103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
SB1557

 

Introduced 2/8/2023, by Sen. Laura M. Murphy

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 5/356z.61 new
305 ILCS 5/5-16.8

    Amends the Illinois Insurance Code. Provides that no individual or group policy of accident and health insurance or managed care organization shall change an insured's eligibility or coverage during a contract period. Provides that during a contract period, insureds shall have the protection and continuity of their providers, medication, covered benefits, and formulary during the contract period. Amends the Illinois Public Aid Code making conforming changes.


LRB103 27648 BMS 54024 b

 

 

A BILL FOR

 

SB1557LRB103 27648 BMS 54024 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 Illinois Insurance Code is amended by
5adding Section 356z.61 as follows:
 
6    (215 ILCS 5/356z.61 new)
7    Sec. 356z.61. Contract terms; coverage. No individual or
8group policy of accident and health insurance or managed care
9organization shall amend, deliver, issue, or renew a policy in
10a way that changes an insured's eligibility or coverage during
11a contract period. During a contract period, an insured shall
12have the protection and continuity of his or her providers,
13his or her medication, his or her covered benefits, and the
14formulary during the contract period.
 
15    Section 10. 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

 

 

SB1557- 2 -LRB103 27648 BMS 54024 b

1under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6,
2356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,
3356z.47, 356z.51, 356z.53, 356z.56, 356z.59, and 356z.60, and
4356z.61 of the Illinois Insurance Code, (ii) be subject to the
5provisions of Sections 356z.19, 356z.44, 356z.49, 364.01,
6370c, and 370c.1 of the Illinois Insurance Code, and (iii) be
7subject to the provisions of subsection (d-5) of Section 10 of
8the Network Adequacy and Transparency Act.
9    The Department, by rule, shall adopt a model similar to
10the requirements of Section 356z.39 of the Illinois Insurance
11Code.
12    On and after July 1, 2012, the Department shall reduce any
13rate of reimbursement for services or other payments or alter
14any methodologies authorized by this Code to reduce any rate
15of reimbursement for services or other payments in accordance
16with Section 5-5e.
17    To ensure full access to the benefits set forth in this
18Section, on and after January 1, 2016, the Department shall
19ensure that provider and hospital reimbursement for
20post-mastectomy care benefits required under this Section are
21no lower than the Medicare reimbursement rate.
22(Source: P.A. 101-81, eff. 7-12-19; 101-218, eff. 1-1-20;
23101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-574, eff.
241-1-20; 101-649, eff. 7-7-20; 102-30, eff. 1-1-22; 102-144,
25eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
26102-530, eff. 1-1-22; 102-642, eff. 1-1-22; 102-804, eff.

 

 

SB1557- 3 -LRB103 27648 BMS 54024 b

11-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093,
2eff. 1-1-23; 102-1117, eff. 1-13-23.)