Bill Text: IL HB3435 | 2019-2020 | 101st General Assembly | Enrolled


Bill Title: Amends the Illinois Insurance Code. Provides that a policy of accident and health insurance or a managed care plan shall provide coverage for epinephrine injectors for persons 18 years of age or under. Makes conforming changes in 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, the Voluntary Health Services Plans Act, and the Illinois Public Aid Code.

Spectrum: Strong Partisan Bill (Democrat 10-1)

Status: (Enrolled) 2019-06-14 - Sent to the Governor [HB3435 Detail]

Download: Illinois-2019-HB3435-Enrolled.html



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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 State Employees Group Insurance Act of 1971
5is amended by changing Section 6.11 as follows:
6 (5 ILCS 375/6.11)
7 (Text of Section before amendment by P.A. 100-1170)
8 Sec. 6.11. Required health benefits; Illinois Insurance
9Code requirements. The program of health benefits shall provide
10the post-mastectomy care benefits required to be covered by a
11policy of accident and health insurance under Section 356t of
12the Illinois Insurance Code. The program of health benefits
13shall provide the coverage required under Sections 356g,
14356g.5, 356g.5-1, 356m, 356u, 356w, 356x, 356z.2, 356z.4,
15356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
16356z.14, 356z.15, 356z.17, 356z.22, 356z.25, and 356z.26, and
17356z.29, 356z.32, and 356z.33 of the Illinois Insurance Code.
18The program of health benefits must comply with Sections
19155.22a, 155.37, 355b, 356z.19, 370c, and 370c.1 of the
20Illinois Insurance Code. The Department of Insurance shall
21enforce the requirements of this Section.
22 Rulemaking authority to implement Public Act 95-1045, if
23any, is conditioned on the rules being adopted in accordance

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1with all provisions of the Illinois Administrative Procedure
2Act and all rules and procedures of the Joint Committee on
3Administrative Rules; any purported rule not so adopted, for
4whatever reason, is unauthorized.
5(Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17;
6100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1024, eff.
71-1-19; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised
81-8-19.)
9 (Text of Section after amendment by P.A. 100-1170)
10 Sec. 6.11. Required health benefits; Illinois Insurance
11Code requirements. The program of health benefits shall provide
12the post-mastectomy care benefits required to be covered by a
13policy of accident and health insurance under Section 356t of
14the Illinois Insurance Code. The program of health benefits
15shall provide the coverage required under Sections 356g,
16356g.5, 356g.5-1, 356m, 356u, 356w, 356x, 356z.2, 356z.4,
17356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
18356z.14, 356z.15, 356z.17, 356z.22, 356z.25, 356z.26, 356z.29,
19and 356z.32, and 356z.33 of the Illinois Insurance Code. The
20program of health benefits must comply with Sections 155.22a,
21155.37, 355b, 356z.19, 370c, and 370c.1 of the Illinois
22Insurance Code. The Department of Insurance shall enforce the
23requirements of this Section with respect to Sections 370c and
24370c.1 of the Illinois Insurance Code; all other requirements
25of this Section shall be enforced by the Department of Central

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1Management Services.
2 Rulemaking authority to implement Public Act 95-1045, if
3any, is conditioned on the rules being adopted in accordance
4with all provisions of the Illinois Administrative Procedure
5Act and all rules and procedures of the Joint Committee on
6Administrative Rules; any purported rule not so adopted, for
7whatever reason, is unauthorized.
8(Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17;
9100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1024, eff.
101-1-19; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19;
11100-1170, eff. 6-1-19.)
12 Section 10. The Counties Code is amended by changing
13Section 5-1069.3 as follows:
14 (55 ILCS 5/5-1069.3)
15 Sec. 5-1069.3. Required health benefits. If a county,
16including a home rule county, is a self-insurer for purposes of
17providing health insurance coverage for its employees, the
18coverage shall include coverage for the post-mastectomy care
19benefits required to be covered by a policy of accident and
20health insurance under Section 356t and the coverage required
21under Sections 356g, 356g.5, 356g.5-1, 356u, 356w, 356x,
22356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
23356z.14, 356z.15, 356z.22, 356z.25, and 356z.26, and 356z.29,
24356z.32, and 356z.33 of the Illinois Insurance Code. The

