Sen. Don Harmon

Filed: 4/15/2013

 

 


 

 


 
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1
AMENDMENT TO SENATE BILL 2366

2    AMENDMENT NO. ______. Amend Senate Bill 2366 by replacing
3everything after the enacting clause with the following:
 
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.22 and 356z.19 of the
16Illinois Insurance Code. The program of health benefits must

 

 

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1comply with Sections 155.22a, 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; 97-813, eff. 7-13-12.)
 
12    Section 10. 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 155.22a and

 

 

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1356z.19 of the Illinois Insurance Code. The requirement that
2health benefits be covered as provided in this Section is an
3exclusive power and function of the State and is a denial and
4limitation under Article VII, Section 6, subsection (h) of the
5Illinois Constitution. A home rule county to which this Section
6applies must comply with every provision of this Section.
7    Rulemaking authority to implement Public Act 95-1045, if
8any, is conditioned on the rules being adopted in accordance
9with all provisions of the Illinois Administrative Procedure
10Act and all rules and procedures of the Joint Committee on
11Administrative Rules; any purported rule not so adopted, for
12whatever reason, is unauthorized.
13(Source: P.A. 96-139, eff. 1-1-10; 96-328, eff. 8-11-09;
1496-1000, eff. 7-2-10; 97-282, eff. 8-9-11; 97-343, eff. 1-1-12;
1597-813, eff. 7-13-12.)
 
16    Section 15. The Illinois Municipal Code is amended by
17changing Section 10-4-2.3 as follows:
 
18    (65 ILCS 5/10-4-2.3)
19    Sec. 10-4-2.3. Required health benefits. If a
20municipality, including a home rule municipality, is a
21self-insurer for purposes of providing health insurance
22coverage for its employees, the coverage shall include coverage
23for the post-mastectomy care benefits required to be covered by
24a policy of accident and health insurance under Section 356t

 

 

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1and the coverage required under Sections 356g, 356g.5,
2356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10,
3356z.11, 356z.12, 356z.13, 356z.14, and 356z.15, and 356z.22 of
4the Illinois Insurance Code. The coverage shall comply with
5Sections 155.22a and 356z.19 of the Illinois Insurance Code.
6The requirement that health benefits be covered as provided in
7this is an exclusive power and function of the State and is a
8denial and limitation under Article VII, Section 6, subsection
9(h) of the Illinois Constitution. A home rule municipality to
10which this Section applies must comply with every provision of
11this Section.
12    Rulemaking authority to implement Public Act 95-1045, if
13any, is conditioned on the rules being adopted in accordance
14with all provisions of the Illinois Administrative Procedure
15Act and all rules and procedures of the Joint Committee on
16Administrative Rules; any purported rule not so adopted, for
17whatever reason, is unauthorized.
18(Source: P.A. 96-139, eff. 1-1-10; 96-328, eff. 8-11-09;
1996-1000, eff. 7-2-10; 97-282, eff. 8-9-11; 97-343, eff. 1-1-12;
2097-813, eff. 7-13-12.)
 
21    Section 20. The School Code is amended by changing Section
2210-22.3f as follows:
 
23    (105 ILCS 5/10-22.3f)
24    Sec. 10-22.3f. Required health benefits. Insurance

 

 

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1protection and benefits for employees shall provide the
2post-mastectomy care benefits required to be covered by a
3policy of accident and health insurance under Section 356t and
4the coverage required under Sections 356g, 356g.5, 356g.5-1,
5356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11, 356z.12,
6356z.13, 356z.14, and 356z.15, and 356z.22 of the Illinois
7Insurance Code. Insurance policies shall comply with Section
8356z.19 of the Illinois Insurance Code. The coverage shall
9comply with Section 155.22a of the Illinois Insurance Code.
10    Rulemaking authority to implement Public Act 95-1045, if
11any, is conditioned on the rules being adopted in accordance
12with all provisions of the Illinois Administrative Procedure
13Act and all rules and procedures of the Joint Committee on
14Administrative Rules; any purported rule not so adopted, for
15whatever reason, is unauthorized.
16(Source: P.A. 96-139, eff. 1-1-10; 96-328, eff. 8-11-09;
1796-1000, eff. 7-2-10; 97-282, eff. 8-9-11; 97-343, eff. 1-1-12;
1897-813, eff. 7-13-12.)
 
