101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
HB5656

 

Introduced , by Rep. Jonathan Pizer

 

SYNOPSIS AS INTRODUCED:
 
55 ILCS 5/5-1069.3
65 ILCS 5/10-4-2.3
105 ILCS 5/10-22.3f
215 ILCS 5/356z.4a
215 ILCS 130/4003  from Ch. 73, par. 1504-3
305 ILCS 5/5-16.8

    Amends the Illinois Insurance Code. In provisions requiring that no individual or group policy of accident and health insurance be issued unless it provides a covered person with coverage for abortion care, removes the condition that it applies to a policy that provides pregnancy-related benefits. Makes conforming changes in the Counties Code, the Illinois Municipal Code, the School Code, the Limited Health Service Organization Act, and the Illinois Public Aid Code.


LRB101 19386 BMS 68858 b

FISCAL NOTE ACT MAY APPLY
STATE MANDATES ACT MAY REQUIRE REIMBURSEMENT

 

 

A BILL FOR

 

HB5656LRB101 19386 BMS 68858 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Counties Code is amended by changing Section
55-1069.3 as follows:
 
6    (55 ILCS 5/5-1069.3)
7    (Text of Section before amendment by P.A. 101-625)
8    Sec. 5-1069.3. Required health benefits. If a county,
9including a home rule county, is a self-insurer for purposes of
10providing health insurance coverage for its employees, the
11coverage shall include coverage for the post-mastectomy care
12benefits required to be covered by a policy of accident and
13health insurance under Section 356t and the coverage required
14under Sections 356g, 356g.5, 356g.5-1, 356u, 356w, 356x,
15356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
16356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
17356z.30a, and 356z.32, and 356z.33, and 356z.36 of the Illinois
18Insurance Code. The coverage shall comply with Sections
19155.22a, 355b, 356z.19, and 370c of the Illinois Insurance
20Code. The Department of Insurance shall enforce the
21requirements of this Section. The requirement that health
22benefits be covered as provided in this Section is an exclusive
23power and function of the State and is a denial and limitation

 

 

HB5656- 2 -LRB101 19386 BMS 68858 b

1under Article VII, Section 6, subsection (h) of the Illinois
2Constitution. A home rule county to which this Section applies
3must comply with every provision of this Section.
4    Rulemaking authority to implement Public Act 95-1045, if
5any, is conditioned on the rules being adopted in accordance
6with all provisions of the Illinois Administrative Procedure
7Act and all rules and procedures of the Joint Committee on
8Administrative Rules; any purported rule not so adopted, for
9whatever reason, is unauthorized.
10(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
11100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
121-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
13eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
14revised 10-16-19.)
 
15    (Text of Section after amendment by P.A. 101-625)
16    Sec. 5-1069.3. Required health benefits. If a county,
17including a home rule county, is a self-insurer for purposes of
18providing health insurance coverage for its employees, the
19coverage shall include coverage for the post-mastectomy care
20benefits required to be covered by a policy of accident and
21health insurance under Section 356t and the coverage required
22under Sections 356g, 356g.5, 356g.5-1, 356u, 356w, 356x,
23356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
24356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
25356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41 of the

 

 

HB5656- 3 -LRB101 19386 BMS 68858 b

1Illinois Insurance Code. The coverage shall comply with
2Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
3Insurance Code. The Department of Insurance shall enforce the
4requirements of this Section. The requirement that health
5benefits be covered as provided in this Section is an exclusive
6power and function of the State and is a denial and limitation
7under Article VII, Section 6, subsection (h) of the Illinois
8Constitution. A home rule county to which this Section applies
9must comply with every provision of this Section.
10    Rulemaking authority to implement Public Act 95-1045, if
11any, is conditioned on the rules being adopted in accordance
12with all provisions of the Illinois Administrative Procedure
13Act and all rules and procedures of the Joint Committee on
14Administrative Rules; any purported rule not so adopted, for
15whatever reason, is unauthorized.
16(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
17100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
181-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
19eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
20101-625, eff. 1-1-21.)
 
