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| Public Act 098-1091 | ||||
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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, | ||||
356g.5, 356g.5-1, 356m,
356u, 356w, 356x, 356z.2, 356z.4, | ||||
356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, | ||||
356z.14, 356z.15, and 356z.17, and 356z.22 of the
Illinois | ||||
Insurance Code.
The program of health benefits must comply with | ||||
Sections 155.22a, 155.37, 355b, and 356z.19 of the
Illinois | ||||
Insurance Code.
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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. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-813, | ||
eff. 7-13-12; 98-189, eff. 1-1-14.) | ||
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, 356g.5, 356g.5-1, 356u,
356w, 356x, | ||
356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, | ||
356z.14, and 356z.15, and 356z.22 of
the Illinois Insurance | ||
Code. The coverage shall comply with Sections 155.22a, 355b, | ||
and 356z.19 of
the Illinois Insurance Code. The requirement | ||
that health benefits be covered
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
rule county to which this | ||
Section applies must comply with every provision of
this | ||
Section.
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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. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-813, | ||
eff. 7-13-12; 98-189, eff. 1-1-14.) | ||
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, 356g.5, | ||
356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10, | ||
356z.11, 356z.12, 356z.13, 356z.14, and 356z.15, and 356z.22 of | ||
the Illinois
Insurance
Code. The coverage shall comply with | ||
Sections 155.22a, 355b, and 356z.19 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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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. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-813, | ||
eff. 7-13-12; 98-189, eff. 1-1-14.) | ||
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, 356g.5, 356g.5-1, | ||
356u, 356w, 356x,
356z.6, 356z.8, 356z.9, 356z.11, 356z.12, | ||
356z.13, 356z.14, and 356z.15, and 356z.22 of
the
Illinois | ||
Insurance Code.
Insurance policies shall comply with Section | ||
356z.19 of the Illinois Insurance Code. The coverage shall | ||
comply with Sections 155.22a and 355b of
the Illinois Insurance | ||
Code.
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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. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-813, | ||
eff. 7-13-12; 98-189, eff. 1-1-14.) | ||
Section 25. The Illinois Insurance Code is amended by | ||
adding Section 356z.22 as follows: | ||
(215 ILCS 5/356z.22 new) | ||
Sec. 356z.22. Coverage for telehealth services. | ||
(a) For purposes of this Section: | ||
"Distant site" means the location at which the health | ||
care provider rendering the telehealth service is located. | ||
"Interactive telecommunications system" means an audio | ||
and video system permitting 2-way, live interactive | ||
communication between the patient and the distant site | ||
health care provider. | ||
"Telehealth services" means the delivery of covered | ||
health care services by way of an interactive | ||
telecommunications system. | ||
(b) If an individual or group policy of accident or health | ||
insurance provides coverage for telehealth services, then it | ||
must comply with the following: | ||
(1) An individual or group policy of accident or health | ||
insurance providing telehealth services may not: | ||
(A) require that in-person contact occur between a | ||
health care provider and a patient; | ||
(B) require the health care provider to document a | ||
barrier to an in-person consultation for coverage of | ||
services to be provided through telehealth; | ||
(C) require the use of telehealth when the health | ||
care provider has determined that it is not | ||
appropriate; or | ||
(D) require the use of telehealth when a patient | ||
chooses an in-person consultation. | ||
(2) Deductibles, copayments, or coinsurance applicable | ||
to services provided through telehealth shall not exceed | ||
the deductibles, copayments, or coinsurance required by | ||
the individual or group policy of accident or health | ||
insurance for the same services provided through in-person | ||
consultation. | ||
(c) Nothing in this Section shall be deemed as precluding a | ||
health insurer from providing benefits for other services, | ||
including, but not limited to, remote monitoring services, | ||
other monitoring services, or oral communications otherwise | ||
covered under the policy. | ||
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, 136, 137, 139, 140, 141.1,
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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, 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.
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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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(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. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-437, | ||
eff. 8-18-11; 97-486, eff. 1-1-12; 97-592, eff. 1-1-12; 97-805, | ||
eff. 1-1-13; 97-813, eff. 7-13-12; 98-189, eff. 1-1-14.) | ||
Section 35. The Limited Health Service Organization Act is | ||
amended by changing Section 4003 as follows:
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(215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
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Sec. 4003. Illinois Insurance Code provisions. Limited | ||
health service
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, 155.37, 355.2, 355.3, 355b, 356v, | ||
356z.10, 356z.21, 356z.22, 368a, 401, 401.1,
402,
403, 403A, | ||
408,
408.2, 409, 412, 444, and 444.1 and Articles IIA, VIII | ||
1/2, XII, XII 1/2,
XIII,
XIII 1/2, XXV, and XXVI of the | ||
Illinois Insurance Code. For purposes of the
Illinois Insurance | ||
Code, except for Sections 444 and 444.1 and Articles XIII
and | ||
XIII 1/2, limited health service organizations in the following | ||
categories
are deemed to be domestic companies:
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(1) a corporation under the laws of this State; or
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(2) a corporation organized under the laws of another | ||
state, 30% of 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.
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(Source: P.A. 97-486, eff. 1-1-12; 97-592, 1-1-12; 97-805, eff. | ||
1-1-13; 97-813, eff. 7-13-12; 98-189, eff. 1-1-14.)
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Section 40. 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, 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,
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356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18, | ||
356z.19, 356z.21, 356z.22, 364.01, 367.2, 368a, 401, 401.1,
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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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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. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-486, | ||
eff. 1-1-12; 97-592, eff. 1-1-12; 97-805, eff. 1-1-13; 97-813, | ||
eff. 7-13-12; 98-189, eff. 1-1-14.)
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