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| Public Act 103-0751
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| SB0773 Enrolled | LRB103 03229 AMQ 48235 b |
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AN ACT concerning regulation.
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Be it enacted by the People of the State of Illinois, |
represented in the General Assembly:
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Section 5. The State Employees Group Insurance Act of 1971 |
is amended by changing Sections 6.11 and 6.11B as follows:
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(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, 356w, 356x, |
356z.2, 356z.4, 356z.4a, 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.30a, 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, |
and 356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, 356z.70, |
and 356z.71 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 Code. The program of health benefits shall |
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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; revised 8-29-23.)
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(5 ILCS 375/6.11B) |
Sec. 6.11B. Infertility coverage. |
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(a) Beginning on January 1, 2024, the State Employees |
Group Insurance Program shall provide coverage for the |
diagnosis and treatment of infertility, including, but not |
limited to, in vitro fertilization, uterine embryo lavage, |
embryo transfer, artificial insemination, gamete |
intrafallopian tube transfer, zygote intrafallopian tube |
transfer, and low tubal ovum transfer. The coverage required |
shall include procedures necessary to screen or diagnose a |
fertilized egg before implantation, including, but not limited |
to, preimplantation genetic diagnosis, preimplantation genetic |
screening, and prenatal genetic diagnosis. |
(b) Beginning on January 1, 2024, coverage under this |
Section for procedures for in vitro fertilization, gamete |
intrafallopian tube transfer, or zygote intrafallopian tube |
transfer shall be required only if the procedures: |
(1) are considered medically appropriate based on |
clinical guidelines or standards developed by the American |
Society for Reproductive Medicine, the American College of |
Obstetricians and Gynecologists, or the Society for |
Assisted Reproductive Technology; and |
(2) are performed at medical facilities or clinics |
that conform to the American College of Obstetricians and |
Gynecologists guidelines for in vitro fertilization or the |
American Society for Reproductive Medicine minimum |
standards for practices offering assisted reproductive |
technologies. |
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(c) As used in this Section, "infertility" means a |
disease, condition, or status characterized by: |
(1) a failure to establish a pregnancy or to carry a |
pregnancy to live birth after 12 months of regular, |
unprotected sexual intercourse if the woman is 35 years of |
age or younger, or after 6 months of regular, unprotected |
sexual intercourse if the woman is over 35 years of age; |
conceiving but having a miscarriage does not restart the |
12-month or 6-month term for determining infertility; |
(2) a person's inability to reproduce either as a |
single individual or with a partner without medical |
intervention; or |
(3) a licensed physician's findings based on a |
patient's medical, sexual, and reproductive history, age, |
physical findings, or diagnostic testing. |
(d) The State Employees Group Insurance Program may not |
impose any exclusions, limitations, or other restrictions on |
coverage of fertility medications that are different from |
those imposed on any other prescription medications, nor may |
it impose any exclusions, limitations, or other restrictions |
on coverage of any fertility services based on a covered |
individual's participation in fertility services provided by |
or to a third party, nor may it impose deductibles, |
copayments, coinsurance, benefit maximums, waiting periods, or |
any other limitations on coverage for the diagnosis of |
infertility, treatment for infertility, and standard fertility |
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preservation services, except as provided in this Section, |
that are different from those imposed upon benefits for |
services not related to infertility. |
(e) This Section applies only to coverage provided on or |
after January 1, 2024 and before July 1, 2026. |
(f) This Section is repealed on July 1, 2026. |
(Source: P.A. 103-8, eff. 1-1-24.)
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Section 10. The Counties Code is amended by changing |
Section 5-1069.3 as follows:
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(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, 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.30a, 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, and |
356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, 356z.70, and |
356z.71 of the Illinois Insurance Code. The coverage shall |
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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, 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; revised |
8-29-23.)
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Section 15. The Illinois Municipal Code is amended by |
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changing Section 10-4-2.3 as follows:
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(65 ILCS 5/10-4-2.3) |
Sec. 10-4-2.3. Required health benefits. If a |
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, 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.30a, 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, and 356z.61, and 356z.62, |
356z.64, 356z.67, 356z.68, 356z.70, and 356z.71 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. |
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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; revised |
8-29-23.)
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Section 20. The School Code is amended by changing Section |
10-22.3f as follows:
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(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, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8, |
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356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, |
356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 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, and |
356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, 356z.70, and |
356z.71 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; revised 8-29-23.)
