[ Search ] [ Legislation ] [ Bill Summary ]
[ Home ] [ Back ] [ Bottom ]
| [ Introduced ] | [ Engrossed ] | [ House Amendment 001 ] |
| [ House Amendment 002 ] | [ Senate Amendment 001 ] | [ Senate Amendment 003 ] |
| [ Senate Amendment 004 ] |
90_HB1552sam002
LRB9004923JSmbam01
1 AMENDMENT TO HOUSE BILL 1552
2 AMENDMENT NO. . Amend House Bill 1552, AS AMENDED,
3 by replacing the title with the following:
4 "AN ACT in relation to health insurance, amending named
5 Acts."; and
6 by replacing everything after the enacting clause with the
7 following:
8 "Section 5. The State Employees Group Insurance Act of
9 1971 is amended by changing and renumbering Section 6.9 as
10 follows:
11 (5 ILCS 375/6.11)
12 Sec. 6.11. 6.9. Required health benefits. The program
13 of health benefits shall provide the post-mastectomy care
14 benefits required to be covered by a policy of accident and
15 health insurance under Section 356t of the Illinois Insurance
16 Code. The program of health benefits shall provide the
17 coverage required under Sections Section 356u and 356w of the
18 Illinois Insurance Code.
19 (Source: P.A. 90-7, eff. 6-10-97; revised 11-10-97.)
20 Section 10. The State Mandates Act is amended by adding
-2- LRB9004923JSmbam01
1 Section 8.22 as follows:
2 (30 ILCS 805/8.22 new)
3 Sec. 8.22. Exempt mandate. Notwithstanding Sections 6
4 and 8 of this Act, no reimbursement by the State is required
5 for the implementation of any mandate created by this
6 amendatory Act of 1998.
7 Section 15. The Counties Code is amended by changing
8 Section 1069.3 as follows:
9 (55 ILCS 5/5-1069.3)
10 Sec. 5-1069.3. Required health benefits. If a county,
11 including a home rule county, is a self-insurer for purposes
12 of providing health insurance coverage for its employees, the
13 coverage shall include coverage for the post-mastectomy care
14 benefits required to be covered by a policy of accident and
15 health insurance under Section 356t and the coverage required
16 under Sections Section 356u and 356w of the Illinois
17 Insurance Code. The requirement that health benefits be
18 covered as provided in this Section is an exclusive power and
19 function of the State and is a denial and limitation under
20 Article VII, Section 6, subsection (h) of the Illinois
21 Constitution. A home rule county to which this Section
22 applies must comply with every provision of this Section.
23 (Source: P.A. 90-7, eff. 6-10-97.)
24 Section 20. The Illinois Municipal Code is amended by
25 changing Section 10-4-2.3 as follows:
26 (65 ILCS 5/10-4-2.3)
27 Sec. 10-4-2.3. Required health benefits. If a
28 municipality, including a home rule municipality, is a
29 self-insurer for purposes of providing health insurance
-3- LRB9004923JSmbam01
1 coverage for its employees, the coverage shall include
2 coverage for the post-mastectomy care benefits required to be
3 covered by a policy of accident and health insurance under
4 Section 356t and the coverage required under Sections Section
5 356u and 356w of the Illinois Insurance Code. The
6 requirement that health benefits be covered as provided in
7 this is an exclusive power and function of the State and is a
8 denial and limitation under Article VII, Section 6,
9 subsection (h) of the Illinois Constitution. A home rule
10 municipality to which this Section applies must comply with
11 every provision of this Section.
12 (Source: P.A. 90-7, eff. 6-10-97.)
13 Section 25. The School Code is amended by changing
14 Section 10-22.3f as follows:
15 (105 ILCS 5/10-22.3f)
16 Sec. 10-22.3f. Required health benefits. Insurance
17 protection and benefits for employees shall provide the
18 post-mastectomy care benefits required to be covered by a
19 policy of accident and health insurance under Section 356t
20 and the coverage required under Sections Section 356u and
21 356w of the Illinois Insurance Code.
