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1 | AN ACT concerning regulation.
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2 | Be it enacted by the People of the State of Illinois,
| |||||||||||||||||||||||||||||||||||
3 | represented in the General Assembly:
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4 | Section 5. The State Employees Group Insurance Act of 1971 | |||||||||||||||||||||||||||||||||||
5 | is amended by changing Section 6.11 as follows:
| |||||||||||||||||||||||||||||||||||
6 | (5 ILCS 375/6.11)
| |||||||||||||||||||||||||||||||||||
7 | (Text of Section before amendment by P.A. 102-768 ) | |||||||||||||||||||||||||||||||||||
8 | Sec. 6.11. Required health benefits; Illinois Insurance | |||||||||||||||||||||||||||||||||||
9 | Code
requirements. The program of health
benefits shall | |||||||||||||||||||||||||||||||||||
10 | provide the post-mastectomy care benefits required to be | |||||||||||||||||||||||||||||||||||
11 | covered
by a policy of accident and health insurance under | |||||||||||||||||||||||||||||||||||
12 | Section 356t of the Illinois
Insurance Code. The program of | |||||||||||||||||||||||||||||||||||
13 | health benefits shall provide the coverage
required under | |||||||||||||||||||||||||||||||||||
14 | Sections 356g, 356g.5, 356g.5-1, 356m, 356q,
356u, 356w, 356x, | |||||||||||||||||||||||||||||||||||
15 | 356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, | |||||||||||||||||||||||||||||||||||
16 | 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22, | |||||||||||||||||||||||||||||||||||
17 | 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, | |||||||||||||||||||||||||||||||||||
18 | 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51, | |||||||||||||||||||||||||||||||||||
19 | 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, and 356z.60 of | |||||||||||||||||||||||||||||||||||
20 | the
Illinois Insurance Code.
The program of health benefits | |||||||||||||||||||||||||||||||||||
21 | must comply with Sections 155.22a, 155.37, 355b, 356z.19, | |||||||||||||||||||||||||||||||||||
22 | 370c, and 370c.1 and Article XXXIIB of the
Illinois Insurance | |||||||||||||||||||||||||||||||||||
23 | Code. The Department of Insurance shall enforce the |
| |||||||
| |||||||
1 | requirements of this Section with respect to Sections 370c and | ||||||
2 | 370c.1 of the Illinois Insurance Code; all other requirements | ||||||
3 | of this Section shall be enforced by the Department of Central | ||||||
4 | Management Services.
| ||||||
5 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
6 | any, is conditioned on the rules being adopted in accordance | ||||||
7 | with all provisions of the Illinois Administrative Procedure | ||||||
8 | Act and all rules and procedures of the Joint Committee on | ||||||
9 | Administrative Rules; any purported rule not so adopted, for | ||||||
10 | whatever reason, is unauthorized. | ||||||
11 | (Source: P.A. 101-13, eff. 6-12-19; 101-281, eff. 1-1-20; | ||||||
12 | 101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff. | ||||||
13 | 1-1-20; 101-625, eff. 1-1-21; 102-30, eff. 1-1-22; 102-103, | ||||||
14 | eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; | ||||||
15 | 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. | ||||||
16 | 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, | ||||||
17 | eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; | ||||||
18 | revised 12-13-22.) | ||||||
19 | (Text of Section after amendment by P.A. 102-768 ) | ||||||
20 | Sec. 6.11. Required health benefits; Illinois Insurance | ||||||
21 | Code
requirements. The program of health
benefits shall | ||||||
22 | provide the post-mastectomy care benefits required to be | ||||||
23 | covered
by a policy of accident and health insurance under | ||||||
24 | Section 356t of the Illinois
Insurance Code. The program of | ||||||
25 | health benefits shall provide the coverage
required under |
| |||||||
| |||||||
1 | Sections 356g, 356g.5, 356g.5-1, 356m, 356q,
356u, 356w, 356x, | ||||||
2 | 356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, | ||||||
3 | 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22, | ||||||
4 | 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, | ||||||
5 | 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51, | ||||||
6 | 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59, and | ||||||
7 | 356z.60 , and 356z.61 of the
Illinois Insurance Code.
