Bill Text: IL HB3503 | 2019-2020 | 101st General Assembly | Enrolled


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, the Voluntary Health Services Plans Act, and the Illinois Public Aid Code to require coverage for hearing instruments and related services for all individuals 65 years of age and older when a hearing care professional prescribes a hearing instrument. Provides that an insurer shall provide coverage for hearing instruments subject to certain restrictions. Provides that an insurer shall not be required to pay a claim if the insured filed such a claim 24 months prior to the date of filing the claim with the insurer and the claim was paid by any insurer.

Spectrum: Partisan Bill (Democrat 19-0)

Status: (Enrolled) 2019-06-28 - Sent to the Governor [HB3503 Detail]

Download: Illinois-2019-HB3503-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, and 356z.32 of the Illinois Insurance Code. The
18program of health benefits must comply with Sections 155.22a,
19155.37, 355b, 356z.19, 370c, and 370c.1 of the Illinois
20Insurance Code. The Department of Insurance shall enforce the
21requirements 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,
19356z.30a, and 356z.32 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.30a, and 356z.32 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.30a, and 356z.32 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.30a, and 356z.32 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.30a as follows:
5 (215 ILCS 5/356z.30a new)
6 Sec. 356z.30a. Coverage for hearing instruments.
7 (a) As used in this Section:
8 "Hearing care professional" means a person who is a
9licensed hearing instrument dispenser, licensed audiologist,
10or a licensed physician.
11 "Hearing instrument" means any wearable non-disposable
12instrument or device designed to aid or compensate for impaired
13human hearing and any parts, attachments, or accessories for
14the instrument or device, including an ear mold but excluding
15batteries and cords.
16 "Related services" means those services necessary to
17assess, select, and adjust or fit the hearing instrument to
18ensure optimal performance, including, but not limited to:
19audiological exams, replacement ear molds, and repairs to the
20hearing instrument.
21 (b) An individual or group policy of accident and health
22insurance or managed care plan that is amended, delivered,
23issued, or renewed after the effective date of this amendatory
24Act of the 101st General Assembly shall offer, for an

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1additional premium and subject to the insurer's standard of
2insurability, optional coverage or optional reimbursement for
3hearing instruments and related services for all individuals
4when a hearing care professional prescribes a hearing
5instrument to augment communication.
6 (c) This optional coverage shall be subject to all
7applicable copayments, coinsurance, deductibles, and
8out-of-pocket limits for the cost of a hearing instrument for
9each ear, as needed, as well as related services, with a
10maximum for the hearing instrument and related services of no
11more than $2,500 per hearing instrument every 24 months.
12 (d) Nothing in this Section precludes an insured from
13selecting a hearing instrument that costs more than the amount
14covered by a plan of accident and health insurance or a managed
15care plan and paying the uncovered cost at his or her own
16expense.
17 (e) Nothing in this Section shall be construed to require a
18group policy of accident and health insurance to provide
19coverage if the group is unable to meet mandatory minimum
20participation requirements set by the insurer.
21 Section 30. The Health Maintenance Organization Act is
22amended by changing Section 5-3 as follows:
23 (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
24 Sec. 5-3. Insurance Code provisions.

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1 (a) Health Maintenance Organizations shall be subject to
2the provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
3141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
4154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2, 355.3,
5355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y, 356z.2, 356z.4,
6356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
7356z.13, 356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.21,
8356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.30a,
9356z.32, 364, 364.01, 367.2, 367.2-5, 367i, 368a, 368b, 368c,
10368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A, 408,
11408.2, 409, 412, 444, and 444.1, paragraph (c) of subsection
12(2) of Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2,
13XIII, XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.
14 (b) For purposes of the Illinois Insurance Code, except for
15Sections 444 and 444.1 and Articles XIII and XIII 1/2, Health
16Maintenance Organizations in the following categories are
17deemed to be "domestic companies":
18 (1) a corporation authorized under the Dental Service
19 Plan Act or the Voluntary Health Services Plans Act;
20 (2) a corporation organized under the laws of this
21 State; or
22 (3) a corporation organized under the laws of another
23 state, 30% or more of the enrollees of which are residents
24 of this State, except a corporation subject to
25 substantially the same requirements in its state of
26 organization as is a "domestic company" under Article VIII

