IL
Illinois House Bill HB3812

Illinois 2023-2024 Regular Session

Illinois House Bill HB3812 Compare Versions

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1-HB3812 EngrossedLRB103 27363 BMS 53735 b HB3812 Engrossed LRB103 27363 BMS 53735 b
2- HB3812 Engrossed LRB103 27363 BMS 53735 b
1+103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB3812 Introduced , by Rep. Angelica Guerrero-Cuellar SYNOPSIS AS INTRODUCED: 5 ILCS 375/6.11 55 ILCS 5/5-1069.3 65 ILCS 5/10-4-2.3 105 ILCS 5/10-22.3f 215 ILCS 5/356z.61 new 215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2 215 ILCS 130/4003 from Ch. 73, par. 1504-3 215 ILCS 165/10 from Ch. 32, par. 604 305 ILCS 5/5-16.8 Amends the Accident and Health Article of the Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed on or after the effective date of the amendatory Act shall provide any mental health treatment coverage without imposing a deductible, coinsurance, copayment, or any other cost-sharing requirement for any police officer, firefighter, emergency medical services personnel, or veteran. Makes conforming changes in the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, the Limited Health Service Organization Act, the Voluntary Health Services Plans Act, and the Medical Assistance Article of the Illinois Public Aid Code. Effective immediately. LRB103 27363 BMS 53735 b A BILL FOR 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB3812 Introduced , by Rep. Angelica Guerrero-Cuellar SYNOPSIS AS INTRODUCED: 5 ILCS 375/6.11 55 ILCS 5/5-1069.3 65 ILCS 5/10-4-2.3 105 ILCS 5/10-22.3f 215 ILCS 5/356z.61 new 215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2 215 ILCS 130/4003 from Ch. 73, par. 1504-3 215 ILCS 165/10 from Ch. 32, par. 604 305 ILCS 5/5-16.8 5 ILCS 375/6.11 55 ILCS 5/5-1069.3 65 ILCS 5/10-4-2.3 105 ILCS 5/10-22.3f 215 ILCS 5/356z.61 new 215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2 215 ILCS 130/4003 from Ch. 73, par. 1504-3 215 ILCS 165/10 from Ch. 32, par. 604 305 ILCS 5/5-16.8 Amends the Accident and Health Article of the Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed on or after the effective date of the amendatory Act shall provide any mental health treatment coverage without imposing a deductible, coinsurance, copayment, or any other cost-sharing requirement for any police officer, firefighter, emergency medical services personnel, or veteran. Makes conforming changes in the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, the Limited Health Service Organization Act, the Voluntary Health Services Plans Act, and the Medical Assistance Article of the Illinois Public Aid Code. Effective immediately. LRB103 27363 BMS 53735 b LRB103 27363 BMS 53735 b A BILL FOR
2+103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB3812 Introduced , by Rep. Angelica Guerrero-Cuellar SYNOPSIS AS INTRODUCED:
3+5 ILCS 375/6.11 55 ILCS 5/5-1069.3 65 ILCS 5/10-4-2.3 105 ILCS 5/10-22.3f 215 ILCS 5/356z.61 new 215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2 215 ILCS 130/4003 from Ch. 73, par. 1504-3 215 ILCS 165/10 from Ch. 32, par. 604 305 ILCS 5/5-16.8 5 ILCS 375/6.11 55 ILCS 5/5-1069.3 65 ILCS 5/10-4-2.3 105 ILCS 5/10-22.3f 215 ILCS 5/356z.61 new 215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2 215 ILCS 130/4003 from Ch. 73, par. 1504-3 215 ILCS 165/10 from Ch. 32, par. 604 305 ILCS 5/5-16.8
4+5 ILCS 375/6.11
5+55 ILCS 5/5-1069.3
6+65 ILCS 5/10-4-2.3
7+105 ILCS 5/10-22.3f
8+215 ILCS 5/356z.61 new
9+215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2
10+215 ILCS 130/4003 from Ch. 73, par. 1504-3
11+215 ILCS 165/10 from Ch. 32, par. 604
12+305 ILCS 5/5-16.8
13+Amends the Accident and Health Article of the Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed on or after the effective date of the amendatory Act shall provide any mental health treatment coverage without imposing a deductible, coinsurance, copayment, or any other cost-sharing requirement for any police officer, firefighter, emergency medical services personnel, or veteran. Makes conforming changes in the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, the Limited Health Service Organization Act, the Voluntary Health Services Plans Act, and the Medical Assistance Article of the Illinois Public Aid Code. Effective immediately.
14+LRB103 27363 BMS 53735 b LRB103 27363 BMS 53735 b
15+ LRB103 27363 BMS 53735 b
16+A BILL FOR
17+HB3812LRB103 27363 BMS 53735 b HB3812 LRB103 27363 BMS 53735 b
18+ HB3812 LRB103 27363 BMS 53735 b
319 1 AN ACT concerning regulation.
