Bill Text: IL HB2948 | 2021-2022 | 102nd General Assembly | Introduced

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Bill Title: Amends the Illinois Insurance Code. Sets forth provisions concerning eligibility for health savings accounts. Provides that an HSA-eligible high deductible health plan is exempt from specified requirements but only until the deductible has been met and only to the extent necessary to allow the policy to satisfy specified federal criteria. Provides that for any HSA-eligible high deductible health plan issued, delivered, amended, or renewed on or after January 1, 2022, a company shall expressly identify the policy as HSA-eligible in all policy forms and in all sales and marketing materials. Provides that for high deductible non-HSA policies issued, delivered, amended, or renewed on or after January 1, 2022, the company shall use the term "non-HSA" in any name or title of the product found in its policy form, as well as in all sales and marketing materials. Provides that beginning January 1, 2022, if a company offers any HSA-eligible HDHP in the large group market, then it shall also offer in the same market at least one high-deductible non-HSA policy. Defines "HSA-eligible HDHP" and "high deductible non-HSA policy". In provisions concerning coverage for screening by low-dose mammography, provisions concerning coverage for contraceptives, and provisions concerning coverage for whole body skin examination, removes provisions stating that the mandates do not apply to required coverage to the extent such coverage would disqualify a high-deductible health plan from eligibility for a health savings account pursuant to specified federal law. Makes a conforming change in the Health Maintenance Organization Act. Amends the Health Maintenance Organization Act and the Voluntary Health Services Plans Act to provide that health maintenance organizations and voluntary health services plans shall be subject to provisions of the Illinois Insurance Code concerning nonparticipating facility-based physicians and providers and provisions concerning eligibility for health savings accounts. Effective January 1, 2022.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2021-04-23 - Rule 19(a) / Re-referred to Rules Committee [HB2948 Detail]

Download: Illinois-2021-HB2948-Introduced.html

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102ND GENERAL ASSEMBLY State of Illinois 2021 and 2022 HB2948 Introduced , by Rep. Bob Morgan SYNOPSIS AS INTRODUCED:
See Index
Amends the Illinois Insurance Code. Sets forth provisions concerning eligibility for health savings accounts. Provides that an HSA-eligible high deductible health plan is exempt from specified requirements but only until the deductible has been met and only to the extent necessary to allow the policy to satisfy specified federal criteria. Provides that for any HSA-eligible high deductible health plan issued, delivered, amended, or renewed on or after January 1, 2022, a company shall expressly identify the policy as HSA-eligible in all policy forms and in all sales and marketing materials. Provides that for high deductible non-HSA policies issued, delivered, amended, or renewed on or after January 1, 2022, the company shall use the term "non-HSA" in any name or title of the product found in its policy form, as well as in all sales and marketing materials. Provides that beginning January 1, 2022, if a company offers any HSA-eligible HDHP in the large group market, then it shall also offer in the same market at least one high-deductible non-HSA policy. Defines "HSA-eligible HDHP" and "high deductible non-HSA policy". In provisions concerning coverage for screening by low-dose mammography, provisions concerning coverage for contraceptives, and provisions concerning coverage for whole body skin examination, removes provisions stating that the mandates do not apply to required coverage to the extent such coverage would disqualify a high-deductible health plan from eligibility for a health savings account pursuant to specified federal law. Makes a conforming change in the Health Maintenance Organization Act. Amends the Health Maintenance Organization Act and the Voluntary Health Services Plans Act to provide that health maintenance organizations and voluntary health services plans shall be subject to provisions of the Illinois Insurance Code concerning nonparticipating facility-based physicians and providers and provisions concerning eligibility for health savings accounts. Effective January 1, 2022.
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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
adding Section 355.5, by changing Sections 356g and 356z.4,
and by renumbering and changing Section 356z.33 as added by
Public Act 101-500 as follows:
(215 ILCS 5/355.5 new)
Sec. 355.5. Eligibility for health savings accounts.
(a) Definitions. As used in this Section:
"High deductible non-HSA policy" means a policy of
individual or group accident and health insurance coverage
that would have qualified as an HSA-eligible HDHP but for its
conformity with any of the Illinois statutes subject to
exemption under subsection (b).
"HSA-eligible HDHP" means a policy of individual or group
accident and health insurance coverage that satisfies the
criteria for a "high-deductible health plan" in 26 U.S.C. 223
as implemented and interpreted by the U.S. Department of the
Treasury in the regulations and guidance in effect at the time
of any transaction or occurrence addressed by this Section.
(b) Exemptions for an HSA-eligible HDHP.
(1) An HSA-eligible HDHP is exempt from the following

