Rep. Sue Scherer

Filed: 3/22/2021

 

 


 

 


 
10200HB2406ham001LRB102 13035 BMS 23859 a

1
AMENDMENT TO HOUSE BILL 2406

2    AMENDMENT NO. ______. Amend House Bill 2406 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Illinois Insurance Code is amended by
5adding Section 356z.43 as follows:
 
6    (215 ILCS 5/356z.43 new)
7    Sec. 356z.43. COVID-19 vaccine administrative cost. An
8individual or group policy of accident and health insurance or
9managed care plan in effect on and after March 9, 2020 must
10provide coverage for the cost of administering a COVID-19
11vaccination without cost sharing.
 
12    Section 10. The Health Maintenance Organization Act is
13amended by changing Section 5-3 as follows:
 
14    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)

 

 

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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,
4141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
5154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2,
6355.3, 355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2,
7356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10,
8356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.18,
9356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30,
10356z.30a, 356z.32, 356z.33, 356z.35, 356z.36, 356z.41,
11356z.43, 364, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c,
12368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A, 408,
13408.2, 409, 412, 444, and 444.1, paragraph (c) of subsection
14(2) of Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2,
15XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the Illinois
16Insurance Code.
17    (b) For purposes of the Illinois Insurance Code, except
18for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
19Health Maintenance Organizations in the following categories
20are deemed to be "domestic companies":
21        (1) a corporation authorized under the Dental Service
22    Plan Act or the Voluntary Health Services Plans Act;
23        (2) a corporation organized under the laws of this
24    State; or
25        (3) a corporation organized under the laws of another
26    state, 30% or more of the enrollees of which are residents

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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1100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff.
21-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81,
3eff. 7-12-19; 101-281, eff. 1-1-20; 101-371, eff. 1-1-20;
4101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
51-1-20; 101-625, eff. 1-1-21.)
 
6    Section 15. The Voluntary Health Services Plans Act is
7amended by changing Section 10 as follows:
 
8    (215 ILCS 165/10)  (from Ch. 32, par. 604)
9    Sec. 10. Application of Insurance Code provisions. Health
10services plan corporations and all persons interested therein
11or dealing therewith shall be subject to the provisions of
12Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
13143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
14356g, 356g.5, 356g.5-1, 356r, 356t, 356u, 356v, 356w, 356x,
15356y, 356z.1, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8,
16356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
17356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29,
18356z.30, 356z.30a, 356z.32, 356z.33, 356z.41, 356z.43, 364.01,
19367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412,
20and paragraphs (7) and (15) of Section 367 of the Illinois
21Insurance Code.
22    Rulemaking authority to implement Public Act 95-1045, if
23any, is conditioned on the rules being adopted in accordance
24with all provisions of the Illinois Administrative Procedure

 

 

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1Act and all rules and procedures of the Joint Committee on
2Administrative Rules; any purported rule not so adopted, for
3whatever reason, is unauthorized.
4(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
5100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff.
61-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81,
7eff. 7-12-19; 101-281, eff. 1-1-20; 101-393, eff. 1-1-20;
8101-625, eff. 1-1-21.)
 
9    Section 20. The Illinois Public Aid Code is amended by
10changing Section 5-16.8 as follows:
 
11    (305 ILCS 5/5-16.8)
12    Sec. 5-16.8. Required health benefits. The medical
13assistance program shall (i) provide the post-mastectomy care
14benefits required to be covered by a policy of accident and
15health insurance under Section 356t and the coverage required
16under Sections 356g.5, 356u, 356w, 356x, 356z.6, 356z.26,
17356z.29, 356z.32, 356z.33, 356z.34, and 356z.35, and 356z.43
18of the Illinois Insurance Code and (ii) be subject to the
19provisions of Sections 356z.19, 364.01, 370c, and 370c.1 of
20the Illinois Insurance Code.
21    The Department, by rule, shall adopt a model similar to
22the requirements of Section 356z.39 of the Illinois Insurance
23Code.
24    On and after July 1, 2012, the Department shall reduce any

 

 

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1rate of reimbursement for services or other payments or alter
2any methodologies authorized by this Code to reduce any rate
3of reimbursement for services or other payments in accordance
4with Section 5-5e.
5    To ensure full access to the benefits set forth in this
6Section, on and after January 1, 2016, the Department shall
7ensure that provider and hospital reimbursement for
8post-mastectomy care benefits required under this Section are
9no lower than the Medicare reimbursement rate.
10(Source: P.A. 100-138, eff. 8-18-17; 100-863, eff. 8-14-18;
11100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff.
127-12-19; 101-218, eff. 1-1-20; 101-281, eff. 1-1-20; 101-371,
13eff. 1-1-20; 101-574, eff. 1-1-20; 101-649, eff. 7-7-20.)".