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Public Act 104-0710
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| SB2762 Enrolled | LRB104 16499 BAB 29895 b |
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AN ACT concerning regulation.
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Be it enacted by the People of the State of Illinois, |
represented in the General Assembly:
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Section 5. The Counties Code is amended by changing |
Section 5-1069.3 as follows:
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(55 ILCS 5/5-1069.3) |
(Text of Section before amendment by P.A. 104-446) |
Sec. 5-1069.3. Required health benefits. If a county, |
including a home rule county, is a self-insurer for purposes |
of providing health insurance coverage for its employees, the |
coverage shall include coverage for the post-mastectomy care |
benefits required to be covered by a policy of accident and |
health insurance under Section 356t and the coverage required |
under Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, |
356u.10, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, |
356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, |
356z.25, 356z.26, 356z.29, 356z.30, 356z.32, 356z.33, 356z.36, |
356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, |
356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, 356z.61, |
356z.62, 356z.64, 356z.67, 356z.68, 356z.70, 356z.71, 356z.74, |
and 356z.77, 356z.79, and 356z.80, 356z.81, 356z.82, 356z.83, |
356z.84, 356z.85, 356z.88, and 356z.89 of the Illinois |
Insurance Code. The coverage shall comply with Sections |
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155.22a, 355b, 356z.19, and 370c of the Illinois Insurance |
Code. The Department of Insurance shall enforce the |
requirements of this Section. The requirement that health |
benefits be covered as provided in this Section is an |
exclusive power and function of the State and is a denial and |
limitation under Article VII, Section 6, subsection (h) of the |
Illinois Constitution. A home rule county to which this |
Section applies must comply with every provision of this |
Section. |
Rulemaking authority to implement Public Act 95-1045, if |
any, is conditioned on the rules being adopted in accordance |
with all provisions of the Illinois Administrative Procedure |
Act and all rules and procedures of the Joint Committee on |
Administrative Rules; any purported rule not so adopted, for |
whatever reason, is unauthorized. |
(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; |
103-420, eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. |
8-11-23; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-718, |
eff. 7-19-24; 103-751, eff. 8-2-24; 103-914, eff. 1-1-25; |
103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-1, eff. |
6-9-25; 104-42, eff. 8-1-25; 104-68, eff. 1-1-26; 104-73, eff. |
1-1-26; 104-289, eff. 1-1-26; 104-324, eff. 1-1-26; 104-379, |
eff. 1-1-26; 104-417, eff. 8-15-25; revised 1-7-26.)
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(Text of Section after amendment by P.A. 104-446) |
Sec. 5-1069.3. Required health benefits. If a county, |
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including a home rule county, is a self-insurer for purposes |
of providing health insurance coverage for its employees, the |
coverage shall include coverage for the post-mastectomy care |
benefits required to be covered by a policy of accident and |
health insurance under Section 356t and the coverage required |
under Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, |
356u.10, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, |
356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, |
356z.25, 356z.26, 356z.29, 356z.30, 356z.32, 356z.33, 356z.36, |
356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, |
356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, 356z.61, |
356z.62, 356z.64, 356z.67, 356z.68, 356z.70, 356z.71, 356z.74, |
and 356z.77, 356z.79, and 356z.80, 356z.81, 356z.82, 356z.83, |
356z.84, 356z.85, 356z.88, and 356z.89 of the Illinois |
Insurance Code. The coverage shall comply with Sections |
155.22a, 355b, 356z.19, 370c, and 370c.4 of the Illinois |
Insurance Code. The Department of Insurance shall enforce the |
requirements of this Section. The requirement that health |
benefits be covered as provided in this Section is an |
exclusive power and function of the State and is a denial and |
limitation under Article VII, Section 6, subsection (h) of the |
Illinois Constitution. A home rule county to which this |
Section applies must comply with every provision of this |
Section. |
Rulemaking authority to implement Public Act 95-1045, if |
any, is conditioned on the rules being adopted in accordance |
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with all provisions of the Illinois Administrative Procedure |
Act and all rules and procedures of the Joint Committee on |
Administrative Rules; any purported rule not so adopted, for |
whatever reason, is unauthorized. |
(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; |
103-420, eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. |
8-11-23; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-718, |
eff. 7-19-24; 103-751, eff. 8-2-24; 103-914, eff. 1-1-25; |
103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-1, eff. |
6-9-25; 104-42, eff. 8-1-25; 104-68, eff. 1-1-26; 104-73, eff. |
1-1-26; 104-289, eff. 1-1-26; 104-324, eff. 1-1-26; 104-379, |
eff. 1-1-26; 104-417, eff. 8-15-25; 104-446, eff. 6-1-26; |
revised 1-7-26.)
