Bill Text: IL SB2241 | 2021-2022 | 102nd General Assembly | Introduced
Bill Title: Amends the Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance or managed care plan that is amended, delivered, issued, or renewed after the effective date of the amendatory Act shall provide coverage for hippotherapy and other forms of therapeutic riding. Makes conforming changes in the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, and the Health Maintenance Organization Act.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2021-04-16 - Rule 3-9(a) / Re-referred to Assignments [SB2241 Detail]
Download: Illinois-2021-SB2241-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 State Employees Group Insurance Act of 1971 | ||||||||||||||||||||||||||||||||||
| 5 | is amended by changing Section 6.11 as follows:
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| 6 | (5 ILCS 375/6.11)
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| 7 | Sec. 6.11. Required health benefits; Illinois Insurance | ||||||||||||||||||||||||||||||||||
| 8 | Code
requirements. The program of health
benefits shall | ||||||||||||||||||||||||||||||||||
| 9 | provide the post-mastectomy care benefits required to be | ||||||||||||||||||||||||||||||||||
| 10 | covered
by a policy of accident and health insurance under | ||||||||||||||||||||||||||||||||||
| 11 | Section 356t of the Illinois
Insurance Code. The program of | ||||||||||||||||||||||||||||||||||
| 12 | health benefits shall provide the coverage
required under | ||||||||||||||||||||||||||||||||||
| 13 | Sections 356g, 356g.5, 356g.5-1, 356m,
356u, 356w, 356x, | ||||||||||||||||||||||||||||||||||
| 14 | 356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, | ||||||||||||||||||||||||||||||||||
| 15 | 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22, | ||||||||||||||||||||||||||||||||||
| 16 | 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, | ||||||||||||||||||||||||||||||||||
| 17 | 356z.36, and 356z.41, and 356z.43 of the
Illinois Insurance | ||||||||||||||||||||||||||||||||||
| 18 | Code.
The program of health benefits must comply with Sections | ||||||||||||||||||||||||||||||||||
| 19 | 155.22a, 155.37, 355b, 356z.19, 370c, and 370c.1 and Article | ||||||||||||||||||||||||||||||||||
| 20 | XXXIIB of the
Illinois Insurance Code. The Department of | ||||||||||||||||||||||||||||||||||
| 21 | Insurance shall enforce the requirements of this Section with | ||||||||||||||||||||||||||||||||||
| 22 | respect to Sections 370c and 370c.1 of the Illinois Insurance | ||||||||||||||||||||||||||||||||||
| 23 | Code; all other requirements of this Section shall be enforced | ||||||||||||||||||||||||||||||||||
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| 1 | by the Department of Central Management Services.
| ||||||
| 2 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
| 3 | any, is conditioned on the rules being adopted in accordance | ||||||
| 4 | with all provisions of the Illinois Administrative Procedure | ||||||
| 5 | Act and all rules and procedures of the Joint Committee on | ||||||
| 6 | Administrative Rules; any purported rule not so adopted, for | ||||||
| 7 | whatever reason, is unauthorized. | ||||||
| 8 | (Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; | ||||||
| 9 | 100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff. | ||||||
| 10 | 1-1-19; 100-1102, eff. 1-1-19; 100-1170, eff. 6-1-19; 101-13, | ||||||
| 11 | eff. 6-12-19; 101-281, eff. 1-1-20; 101-393, eff. 1-1-20; | ||||||
| 12 | 101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff. | ||||||
| 13 | 1-1-21.)
| ||||||
| 14 | Section 10. The Counties Code is amended by changing | ||||||
| 15 | Section 5-1069.3 as follows:
| ||||||
| 16 | (55 ILCS 5/5-1069.3)
| ||||||
| 17 | Sec. 5-1069.3. Required health benefits. If a county, | ||||||
| 18 | including a home
rule
county, is a self-insurer for purposes | ||||||
| 19 | of providing health insurance coverage
for its employees, the | ||||||
| 20 | coverage shall include coverage for the post-mastectomy
care | ||||||
| 21 | benefits required to be covered by a policy of accident and | ||||||
| 22 | health
insurance under Section 356t and the coverage required | ||||||
| 23 | under Sections 356g, 356g.5, 356g.5-1, 356u,
356w, 356x, | ||||||
| 24 | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, | ||||||
| |||||||
| |||||||
| 1 | 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29, | ||||||
| 2 | 356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41, and 356z.43 | ||||||
| 3 | of
the Illinois Insurance Code. The coverage shall comply with | ||||||
| 4 | Sections 155.22a, 355b, 356z.19, and 370c of
the Illinois | ||||||
| 5 | Insurance Code. The Department of Insurance shall enforce the | ||||||
| 6 | requirements of this Section. The requirement that health | ||||||
| 7 | benefits be covered
as provided in this Section is an
| ||||||
| 8 | exclusive power and function of the State and is a denial and | ||||||
| 9 | limitation under
Article VII, Section 6, subsection (h) of the | ||||||
| 10 | Illinois Constitution. A home
rule county to which this | ||||||
| 11 | Section applies must comply with every provision of
this | ||||||
| 12 | Section.