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provisions of Illinois law, but only until the deductible
has been met and only to the extent necessary to allow the
policy to satisfy the criteria for a "high-deductible
health plan" as implemented and interpreted by the U.S.
Department of the Treasury under 26 U.S.C. 223:
(A) the prohibition on cost-sharing requirements
for all coverages provided under subsection (a) of
Section 356g of this Code and subsection (a) of
Section 4-6.1 of the Health Maintenance Organization
Act;
(B) the prohibition on cost-sharing requirements
for coverage of voluntary male sterilization
procedures under paragraph (4) of subsection (a) of
Section 356z.4 of this Code;
(C) the prohibition on cost-sharing requirements
for coverage of whole body skin examinations provided
under Section 356z.37 of this Code;
(D) the requirements in subsection (d) of Section
30 of the Managed Care Reform and Patient Rights Act;
notwithstanding any other provision of this Section,
if any method of reducing an individual's
out-of-pocket expenses addressed in subsection (d) of
Section 30 does not fall within the scope of U.S.
Department of the Treasury regulations or guidance
about the criteria for a high deductible health plan
under 26 U.S.C. 223, or if such regulations or

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guidance indicate that the method of reduction is not
prohibited for such a plan, then an HSA-eligible HDHP
shall not be exempt from the requirements of
subsection (d) of Section 30 relating to that method
of reduction;
(E) other Illinois provisions that the Department
may identify by rule; for such an exemption to be
valid, the Department's rule must cite to the specific
federal statute, regulation, or guidance within or
under 26 U.S.C. 223 that would require a policy to be
exempt from the Illinois statute in order to be an
HSA-eligible HDHP; and
(F) other Illinois provisions that the Department
may acknowledge at a company's request during the
policy form filing process provided under Sections 143
and 355 of this Code. If a company requests an
exemption from a statutory provision under this
subparagraph, the Department may grant the exemption
only if the company has cited a specific federal
statute, regulation, or guidance within or under 26
U.S.C. 223 that would actually require such an
exemption for the policy to be an HSA-eligible HDHP.
Upon the first time granting the exemption to that
Illinois provision, the Department shall publish a
notification to companies indicating that it has done
so and identifying its specific basis for granting the

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exemption.
(2) Notwithstanding any other provision of this
Section, if the U.S. Department of the Treasury determines
by regulation or guidance that any coverage addressed by
one of the above Illinois statutes pertains to preventive
care as that term is used in 26 U.S.C. 223, an exemption
shall not apply with respect to that Illinois statute for
any HSA-eligible HDHP issued, delivered, amended, or
renewed while such regulation or guidance is effective.
(c) For any HSA-eligible HDHP issued, delivered, amended,
or renewed on or after January 1, 2022, a company shall
expressly identify the policy as HSA-eligible in all policy
forms and in all sales and marketing materials. Any name or
title of a product that is an HSA-eligible HDHP shall include
the term "HSA-eligible".
(d) For all policies issued, delivered, amended, or
renewed on or after January 1, 2022, unless the policy is an
HSA-eligible HDHP, no company shall use the terms
"HSA-eligible", "HSA", "for HSAs", "high deductible health
plan", "HDHP", or any substantially similar term or phrase, to
describe a policy of individual or group accident and health
insurance coverage in any policy form or related sales or
marketing materials. For all policies in effect on or after
the effective date of this amendatory Act of the 102nd General
Assembly, a company or producer shall not in any way represent
that a policy not satisfying the definition in subsection (a)

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is an HSA-eligible HDHP.
(e) For high deductible non-HSA policies issued,
delivered, amended, or renewed on or after January 1, 2022,
the company shall use the term "non-HSA" in any name or title
of the product found in its policy form, as well as in all
sales and marketing materials. Any policy, certificate,
evidence of coverage, or outline of coverage for a high
deductible non-HSA policy shall include a statement
substantially the same as the following within the first 2
pages of substantive text: "Pursuant to Section 355.5 of the
Illinois Insurance Code, we are required to disclose that the
coverage provided under this policy may not qualify as a
"high-deductible health plan" under 26 U.S.C. 223. As a
result, your enrollment under this policy may not qualify you
as an "eligible individual" to contribute to a health savings
account.".
(f) Beginning January 1, 2022, if a company offers any
HSA-eligible HDHP in the large group market, then it shall
also offer in the same market at least one high-deductible
non-HSA policy. If a company offers any HSA-eligible HDHP in
the individual or small group market, then it shall also offer
in the same market at least one high-deductible non-HSA policy
at each level of coverage defined in 45 CFR 156.140 for which
the company offers an HSA-eligible HDHP. A company is not
required to offer a high-deductible non-HSA policy version of
every HSA-eligible HDHP that it offers in a market unless the

