Sen. Laura M. Murphy
Filed: 2/22/2024
 
 
 




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1
AMENDMENT TO SENATE BILL 2672 


2 AMENDMENT NO. ______. Amend Senate Bill 2672 by replacing 
3everything after the enacting clause with the following:

4 "Section 5. The Illinois Insurance Code is amended by 
5adding Section 356z.71 as follows:

6 (215 ILCS 5/356z.71 new)
7 Sec. 356z.71. Coverage during a generic drug shortage.
8 (a) As used in this Section:
9 "Eligible prescription drug" means a prescription drug 
10approved under 21 U.S.C. 355(c) that is not under patent.
11 "Generic drug" means a drug that is approved pursuant to 
12an application referencing an eligible prescription drug that 
13is submitted under subsection (j) of Section 505 of the 
14Federal Food, Drug, and Cosmetic Act, 21 U.S.C. 355(j). 
15 "Unavailable" means being listed as Currently in Shortage 
16or as a Discontinuation in the United States Food and Drug 
 
 
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1Administration's Drug Shortages Database. "Unavailable" does 
2not include being listed as a Resolved Shortage in the United 
3States Food and Drug Administration's Drug Shortages Database. 
4 (b) If a generic drug or a therapeutic equivalent is 
5unavailable due to a supply issue and dosage cannot be 
6adjusted, a group or individual policy of accident and health 
7insurance or a managed care plan that is amended, delivered, 
8issued, or renewed after January 1, 2026 shall provide 
9coverage for a brand name eligible prescription drug until 
10supply of the generic drug or a therapeutic equivalent is 
11available.

12 Section 10. The Health Maintenance Organization Act is 
13amended by changing Section 5-3 as follows:

14 (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
15 Sec. 5-3. Insurance Code provisions. 
16 (a) Health Maintenance Organizations shall be subject to 
17the provisions of Sections 133, 134, 136, 137, 139, 140, 
18141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 
19154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 155.49, 
20355.2, 355.3, 355b, 355c, 356f, 356g.5-1, 356m, 356q, 356v, 
21356w, 356x, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, 
22356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 
23356z.15, 356z.17, 356z.18, 356z.19, 356z.20, 356z.21, 356z.22, 
24356z.23, 356z.24, 356z.25, 356z.26, 356z.28, 356z.29, 356z.30, 
 
 
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1356z.30a, 356z.31, 356z.32, 356z.33, 356z.34, 356z.35, 
2356z.36, 356z.37, 356z.38, 356z.39, 356z.40, 356z.41, 356z.44, 
3356z.45, 356z.46, 356z.47, 356z.48, 356z.49, 356z.50, 356z.51, 
4356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.58, 356z.59, 
5356z.60, 356z.61, 356z.62, 356z.64, 356z.65, 356z.67, 356z.68, 
6356z.71, 364, 364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b, 
7368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A, 
8408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of 
9subsection (2) of Section 367, and Articles IIA, VIII 1/2, 
10XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the 
11Illinois Insurance Code.
12 (b) For purposes of the Illinois Insurance Code, except 
13for Sections 444 and 444.1 and Articles XIII and XIII 1/2, 
14Health Maintenance Organizations in the following categories 
15are deemed to be "domestic companies":
16  (1) a corporation authorized under the Dental Service 
17 Plan Act or the Voluntary Health Services Plans Act;
18  (2) a corporation organized under the laws of this 
19 State; or
20  (3) a corporation organized under the laws of another 
21 state, 30% or more of the enrollees of which are residents 
22 of this State, except a corporation subject to 
23 substantially the same requirements in its state of 
24 organization as is a "domestic company" under Article VIII 
25 1/2 of the Illinois Insurance Code.
26 (c) In considering the merger, consolidation, or other 
 
