|
Public Act 100-1026
|
| HB4516 Enrolled | LRB100 17336 SMS 32500 b |
|
|
AN ACT concerning insurance.
|
Be it enacted by the People of the State of Illinois,
|
represented in the General Assembly:
|
Section 5. The Illinois Insurance Code is amended by adding |
Section 356z.29 as follows:
|
(215 ILCS 5/356z.29 new) |
Sec. 356z.29. Coverage for hearing aids for individuals |
under the age of 18. |
(a) As used in this Section: |
"Hearing care professional" means a person who is a
|
licensed hearing instrument dispenser, licensed audiologist, |
or licensed physician. |
"Hearing instrument" or "hearing aid" means any wearable
|
non-disposable, non-experimental instrument or device designed |
to aid or
compensate for impaired human hearing and any parts, |
attachments, or accessories for the instrument or device, |
including
an ear mold but excluding batteries and cords. |
(b) An individual or group policy of accident and health
|
insurance or managed care plan that is amended, delivered,
|
issued, or renewed after the effective date of this amendatory
|
Act of the 100th General Assembly must provide coverage for
|
medically necessary hearing instruments and related services |
for all individuals under the age of 18
when a hearing care |
|
professional prescribes a hearing instrument to augment |
communication. |
(c) An insurer shall provide coverage, subject to all |
applicable co-payments, co-insurance, deductibles, and |
out-of-pocket limits, subject to the following restrictions: |
(1) one hearing instrument shall be covered for each |
ear every 36 months; |
(2) related services, such as audiological exams and |
selection, fitting, and adjustment of ear molds to maintain |
optimal fit shall be covered when deemed medically |
necessary by a hearing care professional; and |
(3) hearing instrument repairs may be covered when |
deemed medically necessary. |
(d) If, at any time before or after the effective date of |
this amendatory Act of the 100th General Assembly, the |
Secretary of the United States Department of Health and Human |
Services, or its successor agency, promulgates rules or |
regulations to be published in the Federal Register, publishes |
a comment in the Federal Register, or issues an opinion, |
guidance, or other action that would require the State, |
pursuant to any provision of the Patient Protection and |
Affordable Care Act (Pub. L. 111–148), including, but not |
limited to, 42 U.S.C. 18031(d)(3)(B) or any successor |
provision, to defray the cost of coverage for medically |
necessary hearing instruments and related services for |
individuals under the age of 18, then this Section is |
|
inoperative with respect to all such coverage other than that |
authorized under Section 1902 of the Social Security Act, 42 |
U.S.C. 1396a, and the State shall not assume any obligation for |
the cost of coverage for medically necessary hearing |
instruments and related services for individuals under the age |
of 18.
|
Section 10. 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, 136, 137, 139, 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, 155.22a, 355.2, 355.3, |
355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y,
356z.2, 356z.4, |
356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, |
356z.13, 356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.21, |
356z.22, 356z.25, 356z.26, 356z.29, 364, 364.01, 367.2, |
367.2-5, 367i, 368a, 368b, 368c, 368d, 368e, 370c,
370c.1, 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
|
(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.
|
(g) Rulemaking authority to implement Public Act 95-1045, |
if any, is conditioned on the rules being adopted in accordance |
with all provisions of the Illinois Administrative Procedure |
Act and all rules and procedures of the Joint Committee on |
Administrative Rules; any purported rule not so adopted, for |
whatever reason, is unauthorized. |
(Source: P.A. 99-761, eff. 1-1-18; 100-24, eff. 7-18-17; |
100-138, eff. 8-18-17; revised 10-5-17.)
|
Section 15. 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, 136, 139, 140, |
143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, 356g, |
356g.5, 356g.5-1, 356r, 356t, 356u, 356v,
356w, 356x, 356y, |
356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9,
|
356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18, |
356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 364.01, |
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
|