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company only offers one HSA-eligible HDHP in the large group
market or one HSA-eligible HDHP in each applicable level of
coverage in the individual or small group market. No company
is required to offer an HSA-eligible HDHP merely because it
offers a high deductible non-HSA policy.
(g) If an applicant or policyholder obtains an
HSA-eligible HDHP, any successive policy shall not be deemed a
renewal policy unless it is issued as an HSA-eligible HDHP.
Nothing in this subsection shall prevent a company from
offering a policyholder a high deductible non-HSA policy as an
alternative to renewing their HSA-eligible HDHP, nor from
discontinuing to offer any HSA-eligible HDHP altogether in the
Illinois individual, small group, or large group market.
(h) This Section does not apply to short-term,
limited-duration health insurance coverage as defined in
Section 5 of the Short-Term, Limited-Duration Health Insurance
Coverage Act.
(215 ILCS 5/356g) (from Ch. 73, par. 968g)
Sec. 356g. Mammograms; mastectomies.
(a) Every insurer shall provide in each group or
individual policy, contract, or certificate of insurance
issued or renewed for persons who are residents of this State,
coverage for screening by low-dose mammography for all women
35 years of age or older for the presence of occult breast
cancer within the provisions of the policy, contract, or

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certificate. The coverage shall be as follows:
(1) A baseline mammogram for women 35 to 39 years of
age.
(2) An annual mammogram for women 40 years of age or
older.
(3) A mammogram at the age and intervals considered
medically necessary by the woman's health care provider
for women under 40 years of age and having a family history
of breast cancer, prior personal history of breast cancer,
positive genetic testing, or other risk factors.
(4) For an individual or group policy of accident and
health insurance or a managed care plan that is amended,
delivered, issued, or renewed on or after the effective
date of this amendatory Act of the 101st General Assembly,
a comprehensive ultrasound screening and MRI of an entire
breast or breasts if a mammogram demonstrates
heterogeneous or dense breast tissue or when medically
necessary as determined by a physician licensed to
practice medicine in all of its branches.
(5) A screening MRI when medically necessary, as
determined by a physician licensed to practice medicine in
all of its branches.
(6) For an individual or group policy of accident and
health insurance or a managed care plan that is amended,
delivered, issued, or renewed on or after the effective
date of this amendatory Act of the 101st General Assembly,

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a diagnostic mammogram when medically necessary, as
determined by a physician licensed to practice medicine in
all its branches, advanced practice registered nurse, or
physician assistant.
A policy subject to this subsection shall not impose a
deductible, coinsurance, copayment, or any other cost-sharing
requirement on the coverage provided; except that this
sentence does not apply to coverage of diagnostic mammograms
to the extent such coverage would disqualify a high-deductible
health plan from eligibility for a health savings account
pursuant to Section 223 of the Internal Revenue Code (26
U.S.C. 223).
For purposes of this Section:
"Diagnostic mammogram" means a mammogram obtained using
diagnostic mammography.
"Diagnostic mammography" means a method of screening that
is designed to evaluate an abnormality in a breast, including
an abnormality seen or suspected on a screening mammogram or a
subjective or objective abnormality otherwise detected in the
breast.
"Low-dose mammography" means the x-ray examination of the
breast using equipment dedicated specifically for mammography,
including the x-ray tube, filter, compression device, and
image receptor, with radiation exposure delivery of less than
1 rad per breast for 2 views of an average size breast. The
term also includes digital mammography and includes breast

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tomosynthesis. As used in this Section, the term "breast
tomosynthesis" means a radiologic procedure that involves the
acquisition of projection images over the stationary breast to
produce cross-sectional digital three-dimensional images of
the breast.
If, at any time, the Secretary of the United States
Department of Health and Human Services, or its successor
agency, promulgates rules or regulations to be published in
the Federal Register or publishes a comment in the Federal
Register or issues an opinion, guidance, or other action that
would require the State, pursuant to any provision of the
Patient Protection and Affordable Care Act (Public Law
111-148), including, but not limited to, 42 U.S.C.
18031(d)(3)(B) or any successor provision, to defray the cost
of any coverage for breast tomosynthesis outlined in this
subsection, then the requirement that an insurer cover breast
tomosynthesis is inoperative other than any such coverage
authorized under Section 1902 of the Social Security Act, 42
U.S.C. 1396a, and the State shall not assume any obligation
for the cost of coverage for breast tomosynthesis set forth in
this subsection.
(a-5) Coverage as described by subsection (a) shall be
provided at no cost to the insured and shall not be applied to
an annual or lifetime maximum benefit.
(a-10) When health care services are available through
contracted providers and a person does not comply with plan