22 (Source: P.A. 90-7, eff. 6-10-97.)
23 Section 30. The Illinois Insurance Code is amended by
24 adding Section 356w as follows:
25 (215 ILCS 5/356w new)
26 Sec. 356w. Diabetes self-management training and
27 education.
28 (a) A group policy of accident and health insurance that
29 is amended, delivered, issued, or renewed after the effective
30 date of this amendatory Act of 1998 shall provide coverage
-4- LRB9004923JSmbam01
1 for outpatient self-management training and education,
2 equipment, and supplies, as set forth in this Section, for
3 the treatment of type 1 diabetes, type 2 diabetes, and
4 gestational diabetes mellitus.
5 (b) As used in this Section:
6 "Diabetes self-management training" means instruction in
7 an outpatient setting which enables a diabetic patient to
8 understand the diabetic management process and daily
9 management of diabetic therapy as a means of avoiding
10 frequent hospitalization and complications. Diabetes
11 self-management training shall include the content areas
12 listed in the National Standards for Diabetes Self-Management
13 Education Programs as published by the American Diabetes
14 Association, including medical nutrition therapy.
15 "Medical nutrition therapy" shall have the meaning
16 ascribed to "medical nutrition care" in the Dietetic and
17 Nutrition Services Practice Act.
18 "Attending physician" means a physician licensed to
19 practice medicine in all of its branches providing care to
20 the individual. The attending physician for an individual
21 enrolled in a health maintenance organization is the
22 individual's primary care physician.
23 "Qualified provider" for an individual that is enrolled
24 in:
25 (1) an insurance plan or health maintenance
26 organization that uses a primary care physician to
27 control access to specialty care means (A) the
28 individual's attending physician licensed to practice
29 medicine in all of its branches, (B) a network physician
30 licensed to practice medicine in all of its branches to
31 whom the individual has been referred by the attending
32 physician, or (C) a certified, registered, or licensed
33 network health care professional with expertise in
34 diabetes management to whom the individual has been
-5- LRB9004923JSmbam01
1 referred by the attending physician.
2 (2) an insurance plan means (A) a physician
3 licensed to practice medicine in all of its branches or
4 (B) a certified, registered, or licensed health care
5 professional with expertise in diabetes management to
6 whom the individual has been referred by the attending
7 physician.
8 (c) Coverage under this Section for diabetes
9 self-management training, including medical nutrition
10 education, shall be limited to the following:
11 (1) Up to 3 medically necessary visits, upon
12 initial diagnosis of diabetes by the patient's attending
13 physician, to a qualified provider.
14 (2) Up to 2 medically necessary visits, upon a
15 diagnosis by a patient's attending physician that
16 represents a significant change in the patient's symptoms
17 or medical condition, to a qualified provider. A
18 "Significant change" in condition means symptomatic
19 hyperglycemia (greater than 250 mg/dl on repeated
20 occasions), severe hypoglycemia (requiring the assistance
21 of another person), onset or progression of diabetes, or
22 a significant change in medical condition that would
23 require a significantly different treatment regimen.
24 Payment by the insurer or health maintenance
25 organization for the coverage required for diabetes
26 self-management training pursuant to the provisions of this
27 Section shall be required only upon certification by the
28 qualified provider providing the training that the patient
29 has successfully completed diabetes self-management training.
30 Coverage under this subsection (c) for diabetes
31 self-management training shall be subject to the same
32 deductible, co-payment, and coinsurance provisions that apply
33 to coverage under the policy for other services provided by
34 the same type of provider.
