HB2499 Enrolled LRB103 30875 AMQ 57395 b
1		AN ACT concerning regulation.
2		Be it enacted by the People of the State of Illinois,
3		represented in the General Assembly:
4		Section 5. The Illinois Insurance Code is amended by
5		changing Sections 121-2.05, 356z.18, 367.3, 367a, and 368f and
6		by adding Section 352c as follows:
7		(215 ILCS 5/121-2.05) (from Ch. 73, par. 733-2.05)
8		Sec. 121-2.05. Group insurance policies issued and
9		delivered in other State-Transactions in this State. With the
10		exception of insurance transactions authorized under Sections
11		230.2 or 367.3 of this Code or transactions described under
12		Section 352c, transactions in this State involving group
13		legal, group life and group accident and health or blanket
14		accident and health insurance or group annuities where the
15		master policy of such groups was lawfully issued and delivered
16		in, and under the laws of, a State in which the insurer was
17		authorized to do an insurance business, to a group properly
18		established pursuant to law or regulation, and where the
19		policyholder is domiciled or otherwise has a bona fide situs.
20		(Source: P.A. 86-753.)
21		(215 ILCS 5/352c new)
22		Sec. 352c. Short-term, limited-duration insurance

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1		prohibited.
2		(a) In this Section:
3		"Excepted benefits" has the meaning given to that term in
4		42 U.S.C. 300gg-91 and implementing regulations. "Excepted
5		benefits" includes individual, group, or blanket coverage.
6		"Short-term, limited-duration insurance" means any type of
7		accident and health insurance offered or provided within this
8		State pursuant to a group or individual policy or individual
9		certificate by a company, regardless of the situs state of the
10		delivery of the policy, that has an expiration date specified
11		in the contract that is fewer than 365 days after the original
12		effective date. Regardless of the duration of coverage,
13		"short-term, limited-duration insurance" does not include
14		excepted benefits or any student health insurance coverage.
15		(b) On and after January 1, 2025, no company shall issue,
16		deliver, amend, or renew short-term, limited-duration
17		insurance to any natural or legal person that is a resident or
18		domiciled in this State.
19		(215 ILCS 5/356z.18)
20		(Text of Section before amendment by P.A. 103-512)
21		Sec. 356z.18. Prosthetic and customized orthotic devices.
22		(a) For the purposes of this Section:
23		"Customized orthotic device" means a supportive device for
24		the body or a part of the body, the head, neck, or extremities,
25		and includes the replacement or repair of the device based on

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1		the patient's physical condition as medically necessary,
2		excluding foot orthotics defined as an in-shoe device designed
3		to support the structural components of the foot during
4		weight-bearing activities.
5		"Licensed provider" means a prosthetist, orthotist, or
6		pedorthist licensed to practice in this State.
7		"Prosthetic device" means an artificial device to replace,
8		in whole or in part, an arm or leg and includes accessories
9		essential to the effective use of the device and the
10		replacement or repair of the device based on the patient's
11		physical condition as medically necessary.
12		(b) This amendatory Act of the 96th General Assembly shall
13		provide benefits to any person covered thereunder for expenses
14		incurred in obtaining a prosthetic or custom orthotic device
15		from any Illinois licensed prosthetist, licensed orthotist, or
16		licensed pedorthist as required under the Orthotics,
17		Prosthetics, and Pedorthics Practice Act.
18		(c) A group or individual major medical policy of accident
19		or health insurance or managed care plan or medical, health,
20		or hospital service corporation contract that provides
21		coverage for prosthetic or custom orthotic care and is
22		amended, delivered, issued, or renewed 6 months after the
23		effective date of this amendatory Act of the 96th General
24		Assembly must provide coverage for prosthetic and orthotic
25		devices in accordance with this subsection (c). The coverage
26		required under this Section shall be subject to the other

