Illinois General Assembly - Full Text of HB5254
Illinois General Assembly

  Bills & Resolutions  
  Compiled Statutes  
  Public Acts  
  Legislative Reports  
  IL Constitution  
  Legislative Guide  
  Legislative Glossary  

 Search By Number
 (example: HB0001)
Search Tips

Search By Keyword

Full Text of HB5254  102nd General Assembly

HB5254ham001 102ND GENERAL ASSEMBLY

Rep. Keith R. Wheeler

Filed: 2/17/2022

 

 


 

 


 
10200HB5254ham001LRB102 25494 BMS 36316 a

1
AMENDMENT TO HOUSE BILL 5254

2    AMENDMENT NO. ______. Amend House Bill 5254 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The State Employees Group Insurance Act of
51971 is amended by changing Section 6.11 as follows:
 
6    (5 ILCS 375/6.11)
7    Sec. 6.11. Required health benefits; Illinois Insurance
8Code requirements. The program of health benefits shall
9provide the post-mastectomy care benefits required to be
10covered by a policy of accident and health insurance under
11Section 356t of the Illinois Insurance Code. The program of
12health benefits shall provide the coverage required under
13Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x,
14356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
15356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,
16356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,

 

 

10200HB5254ham001- 2 -LRB102 25494 BMS 36316 a

1356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
2and 356z.53 and 356z.43 of the Illinois Insurance Code. The
3program of health benefits must comply with Sections 155.22a,
4155.37, 355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of
5the Illinois Insurance Code. The Department of Insurance shall
6enforce the requirements of this Section with respect to
7Sections 370c and 370c.1 of the Illinois Insurance Code; all
8other requirements of this Section shall be enforced by the
9Department of Central Management Services.
10    Rulemaking authority to implement Public Act 95-1045, if
11any, is conditioned on the rules being adopted in accordance
12with all provisions of the Illinois Administrative Procedure
13Act and all rules and procedures of the Joint Committee on
14Administrative Rules; any purported rule not so adopted, for
15whatever reason, is unauthorized.
16(Source: P.A. 101-13, eff. 6-12-19; 101-281, eff. 1-1-20;
17101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
181-1-20; 101-625, eff. 1-1-21; 102-30, eff. 1-1-22; 102-103,
19eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
20102-642, eff. 1-1-22; 102-665, eff. 10-8-21; revised
2110-26-21.)
 
22    Section 10. The Counties Code is amended by changing
23Section 5-1069.3 as follows:
 
24    (55 ILCS 5/5-1069.3)

 

 

10200HB5254ham001- 3 -LRB102 25494 BMS 36316 a

1    Sec. 5-1069.3. Required health benefits. If a county,
2including a home rule county, is a self-insurer for purposes
3of providing health insurance coverage for its employees, the
4coverage shall include coverage for the post-mastectomy care
5benefits required to be covered by a policy of accident and
6health insurance under Section 356t and the coverage required
7under Sections 356g, 356g.5, 356g.5-1, 356q, 356u, 356w, 356x,
8356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
9356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
10356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
11356z.45, 356z.46, 356z.47, 356z.48, 356z.51, and 356z.53 and
12356z.43 of the Illinois Insurance Code. The coverage shall
13comply with Sections 155.22a, 355b, 356z.19, and 370c of the
14Illinois Insurance Code. The Department of Insurance shall
15enforce the requirements of this Section. The requirement that
16health benefits be covered as provided in this Section is an
17exclusive power and function of the State and is a denial and
18limitation under Article VII, Section 6, subsection (h) of the
19Illinois Constitution. A home rule county to which this
20Section applies must comply with every provision of this
21Section.
22    Rulemaking authority to implement Public Act 95-1045, if
23any, is conditioned on the rules being adopted in accordance
24with all provisions of the Illinois Administrative Procedure
25Act and all rules and procedures of the Joint Committee on
26Administrative Rules; any purported rule not so adopted, for

 

 

10200HB5254ham001- 4 -LRB102 25494 BMS 36316 a

1whatever reason, is unauthorized.
2(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
3101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
41-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
5eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22;
6102-642, eff. 1-1-22; 102-665, eff. 10-8-21; revised
710-26-21.)
 
