SB2158 EngrossedLRB102 14125 BMS 19477 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 State Employees Group Insurance Act of 1971
5is amended by changing Section 6.11 as follows:
 
6    (5 ILCS 375/6.11)
7    Sec. 6.11. Required health benefits; Illinois Insurance
8Code requirements. The program of health benefits shall
9provide the post-mastectomy care benefits required to be
10covered by a policy of accident and health insurance under
11Section 356t of the Illinois Insurance Code. The program of
12health benefits shall provide the coverage required under
13Sections 356g, 356g.5, 356g.5-1, 356m, 356u, 356w, 356x,
14356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
15356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,
16356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
17356z.36, and 356z.41, and 356z.43 of the Illinois Insurance
18Code. The program of health benefits must comply with Sections
19155.22a, 155.37, 355b, 356z.19, 370c, and 370c.1 and Article
20XXXIIB of the Illinois Insurance Code. The Department of
21Insurance shall enforce the requirements of this Section with
22respect to Sections 370c and 370c.1 of the Illinois Insurance
23Code; all other requirements of this Section shall be enforced

 

 

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1by the Department of Central Management Services.
2    Rulemaking authority to implement Public Act 95-1045, if
3any, is conditioned on the rules being adopted in accordance
4with all provisions of the Illinois Administrative Procedure
5Act and all rules and procedures of the Joint Committee on
6Administrative Rules; any purported rule not so adopted, for
7whatever reason, is unauthorized.
8(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
9100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
101-1-19; 100-1102, eff. 1-1-19; 100-1170, eff. 6-1-19; 101-13,
11eff. 6-12-19; 101-281, eff. 1-1-20; 101-393, eff. 1-1-20;
12101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
131-1-21.)
 
14    Section 10. The Counties Code is amended by changing
15Section 5-1069.3 as follows:
 
16    (55 ILCS 5/5-1069.3)
17    Sec. 5-1069.3. Required health benefits. If a county,
18including a home rule county, is a self-insurer for purposes
19of providing health insurance coverage for its employees, the
20coverage shall include coverage for the post-mastectomy care
21benefits required to be covered by a policy of accident and
22health insurance under Section 356t and the coverage required
23under Sections 356g, 356g.5, 356g.5-1, 356u, 356w, 356x,
24356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,

 

 

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1356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
2356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41, and 356z.43
3of the Illinois Insurance Code. The coverage shall comply with
4Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
5Insurance Code. The Department of Insurance shall enforce the
6requirements of this Section. The requirement that health
7benefits be covered as provided in this Section is an
8exclusive power and function of the State and is a denial and
9limitation under Article VII, Section 6, subsection (h) of the
10Illinois Constitution. A home rule county to which this
11Section applies must comply with every provision of this
12Section.
13    Rulemaking authority to implement Public Act 95-1045, if
14any, is conditioned on the rules being adopted in accordance
15with all provisions of the Illinois Administrative Procedure
16Act and all rules and procedures of the Joint Committee on
17Administrative Rules; any purported rule not so adopted, for
18whatever 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; 100-1024, eff. 1-1-19; 100-1057, eff.
211-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
22eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
23101-625, eff. 1-1-21.)
 
24    Section 15. The Illinois Municipal Code is amended by
25changing Section 10-4-2.3 as follows:
 

 

 

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1    (65 ILCS 5/10-4-2.3)
2    Sec. 10-4-2.3. Required health benefits. If a
3municipality, including a home rule municipality, is a
4self-insurer for purposes of providing health insurance
5coverage for its employees, the coverage shall include
6coverage for the post-mastectomy care benefits required to be
7covered by a policy of accident and health insurance under
8Section 356t and the coverage required under Sections 356g,
9356g.5, 356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9,
10356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
11356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
12356z.36, and 356z.41, and 356z.43 of the Illinois Insurance
13Code. The coverage shall comply with Sections 155.22a, 355b,
14356z.19, and 370c of the Illinois Insurance Code. The
15Department of Insurance shall enforce the requirements of this
16Section. The requirement that health benefits be covered as
17provided in this is an exclusive power and function of the
18State and is a denial and limitation under Article VII,
19Section 6, subsection (h) of the Illinois Constitution. A home
20rule municipality to which this Section applies must comply
21with every provision of this Section.
22    Rulemaking authority to implement Public Act 95-1045, if
23any, is conditioned on the rules being adopted in accordance
24with all provisions of the Illinois Administrative Procedure
25Act and all rules and procedures of the Joint Committee on

 

 

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1Administrative Rules; any purported rule not so adopted, for
2whatever reason, is unauthorized.
3(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
4100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
51-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
6eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
7101-625, eff. 1-1-21.)
 
