Bill Amendment: IL SB2671 | 2023-2024 | 103rd General Assembly
NOTE: For additional amemendments please see the Bill Drafting List
Bill Title: INS CODE-RIDING THERAPY
Status: 2024-05-17 - Rule 3-9(a) / Re-referred to Assignments [SB2671 Detail]
Download: Illinois-2023-SB2671-Senate_Amendment_001.html
Bill Title: INS CODE-RIDING THERAPY
Status: 2024-05-17 - Rule 3-9(a) / Re-referred to Assignments [SB2671 Detail]
Download: Illinois-2023-SB2671-Senate_Amendment_001.html
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1 | AMENDMENT TO SENATE BILL 2671 | ||||||
2 | AMENDMENT NO. ______. Amend Senate Bill 2671 by replacing | ||||||
3 | everything after the enacting clause with the following:
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4 | "Section 5. The State Employees Group Insurance Act of | ||||||
5 | 1971 is amended by changing Section 6.11 as follows:
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6 | (5 ILCS 375/6.11) | ||||||
7 | Sec. 6.11. Required health benefits; Illinois Insurance | ||||||
8 | Code requirements. The program of health benefits shall | ||||||
9 | provide the post-mastectomy care benefits required to be | ||||||
10 | covered by a policy of accident and health insurance under | ||||||
11 | Section 356t of the Illinois Insurance Code. The program of | ||||||
12 | health benefits shall provide the coverage required under | ||||||
13 | Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x, | ||||||
14 | 356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, | ||||||
15 | 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22, | ||||||
16 | 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, |
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1 | 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51, | ||||||
2 | 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59, 356z.60, | ||||||
3 | and 356z.61, and 356z.62 , 356z.64, 356z.67, 356z.68, 356z.70, | ||||||
4 | and 356z.71 of the Illinois Insurance Code. The program of | ||||||
5 | health benefits must comply with Sections 155.22a, 155.37, | ||||||
6 | 355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of the | ||||||
7 | Illinois Insurance Code. The program of health benefits shall | ||||||
8 | provide the coverage required under Section 356m of the | ||||||
9 | Illinois Insurance Code and, for the employees of the State | ||||||
10 | Employee Group Insurance Program only, the coverage as also | ||||||
11 | provided in Section 6.11B of this Act. The Department of | ||||||
12 | Insurance shall enforce the requirements of this Section with | ||||||
13 | respect to Sections 370c and 370c.1 of the Illinois Insurance | ||||||
14 | Code; all other requirements of this Section shall be enforced | ||||||
15 | by the Department of Central Management Services. | ||||||
16 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
17 | any, is conditioned on the rules being adopted in accordance | ||||||
18 | with all provisions of the Illinois Administrative Procedure | ||||||
19 | Act and all rules and procedures of the Joint Committee on | ||||||
20 | Administrative Rules; any purported rule not so adopted, for | ||||||
21 | whatever reason, is unauthorized. | ||||||
22 | (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; | ||||||
23 | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. | ||||||
24 | 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-768, | ||||||
25 | eff. 1-1-24; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; | ||||||
26 | 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. |
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1 | 1-1-23; 102-1117, eff. 1-13-23; 103-8, eff. 1-1-24; 103-84, | ||||||
2 | eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, eff. 1-1-24; | ||||||
3 | 103-445, eff. 1-1-24; 103-535, eff. 8-11-23; 103-551, eff. | ||||||
4 | 8-11-23; revised 8-29-23.)
