Rep. Natalie A. Manley

Filed: 3/20/2019

 

 


 

 


 
10100HB3503ham002LRB101 09822 RAB 58190 a

1
AMENDMENT TO HOUSE BILL 3503

2    AMENDMENT NO. ______. Amend House Bill 3503 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The State Employees Group Insurance Act of 1971
5is amended by changing Section 6.11 as follows:
 
6    (5 ILCS 375/6.11)
7    (Text of Section before amendment by P.A. 100-1170)
8    Sec. 6.11. Required health benefits; Illinois Insurance
9Code requirements. The program of health benefits shall provide
10the post-mastectomy care benefits required to be covered by a
11policy of accident and health insurance under Section 356t of
12the Illinois Insurance Code. The program of health benefits
13shall provide the coverage required under Sections 356g,
14356g.5, 356g.5-1, 356m, 356u, 356w, 356x, 356z.2, 356z.4,
15356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
16356z.14, 356z.15, 356z.17, 356z.22, 356z.25, and 356z.26, and

 

 

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1356z.29, and 356z.32 of the Illinois Insurance Code. The
2program of health benefits must comply with Sections 155.22a,
3155.37, 355b, 356z.19, 370c, and 370c.1 of the Illinois
4Insurance Code. The Department of Insurance shall enforce the
5requirements of this Section.
6    Rulemaking authority to implement Public Act 95-1045, if
7any, is conditioned on the rules being adopted in accordance
8with all provisions of the Illinois Administrative Procedure
9Act and all rules and procedures of the Joint Committee on
10Administrative Rules; any purported rule not so adopted, for
11whatever reason, is unauthorized.
12(Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17;
13100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1024, eff.
141-1-19; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised
151-8-19.)
 
16    (Text of Section after amendment by P.A. 100-1170)
17    Sec. 6.11. Required health benefits; Illinois Insurance
18Code requirements. The program of health benefits shall provide
19the post-mastectomy care benefits required to be covered by a
20policy of accident and health insurance under Section 356t of
21the Illinois Insurance Code. The program of health benefits
22shall provide the coverage required under Sections 356g,
23356g.5, 356g.5-1, 356m, 356u, 356w, 356x, 356z.2, 356z.4,
24356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
25356z.14, 356z.15, 356z.17, 356z.22, 356z.25, 356z.26, 356z.29,

 

 

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1356z.30a, and 356z.32 of the Illinois Insurance Code. The
2program of health benefits must comply with Sections 155.22a,
3155.37, 355b, 356z.19, 370c, and 370c.1 of the Illinois
4Insurance Code. The Department of Insurance shall enforce the
5requirements of this Section with respect to Sections 370c and
6370c.1 of the Illinois Insurance Code; all other requirements
7of this Section shall be enforced by the Department of Central
8Management Services.
9    Rulemaking authority to implement Public Act 95-1045, if
10any, is conditioned on the rules being adopted in accordance
11with all provisions of the Illinois Administrative Procedure
12Act and all rules and procedures of the Joint Committee on
13Administrative Rules; any purported rule not so adopted, for
14whatever reason, is unauthorized.
15(Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17;
16100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1024, eff.
171-1-19; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19;
18100-1170, eff. 6-1-19.)
 
19    Section 10. The Counties Code is amended by changing
20Section 5-1069.3 as follows:
 
21    (55 ILCS 5/5-1069.3)
22    Sec. 5-1069.3. Required health benefits. If a county,
23including a home rule county, is a self-insurer for purposes of
24providing health insurance coverage for its employees, the

 

 

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1coverage shall include coverage for the post-mastectomy care
2benefits required to be covered by a policy of accident and
3health insurance under Section 356t and the coverage required
4under Sections 356g, 356g.5, 356g.5-1, 356u, 356w, 356x,
5356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
6356z.14, 356z.15, 356z.22, 356z.25, and 356z.26, and 356z.29,
7356z.30a, and 356z.32 of the Illinois Insurance Code. The
8coverage shall comply with Sections 155.22a, 355b, 356z.19, and
9370c of the Illinois Insurance Code. The Department of
10Insurance shall enforce the requirements of this Section. The
11requirement that health benefits be covered as provided in this
12Section is an exclusive power and function of the State and is
13a denial and limitation under Article VII, Section 6,
14subsection (h) of the Illinois Constitution. A home rule county
15to which this Section applies must comply with every provision
16of this Section.
17    Rulemaking authority to implement Public Act 95-1045, if
18any, is conditioned on the rules being adopted in accordance
19with all provisions of the Illinois Administrative Procedure
20Act and all rules and procedures of the Joint Committee on
21Administrative Rules; any purported rule not so adopted, for
22whatever reason, is unauthorized.
23(Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17;
24100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1024, eff.
251-1-19; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised
2610-3-18.)
 

