Bill Text: IL HB3335 | 2025-2026 | 104th General Assembly | Introduced

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Bill Title: Amends the Illinois Insurance Code. Provides that a group or individual plan of accident and health insurance or managed care plan amended, delivered, issued, or renewed after January 1, 2026 that provides coverage for prescription insulin drugs shall limit the total amount that an insured is required to pay for a 30-day supply of covered prescription weight loss drugs, such as Ozempic, Wegovy, and Moujaro, to an amount not to exceed $200, regardless of the quantity or type of covered prescription weight loss drug used to fill the insured's prescription. Provides that an insurer is not prohibited from reducing an insured's cost sharing by an amount greater than the specified amount. Grants the Department of Insurance rulemaking and enforcement authority. Provides that, on January 1 of each year, the limit on the amount that an insured is required to pay for a 30-day supply of a covered prescription insulin drug shall increase by a percentage equal to the percentage change from the preceding year in the medical care component of the Consumer Price Index of the Bureau of Labor Statistics of the United States Department of Labor. Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Illinois Insurance Code, the Health Maintenance Organization Act, the Limited Health Service Organization Act, the Voluntary Health Services Plans Act, and the Illinois Public Aid Code to require coverage under those provisions.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced) 2025-02-07 - Filed with the Clerk by Rep. Thaddeus Jones [HB3335 Detail]

Download: Illinois-2025-HB3335-Introduced.html

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104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB3335 Introduced , by Rep. Thaddeus Jones SYNOPSIS AS INTRODUCED:
5 ILCS 375/6.11
55 ILCS 5/5-1069.3
65 ILCS 5/10-4-2.3
105 ILCS 5/10-22.3f
215 ILCS 5/356z.80 new
215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2
215 ILCS 130/4003 from Ch. 73, par. 1504-3
215 ILCS 165/10 from Ch. 32, par. 604
305 ILCS 5/5-16.8
Amends the Illinois Insurance Code. Provides that a group or individual plan of accident and health insurance or managed care plan amended, delivered, issued, or renewed after January 1, 2026 that provides coverage for prescription insulin drugs shall limit the total amount that an insured is required to pay for a 30-day supply of covered prescription weight loss drugs, such as Ozempic, Wegovy, and Moujaro, to an amount not to exceed $200, regardless of the quantity or type of covered prescription weight loss drug used to fill the insured's prescription. Provides that an insurer is not prohibited from reducing an insured's cost sharing by an amount greater than the specified amount. Grants the Department of Insurance rulemaking and enforcement authority. Provides that, on January 1 of each year, the limit on the amount that an insured is required to pay for a 30-day supply of a covered prescription insulin drug shall increase by a percentage equal to the percentage change from the preceding year in the medical care component of the Consumer Price Index of the Bureau of Labor Statistics of the United States Department of Labor. Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Illinois Insurance Code, the Health Maintenance Organization Act, the Limited Health Service Organization Act, the Voluntary Health Services Plans Act, and the Illinois Public Aid Code to require coverage under those provisions.
LRB104 09521 BAB 19584 b
A BILL FOR
HB3335 LRB104 09521 BAB 19584 b
AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The State Employees Group Insurance Act of 1971
is amended by changing Section 6.11 as follows:
(5 ILCS 375/6.11)
Sec. 6.11. Required health benefits; Illinois Insurance
Code requirements. The program of health benefits shall
provide the post-mastectomy care benefits required to be
covered by a policy of accident and health insurance under
Section 356t of the Illinois Insurance Code. The program of
health benefits shall provide the coverage required under
Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10,
356w, 356x, 356z.2, 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.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32,
356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59,
356z.60, 356z.61, 356z.62, 356z.64, 356z.67, 356z.68, and
356z.70, and 356z.71, 356z.74, 356z.76, 356z.77, and 356z.80
of the Illinois Insurance Code. The program of health benefits
must comply with Sections 155.22a, 155.37, 355b, 356z.19,
370c, and 370c.1 and Article XXXIIB of the Illinois Insurance

