Rep. Mary E. Flowers

Filed: 3/7/2012

 

 


 

 


 
09700HB4085ham007LRB097 15077 RPM 67252 a

1
AMENDMENT TO HOUSE BILL 4085

2    AMENDMENT NO. ______. Amend House Bill 4085 on page 5,
3immediately below line 1, by inserting the following:
 
4    "Section 55. The State Employees Group Insurance Act of
51971 is amended by changing Section 6.11 as follows:
 
6    (5 ILCS 375/6.11)
7    Sec. 6.11. Required health benefits; Illinois Insurance
8Code requirements. The program of health benefits shall provide
9the post-mastectomy care benefits required to be covered by a
10policy of accident and health insurance under Section 356t of
11the Illinois Insurance Code. The program of health benefits
12shall provide the coverage required under Sections 356g,
13356g.5, 356g.5-1, 356m, 356u, 356w, 356x, 356z.2, 356z.4,
14356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
15356z.14, 356z.15, and 356z.17, and 356z.19, and 356z.22 of the
16Illinois Insurance Code. The program of health benefits must

 

 

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1comply with Sections 155.22a, and 155.37, and 356z.19 of the
2Illinois Insurance Code.
3    Rulemaking authority to implement Public Act 95-1045, if
4any, is conditioned on the rules being adopted in accordance
5with all provisions of the Illinois Administrative Procedure
6Act and all rules and procedures of the Joint Committee on
7Administrative Rules; any purported rule not so adopted, for
8whatever reason, is unauthorized.
9(Source: P.A. 96-139, eff. 1-1-10; 96-328, eff. 8-11-09;
1096-639, eff. 1-1-10; 96-1000, eff. 7-2-10; 97-282, eff. 8-9-11;
1197-343, eff. 1-1-12; revised 10-14-11.)
 
12    Section 60. The Counties Code is amended by changing
13Section 5-1069.3 as follows:
 
14    (55 ILCS 5/5-1069.3)
15    Sec. 5-1069.3. Required health benefits. If a county,
16including a home rule county, is a self-insurer for purposes of
17providing health insurance coverage for its employees, the
18coverage shall include coverage for the post-mastectomy care
19benefits required to be covered by a policy of accident and
20health insurance under Section 356t and the coverage required
21under Sections 356g, 356g.5, 356g.5-1, 356u, 356w, 356x,
22356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
23356z.14, and 356z.15, and 356z.22 of the Illinois Insurance
24Code. The coverage shall comply with Sections Section 155.22a

 

 

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1and 356z.19 of the Illinois Insurance Code. The requirement
2that health benefits be covered as provided in this Section is
3an exclusive power and function of the State and is a denial
4and limitation under Article VII, Section 6, subsection (h) of
5the Illinois Constitution. A home rule county to which this
6Section applies must comply with every provision of this
7Section.
8    Rulemaking authority to implement Public Act 95-1045, if
9any, is conditioned on the rules being adopted in accordance
10with all provisions of the Illinois Administrative Procedure
11Act and all rules and procedures of the Joint Committee on
12Administrative Rules; any purported rule not so adopted, for
13whatever reason, is unauthorized.
14(Source: P.A. 96-139, eff. 1-1-10; 96-328, eff. 8-11-09;
1596-1000, eff. 7-2-10; 97-282, eff. 8-9-11; 97-343, eff. 1-1-12;
16revised 10-14-11.)
 