The | ||||||
8 | program of health benefits must comply with Sections 155.22a, | ||||||
9 | 155.37, 355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of | ||||||
10 | the
Illinois Insurance Code. The Department of Insurance shall | ||||||
11 | enforce the requirements of this Section with respect to | ||||||
12 | Sections 370c and 370c.1 of the Illinois Insurance Code; all | ||||||
13 | other requirements of this Section shall be enforced by the | ||||||
14 | Department of Central Management Services.
| ||||||
15 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
16 | any, is conditioned on the rules being adopted in accordance | ||||||
17 | with all provisions of the Illinois Administrative Procedure | ||||||
18 | Act and all rules and procedures of the Joint Committee on | ||||||
19 | Administrative Rules; any purported rule not so adopted, for | ||||||
20 | whatever reason, is unauthorized. | ||||||
21 | (Source: P.A. 101-13, eff. 6-12-19; 101-281, eff. 1-1-20; | ||||||
22 | 101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff. | ||||||
23 | 1-1-20; 101-625, eff. 1-1-21; 102-30, eff. 1-1-22; 102-103, | ||||||
24 | eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; | ||||||
25 | 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. | ||||||
26 | 1-1-23; 102-768, eff. 1-1-24; 102-804, eff. 1-1-23; 102-813, |
| |||||||
| |||||||
1 | eff. 5-13-22; 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; | ||||||
2 | 102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23.) | ||||||
3 | Section 10. The Counties Code is amended by changing | ||||||
4 | Section 5-1069.3 as follows: | ||||||
5 | (55 ILCS 5/5-1069.3)
| ||||||
6 | Sec. 5-1069.3. Required health benefits. If a county, | ||||||
7 | including a home
rule
county, is a self-insurer for purposes | ||||||
8 | of providing health insurance coverage
for its employees, the | ||||||
9 | coverage shall include coverage for the post-mastectomy
care | ||||||
10 | benefits required to be covered by a policy of accident and | ||||||
11 | health
insurance under Section 356t and the coverage required | ||||||
12 | under Sections 356g, 356g.5, 356g.5-1, 356q, 356u,
356w, 356x, | ||||||
13 | 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, | ||||||
14 | 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, | ||||||
15 | 356z.29, 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, | ||||||
16 | 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, | ||||||
17 | 356z.54, 356z.56, 356z.57, 356z.59, and 356z.60 , and 356z.61 | ||||||
18 | of
the Illinois Insurance Code. The coverage shall comply with | ||||||
19 | Sections 155.22a, 355b, 356z.19, and 370c of
the Illinois | ||||||
20 | Insurance Code. The Department of Insurance shall enforce the | ||||||
21 | requirements of this Section. The requirement that health | ||||||
22 | benefits be covered
as provided in this Section is an
| ||||||
23 | exclusive power and function of the State and is a denial and | ||||||
24 | limitation under
Article VII, Section 6, subsection (h) of the |
| |||||||
| |||||||
1 | Illinois Constitution. A home
rule county to which this | ||||||
2 | Section applies must comply with every provision of
this | ||||||
3 | Section.
| ||||||
4 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
5 | any, is conditioned on the rules being adopted in accordance | ||||||
6 | with all provisions of the Illinois Administrative Procedure | ||||||
7 | Act and all rules and procedures of the Joint Committee on | ||||||
8 | Administrative Rules; any purported rule not so adopted, for | ||||||
9 | whatever reason, is unauthorized. | ||||||
10 | (Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20; | ||||||
11 | 101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff. | ||||||
12 | 1-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203, | ||||||
13 | eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22; | ||||||
14 | 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. | ||||||
15 | 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, | ||||||
16 | eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; | ||||||
17 | 102-1117, eff. 1-13-23.) | ||||||
18 | Section 15. The Illinois Municipal Code is amended by | ||||||
19 | changing Section 10-4-2.3 as follows: | ||||||
20 | (65 ILCS 5/10-4-2.3)
| ||||||
21 | Sec. 10-4-2.3. Required health benefits. If a | ||||||
22 | municipality, including a
home rule municipality, is a | ||||||
23 | self-insurer for purposes of providing health
insurance | ||||||
24 | coverage for its employees, the coverage shall include |
| |||||||
| |||||||
1 | coverage for
the post-mastectomy care benefits required to be | ||||||
2 | covered by a policy of
accident and health insurance under | ||||||
3 | Section 356t and the coverage required
under Sections 356g, | ||||||
4 | 356g.5, 356g.5-1, 356q, 356u, 356w, 356x, 356z.4, 356z.4a, | ||||||
5 | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, | ||||||
6 | 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29, | ||||||
7 | 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41, | ||||||
8 | 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54, | ||||||
9 | 356z.56, 356z.57, 356z.59, and 356z.60 , and 356z.61 of the | ||||||
10 | Illinois
Insurance
Code. The coverage shall comply with | ||||||
11 | Sections 155.22a, 355b, 356z.19, and 370c of
the Illinois | ||||||
12 | Insurance Code. The Department of Insurance shall enforce the | ||||||
13 | requirements of this Section. The requirement that health
| ||||||
14 | benefits be covered as provided in this is an exclusive power | ||||||
15 | and function of
the State and is a denial and limitation under | ||||||
16 | Article VII, Section 6,
subsection (h) of the Illinois | ||||||
17 | Constitution. A home rule municipality to which
this Section | ||||||
18 | applies must comply with every provision of this Section.
