HB4271 EnrolledLRB102 21407 BMS 30523 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
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
9provide the post-mastectomy care benefits required to be
10covered by a policy of accident and health insurance under
11Section 356t of the Illinois Insurance Code. The program of
12health benefits shall provide the coverage required under
13Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x,
14356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
15356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,
16356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
17356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
18and 356z.53 356z.43 of the Illinois Insurance Code. The
19program of health benefits must comply with Sections 155.22a,
20155.37, 355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of
21the Illinois Insurance Code. The Department of Insurance shall
22enforce the requirements of this Section with respect to
23Sections 370c and 370c.1 of the Illinois Insurance Code; all

 

 

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1other requirements of this Section shall be enforced by the
2Department of Central Management Services.
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. 101-13, eff. 6-12-19; 101-281, eff. 1-1-20;
10101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
111-1-20; 101-625, eff. 1-1-21; 102-30, eff. 1-1-22; 102-103,
12eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
13102-642, eff. 1-1-22; 102-665, eff. 10-8-21; revised
1410-26-21.)
 
15    Section 10. The Counties Code is amended by changing
16Section 5-1069.3 as follows:
 
17    (55 ILCS 5/5-1069.3)
18    Sec. 5-1069.3. Required health benefits. If a county,
19including a home rule county, is a self-insurer for purposes
20of providing health insurance coverage for its employees, the
21coverage shall include coverage for the post-mastectomy care
22benefits required to be covered by a policy of accident and
23health insurance under Section 356t and the coverage required
24under Sections 356g, 356g.5, 356g.5-1, 356q, 356u, 356w, 356x,

 

 

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1356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
2356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
3356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
4356z.45, 356z.46, 356z.47, 356z.48, 356z.51, and 356z.53
5356z.43 of the Illinois Insurance Code. The coverage shall
6comply with Sections 155.22a, 355b, 356z.19, and 370c of the
7Illinois Insurance Code. The Department of Insurance shall
8enforce the requirements of this Section. The requirement that
9health benefits be covered as provided in this Section is an
10exclusive power and function of the State and is a denial and
11limitation under Article VII, Section 6, subsection (h) of the
12Illinois Constitution. A home rule county to which this
13Section applies must comply with every provision of this
14Section.
15    Rulemaking authority to implement Public Act 95-1045, if
16any, is conditioned on the rules being adopted in accordance
17with all provisions of the Illinois Administrative Procedure
18Act and all rules and procedures of the Joint Committee on
19Administrative Rules; any purported rule not so adopted, for
20whatever reason, is unauthorized.
21(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
22101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
231-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
24eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22;
25102-642, eff. 1-1-22; 102-665, eff. 10-8-21; revised
2610-26-21.)
 

 

 

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1    Section 15. The Illinois Municipal Code is amended by
2changing Section 10-4-2.3 as follows:
 
3    (65 ILCS 5/10-4-2.3)
4    Sec. 10-4-2.3. Required health benefits. If a
5municipality, including a home rule municipality, is a
6self-insurer for purposes of providing health insurance
7coverage for its employees, the coverage shall include
8coverage for the post-mastectomy care benefits required to be
9covered by a policy of accident and health insurance under
10Section 356t and the coverage required under Sections 356g,
11356g.5, 356g.5-1, 356q, 356u, 356w, 356x, 356z.6, 356z.8,
12356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
13356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32,
14356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
15356z.48, 356z.51, and 356z.53 356z.43 of the Illinois
16Insurance Code. The coverage shall comply with Sections
17155.22a, 355b, 356z.19, and 370c of the Illinois Insurance
18Code. The Department of Insurance shall enforce the
19requirements of this Section. The requirement that health
20benefits be covered as provided in this is an exclusive power
21and function of the State and is a denial and limitation under
22Article VII, Section 6, subsection (h) of the Illinois
23Constitution. A home rule municipality to which this Section
24applies must comply with every provision of this Section.

 

 

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1    Rulemaking authority to implement Public Act 95-1045, if
2any, is conditioned on the rules being adopted in accordance
3with all provisions of the Illinois Administrative Procedure
4Act and all rules and procedures of the Joint Committee on
5Administrative Rules; any purported rule not so adopted, for
6whatever reason, is unauthorized.
7(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
8101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
91-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
10eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22;
11102-642, eff. 1-1-22; 102-665, eff. 10-8-21; revised
1210-26-21.)
 
