Full Text of HB3794 102nd General Assembly
HB3794eng 102ND 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 | 9 | | provide the post-mastectomy care benefits required to be | 10 | | covered
by a policy of accident and health insurance under | 11 | | Section 356t of the Illinois
Insurance Code. The program of | 12 | | health benefits shall provide the coverage
required under | 13 | | Sections 356g, 356g.5, 356g.5-1, 356m,
356u, 356w, 356x, | 14 | | 356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, | 15 | | 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22, | 16 | | 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, | 17 | | 356z.36, and 356z.41 , and 356z.43 of the
Illinois Insurance | 18 | | Code.
The program of health benefits must comply with Sections | 19 | | 155.22a, 155.37, 355b, 356z.19, 370c, and 370c.1 and Article | 20 | | XXXIIB of the
Illinois Insurance Code. The Department of | 21 | | Insurance shall enforce the requirements of this Section with | 22 | | respect to Sections 370c and 370c.1 of the Illinois Insurance | 23 | | Code; all other requirements of this Section shall be enforced |
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| 1 | | by the Department of Central Management Services.
| 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. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; | 9 | | 100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff. | 10 | | 1-1-19; 100-1102, eff. 1-1-19; 100-1170, eff. 6-1-19; 101-13, | 11 | | eff. 6-12-19; 101-281, eff. 1-1-20; 101-393, eff. 1-1-20; | 12 | | 101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff. | 13 | | 1-1-21 .) | 14 | | Section 10. The Counties Code is amended by changing | 15 | | Section 5-1069.3 as follows: | 16 | | (55 ILCS 5/5-1069.3)
| 17 | | Sec. 5-1069.3. Required health benefits. If a county, | 18 | | including a home
rule
county, is a self-insurer for purposes | 19 | | of providing health insurance coverage
for its employees, the | 20 | | coverage shall include coverage for the post-mastectomy
care | 21 | | benefits required to be covered by a policy of accident and | 22 | | health
insurance under Section 356t and the coverage required | 23 | | under Sections 356g, 356g.5, 356g.5-1, 356u,
356w, 356x, | 24 | | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, |
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| 1 | | 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29, | 2 | | 356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41 , and 356z.43 | 3 | | of
the Illinois Insurance Code. The coverage shall comply with | 4 | | Sections 155.22a, 355b, 356z.19, and 370c of
the Illinois | 5 | | Insurance Code. The Department of Insurance shall enforce the | 6 | | requirements of this Section. The requirement that health | 7 | | benefits be covered
as provided in this Section is an
| 8 | | exclusive power and function of the State and is a denial and | 9 | | limitation under
Article VII, Section 6, subsection (h) of the | 10 | | Illinois Constitution. A home
rule county to which this | 11 | | Section applies must comply with every provision of
this | 12 | | 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. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; | 20 | | 100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff. | 21 | | 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281, | 22 | | eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20; | 23 | | 101-625, eff. 1-1-21 .) | 24 | | Section 15. The Illinois Municipal Code is amended by | 25 | | changing Section 10-4-2.3 as follows: |
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| 1 | | (65 ILCS 5/10-4-2.3)
| 2 | | Sec. 10-4-2.3. Required health benefits. If a | 3 | | municipality, including a
home rule municipality, is a | 4 | | self-insurer for purposes of providing health
insurance | 5 | | coverage for its employees, the coverage shall include | 6 | | coverage for
the post-mastectomy care benefits required to be | 7 | | covered by a policy of
accident and health insurance under | 8 | | Section 356t and the coverage required
under Sections 356g, | 9 | | 356g.5, 356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, | 10 | | 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, | 11 | | 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, | 12 | | 356z.36, and 356z.41 , and 356z.43 of the Illinois
Insurance
| 13 | | Code. The coverage shall comply with Sections 155.22a, 355b, | 14 | | 356z.19, and 370c of
the Illinois Insurance Code. The | 15 | | Department of Insurance shall enforce the requirements of this | 16 | | Section. The requirement that health
benefits be covered as | 17 | | provided in this is an exclusive power and function of
the | 18 | | State and is a denial and limitation under Article VII, | 19 | | Section 6,
subsection (h) of the Illinois Constitution. A home | 20 | | rule municipality to which
this Section applies must comply | 21 | | with every provision of this Section.
