103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
SB2572

 

Introduced 5/2/2023, by Sen. Cristina Castro

 

SYNOPSIS AS INTRODUCED:
 
See Index

    Amends the Illinois Insurance Code. In provisions concerning infertility coverage, provides that no group policy of accident and health insurance providing coverage for more than 25 employees that provides pregnancy related benefits may be issued, amended, delivered, or renewed in the State on or after January 1, 2024 unless the policy contains coverage for the diagnosis and treatment of infertility, including procedures necessary to screen or diagnose a fertilized egg before implantation. Provides that coverage for procedures for in vitro fertilization, gamete intrafallopian tube transfer, or zygote intrafallopian tube transfer shall be required only if the procedures comply with specified requirements. Provides that a group or individual policy of accident and health insurance providing coverage for more than 25 employees that is amended, delivered, issued, or renewed on or after January 1, 2024 shall provide, for individuals 45 years of age and older, coverage for an annual menopause health visit. Provides that a group or individual policy of accident and health insurance providing coverage for more than 25 employees that is amended, delivered, issued, or renewed on or after January 1, 2024 shall provide coverage for all types of injectable medicines prescribed on-label or off-label to improve glucose or weight loss for use by adults diagnosed or previously diagnosed with prediabetes, gestational diabetes, or obesity. Makes other changes. Makes conforming changes in the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, the Limited Health Service Organization Act, the Voluntary Health Services Plans Act, and the Medical Assistance Article of the Illinois Public Aid Code. Effective immediately.


LRB103 32124 BMS 61192 b

 

 

A BILL FOR

 

SB2572LRB103 32124 BMS 61192 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The State Employees Group Insurance Act of 1971
5is amended by changing Section 6.11 as follows:
 
6    (5 ILCS 375/6.11)
7    (Text of Section before amendment by P.A. 102-768)
8    Sec. 6.11. Required health benefits; Illinois Insurance
9Code requirements. The program of health benefits shall
10provide the post-mastectomy care benefits required to be
11covered by a policy of accident and health insurance under
12Section 356t of the Illinois Insurance Code. The program of
13health benefits shall provide the coverage required under
14Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x,
15356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
16356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,
17356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
18356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
19356z.53, 356z.54, 356z.56, 356z.57, 356z.59, and 356z.60,
20356z.61, and 356z.62 of the Illinois Insurance Code. The
21program of health benefits must comply with Sections 155.22a,
22155.37, 355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of
23the Illinois Insurance Code. The Department of Insurance shall

 

 

SB2572- 2 -LRB103 32124 BMS 61192 b

1enforce the requirements of this Section with respect to
2Sections 370c and 370c.1 of the Illinois Insurance Code; all
3other requirements of this Section shall be enforced by the
4Department of Central Management Services.
5    Rulemaking authority to implement Public Act 95-1045, if
6any, is conditioned on the rules being adopted in accordance
7with all provisions of the Illinois Administrative Procedure
8Act and all rules and procedures of the Joint Committee on
9Administrative Rules; any purported rule not so adopted, for
10whatever reason, is unauthorized.
11(Source: P.A. 101-13, eff. 6-12-19; 101-281, eff. 1-1-20;
12101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
131-1-20; 101-625, eff. 1-1-21; 102-30, eff. 1-1-22; 102-103,
14eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
15102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff.
161-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816,
17eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
18revised 12-13-22.)
 
19    (Text of Section after amendment by P.A. 102-768)
20    Sec. 6.11. Required health benefits; Illinois Insurance
21Code requirements. The program of health benefits shall
22provide the post-mastectomy care benefits required to be
23covered by a policy of accident and health insurance under
24Section 356t of the Illinois Insurance Code. The program of
25health benefits shall provide the coverage required under

 

 

