Illinois General Assembly - Full Text of HB4348
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Full Text of HB4348  95th General Assembly

HB4348 95TH GENERAL ASSEMBLY


 


 
95TH GENERAL ASSEMBLY
State of Illinois
2007 and 2008
HB4348

 

Introduced , by Rep. Fred Crespo

 

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 5/356h   from Ch. 73, par. 968h
215 ILCS 125/5-3   from Ch. 111 1/2, par. 1411.2
215 ILCS 165/10   from Ch. 32, par. 604
215 ILCS 170/43 new

    Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Illinois Insurance Code, the Health Maintenance Organization Act, and the Voluntary Health Services Plans Act to require coverage for a child that is 25 years of age or younger. Also prohibits the exclusion of a child from coverage for the sole reason that the child is adopted or does not reside with the insured. Amends the Covering ALL KIDS Health Insurance Act. Permits dependent children age 19 through 25 to buy into the Covering ALL KIDS Health Insurance Program. Authorizes the Department of Healthcare and Family Services to establish eligibility, co-pay, and premium requirements. Effective January 1, 2009.


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FISCAL NOTE ACT MAY APPLY
STATE MANDATES ACT MAY REQUIRE REIMBURSEMENT

 

 

A BILL FOR

 

HB4348 LRB095 16715 KBJ 42749 b

1     AN ACT concerning regulation.
 
2     Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
 
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 356g.5,
13 356h, 356u, 356w, 356x, 356z.2, 356z.4, 356z.6, and 356z.9, and
14 356z.10 356z.9 of the Illinois Insurance Code. The program of
15 health benefits must comply with Section 155.37 of the Illinois
16 Insurance Code.
17 (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07;
18 95-520, eff. 8-28-07; revised 12-4-07.)
 
19     Section 10. The Counties Code is amended by changing
20 Section 5-1069.3 as follows:
 
21     (55 ILCS 5/5-1069.3)

 

 

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1     Sec. 5-1069.3. Required health benefits. If a county,
2 including a home rule county, is a self-insurer for purposes of
3 providing health insurance coverage for its employees, the
4 coverage shall include coverage for the post-mastectomy care
5 benefits required to be covered by a policy of accident and
6 health insurance under Section 356t and the coverage required
7 under Sections 356g.5, 356h, 356u, 356w, 356x, 356z.6, and
8 356z.9, and 356z.10 356z.9 of the Illinois Insurance Code. The
9 requirement that health benefits be covered as provided in this
10 Section is an exclusive power and function of the State and is
11 a denial and limitation under Article VII, Section 6,
12 subsection (h) of the Illinois Constitution. A home rule county
13 to which this Section applies must comply with every provision
14 of this Section.
15 (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07;
16 95-520, eff. 8-28-07; revised 12-4-07.)
 
17     Section 15. The Illinois Municipal Code is amended by
18 changing Section 10-4-2.3 as follows:
 
19     (65 ILCS 5/10-4-2.3)
20     Sec. 10-4-2.3. Required health benefits. If a
21 municipality, including a home rule municipality, is a
22 self-insurer for purposes of providing health insurance
23 coverage for its employees, the coverage shall include coverage
24 for the post-mastectomy care benefits required to be covered by

 

 

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1 a policy of accident and health insurance under Section 356t
2 and the coverage required under Sections 356g.5, 356h, 356u,
3 356w, 356x, 356z.6, and 356z.9, and 356z.10 356z.9 of the
4 Illinois Insurance Code. The requirement that health benefits
5 be covered as provided in this is an exclusive power and
6 function of the State and is a denial and limitation under
7 Article VII, Section 6, subsection (h) of the Illinois
8 Constitution. A home rule municipality to which this Section
9 applies must comply with every provision of this Section.
10 (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07;
11 95-520, eff. 8-28-07; revised 12-4-07.)
 
12     Section 20. The School Code is amended by changing Section
13 10-22.3f as follows:
 
14     (105 ILCS 5/10-22.3f)
15     Sec. 10-22.3f. Required health benefits. Insurance
16 protection and benefits for employees shall provide the
17 post-mastectomy care benefits required to be covered by a
18 policy of accident and health insurance under Section 356t and
19 the coverage required under Sections 356g.5, 356h, 356u, 356w,
20 356x, 356z.6, and 356z.9 of the Illinois Insurance Code.
21 (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07;
22 revised 12-4-07.)
 
