Rep. Mary E. Flowers
Filed: 5/1/2008
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1 | AMENDMENT TO HOUSE BILL 2286
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2 | AMENDMENT NO. ______. Amend House Bill 2286 by replacing | ||||||
3 | everything after the enacting clause with the following:
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4 | "Section 5. The State Employees Group Insurance Act of 1971 | ||||||
5 | is amended by changing Section 6.11 as follows:
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6 | (5 ILCS 375/6.11)
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7 | Sec. 6.11. Required health benefits; Illinois Insurance | ||||||
8 | Code
requirements. The program of health
benefits shall provide | ||||||
9 | the post-mastectomy care benefits required to be covered
by a | ||||||
10 | policy of accident and health insurance under Section 356t of | ||||||
11 | the Illinois
Insurance Code. The program of health benefits | ||||||
12 | shall provide the coverage
required under Sections 356f.1, | ||||||
13 | 356g.5,
356u, 356w, 356x, 356z.2, 356z.4, 356z.6, and 356z.9, | ||||||
14 | and 356z.10
356z.9 of the
Illinois Insurance Code.
The program | ||||||
15 | of health benefits must comply with Section 155.37 of the
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16 | Illinois Insurance Code.
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1 | (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; | ||||||
2 | 95-520, eff. 8-28-07; revised 12-4-07.)
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3 | Section 10. The Counties Code is amended by changing | ||||||
4 | Section 5-1069.3 as follows: | ||||||
5 | (55 ILCS 5/5-1069.3)
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6 | Sec. 5-1069.3. Required health benefits. If a county, | ||||||
7 | including a home
rule
county, is a self-insurer for purposes of | ||||||
8 | providing health insurance coverage
for its employees, the | ||||||
9 | coverage shall include coverage for the post-mastectomy
care | ||||||
10 | benefits required to be covered by a policy of accident and | ||||||
11 | health
insurance under Section 356t and the coverage required | ||||||
12 | under Sections 356f.1, 356g.5, 356u,
356w, 356x, 356z.6, and | ||||||
13 | 356z.9, and 356z.10
356z.9 of
the Illinois Insurance Code. The | ||||||
14 | requirement that health benefits be covered
as provided in this | ||||||
15 | Section is an
exclusive power and function of the State and is | ||||||
16 | a denial and limitation under
Article VII, Section 6, | ||||||
17 | subsection (h) of the Illinois Constitution. A home
rule county | ||||||
18 | to which this Section applies must comply with every provision | ||||||
19 | of
this Section.
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20 | (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; | ||||||
21 | 95-520, eff. 8-28-07; revised 12-4-07.)
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22 | Section 15. The Illinois Municipal Code is amended by | ||||||
23 | changing Section 10-4-2.3 as follows: |
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1 | (65 ILCS 5/10-4-2.3)
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2 | Sec. 10-4-2.3. Required health benefits. If a | ||||||
3 | municipality, including a
home rule municipality, is a | ||||||
4 | self-insurer for purposes of providing health
insurance | ||||||
5 | coverage for its employees, the coverage shall include coverage | ||||||
6 | for
the post-mastectomy care benefits required to be covered by | ||||||
7 | a policy of
accident and health insurance under Section 356t | ||||||
8 | and the coverage required
under Sections 356f.1, 356g.5, 356u, | ||||||
9 | 356w, 356x, 356z.6, and 356z.9, and 356z.10
356z.9 of the | ||||||
10 | Illinois
Insurance
Code. The requirement that health
benefits | ||||||
11 | be covered as provided in this is an exclusive power and | ||||||
12 | function of
the State and is a denial and limitation under | ||||||
13 | Article VII, Section 6,
subsection (h) of the Illinois | ||||||
14 | Constitution. A home rule municipality to which
this Section | ||||||
15 | applies must comply with every provision of this Section.
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16 | (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; | ||||||
17 | 95-520, eff. 8-28-07; revised 12-4-07.)
