Bill Amendment: IL HB4516 | 2017-2018 | 100th General Assembly
NOTE: For additional amemendments please see the Bill Drafting List
Bill Title: INS CD - HEARING AID COVERAGE
Status: 2018-08-22 - Public Act . . . . . . . . . 100-1026 [HB4516 Detail]
Download: Illinois-2017-HB4516-House_Amendment_001.html
Bill Title: INS CD - HEARING AID COVERAGE
Status: 2018-08-22 - Public Act . . . . . . . . . 100-1026 [HB4516 Detail]
Download: Illinois-2017-HB4516-House_Amendment_001.html
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1 | AMENDMENT TO HOUSE BILL 4516
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2 | AMENDMENT NO. ______. Amend House Bill 4516 by replacing | ||||||
3 | everything after the enacting clause with the following:
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4 | "Section 5. The Illinois Insurance Code is amended by | ||||||
5 | adding Section 356z.29 as follows:
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6 | (215 ILCS 5/356z.29 new) | ||||||
7 | Sec. 356z.29. Coverage for hearing aids for individuals | ||||||
8 | under the age of 18. | ||||||
9 | (a) As used in this Section: | ||||||
10 | "Hearing care professional" means a person who is a
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11 | licensed hearing instrument dispenser, licensed audiologist, | ||||||
12 | or licensed physician. | ||||||
13 | "Hearing instrument" or "hearing aid" means any wearable
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14 | non-disposable, non-experimental instrument or device designed | ||||||
15 | to aid or
compensate for impaired human hearing and any parts, | ||||||
16 | attachments, or accessories for the instrument or device, |
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1 | including
an ear mold but excluding batteries and cords. | ||||||
2 | (b) An individual or group policy of accident and health
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3 | insurance or managed care plan that is amended, delivered,
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4 | issued, or renewed after the effective date of this amendatory
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5 | Act of the 100th General Assembly must provide coverage for
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6 | medically necessary hearing instruments and related services | ||||||
7 | for all individuals under the age of 18
when a hearing care | ||||||
8 | professional prescribes a hearing instrument to augment | ||||||
9 | communication. | ||||||
10 | (c) An insurer shall provide coverage, subject to all | ||||||
11 | applicable co-payments, co-insurance, deductibles, and | ||||||
12 | out-of-pocket limits, subject to the following restrictions: | ||||||
13 | (1) one hearing instrument shall be covered for each | ||||||
14 | ear every 36 months; | ||||||
15 | (2) related services, such as audiological exams and | ||||||
16 | selection, fitting, and adjustment of ear molds to maintain | ||||||
17 | optimal fit shall be covered when deemed medically | ||||||
18 | necessary by a hearing care professional; and | ||||||
19 | (3) hearing instrument repairs may be covered when | ||||||
20 | deemed medically necessary.
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21 | Section 10. The Health Maintenance Organization Act is | ||||||
22 | amended by changing Section 5-3 as follows:
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23 | (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
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24 | Sec. 5-3. Insurance Code provisions.
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1 | (a) Health Maintenance Organizations
shall be subject to | ||||||
2 | the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
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3 | 141.2, 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, 154, | ||||||
4 | 154.5, 154.6,
154.7, 154.8, 155.04, 155.22a, 355.2, 355.3, | ||||||
5 | 355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y,
356z.2, 356z.4, | ||||||
6 | 356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, | ||||||
7 | 356z.13, 356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.21, | ||||||
8 | 356z.22, 356z.25, 356z.26, 356z.29, 364, 364.01, 367.2, | ||||||
9 | 367.2-5, 367i, 368a, 368b, 368c, 368d, 368e, 370c,
370c.1, 401, | ||||||
10 | 401.1, 402, 403, 403A,
408, 408.2, 409, 412, 444,
and
444.1,
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11 | paragraph (c) of subsection (2) of Section 367, and Articles | ||||||
12 | IIA, VIII 1/2,
XII,
XII 1/2, XIII, XIII 1/2, XXV, and XXVI of | ||||||
13 | the Illinois Insurance Code.