23     Section 25. The Illinois Insurance Code is amended by

 

 

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1 changing Section 356h as follows:
 
2     (215 ILCS 5/356h)  (from Ch. 73, par. 968h)
3     Sec. 356h. No individual or group policy of accident and
4 health insurance which covers the insured's immediate family or
5 children, as well as covering the insured, shall exclude a
6 child from coverage or limit coverage for a child solely
7 because the child is an adopted child, or solely because the
8 child does not reside with the insured. For purposes of this
9 Section, a child who is in the custody of the insured, pursuant
10 to an interim court order of adoption or, in the case of group
11 insurance, placement of adoption, whichever comes first,
12 vesting temporary care of the child in the insured, is an
13 adopted child, regardless of whether a final order granting
14 adoption is ultimately issued.
15     No individual or group policy of accident and health
16 insurance which covers the insured's immediate family or
17 children, as well as covering the insured, shall exclude a
18 child from coverage or limit coverage for a child that is 25
19 years of age or younger.
20 (Source: P.A. 91-549, eff. 8-14-99.)
 
21     Section 30. The Health Maintenance Organization Act is
22 amended by changing Section 5-3 as follows:
 
23     (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)

 

 

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1     Sec. 5-3. Insurance Code provisions.
2     (a) Health Maintenance Organizations shall be subject to
3 the provisions of Sections 133, 134, 137, 140, 141.1, 141.2,
4 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5,
5 154.6, 154.7, 154.8, 155.04, 355.2, 356h, 356m, 356v, 356w,
6 356x, 356y, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9,
7 356z.10 356z.9, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c,
8 368d, 368e, 370c, 401, 401.1, 402, 403, 403A, 408, 408.2, 409,
9 412, 444, and 444.1, paragraph (c) of subsection (2) of Section
10 367, and Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2,
11 XXV, and XXVI of the Illinois Insurance Code.
12     (b) For purposes of the Illinois Insurance Code, except for
13 Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health
14 Maintenance Organizations in the following categories are
15 deemed to be "domestic companies":
16         (1) a corporation authorized under the Dental Service
17     Plan Act or the Voluntary Health Services Plans Act;
18         (2) a corporation organized under the laws of this
19     State; or
20         (3) a corporation organized under the laws of another
21     state, 30% or more of the enrollees of which are residents
22     of this State, except a corporation subject to
23     substantially the same requirements in its state of
24     organization as is a "domestic company" under Article VIII
25     1/2 of the Illinois Insurance Code.
26     (c) In considering the merger, consolidation, or other

 

 

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1 acquisition of control of a Health Maintenance Organization
2 pursuant to Article VIII 1/2 of the Illinois Insurance Code,
3         (1) the Director shall give primary consideration to
4     the continuation of benefits to enrollees and the financial
5     conditions of the acquired Health Maintenance Organization
6     after the merger, consolidation, or other acquisition of
7     control takes effect;
8         (2)(i) the criteria specified in subsection (1)(b) of
9     Section 131.8 of the Illinois Insurance Code shall not
10     apply and (ii) the Director, in making his determination
11     with respect to the merger, consolidation, or other
12     acquisition of control, need not take into account the
13     effect on competition of the merger, consolidation, or
14     other acquisition of control;
15         (3) the Director shall have the power to require the
16     following information:
17             (A) certification by an independent actuary of the
18         adequacy of the reserves of the Health Maintenance
19         Organization sought to be acquired;
20             (B) pro forma financial statements reflecting the
21         combined balance sheets of the acquiring company and
22         the Health Maintenance Organization sought to be
23         acquired as of the end of the preceding year and as of
24         a date 90 days prior to the acquisition, as well as pro
25         forma financial statements reflecting projected
26         combined operation for a period of 2 years;

 

 