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18 | Section 20. The School Code is amended by changing Section | ||||||
19 | 10-22.3f as follows: | ||||||
20 | (105 ILCS 5/10-22.3f)
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21 | Sec. 10-22.3f. Required health benefits. Insurance | ||||||
22 | protection and
benefits
for employees shall provide the | ||||||
23 | post-mastectomy care benefits required to be
covered by a |
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1 | policy of accident and health insurance under Section 356t and | ||||||
2 | the
coverage required under Sections 356f.1, 356g.5, 356u, | ||||||
3 | 356w, 356x,
356z.6, and 356z.9 of
the
Illinois Insurance Code.
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4 | (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; | ||||||
5 | revised 12-4-07.)
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6 | Section 25. The Illinois Insurance Code is amended by | ||||||
7 | adding Section 356f.1 as follows: | ||||||
8 | (215 ILCS 5/356f.1 new)
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9 | Sec. 356f.1. Recision, cancellation, or limiting of a plan | ||||||
10 | contract. | ||||||
11 | (a) No insurer or health care service plan shall engage in | ||||||
12 | the practice of postclaims underwriting. For purposes of this | ||||||
13 | Section, "postclaims underwriting" means the rescinding, | ||||||
14 | canceling, or limiting of a plan contract due to the plan's | ||||||
15 | failure to complete medical underwriting and resolve all | ||||||
16 | reasonable questions arising from written information | ||||||
17 | submitted on or with an application before issuing the plan | ||||||
18 | contract. This subsection (a) shall not limit a plan's remedies | ||||||
19 | upon a showing of willful misrepresentation. | ||||||
20 | (b) Notwithstanding any other provision of law, a health | ||||||
21 | care service plan shall seek and receive final approval from | ||||||
22 | the Division of Insurance prior to rescinding a plan contract | ||||||
23 | of a subscriber or enrollee. No later than January 1, 2010, the | ||||||
24 | Department shall contract with one or more appropriately |
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1 | qualified independent review organizations to conduct the | ||||||
2 | review required by this subsection (b). The Department shall | ||||||
3 | ensure that the review organization shall not have any | ||||||
4 | material, professional, familial, or financial affiliation | ||||||
5 | with the health care service plan. | ||||||
6 | (c) Notwithstanding any other rulemaking authority that | ||||||
7 | may exist, neither the Governor nor any agency or agency head | ||||||
8 | under the jurisdiction of the Governor has any authority to | ||||||
9 | make or promulgate rules to implement or enforce the provisions | ||||||
10 | of this amendatory Act of the 95th General Assembly. If, | ||||||
11 | however, the Governor believes that rules are necessary to | ||||||
12 | implement or enforce the provisions of this amendatory Act of | ||||||
13 | the 95th General Assembly, the Governor may suggest rules to | ||||||
14 | the General Assembly by filing them with the Clerk of the House | ||||||
15 | and the Secretary of the Senate and by requesting that the | ||||||
16 | General Assembly authorize such rulemaking by law, enact those | ||||||
17 | suggested rules into law, or take any other appropriate action | ||||||
18 | in the General Assembly's discretion. Nothing contained in this | ||||||
19 | amendatory Act of the 95th General Assembly shall be | ||||||
20 | interpreted to grant rulemaking authority under any other | ||||||
21 | Illinois statute where such authority is not otherwise | ||||||
22 | explicitly given. For the purposes of this amendatory Act of | ||||||
23 | the 95th General Assembly, "rules" is given the meaning | ||||||
24 | contained in Section 1-70 of the Illinois Administrative | ||||||
25 | Procedure Act, and "agency" and "agency head" are given the | ||||||
26 | meanings contained in Sections 1-20 and 1-25 of the Illinois |
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1 | Administrative Procedure Act to the extent that such | ||||||
2 | definitions apply to agencies or agency heads under the | ||||||
3 | jurisdiction of the Governor.
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4 | Section 30. The Health Maintenance Organization Act is | ||||||
5 | amended by changing Section 5-3 as follows:
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6 | (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
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7 | Sec. 5-3. Insurance Code provisions.
