093_HB3060eng

 
HB3060 Engrossed                     LRB093 11021 JLS 11689 b

 1        AN ACT concerning health insurance coverage.

 2        Be it enacted by the People of  the  State  of  Illinois,
 3    represented in the General Assembly:

 4        Section  3.  The Department of Insurance Law of the Civil
 5    Administrative Code of Illinois is amended by adding  Section
 6    1405-35 as follows:

 7        (20 ILCS 1405/1405-35 new)
 8        Sec. 1405-35.  Brain injury coverage study.
 9        (a)  The   Department   of  Insurance  shall  conduct  an
10    analysis and study of costs and  benefits  derived  from  the
11    implementation  of the coverage requirements for treatment of
12    brain  injuries  established  under  Section  356z.4  of  the
13    Illinois Insurance Code. The  study  shall  cover  the  years
14    2004,  2005, and 2006. The study shall include an analysis of
15    the effect of  the  coverage  requirements  on  the  cost  of
16    insurance  and  health care, the results of the treatments to
17    patients, any improvements in the care of patients,  and  any
18    improvements in the quality of life of patients.
19        (b)  The Department shall report the results of its study
20    to  the  General Assembly and the Governor on or before March
21    1, 2007.

22        Section 5.  The State Employees Group  Insurance  Act  of
23    1971 is amended by changing Section 6.11 as follows:

24        (5 ILCS 375/6.11)
25        Sec.  6.11.  Required health benefits; Illinois Insurance
26    Code requirements.  The  program  of  health  benefits  shall
27    provide  the  post-mastectomy  care  benefits  required to be
28    covered by a policy of accident and  health  insurance  under
29    Section  356t of the Illinois Insurance Code.  The program of
 
HB3060 Engrossed            -2-      LRB093 11021 JLS 11689 b
 1    health benefits shall provide  the  coverage  required  under
 2    Sections  356u,  356w,  356x,  and  356z.2, and 356z.4 of the
 3    Illinois Insurance Code. The program of health benefits  must
 4    comply with Section 155.37 of the Illinois Insurance Code.
 5    (Source: P.A. 92-440, eff. 8-17-01; 92-764, eff. 1-1-03.)

 6        Section  10.  The  Counties  Code  is amended by changing
 7    Section 5-1069.3 as follows:

 8        (55 ILCS 5/5-1069.3)
 9        Sec. 5-1069.3.  Required health benefits.  If  a  county,
10    including  a home rule county, is a self-insurer for purposes
11    of providing health insurance coverage for its employees, the
12    coverage shall include coverage for the post-mastectomy  care
13    benefits  required  to be covered by a policy of accident and
14    health insurance under Section 356t and the coverage required
15    under Sections 356u,  356w,  and  356x,  and  356z.4  of  the
16    Illinois   Insurance   Code.   The  requirement  that  health
17    benefits be  covered  as  provided  in  this  Section  is  an
18    exclusive power and function of the State and is a denial and
19    limitation  under  Article  VII, Section 6, subsection (h) of
20    the Illinois Constitution.  A home rule county to which  this
21    Section  applies  must  comply  with  every provision of this
22    Section.
23    (Source: P.A. 90-7, eff. 6-10-97; 90-741, eff. 1-1-99.)

24        Section 15.  The Illinois Municipal Code  is  amended  by
25    changing Section 10-4-2.3 as follows:

26        (65 ILCS 5/10-4-2.3)
27        Sec.   10-4-2.3.    Required   health   benefits.   If  a
28    municipality,  including  a  home  rule  municipality,  is  a
29    self-insurer  for  purposes  of  providing  health  insurance
30    coverage  for  its  employees,  the  coverage  shall  include
 
HB3060 Engrossed            -3-      LRB093 11021 JLS 11689 b
 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 356u,
 4    356w, and 356x, and 356z.4 of the  Illinois  Insurance  Code.
 5    The  requirement  that health benefits be covered as provided
 6    in this is an exclusive power and function of the  State  and
 7    is  a  denial  and  limitation  under Article VII, Section 6,
 8    subsection (h) of the Illinois  Constitution.   A  home  rule
 9    municipality  to  which this Section applies must comply with
10    every provision of this Section.
11    (Source: P.A. 90-7, eff. 6-10-97; 90-741, eff. 1-1-99.)

