Bill Amendment: IL SB3054 | 2021-2022 | 102nd General Assembly
NOTE: For additional amemendments please see the Bill Drafting List
Bill Title: INS-HEALTH BENEFITS
Status: 2022-02-10 - Senate Committee Amendment No. 1 Rule 3-9(a) / Re-referred to Assignments [SB3054 Detail]
Download: Illinois-2021-SB3054-Senate_Amendment_001.html
Bill Title: INS-HEALTH BENEFITS
Status: 2022-02-10 - Senate Committee Amendment No. 1 Rule 3-9(a) / Re-referred to Assignments [SB3054 Detail]
Download: Illinois-2021-SB3054-Senate_Amendment_001.html
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1 | AMENDMENT TO SENATE BILL 3054
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2 | AMENDMENT NO. ______. Amend Senate Bill 3054 by replacing | ||||||
3 | everything after the enacting clause with the following:
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4 | "Section 5. The State Employees Group Insurance Act of | ||||||
5 | 1971 is amended by changing Section 6.11 as follows:
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6 | (5 ILCS 375/6.11)
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7 | Sec. 6.11. Required health benefits; Illinois Insurance | ||||||
8 | Code
requirements. The program of health
benefits shall | ||||||
9 | provide the post-mastectomy care benefits required to be | ||||||
10 | covered
by a policy of accident and health insurance under | ||||||
11 | Section 356t of the Illinois
Insurance Code. The program of | ||||||
12 | health benefits shall provide the coverage
required under | ||||||
13 | Sections 356g, 356g.5, 356g.5-1, 356m, 356q,
356u, 356w, 356x, | ||||||
14 | 356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, | ||||||
15 | 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22, | ||||||
16 | 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, |
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1 | 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51, | ||||||
2 | and 356z.53 and 356z.43 of the
Illinois Insurance Code.
The | ||||||
3 | program of health benefits must comply with Sections 155.22a, | ||||||
4 | 155.37, 355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of | ||||||
5 | the
Illinois Insurance Code. The Department of Insurance shall | ||||||
6 | enforce the requirements of this Section with respect to | ||||||
7 | Sections 370c and 370c.1 of the Illinois Insurance Code; all | ||||||
8 | other requirements of this Section shall be enforced by the | ||||||
9 | Department of Central Management Services.
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10 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
11 | any, is conditioned on the rules being adopted in accordance | ||||||
12 | with all provisions of the Illinois Administrative Procedure | ||||||
13 | Act and all rules and procedures of the Joint Committee on | ||||||
14 | Administrative Rules; any purported rule not so adopted, for | ||||||
15 | whatever reason, is unauthorized. | ||||||
16 | (Source: P.A. 101-13, eff. 6-12-19; 101-281, eff. 1-1-20; | ||||||
17 | 101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff. | ||||||
18 | 1-1-20; 101-625, eff. 1-1-21; 102-30, eff. 1-1-22; 102-103, | ||||||
19 | eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; | ||||||
20 | 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; revised | ||||||
21 | 10-26-21.)
| ||||||
22 | Section 10. The Counties Code is amended by changing | ||||||
23 | Section 5-1069.3 as follows:
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24 | (55 ILCS 5/5-1069.3)
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1 | Sec. 5-1069.3. Required health benefits. If a county, | ||||||
2 | including a home
rule
county, is a self-insurer for purposes | ||||||
3 | of providing health insurance coverage
for its employees, the | ||||||
4 | coverage shall include coverage for 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, 356g.5, 356g.5-1, 356q, 356u,
356w, 356x, | ||||||
8 | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, | ||||||
9 | 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29, | ||||||
10 | 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41, | ||||||
11 | 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, and 356z.53 and | ||||||
12 | 356z.43 of
the Illinois Insurance Code. The coverage shall | ||||||
13 | comply with Sections 155.22a, 355b, 356z.19, and 370c of
the | ||||||
14 | Illinois Insurance Code. The Department of Insurance shall | ||||||
15 | enforce the requirements of this Section. The requirement that | ||||||
16 | health benefits be covered
as provided in this Section is an
| ||||||
17 | exclusive power and function of the State and is a denial and | ||||||
18 | limitation under
Article VII, Section 6, subsection (h) of the | ||||||
19 | Illinois Constitution. A home
rule county to which this | ||||||
20 | Section applies must comply with every provision of
this | ||||||
21 | Section.