21    Section 10. The Illinois Municipal Code is amended by
22changing Section 10-4-2.3 as follows:
 
23    (65 ILCS 5/10-4-2.3)
24    (Text of Section before amendment by P.A. 101-625)

 

 

HB5656- 4 -LRB101 19386 BMS 68858 b

1    Sec. 10-4-2.3. Required health benefits. If a
2municipality, including a home rule municipality, is a
3self-insurer for purposes of providing health insurance
4coverage for its employees, the coverage shall include coverage
5for the post-mastectomy care benefits required to be covered by
6a policy of accident and health insurance under Section 356t
7and the coverage required under Sections 356g, 356g.5,
8356g.5-1, 356u, 356w, 356x, 356z.4a, 356z.6, 356z.8, 356z.9,
9356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
10356z.25, 356z.26, 356z.29, 356z.30a, and 356z.32, and 356z.33,
11and 356z.36 of the Illinois Insurance Code. The coverage shall
12comply with Sections 155.22a, 355b, 356z.19, and 370c of the
13Illinois Insurance Code. The Department of Insurance shall
14enforce the requirements of this Section. The requirement that
15health benefits be covered as provided in this is an exclusive
16power and function of the State and is a denial and limitation
17under Article VII, Section 6, subsection (h) of the Illinois
18Constitution. A home rule municipality to which this Section
19applies must comply with every provision of this Section.
20    Rulemaking authority to implement Public Act 95-1045, if
21any, is conditioned on the rules being adopted in accordance
22with all provisions of the Illinois Administrative Procedure
23Act and all rules and procedures of the Joint Committee on
24Administrative Rules; any purported rule not so adopted, for
25whatever reason, is unauthorized.
26(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;

 

 

HB5656- 5 -LRB101 19386 BMS 68858 b

1100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
21-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
3eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
4revised 10-16-19.)
 
5    (Text of Section after amendment by P.A. 101-625)
6    Sec. 10-4-2.3. Required health benefits. If a
7municipality, including a home rule municipality, is a
8self-insurer for purposes of providing health insurance
9coverage for its employees, the coverage shall include coverage
10for the post-mastectomy care benefits required to be covered by
11a policy of accident and health insurance under Section 356t
12and the coverage required under Sections 356g, 356g.5,
13356g.5-1, 356u, 356w, 356x, 356z.4a, 356z.6, 356z.8, 356z.9,
14356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
15356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
16356z.36, and 356z.41 of the Illinois Insurance Code. The
17coverage shall comply with Sections 155.22a, 355b, 356z.19, and
18370c of the Illinois Insurance Code. The Department of
19Insurance shall enforce the requirements of this Section. The
20requirement that health benefits be covered as provided in this
21is an exclusive power and function of the State and is a denial
22and limitation under Article VII, Section 6, subsection (h) of
23the Illinois Constitution. A home rule municipality to which
24this Section applies must comply with every provision of this
25Section.

 

 

HB5656- 6 -LRB101 19386 BMS 68858 b

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; 101-81, eff. 7-12-19; 101-281,
10eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
11101-625, eff. 1-1-21.)
 
12    Section 15. The School Code is amended by changing Section
1310-22.3f as follows:
 
14    (105 ILCS 5/10-22.3f)
15    (Text of Section before amendment by P.A. 101-625)
16    Sec. 10-22.3f. Required health benefits. Insurance
17protection and benefits for employees shall provide the
18post-mastectomy care benefits required to be covered by a
19policy of accident and health insurance under Section 356t and
20the coverage required under Sections 356g, 356g.5, 356g.5-1,
21356u, 356w, 356x, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.11,
22356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26,
23356z.29, 356z.30a, and 356z.32, and 356z.33, and 356z.36 of the
24Illinois Insurance Code. Insurance policies shall comply with

 

 

HB5656- 7 -LRB101 19386 BMS 68858 b

1Section 356z.19 of the Illinois Insurance Code. The coverage
2shall comply with Sections 155.22a, 355b, and 370c of the
3Illinois Insurance Code. The Department of Insurance shall
4enforce the requirements of this Section.
5    Rulemaking authority to implement Public Act 95-1045, if
6any, is conditioned on the rules being adopted in accordance
7with all provisions of the Illinois Administrative Procedure
8Act and all rules and procedures of the Joint Committee on
9Administrative Rules; any purported rule not so adopted, for
10whatever reason, is unauthorized.
11(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
12100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
131-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
14eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
15revised 10-16-19.)
 
