[ Search ] [ Legislation ]
[ Home ] [ Back ] [ Bottom ]
| [ Introduced ] | [ House Amendment 001 ] |
91_HB0382eng HB0382 Engrossed LRB9100759JSpc 1 AN ACT concerning health benefit notices, amending named 2 Acts. 3 Be it enacted by the People of the State of Illinois, 4 represented in the General Assembly: 5 Section 5. The State Employees Group Insurance Act of 6 1971 is amended by adding Section 6.12 as follows: 7 (5 ILCS 375/6.12 new) 8 Sec. 6.12. Benefit notices. The program of health 9 benefits shall provide the benefit payment or department 10 responsible for resolving disputes and denial notices 11 required under Section 155.36 of the Illinois Insurance Code. 12 13 Section 10. The State Mandates Act is amended by adding 14 Section 8.23 as follows: 15 (30 ILCS 805/8.23 new) 16 Sec. 8.23. Exempt mandate. Notwithstanding Sections 6 17 and 8 of this Act, no reimbursement by the State is required 18 for the implementation of any mandate created by this 19 amendatory Act of 1999. 20 Section 15. The Counties Code is amended by adding 21 Section 5-1069.4 as follows: 22 (55 ILCS 5/5-1069.4 new) 23 Sec. 5-1069.4. Health benefit notices. If a county, 24 including a home rule county, is a self-insurer for purposes 25 of providing health insurance coverage for its employees, the 26 county must provide benefit payment and denial notices as 27 required under Section 155.36 of the Illinois Insurance Code. HB0382 Engrossed -2- LRB9100759JSpc 1 The requirement that benefit payment and denial notices be 2 provided in accordance with this Section is an exclusive 3 power and function of the State and is a denial and 4 limitation under Article VII, Section 6, subsection (h) of 5 the Illinois Constitution. A home rule county to which this 6 Section applies must comply with every provision of this 7 Section. 8 Section 20. The Illinois Municipal Code is amended by 9 adding Section 10-4-2.4 as follows: 10 (65 ILCS 5/10-4-2.4 new) 11 Sec. 10-4-2.4. Health benefit notices. If a 12 municipality, including a home rule municipality, is a 13 self-insurer for purposes of providing health insurance 14 coverage for its employees, the municipality must provide 15 benefit payment and denial notices as required under Section 16 155.36 of the Illinois Insurance Code. The requirement that 17 benefit payment and denial notices be provided in accordance 18 with this Section is an exclusive power and function of the 19 State and is a denial and limitation under Article VII, 20 Section 6, subsection (h) of the Illinois Constitution. A 21 home rule municipality to which this Section applies must 22 comply with every provision of this Section. 23 Section 25. The School Code is amended by adding Section 24 10-22.3g as follows: 25 (105 ILCS 5/10-22.3g new) 26 Sec. 10-22.3g. Health benefit notices. Insurance 27 protection and benefits for employees shall provide the 28 benefit payment and denial notices required under Section 29 155.36 of the Illinois Insurance Code. HB0382 Engrossed -3- LRB9100759JSpc 1 Section 30. The Illinois Insurance Code is amended by 2 adding Sections 155.36 and 511.114 as follows: 3 (215 ILCS 5/155.36 new) 4 Sec. 155.36. Benefit payment and denial notices. 5 (a) An insurance company or managed care plan providing 6 health care benefits shall provide its insureds and enrollees 7 with detailed notices of benefit payment and denial. A 8 notice of denial shall be signed by the individual 9 responsible for denying payment and include an address and 10 accessible telephone number for the individual responsible 11 for denying payment. In addition, a notice of denial shall 12 clearly state the procedures for appealing the denial. The 13 insured or enrollee shall be given the opportunity to respond 14 to any denial and explain any discrepancies. 15 (b) For the purposes of this Section "managed care plan" 16 has the meaning given that term in Section 356r of this Code. 17 18 (215 ILCS 5/511.114 new) 19 Sec. 511.114. Benefit payment and denial notices. An 20 administrator must comply with the requirements of Section 21 155.36 of this Code. 22 Section 35. The Comprehensive Health Insurance Plan Act 23 is amended by adding Section 8.7 as follows: 24 (215 ILCS 105/8.7 new) 25 Sec. 8.7. Benefit notices. The plan is subject to the 26 provisions of Section 155.36 of the Illinois Insurance Code. 27 Section 40. The Health Maintenance Organization Act is 28 amended by adding Section 4-6.6 as follows: HB0382 Engrossed -4- LRB9100759JSpc 1 (215 ILCS 125/4-6.6 new) 2 Sec. 4-6.6. Benefit notices. A health maintenance 3 organization is subject to the provisions of Section 155.36 4 of the Illinois Insurance Code. 5 Section 45. The Limited Health Service Organization Act 6 is amended by changing Section 4003 as follows: 7 (215 ILCS 130/4003) (from Ch. 73, par. 1504-3) 8 Sec. 4003. Illinois Insurance Code provisions. Limited 9 health service organizations shall be subject to the 10 provisions of Sections 133, 134, 137, 140, 141.1, 141.2, 11 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5, 12 154.6, 154.7, 154.8, 155.04, 155.36, 355.2, 356v, 401, 401.1, 13 402, 403, 403A, 408, 408.2, 409, 412, 444, and 444.1 and 14 Articles VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and 15 XXVI of the Illinois Insurance Code. For purposes of the 16 Illinois Insurance Code, except for Sections 444 and 444.1 17 and Articles XIII and XIII 1/2, limited health service 18 organizations in the following categories are deemed to be 19 domestic companies: 20 (1) a corporation under the laws of this State; or 21 (2) a corporation organized under the laws of 22 another state, 30% of more of the enrollees of which are 23 residents 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. 27 (Source: P.A. 90-25, eff. 1-1-98; 90-583, eff. 5-29-98; 28 90-655, eff. 7-30-98.) 29 Section 50. The Voluntary Health Services Plans Act is 30 amended by changing Section 10 as follows: HB0382 Engrossed -5- LRB9100759JSpc 1 (215 ILCS 165/10) (from Ch. 32, par. 604) 2 Sec. 10. Application of Insurance Code provisions. 3 Health services plan corporations and all persons interested 4 therein or dealing therewith shall be subject to the 5 provisions of Article XII 1/2 and Sections 3.1, 133, 140, 6 143, 143c, 149, 155.36, 354, 355.2, 356r, 356t, 356u, 356v, 7 356w, 356x, 367.2, 401, 401.1, 402, 403, 403A, 408, 408.2, 8 and 412, and paragraphs (7) and (15) of Section 367 of the 9 Illinois Insurance Code. 10 (Source: P.A. 89-514, eff. 7-17-96; 90-7, eff. 6-10-97; 11 90-25, eff. 1-1-98; 90-655, eff. 7-30-98; 90-741, eff. 12 1-1-99.)