093_SB0418

 
                                     LRB093 07311 JLS 07471 b

 1        AN ACT in  relation  to  insurance  coverage  for  cancer
 2    screenings, amending named Acts.

 3        Be  it  enacted  by  the People of the State of Illinois,
 4    represented in the General Assembly:

 5        Section 5.  The Illinois Insurance  Code  is  amended  by
 6    adding Section 356z.4 as follows:

 7        (215 ILCS 5/356z.4 new)
 8        Sec.  356z.4.  Cancer  screening tests.  An individual or
 9    group  policy  of  accident  and  health  insurance  amended,
10    delivered, issued, or renewed after  the  effective  date  of
11    this amendatory Act of the 93rd General Assembly must provide
12    coverage   for   all   generally  medically  accepted  cancer
13    screening tests.  Coverage under  this  Section  may  not  be
14    subject  to any greater coinsurance, copayment, or deductible
15    than that applicable for any other coverage under the policy.

16        Section 10.  The Health Maintenance Organization  Act  is
17    amended by changing Section 5-3 as follows:

18        (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
19        Sec. 5-3.  Insurance Code provisions.
20        (a)  Health Maintenance Organizations shall be subject to
21    the  provisions of Sections 133, 134, 137, 140, 141.1, 141.2,
22    141.3, 143, 143c, 147, 148, 149, 151, 152, 153,  154,  154.5,
23    154.6,  154.7,  154.8, 155.04, 355.2, 356m, 356v, 356w, 356x,
24    356y, 356z.2, 356z.4, 367i, 368a, 401, 401.1, 402, 403, 403A,
25    408, 408.2, 409,  412,  444,  and  444.1,  paragraph  (c)  of
26    subsection  (2)  of  Section 367, and Articles IIA, VIII 1/2,
27    XII, XII 1/2, XIII, XIII 1/2, XXV, and XXVI of  the  Illinois
28    Insurance Code.
29        (b)  For  purposes of the Illinois Insurance Code, except
 
                            -2-      LRB093 07311 JLS 07471 b
 1    for Sections 444 and 444.1 and Articles XIII  and  XIII  1/2,
 2    Health  Maintenance Organizations in the following categories
 3    are deemed to be "domestic companies":
 4             (1)  a  corporation  authorized  under  the   Dental
 5        Service  Plan  Act or the Voluntary Health Services Plans
 6        Act;
 7             (2)  a corporation organized under the laws of  this
 8        State; or
 9             (3)  a  corporation  organized  under  the  laws  of
10        another  state, 30% or more of the enrollees of which are
11        residents of this State, except a corporation subject  to
12        substantially  the  same  requirements  in  its  state of
13        organization as is a  "domestic  company"  under  Article
14        VIII 1/2 of the Illinois Insurance Code.
15        (c)  In  considering  the merger, consolidation, or other
16    acquisition of control of a Health  Maintenance  Organization
17    pursuant to Article VIII 1/2 of the Illinois Insurance Code,
18             (1)  the  Director  shall give primary consideration
19        to the continuation of  benefits  to  enrollees  and  the
20        financial  conditions  of the acquired Health Maintenance
21        Organization after the merger,  consolidation,  or  other
22        acquisition of control takes effect;
23             (2)(i)  the  criteria specified in subsection (1)(b)
24        of Section 131.8 of the Illinois Insurance Code shall not
25        apply and (ii) the Director, in making his  determination
26        with  respect  to  the  merger,  consolidation,  or other
27        acquisition of control, need not take  into  account  the
28        effect  on  competition  of the merger, consolidation, or
29        other acquisition of control;
30             (3)  the Director shall have the  power  to  require
31        the following information:
32                  (A)  certification by an independent actuary of
33             the   adequacy   of   the  reserves  of  the  Health
34             Maintenance Organization sought to be acquired;
 
                            -3-      LRB093 07311 JLS 07471 b
 1                  (B)  pro forma financial statements  reflecting
 2             the combined balance sheets of the acquiring company
 3             and the Health Maintenance Organization sought to be
 4             acquired  as of the end of the preceding year and as
 5             of a date 90 days prior to the acquisition, as  well
 6             as   pro   forma   financial  statements  reflecting
 7             projected combined  operation  for  a  period  of  2
 8             years;
 9                  (C)  a  pro  forma  business  plan detailing an
10             acquiring  party's  plans  with   respect   to   the
11             operation  of  the  Health  Maintenance Organization
12             sought to be acquired for a period of not less  than
13             3 years; and
14                  (D)  such  other  information  as  the Director
15             shall require.
16        (d)  The provisions of Article VIII 1/2 of  the  Illinois
17    Insurance  Code  and this Section 5-3 shall apply to the sale
18    by any health maintenance organization of greater than 10% of
19    its enrollee population  (including  without  limitation  the
20    health  maintenance organization's right, title, and interest
21    in and to its health care certificates).
22        (e)  In considering any management  contract  or  service
23    agreement  subject to Section 141.1 of the Illinois Insurance
24    Code, the Director (i) shall, in  addition  to  the  criteria
25    specified  in  Section  141.2 of the Illinois Insurance Code,
26    take into account the effect of the  management  contract  or
27    service   agreement   on  the  continuation  of  benefits  to
28    enrollees  and  the  financial  condition   of   the   health
29    maintenance  organization to be managed or serviced, and (ii)
30    need not take into  account  the  effect  of  the  management
31    contract or service agreement on competition.
32        (f)  Except  for  small employer groups as defined in the
33    Small Employer Rating, Renewability  and  Portability  Health
34    Insurance  Act and except for medicare supplement policies as
 
