101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
HB5490

 

Introduced , by Rep. Karina Villa

 

SYNOPSIS AS INTRODUCED:
 
5 ILCS 375/6.11
55 ILCS 5/5-1069.3
65 ILCS 5/10-4-2.3
105 ILCS 5/10-22.3f
215 ILCS 5/356z.43 new
215 ILCS 125/5-3  from Ch. 111 1/2, par. 1411.2
215 ILCS 165/10  from Ch. 32, par. 604

    Amends the Illinois Insurance Code to require an individual or group policy of accident and health insurance or managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2021 to offer coverage for opioid addiction treatment, recovery, and related services for all individuals when determined medically necessary by a health care professional. Defines "opioid addiction treatment". Makes conforming changes in the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, and the Voluntary Health Services Plans Act. Effective January 1, 2021.


LRB101 18419 BMS 67867 b

FISCAL NOTE ACT MAY APPLY
STATE MANDATES ACT MAY REQUIRE REIMBURSEMENT

 

 

A BILL FOR

 

HB5490LRB101 18419 BMS 67867 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 State Employees Group Insurance Act of 1971
5is amended by changing Section 6.11 as follows:
 
6    (5 ILCS 375/6.11)
7    (Text of Section before amendment by P.A. 101-625)
8    Sec. 6.11. Required health benefits; Illinois Insurance
9Code requirements. The program of health benefits shall provide
10the post-mastectomy care benefits required to be covered by a
11policy of accident and health insurance under Section 356t of
12the Illinois Insurance Code. The program of health benefits
13shall provide the coverage required under Sections 356g,
14356g.5, 356g.5-1, 356m, 356u, 356w, 356x, 356z.2, 356z.4,
15356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
16356z.13, 356z.14, 356z.15, 356z.17, 356z.22, 356z.25, 356z.26,
17356z.29, 356z.30a, 356z.32, and 356z.33, 356z.36, and 356z.43
18of the Illinois Insurance Code. The program of health benefits
19must comply with Sections 155.22a, 155.37, 355b, 356z.19, 370c,
20and 370c.1, and Article XXXIIB of the Illinois Insurance Code.
21The Department of Insurance shall enforce the requirements of
22this Section with respect to Sections 370c and 370c.1 of the
23Illinois Insurance Code; all other requirements of this Section

 

 

HB5490- 2 -LRB101 18419 BMS 67867 b

1shall be enforced by the Department of Central Management
2Services.
3    Rulemaking authority to implement Public Act 95-1045, if
4any, is conditioned on the rules being adopted in accordance
5with all provisions of the Illinois Administrative Procedure
6Act and all rules and procedures of the Joint Committee on
7Administrative Rules; any purported rule not so adopted, for
8whatever reason, is unauthorized.
9(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
10100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
111-1-19; 100-1102, eff. 1-1-19; 100-1170, eff. 6-1-19; 101-13,
12eff. 6-12-19; 101-281, eff. 1-1-20; 101-393, eff. 1-1-20;
13101-452, eff. 1-1-20; 101-461, eff. 1-1-20; revised 10-16-19.)
 
14    (Text of Section after amendment by P.A. 101-625)
15    Sec. 6.11. Required health benefits; Illinois Insurance
16Code requirements. The program of health benefits shall provide
17the post-mastectomy care benefits required to be covered by a
18policy of accident and health insurance under Section 356t of
19the Illinois Insurance Code. The program of health benefits
20shall provide the coverage required under Sections 356g,
21356g.5, 356g.5-1, 356m, 356u, 356w, 356x, 356z.2, 356z.4,
22356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
23356z.13, 356z.14, 356z.15, 356z.17, 356z.22, 356z.25, 356z.26,
24356z.29, 356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41, and
25356z.43 of the Illinois Insurance Code. The program of health

 

 

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1benefits must comply with Sections 155.22a, 155.37, 355b,
2356z.19, 370c, and 370c.1 and Article XXXIIB of the Illinois
3Insurance Code. The Department of Insurance shall enforce the
4requirements of this Section with respect to Sections 370c and
5370c.1 of the Illinois Insurance Code; all other requirements
6of this Section shall be enforced by the Department of Central
7Management Services.
8    Rulemaking authority to implement Public Act 95-1045, if
9any, is conditioned on the rules being adopted in accordance
10with all provisions of the Illinois Administrative Procedure
11Act and all rules and procedures of the Joint Committee on
12Administrative Rules; any purported rule not so adopted, for
13whatever reason, is unauthorized.
14(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
15100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
161-1-19; 100-1102, eff. 1-1-19; 100-1170, eff. 6-1-19; 101-13,
17eff. 6-12-19; 101-281, eff. 1-1-20; 101-393, eff. 1-1-20;
18101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
191-1-21.)
 
