99TH GENERAL ASSEMBLY
State of Illinois
2015 and 2016
HB5604

 

Introduced , by Rep. Deborah Conroy

 

SYNOPSIS AS INTRODUCED:
 
5 ILCS 375/6.11
55 ILCS 5/5-1069.3
65 ILCS 5/10-4-2.3
105 ILCS 5/10-22.3f
215 ILCS 5/356z.24 new
215 ILCS 125/5-3  from Ch. 111 1/2, par. 1411.2
215 ILCS 130/4003  from Ch. 73, par. 1504-3
215 ILCS 165/10  from Ch. 32, par. 604

    Amends the Illinois Insurance Code, the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, the Limited Health Service Organization Act, and the Voluntary Health Services Plans Act. Provides that a group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed after the effective date of the amendatory Act shall provide coverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute-onset neuropsychiatric syndrome, including, but not limited to, the use of intravenous immunoglobulin therapy. Effective immediately.


LRB099 18291 EGJ 42663 b

 

 

A BILL FOR

 

HB5604LRB099 18291 EGJ 42663 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    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 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, and 356z.24 of the
16Illinois Insurance Code. The program of health benefits must
17comply with Sections 155.22a, 155.37, 355b, 356z.19, 370c, and
18370c.1 of the Illinois Insurance Code.
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

 

 

HB5604- 2 -LRB099 18291 EGJ 42663 b

1whatever reason, is unauthorized.
2(Source: P.A. 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15;
399-480, eff. 9-9-15.)
 
4    Section 10. The Counties Code is amended by changing
5Section 5-1069.3 as follows:
 
6    (55 ILCS 5/5-1069.3)
7    Sec. 5-1069.3. Required health benefits. If a county,
8including a home rule county, is a self-insurer for purposes of
9providing health insurance coverage for its employees, the
10coverage shall include coverage for 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, 356g.5, 356g.5-1, 356u, 356w, 356x,
14356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
15356z.14, 356z.15, and 356z.22, and 356z.24 of the Illinois
16Insurance Code. The coverage shall comply with Sections
17155.22a, 355b, 356z.19, and 370c of the Illinois Insurance
18Code. The requirement that health benefits be covered as
19provided in this Section is an exclusive power and function of
20the State and is a denial and limitation under Article VII,
21Section 6, subsection (h) of the Illinois Constitution. A home
22rule county to which this Section applies must comply with
23every provision of this Section.
24    Rulemaking authority to implement Public Act 95-1045, if

 

 

HB5604- 3 -LRB099 18291 EGJ 42663 b

1any, is conditioned on the rules being adopted in accordance
2with all provisions of the Illinois Administrative Procedure
3Act and all rules and procedures of the Joint Committee on
4Administrative Rules; any purported rule not so adopted, for
5whatever reason, is unauthorized.
6(Source: P.A. 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15;
799-480, eff. 9-9-15.)
 
8    Section 15. The Illinois Municipal Code is amended by
9changing Section 10-4-2.3 as follows:
 
10    (65 ILCS 5/10-4-2.3)
11    Sec. 10-4-2.3. Required health benefits. If a
12municipality, including a home rule municipality, is a
13self-insurer for purposes of providing health insurance
14coverage for its employees, the coverage shall include coverage
15for the post-mastectomy care benefits required to be covered by
16a policy of accident and health insurance under Section 356t
17and the coverage required under Sections 356g, 356g.5,
18356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10,
19356z.11, 356z.12, 356z.13, 356z.14, 356z.15, and 356z.22, and
20356z.24 of the Illinois Insurance Code. The coverage shall
21comply with Sections 155.22a, 355b, 356z.19, and 370c of the
22Illinois Insurance Code. The requirement that health benefits
23be covered as provided in this is an exclusive power and
24function of the State and is a denial and limitation under

 

 

HB5604- 4 -LRB099 18291 EGJ 42663 b

1Article VII, Section 6, subsection (h) of the Illinois
2Constitution. A home rule municipality to which this Section
3applies must comply with every provision of this Section.
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. 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15;
1199-480, eff. 9-9-15.)
 
