Full Text of HB4305 97th General Assembly
HB4305ham001 97TH GENERAL ASSEMBLY | Rep. Maria Antonia Berrios Filed: 3/1/2012
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| 1 | | AMENDMENT TO HOUSE BILL 4305
| 2 | | AMENDMENT NO. ______. Amend House Bill 4305 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 5. The State Employees Group Insurance Act of 1971 | 5 | | is amended by
changing Section 6.11 as follows:
| 6 | | (5 ILCS 375/6.11)
| 7 | | 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 356g, | 13 | | 356g.5, 356g.5-1, 356m,
356u, 356w, 356x, 356z.2, 356z.4, | 14 | | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, | 15 | | 356z.14, 356z.15, and 356z.17 and 356z.19 , and 356z.22 of the
| 16 | | Illinois Insurance Code.
The program of health benefits must |
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| 1 | | comply with Sections 155.22a , and 155.37 , and 356z.19 of the
| 2 | | Illinois Insurance Code.
| 3 | | Rulemaking authority to implement Public Act 95-1045, if | 4 | | any, is conditioned on the rules being adopted in accordance | 5 | | with all provisions of the Illinois Administrative Procedure | 6 | | Act and all rules and procedures of the Joint Committee on | 7 | | Administrative Rules; any purported rule not so adopted, for | 8 | | whatever reason, is unauthorized. | 9 | | (Source: P.A. 96-139, eff. 1-1-10; 96-328, eff. 8-11-09; | 10 | | 96-639, eff. 1-1-10; 96-1000, eff. 7-2-10; 97-282, eff. 8-9-11; | 11 | | 97-343, eff. 1-1-12; revised 10-14-11.)
| 12 | | Section 10. The Counties Code is amended by changing | 13 | | Section 5-1069.3 as
follows:
| 14 | | (55 ILCS 5/5-1069.3)
| 15 | | Sec. 5-1069.3. Required health benefits. If a county, | 16 | | including a home
rule
county, is a self-insurer for purposes of | 17 | | providing health insurance coverage
for its employees, the | 18 | | coverage shall include coverage for the post-mastectomy
care | 19 | | benefits required to be covered by a policy of accident and | 20 | | health
insurance under Section 356t and the coverage required | 21 | | under Sections 356g, 356g.5, 356g.5-1, 356u,
356w, 356x, | 22 | | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, | 23 | | 356z.14, and 356z.15 , and 356z.22 of
the Illinois Insurance | 24 | | Code. The coverage shall comply with Sections Section 155.22a |
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| 1 | | and 356z.19 of
the Illinois Insurance Code. The requirement | 2 | | that health benefits be covered
as provided in this Section is | 3 | | an
exclusive power and function of the State and is a denial | 4 | | and limitation under
Article VII, Section 6, subsection (h) of | 5 | | the Illinois Constitution. A home
rule county to which this | 6 | | Section applies must comply with every provision of
this | 7 | | Section.
| 8 | | Rulemaking authority to implement Public Act 95-1045, if | 9 | | any, is conditioned on the rules being adopted in accordance | 10 | | with all provisions of the Illinois Administrative Procedure | 11 | | Act and all rules and procedures of the Joint Committee on | 12 | | Administrative Rules; any purported rule not so adopted, for | 13 | | whatever reason, is unauthorized. | 14 | | (Source: P.A. 96-139, eff. 1-1-10; 96-328, eff. 8-11-09; | 15 | | 96-1000, eff. 7-2-10; 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; | 16 | | revised 10-14-11.)