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1		general exclusions, limitations, and financial requirements of
2		the policy, including coordination of benefits, participating
3		provider requirements, utilization review of health care
4		services, including review of medical necessity, case
5		management, and experimental and investigational treatments,
6		and other managed care provisions under terms and conditions
7		that are no less favorable than the terms and conditions that
8		apply to substantially all medical and surgical benefits
9		provided under the plan or coverage.
10		(d) The policy or plan or contract may require prior
11		authorization for the prosthetic or orthotic devices in the
12		same manner that prior authorization is required for any other
13		covered benefit.
14		(e) Repairs and replacements of prosthetic and orthotic
15		devices are also covered, subject to the co-payments and
16		deductibles, unless necessitated by misuse or loss.
17		(f) A policy or plan or contract may require that, if
18		coverage is provided through a managed care plan, the benefits
19		mandated pursuant to this Section shall be covered benefits
20		only if the prosthetic or orthotic devices are provided by a
21		licensed provider employed by a provider service who contracts
22		with or is designated by the carrier, to the extent that the
23		carrier provides in-network and out-of-network service, the
24		coverage for the prosthetic or orthotic device shall be
25		offered no less extensively.
26		(g) The policy or plan or contract shall also meet

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1		adequacy requirements as established by the Health Care
2		Reimbursement Reform Act of 1985 of the Illinois Insurance
3		Code.
4		(h) This Section shall not apply to accident only,
5		specified disease, short-term travel hospital or medical,
6		hospital confinement indemnity or other fixed indemnity,
7		credit, dental, vision, Medicare supplement, long-term care,
8		basic hospital and medical-surgical expense coverage,
9		disability income insurance coverage, coverage issued as a
10		supplement to liability insurance, workers' compensation
11		insurance, or automobile medical payment insurance.
12		(Source: P.A. 96-833, eff. 6-1-10.)
13		(Text of Section after amendment by P.A. 103-512)
14		Sec. 356z.18. Prosthetic and customized orthotic devices.
15		(a) For the purposes of this Section:
16		"Customized orthotic device" means a supportive device for
17		the body or a part of the body, the head, neck, or extremities,
18		and includes the replacement or repair of the device based on
19		the patient's physical condition as medically necessary,
20		excluding foot orthotics defined as an in-shoe device designed
21		to support the structural components of the foot during
22		weight-bearing activities.
23		"Licensed provider" means a prosthetist, orthotist, or
24		pedorthist licensed to practice in this State.
25		"Prosthetic device" means an artificial device to replace,

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1		in whole or in part, an arm or leg and includes accessories
2		essential to the effective use of the device and the
3		replacement or repair of the device based on the patient's
4		physical condition as medically necessary.
5		(b) This amendatory Act of the 96th General Assembly shall
6		provide benefits to any person covered thereunder for expenses
7		incurred in obtaining a prosthetic or custom orthotic device
8		from any Illinois licensed prosthetist, licensed orthotist, or
9		licensed pedorthist as required under the Orthotics,
10		Prosthetics, and Pedorthics Practice Act.
11		(c) A group or individual major medical policy of accident
12		or health insurance or managed care plan or medical, health,
13		or hospital service corporation contract that provides
14		coverage for prosthetic or custom orthotic care and is
15		amended, delivered, issued, or renewed 6 months after the
16		effective date of this amendatory Act of the 96th General
17		Assembly must provide coverage for prosthetic and orthotic
18		devices in accordance with this subsection (c). The coverage
19		required under this Section shall be subject to the other
20		general exclusions, limitations, and financial requirements of
21		the policy, including coordination of benefits, participating
22		provider requirements, utilization review of health care
23		services, including review of medical necessity, case
24		management, and experimental and investigational treatments,
25		and other managed care provisions under terms and conditions
26		that are no less favorable than the terms and conditions that

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1		apply to substantially all medical and surgical benefits
2		provided under the plan or coverage.
3		(d) With respect to an enrollee at any age, in addition to
4		coverage of a prosthetic or custom orthotic device required by
5		this Section, benefits shall be provided for a prosthetic or
6		custom orthotic device determined by the enrollee's provider
7		to be the most appropriate model that is medically necessary
8		for the enrollee to perform physical activities, as
9		applicable, such as running, biking, swimming, and lifting
10		weights, and to maximize the enrollee's whole body health and
11		strengthen the lower and upper limb function.
12		(e) The requirements of this Section do not constitute an
13		addition to this State's essential health benefits that
14		requires defrayal of costs by this State pursuant to 42 U.S.C.
15		18031(d)(3)(B).
16		(f) The policy or plan or contract may require prior
17		authorization for the prosthetic or orthotic devices in the
18		same manner that prior authorization is required for any other
19		covered benefit.
20		(g) Repairs and replacements of prosthetic and orthotic
21		devices are also covered, subject to the co-payments and
22		deductibles, unless necessitated by misuse or loss.
23		(h) A policy or plan or contract may require that, if
24		coverage is provided through a managed care plan, the benefits
25		mandated pursuant to this Section shall be covered benefits
26		only if the prosthetic or orthotic devices are provided by a

