Full Text of HB4924 96th General Assembly
HB4924eng 96TH GENERAL ASSEMBLY
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HB4924 Engrossed |
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LRB096 16233 RPM 31489 b |
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| AN ACT concerning insurance.
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| Be it enacted by the People of the State of Illinois,
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| represented in the General Assembly:
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| Section 5. The Illinois Insurance Code is amended by adding | 5 |
| Section 356z.19 as follows: | 6 |
| (215 ILCS 5/356z.19 new)
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| Sec. 356z.19. Cochlear implants; audiological services. | 8 |
| (a) A group or individual policy of accident and health | 9 |
| insurance or managed care plan amended, delivered, issued, or | 10 |
| renewed after the effective date of this amendatory Act of the | 11 |
| 96th General Assembly must provide coverage for an operation, | 12 |
| either monaurally or binaurally, to implant cochlear implants | 13 |
| and cochlear devices, including all internal and external | 14 |
| components, and provide post-treatment services, including, | 15 |
| but not limited to, programming, troubleshooting, repairs, | 16 |
| replacement components, such as external speech processors, | 17 |
| microphones, coils, headsets, cables, and batteries, FM | 18 |
| systems, auditory training, aural rehabilitation, and speech | 19 |
| therapy for children identified by 18 years of age as having | 20 |
| hearing impairment to the degree that they would benefit from | 21 |
| implantation. These services must be provided by a | 22 |
| speech-language pathologist, audiologist, or physician | 23 |
| licensed to practice in this State. |
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HB4924 Engrossed |
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LRB096 16233 RPM 31489 b |
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| (b) A group or individual
policy of accident and health | 2 |
| insurance or managed care plan
amended, delivered, issued, or | 3 |
| renewed after the effective date
of this amendatory Act of the | 4 |
| 96th General Assembly must
provide coverage for audiological | 5 |
| services and hearing aids for
children up to 18 years of age. | 6 |
| This coverage shall only apply
to hearing aids that are | 7 |
| prescribed, filled, and dispensed by a
licensed audiologist. A | 8 |
| policy or plan may limit the hearing
aid benefit payable for | 9 |
| each hearing-impaired ear to every 38
months. A policy or plan | 10 |
| may provide for up to 4 additional ear
molds per year for | 11 |
| children up to 2 years of age. | 12 |
| Section 10. The Health Maintenance Organization Act is | 13 |
| amended by changing Section 5-3 as follows:
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| (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
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| (Text of Section before amendment by P.A. 96-833 ) | 16 |
| Sec. 5-3. Insurance Code provisions.
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| (a) Health Maintenance Organizations
shall be subject to | 18 |
| the provisions of Sections 133, 134, 137, 140, 141.1,
141.2, | 19 |
| 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, 154, 154.5, | 20 |
| 154.6,
154.7, 154.8, 155.04, 355.2, 356g.5-1, 356m, 356v, 356w, | 21 |
| 356x, 356y,
356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9, | 22 |
| 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15 356z.14 , | 23 |
| 356z.17 356z.15 , 356z.19, 364.01, 367.2, 367.2-5, 367i, 368a, | 24 |
| 368b, 368c, 368d, 368e, 370c,
401, 401.1, 402, 403, 403A,
408, |
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HB4924 Engrossed |
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LRB096 16233 RPM 31489 b |
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| 408.2, 409, 412, 444,
and
444.1,
paragraph (c) of subsection | 2 |
| (2) of Section 367, and Articles IIA, VIII 1/2,
XII,
XII 1/2, | 3 |
| XIII, XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.
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| (b) For purposes of the Illinois Insurance Code, except for | 5 |
| Sections 444
and 444.1 and Articles XIII and XIII 1/2, Health | 6 |
| Maintenance Organizations in
the following categories are | 7 |
| deemed to be "domestic companies":
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| (1) a corporation authorized under the
Dental Service | 9 |
| Plan Act or the Voluntary Health Services Plans Act;
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| (2) a corporation organized under the laws of this | 11 |
| State; or
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| (3) 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
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| organization as is a "domestic company" under Article VIII | 17 |
| 1/2 of the
Illinois Insurance Code.
