HB2617enr 100TH GENERAL ASSEMBLY

  
  
  

 


 
HB2617 EnrolledLRB100 08150 SMS 18244 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 provide
9the post-mastectomy care benefits required to be covered by a
10policy of accident and health insurance under Section 356t of
11the Illinois Insurance Code. The program of health benefits
12shall provide the coverage required under Sections 356g,
13356g.5, 356g.5-1, 356m, 356u, 356w, 356x, 356z.2, 356z.4,
14356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
15356z.14, 356z.15, 356z.17, 356z.22, and 356z.25, 356z.26, and
16356z.29 of the Illinois Insurance Code. The program of health
17benefits must comply with Sections 155.22a, 155.37, 355b,
18356z.19, 370c, and 370c.1 of the Illinois Insurance Code.
19    Rulemaking authority to implement Public Act 95-1045, if
20any, is conditioned on the rules being adopted in accordance
21with all provisions of the Illinois Administrative Procedure
22Act and all rules and procedures of the Joint Committee on
23Administrative Rules; any purported rule not so adopted, for

 

 

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1whatever reason, is unauthorized.
2(Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17;
3100-138, eff. 8-18-17; revised 10-3-17.)
 
4    Section 10. The Counties Code is amended by changing
5Section 5-1069.3 as follows:
 
6    (55 ILCS 5/5-1069.3)
7    Sec. 5-1069.3. Required health benefits. If a county,
8including a home rule county, is a self-insurer for purposes of
9providing health insurance coverage for its employees, the
10coverage shall include coverage for the post-mastectomy care
11benefits required to be covered by a policy of accident and
12health insurance under Section 356t and the coverage required
13under Sections 356g, 356g.5, 356g.5-1, 356u, 356w, 356x,
14356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
15356z.14, 356z.15, 356z.22, and 356z.25, 356z.26, and 356z.29 of
16the Illinois Insurance Code. The coverage shall comply with
17Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
18Insurance Code. The requirement that health benefits be covered
19as provided in this Section is an exclusive power and function
20of the State and is a denial and limitation under Article VII,
21Section 6, subsection (h) of the Illinois Constitution. A home
22rule county to which this Section applies must comply with
23every provision of this Section.
24    Rulemaking authority to implement Public Act 95-1045, if

 

 

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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. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17;
7100-138, eff. 8-18-17; revised 10-5-17.)
 
8    Section 15. The Illinois Municipal Code is amended by
9changing Section 10-4-2.3 as follows:
 
10    (65 ILCS 5/10-4-2.3)
11    Sec. 10-4-2.3. Required health benefits. If a
12municipality, including a home rule municipality, is a
13self-insurer for purposes of providing health insurance
14coverage for its employees, the coverage shall include coverage
15for the post-mastectomy care benefits required to be covered by
16a policy of accident and health insurance under Section 356t
17and the coverage required under Sections 356g, 356g.5,
18356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10,
19356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, and
20356z.25, 356z.26, and 356z.29 of the Illinois Insurance Code.
21The coverage shall comply with Sections 155.22a, 355b, 356z.19,
22and 370c of the Illinois Insurance Code. The requirement that
23health benefits be covered as provided in this is an exclusive
24power and function of the State and is a denial and limitation

 

 

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1under Article VII, Section 6, subsection (h) of the Illinois
2Constitution. A home rule municipality to which this Section
3applies must comply with every provision of this Section.
4    Rulemaking authority to implement Public Act 95-1045, if
5any, is conditioned on the rules being adopted in accordance
6with all provisions of the Illinois Administrative Procedure
7Act and all rules and procedures of the Joint Committee on
8Administrative Rules; any purported rule not so adopted, for
9whatever reason, is unauthorized.
10(Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17;
11100-138, eff. 8-18-17; revised 10-5-17.)
 
