Bill Amendment: IL HB4475 | 2023-2024 | 103rd General Assembly
NOTE: For additional amemendments please see the Bill Drafting List
Bill Title: INS CD-BEHAVIORIAL HEALTH
Status: 2024-05-21 - Added as Alternate Co-Sponsor Sen. Patrick J. Joyce [HB4475 Detail]
Download: Illinois-2023-HB4475-House_Amendment_001.html
Bill Title: INS CD-BEHAVIORIAL HEALTH
Status: 2024-05-21 - Added as Alternate Co-Sponsor Sen. Patrick J. Joyce [HB4475 Detail]
Download: Illinois-2023-HB4475-House_Amendment_001.html
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1 | AMENDMENT TO HOUSE BILL 4475 | ||||||
2 | AMENDMENT NO. ______. Amend House Bill 4475 by replacing | ||||||
3 | everything after the enacting clause with the following:
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4 | "Section 1. This Act may be referred to as the | ||||||
5 | Strengthening Mental Health and Substance Use Parity Act.
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6 | Section 2. Purpose. The purpose of this Act is to improve | ||||||
7 | mental health and substance use parity, specifically | ||||||
8 | addressing network adequacy and nonquantitative treatment | ||||||
9 | limitations that restrict access to care.
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10 | Section 3. Findings. The General Assembly finds that: | ||||||
11 | (1) A 2021 U.S. Surgeon General Advisory, Protecting Youth | ||||||
12 | Mental Health, reported the COVID-19 pandemic's devastating | ||||||
13 | impact on youth and family mental health: | ||||||
14 | (A) One in 3 high school students reported persistent | ||||||
15 | feelings of hopelessness and sadness in 2019. |
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1 | (B) Rates of depression and anxiety for youth doubled | ||||||
2 | during the pandemic. | ||||||
3 | (C) Black children under 13 are nearly twice as likely | ||||||
4 | to die by suicide than white children. | ||||||
5 | (2) According to a bipartisan U.S. Senate Finance | ||||||
6 | Committee report on Mental Health Care in the United States, | ||||||
7 | symptoms for depression and anxiety in adults increased nearly | ||||||
8 | four-fold during the pandemic. | ||||||
9 | (3) In 2020, 2,944 Illinoisans lost their lives to an | ||||||
10 | opioid overdose according to the Illinois Department of Public | ||||||
11 | Health. | ||||||
12 | (4) Discriminatory commercial insurance practices that do | ||||||
13 | not live up to the federal Mental Health Parity and Addiction | ||||||
14 | Equity Act (MHPAEA) and Illinois' parity laws, specifically | ||||||
15 | regarding insurance network adequacy, severely limit access to | ||||||
16 | care. | ||||||
17 | (5) Commercial insurance practices disincentivize mental | ||||||
18 | health and substance use treatment providers from | ||||||
19 | participating in insurance networks by erecting significant | ||||||
20 | administrative barriers and by reimbursing providers far below | ||||||
21 | the reimbursement of other health care providers despite a | ||||||
22 | behavioral health workforce crisis. | ||||||
23 | (A) Such practices lead to restrictive, narrow | ||||||
24 | insurance networks that restrict access care. | ||||||
25 | (B) 26% of psychiatrists do not participate in | ||||||
26 | insurance networks, according to a report in JAMA |
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1 | Psychiatry. | ||||||
2 | (C) 21% of psychologists do not participate in | ||||||
3 | insurance networks, according to a 2015 American | ||||||
4 | Psychological Association Survey. | ||||||
5 | (D) A significant percentage of behavioral health | ||||||
6 | providers do not contract with insurers, leaving patients | ||||||
7 | to see out-of-network providers. | ||||||
8 | (E) Out-of-network treatment is far more expensive for | ||||||
9 | the patient than in-network care. | ||||||
10 | (F) Mental health and substance use treatment is | ||||||
11 | inaccessible and unaffordable for millions of Illinoisans | ||||||
12 | for these reasons. | ||||||
13 | (6) A recent Milliman report analyzing insurance claims | ||||||
14 | for 37,000,000 Americans, including Illinois residents, found | ||||||
15 | major disparities in out-of-network utilization for behavioral | ||||||
16 | health compared to other health care. The report's findings | ||||||
17 | include: | ||||||
18 | (A) Illinois out-of-network behavioral health | ||||||
19 | utilization was 18.2% for outpatient services in 2017 | ||||||
20 | compared to just 3.9% for medical/surgical services. | ||||||
21 | (B) Illinois out-of-network behavioral health | ||||||
22 | utilization was 12.1% in 2017 for inpatient care compared | ||||||
23 | to just 2.8% for medical/surgical. | ||||||
24 | (C) The disparity between out-of-network usage for | ||||||
25 | behavioral health compared to medical/surgical services | ||||||