SB2572- 3 -LRB103 32124 BMS 61192 b

1Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x,
2356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
3356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,
4356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
5356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
6356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59, and
7356z.60, 356z.61, and 356z.62 of the Illinois Insurance Code.
8The program of health benefits must comply with Sections
9155.22a, 155.37, 355b, 356z.19, 370c, and 370c.1 and Article
10XXXIIB of the Illinois Insurance Code. The Department of
11Insurance shall enforce the requirements of this Section with
12respect to Sections 370c and 370c.1 of the Illinois Insurance
13Code; all other requirements of this Section shall be enforced
14by the Department of Central Management Services.
15    Rulemaking authority to implement Public Act 95-1045, if
16any, is conditioned on the rules being adopted in accordance
17with all provisions of the Illinois Administrative Procedure
18Act and all rules and procedures of the Joint Committee on
19Administrative Rules; any purported rule not so adopted, for
20whatever reason, is unauthorized.
21(Source: P.A. 101-13, eff. 6-12-19; 101-281, eff. 1-1-20;
22101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
231-1-20; 101-625, eff. 1-1-21; 102-30, eff. 1-1-22; 102-103,
24eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
25102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff.
261-1-23; 102-768, eff. 1-1-24; 102-804, eff. 1-1-23; 102-813,

 

 

SB2572- 4 -LRB103 32124 BMS 61192 b

1eff. 5-13-22; 102-816, eff. 1-1-23; 102-860, eff. 1-1-23;
2102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23.)
 
3    Section 10. The Counties Code is amended by changing
4Section 5-1069.3 as follows:
 
5    (55 ILCS 5/5-1069.3)
6    Sec. 5-1069.3. Required health benefits. If a county,
7including a home rule county, is a self-insurer for purposes
8of providing health insurance coverage for its employees, the
9coverage shall include coverage for the post-mastectomy care
10benefits required to be covered by a policy of accident and
11health insurance under Section 356t and the coverage required
12under Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w,
13356x, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
14356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25,
15356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, 356z.36,
16356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51,
17356z.53, 356z.54, 356z.56, 356z.57, 356z.59, and 356z.60,
18356z.61, and 356z.62 of the Illinois Insurance Code. The
19coverage shall comply with Sections 155.22a, 355b, 356z.19,
20and 370c of the Illinois Insurance Code. The Department of
21Insurance shall enforce the requirements of this Section. The
22requirement that health benefits be covered as provided in
23this Section is an exclusive power and function of the State
24and is a denial and limitation under Article VII, Section 6,

 

 

SB2572- 5 -LRB103 32124 BMS 61192 b

1subsection (h) of the Illinois Constitution. A home rule
2county to which this Section applies must comply with every
3provision of this Section.
4    Rulemaking authority to implement Public Act 95-1045, if
5any, is conditioned on the rules being adopted in accordance
6with all provisions of the Illinois Administrative Procedure
7Act and all rules and procedures of the Joint Committee on
8Administrative Rules; any purported rule not so adopted, for
9whatever reason, is unauthorized.
10(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
11101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
121-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
13eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22;
14102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff.
151-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816,
16eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
17102-1117, eff. 1-13-23.)
 
18    Section 15. The Illinois Municipal Code is amended by
19changing Section 10-4-2.3 as follows:
 
20    (65 ILCS 5/10-4-2.3)
21    Sec. 10-4-2.3. Required health benefits. If a
22municipality, including a home rule municipality, is a
23self-insurer for purposes of providing health insurance
24coverage for its employees, the coverage shall include

 

 

SB2572- 6 -LRB103 32124 BMS 61192 b

1coverage for the post-mastectomy care benefits required to be
2covered by a policy of accident and health insurance under
3Section 356t and the coverage required under Sections 356g,
4356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x, 356z.4,
5356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
6356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
7356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
8356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
9356z.56, 356z.57, 356z.59, and 356z.60, 356z.61, and 356z.62
10of the Illinois Insurance Code. The coverage shall comply with
11Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
12Insurance Code. The Department of Insurance shall enforce the
13requirements of this Section. The requirement that health
14benefits be covered as provided in this is an exclusive power
15and function of the State and is a denial and limitation under
16Article VII, Section 6, subsection (h) of the Illinois
17Constitution. A home rule municipality to which this Section
18applies must comply with every provision of this Section.
19    Rulemaking authority to implement Public Act 95-1045, if
20any, is conditioned on the rules being adopted in accordance
21with all provisions of the Illinois Administrative Procedure
22Act and all rules and procedures of the Joint Committee on
23Administrative Rules; any purported rule not so adopted, for
24whatever reason, is unauthorized.
25(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
26101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.

 

 

SB2572- 7 -LRB103 32124 BMS 61192 b

11-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
2eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22;
3102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff.
41-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816,
5eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
6102-1117, eff. 1-13-23.)
 
