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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 | Sec. 6.11. Required health benefits; Illinois Insurance | ||||||||||||||||||||||||||||||||||||||
8 | Code
requirements. The program of health
benefits shall provide | ||||||||||||||||||||||||||||||||||||||
9 | the post-mastectomy care benefits required to be covered
by a | ||||||||||||||||||||||||||||||||||||||
10 | policy of accident and health insurance under Section 356t of | ||||||||||||||||||||||||||||||||||||||
11 | the Illinois
Insurance Code. The program of health benefits | ||||||||||||||||||||||||||||||||||||||
12 | shall provide the coverage
required under Sections 356g.5,
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13 | 356u, 356w, 356x, 356z.2, 356z.4, 356z.6, and 356z.9, 356z.10, | ||||||||||||||||||||||||||||||||||||||
14 | and 356z.11 and
356z.9 of the
Illinois Insurance Code.
The | ||||||||||||||||||||||||||||||||||||||
15 | program of health benefits must comply with Section 155.37 of | ||||||||||||||||||||||||||||||||||||||
16 | the
Illinois Insurance Code.
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17 | (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; | ||||||||||||||||||||||||||||||||||||||
18 | 95-520, eff. 8-28-07; revised 12-4-07.)
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19 | Section 10. The Counties Code is amended by changing | ||||||||||||||||||||||||||||||||||||||
20 | Section 5-1069.3 as follows: | ||||||||||||||||||||||||||||||||||||||
21 | (55 ILCS 5/5-1069.3)
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1 | Sec. 5-1069.3. Required health benefits. If a county, | ||||||
2 | including a home
rule
county, is a self-insurer for purposes of | ||||||
3 | providing health insurance coverage
for its employees, the | ||||||
4 | coverage shall include coverage for the post-mastectomy
care | ||||||
5 | benefits required to be covered by a policy of accident and | ||||||
6 | health
insurance under Section 356t and the coverage required | ||||||
7 | under Sections 356g.5, 356u,
356w, 356x, 356z.6, and 356z.9, | ||||||
8 | 356z.10, and 356z.11 and
356z.9 of
the Illinois Insurance Code. | ||||||
9 | The requirement that health benefits be covered
as provided in | ||||||
10 | this Section is an
exclusive power and function of the State | ||||||
11 | and is a denial and limitation under
Article VII, Section 6, | ||||||
12 | subsection (h) of the Illinois Constitution. A home
rule county | ||||||
13 | to which this Section applies must comply with every provision | ||||||
14 | of
this Section.
| ||||||
15 | (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; | ||||||
16 | 95-520, eff. 8-28-07; revised 12-4-07.)
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17 | Section 15. The Illinois Municipal Code is amended by | ||||||
18 | changing Section 10-4-2.3 as follows: | ||||||
19 | (65 ILCS 5/10-4-2.3)
| ||||||
20 | Sec. 10-4-2.3. Required health benefits. If a | ||||||
21 | municipality, including a
home rule municipality, is a | ||||||
22 | self-insurer for purposes of providing health
insurance | ||||||
23 | coverage for its employees, the coverage shall include coverage | ||||||
24 | for
the post-mastectomy care benefits required to be covered by |
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| |||||||
1 | a policy of
accident and health insurance under Section 356t | ||||||
2 | and the coverage required
under Sections 356g.5, 356u, 356w, | ||||||
3 | 356x, 356z.6, and 356z.9, 356z.10, and 356z.11 and
356z.9 of | ||||||
4 | the Illinois
Insurance
Code. The requirement that health
| ||||||
5 | benefits be covered as provided in this is an exclusive power | ||||||
6 | and function of
the State and is a denial and limitation under | ||||||
7 | Article VII, Section 6,
subsection (h) of the Illinois | ||||||
8 | Constitution. A home rule municipality to which
this Section | ||||||
9 | applies must comply with every provision of this Section.
| ||||||
10 | (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; | ||||||
11 | 95-520, eff. 8-28-07; revised 12-4-07.)
