Full Text of HB2286 95th General Assembly
HB2286ham002 95TH GENERAL ASSEMBLY
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Rep. Mary E. Flowers
Filed: 5/21/2008
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| AMENDMENT TO HOUSE BILL 2286
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| AMENDMENT NO. ______. Amend House Bill 2286 by replacing | 3 |
| everything after the enacting clause with the following:
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| "Section 5. The State Employees Group Insurance Act of 1971 | 5 |
| is amended by changing Section 6.11 as follows:
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| (5 ILCS 375/6.11)
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| Sec. 6.11. Required health benefits; Illinois Insurance | 8 |
| Code
requirements. The program of health
benefits shall provide | 9 |
| the post-mastectomy care benefits required to be covered
by a | 10 |
| policy of accident and health insurance under Section 356t of | 11 |
| the Illinois
Insurance Code. The program of health benefits | 12 |
| shall provide the coverage
required under Sections 356f.1, | 13 |
| 356g.5,
356u, 356w, 356x, 356z.2, 356z.4, 356z.6, and 356z.9, | 14 |
| and 356z.10
356z.9 of the
Illinois Insurance Code.
The program | 15 |
| of health benefits must comply with Section 155.37 of the
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| Illinois Insurance Code.
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| (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; | 2 |
| 95-520, eff. 8-28-07; revised 12-4-07.)
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| Section 10. The Counties Code is amended by changing | 4 |
| Section 5-1069.3 as follows: | 5 |
| (55 ILCS 5/5-1069.3)
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| Sec. 5-1069.3. Required health benefits. If a county, | 7 |
| including a home
rule
county, is a self-insurer for purposes of | 8 |
| providing health insurance coverage
for its employees, the | 9 |
| coverage shall include coverage for the post-mastectomy
care | 10 |
| benefits required to be covered by a policy of accident and | 11 |
| health
insurance under Section 356t and the coverage required | 12 |
| under Sections 356f.1, 356g.5, 356u,
356w, 356x, 356z.6, and | 13 |
| 356z.9, and 356z.10
356z.9 of
the Illinois Insurance Code. The | 14 |
| requirement that health benefits be covered
as provided in this | 15 |
| Section is an
exclusive power and function of the State and is | 16 |
| a denial and limitation under
Article VII, Section 6, | 17 |
| subsection (h) of the Illinois Constitution. A home
rule county | 18 |
| to which this Section applies must comply with every provision | 19 |
| of
this Section.
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| (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; | 21 |
| 95-520, eff. 8-28-07; revised 12-4-07.)
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| Section 15. The Illinois Municipal Code is amended by | 23 |
| changing Section 10-4-2.3 as follows: |
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| (65 ILCS 5/10-4-2.3)
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| Sec. 10-4-2.3. Required health benefits. If a | 3 |
| municipality, including a
home rule municipality, is a | 4 |
| self-insurer for purposes of providing health
insurance | 5 |
| coverage for its employees, the coverage shall include coverage | 6 |
| for
the post-mastectomy care benefits required to be covered by | 7 |
| a policy of
accident and health insurance under Section 356t | 8 |
| and the coverage required
under Sections 356f.1, 356g.5, 356u, | 9 |
| 356w, 356x, 356z.6, and 356z.9, and 356z.10
356z.9 of the | 10 |
| Illinois
Insurance
Code. The requirement that health
benefits | 11 |
| be covered as provided in this is an exclusive power and | 12 |
| function of
the State and is a denial and limitation under | 13 |
| Article VII, Section 6,
subsection (h) of the Illinois | 14 |
| Constitution. A home rule municipality to which
this Section | 15 |
| applies must comply with every provision of this Section.
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| (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; | 17 |
| 95-520, eff. 8-28-07; revised 12-4-07.)
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| Section 20. The School Code is amended by changing Section | 19 |
| 10-22.3f as follows: | 20 |
| (105 ILCS 5/10-22.3f)
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| Sec. 10-22.3f. Required health benefits. Insurance | 22 |
| protection and
benefits
for employees shall provide the | 23 |
| post-mastectomy care benefits required to be
covered by a |
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| policy of accident and health insurance under Section 356t and | 2 |
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coverage required under Sections 356f.1, 356g.5, 356u, | 3 |
| 356w, 356x,
356z.6, and 356z.9 of
the
Illinois Insurance Code.
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| (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; | 5 |
| revised 12-4-07.)
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| Section 25. The Illinois Insurance Code is amended by | 7 |
| adding Section 356f.1 as follows: | 8 |
| (215 ILCS 5/356f.1 new) | 9 |
| Sec. 356f.1. Third-party review. | 10 |
| (a) Definitions. For purposes of this Section, the | 11 |
| following definitions shall apply: | 12 |
| "Authorized representative" means: | 13 |
| (1) a person to whom a covered person has given express | 14 |
| written consent to represent the covered person in a | 15 |
| third-party review; | 16 |
| (2) a person authorized by law to provide substituted | 17 |
| consent for a covered person; or | 18 |
| (3) a family member of the covered person or the | 19 |
| covered person's treating health care professional only | 20 |
| when the covered person is unable to provide consent. | 21 |
| "Director" means the Director of the Division of Insurance | 22 |
| of the Department of Financial and Professional Regulation. | 23 |
| "Covered person" means an individual whose coverage under | 24 |
| an individual health insurance plan has been rescinded. |
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| "Division" means the Division of Insurance of the | 2 |
| Department of Financial and Professional Regulation. | 3 |
| "Disclose" means to release, transfer, or otherwise | 4 |
| divulge protected health information to any person other than | 5 |
| the individual who is the subject of the protected health | 6 |
| information. | 7 |
| "Health insurance plan" means a policy, contract, | 8 |
| certificate, or agreement issued by a
health carrier to | 9 |
| provide, deliver, arrange for, pay, or reimburse any of the | 10 |
| costs of health
care services. For the purposes of this | 11 |
| definition, "health insurance plan" does not include one or | 12 |
| more, or any combination of, the following: coverage only for | 13 |
| accident or disability income insurance; coverage issued as
a | 14 |
| supplement to liability insurance; liability insurance, | 15 |
| including general liability
insurance and automobile liability | 16 |
| insurance; workers' compensation or similar
insurance; | 17 |
| automobile medical payment insurance; credit-only insurance; | 18 |
| coverage for
on-site medical clinics; coverage similar to the | 19 |
| foregoing as specified in federal
regulations issued pursuant | 20 |
| to Public Law 104-191, under which benefits for medical
care | 21 |
| are secondary or incidental to other insurance benefits; dental | 22 |
| or vision benefits;
benefits for long-term care, nursing home | 23 |
| care, home health care, or community-based
care; specified | 24 |
