Bill Text: IL HB0079 | 2015-2016 | 99th General Assembly | Introduced

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Bill Title: Amends the Illinois Insurance Code. Makes a technical change in a Section concerning mental health parity.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2015-03-27 - Rule 19(a) / Re-referred to Rules Committee [HB0079 Detail]

Download: Illinois-2015-HB0079-Introduced.html

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99TH GENERAL ASSEMBLY State of Illinois 2015 and 2016 HB0079 Introduced , by Rep. Lou Lang SYNOPSIS AS INTRODUCED:
215 ILCS 5/370c.1
Amends the Illinois Insurance Code. Makes a technical change in a Section concerning mental health parity.
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A BILL FOR
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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 Illinois Insurance Code is amended by
changing Section 370c.1 as follows:
(215 ILCS 5/370c.1)
Sec. 370c.1. Mental health parity.
(a) On and after the the effective date of this amendatory
Act of the 97th General Assembly, every insurer that amends,
delivers, issues, or renews a group policy of accident and
health insurance in this State providing coverage for hospital
or medical treatment and for the treatment of mental,
emotional, nervous, or substance use disorders or conditions
shall ensure that:
(1) the financial requirements applicable to such
mental, emotional, nervous, or substance use disorder or
condition benefits are no more restrictive than the
predominant financial requirements applied to
substantially all hospital and medical benefits covered by
the policy and that there are no separate cost-sharing
requirements that are applicable only with respect to
mental, emotional, nervous, or substance use disorder or
condition benefits; and

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(2) the treatment limitations applicable to such
mental, emotional, nervous, or substance use disorder or
condition benefits are no more restrictive than the
predominant treatment limitations applied to substantially
all hospital and medical benefits covered by the policy and
that there are no separate treatment limitations that are
applicable only with respect to mental, emotional,
nervous, or substance use disorder or condition benefits.
(b) The following provisions shall apply concerning
aggregate lifetime limits:
(1) In the case of a group policy of accident and
health insurance amended, delivered, issued, or renewed in
this State on or after the effective date of this
amendatory Act of the 97th General Assembly that provides
coverage for hospital or medical treatment and for the
treatment of mental, emotional, nervous, or substance use
disorders or conditions the following provisions shall
apply:
(A) if the policy does not include an aggregate
lifetime limit on substantially all hospital and
medical benefits, then the policy may not impose any
aggregate lifetime limit on mental, emotional,
nervous, or substance use disorder or condition
benefits; or
(B) if the policy includes an aggregate lifetime
limit on substantially all hospital and medical

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benefits (in this subsection referred to as the
"applicable lifetime limit"), then the policy shall
either:
(i) apply the applicable lifetime limit both
to the hospital and medical benefits to which it
otherwise would apply and to mental, emotional,
nervous, or substance use disorder or condition
benefits and not distinguish in the application of
the limit between the hospital and medical
benefits and mental, emotional, nervous, or
substance use disorder or condition benefits; or
(ii) not include any aggregate lifetime limit
on mental, emotional, nervous, or substance use
disorder or condition benefits that is less than
the applicable lifetime limit.
(2) In the case of a policy that is not described in
paragraph (1) of subsection (b) of this Section and that
includes no or different aggregate lifetime limits on
different categories of hospital and medical benefits, the
Director shall establish rules under which subparagraph
(B) of paragraph (1) of subsection (b) of this Section is
applied to such policy with respect to mental, emotional,
nervous, or substance use disorder or condition benefits by
substituting for the applicable lifetime limit an average
aggregate lifetime limit that is computed taking into
account the weighted average of the aggregate lifetime

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limits applicable to such categories.
(c) The following provisions shall apply concerning annual
limits:
(1) In the case of a group policy of accident and
health insurance amended, delivered, issued, or renewed in
this State on or after the effective date of this
amendatory Act of the 97th General Assembly that provides
coverage for hospital or medical treatment and for the
treatment of mental, emotional, nervous, or substance use
disorders or conditions the following provisions shall
apply:
(A) if the policy does not include an annual limit
on substantially all hospital and medical benefits,
then the policy may not impose any annual limits on
mental, emotional, nervous, or substance use disorder
or condition benefits; or
(B) if the policy includes an annual limit on
substantially all hospital and medical benefits (in
this subsection referred to as the "applicable annual
limit"), then the policy shall either:
(i) apply the applicable annual limit both to
the hospital and medical benefits to which it
otherwise would apply and to mental, emotional,
nervous, or substance use disorder or condition
benefits and not distinguish in the application of
the limit between the hospital and medical

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benefits and mental, emotional, nervous, or
substance use disorder or condition benefits; or
(ii) not include any annual limit on mental,
emotional, nervous, or substance use disorder or
condition benefits that is less than the
applicable annual limit.
(2) In the case of a policy that is not described in
paragraph (1) of subsection (c) of this Section and that
includes no or different annual limits on different
categories of hospital and medical benefits, the Director
shall establish rules under which subparagraph (B) of
paragraph (1) of subsection (c) of this Section is applied
to such policy with respect to mental, emotional, nervous,
or substance use disorder or condition benefits by
substituting for the applicable annual limit an average
annual limit that is computed taking into account the
weighted average of the annual limits applicable to such
categories.
(d) This Section shall be interpreted in a manner
consistent with the interim final regulations promulgated by
the U.S. Department of Health and Human Services at 75 FR 5410,
including the prohibition against applying a cumulative
financial requirement or cumulative quantitative treatment
limitation for mental, emotional, nervous, or substance use
disorder benefits that accumulates separately from any
cumulative financial requirement or cumulative quantitative

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treatment limitation established for hospital and medical
benefits in the same classification.
(e) The provisions of subsections (b) and (c) of this
Section shall not be interpreted to allow the use of lifetime
or annual limits otherwise prohibited by State or federal law.
(f) This Section shall not apply to individual health
insurance coverage as defined in Section 5 of the Illinois
Health Insurance Portability and Accountability Act.
(g) As used in this Section:
"Financial requirement" includes deductibles, copayments,
coinsurance, and out-of-pocket maximums, but does not include
an aggregate lifetime limit or an annual limit subject to
subsections (b) and (c).
"Treatment limitation" includes limits on benefits based
on the frequency of treatment, number of visits, days of
coverage, days in a waiting period, or other similar limits on
the scope or duration of treatment. "Treatment limitation"
includes both quantitative treatment limitations, which are
expressed numerically (such as 50 outpatient visits per year),
and nonquantitative treatment limitations, which otherwise
limit the scope or duration of treatment. A permanent exclusion
of all benefits for a particular condition or disorder shall
not be considered a treatment limitation.
(Source: P.A. 97-437, eff. 8-18-11.)