20    Section 10. The Counties Code is amended by changing
21Section 5-1069.3 as follows:
 
22    (55 ILCS 5/5-1069.3)
23    (Text of Section before amendment by P.A. 101-625)
24    Sec. 5-1069.3. Required health benefits. If a county,

 

 

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1including a home rule county, is a self-insurer for purposes of
2providing health insurance coverage for its employees, the
3coverage shall include coverage for the post-mastectomy care
4benefits required to be covered by a policy of accident and
5health insurance under Section 356t and the coverage required
6under Sections 356g, 356g.5, 356g.5-1, 356u, 356w, 356x,
7356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
8356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
9356z.30a, and 356z.32, and 356z.33, 356z.36, and 356z.43 of the
10Illinois Insurance Code. The coverage shall comply with
11Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
12Insurance Code. The Department of Insurance shall enforce the
13requirements of this Section. The requirement that health
14benefits be covered as provided in this Section is an exclusive
15power and function of the State and is a denial and limitation
16under Article VII, Section 6, subsection (h) of the Illinois
17Constitution. A home rule county to which this Section applies
18must comply with every provision of this Section.
19    Rulemaking authority to implement Public Act 95-1045, if
20any, is conditioned on the rules being adopted in accordance
21with all provisions of the Illinois Administrative Procedure
22Act and all rules and procedures of the Joint Committee on
23Administrative Rules; any purported rule not so adopted, for
24whatever reason, is unauthorized.
25(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
26100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.

 

 

HB5490- 5 -LRB101 18419 BMS 67867 b

11-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
2eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
3revised 10-16-19.)
 
4    (Text of Section after amendment by P.A. 101-625)
5    Sec. 5-1069.3. Required health benefits. If a county,
6including a home rule county, is a self-insurer for purposes of
7providing health insurance coverage for its employees, the
8coverage shall include coverage for the post-mastectomy care
9benefits required to be covered by a policy of accident and
10health insurance under Section 356t and the coverage required
11under Sections 356g, 356g.5, 356g.5-1, 356u, 356w, 356x,
12356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
13356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
14356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41, and 356z.43
15of the Illinois Insurance Code. The coverage shall comply with
16Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
17Insurance Code. The Department of Insurance shall enforce the
18requirements of this Section. The requirement that health
19benefits be covered as provided in this Section is an exclusive
20power and function of the State and is a denial and limitation
21under Article VII, Section 6, subsection (h) of the Illinois
22Constitution. A home rule county to which this Section applies
23must comply with every provision of this Section.
24    Rulemaking authority to implement Public Act 95-1045, if
25any, is conditioned on the rules being adopted in accordance

 

 

HB5490- 6 -LRB101 18419 BMS 67867 b

1with all provisions of the Illinois Administrative Procedure
2Act and all rules and procedures of the Joint Committee on
3Administrative Rules; any purported rule not so adopted, for
4whatever reason, is unauthorized.
5(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
6100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
71-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
8eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
9101-625, eff. 1-1-21.)
 
10    Section 15. The Illinois Municipal Code is amended by
11changing Section 10-4-2.3 as follows:
 
12    (65 ILCS 5/10-4-2.3)
13    (Text of Section before amendment by P.A. 101-625)
14    Sec. 10-4-2.3. Required health benefits. If a
15municipality, including a home rule municipality, is a
16self-insurer for purposes of providing health insurance
17coverage for its employees, the coverage shall include coverage
18for the post-mastectomy care benefits required to be covered by
19a policy of accident and health insurance under Section 356t
20and the coverage required under Sections 356g, 356g.5,
21356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10,
22356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25,
23356z.26, 356z.29, 356z.30a, and 356z.32, and 356z.33, 356z.36,
24and 356z.43 of the Illinois Insurance Code. The coverage shall

 

 

HB5490- 7 -LRB101 18419 BMS 67867 b

1comply with Sections 155.22a, 355b, 356z.19, and 370c of the
2Illinois Insurance Code. The Department of Insurance shall
3enforce the requirements of this Section. The requirement that
4health benefits be covered as provided in this is an exclusive
5power and function of the State and is a denial and limitation
6under Article VII, Section 6, subsection (h) of the Illinois
7Constitution. A home rule municipality to which this Section
8applies must comply with every provision of this Section.
9    Rulemaking authority to implement Public Act 95-1045, if
10any, is conditioned on the rules being adopted in accordance
11with all provisions of the Illinois Administrative Procedure
12Act and all rules and procedures of the Joint Committee on
13Administrative Rules; any purported rule not so adopted, for
14whatever reason, is unauthorized.
15(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
16100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
171-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
18eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
19revised 10-16-19.)
 