8    Section 20. The School Code is amended by changing Section
910-22.3f as follows:
 
10    (105 ILCS 5/10-22.3f)
11    Sec. 10-22.3f. Required health benefits. Insurance
12protection and benefits for employees shall provide the
13post-mastectomy care benefits required to be covered by a
14policy of accident and health insurance under Section 356t and
15the coverage required under Sections 356g, 356g.5, 356g.5-1,
16356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11, 356z.12,
17356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
18356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41, and 356z.43
19of the Illinois Insurance Code. Insurance policies shall
20comply with Section 356z.19 of the Illinois Insurance Code.
21The coverage shall comply with Sections 155.22a, 355b, and
22370c of the Illinois Insurance Code. The Department of
23Insurance shall enforce the requirements of this Section.
24    Rulemaking authority to implement Public Act 95-1045, if

 

 

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1any, is conditioned on the rules being adopted in accordance
2with all provisions of the Illinois Administrative Procedure
3Act and all rules and procedures of the Joint Committee on
4Administrative Rules; any purported rule not so adopted, for
5whatever reason, is unauthorized.
6(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
7100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
81-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
9eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
10101-625, eff. 1-1-21.)
 
11    Section 25. The Illinois Insurance Code is amended by
12adding Section 356z.43 as follows:
 
13    (215 ILCS 5/356z.43 new)
14    Sec. 356z.43. Coverage for port-wine stain treatment.
15    (a) A group or individual policy of accident and health
16insurance or managed care plan amended, delivered, issued, or
17renewed on or after January 1, 2022 shall provide coverage for
18treatment to eliminate or provide maximum feasible treatment
19of nevus flammeus, also known as port-wine stains, including,
20but not limited to, port-wine stains caused by Sturge-Weber
21syndrome. For purposes of this Section, treatment or maximum
22feasible treatment shall include early intervention treatment,
23including topical, intralesional, or systemic medical therapy
24and surgery, and laser treatments approved by the U.S. Food

 

 

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1and Drug Administration in children aged 18 years and younger
2that are intended to prevent functional impairment related to
3vision function, oral function, inflammation, bleeding,
4infection, and other medical complications associated with
5port-wine stains.
6    (b) Coverage for treatment required under this Section
7shall not include treatment solely for cosmetic purposes.
 
8    Section 30. The Health Maintenance Organization Act is
9amended by changing Section 5-3 as follows:
 
10    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
11    Sec. 5-3. Insurance Code provisions.
12    (a) Health Maintenance Organizations shall be subject to
13the provisions of Sections 133, 134, 136, 137, 139, 140,
14141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
15154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2,
16355.3, 355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2,
17356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10,
18356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.18,
19356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30,
20356z.30a, 356z.32, 356z.33, 356z.35, 356z.36, 356z.41,
21356z.43, 364, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c,
22368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A, 408,
23408.2, 409, 412, 444, and 444.1, paragraph (c) of subsection
24(2) of Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2,

 

 

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1XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the Illinois
2Insurance Code.
3    (b) For purposes of the Illinois Insurance Code, except
4for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
5Health Maintenance Organizations in the following categories
6are deemed to be "domestic companies":
7        (1) a corporation authorized under the Dental Service
8    Plan Act or the Voluntary Health Services Plans Act;
9        (2) a corporation organized under the laws of this
10    State; or
11        (3) a corporation organized under the laws of another
12    state, 30% or more of the enrollees of which are residents
13    of this State, except a corporation subject to
14    substantially the same requirements in its state of
15    organization as is a "domestic company" under Article VIII
16    1/2 of the Illinois Insurance Code.
17    (c) In considering the merger, consolidation, or other
18acquisition of control of a Health Maintenance Organization
19pursuant to Article VIII 1/2 of the Illinois Insurance Code,
20        (1) the Director shall give primary consideration to
21    the continuation of benefits to enrollees and the
22    financial conditions of the acquired Health Maintenance
23    Organization after the merger, consolidation, or other
24    acquisition of control takes effect;
25        (2)(i) the criteria specified in subsection (1)(b) of
26    Section 131.8 of the Illinois Insurance Code shall not

