Full Text of HB1565 103rd General Assembly
HB1565enr 103RD GENERAL ASSEMBLY |
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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 State Employees Group Insurance Act of 1971 | 5 | | is amended by changing Section 6.11 as follows:
| 6 | | (5 ILCS 375/6.11)
| 7 | | (Text of Section before amendment by P.A. 102-768 ) | 8 | | Sec. 6.11. Required health benefits; Illinois Insurance | 9 | | Code
requirements. The program of health
benefits shall | 10 | | provide the post-mastectomy care benefits required to be | 11 | | covered
by a policy of accident and health insurance under | 12 | | Section 356t of the Illinois
Insurance Code. The program of | 13 | | health benefits shall provide the coverage
required under | 14 | | Sections 356g, 356g.5, 356g.5-1, 356m, 356q,
356u, 356w, 356x, | 15 | | 356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, | 16 | | 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22, | 17 | | 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, | 18 | | 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51, | 19 | | 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, and 356z.60 , and | 20 | | 356z.61 of the
Illinois Insurance Code.
The program of health | 21 | | benefits must comply with Sections 155.22a, 155.37, 355b, | 22 | | 356z.19, 370c, and 370c.1 and Article XXXIIB of the
Illinois | 23 | | Insurance Code. The Department of Insurance shall enforce the |
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| 1 | | requirements of this Section with respect to Sections 370c and | 2 | | 370c.1 of the Illinois Insurance Code; all other requirements | 3 | | of this Section shall be enforced by the Department of Central | 4 | | Management Services.
| 5 | | Rulemaking authority to implement Public Act 95-1045, if | 6 | | any, is conditioned on the rules being adopted in accordance | 7 | | with all provisions of the Illinois Administrative Procedure | 8 | | Act and all rules and procedures of the Joint Committee on | 9 | | Administrative Rules; any purported rule not so adopted, for | 10 | | whatever reason, is unauthorized. | 11 | | (Source: P.A. 101-13, eff. 6-12-19; 101-281, eff. 1-1-20; | 12 | | 101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff. | 13 | | 1-1-20; 101-625, eff. 1-1-21; 102-30, eff. 1-1-22; 102-103, | 14 | | eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; | 15 | | 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. | 16 | | 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, | 17 | | eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; | 18 | | revised 12-13-22.) | 19 | | (Text of Section after amendment by P.A. 102-768 ) | 20 | | Sec. 6.11. Required health benefits; Illinois Insurance | 21 | | Code
requirements. The program of health
benefits shall | 22 | | provide the post-mastectomy care benefits required to be | 23 | | covered
by a policy of accident and health insurance under | 24 | | Section 356t of the Illinois
Insurance Code. The program of | 25 | | health benefits shall provide the coverage
required under |
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| 1 | | Sections 356g, 356g.5, 356g.5-1, 356m, 356q,
356u, 356w, 356x, | 2 | | 356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, | 3 | | 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22, | 4 | | 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, | 5 | | 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51, | 6 | | 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59, and | 7 | | 356z.60 , and 356z.61 of the
Illinois Insurance Code.
The | 8 | | program of health benefits must comply with Sections 155.22a, | 9 | | 155.37, 355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of | 10 | | the
Illinois Insurance Code. The Department of Insurance shall | 11 | | enforce the requirements of this Section with respect to | 12 | | Sections 370c and 370c.1 of the Illinois Insurance Code; all | 13 | | other requirements of this Section shall be enforced by the | 14 | | Department of Central Management Services.