19    Section 25. The Illinois Insurance Code is amended by
20adding Section 356z.22 as follows:
 
21    (215 ILCS 5/356z.22 new)
22    Sec. 356z.22. Telehealth.
23    (a) The General Assembly finds and declares the following:
24         (1) Lack of primary care providers, specialty

 

 

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1    providers, and transportation continue to be significant
2    barriers to access to health services in medically
3    underserved rural and urban areas.
4        (2) Parts of Illinois have difficulty attracting and
5    retaining health professionals, as well as supporting
6    local health facilities to provide a continuum of health
7    care.
8        (3) Individuals in rural areas are much less likely to
9    have access to the specialty health services they need, due
10    to major distance and time barriers, transportation
11    limitations, or mobility limitations, all of which lead to
12    disparities in access to care.
13        (4) Hospital emergency rooms have become the default
14    provider of health care to patients with acute crises and
15    for whom no appropriate alternatives are available, and the
16    majority of emergency rooms do not have reliable, ready
17    consultative access to psychiatrists or other medical
18    specialties.
19        (5) Telehealth has been shown to be an effective medium
20    through which to deliver physical health and mental health
21    care.
22        (6) Key findings from the Illinois Rural Health
23    Association's Mental Health Access Forum Report recommend
24    the increased use of telehealth and technology to improve
25    access to care, increase training opportunities, and
26    evaluate quality of care.

 

 

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1        (7) The State of Illinois has already recognized, and
2    currently reimburses providers for, telepsychiatry
3    services to patients receiving State public aid.
4        (8) Telehealth is a mode of delivering health care
5    services of a personal, family, and public health nature
6    through utilizing information and communication
7    technologies to enable the examination, diagnosis,
8    consultation, treatment, education, care management, and
9    self-management of patients at a distance from health care
10    providers.
11        (9) The use of information and telecommunication
12    technologies to deliver health services has the potential
13    to reduce costs, improve quality, change the conditions of
14    practice, and improve access to health care, particularly
15    in rural and other medically underserved areas, as well as
16    in emergency rooms in large urban areas where the wait for
17    specialty care can be lengthy.
18        (10) Telehealth will assist in maintaining or
19    improving the physical and economic health of medically
20    underserved communities by keeping the source of medical
21    care in the local area by assisting primary care
22    physicians, strengthening the health infrastructure, and
23    preserving health care-related jobs.
24        (11) Consumers of health care will benefit from
25    telehealth in many ways, including expanded access to
26    providers, faster and more convenient treatment, better

 

 

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1    continuity of care, reduction of lost work time and travel
2    costs, and the ability to remain with support networks.
3        (12) It is the intent of the General Assembly that the
4    fundamental health care provider-patient relationship not
5    only be preserved, but also be augmented and enhanced,
6    through the use of telehealth as a tool to be integrated
7    into practices.
8        (13) Without the assurance of payment and the
9    resolution of legal and policy barriers, the full potential
10    of telehealth will not be realized.
11    The purpose of this Section is to require certain insurers,
12nonprofit health service plans, managed care organizations,
13and health maintenance organizations to provide coverage for
14health care services delivered through telehealth in a certain
15manner; prohibit certain insurers, nonprofit health service
16plans, health maintenance organizations and managed care
17organizations from excluding a health care service from
18coverage solely because it is delivered by telehealth and not
19in another manner; require certain insurers, nonprofit health
20service plans, and health maintenance organizations to
21reimburse health care providers for certain services under
22certain circumstances; authorize the imposition of a
23deductible, copayment, coinsurance amount, or annual dollar
24maximum for certain services in compliance with Illinois and
25federal parity laws; prohibit the imposition of a lifetime
26dollar maximum for certain services; prohibit a health

 

 

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1insurance policy or contract from distinguishing between
2patients in rural or urban locations in providing certain
3coverage; and provide for the application of this Code.
4    (b) For the purposes of this Section:
5    "Asynchronous store and forward" means the transmission of
6a patient's medical information from an originating site to the
7health care provider at a distant site without the presence of
8the patient.
9    "Distant site" means the location at which the provider
10rendering the service is located.
11    "Facility fee" means the reimbursement made to the
12following originating sites for the telehealth service:
13physician's office, local health departments, community mental
14health centers, rural health clinics, hospitals, and substance
15use disorder facilities licensed by the Department of Human
16Services or the Department of Public Health.
17    "Health care provider" means a licensed or certified health
18care professional, including, but not limited to, advanced
19practice nurses, psychologists, social workers, physicians,
20licensed clinical professional counselors, and mental health
21professionals as defined in 59 Ill. Adm. Code 132.25 and
22substance use disorder professionals as defined in 77 Ill. Adm.
23Code 2060.309.
24    "Interactive telecommunications system" means multimedia
25communications equipment that includes, at a minimum, audio and
26video equipment permitting 2-way, real-time interactive