| disease or illness coverage, hospital indemnity or other fixed | 25 |
| indemnity
insurance, or such other similar, limited benefits as | 26 |
| are specified in rules; Medicare
supplemental health insurance |
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| as defined under Section 1882(g)(1) of the Social Security
Act; | 2 |
| coverage supplemental to the coverage provided under Chapter 55 | 3 |
| of Title 10 of the
United States Code; or other similar limited | 4 |
| benefit supplemental coverages. | 5 |
| "Health care professional" means a physician or other | 6 |
| health care practitioner licensed,
accredited, or certified in | 7 |
| any state to perform specified health care services. | 8 |
| "Health care services" means services for the diagnosis, | 9 |
| prevention, treatment, or cure of a health condition, illness, | 10 |
| injury, or disease. | 11 |
| "Health carrier" means an entity subject to the insurance | 12 |
| laws and rules of this State or subject to the jurisdiction of | 13 |
| the Division that issues individual health insurance plans | 14 |
| covering one or more residents of this State, including a | 15 |
| sickness and accident insurance
company, a health maintenance | 16 |
| organization, a nonprofit hospital and health corporation, or | 17 |
| any other entity providing or issuing an individual health | 18 |
| insurance plan. | 19 |
| "Health maintenance organization" means an organization | 20 |
| licensed under the Health Maintenance Organization Act. | 21 |
| "Medicare" means coverage under both Parts A and B of Title | 22 |
| XVIII of the Social Security Act. | 23 |
| "Person" means an individual, a corporation, a | 24 |
| partnership, an association, a joint venture, a joint stock | 25 |
| company, a trust, an unincorporated organization, any similar | 26 |
| entity, or any combination of the foregoing. |
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| "Protected health information" means health information | 2 |
| that identifies an individual who is the subject of the | 3 |
| information or with respect to which there is a reasonable | 4 |
| basis to believe that the information could be used to identify | 5 |
| the individual. | 6 |
| "Rescission" means the process of voiding an individual | 7 |
| health insurance plan, from its
inception, on the grounds of | 8 |
| material misrepresentation or omission on the application for
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| insurance that would have resulted in a different decision by | 10 |
| the health carrier with respect to
issuing coverage. | 11 |
| "Review criteria" means the written screening procedures, | 12 |
| decision abstracts, clinical protocols, the health carrier's | 13 |
| underwriting manual, and practice guidelines used by a health | 14 |
| carrier in making its rescission determination. | 15 |
| "Third-party review organization" means an entity that | 16 |
| conducts independent third-party reviews of rescission | 17 |
| decisions made by health carriers that are based on medical | 18 |
| issues for health insurance plan coverage. | 19 |
| (b) Purpose, applicability, and scope. The purpose of this | 20 |
| Section is to provide uniform standards for the establishment | 21 |
| and maintenance of third-party review procedures to ensure that | 22 |
| covered persons have the opportunity for an independent review | 23 |
| of medical issues related to health carrier rescission | 24 |
| decisions. This Section shall apply to rescission decisions | 25 |
| made by health carriers that are based on medical issues for | 26 |
| health insurance plan coverage. This Section does not extend to |
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| allegations related to agent conduct or decisions not based on | 2 |
| medical issues, such as residency and marital status. | 3 |
| (c) Notice of right to third-party review. A health carrier | 4 |
| shall notify the covered person in writing of the covered | 5 |
| person's right to request a third-party review to be conducted | 6 |
| pursuant to subsection (f) of this Section and include the | 7 |
| appropriate statements and information set forth in this | 8 |
| subsection (c) at the same time the health carrier sends | 9 |
| written notice of the rescission of the individual health | 10 |
| insurance plan. As part of the written notice required under | 11 |
| this subsection (c), a health carrier shall include the | 12 |
| following, or substantially equivalent, language: | 13 |
| "We have rescinded your coverage with us based on a | 14 |
| material
misrepresentation contained in your application. | 15 |
| After you have followed the
procedures for our internal | 16 |
| grievance process for this rescission decision (if
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| applicable), you may have the right to have our decision | 18 |
| reviewed by health care and
legal professionals who have no | 19 |
| association with us if our decision was based on a
medical | 20 |
| issue by submitting a request for third-party review to the | 21 |
| Director at
the following address: (insert address where | 22 |
| covered persons are to submit requests
for third-party | 23 |
| review)." | 24 |
| The health carrier shall include the following information | 25 |
| in or attached to the notice required under this subsection | 26 |
| (c): |
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| (1) a description of the standard and expedited | 2 |
| third-party review procedures required under this Section, | 3 |
| highlighting the provisions that give the covered person or | 4 |
| the covered person's authorized representative the right | 5 |
| to file a request for an expedited third-party review if | 6 |
| the covered person has a medical condition where the | 7 |
| timeframe for completion of an expedited review of the | 8 |
| grievance or a standard third-party review under this | 9 |
| Section would seriously jeopardize the life or health of | 10 |
| the covered person or would jeopardize the covered person's | 11 |
| ability to regain maximum function; and | 12 |
| (2) an authorization form or other document approved by | 13 |
| the Director that complies with the requirements of 45 | 14 |
| C.F.R. 164.508 by which the covered person, for purposes of | 15 |
| conducting a third-party review under this Section, | 16 |
| authorizes the health carrier and the covered person's | 17 |
| treating provider to disclose protected health | 18 |
| information, including medical records, concerning the | 19 |
| covered person that are pertinent to the third-party | 20 |
| review, as provided under State medical record privacy laws | 21 |
| and Article XL of this Code. | 22 |
| (d) Third-party review requests. All requests for | 23 |
| third-party review shall be made in writing to the Director. | 24 |
| An expedited third-party review process shall be made | 25 |
| available for the
review of health carrier rescission | 26 |
| decisions. For expedited third-party review of a rescission |
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| decision, a covered person or the covered person's authorized | 2 |
| representative may file a written request for an expedited | 3 |
| third-party review with the Director after the exhaustion of | 4 |
| the health carrier's internal grievance process in accordance | 5 |
| with the requirements of
subsection (e) of this Section or | 6 |
| after the receipt of the written notice of the right to | 7 |
| third-party review pursuant to subsection (c) of this Section, | 8 |
| whichever is later. | 9 |
| (e) Exhaustion of internal grievance process. A | 10 |
| third-party review cannot commence until the covered person has | 11 |
