|
Rep. Mary E. Flowers
Filed: 5/1/2008
|
|
09500HB2286ham001 |
|
LRB095 01343 RPM 49610 a |
|
|
1 |
| AMENDMENT TO HOUSE BILL 2286
|
2 |
| AMENDMENT NO. ______. Amend House Bill 2286 by replacing |
3 |
| everything after the enacting clause with the following:
|
4 |
| "Section 5. The State Employees Group Insurance Act of 1971 |
5 |
| is amended by changing Section 6.11 as follows:
|
6 |
| (5 ILCS 375/6.11)
|
7 |
| Sec. 6.11. Required health benefits; Illinois Insurance |
8 |
| Code
requirements. The program of health
benefits shall provide |
9 |
| the post-mastectomy care benefits required to be covered
by a |
10 |
| policy of accident and health insurance under Section 356t of |
11 |
| the Illinois
Insurance Code. The program of health benefits |
12 |
| shall provide the coverage
required under Sections 356f.1, |
13 |
| 356g.5,
356u, 356w, 356x, 356z.2, 356z.4, 356z.6, and 356z.9, |
14 |
| and 356z.10
356z.9 of the
Illinois Insurance Code.
The program |
15 |
| of health benefits must comply with Section 155.37 of the
|
16 |
| Illinois Insurance Code.
|
|
|
|
09500HB2286ham001 |
- 2 - |
LRB095 01343 RPM 49610 a |
|
|
1 |
| (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; |
2 |
| 95-520, eff. 8-28-07; revised 12-4-07.)
|
3 |
| Section 10. The Counties Code is amended by changing |
4 |
| Section 5-1069.3 as follows: |
5 |
| (55 ILCS 5/5-1069.3)
|
6 |
| Sec. 5-1069.3. Required health benefits. If a county, |
7 |
| including a home
rule
county, is a self-insurer for purposes of |
8 |
| providing health insurance coverage
for its employees, the |
9 |
| coverage shall include coverage for the post-mastectomy
care |
10 |
| benefits required to be covered by a policy of accident and |
11 |
| health
insurance under Section 356t and the coverage required |
12 |
| under Sections 356f.1, 356g.5, 356u,
356w, 356x, 356z.6, and |
13 |
| 356z.9, and 356z.10
356z.9 of
the Illinois Insurance Code. The |
14 |
| requirement that health benefits be covered
as provided in this |
15 |
| Section is an
exclusive power and function of the State and is |
16 |
| a denial and limitation under
Article VII, Section 6, |
17 |
| subsection (h) of the Illinois Constitution. A home
rule county |
18 |
| to which this Section applies must comply with every provision |
19 |
| of
this Section.
|
20 |
| (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; |
21 |
| 95-520, eff. 8-28-07; revised 12-4-07.)
|
22 |
| Section 15. The Illinois Municipal Code is amended by |
23 |
| changing Section 10-4-2.3 as follows: |
|
|
|
09500HB2286ham001 |
- 3 - |
LRB095 01343 RPM 49610 a |
|
|
1 |
| (65 ILCS 5/10-4-2.3)
|
2 |
| Sec. 10-4-2.3. Required health benefits. If a |
3 |
| municipality, including a
home rule municipality, is a |
4 |
| self-insurer for purposes of providing health
insurance |
5 |
| coverage for its employees, the coverage shall include coverage |
6 |
| for
the post-mastectomy care benefits required to be covered by |
7 |
| a policy of
accident and health insurance under Section 356t |
8 |
| and the coverage required
under Sections 356f.1, 356g.5, 356u, |
9 |
| 356w, 356x, 356z.6, and 356z.9, and 356z.10
356z.9 of the |
10 |
| Illinois
Insurance
Code. The requirement that health
benefits |
11 |
| be covered as provided in this is an exclusive power and |
12 |
| function of
the State and is a denial and limitation under |
13 |
| Article VII, Section 6,
subsection (h) of the Illinois |
14 |
| Constitution. A home rule municipality to which
this Section |
15 |
| applies must comply with every provision of this Section.
|
16 |
| (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; |
17 |
| 95-520, eff. 8-28-07; revised 12-4-07.)