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1coverage shall comply with Sections 155.22a, 355b, 356z.19, and
2370c of the Illinois Insurance Code. The Department of
3Insurance shall enforce the requirements of this Section. The
4requirement that health benefits be covered as provided in this
5Section is an exclusive power and function of the State and is
6a denial and limitation under Article VII, Section 6,
7subsection (h) of the Illinois Constitution. A home rule county
8to which this Section applies must comply with every provision
9of this Section.
10 Rulemaking authority to implement Public Act 95-1045, if
11any, is conditioned on the rules being adopted in accordance
12with all provisions of the Illinois Administrative Procedure
13Act and all rules and procedures of the Joint Committee on
14Administrative Rules; any purported rule not so adopted, for
15whatever reason, is unauthorized.
16(Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17;
17100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1024, eff.
181-1-19; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised
1910-3-18.)
20 Section 15. The Illinois Municipal Code is amended by
21changing Section 10-4-2.3 as follows:
22 (65 ILCS 5/10-4-2.3)
23 Sec. 10-4-2.3. Required health benefits. If a
24municipality, including a home rule municipality, is a

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1self-insurer for purposes of providing health insurance
2coverage for its employees, the coverage shall include coverage
3for the post-mastectomy care benefits required to be covered by
4a policy of accident and health insurance under Section 356t
5and the coverage required under Sections 356g, 356g.5,
6356g.5-1, 356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.10,
7356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25,
8and 356z.26, and 356z.29, 356z.32, and 356z.33 of the Illinois
9Insurance Code. The coverage shall comply with Sections
10155.22a, 355b, 356z.19, and 370c of the Illinois Insurance
11Code. The Department of Insurance shall enforce the
12requirements of this Section. The requirement that health
13benefits be covered as provided in this is an exclusive power
14and function of the State and is a denial and limitation under
15Article VII, Section 6, subsection (h) of the Illinois
16Constitution. A home rule municipality to which this Section
17applies must comply with every provision of this Section.
18 Rulemaking authority to implement Public Act 95-1045, if
19any, is conditioned on the rules being adopted in accordance
20with all provisions of the Illinois Administrative Procedure
21Act and all rules and procedures of the Joint Committee on
22Administrative Rules; any purported rule not so adopted, for
23whatever reason, is unauthorized.
24(Source: P.A. 99-480, eff. 9-9-15; 100-24, eff. 7-18-17;
25100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1024, eff.
261-1-19; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised

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110-4-18.)
2 Section 20. The School Code is amended by changing Section
310-22.3f as follows:
4 (105 ILCS 5/10-22.3f)
5 Sec. 10-22.3f. Required health benefits. Insurance
6protection and benefits for employees shall provide the
7post-mastectomy care benefits required to be covered by a
8policy of accident and health insurance under Section 356t and
9the coverage required under Sections 356g, 356g.5, 356g.5-1,
10356u, 356w, 356x, 356z.6, 356z.8, 356z.9, 356z.11, 356z.12,
11356z.13, 356z.14, 356z.15, 356z.22, 356z.25, and 356z.26, and
12356z.29, 356z.32, and 356z.33 of the Illinois Insurance Code.
13Insurance policies shall comply with Section 356z.19 of the
14Illinois Insurance Code. The coverage shall comply with
15Sections 155.22a, 355b, and 370c of the Illinois Insurance
16Code. The Department of Insurance shall enforce the
17requirements of this Section.
18 Rulemaking authority to implement Public Act 95-1045, if
19any, is conditioned on the rules being adopted in accordance
20with all provisions of the Illinois Administrative Procedure
21Act and all rules and procedures of the Joint Committee on
22Administrative Rules; any purported rule not so adopted, for
23whatever reason, is unauthorized.
24(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;

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1100-863, eff. 8-14-18; 100-1024, eff. 1-1-19; 100-1057, eff.
21-1-19; 100-1102, eff. 1-1-19; revised 10-4-18.)
3 Section 25. The Illinois Insurance Code is amended by
4adding Section 356z.33 as follows:
5 (215 ILCS 5/356z.33 new)
6 Sec. 356z.33. Coverage for epinephrine injectors. A group
7or individual policy of accident and health insurance or a
8managed care plan that is amended, delivered, issued, or
9renewed on or after the effective date of this amendatory Act
10of the 101st General Assembly shall provide coverage for
11medically necessary epinephrine injectors for persons 18 years
12of age or under. As used in this Section, "epinephrine
13injector" has the meaning given to that term in Section 5 of
14the Epinephrine Injector Act.
15 Section 30. The Health Maintenance Organization Act is
16amended by changing Section 5-3 as follows:
17 (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
18 Sec. 5-3. Insurance Code provisions.
19 (a) Health Maintenance Organizations shall be subject to
20the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
21141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
22154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2, 355.3,

