13 | a date 90 days
prior to the acquisition, as well as pro | ||||||
14 | forma financial statements
reflecting projected | ||||||
15 | combined operation for a period of 2 years;
| ||||||
16 | (C) a pro forma business plan detailing an | ||||||
17 | acquiring party's plans with
respect to the operation | ||||||
18 | of the Health Maintenance Organization sought to
be | ||||||
19 | acquired for a period of not less than 3 years; and
| ||||||
20 | (D) such other information as the Director shall | ||||||
21 | require.
| ||||||
22 | (d) The provisions of Article VIII 1/2 of the Illinois | ||||||
23 | Insurance Code
and this Section 5-3 shall apply to the sale by | ||||||
24 | any health maintenance
organization of greater than 10% of its
| ||||||
25 | enrollee population (including without limitation the health | ||||||
26 | maintenance
organization's right, title, and interest in and to |
| |||||||
| |||||||
1 | its health care
certificates).
| ||||||
2 | (e) In considering any management contract or service | ||||||
3 | agreement subject
to Section 141.1 of the Illinois Insurance | ||||||
4 | Code, the Director (i) shall, in
addition to the criteria | ||||||
5 | specified in Section 141.2 of the Illinois
Insurance Code, take | ||||||
6 | into account the effect of the management contract or
service | ||||||
7 | agreement on the continuation of benefits to enrollees and the
| ||||||
8 | financial condition of the health maintenance organization to | ||||||
9 | be managed or
serviced, and (ii) need not take into account the | ||||||
10 | effect of the management
contract or service agreement on | ||||||
11 | competition.
| ||||||
12 | (f) Except for small employer groups as defined in the | ||||||
13 | Small Employer
Rating, Renewability and Portability Health | ||||||
14 | Insurance Act and except for
medicare supplement policies as | ||||||
15 | defined in Section 363 of the Illinois
Insurance Code, a Health | ||||||
16 | Maintenance Organization may by contract agree with a
group or | ||||||
17 | other enrollment unit to effect refunds or charge additional | ||||||
18 | premiums
under the following terms and conditions:
| ||||||
19 | (i) the amount of, and other terms and conditions with | ||||||
20 | respect to, the
refund or additional premium are set forth | ||||||
21 | in the group or enrollment unit
contract agreed in advance | ||||||
22 | of the period for which a refund is to be paid or
| ||||||
23 | additional premium is to be charged (which period shall not | ||||||
24 | be less than one
year); and
| ||||||
25 | (ii) the amount of the refund or additional premium | ||||||
26 | shall not exceed 20%
of the Health Maintenance |
| |||||||
| |||||||
1 | Organization's profitable or unprofitable experience
with | ||||||
2 | respect to the group or other enrollment unit for the | ||||||
3 | period (and, for
purposes of a refund or additional | ||||||
4 | premium, the profitable or unprofitable
experience shall | ||||||
5 | be calculated taking into account a pro rata share of the
| ||||||
6 | Health Maintenance Organization's administrative and | ||||||
7 | marketing expenses, but
shall not include any refund to be | ||||||
8 | made or additional premium to be paid
pursuant to this | ||||||
9 | subsection (f)). The Health Maintenance Organization and | ||||||
10 | the
group or enrollment unit may agree that the profitable | ||||||
11 | or unprofitable
experience may be calculated taking into | ||||||
12 | account the refund period and the
immediately preceding 2 | ||||||
13 | plan years.
| ||||||
14 | The Health Maintenance Organization shall include a | ||||||
15 | statement in the
evidence of coverage issued to each enrollee | ||||||
16 | describing the possibility of a
refund or additional premium, | ||||||
17 | and upon request of any group or enrollment unit,
provide to | ||||||
18 | the group or enrollment unit a description of the method used | ||||||
19 | to
calculate (1) the Health Maintenance Organization's | ||||||
20 | profitable experience with
respect to the group or enrollment | ||||||
21 | unit and the resulting refund to the group
or enrollment unit | ||||||
22 | or (2) the Health Maintenance Organization's unprofitable
| ||||||
23 | experience with respect to the group or enrollment unit and the | ||||||
24 | resulting
additional premium to be paid by the group or | ||||||
25 | enrollment unit.
| ||||||
26 | In no event shall the Illinois Health Maintenance |
| |||||||
| |||||||
1 | Organization
Guaranty Association be liable to pay any | ||||||
2 | contractual obligation of an
insolvent organization to pay any | ||||||
3 | refund authorized under this Section.
