Illinois General Assembly - Bill Status for SB3130

Amends the Illinois Insurance Code. Provides that beginning with the operation of a State-based exchange in plan year 2026, a pregnant individual has the right to enroll in a qualified health plan through a special enrollment period at any time after a qualified health care professional certifies that the individual is pregnant. Amends the Illinois Health Insurance Portability and Accountability Act. Provides that notice of a health insurance issuer's election to uniformly modify coverage, uniformly terminate coverage, or discontinue coverage in a marketplace shall be sent by certified mail to the Department of Insurance 45 days (instead of 90 days) in advance of any notification of the company's actions sent to plan sponsors, participants, beneficiaries, and covered individuals. Makes conforming changes. Amends the Managed Care Reform and Patient Rights Act. Makes changes in provisions concerning flat-dollar copayment structures for prescription drug benefits. Amends the Network Adequacy and Transparency Act. Provides that the Act does not apply to an individual or group policy for excepted benefits or short-term, limited-duration health insurance coverage (instead of an individual or group policy for dental or vision insurance or a limited health service organization) with a network plan, except to the extent that federal law establishes network adequacy and transparency standards for stand-alone dental plans, which the Department shall enforce. Provides that if the Centers for Medicare and Medicaid Services establishes minimum provider ratios for stand-alone dental plans in the type of exchange in use in this State for a given plan year, the Department shall enforce those standards for stand-alone dental plans for that plan year. Requires the Department of Insurance to enforce certain appointment wait-time standards, time and distance standards, and other standards if the Centers for Medicare and Medicaid Services establishes those standards for plans in the type of exchange in use in this State. Makes other changes.

Replaces everything after the enacting clause. Reinserts the provisions of the introduced bill with the following changes. Amends the Department of Insurance Law of the Civil Administrative Code of Illinois. Provides that the Marketplace Director of the Illinois Health Benefits Exchange shall serve for a term of 2 years, and until a successor is appointed and qualified; except that the term of the first Marketplace Director appointed shall expire on the third Monday in January 2027. Provides that the Marketplace Director may serve for more than one term. Removes language providing that the Marketplace Director may be an existing employee with other duties. Provides that the Marketplace Director shall (instead of shall not) be subject to the Personnel Code. In the Illinois Insurance Code, provides that a pregnant individual has the right to enroll in a qualified health plan through a special enrollment period within 60 days (instead of at any time) after any qualified health care professional certifies that the individual is pregnant. In the Managed Care Reform and Patient Rights Act, provides that each level of coverage that a health insurance carrier offers of a standardized option in each applicable service area shall be deemed to satisfy (instead of shall satisfy) the requirements for a flat-dollar copay structure. Amends the Health Maintenance Organization Act. Provides that health maintenance organizations shall comply with the Illinois Insurance Code's requirements concerning pregnancy as a qualifying life event. Effective immediately, except that the changes to the Network Adequacy and Transparency Act take effect January 1, 2025.

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