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1355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2, 356z.4,
2356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
3356z.13, 356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.21,
4356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32, 356z.33,
5364, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c, 368d,
6368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A, 408, 408.2,
7409, 412, 444, and 444.1, paragraph (c) of subsection (2) of
8Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2, XIII,
9XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.
10 (b) For purposes of the Illinois Insurance Code, except for
11Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health
12Maintenance Organizations in the following categories are
13deemed to be "domestic companies":
14 (1) a corporation authorized under the Dental Service
15 Plan Act or the Voluntary Health Services Plans Act;
16 (2) a corporation organized under the laws of this
17 State; or
18 (3) a corporation organized under the laws of another
19 state, 30% or more of the enrollees of which are residents
20 of this State, except a corporation subject to
21 substantially the same requirements in its state of
22 organization as is a "domestic company" under Article VIII
23 1/2 of the Illinois Insurance Code.
24 (c) In considering the merger, consolidation, or other
25acquisition of control of a Health Maintenance Organization
26pursuant to Article VIII 1/2 of the Illinois Insurance Code,

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1 (1) the Director shall give primary consideration to
2 the continuation of benefits to enrollees and the financial
3 conditions of the acquired Health Maintenance Organization
4 after the merger, consolidation, or other acquisition of
5 control takes effect;
6 (2)(i) the criteria specified in subsection (1)(b) of
7 Section 131.8 of the Illinois Insurance Code shall not
8 apply and (ii) the Director, in making his determination
9 with respect to the merger, consolidation, or other
10 acquisition of control, need not take into account the
11 effect on competition of the merger, consolidation, or
12 other acquisition of control;
13 (3) the Director shall have the power to require the
14 following information:
15 (A) certification by an independent actuary of the
16 adequacy of the reserves of the Health Maintenance
17 Organization sought to be acquired;
18 (B) pro forma financial statements reflecting the
19 combined balance sheets of the acquiring company and
20 the Health Maintenance Organization sought to be
21 acquired as of the end of the preceding year and as of
22 a date 90 days prior to the acquisition, as well as pro
23 forma financial statements reflecting projected
24 combined operation for a period of 2 years;
25 (C) a pro forma business plan detailing an
26 acquiring party's plans with respect to the operation

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1 of the Health Maintenance Organization sought to be
2 acquired for a period of not less than 3 years; and
3 (D) such other information as the Director shall
4 require.
5 (d) The provisions of Article VIII 1/2 of the Illinois
6Insurance Code and this Section 5-3 shall apply to the sale by
7any health maintenance organization of greater than 10% of its
8enrollee population (including without limitation the health
9maintenance organization's right, title, and interest in and to
10its health care certificates).
11 (e) In considering any management contract or service
12agreement subject to Section 141.1 of the Illinois Insurance
13Code, the Director (i) shall, in addition to the criteria
14specified in Section 141.2 of the Illinois Insurance Code, take
15into account the effect of the management contract or service
16agreement on the continuation of benefits to enrollees and the
17financial condition of the health maintenance organization to
18be managed or serviced, and (ii) need not take into account the
19effect of the management contract or service agreement on
20competition.
21 (f) Except for small employer groups as defined in the
22Small Employer Rating, Renewability and Portability Health
23Insurance Act and except for medicare supplement policies as
24defined in Section 363 of the Illinois Insurance Code, a Health
25Maintenance Organization may by contract agree with a group or
26other enrollment unit to effect refunds or charge additional

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1premiums under the following terms and conditions:
2 (i) the amount of, and other terms and conditions with
3 respect to, the refund or additional premium are set forth
4 in the group or enrollment unit contract agreed in advance
5 of the period for which a refund is to be paid or
6 additional premium is to be charged (which period shall not
7 be less than one year); and
8 (ii) the amount of the refund or additional premium
9 shall not exceed 20% of the Health Maintenance
10 Organization's profitable or unprofitable experience with
11 respect to the group or other enrollment unit for the
12 period (and, for purposes of a refund or additional
13 premium, the profitable or unprofitable experience shall
14 be calculated taking into account a pro rata share of the
15 Health Maintenance Organization's administrative and
16 marketing expenses, but shall not include any refund to be
17 made or additional premium to be paid pursuant to this
18 subsection (f)). The Health Maintenance Organization and
19 the group or enrollment unit may agree that the profitable
20 or unprofitable experience may be calculated taking into
21 account the refund period and the immediately preceding 2
22 plan years.
23 The Health Maintenance Organization shall include a
24statement in the evidence of coverage issued to each enrollee
25describing the possibility of a refund or additional premium,
26and upon request of any group or enrollment unit, provide to

