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91_HB0597eng HB0597 Engrossed LRB9101643JSpc 1 AN ACT concerning insurance coverage for contraceptive 2 services, amending named Acts. 3 Be it enacted by the People of the State of Illinois, 4 represented in the General Assembly: 5 Section 5. The Illinois Insurance Code is amended by 6 adding Section 356y as follows: 7 (215 ILCS 5/356y new) 8 Sec. 356y. Coverage for contraceptives. 9 (a) An individual or group policy of accident and health 10 insurance amended, delivered, issued, or renewed in this 11 State after the effective date of this amendatory Act of the 12 91st General Assembly that provides coverage for outpatient 13 services and outpatient prescription drugs or devices must 14 provide coverage for the insured and any dependent of the 15 insured covered by the policy for outpatient contraceptive 16 services and outpatient contraceptive drugs or devices 17 approved by the Food and Drug Administration. Coverage 18 required under this Section may not impose any deductible, 19 coinsurance, waiting period, or other cost-sharing or 20 limitation that is greater than that required for any 21 outpatient service or outpatient prescription drug or device 22 otherwise covered by the policy. 23 (b) As used in this Section, "outpatient contraceptive 24 service" means consultations, examinations, procedures, and 25 medical services, provided on an outpatient basis and related 26 to the use of contraceptive methods (including natural family 27 planning) to prevent an unintended pregnancy. 28 Section 10. The Health Maintenance Organization Act is 29 amended by changing Section 5-3 as follows: HB0597 Engrossed -2- LRB9101643JSpc 1 (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2) 2 Sec. 5-3. Insurance Code provisions. 3 (a) Health Maintenance Organizations shall be subject to 4 the provisions of Sections 133, 134, 137, 140, 141.1, 141.2, 5 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5, 6 154.6, 154.7, 154.8, 155.04, 355.2, 356m, 356v, 356w, 356x, 7 356y, 367i, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412, 8 444, and 444.1, paragraph (c) of subsection (2) of Section 9 367, and Articles VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, 10 XXV, and XXVI of the Illinois Insurance Code. 11 (b) For purposes of the Illinois Insurance Code, except 12 for Sections 444 and 444.1 and Articles XIII and XIII 1/2, 13 Health Maintenance Organizations in the following categories 14 are deemed to be "domestic companies": 15 (1) a corporation authorized under the Dental 16 Service Plan Act or the Voluntary Health Services Plans 17 Act; 18 (2) a corporation organized under the laws of this 19 State; or 20 (3) a corporation organized under the laws of 21 another state, 30% or more of the enrollees of which are 22 residents of this State, except a corporation subject to 23 substantially the same requirements in its state of 24 organization as is a "domestic company" under Article 25 VIII 1/2 of the Illinois Insurance Code. 26 (c) In considering the merger, consolidation, or other 27 acquisition of control of a Health Maintenance Organization 28 pursuant to Article VIII 1/2 of the Illinois Insurance Code, 29 (1) the Director shall give primary consideration 30 to the continuation of benefits to enrollees and the 31 financial conditions of the acquired Health Maintenance 32 Organization after the merger, consolidation, or other 33 acquisition of control takes effect; 34 (2)(i) the criteria specified in subsection (1)(b) HB0597 Engrossed -3- LRB9101643JSpc 1 of Section 131.8 of the Illinois Insurance Code shall not 2 apply and (ii) the Director, in making his determination 3 with respect to the merger, consolidation, or other 4 acquisition of control, need not take into account the 5 effect on competition of the merger, consolidation, or 6 other acquisition of control; 7 (3) the Director shall have the power to require 8 the following information: 9 (A) certification by an independent actuary of 10 the adequacy of the reserves of the Health 11 Maintenance Organization sought to be acquired; 12 (B) pro forma financial statements reflecting 13 the combined balance sheets of the acquiring company 14 and the Health Maintenance Organization sought to be 15 acquired as of the end of the preceding year and as 16 of a date 90 days prior to the acquisition, as well 17 as pro forma financial statements reflecting 18 projected combined operation for a period of 2 19 years; 20 (C) a pro forma business plan detailing an 21 acquiring party's plans with respect to the 22 operation of the Health Maintenance Organization 23 sought to be acquired for a period of not less than 24 3 years; and 25 (D) such other information as the Director 26 shall require. 