| ||||||
22 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
23 | any, is conditioned on the rules being adopted in accordance | ||||||
24 | with all provisions of the Illinois Administrative Procedure | ||||||
25 | Act and all rules and procedures of the Joint Committee on | ||||||
26 | Administrative Rules; any purported rule not so adopted, for |
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1 | whatever reason, is unauthorized. | ||||||
2 | (Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20; | ||||||
3 | 101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff. | ||||||
4 | 1-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203, | ||||||
5 | eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22; | ||||||
6 | 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; revised | ||||||
7 | 10-26-21.)
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8 | Section 15. The Illinois Municipal Code is amended by | ||||||
9 | changing Section 10-4-2.3 as follows:
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10 | (65 ILCS 5/10-4-2.3)
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11 | Sec. 10-4-2.3. Required health benefits. If a | ||||||
12 | municipality, including a
home rule municipality, is a | ||||||
13 | self-insurer for purposes of providing health
insurance | ||||||
14 | coverage for its employees, the coverage shall include | ||||||
15 | coverage for
the post-mastectomy care benefits required to be | ||||||
16 | covered by a policy of
accident and health insurance under | ||||||
17 | Section 356t and the coverage required
under Sections 356g, | ||||||
18 | 356g.5, 356g.5-1, 356q, 356u, 356w, 356x, 356z.6, 356z.8, | ||||||
19 | 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, | ||||||
20 | 356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, | ||||||
21 | 356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, | ||||||
22 | 356z.48, 356z.51, and 356z.53 and 356z.43 of the Illinois
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23 | Insurance
Code. The coverage shall comply with Sections | ||||||
24 | 155.22a, 355b, 356z.19, and 370c of
the Illinois Insurance |
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| |||||||
1 | Code. The Department of Insurance shall enforce the | ||||||
2 | requirements of this Section. The requirement that health
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3 | benefits be covered as provided in this is an exclusive power | ||||||
4 | and function of
the State and is a denial and limitation under | ||||||
5 | Article VII, Section 6,
subsection (h) of the Illinois | ||||||
6 | Constitution. A home rule municipality to which
this Section | ||||||
7 | applies must comply with every provision of this Section.
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8 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
9 | any, is conditioned on the rules being adopted in accordance | ||||||
10 | with all provisions of the Illinois Administrative Procedure | ||||||
11 | Act and all rules and procedures of the Joint Committee on | ||||||
12 | Administrative Rules; any purported rule not so adopted, for | ||||||
13 | whatever reason, is unauthorized. | ||||||
14 | (Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20; | ||||||
15 | 101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff. | ||||||
16 | 1-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203, | ||||||
17 | eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22; | ||||||
18 | 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; revised | ||||||
19 | 10-26-21.)
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20 | Section 20. The School Code is amended by changing Section | ||||||
21 | 10-22.3f as follows:
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22 | (105 ILCS 5/10-22.3f)
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23 | Sec. 10-22.3f. Required health benefits. Insurance | ||||||
24 | protection and
benefits
for employees shall provide the |
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1 | post-mastectomy care benefits required to be
covered by a | ||||||
2 | policy of accident and health insurance under Section 356t and | ||||||
3 | the
coverage required under Sections 356g, 356g.5, 356g.5-1, | ||||||
4 | 356q, 356u, 356w, 356x,
356z.6, 356z.8, 356z.9, 356z.11, | ||||||
5 | 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, | ||||||
6 | 356z.29, 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, | ||||||
7 | 356z.41, 356z.45, 356z.46, 356z.47, 356z.51, and 356z.53 and | ||||||
8 | 356z.43 of
the
Illinois Insurance Code.
