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| 1 | AN ACT concerning insurance.
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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 Health Maintenance Organization Act is | ||||||
| 5 | amended by changing Section 2-3 as follows:
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| 6 | (215 ILCS 125/2-3) (from Ch. 111 1/2, par. 1405)
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| 7 | Sec. 2-3. Powers of health maintenance organizations. The | ||||||
| 8 | powers of a health maintenance organization include, but are | ||||||
| 9 | not
limited to the following:
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| 10 | (a) The purchase, lease, construction, renovation, | ||||||
| 11 | operation, or
maintenance of hospitals, medical facilities | ||||||
| 12 | or both, and their ancillary
equipment, and such property | ||||||
| 13 | as may reasonably be required for its
principal office or | ||||||
| 14 | for such other purposes as may be necessary in the
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| 15 | transaction of the business of the organization.
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| 16 | (b) The making of loans to a medical group under | ||||||
| 17 | contract with it and in
furtherance of its program or the | ||||||
| 18 | making of loans to a corporation or
corporations under its | ||||||
| 19 | control for the purpose of acquiring or constructing
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| 20 | medical facilities at hospitals or in furtherance of a | ||||||
| 21 | program providing
health care services for enrollees.
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| 22 | (c) The furnishing of health care services through | ||||||
| 23 | providers which are
under contract with or employed by the | ||||||
| 24 | health maintenance
organization.
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| 25 | (d) The contracting with any person for the performance | ||||||
| 26 | on its behalf of
certain functions such as marketing, | ||||||
| 27 | enrollment and administration.
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| 28 | (e) The contracting with an insurance company licensed | ||||||
| 29 | in this State, or
with a hospital, medical, dental, vision | ||||||
| 30 | or pharmaceutical service
corporation authorized to do | ||||||
| 31 | business in this State, for the provision of
insurance, | ||||||
| 32 | indemnity, or reimbursement against the cost of health care
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| 1 | service provided by the health maintenance organization.
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| 2 | (f) The offering, in addition to basic health care | ||||||
| 3 | services, of (1)
health care services, (2) indemnity | ||||||
| 4 | benefits covering out of area or
emergency services, (3) | ||||||
| 5 | indemnity benefits provided through insurers or
hospital, | ||||||
| 6 | medical, dental, vision, or pharmaceutical service
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| 7 | corporations, and (4) health maintenance organization | ||||||
| 8 | point-of-service
benefits as authorized under Article 4.5.
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| 9 | (g) Rendering services related to the functions | ||||||
| 10 | involved in the
operating of its health maintenance | ||||||
| 11 | organization business including but not
limited to | ||||||
| 12 | providing health services, data processing, accounting, or
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| 13 | claims.
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| 14 | (g-5) Indemnification for services provided to a child | ||||||
| 15 | as required under
subdivision (e)(3) of Section 4-2.
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| 16 | (h) Any other business activity reasonably | ||||||
| 17 | complementary or
supplementary to its health maintenance | ||||||
| 18 | organization business to the extent
approved by the | ||||||
| 19 | Director.
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| 20 | Nothing in this Section shall be construed or interpreted | ||||||
| 21 | to prohibit or prevent a health care plan that qualifies as a | ||||||
| 22 | high deductible health plan, as defined by Section 223 of the | ||||||
| 23 | federal Internal Revenue Code, as now or hereafter amended, | ||||||
| 24 | from requiring the application of deductibles to benefits | ||||||
| 25 | provided under the plan.
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| 26 | (Source: P.A. 92-135, eff. 1-1-02.)
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| 27 | Section 99. Effective date. This Act takes effect upon | ||||||
| 28 | becoming law.
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