12        Section 20.  The Illinois Insurance Code  is  amended  by
13    changing Section 351B-5 and adding Section 356z.4 as follows:

14        (215 ILCS 5/351B-5) (from Ch. 73, par. 963B-5)
15        Sec. 351B-5.  Applicability of other Code provisions. All
16    policies  of  accident and health insurance issued under this
17    Article shall be subject to the provisions of Sections  356c,
18    subsection  (a)  of  Section  356g, 356h, 356n, 356z.4, 367c,
19    367d, 370, 370a, and 370e of this Code.
20    (Source: P.A. 86-1407; 87-792; 87-1066.)

21        (215 ILCS 5/356z.4 new)
22        Sec. 356z.4.  Coverage for certain  benefits  related  to
23    brain injury.
24        (a)  A  group or individual policy of accident and health
25    insurance, a managed care plan, or multiple employer  welfare
26    arrangement,  that  is amended, delivered, issued, or renewed
27    after the effective date of this amendatory Act of  the  93rd
28    General  Assembly  may  not  exclude  coverage  for cognitive
29    rehabilitation  therapy,  cognitive  communication   therapy,
30    neurocognitive  therapy  and rehabilitation, neurobehavioral,
31    neurophysiological,          neuropsychological,          and
 
HB3060 Engrossed            -4-      LRB093 11021 JLS 11689 b
 1    psychophysiological  testing  or   treatment,   neurofeedback
 2    therapy,  remediation,  post-acute  transition  services,  or
 3    community reintegration services necessary as a result of and
 4    related to an acquired brain injury.
 5        (b)  Coverage  required under this Section may be subject
 6    to deductibles, copayments, coinsurance, or annual or maximum
 7    payment  limits  that  are   consistent   with   deductibles,
 8    copayments, coinsurance, and annual or maximum payment limits
 9    applicable to other similar coverage under the policy.
10        (c)  The  Department  shall  adopt  rules as necessary to
11    implement this Section.
12        (d)  This Section is inoperative after December 31, 2007.

13        Section 25.  The Health Maintenance Organization  Act  is
14    amended by changing Section 4-6.5 as follows:

15        (215 ILCS 125/4-6.5)
16        Sec. 4-6.5.  Required health benefits; Illinois Insurance
17    Code  requirements.   A  health  maintenance  organization is
18    subject to the provisions of Sections 155.37, 356t, 356u, and
19    356z.1, and 356z.4 of the Illinois Insurance Code.
20    (Source: P.A. 92-130, eff.  7-20-01;  92-440,  eff.  8-17-01;
21    92-651, eff. 7-11-02.)

22        Section  30.  The  Voluntary Health Services Plans Act is
23    amended by changing Section 10 as follows:

24        (215 ILCS 165/10) (from Ch. 32, par. 604)
25        Sec.  10.  Application  of  Insurance  Code   provisions.
26    Health  services plan corporations and all persons interested
27    therein  or  dealing  therewith  shall  be  subject  to   the
28    provisions of Articles IIA and XII 1/2 and Sections 3.1, 133,
29    140,  143,  143c,  149, 155.37, 354, 355.2, 356r, 356t, 356u,
30    356v, 356w, 356x, 356y, 356z.1, 356z.2, 356z.4, 367.2,  368a,
 
HB3060 Engrossed            -5-      LRB093 11021 JLS 11689 b
 1    401,  401.1,  402,  403,  403A,  408,  408.2,  and  412,  and
 2    paragraphs  (7)  and  (15)  of  Section  367  of the Illinois
 3    Insurance Code.
 4    (Source: P.A. 91-406,  eff.  1-1-00;  91-549,  eff.  8-14-99;
 5    91-605,  eff.  12-14-99;  91-788,  eff.  6-9-00; 92-130, eff.
 6    7-20-01; 92-440, eff. 8-17-01; 92-651, eff. 7-11-02;  92-764,
 7    eff. 1-1-03.)

 8        Section  90.  The State Mandates Act is amended by adding
 9    Section 8.27 as follows:

10        (30 ILCS 805/8.27 new)
11        Sec. 8.27.  Exempt mandate.  Notwithstanding  Sections  6
12    and  8 of this Act, no reimbursement by the State is required
13    for  the  implementation  of  any  mandate  created  by  this
14    amendatory Act of the 93rd General Assembly.