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provisions specific to the use of contracted providers, the
requirements of subsection (a-5) are not applicable. When a
person does not comply with plan provisions specific to the
use of contracted providers, plan provisions specific to the
use of non-contracted providers must be applied without
distinction for coverage required by this Section and shall be
at least as favorable as for other radiological examinations
covered by the policy or contract.
(b) No policy of accident or health insurance that
provides for the surgical procedure known as a mastectomy
shall be issued, amended, delivered, or renewed in this State
unless that coverage also provides for prosthetic devices or
reconstructive surgery incident to the mastectomy. Coverage
for breast reconstruction in connection with a mastectomy
shall include:
(1) reconstruction of the breast upon which the
mastectomy has been performed;
(2) surgery and reconstruction of the other breast to
produce a symmetrical appearance; and
(3) prostheses and treatment for physical
complications at all stages of mastectomy, including
lymphedemas.
Care shall be determined in consultation with the attending
physician and the patient. The offered coverage for prosthetic
devices and reconstructive surgery shall be subject to the
deductible and coinsurance conditions applied to the

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mastectomy, and all other terms and conditions applicable to
other benefits. When a mastectomy is performed and there is no
evidence of malignancy then the offered coverage may be
limited to the provision of prosthetic devices and
reconstructive surgery to within 2 years after the date of the
mastectomy. As used in this Section, "mastectomy" means the
removal of all or part of the breast for medically necessary
reasons, as determined by a licensed physician.
Written notice of the availability of coverage under this
Section shall be delivered to the insured upon enrollment and
annually thereafter. An insurer may not deny to an insured
eligibility, or continued eligibility, to enroll or to renew
coverage under the terms of the plan solely for the purpose of
avoiding the requirements of this Section. An insurer may not
penalize or reduce or limit the reimbursement of an attending
provider or provide incentives (monetary or otherwise) to an
attending provider to induce the provider to provide care to
an insured in a manner inconsistent with this Section.
(c) Rulemaking authority to implement Public Act 95-1045,
if any, is conditioned on the rules being adopted in
accordance with all provisions of the Illinois Administrative
Procedure Act and all rules and procedures of the Joint
Committee on Administrative Rules; any purported rule not so
adopted, for whatever reason, is unauthorized.
(Source: P.A. 100-395, eff. 1-1-18; 101-580, eff. 1-1-20.)

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(215 ILCS 5/356z.4)
Sec. 356z.4. Coverage for contraceptives.
(a)(1) The General Assembly hereby finds and declares all
of the following:
(A) Illinois has a long history of expanding timely
access to birth control to prevent unintended pregnancy.
(B) The federal Patient Protection and Affordable Care
Act includes a contraceptive coverage guarantee as part of
a broader requirement for health insurance to cover key
preventive care services without out-of-pocket costs for
patients.
(C) The General Assembly intends to build on existing
State and federal law to promote gender equity and women's
health and to ensure greater contraceptive coverage equity
and timely access to all federal Food and Drug
Administration approved methods of birth control for all
individuals covered by an individual or group health
insurance policy in Illinois.
(D) Medical management techniques such as denials,
step therapy, or prior authorization in public and private
health care coverage can impede access to the most
effective contraceptive methods.
(2) As used in this subsection (a):
"Contraceptive services" includes consultations,
examinations, procedures, and medical services related to the
use of contraceptive methods (including natural family

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planning) to prevent an unintended pregnancy.
"Medical necessity", for the purposes of this subsection
(a), includes, but is not limited to, considerations such as
severity of side effects, differences in permanence and
reversibility of contraceptive, and ability to adhere to the
appropriate use of the item or service, as determined by the
attending provider.
"Therapeutic equivalent version" means drugs, devices, or
products that can be expected to have the same clinical effect
and safety profile when administered to patients under the
conditions specified in the labeling and satisfy the following
general criteria:
(i) they are approved as safe and effective;
(ii) they are pharmaceutical equivalents in that they
(A) contain identical amounts of the same active drug
ingredient in the same dosage form and route of
administration and (B) meet compendial or other applicable
standards of strength, quality, purity, and identity;
(iii) they are bioequivalent in that (A) they do not
present a known or potential bioequivalence problem and
they meet an acceptable in vitro standard or (B) if they do
present such a known or potential problem, they are shown
to meet an appropriate bioequivalence standard;
(iv) they are adequately labeled; and
(v) they are manufactured in compliance with Current
Good Manufacturing Practice regulations.

