Rep. Ann M. Williams

Filed: 3/28/2016

 

 


 

 


 
09900HB0887ham001LRB099 04711 EGJ 46011 a

1
AMENDMENT TO HOUSE BILL 887

2    AMENDMENT NO. ______. Amend House Bill 887 by replacing
3everything after the enacting clause with the following:
 
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 provide
9the post-mastectomy care benefits required to be covered by a
10policy of accident and health insurance under Section 356t of
11the Illinois Insurance Code. The program of health benefits
12shall provide the coverage required under Sections 355c, 356g,
13356g.5, 356g.5-1, 356m, 356u, 356w, 356x, 356z.2, 356z.4,
14356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
15356z.14, 356z.15, 356z.17, and 356z.22 of the Illinois
16Insurance Code. The program of health benefits must comply with

 

 

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1Sections 155.22a, 155.37, 355b, 356z.19, 370c, and 370c.1 of
2the Illinois Insurance Code.
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. 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15;
1099-480, eff. 9-9-15.)
 
11    Section 10. The Counties Code is amended by changing
12Section 5-1069.3 as follows:
 
13    (55 ILCS 5/5-1069.3)
14    Sec. 5-1069.3. Required health benefits. If a county,
15including a home rule county, is a self-insurer for purposes of
16providing health insurance coverage for its employees, the
17coverage shall include coverage for the post-mastectomy care
18benefits required to be covered by a policy of accident and
19health insurance under Section 356t and the coverage required
20under Sections 355c, 356g, 356g.5, 356g.5-1, 356u, 356w, 356x,
21356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
22356z.14, 356z.15, and 356z.22 of the Illinois Insurance Code.
23The coverage shall comply with Sections 155.22a, 355b, 356z.19,
24and 370c of the Illinois Insurance Code. The requirement that

 

 

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1health benefits be covered as provided in this Section is an
2exclusive power and function of the State and is a denial and
3limitation under Article VII, Section 6, subsection (h) of the
4Illinois Constitution. A home rule county to which this Section
5applies must comply with every provision 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. 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15;
1399-480, eff. 9-9-15.)
 
14    Section 15. The Illinois Municipal Code is amended by
15changing Section 10-4-2.3 as follows:
 
16    (65 ILCS 5/10-4-2.3)
17    Sec. 10-4-2.3. Required health benefits. If a
18municipality, including a home rule municipality, is a
19self-insurer for purposes of providing health insurance
20coverage for its employees, the coverage shall include coverage
21for the post-mastectomy care benefits required to be covered by
22a policy of accident and health insurance under Section 356t
23and the coverage required under Sections 355c, 356g, 356g.5,
24356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10,

 

 

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1356z.11, 356z.12, 356z.13, 356z.14, 356z.15, and 356z.22 of the
2Illinois Insurance Code. The coverage shall comply with
3Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
4Insurance Code. The requirement that health benefits be covered
5as provided in this is an exclusive power and function of the
6State and is a denial and limitation under Article VII, Section
76, subsection (h) of the Illinois Constitution. A home rule
8municipality to which this Section applies must comply with
9every provision of this Section.
10    Rulemaking authority to implement Public Act 95-1045, if
11any, is conditioned on the rules being adopted in accordance
12with all provisions of the Illinois Administrative Procedure
13Act and all rules and procedures of the Joint Committee on
14Administrative Rules; any purported rule not so adopted, for
15whatever reason, is unauthorized.
16(Source: P.A. 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15;
1799-480, eff. 9-9-15.)
 
18    Section 20. The School Code is amended by changing Section
1910-22.3f as follows:
 
20    (105 ILCS 5/10-22.3f)
21    Sec. 10-22.3f. Required health benefits. Insurance
22protection and benefits for employees shall provide the
23post-mastectomy care benefits required to be covered by a
24policy of accident and health insurance under Section 356t and

 

 

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1the coverage required under Sections 355c, 356g, 356g.5,
2356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11,
3356z.12, 356z.13, 356z.14, 356z.15, and 356z.22 of the Illinois
4Insurance Code. Insurance policies shall comply with Section
5356z.19 of the Illinois Insurance Code. The coverage shall
6comply with Sections 155.22a and 355b of the Illinois Insurance
7Code.
8    Rulemaking authority to implement Public Act 95-1045, if
9any, is conditioned on the rules being adopted in accordance
10with all provisions of the Illinois Administrative Procedure
11Act and all rules and procedures of the Joint Committee on
12Administrative Rules; any purported rule not so adopted, for
13whatever reason, is unauthorized.
14(Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-813,
15eff. 7-13-12; 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15.)
 
