Sen. Laura Fine

Filed: 5/20/2024

 

 


 

 


 
10300HB2499sam002LRB103 30875 RPS 73636 a

1
AMENDMENT TO HOUSE BILL 2499

2    AMENDMENT NO. ______. Amend House Bill 2499, AS AMENDED,
3by replacing everything after the enacting clause with the
4following:
 
5    "Section 5. The Illinois Insurance Code is amended by
6changing Sections 121-2.05, 356z.18, 367.3, 367a, and 368f and
7by adding Section 352c as follows:
 
8    (215 ILCS 5/121-2.05)  (from Ch. 73, par. 733-2.05)
9    Sec. 121-2.05. Group insurance policies issued and
10delivered in other State-Transactions in this State. With the
11exception of insurance transactions authorized under Sections
12230.2 or 367.3 of this Code or transactions described under
13Section 352c, transactions in this State involving group
14legal, group life and group accident and health or blanket
15accident and health insurance or group annuities where the
16master policy of such groups was lawfully issued and delivered

 

 

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1in, and under the laws of, a State in which the insurer was
2authorized to do an insurance business, to a group properly
3established pursuant to law or regulation, and where the
4policyholder is domiciled or otherwise has a bona fide situs.
5(Source: P.A. 86-753.)
 
6    (215 ILCS 5/352c new)
7    Sec. 352c. Short-term, limited-duration insurance
8prohibited.
9    (a) In this Section:
10    "Excepted benefits" has the meaning given to that term in
1142 U.S.C. 300gg-91 and implementing regulations. "Excepted
12benefits" includes individual, group, or blanket coverage.
13    "Short-term, limited-duration insurance" means any type of
14accident and health insurance offered or provided within this
15State pursuant to a group or individual policy or individual
16certificate by a company, regardless of the situs state of the
17delivery of the policy, that has an expiration date specified
18in the contract that is fewer than 365 days after the original
19effective date. Regardless of the duration of coverage,
20"short-term, limited-duration insurance" does not include
21excepted benefits or any student health insurance coverage.
22    (b) On and after January 1, 2025, no company shall issue,
23deliver, amend, or renew short-term, limited-duration
24insurance to any natural or legal person that is a resident or
25domiciled in this State.
 

 

 

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1    (215 ILCS 5/356z.18)
2    (Text of Section before amendment by P.A. 103-512)
3    Sec. 356z.18. Prosthetic and customized orthotic devices.
4    (a) For the purposes of this Section:
5    "Customized orthotic device" means a supportive device for
6the body or a part of the body, the head, neck, or extremities,
7and includes the replacement or repair of the device based on
8the patient's physical condition as medically necessary,
9excluding foot orthotics defined as an in-shoe device designed
10to support the structural components of the foot during
11weight-bearing activities.
12    "Licensed provider" means a prosthetist, orthotist, or
13pedorthist licensed to practice in this State.
14    "Prosthetic device" means an artificial device to replace,
15in whole or in part, an arm or leg and includes accessories
16essential to the effective use of the device and the
17replacement or repair of the device based on the patient's
18physical condition as medically necessary.
19    (b) This amendatory Act of the 96th General Assembly shall
20provide benefits to any person covered thereunder for expenses
21incurred in obtaining a prosthetic or custom orthotic device
22from any Illinois licensed prosthetist, licensed orthotist, or
23licensed pedorthist as required under the Orthotics,
24Prosthetics, and Pedorthics Practice Act.
25    (c) A group or individual major medical policy of accident

 

 

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1or health insurance or managed care plan or medical, health,
2or hospital service corporation contract that provides
3coverage for prosthetic or custom orthotic care and is
4amended, delivered, issued, or renewed 6 months after the
5effective date of this amendatory Act of the 96th General
6Assembly must provide coverage for prosthetic and orthotic
7devices in accordance with this subsection (c). The coverage
8required under this Section shall be subject to the other
9general exclusions, limitations, and financial requirements of
10the policy, including coordination of benefits, participating
11provider requirements, utilization review of health care
12services, including review of medical necessity, case
13management, and experimental and investigational treatments,
14and other managed care provisions under terms and conditions
15that are no less favorable than the terms and conditions that
16apply to substantially all medical and surgical benefits
17provided under the plan or coverage.
18    (d) The policy or plan or contract may require prior
19authorization for the prosthetic or orthotic devices in the
20same manner that prior authorization is required for any other
21covered benefit.
22    (e) Repairs and replacements of prosthetic and orthotic
23devices are also covered, subject to the co-payments and
24deductibles, unless necessitated by misuse or loss.
25    (f) A policy or plan or contract may require that, if
26coverage is provided through a managed care plan, the benefits