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8 | (a) Health Maintenance Organizations
shall be subject to | ||||||
9 | the provisions of Sections 133, 134, 137, 140, 141.1,
141.2, | ||||||
10 | 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, 154, 154.5, | ||||||
11 | 154.6,
154.7, 154.8, 155.04, 355.2, 356f.1, 356m, 356v, 356w, | ||||||
12 | 356x, 356y,
356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9, | ||||||
13 | 356z.10
356z.9 , 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c, | ||||||
14 | 368d, 368e, 370c,
401, 401.1, 402, 403, 403A,
408, 408.2, 409, | ||||||
15 | 412, 444,
and
444.1,
paragraph (c) of subsection (2) of Section | ||||||
16 | 367, and Articles IIA, VIII 1/2,
XII,
XII 1/2, XIII, XIII 1/2, | ||||||
17 | XXV, and XXVI of the Illinois Insurance Code.
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18 | (b) For purposes of the Illinois Insurance Code, except for | ||||||
19 | Sections 444
and 444.1 and Articles XIII and XIII 1/2, Health | ||||||
20 | Maintenance Organizations in
the following categories are | ||||||
21 | deemed to be "domestic companies":
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22 | (1) a corporation authorized under the
Dental Service | ||||||
23 | Plan Act or the Voluntary Health Services Plans Act;
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24 | (2) a corporation organized under the laws of this |
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1 | State; or
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2 | (3) a corporation organized under the laws of another | ||||||
3 | state, 30% or more
of the enrollees of which are residents | ||||||
4 | of this State, except a
corporation subject to | ||||||
5 | substantially the same requirements in its state of
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6 | organization as is a "domestic company" under Article VIII | ||||||
7 | 1/2 of the
Illinois Insurance Code.
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8 | (c) In considering the merger, consolidation, or other | ||||||
9 | acquisition of
control of a Health Maintenance Organization | ||||||
10 | pursuant to Article VIII 1/2
of the Illinois Insurance Code,
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11 | (1) the Director shall give primary consideration to | ||||||
12 | the continuation of
benefits to enrollees and the financial | ||||||
13 | conditions of the acquired Health
Maintenance Organization | ||||||
14 | after the merger, consolidation, or other
acquisition of | ||||||
15 | control takes effect;
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16 | (2)(i) the criteria specified in subsection (1)(b) of | ||||||
17 | Section 131.8 of
the Illinois Insurance Code shall not | ||||||
18 | apply and (ii) the Director, in making
his determination | ||||||
19 | with respect to the merger, consolidation, or other
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20 | acquisition of control, need not take into account the | ||||||
21 | effect on
competition of the merger, consolidation, or | ||||||
22 | other acquisition of control;
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23 | (3) the Director shall have the power to require the | ||||||
24 | following
information:
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25 | (A) certification by an independent actuary of the | ||||||
26 | adequacy
of the reserves of the Health Maintenance |
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1 | Organization sought to be acquired;
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2 | (B) pro forma financial statements reflecting the | ||||||
3 | combined balance
sheets of the acquiring company and | ||||||
4 | the Health Maintenance Organization sought
to be | ||||||
5 | acquired as of the end of the preceding year and as of | ||||||
6 | a date 90 days
prior to the acquisition, as well as pro | ||||||
7 | forma financial statements
reflecting projected | ||||||
8 | combined operation for a period of 2 years;
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9 | (C) a pro forma business plan detailing an | ||||||
10 | acquiring party's plans with
respect to the operation | ||||||
11 | of the Health Maintenance Organization sought to
be | ||||||
12 | acquired for a period of not less than 3 years; and
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13 | (D) such other information as the Director shall | ||||||
14 | require.