| exhausted the health carrier's internal grievance process in | 12 |
| accordance with the requirements of this subsection (e). | 13 |
| For rescission decisions, a covered person shall be | 14 |
| considered to have exhausted the health
carrier's internal | 15 |
| grievance process for purposes of this Section if: | 16 |
| (1) the health carrier has an internal grievance | 17 |
| process for rescission decisions and the covered
person or | 18 |
| the covered person's authorized representative has | 19 |
| complied with all of the
steps required in the health | 20 |
| carrier's internal grievance process that is established
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| pursuant to this Section and, except to the extent
the | 22 |
| covered person or the covered person's authorized | 23 |
| representative requested or agreed
to a delay, has not | 24 |
| received a written decision on the grievance from the | 25 |
| health carrier
within 30 days after the date the covered | 26 |
| person or the covered person's
authorized representative |
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| filed the grievance with the health carrier or the date the | 2 |
| health
carrier receives any requested information, | 3 |
| whichever is later; | 4 |
| (2) the grievance concerns a rescission decision and | 5 |
| the covered person (i) is subject to procedures, | 6 |
| treatments, or an ongoing course of treatment ordered by a | 7 |
| health care provider, the suspension or termination of | 8 |
| which could significantly increase the risk to the person's | 9 |
| health or (ii) has received a treatment referral for a | 10 |
| service, procedure, or other health care service, the | 11 |
| denial of which could significantly increase the risk to | 12 |
| the person's health, the policy or plan must allow for the | 13 |
| filing of an expedited internal grievance either orally or | 14 |
| in writing; upon submission of the expedited internal | 15 |
| grievance, a policy or plan must notify the party filing | 16 |
| the expedited internal grievance as soon as possible, but | 17 |
| in no event more than 24 hours after the submission of the | 18 |
| expedited internal grievance, of all information that the | 19 |
| plan requires to evaluate the expedited internal | 20 |
| grievance; the policy or plan shall render a decision on | 21 |
| the expedited internal grievance within 24 hours after | 22 |
| receipt of the required information; the policy or plan | 23 |
| shall notify the party filing the expedited internal | 24 |
| grievance and the person, the person's primary care | 25 |
| physician, and any health care provider who recommended the | 26 |
| health care service involved in the expedited internal |
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| grievance of its decision orally followed by a written | 2 |
| notice of the determination; or | 3 |
| (3) the health carrier waives the exhaustion | 4 |
| requirement in writing. | 5 |
| (f) Third-party review process - standard and expedited. | 6 |
| Immediately following receipt of a request for an expedited | 7 |
| third-party review, or within one business day after the date | 8 |
| of receipt of a request for a standard third-party review, the | 9 |
| Director shall do the following: | 10 |
| (1) send a copy of the request to the health carrier; | 11 |
| and | 12 |
| (2) send written notice to the covered person or the | 13 |
| covered person's authorized
representative informing him | 14 |
| or her of the right to submit additional information to the
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| Director that the covered person or the covered person's | 16 |
| authorized
representative would like considered by the | 17 |
| health carrier. These materials must
be submitted to the | 18 |
| Director within 3 business days after receipt of
the | 19 |
| Director's written notice provided under this subsection | 20 |
| (f). | 21 |
| Within one business day after receipt of any information | 22 |
| submitted by the covered
person or the covered person's | 23 |
| authorized representative pursuant to this subsection
(f), the | 24 |
| Director shall forward the information to the health carrier. | 25 |
| Upon receipt of the information, if any, required to be | 26 |
| forwarded pursuant to this subsection (f), the health carrier |
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| may reconsider its determination that is the subject of the | 2 |
| third-party review. Reconsideration by the health carrier of | 3 |
| its determination pursuant to this subsection (f) shall not | 4 |
| delay or terminate the third-party review. The third-party | 5 |
| review may only be terminated if the health carrier decides, | 6 |
| upon completion of its reconsideration, to reverse its
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| determination and provide coverage for the health care service | 8 |
| or reinstate the health insurance plan. Within one business day | 9 |
| after making the decision to reverse its determination
pursuant | 10 |
| to this subsection (f), the health carrier shall notify the | 11 |
| covered person, the covered person's authorized | 12 |
| representative, the assigned third-party review organization, | 13 |
| and the Director in writing of its decision. The assigned | 14 |
| third-party review organization shall terminate the | 15 |
| third-party review upon receipt of the notice from the health | 16 |
| carrier sent pursuant to this subsection (f). | 17 |
| Immediately following receipt of a request for an expedited | 18 |
| third-party review or within 5 business days after the date of | 19 |
| receipt of a standard third-party review request, the Director | 20 |
| shall complete a preliminary review of the request to determine | 21 |
| the following concerning rescission third-party reviews: | 22 |
| (i) the individual's coverage under an individual | 23 |
| health insurance plan has been rescinded; | 24 |
| (ii) the rescission decision made by the health carrier | 25 |
| is based on a medical issue; | 26 |
| (iii) if the health carrier has an internal grievance |
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| process for rescission decisions, the
covered person has | 2 |
| exhausted the health carrier's internal grievance process | 3 |
| as set
forth in this Section, unless the covered
person is | 4 |
| exempt under subsection (e) of this Section; and | 5 |
| (iv) the covered person has provided all the | 6 |
| information and forms required to proceed
with the | 7 |
| third-party review. | 8 |
| The Director shall notify the covered person, the covered | 9 |
| person's authorized
representative, and the health carrier in | 10 |
| writing whether the request is complete and
eligible for | 11 |
| third-party review immediately after completion of the | 12 |
| preliminary review under this subsection (f) for an expedited | 13 |
| third-party review request or within one business day after | 14 |
| completion of the preliminary review under this subsection (f) | 15 |
| for a standard third-party review request. If the request is | 16 |
| not complete, the Director shall include a statement in the | 17 |
| notice required under this subsection (f) informing the covered | 18 |
| person, the covered person's
authorized representative, and | 19 |
| the health carrier in writing and include in the notice what
| 20 |
| information or materials are needed to make the request | 21 |
| complete. If the request is not eligible for third-party | 22 |
| review, the Director shall include a statement in the notice | 23 |
| required under this subsection (f) informing the covered | 24 |
| person, the covered person's authorized representative, and | 25 |