 

 

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1communication between the patient and the distant site
2provider. Telephones, facsimile machines, and electronic mail
3systems do not meet the definition of "interactive
4telecommunications system".
5    "Originating site" means the location at which the
6participant receiving the service is located, including, but
7not limited to, hospitals, rural health clinics, Federally
8Qualified Health Centers, and other health care providers.
9    "Physician" means a physician licensed to practice
10medicine in all its branches.
11    "Synchronous interaction" means a real-time interaction
12between a patient at an originating site and a health care
13provider located at a distant site.
14    "Telecommunication system" means an asynchronous store and
15forward technology or an interactive telecommunications
16system, or both, that is used to transmit data between the
17originating and distant sites.
18     "Telehealth" means (1) the provision of services and the
19mode of delivering health care services and public health via
20information and communication technologies to facilitate the
21examination, assessment, diagnosis, consultation, treatment,
22education, care management, and self-management of a patient's
23health care while the patient is at the originating site and
24the health care provider is at a distant site; telehealth
25facilitates patient self-management and caregiver support for
26patients and includes synchronous interactions and

 

 

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1asynchronous store and forward transfers and (2) as it relates
2to the delivery of health care, mental health care, substance
3use disorder treatment, and public health services, the use of
4interactive audio, video, or other telecommunications or
5electronic technology by a health care provider to deliver a
6health care service within the scope of practice of the health
7care provider from the distant site to the originating site at
8which the patient is located; telehealth is the provision of
9services via information and communication technologies to
10facilitate the assessment, diagnosis, consultation, treatment,
11education, care management, and self-management of a patient's
12health care while the patient is at the originating site and
13the health care provider is at a distant site; telehealth
14facilitates patient self-management and caregiver support for
15patients and includes synchronous interactions and
16asynchronous store and forward transfers. "Telehealth" does
17not include:
18        (A) an audio-only telephone conversation between a
19    health care provider and a patient;
20        (B) an electronic mail message between a health care
21    provider and a patient; or
22        (C) a facsimile transmission between a health care
23    provider and a patient.
24    "Teleophthalmology and teledermatology by store and
25forward" means an asynchronous transmission of medical
26information to be reviewed at a later time by a physician at a

 

 

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1distant site who is trained in ophthalmology or dermatology or,
2for teleophthalmology, by an optometrist who is licensed
3pursuant to the Illinois Optometric Practice Act of 1987 where
4the physician or optometrist at the distant site reviews the
5medical information without the patient being present in real
6time.
7    (c) This Section applies to:
8        (1) insurers and nonprofit health service plans that
9    provide hospital, medical, mental health, substance use
10    disorder, or surgical benefits to individuals or groups on
11    an expense-incurred basis under health insurance policies
12    or contracts that are issued or delivered in this State;
13    and
14        (2) health maintenance organizations that provide
15    hospital, medical, mental health, substance use disorder,
16    or surgical benefits to individuals or groups under
17    contracts that are issued or delivered in this State.
18    This Section shall not be construed to alter the scope of
19practice of any health care provider or authorize the delivery
20of health care services in a setting or in a manner not
21otherwise authorized by law. All laws regarding the
22confidentiality of health care information and a patient's
23rights to his or her medical information shall apply to
24telehealth interactions. This Section applies to a group or
25individual policy of accident and health insurance or managed
26care plan amended, delivered, issued, or renewed after the

 

 