20    (Text of Section after amendment by P.A. 101-625)
21    Sec. 10-4-2.3. Required health benefits. If a
22municipality, including a home rule municipality, is a
23self-insurer for purposes of providing health insurance
24coverage for its employees, the coverage shall include coverage
25for the post-mastectomy care benefits required to be covered by

 

 

HB5490- 8 -LRB101 18419 BMS 67867 b

1a policy of accident and health insurance under Section 356t
2and the coverage required under Sections 356g, 356g.5,
3356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10,
4356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25,
5356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, 356z.36, and
6356z.41, and 356z.43 of the Illinois Insurance Code. The
7coverage shall comply with Sections 155.22a, 355b, 356z.19, and
8370c of the Illinois Insurance Code. The Department of
9Insurance shall enforce the requirements of this Section. The
10requirement that health benefits be covered as provided in this
11is an exclusive power and function of the State and is a denial
12and limitation under Article VII, Section 6, subsection (h) of
13the Illinois Constitution. A home rule municipality to which
14this Section applies must comply with every provision of this
15Section.
16    Rulemaking authority to implement Public Act 95-1045, if
17any, is conditioned on the rules being adopted in accordance
18with all provisions of the Illinois Administrative Procedure
19Act and all rules and procedures of the Joint Committee on
20Administrative Rules; any purported rule not so adopted, for
21whatever reason, is unauthorized.
22(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
23100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
241-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
25eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
26101-625, eff. 1-1-21.)
 

 

 

HB5490- 9 -LRB101 18419 BMS 67867 b

1    Section 20. The School Code is amended by changing Section
210-22.3f as follows:
 
3    (105 ILCS 5/10-22.3f)
4    (Text of Section before amendment by P.A. 101-625)
5    Sec. 10-22.3f. Required health benefits. Insurance
6protection and benefits for employees shall provide the
7post-mastectomy care benefits required to be covered by a
8policy of accident and health insurance under Section 356t and
9the coverage required under Sections 356g, 356g.5, 356g.5-1,
10356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11, 356z.12,
11356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
12356z.30a, and 356z.32, and 356z.33, 356z.36, and 356z.43 of the
13Illinois Insurance Code. Insurance policies shall comply with
14Section 356z.19 of the Illinois Insurance Code. The coverage
15shall comply with Sections 155.22a, 355b, and 370c of the
16Illinois Insurance Code. The Department of Insurance shall
17enforce the requirements of this Section.
18    Rulemaking authority to implement Public Act 95-1045, if
19any, is conditioned on the rules being adopted in accordance
20with all provisions of the Illinois Administrative Procedure
21Act and all rules and procedures of the Joint Committee on
22Administrative Rules; any purported rule not so adopted, for
23whatever reason, is unauthorized.
24(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;

 

 

HB5490- 10 -LRB101 18419 BMS 67867 b

1100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
21-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
3eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
4revised 10-16-19.)
 
5    (Text of Section after amendment by P.A. 101-625)
6    Sec. 10-22.3f. Required health benefits. Insurance
7protection and benefits for employees shall provide the
8post-mastectomy care benefits required to be covered by a
9policy of accident and health insurance under Section 356t and
10the coverage required under Sections 356g, 356g.5, 356g.5-1,
11356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11, 356z.12,
12356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
13356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41, and 356z.43
14of the Illinois Insurance Code. Insurance policies shall comply
15with Section 356z.19 of the Illinois Insurance Code. The
16coverage shall comply with Sections 155.22a, 355b, and 370c of
17the Illinois Insurance Code. The Department of Insurance shall
18enforce the requirements of this Section.
19    Rulemaking authority to implement Public Act 95-1045, if
20any, is conditioned on the rules being adopted in accordance
21with all provisions of the Illinois Administrative Procedure
22Act and all rules and procedures of the Joint Committee on
23Administrative Rules; any purported rule not so adopted, for
24whatever reason, is unauthorized.
25(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;

 

 

HB5490- 11 -LRB101 18419 BMS 67867 b

1100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
21-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281,
3eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20;
4101-625, eff. 1-1-21.)
 