Insurance policies | ||||||
9 | shall comply with Section 356z.19 of the Illinois Insurance | ||||||
10 | Code. The coverage shall comply with Sections 155.22a, 355b, | ||||||
11 | and 370c of
the Illinois Insurance Code. The Department of | ||||||
12 | Insurance shall enforce the requirements of this Section.
| ||||||
13 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
14 | any, is conditioned on the rules being adopted in accordance | ||||||
15 | with all provisions of the Illinois Administrative Procedure | ||||||
16 | Act and all rules and procedures of the Joint Committee on | ||||||
17 | Administrative Rules; any purported rule not so adopted, for | ||||||
18 | whatever reason, is unauthorized. | ||||||
19 | (Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20; | ||||||
20 | 101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff. | ||||||
21 | 1-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203, | ||||||
22 | eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. 1-1-22; | ||||||
23 | 102-665, eff. 10-8-21; revised 10-27-21.)
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24 | Section 25. The Illinois Insurance Code is amended by | ||||||
25 | adding Section 356z.53 as follows:
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1 | (215 ILCS 5/356z.53 new) | ||||||
2 | Sec. 356z.53. Coverage for compression sleeves. A group or | ||||||
3 | individual policy of accident and health insurance or a | ||||||
4 | managed care plan that is amended, delivered, issued, or | ||||||
5 | renewed on or after January 1, 2024 shall provide coverage for | ||||||
6 | medically necessary compression sleeves.
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7 | Section 30. The Health Maintenance Organization Act is | ||||||
8 | amended by changing Section 5-3 as follows:
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9 | (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
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10 | Sec. 5-3. Insurance Code provisions.
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11 | (a) Health Maintenance Organizations
shall be subject to | ||||||
12 | the provisions of Sections 133, 134, 136, 137, 139, 140, | ||||||
13 | 141.1,
141.2, 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, | ||||||
14 | 154, 154.5, 154.6,
154.7, 154.8, 155.04, 155.22a, 355.2, | ||||||
15 | 355.3, 355b, 356g.5-1, 356m, 356q, 356v, 356w, 356x, 356y,
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16 | 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, | ||||||
17 | 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, | ||||||
18 | 356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, | ||||||
19 | 356z.30, 356z.30a, 356z.32, 356z.33, 356z.35, 356z.36, | ||||||
20 | 356z.40, 356z.41, 356z.43, 356z.46, 356z.47, 356z.48, 356z.50, | ||||||
21 | 356z.51, 356z.53, 364, 364.01, 367.2, 367.2-5, 367i, 368a, | ||||||
22 | 368b, 368c, 368d, 368e, 370c,
370c.1, 401, 401.1, 402, 403, | ||||||
23 | 403A,
408, 408.2, 409, 412, 444,
and
444.1,
paragraph (c) of |
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1 | subsection (2) of Section 367, and Articles IIA, VIII 1/2,
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2 | XII,
XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the | ||||||
3 | Illinois Insurance Code.
| ||||||
4 | (b) For purposes of the Illinois Insurance Code, except | ||||||
5 | for Sections 444
and 444.1 and Articles XIII and XIII 1/2, | ||||||
6 | Health Maintenance Organizations in
the following categories | ||||||
7 | are deemed to be "domestic companies":
| ||||||
8 | (1) a corporation authorized under the
Dental Service | ||||||
9 | Plan Act or the Voluntary Health Services Plans Act;
| ||||||
10 | (2) a corporation organized under the laws of this | ||||||
11 | State; or
| ||||||
12 | (3) a corporation organized under the laws of another | ||||||
13 | state, 30% or more
of the enrollees of which are residents | ||||||
14 | of this State, except a
corporation subject to | ||||||
15 | substantially the same requirements in its state of
| ||||||
16 | organization as is a "domestic company" under Article VIII | ||||||
17 | 1/2 of the
Illinois Insurance Code.