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1		licensed provider employed by a provider service who contracts
2		with or is designated by the carrier, to the extent that the
3		carrier provides in-network and out-of-network service, the
4		coverage for the prosthetic or orthotic device shall be
5		offered no less extensively.
6		(i) The policy or plan or contract shall also meet
7		adequacy requirements as established by the Health Care
8		Reimbursement Reform Act of 1985 of the Illinois Insurance
9		Code.
10		(j) This Section shall not apply to accident only,
11		specified disease, short-term travel hospital or medical,
12		hospital confinement indemnity or other fixed indemnity,
13		credit, dental, vision, Medicare supplement, long-term care,
14		basic hospital and medical-surgical expense coverage,
15		disability income insurance coverage, coverage issued as a
16		supplement to liability insurance, workers' compensation
17		insurance, or automobile medical payment insurance.
18		(Source: P.A. 103-512, eff. 1-1-25.)
19		(215 ILCS 5/367.3) (from Ch. 73, par. 979.3)
20		Sec. 367.3. Group accident and health insurance;
21		discretionary groups.
22		(a) No group health insurance offered to a resident of
23		this State under a policy issued to a group, other than one
24		specifically described in Section 367(1), shall be delivered
25		or issued for delivery in this State unless the Director

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1		determines that:
2		(1) the issuance of the policy is not contrary to the
3		public interest;
4		(2) the issuance of the policy will result in
5		economies of acquisition and administration; and
6		(3) the benefits under the policy are reasonable in
7		relation to the premium charged.
8		(b) No such group health insurance may be offered in this
9		State under a policy issued in another state unless this State
10		or the state in which the group policy is issued has made a
11		determination that the requirements of subsection (a) have
12		been met.
13		Where insurance is to be offered in this State under a
14		policy described in this subsection, the insurer shall file
15		for informational review purposes:
16		(1) a copy of the group master contract;
17		(2) a copy of the statute authorizing the issuance of
18		the group policy in the state of situs, which statute has
19		the same or similar requirements as this State, or in the
20		absence of such statute, a certification by an officer of
21		the company that the policy meets the Illinois minimum
22		standards required for individual accident and health
23		policies under authority of Section 401 of this Code, as
24		now or hereafter amended, as promulgated by rule at 50
25		Illinois Administrative Code, Ch. I, Sec. 2007, et seq.,
26		as now or hereafter amended, or by a successor rule;

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1		(3) evidence of approval by the state of situs of the
2		group master policy; and
3		(4) copies of all supportive material furnished to the
4		state of situs to satisfy the criteria for approval.
5		(c) The Director may, at any time after receipt of the
6		information required under subsection (b) and after finding
7		that the standards of subsection (a) have not been met, order
8		the insurer to cease the issuance or marketing of that
9		coverage in this State.
10		(d) Notwithstanding subsections (a) and (b), group Group
11		accident and health insurance subject to the provisions of
12		this Section is also subject to the provisions of Sections
13		352c and Section 367i of this Code and rules thereunder.
14		(Source: P.A. 90-655, eff. 7-30-98.)
15		(215 ILCS 5/367a) (from Ch. 73, par. 979a)
16		Sec. 367a. Blanket accident and health insurance.
17		(1) Blanket accident and health insurance is the that form
18		of accident and health insurance providing excepted benefits,
19		as defined in Section 352c, that covers covering special
20		groups of persons as enumerated in one of the following
21		paragraphs (a) to (g), inclusive:
22		(a) Under a policy or contract issued to any carrier for
23		hire, which shall be deemed the policyholder, covering a group
24		defined as all persons who may become passengers on such
25		carrier.

