Bill Text: IL SB1561 | 2023-2024 | 103rd General Assembly | Enrolled

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

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Bill Title: Changes the effective date of the Abortion Care Clinical Training Program Act to January 1, 2025 (rather than effective immediately). Amends the Criminal Identification Act. Changes the definition of "lawful health care". Amends the Accident and Health Article of the Illinois Insurance Code. Sets forth provisions concerning coverage of preventive health services. 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, and the Voluntary Health Services Plans Act. Amends the Medical Practice Act of 1987. Sets forth provisions concerning postgraduate training exemption periods and visiting rotations. Makes other changes. Effective immediately.

Spectrum: Partisan Bill (Democrat 63-0)

Status: (Passed) 2023-08-11 - Public Act . . . . . . . . . 103-0551 [SB1561 Detail]

Download: Illinois-2023-SB1561-Enrolled.html

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AN ACT concerning health.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. "An Act concerning regulation", approved
January 13, 2023, Public Act 102-1117, is amended by changing
Section 99-99 as follows:
(P.A. 102-1117, Sec. 99-99)
Sec. 99-99. Effective date. This Act takes effect upon
becoming law, except that Article 16 takes effect on January
1, 2025.
(Source: P.A. 102-1117, eff. 1-13-23.)
Section 10. The State Employees Group Insurance Act of
1971 is amended by changing Section 6.11 as follows:
(5 ILCS 375/6.11)
(Text of Section before amendment by P.A. 102-768)
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

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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.56, 356z.57, 356z.59, and 356z.60, and
356z.62 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 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. 101-13, eff. 6-12-19; 101-281, eff. 1-1-20;
101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
1-1-20; 101-625, eff. 1-1-21; 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,

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eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
revised 12-13-22.)
(Text of Section after amendment by P.A. 102-768)
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, and
356z.60, and 356z.62 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 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

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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. 101-13, eff. 6-12-19; 101-281, eff. 1-1-20;
101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
1-1-20; 101-625, eff. 1-1-21; 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.)
Section 15. The Criminal Identification Act is amended by
changing Section 3.2 as follows:
(20 ILCS 2630/3.2) (from Ch. 38, par. 206-3.2)
Sec. 3.2. (a) It is the duty of any person conducting or
operating a medical facility, or any physician or nurse as
soon as treatment permits to notify the local law enforcement
agency of that jurisdiction upon the application for treatment
of a person who is not accompanied by a law enforcement
officer, when it reasonably appears that the person requesting
treatment has received:
(1) any injury resulting from the discharge of a
firearm; or

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(2) any injury sustained in the commission of or as a
victim of a criminal offense.
Any hospital, physician or nurse shall be forever held
harmless from any civil liability for their reasonable
compliance with the provisions of this Section.
(b) Notwithstanding subsection (a), nothing in this
Section shall be construed to require the reporting of lawful
health care activity, whether such activity may constitute a
violation of another state's law.
(c) As used in this Section:
"Lawful health care" means:
(1) reproductive health care that is not unlawful
under the laws of this State or was not unlawful under the
laws of this State as of January 13, 2023 (the effective
date of Public Act 102-1117), including on any theory of
vicarious, joint, several, or conspiracy liability; or
(2) the treatment of gender dysphoria or the
affirmation of an individual's gender identity or gender
expression, including but not limited to, all supplies,
care, and services of a medical, behavioral health, mental
health, surgical, psychiatric, therapeutic, diagnostic,
preventative, rehabilitative, or supportive nature that is
not unlawful under the laws of this State or was not
unlawful under the laws of this State as of January 13,
2023 (the effective date of Public Act 102-1117),
including on any theory of vicarious, joint, several, or

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conspiracy liability.
"Lawful health care activity" means seeking, providing,
receiving, assisting in seeking, providing, or receiving,
providing material support for, or traveling to obtain lawful
health care.
(Source: P.A. 102-1117, eff. 1-13-23.)
Section 20. 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, 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, and 356z.60, and 356z.62
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

