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Compliance Corner

State Updates

Chicago Expands Reasons for Paid Sick Leave

July 20, 2021

On June 25, 2021, Ordinance 02021-2182 was passed by the Chicago City Council. In addition to creating new wage theft protections, the Ordinance expands reasons for use of paid sick leave. 

As background, the city requires employers to provide employees with paid sick leave to care for themselves (or a family member) if they work at least 80 hours within any 120-day period (eligible for use by the 180th day of employment). The ordinance applies to all employers with at least one covered employee. 

The ordinance expands reasons for paid sick leave to include absence due to an order to quarantine or stay home to prevent spread of a communicable disease issued by the mayor, Illinois government, Chicago Department of Public Health or a healthcare provider. It also expands reasons that already exist, such that leave is permitted:

  • To care for family members whose school or place of care has been closed (omitting the closure to be caused by order of a public official due to a public health emergency)
  • If an employee or covered family member is a victim of a sex offense, which now includes stalking, aggravated stalking or cyber stalking
  • For the purpose of receiving diagnosis or treatment for mental or behavioral issues, including substance abuse disorders (or if a covered family member is receiving such services)

Employers with employees in Chicago should be aware of the expanded reasons for use of Chicago paid sick leave and ensure compliance with the revised paid sick leave rules effective August 1, 2021.

Ordinance 02021-2182 »

Expansion of Telehealth Services Extended Once Again

July 07, 2021

On June 25, 2021, Gov. Pritzker issued Executive Order 2021-14, once again extending the applicability of several prior COVID-19-related executive orders, considering the continued public health emergency. Executive Order 2020-09 was also included in the order, extending its applicability generally through July 24, 2021 (among several other executive orders).

As mentioned in the March 31, 2020, edition of Compliance Corner, in the Illinois article “COVID-19 and Health Insurance Coverage,” Executive Order 2020-09 expands telehealth services to also include electronic and telephonic methods and requires health insurers to cover the costs of in-network telehealth services for any clinically appropriate, medically necessary covered services and treatments.

The order was originally effective beginning March 19, 2020, and stated that it will continue for the duration of the governor’s proclamation of disaster. It has been extended several times and is now extended through July 24, 2021 (or, for some portions of the order, until corresponding legislation is enacted and takes effect, whichever occurs first).

Employers should be aware of these developments.

Executive Order 2021-14 »
Executive Order 2020-09 »

Employee Sick Leave Act Amended Permitting Leave to Provide Personal Care to Family Members

May 11, 2021

On April 27, 2021, House Bill 158 was signed into law by Gov. Pritzker. This new law amends Illinois’ Employee Sick Leave Act (ESLA) to allow employees to use personal sick leave benefits, if provided by their employer, to provide personal care to family members.

Prior to this amendment, personal sick leave benefits could be used for absences due to a family member’s illness, injury or medical appointment. Now, employees can use personal sick leave for personal care, which includes time spent ensuring that family members' basic medical, hygiene, nutritional or safety needs are met. This also includes providing family members with transportation to medical appointments, if they are unable to meet their own needs, and being physically present to provide emotional support for family members who have a serious health condition and are receiving inpatient or home care.

Employers who provide personal sick leave benefits should be aware of these developments and update personal sick leave policies as applicable.

House Bill 158 »

Employer Guidance on Leave for COVID-19 Vaccine

March 16, 2021

Recently, the Illinois Department of Labor issued guidance on employee leave related to COVID-19 vaccinations.

Highlights include:

  • Employer’s mandatory COVID-19 vaccination requirements should be combined with paid leave or other compensation for time taken to get vaccinated.
  • Employees who voluntarily obtain a vaccine should be permitted to use sick leave or other paid time off (or employers should provide flex time to avoid having to take unpaid time).
  • Employers should allow employees to use sick-leave benefits for a qualifying family members' vaccination appointments.

The department recommends that employers review their leave policies and vaccination policies, and update to reflect leave permitted to obtain the COVID-19 vaccine.

Employer Guidance: Compensation, Paid Leave and COVID-19 Vaccine »

Extension of Transition Policies for Non-ACA Compliant Plans

March 02, 2021

On February 10, 2021, Gov. Pritzker issued Company Bulletin 2021-01, permitting health insurance carriers to continue transitional health insurance plans that renew for a policy year starting on or before October 1, 2022, as long as the coverage comes into compliance by January 1, 2023. As background, on January 19, 2021, CMS provided guidance for a transition policy extension that allows insurers the option to renew non-grandfathered non-ACA-compliant plans, as long as the state allows. Such transition policies are not required to comply with certain ACA mandates including community rating, coverage of essential health benefits, prohibition on pre-existing condition exclusions, and the annual out-of-pocket maximum limit.

Transitional relief for these “grandmothered” plans has been extended several times before, and this bulletin applies the most recent federal extension to Illinois and allows insurers to renew policies in the individual market and the small group market according to the extended transitional policy for a policy year starting on or before October 1, 2022. This bulletin reflects the guidance allowing states the option to extend transitional policies for individual and small group health insurance plans that have continually been renewed since 2014.

