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92_HB0241eng HB0241 Engrossed LRB9201409JScs 1 AN ACT concerning health services. 2 Be it enacted by the People of the State of Illinois, 3 represented in the General Assembly: 4 Section 5. The State Employees Group Insurance Act of 5 1971 is amended by changing Section 6.11 as follows: 6 (5 ILCS 375/6.11) 7 Sec. 6.11. Required health benefits. The program of 8 health benefits shall provide the post-mastectomy care 9 benefits required to be covered by a policy of accident and 10 health insurance under Section 356t of the Illinois Insurance 11 Code. The program of health benefits shall provide the 12 coverage required under Sections 356u, 356w,and356x, 13 356z.2, and 356z.3 of the Illinois Insurance Code. 14 (Source: P.A. 90-7, eff. 6-10-97; 90-655, eff. 7-30-98; 15 90-741, eff. 1-1-99.) 16 Section 10. The Counties Code is amended by changing 17 Section 5-1069.3 as follows: 18 (55 ILCS 5/5-1069.3) 19 Sec. 5-1069.3. Required health benefits. If a county, 20 including a home rule county, is a self-insurer for purposes 21 of providing health insurance coverage for its employees, the 22 coverage shall include coverage for the post-mastectomy care 23 benefits required to be covered by a policy of accident and 24 health insurance under Section 356t and the coverage required 25 under Sections 356u, 356w,and356x, 356z.2, and 356z.3 of 26 the Illinois Insurance Code. The requirement that health 27 benefits be covered as provided in this Section is an 28 exclusive power and function of the State and is a denial and 29 limitation under Article VII, Section 6, subsection (h) of HB0241 Engrossed -2- LRB9201409JScs 1 the Illinois Constitution. A home rule county to which this 2 Section applies must comply with every provision of this 3 Section. 4 (Source: P.A. 90-7, eff. 6-10-97; 90-741, eff. 1-1-99.) 5 Section 15. The Illinois Municipal Code is amended by 6 changing Section 10-4-2.3 as follows: 7 (65 ILCS 5/10-4-2.3) 8 Sec. 10-4-2.3. Required health benefits. If a 9 municipality, including a home rule municipality, is a 10 self-insurer for purposes of providing health insurance 11 coverage for its employees, the coverage shall include 12 coverage for the post-mastectomy care benefits required to be 13 covered by a policy of accident and health insurance under 14 Section 356t and the coverage required under Sections 356u, 15 356w,and356x, 356z.2, and 356z.3 of the Illinois Insurance 16 Code. The requirement that health benefits be covered as 17 provided in this is an exclusive power and function of the 18 State and is a denial and limitation under Article VII, 19 Section 6, subsection (h) of the Illinois Constitution. A 20 home rule municipality to which this Section applies must 21 comply with every provision of this Section. 22 (Source: P.A. 90-7, eff. 6-10-97; 90-741, eff. 1-1-99.) 23 Section 20. The School Code is amended by changing 24 Section 10-22.3f as follows: 25 (105 ILCS 5/10-22.3f) 26 Sec. 10-22.3f. Required health benefits. Insurance 27 protection and benefits for employees shall provide the 28 post-mastectomy care benefits required to be covered by a 29 policy of accident and health insurance under Section 356t 30 and the coverage required under Sections 356u, 356w,andHB0241 Engrossed -3- LRB9201409JScs 1 356x, 356z.2, and 356z.3 of the Illinois Insurance Code. 2 (Source: P.A. 90-7, eff. 6-10-97; 90-741, eff. 1-1-99.) 3 Section 25. The Hospital Licensing Act is amended by 4 adding Section 11.4 as follows: 5 (210 ILCS 85/11.4 new) 6 Sec. 11.4. Uniform standards of obstetrical care 7 regardless of source of or ability to pay. 8 (a) A hospital may not promulgate policies or implement 9 practices that determine differing standards of obstetrical 10 care based upon a patient's source of payment or ability to 11 pay for medical services. 12 (b) A hospital shall develop a written policy statement 13 reflecting the requirements of subsection (a) and shall post 14 written notices of this policy in the obstetrical admitting 15 areas of the hospital by July 1, 2001. Notices posted 16 pursuant to this Section shall be posted in the predominant 17 language or languages spoken in the hospital's service area. 18 Section 30. The Illinois Insurance Code is amended by 19 adding Sections 356z.2 and 356z.3 as follows: 20 (215 ILCS 5/356z.2 new) 21 Sec. 356z.2. Epidural anesthesia services. A group or 22 individual policy of accident and health insurance or managed 23 care plan amended, delivered, issued, or renewed after the 24 effective date of this amendatory Act of the 92nd General 25 Assembly that provides coverage for hospital or medical 26 expenses must provide coverage for reimbursement to medical 27 providers for epidural anesthesia services when ordered by 28 the attending practitioner at the time of delivery. 