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1 | AN ACT concerning regulation.
| ||||||||||||||||||||||||||||||||||||||
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, 356z.13, | ||||||||||||||||||||||||||||||||||||||
15 | 356z.14, 356z.15, 356z.17, and 356z.22 , and 356z.25 of the
| ||||||||||||||||||||||||||||||||||||||
16 | Illinois Insurance Code.
The program of health benefits must | ||||||||||||||||||||||||||||||||||||||
17 | comply with Sections 155.22a, 155.37, 355b, 356z.19, 370c, and | ||||||||||||||||||||||||||||||||||||||
18 | 370c.1 of the
Illinois Insurance Code.
| ||||||||||||||||||||||||||||||||||||||
19 | Rulemaking authority to implement Public Act 95-1045, if | ||||||||||||||||||||||||||||||||||||||
20 | any, is conditioned on the rules being adopted in accordance | ||||||||||||||||||||||||||||||||||||||
21 | with all provisions of the Illinois Administrative Procedure | ||||||||||||||||||||||||||||||||||||||
22 | Act and all rules and procedures of the Joint Committee on | ||||||||||||||||||||||||||||||||||||||
23 | Administrative Rules; any purported rule not so adopted, for |
| |||||||
| |||||||
1 | whatever reason, is unauthorized. | ||||||
2 | (Source: P.A. 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15; | ||||||
3 | 99-480, eff. 9-9-15.) | ||||||
4 | Section 10. The Counties Code is amended by changing | ||||||
5 | Section 5-1069.3 as follows: | ||||||
6 | (55 ILCS 5/5-1069.3)
| ||||||
7 | Sec. 5-1069.3. Required health benefits. If a county, | ||||||
8 | including a home
rule
county, is a self-insurer for purposes of | ||||||
9 | providing health insurance coverage
for its employees, the | ||||||
10 | coverage shall include coverage for the post-mastectomy
care | ||||||
11 | benefits required to be covered by a policy of accident and | ||||||
12 | health
insurance under Section 356t and the coverage required | ||||||
13 | under Sections 356g, 356g.5, 356g.5-1, 356u,
356w, 356x, | ||||||
14 | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, | ||||||
15 | 356z.14, 356z.15, and 356z.22 , and 356z.25 of
the Illinois | ||||||
16 | Insurance Code. The coverage shall comply with Sections | ||||||
17 | 155.22a, 355b, 356z.19, and 370c of
the Illinois Insurance | ||||||
18 | Code. The requirement that health benefits be covered
as | ||||||
19 | provided in this Section is an
exclusive power and function of | ||||||
20 | the State and is a denial and limitation under
Article VII, | ||||||
21 | Section 6, subsection (h) of the Illinois Constitution. A home
| ||||||
22 | rule county to which this Section applies must comply with | ||||||
23 | every provision of
this Section.
| ||||||
24 | Rulemaking authority to implement Public Act 95-1045, if |
| |||||||
| |||||||
1 | any, is conditioned on the rules being adopted in accordance | ||||||
2 | with all provisions of the Illinois Administrative Procedure | ||||||
3 | Act and all rules and procedures of the Joint Committee on | ||||||
4 | Administrative Rules; any purported rule not so adopted, for | ||||||
5 | whatever reason, is unauthorized. | ||||||
6 | (Source: P.A. 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15; | ||||||
7 | 99-480, eff. 9-9-15.) | ||||||
8 | Section 15. The Illinois Municipal Code is amended by | ||||||
9 | changing Section 10-4-2.3 as follows: | ||||||
10 | (65 ILCS 5/10-4-2.3)
| ||||||
11 | Sec. 10-4-2.3. Required health benefits. If a | ||||||
12 | municipality, including a
home rule municipality, is a | ||||||
13 | self-insurer for purposes of providing health
insurance | ||||||
14 | coverage for its employees, the coverage shall include coverage | ||||||
15 | for
the post-mastectomy care benefits required to be covered by | ||||||
16 | a policy of
accident and health insurance under Section 356t | ||||||
17 | and the coverage required
under Sections 356g, 356g.5, | ||||||
18 | 356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10, | ||||||
19 | 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, and 356z.22 , and | ||||||
20 | 356z.25 of the Illinois
Insurance
Code. The coverage shall | ||||||
21 | comply with Sections 155.22a, 355b, 356z.19, and 370c of
the | ||||||
22 | Illinois Insurance Code. The requirement that health
benefits | ||||||
23 | be covered as provided in this is an exclusive power and | ||||||
24 | 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 municipality to which
this Section | ||||||
3 | applies must comply with every provision of this Section.