420 2 Be it enacted by the People of the State of Illinois,
521 3 represented in the General Assembly:
622 4 Section 5. The State Employees Group Insurance Act of 1971
723 5 is amended by changing Section 6.11 as follows:
824 6 (5 ILCS 375/6.11)
925 7 (Text of Section before amendment by P.A. 102-768)
1026 8 Sec. 6.11. Required health benefits; Illinois Insurance
1127 9 Code requirements. The program of health benefits shall
1228 10 provide the post-mastectomy care benefits required to be
1329 11 covered by a policy of accident and health insurance under
1430 12 Section 356t of the Illinois Insurance Code. The program of
1531 13 health benefits shall provide the coverage required under
1632 14 Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x,
1733 15 356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
1834 16 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,
1935 17 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
2036 18 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
2137 19 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, and 356z.60 of
2238 20 the Illinois Insurance Code. The program of health benefits
2339 21 must comply with Sections 155.22a, 155.37, 355b, 356z.19,
2440 22 370c, and 370c.1 and Article XXXIIB of the Illinois Insurance
2541 23 Code. The Department of Insurance shall enforce the
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45+103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB3812 Introduced , by Rep. Angelica Guerrero-Cuellar SYNOPSIS AS INTRODUCED:
46+5 ILCS 375/6.11 55 ILCS 5/5-1069.3 65 ILCS 5/10-4-2.3 105 ILCS 5/10-22.3f 215 ILCS 5/356z.61 new 215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2 215 ILCS 130/4003 from Ch. 73, par. 1504-3 215 ILCS 165/10 from Ch. 32, par. 604 305 ILCS 5/5-16.8 5 ILCS 375/6.11 55 ILCS 5/5-1069.3 65 ILCS 5/10-4-2.3 105 ILCS 5/10-22.3f 215 ILCS 5/356z.61 new 215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2 215 ILCS 130/4003 from Ch. 73, par. 1504-3 215 ILCS 165/10 from Ch. 32, par. 604 305 ILCS 5/5-16.8
47+5 ILCS 375/6.11
48+55 ILCS 5/5-1069.3
49+65 ILCS 5/10-4-2.3
50+105 ILCS 5/10-22.3f
51+215 ILCS 5/356z.61 new
52+215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2
53+215 ILCS 130/4003 from Ch. 73, par. 1504-3
54+215 ILCS 165/10 from Ch. 32, par. 604
55+305 ILCS 5/5-16.8
56+Amends the Accident and Health Article of the Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed on or after the effective date of the amendatory Act shall provide any mental health treatment coverage without imposing a deductible, coinsurance, copayment, or any other cost-sharing requirement for any police officer, firefighter, emergency medical services personnel, or veteran. Makes conforming changes in the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, the Limited Health Service Organization Act, the Voluntary Health Services Plans Act, and the Medical Assistance Article of the Illinois Public Aid Code. Effective immediately.
57+LRB103 27363 BMS 53735 b LRB103 27363 BMS 53735 b
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59+A BILL FOR
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65+5 ILCS 375/6.11
66+55 ILCS 5/5-1069.3
67+65 ILCS 5/10-4-2.3
68+105 ILCS 5/10-22.3f
69+215 ILCS 5/356z.61 new
70+215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2
71+215 ILCS 130/4003 from Ch. 73, par. 1504-3
72+215 ILCS 165/10 from Ch. 32, par. 604
73+305 ILCS 5/5-16.8
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3492 1 requirements of this Section with respect to Sections 370c and
3593 2 370c.1 of the Illinois Insurance Code; all other requirements
3694 3 of this Section shall be enforced by the Department of Central
3795 4 Management Services.
3896 5 Rulemaking authority to implement Public Act 95-1045, if
3997 6 any, is conditioned on the rules being adopted in accordance
4098 7 with all provisions of the Illinois Administrative Procedure
4199 8 Act and all rules and procedures of the Joint Committee on
42100 9 Administrative Rules; any purported rule not so adopted, for
43101 10 whatever reason, is unauthorized.
44102 11 (Source: P.A. 101-13, eff. 6-12-19; 101-281, eff. 1-1-20;
45103 12 101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
46104 13 1-1-20; 101-625, eff. 1-1-21; 102-30, eff. 1-1-22; 102-103,
47105 14 eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
48106 15 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff.
49107 16 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816,
50108 17 eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
51109 18 revised 12-13-22.)