29 (215 ILCS 5/356z.3 new) HB0241 Engrossed -4- LRB9201409JScs 1 Sec. 356z.3. Prescription nutritional supplements. A 2 group or individual policy of accident and health insurance 3 or managed care plan amended, delivered, issued, or renewed 4 after the effective date of this amendatory Act of the 92nd 5 General Assembly that provides coverage for prescription 6 drugs must provide coverage for reimbursement for medically 7 appropriate prescription nutritional supplements when ordered 8 by a physician licensed to practice medicine in all its 9 branches and the insured suffers from a condition that 10 prevents him or her from taking sufficient oral nourishment 11 to sustain life. 12 Section 35. The Health Maintenance Organization Act is 13 amended by changing Section 5-3 as follows: 14 (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2) 15 Sec. 5-3. Insurance Code provisions. 16 (a) Health Maintenance Organizations shall be subject to 17 the provisions of Sections 133, 134, 137, 140, 141.1, 141.2, 18 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5, 19 154.6, 154.7, 154.8, 155.04, 355.2, 356m, 356v, 356w, 356x, 20 356y, 356z.2, 356z.3, 367i, 368a, 401, 401.1, 402, 403, 403A, 21 408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of 22 subsection (2) of Section 367, and Articles IIA, VIII 1/2, 23 XII, XII 1/2, XIII, XIII 1/2, XXV, and XXVI of the Illinois 24 Insurance Code. 25 (b) For purposes of the Illinois Insurance Code, except 26 for Sections 444 and 444.1 and Articles XIII and XIII 1/2, 27 Health Maintenance Organizations in the following categories 28 are deemed to be "domestic companies": 29 (1) a corporation authorized under the Dental 30 Service Plan Act or the Voluntary Health Services Plans 31 Act; 32 (2) a corporation organized under the laws of this HB0241 Engrossed -5- LRB9201409JScs 1 State; or 2 (3) a corporation organized under the laws of 3 another state, 30% or more of the enrollees of which are 4 residents of this State, except a corporation subject to 5 substantially the same requirements in its state of 6 organization as is a "domestic company" under Article 7 VIII 1/2 of the Illinois Insurance Code. 8 (c) In considering the merger, consolidation, or other 9 acquisition of control of a Health Maintenance Organization 10 pursuant to Article VIII 1/2 of the Illinois Insurance Code, 11 (1) the Director shall give primary consideration 12 to the continuation of benefits to enrollees and the 13 financial conditions of the acquired Health Maintenance 14 Organization after the merger, consolidation, or other 15 acquisition of control takes effect; 16 (2)(i) the criteria specified in subsection (1)(b) 17 of Section 131.8 of the Illinois Insurance Code shall not 18 apply and (ii) the Director, in making his determination 19 with respect to the merger, consolidation, or other 20 acquisition of control, need not take into account the 21 effect on competition of the merger, consolidation, or 22 other acquisition of control; 23 (3) the Director shall have the power to require 24 the following information: 25 (A) certification by an independent actuary of 26 the adequacy of the reserves of the Health 27 Maintenance Organization sought to be acquired; 28 (B) pro forma financial statements reflecting 29 the combined balance sheets of the acquiring company 30 and the Health Maintenance Organization sought to be 31 acquired as of the end of the preceding year and as 32 of a date 90 days prior to the acquisition, as well 33 as pro forma financial statements reflecting 34 projected combined operation for a period of 2 HB0241 Engrossed -6- LRB9201409JScs 1 years; 2 (C) a pro forma business plan detailing an 3 acquiring party's plans with respect to the 4 operation of the Health Maintenance Organization 5 sought to be acquired for a period of not less than 6 3 years; and 7 (D) such other information as the Director 8 shall require. 9 (d) The provisions of Article VIII 1/2 of the Illinois 10 Insurance Code and this Section 5-3 shall apply to the sale 11 by any health maintenance organization of greater than 10% of 12 its enrollee population (including without limitation the 13 health maintenance organization's right, title, and interest 14 in and to its health care certificates). 