| 15 | | Rulemaking authority to implement Public Act 95-1045, if | 16 | | any, is conditioned on the rules being adopted in accordance | 17 | | with all provisions of the Illinois Administrative Procedure | 18 | | Act and all rules and procedures of the Joint Committee on | 19 | | Administrative Rules; any purported rule not so adopted, for | 20 | | whatever reason, is unauthorized. | 21 | | (Source: P.A. 101-13, eff. 6-12-19; 101-281, eff. 1-1-20; | 22 | | 101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff. | 23 | | 1-1-20; 101-625, eff. 1-1-21; 102-30, eff. 1-1-22; 102-103, | 24 | | eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; | 25 | | 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. | 26 | | 1-1-23; 102-768, eff. 1-1-24; 102-804, eff. 1-1-23; 102-813, |
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| 1 | | eff. 5-13-22; 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; | 2 | | 102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23.) | 3 | | Section 10. The Counties Code is amended by changing | 4 | | Section 5-1069.3 as follows: | 5 | | (55 ILCS 5/5-1069.3)
| 6 | | Sec. 5-1069.3. Required health benefits. If a county, | 7 | | including a home
rule
county, is a self-insurer for purposes | 8 | | of providing health insurance coverage
for its employees, the | 9 | | coverage shall include coverage for the post-mastectomy
care | 10 | | benefits required to be covered by a policy of accident and | 11 | | health
insurance under Section 356t and the coverage required | 12 | | under Sections 356g, 356g.5, 356g.5-1, 356q, 356u,
356w, 356x, | 13 | | 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, | 14 | | 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, | 15 | | 356z.29, 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, | 16 | | 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, | 17 | | 356z.54, 356z.56, 356z.57, 356z.59, and 356z.60 , and 356z.61 | 18 | | of
the Illinois Insurance Code. The coverage shall comply with | 19 | | Sections 155.22a, 355b, 356z.19, and 370c of
the Illinois | 20 | | Insurance Code. The Department of Insurance shall enforce the | 21 | | requirements of this Section. The requirement that health | 22 | | benefits be covered
as provided in this Section is an
| 23 | | exclusive power and function of the State and is a denial and | 24 | | limitation under
Article VII, Section 6, subsection (h) of the |
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| 1 | | Illinois Constitution. A home
rule county to which this | 2 | | Section applies must comply with every provision of
this | 3 | | Section.
| 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. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20; | 11 | | 101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff. | 12 | | 1-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203, | 13 | | eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22; | 14 | | 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. | 15 | | 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, | 16 | | eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; | 17 | | 102-1117, eff. 1-13-23.) | 18 | | Section 15. The Illinois Municipal Code is amended by | 19 | | changing Section 10-4-2.3 as follows: | 20 | | (65 ILCS 5/10-4-2.3)
| 21 | | Sec. 10-4-2.3. Required health benefits. If a | 22 | | municipality, including a
home rule municipality, is a | 23 | | self-insurer for purposes of providing health
insurance | 24 | | coverage for its employees, the coverage shall include |
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| 1 | | coverage for
the post-mastectomy care benefits required to be | 2 | | covered by a policy of
accident and health insurance under | 3 | | Section 356t and the coverage required
under Sections 356g, | 4 | | 356g.5, 356g.5-1, 356q, 356u, 356w, 356x, 356z.4, 356z.4a, | 5 | | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, | 6 | | 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29, | 7 | | 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41, | 8 | | 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54, | 9 | | 356z.56, 356z.57, 356z.59, and 356z.60 , and 356z.61 of the | 10 | | Illinois
Insurance
Code. The coverage shall comply with | 11 | | Sections 155.22a, 355b, 356z.19, and 370c of
the Illinois | 12 | | Insurance Code. The Department of Insurance shall enforce the | 13 | | requirements of this Section. The requirement that health
| 14 | | benefits be covered as provided in this is an exclusive power | 15 | | and function of
the State and is a denial and limitation under | 16 | | Article VII, Section 6,
subsection (h) of the Illinois | 17 | | Constitution. A home rule municipality to which
this Section | 18 | | applies must comply with every provision of this Section.
| 19 | | Rulemaking authority to implement Public Act 95-1045, if | 20 | | any, is conditioned on the rules being adopted in accordance | 21 | | with all provisions of the Illinois Administrative Procedure | 22 | | Act and all rules and procedures of the Joint Committee on | 23 | | Administrative Rules; any purported rule not so adopted, for | 24 | | whatever reason, is unauthorized. | 25 | | (Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20; | 26 | | 101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff. |
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| 1 | | 1-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203, | 2 | | eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22; | 3 | | 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. | 4 | | 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, | 5 | | eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; | 6 | | 102-1117, eff. 1-13-23.) | 7 | | Section 20. The School Code is amended by changing Section | 8 | | 10-22.3f as follows: | 9 | | (105 ILCS 5/10-22.3f)
| 10 | | Sec. 10-22.3f. Required health benefits. Insurance | 11 | | protection and
benefits
for employees shall provide the | 12 | | post-mastectomy care benefits required to be
covered by a | 13 | | policy of accident and health insurance under Section 356t and | 14 | | the
coverage required under Sections 356g, 356g.5, 356g.5-1, | 15 | | 356q, 356u, 356w, 356x, 356z.4, 356z.4a,
356z.6, 356z.8, | 16 | | 356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, | 17 | | 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, | 18 | | 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51, | 19 | | 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, and 356z.60 , and | 20 | | 356z.61 of
the
Illinois Insurance Code.
