Full Text of SB2671 103rd General Assembly
SB2671sam002 103RD GENERAL ASSEMBLY | Sen. Laura M. Murphy Filed: 3/8/2024 | | 10300SB2671sam002 | | LRB103 35940 RPS 70838 a |
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| 1 | | AMENDMENT TO SENATE BILL 2671
| 2 | | AMENDMENT NO. ______. Amend Senate Bill 2671 by replacing | 3 | | everything after the enacting clause with the following: | 4 | | "Section 5. The State Employees Group Insurance Act of | 5 | | 1971 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 | 9 | | provide the post-mastectomy care benefits required to be | 10 | | covered by a policy of accident and health insurance under | 11 | | Section 356t of the Illinois Insurance Code. The program of | 12 | | health benefits shall provide the coverage required under | 13 | | Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x, | 14 | | 356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, | 15 | | 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22, | 16 | | 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, |
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| 1 | | 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51, | 2 | | 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59, 356z.60, | 3 | | and 356z.61, and 356z.62 , 356z.64, 356z.67, 356z.68, 356z.70, | 4 | | and 356z.71 of the Illinois Insurance Code. The program of | 5 | | health benefits must comply with Sections 155.22a, 155.37, | 6 | | 355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of the | 7 | | Illinois Insurance Code. The program of health benefits shall | 8 | | provide the coverage required under Section 356m of the | 9 | | Illinois Insurance Code and, for the employees of the State | 10 | | Employee Group Insurance Program only, the coverage as also | 11 | | provided in Section 6.11B of this Act. The Department of | 12 | | Insurance shall enforce the requirements of this Section with | 13 | | respect to Sections 370c and 370c.1 of the Illinois Insurance | 14 | | Code; all other requirements of this Section shall be enforced | 15 | | by the Department of Central Management Services. | 16 | | Rulemaking authority to implement Public Act 95-1045, if | 17 | | any, is conditioned on the rules being adopted in accordance | 18 | | with all provisions of the Illinois Administrative Procedure | 19 | | Act and all rules and procedures of the Joint Committee on | 20 | | Administrative Rules; any purported rule not so adopted, for | 21 | | whatever reason, is unauthorized. | 22 | | (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; | 23 | | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. | 24 | | 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-768, | 25 | | eff. 1-1-24; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; | 26 | | 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. |
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| 1 | | 1-1-23; 102-1117, eff. 1-13-23; 103-8, eff. 1-1-24; 103-84, | 2 | | eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, eff. 1-1-24; | 3 | | 103-445, eff. 1-1-24; 103-535, eff. 8-11-23; 103-551, eff. | 4 | | 8-11-23; revised 8-29-23.) | 5 | | Section 10. The Counties Code is amended by changing | 6 | | Section 5-1069.3 as follows: | 7 | | (55 ILCS 5/5-1069.3) | 8 | | Sec. 5-1069.3. Required health benefits. If a county, | 9 | | including a home rule county, is a self-insurer for purposes | 10 | | of providing health insurance coverage for its employees, the | 11 | | coverage shall include coverage for the post-mastectomy care | 12 | | benefits required to be covered by a policy of accident and | 13 | | health insurance under Section 356t and the coverage required | 14 | | under Sections 356g, 356g.5, 356g.5-1, 356q, 356u, 356w, 356x, | 15 | | 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, | 16 | | 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, | 17 | | 356z.29, 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, | 18 | | 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, | 19 | | 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and 356z.61, and | 20 | | 356z.62 , 356z.64, 356z.67, 356z.68, 356z.70, and 356z.71 of | 21 | | the Illinois Insurance Code. The coverage shall comply with | 22 | | Sections 155.22a, 355b, 356z.19, and 370c of the Illinois | 23 | | Insurance Code. The Department of Insurance shall enforce the | 24 | | requirements of this Section. The requirement that health |
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| 1 | | benefits be covered as provided in this Section is an | 2 | | exclusive power and function of the State and is a denial and | 3 | | limitation under Article VII, Section 6, subsection (h) of the | 4 | | Illinois Constitution. A home rule county to which this | 5 | | Section applies must comply with every provision of this | 6 | | Section. | 7 | | Rulemaking authority to implement Public Act 95-1045, if | 8 | | any, is conditioned on the rules being adopted in accordance | 9 | | with all provisions of the Illinois Administrative Procedure | 10 | | Act and all rules and procedures of the Joint Committee on | 11 | | Administrative Rules; any purported rule not so adopted, for | 12 | | whatever reason, is unauthorized. | 13 | | (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; | 14 | | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. | 15 | | 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, | 16 | | eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; | 17 | | 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. | 18 | | 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, | 19 | | eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24; | 20 | | 103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised | 21 | | 8-29-23.) | 22 | | Section 15. The Illinois Municipal Code is amended by | 23 | | changing Section 10-4-2.3 as follows: | 24 | | (65 ILCS 5/10-4-2.3) |