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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. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
1-1-21; 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.)
Section 25. The Illinois Municipal Code is amended by
changing Section 10-4-2.3 as follows:
(65 ILCS 5/10-4-2.3)

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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, 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, and 356z.60, and 356z.62 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

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Administrative Rules; any purported rule not so adopted, for
whatever reason, is unauthorized.
(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
1-1-21; 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.)
Section 30. 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,
356q, 356u, 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.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, and 356z.60, and
356z.62 of the Illinois Insurance Code. Insurance policies

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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. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
1-1-21; 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.)
Section 35. The Illinois Insurance Code is amended by
changing Section 356z.4 and by adding Section 356z.62 as
follows:
(215 ILCS 5/356z.4)
Sec. 356z.4. Coverage for contraceptives.
(a)(1) The General Assembly hereby finds and declares all
of the following:

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(A) Illinois has a long history of expanding timely
access to birth control to prevent unintended pregnancy.
(B) The federal Patient Protection and Affordable Care
Act includes a contraceptive coverage guarantee as part of
a broader requirement for health insurance to cover key
preventive care services without out-of-pocket costs for
patients.
(C) The General Assembly intends to build on existing
State and federal law to promote gender equity and women's
health and to ensure greater contraceptive coverage equity
and timely access to all federal Food and Drug
Administration approved methods of birth control for all
individuals covered by an individual or group health
insurance policy in Illinois.
(D) Medical management techniques such as denials,
step therapy, or prior authorization in public and private
health care coverage can impede access to the most
effective contraceptive methods.
(2) As used in this subsection (a):
"Contraceptive services" includes consultations,
examinations, procedures, and medical services related to the
use of contraceptive methods (including natural family
planning) to prevent an unintended pregnancy.
"Medical necessity", for the purposes of this subsection
(a), includes, but is not limited to, considerations such as
severity of side effects, differences in permanence and

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reversibility of contraceptive, and ability to adhere to the
appropriate use of the item or service, as determined by the
attending provider.
"Therapeutic equivalent version" means drugs, devices, or
products that can be expected to have the same clinical effect
and safety profile when administered to patients under the
conditions specified in the labeling and satisfy the following
general criteria:
(i) they are approved as safe and effective;
(ii) they are pharmaceutical equivalents in that they
(A) contain identical amounts of the same active drug
ingredient in the same dosage form and route of
administration and (B) meet compendial or other applicable
standards of strength, quality, purity, and identity;
(iii) they are bioequivalent in that (A) they do not
present a known or potential bioequivalence problem and
they meet an acceptable in vitro standard or (B) if they do
present such a known or potential problem, they are shown
to meet an appropriate bioequivalence standard;
(iv) they are adequately labeled; and
(v) they are manufactured in compliance with Current
Good Manufacturing Practice regulations.
(3) An individual or group policy of accident and health
insurance amended, delivered, issued, or renewed in this State
after the effective date of this amendatory Act of the 99th
General Assembly shall provide coverage for all of the

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following services and contraceptive methods:
(A) All contraceptive drugs, devices, and other
products approved by the United States Food and Drug
Administration. This includes all over-the-counter
contraceptive drugs, devices, and products approved by the
United States Food and Drug Administration, excluding male
condoms, except as provided in the current comprehensive
guidelines supported by the Health Resources and Services
Administration. The following apply:
(i) If the United States Food and Drug
Administration has approved one or more therapeutic
equivalent versions of a contraceptive drug, device,
or product, a policy is not required to include all
such therapeutic equivalent versions in its formulary,
so long as at least one is included and covered without
cost-sharing and in accordance with this Section.
(ii) If an individual's attending provider
recommends a particular service or item approved by
the United States Food and Drug Administration based
on a determination of medical necessity with respect
to that individual, the plan or issuer must cover that
service or item without cost sharing. The plan or
issuer must defer to the determination of the
attending provider.
(iii) If a drug, device, or product is not
covered, plans and issuers must have an easily

