Bill Text: IL HB3300 | 2013-2014 | 98th General Assembly | Enrolled

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Bill Title: Amends the Illinois Insurance Code, the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, the Limited Health Service Organization Act, and the Voluntary Health Services Plans Act to provide that a company that issues, delivers, amends, or renews a policy of accident and health insurance shall accommodate a reasonable request by a person covered by a policy issued by the company to receive communications of claim-related information from the company by alternative means or at alternative locations if the person clearly states that disclosure of all or part of the information could endanger the person. Provides that if a child is covered by a policy issued by a company, then the child's parent or guardian may make a request to the company pursuant to the provision concerning alternative means of communication. Provides that a company may require (1) a person making a request pursuant to the provision concerning alternative means of communication to do so in writing, (2) the request to contain a statement that disclosure of all or part of the claim-related information to which the request pertains could endanger the person or child, and (3) the specification of an alternative address, telephone number, or other method of contact. Sets forth provisions concerning liability, the disclosure of protected information, and court orders.

Spectrum: Partisan Bill (Democrat 23-1)

Status: (Passed) 2013-08-06 - Public Act . . . . . . . . . 98-0189 [HB3300 Detail]

Download: Illinois-2013-HB3300-Enrolled.html

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AN ACT concerning insurance.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The State Employees Group Insurance Act of 1971
is amended by changing Section 6.11 as follows:
(5 ILCS 375/6.11)
Sec. 6.11. Required health benefits; Illinois Insurance
Code requirements. The program of health benefits shall provide
the post-mastectomy care benefits required to be covered by a
policy of accident and health insurance under Section 356t of
the Illinois Insurance Code. The program of health benefits
shall provide the coverage required under Sections 356g,
356g.5, 356g.5-1, 356m, 356u, 356w, 356x, 356z.2, 356z.4,
356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
356z.14, 356z.15, and 356z.17 and 356z.19 of the Illinois
Insurance Code. The program of health benefits must comply with
Sections 155.22a, 155.37, 355b, and 356z.19 of the Illinois
Insurance Code.
Rulemaking authority to implement Public Act 95-1045, if
any, is conditioned on the rules being adopted in accordance
with all provisions of the Illinois Administrative Procedure
Act and all rules and procedures of the Joint Committee on
Administrative Rules; any purported rule not so adopted, for

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whatever reason, is unauthorized.
(Source: P.A. 96-139, eff. 1-1-10; 96-328, eff. 8-11-09;
96-639, eff. 1-1-10; 96-1000, eff. 7-2-10; 97-282, eff. 8-9-11;
97-343, eff. 1-1-12; 97-813, eff. 7-13-12.)
Section 10. The Counties Code is amended by changing
Section 5-1069.3 as follows:
(55 ILCS 5/5-1069.3)
Sec. 5-1069.3. Required health benefits. If a county,
including a home rule county, is a self-insurer for purposes of
providing health insurance coverage for its employees, the
coverage shall include coverage for the post-mastectomy care
benefits required to be covered by a policy of accident and
health insurance under Section 356t and the coverage required
under Sections 356g, 356g.5, 356g.5-1, 356u, 356w, 356x,
356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
356z.14, and 356z.15 of the Illinois Insurance Code. The
coverage shall comply with Sections 155.22a, 355b, and 356z.19
of the Illinois Insurance Code. The requirement that health
benefits be covered as provided in this Section is an exclusive
power and function of the State and is a denial and limitation
under Article VII, Section 6, subsection (h) of the Illinois
Constitution. A home rule county to which this Section applies
must comply with every provision of this Section.
Rulemaking authority to implement Public Act 95-1045, if

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any, is conditioned on the rules being adopted in accordance
with all provisions of the Illinois Administrative Procedure
Act and all rules and procedures of the Joint Committee on
Administrative Rules; any purported rule not so adopted, for
whatever reason, is unauthorized.
(Source: P.A. 96-139, eff. 1-1-10; 96-328, eff. 8-11-09;
96-1000, eff. 7-2-10; 97-282, eff. 8-9-11; 97-343, eff. 1-1-12;
97-813, eff. 7-13-12.)
Section 15. The Illinois Municipal Code is amended by
changing Section 10-4-2.3 as follows:
(65 ILCS 5/10-4-2.3)
Sec. 10-4-2.3. Required health benefits. If a
municipality, including a home rule municipality, is a
self-insurer for purposes of providing health insurance
coverage for its employees, the coverage shall include coverage
for the post-mastectomy care benefits required to be covered by
a policy of accident and health insurance under Section 356t
and the coverage required under Sections 356g, 356g.5,
356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10,
356z.11, 356z.12, 356z.13, 356z.14, and 356z.15 of the Illinois
Insurance Code. The coverage shall comply with Sections
155.22a, 355b, and 356z.19 of the Illinois Insurance Code. The
requirement that health benefits be covered as provided in this
is an exclusive power and function of the State and is a denial

