Illinois General Assembly - Full Text of SB3819
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Full Text of SB3819  102nd General Assembly

SB3819enr 102ND GENERAL ASSEMBLY

  
  
  

 


 
SB3819 EnrolledLRB102 23224 BMS 34475 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, 356q, 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, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
18and 356z.53 and 356z.43 of the Illinois Insurance Code. The
19program of health benefits must comply with Sections 155.22a,
20155.37, 355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of
21the Illinois Insurance Code. The Department of Insurance shall
22enforce the requirements of this Section with respect to
23Sections 370c and 370c.1 of the Illinois Insurance Code; all

 

 

SB3819 Enrolled- 2 -LRB102 23224 BMS 34475 b

1other requirements of this Section shall be enforced by the
2Department of Central Management Services.
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. 101-13, eff. 6-12-19; 101-281, eff. 1-1-20;
10101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
111-1-20; 101-625, eff. 1-1-21; 102-30, eff. 1-1-22; 102-103,
12eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
13102-642, eff. 1-1-22; 102-665, eff. 10-8-21; revised
1410-26-21.)
 
15    Section 10. The Counties Code is amended by changing
16Section 5-1069.3 as follows:
 
17    (55 ILCS 5/5-1069.3)
18    Sec. 5-1069.3. Required health benefits. If a county,
19including a home rule county, is a self-insurer for purposes
20of providing health insurance coverage for its employees, the
21coverage shall include coverage for the post-mastectomy care
22benefits required to be covered by a policy of accident and
23health insurance under Section 356t and the coverage required
24under Sections 356g, 356g.5, 356g.5-1, 356q, 356u, 356w, 356x,

 

 

SB3819 Enrolled- 3 -LRB102 23224 BMS 34475 b

1356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
2356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
3356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
4356z.45, 356z.46, 356z.47, 356z.48, 356z.51, and 356z.53 and
5356z.43 of the Illinois Insurance Code. The coverage shall
6comply with Sections 155.22a, 355b, 356z.19, and 370c of the
7Illinois Insurance Code. The Department of Insurance shall
8enforce the requirements of this Section. The requirement that
9health benefits be covered as provided in this Section is an
10exclusive power and function of the State and is a denial and
11limitation under Article VII, Section 6, subsection (h) of the
12Illinois Constitution. A home rule county to which this
13Section applies must comply with every provision of this
14Section.
15    Rulemaking authority to implement Public Act 95-1045, if
16any, is conditioned on the rules being adopted in accordance
17with all provisions of the Illinois Administrative Procedure
18Act and all rules and procedures of the Joint Committee on
19Administrative Rules; any purported rule not so adopted, for
20whatever reason, is unauthorized.
21(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
22101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
231-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
24eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22;
25102-642, eff. 1-1-22; 102-665, eff. 10-8-21; revised
2610-26-21.)
 

 

 

SB3819 Enrolled- 4 -LRB102 23224 BMS 34475 b

1    Section 15. The Illinois Municipal Code is amended by
2changing Section 10-4-2.3 as follows:
 
3    (65 ILCS 5/10-4-2.3)
4    Sec. 10-4-2.3. Required health benefits. If a
5municipality, including a home rule municipality, is a
6self-insurer for purposes of providing health insurance
7coverage for its employees, the coverage shall include
8coverage for the post-mastectomy care benefits required to be
9covered by a policy of accident and health insurance under
10Section 356t and the coverage required under Sections 356g,
11356g.5, 356g.5-1, 356q, 356u, 356w, 356x, 356z.6, 356z.8,
12356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
13356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32,
14356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
15356z.48, 356z.51, and 356z.53 and 356z.43 of the Illinois
16Insurance Code. The coverage shall comply with Sections
17155.22a, 355b, 356z.19, and 370c of the Illinois Insurance
18Code. The Department of Insurance shall enforce the
19requirements of this Section. The requirement that health
20benefits be covered as provided in this is an exclusive power
21and function of the State and is a denial and limitation under
22Article VII, Section 6, subsection (h) of the Illinois
23Constitution. A home rule municipality to which this Section
24applies must comply with every provision of this Section.