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1             (C) a pro forma business plan detailing an
2         acquiring party's plans with respect to the operation
3         of the Health Maintenance Organization sought to be
4         acquired for a period of not less than 3 years; and
5             (D) such other information as the Director shall
6         require.
7     (d) The provisions of Article VIII 1/2 of the Illinois
8 Insurance Code and this Section 5-3 shall apply to the sale by
9 any health maintenance organization of greater than 10% of its
10 enrollee population (including without limitation the health
11 maintenance organization's right, title, and interest in and to
12 its health care certificates).
13     (e) In considering any management contract or service
14 agreement subject to Section 141.1 of the Illinois Insurance
15 Code, the Director (i) shall, in addition to the criteria
16 specified in Section 141.2 of the Illinois Insurance Code, take
17 into account the effect of the management contract or service
18 agreement on the continuation of benefits to enrollees and the
19 financial condition of the health maintenance organization to
20 be managed or serviced, and (ii) need not take into account the
21 effect of the management contract or service agreement on
22 competition.
23     (f) Except for small employer groups as defined in the
24 Small Employer Rating, Renewability and Portability Health
25 Insurance Act and except for medicare supplement policies as
26 defined in Section 363 of the Illinois Insurance Code, a Health

 

 

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1 Maintenance Organization may by contract agree with a group or
2 other enrollment unit to effect refunds or charge additional
3 premiums under the following terms and conditions:
4         (i) the amount of, and other terms and conditions with
5     respect to, the refund or additional premium are set forth
6     in the group or enrollment unit contract agreed in advance
7     of the period for which a refund is to be paid or
8     additional premium is to be charged (which period shall not
9     be less than one year); and
10         (ii) the amount of the refund or additional premium
11     shall not exceed 20% of the Health Maintenance
12     Organization's profitable or unprofitable experience with
13     respect to the group or other enrollment unit for the
14     period (and, for purposes of a refund or additional
15     premium, the profitable or unprofitable experience shall
16     be calculated taking into account a pro rata share of the
17     Health Maintenance Organization's administrative and
18     marketing expenses, but shall not include any refund to be
19     made or additional premium to be paid pursuant to this
20     subsection (f)). The Health Maintenance Organization and
21     the group or enrollment unit may agree that the profitable
22     or unprofitable experience may be calculated taking into
23     account the refund period and the immediately preceding 2
24     plan years.
25     The Health Maintenance Organization shall include a
26 statement in the evidence of coverage issued to each enrollee

 

 

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1 describing the possibility of a refund or additional premium,
2 and upon request of any group or enrollment unit, provide to
3 the group or enrollment unit a description of the method used
4 to calculate (1) the Health Maintenance Organization's
5 profitable experience with respect to the group or enrollment
6 unit and the resulting refund to the group or enrollment unit
7 or (2) the Health Maintenance Organization's unprofitable
8 experience with respect to the group or enrollment unit and the
9 resulting additional premium to be paid by the group or
10 enrollment unit.
11     In no event shall the Illinois Health Maintenance
12 Organization Guaranty Association be liable to pay any
13 contractual obligation of an insolvent organization to pay any
14 refund authorized under this Section.
15 (Source: P.A. 94-906, eff. 1-1-07; 94-1076, eff. 12-29-06;
16 95-422, eff. 8-24-07; 95-520, eff. 8-28-07; revised 12-4-07.)
 
17     Section 35. The Voluntary Health Services Plans Act is
18 amended by changing Section 10 as follows:
 
19     (215 ILCS 165/10)  (from Ch. 32, par. 604)
20     Sec. 10. Application of Insurance Code provisions. Health
21 services plan corporations and all persons interested therein
22 or dealing therewith shall be subject to the provisions of
23 Articles IIA and XII 1/2 and Sections 3.1, 133, 140, 143, 143c,
24 149, 155.37, 354, 355.2, 356g.5, 356h, 356r, 356t, 356u, 356v,

 

 

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1 356w, 356x, 356y, 356z.1, 356z.2, 356z.4, 356z.5, 356z.6,
2 356z.8, 356z.9, 356z.10 356z.9, 364.01, 367.2, 368a, 401,
3 401.1, 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7)
4 and (15) of Section 367 of the Illinois Insurance Code.
5 (Source: P.A. 94-1076, eff. 12-29-06; 95-189, eff. 8-16-07;
6 95-331, eff. 8-21-07; 95-422, eff. 8-24-07; 95-520, eff.
7 8-28-07; revised 12-5-07.)
 
8     Section 40. The Covering ALL KIDS Health Insurance Act is
9 amended by adding Section 43 as follows:
 
10     (215 ILCS 170/43 new)
11     Sec. 43. Dependent children. The Department may establish a
12 buy-in option for the Program for dependent children age 19
13 through 25. The Department may adopt rules necessary to
14 establish eligibility, co-pay, and premium requirements for
15 children enrolled in the Program under this Section.
 
16     Section 99. Effective date. This Act takes effect January
17 1, 2009.