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and limitation under Article VII, Section 6, subsection (h) of
the Illinois Constitution. A home rule municipality to which
this Section applies must comply with every provision of this
Section.
Rulemaking authority to implement Public Act 95-1045, if
any, is conditioned on the rules being adopted in accordance
with all provisions of the Illinois Administrative Procedure
Act and all rules and procedures of the Joint Committee on
Administrative Rules; any purported rule not so adopted, for
whatever reason, is unauthorized.
(Source: P.A. 96-139, eff. 1-1-10; 96-328, eff. 8-11-09;
96-1000, eff. 7-2-10; 97-282, eff. 8-9-11; 97-343, eff. 1-1-12;
97-813, eff. 7-13-12.)
Section 20. The School Code is amended by changing Section
10-22.3f as follows:
(105 ILCS 5/10-22.3f)
Sec. 10-22.3f. Required health benefits. Insurance
protection and benefits for employees shall provide the
post-mastectomy care benefits required to be covered by a
policy of accident and health insurance under Section 356t and
the coverage required under Sections 356g, 356g.5, 356g.5-1,
356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11, 356z.12,
356z.13, 356z.14, and 356z.15 of the Illinois Insurance Code.
Insurance policies shall comply with Section 356z.19 of the

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Illinois Insurance Code. The coverage shall comply with
Sections Section 155.22a and 355b of the Illinois Insurance
Code.
Rulemaking authority to implement Public Act 95-1045, if
any, is conditioned on the rules being adopted in accordance
with all provisions of the Illinois Administrative Procedure
Act and all rules and procedures of the Joint Committee on
Administrative Rules; any purported rule not so adopted, for
whatever reason, is unauthorized.
(Source: P.A. 96-139, eff. 1-1-10; 96-328, eff. 8-11-09;
96-1000, eff. 7-2-10; 97-282, eff. 8-9-11; 97-343, eff. 1-1-12;
97-813, eff. 7-13-12.)
Section 25. The Illinois Insurance Code is amended by
adding Sections 355b and 356z.16 as follows:
(215 ILCS 5/355b new)
Sec. 355b. Claim-related information; alternative means of
communication.
(a) For the purposes of this Section, "claim-related
information" means all claim or billing information relating
specifically to an insured, subscriber, or person covered by an
individual or group policy of accident and health insurance
issued, delivered, amended, or renewed by a company doing
business in this State.
(b) A company that issues, delivers, amends, or renews an

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individual or group policy of accident and health insurance on
or after the effective date of this amendatory Act of the 98th
General Assembly shall accommodate a reasonable request by a
person covered by a policy issued by the company to receive
communications of claim-related information from the company
by alternative means or at alternative locations if the person
clearly states that disclosure of all or part of the
information could endanger the person.
(c) If a child is covered by a policy issued by a company,
then the child's parent or guardian may make a request to the
company pursuant to subsection (b) of this Section.
(d) A company may require (1) a person making a request
pursuant to subsection (b) of this Section to do so in writing,
(2) the request to contain a statement that disclosure of all
or part of the claim-related information to which the request
pertains could endanger the person or child, and (3) the
specification of an alternative address, telephone number, or
other method of contact.
(e) Except with the express consent of the person making a
request pursuant to subsection (b) of this Section, a company
may not disclose to the policyholder (1) the address, telephone
number, or any other personally identifying information of the
person who made the request or child for whose benefit a
request was made, (2) the nature of the health care services
provided, or (3) the name or address of the provider of the
health care services.