| ||||||
12 | Section 20. The School Code is amended by changing Section | ||||||
13 | 10-22.3f as follows: | ||||||
14 | (105 ILCS 5/10-22.3f)
| ||||||
15 | Sec. 10-22.3f. Required health benefits. Insurance | ||||||
16 | protection and
benefits
for employees shall provide the | ||||||
17 | post-mastectomy care benefits required to be
covered by a | ||||||
18 | policy of accident and health insurance under Section 356t and | ||||||
19 | the
coverage required under Sections 356g.5, 356u, 356w, 356x,
| ||||||
20 | 356z.6, and 356z.9 , and 356z.11 of
the
Illinois Insurance Code.
| ||||||
21 | (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; | ||||||
22 | revised 12-4-07.)
| ||||||
23 | Section 25. The Illinois Insurance Code is amended by |
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1 | adding Section 356z.11 as follows: | ||||||
2 | (215 ILCS 5/356z.11 new) | ||||||
3 | Sec. 356z.11. Heart disease prevention testing for women. A | ||||||
4 | group or individual policy of accident and health insurance or | ||||||
5 | managed care plan amended, delivered, issued, or renewed after | ||||||
6 | the effective date of this amendatory Act of the 95th General | ||||||
7 | Assembly must provide coverage for heart disease prevention | ||||||
8 | tests for women including, but not limited to testing for | ||||||
9 | cholesterol and blood sugar. | ||||||
10 | Section 30. The Health Maintenance Organization Act is | ||||||
11 | amended by changing Section 5-3 as follows:
| ||||||
12 | (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
| ||||||
13 | Sec. 5-3. Insurance Code provisions.
| ||||||
14 | (a) Health Maintenance Organizations
shall be subject to | ||||||
15 | the provisions of Sections 133, 134, 137, 140, 141.1,
141.2, | ||||||
16 | 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, 154, 154.5, | ||||||
17 | 154.6,
154.7, 154.8, 155.04, 355.2, 356m, 356v, 356w, 356x, | ||||||
18 | 356y,
356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10, | ||||||
19 | 356z.11
356z.9 , 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c, | ||||||
20 | 368d, 368e, 370c,
401, 401.1, 402, 403, 403A,
408, 408.2, 409, | ||||||
21 | 412, 444,
and
444.1,
paragraph (c) of subsection (2) of Section | ||||||
22 | 367, and Articles IIA, VIII 1/2,
XII,
XII 1/2, XIII, XIII 1/2, | ||||||
23 | XXV, and XXVI of the Illinois Insurance Code.
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1 | (b) For purposes of the Illinois Insurance Code, except for | ||||||
2 | Sections 444
and 444.1 and Articles XIII and XIII 1/2, Health | ||||||
3 | Maintenance Organizations in
the following categories are | ||||||
4 | deemed to be "domestic companies":
| ||||||
5 | (1) a corporation authorized under the
Dental Service | ||||||
6 | Plan Act or the Voluntary Health Services Plans Act;
| ||||||
7 | (2) a corporation organized under the laws of this | ||||||
8 | State; or
| ||||||
9 | (3) a corporation organized under the laws of another | ||||||
10 | state, 30% or more
of the enrollees of which are residents | ||||||
11 | of this State, except a
corporation subject to | ||||||
12 | substantially the same requirements in its state of
| ||||||
13 | organization as is a "domestic company" under Article VIII | ||||||
14 | 1/2 of the
Illinois Insurance Code.
