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Full Text of HB2070  95th General Assembly

HB2070sam002 95TH GENERAL ASSEMBLY

Sen. James A. DeLeo

Filed: 9/22/2008

 

 


 

 


 
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1
AMENDMENT TO HOUSE BILL 2070

2     AMENDMENT NO. ______. Amend House Bill 2070, AS AMENDED, by
3 replacing everything after the enacting clause with the
4 following:
 
5     "Section 5. The State Employees Group Insurance Act of 1971
6 is amended by changing Section 6.11 as follows:
 
7     (5 ILCS 375/6.11)
8     (Text of Section before amendment by P.A. 95-958)
9     Sec. 6.11. Required health benefits; Illinois Insurance
10 Code requirements. The program of health benefits shall provide
11 the post-mastectomy care benefits required to be covered by a
12 policy of accident and health insurance under Section 356t of
13 the Illinois Insurance Code. The program of health benefits
14 shall provide the coverage required under Sections 356g.5,
15 356u, 356w, 356x, 356z.2, 356z.4, 356z.6, 356z.9, and 356z.10,
16 and 356z.13 of the Illinois Insurance Code. The program of

 

 

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1 health benefits must comply with Section 155.37 of the Illinois
2 Insurance Code.
3 (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07;
4 95-520, eff. 8-28-07; 95-876, eff. 8-21-08.)
 
5     (Text of Section after amendment by P.A. 95-958)
6     Sec. 6.11. Required health benefits; Illinois Insurance
7 Code requirements. The program of health benefits shall provide
8 the post-mastectomy care benefits required to be covered by a
9 policy of accident and health insurance under Section 356t of
10 the Illinois Insurance Code. The program of health benefits
11 shall provide the coverage required under Sections 356g.5,
12 356u, 356w, 356x, 356z.2, 356z.4, 356z.6, 356z.9, 356z.10,
13 356z.11, and 356z.12, and 356z.13 of the Illinois Insurance
14 Code. The program of health benefits must comply with Section
15 155.37 of the Illinois Insurance Code.
16 (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07;
17 95-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff.
18 6-1-09.)
 
19     Section 10. The Counties Code is amended by changing
20 Section 5-1069.3 as follows:
 
21     (55 ILCS 5/5-1069.3)
22     (Text of Section before amendment by P.A. 95-958)
23     Sec. 5-1069.3. Required health benefits. If a county,

 

 

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1 including a home rule county, is a self-insurer for purposes of
2 providing health insurance coverage for its employees, the
3 coverage shall include coverage for the post-mastectomy care
4 benefits required to be covered by a policy of accident and
5 health insurance under Section 356t and the coverage required
6 under Sections 356g.5, 356u, 356w, 356x, 356z.6, 356z.9, and
7 356z.10, and 356z.13 of the Illinois Insurance Code. The
8 requirement that health benefits be covered as provided in this
9 Section is an exclusive power and function of the State and is
10 a denial and limitation under Article VII, Section 6,
11 subsection (h) of the Illinois Constitution. A home rule county
12 to which this Section applies must comply with every provision
13 of this Section.
14 (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07;
15 95-520, eff. 8-28-07; 95-876, eff. 8-21-08.)
 
16     (Text of Section after amendment by P.A. 95-958)
17     Sec. 5-1069.3. Required health benefits. If a county,
18 including a home rule county, is a self-insurer for purposes of
19 providing health insurance coverage for its employees, the
20 coverage shall include coverage for the post-mastectomy care
21 benefits required to be covered by a policy of accident and
22 health insurance under Section 356t and the coverage required
23 under Sections 356g.5, 356u, 356w, 356x, 356z.6, 356z.9,
24 356z.10, 356z.11, and 356z.12, and 356z.13 of the Illinois
25 Insurance Code. The requirement that health benefits be covered

 

 

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1 as provided in this Section is an exclusive power and function
2 of the State and is a denial and limitation under Article VII,
3 Section 6, subsection (h) of the Illinois Constitution. A home
4 rule county to which this Section applies must comply with
5 every provision of this Section.
6 (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07;
7 95-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff.
8 6-1-09.)
 