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(3) An individual or group policy of accident and health
insurance amended, delivered, issued, or renewed in this State
after the effective date of this amendatory Act of the 99th
General Assembly shall provide coverage for all of the
following services and contraceptive methods:
(A) All contraceptive drugs, devices, and other
products approved by the United States Food and Drug
Administration. This includes all over-the-counter
contraceptive drugs, devices, and products approved by the
United States Food and Drug Administration, excluding male
condoms. The following apply:
(i) If the United States Food and Drug
Administration has approved one or more therapeutic
equivalent versions of a contraceptive drug, device,
or product, a policy is not required to include all
such therapeutic equivalent versions in its formulary,
so long as at least one is included and covered without
cost-sharing and in accordance with this Section.
(ii) If an individual's attending provider
recommends a particular service or item approved by
the United States Food and Drug Administration based
on a determination of medical necessity with respect
to that individual, the plan or issuer must cover that
service or item without cost sharing. The plan or
issuer must defer to the determination of the
attending provider.

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(iii) If a drug, device, or product is not
covered, plans and issuers must have an easily
accessible, transparent, and sufficiently expedient
process that is not unduly burdensome on the
individual or a provider or other individual acting as
a patient's authorized representative to ensure
coverage without cost sharing.
(iv) This coverage must provide for the dispensing
of 12 months' worth of contraception at one time.
(B) Voluntary sterilization procedures.
(C) Contraceptive services, patient education, and
counseling on contraception.
(D) Follow-up services related to the drugs, devices,
products, and procedures covered under this Section,
including, but not limited to, management of side effects,
counseling for continued adherence, and device insertion
and removal.
(4) Except as otherwise provided in this subsection (a), a
policy subject to this subsection (a) shall not impose a
deductible, coinsurance, copayment, or any other cost-sharing
requirement on the coverage provided. The provisions of this
paragraph do not apply to coverage of voluntary male
sterilization procedures to the extent such coverage would
disqualify a high-deductible health plan from eligibility for
a health savings account pursuant to the federal Internal
Revenue Code, 26 U.S.C. 223.

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(5) Except as otherwise authorized under this subsection
(a), a policy shall not impose any restrictions or delays on
the coverage required under this subsection (a).
(6) If, at any time, the Secretary of the United States
Department of Health and Human Services, or its successor
agency, promulgates rules or regulations to be published in
the Federal Register or publishes a comment in the Federal
Register or issues an opinion, guidance, or other action that
would require the State, pursuant to any provision of the
Patient Protection and Affordable Care Act (Public Law
111-148), including, but not limited to, 42 U.S.C.
18031(d)(3)(B) or any successor provision, to defray the cost
of any coverage outlined in this subsection (a), then this
subsection (a) is inoperative with respect to all coverage
outlined in this subsection (a) other than that authorized
under Section 1902 of the Social Security Act, 42 U.S.C.
1396a, and the State shall not assume any obligation for the
cost of the coverage set forth in this subsection (a).
(b) This subsection (b) shall become operative if and only
if subsection (a) becomes inoperative.
An individual or group policy of accident and health
insurance amended, delivered, issued, or renewed in this State
after the date this subsection (b) becomes operative that
provides coverage for outpatient services and outpatient
prescription drugs or devices must provide coverage for the
insured and any dependent of the insured covered by the policy

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for all outpatient contraceptive services and all outpatient
contraceptive drugs and devices approved by the Food and Drug
Administration. Coverage required under this Section may not
impose any deductible, coinsurance, waiting period, or other
cost-sharing or limitation that is greater than that required
for any outpatient service or outpatient prescription drug or
device otherwise covered by the policy.
Nothing in this subsection (b) shall be construed to
require an insurance company to cover services related to
permanent sterilization that requires a surgical procedure.
As used in this subsection (b), "outpatient contraceptive
service" means consultations, examinations, procedures, and
medical services, provided on an outpatient basis and related
to the use of contraceptive methods (including natural family
planning) to prevent an unintended pregnancy.
(c) (Blank).
(d) If a plan or issuer utilizes a network of providers,
nothing in this Section shall be construed to require coverage
or to prohibit the plan or issuer from imposing cost-sharing
for items or services described in this Section that are
provided or delivered by an out-of-network provider, unless
the plan or issuer does not have in its network a provider who
is able to or is willing to provide the applicable items or
services.
(Source: P.A. 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19.)