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| (c) In considering the merger, consolidation, or other | 19 |
| acquisition of
control of a Health Maintenance Organization | 20 |
| pursuant to Article VIII 1/2
of the Illinois Insurance Code,
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| (1) the Director shall give primary consideration to | 22 |
| the continuation of
benefits to enrollees and the financial | 23 |
| conditions of the acquired Health
Maintenance Organization | 24 |
| after the merger, consolidation, or other
acquisition of | 25 |
| control takes effect;
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| (2)(i) the criteria specified in subsection (1)(b) of |
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HB4924 Engrossed |
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LRB096 16233 RPM 31489 b |
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| Section 131.8 of
the Illinois Insurance Code shall not | 2 |
| apply and (ii) the Director, in making
his determination | 3 |
| with respect to the merger, consolidation, or other
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| acquisition of control, need not take into account the | 5 |
| effect on
competition of the merger, consolidation, or | 6 |
| other acquisition of control;
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| (3) the Director shall have the power to require the | 8 |
| following
information:
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| (A) certification by an independent actuary of the | 10 |
| adequacy
of the reserves of the Health Maintenance | 11 |
| Organization sought to be acquired;
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| (B) pro forma financial statements reflecting the | 13 |
| combined balance
sheets of the acquiring company and | 14 |
| the Health Maintenance Organization sought
to be | 15 |
| acquired as of the end of the preceding year and as of | 16 |
| a date 90 days
prior to the acquisition, as well as pro | 17 |
| forma financial statements
reflecting projected | 18 |
| combined operation for a period of 2 years;
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| (C) a pro forma business plan detailing an | 20 |
| acquiring party's plans with
respect to the operation | 21 |
| of the Health Maintenance Organization sought to
be | 22 |
| acquired for a period of not less than 3 years; and
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| (D) such other information as the Director shall | 24 |
| require.
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| (d) The provisions of Article VIII 1/2 of the Illinois | 26 |
| Insurance Code
and this Section 5-3 shall apply to the sale by |
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HB4924 Engrossed |
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LRB096 16233 RPM 31489 b |
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| any health maintenance
organization of greater than 10% of its
| 2 |
| enrollee population (including without limitation the health | 3 |
| maintenance
organization's right, title, and interest in and to | 4 |
| its health care
certificates).
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| (e) In considering any management contract or service | 6 |
| agreement subject
to Section 141.1 of the Illinois Insurance | 7 |
| Code, the Director (i) shall, in
addition to the criteria | 8 |
| specified in Section 141.2 of the Illinois
Insurance Code, take | 9 |
| into account the effect of the management contract or
service | 10 |
| agreement on the continuation of benefits to enrollees and the
| 11 |
| financial condition of the health maintenance organization to | 12 |
| be managed or
serviced, and (ii) need not take into account the | 13 |
| effect of the management
contract or service agreement on | 14 |
| competition.
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| (f) Except for small employer groups as defined in the | 16 |
| Small Employer
Rating, Renewability and Portability Health | 17 |
| Insurance Act and except for
medicare supplement policies as | 18 |
| defined in Section 363 of the Illinois
Insurance Code, a Health | 19 |
| Maintenance Organization may by contract agree with a
group or | 20 |
| other enrollment unit to effect refunds or charge additional | 21 |
| premiums
under the following terms and conditions:
| 22 |
| (i) the amount of, and other terms and conditions with | 23 |
| respect to, the
refund or additional premium are set forth | 24 |
| in the group or enrollment unit
contract agreed in advance | 25 |
| of the period for which a refund is to be paid or
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| additional premium is to be charged (which period shall not |
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HB4924 Engrossed |
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LRB096 16233 RPM 31489 b |
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| be less than one
year); and
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| (ii) the amount of the refund or additional premium | 3 |
| shall not exceed 20%
of the Health Maintenance | 4 |
| Organization's profitable or unprofitable experience
with | 5 |
| respect to the group or other enrollment unit for the | 6 |
| period (and, for
purposes of a refund or additional | 7 |
| premium, the profitable or unprofitable
experience shall | 8 |
| be calculated taking into account a pro rata share of the
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| Health Maintenance Organization's administrative and | 10 |
| marketing expenses, but
shall not include any refund to be | 11 |
| made or additional premium to be paid
pursuant to this | 12 |
| subsection (f)). The Health Maintenance Organization and | 13 |
| the
group or enrollment unit may agree that the profitable | 14 |
| or unprofitable
experience may be calculated taking into | 15 |
| account the refund period and the
immediately preceding 2 | 16 |
| plan years.
