Public Act 095-0958
 
HB5285 Re-Enrolled LRB095 17860 KBJ 43940 b

    AN ACT concerning regulation.
 
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
 
    Section 5. The State Employees Group Insurance Act of 1971
is amended by changing Section 6.11 as follows:
 
    (5 ILCS 375/6.11)
    Sec. 6.11. Required health benefits; Illinois Insurance
Code requirements. The program of health benefits shall provide
the post-mastectomy care benefits required to be covered by a
policy of accident and health insurance under Section 356t of
the Illinois Insurance Code. The program of health benefits
shall provide the coverage required under Sections 356g.5,
356u, 356w, 356x, 356z.2, 356z.4, 356z.6, and 356z.9, 356z.10,
356z.11, and 356z.12 and 356z.9 of the Illinois Insurance Code.
The program of health benefits must comply with Section 155.37
of the Illinois Insurance Code.
(Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07;
95-520, eff. 8-28-07; revised 12-4-07.)
 
    Section 10. 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.5, 356u, 356w, 356x, 356z.6, and 356z.9,
356z.10, 356z.11, and 356z.12 and 356z.9 of the Illinois
Insurance Code. 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.
(Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07;
95-520, eff. 8-28-07; revised 12-4-07.)
 
    Section 15. 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.5, 356u, 356w,
356x, 356z.6, and 356z.9, 356z.10, 356z.11, and 356z.12 and
356z.9 of the Illinois Insurance Code. 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.
(Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07;
95-520, eff. 8-28-07; revised 12-4-07.)
 
    Section 20. The School Code is amended by changing Section
10-22.3f as follows:
 
    (105 ILCS 5/10-22.3f)
    Sec. 10-22.3f. Required health benefits. Insurance
protection and benefits for employees shall provide 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.5, 356u, 356w, 356x,
356z.6, and 356z.9, 356z.11, and 356z.12 of the Illinois
Insurance Code.
(Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07;
revised 12-4-07.)
 
    Section 25. The Illinois Insurance Code is amended by
adding Section 356z.11 and Section 356z.12 as follows:
 
    (215 ILCS 5/356z.11 new)
    Sec. 356z.11. Dependent students; medical leave of
absence. A group or individual policy of accident and health
insurance or managed care plan amended, delivered, issued, or
renewed after the effective date of this amendatory Act of the
95th General Assembly must continue to provide coverage for a
dependent college student who takes a medical leave of absence
or reduces his or her course load to part-time status because
of a catastrophic illness or injury.
    Continuation of coverage under this Section is subject to
all of the policy's terms and conditions applicable to those
forms of insurance. Continuation of insurance under the policy
shall terminate 12 months after notice of the illness or injury
or until the coverage would have otherwise lapsed pursuant to
the terms and conditions of the policy, whichever comes first,
provided the need for part-time status or medical leave of
absence is supported by a clinical certification of need from a
physician licensed to practice medicine in all its branches.
    The provisions of this Section do not apply to short-term
travel, accident-only, limited, or specified disease policies
or to policies or contracts designed for issuance to persons
eligible for coverage under Title XVIII of the Social Security
Act, known as Medicare, or any other similar coverage under
State or federal governmental plans.
 