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(215 ILCS 5/356z.37)
Sec. 356z.37 356z.33. Whole body skin examination. An
individual or group policy of accident and health insurance
shall cover, without imposing a deductible, coinsurance,
copayment, or any other cost-sharing requirement upon the
insured patient, one annual office visit, using appropriate
routine evaluation and management Current Procedural
Terminology codes or any successor codes, for a whole body
skin examination for lesions suspicious for skin cancer. The
whole body skin examination shall be indicated using an
appropriate International Statistical Classification of
Diseases and Related Health Problems code or any successor
codes. The provisions of this Section do not apply to the
extent such coverage would disqualify a high-deductible health
plan from eligibility for a health savings account pursuant to
26 U.S.C. 223.
(Source: P.A. 101-500, eff. 1-1-20; revised 10-16-19.)
Section 10. The Health Maintenance Organization Act is
amended by changing Sections 4-6.1 and 5-3 as follows:
(215 ILCS 125/4-6.1) (from Ch. 111 1/2, par. 1408.7)
Sec. 4-6.1. Mammograms; mastectomies.
(a) Every contract or evidence of coverage issued by a
Health Maintenance Organization for persons who are residents
of this State shall contain coverage for screening by low-dose

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mammography for all women 35 years of age or older for the
presence of occult breast cancer. The coverage shall be as
follows:
(1) A baseline mammogram for women 35 to 39 years of
age.
(2) An annual mammogram for women 40 years of age or
older.
(3) A mammogram at the age and intervals considered
medically necessary by the woman's health care provider
for women under 40 years of age and having a family history
of breast cancer, prior personal history of breast cancer,
positive genetic testing, or other risk factors.
(4) For an individual or group policy of accident and
health insurance or a managed care plan that is amended,
delivered, issued, or renewed on or after the effective
date of this amendatory Act of the 101st General Assembly,
a comprehensive ultrasound screening and MRI of an entire
breast or breasts if a mammogram demonstrates
heterogeneous or dense breast tissue or when medically
necessary as determined by a physician licensed to
practice medicine in all of its branches.
(5) For an individual or group policy of accident and
health insurance or a managed care plan that is amended,
delivered, issued, or renewed on or after the effective
date of this amendatory Act of the 101st General Assembly,
a diagnostic mammogram when medically necessary, as

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determined by a physician licensed to practice medicine in
all its branches, advanced practice registered nurse, or
physician assistant.
A policy subject to this subsection shall not impose a
deductible, coinsurance, copayment, or any other cost-sharing
requirement on the coverage provided; except that this
sentence does not apply to coverage of diagnostic mammograms
to the extent such coverage would disqualify a high-deductible
health plan from eligibility for a health savings account
pursuant to Section 223 of the Internal Revenue Code (26
U.S.C. 223).
For purposes of this Section:
"Diagnostic mammogram" means a mammogram obtained using
diagnostic mammography.
"Diagnostic mammography" means a method of screening that
is designed to evaluate an abnormality in a breast, including
an abnormality seen or suspected on a screening mammogram or a
subjective or objective abnormality otherwise detected in the
breast.
"Low-dose mammography" means the x-ray examination of the
breast using equipment dedicated specifically for mammography,
including the x-ray tube, filter, compression device, and
image receptor, with radiation exposure delivery of less than
1 rad per breast for 2 views of an average size breast. The
term also includes digital mammography and includes breast
tomosynthesis.

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"Breast tomosynthesis" means a radiologic procedure that
involves the acquisition of projection images over the
stationary breast to produce cross-sectional digital
three-dimensional images of the breast.
If, at any time, the Secretary of the United States
Department of Health and Human Services, or its successor
agency, promulgates rules or regulations to be published in
the Federal Register or publishes a comment in the Federal
Register or issues an opinion, guidance, or other action that
would require the State, pursuant to any provision of the
Patient Protection and Affordable Care Act (Public Law
111-148), including, but not limited to, 42 U.S.C.
18031(d)(3)(B) or any successor provision, to defray the cost
of any coverage for breast tomosynthesis outlined in this
subsection, then the requirement that an insurer cover breast
tomosynthesis is inoperative other than any such coverage
authorized under Section 1902 of the Social Security Act, 42
U.S.C. 1396a, and the State shall not assume any obligation
for the cost of coverage for breast tomosynthesis set forth in
this subsection.
(a-5) Coverage as described in subsection (a) shall be
provided at no cost to the enrollee and shall not be applied to
an annual or lifetime maximum benefit.
(b) No contract or evidence of coverage issued by a health
maintenance organization that provides for the surgical
procedure known as a mastectomy shall be issued, amended,