Carriers must notify the Department of Insurance of their intention to operate under this transition guidance by April 30, 2021.

Small employers that are interested in renewing their non-ACA-compliant plan should work with their advisors and insurers.

Company Bulletin 2021-01 »

Expansion of Telehealth Services Extended Again

February 17, 2021

On February 5, 2021, Gov. Pritzker issued Executive Order 2021-04 extending once again the applicability of several prior COVID-19-related executive orders, in light of the continued public health emergency. Executive Order 2020-09 was also included in the order, extending its applicability through March 6, 2021 (among several other executive orders).

As mentioned in the March 31, 2020, edition of Compliance Corner, in the Illinois article “COVID-19 and Health Insurance Coverage,” Executive Order 2020-09 expands telehealth services to also include electronic and telephonic methods and requires health insurers to cover the costs of in-network telehealth services for any clinically appropriate, medically necessary covered services and treatments.

The order was originally effective beginning March 19, 2020, and stated that it will continue for the duration of the governor’s proclamation of disaster. It has been extended several times and is now extended through March 6, 2021.

Employers should be aware of these developments.

Executive Order 2021-04 »

Clarification on Association Health Plans

January 20, 2021

On December 31, 2020, the Illinois Department of Insurance (Department) issued Company Bulletin 2020-20, which clarifies that the expanded eligibility standards from the 2018 Association Health Plan (AHP) rules no longer apply.

As background, the EBSA issued final regulations in 2018 related to the creation and maintenance of Association Health Plans (AHPs) under ERISA. The final regulations allowed AHPs to include employers without a commonality of interest if they are located in the same state or metropolitan area (for example, DC/MD/VA or NY/NJ/CT). Further, AHPs could form for the primary purpose of providing benefits (something that was prohibited before 2018), if they can show a “substantial business purpose,” which includes fairly minimal proof — anything from setting business standards and practices to publishing a newsletter. Importantly, the 2018 rules also allowed an AHP to cover non-employees (sole proprietors, independent contractors, partners and other businesses without any employees).

In March 2019, a federal district court vacated the AHP rule’s expanded eligibility standards and vacated the portion of the rule that permitted working-owner participation (as reported in the April 2, 2019, Compliance Corner edition). As such, the department explains that the expanded eligibility provisions set forth in the AHP rule no longer apply. Further, if an insurer enters into a contract with an association of employers that does not qualify as an employer under the AHP sub-regulatory guidance (those that have a commonality of interest, exclude sole proprietors and exercise control over the AHP) and have its own ERISA group health plan, such contract between the association and insurer would not qualify as group health insurance coverage. In other words, if an association is not a bona fide association health plan per the sub-regulatory guidance, large or small group market standards would be applied separately and determined for each employer member based on that employer’s number of employees.

Employers should be aware that AHPs can only form subject to the sub-regulatory guidance in effect prior to the 2018 AHP rules.

Company Bulletin 2020-20 »

Updated Poster for Domestic Violence Leave

August 04, 2020

In July 2020, Illinois updated its Victims’ Economic Security and Safety Act (VESSA) poster required to be displayed by employers.

As background, VESSA provides an employee who is a victim of domestic or sexual violence (or who has a family member who is a victim of domestic or sexual violence) with up to 12 weeks of unpaid leave (per any 12 month period) to address issues arising from domestic or sexual violence. Among other requirements, employers must maintain health and other benefits for an employee exercising such leave and employers must post a notice in their workplace summarizing the requirements under the act.

VESSA applies to employers with at least one employee, the state of Illinois and any unit of local government or school district. To maintain compliance, employers should be sure to utilize the updated poster.

Victims’ Economic Security and Safety Act Poster »

Updated Chicago Paid Leave Notice

July 21, 2020

On July 7, 2020, the City of Chicago updated the notice required by its paid sick leave (PSL) ordinance. As background, employers must provide employees with PSL to care for themselves (or a family member) if they work at least 80 hours within any 120-day period (eligible for use by the 180th day of employment).

As a reminder, recent changes to Chicago’s paid sick leave rules require employers to provide covered employees with an individual paid sick leave notice along with their first paycheck subject to the PSL ordinance (and annually thereafter), among other requirements such as a workplace posting. (See the Compliance Corner article from May 27, 2020, “Chicago Enhances Paid Sick Leave Ordinance” for additional information).

The ordinance applies to all employers with at least one covered employee. Employers with employees in Chicago should utilize the updated notice and ensure compliance with the PSL ordinance and revised rules effective July 1, 2020.

Chicago Minimum Wage and Paid Sick Leave Rules »
Paid Sick Leave Notice »

Expansion of Telehealth Services Extended Again

July 07, 2020

On June 26, 2020, Gov. Pritzker issued Executive Order 2020-44 extending once again the applicability of several prior COVID-19-related executive orders in light of the continued public health emergency. Executive Order 2020-09 was included in the order, extending its applicability through July 26, 2020 (among several other executive orders).

