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| Public Act 095-0958 |
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AN ACT concerning regulation.
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Be it enacted by the People of the State of Illinois,
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represented in the General Assembly:
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Section 5. The State Employees Group Insurance Act of 1971 | ||||
is amended by changing Section 6.11 as follows:
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(5 ILCS 375/6.11)
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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.5,
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356u, 356w, 356x, 356z.2, 356z.4, 356z.6, and 356z.9, 356z.10, | ||||
356z.11, and 356z.12 and
356z.9 of the
Illinois Insurance Code.
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The program of health benefits must comply with Section 155.37 | ||||
of the
Illinois Insurance Code.
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(Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; | ||||
95-520, eff. 8-28-07; revised 12-4-07.)
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Section 10. The Counties Code is amended by changing | ||||
Section 5-1069.3 as follows: | ||||
(55 ILCS 5/5-1069.3)
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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.5, 356u,
356w, 356x, 356z.6, and 356z.9, | ||
356z.10, 356z.11, and 356z.12 and
356z.9 of
the Illinois | ||
Insurance Code. The requirement that health benefits be covered
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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
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rule county to which this Section applies must comply with | ||
every provision of
this Section.
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(Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; | ||
95-520, eff. 8-28-07; revised 12-4-07.)
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Section 15. The Illinois Municipal Code is amended by | ||
changing Section 10-4-2.3 as follows: | ||
(65 ILCS 5/10-4-2.3)
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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.5, 356u, 356w, | ||
356x, 356z.6, and 356z.9, 356z.10, 356z.11, and 356z.12 and
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356z.9 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.
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(Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; | ||
95-520, eff. 8-28-07; revised 12-4-07.)
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Section 20. The School Code is amended by changing Section | ||
10-22.3f as follows: | ||
(105 ILCS 5/10-22.3f)
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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.5, 356u, 356w, 356x,
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356z.6, and 356z.9, 356z.11, and 356z.12 of
the
Illinois | ||
Insurance Code.
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(Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; | ||
revised 12-4-07.)
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Section 25. The Illinois Insurance Code is amended by | ||
adding Section 356z.11 and Section 356z.12 as follows: | ||
(215 ILCS 5/356z.11 new) | ||
Sec. 356z.11. Dependent students; medical leave of | ||
absence. A group or individual policy of accident and health | ||
insurance or managed care plan amended, delivered, issued, or | ||
renewed after the effective date of this amendatory Act of the | ||
95th General Assembly must continue to provide coverage for a | ||
dependent college student who takes a medical leave of absence | ||
or reduces his or her course load to part-time status because | ||
of a catastrophic illness or injury. | ||
Continuation of coverage under this Section is subject to | ||
all of the policy's terms and
conditions applicable to those | ||
forms of insurance. Continuation of insurance under the policy | ||
shall terminate 12 months after notice of the illness or injury | ||
or until the coverage would have otherwise lapsed pursuant to | ||
the terms and conditions of the policy, whichever comes first, | ||
provided the need for part-time status or medical leave of | ||
absence is supported by a clinical certification of need from a | ||
physician licensed to practice medicine in all its branches. | ||
The provisions of this Section do not apply to short-term | ||
travel, accident-only, limited, or specified disease policies | ||
or to policies or contracts designed for issuance to persons | ||
eligible for coverage under Title XVIII of the Social Security | ||
Act, known as Medicare, or any other similar coverage under | ||
State or federal governmental plans. | ||
(215 ILCS 5/356z.12 new) | ||
Sec. 356z.12. Dependent coverage. | ||
(a) A group or individual policy of accident and health | ||
insurance or managed care plan that provides coverage for | ||
dependents and that is amended, delivered, issued, or renewed | ||
after the effective date of this amendatory Act of the 95th | ||
General Assembly shall not terminate coverage or deny the | ||
election of coverage for an unmarried dependent by reason of | ||
the dependent's age before the dependent's 26th birthday. | ||
(b) A policy or plan subject to this Section shall, upon | ||
amendment, delivery, issuance, or renewal, establish an | ||
initial enrollment period of not less than 90 days during which | ||
an insured may make a written election for coverage of an | ||
unmarried person as a dependent under this Section. After the | ||
initial enrollment period, enrollment by a dependent pursuant | ||
to this Section shall be consistent with the enrollment terms | ||
of the plan or policy. | ||
(c) A policy or plan subject to this Section shall allow | ||
for dependent coverage during the annual open enrollment date | ||
or the annual renewal date if the dependent, as of the date on | ||
which the insured elects dependent coverage under this | ||
subsection, has: | ||
(1) a period of continuous creditable coverage of 90 | ||
days or more; and | ||
(2) not been without creditable coverage for more than | ||
63 days. | ||
An insured may elect coverage for a dependent who does not meet | ||
the continuous creditable coverage requirements of this | ||
subsection (c) and that dependent shall not be denied coverage | ||
due to age. | ||
For purposes of this subsection (c), "creditable coverage" | ||
shall have the meaning provided under subsection (C)(1) of | ||
Section 20 of the Illinois Health Insurance Portability and | ||
Accountability Act. | ||
(d) Military personnel. A group or individual policy of | ||
accident and health insurance or managed care plan that | ||