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

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

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Administration. Coverage required under this Section may not
impose any deductible, coinsurance, waiting period, or other
cost-sharing or limitation that is greater than that required
for any outpatient service or outpatient prescription drug or
device otherwise covered by the policy.
Nothing in this subsection (b) shall be construed to
require an insurance company to cover services related to
permanent sterilization that requires a surgical procedure.
As used in this subsection (b), "outpatient contraceptive
service" means consultations, examinations, procedures, and
medical services, provided on an outpatient basis and related
to the use of contraceptive methods (including natural family
planning) to prevent an unintended pregnancy.
(c) (Blank).
(d) If a plan or issuer utilizes a network of providers,
nothing in this Section shall be construed to require coverage
or to prohibit the plan or issuer from imposing cost-sharing
for items or services described in this Section that are
provided or delivered by an out-of-network provider, unless
the plan or issuer does not have in its network a provider who
is able to or is willing to provide the applicable items or
services.
(Source: P.A. 100-1102, eff. 1-1-19; 101-13, eff. 6-12-19.)
(215 ILCS 5/356z.62 new)
Sec. 356z.62. Coverage of preventive health services.

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(a) A policy of group health insurance coverage or
individual health insurance coverage as defined in Section 5
of the Illinois Health Insurance Portability and
Accountability Act shall, at a minimum, provide coverage for
and shall not impose any cost-sharing requirements, including
a copayment, coinsurance, or deductible, for:
(1) evidence-based items or services that have in
effect a rating of "A" or "B" in the current
recommendations of the United States Preventive Services
Task Force;
(2) immunizations that have in effect a recommendation
from the Advisory Committee on Immunization Practices of
the Centers for Disease Control and Prevention with
respect to the individual involved;
(3) with respect to infants, children, and
adolescents, evidence-informed preventive care and
screenings provided for in the comprehensive guidelines
supported by the Health Resources and Services
Administration; and
(4) with respect to women, such additional preventive
care and screenings not described in paragraph (1) of this
subsection (a) as provided for in comprehensive guidelines
supported by the Health Resources and Services
Administration for purposes of this paragraph.
(b) For purposes of this Section, and for purposes of any
other provision of State law, recommendations of the United

SB1561 Enrolled - 18 - LRB103 27713 CPF 54090 b
States Preventive Services Task Force regarding breast cancer
screening, mammography, and prevention issued in or around
November 2009 are not considered to be current.
(c) For office visits:
(1) if an item or service described in subsection (a)
is billed separately or is tracked as individual encounter
data separately from an office visit, then a policy may
impose cost-sharing requirements with respect to the
office visit;
(2) if an item or service described in subsection (a)
is not billed separately or is not tracked as individual
encounter data separately from an office visit and the
primary purpose of the office visit is the delivery of
such an item or service, then a policy may not impose
cost-sharing requirements with respect to the office
visit; and
(3) if an item or service described in subsection (a)
is not billed separately or is not tracked as individual
encounter data separately from an office visit and the
primary purpose of the office visit is not the delivery of
such an item or service, then a policy may impose
cost-sharing requirements with respect to the office
visit.
(d) A policy must provide coverage pursuant to subsection
(a) for plan or policy years that begin on or after the date
that is one year after the date the recommendation or

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guideline is issued. If a recommendation or guideline is in
effect on the first day of the plan or policy year, the policy
shall cover the items and services specified in the
recommendation or guideline through the last day of the plan
or policy year unless either:
(1) a recommendation under paragraph (1) of subsection
(a) is downgraded to a "D" rating; or
(2) the item or service is subject to a safety recall
or is otherwise determined to pose a significant safety
concern by a federal agency authorized to regulate the
item or service during the plan or policy year.
(e) Network limitations.
(1) Subject to paragraph (3) of this subsection,
nothing in this Section requires coverage for items or
services described in subsection (a) that are delivered by
an out-of-network provider under a health maintenance
organization health care plan, other than a
point-of-service contract, or under a voluntary health
services plan that generally excludes coverage for
out-of-network services except as otherwise required by
law.
(2) Subject to paragraph (3) of this subsection,
nothing in this Section precludes a policy with a
preferred provider program under Article XX-1/2 of this
Code, a health maintenance organization point-of-service
contract, or a similarly designed voluntary health