 

 

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1mandated pursuant to this Section shall be covered benefits
2only if the prosthetic or orthotic devices are provided by a
3licensed provider employed by a provider service who contracts
4with or is designated by the carrier, to the extent that the
5carrier provides in-network and out-of-network service, the
6coverage for the prosthetic or orthotic device shall be
7offered no less extensively.
8    (g) The policy or plan or contract shall also meet
9adequacy requirements as established by the Health Care
10Reimbursement Reform Act of 1985 of the Illinois Insurance
11Code.
12    (h) This Section shall not apply to accident only,
13specified disease, short-term travel hospital or medical,
14hospital confinement indemnity or other fixed indemnity,
15credit, dental, vision, Medicare supplement, long-term care,
16basic hospital and medical-surgical expense coverage,
17disability income insurance coverage, coverage issued as a
18supplement to liability insurance, workers' compensation
19insurance, or automobile medical payment insurance.
20(Source: P.A. 96-833, eff. 6-1-10.)
 
21    (Text of Section after amendment by P.A. 103-512)
22    Sec. 356z.18. Prosthetic and customized orthotic devices.
23    (a) For the purposes of this Section:
24    "Customized orthotic device" means a supportive device for
25the body or a part of the body, the head, neck, or extremities,

 

 

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1and includes the replacement or repair of the device based on
2the patient's physical condition as medically necessary,
3excluding foot orthotics defined as an in-shoe device designed
4to support the structural components of the foot during
5weight-bearing activities.
6    "Licensed provider" means a prosthetist, orthotist, or
7pedorthist licensed to practice in this State.
8    "Prosthetic device" means an artificial device to replace,
9in whole or in part, an arm or leg and includes accessories
10essential to the effective use of the device and the
11replacement or repair of the device based on the patient's
12physical condition as medically necessary.
13    (b) This amendatory Act of the 96th General Assembly shall
14provide benefits to any person covered thereunder for expenses
15incurred in obtaining a prosthetic or custom orthotic device
16from any Illinois licensed prosthetist, licensed orthotist, or
17licensed pedorthist as required under the Orthotics,
18Prosthetics, and Pedorthics Practice Act.
19    (c) A group or individual major medical policy of accident
20or health insurance or managed care plan or medical, health,
21or hospital service corporation contract that provides
22coverage for prosthetic or custom orthotic care and is
23amended, delivered, issued, or renewed 6 months after the
24effective date of this amendatory Act of the 96th General
25Assembly must provide coverage for prosthetic and orthotic
26devices in accordance with this subsection (c). The coverage

 

 

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1required under this Section shall be subject to the other
2general exclusions, limitations, and financial requirements of
3the policy, including coordination of benefits, participating
4provider requirements, utilization review of health care
5services, including review of medical necessity, case
6management, and experimental and investigational treatments,
7and other managed care provisions under terms and conditions
8that are no less favorable than the terms and conditions that
9apply to substantially all medical and surgical benefits
10provided under the plan or coverage.
11    (d) With respect to an enrollee at any age, in addition to
12coverage of a prosthetic or custom orthotic device required by
13this Section, benefits shall be provided for a prosthetic or
14custom orthotic device determined by the enrollee's provider
15to be the most appropriate model that is medically necessary
16for the enrollee to perform physical activities, as
17applicable, such as running, biking, swimming, and lifting
18weights, and to maximize the enrollee's whole body health and
19strengthen the lower and upper limb function.
20    (e) The requirements of this Section do not constitute an
21addition to this State's essential health benefits that
22requires defrayal of costs by this State pursuant to 42 U.S.C.
2318031(d)(3)(B).
24    (f) The policy or plan or contract may require prior
25authorization for the prosthetic or orthotic devices in the
26same manner that prior authorization is required for any other

 

 

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1covered benefit.
2    (g) Repairs and replacements of prosthetic and orthotic
3devices are also covered, subject to the co-payments and
4deductibles, unless necessitated by misuse or loss.
5    (h) A policy or plan or contract may require that, if
6coverage is provided through a managed care plan, the benefits
7mandated pursuant to this Section shall be covered benefits
8only if the prosthetic or orthotic devices are provided by a
9licensed provider employed by a provider service who contracts
10with or is designated by the carrier, to the extent that the
11carrier provides in-network and out-of-network service, the
12coverage for the prosthetic or orthotic device shall be
13offered no less extensively.
14    (i) The policy or plan or contract shall also meet
15adequacy requirements as established by the Health Care
16Reimbursement Reform Act of 1985 of the Illinois Insurance
17Code.
18    (j) This Section shall not apply to accident only,
19specified disease, short-term travel hospital or medical,
20hospital confinement indemnity or other fixed indemnity,
21credit, dental, vision, Medicare supplement, long-term care,
22basic hospital and medical-surgical expense coverage,
23disability income insurance coverage, coverage issued as a
24supplement to liability insurance, workers' compensation
25insurance, or automobile medical payment insurance.
26(Source: P.A. 103-512, eff. 1-1-25.)
 