As mentioned in our prior Compliance Corner March 31, 2020, Illinois article “COVID-19 and Health Insurance Coverage,” Executive Order 2020-09 expands telehealth services to also include electronic and telephonic methods, and requires health insurers to cover the costs of in-network telehealth services for any clinically appropriate, medically necessary covered services and treatments.

The order was originally effective beginning March 19, 2020, and stated that it will continue for the duration of the governor’s proclamation of disaster. It was first extended to June 27, 2020, via Executive Order 2020-39, and is now extended through July 26, 2020.

Employers should be aware of these developments.

Executive Order 2020-44 »

Discrimination Prohibited Based on Gender Identity or Sexual Orientation

June 23, 2020

On June 15, 2020, the Department of Insurance released Company Bulletin 2020-16 in light of CMS filing a final rule that rescinds existing protections against discrimination. The bulletin reiterates that Illinois law remains unchanged despite the recently finalized federal rule regarding Section 1557 of the ACA. As background, this federal rule removes certain federal protections against discrimination based on gender identity or sexual orientation in the provision of health insurance coverage (expected to take effect August 18, 2020).

The bulletin serves as a reminder for insurers to comply with existing state laws that prohibit discrimination based on actual or perceived gender identity or sexual orientation. More specifically, the Illinois Human Rights Act prohibits unlawful discrimination on the basis of sex and sexual orientation, which includes “actual or perceived heterosexuality, homosexuality, bisexuality, or gender-related identity, whether or not traditionally associated with the person’s designated sex at birth.” Further, the Illinois Insurance Code (Code) requires insurance policies that provide coverage for the treatment of mental conditions ensure that limitations applicable to mental or emotional conditions (e.g., gender dysphoria) are no more restrictive than limitations applied to medical benefits covered by the policy (and that there are no separate limitations applicable only to mental benefits).

Part 2603 of the Code clarifies that the Illinois nondiscrimination laws apply to matters relating to gender identity and sexual orientation in health insurance coverage. Importantly, no company shall refuse to issue insurance (or decline to renew) based on sex, sexual orientation or marital status of the insured or prospective insured. In addition, no group health insurance plans may discriminate on the basis of an insured’s actual or perceived gender identity or on the basis that the insured is a transgender person. For specific prohibitions required by the regulations, see Company Bulletin 2020-16.

While the bulletin applies to Illinois-licensed health insurance issuers, employers should be aware of these developments and reminders.

Company Bulletin 2020-16 »

Expansion of Telehealth Services Extended

June 09, 2020

On May 29, 2020, Gov. Pritzker issued Executive Order 2020-39 extending the applicability of several prior COVID-19-related Executive Orders in light of the continued public health emergency. Included in the order was reference to Executive Order 2020-09, extending its applicability through June 27, 2020 (among several other executive orders).

As mentioned in our prior Compliance Corner March 31, 2020, article “COVID-19 and Health Insurance Coverage,” Executive Order 2020-09 expands telehealth services to also include electronic and telephonic methods, and requires health insurers to cover the costs of in-network telehealth services for any clinically appropriate, medically necessary covered services and treatments.

The order was originally effective beginning March 19, 2020, and stated that it will continue for the duration of the governor’s proclamation of disaster. Executive Order 2020-39 now extends its applicability through June 27, 2020.

Employers should be aware of these developments.

Executive Order 2020-39 »

Chicago Enhances Paid Sick Leave Ordinance

May 27, 2020

On May 20, 2020, the Chicago City Council approved Substitute Ordinance 2020-2343. In addition to protecting employees from adverse employment action in response to the COVID-19 public health crisis, the ordinance also revises Chicago’s Paid Sick Leave Ordinance (PSLO) that is effective July 1, 2020.

As background, employers must provide employees with paid sick leave (PSL) to care for themselves (or a family member) if they work at least 80 hours within any 120-day period (eligible for use by the 180th day of employment). PSLO amendments were previously enacted in December 2019 to take effect July 1, 2020. The Substitute Ordinance 2020-2343 redefines employees for purposes of paid sick leave to include certain categories that were erroneously left out, such as an outside salesperson, member of a religious corporation/organization, a student at and employed by an accredited Illinois college or university, and motor carriers regulated by the US Secretary of Transportation or the State of Illinois.

Further, changes to Chicago’s paid sick leave rules require employers to provide covered employees with an individual paid sick leave notice along with their first paycheck subject to the PSLO (and annually thereafter), among other requirements such as a workplace posting and new recordkeeping procedures.

The ordinance applies to all employers with at least one covered employee. Employers with employees in Chicago should be aware of the new requirements and ensure compliance with the PSLO and revised paid sick leave rules effective July 1, 2020.

