Full Text of HB5766 96th General Assembly
HB5766eng 96TH GENERAL ASSEMBLY
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HB5766 Engrossed |
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LRB096 19907 RPM 35370 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 State Employees Group Insurance Act of 1971 | 5 |
| is amended by changing Section 6.11 as follows:
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| (5 ILCS 375/6.11)
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| 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, and | 15 |
| 356z.13, and 356z.14, 356z.15 and 356z.14 , and 356z.17 356z.15 , | 16 |
| and 356z.19 of the
Illinois Insurance Code.
The program of | 17 |
| health benefits must comply with Section 155.37 of the
Illinois | 18 |
| Insurance Code.
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| Rulemaking authority to implement Public Act 95-1045 this | 20 |
| amendatory Act of the 95th General Assembly , if any, is | 21 |
| conditioned on the rules being adopted in accordance with all | 22 |
| provisions of the Illinois Administrative Procedure Act and all | 23 |
| rules and procedures of the Joint Committee on Administrative |
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HB5766 Engrossed |
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LRB096 19907 RPM 35370 b |
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| Rules; any purported rule not so adopted, for whatever reason, | 2 |
| is unauthorized. | 3 |
| (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; | 4 |
| 95-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff. | 5 |
| 6-1-09; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; 95-1044, | 6 |
| eff. 3-26-09; 95-1045, eff. 3-27-09; 95-1049, eff. 1-1-10; | 7 |
| 96-139, eff. 1-1-10; 96-328, eff. 8-11-09; 96-639, eff. 1-1-10; | 8 |
| revised 10-22-09.) | 9 |
| Section 10. The Counties Code is amended by changing | 10 |
| Section 5-1069.3 as follows: | 11 |
| (55 ILCS 5/5-1069.3)
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| Sec. 5-1069.3. Required health benefits. If a county, | 13 |
| including a home
rule
county, is a self-insurer for purposes of | 14 |
| providing health insurance coverage
for its employees, the | 15 |
| coverage shall include coverage for the post-mastectomy
care | 16 |
| benefits required to be covered by a policy of accident and | 17 |
| health
insurance under Section 356t and the coverage required | 18 |
| under Sections 356g, 356g.5, 356g.5-1, 356u,
356w, 356x, | 19 |
| 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, and | 20 |
| 356z.13, and 356z.14, and 356z.15 356z.14 , and 356z.19 of
the | 21 |
| Illinois Insurance Code. The requirement that health benefits | 22 |
| be covered
as provided in this Section is an
exclusive power | 23 |
| and function of the State and is a denial and limitation under
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| Article VII, Section 6, subsection (h) of the Illinois |
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HB5766 Engrossed |
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LRB096 19907 RPM 35370 b |
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| Constitution. A home
rule county to which this Section applies | 2 |
| must comply with every provision of
this Section.
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| Rulemaking authority to implement Public Act 95-1045 this | 4 |
| amendatory Act of the 95th General Assembly , if any, is | 5 |
| conditioned on the rules being adopted in accordance with all | 6 |
| provisions of the Illinois Administrative Procedure Act and all | 7 |
| rules and procedures of the Joint Committee on Administrative | 8 |
| Rules; any purported rule not so adopted, for whatever reason, | 9 |
| is unauthorized. | 10 |
| (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; | 11 |
| 95-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff. | 12 |
| 6-1-09; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; 95-1045, | 13 |
| eff. 3-27-09; 95-1049, eff. 1-1-10; 96-139, eff. 1-1-10; | 14 |
| 96-328, eff. 8-11-09; revised 10-22-09.) | 15 |
| Section 15. The Illinois Municipal Code is amended by | 16 |
| changing Section 10-4-2.3 as follows: | 17 |
| (65 ILCS 5/10-4-2.3)
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| Sec. 10-4-2.3. Required health benefits. If a | 19 |
| municipality, including a
home rule municipality, is a | 20 |
| self-insurer for purposes of providing health
insurance | 21 |
| coverage for its employees, the coverage shall include coverage | 22 |
| for
the post-mastectomy care benefits required to be covered by | 23 |
| a policy of
accident and health insurance under Section 356t | 24 |
| and the coverage required
under Sections 356g, 356g.5, |
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HB5766 Engrossed |
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| 356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10, | 2 |
| 356z.11, 356z.12, and 356z.13, and 356z.14, and 356z.15 | 3 |
| 356z.14 , and 356z.19 of the Illinois
Insurance
Code. The | 4 |
| requirement that health
benefits be covered as provided in this | 5 |
| is an exclusive power and function of
the State and is a denial | 6 |
| and limitation under Article VII, Section 6,
subsection (h) of | 7 |
| the Illinois Constitution. A home rule municipality to which
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| this Section applies must comply with every provision of this | 9 |
| Section.