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(f) A company that makes reasonable and good faith efforts
to comply with this Section shall not be subject to civil or
criminal liability on the grounds of noncompliance with this
Section.
(g) The Director shall adopt rules to guide companies in
guarding against the disclosure of the information protected
pursuant to this Section.
(h) Nothing in this Section shall prevent, hinder, or
otherwise affect the entry of an appropriate order made in the
best interests of a child by a court of competent jurisdiction
adjudicating disputed issues of child welfare or custody.
(215 ILCS 5/356z.16)
Sec. 356z.16. Applicability of mandated benefits to
supplemental policies. Unless specified otherwise, the
following Sections of the Illinois Insurance Code do not apply
to short-term travel, disability income, long-term care,
accident only, or limited or specified disease policies: 355b,
356b, 356c, 356d, 356g, 356k, 356m, 356n, 356p, 356q, 356r,
356t, 356u, 356w, 356x, 356z.1, 356z.2, 356z.4, 356z.5, 356z.6,
356z.8, 356z.12, 356z.14, 356z.19, 356z.21, 364.01, 367.2-5,
and 367e.
(Source: P.A. 96-180, eff. 1-1-10; 96-1000, eff. 7-2-10;
96-1034, eff. 1-1-11; 97-91, eff. 1-1-12; 97-282, eff. 8-9-11;
97-592, eff. 1-1-12; 97-813, eff. 7-13-12; 97-972, eff.
1-1-13.)

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Section 30. The Health Maintenance Organization Act is
amended by changing Section 5-3 as follows:
(215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
Sec. 5-3. Insurance Code provisions.
(a) Health Maintenance Organizations shall be subject to
the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2, 355.3,
355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2, 356z.4,
356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
356z.13, 356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.21,
364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c, 368d, 368e,
370c, 370c.1, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412,
444, and 444.1, paragraph (c) of subsection (2) of Section 367,
and Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV,
and XXVI of the Illinois Insurance Code.
(b) For purposes of the Illinois Insurance Code, except for
Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health
Maintenance Organizations in the following categories are
deemed to be "domestic companies":
(1) a corporation authorized under the Dental Service
Plan Act or the Voluntary Health Services Plans Act;
(2) a corporation organized under the laws of this
State; or

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(3) a corporation organized under the laws of another
state, 30% or more of the enrollees of which are residents
of this State, except a corporation subject to
substantially the same requirements in its state of
organization as is a "domestic company" under Article VIII
1/2 of the Illinois Insurance Code.
(c) In considering the merger, consolidation, or other
acquisition of control of a Health Maintenance Organization
pursuant to Article VIII 1/2 of the Illinois Insurance Code,
(1) the Director shall give primary consideration to
the continuation of benefits to enrollees and the financial
conditions of the acquired Health Maintenance Organization
after the merger, consolidation, or other acquisition of
control takes effect;
(2)(i) the criteria specified in subsection (1)(b) of
Section 131.8 of the Illinois Insurance Code shall not
apply and (ii) the Director, in making his determination
with respect to the merger, consolidation, or other
acquisition of control, need not take into account the
effect on competition of the merger, consolidation, or
other acquisition of control;
(3) the Director shall have the power to require the
following information:
(A) certification by an independent actuary of the
adequacy of the reserves of the Health Maintenance
Organization sought to be acquired;

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(B) pro forma financial statements reflecting the
combined balance sheets of the acquiring company and
the Health Maintenance Organization sought to be
acquired as of the end of the preceding year and as of
a date 90 days prior to the acquisition, as well as pro
forma financial statements reflecting projected
combined operation for a period of 2 years;
(C) a pro forma business plan detailing an
acquiring party's plans with respect to the operation
of the Health Maintenance Organization sought to be
acquired for a period of not less than 3 years; and
(D) such other information as the Director shall
require.
(d) The provisions of Article VIII 1/2 of the Illinois
Insurance Code and this Section 5-3 shall apply to the sale by
any health maintenance organization of greater than 10% of its
enrollee population (including without limitation the health
maintenance organization's right, title, and interest in and to
its health care certificates).
(e) In considering any management contract or service
agreement subject to Section 141.1 of the Illinois Insurance
Code, the Director (i) shall, in addition to the criteria
specified in Section 141.2 of the Illinois Insurance Code, take
into account the effect of the management contract or service
agreement on the continuation of benefits to enrollees and the
financial condition of the health maintenance organization to

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be managed or serviced, and (ii) need not take into account the
effect of the management contract or service agreement on
competition.
(f) Except for small employer groups as defined in the
Small Employer Rating, Renewability and Portability Health
Insurance Act and except for medicare supplement policies as
defined in Section 363 of the Illinois Insurance Code, a Health
Maintenance Organization may by contract agree with a group or
other enrollment unit to effect refunds or charge additional
premiums under the following terms and conditions:
(i) the amount of, and other terms and conditions with
respect to, the refund or additional premium are set forth
in the group or enrollment unit contract agreed in advance
of the period for which a refund is to be paid or
additional premium is to be charged (which period shall not
be less than one year); and
(ii) the amount of the refund or additional premium
shall not exceed 20% of the Health Maintenance
Organization's profitable or unprofitable experience with
respect to the group or other enrollment unit for the
period (and, for purposes of a refund or additional
premium, the profitable or unprofitable experience shall
be calculated taking into account a pro rata share of the
Health Maintenance Organization's administrative and
marketing expenses, but shall not include any refund to be
made or additional premium to be paid pursuant to this

