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92_HB0980eng HB0980 Engrossed LRB9204218JSpc 1 AN ACT concerning insurance coverage. 2 Be it enacted by the People of the State of Illinois, 3 represented in the General Assembly: 4 Section 5. The Illinois Insurance Code is amended by 5 adding Section 356z.1 as follows: 6 (215 ILCS 5/356z.1 new) 7 Sec. 356z.1. Coverage for contraceptives. 8 (a) An individual or group policy of accident and health 9 insurance amended, delivered, issued, or renewed in this 10 State after the effective date of this amendatory Act of the 11 92nd General Assembly that provides coverage for outpatient 12 services and outpatient prescription drugs or devices must 13 provide coverage for the insured and any dependent of the 14 insured covered by the policy for outpatient contraceptive 15 services and outpatient contraceptive drugs or devices 16 approved by the Food and Drug Administration. Coverage 17 required under this Section may not impose any deductible, 18 coinsurance, waiting period, or other cost-sharing or 19 limitation that is greater than that required for any 20 outpatient service or outpatient prescription drug or device 21 otherwise covered by the policy. 22 (b) As used in this Section, "outpatient contraceptive 23 service" means consultations, examinations, procedures, and 24 medical services, provided on an outpatient basis and related 25 to the use of contraceptive methods (including natural family 26 planning) to prevent an unintended pregnancy. 27 Section 10. The Health Maintenance Organization Act is 28 amended by changing Section 5-3 as follows: 29 (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2) HB0980 Engrossed -2- LRB9204218JSpc 1 Sec. 5-3. Insurance Code provisions. 2 (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, 356m, 356v, 356w, 356x, 6 356y, 356z.1, 367i, 368a, 401, 401.1, 402, 403, 403A, 408, 7 408.2, 409, 412, 444, and 444.1, paragraph (c) of subsection 8 (2) of Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2, 9 XIII, XIII 1/2, XXV, and XXVI of the Illinois Insurance Code. 10 (b) For purposes of the Illinois Insurance Code, except 11 for Sections 444 and 444.1 and Articles XIII and XIII 1/2, 12 Health Maintenance Organizations in the following categories 13 are deemed to be "domestic companies": 14 (1) a corporation authorized under the Dental 15 Service Plan Act or the Voluntary Health Services Plans 16 Act; 17 (2) a corporation organized under the laws of this 18 State; or 19 (3) a corporation organized under the laws of 20 another state, 30% or more of the enrollees of which are 21 residents of this State, except a corporation subject to 22 substantially the same requirements in its state of 23 organization as is a "domestic company" under Article 24 VIII 1/2 of the Illinois Insurance Code. 25 (c) In considering the merger, consolidation, or other 26 acquisition of control of a Health Maintenance Organization 27 pursuant to Article VIII 1/2 of the Illinois Insurance Code, 28 (1) the Director shall give primary consideration 29 to the continuation of benefits to enrollees and the 30 financial conditions of the acquired Health Maintenance 31 Organization after the merger, consolidation, or other 32 acquisition of control takes effect; 33 (2)(i) the criteria specified in subsection (1)(b) 34 of Section 131.8 of the Illinois Insurance Code shall not HB0980 Engrossed -3- LRB9204218JSpc 1 apply and (ii) the Director, in making his determination 2 with respect to the merger, consolidation, or other 3 acquisition of control, need not take into account the 4 effect on competition of the merger, consolidation, or 5 other acquisition of control; 6 (3) the Director shall have the power to require 7 the following information: 8 (A) certification by an independent actuary of 9 the adequacy of the reserves of the Health 10 Maintenance Organization sought to be acquired; 11 (B) pro forma financial statements reflecting 12 the combined balance sheets of the acquiring company 13 and the Health Maintenance Organization sought to be 14 acquired as of the end of the preceding year and as 15 of a date 90 days prior to the acquisition, as well 16 as pro forma financial statements reflecting 17 projected combined operation for a period of 2 18 years; 19 (C) a pro forma business plan detailing an 20 acquiring party's plans with respect to the 21 operation of the Health Maintenance Organization 22 sought to be acquired for a period of not less than 23 3 years; and 24 (D) such other information as the Director 25 shall require. 