9     Section 15. The Illinois Municipal Code is amended by
10 changing Section 10-4-2.3 as follows:
 
11     (65 ILCS 5/10-4-2.3)
12     (Text of Section before amendment by P.A. 95-958)
13     Sec. 10-4-2.3. Required health benefits. If a
14 municipality, including a home rule municipality, is a
15 self-insurer for purposes of providing health insurance
16 coverage for its employees, the coverage shall include coverage
17 for the post-mastectomy care benefits required to be covered by
18 a policy of accident and health insurance under Section 356t
19 and the coverage required under Sections 356g.5, 356u, 356w,
20 356x, 356z.6, 356z.9, and 356z.10, and 356z.13 of the Illinois
21 Insurance Code. The requirement that health benefits be covered
22 as provided in this is an exclusive power and function of the
23 State and is a denial and limitation under Article VII, Section
24 6, subsection (h) of the Illinois Constitution. A home rule

 

 

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1 municipality to which this Section applies must comply with
2 every provision of this Section.
3 (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07;
4 95-520, eff. 8-28-07; 95-876, eff. 8-21-08.)
 
5     (Text of Section after amendment by P.A. 95-958)
6     Sec. 10-4-2.3. Required health benefits. If a
7 municipality, including a home rule municipality, is a
8 self-insurer for purposes of providing health insurance
9 coverage for its employees, the coverage shall include coverage
10 for the post-mastectomy care benefits required to be covered by
11 a policy of accident and health insurance under Section 356t
12 and the coverage required under Sections 356g.5, 356u, 356w,
13 356x, 356z.6, 356z.9, 356z.10, 356z.11, and 356z.12, and
14 356z.13 of the Illinois Insurance Code. The requirement that
15 health benefits be covered as provided in this is an exclusive
16 power and function of the State and is a denial and limitation
17 under Article VII, Section 6, subsection (h) of the Illinois
18 Constitution. A home rule municipality to which this Section
19 applies must comply with every provision 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; 95-876, eff. 8-21-08; 95-958, eff.
22 6-1-09.)
 
23     Section 20. The School Code is amended by changing Section
24 10-22.3f as follows:
 

 

 

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1     (105 ILCS 5/10-22.3f)
2     (Text of Section before amendment by P.A. 95-958)
3     Sec. 10-22.3f. Required health benefits. Insurance
4 protection and benefits for employees shall provide the
5 post-mastectomy care benefits required to be covered by a
6 policy of accident and health insurance under Section 356t and
7 the coverage required under Sections 356g.5, 356u, 356w, 356x,
8 356z.6, and 356z.9, and 356z.13 of the Illinois Insurance Code.
9 (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07;
10 95-876, eff. 8-21-08.)
 
11     (Text of Section after amendment by P.A. 95-958)
12     Sec. 10-22.3f. Required health benefits. Insurance
13 protection and benefits for employees shall provide the
14 post-mastectomy care benefits required to be covered by a
15 policy of accident and health insurance under Section 356t and
16 the coverage required under Sections 356g.5, 356u, 356w, 356x,
17 356z.6, 356z.9, 356z.11, and 356z.12, and 356z.13 of the
18 Illinois Insurance Code.
19 (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07;
20 95-876, eff. 8-21-08; 95-958, eff. 6-1-09.)
 
21     Section 25. The Illinois Insurance Code is amended by
22 adding Section 356z.13 as follows:
 

 

 