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14 | (b) For purposes of the Illinois Insurance Code, except for | ||||||
15 | Sections 444
and 444.1 and Articles XIII and XIII 1/2, Health | ||||||
16 | Maintenance Organizations in
the following categories are | ||||||
17 | deemed to be "domestic companies":
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18 | (1) a corporation authorized under the
Dental Service | ||||||
19 | Plan Act or the Voluntary Health Services Plans Act;
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20 | (2) a corporation organized under the laws of this | ||||||
21 | State; or
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22 | (3) a corporation organized under the laws of another | ||||||
23 | state, 30% or more
of the enrollees of which are residents | ||||||
24 | of this State, except a
corporation subject to | ||||||
25 | substantially the same requirements in its state of
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26 | organization as is a "domestic company" under Article VIII |
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1 | 1/2 of the
Illinois Insurance Code.
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2 | (c) In considering the merger, consolidation, or other | ||||||
3 | acquisition of
control of a Health Maintenance Organization | ||||||
4 | pursuant to Article VIII 1/2
of the Illinois Insurance Code,
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5 | (1) the Director shall give primary consideration to | ||||||
6 | the continuation of
benefits to enrollees and the financial | ||||||
7 | conditions of the acquired Health
Maintenance Organization | ||||||
8 | after the merger, consolidation, or other
acquisition of | ||||||
9 | control takes effect;
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10 | (2)(i) the criteria specified in subsection (1)(b) of | ||||||
11 | Section 131.8 of
the Illinois Insurance Code shall not | ||||||
12 | apply and (ii) the Director, in making
his determination | ||||||
13 | with respect to the merger, consolidation, or other
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14 | acquisition of control, need not take into account the | ||||||
15 | effect on
competition of the merger, consolidation, or | ||||||
16 | other acquisition of control;
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17 | (3) the Director shall have the power to require the | ||||||
18 | following
information:
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19 | (A) certification by an independent actuary of the | ||||||
20 | adequacy
of the reserves of the Health Maintenance | ||||||
21 | Organization sought to be acquired;
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22 | (B) pro forma financial statements reflecting the | ||||||
23 | combined balance
sheets of the acquiring company and | ||||||
24 | the Health Maintenance Organization sought
to be | ||||||
25 | acquired as of the end of the preceding year and as of | ||||||
26 | a date 90 days
prior to the acquisition, as well as pro |
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1 | forma financial statements
reflecting projected | ||||||
2 | combined operation for a period of 2 years;
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3 | (C) a pro forma business plan detailing an | ||||||
4 | acquiring party's plans with
respect to the operation | ||||||
5 | of the Health Maintenance Organization sought to
be | ||||||
6 | acquired for a period of not less than 3 years; and
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7 | (D) such other information as the Director shall | ||||||
8 | require.
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9 | (d) The provisions of Article VIII 1/2 of the Illinois | ||||||
10 | Insurance Code
and this Section 5-3 shall apply to the sale by | ||||||
11 | any health maintenance
organization of greater than 10% of its
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12 | enrollee population (including without limitation the health | ||||||
13 | maintenance
organization's right, title, and interest in and to | ||||||
14 | its health care
certificates).
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15 | (e) In considering any management contract or service | ||||||
16 | agreement subject
to Section 141.1 of the Illinois Insurance | ||||||
17 | Code, the Director (i) shall, in
addition to the criteria | ||||||
18 | specified in Section 141.2 of the Illinois
Insurance Code, take | ||||||
19 | into account the effect of the management contract or
service | ||||||
20 | agreement on the continuation of benefits to enrollees and the
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21 | financial condition of the health maintenance organization to | ||||||
22 | be managed or
serviced, and (ii) need not take into account the | ||||||
23 | effect of the management
contract or service agreement on | ||||||
24 | competition.