Substitute Ordinance 2020-2343 »
Chicago Minimum Wage and Paid Sick Leave Rules »
Paid Sick Leave Notice »

COVID-19 Emergency Rules

April 28, 2020

On April 20, 2020, the Department of Insurance issued Company Bulletin 2020-11 that summarizes emergency rules submitted to the Secretary of State addressing financial, coverage and prescription drug supply concerns arising from the COVID-19 pandemic. These rules are effective immediately. Highlights include:

  • Insurers are required to provide 30 or 60 day extensions on premium payments in certain circumstances.
  • Insurers are prohibited from interfering with an employer who wants to keep their employees eligible for coverage despite a reduction in hours or temporary layoff.
  • A special enrollment period is provided due to loss of employer-sponsored group health plan coverage (and new coverage can apply retroactively to the day after their loss of coverage).
  • Coverage is required for non-formulary prescriptions if there is a shortage of formulary drugs. In addition, coverage is required for a 90-day supply of covered maintenance medications (but not those prone to misuse).

Further, the DOI urges insurers to not raise premiums due to any decrease in enrollment or participation due to the public health crisis.

Employers should be aware of these developments.

Company Bulletin 2020-11 »

Telehealth Rules Amended

April 14, 2020

On March 31, 2020, Healthcare and Family Services provided a Notice of Emergency Amendment, updating its telehealth rules in response to the global COVID-19 public health emergency. The amendment provides that to protect the public health, the department will reimburse medically necessary and clinically appropriate telehealth services with dates of service on or after March 9, 2020 (and until the public health emergency no longer exists). This includes services that do not meet the current definition of telehealth (e.g., virtual check-in that uses audio-only interactions, e-visit services that are non-face-to-face communications using online portals, and visits with distance site providers). Further, reimbursement for telehealth services will be made at the same rate as is paid for face-to-face services.

Employers should be aware of these developments.

Notice of Emergency Amendment  »

COVID-19 and Health Insurance Coverage

March 31, 2020

On March 2, 2020, the Department of Insurance (DOI) released Company Bulletin 2020-2 providing information regarding insurance coverage for COVID-19. With the ongoing COVID-19 pandemic, the DOI issued this bulletin for guidance on the role that health insurance coverage plays regarding access to health care services. Highlights include:

  • CDC and Illinois Department of Public Health agreed to bear the cost of COVID-19 testing. However, health care providers may still charge their own fees for collecting specimen for testing, which may be billed to the insurer (or the patient if uninsured).
  • Insurers are prohibited by Illinois Insurance Code Section 356z.3a from charging higher cost sharing for out-of-network providers at an in-network facility (if there are no in-network providers available). However, this does not apply if an individual purposefully chooses an out-of-network provider when an in-network provider was available.
  • Emergency services for an emergency medical condition must be covered at the in-network levels, regardless of which provider performs the services.
  • Health insurers are prohibited from nonrenewing (or cancelling) group health coverage due to any pre-existing conditions (this includes conditions connected with COVID-19).
  • Travel insurance must cover risks related to COVID-19 if it covers sickness, accident, or death incident to travel — unless a policy contains an exception applicable to COVID-19.

In addition, Executive Order 2020-09 expands telehealth services (effective beginning March 19, 2020, and will continue for the duration of the governor’s proclamation of disaster) to also include electronic and telephonic methods, and requires health insurers to cover the costs of in-network telehealth services for any clinically appropriate, medically necessary covered services and treatments. Further, health insurers are prohibited from imposing utilization review requirements on telehealth (or any treatment limits that are more restrictive than in-person care). Bulletin 2020-04 provides guidance to carriers on the governor’s executive order, reiterating that while the executive order is in effect, prior authorizations are not permitted for telehealth services related to COVID-19 (when delivered by in-network providers).

Lastly, on March 23, 2020, CMS notified the Illinois Department of Healthcare and Family Services that the state’s request for Medicaid waivers was approved. This temporarily suspends Medicaid fee-for-service prior authorization requirements, among other items, for the duration of the public health emergency.

Employers should be aware of these developments. As a reminder, the DOI released Frequently Asked Questions about Insurance Coverage and the Coronavirus COVID 19, which answers frequently asked questions regarding health insurance access to health care services.

Bulletin 2020-02 »
Executive Order 2020-09 »
Bulletin 2020-04 »
CMS Notification »
Frequently Asked Questions about Insurance Coverage and the Coronavirus COVID 19 »

FAQ Released About Insurance Coverage and COVID 19

March 17, 2020

On March 3, 2020, the Department of Insurance (DOI) released Frequently Asked Questions about Insurance Coverage and the Coronavirus COVID 19. With the ongoing COVID-19 pandemic, the DOI answers frequently asked questions on the critical role that health insurance coverage plays regarding access to health care services.

Of the guidance provided, the DOI explains that individuals should call their insurer to understand costs associated with paying for a COVID-19 diagnostic test (if any), that individuals will not be subject to higher cost sharing if they unintentionally receive care from out-of-network specialists in an in-network hospital, and provides contact information for further questions, among other information.

Employers with employees in Illinois should consult their carriers, as applicable, and reference the DOI’s guidance in its FAQ when addressing questions regarding health insurance coverage and COVID-19.