12    Section 20. The School Code is amended by changing Section
1310-22.3f as follows:
 
14    (105 ILCS 5/10-22.3f)
15    Sec. 10-22.3f. Required health benefits. Insurance
16protection and benefits for employees shall provide the
17post-mastectomy care benefits required to be covered by a
18policy of accident and health insurance under Section 356t and
19the coverage required under Sections 356g, 356g.5, 356g.5-1,
20356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11, 356z.12,
21356z.13, 356z.14, 356z.15, 356z.22, and 356z.25, 356z.26, and
22356z.29 of the Illinois Insurance Code. Insurance policies
23shall comply with Section 356z.19 of the Illinois Insurance
24Code. The coverage shall comply with Sections 155.22a and 355b

 

 

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1of the Illinois Insurance Code.
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;
9revised 9-25-17.)
 
10    Section 25. The Illinois Insurance Code is amended by
11changing Section 356z.4 and adding Section 356z.29 as follows:
 
12    (215 ILCS 5/356z.4)
13    Sec. 356z.4. Coverage for contraceptives.
14    (a)(1) The General Assembly hereby finds and declares all
15of the following:
16        (A) Illinois has a long history of expanding timely
17    access to birth control to prevent unintended pregnancy.
18        (B) The federal Patient Protection and Affordable Care
19    Act includes a contraceptive coverage guarantee as part of
20    a broader requirement for health insurance to cover key
21    preventive care services without out-of-pocket costs for
22    patients.
23        (C) The General Assembly intends to build on existing
24    State and federal law to promote gender equity and women's

 

 

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1    health and to ensure greater contraceptive coverage equity
2    and timely access to all federal Food and Drug
3    Administration approved methods of birth control for all
4    individuals covered by an individual or group health
5    insurance policy in Illinois.
6        (D) Medical management techniques such as denials,
7    step therapy, or prior authorization in public and private
8    health care coverage can impede access to the most
9    effective contraceptive methods.
10    (2) As used in this subsection (a):
11    "Contraceptive services" includes consultations,
12examinations, procedures, and medical services related to the
13use of contraceptive methods (including natural family
14planning) to prevent an unintended pregnancy.
15    "Medical necessity", for the purposes of this subsection
16(a), includes, but is not limited to, considerations such as
17severity of side effects, differences in permanence and
18reversibility of contraceptive, and ability to adhere to the
19appropriate use of the item or service, as determined by the
20attending provider.
21    "Therapeutic equivalent version" means drugs, devices, or
22products that can be expected to have the same clinical effect
23and safety profile when administered to patients under the
24conditions specified in the labeling and satisfy the following
25general criteria:
26        (i) they are approved as safe and effective;

 

 

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1        (ii) they are pharmaceutical equivalents in that they
2    (A) contain identical amounts of the same active drug
3    ingredient in the same dosage form and route of
4    administration and (B) meet compendial or other applicable
5    standards of strength, quality, purity, and identity;
6        (iii) they are bioequivalent in that (A) they do not
7    present a known or potential bioequivalence problem and
8    they meet an acceptable in vitro standard or (B) if they do
9    present such a known or potential problem, they are shown
10    to meet an appropriate bioequivalence standard;
11        (iv) they are adequately labeled; and
12        (v) they are manufactured in compliance with Current
13    Good Manufacturing Practice regulations.
14    (3) An individual or group policy of accident and health
15insurance amended, delivered, issued, or renewed in this State
16after the effective date of this amendatory Act of the 99th
17General Assembly shall provide coverage for all of the
18following services and contraceptive methods:
19        (A) All contraceptive drugs, devices, and other
20    products approved by the United States Food and Drug
21    Administration. This includes all over-the-counter
22    contraceptive drugs, devices, and products approved by the
23    United States Food and Drug Administration, excluding male
24    condoms. The following apply:
25            (i) If the United States Food and Drug
26        Administration has approved one or more therapeutic

 

 

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1        equivalent versions of a contraceptive drug, device,
2        or product, a policy is not required to include all
3        such therapeutic equivalent versions in its formulary,
4        so long as at least one is included and covered without
5        cost-sharing and in accordance with this Section.
6            (ii) If an individual's attending provider
7        recommends a particular service or item approved by the
8        United States Food and Drug Administration based on a
9        determination of medical necessity with respect to
10        that individual, the plan or issuer must cover that
11        service or item without cost sharing. The plan or
12        issuer must defer to the determination of the attending
13        provider.
14            (iii) If a drug, device, or product is not covered,
15        plans and issuers must have an easily accessible,
16        transparent, and sufficiently expedient process that
17        is not unduly burdensome on the individual or a
18        provider or other individual acting as a patient's
19        authorized representative to ensure coverage without
20        cost sharing.
21            (iv) This coverage must provide for the dispensing
22        of 12 months' worth of contraception at one time.
23        (B) Voluntary sterilization procedures.
24        (C) Contraceptive services, patient education, and
25    counseling on contraception.
26        (D) Follow-up services related to the drugs, devices,

