99TH GENERAL ASSEMBLY
State of Illinois
2015 and 2016
HB0081
 
Introduced , by Rep. Lou Lang
 
SYNOPSIS AS INTRODUCED:



215 ILCS 5/370c.1

 Amends the Illinois Insurance Code. Makes a technical change in a Section concerning mental health parity.



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A BILL FOR
 


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1 AN ACT concerning regulation.


2 Be it enacted by the People of the State of Illinois,

3represented in the General Assembly:



4 Section 5. The Illinois Insurance Code is amended by 
5changing Section 370c.1 as follows:

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 
9Act of the 97th General Assembly, every insurer that amends, 
10delivers, issues, or renews a group policy of accident and 
11health insurance in this State providing coverage for hospital 
12or medical treatment and for the treatment of mental, 
13emotional, nervous, or substance use disorders or conditions 
14shall 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 
10aggregate 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 
3limits:
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 
20consistent with the interim final regulations promulgated by 
21the U.S. Department of Health and Human Services at 75 FR 5410, 
22including the prohibition against applying a cumulative 
23financial requirement or cumulative quantitative treatment 
24limitation for mental, emotional, nervous, or substance use 
25disorder benefits that accumulates separately from any 
26cumulative financial requirement or cumulative quantitative 
 
 
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1treatment limitation established for hospital and medical 
2benefits in the same classification.
3 (e) The provisions of subsections (b) and (c) of this 
4Section shall not be interpreted to allow the use of lifetime 
5or annual limits otherwise prohibited by State or federal law.
6 (f) This Section shall not apply to individual health 
7insurance coverage as defined in Section 5 of the Illinois 
8Health Insurance Portability and Accountability Act. 
9 (g) As used in this Section:
10 "Financial requirement" includes deductibles, copayments, 
11coinsurance, and out-of-pocket maximums, but does not include 
12an aggregate lifetime limit or an annual limit subject to 
13subsections (b) and (c).
14 "Treatment limitation" includes limits on benefits based 
15on the frequency of treatment, number of visits, days of 
16coverage, days in a waiting period, or other similar limits on 
17the scope or duration of treatment. "Treatment limitation" 
18includes both quantitative treatment limitations, which are 
19expressed numerically (such as 50 outpatient visits per year), 
20and nonquantitative treatment limitations, which otherwise 
21limit the scope or duration of treatment. A permanent exclusion 
22of all benefits for a particular condition or disorder shall 
23not be considered a treatment limitation. 

24(Source: P.A. 97-437, eff. 8-18-11.)