99TH GENERAL ASSEMBLY
State of Illinois
2015 and 2016
SB1515

 

Introduced 2/20/2015, by Sen. John G. Mulroe

 

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.23 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. Provides that group or individual major medical accident and health insurance policies or managed care plans issued, amended, delivered, or renewed on or after the effective date of the Act must provide coverage and reimbursement for the treatment of mitochondrial disease. Provides that coverage shall include, but not be limited to, the use of vitamin and nutritional supplements, such as coenzyme Q10, vitamin E, vitamin C, vitamin B-1, vitamin B-2, vitamin K-1, and L-carnitine. Makes conforming changes in 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 Services Organization Act, and the Voluntary Health Services Plan Act.


LRB099 10074 MLM 30297 b

FISCAL NOTE ACT MAY APPLY
STATE MANDATES ACT MAY REQUIRE REIMBURSEMENT

 

 

A BILL FOR

 

SB1515LRB099 10074 MLM 30297 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.23 of the
16Illinois Insurance Code. The program of health benefits must
17comply with Sections 155.22a, 155.37, 355b, and 356z.19 of the
18Illinois 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

 

 

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1whatever reason, is unauthorized.
2(Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-813,
3eff. 7-13-12; 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15.)
 
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.23 of the Illinois
16Insurance Code. The coverage shall comply with Sections
17155.22a, 355b, and 356z.19 of the Illinois Insurance Code. The
18requirement that health benefits be covered as provided in this
19Section is an exclusive power and function of the State and is
20a denial and limitation under Article VII, Section 6,
21subsection (h) of the Illinois Constitution. A home rule county
22to which this Section applies must comply with every provision
23of this Section.
24    Rulemaking authority to implement Public Act 95-1045, if

 

 

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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. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-813,
7eff. 7-13-12; 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15.)
 
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.23 of the Illinois Insurance Code. The coverage shall
21comply with Sections 155.22a, 355b, and 356z.19 of the Illinois
22Insurance Code. The requirement that health benefits be covered
23as provided in this is an exclusive power and function of the
24State and is a denial and limitation under Article VII, Section

 

 

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16, subsection (h) of the Illinois Constitution. A home rule
2municipality to which this Section applies must comply with
3every 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. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-813,
11eff. 7-13-12; 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15.)
 
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.23 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

 

 

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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.23 as follows:
 
12    (215 ILCS 5/356z.23 new)
13    Sec. 356z.23. Mitochondrial disease. A group or individual
14major medical accident and health insurance policy or managed
15care plan issued, amended, delivered, or renewed on or after
16the effective date of this amendatory Act of the 99th General
17Assembly must provide coverage and reimbursement for the
18treatment of mitochondrial disease. This coverage shall
19include, but is not limited to, the use of vitamin and
20nutritional supplements, such as coenzyme Q10, vitamin E,
21vitamin C, vitamin B-1, vitamin B-2, vitamin K-1, and
22L-carnitine.
 
23    Section 30. The Health Maintenance Organization Act is

 

 

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1amended by changing Section 5-3 as follows:
 
2    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
3    Sec. 5-3. Insurance Code provisions.
4    (a) Health Maintenance Organizations shall be subject to
5the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
6141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
7154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2, 355.3,
8355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2, 356z.4,
9356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
10356z.13, 356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.21,
11356z.22, 356z.23, 364.01, 367.2, 367.2-5, 367i, 368a, 368b,
12368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A,
13408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of
14subsection (2) of Section 367, and Articles IIA, VIII 1/2, XII,
15XII 1/2, XIII, XIII 1/2, XXV, and XXVI of the Illinois
16Insurance Code.
17    (b) For purposes of the Illinois Insurance Code, except for
18Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health
19Maintenance Organizations in the following categories are
20deemed to be "domestic companies":
21        (1) a corporation authorized under the Dental Service
22    Plan Act or the Voluntary Health Services Plans Act;
23        (2) a corporation organized under the laws of this
24    State; or
25        (3) a corporation organized under the laws of another

