Full Text of HB5285 95th General Assembly
HB5285enr 95TH GENERAL ASSEMBLY
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HB5285 Enrolled |
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| AN ACT concerning regulation.
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| Be it enacted by the People of the State of Illinois,
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| represented in the General Assembly:
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| Section 5. The State Employees Group Insurance Act of 1971 | 5 |
| is amended by changing Section 6.11 as follows:
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| (5 ILCS 375/6.11)
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| 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,
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| 356u, 356w, 356x, 356z.2, 356z.4, 356z.6, and 356z.9, 356z.10, | 14 |
| and 356z.11 and
356z.9 of the
Illinois Insurance Code.
The | 15 |
| program of health benefits must comply with Section 155.37 of | 16 |
| the
Illinois Insurance Code.
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| (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.)
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| 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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| 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, 356u,
356w, 356x, 356z.6, and 356z.9, | 8 |
| 356z.10, and 356z.11 and
356z.9 of
the Illinois Insurance Code. | 9 |
| The requirement that health benefits be covered
as provided in | 10 |
| this Section is an
exclusive power and function of the State | 11 |
| and is 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.
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| (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.)
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| 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)
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| 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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| a policy of
accident and health insurance under Section 356t | 2 |
| and the coverage required
under Sections 356g.5, 356u, 356w, | 3 |
| 356x, 356z.6, and 356z.9, 356z.10, and 356z.11 and
356z.9 of | 4 |
| the Illinois
Insurance
Code. The requirement that health
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| benefits be covered as provided in this is an exclusive power | 6 |
| and 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.
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| (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.)
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| Section 20. The School Code is amended by changing Section | 13 |
| 10-22.3f as follows: | 14 |
| (105 ILCS 5/10-22.3f)
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| 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, 356u, 356w, 356x,
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| 356z.6, and 356z.9 , and 356z.11 of
the
Illinois Insurance Code.
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| (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; | 22 |
| revised 12-4-07.)
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| Section 25. The Illinois Insurance Code is amended by |
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| adding Section 356z.11 as follows: | 2 |
| (215 ILCS 5/356z.11 new) | 3 |
| Sec. 356z.11. Dependent students; medical leave of | 4 |
| absence. A group or individual policy of accident and health | 5 |
| insurance or managed care plan amended, delivered, issued, or | 6 |
| renewed after the effective date of this amendatory Act of the | 7 |
| 95th General Assembly must continue to provide coverage for a | 8 |
| dependent college student who takes a medical leave of absence | 9 |
| or reduces his or her course load to part-time status because | 10 |
| of a catastrophic illness or injury. | 11 |
| Continuation of coverage under this Section is subject to | 12 |
| all of the policy's terms and
conditions applicable to those | 13 |
| forms of insurance. Continuation of insurance under the policy | 14 |
| shall terminate 12 months after notice of the illness or injury | 15 |
| or until the coverage would have otherwise lapsed pursuant to | 16 |
| the terms and conditions of the policy, whichever comes first, | 17 |
| provided the need for part-time status or medical leave of | 18 |
| absence is supported by a clinical certification of need from a | 19 |
| physician licensed to practice medicine in all its branches. | 20 |
| The provisions of this Section do not apply to short-term | 21 |
| travel, accident-only, limited, or specified disease policies | 22 |
| or to policies or contracts designed for issuance to persons | 23 |
| eligible for coverage under Title XVIII of the Social Security | 24 |
| Act, known as Medicare, or any other similar coverage under | 25 |
| State or federal governmental plans. |
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| Section 30. The Health Maintenance Organization Act is | 2 |
| amended by changing Section 5-3 as follows:
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| (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
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| Sec. 5-3. Insurance Code provisions.
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| (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.9 , 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c, | 11 |
| 368d, 368e, 370c,
401, 401.1, 402, 403, 403A,
408, 408.2, 409, | 12 |
| 412, 444,
and
444.1,
paragraph (c) of subsection (2) of Section | 13 |
| 367, and Articles IIA, VIII 1/2,
XII,
XII 1/2, XIII, XIII 1/2, | 14 |
| XXV, and XXVI of the Illinois Insurance Code.
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| (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":
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| (1) a corporation authorized under the
Dental Service | 20 |
| Plan Act or the Voluntary Health Services Plans Act;
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| (2) a corporation organized under the laws of this | 22 |
| State; or
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| (3) a corporation organized under the laws of another | 24 |
| state, 30% or more
of the enrollees of which are residents |
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| of this State, except a
corporation subject to | 2 |
| substantially the same requirements in its state of
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| organization as is a "domestic company" under Article VIII | 4 |
| 1/2 of the
Illinois Insurance Code.
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| (c) In considering the merger, consolidation, or other | 6 |
| acquisition of
control of a Health Maintenance Organization | 7 |
| pursuant to Article VIII 1/2
of the Illinois Insurance Code,
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| (1) the Director shall give primary consideration to | 9 |
| the continuation of
benefits to enrollees and the financial | 10 |
| conditions of the acquired Health
Maintenance Organization | 11 |
| after the merger, consolidation, or other
acquisition of | 12 |
| control takes effect;
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| (2)(i) the criteria specified in subsection (1)(b) of | 14 |
| Section 131.8 of
the Illinois Insurance Code shall not | 15 |
| apply and (ii) the Director, in making
his determination | 16 |
| with respect to the merger, consolidation, or other
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| acquisition of control, need not take into account the | 18 |
| effect on
competition of the merger, consolidation, or | 19 |
| other acquisition of control;
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| (3) the Director shall have the power to require the | 21 |
| following
information:
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| (A) certification by an independent actuary of the | 23 |
| adequacy
of the reserves of the Health Maintenance | 24 |
| Organization sought to be acquired;
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| (B) pro forma financial statements reflecting the | 26 |
| combined balance
sheets of the acquiring company and |
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| the Health Maintenance Organization sought
to be | 2 |
| acquired as of the end of the preceding year and as of | 3 |
| a date 90 days
prior to the acquisition, as well as pro | 4 |
| forma financial statements
reflecting projected | 5 |
| combined operation for a period of 2 years;
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| (C) a pro forma business plan detailing an | 7 |
| acquiring party's plans with
respect to the operation | 8 |
| of the Health Maintenance Organization sought to
be | 9 |
| acquired for a period of not less than 3 years; and
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| (D) such other information as the Director shall | 11 |
| require.