| ||||||
18 | (c) In considering the merger, consolidation, or other | ||||||
19 | acquisition of
control of a Health Maintenance Organization | ||||||
20 | pursuant to Article VIII 1/2
of the Illinois Insurance Code,
| ||||||
21 | (1) the Director shall give primary consideration to | ||||||
22 | the continuation of
benefits to enrollees and the | ||||||
23 | financial conditions of the acquired Health
Maintenance | ||||||
24 | Organization after the merger, consolidation, or other
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25 | acquisition of control takes effect;
| ||||||
26 | (2)(i) the criteria specified in subsection (1)(b) of |
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1 | Section 131.8 of
the Illinois Insurance Code shall not | ||||||
2 | apply and (ii) the Director, in making
his determination | ||||||
3 | with respect to the merger, consolidation, or other
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4 | acquisition of control, need not take into account the | ||||||
5 | effect on
competition of the merger, consolidation, or | ||||||
6 | other acquisition of control;
| ||||||
7 | (3) the Director shall have the power to require the | ||||||
8 | following
information:
| ||||||
9 | (A) certification by an independent actuary of the | ||||||
10 | adequacy
of the reserves of the Health Maintenance | ||||||
11 | Organization sought to be acquired;
| ||||||
12 | (B) pro forma financial statements reflecting the | ||||||
13 | combined balance
sheets of the acquiring company and | ||||||
14 | the Health Maintenance Organization sought
to be | ||||||
15 | acquired as of the end of the preceding year and as of | ||||||
16 | a date 90 days
prior to the acquisition, as well as pro | ||||||
17 | forma financial statements
reflecting projected | ||||||
18 | combined operation for a period of 2 years;
| ||||||
19 | (C) a pro forma business plan detailing an | ||||||
20 | acquiring party's plans with
respect to the operation | ||||||
21 | of the Health Maintenance Organization sought to
be | ||||||
22 | acquired for a period of not less than 3 years; and
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23 | (D) such other information as the Director shall | ||||||
24 | require.
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25 | (d) The provisions of Article VIII 1/2 of the Illinois | ||||||
26 | Insurance Code
and this Section 5-3 shall apply to the sale by |
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1 | any health maintenance
organization of greater than 10% of its
| ||||||
2 | enrollee population (including without limitation the health | ||||||
3 | maintenance
organization's right, title, and interest in and | ||||||
4 | to its health care
certificates).
| ||||||
5 | (e) In considering any management contract or service | ||||||
6 | agreement subject
to Section 141.1 of the Illinois Insurance | ||||||
7 | Code, the Director (i) shall, in
addition to the criteria | ||||||
8 | specified in Section 141.2 of the Illinois
Insurance Code, | ||||||
9 | take into account the effect of the management contract or
| ||||||
10 | service agreement on the continuation of benefits to enrollees | ||||||
11 | and the
financial condition of the health maintenance | ||||||
12 | organization to be managed or
serviced, and (ii) need not take | ||||||
13 | into account the effect of the management
contract or service | ||||||
14 | agreement on competition.
| ||||||
15 | (f) Except for small employer groups as defined in the | ||||||
16 | Small Employer
Rating, Renewability and Portability Health | ||||||
17 | Insurance Act and except for
medicare supplement policies as | ||||||
18 | defined in Section 363 of the Illinois
Insurance Code, a | ||||||
19 | Health Maintenance Organization may by contract agree with a
| ||||||
20 | group or other enrollment unit to effect refunds or charge | ||||||
21 | additional premiums
under the following terms and conditions:
| ||||||
22 | (i) the amount of, and other terms and conditions with | ||||||
23 | respect to, the
refund or additional premium are set forth | ||||||
24 | in the group or enrollment unit
contract agreed in advance | ||||||
25 | of the period for which a refund is to be paid or
| ||||||
26 | additional premium is to be charged (which period shall |
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1 | not be less than one
year); and
| ||||||
2 | (ii) the amount of the refund or additional premium | ||||||
3 | shall not exceed 20%
of the Health Maintenance | ||||||
4 | Organization's profitable or unprofitable experience
with | ||||||
5 | respect to the group or other enrollment unit for the | ||||||
6 | period (and, for
purposes of a refund or additional | ||||||
7 | premium, the profitable or unprofitable
experience shall | ||||||
8 | be calculated taking into account a pro rata share of the
| ||||||
9 | Health Maintenance Organization's administrative and | ||||||
10 | marketing expenses, but
shall not include any refund to be | ||||||
11 | made or additional premium to be paid
pursuant to this | ||||||
12 | subsection (f)). The Health Maintenance Organization and | ||||||
13 | the
group or enrollment unit may agree that the profitable | ||||||
14 | or unprofitable
experience may be calculated taking into | ||||||
15 | account the refund period and the
immediately preceding 2 | ||||||
16 | plan years.