FAQ About Insurance Coverage and the Coronavirus COVID 19 »

Guidance on Short-Term Limited-Duration Insurance

November 12, 2019

On September 27, 2019, Director of Insurance Muriel issued Company Bulletin 2019-07 to provide guidance on fully insured short-term limited-duration insurance (STLDI) offered in Illinois. This bulletin is intended to remind carriers doing business in the state that state law isn’t preempted regarding short-term health insurance and, thus, carriers doing business in Illinois must continue to comply with state law.

As background, the federal government issued a rule in August 2018 that extended the initial contract term of STLDI policies issued on or after October 2, 2018, to be no more than 12 months while allowing renewals or extension of such policies of no more than 36 months. Unlike the federal rule, Illinois law limits an STLDI policy to a term that is less than 181 days. Moreover, short-term policies in Illinois cannot be renewed for 365 days after termination with a single issuer, and the insurer cannot issue a different STLDI to the same consumer for a period of 60 days from the expiration of the original policy.

The main purpose of this bulletin is to remind insurers doing business in Illinois that the state retains the right to regulate STLDI coverage. Employers do not need to take any action but may want to be familiar with the state’s individual insurance market requirements.

Company Bulletin 2019-07 »

Extension for Grandmothered Plans

April 30, 2019

On March 28, 2019, the Illinois Department of Insurance published Company Bulletin CB# 2019-03. The bulletin relates to the March 25, 2019, CMS guidance titled “Extension of Limited Non-Enforcement Policy through 2020,” which is CMS’s latest transitional policy extension for so-called “grandmothered plans” in the individual and small group markets. According to the bulletin, plans issued in Illinois continually since January 1, 2014, may renew such coverage for a policy year starting on or before October 1, 2020, so long as the policies do not extend past December 31, 2020.

Company Bulletin CB# 2019-03 »

Review of Federal Regulation of Association Health Plans and State Law

November 28, 2018

On Sept. 19, 2018, Insurance Director Rauner issued Bulletin 2018-07. The bulletin discusses the state and federal regulation of association health plans (AHPs), after the DOL’s final rules on AHPs were issued this summer. As background, AHPs are MEWAs and can fall under the jurisdiction of both federal and state law. This bulletin addresses fully insured group health plans and how Illinois law applies to them.

The bulletin essentially confirms that insurers in IL may issue group health insurance to associations that either satisfy the requirements under state law or the DOL’s final rule. Additionally, IL laws regarding the filing and review of group health coverage apply to policies issued to associations that meet the DOL’s requirements.

Finally, the IL Department of Insurance will not require entities to file documents demonstrating an association's qualification for a group health insurance policy, unless the policy incorporates by reference the association's documents.

Bulletin 2018-07 »

Extension of Non-ACA-Compliant Small Group and Individual Policies and Plans

June 26, 2018

On May 1, 2018, Director of Insurance Hammer released Company Bulletin 2018-02, related to the extension of non-ACA-compliant small group and individual policies and plans. As background, on April 9, 2018, the federal government announced an additional transition policy that allows insurers (if allowed by the state) to renew non-grandfathered non-ACA-compliant plans (this transitional relief has been extended several times before). Such policies aren’t required to be in compliance with certain ACA mandates, including community rating, coverage of essential health benefits, prohibition on pre-existing condition exclusions and the annual out-of-pocket maximum limit.

The bulletin states that Illinois will allow insurers to renew policies in the individual market and the small group market as long as the policy ends by Dec. 31, 2019, according to the extended transitional policy. Employers with non-ACA-compliant plans should work with their insurer and advisor on any policy extension.

Company Bulletin 2018-02 »

Disclosure of Genetic Information

September 19, 2017

On Aug. 25, 2017, Gov. Rauner signed SB 0318, enacting Public Act 100-0396. This law, amending the Illinois Genetic Information Privacy Act (IGIPA), prohibits an employer from penalizing an employee who does not disclose his or her genetic information or chooses not to participate in a program requiring disclosure of the employee’s genetic information.

As background, under the IGIPA, employers must treat genetic information and testing in such a manner that is consistent with the requirements of federal law (e.g., GINA, the ADA, Title VII of the Civil Rights Act, the FMLA, etc.).

GINA defines “genetic information” as information about an individual's genetic tests, about the genetic tests of an individual's family members, or about the manifestation of a disease or disorder in an individual's family members. Genetic information includes any request for, or receipt of, genetic services (including genetic testing, counseling or education), or participation in clinical research, which includes such services, by the individual or family member. Genetic information also includes genetic information of any fetus carried by an individual or by a pregnant woman who is a family member, as well as genetic information of any embryo legally held by an individual or family member who is utilizing assisted reproductive technology. Genetic information does not, however, include information about the sex or age of any individual, or information about the race or ethnicity of the individual or family members that is not derived from a genetic test.

GINA defines a “genetic test” as “an analysis of human DNA, RNA, chromosomes, proteins or metabolites, which detects genotypes, mutations or chromosomal changes.” The final regulations contain many examples of tests that fall within this definition. Also included in the regulations are examples of tests or procedures that are not genetic tests, among which are complete blood counts, cholesterol tests, liver-function tests, and alcohol and drug tests.