| 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 | 25 | | Act and all rules and procedures of the Joint Committee on |
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| 1 | | Administrative Rules; any purported rule not so adopted, for | 2 | | whatever reason, is unauthorized. | 3 | | (Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; | 4 | | 100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff. | 5 | | 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281, | 6 | | eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20; | 7 | | 101-625, eff. 1-1-21 .) | 8 | | Section 20. The School Code is amended by changing Section | 9 | | 10-22.3f as follows: | 10 | | (105 ILCS 5/10-22.3f)
| 11 | | Sec. 10-22.3f. Required health benefits. Insurance | 12 | | protection and
benefits
for employees shall provide the | 13 | | post-mastectomy care benefits required to be
covered by a | 14 | | policy of accident and health insurance under Section 356t and | 15 | | the
coverage required under Sections 356g, 356g.5, 356g.5-1, | 16 | | 356u, 356w, 356x,
356z.6, 356z.8, 356z.9, 356z.11, 356z.12, | 17 | | 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29, | 18 | | 356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41 , and 356z.43 | 19 | | of
the
Illinois Insurance Code.
Insurance policies shall | 20 | | comply with Section 356z.19 of the Illinois Insurance Code. | 21 | | The coverage shall comply with Sections 155.22a, 355b, and | 22 | | 370c of
the Illinois Insurance Code. The Department of | 23 | | Insurance shall enforce the requirements of this 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. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; | 7 | | 100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff. | 8 | | 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281, | 9 | | eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20; | 10 | | 101-625, eff. 1-1-21 .) | 11 | | Section 25. The Illinois Insurance Code is amended by | 12 | | changing Section 356w and by adding Section 356z.43 as | 13 | | follows:
| 14 | | (215 ILCS 5/356w)
| 15 | | Sec. 356w. Diabetes self-management training and | 16 | | education.
| 17 | | (a) A group policy of accident and health insurance that | 18 | | is amended,
delivered,
issued, or renewed after the
effective | 19 | | date of this amendatory Act of 1998 shall provide coverage for
| 20 | | outpatient self-management
training and education, equipment, | 21 | | and supplies, as set forth in this Section,
for the treatment | 22 | | of type 1 diabetes, type 2 diabetes, and gestational diabetes
| 23 | | mellitus.
| 24 | | (b) As used in this Section:
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| 1 | | "Diabetes self-management training"
means instruction in | 2 | | an outpatient setting
which enables a diabetic patient to | 3 | | understand the diabetic management process
and daily | 4 | | management of
diabetic therapy as a means of avoiding frequent | 5 | | hospitalization and
complications. Diabetes self-management | 6 | | training shall include
the content areas listed in the | 7 | | National Standards for Diabetes Self-Management
Education | 8 | | Programs as published by the American Diabetes Association, | 9 | | including
medical nutrition therapy and education programs, as | 10 | | defined by the contract of insurance, that allow the patient | 11 | | to maintain an A1c level within the range identified in | 12 | | nationally recognized standards of care.
| 13 | | "Medical nutrition therapy" shall have the meaning
| 14 | | ascribed to that term in the Dietitian Nutritionist
Practice | 15 | | Act.
| 16 | | "Physician" means a
physician licensed to practice | 17 | | medicine in all of
its branches providing care to the | 18 | | individual.
| 19 | | "Qualified provider" for an
individual that is enrolled | 20 | | in:
| 21 | | (1) a health maintenance organization that uses a
| 22 | | primary
care physician to
control access to specialty care | 23 | | means (A) the individual's primary care
physician licensed | 24 | | to practice
medicine in all of its branches, (B) a | 25 | | physician licensed to practice
medicine in all of its | 26 | | branches to
whom the individual has been referred by the |
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| 1 | | primary care physician, or (C) a
certified, registered, or
| 2 | | licensed network health care professional with expertise | 3 | | in diabetes management
to whom the individual
has been | 4 | | referred by the primary care physician.