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1the group or enrollment unit a description of the method used
2to calculate (1) the Health Maintenance Organization's
3profitable experience with respect to the group or enrollment
4unit and the resulting refund to the group or enrollment unit
5or (2) the Health Maintenance Organization's unprofitable
6experience with respect to the group or enrollment unit and the
7resulting additional premium to be paid by the group or
8enrollment unit.
9 In no event shall the Illinois Health Maintenance
10Organization Guaranty Association be liable to pay any
11contractual obligation of an insolvent organization to pay any
12refund authorized under this Section.
13 (g) Rulemaking authority to implement Public Act 95-1045,
14if any, is conditioned on the rules being adopted in accordance
15with all provisions of the Illinois Administrative Procedure
16Act and all rules and procedures of the Joint Committee on
17Administrative Rules; any purported rule not so adopted, for
18whatever reason, is unauthorized.
19(Source: P.A. 99-761, eff. 1-1-18; 100-24, eff. 7-18-17;
20100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1026, eff.
218-22-18; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised
2210-4-18.)
23 Section 35. The Limited Health Service Organization Act is
24amended by changing Section 4003 as follows:

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1 (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
2 Sec. 4003. Illinois Insurance Code provisions. Limited
3health service organizations shall be subject to the provisions
4of Sections 133, 134, 136, 137, 139, 140, 141.1, 141.2, 141.3,
5143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5, 154.6,
6154.7, 154.8, 155.04, 155.37, 355.2, 355.3, 355b, 356v,
7356z.10, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.32,
8356z.33, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, 409,
9412, 444, and 444.1 and Articles IIA, VIII 1/2, XII, XII 1/2,
10XIII, XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.
11For purposes of the Illinois Insurance Code, except for
12Sections 444 and 444.1 and Articles XIII and XIII 1/2, limited
13health service organizations in the following categories are
14deemed to be domestic companies:
15 (1) a corporation under the laws of this State; or
16 (2) a corporation organized under the laws of another
17 state, 30% or more of the enrollees of which are residents
18 of this State, except a corporation subject to
19 substantially the same requirements in its state of
20 organization as is a domestic company under Article VIII
21 1/2 of the Illinois Insurance Code.
22(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
23100-201, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1057, eff.
241-1-19; 100-1102, eff. 1-1-19; revised 10-4-18.)
25 Section 40. The Voluntary Health Services Plans Act is

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1amended by changing Section 10 as follows:
2 (215 ILCS 165/10) (from Ch. 32, par. 604)
3 Sec. 10. Application of Insurance Code provisions. Health
4services plan corporations and all persons interested therein
5or dealing therewith shall be subject to the provisions of
6Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
7143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, 356g,
8356g.5, 356g.5-1, 356r, 356t, 356u, 356v, 356w, 356x, 356y,
9356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9,
10356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18,
11356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30,
12356z.32, 356z.33, 364.01, 367.2, 368a, 401, 401.1, 402, 403,
13403A, 408, 408.2, and 412, and paragraphs (7) and (15) of
14Section 367 of the Illinois Insurance Code.
15 Rulemaking authority to implement Public Act 95-1045, if
16any, is conditioned on the rules being adopted in accordance
17with all provisions of the Illinois Administrative Procedure
18Act and all rules and procedures of the Joint Committee on
19Administrative Rules; any purported rule not so adopted, for
20whatever reason, is unauthorized.
21(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
22100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff.
231-1-19; 100-1102, eff. 1-1-19; revised 10-4-18.)
24 Section 45. The Illinois Public Aid Code is amended by

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1changing Section 5-16.8 as follows:
2 (305 ILCS 5/5-16.8)
3 Sec. 5-16.8. Required health benefits. The medical
4assistance program shall (i) provide the post-mastectomy care
5benefits required to be covered by a policy of accident and
6health insurance under Section 356t and the coverage required
7under Sections 356g.5, 356u, 356w, 356x, 356z.6, 356z.26, and
8356z.29, 356z.32, and 356z.33 of the Illinois Insurance Code
9and (ii) be subject to the provisions of Sections 356z.19,
10364.01, 370c, and 370c.1 of the Illinois Insurance Code.
11 On and after July 1, 2012, the Department shall reduce any
12rate of reimbursement for services or other payments or alter
13any methodologies authorized by this Code to reduce any rate of
14reimbursement for services or other payments in accordance with
15Section 5-5e.
16 To ensure full access to the benefits set forth in this
17Section, on and after January 1, 2016, the Department shall
18ensure that provider and hospital reimbursement for
19post-mastectomy care benefits required under this Section are
20no lower than the Medicare reimbursement rate.
21(Source: P.A. 99-433, eff. 8-21-15; 99-480, eff. 9-9-15;
2299-642, eff. 7-28-16; 100-138, eff. 8-18-17; 100-863, eff.
238-14-18; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised
2410-4-18.)

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1 Section 95. No acceleration or delay. Where this Act makes
2changes in a statute that is represented in this Act by text
3that is not yet or no longer in effect (for example, a Section
4represented by multiple versions), the use of that text does
5not accelerate or delay the taking effect of (i) the changes
6made by this Act or (ii) provisions derived from any other
7Public Act.
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