 

 

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1    products, and procedures covered under this Section,
2    including, but not limited to, management of side effects,
3    counseling for continued adherence, and device insertion
4    and removal.
5    (4) Except as otherwise provided in this subsection (a), a
6policy subject to this subsection (a) shall not impose a
7deductible, coinsurance, copayment, or any other cost-sharing
8requirement on the coverage provided. The provisions of this
9paragraph do not apply to coverage of voluntary male
10sterilization procedures to the extent such coverage would
11disqualify a high-deductible health plan from eligibility for a
12health savings account pursuant to the federal Internal Revenue
13Code, 26 U.S.C. 223.
14    (5) Except as otherwise authorized under this subsection
15(a), a policy shall not impose any restrictions or delays on
16the coverage required under this subsection (a).
17    (6) If, at any time, the Secretary of the United States
18Department of Health and Human Services, or its successor
19agency, promulgates rules or regulations to be published in the
20Federal Register or publishes a comment in the Federal Register
21or issues an opinion, guidance, or other action that would
22require the State, pursuant to any provision of the Patient
23Protection and Affordable Care Act (Public Law 111-148),
24including, but not limited to, 42 U.S.C. 18031(d)(3)(B) or any
25successor provision, to defray the cost of any coverage
26outlined in this subsection (a), then this subsection (a) is

 

 

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1inoperative with respect to all coverage outlined in this
2subsection (a) other than that authorized under Section 1902 of
3the Social Security Act, 42 U.S.C. 1396a, and the State shall
4not assume any obligation for the cost of the coverage set
5forth in this subsection (a).
6    (b) This subsection (b) shall become operative if and only
7if subsection (a) becomes inoperative.
8    An individual or group policy of accident and health
9insurance amended, delivered, issued, or renewed in this State
10after the date this subsection (b) becomes operative that
11provides coverage for outpatient services and outpatient
12prescription drugs or devices must provide coverage for the
13insured and any dependent of the insured covered by the policy
14for all outpatient contraceptive services and all outpatient
15contraceptive drugs and devices approved by the Food and Drug
16Administration. Coverage required under this Section may not
17impose any deductible, coinsurance, waiting period, or other
18cost-sharing or limitation that is greater than that required
19for any outpatient service or outpatient prescription drug or
20device otherwise covered by the policy.
21    Nothing in this subsection (b) shall be construed to
22require an insurance company to cover services related to
23permanent sterilization that requires a surgical procedure.
24    As used in this subsection (b), "outpatient contraceptive
25service" means consultations, examinations, procedures, and
26medical services, provided on an outpatient basis and related

 

 

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1to the use of contraceptive methods (including natural family
2planning) to prevent an unintended pregnancy.
3    (c) Nothing in this Section shall be construed to require
4an insurance company to cover services related to an abortion
5as the term "abortion" is defined in the Illinois Abortion Law
6of 1975.
7    (d) If a plan or issuer utilizes a network of providers,
8nothing in this Section shall be construed to require coverage
9or to prohibit the plan or issuer from imposing cost-sharing
10for items or services described in this Section that are
11provided or delivered by an out-of-network provider, unless the
12plan or issuer does not have in its network a provider who is
13able to or is willing to provide the applicable items or
14services.
15(Source: P.A. 99-672, eff. 1-1-17.)
 
