Full Text of HB2709 099th General Assembly
HB2709 99TH GENERAL ASSEMBLY |
| | 99TH GENERAL ASSEMBLY
State of Illinois
2015 and 2016 HB2709 Introduced , by Rep. Dan Brady SYNOPSIS AS INTRODUCED: |
| 215 ILCS 5/356z.23 new | | 215 ILCS 125/5-3 | from Ch. 111 1/2, par. 1411.2 | 215 ILCS 165/10 | from Ch. 32, par. 604 |
| Amends the Illinois Insurance Code, the Voluntary Health Services Plans Act, and the Voluntary Health Services Plans Act to require coverage for hearing instruments and related services for minors
when a hearing care professional prescribes a hearing instrument. Provides that an insurer shall provide coverage for up to $2,500 per hearing aid per insured's hearing impaired ear subject to certain restrictions. Provides that an insurer shall not be required to pay a claim if the insured filed such a claim 36 months prior to the date
of filing the claim with the insurer and the claim was paid by any insurer. Effective immediately.
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| | A BILL FOR |
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| 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 Illinois Insurance Code is amended by adding | 5 | | Section 356z.23 as follows: | 6 | | (215 ILCS 5/356z.23 new) | 7 | | Sec. 356z.23. Coverage for hearing aids for minors. | 8 | | (a) As used in this Section: | 9 | | "Hearing care professional" means a person who is a
| 10 | | licensed audiologist or a licensed physician. | 11 | | "Hearing instrument" or "hearing aid" means any wearable
| 12 | | non-disposable instrument or device designed to aid or
| 13 | | compensate for impaired human hearing in cases where functional | 14 | | ability cannot be restored
either medically or surgically and | 15 | | any parts, attachments, or accessories for the instrument or | 16 | | device, including
an ear mold but excluding batteries and | 17 | | cords. | 18 | | "Minor" means any person under 18 years of age. | 19 | | "Related services" means those services necessary to | 20 | | assess, select, and adjust or fit the hearing instrument to | 21 | | ensure optimal performance, including, but not limited to: | 22 | | audiological exams, replacement ear molds, and repairs to the | 23 | | hearing instrument. |
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| 1 | | (b) An individual or group policy of accident and health
| 2 | | insurance or managed care plan that is amended, delivered,
| 3 | | issued, or renewed after the effective date of this amendatory
| 4 | | Act of the 99th General Assembly must provide coverage for
| 5 | | hearing instruments and related services for minors
when a | 6 | | hearing care professional prescribes a hearing instrument to | 7 | | augment communication. | 8 | | (c) An insurer shall provide the coverage required under | 9 | | this Section, subject to all applicable co-payments, | 10 | | co-insurance, deductibles, and out-of-pocket limits, for up to | 11 | | $2,500 per hearing aid per insured's hearing impaired ear | 12 | | subject to the following restrictions: | 13 | | (1) hearing aids may be replaced up to once every 36 | 14 | | months as prescribed and dispensed by a hearing care | 15 | | professional; | 16 | | (2) any hearing aid may be replaced at any time | 17 | | regardless of the above restrictions if there is a | 18 | | significant change in the insured individual's hearing | 19 | | status; such significant change is defined as a change of | 20 | | 10 decibels HL on the three-frequency pure-tone average | 21 | | (500 Hz, 1000 Hz, and 2000 Hz) on a valid audiogram | 22 | | provided by a hearing care professional; and | 23 | | (3) related services, such as audiological exams, ear | 24 | | molds, and hearing aid repairs, shall be covered at all | 25 | | times when prescribed by a hearing care professional. | 26 | | (d) An insurer shall not be required to pay a claim filed
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| 1 | | by its insured for the payment of the cost of a hearing aid
| 2 | | covered by this Section if less than 36 months prior to the | 3 | | date
of the claim its insured filed a claim for payment of the | 4 | | cost
of the hearing aid and the claim was paid by any insurer. | 5 | | Section 10. The Health Maintenance Organization Act is | 6 | | amended by changing Section 5-3 as follows:
| 7 | | (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
| 8 | | Sec. 5-3. Insurance Code provisions.