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services plan from imposing cost-sharing requirements for
items or services described in subsection (a) that are
delivered by an out-of-network provider.
(3) If a policy does not have in its network a provider
who can provide an item or service described in subsection
(a), then the policy must cover the item or service when
performed by an out-of-network provider and it may not
impose cost-sharing with respect to the item or service.
(f) Nothing in this Section prevents a company from using
reasonable medical management techniques to determine the
frequency, method, treatment, or setting for an item or
service described in subsection (a) to the extent not
specified in the recommendation or guideline.
(g) Nothing in this Section shall be construed to prohibit
a policy from providing coverage for items or services in
addition to those required under subsection (a) or from
denying coverage for items or services that are not required
under subsection (a). Unless prohibited by other law, a policy
may impose cost-sharing requirements for a treatment not
described in subsection (a) even if the treatment results from
an item or service described in subsection (a). Nothing in
this Section shall be construed to limit coverage requirements
provided under other law.
(h) The Director may develop guidelines to permit a
company to utilize value-based insurance designs. In the
absence of guidelines developed by the Director, any such

SB1561 Enrolled - 21 - LRB103 27713 CPF 54090 b
guidelines developed by the Secretary of the U.S. Department
of Health and Human Services that are in force under 42 U.S.C.
300gg-13 shall apply.
(i) For student health insurance coverage as defined at 45
CFR 147.145, student administrative health fees are not
considered cost-sharing requirements with respect to
preventive services specified under subsection (a). As used in
this subsection, "student administrative health fee" means a
fee charged by an institution of higher education on a
periodic basis to its students to offset the cost of providing
health care through health clinics regardless of whether the
students utilize the health clinics or enroll in student
health insurance coverage.
(j) For any recommendation or guideline specifically
referring to women or men, a company shall not deny or limit
the coverage required or a claim made under subsection (a)
based solely on the individual's recorded sex or actual or
perceived gender identity, or for the reason that the
individual is gender nonconforming, intersex, transgender, or
has undergone, or is in the process of undergoing, gender
transition, if, notwithstanding the sex or gender assigned at
birth, the covered individual meets the conditions for the
recommendation or guideline at the time the item or service is
furnished.
(k) This Section does not apply to grandfathered health
plans, excepted benefits, or short-term, limited-duration

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health insurance coverage.
Section 40. 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)
Sec. 5-3. Insurance Code provisions.
(a) Health Maintenance Organizations shall be subject to
the provisions of Sections 133, 134, 136, 137, 139, 140,
141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2,
355.3, 355b, 355c, 356g.5-1, 356m, 356q, 356v, 356w, 356x,
356y, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6,
356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14,
356z.15, 356z.17, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25,
356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33,
356z.35, 356z.36, 356z.40, 356z.41, 356z.46, 356z.47, 356z.48,
356z.50, 356z.51, 356z.53 256z.53, 356z.54, 356z.56, 356z.57,
356z.59, 356z.60, 356z.62, 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,

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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
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

SB1561 Enrolled - 24 - LRB103 27713 CPF 54090 b
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
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

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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
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

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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,
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

SB1561 Enrolled - 27 - LRB103 27713 CPF 54090 b
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. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19;
101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-393, eff.
1-1-20; 101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625,
eff. 1-1-21; 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; revised 1-22-23.)
Section 45. 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,

SB1561 Enrolled - 28 - LRB103 27713 CPF 54090 b
143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
356g, 356g.5, 356g.5-1, 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.33,
356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
356z.56, 356z.57, 356z.59, 356z.60, 356z.62, 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. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19;
101-281, eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff.
1-1-21; 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.)