| ||||||
4 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
5 | 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. 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15; | ||||||
11 | 99-480, eff. 9-9-15.) | ||||||
12 | Section 20. The School Code is amended by changing Section | ||||||
13 | 10-22.3f as follows: | ||||||
14 | (105 ILCS 5/10-22.3f)
| ||||||
15 | Sec. 10-22.3f. Required health benefits. Insurance | ||||||
16 | protection and
benefits
for employees shall provide the | ||||||
17 | post-mastectomy care benefits required to be
covered by a | ||||||
18 | policy of accident and health insurance under Section 356t and | ||||||
19 | the
coverage required under Sections 356g, 356g.5, 356g.5-1, | ||||||
20 | 356u, 356w, 356x,
356z.6, 356z.8, 356z.9, 356z.11, 356z.12, | ||||||
21 | 356z.13, 356z.14, 356z.15, and 356z.22 , and 356z.25 of
the
| ||||||
22 | Illinois Insurance Code.
Insurance policies shall comply with | ||||||
23 | Section 356z.19 of the Illinois Insurance Code. The coverage | ||||||
24 | shall comply with Sections 155.22a and 355b of
the Illinois |
| |||||||
| |||||||
1 | 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. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-813, | ||||||
9 | eff. 7-13-12; 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15 .) | ||||||
10 | Section 25. The Illinois Insurance Code is amended by | ||||||
11 | adding Section 356Z.25 as follows: | ||||||
12 | (215 ILCS 5/356Z.25 new) | ||||||
13 | Sec. 356Z.25. Access to opioid analgesics with | ||||||
14 | abuse-deterrent properties. | ||||||
15 | (a) For purposes of this Section: | ||||||
16 | "Abuse-deterrent opioid analgesic drug product" means a | ||||||
17 | brand or generic opioid analgesic drug product approved by the
| ||||||
18 | U.S. Food and Drug Administration with abuse-deterrence | ||||||
19 | labeling claims that indicate the drug product's | ||||||
20 | abuse-deterrent properties are expected to deter or reduce its | ||||||
21 | abuse. | ||||||
22 | "Covered individual" means an individual covered by an | ||||||
23 | individual or group policy of accident and health insurance. | ||||||
24 | "Health insurer" means an entity or company licensed or |
| |||||||
| |||||||
1 | authorized by the State to sell health insurance policies or | ||||||
2 | that provides health care coverage, including pharmacy benefit | ||||||
3 | managers that administer the pharmacy benefit for an entity or | ||||||
4 | company. | ||||||
5 | "Opioid analgesic drug product" means a drug product that | ||||||
6 | contains an opioid agonist and that is indicated by the U.S. | ||||||
7 | Food and Drug Administration for the treatment of pain, whether | ||||||
8 | in an immediate-release or extended-release formulation and | ||||||
9 | whether or not the drug product contains other drug substances. | ||||||
10 | (b) On or after the effective date of this amendatory Act | ||||||
11 | of the 100th General Assembly, a health insurer that amends, | ||||||
12 | delivers, issues, or renews a group accident and health policy | ||||||
13 | that provides coverage for prescription drugs shall not require | ||||||
14 | that a covered individual first use an opioid analgesic drug | ||||||
15 | product without abuse-deterrence labeling claims before | ||||||
16 | providing coverage for an abuse-deterrent opioid analgesic | ||||||
17 | drug product. | ||||||
18 | Section 30. The Health Maintenance Organization Act is | ||||||
19 | amended by changing Section 5-3 as follows:
| ||||||
20 | (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
| ||||||
21 | (Text of Section before amendment by P.A. 99-761 ) | ||||||
22 | Sec. 5-3. Insurance Code provisions.