 

 

SB3819 Enrolled- 5 -LRB102 23224 BMS 34475 b

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. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
8101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
91-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
10eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22;
11102-642, eff. 1-1-22; 102-665, eff. 10-8-21; revised
1210-26-21.)
 
13    Section 20. The School Code is amended by changing Section
1410-22.3f as follows:
 
15    (105 ILCS 5/10-22.3f)
16    Sec. 10-22.3f. Required health benefits. Insurance
17protection and benefits for employees shall provide the
18post-mastectomy care benefits required to be covered by a
19policy of accident and health insurance under Section 356t and
20the coverage required under Sections 356g, 356g.5, 356g.5-1,
21356q, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11,
22356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26,
23356z.29, 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40,
24356z.41, 356z.45, 356z.46, 356z.47, 356z.51, and 356z.53 and

 

 

SB3819 Enrolled- 6 -LRB102 23224 BMS 34475 b

1356z.43 of the Illinois Insurance Code. Insurance policies
2shall comply with Section 356z.19 of the Illinois Insurance
3Code. The coverage shall comply with Sections 155.22a, 355b,
4and 370c of the Illinois Insurance Code. The Department of
5Insurance shall enforce the requirements 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. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
13101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
141-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
15eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. 1-1-22;
16102-665, eff. 10-8-21; revised 10-27-21.)
 
17    Section 25. The Illinois Insurance Code is amended by
18adding Section 356z.53 as follows:
 
19    (215 ILCS 5/356z.53 new)
20    Sec. 356z.53. Pediatric palliative care.
21    (a) A group or individual policy of accident and health
22insurance or a managed care plan amended, delivered, issued,
23or renewed on or after January 1, 2024 shall provide coverage
24for community-based pediatric palliative care and hospice

 

 

SB3819 Enrolled- 7 -LRB102 23224 BMS 34475 b

1care. This care shall be delivered to any qualifying child
2with a serious illness by a trained interdisciplinary team
3that allows a child to receive community-based pediatric
4palliative care and hospice care while continuing to pursue
5curative treatment and disease-directed therapies for the
6qualifying illness.
7    (b) As used in this Section, "palliative care" and
8"serious illness" have the same meaning as set forth in the
9Pediatric Palliative Care Act.
 
10    Section 30. The Health Maintenance Organization Act is
11amended by changing Section 5-3 as follows:
 
12    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
13    Sec. 5-3. Insurance Code provisions.
14    (a) Health Maintenance Organizations shall be subject to
15the provisions of Sections 133, 134, 136, 137, 139, 140,
16141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
17154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2,
18355.3, 355b, 356g.5-1, 356m, 356q, 356v, 356w, 356x, 356y,
19356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9,
20356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17,
21356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29,
22356z.30, 356z.30a, 356z.32, 356z.33, 356z.35, 356z.36,
23356z.40, 356z.41, 356z.43, 356z.46, 356z.47, 356z.48, 356z.50,
24356z.51, 356z.53, 364, 364.01, 367.2, 367.2-5, 367i, 368a,

 

 

SB3819 Enrolled- 8 -LRB102 23224 BMS 34475 b

1368b, 368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403,
2403A, 408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of
3subsection (2) of Section 367, and Articles IIA, VIII 1/2,
4XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the
5Illinois Insurance Code.
6    (b) For purposes of the Illinois Insurance Code, except
7for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
8Health Maintenance Organizations in the following categories
9are deemed to be "domestic companies":
10        (1) a corporation authorized under the Dental Service
11    Plan Act or the Voluntary Health Services Plans Act;
12        (2) a corporation organized under the laws of this
13    State; or
14        (3) a corporation organized under the laws of another
15    state, 30% or more of the enrollees of which are residents
16    of this State, except a corporation subject to
17    substantially the same requirements in its state of
18    organization as is a "domestic company" under Article VIII
19    1/2 of the Illinois Insurance Code.
20    (c) In considering the merger, consolidation, or other
21acquisition of control of a Health Maintenance Organization
22pursuant to Article VIII 1/2 of the Illinois Insurance Code,
23        (1) the Director shall give primary consideration to
24    the continuation of benefits to enrollees and the
25    financial conditions of the acquired Health Maintenance
26    Organization after the merger, consolidation, or other