52110 19 (Text of Section after amendment by P.A. 102-768)
53111 20 Sec. 6.11. Required health benefits; Illinois Insurance
54112 21 Code requirements. The program of health benefits shall
55113 22 provide the post-mastectomy care benefits required to be
56114 23 covered by a policy of accident and health insurance under
57115 24 Section 356t of the Illinois Insurance Code. The program of
58116 25 health benefits shall provide the coverage required under
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69127 1 Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x,
70128 2 356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
71129 3 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,
72130 4 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
73131 5 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
74132 6 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59, and
75133 7 356z.60, and 356z.61 of the Illinois Insurance Code. The
76134 8 program of health benefits must comply with Sections 155.22a,
77135 9 155.37, 355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of
78136 10 the Illinois Insurance Code. The Department of Insurance shall
79137 11 enforce the requirements of this Section with respect to
80138 12 Sections 370c and 370c.1 of the Illinois Insurance Code; all
81139 13 other requirements of this Section shall be enforced by the
82140 14 Department of Central Management Services.
83141 15 Rulemaking authority to implement Public Act 95-1045, if
84142 16 any, is conditioned on the rules being adopted in accordance
85143 17 with all provisions of the Illinois Administrative Procedure
86144 18 Act and all rules and procedures of the Joint Committee on
87145 19 Administrative Rules; any purported rule not so adopted, for
88146 20 whatever reason, is unauthorized.
89147 21 (Source: P.A. 101-13, eff. 6-12-19; 101-281, eff. 1-1-20;
90148 22 101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
91149 23 1-1-20; 101-625, eff. 1-1-21; 102-30, eff. 1-1-22; 102-103,
92150 24 eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
93151 25 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff.
94152 26 1-1-23; 102-768, eff. 1-1-24; 102-804, eff. 1-1-23; 102-813,
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105163 1 eff. 5-13-22; 102-816, eff. 1-1-23; 102-860, eff. 1-1-23;
106164 2 102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23.)
107165 3 Section 10. The Counties Code is amended by changing
108166 4 Section 5-1069.3 as follows:
109167 5 (55 ILCS 5/5-1069.3)
110168 6 Sec. 5-1069.3. Required health benefits. If a county,
111169 7 including a home rule county, is a self-insurer for purposes
112170 8 of providing health insurance coverage for its employees, the
113171 9 coverage shall include coverage for the post-mastectomy care
114172 10 benefits required to be covered by a policy of accident and
115173 11 health insurance under Section 356t and the coverage required
116174 12 under Sections 356g, 356g.5, 356g.5-1, 356q, 356u, 356w, 356x,
117175 13 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11,
118176 14 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26,
119177 15 356z.29, 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40,
120178 16 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53,
121179 17 356z.54, 356z.56, 356z.57, 356z.59, and 356z.60, and 356z.61
122180 18 of the Illinois Insurance Code. The coverage shall comply with
123181 19 Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
124182 20 Insurance Code. The Department of Insurance shall enforce the
125183 21 requirements of this Section. The requirement that health
126184 22 benefits be covered as provided in this Section is an
127185 23 exclusive power and function of the State and is a denial and
128186 24 limitation under Article VII, Section 6, subsection (h) of the
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139197 1 Illinois Constitution. A home rule county to which this
140198 2 Section applies must comply with every provision of this
141199 3 Section.
142200 4 Rulemaking authority to implement Public Act 95-1045, if
143201 5 any, is conditioned on the rules being adopted in accordance
144202 6 with all provisions of the Illinois Administrative Procedure
145203 7 Act and all rules and procedures of the Joint Committee on
146204 8 Administrative Rules; any purported rule not so adopted, for
147205 9 whatever reason, is unauthorized.
148206 10 (Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
149207 11 101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
150208 12 1-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
151209 13 eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22;
152210 14 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff.
153211 15 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816,
154212 16 eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
155213 17 102-1117, eff. 1-13-23.)
156214 18 Section 15. The Illinois Municipal Code is amended by
157215 19 changing Section 10-4-2.3 as follows:
158216 20 (65 ILCS 5/10-4-2.3)
159217 21 Sec. 10-4-2.3. Required health benefits. If a
160218 22 municipality, including a home rule municipality, is a
161219 23 self-insurer for purposes of providing health insurance
162220 24 coverage for its employees, the coverage shall include
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173231 1 coverage for the post-mastectomy care benefits required to be
174232 2 covered by a policy of accident and health insurance under
175233 3 Section 356t and the coverage required under Sections 356g,
176234 4 356g.5, 356g.5-1, 356q, 356u, 356w, 356x, 356z.4, 356z.4a,
177235 5 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
178236 6 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
179237 7 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
180238 8 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
181239 9 356z.56, 356z.57, 356z.59, and 356z.60, and 356z.61 of the
182240 10 Illinois Insurance Code. The coverage shall comply with
183241 11 Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
184242 12 Insurance Code. The Department of Insurance shall enforce the
185243 13 requirements of this Section. The requirement that health
186244 14 benefits be covered as provided in this is an exclusive power
187245 15 and function of the State and is a denial and limitation under
188246 16 Article VII, Section 6, subsection (h) of the Illinois
189247 17 Constitution. A home rule municipality to which this Section
190248 18 applies must comply with every provision of this Section.
