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Public Act 093-0853
Public Act 0853 93RD GENERAL ASSEMBLY
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Public Act 093-0853
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| SB2744 Enrolled |
LRB093 20224 SAS 45982 b |
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| AN ACT concerning insurance coverage.
| Be it enacted by the People of the State of Illinois, | represented in the General Assembly:
| Section 5. The State Employees Group Insurance Act of 1971 | is amended by
changing Section 6.11 as follows:
| (5 ILCS 375/6.11)
| Sec. 6.11. Required health benefits; Illinois Insurance | Code
requirements. The program of health
benefits shall provide | the post-mastectomy care benefits required to be covered
by a | policy of accident and health insurance under Section 356t of | the Illinois
Insurance Code. The program of health benefits | shall provide the coverage
required under Sections 356u, 356w, | 356x, 356z.2, and 356z.4, and 356z.6 of the
Illinois Insurance | Code.
The program of health benefits must comply with Section | 155.37 of the
Illinois Insurance Code.
| (Source: P.A. 92-440, eff. 8-17-01; 92-764, eff. 1-1-03; | 93-102, eff. 1-1-04.)
| Section 10. The Counties Code is amended by changing
| Section 5-1069.3 as follows:
| (55 ILCS 5/5-1069.3)
| Sec. 5-1069.3. Required health benefits. If a county, | including a home
rule
county, is a self-insurer for purposes of | providing health insurance coverage
for its employees, the | coverage shall include coverage for the post-mastectomy
care | benefits required to be covered by a policy of accident and | health
insurance under Section 356t and the coverage required | under Sections 356u,
356w, and 356x and 356z.6 of
the Illinois | Insurance Code. The requirement that health benefits be covered
| as provided in this Section is an
exclusive power and function | of the State and is a denial and limitation under
Article VII, |
| Section 6, subsection (h) of the Illinois Constitution. A home
| rule county to which this Section applies must comply with | every provision of
this Section.
| (Source: P.A. 90-7, eff. 6-10-97; 90-741, eff. 1-1-99.)
| Section 15. The Illinois Municipal Code is amended by | changing
Section 10-4-2.3 as follows:
| (65 ILCS 5/10-4-2.3)
| Sec. 10-4-2.3. Required health benefits. If a | municipality, including a
home rule municipality, is a | self-insurer for purposes of providing health
insurance | coverage for its employees, the coverage shall include coverage | for
the post-mastectomy care benefits required to be covered by | a policy of
accident and health insurance under Section 356t | and the coverage required
under Sections 356u, 356w, and 356x | and 356z.6 of the Illinois
Insurance
Code. The requirement that | health
benefits be covered as provided in this is an exclusive | power and function of
the State and is a denial and limitation | under Article VII, Section 6,
subsection (h) of the Illinois | Constitution. A home rule municipality to which
this Section | applies must comply with every provision of this Section.
| (Source: P.A. 90-7, eff. 6-10-97; 90-741, eff. 1-1-99.)
| Section 20. The School Code is amended by changing
Section | 10-22.3f as follows:
| (105 ILCS 5/10-22.3f)
| Sec. 10-22.3f. Required health benefits. Insurance | protection and
benefits
for employees shall provide the | post-mastectomy care benefits required to be
covered by a | policy of accident and health insurance under Section 356t and | the
coverage required under Sections 356u, 356w, and 356x and | 356z.6 of
the
Illinois Insurance Code.
| (Source: P.A. 90-7, eff. 6-10-97; 90-741, eff. 1-1-99.)
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| Section 25. The Illinois Insurance Code is amended by | adding Section 356z.6
as
follows:
| (215 ILCS 5/356z.6 new)
| Sec. 356z.6. Bone mass measurement; osteoporosis. A group | or individual
policy of
accident and health insurance amended, | delivered, issued,
or renewed after the effective date of this | amendatory Act of the 93rd General
Assembly must
provide | coverage for
medically necessary bone mass measurement and for | the diagnosis and treatment
of osteoporosis on
the
same terms | and conditions that are generally
applicable
to coverage for | other
medical conditions.
| Section 30. The Health Maintenance Organization Act is | amended by changing
Section 5-3 as follows:
| (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
| Sec. 5-3. Insurance Code provisions.
| (a) Health Maintenance Organizations
shall be subject to | the provisions of Sections 133, 134, 137, 140, 141.1,
141.2, | 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, 154, 154.5, | 154.6,
154.7, 154.8, 155.04, 355.2, 356m, 356v, 356w, 356x, | 356y,
356z.2, 356z.4, 356z.5, 356z.6, 367.2, 367.2-5, 367i, | 368a, 368b, 368c, 368d, 368e,
401, 401.1, 402, 403, 403A,
408, | 408.2, 409, 412, 444,
and
444.1,
paragraph (c) of subsection | (2) of Section 367, and Articles IIA, VIII 1/2,
XII,
XII 1/2, | XIII, XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.
| (b) For purposes of the Illinois Insurance Code, except for | Sections 444
and 444.1 and Articles XIII and XIII 1/2, Health | Maintenance Organizations in
the following categories are | deemed to be "domestic companies":
| (1) a corporation authorized under the
Dental Service | Plan Act or the Voluntary Health Services Plans Act;
| (2) a corporation organized under the laws of this | State; or
| (3) a corporation organized under the laws of another |
| state, 30% or more
of the enrollees of which are residents | of this State, except a
corporation subject to | substantially the same requirements in its state of
| organization as is a "domestic company" under Article VIII | 1/2 of the
Illinois Insurance Code.