Insurance policies | 21 | | shall comply with Section 356z.19 of the Illinois Insurance | 22 | | Code. The coverage shall comply with Sections 155.22a, 355b, | 23 | | and 370c of
the Illinois Insurance Code. The Department of | 24 | | Insurance shall enforce the requirements of this Section.
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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. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20; | 8 | | 101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff. | 9 | | 1-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203, | 10 | | eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. 1-1-22; | 11 | | 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 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; 102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23.) | 14 | | Section 25. The Illinois Insurance Code is amended by | 15 | | adding Section 356z.61 as follows: | 16 | | (215 ILCS 5/356z.61 new) | 17 | | Sec. 356z.61. Coverage of prescription estrogen. | 18 | | (a) A group or individual policy of accident and health | 19 | | insurance or a managed care plan that is amended, delivered, | 20 | | issued, or renewed on or after January 1, 2025 and that | 21 | | provides coverage for prescription drugs shall include | 22 | | coverage for one or more therapeutic equivalent versions of | 23 | | vaginal estrogen in its formulary. | 24 | | (b) If a particular vaginal estrogen product or its |
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| 1 | | therapeutic equivalent version approved by the United States | 2 | | Food and Drug Administration is determined to be medically | 3 | | necessary, the issuer must cover that service or item pursuant | 4 | | to the cost-sharing requirement contained in subsection (c). | 5 | | (c) A policy subject to this Section shall not impose a | 6 | | deductible, copayment, or any other cost sharing requirement | 7 | | that exceeds any deductible, coinsurance, copayment, or any | 8 | | other cost-sharing requirement imposed on any prescription | 9 | | drug authorized for the treatment of erectile dysfunction | 10 | | covered by the policy; except that this subsection does not | 11 | | apply to coverage of vaginal estrogen to the extent such | 12 | | coverage would disqualify a high-deductible health plan from | 13 | | eligibility for a health savings account pursuant to Section | 14 | | 223 of the Internal Revenue Code. | 15 | | (d) As used in this Section, "therapeutic equivalent | 16 | | version" has the meaning given to that term in paragraph (2) of | 17 | | subsection (a) of Section 356z.4. | 18 | | Section 30. The Health Maintenance Organization Act is | 19 | | amended by changing Section 5-3 as follows:
| 20 | | (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
| 21 | | Sec. 5-3. Insurance Code provisions.
| 22 | | (a) Health Maintenance Organizations
shall be subject to | 23 | | the provisions of Sections 133, 134, 136, 137, 139, 140, | 24 | | 141.1,
141.2, 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, |
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| 1 | | 154, 154.5, 154.6,
154.7, 154.8, 155.04, 155.22a, 355.2, | 2 | | 355.3, 355b, 355c, 356g.5-1, 356m, 356q, 356v, 356w, 356x, | 3 | | 356y,
356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, | 4 | | 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, | 5 | | 356z.15, 356z.17, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25, | 6 | | 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33, | 7 | | 356z.35, 356z.36, 356z.40, 356z.41, 356z.46, 356z.47, 356z.48, | 8 | | 356z.50, 356z.51, 356z.53 256z.53 , 356z.54, 356z.56, 356z.57, | 9 | | 356z.59, 356z.60, 356z.61, 364, 364.01, 364.3, 367.2, 367.2-5, | 10 | | 367i, 368a, 368b, 368c, 368d, 368e, 370c,
370c.1, 401, 401.1, | 11 | | 402, 403, 403A,
408, 408.2, 409, 412, 444,
and
444.1,
| 12 | | paragraph (c) of subsection (2) of Section 367, and Articles | 13 | | IIA, VIII 1/2,
XII,
XII 1/2, XIII, XIII 1/2, XXV, XXVI, and | 14 | | XXXIIB of the Illinois Insurance Code.
