Full Text of SB1211 95th General Assembly
SB1211 95TH GENERAL ASSEMBLY
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95TH GENERAL ASSEMBLY
State of Illinois
2007 and 2008 SB1211
Introduced 2/9/2007, by Sen. Dale E. Risinger SYNOPSIS AS INTRODUCED: |
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215 ILCS 5/356z.9 new |
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215 ILCS 125/5-3 |
from Ch. 111 1/2, par. 1411.2 |
215 ILCS 165/10 |
from Ch. 32, par. 604 |
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Amends the Illinois Insurance Code, the Health Maintenance Organization Act, and the Voluntary Health Services Plans Act to provide coverage for federally approved Continuous Glucose Monitoring Systems. Effective immediately.
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A BILL FOR
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SB1211 |
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LRB095 09749 KBJ 29957 b |
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| AN ACT concerning insurance.
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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 Illinois Insurance Code is amended by adding | 5 |
| Section 356z.9 as follows: | 6 |
| (215 ILCS 5/356z.9 new) | 7 |
| Sec. 356z.9. Continuous Glucose Monitoring Systems. A | 8 |
| group or individual policy of accident and health insurance or | 9 |
| managed care plan amended, delivered, issued, or renewed after | 10 |
| the effective date of this amendatory Act of the 95th General | 11 |
| Assembly must provide coverage for Continuous Glucose | 12 |
| Monitoring Systems approved by the federal Food and Drug | 13 |
| Administration. | 14 |
| Section 10. The Health Maintenance Organization Act is | 15 |
| 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 | 19 |
| the provisions of Sections 133, 134, 137, 140, 141.1,
141.2, | 20 |
| 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, 154, 154.5, | 21 |
| 154.6,
154.7, 154.8, 155.04, 355.2, 356m, 356v, 356w, 356x, |
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| 356y,
356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9, 364.01, | 2 |
| 367.2, 367.2-5, 367i, 368a, 368b, 368c, 368d, 368e, 370c,
401, | 3 |
| 401.1, 402, 403, 403A,
408, 408.2, 409, 412, 444,
and
444.1,
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| paragraph (c) of subsection (2) of Section 367, and Articles | 5 |
| IIA, VIII 1/2,
XII,
XII 1/2, XIII, XIII 1/2, XXV, and XXVI of | 6 |
| the Illinois Insurance Code.
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| (b) For purposes of the Illinois Insurance Code, except for | 8 |
| Sections 444
and 444.1 and Articles XIII and XIII 1/2, Health | 9 |
| Maintenance Organizations in
the following categories are | 10 |
| deemed to be "domestic companies":
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| (1) a corporation authorized under the
Dental Service | 12 |
| Plan Act or the Voluntary Health Services Plans Act;
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| (2) a corporation organized under the laws of this | 14 |
| State; or
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| (3) a corporation organized under the laws of another | 16 |
| state, 30% or more
of the enrollees of which are residents | 17 |
| of this State, except a
corporation subject to | 18 |
| substantially the same requirements in its state of
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| organization as is a "domestic company" under Article VIII | 20 |
| 1/2 of the
Illinois Insurance Code.
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| (c) In considering the merger, consolidation, or other | 22 |
| acquisition of
control of a Health Maintenance Organization | 23 |
| pursuant to Article VIII 1/2
of the Illinois Insurance Code,
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| (1) the Director shall give primary consideration to | 25 |
| the continuation of
benefits to enrollees and the financial | 26 |
| conditions of the acquired Health
Maintenance Organization |
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| after the merger, consolidation, or other
acquisition of | 2 |
| control takes effect;
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| (2)(i) the criteria specified in subsection (1)(b) of | 4 |
| Section 131.8 of
the Illinois Insurance Code shall not | 5 |
| apply and (ii) the Director, in making
his determination | 6 |
| with respect to the merger, consolidation, or other
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| acquisition of control, need not take into account the | 8 |
| effect on
competition of the merger, consolidation, or | 9 |
| other acquisition of control;
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| (3) the Director shall have the power to require the | 11 |
| following
information:
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| (A) certification by an independent actuary of the | 13 |
| adequacy
of the reserves of the Health Maintenance | 14 |
| Organization sought to be acquired;
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| (B) pro forma financial statements reflecting the | 16 |
| combined balance
sheets of the acquiring company and | 17 |
| the Health Maintenance Organization sought
to be | 18 |
| acquired as of the end of the preceding year and as of | 19 |
| a date 90 days
prior to the acquisition, as well as pro | 20 |
| forma financial statements
reflecting projected | 21 |
| combined operation for a period of 2 years;
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| (C) a pro forma business plan detailing an | 23 |
| acquiring party's plans with
respect to the operation | 24 |
| of the Health Maintenance Organization sought to
be | 25 |
| acquired for a period of not less than 3 years; and
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| (D) such other information as the Director shall |
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| require.
