Rep. Mary E. Flowers
Filed: 4/8/2014
 
 

 

 

 
09800HB4335ham003LRB098 17245 RPM 58437 a



1
AMENDMENT TO HOUSE BILL 4335




2    AMENDMENT NO. ______. Amend House Bill 4335 by replacing 
3everything after the enacting clause with the following:




 
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    Sec. 6.11. Required health benefits; Illinois Insurance 
8Code
requirements.  The program of health
benefits shall provide 
9the post-mastectomy care benefits required to be covered
by a 
10policy of accident and health insurance under Section 356t of 
11the Illinois
Insurance Code.  The program of health benefits 
12shall provide the coverage
required under Sections 356g, 
13356g.5, 356g.5-1, 356m,
356u, 356w, 356x, 356z.2, 356z.4, 
14356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 
15356z.14, 356z.15, and 356z.17, and 356z.22 of the
Illinois 
16Insurance Code.
The program of health benefits must comply with 
 
 
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1Sections 155.22a, 155.37, 355b, and 356z.19 of the
Illinois 
2Insurance Code.

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. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-813, 
10eff. 7-13-12; 98-189, eff. 1-1-14.)
 
11    Section 10. The Counties Code is amended  by changing 
12Section 5-1069.3 as follows:
 
13    (55 ILCS 5/5-1069.3)

14    Sec. 5-1069.3. Required health benefits.   If a county, 
15including a home
rule
county, is a self-insurer for purposes of 
16providing health insurance coverage
for its employees, the 
17coverage shall include coverage for the post-mastectomy
care 
18benefits required to be covered by a policy of accident and 
19health
insurance under Section 356t and the coverage required 
20under Sections 356g, 356g.5, 356g.5-1, 356u,
356w, 356x, 
21356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 
22356z.14, and 356z.15, and 356z.22 of
the Illinois Insurance 
23Code. The coverage shall comply with Sections 155.22a, 355b, 
24and 356z.19 of
the Illinois Insurance Code.  The requirement 
 
 
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1that health benefits be covered
as provided in this Section is 
2an
exclusive power and function of the State and is a denial 
3and limitation under
Article VII, Section 6, subsection (h) of 
4the Illinois Constitution.  A home
rule county to which this 
5Section applies must comply with every provision of
this 
6Section.


7    Rulemaking authority to implement Public Act 95-1045, if 
8any, is conditioned on the rules being adopted in accordance 
9with all provisions of the Illinois Administrative Procedure 
10Act and all rules and procedures of the Joint Committee on 
11Administrative Rules; any purported rule not so adopted, for 
12whatever reason, is unauthorized. 
13(Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-813, 
14eff. 7-13-12; 98-189, eff. 1-1-14.)
 
15    Section 15. The Illinois Municipal Code is amended  by 
16changing Section 10-4-2.3 as follows:
 
17    (65 ILCS 5/10-4-2.3)

18    Sec. 10-4-2.3. Required health benefits.   If a 
19municipality, including a
home rule municipality, is a 
20self-insurer for purposes of providing health
insurance 
21coverage for its employees, the coverage shall include coverage 
22for
the post-mastectomy care benefits required to be covered by 
23a policy of
accident and health insurance under Section 356t 
24and the coverage required
under Sections 356g, 356g.5, 
 
 
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1356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10, 
2356z.11, 356z.12, 356z.13, 356z.14, and 356z.15, and 356z.22 of 
3the Illinois
Insurance
Code. The coverage shall comply with 
4Sections 155.22a, 355b, and 356z.19 of
the Illinois Insurance 
5Code.  The requirement that health
benefits be covered as 
6provided in this is an exclusive power and function of
the 
7State and is a denial and limitation under Article VII, Section 
86,
subsection (h) of the Illinois Constitution.  A home rule 
9municipality to which
this Section applies must comply with 
10every provision of this Section.


11    Rulemaking authority to implement Public Act 95-1045, if 
12any, is conditioned on the rules being adopted in accordance 
13with all provisions of the Illinois Administrative Procedure 
14Act and all rules and procedures of the Joint Committee on 
15Administrative Rules; any purported rule not so adopted, for 
16whatever reason, is unauthorized. 
17(Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-813, 
18eff. 7-13-12; 98-189, eff. 1-1-14.)
 
19    Section 20. The Illinois Insurance Code is amended  by 
20adding Section 356z.22 as follows:
 
21    (215 ILCS 5/356z.22  new)
22    Sec. 356z.22. Hospital patient assessments. A group or 
23individual policy of accident and health insurance or managed 
24care plan amended, delivered, issued, or renewed after the 
 
 
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1effective date of this amendatory Act of the 98th General 
2Assembly that provides coverage for hospital care shall include 
3in that coverage all services ordered by a physician and 
4provided in the hospital that are considered medically 
5necessary per the terms set forth in the insurance policy or 
6certificate or, in the case of programs administered by the 
7Department of Healthcare and Family Services, within the 
8services covered by the Illinois Title XIX State Plan and the 
9Illinois Title XXI State Plan for the evaluation, assessment, 
10and diagnosis of the illness or condition that resulted in the 
11hospital stay of the  enrollee or recipient. The services are 
12subject to reasonable review and utilization standards 
13required by the policy or plan for all hospital services, as 
14defined by the Department or its successor agency.
 
15    Section 25. The Illinois Public Aid Code is amended  by 
16changing Section 5-16.8 as follows:
 



17    (305 ILCS 5/5-16.8)


18    Sec. 5-16.8. Required health benefits. The medical 
19assistance program
shall
(i) provide the post-mastectomy care 
20benefits required to be covered by a policy of
accident and 
21health insurance under Section 356t and the coverage required

22under Sections 356g.5, 356u, 356w, 356x, and 356z.6, and 
23356z.22 of the Illinois
Insurance Code and (ii) be subject to 
24the provisions of Sections 356z.19 and 364.01 of the Illinois

 
 
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1Insurance Code.

2    On and after July 1, 2012, the Department shall reduce any 
3rate of reimbursement for services or other payments or alter 
4any methodologies authorized by this Code to reduce any rate of 
5reimbursement for services or other payments in accordance with 
6Section 5-5e. 
7(Source: P.A. 97-282, eff. 8-9-11; 97-689, eff. 6-14-12.)

 
8    Section 30. The Medical Patient Rights Act is amended  by 
9changing Section 2.04 as follows:

 



10    (410 ILCS 50/2.04)  (from Ch. 111 1/2, par. 5402.04)



11    Sec. 2.04. 
"Insurance company" means (1) an insurance 
12company, fraternal
benefit society, and any other insurer 
13subject to regulation under the
Illinois Insurance Code; or (2) 
14a health maintenance organization, a limited health service 
15organization under the Limited Health Service Organization 
16Act, or a voluntary health services plan under the Voluntary 
17Health Services Plans Act.

18(Source: P.A. 85-677; 85-679.)


 
19    Section 99. Effective date. This Act takes effect upon 
20becoming law.".