 

 

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1    apply and (ii) the Director, in making his determination
2    with respect to the merger, consolidation, or other
3    acquisition of control, need not take into account the
4    effect on competition of the merger, consolidation, or
5    other acquisition of control;
6        (3) the Director shall have the power to require the
7    following information:
8            (A) certification by an independent actuary of the
9        adequacy of the reserves of the Health Maintenance
10        Organization sought to be acquired;
11            (B) pro forma financial statements reflecting the
12        combined balance sheets of the acquiring company and
13        the Health Maintenance Organization sought to be
14        acquired as of the end of the preceding year and as of
15        a date 90 days prior to the acquisition, as well as pro
16        forma financial statements reflecting projected
17        combined operation for a period of 2 years;
18            (C) a pro forma business plan detailing an
19        acquiring party's plans with respect to the operation
20        of the Health Maintenance Organization sought to be
21        acquired for a period of not less than 3 years; and
22            (D) such other information as the Director shall
23        require.
24    (d) The provisions of Article VIII 1/2 of the Illinois
25Insurance Code and this Section 5-3 shall apply to the sale by
26any health maintenance organization of greater than 10% of its

 

 

SB2158 Engrossed- 10 -LRB102 14125 BMS 19477 b

1enrollee population (including without limitation the health
2maintenance organization's right, title, and interest in and
3to its health care certificates).
4    (e) In considering any management contract or service
5agreement subject to Section 141.1 of the Illinois Insurance
6Code, the Director (i) shall, in addition to the criteria
7specified in Section 141.2 of the Illinois Insurance Code,
8take into account the effect of the management contract or
9service agreement on the continuation of benefits to enrollees
10and the financial condition of the health maintenance
11organization to be managed or serviced, and (ii) need not take
12into account the effect of the management contract or service
13agreement on competition.
14    (f) Except for small employer groups as defined in the
15Small Employer Rating, Renewability and Portability Health
16Insurance Act and except for medicare supplement policies as
17defined in Section 363 of the Illinois Insurance Code, a
18Health Maintenance Organization may by contract agree with a
19group or other enrollment unit to effect refunds or charge
20additional premiums under the following terms and conditions:
21        (i) the amount of, and other terms and conditions with
22    respect to, the refund or additional premium are set forth
23    in the group or enrollment unit contract agreed in advance
24    of the period for which a refund is to be paid or
25    additional premium is to be charged (which period shall
26    not be less than one year); and

 

 

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1        (ii) the amount of the refund or additional premium
2    shall not exceed 20% of the Health Maintenance
3    Organization's profitable or unprofitable experience with
4    respect to the group or other enrollment unit for the
5    period (and, for purposes of a refund or additional
6    premium, the profitable or unprofitable experience shall
7    be calculated taking into account a pro rata share of the
8    Health Maintenance Organization's administrative and
9    marketing expenses, but shall not include any refund to be
10    made or additional premium to be paid pursuant to this
11    subsection (f)). The Health Maintenance Organization and
12    the group or enrollment unit may agree that the profitable
13    or unprofitable experience may be calculated taking into
14    account the refund period and the immediately preceding 2
15    plan years.
16    The Health Maintenance Organization shall include a
17statement in the evidence of coverage issued to each enrollee
18describing the possibility of a refund or additional premium,
19and upon request of any group or enrollment unit, provide to
20the group or enrollment unit a description of the method used
21to calculate (1) the Health Maintenance Organization's
22profitable experience with respect to the group or enrollment
23unit and the resulting refund to the group or enrollment unit
24or (2) the Health Maintenance Organization's unprofitable
25experience with respect to the group or enrollment unit and
26the resulting additional premium to be paid by the group or

 

 

SB2158 Engrossed- 12 -LRB102 14125 BMS 19477 b

1enrollment unit.
2    In no event shall the Illinois Health Maintenance
3Organization Guaranty Association be liable to pay any
4contractual obligation of an insolvent organization to pay any
5refund authorized under this Section.
6    (g) Rulemaking authority to implement Public Act 95-1045,
7if any, is conditioned on the rules being adopted in
8accordance with all provisions of the Illinois Administrative
9Procedure Act and all rules and procedures of the Joint
10Committee on Administrative Rules; any purported rule not so
11adopted, for whatever reason, is unauthorized.
12(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
13100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff.
141-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81,
15eff. 7-12-19; 101-281, eff. 1-1-20; 101-371, eff. 1-1-20;
16101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
171-1-20; 101-625, eff. 1-1-21.)
 