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| The Health Maintenance Organization shall include a | 18 |
| statement in the
evidence of coverage issued to each enrollee | 19 |
| describing the possibility of a
refund or additional premium, | 20 |
| and upon request of any group or enrollment unit,
provide to | 21 |
| the group or enrollment unit a description of the method used | 22 |
| to
calculate (1) the Health Maintenance Organization's | 23 |
| profitable experience with
respect to the group or enrollment | 24 |
| unit and the resulting refund to the group
or enrollment unit | 25 |
| or (2) the Health Maintenance Organization's unprofitable
| 26 |
| experience with respect to the group or enrollment unit and the |
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HB4924 Engrossed |
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LRB096 16233 RPM 31489 b |
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| resulting
additional premium to be paid by the group or | 2 |
| enrollment unit.
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| In no event shall the Illinois Health Maintenance | 4 |
| Organization
Guaranty Association be liable to pay any | 5 |
| contractual obligation of an
insolvent organization to pay any | 6 |
| refund authorized under this Section.
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| (g) Rulemaking authority to implement Public Act 95-1045 | 8 |
| this amendatory Act of the 95th General Assembly , if any, is | 9 |
| conditioned on the rules being adopted in accordance with all | 10 |
| provisions of the Illinois Administrative Procedure Act and all | 11 |
| rules and procedures of the Joint Committee on Administrative | 12 |
| Rules; any purported rule not so adopted, for whatever reason, | 13 |
| is unauthorized. | 14 |
| (Source: P.A. 95-422, eff. 8-24-07; 95-520, eff. 8-28-07; | 15 |
| 95-876, eff. 8-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09; | 16 |
| 95-1005, eff. 12-12-08; 95-1045, eff. 3-27-09; 95-1049, eff. | 17 |
| 1-1-10; 96-328, eff. 8-11-09; 96-639, eff. 1-1-10; revised | 18 |
| 10-23-09.) | 19 |
| (Text of Section after amendment by P.A. 96-833 ) | 20 |
| Sec. 5-3. Insurance Code provisions.
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| (a) Health Maintenance Organizations
shall be subject to | 22 |
| the provisions of Sections 133, 134, 137, 140, 141.1,
141.2, | 23 |
| 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, 154, 154.5, | 24 |
| 154.6,
154.7, 154.8, 155.04, 355.2, 356g.5-1, 356m, 356v, 356w, | 25 |
| 356x, 356y,
356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9, |
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HB4924 Engrossed |
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LRB096 16233 RPM 31489 b |
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| 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, | 2 |
| 356z.18, 356z.19, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, | 3 |
| 368c, 368d, 368e, 370c,
401, 401.1, 402, 403, 403A,
408, 408.2, | 4 |
| 409, 412, 444,
and
444.1,
paragraph (c) of subsection (2) of | 5 |
| Section 367, and Articles IIA, VIII 1/2,
XII,
XII 1/2, XIII, | 6 |
| XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.