-6- LRB9004923JSmbam01
1 (d) Coverage shall be provided for the following
2 medically necessary equipment when medically necessary and
3 prescribed by the attending physician licensed to practice
4 medicine in all of its branches if an individual's group
5 policy of accident and health insurance provides for a
6 durable medical equipment benefit. Coverage for the
7 following items shall be subject to deductible, co-payment
8 and co-insurance provisions provided for under the policy or
9 a durable medical equipment rider to the policy:
10 (1) blood glucose monitors;
11 (2) blood glucose monitors for the legally blind;
12 (3) cartridges for the legally blind;
13 (4) lancets and lancing devices; and
14 (e) Coverage shall be provided for the following
15 medically necessary pharmaceuticals and supplies when
16 medically necessary and prescribed by the attending physician
17 licensed to practice medicine in all of its branches if an
18 individual's group policy of accident and health insurance
19 provides for a drug benefit. Coverage for the following
20 items shall be subject to the same deductible, co-payment,
21 and co-insurance provisions under the policy or a drug rider
22 to the policy:
23 (1) insulin that is on the insurer's or health
24 maintenance organization's drug formulary;
25 (2) syringes and needles;
26 (3) test strips for glucose monitors; and
27 (4) FDA approved oral agents used to control blood
28 sugar that are on the insurer's or health maintenance
29 organization's drug formulary.
30 (5) glucagon emergency kits.
31 (f) Coverage shall be provided for regular foot care
32 exams by the attending physician or by a network physician to
33 whom the attending physician has referred the patient.
34 Coverage for regular foot care exams shall subject to the
-7- LRB9004923JSmbam01
1 same deductible, co-payment, and co-insurance provisions that
2 apply under the policy for other services provided by the
3 same type of provider.
4 (g) If authorized by the attending physician, diabetes
5 self-management training may be provided as a part of an
6 office visit, group setting, or home visit.
7 (h) This Section shall not apply to agreements,
8 contracts, or policies that provide coverage for a specified
9 diagnosis or other limited benefit coverage.
10 Section 35. The Health Maintenance Organization Act is
11 amended by changing Section 5-3 as follows:
12 (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
13 (Text of Section before amendment by P.A. 90-372)
14 Sec. 5-3. Insurance Code provisions.
15 (a) Health Maintenance Organizations shall be subject to
16 the provisions of Sections 133, 134, 137, 140, 141.1, 141.2,
17 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5,
18 154.6, 154.7, 154.8, 155.04, 355.2, 356m, 356v, 356w, 356t,
19 367i, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412,
20 paragraph (c) of subsection (2) of Section 367, and Articles
21 VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, and XXVI of the
22 Illinois Insurance Code.
23 (b) For purposes of the Illinois Insurance Code, except
24 for Articles XIII and XIII 1/2, Health Maintenance
25 Organizations in the following categories are deemed to be
26 "domestic companies":
27 (1) a corporation authorized under the Medical
28 Service Plan Act, the Dental Service Plan Act, the
29 Pharmaceutical Service Plan Act, or the Voluntary Health
30 Services Plans Plan Act, or the Nonprofit Health Care
31 Service Plan Act;
32 (2) a corporation organized under the laws of this
-8- LRB9004923JSmbam01
1 State; or
2 (3) a corporation organized under the laws of
3 another state, 30% or more of the enrollees of which are
4 residents of this State, except a corporation subject to
5 substantially the same requirements in its state of
6 organization as is a "domestic company" under Article
7 VIII 1/2 of the Illinois Insurance Code.
8 (c) In considering the merger, consolidation, or other
9 acquisition of control of a Health Maintenance Organization
10 pursuant to Article VIII 1/2 of the Illinois Insurance Code,
11 (1) the Director shall give primary consideration
12 to the continuation of benefits to enrollees and the
13 financial conditions of the acquired Health Maintenance
14 Organization after the merger, consolidation, or other
15 acquisition of control takes effect;
16 (2)(i) the criteria specified in subsection (1)(b)
17 of Section 131.8 of the Illinois Insurance Code shall not
18 apply and (ii) the Director, in making his determination
19 with respect to the merger, consolidation, or other
20 acquisition of control, need not take into account the
21 effect on competition of the merger, consolidation, or
22 other acquisition of control;
23 (3) the Director shall have the power to require
24 the following information:
25 (A) certification by an independent actuary of
26 the adequacy of the reserves of the Health
27 Maintenance Organization sought to be acquired;
28 (B) pro forma financial statements reflecting
29 the combined balance sheets of the acquiring company
30 and the Health Maintenance Organization sought to be
31 acquired as of the end of the preceding year and as
32 of a date 90 days prior to the acquisition, as well
33 as pro forma financial statements reflecting
34 projected combined operation for a period of 2
-9- LRB9004923JSmbam01
1 years;
2 (C) a pro forma business plan detailing an
3 acquiring party's plans with respect to the
4 operation of the Health Maintenance Organization
5 sought to be acquired for a period of not less than
6 3 years; and
7 (D) such other information as the Director
8 shall require.
