Illinois-2023-HB3838-Introduced

103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB3838

Introduced , by Rep. Brad Halbrook

SYNOPSIS AS INTRODUCED:

55 ILCS 5/5-1069 from Ch. 34, par. 5-1069

Amends the Counties Code. Provides that, on and after January 1, 2024, group life, health, accident, hospital, and medical insurance may not be provided to part-time county board members unless the same benefits are provided or offered to part-time employees of the county. Effective immediately.

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A BILL FOR

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1 AN ACT concerning local government.

2 Be it enacted by the People of the State of Illinois,

3 represented in the General Assembly:

4 Section 5. The Counties Code is amended by changing

5 Section 5-1069 as follows:

6 (55 ILCS 5/5-1069) (from Ch. 34, par. 5-1069)

7 Sec. 5-1069. Group life, health, accident, hospital, and

8 medical insurance.

9 (a) The county board of any county may arrange to provide,

10 for the benefit of employees of the county, group life,

11 health, accident, hospital, and medical insurance, or any one

12 or any combination of those types of insurance, or the county

13 board may self-insure, for the benefit of its employees, all

14 or a portion of the employees' group life, health, accident,

15 hospital, and medical insurance, or any one or any combination

16 of those types of insurance, including a combination of

17 self-insurance and other types of insurance authorized by this

18 Section, provided that the county board complies with all

19 other requirements of this Section. The insurance may include

20 provision for employees who rely on treatment by prayer or

21 spiritual means alone for healing in accordance with the

22 tenets and practice of a well recognized religious

23 denomination. The county board may provide for payment by the

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1 county of a portion or all of the premium or charge for the

2 insurance with the employee paying the balance of the premium

3 or charge, if any. If the county board undertakes a plan under

4 which the county pays only a portion of the premium or charge,

5 the county board shall provide for withholding and deducting

6 from the compensation of those employees who consent to join

7 the plan the balance of the premium or charge for the

8 insurance.

9 (b) If the county board does not provide for

10 self-insurance or for a plan under which the county pays a

11 portion or all of the premium or charge for a group insurance

12 plan, the county board may provide for withholding and

13 deducting from the compensation of those employees who consent

14 thereto the total premium or charge for any group life,

15 health, accident, hospital, and medical insurance.

16 (c) The county board may exercise the powers granted in

17 this Section only if it provides for self-insurance or, where

18 it makes arrangements to provide group insurance through an

19 insurance carrier, if the kinds of group insurance are

20 obtained from an insurance company authorized to do business

21 in the State of Illinois. The county board may enact an

22 ordinance prescribing the method of operation of the insurance

23 program.

24 (c-5) On and after January 1, 2024, benefits under this

25 Section may not be provided to part-time county board members

26 unless the same benefits are provided or offered to part-time

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1 employees of the county.

2 (d) If a county, including a home rule county, is a

3 self-insurer for purposes of providing health insurance

4 coverage for its employees, the insurance coverage shall

5 include screening by low-dose mammography for all women 35

6 years of age or older for the presence of occult breast cancer

7 unless the county elects to provide mammograms itself under

8 Section 5-1069.1. The coverage shall be as follows:

9 (1) A baseline mammogram for women 35 to 39 years of

10 age.

11 (2) An annual mammogram for women 40 years of age or

12 older.

13 (3) A mammogram at the age and intervals considered

14 medically necessary by the woman's health care provider

15 for women under 40 years of age and having a family history

16 of breast cancer, prior personal history of breast cancer,

17 positive genetic testing, or other risk factors.

18 (4) For a group policy of accident and health

19 insurance that is amended, delivered, issued, or renewed

20 on or after the effective date of this amendatory Act of

21 the 101st General Assembly, a comprehensive ultrasound

22 screening of an entire breast or breasts if a mammogram

23 demonstrates heterogeneous or dense breast tissue or when

24 medically necessary as determined by a physician licensed

25 to practice medicine in all of its branches, advanced

26 practice registered nurse, or physician assistant.

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1 (5) For a group policy of accident and health

2 insurance that is amended, delivered, issued, or renewed

3 on or after the effective date of this amendatory Act of

4 the 101st General Assembly, a diagnostic mammogram when

5 medically necessary, as determined by a physician licensed

6 to practice medicine in all its branches, advanced

7 practice registered nurse, or physician assistant.