    (215 ILCS 5/356z.12 new)
    Sec. 356z.12. Dependent coverage.
    (a) A group or individual policy of accident and health
insurance or managed care plan that provides coverage for
dependents and that is amended, delivered, issued, or renewed
after the effective date of this amendatory Act of the 95th
General Assembly shall not terminate coverage or deny the
election of coverage for an unmarried dependent by reason of
the dependent's age before the dependent's 26th birthday.
    (b) A policy or plan subject to this Section shall, upon
amendment, delivery, issuance, or renewal, establish an
initial enrollment period of not less than 90 days during which
an insured may make a written election for coverage of an
unmarried person as a dependent under this Section. After the
initial enrollment period, enrollment by a dependent pursuant
to this Section shall be consistent with the enrollment terms
of the plan or policy.
    (c) A policy or plan subject to this Section shall allow
for dependent coverage during the annual open enrollment date
or the annual renewal date if the dependent, as of the date on
which the insured elects dependent coverage under this
subsection, has:
        (1) a period of continuous creditable coverage of 90
    days or more; and
        (2) not been without creditable coverage for more than
    63 days.
An insured may elect coverage for a dependent who does not meet
the continuous creditable coverage requirements of this
subsection (c) and that dependent shall not be denied coverage
due to age.
    For purposes of this subsection (c), "creditable coverage"
shall have the meaning provided under subsection (C)(1) of
Section 20 of the Illinois Health Insurance Portability and
Accountability Act.
    (d) Military personnel. A group or individual policy of
accident and health insurance or managed care plan that
provides coverage for dependents and that is amended,
delivered, issued, or renewed after the effective date of this
amendatory Act of the 95th General Assembly shall not terminate
coverage or deny the election of coverage for an unmarried
dependent by reason of the dependent's age before the
dependent's 30th birthday if the dependent (i) is an Illinois
resident, (ii) served as a member of the active or reserve
components of any of the branches of the Armed Forces of the
United States, and (iii) has received a release or discharge
other than a dishonorable discharge. To be eligible for
coverage under this subsection (d), the eligible dependent
shall submit to the insurer a form approved by the Illinois
Department of Veterans' Affairs stating the date on which the
dependent was released from service.
    (e) Calculation of the cost of coverage provided to an
unmarried dependent under this Section shall be identical.
    (f) Nothing in this Section shall prohibit an employer from
requiring an employee to pay all or part of the cost of
coverage provided under this Section.
    (g) No exclusions or limitations may be applied to coverage
elected pursuant to this Section that do not apply to all
dependents covered under the policy.
    (h) A policy or plan subject to this Section shall not
condition eligibility for dependent coverage provided pursuant
to this Section on enrollment in any educational institution.
    (i) Notice regarding coverage for a dependent as provided
pursuant to this Section shall be provided to an insured by the
insurer:
        (1) upon application or enrollment;
        (2) in the certificate of coverage or equivalent
    document prepared for an insured and delivered on or about
    the date on which the coverage commences; and
        (3) in a notice delivered to an insured on a
    semi-annual basis.
 
    Section 30. 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, 137, 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, 355.2, 356m, 356v, 356w, 356x,
356y, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10,
356z.11, 356z.12 356z.9, 364.01, 367.2, 367.2-5, 367i, 368a,
368b, 368c, 368d, 368e, 370c, 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, and XXVI 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.
(Source: P.A. 94-906, eff. 1-1-07; 94-1076, eff. 12-29-06;
95-422, eff. 8-24-07; 95-520, eff. 8-28-07; revised 12-4-07.)
 
    Section 35. The Voluntary Health Services Plans Act is
amended by changing Section 10 as follows:
 
    (215 ILCS 165/10)  (from Ch. 32, par. 604)
    Sec. 10. Application of Insurance Code provisions. Health
services plan corporations and all persons interested therein
or dealing therewith shall be subject to the provisions of
Articles IIA and XII 1/2 and Sections 3.1, 133, 140, 143, 143c,
149, 155.37, 354, 355.2, 356g.5, 356r, 356t, 356u, 356v, 356w,
356x, 356y, 356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8,
356z.9, 356z.10, 356z.11, 356z.12 356z.9, 364.01, 367.2, 368a,
401, 401.1, 402, 403, 403A, 408, 408.2, and 412, and paragraphs
(7) and (15) of Section 367 of the Illinois Insurance Code.
(Source: P.A. 94-1076, eff. 12-29-06; 95-189, eff. 8-16-07;
95-331, eff. 8-21-07; 95-422, eff. 8-24-07; 95-520, eff.
8-28-07; revised 12-5-07.)

Effective Date: 6/1/2009