9 (d) The provisions of Article VIII 1/2 of the Illinois
10 Insurance Code and this Section 5-3 shall apply to the sale
11 by any health maintenance organization of greater than 10% of
12 its enrollee population (including without limitation the
13 health maintenance organization's right, title, and interest
14 in and to its health care certificates).
15 (e) In considering any management contract or service
16 agreement subject to Section 141.1 of the Illinois Insurance
17 Code, the Director (i) shall, in addition to the criteria
18 specified in Section 141.2 of the Illinois Insurance Code,
19 take into account the effect of the management contract or
20 service agreement on the continuation of benefits to
21 enrollees and the financial condition of the health
22 maintenance organization to be managed or serviced, and (ii)
23 need not take into account the effect of the management
24 contract or service agreement on competition.
25 (f) Except for small employer groups as defined in the
26 Small Employer Rating, Renewability and Portability Health
27 Insurance Act and except for medicare supplement policies as
28 defined in Section 363 of the Illinois Insurance Code, a
29 Health Maintenance Organization may by contract agree with a
30 group or other enrollment unit to effect refunds or charge
31 additional premiums under the following terms and conditions:
32 (i) the amount of, and other terms and conditions
33 with respect to, the refund or additional premium are set
34 forth in the group or enrollment unit contract agreed in
-10- LRB9004923JSmbam01
1 advance of the period for which a refund is to be paid or
2 additional premium is to be charged (which period shall
3 not be less than one year); and
4 (ii) the amount of the refund or additional premium
5 shall not exceed 20% of the Health Maintenance
6 Organization's profitable or unprofitable experience with
7 respect to the group or other enrollment unit for the
8 period (and, for purposes of a refund or additional
9 premium, the profitable or unprofitable experience shall
10 be calculated taking into account a pro rata share of the
11 Health Maintenance Organization's administrative and
12 marketing expenses, but shall not include any refund to
13 be made or additional premium to be paid pursuant to this
14 subsection (f)). The Health Maintenance Organization and
15 the group or enrollment unit may agree that the
16 profitable or unprofitable experience may be calculated
17 taking into account the refund period and the immediately
18 preceding 2 plan years.
19 The Health Maintenance Organization shall include a
20 statement in the evidence of coverage issued to each enrollee
21 describing the possibility of a refund or additional premium,
22 and upon request of any group or enrollment unit, provide to
23 the group or enrollment unit a description of the method used
24 to calculate (1) the Health Maintenance Organization's
25 profitable experience with respect to the group or enrollment
26 unit and the resulting refund to the group or enrollment unit
27 or (2) the Health Maintenance Organization's unprofitable
28 experience with respect to the group or enrollment unit and
29 the resulting additional premium to be paid by the group or
30 enrollment unit.
31 In no event shall the Illinois Health Maintenance
32 Organization Guaranty Association be liable to pay any
33 contractual obligation of an insolvent organization to pay
34 any refund authorized under this Section.
-11- LRB9004923JSmbam01
1 (Source: P.A. 89-90, eff. 6-30-95; 90-25, eff. 1-1-98;
2 90-177, eff. 7-23-97; revised 11-21-97.)