HB3335 - 2 - LRB104 09521 BAB 19584 b
Code. The program of health benefits shall provide the
coverage required under Section 356m of the Illinois Insurance
Code and, for the employees of the State Employee Group
Insurance Program only, the coverage as also provided in
Section 6.11B of this Act. The Department of Insurance shall
enforce the requirements of this Section with respect to
Sections 370c and 370c.1 of the Illinois Insurance Code; all
other requirements of this Section shall be enforced by the
Department of Central Management Services.
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. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-768,
eff. 1-1-24; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
1-1-23; 102-1117, eff. 1-13-23; 103-8, eff. 1-1-24; 103-84,
eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, eff. 1-1-24;
103-445, eff. 1-1-24; 103-535, eff. 8-11-23; 103-551, eff.
8-11-23; 103-605, eff. 7-1-24; 103-718, eff. 7-19-24; 103-751,
eff. 8-2-24; 103-870, eff. 1-1-25; 103-914, eff. 1-1-25;
103-918, eff. 1-1-25; 103-951, eff. 1-1-25; 103-1024, eff.

HB3335 - 3 - LRB104 09521 BAB 19584 b
1-1-25; revised 11-26-24.)
Section 10. The Counties Code is amended by changing
Section 5-1069.3 as follows:
(55 ILCS 5/5-1069.3)
Sec. 5-1069.3. Required health benefits. If a county,
including a home rule county, is a self-insurer for purposes
of providing health insurance coverage for its employees, the
coverage shall include coverage for the post-mastectomy care
benefits required to be covered by a policy of accident and
health insurance under Section 356t and the coverage required
under Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u,
356u.10, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9,
356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
356z.25, 356z.26, 356z.29, 356z.30, 356z.32, 356z.33, 356z.36,
356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51,
356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, 356z.61,
356z.62, 356z.64, 356z.67, 356z.68, and 356z.70, and 356z.71,
356z.74, 356z.77, and 356z.80 of the Illinois Insurance Code.
The coverage shall comply with Sections 155.22a, 355b,
356z.19, and 370c of the Illinois Insurance Code. The
Department of Insurance shall enforce the requirements of this
Section. The requirement that health benefits be covered as
provided in this Section is an exclusive power and function of
the State and is a denial and limitation under Article VII,

HB3335 - 4 - LRB104 09521 BAB 19584 b
Section 6, subsection (h) of the Illinois Constitution. A home
rule county to which this Section applies must comply with
every provision of this Section.
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. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
103-535, eff. 8-11-23; 103-551, eff. 8-11-23; 103-605, eff.
7-1-24; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-914,
eff. 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25;
revised 11-26-24.)
Section 15. The Illinois Municipal Code is amended by
changing Section 10-4-2.3 as follows:
(65 ILCS 5/10-4-2.3)
Sec. 10-4-2.3. Required health benefits. If a

HB3335 - 5 - LRB104 09521 BAB 19584 b
municipality, including a home rule municipality, is a
self-insurer for purposes of providing health insurance
coverage for its employees, the coverage shall include
coverage for the post-mastectomy care benefits required to be
covered by a policy of accident and health insurance under
Section 356t and the coverage required under Sections 356g,
356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10, 356w, 356x,
356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11,
356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26,
356z.29, 356z.30, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64,
356z.67, 356z.68, and 356z.70, and 356z.71, 356z.74, 356z.77,
and 356z.80 of the Illinois Insurance Code. The coverage shall
comply with Sections 155.22a, 355b, 356z.19, and 370c of the
Illinois Insurance Code. The Department of Insurance shall
enforce the requirements of this Section. The requirement that
health benefits be covered as provided in this is an exclusive
power and function of the State and is a denial and limitation
under Article VII, Section 6, subsection (h) of the Illinois
Constitution. A home rule municipality to which this Section
applies must comply with every provision of this Section.
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

HB3335 - 6 - LRB104 09521 BAB 19584 b
Administrative Rules; any purported rule not so adopted, for
whatever reason, is unauthorized.
(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
103-535, eff. 8-11-23; 103-551, eff. 8-11-23; 103-605, eff.
7-1-24; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-914,
eff. 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25;
revised 11-26-24.)
Section 20. The School Code is amended by changing Section
10-22.3f as follows:
(105 ILCS 5/10-22.3f)
Sec. 10-22.3f. Required health benefits. Insurance
protection and benefits for employees shall provide the
post-mastectomy care benefits required to be covered by a
policy of accident and health insurance under Section 356t and
the coverage required under Sections 356g, 356g.5, 356g.5-1,
356m, 356q, 356u, 356u.10, 356w, 356x, 356z.4, 356z.4a,
356z.6, 356z.8, 356z.9, 356z.11, 356z.12, 356z.13, 356z.14,
356z.15, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32,