27 (d) The provisions of Article VIII 1/2 of the Illinois 28 Insurance Code and this Section 5-3 shall apply to the sale 29 by any health maintenance organization of greater than 10% of 30 its enrollee population (including without limitation the 31 health maintenance organization's right, title, and interest 32 in and to its health care certificates). 33 (e) In considering any management contract or service 34 agreement subject to Section 141.1 of the Illinois Insurance HB0597 Engrossed -4- LRB9101643JSpc 1 Code, the Director (i) shall, in addition to the criteria 2 specified in Section 141.2 of the Illinois Insurance Code, 3 take into account the effect of the management contract or 4 service agreement on the continuation of benefits to 5 enrollees and the financial condition of the health 6 maintenance organization to be managed or serviced, and (ii) 7 need not take into account the effect of the management 8 contract or service agreement on competition. 9 (f) Except for small employer groups as defined in the 10 Small Employer Rating, Renewability and Portability Health 11 Insurance Act and except for medicare supplement policies as 12 defined in Section 363 of the Illinois Insurance Code, a 13 Health Maintenance Organization may by contract agree with a 14 group or other enrollment unit to effect refunds or charge 15 additional premiums under the following terms and conditions: 16 (i) the amount of, and other terms and conditions 17 with respect to, the refund or additional premium are set 18 forth in the group or enrollment unit contract agreed in 19 advance of the period for which a refund is to be paid or 20 additional premium is to be charged (which period shall 21 not be less than one year); and 22 (ii) the amount of the refund or additional premium 23 shall not exceed 20% of the Health Maintenance 24 Organization's profitable or unprofitable experience with 25 respect to the group or other enrollment unit for the 26 period (and, for purposes of a refund or additional 27 premium, the profitable or unprofitable experience shall 28 be calculated taking into account a pro rata share of the 29 Health Maintenance Organization's administrative and 30 marketing expenses, but shall not include any refund to 31 be made or additional premium to be paid pursuant to this 32 subsection (f)). The Health Maintenance Organization and 33 the group or enrollment unit may agree that the 34 profitable or unprofitable experience may be calculated HB0597 Engrossed -5- LRB9101643JSpc 1 taking into account the refund period and the immediately 2 preceding 2 plan years. 3 The Health Maintenance Organization shall include a 4 statement in the evidence of coverage issued to each enrollee 5 describing the possibility of a refund or additional premium, 6 and upon request of any group or enrollment unit, provide to 7 the group or enrollment unit a description of the method used 8 to calculate (1) the Health Maintenance Organization's 9 profitable experience with respect to the group or enrollment 10 unit and the resulting refund to the group or enrollment unit 11 or (2) the Health Maintenance Organization's unprofitable 12 experience with respect to the group or enrollment unit and 13 the resulting additional premium to be paid by the group or 14 enrollment unit. 15 In no event shall the Illinois Health Maintenance 16 Organization Guaranty Association be liable to pay any 17 contractual obligation of an insolvent organization to pay 18 any refund authorized under this Section. 19 (Source: P.A. 89-90, eff. 6-30-95; 90-25, eff. 1-1-98; 20 90-177, eff. 7-23-97; 90-372, eff. 7-1-98; 90-583, eff. 21 5-29-98; 90-655, eff. 7-30-98; 90-741, eff. 1-1-99; revised 22 9-8-98.) 23 Section 15. The Voluntary Health Services Plans Act is 24 amended by changing Section 10 as follows: 25 (215 ILCS 165/10) (from Ch. 32, par. 604) 26 Sec. 10. Application of Insurance Code provisions. 27 Health services plan corporations and all persons interested 28 therein or dealing therewith shall be subject to the 29 provisions of Article XII 1/2 and Sections 3.1, 133, 140, 30 143, 143c, 149, 354, 355.2, 356r, 356t, 356u, 356v, 356w, 31 356x, 356y, 367.2, 401, 401.1, 402, 403, 403A, 408, 408.2, 32 and 412, and paragraphs (7) and (15) of Section 367 of the HB0597 Engrossed -6- LRB9101643JSpc 1 Illinois Insurance Code. 2 (Source: P.A. 89-514, eff. 7-17-96; 90-7, eff. 6-10-97; 3 90-25, eff. 1-1-98; 90-655, eff. 7-30-98; 90-741, eff. 4 1-1-99.)