SB1527 EngrossedLRB103 27266 BMS 53637 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    (Text of Section before amendment by P.A. 102-768)
8    Sec. 6.11. Required health benefits; Illinois Insurance
9Code requirements. The program of health benefits shall
10provide the post-mastectomy care benefits required to be
11covered by a policy of accident and health insurance under
12Section 356t of the Illinois Insurance Code. The program of
13health benefits shall provide the coverage required under
14Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x,
15356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
16356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,
17356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
18356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
19356z.53, 356z.54, 356z.56, 356z.57, 356z.59, and 356z.60 of
20the Illinois Insurance Code. The program of health benefits
21must comply with Sections 155.22a, 155.37, 355b, 356z.19,
22370c, and 370c.1 and Article XXXIIB of the Illinois Insurance
23Code. The Department of Insurance shall enforce the

 

 

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1requirements of this Section with respect to Sections 370c and
2370c.1 of the Illinois Insurance Code; all other requirements
3of this Section shall be enforced by the Department of Central
4Management Services.
5    Rulemaking authority to implement Public Act 95-1045, if
6any, is conditioned on the rules being adopted in accordance
7with all provisions of the Illinois Administrative Procedure
8Act and all rules and procedures of the Joint Committee on
9Administrative Rules; any purported rule not so adopted, for
10whatever reason, is unauthorized.
11(Source: P.A. 101-13, eff. 6-12-19; 101-281, eff. 1-1-20;
12101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
131-1-20; 101-625, eff. 1-1-21; 102-30, eff. 1-1-22; 102-103,
14eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
15102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff.
161-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816,
17eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
18revised 12-13-22.)
 
19    (Text of Section after amendment by P.A. 102-768)
20    Sec. 6.11. Required health benefits; Illinois Insurance
21Code requirements. The program of health benefits shall
22provide the post-mastectomy care benefits required to be
23covered by a policy of accident and health insurance under
24Section 356t of the Illinois Insurance Code. The program of
25health benefits shall provide the coverage required under

 

 

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1Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x,
2356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
3356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,
4356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
5356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
6356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59, and
7356z.60, and 356z.61 of the Illinois Insurance Code. The
8program of health benefits must comply with Sections 155.22a,
9155.37, 355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of
10the Illinois Insurance Code. The Department of Insurance shall
11enforce the requirements of this Section with respect to
12Sections 370c and 370c.1 of the Illinois Insurance Code; all
13other requirements of this Section shall be enforced by the
14Department of Central Management Services.
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. 101-13, eff. 6-12-19; 101-281, eff. 1-1-20;
22101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
231-1-20; 101-625, eff. 1-1-21; 102-30, eff. 1-1-22; 102-103,
24eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
25102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff.
261-1-23; 102-768, eff. 1-1-24; 102-804, eff. 1-1-23; 102-813,

 

 

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1eff. 5-13-22; 102-816, eff. 1-1-23; 102-860, eff. 1-1-23;
2102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23.)
 
3    Section 10. The Counties Code is amended by changing
4Section 5-1069.3 as follows:
 
5    (55 ILCS 5/5-1069.3)
6    Sec. 5-1069.3. Required health benefits. If a county,
7including a home rule county, is a self-insurer for purposes
8of providing health insurance coverage for its employees, the
9coverage shall include coverage for the post-mastectomy care
10benefits required to be covered by a policy of accident and
11health insurance under Section 356t and the coverage required
12under Sections 356g, 356g.5, 356g.5-1, 356q, 356u, 356w, 356x,
13356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11,
14356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26,
15356z.29, 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40,
16356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53,
17356z.54, 356z.56, 356z.57, 356z.59, and 356z.60, and 356z.61
18of the Illinois Insurance Code. The coverage shall comply with
19Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
20Insurance Code. The Department of Insurance shall enforce the
21requirements of this Section. The requirement that health
22benefits be covered as provided in this Section is an
23exclusive power and function of the State and is a denial and
24limitation under Article VII, Section 6, subsection (h) of the

 

 

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1Illinois Constitution. A home rule county to which this
2Section applies must comply with every provision of this
3Section.
4    Rulemaking authority to implement Public Act 95-1045, if
5any, is conditioned on the rules being adopted in accordance
6with all provisions of the Illinois Administrative Procedure
7Act and all rules and procedures of the Joint Committee on
8Administrative Rules; any purported rule not so adopted, for
9whatever reason, is unauthorized.
10(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
11101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
121-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
13eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22;
14102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff.
151-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816,
16eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
17102-1117, eff. 1-13-23.)
 