| 5 | | (2) an insurance plan
means (A) a physician licensed | 6 | | to practice medicine in
all of its branches or (B) a
| 7 | | certified, registered, or licensed health care | 8 | | professional with expertise in
diabetes management to whom | 9 | | the individual has been referred by a physician.
| 10 | | (c) Coverage under this Section for diabetes | 11 | | self-management training,
including medical nutrition
| 12 | | education, shall be limited to the following:
| 13 | | (1) Up to 3 medically necessary visits to a qualified | 14 | | provider upon
initial diagnosis of diabetes
by the | 15 | | patient's
physician or, if diagnosis of diabetes was made | 16 | | within one year prior to the
effective date of
this | 17 | | amendatory Act
of 1998 where the insured was a covered | 18 | | individual, up to 3 medically necessary
visits to a | 19 | | qualified provider within one
year after that
effective
| 20 | | date.
| 21 | | (2) Up to 2 medically necessary visits to a qualified | 22 | | provider upon a
determination by a
patient's
physician | 23 | | that a significant change in the patient's symptoms or | 24 | | medical
condition has
occurred. A "significant change" in | 25 | | condition means symptomatic
hyperglycemia (greater than | 26 | | 250 mg/dl on repeated occasions), severe
hypoglycemia |
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| 1 | | (requiring the assistance of another person), onset or | 2 | | progression
of diabetes, or a significant change in | 3 | | medical condition that would require a
significantly | 4 | | different treatment regimen.
| 5 | | Payment by the insurer or health maintenance organization | 6 | | for the coverage
required for diabetes self-management | 7 | | training pursuant to the provisions of
this Section is only | 8 | | required to be made for services provided.
No coverage is | 9 | | required for additional visits beyond those specified in items
| 10 | | (1) and (2) of this subsection.
| 11 | | Coverage under this subsection (c) for diabetes | 12 | | self-management training
shall
be subject to the same
| 13 | | deductible, co-payment, and co-insurance provisions that apply | 14 | | to coverage
under
the policy for other
services provided by | 15 | | the same type of provider.
| 16 | | (d) Coverage shall be provided for the following
equipment | 17 | | when medically necessary
and prescribed by a physician | 18 | | licensed to practice medicine in all
of its branches.
Coverage | 19 | | for the following items shall be subject to deductible, | 20 | | co-payment
and co-insurance provisions
provided for under the | 21 | | policy or a durable medical equipment rider to the
policy:
| 22 | | (1) blood glucose monitors;
| 23 | | (2) blood glucose monitors for the legally blind;
| 24 | | (3) cartridges for the legally blind; and
| 25 | | (4) lancets and lancing devices.
| 26 | | This subsection does not apply to a group policy of |
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| 1 | | accident and health
insurance that does not provide a durable | 2 | | medical equipment benefit.
| 3 | | (e) Coverage shall be provided for the following | 4 | | pharmaceuticals and
supplies when
medically necessary and | 5 | | prescribed by a physician licensed to
practice medicine in all | 6 | | of its
branches.
Coverage for the following items shall be | 7 | | subject to the same coverage,
deductible,
co-payment, and | 8 | | co-insurance
provisions under the policy or a drug rider to | 9 | | the policy, except as otherwise provided for under Sections | 10 | | Section 356z.41 and 356z.43 :
| 11 | | (1) insulin;
| 12 | | (2) syringes and needles;
| 13 | | (3) test strips for glucose monitors;
| 14 | | (4) FDA approved oral agents used to control blood | 15 | | sugar; and
| 16 | | (5) glucagon emergency kits.
| 17 | | This subsection does not apply to a group policy of | 18 | | accident and health
insurance that does not provide a drug | 19 | | benefit.
| 20 | | (f) Coverage shall be provided for regular foot care exams | 21 | | by a
physician or by a
physician to whom a physician has | 22 | | referred the patient. Coverage
for regular foot care exams
| 23 | | shall be subject to the same deductible, co-payment, and | 24 | | co-insurance
provisions
that apply under the policy for
other | 25 | | services provided by the same type of provider.