| 15 | | (b) For purposes of the Illinois Insurance Code, except | 16 | | for Sections 444
and 444.1 and Articles XIII and XIII 1/2, | 17 | | Health Maintenance Organizations in
the following categories | 18 | | are deemed to be "domestic companies":
| 19 | | (1) a corporation authorized under the
Dental Service | 20 | | Plan Act or the Voluntary Health Services Plans Act;
| 21 | | (2) a corporation organized under the laws of this | 22 | | State; or
| 23 | | (3) a corporation organized under the laws of another | 24 | | state, 30% or more
of the enrollees of which are residents | 25 | | of this State, except a
corporation subject to | 26 | | substantially the same requirements in its state of
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| 1 | | organization as is a "domestic company" under Article VIII | 2 | | 1/2 of the
Illinois Insurance Code.
| 3 | | (c) In considering the merger, consolidation, or other | 4 | | acquisition of
control of a Health Maintenance Organization | 5 | | pursuant to Article VIII 1/2
of the Illinois Insurance Code,
| 6 | | (1) the Director shall give primary consideration to | 7 | | the continuation of
benefits to enrollees and the | 8 | | financial conditions of the acquired Health
Maintenance | 9 | | Organization after the merger, consolidation, or other
| 10 | | acquisition of control takes effect;
| 11 | | (2)(i) the criteria specified in subsection (1)(b) of | 12 | | Section 131.8 of
the Illinois Insurance Code shall not | 13 | | apply and (ii) the Director, in making
his determination | 14 | | with respect to the merger, consolidation, or other
| 15 | | acquisition of control, need not take into account the | 16 | | effect on
competition of the merger, consolidation, or | 17 | | other acquisition of control;
| 18 | | (3) the Director shall have the power to require the | 19 | | following
information:
| 20 | | (A) certification by an independent actuary of the | 21 | | adequacy
of the reserves of the Health Maintenance | 22 | | Organization sought to be acquired;
| 23 | | (B) pro forma financial statements reflecting the | 24 | | combined balance
sheets of the acquiring company and | 25 | | the Health Maintenance Organization sought
to be | 26 | | acquired as of the end of the preceding year and as of |
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| 1 | | a date 90 days
prior to the acquisition, as well as pro | 2 | | forma financial statements
reflecting projected | 3 | | combined operation for a period of 2 years;
| 4 | | (C) a pro forma business plan detailing an | 5 | | acquiring party's plans with
respect to the operation | 6 | | of the Health Maintenance Organization sought to
be | 7 | | acquired for a period of not less than 3 years; and
| 8 | | (D) such other information as the Director shall | 9 | | require.
| 10 | | (d) The provisions of Article VIII 1/2 of the Illinois | 11 | | Insurance Code
and this Section 5-3 shall apply to the sale by | 12 | | any health maintenance
organization of greater than 10% of its
| 13 | | enrollee population (including without limitation the health | 14 | | maintenance
organization's right, title, and interest in and | 15 | | to its health care
certificates).
| 16 | | (e) In considering any management contract or service | 17 | | agreement subject
to Section 141.1 of the Illinois Insurance | 18 | | Code, the Director (i) shall, in
addition to the criteria | 19 | | specified in Section 141.2 of the Illinois
Insurance Code, | 20 | | take into account the effect of the management contract or
| 21 | | service agreement on the continuation of benefits to enrollees | 22 | | and the
financial condition of the health maintenance | 23 | | organization to be managed or
serviced, and (ii) need not take | 24 | | into account the effect of the management
contract or service | 25 | | agreement on competition.
| 26 | | (f) Except for small employer groups as defined in the |
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| 1 | | Small Employer
Rating, Renewability and Portability Health | 2 | | Insurance Act and except for
medicare supplement policies as | 3 | | defined in Section 363 of the Illinois
Insurance Code, a | 4 | | Health Maintenance Organization may by contract agree with a
| 5 | | group or other enrollment unit to effect refunds or charge | 6 | | additional premiums
under the following terms and conditions:
| 7 | | (i) the amount of, and other terms and conditions with | 8 | | respect to, the
refund or additional premium are set forth | 9 | | in the group or enrollment unit
contract agreed in advance | 10 | | of the period for which a refund is to be paid or
| 11 | | additional premium is to be charged (which period shall | 12 | | not be less than one
year); and
| 13 | | (ii) the amount of the refund or additional premium | 14 | | shall not exceed 20%
of the Health Maintenance | 15 | | Organization's profitable or unprofitable experience
with | 16 | | respect to the group or other enrollment unit for the | 17 | | period (and, for
purposes of a refund or additional | 18 | | premium, the profitable or unprofitable
experience shall | 19 | | be calculated taking into account a pro rata share of the
| 20 | | Health Maintenance Organization's administrative and | 21 | | marketing expenses, but
shall not include any refund to be | 22 | | made or additional premium to be paid
pursuant to this | 23 | | subsection (f)). The Health Maintenance Organization and | 24 | | the
group or enrollment unit may agree that the profitable | 25 | | or unprofitable
experience may be calculated taking into | 26 | | account the refund period and the
immediately preceding 2 |
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| 1 | | plan years.