18    Section 15. The Illinois Municipal Code is amended by
19changing Section 10-4-2.3 as follows:
 
20    (65 ILCS 5/10-4-2.3)
21    Sec. 10-4-2.3. Required health benefits. If a
22municipality, including a home rule municipality, is a
23self-insurer for purposes of providing health insurance
24coverage for its employees, the coverage shall include

 

 

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1coverage for the post-mastectomy care benefits required to be
2covered by a policy of accident and health insurance under
3Section 356t and the coverage required under Sections 356g,
4356g.5, 356g.5-1, 356q, 356u, 356w, 356x, 356z.4, 356z.4a,
5356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
6356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
7356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
8356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
9356z.56, 356z.57, 356z.59, and 356z.60, and 356z.61 of the
10Illinois Insurance Code. The coverage shall comply with
11Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
12Insurance Code. The Department of Insurance shall enforce the
13requirements of this Section. The requirement that health
14benefits be covered as provided in this is an exclusive power
15and function of the State and is a denial and limitation under
16Article VII, Section 6, subsection (h) of the Illinois
17Constitution. A home rule municipality to which this Section
18applies must comply with every provision of this Section.
19    Rulemaking authority to implement Public Act 95-1045, if
20any, is conditioned on the rules being adopted in accordance
21with all provisions of the Illinois Administrative Procedure
22Act and all rules and procedures of the Joint Committee on
23Administrative Rules; any purported rule not so adopted, for
24whatever reason, is unauthorized.
25(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
26101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.

 

 

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11-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
2eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22;
3102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff.
41-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816,
5eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
6102-1117, eff. 1-13-23.)
 
7    Section 20. The School Code is amended by changing Section
810-22.3f as follows:
 
9    (105 ILCS 5/10-22.3f)
10    Sec. 10-22.3f. Required health benefits. Insurance
11protection and benefits for employees shall provide the
12post-mastectomy care benefits required to be covered by a
13policy of accident and health insurance under Section 356t and
14the coverage required under Sections 356g, 356g.5, 356g.5-1,
15356q, 356u, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8,
16356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
17356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
18356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
19356z.53, 356z.54, 356z.56, 356z.57, 356z.59, and 356z.60, and
20356z.61 of the Illinois Insurance Code. Insurance policies
21shall comply with Section 356z.19 of the Illinois Insurance
22Code. The coverage shall comply with Sections 155.22a, 355b,
23and 370c of the Illinois Insurance Code. The Department of
24Insurance shall enforce the requirements 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; 102-642, eff. 1-1-22;
11102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804, eff.
121-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860,
13eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23.)
 
14    Section 25. The Illinois Insurance Code is amended by
15adding Section 356z.61 as follows:
 
16    (215 ILCS 5/356z.61 new)
17    Sec. 356z.61. Coverage for compression sleeves. A group or
18individual policy of accident and health insurance or a
19managed care plan that is amended, delivered, issued, or
20renewed on or after January 1, 2025 shall provide coverage for
21compression sleeves that is medically necessary for the
22enrollee to prevent or mitigate lymphedema.
 
23    Section 30. The Health Maintenance Organization Act is

 

 

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1amended by changing Section 5-3 as follows:
 
2    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
3    Sec. 5-3. Insurance Code provisions.
4    (a) Health Maintenance Organizations shall be subject to
5the provisions of Sections 133, 134, 136, 137, 139, 140,
6141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
7154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2,
8355.3, 355b, 355c, 356g.5-1, 356m, 356q, 356v, 356w, 356x,
9356y, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6,
10356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14,
11356z.15, 356z.17, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25,
12356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33,
13356z.35, 356z.36, 356z.40, 356z.41, 356z.46, 356z.47, 356z.48,
14356z.50, 356z.51, 356z.53 256z.53, 356z.54, 356z.56, 356z.57,
15356z.59, 356z.60, 356z.61, 364, 364.01, 364.3, 367.2, 367.2-5,
16367i, 368a, 368b, 368c, 368d, 368e, 370c, 370c.1, 401, 401.1,
17402, 403, 403A, 408, 408.2, 409, 412, 444, and 444.1,
18paragraph (c) of subsection (2) of Section 367, and Articles
19IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and
20XXXIIB of the Illinois 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":
25        (1) a corporation authorized under the Dental Service

 

 

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

 

 

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

 

 

SB1527 Engrossed- 12 -LRB103 27266 BMS 53637 b

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

 

 

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

 

 

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1accordance with all provisions of the Illinois Administrative
2Procedure Act and all rules and procedures of the Joint
3Committee on Administrative Rules; any purported rule not so
4adopted, for whatever reason, is unauthorized.
5(Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19;
6101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-393, eff.
71-1-20; 101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625,
8eff. 1-1-21; 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
9102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
101-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
11eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
12102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
131-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
14eff. 1-1-23; 102-1117, eff. 1-13-23; revised 1-22-23.)
 