| 9 | | (a) Health Maintenance Organizations
shall be subject to | 10 | | the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
| 11 | | 141.2, 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, 154, | 12 | | 154.5, 154.6,
154.7, 154.8, 155.04, 155.22a, 355.2, 355.3, | 13 | | 355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y,
356z.2, 356z.4, | 14 | | 356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, | 15 | | 356z.13, 356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.21, | 16 | | 356z.22, 356z.23, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, | 17 | | 368c, 368d, 368e, 370c,
370c.1, 401, 401.1, 402, 403, 403A,
| 18 | | 408, 408.2, 409, 412, 444,
and
444.1,
paragraph (c) of | 19 | | subsection (2) of Section 367, and Articles IIA, VIII 1/2,
XII,
| 20 | | XII 1/2, XIII, XIII 1/2, XXV, and XXVI of the Illinois | 21 | | Insurance Code.
| 22 | | (b) For purposes of the Illinois Insurance Code, except for | 23 | | Sections 444
and 444.1 and Articles XIII and XIII 1/2, Health | 24 | | Maintenance Organizations in
the following categories are |
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| 1 | | deemed to be "domestic companies":
| 2 | | (1) a corporation authorized under the
Dental Service | 3 | | Plan Act or the Voluntary Health Services Plans Act;
| 4 | | (2) a corporation organized under the laws of this | 5 | | State; or
| 6 | | (3) a corporation organized under the laws of another | 7 | | state, 30% or more
of the enrollees of which are residents | 8 | | of this State, except a
corporation subject to | 9 | | substantially the same requirements in its state of
| 10 | | organization as is a "domestic company" under Article VIII | 11 | | 1/2 of the
Illinois Insurance Code.
| 12 | | (c) In considering the merger, consolidation, or other | 13 | | acquisition of
control of a Health Maintenance Organization | 14 | | pursuant to Article VIII 1/2
of the Illinois Insurance Code,
| 15 | | (1) the Director shall give primary consideration to | 16 | | the continuation of
benefits to enrollees and the financial | 17 | | conditions of the acquired Health
Maintenance Organization | 18 | | after the merger, consolidation, or other
acquisition of | 19 | | control takes effect;
| 20 | | (2)(i) the criteria specified in subsection (1)(b) of | 21 | | Section 131.8 of
the Illinois Insurance Code shall not | 22 | | apply and (ii) the Director, in making
his determination | 23 | | with respect to the merger, consolidation, or other
| 24 | | acquisition of control, need not take into account the | 25 | | effect on
competition of the merger, consolidation, or | 26 | | other acquisition of control;
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| 1 | | (3) the Director shall have the power to require the | 2 | | following
information:
| 3 | | (A) certification by an independent actuary of the | 4 | | adequacy
of the reserves of the Health Maintenance | 5 | | Organization sought to be acquired;
| 6 | | (B) pro forma financial statements reflecting the | 7 | | combined balance
sheets of the acquiring company and | 8 | | the Health Maintenance Organization sought
to be | 9 | | acquired as of the end of the preceding year and as of | 10 | | a date 90 days
prior to the acquisition, as well as pro | 11 | | forma financial statements
reflecting projected | 12 | | combined operation for a period of 2 years;
| 13 | | (C) a pro forma business plan detailing an | 14 | | acquiring party's plans with
respect to the operation | 15 | | of the Health Maintenance Organization sought to
be | 16 | | acquired for a period of not less than 3 years; and
| 17 | | (D) such other information as the Director shall | 18 | | require.
| 19 | | (d) The provisions of Article VIII 1/2 of the Illinois | 20 | | Insurance Code
and this Section 5-3 shall apply to the sale by | 21 | | any health maintenance
organization of greater than 10% of its
| 22 | | enrollee population (including without limitation the health | 23 | | maintenance
organization's right, title, and interest in and to | 24 | | its health care
certificates).
| 25 | | (e) In considering any management contract or service | 26 | | agreement subject
to Section 141.1 of the Illinois Insurance |
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| 1 | | Code, the Director (i) shall, in
addition to the criteria | 2 | | specified in Section 141.2 of the Illinois
Insurance Code, take | 3 | | into account the effect of the management contract or
service | 4 | | agreement on the continuation of benefits to enrollees and the
| 5 | | financial condition of the health maintenance organization to | 6 | | be managed or
serviced, and (ii) need not take into account the | 7 | | effect of the management
contract or service agreement on | 8 | | competition.
