SB 475 — INS CANCER TRIAL ROUTINE COSTS

1-1-99.) Section 20.

The School Code is amended by changing Section 10-22.3f as follows:

(105 ILCS 5/10-22.3f) Sec.

10-22.3f.

Required health benefits.

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 -3- LRB093 05172 JLS 05232 b and the coverage required under Sections 356u, 356w, a--- 356x__a__________ of the Illinois Insurance Code.

(Source:

P.A.

90-7, eff.

6-10-97;

90-741, eff.

1-1-99.) Section 25.

The Illinois Insurance Code is amended by adding Section 356z.4 as follows:

(215 ILCS 5/356z.4 new) _e_____________________l______________________u_____________ _____c______ _a______________________o_____________________h_____________ ______h____________________e________ _________________r______________________o_____________ _e_____________________i_____________ _________________e______________________t_____________ _i_____________________w_______________________n____________ _o_____________________p_______________________l____________ _h_____________________f______________________l________ ____________e______________________g_____________ _________________e______________________n___________ ____________c______________________t_____________ _________________a______________________v______ _________________t______________________a_____________ _s_____________________o______________________e_____________ _o_____________________c______________________l_____________ _t_____________________e______________________n_____________ _n_____________________t______________________p_____________ _e_____________________e_______________________n____________ _h_______________________w____________________o_____________ _o_________ ____________t______________________n_____________ _______ ____________s______________________r_____________ _________________t______________________e_____________ -4- LRB093 05172 JLS 05232 b _________________e_______________________f____________ _________________r_____ ____________t______________________m_____________ _________________e______________________r_____ ____________s______________________c_____________ _________________e______________________o_____________ _________________o______________________l__ _b_____________________i______________________n_____________ _____a______________________d_______________________r___________ _____S_____________________e______________________i_____________ _____o______________________A______________________c____________ _____n______________________f_____________________e_____________ _______I____________________I_____________________h_____________ _____r_____________________c______________________h_____________ _____t______________ _________________n______________________d_____________ _i_____________________a__________________ _________________u_________________________r__________ _a_____________________l__________________ _________________'______________________e_____________ _l_____________________l______________________i_____________ _n_____________________a______________________ _c_____________________a______________________l_____________ _____v_____________________l_______ _________________a______________________H_______ _________________F______________________s_____________ _h_____________________g______________________i________ _________________n______________ _d_____________________r______________________o_____________ _____p_____________________r______________________a_____________ _____d_____________________a______________________i_____________ _____a_____________________a______________________r_____________ ______p____________________e______________________i_____________ _____i_____________________o________________________a___________ -5- LRB093 05172 JLS 05232 b ________r__________________r________________________t___________ _____c_____________________d______________________i_____________ _____c_____________________t________________________f___________ _____o______________________I___________________ _e_____________________r______________________a_____________ _____a_____________________n______________________n_____________ ________a__________________t________________________s___________ _____r_____________________o______________________e_____________ _____c_____________________b_______________________t____________ _____s_____________________e______________________a_____________ _____e_____________________t_________ _h______________________a_____________________h_____________ _____e___ _h_____________________d______________________t_____________ _____o_________ _________________t__________ __________________t__________ _________________b______________________r_____ _________________y______________________m_____________ _h_____________________n____ _f_____________________n______________________i_____________ _____t_____________________e______________________i_____________ _____t_____________________h______________________t_____________ _____e_______________________a____________________i_____________ _____l_______________________r______________________t___________ _____r_____________________p______________________o_____________ _____a____________ Section 30.

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 -6- LRB093 05172 JLS 05232 b the provisions of Sections 133, 134, 137, 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, 355.2, 356m, 356v, 356w, 356x, 356y, 356z.2, 3_______ 367i, 368a, 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 -7- LRB093 05172 JLS 05232 b 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, -8- LRB093 05172 JLS 05232 b 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.

-9- LRB093 05172 JLS 05232 b 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.

(Source:

P.A.

91-357, eff.

7-29-99;

91-406, eff.

1-1-00;

91-549, eff.

8-14-99;

91-605, eff.

12-14-99;

91-788, eff.

6-9-00;

92-764, eff.

1-1-03.) Section 35.

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, 140, 143, 143c, 149, 155.37, 354, 355.2, 356r, 356t, 356u, 356v, 356w, 356x, 356y, 356z.1, 356z.2, 3 _______ 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.

(Source:

P.A.

91-406, eff.

1-1-00;

91-549, eff.

8-14-99;

-10- LRB093 05172 JLS 05232 b 91-605, eff.

12-14-99;

91-788, eff.

6-9-00;

92-130, eff.

7-20-01;

92-440, eff.

8-17-01;

92-651, eff.

7-11-02;

92-764, eff.

1-1-03.)