Bill Text: IL SB0773 | 2023-2024 | 103rd General Assembly | Enrolled

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Amends the State Employees Group Insurance Act of 1971. Provides that provisions concerning infertility coverage apply only to coverage provided on or after January 1, 2024 and before July 1, 2026. Amends the Illinois Insurance Code. Provides that 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 specified procedures. Provides that the coverage required shall include procedures necessary to screen or diagnose a fertilized egg before implantation. Provides that 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. Provides that the coverage shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement. Makes other changes. Makes conforming changes in the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, the Limited Health Service Organization Act, and the Voluntary Health Services Plans Act. Effective immediately.

Spectrum: Strong Partisan Bill (Democrat 55-3)

Status: (Passed) 2024-08-02 - Public Act . . . . . . . . . 103-0751 [SB0773 Detail]

Download: Illinois-2023-SB0773-Enrolled.html

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SB0773 Enrolled LRB103 03229 AMQ 48235 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 Sections 6.11 and 6.11B 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, 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.)
(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.)
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, 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.)
Section 15. The Illinois Municipal Code is amended by

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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
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.)
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, 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.)
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:
(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.)
(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.
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

SB0773 Enrolled - 18 - LRB103 03229 AMQ 48235 b
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,

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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,

SB0773 Enrolled - 21 - LRB103 03229 AMQ 48235 b
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.)

SB0773 Enrolled - 22 - LRB103 03229 AMQ 48235 b
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

SB0773 Enrolled - 23 - LRB103 03229 AMQ 48235 b
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.)