| ||||||
19 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
20 | any, is conditioned on the rules being adopted in accordance | ||||||
21 | with all provisions of the Illinois Administrative Procedure | ||||||
22 | Act and all rules and procedures of the Joint Committee on | ||||||
23 | Administrative Rules; any purported rule not so adopted, for | ||||||
24 | whatever reason, is unauthorized. | ||||||
25 | (Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20; | ||||||
26 | 101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff. |
| |||||||
| |||||||
1 | 1-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203, | ||||||
2 | eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22; | ||||||
3 | 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. | ||||||
4 | 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, | ||||||
5 | eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; | ||||||
6 | 102-1117, eff. 1-13-23.) | ||||||
7 | Section 20. The School Code is amended by changing Section | ||||||
8 | 10-22.3f as follows: | ||||||
9 | (105 ILCS 5/10-22.3f)
| ||||||
10 | Sec. 10-22.3f. Required health benefits. Insurance | ||||||
11 | protection and
benefits
for employees shall provide the | ||||||
12 | post-mastectomy care benefits required to be
covered by a | ||||||
13 | policy of accident and health insurance under Section 356t and | ||||||
14 | the
coverage required under Sections 356g, 356g.5, 356g.5-1, | ||||||
15 | 356q, 356u, 356w, 356x, 356z.4, 356z.4a,
356z.6, 356z.8, | ||||||
16 | 356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, | ||||||
17 | 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, | ||||||
18 | 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51, | ||||||
19 | 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, and 356z.60 , and | ||||||
20 | 356z.61 of
the
Illinois Insurance Code.
Insurance policies | ||||||
21 | shall comply with Section 356z.19 of the Illinois Insurance | ||||||
22 | Code. The coverage shall comply with Sections 155.22a, 355b, | ||||||
23 | and 370c of
the Illinois Insurance Code. The Department of | ||||||
24 | Insurance shall enforce the requirements of this Section.
|
| |||||||
| |||||||
1 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
2 | any, is conditioned on the rules being adopted in accordance | ||||||
3 | with all provisions of the Illinois Administrative Procedure | ||||||
4 | Act and all rules and procedures of the Joint Committee on | ||||||
5 | Administrative Rules; any purported rule not so adopted, for | ||||||
6 | whatever reason, is unauthorized. | ||||||
7 | (Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20; | ||||||
8 | 101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff. | ||||||
9 | 1-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203, | ||||||
10 | eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. 1-1-22; | ||||||
11 | 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804, eff. | ||||||
12 | 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860, | ||||||
13 | eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23.) | ||||||
14 | Section 25. The Illinois Insurance Code is amended by | ||||||
15 | adding Section 356z.61 as follows: | ||||||
16 | (215 ILCS 5/356z.61 new) | ||||||
17 | Sec. 356z.61. Cost sharing in mental health treatment. A | ||||||
18 | group or individual policy of accident and health insurance or | ||||||
19 | managed care plan amended, delivered, issued, or renewed on or | ||||||
20 | after the effective date of this amendatory Act of the 103rd | ||||||
21 | General Assembly shall provide any mental health treatment | ||||||
22 | coverage without imposing a deductible, coinsurance, | ||||||
23 | copayment, or any other cost-sharing requirement for any | ||||||
24 | police officer, firefighter, emergency medical services |
| |||||||
| |||||||
1 | personnel, or veteran. | ||||||
2 | Section 30. The Health Maintenance Organization Act is | ||||||
3 | amended by changing Section 5-3 as follows:
| ||||||
4 | (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
| ||||||
5 | Sec. 5-3. Insurance Code provisions.