13    Section 20. The School Code is amended by changing Section
1410-22.3f as follows:
 
15    (105 ILCS 5/10-22.3f)
16    Sec. 10-22.3f. Required health benefits. Insurance
17protection and benefits for employees shall provide the
18post-mastectomy care benefits required to be covered by a
19policy of accident and health insurance under Section 356t and
20the coverage required under Sections 356g, 356g.5, 356g.5-1,
21356q, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11,
22356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26,
23356z.29, 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40,
24356z.41, 356z.45, 356z.46, 356z.47, 356z.51, and 356z.53

 

 

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1356z.43 of the Illinois Insurance Code. Insurance policies
2shall comply with Section 356z.19 of the Illinois Insurance
3Code. The coverage shall comply with Sections 155.22a, 355b,
4and 370c of the Illinois Insurance Code. The Department of
5Insurance shall enforce the requirements of this Section.
6    Rulemaking authority to implement Public Act 95-1045, if
7any, is conditioned on the rules being adopted in accordance
8with all provisions of the Illinois Administrative Procedure
9Act and all rules and procedures of the Joint Committee on
10Administrative Rules; any purported rule not so adopted, for
11whatever reason, is unauthorized.
12(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
13101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
141-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
15eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. 1-1-22;
16102-665, eff. 10-8-21; revised 10-27-21.)
 
17    Section 25. The Illinois Insurance Code is amended by
18adding Section 356z.53 as follows:
 
19    (215 ILCS 5/356z.53 new)
20    Sec. 356z.53. Coverage for breast reduction surgery. A
21group or individual policy of accident and health insurance or
22a managed care plan that is amended, delivered, issued, or
23renewed on or after January 1, 2024 shall provide coverage for
24medically necessary breast reduction surgery.
 

 

 

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1    Section 30. The Health Maintenance Organization Act is
2amended by changing Section 5-3 as follows:
 
3    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
4    Sec. 5-3. Insurance Code provisions.
5    (a) Health Maintenance Organizations shall be subject to
6the provisions of Sections 133, 134, 136, 137, 139, 140,
7141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
8154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2,
9355.3, 355b, 356g.5-1, 356m, 356q, 356v, 356w, 356x, 356y,
10356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9,
11356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17,
12356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29,
13356z.30, 356z.30a, 356z.32, 356z.33, 356z.35, 356z.36,
14356z.40, 356z.41, 356z.43, 356z.46, 356z.47, 356z.48, 356z.50,
15356z.51, 356z.53, 364, 364.01, 367.2, 367.2-5, 367i, 368a,
16368b, 368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403,
17403A, 408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of
18subsection (2) of Section 367, and Articles IIA, VIII 1/2,
19XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the
20Illinois Insurance Code.
21    (b) For purposes of the Illinois Insurance Code, except
22for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
23Health Maintenance Organizations in the following categories
24are deemed to be "domestic companies":

 

 

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1        (1) a corporation authorized under the Dental Service
2    Plan Act or the Voluntary Health Services Plans Act;
3        (2) a corporation organized under the laws of this
4    State; or
5        (3) a corporation organized under the laws of another
6    state, 30% or more of the enrollees of which are residents
7    of this State, except a corporation subject to
8    substantially the same requirements in its state of
9    organization as is a "domestic company" under Article VIII
10    1/2 of the Illinois Insurance Code.
11    (c) In considering the merger, consolidation, or other
12acquisition of control of a Health Maintenance Organization
13pursuant to Article VIII 1/2 of the Illinois Insurance Code,
14        (1) the Director shall give primary consideration to
15    the continuation of benefits to enrollees and the
16    financial conditions of the acquired Health Maintenance
17    Organization after the merger, consolidation, or other
18    acquisition of control takes effect;
19        (2)(i) the criteria specified in subsection (1)(b) of
20    Section 131.8 of the Illinois Insurance Code shall not
21    apply and (ii) the Director, in making his determination
22    with respect to the merger, consolidation, or other
23    acquisition of control, need not take into account the
24    effect on competition of the merger, consolidation, or
25    other acquisition of control;
26        (3) the Director shall have the power to require the

 

 

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

 

 

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1specified in Section 141.2 of the Illinois Insurance Code,
2take into account the effect of the management contract or
3service agreement on the continuation of benefits to enrollees
4and the financial condition of the health maintenance
5organization to be managed or serviced, and (ii) need not take
6into account the effect of the management contract or service
7agreement on competition.
8    (f) Except for small employer groups as defined in the
9Small Employer Rating, Renewability and Portability Health
10Insurance Act and except for medicare supplement policies as
11defined in Section 363 of the Illinois Insurance Code, a
12Health Maintenance Organization may by contract agree with a
13group or other enrollment unit to effect refunds or charge
14additional premiums under the following terms and conditions:
15        (i) the amount of, and other terms and conditions with
16    respect to, the refund or additional premium are set forth
17    in the group or enrollment unit contract agreed in advance
18    of the period for which a refund is to be paid or
19    additional premium is to be charged (which period shall
20    not be less than one year); and
21        (ii) the amount of the refund or additional premium
22    shall not exceed 20% of the Health Maintenance
23    Organization's profitable or unprofitable experience with
24    respect to the group or other enrollment unit for the
25    period (and, for purposes of a refund or additional
26    premium, the profitable or unprofitable experience shall