5    Section 25. The Illinois Insurance Code is amended by
6adding Section 356z.43 as follows:
 
7    (215 ILCS 5/356z.43 new)
8    Sec. 356z.43. Opioid addiction treatment.
9    (a) As used in this Section, "opioid addiction treatment"
10includes, but is not limited to, medication-assisted
11treatment, counseling, behavioral therapies, and any other
12treatment deemed medically necessary.
13    (b) An individual or group policy of accident and health
14insurance or managed care plan that is amended, delivered,
15issued, or renewed on or after January 1, 2021 shall offer
16coverage for opioid addiction treatment, recovery, and related
17services for all individuals when determined medically
18necessary by a health care professional.
 
19    Section 30. The Health Maintenance Organization Act is
20amended by changing Section 5-3 as follows:
 
21    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
22    (Text of Section before amendment by P.A. 101-625)

 

 

HB5490- 12 -LRB101 18419 BMS 67867 b

1    Sec. 5-3. Insurance Code provisions.
2    (a) Health Maintenance Organizations shall be subject to
3the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
4141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
5154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2, 355.3,
6355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2, 356z.4,
7356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11,
8356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.18, 356z.19,
9356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30,
10356z.30a, 356z.32, 356z.33, 356z.35, 356z.36, 356z.43, 364,
11364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c, 368d, 368e,
12370c, 370c.1, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412,
13444, and 444.1, paragraph (c) of subsection (2) of Section 367,
14and Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV,
15XXVI, and XXXIIB of the Illinois Insurance Code.
16    (b) For purposes of the Illinois Insurance Code, except for
17Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health
18Maintenance Organizations in the following categories are
19deemed to be "domestic companies":
20        (1) a corporation authorized under the Dental Service
21    Plan Act or the Voluntary Health Services Plans Act;
22        (2) a corporation organized under the laws of this
23    State; or
24        (3) a corporation organized under the laws of another
25    state, 30% or more of the enrollees of which are residents
26    of this State, except a corporation subject to

 

 

HB5490- 13 -LRB101 18419 BMS 67867 b

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

 

 

HB5490- 14 -LRB101 18419 BMS 67867 b

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

 

 

HB5490- 15 -LRB101 18419 BMS 67867 b

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

 

 

HB5490- 16 -LRB101 18419 BMS 67867 b

1    account the refund period and the immediately preceding 2
2    plan years.
3    The Health Maintenance Organization shall include a
4statement in the evidence of coverage issued to each enrollee
5describing the possibility of a refund or additional premium,
6and upon request of any group or enrollment unit, provide to
7the group or enrollment unit a description of the method used
8to calculate (1) the Health Maintenance Organization's
9profitable experience with respect to the group or enrollment
10unit and the resulting refund to the group or enrollment unit
11or (2) the Health Maintenance Organization's unprofitable
12experience with respect to the group or enrollment unit and the
13resulting additional premium to be paid by the group or
14enrollment unit.
15    In no event shall the Illinois Health Maintenance
16Organization Guaranty Association be liable to pay any
17contractual obligation of an insolvent organization to pay any
18refund authorized under this Section.
19    (g) Rulemaking authority to implement Public Act 95-1045,
20if any, is conditioned on the rules being adopted in accordance
21with all provisions of the Illinois Administrative Procedure
22Act and all rules and procedures of the Joint Committee on
23Administrative Rules; any purported rule not so adopted, for
24whatever reason, is unauthorized.
25(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
26100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff.

 

 

HB5490- 17 -LRB101 18419 BMS 67867 b

11-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81,
2eff. 7-12-19; 101-281, eff. 1-1-20; 101-371, eff. 1-1-20;
3101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
41-1-20; revised 10-16-19.)
 
5    (Text of Section after amendment by P.A. 101-625)
6    Sec. 5-3. Insurance Code provisions.
7    (a) Health Maintenance Organizations shall be subject to
8the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
9141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
10154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2, 355.3,
11355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2, 356z.4,
12356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11,
13356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.18, 356z.19,
14356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30,
15356z.30a, 356z.32, 356z.33, 356z.35, 356z.36, 356z.41,
16356z.43, 364, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c,
17368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A, 408,
18408.2, 409, 412, 444, and 444.1, paragraph (c) of subsection
19(2) of Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2,
20XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the Illinois Insurance
21Code.
22    (b) For purposes of the Illinois Insurance Code, except for
23Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health
24Maintenance Organizations in the following categories are
25deemed to be "domestic companies":

 

 

HB5490- 18 -LRB101 18419 BMS 67867 b

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

 

 

HB5490- 19 -LRB101 18419 BMS 67867 b

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

 

 