HB2948 - 22 - LRB102 11004 BMS 16336 b
delivered, or renewed in this State on or after the effective
date of this amendatory Act of the 92nd General Assembly
unless that coverage also provides for prosthetic devices or
reconstructive surgery incident to the mastectomy, providing
that the mastectomy is performed after the effective date of
this amendatory Act. Coverage for breast reconstruction in
connection with a mastectomy shall include:
(1) reconstruction of the breast upon which the
mastectomy has been performed;
(2) surgery and reconstruction of the other breast to
produce a symmetrical appearance; and
(3) prostheses and treatment for physical
complications at all stages of mastectomy, including
lymphedemas.
Care shall be determined in consultation with the attending
physician and the patient. The offered coverage for prosthetic
devices and reconstructive surgery shall be subject to the
deductible and coinsurance conditions applied to the
mastectomy and all other terms and conditions applicable to
other benefits. When a mastectomy is performed and there is no
evidence of malignancy, then the offered coverage may be
limited to the provision of prosthetic devices and
reconstructive surgery to within 2 years after the date of the
mastectomy. As used in this Section, "mastectomy" means the
removal of all or part of the breast for medically necessary
reasons, as determined by a licensed physician.

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Written notice of the availability of coverage under this
Section shall be delivered to the enrollee upon enrollment and
annually thereafter. A health maintenance organization may not
deny to an enrollee eligibility, or continued eligibility, to
enroll or to renew coverage under the terms of the plan solely
for the purpose of avoiding the requirements of this Section.
A health maintenance organization may not penalize or reduce
or limit the reimbursement of an attending provider or provide
incentives (monetary or otherwise) to an attending provider to
induce the provider to provide care to an insured in a manner
inconsistent with this Section.
(c) Rulemaking authority to implement this amendatory Act
of the 95th General Assembly, if any, is conditioned on the
rules being adopted in accordance with all provisions of the
Illinois Administrative Procedure Act and all rules and
procedures of the Joint Committee on Administrative Rules; any
purported rule not so adopted, for whatever reason, is
unauthorized.
(Source: P.A. 100-395, eff. 1-1-18; 101-580, eff. 1-1-20.)
(215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
Sec. 5-3. Insurance Code provisions.
(a) Health Maintenance Organizations shall be subject to
the provisions of Sections 133, 134, 136, 137, 139, 140,
141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2,

HB2948 - 24 - LRB102 11004 BMS 16336 b
355.3, 355.5, 355b, 356g.5-1, 356m, 356v, 356w, 356x, 356y,
356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8,
356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
356z.17, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26,
356z.29, 356z.30, 356z.30a, 356z.32, 356z.33, 356z.35,
356z.36, 356z.41, 364, 364.01, 367.2, 367.2-5, 367i, 368a,
368b, 368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403,
403A, 408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of
subsection (2) of Section 367, and Articles IIA, VIII 1/2,
XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the
Illinois Insurance Code.
(b) For purposes of the Illinois Insurance Code, except
for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
Health Maintenance Organizations in the following categories
are deemed to be "domestic companies":
(1) a corporation authorized under the Dental Service
Plan Act or the Voluntary Health Services Plans Act;
(2) a corporation organized under the laws of this
State; or
(3) a corporation organized under the laws of another
state, 30% or more of the enrollees of which are residents
of this State, except a corporation subject to
substantially the same requirements in its state of
organization as is a "domestic company" under Article VIII
1/2 of the Illinois Insurance Code.
(c) In considering the merger, consolidation, or other

HB2948 - 25 - LRB102 11004 BMS 16336 b
acquisition of control of a Health Maintenance Organization
pursuant to Article VIII 1/2 of the Illinois Insurance Code,
(1) the Director shall give primary consideration to
the continuation of benefits to enrollees and the
financial conditions of the acquired Health Maintenance
Organization after the merger, consolidation, or other
acquisition of control takes effect;
(2)(i) the criteria specified in subsection (1)(b) of
Section 131.8 of the Illinois Insurance Code shall not
apply and (ii) the Director, in making his determination
with respect to the merger, consolidation, or other
acquisition of control, need not take into account the
effect on competition of the merger, consolidation, or
other acquisition of control;
(3) the Director shall have the power to require the
following information:
(A) certification by an independent actuary of the
adequacy of the reserves of the Health Maintenance
Organization sought to be acquired;
(B) pro forma financial statements reflecting the
combined balance sheets of the acquiring company and
the Health Maintenance Organization sought to be
acquired as of the end of the preceding year and as of
a date 90 days prior to the acquisition, as well as pro
forma financial statements reflecting projected
combined operation for a period of 2 years;