| ||||||
6 | (a) Health Maintenance Organizations
shall be subject to | ||||||
7 | the provisions of Sections 133, 134, 136, 137, 139, 140, | ||||||
8 | 141.1,
141.2, 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, | ||||||
9 | 154, 154.5, 154.6,
154.7, 154.8, 155.04, 155.22a, 355.2, | ||||||
10 | 355.3, 355b, 355c, 356g.5-1, 356m, 356q, 356v, 356w, 356x, | ||||||
11 | 356y,
356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, | ||||||
12 | 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, | ||||||
13 | 356z.15, 356z.17, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25, | ||||||
14 | 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33, | ||||||
15 | 356z.35, 356z.36, 356z.40, 356z.41, 356z.46, 356z.47, 356z.48, | ||||||
16 | 356z.50, 356z.51, 356z.53 256z.53 , 356z.54, 356z.56, 356z.57, | ||||||
17 | 356z.59, 356z.60, 356z.61, 364, 364.01, 364.3, 367.2, 367.2-5, | ||||||
18 | 367i, 368a, 368b, 368c, 368d, 368e, 370c,
370c.1, 401, 401.1, | ||||||
19 | 402, 403, 403A,
408, 408.2, 409, 412, 444,
and
444.1,
| ||||||
20 | paragraph (c) of subsection (2) of Section 367, and Articles | ||||||
21 | IIA, VIII 1/2,
XII,
XII 1/2, XIII, XIII 1/2, XXV, XXVI, and | ||||||
22 | XXXIIB of the Illinois Insurance Code.
| ||||||
23 | (b) For purposes of the Illinois Insurance Code, except | ||||||
24 | for Sections 444
and 444.1 and Articles XIII and XIII 1/2, |
| |||||||
| |||||||
1 | Health Maintenance Organizations in
the following categories | ||||||
2 | are deemed to be "domestic companies":
| ||||||
3 | (1) a corporation authorized under the
Dental Service | ||||||
4 | Plan Act or the Voluntary Health Services Plans Act;
| ||||||
5 | (2) a corporation organized under the laws of this | ||||||
6 | State; or
| ||||||
7 | (3) a corporation organized under the laws of another | ||||||
8 | state, 30% or more
of the enrollees of which are residents | ||||||
9 | of this State, except a
corporation subject to | ||||||
10 | substantially the same requirements in its state of
| ||||||
11 | organization as is a "domestic company" under Article VIII | ||||||
12 | 1/2 of the
Illinois Insurance Code.
| ||||||
13 | (c) In considering the merger, consolidation, or other | ||||||
14 | acquisition of
control of a Health Maintenance Organization | ||||||
15 | pursuant to Article VIII 1/2
of the Illinois Insurance Code,
| ||||||
16 | (1) the Director shall give primary consideration to | ||||||
17 | the continuation of
benefits to enrollees and the | ||||||
18 | financial conditions of the acquired Health
Maintenance | ||||||
19 | Organization after the merger, consolidation, or other
| ||||||
20 | acquisition of control takes effect;
| ||||||
21 | (2)(i) the criteria specified in subsection (1)(b) of | ||||||
22 | Section 131.8 of
the Illinois Insurance Code shall not | ||||||
23 | apply and (ii) the Director, in making
his determination | ||||||
24 | with respect to the merger, consolidation, or other
| ||||||
25 | acquisition of control, need not take into account the | ||||||
26 | effect on
competition of the merger, consolidation, or |
| |||||||
| |||||||
1 | other acquisition of control;
| ||||||
2 | (3) the Director shall have the power to require the | ||||||
3 | following
information:
| ||||||
4 | (A) certification by an independent actuary of the | ||||||
5 | adequacy
of the reserves of the Health Maintenance | ||||||
6 | Organization sought to be acquired;
| ||||||
7 | (B) pro forma financial statements reflecting the | ||||||
8 | combined balance
sheets of the acquiring company and | ||||||
9 | the Health Maintenance Organization sought
to be | ||||||
10 | acquired as of the end of the preceding year and as of | ||||||
11 | a date 90 days
prior to the acquisition, as well as pro | ||||||
12 | forma financial statements
reflecting projected | ||||||
13 | combined operation for a period of 2 years;
| ||||||
14 | (C) a pro forma business plan detailing an | ||||||
15 | acquiring party's plans with
respect to the operation | ||||||
16 | of the Health Maintenance Organization sought to
be | ||||||
17 | acquired for a period of not less than 3 years; and
| ||||||
18 | (D) such other information as the Director shall | ||||||
19 | require.