SB1561 Enrolled - 29 - LRB103 27713 CPF 54090 b
Section 50. The Medical Practice Act of 1987 is amended by
changing Section 18 as follows:
(225 ILCS 60/18) (from Ch. 111, par. 4400-18)
(Section scheduled to be repealed on January 1, 2027)
Sec. 18. Visiting professor, physician, or resident
permits.
(A) Visiting professor permit.
(1) A visiting professor permit shall entitle a person
to practice medicine in all of its branches or to practice
the treatment of human ailments without the use of drugs
and without operative surgery provided:
(a) the person maintains an equivalent
authorization to practice medicine in all of its
branches or to practice the treatment of human
ailments without the use of drugs and without
operative surgery in good standing in his or her
native licensing jurisdiction during the period of the
visiting professor permit;
(b) the person has received a faculty appointment
to teach in a medical, osteopathic or chiropractic
school in Illinois; and
(c) the Department may prescribe the information
necessary to establish an applicant's eligibility for
a permit. This information shall include without
limitation (i) a statement from the dean of the

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medical school at which the applicant will be employed
describing the applicant's qualifications and (ii) a
statement from the dean of the medical school listing
every affiliated institution in which the applicant
will be providing instruction as part of the medical
school's education program and justifying any clinical
activities at each of the institutions listed by the
dean.
(2) Application for visiting professor permits shall
be made to the Department, in writing, on forms prescribed
by the Department and shall be accompanied by the required
fee established by rule, which shall not be refundable.
Any application shall require the information as, in the
judgment of the Department, will enable the Department to
pass on the qualifications of the applicant.
(3) A visiting professor permit shall be valid for no
longer than 2 years from the date of issuance or until the
time the faculty appointment is terminated, whichever
occurs first, and may be renewed only in accordance with
subdivision (A)(6) of this Section.
(4) The applicant may be required to appear before the
Medical Board for an interview prior to, and as a
requirement for, the issuance of the original permit and
the renewal.
(5) Persons holding a permit under this Section shall
only practice medicine in all of its branches or practice

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the treatment of human ailments without the use of drugs
and without operative surgery in the State of Illinois in
their official capacity under their contract within the
medical school itself and any affiliated institution in
which the permit holder is providing instruction as part
of the medical school's educational program and for which
the medical school has assumed direct responsibility.
(6) After the initial renewal of a visiting professor
permit, a visiting professor permit shall be valid until
the last day of the next physician license renewal period,
as set by rule, and may only be renewed for applicants who
meet the following requirements:
(i) have obtained the required continuing
education hours as set by rule; and
(ii) have paid the fee prescribed for a license
under Section 21 of this Act.
For initial renewal, the visiting professor must
successfully pass a general competency examination authorized
by the Department by rule, unless he or she was issued an
initial visiting professor permit on or after January 1, 2007,
but prior to July 1, 2007.
(B) Visiting physician permit.
(1) The Department may, in its discretion, issue a
temporary visiting physician permit, without examination,
provided:

SB1561 Enrolled - 32 - LRB103 27713 CPF 54090 b
(a) (blank);
(b) that the person maintains an equivalent
authorization to practice medicine in all of its
branches or to practice the treatment of human
ailments without the use of drugs and without
operative surgery in good standing in his or her
native licensing jurisdiction during the period of the
temporary visiting physician permit;
(c) that the person has received an invitation or
appointment to study, demonstrate, or perform a
specific medical, osteopathic, chiropractic or
clinical subject or technique in a medical,
osteopathic, or chiropractic school, a state or
national medical, osteopathic, or chiropractic
professional association or society conference or
meeting, a hospital licensed under the Hospital
Licensing Act, a hospital organized under the
University of Illinois Hospital Act, or a facility
operated pursuant to the Ambulatory Surgical Treatment
Center Act; and
(d) that the temporary visiting physician permit
shall only permit the holder to practice medicine in
all of its branches or practice the treatment of human
ailments without the use of drugs and without
operative surgery within the scope of the medical,
osteopathic, chiropractic, or clinical studies, or in

