Bill Text: IL HB0081 | 2015-2016 | 99th General Assembly | Introduced
Bill Title: Amends the Illinois Insurance Code. Makes a technical change in a Section concerning mental health parity.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2015-03-27 - Rule 19(a) / Re-referred to Rules Committee [HB0081 Detail]
Download: Illinois-2015-HB0081-Introduced.html
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1 | AN ACT concerning regulation.
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2 | Be it enacted by the People of the State of Illinois,
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3 | represented in the General Assembly:
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4 | Section 5. The Illinois Insurance Code is amended by | |||||||||||||||||||
5 | changing Section 370c.1 as follows:
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6 | (215 ILCS 5/370c.1) | |||||||||||||||||||
7 | Sec. 370c.1. Mental health parity. | |||||||||||||||||||
8 | (a) On and after the the effective date of this amendatory | |||||||||||||||||||
9 | Act of the 97th General Assembly, every insurer that amends, | |||||||||||||||||||
10 | delivers, issues, or renews a group policy of accident and | |||||||||||||||||||
11 | health insurance in this State providing coverage for hospital | |||||||||||||||||||
12 | or medical treatment and for the treatment of mental, | |||||||||||||||||||
13 | emotional, nervous, or substance use disorders or conditions | |||||||||||||||||||
14 | shall ensure that: | |||||||||||||||||||
15 | (1) the financial requirements applicable to such | |||||||||||||||||||
16 | mental, emotional, nervous, or substance use disorder or | |||||||||||||||||||
17 | condition benefits are no more restrictive than the | |||||||||||||||||||
18 | predominant financial requirements applied to | |||||||||||||||||||
19 | substantially all hospital and medical benefits covered by | |||||||||||||||||||
20 | the policy and that there are no separate cost-sharing | |||||||||||||||||||
21 | requirements that are applicable only with respect to | |||||||||||||||||||
22 | mental, emotional, nervous, or substance use disorder or | |||||||||||||||||||
23 | condition benefits; and |
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1 | (2) the treatment limitations applicable to such | ||||||
2 | mental, emotional, nervous, or substance use disorder or | ||||||
3 | condition benefits are no more restrictive than the | ||||||
4 | predominant treatment limitations applied to substantially | ||||||
5 | all hospital and medical benefits covered by the policy and | ||||||
6 | that there are no separate treatment limitations that are | ||||||
7 | applicable only with respect to mental, emotional, | ||||||
8 | nervous, or substance use disorder or condition benefits. | ||||||
9 | (b) The following provisions shall apply concerning | ||||||
10 | aggregate lifetime limits: | ||||||
11 | (1) In the case of a group policy of accident and | ||||||
12 | health insurance amended, delivered, issued, or renewed in | ||||||
13 | this State on or after the effective date of this | ||||||
14 | amendatory Act of the 97th General Assembly that provides | ||||||
15 | coverage for hospital or medical treatment and for the | ||||||
16 | treatment of mental, emotional, nervous, or substance use | ||||||
17 | disorders or conditions the following provisions shall | ||||||
18 | apply: | ||||||
19 | (A) if the policy does not include an aggregate | ||||||
20 | lifetime limit on substantially all hospital and | ||||||
21 | medical benefits, then the policy may not impose any | ||||||
22 | aggregate lifetime limit on mental, emotional, | ||||||
23 | nervous, or substance use disorder or condition | ||||||
24 | benefits; or | ||||||
25 | (B) if the policy includes an aggregate lifetime | ||||||
26 | limit on substantially all hospital and medical |
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1 | benefits (in this subsection referred to as the | ||||||
2 | "applicable lifetime limit"), then the policy shall | ||||||
3 | either: | ||||||
4 | (i) apply the applicable lifetime limit both | ||||||
5 | to the hospital and medical benefits to which it | ||||||
6 | otherwise would apply and to mental, emotional, | ||||||
7 | nervous, or substance use disorder or condition | ||||||
8 | benefits and not distinguish in the application of | ||||||
9 | the limit between the hospital and medical | ||||||
10 | benefits and mental, emotional, nervous, or | ||||||
11 | substance use disorder or condition benefits; or | ||||||
12 | (ii) not include any aggregate lifetime limit | ||||||
13 | on mental, emotional, nervous, or substance use | ||||||
14 | disorder or condition benefits that is less than | ||||||
15 | the applicable lifetime limit. | ||||||
16 | (2) In the case of a policy that is not described in | ||||||
17 | paragraph (1) of subsection (b) of this Section and that | ||||||
18 | includes no or different aggregate lifetime limits on | ||||||
19 | different categories of hospital and medical benefits, the | ||||||
20 | Director shall establish rules under which subparagraph | ||||||
21 | (B) of paragraph (1) of subsection (b) of this Section is | ||||||
22 | applied to such policy with respect to mental, emotional, | ||||||
23 | nervous, or substance use disorder or condition benefits by | ||||||