| ||||||
20 | (d) The provisions of Article VIII 1/2 of the Illinois | ||||||
21 | Insurance Code
and this Section 5-3 shall apply to the sale by | ||||||
22 | any health maintenance
organization of greater than 10% of its
| ||||||
23 | enrollee population (including without limitation the health | ||||||
24 | maintenance
organization's right, title, and interest in and | ||||||
25 | to its health care
certificates).
| ||||||
26 | (e) In considering any management contract or service |
| |||||||
| |||||||
1 | agreement subject
to Section 141.1 of the Illinois Insurance | ||||||
2 | Code, the Director (i) shall, in
addition to the criteria | ||||||
3 | specified in Section 141.2 of the Illinois
Insurance Code, | ||||||
4 | take into account the effect of the management contract or
| ||||||
5 | service agreement on the continuation of benefits to enrollees | ||||||
6 | and the
financial condition of the health maintenance | ||||||
7 | organization to be managed or
serviced, and (ii) need not take | ||||||
8 | into account the effect of the management
contract or service | ||||||
9 | agreement on competition.
| ||||||
10 | (f) Except for small employer groups as defined in the | ||||||
11 | Small Employer
Rating, Renewability and Portability Health | ||||||
12 | Insurance Act and except for
medicare supplement policies as | ||||||
13 | defined in Section 363 of the Illinois
Insurance Code, a | ||||||
14 | Health Maintenance Organization may by contract agree with a
| ||||||
15 | group or other enrollment unit to effect refunds or charge | ||||||
16 | additional premiums
under the following terms and conditions:
| ||||||
17 | (i) the amount of, and other terms and conditions with | ||||||
18 | respect to, the
refund or additional premium are set forth | ||||||
19 | in the group or enrollment unit
contract agreed in advance | ||||||
20 | of the period for which a refund is to be paid or
| ||||||
21 | additional premium is to be charged (which period shall | ||||||
22 | not be less than one
year); and
| ||||||
23 | (ii) the amount of the refund or additional premium | ||||||
24 | shall not exceed 20%
of the Health Maintenance | ||||||
25 | Organization's profitable or unprofitable experience
with | ||||||
26 | respect to the group or other enrollment unit for the |
| |||||||
| |||||||
1 | period (and, for
purposes of a refund or additional | ||||||
2 | premium, the profitable or unprofitable
experience shall | ||||||
3 | be calculated taking into account a pro rata share of the
| ||||||
4 | Health Maintenance Organization's administrative and | ||||||
5 | marketing expenses, but
shall not include any refund to be | ||||||
6 | made or additional premium to be paid
pursuant to this | ||||||
7 | subsection (f)). The Health Maintenance Organization and | ||||||
8 | the
group or enrollment unit may agree that the profitable | ||||||
9 | or unprofitable
experience may be calculated taking into | ||||||
10 | account the refund period and the
immediately preceding 2 | ||||||
11 | plan years.
| ||||||
12 | The Health Maintenance Organization shall include a | ||||||
13 | statement in the
evidence of coverage issued to each enrollee | ||||||
14 | describing the possibility of a
refund or additional premium, | ||||||
15 | and upon request of any group or enrollment unit,
provide to | ||||||
16 | the group or enrollment unit a description of the method used | ||||||
17 | to
calculate (1) the Health Maintenance Organization's | ||||||
18 | profitable experience with
respect to the group or enrollment | ||||||
19 | unit and the resulting refund to the group
or enrollment unit | ||||||
20 | or (2) the Health Maintenance Organization's unprofitable
| ||||||
21 | experience with respect to the group or enrollment unit and | ||||||
22 | the resulting
additional premium to be paid by the group or | ||||||
23 | enrollment unit.