| 17 | | Section 15. The Illinois Municipal Code is amended by | 18 | | changing Section
10-4-2.3 as follows:
| 19 | | (65 ILCS 5/10-4-2.3)
| 20 | | Sec. 10-4-2.3. Required health benefits. If a | 21 | | municipality, including a
home rule municipality, is a | 22 | | self-insurer for purposes of providing health
insurance | 23 | | coverage for its employees, the coverage shall include coverage | 24 | | for
the post-mastectomy care benefits required to be covered by |
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| 1 | | a policy of
accident and health insurance under Section 356t | 2 | | and the coverage required
under Sections 356g, 356g.5, | 3 | | 356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10, | 4 | | 356z.11, 356z.12, 356z.13, 356z.14, and 356z.15 , and 356z.22 of | 5 | | the Illinois
Insurance
Code. The coverage shall comply with | 6 | | Sections Section 155.22a and 356z.19 of
the Illinois Insurance | 7 | | Code. The requirement that health
benefits be covered as | 8 | | provided in this is an exclusive power and function of
the | 9 | | State and is a denial and limitation under Article VII, Section | 10 | | 6,
subsection (h) of the Illinois Constitution. A home rule | 11 | | municipality to which
this Section applies must comply with | 12 | | every provision of this Section.
| 13 | | Rulemaking authority to implement Public Act 95-1045, if | 14 | | any, is conditioned on the rules being adopted in accordance | 15 | | with all provisions of the Illinois Administrative Procedure | 16 | | Act and all rules and procedures of the Joint Committee on | 17 | | Administrative Rules; any purported rule not so adopted, for | 18 | | whatever reason, is unauthorized. | 19 | | (Source: P.A. 96-139, eff. 1-1-10; 96-328, eff. 8-11-09; | 20 | | 96-1000, eff. 7-2-10; 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; | 21 | | revised 10-14-11.)
| 22 | | Section 20. The School Code is amended by changing Section | 23 | | 10-22.3f as
follows:
| 24 | | (105 ILCS 5/10-22.3f)
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| 1 | | Sec. 10-22.3f. Required health benefits. Insurance | 2 | | protection and
benefits
for employees shall provide the | 3 | | post-mastectomy care benefits required to be
covered by a | 4 | | policy of accident and health insurance under Section 356t and | 5 | | the
coverage required under Sections 356g, 356g.5, 356g.5-1, | 6 | | 356u, 356w, 356x,
356z.6, 356z.8, 356z.9, 356z.11, 356z.12, | 7 | | 356z.13, 356z.14, and 356z.15 , and 356z.22 of
the
Illinois | 8 | | Insurance Code.
Insurance policies shall comply with Section | 9 | | 356z.19 of the Illinois Insurance Code. The coverage shall | 10 | | comply with Section 155.22a of
the Illinois Insurance Code.
| 11 | | Rulemaking authority to implement Public Act 95-1045, if | 12 | | any, is conditioned on the rules being adopted in accordance | 13 | | with all provisions of the Illinois Administrative Procedure | 14 | | Act and all rules and procedures of the Joint Committee on | 15 | | Administrative Rules; any purported rule not so adopted, for | 16 | | whatever reason, is unauthorized. | 17 | | (Source: P.A. 96-139, eff. 1-1-10; 96-328, eff. 8-11-09; | 18 | | 96-1000, eff. 7-2-10; 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; | 19 | | revised 9-28-11.)
| 20 | | Section 25. The Illinois Insurance Code is amended by | 21 | | adding Section
356z.22
as
follows:
| 22 | | (215 ILCS 5/356z.22 new)
| 23 | | Sec. 356z.22. Prescription drugs. A group or individual | 24 | | policy of
accident and health insurance or managed care plan |
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| 1 | | amended, delivered, issued,
or renewed after the effective date | 2 | | of this amendatory Act of the 97th General
Assembly that | 3 | | provides coverage for prescription drugs shall permit each | 4 | | participant to fill any mail order covered prescription, at his | 5 | | or her option, at any mail order pharmacy or network | 6 | | participating non-mail order retail pharmacy if the network | 7 | | participating non-mail order retail pharmacy offers to accept a | 8 | | price that is comparable to that of the mail order pharmacy. | 9 | | Any policy or plan that provides coverage for prescription | 10 | | drugs shall not impose a co-payment fee or other condition on | 11 | | any insured who elects to purchase drugs from a network | 12 | | participating non-mail order retail pharmacy that is not also | 13 | | imposed on insureds electing to purchase drugs from a | 14 | | designated mail order pharmacy. The provisions of this Section | 15 | | shall not supersede the terms of a collective bargaining | 16 | | agreement or apply to a policy that is the result of a | 17 | | collective bargaining agreement between an employer and a | 18 | | recognized or certified employee organization.