| ||||||
15 | (c) In considering the merger, consolidation, or other | ||||||
16 | acquisition of
control of a Health Maintenance Organization | ||||||
17 | pursuant to Article VIII 1/2
of the Illinois Insurance Code,
| ||||||
18 | (1) the Director shall give primary consideration to | ||||||
19 | the continuation of
benefits to enrollees and the financial | ||||||
20 | conditions of the acquired Health
Maintenance Organization | ||||||
21 | after the merger, consolidation, or other
acquisition of | ||||||
22 | control takes effect;
| ||||||
23 | (2)(i) the criteria specified in subsection (1)(b) of | ||||||
24 | Section 131.8 of
the Illinois Insurance Code shall not | ||||||
25 | apply and (ii) the Director, in making
his determination | ||||||
26 | with respect to the merger, consolidation, or other
|
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1 | acquisition of control, need not take into account the | ||||||
2 | effect on
competition of the merger, consolidation, or | ||||||
3 | other acquisition of control;
| ||||||
4 | (3) the Director shall have the power to require the | ||||||
5 | following
information:
| ||||||
6 | (A) certification by an independent actuary of the | ||||||
7 | adequacy
of the reserves of the Health Maintenance | ||||||
8 | Organization sought to be acquired;
| ||||||
9 | (B) pro forma financial statements reflecting the | ||||||
10 | combined balance
sheets of the acquiring company and | ||||||
11 | the Health Maintenance Organization sought
to be | ||||||
12 | acquired as of the end of the preceding year and as of | ||||||
13 | a date 90 days
prior to the acquisition, as well as pro | ||||||
14 | forma financial statements
reflecting projected | ||||||
15 | combined operation for a period of 2 years;
| ||||||
16 | (C) a pro forma business plan detailing an | ||||||
17 | acquiring party's plans with
respect to the operation | ||||||
18 | of the Health Maintenance Organization sought to
be | ||||||
19 | acquired for a period of not less than 3 years; and
| ||||||
20 | (D) such other information as the Director shall | ||||||
21 | require.
| ||||||
22 | (d) The provisions of Article VIII 1/2 of the Illinois | ||||||
23 | Insurance Code
and this Section 5-3 shall apply to the sale by | ||||||
24 | any health maintenance
organization of greater than 10% of its
| ||||||
25 | enrollee population (including without limitation the health | ||||||
26 | maintenance
organization's right, title, and interest in and to |
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1 | its health care
certificates).
| ||||||
2 | (e) In considering any management contract or service | ||||||
3 | agreement subject
to Section 141.1 of the Illinois Insurance | ||||||
4 | Code, the Director (i) shall, in
addition to the criteria | ||||||
5 | specified in Section 141.2 of the Illinois
Insurance Code, take | ||||||
6 | into account the effect of the management contract or
service | ||||||
7 | agreement on the continuation of benefits to enrollees and the
| ||||||
8 | financial condition of the health maintenance organization to | ||||||
9 | be managed or
serviced, and (ii) need not take into account the | ||||||
10 | effect of the management
contract or service agreement on | ||||||
11 | competition.
| ||||||
12 | (f) Except for small employer groups as defined in the | ||||||
13 | Small Employer
Rating, Renewability and Portability Health | ||||||
14 | Insurance Act and except for
medicare supplement policies as | ||||||
15 | defined in Section 363 of the Illinois
Insurance Code, a Health | ||||||
16 | Maintenance Organization may by contract agree with a
group or | ||||||
17 | other enrollment unit to effect refunds or charge additional | ||||||
18 | premiums
under the following terms and conditions:
| ||||||
19 | (i) the amount of, and other terms and conditions with | ||||||
20 | respect to, the
refund or additional premium are set forth | ||||||
21 | in the group or enrollment unit
contract agreed in advance | ||||||
22 | of the period for which a refund is to be paid or
| ||||||
23 | additional premium is to be charged (which period shall not | ||||||
24 | be less than one
year); and
| ||||||
25 | (ii) the amount of the refund or additional premium | ||||||
26 | shall not exceed 20%
of the Health Maintenance |
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| |||||||
1 | Organization's profitable or unprofitable experience
with | ||||||
2 | respect to the group or other enrollment unit for the | ||||||
3 | period (and, for
purposes of a refund or additional | ||||||
4 | premium, the profitable or unprofitable
experience shall | ||||||
5 | be calculated taking into account a pro rata share of the
| ||||||
6 | Health Maintenance Organization's administrative and | ||||||
7 | marketing expenses, but
shall not include any refund to be | ||||||
8 | made or additional premium to be paid
pursuant to this | ||||||
9 | subsection (f)). The Health Maintenance Organization and | ||||||
10 | the
group or enrollment unit may agree that the profitable | ||||||
11 | or unprofitable
experience may be calculated taking into | ||||||
12 | account the refund period and the
immediately preceding 2 | ||||||
13 | plan years.