8 A policy subject to this subsection shall not impose a

9 deductible, coinsurance, copayment, or any other cost-sharing

10 requirement on the coverage provided; except that this

11 sentence does not apply to coverage of diagnostic mammograms

12 to the extent such coverage would disqualify a high-deductible

13 health plan from eligibility for a health savings account

14 pursuant to Section 223 of the Internal Revenue Code (26

15 U.S.C. 223).

16 For purposes of this subsection:

17 "Diagnostic mammogram" means a mammogram obtained using

18 diagnostic mammography.

19 "Diagnostic mammography" means a method of screening that

20 is designed to evaluate an abnormality in a breast, including

21 an abnormality seen or suspected on a screening mammogram or a

22 subjective or objective abnormality otherwise detected in the

23 breast.

24 "Low-dose mammography" means the x-ray examination of the

25 breast using equipment dedicated specifically for mammography,

26 including the x-ray tube, filter, compression device, and

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1 image receptor, with an average radiation exposure delivery of

2 less than one rad per breast for 2 views of an average size

3 breast. The term also includes digital mammography.

4 (d-5) Coverage as described by subsection (d) shall be

5 provided at no cost to the insured and shall not be applied to

6 an annual or lifetime maximum benefit.

7 (d-10) When health care services are available through

8 contracted providers and a person does not comply with plan

9 provisions specific to the use of contracted providers, the

10 requirements of subsection (d-5) are not applicable. When a

11 person does not comply with plan provisions specific to the

12 use of contracted providers, plan provisions specific to the

13 use of non-contracted providers must be applied without

14 distinction for coverage required by this Section and shall be

15 at least as favorable as for other radiological examinations

16 covered by the policy or contract.

17 (d-15) If a county, including a home rule county, is a

18 self-insurer for purposes of providing health insurance

19 coverage for its employees, the insurance coverage shall

20 include mastectomy coverage, which includes coverage for

21 prosthetic devices or reconstructive surgery incident to the

22 mastectomy. Coverage for breast reconstruction in connection

23 with a mastectomy shall include:

24 (1) reconstruction of the breast upon which the

25 mastectomy has been performed;

26 (2) surgery and reconstruction of the other breast to

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1 produce a symmetrical appearance; and

2 (3) prostheses and treatment for physical

3 complications at all stages of mastectomy, including

4 lymphedemas.

5 Care shall be determined in consultation with the attending

6 physician and the patient. The offered coverage for prosthetic

7 devices and reconstructive surgery shall be subject to the

8 deductible and coinsurance conditions applied to the

9 mastectomy, and all other terms and conditions applicable to

10 other benefits. When a mastectomy is performed and there is no

11 evidence of malignancy then the offered coverage may be

12 limited to the provision of prosthetic devices and

13 reconstructive surgery to within 2 years after the date of the

14 mastectomy. As used in this Section, "mastectomy" means the

15 removal of all or part of the breast for medically necessary

16 reasons, as determined by a licensed physician.

17 A county, including a home rule county, that is a

18 self-insurer for purposes of providing health insurance

19 coverage for its employees, may not penalize or reduce or

20 limit the reimbursement of an attending provider or provide

21 incentives (monetary or otherwise) to an attending provider to

22 induce the provider to provide care to an insured in a manner

23 inconsistent with this Section.

24 (d-20) The requirement that mammograms be included in

25 health insurance coverage as provided in subsections (d)

26 through (d-15) is an exclusive power and function of the State

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1 and is a denial and limitation under Article VII, Section 6,

2 subsection (h) of the Illinois Constitution of home rule

3 county powers. A home rule county to which subsections (d)

4 through (d-15) apply must comply with every provision of those

5 subsections.

6 (e) The term "employees" as used in this Section includes

7 elected or appointed officials but does not include temporary

8 employees.

9 (f) The county board may, by ordinance, arrange to provide

10 group life, health, accident, hospital, and medical insurance,

11 or any one or a combination of those types of insurance, under

12 this Section to retired former employees and retired former

13 elected or appointed officials of the county.

14 (g) Rulemaking authority to implement this amendatory Act

15 of the 95th General Assembly, if any, is conditioned on the

16 rules being adopted in accordance with all provisions of the

17 Illinois Administrative Procedure Act and all rules and

18 procedures of the Joint Committee on Administrative Rules; any

19 purported rule not so adopted, for whatever reason, is

20 unauthorized.

21 (Source: P.A. 100-513, eff. 1-1-18; 101-580, eff. 1-1-20.)

22 Section 99. Effective date. This Act takes effect upon

23 becoming law.