16    Section 25. The Illinois Insurance Code is amended by
17adding Section 355c and by changing Section 356z.16 as follows:
 
18    (215 ILCS 5/355c new)
19    Sec. 355c. Confidential communications.
20    (a) As used in this Section:
21    "Business associate" has the same meaning as in 45 CFR
22160.103.
23    "Confidential communication request" means any request for
24confidential communication made to a health insurance provider

 

 

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1pursuant to paragraph (1) of subsection (b) of this Section.
2    "Health insurance provider" includes any entity that
3issues, delivers, amends, or renews any individual or group
4policy of accident and health insurance on or after the
5effective date of this amendatory Act of the 99th General
6Assembly, including any business associates of a health
7insurance provider engaged in billing or communication
8activities on behalf of the health insurance provider.
9    "Department" means the Department of Insurance.
10    "Protected health information" has the same meaning as in
1145 CFR 160.103.
12    "Sensitive health services" includes, but is not limited
13to, prevention, screening, consultation, examination,
14treatment, or follow up related to:
15        (1) reproductive health, including, but not limited
16    to, family planning, maternity, abortion, fertility,
17    transgender-related care, and HIV/AIDS and sexually
18    transmitted infection services;
19        (2) substance abuse;
20        (3) mental health; or
21        (4) domestic violence, sexual violence, and other
22    interpersonal violence services.
23    (b) Notwithstanding any other law to the contrary and to
24the extent permitted by federal law, a health insurance
25provider shall take the following steps to protect the
26confidentiality of protected health information on and after

 

 

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1January 1, 2018:
2        (1) Health insurance providers must permit individuals
3    to request and must accommodate reasonable requests to
4    receive communications of protected health information by
5    alternative means or at alternative locations. All
6    confidential communication requests made under this
7    Section must be accommodated by the health insurance
8    provider where:
9            (A) the means of communication requested is
10        readily producible; and
11            (B) the individual has clearly stated in the
12        confidential communication request that:
13                (i) the confidential communications request is
14            limited to disclosure of information regarding
15            sensitive health services, including the name or
16            address of the health care provider that provided
17            the sensitive health services; or
18                (ii) disclosure other than in the manner
19            called for by the confidential communication
20            request of all or part of the individual's
21            protected health information, including the name
22            or address of the health care providers that
23            provided the health care services related to the
24            protected health information, could endanger the
25            covered individual.
26        (2) A health insurance provider may require that a

 

 

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1    confidential communication request described in paragraph
2    (1) of this subsection be made in writing, but shall
3    include the option to make the request by electronic
4    transmission.
5        (3) A health insurance provider shall not require from
6    the individual making the request an explanation regarding
7    the basis for the confidential communications request as a
8    condition of providing communications in the manner
9    requested.
10    A confidential communication request shall be valid until
11the individual making the request submits a revocation of the
12confidential communication request or a new confidential
13communication request to the health insurance provider.
14    For the purposes of this Section, a health insurance
15provider shall comply with any confidential communications
16request beginning either 7 calendar days following receipt of
17an electronic transmission or telephonic confidential
18communication request or 14 calendar days following receipt of
19a confidential communication request received by first-class
20mail. During the respective 7-day or 14-day period after
21receiving a confidential communication request, the health
22insurance provider shall use its best efforts to abstain from
23sending any communications to the individual unless such
24communications are sent in a manner that complies with the
25terms of the confidential communication request.
26    (c) The health insurance provider shall acknowledge

 

 