|
18 |
| Section 20. The School Code is amended by changing Section |
19 |
| 10-22.3f as follows: |
20 |
| (105 ILCS 5/10-22.3f)
|
21 |
| Sec. 10-22.3f. Required health benefits. Insurance |
22 |
| protection and
benefits
for employees shall provide the |
23 |
| post-mastectomy care benefits required to be
covered by a |
|
|
|
09500HB2286ham001 |
- 4 - |
LRB095 01343 RPM 49610 a |
|
|
1 |
| policy of accident and health insurance under Section 356t and |
2 |
| the
coverage required under Sections 356f.1, 356g.5, 356u, |
3 |
| 356w, 356x,
356z.6, and 356z.9 of
the
Illinois Insurance Code.
|
4 |
| (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; |
5 |
| revised 12-4-07.)
|
6 |
| Section 25. The Illinois Insurance Code is amended by |
7 |
| adding Section 356f.1 as follows: |
8 |
| (215 ILCS 5/356f.1 new)
|
9 |
| Sec. 356f.1. Recision, cancellation, or limiting of a plan |
10 |
| contract. |
11 |
| (a) No insurer or health care service plan shall engage in |
12 |
| the practice of postclaims underwriting. For purposes of this |
13 |
| Section, "postclaims underwriting" means the rescinding, |
14 |
| canceling, or limiting of a plan contract due to the plan's |
15 |
| failure to complete medical underwriting and resolve all |
16 |
| reasonable questions arising from written information |
17 |
| submitted on or with an application before issuing the plan |
18 |
| contract. This subsection (a) shall not limit a plan's remedies |
19 |
| upon a showing of willful misrepresentation. |
20 |
| (b) Notwithstanding any other provision of law, a health |
21 |
| care service plan shall seek and receive final approval from |
22 |
| the Division of Insurance prior to rescinding a plan contract |
23 |
| of a subscriber or enrollee. No later than January 1, 2010, the |
24 |
| Department shall contract with one or more appropriately |
|
|
|
09500HB2286ham001 |
- 5 - |
LRB095 01343 RPM 49610 a |
|
|
1 |
| qualified independent review organizations to conduct the |
2 |
| review required by this subsection (b). The Department shall |
3 |
| ensure that the review organization shall not have any |
4 |
| material, professional, familial, or financial affiliation |
5 |
| with the health care service plan. |
6 |
| (c) Notwithstanding any other rulemaking authority that |
7 |
| may exist, neither the Governor nor any agency or agency head |
8 |
| under the jurisdiction of the Governor has any authority to |
9 |
| make or promulgate rules to implement or enforce the provisions |
10 |
| of this amendatory Act of the 95th General Assembly. If, |
11 |
| however, the Governor believes that rules are necessary to |
12 |
| implement or enforce the provisions of this amendatory Act of |
13 |
| the 95th General Assembly, the Governor may suggest rules to |
14 |
| the General Assembly by filing them with the Clerk of the House |
15 |
| and the Secretary of the Senate and by requesting that the |
16 |
| General Assembly authorize such rulemaking by law, enact those |
17 |
| suggested rules into law, or take any other appropriate action |
18 |
| in the General Assembly's discretion. Nothing contained in this |
19 |
| amendatory Act of the 95th General Assembly shall be |
20 |
| interpreted to grant rulemaking authority under any other |
21 |
| Illinois statute where such authority is not otherwise |
22 |
| explicitly given. For the purposes of this amendatory Act of |
23 |
| the 95th General Assembly, "rules" is given the meaning |
24 |
| contained in Section 1-70 of the Illinois Administrative |
25 |
| Procedure Act, and "agency" and "agency head" are given the |
26 |
| meanings contained in Sections 1-20 and 1-25 of the Illinois |
|
|
|
09500HB2286ham001 |
- 6 - |
LRB095 01343 RPM 49610 a |
|
|
1 |
| Administrative Procedure Act to the extent that such |
2 |
| definitions apply to agencies or agency heads under the |
3 |
| jurisdiction of the Governor.