16    (215 ILCS 5/356z.29 new)
17    Sec. 356z.29. Coverage for fertility preservation
18services.
19    (a) As used in this Section:
20        "Iatrogenic infertility" means in impairment of
21    fertility by surgery, radiation, chemotherapy, or other
22    medical treatment affecting reproductive organs or
23    processes.
24        "May directly or indirectly cause" means the likely
25    possibility that treatment will cause a side effect of

 

 

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1    infertility, based upon current evidence-based standards
2    of care established by the American Society for
3    Reproductive Medicine, the American Society of Clinical
4    Oncology, or other national medical associations that
5    follow current evidence-based standards of care.
6        "Standard fertility preservation services" means
7    procedures based upon current evidence-based standards of
8    care established by the American Society for Reproductive
9    Medicine, the American Society of Clinical Oncology, or
10    other national medical associations that follow current
11    evidence-based standards of care.
12    (b) An individual or group policy of accident and health
13insurance amended, delivered, issued, or renewed in this State
14after the effective date of this amendatory Act of the 100th
15General Assembly must provide coverage for medically necessary
16expenses for standard fertility preservation services when a
17necessary medical treatment may directly or indirectly cause
18iatrogenic infertility to an enrollee.
19    (c) In determining coverage pursuant to this Section, an
20insurer shall not discriminate based on an individual's
21expected length of life, present or predicted disability,
22degree of medical dependency, quality of life, or other health
23conditions, nor based on personal characteristics, including
24age, sex, sexual orientation, or marital status.
25    (d) If, at any time before or after the effective date of
26this amendatory Act of the 100th General Assembly, the

 

 

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1Secretary of the United States Department of Health and Human
2Services, or its successor agency, promulgates rules or
3regulations to be published in the Federal Register, publishes
4a comment in the Federal Register, or issues an opinion,
5guidance, or other action that would require the State,
6pursuant to any provision of the Patient Protection and
7Affordable Care Act (Pub. L. 111148), including, but not
8limited to, 42 U.S.C. 18031(d)(3)(B) or any successor
9provision, to defray the cost of coverage for fertility
10preservation services, then this Section is inoperative with
11respect to all such coverage other than that authorized under
12Section 1902 of the Social Security Act, 42 U.S.C. 1396a, and
13the State shall not assume any obligation for the cost of
14coverage for fertility preservation services.
 
15    Section 30. The Health Maintenance Organization Act is
16amended by changing Section 5-3 as follows:
 
17    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
18    Sec. 5-3. Insurance Code provisions.
19    (a) Health Maintenance Organizations shall be subject to
20the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
21141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
22154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2, 355.3,
23355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2, 356z.4,
24356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,

 

 

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1356z.13, 356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.21,
2356z.22, 356z.25, 356z.26, 356z.29, 364, 364.01, 367.2,
3367.2-5, 367i, 368a, 368b, 368c, 368d, 368e, 370c, 370c.1, 401,
4401.1, 402, 403, 403A, 408, 408.2, 409, 412, 444, and 444.1,
5paragraph (c) of subsection (2) of Section 367, and Articles
6IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and XXVI of
7the Illinois Insurance Code.
8    (b) For purposes of the Illinois Insurance Code, except for
9Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health
10Maintenance Organizations in the following categories are
11deemed to be "domestic companies":
12        (1) a corporation authorized under the Dental Service
13    Plan Act or the Voluntary Health Services Plans Act;
14        (2) a corporation organized under the laws of this
15    State; or
16        (3) a corporation organized under the laws of another
17    state, 30% or more of the enrollees of which are residents
18    of this State, except a corporation subject to
19    substantially the same requirements in its state of
20    organization as is a "domestic company" under Article VIII
21    1/2 of the Illinois Insurance Code.
22    (c) In considering the merger, consolidation, or other
23acquisition of control of a Health Maintenance Organization
24pursuant to Article VIII 1/2 of the Illinois Insurance Code,
25        (1) the Director shall give primary consideration to
26    the continuation of benefits to enrollees and the financial

 

 

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

 

 

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

 

 

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

 

 

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1profitable experience with respect to the group or enrollment
2unit and the resulting refund to the group or enrollment unit
3or (2) the Health Maintenance Organization's unprofitable
4experience with respect to the group or enrollment unit and the
5resulting additional premium to be paid by the group or
6enrollment unit.
7    In no event shall the Illinois Health Maintenance
8Organization Guaranty Association be liable to pay any
9contractual obligation of an insolvent organization to pay any
10refund authorized under this Section.
11    (g) Rulemaking authority to implement Public Act 95-1045,
12if any, is conditioned on the rules being adopted in accordance
13with all provisions of the Illinois Administrative Procedure
14Act and all rules and procedures of the Joint Committee on
15Administrative Rules; any purported rule not so adopted, for
16whatever reason, is unauthorized.
17(Source: P.A. 99-761, eff. 1-1-18; 100-24, eff. 7-18-17;
18100-138, eff. 8-18-17; revised 10-5-17.)
 