HB3335 - 7 - LRB104 09521 BAB 19584 b
356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60,
356z.61, 356z.62, 356z.64, 356z.67, 356z.68, and 356z.70, and
356z.71, 356z.74, 356z.77, and 356z.80 of the Illinois
Insurance Code. Insurance policies shall comply with Section
356z.19 of the Illinois Insurance Code. The coverage shall
comply with Sections 155.22a, 355b, and 370c of the Illinois
Insurance Code. The Department of Insurance shall enforce the
requirements of this Section.
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. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804,
eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff.
1-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420,
eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. 8-11-23;
103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-718, eff.
7-19-24; 103-751, eff. 8-2-24; 103-914, eff. 1-1-25; 103-918,
eff. 1-1-25; 103-1024, eff. 1-1-25; revised 11-26-24.)

HB3335 - 8 - LRB104 09521 BAB 19584 b
Section 22. The Illinois Insurance Code is amended by
adding Section 356z.80 as follows:
(215 ILCS 5/356z.80 new)
Sec. 356z.80. Cost sharing in prescription weight loss
drugs; limits; confidentiality of rebate information.
(a) As used in this Section, "prescription weight loss
drug" means a prescription drug that contains weight loss
medication and is administered into the veins to control
weight levels.
(b) A group or individual plan of accident and health
insurance or managed care plan amended, delivered, issued, or
renewed on or after January 1, 2026 that provides coverage for
prescription insulin drugs shall limit the total amount that
an insured is required to pay for a 30-day supply of covered
prescription weight loss drugs, such as Ozempic, Wegovy, and
Moujaro, to an amount not to exceed $200, regardless of the
quantity or type of covered prescription weight loss drug used
to fill the insured's prescription.
(c) Nothing in this Section prevents an insurer from
reducing an insured's cost sharing by an amount greater than
the amount specified in subsection (b).
(d) The Director may use any of the Director's enforcement
powers to obtain an insurer's compliance with this Section.
(e) The Department may adopt rules as necessary to
implement and administer this Section and to align it with

HB3335 - 9 - LRB104 09521 BAB 19584 b
federal requirements.
(f) On January 1 of each year, beginning on January 1 of
the year following the effective date of this amendatory Act
of the 104th General Assembly, the limit on the amount that an
insured is required to pay for a 30-day supply of a covered
prescription insulin drug shall increase by a percentage equal
to the percentage change from the preceding year in the
medical care component of the Consumer Price Index of the
Bureau of Labor Statistics of the United States Department of
Labor.
Section 25. The Health Maintenance Organization Act is
amended by changing Section 5-3 as follows:
(215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
(Text of Section before amendment by P.A. 103-808)
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, 143.31, 143c, 147, 148, 149, 151,
152, 153, 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a,
155.49, 352c, 355.2, 355.3, 355.6, 355b, 355c, 356f, 356g.5-1,
356m, 356q, 356u.10, 356v, 356w, 356x, 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.20, 356z.21, 356z.22, 356z.23, 356z.24, 356z.25,

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356z.26, 356z.28, 356z.29, 356z.30, 356z.31, 356z.32, 356z.33,
356z.34, 356z.35, 356z.36, 356z.37, 356z.38, 356z.39, 356z.40,
356z.40a, 356z.41, 356z.44, 356z.45, 356z.46, 356z.47,
356z.48, 356z.49, 356z.50, 356z.51, 356z.53, 356z.54, 356z.55,
356z.56, 356z.57, 356z.58, 356z.59, 356z.60, 356z.61, 356z.62,
356z.63, 356z.64, 356z.65, 356z.66, 356z.67, 356z.68, 356z.69,
356z.70, 356z.71, 356z.72, 356z.73, 356z.74, 356z.75, 356z.77,
356z.80, 364, 364.01, 364.3, 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

HB3335 - 11 - LRB104 09521 BAB 19584 b
1/2 of the Illinois Insurance Code.
(c) In considering the merger, consolidation, or other
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

HB3335 - 12 - LRB104 09521 BAB 19584 b
forma financial statements reflecting projected
combined operation for a period of 2 years;
(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

HB3335 - 13 - LRB104 09521 BAB 19584 b
Insurance Act and except for medicare supplement policies as
defined in Section 363 of the Illinois Insurance Code, a
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.