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| 1 | | Sec. 10-4-2.3. Required health benefits. If a | 2 | | municipality, including a home rule municipality, is a | 3 | | self-insurer for purposes of providing health insurance | 4 | | coverage for its employees, the coverage shall include | 5 | | coverage for the post-mastectomy care benefits required to be | 6 | | covered by a policy of accident and health insurance under | 7 | | Section 356t and the coverage required under Sections 356g, | 8 | | 356g.5, 356g.5-1, 356q, 356u, 356w, 356x, 356z.4, 356z.4a, | 9 | | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, | 10 | | 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29, | 11 | | 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41, | 12 | | 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54, | 13 | | 356z.56, 356z.57, 356z.59, 356z.60, and 356z.61, and 356z.62 , | 14 | | 356z.64, 356z.67, 356z.68, 356z.70, and 356z.71 of the | 15 | | Illinois Insurance Code. The coverage shall comply with | 16 | | Sections 155.22a, 355b, 356z.19, and 370c of the Illinois | 17 | | Insurance Code. The Department of Insurance shall enforce the | 18 | | requirements of this Section. The requirement that health | 19 | | benefits be covered as provided in this is an exclusive power | 20 | | and function of the State and is a denial and limitation under | 21 | | Article VII, Section 6, subsection (h) of the Illinois | 22 | | Constitution. A home rule municipality to which this Section | 23 | | applies must comply with every provision of this Section. | 24 | | Rulemaking authority to implement Public Act 95-1045, if | 25 | | any, is conditioned on the rules being adopted in accordance | 26 | | with all provisions of the Illinois Administrative Procedure |
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| 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. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; | 5 | | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. | 6 | | 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, | 7 | | eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; | 8 | | 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. | 9 | | 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, | 10 | | eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24; | 11 | | 103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised | 12 | | 8-29-23.) | 13 | | Section 20. The School Code is amended by changing Section | 14 | | 10-22.3f as follows: | 15 | | (105 ILCS 5/10-22.3f) | 16 | | Sec. 10-22.3f. Required health benefits. Insurance | 17 | | protection and benefits for employees shall provide the | 18 | | post-mastectomy care benefits required to be covered by a | 19 | | policy of accident and health insurance under Section 356t and | 20 | | the coverage required under Sections 356g, 356g.5, 356g.5-1, | 21 | | 356q, 356u, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8, | 22 | | 356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, | 23 | | 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, | 24 | | 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51, |
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| 1 | | 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and | 2 | | 356z.61, and 356z.62 , 356z.64, 356z.67, 356z.68, 356z.70, and | 3 | | 356z.71 of the Illinois Insurance Code. Insurance policies | 4 | | shall comply with Section 356z.19 of the Illinois Insurance | 5 | | Code. The coverage shall comply with Sections 155.22a, 355b, | 6 | | and 370c of the Illinois Insurance Code. The Department of | 7 | | Insurance shall enforce the requirements of this Section. | 8 | | Rulemaking authority to implement Public Act 95-1045, if | 9 | | any, is conditioned on the rules being adopted in accordance | 10 | | with all provisions of the Illinois Administrative Procedure | 11 | | Act and all rules and procedures of the Joint Committee on | 12 | | Administrative Rules; any purported rule not so adopted, for | 13 | | whatever reason, is unauthorized. | 14 | | (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; | 15 | | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. | 16 | | 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804, | 17 | | eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; | 18 | | 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff. | 19 | | 1-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, | 20 | | eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. 8-11-23; | 21 | | 103-551, eff. 8-11-23; revised 8-29-23.) | 22 | | Section 25. The Illinois Insurance Code is amended by | 23 | | adding Section 356z.71 as follows: | 24 | | (215 ILCS 5/356z.71 new) |