3 (Text of Section after amendment by P.A. 90-372)
4 Sec. 5-3. Insurance Code provisions.
5 (a) Health Maintenance Organizations shall be subject to
6 the provisions of Sections 133, 134, 137, 140, 141.1, 141.2,
7 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5,
8 154.6, 154.7, 154.8, 155.04, 355.2, 356m, 356v, 356w, 356t,
9 367i, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412,
10 paragraph (c) of subsection (2) of Section 367, and Articles
11 VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, and XXVI of the
12 Illinois Insurance Code.
13 (b) For purposes of the Illinois Insurance Code, except
14 for Articles XIII and XIII 1/2, Health Maintenance
15 Organizations in the following categories are deemed to be
16 "domestic companies":
17 (1) a corporation authorized under the Medical
18 Service Plan Act, the Dental Service Plan Act or, the
19 Voluntary Health Services Plans Plan Act, or the
20 Nonprofit Health Care Service Plan Act;
21 (2) a corporation organized under the laws of this
22 State; or
23 (3) a corporation organized under the laws of
24 another state, 30% or more of the enrollees of which are
25 residents of this State, except a corporation subject to
26 substantially the same requirements in its state of
27 organization as is a "domestic company" under Article
28 VIII 1/2 of the Illinois Insurance Code.
29 (c) In considering the merger, consolidation, or other
30 acquisition of control of a Health Maintenance Organization
31 pursuant to Article VIII 1/2 of the Illinois Insurance Code,
32 (1) the Director shall give primary consideration
33 to the continuation of benefits to enrollees and the
34 financial conditions of the acquired Health Maintenance
-12- LRB9004923JSmbam01
1 Organization after the merger, consolidation, or other
2 acquisition of control takes effect;
3 (2)(i) the criteria specified in subsection (1)(b)
4 of 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
11 the following information:
12 (A) certification by an independent actuary of
13 the adequacy of the reserves of the Health
14 Maintenance Organization sought to be acquired;
15 (B) pro forma financial statements reflecting
16 the combined balance sheets of the acquiring company
17 and the Health Maintenance Organization sought to be
18 acquired as of the end of the preceding year and as
19 of a date 90 days prior to the acquisition, as well
20 as pro forma financial statements reflecting
21 projected combined operation for a period of 2
22 years;
23 (C) a pro forma business plan detailing an
24 acquiring party's plans with respect to the
25 operation of the Health Maintenance Organization
26 sought to be acquired for a period of not less than
27 3 years; and
28 (D) such other information as the Director
29 shall require.
30 (d) The provisions of Article VIII 1/2 of the Illinois
31 Insurance Code and this Section 5-3 shall apply to the sale
32 by any health maintenance organization of greater than 10% of
33 its enrollee population (including without limitation the
34 health maintenance organization's right, title, and interest
-13- LRB9004923JSmbam01
1 in and to its health care certificates).
2 (e) In considering any management contract or service
3 agreement subject to Section 141.1 of the Illinois Insurance
4 Code, the Director (i) shall, in addition to the criteria
5 specified in Section 141.2 of the Illinois Insurance Code,
6 take into account the effect of the management contract or
7 service agreement on the continuation of benefits to
8 enrollees and the financial condition of the health
9 maintenance organization to be managed or serviced, and (ii)
10 need not take into account the effect of the management
11 contract or service agreement on competition.
12 (f) Except for small employer groups as defined in the
13 Small Employer Rating, Renewability and Portability Health
14 Insurance Act and except for medicare supplement policies as
15 defined in Section 363 of the Illinois Insurance Code, a
16 Health Maintenance Organization may by contract agree with a
17 group or other enrollment unit to effect refunds or charge
18 additional premiums under the following terms and conditions:
19 (i) the amount of, and other terms and conditions
20 with respect to, the refund or additional premium are set
21 forth in the group or enrollment unit contract agreed in
22 advance of the period for which a refund is to be paid or
23 additional premium is to be charged (which period shall
24 not be less than one year); and
25 (ii) the amount of the refund or additional premium
26 shall not exceed 20% of the Health Maintenance
27 Organization's profitable or unprofitable experience with
28 respect to the group or other enrollment unit for the
29 period (and, for purposes of a refund or additional
30 premium, the profitable or unprofitable experience shall
31 be calculated taking into account a pro rata share of the
32 Health Maintenance Organization's administrative and
33 marketing expenses, but shall not include any refund to
34 be made or additional premium to be paid pursuant to this
-14- LRB9004923JSmbam01
1 subsection (f)). The Health Maintenance Organization and
2 the group or enrollment unit may agree that the
3 profitable or unprofitable experience may be calculated
4 taking into account the refund period and the immediately
5 preceding 2 plan years.
