HB2499 EnrolledLRB103 30875 AMQ 57395 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Insurance Code is amended by
5changing Sections 121-2.05, 356z.18, 367.3, 367a, and 368f and
6by adding Section 352c as follows:
 
7    (215 ILCS 5/121-2.05)  (from Ch. 73, par. 733-2.05)
8    Sec. 121-2.05. Group insurance policies issued and
9delivered in other State-Transactions in this State. With the
10exception of insurance transactions authorized under Sections
11230.2 or 367.3 of this Code or transactions described under
12Section 352c, transactions in this State involving group
13legal, group life and group accident and health or blanket
14accident and health insurance or group annuities where the
15master policy of such groups was lawfully issued and delivered
16in, and under the laws of, a State in which the insurer was
17authorized to do an insurance business, to a group properly
18established pursuant to law or regulation, and where the
19policyholder is domiciled or otherwise has a bona fide situs.
20(Source: P.A. 86-753.)
 
21    (215 ILCS 5/352c new)
22    Sec. 352c. Short-term, limited-duration insurance

 

 

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1prohibited.
2    (a) In this Section:
3    "Excepted benefits" has the meaning given to that term in
442 U.S.C. 300gg-91 and implementing regulations. "Excepted
5benefits" includes individual, group, or blanket coverage.
6    "Short-term, limited-duration insurance" means any type of
7accident and health insurance offered or provided within this
8State pursuant to a group or individual policy or individual
9certificate by a company, regardless of the situs state of the
10delivery of the policy, that has an expiration date specified
11in the contract that is fewer than 365 days after the original
12effective date. Regardless of the duration of coverage,
13"short-term, limited-duration insurance" does not include
14excepted benefits or any student health insurance coverage.
15    (b) On and after January 1, 2025, no company shall issue,
16deliver, amend, or renew short-term, limited-duration
17insurance to any natural or legal person that is a resident or
18domiciled in this State.
 
19    (215 ILCS 5/356z.18)
20    (Text of Section before amendment by P.A. 103-512)
21    Sec. 356z.18. Prosthetic and customized orthotic devices.
22    (a) For the purposes of this Section:
23    "Customized orthotic device" means a supportive device for
24the body or a part of the body, the head, neck, or extremities,
25and includes the replacement or repair of the device based on

 

 

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1the patient's physical condition as medically necessary,
2excluding foot orthotics defined as an in-shoe device designed
3to support the structural components of the foot during
4weight-bearing activities.
5    "Licensed provider" means a prosthetist, orthotist, or
6pedorthist licensed to practice in this State.
7    "Prosthetic device" means an artificial device to replace,
8in whole or in part, an arm or leg and includes accessories
9essential to the effective use of the device and the
10replacement or repair of the device based on the patient's
11physical condition as medically necessary.
12    (b) This amendatory Act of the 96th General Assembly shall
13provide benefits to any person covered thereunder for expenses
14incurred in obtaining a prosthetic or custom orthotic device
15from any Illinois licensed prosthetist, licensed orthotist, or
16licensed pedorthist as required under the Orthotics,
17Prosthetics, and Pedorthics Practice Act.
18    (c) A group or individual major medical policy of accident
19or health insurance or managed care plan or medical, health,
20or hospital service corporation contract that provides
21coverage for prosthetic or custom orthotic care and is
22amended, delivered, issued, or renewed 6 months after the
23effective date of this amendatory Act of the 96th General
24Assembly must provide coverage for prosthetic and orthotic
25devices in accordance with this subsection (c). The coverage
26required under this Section shall be subject to the other

 

 

