102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
SB3819

 

Introduced 1/21/2022, by Sen. Laura Fine

 

SYNOPSIS AS INTRODUCED:
 
5 ILCS 375/6.11
55 ILCS 5/5-1069.3
65 ILCS 5/10-4-2.3
105 ILCS 5/10-22.3f
215 ILCS 5/356z.53 new
215 ILCS 125/5-3  from Ch. 111 1/2, par. 1411.2
215 ILCS 130/4003  from Ch. 73, par. 1504-3
215 ILCS 165/10  from Ch. 32, par. 604

    Amends the Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance or a managed care plan amended, delivered, issued, or renewed on or after the effective date of the amendatory Act shall provide coverage for community-based pediatric palliative or hospice care. Provides that the care shall be delivered to any qualifying child by a trained interdisciplinary team in accordance with all the terms of the Pediatric Palliative Care Act, which allows a child to receive community-based pediatric palliative and hospice care while continuing to pursue curative treatment and disease-directed therapies for the qualifying illness. Makes conforming changes in the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, the Limited Health Service Organization Act, and the Voluntary Health Services Plans Act.


LRB102 23224 BMS 34475 b

STATE MANDATES ACT MAY REQUIRE REIMBURSEMENT
MAY APPLY

 

 

A BILL FOR

 

SB3819LRB102 23224 BMS 34475 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 and 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

 

 

SB3819- 2 -LRB102 23224 BMS 34475 b

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,

 

 

SB3819- 3 -LRB102 23224 BMS 34475 b

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 and
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 and 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 and

 

 

SB3819- 6 -LRB102 23224 BMS 34475 b

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. Pediatric palliative care. A group or
21individual policy of accident and health insurance or a
22managed care plan amended, delivered, issued, or renewed on or
23after the effective date of this amendatory Act of the 102nd
24General Assembly shall provide coverage for community-based

 

 

SB3819- 7 -LRB102 23224 BMS 34475 b

1pediatric palliative and hospice care. This care shall be
2delivered to any qualifying child by a trained
3interdisciplinary team in accordance with all the terms of the
4Pediatric Palliative Care Act, which allows a child to receive
5community-based pediatric palliative and hospice care while
6continuing to pursue curative treatment and disease-directed
7therapies for the qualifying illness.
 
8    Section 30. The Health Maintenance Organization Act is
9amended by changing Section 5-3 as follows:
 
10    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
11    Sec. 5-3. Insurance Code provisions.
12    (a) Health Maintenance Organizations shall be subject to
13the provisions of Sections 133, 134, 136, 137, 139, 140,
14141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
15154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2,
16355.3, 355b, 356g.5-1, 356m, 356q, 356v, 356w, 356x, 356y,
17356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9,
18356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17,
19356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29,
20356z.30, 356z.30a, 356z.32, 356z.33, 356z.35, 356z.36,
21356z.40, 356z.41, 356z.43, 356z.46, 356z.47, 356z.48, 356z.50,
22356z.51, 356z.53, 364, 364.01, 367.2, 367.2-5, 367i, 368a,
23368b, 368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403,
24403A, 408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of

 

 

SB3819- 8 -LRB102 23224 BMS 34475 b

1subsection (2) of Section 367, and Articles IIA, VIII 1/2,
2XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the
3Illinois Insurance Code.
4    (b) For purposes of the Illinois Insurance Code, except
5for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
6Health Maintenance Organizations in the following categories
7are deemed to be "domestic companies":
8        (1) a corporation authorized under the Dental Service
9    Plan Act or the Voluntary Health Services Plans Act;
10        (2) a corporation organized under the laws of this
11    State; or
12        (3) a corporation organized under the laws of another
13    state, 30% or more of the enrollees of which are residents
14    of this State, except a corporation subject to
15    substantially the same requirements in its state of
16    organization as is a "domestic company" under Article VIII
17    1/2 of the Illinois Insurance Code.
18    (c) In considering the merger, consolidation, or other
19acquisition of control of a Health Maintenance Organization
20pursuant to Article VIII 1/2 of the Illinois Insurance Code,
21        (1) the Director shall give primary consideration to
22    the continuation of benefits to enrollees and the
23    financial conditions of the acquired Health Maintenance
24    Organization after the merger, consolidation, or other
25    acquisition of control takes effect;
26        (2)(i) the criteria specified in subsection (1)(b) of