| (c) In considering the merger, consolidation, or other | acquisition of
control of a Health Maintenance Organization | pursuant to Article VIII 1/2
of the Illinois Insurance Code,
| (1) the Director shall give primary consideration to | the continuation of
benefits to enrollees and the financial | conditions of the acquired Health
Maintenance Organization | after the merger, consolidation, or other
acquisition of | control takes effect;
| (2)(i) the criteria specified in subsection (1)(b) of | Section 131.8 of
the Illinois Insurance Code shall not | apply and (ii) the Director, in making
his determination | with respect to the merger, consolidation, or other
| acquisition of control, need not take into account the | effect on
competition of the merger, consolidation, or | other acquisition of control;
| (3) the Director shall have the power to require the | following
information:
| (A) certification by an independent actuary of the | adequacy
of the reserves of the Health Maintenance | Organization sought to be acquired;
| (B) pro forma financial statements reflecting the | combined balance
sheets of the acquiring company and | the Health Maintenance Organization sought
to be | acquired as of the end of the preceding year and as of | a date 90 days
prior to the acquisition, as well as pro | forma financial statements
reflecting projected | combined operation for a period of 2 years;
| (C) a pro forma business plan detailing an | acquiring party's plans with
respect to the operation | of the Health Maintenance Organization sought to
be | acquired for a period of not less than 3 years; and
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| (D) such other information as the Director shall | require.
| (d) The provisions of Article VIII 1/2 of the Illinois | Insurance Code
and this Section 5-3 shall apply to the sale by | any health maintenance
organization of greater than 10% of its
| enrollee population (including without limitation the health | maintenance
organization's right, title, and interest in and to | its health care
certificates).
| (e) In considering any management contract or service | agreement subject
to Section 141.1 of the Illinois Insurance | Code, the Director (i) shall, in
addition to the criteria | specified in Section 141.2 of the Illinois
Insurance Code, take | into account the effect of the management contract or
service | agreement on the continuation of benefits to enrollees and the
| financial condition of the health maintenance organization to | be managed or
serviced, and (ii) need not take into account the | effect of the management
contract or service agreement on | competition.
| (f) Except for small employer groups as defined in the | Small Employer
Rating, Renewability and Portability Health | Insurance Act and except for
medicare supplement policies as | defined in Section 363 of the Illinois
Insurance Code, a Health | Maintenance Organization may by contract agree with a
group or | other enrollment unit to effect refunds or charge additional | premiums
under the following terms and conditions:
| (i) the amount of, and other terms and conditions with | respect to, the
refund or additional premium are set forth | in the group or enrollment unit
contract agreed in advance | of the period for which a refund is to be paid or
| additional premium is to be charged (which period shall not | be less than one
year); and
| (ii) the amount of the refund or additional premium | shall not exceed 20%
of the Health Maintenance | Organization's profitable or unprofitable experience
with | respect to the group or other enrollment unit for the | period (and, for
purposes of a refund or additional |
| premium, the profitable or unprofitable
experience shall | be calculated taking into account a pro rata share of the
| Health Maintenance Organization's administrative and | marketing expenses, but
shall not include any refund to be | made or additional premium to be paid
pursuant to this | subsection (f)). The Health Maintenance Organization and | the
group or enrollment unit may agree that the profitable | or unprofitable
experience may be calculated taking into | account the refund period and the
immediately preceding 2 | plan years.
| The Health Maintenance Organization shall include a | statement in the
evidence of coverage issued to each enrollee | describing the possibility of a
refund or additional premium, | and upon request of any group or enrollment unit,
provide to | the group or enrollment unit a description of the method used | to
calculate (1) the Health Maintenance Organization's | profitable experience with
respect to the group or enrollment | unit and the resulting refund to the group
or enrollment unit | or (2) the Health Maintenance Organization's unprofitable
| experience with respect to the group or enrollment unit and the | resulting
additional premium to be paid by the group or | enrollment unit.
| In no event shall the Illinois Health Maintenance | Organization
Guaranty Association be liable to pay any | contractual obligation of an
insolvent organization to pay any | refund authorized under this Section.
| (Source: P.A. 92-764, eff. 1-1-03; 93-102, eff. 1-1-04; 93-261, | eff. 1-1-04;
93-477, eff. 8-8-03; 93-529, eff. 8-14-03; revised | 9-25-03.)
| Section 35. The Voluntary Health Services Plans Act is | amended by changing
Section 10 as follows:
| (215 ILCS 165/10) (from Ch. 32, par. 604)
| Sec. 10. Application of Insurance Code provisions. Health | services
plan corporations and all persons interested therein |
| or dealing therewith
shall be subject to the provisions of | Articles IIA and XII 1/2 and Sections
3.1, 133, 140, 143, 143c, | 149, 155.37, 354, 355.2, 356r, 356t, 356u, 356v,
356w, 356x, | 356y, 356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 367.2, 368a, 401, | 401.1,
402,
403, 403A, 408,
408.2, and 412, and paragraphs (7) | and (15) of Section 367 of the Illinois
Insurance Code.
| (Source: P.A. 92-130, eff. 7-20-01; 92-440, eff. 8-17-01;
| 92-651, eff. 7-11-02; 92-764, eff. 1-1-03; 93-102, eff. 1-1-04; | 93-529, eff.
8-14-03; revised 9-25-03.)
| Section 40. The Illinois Public Aid Code is amended by | changing
Section 5-16.8 as follows:
| (305 ILCS 5/5-16.8)
| Sec. 5-16.8. Required health benefits. The medical | assistance program
shall
provide the post-mastectomy care | benefits required to be covered by a policy of
accident and | health insurance under Section 356t and the coverage required
| under Sections 356u, 356w, and 356x and 356z.6 of the Illinois
| Insurance Code.
| (Source: P.A. 90-7, eff. 6-10-97; 90-741, eff. 1-1-99.)
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Effective Date: 1/1/2005
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