Sen. Jil Tracy
Filed: 5/4/2021
 
 


 




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1
AMENDMENT TO SENATE BILL 2158




2 AMENDMENT NO. ______. Amend Senate Bill 2158 by replacing 
3everything after the enacting clause with the following:


4 "Section 5. The State Employees Group Insurance Act of 
51971 is amended by changing Section 6.11 as follows:



6 (5 ILCS 375/6.11)

7 Sec. 6.11. Required health benefits; Illinois Insurance 
8Code
requirements. The program of health
benefits shall 
9provide the post-mastectomy care benefits required to be 
10covered
by a policy of accident and health insurance under 
11Section 356t of the Illinois
Insurance Code. The program of 
12health benefits shall provide the coverage
required under 
13Sections 356g, 356g.5, 356g.5-1, 356m,
356u, 356w, 356x, 
14356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 
15356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22, 
16356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, 
 
 
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1356z.36, and 356z.41, and 356z.43 of the
Illinois Insurance 
2Code.
The program of health benefits must comply with Sections 
3155.22a, 155.37, 355b, 356z.19, 370c, and 370c.1 and Article 
4XXXIIB of the
Illinois Insurance Code. The Department of 
5Insurance shall enforce the requirements of this Section with 
6respect to Sections 370c and 370c.1 of the Illinois Insurance 
7Code; all other requirements of this Section shall be enforced 
8by the Department of Central Management Services.

9 Rulemaking authority to implement Public Act 95-1045, if 
10any, is conditioned on the rules being adopted in accordance 
11with all provisions of the Illinois Administrative Procedure 
12Act and all rules and procedures of the Joint Committee on 
13Administrative Rules; any purported rule not so adopted, for 
14whatever reason, is unauthorized. 
15(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; 
16100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff. 
171-1-19; 100-1102, eff. 1-1-19; 100-1170, eff. 6-1-19; 101-13, 
18eff. 6-12-19; 101-281, eff. 1-1-20; 101-393, eff. 1-1-20; 
19101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff. 
201-1-21.)

21 Section 10. The Counties Code is amended by changing 
22Section 5-1069.3 as follows:

23 (55 ILCS 5/5-1069.3)

24 Sec. 5-1069.3. Required health benefits.  If a county, 
 
 
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1including a home
rule
county, is a self-insurer for purposes 
2of providing health insurance coverage
for its employees, the 
3coverage shall include coverage for the post-mastectomy
care 
4benefits required to be covered by a policy of accident and 
5health
insurance under Section 356t and the coverage required 
6under Sections 356g, 356g.5, 356g.5-1, 356u,
356w, 356x, 
7356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 
8356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29, 
9356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41, and 356z.43 
10of
the Illinois Insurance Code. The coverage shall comply with 
11Sections 155.22a, 355b, 356z.19, and 370c of
the Illinois 
12Insurance Code. The Department of Insurance shall enforce the 
13requirements of this Section. The requirement that health 
14benefits be covered
as provided in this Section is an

15exclusive power and function of the State and is a denial and 
16limitation under
Article VII, Section 6, subsection (h) of the 
17Illinois Constitution. A home
rule county to which this 
18Section applies must comply with every provision of
this 
19Section.


20 Rulemaking authority to implement Public Act 95-1045, if 
21any, is conditioned on the rules being adopted in accordance 
22with all provisions of the Illinois Administrative Procedure 
23Act and all rules and procedures of the Joint Committee on 
24Administrative Rules; any purported rule not so adopted, for 
25whatever reason, is unauthorized. 
26(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; 
 
 
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1100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff. 
21-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281, 
3eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 
4101-625, eff. 1-1-21.)

5 Section 15. The Illinois Municipal Code is amended by 
6changing Section 10-4-2.3 as follows:

7 (65 ILCS 5/10-4-2.3)

8 Sec. 10-4-2.3. Required health benefits.  If a 
9municipality, including a
home rule municipality, is a 
10self-insurer for purposes of providing health
insurance 
11coverage for its employees, the coverage shall include 
12coverage for
the post-mastectomy care benefits required to be 
13covered by a policy of
accident and health insurance under 
14Section 356t and the coverage required
under Sections 356g, 
15356g.5, 356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 
16356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 
17356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, 
18356z.36, and 356z.41, and 356z.43 of the Illinois
Insurance

19Code. The coverage shall comply with Sections 155.22a, 355b, 
20356z.19, and 370c of
the Illinois Insurance Code. The 
21Department of Insurance shall enforce the requirements of this 
22Section. The requirement that health
benefits be covered as 
23provided in this is an exclusive power and function of
the 
24State and is a denial and limitation under Article VII, 
 
 
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1Section 6,
subsection (h) of the Illinois Constitution. A home 
2rule municipality to which
this Section applies must comply 
3with every provision of this Section.