| 7 |
| (b) For purposes of the Illinois Insurance Code, except for | 8 |
| Sections 444
and 444.1 and Articles XIII and XIII 1/2, Health | 9 |
| Maintenance Organizations in
the following categories are | 10 |
| deemed to be "domestic companies":
| 11 |
| (1) a corporation authorized under the
Dental Service | 12 |
| Plan Act or the Voluntary Health Services Plans Act;
| 13 |
| (2) a corporation organized under the laws of this | 14 |
| State; or
| 15 |
| (3) a corporation organized under the laws of another | 16 |
| state, 30% or more
of the enrollees of which are residents | 17 |
| of this State, except a
corporation subject to | 18 |
| substantially the same requirements in its state of
| 19 |
| organization as is a "domestic company" under Article VIII | 20 |
| 1/2 of the
Illinois Insurance Code.
| 21 |
| (c) In considering the merger, consolidation, or other | 22 |
| acquisition of
control of a Health Maintenance Organization | 23 |
| pursuant to Article VIII 1/2
of the Illinois Insurance Code,
| 24 |
| (1) the Director shall give primary consideration to | 25 |
| the continuation of
benefits to enrollees and the financial | 26 |
| conditions of the acquired Health
Maintenance Organization |
|
|
|
HB4924 Engrossed |
- 9 - |
LRB096 16233 RPM 31489 b |
|
| 1 |
| after the merger, consolidation, or other
acquisition of | 2 |
| control takes effect;
| 3 |
| (2)(i) the criteria specified in subsection (1)(b) of | 4 |
| Section 131.8 of
the Illinois Insurance Code shall not | 5 |
| apply and (ii) the Director, in making
his determination | 6 |
| with respect to the merger, consolidation, or other
| 7 |
| acquisition of control, need not take into account the | 8 |
| effect on
competition of the merger, consolidation, or | 9 |
| other acquisition of control;
| 10 |
| (3) the Director shall have the power to require the | 11 |
| following
information:
| 12 |
| (A) certification by an independent actuary of the | 13 |
| adequacy
of the reserves of the Health Maintenance | 14 |
| Organization sought to be acquired;
| 15 |
| (B) pro forma financial statements reflecting the | 16 |
| combined balance
sheets of the acquiring company and | 17 |
| the Health Maintenance Organization sought
to be | 18 |
| acquired as of the end of the preceding year and as of | 19 |
| a date 90 days
prior to the acquisition, as well as pro | 20 |
| forma financial statements
reflecting projected | 21 |
| combined operation for a period of 2 years;
| 22 |
| (C) a pro forma business plan detailing an | 23 |
| acquiring party's plans with
respect to the operation | 24 |
| of the Health Maintenance Organization sought to
be | 25 |
| acquired for a period of not less than 3 years; and
| 26 |
| (D) such other information as the Director shall |
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|
HB4924 Engrossed |
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LRB096 16233 RPM 31489 b |
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| 1 |
| require.
| 2 |
| (d) The provisions of Article VIII 1/2 of the Illinois | 3 |
| Insurance Code
and this Section 5-3 shall apply to the sale by | 4 |
| any health maintenance
organization of greater than 10% of its
| 5 |
| enrollee population (including without limitation the health | 6 |
| maintenance
organization's right, title, and interest in and to | 7 |
| its health care
certificates).
| 8 |
| (e) In considering any management contract or service | 9 |
| agreement subject
to Section 141.1 of the Illinois Insurance | 10 |
| Code, the Director (i) shall, in
addition to the criteria | 11 |
| specified in Section 141.2 of the Illinois
Insurance Code, take | 12 |
| into account the effect of the management contract or
service | 13 |
| agreement on the continuation of benefits to enrollees and the
| 14 |
| financial condition of the health maintenance organization to | 15 |
| be managed or
serviced, and (ii) need not take into account the | 16 |
| effect of the management
contract or service agreement on | 17 |
| competition.