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1		(b) Under a policy or contract issued to an employer, who
2		shall be deemed the policyholder, covering all employees or
3		any group of employees defined by reference to exceptional
4		hazards incident to such employment.
5		(c) Under a policy or contract issued to a college,
6		school, or other institution of learning or to the head or
7		principal thereof, who or which shall be deemed the
8		policyholder, covering students or teachers. However, student
9		health insurance coverage, as defined in 45 CFR 147.145, shall
10		remain subject to the standards and requirements for
11		individual health insurance coverage except where inconsistent
12		with that regulation. An issuer providing student health
13		insurance coverage or a policy or contract covering students
14		for limited-scope dental or vision under 45 CFR 148.220 shall
15		require an individual application or enrollment form and shall
16		furnish each insured individual a certificate, which shall
17		have been approved by the Director under Section 355.
18		(d) Under a policy or contract issued in the name of any
19		volunteer fire department, first aid, or other such volunteer
20		group, which shall be deemed the policyholder, covering all of
21		the members of such department or group.
22		(e) Under a policy or contract issued to a creditor, who
23		shall be deemed the policyholder, to insure debtors of the
24		creditors; Provided, however, that in the case of a loan which
25		is subject to the Small Loans Act, no insurance premium or
26		other cost shall be directly or indirectly charged or assessed

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1		against, or collected or received from the borrower.
2		(f) Under a policy or contract issued to a sports team or
3		to a camp, which team or camp sponsor shall be deemed the
4		policyholder, covering members or campers.
5		(g) Under a policy or contract issued to any other
6		substantially similar group which, in the discretion of the
7		Director, may be subject to the issuance of a blanket accident
8		and health policy or contract.
9		(2) Any insurance company authorized to write accident and
10		health insurance in this state shall have the power to issue
11		blanket accident and health insurance. No such blanket policy
12		may be issued or delivered in this State unless a copy of the
13		form thereof shall have been filed in accordance with Section
14		355, and it contains in substance such of those provisions
15		contained in Sections 357.1 through 357.30 as may be
16		applicable to blanket accident and health insurance and the
17		following provisions:
18		(a) A provision that the policy and the application shall
19		constitute the entire contract between the parties, and that
20		all statements made by the policyholder shall, in absence of
21		fraud, be deemed representations and not warranties, and that
22		no such statements shall be used in defense to a claim under
23		the policy, unless it is contained in a written application.
24		(b) A provision that to the group or class thereof
25		originally insured shall be added from time to time all new
26		persons or individuals eligible for coverage.

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1		(3) An individual application shall not be required from a
2		person covered under a blanket accident or health policy or
3		contract, nor shall it be necessary for the insurer to furnish
4		each person a certificate.
5		(4) All benefits under any blanket accident and health
6		policy shall be payable to the person insured, or to his
7		designated beneficiary or beneficiaries, or to his or her
8		estate, except that if the person insured be a minor or person
9		under legal disability, such benefits may be made payable to
10		his or her parent, guardian, or other person actually
11		supporting him or her. Provided further, however, that the
12		policy may provide that all or any portion of any indemnities
13		provided by any such policy on account of hospital, nursing,
14		medical or surgical services may, at the insurer's option, be
15		paid directly to the hospital or person rendering such
16		services; but the policy may not require that the service be
17		rendered by a particular hospital or person. Payment so made
18		shall discharge the insurer's obligation with respect to the
19		amount of insurance so paid.
20		(5) Nothing contained in this section shall be deemed to
21		affect the legal liability of policyholders for the death of
22		or injury to, any such member of such group.
23		(Source: P.A. 83-1362.)
24		(215 ILCS 5/368f)
25		Sec. 368f. Military service member insurance

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1		reinstatement.
2		(a) No Illinois resident activated for military service
3		and no spouse or dependent of the resident who becomes
4		eligible for a federal government-sponsored health insurance
5		program, including the TriCare program providing coverage for
6		civilian dependents of military personnel, as a result of the
7		activation shall be denied reinstatement into the same
8		individual health insurance coverage with the health insurer
9		that the resident lapsed as a result of activation or becoming
10		covered by the federal government-sponsored health insurance
11		program. The resident shall have the right to reinstatement in
12		the same individual health insurance coverage without medical
13		underwriting, subject to payment of the current premium
14		charged to other persons of the same age and gender that are
15		covered under the same individual health coverage. Except in
16		the case of birth or adoption that occurs during the period of
17		activation, reinstatement must be into the same coverage type
18		as the resident held prior to lapsing the individual health
19		insurance coverage and at the same or, at the option of the
20		resident, higher deductible level. The reinstatement rights
21		provided under this subsection (a) are not available to a
22		resident or dependents if the activated person is discharged
23		from the military under other than honorable conditions.
24		(b) The health insurer with which the reinstatement is
25		being requested must receive a request for reinstatement no
26		later than 63 days following the later of (i) deactivation or