8    Section 15. The Illinois Municipal Code is amended by
9changing Section 10-4-2.3 as follows:
 
10    (65 ILCS 5/10-4-2.3)
11    Sec. 10-4-2.3. Required health benefits. If a
12municipality, including a home rule municipality, is a
13self-insurer for purposes of providing health insurance
14coverage for its employees, the coverage shall include
15coverage for the post-mastectomy care benefits required to be
16covered by a policy of accident and health insurance under
17Section 356t and the coverage required under Sections 356g,
18356g.5, 356g.5-1, 356q, 356u, 356w, 356x, 356z.6, 356z.8,
19356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
20356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32,
21356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
22356z.48, 356z.51, and 356z.53 and 356z.43 of the Illinois
23Insurance Code. The coverage shall comply with Sections
24155.22a, 355b, 356z.19, and 370c of the Illinois Insurance

 

 

10200HB5254ham001- 5 -LRB102 25494 BMS 36316 a

1Code. The Department of Insurance shall enforce the
2requirements of this Section. The requirement that health
3benefits be covered as provided in this is an exclusive power
4and function of the State and is a denial and limitation under
5Article VII, Section 6, subsection (h) of the Illinois
6Constitution. A home rule municipality to which this Section
7applies must comply with every provision of this Section.
8    Rulemaking authority to implement Public Act 95-1045, if
9any, is conditioned on the rules being adopted in accordance
10with all provisions of the Illinois Administrative Procedure
11Act and all rules and procedures of the Joint Committee on
12Administrative Rules; any purported rule not so adopted, for
13whatever reason, is unauthorized.
14(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
15101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
161-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
17eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22;
18102-642, eff. 1-1-22; 102-665, eff. 10-8-21; revised
1910-26-21.)
 
20    Section 20. The School Code is amended by changing Section
2110-22.3f as follows:
 
22    (105 ILCS 5/10-22.3f)
23    Sec. 10-22.3f. Required health benefits. Insurance
24protection and benefits for employees shall provide the

 

 

10200HB5254ham001- 6 -LRB102 25494 BMS 36316 a

1post-mastectomy care benefits required to be covered by a
2policy of accident and health insurance under Section 356t and
3the coverage required under Sections 356g, 356g.5, 356g.5-1,
4356q, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11,
5356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26,
6356z.29, 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40,
7356z.41, 356z.45, 356z.46, 356z.47, 356z.51, and 356z.53 and
8356z.43 of the Illinois Insurance Code. Insurance policies
9shall comply with Section 356z.19 of the Illinois Insurance
10Code. The coverage shall comply with Sections 155.22a, 355b,
11and 370c of the Illinois Insurance Code. The Department of
12Insurance shall enforce the requirements of this Section.
13    Rulemaking authority to implement Public Act 95-1045, if
14any, is conditioned on the rules being adopted in accordance
15with all provisions of the Illinois Administrative Procedure
16Act and all rules and procedures of the Joint Committee on
17Administrative Rules; any purported rule not so adopted, for
18whatever reason, is unauthorized.
19(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
20101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
211-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
22eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. 1-1-22;
23102-665, eff. 10-8-21; revised 10-27-21.)
 
24    Section 25. The Illinois Insurance Code is amended by
25adding Section 356z.53 as follows:
 

 

 

10200HB5254ham001- 7 -LRB102 25494 BMS 36316 a

1    (215 ILCS 5/356z.53 new)
2    Sec. 356z.53. Coverage for hormone therapy to treat
3menopause. A group or individual policy of accident and health
4insurance or a managed care plan that is amended, delivered,
5issued, or renewed on or after January 1, 2024 shall provide
6coverage for medically necessary hormone therapy treatment to
7treat menopause that has been induced by a hysterectomy.
 