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1     (215 ILCS 5/356z.13 new)
2     Sec. 356z.13. Autism spectrum disorders.
3     (a) A group or individual policy of accident and health
4 insurance or managed care plan amended, delivered, issued, or
5 renewed after the effective date of this amendatory Act of the
6 95th General Assembly must provide individuals under 21 years
7 of age coverage for the diagnosis of autism spectrum disorders
8 and for the treatment of autism spectrum disorders to the
9 extent that the diagnosis and treatment of autism spectrum
10 disorders are not already covered by the policy of accident and
11 health insurance or managed care plan.
12     (b) Coverage provided under this Section shall be subject
13 to a maximum benefit of $36,000 per year, but shall not be
14 subject to any limits on the number of visits to a service
15 provider. After December 30, 2009, the Director of the Division
16 of Insurance shall, on an annual basis, adjust the maximum
17 benefit for inflation using the Medical Care Component of the
18 United States Department of Labor Consumer Price Index for All
19 Urban Consumers. Payments made by an insurer on behalf of a
20 covered individual for any care, treatment, intervention,
21 service, or item, the provision of which was for the treatment
22 of a health condition not diagnosed as an autism spectrum
23 disorder, shall not be applied toward any maximum benefit
24 established under this subsection.
25     (c) Coverage under this Section shall be subject to
26 co-payment, deductible, and coinsurance provisions of a policy

 

 

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1 of accident and health insurance or managed care plan to the
2 extent that other medical services covered by the policy of
3 accident and health insurance or managed care plan are subject
4 to these provisions.
5     (d) This Section shall not be construed as limiting
6 benefits that are otherwise available to an individual under a
7 policy of accident and health insurance or managed care plan
8 and benefits provided under this Section may not be subject to
9 dollar limits, deductibles, copayments, or coinsurance
10 provisions that are less favorable to the insured than the
11 dollar limits, deductibles, or coinsurance provisions that
12 apply to physical illness generally.
13     (e) An insurer may not deny or refuse to provide otherwise
14 covered services, or refuse to renew, refuse to reissue, or
15 otherwise terminate or restrict coverage under an individual
16 contract to provide services to an individual because the
17 individual or their dependent is diagnosed with an autism
18 spectrum disorder or due to the individual utilizing benefits
19 in this Section.
20     (f) Upon request of the reimbursing insurer, a provider of
21 treatment for autism spectrum disorders shall furnish medical
22 records, clinical notes, or other necessary data that
23 substantiate that initial or continued medical treatment is
24 medically necessary and is resulting in improved clinical
25 status. When treatment is anticipated to require continued
26 services to achieve demonstrable progress, the insurer may

 

 

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1 request a treatment plan consisting of diagnosis, proposed
2 treatment by type, frequency, anticipated duration of
3 treatment, the anticipated outcomes stated as goals, and the
4 frequency by which the treatment plan will be updated.
5     (g) When making a determination of medical necessity for a
6 treatment modality for autism spectrum disorders, an insurer
7 must make the determination in a manner that is consistent with
8 the manner used to make that determination with respect to
9 other diseases or illnesses covered under the policy, including
10 an appeals process. During the appeals process, any challenge
11 to medical necessity must be viewed as reasonable only if the
12 review includes a physician with expertise in the most current
13 and effective treatment modalities for autism spectrum
14 disorders.
15     (h) Coverage for medically necessary early intervention
16 services must be delivered by certified early intervention
17 specialists, as defined in the early intervention operational
18 standards by the Department of Human Services and in accordance
19 with applicable certification requirements.
20     (i) As used in this Section:
21     "Autism spectrum disorders" means pervasive developmental
22 disorders as defined in the most recent edition of the
23 Diagnostic and Statistical Manual of Mental Disorders,
24 including autism, Asperger's disorder, and pervasive
25 developmental disorder not otherwise specified.
26     "Diagnosis of autism spectrum disorders" means a diagnosis

 

 

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1 of an individual with an autism spectrum disorder by (A) a
2 physician licensed to practice medicine in all its branches or
3 (B) a licensed clinical psychologist with expertise in
4 diagnosing autism spectrum disorders.
5     "Medically necessary" means any care, treatment,
6 intervention, service or item which will or is reasonably
7 expected to do any of the following: (i) prevent the onset of
8 an illness, condition, injury, disease or disability; (ii)
9 reduce or ameliorate the physical, mental or developmental
10 effects of an illness, condition, injury, disease or
11 disability; or (iii) assist to achieve or maintain maximum
12 functional activity in performing daily activities.
13     "Treatment for autism spectrum disorders" shall include
14 the following care prescribed, provided, or ordered for an
15 individual diagnosed with an autism spectrum disorder by (A) a
16 physician licensed to practice medicine in all its branches or
17 (B) a certified, registered, or licensed health care
18 professional with expertise in treating effects of autism
19 spectrum disorders when the care is determined to be medically
20 necessary and ordered by a physician licensed to practice
21 medicine in all its branches:
22         (1) Psychiatric care, including diagnostic services.
23         (2) Psychological assessments and treatments.
24         (3) Rehabilitative treatments.
25         (4) Therapeutic care, including behavioral speech,
26     occupational, and physical therapies that provide