15 (e) In considering any management contract or service 16 agreement subject to Section 141.1 of the Illinois Insurance 17 Code, the Director (i) shall, in addition to the criteria 18 specified in Section 141.2 of the Illinois Insurance Code, 19 take into account the effect of the management contract or 20 service agreement on the continuation of benefits to 21 enrollees and the financial condition of the health 22 maintenance organization to be managed or serviced, and (ii) 23 need not take into account the effect of the management 24 contract or service agreement on competition. 25 (f) Except for small employer groups as defined in the 26 Small Employer Rating, Renewability and Portability Health 27 Insurance Act and except for medicare supplement policies as 28 defined in Section 363 of the Illinois Insurance Code, a 29 Health Maintenance Organization may by contract agree with a 30 group or other enrollment unit to effect refunds or charge 31 additional premiums under the following terms and conditions: 32 (i) the amount of, and other terms and conditions 33 with respect to, the refund or additional premium are set 34 forth in the group or enrollment unit contract agreed in HB0241 Engrossed -7- LRB9201409JScs 1 advance of the period for which a refund is to be paid or 2 additional premium is to be charged (which period shall 3 not be less than one year); and 4 (ii) the amount of the refund or additional premium 5 shall not exceed 20% of the Health Maintenance 6 Organization's profitable or unprofitable experience with 7 respect to the group or other enrollment unit for the 8 period (and, for purposes of a refund or additional 9 premium, the profitable or unprofitable experience shall 10 be calculated taking into account a pro rata share of the 11 Health Maintenance Organization's administrative and 12 marketing expenses, but shall not include any refund to 13 be made or additional premium to be paid pursuant to this 14 subsection (f)). The Health Maintenance Organization and 15 the group or enrollment unit may agree that the 16 profitable or unprofitable experience may be calculated 17 taking into account the refund period and the immediately 18 preceding 2 plan years. 19 The Health Maintenance Organization shall include a 20 statement in the evidence of coverage issued to each enrollee 21 describing the possibility of a refund or additional premium, 22 and upon request of any group or enrollment unit, provide to 23 the group or enrollment unit a description of the method used 24 to calculate (1) the Health Maintenance Organization's 25 profitable experience with respect to the group or enrollment 26 unit and the resulting refund to the group or enrollment unit 27 or (2) the Health Maintenance Organization's unprofitable 28 experience with respect to the group or enrollment unit and 29 the resulting additional premium to be paid by the group or 30 enrollment unit. 31 In no event shall the Illinois Health Maintenance 32 Organization Guaranty Association be liable to pay any 33 contractual obligation of an insolvent organization to pay 34 any refund authorized under this Section. HB0241 Engrossed -8- LRB9201409JScs 1 (Source: P.A. 90-25, eff. 1-1-98; 90-177, eff. 7-23-97; 2 90-372, eff. 7-1-98; 90-583, eff. 5-29-98; 90-655, eff. 3 7-30-98; 90-741, eff. 1-1-99; 91-357, eff. 7-29-99; 91-406, 4 eff. 1-1-00; 91-549, eff. 8-14-99; 91-605, eff. 12-14-99; 5 91-788, eff. 6-9-00.) 6 Section 40. The Voluntary Health Services Plans Act is 7 amended by changing Section 10 as follows: 8 (215 ILCS 165/10) (from Ch. 32, par. 604) 9 Sec. 10. Application of Insurance Code provisions. 10 Health services plan corporations and all persons interested 11 therein or dealing therewith shall be subject to the 12 provisions of Articles IIA and XII 1/2 and Sections 3.1, 133, 13 140, 143, 143c, 149, 354, 355.2, 356r, 356t, 356u, 356v, 14 356w, 356x, 356y, 356z.2, 356z.3, 367.2, 368a, 401, 401.1, 15 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7) and 16 (15) of Section 367 of the Illinois Insurance Code. 17 (Source: P.A. 90-7, eff. 6-10-97; 90-25, eff. 1-1-98; 90-655, 18 eff. 7-30-98; 90-741, eff. 1-1-99; 91-406, eff. 1-1-00; 19 91-549, eff. 8-14-99; 91-605, eff. 12-14-99; 91-788, eff. 20 6-9-00.) 21 Section 99. Effective date. This Act takes effect upon 22 becoming law.