HB3335 - 14 - LRB104 09521 BAB 19584 b
The Health Maintenance Organization shall include a
statement in the evidence of coverage issued to each enrollee
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. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;

HB3335 - 15 - LRB104 09521 BAB 19584 b
102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;
103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.
6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
eff. 1-1-24; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24;
103-618, eff. 1-1-25; 103-649, eff. 1-1-25; 103-656, eff.
1-1-25; 103-700, eff. 1-1-25; 103-718, eff. 7-19-24; 103-751,
eff. 8-2-24; 103-753, eff. 8-2-24; 103-758, eff. 1-1-25;
103-777, eff. 8-2-24; 103-914, eff. 1-1-25; 103-918, eff.
1-1-25; 103-1024, eff. 1-1-25; revised 9-26-24.)
(Text of Section after amendment by P.A. 103-808)
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, 143.31, 143c, 147, 148, 149, 151,
152, 153, 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a,
155.49, 352c, 355.2, 355.3, 355.6, 355b, 355c, 356f, 356g,
356g.5-1, 356m, 356q, 356u.10, 356v, 356w, 356x, 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.20, 356z.21, 356z.22, 356z.23, 356z.24,
356z.25, 356z.26, 356z.28, 356z.29, 356z.30, 356z.31, 356z.32,
356z.33, 356z.34, 356z.35, 356z.36, 356z.37, 356z.38, 356z.39,
356z.40, 356z.40a, 356z.41, 356z.44, 356z.45, 356z.46,

HB3335 - 16 - LRB104 09521 BAB 19584 b
356z.47, 356z.48, 356z.49, 356z.50, 356z.51, 356z.53, 356z.54,
356z.55, 356z.56, 356z.57, 356z.58, 356z.59, 356z.60, 356z.61,
356z.62, 356z.63, 356z.64, 356z.65, 356z.66, 356z.67, 356z.68,
356z.69, 356z.70, 356z.71, 356z.72, 356z.73, 356z.74, 356z.75,
356z.77, 356z.80, 364, 364.01, 364.3, 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
acquisition of control of a Health Maintenance Organization

HB3335 - 17 - LRB104 09521 BAB 19584 b
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;
(C) a pro forma business plan detailing an

HB3335 - 18 - LRB104 09521 BAB 19584 b
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
Health Maintenance Organization may by contract agree with a

HB3335 - 19 - LRB104 09521 BAB 19584 b
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
describing the possibility of a refund or additional premium,

HB3335 - 20 - LRB104 09521 BAB 19584 b
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. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;

HB3335 - 21 - LRB104 09521 BAB 19584 b
103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.
6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
eff. 1-1-24; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24;
103-618, eff. 1-1-25; 103-649, eff. 1-1-25; 103-656, eff.
1-1-25; 103-700, eff. 1-1-25; 103-718, eff. 7-19-24; 103-751,
eff. 8-2-24; 103-753, eff. 8-2-24; 103-758, eff. 1-1-25;
103-777, eff. 8-2-24; 103-808, eff. 1-1-26; 103-914, eff.
1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; revised
11-26-24.)
Section 30. The Limited Health Service Organization Act is
amended by changing Section 4003 as follows:
(215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
Sec. 4003. Illinois Insurance Code provisions. Limited
health service organizations shall be subject to the
provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151, 152, 153,
154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 352c,
355.2, 355.3, 355b, 355d, 356m, 356q, 356v, 356z.4, 356z.4a,
356z.10, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.32,
356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68, 356z.71,
356z.73, 356z.74, 356z.75, 356z.80, 364.3, 368a, 401, 401.1,
402, 403, 403A, 408, 408.2, 409, 412, 444, and 444.1 and
Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and