| ||||||
| 13 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
| 14 | any, is conditioned on the rules being adopted in accordance | ||||||
| 15 | with all provisions of the Illinois Administrative Procedure | ||||||
| 16 | Act and all rules and procedures of the Joint Committee on | ||||||
| 17 | Administrative Rules; any purported rule not so adopted, for | ||||||
| 18 | whatever reason, is unauthorized. | ||||||
| 19 | (Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; | ||||||
| 20 | 100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff. | ||||||
| 21 | 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281, | ||||||
| 22 | eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20; | ||||||
| 23 | 101-625, eff. 1-1-21.)
| ||||||
| 24 | Section 15. The Illinois Municipal Code is amended by | ||||||
| 25 | changing Section 10-4-2.3 as follows:
| ||||||
| |||||||
| |||||||
| 1 | (65 ILCS 5/10-4-2.3)
| ||||||
| 2 | Sec. 10-4-2.3. Required health benefits. If a | ||||||
| 3 | municipality, including a
home rule municipality, is a | ||||||
| 4 | self-insurer for purposes of providing health
insurance | ||||||
| 5 | coverage for its employees, the coverage shall include | ||||||
| 6 | coverage for
the post-mastectomy care benefits required to be | ||||||
| 7 | covered by a policy of
accident and health insurance under | ||||||
| 8 | Section 356t and the coverage required
under Sections 356g, | ||||||
| 9 | 356g.5, 356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, | ||||||
| 10 | 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, | ||||||
| 11 | 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, | ||||||
| 12 | 356z.36, and 356z.41, and 356z.43 of the Illinois
Insurance
| ||||||
| 13 | Code. The coverage shall comply with Sections 155.22a, 355b, | ||||||
| 14 | 356z.19, and 370c of
the Illinois Insurance Code. The | ||||||
| 15 | Department of Insurance shall enforce the requirements of this | ||||||
| 16 | Section. The requirement that health
benefits be covered as | ||||||
| 17 | provided in this is an exclusive power and function of
the | ||||||
| 18 | State and is a denial and limitation under Article VII, | ||||||
| 19 | Section 6,
subsection (h) of the Illinois Constitution. A home | ||||||
| 20 | rule municipality to which
this Section applies must comply | ||||||
| 21 | with every provision of this Section.
| ||||||
| 22 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
| 23 | any, is conditioned on the rules being adopted in accordance | ||||||
| 24 | with all provisions of the Illinois Administrative Procedure | ||||||
| 25 | Act and all rules and procedures of the Joint Committee on | ||||||
| |||||||
| |||||||
| 1 | Administrative Rules; any purported rule not so adopted, for | ||||||
| 2 | whatever reason, is unauthorized. | ||||||
| 3 | (Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; | ||||||
| 4 | 100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff. | ||||||
| 5 | 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281, | ||||||
| 6 | eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20; | ||||||
| 7 | 101-625, eff. 1-1-21.)
| ||||||
| 8 | Section 20. The School Code is amended by changing Section | ||||||
| 9 | 10-22.3f as follows:
| ||||||
| 10 | (105 ILCS 5/10-22.3f)
| ||||||
| 11 | Sec. 10-22.3f. Required health benefits. Insurance | ||||||
| 12 | protection and
benefits
for employees shall provide the | ||||||
| 13 | post-mastectomy care benefits required to be
covered by a | ||||||
| 14 | policy of accident and health insurance under Section 356t and | ||||||
| 15 | the
coverage required under Sections 356g, 356g.5, 356g.5-1, | ||||||
| 16 | 356u, 356w, 356x,
356z.6, 356z.8, 356z.9, 356z.11, 356z.12, | ||||||
| 17 | 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29, | ||||||
| 18 | 356z.30a, 356z.32, 356z.33, 356z.36, and 356z.41, and 356z.43 | ||||||
| 19 | of
the
Illinois Insurance Code.