| ||||||
24 | In no event shall the Illinois Health Maintenance | ||||||
25 | Organization
Guaranty Association be liable to pay any | ||||||
26 | contractual obligation of an
insolvent organization to pay any |
| |||||||
| |||||||
1 | refund authorized under this Section.
| ||||||
2 | (g) Rulemaking authority to implement Public Act 95-1045, | ||||||
3 | if any, is conditioned on the rules being adopted in | ||||||
4 | accordance with all provisions of the Illinois Administrative | ||||||
5 | Procedure Act and all rules and procedures of the Joint | ||||||
6 | Committee on Administrative Rules; any purported rule not so | ||||||
7 | adopted, for whatever reason, is unauthorized. | ||||||
8 | (Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19; | ||||||
9 | 101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-393, eff. | ||||||
10 | 1-1-20; 101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, | ||||||
11 | eff. 1-1-21; 102-30, eff. 1-1-22; 102-34, eff. 6-25-21; | ||||||
12 | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. | ||||||
13 | 1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, | ||||||
14 | eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; | ||||||
15 | 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. | ||||||
16 | 1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, | ||||||
17 | eff. 1-1-23; 102-1117, eff. 1-13-23; revised 1-22-23.) | ||||||
18 | Section 35. The Limited Health Service Organization Act is | ||||||
19 | amended 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 | ||||||
22 | health service
organizations shall be subject to the | ||||||
23 | provisions of Sections 133, 134, 136, 137, 139,
140, 141.1, | ||||||
24 | 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154, |
| |||||||
| |||||||
1 | 154.5,
154.6, 154.7, 154.8, 155.04, 155.37, 355.2, 355.3, | ||||||
2 | 355b, 356q, 356v, 356z.4, 356z.4a, 356z.10, 356z.21, 356z.22, | ||||||
3 | 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, | ||||||
4 | 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54, 356z.57, | ||||||
5 | 356z.59, 356z.61, 364.3, 368a, 401, 401.1,
402,
403, 403A, | ||||||
6 | 408,
408.2, 409, 412, 444, and 444.1 and Articles IIA, VIII | ||||||
7 | 1/2, XII, XII 1/2,
XIII,
XIII 1/2, XXV, and XXVI of the | ||||||
8 | Illinois Insurance Code. Nothing in this Section shall require | ||||||
9 | a limited health care plan to cover any service that is not a | ||||||
10 | limited health service. For purposes of the
Illinois Insurance | ||||||
11 | Code, except for Sections 444 and 444.1 and Articles XIII
and | ||||||
12 | XIII 1/2, limited health service organizations in the | ||||||
13 | following categories
are deemed to be domestic companies:
| ||||||
14 | (1) a corporation under the laws of this State; or
| ||||||
15 | (2) a corporation organized under the laws of another | ||||||
16 | state, 30% or more
of the enrollees of which are residents | ||||||
17 | of this State, except a corporation
subject to | ||||||
18 | substantially the same requirements in its state of | ||||||
19 | organization as
is a domestic company under Article VIII | ||||||
20 | 1/2 of the Illinois Insurance Code.
| ||||||
21 | (Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20; | ||||||
22 | 101-393, eff. 1-1-20; 101-625, eff. 1-1-21; 102-30, eff. | ||||||
23 | 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, | ||||||
24 | eff. 1-1-22; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; | ||||||
25 | 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860, eff. | ||||||
26 | 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23.) |
| |||||||
| |||||||
1 | Section 40. The Voluntary Health Services Plans Act is | ||||||
2 | amended by changing Section 10 as follows:
| ||||||
3 | (215 ILCS 165/10) (from Ch. 32, par. 604)
| ||||||
4 | Sec. 10. Application of Insurance Code provisions. Health | ||||||
5 | services
plan corporations and all persons interested therein | ||||||
6 | or dealing therewith
shall be subject to the provisions of | ||||||
7 | Articles IIA and XII 1/2 and Sections
3.1, 133, 136, 139, 140, | ||||||
8 | 143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, | ||||||
9 | 356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356v,
356w, | ||||||
10 | 356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, | ||||||
11 | 356z.6, 356z.8, 356z.9,
356z.10, 356z.11, 356z.12, 356z.13, | ||||||
12 | 356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25, | ||||||
13 | 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33, | ||||||
14 | 356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54, | ||||||
15 | 356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 364.01, 364.3, | ||||||
16 | 367.2, 368a, 401, 401.1,
402,
403, 403A, 408,
408.2, and 412, | ||||||
17 | and paragraphs (7) and (15) of Section 367 of the Illinois
| ||||||
18 | Insurance Code.