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

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

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1Insurance Act and except for medicare supplement policies as
2defined in Section 363 of the Illinois Insurance Code, a Health
3Maintenance Organization may by contract agree with a group or
4other enrollment unit to effect refunds or charge additional
5premiums under the following terms and conditions:
6 (i) the amount of, and other terms and conditions with
7 respect to, the refund or additional premium are set forth
8 in the group or enrollment unit contract agreed in advance
9 of the period for which a refund is to be paid or
10 additional premium is to be charged (which period shall not
11 be less than one year); and
12 (ii) the amount of the refund or additional premium
13 shall not exceed 20% of the Health Maintenance
14 Organization's profitable or unprofitable experience with
15 respect to the group or other enrollment unit for the
16 period (and, for purposes of a refund or additional
17 premium, the profitable or unprofitable experience shall
18 be calculated taking into account a pro rata share of the
19 Health Maintenance Organization's administrative and
20 marketing expenses, but shall not include any refund to be
21 made or additional premium to be paid pursuant to this
22 subsection (f)). The Health Maintenance Organization and
23 the group or enrollment unit may agree that the profitable
24 or unprofitable experience may be calculated taking into
25 account the refund period and the immediately preceding 2
26 plan years.

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1 The Health Maintenance Organization shall include a
2statement in the evidence of coverage issued to each enrollee
3describing the possibility of a refund or additional premium,
4and upon request of any group or enrollment unit, provide to
5the group or enrollment unit a description of the method used
6to calculate (1) the Health Maintenance Organization's
7profitable experience with respect to the group or enrollment
8unit and the resulting refund to the group or enrollment unit
9or (2) the Health Maintenance Organization's unprofitable
10experience with respect to the group or enrollment unit and the
11resulting additional premium to be paid by the group or
12enrollment unit.
13 In no event shall the Illinois Health Maintenance
14Organization Guaranty Association be liable to pay any
15contractual obligation of an insolvent organization to pay any
16refund authorized under this Section.
17 (g) Rulemaking authority to implement Public Act 95-1045,
18if any, is conditioned on the rules being adopted in accordance
19with all provisions of the Illinois Administrative Procedure
20Act and all rules and procedures of the Joint Committee on
21Administrative Rules; any purported rule not so adopted, for
22whatever reason, is unauthorized.
23(Source: P.A. 99-761, eff. 1-1-18; 100-24, eff. 7-18-17;
24100-138, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1026, eff.
258-22-18; 100-1057, eff. 1-1-19; 100-1102, eff. 1-1-19; revised
2610-4-18.)

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1 Section 35. The Limited Health Service Organization Act is
2amended by changing Section 4003 as follows:
3 (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
4 Sec. 4003. Illinois Insurance Code provisions. Limited
5health service organizations shall be subject to the provisions
6of Sections 133, 134, 136, 137, 139, 140, 141.1, 141.2, 141.3,
7143, 143c, 147, 148, 149, 151, 152, 153, 154, 154.5, 154.6,
8154.7, 154.8, 155.04, 155.37, 355.2, 355.3, 355b, 356v,
9356z.10, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29,
10356z.30a, 356z.32, 368a, 401, 401.1, 402, 403, 403A, 408,
11408.2, 409, 412, 444, and 444.1 and Articles IIA, VIII 1/2,
12XII, XII 1/2, XIII, XIII 1/2, XXV, and XXVI of the Illinois
13Insurance Code. For purposes of the Illinois Insurance Code,
14except for Sections 444 and 444.1 and Articles XIII and XIII
151/2, limited health service organizations in the following
16categories are deemed to be domestic companies:
17 (1) a corporation under the laws of this State; or
18 (2) 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(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;

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1100-201, eff. 8-18-17; 100-863, eff. 8-14-18; 100-1057, eff.
21-1-19; 100-1102, eff. 1-1-19; revised 10-4-18.)
3 Section 40. The Voluntary Health Services Plans Act is
4amended by changing Section 10 as follows:
5 (215 ILCS 165/10) (from Ch. 32, par. 604)
6 Sec. 10. Application of Insurance Code provisions. Health
7services plan corporations and all persons interested therein
8or dealing therewith shall be subject to the provisions of
9Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
10143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, 356g,
11356g.5, 356g.5-1, 356r, 356t, 356u, 356v, 356w, 356x, 356y,
12356z.1, 356z.2, 356z.4, 356z.5, 356z.6, 356z.8, 356z.9,
13356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18,
14356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29,
15356z.30a, 356z.32, 364.01, 367.2, 368a, 401, 401.1, 402, 403,
16403A, 408, 408.2, and 412, and paragraphs (7) and (15) of
17Section 367 of the Illinois Insurance Code.
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; 100-1026, eff. 8-22-18; 100-1057, eff.
21-1-19; 100-1102, eff. 1-1-19; revised 10-4-18.)
3 Section 95. No acceleration or delay. Where this Act makes
4changes in a statute that is represented in this Act by text
5that is not yet or no longer in effect (for example, a Section
6represented by multiple versions), the use of that text does
7not accelerate or delay the taking effect of (i) the changes
8made by this Act or (ii) provisions derived from any other
9Public Act.
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