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15 | (d) The provisions of Article VIII 1/2 of the Illinois | ||||||
16 | Insurance Code
and this Section 5-3 shall apply to the sale by | ||||||
17 | any health maintenance
organization of greater than 10% of its
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18 | enrollee population (including without limitation the health | ||||||
19 | maintenance
organization's right, title, and interest in and to | ||||||
20 | its health care
certificates).
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21 | (e) In considering any management contract or service | ||||||
22 | agreement subject
to Section 141.1 of the Illinois Insurance | ||||||
23 | Code, the Director (i) shall, in
addition to the criteria | ||||||
24 | specified in Section 141.2 of the Illinois
Insurance Code, take | ||||||
25 | into account the effect of the management contract or
service | ||||||
26 | agreement on the continuation of benefits to enrollees and the
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1 | financial condition of the health maintenance organization to | ||||||
2 | be managed or
serviced, and (ii) need not take into account the | ||||||
3 | effect of the management
contract or service agreement on | ||||||
4 | competition.
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5 | (f) Except for small employer groups as defined in the | ||||||
6 | Small Employer
Rating, Renewability and Portability Health | ||||||
7 | Insurance Act and except for
medicare supplement policies as | ||||||
8 | defined in Section 363 of the Illinois
Insurance Code, a Health | ||||||
9 | Maintenance Organization may by contract agree with a
group or | ||||||
10 | other enrollment unit to effect refunds or charge additional | ||||||
11 | premiums
under the following terms and conditions:
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12 | (i) the amount of, and other terms and conditions with | ||||||
13 | respect to, the
refund or additional premium are set forth | ||||||
14 | in the group or enrollment unit
contract agreed in advance | ||||||
15 | of the period for which a refund is to be paid or
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16 | additional premium is to be charged (which period shall not | ||||||
17 | be less than one
year); and
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18 | (ii) the amount of the refund or additional premium | ||||||
19 | shall not exceed 20%
of the Health Maintenance | ||||||
20 | Organization's profitable or unprofitable experience
with | ||||||
21 | respect to the group or other enrollment unit for the | ||||||
22 | period (and, for
purposes of a refund or additional | ||||||
23 | premium, the profitable or unprofitable
experience shall | ||||||
24 | be calculated taking into account a pro rata share of the
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25 | Health Maintenance Organization's administrative and | ||||||
26 | marketing expenses, but
shall not include any refund to be |
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1 | made or additional premium to be paid
pursuant to this | ||||||
2 | subsection (f)). The Health Maintenance Organization and | ||||||
3 | the
group or enrollment unit may agree that the profitable | ||||||
4 | or unprofitable
experience may be calculated taking into | ||||||
5 | account the refund period and the
immediately preceding 2 | ||||||
6 | plan years.
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7 | The Health Maintenance Organization shall include a | ||||||
8 | statement in the
evidence of coverage issued to each enrollee | ||||||
9 | describing the possibility of a
refund or additional premium, | ||||||
10 | and upon request of any group or enrollment unit,
provide to | ||||||
11 | the group or enrollment unit a description of the method used | ||||||
12 | to
calculate (1) the Health Maintenance Organization's | ||||||
13 | profitable experience with
respect to the group or enrollment | ||||||
14 | unit and the resulting refund to the group
or enrollment unit | ||||||
15 | or (2) the Health Maintenance Organization's unprofitable
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16 | experience with respect to the group or enrollment unit and the | ||||||
17 | resulting
additional premium to be paid by the group or | ||||||
18 | enrollment unit.
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19 | In no event shall the Illinois Health Maintenance | ||||||
20 | Organization
Guaranty Association be liable to pay any | ||||||
21 | contractual obligation of an
insolvent organization to pay any | ||||||
22 | refund authorized under this Section.
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23 | (Source: P.A. 94-906, eff. 1-1-07; 94-1076, eff. 12-29-06; | ||||||
24 | 95-422, eff. 8-24-07; 95-520, eff. 8-28-07; revised 12-4-07.)