| ||||||
19 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
20 | any, is conditioned on the rules being adopted in accordance | ||||||
21 | with all provisions of the Illinois Administrative Procedure | ||||||
22 | Act and all rules and procedures of the Joint Committee on | ||||||
23 | Administrative Rules; any purported rule not so adopted, for | ||||||
24 | whatever reason, is unauthorized. |
| |||||||
| |||||||
1 | (Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19; | ||||||
2 | 101-281, eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff. | ||||||
3 | 1-1-21; 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, | ||||||
4 | eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; | ||||||
5 | 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804, eff. | ||||||
6 | 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860, | ||||||
7 | eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff. 1-1-23; | ||||||
8 | 102-1117, eff. 1-13-23.) | ||||||
9 | Section 45. The Illinois Public Aid Code is amended by | ||||||
10 | changing Section 5-16.8 as follows:
| ||||||
11 | (305 ILCS 5/5-16.8)
| ||||||
12 | Sec. 5-16.8. Required health benefits. The medical | ||||||
13 | assistance program
shall
(i) provide the post-mastectomy care | ||||||
14 | benefits required to be covered by a policy of
accident and | ||||||
15 | health insurance under Section 356t and the coverage required
| ||||||
16 | under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6, | ||||||
17 | 356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46, | ||||||
18 | 356z.47, 356z.51, 356z.53, 356z.56, 356z.59, and 356z.60 , and | ||||||
19 | 356z.61 of the Illinois
Insurance Code, (ii) be subject to the | ||||||
20 | provisions of Sections 356z.19, 356z.44, 356z.49, 364.01, | ||||||
21 | 370c, and 370c.1 of the Illinois
Insurance Code, and (iii) be | ||||||
22 | subject to the provisions of subsection (d-5) of Section 10 of | ||||||
23 | the Network Adequacy and Transparency Act.
| ||||||
24 | The Department, by rule, shall adopt a model similar to |
| |||||||
| |||||||
1 | the requirements of Section 356z.39 of the Illinois Insurance | ||||||
2 | Code. | ||||||
3 | On and after July 1, 2012, the Department shall reduce any | ||||||
4 | rate of reimbursement for services or other payments or alter | ||||||
5 | any methodologies authorized by this Code to reduce any rate | ||||||
6 | of reimbursement for services or other payments in accordance | ||||||
7 | with Section 5-5e. | ||||||
8 | To ensure full access to the benefits set forth in this | ||||||
9 | Section, on and after January 1, 2016, the Department shall | ||||||
10 | ensure that provider and hospital reimbursement for | ||||||
11 | post-mastectomy care benefits required under this Section are | ||||||
12 | no lower than the Medicare reimbursement rate. | ||||||
13 | (Source: P.A. 101-81, eff. 7-12-19; 101-218, eff. 1-1-20; | ||||||
14 | 101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-574, eff. | ||||||
15 | 1-1-20; 101-649, eff. 7-7-20; 102-30, eff. 1-1-22; 102-144, | ||||||
16 | eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; | ||||||
17 | 102-530, eff. 1-1-22; 102-642, eff. 1-1-22; 102-804, eff. | ||||||
18 | 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093, | ||||||
19 | eff. 1-1-23; 102-1117, eff. 1-13-23.)
| ||||||
20 | Section 95. No acceleration or delay. Where this Act makes | ||||||
21 | changes in a statute that is represented in this Act by text | ||||||
22 | that is not yet or no longer in effect (for example, a Section | ||||||
23 | represented by multiple versions), the use of that text does | ||||||
24 | not accelerate or delay the taking effect of (i) the changes | ||||||
25 | made by this Act or (ii) provisions derived from any other |
| |||||||
| |||||||
1 | Public Act. | ||||||
2 | Section 99. Effective date. This Act takes effect upon | ||||||
3 | becoming law.
|