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| Rulemaking authority to implement Public Act 95-1045 this | 11 |
| amendatory Act of the 95th General Assembly , if any, is | 12 |
| conditioned on the rules being adopted in accordance with all | 13 |
| provisions of the Illinois Administrative Procedure Act and all | 14 |
| rules and procedures of the Joint Committee on Administrative | 15 |
| Rules; any purported rule not so adopted, for whatever reason, | 16 |
| is unauthorized. | 17 |
| (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; | 18 |
| 95-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff. | 19 |
| 6-1-09; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; 95-1045, | 20 |
| eff. 3-27-09; 95-1049, eff. 1-1-10; 96-139, eff. 1-1-10; | 21 |
| 96-328, eff. 8-11-09; revised 10-23-09.) | 22 |
| Section 20. The School Code is amended by changing Section | 23 |
| 10-22.3f as follows: | 24 |
| (105 ILCS 5/10-22.3f)
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HB5766 Engrossed |
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LRB096 19907 RPM 35370 b |
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| Sec. 10-22.3f. Required health benefits. Insurance | 2 |
| protection and
benefits
for employees shall provide the | 3 |
| post-mastectomy care benefits required to be
covered by a | 4 |
| policy of accident and health insurance under Section 356t and | 5 |
| the
coverage required under Sections 356g, 356g.5, 356g.5-1, | 6 |
| 356u, 356w, 356x,
356z.6, 356z.8, 356z.9, 356z.11, 356z.12, | 7 |
| 356z.13, and 356z.14, and 356z.15 356z.14 , and 356z.19 of
the
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| Illinois Insurance Code.
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| Rulemaking authority to implement Public Act 95-1045 this | 10 |
| amendatory Act of the 95th General Assembly , if any, is | 11 |
| conditioned on the rules being adopted in accordance with all | 12 |
| provisions of the Illinois Administrative Procedure Act and all | 13 |
| rules and procedures of the Joint Committee on Administrative | 14 |
| Rules; any purported rule not so adopted, for whatever reason, | 15 |
| is unauthorized. | 16 |
| (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; | 17 |
| 95-876, eff. 8-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09; | 18 |
| 95-1005, 12-12-08; 95-1045, eff. 3-27-09; 95-1049, eff. | 19 |
| 1-1-10; 96-139, eff. 1-1-10; 96-328, eff. 8-11-09; revised | 20 |
| 10-23-09.) | 21 |
| Section 25. The Illinois Insurance Code is amended by | 22 |
| adding Section 356z.19 as follows: | 23 |
| (215 ILCS 5/356z.19 new) | 24 |
| Sec. 356z.19. Tobacco use cessation programs. |
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HB5766 Engrossed |
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| (a) This Section may be referred to as the Tobacco | 2 |
| Dependence Coverage Law. | 3 |
| (b) Tobacco use is the number one cause of preventable | 4 |
| disease and death in Illinois, costing $4.1 billion annually in | 5 |
| direct health care costs and an additional $4.35 billion in | 6 |
| lost productivity. In Illinois, the smoking rates are highest | 7 |
| among African Americans (25.8%). Smoking rates among lesbian, | 8 |
| gay, and bisexual adults range from 25% to 44%. The U.S. Public | 9 |
| Health Service Clinical Practice Guideline 2008 Update found | 10 |
| that tobacco dependence treatments are both clinically | 11 |
| effective and highly cost effective. A study in the Journal of | 12 |
| Preventive Medicine concluded that comprehensive smoking | 13 |
| cessation treatment is one of the 3 most important and cost | 14 |
| effective preventive services that can be provided in medical | 15 |
| practice. Greater efforts are needed to achieve more of this | 16 |
| potential value by increasing current low
levels of | 17 |
| performance. | 18 |
| (c) In this Section, "tobacco use cessation program" means | 19 |
| a program recommended by a physician that follows | 20 |
| evidence-based treatment, such as is outlined in the United | 21 |
| States Public Health Service guidelines for tobacco use | 22 |
| cessation. "Tobacco use cessation program" includes education | 23 |
| and medical treatment components designed to assist a person in | 24 |
| ceasing the use of tobacco products. "Tobacco use cessation | 25 |
| program" includes education and counseling by physicians or | 26 |
| associated medical personnel and all FDA approved medications |
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HB5766 Engrossed |
