Full Text of SB2573 103rd General Assembly
SB2573enr 103RD GENERAL ASSEMBLY | | | SB2573 Enrolled | | LRB103 31822 BMS 60443 b |
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| 1 | | AN ACT concerning regulation. | 2 | | Be it enacted by the People of the State of Illinois, | 3 | | represented in the General Assembly: | 4 | | Section 5. The Illinois Insurance Code is amended by | 5 | | adding Section 356z.61 as follows: | 6 | | (215 ILCS 5/356z.61 new) | 7 | | Sec. 356z.61. Wigs and hair prostheses. A group or | 8 | | individual plan of accident and health insurance or managed | 9 | | care plan amended, delivered, issued, or renewed after January | 10 | | 1, 2026 must provide coverage, no less than once every 12 | 11 | | months, for one wig or other scalp prosthesis worn for hair | 12 | | loss caused by alopecia, chemotherapy, or radiation treatment | 13 | | for cancer or other conditions. | 14 | | Section 10. The Health Maintenance Organization Act is | 15 | | amended by changing Section 5-3 as follows: | 16 | | (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2) | 17 | | Sec. 5-3. Insurance Code provisions. | 18 | | (a) Health Maintenance Organizations shall be subject to | 19 | | the provisions of Sections 133, 134, 136, 137, 139, 140, | 20 | | 141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, | 21 | | 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2, |
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| 1 | | 355.3, 355b, 355c, 356g.5-1, 356m, 356q, 356v, 356w, 356x, | 2 | | 356y, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, | 3 | | 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, | 4 | | 356z.15, 356z.17, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25, | 5 | | 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33, | 6 | | 356z.35, 356z.36, 356z.40, 356z.41, 356z.46, 356z.47, 356z.48, | 7 | | 356z.50, 356z.51, 356z.53 256z.53 , 356z.54, 356z.56, 356z.57, | 8 | | 356z.59, 356z.60, 356z.61, 364, 364.01, 364.3, 367.2, 367.2-5, | 9 | | 367i, 368a, 368b, 368c, 368d, 368e, 370c, 370c.1, 401, 401.1, | 10 | | 402, 403, 403A, 408, 408.2, 409, 412, 444, and 444.1, | 11 | | paragraph (c) of subsection (2) of Section 367, and Articles | 12 | | IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and | 13 | | XXXIIB of the Illinois Insurance Code. | 14 | | (b) For purposes of the Illinois Insurance Code, except | 15 | | for Sections 444 and 444.1 and Articles XIII and XIII 1/2, | 16 | | Health Maintenance Organizations in the following categories | 17 | | are deemed to be "domestic companies": | 18 | | (1) a corporation authorized under the Dental Service | 19 | | Plan Act or the Voluntary Health Services Plans Act; | 20 | | (2) a corporation organized under the laws of this | 21 | | State; or | 22 | | (3) a corporation organized under the laws of another | 23 | | state, 30% or more of the enrollees of which are residents | 24 | | of this State, except a corporation subject to | 25 | | substantially the same requirements in its state of | 26 | | organization as is a "domestic company" under Article VIII |
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| 1 | | 1/2 of the Illinois Insurance Code. | 2 | | (c) In considering the merger, consolidation, or other | 3 | | acquisition of control of a Health Maintenance Organization | 4 | | pursuant to Article VIII 1/2 of the Illinois Insurance Code, | 5 | | (1) the Director shall give primary consideration to | 6 | | the continuation of benefits to enrollees and the | 7 | | financial conditions of the acquired Health Maintenance | 8 | | Organization after the merger, consolidation, or other | 9 | | acquisition of control takes effect; | 10 | | (2)(i) the criteria specified in subsection (1)(b) of | 11 | | Section 131.8 of the Illinois Insurance Code shall not | 12 | | apply and (ii) the Director, in making his determination | 13 | | with respect to the merger, consolidation, or other | 14 | | acquisition of control, need not take into account the | 15 | | effect on competition of the merger, consolidation, or | 16 | | other acquisition of control; | 17 | | (3) the Director shall have the power to require the | 18 | | following information: | 19 | | (A) certification by an independent actuary of the | 20 | | adequacy of the reserves of the Health Maintenance | 21 | | Organization sought to be acquired; | 22 | | (B) pro forma financial statements reflecting the | 23 | | combined balance sheets of the acquiring company and | 24 | | the Health Maintenance Organization sought to be | 25 | | acquired as of the end of the preceding year and as of | 26 | | a date 90 days prior to the acquisition, as well as pro |
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| 1 | | forma financial statements reflecting projected | 2 | | combined operation for a period of 2 years; | 3 | | (C) a pro forma business plan detailing an | 4 | | acquiring party's plans with respect to the operation | 5 | | of the Health Maintenance Organization sought to be | 6 | | acquired for a period of not less than 3 years; and | 7 | | (D) such other information as the Director shall | 8 | | require. | 9 | | (d) The provisions of Article VIII 1/2 of the Illinois | 10 | | Insurance Code and this Section 5-3 shall apply to the sale by | 11 | | any health maintenance organization of greater than 10% of its | 12 | | enrollee population (including without limitation the health | 13 | | maintenance organization's right, title, and interest in and | 14 | | to its health care certificates). | 15 | | (e) In considering any management contract or service | 16 | | agreement subject to Section 141.1 of the Illinois Insurance | 17 | | Code, the Director (i) shall, in addition to the criteria | 18 | | specified in Section 141.2 of the Illinois Insurance Code, | 19 | | take into account the effect of the management contract or | 20 | | service agreement on the continuation of benefits to enrollees | 21 | | and the financial condition of the health maintenance | 22 | | organization to be managed or serviced, and (ii) need not take | 23 | | into account the effect of the management contract or service | 24 | | agreement on competition. | 25 | | (f) Except for small employer groups as defined in the | 26 | | Small Employer Rating, Renewability and Portability Health |