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1effective date of this amendatory Act of the 98th General
2Assembly.
3    (d) An entity subject to this Section:
4        (1) shall provide coverage under a health insurance
5    policy or contract for health care services appropriately
6    delivered through telehealth;
7        (2) may not exclude from coverage a health care service
8    solely because it is provided through telehealth and is not
9    provided through an in-person consultation or contact
10    between a health care provider and a patient; and
11        (3) shall not require that in-person contact occur
12    between a health care provider and a patient before payment
13    is made for the covered services appropriately provided
14    through telehealth.
15    No health care service plan shall require the health care
16provider to document a barrier to an in-person visit for
17coverage of services to be provided via telehealth. No health
18care service plan shall limit the type of setting where
19services are provided for the patient or by the health care
20provider before payment is made for the covered services
21appropriately provided through telehealth, subject to the
22terms and conditions of the contract entered into between the
23enrollee or subscriber and the health care service plan and its
24participating providers or provider groups.
25    Notwithstanding any other provision, this Section shall
26not be interpreted to authorize a health care service plan to

 

 

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1require the use of telehealth when the health care provider has
2determined that it is not appropriate.
3    (e) With regard to reimbursement, an entity subject to this
4Section:
5        (1) shall reimburse a health care provider for the
6    examination, assessment, diagnosis, consultation, and
7    treatment of an insured patient for a health care service
8    covered under a health insurance policy or contract that
9    can appropriately be provided through telehealth;
10        (2) is not required to:
11            (A) reimburse a health care provider for a health
12        care service delivered in person or through telehealth
13        that is not a covered benefit under the health
14        insurance policy or contract; or
15            (B) reimburse a health care provider who is not a
16        covered provider under the health insurance policy or
17        contract;
18        (3) may impose the same deductible, copayment, or
19    coinsurance amount on benefits for health care services
20    that are delivered through an in-person consultation or
21    through telehealth in compliance with Illinois and federal
22    parity laws; and
23        (4) may not impose a lifetime dollar maximum or limit
24    the provision of mental health or substance use disorder
25    services in a manner that violates Illinois or federal
26    parity laws.

 

 

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1    A facility fee shall be paid to providers. Participating
2providers shall be reimbursed for the appropriate current
3procedural terminology (CPT) code for the telehealth service
4rendered.
5    (f) A patient receiving services by store and forward shall
6be notified of the right to receive interactive communication
7with the distant specialist physician or optometrist, and shall
8receive an interactive communication with the distant
9specialist physician or optometrist upon request. If
10requested, communication with the distant specialist physician
11or optometrist may occur either at the time of the consultation
12or within 30 days after the patient's notification of the
13results of the consultation. If the reviewing optometrist
14identifies a disease or condition requiring consultation or
15referral, then that consultation or referral shall be with an
16ophthalmologist or other appropriate physician and surgeon as
17required.
18    (g) The requirements for telehealth services are as
19follows:
20        (1) A physician or other health care provider must be
21    onsite and available to the patient at the originating
22    site, except:
23            (A) where the patient requests that the health care
24        provider not be present in the same room with the
25        patient, but such health care provider is otherwise
26        available to the patient onsite; or

 

 

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1            (B) where the patient and his or her treating
2        health care provider consent to the provision of level
3        one substance use disorder treatment services in
4        accordance with 77 Ill. Adm. Code 2060.401 without a
5        health care provider present onsite with the patient.
6        (2) The distant site provider must be a physician or
7    health care provider.
8        (3) Medical data may be exchanged through a
9    telecommunication system.
10        (4) The interactive telecommunications system must, at
11    a minimum, have the capability of allowing the consulting
12    physician to examine the patient sufficiently to allow
13    proper diagnosis. The system must also be capable of
14    transmitting clearly audible sounds as well as clear video
15    images.
16    (h) The requirements for telepsychiatry services are as
17follows:
18        (1) A physician or other health care provider as
19    defined in 59 Ill. Adm. Code 132.25 must be onsite and
20    available to the patient at the originating site, but at
21    the patient's request does not need to be present in the
22    room with the patient.
23        (2) The distant site provider must be a physician or
24    health care provider licensed by the State of Illinois or
25    by the state where the patient is located and must have
26    completed or be registered in and supervised by a physician

 

 

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1    who has completed an approved general psychiatry residency
2    program. When treating patients age 16 and younger, the
3    physician must have also completed an approved child and
4    adolescent residency program or be registered in an
5    approved general psychiatry residency program or a child
6    and adolescent psychiatry fellowship program and
7    supervised by a physician who has completed an approved
8    child and adolescent psychiatry fellowship program. The
9    distant site provider must personally render the
10    telepsychiatry service. Telepsychiatry services must be
11    rendered using an interactive video telecommunications
12    system.
13    Group psychotherapy is a covered telepsychiatry service.
14    (i) The originating site must maintain records to document
15the services provided to patients and the health care providers
16involved in the services at all originating and distant site
17locations.
 