191249 19 Rulemaking authority to implement Public Act 95-1045, if
192250 20 any, is conditioned on the rules being adopted in accordance
193251 21 with all provisions of the Illinois Administrative Procedure
194252 22 Act and all rules and procedures of the Joint Committee on
195253 23 Administrative Rules; any purported rule not so adopted, for
196254 24 whatever reason, is unauthorized.
197255 25 (Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
198256 26 101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
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209267 1 1-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
210268 2 eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22;
211269 3 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff.
212270 4 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816,
213271 5 eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
214272 6 102-1117, eff. 1-13-23.)
215273 7 Section 20. The School Code is amended by changing Section
216274 8 10-22.3f as follows:
217275 9 (105 ILCS 5/10-22.3f)
218276 10 Sec. 10-22.3f. Required health benefits. Insurance
219277 11 protection and benefits for employees shall provide the
220278 12 post-mastectomy care benefits required to be covered by a
221279 13 policy of accident and health insurance under Section 356t and
222280 14 the coverage required under Sections 356g, 356g.5, 356g.5-1,
223281 15 356q, 356u, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8,
224282 16 356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
225283 17 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
226284 18 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
227285 19 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, and 356z.60, and
228286 20 356z.61 of the Illinois Insurance Code. Insurance policies
229287 21 shall comply with Section 356z.19 of the Illinois Insurance
230288 22 Code. The coverage shall comply with Sections 155.22a, 355b,
231289 23 and 370c of the Illinois Insurance Code. The Department of
232290 24 Insurance shall enforce the requirements of this Section.
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243301 1 Rulemaking authority to implement Public Act 95-1045, if
244302 2 any, is conditioned on the rules being adopted in accordance
245303 3 with all provisions of the Illinois Administrative Procedure
246304 4 Act and all rules and procedures of the Joint Committee on
247305 5 Administrative Rules; any purported rule not so adopted, for
248306 6 whatever reason, is unauthorized.
249307 7 (Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
250308 8 101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
251309 9 1-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
252310 10 eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. 1-1-22;
253311 11 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804, eff.
254312 12 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860,
255313 13 eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23.)
256314 14 Section 25. The Illinois Insurance Code is amended by
257315 15 adding Section 356z.61 as follows:
258316 16 (215 ILCS 5/356z.61 new)
259317 17 Sec. 356z.61. Cost sharing in mental health treatment. A
260318 18 group or individual policy of accident and health insurance or
261319 19 managed care plan amended, delivered, issued, or renewed on or
262320 20 after the effective date of this amendatory Act of the 103rd
263321 21 General Assembly shall provide any mental health treatment
264322 22 coverage without imposing a deductible, coinsurance,
265323 23 copayment, or any other cost-sharing requirement for any
266324 24 police officer, firefighter, emergency medical services
267325
268326
269327
270328
271329
272- HB3812 Engrossed - 8 - LRB103 27363 BMS 53735 b
330+ HB3812 - 8 - LRB103 27363 BMS 53735 b
273331
274332
275-HB3812 Engrossed- 9 -LRB103 27363 BMS 53735 b HB3812 Engrossed - 9 - LRB103 27363 BMS 53735 b
276- HB3812 Engrossed - 9 - LRB103 27363 BMS 53735 b
333+HB3812- 9 -LRB103 27363 BMS 53735 b HB3812 - 9 - LRB103 27363 BMS 53735 b
334+ HB3812 - 9 - LRB103 27363 BMS 53735 b
277335 1 personnel, or veteran.
278336 2 Section 30. The Health Maintenance Organization Act is
279337 3 amended by changing Section 5-3 as follows:
280338 4 (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
281339 5 Sec. 5-3. Insurance Code provisions.
282340 6 (a) Health Maintenance Organizations shall be subject to
283341 7 the provisions of Sections 133, 134, 136, 137, 139, 140,
284342 8 141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
285343 9 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2,
286344 10 355.3, 355b, 355c, 356g.5-1, 356m, 356q, 356v, 356w, 356x,
287345 11 356y, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6,
288346 12 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14,
289347 13 356z.15, 356z.17, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25,
290348 14 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33,
291349 15 356z.35, 356z.36, 356z.40, 356z.41, 356z.46, 356z.47, 356z.48,
292350 16 356z.50, 356z.51, 356z.53 256z.53, 356z.54, 356z.56, 356z.57,
293351 17 356z.59, 356z.60, 356z.61, 364, 364.01, 364.3, 367.2, 367.2-5,
294352 18 367i, 368a, 368b, 368c, 368d, 368e, 370c, 370c.1, 401, 401.1,
295353 19 402, 403, 403A, 408, 408.2, 409, 412, 444, and 444.1,
296354 20 paragraph (c) of subsection (2) of Section 367, and Articles
297355 21 IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and
298356 22 XXXIIB of the Illinois Insurance Code.
