Bill Amendment: IL HB3812 | 2023-2024 | 103rd General Assembly
NOTE: For additional amemendments please see the Bill Drafting List
Bill Title: INS-HEALTH BENEFITS/COST SHARE
Status: 2024-04-19 - House Floor Amendment No. 2 Rule 19(c) / Re-referred to Rules Committee [HB3812 Detail]
Download: Illinois-2023-HB3812-House_Amendment_002.html
Bill Title: INS-HEALTH BENEFITS/COST SHARE
Status: 2024-04-19 - House Floor Amendment No. 2 Rule 19(c) / Re-referred to Rules Committee [HB3812 Detail]
Download: Illinois-2023-HB3812-House_Amendment_002.html
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1 | AMENDMENT TO HOUSE BILL 3812
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2 | AMENDMENT NO. ______. Amend House Bill 3812 by replacing | ||||||
3 | everything after the enacting clause with the following:
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4 | "Section 5. The Counties Code is amended by changing | ||||||
5 | Section 5-1069 as follows:
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6 | (55 ILCS 5/5-1069) (from Ch. 34, par. 5-1069)
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7 | Sec. 5-1069. Group life, health, accident, hospital, and | ||||||
8 | medical
insurance. | ||||||
9 | (a) The county board of any county may arrange to provide, | ||||||
10 | for
the benefit of employees of the county, group life, | ||||||
11 | health, accident, hospital,
and medical insurance, or any one | ||||||
12 | or any combination of those types of
insurance, or the county | ||||||
13 | board may self-insure, for the benefit of its
employees, all | ||||||
14 | or a portion of the employees' group life, health, accident,
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15 | hospital, and medical insurance, or any one or any combination | ||||||
16 | of those
types of insurance, including a combination of |
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1 | self-insurance and other
types of insurance authorized by this | ||||||
2 | Section, provided that the county
board complies with all | ||||||
3 | other requirements of this Section. The insurance
may include | ||||||
4 | provision for employees who rely on treatment by prayer or
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5 | spiritual means alone for healing in accordance with the | ||||||
6 | tenets and
practice of a well recognized religious | ||||||
7 | denomination. The county board may
provide for payment by the | ||||||
8 | county of a portion or all of the premium or
charge for the | ||||||
9 | insurance with the employee paying the balance of the
premium | ||||||
10 | or charge, if any. If the county board undertakes a plan under
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11 | which the county pays only a portion of the premium or charge, | ||||||
12 | the county
board shall provide for withholding and deducting | ||||||
13 | from the compensation of
those employees who consent to join | ||||||
14 | the plan the balance of the premium or
charge for the | ||||||
15 | insurance.
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16 | (b) If the county board does not provide for | ||||||
17 | self-insurance or for a plan
under which the county pays a | ||||||
18 | portion or all of the premium or charge for a
group insurance | ||||||
19 | plan, the county board may provide for withholding and
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20 | deducting from the compensation of those employees who consent | ||||||
21 | thereto the
total premium or charge for any group life, | ||||||
22 | health, accident, hospital, and
medical insurance.
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23 | (c) The county board may exercise the powers granted in | ||||||
24 | this Section only if
it provides for self-insurance or, where | ||||||
25 | it makes arrangements to provide
group insurance through an | ||||||
26 | insurance carrier, if the kinds of group
insurance are |
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1 | obtained from an insurance company authorized to do business
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2 | in the State of Illinois. The county board may enact an | ||||||
3 | ordinance
prescribing the method of operation of the insurance | ||||||
4 | program.
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5 | (d) If a county, including a home rule county, is a | ||||||
6 | self-insurer for
purposes of providing health insurance | ||||||
7 | coverage for its employees, the
insurance coverage shall | ||||||
8 | include screening by low-dose mammography for all
women 35 | ||||||
9 | years of age or older for the presence of occult breast cancer
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10 | unless the county elects to provide mammograms itself under | ||||||
11 | Section
5-1069.1. The coverage shall be as follows:
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12 | (1) A baseline mammogram for women 35 to 39 years of | ||||||
13 | age.
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14 | (2) An annual mammogram for women 40 years of age or | ||||||
15 | older.