19    Section 35. The Limited Health Service Organization Act is
20amended by changing Section 4003 as follows:
 
21    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
22    Sec. 4003. Illinois Insurance Code provisions. Limited
23health service organizations shall be subject to the provisions
24of Sections 133, 134, 136, 137, 139, 140, 141.1, 141.2, 141.3,

 

 

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1143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5, 154.6,
2154.7, 154.8, 155.04, 155.37, 355.2, 355.3, 355b, 356v,
3356z.10, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 368a,
4401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412, 444, and
5444.1 and Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2,
6XXV, and XXVI of the Illinois Insurance Code. For purposes of
7the Illinois Insurance Code, except for Sections 444 and 444.1
8and Articles XIII and XIII 1/2, limited health service
9organizations in the following categories are deemed to be
10domestic companies:
11        (1) a corporation under the laws of this State; or
12        (2) a corporation organized under the laws of another
13    state, 30% or more of the enrollees of which are residents
14    of this State, except a corporation subject to
15    substantially the same requirements in its state of
16    organization as is a domestic company under Article VIII
17    1/2 of the Illinois Insurance Code.
18(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
19100-201, eff. 8-18-17; revised 10-5-17.)
 
20    Section 40. The Voluntary Health Services Plans Act is
21amended by changing Section 10 as follows:
 
22    (215 ILCS 165/10)  (from Ch. 32, par. 604)
23    Sec. 10. Application of Insurance Code provisions. Health
24services plan corporations and all persons interested therein

 

 

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1or dealing therewith shall be subject to the provisions of
2Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
3143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, 356g,
4356g.5, 356g.5-1, 356r, 356t, 356u, 356v, 356w, 356x, 356y,
5356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9,
6356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18,
7356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 364.01,
8367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412,
9and paragraphs (7) and (15) of Section 367 of the Illinois
10Insurance Code.
11    Rulemaking authority to implement Public Act 95-1045, if
12any, is conditioned on the rules being adopted in accordance
13with all provisions of the Illinois Administrative Procedure
14Act and all rules and procedures of the Joint Committee on
15Administrative Rules; any purported rule not so adopted, for
16whatever reason, is unauthorized.
17(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
18revised 10-5-17.)
 
19    Section 45. The Illinois Public Aid Code is amended by
20changing Section 5-16.8 as follows:
 
21    (305 ILCS 5/5-16.8)
22    Sec. 5-16.8. Required health benefits. The medical
23assistance program shall (i) provide the post-mastectomy care
24benefits required to be covered by a policy of accident and

 

 

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1health insurance under Section 356t and the coverage required
2under Sections 356g.5, 356u, 356w, 356x, 356z.6, 356z.26, and
3356z.29 and 356z.25 of the Illinois Insurance Code and (ii) be
4subject to the provisions of Sections 356z.19, 364.01, 370c,
5and 370c.1 of the Illinois Insurance Code.
6    On and after July 1, 2012, the Department shall reduce any
7rate of reimbursement for services or other payments or alter
8any methodologies authorized by this Code to reduce any rate of
9reimbursement for services or other payments in accordance with
10Section 5-5e.
11    To ensure full access to the benefits set forth in this
12Section, on and after January 1, 2016, the Department shall
13ensure that provider and hospital reimbursement for
14post-mastectomy care benefits required under this Section are
15no lower than the Medicare reimbursement rate.
16(Source: P.A. 99-433, eff. 8-21-15; 99-480, eff. 9-9-15;
1799-642, eff. 7-28-16; 100-138, eff. 8-18-17; revised 1-29-18.)