26 | grew significantly between 2013 and 2017: Out-of-network |
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1 | behavioral health utilization for outpatient visits grew | ||||||
2 | by 44%, while out-of-network utilization for | ||||||
3 | medical/surgical services decreased by 42% over the same | ||||||
4 | period in Illinois. | ||||||
5 | (D) Nearly 14% of behavioral health office visits for | ||||||
6 | individuals with a preferred provider organization plan | ||||||
7 | were out-of-network in Illinois. | ||||||
8 | (7) Mental health and substance use care, which represents | ||||||
9 | just 5.2% of all health care spending, does not drive up | ||||||
10 | premiums. | ||||||
11 | (8) Improved access to behavioral health care is expected | ||||||
12 | to reduce overall health care spending because: | ||||||
13 | (A) spending on physical health care is 2 to 3 times | ||||||
14 | higher for patients with ongoing mental health and | ||||||
15 | substance use diagnoses, according to a 2018 Milliman | ||||||
16 | research report; and | ||||||
17 | (B) improved utilization of mental health services has | ||||||
18 | been demonstrated empirically to reduce overall health | ||||||
19 | care spending (Biu, Yoon, & Hines, 2021). | ||||||
20 | (9) Illinois must strengthen its parity laws to prevent | ||||||
21 | insurance practices that restrict access to mental health and | ||||||
22 | substance use care.
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23 | Section 10. The Illinois Insurance Code is amended by | ||||||
24 | adding Section 370c.3 as follows:
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1 | (215 ILCS 5/370c.3 new) | ||||||
2 | Sec. 370c.3. Mental health and substance use parity. | ||||||
3 | (a) In this Section: | ||||||
4 | "Application" means a person's or facility's application | ||||||
5 | to become a participating provider with an insurer in at least | ||||||
6 | one of the insurer's provider networks. | ||||||
7 | "Applying provider" means a provider or facility that has | ||||||
8 | submitted a completed application to become a participating | ||||||
9 | provider or facility with an insurer. | ||||||
10 | "Behavioral health trainee" means any person: (1) engaged | ||||||
11 | in the provision of mental health or substance use disorder | ||||||
12 | clinical services as part of that person's supervised course | ||||||
13 | of study while enrolled in a master's or doctoral psychology, | ||||||
14 | social work, counseling, or marriage or family therapy program | ||||||
15 | or as a postdoctoral graduate working toward licensure; and | ||||||
16 | (2) who is working toward clinical State licensure under the | ||||||
17 | clinical supervision of a fully licensed mental health or | ||||||
18 | substance use disorder treatment provider. | ||||||
19 | "Completed application" means a person's or facility's | ||||||
20 | application to become a participating provider that has been | ||||||
21 | submitted to the insurer and includes all the required | ||||||
22 | information for the application to be considered by the | ||||||
23 | insurer according to the insurer's policies and procedures for | ||||||
24 | verifying a provider's or facility's credentials. | ||||||
25 | "Contracting process" means the process by which a mental | ||||||
26 | health or substance use disorder treatment provider or |
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1 | facility makes a completed application with an insurer to | ||||||
2 | become a participating provider with the insurer until the | ||||||
3 | effective date of a final contract between the provider or | ||||||
4 | facility and the insurer. "Contracting process" includes the | ||||||
5 | process of verifying a provider's credentials. | ||||||
6 | "Participating provider" means any mental health or | ||||||
7 | substance use disorder treatment provider that has a contract | ||||||
8 | to provide mental health or substance use disorder services | ||||||
9 | with an insurer. | ||||||
10 | (b) For all group or individual policies of accident and | ||||||
11 | health insurance or managed care plans that are amended, | ||||||
12 | delivered, issued, or renewed on or after January 1, 2026, or | ||||||
13 | any contracted third party administering the behavioral health | ||||||
14 | benefits for the insurer, reimbursement for in-network mental | ||||||
15 | health and substance use disorder treatment services delivered | ||||||
16 | by Illinois providers and facilities must be, on average, at | ||||||
17 | least as favorable as professional services provided by | ||||||
18 | in-network primary care providers. Reimbursement rates for | ||||||
19 | services paid to Illinois mental health and substance use | ||||||
20 | disorder treatment providers and facilities do not meet this | ||||||
