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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,
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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:
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6 | | (5 ILCS 375/6.11)
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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 |
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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.
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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 |
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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.
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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, |
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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)
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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
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23 | | exclusive power and function of the State and is a denial and |
24 | | limitation under
Article VII, Section 6, subsection (h) of the |
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1 | | Illinois Constitution. A home
rule county to which this |
2 | | Section applies must comply with every provision of
this |
3 | | Section.
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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)
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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 |
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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
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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.
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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. |
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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)
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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.
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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. Coverage for compression sleeves. A group or |
18 | | individual policy of accident and health insurance or a |
19 | | managed care plan that is amended, delivered, issued, or |
20 | | renewed on or after January 1, 2025 shall provide coverage for |
21 | | compression sleeves that is medically necessary for the |
22 | | enrollee to prevent or mitigate lymphedema. |
23 | | Section 30. The Health Maintenance Organization Act is |
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1 | | amended by changing Section 5-3 as follows:
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2 | | (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
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3 | | Sec. 5-3. Insurance Code provisions.
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4 | | (a) Health Maintenance Organizations
shall be subject to |
5 | | the provisions of Sections 133, 134, 136, 137, 139, 140, |
6 | | 141.1,
141.2, 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, |
7 | | 154, 154.5, 154.6,
154.7, 154.8, 155.04, 155.22a, 355.2, |
8 | | 355.3, 355b, 355c, 356g.5-1, 356m, 356q, 356v, 356w, 356x, |
9 | | 356y,
356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, |
10 | | 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, |
11 | | 356z.15, 356z.17, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25, |
12 | | 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33, |
13 | | 356z.35, 356z.36, 356z.40, 356z.41, 356z.46, 356z.47, 356z.48, |
14 | | 356z.50, 356z.51, 356z.53 256z.53 , 356z.54, 356z.56, 356z.57, |
15 | | 356z.59, 356z.60, 356z.61, 364, 364.01, 364.3, 367.2, 367.2-5, |
16 | | 367i, 368a, 368b, 368c, 368d, 368e, 370c,
370c.1, 401, 401.1, |
17 | | 402, 403, 403A,
408, 408.2, 409, 412, 444,
and
444.1,
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18 | | paragraph (c) of subsection (2) of Section 367, and Articles |
19 | | IIA, VIII 1/2,
XII,
XII 1/2, XIII, XIII 1/2, XXV, XXVI, and |
20 | | XXXIIB of the Illinois Insurance Code.
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21 | | (b) For purposes of the Illinois Insurance Code, except |
22 | | for Sections 444
and 444.1 and Articles XIII and XIII 1/2, |
23 | | Health Maintenance Organizations in
the following categories |
24 | | are deemed to be "domestic companies":
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25 | | (1) a corporation authorized under the
Dental Service |
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1 | | Plan Act or the Voluntary Health Services Plans Act;
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2 | | (2) a corporation organized under the laws of this |
3 | | State; or
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4 | | (3) a corporation organized under the laws of another |
5 | | state, 30% or more
of the enrollees of which are residents |
6 | | of this State, except a
corporation subject to |
7 | | substantially the same requirements in its state of
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8 | | organization as is a "domestic company" under Article VIII |
9 | | 1/2 of the
Illinois Insurance Code.
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10 | | (c) In considering the merger, consolidation, or other |
11 | | acquisition of
control of a Health Maintenance Organization |
12 | | pursuant to Article VIII 1/2
of the Illinois Insurance Code,
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13 | | (1) the Director shall give primary consideration to |
14 | | the continuation of
benefits to enrollees and the |
15 | | financial conditions of the acquired Health
Maintenance |
16 | | Organization after the merger, consolidation, or other
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17 | | acquisition of control takes effect;
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18 | | (2)(i) the criteria specified in subsection (1)(b) of |
19 | | Section 131.8 of
the Illinois Insurance Code shall not |
20 | | apply and (ii) the Director, in making
his determination |
21 | | with respect to the merger, consolidation, or other
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22 | | acquisition of control, need not take into account the |
23 | | effect on
competition of the merger, consolidation, or |
24 | | other acquisition of control;
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25 | | (3) the Director shall have the power to require the |
26 | | following
information:
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1 | | (A) certification by an independent actuary of the |
2 | | adequacy
of the reserves of the Health Maintenance |
3 | | Organization sought to be acquired;
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4 | | (B) pro forma financial statements reflecting the |
5 | | combined balance
sheets of the acquiring company and |
6 | | the Health Maintenance Organization sought
to be |
7 | | acquired as of the end of the preceding year and as of |
8 | | a date 90 days
prior to the acquisition, as well as pro |
9 | | forma financial statements
reflecting projected |
10 | | combined operation for a period of 2 years;
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11 | | (C) a pro forma business plan detailing an |
12 | | acquiring party's plans with
respect to the operation |
13 | | of the Health Maintenance Organization sought to
be |
14 | | acquired for a period of not less than 3 years; and
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15 | | (D) such other information as the Director shall |
16 | | require.