 

 

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1    be calculated taking into account a pro rata share of the
2    Health Maintenance Organization's administrative and
3    marketing expenses, but shall not include any refund to be
4    made or additional premium to be paid pursuant to this
5    subsection (f)). The Health Maintenance Organization and
6    the group or enrollment unit may agree that the profitable
7    or unprofitable experience may be calculated taking into
8    account the refund period and the immediately preceding 2
9    plan years.
10    The Health Maintenance Organization shall include a
11statement in the evidence of coverage issued to each enrollee
12describing the possibility of a refund or additional premium,
13and upon request of any group or enrollment unit, provide to
14the group or enrollment unit a description of the method used
15to calculate (1) the Health Maintenance Organization's
16profitable experience with respect to the group or enrollment
17unit and the resulting refund to the group or enrollment unit
18or (2) the Health Maintenance Organization's unprofitable
19experience with respect to the group or enrollment unit and
20the resulting additional premium to be paid by the group or
21enrollment unit.
22    In no event shall the Illinois Health Maintenance
23Organization Guaranty Association be liable to pay any
24contractual obligation of an insolvent organization to pay any
25refund authorized under this Section.
26    (g) Rulemaking authority to implement Public Act 95-1045,

 

 

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1if any, is conditioned on the rules being adopted in
2accordance with all provisions of the Illinois Administrative
3Procedure Act and all rules and procedures of the Joint
4Committee on Administrative Rules; any purported rule not so
5adopted, for whatever reason, is unauthorized.
6(Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19;
7101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-393, eff.
81-1-20; 101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625,
9eff. 1-1-21; 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
10102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
111-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
12eff. 10-8-21; revised 10-27-21.)
 
13    Section 35. The Limited Health Service Organization Act is
14amended by changing Section 4003 as follows:
 
15    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
16    Sec. 4003. Illinois Insurance Code provisions. Limited
17health service organizations shall be subject to the
18provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
19141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
20154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 355.2, 355.3,
21355b, 356q, 356v, 356z.10, 356z.21, 356z.22, 356z.25, 356z.26,
22356z.29, 356z.30a, 356z.32, 356z.33, 356z.41, 356z.46,
23356z.47, 356z.51, 356z.53, 356z.43, 368a, 401, 401.1, 402,
24403, 403A, 408, 408.2, 409, 412, 444, and 444.1 and Articles

 

 

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1IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and XXVI of
2the Illinois Insurance Code. For purposes of the Illinois
3Insurance Code, except for Sections 444 and 444.1 and Articles
4XIII and XIII 1/2, limited health service organizations in the
5following categories are deemed to be domestic companies:
6        (1) a corporation under the laws of this State; or
7        (2) a corporation organized under the laws of another
8    state, 30% or more of the enrollees of which are residents
9    of this State, except a corporation subject to
10    substantially the same requirements in its state of
11    organization as is a domestic company under Article VIII
12    1/2 of the Illinois Insurance Code.
13(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
14101-393, eff. 1-1-20; 101-625, eff. 1-1-21; 102-30, eff.
151-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642,
16eff. 1-1-22; revised 10-27-21.)
 
17    Section 40. The Voluntary Health Services Plans Act is
18amended by changing Section 10 as follows:
 
19    (215 ILCS 165/10)  (from Ch. 32, par. 604)
20    Sec. 10. Application of Insurance Code provisions. Health
21services plan corporations and all persons interested therein
22or dealing therewith shall be subject to the provisions of
23Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
24143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,

 

 

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1356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356v, 356w,
2356x, 356y, 356z.1, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6,
3356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14,
4356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26,
5356z.29, 356z.30, 356z.30a, 356z.32, 356z.33, 356z.40,
6356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.43, 364.01,
7367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412,
8and paragraphs (7) and (15) of Section 367 of the Illinois
9Insurance Code.
10    Rulemaking authority to implement Public Act 95-1045, if
11any, is conditioned on the rules being adopted in accordance
12with all provisions of the Illinois Administrative Procedure
13Act and all rules and procedures of the Joint Committee on
14Administrative Rules; any purported rule not so adopted, for
15whatever reason, is unauthorized.
16(Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19;
17101-281, eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff.
181-1-21; 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; 102-306,
19eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21;
20revised 10-27-21.)