Bill Text: IL HB2805 | 2025-2026 | 104th General Assembly | Introduced

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Bill Title: Amends the Illinois Insurance Code. In a provision requiring policies of group accident and health insurance to provide coverage for certain examination and testing services provided to a victim of specified criminal offenses, prohibits the policy from imposing a deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage provided, except to the extent that the coverage would disqualify a high-deductible health plan from eligibility for a health savings account under the Internal Revenue Code. Effective January 1, 2026.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced) 2025-02-06 - Referred to Rules Committee [HB2805 Detail]

Download: Illinois-2025-HB2805-Introduced.html

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104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB2805 Introduced , by Rep. Tony M. McCombie SYNOPSIS AS INTRODUCED:
215 ILCS 5/356e from Ch. 73, par. 968e
215 ILCS 5/367 from Ch. 73, par. 979
Amends the Illinois Insurance Code. In a provision requiring policies of group accident and health insurance to provide coverage for certain examination and testing services provided to a victim of specified criminal offenses, prohibits the policy from imposing a deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage provided, except to the extent that the coverage would disqualify a high-deductible health plan from eligibility for a health savings account under the Internal Revenue Code. Effective January 1, 2026.
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A BILL FOR
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AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Illinois Insurance Code is amended by
changing Sections 356e and 367 as follows:
(215 ILCS 5/356e) (from Ch. 73, par. 968e)
Sec. 356e. Victims of certain offenses.
(1) No individual policy of accident and health insurance,
which provides benefits for hospital or medical expenses based
upon the actual expenses incurred, delivered, or issued for
delivery to any person in this State shall contain any
specific exception to coverage which would preclude the
payment under that policy of actual expenses incurred in the
examination and testing of a victim of an offense defined in
Sections 11-1.20 through 11-1.60 or 12-13 through 12-16 of the
Criminal Code of 1961 or the Criminal Code of 2012, or an
attempt to commit such offense to establish that sexual
contact did occur or did not occur, and to establish the
presence or absence of sexually transmitted disease or
infection, and examination and treatment of injuries and
trauma sustained by a victim of such offense arising out of the
offense. A policy subject to this subsection shall not impose
a deductible, coinsurance, copayment, or any other

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cost-sharing requirement on the coverage provided, except that
this subsection does not apply to the extent that the coverage
would disqualify a high-deductible health plan from
eligibility for a health savings account pursuant to Section
223 of the Internal Revenue Code. Every policy of accident and
health insurance which specifically provides benefits for
routine physical examinations shall provide full coverage for
expenses incurred in the examination and testing of a victim
of an offense defined in Sections 11-1.20 through 11-1.60 or
12-13 through 12-16 of the Criminal Code of 1961 or the
Criminal Code of 2012, or an attempt to commit such offense as
set forth in this Section. This Section shall not apply to a
policy which covers hospital and medical expenses for
specified illnesses or injuries only.
(2) For purposes of enabling the recovery of State funds,
any insurance carrier subject to this Section shall upon
reasonable demand by the Department of Public Health disclose
the names and identities of its insureds entitled to benefits
under this provision to the Department of Public Health
whenever the Department of Public Health has determined that
it has paid, or is about to pay, hospital or medical expenses
for which an insurance carrier is liable under this Section.
All information received by the Department of Public Health
under this provision shall be held on a confidential basis and
shall not be subject to subpoena and shall not be made public
by the Department of Public Health or used for any purpose

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other than that authorized by this Section.
(3) Whenever the Department of Public Health finds that it
has paid all or part of any hospital or medical expenses which
an insurance carrier is obligated to pay under this Section,
the Department of Public Health shall be entitled to receive
reimbursement for its payments from such insurance carrier
provided that the Department of Public Health has notified the
insurance carrier of its claims before the carrier has paid
such benefits to its insureds or in behalf of its insureds.
(Source: P.A. 103-718, eff. 7-19-24.)
(215 ILCS 5/367) (from Ch. 73, par. 979)
Sec. 367. Group accident and health insurance.
(1) Group accident and health insurance is hereby declared
to be that form of accident and health insurance covering not
less than 2 employees, members, or employees of members,
written under a master policy issued to any governmental
corporation, unit, agency or department thereof, or to any
corporation, copartnership, individual employer, or to any
association upon application of an executive officer or
trustee of such association having a constitution or bylaws
and formed in good faith for purposes other than that of
obtaining insurance, where officers, members, employees,
employees of members or classes or department thereof, may be
insured for their individual benefit. In addition a group
accident and health policy may be written to insure any group