                            -4-      LRB093 07311 JLS 07471 b
 1    defined in Section 363 of  the  Illinois  Insurance  Code,  a
 2    Health  Maintenance Organization may by contract agree with a
 3    group or other enrollment unit to effect  refunds  or  charge
 4    additional premiums under the following terms and conditions:
 5             (i)  the  amount  of, and other terms and conditions
 6        with respect to, the refund or additional premium are set
 7        forth in the group or enrollment unit contract agreed  in
 8        advance of the period for which a refund is to be paid or
 9        additional  premium  is to be charged (which period shall
10        not be less than one year); and
11             (ii)  the amount of the refund or additional premium
12        shall  not  exceed  20%   of   the   Health   Maintenance
13        Organization's profitable or unprofitable experience with
14        respect  to  the  group  or other enrollment unit for the
15        period (and, for  purposes  of  a  refund  or  additional
16        premium,  the profitable or unprofitable experience shall
17        be calculated taking into account a pro rata share of the
18        Health  Maintenance  Organization's  administrative   and
19        marketing  expenses,  but shall not include any refund to
20        be made or additional premium to be paid pursuant to this
21        subsection (f)).  The Health Maintenance Organization and
22        the  group  or  enrollment  unit  may  agree   that   the
23        profitable  or  unprofitable experience may be calculated
24        taking into account the refund period and the immediately
25        preceding 2 plan years.
26        The  Health  Maintenance  Organization  shall  include  a
27    statement in the evidence of coverage issued to each enrollee
28    describing the possibility of a refund or additional premium,
29    and upon request of any group or enrollment unit, provide  to
30    the group or enrollment unit a description of the method used
31    to   calculate  (1)  the  Health  Maintenance  Organization's
32    profitable experience with respect to the group or enrollment
33    unit and the resulting refund to the group or enrollment unit
34    or (2) the  Health  Maintenance  Organization's  unprofitable
 
                            -5-      LRB093 07311 JLS 07471 b
 1    experience  with  respect to the group or enrollment unit and
 2    the resulting additional premium to be paid by the  group  or
 3    enrollment unit.
 4        In   no  event  shall  the  Illinois  Health  Maintenance
 5    Organization  Guaranty  Association  be  liable  to  pay  any
 6    contractual obligation of an insolvent  organization  to  pay
 7    any refund authorized under this Section.
 8    (Source: P.A.  91-357,  eff.  7-29-99;  91-406,  eff. 1-1-00;
 9    91-549, eff. 8-14-99; 91-605,  eff.  12-14-99;  91-788,  eff.
10    6-9-00; 92-764, eff. 1-1-03.)

11        Section   15.  The Voluntary Health Services Plans Act is
12    amended by changing Section 10 as follows:

13        (215 ILCS 165/10) (from Ch. 32, par. 604)
14        Sec.  10.  Application  of  Insurance  Code   provisions.
15    Health  services plan corporations and all persons interested
16    therein  or  dealing  therewith  shall  be  subject  to   the
17    provisions of Articles IIA and XII 1/2 and Sections 3.1, 133,
18    140,  143,  143c,  149, 155.37, 354, 355.2, 356r, 356t, 356u,
19    356v, 356w, 356x, 356y, 356z.1, 356z.2, 356z.4, 367.2,  368a,
20    401,  401.1,  402,  403,  403A,  408,  408.2,  and  412,  and
21    paragraphs  (7)  and  (15)  of  Section  367  of the Illinois
22    Insurance Code.
23    (Source: P.A. 91-406,  eff.  1-1-00;  91-549,  eff.  8-14-99;
24    91-605,  eff.  12-14-99;  91-788,  eff.  6-9-00; 92-130, eff.
25    7-20-01; 92-440, eff. 8-17-01; 92-651, eff. 7-11-02;  92-764,
26    eff. 1-1-03.)

27        Section  99.  Effective date.  This Act takes effect upon
28    becoming law.