7    Section 20. The School Code is amended by changing Section
810-22.3f as follows:
 
9    (105 ILCS 5/10-22.3f)
10    Sec. 10-22.3f. Required health benefits. Insurance
11protection and benefits for employees shall provide the
12post-mastectomy care benefits required to be covered by a
13policy of accident and health insurance under Section 356t and
14the coverage required under Sections 356g, 356g.5, 356g.5-1,
15356m, 356q, 356u, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8,
16356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
17356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
18356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
19356z.53, 356z.54, 356z.56, 356z.57, 356z.59, and 356z.60,
20356z.61, and 356z.62 of the Illinois Insurance Code. Insurance
21policies shall comply with Section 356z.19 of the Illinois
22Insurance Code. The coverage shall comply with Sections
23155.22a, 355b, and 370c of the Illinois Insurance Code. The
24Department of Insurance shall enforce the requirements of this

 

 

SB2572- 8 -LRB103 32124 BMS 61192 b

1Section.
2    Rulemaking authority to implement Public Act 95-1045, if
3any, is conditioned on the rules being adopted in accordance
4with all provisions of the Illinois Administrative Procedure
5Act and all rules and procedures of the Joint Committee on
6Administrative Rules; any purported rule not so adopted, for
7whatever reason, is unauthorized.
8(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
9101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
101-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
11eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. 1-1-22;
12102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804, eff.
131-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860,
14eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23.)
 
15    Section 25. The Illinois Insurance Code is amended by
16changing Section 356m and by adding Sections 356z.61 and
17356z.62 as follows:
 
18    (215 ILCS 5/356m)  (from Ch. 73, par. 968m)
19    Sec. 356m. Infertility coverage.
20    (a) No group policy of accident and health insurance
21providing coverage for more than 25 employees that provides
22pregnancy related benefits may be issued, amended, delivered,
23or renewed in this State after January 1, 2016 and through
24December 31, 2023 the effective date of this amendatory Act of

 

 

SB2572- 9 -LRB103 32124 BMS 61192 b

1the 99th General Assembly unless the policy contains coverage
2for the diagnosis and treatment of infertility including, but
3not limited to, in vitro fertilization, uterine embryo lavage,
4embryo transfer, artificial insemination, gamete
5intrafallopian tube transfer, zygote intrafallopian tube
6transfer, and low tubal ovum transfer.
7    (a-5) No group policy of accident and health insurance
8providing coverage for more than 25 employees that provides
9pregnancy related benefits may be issued, amended, delivered,
10or renewed in this State on or after January 1, 2024 unless the
11policy contains coverage for the diagnosis and treatment of
12infertility, including, but not limited to, in vitro
13fertilization, uterine embryo lavage, embryo transfer,
14artificial insemination, gamete intrafallopian tube transfer,
15zygote intrafallopian tube transfer, and low tubal ovum
16transfer. The coverage required shall include procedures
17necessary to screen or diagnose a fertilized egg before
18implantation, including, but not limited to, preimplantation
19genetic diagnosis, preimplantation genetic screening, and
20prenatal genetic diagnosis. Coverage for procedures for in
21vitro fertilization, gamete intrafallopian tube transfer, or
22zygote intrafallopian tube transfer shall be required only if
23the procedures:
24        (1) are considered medically appropriate based on
25    clinical guidelines or standards developed by the American
26    Society for Reproductive Medicine, the American College of

 

 

SB2572- 10 -LRB103 32124 BMS 61192 b

1    Obstetricians and Gynecologists, or the Society for
2    Assisted Reproductive Technology; and
3        (2) are performed at medical facilities or clinics
4    that conform to the American College of Obstetricians and
5    Gynecologists guidelines for in vitro fertilization or the
6    American Society for Reproductive Medicine minimum
7    standards for practices offering assisted reproductive
8    technologies.
9    (b) The coverage required under subsection (a) for
10procedures for in vitro fertilization, gamete intrafallopian
11tube transfer, or zygote intrafallopian tube transfer shall be
12required only if is subject to the following conditions:
13        (1) Coverage for procedures for in vitro
14    fertilization, gamete intrafallopian tube transfer, or
15    zygote intrafallopian tube transfer shall be required only
16    if:
17        (1) (A) the covered individual has been unable to
18    attain a viable pregnancy, maintain a viable pregnancy, or
19    sustain a successful pregnancy through reasonable, less
20    costly medically appropriate infertility treatments for
21    which coverage is available under the policy, plan, or
22    contract;
23        (2) (B) the covered individual has not undergone 4
24    completed oocyte retrievals, except that if a live birth
25    follows a completed oocyte retrieval, then 2 more
26    completed oocyte retrievals shall be covered; and

