Full Text of HB0081 99th General Assembly
HB0081 99TH GENERAL ASSEMBLY |
| | 99TH GENERAL ASSEMBLY
State of Illinois
2015 and 2016 HB0081 Introduced , by Rep. Lou Lang SYNOPSIS AS INTRODUCED: |
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Amends the Illinois Insurance Code. Makes a technical change in a Section concerning mental health parity.
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| | A BILL FOR |
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| 1 | | AN ACT concerning regulation.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | Section 5. The Illinois Insurance Code is amended by | 5 | | changing Section 370c.1 as follows: | 6 | | (215 ILCS 5/370c.1) | 7 | | Sec. 370c.1. Mental health parity. | 8 | | (a) On and after the the effective date of this amendatory | 9 | | Act of the 97th General Assembly, every insurer that amends, | 10 | | delivers, issues, or renews a group policy of accident and | 11 | | health insurance in this State providing coverage for hospital | 12 | | or medical treatment and for the treatment of mental, | 13 | | emotional, nervous, or substance use disorders or conditions | 14 | | shall ensure that: | 15 | | (1) the financial requirements applicable to such | 16 | | mental, emotional, nervous, or substance use disorder or | 17 | | condition benefits are no more restrictive than the | 18 | | predominant financial requirements applied to | 19 | | substantially all hospital and medical benefits covered by | 20 | | the policy and that there are no separate cost-sharing | 21 | | requirements that are applicable only with respect to | 22 | | mental, emotional, nervous, or substance use disorder or | 23 | | condition benefits; and |
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| 1 | | (2) the treatment limitations applicable to such | 2 | | mental, emotional, nervous, or substance use disorder or | 3 | | condition benefits are no more restrictive than the | 4 | | predominant treatment limitations applied to substantially | 5 | | all hospital and medical benefits covered by the policy and | 6 | | that there are no separate treatment limitations that are | 7 | | applicable only with respect to mental, emotional, | 8 | | nervous, or substance use disorder or condition benefits. | 9 | | (b) The following provisions shall apply concerning | 10 | | aggregate lifetime limits: | 11 | | (1) In the case of a group policy of accident and | 12 | | health insurance amended, delivered, issued, or renewed in | 13 | | this State on or after the effective date of this | 14 | | amendatory Act of the 97th General Assembly that provides | 15 | | coverage for hospital or medical treatment and for the | 16 | | treatment of mental, emotional, nervous, or substance use | 17 | | disorders or conditions the following provisions shall | 18 | | apply: | 19 | | (A) if the policy does not include an aggregate | 20 | | lifetime limit on substantially all hospital and | 21 | | medical benefits, then the policy may not impose any | 22 | | aggregate lifetime limit on mental, emotional, | 23 | | nervous, or substance use disorder or condition | 24 | | benefits; or | 25 | | (B) if the policy includes an aggregate lifetime | 26 | | limit on substantially all hospital and medical |
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| 1 | | benefits (in this subsection referred to as the | 2 | | "applicable lifetime limit"), then the policy shall | 3 | | either: | 4 | | (i) apply the applicable lifetime limit both | 5 | | to the hospital and medical benefits to which it | 6 | | otherwise would apply and to mental, emotional, | 7 | | nervous, or substance use disorder or condition | 8 | | benefits and not distinguish in the application of | 9 | | the limit between the hospital and medical | 10 | | benefits and mental, emotional, nervous, or | 11 | | substance use disorder or condition benefits; or | 12 | | (ii) not include any aggregate lifetime limit | 13 | | on mental, emotional, nervous, or substance use | 14 | | disorder or condition benefits that is less than | 15 | | the applicable lifetime limit. | 16 | | (2) In the case of a policy that is not described in | 17 | | paragraph (1) of subsection (b) of this Section and that | 18 | | includes no or different aggregate lifetime limits on | 19 | | different categories of hospital and medical benefits, the | 20 | | Director shall establish rules under which subparagraph | 21 | | (B) of paragraph (1) of subsection (b) of this Section is | 22 | | applied to such policy with respect to mental, emotional, | 23 | | nervous, or substance use disorder or condition benefits by | 24 | | substituting for the applicable lifetime limit an average | 25 | | aggregate lifetime limit that is computed taking into | 26 | | account the weighted average of the aggregate lifetime |