21 | required standard unless the reimbursement rates are, on | ||||||
22 | average, equal to or greater than 141% of the Medicare | ||||||
23 | reimbursement rate for the same service. For services not | ||||||
24 | covered by Medicare, the reimbursement rates must be, on | ||||||
25 | average, equal to or greater than 144% of the standard | ||||||
26 | in-network reimbursement rate for such service on the |
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1 | effective date of this amendatory Act of the 103rd General | ||||||
2 | Assembly. This Section applies to all covered office, | ||||||
3 | outpatient, inpatient, and residential mental health and | ||||||
4 | substance use disorder services. | ||||||
5 | (c) A group or individual policy of accident and health | ||||||
6 | insurance or managed care plan that is amended, delivered, | ||||||
7 | issued, or renewed on or after January 1, 2025, or contracted | ||||||
8 | third party administering the behavioral health benefits for | ||||||
9 | the insurer, shall cover all medically necessary mental health | ||||||
10 | or substance use disorder services received by the same | ||||||
11 | insured on the same day from the same or different mental | ||||||
12 | health or substance use provider or facility for both | ||||||
13 | outpatient and inpatient care. | ||||||
14 | (d) A group or individual policy of accident and health | ||||||
15 | insurance or managed care plan that is amended, delivered, | ||||||
16 | issued, or renewed on or after January 1, 2025, or any | ||||||
17 | contracted third party administering the behavioral health | ||||||
18 | benefits for the insurer, shall cover any medically necessary | ||||||
19 | mental health or substance use disorder service provided by a | ||||||
20 | behavioral health trainee when the trainee is working toward | ||||||
21 | clinical State licensure and is under the supervision of a | ||||||
22 | fully licensed mental health or substance use disorder | ||||||
23 | treatment provider, which is a physician licensed to practice | ||||||
24 | medicine in all its branches, licensed clinical psychologist, | ||||||
25 | licensed clinical social worker, licensed clinical | ||||||
26 | professional counselor, licensed marriage and family |
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1 | therapist, licensed speech-language pathologist, or other | ||||||
2 | licensed or certified professional at a program licensed | ||||||
3 | pursuant to the Substance Use Disorder Act who is engaged in | ||||||
4 | treating mental, emotional, nervous, or substance use | ||||||
5 | disorders or conditions. Services provided by the trainee must | ||||||
6 | be billed under the supervising clinician's rendering National | ||||||
7 | Provider Identifier. | ||||||
8 | (e) A group or individual policy of accident and health | ||||||
9 | insurance or managed care plan that is amended, delivered, | ||||||
10 | issued, or renewed on or after January 1, 2025, or any | ||||||
11 | contracted third party administering the behavioral health | ||||||
12 | benefits for the insurer, shall: | ||||||
13 | (1) cover medically necessary 60-minute psychotherapy | ||||||
14 | billed using the CPT Code 90837 for Individual Therapy; | ||||||
15 | (2) not impose more onerous documentation requirements | ||||||
16 | on the provider than is required for other psychotherapy | ||||||
17 | CPT Codes; and | ||||||
18 | (3) not audit the use of CPT Code 90837 any more | ||||||
19 | frequently than audits for the use of other psychotherapy | ||||||
20 | CPT Codes. | ||||||
21 | (f)(1) Any group or individual policy of accident and | ||||||
22 | health insurance or managed care plan that is amended, | ||||||
23 | delivered, issued, or renewed on or after January 1, 2026, or | ||||||
24 | any contracted third party administering the behavioral health | ||||||
25 | benefits for the insurer, shall complete the contracting | ||||||
26 | process with a mental health or substance use disorder |
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1 | treatment provider or facility for becoming a participating | ||||||
2 | provider in the insurer's network, including the verification | ||||||
3 | of the provider's credentials, within 60 days from the date of | ||||||
4 | a completed application to the insurer to become a | ||||||
5 | participating provider. Nothing in this paragraph (1), | ||||||
6 | however, presumes or establishes a contract between an insurer | ||||||
7 | and a provider. | ||||||
8 | (2) Any group or individual policy of accident and health | ||||||
9 | insurance or managed care plan that is amended, delivered, | ||||||
10 | issued, or renewed on or after January 1, 2025, or any | ||||||
11 | contracted third party administering the behavioral health | ||||||
