Full Text of SB0647 98th General Assembly
SB0647enr 98TH GENERAL ASSEMBLY |
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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 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.22 of the
Illinois | 16 | | Insurance Code.
The program of health benefits must comply with | 17 | | Sections 155.22a, 155.37, 355b, and 356z.19 of the
Illinois | 18 | | Insurance Code.
| 19 | | Rulemaking authority to implement Public Act 95-1045, if | 20 | | any, is conditioned on the rules being adopted in accordance | 21 | | with all provisions of the Illinois Administrative Procedure | 22 | | Act and all rules and procedures of the Joint Committee on | 23 | | Administrative Rules; any purported rule not so adopted, for |
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| 1 | | whatever reason, is unauthorized. | 2 | | (Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-813, | 3 | | eff. 7-13-12; 98-189, eff. 1-1-14.) | 4 | | Section 10. The Counties Code is amended by changing | 5 | | Section 5-1069.3 as follows: | 6 | | (55 ILCS 5/5-1069.3)
| 7 | | Sec. 5-1069.3. Required health benefits. If a county, | 8 | | including a home
rule
county, is a self-insurer for purposes of | 9 | | providing health insurance coverage
for its employees, the | 10 | | coverage shall include coverage for the post-mastectomy
care | 11 | | benefits required to be covered by a policy of accident and | 12 | | health
insurance under Section 356t and the coverage required | 13 | | under Sections 356g, 356g.5, 356g.5-1, 356u,
356w, 356x, | 14 | | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, | 15 | | 356z.14, and 356z.15 , and 356z.22 of
the Illinois Insurance | 16 | | Code. The coverage shall comply with Sections 155.22a, 355b, | 17 | | and 356z.19 of
the Illinois Insurance Code. The requirement | 18 | | that health benefits be covered
as provided in this Section is | 19 | | an
exclusive power and function of the State and is a denial | 20 | | and limitation under
Article VII, Section 6, subsection (h) of | 21 | | the Illinois Constitution. A home
rule county to which this | 22 | | Section applies must comply with every provision of
this | 23 | | Section.
| 24 | | Rulemaking authority to implement Public Act 95-1045, if |
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| 1 | | any, is conditioned on the rules being adopted in accordance | 2 | | with all provisions of the Illinois Administrative Procedure | 3 | | Act and all rules and procedures of the Joint Committee on | 4 | | Administrative Rules; any purported rule not so adopted, for | 5 | | whatever reason, is unauthorized. | 6 | | (Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-813, | 7 | | eff. 7-13-12; 98-189, eff. 1-1-14.) | 8 | | Section 15. The Illinois Municipal Code is amended by | 9 | | changing 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 | 12 | | municipality, including a
home rule municipality, is a | 13 | | self-insurer for purposes of providing health
insurance | 14 | | coverage for its employees, the coverage shall include coverage | 15 | | for
the post-mastectomy care benefits required to be covered by | 16 | | a policy of
accident and health insurance under Section 356t | 17 | | and the coverage required
under Sections 356g, 356g.5, | 18 | | 356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10, | 19 | | 356z.11, 356z.12, 356z.13, 356z.14, and 356z.15 , and 356z.22 of | 20 | | the Illinois
Insurance
Code. The coverage shall comply with | 21 | | Sections 155.22a, 355b, and 356z.19 of
the Illinois Insurance | 22 | | Code. The requirement that health
benefits be covered as | 23 | | provided in this is an exclusive power and function of
the | 24 | | State and is a denial and limitation under Article VII, Section |
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| 1 | | 6,
subsection (h) of the Illinois Constitution. A home rule | 2 | | municipality to which
this Section applies must comply with | 3 | | every provision of this Section.
| 4 | | Rulemaking authority to implement Public Act 95-1045, if | 5 | | any, is conditioned on the rules being adopted in accordance | 6 | | with all provisions of the Illinois Administrative Procedure | 7 | | Act and all rules and procedures of the Joint Committee on | 8 | | Administrative Rules; any purported rule not so adopted, for | 9 | | whatever reason, is unauthorized. | 10 | | (Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-813, | 11 | | eff. 7-13-12; 98-189, eff. 1-1-14.) | 12 | | Section 20. The School Code is amended by changing Section | 13 | | 10-22.3f as follows: | 14 | | (105 ILCS 5/10-22.3f)
| 15 | | Sec. 10-22.3f. Required health benefits. Insurance | 16 | | protection and
benefits
for employees shall provide the | 17 | | post-mastectomy care benefits required to be
covered by a | 18 | | policy of accident and health insurance under Section 356t and | 19 | | the
coverage required under Sections 356g, 356g.5, 356g.5-1, | 20 | | 356u, 356w, 356x,
356z.6, 356z.8, 356z.9, 356z.11, 356z.12, | 21 | | 356z.13, 356z.14, and 356z.15 , and 356z.22 of
the
Illinois | 22 | | Insurance Code.