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which may be insured under a group life insurance policy. The
term "employees" shall include the officers, managers and
employees of subsidiary or affiliated corporations, and the
individual proprietors, partners and employees of affiliated
individuals and firms, when the business of such subsidiary or
affiliated corporations, firms or individuals, is controlled
by a common employer through stock ownership, contract or
otherwise.
(2) Any insurance company authorized to write accident and
health insurance in this State shall have power to issue group
accident and health policies. No policy of group accident and
health insurance may be issued or delivered in this State
unless a copy of the form thereof shall have been filed with
the department and approved by it in accordance with Section
355, and it contains in substance those provisions contained
in Sections 357.1 through 357.30 as may be applicable to group
accident and health insurance and the following provisions:
(a) A provision that the policy, the application of
the employer, or executive officer or trustee of any
association, and the individual applications, if any, of
the employees, members or employees of members insured
shall constitute the entire contract between the parties,
and that all statements made by the employer, or the
executive officer or trustee, or by the individual
employees, members or employees of members shall (in the
absence of fraud) be deemed representations and not

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warranties, and that no such statement shall be used in
defense to a claim under the policy, unless it is
contained in a written application.
(b) A provision that the insurer will issue to the
employer, or to the executive officer or trustee of the
association, for delivery to the employee, member or
employee of a member, who is insured under such policy, an
individual certificate setting forth a statement as to the
insurance protection to which he is entitled and to whom
payable.
(c) A provision that to the group or class thereof
originally insured shall be added from time to time all
new employees of the employer, members of the association
or employees of members eligible to and applying for
insurance in such group or class.
(3) Anything in this code to the contrary notwithstanding,
any group accident and health policy may provide that all or
any portion of any indemnities provided by any such policy on
account of hospital, nursing, medical or surgical services,
may, at the insurer's option, be paid directly to the hospital
or person rendering such services; but the policy may not
require that the service be rendered by a particular hospital
or person. Payment so made shall discharge the insurer's
obligation with respect to the amount of insurance so paid.
Nothing in this subsection (3) shall prohibit an insurer from
providing incentives for insureds to utilize the services of a

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particular hospital or person.
(4) Special group policies may be issued to school
districts providing medical or hospital service, or both, for
pupils of the district injured while participating in any
athletic activity under the jurisdiction of or sponsored or
controlled by the district or the authorities of any school
thereof. The provisions of this Section governing the issuance
of group accident and health insurance shall, insofar as
applicable, control the issuance of such policies issued to
schools.
(5) No policy of group accident and health insurance may
be issued or delivered in this State unless it provides that
upon the death of the insured employee or group member the
dependents' coverage, if any, continues for a period of at
least 90 days subject to any other policy provisions relating
to termination of dependents' coverage.
(6) No group hospital policy covering miscellaneous
hospital expenses issued or delivered in this State shall
contain any exception or exclusion from coverage which would
preclude the payment of expenses incurred for the processing
and administration of blood and its components.
(7) No policy of group accident and health insurance,
delivered in this State more than 120 days after the effective
day of the Section, which provides inpatient hospital coverage
for sicknesses shall exclude from such coverage the treatment
of alcoholism. This subsection shall not apply to a policy

