HB 637 — INS-VARIOUS HEALTH COVERAGES

*LRB09406857LJB36963b* HB0637 94THEngrossed GENERALLRB094 ASSEMBLY06857 StateLJB of36963 Illinoisb andAN 2006ACT HB0637concerning Introducedinsurance. 1/28/2005, 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.7 new ILCS 5/356z.8 new ILCS 5/356z.9 new ILCS 5/356z.10 new ILCS 125/5-3 from Ch.

111 1/2, par.

1411.2 ILCS 165/10 from Ch.

32, par.

604 ILCS 805/8.29 new Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Illinois Insurance Code, the Health Maintenance Organization Act, and the Voluntary Health Services Plans Act.

Provides that an individual or group policy of accident and health insurance or managed care plan must provide coverage for intravenous feeding, federally approved AIDS vaccines, prescription nutritional supplements, and physician prescribed or ordered pain medication.

Amends the State Mandates Act to require implementation without reimbursement by the State.

LRB094 06857 LJB 36963 b FISCAL NOTE ACT STATE MANDATES MAY APPLY ACT MAY REQUIRE REIMBURSEMENT A BILL FOR HB0637 LRB094 06857 LJB 36963 b AN ACT concerning insurance.

The program of health benefits shall provide the coverage required under Sections 356u, 356w, 356x, 356z.2, 356z.4, and 356z.6, 356z.7, 356z.8, 356z.9, and 356z.10 of the Illinois Insurance Code.

If a county, including a home rule county, is a self-insurer for purposes of providing health insurance coverage for its employees, the coverage shall include coverage for 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 356u, 356w, 356x, and 356z.6, 356z.7, 356z.8, 356z.9, and 356z.10 of the Illinois Insurance Code.

The requirement that health benefits be covered as provided in this HB0637 - 2 - LRB094 06857 LJB 36963 b Section is an exclusive power and function of the State and is a denial HB0637 Engrossed - 2 - LRB094 06857 LJB 36963 b and limitation under Article VII, Section 6, subsection (h) of the Illinois Constitution.

If a municipality, including a home rule municipality, is a self-insurer for purposes of providing health insurance coverage for its employees, the coverage shall include coverage for 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 356u, 356w, 356x,356x , and 356z.6, 356z.7, 356z.8, 356z.9, and 356z.10 of the Illinois Insurance Code.

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 356u, 356w, 356x,356x , and HB0637356z.6, -356z.7, 3356z.9, -and LRB094356z.10 06857of LJBthe 36963Illinois bInsurance 356z.6,HB0637 356z.7,Engrossed 356z.8,- 356z.9,3 and- 356z.10LRB094 of06857 theLJB Illinois36963 Insuranceb Code.

The Illinois Insurance Code is amended by adding Sections 356z.7, 356z.8, 356z.9, and 356z.10 as follows:

(215 ILCS 5/356z.85/356z.9 new) Sec.

356z.8.

AIDS vaccine.

(a) A group or individual policy of accident and health and health insurance or managed care plan amended, delivered, issued, or renewed after the effective date of this amendatory Act of the 94th General Assembly 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.

(b) This Section 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.

(215 ILCS 5/356z.9 new) HB0637 - 4 - LRB094 06857 LJB 36963 b Sec.

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 94th General Assembly that provides coverage for prescription drugs must HB0637 Engrossed - 4 - LRB094 06857 LJB 36963 b provide coverage for any pain medication prescribed or ordered by the insured’s treating physician.physician licensed to practice medicine in all its branches.

(a) Health Maintenance Organizations shall be subject to 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, 356z.4, 356z.5, 356z.6, 356z.7, 356z.8, 356z.9, 356z.10, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c, 368d, 368e, 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 HB0637 - 5 - LRB094 06857 LJB 36963 b 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":

(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, HB0637 Engrossed - 5 - LRB094 06857 LJB 36963 b (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;

(B) pro forma financial statements reflecting the combined balance sheets of the acquiring company and the Health Maintenance Organization sought to be HB0637 - 6 - LRB094 06857 LJB 36963 b 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;

HB0637 Engrossed - 6 - LRB094 06857 LJB 36963 b (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.

(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 HB0637 - 7 - LRB094 06857 LJB 36963 b 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);

The Health Maintenance Organization and the group or enrollment unit may agree that the profitable or unprofitable experience may be calculated taking into HB0637 Engrossed - 7 - LRB094 06857 LJB 36963 b account the refund period and the immediately preceding 2 plan years.

93-853, HB0637 - 8 - LRB094 06857 LJB 36963 b eff.

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, 356z.4, 356z.5, 356z.6, 356z.7, 356z.8, 356z.9, 356z.10, 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.

HB0637 Engrossed - 8 - LRB094 06857 LJB 36963 b 92-651, eff.