|
|
|
|
95TH GENERAL ASSEMBLY
State of Illinois
2007 and 2008
SB1211
Introduced 2/9/2007, by Sen. Dale E. Risinger SYNOPSIS AS INTRODUCED:
|
|
215 ILCS 5/356z.9 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 provide coverage for federally approved Continuous Glucose Monitoring Systems. Effective immediately.
|
| |
|
|
|
|
A BILL FOR
|
|
|
|
|
SB1211 |
|
LRB095 09749 KBJ 29957 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.9 as follows:
|
| 6 |
| (215 ILCS 5/356z.9 new) |
| 7 |
| Sec. 356z.9. Continuous Glucose Monitoring Systems. A |
| 8 |
| group or individual policy of accident and health insurance or |
| 9 |
| managed care plan amended, delivered, issued, or renewed after |
| 10 |
| the effective date of this amendatory Act of the 95th General |
| 11 |
| Assembly must provide coverage for Continuous Glucose |
| 12 |
| Monitoring Systems approved by the federal Food and Drug |
| 13 |
| Administration.
|
| 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, |
|
|
|
SB1211 |
- 2 - |
LRB095 09749 KBJ 29957 b |
|
|
| 1 |
| 356y,
356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9, 364.01, |
| 2 |
| 367.2, 367.2-5, 367i, 368a, 368b, 368c, 368d, 368e, 370c,
401, |
| 3 |
| 401.1, 402, 403, 403A,
408, 408.2, 409, 412, 444,
and
444.1,
|
| 4 |
| paragraph (c) of subsection (2) of Section 367, and Articles |
| 5 |
| IIA, VIII 1/2,
XII,
XII 1/2, XIII, XIII 1/2, XXV, and XXVI of |
| 6 |
| the Illinois Insurance Code.
|
| 7 |
| (b) For purposes of the Illinois Insurance Code, except for |
| 8 |
| Sections 444
and 444.1 and Articles XIII and XIII 1/2, Health |
| 9 |
| Maintenance Organizations in
the following categories are |
| 10 |
| deemed to be "domestic companies":
|
| 11 |
| (1) a corporation authorized under the
Dental Service |
| 12 |
| Plan Act or the Voluntary Health Services Plans Act;
|
| 13 |
| (2) a corporation organized under the laws of this |
| 14 |
| State; or
|
| 15 |
| (3) a corporation organized under the laws of another |
| 16 |
| state, 30% or more
of the enrollees of which are residents |
| 17 |
| of this State, except a
corporation subject to |
| 18 |
| substantially the same requirements in its state of
|
| 19 |
| organization as is a "domestic company" under Article VIII |
| 20 |
| 1/2 of the
Illinois Insurance Code.
|
| 21 |
| (c) In considering the merger, consolidation, or other |
| 22 |
| acquisition of
control of a Health Maintenance Organization |
| 23 |
| pursuant to Article VIII 1/2
of the Illinois Insurance Code,
|
| 24 |
| (1) the Director shall give primary consideration to |
| 25 |
| the continuation of
benefits to enrollees and the financial |
| 26 |
| conditions of the acquired Health
Maintenance Organization |
|
|
|
SB1211 |
- 3 - |
LRB095 09749 KBJ 29957 b |
|
|
| 1 |
| after the merger, consolidation, or other
acquisition of |
| 2 |
| control takes effect;
|
| 3 |
| (2)(i) the criteria specified in subsection (1)(b) of |
| 4 |
| Section 131.8 of
the Illinois Insurance Code shall not |
| 5 |
| apply and (ii) the Director, in making
his determination |
| 6 |
| with respect to the merger, consolidation, or other
|
| 7 |
| acquisition of control, need not take into account the |
| 8 |
| effect on
competition of the merger, consolidation, or |
| 9 |
| other acquisition of control;
|
| 10 |
| (3) the Director shall have the power to require the |
| 11 |
| following
information:
|
| 12 |
| (A) certification by an independent actuary of the |
| 13 |
| adequacy
of the reserves of the Health Maintenance |
| 14 |
| Organization sought to be acquired;
|
| 15 |
| (B) pro forma financial statements reflecting the |
| 16 |
| combined balance
sheets of the acquiring company and |
| 17 |
| the Health Maintenance Organization sought
to be |
| 18 |
| acquired as of the end of the preceding year and as of |
| 19 |
| a date 90 days
prior to the acquisition, as well as pro |
| 20 |
| forma financial statements
reflecting projected |
| 21 |
| combined operation for a period of 2 years;
|
| 22 |
| (C) a pro forma business plan detailing an |
| 23 |
| acquiring party's plans with
respect to the operation |
| 24 |
| of the Health Maintenance Organization sought to
be |
| 25 |
| acquired for a period of not less than 3 years; and
|
| 26 |
| (D) such other information as the Director shall |
|
|
|
SB1211 |
- 4 - |
LRB095 09749 KBJ 29957 b |
|
|
| 1 |
| require.