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which covers only specified sicknesses.
(8) No policy of group accident and health insurance,
which provides benefits for hospital or medical expenses based
upon the actual expenses incurred, issued, or delivered in
this State shall contain any specific exception to coverage
which would preclude the payment of actual expenses incurred
in the examination and testing of a victim of an offense
defined in Sections 11-1.20 through 11-1.60 or 12-13 through
12-16 of the Criminal Code of 1961 or the Criminal Code of
2012, or an attempt to commit such offense, to establish that
sexual contact did occur or did not occur, and to establish the
presence or absence of sexually transmitted disease or
infection, and examination and treatment of injuries and
trauma sustained by the victim of such offense, arising out of
the offense. Every group policy of accident and health
insurance which specifically provides benefits for routine
physical examinations shall provide full coverage for expenses
incurred in the examination and testing of a victim of an
offense defined in Sections 11-1.20 through 11-1.60 or 12-13
through 12-16 of the Criminal Code of 1961 or the Criminal Code
of 2012, or an attempt to commit such offense, as set forth in
this Section. This subsection shall not apply to a policy
which covers hospital and medical expenses for specified
illnesses and injuries only. A policy subject to this
subsection shall not impose a deductible, coinsurance,
copayment, or any other cost-sharing requirement on the

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coverage provided, except that this subsection does not apply
to the extent that the coverage would disqualify a
high-deductible health plan from eligibility for a health
savings account pursuant to Section 223 of the Internal
Revenue Code.
(9) For purposes of enabling the recovery of State funds,
any insurance carrier subject to this Section shall upon
reasonable demand by the Department of Public Health disclose
the names and identities of its insureds entitled to benefits
under this provision to the Department of Public Health
whenever the Department of Public Health has determined that
it has paid, or is about to pay, hospital or medical expenses
for which an insurance carrier is liable under this Section.
All information received by the Department of Public Health
under this provision shall be held on a confidential basis and
shall not be subject to subpoena and shall not be made public
by the Department of Public Health or used for any purpose
other than that authorized by this Section.
(10) Whenever the Department of Public Health finds that
it has paid all or part of any hospital or medical expenses
which an insurance carrier is obligated to pay under this
Section, the Department of Public Health shall be entitled to
receive reimbursement for its payments from such insurance
carrier provided that the Department of Public Health has
notified the insurance carrier of its claim before the carrier
has paid the benefits to its insureds or the insureds'

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assignees.
(11) (a) No group hospital, medical or surgical expense
policy shall contain any provision whereby benefits
otherwise payable thereunder are subject to reduction
solely on account of the existence of similar benefits
provided under other group or group-type accident and
sickness insurance policies where such reduction would
operate to reduce total benefits payable under these
policies below an amount equal to 100% of total allowable
expenses provided under these policies.
(b) When dependents of insureds are covered under 2
policies, both of which contain coordination of benefits
provisions, benefits of the policy of the insured whose
birthday falls earlier in the year are determined before
those of the policy of the insured whose birthday falls
later in the year. Birthday, as used herein, refers only
to the month and day in a calendar year, not the year in
which the person was born. The Department of Insurance
shall promulgate rules defining the order of benefit
determination pursuant to this paragraph (b).
(12) Every group policy under this Section shall be
subject to the provisions of Sections 356g and 356n of this
Code.
(13) No accident and health insurer providing coverage for
hospital or medical expenses on an expense incurred basis
shall deny reimbursement for an otherwise covered expense

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incurred for any organ transplantation procedure solely on the
basis that such procedure is deemed experimental or
investigational unless supported by the determination of the
Office of Health Care Technology Assessment within the Agency
for Health Care Policy and Research within the federal
Department of Health and Human Services that such procedure is
either experimental or investigational or that there is
insufficient data or experience to determine whether an organ
transplantation procedure is clinically acceptable. If an
accident and health insurer has made written request, or had
one made on its behalf by a national organization, for
determination by the Office of Health Care Technology
Assessment within the Agency for Health Care Policy and
Research within the federal Department of Health and Human
Services as to whether a specific organ transplantation
procedure is clinically acceptable and said organization fails
to respond to such a request within a period of 90 days, the
failure to act may be deemed a determination that the
procedure is deemed to be experimental or investigational.
(14) Whenever a claim for benefits by an insured under a
dental prepayment program is denied or reduced, based on the
review of x-ray films, such review must be performed by a
dentist.
(Source: P.A. 96-1551, eff. 7-1-11; 97-1150, eff. 1-25-13.)
Section 99. Effective date. This Act takes effect January
1, 2026.