| 19 | | Section 30. The Health Maintenance Organization Act is | 20 | | amended by changing
Section 5-3 as follows:
| 21 | | (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
| 22 | | Sec. 5-3. Insurance Code provisions.
| 23 | | (a) Health Maintenance Organizations
shall be subject to | 24 | | the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
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| 1 | | 141.2, 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, 154, | 2 | | 154.5, 154.6,
154.7, 154.8, 155.04, 155.22a, 355.2, 356g.5-1, | 3 | | 356m, 356v, 356w, 356x, 356y,
356z.2, 356z.4, 356z.5, 356z.6, | 4 | | 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, | 5 | | 356z.15, 356z.17, 356z.18, 356z.19, 356z.21 356z.19 , 356z.22, | 6 | | 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c, 368d, 368e, | 7 | | 370c,
370c.1, 401, 401.1, 402, 403, 403A,
408, 408.2, 409, 412, | 8 | | 444,
and
444.1,
paragraph (c) of subsection (2) of Section 367, | 9 | | and Articles IIA, VIII 1/2,
XII,
XII 1/2, XIII, XIII 1/2, XXV, | 10 | | and XXVI of the Illinois Insurance Code.
| 11 | | (b) For purposes of the Illinois Insurance Code, except for | 12 | | Sections 444
and 444.1 and Articles XIII and XIII 1/2, Health | 13 | | Maintenance Organizations in
the following categories are | 14 | | deemed to be "domestic companies":
| 15 | | (1) a corporation authorized under the
Dental Service | 16 | | Plan Act or the Voluntary Health Services Plans Act;
| 17 | | (2) a corporation organized under the laws of this | 18 | | State; or
| 19 | | (3) a corporation organized under the laws of another | 20 | | state, 30% or more
of the enrollees of which are residents | 21 | | of this State, except a
corporation subject to | 22 | | substantially the same requirements in its state of
| 23 | | organization as is a "domestic company" under Article VIII | 24 | | 1/2 of the
Illinois Insurance Code.
| 25 | | (c) In considering the merger, consolidation, or other | 26 | | acquisition of
control of a Health Maintenance Organization |
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| 1 | | pursuant to Article VIII 1/2
of the Illinois Insurance Code,
| 2 | | (1) the Director shall give primary consideration to | 3 | | the continuation of
benefits to enrollees and the financial | 4 | | conditions of the acquired Health
Maintenance Organization | 5 | | after the merger, consolidation, or other
acquisition of | 6 | | control takes effect;
| 7 | | (2)(i) the criteria specified in subsection (1)(b) of | 8 | | Section 131.8 of
the Illinois Insurance Code shall not | 9 | | apply and (ii) the Director, in making
his determination | 10 | | with respect to the merger, consolidation, or other
| 11 | | acquisition of control, need not take into account the | 12 | | effect on
competition of the merger, consolidation, or | 13 | | other acquisition of control;
| 14 | | (3) the Director shall have the power to require the | 15 | | following
information:
| 16 | | (A) certification by an independent actuary of the | 17 | | adequacy
of the reserves of the Health Maintenance | 18 | | Organization sought to be acquired;
| 19 | | (B) pro forma financial statements reflecting the | 20 | | combined balance
sheets of the acquiring company and | 21 | | the Health Maintenance Organization sought
to be | 22 | | acquired as of the end of the preceding year and as of | 23 | | a date 90 days
prior to the acquisition, as well as pro | 24 | | forma financial statements
reflecting projected | 25 | | combined operation for a period of 2 years;
| 26 | | (C) a pro forma business plan detailing an |
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| 1 | | acquiring party's plans with
respect to the operation | 2 | | of the Health Maintenance Organization sought to
be | 3 | | acquired for a period of not less than 3 years; and
| 4 | | (D) such other information as the Director shall | 5 | | require.
