HB 22 — INS CD-AIDS VACCINE

*LRB09800009RPM30009b* HB0022 98THEngrossed GENERALLRB098 ASSEMBLY00009 StateRPM of30009 Illinoisb andAN 2014ACT HB0022concerning Introducedinsurance. 1/9/2013, by Rep.

Mary E.

Flowers SYNOPSIS AS INTRODUCED:

ILCS 375/6.11 ILCS 5/5-1069.3 ILCS 5/10-4-2.3 ILCS 5/10-22.3f ILCS 5/356z.22 new ILCS 125/5-3 from Ch.

111 1/2, par.

1411.2 ILCS 165/10 from Ch.

32, par.

604 Amends the State Employees Group Insurance Act of 1971, Counties Code, Illinois Municipal Code, School Code, Illinois Insurance Code, Health Maintenance Organization Act, and Voluntary Health Services Plans Act.

Provides that group and individual policies of accident and health insurance and managed care plans must provide coverage for a vaccine for acquired immune deficiency syndrome (AIDS) that is approved for marketing by the federal Food and Drug Administration and that is recommended by the United States Public Health Service.

Provides that the provision concerning AIDS vaccines does not require a policy of accident and health insurance to provide coverage for any clinical trials relating to an AIDS vaccine or for any AIDS vaccine that has been approved by the federal Food and Drug Administration in the form of an investigational new drug application.

LRB098 00009 RPM 30009 b FISCAL NOTE ACT STATE MANDATES MAY APPLY ACT MAY REQUIRE REIMBURSEMENT A BILL FOR HB0022 LRB098 00009 RPM 30009 b AN ACT concerning insurance.

any purported rule not so adopted, for HB0022 Engrossed - 2 - LRB098 00009 RPM 30009 b whatever reason, is unauthorized.

HB0022 Engrossed - 3 - LRB098 00009 RPM 30009 b 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;

The requirement that health benefits be covered as HB0022 Engrossed - 4 - LRB098 00009 RPM 30009 b 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.

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 HB0022 Engrossed - 5 - LRB098 00009 RPM 30009 b Insurance Code.

AIDS vaccine.prevention.

(a) A group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed after the effective date of this amendatory Act of the 98th General Assembly must provide coverage for adrugs vaccine for acquired immune deficiency syndrome (AIDS) that isare approved for marketing by the federal Food and Drug Administration and that isare recommended by the United States Public Health Service.Service or the U.S.

(b)Centers Thisfor SectionDisease doesControl notand requirePrevention afor policypre-exposure ofprophylaxis accident(PrEP) andto reduce HB0022 Engrossed - 6 - LRB098 00009 RPM 30009 b healththe insurancelikelihood toof provideHIV coverageinfection foramong anyindividuals clinicalwho trialsare relatingnot toinfected anwith AIDSHIV vaccinebut orwho forare anyat AIDShigh vaccinerisk that has been approved by the federal Food and Drug Administration in the form of anHIV investigationalinfection. new drug application.

(b) This Section does not require a policy of accident and health insurance to provide coverage for any clinical trials relating to any drug that is for pre-exposure prophylaxis for HIV that has been approved by the federal Food and Drug Administration in the form of an investigational new drug application.

HB0022 Engrossed - 7 - LRB098 00009 RPM 30009 b (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":

HB0022 - 7 - LRB098 00009 RPM 30009 b (1) a corporation authorized under the Dental Service Plan Act or the Voluntary Health Services Plans Act;

(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 HB0022 Engrossed - 8 - LRB098 00009 RPM 30009 b 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 HB0022 - 8 - LRB098 00009 RPM 30009 b following information:

(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 HB0022 Engrossed - 9 - LRB098 00009 RPM 30009 b 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 HB0022 - 9 - LRB098 00009 RPM 30009 b 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 HB0022 Engrossed - 10 - LRB098 00009 RPM 30009 b 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 HB0022 - 10 - LRB098 00009 RPM 30009 b 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)).

In no event shall the Illinois Health Maintenance HB0022 Engrossed - 11 - LRB098 00009 RPM 30009 b 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, HB0022 - 11 - LRB098 00009 RPM 30009 b 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;

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, 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, HB0022 Engrossed - 12 - LRB098 00009 RPM 30009 b 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, 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7) and (15) of Section 367 of the Illinois Insurance Code.

HB0022 - 12 - LRB098 00009 RPM 30009 b 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;