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Public Act 102-0443
Public Act 0443 102ND GENERAL ASSEMBLY
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Public Act 102-0443
| | HB2653 Enrolled | LRB102 03848 BMS 13862 b |
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| AN ACT concerning regulation.
| Be it enacted by the People of the State of Illinois,
| represented in the General Assembly:
| Section 5. The Counties Code is amended by changing | Section 5-1069.3 as follows:
| (55 ILCS 5/5-1069.3)
| Sec. 5-1069.3. Required health benefits. If a county, | including a home
rule
county, is a self-insurer for purposes | of providing health insurance coverage
for its employees, the | coverage shall include coverage for the post-mastectomy
care | benefits required to be covered by a policy of accident and | health
insurance under Section 356t and the coverage required | under Sections 356g, 356g.5, 356g.5-1, 356u,
356w, 356x, | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, | 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29, | 356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41, and 356z.43 | of
the Illinois Insurance Code. The coverage shall comply with | Sections 155.22a, 355b, 356z.19, and 370c of
the Illinois | Insurance Code. The Department of Insurance shall enforce the | requirements of this Section. The requirement that health | benefits be covered
as provided in this Section is an
| exclusive power and function of the State and is a denial and | limitation under
Article VII, Section 6, subsection (h) of the |
| Illinois Constitution. A home
rule county to which this | Section applies must comply with every provision of
this | Section.
| Rulemaking authority to implement Public Act 95-1045, if | any, is conditioned on the rules being adopted in accordance | with all provisions of the Illinois Administrative Procedure | Act and all rules and procedures of the Joint Committee on | Administrative Rules; any purported rule not so adopted, for | whatever reason, is unauthorized. | (Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; | 100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff. | 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281, | eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20; | 101-625, eff. 1-1-21.)
| Section 10. The Illinois Municipal Code is amended by | changing Section 10-4-2.3 as follows:
| (65 ILCS 5/10-4-2.3)
| Sec. 10-4-2.3. Required health benefits. If a | municipality, including a
home rule municipality, is a | self-insurer for purposes of providing health
insurance | coverage for its employees, the coverage shall include | coverage for
the post-mastectomy care benefits required to be | covered by a policy of
accident and health insurance under | Section 356t and the coverage required
under Sections 356g, |
| 356g.5, 356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, | 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, | 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, | 356z.36, and 356z.41, and 356z.43 of the Illinois
Insurance
| Code. The coverage shall comply with Sections 155.22a, 355b, | 356z.19, and 370c of
the Illinois Insurance Code. The | Department of Insurance shall enforce the requirements of this | Section. The requirement that health
benefits be covered as | provided in this is an exclusive power and function of
the | State and is a denial and limitation under Article VII, | Section 6,
subsection (h) of the Illinois Constitution. A home | rule municipality to which
this Section applies must comply | with every provision of this Section.
| Rulemaking authority to implement Public Act 95-1045, if | any, is conditioned on the rules being adopted in accordance | with all provisions of the Illinois Administrative Procedure | Act and all rules and procedures of the Joint Committee on | Administrative Rules; any purported rule not so adopted, for | whatever reason, is unauthorized. | (Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; | 100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff. | 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281, | eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20; | 101-625, eff. 1-1-21.)
| Section 15. The Illinois Insurance Code is amended by |
| adding Section 356z.43 as follows:
| (215 ILCS 5/356z.43 new) | Sec. 356z.43. Colonoscopy coverage. | (a) A group policy of accident and health insurance that | is amended, delivered, issued, or renewed on or after January | 1, 2022 shall provide coverage for a colonoscopy that is a | follow-up exam based on an initial screen where the | colonoscopy was determined to be medically necessary by a | physician licensed to practice medicine in all its branches, | an advanced practice registered nurse, or a physician | assistant. | (b) A policy subject to this Section shall not impose a | deductible, coinsurance, copayment, or any other cost-sharing | requirement on the coverage provided; except that this | subsection does not apply to coverage of colonoscopies to the | extent such coverage would disqualify a high-deductible health | plan from eligibility for a health savings account pursuant to | Section 223 of the Internal Revenue Code.
| Section 20. The Health Maintenance Organization Act is | amended by changing Section 5-3 as follows:
| (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
| Sec. 5-3. Insurance Code provisions.
| (a) Health Maintenance Organizations
shall be subject to |
| the provisions of Sections 133, 134, 136, 137, 139, 140, | 141.1,
141.2, 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, | 154, 154.5, 154.6,
154.7, 154.8, 155.04, 155.22a, 355.2, | 355.3, 355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y,
356z.2, | 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10, | 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.18, | 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, | 356z.30a, 356z.32, 356z.33, 356z.35, 356z.36, 356z.41, | 356z.43, 364, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c, | 368d, 368e, 370c,
370c.1, 401, 401.1, 402, 403, 403A,
408, | 408.2, 409, 412, 444,
and
444.1,
paragraph (c) of subsection | (2) of Section 367, and Articles IIA, VIII 1/2,
XII,
XII 1/2, | XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the Illinois | Insurance Code.