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25 | (f) Except for small employer groups as defined in the | ||||||
26 | Small Employer
Rating, Renewability and Portability Health |
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1 | Insurance Act and except for
medicare supplement policies as | ||||||
2 | defined in Section 363 of the Illinois
Insurance Code, a Health | ||||||
3 | Maintenance Organization may by contract agree with a
group or | ||||||
4 | other enrollment unit to effect refunds or charge additional | ||||||
5 | premiums
under the following terms and conditions:
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6 | (i) the amount of, and other terms and conditions with | ||||||
7 | respect to, the
refund or additional premium are set forth | ||||||
8 | in the group or enrollment unit
contract agreed in advance | ||||||
9 | of the period for which a refund is to be paid or
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10 | additional premium is to be charged (which period shall not | ||||||
11 | be less than one
year); and
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12 | (ii) the amount of the refund or additional premium | ||||||
13 | shall not exceed 20%
of the Health Maintenance | ||||||
14 | Organization's profitable or unprofitable experience
with | ||||||
15 | respect to the group or other enrollment unit for the | ||||||
16 | period (and, for
purposes of a refund or additional | ||||||
17 | premium, the profitable or unprofitable
experience shall | ||||||
18 | be calculated taking into account a pro rata share of the
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19 | Health Maintenance Organization's administrative and | ||||||
20 | marketing expenses, but
shall not include any refund to be | ||||||
21 | made or additional premium to be paid
pursuant to this | ||||||
22 | subsection (f)). The Health Maintenance Organization and | ||||||
23 | the
group or enrollment unit may agree that the profitable | ||||||
24 | or unprofitable
experience may be calculated taking into | ||||||
25 | account the refund period and the
immediately preceding 2 | ||||||
26 | plan years.
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1 | The Health Maintenance Organization shall include a | ||||||
2 | statement in the
evidence of coverage issued to each enrollee | ||||||
3 | describing the possibility of a
refund or additional premium, | ||||||
4 | and upon request of any group or enrollment unit,
provide to | ||||||
5 | the group or enrollment unit a description of the method used | ||||||
6 | to
calculate (1) the Health Maintenance Organization's | ||||||
7 | profitable experience with
respect to the group or enrollment | ||||||
8 | unit and the resulting refund to the group
or enrollment unit | ||||||
9 | or (2) the Health Maintenance Organization's unprofitable
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10 | experience with respect to the group or enrollment unit and the | ||||||
11 | resulting
additional premium to be paid by the group or | ||||||
12 | enrollment unit.
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13 | In no event shall the Illinois Health Maintenance | ||||||
14 | Organization
Guaranty Association be liable to pay any | ||||||
15 | contractual obligation of an
insolvent organization to pay any | ||||||
16 | refund authorized under this Section.
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17 | (g) Rulemaking authority to implement Public Act 95-1045, | ||||||
18 | if any, is conditioned on the rules being adopted in accordance | ||||||
19 | with all provisions of the Illinois Administrative Procedure | ||||||
20 | Act and all rules and procedures of the Joint Committee on | ||||||
21 | Administrative Rules; any purported rule not so adopted, for | ||||||
22 | whatever reason, is unauthorized. | ||||||
23 | (Source: P.A. 99-761, eff. 1-1-18; 100-24, eff. 7-18-17; | ||||||
24 | 100-138, eff. 8-18-17; revised 10-5-17.)
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25 | Section 15. The Voluntary Health Services Plans Act is |
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1 | amended by changing Section 10 as follows:
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2 | (215 ILCS 165/10) (from Ch. 32, par. 604)
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3 | Sec. 10. Application of Insurance Code provisions. Health | ||||||
4 | services
plan corporations and all persons interested therein | ||||||
5 | or dealing therewith
shall be subject to the provisions of | ||||||
6 | Articles IIA and XII 1/2 and Sections
3.1, 133, 136, 139, 140, | ||||||
7 | 143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, 356g, | ||||||
8 | 356g.5, 356g.5-1, 356r, 356t, 356u, 356v,
356w, 356x, 356y, | ||||||
9 | 356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9,
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10 | 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18, | ||||||
11 | 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 364.01, | ||||||
12 | 367.2, 368a, 401, 401.1,
402,
403, 403A, 408,
408.2, and 412, | ||||||
13 | and paragraphs (7) and (15) of Section 367 of the Illinois
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14 | Insurance Code.
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15 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
16 | any, is conditioned on the rules being adopted in accordance | ||||||
17 | with all provisions of the Illinois Administrative Procedure | ||||||
18 | Act and all rules and procedures of the Joint Committee on | ||||||
19 | Administrative Rules; any purported rule not so adopted, for | ||||||
20 | whatever reason, is unauthorized. | ||||||
21 | (Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; | ||||||
22 | revised 10-5-17.)
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23 | Section 99. Effective date. This Act takes effect upon | ||||||
24 | becoming law.".
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