Bill Amendment: IL HB0887 | 2015-2016 | 99th General Assembly

NOTE: For additional amemendments please see the Bill Drafting List

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Bill Title: REGULATION-TECH

Status: 2016-04-22 - Rule 19(a) / Re-referred to Rules Committee [HB0887 Detail]

Download: Illinois-2015-HB0887-House_Amendment_001.html

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Rep. Ann M. Williams

Filed: 3/28/2016

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AMENDMENT TO HOUSE BILL 887
AMENDMENT NO. ______. Amend House Bill 887 by replacing
everything after the enacting clause with the following:
"Section 5. The State Employees Group Insurance Act of 1971
is amended by changing Section 6.11 as follows:
(5 ILCS 375/6.11)
Sec. 6.11. Required health benefits; Illinois Insurance
Code requirements. The program of health benefits shall provide
the post-mastectomy care benefits required to be covered by a
policy of accident and health insurance under Section 356t of
the Illinois Insurance Code. The program of health benefits
shall provide the coverage required under Sections 355c, 356g,
356g.5, 356g.5-1, 356m, 356u, 356w, 356x, 356z.2, 356z.4,
356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
356z.14, 356z.15, 356z.17, and 356z.22 of the Illinois
Insurance Code. The program of health benefits must comply with

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Sections 155.22a, 155.37, 355b, 356z.19, 370c, and 370c.1 of
the Illinois Insurance Code.
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; any purported rule not so adopted, for
whatever reason, is unauthorized.
(Source: P.A. 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15;
99-480, eff. 9-9-15.)
Section 10. The Counties Code is amended by changing
Section 5-1069.3 as follows:
(55 ILCS 5/5-1069.3)
Sec. 5-1069.3. Required health benefits. 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 355c, 356g, 356g.5, 356g.5-1, 356u, 356w, 356x,
356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
356z.14, 356z.15, and 356z.22 of the Illinois Insurance Code.
The coverage shall comply with Sections 155.22a, 355b, 356z.19,
and 370c of the Illinois Insurance Code. The requirement that

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health benefits be covered as provided in this Section 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. A home rule county to which this Section
applies must comply with every provision of this Section.
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; any purported rule not so adopted, for
whatever reason, is unauthorized.
(Source: P.A. 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15;
99-480, eff. 9-9-15.)
Section 15. The Illinois Municipal Code is amended by
changing Section 10-4-2.3 as follows:
(65 ILCS 5/10-4-2.3)
Sec. 10-4-2.3. Required health benefits. 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 355c, 356g, 356g.5,
356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10,

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356z.11, 356z.12, 356z.13, 356z.14, 356z.15, and 356z.22 of the
Illinois Insurance Code. The coverage shall comply with
Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
Insurance Code. The requirement that health benefits be covered
as 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. A home rule
municipality to which this Section applies must comply with
every provision of this Section.
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; any purported rule not so adopted, for
whatever reason, is unauthorized.
(Source: P.A. 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15;
99-480, eff. 9-9-15.)
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 and

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the coverage required under Sections 355c, 356g, 356g.5,
356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11,
356z.12, 356z.13, 356z.14, 356z.15, and 356z.22 of the Illinois
Insurance Code. Insurance policies shall comply with Section
356z.19 of the Illinois Insurance Code. The coverage shall
comply with Sections 155.22a and 355b of the Illinois Insurance
Code.
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; any purported rule not so adopted, for
whatever reason, is unauthorized.
(Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-813,
eff. 7-13-12; 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15.)
Section 25. The Illinois Insurance Code is amended by
adding Section 355c and by changing Section 356z.16 as follows:
(215 ILCS 5/355c new)
Sec. 355c. Confidential communications.
(a) As used in this Section:
"Business associate" has the same meaning as in 45 CFR
160.103.
"Confidential communication request" means any request for
confidential communication made to a health insurance provider

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pursuant to paragraph (1) of subsection (b) of this Section.
"Health insurance provider" includes any entity that
issues, delivers, amends, or renews any individual or group
policy of accident and health insurance on or after the
effective date of this amendatory Act of the 99th General
Assembly, including any business associates of a health
insurance provider engaged in billing or communication
activities on behalf of the health insurance provider.
"Department" means the Department of Insurance.
"Protected health information" has the same meaning as in
45 CFR 160.103.
"Sensitive health services" includes, but is not limited
to, prevention, screening, consultation, examination,
treatment, or follow up related to:
(1) reproductive health, including, but not limited
to, family planning, maternity, abortion, fertility,
transgender-related care, and HIV/AIDS and sexually
transmitted infection services;
(2) substance abuse;
(3) mental health; or
(4) domestic violence, sexual violence, and other
interpersonal violence services.
(b) Notwithstanding any other law to the contrary and to
the extent permitted by federal law, a health insurance
provider shall take the following steps to protect the
confidentiality of protected health information on and after

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January 1, 2018:
(1) Health insurance providers must permit individuals
to request and must accommodate reasonable requests to
receive communications of protected health information by
alternative means or at alternative locations. All
confidential communication requests made under this
Section must be accommodated by the health insurance
provider where:
(A) the means of communication requested is
readily producible; and
(B) the individual has clearly stated in the
confidential communication request that:
(i) the confidential communications request is
limited to disclosure of information regarding
sensitive health services, including the name or
address of the health care provider that provided
the sensitive health services; or
(ii) disclosure other than in the manner
called for by the confidential communication
request of all or part of the individual's
protected health information, including the name
or address of the health care providers that
provided the health care services related to the
protected health information, could endanger the
covered individual.
(2) A health insurance provider may require that a