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LRB096 19907 RPM 35370 b |
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| for the treatment of tobacco dependence irrespective of whether | 2 |
| they are available only over the counter, only by prescription, | 3 |
| or both over the counter and by prescription. | 4 |
| (d) A group or individual policy of accident and health | 5 |
| insurance or managed care plan amended, delivered, issued, or | 6 |
| renewed after the effective date of this amendatory Act of the | 7 |
| 96th General Assembly to a resident of this State must provide | 8 |
| coverage or reimbursement of up to $500 annually for a tobacco | 9 |
| use cessation program for a person enrolled in the plan who is | 10 |
| 18 years of age or older. | 11 |
| (e) Written notice of the availability of coverage under | 12 |
| this Section shall be delivered to the insured upon enrollment | 13 |
| and annually thereafter. An insurer may not deny to an insured | 14 |
| eligibility or continued eligibility to enroll or to renew | 15 |
| coverage under the terms of the plan solely for the purpose of | 16 |
| avoiding the requirements of this Section. An insurer may not | 17 |
| penalize or reduce or limit the reimbursement of an attending | 18 |
| provider or provide incentives, monetary or otherwise, to an | 19 |
| attending provider to induce the provider to provide care to an | 20 |
| insured in a manner inconsistent with this Section.
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| Section 30. The Health Maintenance Organization Act is | 22 |
| 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 ) |
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HB5766 Engrossed |
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LRB096 19907 RPM 35370 b |
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| Sec. 5-3. Insurance Code provisions.
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| (a) Health Maintenance Organizations
shall be subject to | 3 |
| the provisions of Sections 133, 134, 137, 140, 141.1,
141.2, | 4 |
| 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, 154, 154.5, | 5 |
| 154.6,
154.7, 154.8, 155.04, 355.2, 356g.5-1, 356m, 356v, 356w, | 6 |
| 356x, 356y,
356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9, | 7 |
| 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15 356z.14 , | 8 |
| 356z.17 356z.15 , 356z.19, 364.01, 367.2, 367.2-5, 367i, 368a, | 9 |
| 368b, 368c, 368d, 368e, 370c,
401, 401.1, 402, 403, 403A,
408, | 10 |
| 408.2, 409, 412, 444,
and
444.1,
paragraph (c) of subsection | 11 |
| (2) of Section 367, and Articles IIA, VIII 1/2,
XII,
XII 1/2, | 12 |
| 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 | 14 |
| Sections 444
and 444.1 and Articles XIII and XIII 1/2, Health | 15 |
| Maintenance Organizations in
the following categories are | 16 |
| deemed to be "domestic companies":
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| (1) a corporation authorized under the
Dental Service | 18 |
| Plan Act or the Voluntary Health Services Plans Act;
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| (2) a corporation organized under the laws of this | 20 |
| State; or
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| (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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HB5766 Engrossed |
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LRB096 19907 RPM 35370 b |
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| (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,
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| (1) the Director shall give primary consideration to | 5 |
| the continuation of
benefits to enrollees and the financial | 6 |
| conditions of the acquired Health
Maintenance Organization | 7 |
| after the merger, consolidation, or other
acquisition of | 8 |
| control takes effect;
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| (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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HB5766 Engrossed |
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LRB096 19907 RPM 35370 b |
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| combined operation for a period of 2 years;
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| (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
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| (D) such other information as the Director shall | 7 |
| require.