| ||||||
23 | (a) Health Maintenance Organizations
shall be subject to | ||||||
24 | the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
|
| |||||||
| |||||||
1 | 141.2, 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, 154, | ||||||
2 | 154.5, 154.6,
154.7, 154.8, 155.04, 155.22a, 355.2, 355.3, | ||||||
3 | 355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y,
356z.2, 356z.4, | ||||||
4 | 356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, | ||||||
5 | 356z.13, 356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.21, | ||||||
6 | 356z.22, 356z.25, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, | ||||||
7 | 368c, 368d, 368e, 370c,
370c.1, 401, 401.1, 402, 403, 403A,
| ||||||
8 | 408, 408.2, 409, 412, 444,
and
444.1,
paragraph (c) of | ||||||
9 | subsection (2) of Section 367, and Articles IIA, VIII 1/2,
XII,
| ||||||
10 | XII 1/2, XIII, XIII 1/2, XXV, and XXVI of the Illinois | ||||||
11 | Insurance Code.
| ||||||
12 | (b) For purposes of the Illinois Insurance Code, except for | ||||||
13 | Sections 444
and 444.1 and Articles XIII and XIII 1/2, Health | ||||||
14 | Maintenance Organizations in
the following categories are | ||||||
15 | deemed to be "domestic companies":
| ||||||
16 | (1) a corporation authorized under the
Dental Service | ||||||
17 | Plan Act or the Voluntary Health Services Plans Act;
| ||||||
18 | (2) a corporation organized under the laws of this | ||||||
19 | State; or
| ||||||
20 | (3) a corporation organized under the laws of another | ||||||
21 | state, 30% or more
of the enrollees of which are residents | ||||||
22 | of this State, except a
corporation subject to | ||||||
23 | substantially the same requirements in its state of
| ||||||
24 | organization as is a "domestic company" under Article VIII | ||||||
25 | 1/2 of the
Illinois Insurance Code.
| ||||||
26 | (c) In considering the merger, consolidation, or other |
| |||||||
| |||||||
1 | acquisition of
control of a Health Maintenance Organization | ||||||
2 | pursuant to Article VIII 1/2
of the Illinois Insurance Code,
| ||||||
3 | (1) the Director shall give primary consideration to | ||||||
4 | the continuation of
benefits to enrollees and the financial | ||||||
5 | conditions of the acquired Health
Maintenance Organization | ||||||
6 | after the merger, consolidation, or other
acquisition of | ||||||
7 | control takes effect;
| ||||||
8 | (2)(i) the criteria specified in subsection (1)(b) of | ||||||
9 | Section 131.8 of
the Illinois Insurance Code shall not | ||||||
10 | apply and (ii) the Director, in making
his determination | ||||||
11 | with respect to the merger, consolidation, or other
| ||||||
12 | acquisition of control, need not take into account the | ||||||
13 | effect on
competition of the merger, consolidation, or | ||||||
14 | other acquisition of control;
| ||||||
15 | (3) the Director shall have the power to require the | ||||||
16 | following
information:
| ||||||
17 | (A) certification by an independent actuary of the | ||||||
18 | adequacy
of the reserves of the Health Maintenance | ||||||
19 | Organization sought to be acquired;
| ||||||
20 | (B) pro forma financial statements reflecting the | ||||||
21 | combined balance
sheets of the acquiring company and | ||||||
22 | the Health Maintenance Organization sought
to be | ||||||
23 | acquired as of the end of the preceding year and as of | ||||||
24 | a date 90 days
prior to the acquisition, as well as pro | ||||||
25 | forma financial statements
reflecting projected | ||||||
26 | combined operation for a period of 2 years;
|
| |||||||
| |||||||
1 | (C) a pro forma business plan detailing an | ||||||
2 | acquiring party's plans with
respect to the operation | ||||||
3 | of the Health Maintenance Organization sought to
be | ||||||
4 | acquired for a period of not less than 3 years; and
| ||||||
5 | (D) such other information as the Director shall | ||||||
6 | require.
| ||||||
7 | (d) The provisions of Article VIII 1/2 of the Illinois | ||||||
8 | Insurance Code
and this Section 5-3 shall apply to the sale by | ||||||
9 | any health maintenance
organization of greater than 10% of its
| ||||||
10 | enrollee population (including without limitation the health | ||||||
11 | maintenance
organization's right, title, and interest in and to | ||||||
12 | its health care
certificates).