 

 

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1    (215 ILCS 5/367.3)  (from Ch. 73, par. 979.3)
2    Sec. 367.3. Group accident and health insurance;
3discretionary groups.
4    (a) No group health insurance offered to a resident of
5this State under a policy issued to a group, other than one
6specifically described in Section 367(1), shall be delivered
7or issued for delivery in this State unless the Director
8determines that:
9        (1) the issuance of the policy is not contrary to the
10    public interest;
11        (2) the issuance of the policy will result in
12    economies of acquisition and administration; and
13        (3) the benefits under the policy are reasonable in
14    relation to the premium charged.
15    (b) No such group health insurance may be offered in this
16State under a policy issued in another state unless this State
17or the state in which the group policy is issued has made a
18determination that the requirements of subsection (a) have
19been met.
20    Where insurance is to be offered in this State under a
21policy described in this subsection, the insurer shall file
22for informational review purposes:
23        (1) a copy of the group master contract;
24        (2) a copy of the statute authorizing the issuance of
25    the group policy in the state of situs, which statute has

 

 

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1    the same or similar requirements as this State, or in the
2    absence of such statute, a certification by an officer of
3    the company that the policy meets the Illinois minimum
4    standards required for individual accident and health
5    policies under authority of Section 401 of this Code, as
6    now or hereafter amended, as promulgated by rule at 50
7    Illinois Administrative Code, Ch. I, Sec. 2007, et seq.,
8    as now or hereafter amended, or by a successor rule;
9        (3) evidence of approval by the state of situs of the
10    group master policy; and
11        (4) copies of all supportive material furnished to the
12    state of situs to satisfy the criteria for approval.
13    (c) The Director may, at any time after receipt of the
14information required under subsection (b) and after finding
15that the standards of subsection (a) have not been met, order
16the insurer to cease the issuance or marketing of that
17coverage in this State.
18    (d) Notwithstanding subsections (a) and (b), group Group
19accident and health insurance subject to the provisions of
20this Section is also subject to the provisions of Sections
21352c and Section 367i of this Code and rules thereunder.
22(Source: P.A. 90-655, eff. 7-30-98.)
 
23    (215 ILCS 5/367a)  (from Ch. 73, par. 979a)
24    Sec. 367a. Blanket accident and health insurance.
25    (1) Blanket accident and health insurance is the that form

 

 

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1of accident and health insurance providing excepted benefits,
2as defined in Section 352c, that covers covering special
3groups of persons as enumerated in one of the following
4paragraphs (a) to (g), inclusive:
5    (a) Under a policy or contract issued to any carrier for
6hire, which shall be deemed the policyholder, covering a group
7defined as all persons who may become passengers on such
8carrier.
9    (b) Under a policy or contract issued to an employer, who
10shall be deemed the policyholder, covering all employees or
11any group of employees defined by reference to exceptional
12hazards incident to such employment.
13    (c) Under a policy or contract issued to a college,
14school, or other institution of learning or to the head or
15principal thereof, who or which shall be deemed the
16policyholder, covering students or teachers. However, student
17health insurance coverage, as defined in 45 CFR 147.145, shall
18remain subject to the standards and requirements for
19individual health insurance coverage except where inconsistent
20with that regulation. An issuer providing student health
21insurance coverage or a policy or contract covering students
22for limited-scope dental or vision under 45 CFR 148.220 shall
23require an individual application or enrollment form and shall
24furnish each insured individual a certificate, which shall
25have been approved by the Director under Section 355.
26    (d) Under a policy or contract issued in the name of any

 

 