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| (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 to | 13 |
| its health care
certificates).
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| (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, take | 18 |
| into account the effect of the management contract or
service | 19 |
| agreement on the continuation of benefits to enrollees and the
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| financial condition of the health maintenance organization to | 21 |
| be managed or
serviced, and (ii) need not take into account the | 22 |
| effect of the management
contract or service agreement on | 23 |
| competition.
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| (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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HB5766 Engrossed |
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LRB096 19907 RPM 35370 b |
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| defined in Section 363 of the Illinois
Insurance Code, a Health | 2 |
| Maintenance Organization may by contract agree with a
group or | 3 |
| other enrollment unit to effect refunds or charge additional | 4 |
| 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 not | 10 |
| be less than one
year); and
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| (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
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| 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.
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| The Health Maintenance Organization shall include a |
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HB5766 Engrossed |
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LRB096 19907 RPM 35370 b |
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| 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 the | 10 |
| resulting
additional premium to be paid by the group or | 11 |
| enrollment unit.
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| 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 |
| this amendatory Act of the 95th General Assembly , if any, is | 18 |
| conditioned on the rules being adopted in accordance with all | 19 |
| provisions of the Illinois Administrative Procedure Act and all | 20 |
| rules and procedures of the Joint Committee on Administrative | 21 |
| Rules; any purported rule not so adopted, for whatever reason, | 22 |
| is unauthorized. | 23 |
| (Source: P.A. 95-422, eff. 8-24-07; 95-520, eff. 8-28-07; | 24 |
| 95-876, eff. 8-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09; | 25 |
| 95-1005, eff. 12-12-08; 95-1045, eff. 3-27-09; 95-1049, eff. | 26 |
| 1-1-10; 96-328, eff. 8-11-09; 96-639, eff. 1-1-10; revised |
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HB5766 Engrossed |
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LRB096 19907 RPM 35370 b |
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| 1 |
| 10-23-09.) | 2 |
| (Text of Section after amendment by P.A. 96-833 ) | 3 |
| Sec. 5-3. Insurance Code provisions.
| 4 |
| (a) Health Maintenance Organizations
shall be subject to | 5 |
| the provisions of Sections 133, 134, 137, 140, 141.1,
141.2, | 6 |
| 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, 154, 154.5, | 7 |
| 154.6,
154.7, 154.8, 155.04, 355.2, 356g.5-1, 356m, 356v, 356w, | 8 |
| 356x, 356y,
356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9, | 9 |
| 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, | 10 |
| 356z.18, 356z.19, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, | 11 |
| 368c, 368d, 368e, 370c,
401, 401.1, 402, 403, 403A,
408, 408.2, | 12 |
| 409, 412, 444,
and
444.1,
paragraph (c) of subsection (2) of | 13 |
| Section 367, and Articles IIA, VIII 1/2,
XII,
XII 1/2, XIII, | 14 |
| XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.
| 15 |
| (b) For purposes of the Illinois Insurance Code, except for | 16 |
| Sections 444
and 444.1 and Articles XIII and XIII 1/2, Health | 17 |
| Maintenance Organizations in
the following categories are | 18 |
| deemed to be "domestic companies":
| 19 |
| (1) a corporation authorized under the
Dental Service | 20 |
| Plan Act or the Voluntary Health Services Plans Act;
| 21 |
| (2) a corporation organized under the laws of this | 22 |
| State; or
| 23 |
| (3) a corporation organized under the laws of another | 24 |
| state, 30% or more
of the enrollees of which are residents | 25 |
| of this State, except a
corporation subject to |
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|
|
HB5766 Engrossed |
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LRB096 19907 RPM 35370 b |
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| 1 |
| substantially the same requirements in its state of
| 2 |
| organization as is a "domestic company" under Article VIII | 3 |
| 1/2 of the
Illinois Insurance Code.