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subsection (f)). The Health Maintenance Organization and
the group or enrollment unit may agree that the profitable
or unprofitable experience may be calculated taking into
account the refund period and the immediately preceding 2
plan years.
The Health Maintenance Organization shall include a
statement in the evidence of coverage issued to each enrollee
describing the possibility of a refund or additional premium,
and upon request of any group or enrollment unit, provide to
the group or enrollment unit a description of the method used
to calculate (1) the Health Maintenance Organization's
profitable experience with respect to the group or enrollment
unit and the resulting refund to the group or enrollment unit
or (2) the Health Maintenance Organization's unprofitable
experience with respect to the group or enrollment unit and the
resulting additional premium to be paid by the group or
enrollment unit.
In no event shall the Illinois Health Maintenance
Organization Guaranty Association be liable to pay any
contractual obligation of an insolvent organization to pay any
refund authorized under this Section.
(g) Rulemaking authority to implement Public Act 95-1045,
if any, is conditioned on the rules being adopted in accordance
with all provisions of the Illinois Administrative Procedure
Act and all rules and procedures of the Joint Committee on
Administrative Rules; any purported rule not so adopted, for

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whatever reason, is unauthorized.
(Source: P.A. 96-328, eff. 8-11-09; 96-639, eff. 1-1-10;
96-833, eff. 6-1-10; 96-1000, eff. 7-2-10; 97-282, eff. 8-9-11;
97-343, eff. 1-1-12; 97-437, eff. 8-18-11; 97-486, eff. 1-1-12;
97-592, eff. 1-1-12; 97-805, eff. 1-1-13; 97-813, eff.
7-13-12.)
Section 35. The Limited Health Service Organization Act is
amended by changing Section 4003 as follows:
(215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
Sec. 4003. Illinois Insurance Code provisions. Limited
health service organizations shall be subject to the provisions
of Sections 133, 134, 136, 137, 139, 140, 141.1, 141.2, 141.3,
143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5, 154.6,
154.7, 154.8, 155.04, 155.37, 355.2, 355.3, 355b, 356v,
356z.10, 356z.21, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2,
409, 412, 444, and 444.1 and Articles IIA, VIII 1/2, XII, XII
1/2, XIII, XIII 1/2, XXV, and XXVI of the Illinois Insurance
Code. For purposes of the Illinois Insurance Code, except for
Sections 444 and 444.1 and Articles XIII and XIII 1/2, limited
health service organizations in the following categories are
deemed to be domestic companies:
(1) a corporation under the laws of this State; or
(2) a corporation organized under the laws of another
state, 30% of more of the enrollees of which are residents

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of this State, except a corporation subject to
substantially the same requirements in its state of
organization as is a domestic company under Article VIII
1/2 of the Illinois Insurance Code.
(Source: P.A. 97-486, eff. 1-1-12; 97-592, 1-1-12; 97-805, eff.
1-1-13; 97-813, eff. 7-13-12.)
Section 40. The Voluntary Health Services Plans Act is
amended by changing Section 10 as follows:
(215 ILCS 165/10) (from Ch. 32, par. 604)
Sec. 10. Application of Insurance Code provisions. Health
services plan corporations and all persons interested therein
or dealing therewith shall be subject to the provisions of
Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, 356g,
356g.5, 356g.5-1, 356r, 356t, 356u, 356v, 356w, 356x, 356y,
356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9,
356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18,
356z.19, 356z.21, 364.01, 367.2, 368a, 401, 401.1, 402, 403,
403A, 408, 408.2, and 412, and paragraphs (7) and (15) of
Section 367 of the Illinois Insurance Code.
Rulemaking authority to implement Public Act 95-1045, if
any, is conditioned on the rules being adopted in accordance
with all provisions of the Illinois Administrative Procedure
Act and all rules and procedures of the Joint Committee on

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Administrative Rules; any purported rule not so adopted, for
whatever reason, is unauthorized.
(Source: P.A. 96-328, eff. 8-11-09; 96-833, eff. 6-1-10;
96-1000, eff. 7-2-10; 97-282, eff. 8-9-11; 97-343, eff. 1-1-12;
97-486, eff. 1-1-12; 97-592, eff. 1-1-12; 97-805, eff. 1-1-13;
97-813, eff. 7-13-12.)
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INDEX
Statutes amended in order of appearance