 

 

SB2572- 11 -LRB103 32124 BMS 61192 b

1        (3) (C) the procedures are performed at medical
2    facilities that conform to the American College of
3    Obstetric and Gynecology guidelines for in vitro
4    fertilization clinics or to the American Fertility Society
5    minimal standards for programs of in vitro fertilization.
6        (2) The procedures required to be covered under this
7    Section are not required to be contained in any policy or
8    plan issued to or by a religious institution or
9    organization or to or by an entity sponsored by a
10    religious institution or organization that finds the
11    procedures required to be covered under this Section to
12    violate its religious and moral teachings and beliefs.
13    (c) As used in this Section, "infertility" means a
14disease, condition, or status characterized by:
15        (1) a failure to establish a pregnancy or to carry a
16    pregnancy to live birth after 12 months of regular,
17    unprotected sexual intercourse if the woman is 35 years of
18    age or younger, or after 6 months of regular, unprotected
19    sexual intercourse if the woman is over 35 years of age;
20    conceiving but having a miscarriage does not restart the
21    12-month or 6-month term for determining infertility;
22        (2) a person's inability to reproduce either as a
23    single individual or with a partner without medical
24    intervention; or
25        (3) a licensed physician's findings based on a
26    patient's medical, sexual, and reproductive history, age,

 

 

SB2572- 12 -LRB103 32124 BMS 61192 b

1    physical findings, or diagnostic testing.
2    (d) A policy, contract, or certificate may not impose any
3exclusions, limitations, or other restrictions on coverage of
4fertility medications that are different from those imposed on
5any other prescription medications, nor may it impose any
6exclusions, limitations, or other restrictions on coverage of
7any fertility services based on a covered individual's
8participation in fertility services provided by or to a third
9party, nor may it impose deductibles, copayments, coinsurance,
10benefit maximums, waiting periods, or any other limitations on
11coverage for the diagnosis of infertility, treatment for
12infertility, and standard fertility preservation services,
13except as provided in this Section, that are different from
14those imposed upon benefits for services not related to
15infertility.
16    (e) The procedures required to be covered under this
17Section are not required to be contained in any policy or plan
18issued to or by a religious institution or organization or to
19or by an entity sponsored by a religious institution or
20organization that finds the procedures required to be covered
21under this Section to violate its religious and moral
22teachings and beliefs.
23(Source: P.A. 102-170, eff. 1-1-22.)
 
24    (215 ILCS 5/356z.61 new)
25    Sec. 356z.61. Coverage for annual menopause health visit.

 

 

SB2572- 13 -LRB103 32124 BMS 61192 b

1A group or individual policy of accident and health insurance
2providing coverage for more than 25 employees that is amended,
3delivered, issued, or renewed on or after January 1, 2024
4shall provide, for individuals 45 years of age and older,
5coverage for an annual menopause health visit. A policy
6subject to this Section shall not impose a deductible,
7coinsurance, copayment, or any other cost-sharing requirement
8on the coverage provided; except that this Section does not
9apply to this coverage to the extent such coverage would
10disqualify a high-deductible health plan from eligibility from
11a health savings account pursuant to Section 223 of the
12Internal Revenue Code.
 
13    (215 ILCS 5/356z.62 new)
14    Sec. 356z.62. Coverage for injectable medicines to improve
15glucose or weight loss. A group or individual policy of
16accident and health insurance providing coverage for more than
1725 employees that is amended, delivered, issued, or renewed on
18or after January 1, 2024 shall provide coverage for all types
19of injectable medicines prescribed on-label or off-label to
20improve glucose or weight loss for use by adults diagnosed or
21previously diagnosed with prediabetes, gestational diabetes,
22or obesity.
 