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16 | (3) A mammogram at the age and intervals considered | ||||||
17 | medically necessary by the woman's health care provider | ||||||
18 | for women under 40 years of age and having a family history | ||||||
19 | of breast cancer, prior personal history of breast cancer, | ||||||
20 | positive genetic testing, or other risk factors. | ||||||
21 | (4) For a group policy of accident and health | ||||||
22 | insurance that is amended, delivered, issued, or renewed | ||||||
23 | on or after the effective date of this amendatory Act of | ||||||
24 | the 101st General Assembly, a comprehensive ultrasound | ||||||
25 | screening of an entire breast or breasts if a mammogram | ||||||
26 | demonstrates heterogeneous or dense breast tissue or when |
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1 | medically necessary as determined by a physician licensed | ||||||
2 | to practice medicine in all of its branches, advanced | ||||||
3 | practice registered nurse, or physician assistant. | ||||||
4 | (5) For a group policy of accident and health | ||||||
5 | insurance that is amended, delivered, issued, or renewed | ||||||
6 | on or after the effective date of this amendatory Act of | ||||||
7 | the 101st General Assembly, a diagnostic mammogram when | ||||||
8 | medically necessary, as determined by a physician licensed | ||||||
9 | to practice medicine in all its branches, advanced | ||||||
10 | practice registered nurse, or physician assistant. | ||||||
11 | A policy subject to this subsection shall not impose a | ||||||
12 | deductible, coinsurance, copayment, or any other cost-sharing | ||||||
13 | requirement on the coverage provided; except that this | ||||||
14 | sentence does not apply to coverage of diagnostic mammograms | ||||||
15 | to the extent such coverage would disqualify a high-deductible | ||||||
16 | health plan from eligibility for a health savings account | ||||||
17 | pursuant to Section 223 of the Internal Revenue Code (26 | ||||||
18 | U.S.C. 223). | ||||||
19 | For purposes of this subsection: | ||||||
20 | "Diagnostic
mammogram" means a mammogram obtained using | ||||||
21 | diagnostic mammography. | ||||||
22 | "Diagnostic
mammography" means a method of screening that | ||||||
23 | is designed to
evaluate an abnormality in a breast, including | ||||||
24 | an abnormality seen
or suspected on a screening mammogram or a | ||||||
25 | subjective or objective
abnormality otherwise detected in the | ||||||
26 | breast. |
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1 | "Low-dose mammography"
means the x-ray examination of the | ||||||
2 | breast using equipment dedicated
specifically for mammography, | ||||||
3 | including the x-ray tube, filter, compression
device, and | ||||||
4 | image receptor, with an average radiation exposure
delivery of | ||||||
5 | less than one rad per breast for 2 views of an average size | ||||||
6 | breast. The term also includes digital mammography. | ||||||
7 | (d-5) Coverage as described by subsection (d) shall be | ||||||
8 | provided at no cost to the insured and shall not be applied to | ||||||
9 | an annual or lifetime maximum benefit. | ||||||
10 | (d-10) When health care services are available through | ||||||
11 | contracted providers and a person does not comply with plan | ||||||
12 | provisions specific to the use of contracted providers, the | ||||||
13 | requirements of subsection (d-5) are not applicable. When a | ||||||
14 | person does not comply with plan provisions specific to the | ||||||
15 | use of contracted providers, plan provisions specific to the | ||||||
16 | use of non-contracted providers must be applied without | ||||||
17 | distinction for coverage required by this Section and shall be | ||||||
18 | at least as favorable as for other radiological examinations | ||||||
19 | covered by the policy or contract. | ||||||
20 | (d-15) If a county, including a home rule county, is a | ||||||
21 | self-insurer for purposes of providing health insurance | ||||||
22 | coverage for its employees, the insurance coverage shall | ||||||
23 | include mastectomy coverage, which includes coverage for | ||||||
24 | prosthetic devices or reconstructive surgery incident to the | ||||||
25 | mastectomy. Coverage for breast reconstruction in connection | ||||||
26 | with a mastectomy shall include: |
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1 | (1) reconstruction of the breast upon which the | ||||||
2 | mastectomy has been performed; | ||||||
3 | (2) surgery and reconstruction of the other breast to | ||||||
4 | produce a symmetrical appearance; and | ||||||
5 | (3) prostheses and treatment for physical | ||||||
6 | complications at all stages of mastectomy, including | ||||||
7 | lymphedemas. | ||||||
8 | Care shall be determined in consultation with the attending | ||||||
9 | physician and the patient. The offered coverage for prosthetic | ||||||
10 | devices and reconstructive surgery shall be subject to the | ||||||
11 | deductible and coinsurance conditions applied to the | ||||||
12 | mastectomy, and all other terms and conditions applicable to | ||||||
13 | other benefits. When a mastectomy is performed and there is no | ||||||
14 | evidence of malignancy then the offered coverage may be | ||||||
15 | limited to the provision of prosthetic devices and | ||||||
16 | reconstructive surgery to within 2 years after the date of the | ||||||
17 | mastectomy. As used in this Section, "mastectomy" means the | ||||||
18 | removal of all or part of the breast for medically necessary | ||||||
19 | reasons, as determined by a licensed physician. | ||||||
20 | A county, including a home rule county, that is a | ||||||
21 | self-insurer for purposes of providing health insurance | ||||||
22 | coverage for its employees, may not penalize or reduce or | ||||||
23 | limit the reimbursement of an attending provider or provide | ||||||
24 | incentives (monetary or otherwise) to an attending provider to | ||||||
25 | induce the provider to provide care to an insured in a manner | ||||||
26 | inconsistent with this Section. |
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1 | (d-20) The
requirement that mammograms be included in | ||||||
2 | health insurance coverage as
provided in subsections (d) | ||||||
3 | through (d-15) is an exclusive power and function of the
State | ||||||
4 | and is a denial and limitation under Article VII, Section 6,
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5 | subsection (h) of the Illinois Constitution of home rule | ||||||
6 | county powers. A
home rule county to which subsections (d) | ||||||
7 | through (d-15) apply must comply with every
provision of those | ||||||
8 | subsections.