HB2948 - 26 - LRB102 11004 BMS 16336 b
(C) a pro forma business plan detailing an
acquiring party's plans with respect to the operation
of the Health Maintenance Organization sought to be
acquired for a period of not less than 3 years; and
(D) such other information as the Director shall
require.
(d) The provisions of Article VIII 1/2 of the Illinois
Insurance Code and this Section 5-3 shall apply to the sale by
any health maintenance organization of greater than 10% of its
enrollee population (including without limitation the health
maintenance organization's right, title, and interest in and
to its health care certificates).
(e) In considering any management contract or service
agreement subject to Section 141.1 of the Illinois Insurance
Code, the Director (i) shall, in addition to the criteria
specified in Section 141.2 of the Illinois Insurance Code,
take into account the effect of the management contract or
service agreement on the continuation of benefits to enrollees
and the financial condition of the health maintenance
organization to be managed or serviced, and (ii) need not take
into account the effect of the management contract or service
agreement on competition.
(f) Except for small employer groups as defined in the
Small Employer Rating, Renewability and Portability Health
Insurance Act and except for medicare supplement policies as
defined in Section 363 of the Illinois Insurance Code, a

HB2948 - 27 - LRB102 11004 BMS 16336 b
Health Maintenance Organization may by contract agree with a
group or other enrollment unit to effect refunds or charge
additional premiums under the following terms and conditions:
(i) the amount of, and other terms and conditions with
respect to, the refund or additional premium are set forth
in the group or enrollment unit contract agreed in advance
of the period for which a refund is to be paid or
additional premium is to be charged (which period shall
not be less than one year); and
(ii) the amount of the refund or additional premium
shall not exceed 20% of the Health Maintenance
Organization's profitable or unprofitable experience with
respect to the group or other enrollment unit for the
period (and, for purposes of a refund or additional
premium, the profitable or unprofitable experience shall
be calculated taking into account a pro rata share of the
Health Maintenance Organization's administrative and
marketing expenses, but shall not include any refund to be
made or additional premium to be paid pursuant to this
subsection (f)). The Health Maintenance Organization and
the group or enrollment unit may agree that the profitable
or unprofitable experience may be calculated taking into
account the refund period and the immediately preceding 2
plan years.
The Health Maintenance Organization shall include a
statement in the evidence of coverage issued to each enrollee

HB2948 - 28 - LRB102 11004 BMS 16336 b
describing the possibility of a refund or additional premium,
and upon request of any group or enrollment unit, provide to
the group or enrollment unit a description of the method used
to calculate (1) the Health Maintenance Organization's
profitable experience with respect to the group or enrollment
unit and the resulting refund to the group or enrollment unit
or (2) the Health Maintenance Organization's unprofitable
experience with respect to the group or enrollment unit and
the resulting additional premium to be paid by the group or
enrollment unit.
In no event shall the Illinois Health Maintenance
Organization Guaranty Association be liable to pay any
contractual obligation of an insolvent organization to pay any
refund authorized under this Section.
(g) Rulemaking authority to implement Public Act 95-1045,
if any, is conditioned on the rules being adopted in
accordance with all provisions of the Illinois Administrative
Procedure Act and all rules and procedures of the Joint
Committee on Administrative Rules; any purported rule not so
adopted, for whatever reason, is unauthorized.
(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff.
1-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81,
eff. 7-12-19; 101-281, eff. 1-1-20; 101-371, eff. 1-1-20;
101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
1-1-20; 101-625, eff. 1-1-21.)

HB2948 - 29 - LRB102 11004 BMS 16336 b
Section 15. The Voluntary Health Services Plans Act is
amended by changing Section 10 as follows:
(215 ILCS 165/10) (from Ch. 32, par. 604)
Sec. 10. Application of Insurance Code provisions. Health
services plan corporations and all persons interested therein
or dealing therewith shall be subject to the provisions of
Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355.5,
355b, 356g, 356g.5, 356g.5-1, 356r, 356t, 356u, 356v, 356w,
356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5,
356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25,
356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33,
356z.41, 364.01, 367.2, 368a, 401, 401.1, 402, 403, 403A, 408,
408.2, and 412, and paragraphs (7) and (15) of Section 367 of
the Illinois Insurance Code.
Rulemaking authority to implement Public Act 95-1045, if
any, is conditioned on the rules being adopted in accordance
with all provisions of the Illinois Administrative Procedure
Act and all rules and procedures of the Joint Committee on
Administrative Rules; any purported rule not so adopted, for
whatever reason, is unauthorized.
(Source: P.A. 100-24, eff. 7-18-17; 100-138, eff. 8-18-17;
100-863, eff. 8-14-18; 100-1026, eff. 8-22-18; 100-1057, eff.

HB2948 - 30 - LRB102 11004 BMS 16336 b
1-1-19; 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19; 101-81,
eff. 7-12-19; 101-281, eff. 1-1-20; 101-393, eff. 1-1-20;
101-625, eff. 1-1-21.)
Section 99. Effective date. This Act takes effect January
1, 2022.
HB2948 - 31 - LRB102 11004 BMS 16336 b
INDEX
Statutes amended in order of appearance