16    (Text of Section after amendment by P.A. 101-625)
17    Sec. 10-22.3f. Required health benefits. Insurance
18protection and benefits for employees shall provide the
19post-mastectomy care benefits required to be covered by a
20policy of accident and health insurance under Section 356t and
21the coverage required under Sections 356g, 356g.5, 356g.5-1,
22356u, 356w, 356x, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.11,
23356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26,
24356z.29, 356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41 of
25the Illinois Insurance Code. Insurance policies shall comply

 

 

HB5656- 8 -LRB101 19386 BMS 68858 b

1with Section 356z.19 of the Illinois Insurance Code. The
2coverage shall comply with Sections 155.22a, 355b, and 370c of
3the Illinois Insurance Code. The Department of Insurance shall
4enforce the requirements of this Section.
5    Rulemaking authority to implement Public Act 95-1045, if
6any, is conditioned on the rules being adopted in accordance
7with all provisions of the Illinois Administrative Procedure
8Act and all rules and procedures of the Joint Committee on
9Administrative Rules; any purported rule not so adopted, for
10whatever reason, is unauthorized.
11(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
12100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
131-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
14eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
15101-625, eff. 1-1-21.)
 
16    Section 20. The Illinois Insurance Code is amended by
17changing Section 356z.4a as follows:
 
18    (215 ILCS 5/356z.4a)
19    Sec. 356z.4a. Coverage for abortion.
20    (a) Except as otherwise provided in this Section, no
21individual or group policy of accident and health insurance
22that provides pregnancy-related benefits may be issued,
23amended, delivered, or renewed in this State after the
24effective date of this amendatory Act of the 101st General

 

 

HB5656- 9 -LRB101 19386 BMS 68858 b

1Assembly the effective date of this amendatory Act of the 101st
2General Assembly unless the policy provides a covered person
3with coverage for abortion care.
4    (b) Coverage for abortion care may not impose any
5deductible, coinsurance, waiting period, or other cost-sharing
6limitation that is greater than that required for other
7pregnancy-related benefits covered by the policy.
8    (c) Except as otherwise authorized under this Section, a
9policy shall not impose any restrictions or delays on the
10coverage required under this Section.
11    (d) This Section does not, pursuant to 42 U.S.C.
1218054(a)(6), apply to a multistate plan that does not provide
13coverage for abortion.
14    (e) If the Department concludes that enforcement of this
15Section may adversely affect the allocation of federal funds to
16this State, the Department may grant an exemption to the
17requirements, but only to the minimum extent necessary to
18ensure the continued receipt of federal funds.
19(Source: P.A. 101-13, eff. 6-12-19.)
 
20    Section 25. The Limited Health Service Organization Act is
21amended by changing Section 4003 as follows:
 
22    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
23    (Text of Section before amendment by P.A. 101-625)
24    Sec. 4003. Illinois Insurance Code provisions. Limited

 

 