| the health carrier in writing and include in the notice the | 26 |
| reasons for its ineligibility. If the request is complete and |
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| eligible for third-party review, the Director shall
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| immediately randomly assign a third-party review organization | 3 |
| from the list of approved
third-party review organizations | 4 |
| compiled and maintained pursuant to subsection (j) of this | 5 |
| Section to conduct the third-party review and shall notify the | 6 |
| third-party review organization and the health carrier of the | 7 |
| assignment. | 8 |
| The health carrier shall provide to the assigned | 9 |
| third-party review organization the
documents and any | 10 |
| information considered in making its determination within one | 11 |
| business day after the date of receipt of the notice provided | 12 |
| pursuant to this subsection (f) for expedited third-party | 13 |
| review or within 5 business days after the date of receipt of | 14 |
| the notice provided
pursuant to this subsection (f) for | 15 |
| standard third-party reviews. Failure by the health carrier to | 16 |
| provide the documents and information within the time specified | 17 |
| in this subsection (f) shall not delay the conduct of the | 18 |
| third-party review. If the health carrier fails to provide the | 19 |
| documents and information within the time specified in this | 20 |
| subsection (f), the assigned third-party review organization | 21 |
| may terminate the third-party review and make a decision to | 22 |
| reverse the health carrier's determination. Within one | 23 |
| business day after making the decision under this subsection | 24 |
| (f), the third-party review organization shall notify the | 25 |
| covered person,
the covered person's authorized | 26 |
| representative, if applicable, the health carrier,
and the |
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| Director. | 2 |
| (g) Third-party review process - health care review panel. | 3 |
| The assigned third-party review organization shall select a | 4 |
| panel of health care professional reviewers and legal reviewers | 5 |
| to conduct the third-party review in accordance with subsection | 6 |
| (f) of this Section immediately after being assigned by the | 7 |
| Director to conduct an expedited
third-party review or within | 8 |
| one business day after being assigned by the Director to | 9 |
| conduct
a standard third-party review. | 10 |
| For third-party reviews of rescission decisions, the panel | 11 |
| shall consist of one health care professional reviewer and 2 | 12 |
| legal reviewers and must include individuals with expertise and | 13 |
| knowledge of the individual health insurance market, including | 14 |
| the underwriting process. In selecting the third-party review | 15 |
| panel, the assigned third-party review
organization shall | 16 |
| select physicians, health care professionals, and attorneys | 17 |
| who
meet the minimum qualifications described in subsections | 18 |
| (k) and (l) of this Section. Neither the covered person, the | 19 |
| covered person's authorized representative, the health | 20 |
| carrier, nor the Director shall choose or control the choice of | 21 |
| the physicians, health care professionals, or attorneys | 22 |
| selected to conduct the third-party review. | 23 |
| The third-party review panel shall provide an opinion to | 24 |
| the assigned third-party review
organization on whether the | 25 |
| medical condition should be covered or whether the health
| 26 |
| insurance plan should be reinstated as expeditiously as the |
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| covered person's medical condition or circumstances require, | 2 |
| but in no event more than 2 business days after being selected | 3 |
| to conduct the expedited third-party review or within 20 days | 4 |
| after being selected to conduct the standard third-party | 5 |
| review. | 6 |
| Each third-party review panel opinion shall be in writing | 7 |
| and include the following information: | 8 |
| (1) a description of the covered person's medical | 9 |
| condition; | 10 |
| (2) a description of the relevant information from the | 11 |
| individual's application; | 12 |
| (3) a description and analysis of any medical or | 13 |
| scientific evidence considered in
reaching the opinion; | 14 |
| (4) a description and analysis of any applicable legal | 15 |
| standard or requirement; | 16 |
| (5) an identification of the applicable terms of the | 17 |
| health insurance plan; and | 18 |
| (6) an explanation of the panel's rationale for the | 19 |
| opinion. | 20 |
| In rendering its decision, neither the third-party review | 21 |
| panel nor the third-party review
organization is bound by any | 22 |
| decisions or conclusions reached during the health carrier's
| 23 |
| initial determination or the health carrier's internal | 24 |
| grievance process, if applicable, as set
forth in this Section; | 25 |
| however, the third-party review panel and the third-party | 26 |
| review organization must use the health carrier's underwriting |
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| 1 |
| guidelines that were in effect at the time the person was first | 2 |
| issued the health insurance plan. | 3 |
| The assigned third-party review organization shall make a | 4 |
| decision and provide written
notice of the decision, in | 5 |
| accordance with this subsection (g), to the covered person, the | 6 |
| covered person's authorized representative, the health | 7 |
| carrier, and the Director immediately upon receipt of the | 8 |
| third-party review panel opinion, but in no event
more than 3 | 9 |
| business days after being selected to conduct the expedited | 10 |
| third-party review or within 20 days after receipt of the | 11 |
| third-party review panel opinion, but in no event more than 45 | 12 |
| days after being selected to conduct the standard third-party | 13 |
| review. | 14 |
| The third-party review organization shall include the | 15 |
| following information in the notice
sent pursuant to this | 16 |
| subsection (g): | 17 |
| (i) a general description of the reason for the request | 18 |
| for third-party review; | 19 |
| (ii) the date the third-party review organization | 20 |
| received the assignment to conduct
the third-party review; | 21 |
| (iii) the written opinion of the third-party review | 22 |
| panel, including the recommendation
of the panel as to | 23 |
| whether the medical condition should be covered or the | 24 |
| health
insurance plan reinstated; | 25 |
| (iv) the date the third-party review was conducted, if | 26 |
| appropriate; |
|
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| (v) the date of its decision; | 2 |
| (vi) the principal reason or reasons for its decision; | 3 |
| (vii) the rationale for its decision; and | 4 |
| (viii) references to the evidence or documentation | 5 |
| considered in reaching its decision,
including the | 6 |
| relevant portions of the covered person's application, the | 7 |
| terms of
the health insurance plan, any medical and | 8 |
| scientific evidence, and the applicable
legal | 9 |
| requirements. | 10 |
| Upon receipt of a notice of the third-party review | 11 |
| organization's decision pursuant to this subsection (g) that | 12 |
| reverses the health carrier's determination, the health | 13 |
| carrier immediately shall reinstate the health insurance plan | 14 |
| that was the subject of the third-party review. | 15 |
| (h) Binding nature of third-party review decision. A | 16 |
| third-party review decision is binding on the health carrier | 17 |
| except to the extent the health carrier has other remedies | 18 |