23    Section 30. The Health Maintenance Organization Act is
24amended by changing Section 5-3 as follows:
 

 

 

SB2572- 14 -LRB103 32124 BMS 61192 b

1    (215 ILCS 125/5-3)  (from Ch. 111 1/2, par. 1411.2)
2    Sec. 5-3. Insurance Code provisions.
3    (a) Health Maintenance Organizations shall be subject to
4the provisions of Sections 133, 134, 136, 137, 139, 140,
5141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
6154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2,
7355.3, 355b, 355c, 356g.5-1, 356m, 356q, 356v, 356w, 356x,
8356y, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6,
9356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14,
10356z.15, 356z.17, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25,
11356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33,
12356z.35, 356z.36, 356z.40, 356z.41, 356z.46, 356z.47, 356z.48,
13356z.50, 356z.51, 356z.53 256z.53, 356z.54, 356z.56, 356z.57,
14356z.59, 356z.60, 356z.61, 356z.62, 364, 364.01, 364.3, 367.2,
15367.2-5, 367i, 368a, 368b, 368c, 368d, 368e, 370c, 370c.1,
16401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412, 444, and
17444.1, paragraph (c) of subsection (2) of Section 367, and
18Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV,
19XXVI, and XXXIIB of the Illinois Insurance Code.
20    (b) For purposes of the Illinois Insurance Code, except
21for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
22Health Maintenance Organizations in the following categories
23are deemed to be "domestic companies":
24        (1) a corporation authorized under the Dental Service
25    Plan Act or the Voluntary Health Services Plans Act;

 

 

SB2572- 15 -LRB103 32124 BMS 61192 b

1        (2) a corporation organized under the laws of this
2    State; or
3        (3) a corporation organized under the laws of another
4    state, 30% or more of the enrollees of which are residents
5    of this State, except a corporation subject to
6    substantially the same requirements in its state of
7    organization as is a "domestic company" under Article VIII
8    1/2 of the Illinois Insurance Code.
9    (c) In considering the merger, consolidation, or other
10acquisition of control of a Health Maintenance Organization
11pursuant to Article VIII 1/2 of the Illinois Insurance Code,
12        (1) the Director shall give primary consideration to
13    the continuation of benefits to enrollees and the
14    financial conditions of the acquired Health Maintenance
15    Organization after the merger, consolidation, or other
16    acquisition of control takes effect;
17        (2)(i) the criteria specified in subsection (1)(b) of
18    Section 131.8 of the Illinois Insurance Code shall not
19    apply and (ii) the Director, in making his determination
20    with respect to the merger, consolidation, or other
21    acquisition of control, need not take into account the
22    effect on competition of the merger, consolidation, or
23    other acquisition of control;
24        (3) the Director shall have the power to require the
25    following information:
26            (A) certification by an independent actuary of the

 

 

SB2572- 16 -LRB103 32124 BMS 61192 b

1        adequacy of the reserves of the Health Maintenance
2        Organization sought to be acquired;
3            (B) pro forma financial statements reflecting the
4        combined balance sheets of the acquiring company and
5        the Health Maintenance Organization sought to be
6        acquired as of the end of the preceding year and as of
7        a date 90 days prior to the acquisition, as well as pro
8        forma financial statements reflecting projected
9        combined operation for a period of 2 years;
10            (C) a pro forma business plan detailing an
11        acquiring party's plans with respect to the operation
12        of the Health Maintenance Organization sought to be
13        acquired for a period of not less than 3 years; and
14            (D) such other information as the Director shall
15        require.
16    (d) The provisions of Article VIII 1/2 of the Illinois
17Insurance Code and this Section 5-3 shall apply to the sale by
18any health maintenance organization of greater than 10% of its
19enrollee population (including without limitation the health
20maintenance organization's right, title, and interest in and
21to its health care certificates).
22    (e) In considering any management contract or service
23agreement subject to Section 141.1 of the Illinois Insurance
24Code, the Director (i) shall, in addition to the criteria
25specified in Section 141.2 of the Illinois Insurance Code,
26take into account the effect of the management contract or

 

 