12    Section 20. The School Code is amended by changing Section
1310-22.3f as follows:
 
14    (105 ILCS 5/10-22.3f)
15    Sec. 10-22.3f. Required health benefits. Insurance
16protection and benefits for employees shall provide the
17post-mastectomy care benefits required to be covered by a
18policy of accident and health insurance under Section 356t and
19the coverage required under Sections 356g, 356g.5, 356g.5-1,
20356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11, 356z.12,
21356z.13, 356z.14, 356z.15, and 356z.22, and 356z.24 of the
22Illinois Insurance Code. Insurance policies shall comply with
23Section 356z.19 of the Illinois Insurance Code. The coverage
24shall comply with Sections 155.22a and 355b of the Illinois

 

 

HB5604- 5 -LRB099 18291 EGJ 42663 b

1Insurance Code.
2    Rulemaking authority to implement Public Act 95-1045, if
3any, is conditioned on the rules being adopted in accordance
4with all provisions of the Illinois Administrative Procedure
5Act and all rules and procedures of the Joint Committee on
6Administrative Rules; any purported rule not so adopted, for
7whatever reason, is unauthorized.
8(Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-813,
9eff. 7-13-12; 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15.)
 
10    Section 25. The Illinois Insurance Code is amended by
11adding Section 356z.24 as follows:
 
12    (215 ILCS 5/356z.24 new)
13    Sec. 356z.24. Coverage for treatment of pediatric
14autoimmune neuropsychiatric disorders associated with
15streptococcal infections and pediatric acute onset
16neuropsychiatric syndrome. A group or individual policy of
17accident and health insurance or managed care plan that is
18amended, delivered, issued, or renewed after the effective date
19of this amendatory Act of the 99th General Assembly shall
20provide coverage for treatment of pediatric autoimmune
21neuropsychiatric disorders associated with streptococcal
22infections and pediatric acute-onset neuropsychiatric
23syndrome, including, but not limited to, the use of intravenous
24immunoglobulin therapy.
 

 

 

HB5604- 6 -LRB099 18291 EGJ 42663 b

1    Section 30. The Health Maintenance Organization Act is
2amended by changing Section 5-3 as follows:
 
3    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
4    Sec. 5-3. Insurance Code provisions.
5    (a) Health Maintenance Organizations shall be subject to
6the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
7141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
8154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2, 355.3,
9355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2, 356z.4,
10356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
11356z.13, 356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.21,
12356z.22, 356z.24, 364.01, 367.2, 367.2-5, 367i, 368a, 368b,
13368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A,
14408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of
15subsection (2) of Section 367, and Articles IIA, VIII 1/2, XII,
16XII 1/2, XIII, XIII 1/2, XXV, and XXVI of the Illinois
17Insurance Code.
18    (b) For purposes of the Illinois Insurance Code, except for
19Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health
20Maintenance Organizations in the following categories are
21deemed 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

 

 

HB5604- 7 -LRB099 18291 EGJ 42663 b

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
9acquisition of control of a Health Maintenance Organization
10pursuant 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

 

 

HB5604- 8 -LRB099 18291 EGJ 42663 b

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
16Insurance Code and this Section 5-3 shall apply to the sale by
17any health maintenance organization of greater than 10% of its
18enrollee population (including without limitation the health
19maintenance organization's right, title, and interest in and to
20its health care certificates).
21    (e) In considering any management contract or service
22agreement subject to Section 141.1 of the Illinois Insurance
23Code, the Director (i) shall, in addition to the criteria
24specified in Section 141.2 of the Illinois Insurance Code, take
25into account the effect of the management contract or service
26agreement on the continuation of benefits to enrollees and the

 

 

HB5604- 9 -LRB099 18291 EGJ 42663 b

1financial condition of the health maintenance organization to
2be managed or serviced, and (ii) need not take into account the
3effect of the management contract or service agreement on
4competition.
5    (f) Except for small employer groups as defined in the
6Small Employer Rating, Renewability and Portability Health
7Insurance Act and except for medicare supplement policies as
8defined in Section 363 of the Illinois Insurance Code, a Health
9Maintenance Organization may by contract agree with a group or
10other enrollment unit to effect refunds or charge additional
11premiums 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

 

 

