SB2573 EngrossedLRB103 31822 BMS 60443 b


1 AN ACT concerning regulation.

2 Be it enacted by the People of the State of Illinois, 
3represented in the General Assembly:

4 Section 5. The Illinois Insurance Code is amended by 
5adding Section 356z.61 as follows:

6 (215 ILCS 5/356z.61 new)
7 Sec. 356z.61. Wigs and hair prostheses. A group or 
8individual plan of accident and health insurance or managed 
9care plan amended, delivered, issued, or renewed after January 
101, 2026 must provide coverage, no less than once every 12 
11months, for one wig or other scalp prosthesis worn for hair 
12loss caused by alopecia, chemotherapy, or radiation treatment 
13for cancer or other conditions.

14 Section 10. The Health Maintenance Organization Act is 
15amended by changing Section 5-3 as follows:

16 (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
17 Sec. 5-3. Insurance Code provisions. 
18 (a) Health Maintenance Organizations shall be subject to 
19the provisions of Sections 133, 134, 136, 137, 139, 140, 
20141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 
21154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2, 
 
 
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1355.3, 355b, 355c, 356g.5-1, 356m, 356q, 356v, 356w, 356x, 
2356y, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, 
3356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 
4356z.15, 356z.17, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 
5356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33, 
6356z.35, 356z.36, 356z.40, 356z.41, 356z.46, 356z.47, 356z.48, 
7356z.50, 356z.51, 356z.53 256z.53, 356z.54, 356z.56, 356z.57, 
8356z.59, 356z.60, 356z.61, 364, 364.01, 364.3, 367.2, 367.2-5, 
9367i, 368a, 368b, 368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 
10402, 403, 403A, 408, 408.2, 409, 412, 444, and 444.1, 
11paragraph (c) of subsection (2) of Section 367, and Articles 
12IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and 
13XXXIIB of the Illinois Insurance Code.
14 (b) For purposes of the Illinois Insurance Code, except 
15for Sections 444 and 444.1 and Articles XIII and XIII 1/2, 
16Health Maintenance Organizations in the following categories 
17are deemed to be "domestic companies":
18  (1) a corporation authorized under the Dental Service 
19 Plan Act or the Voluntary Health Services Plans Act;
20  (2) a corporation organized under the laws of this 
21 State; or
22  (3) a corporation organized under the laws of another 
23 state, 30% or more of the enrollees of which are residents 
24 of this State, except a corporation subject to 
25 substantially the same requirements in its state of 
26 organization as is a "domestic company" under Article VIII 
 
 
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1 1/2 of the Illinois Insurance Code.
2 (c) In considering the merger, consolidation, or other 
3acquisition of control of a Health Maintenance Organization 
4pursuant to Article VIII 1/2 of the Illinois Insurance Code,
5  (1) the Director shall give primary consideration to 
6 the continuation of benefits to enrollees and the 
7 financial conditions of the acquired Health Maintenance 
8 Organization after the merger, consolidation, or other 
9 acquisition of control takes effect;
10  (2)(i) the criteria specified in subsection (1)(b) of 
11 Section 131.8 of the Illinois Insurance Code shall not 
12 apply and (ii) the Director, in making his determination 
13 with respect to the merger, consolidation, or other 
14 acquisition of control, need not take into account the 
15 effect on competition of the merger, consolidation, or 
16 other acquisition of control;
17  (3) the Director shall have the power to require the 
18 following information:
19   (A) certification by an independent actuary of the 
20 adequacy of the reserves of the Health Maintenance 
21 Organization sought to be acquired;
22   (B) pro forma financial statements reflecting the 
23 combined balance sheets of the acquiring company and 
24 the Health Maintenance Organization sought to be 
25 acquired as of the end of the preceding year and as of 
26 a date 90 days prior to the acquisition, as well as pro 
 
 
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1 forma financial statements reflecting projected 
2 combined operation for a period of 2 years;
3   (C) a pro forma business plan detailing an 
4 acquiring party's plans with respect to the operation 
5 of the Health Maintenance Organization sought to be 
6 acquired for a period of not less than 3 years; and
7   (D) such other information as the Director shall 
8 require.
9 (d) The provisions of Article VIII 1/2 of the Illinois 
10Insurance Code and this Section 5-3 shall apply to the sale by 
11any health maintenance organization of greater than 10% of its 
12enrollee population (including without limitation the health 
13maintenance organization's right, title, and interest in and 
14to its health care certificates).
15 (e) In considering any management contract or service 
16agreement subject to Section 141.1 of the Illinois Insurance 
17Code, the Director (i) shall, in addition to the criteria 
18specified in Section 141.2 of the Illinois Insurance Code, 
19take into account the effect of the management contract or 
20service agreement on the continuation of benefits to enrollees 
21and the financial condition of the health maintenance 
22organization to be managed or serviced, and (ii) need not take 
23into account the effect of the management contract or service 
24agreement on competition.
25 (f) Except for small employer groups as defined in the 
26Small Employer Rating, Renewability and Portability Health 
 