| 6 | | (d) The provisions of Article VIII 1/2 of the Illinois | 7 | | Insurance Code
and this Section 5-3 shall apply to the sale by | 8 | | any health maintenance
organization of greater than 10% of its
| 9 | | enrollee population (including without limitation the health | 10 | | maintenance
organization's right, title, and interest in and to | 11 | | its health care
certificates).
| 12 | | (e) In considering any management contract or service | 13 | | agreement subject
to Section 141.1 of the Illinois Insurance | 14 | | Code, the Director (i) shall, in
addition to the criteria | 15 | | specified in Section 141.2 of the Illinois
Insurance Code, take | 16 | | into account the effect of the management contract or
service | 17 | | agreement on the continuation of benefits to enrollees and the
| 18 | | financial condition of the health maintenance organization to | 19 | | be managed or
serviced, and (ii) need not take into account the | 20 | | effect of the management
contract or service agreement on | 21 | | competition.
| 22 | | (f) Except for small employer groups as defined in the | 23 | | Small Employer
Rating, Renewability and Portability Health | 24 | | Insurance Act and except for
medicare supplement policies as | 25 | | defined in Section 363 of the Illinois
Insurance Code, a Health | 26 | | Maintenance Organization may by contract agree with a
group or |
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| 1 | | other enrollment unit to effect refunds or charge additional | 2 | | premiums
under the following terms and conditions:
| 3 | | (i) the amount of, and other terms and conditions with | 4 | | respect to, the
refund or additional premium are set forth | 5 | | in the group or enrollment unit
contract agreed in advance | 6 | | of the period for which a refund is to be paid or
| 7 | | additional premium is to be charged (which period shall not | 8 | | be less than one
year); and
| 9 | | (ii) the amount of the refund or additional premium | 10 | | shall not exceed 20%
of the Health Maintenance | 11 | | Organization's profitable or unprofitable experience
with | 12 | | respect to the group or other enrollment unit for the | 13 | | period (and, for
purposes of a refund or additional | 14 | | premium, the profitable or unprofitable
experience shall | 15 | | be calculated taking into account a pro rata share of the
| 16 | | Health Maintenance Organization's administrative and | 17 | | marketing expenses, but
shall not include any refund to be | 18 | | made or additional premium to be paid
pursuant to this | 19 | | subsection (f)). The Health Maintenance Organization and | 20 | | the
group or enrollment unit may agree that the profitable | 21 | | or unprofitable
experience may be calculated taking into | 22 | | account the refund period and the
immediately preceding 2 | 23 | | plan years.
| 24 | | The Health Maintenance Organization shall include a | 25 | | statement in the
evidence of coverage issued to each enrollee | 26 | | describing the possibility of a
refund or additional premium, |
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| 1 | | and upon request of any group or enrollment unit,
provide to | 2 | | the group or enrollment unit a description of the method used | 3 | | to
calculate (1) the Health Maintenance Organization's | 4 | | profitable experience with
respect to the group or enrollment | 5 | | unit and the resulting refund to the group
or enrollment unit | 6 | | or (2) the Health Maintenance Organization's unprofitable
| 7 | | experience with respect to the group or enrollment unit and the | 8 | | resulting
additional premium to be paid by the group or | 9 | | enrollment unit.
| 10 | | In no event shall the Illinois Health Maintenance | 11 | | Organization
Guaranty Association be liable to pay any | 12 | | contractual obligation of an
insolvent organization to pay any | 13 | | refund authorized under this Section.