| 4 |
| (c) In considering the merger, consolidation, or other | 5 |
| acquisition of
control of a Health Maintenance Organization | 6 |
| pursuant to Article VIII 1/2
of the Illinois Insurance Code,
| 7 |
| (1) the Director shall give primary consideration to | 8 |
| the continuation of
benefits to enrollees and the financial | 9 |
| conditions of the acquired Health
Maintenance Organization | 10 |
| after the merger, consolidation, or other
acquisition of | 11 |
| control takes effect;
| 12 |
| (2)(i) the criteria specified in subsection (1)(b) of | 13 |
| Section 131.8 of
the Illinois Insurance Code shall not | 14 |
| apply and (ii) the Director, in making
his determination | 15 |
| with respect to the merger, consolidation, or other
| 16 |
| acquisition of control, need not take into account the | 17 |
| effect on
competition of the merger, consolidation, or | 18 |
| other acquisition of control;
| 19 |
| (3) the Director shall have the power to require the | 20 |
| following
information:
| 21 |
| (A) certification by an independent actuary of the | 22 |
| adequacy
of the reserves of the Health Maintenance | 23 |
| Organization sought to be acquired;
| 24 |
| (B) pro forma financial statements reflecting the | 25 |
| combined balance
sheets of the acquiring company and | 26 |
| the Health Maintenance Organization sought
to be |
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HB5766 Engrossed |
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LRB096 19907 RPM 35370 b |
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| acquired as of the end of the preceding year and as of | 2 |
| a date 90 days
prior to the acquisition, as well as pro | 3 |
| forma financial statements
reflecting projected | 4 |
| combined operation for a period of 2 years;
| 5 |
| (C) a pro forma business plan detailing an | 6 |
| acquiring party's plans with
respect to the operation | 7 |
| of the Health Maintenance Organization sought to
be | 8 |
| acquired for a period of not less than 3 years; and
| 9 |
| (D) such other information as the Director shall | 10 |
| require.
| 11 |
| (d) The provisions of Article VIII 1/2 of the Illinois | 12 |
| Insurance Code
and this Section 5-3 shall apply to the sale by | 13 |
| any health maintenance
organization of greater than 10% of its
| 14 |
| enrollee population (including without limitation the health | 15 |
| maintenance
organization's right, title, and interest in and to | 16 |
| its health care
certificates).
| 17 |
| (e) In considering any management contract or service | 18 |
| agreement subject
to Section 141.1 of the Illinois Insurance | 19 |
| Code, the Director (i) shall, in
addition to the criteria | 20 |
| specified in Section 141.2 of the Illinois
Insurance Code, take | 21 |
| into account the effect of the management contract or
service | 22 |
| agreement on the continuation of benefits to enrollees and the
| 23 |
| financial condition of the health maintenance organization to | 24 |
| be managed or
serviced, and (ii) need not take into account the | 25 |
| effect of the management
contract or service agreement on | 26 |
| competition.
|
|
|
|
HB5766 Engrossed |
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LRB096 19907 RPM 35370 b |
|
| 1 |
| (f) Except for small employer groups as defined in the | 2 |
| Small Employer
Rating, Renewability and Portability Health | 3 |
| Insurance Act and except for
medicare supplement policies as | 4 |
| defined in Section 363 of the Illinois
Insurance Code, a Health | 5 |
| Maintenance Organization may by contract agree with a
group or | 6 |
| other enrollment unit to effect refunds or charge additional | 7 |
| premiums
under the following terms and conditions:
| 8 |
| (i) the amount of, and other terms and conditions with | 9 |
| respect to, the
refund or additional premium are set forth | 10 |
| in the group or enrollment unit
contract agreed in advance | 11 |
| of the period for which a refund is to be paid or
| 12 |
| additional premium is to be charged (which period shall not | 13 |
| be less than one
year); and
| 14 |
| (ii) the amount of the refund or additional premium | 15 |
| shall not exceed 20%
of the Health Maintenance | 16 |
| Organization's profitable or unprofitable experience
with | 17 |
| respect to the group or other enrollment unit for the | 18 |
| period (and, for
purposes of a refund or additional | 19 |
| premium, the profitable or unprofitable
experience shall | 20 |
| be calculated taking into account a pro rata share of the
| 21 |
| Health Maintenance Organization's administrative and | 22 |
| marketing expenses, but
shall not include any refund to be | 23 |
| made or additional premium to be paid
pursuant to this | 24 |
| subsection (f)). The Health Maintenance Organization and | 25 |
| the
group or enrollment unit may agree that the profitable | 26 |
| or unprofitable
experience may be calculated taking into |
|
|
|
HB5766 Engrossed |
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LRB096 19907 RPM 35370 b |
|
| 1 |
| account the refund period and the
immediately preceding 2 | 2 |
| plan years.