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5 | Section 10. The Counties Code is amended by changing | ||||||
6 | Section 5-1069.3 as follows:
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7 | (55 ILCS 5/5-1069.3) | ||||||
8 | Sec. 5-1069.3. Required health benefits. If a county, | ||||||
9 | including a home rule county, is a self-insurer for purposes | ||||||
10 | of providing health insurance coverage for its employees, the | ||||||
11 | coverage shall include coverage for the post-mastectomy care | ||||||
12 | benefits required to be covered by a policy of accident and | ||||||
13 | health insurance under Section 356t and the coverage required | ||||||
14 | under Sections 356g, 356g.5, 356g.5-1, 356q, 356u, 356w, 356x, | ||||||
15 | 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, | ||||||
16 | 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, | ||||||
17 | 356z.29, 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, | ||||||
18 | 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, | ||||||
19 | 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and 356z.61, and | ||||||
20 | 356z.62 , 356z.64, 356z.67, 356z.68, 356z.70, and 356z.71 of | ||||||
21 | the Illinois Insurance Code. The coverage shall comply with | ||||||
22 | Sections 155.22a, 355b, 356z.19, and 370c of the Illinois | ||||||
23 | Insurance Code. The Department of Insurance shall enforce the | ||||||
24 | requirements of this Section. The requirement that health |
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1 | benefits be covered as provided in this Section is an | ||||||
2 | exclusive power and function of the State and is a denial and | ||||||
3 | limitation under Article VII, Section 6, subsection (h) of the | ||||||
4 | Illinois Constitution. A home rule county to which this | ||||||
5 | Section applies must comply with every provision of this | ||||||
6 | Section. | ||||||
7 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
8 | any, is conditioned on the rules being adopted in accordance | ||||||
9 | with all provisions of the Illinois Administrative Procedure | ||||||
10 | Act and all rules and procedures of the Joint Committee on | ||||||
11 | Administrative Rules; any purported rule not so adopted, for | ||||||
12 | whatever reason, is unauthorized. | ||||||
13 | (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; | ||||||
14 | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. | ||||||
15 | 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, | ||||||
16 | eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; | ||||||
17 | 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. | ||||||
18 | 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, | ||||||
19 | eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24; | ||||||
20 | 103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised | ||||||
21 | 8-29-23.)
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22 | Section 15. The Illinois Municipal Code is amended by | ||||||
23 | changing Section 10-4-2.3 as follows:
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24 | (65 ILCS 5/10-4-2.3) |
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1 | Sec. 10-4-2.3. Required health benefits. If a | ||||||
2 | municipality, including a home rule municipality, is a | ||||||
3 | self-insurer for purposes of providing health insurance | ||||||
4 | coverage for its employees, the coverage shall include | ||||||
5 | coverage for the post-mastectomy care benefits required to be | ||||||
6 | covered by a policy of accident and health insurance under | ||||||
7 | Section 356t and the coverage required under Sections 356g, | ||||||
8 | 356g.5, 356g.5-1, 356q, 356u, 356w, 356x, 356z.4, 356z.4a, | ||||||
9 | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, | ||||||
10 | 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29, | ||||||
11 | 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41, | ||||||
12 | 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54, | ||||||
13 | 356z.56, 356z.57, 356z.59, 356z.60, and 356z.61, and 356z.62 , | ||||||
14 | 356z.64, 356z.67, 356z.68, 356z.70, and 356z.71 of the | ||||||
15 | Illinois Insurance Code. The coverage shall comply with | ||||||
16 | Sections 155.22a, 355b, 356z.19, and 370c of the Illinois | ||||||
17 | Insurance Code. The Department of Insurance shall enforce the | ||||||
18 | requirements of this Section. The requirement that health | ||||||
19 | benefits be covered as provided in this is an exclusive power | ||||||
20 | and function of the State and is a denial and limitation under | ||||||
21 | Article VII, Section 6, subsection (h) of the Illinois | ||||||
22 | Constitution. A home rule municipality to which this Section | ||||||
23 | applies must comply with every provision of this Section. | ||||||
24 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
25 | any, is conditioned on the rules being adopted in accordance | ||||||
26 | with all provisions of the Illinois Administrative Procedure |
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1 | Act and all rules and procedures of the Joint Committee on | ||||||
2 | Administrative Rules; any purported rule not so adopted, for | ||||||
3 | whatever reason, is unauthorized. | ||||||
4 | (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; | ||||||
5 | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. | ||||||
6 | 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, | ||||||
7 | eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; | ||||||
8 | 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. | ||||||
9 | 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, | ||||||
10 | eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24; | ||||||
11 | 103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised | ||||||
12 | 8-29-23.)
