Hb 0147 Insurance-Clinical Breast Exam

INSURANCE

2007 LEGISLATIVE SUMMARY

Public Acts

HOUSE BILLS

HB 0147 INSURANCE-CLINICAL BREAST EXAM

Public Act 95-0189 – Effective August 16, 2007

Rep. Greg Harris

Sen. David Koehler

Amends the Illinois Insurance Code, the Health Maintenance Organization Act, and the Voluntary Health Services Plans Act. Provides that every insurer shall provide, in each group or individual policy, contract, or certificate of accident or health insurance issued or renewed for persons who are residents of Illinois, coverage for a complete and thorough physical examination of the breast, including but not limited to a comprehensive clinical breast examination of 6-10 minutes in length (that is, an examination of 3-5 minutes in length for each breast), performed by a health care provider to check for lumps and other changes for the purpose of early detection and prevention of breast cancer as follows: (1) annually for women 18 years of age and older; and (2) at any time at the recommendation of the woman's health care provider. Provides that every insurer must establish a separate and distinct reimbursement code for comprehensive clinical breast examinations of 6-10 minutes in length. Makes these provisions applicable to health maintenance organizations and health services plan corporations. Effective immediately.
House Amendment No. 1

Replaces the provisions amending the Illinois Insurance Code. Inserts similar provisions amending the Illinois Insurance Code, but with changes that include the following: (1) removes references to a time period of "6-10 minutes" for breast examinations; (2) requires coverage for a comprehensive clinical breast examination by a physician, an advanced practice nurse, or a physician assistant (instead of by a health care provider); (3) provides for an examination at any time at the recommendation of a woman's health care professional (instead of her health care provider); and (4) requires that an insurance policy provide separate and distinct coverage for such breast examinations (instead of requiring that every insurer establish a separate and distinct reimbursement code for comprehensive clinical breast examinations). Also amends the Department of Public Health Powers and Duties Law of the Civil Administrative Code of Illinois to require the Department's written summary concerning breast cancer to specifically address the

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benefits of early detection and regular comprehensive clinical breast examinations as well as the mandate that health and government payers pay for the breast examinations.
House Amendment No. 2

Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, and the Illinois Public Aid Code to require coverage of comprehensive clinical breast exams under each of those Acts as provided in the provisions added to the Illinois Insurance Code.

House Amendment No. 3
Requires that the Department of Public Health's summary concerning breast cancer include the benefits of clinical breast exams; also requires that the summary (1) review the clinical standard recommendations by the Centers for Disease Control and Prevention and the American Cancer Society for mammography, clinical breast exams, and breast self-exams (instead of requiring that the summary address regular comprehensive clinical breast examinations) and (2) inform individuals that public and private insurance providers shall pay for clinical breast exams as part of an exam, as indicated by guidelines of practice (instead of requiring that the summary address the mandate that health and government benefit payers pay for the breast examinations). In references to clinical breast examinations, deletes "comprehensive". Requires that insurers provide coverage of breast examinations (i) at least every 3 years for women ages 20 to 39 and (ii) annually for women age 40 and older (instead of annually for women age 18 and older and at any time at the recommendation of the woman's health care professional). Makes other changes.

HB 0517 LONG-TERM CARE PARTNERSHIP ACT

Public Act 95-0200 – Effective August 16, 2007

Rep. Carolyn H. Krause

Sen. Dan Kotowski

Creates the Illinois Long-Term Care Partnership Program Act. Establishes the Illinois Long-Term Care Partnership Program to: (i) provide incentives for individuals to insure against the costs of providing for their long-term care needs; (ii) provide a mechanism for individuals to qualify for coverage of the cost of their long-term care needs under Medicaid without first being required to substantially exhaust their resources; (iii) provide counseling services to individuals planning for their long-term care needs; and (iv) alleviate the financial burden on the State's medical assistance program by encouraging the pursuit of private initiatives. Sets out the duties of the Department of Healthcare and Family Services and the Department of Financial and Professional Regulation regarding long-term care partnership policies. Requires the issuers of qualified long-term care partnership policies in Illinois to provide regular reports to the Department of Healthcare and Family Services, the federal Department of Health and Human Services, and the Department of Financial and Professional Regulation. Authorizes the Department of Healthcare and Family Services and the Department of Financial and Professional Regulation to adopt rules and regulations. Repeals the Partnership for Long Term Care Act.

HB 0938 INS CD-LIFE & HEALTH GUARANTY

Public Act 95-0086 – Effective January 1, 2008

Rep. Mark H. Beaubien Jr.

Sen. William E. Peterson

Amends the Illinois Insurance Code. In an Article involving the Illinois Life and Health Insurance Guaranty Association, provides that the amount of any Class A assessment for member insurers shall be determined at the discretion of the board of directors of the Association and such assessments shall be authorized and called on a non pro-rata basis (instead of the amount being determined by the board, which may be made on a non-pro rata basis). Deletes a provision stating that such assessments shall not exceed $200 per company in any one calendar year.
House Amendment No. 1

Further amends the Illinois Insurance Code. In a Section involving the valuation of reserve liabilities, provides that other assumptions may be incorporated into the reserve calculation to the extent permitted by the National Association of Insurance Commissioners' Accounting Practices and Procedures Manual.