SB2572- 17 -LRB103 32124 BMS 61192 b

1service agreement on the continuation of benefits to enrollees
2and the financial condition of the health maintenance
3organization to be managed or serviced, and (ii) need not take
4into account the effect of the management contract or service
5agreement on competition.
6    (f) Except for small employer groups as defined in the
7Small Employer Rating, Renewability and Portability Health
8Insurance Act and except for medicare supplement policies as
9defined in Section 363 of the Illinois Insurance Code, a
10Health Maintenance Organization may by contract agree with a
11group or other enrollment unit to effect refunds or charge
12additional premiums under the following terms and conditions:
13        (i) the amount of, and other terms and conditions with
14    respect to, the refund or additional premium are set forth
15    in the group or enrollment unit contract agreed in advance
16    of the period for which a refund is to be paid or
17    additional premium is to be charged (which period shall
18    not be less than one year); and
19        (ii) the amount of the refund or additional premium
20    shall not exceed 20% of the Health Maintenance
21    Organization's profitable or unprofitable experience with
22    respect to the group or other enrollment unit for the
23    period (and, for purposes of a refund or additional
24    premium, the profitable or unprofitable experience shall
25    be calculated taking into account a pro rata share of the
26    Health Maintenance Organization's administrative and

 

 

SB2572- 18 -LRB103 32124 BMS 61192 b

1    marketing expenses, but shall not include any refund to be
2    made or additional premium to be paid pursuant to this
3    subsection (f)). The Health Maintenance Organization and
4    the group or enrollment unit may agree that the profitable
5    or unprofitable experience may be calculated taking into
6    account the refund period and the immediately preceding 2
7    plan years.
8    The Health Maintenance Organization shall include a
9statement in the evidence of coverage issued to each enrollee
10describing the possibility of a refund or additional premium,
11and upon request of any group or enrollment unit, provide to
12the group or enrollment unit a description of the method used
13to calculate (1) the Health Maintenance Organization's
14profitable experience with respect to the group or enrollment
15unit and the resulting refund to the group or enrollment unit
16or (2) the Health Maintenance Organization's unprofitable
17experience with respect to the group or enrollment unit and
18the resulting additional premium to be paid by the group or
19enrollment unit.
20    In no event shall the Illinois Health Maintenance
21Organization Guaranty Association be liable to pay any
22contractual obligation of an insolvent organization to pay any
23refund authorized under this Section.
24    (g) Rulemaking authority to implement Public Act 95-1045,
25if any, is conditioned on the rules being adopted in
26accordance with all provisions of the Illinois Administrative

 

 

SB2572- 19 -LRB103 32124 BMS 61192 b

1Procedure Act and all rules and procedures of the Joint
2Committee on Administrative Rules; any purported rule not so
3adopted, for whatever reason, is unauthorized.
4(Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19;
5101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-393, eff.
61-1-20; 101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625,
7eff. 1-1-21; 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
8102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
91-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
10eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
11102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
121-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
13eff. 1-1-23; 102-1117, eff. 1-13-23; revised 1-22-23.)
 
14    Section 35. The Limited Health Service Organization Act is
15amended by changing Section 4003 as follows:
 
16    (215 ILCS 130/4003)  (from Ch. 73, par. 1504-3)
17    Sec. 4003. Illinois Insurance Code provisions. Limited
18health service organizations shall be subject to the
19provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
20141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
21154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 355.2, 355.3,
22355b, 356m, 356q, 356v, 356z.4, 356z.4a, 356z.10, 356z.21,
23356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32,
24356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,

 

 

SB2572- 20 -LRB103 32124 BMS 61192 b

1356z.57, 356z.59, 356z.61, 356z.62, 364.3, 368a, 401, 401.1,
2402, 403, 403A, 408, 408.2, 409, 412, 444, and 444.1 and
3Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and
4XXVI of the Illinois Insurance Code. Nothing in this Section
5shall require a limited health care plan to cover any service
6that is not a limited health service. For purposes of the
7Illinois Insurance Code, except for Sections 444 and 444.1 and
8Articles XIII and XIII 1/2, limited health service
9organizations in the following categories are deemed to be
10domestic companies:
11        (1) a corporation under the laws of this State; or
12        (2) a corporation organized under the laws of another
13    state, 30% or more of the enrollees of which are residents
14    of this State, except a corporation subject to
15    substantially the same requirements in its state of
16    organization as is a domestic company under Article VIII
17    1/2 of the Illinois Insurance Code.
18(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
19101-393, eff. 1-1-20; 101-625, eff. 1-1-21; 102-30, eff.
201-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642,
21eff. 1-1-22; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
22102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860, eff.
231-1-23; 102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23.)
 