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13 | Section 20. The School Code is amended by changing Section | ||||||
14 | 10-22.3f as follows:
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15 | (105 ILCS 5/10-22.3f) | ||||||
16 | Sec. 10-22.3f. Required health benefits. Insurance | ||||||
17 | protection and benefits for employees shall provide the | ||||||
18 | post-mastectomy care benefits required to be covered by a | ||||||
19 | policy of accident and health insurance under Section 356t and | ||||||
20 | the coverage required under Sections 356g, 356g.5, 356g.5-1, | ||||||
21 | 356q, 356u, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8, | ||||||
22 | 356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, | ||||||
23 | 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, | ||||||
24 | 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51, |
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1 | 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and | ||||||
2 | 356z.61, and 356z.62 , 356z.64, 356z.67, 356z.68, 356z.70, and | ||||||
3 | 356z.71 of the Illinois Insurance Code. Insurance policies | ||||||
4 | shall comply with Section 356z.19 of the Illinois Insurance | ||||||
5 | Code. The coverage shall comply with Sections 155.22a, 355b, | ||||||
6 | and 370c of the Illinois Insurance Code. The Department of | ||||||
7 | Insurance shall enforce the requirements of this Section. | ||||||
8 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
9 | any, is conditioned on the rules being adopted in accordance | ||||||
10 | with all provisions of the Illinois Administrative Procedure | ||||||
11 | Act and all rules and procedures of the Joint Committee on | ||||||
12 | Administrative Rules; any purported rule not so adopted, for | ||||||
13 | whatever reason, is unauthorized. | ||||||
14 | (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; | ||||||
15 | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. | ||||||
16 | 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804, | ||||||
17 | eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; | ||||||
18 | 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff. | ||||||
19 | 1-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, | ||||||
20 | eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. 8-11-23; | ||||||
21 | 103-551, eff. 8-11-23; revised 8-29-23.)
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22 | Section 25. The Illinois Insurance Code is amended by | ||||||
23 | adding Section 356z.71 as follows:
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24 | (215 ILCS 5/356z.71 new) |
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1 | Sec. 356z.71. Coverage for hippotherapy, equine therapy, | ||||||
2 | and therapeutic riding. | ||||||
3 | (a) As used in this Section: | ||||||
4 | "Disability" means a determinable physical or mental | ||||||
5 | characteristic of a person, including, but not limited to, a | ||||||
6 | determinable physical characteristic that necessitates the | ||||||
7 | person's use of a guide, hearing, or support dog, that may | ||||||
8 | result from a disease, injury, or congenital condition of | ||||||
9 | birth or a functional disorder. | ||||||
10 | "Equine therapy" means behavioral health therapy delivered | ||||||
11 | by a licensed clinical social worker, licensed marriage and | ||||||
12 | family therapist, or licensed clinical professional counselor, | ||||||
13 | in conjunction with a professional horse handler and a therapy | ||||||
14 | horse. | ||||||
15 | "Hippotherapy" means physical, occupational, or speech | ||||||
16 | therapy, prescribed by a physician and delivered by a licensed | ||||||
17 | occupational therapist, physical therapist, or speech-language | ||||||
18 | pathologist, in conjunction with a professional horse handler | ||||||
19 | and a therapy horse. | ||||||
20 | "Therapeutic riding" means horseback riding lessons | ||||||
21 | adapted to an individual with a disability, delivered by a | ||||||
22 | professional horse handler and a therapy horse. | ||||||
23 | (b) A group or individual policy of accident and health | ||||||
24 | insurance or managed care plan that is amended, delivered, | ||||||
25 | issued, or renewed after the effective date of this amendatory | ||||||
26 | Act of the 103rd General Assembly shall provide coverage for |
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1 | hippotherapy, equine therapy, and other forms of therapeutic | ||||||
2 | riding.