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Section 10. The Illinois Municipal Code is amended by |
changing Section 10-4-2.3 as follows:
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(65 ILCS 5/10-4-2.3) |
(Text of Section before amendment by P.A. 104-446) |
Sec. 10-4-2.3. Required health benefits. If a |
municipality, including a home rule municipality, is a |
self-insurer for purposes of providing health insurance |
coverage for its employees, the coverage shall include |
coverage for the post-mastectomy care benefits required to be |
covered by a policy of accident and health insurance under |
Section 356t and the coverage required under Sections 356g, |
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356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10, 356w, 356x, |
356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, |
356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, |
356z.29, 356z.30, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41, |
356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54, |
356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64, |
356z.67, 356z.68, 356z.70, 356z.71, 356z.74, and 356z.77, |
356z.79, and 356z.80, 356z.81, 356z.82, 356z.83, 356z.84, |
356z.85, 356z.88, and 356z.89 of the Illinois Insurance Code. |
The coverage shall comply with Sections 155.22a, 355b, |
356z.19, and 370c of the Illinois Insurance Code. The |
Department of Insurance shall enforce the requirements of this |
Section. The requirement that health benefits be covered as |
provided in this Section is an exclusive power and function of |
the State and is a denial and limitation under Article VII, |
Section 6, subsection (h) of the Illinois Constitution. A home |
rule municipality to which this Section applies must comply |
with every provision of this Section. |
Rulemaking authority to implement Public Act 95-1045, if |
any, is conditioned on the rules being adopted in accordance |
with all provisions of the Illinois Administrative Procedure |
Act and all rules and procedures of the Joint Committee on |
Administrative Rules; any purported rule not so adopted, for |
whatever reason, is unauthorized. |
(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; |
103-420, eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. |
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8-11-23; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-718, |
eff. 7-19-24; 103-751, eff. 8-2-24; 103-914, eff. 1-1-25; |
103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-1, eff. |
6-9-25; 104-42, eff. 8-1-25; 104-68, eff. 1-1-26; 104-73, eff. |
1-1-26; 104-289, eff. 1-1-26; 104-324, eff. 1-1-26; 104-379, |
eff. 1-1-26; 104-417, eff. 8-15-25; revised 1-8-26.)
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(Text of Section after amendment by P.A. 104-446) |
Sec. 10-4-2.3. Required health benefits. If a |
municipality, including a home rule municipality, is a |
self-insurer for purposes of providing health insurance |
coverage for its employees, the coverage shall include |
coverage for the post-mastectomy care benefits required to be |
covered by a policy of accident and health insurance under |
Section 356t and the coverage required under Sections 356g, |
356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10, 356w, 356x, |
356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, |
356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, |
356z.29, 356z.30, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41, |
356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54, |
356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64, |
356z.67, 356z.68, 356z.70, 356z.71, 356z.74, and 356z.77, |
356z.79, and 356z.80, 356z.81, 356z.82, 356z.83, 356z.84, |
356z.85, 356z.88, and 356z.89 of the Illinois Insurance Code. |
The coverage shall comply with Sections 155.22a, 355b, |
356z.19, 370c, and 370c.4 of the Illinois Insurance Code. The |
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Department of Insurance shall enforce the requirements of this |
Section. The requirement that health benefits be covered as |
provided in this Section is an exclusive power and function of |
the State and is a denial and limitation under Article VII, |
Section 6, subsection (h) of the Illinois Constitution. A home |
rule municipality to which this Section applies must comply |
with every provision of this Section. |
Rulemaking authority to implement Public Act 95-1045, if |
any, is conditioned on the rules being adopted in accordance |
with all provisions of the Illinois Administrative Procedure |
Act and all rules and procedures of the Joint Committee on |
Administrative Rules; any purported rule not so adopted, for |
whatever reason, is unauthorized. |
(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; |
103-420, eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. |
8-11-23; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-718, |
eff. 7-19-24; 103-751, eff. 8-2-24; 103-914, eff. 1-1-25; |
103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-1, eff. |
6-9-25; 104-42, eff. 8-1-25; 104-68, eff. 1-1-26; 104-73, eff. |
1-1-26; 104-289, eff. 1-1-26; 104-324, eff. 1-1-26; 104-379, |
eff. 1-1-26; 104-417, eff. 8-15-25; 104-446, eff. 6-1-26; |
revised 1-8-26.)