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9 | (e) The term "employees" as used in this Section includes | ||||||
10 | elected or
appointed officials but does not include temporary | ||||||
11 | employees.
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12 | (f) The county board may, by ordinance, arrange to provide | ||||||
13 | group life,
health, accident, hospital, and medical insurance, | ||||||
14 | or any one or a combination
of those types of insurance, under | ||||||
15 | this Section to retired former employees and
retired former | ||||||
16 | elected or appointed officials of the county.
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17 | (g) Rulemaking authority to implement this amendatory Act | ||||||
18 | of the 95th General Assembly, if any, is conditioned on the | ||||||
19 | rules being adopted in accordance with all provisions of the | ||||||
20 | Illinois Administrative Procedure Act and all rules and | ||||||
21 | procedures of the Joint Committee on Administrative Rules; any | ||||||
22 | purported rule not so adopted, for whatever reason, is | ||||||
23 | unauthorized. | ||||||
24 | (h) If a county, including a home rule county, is a | ||||||
25 | self-insurer for purposes of providing health insurance | ||||||
26 | coverage for its employees, the insurance coverage shall |
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1 | include mental health counseling for any police officer, | ||||||
2 | firefighter, emergency medical services personnel, or employee | ||||||
3 | who is a veteran without imposing a deductible, coinsurance, | ||||||
4 | copayment, or any other cost-sharing requirement on the | ||||||
5 | coverage to the extent such coverage would disqualify a | ||||||
6 | high-deductible health plan from eligibility from a health | ||||||
7 | savings account pursuant to Section 223 of the Internal | ||||||
8 | Revenue Code. | ||||||
9 | The
requirement that mental health counseling be included | ||||||
10 | in health insurance coverage as
provided in this subsection is | ||||||
11 | an exclusive power and function of the
State and is a denial | ||||||
12 | and limitation under Article VII, Section 6,
subsection (h) of | ||||||
13 | the Illinois Constitution of home rule county powers. | ||||||
14 | (Source: P.A. 100-513, eff. 1-1-18; 101-580, eff. 1-1-20 .)
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15 | Section 10. The Illinois Municipal Code is amended by | ||||||
16 | adding Section 10-4-2.4 as follows:
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17 | (65 ILCS 5/10-4-2.4 new) | ||||||
18 | Sec. 10-4-2.4. Mental health counseling. If a | ||||||
19 | municipality, including a home rule municipality, is a | ||||||
20 | self-insurer for purposes of providing health insurance | ||||||
21 | coverage for its employees, the insurance coverage shall | ||||||
22 | include mental health counseling for any police officer, | ||||||
23 | firefighter, emergency medical services personnel, or employee | ||||||
24 | who is a veteran without imposing a deductible, coinsurance, |
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1 | copayment, or any other cost-sharing requirement on the | ||||||
2 | coverage to the extent such coverage would disqualify a | ||||||
3 | high-deductible health plan from eligibility from a health | ||||||
4 | savings account pursuant to Section 223 of the Internal | ||||||
5 | Revenue Code. | ||||||
6 | The
requirement that mental health counseling be included | ||||||
7 | in health insurance coverage as
provided in this Section is an | ||||||
8 | exclusive power and function of the
State and is a denial and | ||||||
9 | limitation under Article VII, Section 6,
subsection (h) of the | ||||||
10 | Illinois Constitution of home rule powers. ".
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