| ||||||
13 | (e) In considering any management contract or service | ||||||
14 | agreement subject
to Section 141.1 of the Illinois Insurance | ||||||
15 | Code, the Director (i) shall, in
addition to the criteria | ||||||
16 | specified in Section 141.2 of the Illinois
Insurance Code, take | ||||||
17 | into account the effect of the management contract or
service | ||||||
18 | agreement on the continuation of benefits to enrollees and the
| ||||||
19 | financial condition of the health maintenance organization to | ||||||
20 | be managed or
serviced, and (ii) need not take into account the | ||||||
21 | effect of the management
contract or service agreement on | ||||||
22 | competition.
| ||||||
23 | (f) Except for small employer groups as defined in the | ||||||
24 | Small Employer
Rating, Renewability and Portability Health | ||||||
25 | Insurance Act and except for
medicare supplement policies as | ||||||
26 | defined in Section 363 of the Illinois
Insurance Code, a Health |
| |||||||
| |||||||
1 | Maintenance Organization may by contract agree with a
group or | ||||||
2 | other enrollment unit to effect refunds or charge additional | ||||||
3 | premiums
under the following terms and conditions:
| ||||||
4 | (i) the amount of, and other terms and conditions with | ||||||
5 | respect to, the
refund or additional premium are set forth | ||||||
6 | in the group or enrollment unit
contract agreed in advance | ||||||
7 | of the period for which a refund is to be paid or
| ||||||
8 | additional premium is to be charged (which period shall not | ||||||
9 | be less than one
year); and
| ||||||
10 | (ii) the amount of the refund or additional premium | ||||||
11 | shall not exceed 20%
of the Health Maintenance | ||||||
12 | Organization's profitable or unprofitable experience
with | ||||||
13 | respect to the group or other enrollment unit for the | ||||||
14 | period (and, for
purposes of a refund or additional | ||||||
15 | premium, the profitable or unprofitable
experience shall | ||||||
16 | be calculated taking into account a pro rata share of the
| ||||||
17 | Health Maintenance Organization's administrative and | ||||||
18 | marketing expenses, but
shall not include any refund to be | ||||||
19 | made or additional premium to be paid
pursuant to this | ||||||
20 | subsection (f)). The Health Maintenance Organization and | ||||||
21 | the
group or enrollment unit may agree that the profitable | ||||||
22 | or unprofitable
experience may be calculated taking into | ||||||
23 | account the refund period and the
immediately preceding 2 | ||||||
24 | plan years.
| ||||||
25 | The Health Maintenance Organization shall include a | ||||||
26 | statement in the
evidence of coverage issued to each enrollee |
| |||||||
| |||||||
1 | describing the possibility of a
refund or additional premium, | ||||||
2 | and upon request of any group or enrollment unit,
provide to | ||||||
3 | the group or enrollment unit a description of the method used | ||||||
4 | to
calculate (1) the Health Maintenance Organization's | ||||||
5 | profitable experience with
respect to the group or enrollment | ||||||
6 | unit and the resulting refund to the group
or enrollment unit | ||||||
7 | or (2) the Health Maintenance Organization's unprofitable
| ||||||
8 | experience with respect to the group or enrollment unit and the | ||||||
9 | resulting
additional premium to be paid by the group or | ||||||
10 | enrollment unit.
| ||||||
11 | In no event shall the Illinois Health Maintenance | ||||||
12 | Organization
Guaranty Association be liable to pay any | ||||||
13 | contractual obligation of an
insolvent organization to pay any | ||||||
14 | refund authorized under this Section.
| ||||||
15 | (g) Rulemaking authority to implement Public Act 95-1045, | ||||||
16 | if any, is conditioned on the rules being adopted in accordance | ||||||
17 | with all provisions of the Illinois Administrative Procedure | ||||||
18 | Act and all rules and procedures of the Joint Committee on | ||||||
19 | Administrative Rules; any purported rule not so adopted, for | ||||||
20 | whatever reason, is unauthorized. | ||||||
21 | (Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-437, | ||||||
22 | eff. 8-18-11; 97-486, eff. 1-1-12; 97-592, eff. 1-1-12; 97-805, | ||||||
23 | eff. 1-1-13; 97-813, eff. 7-13-12; 98-189, eff. 1-1-14; | ||||||
24 | 98-1091, eff. 1-1-15 .) | ||||||
25 | (Text of Section after amendment by P.A. 99-761 ) |
| |||||||
| |||||||
1 | Sec. 5-3. Insurance Code provisions.