| 2 | | The Health Maintenance Organization shall include a | 3 | | statement in the
evidence of coverage issued to each enrollee | 4 | | describing the possibility of a
refund or additional premium, | 5 | | and upon request of any group or enrollment unit,
provide to | 6 | | the group or enrollment unit a description of the method used | 7 | | to
calculate (1) the Health Maintenance Organization's | 8 | | profitable experience with
respect to the group or enrollment | 9 | | unit and the resulting refund to the group
or enrollment unit | 10 | | or (2) the Health Maintenance Organization's unprofitable
| 11 | | experience with respect to the group or enrollment unit and | 12 | | the resulting
additional premium to be paid by the group or | 13 | | enrollment unit.
| 14 | | In no event shall the Illinois Health Maintenance | 15 | | Organization
Guaranty Association be liable to pay any | 16 | | contractual obligation of an
insolvent organization to pay any | 17 | | refund authorized under this Section.
| 18 | | (g) Rulemaking authority to implement Public Act 95-1045, | 19 | | if any, is conditioned on the rules being adopted in | 20 | | accordance with all provisions of the Illinois Administrative | 21 | | Procedure Act and all rules and procedures of the Joint | 22 | | Committee on Administrative Rules; any purported rule not so | 23 | | adopted, for whatever reason, is unauthorized. | 24 | | (Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19; | 25 | | 101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-393, eff. | 26 | | 1-1-20; 101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, |
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| 1 | | eff. 1-1-21; 102-30, eff. 1-1-22; 102-34, eff. 6-25-21; | 2 | | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. | 3 | | 1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, | 4 | | eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; | 5 | | 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. | 6 | | 1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, | 7 | | eff. 1-1-23; 102-1117, eff. 1-13-23; revised 1-22-23.) | 8 | | Section 35. The Limited Health Service Organization Act is | 9 | | amended by changing Section 4003 as follows:
| 10 | | (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
| 11 | | Sec. 4003. Illinois Insurance Code provisions. Limited | 12 | | health service
organizations shall be subject to the | 13 | | provisions of Sections 133, 134, 136, 137, 139,
140, 141.1, | 14 | | 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154, | 15 | | 154.5,
154.6, 154.7, 154.8, 155.04, 155.37, 355.2, 355.3, | 16 | | 355b, 356q, 356v, 356z.4, 356z.4a, 356z.10, 356z.21, 356z.22, | 17 | | 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, | 18 | | 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54, 356z.57, | 19 | | 356z.59, 356z.61, 364.3, 368a, 401, 401.1,
402,
403, 403A, | 20 | | 408,
408.2, 409, 412, 444, and 444.1 and Articles IIA, VIII | 21 | | 1/2, XII, XII 1/2,
XIII,
XIII 1/2, XXV, and XXVI of the | 22 | | Illinois Insurance Code. Nothing in this Section shall require | 23 | | a limited health care plan to cover any service that is not a | 24 | | limited health service. For purposes of the
Illinois Insurance |
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| 1 | | Code, except for Sections 444 and 444.1 and Articles XIII
and | 2 | | XIII 1/2, limited health service organizations in the | 3 | | following categories
are deemed to be domestic companies:
| 4 | | (1) a corporation under the laws of this State; or
| 5 | | (2) 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 | | (Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20; | 12 | | 101-393, eff. 1-1-20; 101-625, eff. 1-1-21; 102-30, eff. | 13 | | 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, | 14 | | eff. 1-1-22; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; | 15 | | 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860, eff. | 16 | | 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23.) | 17 | | Section 40. The Voluntary Health Services Plans Act is | 18 | | amended by changing Section 10 as follows:
| 19 | | (215 ILCS 165/10) (from Ch. 32, par. 604)
| 20 | | Sec. 10. Application of Insurance Code provisions. Health | 21 | | services
plan corporations and all persons interested therein | 22 | | or dealing therewith
shall be subject to the provisions of | 23 | | Articles IIA and XII 1/2 and Sections
3.1, 133, 136, 139, 140, | 24 | | 143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, |
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| 1 | | 356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356v,
356w, | 2 | | 356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, | 3 | | 356z.6, 356z.8, 356z.9,
356z.10, 356z.11, 356z.12, 356z.13, | 4 | | 356z.14, 356z.15, 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.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54, | 7 | | 356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 364.01, 364.3, | 8 | | 367.2, 368a, 401, 401.1,
402,
403, 403A, 408,
408.2, and 412, | 9 | | and paragraphs (7) and (15) of Section 367 of the Illinois
| 10 | | Insurance Code.