| 26 | | (g) If authorized by a physician, diabetes self-management
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| 1 | | training may be provided as a part of an office visit, group | 2 | | setting, or home
visit.
| 3 | | (h) This Section shall not apply to agreements, contracts, | 4 | | or policies that
provide coverage for a specified diagnosis or | 5 | | other limited benefit coverage.
| 6 | | (Source: P.A. 101-625, eff. 1-1-21 .)
| 7 | | (215 ILCS 5/356z.43 new) | 8 | | Sec. 356z.43. Cost sharing in diabetic self-management | 9 | | supplies; limits; confidentiality of rebate information. | 10 | | (a) As used in this Section, "diabetic self-management | 11 | | supplies" means items determined to be medically necessary for | 12 | | a person with diabetes for diabetic self-management, including | 13 | | blood test strips for glucose monitors and the monthly lease | 14 | | of an insulin pump. "Diabetic self-management supplies" do not | 15 | | include insulin drugs. | 16 | | (b) This Section applies to a group or individual policy | 17 | | of accident and health insurance amended, delivered, issued, | 18 | | or renewed on or after the effective date of this amendatory | 19 | | Act of the 102nd General Assembly. | 20 | | (c) An insurer that provides coverage for diabetic | 21 | | self-management supplies pursuant to the terms of a health | 22 | | coverage plan the insurer offers shall limit the total amount | 23 | | that an insured is required to pay for a 30-day supply of | 24 | | diabetic self-management supplies at an amount not to exceed | 25 | | $100, regardless of the quantity or type of diabetic |
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| 1 | | self-management supplies required by an insured with diabetes | 2 | | for diabetic self-management. | 3 | | (d) Nothing in this Section prevents an insurer from | 4 | | reducing an insured's cost sharing by an amount greater than | 5 | | the amount specified in subsection (c). | 6 | | (e) The Director may use any of the Director's enforcement | 7 | | powers to obtain an insurer's compliance with this Section. | 8 | | (f) The Department may adopt rules as necessary to | 9 | | implement and administer this Section and to align it with | 10 | | federal requirements. | 11 | | (g) On January 1 of each year, the limit on the amount that | 12 | | an insured is required to pay for a 30-day supply of diabetic | 13 | | self-management supplies shall increase by a percentage equal | 14 | | to the percentage change from the preceding year in the | 15 | | medical care component of the Consumer Price Index of the | 16 | | Bureau of Labor Statistics of the United States Department of | 17 | | Labor. | 18 | | Section 30. The Health Maintenance Organization Act is | 19 | | amended by changing Section 5-3 as follows:
| 20 | | (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
| 21 | | Sec. 5-3. Insurance Code provisions.
| 22 | | (a) Health Maintenance Organizations
shall be subject to | 23 | | the provisions of Sections 133, 134, 136, 137, 139, 140, | 24 | | 141.1,
141.2, 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, |
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| 1 | | 154, 154.5, 154.6,
154.7, 154.8, 155.04, 155.22a, 355.2, | 2 | | 355.3, 355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y,
356z.2, | 3 | | 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10, | 4 | | 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.18, | 5 | | 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, | 6 | | 356z.30a, 356z.32, 356z.33, 356z.35, 356z.36, 356z.41, | 7 | | 356z.43, 364, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c, | 8 | | 368d, 368e, 370c,
370c.1, 401, 401.1, 402, 403, 403A,
408, | 9 | | 408.2, 409, 412, 444,
and
444.1,
paragraph (c) of subsection | 10 | | (2) of Section 367, and Articles IIA, VIII 1/2,
XII,
XII 1/2, | 11 | | XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the Illinois | 12 | | Insurance Code.
| 13 | | (b) For purposes of the Illinois Insurance Code, except | 14 | | for Sections 444
and 444.1 and Articles XIII and XIII 1/2, | 15 | | Health Maintenance Organizations in
the following categories | 16 | | are deemed to be "domestic companies":
| 17 | | (1) a corporation authorized under the
Dental Service | 18 | | Plan Act or the Voluntary Health Services Plans Act;
| 19 | | (2) a corporation organized under the laws of this | 20 | | State; or
| 21 | | (3) a corporation organized under the laws of another | 22 | | state, 30% or more
of the enrollees of which are residents | 23 | | of this State, except a
corporation subject to | 24 | | substantially the same requirements in its state of
| 25 | | organization as is a "domestic company" under Article VIII | 26 | | 1/2 of the
Illinois Insurance Code.