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1general exclusions, limitations, and financial requirements of
2the policy, including coordination of benefits, participating
3provider requirements, utilization review of health care
4services, including review of medical necessity, case
5management, and experimental and investigational treatments,
6and other managed care provisions under terms and conditions
7that are no less favorable than the terms and conditions that
8apply to substantially all medical and surgical benefits
9provided under the plan or coverage.
10    (d) The policy or plan or contract may require prior
11authorization for the prosthetic or orthotic devices in the
12same manner that prior authorization is required for any other
13covered benefit.
14    (e) Repairs and replacements of prosthetic and orthotic
15devices are also covered, subject to the co-payments and
16deductibles, unless necessitated by misuse or loss.
17    (f) A policy or plan or contract may require that, if
18coverage is provided through a managed care plan, the benefits
19mandated pursuant to this Section shall be covered benefits
20only if the prosthetic or orthotic devices are provided by a
21licensed provider employed by a provider service who contracts
22with or is designated by the carrier, to the extent that the
23carrier provides in-network and out-of-network service, the
24coverage for the prosthetic or orthotic device shall be
25offered no less extensively.
26    (g) The policy or plan or contract shall also meet

 

 

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1adequacy requirements as established by the Health Care
2Reimbursement Reform Act of 1985 of the Illinois Insurance
3Code.
4    (h) This Section shall not apply to accident only,
5specified disease, short-term travel hospital or medical,
6hospital confinement indemnity or other fixed indemnity,
7credit, dental, vision, Medicare supplement, long-term care,
8basic hospital and medical-surgical expense coverage,
9disability income insurance coverage, coverage issued as a
10supplement to liability insurance, workers' compensation
11insurance, or automobile medical payment insurance.
12(Source: P.A. 96-833, eff. 6-1-10.)
 
13    (Text of Section after amendment by P.A. 103-512)
14    Sec. 356z.18. Prosthetic and customized orthotic devices.
15    (a) For the purposes of this Section:
16    "Customized orthotic device" means a supportive device for
17the body or a part of the body, the head, neck, or extremities,
18and includes the replacement or repair of the device based on
19the patient's physical condition as medically necessary,
20excluding foot orthotics defined as an in-shoe device designed
21to support the structural components of the foot during
22weight-bearing activities.
23    "Licensed provider" means a prosthetist, orthotist, or
24pedorthist licensed to practice in this State.
25    "Prosthetic device" means an artificial device to replace,

 

 

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1in whole or in part, an arm or leg and includes accessories
2essential to the effective use of the device and the
3replacement or repair of the device based on the patient's
4physical condition as medically necessary.
5    (b) This amendatory Act of the 96th General Assembly shall
6provide benefits to any person covered thereunder for expenses
7incurred in obtaining a prosthetic or custom orthotic device
8from any Illinois licensed prosthetist, licensed orthotist, or
9licensed pedorthist as required under the Orthotics,
10Prosthetics, and Pedorthics Practice Act.
11    (c) A group or individual major medical policy of accident
12or health insurance or managed care plan or medical, health,
13or hospital service corporation contract that provides
14coverage for prosthetic or custom orthotic care and is
15amended, delivered, issued, or renewed 6 months after the
16effective date of this amendatory Act of the 96th General
17Assembly must provide coverage for prosthetic and orthotic
18devices in accordance with this subsection (c). The coverage
19required under this Section shall be subject to the other
20general exclusions, limitations, and financial requirements of
21the policy, including coordination of benefits, participating
22provider requirements, utilization review of health care
23services, including review of medical necessity, case
24management, and experimental and investigational treatments,
25and other managed care provisions under terms and conditions
26that are no less favorable than the terms and conditions that

 

 

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1apply to substantially all medical and surgical benefits
2provided under the plan or coverage.
3    (d) With respect to an enrollee at any age, in addition to
4coverage of a prosthetic or custom orthotic device required by
5this Section, benefits shall be provided for a prosthetic or
6custom orthotic device determined by the enrollee's provider
7to be the most appropriate model that is medically necessary
8for the enrollee to perform physical activities, as
9applicable, such as running, biking, swimming, and lifting
10weights, and to maximize the enrollee's whole body health and
11strengthen the lower and upper limb function.
12    (e) The requirements of this Section do not constitute an
13addition to this State's essential health benefits that
14requires defrayal of costs by this State pursuant to 42 U.S.C.
1518031(d)(3)(B).
16    (f) The policy or plan or contract may require prior
17authorization for the prosthetic or orthotic devices in the
18same manner that prior authorization is required for any other
19covered benefit.
20    (g) Repairs and replacements of prosthetic and orthotic
21devices are also covered, subject to the co-payments and
22deductibles, unless necessitated by misuse or loss.
23    (h) A policy or plan or contract may require that, if
24coverage is provided through a managed care plan, the benefits
25mandated pursuant to this Section shall be covered benefits
26only if the prosthetic or orthotic devices are provided by a