HB 1004 INS CD-MINE SUBSIDENCE

Public Act 95-0092 – Effective January 1, 2008

Rep. Frank J. Mautino

Sen. Gary G. Dahl

Amends the Illinois Insurance Code. Provides that the Illinois Mine Subsidence Insurance Fund shall establish the maximum amount of reinsurance available per residence, commercial building, and living unit for mine subsidence insurance. Provides that, for all policies issued or renewed on or after January 1, 2008, the reinsured loss per residence, per commercial building, and per living unit shall be the amounts established by the Fund and approved by the Director (now, the reinsured loss shall not exceed $350,000 per residence, $350,000 per commercial building, or $15,000 per living unit).

HB 1439 CD CORR-PROOF OF INSURANCE

Public Act 95-0211 – Effective January 1, 2008

Rep. Maria Antonia Berrios

Sen. James A. DeLeo

Amends the Unified Code of Corrections. Provides that a person placed on court supervision for driving an uninsured vehicle must maintain proof of financial responsibility, in a manner satisfactory to the Secretary of State, for a period of at least 3 years (rather than one year) after the date the proof is first filed.
House Amendment No. 1

Amends the Illinois Vehicle Code. Provides that a person convicted a third or subsequent time of driving without insurance must maintain proof of the person's financial responsibility in a manner satisfactory to the Secretary for a minimum period of 3 years (rather than one year).

HB 1555 INS CD-PUBLIC INSURANCE ADJ

Public Act 95-0213 – Effective January 1, 2008

Rep. Edward J. Acevedo

Sen. Kwame Raoul

Amends the Illinois Insurance Code. In the Article concerning Public Insurance Adjusters, changes the definition of "Public Insurance Adjuster". Provides that no person may solicit or hold himself out to be in the business of adjusting insurance claims. Provides that each Public Insurance Adjuster license shall contain the business address of the Public Insurance Adjuster and that the holder of license shall notify the Director of Insurance, in writing, of a change of business address within 30 days of the change. Provides that no person shall engage in the business of adjusting insurance claims unless person is licensed pursuant to the Article and registered with the Director. Provides that registered firm may only be comprised of licensed Public Insurance Adjusters. Provides that a Public Insurance Adjuster shall not agree to any loss settlement without the insured's knowledge and consent and shall provide the insured with a document setting forth the scope, amount, and value of the damages prior to requesting the insured for authority to settling any loss. Provides that in all cases where the loss giving rise to the claim for which the Public Insurance Adjuster was retained arise from damage to a personal residence, the insurance proceeds shall be delivered in person to the named insured or his or her designee. Provides that a Public Insurance Adjuster shall not advance money or any valuable consideration to an insured pending adjustment of a claim or provide legal advice or representation to the insure, or engage in the unauthorized practice of law. Provides that a Public Insurance Adjuster shall disclose to the insured if he or she has any interest or will be compensated by certain business that perform any work in conjunction with the damages caused by the insured loss. Makes other changes.

HB 2786 INS CD-LAWFUL TRAVEL DISCRIMIN

Public Act 95-0163 – Effective January 1, 2008

Rep. Sidney H. Mathias

Sen. Ira I. Silverstein

Provides that an insurer or producer authorized to issue policies of insurance in this State may not make a distinction or otherwise discriminate between persons, reject an applicant, cancel a policy, or demand or require a higher rate of premium for reasons based solely upon an applicant's or insured's past lawful travel experiences or future lawful travel plans. Provides that this provision does not prohibit an insurer or producer from excluding or limiting coverage under a policy or refusing to offer the policy based upon past lawful travel or future lawful travel plans or from charging a different rate for that coverage when that action is based upon sound actuarial principles or is related to actual or reasonably expected experience and is not based solely on the destination's inclusion on the United States Department of State's travel warning list.

SENATE BILLS

SB 0021 INS-POLICY-NARCOTIC EXCLUSION

Public Act 95-0230 – Effective January 1, 2008

Sen. John J. Cullerton

Rep. Frank J. Mautino

Amends the Illinois Insurance Code. Prohibits health benefit plans from excluding coverage for treatment related to an injury acquired while an insured was intoxicated or under the influence of narcotics when the exclusion is based solely on the insured being intoxicated or under the influence of narcotics. Provides that coverage may be subject to additional terms of the health benefit plan. Repeals a provision allowing accident and health policies to contain an exclusion for losses caused by an insured being intoxicated or under the influence of narcotics.
Senate Floor Amendment No. 2
Provides that a group or individual major medical policy of accident or health insurance or managed care plan amended, delivered, issued, or renewed after January 1, 2008 (instead of just a health benefit plan) shall not, solely on the basis of the insured being intoxicated or under the influence of a narcotic, exclude coverage for any emergency or other medical, hospital, or surgical expenses incurred by an insured as a result of and related to an injury acquired while the insured is intoxicated or under the influence of any narcotic.

SB 0873 Medicare Supplemental Insurance

Public Act 95-0436 – Effective June 1, 2008

Sen. M. Maggie Crotty

Rep. Elaine Nekritz

Provides that an issuer of a Medicare supplement policy shall not charge individuals who become eligible for Medicare by reason of disability and who are under the age of 65 premium rates for any medical supplemental insurance benefit plan offered by the issuer that exceed the issuer's highest rate on the current rate schedule filed with the Division of Insurance (instead of the issuer's premium rates) for that plan to individuals who are age 65 and older.

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