24 | substituting for the applicable lifetime limit an average | ||||||
25 | aggregate lifetime limit that is computed taking into | ||||||
26 | account the weighted average of the aggregate lifetime |
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1 | limits applicable to such categories. | ||||||
2 | (c) The following provisions shall apply concerning annual | ||||||
3 | limits: | ||||||
4 | (1) In the case of a group policy of accident and | ||||||
5 | health insurance amended, delivered, issued, or renewed in | ||||||
6 | this State on or after the effective date of this | ||||||
7 | amendatory Act of the 97th General Assembly that provides | ||||||
8 | coverage for hospital or medical treatment and for the | ||||||
9 | treatment of mental, emotional, nervous, or substance use | ||||||
10 | disorders or conditions the following provisions shall | ||||||
11 | apply: | ||||||
12 | (A) if the policy does not include an annual limit | ||||||
13 | on substantially all hospital and medical benefits, | ||||||
14 | then the policy may not impose any annual limits on | ||||||
15 | mental, emotional, nervous, or substance use disorder | ||||||
16 | or condition benefits; or | ||||||
17 | (B) if the policy includes an annual limit on | ||||||
18 | substantially all hospital and medical benefits (in | ||||||
19 | this subsection referred to as the "applicable annual | ||||||
20 | limit"), then the policy shall either: | ||||||
21 | (i) apply the applicable annual limit both to | ||||||
22 | the hospital and medical benefits to which it | ||||||
23 | otherwise would apply and to mental, emotional, | ||||||
24 | nervous, or substance use disorder or condition | ||||||
25 | benefits and not distinguish in the application of | ||||||
26 | the limit between the hospital and medical |
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1 | benefits and mental, emotional, nervous, or | ||||||
2 | substance use disorder or condition benefits; or | ||||||
3 | (ii) not include any annual limit on mental, | ||||||
4 | emotional, nervous, or substance use disorder or | ||||||
5 | condition benefits that is less than the | ||||||
6 | applicable annual limit. | ||||||
7 | (2) In the case of a policy that is not described in | ||||||
8 | paragraph (1) of subsection (c) of this Section and that | ||||||
9 | includes no or different annual limits on different | ||||||
10 | categories of hospital and medical benefits, the Director | ||||||
11 | shall establish rules under which subparagraph (B) of | ||||||
12 | paragraph (1) of subsection (c) of this Section is applied | ||||||
13 | to such policy with respect to mental, emotional, nervous, | ||||||
14 | or substance use disorder or condition benefits by | ||||||
15 | substituting for the applicable annual limit an average | ||||||
16 | annual limit that is computed taking into account the | ||||||
17 | weighted average of the annual limits applicable to such | ||||||
18 | categories. | ||||||
19 | (d) This Section shall be interpreted in a manner | ||||||
20 | consistent with the interim final regulations promulgated by | ||||||
21 | the U.S. Department of Health and Human Services at 75 FR 5410, | ||||||
22 | including the prohibition against applying a cumulative | ||||||
23 | financial requirement or cumulative quantitative treatment | ||||||
24 | limitation for mental, emotional, nervous, or substance use | ||||||
25 | disorder benefits that accumulates separately from any | ||||||
26 | cumulative financial requirement or cumulative quantitative |
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1 | treatment limitation established for hospital and medical | ||||||
2 | benefits in the same classification. | ||||||
3 | (e) The provisions of subsections (b) and (c) of this | ||||||
4 | Section shall not be interpreted to allow the use of lifetime | ||||||
5 | or annual limits otherwise prohibited by State or federal law. | ||||||
6 | (f) This Section shall not apply to individual health | ||||||
7 | insurance coverage as defined in Section 5 of the Illinois | ||||||
8 | Health Insurance Portability and Accountability Act. | ||||||
9 | (g) As used in this Section: | ||||||
10 | "Financial requirement" includes deductibles, copayments, | ||||||
11 | coinsurance, and out-of-pocket maximums, but does not include | ||||||
12 | an aggregate lifetime limit or an annual limit subject to | ||||||
13 | subsections (b) and (c). | ||||||
14 | "Treatment limitation" includes limits on benefits based | ||||||
15 | on the frequency of treatment, number of visits, days of | ||||||
16 | coverage, days in a waiting period, or other similar limits on | ||||||
17 | the scope or duration of treatment. "Treatment limitation" | ||||||
18 | includes both quantitative treatment limitations, which are | ||||||
19 | expressed numerically (such as 50 outpatient visits per year), | ||||||
20 | and nonquantitative treatment limitations, which otherwise | ||||||
21 | limit the scope or duration of treatment. A permanent exclusion | ||||||
22 | of all benefits for a particular condition or disorder shall | ||||||
23 | not be considered a treatment limitation.
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24 | (Source: P.A. 97-437, eff. 8-18-11.)
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