|
4 |
| Section 30. The Health Maintenance Organization Act is |
5 |
| amended by changing Section 5-3 as follows:
|
6 |
| (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
|
7 |
| Sec. 5-3. Insurance Code provisions.
|
8 |
| (a) Health Maintenance Organizations
shall be subject to |
9 |
| the provisions of Sections 133, 134, 137, 140, 141.1,
141.2, |
10 |
| 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, 154, 154.5, |
11 |
| 154.6,
154.7, 154.8, 155.04, 355.2, 356f.1, 356m, 356v, 356w, |
12 |
| 356x, 356y,
356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9, |
13 |
| 356z.10
356z.9 , 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c, |
14 |
| 368d, 368e, 370c,
401, 401.1, 402, 403, 403A,
408, 408.2, 409, |
15 |
| 412, 444,
and
444.1,
paragraph (c) of subsection (2) of Section |
16 |
| 367, and Articles IIA, VIII 1/2,
XII,
XII 1/2, XIII, XIII 1/2, |
17 |
| XXV, and XXVI of the Illinois Insurance Code.
|
18 |
| (b) For purposes of the Illinois Insurance Code, except for |
19 |
| Sections 444
and 444.1 and Articles XIII and XIII 1/2, Health |
20 |
| Maintenance Organizations in
the following categories are |
21 |
| deemed to be "domestic companies":
|
22 |
| (1) a corporation authorized under the
Dental Service |
23 |
| Plan Act or the Voluntary Health Services Plans Act;
|
24 |
| (2) a corporation organized under the laws of this |
|
|
|
09500HB2286ham001 |
- 7 - |
LRB095 01343 RPM 49610 a |
|
|
1 |
| State; or
|
2 |
| (3) a corporation organized under the laws of another |
3 |
| state, 30% or more
of the enrollees of which are residents |
4 |
| of this State, except a
corporation subject to |
5 |
| substantially the same requirements in its state of
|
6 |
| organization as is a "domestic company" under Article VIII |
7 |
| 1/2 of the
Illinois Insurance Code.
|
8 |
| (c) In considering the merger, consolidation, or other |
9 |
| acquisition of
control of a Health Maintenance Organization |
10 |
| pursuant to Article VIII 1/2
of the Illinois Insurance Code,
|
11 |
| (1) the Director shall give primary consideration to |
12 |
| the continuation of
benefits to enrollees and the financial |
13 |
| conditions of the acquired Health
Maintenance Organization |
14 |
| after the merger, consolidation, or other
acquisition of |
15 |
| control takes effect;
|
16 |
| (2)(i) the criteria specified in subsection (1)(b) of |
17 |
| Section 131.8 of
the Illinois Insurance Code shall not |
18 |
| apply and (ii) the Director, in making
his determination |
19 |
| with respect to the merger, consolidation, or other
|
20 |
| acquisition of control, need not take into account the |
21 |
| effect on
competition of the merger, consolidation, or |
22 |
| other acquisition of control;
|
23 |
| (3) the Director shall have the power to require the |
24 |
| following
information:
|
25 |
| (A) certification by an independent actuary of the |
26 |
| adequacy
of the reserves of the Health Maintenance |
|
|
|
09500HB2286ham001 |
- 8 - |
LRB095 01343 RPM 49610 a |
|
|
1 |
| Organization sought to be acquired;
|
2 |
| (B) pro forma financial statements reflecting the |
3 |
| combined balance
sheets of the acquiring company and |
4 |
| the Health Maintenance Organization sought
to be |
5 |
| acquired as of the end of the preceding year and as of |
6 |
| a date 90 days
prior to the acquisition, as well as pro |
7 |
| forma financial statements
reflecting projected |
8 |
| combined operation for a period of 2 years;
|
9 |
| (C) a pro forma business plan detailing an |
10 |
| acquiring party's plans with
respect to the operation |
11 |
| of the Health Maintenance Organization sought to
be |
12 |
| acquired for a period of not less than 3 years; and
|
13 |
| (D) such other information as the Director shall |
14 |
| require.
|
15 |
| (d) The provisions of Article VIII 1/2 of the Illinois |
16 |
| Insurance Code
and this Section 5-3 shall apply to the sale by |
17 |
| any health maintenance
organization of greater than 10% of its
|
18 |
| enrollee population (including without limitation the health |
19 |
| maintenance
organization's right, title, and interest in and to |
20 |
| its health care
certificates).