| 14 | | (g) Rulemaking authority to implement Public Act 95-1045, | 15 | | if any, is conditioned on the rules being adopted in accordance | 16 | | with all provisions of the Illinois Administrative Procedure | 17 | | Act and all rules and procedures of the Joint Committee on | 18 | | Administrative Rules; any purported rule not so adopted, for | 19 | | whatever reason, is unauthorized. | 20 | | (Source: P.A. 96-328, eff. 8-11-09; 96-639, eff. 1-1-10; | 21 | | 96-833, eff. 6-1-10; 96-1000, eff. 7-2-10; 97-282, eff. 8-9-11; | 22 | | 97-343, eff. 1-1-12; 97-437, eff. 8-18-11; 97-486, eff. 1-1-12; | 23 | | 97-592, eff. 1-1-12; revised 10-13-11.)
| 24 | | Section 35. The Limited Health Service Organization Act is | 25 | | amended by changing Section 4003 as follows:
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| 1 | | (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
| 2 | | Sec. 4003. Illinois Insurance Code provisions. Limited | 3 | | health service
organizations shall be subject to the provisions | 4 | | of Sections 133, 134, 136, 137, 139,
140, 141.1, 141.2, 141.3, | 5 | | 143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5,
154.6, | 6 | | 154.7, 154.8, 155.04, 155.37, 355.2, 356v, 356z.10, 356z.21 | 7 | | 356z.19 , 356z.22, 368a, 401, 401.1,
402,
403, 403A, 408,
408.2, | 8 | | 409, 412, 444, and 444.1 and Articles IIA, VIII 1/2, XII, XII | 9 | | 1/2,
XIII,
XIII 1/2, XXV, and XXVI of the Illinois Insurance | 10 | | Code. For purposes of the
Illinois Insurance Code, except for | 11 | | Sections 444 and 444.1 and Articles XIII
and XIII 1/2, limited | 12 | | health service organizations in the following categories
are | 13 | | deemed to be domestic 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% of 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. 97-486, eff. 1-1-12; 97-592, 1-1-12; revised | 22 | | 10-13-11.)
| 23 | | Section 40. The Voluntary Health Services Plans Act is | 24 | | amended by changing
Section 10 as follows:
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| 1 | | (215 ILCS 165/10) (from Ch. 32, par. 604)
| 2 | | Sec. 10. Application of Insurance Code provisions. Health | 3 | | services
plan corporations and all persons interested therein | 4 | | or dealing therewith
shall be subject to the provisions of | 5 | | Articles IIA and XII 1/2 and Sections
3.1, 133, 136, 139, 140, | 6 | | 143, 143c, 149, 155.22a, 155.37, 354, 355.2, 356g, 356g.5, | 7 | | 356g.5-1, 356r, 356t, 356u, 356v,
356w, 356x, 356y, 356z.1, | 8 | | 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9,
356z.10, | 9 | | 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18, 356z.19, | 10 | | 356z.21 356z.19 , 356z.22, 364.01, 367.2, 368a, 401, 401.1,
402,
| 11 | | 403, 403A, 408,
408.2, and 412, and paragraphs (7) and (15) of | 12 | | Section 367 of the Illinois
Insurance Code.
| 13 | | Rulemaking authority to implement Public Act 95-1045, if | 14 | | any, is conditioned on the rules being adopted in accordance | 15 | | with all provisions of the Illinois Administrative Procedure | 16 | | Act and all rules and procedures of the Joint Committee on | 17 | | Administrative Rules; any purported rule not so adopted, for | 18 | | whatever reason, is unauthorized. | 19 | | (Source: P.A. 96-328, eff. 8-11-09; 96-833, eff. 6-1-10; | 20 | | 96-1000, eff. 7-2-10; 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; | 21 | | 97-486, eff. 1-1-12; 97-592, eff. 1-1-12; revised 10-13-11.)".
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