 

 

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1    Section 15. The Illinois Municipal Code is amended by
2changing Section 10-4-2.3 as follows:
 
3    (65 ILCS 5/10-4-2.3)
4    Sec. 10-4-2.3. Required health benefits. If a
5municipality, including a home rule municipality, is a
6self-insurer for purposes of providing health insurance
7coverage for its employees, the coverage shall include coverage
8for the post-mastectomy care benefits required to be covered by
9a policy of accident and health insurance under Section 356t
10and the coverage required under Sections 356g, 356g.5,
11356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10,
12356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25,
13and 356z.26, and 356z.29, 356z.30a, and 356z.32 of the Illinois
14Insurance Code. The coverage shall comply with Sections
15155.22a, 355b, 356z.19, and 370c of the Illinois Insurance
16Code. The Department of Insurance shall enforce the
17requirements of this Section. The requirement that health
18benefits be covered as provided in this is an exclusive power
19and function of the State and is a denial and limitation under
20Article VII, Section 6, subsection (h) of the Illinois
21Constitution. A home rule municipality to which this Section
22applies must comply with every provision of this Section.
23    Rulemaking authority to implement Public Act 95-1045, if
24any, is conditioned on the rules being adopted in accordance

 

 

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1with all provisions of the Illinois Administrative Procedure
2Act and all rules and procedures of the Joint Committee on
3Administrative Rules; any purported rule not so adopted, for
4whatever reason, is unauthorized.
5(Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17;
6100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1024, eff.
71-1-19; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised
810-4-18.)
 
9    Section 20. The School Code is amended by changing Section
1010-22.3f as follows:
 
11    (105 ILCS 5/10-22.3f)
12    Sec. 10-22.3f. Required health benefits. Insurance
13protection and benefits for employees shall provide the
14post-mastectomy care benefits required to be covered by a
15policy of accident and health insurance under Section 356t and
16the coverage required under Sections 356g, 356g.5, 356g.5-1,
17356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11, 356z.12,
18356z.13, 356z.14, 356z.15, 356z.22, 356z.25, and 356z.26, and
19356z.29, 356z.30a, and 356z.32 of the Illinois Insurance Code.
20Insurance policies shall comply with Section 356z.19 of the
21Illinois Insurance Code. The coverage shall comply with
22Sections 155.22a, 355b, and 370c of the Illinois Insurance
23Code. The Department of Insurance shall enforce the
24requirements of this Section.

 

 

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1    Rulemaking authority to implement Public Act 95-1045, if
2any, is conditioned on the rules being adopted in accordance
3with all provisions of the Illinois Administrative Procedure
4Act and all rules and procedures of the Joint Committee on
5Administrative Rules; any purported rule not so adopted, for
6whatever reason, is unauthorized.
7(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
8100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
91-1-19; 100-1102, eff. 1-1-19; revised 10-4-18.)
 
10    Section 25. The Illinois Insurance Code is amended by
11adding Section 356z.30a as follows:
 
12    (215 ILCS 5/356z.30a new)
13    Sec. 356z.30a. Coverage for hearing instruments.
14    (a) As used in this Section:
15    "Hearing care professional" means a person who is a
16licensed audiologist or a licensed physician.
17    "Hearing instrument" means any wearable non-disposable
18instrument or device designed to aid or compensate for impaired
19human hearing and any parts, attachments, or accessories for
20the instrument or device, including an ear mold but excluding
21batteries and cords.
22    "Related services" means those services necessary to
23assess, select, and adjust or fit the hearing instrument to
24ensure optimal performance, including, but not limited to:

 

 

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1audiological exams, replacement ear molds, and repairs to the
2hearing instrument.
3    (b) An individual or group policy of accident and health
4insurance or managed care plan that is amended, delivered,
5issued, or renewed after the effective date of this amendatory
6Act of the 101st General Assembly shall offer, for an
7additional premium and subject to the insurer's standard of
8insurability, optional coverage or optional reimbursement for
9hearing instruments and related services for all individuals
10when a hearing care professional prescribes a hearing
11instrument to augment communication.
12    (c) This optional coverage shall be subject to all
13applicable copayments, coinsurance, deductibles, and
14out-of-pocket limits for the cost of a hearing instrument for
15each ear, as needed, as well as related services, with a
16maximum for the hearing instrument and related services of no
17more than $2,500 per hearing instrument every 24 months.
18    (d) Nothing in this Section precludes an insured from
19selecting a more expensive hearing instrument at his or her own
20expense.
 
21    Section 30. The Health Maintenance Organization Act is
22amended by changing Section 5-3 as follows:
 
23    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
24    Sec. 5-3. Insurance Code provisions.