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25 | Section 35. The Limited Health Service Organization Act is |
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1 | amended by changing Section 4003 as follows:
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2 | (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
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3 | Sec. 4003. Illinois Insurance Code provisions. Limited | ||||||
4 | health service
organizations shall be subject to the provisions | ||||||
5 | of Sections 133, 134, 137,
140, 141.1, 141.2, 141.3, 143, 143c, | ||||||
6 | 147, 148, 149, 151, 152, 153, 154, 154.5,
154.6, 154.7, 154.8, | ||||||
7 | 155.04, 155.37, 355.2, 356f.1, 356v, 356z.10
356z.9 , 368a, 401, | ||||||
8 | 401.1,
402,
403, 403A, 408,
408.2, 409, 412, 444, and 444.1 and | ||||||
9 | Articles IIA, VIII 1/2, XII, XII 1/2,
XIII,
XIII 1/2, XXV, and | ||||||
10 | XXVI of the Illinois Insurance Code. For purposes of the
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11 | Illinois Insurance Code, except for Sections 444 and 444.1 and | ||||||
12 | Articles XIII
and XIII 1/2, limited health service | ||||||
13 | organizations in the following categories
are deemed to be | ||||||
14 | domestic companies:
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15 | (1) a corporation under the laws of this State; or
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16 | (2) a corporation organized under the laws of another | ||||||
17 | state, 30% of more
of the enrollees of which are residents | ||||||
18 | of this State, except a corporation
subject to | ||||||
19 | substantially the same requirements in its state of | ||||||
20 | organization as
is a domestic company under Article VIII | ||||||
21 | 1/2 of the Illinois Insurance Code.
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22 | (Source: P.A. 95-520, eff. 8-28-07; revised 12-5-07.)
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23 | Section 37. The Managed Care Reform and Patient Rights Act | ||||||
24 | is amended by changing Section 20 as follows:
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1 | (215 ILCS 134/20)
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2 | Sec. 20. Notice of nonrenewal or termination. A health care | ||||||
3 | plan must
give at least 60
days notice of nonrenewal or | ||||||
4 | termination of a health
care provider to the health care
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5 | provider and to the enrollees served by the health care | ||||||
6 | provider.
The notice shall include a name and address to which | ||||||
7 | an enrollee or health care
provider may direct
comments and | ||||||
8 | concerns regarding the nonrenewal or termination.
Immediate | ||||||
9 | written notice may be provided without 60 days notice when a | ||||||
10 | health
care provider's license has been disciplined by a State | ||||||
11 | licensing board. All health care plans shall comply with | ||||||
12 | Section 356f.1 of the Illinois Insurance Code.
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13 | (Source: P.A. 91-617, eff. 1-1-00.)
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14 | Section 40. The Voluntary Health Services Plans Act is | ||||||
15 | amended by changing Section 10 as follows:
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16 | (215 ILCS 165/10) (from Ch. 32, par. 604)
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17 | Sec. 10. Application of Insurance Code provisions. Health | ||||||
18 | services
plan corporations and all persons interested therein | ||||||
19 | or dealing therewith
shall be subject to the provisions of | ||||||
20 | Articles IIA and XII 1/2 and Sections
3.1, 133, 140, 143, 143c, | ||||||
21 | 149, 155.37, 354, 355.2, 356f.1, 356g.5, 356r, 356t, 356u, | ||||||
22 | 356v,
356w, 356x, 356y, 356z.1, 356z.2, 356z.4, 356z.5, 356z.6, | ||||||
23 | 356z.8, 356z.9,
356z.10
356z.9 , 364.01, 367.2, 368a, 401, |
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1 | 401.1,
402,
403, 403A, 408,
408.2, and 412, and paragraphs (7) | ||||||
2 | and (15) of Section 367 of the Illinois
Insurance Code.
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3 | (Source: P.A. 94-1076, eff. 12-29-06; 95-189, eff. 8-16-07; | ||||||
4 | 95-331, eff. 8-21-07; 95-422, eff. 8-24-07; 95-520, eff. | ||||||
5 | 8-28-07; revised 12-5-07.)".
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