This amendment of the IGIPA is important because, under the current IGIPA, employers are generally prohibited from using genetic information or genetic testing in furtherance of a workplace wellness program benefiting employees, unless four conditions are met. Now, an employer cannot penalize an employee who does not disclose his or her genetic information or chooses not to participate in the program if it requires such disclosure.

In order to ensure compliance with IGIPA and the requirements of federal law, employers should take various actions, including, but not limited to, reviewing their group health plan design, provisions and administrative procedures.

The law is effective Jan. 1, 2018.

Public Act 100-0396 »

Mammography Screenings

September 19, 2017

On Aug. 25, 2017, Gov. Rauner signed SB 0314, enacting Public Act 100-0395. This law amends the Illinois Insurance Code regarding coverage for low-dose mammography screenings. The law now includes coverage for MRI of an entire breast or breasts if a mammogram demonstrates heterogeneous or dense breast tissue and is determined by licensed physicians to be medically necessary.

This law is effective Jan. 1, 2018.

Public Act 100-0395 »

Treatment of Serious Mental Illness

September 19, 2017

On Aug. 24, 2017, Gov. Rauner signed HB 1332, enacting Public Act 100-0305. The law regarding coverage for treatment of serious mental illnesses is now expanded to include coverage for eating disorders, including, but not limited to, anorexia/bulimia nervosa, avoidant/restrictive food intake disorder and any other eating disorders contained in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association. Additionally, an insurer that provides coverage for hospital or medical expenses under an individual policy of accident and health insurance must also provide coverage for treatment of serious mental illnesses, including eating disorders.

This law is effective immediately.

Public Act 100-0305 »

Synchronization of Prescription Drug Refills

September 19, 2017

On Aug. 18, 2017, Gov. Rauner signed HB 2957, enacting Public Act 100-0138, which requires plans that provide coverage for prescription drugs to provide coverage for synchronization of prescription drug refills at least once a year for each plan participant if certain conditions are met. Specifically, this law requires insurers to provide prorated daily cost-sharing rates to any medication dispensed by a network pharmacy when necessary.

"Synchronization" is defined to mean the coordination of medication refills for a patient taking two or more medications for one or more chronic conditions (rather than for a single chronic condition) such that the patient's medications are refilled on the same schedule for a given time period. For a policy of health and accident insurance to provide for synchronization of prescriptions drug refills, the prescription drugs must be covered by the policy's clinical coverage policy or have been approved by a formulary exceptions process, among other specified conditions.

This law is effective immediately.

Public Act 100-0138 »

New Law Mandates Coverage for PANDAS and PANS

July 25, 2017

On July 18, 2017, Gov. Rauner signed HB 2721 into law, amending the Illinois Insurance Code and creating Public Act 100-0024, or Charlie’s Law. This new law will provide coverage for treatments for two pediatric autoimmune disorders: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Strep (PANDAS) and Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS).

Specifically, 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 this new law must provide coverage for treatment of PANDAS and PANS, including, but not limited to, the use of intravenous immunoglobulin therapy.

The implementation of this new law may require affected employers (those that are fully insured) to review and revise their benefits policies with their carrier to be compliant with these new requirements.

This law is effective immediately.

Public Act 100-0024 »

Cook County Publishes Procedural Rules for Sick Leave Ordinance

June 13, 2017

In the Oct. 18, 2016, Compliance Corner, we reported on the passage of the Cook County Earned Sick Leave Ordinance 16-4229, which enacts Cook County Code Chapter 42, Human Relations, Article 1. The ordinance creates paid sick leave provisions that provide paid sick and safe leave to employees performing more than 80 hours of work in Cook County for an employer within any 120-day period. Further, the Cook County Commission on Human Rights (“the Commission”) will administer and enforce the ordinance.

After engaging in a public rulemaking process, the Commission adopted interpretative and procedural rules for its enforcement of the ordinance. Some of the highlights of the ordinance and its procedural rules are as follows:

  • Employers that gainfully employ at least one covered employee and who have at least one place of business within Cook County are covered by the ordinance. Some exemptions from coverage apply, such as construction workers who are covered by a collective bargaining agreement, Indian tribes and governmental employers.
  • The ordinance covers employees who work within Cook County for at least two hours in a two-week period for a covered employer while physically present in Cook County. Some exceptions from coverage apply.
  • The ordinance is not limited to full-time employees, but also covers part-time, temporary, seasonal, occasional and new or re-hired employees.
  • New employees can use accrued sick leave after an initial six-month probationary period, and employers that offer combined leave benefits such as paid time off (PTO) are exempt from these requirements so long as employees could accrue and use up to five days (40 hours) of PTO within a calendar year.
  • The ordinance requires employers to provide employees with one hour of paid sick and safe leave for every 40 hours worked.
  • Employees may accrue a maximum of 40 hours of paid sick leave over the course of one year and can roll over up to half of their unused accrued earned sick leave to the following year, up to a maximum of 20 hours.
  • If an employer is subject to FMLA, each of the employer's covered employees shall be allowed, at the end of his or her 12-month accrual period, to carry over up to 40 hours of unused accrued earned sick leave, in addition to the allowed 20-hour carryover, to use exclusively for FMLA-eligible purposes.
  • Employers may establish reasonable notice requirements for employees to use sick leave under the ordinance.
  • Certain employer notices and postings are required. A model notice is available from the Commission.