| ||||||
2 | (a) Health Maintenance Organizations
shall be subject to | ||||||
3 | the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
| ||||||
4 | 141.2, 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, 154, | ||||||
5 | 154.5, 154.6,
154.7, 154.8, 155.04, 155.22a, 355.2, 355.3, | ||||||
6 | 355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y,
356z.2, 356z.4, | ||||||
7 | 356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, | ||||||
8 | 356z.13, 356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.21, | ||||||
9 | 356z.22, 356z.25, 364, 364.01, 367.2, 367.2-5, 367i, 368a, | ||||||
10 | 368b, 368c, 368d, 368e, 370c,
370c.1, 401, 401.1, 402, 403, | ||||||
11 | 403A,
408, 408.2, 409, 412, 444,
and
444.1,
paragraph (c) of | ||||||
12 | subsection (2) of Section 367, and Articles IIA, VIII 1/2,
XII,
| ||||||
13 | XII 1/2, XIII, XIII 1/2, XXV, and XXVI of the Illinois | ||||||
14 | 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 | ||||||
26 | substantially the same requirements in its state of
|
| |||||||
| |||||||
1 | organization as is a "domestic company" under Article VIII | ||||||
2 | 1/2 of the
Illinois Insurance Code.
| ||||||
3 | (c) In considering the merger, consolidation, or other | ||||||
4 | acquisition of
control of a Health Maintenance Organization | ||||||
5 | pursuant to Article VIII 1/2
of the Illinois Insurance Code,
| ||||||
6 | (1) the Director shall give primary consideration to | ||||||
7 | the continuation of
benefits to enrollees and the financial | ||||||
8 | conditions of the acquired Health
Maintenance Organization | ||||||
9 | after the merger, consolidation, or other
acquisition of | ||||||
10 | control takes effect;
| ||||||
11 | (2)(i) the criteria specified in subsection (1)(b) of | ||||||
12 | Section 131.8 of
the Illinois Insurance Code shall not | ||||||
13 | apply and (ii) the Director, in making
his determination | ||||||
14 | with respect to the merger, consolidation, or other
| ||||||
15 | acquisition of control, need not take into account the | ||||||
16 | effect on
competition of the merger, consolidation, or | ||||||
17 | other acquisition of control;
| ||||||
18 | (3) the Director shall have the power to require the | ||||||
19 | following
information:
| ||||||
20 | (A) certification by an independent actuary of the | ||||||
21 | adequacy
of the reserves of the Health Maintenance | ||||||
22 | Organization sought to be acquired;
| ||||||
23 | (B) pro forma financial statements reflecting the | ||||||
24 | combined balance
sheets of the acquiring company and | ||||||
25 | the Health Maintenance Organization sought
to be | ||||||
26 | acquired as of the end of the preceding year and as of |
| |||||||
| |||||||
1 | a date 90 days
prior to the acquisition, as well as pro | ||||||
2 | forma financial statements
reflecting projected | ||||||
3 | combined operation for a period of 2 years;
| ||||||
4 | (C) a pro forma business plan detailing an | ||||||
5 | acquiring party's plans with
respect to the operation | ||||||
6 | of the Health Maintenance Organization sought to
be | ||||||
7 | acquired for a period of not less than 3 years; and
| ||||||
8 | (D) such other information as the Director shall | ||||||
9 | require.
| ||||||
10 | (d) The provisions of Article VIII 1/2 of the Illinois | ||||||
11 | Insurance Code
and this Section 5-3 shall apply to the sale by | ||||||
12 | any health maintenance
organization of greater than 10% of its
| ||||||
13 | enrollee population (including without limitation the health | ||||||
14 | maintenance
organization's right, title, and interest in and to | ||||||
15 | its health care
certificates).