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1volunteer fire department, first aid, or other such volunteer
2group, which shall be deemed the policyholder, covering all of
3the members of such department or group.
4    (e) Under a policy or contract issued to a creditor, who
5shall be deemed the policyholder, to insure debtors of the
6creditors; Provided, however, that in the case of a loan which
7is subject to the Small Loans Act, no insurance premium or
8other cost shall be directly or indirectly charged or assessed
9against, or collected or received from the borrower.
10    (f) Under a policy or contract issued to a sports team or
11to a camp, which team or camp sponsor shall be deemed the
12policyholder, covering members or campers.
13    (g) Under a policy or contract issued to any other
14substantially similar group which, in the discretion of the
15Director, may be subject to the issuance of a blanket accident
16and health policy or contract.
17    (2) Any insurance company authorized to write accident and
18health insurance in this state shall have the power to issue
19blanket accident and health insurance. No such blanket policy
20may be issued or delivered in this State unless a copy of the
21form thereof shall have been filed in accordance with Section
22355, and it contains in substance such of those provisions
23contained in Sections 357.1 through 357.30 as may be
24applicable to blanket accident and health insurance and the
25following provisions:
26    (a) A provision that the policy and the application shall

 

 

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1constitute the entire contract between the parties, and that
2all statements made by the policyholder shall, in absence of
3fraud, be deemed representations and not warranties, and that
4no such statements shall be used in defense to a claim under
5the policy, unless it is contained in a written application.
6    (b) A provision that to the group or class thereof
7originally insured shall be added from time to time all new
8persons or individuals eligible for coverage.
9    (3) An individual application shall not be required from a
10person covered under a blanket accident or health policy or
11contract, nor shall it be necessary for the insurer to furnish
12each person a certificate.
13    (4) All benefits under any blanket accident and health
14policy shall be payable to the person insured, or to his
15designated beneficiary or beneficiaries, or to his or her
16estate, except that if the person insured be a minor or person
17under legal disability, such benefits may be made payable to
18his or her parent, guardian, or other person actually
19supporting him or her. Provided further, however, that the
20policy may provide that all or any portion of any indemnities
21provided by any such policy on account of hospital, nursing,
22medical or surgical services may, at the insurer's option, be
23paid directly to the hospital or person rendering such
24services; but the policy may not require that the service be
25rendered by a particular hospital or person. Payment so made
26shall discharge the insurer's obligation with respect to the

 

 

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1amount of insurance so paid.
2    (5) Nothing contained in this section shall be deemed to
3affect the legal liability of policyholders for the death of
4or injury to, any such member of such group.
5(Source: P.A. 83-1362.)
 
6    (215 ILCS 5/368f)
7    Sec. 368f. Military service member insurance
8reinstatement.
9    (a) No Illinois resident activated for military service
10and no spouse or dependent of the resident who becomes
11eligible for a federal government-sponsored health insurance
12program, including the TriCare program providing coverage for
13civilian dependents of military personnel, as a result of the
14activation shall be denied reinstatement into the same
15individual health insurance coverage with the health insurer
16that the resident lapsed as a result of activation or becoming
17covered by the federal government-sponsored health insurance
18program. The resident shall have the right to reinstatement in
19the same individual health insurance coverage without medical
20underwriting, subject to payment of the current premium
21charged to other persons of the same age and gender that are
22covered under the same individual health coverage. Except in
23the case of birth or adoption that occurs during the period of
24activation, reinstatement must be into the same coverage type
25as the resident held prior to lapsing the individual health

 

 

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1insurance coverage and at the same or, at the option of the
2resident, higher deductible level. The reinstatement rights
3provided under this subsection (a) are not available to a
4resident or dependents if the activated person is discharged
5from the military under other than honorable conditions.
6    (b) The health insurer with which the reinstatement is
7being requested must receive a request for reinstatement no
8later than 63 days following the later of (i) deactivation or
9(ii) loss of coverage under the federal government-sponsored
10health insurance program. The health insurer may request proof
11of loss of coverage and the timing of the loss of coverage of
12the government-sponsored coverage in order to determine
13eligibility for reinstatement into the individual coverage.
14The effective date of the reinstatement of individual health
15coverage shall be the first of the month following receipt of
16the notice requesting reinstatement.
17    (c) All insurers must provide written notice to the
18policyholder of individual health coverage of the rights
19described in subsection (a) of this Section. In lieu of the
20inclusion of the notice in the individual health insurance
21policy, an insurance company may satisfy the notification
22requirement by providing a single written notice:
23        (1) in conjunction with the enrollment process for a
24    policyholder initially enrolling in the individual
25    coverage on or after the effective date of this amendatory
26    Act of the 94th General Assembly; or

 

 