As a reminder, the ordinance goes into effect on July 1, 2017. The implementation of the ordinance may require affected employers to review and revise their benefits policies to be compliant with these new requirements.

Ordinance 16-4229 »
Procedural Rules »
Model Notice »

Extension of Non-PPACA-Compliant Small Group and Individual Policies and Plans

March 21, 2017

On March 10, 2017, Illinois Director of Insurance Hammer released Company Bulletin 2017-01 related to the extension of non-PPACA-compliant small group and individual policies and plans. As background, on Feb. 23, 2017, the federal government announced an additional transition policy that allows insurers (if allowed by the state) to renew non-grandfathered non-PPACA-compliant plans (this transitional relief has been extended twice before). Such policies are not required to be in compliance with certain PPACA mandates including community rating, coverage of essential health benefits, prohibition on pre-existing condition exclusions and the annual out-of-pocket maximum limit.

The Bulletin states that Illinois will allow insurers to renew policies in the individual market and the small group market according to the extended transitional policy. Employers with non-PPACA-compliant plans should work with their insurer on any policy extension.

Company Bulletin 2017-01 »

New Law Amends Employee Sick Leave Act

February 07, 2017

On Jan. 13, 2017, Gov. Rauner signed SB 2799 into law, creating Public Act 99-0921, which amends the recently-enacted Employee Sick Leave Act (covered in the Aug. 23, 2016, edition of Compliance Corner).

As background, the Employee Sick Leave Act (the Act) went into effect on Jan. 1, 2017, and provides flexibility for caregivers by providing that employees may use personal sick leave benefits provided by the employer for absences due to an illness, injury or medical appointment of the employee's family member.

The amendments or clarifications in this new Act are as follows:

  • Revises the definition of "personal sick leave benefits" to include paid or unpaid time accrued and available to an employee, as provided through an employment benefit plan or policy;
  • Provides that an employment benefit plan or paid time off policy does not include long term disability, short term disability, an insurance policy, or other comparable benefit plan or policy;
  • Adds stepchildren and domestic partners to the list of persons for whom an employee may use personal sick leave benefits;
  • Provides that an employer may request written verification of the employee's absence from a health care professional if such verification is required under the employer's employment benefit plan or paid time off policy;
  • Allows employers who base personal sick leave benefits on an employee's years of service instead of annual or monthly accrual to limit the amount of sick leave to be used under the law to half of the employee's maximum annual grant;
  • In a provision prohibiting retaliation, it provides that nothing prohibits an employer from applying the terms and conditions set forth in the employment benefit plan or paid time off policy applicable to personal sick leave benefits;
  • Stipulates that the law does not apply to an employee of an employer subject to certain provisions of the Railway Labor Act, or to an employer or employee as defined in either the federal Railroad Unemployment Insurance Act or the Federal Employers' Liability Act;
  • Provides that the law does not affect collective-bargaining agreements or any party’s power to collectively bargain; and
  • Grants the Illinois Department of Labor rulemaking authority.

As stated above, the Act went into effect Jan. 13, 2017. The implementation of the Act may require affected employers to review and revise their benefit policies to be compliant with these new requirements.

Public Act 99-0921 »
Employee Sick Leave Act FAQs »

IL State Updates - 2015 Jan 20 No.01

October 20, 2015

On Oct. 16, 2015, the Illinois Department of Insurance released Revised CB 2015-10. This bulletin acknowledged the passage of the PACE Act, which was signed into federal law Oct. 8, 2015 and repealed PPACA’s mandated small-group expansion. As a result of the PACE act, the federal government will continue to define small groups as those with 1-50 employees. Illinois reported that the state will continue to define small group as those employers with 2-50 employees.

Although the PACE Act came too late to allow for changes in the rates that will be imposed by many carriers on Jan. 1, 2016, Illinois will allow carriers to submit revisions to their small group rates on a quarterly basis beginning in April 2016.

CB 2015-10 »

IL State Updates - 2015 Jan 08 No.02

September 08, 2015

On Aug. 20, 2015, Gov. Rauner signed SB 1764 into law. This law requires fully insured plans that cover more than 25 employees to provide coverage for the diagnosis and treatment of infertility if the plan covers pregnancy-related benefits. Specifically, such plans must cover in vitro fertilization, uterine embryo lavage, embryo transfer, artificial insemination, gamete intrafallopian tube transfer, zygote intrafallopian tube transfer and low tubal ovum transfer.