 

 

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1licensed provider employed by a provider service who contracts
2with or is designated by the carrier, to the extent that the
3carrier provides in-network and out-of-network service, the
4coverage for the prosthetic or orthotic device shall be
5offered no less extensively.
6    (i) The policy or plan or contract shall also meet
7adequacy requirements as established by the Health Care
8Reimbursement Reform Act of 1985 of the Illinois Insurance
9Code.
10    (j) This Section shall not apply to accident only,
11specified disease, short-term travel hospital or medical,
12hospital confinement indemnity or other fixed indemnity,
13credit, dental, vision, Medicare supplement, long-term care,
14basic hospital and medical-surgical expense coverage,
15disability income insurance coverage, coverage issued as a
16supplement to liability insurance, workers' compensation
17insurance, or automobile medical payment insurance.
18(Source: P.A. 103-512, eff. 1-1-25.)
 
19    (215 ILCS 5/367.3)  (from Ch. 73, par. 979.3)
20    Sec. 367.3. Group accident and health insurance;
21discretionary groups.
22    (a) No group health insurance offered to a resident of
23this State under a policy issued to a group, other than one
24specifically described in Section 367(1), shall be delivered
25or issued for delivery in this State unless the Director

 

 

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1determines that:
2        (1) the issuance of the policy is not contrary to the
3    public interest;
4        (2) the issuance of the policy will result in
5    economies of acquisition and administration; and
6        (3) the benefits under the policy are reasonable in
7    relation to the premium charged.
8    (b) No such group health insurance may be offered in this
9State under a policy issued in another state unless this State
10or the state in which the group policy is issued has made a
11determination that the requirements of subsection (a) have
12been met.
13    Where insurance is to be offered in this State under a
14policy described in this subsection, the insurer shall file
15for informational review purposes:
16        (1) a copy of the group master contract;
17        (2) a copy of the statute authorizing the issuance of
18    the group policy in the state of situs, which statute has
19    the same or similar requirements as this State, or in the
20    absence of such statute, a certification by an officer of
21    the company that the policy meets the Illinois minimum
22    standards required for individual accident and health
23    policies under authority of Section 401 of this Code, as
24    now or hereafter amended, as promulgated by rule at 50
25    Illinois Administrative Code, Ch. I, Sec. 2007, et seq.,
26    as now or hereafter amended, or by a successor rule;

 

 

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1        (3) evidence of approval by the state of situs of the
2    group master policy; and
3        (4) copies of all supportive material furnished to the
4    state of situs to satisfy the criteria for approval.
5    (c) The Director may, at any time after receipt of the
6information required under subsection (b) and after finding
7that the standards of subsection (a) have not been met, order
8the insurer to cease the issuance or marketing of that
9coverage in this State.
10    (d) Notwithstanding subsections (a) and (b), group Group
11accident and health insurance subject to the provisions of
12this Section is also subject to the provisions of Sections
13352c and Section 367i of this Code and rules thereunder.
14(Source: P.A. 90-655, eff. 7-30-98.)
 
15    (215 ILCS 5/367a)  (from Ch. 73, par. 979a)
16    Sec. 367a. Blanket accident and health insurance.
17    (1) Blanket accident and health insurance is the that form
18of accident and health insurance providing excepted benefits,
19as defined in Section 352c, that covers covering special
20groups of persons as enumerated in one of the following
21paragraphs (a) to (g), inclusive:
22    (a) Under a policy or contract issued to any carrier for
23hire, which shall be deemed the policyholder, covering a group
24defined as all persons who may become passengers on such
25carrier.