26 (d) The provisions of Article VIII 1/2 of the Illinois 27 Insurance Code and this Section 5-3 shall apply to the sale 28 by any health maintenance organization of greater than 10% of 29 its enrollee population (including without limitation the 30 health maintenance organization's right, title, and interest 31 in and to its health care certificates). 32 (e) In considering any management contract or service 33 agreement subject to Section 141.1 of the Illinois Insurance 34 Code, the Director (i) shall, in addition to the criteria HB0980 Engrossed -4- LRB9204218JSpc 1 specified in Section 141.2 of the Illinois Insurance Code, 2 take into account the effect of the management contract or 3 service agreement on the continuation of benefits to 4 enrollees and the financial condition of the health 5 maintenance organization to be managed or serviced, and (ii) 6 need not take into account the effect of the management 7 contract or service agreement on competition. 8 (f) Except for small employer groups as defined in the 9 Small Employer Rating, Renewability and Portability Health 10 Insurance Act and except for medicare supplement policies as 11 defined in Section 363 of the Illinois Insurance Code, a 12 Health Maintenance Organization may by contract agree with a 13 group or other enrollment unit to effect refunds or charge 14 additional premiums under the following terms and conditions: 15 (i) the amount of, and other terms and conditions 16 with respect to, the refund or additional premium are set 17 forth in the group or enrollment unit contract agreed in 18 advance of the period for which a refund is to be paid or 19 additional premium is to be charged (which period shall 20 not be less than one year); and 21 (ii) the amount of the refund or additional premium 22 shall not exceed 20% of the Health Maintenance 23 Organization's profitable or unprofitable experience with 24 respect to the group or other enrollment unit for the 25 period (and, for purposes of a refund or additional 26 premium, the profitable or unprofitable experience shall 27 be calculated taking into account a pro rata share of the 28 Health Maintenance Organization's administrative and 29 marketing expenses, but shall not include any refund to 30 be made or additional premium to be paid pursuant to this 31 subsection (f)). The Health Maintenance Organization and 32 the group or enrollment unit may agree that the 33 profitable or unprofitable experience may be calculated 34 taking into account the refund period and the immediately HB0980 Engrossed -5- LRB9204218JSpc 1 preceding 2 plan years. 2 The Health Maintenance Organization shall include a 3 statement in the evidence of coverage issued to each enrollee 4 describing the possibility of a refund or additional premium, 5 and upon request of any group or enrollment unit, provide to 6 the group or enrollment unit a description of the method used 7 to calculate (1) the Health Maintenance Organization's 8 profitable experience with respect to the group or enrollment 9 unit and the resulting refund to the group or enrollment unit 10 or (2) the Health Maintenance Organization's unprofitable 11 experience with respect to the group or enrollment unit and 12 the resulting additional premium to be paid by the group or 13 enrollment unit. 14 In no event shall the Illinois Health Maintenance 15 Organization Guaranty Association be liable to pay any 16 contractual obligation of an insolvent organization to pay 17 any refund authorized under this Section. 18 (Source: P.A. 90-25, eff. 1-1-98; 90-177, eff. 7-23-97; 19 90-372, eff. 7-1-98; 90-583, eff. 5-29-98; 90-655, eff. 20 7-30-98; 90-741, eff. 1-1-99; 91-357, eff. 7-29-99; 91-406, 21 eff. 1-1-00; 91-549, eff. 8-14-99; 91-605, eff. 12-14-99; 22 91-788, eff. 6-9-00.) 23 Section 15. The Voluntary Health Services Plans Act is 24 amended by changing Section 10 as follows: 25 (215 ILCS 165/10) (from Ch. 32, par. 604) 26 Sec. 10. Application of Insurance Code provisions. 27 Health services plan corporations and all persons interested 28 therein or dealing therewith shall be subject to the 29 provisions of Articles IIA and XII 1/2 and Sections 3.1, 133, 30 140, 143, 143c, 149, 354, 355.2, 356r, 356t, 356u, 356v, 31 356w, 356x, 356y, 356z.1, 367.2, 368a, 401, 401.1, 402, 403, 32 403A, 408, 408.2, and 412, and paragraphs (7) and (15) of HB0980 Engrossed -6- LRB9204218JSpc 1 Section 367 of the Illinois Insurance Code. 2 (Source: P.A. 90-7, eff. 6-10-97; 90-25, eff. 1-1-98; 90-655, 3 eff. 7-30-98; 90-741, eff. 1-1-99; 91-406, eff. 1-1-00; 4 91-549, eff. 8-14-99; 91-605, eff. 12-14-99; 91-788, eff. 5 6-9-00.)