| ||||||
16 | (e) In considering any management contract or service | ||||||
17 | agreement subject
to Section 141.1 of the Illinois Insurance | ||||||
18 | Code, the Director (i) shall, in
addition to the criteria | ||||||
19 | specified in Section 141.2 of the Illinois
Insurance Code, take | ||||||
20 | into account the effect of the management contract or
service | ||||||
21 | agreement on the continuation of benefits to enrollees and the
| ||||||
22 | financial condition of the health maintenance organization to | ||||||
23 | be managed or
serviced, and (ii) need not take into account the | ||||||
24 | effect of the management
contract or service agreement on | ||||||
25 | competition.
| ||||||
26 | (f) Except for small employer groups as defined in the |
| |||||||
| |||||||
1 | Small Employer
Rating, Renewability and Portability Health | ||||||
2 | Insurance Act and except for
medicare supplement policies as | ||||||
3 | defined in Section 363 of the Illinois
Insurance Code, a Health | ||||||
4 | Maintenance Organization may by contract agree with a
group or | ||||||
5 | other enrollment unit to effect refunds or charge additional | ||||||
6 | premiums
under the following terms and conditions:
| ||||||
7 | (i) the amount of, and other terms and conditions with | ||||||
8 | respect to, the
refund or additional premium are set forth | ||||||
9 | in the group or enrollment unit
contract agreed in advance | ||||||
10 | of the period for which a refund is to be paid or
| ||||||
11 | additional premium is to be charged (which period shall not | ||||||
12 | be less than one
year); and
| ||||||
13 | (ii) the amount of the refund or additional premium | ||||||
14 | shall not exceed 20%
of the Health Maintenance | ||||||
15 | Organization's profitable or unprofitable experience
with | ||||||
16 | respect to the group or other enrollment unit for the | ||||||
17 | period (and, for
purposes of a refund or additional | ||||||
18 | premium, the profitable or unprofitable
experience shall | ||||||
19 | be calculated taking into account a pro rata share of the
| ||||||
20 | Health Maintenance Organization's administrative and | ||||||
21 | marketing expenses, but
shall not include any refund to be | ||||||
22 | made or additional premium to be paid
pursuant to this | ||||||
23 | subsection (f)). The Health Maintenance Organization and | ||||||
24 | the
group or enrollment unit may agree that the profitable | ||||||
25 | or unprofitable
experience may be calculated taking into | ||||||
26 | account the refund period and the
immediately preceding 2 |
| |||||||
| |||||||
1 | plan years.
| ||||||
2 | The Health Maintenance Organization shall include a | ||||||
3 | statement in the
evidence of coverage issued to each enrollee | ||||||
4 | describing the possibility of a
refund or additional premium, | ||||||
5 | and upon request of any group or enrollment unit,
provide to | ||||||
6 | the group or enrollment unit a description of the method used | ||||||
7 | to
calculate (1) the Health Maintenance Organization's | ||||||
8 | profitable experience with
respect to the group or enrollment | ||||||
9 | unit and the resulting refund to the group
or enrollment unit | ||||||
10 | or (2) the Health Maintenance Organization's unprofitable
| ||||||
11 | experience with respect to the group or enrollment unit and the | ||||||
12 | resulting
additional premium to be paid by the group or | ||||||
13 | enrollment unit.
| ||||||
14 | In no event shall the Illinois Health Maintenance | ||||||
15 | Organization
Guaranty Association be liable to pay any | ||||||
16 | contractual obligation of an
insolvent organization to pay any | ||||||
17 | refund authorized under this Section.
