Illinois General Assembly - Full Text of SB0499
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Full Text of SB0499  102nd General Assembly

SB0499enr 102ND GENERAL ASSEMBLY

  
  
  

 


 
SB0499 EnrolledLRB102 16313 BMS 21699 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, and 356z.41 of the Illinois Insurance Code. The
18program of health benefits must comply with Sections 155.22a,
19155.37, 355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of
20the Illinois Insurance Code. The Department of Insurance shall
21enforce the requirements of this Section with respect to
22Sections 370c and 370c.1 of the Illinois Insurance Code; all
23other requirements of this Section shall be enforced by the

 

 

SB0499 Enrolled- 2 -LRB102 16313 BMS 21699 b

1Department 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, 356q, 356u, 356w, 356x,
24356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,

 

 

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1356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
2356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41 of the
3Illinois 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:
 

 

 

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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, 356q, 356u, 356w, 356x, 356z.6, 356z.8,
10356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
11356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32,
12356z.33, 356z.36, and 356z.41 of the Illinois Insurance Code.
13The 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

 

 

SB0499 Enrolled- 5 -LRB102 16313 BMS 21699 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,
16356q, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11,
17356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26,
18356z.29, 356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41 of
19the Illinois Insurance Code. Insurance policies shall comply
20with Section 356z.19 of the Illinois Insurance Code. The
21coverage shall comply with Sections 155.22a, 355b, and 370c of
22the Illinois Insurance Code. The Department of Insurance shall
23enforce the requirements of this Section.
24    Rulemaking authority to implement Public Act 95-1045, if

 

 

SB0499 Enrolled- 6 -LRB102 16313 BMS 21699 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 Health Maintenance Organization Act is
12amended by changing Section 5-3 as follows:
 
13    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
14    Sec. 5-3. Insurance Code provisions.
15    (a) Health Maintenance Organizations shall be subject to
16the provisions of Sections 133, 134, 136, 137, 139, 140,
17141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
18154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2,
19355.3, 355b, 356g.5-1, 356m, 356q, 356v, 356w, 356x, 356y,
20356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9,
21356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17,
22356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29,
23356z.30, 356z.30a, 356z.32, 356z.33, 356z.35, 356z.36,
24356z.41, 364, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c,

 

 

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1368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A, 408,
2408.2, 409, 412, 444, and 444.1, paragraph (c) of subsection
3(2) of Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2,
4XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the Illinois
5Insurance 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

 

 

SB0499 Enrolled- 8 -LRB102 16313 BMS 21699 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.

 

 

SB0499 Enrolled- 9 -LRB102 16313 BMS 21699 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

 

 

SB0499 Enrolled- 10 -LRB102 16313 BMS 21699 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

 

 

SB0499 Enrolled- 11 -LRB102 16313 BMS 21699 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. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
16100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff.
171-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81,
18eff. 7-12-19; 101-281, eff. 1-1-20; 101-371, eff. 1-1-20;
19101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
201-1-20; 101-625, eff. 1-1-21.)
 
21    Section 30. The Limited Health Service Organization Act is
22amended by changing Section 4003 as follows:
 
23    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
24    Sec. 4003. Illinois Insurance Code provisions. Limited

 

 

SB0499 Enrolled- 12 -LRB102 16313 BMS 21699 b

1health service organizations shall be subject to the
2provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
3141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
4154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 355.2, 355.3,
5355b, 356q, 356v, 356z.10, 356z.21, 356z.22, 356z.25, 356z.26,
6356z.29, 356z.30a, 356z.32, 356z.33, 356z.41, 368a, 401,
7401.1, 402, 403, 403A, 408, 408.2, 409, 412, 444, and 444.1 and
8Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and
9XXVI of the Illinois Insurance Code. For purposes of the
10Illinois Insurance Code, except for Sections 444 and 444.1 and
11Articles XIII and XIII 1/2, limited health service
12organizations in the following categories are deemed to be
13domestic 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% or 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. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
22100-201, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1057, eff.
231-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
24eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff. 1-1-21.)
 
25    Section 35. The Voluntary Health Services Plans Act is

 

 

SB0499 Enrolled- 13 -LRB102 16313 BMS 21699 b

1amended by changing Section 10 as follows:
 
2    (215 ILCS 165/10)  (from Ch. 32, par. 604)
3    Sec. 10. Application of Insurance Code provisions. Health
4services plan corporations and all persons interested therein
5or dealing therewith shall be subject to the provisions of
6Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
7143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
8356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356v, 356w,
9356x, 356y, 356z.1, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6,
10356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14,
11356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26,
12356z.29, 356z.30, 356z.30a, 356z.32, 356z.33, 356z.41, 364.01,
13367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412,
14and paragraphs (7) and (15) of Section 367 of the Illinois
15Insurance Code.
16    Rulemaking authority to implement Public Act 95-1045, if
17any, is conditioned on the rules being adopted in accordance
18with all provisions of the Illinois Administrative Procedure
19Act and all rules and procedures of the Joint Committee on
20Administrative Rules; any purported rule not so adopted, for
21whatever reason, is unauthorized.
22(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
23100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff.
241-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81,
25eff. 7-12-19; 101-281, eff. 1-1-20; 101-393, eff. 1-1-20;

 

 

SB0499 Enrolled- 14 -LRB102 16313 BMS 21699 b

1101-625, eff. 1-1-21.)
 
2    Section 40. The Illinois Public Aid Code is amended by
3changing Section 5-16.8 as follows:
 
4    (305 ILCS 5/5-16.8)
5    Sec. 5-16.8. Required health benefits. The medical
6assistance program shall (i) provide the post-mastectomy care
7benefits required to be covered by a policy of accident and
8health insurance under Section 356t and the coverage required
9under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6,
10356z.26, 356z.29, 356z.32, 356z.33, 356z.34, and 356z.35 of
11the Illinois Insurance Code and (ii) be subject to the
12provisions of Sections 356z.19, 364.01, 370c, and 370c.1 of
13the Illinois Insurance Code.
14    The Department, by rule, shall adopt a model similar to
15the requirements of Section 356z.39 of the Illinois Insurance
16Code.
17    On and after July 1, 2012, the Department shall reduce any
18rate of reimbursement for services or other payments or alter
19any methodologies authorized by this Code to reduce any rate
20of reimbursement for services or other payments in accordance
21with Section 5-5e.
22    To ensure full access to the benefits set forth in this
23Section, on and after January 1, 2016, the Department shall
24ensure that provider and hospital reimbursement for

 

 

SB0499 Enrolled- 15 -LRB102 16313 BMS 21699 b

1post-mastectomy care benefits required under this Section are
2no lower than the Medicare reimbursement rate.
3(Source: P.A. 100-138, eff. 8-18-17; 100-863, eff. 8-14-18;
4100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff.
57-12-19; 101-218, eff. 1-1-20; 101-281, eff. 1-1-20; 101-371,
6eff. 1-1-20; 101-574, eff. 1-1-20; 101-649, eff. 7-7-20.)