HB3335 - 22 - LRB104 09521 BAB 19584 b
XXVI of the Illinois Insurance Code. Nothing in this Section
shall require a limited health care plan to cover any service
that is not a limited health service. For purposes of the
Illinois Insurance Code, except for Sections 444 and 444.1 and
Articles XIII and XIII 1/2, limited health service
organizations in the following categories are deemed to be
domestic companies:
(1) a corporation under the laws of this State; or
(2) 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.
(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-731, eff.
1-1-23; 102-775, eff. 5-13-22; 102-813, eff. 5-13-22; 102-816,
eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
1-1-24; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
eff. 1-1-24; 103-605, eff. 7-1-24; 103-649, eff. 1-1-25;
103-656, eff. 1-1-25; 103-700, eff. 1-1-25; 103-718, eff.
7-19-24; 103-751, eff. 8-2-24; 103-758, eff. 1-1-25; 103-832,
eff. 1-1-25; 103-1024, eff. 1-1-25; revised 11-26-24.)
Section 35. The Voluntary Health Services Plans Act is

HB3335 - 23 - LRB104 09521 BAB 19584 b
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, 143.31, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3,
355b, 355d, 356g, 356g.5, 356g.5-1, 356m, 356q, 356r, 356t,
356u, 356u.10, 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.32, 356z.32a, 356z.33, 356z.40, 356z.41, 356z.46,
356z.47, 356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59,
356z.60, 356z.61, 356z.62, 356z.64, 356z.67, 356z.68, 356z.71,
356z.72, 356z.74, 356z.75, 356z.77, 356z.80, 364.01, 364.3,
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.

HB3335 - 24 - LRB104 09521 BAB 19584 b
(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff.
10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804,
eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff.
1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-656, eff.
1-1-25; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-753,
eff. 8-2-24; 103-758, eff. 1-1-25; 103-832, eff. 1-1-25;
103-914, eff. 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff.
1-1-25; revised 11-26-24.)
Section 40. The Illinois Public Aid Code is amended by
changing Section 5-16.8 as follows:
(305 ILCS 5/5-16.8)
Sec. 5-16.8. Required health benefits. The medical
assistance program shall (i) provide the post-mastectomy care
benefits required to be covered by a policy of accident and
health insurance under Section 356t and the coverage required
under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6,
356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,
356z.47, 356z.51, 356z.53, 356z.59, 356z.60, 356z.61, 356z.64,
and 356z.67, and 356z.71, 356z.75, and 356z.80 of the Illinois
Insurance Code, (ii) be subject to the provisions of Sections

HB3335 - 25 - LRB104 09521 BAB 19584 b
356z.19, 356z.44, 356z.49, 364.01, 370c, and 370c.1 of the
Illinois Insurance Code, and (iii) be subject to the
provisions of subsection (d-5) of Section 10 of the Network
Adequacy and Transparency Act.
The Department, by rule, shall adopt a model similar to
the requirements of Section 356z.39 of the Illinois Insurance
Code.
On and after July 1, 2012, the Department shall reduce any
rate of reimbursement for services or other payments or alter
any methodologies authorized by this Code to reduce any rate
of reimbursement for services or other payments in accordance
with Section 5-5e.
To ensure full access to the benefits set forth in this
Section, on and after January 1, 2016, the Department shall
ensure that provider and hospital reimbursement for
post-mastectomy care benefits required under this Section are
no lower than the Medicare reimbursement rate.
(Source: P.A. 102-30, eff. 1-1-22; 102-144, eff. 1-1-22;
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-530, eff.
1-1-22; 102-642, eff. 1-1-22; 102-804, eff. 1-1-23; 102-813,
eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093, eff. 1-1-23;
102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
1-1-24; 103-420, eff. 1-1-24; 103-605, eff. 7-1-24; 103-703,
eff. 1-1-25; 103-758, eff. 1-1-25; 103-1024, eff. 1-1-25;
revised 11-26-24.)

HB3335 - 26 - LRB104 09521 BAB 19584 b
Section 95. No acceleration or delay. Where this Act makes
changes in a statute that is represented in this Act by text
that is not yet or no longer in effect (for example, a Section
represented by multiple versions), the use of that text does
not accelerate or delay the taking effect of (i) the changes
made by this Act or (ii) provisions derived from any other
Public Act.