4 Rulemaking authority to implement Public Act 95-1045, if 
5any, is conditioned on the rules being adopted in accordance 
6with all provisions of the Illinois Administrative Procedure 
7Act and all rules and procedures of the Joint Committee on 
8Administrative Rules; any purported rule not so adopted, for 
9whatever reason, is unauthorized. 
10(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; 
11100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff. 
121-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281, 
13eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 
14101-625, eff. 1-1-21.)

15 Section 20. The School Code is amended by changing Section 
1610-22.3f as follows:

17 (105 ILCS 5/10-22.3f)

18 Sec. 10-22.3f. Required health benefits.  Insurance 
19protection and
benefits
for employees shall provide the 
20post-mastectomy care benefits required to be
covered by a 
21policy of accident and health insurance under Section 356t and 
22the
coverage required under Sections 356g, 356g.5, 356g.5-1, 
23356u, 356w, 356x,
356z.6, 356z.8, 356z.9, 356z.11, 356z.12, 
24356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29, 
 
 
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1356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41, and 356z.43 
2of
the
Illinois Insurance Code.
Insurance policies shall 
3comply with Section 356z.19 of the Illinois Insurance Code. 
4The coverage shall comply with Sections 155.22a, 355b, and 
5370c of
the Illinois Insurance Code. The Department of 
6Insurance shall enforce the requirements of this Section. 

7 Rulemaking authority to implement Public Act 95-1045, if 
8any, is conditioned on the rules being adopted in accordance 
9with all provisions of the Illinois Administrative Procedure 
10Act and all rules and procedures of the Joint Committee on 
11Administrative Rules; any purported rule not so adopted, for 
12whatever reason, is unauthorized. 
13(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; 
14100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff. 
151-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281, 
16eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 
17101-625, eff. 1-1-21.)

18 Section 25. The Illinois Insurance Code is amended by 
19adding Section 356z.43 as follows:

20 (215 ILCS 5/356z.43 new)
21 Sec. 356z.43. Coverage for port-wine stain treatment.
22 (a) A group or individual policy of accident and health

23insurance or managed care plan amended, delivered, issued, or

24renewed on or after January 1, 2022 shall provide coverage for

 
 
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1treatment to eliminate or provide maximum
feasible treatment 
2of nevus flammeus, also known as port-wine
stains, including, 
3but not limited to, port-wine stains caused
by Sturge-Weber 
4syndrome. For purposes of this Section, treatment or maximum 
5feasible treatment shall include early intervention treatment, 
6including topical, intralesional, or systemic medical therapy 
7and surgery, in children aged 5 years and younger that is 
8intended to prevent functional impairment related to vision 
9and oral function, inflammation, bleeding, and infection.
10 (b) Coverage for treatment required under this Section 
11shall not include treatment solely for cosmetic purposes. 

12 Section 30. The Health Maintenance Organization Act is 
13amended by changing Section 5-3 as follows:



14 (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)


15 Sec. 5-3. Insurance Code provisions. 

16 (a) Health Maintenance Organizations
shall be subject to 
17the provisions of Sections 133, 134, 136, 137, 139, 140, 
18141.1,
141.2, 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, 
19154, 154.5, 154.6,
154.7, 154.8, 155.04, 155.22a, 355.2, 
20355.3, 355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y,
356z.2, 
21356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 
22356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.18, 
23356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 
24356z.30a, 356z.32, 356z.33, 356z.35, 356z.36, 356z.41, 
 
 
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1356z.43, 364, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c, 
2368d, 368e, 370c,
370c.1, 401, 401.1, 402, 403, 403A,
408, 
3408.2, 409, 412, 444,
and
444.1,
paragraph (c) of subsection 
4(2) of Section 367, and Articles IIA, VIII 1/2,
XII,
XII 1/2, 
5XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the Illinois 
6Insurance Code.

7 (b) For purposes of the Illinois Insurance Code, except 
8for Sections 444
and 444.1 and Articles XIII and XIII 1/2, 
9Health Maintenance Organizations in
the following categories 
10are deemed to be "domestic companies":

11  (1) a corporation authorized under the
Dental Service 
12 Plan Act or the Voluntary Health Services Plans Act;

13  (2) a corporation organized under the laws of this 
14 State; or

15  (3) a corporation organized under the laws of another 
16 state, 30% or more
of the enrollees of which are residents 
17 of this State, except a
corporation subject to 
18 substantially the same requirements in its state of

19 organization as is a "domestic company" under Article VIII 
20 1/2 of the
Illinois Insurance Code.

