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92_SB1051 LRB9201975JSpc 1 AN ACT in relation to insurance coverage for cancer 2 screenings, amending named Acts. 3 Be it enacted by the People of the State of Illinois, 4 represented in the General Assembly: 5 Section 5. The Illinois Insurance Code is amended by 6 adding Section 356z.1 as follows: 7 (215 ILCS 5/356z.1 new) 8 Sec. 356z.1. Cancer screening tests. An individual or 9 group policy of accident and health insurance amended, 10 delivered, issued, or renewed after the effective date of 11 this amendatory Act of the 92nd General Assembly must provide 12 coverage for all generally medically accepted cancer 13 screening tests. Coverage under this Section may not be 14 subject to any greater coinsurance, copayment, or deductible 15 than that applicable for any other coverage under the policy. 16 Section 10. The Health Maintenance Organization Act is 17 amended by changing Section 5-3 as follows: 18 (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2) 19 Sec. 5-3. Insurance Code provisions. 20 (a) Health Maintenance Organizations shall be subject to 21 the provisions of Sections 133, 134, 137, 140, 141.1, 141.2, 22 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5, 23 154.6, 154.7, 154.8, 155.04, 355.2, 356m, 356v, 356w, 356x, 24 356y, 356z.1, 367i, 368a, 401, 401.1, 402, 403, 403A, 408, 25 408.2, 409, 412, 444, and 444.1, paragraph (c) of subsection 26 (2) of Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2, 27 XIII, XIII 1/2, XXV, and XXVI of the Illinois Insurance Code. 28 (b) For purposes of the Illinois Insurance Code, except 29 for Sections 444 and 444.1 and Articles XIII and XIII 1/2, -2- LRB9201975JSpc 1 Health Maintenance Organizations in the following categories 2 are deemed to be "domestic companies": 3 (1) a corporation authorized under the Dental 4 Service Plan Act or the Voluntary Health Services Plans 5 Act; 6 (2) a corporation organized under the laws of this 7 State; or 8 (3) a corporation organized under the laws of 9 another state, 30% or more of the enrollees of which are 10 residents of this State, except a corporation subject to 11 substantially the same requirements in its state of 12 organization as is a "domestic company" under Article 13 VIII 1/2 of the Illinois Insurance Code. 14 (c) In considering the merger, consolidation, or other 15 acquisition of control of a Health Maintenance Organization 16 pursuant to Article VIII 1/2 of the Illinois Insurance Code, 17 (1) the Director shall give primary consideration 18 to the continuation of benefits to enrollees and the 19 financial conditions of the acquired Health Maintenance 20 Organization after the merger, consolidation, or other 21 acquisition of control takes effect; 22 (2)(i) the criteria specified in subsection (1)(b) 23 of Section 131.8 of the Illinois Insurance Code shall not 24 apply and (ii) the Director, in making his determination 25 with respect to the merger, consolidation, or other 26 acquisition of control, need not take into account the 27 effect on competition of the merger, consolidation, or 28 other acquisition of control; 29 (3) the Director shall have the power to require 30 the following information: 31 (A) certification by an independent actuary of 32 the adequacy of the reserves of the Health 33 Maintenance Organization sought to be acquired; 34 (B) pro forma financial statements reflecting -3- LRB9201975JSpc 1 the combined balance sheets of the acquiring company 2 and the Health Maintenance Organization sought to be 3 acquired as of the end of the preceding year and as 4 of a date 90 days prior to the acquisition, as well 5 as pro forma financial statements reflecting 6 projected combined operation for a period of 2 7 years; 8 (C) a pro forma business plan detailing an 9 acquiring party's plans with respect to the 10 operation of the Health Maintenance Organization 11 sought to be acquired for a period of not less than 12 3 years; and 13 (D) such other information as the Director 14 shall require. 15 (d) The provisions of Article VIII 1/2 of the Illinois 16 Insurance Code and this Section 5-3 shall apply to the sale 17 by any health maintenance organization of greater than 10% of 18 its enrollee population (including without limitation the 19 health maintenance organization's right, title, and interest 20 in and to its health care certificates). 