 
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1acquisition of control of a Health Maintenance Organization 
2pursuant to Article VIII 1/2 of the Illinois Insurance Code,
3  (1) the Director shall give primary consideration to 
4 the continuation of benefits to enrollees and the 
5 financial conditions of the acquired Health Maintenance 
6 Organization after the merger, consolidation, or other 
7 acquisition of control takes effect;
8  (2)(i) the criteria specified in subsection (1)(b) of 
9 Section 131.8 of the Illinois Insurance Code shall not 
10 apply and (ii) the Director, in making his determination 
11 with respect to the merger, consolidation, or other 
12 acquisition of control, need not take into account the 
13 effect on competition of the merger, consolidation, or 
14 other acquisition of control;
15  (3) the Director shall have the power to require the 
16 following information:
17   (A) certification by an independent actuary of the 
18 adequacy of the reserves of the Health Maintenance 
19 Organization sought to be acquired;
20   (B) pro forma financial statements reflecting the 
21 combined balance sheets of the acquiring company and 
22 the Health Maintenance Organization sought to be 
23 acquired as of the end of the preceding year and as of 
24 a date 90 days prior to the acquisition, as well as pro 
25 forma financial statements reflecting projected 
26 combined operation for a period of 2 years;
 
 
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1   (C) a pro forma business plan detailing an 
2 acquiring party's plans with respect to the operation 
3 of the Health Maintenance Organization sought to be 
4 acquired for a period of not less than 3 years; and
5   (D) such other information as the Director shall 
6 require.
7 (d) The provisions of Article VIII 1/2 of the Illinois 
8Insurance Code and this Section 5-3 shall apply to the sale by 
9any health maintenance organization of greater than 10% of its 
10enrollee population (including, without limitation, the health 
11maintenance organization's right, title, and interest in and 
12to its health care certificates).
13 (e) In considering any management contract or service 
14agreement subject to Section 141.1 of the Illinois Insurance 
15Code, the Director (i) shall, in addition to the criteria 
16specified in Section 141.2 of the Illinois Insurance Code, 
17take into account the effect of the management contract or 
18service agreement on the continuation of benefits to enrollees 
19and the financial condition of the health maintenance 
20organization to be managed or serviced, and (ii) need not take 
21into account the effect of the management contract or service 
22agreement on competition.
23 (f) Except for small employer groups as defined in the 
24Small Employer Rating, Renewability and Portability Health 
25Insurance Act and except for medicare supplement policies as 
26defined in Section 363 of the Illinois Insurance Code, a 
 
 
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1Health Maintenance Organization may by contract agree with a 
2group or other enrollment unit to effect refunds or charge 
3additional premiums under the following terms and conditions:
4  (i) the amount of, and other terms and conditions with 
5 respect to, the refund or additional premium are set forth 
6 in the group or enrollment unit contract agreed in advance 
7 of the period for which a refund is to be paid or 
8 additional premium is to be charged (which period shall 
9 not be less than one year); and
10  (ii) the amount of the refund or additional premium 
11 shall not exceed 20% of the Health Maintenance 
12 Organization's profitable or unprofitable experience with 
13 respect to the group or other enrollment unit for the 
14 period (and, for purposes of a refund or additional 
15 premium, the profitable or unprofitable experience shall 
16 be calculated taking into account a pro rata share of the 
17 Health Maintenance Organization's administrative and 
18 marketing expenses, but shall not include any refund to be 
19 made or additional premium to be paid pursuant to this 
20 subsection (f)). The Health Maintenance Organization and 
21 the group or enrollment unit may agree that the profitable 
22 or unprofitable experience may be calculated taking into 
23 account the refund period and the immediately preceding 2 
24 plan years.
25 The Health Maintenance Organization shall include a 
26statement in the evidence of coverage issued to each enrollee 
 
 
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1describing the possibility of a refund or additional premium, 
2and upon request of any group or enrollment unit, provide to 
3the group or enrollment unit a description of the method used 
4to calculate (1) the Health Maintenance Organization's 
5profitable experience with respect to the group or enrollment 
6unit and the resulting refund to the group or enrollment unit 
7or (2) the Health Maintenance Organization's unprofitable 
8experience with respect to the group or enrollment unit and 
9the resulting additional premium to be paid by the group or 
10enrollment unit.
11 In no event shall the Illinois Health Maintenance 
12Organization Guaranty Association be liable to pay any 
13contractual obligation of an insolvent organization to pay any 
14refund authorized under this Section.
15 (g) Rulemaking authority to implement Public Act 95-1045, 
16if any, is conditioned on the rules being adopted in 
17accordance with all provisions of the Illinois Administrative 
18Procedure Act and all rules and procedures of the Joint 
19Committee on Administrative Rules; any purported rule not so 
20adopted, for whatever reason, is unauthorized. 
21(Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21; 
22102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 
231-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, 
24eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 
25102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 
261-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, 
 
 
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1eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 
2103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff. 
36-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445, 
4eff. 1-1-24; 103-551, eff. 8-11-23; revised 8-29-23.)

