Full Text of HB1267 97th General Assembly
HB1267eng 97TH GENERAL ASSEMBLY |
| | HB1267 Engrossed | | LRB097 07252 RPM 47361 b |
|
| 1 | | AN ACT concerning insurance.
| 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, | 13 | | 356g.5, 356g.5-1, 356m,
356u, 356w, 356x, 356z.2, 356z.4, | 14 | | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, | 15 | | 356z.14, 356z.15, and 356z.17 , 356z.19, and 356z.20 of the
| 16 | | Illinois Insurance Code.
The program of health benefits must | 17 | | comply with Section 155.37 of the
Illinois Insurance Code.
| 18 | | Rulemaking authority to implement Public Act 95-1045, if | 19 | | any, is conditioned on the rules being adopted in accordance | 20 | | with all provisions of the Illinois Administrative Procedure | 21 | | Act and all rules and procedures of the Joint Committee on | 22 | | Administrative Rules; any purported rule not so adopted, for | 23 | | whatever reason, is unauthorized. |
| | | HB1267 Engrossed | - 2 - | LRB097 07252 RPM 47361 b |
|
| 1 | | (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; | 2 | | 95-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff. | 3 | | 6-1-09; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; 95-1044, | 4 | | eff. 3-26-09; 95-1045, eff. 3-27-09; 95-1049, eff. 1-1-10; | 5 | | 96-139, eff. 1-1-10; 96-328, eff. 8-11-09; 96-639, eff. 1-1-10; | 6 | | 96-1000, eff. 7-2-10.)
| 7 | | Section 10. The Counties Code is amended by changing | 8 | | Section 5-1069.3 as
follows:
| 9 | | (55 ILCS 5/5-1069.3)
| 10 | | Sec. 5-1069.3. Required health benefits. If a county, | 11 | | including a home
rule
county, is a self-insurer for purposes of | 12 | | providing health insurance coverage
for its employees, the | 13 | | coverage shall include coverage for the post-mastectomy
care | 14 | | benefits required to be covered by a policy of accident and | 15 | | health
insurance under Section 356t and the coverage required | 16 | | under Sections 356g, 356g.5, 356g.5-1, 356u,
356w, 356x, | 17 | | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, | 18 | | 356z.14, and 356z.15 , 356z.19, and 356z.20 of
the Illinois | 19 | | Insurance Code. The requirement that health benefits be covered
| 20 | | as provided in this Section is an
exclusive power and function | 21 | | of the State and is a denial and limitation under
Article VII, | 22 | | Section 6, subsection (h) of the Illinois Constitution. A home
| 23 | | rule county to which this Section applies must comply with | 24 | | every provision of
this Section.
|
| | | HB1267 Engrossed | - 3 - | LRB097 07252 RPM 47361 b |
|
| 1 | | Rulemaking authority to implement Public Act 95-1045, if | 2 | | any, is conditioned on the rules being adopted in accordance | 3 | | with all provisions of the Illinois Administrative Procedure | 4 | | Act and all rules and procedures of the Joint Committee on | 5 | | Administrative Rules; any purported rule not so adopted, for | 6 | | whatever reason, is unauthorized. | 7 | | (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; | 8 | | 95-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff. | 9 | | 6-1-09; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; 95-1045, | 10 | | eff. 3-27-09; 95-1049, eff. 1-1-10; 96-139, eff. 1-1-10; | 11 | | 96-328, eff. 8-11-09; 96-1000, eff. 7-2-10.)
| 12 | | Section 15. The Illinois Municipal Code is amended by | 13 | | changing Section
10-4-2.3 as follows:
| 14 | | (65 ILCS 5/10-4-2.3)
| 15 | | Sec. 10-4-2.3. Required health benefits. If a | 16 | | municipality, including a
home rule municipality, is a | 17 | | self-insurer for purposes of providing health
insurance | 18 | | coverage for its employees, the coverage shall include coverage | 19 | | for
the post-mastectomy care benefits required to be covered by | 20 | | a policy of
accident and health insurance under Section 356t | 21 | | and the coverage required
under Sections 356g, 356g.5, | 22 | | 356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10, | 23 | | 356z.11, 356z.12, 356z.13, 356z.14, and 356z.15 , 356z.19, and | 24 | | 356z.20 of the Illinois
Insurance
Code. The requirement that |
| | | HB1267 Engrossed | - 4 - | LRB097 07252 RPM 47361 b |
|
| 1 | | health
benefits be covered as provided in this is an exclusive | 2 | | power and function of
the State and is a denial and limitation | 3 | | under Article VII, Section 6,
subsection (h) of the Illinois | 4 | | Constitution. A home rule municipality to which
this Section | 5 | | applies must comply with every provision of this Section.