12 | benefits for the insurer, shall reimburse a participating | ||||||
13 | mental health or substance use disorder treatment provider or | ||||||
14 | facility at the contracted reimbursement rate for any | ||||||
15 | medically necessary services provided to an insured from the | ||||||
16 | date of submission of the provider's or facility's completed | ||||||
17 | application to become a participating provider with the | ||||||
18 | insurer up to the effective date of the provider's contract. | ||||||
19 | The provider's claims for such services shall be reimbursed | ||||||
20 | only when submitted after the effective date of the provider's | ||||||
21 | contract with the insurer. This paragraph (2) does not apply | ||||||
22 | to a provider that does not have a completed contract with an | ||||||
23 | insurer. If a provider opts to submit claims for medically | ||||||
24 | necessary mental health or substance use disorder services | ||||||
25 | pursuant to this paragraph (2), the provider must notify the | ||||||
26 | insured following submission of the claims to the insurer that |
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1 | the services provided to the insured may be treated as | ||||||
2 | in-network services. | ||||||
3 | (3) Any group or individual policy of accident and health | ||||||
4 | insurance or managed care plan that is amended, delivered, | ||||||
5 | issued, or renewed on or after January 1, 2025, or any | ||||||
6 | contracted third party administering the behavioral health | ||||||
7 | benefits for the insurer, shall cover any medically necessary | ||||||
8 | mental health or substance use disorder service provided by a | ||||||
9 | fully licensed mental health or substance use disorder | ||||||
10 | treatment provider affiliated with a mental health or | ||||||
11 | substance use disorder treatment group practice who has | ||||||
12 | submitted a completed application to become a participating | ||||||
13 | provider with an insurer who is delivering services under the | ||||||
14 | supervision of another fully licensed participating mental | ||||||
15 | health or substance use disorder treatment provider within the | ||||||
16 | same group practice up to the effective date of the applying | ||||||
17 | provider's contract with the insurer as a participating | ||||||
18 | provider. Services provided by the applying provider must be | ||||||
19 | billed under the supervising licensed provider's rendering | ||||||
20 | National Provider Identifier. | ||||||
21 | (4) Upon request, an insurer, or any contracted third | ||||||
22 | party administering the behavioral health benefits for the | ||||||
23 | insurer, shall provide an applying provider with the insurer's | ||||||
24 | credentialing policies and procedures. An insurer, or any | ||||||
25 | contracted third party administering the behavioral health | ||||||
26 | benefits for the insurer, shall post the following |
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1 | nonproprietary information on its website and make that | ||||||
2 | information available to all applicants: | ||||||
3 | (A) a list of the information required to be included | ||||||
4 | in an application; | ||||||
5 | (B) a checklist of the materials that must be | ||||||
6 | submitted in the credentialing process; and | ||||||
7 | (C) designated contact information of a network | ||||||
8 | representative, including a designated point of contact, | ||||||
9 | an email address, and a telephone number, to which an | ||||||
10 | applicant may address any credentialing inquiries. | ||||||
11 | (g) The Department has the same authority to enforce this | ||||||
12 | Section as it has to enforce compliance with Sections 370c and | ||||||
13 | 370c.1. Additionally, if the Department determines that an | ||||||
14 | insurer or a contracted third party administering the | ||||||
15 | behavioral health benefits for the insurer has violated this | ||||||
16 | Section, the Department shall, after appropriate notice and | ||||||
17 | opportunity for hearing in accordance with Section 402, by | ||||||
18 | order assess a civil penalty of $5,000 for each violation. The | ||||||
19 | Department shall establish any processes or procedures | ||||||
20 | necessary to monitor compliance with this Section, including | ||||||
21 | the ability to receive complaints from mental health and | ||||||
22 | substance use disorder treatment providers impacted by an | ||||||
23 | insurer's failure to comply, or a contracted third party's | ||||||
24 | failure to comply, while ensuring adherence to all federal and | ||||||
25 | State privacy and confidentiality laws. | ||||||
26 | (h) The Department shall adopt any rules necessary to |
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1 | implement this Section by no later than May 1, 2025.
