Bill Amendment: IL HB3185 | 2015-2016 | 99th General Assembly

NOTE: For additional amemendments please see the Bill Drafting List

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Bill Title: REGULATION-TECH

Status: 2015-03-27 - Rule 19(a) / Re-referred to Rules Committee [HB3185 Detail]

Download: Illinois-2015-HB3185-House_Amendment_001.html

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Rep. Robyn Gabel

Filed: 3/16/2015

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AMENDMENT TO HOUSE BILL 3185
AMENDMENT NO. ______. Amend House Bill 3185 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 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, 355c, and 356z.19 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 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 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, 355c,
and 356z.19 of the Illinois Insurance Code. The requirement

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that 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. 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 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 356g, 356g.5,

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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, 355c, and 356z.19 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. 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 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

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policy of accident and health insurance under Section 356t and
the coverage required under Sections 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, and 355c, 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
changing Section 356z.16 and by adding Section 355c as follows:
(215 ILCS 5/355c new)
Sec. 355c. Confidential services.
(a) As used in this Section:
"Claim-related information" means an explanation of
benefits notice, information about an appointment,
including a confirmation and a reminder, notice of an

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adverse benefit determination, an insurer's request for
additional information regarding a claim, a notice of a
contested claim, the name and address of a provider, a
description of services provided and other visit
information, and any written, oral, or electronic
communication from an insurer to a policyholder,
certificate holder, or covered individual that contains
personal health information.
"Confidential communications request" means a request
from a covered individual to an insurer that communications
related to confidential services be sent directly to the
covered individual at a specified mail or electronic mail
address or specified telephone number designated by the
covered individual and that the insurer refrain from
sending communications concerning the covered individual
to the policyholder or certificate holder.
"Confidential services" means any health care service
that the recipient of the service is able to consent to
under State or federal law.
"Personal health information" means information or
data created by or derived from a provider about an
individual that relates to the past, present, or future
health condition of the individual, the provision of health
care to the individual, a request for the provision of
health care to the individual, or the cost of or payment
for health care provided to the individual.

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(b) An insurer that issues, delivers, amends, or renews an
individual or group policy of accident and health insurance on
or after the effective date of this amendatory Act of the 99th
General Assembly:
(1) shall accommodate a confidential communication
request by a person covered by a policy issued by the
insurer;
(2) may not reveal in any communication to a
policyholder or certificate holder personal health
information about confidential services that are subject
to a confidential communication request;
(3) shall send any communication regarding
confidential services subject to a confidential
communication request directly to the covered individual
who sought or received the services;
(4) shall permit any covered individual who received
confidential services to submit a confidential
communications request;
(5) shall update a covered individual on the status of
implementing a confidential communications request upon
the covered individual's inquiry; and
(6) shall notify all covered individuals in a health
benefit policy offered or administered by the insurer about
a covered individual's right under this Section to make a
confidential communications request and the insurer's duty
under this Section to provide communications regarding

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confidential services only to the covered individual who
sought or received the services.
(c) The procedure adopted by an insurer of covered
individuals to make confidential communications requests:
(1) must use the form described in subsection (e) of
this Section;
(2) may not require the covered individual to explain
why the covered individual is requesting confidential
communications;
(3) shall ensure that the confidential communications
request remains in effect until the covered individual
revokes the request in writing or submits a new
confidential communications request;
(4) shall ensure that the confidential communications
request is acted upon and implemented by the insurer not
later than 7 days after receipt of a request by electronic
means or 14 days after receipt of a request in hard copy;
(5) must include a insurer's immediate acknowledgement
to a covered individual by mail, telephone, or electronic
means of receipt by the insurer of a confidential
communications request;
(6) may not require a covered individual to waive any
right to limit disclosure under this Section as a condition
of eligibility for or coverage under an accident and health
insurance policy; and
(7) must be easy to understand and to complete.

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(d) A provider may make an arrangement with a covered
individual for the covered individual to pay to the provider
any cost-sharing required under the policy and shall
communicate the arrangement to the insurer.
(e) The Department shall develop and make available to the
public a standardized form for a covered individual to use to
make a confidential communications request. The Department
shall encourage providers to clearly display the form and make
it available to patients. The form must, at a minimum, allow a
covered individual to:
(1) provide the name and address of the covered
individual making the request;
(2) provide a description of the type of information
and type of services that should not be disclosed;
(3) indicate whether communications should be withheld
by the insurer or should be redirected to a specified mail
or electronic mail address or specified telephone number;
and
(4) designate a telephone number or mail or electronic
mail address for the insurer to contact the covered
individual if additional information or clarification is
necessary to process the confidential communications
request.
(f) The Department shall work with insurers and other
stakeholders to develop effective systems to protect the
confidentiality of personal health information and to ensure

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that plans communicate directly with a covered individual
regarding confidential services sought or received by the
covered individual.
(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,
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,

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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.
(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

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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
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

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acquiring party's plans with respect to the operation
of the Health Maintenance Organization sought to be
acquired for a period of not less than 3 years; and
(D) such other information as the Director shall
require.
(d) The provisions of Article VIII 1/2 of the Illinois
Insurance Code and this Section 5-3 shall apply to the sale by
any health maintenance organization of greater than 10% of its
enrollee population (including without limitation the health
maintenance organization's right, title, and interest in and to
its health care certificates).
(e) In considering any management contract or service
agreement subject to Section 141.1 of the Illinois Insurance
Code, the Director (i) shall, in addition to the criteria
specified in Section 141.2 of the Illinois Insurance Code, 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

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other enrollment unit to effect refunds or charge additional
premiums under the following terms and conditions:
(i) the amount of, and other terms and conditions with
respect to, the refund or additional premium are set forth
in the group or enrollment unit contract agreed in advance
of the period for which a refund is to be paid or
additional premium is to be charged (which period shall not
be less than one year); and
(ii) the amount of the refund or additional premium
shall not exceed 20% of the Health Maintenance
Organization's profitable or unprofitable experience with
respect to the group or other enrollment unit for the
period (and, for purposes of a refund or additional
premium, the profitable or unprofitable experience shall
be calculated taking into account a pro rata share of the
Health Maintenance Organization's administrative and
marketing expenses, but shall not include any refund to be
made or additional premium to be paid pursuant to this
subsection (f)). The Health Maintenance Organization and
the group or enrollment unit may agree that the profitable
or unprofitable experience may be calculated taking into
account the refund period and the immediately preceding 2
plan years.
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,

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and upon request of any group or enrollment unit, provide to
the group or enrollment unit a description of the method used
to calculate (1) the Health Maintenance Organization's
profitable experience with respect to the group or enrollment
unit and the resulting refund to the group or enrollment unit
or (2) the Health Maintenance Organization's unprofitable
experience with respect to the group or enrollment unit and the
resulting additional premium to be paid by the group or
enrollment unit.
In no event shall the Illinois Health Maintenance
Organization Guaranty Association be liable to pay any
contractual obligation of an insolvent organization to pay any
refund authorized under this Section.
(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:

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(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
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

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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,
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.)".