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Section 15. The School Code is amended by changing Section |
10-22.3f as follows:
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(105 ILCS 5/10-22.3f) |
(Text of Section before amendment by P.A. 104-446) |
Sec. 10-22.3f. Required health benefits. Insurance |
protection and benefits for employees shall provide the |
post-mastectomy care benefits required to be covered by a |
policy of accident and health insurance under Section 356t and |
the coverage required under Sections 356g, 356g.5, 356g.5-1, |
356m, 356q, 356u, 356u.10, 356w, 356x, 356z.4, 356z.4a, |
356z.6, 356z.8, 356z.9, 356z.11, 356z.12, 356z.13, 356z.14, |
356z.15, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32, |
356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, |
356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, |
356z.61, 356z.62, 356z.64, 356z.67, 356z.68, 356z.70, 356z.71, |
356z.74, and 356z.77, 356z.79, and 356z.80, 356z.81, 356z.82, |
356z.83, 356z.84, 356z.85, 356z.88, and 356z.89 of the |
Illinois Insurance Code. Insurance policies shall comply with |
Section 356z.19 of the Illinois Insurance Code. The coverage |
shall comply with Sections 155.22a, 355b, and 370c and Article |
XXXIIB of the Illinois Insurance Code. The Department of |
Insurance shall enforce the requirements of this Section. |
Rulemaking authority to implement Public Act 95-1045, if |
any, is conditioned on the rules being adopted in accordance |
with all provisions of the Illinois Administrative Procedure |
Act and all rules and procedures of the Joint Committee on |
Administrative Rules; any purported rule not so adopted, for |
whatever reason, is unauthorized. |
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(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; |
103-420, eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. |
8-11-23; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-718, |
eff. 7-19-24; 103-751, eff. 8-2-24; 103-914, eff. 1-1-25; |
103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-1, eff. |
6-9-25; 104-27, eff. 1-1-26; 104-42, eff. 8-1-25; 104-68, eff. |
1-1-26; 104-73, eff. 1-1-26; 104-289, eff. 1-1-26; 104-324, |
eff. 1-1-26; 104-379, eff. 1-1-26; 104-417, eff. 8-15-25; |
revised 1-8-26.)
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(Text of Section after amendment by P.A. 104-446) |
Sec. 10-22.3f. Required health benefits. Insurance |
protection and benefits for employees shall provide the |
post-mastectomy care benefits required to be covered by a |
policy of accident and health insurance under Section 356t and |
the coverage required under Sections 356g, 356g.5, 356g.5-1, |
356m, 356q, 356u, 356u.10, 356w, 356x, 356z.4, 356z.4a, |
356z.6, 356z.8, 356z.9, 356z.11, 356z.12, 356z.13, 356z.14, |
356z.15, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32, |
356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, |
356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, |
356z.61, 356z.62, 356z.64, 356z.67, 356z.68, 356z.70, 356z.71, |
356z.74, and 356z.77, 356z.79, and 356z.80, 356z.81, 356z.82, |
356z.83, 356z.84, 356z.85, 356z.88, and 356z.89 of the |
Illinois Insurance Code. Insurance policies shall comply with |
Section 356z.19 of the Illinois Insurance Code. The coverage |
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shall comply with Sections 155.22a, 355b, 370c, and 370c.4 and |
Article XXXIIB of the Illinois Insurance Code. The Department |
of Insurance shall enforce the requirements of this Section. |
Rulemaking authority to implement Public Act 95-1045, if |
any, is conditioned on the rules being adopted in accordance |
with all provisions of the Illinois Administrative Procedure |
Act and all rules and procedures of the Joint Committee on |
Administrative Rules; any purported rule not so adopted, for |
whatever reason, is unauthorized. |
(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; |
103-420, eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. |
8-11-23; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-718, |
eff. 7-19-24; 103-751, eff. 8-2-24; 103-914, eff. 1-1-25; |
103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-1, eff. |
6-9-25; 104-27, eff. 1-1-26; 104-42, eff. 8-1-25; 104-68, eff. |
1-1-26; 104-73, eff. 1-1-26; 104-289, eff. 1-1-26; 104-324, |
eff. 1-1-26; 104-379, eff. 1-1-26; 104-417, eff. 8-15-25; |
104-446, eff. 6-1-26; revised 1-8-26.)