18    Section 35. The Limited Health Service Organization Act is
19amended by changing Section 4003 as follows:
 
20    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
21    Sec. 4003. Illinois Insurance Code provisions. Limited
22health service organizations shall be subject to the
23provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
24141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,

 

 

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1154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 355.2, 355.3,
2355b, 356v, 356z.10, 356z.21, 356z.22, 356z.25, 356z.26,
3356z.29, 356z.30a, 356z.32, 356z.33, 356z.41, 356z.43, 368a,
4401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412, 444, and
5444.1 and Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2,
6XXV, and XXVI of the Illinois Insurance Code. For purposes of
7the Illinois Insurance Code, except for Sections 444 and 444.1
8and Articles XIII and XIII 1/2, limited health service
9organizations in the following categories are deemed to be
10domestic companies:
11        (1) a corporation under the laws of this State; or
12        (2) a corporation organized under the laws of another
13    state, 30% or more of the enrollees of which are residents
14    of this State, except a corporation subject to
15    substantially the same requirements in its state of
16    organization as is a domestic company under Article VIII
17    1/2 of the Illinois Insurance Code.
18(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
19100-201, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1057, eff.
201-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
21eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff. 1-1-21.)
 
22    Section 40. The Voluntary Health Services Plans Act is
23amended by changing Section 10 as follows:
 
24    (215 ILCS 165/10)  (from Ch. 32, par. 604)

 

 

SB2158 Engrossed- 14 -LRB102 14125 BMS 19477 b

1    Sec. 10. Application of Insurance Code provisions. Health
2services plan corporations and all persons interested therein
3or dealing therewith shall be subject to the provisions of
4Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
5143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
6356g, 356g.5, 356g.5-1, 356r, 356t, 356u, 356v, 356w, 356x,
7356y, 356z.1, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8,
8356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
9356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29,
10356z.30, 356z.30a, 356z.32, 356z.33, 356z.41, 356z.43, 364.01,
11367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412,
12and paragraphs (7) and (15) of Section 367 of the Illinois
13Insurance Code.
14    Rulemaking authority to implement Public Act 95-1045, if
15any, is conditioned on the rules being adopted in accordance
16with all provisions of the Illinois Administrative Procedure
17Act and all rules and procedures of the Joint Committee on
18Administrative Rules; any purported rule not so adopted, for
19whatever reason, is unauthorized.
20(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
21100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff.
221-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81,
23eff. 7-12-19; 101-281, eff. 1-1-20; 101-393, eff. 1-1-20;
24101-625, eff. 1-1-21.)
 
25    Section 45. The Illinois Public Aid Code is amended by

 

 

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1changing Section 5-16.8 as follows:
 
2    (305 ILCS 5/5-16.8)
3    Sec. 5-16.8. Required health benefits. The medical
4assistance program shall (i) provide the post-mastectomy care
5benefits required to be covered by a policy of accident and
6health insurance under Section 356t and the coverage required
7under Sections 356g.5, 356u, 356w, 356x, 356z.6, 356z.26,
8356z.29, 356z.32, 356z.33, 356z.34, and 356z.35, and 356z.43
9of the Illinois Insurance Code and (ii) be subject to the
10provisions of Sections 356z.19, 364.01, 370c, and 370c.1 of
11the Illinois Insurance Code.
12    The Department, by rule, shall adopt a model similar to
13the requirements of Section 356z.39 of the Illinois Insurance
14Code.
15    On and after July 1, 2012, the Department shall reduce any
16rate of reimbursement for services or other payments or alter
17any methodologies authorized by this Code to reduce any rate
18of reimbursement for services or other payments in accordance
19with Section 5-5e.
20    To ensure full access to the benefits set forth in this
21Section, on and after January 1, 2016, the Department shall
22ensure that provider and hospital reimbursement for
23post-mastectomy care benefits required under this Section are
24no lower than the Medicare reimbursement rate.
25(Source: P.A. 100-138, eff. 8-18-17; 100-863, eff. 8-14-18;

 

 

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1100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff.
27-12-19; 101-218, eff. 1-1-20; 101-281, eff. 1-1-20; 101-371,
3eff. 1-1-20; 101-574, eff. 1-1-20; 101-649, eff. 7-7-20.)