299357 23 (b) For purposes of the Illinois Insurance Code, except
300358 24 for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
301359
302360
303361
304362
305363
306- HB3812 Engrossed - 9 - LRB103 27363 BMS 53735 b
364+ HB3812 - 9 - LRB103 27363 BMS 53735 b
307365
308366
309-HB3812 Engrossed- 10 -LRB103 27363 BMS 53735 b HB3812 Engrossed - 10 - LRB103 27363 BMS 53735 b
310- HB3812 Engrossed - 10 - LRB103 27363 BMS 53735 b
367+HB3812- 10 -LRB103 27363 BMS 53735 b HB3812 - 10 - LRB103 27363 BMS 53735 b
368+ HB3812 - 10 - LRB103 27363 BMS 53735 b
311369 1 Health Maintenance Organizations in the following categories
312370 2 are deemed to be "domestic companies":
313371 3 (1) a corporation authorized under the Dental Service
314372 4 Plan Act or the Voluntary Health Services Plans Act;
315373 5 (2) a corporation organized under the laws of this
316374 6 State; or
317375 7 (3) a corporation organized under the laws of another
318376 8 state, 30% or more of the enrollees of which are residents
319377 9 of this State, except a corporation subject to
320378 10 substantially the same requirements in its state of
321379 11 organization as is a "domestic company" under Article VIII
322380 12 1/2 of the Illinois Insurance Code.
323381 13 (c) In considering the merger, consolidation, or other
324382 14 acquisition of control of a Health Maintenance Organization
325383 15 pursuant to Article VIII 1/2 of the Illinois Insurance Code,
326384 16 (1) the Director shall give primary consideration to
327385 17 the continuation of benefits to enrollees and the
328386 18 financial conditions of the acquired Health Maintenance
329387 19 Organization after the merger, consolidation, or other
330388 20 acquisition of control takes effect;
331389 21 (2)(i) the criteria specified in subsection (1)(b) of
332390 22 Section 131.8 of the Illinois Insurance Code shall not
333391 23 apply and (ii) the Director, in making his determination
334392 24 with respect to the merger, consolidation, or other
335393 25 acquisition of control, need not take into account the
336394 26 effect on competition of the merger, consolidation, or
337395
338396
339397
340398
341399
342- HB3812 Engrossed - 10 - LRB103 27363 BMS 53735 b
400+ HB3812 - 10 - LRB103 27363 BMS 53735 b
343401
344402
345-HB3812 Engrossed- 11 -LRB103 27363 BMS 53735 b HB3812 Engrossed - 11 - LRB103 27363 BMS 53735 b
346- HB3812 Engrossed - 11 - LRB103 27363 BMS 53735 b
403+HB3812- 11 -LRB103 27363 BMS 53735 b HB3812 - 11 - LRB103 27363 BMS 53735 b
404+ HB3812 - 11 - LRB103 27363 BMS 53735 b
347405 1 other acquisition of control;
348406 2 (3) the Director shall have the power to require the
349407 3 following information:
350408 4 (A) certification by an independent actuary of the
351409 5 adequacy of the reserves of the Health Maintenance
352410 6 Organization sought to be acquired;
353411 7 (B) pro forma financial statements reflecting the
354412 8 combined balance sheets of the acquiring company and
355413 9 the Health Maintenance Organization sought to be
356414 10 acquired as of the end of the preceding year and as of
357415 11 a date 90 days prior to the acquisition, as well as pro
358416 12 forma financial statements reflecting projected
359417 13 combined operation for a period of 2 years;
360418 14 (C) a pro forma business plan detailing an
361419 15 acquiring party's plans with respect to the operation
362420 16 of the Health Maintenance Organization sought to be
363421 17 acquired for a period of not less than 3 years; and
364422 18 (D) such other information as the Director shall
365423 19 require.
366424 20 (d) The provisions of Article VIII 1/2 of the Illinois
367425 21 Insurance Code and this Section 5-3 shall apply to the sale by
368426 22 any health maintenance organization of greater than 10% of its
369427 23 enrollee population (including without limitation the health
370428 24 maintenance organization's right, title, and interest in and
371429 25 to its health care certificates).
372430 26 (e) In considering any management contract or service
373431
374432
375433
376434
377435
378- HB3812 Engrossed - 11 - LRB103 27363 BMS 53735 b
436+ HB3812 - 11 - LRB103 27363 BMS 53735 b
379437
380438
381-HB3812 Engrossed- 12 -LRB103 27363 BMS 53735 b HB3812 Engrossed - 12 - LRB103 27363 BMS 53735 b
382- HB3812 Engrossed - 12 - LRB103 27363 BMS 53735 b
439+HB3812- 12 -LRB103 27363 BMS 53735 b HB3812 - 12 - LRB103 27363 BMS 53735 b
440+ HB3812 - 12 - LRB103 27363 BMS 53735 b
383441 1 agreement subject to Section 141.1 of the Illinois Insurance
384442 2 Code, the Director (i) shall, in addition to the criteria
385443 3 specified in Section 141.2 of the Illinois Insurance Code,
386444 4 take into account the effect of the management contract or
387445 5 service agreement on the continuation of benefits to enrollees
388446 6 and the financial condition of the health maintenance
389447 7 organization to be managed or serviced, and (ii) need not take
390448 8 into account the effect of the management contract or service
391449 9 agreement on competition.