| 6 | | Rulemaking authority to implement Public Act 95-1045, if | 7 | | any, is conditioned on the rules being adopted in accordance | 8 | | with all provisions of the Illinois Administrative Procedure | 9 | | Act and all rules and procedures of the Joint Committee on | 10 | | Administrative Rules; any purported rule not so adopted, for | 11 | | whatever reason, is unauthorized. | 12 | | (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; | 13 | | 95-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff. | 14 | | 6-1-09; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; 95-1045, | 15 | | eff. 3-27-09; 95-1049, eff. 1-1-10; 96-139, eff. 1-1-10; | 16 | | 96-328, eff. 8-11-09; 96-1000, eff. 7-2-10.)
| 17 | | Section 20. The School Code is amended by changing Section | 18 | | 10-22.3f as
follows:
| 19 | | (105 ILCS 5/10-22.3f)
| 20 | | Sec. 10-22.3f. Required health benefits. Insurance | 21 | | protection and
benefits
for employees shall provide the | 22 | | post-mastectomy care benefits required to be
covered by a | 23 | | policy of accident and health insurance under Section 356t and | 24 | | the
coverage required under Sections 356g, 356g.5, 356g.5-1, |
| | | HB1267 Engrossed | - 5 - | LRB097 07252 RPM 47361 b |
|
| 1 | | 356u, 356w, 356x,
356z.6, 356z.8, 356z.9, 356z.11, 356z.12, | 2 | | 356z.13, 356z.14, and 356z.15 , 356z.19, and 356z.20 of
the
| 3 | | Illinois Insurance Code.
| 4 | | Rulemaking authority to implement Public Act 95-1045, if | 5 | | any, is conditioned on the rules being adopted in accordance | 6 | | with all provisions of the Illinois Administrative Procedure | 7 | | Act and all rules and procedures of the Joint Committee on | 8 | | Administrative Rules; any purported rule not so adopted, for | 9 | | whatever reason, is unauthorized. | 10 | | (Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; | 11 | | 95-876, eff. 8-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09; | 12 | | 95-1005, 12-12-08; 95-1045, eff. 3-27-09; 95-1049, eff. | 13 | | 1-1-10; 96-139, eff. 1-1-10; 96-328, eff. 8-11-09; 96-1000, | 14 | | eff. 7-2-10.)
| 15 | | Section 25. The Illinois Insurance Code is amended by | 16 | | adding Sections
356z.19
and 356z.20 as
follows:
| 17 | | (215 ILCS 5/356z.19 new)
| 18 | | Sec. 356z.19. Nutritional support and hydration. | 19 | | (a) The General Assembly finds that people who are | 20 | | physically unable to swallow, digest, or absorb food and fluids | 21 | | taken by mouth are at risk of malnutrition and dehydration. | 22 | | Without nutritional support and hydration, such individuals | 23 | | will become increasingly weakened. As their immune system | 24 | | functioning is reduced, they may die from infections before |
| | | HB1267 Engrossed | - 6 - | LRB097 07252 RPM 47361 b |
|
| 1 | | death can occur from malnutrition or dehydration. | 2 | | (b) A group or individual policy of
accident and health | 3 | | insurance or managed care plan amended, delivered, issued,
or | 4 | | renewed after the effective date of this amendatory Act of the | 5 | | 97th General
Assembly must provide coverage for intravenous | 6 | | feeding and for enteral or tube feeding. The benefits under
| 7 | | this Section shall be at least as favorable as for other | 8 | | coverages under the
policy and may be subject to the same | 9 | | dollar amount limits, deductibles, and
co-insurance | 10 | | requirements applicable generally to other coverages under the
| 11 | | policy. | 12 | | (c) For the purpose of this Section, "enteral or tube | 13 | | feeding" means the process by which nutritional formulas are | 14 | | delivered via a tube into the digestive tract. | 15 | | (215 ILCS 5/356z.20 new)
| 16 | | Sec. 356z.20. Prescription nutritional supplements. A | 17 | | group or individual
policy of
accident and health insurance or | 18 | | managed care plan amended, delivered, issued,
or renewed
after | 19 | | the effective date of this amendatory Act of the 97th General | 20 | | Assembly
that provides
coverage for prescription drugs must | 21 | | provide coverage for reimbursement for
medically
appropriate | 22 | | prescription nutritional supplements, limited to those | 23 | | products that are issued only by a physician's written order, | 24 | | when ordered by a physician
licensed to
practice medicine in | 25 | | all its branches and the insured suffers from a condition
that |
| | | HB1267 Engrossed | - 7 - | LRB097 07252 RPM 47361 b |
|
| 1 | | prevents
him or her from taking sufficient oral nourishment to | 2 | | sustain life.