| available under applicable federal or State law. | 19 |
| A covered person or the covered person's authorized | 20 |
| representative may not file a subsequent request for | 21 |
| third-party review involving the same medical condition that | 22 |
| was the subject of the rescission decision or health carrier | 23 |
| determination for which the covered person has already received | 24 |
| a third-party review decision pursuant to this Section. | 25 |
| (i) Exhaustion of third-party review process. A covered | 26 |
| person or the covered person's authorized representative may |
|
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| 1 |
| not pursue litigation of a health carrier's decisions based on | 2 |
| medical issues involved in a denial of a claim based on the | 3 |
| determination to rescind a policy until the covered person has | 4 |
| exhausted the third-party review process as set forth in this | 5 |
| Section. | 6 |
| (j) Approval of third-party review organizations. The | 7 |
| Director shall approve third-party review organizations | 8 |
| eligible to be assigned to conduct third-party reviews under | 9 |
| this Section. In order to be eligible for approval by the | 10 |
| Director under this Section to conduct third-party reviews | 11 |
| under this Section, a third-party review organization shall | 12 |
| submit an application for approval pursuant to this subsection | 13 |
| (j). The Director shall develop an application form for | 14 |
| initially approving and for re-approving third-party review | 15 |
| organizations to conduct third-party reviews. | 16 |
| Any third-party review organization wishing to be approved | 17 |
| to conduct third-party
reviews under this Section shall submit | 18 |
| the application form and include with the form all
| 19 |
| documentation and information necessary for the Director to | 20 |
| determine if the third-party review organization satisfies the | 21 |
| minimum qualifications established under subsections (k) and | 22 |
| (l) of this Section. The Director may charge an application fee | 23 |
| that third-party review organizations
shall submit to the | 24 |
| Director with an application for approval or re-approval. A | 25 |
| third-party review organization shall be deemed approved 90 | 26 |
| days after the date of receipt of a complete application |
|
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| submitted under this subsection (j), unless the Director | 2 |
| disapproves the application within that period or the Director | 3 |
| extends the timeframe for an additional 90 days. If the | 4 |
| Director extends the timeframe for an additional 90 days, the | 5 |
| third-party review organization shall be deemed approved at the | 6 |
| end of that additional period, unless the Director disapproves
| 7 |
| the application within the extended 90-day period. | 8 |
| An approval is effective for 2 years, unless the Director | 9 |
| determines before its expiration that the third-party review | 10 |
| organization is not satisfying the minimum qualifications | 11 |
| established under subsections (k) and (l) of this Section. | 12 |
| Whenever the Director determines that a third-party review | 13 |
| organization no longer satisfies the minimum requirements | 14 |
| established under subsections (k) and (l) of this Section, the | 15 |
| Director shall terminate the approval of the third-party review | 16 |
| organization and remove the third-party review organization | 17 |
| from the list of third-party review organizations approved to | 18 |
| conduct third-party reviews under this Section that is | 19 |
| maintained by the Director. The Director shall maintain and | 20 |
| periodically update a list of approved third-party review | 21 |
| organizations. | 22 |
| (k) Minimum qualifications for third-party review | 23 |
| organizations' written policies and procedures. To be approved | 24 |
| under subsection (j) of this Section to conduct third-party | 25 |
| reviews, a third-party review organization shall have and | 26 |
| maintain written policies and procedures that govern all |
|
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| aspects of both the standard third-party review process and the | 2 |
| expedited third-party review process set forth in this Section, | 3 |
| which include, at a minimum, the following: | 4 |
| (1) a quality assurance mechanism in place that | 5 |
| ensures: | 6 |
| (A) that third-party reviews are conducted within | 7 |
| the specified time frames and required notices are | 8 |
| provided in a timely manner; | 9 |
| (B) the selection of qualified and impartial | 10 |
| health care professional reviewers and legal reviewers | 11 |
| with expertise and knowledge about the individual | 12 |
| health insurance market, including the underwriting | 13 |
| process, to conduct each third-party review on behalf | 14 |
| of the third-party review organization, suitable | 15 |
| matching of reviewers to specific cases, and that the | 16 |
| third-party review organization employs or contracts | 17 |
| with an adequate number of health care professional | 18 |
| reviewers and legal reviewers to meet this objective; | 19 |
| (C) the confidentiality of medical and treatment | 20 |
| records and review criteria; and | 21 |
| (D) that any person employed by or under contract | 22 |
| with the third-party review organization adheres to | 23 |
| the requirements of this Section; | 24 |
| (2) a toll-free telephone service to receive | 25 |
| information on a 24-hour-a-day, 7-day-a-week basis related | 26 |
| to third-party reviews that is capable of accepting, |
|
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| recording, or providing appropriate instruction to | 2 |
| incoming telephone callers during other than normal | 3 |
| business hours; and | 4 |
| (3) agreement to maintain and provide to the Director | 5 |
| the information set out in subsection (n) of this Section. | 6 |
| (l) Minimum qualifications for third-party review | 7 |
| organizations. All legal reviewers assigned by a third-party | 8 |
| review organization to conduct third-party reviews shall be | 9 |
| licensed attorneys who meet the following minimum | 10 |
| qualifications: | 11 |
| (1) possess demonstrated expertise in contract and | 12 |
| insurance law with knowledge of the
individual health | 13 |
| insurance market, including the underwriting process; | 14 |
| (2) hold a non-restricted license to practice law in | 15 |
| any state or the District of
Columbia; and | 16 |
| (3) have no history of disciplinary actions or | 17 |
| sanctions that have been taken or are
pending by any state | 18 |
| bar association, regulatory body, or court of law that | 19 |
| raise a
substantial question as to the legal reviewer's | 20 |
| physical, mental, or professional
competence or moral | 21 |
| character. | 22 |
| All health care professional reviewers assigned by a | 23 |
| third-party review organization to
conduct third-party reviews | 24 |
| shall be physicians or other appropriate health care providers
| 25 |
| who meet the following minimum qualifications: | 26 |
| (A) be knowledgeable about the relevant health care |
|
|
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| service or treatment through
recent or current actual | 2 |
| clinical experience treating patients with the same or
| 3 |
| similar medical condition of the covered person; | 4 |
| (B) hold a non-restricted license in any state or the | 5 |
| District of Columbia and, for
physicians, a current | 6 |
| certification by a recognized American medical specialty
| 7 |
| board in the area or areas appropriate to the subject of | 8 |
| the third-party review; and | 9 |