 

 

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1    Section 131.8 of the Illinois Insurance Code shall not
2    apply and (ii) the Director, in making his determination
3    with respect to the merger, consolidation, or other
4    acquisition of control, need not take into account the
5    effect on competition of the merger, consolidation, or
6    other acquisition of control;
7        (3) the Director shall have the power to require the
8    following information:
9            (A) certification by an independent actuary of the
10        adequacy of the reserves of the Health Maintenance
11        Organization sought to be acquired;
12            (B) pro forma financial statements reflecting the
13        combined balance sheets of the acquiring company and
14        the Health Maintenance Organization sought to be
15        acquired as of the end of the preceding year and as of
16        a date 90 days prior to the acquisition, as well as pro
17        forma financial statements reflecting projected
18        combined operation for a period of 2 years;
19            (C) a pro forma business plan detailing an
20        acquiring party's plans with respect to the operation
21        of the Health Maintenance Organization sought to be
22        acquired for a period of not less than 3 years; and
23            (D) such other information as the Director shall
24        require.
25    (d) The provisions of Article VIII 1/2 of the Illinois
26Insurance Code and this Section 5-3 shall apply to the sale by

 

 

SB3819- 10 -LRB102 23224 BMS 34475 b

1any health maintenance organization of greater than 10% of its
2enrollee population (including without limitation the health
3maintenance organization's right, title, and interest in and
4to its health care certificates).
5    (e) In considering any management contract or service
6agreement subject to Section 141.1 of the Illinois Insurance
7Code, the Director (i) shall, in addition to the criteria
8specified in Section 141.2 of the Illinois Insurance Code,
9take into account the effect of the management contract or
10service agreement on the continuation of benefits to enrollees
11and the financial condition of the health maintenance
12organization to be managed or serviced, and (ii) need not take
13into account the effect of the management contract or service
14agreement on competition.
15    (f) Except for small employer groups as defined in the
16Small Employer Rating, Renewability and Portability Health
17Insurance Act and except for medicare supplement policies as
18defined in Section 363 of the Illinois Insurance Code, a
19Health Maintenance Organization may by contract agree with a
20group or other enrollment unit to effect refunds or charge
21additional premiums under the following terms and conditions:
22        (i) the amount of, and other terms and conditions with
23    respect to, the refund or additional premium are set forth
24    in the group or enrollment unit contract agreed in advance
25    of the period for which a refund is to be paid or
26    additional premium is to be charged (which period shall

 

 

SB3819- 11 -LRB102 23224 BMS 34475 b

1    not be less than one year); and
2        (ii) the amount of the refund or additional premium
3    shall not exceed 20% of the Health Maintenance
4    Organization's profitable or unprofitable experience with
5    respect to the group or other enrollment unit for the
6    period (and, for purposes of a refund or additional
7    premium, the profitable or unprofitable experience shall
8    be calculated taking into account a pro rata share of the
9    Health Maintenance Organization's administrative and
10    marketing expenses, but shall not include any refund to be
11    made or additional premium to be paid pursuant to this
12    subsection (f)). The Health Maintenance Organization and
13    the group or enrollment unit may agree that the profitable
14    or unprofitable experience may be calculated taking into
15    account the refund period and the immediately preceding 2
16    plan years.
17    The Health Maintenance Organization shall include a
18statement in the evidence of coverage issued to each enrollee
19describing the possibility of a refund or additional premium,
20and upon request of any group or enrollment unit, provide to
21the group or enrollment unit a description of the method used
22to calculate (1) the Health Maintenance Organization's
23profitable experience with respect to the group or enrollment
24unit and the resulting refund to the group or enrollment unit
25or (2) the Health Maintenance Organization's unprofitable
26experience with respect to the group or enrollment unit and