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3 | Section 30. The Health Maintenance Organization Act is | ||||||
4 | amended by changing Section 5-3 as follows:
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5 | (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2) | ||||||
6 | Sec. 5-3. Insurance Code provisions. | ||||||
7 | (a) Health Maintenance Organizations shall be subject to | ||||||
8 | the provisions of Sections 133, 134, 136, 137, 139, 140, | ||||||
9 | 141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, | ||||||
10 | 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 155.49, | ||||||
11 | 355.2, 355.3, 355b, 355c, 356f, 356g.5-1, 356m, 356q, 356v, | ||||||
12 | 356w, 356x, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, | ||||||
13 | 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, | ||||||
14 | 356z.15, 356z.17, 356z.18, 356z.19, 356z.20, 356z.21, 356z.22, | ||||||
15 | 356z.23, 356z.24, 356z.25, 356z.26, 356z.28, 356z.29, 356z.30, | ||||||
16 | 356z.30a, 356z.31, 356z.32, 356z.33, 356z.34, 356z.35, | ||||||
17 | 356z.36, 356z.37, 356z.38, 356z.39, 356z.40, 356z.41, 356z.44, | ||||||
18 | 356z.45, 356z.46, 356z.47, 356z.48, 356z.49, 356z.50, 356z.51, | ||||||
19 | 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.58, 356z.59, | ||||||
20 | 356z.60, 356z.61, 356z.62, 356z.64, 356z.65, 356z.67, 356z.68, | ||||||
21 | 356z.71, 364, 364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b, | ||||||
22 | 368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A, | ||||||
23 | 408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of | ||||||
24 | subsection (2) of Section 367, and Articles IIA, VIII 1/2, |
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1 | XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the | ||||||
2 | Illinois Insurance Code. | ||||||
3 | (b) For purposes of the Illinois Insurance Code, except | ||||||
4 | for Sections 444 and 444.1 and Articles XIII and XIII 1/2, | ||||||
5 | Health Maintenance Organizations in the following categories | ||||||
6 | are deemed to be "domestic companies": | ||||||
7 | (1) a corporation authorized under the Dental Service | ||||||
8 | Plan Act or the Voluntary Health Services Plans Act; | ||||||
9 | (2) a corporation organized under the laws of this | ||||||
10 | State; or | ||||||
11 | (3) a corporation organized under the laws of another | ||||||
12 | state, 30% or more of the enrollees of which are residents | ||||||
13 | of this State, except a corporation subject to | ||||||
14 | substantially the same requirements in its state of | ||||||
15 | organization as is a "domestic company" under Article VIII | ||||||
16 | 1/2 of the Illinois Insurance Code. | ||||||
17 | (c) In considering the merger, consolidation, or other | ||||||
18 | acquisition of control of a Health Maintenance Organization | ||||||
19 | pursuant to Article VIII 1/2 of the Illinois Insurance Code, | ||||||
20 | (1) the Director shall give primary consideration to | ||||||
21 | the continuation of benefits to enrollees and the | ||||||
22 | financial conditions of the acquired Health Maintenance | ||||||
23 | Organization after the merger, consolidation, or other | ||||||
24 | acquisition of control takes effect; | ||||||
25 | (2)(i) the criteria specified in subsection (1)(b) of | ||||||
26 | Section 131.8 of the Illinois Insurance Code shall not |
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1 | apply and (ii) the Director, in making his determination | ||||||
2 | with respect to the merger, consolidation, or other | ||||||
3 | acquisition of control, need not take into account the | ||||||
4 | effect on competition of the merger, consolidation, or | ||||||
5 | other acquisition of control; | ||||||
6 | (3) the Director shall have the power to require the | ||||||
7 | following information: | ||||||
8 | (A) certification by an independent actuary of the | ||||||
9 | adequacy of the reserves of the Health Maintenance | ||||||
10 | Organization sought to be acquired; | ||||||
11 | (B) pro forma financial statements reflecting the | ||||||
12 | combined balance sheets of the acquiring company and | ||||||
13 | the Health Maintenance Organization sought to be | ||||||
14 | acquired as of the end of the preceding year and as of | ||||||
15 | a date 90 days prior to the acquisition, as well as pro | ||||||