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1		(ii) loss of coverage under the federal government-sponsored
2		health insurance program. The health insurer may request proof
3		of loss of coverage and the timing of the loss of coverage of
4		the government-sponsored coverage in order to determine
5		eligibility for reinstatement into the individual coverage.
6		The effective date of the reinstatement of individual health
7		coverage shall be the first of the month following receipt of
8		the notice requesting reinstatement.
9		(c) All insurers must provide written notice to the
10		policyholder of individual health coverage of the rights
11		described in subsection (a) of this Section. In lieu of the
12		inclusion of the notice in the individual health insurance
13		policy, an insurance company may satisfy the notification
14		requirement by providing a single written notice:
15		(1) in conjunction with the enrollment process for a
16		policyholder initially enrolling in the individual
17		coverage on or after the effective date of this amendatory
18		Act of the 94th General Assembly; or
19		(2) by mailing written notice to policyholders whose
20		coverage was effective prior to the effective date of this
21		amendatory Act of the 94th General Assembly no later than
22		90 days following the effective date of this amendatory
23		Act of the 94th General Assembly.
24		(d) The provisions of subsection (a) of this Section do
25		not apply to any policy or certificate providing coverage for
26		any specified disease, specified accident or accident-only

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1		coverage, credit, dental, disability income, hospital
2		indemnity or other fixed indemnity, long-term care, Medicare
3		supplement, vision care, or short-term travel nonrenewable
4		health policy or other limited-benefit supplemental insurance,
5		or any coverage issued as a supplement to any liability
6		insurance, workers' compensation or similar insurance, or any
7		insurance under which benefits are payable with or without
8		regard to fault, whether written on a group, blanket, or
9		individual basis.
10		(e) Nothing in this Section shall require an insurer to
11		reinstate the resident if the insurer requires residency in an
12		enrollment area and those residency requirements are not met
13		after deactivation or loss of coverage under the
14		government-sponsored health insurance program.
15		(f) All terms, conditions, and limitations of the
16		individual coverage into which reinstatement is made apply
17		equally to all insureds enrolled in the coverage.
18		(g) The Secretary may adopt rules as may be necessary to
19		carry out the provisions of this Section.
20		(Source: P.A. 94-1037, eff. 7-20-06.)
21		Section 10. The Health Maintenance Organization Act is
22		amended by changing Section 5-3 as follows:
23		(215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
24		Sec. 5-3. Insurance Code provisions.

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1		(a) Health Maintenance Organizations shall be subject to
2		the provisions of Sections 133, 134, 136, 137, 139, 140,
3		141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
4		154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 155.49,
5		352c, 355.2, 355.3, 355b, 355c, 356f, 356g.5-1, 356m, 356q,
6		356v, 356w, 356x, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5,
7		356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
8		356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.20, 356z.21,
9		356z.22, 356z.23, 356z.24, 356z.25, 356z.26, 356z.28, 356z.29,
10		356z.30, 356z.30a, 356z.31, 356z.32, 356z.33, 356z.34,
11		356z.35, 356z.36, 356z.37, 356z.38, 356z.39, 356z.40, 356z.41,
12		356z.44, 356z.45, 356z.46, 356z.47, 356z.48, 356z.49, 356z.50,
13		356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.58,
14		356z.59, 356z.60, 356z.61, 356z.62, 356z.64, 356z.65, 356z.67,
15		356z.68, 364, 364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b,
16		368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A,
17		408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of
18		subsection (2) of Section 367, and Articles IIA, VIII 1/2,
19		XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the
20		Illinois Insurance Code.
21		(b) For purposes of the Illinois Insurance Code, except
22		for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
23		Health Maintenance Organizations in the following categories
24		are deemed to be "domestic companies":
25		(1) a corporation authorized under the Dental Service
26		Plan Act or the Voluntary Health Services Plans Act;

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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
10		acquisition of control of a Health Maintenance Organization
11		pursuant 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

