Illinois General Assembly - Full Text of HB3312
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Full Text of HB3312  102nd General Assembly

HB3312 102ND GENERAL ASSEMBLY

  
  

 


 
102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
HB3312

 

Introduced 2/19/2021, by Rep. David A. Welter

 

SYNOPSIS AS INTRODUCED:
 
5 ILCS 375/6.11
55 ILCS 5/5-1069.3
65 ILCS 5/10-4-2.3
105 ILCS 5/10-22.3f
215 ILCS 5/356z.43 new
215 ILCS 125/5-3  from Ch. 111 1/2, par. 1411.2
215 ILCS 130/4003  from Ch. 73, par. 1504-3
215 ILCS 165/10  from Ch. 32, par. 604

    Amends the Illinois Insurance Code. Requires insurers that provide coverage for prescription inhalant drugs to limit the total amount an insured is required to pay for a covered prescription inhalant drug to $100 per 30-day supply regardless of the type and amount of inhalant drug needed by the insured. Provides that the Department of Insurance may adopt rules as necessary to implement and administer the provisions. Provides that on January 1 of each year, the limit on the amount that an insured is required to pay for a 30-day supply of a covered prescription inhalant drug shall increase by a percentage equal to the percentage change from the preceding year in the medical care component of the Consumer Price Index of the Bureau of Labor Statistics of the United States Department of Labor. Makes conforming changes in the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, the Limited Health Service Organization Act, and the Voluntary Health Services Plans Act.


LRB102 13831 BMS 19182 b

FISCAL NOTE ACT MAY APPLY
STATE MANDATES ACT MAY REQUIRE REIMBURSEMENT

 

 

A BILL FOR

 

HB3312LRB102 13831 BMS 19182 b

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 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
9provide the post-mastectomy care benefits required to be
10covered by a policy of accident and health insurance under
11Section 356t of the Illinois Insurance Code. The program of
12health benefits shall provide the coverage required under
13Sections 356g, 356g.5, 356g.5-1, 356m, 356u, 356w, 356x,
14356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
15356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,
16356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
17356z.36, and 356z.41, and 356z.43 of the Illinois Insurance
18Code. The program of health benefits must comply with Sections
19155.22a, 155.37, 355b, 356z.19, 370c, and 370c.1 and Article
20XXXIIB of the Illinois Insurance Code. The Department of
21Insurance shall enforce the requirements of this Section with
22respect to Sections 370c and 370c.1 of the Illinois Insurance
23Code; all other requirements of this Section shall be enforced

 

 

HB3312- 2 -LRB102 13831 BMS 19182 b

1by the Department of Central Management Services.
2    Rulemaking authority to implement Public Act 95-1045, if
3any, is conditioned on the rules being adopted in accordance
4with all provisions of the Illinois Administrative Procedure
5Act and all rules and procedures of the Joint Committee on
6Administrative Rules; any purported rule not so adopted, for
7whatever reason, is unauthorized.
8(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
9100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
101-1-19; 100-1102, eff. 1-1-19; 100-1170, eff. 6-1-19; 101-13,
11eff. 6-12-19; 101-281, eff. 1-1-20; 101-393, eff. 1-1-20;
12101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
131-1-21.)
 
14    Section 10. The Counties Code is amended by changing
15Section 5-1069.3 as follows:
 
16    (55 ILCS 5/5-1069.3)
17    Sec. 5-1069.3. Required health benefits. If a county,
18including a home rule county, is a self-insurer for purposes
19of providing health insurance coverage for its employees, the
20coverage shall include coverage for the post-mastectomy care
21benefits required to be covered by a policy of accident and
22health insurance under Section 356t and the coverage required
23under Sections 356g, 356g.5, 356g.5-1, 356u, 356w, 356x,
24356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,

 

 

HB3312- 3 -LRB102 13831 BMS 19182 b

1356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
2356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41, and 356z.43
3of the Illinois Insurance Code. The coverage shall comply with
4Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
5Insurance Code. The Department of Insurance shall enforce the
6requirements of this Section. The requirement that health
7benefits be covered as provided in this Section is an
8exclusive power and function of the State and is a denial and
9limitation under Article VII, Section 6, subsection (h) of the
10Illinois Constitution. A home rule county to which this
11Section applies must comply with every provision of this
12Section.
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. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
20100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
211-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
22eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
23101-625, eff. 1-1-21.)
 