| 11 | | Rulemaking authority to implement Public Act 95-1045, if | 12 | | any, is conditioned on the rules being adopted in accordance | 13 | | with all provisions of the Illinois Administrative Procedure | 14 | | Act and all rules and procedures of the Joint Committee on | 15 | | Administrative Rules; any purported rule not so adopted, for | 16 | | whatever reason, is unauthorized. | 17 | | (Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19; | 18 | | 101-281, eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff. | 19 | | 1-1-21; 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, | 20 | | eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; | 21 | | 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804, eff. | 22 | | 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860, | 23 | | eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff. 1-1-23; | 24 | | 102-1117, eff. 1-13-23.) | 25 | | Section 45. The Illinois Public Aid Code is amended by |
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| 1 | | changing Section 5-16.8 as follows:
| 2 | | (305 ILCS 5/5-16.8)
| 3 | | Sec. 5-16.8. Required health benefits. The medical | 4 | | assistance program
shall
(i) provide the post-mastectomy care | 5 | | benefits required to be covered by a policy of
accident and | 6 | | health insurance under Section 356t and the coverage required
| 7 | | under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6, | 8 | | 356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46, | 9 | | 356z.47, 356z.51, 356z.53, 356z.56, 356z.59, and 356z.60 , and | 10 | | 356z.61 of the Illinois
Insurance Code, (ii) be subject to the | 11 | | provisions of Sections 356z.19, 356z.44, 356z.49, 364.01, | 12 | | 370c, and 370c.1 of the Illinois
Insurance Code, and (iii) be | 13 | | subject to the provisions of subsection (d-5) of Section 10 of | 14 | | the Network Adequacy and Transparency Act.
| 15 | | The Department, by rule, shall adopt a model similar to | 16 | | the requirements of Section 356z.39 of the Illinois Insurance | 17 | | Code. | 18 | | On and after July 1, 2012, the Department shall reduce any | 19 | | rate of reimbursement for services or other payments or alter | 20 | | any methodologies authorized by this Code to reduce any rate | 21 | | of reimbursement for services or other payments in accordance | 22 | | with Section 5-5e. | 23 | | To ensure full access to the benefits set forth in this | 24 | | Section, on and after January 1, 2016, the Department shall | 25 | | ensure that provider and hospital reimbursement for |
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| 1 | | post-mastectomy care benefits required under this Section are | 2 | | no lower than the Medicare reimbursement rate. | 3 | | (Source: P.A. 101-81, eff. 7-12-19; 101-218, eff. 1-1-20; | 4 | | 101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-574, eff. | 5 | | 1-1-20; 101-649, eff. 7-7-20; 102-30, eff. 1-1-22; 102-144, | 6 | | eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; | 7 | | 102-530, eff. 1-1-22; 102-642, eff. 1-1-22; 102-804, eff. | 8 | | 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093, | 9 | | eff. 1-1-23; 102-1117, eff. 1-13-23.)
| 10 | | Section 95. No acceleration or delay. Where this Act makes | 11 | | changes in a statute that is represented in this Act by text | 12 | | that is not yet or no longer in effect (for example, a Section | 13 | | represented by multiple versions), the use of that text does | 14 | | not accelerate or delay the taking effect of (i) the changes | 15 | | made by this Act or (ii) provisions derived from any other | 16 | | Public Act. |
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