| 3 | | Section 30. The Health Maintenance Organization Act is | 4 | | amended by changing
Section 5-3 as follows:
| 5 | | (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
| 6 | | Sec. 5-3. Insurance Code provisions.
| 7 | | (a) Health Maintenance Organizations
shall be subject to | 8 | | the provisions of Sections 133, 134, 137, 140, 141.1,
141.2, | 9 | | 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, 154, 154.5, | 10 | | 154.6,
154.7, 154.8, 155.04, 355.2, 356g.5-1, 356m, 356v, 356w, | 11 | | 356x, 356y,
356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9, | 12 | | 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, | 13 | | 356z.18, 356z.19, 356z.20, 364.01, 367.2, 367.2-5, 367i, 368a, | 14 | | 368b, 368c, 368d, 368e, 370c,
401, 401.1, 402, 403, 403A,
408, | 15 | | 408.2, 409, 412, 444,
and
444.1,
paragraph (c) of subsection | 16 | | (2) of Section 367, and Articles IIA, VIII 1/2,
XII,
XII 1/2, | 17 | | XIII, XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.
| 18 | | (b) For purposes of the Illinois Insurance Code, except for | 19 | | Sections 444
and 444.1 and Articles XIII and XIII 1/2, Health | 20 | | Maintenance Organizations in
the following categories are | 21 | | deemed to be "domestic companies":
| 22 | | (1) a corporation authorized under the
Dental Service | 23 | | Plan Act or the Voluntary Health Services Plans Act;
| 24 | | (2) a corporation organized under the laws of this |
| | | HB1267 Engrossed | - 8 - | LRB097 07252 RPM 47361 b |
|
| 1 | | State; or
| 2 | | (3) a corporation organized under the laws of another | 3 | | state, 30% or more
of the enrollees of which are residents | 4 | | of this State, except a
corporation subject to | 5 | | substantially the same requirements in its state of
| 6 | | organization as is a "domestic company" under Article VIII | 7 | | 1/2 of the
Illinois Insurance Code.