 

 

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1    state, 30% or more of the enrollees of which are residents
2    of this State, except a corporation subject to
3    substantially the same requirements in its state of
4    organization as is a "domestic company" under Article VIII
5    1/2 of the Illinois Insurance Code.
6    (c) In considering the merger, consolidation, or other
7acquisition of control of a Health Maintenance Organization
8pursuant to Article VIII 1/2 of the Illinois Insurance Code,
9        (1) the Director shall give primary consideration to
10    the continuation of benefits to enrollees and the financial
11    conditions of the acquired Health Maintenance Organization
12    after the merger, consolidation, or other acquisition of
13    control takes effect;
14        (2)(i) the criteria specified in subsection (1)(b) of
15    Section 131.8 of the Illinois Insurance Code shall not
16    apply and (ii) the Director, in making his determination
17    with respect to the merger, consolidation, or other
18    acquisition of control, need not take into account the
19    effect on competition of the merger, consolidation, or
20    other acquisition of control;
21        (3) the Director shall have the power to require the
22    following information:
23            (A) certification by an independent actuary of the
24        adequacy of the reserves of the Health Maintenance
25        Organization sought to be acquired;
26            (B) pro forma financial statements reflecting the

 

 

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1        combined balance sheets of the acquiring company and
2        the Health Maintenance Organization sought to be
3        acquired as of the end of the preceding year and as of
4        a date 90 days prior to the acquisition, as well as pro
5        forma financial statements reflecting projected
6        combined operation for a period of 2 years;
7            (C) a pro forma business plan detailing an
8        acquiring party's plans with respect to the operation
9        of the Health Maintenance Organization sought to be
10        acquired for a period of not less than 3 years; and
11            (D) such other information as the Director shall
12        require.
13    (d) The provisions of Article VIII 1/2 of the Illinois
14Insurance Code and this Section 5-3 shall apply to the sale by
15any health maintenance organization of greater than 10% of its
16enrollee population (including without limitation the health
17maintenance organization's right, title, and interest in and to
18its health care certificates).
19    (e) In considering any management contract or service
20agreement subject to Section 141.1 of the Illinois Insurance
21Code, the Director (i) shall, in addition to the criteria
22specified in Section 141.2 of the Illinois Insurance Code, take
23into account the effect of the management contract or service
24agreement on the continuation of benefits to enrollees and the
25financial condition of the health maintenance organization to
26be managed or serviced, and (ii) need not take into account the

 

 

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1effect of the management contract or service agreement on
2competition.
3    (f) Except for small employer groups as defined in the
4Small Employer Rating, Renewability and Portability Health
5Insurance Act and except for medicare supplement policies as
6defined in Section 363 of the Illinois Insurance Code, a Health
7Maintenance Organization may by contract agree with a group or
8other enrollment unit to effect refunds or charge additional
9premiums under the following terms and conditions:
10        (i) the amount of, and other terms and conditions with
11    respect to, the refund or additional premium are set forth
12    in the group or enrollment unit contract agreed in advance
13    of the period for which a refund is to be paid or
14    additional premium is to be charged (which period shall not
15    be less than one year); and
16        (ii) the amount of the refund or additional premium
17    shall not exceed 20% of the Health Maintenance
18    Organization's profitable or unprofitable experience with
19    respect to the group or other enrollment unit for the
20    period (and, for purposes of a refund or additional
21    premium, the profitable or unprofitable experience shall
22    be calculated taking into account a pro rata share of the
23    Health Maintenance Organization's administrative and
24    marketing expenses, but shall not include any refund to be
25    made or additional premium to be paid pursuant to this
26    subsection (f)). The Health Maintenance Organization and

 

 