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| 1 | | (c) In considering the merger, consolidation, or other | 2 | | acquisition of
control of a Health Maintenance Organization | 3 | | pursuant to Article VIII 1/2
of the Illinois Insurance Code,
| 4 | | (1) the Director shall give primary consideration to | 5 | | the continuation of
benefits to enrollees and the | 6 | | financial conditions of the acquired Health
Maintenance | 7 | | Organization after the merger, consolidation, or other
| 8 | | acquisition of control takes effect;
| 9 | | (2)(i) the criteria specified in subsection (1)(b) of | 10 | | Section 131.8 of
the Illinois Insurance Code shall not | 11 | | apply and (ii) the Director, in making
his determination | 12 | | with respect to the merger, consolidation, or other
| 13 | | acquisition of control, need not take into account the | 14 | | effect on
competition of the merger, consolidation, or | 15 | | other acquisition of control;
| 16 | | (3) the Director shall have the power to require the | 17 | | following
information:
| 18 | | (A) certification by an independent actuary of the | 19 | | adequacy
of the reserves of the Health Maintenance | 20 | | Organization sought to be acquired;
| 21 | | (B) pro forma financial statements reflecting the | 22 | | combined balance
sheets of the acquiring company and | 23 | | the Health Maintenance Organization sought
to be | 24 | | acquired as of the end of the preceding year and as of | 25 | | a date 90 days
prior to the acquisition, as well as pro | 26 | | forma financial statements
reflecting projected |
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| 1 | | combined operation for a period of 2 years;
| 2 | | (C) a pro forma business plan detailing an | 3 | | acquiring party's plans with
respect to the operation | 4 | | of the Health Maintenance Organization sought to
be | 5 | | acquired for a period of not less than 3 years; and
| 6 | | (D) such other information as the Director shall | 7 | | require.
| 8 | | (d) The provisions of Article VIII 1/2 of the Illinois | 9 | | Insurance Code
and this Section 5-3 shall apply to the sale by | 10 | | any health maintenance
organization of greater than 10% of its
| 11 | | enrollee population (including without limitation the health | 12 | | maintenance
organization's right, title, and interest in and | 13 | | to its health care
certificates).
| 14 | | (e) In considering any management contract or service | 15 | | agreement subject
to Section 141.1 of the Illinois Insurance | 16 | | Code, the Director (i) shall, in
addition to the criteria | 17 | | specified in Section 141.2 of the Illinois
Insurance Code, | 18 | | take into account the effect of the management contract or
| 19 | | service agreement on the continuation of benefits to enrollees | 20 | | and the
financial condition of the health maintenance | 21 | | organization to be managed or
serviced, and (ii) need not take | 22 | | into account the effect of the management
contract or service | 23 | | agreement on competition.