6 The Health Maintenance Organization shall include a
7 statement in the evidence of coverage issued to each enrollee
8 describing the possibility of a refund or additional premium,
9 and upon request of any group or enrollment unit, provide to
10 the group or enrollment unit a description of the method used
11 to calculate (1) the Health Maintenance Organization's
12 profitable experience with respect to the group or enrollment
13 unit and the resulting refund to the group or enrollment unit
14 or (2) the Health Maintenance Organization's unprofitable
15 experience with respect to the group or enrollment unit and
16 the resulting additional premium to be paid by the group or
17 enrollment unit.
18 In no event shall the Illinois Health Maintenance
19 Organization Guaranty Association be liable to pay any
20 contractual obligation of an insolvent organization to pay
21 any refund authorized under this Section.
22 (Source: P.A. 89-90, eff. 6-30-95; 90-25, eff. 1-1-98;
23 90-177, eff. 7-23-97; 90-372, eff. 7-1-98; revised 11-21-97.)
24 Section 40. The Limited Health Service Organization Act
25 is amended by changing Section 3009 as follows:
26 (215 ILCS 130/3009) (from Ch. 73, par. 1503-9)
27 Sec. 3009. Point-of-service limited health service
28 contracts.
29 (a) An LHSO that offers a POS contract:
30 (1) shall include as in-plan covered services all
31 services required by law to be provided by an LHSO;
32 (2) shall provide incentives, which shall include
-15- LRB9004923JSmbam01
1 financial incentives, for enrollees to use in-plan
2 covered services;
3 (3) shall not offer services out-of-plan without
4 providing those services on an in-plan basis;
5 (4) may limit or exclude specific types of services
6 from coverage when obtained out-of-plan;
7 (5) may include annual out-of-pocket limits and
8 lifetime maximum benefits allowances for out-of-plan
9 services that are separate from any limits or allowances
10 applied to in-plan services;
11 (6) shall include an annual maximum benefit
12 allowance not to exceed $2,500 per year that is separate
13 from any limits or allowances applied to in-plan
14 services;
15 (7) may limit the groups to which a POS product is
16 offered, however, if a POS product is offered to a group,
17 then it must be offered to all eligible members of that
18 group, when an LHSO provider is available;
19 (8) shall not consider emergency services,
20 authorized referral services, or non-routine services
21 obtained out of the service area to be POS services; and
22 (9) may treat as out-of-plan services those
23 services that an enrollee obtains from a participating
24 provider, but for which the proper authorization was not
25 given by the LHSO.
26 (b) An LHSO offering a POS contract shall be subject to
27 the following limitations:
28 (1) The LHSO shall not expend in any calendar
29 quarter more than 20% of its total limited health
30 services expenditures for all its members for out-of-plan
31 covered services.
32 (2) If the amount specified in paragraph (1) is
33 exceeded by 2% in a quarter, the LHSO shall effect
34 compliance with paragraph (1) by the end of the following
-16- LRB9004923JSmbam01
1 quarter.
2 (3) If compliance with the amount specified in
3 paragraph (1) is not demonstrated in the LHSO's next
4 quarterly report, the LHSO may not offer the POS contract
5 to new groups or include the POS option in the renewal of
6 an existing group until compliance with the amount
7 specified in paragraph (1) is demonstrated or otherwise
8 allowed by the Director.
9 (4) Any LHSO failing, without just cause, to comply
10 with the provisions of this subsection shall be required,
11 after notice and hearing, to pay a penalty of $250 for
12 each day out of compliance, to be recovered by the
13 Director of Insurance. Any penalty recovered shall be
14 paid into the General Revenue Fund. The Director may
15 reduce the penalty if the LHSO demonstrates to the
16 Director that the imposition of the penalty would
17 constitute a financial hardship to the LHSO.