18    Section 30. The Health Maintenance Organization Act is
19amended by changing Section 5-3 as follows:
 
20    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
21    Sec. 5-3. Insurance Code provisions.
22    (a) Health Maintenance Organizations shall be subject to
23the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
24141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,

 

 

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1154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2, 355.3,
2356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2, 356z.4, 356z.5,
3356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
4356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.21, 356z.22,
5364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c, 368d, 368e,
6370c, 370c.1, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412,
7444, and 444.1, paragraph (c) of subsection (2) of Section 367,
8and Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV,
9and XXVI of the Illinois Insurance Code.
10    (b) For purposes of the Illinois Insurance Code, except for
11Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health
12Maintenance Organizations in the following categories are
13deemed to be "domestic companies":
14        (1) a corporation authorized under the Dental Service
15    Plan Act or the Voluntary Health Services Plans Act;
16        (2) a corporation organized under the laws of this
17    State; or
18        (3) a corporation organized under the laws of another
19    state, 30% or more of the enrollees of which are residents
20    of this State, except a corporation subject to
21    substantially the same requirements in its state of
22    organization as is a "domestic company" under Article VIII
23    1/2 of the Illinois Insurance Code.
24    (c) In considering the merger, consolidation, or other
25acquisition of control of a Health Maintenance Organization
26pursuant to Article VIII 1/2 of the Illinois Insurance Code,

 

 

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1        (1) the Director shall give primary consideration to
2    the continuation of benefits to enrollees and the financial
3    conditions of the acquired Health Maintenance Organization
4    after the merger, consolidation, or other acquisition of
5    control takes effect;
6        (2)(i) the criteria specified in subsection (1)(b) of
7    Section 131.8 of the Illinois Insurance Code shall not
8    apply and (ii) the Director, in making his determination
9    with respect to the merger, consolidation, or other
10    acquisition of control, need not take into account the
11    effect on competition of the merger, consolidation, or
12    other acquisition of control;
13        (3) the Director shall have the power to require the
14    following information:
15            (A) certification by an independent actuary of the
16        adequacy of the reserves of the Health Maintenance
17        Organization sought to be acquired;
18            (B) pro forma financial statements reflecting the
19        combined balance sheets of the acquiring company and
20        the Health Maintenance Organization sought to be
21        acquired as of the end of the preceding year and as of
22        a date 90 days prior to the acquisition, as well as pro
23        forma financial statements reflecting projected
24        combined operation for a period of 2 years;
25            (C) a pro forma business plan detailing an
26        acquiring party's plans with respect to the operation

 

 

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1        of the Health Maintenance Organization sought to be
2        acquired for a period of not less than 3 years; and
3            (D) such other information as the Director shall
4        require.
5    (d) The provisions of Article VIII 1/2 of the Illinois
6Insurance Code and this Section 5-3 shall apply to the sale by
7any health maintenance organization of greater than 10% of its
8enrollee population (including without limitation the health
9maintenance organization's right, title, and interest in and to
10its health care certificates).
11    (e) In considering any management contract or service
12agreement subject to Section 141.1 of the Illinois Insurance
13Code, the Director (i) shall, in addition to the criteria
14specified in Section 141.2 of the Illinois Insurance Code, take
15into account the effect of the management contract or service
16agreement on the continuation of benefits to enrollees and the
17financial condition of the health maintenance organization to
18be managed or serviced, and (ii) need not take into account the
19effect of the management contract or service agreement on
20competition.
21    (f) Except for small employer groups as defined in the
22Small Employer Rating, Renewability and Portability Health
23Insurance Act and except for medicare supplement policies as
24defined in Section 363 of the Illinois Insurance Code, a Health
25Maintenance Organization may by contract agree with a group or
26other enrollment unit to effect refunds or charge additional

 

 