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Section 20. The Illinois Insurance Code is amended by |
adding Sections 356z.88 and 356z.89 as follows:
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(215 ILCS 5/356z.88 new) |
Sec. 356z.88. Coverage for seizure detection devices. |
(a) For the purposes of this Section, "seizure detection |
device" means a monitoring device cleared by the United States |
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Food and Drug Administration, and any related technology, |
application, service, or subscription supporting the |
prescribed use of the device, that provides the following: |
(1) individual monitoring and alert services relating |
to seizure activity; |
(2) detection or prediction of seizure activity and |
transmission of notification of the seizure activity to |
the individual or a caregiver for appropriate medical |
response; or |
(3) collection of data of the seizure activity of the |
individual that can be used by a health care provider to |
diagnose or appropriately treat a health care condition |
that causes the seizure activity. |
(b) A group or individual plan of accident and health |
insurance or managed care plan amended, delivered, issued, or |
renewed on or after January 1, 2029 shall provide coverage for |
medically prescribed seizure detection devices. |
(c) All seizure detection devices covered under this |
Section shall be approved for use by individuals, and the |
choice of device shall be made based upon the individual's |
circumstances and medical needs in consultation with the |
individual's medical provider. |
(d) Any individual who has been prescribed a seizure |
detection device shall not be required to obtain prior |
authorization for coverage for a seizure detection device, and |
coverage shall be continuous once the seizure detection device |
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is prescribed. |
(e) A group or individual policy of accident and health |
insurance or a managed care plan that is amended, delivered, |
issued, or renewed on or after January 1, 2029 shall not impose |
a deductible, coinsurance, copayment, or any other |
cost-sharing requirement of more than $50 on the coverage of a |
seizure detection device per plan year. The provisions of this |
subsection do not apply to coverage under this Section to the |
extent that the coverage would disqualify a high-deductible |
health plan from eligibility for a health savings account.
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(215 ILCS 5/356z.89 new) |
Sec. 356z.89. Coverage for preeclampsia biomarker testing. |
Any group or individual policy of accident and health |
insurance or managed care plan amended, delivered, issued, or |
renewed on or after January 1, 2028 shall cover, without |
imposing a deductible, coinsurance, copayment, or any other |
cost-sharing requirement upon the insured, preeclampsia |
biomarker testing for predictive screening in asymptomatic |
individuals, or for diagnosis and management when symptoms are |
present.