| 8 | | (c) In considering the merger, consolidation, or other | 9 | | acquisition of
control of a Health Maintenance Organization | 10 | | pursuant to Article VIII 1/2
of the Illinois Insurance Code,
| 11 | | (1) the Director shall give primary consideration to | 12 | | the continuation of
benefits to enrollees and the financial | 13 | | conditions of the acquired Health
Maintenance Organization | 14 | | after the merger, consolidation, or other
acquisition of | 15 | | control takes effect;
| 16 | | (2)(i) the criteria specified in subsection (1)(b) of | 17 | | Section 131.8 of
the Illinois Insurance Code shall not | 18 | | apply and (ii) the Director, in making
his determination | 19 | | with respect to the merger, consolidation, or other
| 20 | | acquisition of control, need not take into account the | 21 | | effect on
competition of the merger, consolidation, or | 22 | | other acquisition of control;
| 23 | | (3) the Director shall have the power to require the | 24 | | following
information:
| 25 | | (A) certification by an independent actuary of the | 26 | | adequacy
of the reserves of the Health Maintenance |
| | | HB1267 Engrossed | - 9 - | LRB097 07252 RPM 47361 b |
|
| 1 | | Organization sought to be acquired;
| 2 | | (B) pro forma financial statements reflecting the | 3 | | combined balance
sheets of the acquiring company and | 4 | | the Health Maintenance Organization sought
to be | 5 | | acquired as of the end of the preceding year and as of | 6 | | a date 90 days
prior to the acquisition, as well as pro | 7 | | forma financial statements
reflecting projected | 8 | | combined operation for a period of 2 years;
| 9 | | (C) a pro forma business plan detailing an | 10 | | acquiring party's plans with
respect to the operation | 11 | | of the Health Maintenance Organization sought to
be | 12 | | acquired for a period of not less than 3 years; and
| 13 | | (D) such other information as the Director shall | 14 | | require.
| 15 | | (d) The provisions of Article VIII 1/2 of the Illinois | 16 | | Insurance Code
and this Section 5-3 shall apply to the sale by | 17 | | any health maintenance
organization of greater than 10% of its
| 18 | | enrollee population (including without limitation the health | 19 | | maintenance
organization's right, title, and interest in and to | 20 | | its health care
certificates).
| 21 | | (e) In considering any management contract or service | 22 | | agreement subject
to Section 141.1 of the Illinois Insurance | 23 | | Code, the Director (i) shall, in
addition to the criteria | 24 | | specified in Section 141.2 of the Illinois
Insurance Code, take | 25 | | into account the effect of the management contract or
service | 26 | | agreement on the continuation of benefits to enrollees and the
|
| | | HB1267 Engrossed | - 10 - | LRB097 07252 RPM 47361 b |
|
| 1 | | financial condition of the health maintenance organization to | 2 | | be managed or
serviced, and (ii) need not take into account the | 3 | | effect of the management
contract or service agreement on | 4 | | competition.
| 5 | | (f) Except for small employer groups as defined in the | 6 | | Small Employer
Rating, Renewability and Portability Health | 7 | | Insurance Act and except for
medicare supplement policies as | 8 | | defined in Section 363 of the Illinois
Insurance Code, a Health | 9 | | Maintenance Organization may by contract agree with a
group or | 10 | | other enrollment unit to effect refunds or charge additional | 11 | | premiums
under the following terms and conditions:
| 12 | | (i) the amount of, and other terms and conditions with | 13 | | respect to, the
refund or additional premium are set forth | 14 | | in the group or enrollment unit
contract agreed in advance | 15 | | of the period for which a refund is to be paid or
| 16 | | additional premium is to be charged (which period shall not | 17 | | be less than one
year); and
| 18 | | (ii) the amount of the refund or additional premium | 19 | | shall not exceed 20%
of the Health Maintenance | 20 | | Organization's profitable or unprofitable experience
with | 21 | | respect to the group or other enrollment unit for the | 22 | | period (and, for
purposes of a refund or additional | 23 | | premium, the profitable or unprofitable
experience shall | 24 | | be calculated taking into account a pro rata share of the
| 25 | | Health Maintenance Organization's administrative and | 26 | | marketing expenses, but
shall not include any refund to be |
| | | HB1267 Engrossed | - 11 - | LRB097 07252 RPM 47361 b |
|
| 1 | | made or additional premium to be paid
pursuant to this | 2 | | subsection (f)). The Health Maintenance Organization and | 3 | | the
group or enrollment unit may agree that the profitable | 4 | | or unprofitable
experience may be calculated taking into | 5 | | account the refund period and the
immediately preceding 2 | 6 | | plan years.
| 7 | | The Health Maintenance Organization shall include a | 8 | | statement in the
evidence of coverage issued to each enrollee | 9 | | describing the possibility of a
refund or additional premium, | 10 | | and upon request of any group or enrollment unit,
provide to | 11 | | the group or enrollment unit a description of the method used | 12 | | to
calculate (1) the Health Maintenance Organization's | 13 | | profitable experience with
respect to the group or enrollment | 14 | | unit and the resulting refund to the group
or enrollment unit | 15 | | or (2) the Health Maintenance Organization's unprofitable
| 16 | | experience with respect to the group or enrollment unit and the | 17 | | resulting
additional premium to be paid by the group or | 18 | | enrollment unit.