| (b) For purposes of the Illinois Insurance Code, except | for Sections 444
and 444.1 and Articles XIII and XIII 1/2, | Health Maintenance Organizations in
the following categories | are deemed to be "domestic companies":
| (1) a corporation authorized under the
Dental Service | Plan Act or the Voluntary Health Services Plans Act;
| (2) a corporation organized under the laws of this | State; or
| (3) a corporation organized under the laws of another | state, 30% or more
of the enrollees of which are residents | of this State, except a
corporation subject to | substantially the same requirements in its state of
|
| organization as is a "domestic company" under Article VIII | 1/2 of the
Illinois Insurance Code.
| (c) In considering the merger, consolidation, or other | acquisition of
control of a Health Maintenance Organization | pursuant to Article VIII 1/2
of the Illinois Insurance Code,
| (1) the Director shall give primary consideration to | the continuation of
benefits to enrollees and the | financial conditions of the acquired Health
Maintenance | Organization after the merger, consolidation, or other
| acquisition of control takes effect;
| (2)(i) the criteria specified in subsection (1)(b) of | Section 131.8 of
the Illinois Insurance Code shall not | apply and (ii) the Director, in making
his determination | with respect to the merger, consolidation, or other
| acquisition of control, need not take into account the | effect on
competition of the merger, consolidation, or | other acquisition of control;
| (3) the Director shall have the power to require the | following
information:
| (A) certification by an independent actuary of the | adequacy
of the reserves of the Health Maintenance | Organization sought to be acquired;
| (B) pro forma financial statements reflecting the | combined balance
sheets of the acquiring company and | the Health Maintenance Organization sought
to be | acquired as of the end of the preceding year and as of |
| a date 90 days
prior to the acquisition, as well as pro | forma financial statements
reflecting projected | combined operation for a period of 2 years;
| (C) a pro forma business plan detailing an | acquiring party's plans with
respect to the operation | of the Health Maintenance Organization sought to
be | acquired for a period of not less than 3 years; and
| (D) such other information as the Director shall | require.
| (d) The provisions of Article VIII 1/2 of the Illinois | Insurance Code
and this Section 5-3 shall apply to the sale by | any health maintenance
organization of greater than 10% of its
| enrollee population (including without limitation the health | maintenance
organization's right, title, and interest in and | to its health care
certificates).
| (e) In considering any management contract or service | agreement subject
to Section 141.1 of the Illinois Insurance | Code, the Director (i) shall, in
addition to the criteria | specified in Section 141.2 of the Illinois
Insurance Code, | take into account the effect of the management contract or
| service agreement on the continuation of benefits to enrollees | and the
financial condition of the health maintenance | organization to be managed or
serviced, and (ii) need not take | into account the effect of the management
contract or service | agreement on competition.
| (f) Except for small employer groups as defined in the |
| Small Employer
Rating, Renewability and Portability Health | Insurance Act and except for
medicare supplement policies as | defined in Section 363 of the Illinois
Insurance Code, a | Health Maintenance Organization may by contract agree with a
| group or other enrollment unit to effect refunds or charge | additional premiums
under the following terms and conditions:
| (i) the amount of, and other terms and conditions with | respect to, the
refund or additional premium are set forth | in the group or enrollment unit
contract agreed in advance | of the period for which a refund is to be paid or
| additional premium is to be charged (which period shall | not be less than one
year); and
| (ii) the amount of the refund or additional premium | shall not exceed 20%
of the Health Maintenance | Organization's profitable or unprofitable experience
with | respect to the group or other enrollment unit for the | period (and, for
purposes of a refund or additional | premium, the profitable or unprofitable
experience shall | be calculated taking into account a pro rata share of the
| Health Maintenance Organization's administrative and | marketing expenses, but
shall not include any refund to be | made or additional premium to be paid
pursuant to this | subsection (f)). The Health Maintenance Organization and | the
group or enrollment unit may agree that the profitable | or unprofitable
experience may be calculated taking into | account the refund period and the
immediately preceding 2 |
| plan years.
| The Health Maintenance Organization shall include a | statement in the
evidence of coverage issued to each enrollee | describing the possibility of a
refund or additional premium, | and upon request of any group or enrollment unit,
provide to | the group or enrollment unit a description of the method used | to
calculate (1) the Health Maintenance Organization's | profitable experience with
respect to the group or enrollment | unit and the resulting refund to the group
or enrollment unit | or (2) the Health Maintenance Organization's unprofitable
| experience with respect to the group or enrollment unit and | the resulting
additional premium to be paid by the group or | enrollment unit.
| In no event shall the Illinois Health Maintenance | Organization
Guaranty Association be liable to pay any | contractual obligation of an
insolvent organization to pay any | refund authorized under this Section.
| (g) Rulemaking authority to implement Public Act 95-1045, | if any, is conditioned on the rules being adopted in | accordance with all provisions of the Illinois Administrative | Procedure Act and all rules and procedures of the Joint | Committee on Administrative Rules; any purported rule not so | adopted, for whatever reason, is unauthorized. | (Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; | 100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff. | 1-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81, |
| eff. 7-12-19; 101-281, eff. 1-1-20; 101-371, eff. 1-1-20; | 101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff. | 1-1-20; 101-625, eff. 1-1-21.)
| Section 99. Effective date. This Act takes effect January | 1, 2022.
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Effective Date: 1/1/2022
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