 

 

SB3819- 12 -LRB102 23224 BMS 34475 b

1the resulting additional premium to be paid by the group or
2enrollment unit.
3    In no event shall the Illinois Health Maintenance
4Organization Guaranty Association be liable to pay any
5contractual obligation of an insolvent organization to pay any
6refund authorized under this Section.
7    (g) Rulemaking authority to implement Public Act 95-1045,
8if any, is conditioned on the rules being adopted in
9accordance with all provisions of the Illinois Administrative
10Procedure Act and all rules and procedures of the Joint
11Committee on Administrative Rules; any purported rule not so
12adopted, for whatever reason, is unauthorized.
13(Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19;
14101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-393, eff.
151-1-20; 101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625,
16eff. 1-1-21; 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
17102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
181-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
19eff. 10-8-21; revised 10-27-21.)
 
20    Section 35. The Limited Health Service Organization Act is
21amended by changing Section 4003 as follows:
 
22    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
23    Sec. 4003. Illinois Insurance Code provisions. Limited
24health service organizations shall be subject to the

 

 

SB3819- 13 -LRB102 23224 BMS 34475 b

1provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
2141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
3154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 355.2, 355.3,
4355b, 356q, 356v, 356z.10, 356z.21, 356z.22, 356z.25, 356z.26,
5356z.29, 356z.30a, 356z.32, 356z.33, 356z.41, 356z.46,
6356z.47, 356z.51, 356z.53, 356z.43, 368a, 401, 401.1, 402,
7403, 403A, 408, 408.2, 409, 412, 444, and 444.1 and Articles
8IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and XXVI of
9the Illinois Insurance Code. For purposes of the Illinois
10Insurance Code, except for Sections 444 and 444.1 and Articles
11XIII and XIII 1/2, limited health service organizations in the
12following categories are deemed to be domestic companies:
13        (1) a corporation under the laws of this State; or
14        (2) a corporation organized under the laws of another
15    state, 30% or more of the enrollees of which are residents
16    of this State, except a corporation subject to
17    substantially the same requirements in its state of
18    organization as is a domestic company under Article VIII
19    1/2 of the Illinois Insurance Code.
20(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
21101-393, eff. 1-1-20; 101-625, eff. 1-1-21; 102-30, eff.
221-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642,
23eff. 1-1-22; revised 10-27-21.)
 
24    Section 40. The Voluntary Health Services Plans Act is
25amended by changing Section 10 as follows:
 

 

 

SB3819- 14 -LRB102 23224 BMS 34475 b

1    (215 ILCS 165/10)  (from Ch. 32, par. 604)
2    Sec. 10. Application of Insurance Code provisions. Health
3services plan corporations and all persons interested therein
4or dealing therewith shall be subject to the provisions of
5Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
6143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
7356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356v, 356w,
8356x, 356y, 356z.1, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6,
9356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14,
10356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26,
11356z.29, 356z.30, 356z.30a, 356z.32, 356z.33, 356z.40,
12356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.43, 364.01,
13367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412,
14and paragraphs (7) and (15) of Section 367 of the Illinois
15Insurance Code.
16    Rulemaking authority to implement Public Act 95-1045, if
17any, is conditioned on the rules being adopted in accordance
18with all provisions of the Illinois Administrative Procedure
19Act and all rules and procedures of the Joint Committee on
20Administrative Rules; any purported rule not so adopted, for
21whatever reason, is unauthorized.
22(Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19;
23101-281, eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff.
241-1-21; 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; 102-306,
25eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21;

 

 

SB3819- 15 -LRB102 23224 BMS 34475 b

1revised 10-27-21.)