Full Text of HB2406 102nd General Assembly
HB2406ham001 102ND GENERAL ASSEMBLY | Rep. Sue Scherer Filed: 3/22/2021
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| 1 | | AMENDMENT TO HOUSE BILL 2406
| 2 | | AMENDMENT NO. ______. Amend House Bill 2406 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 5. The Illinois Insurance Code is amended by | 5 | | adding Section 356z.43 as follows: | 6 | | (215 ILCS 5/356z.43 new) | 7 | | Sec. 356z.43. COVID-19 vaccine administrative cost. An | 8 | | individual or group policy of accident and health insurance or | 9 | | managed care plan in effect on and after March 9, 2020 must | 10 | | provide coverage for the cost of administering a COVID-19 | 11 | | vaccination without cost sharing. | 12 | | Section 10. The Health Maintenance Organization Act is | 13 | | amended by changing Section 5-3 as follows:
| 14 | | (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
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| 1 | | Sec. 5-3. Insurance Code provisions.
| 2 | | (a) Health Maintenance Organizations
shall be subject to | 3 | | the provisions of Sections 133, 134, 136, 137, 139, 140, | 4 | | 141.1,
141.2, 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, | 5 | | 154, 154.5, 154.6,
154.7, 154.8, 155.04, 155.22a, 355.2, | 6 | | 355.3, 355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y,
356z.2, | 7 | | 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10, | 8 | | 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.18, | 9 | | 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, | 10 | | 356z.30a, 356z.32, 356z.33, 356z.35, 356z.36, 356z.41, | 11 | | 356z.43, 364, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c, | 12 | | 368d, 368e, 370c,
370c.1, 401, 401.1, 402, 403, 403A,
408, | 13 | | 408.2, 409, 412, 444,
and
444.1,
paragraph (c) of subsection | 14 | | (2) of Section 367, and Articles IIA, VIII 1/2,
XII,
XII 1/2, | 15 | | XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the Illinois | 16 | | Insurance Code.
| 17 | | (b) For purposes of the Illinois Insurance Code, except | 18 | | for Sections 444
and 444.1 and Articles XIII and XIII 1/2, | 19 | | Health Maintenance Organizations in
the following categories | 20 | | are deemed to be "domestic companies":
| 21 | | (1) a corporation authorized under the
Dental Service | 22 | | Plan Act or the Voluntary Health Services Plans Act;
| 23 | | (2) a corporation organized under the laws of this | 24 | | State; or
| 25 | | (3) a corporation organized under the laws of another | 26 | | state, 30% or more
of the enrollees of which are residents |
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| 1 | | of this State, except a
corporation subject to | 2 | | substantially the same requirements in its state of
| 3 | | organization as is a "domestic company" under Article VIII | 4 | | 1/2 of the
Illinois Insurance Code.
| 5 | | (c) In considering the merger, consolidation, or other | 6 | | acquisition of
control of a Health Maintenance Organization | 7 | | pursuant to Article VIII 1/2
of the Illinois Insurance Code,
| 8 | | (1) the Director shall give primary consideration to | 9 | | the continuation of
benefits to enrollees and the | 10 | | financial conditions of the acquired Health
Maintenance | 11 | | Organization after the merger, consolidation, or other
| 12 | | acquisition of control takes effect;
| 13 | | (2)(i) the criteria specified in subsection (1)(b) of | 14 | | Section 131.8 of
the Illinois Insurance Code shall not | 15 | | apply and (ii) the Director, in making
his determination | 16 | | with respect to the merger, consolidation, or other
| 17 | | acquisition of control, need not take into account the | 18 | | effect on
competition of the merger, consolidation, or | 19 | | other acquisition of control;
| 20 | | (3) the Director shall have the power to require the | 21 | | following
information:
| 22 | | (A) certification by an independent actuary of the | 23 | | adequacy
of the reserves of the Health Maintenance | 24 | | Organization sought to be acquired;
| 25 | | (B) pro forma financial statements reflecting the | 26 | | combined balance
sheets of the acquiring company and |
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| 1 | | the Health Maintenance Organization sought
to be | 2 | | acquired as of the end of the preceding year and as of | 3 | | a date 90 days
prior to the acquisition, as well as pro | 4 | | forma financial statements
reflecting projected | 5 | | combined operation for a period of 2 years;
| 6 | | (C) a pro forma business plan detailing an | 7 | | acquiring party's plans with
respect to the operation | 8 | | of the Health Maintenance Organization sought to
be | 9 | | acquired for a period of not less than 3 years; and
| 10 | | (D) such other information as the Director shall | 11 | | require.