 

 

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1     treatment in the following areas: (i) self care and
2     feeding, (ii) pragmatic, receptive, and expressive
3     language, (iii) cognitive functioning, (iv) applied
4     behavior analysis, intervention, and modification, (v)
5     motor planning, and (vi) sensory processing.
 
6     Section 30. The Health Maintenance Organization Act is
7 amended by changing Section 5-3 as follows:
 
8     (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
9     (Text of Section before amendment by P.A. 95-958)
10     Sec. 5-3. Insurance Code provisions.
11     (a) Health Maintenance Organizations shall be subject to
12 the provisions of Sections 133, 134, 137, 140, 141.1, 141.2,
13 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5,
14 154.6, 154.7, 154.8, 155.04, 355.2, 356m, 356v, 356w, 356x,
15 356y, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10,
16 356z.13, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c, 368d,
17 368e, 370c, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412,
18 444, and 444.1, paragraph (c) of subsection (2) of Section 367,
19 and Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV,
20 and XXVI of the Illinois Insurance Code.
21     (b) For purposes of the Illinois Insurance Code, except for
22 Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health
23 Maintenance Organizations in the following categories are
24 deemed to be "domestic companies":

 

 

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

 

 

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

 

 

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

 

 

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1     be calculated taking into account a pro rata share of the
2     Health Maintenance Organization's administrative and
3     marketing expenses, but shall not include any refund to be
4     made or additional premium to be paid pursuant to this
5     subsection (f)). The Health Maintenance Organization and
6     the group or enrollment unit may agree that the profitable
7     or unprofitable experience may be calculated taking into
8     account the refund period and the immediately preceding 2
9     plan years.
10     The Health Maintenance Organization shall include a
11 statement in the evidence of coverage issued to each enrollee
12 describing the possibility of a refund or additional premium,
13 and upon request of any group or enrollment unit, provide to
14 the group or enrollment unit a description of the method used
15 to calculate (1) the Health Maintenance Organization's
16 profitable experience with respect to the group or enrollment
17 unit and the resulting refund to the group or enrollment unit
18 or (2) the Health Maintenance Organization's unprofitable
19 experience with respect to the group or enrollment unit and the
20 resulting additional premium to be paid by the group or
21 enrollment unit.
22     In no event shall the Illinois Health Maintenance
23 Organization Guaranty Association be liable to pay any
24 contractual obligation of an insolvent organization to pay any
25 refund authorized under this Section.
26 (Source: P.A. 94-906, eff. 1-1-07; 94-1076, eff. 12-29-06;

 

 

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1 95-422, eff. 8-24-07; 95-520, eff. 8-28-07; 95-876, eff.
2 8-21-08.)
 
3     (Text of Section after amendment by P.A. 95-958)
4     Sec. 5-3. Insurance Code provisions.
5     (a) Health Maintenance Organizations shall be subject to
6 the provisions of Sections 133, 134, 137, 140, 141.1, 141.2,
7 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5,
8 154.6, 154.7, 154.8, 155.04, 355.2, 356m, 356v, 356w, 356x,
9 356y, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10,
10 356z.11, 356z.12, 356z.13, 364.01, 367.2, 367.2-5, 367i, 368a,
11 368b, 368c, 368d, 368e, 370c, 401, 401.1, 402, 403, 403A, 408,
12 408.2, 409, 412, 444, and 444.1, paragraph (c) of subsection
13 (2) of Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2,
14 XIII, XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.
15     (b) For purposes of the Illinois Insurance Code, except for
16 Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health
17 Maintenance Organizations in the following categories are
18 deemed to be "domestic companies":
19         (1) a corporation authorized under the Dental Service
20     Plan Act or the Voluntary Health Services Plans Act;
21         (2) a corporation organized under the laws of this
22     State; or
23         (3) a corporation organized under the laws of another
24     state, 30% or more of the enrollees of which are residents
25     of this State, except a corporation subject to