HB5656- 10 -LRB101 19386 BMS 68858 b

1health service organizations shall be subject to the provisions
2of Sections 133, 134, 136, 137, 139, 140, 141.1, 141.2, 141.3,
3143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5, 154.6,
4154.7, 154.8, 155.04, 155.37, 355.2, 355.3, 355b, 356v,
5356z.4a, 356z.10, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29,
6356z.30a, 356z.32, 356z.33, 368a, 401, 401.1, 402, 403, 403A,
7408, 408.2, 409, 412, 444, and 444.1 and Articles IIA, VIII
81/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and XXVI of the
9Illinois Insurance Code. For purposes of the Illinois Insurance
10Code, except for Sections 444 and 444.1 and Articles XIII and
11XIII 1/2, limited health service organizations in the following
12categories are deemed to be domestic companies:
13        (1) a corporation under the laws of this State; or
14        (2) a corporation organized under the laws of another
15    state, 30% or more of the enrollees of which are residents
16    of this State, except a corporation subject to
17    substantially the same requirements in its state of
18    organization as is a domestic company under Article VIII
19    1/2 of the Illinois Insurance Code.
20(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
21100-201, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1057, eff.
221-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
23eff. 1-1-20; 101-393, eff. 1-1-20; revised 10-16-19.)
 
24    (Text of Section after amendment by P.A. 101-625)
25    Sec. 4003. Illinois Insurance Code provisions. Limited

 

 

HB5656- 11 -LRB101 19386 BMS 68858 b

1health service organizations shall be subject to the provisions
2of Sections 133, 134, 136, 137, 139, 140, 141.1, 141.2, 141.3,
3143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5, 154.6,
4154.7, 154.8, 155.04, 155.37, 355.2, 355.3, 355b, 356v,
5356z.4a, 356z.10, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29,
6356z.30a, 356z.32, 356z.33, 356z.41, 368a, 401, 401.1, 402,
7403, 403A, 408, 408.2, 409, 412, 444, and 444.1 and Articles
8IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and XXVI of
9the Illinois Insurance Code. For purposes of the Illinois
10Insurance Code, except for Sections 444 and 444.1 and Articles
11XIII and XIII 1/2, limited health service organizations in the
12following categories are deemed to be domestic companies:
13        (1) a corporation under the laws of this State; or
14        (2) a corporation organized under the laws of another
15    state, 30% or more of the enrollees of which are residents
16    of this State, except a corporation subject to
17    substantially the same requirements in its state of
18    organization as is a domestic company under Article VIII
19    1/2 of the Illinois Insurance Code.
20(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
21100-201, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1057, eff.
221-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
23eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff. 1-1-21.)
 
24    Section 30. The Illinois Public Aid Code is amended by
25changing Section 5-16.8 as follows:
 

 

 

HB5656- 12 -LRB101 19386 BMS 68858 b

1    (305 ILCS 5/5-16.8)
2    Sec. 5-16.8. Required health benefits. The medical
3assistance program shall (i) provide the post-mastectomy care
4benefits required to be covered by a policy of accident and
5health insurance under Section 356t and the coverage required
6under Sections 356g.5, 356u, 356w, 356x, 356z.4a, 356z.6,
7356z.26, 356z.29, and 356z.32, and 356z.33, 356z.34, 356z.35,
8and 356z.39 of the Illinois Insurance Code and (ii) be subject
9to the provisions of Sections 356z.19, 364.01, 370c, and 370c.1
10of the Illinois Insurance Code.
11    On and after July 1, 2012, the Department shall reduce any
12rate of reimbursement for services or other payments or alter
13any methodologies authorized by this Code to reduce any rate of
14reimbursement for services or other payments in accordance with
15Section 5-5e.
16    To ensure full access to the benefits set forth in this
17Section, on and after January 1, 2016, the Department shall
18ensure that provider and hospital reimbursement for
19post-mastectomy care benefits required under this Section are
20no lower than the Medicare reimbursement rate.
21(Source: P.A. 100-138, eff. 8-18-17; 100-863, eff. 8-14-18;
22100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff.
237-12-19; 101-218, eff. 1-1-20; 101-281, eff. 1-1-20; 101-371,
24eff. 1-1-20; 101-574, eff. 1-1-20; revised 10-16-19.)
 

 

 

HB5656- 13 -LRB101 19386 BMS 68858 b

1    Section 95. No acceleration or delay. Where this Act makes
2changes in a statute that is represented in this Act by text
3that is not yet or no longer in effect (for example, a Section
4represented by multiple versions), the use of that text does
5not accelerate or delay the taking effect of (i) the changes
6made by this Act or (ii) provisions derived from any other
7Public Act.