Insurance policies shall comply with Section | 23 | | 356z.19 of the Illinois Insurance Code. The coverage shall | 24 | | comply with Sections 155.22a and 355b of
the Illinois Insurance |
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| 1 | | Code.
| 2 | | Rulemaking authority to implement Public Act 95-1045, if | 3 | | any, is conditioned on the rules being adopted in accordance | 4 | | with all provisions of the Illinois Administrative Procedure | 5 | | Act and all rules and procedures of the Joint Committee on | 6 | | Administrative Rules; any purported rule not so adopted, for | 7 | | whatever reason, is unauthorized. | 8 | | (Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-813, | 9 | | eff. 7-13-12; 98-189, eff. 1-1-14.) | 10 | | Section 25. The Illinois Insurance Code is amended by | 11 | | adding Section 356z.22 as follows: | 12 | | (215 ILCS 5/356z.22 new) | 13 | | Sec. 356z.22. Coverage for telehealth services. | 14 | | (a) For purposes of this Section: | 15 | | "Distant site" means the location at which the health | 16 | | care provider rendering the telehealth service is located. | 17 | | "Interactive telecommunications system" means an audio | 18 | | and video system permitting 2-way, live interactive | 19 | | communication between the patient and the distant site | 20 | | health care provider. | 21 | | "Telehealth services" means the delivery of covered | 22 | | health care services by way of an interactive | 23 | | telecommunications system. | 24 | | (b) If an individual or group policy of accident or health |
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| 1 | | insurance provides coverage for telehealth services, then it | 2 | | must comply with the following: | 3 | | (1) An individual or group policy of accident or health | 4 | | insurance providing telehealth services may not: | 5 | | (A) require that in-person contact occur between a | 6 | | health care provider and a patient; | 7 | | (B) require the health care provider to document a | 8 | | barrier to an in-person consultation for coverage of | 9 | | services to be provided through telehealth; | 10 | | (C) require the use of telehealth when the health | 11 | | care provider has determined that it is not | 12 | | appropriate; or | 13 | | (D) require the use of telehealth when a patient | 14 | | chooses an in-person consultation. | 15 | | (2) Deductibles, copayments, or coinsurance applicable | 16 | | to services provided through telehealth shall not exceed | 17 | | the deductibles, copayments, or coinsurance required by | 18 | | the individual or group policy of accident or health | 19 | | insurance for the same services provided through in-person | 20 | | consultation. | 21 | | (c) Nothing in this Section shall be deemed as precluding a | 22 | | health insurer from providing benefits for other services, | 23 | | including, but not limited to, remote monitoring services, | 24 | | other monitoring services, or oral communications otherwise | 25 | | covered under the policy. |
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| 1 | | Section 30. The Health Maintenance Organization Act is | 2 | | amended by changing Section 5-3 as follows:
| 3 | | (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
| 4 | | Sec. 5-3. Insurance Code provisions.
| 5 | | (a) Health Maintenance Organizations
shall be subject to | 6 | | the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
| 7 | | 141.2, 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, 154, | 8 | | 154.5, 154.6,
154.7, 154.8, 155.04, 155.22a, 355.2, 355.3, | 9 | | 355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y,
356z.2, 356z.4, | 10 | | 356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, | 11 | | 356z.13, 356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.21, | 12 | | 356z.22, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c, 368d, | 13 | | 368e, 370c,
370c.1, 401, 401.1, 402, 403, 403A,
408, 408.2, | 14 | | 409, 412, 444,
and
444.1,
paragraph (c) of subsection (2) of | 15 | | Section 367, and Articles IIA, VIII 1/2,
XII,
XII 1/2, XIII, | 16 | | XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.
| 17 | | (b) For purposes of the Illinois Insurance Code, except for | 18 | | Sections 444
and 444.1 and Articles XIII and XIII 1/2, Health | 19 | | Maintenance Organizations in
the following categories are | 20 | | 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 |
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| 1 | | state, 30% or more
of the enrollees of which are residents | 2 | | of this State, except a
corporation subject to | 3 | | substantially the same requirements in its state of
| 4 | | organization as is a "domestic company" under Article VIII | 5 | | 1/2 of the
Illinois Insurance Code.