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| (d) The provisions of Article VIII 1/2 of the Illinois | 3 |
| Insurance Code
and this Section 5-3 shall apply to the sale by | 4 |
| any health maintenance
organization of greater than 10% of its
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| enrollee population (including without limitation the health | 6 |
| maintenance
organization's right, title, and interest in and to | 7 |
| its health care
certificates).
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| (e) In considering any management contract or service | 9 |
| agreement subject
to Section 141.1 of the Illinois Insurance | 10 |
| Code, the Director (i) shall, in
addition to the criteria | 11 |
| specified in Section 141.2 of the Illinois
Insurance Code, take | 12 |
| into account the effect of the management contract or
service | 13 |
| agreement on the continuation of benefits to enrollees and the
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| financial condition of the health maintenance organization to | 15 |
| be managed or
serviced, and (ii) need not take into account the | 16 |
| effect of the management
contract or service agreement on | 17 |
| competition.
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| (f) Except for small employer groups as defined in the | 19 |
| Small Employer
Rating, Renewability and Portability Health | 20 |
| Insurance Act and except for
medicare supplement policies as | 21 |
| defined in Section 363 of the Illinois
Insurance Code, a Health | 22 |
| Maintenance Organization may by contract agree with a
group or | 23 |
| other enrollment unit to effect refunds or charge additional | 24 |
| premiums
under the following terms and conditions:
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| (i) the amount of, and other terms and conditions with | 26 |
| respect to, the
refund or additional premium are set forth |
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| in the group or enrollment unit
contract agreed in advance | 2 |
| 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 | 4 |
| be less than one
year); and
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| (ii) the amount of the refund or additional premium | 6 |
| shall not exceed 20%
of the Health Maintenance | 7 |
| Organization's profitable or unprofitable experience
with | 8 |
| respect to the group or other enrollment unit for the | 9 |
| period (and, for
purposes of a refund or additional | 10 |
| premium, the profitable or unprofitable
experience shall | 11 |
| be calculated taking into account a pro rata share of the
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| Health Maintenance Organization's administrative and | 13 |
| marketing expenses, but
shall not include any refund to be | 14 |
| made or additional premium to be paid
pursuant to this | 15 |
| subsection (f)). The Health Maintenance Organization and | 16 |
| the
group or enrollment unit may agree that the profitable | 17 |
| or unprofitable
experience may be calculated taking into | 18 |
| account the refund period and the
immediately preceding 2 | 19 |
| plan years.
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| The Health Maintenance Organization shall include a | 21 |
| statement in the
evidence of coverage issued to each enrollee | 22 |
| describing the possibility of a
refund or additional premium, | 23 |
| and upon request of any group or enrollment unit,
provide to | 24 |
| the group or enrollment unit a description of the method used | 25 |
| to
calculate (1) the Health Maintenance Organization's | 26 |
| profitable experience with
respect to the group or enrollment |
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| unit and the resulting refund to the group
or enrollment unit | 2 |
| or (2) the Health Maintenance Organization's unprofitable
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| experience with respect to the group or enrollment unit and the | 4 |
| resulting
additional premium to be paid by the group or | 5 |
| enrollment unit.
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| In no event shall the Illinois Health Maintenance | 7 |
| Organization
Guaranty Association be liable to pay any | 8 |
| contractual obligation of an
insolvent organization to pay any | 9 |
| refund authorized under this Section.
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| (Source: P.A. 93-102, eff. 1-1-04; 93-261, eff. 1-1-04; 93-477, | 11 |
| eff. 8-8-03; 93-529, eff. 8-14-03; 93-853, eff. 1-1-05; | 12 |
| 93-1000, eff. 1-1-05; 94-906, eff. 1-1-07; 94-1076, eff. | 13 |
| 12-29-06; revised 1-5-07.)
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| Section 15. The Voluntary Health Services Plans Act is | 15 |
| amended by changing Section 10 as follows:
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| (215 ILCS 165/10) (from Ch. 32, par. 604)
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| Sec. 10. Application of Insurance Code provisions. Health | 18 |
| services
plan corporations and all persons interested therein | 19 |
| or dealing therewith
shall be subject to the provisions of | 20 |
| Articles IIA and XII 1/2 and Sections
3.1, 133, 140, 143, 143c, | 21 |
| 149, 155.37, 354, 355.2, 356r, 356t, 356u, 356v,
356w, 356x, | 22 |
| 356y, 356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9, | 23 |
| 364.01, 367.2, 368a, 401, 401.1,
402,
403, 403A, 408,
408.2, | 24 |
| and 412, and paragraphs (7) and (15) of Section 367 of the |
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| Illinois
Insurance Code.
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| (Source: P.A. 93-102, eff. 1-1-04; 93-529, eff. 8-14-03; | 3 |
| 93-853, eff. 1-1-05; 93-1000, eff. 1-1-05; 94-1076, eff. | 4 |
| 12-29-06.)
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| Section 99. Effective date. This Act takes effect upon | 6 |
| becoming law.
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