5 Section 15. The Limited Health Service Organization Act is 
6amended by changing Section 4003 as follows:

7 (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
8 Sec. 4003. Illinois Insurance Code provisions. Limited 
9health service organizations shall be subject to the 
10provisions of Sections 133, 134, 136, 137, 139, 140, 141.1, 
11141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154, 
12154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 355.2, 
13355.3, 355b, 356q, 356v, 356z.4, 356z.4a, 356z.10, 356z.21, 
14356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 
15356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54, 
16356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68, 356z.71, 
17364.3, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412, 
18444, and 444.1 and Articles IIA, VIII 1/2, XII, XII 1/2, XIII, 
19XIII 1/2, XXV, and XXVI of the Illinois Insurance Code. 
20Nothing in this Section shall require a limited health care 
21plan to cover any service that is not a limited health service. 
22For purposes of the Illinois Insurance Code, except for 
23Sections 444 and 444.1 and Articles XIII and XIII 1/2, limited 
24health service organizations in the following categories are 
 
 
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1deemed to be domestic companies:
2  (1) a corporation under the laws of this State; or
3  (2) 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(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; 
10102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-731, eff. 
111-1-23; 102-775, eff. 5-13-22; 102-813, eff. 5-13-22; 102-816, 
12eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 
13102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff. 
141-1-24; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445, 
15eff. 1-1-24; revised 8-29-23.)

16 Section 20. The Voluntary Health Services Plans Act is 
17amended by changing Section 10 as follows:

18 (215 ILCS 165/10) (from Ch. 32, par. 604)
19 Sec. 10. Application of Insurance Code provisions. Health 
20services plan corporations and all persons interested therein 
21or dealing therewith shall be subject to the provisions of 
22Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140, 
23143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, 
24356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356v, 356w, 
 
 
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1356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 
2356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 
3356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 
4356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33, 
5356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54, 
6356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64, 
7356z.67, 356z.68, 356z.71, 364.01, 364.3, 367.2, 368a, 401, 
8401.1, 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7) 
9and (15) of Section 367 of the Illinois Insurance Code.
10 Rulemaking authority to implement Public Act 95-1045, if 
11any, is conditioned on the rules being adopted in accordance 
12with all provisions of the Illinois Administrative Procedure 
13Act and all rules and procedures of the Joint Committee on 
14Administrative Rules; any purported rule not so adopted, for 
15whatever reason, is unauthorized. 
16(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; 
17102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 
1810-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804, 
19eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 
20102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff. 
211-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, 
22eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24; 
23103-551, eff. 8-11-23; revised 8-29-23.)

24 Section 25. The Illinois Public Aid Code is amended by 
25changing Section 5-16.8 as follows:

 
 
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1 (305 ILCS 5/5-16.8)
2 Sec. 5-16.8. Required health benefits. The medical 
3assistance program shall (i) provide the post-mastectomy care 
4benefits required to be covered by a policy of accident and 
5health insurance under Section 356t and the coverage required 
6under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6, 
7356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46, 
8356z.47, 356z.51, 356z.53, 356z.56, 356z.59, 356z.60, and 
9356z.61, 356z.64, 356z.67, and 356z.71 of the Illinois 
10Insurance Code, (ii) be subject to the provisions of Sections 
11356z.19, 356z.44, 356z.49, 364.01, 370c, and 370c.1 of the 
12Illinois Insurance Code, and (iii) be subject to the 
13provisions of subsection (d-5) of Section 10 of the Network 
14Adequacy and Transparency Act.
15 The Department, by rule, shall adopt a model similar to 
16the requirements of Section 356z.39 of the Illinois Insurance 
17Code. 
18 On and after July 1, 2012, the Department shall reduce any 
19rate of reimbursement for services or other payments or alter 
20any methodologies authorized by this Code to reduce any rate 
21of reimbursement for services or other payments in accordance 
22with Section 5-5e. 
23 To ensure full access to the benefits set forth in this 
24Section, on and after January 1, 2016, the Department shall 
25ensure that provider and hospital reimbursement for 
 
 
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