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confidential communication request described in paragraph
(1) of this subsection be made in writing, but shall
include the option to make the request by electronic
transmission.
(3) A health insurance provider shall not require from
the individual making the request an explanation regarding
the basis for the confidential communications request as a
condition of providing communications in the manner
requested.
A confidential communication request shall be valid until
the individual making the request submits a revocation of the
confidential communication request or a new confidential
communication request to the health insurance provider.
For the purposes of this Section, a health insurance
provider shall comply with any confidential communications
request beginning either 7 calendar days following receipt of
an electronic transmission or telephonic confidential
communication request or 14 calendar days following receipt of
a confidential communication request received by first-class
mail. During the respective 7-day or 14-day period after
receiving a confidential communication request, the health
insurance provider shall use its best efforts to abstain from
sending any communications to the individual unless such
communications are sent in a manner that complies with the
terms of the confidential communication request.
(c) The health insurance provider shall acknowledge

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receipt of the confidential communication request as soon as
practicable after receiving the confidential communication
request and shall notify the individual of the date on which it
will begin complying with the terms of the confidential
communication request. That acknowledgment and notification
shall be communicated by the health insurance provider in
accordance with the terms of the confidential communication
request.
(d) Notwithstanding subparagraph (B) of paragraph (1) of
subsection (b), the provider of health care may make
arrangements with the covered individual for the payment of
benefit cost sharing and communicate that arrangement with the
health care service plan.
(e) A health insurance provider shall not condition
enrollment or coverage on the waiver of rights provided in this
Section.
(f) The Department shall develop and make available to the
public a standardized form that individuals may use to make a
confidential communications request. The Department shall
encourage providers to clearly display the form and make it
available to insured individuals. The form must, at a minimum,
allow an individual to:
(1) provide their name, address, and member number;
(2) specify whether their request applies to:
(i) all information relating to sensitive health
services; or

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(ii) all protected health information, as
disclosure in another manner could endanger the
individual;
(3) indicate whether communications should be withheld
by the health insurance provider or redirected to a
specified mail or electronic mail address or specified
telephone number; and
(4) designate a telephone number, mailing address, or
electronic mail address for the health insurance provider
to contact the individual if additional information or
clarification is necessary to process the confidential
communications request.
(g) The Department shall work with health insurance
providers and other stakeholders to ensure the development and
implementation of effective and consumer-friendly systems for
receiving and processing confidential communications requests,
monitor compliance with this Section, and collect, track, and
investigate complaints of unauthorized disclosure of
information under this Section.
(215 ILCS 5/356z.16)
Sec. 356z.16. Applicability of mandated benefits to
supplemental policies. Unless specified otherwise, the
following Sections of the Illinois Insurance Code do not apply
to short-term travel, disability income, long-term care,
accident only, or limited or specified disease policies: 355b,

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355c, 356b, 356c, 356d, 356g, 356k, 356m, 356n, 356p, 356q,
356r, 356t, 356u, 356w, 356x, 356z.1, 356z.2, 356z.4, 356z.5,
356z.6, 356z.8, 356z.12, 356z.14, 356z.19, 356z.21, 364.01,
367.2-5, and 367e.
(Source: P.A. 97-91, eff. 1-1-12; 97-282, eff. 8-9-11; 97-592,
eff. 1-1-12; 97-813, eff. 7-13-12; 97-972, eff. 1-1-13; 98-189,
eff. 1-1-14.)
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
the provisions of Sections 133, 134, 136, 137, 139, 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, 155.22a, 355.2, 355.3,
355b, 355c, 356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2,
356z.4, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11,
356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.18, 356z.19,
356z.21, 356z.22, 364.01, 367.2, 367.2-5, 367i, 368a, 368b,
368c, 368d, 368e, 370c, 370c.1, 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.

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(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
with respect to the merger, consolidation, or other

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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

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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, 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

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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.
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

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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,
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; any purported rule not so adopted, for
whatever reason, is unauthorized.
(Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-437,
eff. 8-18-11; 97-486, eff. 1-1-12; 97-592, eff. 1-1-12; 97-805,
eff. 1-1-13; 97-813, eff. 7-13-12; 98-189, eff. 1-1-14;
98-1091, eff. 1-1-15.)
Section 35. The Limited Health Service Organization Act is
amended by changing Section 4003 as follows:
(215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
Sec. 4003. Illinois Insurance Code provisions. Limited
health service organizations shall be subject to the provisions
of Sections 133, 134, 136, 137, 139, 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, 155.37, 355.2, 355.3, 355b, 355c, 356v,
356z.10, 356z.21, 356z.22, 368a, 401, 401.1, 402, 403, 403A,
408, 408.2, 409, 412, 444, and 444.1 and Articles IIA, VIII
1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and XXVI of the

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Illinois Insurance Code. For purposes of the Illinois Insurance
Code, except for Sections 444 and 444.1 and Articles XIII and
XIII 1/2, limited health service organizations in the following
categories are deemed to be domestic companies:
(1) a corporation under the laws of this State; or
(2) a corporation organized under the laws of another
state, 30% of 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.
(Source: P.A. 97-486, eff. 1-1-12; 97-592, 1-1-12; 97-805, eff.
1-1-13; 97-813, eff. 7-13-12; 98-189, eff. 1-1-14; 98-1091,
eff. 1-1-15.)
Section 40. 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, 136, 139, 140,
143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, 355c,
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,

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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.
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; any purported rule not so adopted, for
whatever reason, is unauthorized.
(Source: P.A. 97-282, eff. 8-9-11; 97-343, eff. 1-1-12; 97-486,
eff. 1-1-12; 97-592, eff. 1-1-12; 97-805, eff. 1-1-13; 97-813,
eff. 7-13-12; 98-189, eff. 1-1-14; 98-1091, eff. 1-1-15.)".