Public Act 100-1026
Public Act 1026 100TH GENERAL ASSEMBLY
|
Public Act 100-1026
| | HB4516 Enrolled | LRB100 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.
|
Effective Date: 8/22/2018
|
Translate