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| 1 | | Insurance Act and except for medicare supplement policies as | 2 | | defined in Section 363 of the Illinois Insurance Code, a | 3 | | Health Maintenance Organization may by contract agree with a | 4 | | group or other enrollment unit to effect refunds or charge | 5 | | additional premiums under the following terms and conditions: | 6 | | (i) the amount of, and other terms and conditions with | 7 | | respect to, the refund or additional premium are set forth | 8 | | in the group or enrollment unit contract agreed in advance | 9 | | of the period for which a refund is to be paid or | 10 | | additional premium is to be charged (which period shall | 11 | | not be less than one year); and | 12 | | (ii) the amount of the refund or additional premium | 13 | | shall not exceed 20% of the Health Maintenance | 14 | | Organization's profitable or unprofitable experience with | 15 | | respect to the group or other enrollment unit for the | 16 | | period (and, for purposes of a refund or additional | 17 | | premium, the profitable or unprofitable experience shall | 18 | | be calculated taking into account a pro rata share of the | 19 | | Health Maintenance Organization's administrative and | 20 | | marketing expenses, but shall not include any refund to be | 21 | | made or additional premium to be paid pursuant to this | 22 | | subsection (f)). The Health Maintenance Organization and | 23 | | the group or enrollment unit may agree that the profitable | 24 | | or unprofitable experience may be calculated taking into | 25 | | account the refund period and the immediately preceding 2 | 26 | | plan years. |
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| 1 | | The Health Maintenance Organization shall include a | 2 | | statement in the evidence of coverage issued to each enrollee | 3 | | describing the possibility of a refund or additional premium, | 4 | | and upon request of any group or enrollment unit, provide to | 5 | | the group or enrollment unit a description of the method used | 6 | | to calculate (1) the Health Maintenance Organization's | 7 | | profitable experience with respect to the group or enrollment | 8 | | unit and the resulting refund to the group or enrollment unit | 9 | | or (2) the Health Maintenance Organization's unprofitable | 10 | | experience with respect to the group or enrollment unit and | 11 | | the resulting additional premium to be paid by the group or | 12 | | enrollment unit. | 13 | | In no event shall the Illinois Health Maintenance | 14 | | Organization Guaranty Association be liable to pay any | 15 | | contractual obligation of an insolvent organization to pay any | 16 | | refund authorized under this Section. | 17 | | (g) Rulemaking authority to implement Public Act 95-1045, | 18 | | if any, is conditioned on the rules being adopted in | 19 | | accordance with all provisions of the Illinois Administrative | 20 | | Procedure Act and all rules and procedures of the Joint | 21 | | Committee on Administrative Rules; any purported rule not so | 22 | | adopted, for whatever reason, is unauthorized. | 23 | | (Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19; | 24 | | 101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-393, eff. | 25 | | 1-1-20; 101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, | 26 | | eff. 1-1-21; 102-30, eff. 1-1-22; 102-34, eff. 6-25-21; |
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| 1 | | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. | 2 | | 1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, | 3 | | eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; | 4 | | 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. | 5 | | 1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, | 6 | | eff. 1-1-23; 102-1117, eff. 1-13-23; revised 1-22-23.) | 7 | | Section 15. The Voluntary Health Services Plans Act is | 8 | | amended by changing Section 10 as follows: | 9 | | (215 ILCS 165/10) (from Ch. 32, par. 604) | 10 | | Sec. 10. Application of Insurance Code provisions. Health | 11 | | services plan corporations and all persons interested therein | 12 | | or dealing therewith shall be subject to the provisions of | 13 | | Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140, | 14 | | 143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, | 15 | | 356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356v, 356w, | 16 | | 356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, 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.21, 356z.22, 356z.25, | 19 | | 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33, | 20 | | 356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54, | 21 | | 356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 364.01, 364.3, | 22 | | 367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412, | 23 | | and paragraphs (7) and (15) of Section 367 of the Illinois | 24 | | Insurance Code. |
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| 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. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19; | 8 | | 101-281, eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff. | 9 | | 1-1-21; 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, | 10 | | eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; | 11 | | 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804, eff. | 12 | | 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860, | 13 | | eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff. 1-1-23; | 14 | | 102-1117, eff. 1-13-23.) | 15 | | Section 99. Effective date. This Act takes effect upon | 16 | | becoming law. |
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