| 9 | | (f) Except for small employer groups as defined in the | 10 | | Small Employer
Rating, Renewability and Portability Health | 11 | | Insurance Act and except for
medicare supplement policies as | 12 | | defined in Section 363 of the Illinois
Insurance Code, a Health | 13 | | Maintenance Organization may by contract agree with a
group or | 14 | | other enrollment unit to effect refunds or charge additional | 15 | | premiums
under the following terms and conditions:
| 16 | | (i) the amount of, and other terms and conditions with | 17 | | respect to, the
refund or additional premium are set forth | 18 | | in the group or enrollment unit
contract agreed in advance | 19 | | of the period for which a refund is to be paid or
| 20 | | additional premium is to be charged (which period shall not | 21 | | be less than one
year); and
| 22 | | (ii) the amount of the refund or additional premium | 23 | | shall not exceed 20%
of the Health Maintenance | 24 | | Organization's profitable or unprofitable experience
with | 25 | | respect to the group or other enrollment unit for the | 26 | | period (and, for
purposes of a refund or additional |
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| 1 | | premium, the profitable or unprofitable
experience shall | 2 | | be calculated taking into account a pro rata share of the
| 3 | | Health Maintenance Organization's administrative and | 4 | | marketing expenses, but
shall not include any refund to be | 5 | | made or additional premium to be paid
pursuant to this | 6 | | subsection (f)). The Health Maintenance Organization and | 7 | | the
group or enrollment unit may agree that the profitable | 8 | | or unprofitable
experience may be calculated taking into | 9 | | account the refund period and the
immediately preceding 2 | 10 | | plan years.
| 11 | | The Health Maintenance Organization shall include a | 12 | | statement in the
evidence of coverage issued to each enrollee | 13 | | describing the possibility of a
refund or additional premium, | 14 | | and upon request of any group or enrollment unit,
provide to | 15 | | the group or enrollment unit a description of the method used | 16 | | to
calculate (1) the Health Maintenance Organization's | 17 | | profitable experience with
respect to the group or enrollment | 18 | | unit and the resulting refund to the group
or enrollment unit | 19 | | or (2) the Health Maintenance Organization's unprofitable
| 20 | | experience with respect to the group or enrollment unit and the | 21 | | resulting
additional premium to be paid by the group or | 22 | | enrollment unit.
| 23 | | In no event shall the Illinois Health Maintenance | 24 | | Organization
Guaranty Association be liable to pay any | 25 | | contractual obligation of an
insolvent organization to pay any | 26 | | refund authorized under this Section.
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| 1 | | (g) Rulemaking authority to implement Public Act 95-1045, | 2 | | if 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. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-437, | 8 | | eff. 8-18-11; 97-486, eff. 1-1-12; 97-592, eff. 1-1-12; 97-805, | 9 | | eff. 1-1-13; 97-813, eff. 7-13-12; 98-189, eff. 1-1-14; | 10 | | 98-1091, eff. 1-1-15 .) | 11 | | Section 15. The Voluntary Health Services Plans Act is | 12 | | amended by changing Section 10 as follows:
| 13 | | (215 ILCS 165/10) (from Ch. 32, par. 604)
| 14 | | Sec. 10. Application of Insurance Code provisions. Health | 15 | | services
plan corporations and all persons interested therein | 16 | | or dealing therewith
shall be subject to the provisions of | 17 | | Articles IIA and XII 1/2 and Sections
3.1, 133, 136, 139, 140, | 18 | | 143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, 356g, | 19 | | 356g.5, 356g.5-1, 356r, 356t, 356u, 356v,
356w, 356x, 356y, | 20 | | 356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9,
| 21 | | 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18, | 22 | | 356z.19, 356z.21, 356z.22, 356z.23, 364.01, 367.2, 368a, 401, | 23 | | 401.1,
402,
403, 403A, 408,
408.2, and 412, and paragraphs (7) | 24 | | and (15) of Section 367 of the Illinois
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. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-486, | 8 | | eff. 1-1-12; 97-592, eff. 1-1-12; 97-805, eff. 1-1-13; 97-813, | 9 | | eff. 7-13-12; 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15 .)
| 10 | | Section 99. Effective date. This Act takes effect upon | 11 | | becoming law.
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