|
| 2 |
| (d) The provisions of Article VIII 1/2 of the Illinois |
| 3 |
| Insurance Code
and this Section 5-3 shall apply to the sale by |
| 4 |
| any health maintenance
organization of greater than 10% of its
|
| 5 |
| enrollee population (including without limitation the health |
| 6 |
| maintenance
organization's right, title, and interest in and to |
| 7 |
| its health care
certificates).
|
| 8 |
| (e) In considering any management contract or service |
| 9 |
| agreement subject
to Section 141.1 of the Illinois Insurance |
| 10 |
| Code, the Director (i) shall, in
addition to the criteria |
| 11 |
| specified in Section 141.2 of the Illinois
Insurance Code, take |
| 12 |
| into account the effect of the management contract or
service |
| 13 |
| agreement on the continuation of benefits to enrollees and the
|
| 14 |
| financial condition of the health maintenance organization to |
| 15 |
| be managed or
serviced, and (ii) need not take into account the |
| 16 |
| effect of the management
contract or service agreement on |
| 17 |
| competition.
|
| 18 |
| (f) Except for small employer groups as defined in the |
| 19 |
| Small Employer
Rating, Renewability and Portability Health |
| 20 |
| Insurance Act and except for
medicare supplement policies as |
| 21 |
| defined in Section 363 of the Illinois
Insurance Code, a Health |
| 22 |
| Maintenance Organization may by contract agree with a
group or |
| 23 |
| other enrollment unit to effect refunds or charge additional |
| 24 |
| premiums
under the following terms and conditions:
|
| 25 |
| (i) the amount of, and other terms and conditions with |
| 26 |
| respect to, the
refund or additional premium are set forth |
|
|
|
SB1211 |
- 5 - |
LRB095 09749 KBJ 29957 b |
|
|
| 1 |
| in the group or enrollment unit
contract agreed in advance |
| 2 |
| of the period for which a refund is to be paid or
|
| 3 |
| additional premium is to be charged (which period shall not |
| 4 |
| be less than one
year); and
|
| 5 |
| (ii) the amount of the refund or additional premium |
| 6 |
| shall not exceed 20%
of the Health Maintenance |
| 7 |
| Organization's profitable or unprofitable experience
with |
| 8 |
| respect to the group or other enrollment unit for the |
| 9 |
| period (and, for
purposes of a refund or additional |
| 10 |
| premium, the profitable or unprofitable
experience shall |
| 11 |
| be calculated taking into account a pro rata share of the
|
| 12 |
| Health Maintenance Organization's administrative and |
| 13 |
| marketing expenses, but
shall not include any refund to be |
| 14 |
| made or additional premium to be paid
pursuant to this |
| 15 |
| subsection (f)). The Health Maintenance Organization and |
| 16 |
| the
group or enrollment unit may agree that the profitable |
| 17 |
| or unprofitable
experience may be calculated taking into |
| 18 |
| account the refund period and the
immediately preceding 2 |
| 19 |
| plan years.
|
| 20 |
| The Health Maintenance Organization shall include a |
| 21 |
| statement in the
evidence of coverage issued to each enrollee |
| 22 |
| describing the possibility of a
refund or additional premium, |
| 23 |
| and upon request of any group or enrollment unit,
provide to |
| 24 |
| the group or enrollment unit a description of the method used |
| 25 |
| to
calculate (1) the Health Maintenance Organization's |
| 26 |
| profitable experience with
respect to the group or enrollment |
|
|
|
SB1211 |
- 6 - |
LRB095 09749 KBJ 29957 b |
|
|
| 1 |
| unit and the resulting refund to the group
or enrollment unit |
| 2 |
| or (2) the Health Maintenance Organization's unprofitable
|
| 3 |
| experience with respect to the group or enrollment unit and the |
| 4 |
| resulting
additional premium to be paid by the group or |
| 5 |
| enrollment unit.
|
| 6 |
| In no event shall the Illinois Health Maintenance |
| 7 |
| Organization
Guaranty Association be liable to pay any |
| 8 |
| contractual obligation of an
insolvent organization to pay any |
| 9 |
| refund authorized under this Section.
|
| 10 |
| (Source: P.A. 93-102, eff. 1-1-04; 93-261, eff. 1-1-04; 93-477, |
| 11 |
| eff. 8-8-03; 93-529, eff. 8-14-03; 93-853, eff. 1-1-05; |
| 12 |
| 93-1000, eff. 1-1-05; 94-906, eff. 1-1-07; 94-1076, eff. |
| 13 |
| 12-29-06; revised 1-5-07.)
|
| 14 |
| Section 15. The Voluntary Health Services Plans Act is |
| 15 |
| amended by changing Section 10 as follows:
|
| 16 |
| (215 ILCS 165/10) (from Ch. 32, par. 604)
|
| 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, 356r, 356t, 356u, 356v,
356w, 356x, |
| 22 |
| 356y, 356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9, |
| 23 |
| 364.01, 367.2, 368a, 401, 401.1,
402,
403, 403A, 408,
408.2, |
| 24 |
| and 412, and paragraphs (7) and (15) of Section 367 of the |