8    Section 30. The Health Maintenance Organization Act is
9amended by changing Section 5-3 as follows:
 
10    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
11    Sec. 5-3. Insurance Code provisions.
12    (a) Health Maintenance Organizations shall be subject to
13the provisions of Sections 133, 134, 136, 137, 139, 140,
14141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
15154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2,
16355.3, 355b, 356g.5-1, 356m, 356q, 356v, 356w, 356x, 356y,
17356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9,
18356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17,
19356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29,
20356z.30, 356z.30a, 356z.32, 356z.33, 356z.35, 356z.36,
21356z.40, 356z.41, 356z.43, 356z.46, 356z.47, 356z.48, 356z.50,
22356z.51, 356z.53, 364, 364.01, 367.2, 367.2-5, 367i, 368a,
23368b, 368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403,

 

 

10200HB5254ham001- 8 -LRB102 25494 BMS 36316 a

1403A, 408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of
2subsection (2) of Section 367, and Articles IIA, VIII 1/2,
3XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the
4Illinois Insurance Code.
5    (b) For purposes of the Illinois Insurance Code, except
6for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
7Health Maintenance Organizations in the following categories
8are deemed to be "domestic companies":
9        (1) a corporation authorized under the Dental Service
10    Plan Act or the Voluntary Health Services Plans Act;
11        (2) a corporation organized under the laws of this
12    State; or
13        (3) a corporation organized under the laws of another
14    state, 30% or more of the enrollees of which are residents
15    of this State, except a corporation subject to
16    substantially the same requirements in its state of
17    organization as is a "domestic company" under Article VIII
18    1/2 of the Illinois Insurance Code.
19    (c) In considering the merger, consolidation, or other
20acquisition of control of a Health Maintenance Organization
21pursuant to Article VIII 1/2 of the Illinois Insurance Code,
22        (1) the Director shall give primary consideration to
23    the continuation of benefits to enrollees and the
24    financial conditions of the acquired Health Maintenance
25    Organization after the merger, consolidation, or other
26    acquisition of control takes effect;

 

 

10200HB5254ham001- 9 -LRB102 25494 BMS 36316 a

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

 

 

10200HB5254ham001- 10 -LRB102 25494 BMS 36316 a

1Insurance Code and this Section 5-3 shall apply to the sale by
2any health maintenance organization of greater than 10% of its
3enrollee population (including without limitation the health
4maintenance organization's right, title, and interest in and
5to its health care certificates).
6    (e) In considering any management contract or service
7agreement subject to Section 141.1 of the Illinois Insurance
8Code, the Director (i) shall, in addition to the criteria
9specified in Section 141.2 of the Illinois Insurance Code,
10take into account the effect of the management contract or
11service agreement on the continuation of benefits to enrollees
12and the financial condition of the health maintenance
13organization to be managed or serviced, and (ii) need not take
14into account the effect of the management contract or service
15agreement on competition.
16    (f) Except for small employer groups as defined in the
17Small Employer Rating, Renewability and Portability Health
18Insurance Act and except for medicare supplement policies as
19defined in Section 363 of the Illinois Insurance Code, a
20Health Maintenance Organization may by contract agree with a
21group or other enrollment unit to effect refunds or charge
22additional premiums under the following terms and conditions:
23        (i) the amount of, and other terms and conditions with
24    respect to, the refund or additional premium are set forth
25    in the group or enrollment unit contract agreed in advance
26    of the period for which a refund is to be paid or

 

 

10200HB5254ham001- 11 -LRB102 25494 BMS 36316 a

1    additional premium is to be charged (which period shall
2    not be less than one year); and
3        (ii) the amount of the refund or additional premium
4    shall not exceed 20% of the Health Maintenance
5    Organization's profitable or unprofitable experience with
6    respect to the group or other enrollment unit for the
7    period (and, for purposes of a refund or additional
8    premium, the profitable or unprofitable experience shall
9    be calculated taking into account a pro rata share of the
10    Health Maintenance Organization's administrative and
11    marketing expenses, but shall not include any refund to be
12    made or additional premium to be paid pursuant to this
13    subsection (f)). The Health Maintenance Organization and
14    the group or enrollment unit may agree that the profitable
15    or unprofitable experience may be calculated taking into
16    account the refund period and the immediately preceding 2
17    plan years.
18    The Health Maintenance Organization shall include a
19statement in the evidence of coverage issued to each enrollee
20describing the possibility of a refund or additional premium,
21and upon request of any group or enrollment unit, provide to
22the group or enrollment unit a description of the method used
23to calculate (1) the Health Maintenance Organization's
24profitable experience with respect to the group or enrollment
25unit and the resulting refund to the group or enrollment unit
26or (2) the Health Maintenance Organization's unprofitable