392450 10 (f) Except for small employer groups as defined in the
393451 11 Small Employer Rating, Renewability and Portability Health
394452 12 Insurance Act and except for medicare supplement policies as
395453 13 defined in Section 363 of the Illinois Insurance Code, a
396454 14 Health Maintenance Organization may by contract agree with a
397455 15 group or other enrollment unit to effect refunds or charge
398456 16 additional premiums under the following terms and conditions:
399457 17 (i) the amount of, and other terms and conditions with
400458 18 respect to, the refund or additional premium are set forth
401459 19 in the group or enrollment unit contract agreed in advance
402460 20 of the period for which a refund is to be paid or
403461 21 additional premium is to be charged (which period shall
404462 22 not be less than one year); and
405463 23 (ii) the amount of the refund or additional premium
406464 24 shall not exceed 20% of the Health Maintenance
407465 25 Organization's profitable or unprofitable experience with
408466 26 respect to the group or other enrollment unit for the
409467
410468
411469
412470
413471
414- HB3812 Engrossed - 12 - LRB103 27363 BMS 53735 b
472+ HB3812 - 12 - LRB103 27363 BMS 53735 b
415473
416474
417-HB3812 Engrossed- 13 -LRB103 27363 BMS 53735 b HB3812 Engrossed - 13 - LRB103 27363 BMS 53735 b
418- HB3812 Engrossed - 13 - LRB103 27363 BMS 53735 b
475+HB3812- 13 -LRB103 27363 BMS 53735 b HB3812 - 13 - LRB103 27363 BMS 53735 b
476+ HB3812 - 13 - LRB103 27363 BMS 53735 b
419477 1 period (and, for purposes of a refund or additional
420478 2 premium, the profitable or unprofitable experience shall
421479 3 be calculated taking into account a pro rata share of the
422480 4 Health Maintenance Organization's administrative and
423481 5 marketing expenses, but shall not include any refund to be
424482 6 made or additional premium to be paid pursuant to this
425483 7 subsection (f)). The Health Maintenance Organization and
426484 8 the group or enrollment unit may agree that the profitable
427485 9 or unprofitable experience may be calculated taking into
428486 10 account the refund period and the immediately preceding 2
429487 11 plan years.
430488 12 The Health Maintenance Organization shall include a
431489 13 statement in the evidence of coverage issued to each enrollee
432490 14 describing the possibility of a refund or additional premium,
433491 15 and upon request of any group or enrollment unit, provide to
434492 16 the group or enrollment unit a description of the method used
435493 17 to calculate (1) the Health Maintenance Organization's
436494 18 profitable experience with respect to the group or enrollment
437495 19 unit and the resulting refund to the group or enrollment unit
438496 20 or (2) the Health Maintenance Organization's unprofitable
439497 21 experience with respect to the group or enrollment unit and
440498 22 the resulting additional premium to be paid by the group or
441499 23 enrollment unit.
442500 24 In no event shall the Illinois Health Maintenance
443501 25 Organization Guaranty Association be liable to pay any
444502 26 contractual obligation of an insolvent organization to pay any
445503
446504
447505
448506
449507
450- HB3812 Engrossed - 13 - LRB103 27363 BMS 53735 b
508+ HB3812 - 13 - LRB103 27363 BMS 53735 b
451509
452510
453-HB3812 Engrossed- 14 -LRB103 27363 BMS 53735 b HB3812 Engrossed - 14 - LRB103 27363 BMS 53735 b
454- HB3812 Engrossed - 14 - LRB103 27363 BMS 53735 b
511+HB3812- 14 -LRB103 27363 BMS 53735 b HB3812 - 14 - LRB103 27363 BMS 53735 b
512+ HB3812 - 14 - LRB103 27363 BMS 53735 b
455513 1 refund authorized under this Section.
456514 2 (g) Rulemaking authority to implement Public Act 95-1045,
457515 3 if any, is conditioned on the rules being adopted in
458516 4 accordance with all provisions of the Illinois Administrative
459517 5 Procedure Act and all rules and procedures of the Joint
460518 6 Committee on Administrative Rules; any purported rule not so
461519 7 adopted, for whatever reason, is unauthorized.
462520 8 (Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19;
463521 9 101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-393, eff.