17    Section 65. The Illinois Municipal Code is amended by
18changing 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
21municipality, including a home rule municipality, is a
22self-insurer for purposes of providing health insurance
23coverage for its employees, the coverage shall include coverage
24for the post-mastectomy care benefits required to be covered by

 

 

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1a policy of accident and health insurance under Section 356t
2and the coverage required under Sections 356g, 356g.5,
3356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10,
4356z.11, 356z.12, 356z.13, 356z.14, and 356z.15, and 356z.22 of
5the Illinois Insurance Code. The coverage shall comply with
6Sections Section 155.22a and 356z.19 of the Illinois Insurance
7Code. The requirement that health benefits be covered as
8provided in this is an exclusive power and function of the
9State and is a denial and limitation under Article VII, Section
106, subsection (h) of the Illinois Constitution. A home rule
11municipality to which this Section applies must comply with
12every provision of this Section.
13    Rulemaking authority to implement Public Act 95-1045, if
14any, is conditioned on the rules being adopted in accordance
15with all provisions of the Illinois Administrative Procedure
16Act and all rules and procedures of the Joint Committee on
17Administrative Rules; any purported rule not so adopted, for
18whatever reason, is unauthorized.
19(Source: P.A. 96-139, eff. 1-1-10; 96-328, eff. 8-11-09;
2096-1000, eff. 7-2-10; 97-282, eff. 8-9-11; 97-343, eff. 1-1-12;
21revised 10-14-11.)
 
22    Section 70. The School Code is amended by changing Section
2310-22.3f as follows:
 
24    (105 ILCS 5/10-22.3f)

 

 

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1    Sec. 10-22.3f. Required health benefits. Insurance
2protection and benefits for employees shall provide the
3post-mastectomy care benefits required to be covered by a
4policy of accident and health insurance under Section 356t and
5the coverage required under Sections 356g, 356g.5, 356g.5-1,
6356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11, 356z.12,
7356z.13, 356z.14, and 356z.15, and 356z.22 of the Illinois
8Insurance Code. Insurance policies shall comply with Section
9356z.19 of the Illinois Insurance Code. The coverage shall
10comply with Section 155.22a of the Illinois Insurance Code.
11    Rulemaking authority to implement Public Act 95-1045, if
12any, is conditioned on the rules being adopted in accordance
13with all provisions of the Illinois Administrative Procedure
14Act and all rules and procedures of the Joint Committee on
15Administrative Rules; any purported rule not so adopted, for
16whatever reason, is unauthorized.
17(Source: P.A. 96-139, eff. 1-1-10; 96-328, eff. 8-11-09;
1896-1000, eff. 7-2-10; 97-282, eff. 8-9-11; 97-343, eff. 1-1-12;
19revised 9-28-11.)
 
20    Section 75. The Illinois Insurance Code is amended by
21adding Section 356z.22 as follows:
 
22    (215 ILCS 5/356z.22 new)
23    Sec. 356z.22. Limitation; erectile dysfunction medication.
24A group or individual policy of accident and health insurance

 

 

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1or managed care plan amended, delivered, issued, or renewed
2after the effective date of this amendatory Act of the 97th
3General Assembly that does not provide coverage for
4contraception may not provide coverage for erectile
5dysfunction medication.
 
6    Section 80. The Health Maintenance Organization Act is
7amended by changing Section 5-3 as follows:
 
8    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
9    Sec. 5-3. Insurance Code provisions.
10    (a) Health Maintenance Organizations shall be subject to
11the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
12141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
13154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2, 356g.5-1,
14356m, 356v, 356w, 356x, 356y, 356z.2, 356z.4, 356z.5, 356z.6,
15356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14,
16356z.15, 356z.17, 356z.18, 356z.19, 356z.21 356z.19, 356z.22,
17364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c, 368d, 368e,
18370c, 370c.1, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412,
19444, and 444.1, paragraph (c) of subsection (2) of Section 367,
20and Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV,
21and XXVI of the Illinois Insurance Code.
22    (b) For purposes of the Illinois Insurance Code, except for
23Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health
24Maintenance Organizations in the following categories are

 

 