| 3 |
| The Health Maintenance Organization shall include a | 4 |
| statement in the
evidence of coverage issued to each enrollee | 5 |
| describing the possibility of a
refund or additional premium, | 6 |
| and upon request of any group or enrollment unit,
provide to | 7 |
| the group or enrollment unit a description of the method used | 8 |
| to
calculate (1) the Health Maintenance Organization's | 9 |
| profitable experience with
respect to the group or enrollment | 10 |
| unit and the resulting refund to the group
or enrollment unit | 11 |
| or (2) the Health Maintenance Organization's unprofitable
| 12 |
| experience with respect to the group or enrollment unit and the | 13 |
| resulting
additional premium to be paid by the group or | 14 |
| enrollment unit.
| 15 |
| In no event shall the Illinois Health Maintenance | 16 |
| Organization
Guaranty Association be liable to pay any | 17 |
| contractual obligation of an
insolvent organization to pay any | 18 |
| refund authorized under this Section.
| 19 |
| (g) Rulemaking authority to implement Public Act 95-1045, | 20 |
| if 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 | 24 |
| whatever reason, is unauthorized. | 25 |
| (Source: P.A. 95-422, eff. 8-24-07; 95-520, eff. 8-28-07; | 26 |
| 95-876, eff. 8-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09; |
|
|
|
HB5766 Engrossed |
- 18 - |
LRB096 19907 RPM 35370 b |
|
| 1 |
| 95-1005, eff. 12-12-08; 95-1045, eff. 3-27-09; 95-1049, eff. | 2 |
| 1-1-10; 96-328, eff. 8-11-09; 96-639, eff. 1-1-10; 96-833, eff. | 3 |
| 6-1-10.) | 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, 137,
140, 141.1, 141.2, 141.3, 143, 143c, | 10 |
| 147, 148, 149, 151, 152, 153, 154, 154.5,
154.6, 154.7, 154.8, | 11 |
| 155.04, 155.37, 355.2, 356v, 356z.10, 356z.19, 368a, 401, | 12 |
| 401.1,
402,
403, 403A, 408,
408.2, 409, 412, 444, and 444.1 and | 13 |
| Articles IIA, VIII 1/2, XII, XII 1/2,
XIII,
XIII 1/2, XXV, and | 14 |
| XXVI of the Illinois Insurance Code. For purposes of the
| 15 |
| Illinois Insurance Code, except for Sections 444 and 444.1 and | 16 |
| 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% 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 |
|
|
|
HB5766 Engrossed |
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LRB096 19907 RPM 35370 b |
|
| 1 |
| 1/2 of the Illinois Insurance Code.
| 2 |
| (Source: P.A. 95-520, eff. 8-28-07; 95-876, eff. 8-21-08.)