| 18 |
| (f) Except for small employer groups as defined in the | 19 |
| Small Employer
Rating, Renewability and Portability Health | 20 |
| Insurance Act and except for
medicare supplement policies as | 21 |
| defined in Section 363 of the Illinois
Insurance Code, a Health | 22 |
| Maintenance Organization may by contract agree with a
group or | 23 |
| other enrollment unit to effect refunds or charge additional | 24 |
| premiums
under the following terms and conditions:
| 25 |
| (i) the amount of, and other terms and conditions with | 26 |
| respect to, the
refund or additional premium are set forth |
|
|
|
HB4924 Engrossed |
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LRB096 16233 RPM 31489 b |
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| 1 |
| in the group or enrollment unit
contract agreed in advance | 2 |
| of the period for which a refund is to be paid or
| 3 |
| additional premium is to be charged (which period shall not | 4 |
| be less than one
year); and
| 5 |
| (ii) the amount of the refund or additional premium | 6 |
| shall not exceed 20%
of the Health Maintenance | 7 |
| Organization's profitable or unprofitable experience
with | 8 |
| respect to the group or other enrollment unit for the | 9 |
| period (and, for
purposes of a refund or additional | 10 |
| premium, the profitable or unprofitable
experience shall | 11 |
| be calculated taking into account a pro rata share of the
| 12 |
| Health Maintenance Organization's administrative and | 13 |
| marketing expenses, but
shall not include any refund to be | 14 |
| made or additional premium to be paid
pursuant to this | 15 |
| subsection (f)). The Health Maintenance Organization and | 16 |
| the
group or enrollment unit may agree that the profitable | 17 |
| or unprofitable
experience may be calculated taking into | 18 |
| account the refund period and the
immediately preceding 2 | 19 |
| plan years.
| 20 |
| The Health Maintenance Organization shall include a | 21 |
| statement in the
evidence of coverage issued to each enrollee | 22 |
| describing the possibility of a
refund or additional premium, | 23 |
| and upon request of any group or enrollment unit,
provide to | 24 |
| the group or enrollment unit a description of the method used | 25 |
| to
calculate (1) the Health Maintenance Organization's | 26 |
| profitable experience with
respect to the group or enrollment |
|
|
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HB4924 Engrossed |
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LRB096 16233 RPM 31489 b |
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| 1 |
| unit and the resulting refund to the group
or enrollment unit | 2 |
| or (2) the Health Maintenance Organization's unprofitable
| 3 |
| experience with respect to the group or enrollment unit and the | 4 |
| resulting
additional premium to be paid by the group or | 5 |
| enrollment unit.
| 6 |
| In no event shall the Illinois Health Maintenance | 7 |
| Organization
Guaranty Association be liable to pay any | 8 |
| contractual obligation of an
insolvent organization to pay any | 9 |
| refund authorized under this Section.
| 10 |
| (g) Rulemaking authority to implement Public Act 95-1045, | 11 |
| if any, is conditioned on the rules being adopted in accordance | 12 |
| with all provisions of the Illinois Administrative Procedure | 13 |
| Act and all rules and procedures of the Joint Committee on | 14 |
| Administrative Rules; any purported rule not so adopted, for | 15 |
| whatever reason, is unauthorized. | 16 |
| (Source: P.A. 95-422, eff. 8-24-07; 95-520, eff. 8-28-07; | 17 |
| 95-876, eff. 8-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09; | 18 |
| 95-1005, eff. 12-12-08; 95-1045, eff. 3-27-09; 95-1049, eff. | 19 |
| 1-1-10; 96-328, eff. 8-11-09; 96-639, eff. 1-1-10; 96-833, eff. | 20 |
| 6-1-10.) | 21 |
| Section 15. The Voluntary Health Services Plans Act is | 22 |
| amended by changing Section 10 as follows:
| 23 |
| (215 ILCS 165/10) (from Ch. 32, par. 604)
| 24 |
| (Text of Section before amendment by P.A. 96-833 ) |
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HB4924 Engrossed |
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LRB096 16233 RPM 31489 b |
|
| 1 |
| Sec. 10. Application of Insurance Code provisions. Health | 2 |
| services
plan corporations and all persons interested therein | 3 |
| or dealing therewith
shall be subject to the provisions of | 4 |
| Articles IIA and XII 1/2 and Sections
3.1, 133, 140, 143, 143c, | 5 |
| 149, 155.37, 354, 355.2, 356g, 356g.5, 356g.5-1, 356r, 356t, | 6 |
| 356u, 356v,
356w, 356x, 356y, 356z.1, 356z.2, 356z.4, 356z.5, | 7 |
| 356z.6, 356z.8, 356z.9,
356z.10, 356z.11, 356z.12, 356z.13, | 8 |
| 356z.14, 356z.15
356z.14 , 356z.19, 364.01, 367.2, 368a, 401, | 9 |
| 401.1,
402,
403, 403A, 408,
408.2, and 412, and paragraphs (7) | 10 |
| and (15) of Section 367 of the Illinois
Insurance Code.