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2 | Section 15. The Health Maintenance Organization Act is | ||||||
3 | amended by changing Section 5-3 as follows:
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4 | (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2) | ||||||
5 | Sec. 5-3. Insurance Code provisions. | ||||||
6 | (a) Health Maintenance Organizations shall be subject to | ||||||
7 | the provisions of Sections 133, 134, 136, 137, 139, 140, | ||||||
8 | 141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, | ||||||
9 | 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 155.49, | ||||||
10 | 355.2, 355.3, 355b, 355c, 356f, 356g.5-1, 356m, 356q, 356v, | ||||||
11 | 356w, 356x, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, | ||||||
12 | 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, | ||||||
13 | 356z.15, 356z.17, 356z.18, 356z.19, 356z.20, 356z.21, 356z.22, | ||||||
14 | 356z.23, 356z.24, 356z.25, 356z.26, 356z.28, 356z.29, 356z.30, | ||||||
15 | 356z.30a, 356z.31, 356z.32, 356z.33, 356z.34, 356z.35, | ||||||
16 | 356z.36, 356z.37, 356z.38, 356z.39, 356z.40, 356z.41, 356z.44, | ||||||
17 | 356z.45, 356z.46, 356z.47, 356z.48, 356z.49, 356z.50, 356z.51, | ||||||
18 | 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.58, 356z.59, | ||||||
19 | 356z.60, 356z.61, 356z.62, 356z.64, 356z.65, 356z.67, 356z.68, | ||||||
20 | 364, 364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b, 368c, | ||||||
21 | 368d, 368e, 370c, 370c.3, 370c.1, 401, 401.1, 402, 403, 403A, | ||||||
22 | 408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of | ||||||
23 | subsection (2) of Section 367, and Articles IIA, VIII 1/2, | ||||||
24 | XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the |
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1 | Illinois Insurance Code. | ||||||
2 | (b) For purposes of the Illinois Insurance Code, except | ||||||
3 | for Sections 444 and 444.1 and Articles XIII and XIII 1/2, | ||||||
4 | Health Maintenance Organizations in the following categories | ||||||
5 | are deemed to be "domestic companies": | ||||||
6 | (1) a corporation authorized under the Dental Service | ||||||
7 | Plan Act or the Voluntary Health Services Plans Act; | ||||||
8 | (2) a corporation organized under the laws of this | ||||||
9 | State; or | ||||||
10 | (3) a corporation organized under the laws of another | ||||||
11 | state, 30% or more of the enrollees of which are residents | ||||||
12 | of this State, except a corporation subject to | ||||||
13 | substantially the same requirements in its state of | ||||||
14 | organization as is a "domestic company" under Article VIII | ||||||
15 | 1/2 of the Illinois Insurance Code. | ||||||
16 | (c) In considering the merger, consolidation, or other | ||||||
17 | acquisition of control of a Health Maintenance Organization | ||||||
18 | pursuant to Article VIII 1/2 of the Illinois Insurance Code, | ||||||
19 | (1) the Director shall give primary consideration to | ||||||
20 | the continuation of benefits to enrollees and the | ||||||
21 | financial conditions of the acquired Health Maintenance | ||||||
22 | Organization after the merger, consolidation, or other | ||||||
23 | acquisition of control takes effect; | ||||||
24 | (2)(i) the criteria specified in subsection (1)(b) of | ||||||
25 | Section 131.8 of the Illinois Insurance Code shall not | ||||||
26 | apply and (ii) the Director, in making his determination |
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1 | with respect to the merger, consolidation, or other | ||||||
2 | acquisition of control, need not take into account the | ||||||
3 | effect on competition of the merger, consolidation, or | ||||||
4 | other acquisition of control; | ||||||
5 | (3) the Director shall have the power to require the | ||||||
6 | following information: | ||||||
7 | (A) certification by an independent actuary of the | ||||||
8 | adequacy of the reserves of the Health Maintenance | ||||||
9 | Organization sought to be acquired; | ||||||
10 | (B) pro forma financial statements reflecting the | ||||||
11 | combined balance sheets of the acquiring company and | ||||||
12 | the Health Maintenance Organization sought to be | ||||||
13 | acquired as of the end of the preceding year and as of | ||||||
14 | a date 90 days prior to the acquisition, as well as pro | ||||||
15 | forma financial statements reflecting projected | ||||||
16 | combined operation for a period of 2 years; | ||||||
17 | (C) a pro forma business plan detailing an | ||||||
18 | acquiring party's plans with respect to the operation | ||||||
19 | of the Health Maintenance Organization sought to be | ||||||
20 | acquired for a period of not less than 3 years; and | ||||||
21 | (D) such other information as the Director shall | ||||||
22 | require. | ||||||
23 | (d) The provisions of Article VIII 1/2 of the Illinois | ||||||
24 | Insurance Code and this Section 5-3 shall apply to the sale by | ||||||
25 | any health maintenance organization of greater than 10% of its | ||||||
26 | enrollee population (including , without limitation , the health |