 

 

10200HB5254ham001- 12 -LRB102 25494 BMS 36316 a

1experience with respect to the group or enrollment unit and
2the resulting additional premium to be paid by the group or
3enrollment unit.
4    In no event shall the Illinois Health Maintenance
5Organization Guaranty Association be liable to pay any
6contractual obligation of an insolvent organization to pay any
7refund authorized under this Section.
8    (g) Rulemaking authority to implement Public Act 95-1045,
9if any, is conditioned on the rules being adopted in
10accordance with all provisions of the Illinois Administrative
11Procedure Act and all rules and procedures of the Joint
12Committee on Administrative Rules; any purported rule not so
13adopted, for whatever reason, is unauthorized.
14(Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19;
15101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-393, eff.
161-1-20; 101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625,
17eff. 1-1-21; 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
18102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
191-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
20eff. 10-8-21; revised 10-27-21.)
 
21    Section 35. The Voluntary Health Services Plans Act is
22amended by changing Section 10 as follows:
 
23    (215 ILCS 165/10)  (from Ch. 32, par. 604)
24    Sec. 10. Application of Insurance Code provisions. Health

 

 

10200HB5254ham001- 13 -LRB102 25494 BMS 36316 a

1services plan corporations and all persons interested therein
2or dealing therewith shall be subject to the provisions of
3Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
4143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
5356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356v, 356w,
6356x, 356y, 356z.1, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6,
7356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14,
8356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26,
9356z.29, 356z.30, 356z.30a, 356z.32, 356z.33, 356z.40,
10356z.41, 356z.46, 356z.47, 356z.51, 356z.53 356z.43, 364.01,
11367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412,
12and paragraphs (7) and (15) of Section 367 of the Illinois
13Insurance Code.
14    Rulemaking authority to implement Public Act 95-1045, if
15any, is conditioned on the rules being adopted in accordance
16with all provisions of the Illinois Administrative Procedure
17Act and all rules and procedures of the Joint Committee on
18Administrative Rules; any purported rule not so adopted, for
19whatever reason, is unauthorized.
20(Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19;
21101-281, eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff.
221-1-21; 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; 102-306,
23eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21;
24revised 10-27-21.)
 
25    Section 40. The Illinois Public Aid Code is amended by

 

 

10200HB5254ham001- 14 -LRB102 25494 BMS 36316 a

1changing Section 5-16.8 as follows:
 
2    (305 ILCS 5/5-16.8)
3    Sec. 5-16.8. Required health benefits. The medical
4assistance program shall (i) provide the post-mastectomy care
5benefits required to be covered by a policy of accident and
6health insurance under Section 356t and the coverage required
7under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6,
8356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,
9356z.47, 356z.51, and 356z.53 and 356z.43 of the Illinois
10Insurance Code, (ii) be subject to the provisions of Sections
11356z.19, 356z.43, 356z.44, 356z.49, 364.01, 370c, and 370c.1
12of the Illinois Insurance Code, and (iii) be subject to the
13provisions of subsection (d-5) of Section 10 of the Network
14Adequacy and Transparency Act.
15    The Department, by rule, shall adopt a model similar to
16the requirements of Section 356z.39 of the Illinois Insurance
17Code.
18    On and after July 1, 2012, the Department shall reduce any
19rate of reimbursement for services or other payments or alter
20any methodologies authorized by this Code to reduce any rate
21of reimbursement for services or other payments in accordance
22with Section 5-5e.
23    To ensure full access to the benefits set forth in this
24Section, on and after January 1, 2016, the Department shall
25ensure that provider and hospital reimbursement for

 

 

10200HB5254ham001- 15 -LRB102 25494 BMS 36316 a

1post-mastectomy care benefits required under this Section are
2no lower than the Medicare reimbursement rate.
3(Source: P.A. 101-81, eff. 7-12-19; 101-218, eff. 1-1-20;
4101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-574, eff.
51-1-20; 101-649, eff. 7-7-20; 102-30, eff. 1-1-22; 102-144,
6eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
7102-530, eff. 1-1-22; 102-642, eff. 1-1-22; revised
810-27-21.)".