| 24 | | (f) Except for small employer groups as defined in the | 25 | | Small Employer
Rating, Renewability and Portability Health | 26 | | Insurance Act and except for
medicare supplement policies as |
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| 1 | | defined in Section 363 of the Illinois
Insurance Code, a | 2 | | Health Maintenance Organization may by contract agree with a
| 3 | | group or other enrollment unit to effect refunds or charge | 4 | | additional premiums
under the following terms and conditions:
| 5 | | (i) the amount of, and other terms and conditions with | 6 | | respect to, the
refund or additional premium are set forth | 7 | | in the group or enrollment unit
contract agreed in advance | 8 | | of the period for which a refund is to be paid or
| 9 | | additional premium is to be charged (which period shall | 10 | | not be less than one
year); and
| 11 | | (ii) the amount of the refund or additional premium | 12 | | shall not exceed 20%
of the Health Maintenance | 13 | | Organization's profitable or unprofitable experience
with | 14 | | respect to the group or other enrollment unit for the | 15 | | period (and, for
purposes of a refund or additional | 16 | | premium, the profitable or unprofitable
experience shall | 17 | | be calculated taking into account a pro rata share of the
| 18 | | Health Maintenance Organization's administrative and | 19 | | marketing expenses, but
shall not include any refund to be | 20 | | made or additional premium to be paid
pursuant to this | 21 | | subsection (f)). The Health Maintenance Organization and | 22 | | the
group or enrollment unit may agree that the profitable | 23 | | or unprofitable
experience may be calculated taking into | 24 | | account the refund period and the
immediately preceding 2 | 25 | | plan years.
| 26 | | The Health Maintenance Organization shall include a |
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| 1 | | statement in the
evidence of coverage issued to each enrollee | 2 | | describing the possibility of a
refund or additional premium, | 3 | | and upon request of any group or enrollment unit,
provide to | 4 | | the group or enrollment unit a description of the method used | 5 | | to
calculate (1) the Health Maintenance Organization's | 6 | | profitable experience with
respect to the group or enrollment | 7 | | unit and the resulting refund to the group
or enrollment unit | 8 | | or (2) the Health Maintenance Organization's unprofitable
| 9 | | experience with respect to the group or enrollment unit and | 10 | | the resulting
additional premium to be paid by the group or | 11 | | enrollment unit.
| 12 | | In no event shall the Illinois Health Maintenance | 13 | | Organization
Guaranty Association be liable to pay any | 14 | | contractual obligation of an
insolvent organization to pay any | 15 | | refund authorized under this Section.
| 16 | | (g) Rulemaking authority to implement Public Act 95-1045, | 17 | | if any, is conditioned on the rules being adopted in | 18 | | accordance with all provisions of the Illinois Administrative | 19 | | Procedure Act and all rules and procedures of the Joint | 20 | | Committee on Administrative Rules; any purported rule not so | 21 | | adopted, for whatever reason, is unauthorized. | 22 | | (Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; | 23 | | 100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff. | 24 | | 1-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81, | 25 | | eff. 7-12-19; 101-281, eff. 1-1-20; 101-371, eff. 1-1-20; | 26 | | 101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff. |
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| 1 | | 1-1-20; 101-625, eff. 1-1-21 .) | 2 | | Section 35. The Limited Health Service Organization Act is | 3 | | amended by changing Section 4003 as follows:
| 4 | | (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
| 5 | | Sec. 4003. Illinois Insurance Code provisions. Limited | 6 | | health service
organizations shall be subject to the | 7 | | provisions of Sections 133, 134, 136, 137, 139,
140, 141.1, | 8 | | 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154, | 9 | | 154.5,
154.6, 154.7, 154.8, 155.04, 155.37, 355.2, 355.3, | 10 | | 355b, 356v, 356z.10, 356z.21, 356z.22, 356z.25, 356z.26, | 11 | | 356z.29, 356z.30a, 356z.32, 356z.33, 356z.41, 356z.43, 368a, | 12 | | 401, 401.1,
402,
403, 403A, 408,
408.2, 409, 412, 444, and | 13 | | 444.1 and Articles IIA, VIII 1/2, XII, XII 1/2,
XIII,
XIII 1/2, | 14 | | XXV, and XXVI of the Illinois Insurance Code. For purposes of | 15 | | the
Illinois Insurance Code, except for Sections 444 and 444.1 | 16 | | and Articles XIII
and XIII 1/2, limited health service | 17 | | organizations in the following categories
are deemed to be | 18 | | 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% or 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. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; | 3 | | 100-201, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1057, eff. | 4 | | 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281, | 5 | | eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff. 1-1-21 .)
| 6 | | Section 40. 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 99. Effective date. This Act takes effect January | 10 | | 1, 2022.
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