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1    AN ACT concerning insurance.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The State Employees Group Insurance Act of 1971
5is 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
17comply with Sections 155.22a, and 155.37, and 356z.19 of the
18Illinois Insurance Code.
19    Rulemaking authority to implement Public Act 95-1045, if
20any, is conditioned on the rules being adopted in accordance
21with all provisions of the Illinois Administrative Procedure
22Act and all rules and procedures of the Joint Committee on
23Administrative Rules; any purported rule not so adopted, for

 

 

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1whatever reason, is unauthorized.
2(Source: P.A. 96-139, eff. 1-1-10; 96-328, eff. 8-11-09;
396-639, eff. 1-1-10; 96-1000, eff. 7-2-10; 97-282, eff. 8-9-11;
497-343, eff. 1-1-12; revised 10-14-11.)
 
5    Section 10. The Counties Code is amended by changing
6Section 5-1069.3 as follows:
 
7    (55 ILCS 5/5-1069.3)
8    Sec. 5-1069.3. Required health benefits. If a county,
9including a home rule county, is a self-insurer for purposes of
10providing health insurance coverage for its employees, the
11coverage shall include coverage for the post-mastectomy care
12benefits required to be covered by a policy of accident and
13health insurance under Section 356t and the coverage required
14under Sections 356g, 356g.5, 356g.5-1, 356u, 356w, 356x,
15356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
16356z.14, and 356z.15, and 356z.22 of the Illinois Insurance
17Code. The coverage shall comply with Sections Section 155.22a
18and 356z.19 of the Illinois Insurance Code. The requirement
19that health benefits be covered as provided in this Section is
20an exclusive power and function of the State and is a denial
21and limitation under Article VII, Section 6, subsection (h) of
22the Illinois Constitution. A home rule county to which this
23Section applies must comply with every provision of this
24Section.

 

 

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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. 96-139, eff. 1-1-10; 96-328, eff. 8-11-09;
896-1000, eff. 7-2-10; 97-282, eff. 8-9-11; 97-343, eff. 1-1-12;
9revised 10-14-11.)
 
10    Section 15. The Illinois Municipal Code is amended by
11changing Section 10-4-2.3 as follows:
 
12    (65 ILCS 5/10-4-2.3)
13    Sec. 10-4-2.3. Required health benefits. If a
14municipality, including a home rule municipality, is a
15self-insurer for purposes of providing health insurance
16coverage for its employees, the coverage shall include coverage
17for the post-mastectomy care benefits required to be covered by
18a policy of accident and health insurance under Section 356t
19and the coverage required under Sections 356g, 356g.5,
20356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10,
21356z.11, 356z.12, 356z.13, 356z.14, and 356z.15, and 356z.22 of
22the Illinois Insurance Code. The coverage shall comply with
23Sections Section 155.22a and 356z.19 of the Illinois Insurance
24Code. The requirement that health benefits be covered as

 

 

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1provided in this is an exclusive power and function of the
2State and is a denial and limitation under Article VII, Section
36, subsection (h) of the Illinois Constitution. A home rule
4municipality to which this Section applies must comply with
5every provision of this Section.
6    Rulemaking authority to implement Public Act 95-1045, if
7any, is conditioned on the rules being adopted in accordance
8with all provisions of the Illinois Administrative Procedure
9Act and all rules and procedures of the Joint Committee on
10Administrative Rules; any purported rule not so adopted, for
11whatever reason, is unauthorized.
12(Source: P.A. 96-139, eff. 1-1-10; 96-328, eff. 8-11-09;
1396-1000, eff. 7-2-10; 97-282, eff. 8-9-11; 97-343, eff. 1-1-12;
14revised 10-14-11.)
 
15    Section 20. The School Code is amended by changing Section
1610-22.3f as follows:
 
17    (105 ILCS 5/10-22.3f)
18    Sec. 10-22.3f. Required health benefits. Insurance
19protection and benefits for employees shall provide the
20post-mastectomy care benefits required to be covered by a
21policy of accident and health insurance under Section 356t and
22the coverage required under Sections 356g, 356g.5, 356g.5-1,
23356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11, 356z.12,
24356z.13, 356z.14, and 356z.15, and 356z.22 of the Illinois

 

 

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1Insurance Code. Insurance policies shall comply with Section
2356z.19 of the Illinois Insurance Code. The coverage shall
3comply with Section 155.22a of the Illinois Insurance Code.
4    Rulemaking authority to implement Public Act 95-1045, if
5any, is conditioned on the rules being adopted in accordance
6with all provisions of the Illinois Administrative Procedure
7Act and all rules and procedures of the Joint Committee on
8Administrative Rules; any purported rule not so adopted, for
9whatever reason, is unauthorized.
10(Source: P.A. 96-139, eff. 1-1-10; 96-328, eff. 8-11-09;
1196-1000, eff. 7-2-10; 97-282, eff. 8-9-11; 97-343, eff. 1-1-12;
12revised 9-28-11.)
 