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Section 25. The Health Maintenance Organization Act is |
amended by changing Section 5-3 as follows:
|
(215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2) |
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Sec. 5-3. Illinois Insurance Code provisions. |
(a) Health Maintenance Organizations shall be subject to |
the provisions of Sections 133, 134, 136, 137, 139, 140, |
141.1, 141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151, |
152, 153, 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, |
155.49, 352c, 355.2, 355.3, 355.6, 355.7, 355b, 355c, 356f, |
356g, 356g.5-1, 356m, 356q, 356u.10, 356v, 356w, 356x, 356z.2, |
356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, |
356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, |
356z.18, 356z.19, 356z.20, 356z.21, 356z.22, 356z.23, 356z.24, |
356z.25, 356z.26, 356z.28, 356z.29, 356z.30, 356z.31, 356z.32, |
356z.33, 356z.34, 356z.35, 356z.36, 356z.37, 356z.38, 356z.39, |
356z.40, 356z.40a, 356z.41, 356z.44, 356z.45, 356z.46, |
356z.47, 356z.48, 356z.49, 356z.50, 356z.51, 356z.53, 356z.54, |
356z.55, 356z.56, 356z.57, 356z.58, 356z.59, 356z.60, 356z.61, |
356z.62, 356z.63, 356z.64, 356z.65, 356z.66, 356z.67, 356z.68, |
356z.69, 356z.70, 356z.71, 356z.72, 356z.73, 356z.74, 356z.75, |
356z.76, 356z.77, 356z.78, 356z.79, 356z.80, 356z.81, 356z.82, |
356z.83, 356z.84, 356z.85, 356z.88, 356z.89, 364, 364.01, |
364.3, 367.2, 367.2-5, 367i, 368a, 368b, 368c, 368d, 368e, |
370a, 370c, 370c.1, 401, 401.1, 402, 403, 403A, 408, 408.2, |
409, 412, 444, and 444.1, paragraph (c) of subsection (2) of |
Section 367, and Articles IIA, VIII 1/2, XII, XII 1/2, XIII, |
XIII 1/2, XXV, XXVI, and XXXIIB of the Illinois Insurance |
Code. |
(b) For purposes of the Illinois Insurance Code, except |
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for Sections 444 and 444.1 and Articles XIII and XIII 1/2, |
Health Maintenance Organizations in the following categories |
are deemed to be "domestic companies": |
(1) a corporation authorized under the Dental Service |
Plan Act or the Voluntary Health Services Plans Act; |
(2) a corporation organized under the laws of this |
State; or |
(3) a corporation organized under the laws of another |
state, 30% or more of the enrollees of which are residents |
of this State, except a corporation subject to |
substantially the same requirements in its state of |
organization as is a "domestic company" under Article VIII |
1/2 of the Illinois Insurance Code. |
(c) In considering the merger, consolidation, or other |
acquisition of control of a Health Maintenance Organization |
pursuant to Article VIII 1/2 of the Illinois Insurance Code, |
(1) the Director shall give primary consideration to |
the continuation of benefits to enrollees and the |
financial conditions of the acquired Health Maintenance |
Organization after the merger, consolidation, or other |
acquisition of control takes effect; |
(2)(i) the criteria specified in subsection (1)(b) of |
Section 131.8 of the Illinois Insurance Code shall not |
apply and (ii) the Director, in making his determination |
with respect to the merger, consolidation, or other |
acquisition of control, need not take into account the |
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effect on competition of the merger, consolidation, or |
other acquisition of control; |
(3) the Director shall have the power to require the |
following information: |
(A) certification by an independent actuary of the |
adequacy of the reserves of the Health Maintenance |
Organization sought to be acquired; |
(B) pro forma financial statements reflecting the |
combined balance sheets of the acquiring company and |
the Health Maintenance Organization sought to be |
acquired as of the end of the preceding year and as of |
a date 90 days prior to the acquisition, as well as pro |
forma financial statements reflecting projected |
combined operation for a period of 2 years; |
(C) a pro forma business plan detailing an |
acquiring party's plans with respect to the operation |
of the Health Maintenance Organization sought to be |
acquired for a period of not less than 3 years; and |
(D) such other information as the Director shall |
require. |
(d) The provisions of Article VIII 1/2 of the Illinois |
Insurance Code and this Section 5-3 shall apply to the sale by |
any health maintenance organization of greater than 10% of its |