| (C) have no history of disciplinary actions or | 10 |
| sanctions, including loss of staff
privileges or | 11 |
| participation restrictions, that have been taken or are | 12 |
| pending by any
hospital, governmental agency or unit, or | 13 |
| regulatory body that raise a substantial
question as to the | 14 |
| health care professional reviewer's physical, mental, or
| 15 |
| professional competence or moral character. | 16 |
| In addition to the requirements set forth in subsection (k) | 17 |
| of this Section, the third-party review organization selected | 18 |
| to conduct the third-party review and any health care | 19 |
| professional reviewer or legal reviewer assigned by the | 20 |
| third-party review organization to conduct the third-party | 21 |
| review may not own or control, be a subsidiary of, or in any | 22 |
| way be owned or controlled by or exercise control with a health | 23 |
| carrier; a national, state, or local trade association of | 24 |
| health carriers; or a national, state, or local trade | 25 |
| association of health care
providers. The third-party review | 26 |
| organization shall be unbiased. A third-party review |
|
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| organization shall establish and maintain written procedures | 2 |
| to ensure that it is unbiased in addition to any other | 3 |
| procedures required under this Section. | 4 |
| In addition to the requirements set forth in this | 5 |
| subsection and subsection (k) of this Section, to be approved | 6 |
| pursuant to subsection (j) of this Section to conduct a | 7 |
| third-party review of a specified case, neither the third-party | 8 |
| review organization selected to conduct the third-party review | 9 |
| nor any health care professional reviewer or legal reviewer | 10 |
| assigned by the third-party review organization to conduct the | 11 |
| third-party review may have a material professional, familial, | 12 |
| or financial conflict of interest with any of the following: | 13 |
| (i) the health carrier that is the subject of the | 14 |
| third-party review; | 15 |
| (ii) the covered person whose treatment is the subject | 16 |
| of the third-party review or the
covered person's | 17 |
| authorized representative; | 18 |
| (iii) any officer, director, or management employee of | 19 |
| the health carrier that is the
subject of the third-party | 20 |
| review; | 21 |
| (iv) the health care provider or the health care | 22 |
| provider's medical group or
independent practice | 23 |
| association recommending the health care service or
| 24 |
| treatment that is the subject of the third-party review; | 25 |
| (v) the facility at which the recommended health care | 26 |
| service or treatment would be
provided; or |
|
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|
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| (vi) the developer or manufacturer of the principal | 2 |
| drug, device, procedure, or other
therapy being | 3 |
| recommended for the covered person whose treatment is the | 4 |
| subject
of the third-party review. | 5 |
| In determining whether a material professional, familial, or | 6 |
| financial conflict of interest
exists for purposes of this | 7 |
| subsection (l), the Director shall take into consideration
| 8 |
| situations where the third-party review organization, the | 9 |
| health care professional
reviewer, or legal reviewer may have | 10 |
| an apparent professional, familial, or financial
relationship | 11 |
| or connection with a person described in this subsection (l), | 12 |
| but the
characteristics of that relationship or connection are | 13 |
| such that they do not create a
material professional, familial, | 14 |
| or financial conflict of interest. | 15 |
| (m) Hold harmless for third-party review organizations. No | 16 |
| third-party review organization; health care professional | 17 |
| reviewer or legal reviewer working on behalf of a third-party | 18 |
| review organization; or an employee, agent, or contractor of a | 19 |
| third-party review organization shall be liable in damages to | 20 |
| any person for any opinions rendered or acts or omissions | 21 |
| performed within the scope of the organization's or person's | 22 |
| duties under the law during or upon completion of a third-party | 23 |
| review conducted pursuant to this Section, unless the opinion | 24 |
| was rendered or act or omission performed in bad faith or | 25 |
| involved gross negligence. | 26 |
| (n) Third-party review reporting requirements. A |
|
|
|
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| third-party review organization assigned to conduct a | 2 |
| third-party review shall maintain written records in the | 3 |
| aggregate, by state, and by health carrier on all requests for | 4 |
| which it received a request to conduct a third-party review | 5 |
| during a calendar year. The third-party review organization | 6 |
| shall retain the written records required pursuant to this | 7 |
| subsection (n) for at least 3 years. | 8 |
| Each third-party review organization shall submit to the | 9 |
| Director, upon request, a report in the format specified by the | 10 |
| Director. The report shall include, at a minimum, the following | 11 |
| information in the aggregate, by state, and for each health | 12 |
| carrier: | 13 |
| (1) the total number of assigned third-party review | 14 |
| requests; | 15 |
| (2) the number of third-party review requests resolved | 16 |
| by the third-party review
organization and, of those | 17 |
| resolved, the number resolved upholding the
health | 18 |
| carrier's determination and the number resolved reversing | 19 |
| the health
carrier's determination; | 20 |
| (3) the average length of time for resolution; | 21 |
| (4) a summary of the types of coverages or cases for | 22 |
| which a third-party review
was sought, as provided in the | 23 |
| format required by the Director; | 24 |
| (5) the number of third-party reviews that were | 25 |
| terminated as the result of a
reconsideration by the health | 26 |
| carrier of its determination after the receipt of
|
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| additional information from the covered person or the | 2 |
| covered person's
authorized representative pursuant to | 3 |
| subsection (f) of this Section; and | 4 |
| (6) any other information the Director may request or | 5 |
| require. | 6 |
| Each health carrier shall maintain written records in the | 7 |
| aggregate, by state, and for each
type of health insurance plan | 8 |
| offered by the health carrier for all third-party review | 9 |
| requests received by the health carrier pursuant to subsection | 10 |
| (f) of this Section. The health carrier
shall retain the | 11 |
| written records required pursuant to this subsection (n) for at | 12 |
| least 3 years. Each health carrier shall submit to the | 13 |
| Director, upon request, a report on all third-party review | 14 |
| requests received by the health carrier pursuant to subsection | 15 |
| (f) of this Section in the format specified by the Director. | 16 |
| The Director shall annually collect data on the third-party | 17 |
| reviews conducted in this State and issue a report that | 18 |
| includes the information reported by third-party review | 19 |
| organizations and health carriers under this subsection (n), | 20 |
| along with the total number of written third-party review | 21 |
| requests received by the Director. | 22 |
| (o) Funding of third-party review process. The health | 23 |
| carrier against which a third-party review request is filed | 24 |
| shall pay the reasonable and necessary costs associated with | 25 |
| the review process. The Director shall maintain active | 26 |