| 6 | | (c) In considering the merger, consolidation, or other | 7 | | acquisition of
control of a Health Maintenance Organization | 8 | | pursuant to Article VIII 1/2
of the Illinois Insurance Code,
| 9 | | (1) the Director shall give primary consideration to | 10 | | the continuation of
benefits to enrollees and the financial | 11 | | conditions of the acquired Health
Maintenance Organization | 12 | | after the merger, consolidation, or other
acquisition of | 13 | | control takes effect;
| 14 | | (2)(i) the criteria specified in subsection (1)(b) of | 15 | | Section 131.8 of
the Illinois Insurance Code shall not | 16 | | apply and (ii) the Director, in making
his determination | 17 | | with respect to the merger, consolidation, or other
| 18 | | acquisition of control, need not take into account the | 19 | | effect on
competition of the merger, consolidation, or | 20 | | other acquisition of control;
| 21 | | (3) the Director shall have the power to require the | 22 | | following
information:
| 23 | | (A) certification by an independent actuary of the | 24 | | adequacy
of the reserves of the Health Maintenance | 25 | | Organization sought to be acquired;
| 26 | | (B) pro forma financial statements reflecting the |
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| 1 | | combined balance
sheets of the acquiring company and | 2 | | the Health Maintenance Organization sought
to be | 3 | | acquired as of the end of the preceding year and as of | 4 | | a date 90 days
prior to the acquisition, as well as pro | 5 | | forma financial statements
reflecting projected | 6 | | combined operation for a period of 2 years;
| 7 | | (C) a pro forma business plan detailing an | 8 | | acquiring party's plans with
respect to the operation | 9 | | of the Health Maintenance Organization sought to
be | 10 | | acquired for a period of not less than 3 years; and
| 11 | | (D) such other information as the Director shall | 12 | | require.
| 13 | | (d) The provisions of Article VIII 1/2 of the Illinois | 14 | | Insurance Code
and this Section 5-3 shall apply to the sale by | 15 | | any health maintenance
organization of greater than 10% of its
| 16 | | enrollee population (including without limitation the health | 17 | | maintenance
organization's right, title, and interest in and to | 18 | | its health care
certificates).
| 19 | | (e) In considering any management contract or service | 20 | | agreement subject
to Section 141.1 of the Illinois Insurance | 21 | | Code, the Director (i) shall, in
addition to the criteria | 22 | | specified in Section 141.2 of the Illinois
Insurance Code, take | 23 | | into account the effect of the management contract or
service | 24 | | agreement on the continuation of benefits to enrollees and the
| 25 | | financial condition of the health maintenance organization to | 26 | | be managed or
serviced, and (ii) need not take into account the |
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| 1 | | effect of the management
contract or service agreement on | 2 | | competition.
| 3 | | (f) Except for small employer groups as defined in the | 4 | | Small Employer
Rating, Renewability and Portability Health | 5 | | Insurance Act and except for
medicare supplement policies as | 6 | | defined in Section 363 of the Illinois
Insurance Code, a Health | 7 | | Maintenance Organization may by contract agree with a
group or | 8 | | other enrollment unit to effect refunds or charge additional | 9 | | premiums
under the following terms and conditions:
| 10 | | (i) the amount of, and other terms and conditions with | 11 | | respect to, the
refund or additional premium are set forth | 12 | | in the group or enrollment unit
contract agreed in advance | 13 | | of the period for which a refund is to be paid or
| 14 | | additional premium is to be charged (which period shall not | 15 | | be less than one
year); and
| 16 | | (ii) the amount of the refund or additional premium | 17 | | shall not exceed 20%
of the Health Maintenance | 18 | | Organization's profitable or unprofitable experience
with | 19 | | respect to the group or other enrollment unit for the | 20 | | period (and, for
purposes of a refund or additional | 21 | | premium, the profitable or unprofitable
experience shall | 22 | | be calculated taking into account a pro rata share of the
| 23 | | Health Maintenance Organization's administrative and | 24 | | marketing expenses, but
shall not include any refund to be | 25 | | made or additional premium to be paid
pursuant to this | 26 | | subsection (f)). The Health Maintenance Organization and |
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| 1 | | the
group or enrollment unit may agree that the profitable | 2 | | or unprofitable
experience may be calculated taking into | 3 | | account the refund period and the
immediately preceding 2 | 4 | | plan years.