provides coverage for dependents and that is amended, | ||
delivered, issued, or renewed after the effective date of this | ||
amendatory Act of the 95th General Assembly shall not terminate | ||
coverage or deny the election of coverage for an unmarried | ||
dependent by reason of the dependent's age before the | ||
dependent's 30th birthday if the dependent (i) is an Illinois | ||
resident, (ii) served as a member of the active or reserve | ||
components of any of the branches of the Armed Forces of the | ||
United States, and (iii) has received a release or discharge | ||
other than a dishonorable discharge. To be eligible for | ||
coverage under this subsection (d), the eligible dependent | ||
shall submit to the insurer a form approved by the Illinois | ||
Department of Veterans' Affairs stating the date on which the | ||
dependent was released from service. | ||
(e) Calculation of the cost of coverage provided to an | ||
unmarried dependent under this Section shall be identical. | ||
(f) Nothing in this Section shall prohibit an employer from | ||
requiring an employee to pay all or part of the cost of | ||
coverage provided under this Section. | ||
(g) No exclusions or limitations may be applied to coverage | ||
elected pursuant to this Section that do not apply to all | ||
dependents covered under the policy. | ||
(h) A policy or plan subject to this Section shall not | ||
condition eligibility for dependent coverage provided pursuant | ||
to this Section on enrollment in any educational institution. | ||
(i) Notice regarding coverage for a dependent as provided | ||
pursuant to this Section shall be provided to an insured by the | ||
insurer: | ||
(1) upon application or enrollment; | ||
(2) in the certificate of coverage or equivalent | ||
document prepared for an insured and delivered on or about | ||
the date on which the coverage commences; and | ||
(3) in a notice delivered to an insured on a | ||
semi-annual basis. | ||
Section 30. The Health Maintenance Organization Act is | ||
amended by changing Section 5-3 as follows:
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(215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
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Sec. 5-3. Insurance Code provisions.
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(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, 355.2, 356m, 356v, 356w, 356x, | ||
356y,
356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10, | ||
356z.11, 356z.12
356z.9, 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.
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(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":
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(1) a corporation authorized under the
Dental Service | ||
Plan Act or the Voluntary Health Services Plans Act;
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(2) a corporation organized under the laws of this | ||
State; or
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(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
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organization as is a "domestic company" under Article VIII | ||
1/2 of the
Illinois Insurance Code.
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(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,
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(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;
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(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
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acquisition of control, need not take into account the | ||
effect on
competition of the merger, consolidation, or | ||
other acquisition of control;
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(3) the Director shall have the power to require the | ||
following
information:
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(A) certification by an independent actuary of the | ||
adequacy
of the reserves of the Health Maintenance | ||
Organization sought to be acquired;
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(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;
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(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
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(D) such other information as the Director shall | ||
require.
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(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
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enrollee population (including without limitation the health | ||
maintenance
organization's right, title, and interest in and to | ||
its health care
certificates).
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(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
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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.
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(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:
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(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
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additional premium is to be charged (which period shall not | ||
be less than one
year); and
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(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
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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.
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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
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experience with respect to the group or enrollment unit and the | ||
resulting
additional premium to be paid by the group or | ||
enrollment unit.
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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.
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(Source: P.A. 94-906, eff. 1-1-07; 94-1076, eff. 12-29-06; | ||
95-422, eff. 8-24-07; 95-520, eff. 8-28-07; revised 12-4-07.)
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Section 35. The Voluntary Health Services Plans Act is | ||
amended by changing Section 10 as follows:
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(215 ILCS 165/10) (from Ch. 32, par. 604)
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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, 155.37, 354, 355.2, 356g.5, 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.9, 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.
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(Source: P.A. 94-1076, eff. 12-29-06; 95-189, eff. 8-16-07; | ||
95-331, eff. 8-21-07; 95-422, eff. 8-24-07; 95-520, eff. | ||
8-28-07; revised 12-5-07.)
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