Insurance policies shall | ||||||
| 20 | comply with Section 356z.19 of the Illinois Insurance Code. | ||||||
| 21 | The coverage shall comply with Sections 155.22a, 355b, and | ||||||
| 22 | 370c of
the Illinois Insurance Code. The Department of | ||||||
| 23 | Insurance shall enforce the requirements of this Section.
| ||||||
| 24 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
| |||||||
| |||||||
| 1 | any, is conditioned on the rules being adopted in accordance | ||||||
| 2 | with all provisions of the Illinois Administrative Procedure | ||||||
| 3 | Act and all rules and procedures of the Joint Committee on | ||||||
| 4 | Administrative Rules; any purported rule not so adopted, for | ||||||
| 5 | whatever reason, is unauthorized. | ||||||
| 6 | (Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; | ||||||
| 7 | 100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff. | ||||||
| 8 | 1-1-19; 100-1102, eff. 1-1-19; 101-81, eff. 7-12-19; 101-281, | ||||||
| 9 | eff. 1-1-20; 101-393, eff. 1-1-20; 101-461, eff. 1-1-20; | ||||||
| 10 | 101-625, eff. 1-1-21.)
| ||||||
| 11 | Section 25. The Illinois Insurance Code is amended by | ||||||
| 12 | adding Section 356z.43 as follows:
| ||||||
| 13 | (215 ILCS 5/356z.43 new) | ||||||
| 14 | Sec. 356z.43. Coverage for hippotherapy and therapeutic | ||||||
| 15 | riding. | ||||||
| 16 | (a) As used in this Section: | ||||||
| 17 | "Disability" means a determinable physical or mental | ||||||
| 18 | characteristic of a person, including, but not limited to, a | ||||||
| 19 | determinable physical characteristic that necessitates the | ||||||
| 20 | person's use of a guide, hearing, or support dog, that may | ||||||
| 21 | result from a disease, injury, or congenital condition of | ||||||
| 22 | birth or a functional disorder. | ||||||
| 23 | "Hippotherapy" means physical, occupational, or speech | ||||||
| 24 | therapy, prescribed by a physician and delivered by a licensed | ||||||
| |||||||
| |||||||
| 1 | occupational therapist, physical therapist, or speech-language | ||||||
| 2 | pathologist, in conjunction with a professional horse handler | ||||||
| 3 | and a therapy horse. | ||||||
| 4 | "Therapeutic riding" means horseback riding lessons | ||||||
| 5 | adapted to an individual with a disability, delivered by a | ||||||
| 6 | professional horse handler and a therapy horse. | ||||||
| 7 | (b) A group or individual policy of accident and health | ||||||
| 8 | insurance or managed care plan that is amended, delivered, | ||||||
| 9 | issued, or renewed after the effective date of this amendatory | ||||||
| 10 | Act of the 102nd General Assembly shall provide coverage for | ||||||
| 11 | hippotherapy and other forms of therapeutic riding.
| ||||||
| 12 | Section 30. The Health Maintenance Organization Act is | ||||||
| 13 | amended 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 | ||||||
| 17 | the provisions of Sections 133, 134, 136, 137, 139, 140, | ||||||
| 18 | 141.1,
141.2, 141.3, 143, 143c, 147, 148, 149, 151,
152, 153, | ||||||
| 19 | 154, 154.5, 154.6,
154.7, 154.8, 155.04, 155.22a, 355.2, | ||||||
| 20 | 355.3, 355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y,
356z.2, | ||||||
| 21 | 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10, | ||||||
| 22 | 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.18, | ||||||
| 23 | 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, | ||||||
| 24 | 356z.30a, 356z.32, 356z.33, 356z.35, 356z.36, 356z.41, | ||||||
| |||||||
| |||||||
| 1 | 356z.43, 364, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c, | ||||||
| 2 | 368d, 368e, 370c,
370c.1, 401, 401.1, 402, 403, 403A,
408, | ||||||
| 3 | 408.2, 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, | ||||||
| 5 | XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the Illinois | ||||||
| 6 | Insurance Code.