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1 | maintenance organization's right, title, and interest in and | ||||||
2 | to its health care certificates). | ||||||
3 | (e) In considering any management contract or service | ||||||
4 | agreement subject to Section 141.1 of the Illinois Insurance | ||||||
5 | Code, the Director (i) shall, in addition to the criteria | ||||||
6 | specified in Section 141.2 of the Illinois Insurance Code, | ||||||
7 | take into account the effect of the management contract or | ||||||
8 | service agreement on the continuation of benefits to enrollees | ||||||
9 | and the financial condition of the health maintenance | ||||||
10 | organization to be managed or serviced, and (ii) need not take | ||||||
11 | into account the effect of the management contract or service | ||||||
12 | agreement on competition. | ||||||
13 | (f) Except for small employer groups as defined in the | ||||||
14 | Small Employer Rating, Renewability and Portability Health | ||||||
15 | Insurance Act and except for medicare supplement policies as | ||||||
16 | defined in Section 363 of the Illinois Insurance Code, a | ||||||
17 | Health Maintenance Organization may by contract agree with a | ||||||
18 | group or other enrollment unit to effect refunds or charge | ||||||
19 | additional premiums under the following terms and conditions: | ||||||
20 | (i) the amount of, and other terms and conditions with | ||||||
21 | respect to, the refund or additional premium are set forth | ||||||
22 | in the group or enrollment unit contract agreed in advance | ||||||
23 | of the period for which a refund is to be paid or | ||||||
24 | additional premium is to be charged (which period shall | ||||||
25 | not be less than one year); and | ||||||
26 | (ii) the amount of the refund or additional premium |
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1 | shall not exceed 20% of the Health Maintenance | ||||||
2 | Organization's profitable or unprofitable experience with | ||||||
3 | respect to the group or other enrollment unit for the | ||||||
4 | period (and, for purposes of a refund or additional | ||||||
5 | premium, the profitable or unprofitable experience shall | ||||||
6 | be calculated taking into account a pro rata share of the | ||||||
7 | Health Maintenance Organization's administrative and | ||||||
8 | marketing expenses, but shall not include any refund to be | ||||||
9 | made or additional premium to be paid pursuant to this | ||||||
10 | subsection (f)). The Health Maintenance Organization and | ||||||
11 | the group or enrollment unit may agree that the profitable | ||||||
12 | or unprofitable experience may be calculated taking into | ||||||
13 | account the refund period and the immediately preceding 2 | ||||||
14 | plan years. | ||||||
15 | The Health Maintenance Organization shall include a | ||||||
16 | statement in the evidence of coverage issued to each enrollee | ||||||
17 | describing the possibility of a refund or additional premium, | ||||||
18 | and upon request of any group or enrollment unit, provide to | ||||||
19 | the group or enrollment unit a description of the method used | ||||||
20 | to calculate (1) the Health Maintenance Organization's | ||||||
21 | profitable experience with respect to the group or enrollment | ||||||
22 | unit and the resulting refund to the group or enrollment unit | ||||||
23 | or (2) the Health Maintenance Organization's unprofitable | ||||||
24 | experience with respect to the group or enrollment unit and | ||||||
25 | the resulting additional premium to be paid by the group or | ||||||
26 | enrollment unit. |
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1 | In no event shall the Illinois Health Maintenance | ||||||
2 | Organization Guaranty Association be liable to pay any | ||||||
3 | contractual obligation of an insolvent organization to pay any | ||||||
4 | refund authorized under this Section. | ||||||
5 | (g) Rulemaking authority to implement Public Act 95-1045, | ||||||
6 | if any, is conditioned on the rules being adopted in | ||||||
7 | accordance with all provisions of the Illinois Administrative | ||||||
8 | Procedure Act and all rules and procedures of the Joint | ||||||
9 | Committee on Administrative Rules; any purported rule not so | ||||||
10 | adopted, for whatever reason, is unauthorized. | ||||||
11 | (Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21; | ||||||
12 | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. | ||||||
13 | 1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, | ||||||
14 | eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; | ||||||
15 | 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. | ||||||
16 | 1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, | ||||||
17 | eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; | ||||||
18 | 103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff. | ||||||
19 | 6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445, | ||||||
20 | eff. 1-1-24; 103-551, eff. 8-11-23; revised 8-29-23.)
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