98TH GENERAL ASSEMBLY
State of Illinois
2013 and 2014
HB1075

 

Introduced 1/30/2013, by Rep. Lou Lang

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 5/370c.1

    Amends the Illinois Insurance Code. Makes a technical change in a Section concerning mental health parity.


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A BILL FOR

 

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1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Insurance Code is amended by
5changing Section 370c.1 as follows:
 
6    (215 ILCS 5/370c.1)
7    Sec. 370c.1. Mental health parity.
8    (a) On and after the the effective date of this amendatory
9Act of the 97th General Assembly, every insurer that amends,
10delivers, issues, or renews a group policy of accident and
11health insurance in this State providing coverage for hospital
12or medical treatment and for the treatment of mental,
13emotional, nervous, or substance use disorders or conditions
14shall ensure that:
15        (1) the financial requirements applicable to such
16    mental, emotional, nervous, or substance use disorder or
17    condition benefits are no more restrictive than the
18    predominant financial requirements applied to
19    substantially all hospital and medical benefits covered by
20    the policy and that there are no separate cost-sharing
21    requirements that are applicable only with respect to
22    mental, emotional, nervous, or substance use disorder or
23    condition benefits; and

 

 

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1        (2) the treatment limitations applicable to such
2    mental, emotional, nervous, or substance use disorder or
3    condition benefits are no more restrictive than the
4    predominant treatment limitations applied to substantially
5    all hospital and medical benefits covered by the policy and
6    that there are no separate treatment limitations that are
7    applicable only with respect to mental, emotional,
8    nervous, or substance use disorder or condition benefits.
9    (b) The following provisions shall apply concerning
10aggregate lifetime limits:
11        (1) In the case of a group policy of accident and
12    health insurance amended, delivered, issued, or renewed in
13    this State on or after the effective date of this
14    amendatory Act of the 97th General Assembly that provides
15    coverage for hospital or medical treatment and for the
16    treatment of mental, emotional, nervous, or substance use
17    disorders or conditions the following provisions shall
18    apply:
19            (A) if the policy does not include an aggregate
20        lifetime limit on substantially all hospital and
21        medical benefits, then the policy may not impose any
22        aggregate lifetime limit on mental, emotional,
23        nervous, or substance use disorder or condition
24        benefits; or
25            (B) if the policy includes an aggregate lifetime
26        limit on substantially all hospital and medical

 

 

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1        benefits (in this subsection referred to as the
2        "applicable lifetime limit"), then the policy shall
3        either:
4                (i) apply the applicable lifetime limit both
5            to the hospital and medical benefits to which it
6            otherwise would apply and to mental, emotional,
7            nervous, or substance use disorder or condition
8            benefits and not distinguish in the application of
9            the limit between the hospital and medical
10            benefits and mental, emotional, nervous, or
11            substance use disorder or condition benefits; or
12                (ii) not include any aggregate lifetime limit
13            on mental, emotional, nervous, or substance use
14            disorder or condition benefits that is less than
15            the applicable lifetime limit.
16        (2) In the case of a policy that is not described in
17    paragraph (1) of subsection (b) of this Section and that
18    includes no or different aggregate lifetime limits on
19    different categories of hospital and medical benefits, the
20    Director shall establish rules under which subparagraph
21    (B) of paragraph (1) of subsection (b) of this Section is
22    applied to such policy with respect to mental, emotional,
23    nervous, or substance use disorder or condition benefits by
24    substituting for the applicable lifetime limit an average
25    aggregate lifetime limit that is computed taking into
26    account the weighted average of the aggregate lifetime

 

 

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1    limits applicable to such categories.
2    (c) The following provisions shall apply concerning annual
3limits:
4        (1) In the case of a group policy of accident and
5    health insurance amended, delivered, issued, or renewed in
6    this State on or after the effective date of this
7    amendatory Act of the 97th General Assembly that provides
8    coverage for hospital or medical treatment and for the
9    treatment of mental, emotional, nervous, or substance use
10    disorders or conditions the following provisions shall
11    apply:
12            (A) if the policy does not include an annual limit
13        on substantially all hospital and medical benefits,
14        then the policy may not impose any annual limits on
15        mental, emotional, nervous, or substance use disorder
16        or condition benefits; or
17            (B) if the policy includes an annual limit on
18        substantially all hospital and medical benefits (in
19        this subsection referred to as the "applicable annual
20        limit"), then the policy shall either:
21                (i) apply the applicable annual limit both to
22            the hospital and medical benefits to which it
23            otherwise would apply and to mental, emotional,
24            nervous, or substance use disorder or condition
25            benefits and not distinguish in the application of
26            the limit between the hospital and medical

 

 

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1            benefits and mental, emotional, nervous, or
2            substance use disorder or condition benefits; or
3                (ii) not include any annual limit on mental,
4            emotional, nervous, or substance use disorder or
5            condition benefits that is less than the
6            applicable annual limit.
7        (2) In the case of a policy that is not described in
8    paragraph (1) of subsection (c) of this Section and that
9    includes no or different annual limits on different
10    categories of hospital and medical benefits, the Director
11    shall establish rules under which subparagraph (B) of
12    paragraph (1) of subsection (c) of this Section is applied
13    to such policy with respect to mental, emotional, nervous,
14    or substance use disorder or condition benefits by
15    substituting for the applicable annual limit an average
16    annual limit that is computed taking into account the
17    weighted average of the annual limits applicable to such
18    categories.
19    (d) This Section shall be interpreted in a manner
20consistent with the interim final regulations promulgated by
21the U.S. Department of Health and Human Services at 75 FR 5410,
22including the prohibition against applying a cumulative
23financial requirement or cumulative quantitative treatment
24limitation for mental, emotional, nervous, or substance use
25disorder benefits that accumulates separately from any
26cumulative financial requirement or cumulative quantitative

 

 

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1treatment limitation established for hospital and medical
2benefits in the same classification.
3    (e) The provisions of subsections (b) and (c) of this
4Section shall not be interpreted to allow the use of lifetime
5or annual limits otherwise prohibited by State or federal law.
6    (f) This Section shall not apply to individual health
7insurance coverage as defined in Section 5 of the Illinois
8Health Insurance Portability and Accountability Act.
9    (g) As used in this Section:
10    "Financial requirement" includes deductibles, copayments,
11coinsurance, and out-of-pocket maximums, but does not include
12an aggregate lifetime limit or an annual limit subject to
13subsections (b) and (c).
14    "Treatment limitation" includes limits on benefits based
15on the frequency of treatment, number of visits, days of
16coverage, days in a waiting period, or other similar limits on
17the scope or duration of treatment. "Treatment limitation"
18includes both quantitative treatment limitations, which are
19expressed numerically (such as 50 outpatient visits per year),
20and nonquantitative treatment limitations, which otherwise
21limit the scope or duration of treatment. A permanent exclusion
22of all benefits for a particular condition or disorder shall
23not be considered a treatment limitation.
24(Source: P.A. 97-437, eff. 8-18-11.)