| 3 |
| Section 40. The Voluntary Health Services Plans Act is | 4 |
| amended by changing Section 10 as follows:
| 5 |
| (215 ILCS 165/10) (from Ch. 32, par. 604)
| 6 |
| (Text of Section before amendment by P.A. 96-833 ) | 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, 140, 143, 143c, | 11 |
| 149, 155.37, 354, 355.2, 356g, 356g.5, 356g.5-1, 356r, 356t, | 12 |
| 356u, 356v,
356w, 356x, 356y, 356z.1, 356z.2, 356z.4, 356z.5, | 13 |
| 356z.6, 356z.8, 356z.9,
356z.10, 356z.11, 356z.12, 356z.13, | 14 |
| 356z.14, 356z.15
356z.14 , 356z.19, 364.01, 367.2, 368a, 401, | 15 |
| 401.1,
402,
403, 403A, 408,
408.2, and 412, and paragraphs (7) | 16 |
| and (15) of Section 367 of the Illinois
Insurance Code.
| 17 |
| Rulemaking authority to implement Public Act 95-1045
this | 18 |
| amendatory Act of the 95th General Assembly , if any, is | 19 |
| conditioned on the rules being adopted in accordance with all | 20 |
| provisions of the Illinois Administrative Procedure Act and all | 21 |
| rules and procedures of the Joint Committee on Administrative | 22 |
| Rules; any purported rule not so adopted, for whatever reason, | 23 |
| is unauthorized. | 24 |
| (Source: P.A. 95-189, eff. 8-16-07; 95-331, eff. 8-21-07; |
|
|
|
HB5766 Engrossed |
- 20 - |
LRB096 19907 RPM 35370 b |
|
| 1 |
| 95-422, eff. 8-24-07; 95-520, eff. 8-28-07; 95-876, eff. | 2 |
| 8-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09; 95-1005, | 3 |
| eff. 12-12-08; 95-1045, eff. 3-27-09; 95-1049, eff. 1-1-10; | 4 |
| 96-328, eff. 8-11-09; revised 9-25-09.) | 5 |
| (Text of Section after amendment by P.A. 96-833 ) | 6 |
| Sec. 10. Application of Insurance Code provisions. Health | 7 |
| services
plan corporations and all persons interested therein | 8 |
| or dealing therewith
shall be subject to the provisions of | 9 |
| Articles IIA and XII 1/2 and Sections
3.1, 133, 140, 143, 143c, | 10 |
| 149, 155.37, 354, 355.2, 356g, 356g.5, 356g.5-1, 356r, 356t, | 11 |
| 356u, 356v,
356w, 356x, 356y, 356z.1, 356z.2, 356z.4, 356z.5, | 12 |
| 356z.6, 356z.8, 356z.9,
356z.10, 356z.11, 356z.12, 356z.13, | 13 |
| 356z.14, 356z.15, 356z.18, 356z.19, 364.01, 367.2, 368a, 401, | 14 |
| 401.1,
402,
403, 403A, 408,
408.2, and 412, and paragraphs (7) | 15 |
| and (15) of Section 367 of the Illinois
Insurance Code.
| 16 |
| Rulemaking authority to implement Public Act 95-1045, if | 17 |
| any, is conditioned on the rules being adopted in accordance | 18 |
| with all provisions of the Illinois Administrative Procedure | 19 |
| Act and all rules and procedures of the Joint Committee on | 20 |
| Administrative Rules; any purported rule not so adopted, for | 21 |
| whatever reason, is unauthorized. | 22 |
| (Source: P.A. 95-189, eff. 8-16-07; 95-331, eff. 8-21-07; | 23 |
| 95-422, eff. 8-24-07; 95-520, eff. 8-28-07; 95-876, eff. | 24 |
| 8-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09; 95-1005, | 25 |
| eff. 12-12-08; 95-1045, eff. 3-27-09; 95-1049, eff. 1-1-10; |
|
|
|
HB5766 Engrossed |
- 21 - |
LRB096 19907 RPM 35370 b |
|
| 1 |
| 96-328, eff. 8-11-09; 96-833, eff. 6-1-10.) | 2 |
| Section 95. No acceleration or delay. Where this Act makes | 3 |
| changes in a statute that is represented in this Act by text | 4 |
| that is not yet or no longer in effect (for example, a Section | 5 |
| represented by multiple versions), the use of that text does | 6 |
| not accelerate or delay the taking effect of (i) the changes | 7 |
| made by this Act or (ii) provisions derived from any other | 8 |
| Public Act. |
|