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| 1 | | limits applicable to such categories. | 2 | | (c) The following provisions shall apply concerning annual | 3 | | limits: | 4 | | (1) In the case of a group policy of accident and | 5 | | health insurance amended, delivered, issued, or renewed in | 6 | | this State on or after the effective date of this | 7 | | amendatory Act of the 97th General Assembly that provides | 8 | | coverage for hospital or medical treatment and for the | 9 | | treatment of mental, emotional, nervous, or substance use | 10 | | disorders or conditions the following provisions shall | 11 | | apply: | 12 | | (A) if the policy does not include an annual limit | 13 | | on substantially all hospital and medical benefits, | 14 | | then the policy may not impose any annual limits on | 15 | | mental, emotional, nervous, or substance use disorder | 16 | | or condition benefits; or | 17 | | (B) if the policy includes an annual limit on | 18 | | substantially all hospital and medical benefits (in | 19 | | this subsection referred to as the "applicable annual | 20 | | limit"), then the policy shall either: | 21 | | (i) apply the applicable annual limit both to | 22 | | the hospital and medical benefits to which it | 23 | | otherwise would apply and to mental, emotional, | 24 | | nervous, or substance use disorder or condition | 25 | | benefits and not distinguish in the application of | 26 | | the limit between the hospital and medical |
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| 1 | | benefits and mental, emotional, nervous, or | 2 | | substance use disorder or condition benefits; or | 3 | | (ii) not include any annual limit on mental, | 4 | | emotional, nervous, or substance use disorder or | 5 | | condition benefits that is less than the | 6 | | applicable annual limit. | 7 | | (2) In the case of a policy that is not described in | 8 | | paragraph (1) of subsection (c) of this Section and that | 9 | | includes no or different annual limits on different | 10 | | categories of hospital and medical benefits, the Director | 11 | | shall establish rules under which subparagraph (B) of | 12 | | paragraph (1) of subsection (c) of this Section is applied | 13 | | to such policy with respect to mental, emotional, nervous, | 14 | | or substance use disorder or condition benefits by | 15 | | substituting for the applicable annual limit an average | 16 | | annual limit that is computed taking into account the | 17 | | weighted average of the annual limits applicable to such | 18 | | categories. | 19 | | (d) This Section shall be interpreted in a manner | 20 | | consistent with the interim final regulations promulgated by | 21 | | the U.S. Department of Health and Human Services at 75 FR 5410, | 22 | | including the prohibition against applying a cumulative | 23 | | financial requirement or cumulative quantitative treatment | 24 | | limitation for mental, emotional, nervous, or substance use | 25 | | disorder benefits that accumulates separately from any | 26 | | cumulative financial requirement or cumulative quantitative |
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| 1 | | treatment limitation established for hospital and medical | 2 | | benefits in the same classification. | 3 | | (e) The provisions of subsections (b) and (c) of this | 4 | | Section shall not be interpreted to allow the use of lifetime | 5 | | or annual limits otherwise prohibited by State or federal law. | 6 | | (f) This Section shall not apply to individual health | 7 | | insurance coverage as defined in Section 5 of the Illinois | 8 | | Health Insurance Portability and Accountability Act. | 9 | | (g) As used in this Section: | 10 | | "Financial requirement" includes deductibles, copayments, | 11 | | coinsurance, and out-of-pocket maximums, but does not include | 12 | | an aggregate lifetime limit or an annual limit subject to | 13 | | subsections (b) and (c). | 14 | | "Treatment limitation" includes limits on benefits based | 15 | | on the frequency of treatment, number of visits, days of | 16 | | coverage, days in a waiting period, or other similar limits on | 17 | | the scope or duration of treatment. "Treatment limitation" | 18 | | includes both quantitative treatment limitations, which are | 19 | | expressed numerically (such as 50 outpatient visits per year), | 20 | | and nonquantitative treatment limitations, which otherwise | 21 | | limit the scope or duration of treatment. A permanent exclusion | 22 | | of all benefits for a particular condition or disorder shall | 23 | | not be considered a treatment limitation.
| 24 | | (Source: P.A. 97-437, eff. 8-18-11.)
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