|
21 |
| (e) In considering any management contract or service |
22 |
| agreement subject
to Section 141.1 of the Illinois Insurance |
23 |
| Code, the Director (i) shall, in
addition to the criteria |
24 |
| specified in Section 141.2 of the Illinois
Insurance Code, take |
25 |
| into account the effect of the management contract or
service |
26 |
| agreement on the continuation of benefits to enrollees and the
|
|
|
|
09500HB2286ham001 |
- 9 - |
LRB095 01343 RPM 49610 a |
|
|
1 |
| financial condition of the health maintenance organization to |
2 |
| be managed or
serviced, and (ii) need not take into account the |
3 |
| effect of the management
contract or service agreement on |
4 |
| competition.
|
5 |
| (f) Except for small employer groups as defined in the |
6 |
| Small Employer
Rating, Renewability and Portability Health |
7 |
| Insurance Act and except for
medicare supplement policies as |
8 |
| defined in Section 363 of the Illinois
Insurance Code, a Health |
9 |
| Maintenance Organization may by contract agree with a
group or |
10 |
| other enrollment unit to effect refunds or charge additional |
11 |
| premiums
under the following terms and conditions:
|
12 |
| (i) the amount of, and other terms and conditions with |
13 |
| respect to, the
refund or additional premium are set forth |
14 |
| in the group or enrollment unit
contract agreed in advance |
15 |
| of the period for which a refund is to be paid or
|
16 |
| additional premium is to be charged (which period shall not |
17 |
| be less than one
year); and
|
18 |
| (ii) the amount of the refund or additional premium |
19 |
| shall not exceed 20%
of the Health Maintenance |
20 |
| Organization's profitable or unprofitable experience
with |
21 |
| respect to the group or other enrollment unit for the |
22 |
| period (and, for
purposes of a refund or additional |
23 |
| premium, the profitable or unprofitable
experience shall |
24 |
| be calculated taking into account a pro rata share of the
|
25 |
| Health Maintenance Organization's administrative and |
26 |
| marketing expenses, but
shall not include any refund to be |
|
|
|
09500HB2286ham001 |
- 10 - |
LRB095 01343 RPM 49610 a |
|
|
1 |
| made or additional premium to be paid
pursuant to this |
2 |
| subsection (f)). The Health Maintenance Organization and |
3 |
| the
group or enrollment unit may agree that the profitable |
4 |
| or unprofitable
experience may be calculated taking into |
5 |
| account the refund period and the
immediately preceding 2 |
6 |
| plan years.
|
7 |
| The Health Maintenance Organization shall include a |
8 |
| statement in the
evidence of coverage issued to each enrollee |
9 |
| describing the possibility of a
refund or additional premium, |
10 |
| and upon request of any group or enrollment unit,
provide to |
11 |
| the group or enrollment unit a description of the method used |
12 |
| to
calculate (1) the Health Maintenance Organization's |
13 |
| profitable experience with
respect to the group or enrollment |
14 |
| unit and the resulting refund to the group
or enrollment unit |
15 |
| or (2) the Health Maintenance Organization's unprofitable
|
16 |
| experience with respect to the group or enrollment unit and the |
17 |
| resulting
additional premium to be paid by the group or |
18 |
| enrollment unit.
|
19 |
| In no event shall the Illinois Health Maintenance |
20 |
| Organization
Guaranty Association be liable to pay any |
21 |
| contractual obligation of an
insolvent organization to pay any |
22 |
| refund authorized under this Section.
|
23 |
| (Source: P.A. 94-906, eff. 1-1-07; 94-1076, eff. 12-29-06; |
24 |
| 95-422, eff. 8-24-07; 95-520, eff. 8-28-07; revised 12-4-07.)