| 19 | | In no event shall the Illinois Health Maintenance | 20 | | Organization
Guaranty Association be liable to pay any | 21 | | contractual obligation of an
insolvent organization to pay any | 22 | | refund authorized under this Section.
| 23 | | (g) Rulemaking authority to implement Public Act 95-1045, | 24 | | if any, is conditioned on the rules being adopted in accordance | 25 | | with all provisions of the Illinois Administrative Procedure | 26 | | Act and all rules and procedures of the Joint Committee on |
| | | HB1267 Engrossed | - 12 - | LRB097 07252 RPM 47361 b |
|
| 1 | | Administrative Rules; any purported rule not so adopted, for | 2 | | whatever reason, is unauthorized. | 3 | | (Source: P.A. 95-422, eff. 8-24-07; 95-520, eff. 8-28-07; | 4 | | 95-876, eff. 8-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09; | 5 | | 95-1005, eff. 12-12-08; 95-1045, eff. 3-27-09; 95-1049, eff. | 6 | | 1-1-10; 96-328, eff. 8-11-09; 96-639, eff. 1-1-10; 96-833, eff. | 7 | | 6-1-10; 96-1000, eff. 7-2-10.)
| 8 | | Section 35. The Voluntary Health Services Plans Act is | 9 | | amended by changing
Section 10 as follows:
| 10 | | (215 ILCS 165/10) (from Ch. 32, par. 604)
| 11 | | Sec. 10. Application of Insurance Code provisions. Health | 12 | | services
plan corporations and all persons interested therein | 13 | | or dealing therewith
shall be subject to the provisions of | 14 | | Articles IIA and XII 1/2 and Sections
3.1, 133, 140, 143, 143c, | 15 | | 149, 155.37, 354, 355.2, 356g, 356g.5, 356g.5-1, 356r, 356t, | 16 | | 356u, 356v,
356w, 356x, 356y, 356z.1, 356z.2, 356z.4, 356z.5, | 17 | | 356z.6, 356z.8, 356z.9,
356z.10, 356z.11, 356z.12, 356z.13, | 18 | | 356z.14, 356z.15, 356z.18, 356z.19, 356z.20, 364.01, 367.2, | 19 | | 368a, 401, 401.1,
402,
403, 403A, 408,
408.2, and 412, and | 20 | | paragraphs (7) and (15) of Section 367 of the Illinois
| 21 | | Insurance Code.
| 22 | | Rulemaking authority to implement Public Act 95-1045, if | 23 | | any, is conditioned on the rules being adopted in accordance | 24 | | with all provisions of the Illinois Administrative Procedure |
| | | HB1267 Engrossed | - 13 - | LRB097 07252 RPM 47361 b |
|
| 1 | | Act and all rules and procedures of the Joint Committee on | 2 | | Administrative Rules; any purported rule not so adopted, for | 3 | | whatever reason, is unauthorized. | 4 | | (Source: P.A. 95-189, eff. 8-16-07; 95-331, eff. 8-21-07; | 5 | | 95-422, eff. 8-24-07; 95-520, eff. 8-28-07; 95-876, eff. | 6 | | 8-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09; 95-1005, | 7 | | eff. 12-12-08; 95-1045, eff. 3-27-09; 95-1049, eff. 1-1-10; | 8 | | 96-328, eff. 8-11-09; 96-833, eff. 6-1-10; 96-1000, eff. | 9 | | 7-2-10.)
| 10 | | Section 90. The State Mandates Act is amended by adding | 11 | | Section 8.35 as follows: | 12 | | (30 ILCS 805/8.35 new) | 13 | | Sec. 8.35. Exempt mandate. Notwithstanding Sections 6 and 8 | 14 | | of this Act, no reimbursement by the State is required for the | 15 | | implementation of any mandate created by this amendatory Act of | 16 | | the 97th General Assembly.
|
|