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1premiums under the following terms and conditions:
2        (i) the amount of, and other terms and conditions with
3    respect to, the refund or additional premium are set forth
4    in the group or enrollment unit contract agreed in advance
5    of the period for which a refund is to be paid or
6    additional premium is to be charged (which period shall not
7    be less than one year); and
8        (ii) the amount of the refund or additional premium
9    shall not exceed 20% of the Health Maintenance
10    Organization's profitable or unprofitable experience with
11    respect to the group or other enrollment unit for the
12    period (and, for purposes of a refund or additional
13    premium, the profitable or unprofitable experience shall
14    be calculated taking into account a pro rata share of the
15    Health Maintenance Organization's administrative and
16    marketing expenses, but shall not include any refund to be
17    made or additional premium to be paid pursuant to this
18    subsection (f)). The Health Maintenance Organization and
19    the group or enrollment unit may agree that the profitable
20    or unprofitable experience may be calculated taking into
21    account the refund period and the immediately preceding 2
22    plan years.
23    The Health Maintenance Organization shall include a
24statement in the evidence of coverage issued to each enrollee
25describing the possibility of a refund or additional premium,
26and upon request of any group or enrollment unit, provide to

 

 

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1the group or enrollment unit a description of the method used
2to calculate (1) the Health Maintenance Organization's
3profitable experience with respect to the group or enrollment
4unit and the resulting refund to the group or enrollment unit
5or (2) the Health Maintenance Organization's unprofitable
6experience with respect to the group or enrollment unit and the
7resulting additional premium to be paid by the group or
8enrollment unit.
9    In no event shall the Illinois Health Maintenance
10Organization Guaranty Association be liable to pay any
11contractual obligation of an insolvent organization to pay any
12refund authorized under this Section.
13    (g) Rulemaking authority to implement Public Act 95-1045,
14if any, 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. 96-328, eff. 8-11-09; 96-639, eff. 1-1-10;
2096-833, eff. 6-1-10; 96-1000, eff. 7-2-10; 97-282, eff. 8-9-11;
2197-343, eff. 1-1-12; 97-437, eff. 8-18-11; 97-486, eff. 1-1-12;
2297-592, eff. 1-1-12; 97-805, eff. 1-1-13; 97-813, eff.
237-13-12.)
 
24    Section 35. The Limited Health Service Organization Act is
25amended by changing Section 4003 as follows:
 

 

 

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1    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
2    Sec. 4003. Illinois Insurance Code provisions. Limited
3health service organizations shall be subject to the provisions
4of Sections 133, 134, 136, 137, 139, 140, 141.1, 141.2, 141.3,
5143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5, 154.6,
6154.7, 154.8, 155.04, 155.37, 355.2, 355.3, 356v, 356z.10,
7356z.21, 356z.22, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2,
8409, 412, 444, and 444.1 and Articles IIA, VIII 1/2, XII, XII
91/2, XIII, XIII 1/2, XXV, and XXVI of the Illinois Insurance
10Code. For purposes of the Illinois Insurance Code, except for
11Sections 444 and 444.1 and Articles XIII and XIII 1/2, limited
12health service organizations in the following categories are
13deemed to be domestic companies:
14        (1) a corporation under the laws of this State; or
15        (2) a corporation organized under the laws of another
16    state, 30% of more of the enrollees of which are residents
17    of this State, except a corporation subject to
18    substantially the same requirements in its state of
19    organization as is a domestic company under Article VIII
20    1/2 of the Illinois Insurance Code.
21(Source: P.A. 97-486, eff. 1-1-12; 97-592, 1-1-12; 97-805, eff.
221-1-13; 97-813, eff. 7-13-12.)
 
23    Section 40. The Voluntary Health Services Plans Act is
24amended by changing Section 10 as follows:
 

 

 

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1    (215 ILCS 165/10)  (from Ch. 32, par. 604)
2    Sec. 10. Application of Insurance Code provisions. Health
3services plan corporations and all persons interested therein
4or dealing therewith shall be subject to the provisions of
5Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
6143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 356g,
7356g.5, 356g.5-1, 356r, 356t, 356u, 356v, 356w, 356x, 356y,
8356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9,
9356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18,
10356z.19, 356z.21, 356z.22, 364.01, 367.2, 368a, 401, 401.1,
11402, 403, 403A, 408, 408.2, and 412, and paragraphs (7) and
12(15) of Section 367 of the Illinois Insurance Code.
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. 96-328, eff. 8-11-09; 96-833, eff. 6-1-10;
2096-1000, eff. 7-2-10; 97-282, eff. 8-9-11; 97-343, eff. 1-1-12;
2197-486, eff. 1-1-12; 97-592, eff. 1-1-12; 97-805, eff. 1-1-13;
2297-813, eff. 7-13-12.)".