 

 

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1    (b) Under a policy or contract issued to an employer, who
2shall be deemed the policyholder, covering all employees or
3any group of employees defined by reference to exceptional
4hazards incident to such employment.
5    (c) Under a policy or contract issued to a college,
6school, or other institution of learning or to the head or
7principal thereof, who or which shall be deemed the
8policyholder, covering students or teachers. However, student
9health insurance coverage, as defined in 45 CFR 147.145, shall
10remain subject to the standards and requirements for
11individual health insurance coverage except where inconsistent
12with that regulation. An issuer providing student health
13insurance coverage or a policy or contract covering students
14for limited-scope dental or vision under 45 CFR 148.220 shall
15require an individual application or enrollment form and shall
16furnish each insured individual a certificate, which shall
17have been approved by the Director under Section 355.
18    (d) Under a policy or contract issued in the name of any
19volunteer fire department, first aid, or other such volunteer
20group, which shall be deemed the policyholder, covering all of
21the members of such department or group.
22    (e) Under a policy or contract issued to a creditor, who
23shall be deemed the policyholder, to insure debtors of the
24creditors; Provided, however, that in the case of a loan which
25is subject to the Small Loans Act, no insurance premium or
26other cost shall be directly or indirectly charged or assessed

 

 

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1against, or collected or received from the borrower.
2    (f) Under a policy or contract issued to a sports team or
3to a camp, which team or camp sponsor shall be deemed the
4policyholder, covering members or campers.
5    (g) Under a policy or contract issued to any other
6substantially similar group which, in the discretion of the
7Director, may be subject to the issuance of a blanket accident
8and health policy or contract.
9    (2) Any insurance company authorized to write accident and
10health insurance in this state shall have the power to issue
11blanket accident and health insurance. No such blanket policy
12may be issued or delivered in this State unless a copy of the
13form thereof shall have been filed in accordance with Section
14355, and it contains in substance such of those provisions
15contained in Sections 357.1 through 357.30 as may be
16applicable to blanket accident and health insurance and the
17following provisions:
18    (a) A provision that the policy and the application shall
19constitute the entire contract between the parties, and that
20all statements made by the policyholder shall, in absence of
21fraud, be deemed representations and not warranties, and that
22no such statements shall be used in defense to a claim under
23the policy, unless it is contained in a written application.
24    (b) A provision that to the group or class thereof
25originally insured shall be added from time to time all new
26persons or individuals eligible for coverage.

 

 

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1    (3) An individual application shall not be required from a
2person covered under a blanket accident or health policy or
3contract, nor shall it be necessary for the insurer to furnish
4each person a certificate.
5    (4) All benefits under any blanket accident and health
6policy shall be payable to the person insured, or to his
7designated beneficiary or beneficiaries, or to his or her
8estate, except that if the person insured be a minor or person
9under legal disability, such benefits may be made payable to
10his or her parent, guardian, or other person actually
11supporting him or her. Provided further, however, that the
12policy may provide that all or any portion of any indemnities
13provided by any such policy on account of hospital, nursing,
14medical or surgical services may, at the insurer's option, be
15paid directly to the hospital or person rendering such
16services; but the policy may not require that the service be
17rendered by a particular hospital or person. Payment so made
18shall discharge the insurer's obligation with respect to the
19amount of insurance so paid.
20    (5) Nothing contained in this section shall be deemed to
21affect the legal liability of policyholders for the death of
22or injury to, any such member of such group.
23(Source: P.A. 83-1362.)
 