16 | forma financial statements reflecting projected | ||||||
17 | combined operation for a period of 2 years; | ||||||
18 | (C) a pro forma business plan detailing an | ||||||
19 | acquiring party's plans with respect to the operation | ||||||
20 | of the Health Maintenance Organization sought to be | ||||||
21 | acquired for a period of not less than 3 years; and | ||||||
22 | (D) such other information as the Director shall | ||||||
23 | require. | ||||||
24 | (d) The provisions of Article VIII 1/2 of the Illinois | ||||||
25 | Insurance Code and this Section 5-3 shall apply to the sale by | ||||||
26 | any health maintenance organization of greater than 10% of its |
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1 | enrollee population (including , without limitation , the health | ||||||
2 | maintenance organization's right, title, and interest in and | ||||||
3 | to its health care certificates). | ||||||
4 | (e) In considering any management contract or service | ||||||
5 | agreement subject to Section 141.1 of the Illinois Insurance | ||||||
6 | Code, the Director (i) shall, in addition to the criteria | ||||||
7 | specified in Section 141.2 of the Illinois Insurance Code, | ||||||
8 | take into account the effect of the management contract or | ||||||
9 | service agreement on the continuation of benefits to enrollees | ||||||
10 | and the financial condition of the health maintenance | ||||||
11 | organization to be managed or serviced, and (ii) need not take | ||||||
12 | into account the effect of the management contract or service | ||||||
13 | agreement on competition. | ||||||
14 | (f) Except for small employer groups as defined in the | ||||||
15 | Small Employer Rating, Renewability and Portability Health | ||||||
16 | Insurance Act and except for medicare supplement policies as | ||||||
17 | defined in Section 363 of the Illinois Insurance Code, a | ||||||
18 | Health Maintenance Organization may by contract agree with a | ||||||
19 | group or other enrollment unit to effect refunds or charge | ||||||
20 | additional premiums under the following terms and conditions: | ||||||
21 | (i) the amount of, and other terms and conditions with | ||||||
22 | respect to, the refund or additional premium are set forth | ||||||
23 | in the group or enrollment unit contract agreed in advance | ||||||
24 | of the period for which a refund is to be paid or | ||||||
25 | additional premium is to be charged (which period shall | ||||||
26 | not be less than one year); and |
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1 | (ii) the amount of the refund or additional premium | ||||||
2 | shall not exceed 20% of the Health Maintenance | ||||||
3 | Organization's profitable or unprofitable experience with | ||||||
4 | respect to the group or other enrollment unit for the | ||||||
5 | period (and, for purposes of a refund or additional | ||||||
6 | premium, the profitable or unprofitable experience shall | ||||||
7 | be calculated taking into account a pro rata share of the | ||||||
8 | Health Maintenance Organization's administrative and | ||||||
9 | marketing expenses, but shall not include any refund to be | ||||||
10 | made or additional premium to be paid pursuant to this | ||||||
11 | subsection (f)). The Health Maintenance Organization and | ||||||
12 | the group or enrollment unit may agree that the profitable | ||||||
13 | or unprofitable experience may be calculated taking into | ||||||
14 | account the refund period and the immediately preceding 2 | ||||||
15 | plan years. | ||||||
16 | The Health Maintenance Organization shall include a | ||||||
17 | statement in the evidence of coverage issued to each enrollee | ||||||
18 | describing the possibility of a refund or additional premium, | ||||||
19 | and upon request of any group or enrollment unit, provide to | ||||||
20 | the group or enrollment unit a description of the method used | ||||||
21 | to calculate (1) the Health Maintenance Organization's | ||||||
22 | profitable experience with respect to the group or enrollment | ||||||
23 | unit and the resulting refund to the group or enrollment unit | ||||||
24 | or (2) the Health Maintenance Organization's unprofitable | ||||||
25 | experience with respect to the group or enrollment unit and | ||||||
26 | the resulting additional premium to be paid by the group or |
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