HB5490- 20 -LRB101 18419 BMS 67867 b

1specified in Section 141.2 of the Illinois Insurance Code, take
2into account the effect of the management contract or service
3agreement on the continuation of benefits to enrollees and the
4financial condition of the health maintenance organization to
5be managed or serviced, and (ii) need not take into account the
6effect of the management contract or service agreement on
7competition.
8    (f) Except for small employer groups as defined in the
9Small Employer Rating, Renewability and Portability Health
10Insurance Act and except for medicare supplement policies as
11defined in Section 363 of the Illinois Insurance Code, a Health
12Maintenance Organization may by contract agree with a group or
13other enrollment unit to effect refunds or charge additional
14premiums under the following terms and conditions:
15        (i) the amount of, and other terms and conditions with
16    respect to, the refund or additional premium are set forth
17    in the group or enrollment unit contract agreed in advance
18    of the period for which a refund is to be paid or
19    additional premium is to be charged (which period shall not
20    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

 

 

HB5490- 21 -LRB101 18419 BMS 67867 b

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

 

 

HB5490- 22 -LRB101 18419 BMS 67867 b

1if any, is conditioned on the rules being adopted in accordance
2with all provisions of the Illinois Administrative Procedure
3Act and all rules and procedures of the Joint Committee on
4Administrative Rules; any purported rule not so adopted, for
5whatever reason, is unauthorized.
6(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
7100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff.
81-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81,
9eff. 7-12-19; 101-281, eff. 1-1-20; 101-371, eff. 1-1-20;
10101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
111-1-20; 101-625, eff. 1-1-21.)
 
12    Section 35. The Voluntary Health Services Plans Act is
13amended by changing Section 10 as follows:
 
14    (215 ILCS 165/10)  (from Ch. 32, par. 604)
15    (Text of Section before amendment by P.A. 101-625)
16    Sec. 10. Application of Insurance Code provisions. Health
17services plan corporations and all persons interested therein
18or dealing therewith shall be subject to the provisions of
19Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
20143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, 356g,
21356g.5, 356g.5-1, 356r, 356t, 356u, 356v, 356w, 356x, 356y,
22356z.1, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8,
23356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
24356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29,

 

 

HB5490- 23 -LRB101 18419 BMS 67867 b

1356z.30, 356z.30a, 356z.32, 356z.33, 356z.43, 364.01, 367.2,
2368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412, and
3paragraphs (7) and (15) of Section 367 of the Illinois
4Insurance Code.
5    Rulemaking authority to implement Public Act 95-1045, if
6any, is conditioned on the rules being adopted in accordance
7with all provisions of the Illinois Administrative Procedure
8Act and all rules and procedures of the Joint Committee on
9Administrative Rules; any purported rule not so adopted, for
10whatever reason, is unauthorized.
11(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
12100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff.
131-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81,
14eff. 7-12-19; 101-281, eff. 1-1-20; 101-393, eff. 1-1-20;
15revised 10-16-19.)
 
16    (Text of Section after amendment by P.A. 101-625)
17    Sec. 10. Application of Insurance Code provisions. Health
18services plan corporations and all persons interested therein
19or dealing therewith shall be subject to the provisions of
20Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
21143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, 356g,
22356g.5, 356g.5-1, 356r, 356t, 356u, 356v, 356w, 356x, 356y,
23356z.1, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8,
24356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
25356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29,

 

 

HB5490- 24 -LRB101 18419 BMS 67867 b

1356z.30, 356z.30a, 356z.32, 356z.33, 356z.41, 356z.43, 364.01,
2367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412,
3and paragraphs (7) and (15) of Section 367 of the Illinois
4Insurance Code.
5    Rulemaking authority to implement Public Act 95-1045, if
6any, is conditioned on the rules being adopted in accordance
7with all provisions of the Illinois Administrative Procedure
8Act and all rules and procedures of the Joint Committee on
9Administrative Rules; any purported rule not so adopted, for
10whatever reason, is unauthorized.
11(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
12100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff.
131-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81,
14eff. 7-12-19; 101-281, eff. 1-1-20; 101-393, eff. 1-1-20;
15101-625, eff. 1-1-21.)
 
16    Section 95. No acceleration or delay. Where this Act makes
17changes in a statute that is represented in this Act by text
18that is not yet or no longer in effect (for example, a Section
19represented by multiple versions), the use of that text does
20not accelerate or delay the taking effect of (i) the changes
21made by this Act or (ii) provisions derived from any other
22Public Act.
 
23    Section 999. Effective date. This Act takes effect January
241, 2021.