 

 

SB3819 Enrolled- 9 -LRB102 23224 BMS 34475 b

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

 

 

SB3819 Enrolled- 10 -LRB102 23224 BMS 34475 b

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

 

 

SB3819 Enrolled- 11 -LRB102 23224 BMS 34475 b

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

 

 

SB3819 Enrolled- 12 -LRB102 23224 BMS 34475 b

1or (2) the Health Maintenance Organization's unprofitable
2experience with respect to the group or enrollment unit and
3the resulting additional premium to be paid by the group or
4enrollment unit.
5    In no event shall the Illinois Health Maintenance
6Organization Guaranty Association be liable to pay any
7contractual obligation of an insolvent organization to pay any
8refund authorized under this Section.
9    (g) Rulemaking authority to implement Public Act 95-1045,
10if any, is conditioned on the rules being adopted in
11accordance with all provisions of the Illinois Administrative
12Procedure Act and all rules and procedures of the Joint
13Committee on Administrative Rules; any purported rule not so
14adopted, for whatever reason, is unauthorized.
15(Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19;
16101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-393, eff.
171-1-20; 101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625,
18eff. 1-1-21; 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
19102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
201-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
21eff. 10-8-21; revised 10-27-21.)
 
22    Section 35. The Limited Health Service Organization Act is
23amended by changing Section 4003 as follows:
 
24    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)

 

 

SB3819 Enrolled- 13 -LRB102 23224 BMS 34475 b

1    Sec. 4003. Illinois Insurance Code provisions. Limited
2health service organizations shall be subject to the
3provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
4141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
5154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 355.2, 355.3,
6355b, 356q, 356v, 356z.10, 356z.21, 356z.22, 356z.25, 356z.26,
7356z.29, 356z.30a, 356z.32, 356z.33, 356z.41, 356z.46,
8356z.47, 356z.51, 356z.53, 356z.43, 368a, 401, 401.1, 402,
9403, 403A, 408, 408.2, 409, 412, 444, and 444.1 and Articles
10IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and XXVI of
11the Illinois Insurance Code. For purposes of the Illinois
12Insurance Code, except for Sections 444 and 444.1 and Articles
13XIII and XIII 1/2, limited health service organizations in the
14following categories are deemed to be domestic companies:
15        (1) a corporation under the laws of this State; or
16        (2) a corporation organized under the laws of another
17    state, 30% or more of the enrollees of which are residents
18    of this State, except a corporation subject to
19    substantially the same requirements in its state of
20    organization as is a domestic company under Article VIII
21    1/2 of the Illinois Insurance Code.
22(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
23101-393, eff. 1-1-20; 101-625, eff. 1-1-21; 102-30, eff.
241-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642,
25eff. 1-1-22; revised 10-27-21.)
 

 

 

SB3819 Enrolled- 14 -LRB102 23224 BMS 34475 b

1    Section 40. The Voluntary Health Services Plans Act is
2amended by changing Section 10 as follows:
 
3    (215 ILCS 165/10)  (from Ch. 32, par. 604)
4    Sec. 10. Application of Insurance Code provisions. Health
5services plan corporations and all persons interested therein
6or dealing therewith shall be subject to the provisions of
7Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
8143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
9356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356v, 356w,
10356x, 356y, 356z.1, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6,
11356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14,
12356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26,
13356z.29, 356z.30, 356z.30a, 356z.32, 356z.33, 356z.40,
14356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.43, 364.01,
15367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412,
16and paragraphs (7) and (15) of Section 367 of the Illinois
17Insurance Code.
18    Rulemaking authority to implement Public Act 95-1045, if
19any, is conditioned on the rules being adopted in accordance
20with all provisions of the Illinois Administrative Procedure
21Act and all rules and procedures of the Joint Committee on
22Administrative Rules; any purported rule not so adopted, for
23whatever reason, is unauthorized.
24(Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19;
25101-281, eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff.

 

 

SB3819 Enrolled- 15 -LRB102 23224 BMS 34475 b

11-1-21; 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; 102-306,
2eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21;
3revised 10-27-21.)