21 (c) In considering the merger, consolidation, or other 
22acquisition of
control of a Health Maintenance Organization 
23pursuant to Article VIII 1/2
of the Illinois Insurance Code,

24  (1) the Director shall give primary consideration to 
25 the continuation of
benefits to enrollees and the 
26 financial conditions of the acquired Health
Maintenance 
 
 
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1 Organization after the merger, consolidation, or other

2 acquisition of control takes effect;

3  (2)(i) the criteria specified in subsection (1)(b) of 
4 Section 131.8 of
the Illinois Insurance Code shall not 
5 apply and (ii) the Director, in making
his determination 
6 with respect to the merger, consolidation, or other

7 acquisition of control, need not take into account the 
8 effect on
competition of the merger, consolidation, or 
9 other acquisition of control;

10  (3) the Director shall have the power to require the 
11 following
information:

12   (A) certification by an independent actuary of the 
13 adequacy
of the reserves of the Health Maintenance 
14 Organization sought to be acquired;

15   (B) pro forma financial statements reflecting the 
16 combined balance
sheets of the acquiring company and 
17 the Health Maintenance Organization sought
to be 
18 acquired as of the end of the preceding year and as of 
19 a date 90 days
prior to the acquisition, as well as pro 
20 forma financial statements
reflecting projected 
21 combined operation for a period of 2 years;

22   (C) a pro forma business plan detailing an 
23 acquiring party's plans with
respect to the operation 
24 of the Health Maintenance Organization sought to
be 
25 acquired for a period of not less than 3 years; and

26   (D) such other information as the Director shall 
 
 
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1 require.

2 (d) The provisions of Article VIII 1/2 of the Illinois 
3Insurance Code
and this Section 5-3 shall apply to the sale by 
4any health maintenance
organization of greater than 10% of its

5enrollee population (including without limitation the health 
6maintenance
organization's right, title, and interest in and 
7to its health care
certificates).

8 (e) In considering any management contract or service 
9agreement subject
to Section 141.1 of the Illinois Insurance 
10Code, the Director (i) shall, in
addition to the criteria 
11specified in Section 141.2 of the Illinois
Insurance Code, 
12take into account the effect of the management contract or

13service agreement on the continuation of benefits to enrollees 
14and the
financial condition of the health maintenance 
15organization to be managed or
serviced, and (ii) need not take 
16into account the effect of the management
contract or service 
17agreement on competition.

18 (f) Except for small employer groups as defined in the 
19Small Employer
Rating, Renewability and Portability Health 
20Insurance Act and except for
medicare supplement policies as 
21defined in Section 363 of the Illinois
Insurance Code, a 
22Health Maintenance Organization may by contract agree with a

23group or other enrollment unit to effect refunds or charge 
24additional premiums
under the following terms and conditions:

25  (i) the amount of, and other terms and conditions with 
26 respect to, the
refund or additional premium are set forth 
 
 
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1 in the group or enrollment unit
contract agreed in advance 
2 of the period for which a refund is to be paid or

3 additional premium is to be charged (which period shall 
4 not be less than one
year); and

5  (ii) the amount of the refund or additional premium 
6 shall not exceed 20%
of the Health Maintenance 
7 Organization's profitable or unprofitable experience
with 
8 respect to the group or other enrollment unit for the 
9 period (and, for
purposes of a refund or additional 
10 premium, the profitable or unprofitable
experience shall 
11 be calculated taking into account a pro rata share of the

12 Health Maintenance Organization's administrative and 
13 marketing expenses, but
shall not include any refund to be 
14 made or additional premium to be paid
pursuant to this 
15 subsection (f)). The Health Maintenance Organization and 
16 the
group or enrollment unit may agree that the profitable 
17 or unprofitable
experience may be calculated taking into 
18 account the refund period and the
immediately preceding 2 
19 plan years.

20 The Health Maintenance Organization shall include a 
21statement in the
evidence of coverage issued to each enrollee 
22describing the possibility of a
refund or additional premium, 
23and upon request of any group or enrollment unit,
provide to 
24the group or enrollment unit a description of the method used 
25to
calculate (1) the Health Maintenance Organization's 
26profitable experience with
respect to the group or enrollment 
 
 
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1unit and the resulting refund to the group
or enrollment unit 
2or (2) the Health Maintenance Organization's unprofitable

3experience with respect to the group or enrollment unit and 
4the resulting
additional premium to be paid by the group or 
5enrollment unit.

6 In no event shall the Illinois Health Maintenance 
7Organization
Guaranty Association be liable to pay any 
8contractual obligation of an
insolvent organization to pay any 
9refund authorized under this Section.

10 (g) Rulemaking authority to implement Public Act 95-1045, 
11if any, is conditioned on the rules being adopted in 
12accordance with all provisions of the Illinois Administrative 
13Procedure Act and all rules and procedures of the Joint 
14Committee on Administrative Rules; any purported rule not so 
15adopted, for whatever reason, is unauthorized. 
16(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; 
17100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff. 
181-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81, 
19eff. 7-12-19; 101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 
20101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff. 
211-1-20; 101-625, eff. 1-1-21.)