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| 1 | | Sec. 356z.71. Coverage for hippotherapy and therapeutic | 2 | | riding. | 3 | | (a) As used in this Section: | 4 | | "Disability" means a determinable physical or mental | 5 | | characteristic of a person, including, but not limited to, a | 6 | | determinable physical characteristic that necessitates the | 7 | | person's use of a guide, hearing, or support dog, that may | 8 | | result from a disease, injury, or congenital condition of | 9 | | birth or a functional disorder. | 10 | | "Hippotherapy" means physical, occupational, or speech | 11 | | therapy, prescribed by a physician and delivered by a licensed | 12 | | occupational therapist, physical therapist, or speech-language | 13 | | pathologist, in conjunction with a professional horse handler | 14 | | and a therapy horse. | 15 | | "Therapeutic riding" means horseback riding lessons | 16 | | adapted to an individual with a disability, delivered by a | 17 | | professional horse handler and a therapy horse. | 18 | | (b) A group or individual policy of accident and health | 19 | | insurance or managed care plan that is amended, delivered, | 20 | | issued, or renewed on or after January 1, 2026 shall provide | 21 | | medically necessary coverage for hippotherapy and other forms | 22 | | of therapeutic riding. | 23 | | Section 30. The Health Maintenance Organization Act is | 24 | | amended by changing Section 5-3 as follows: |
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| 1 | | (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2) | 2 | | Sec. 5-3. Insurance Code provisions. | 3 | | (a) Health Maintenance Organizations shall be subject to | 4 | | the provisions of Sections 133, 134, 136, 137, 139, 140, | 5 | | 141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, | 6 | | 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 155.49, | 7 | | 355.2, 355.3, 355b, 355c, 356f, 356g.5-1, 356m, 356q, 356v, | 8 | | 356w, 356x, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, | 9 | | 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, | 10 | | 356z.15, 356z.17, 356z.18, 356z.19, 356z.20, 356z.21, 356z.22, | 11 | | 356z.23, 356z.24, 356z.25, 356z.26, 356z.28, 356z.29, 356z.30, | 12 | | 356z.30a, 356z.31, 356z.32, 356z.33, 356z.34, 356z.35, | 13 | | 356z.36, 356z.37, 356z.38, 356z.39, 356z.40, 356z.41, 356z.44, | 14 | | 356z.45, 356z.46, 356z.47, 356z.48, 356z.49, 356z.50, 356z.51, | 15 | | 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.58, 356z.59, | 16 | | 356z.60, 356z.61, 356z.62, 356z.64, 356z.65, 356z.67, 356z.68, | 17 | | 356z.71, 364, 364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b, | 18 | | 368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A, | 19 | | 408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of | 20 | | subsection (2) of Section 367, and Articles IIA, VIII 1/2, | 21 | | XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the | 22 | | Illinois Insurance Code. | 23 | | (b) For purposes of the Illinois Insurance Code, except | 24 | | for Sections 444 and 444.1 and Articles XIII and XIII 1/2, | 25 | | Health Maintenance Organizations in the following categories | 26 | | are 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 | 16 | | financial conditions of the acquired Health Maintenance | 17 | | Organization after the merger, consolidation, or other | 18 | | acquisition of 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 | 23 | | to 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, | 2 | | take into account the effect of the management contract or | 3 | | service agreement on the continuation of benefits to enrollees | 4 | | and the financial condition of the health maintenance | 5 | | organization to be managed or serviced, and (ii) need not take | 6 | | into account the effect of the management contract or service | 7 | | agreement on 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 | 12 | | Health Maintenance Organization may by contract agree with a | 13 | | group or other enrollment unit to effect refunds or charge | 14 | | additional 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 | 20 | | not 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 | 20 | | the 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 | | (g) Rulemaking authority to implement Public Act 95-1045, |
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| 1 | | if any, is conditioned on the rules being adopted in | 2 | | accordance with all provisions of the Illinois Administrative | 3 | | Procedure Act and all rules and procedures of the Joint | 4 | | Committee on Administrative Rules; any purported rule not so | 5 | | adopted, for whatever reason, is unauthorized. | 6 | | (Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21; | 7 | | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. | 8 | | 1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, | 9 | | eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; | 10 | | 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. | 11 | | 1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, | 12 | | eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; | 13 | | 103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff. | 14 | | 6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445, | 15 | | eff. 1-1-24; 103-551, eff. 8-11-23; revised 8-29-23.)". |
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