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1    the group or enrollment unit may agree that the profitable
2    or unprofitable experience may be calculated taking into
3    account the refund period and the immediately preceding 2
4    plan years.
5    The Health Maintenance Organization shall include a
6statement in the evidence of coverage issued to each enrollee
7describing the possibility of a refund or additional premium,
8and upon request of any group or enrollment unit, provide to
9the group or enrollment unit a description of the method used
10to calculate (1) the Health Maintenance Organization's
11profitable experience with respect to the group or enrollment
12unit and the resulting refund to the group or enrollment unit
13or (2) the Health Maintenance Organization's unprofitable
14experience with respect to the group or enrollment unit and the
15resulting additional premium to be paid by the group or
16enrollment unit.
17    In no event shall the Illinois Health Maintenance
18Organization Guaranty Association be liable to pay any
19contractual obligation of an insolvent organization to pay any
20refund authorized under this Section.
21    (g) Rulemaking authority to implement Public Act 95-1045,
22if any, is conditioned on the rules being adopted in accordance
23with all provisions of the Illinois Administrative Procedure
24Act and all rules and procedures of the Joint Committee on
25Administrative Rules; any purported rule not so adopted, for
26whatever reason, is unauthorized.

 

 

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1(Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-437,
2eff. 8-18-11; 97-486, eff. 1-1-12; 97-592, eff. 1-1-12; 97-805,
3eff. 1-1-13; 97-813, eff. 7-13-12; 98-189, eff. 1-1-14;
498-1091, eff. 1-1-15.)
 
5    Section 35. The Limited Health Service Organization Act is
6amended by changing Section 4003 as follows:
 
7    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
8    Sec. 4003. Illinois Insurance Code provisions. Limited
9health service organizations shall be subject to the provisions
10of Sections 133, 134, 136, 137, 139, 140, 141.1, 141.2, 141.3,
11143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5, 154.6,
12154.7, 154.8, 155.04, 155.37, 355.2, 355.3, 355b, 356v,
13356z.10, 356z.21, 356z.22, 356z.23, 368a, 401, 401.1, 402, 403,
14403A, 408, 408.2, 409, 412, 444, and 444.1 and Articles IIA,
15VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and XXVI of the
16Illinois Insurance Code. For purposes of the Illinois Insurance
17Code, except for Sections 444 and 444.1 and Articles XIII and
18XIII 1/2, limited health service organizations in the following
19categories are deemed to be domestic companies:
20        (1) a corporation under the laws of this State; or
21        (2) a corporation organized under the laws of another
22    state, 30% of more of the enrollees of which are residents
23    of this State, except a corporation subject to
24    substantially the same requirements in its state of

 

 

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1    organization as is a domestic company under Article VIII
2    1/2 of the Illinois Insurance Code.
3(Source: P.A. 97-486, eff. 1-1-12; 97-592, 1-1-12; 97-805, eff.
41-1-13; 97-813, eff. 7-13-12; 98-189, eff. 1-1-14; 98-1091,
5eff. 1-1-15.)
 
6    Section 40. The Voluntary Health Services Plans Act is
7amended by changing Section 10 as follows:
 
8    (215 ILCS 165/10)  (from Ch. 32, par. 604)
9    Sec. 10. Application of Insurance Code provisions. Health
10services plan corporations and all persons interested therein
11or dealing therewith shall be subject to the provisions of
12Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
13143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, 356g,
14356g.5, 356g.5-1, 356r, 356t, 356u, 356v, 356w, 356x, 356y,
15356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9,
16356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18,
17356z.19, 356z.21, 356z.22, 356z.23, 364.01, 367.2, 368a, 401,
18401.1, 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7)
19and (15) of Section 367 of the Illinois Insurance Code.
20    Rulemaking authority to implement Public Act 95-1045, if
21any, is conditioned on the rules being adopted in accordance
22with all provisions of the Illinois Administrative Procedure
23Act and all rules and procedures of the Joint Committee on
24Administrative Rules; any purported rule not so adopted, for

 

 

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1whatever reason, is unauthorized.
2(Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-486,
3eff. 1-1-12; 97-592, eff. 1-1-12; 97-805, eff. 1-1-13; 97-813,
4eff. 7-13-12; 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15.)