| 5 | | The Health Maintenance Organization shall include a | 6 | | statement in the
evidence of coverage issued to each enrollee | 7 | | describing the possibility of a
refund or additional premium, | 8 | | and upon request of any group or enrollment unit,
provide to | 9 | | the group or enrollment unit a description of the method used | 10 | | to
calculate (1) the Health Maintenance Organization's | 11 | | profitable experience with
respect to the group or enrollment | 12 | | unit and the resulting refund to the group
or enrollment unit | 13 | | or (2) the Health Maintenance Organization's unprofitable
| 14 | | experience with respect to the group or enrollment unit and the | 15 | | resulting
additional premium to be paid by the group or | 16 | | enrollment unit.
| 17 | | In no event shall the Illinois Health Maintenance | 18 | | Organization
Guaranty Association be liable to pay any | 19 | | contractual obligation of an
insolvent organization to pay any | 20 | | refund authorized under this Section.
| 21 | | (g) Rulemaking authority to implement Public Act 95-1045, | 22 | | if any, is conditioned on the rules being adopted in accordance | 23 | | with all provisions of the Illinois Administrative Procedure | 24 | | Act and all rules and procedures of the Joint Committee on | 25 | | Administrative Rules; any purported rule not so adopted, for | 26 | | whatever reason, is unauthorized. |
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| 1 | | (Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-437, | 2 | | eff. 8-18-11; 97-486, eff. 1-1-12; 97-592, eff. 1-1-12; 97-805, | 3 | | eff. 1-1-13; 97-813, eff. 7-13-12; 98-189, eff. 1-1-14.) | 4 | | Section 35. The Limited Health Service Organization Act is | 5 | | amended by changing Section 4003 as follows:
| 6 | | (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
| 7 | | Sec. 4003. Illinois Insurance Code provisions. Limited | 8 | | health service
organizations shall be subject to the provisions | 9 | | of Sections 133, 134, 136, 137, 139,
140, 141.1, 141.2, 141.3, | 10 | | 143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5,
154.6, | 11 | | 154.7, 154.8, 155.04, 155.37, 355.2, 355.3, 355b, 356v, | 12 | | 356z.10, 356z.21, 356z.22, 368a, 401, 401.1,
402,
403, 403A, | 13 | | 408,
408.2, 409, 412, 444, and 444.1 and Articles IIA, VIII | 14 | | 1/2, XII, XII 1/2,
XIII,
XIII 1/2, XXV, and XXVI of the | 15 | | Illinois Insurance Code. For purposes of the
Illinois Insurance | 16 | | Code, except for Sections 444 and 444.1 and Articles XIII
and | 17 | | XIII 1/2, limited health service organizations in the following | 18 | | categories
are deemed to be domestic companies:
| 19 | | (1) a corporation under the laws of this State; or
| 20 | | (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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| 1 | | 1/2 of the Illinois Insurance Code.
| 2 | | (Source: P.A. 97-486, eff. 1-1-12; 97-592, 1-1-12; 97-805, eff. | 3 | | 1-1-13; 97-813, eff. 7-13-12; 98-189, eff. 1-1-14.)
| 4 | | Section 40. The Voluntary Health Services Plans Act is | 5 | | amended by changing Section 10 as follows:
| 6 | | (215 ILCS 165/10) (from Ch. 32, par. 604)
| 7 | | Sec. 10. Application of Insurance Code provisions. Health | 8 | | services
plan corporations and all persons interested therein | 9 | | or dealing therewith
shall be subject to the provisions of | 10 | | Articles IIA and XII 1/2 and Sections
3.1, 133, 136, 139, 140, | 11 | | 143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, 356g, | 12 | | 356g.5, 356g.5-1, 356r, 356t, 356u, 356v,
356w, 356x, 356y, | 13 | | 356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9,
| 14 | | 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18, | 15 | | 356z.19, 356z.21, 356z.22, 364.01, 367.2, 368a, 401, 401.1,
| 16 | | 402,
403, 403A, 408,
408.2, and 412, and paragraphs (7) and | 17 | | (15) of Section 367 of the Illinois
Insurance Code.
| 18 | | Rulemaking authority to implement Public Act 95-1045, if | 19 | | any, is conditioned on the rules being adopted in accordance | 20 | | with all provisions of the Illinois Administrative Procedure | 21 | | Act and all rules and procedures of the Joint Committee on | 22 | | Administrative Rules; any purported rule not so adopted, for | 23 | | whatever reason, is unauthorized. | 24 | | (Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-486, |
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| 1 | | eff. 1-1-12; 97-592, eff. 1-1-12; 97-805, eff. 1-1-13; 97-813, | 2 | | eff. 7-13-12; 98-189, eff. 1-1-14.)
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