464522 10 1-1-20; 101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625,
465523 11 eff. 1-1-21; 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
466524 12 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
467525 13 1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
468526 14 eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
469527 15 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
470528 16 1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
471529 17 eff. 1-1-23; 102-1117, eff. 1-13-23; revised 1-22-23.)
472530 18 Section 35. The Limited Health Service Organization Act is
473531 19 amended by changing Section 4003 as follows:
474532 20 (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
475533 21 Sec. 4003. Illinois Insurance Code provisions. Limited
476534 22 health service organizations shall be subject to the
477535 23 provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
478536 24 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
479537
480538
481539
482540
483541
484- HB3812 Engrossed - 14 - LRB103 27363 BMS 53735 b
542+ HB3812 - 14 - LRB103 27363 BMS 53735 b
485543
486544
487-HB3812 Engrossed- 15 -LRB103 27363 BMS 53735 b HB3812 Engrossed - 15 - LRB103 27363 BMS 53735 b
488- HB3812 Engrossed - 15 - LRB103 27363 BMS 53735 b
545+HB3812- 15 -LRB103 27363 BMS 53735 b HB3812 - 15 - LRB103 27363 BMS 53735 b
546+ HB3812 - 15 - LRB103 27363 BMS 53735 b
489547 1 154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 355.2, 355.3,
490548 2 355b, 356q, 356v, 356z.4, 356z.4a, 356z.10, 356z.21, 356z.22,
491549 3 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
492550 4 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54, 356z.57,
493551 5 356z.59, 356z.61, 364.3, 368a, 401, 401.1, 402, 403, 403A,
494552 6 408, 408.2, 409, 412, 444, and 444.1 and Articles IIA, VIII
495553 7 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and XXVI of the
496554 8 Illinois Insurance Code. Nothing in this Section shall require
497555 9 a limited health care plan to cover any service that is not a
498556 10 limited health service. For purposes of the Illinois Insurance
499557 11 Code, except for Sections 444 and 444.1 and Articles XIII and
500558 12 XIII 1/2, limited health service organizations in the
501559 13 following categories are deemed to be domestic companies:
502560 14 (1) a corporation under the laws of this State; or
503561 15 (2) a corporation organized under the laws of another
504562 16 state, 30% or more of the enrollees of which are residents
505563 17 of this State, except a corporation subject to
506564 18 substantially the same requirements in its state of
507565 19 organization as is a domestic company under Article VIII
508566 20 1/2 of the Illinois Insurance Code.
509567 21 (Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
510568 22 101-393, eff. 1-1-20; 101-625, eff. 1-1-21; 102-30, eff.
511569 23 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642,
512570 24 eff. 1-1-22; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
513571 25 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860, eff.
514572 26 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23.)
515573
516574
517575
518576
519577
520- HB3812 Engrossed - 15 - LRB103 27363 BMS 53735 b
578+ HB3812 - 15 - LRB103 27363 BMS 53735 b
521579
522580
523-HB3812 Engrossed- 16 -LRB103 27363 BMS 53735 b HB3812 Engrossed - 16 - LRB103 27363 BMS 53735 b
524- HB3812 Engrossed - 16 - LRB103 27363 BMS 53735 b
581+HB3812- 16 -LRB103 27363 BMS 53735 b HB3812 - 16 - LRB103 27363 BMS 53735 b
582+ HB3812 - 16 - LRB103 27363 BMS 53735 b
525583 1 Section 40. The Voluntary Health Services Plans Act is
526584 2 amended by changing Section 10 as follows:
527585 3 (215 ILCS 165/10) (from Ch. 32, par. 604)
528586 4 Sec. 10. Application of Insurance Code provisions. Health
529587 5 services plan corporations and all persons interested therein
530588 6 or dealing therewith shall be subject to the provisions of
531589 7 Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
532590 8 143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
533591 9 356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356v, 356w,
534592 10 356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5,
535593 11 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
536594 12 356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25,
537595 13 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33,
538596 14 356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
539597 15 356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 364.01, 364.3,
540598 16 367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412,
541599 17 and paragraphs (7) and (15) of Section 367 of the Illinois
542600 18 Insurance Code.
543601 19 Rulemaking authority to implement Public Act 95-1045, if
544602 20 any, is conditioned on the rules being adopted in accordance
545603 21 with all provisions of the Illinois Administrative Procedure
546604 22 Act and all rules and procedures of the Joint Committee on
547605 23 Administrative Rules; any purported rule not so adopted, for
548606 24 whatever reason, is unauthorized.
