Public Act 100-1026
 
HB4516 EnrolledLRB100 17336 SMS 32500 b



    AN ACT concerning insurance.

 
    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 adding 
Section 356z.29 as follows:
 
    (215 ILCS 5/356z.29 new)
    Sec. 356z.29. Coverage for hearing aids for individuals 
under the age of 18.
    (a) As used in this Section:
    "Hearing care professional" means a person who is a

licensed hearing instrument dispenser, licensed audiologist, 
or licensed physician.
    "Hearing instrument" or "hearing aid" means any wearable

non-disposable, non-experimental instrument or device designed 
to aid or
compensate for impaired human hearing and any parts, 
attachments, or accessories for the instrument or device, 
including
an ear mold but excluding batteries and cords.
    (b) An individual or group policy of accident and health

insurance or managed care plan that is amended, delivered,

issued, or renewed after the effective date of this amendatory

Act of the 100th General Assembly must provide coverage for

medically necessary hearing instruments and related services 
for all individuals under the age of 18
when a hearing care 
professional prescribes a hearing instrument to augment 
communication.
    (c) An insurer shall provide coverage, subject to all 
applicable co-payments, co-insurance, deductibles, and 
out-of-pocket limits, subject to the following restrictions:
        (1) one hearing instrument shall be covered for each 
    ear every 36 months;
        (2) related services, such as audiological exams and 
    selection, fitting, and adjustment of ear molds to maintain 
    optimal fit shall be covered when deemed medically 
    necessary by a hearing care professional; and
        (3) hearing instrument repairs may be covered when 
    deemed medically necessary.
    (d) If, at any time before or after the effective date of 
this amendatory Act of the 100th General Assembly, the 
Secretary of the United States Department of Health and Human 
Services, or its successor agency, promulgates rules or 
regulations to be published in the Federal Register, publishes 
a comment in the Federal Register, or issues an opinion, 
guidance, or other action that would require the State, 
pursuant to any provision of the Patient Protection and 
Affordable Care Act (Pub. L. 111–148), including, but not 
limited to, 42 U.S.C. 18031(d)(3)(B) or any successor 
provision,  to defray the cost of coverage for medically 
necessary hearing instruments and related services for 
individuals under the age of 18, then this Section is 
inoperative with respect to all such coverage other than that 
authorized under Section 1902 of the Social Security Act, 42 
U.S.C. 1396a, and the State shall not assume any obligation for 
the cost of coverage for medically necessary hearing 
instruments and related services for individuals under the age 
of 18. 
 
    Section 10. 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, 136, 137, 139, 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, 355.3, 
355b, 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, 356z.19, 356z.21, 
356z.22, 356z.25, 356z.26, 356z.29, 364, 364.01, 367.2, 
367.2-5, 367i, 368a, 368b, 368c, 368d, 368e, 370c,
370c.1, 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. 99-761, eff. 1-1-18; 100-24, eff. 7-18-17; 
100-138, eff. 8-18-17; revised 10-5-17.)
 
    Section 15. 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, 136, 139, 140, 
143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, 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, 
356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 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. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; 
revised 10-5-17.)
 

    Section 99. Effective date. This Act takes effect upon 
becoming law.