| 12 | | (d) The provisions of Article VIII 1/2 of the Illinois | 13 | | Insurance Code
and this Section 5-3 shall apply to the sale by | 14 | | any health maintenance
organization of greater than 10% of its
| 15 | | enrollee population (including without limitation the health | 16 | | maintenance
organization's right, title, and interest in and | 17 | | to its health care
certificates).
| 18 | | (e) In considering any management contract or service | 19 | | agreement subject
to Section 141.1 of the Illinois Insurance | 20 | | Code, the Director (i) shall, in
addition to the criteria | 21 | | specified in Section 141.2 of the Illinois
Insurance Code, | 22 | | take into account the effect of the management contract or
| 23 | | service agreement on the continuation of benefits to enrollees | 24 | | and the
financial condition of the health maintenance | 25 | | organization to be managed or
serviced, and (ii) need not take | 26 | | into account the effect of the management
contract or service |
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| 1 | | agreement on competition.
| 2 | | (f) Except for small employer groups as defined in the | 3 | | Small Employer
Rating, Renewability and Portability Health | 4 | | Insurance Act and except for
medicare supplement policies as | 5 | | defined in Section 363 of the Illinois
Insurance Code, a | 6 | | Health Maintenance Organization may by contract agree with a
| 7 | | group or other enrollment unit to effect refunds or charge | 8 | | additional premiums
under the following terms and conditions:
| 9 | | (i) the amount of, and other terms and conditions with | 10 | | respect to, the
refund or additional premium are set forth | 11 | | in the group or enrollment unit
contract agreed in advance | 12 | | of the period for which a refund is to be paid or
| 13 | | additional premium is to be charged (which period shall | 14 | | not be less than one
year); and
| 15 | | (ii) the amount of the refund or additional premium | 16 | | shall not exceed 20%
of the Health Maintenance | 17 | | Organization's profitable or unprofitable experience
with | 18 | | respect to the group or other enrollment unit for the | 19 | | period (and, for
purposes of a refund or additional | 20 | | premium, the profitable or unprofitable
experience shall | 21 | | be calculated taking into account a pro rata share of the
| 22 | | Health Maintenance Organization's administrative and | 23 | | marketing expenses, but
shall not include any refund to be | 24 | | made or additional premium to be paid
pursuant to this | 25 | | subsection (f)). The Health Maintenance Organization and | 26 | | the
group or enrollment unit may agree that the profitable |
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| 1 | | or unprofitable
experience may be calculated taking into | 2 | | account the refund period and the
immediately preceding 2 | 3 | | plan years.
| 4 | | The Health Maintenance Organization shall include a | 5 | | statement in the
evidence of coverage issued to each enrollee | 6 | | describing the possibility of a
refund or additional premium, | 7 | | and upon request of any group or enrollment unit,
provide to | 8 | | the group or enrollment unit a description of the method used | 9 | | to
calculate (1) the Health Maintenance Organization's | 10 | | profitable experience with
respect to the group or enrollment | 11 | | unit and the resulting refund to the group
or enrollment unit | 12 | | or (2) the Health Maintenance Organization's unprofitable
| 13 | | experience with respect to the group or enrollment unit and | 14 | | the resulting
additional premium to be paid by the group or | 15 | | enrollment unit.
| 16 | | In no event shall the Illinois Health Maintenance | 17 | | Organization
Guaranty Association be liable to pay any | 18 | | contractual obligation of an
insolvent organization to pay any | 19 | | refund authorized under this Section.