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conjunction with the state or national medical,
osteopathic, or chiropractic professional association
or society conference or meeting, for which the holder
was invited or appointed.
(2) The application for the temporary visiting
physician permit shall be made to the Department, in
writing, on forms prescribed by the Department, and shall
be accompanied by the required fee established by rule,
which shall not be refundable. The application shall
require information that, in the judgment of the
Department, will enable the Department to pass on the
qualification of the applicant, and the necessity for the
granting of a temporary visiting physician permit.
(3) A temporary visiting physician permit shall be
valid for no longer than (i) 180 days from the date of
issuance or (ii) until the time the medical, osteopathic,
chiropractic, or clinical studies are completed, or the
state or national medical, osteopathic, or chiropractic
professional association or society conference or meeting
has concluded, whichever occurs first. The temporary
visiting physician permit may be issued multiple times to
a visiting physician under this paragraph (3) as long as
the total number of days it is active do not exceed 180
days within a 365-day period.
(4) The applicant for a temporary visiting physician
permit may be required to appear before the Medical Board

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for an interview prior to, and as a requirement for, the
issuance of a temporary visiting physician permit.
(5) A limited temporary visiting physician permit
shall be issued to a physician licensed in another state
who has been requested to perform emergency procedures in
Illinois if he or she meets the requirements as
established by rule.
(C) Visiting resident permit.
(1) The Department may, in its discretion, issue a
temporary visiting resident permit, without examination,
provided:
(a) (blank);
(b) that the person maintains an equivalent
authorization to practice medicine in all of its
branches or to practice the treatment of human
ailments without the use of drugs and without
operative surgery in good standing in his or her
native licensing jurisdiction during the period of the
temporary visiting resident permit;
(c) that the applicant is enrolled in a
postgraduate clinical training program outside the
State of Illinois that is approved by the Department;
(d) that the individual has been invited or
appointed for a specific period of time to perform a
portion of that post graduate clinical training

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program under the supervision of an Illinois licensed
physician in an Illinois patient care clinic or
facility that is affiliated with the out-of-State post
graduate training program; and
(e) that the temporary visiting resident permit
shall only permit the holder to practice medicine in
all of its branches or practice the treatment of human
ailments without the use of drugs and without
operative surgery within the scope of the medical,
osteopathic, chiropractic or clinical studies for
which the holder was invited or appointed.
(2) The application for the temporary visiting
resident permit shall be made to the Department, in
writing, on forms prescribed by the Department, and shall
be accompanied by the required fee established by rule.
The application shall require information that, in the
judgment of the Department, will enable the Department to
pass on the qualifications of the applicant.
(3) A temporary visiting resident permit shall be
valid for 180 days from the date of issuance or until the
time the medical, osteopathic, chiropractic, or clinical
studies are completed, whichever occurs first.
(4) The applicant for a temporary visiting resident
permit may be required to appear before the Medical Board
for an interview prior to, and as a requirement for, the
issuance of a temporary visiting resident permit.

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(D) Postgraduate training exemption period; visiting
rotations. A person may participate in visiting rotations in
an approved postgraduate training program, not to exceed a
total of 90 days for all rotations, if the following
information is submitted in writing or electronically to the
Department by the patient care clinics or facilities where the
person will be performing the training or by an affiliated
program:
(1) The person who has been invited or appointed to
perform a portion of their postgraduate clinical training
program in Illinois.
(2) The name and address of the primary patient care
clinic or facility, the date the training is to begin, and
the length of time of the invitation or appointment.
(3) The name and license number of the Illinois
physician who will be responsible for supervising the
trainee and the medical director or division director of
the department or facility.
(4) Certification from the postgraduate training
program that the person is approved and enrolled in an
graduate training program approved by the Department in
their home state.
(Source: P.A. 102-20, eff. 1-1-22.)
Section 95. No acceleration or delay. Where this Act makes

SB1561 Enrolled - 37 - LRB103 27713 CPF 54090 b
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.