| ||||||
14 | The Health Maintenance Organization shall include a | ||||||
15 | statement in the
evidence of coverage issued to each enrollee | ||||||
16 | describing the possibility of a
refund or additional premium, | ||||||
17 | and upon request of any group or enrollment unit,
provide to | ||||||
18 | the group or enrollment unit a description of the method used | ||||||
19 | to
calculate (1) the Health Maintenance Organization's | ||||||
20 | profitable experience with
respect to the group or enrollment | ||||||
21 | unit and the resulting refund to the group
or enrollment unit | ||||||
22 | or (2) the Health Maintenance Organization's unprofitable
| ||||||
23 | experience with respect to the group or enrollment unit and the | ||||||
24 | resulting
additional premium to be paid by the group or | ||||||
25 | enrollment unit.
| ||||||
26 | In no event shall the Illinois Health Maintenance |
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| |||||||
1 | Organization
Guaranty Association be liable to pay any | ||||||
2 | contractual obligation of an
insolvent organization to pay any | ||||||
3 | refund authorized under this Section.
| ||||||
4 | (Source: P.A. 94-906, eff. 1-1-07; 94-1076, eff. 12-29-06; | ||||||
5 | 95-422, eff. 8-24-07; 95-520, eff. 8-28-07; revised 12-4-07.)
| ||||||
6 | Section 35. The Voluntary Health Services Plans Act is | ||||||
7 | amended by changing Section 10 as follows:
| ||||||
8 | (215 ILCS 165/10) (from Ch. 32, par. 604)
| ||||||
9 | Sec. 10. Application of Insurance Code provisions. Health | ||||||
10 | services
plan corporations and all persons interested therein | ||||||
11 | or dealing therewith
shall be subject to the provisions of | ||||||
12 | Articles IIA and XII 1/2 and Sections
3.1, 133, 140, 143, 143c, | ||||||
13 | 149, 155.37, 354, 355.2, 356g.5, 356r, 356t, 356u, 356v,
356w, | ||||||
14 | 356x, 356y, 356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, | ||||||
15 | 356z.9,
356z.10, 356z.11
356z.9 , 364.01, 367.2, 368a, 401, | ||||||
16 | 401.1,
402,
403, 403A, 408,
408.2, and 412, and paragraphs (7) | ||||||
17 | and (15) of Section 367 of the Illinois
Insurance Code.
| ||||||
18 | (Source: P.A. 94-1076, eff. 12-29-06; 95-189, eff. 8-16-07; | ||||||
19 | 95-331, eff. 8-21-07; 95-422, eff. 8-24-07; 95-520, eff. | ||||||
20 | 8-28-07; revised 12-5-07.)
| ||||||
21 | Section 40. The Illinois Public Aid Code is amended by | ||||||
22 | changing Section 5-16.8 as follows:
|
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| |||||||
1 | (305 ILCS 5/5-16.8)
| ||||||
2 | Sec. 5-16.8. Required health benefits. The medical | ||||||
3 | assistance program
shall
(i) provide the post-mastectomy care | ||||||
4 | benefits required to be covered by a policy of
accident and | ||||||
5 | health insurance under Section 356t and the coverage required
| ||||||
6 | under Sections 356g.5, 356u, 356w, 356x, and 356z.6 , and | ||||||
7 | 356z.11 of the Illinois
Insurance Code and (ii) be subject to | ||||||
8 | the provisions of Section 364.01 of the Illinois
Insurance | ||||||
9 | Code.
| ||||||
10 | (Source: P.A. 95-189, eff. 8-16-07; 95-331, eff. 8-21-07.)
| ||||||
11 | Section 99. Effective date. This Act takes effect upon | ||||||
12 | becoming law.
|