 
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1Insurance Act and except for medicare supplement policies as 
2defined in Section 363 of the Illinois Insurance Code, a 
3Health Maintenance Organization may by contract agree with a 
4group or other enrollment unit to effect refunds or charge 
5additional premiums under the following terms and conditions:
6  (i) the amount of, and other terms and conditions with 
7 respect to, the refund or additional premium are set forth 
8 in the group or enrollment unit contract agreed in advance 
9 of the period for which a refund is to be paid or 
10 additional premium is to be charged (which period shall 
11 not be less than one year); and
12  (ii) the amount of the refund or additional premium 
13 shall not exceed 20% of the Health Maintenance 
14 Organization's profitable or unprofitable experience with 
15 respect to the group or other enrollment unit for the 
16 period (and, for purposes of a refund or additional 
17 premium, the profitable or unprofitable experience shall 
18 be calculated taking into account a pro rata share of the 
19 Health Maintenance Organization's administrative and 
20 marketing expenses, but shall not include any refund to be 
21 made or additional premium to be paid pursuant to this 
22 subsection (f)). The Health Maintenance Organization and 
23 the group or enrollment unit may agree that the profitable 
24 or unprofitable experience may be calculated taking into 
25 account the refund period and the immediately preceding 2 
26 plan years.
 
 
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1 The Health Maintenance Organization shall include a 
2statement in the evidence of coverage issued to each enrollee 
3describing the possibility of a refund or additional premium, 
4and upon request of any group or enrollment unit, provide to 
5the group or enrollment unit a description of the method used 
6to calculate (1) the Health Maintenance Organization's 
7profitable experience with respect to the group or enrollment 
8unit and the resulting refund to the group or enrollment unit 
9or (2) the Health Maintenance Organization's unprofitable 
10experience with respect to the group or enrollment unit and 
11the resulting additional premium to be paid by the group or 
12enrollment unit.
13 In no event shall the Illinois Health Maintenance 
14Organization Guaranty Association be liable to pay any 
15contractual obligation of an insolvent organization to pay any 
16refund authorized under this Section.
17 (g) Rulemaking authority to implement Public Act 95-1045, 
18if any, is conditioned on the rules being adopted in 
19accordance with all provisions of the Illinois Administrative 
20Procedure Act and all rules and procedures of the Joint 
21Committee on Administrative Rules; any purported rule not so 
22adopted, for whatever reason, is unauthorized. 
23(Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19; 
24101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-393, eff. 
251-1-20; 101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, 
26eff. 1-1-21; 102-30, eff. 1-1-22; 102-34, eff. 6-25-21; 
 
 
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1102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 
21-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, 
3eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 
4102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 
51-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, 
6eff. 1-1-23; 102-1117, eff. 1-13-23; revised 1-22-23.)

7 Section 15. The Voluntary Health Services Plans Act is 
8amended by changing Section 10 as follows:

9 (215 ILCS 165/10) (from Ch. 32, par. 604)
10 Sec. 10. Application of Insurance Code provisions. Health 
11services plan corporations and all persons interested therein 
12or dealing therewith shall be subject to the provisions of 
13Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140, 
14143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, 
15356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356v, 356w, 
16356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 
17356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 
18356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 
19356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33, 
20356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54, 
21356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 364.01, 364.3, 
22367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412, 
23and paragraphs (7) and (15) of Section 367 of the Illinois 
24Insurance Code.
 
 
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1 Rulemaking authority to implement Public Act 95-1045, if 
2any, is conditioned on the rules being adopted in accordance 
3with all provisions of the Illinois Administrative Procedure 
4Act and all rules and procedures of the Joint Committee on 
5Administrative Rules; any purported rule not so adopted, for 
6whatever reason, is unauthorized. 
7(Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19; 
8101-281, eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff. 
91-1-21; 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, 
10eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 
11102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804, eff. 
121-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860, 
13eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff. 1-1-23; 
14102-1117, eff. 1-13-23.)