| management and oversight of the third-party review process, |
|
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| including, but not limited to, the administrative costs | 2 |
| associated with the process, and the fees associated with the | 3 |
| use of health care professional reviewers and legal reviewers. | 4 |
| The Director shall review and affirmatively endorse detailed | 5 |
| billings from the third-party review organization before the | 6 |
| detailed billings are sent to the health carrier. | 7 |
| (p) Health carrier disclosure requirements. Each health | 8 |
| carrier shall include a description of the third-party review | 9 |
| procedures in or attached to the policy, certificate, | 10 |
| membership booklet, outline of coverage, or other evidence of | 11 |
| coverage it provides to covered persons that includes, at a | 12 |
| minimum, the following information: | 13 |
| (1) a statement that informs the covered person of the | 14 |
| right to file a request for a third-party review of | 15 |
| rescission decisions made by the health carrier are based | 16 |
| on medical issues for health insurance plan coverage. The | 17 |
| statement shall explain that third-party review is only | 18 |
| available when the rescission decisions made by the health | 19 |
| carrier are based on medical issues for health insurance | 20 |
| plan coverage and include the telephone number and address | 21 |
| of the Director where the policy is issued and delivered; | 22 |
| and | 23 |
| (2) a statement that informs the covered person that, | 24 |
| when filing a request for a third-party review, the covered | 25 |
| person will be required to authorize the release of any
| 26 |
| medical records of the covered person that may be required |
|
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| to be reviewed for the
purpose of reaching a decision on | 2 |
| the third-party review. | 3 |
| The disclosure required by this subsection (p) shall be in | 4 |
| a format prescribed by the Director. | 5 |
| (q) Third-party review panel confidentiality. A | 6 |
| third-party review organization shall not disclose the | 7 |
| identity of the health care professional reviewers or legal | 8 |
| reviewers involved in the third-party review process, unless | 9 |
| otherwise directed to divulge this information by a federal or | 10 |
| State court of law. | 11 |
| (r) Notwithstanding any other rulemaking authority that | 12 |
| may exist, neither the Governor nor any agency or agency head | 13 |
| under the jurisdiction of the Governor has any authority to | 14 |
| make or promulgate rules to implement or enforce the provisions | 15 |
| of this amendatory Act of the 95th General Assembly. If, | 16 |
| however, the Governor believes that rules are necessary to | 17 |
| implement or enforce the provisions of this amendatory Act of | 18 |
| the 95th General Assembly, the Governor may suggest rules to | 19 |
| the General Assembly by filing them with the Clerk of the House | 20 |
| and the Secretary of the Senate and by requesting that the | 21 |
| General Assembly authorize such rulemaking by law, enact those | 22 |
| suggested rules into law, or take any other appropriate action | 23 |
| in the General Assembly's discretion. Nothing contained in this | 24 |
| amendatory Act of the 95th General Assembly shall be | 25 |
| interpreted to grant rulemaking authority under any other | 26 |
| Illinois statute where such authority is not otherwise |
|
|
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| explicitly given. For the purposes of this amendatory Act of | 2 |
| the 95th General Assembly, "rules" is given the meaning | 3 |
| contained in Section 1-70 of the Illinois Administrative | 4 |
| Procedure Act, and "agency" and "agency head" are given the | 5 |
| meanings contained in Sections 1-20 and 1-25 of the Illinois | 6 |
| Administrative Procedure Act to the extent that such | 7 |
| definitions apply to agencies or agency heads under the | 8 |
| jurisdiction of the Governor.
| 9 |
| Section 30. The Health Maintenance Organization Act is | 10 |
| amended by changing Section 5-3 as follows:
| 11 |
| (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
| 12 |
| Sec. 5-3. Insurance Code provisions.
| 13 |
| (a) Health Maintenance Organizations
shall be subject to | 14 |
| the provisions of Sections 133, 134, 137, 140, 141.1,
141.2, | 15 |
| 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, 154, 154.5, | 16 |
| 154.6,
154.7, 154.8, 155.04, 355.2, 356f.1, 356m, 356v, 356w, | 17 |
| 356x, 356y,
356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9, | 18 |
| 356z.10
356z.9 , 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c, | 19 |
| 368d, 368e, 370c,
401, 401.1, 402, 403, 403A,
408, 408.2, 409, | 20 |
| 412, 444,
and
444.1,
paragraph (c) of subsection (2) of Section | 21 |
| 367, and Articles IIA, VIII 1/2,
XII,
XII 1/2, XIII, XIII 1/2, | 22 |
| XXV, and XXVI of the Illinois Insurance Code.
| 23 |
| (b) For purposes of the Illinois Insurance Code, except for | 24 |
| Sections 444
and 444.1 and Articles XIII and XIII 1/2, Health |
|
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| Maintenance Organizations in
the following categories are | 2 |
| deemed to be "domestic companies":
| 3 |
| (1) a corporation authorized under the
Dental Service | 4 |
| Plan Act or the Voluntary Health Services Plans Act;
| 5 |
| (2) a corporation organized under the laws of this | 6 |
| State; or
| 7 |
| (3) a corporation organized under the laws of another | 8 |
| state, 30% or more
of the enrollees of which are residents | 9 |
| of this State, except a
corporation subject to | 10 |
| substantially the same requirements in its state of
| 11 |
| organization as is a "domestic company" under Article VIII | 12 |
| 1/2 of the
Illinois Insurance Code.
| 13 |
| (c) In considering the merger, consolidation, or other | 14 |
| acquisition of
control of a Health Maintenance Organization | 15 |
| pursuant to Article VIII 1/2
of the Illinois Insurance Code,
| 16 |
| (1) the Director shall give primary consideration to | 17 |
| the continuation of
benefits to enrollees and the financial | 18 |
| conditions of the acquired Health
Maintenance Organization | 19 |
| after the merger, consolidation, or other
acquisition of | 20 |
| control takes effect;
| 21 |
| (2)(i) the criteria specified in subsection (1)(b) of | 22 |
| Section 131.8 of
the Illinois Insurance Code shall not | 23 |
| apply and (ii) the Director, in making
his determination | 24 |
| with respect to the merger, consolidation, or other
| 25 |
| acquisition of control, need not take into account the | 26 |
| effect on
competition of the merger, consolidation, or |
|
|
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| other acquisition of control;
| 2 |
| (3) the Director shall have the power to require the | 3 |
| following
information:
| 4 |
| (A) certification by an independent actuary of the | 5 |
| adequacy
of the reserves of the Health Maintenance | 6 |
| Organization sought to be acquired;
| 7 |
| (B) pro forma financial statements reflecting the | 8 |
| combined balance
sheets of the acquiring company and | 9 |
| the Health Maintenance Organization sought
to be | 10 |
| acquired as of the end of the preceding year and as of | 11 |
| a date 90 days
prior to the acquisition, as well as pro | 12 |
| forma financial statements
reflecting projected | 13 |
| combined operation for a period of 2 years;
| 14 |
| (C) a pro forma business plan detailing an | 15 |
| acquiring party's plans with
respect to the operation | 16 |
| of the Health Maintenance Organization sought to
be | 17 |
| acquired for a period of not less than 3 years; and
| 18 |
| (D) such other information as the Director shall | 19 |
| require.
