HB2406 EngrossedLRB102 13035 BMS 18378 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 Illinois Insurance Code is amended by
5adding Section 356z.43 as follows:
 
6    (215 ILCS 5/356z.43 new)
7    Sec. 356z.43. COVID-19 vaccine administrative cost. An
8individual or group policy of accident and health insurance or
9managed care plan in effect on and after March 9, 2020 must
10provide coverage for the cost of administering a COVID-19
11vaccination without cost sharing.
 
12    Section 10. The Health Maintenance Organization Act is
13amended by changing Section 5-3 as follows:
 
14    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
15    Sec. 5-3. Insurance Code provisions.
16    (a) Health Maintenance Organizations shall be subject to
17the provisions of Sections 133, 134, 136, 137, 139, 140,
18141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
19154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2,
20355.3, 355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2,
21356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10,

 

 

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1356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.18,
2356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30,
3356z.30a, 356z.32, 356z.33, 356z.35, 356z.36, 356z.41,
4356z.43, 364, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c,
5368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A, 408,
6408.2, 409, 412, 444, and 444.1, paragraph (c) of subsection
7(2) of Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2,
8XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the Illinois
9Insurance Code.
10    (b) For purposes of the Illinois Insurance Code, except
11for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
12Health Maintenance Organizations in the following categories
13are deemed to be "domestic companies":
14        (1) a corporation authorized under the Dental Service
15    Plan Act or the Voluntary Health Services Plans Act;
16        (2) a corporation organized under the laws of this
17    State; or
18        (3) 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    (c) In considering the merger, consolidation, or other
25acquisition of control of a Health Maintenance Organization
26pursuant to Article VIII 1/2 of the Illinois Insurance Code,

 

 

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1        (1) the Director shall give primary consideration to
2    the continuation of benefits to enrollees and the
3    financial conditions of the acquired Health Maintenance
4    Organization after the merger, consolidation, or other
5    acquisition of control takes effect;
6        (2)(i) the criteria specified in subsection (1)(b) of
7    Section 131.8 of the Illinois Insurance Code shall not
8    apply and (ii) the Director, in making his determination
9    with respect to the merger, consolidation, or other
10    acquisition of control, need not take into account the
11    effect on competition of the merger, consolidation, or
12    other acquisition of control;
13        (3) the Director shall have the power to require the
14    following information:
15            (A) certification by an independent actuary of the
16        adequacy of the reserves of the Health Maintenance
17        Organization sought to be acquired;
18            (B) pro forma financial statements reflecting the
19        combined balance sheets of the acquiring company and
20        the Health Maintenance Organization sought to be
21        acquired as of the end of the preceding year and as of
22        a date 90 days prior to the acquisition, as well as pro
23        forma financial statements reflecting projected
24        combined operation for a period of 2 years;
25            (C) a pro forma business plan detailing an
26        acquiring party's plans with respect to the operation

 

 

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1        of the Health Maintenance Organization sought to be
2        acquired for a period of not less than 3 years; and
3            (D) such other information as the Director shall
4        require.
5    (d) The provisions of Article VIII 1/2 of the Illinois
6Insurance Code and this Section 5-3 shall apply to the sale by
7any health maintenance organization of greater than 10% of its
8enrollee population (including without limitation the health
9maintenance organization's right, title, and interest in and
10to its health care certificates).
11    (e) In considering any management contract or service
12agreement subject to Section 141.1 of the Illinois Insurance
13Code, the Director (i) shall, in addition to the criteria
14specified in Section 141.2 of the Illinois Insurance Code,
15take into account the effect of the management contract or
16service agreement on the continuation of benefits to enrollees
17and the financial condition of the health maintenance
18organization to be managed or serviced, and (ii) need not take
19into account the effect of the management contract or service
20agreement on competition.
21    (f) Except for small employer groups as defined in the
22Small Employer Rating, Renewability and Portability Health
23Insurance Act and except for medicare supplement policies as
24defined in Section 363 of the Illinois Insurance Code, a
25Health Maintenance Organization may by contract agree with a
26group or other enrollment unit to effect refunds or charge

 

 