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1deemed to be "domestic companies":
2        (1) a corporation authorized under the Dental Service
3    Plan Act or the Voluntary Health Services Plans Act;
4        (2) a corporation organized under the laws of this
5    State; or
6        (3) a corporation organized under the laws of another
7    state, 30% or more of the enrollees of which are residents
8    of this State, except a corporation subject to
9    substantially the same requirements in its state of
10    organization as is a "domestic company" under Article VIII
11    1/2 of the Illinois Insurance Code.
12    (c) In considering the merger, consolidation, or other
13acquisition of control of a Health Maintenance Organization
14pursuant to Article VIII 1/2 of the Illinois Insurance Code,
15        (1) the Director shall give primary consideration to
16    the continuation of benefits to enrollees and the financial
17    conditions of the acquired Health Maintenance Organization
18    after the merger, consolidation, or other acquisition of
19    control takes effect;
20        (2)(i) the criteria specified in subsection (1)(b) of
21    Section 131.8 of the Illinois Insurance Code shall not
22    apply and (ii) the Director, in making his determination
23    with respect to the merger, consolidation, or other
24    acquisition of control, need not take into account the
25    effect on competition of the merger, consolidation, or
26    other acquisition of control;

 

 

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1        (3) the Director shall have the power to require the
2    following information:
3            (A) certification by an independent actuary of the
4        adequacy of the reserves of the Health Maintenance
5        Organization sought to be acquired;
6            (B) pro forma financial statements reflecting the
7        combined balance sheets of the acquiring company and
8        the Health Maintenance Organization sought to be
9        acquired as of the end of the preceding year and as of
10        a date 90 days prior to the acquisition, as well as pro
11        forma financial statements reflecting projected
12        combined operation for a period of 2 years;
13            (C) a pro forma business plan detailing an
14        acquiring party's plans with respect to the operation
15        of the Health Maintenance Organization sought to be
16        acquired for a period of not less than 3 years; and
17            (D) such other information as the Director shall
18        require.
19    (d) The provisions of Article VIII 1/2 of the Illinois
20Insurance Code and this Section 5-3 shall apply to the sale by
21any health maintenance organization of greater than 10% of its
22enrollee population (including without limitation the health
23maintenance organization's right, title, and interest in and to
24its health care certificates).
25    (e) In considering any management contract or service
26agreement subject to Section 141.1 of the Illinois Insurance

 

 

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1Code, the Director (i) shall, in addition to the criteria
2specified in Section 141.2 of the Illinois Insurance Code, take
3into account the effect of the management contract or service
4agreement on the continuation of benefits to enrollees and the
5financial condition of the health maintenance organization to
6be managed or serviced, and (ii) need not take into account the
7effect of the management contract or service agreement on
8competition.
9    (f) Except for small employer groups as defined in the
10Small Employer Rating, Renewability and Portability Health
11Insurance Act and except for medicare supplement policies as
12defined in Section 363 of the Illinois Insurance Code, a Health
13Maintenance Organization may by contract agree with a group or
14other enrollment unit to effect refunds or charge additional
15premiums under the following terms and conditions:
16        (i) the amount of, and other terms and conditions with
17    respect to, the refund or additional premium are set forth
18    in the group or enrollment unit contract agreed in advance
19    of the period for which a refund is to be paid or
20    additional premium is to be charged (which period shall not
21    be less than one year); and
22        (ii) the amount of the refund or additional premium
23    shall not exceed 20% of the Health Maintenance
24    Organization's profitable or unprofitable experience with
25    respect to the group or other enrollment unit for the
26    period (and, for purposes of a refund or additional

 

 

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1    premium, the profitable or unprofitable experience shall
2    be calculated taking into account a pro rata share of the
3    Health Maintenance Organization's administrative and
4    marketing expenses, but shall not include any refund to be
5    made or additional premium to be paid pursuant to this
6    subsection (f)). The Health Maintenance Organization and
7    the group or enrollment unit may agree that the profitable
8    or unprofitable experience may be calculated taking into
9    account the refund period and the immediately preceding 2
10    plan years.
11    The Health Maintenance Organization shall include a
12statement in the evidence of coverage issued to each enrollee
13describing the possibility of a refund or additional premium,
14and upon request of any group or enrollment unit, provide to
15the group or enrollment unit a description of the method used
16to calculate (1) the Health Maintenance Organization's
17profitable experience with respect to the group or enrollment
18unit and the resulting refund to the group or enrollment unit
19or (2) the Health Maintenance Organization's unprofitable
20experience with respect to the group or enrollment unit and the
21resulting additional premium to be paid by the group or
22enrollment unit.
23    In no event shall the Illinois Health Maintenance
24Organization Guaranty Association be liable to pay any
25contractual obligation of an insolvent organization to pay any
26refund authorized under this Section.