21 (e) In considering any management contract or service 22 agreement subject to Section 141.1 of the Illinois Insurance 23 Code, the Director (i) shall, in addition to the criteria 24 specified in Section 141.2 of the Illinois Insurance Code, 25 take into account the effect of the management contract or 26 service agreement on the continuation of benefits to 27 enrollees and the financial condition of the health 28 maintenance organization to be managed or serviced, and (ii) 29 need not take into account the effect of the management 30 contract or service agreement on competition. 31 (f) Except for small employer groups as defined in the 32 Small Employer Rating, Renewability and Portability Health 33 Insurance Act and except for medicare supplement policies as 34 defined in Section 363 of the Illinois Insurance Code, a -4- LRB9201975JSpc 1 Health Maintenance Organization may by contract agree with a 2 group or other enrollment unit to effect refunds or charge 3 additional premiums under the following terms and conditions: 4 (i) the amount of, and other terms and conditions 5 with respect to, the refund or additional premium are set 6 forth in the group or enrollment unit contract agreed in 7 advance of the period for which a refund is to be paid or 8 additional premium is to be charged (which period shall 9 not be less than one year); and 10 (ii) the amount of the refund or additional premium 11 shall not exceed 20% of the Health Maintenance 12 Organization's profitable or unprofitable experience with 13 respect to the group or other enrollment unit for the 14 period (and, for purposes of a refund or additional 15 premium, the profitable or unprofitable experience shall 16 be calculated taking into account a pro rata share of the 17 Health Maintenance Organization's administrative and 18 marketing expenses, but shall not include any refund to 19 be made or additional premium to be paid pursuant to this 20 subsection (f)). The Health Maintenance Organization and 21 the group or enrollment unit may agree that the 22 profitable or unprofitable experience may be calculated 23 taking into account the refund period and the immediately 24 preceding 2 plan years. 25 The Health Maintenance Organization shall include a 26 statement in the evidence of coverage issued to each enrollee 27 describing the possibility of a refund or additional premium, 28 and upon request of any group or enrollment unit, provide to 29 the group or enrollment unit a description of the method used 30 to calculate (1) the Health Maintenance Organization's 31 profitable experience with respect to the group or enrollment 32 unit and the resulting refund to the group or enrollment unit 33 or (2) the Health Maintenance Organization's unprofitable 34 experience with respect to the group or enrollment unit and -5- LRB9201975JSpc 1 the resulting additional premium to be paid by the group or 2 enrollment unit. 3 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 6 any refund authorized under this Section. 7 (Source: P.A. 90-25, eff. 1-1-98; 90-177, eff. 7-23-97; 8 90-372, eff. 7-1-98; 90-583, eff. 5-29-98; 90-655, eff. 9 7-30-98; 90-741, eff. 1-1-99; 91-357, eff. 7-29-99; 91-406, 10 eff. 1-1-00; 91-549, eff. 8-14-99; 91-605, eff. 12-14-99; 11 91-788, eff. 6-9-00.) 12 Section 15. The Voluntary Health Services Plans Act is 13 amended by changing Section 10 as follows: 14 (215 ILCS 165/10) (from Ch. 32, par. 604) 15 Sec. 10. Application of Insurance Code provisions. 16 Health services plan corporations and all persons interested 17 therein or dealing therewith shall be subject to the 18 provisions of Articles IIA and XII 1/2 and Sections 3.1, 133, 19 140, 143, 143c, 149, 354, 355.2, 356r, 356t, 356u, 356v, 20 356w, 356x, 356y, 356z.1, 367.2, 368a, 401, 401.1, 402, 403, 21 403A, 408, 408.2, and 412, and paragraphs (7) and (15) of 22 Section 367 of the Illinois Insurance Code. 23 (Source: P.A. 90-7, eff. 6-10-97; 90-25, eff. 1-1-98; 90-655, 24 eff. 7-30-98; 90-741, eff. 1-1-99; 91-406, eff. 1-1-00; 25 91-549, eff. 8-14-99; 91-605, eff. 12-14-99; 91-788, eff. 26 6-9-00.) 27 Section 99. Effective date. This Act takes effect upon 28 becoming law.