|
25 |
| Section 35. The Limited Health Service Organization Act is |
|
|
|
09500HB2286ham001 |
- 11 - |
LRB095 01343 RPM 49610 a |
|
|
1 |
| amended by changing Section 4003 as follows:
|
2 |
| (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
|
3 |
| Sec. 4003. Illinois Insurance Code provisions. Limited |
4 |
| health service
organizations shall be subject to the provisions |
5 |
| of Sections 133, 134, 137,
140, 141.1, 141.2, 141.3, 143, 143c, |
6 |
| 147, 148, 149, 151, 152, 153, 154, 154.5,
154.6, 154.7, 154.8, |
7 |
| 155.04, 155.37, 355.2, 356f.1, 356v, 356z.10
356z.9 , 368a, 401, |
8 |
| 401.1,
402,
403, 403A, 408,
408.2, 409, 412, 444, and 444.1 and |
9 |
| Articles IIA, VIII 1/2, XII, XII 1/2,
XIII,
XIII 1/2, XXV, and |
10 |
| XXVI of the Illinois Insurance Code. For purposes of the
|
11 |
| Illinois Insurance Code, except for Sections 444 and 444.1 and |
12 |
| Articles XIII
and XIII 1/2, limited health service |
13 |
| organizations in the following categories
are deemed to be |
14 |
| domestic companies:
|
15 |
| (1) a corporation under the laws of this State; or
|
16 |
| (2) a corporation organized under the laws of another |
17 |
| state, 30% of more
of the enrollees of which are residents |
18 |
| of this State, except a corporation
subject to |
19 |
| substantially the same requirements in its state of |
20 |
| organization as
is a domestic company under Article VIII |
21 |
| 1/2 of the Illinois Insurance Code.
|
22 |
| (Source: P.A. 95-520, eff. 8-28-07; revised 12-5-07.)
|
23 |
| Section 37. The Managed Care Reform and Patient Rights Act |
24 |
| is amended by changing Section 20 as follows:
|
|
|
|
09500HB2286ham001 |
- 12 - |
LRB095 01343 RPM 49610 a |
|
|
1 |
| (215 ILCS 134/20)
|
2 |
| Sec. 20. Notice of nonrenewal or termination. A health care |
3 |
| plan must
give at least 60
days notice of nonrenewal or |
4 |
| termination of a health
care provider to the health care
|
5 |
| provider and to the enrollees served by the health care |
6 |
| provider.
The notice shall include a name and address to which |
7 |
| an enrollee or health care
provider may direct
comments and |
8 |
| concerns regarding the nonrenewal or termination.
Immediate |
9 |
| written notice may be provided without 60 days notice when a |
10 |
| health
care provider's license has been disciplined by a State |
11 |
| licensing board. All health care plans shall comply with |
12 |
| Section 356f.1 of the Illinois Insurance Code.
|
13 |
| (Source: P.A. 91-617, eff. 1-1-00.)
|
14 |
| Section 40. The Voluntary Health Services Plans Act is |
15 |
| amended by changing Section 10 as follows:
|
16 |
| (215 ILCS 165/10) (from Ch. 32, par. 604)
|
17 |
| Sec. 10. Application of Insurance Code provisions. Health |
18 |
| services
plan corporations and all persons interested therein |
19 |
| or dealing therewith
shall be subject to the provisions of |
20 |
| Articles IIA and XII 1/2 and Sections
3.1, 133, 140, 143, 143c, |
21 |
| 149, 155.37, 354, 355.2, 356f.1, 356g.5, 356r, 356t, 356u, |
22 |
| 356v,
356w, 356x, 356y, 356z.1, 356z.2, 356z.4, 356z.5, 356z.6, |
23 |
| 356z.8, 356z.9,
356z.10
356z.9 , 364.01, 367.2, 368a, 401, |
|
|
|
09500HB2286ham001 |
- 13 - |
LRB095 01343 RPM 49610 a |
|
|
1 |
| 401.1,
402,
403, 403A, 408,
408.2, and 412, and paragraphs (7) |
2 |
| and (15) of Section 367 of the Illinois
Insurance Code.
|
3 |
| (Source: P.A. 94-1076, eff. 12-29-06; 95-189, eff. 8-16-07; |
4 |
| 95-331, eff. 8-21-07; 95-422, eff. 8-24-07; 95-520, eff. |
5 |
| 8-28-07; revised 12-5-07.)".
|