| ||||||
4 | (g) Rulemaking authority to implement Public Act 95-1045, | ||||||
5 | if any, is conditioned on the rules being adopted in accordance | ||||||
6 | with all provisions of the Illinois Administrative Procedure | ||||||
7 | Act and all rules and procedures of the Joint Committee on | ||||||
8 | Administrative Rules; any purported rule not so adopted, for | ||||||
9 | whatever reason, is unauthorized. | ||||||
10 | (Source: P.A. 95-422, eff. 8-24-07; 95-520, eff. 8-28-07; | ||||||
11 | 95-876, eff. 8-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09; | ||||||
12 | 95-1005, eff. 12-12-08; 95-1045, eff. 3-27-09; 95-1049, eff. | ||||||
13 | 1-1-10; 96-328, eff. 8-11-09; 96-639, eff. 1-1-10; 96-833, eff. | ||||||
14 | 6-1-10.) | ||||||
15 | Section 35. The Limited Health Service Organization Act is | ||||||
16 | amended by changing Section 4003 as follows:
| ||||||
17 | (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
| ||||||
18 | Sec. 4003. Illinois Insurance Code provisions. Limited | ||||||
19 | health service
organizations shall be subject to the provisions | ||||||
20 | of Sections 133, 134, 137,
140, 141.1, 141.2, 141.3, 143, 143c, | ||||||
21 | 147, 148, 149, 151, 152, 153, 154, 154.5,
154.6, 154.7, 154.8, | ||||||
22 | 155.04, 155.37, 355.2, 356v, 356z.10, 359d, 368a, 401, 401.1,
| ||||||
23 | 402,
403, 403A, 408,
408.2, 409, 412, 444, and 444.1 and | ||||||
24 | Articles IIA, VIII 1/2, XII, XII 1/2,
XIII,
XIII 1/2, XXV, and |
| |||||||
| |||||||
1 | XXVI of the Illinois Insurance Code. For purposes of the
| ||||||
2 | Illinois Insurance Code, except for Sections 444 and 444.1 and | ||||||
3 | Articles XIII
and XIII 1/2, limited health service | ||||||
4 | organizations in the following categories
are deemed to be | ||||||
5 | domestic companies:
| ||||||
6 | (1) a corporation under the laws of this State; or
| ||||||
7 | (2) a corporation organized under the laws of another | ||||||
8 | state, 30% of more
of the enrollees of which are residents | ||||||
9 | of this State, except a corporation
subject to | ||||||
10 | substantially the same requirements in its state of | ||||||
11 | organization as
is a domestic company under Article VIII | ||||||
12 | 1/2 of the Illinois Insurance Code.
| ||||||
13 | (Source: P.A. 95-520, eff. 8-28-07; 95-876, eff. 8-21-08.)
| ||||||
14 | Section 40. The Voluntary Health Services Plans Act is | ||||||
15 | amended by changing Section 10 as follows:
| ||||||
16 | (215 ILCS 165/10) (from Ch. 32, par. 604)
| ||||||
17 | (Text of Section before amendment by P.A. 96-833 ) | ||||||
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, 356g.5, 356g.5-1, 356r, 356t, | ||||||
23 | 356u, 356v,
356w, 356x, 356y, 356z.1, 356z.2, 356z.4, 356z.5, | ||||||
24 | 356z.6, 356z.8, 356z.9,
356z.10, 356z.11, 356z.12, 356z.13, |
| |||||||
| |||||||
1 | 356z.14, 356z.15
356z.14 , 359d, 364.01, 367.2, 368a, 401, | ||||||
2 | 401.1,
402,
403, 403A, 408,
408.2, and 412, and paragraphs (7) | ||||||
3 | and (15) of Section 367 of the Illinois
Insurance Code.
| ||||||
4 | Rulemaking authority to implement Public Act 95-1045
this | ||||||
5 | amendatory Act of the 95th General Assembly , if any, is | ||||||
6 | conditioned on the rules being adopted in accordance with all | ||||||
7 | provisions of the Illinois Administrative Procedure Act and all | ||||||
8 | rules and procedures of the Joint Committee on Administrative | ||||||
9 | Rules; any purported rule not so adopted, for whatever reason, | ||||||
10 | is unauthorized. | ||||||
11 | (Source: P.A. 95-189, eff. 8-16-07; 95-331, eff. 8-21-07; | ||||||
12 | 95-422, eff. 8-24-07; 95-520, eff. 8-28-07; 95-876, eff. | ||||||
13 | 8-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09; 95-1005, | ||||||
14 | eff. 12-12-08; 95-1045, eff. 3-27-09; 95-1049, eff. 1-1-10; | ||||||
15 | 96-328, eff. 8-11-09; revised 9-25-09.) | ||||||
16 | (Text of Section after amendment by P.A. 96-833 ) | ||||||
17 | Sec. 10. Application of Insurance Code provisions. Health | ||||||
18 | services
plan corporations and all persons interested therein | ||||||
19 | or dealing therewith
shall be subject to the provisions of | ||||||
20 | Articles IIA and XII 1/2 and Sections
3.1, 133, 140, 143, 143c, | ||||||
21 | 149, 155.37, 354, 355.2, 356g, 356g.5, 356g.5-1, 356r, 356t, | ||||||
22 | 356u, 356v,
356w, 356x, 356y, 356z.1, 356z.2, 356z.4, 356z.5, | ||||||
23 | 356z.6, 356z.8, 356z.9,
356z.10, 356z.11, 356z.12, 356z.13, | ||||||
24 | 356z.14, 356z.15, 356z.18, 359d, 364.01, 367.2, 368a, 401, | ||||||
25 | 401.1,
402,
403, 403A, 408,
408.2, and 412, and paragraphs (7) |
| |||||||
| |||||||
1 | and (15) of Section 367 of the Illinois
Insurance Code.
| ||||||
2 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
3 | any, is conditioned on the rules being adopted in accordance | ||||||
4 | with all provisions of the Illinois Administrative Procedure | ||||||
5 | Act and all rules and procedures of the Joint Committee on | ||||||
6 | Administrative Rules; any purported rule not so adopted, for | ||||||
7 | whatever reason, is unauthorized. | ||||||
8 | (Source: P.A. 95-189, eff. 8-16-07; 95-331, eff. 8-21-07; | ||||||
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; 95-1045, eff. 3-27-09; 95-1049, eff. 1-1-10; | ||||||
12 | 96-328, eff. 8-11-09; 96-833, eff. 6-1-10.) | ||||||
13 | Section 95. No acceleration or delay. Where this Act makes | ||||||
14 | changes in a statute that is represented in this Act by text | ||||||
15 | that is not yet or no longer in effect (for example, a Section | ||||||
16 | represented by multiple versions), the use of that text does | ||||||
17 | not accelerate or delay the taking effect of (i) the changes | ||||||
18 | made by this Act or (ii) provisions derived from any other | ||||||
19 | Public Act.
|