| ||||||
17 | The Health Maintenance Organization shall include a | ||||||
18 | statement in the
evidence of coverage issued to each enrollee | ||||||
19 | describing the possibility of a
refund or additional premium, | ||||||
20 | and upon request of any group or enrollment unit,
provide to | ||||||
21 | the group or enrollment unit a description of the method used | ||||||
22 | to
calculate (1) the Health Maintenance Organization's | ||||||
23 | profitable experience with
respect to the group or enrollment | ||||||
24 | unit and the resulting refund to the group
or enrollment unit | ||||||
25 | or (2) the Health Maintenance Organization's unprofitable
| ||||||
26 | experience with respect to the group or enrollment unit and |
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| |||||||
1 | the resulting
additional premium to be paid by the group or | ||||||
2 | enrollment unit.
| ||||||
3 | In no event shall the Illinois Health Maintenance | ||||||
4 | Organization
Guaranty Association be liable to pay any | ||||||
5 | contractual obligation of an
insolvent organization to pay any | ||||||
6 | refund authorized under this Section.
| ||||||
7 | (g) Rulemaking authority to implement Public Act 95-1045, | ||||||
8 | if any, is conditioned on the rules being adopted in | ||||||
9 | accordance with all provisions of the Illinois Administrative | ||||||
10 | Procedure Act and all rules and procedures of the Joint | ||||||
11 | Committee on Administrative Rules; any purported rule not so | ||||||
12 | adopted, for whatever reason, is unauthorized. | ||||||
13 | (Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19; | ||||||
14 | 101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-393, eff. | ||||||
15 | 1-1-20; 101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, | ||||||
16 | eff. 1-1-21; 102-30, eff. 1-1-22; 102-34, eff. 6-25-21; | ||||||
17 | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. | ||||||
18 | 1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, | ||||||
19 | eff. 10-8-21; revised 10-27-21.)
| ||||||
20 | Section 35. The Limited Health Service Organization Act is | ||||||
21 | amended by changing Section 4003 as follows:
| ||||||
22 | (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
| ||||||
23 | Sec. 4003. Illinois Insurance Code provisions. Limited | ||||||
24 | health service
organizations shall be subject to the |
| |||||||
| |||||||
1 | provisions of Sections 133, 134, 136, 137, 139,
140, 141.1, | ||||||
2 | 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154, | ||||||
3 | 154.5,
154.6, 154.7, 154.8, 155.04, 155.37, 355.2, 355.3, | ||||||
4 | 355b, 356q, 356v, 356z.10, 356z.21, 356z.22, 356z.25, 356z.26, | ||||||
5 | 356z.29, 356z.30a, 356z.32, 356z.33, 356z.41, 356z.46, | ||||||
6 | 356z.47, 356z.51, 356z.53, 356z.43, 368a, 401, 401.1,
402,
| ||||||
7 | 403, 403A, 408,
408.2, 409, 412, 444, and 444.1 and Articles | ||||||
8 | IIA, VIII 1/2, XII, XII 1/2,
XIII,
XIII 1/2, XXV, and XXVI of | ||||||
9 | the Illinois Insurance Code. For purposes of the
Illinois | ||||||
10 | Insurance Code, except for Sections 444 and 444.1 and Articles | ||||||
11 | XIII
and XIII 1/2, limited health service organizations in the | ||||||
12 | following categories
are deemed to be domestic companies:
| ||||||
13 | (1) a corporation under the laws of this State; or
| ||||||
14 | (2) a corporation organized under the laws of another | ||||||
15 | state, 30% or more
of the enrollees of which are residents | ||||||
16 | of this State, except a corporation
subject to | ||||||
17 | substantially the same requirements in its state of | ||||||
18 | organization as
is a domestic company under Article VIII | ||||||
19 | 1/2 of the Illinois Insurance Code.
| ||||||
20 | (Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20; | ||||||
21 | 101-393, eff. 1-1-20; 101-625, eff. 1-1-21; 102-30, eff. | ||||||
22 | 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, | ||||||
23 | eff. 1-1-22; revised 10-27-21.)