15    Section 35. The Limited Health Service Organization Act is
16amended by changing Section 4003 as follows:
 
17    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
18    Sec. 4003. Illinois Insurance Code provisions. Limited
19health service organizations shall be subject to the
20provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
21141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
22154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 355.2, 355.3,
23355b, 356q, 356v, 356z.4, 356z.4a, 356z.10, 356z.21, 356z.22,
24356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,

 

 

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1356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54, 356z.57,
2356z.59, 356z.61, 364.3, 368a, 401, 401.1, 402, 403, 403A,
3408, 408.2, 409, 412, 444, and 444.1 and Articles IIA, VIII
41/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and XXVI of the
5Illinois Insurance Code. Nothing in this Section shall require
6a limited health care plan to cover any service that is not a
7limited health service. For purposes of the Illinois Insurance
8Code, except for Sections 444 and 444.1 and Articles XIII and
9XIII 1/2, limited health service organizations in the
10following categories are deemed to be domestic companies:
11        (1) a corporation under the laws of this State; or
12        (2) 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(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
19101-393, eff. 1-1-20; 101-625, eff. 1-1-21; 102-30, eff.
201-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642,
21eff. 1-1-22; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
22102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860, eff.
231-1-23; 102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23.)
 
24    Section 40. The Voluntary Health Services Plans Act is
25amended by changing Section 10 as follows:
 

 

 

SB1527 Engrossed- 16 -LRB103 27266 BMS 53637 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.3a, 356z.4, 356z.4a, 356z.5,
9356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
10356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25,
11356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33,
12356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
13356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 364.01, 364.3,
14367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412,
15and paragraphs (7) and (15) of Section 367 of the Illinois
16Insurance Code.
17    Rulemaking authority to implement Public Act 95-1045, if
18any, is conditioned on the rules being adopted in accordance
19with all provisions of the Illinois Administrative Procedure
20Act and all rules and procedures of the Joint Committee on
21Administrative Rules; any purported rule not so adopted, for
22whatever reason, is unauthorized.
23(Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19;
24101-281, eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff.
251-1-21; 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; 102-306,

 

 

SB1527 Engrossed- 17 -LRB103 27266 BMS 53637 b

1eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21;
2102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804, eff.
31-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860,
4eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff. 1-1-23;
5102-1117, eff. 1-13-23.)
 
6    Section 45. The Illinois Public Aid Code is amended by
7changing Section 5-16.8 as follows:
 
8    (305 ILCS 5/5-16.8)
9    Sec. 5-16.8. Required health benefits. The medical
10assistance program shall (i) provide the post-mastectomy care
11benefits required to be covered by a policy of accident and
12health insurance under Section 356t and the coverage required
13under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6,
14356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,
15356z.47, 356z.51, 356z.53, 356z.56, 356z.59, and 356z.60, and
16356z.61 of the Illinois Insurance Code, (ii) be subject to the
17provisions of Sections 356z.19, 356z.44, 356z.49, 364.01,
18370c, and 370c.1 of the Illinois Insurance Code, and (iii) be
19subject to the provisions of subsection (d-5) of Section 10 of
20the Network Adequacy and Transparency Act.
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

 

 

SB1527 Engrossed- 18 -LRB103 27266 BMS 53637 b

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. 101-81, eff. 7-12-19; 101-218, eff. 1-1-20;
11101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-574, eff.
121-1-20; 101-649, eff. 7-7-20; 102-30, eff. 1-1-22; 102-144,
13eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
14102-530, eff. 1-1-22; 102-642, eff. 1-1-22; 102-804, eff.
151-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093,
16eff. 1-1-23; 102-1117, eff. 1-13-23.)
 
17    Section 95. No acceleration or delay. Where this Act makes
18changes in a statute that is represented in this Act by text
19that is not yet or no longer in effect (for example, a Section
20represented by multiple versions), the use of that text does
21not accelerate or delay the taking effect of (i) the changes
22made by this Act or (ii) provisions derived from any other
23Public Act.