94TH GENERAL ASSEMBLY
State of Illinois
2005 and 2006
SB2447


 
Introduced 1/18/2006, by Sen. M. Maggie Crotty
 
SYNOPSIS AS INTRODUCED:
 		

















215 ILCS 5/356z.8 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, the Health Maintenance Organization Act, and the Voluntary Health Services Plans Act to require coverage of preventative physical therapy for insureds diagnosed with multiple sclerosis. Effective immediately.
















LRB094 18810 LJB 54220 b

















 


 


A BILL FOR









 









SB2447

LRB094 18810 LJB 54220 b






1
    AN ACT concerning insurance.

 
2
    Be it enacted by the People of the State of Illinois,
 
3
represented in the General Assembly:


 
4
    Section 5. The Illinois Insurance Code is amended  by adding 
5
Section 356z.8 as follows:
 
6
    (215 ILCS 5/356z.8 new)

7
    Sec. 356z.8. Multiple sclerosis preventative physical 
8
therapy. A  group or individual policy of accident and health 
9
insurance or managed care plan amended, delivered, issued, or 
10
renewed after the effective date of this amendatory  Act  of the 
11
94th General Assembly must provide coverage of preventative 
12
physical therapy for insureds diagnosed with multiple 
13
sclerosis.

 
14
    Section 10. The Health Maintenance Organization Act is 
15
amended  by changing Section 5-3 as follows:
 



16
    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)


17
    Sec. 5-3. Insurance Code provisions. 

18
    (a) Health Maintenance Organizations
shall be subject to 
19
the provisions of Sections 133, 134, 137, 140, 141.1,
141.2, 
20
141.3, 143, 143c, 147, 148, 149, 151,
152, 153, 154, 154.5, 
21
154.6,
154.7, 154.8, 155.04, 355.2, 356m, 356v, 356w, 356x, 
22
356y,
356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 364.01, 367.2, 
23
367.2-5, 367i, 368a, 368b, 368c, 368d, 368e,
401, 401.1, 402, 
24
403, 403A,
408, 408.2, 409, 412, 444,
and
444.1,
paragraph (c) 
25
of subsection (2) of Section 367, and Articles IIA, VIII 1/2,

26
XII,
XII 1/2, XIII, XIII 1/2, XXV, and XXVI of the Illinois 
27
Insurance Code.

28
    (b) For purposes of the Illinois Insurance Code, except for 
29
Sections 444
and 444.1 and Articles XIII and XIII 1/2, Health 
30
Maintenance Organizations in
the following categories are 
 


 






SB2447
- 2 -
LRB094 18810 LJB 54220 b




1
deemed to be "domestic companies":


2
        (1) a corporation authorized under the
Dental Service 
3
    Plan Act or the Voluntary Health Services Plans Act;


4
        (2) a corporation organized under the laws of this 
5
    State; or


6
        (3) a corporation organized under the laws of another 
7
    state, 30% or more
of the enrollees of which are residents 
8
    of this State, except a
corporation subject to 
9
    substantially the same requirements in its state of

10
    organization as is a "domestic company" under Article VIII 
11
    1/2 of the
Illinois Insurance Code.

12
    (c) In considering the merger, consolidation, or other 
13
acquisition of
control of a Health Maintenance Organization 
14
pursuant to Article VIII 1/2
of the Illinois Insurance Code,


15
        (1) the Director shall give primary consideration to 
16
    the continuation of
benefits to enrollees and the financial 
17
    conditions of the acquired Health
Maintenance Organization 
18
    after the merger, consolidation, or other
acquisition of 
19
    control takes effect;


20
        (2)(i) the criteria specified in subsection (1)(b) of 
21
    Section 131.8 of
the Illinois Insurance Code shall not 
22
    apply and (ii) the Director, in making
his determination 
23
    with respect to the merger, consolidation, or other

24
    acquisition of control, need not take into account the 
25
    effect on
competition of the merger, consolidation, or 
26
    other acquisition of control;


27
        (3) the Director shall have the power to require the 
28
    following
information:


29
            (A) certification by an independent actuary of the 
30
        adequacy
of the reserves of the Health Maintenance 
31
        Organization sought to be acquired;


32
            (B) pro forma financial statements reflecting the 
33
        combined balance
sheets of the acquiring company and 
34
        the Health Maintenance Organization sought
to be 
35
        acquired as of the end of the preceding year and as of 
36
        a date 90 days
prior to the acquisition, as well as pro 
 


 






SB2447
- 3 -
LRB094 18810 LJB 54220 b




1
        forma financial statements
reflecting projected 
2
        combined operation for a period of 2 years;


3
            (C) a pro forma business plan detailing an 
4
        acquiring party's plans with
respect to the operation 
5
        of the Health Maintenance Organization sought to
be 
6
        acquired for a period of not less than 3 years; and


7
            (D) such other information as the Director shall 
8
        require.