24    Section 15. The Illinois Municipal Code is amended by
25changing Section 10-4-2.3 as follows:
 

 

 

HB3312- 4 -LRB102 13831 BMS 19182 b

1    (65 ILCS 5/10-4-2.3)
2    Sec. 10-4-2.3. Required health benefits. If a
3municipality, including a home rule municipality, is a
4self-insurer for purposes of providing health insurance
5coverage for its employees, the coverage shall include
6coverage for the post-mastectomy care benefits required to be
7covered by a policy of accident and health insurance under
8Section 356t and the coverage required under Sections 356g,
9356g.5, 356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9,
10356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
11356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
12356z.36, and 356z.41, and 356z.43 of the Illinois Insurance
13Code. The coverage shall comply with Sections 155.22a, 355b,
14356z.19, and 370c of the Illinois Insurance Code. The
15Department of Insurance shall enforce the requirements of this
16Section. The requirement that health benefits be covered as
17provided in this is an exclusive power and function of the
18State and is a denial and limitation under Article VII,
19Section 6, subsection (h) of the Illinois Constitution. A home
20rule municipality to which this Section applies must comply
21with every provision of this Section.
22    Rulemaking authority to implement Public Act 95-1045, if
23any, is conditioned on the rules being adopted in accordance
24with all provisions of the Illinois Administrative Procedure
25Act and all rules and procedures of the Joint Committee on

 

 

HB3312- 5 -LRB102 13831 BMS 19182 b

1Administrative Rules; any purported rule not so adopted, for
2whatever reason, is unauthorized.
3(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
4100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
51-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
6eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
7101-625, eff. 1-1-21.)
 
8    Section 20. The School Code is amended by changing Section
910-22.3f as follows:
 
10    (105 ILCS 5/10-22.3f)
11    Sec. 10-22.3f. Required health benefits. Insurance
12protection and benefits for employees shall provide the
13post-mastectomy care benefits required to be covered by a
14policy of accident and health insurance under Section 356t and
15the coverage required under Sections 356g, 356g.5, 356g.5-1,
16356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11, 356z.12,
17356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
18356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41, and 356z.43
19of the Illinois Insurance Code. Insurance policies shall
20comply with Section 356z.19 of the Illinois Insurance Code.
21The coverage shall comply with Sections 155.22a, 355b, and
22370c of the Illinois Insurance Code. The Department of
23Insurance shall enforce the requirements of this Section.
24    Rulemaking authority to implement Public Act 95-1045, if

 

 

HB3312- 6 -LRB102 13831 BMS 19182 b

1any, is conditioned on the rules being adopted in accordance
2with all provisions of the Illinois Administrative Procedure
3Act and all rules and procedures of the Joint Committee on
4Administrative Rules; any purported rule not so adopted, for
5whatever reason, is unauthorized.
6(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
7100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
81-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
9eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
10101-625, eff. 1-1-21.)
 
11    Section 25. The Illinois Insurance Code is amended by
12adding Section 356z.43 as follows:
 
13    (215 ILCS 5/356z.43 new)
14    Sec. 356z.43. Cost sharing for prescription inhalants;
15limits.
16    (a) This Section applies to a group or individual policy
17of accident and health insurance amended, delivered, issued,
18or renewed on or after the effective date of this amendatory
19Act of the 102nd General Assembly.
20    (b) An insurance policy that provides coverage for
21prescription inhalant drugs shall limit the total amount that
22an insured is required to pay for a 30-day supply of covered
23prescription inhalant drugs at an amount not to exceed $100,
24regardless of the quantity or type of covered prescription

 

 

HB3312- 7 -LRB102 13831 BMS 19182 b

1inhalant drug used to fill the insured's prescription.
2    (c) Nothing in this Section prevents an insurer from
3reducing an insured's cost sharing by an amount greater than
4the amount specified in subsection (b).
5    (d) The Director may use any of the Director's enforcement
6powers to obtain an insurer's compliance with this Section.
7    (e) The Department may adopt rules as necessary to
8implement and administer this Section and to align it with
9federal requirements.
10    (f) On January 1 of each year, the limit on the amount that
11an insured is required to pay for a 30-day supply of a covered
12prescription inhalant drug shall increase by a percentage
13equal to the percentage change from the preceding year in the
14medical care component of the Consumer Price Index of the
15Bureau of Labor Statistics of the United States Department of
16Labor.
 
17    Section 30. The Health Maintenance Organization Act is
18amended by changing Section 5-3 as follows:
 
19    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
20    Sec. 5-3. Insurance Code provisions.
21    (a) Health Maintenance Organizations shall be subject to
22the provisions of Sections 133, 134, 136, 137, 139, 140,
23141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
24154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2,

 

 