18 (c) Any LHSO that offers a POS product shall:
19 (1) File a quarterly financial statement detailing
20 compliance with the requirements of subsection (b).
21 (2) Track out-of-plan POS utilization separately
22 from in-plan or non-POS out-of-plan emergency care,
23 referral care, and urgent care out of the service area
24 utilization.
25 (3) Record out-of-plan utilization in a manner that
26 will permit such utilization and cost reporting as the
27 Director may, by regulation, require.
28 (4) Demonstrate to the Director's satisfaction that
29 the LHSO has the fiscal, administrative, and marketing
30 capacity to control its POS enrollment, utilization, and
31 costs so as not to jeopardize the financial security of
32 the LHSO.
33 (5) Maintain the deposit required by subsection (b)
34 of Section 2006 in addition to any other deposit required
-17- LRB9004923JSmbam01
1 under this Act.
2 (d) An LHSO shall not issue a POS contract until it has
3 filed and had approved by the Director a plan to comply with
4 the provisions of this Section. The compliance plan shall at
5 a minimum include provisions demonstrating that the LHSO will
6 do all of the following:
7 (1) Design the benefit levels and conditions of
8 coverage for in-plan covered services and out-of-plan
9 covered services as required by this Article.
10 (2) Provide or arrange for the provision of
11 adequate systems to:
12 (A) process and pay claims for all out-of-plan
13 covered services;
14 (B) meet the requirements for a POS contract
15 set forth in this Section and any additional
16 requirements that may be set forth by the Director;
17 and
18 (C) generate accurate data and financial and
19 regulatory reports on a timely basis so that the
20 Department can evaluate the LHSO's experience with
21 the POS contract and monitor compliance with POS
22 contract provisions.
23 (3) Comply initially and on an ongoing basis with
24 the requirements of subsections (b) and (c).
25 (e) A limited health service organization that offers a
26 POS contract must comply with Section 356w of the Illinois
27 Insurance Code.
28 (Source: P.A. 87-1079; 88-667, eff. 9-16-94.)
29 Section 45. The Voluntary Health Services Plans Act is
30 amended by changing Section 10 as follows:
31 (215 ILCS 165/10) (from Ch. 32, par. 604)
32 Sec. 10. Application of Insurance Code provisions.
-18- LRB9004923JSmbam01
1 Health services plan corporations and all persons interested
2 therein or dealing therewith shall be subject to the
3 provisions of Article XII 1/2 and Sections 3.1, 133, 140,
4 143, 143c, 149, 354, 355.2, 356r, 356t, 356u, 356v, 356w,
5 367.2, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412, and
6 paragraphs (7) and (15) of Section 367 of the Illinois
7 Insurance Code.
8 (Source: P.A. 89-514, eff. 7-17-96; 90-7, eff. 6-10-97;
9 90-25, eff. 1-1-98; revised 10-14-97.)
10 Section 50. The Illinois Public Aid Code is amended by
11 changing Section 5-16.8 as follows:
12 (305 ILCS 5/5-16.8)
13 Sec. 5-16.8. Required health benefits. The medical
14 assistance program shall provide the post-mastectomy care
15 benefits required to be covered by a policy of accident and
16 health insurance under Section 356t and the coverage required
17 under Sections Section 356u and 356w of the Illinois
18 Insurance Code.
19 (Source: P.A. 90-7, eff. 6-10-97.)
20 Section 95. No acceleration or delay. Where this Act
21 makes changes in a statute that is represented in this Act by
22 text that is not yet or no longer in effect (for example, a
23 Section represented by multiple versions), the use of that
24 text does not accelerate or delay the taking effect of (i)
25 the changes made by this Act or (ii) provisions derived from
26 any other Public Act.
27 Section 99. Effective date. This Act takes effect
28 January 1, 1999.".