549607
550608
551609
552610
553611
554- HB3812 Engrossed - 16 - LRB103 27363 BMS 53735 b
612+ HB3812 - 16 - LRB103 27363 BMS 53735 b
555613
556614
557-HB3812 Engrossed- 17 -LRB103 27363 BMS 53735 b HB3812 Engrossed - 17 - LRB103 27363 BMS 53735 b
558- HB3812 Engrossed - 17 - LRB103 27363 BMS 53735 b
615+HB3812- 17 -LRB103 27363 BMS 53735 b HB3812 - 17 - LRB103 27363 BMS 53735 b
616+ HB3812 - 17 - LRB103 27363 BMS 53735 b
559617 1 (Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19;
560618 2 101-281, eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff.
561619 3 1-1-21; 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; 102-306,
562620 4 eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21;
563621 5 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804, eff.
564622 6 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860,
565623 7 eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff. 1-1-23;
566624 8 102-1117, eff. 1-13-23.)
567625 9 Section 45. The Illinois Public Aid Code is amended by
568626 10 changing Section 5-16.8 as follows:
569627 11 (305 ILCS 5/5-16.8)
570628 12 Sec. 5-16.8. Required health benefits. The medical
571629 13 assistance program shall (i) provide the post-mastectomy care
572630 14 benefits required to be covered by a policy of accident and
573631 15 health insurance under Section 356t and the coverage required
574632 16 under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6,
575633 17 356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,
576634 18 356z.47, 356z.51, 356z.53, 356z.56, 356z.59, and 356z.60, and
577635 19 356z.61 of the Illinois Insurance Code, (ii) be subject to the
578636 20 provisions of Sections 356z.19, 356z.44, 356z.49, 364.01,
579637 21 370c, and 370c.1 of the Illinois Insurance Code, and (iii) be
580638 22 subject to the provisions of subsection (d-5) of Section 10 of
581639 23 the Network Adequacy and Transparency Act.
582640 24 The Department, by rule, shall adopt a model similar to
583641
584642
585643
586644
587645
588- HB3812 Engrossed - 17 - LRB103 27363 BMS 53735 b
646+ HB3812 - 17 - LRB103 27363 BMS 53735 b
589647
590648
591-HB3812 Engrossed- 18 -LRB103 27363 BMS 53735 b HB3812 Engrossed - 18 - LRB103 27363 BMS 53735 b
592- HB3812 Engrossed - 18 - LRB103 27363 BMS 53735 b
649+HB3812- 18 -LRB103 27363 BMS 53735 b HB3812 - 18 - LRB103 27363 BMS 53735 b
650+ HB3812 - 18 - LRB103 27363 BMS 53735 b
593651 1 the requirements of Section 356z.39 of the Illinois Insurance
594652 2 Code.
595653 3 On and after July 1, 2012, the Department shall reduce any
596654 4 rate of reimbursement for services or other payments or alter
597655 5 any methodologies authorized by this Code to reduce any rate
598656 6 of reimbursement for services or other payments in accordance
599657 7 with Section 5-5e.
600658 8 To ensure full access to the benefits set forth in this
601659 9 Section, on and after January 1, 2016, the Department shall
602660 10 ensure that provider and hospital reimbursement for
603661 11 post-mastectomy care benefits required under this Section are
604662 12 no lower than the Medicare reimbursement rate.
605663 13 (Source: P.A. 101-81, eff. 7-12-19; 101-218, eff. 1-1-20;
606664 14 101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-574, eff.
607665 15 1-1-20; 101-649, eff. 7-7-20; 102-30, eff. 1-1-22; 102-144,
608666 16 eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
609667 17 102-530, eff. 1-1-22; 102-642, eff. 1-1-22; 102-804, eff.
610668 18 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093,
611669 19 eff. 1-1-23; 102-1117, eff. 1-13-23.)
612670 20 Section 95. No acceleration or delay. Where this Act makes
613671 21 changes in a statute that is represented in this Act by text
614672 22 that is not yet or no longer in effect (for example, a Section
615673 23 represented by multiple versions), the use of that text does
616674 24 not accelerate or delay the taking effect of (i) the changes
617675 25 made by this Act or (ii) provisions derived from any other
618676
619677
620678
621679
622680
623- HB3812 Engrossed - 18 - LRB103 27363 BMS 53735 b
681+ HB3812 - 18 - LRB103 27363 BMS 53735 b
624682
625683
626-HB3812 Engrossed- 19 -LRB103 27363 BMS 53735 b HB3812 Engrossed - 19 - LRB103 27363 BMS 53735 b
627- HB3812 Engrossed - 19 - LRB103 27363 BMS 53735 b
684+HB3812- 19 -LRB103 27363 BMS 53735 b HB3812 - 19 - LRB103 27363 BMS 53735 b
685+ HB3812 - 19 - LRB103 27363 BMS 53735 b
628686 1 Public Act.
629687 2 Section 99. Effective date. This Act takes effect upon
630688 3 becoming law.
631689
632690
633691
634692
635693
636- HB3812 Engrossed - 19 - LRB103 27363 BMS 53735 b
694+ HB3812 - 19 - LRB103 27363 BMS 53735 b