9
    (d) The provisions of Article VIII 1/2 of the Illinois 
10
Insurance Code
and this Section 5-3 shall apply to the sale by 
11
any health maintenance
organization of greater than 10% of its

12
enrollee population (including without limitation the health 
13
maintenance
organization's right, title, and interest in and to 
14
its health care
certificates).

15
    (e) In considering any management contract or service 
16
agreement subject
to Section 141.1 of the Illinois Insurance 
17
Code, the Director (i) shall, in
addition to the criteria 
18
specified in Section 141.2 of the Illinois
Insurance Code, take 
19
into account the effect of the management contract or
service 
20
agreement on the continuation of benefits to enrollees and the

21
financial condition of the health maintenance organization to 
22
be managed or
serviced, and (ii) need not take into account the 
23
effect of the management
contract or service agreement on 
24
competition.

25
    (f) Except for small employer groups as defined in the 
26
Small Employer
Rating, Renewability and Portability Health 
27
Insurance Act and except for
medicare supplement policies as 
28
defined in Section 363 of the Illinois
Insurance Code, a Health 
29
Maintenance Organization may by contract agree with a
group or 
30
other enrollment unit to effect refunds or charge additional 
31
premiums
under the following terms and conditions:


32
        (i) the amount of, and other terms and conditions with 
33
    respect to, the
refund or additional premium are set forth 
34
    in the group or enrollment unit
contract agreed in advance 
35
    of the period for which a refund is to be paid or

36
    additional premium is to be charged (which period shall not 
 


 






SB2447
- 4 -
LRB094 18810 LJB 54220 b




1
    be less than one
year); and


2
        (ii) the amount of the refund or additional premium 
3
    shall not exceed 20%
of the Health Maintenance 
4
    Organization's profitable or unprofitable experience
with 
5
    respect to the group or other enrollment unit for the 
6
    period (and, for
purposes of a refund or additional 
7
    premium, the profitable or unprofitable
experience shall 
8
    be calculated taking into account a pro rata share of the

9
    Health Maintenance Organization's administrative and 
10
    marketing expenses, but
shall not include any refund to be 
11
    made or additional premium to be paid
pursuant to this 
12
    subsection (f)).  The Health Maintenance Organization and 
13
    the
group or enrollment unit may agree that the profitable 
14
    or unprofitable
experience may be calculated taking into 
15
    account the refund period and the
immediately preceding 2 
16
    plan years.

17
    The Health Maintenance Organization shall include a 
18
statement in the
evidence of coverage issued to each enrollee 
19
describing the possibility of a
refund or additional premium, 
20
and upon request of any group or enrollment unit,
provide to 
21
the group or enrollment unit a description of the method used 
22
to
calculate (1) the Health Maintenance Organization's 
23
profitable experience with
respect to the group or enrollment 
24
unit and the resulting refund to the group
or enrollment unit 
25
or (2) the Health Maintenance Organization's unprofitable

26
experience with respect to the group or enrollment unit and the 
27
resulting
additional premium to be paid by the group or 
28
enrollment unit.

29
    In no event shall the Illinois Health Maintenance 
30
Organization
Guaranty Association be liable to pay any 
31
contractual obligation of an
insolvent organization to pay any 
32
refund authorized under this Section.

33
(Source: P.A. 92-764, eff. 1-1-03; 93-102, eff. 1-1-04; 93-261, 
34
eff. 1-1-04; 93-477, eff. 8-8-03; 93-529, eff. 8-14-03; 93-853, 
35
eff. 1-1-05; 93-1000, eff. 1-1-05; revised 10-14-04.)



 
 


 






SB2447
- 5 -
LRB094 18810 LJB 54220 b




1
    Section 15. The Voluntary Health Services Plans Act is 
2
amended  by changing Section 10 as follows:
 



3
    (215 ILCS 165/10)  (from Ch. 32, par. 604)


4
    Sec. 10. Application of Insurance Code provisions. Health 
5
services
plan corporations and all persons interested therein 
6
or dealing therewith
shall be subject to the provisions of 
7
Articles IIA and XII 1/2 and Sections
3.1, 133, 140, 143, 143c, 
8
149, 155.37, 354, 355.2, 356r, 356t, 356u, 356v,
356w, 356x, 
9
356y, 356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 364.01, 
10
367.2, 368a, 401, 401.1,
402,
403, 403A, 408,
408.2, and 412, 
11
and paragraphs (7) and (15) of Section 367 of the Illinois

12
Insurance Code.

13
(Source: P.A. 92-130, eff. 7-20-01; 92-440, eff. 8-17-01; 
14
92-651, eff. 7-11-02; 92-764, eff. 1-1-03; 93-102, eff. 1-1-04; 
15
93-529, eff. 8-14-03; 93-853, eff. 1-1-05; 93-1000, eff. 
16
1-1-05; revised 10-14-04.)



 
17
    Section 99. Effective date. This Act takes effect upon 
18
becoming law.