HB 2957 — INS CD-SYNCHRONIZATION

HB2957 EngrossedEnrolled LRB100 05656 SMS 15673 b AN ACT concerning insurance.

any purported rule not so adopted, for HB2957 EngrossedEnrolled - 2 - LRB100 05656 SMS 15673 b whatever reason, is unauthorized.

Rulemaking authority to implement Public Act 95-1045, if HB2957 EngrossedEnrolled - 3 - LRB100 05656 SMS 15673 b 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;

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 HB2957 EngrossedEnrolled - 4 - LRB100 05656 SMS 15673 b Article VII, Section 6, subsection (h) of the Illinois Constitution.

The coverage shall comply with Sections 155.22a and 355b of the Illinois HB2957 EngrossedEnrolled - 5 - LRB100 05656 SMS 15673 b Insurance Code.

(b) Every policy of health and accident insurance amended, delivered, issued, or renewed after the effective date of this amendatory Act of the 100th General Assembly that provides coverage for prescription drugs shall provide for synchronization of prescription drug refills on at least one occasion per insured per year, provided all of the following HB2957 EngrossedEnrolled - 6 - LRB100 05656 SMS 15673 b conditions are met:

HB2957 EngrossedEnrolled - 7 - LRB100 05656 SMS 15673 b Section 30.

HB2957 EngrossedEnrolled - 8 - LRB100 05656 SMS 15673 b (2) a corporation organized under the laws of this State;

(A) certification by an independent actuary of the HB2957 EngrossedEnrolled - 9 - LRB100 05656 SMS 15673 b adequacy of the reserves of the Health Maintenance Organization sought to be acquired;

(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 HB2957 EngrossedEnrolled - 10 - LRB100 05656 SMS 15673 b 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.

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 HB2957 EngrossedEnrolled - 11 - LRB100 05656 SMS 15673 b marketing expenses, but shall not include any refund to be made or additional premium to be paid pursuant to this subsection (f)).

(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 HB2957 EngrossedEnrolled - 12 - LRB100 05656 SMS 15673 b Act and all rules and procedures of the Joint Committee on Administrative Rules;

(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 HB2957 EngrossedEnrolled - 13 - LRB100 05656 SMS 15673 b deemed to be "domestic companies":

HB2957 EngrossedEnrolled - 14 - LRB100 05656 SMS 15673 b (3) the Director shall have the power to require the following information:

(e) In considering any management contract or service agreement subject to Section 141.1 of the Illinois Insurance HB2957 EngrossedEnrolled - 15 - LRB100 05656 SMS 15673 b 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.

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 HB2957 EngrossedEnrolled - 16 - LRB100 05656 SMS 15673 b 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)).

HB2957 EngrossedEnrolled - 17 - LRB100 05656 SMS 15673 b (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;

or HB2957 EngrossedEnrolled - 18 - LRB100 05656 SMS 15673 b (2) a corporation organized under the laws of another state, 30% or 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.

Rulemaking authority to implement Public Act 95-1045, if HB2957 EngrossedEnrolled - 19 - LRB100 05656 SMS 15673 b 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;

HB2957 EngrossedEnrolled - 20 - LRB100 05656 SMS 15673 b To ensure full access to the benefits set forth in this Section, on and after January 1, 2016, the Department shall ensure that provider and hospital reimbursement for post-mastectomy care benefits required under this Section are no lower than the Medicare reimbursement rate.