| 20 |
| (d) The provisions of Article VIII 1/2 of the Illinois | 21 |
| Insurance Code
and this Section 5-3 shall apply to the sale by | 22 |
| any health maintenance
organization of greater than 10% of its
| 23 |
| enrollee population (including without limitation the health | 24 |
| maintenance
organization's right, title, and interest in and to | 25 |
| its health care
certificates).
| 26 |
| (e) In considering any management contract or service |
|
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| agreement subject
to Section 141.1 of the Illinois Insurance | 2 |
| Code, the Director (i) shall, in
addition to the criteria | 3 |
| specified in Section 141.2 of the Illinois
Insurance Code, take | 4 |
| into account the effect of the management contract or
service | 5 |
| agreement on the continuation of benefits to enrollees and the
| 6 |
| financial condition of the health maintenance organization to | 7 |
| be managed or
serviced, and (ii) need not take into account the | 8 |
| effect of the management
contract or service agreement on | 9 |
| competition.
| 10 |
| (f) Except for small employer groups as defined in the | 11 |
| Small Employer
Rating, Renewability and Portability Health | 12 |
| Insurance Act and except for
medicare supplement policies as | 13 |
| defined in Section 363 of the Illinois
Insurance Code, a Health | 14 |
| Maintenance Organization may by contract agree with a
group or | 15 |
| other enrollment unit to effect refunds or charge additional | 16 |
| premiums
under the following terms and conditions:
| 17 |
| (i) the amount of, and other terms and conditions with | 18 |
| respect to, the
refund or additional premium are set forth | 19 |
| in the group or enrollment unit
contract agreed in advance | 20 |
| of the period for which a refund is to be paid or
| 21 |
| additional premium is to be charged (which period shall not | 22 |
| be less than one
year); and
| 23 |
| (ii) the amount of the refund or additional premium | 24 |
| shall not exceed 20%
of the Health Maintenance | 25 |
| Organization's profitable or unprofitable experience
with | 26 |
| respect to the group or other enrollment unit for the |
|
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09500HB2286ham002 |
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LRB095 01343 RPM 51135 a |
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| period (and, for
purposes of a refund or additional | 2 |
| premium, the profitable or unprofitable
experience shall | 3 |
| be calculated taking into account a pro rata share of the
| 4 |
| Health Maintenance Organization's administrative and | 5 |
| marketing expenses, but
shall not include any refund to be | 6 |
| made or additional premium to be paid
pursuant to this | 7 |
| subsection (f)). The Health Maintenance Organization and | 8 |
| the
group or enrollment unit may agree that the profitable | 9 |
| or unprofitable
experience may be calculated taking into | 10 |
| account the refund period and the
immediately preceding 2 | 11 |
| plan years.
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| The Health Maintenance Organization shall include a | 13 |
| statement in the
evidence of coverage issued to each enrollee | 14 |
| describing the possibility of a
refund or additional premium, | 15 |
| and upon request of any group or enrollment unit,
provide to | 16 |
| the group or enrollment unit a description of the method used | 17 |
| to
calculate (1) the Health Maintenance Organization's | 18 |
| profitable experience with
respect to the group or enrollment | 19 |
| unit and the resulting refund to the group
or enrollment unit | 20 |
| or (2) the Health Maintenance Organization's unprofitable
| 21 |
| experience with respect to the group or enrollment unit and the | 22 |
| resulting
additional premium to be paid by the group or | 23 |
| enrollment unit.
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| In no event shall the Illinois Health Maintenance | 25 |
| Organization
Guaranty Association be liable to pay any | 26 |
| contractual obligation of an
insolvent organization to pay any |
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09500HB2286ham002 |
- 36 - |
LRB095 01343 RPM 51135 a |
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| refund authorized under this Section.
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| (Source: P.A. 94-906, eff. 1-1-07; 94-1076, eff. 12-29-06; | 3 |
| 95-422, eff. 8-24-07; 95-520, eff. 8-28-07; revised 12-4-07.)
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| Section 35. The Limited Health Service Organization Act is | 5 |
| amended by changing Section 4003 as follows:
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| (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
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| Sec. 4003. Illinois Insurance Code provisions. Limited | 8 |
| health service
organizations shall be subject to the provisions | 9 |
| of Sections 133, 134, 137,
140, 141.1, 141.2, 141.3, 143, 143c, | 10 |
| 147, 148, 149, 151, 152, 153, 154, 154.5,
154.6, 154.7, 154.8, | 11 |
| 155.04, 155.37, 355.2, 356f.1, 356v, 356z.10
356z.9 , 368a, 401, | 12 |
| 401.1,
402,
403, 403A, 408,
408.2, 409, 412, 444, and 444.1 and | 13 |
| Articles IIA, VIII 1/2, XII, XII 1/2,
XIII,
XIII 1/2, XXV, and | 14 |
| XXVI of the Illinois Insurance Code. For purposes of the
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| Illinois Insurance Code, except for Sections 444 and 444.1 and | 16 |
| Articles XIII
and XIII 1/2, limited health service | 17 |
| organizations in the following categories
are deemed to be | 18 |
| domestic companies:
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| (1) a corporation under the laws of this State; or
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| (2) a corporation organized under the laws of another | 21 |
| state, 30% of 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 |
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09500HB2286ham002 |
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LRB095 01343 RPM 51135 a |
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| 1/2 of the Illinois Insurance Code.
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| (Source: P.A. 95-520, eff. 8-28-07; revised 12-5-07.)
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| Section 40. The Voluntary Health Services Plans Act is | 4 |
| amended by changing Section 10 as follows:
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| (215 ILCS 165/10) (from Ch. 32, par. 604)
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| Sec. 10. Application of Insurance Code provisions. Health | 7 |
| services
plan corporations and all persons interested therein | 8 |
| or dealing therewith
shall be subject to the provisions of | 9 |
| Articles IIA and XII 1/2 and Sections
3.1, 133, 140, 143, 143c, | 10 |
| 149, 155.37, 354, 355.2, 356f.1, 356g.5, 356r, 356t, 356u, | 11 |
| 356v,
356w, 356x, 356y, 356z.1, 356z.2, 356z.4, 356z.5, 356z.6, | 12 |
| 356z.8, 356z.9,
356z.10
356z.9 , 364.01, 367.2, 368a, 401, | 13 |
| 401.1,
402,
403, 403A, 408,
408.2, and 412, and paragraphs (7) | 14 |
| and (15) of Section 367 of the Illinois
Insurance Code.
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| (Source: P.A. 94-1076, eff. 12-29-06; 95-189, eff. 8-16-07; | 16 |
| 95-331, eff. 8-21-07; 95-422, eff. 8-24-07; 95-520, eff. | 17 |
| 8-28-07; revised 12-5-07.)".
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