 

 

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1    (g) Rulemaking authority to implement Public Act 95-1045,
2if any, is conditioned on the rules being adopted in accordance
3with all provisions of the Illinois Administrative Procedure
4Act and all rules and procedures of the Joint Committee on
5Administrative Rules; any purported rule not so adopted, for
6whatever reason, is unauthorized.
7(Source: P.A. 96-328, eff. 8-11-09; 96-639, eff. 1-1-10;
896-833, eff. 6-1-10; 96-1000, eff. 7-2-10; 97-282, eff. 8-9-11;
997-343, eff. 1-1-12; 97-437, eff. 8-18-11; 97-486, eff. 1-1-12;
1097-592, eff. 1-1-12; revised 10-13-11.)
 
11    Section 85. The Limited Health Service Organization Act is
12amended by changing Section 4003 as follows:
 
13    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
14    Sec. 4003. Illinois Insurance Code provisions. Limited
15health service organizations shall be subject to the provisions
16of Sections 133, 134, 136, 137, 139, 140, 141.1, 141.2, 141.3,
17143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5, 154.6,
18154.7, 154.8, 155.04, 155.37, 355.2, 356v, 356z.10, 356z.21
19356z.19, 356z.22, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2,
20409, 412, 444, and 444.1 and Articles IIA, VIII 1/2, XII, XII
211/2, XIII, XIII 1/2, XXV, and XXVI of the Illinois Insurance
22Code. For purposes of the Illinois Insurance Code, except for
23Sections 444 and 444.1 and Articles XIII and XIII 1/2, limited
24health service organizations in the following categories are

 

 

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1deemed to be domestic companies:
2        (1) a corporation under the laws of this State; or
3        (2) a corporation organized under the laws of another
4    state, 30% of more of the enrollees of which are residents
5    of this State, except a corporation subject to
6    substantially the same requirements in its state of
7    organization as is a domestic company under Article VIII
8    1/2 of the Illinois Insurance Code.
9(Source: P.A. 97-486, eff. 1-1-12; 97-592, 1-1-12; revised
1010-13-11.)
 
11    Section 90. The Voluntary Health Services Plans Act is
12amended by changing Section 10 as follows:
 
13    (215 ILCS 165/10)  (from Ch. 32, par. 604)
14    Sec. 10. Application of Insurance Code provisions. Health
15services plan corporations and all persons interested therein
16or dealing therewith shall be subject to the provisions of
17Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
18143, 143c, 149, 155.22a, 155.37, 354, 355.2, 356g, 356g.5,
19356g.5-1, 356r, 356t, 356u, 356v, 356w, 356x, 356y, 356z.1,
20356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10,
21356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18, 356z.19,
22356z.21 356z.19, 356z.22, 364.01, 367.2, 368a, 401, 401.1, 402,
23403, 403A, 408, 408.2, and 412, and paragraphs (7) and (15) of
24Section 367 of the Illinois Insurance Code.

 

 

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1    Rulemaking authority to implement Public Act 95-1045, if
2any, is conditioned on the rules being adopted in accordance
3with all provisions of the Illinois Administrative Procedure
4Act and all rules and procedures of the Joint Committee on
5Administrative Rules; any purported rule not so adopted, for
6whatever reason, is unauthorized.
7(Source: P.A. 96-328, eff. 8-11-09; 96-833, eff. 6-1-10;
896-1000, eff. 7-2-10; 97-282, eff. 8-9-11; 97-343, eff. 1-1-12;
997-486, eff. 1-1-12; 97-592, eff. 1-1-12; revised 10-13-11.)".