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17 | | (d) The provisions of Article VIII 1/2 of the Illinois |
18 | | Insurance Code
and this Section 5-3 shall apply to the sale by |
19 | | any health maintenance
organization of greater than 10% of its
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20 | | enrollee population (including without limitation the health |
21 | | maintenance
organization's right, title, and interest in and |
22 | | to its health care
certificates).
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23 | | (e) In considering any management contract or service |
24 | | agreement subject
to Section 141.1 of the Illinois Insurance |
25 | | Code, the Director (i) shall, in
addition to the criteria |
26 | | specified in Section 141.2 of the Illinois
Insurance Code, |
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1 | | take into account the effect of the management contract or
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2 | | service agreement on the continuation of benefits to enrollees |
3 | | and the
financial condition of the health maintenance |
4 | | organization to be managed or
serviced, and (ii) need not take |
5 | | into account the effect of the management
contract or service |
6 | | agreement on competition.
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7 | | (f) Except for small employer groups as defined in the |
8 | | Small Employer
Rating, Renewability and Portability Health |
9 | | Insurance Act and except for
medicare supplement policies as |
10 | | defined in Section 363 of the Illinois
Insurance Code, a |
11 | | Health Maintenance Organization may by contract agree with a
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12 | | group or other enrollment unit to effect refunds or charge |
13 | | additional premiums
under the following terms and conditions:
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14 | | (i) the amount of, and other terms and conditions with |
15 | | respect to, the
refund or additional premium are set forth |
16 | | in the group or enrollment unit
contract agreed in advance |
17 | | of the period for which a refund is to be paid or
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18 | | additional premium is to be charged (which period shall |
19 | | not be less than one
year); and
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20 | | (ii) the amount of the refund or additional premium |
21 | | shall not exceed 20%
of the Health Maintenance |
22 | | Organization's profitable or unprofitable experience
with |
23 | | respect to the group or other enrollment unit for the |
24 | | period (and, for
purposes of a refund or additional |
25 | | premium, the profitable or unprofitable
experience shall |
26 | | be calculated taking into account a pro rata share of the
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1 | | Health Maintenance Organization's administrative and |
2 | | marketing expenses, but
shall not include any refund to be |
3 | | made or additional premium to be paid
pursuant to this |
4 | | subsection (f)). The Health Maintenance Organization and |
5 | | the
group or enrollment unit may agree that the profitable |
6 | | or unprofitable
experience may be calculated taking into |
7 | | account the refund period and the
immediately preceding 2 |
8 | | plan years.
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9 | | The Health Maintenance Organization shall include a |
10 | | statement in the
evidence of coverage issued to each enrollee |
11 | | describing the possibility of a
refund or additional premium, |
12 | | and upon request of any group or enrollment unit,
provide to |
13 | | the group or enrollment unit a description of the method used |
14 | | to
calculate (1) the Health Maintenance Organization's |
15 | | profitable experience with
respect to the group or enrollment |
16 | | unit and the resulting refund to the group
or enrollment unit |
17 | | or (2) the Health Maintenance Organization's unprofitable
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18 | | experience with respect to the group or enrollment unit and |
19 | | the resulting
additional premium to be paid by the group or |
20 | | enrollment unit.
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21 | | In no event shall the Illinois Health Maintenance |
22 | | Organization
Guaranty Association be liable to pay any |
23 | | contractual obligation of an
insolvent organization to pay any |
24 | | refund authorized under this Section.
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25 | | (g) Rulemaking authority to implement Public Act 95-1045, |
26 | | if any, is conditioned on the rules being adopted in |
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1 | | accordance with all provisions of the Illinois Administrative |
2 | | Procedure Act and all rules and procedures of the Joint |
3 | | Committee on Administrative Rules; any purported rule not so |
4 | | adopted, for whatever reason, is unauthorized. |
5 | | (Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19; |
6 | | 101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-393, eff. |
7 | | 1-1-20; 101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, |
8 | | eff. 1-1-21; 102-30, eff. 1-1-22; 102-34, eff. 6-25-21; |
9 | | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. |
10 | | 1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, |
11 | | eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; |
12 | | 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. |
13 | | 1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, |
14 | | eff. 1-1-23; 102-1117, eff. 1-13-23; revised 1-22-23.) |
15 | | Section 35. The Limited Health Service Organization Act is |
16 | | amended by changing Section 4003 as follows:
|
17 | | (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
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18 | | Sec. 4003. Illinois Insurance Code provisions. Limited |
19 | | health service
organizations shall be subject to the |
20 | | provisions of Sections 133, 134, 136, 137, 139,
140, 141.1, |
21 | | 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154, |
22 | | 154.5,
154.6, 154.7, 154.8, 155.04, 155.37, 355.2, 355.3, |
23 | | 355b, 356q, 356v, 356z.4, 356z.4a, 356z.10, 356z.21, 356z.22, |
24 | | 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, |