| ||||||
| 7 | (b) For purposes of the Illinois Insurance Code, except | ||||||
| 8 | for Sections 444
and 444.1 and Articles XIII and XIII 1/2, | ||||||
| 9 | Health Maintenance Organizations in
the following categories | ||||||
| 10 | are 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 | ||||||
| 22 | acquisition of
control of a Health Maintenance Organization | ||||||
| 23 | pursuant 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 | ||||||
| |||||||
| |||||||
| 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 | ||||||
| |||||||
| |||||||
| 1 | require.
| ||||||
| 2 | (d) The provisions of Article VIII 1/2 of the Illinois | ||||||
| 3 | Insurance Code
and this Section 5-3 shall apply to the sale by | ||||||
| 4 | any health maintenance
organization of greater than 10% of its
| ||||||
| 5 | enrollee population (including without limitation the health | ||||||
| 6 | maintenance
organization's right, title, and interest in and | ||||||
| 7 | to its health care
certificates).
| ||||||
| 8 | (e) In considering any management contract or service | ||||||
| 9 | agreement subject
to Section 141.1 of the Illinois Insurance | ||||||
| 10 | Code, the Director (i) shall, in
addition to the criteria | ||||||
| 11 | specified in Section 141.2 of the Illinois
Insurance Code, | ||||||
| 12 | take into account the effect of the management contract or
| ||||||
| 13 | service agreement on the continuation of benefits to enrollees | ||||||
| 14 | and the
financial condition of the health maintenance | ||||||
| 15 | organization to be managed or
serviced, and (ii) need not take | ||||||
| 16 | into account the effect of the management
contract or service | ||||||
| 17 | agreement on competition.
| ||||||
| 18 | (f) Except for small employer groups as defined in the | ||||||
| 19 | Small Employer
Rating, Renewability and Portability Health | ||||||
| 20 | Insurance Act and except for
medicare supplement policies as | ||||||
| 21 | defined in Section 363 of the Illinois
Insurance Code, a | ||||||
| 22 | Health Maintenance Organization may by contract agree with a
| ||||||
| 23 | group or other enrollment unit to effect refunds or charge | ||||||
| 24 | additional 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 | ||||||
| |||||||
| |||||||
| 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 | ||||||
| 21 | statement in the
evidence of coverage issued to each enrollee | ||||||
| 22 | describing the possibility of a
refund or additional premium, | ||||||
| 23 | and upon request of any group or enrollment unit,
provide to | ||||||
| 24 | the group or enrollment unit a description of the method used | ||||||
| 25 | to
calculate (1) the Health Maintenance Organization's | ||||||
| 26 | profitable experience with
respect to the group or enrollment | ||||||
| |||||||
| |||||||
| 1 | unit and the resulting refund to the group
or enrollment unit | ||||||
| 2 | or (2) the Health Maintenance Organization's unprofitable
| ||||||
| 3 | experience with respect to the group or enrollment unit and | ||||||
| 4 | the resulting
additional premium to be paid by the group or | ||||||
| 5 | enrollment unit.
| ||||||
| 6 | In no event shall the Illinois Health Maintenance | ||||||
| 7 | Organization
Guaranty Association be liable to pay any | ||||||
| 8 | contractual obligation of an
insolvent organization to pay any | ||||||
| 9 | refund authorized under this Section.
| ||||||
| 10 | (g) Rulemaking authority to implement Public Act 95-1045, | ||||||
| 11 | if any, is conditioned on the rules being adopted in | ||||||
| 12 | accordance with all provisions of the Illinois Administrative | ||||||
| 13 | Procedure Act and all rules and procedures of the Joint | ||||||
| 14 | Committee on Administrative Rules; any purported rule not so | ||||||
| 15 | adopted, for whatever reason, is unauthorized. | ||||||
| 16 | (Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17; | ||||||
| 17 | 100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff. | ||||||
| 18 | 1-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81, | ||||||
| 19 | eff. 7-12-19; 101-281, eff. 1-1-20; 101-371, eff. 1-1-20; | ||||||
| 20 | 101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff. | ||||||
| 21 | 1-1-20; 101-625, eff. 1-1-21.)
| ||||||