HB5604- 10 -LRB099 18291 EGJ 42663 b

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
8statement in the evidence of coverage issued to each enrollee
9describing the possibility of a refund or additional premium,
10and upon request of any group or enrollment unit, provide to
11the group or enrollment unit a description of the method used
12to calculate (1) the Health Maintenance Organization's
13profitable experience with respect to the group or enrollment
14unit and the resulting refund to the group or enrollment unit
15or (2) the Health Maintenance Organization's unprofitable
16experience with respect to the group or enrollment unit and the
17resulting additional premium to be paid by the group or
18enrollment unit.
19    In no event shall the Illinois Health Maintenance
20Organization Guaranty Association be liable to pay any
21contractual obligation of an insolvent organization to pay any
22refund authorized under this Section.
23    (g) Rulemaking authority to implement Public Act 95-1045,
24if any, is conditioned on the rules being adopted in accordance
25with all provisions of the Illinois Administrative Procedure
26Act and all rules and procedures of the Joint Committee on

 

 

HB5604- 11 -LRB099 18291 EGJ 42663 b

1Administrative Rules; any purported rule not so adopted, for
2whatever reason, is unauthorized.
3(Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-437,
4eff. 8-18-11; 97-486, eff. 1-1-12; 97-592, eff. 1-1-12; 97-805,
5eff. 1-1-13; 97-813, eff. 7-13-12; 98-189, eff. 1-1-14;
698-1091, eff. 1-1-15.)
 
7    Section 35. The Limited Health Service Organization Act is
8amended by changing Section 4003 as follows:
 
9    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
10    Sec. 4003. Illinois Insurance Code provisions. Limited
11health service organizations shall be subject to the provisions
12of Sections 133, 134, 136, 137, 139, 140, 141.1, 141.2, 141.3,
13143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5, 154.6,
14154.7, 154.8, 155.04, 155.37, 355.2, 355.3, 355b, 356v,
15356z.10, 356z.21, 356z.22, 356z.24, 368a, 401, 401.1, 402, 403,
16403A, 408, 408.2, 409, 412, 444, and 444.1 and Articles IIA,
17VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and XXVI of the
18Illinois Insurance Code. For purposes of the Illinois Insurance
19Code, except for Sections 444 and 444.1 and Articles XIII and
20XIII 1/2, limited health service organizations in the following
21categories are deemed to be domestic companies:
22        (1) a corporation under the laws of this State; or
23        (2) a corporation organized under the laws of another
24    state, 30% of more of the enrollees of which are residents

 

 

HB5604- 12 -LRB099 18291 EGJ 42663 b

1    of this State, except a corporation subject to
2    substantially the same requirements in its state of
3    organization as is a domestic company under Article VIII
4    1/2 of the Illinois Insurance Code.
5(Source: P.A. 97-486, eff. 1-1-12; 97-592, 1-1-12; 97-805, eff.
61-1-13; 97-813, eff. 7-13-12; 98-189, eff. 1-1-14; 98-1091,
7eff. 1-1-15.)
 
8    Section 40. The Voluntary Health Services Plans Act is
9amended by changing Section 10 as follows:
 
10    (215 ILCS 165/10)  (from Ch. 32, par. 604)
11    Sec. 10. Application of Insurance Code provisions. Health
12services plan corporations and all persons interested therein
13or dealing therewith shall be subject to the provisions of
14Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
15143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, 356g,
16356g.5, 356g.5-1, 356r, 356t, 356u, 356v, 356w, 356x, 356y,
17356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9,
18356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18,
19356z.19, 356z.21, 356z.22, 356z.24, 364.01, 367.2, 368a, 401,
20401.1, 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7)
21and (15) of Section 367 of the Illinois Insurance Code.
22    Rulemaking authority to implement Public Act 95-1045, if
23any, is conditioned on the rules being adopted in accordance
24with all provisions of the Illinois Administrative Procedure

 

 

HB5604- 13 -LRB099 18291 EGJ 42663 b

1Act and all rules and procedures of the Joint Committee on
2Administrative Rules; any purported rule not so adopted, for
3whatever reason, is unauthorized.
4(Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-486,
5eff. 1-1-12; 97-592, eff. 1-1-12; 97-805, eff. 1-1-13; 97-813,
6eff. 7-13-12; 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15.)
 
7    Section 99. Effective date. This Act takes effect upon
8becoming law.