enrollee population (including, without limitation, the health |
maintenance organization's right, title, and interest in and |
to its health care certificates). |
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(e) In considering any management contract or service |
agreement subject to Section 141.1 of the Illinois Insurance |
Code, the Director (i) shall, in addition to the criteria |
specified in Section 141.2 of the Illinois Insurance Code, |
take into account the effect of the management contract or |
service agreement on the continuation of benefits to enrollees |
and the financial condition of the health maintenance |
organization to be managed or serviced, and (ii) need not take |
into account the effect of the management contract or service |
agreement on competition. |
(f) Except for small employer groups as defined in the |
Small Employer Rating, Renewability and Portability Health |
Insurance Act and except for medicare supplement policies as |
defined in Section 363 of the Illinois Insurance Code, a |
Health Maintenance Organization may by contract agree with a |
group or other enrollment unit to effect refunds or charge |
additional premiums under the following terms and conditions: |
(i) the amount of, and other terms and conditions with |
respect to, the refund or additional premium are set forth |
in the group or enrollment unit contract agreed in advance |
of the period for which a refund is to be paid or |
additional premium is to be charged (which period shall |
not be less than one year); and |
(ii) the amount of the refund or additional premium |
shall not exceed 20% of the Health Maintenance |
Organization's profitable or unprofitable experience with |
|
respect to the group or other enrollment unit for the |
period (and, for purposes of a refund or additional |
premium, the profitable or unprofitable experience shall |
be calculated taking into account a pro rata share of the |
Health Maintenance Organization's administrative and |
marketing expenses, but shall not include any refund to be |
made or additional premium to be paid pursuant to this |
subsection (f)). The Health Maintenance Organization and |
the group or enrollment unit may agree that the profitable |
or unprofitable experience may be calculated taking into |
account the refund period and the immediately preceding 2 |
plan years. |
The Health Maintenance Organization shall include a |
statement in the evidence of coverage issued to each enrollee |
describing the possibility of a refund or additional premium, |
and upon request of any group or enrollment unit, provide to |
the group or enrollment unit a description of the method used |
to calculate (1) the Health Maintenance Organization's |
profitable experience with respect to the group or enrollment |
unit and the resulting refund to the group or enrollment unit |
or (2) the Health Maintenance Organization's unprofitable |
experience with respect to the group or enrollment unit and |
the resulting additional premium to be paid by the group or |
enrollment unit. |
In no event shall the Illinois Health Maintenance |
Organization Guaranty Association be liable to pay any |
|
contractual obligation of an insolvent organization to pay any |
refund authorized under this Section. |
(g) Rulemaking authority to implement Public Act 95-1045, |
if any, is conditioned on the rules being adopted in |
accordance with all provisions of the Illinois Administrative |
Procedure Act and all rules and procedures of the Joint |
Committee on Administrative Rules; any purported rule not so |
adopted, for whatever reason, is unauthorized. |
(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; |
103-123, eff. 1-1-24; 103-154, eff. 6-30-23; 103-420, eff. |
1-1-24; 103-426, eff. 8-4-23; 103-445, eff. 1-1-24; 103-551, |
eff. 8-11-23; 103-605, eff. 7-1-24; 103-618, eff. 1-1-25; |
103-649, eff. 1-1-25; 103-656, eff. 1-1-25; 103-700, eff. |
1-1-25; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-753, |
eff. 8-2-24; 103-758, eff. 1-1-25; 103-777, eff. 8-2-24; |
103-808, eff. 1-1-26; 103-914, eff. 1-1-25; 103-918, eff. |
1-1-25; 103-1024, eff. 1-1-25; 104-1, eff. 6-9-25; 104-28, |
eff. 1-1-26; 104-42, eff. 8-1-25; 104-68, eff. 1-1-26; 104-73, |
eff. 1-1-26; 104-98, eff. 1-1-26; 104-289, eff. 1-1-26; |
104-324, eff. 1-1-26; 104-334, eff. 8-15-25; 104-379, eff. |
1-1-26; 104-417, eff. 8-15-25; revised 11-21-25.)