24    (215 ILCS 5/368f)
25    Sec. 368f. Military service member insurance

 

 

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1reinstatement.
2    (a) No Illinois resident activated for military service
3and no spouse or dependent of the resident who becomes
4eligible for a federal government-sponsored health insurance
5program, including the TriCare program providing coverage for
6civilian dependents of military personnel, as a result of the
7activation shall be denied reinstatement into the same
8individual health insurance coverage with the health insurer
9that the resident lapsed as a result of activation or becoming
10covered by the federal government-sponsored health insurance
11program. The resident shall have the right to reinstatement in
12the same individual health insurance coverage without medical
13underwriting, subject to payment of the current premium
14charged to other persons of the same age and gender that are
15covered under the same individual health coverage. Except in
16the case of birth or adoption that occurs during the period of
17activation, reinstatement must be into the same coverage type
18as the resident held prior to lapsing the individual health
19insurance coverage and at the same or, at the option of the
20resident, higher deductible level. The reinstatement rights
21provided under this subsection (a) are not available to a
22resident or dependents if the activated person is discharged
23from the military under other than honorable conditions.
24    (b) The health insurer with which the reinstatement is
25being requested must receive a request for reinstatement no
26later than 63 days following the later of (i) deactivation or

 

 

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1(ii) loss of coverage under the federal government-sponsored
2health insurance program. The health insurer may request proof
3of loss of coverage and the timing of the loss of coverage of
4the government-sponsored coverage in order to determine
5eligibility for reinstatement into the individual coverage.
6The effective date of the reinstatement of individual health
7coverage shall be the first of the month following receipt of
8the notice requesting reinstatement.
9    (c) All insurers must provide written notice to the
10policyholder of individual health coverage of the rights
11described in subsection (a) of this Section. In lieu of the
12inclusion of the notice in the individual health insurance
13policy, an insurance company may satisfy the notification
14requirement by providing a single written notice:
15        (1) in conjunction with the enrollment process for a
16    policyholder initially enrolling in the individual
17    coverage on or after the effective date of this amendatory
18    Act of the 94th General Assembly; or
19        (2) by mailing written notice to policyholders whose
20    coverage was effective prior to the effective date of this
21    amendatory Act of the 94th General Assembly no later than
22    90 days following the effective date of this amendatory
23    Act of the 94th General Assembly.
24    (d) The provisions of subsection (a) of this Section do
25not apply to any policy or certificate providing coverage for
26any specified disease, specified accident or accident-only

 

 

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1coverage, credit, dental, disability income, hospital
2indemnity or other fixed indemnity, long-term care, Medicare
3supplement, vision care, or short-term travel nonrenewable
4health policy or other limited-benefit supplemental insurance,
5or any coverage issued as a supplement to any liability
6insurance, workers' compensation or similar insurance, or any
7insurance under which benefits are payable with or without
8regard to fault, whether written on a group, blanket, or
9individual basis.
10    (e) Nothing in this Section shall require an insurer to
11reinstate the resident if the insurer requires residency in an
12enrollment area and those residency requirements are not met
13after deactivation or loss of coverage under the
14government-sponsored health insurance program.
15    (f) All terms, conditions, and limitations of the
16individual coverage into which reinstatement is made apply
17equally to all insureds enrolled in the coverage.
18    (g) The Secretary may adopt rules as may be necessary to
19carry out the provisions of this Section.
20(Source: P.A. 94-1037, eff. 7-20-06.)
 
21    Section 10. The Health Maintenance Organization Act is
22amended by changing Section 5-3 as follows:
 
23    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
24    Sec. 5-3. Insurance Code provisions.

 

 

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1    (a) Health Maintenance Organizations shall be subject to
2the provisions of Sections 133, 134, 136, 137, 139, 140,
3141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
4154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 155.49,
5352c, 355.2, 355.3, 355b, 355c, 356f, 356g.5-1, 356m, 356q,
6356v, 356w, 356x, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5,
7356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
8356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.20, 356z.21,
9356z.22, 356z.23, 356z.24, 356z.25, 356z.26, 356z.28, 356z.29,
10356z.30, 356z.30a, 356z.31, 356z.32, 356z.33, 356z.34,
11356z.35, 356z.36, 356z.37, 356z.38, 356z.39, 356z.40, 356z.41,
12356z.44, 356z.45, 356z.46, 356z.47, 356z.48, 356z.49, 356z.50,
13356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.58,
14356z.59, 356z.60, 356z.61, 356z.62, 356z.64, 356z.65, 356z.67,
15356z.68, 364, 364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b,
16368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A,
17408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of
18subsection (2) of Section 367, and Articles IIA, VIII 1/2,
19XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the
20Illinois Insurance Code.
21    (b) For purposes of the Illinois Insurance Code, except
22for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
23Health Maintenance Organizations in the following categories
24are deemed to be "domestic companies":
25        (1) a corporation authorized under the Dental Service
26    Plan Act or the Voluntary Health Services Plans Act;