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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
17		Insurance Code and this Section 5-3 shall apply to the sale by
18		any health maintenance organization of greater than 10% of its
19		enrollee population (including, without limitation, the health
20		maintenance organization's right, title, and interest in and
21		to its health care certificates).
22		(e) In considering any management contract or service
23		agreement subject to Section 141.1 of the Illinois Insurance
24		Code, the Director (i) shall, in addition to the criteria
25		specified in Section 141.2 of the Illinois Insurance Code,
26		take into account the effect of the management contract or

HB2499 Enrolled - 20 - LRB103 30875 AMQ 57395 b
1		service agreement on the continuation of benefits to enrollees
2		and the financial condition of the health maintenance
3		organization to be managed or serviced, and (ii) need not take
4		into account the effect of the management contract or service
5		agreement on competition.
6		(f) Except for small employer groups as defined in the
7		Small Employer Rating, Renewability and Portability Health
8		Insurance Act and except for medicare supplement policies as
9		defined in Section 363 of the Illinois Insurance Code, a
10		Health Maintenance Organization may by contract agree with a
11		group or other enrollment unit to effect refunds or charge
12		additional 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

HB2499 Enrolled - 21 - LRB103 30875 AMQ 57395 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
9		statement in the evidence of coverage issued to each enrollee
10		describing the possibility of a refund or additional premium,
11		and upon request of any group or enrollment unit, provide to
12		the group or enrollment unit a description of the method used
13		to calculate (1) the Health Maintenance Organization's
14		profitable experience with respect to the group or enrollment
15		unit and the resulting refund to the group or enrollment unit
16		or (2) the Health Maintenance Organization's unprofitable
17		experience with respect to the group or enrollment unit and
18		the resulting additional premium to be paid by the group or
19		enrollment unit.
20		In no event shall the Illinois Health Maintenance
21		Organization Guaranty Association be liable to pay any
22		contractual obligation of an insolvent organization to pay any
23		refund authorized under this Section.
24		(g) Rulemaking authority to implement Public Act 95-1045,
25		if any, is conditioned on the rules being adopted in
26		accordance with all provisions of the Illinois Administrative

HB2499 Enrolled - 22 - LRB103 30875 AMQ 57395 b
1		Procedure Act and all rules and procedures of the Joint
2		Committee on Administrative Rules; any purported rule not so
3		adopted, for whatever reason, is unauthorized.
4		(Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
5		102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
6		1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
7		eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
8		102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
9		1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
10		eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;
11		103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.
12		6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
13		eff. 1-1-24; 103-551, eff. 8-11-23; revised 8-29-23.)
14		Section 15. The Limited Health Service Organization Act is
15		amended 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
18		health service organizations shall be subject to the
19		provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
20		141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
21		154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 352c,
22		355.2, 355.3, 355b, 356q, 356v, 356z.4, 356z.4a, 356z.10,
23		356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30a,
24		356z.32, 356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53,

HB2499 Enrolled - 23 - LRB103 30875 AMQ 57395 b
1		356z.54, 356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68,
2		364.3, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412,
3		444, and 444.1 and Articles IIA, VIII 1/2, XII, XII 1/2, XIII,
4		XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.
5		Nothing in this Section shall require a limited health care
6		plan to cover any service that is not a limited health service.
7		For purposes of the Illinois Insurance Code, except for
8		Sections 444 and 444.1 and Articles XIII and XIII 1/2, limited
9		health service organizations in the following categories are
10		deemed to be domestic 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. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
19		102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-731, eff.
20		1-1-23; 102-775, eff. 5-13-22; 102-813, eff. 5-13-22; 102-816,
21		eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
22		102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
23		1-1-24; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
24		eff. 1-1-24; revised 8-29-23.)
25		(215 ILCS 190/Act rep.)

HB2499 Enrolled - 24 - LRB103 30875 AMQ 57395 b
1		Section 20. The Short-Term, Limited-Duration Health
2		Insurance Coverage Act is repealed.
3		Section 95. No acceleration or delay. Where this Act makes
4		changes in a statute that is represented in this Act by text
5		that is not yet or no longer in effect (for example, a Section
6		represented by multiple versions), the use of that text does
7		not accelerate or delay the taking effect of (i) the changes
8		made by this Act or (ii) provisions derived from any other
9		Public Act.