 

 

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1    (a) Health Maintenance Organizations shall be subject to
2the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
3141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
4154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2, 355.3,
5355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2, 356z.4,
6356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
7356z.13, 356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.21,
8356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.30a,
9356z.32, 364, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c,
10368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A, 408,
11408.2, 409, 412, 444, and 444.1, paragraph (c) of subsection
12(2) of Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2,
13XIII, XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.
14    (b) For purposes of the Illinois Insurance Code, except for
15Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health
16Maintenance Organizations in the following categories are
17deemed 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

 

 

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1    1/2 of the Illinois Insurance Code.
2    (c) In considering the merger, consolidation, or other
3acquisition of control of a Health Maintenance Organization
4pursuant 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

 

 

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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
10Insurance Code and this Section 5-3 shall apply to the sale by
11any health maintenance organization of greater than 10% of its
12enrollee population (including without limitation the health
13maintenance organization's right, title, and interest in and to
14its health care certificates).
15    (e) In considering any management contract or service
16agreement subject to Section 141.1 of the Illinois Insurance
17Code, the Director (i) shall, in addition to the criteria
18specified in Section 141.2 of the Illinois Insurance Code, take
19into account the effect of the management contract or service
20agreement on the continuation of benefits to enrollees and the
21financial condition of the health maintenance organization to
22be managed or serviced, and (ii) need not take into account the
23effect of the management contract or service agreement on
24competition.
25    (f) Except for small employer groups as defined in the
26Small Employer Rating, Renewability and Portability Health

 

 

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1Insurance Act and except for medicare supplement policies as
2defined in Section 363 of the Illinois Insurance Code, a Health
3Maintenance Organization may by contract agree with a group or
4other enrollment unit to effect refunds or charge additional
5premiums 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.

 

 

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1    The Health Maintenance Organization shall include a
2statement in the evidence of coverage issued to each enrollee
3describing the possibility of a refund or additional premium,
4and upon request of any group or enrollment unit, provide to
5the group or enrollment unit a description of the method used
6to calculate (1) the Health Maintenance Organization's
7profitable experience with respect to the group or enrollment
8unit and the resulting refund to the group or enrollment unit
9or (2) the Health Maintenance Organization's unprofitable
10experience with respect to the group or enrollment unit and the
11resulting additional premium to be paid by the group or
12enrollment unit.
13    In no event shall the Illinois Health Maintenance
14Organization Guaranty Association be liable to pay any
15contractual obligation of an insolvent organization to pay any
16refund authorized under this Section.
17    (g) Rulemaking authority to implement Public Act 95-1045,
18if any, is conditioned on the rules being adopted in accordance
19with all provisions of the Illinois Administrative Procedure
20Act and all rules and procedures of the Joint Committee on
21Administrative Rules; any purported rule not so adopted, for
22whatever reason, is unauthorized.
23(Source: P.A. 99-761, eff. 1-1-18; 100-24, eff. 7-18-17;
24100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1026, eff.
258-22-18; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised
2610-4-18.)
 

 

 

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1    Section 35. The Limited Health Service Organization Act is
2amended 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
5health service organizations shall be subject to the provisions
6of Sections 133, 134, 136, 137, 139, 140, 141.1, 141.2, 141.3,
7143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5, 154.6,
8154.7, 154.8, 155.04, 155.37, 355.2, 355.3, 355b, 356v,
9356z.10, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29,
10356z.30a, 356z.32, 368a, 401, 401.1, 402, 403, 403A, 408,
11408.2, 409, 412, 444, and 444.1 and Articles IIA, VIII 1/2,
12XII, XII 1/2, XIII, XIII 1/2, XXV, and XXVI of the Illinois
13Insurance Code. For purposes of the Illinois Insurance Code,
14except for Sections 444 and 444.1 and Articles XIII and XIII
151/2, limited health service organizations in the following
16categories are deemed to be domestic companies:
17        (1) a corporation under the laws of this State; or
18        (2) a corporation organized under the laws of another
19    state, 30% or more of the enrollees of which are residents
20    of this State, except a corporation subject to
21    substantially the same requirements in its state of
22    organization as is a domestic company under Article VIII
23    1/2 of the Illinois Insurance Code.
24(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;

 

 

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1100-201, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1057, eff.
21-1-19; 100-1102, eff. 1-1-19; revised 10-4-18.)
 
3    Section 40. The Voluntary Health Services Plans Act is
4amended by changing Section 10 as follows:
 
5    (215 ILCS 165/10)  (from Ch. 32, par. 604)
6    Sec. 10. Application of Insurance Code provisions. Health
7services plan corporations and all persons interested therein
8or dealing therewith shall be subject to the provisions of
9Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
10143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, 356g,
11356g.5, 356g.5-1, 356r, 356t, 356u, 356v, 356w, 356x, 356y,
12356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9,
13356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18,
14356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29,
15356z.30a, 356z.32, 364.01, 367.2, 368a, 401, 401.1, 402, 403,
16403A, 408, 408.2, and 412, and paragraphs (7) and (15) of
17Section 367 of the Illinois Insurance Code.
18    Rulemaking authority to implement Public Act 95-1045, if
19any, is conditioned on the rules being adopted in accordance
20with all provisions of the Illinois Administrative Procedure
21Act and all rules and procedures of the Joint Committee on
22Administrative Rules; any purported rule not so adopted, for
23whatever reason, is unauthorized.
24(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;

 

 

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1100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff.
21-1-19; 100-1102, eff. 1-1-19; revised 10-4-18.)
 
3    Section 95. No acceleration or delay. Where this Act makes
4changes in a statute that is represented in this Act by text
5that is not yet or no longer in effect (for example, a Section
6represented by multiple versions), the use of that text does
7not accelerate or delay the taking effect of (i) the changes
8made by this Act or (ii) provisions derived from any other
9Public Act.".