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1additional premiums under the following terms and conditions:
2        (i) the amount of, and other terms and conditions with
3    respect to, the refund or additional premium are set forth
4    in the group or enrollment unit contract agreed in advance
5    of the period for which a refund is to be paid or
6    additional premium is to be charged (which period shall
7    not be less than one year); and
8        (ii) the amount of the refund or additional premium
9    shall not exceed 20% of the Health Maintenance
10    Organization's profitable or unprofitable experience with
11    respect to the group or other enrollment unit for the
12    period (and, for purposes of a refund or additional
13    premium, the profitable or unprofitable experience shall
14    be calculated taking into account a pro rata share of the
15    Health Maintenance Organization's administrative and
16    marketing expenses, but shall not include any refund to be
17    made or additional premium to be paid pursuant to this
18    subsection (f)). The Health Maintenance Organization and
19    the group or enrollment unit may agree that the profitable
20    or unprofitable experience may be calculated taking into
21    account the refund period and the immediately preceding 2
22    plan years.
23    The Health Maintenance Organization shall include a
24statement in the evidence of coverage issued to each enrollee
25describing the possibility of a refund or additional premium,
26and upon request of any group or enrollment unit, provide to

 

 

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1the group or enrollment unit a description of the method used
2to calculate (1) the Health Maintenance Organization's
3profitable experience with respect to the group or enrollment
4unit and the resulting refund to the group or enrollment unit
5or (2) the Health Maintenance Organization's unprofitable
6experience with respect to the group or enrollment unit and
7the resulting additional premium to be paid by the group or
8enrollment unit.
9    In no event shall the Illinois Health Maintenance
10Organization Guaranty Association be liable to pay any
11contractual obligation of an insolvent organization to pay any
12refund authorized under this Section.
13    (g) Rulemaking authority to implement Public Act 95-1045,
14if any, is conditioned on the rules being adopted in
15accordance with all provisions of the Illinois Administrative
16Procedure Act and all rules and procedures of the Joint
17Committee on Administrative Rules; any purported rule not so
18adopted, for whatever reason, is unauthorized.
19(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
20100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff.
211-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81,
22eff. 7-12-19; 101-281, eff. 1-1-20; 101-371, eff. 1-1-20;
23101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
241-1-20; 101-625, eff. 1-1-21.)
 
25    Section 15. The Voluntary Health Services Plans Act is

 

 

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1amended by changing Section 10 as follows:
 
2    (215 ILCS 165/10)  (from Ch. 32, par. 604)
3    Sec. 10. Application of Insurance Code provisions. Health
4services plan corporations and all persons interested therein
5or dealing therewith shall be subject to the provisions of
6Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
7143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
8356g, 356g.5, 356g.5-1, 356r, 356t, 356u, 356v, 356w, 356x,
9356y, 356z.1, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8,
10356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
11356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29,
12356z.30, 356z.30a, 356z.32, 356z.33, 356z.41, 356z.43, 364.01,
13367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412,
14and paragraphs (7) and (15) of Section 367 of the Illinois
15Insurance Code.
16    Rulemaking authority to implement Public Act 95-1045, if
17any, is conditioned on the rules being adopted in accordance
18with all provisions of the Illinois Administrative Procedure
19Act and all rules and procedures of the Joint Committee on
20Administrative Rules; any purported rule not so adopted, for
21whatever reason, is unauthorized.
22(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
23100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff.
241-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81,
25eff. 7-12-19; 101-281, eff. 1-1-20; 101-393, eff. 1-1-20;

 

 

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1101-625, eff. 1-1-21.)
 
2    Section 20. The Illinois Public Aid Code is amended by
3changing Section 5-16.8 as follows:
 
4    (305 ILCS 5/5-16.8)
5    Sec. 5-16.8. Required health benefits. The medical
6assistance program shall (i) provide the post-mastectomy care
7benefits required to be covered by a policy of accident and
8health insurance under Section 356t and the coverage required
9under Sections 356g.5, 356u, 356w, 356x, 356z.6, 356z.26,
10356z.29, 356z.32, 356z.33, 356z.34, and 356z.35, and 356z.43
11of the Illinois Insurance Code and (ii) be subject to the
12provisions of Sections 356z.19, 364.01, 370c, and 370c.1 of
13the Illinois Insurance Code.
14    The Department, by rule, shall adopt a model similar to
15the requirements of Section 356z.39 of the Illinois Insurance
16Code.
17    On and after July 1, 2012, the Department shall reduce any
18rate of reimbursement for services or other payments or alter
19any methodologies authorized by this Code to reduce any rate
20of reimbursement for services or other payments in accordance
21with Section 5-5e.
22    To ensure full access to the benefits set forth in this
23Section, on and after January 1, 2016, the Department shall
24ensure that provider and hospital reimbursement for

 

 

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1post-mastectomy care benefits required under this Section are
2no lower than the Medicare reimbursement rate.
3(Source: P.A. 100-138, eff. 8-18-17; 100-863, eff. 8-14-18;
4100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff.
57-12-19; 101-218, eff. 1-1-20; 101-281, eff. 1-1-20; 101-371,
6eff. 1-1-20; 101-574, eff. 1-1-20; 101-649, eff. 7-7-20.)