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Section 25. The Illinois Insurance Code is amended by |
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changing Sections 356m and 356z.32 and by adding Section |
356z.71 as follows:
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(215 ILCS 5/356m) (from Ch. 73, par. 968m) |
Sec. 356m. Infertility coverage. |
(a) No group policy of accident and health insurance |
providing coverage for more than 25 employees that provides |
pregnancy-related pregnancy related benefits may be issued, |
amended, delivered, or renewed in this State after January 1, |
2016 and through December 31, 2025 the effective date of this |
amendatory Act of the 99th General Assembly unless the policy |
contains coverage for the diagnosis and treatment of |
infertility including, but not limited to, in vitro |
fertilization, uterine embryo lavage, embryo transfer, |
artificial insemination, gamete intrafallopian tube transfer, |
zygote intrafallopian tube transfer, and low tubal ovum |
transfer. |
(a-5) No group policy of accident and health insurance |
that provides pregnancy-related benefits may be issued, |
amended, delivered, or renewed in this State on or after |
January 1, 2026 unless the policy contains coverage for the |
diagnosis and treatment of infertility, including, but not |
limited to, in vitro fertilization, uterine embryo lavage, |
embryo transfer, artificial insemination, gamete |
intrafallopian tube transfer, zygote intrafallopian tube |
transfer, surgical sperm extraction procedures, and low tubal |
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ovum transfer. The coverage required shall include procedures |
necessary to screen or diagnose a fertilized egg before |
implantation, including, but not limited to, preimplantation |
genetic testing for aneuploidy, preimplantation genetic |
testing for chromosome structural rearrangements, and |
preimplantation genetic testing for monogenic or single gene |
disorders. Coverage under this subsection for the diagnosis |
and treatment of infertility shall be required only if the |
procedures: |
(1) are considered medically appropriate by the |
patient's medical provider based on clinical guidelines or |
standards developed by the American Society for |
Reproductive Medicine, the American College of |
Obstetricians and Gynecologists, or the Society for |
Assisted Reproductive Technology; and |
(2) are performed at medical facilities or clinics |
that are members in good standing of the Society for |
Assisted Reproductive Technology. |
(b) The coverage required under subsection (a) for |
procedures for in vitro fertilization, gamete intrafallopian |
tube transfer, or zygote intrafallopian tube transfer shall be |
required only if is subject to the following conditions: |
(1) Coverage for procedures for in vitro |
fertilization, gamete intrafallopian tube transfer, or |
zygote intrafallopian tube transfer shall be required only |
if: |
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(1) (A) the covered individual has been unable to |
attain a viable pregnancy, maintain a viable pregnancy, or |
sustain a successful pregnancy through reasonable, less |
costly medically appropriate infertility treatments for |
which coverage is available under the policy, plan, or |
contract; |
(2) (B) the covered individual has not undergone 4 |
completed oocyte retrievals, except that if a live birth |
follows a completed oocyte retrieval, then 2 more |
completed oocyte retrievals shall be covered; and |
(3) (C) the procedures are performed at medical |
facilities that conform to the American College of |
Obstetric and Gynecology guidelines for in vitro |
fertilization clinics or to the American Fertility Society |
minimal standards for programs of in vitro fertilization. |
(2) The procedures required to be covered under this |
Section are not required to be contained in any policy or |
plan issued to or by a religious institution or |
organization or to or by an entity sponsored by a |
religious institution or organization that finds the |
procedures required to be covered under this Section to |
violate its religious and moral teachings and beliefs. |
(c) As used in this Section, "infertility" means a |
disease, condition, or status characterized by: |
(1) a failure to establish a pregnancy or to carry a |
pregnancy to live birth after 12 months of regular, |
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unprotected sexual intercourse if the woman is 35 years of |
age or younger, or after 6 months of regular, unprotected |
sexual intercourse if the woman is over 35 years of age; |
conceiving but having a miscarriage does not restart the |
12-month or 6-month term for determining infertility; |
(2) a person's inability to reproduce either as a |
single individual or with a partner without medical |
intervention; or |
(3) a licensed physician's findings based on a |
patient's medical, sexual, and reproductive history, age, |
physical findings, or diagnostic testing. |
(d) A policy, contract, or certificate may not impose any |
exclusions, limitations, or other restrictions on coverage of |
fertility medications that are different from those imposed on |
any other prescription medications, nor may it impose any |
exclusions, limitations, or other restrictions on coverage of |
any fertility services based on a covered individual's |
participation in fertility services provided by or to a third |
party, nor may it impose deductibles, copayments, coinsurance, |
benefit maximums, waiting periods, or any other limitations on |
coverage for the diagnosis of infertility, treatment for |
infertility, and standard fertility preservation services, |
except as provided in this Section, that are different from |
those imposed upon benefits for services not related to |
infertility. |
(e) The procedures required to be covered under this |
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Section are not required to be contained in any policy or plan |
issued to or by a religious institution or organization or to |
or by an entity sponsored by a religious institution or |
organization that finds the procedures required to be covered |
under this Section to violate its religious and moral |
teachings and beliefs. |
(Source: P.A. 102-170, eff. 1-1-22.)
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(215 ILCS 5/356z.71 new) |
Sec. 356z.71. Coverage for annual menopause health visit. |
A group or individual policy of accident and health insurance |
providing coverage for more than 25 employees that is amended, |
delivered, issued, or renewed on or after January 1, 2026 |
shall provide, for individuals 45 years of age and older, |
coverage for an annual menopause health visit. A policy |
subject to this Section shall not impose a deductible, |
coinsurance, copayment, or any other cost-sharing requirement |
on the coverage provided; except that this Section does not |
apply to this coverage 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.
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Section 30. The Health Maintenance Organization Act is |
amended by changing Section 5-3 as follows:
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(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, 155.49, |
355.2, 355.3, 355b, 355c, 356f, 356g.5-1, 356m, 356q, 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.30a, 356z.31, 356z.32, 356z.33, 356z.34, 356z.35, |
356z.36, 356z.37, 356z.38, 356z.39, 356z.40, 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.64, 356z.65, 356z.67, 356z.68, |
356z.71, 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": |
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(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 |
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 |
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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 |
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 |
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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 |
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 |
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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, |
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; |
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; revised 8-29-23.)
|
Section 35. 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, 143c, 147, 148, 149, 151, 152, 153, 154, |
154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 355.2, |
355.3, 355b, 356m, 356q, 356v, 356z.4, 356z.4a, 356z.10, |
|
356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, |
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, 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 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; revised 8-29-23.)
|
|
Section 40. 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, 355b, |
356g, 356g.5, 356g.5-1, 356m, 356q, 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.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, 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. |
(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; revised 8-29-23.)
|