The law defines "infertility" as the inability to conceive after one year of unprotected sexual intercourse, the inability to conceive after one year of attempts to produce conception, the inability to conceive after being diagnosed with conditions affecting infertility or the inability to sustain successful pregnancies.

Further, coverage for vitro fertilization, gamete intrafallopian tube transfer or zygote intrafallopian tube transfer is required only if three conditions are met:

The participant must be unable to attain, maintain or sustain a viable and successful pregnancy through other covered, reasonable and less costly infertility treatments.The participant must not have gone through four completed oocyte retrievals. However, if a live birth follows one oocyte retrieval, then two more oocyte retrievals must be covered.The procedures must be performed at a medical facility that conforms to the American College of Obstetrics and Gynecology guidelines for in vitro fertilization clinics or to the American Fertility Society minimal standards for programs of in vitro fertilization.

The law also provides an exemption for religious institutions and organizations if such coverage violates their religious and moral teachings and beliefs.

The law takes effect for plans issued on or after Jan. 1, 2016.

SB 1764 »

IL State Updates - 2015 Jan 08 No.01

September 08, 2015

On Aug. 19, 2015, Gov. Rauner signed SB 54 into law. This law amends the Illinois Insurance Code by including breast tomosynthesis in the definition of “low-dose mammography.” “Breast tomosynthesis” is a radiologic procedure that involves the acquisition of projection images over the stationary breast to produce cross-sectional, digital three-dimensional images of the breast.

As background, Illinois requires fully insured plans to cover low-dose mammography to detect the presence of occult breast cancer in plan participants who are age 35 and older. As such, this amendment requires plans to cover breast tomosynthesis.

This law takes effect July 1, 2016, but only if:

PPACA is repealed by Congress or invalidated by a decision of the U.S. Supreme Court;HHS promulgates a rule, regulation or comment that eliminates the state’s responsibility to defray the cost of state-mandated benefits or that requires breast tomosyntheses to be covered as an essential health benefit under a qualified health plan.

SB 54 »

IL State Updates - 2015 Jan 08 No.03

September 08, 2015

On Aug. 21, 2015, Gov. Rauner signed HB 3673 into law. This law amends the state benefit mandates pertaining to mammogram coverage by requiring a screening MRI, when medically necessary, for women 35 years of age or older who are at high risk for breast cancer. This provision became effective Aug. 21, 2015.

The law also provides additional access to breast imaging for clients of the Illinois Department of Healthcare and Family Services and stipulates a minimum reimbursement rate for providers who participate in the Department’s breast cancer treatment quality improvement program. These provisions take effect in January 2016 and January 2017, respectively.

HB 3673 »

IL State Updates - 2015 Jan 25 No.01

August 25, 2015

On July 27, 2015, Gov. Rauner signed HB 235 into law. This law requires plans to provide coverage for anesthesia and expenses related to dental care for participants under age 19 who are diagnosed with autism spectrum disorders or with developmental disabilities. For purposes of this law, “developmental disabilities” is defined as intellectual disabilities or related conditions that are attributable to cerebral palsy, epilepsy or other conditions, except for mental illnesses; are likely to continue indefinitely; and?result in substantial functional limitations in three or more of the following major life activities: capacity for independent living, language, learning, mobility, self-care and self-direction. Additionally, plans can require that plan participants make two visits to the dental care provider before receiving additional treatment under this law.

The law takes effect Jan. 1, 2016.

HB 235 »

IL State Updates - 2015 Jan 25 No.02

August 25, 2015

On Aug. 3, 2015, Gov. Rauner signed HB 3137 into law. This law, entitled the “Topical Eye Medication Prescription Act”, requires insurers to cover topical eye medication refills when the following conditions are met:

The medication is to treat a chronic condition of the eye.The refill is requested by the insured before the last day of the prescribed dosage period and after at least 75 percent of the predicted days of use.The prescribing doctor indicates on the prescription that refills are permitted and that the early refills do not exceed the total number of refills prescribed.

The law takes effect for policies issued or renewed on or after Jan. 1, 2016.

HB 3137 »

IL State Updates - 2015 Jan 10 No.01

February 10, 2015

On Jan. 22, 2015, the Illinois Department of Healthcare and Family Services released a notice providing guidance on federal restrictions on individuals who are eligible for both Medicare and Medicaid. Specifically, the Social Security Act does not allow insurance policies (Medigap) to be sold to individuals who are eligible for both programs. The notice also includes a link to a CMS bulletin that includes FAQs on the prohibition.

Informational Notice  »

IL State Updates - 2015 Jan 13 No.01

January 13, 2015

On Jan. 4, 2015, Governor Pat Quinn signed the Illinois Secure Choice Savings Plan Act into law, creating Public Act 098-1150. The new legislation provides an individual retirement savings program for private-sector employees who don’t have access to an employer-sponsored retirement plan. Employers that have been in business for at least two years and employ 25 or more employees are required to participate by enrolling their participants in the plan and remitting after-tax contributions to the plan. The new law is effective June 1, 2015, and implementation must be completed within 24 months of the Act.

Public Act 098-1150  »


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