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1 | | 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54, 356z.57, |
2 | | 356z.59, 356z.61, 364.3, 368a, 401, 401.1,
402,
403, 403A, |
3 | | 408,
408.2, 409, 412, 444, and 444.1 and Articles IIA, VIII |
4 | | 1/2, XII, XII 1/2,
XIII,
XIII 1/2, XXV, and XXVI of the |
5 | | Illinois Insurance Code. Nothing in this Section shall require |
6 | | a limited health care plan to cover any service that is not a |
7 | | limited health service. For purposes of the
Illinois Insurance |
8 | | Code, except for Sections 444 and 444.1 and Articles XIII
and |
9 | | XIII 1/2, limited health service organizations in the |
10 | | following categories
are deemed to be domestic companies:
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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. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20; |
19 | | 101-393, eff. 1-1-20; 101-625, eff. 1-1-21; 102-30, eff. |
20 | | 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, |
21 | | eff. 1-1-22; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; |
22 | | 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860, eff. |
23 | | 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23.) |
24 | | Section 40. The Voluntary Health Services Plans Act is |
25 | | amended by changing Section 10 as follows:
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1 | | (215 ILCS 165/10) (from Ch. 32, par. 604)
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2 | | Sec. 10. Application of Insurance Code provisions. Health |
3 | | services
plan corporations and all persons interested therein |
4 | | or dealing therewith
shall be subject to the provisions of |
5 | | Articles IIA and XII 1/2 and Sections
3.1, 133, 136, 139, 140, |
6 | | 143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, |
7 | | 356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356v,
356w, |
8 | | 356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, |
9 | | 356z.6, 356z.8, 356z.9,
356z.10, 356z.11, 356z.12, 356z.13, |
10 | | 356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25, |
11 | | 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33, |
12 | | 356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54, |
13 | | 356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 364.01, 364.3, |
14 | | 367.2, 368a, 401, 401.1,
402,
403, 403A, 408,
408.2, and 412, |
15 | | and paragraphs (7) and (15) of Section 367 of the Illinois
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16 | | Insurance Code.
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17 | | Rulemaking authority to implement Public Act 95-1045, if |
18 | | any, is conditioned on the rules being adopted in accordance |
19 | | with all provisions of the Illinois Administrative Procedure |
20 | | Act and all rules and procedures of the Joint Committee on |
21 | | Administrative Rules; any purported rule not so adopted, for |
22 | | whatever reason, is unauthorized. |
23 | | (Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19; |
24 | | 101-281, eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff. |
25 | | 1-1-21; 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, |
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1 | | eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; |
2 | | 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804, eff. |
3 | | 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860, |
4 | | eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff. 1-1-23; |
5 | | 102-1117, eff. 1-13-23.) |
6 | | Section 45. The Illinois Public Aid Code is amended by |
7 | | changing Section 5-16.8 as follows:
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8 | | (305 ILCS 5/5-16.8)
|
9 | | Sec. 5-16.8. Required health benefits. The medical |
10 | | assistance program
shall
(i) provide the post-mastectomy care |
11 | | benefits required to be covered by a policy of
accident and |
12 | | health insurance under Section 356t and the coverage required
|
13 | | under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6, |
14 | | 356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46, |
15 | | 356z.47, 356z.51, 356z.53, 356z.56, 356z.59, and 356z.60 , and |
16 | | 356z.61 of the Illinois
Insurance Code, (ii) be subject to the |
17 | | provisions of Sections 356z.19, 356z.44, 356z.49, 364.01, |
18 | | 370c, and 370c.1 of the Illinois
Insurance Code, and (iii) be |
19 | | subject to the provisions of subsection (d-5) of Section 10 of |
20 | | the Network Adequacy and Transparency Act.
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21 | | The Department, by rule, shall adopt a model similar to |
22 | | the requirements of Section 356z.39 of the Illinois Insurance |
23 | | Code. |
24 | | On and after July 1, 2012, the Department shall reduce any |
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1 | | rate of reimbursement for services or other payments or alter |
2 | | any methodologies authorized by this Code to reduce any rate |
3 | | of reimbursement for services or other payments in accordance |
4 | | with Section 5-5e. |
5 | | To ensure full access to the benefits set forth in this |
6 | | Section, on and after January 1, 2016, the Department shall |
7 | | ensure that provider and hospital reimbursement for |
8 | | post-mastectomy care benefits required under this Section are |
9 | | no lower than the Medicare reimbursement rate. |
10 | | (Source: P.A. 101-81, eff. 7-12-19; 101-218, eff. 1-1-20; |
11 | | 101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-574, eff. |
12 | | 1-1-20; 101-649, eff. 7-7-20; 102-30, eff. 1-1-22; 102-144, |
13 | | eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; |
14 | | 102-530, eff. 1-1-22; 102-642, eff. 1-1-22; 102-804, eff. |
15 | | 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093, |
16 | | eff. 1-1-23; 102-1117, eff. 1-13-23.)
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17 | | Section 95. No acceleration or delay. Where this Act makes |
18 | | changes in a statute that is represented in this Act by text |
19 | | that is not yet or no longer in effect (for example, a Section |
20 | | represented by multiple versions), the use of that text does |
21 | | not accelerate or delay the taking effect of (i) the changes |
22 | | made by this Act or (ii) provisions derived from any other |
23 | | Public Act.
|