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1receipt of the confidential communication request as soon as
2practicable after receiving the confidential communication
3request and shall notify the individual of the date on which it
4will begin complying with the terms of the confidential
5communication request. That acknowledgment and notification
6shall be communicated by the health insurance provider in
7accordance with the terms of the confidential communication
8request.
9    (d) Notwithstanding subparagraph (B) of paragraph (1) of
10subsection (b), the provider of health care may make
11arrangements with the covered individual for the payment of
12benefit cost sharing and communicate that arrangement with the
13health care service plan.
14    (e) A health insurance provider shall not condition
15enrollment or coverage on the waiver of rights provided in this
16Section.
17    (f) The Department shall develop and make available to the
18public a standardized form that individuals may use to make a
19confidential communications request. The Department shall
20encourage providers to clearly display the form and make it
21available to insured individuals. The form must, at a minimum,
22allow an individual to:
23        (1) provide their name, address, and member number;
24        (2) specify whether their request applies to:
25            (i) all information relating to sensitive health
26        services; or

 

 

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1            (ii) all protected health information, as
2        disclosure in another manner could endanger the
3        individual;
4        (3) indicate whether communications should be withheld
5    by the health insurance provider or redirected to a
6    specified mail or electronic mail address or specified
7    telephone number; and
8        (4) designate a telephone number, mailing address, or
9    electronic mail address for the health insurance provider
10    to contact the individual if additional information or
11    clarification is necessary to process the confidential
12    communications request.
13    (g) The Department shall work with health insurance
14providers and other stakeholders to ensure the development and
15implementation of effective and consumer-friendly systems for
16receiving and processing confidential communications requests,
17monitor compliance with this Section, and collect, track, and
18investigate complaints of unauthorized disclosure of
19information under this Section.
 
20    (215 ILCS 5/356z.16)
21    Sec. 356z.16. Applicability of mandated benefits to
22supplemental policies. Unless specified otherwise, the
23following Sections of the Illinois Insurance Code do not apply
24to short-term travel, disability income, long-term care,
25accident only, or limited or specified disease policies: 355b,

 

 

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1355c, 356b, 356c, 356d, 356g, 356k, 356m, 356n, 356p, 356q,
2356r, 356t, 356u, 356w, 356x, 356z.1, 356z.2, 356z.4, 356z.5,
3356z.6, 356z.8, 356z.12, 356z.14, 356z.19, 356z.21, 364.01,
4367.2-5, and 367e.
5(Source: P.A. 97-91, eff. 1-1-12; 97-282, eff. 8-9-11; 97-592,
6eff. 1-1-12; 97-813, eff. 7-13-12; 97-972, eff. 1-1-13; 98-189,
7eff. 1-1-14.)
 
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, 141.1,
14141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
15154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2, 355.3,
16355b, 355c, 356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2,
17356z.4, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11,
18356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.18, 356z.19,
19356z.21, 356z.22, 364.01, 367.2, 367.2-5, 367i, 368a, 368b,
20368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A,
21408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of
22subsection (2) of Section 367, and Articles IIA, VIII 1/2, XII,
23XII 1/2, XIII, XIII 1/2, XXV, and XXVI of the Illinois
24Insurance Code.

 

 

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

 

 

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

 

 

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1its health care certificates).
2    (e) In considering any management contract or service
3agreement subject to Section 141.1 of the Illinois Insurance
4Code, the Director (i) shall, in addition to the criteria
5specified in Section 141.2 of the Illinois Insurance Code, take
6into account the effect of the management contract or service
7agreement on the continuation of benefits to enrollees and the
8financial condition of the health maintenance organization to
9be managed or serviced, and (ii) need not take into account the
10effect of the management contract or service agreement on
11competition.
12    (f) Except for small employer groups as defined in the
13Small Employer Rating, Renewability and Portability Health
14Insurance Act and except for medicare supplement policies as
15defined in Section 363 of the Illinois Insurance Code, a Health
16Maintenance Organization may by contract agree with a group or
17other enrollment unit to effect refunds or charge additional
18premiums under the following terms and conditions:
19        (i) the amount of, and other terms and conditions with
20    respect to, the refund or additional premium are set forth
21    in the group or enrollment unit contract agreed in advance
22    of the period for which a refund is to be paid or
23    additional premium is to be charged (which period shall not
24    be less than one year); and
25        (ii) the amount of the refund or additional premium
26    shall not exceed 20% of the Health Maintenance

 

 