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| (d) The provisions of Article VIII 1/2 of the Illinois | 13 |
| Insurance Code
and this Section 5-3 shall apply to the sale by | 14 |
| any health maintenance
organization of greater than 10% of its
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| enrollee population (including without limitation the health | 16 |
| maintenance
organization's right, title, and interest in and to | 17 |
| its health care
certificates).
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| (e) In considering any management contract or service | 19 |
| agreement subject
to Section 141.1 of the Illinois Insurance | 20 |
| Code, the Director (i) shall, in
addition to the criteria | 21 |
| specified in Section 141.2 of the Illinois
Insurance Code, take | 22 |
| into account the effect of the management contract or
service | 23 |
| agreement on the continuation of benefits to enrollees and the
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| financial condition of the health maintenance organization to | 25 |
| be managed or
serviced, and (ii) need not take into account the | 26 |
| effect of the management
contract or service agreement on |
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| competition.
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| (f) Except for small employer groups as defined in the | 3 |
| Small Employer
Rating, Renewability and Portability Health | 4 |
| Insurance Act and except for
medicare supplement policies as | 5 |
| defined in Section 363 of the Illinois
Insurance Code, a Health | 6 |
| Maintenance Organization may by contract agree with a
group or | 7 |
| other enrollment unit to effect refunds or charge additional | 8 |
| premiums
under the following terms and conditions:
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| (i) the amount of, and other terms and conditions with | 10 |
| respect to, the
refund or additional premium are set forth | 11 |
| in the group or enrollment unit
contract agreed in advance | 12 |
| of the period for which a refund is to be paid or
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| additional premium is to be charged (which period shall not | 14 |
| be less than one
year); and
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| (ii) the amount of the refund or additional premium | 16 |
| shall not exceed 20%
of the Health Maintenance | 17 |
| Organization's profitable or unprofitable experience
with | 18 |
| respect to the group or other enrollment unit for the | 19 |
| period (and, for
purposes of a refund or additional | 20 |
| premium, the profitable or unprofitable
experience shall | 21 |
| be calculated taking into account a pro rata share of the
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| Health Maintenance Organization's administrative and | 23 |
| marketing expenses, but
shall not include any refund to be | 24 |
| made or additional premium to be paid
pursuant to this | 25 |
| subsection (f)). The Health Maintenance Organization and | 26 |
| the
group or enrollment unit may agree that the profitable |
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| or unprofitable
experience may be calculated taking into | 2 |
| account the refund period and the
immediately preceding 2 | 3 |
| plan years.
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| The Health Maintenance Organization shall include a | 5 |
| statement in the
evidence of coverage issued to each enrollee | 6 |
| describing the possibility of a
refund or additional premium, | 7 |
| and upon request of any group or enrollment unit,
provide to | 8 |
| the group or enrollment unit a description of the method used | 9 |
| to
calculate (1) the Health Maintenance Organization's | 10 |
| profitable experience with
respect to the group or enrollment | 11 |
| unit and the resulting refund to the group
or enrollment unit | 12 |
| or (2) the Health Maintenance Organization's unprofitable
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| experience with respect to the group or enrollment unit and the | 14 |
| resulting
additional premium to be paid by the group or | 15 |
| enrollment unit.
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| In no event shall the Illinois Health Maintenance | 17 |
| Organization
Guaranty Association be liable to pay any | 18 |
| contractual obligation of an
insolvent organization to pay any | 19 |
| refund authorized under this Section.
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| (Source: P.A. 94-906, eff. 1-1-07; 94-1076, eff. 12-29-06; | 21 |
| 95-422, eff. 8-24-07; 95-520, eff. 8-28-07; revised 12-4-07.)
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| Section 35. The Voluntary Health Services Plans Act is | 23 |
| amended by changing Section 10 as follows:
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| (215 ILCS 165/10) (from Ch. 32, par. 604)
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HB5285 Enrolled |
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| Sec. 10. Application of Insurance Code provisions. Health | 2 |
| services
plan corporations and all persons interested therein | 3 |
| or dealing therewith
shall be subject to the provisions of | 4 |
| Articles IIA and XII 1/2 and Sections
3.1, 133, 140, 143, 143c, | 5 |
| 149, 155.37, 354, 355.2, 356g.5, 356r, 356t, 356u, 356v,
356w, | 6 |
| 356x, 356y, 356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, | 7 |
| 356z.9,
356z.10, 356z.11
356z.9 , 364.01, 367.2, 368a, 401, | 8 |
| 401.1,
402,
403, 403A, 408,
408.2, and 412, and paragraphs (7) | 9 |
| and (15) of Section 367 of the Illinois
Insurance Code.
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| (Source: P.A. 94-1076, eff. 12-29-06; 95-189, eff. 8-16-07; | 11 |
| 95-331, eff. 8-21-07; 95-422, eff. 8-24-07; 95-520, eff. | 12 |
| 8-28-07; revised 12-5-07.)
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