 

 

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1        (2) a corporation organized under the laws of this
2    State; or
3        (3) a corporation organized under the laws of another
4    state, 30% or more of the enrollees of which are residents
5    of this State, except a corporation subject to
6    substantially the same requirements in its state of
7    organization as is a "domestic company" under Article VIII
8    1/2 of the Illinois Insurance Code.
9    (c) In considering the merger, consolidation, or other
10acquisition of control of a Health Maintenance Organization
11pursuant to Article VIII 1/2 of the Illinois Insurance Code,
12        (1) the Director shall give primary consideration to
13    the continuation of benefits to enrollees and the
14    financial conditions of the acquired Health Maintenance
15    Organization after the merger, consolidation, or other
16    acquisition of control takes effect;
17        (2)(i) the criteria specified in subsection (1)(b) of
18    Section 131.8 of the Illinois Insurance Code shall not
19    apply and (ii) the Director, in making his determination
20    with respect to the merger, consolidation, or other
21    acquisition of control, need not take into account the
22    effect on competition of the merger, consolidation, or
23    other acquisition of control;
24        (3) the Director shall have the power to require the
25    following information:
26            (A) certification by an independent actuary of the

 

 

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1        adequacy of the reserves of the Health Maintenance
2        Organization sought to be acquired;
3            (B) pro forma financial statements reflecting the
4        combined balance sheets of the acquiring company and
5        the Health Maintenance Organization sought to be
6        acquired as of the end of the preceding year and as of
7        a date 90 days prior to the acquisition, as well as pro
8        forma financial statements reflecting projected
9        combined operation for a period of 2 years;
10            (C) a pro forma business plan detailing an
11        acquiring party's plans with respect to the operation
12        of the Health Maintenance Organization sought to be
13        acquired for a period of not less than 3 years; and
14            (D) such other information as the Director shall
15        require.
16    (d) The provisions of Article VIII 1/2 of the Illinois
17Insurance Code and this Section 5-3 shall apply to the sale by
18any health maintenance organization of greater than 10% of its
19enrollee population (including, without limitation, the health
20maintenance organization's right, title, and interest in and
21to its health care certificates).
22    (e) In considering any management contract or service
23agreement subject to Section 141.1 of the Illinois Insurance
24Code, the Director (i) shall, in addition to the criteria
25specified in Section 141.2 of the Illinois Insurance Code,
26take into account the effect of the management contract or

 

 

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1service agreement on the continuation of benefits to enrollees
2and the financial condition of the health maintenance
3organization to be managed or serviced, and (ii) need not take
4into account the effect of the management contract or service
5agreement on competition.
6    (f) Except for small employer groups as defined in the
7Small Employer Rating, Renewability and Portability Health
8Insurance Act and except for medicare supplement policies as
9defined in Section 363 of the Illinois Insurance Code, a
10Health Maintenance Organization may by contract agree with a
11group or other enrollment unit to effect refunds or charge
12additional premiums under the following terms and conditions:
13        (i) the amount of, and other terms and conditions with
14    respect to, the refund or additional premium are set forth
15    in the group or enrollment unit contract agreed in advance
16    of the period for which a refund is to be paid or
17    additional premium is to be charged (which period shall
18    not be less than one year); and
19        (ii) the amount of the refund or additional premium
20    shall not exceed 20% of the Health Maintenance
21    Organization's profitable or unprofitable experience with
22    respect to the group or other enrollment unit for the
23    period (and, for purposes of a refund or additional
24    premium, the profitable or unprofitable experience shall
25    be calculated taking into account a pro rata share of the
26    Health Maintenance Organization's administrative and

