Public Act 097-0343
 
HB3358 EnrolledLRB097 10892 RPM 51423 b


  
    AN ACT concerning insurance.
  
 
    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, 
356g.5, 356g.5-1, 356m,
356u, 356w, 356x, 356z.2, 356z.4, 
356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 
356z.14, 356z.15, and 356z.17 of the
Illinois Insurance Code.

The program of health benefits must comply with Sections 
155.22a and Section 155.37 of the
Illinois Insurance Code.

    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. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; 
95-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff. 
6-1-09; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; 95-1044, 
eff. 3-26-09; 95-1045, eff. 3-27-09; 95-1049, eff. 1-1-10; 
96-139, eff. 1-1-10; 96-328, eff. 8-11-09; 96-639, eff. 1-1-10; 
96-1000, eff. 7-2-10.)
 
    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, 356g.5, 356g.5-1, 356u,
356w, 356x, 
356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 
356z.14, and 356z.15 of
the Illinois Insurance Code. The 
coverage shall comply with Section 155.22a 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.


    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. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; 
95-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff. 
6-1-09; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; 95-1045, 
eff. 3-27-09; 95-1049, eff. 1-1-10; 96-139, eff. 1-1-10; 
96-328, eff. 8-11-09; 96-1000, eff. 7-2-10.)
 
    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, 356g.5, 
356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10, 
356z.11, 356z.12, 356z.13, 356z.14, and 356z.15 of the Illinois

Insurance
Code. The coverage shall comply with Section 155.22a 
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.


    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. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; 
95-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff. 
6-1-09; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; 95-1045, 
eff. 3-27-09; 95-1049, eff. 1-1-10; 96-139, eff. 1-1-10; 
96-328, eff. 8-11-09; 96-1000, eff. 7-2-10.)
 
    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, 356g.5, 356g.5-1, 
356u, 356w, 356x,

356z.6, 356z.8, 356z.9, 356z.11, 356z.12, 
356z.13, 356z.14, and 356z.15 of
the
Illinois Insurance Code. 
The coverage shall comply with Section 155.22a of
the Illinois 
Insurance Code.


    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. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; 
95-876, eff. 8-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09; 
95-1005, 12-12-08; 95-1045, eff. 3-27-09; 95-1049, eff. 
1-1-10; 96-139, eff. 1-1-10; 96-328, eff. 8-11-09; 96-1000, 
eff. 7-2-10.)
 
    Section 25. 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, 155.22a, 355.2, 356g.5-1, 356m, 
356v, 356w, 356x, 356y,
356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 
356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 
356z.17, 356z.18, 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.

    (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. 95-422, eff. 8-24-07; 95-520, eff. 8-28-07; 
95-876, eff. 8-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09; 
95-1005, eff. 12-12-08; 95-1045, eff. 3-27-09; 95-1049, eff. 
1-1-10; 96-328, eff. 8-11-09; 96-639, eff. 1-1-10; 96-833, eff. 
6-1-10; 96-1000, eff. 7-2-10.)
 
    Section 30. 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, 155.22a, 155.37, 354, 355.2,  356g, 356g.5, 356g.5-1, 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.13, 356z.14, 356z.15, 356z.18, 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.

    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. 95-189, eff. 8-16-07; 95-331, eff. 8-21-07; 
95-422, eff. 8-24-07; 95-520, eff. 8-28-07; 95-876, eff. 
8-21-08; 95-958, eff. 6-1-09; 95-978, eff. 1-1-09; 95-1005, 
eff. 12-12-08; 95-1045, eff. 3-27-09; 95-1049, eff. 1-1-10; 
96-328, eff. 8-11-09; 96-833, eff. 6-1-10; 96-1000, eff. 
7-2-10.)
  


Effective Date:  1/1/2012