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1    Organization's profitable or unprofitable experience with
2    respect to the group or other enrollment unit for the
3    period (and, for purposes of a refund or additional
4    premium, the profitable or unprofitable experience shall
5    be calculated taking into account a pro rata share of the
6    Health Maintenance Organization's administrative and
7    marketing expenses, but shall not include any refund to be
8    made or additional premium to be paid pursuant to this
9    subsection (f)). The Health Maintenance Organization and
10    the group or enrollment unit may agree that the profitable
11    or unprofitable experience may be calculated taking into
12    account the refund period and the immediately preceding 2
13    plan years.
14    The Health Maintenance Organization shall include a
15statement in the evidence of coverage issued to each enrollee
16describing the possibility of a refund or additional premium,
17and upon request of any group or enrollment unit, provide to
18the group or enrollment unit a description of the method used
19to calculate (1) the Health Maintenance Organization's
20profitable experience with respect to the group or enrollment
21unit and the resulting refund to the group or enrollment unit
22or (2) the Health Maintenance Organization's unprofitable
23experience with respect to the group or enrollment unit and the
24resulting additional premium to be paid by the group or
25enrollment unit.
26    In no event shall the Illinois Health Maintenance

 

 

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1Organization Guaranty Association be liable to pay any
2contractual obligation of an insolvent organization to pay any
3refund authorized under this Section.
4    (g) Rulemaking authority to implement Public Act 95-1045,
5if any, 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. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-437,
11eff. 8-18-11; 97-486, eff. 1-1-12; 97-592, eff. 1-1-12; 97-805,
12eff. 1-1-13; 97-813, eff. 7-13-12; 98-189, eff. 1-1-14;
1398-1091, eff. 1-1-15.)
 
14    Section 35. The Limited Health Service Organization Act is
15amended by changing Section 4003 as follows:
 
16    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
17    Sec. 4003. Illinois Insurance Code provisions. Limited
18health service organizations shall be subject to the provisions
19of Sections 133, 134, 136, 137, 139, 140, 141.1, 141.2, 141.3,
20143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5, 154.6,
21154.7, 154.8, 155.04, 155.37, 355.2, 355.3, 355b, 355c, 356v,
22356z.10, 356z.21, 356z.22, 368a, 401, 401.1, 402, 403, 403A,
23408, 408.2, 409, 412, 444, and 444.1 and Articles IIA, VIII
241/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and XXVI of the

 

 

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1Illinois Insurance Code. For purposes of the Illinois Insurance
2Code, except for Sections 444 and 444.1 and Articles XIII and
3XIII 1/2, limited health service organizations in the following
4categories are deemed to be domestic companies:
5        (1) a corporation under the laws of this State; or
6        (2) a corporation organized under the laws of another
7    state, 30% of more of the enrollees of which are residents
8    of this State, except a corporation subject to
9    substantially the same requirements in its state of
10    organization as is a domestic company under Article VIII
11    1/2 of the Illinois Insurance Code.
12(Source: P.A. 97-486, eff. 1-1-12; 97-592, 1-1-12; 97-805, eff.
131-1-13; 97-813, eff. 7-13-12; 98-189, eff. 1-1-14; 98-1091,
14eff. 1-1-15.)
 
15    Section 40. The Voluntary Health Services Plans Act is
16amended by changing Section 10 as follows:
 
17    (215 ILCS 165/10)  (from Ch. 32, par. 604)
18    Sec. 10. Application of Insurance Code provisions. Health
19services plan corporations and all persons interested therein
20or dealing therewith shall be subject to the provisions of
21Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
22143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, 355c,
23356g, 356g.5, 356g.5-1, 356r, 356t, 356u, 356v, 356w, 356x,
24356y, 356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9,

 

 

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1356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18,
2356z.19, 356z.21, 356z.22, 364.01, 367.2, 368a, 401, 401.1,
3402, 403, 403A, 408, 408.2, and 412, and paragraphs (7) and
4(15) of Section 367 of the Illinois Insurance Code.
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. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-486,
12eff. 1-1-12; 97-592, eff. 1-1-12; 97-805, eff. 1-1-13; 97-813,
13eff. 7-13-12; 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15.)".