| ||||||
18 | (g) Rulemaking authority to implement Public Act 95-1045, | ||||||
19 | if any, is conditioned on the rules being adopted in accordance | ||||||
20 | with all provisions of the Illinois Administrative Procedure | ||||||
21 | Act and all rules and procedures of the Joint Committee on | ||||||
22 | Administrative Rules; any purported rule not so adopted, for | ||||||
23 | whatever reason, is unauthorized. | ||||||
24 | (Source: P.A. 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15; | ||||||
25 | 99-761, eff. 1-1-18.) |
| |||||||
| |||||||
1 | Section 35. The Limited Health Service Organization Act is | ||||||
2 | amended by changing Section 4003 as follows:
| ||||||
3 | (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
| ||||||
4 | Sec. 4003. Illinois Insurance Code provisions. Limited | ||||||
5 | health service
organizations shall be subject to the provisions | ||||||
6 | of Sections 133, 134, 136, 137, 139,
140, 141.1, 141.2, 141.3, | ||||||
7 | 143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5,
154.6, | ||||||
8 | 154.7, 154.8, 155.04, 155.37, 355.2, 355.3, 355b, 356v, | ||||||
9 | 356z.10, 356z.21, 356z.22, 356z.25, 368a, 401, 401.1,
402,
403, | ||||||
10 | 403A, 408,
408.2, 409, 412, 444, and 444.1 and Articles IIA, | ||||||
11 | VIII 1/2, XII, XII 1/2,
XIII,
XIII 1/2, XXV, and XXVI of the | ||||||
12 | Illinois Insurance Code. For purposes of the
Illinois Insurance | ||||||
13 | Code, except for Sections 444 and 444.1 and Articles XIII
and | ||||||
14 | XIII 1/2, limited health service organizations in the following | ||||||
15 | categories
are deemed to be domestic companies:
| ||||||
16 | (1) a corporation under the laws of this State; or
| ||||||
17 | (2) a corporation organized under the laws of another | ||||||
18 | state, 30% or of more
of the enrollees of which are | ||||||
19 | residents of this State, except a corporation
subject to | ||||||
20 | substantially the same requirements in its state of | ||||||
21 | organization as
is a domestic company under Article VIII | ||||||
22 | 1/2 of the Illinois Insurance Code.
| ||||||
23 | (Source: P.A. 97-486, eff. 1-1-12; 97-592, 1-1-12; 97-805, eff. | ||||||
24 | 1-1-13; 97-813, eff. 7-13-12; 98-189, eff. 1-1-14; 98-1091, | ||||||
25 | eff. 1-1-15; revised 10-5-16.)
|
| |||||||
| |||||||
1 | Section 40. The Voluntary Health Services Plans Act is | ||||||
2 | amended by changing Section 10 as follows:
| ||||||
3 | (215 ILCS 165/10) (from Ch. 32, par. 604)
| ||||||
4 | Sec. 10. Application of Insurance Code provisions. Health | ||||||
5 | services
plan corporations and all persons interested therein | ||||||
6 | or dealing therewith
shall be subject to the provisions of | ||||||
7 | Articles IIA and XII 1/2 and Sections
3.1, 133, 136, 139, 140, | ||||||
8 | 143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, 356g, | ||||||
9 | 356g.5, 356g.5-1, 356r, 356t, 356u, 356v,
356w, 356x, 356y, | ||||||
10 | 356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9,
| ||||||
11 | 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18, | ||||||
12 | 356z.19, 356z.21, 356z.22, 356z.25, 364.01, 367.2, 368a, 401, | ||||||
13 | 401.1,
402,
403, 403A, 408,
408.2, and 412, and paragraphs (7) | ||||||
14 | and (15) of Section 367 of the Illinois
Insurance Code.
| ||||||
15 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
16 | any, is conditioned on the rules being adopted in accordance | ||||||
17 | with all provisions of the Illinois Administrative Procedure | ||||||
18 | Act and all rules and procedures of the Joint Committee on | ||||||
19 | Administrative Rules; any purported rule not so adopted, for | ||||||
20 | whatever reason, is unauthorized. | ||||||
21 | (Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-486, | ||||||
22 | eff. 1-1-12; 97-592, eff. 1-1-12; 97-805, eff. 1-1-13; 97-813, | ||||||
23 | eff. 7-13-12; 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15 .)
|
| |||||||
| |||||||
1 | Section 95. No acceleration or delay. Where this Act makes | ||||||
2 | changes in a statute that is represented in this Act by text | ||||||
3 | that is not yet or no longer in effect (for example, a Section | ||||||
4 | represented by multiple versions), the use of that text does | ||||||
5 | not accelerate or delay the taking effect of (i) the changes | ||||||
6 | made by this Act or (ii) provisions derived from any other | ||||||
7 | Public Act. |