13    Section 25. The Illinois Insurance Code is amended by
14adding Section 356z.22 as follows:
 
15    (215 ILCS 5/356z.22 new)
16    Sec. 356z.22. AIDS prevention.
17    (a) A group or individual policy of accident and health
18insurance or managed care plan amended, delivered, issued, or
19renewed after the effective date of this amendatory Act of the
2098th General Assembly must provide coverage for drugs that are
21approved for marketing by the federal Food and Drug
22Administration and that are recommended by the United States
23Public Health Service or the U.S. Centers for Disease Control
24and Prevention for pre-exposure prophylaxis (PrEP) to reduce

 

 

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1the likelihood of HIV infection among individuals who are not
2infected with HIV but who are at high risk of HIV infection.
3    (b) This Section does not require a policy of accident and
4health insurance to provide coverage for any clinical trials
5relating to any drug that is for pre-exposure prophylaxis for
6HIV that has been approved by the federal Food and Drug
7Administration in the form of an investigational new drug
8application.
 
9    Section 30. The Health Maintenance Organization Act is
10amended by changing Section 5-3 as follows:
 
11    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
12    Sec. 5-3. Insurance Code provisions.
13    (a) Health Maintenance Organizations shall be subject to
14the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
15141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
16154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2, 355.3,
17356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2, 356z.4, 356z.5,
18356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
19356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.21, 356z.22,
20364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c, 368d, 368e,
21370c, 370c.1, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412,
22444, and 444.1, paragraph (c) of subsection (2) of Section 367,
23and Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV,
24and XXVI of the Illinois Insurance Code.

 

 

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1    (b) For purposes of the Illinois Insurance Code, except for
2Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health
3Maintenance Organizations in the following categories are
4deemed 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
16acquisition of control of a Health Maintenance Organization
17pursuant 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
23Insurance Code and this Section 5-3 shall apply to the sale by
24any health maintenance organization of greater than 10% of its
25enrollee population (including without limitation the health
26maintenance organization's right, title, and interest in and to

 

 

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1its health care certificates).
2    (e) In considering any management contract or service
3agreement subject to Section 141.1 of the Illinois Insurance
4Code, the Director (i) shall, in addition to the criteria
5specified in Section 141.2 of the Illinois Insurance Code, take
6into account the effect of the management contract or service
7agreement on the continuation of benefits to enrollees and the
8financial condition of the health maintenance organization to
9be managed or serviced, and (ii) need not take into account the
10effect of the management contract or service agreement on
11competition.
12    (f) Except for small employer groups as defined in the
13Small Employer Rating, Renewability and Portability Health
14Insurance Act and except for medicare supplement policies as
15defined in Section 363 of the Illinois Insurance Code, a Health
16Maintenance Organization may by contract agree with a group or
17other enrollment unit to effect refunds or charge additional
18premiums 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
15statement in the evidence of coverage issued to each enrollee
16describing the possibility of a refund or additional premium,
17and upon request of any group or enrollment unit, provide to
18the group or enrollment unit a description of the method used
19to calculate (1) the Health Maintenance Organization's
20profitable experience with respect to the group or enrollment
21unit and the resulting refund to the group or enrollment unit
22or (2) the Health Maintenance Organization's unprofitable
23experience with respect to the group or enrollment unit and the
24resulting additional premium to be paid by the group or
25enrollment unit.
26    In no event shall the Illinois Health Maintenance

 

 

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1Organization Guaranty Association be liable to pay any
2contractual obligation of an insolvent organization to pay any
3refund authorized under this Section.
4    (g) Rulemaking authority to implement Public Act 95-1045,
5if any, is conditioned on the rules being adopted in accordance
6with all provisions of the Illinois Administrative Procedure
7Act and all rules and procedures of the Joint Committee on
8Administrative Rules; any purported rule not so adopted, for
9whatever reason, is unauthorized.
10(Source: P.A. 96-328, eff. 8-11-09; 96-639, eff. 1-1-10;
1196-833, eff. 6-1-10; 96-1000, eff. 7-2-10; 97-282, eff. 8-9-11;
1297-343, eff. 1-1-12; 97-437, eff. 8-18-11; 97-486, eff. 1-1-12;
1397-592, eff. 1-1-12; 97-805, eff. 1-1-13; 97-813, eff.
147-13-12.)
 
15    Section 35. The Voluntary Health Services Plans Act is
16amended by changing Section 10 as follows:
 
17    (215 ILCS 165/10)  (from Ch. 32, par. 604)
18    Sec. 10. Application of Insurance Code provisions. Health
19services plan corporations and all persons interested therein
20or dealing therewith shall be subject to the provisions of
21Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
22143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 356g,
23356g.5, 356g.5-1, 356r, 356t, 356u, 356v, 356w, 356x, 356y,
24356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9,

 

 

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1356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18,
2356z.19, 356z.21, 356z.22, 364.01, 367.2, 368a, 401, 401.1,
3402, 403, 403A, 408, 408.2, and 412, and paragraphs (7) and
4(15) of Section 367 of the Illinois Insurance Code.
5    Rulemaking authority to implement Public Act 95-1045, if
6any, is conditioned on the rules being adopted in accordance
7with all provisions of the Illinois Administrative Procedure
8Act and all rules and procedures of the Joint Committee on
9Administrative Rules; any purported rule not so adopted, for
10whatever reason, is unauthorized.
11(Source: P.A. 96-328, eff. 8-11-09; 96-833, eff. 6-1-10;
1296-1000, eff. 7-2-10; 97-282, eff. 8-9-11; 97-343, eff. 1-1-12;
1397-486, eff. 1-1-12; 97-592, eff. 1-1-12; 97-805, eff. 1-1-13;
1497-813, eff. 7-13-12.)