| 20 | | (g) Rulemaking authority to implement Public Act 95-1045, | 21 | | if any, is conditioned on the rules being adopted in | 22 | | accordance with all provisions of the Illinois Administrative | 23 | | Procedure Act and all rules and procedures of the Joint | 24 | | Committee on Administrative Rules; any purported rule not so | 25 | | adopted, for whatever reason, is unauthorized. | 26 | | (Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; |
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| 1 | | 100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff. | 2 | | 1-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81, | 3 | | eff. 7-12-19; 101-281, eff. 1-1-20; 101-371, eff. 1-1-20; | 4 | | 101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff. | 5 | | 1-1-20; 101-625, eff. 1-1-21 .) | 6 | | Section 15. The Voluntary Health Services Plans Act is | 7 | | amended by changing Section 10 as follows:
| 8 | | (215 ILCS 165/10) (from Ch. 32, par. 604)
| 9 | | Sec. 10. Application of Insurance Code provisions. Health | 10 | | services
plan corporations and all persons interested therein | 11 | | or dealing therewith
shall be subject to the provisions of | 12 | | Articles IIA and XII 1/2 and Sections
3.1, 133, 136, 139, 140, | 13 | | 143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, | 14 | | 356g, 356g.5, 356g.5-1, 356r, 356t, 356u, 356v,
356w, 356x, | 15 | | 356y, 356z.1, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, | 16 | | 356z.9,
356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, | 17 | | 356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, | 18 | | 356z.30, 356z.30a, 356z.32, 356z.33, 356z.41, 356z.43, 364.01, | 19 | | 367.2, 368a, 401, 401.1,
402,
403, 403A, 408,
408.2, and 412, | 20 | | and paragraphs (7) and (15) of Section 367 of the Illinois
| 21 | | Insurance Code.
| 22 | | Rulemaking authority to implement Public Act 95-1045, if | 23 | | any, is conditioned on the rules being adopted in accordance | 24 | | with all provisions of the Illinois Administrative Procedure |
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| 1 | | Act and all rules and procedures of the Joint Committee on | 2 | | Administrative Rules; any purported rule not so adopted, for | 3 | | whatever reason, is unauthorized. | 4 | | (Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; | 5 | | 100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff. | 6 | | 1-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81, | 7 | | eff. 7-12-19; 101-281, eff. 1-1-20; 101-393, eff. 1-1-20; | 8 | | 101-625, eff. 1-1-21 .) | 9 | | Section 20. The Illinois Public Aid Code is amended by | 10 | | changing Section 5-16.8 as follows:
| 11 | | (305 ILCS 5/5-16.8)
| 12 | | Sec. 5-16.8. Required health benefits. The medical | 13 | | assistance program
shall
(i) provide the post-mastectomy care | 14 | | benefits required to be covered by a policy of
accident and | 15 | | health insurance under Section 356t and the coverage required
| 16 | | under Sections 356g.5, 356u, 356w, 356x, 356z.6, 356z.26, | 17 | | 356z.29, 356z.32, 356z.33, 356z.34, and 356z.35 , and 356z.43 | 18 | | of the Illinois
Insurance Code and (ii) be subject to the | 19 | | provisions of Sections 356z.19, 364.01, 370c, and 370c.1 of | 20 | | the Illinois
Insurance Code.
| 21 | | The Department, by rule, shall adopt a model similar to | 22 | | the requirements of Section 356z.39 of the Illinois Insurance | 23 | | Code. | 24 | | On and after July 1, 2012, the Department shall reduce any |
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| 1 | | rate of reimbursement for services or other payments or alter | 2 | | any methodologies authorized by this Code to reduce any rate | 3 | | of reimbursement for services or other payments in accordance | 4 | | with Section 5-5e. | 5 | | To ensure full access to the benefits set forth in this | 6 | | Section, on and after January 1, 2016, the Department shall | 7 | | ensure that provider and hospital reimbursement for | 8 | | post-mastectomy care benefits required under this Section are | 9 | | no lower than the Medicare reimbursement rate. | 10 | | (Source: P.A. 100-138, eff. 8-18-17; 100-863, eff. 8-14-18; | 11 | | 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff. | 12 | | 7-12-19; 101-218, eff. 1-1-20; 101-281, eff. 1-1-20; 101-371, | 13 | | eff. 1-1-20; 101-574, eff. 1-1-20; 101-649, eff. 7-7-20.)".
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