HB3312- 8 -LRB102 13831 BMS 19182 b

1355.3, 355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2,
2356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10,
3356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.18,
4356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30,
5356z.30a, 356z.32, 356z.33, 356z.35, 356z.36, 356z.41,
6356z.43, 364, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c,
7368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A, 408,
8408.2, 409, 412, 444, and 444.1, paragraph (c) of subsection
9(2) of Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2,
10XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the Illinois
11Insurance Code.
12    (b) For purposes of the Illinois Insurance Code, except
13for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
14Health Maintenance Organizations in the following categories
15are deemed to be "domestic companies":
16        (1) a corporation authorized under the Dental Service
17    Plan Act or the Voluntary Health Services Plans Act;
18        (2) a corporation organized under the laws of this
19    State; or
20        (3) a corporation organized under the laws of another
21    state, 30% or more of the enrollees of which are residents
22    of this State, except a corporation subject to
23    substantially the same requirements in its state of
24    organization as is a "domestic company" under Article VIII
25    1/2 of the Illinois Insurance Code.
26    (c) In considering the merger, consolidation, or other

 

 

HB3312- 9 -LRB102 13831 BMS 19182 b

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

 

 

HB3312- 10 -LRB102 13831 BMS 19182 b

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

 

 

HB3312- 11 -LRB102 13831 BMS 19182 b

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

 

 

HB3312- 12 -LRB102 13831 BMS 19182 b

1describing the possibility of a refund or additional premium,
2and upon request of any group or enrollment unit, provide to
3the group or enrollment unit a description of the method used
4to calculate (1) the Health Maintenance Organization's
5profitable experience with respect to the group or enrollment
6unit and the resulting refund to the group or enrollment unit
7or (2) the Health Maintenance Organization's unprofitable
8experience with respect to the group or enrollment unit and
9the resulting additional premium to be paid by the group or
10enrollment unit.
11    In no event shall the Illinois Health Maintenance
12Organization Guaranty Association be liable to pay any
13contractual obligation of an insolvent organization to pay any
14refund authorized under this Section.
15    (g) Rulemaking authority to implement Public Act 95-1045,
16if any, is conditioned on the rules being adopted in
17accordance with all provisions of the Illinois Administrative
18Procedure Act and all rules and procedures of the Joint
19Committee on Administrative Rules; any purported rule not so
20adopted, for whatever reason, is unauthorized.
21(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
22100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff.
231-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81,
24eff. 7-12-19; 101-281, eff. 1-1-20; 101-371, eff. 1-1-20;
25101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
261-1-20; 101-625, eff. 1-1-21.)
 

 

 

HB3312- 13 -LRB102 13831 BMS 19182 b

1    Section 35. The Limited Health Service Organization Act is
2amended by changing Section 4003 as follows:
 
3    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
4    Sec. 4003. Illinois Insurance Code provisions. Limited
5health service organizations shall be subject to the
6provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
7141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
8154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 355.2, 355.3,
9355b, 356v, 356z.10, 356z.21, 356z.22, 356z.25, 356z.26,
10356z.29, 356z.30a, 356z.32, 356z.33, 356z.41, 356z.43, 368a,
11401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412, 444, and
12444.1 and Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2,
13XXV, and XXVI of the Illinois Insurance Code. For purposes of
14the Illinois Insurance Code, except for Sections 444 and 444.1
15and Articles XIII and XIII 1/2, limited health service
16organizations in the following categories are deemed to be
17domestic companies:
18        (1) a corporation under the laws of this State; or
19        (2) a corporation organized under the laws of another
20    state, 30% or more of the enrollees of which are residents
21    of this State, except a corporation subject to
22    substantially the same requirements in its state of
23    organization as is a domestic company under Article VIII
24    1/2 of the Illinois Insurance Code.

 

 

HB3312- 14 -LRB102 13831 BMS 19182 b

1(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
2100-201, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1057, eff.
31-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
4eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff. 1-1-21.)
 
5    Section 40. The Voluntary Health Services Plans Act is
6amended by changing Section 10 as follows:
 
7    (215 ILCS 165/10)  (from Ch. 32, par. 604)
8    Sec. 10. Application of Insurance Code provisions. Health
9services plan corporations and all persons interested therein
10or dealing therewith shall be subject to the provisions of
11Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
12143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
13356g, 356g.5, 356g.5-1, 356r, 356t, 356u, 356v, 356w, 356x,
14356y, 356z.1, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8,
15356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
16356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29,
17356z.30, 356z.30a, 356z.32, 356z.33, 356z.41, 356z.43, 364.01,
18367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412,
19and paragraphs (7) and (15) of Section 367 of the Illinois
20Insurance Code.
21    Rulemaking authority to implement Public Act 95-1045, if
22any, is conditioned on the rules being adopted in accordance
23with all provisions of the Illinois Administrative Procedure
24Act and all rules and procedures of the Joint Committee on

 

 

HB3312- 15 -LRB102 13831 BMS 19182 b

1Administrative Rules; any purported rule not so adopted, for
2whatever reason, is unauthorized.
3(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
4100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff.
51-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81,
6eff. 7-12-19; 101-281, eff. 1-1-20; 101-393, eff. 1-1-20;
7101-625, eff. 1-1-21.)