| 11 |
| Rulemaking authority to implement Public Act 95-1045
this | 12 |
| amendatory Act of the 95th General Assembly , if any, is | 13 |
| conditioned on the rules being adopted in accordance with all | 14 |
| provisions of the Illinois Administrative Procedure Act and all | 15 |
| rules and procedures of the Joint Committee on Administrative | 16 |
| Rules; any purported rule not so adopted, for whatever reason, | 17 |
| is unauthorized. | 18 |
| (Source: P.A. 95-189, eff. 8-16-07; 95-331, eff. 8-21-07; | 19 |
| 95-422, eff. 8-24-07; 95-520, eff. 8-28-07; 95-876, eff. | 20 |
| 8-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09; 95-1005, | 21 |
| eff. 12-12-08; 95-1045, eff. 3-27-09; 95-1049, eff. 1-1-10; | 22 |
| 96-328, eff. 8-11-09; revised 9-25-09.) | 23 |
| (Text of Section after amendment by P.A. 96-833 ) | 24 |
| Sec. 10. Application of Insurance Code provisions. Health | 25 |
| services
plan corporations and all persons interested therein |
|
|
|
HB4924 Engrossed |
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LRB096 16233 RPM 31489 b |
|
| 1 |
| or dealing therewith
shall be subject to the provisions of | 2 |
| Articles IIA and XII 1/2 and Sections
3.1, 133, 140, 143, 143c, | 3 |
| 149, 155.37, 354, 355.2, 356g, 356g.5, 356g.5-1, 356r, 356t, | 4 |
| 356u, 356v,
356w, 356x, 356y, 356z.1, 356z.2, 356z.4, 356z.5, | 5 |
| 356z.6, 356z.8, 356z.9,
356z.10, 356z.11, 356z.12, 356z.13, | 6 |
| 356z.14, 356z.15, 356z.18, 356z.19, 364.01, 367.2, 368a, 401, | 7 |
| 401.1,
402,
403, 403A, 408,
408.2, and 412, and paragraphs (7) | 8 |
| and (15) of Section 367 of the Illinois
Insurance Code.
| 9 |
| Rulemaking authority to implement Public Act 95-1045, if | 10 |
| any, is conditioned on the rules being adopted in accordance | 11 |
| with all provisions of the Illinois Administrative Procedure | 12 |
| Act and all rules and procedures of the Joint Committee on | 13 |
| Administrative Rules; any purported rule not so adopted, for | 14 |
| whatever reason, is unauthorized. | 15 |
| (Source: P.A. 95-189, eff. 8-16-07; 95-331, eff. 8-21-07; | 16 |
| 95-422, eff. 8-24-07; 95-520, eff. 8-28-07; 95-876, eff. | 17 |
| 8-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09; 95-1005, | 18 |
| eff. 12-12-08; 95-1045, eff. 3-27-09; 95-1049, eff. 1-1-10; | 19 |
| 96-328, eff. 8-11-09; 96-833, eff. 6-1-10.)
| 20 |
| Section 95. No acceleration or delay. Where this Act makes | 21 |
| changes in a statute that is represented in this Act by text | 22 |
| that is not yet or no longer in effect (for example, a Section | 23 |
| represented by multiple versions), the use of that text does | 24 |
| not accelerate or delay the taking effect of (i) the changes | 25 |
| made by this Act or (ii) provisions derived from any other |
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HB4924 Engrossed |
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LRB096 16233 RPM 31489 b |
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| Public Act.
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