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1        (2) by mailing written notice to policyholders whose
2    coverage was effective prior to the effective date of this
3    amendatory Act of the 94th General Assembly no later than
4    90 days following the effective date of this amendatory
5    Act of the 94th General Assembly.
6    (d) The provisions of subsection (a) of this Section do
7not apply to any policy or certificate providing coverage for
8any specified disease, specified accident or accident-only
9coverage, credit, dental, disability income, hospital
10indemnity or other fixed indemnity, long-term care, Medicare
11supplement, vision care, or short-term travel nonrenewable
12health policy or other limited-benefit supplemental insurance,
13or any coverage issued as a supplement to any liability
14insurance, workers' compensation or similar insurance, or any
15insurance under which benefits are payable with or without
16regard to fault, whether written on a group, blanket, or
17individual basis.
18    (e) Nothing in this Section shall require an insurer to
19reinstate the resident if the insurer requires residency in an
20enrollment area and those residency requirements are not met
21after deactivation or loss of coverage under the
22government-sponsored health insurance program.
23    (f) All terms, conditions, and limitations of the
24individual coverage into which reinstatement is made apply
25equally to all insureds enrolled in the coverage.
26    (g) The Secretary may adopt rules as may be necessary to

 

 

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1carry out the provisions of this Section.
2(Source: P.A. 94-1037, eff. 7-20-06.)
 
3    Section 10. The Health Maintenance Organization Act is
4amended by changing Section 5-3 as follows:
 
5    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
6    Sec. 5-3. Insurance Code provisions.
7    (a) Health Maintenance Organizations shall be subject to
8the provisions of Sections 133, 134, 136, 137, 139, 140,
9141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
10154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 155.49,
11352c, 355.2, 355.3, 355b, 355c, 356f, 356g.5-1, 356m, 356q,
12356v, 356w, 356x, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5,
13356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
14356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.20, 356z.21,
15356z.22, 356z.23, 356z.24, 356z.25, 356z.26, 356z.28, 356z.29,
16356z.30, 356z.30a, 356z.31, 356z.32, 356z.33, 356z.34,
17356z.35, 356z.36, 356z.37, 356z.38, 356z.39, 356z.40, 356z.41,
18356z.44, 356z.45, 356z.46, 356z.47, 356z.48, 356z.49, 356z.50,
19356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.58,
20356z.59, 356z.60, 356z.61, 356z.62, 356z.64, 356z.65, 356z.67,
21356z.68, 364, 364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b,
22368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A,
23408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of
24subsection (2) of Section 367, and Articles IIA, VIII 1/2,

 

 

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1XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the
2Illinois Insurance 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

 

 

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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

 

 

10300HB2499sam002- 21 -LRB103 30875 RPS 73636 a

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

 

 

10300HB2499sam002- 22 -LRB103 30875 RPS 73636 a

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. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
13102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
141-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
15eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
16102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
171-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
18eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;
19103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.
206-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
21eff. 1-1-24; 103-551, eff. 8-11-23; revised 8-29-23.)
 
22    Section 15. The Limited Health Service Organization Act is
23amended by changing Section 4003 as follows:
 
24    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)

 

 

10300HB2499sam002- 23 -LRB103 30875 RPS 73636 a

1    Sec. 4003. Illinois Insurance Code provisions. Limited
2health service organizations shall be subject to the
3provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
4141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
5154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 352c,
6355.2, 355.3, 355b, 356q, 356v, 356z.4, 356z.4a, 356z.10,
7356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30a,
8356z.32, 356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53,
9356z.54, 356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68,
10364.3, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412,
11444, and 444.1 and Articles IIA, VIII 1/2, XII, XII 1/2, XIII,
12XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.
13Nothing in this Section shall require a limited health care
14plan to cover any service that is not a limited health service.
15For purposes of the Illinois Insurance Code, except for
16Sections 444 and 444.1 and Articles XIII and XIII 1/2, limited
17health service organizations in the following categories are
18deemed to be domestic companies:
19        (1) a corporation under the laws of this State; or
20        (2) 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(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;

 

 

10300HB2499sam002- 24 -LRB103 30875 RPS 73636 a

1102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-731, eff.
21-1-23; 102-775, eff. 5-13-22; 102-813, eff. 5-13-22; 102-816,
3eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
4102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
51-1-24; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
6eff. 1-1-24; revised 8-29-23.)
 
7    (215 ILCS 190/Act rep.)
8    Section 20. The Short-Term, Limited-Duration Health
9Insurance Coverage Act is repealed.
 
10    Section 95. No acceleration or delay. Where this Act makes
11changes in a statute that is represented in this Act by text
12that is not yet or no longer in effect (for example, a Section
13represented by multiple versions), the use of that text does
14not accelerate or delay the taking effect of (i) the changes
15made by this Act or (ii) provisions derived from any other
16Public Act.
 
17    Section 99. Effective date. This Act takes effect January
181, 2025.".