|
Section 30. The Limited Health Service Organization Act is |
amended by changing Section 4003 as follows:
|
(215 ILCS 130/4003) (from Ch. 73, par. 1504-3) |
|
Sec. 4003. Illinois Insurance Code provisions. Limited |
health service organizations shall be subject to the |
provisions of Sections 133, 134, 136, 137, 139, 140, 141.1, |
141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151, 152, 153, |
154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 352c, |
355.2, 355.3, 355b, 355d, 356m, 356q, 356v, 356z.4, 356z.4a, |
356z.10, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.32, |
356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54, |
356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68, 356z.71, |
356z.73, 356z.74, 356z.75, 356z.79, 356z.80, 356z.81, 356z.83, |
356z.84, 356z.85, 356z.88, 356z.89, 364.3, 368a, 370a, 401, |
401.1, 402, 403, 403A, 408, 408.2, 409, 412, 444, and 444.1 and |
Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, |
XXVI, and XXXIIB of the Illinois Insurance Code. Nothing in |
this Section shall require a limited health care plan to cover |
any service that is not a limited health service. For purposes |
of the Illinois Insurance Code, except for Sections 444 and |
444.1 and Articles XIII and XIII 1/2, limited health service |
organizations in the following categories are deemed to be |
domestic companies: |
(1) a corporation under the laws of this State; or |
(2) a corporation organized under the laws of another |
state, 30% or more of the enrollees of which are residents |
of this State, except a corporation subject to |
substantially the same requirements in its state of |
organization as is a domestic company under Article VIII |
|
1/2 of the Illinois Insurance Code. |
(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; |
103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445, eff. |
1-1-24; 103-605, eff. 7-1-24; 103-649, eff. 1-1-25; 103-656, |
eff. 1-1-25; 103-700, eff. 1-1-25; 103-718, eff. 7-19-24; |
103-751, eff. 8-2-24; 103-758, eff. 1-1-25; 103-832, eff. |
1-1-25; 103-1024, eff. 1-1-25; 104-1, eff. 6-9-25; 104-42, |
eff. 8-1-25; 104-73, eff. 1-1-26; 104-98, eff. 1-1-26; |
104-289, eff. 1-1-26; 104-324, eff. 1-1-26; 104-334, eff. |
8-15-25; 104-379, eff. 1-1-26; 104-417, eff. 8-15-25; revised |
11-21-25.)
|
Section 35. The Voluntary Health Services Plans Act is |
amended by changing Section 10 as follows:
|
(215 ILCS 165/10) (from Ch. 32, par. 604) |
Sec. 10. Application of Illinois Insurance Code |
provisions. Health services plan corporations and all persons |
interested therein or dealing therewith shall be subject to |
the provisions of Articles IIA and XII 1/2 and Sections 3.1, |
133, 136, 139, 140, 143, 143.31, 143c, 149, 155.22a, 155.37, |
354, 355.2, 355.3, 355.7, 355b, 355d, 356g, 356g.5, 356g.5-1, |
356m, 356q, 356r, 356t, 356u, 356u.10, 356v, 356w, 356x, 356y, |
356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, |
356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, |
356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, |
|
356z.29, 356z.30, 356z.32, 356z.32a, 356z.33, 356z.40, |
356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54, 356z.56, |
356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64, 356z.67, |
356z.68, 356z.71, 356z.72, 356z.74, 356z.75, 356z.77, 356z.79, |
356z.80, 356z.81, 356z.83, 356z.84, 356z.85, 356z.88, 356z.89, |
364.01, 364.3, 367.2, 368a, 370a, 401, 401.1, 402, 403, 403A, |
408, 408.2, and 412, and paragraphs (7) and (15) of Section 367 |
of the Illinois Insurance Code. |
Rulemaking authority to implement Public Act 95-1045, if |
any, is conditioned on the rules being adopted in accordance |
with all provisions of the Illinois Administrative Procedure |
Act and all rules and procedures of the Joint Committee on |
Administrative Rules; any purported rule not so adopted, for |
whatever reason, is unauthorized. |
(Source: P.A. 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; |
103-420, eff. 1-1-24; 103-445, eff. 1-1-24; 103-551, eff. |
8-11-23; 103-605, eff. 7-1-24; 103-656, eff. 1-1-25; 103-718, |
eff. 7-19-24; 103-751, eff. 8-2-24; 103-753, eff. 8-2-24; |
103-758, eff. 1-1-25; 103-832, eff. 1-1-25; 103-914, eff. |
1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; 104-1, |
eff. 6-9-25; 104-28, eff. 1-1-26; 104-42, eff. 8-1-25; 104-73, |
eff. 1-1-26; 104-98, eff. 1-1-26; 104-289, eff. 1-1-26; |
104-324, eff. 1-1-26; 104-379, eff. 1-1-26; 104-417, eff. |
8-15-25; revised 11-21-25.)
|
Section 95. No acceleration or delay. Where this Act makes |
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