 

 

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

 

 

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

 

 

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

 

 

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1     account the refund period and the immediately preceding 2
2     plan years.
3     The Health Maintenance Organization shall include a
4 statement in the evidence of coverage issued to each enrollee
5 describing the possibility of a refund or additional premium,
6 and upon request of any group or enrollment unit, provide to
7 the group or enrollment unit a description of the method used
8 to calculate (1) the Health Maintenance Organization's
9 profitable experience with respect to the group or enrollment
10 unit and the resulting refund to the group or enrollment unit
11 or (2) the Health Maintenance Organization's unprofitable
12 experience with respect to the group or enrollment unit and the
13 resulting additional premium to be paid by the group or
14 enrollment unit.
15     In no event shall the Illinois Health Maintenance
16 Organization Guaranty Association be liable to pay any
17 contractual obligation of an insolvent organization to pay any
18 refund authorized under this Section.
19 (Source: P.A. 94-906, eff. 1-1-07; 94-1076, eff. 12-29-06;
20 95-422, eff. 8-24-07; 95-520, eff. 8-28-07; 95-876, eff.
21 8-21-08; 95-958, eff. 6-1-09.)
 
22     Section 35. The Voluntary Health Services Plans Act is
23 amended by changing Section 10 as follows:
 
24     (215 ILCS 165/10)  (from Ch. 32, par. 604)

 

 

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1     (Text of Section before amendment by P.A. 95-958)
2     Sec. 10. Application of Insurance Code provisions. Health
3 services plan corporations and all persons interested therein
4 or dealing therewith shall be subject to the provisions of
5 Articles IIA and XII 1/2 and Sections 3.1, 133, 140, 143, 143c,
6 149, 155.37, 354, 355.2, 356g.5, 356r, 356t, 356u, 356v, 356w,
7 356x, 356y, 356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8,
8 356z.9, 356z.10, 356z.13, 364.01, 367.2, 368a, 401, 401.1, 402,
9 403, 403A, 408, 408.2, and 412, and paragraphs (7) and (15) of
10 Section 367 of the Illinois Insurance Code.
11 (Source: P.A. 94-1076, eff. 12-29-06; 95-189, eff. 8-16-07;
12 95-331, eff. 8-21-07; 95-422, eff. 8-24-07; 95-520, eff.
13 8-28-07; 95-876, eff. 8-21-08.)
 
14     (Text of Section after amendment by P.A. 95-958)
15     Sec. 10. Application of Insurance Code provisions. Health
16 services plan corporations and all persons interested therein
17 or dealing therewith shall be subject to the provisions of
18 Articles IIA and XII 1/2 and Sections 3.1, 133, 140, 143, 143c,
19 149, 155.37, 354, 355.2, 356g.5, 356r, 356t, 356u, 356v, 356w,
20 356x, 356y, 356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8,
21 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 364.01, 367.2,
22 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412, and
23 paragraphs (7) and (15) of Section 367 of the Illinois
24 Insurance Code.
25 (Source: P.A. 94-1076, eff. 12-29-06; 95-189, eff. 8-16-07;

 

 

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1 95-331, eff. 8-21-07; 95-422, eff. 8-24-07; 95-520, eff.
2 8-28-07; 95-876, eff. 8-21-08; 95-958, eff. 6-1-09.)
 
3     Section 95. No acceleration or delay. Where this Act makes
4 changes in a statute that is represented in this Act by text
5 that is not yet or no longer in effect (for example, a Section
6 represented by multiple versions), the use of that text does
7 not accelerate or delay the taking effect of (i) the changes
8 made by this Act or (ii) provisions derived from any other
9 Public Act.
 
10     Section 99. Effective date. This Act takes effect upon
11 becoming law.".