| ||||||
24 | Section 40. The Voluntary Health Services Plans Act is | ||||||
25 | amended by changing Section 10 as follows:
|
| |||||||
| |||||||
1 | (215 ILCS 165/10) (from Ch. 32, par. 604)
| ||||||
2 | Sec. 10. Application of Insurance Code provisions. Health | ||||||
3 | services
plan corporations and all persons interested therein | ||||||
4 | or dealing therewith
shall be subject to the provisions of | ||||||
5 | Articles IIA and XII 1/2 and Sections
3.1, 133, 136, 139, 140, | ||||||
6 | 143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, | ||||||
7 | 356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356v,
356w, | ||||||
8 | 356x, 356y, 356z.1, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, | ||||||
9 | 356z.8, 356z.9,
356z.10, 356z.11, 356z.12, 356z.13, 356z.14, | ||||||
10 | 356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, | ||||||
11 | 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33, 356z.40, | ||||||
12 | 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.43, 364.01, | ||||||
13 | 367.2, 368a, 401, 401.1,
402,
403, 403A, 408,
408.2, and 412, | ||||||
14 | and paragraphs (7) and (15) of Section 367 of the Illinois
| ||||||
15 | Insurance Code.
| ||||||
16 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
17 | any, is conditioned on the rules being adopted in accordance | ||||||
18 | with all provisions of the Illinois Administrative Procedure | ||||||
19 | Act and all rules and procedures of the Joint Committee on | ||||||
20 | Administrative Rules; any purported rule not so adopted, for | ||||||
21 | whatever reason, is unauthorized. | ||||||
22 | (Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19; | ||||||
23 | 101-281, eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff. | ||||||
24 | 1-1-21; 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, | ||||||
25 | eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; |
| |||||||
| |||||||
1 | revised 10-27-21.)
| ||||||
2 | Section 45. The Illinois Public Aid Code is amended by | ||||||
3 | changing Section 5-16.8 as follows:
| ||||||
4 | (305 ILCS 5/5-16.8)
| ||||||
5 | Sec. 5-16.8. Required health benefits. The medical | ||||||
6 | assistance program
shall
(i) provide the post-mastectomy care | ||||||
7 | benefits required to be covered by a policy of
accident and | ||||||
8 | health insurance under Section 356t and the coverage required
| ||||||
9 | under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6, | ||||||
10 | 356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46, | ||||||
11 | 356z.47, 356z.51, and 356z.53 and 356z.43 of the Illinois
| ||||||
12 | Insurance Code, (ii) be subject to the provisions of Sections | ||||||
13 | 356z.19, 356z.43, 356z.44, 356z.49, 364.01, 370c, and 370c.1 | ||||||
14 | of the Illinois
Insurance Code, and (iii) be subject to the | ||||||
15 | provisions of subsection (d-5) of Section 10 of the Network | ||||||
16 | Adequacy and Transparency Act.
| ||||||
17 | The Department, by rule, shall adopt a model similar to | ||||||
18 | the requirements of Section 356z.39 of the Illinois Insurance | ||||||
19 | Code. | ||||||
20 | On and after July 1, 2012, the Department shall reduce any | ||||||
21 | rate of reimbursement for services or other payments or alter | ||||||
22 | any methodologies authorized by this Code to reduce any rate | ||||||
23 | of reimbursement for services or other payments in accordance | ||||||
24 | with Section 5-5e. |
| |||||||
| |||||||
1 | To ensure full access to the benefits set forth in this | ||||||
2 | Section, on and after January 1, 2016, the Department shall | ||||||
3 | ensure that provider and hospital reimbursement for | ||||||
4 | post-mastectomy care benefits required under this Section are | ||||||
5 | no lower than the Medicare reimbursement rate. | ||||||
6 | (Source: P.A. 101-81, eff. 7-12-19; 101-218, eff. 1-1-20; | ||||||
7 | 101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-574, eff. | ||||||
8 | 1-1-20; 101-649, eff. 7-7-20; 102-30, eff. 1-1-22; 102-144, | ||||||
9 | eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; | ||||||
10 | 102-530, eff. 1-1-22; 102-642, eff. 1-1-22; revised | ||||||
11 | 10-27-21.)".
|