22 Section 35. The Limited Health Service Organization Act is 
23amended by changing Section 4003 as follows:



24 (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)


 
 
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1 Sec. 4003. Illinois Insurance Code provisions. Limited 
2health service
organizations shall be subject to the 
3provisions of Sections 133, 134, 136, 137, 139,
140, 141.1, 
4141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154, 
5154.5,
154.6, 154.7, 154.8, 155.04, 155.37, 355.2, 355.3, 
6355b, 356v, 356z.10, 356z.21, 356z.22, 356z.25, 356z.26, 
7356z.29, 356z.30a, 356z.32, 356z.33, 356z.41, 356z.43, 368a, 
8401, 401.1,
402,
403, 403A, 408,
408.2, 409, 412, 444, and 
9444.1 and Articles IIA, VIII 1/2, XII, XII 1/2,
XIII,
XIII 1/2, 
10XXV, and XXVI of the Illinois Insurance Code. For purposes of 
11the
Illinois Insurance Code, except for Sections 444 and 444.1 
12and Articles XIII
and XIII 1/2, limited health service 
13organizations in the following categories
are deemed to be 
14domestic companies:

15  (1) a corporation under the laws of this State; or

16  (2) a corporation organized under the laws of another 
17 state, 30% or more
of the enrollees of which are residents 
18 of this State, except a corporation
subject to 
19 substantially the same requirements in its state of 
20 organization as
is a domestic company under Article VIII 
21 1/2 of the Illinois Insurance Code.

22(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; 
23100-201, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1057, eff. 
241-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281, 
25eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff. 1-1-21.)


 
 
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1 Section 40. The Voluntary Health Services Plans Act is 
2amended by changing Section 10 as follows:



3 (215 ILCS 165/10) (from Ch. 32, par. 604)

4 Sec. 10. Application of Insurance Code provisions. Health 
5services
plan corporations and all persons interested therein 
6or dealing therewith
shall be subject to the provisions of 
7Articles IIA and XII 1/2 and Sections
3.1, 133, 136, 139, 140, 
8143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, 
9356g, 356g.5, 356g.5-1, 356r, 356t, 356u, 356v,
356w, 356x, 
10356y, 356z.1, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 
11356z.9,
356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 
12356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 
13356z.30, 356z.30a, 356z.32, 356z.33, 356z.41, 356z.43, 364.01, 
14367.2, 368a, 401, 401.1,
402,
403, 403A, 408,
408.2, and 412, 
15and paragraphs (7) and (15) of Section 367 of the Illinois

16Insurance Code.

17 Rulemaking authority to implement Public Act 95-1045, if 
18any, is conditioned on the rules being adopted in accordance 
19with all provisions of the Illinois Administrative Procedure 
20Act and all rules and procedures of the Joint Committee on 
21Administrative Rules; any purported rule not so adopted, for 
22whatever reason, is unauthorized. 
23(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; 
24100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff. 
251-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81, 
 
 
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1eff. 7-12-19; 101-281, eff. 1-1-20; 101-393, eff. 1-1-20; 
2101-625, eff. 1-1-21.)

3 Section 45. The Illinois Public Aid Code is amended by 
4changing Section 5-16.8 as follows:



5 (305 ILCS 5/5-16.8)


6 Sec. 5-16.8. Required health benefits. The medical 
7assistance program
shall
(i) provide the post-mastectomy care 
8benefits required to be covered by a policy of
accident and 
9health insurance under Section 356t and the coverage required

10under Sections 356g.5, 356u, 356w, 356x, 356z.6, 356z.26, 
11356z.29, 356z.32, 356z.33, 356z.34, and 356z.35, and 356z.43 
12of the Illinois
Insurance Code and (ii) be subject to the 
13provisions of Sections 356z.19, 364.01, 370c, and 370c.1 of 
14the Illinois
Insurance Code.

15 The Department, by rule, shall adopt a model similar to 
16the requirements of Section 356z.39 of the Illinois Insurance 
17Code. 
18 On and after July 1, 2012, the Department shall reduce any 
19rate of reimbursement for services or other payments or alter 
20any methodologies authorized by this Code to reduce any rate 
21of reimbursement for services or other payments in accordance 
22with Section 5-5e. 
23 To ensure full access to the benefits set forth in this 
24Section, on and after January 1, 2016, the Department shall 
 
 
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1ensure that provider and hospital reimbursement for 
2post-mastectomy care benefits required under this Section are 
3no lower than the Medicare reimbursement rate. 
4(Source: P.A. 100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 
5100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 
67-12-19; 101-218, eff. 1-1-20; 101-281, eff. 1-1-20; 101-371, 
7eff. 1-1-20; 101-574, eff. 1-1-20; 101-649, eff. 7-7-20.)".