24    Section 40. The Voluntary Health Services Plans Act is
25amended by changing Section 10 as follows:
 

 

 

SB2572- 21 -LRB103 32124 BMS 61192 b

1    (215 ILCS 165/10)  (from Ch. 32, par. 604)
2    Sec. 10. Application of Insurance Code provisions. Health
3services plan corporations and all persons interested therein
4or dealing therewith shall be subject to the provisions of
5Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
6143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
7356g, 356g.5, 356g.5-1, 356m, 356q, 356r, 356t, 356u, 356v,
8356w, 356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a,
9356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
10356z.13, 356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22,
11356z.25, 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32,
12356z.33, 356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53,
13356z.54, 356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62,
14364.01, 364.3, 367.2, 368a, 401, 401.1, 402, 403, 403A, 408,
15408.2, and 412, and paragraphs (7) and (15) of Section 367 of
16the Illinois Insurance Code.
17    Rulemaking authority to implement Public Act 95-1045, if
18any, is conditioned on the rules being adopted in accordance
19with all provisions of the Illinois Administrative Procedure
20Act and all rules and procedures of the Joint Committee on
21Administrative Rules; any purported rule not so adopted, for
22whatever reason, is unauthorized.
23(Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19;
24101-281, eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff.
251-1-21; 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; 102-306,

 

 

SB2572- 22 -LRB103 32124 BMS 61192 b

1eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21;
2102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804, eff.
31-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860,
4eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff. 1-1-23;
5102-1117, eff. 1-13-23.)
 
6    Section 45. The Illinois Public Aid Code is amended by
7changing Section 5-16.8 as follows:
 
8    (305 ILCS 5/5-16.8)
9    Sec. 5-16.8. Required health benefits. The medical
10assistance program shall (i) provide the post-mastectomy care
11benefits required to be covered by a policy of accident and
12health insurance under Section 356t and the coverage required
13under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6,
14356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,
15356z.47, 356z.51, 356z.53, 356z.56, 356z.59, and 356z.60, and
16356z.62 of the Illinois Insurance Code, (ii) be subject to the
17provisions of Sections 356z.19, 356z.44, 356z.49, 364.01,
18370c, and 370c.1 of the Illinois Insurance Code, and (iii) be
19subject to the provisions of subsection (d-5) of Section 10 of
20the Network Adequacy and Transparency Act.
21    The Department, by rule, shall adopt a model similar to
22the requirements of Section 356z.39 of the Illinois Insurance
23Code.
24    On and after July 1, 2012, the Department shall reduce any

 

 

SB2572- 23 -LRB103 32124 BMS 61192 b

1rate of reimbursement for services or other payments or alter
2any methodologies authorized by this Code to reduce any rate
3of reimbursement for services or other payments in accordance
4with Section 5-5e.
5    To ensure full access to the benefits set forth in this
6Section, on and after January 1, 2016, the Department shall
7ensure that provider and hospital reimbursement for
8post-mastectomy care benefits required under this Section are
9no lower than the Medicare reimbursement rate.
10(Source: P.A. 101-81, eff. 7-12-19; 101-218, eff. 1-1-20;
11101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-574, eff.
121-1-20; 101-649, eff. 7-7-20; 102-30, eff. 1-1-22; 102-144,
13eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
14102-530, eff. 1-1-22; 102-642, eff. 1-1-22; 102-804, eff.
151-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093,
16eff. 1-1-23; 102-1117, eff. 1-13-23.)
 
17    Section 95. No acceleration or delay. Where this Act makes
18changes in a statute that is represented in this Act by text
19that is not yet or no longer in effect (for example, a Section
20represented by multiple versions), the use of that text does
21not accelerate or delay the taking effect of (i) the changes
22made by this Act or (ii) provisions derived from any other
23Public Act.
 
24    Section 99. Effective date. This Act takes effect upon
25becoming law.

 

 

SB2572- 24 -LRB103 32124 BMS 61192 b

1 INDEX
2 Statutes amended in order of appearance
3    5 ILCS 375/6.11
4    55 ILCS 5/5-1069.3
5    65 ILCS 5/10-4-2.3
6    105 ILCS 5/10-22.3f
7    215 ILCS 5/356mfrom Ch. 73, par. 968m
8    215 ILCS 5/356z.61 new
9    215 ILCS 5/356z.62 new
10    215 ILCS 125/5-3from Ch. 111 1/2, par. 1411.2
11    215 ILCS 130/4003from Ch. 73, par. 1504-3
12    215 ILCS 165/10from Ch. 32, par. 604
13    305 ILCS 5/5-16.8