 

 

HB2499 Enrolled- 21 -LRB103 30875 AMQ 57395 b

1    marketing expenses, but shall not include any refund to be
2    made or additional premium to be paid pursuant to this
3    subsection (f)). The Health Maintenance Organization and
4    the group or enrollment unit may agree that the profitable
5    or unprofitable experience may be calculated taking into
6    account the refund period and the immediately preceding 2
7    plan years.
8    The Health Maintenance Organization shall include a
9statement in the evidence of coverage issued to each enrollee
10describing the possibility of a refund or additional premium,
11and upon request of any group or enrollment unit, provide to
12the group or enrollment unit a description of the method used
13to calculate (1) the Health Maintenance Organization's
14profitable experience with respect to the group or enrollment
15unit and the resulting refund to the group or enrollment unit
16or (2) the Health Maintenance Organization's unprofitable
17experience with respect to the group or enrollment unit and
18the resulting additional premium to be paid by the group or
19enrollment unit.
20    In no event shall the Illinois Health Maintenance
21Organization Guaranty Association be liable to pay any
22contractual obligation of an insolvent organization to pay any
23refund authorized under this Section.
24    (g) Rulemaking authority to implement Public Act 95-1045,
25if any, is conditioned on the rules being adopted in
26accordance with all provisions of the Illinois Administrative

 

 

HB2499 Enrolled- 22 -LRB103 30875 AMQ 57395 b

1Procedure Act and all rules and procedures of the Joint
2Committee on Administrative Rules; any purported rule not so
3adopted, for whatever reason, is unauthorized.
4(Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
5102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
61-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
7eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
8102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
91-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
10eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;
11103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.
126-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
13eff. 1-1-24; 103-551, eff. 8-11-23; revised 8-29-23.)
 
14    Section 15. The Limited Health Service Organization Act is
15amended by changing Section 4003 as follows:
 
16    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
17    Sec. 4003. Illinois Insurance Code provisions. Limited
18health service organizations shall be subject to the
19provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
20141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
21154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 352c,
22355.2, 355.3, 355b, 356q, 356v, 356z.4, 356z.4a, 356z.10,
23356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30a,
24356z.32, 356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53,

 

 

HB2499 Enrolled- 23 -LRB103 30875 AMQ 57395 b

1356z.54, 356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68,
2364.3, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412,
3444, and 444.1 and Articles IIA, VIII 1/2, XII, XII 1/2, XIII,
4XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.
5Nothing in this Section shall require a limited health care
6plan to cover any service that is not a limited health service.
7For purposes of the Illinois Insurance Code, except for
8Sections 444 and 444.1 and Articles XIII and XIII 1/2, limited
9health service organizations in the following categories are
10deemed to be domestic companies:
11        (1) a corporation under the laws of this State; or
12        (2) a corporation organized under the laws of another
13    state, 30% or more of the enrollees of which are residents
14    of this State, except a corporation subject to
15    substantially the same requirements in its state of
16    organization as is a domestic company under Article VIII
17    1/2 of the Illinois Insurance Code.
18(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
19102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-731, eff.
201-1-23; 102-775, eff. 5-13-22; 102-813, eff. 5-13-22; 102-816,
21eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
22102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
231-1-24; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
24eff. 1-1-24; revised 8-29-23.)
 
25    (215 ILCS 190/Act rep.)

 

 

HB2499 Enrolled- 24 -LRB103 30875 AMQ 57395 b

1    Section 20. The Short-Term, Limited-Duration Health
2Insurance Coverage Act is repealed.
 
3    Section 95. No acceleration or delay. Where this Act makes
4changes in a statute that is represented in this Act by text
5that is not yet or no longer in effect (for example, a Section
6represented by multiple versions), the use of that text does
7not accelerate or delay the taking effect of (i) the changes
8made by this Act or (ii) provisions derived from any other
9Public Act.
 
10    Section 99. Effective date. This Act takes effect January
111, 2025.