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| Public Act 103-0914
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| SB2697 Enrolled | LRB103 35895 RPS 65980 b |
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AN ACT concerning regulation.
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Be it enacted by the People of the State of Illinois, |
represented in the General Assembly:
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Section 5. The State Employees Group Insurance Act of 1971 |
is amended by changing Section 6.11 as follows:
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(5 ILCS 375/6.11) |
Sec. 6.11. Required health benefits; Illinois Insurance |
Code requirements. The program of health benefits shall |
provide the post-mastectomy care benefits required to be |
covered by a policy of accident and health insurance under |
Section 356t of the Illinois Insurance Code. The program of |
health benefits shall provide the coverage required under |
Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10, |
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, |
and 356z.70 of the Illinois Insurance Code. The program of |
health benefits must comply with Sections 155.22a, 155.37, |
355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of the |
Illinois Insurance Code. The program of health benefits shall |
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provide the coverage required under Section 356m of the |
Illinois Insurance Code and, for the employees of the State |
Employee Group Insurance Program only, the coverage as also |
provided in Section 6.11B of this Act. The Department of |
Insurance shall enforce the requirements of this Section with |
respect to Sections 370c and 370c.1 of the Illinois Insurance |
Code; all other requirements of this Section shall be enforced |
by the Department of Central Management Services. |
Rulemaking authority to implement Public Act 95-1045, if |
any, is conditioned on the rules being adopted in accordance |
with all provisions of the Illinois Administrative Procedure |
Act and all rules and procedures of the Joint Committee on |
Administrative Rules; any purported rule not so adopted, for |
whatever reason, is unauthorized. |
(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; |
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. |
1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-768, |
eff. 1-1-24; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; |
102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. |
1-1-23; 102-1117, eff. 1-13-23; 103-8, eff. 1-1-24; 103-84, |
eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, eff. 1-1-24; |
103-445, eff. 1-1-24; 103-535, eff. 8-11-23; 103-551, eff. |
8-11-23; revised 8-29-23.)
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Section 10. The Counties Code is amended by changing |
Section 5-1069.3 as follows:
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(55 ILCS 5/5-1069.3) |
Sec. 5-1069.3. Required health benefits. If a county, |
including a home rule county, is a self-insurer for purposes |
of providing health insurance coverage for its employees, the |
coverage shall include coverage for the post-mastectomy care |
benefits required to be covered by a policy of accident and |
health insurance under Section 356t and the coverage required |
under Sections 356g, 356g.5, 356g.5-1, 356q, 356u, 356u.10, |
356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, |
356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, |
356z.26, 356z.29, 356z.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, and 356z.70 |
of the Illinois Insurance Code. The coverage shall comply with |
Sections 155.22a, 355b, 356z.19, and 370c of the Illinois |
Insurance Code. The Department of Insurance shall enforce the |
requirements of this Section. The requirement that health |
benefits be covered as provided in this Section is an |
exclusive power and function of the State and is a denial and |
limitation under Article VII, 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 |
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any, is conditioned on the rules being adopted in accordance |
with all provisions of the Illinois Administrative Procedure |
Act and all rules and procedures of the Joint Committee on |
Administrative Rules; any purported rule not so adopted, for |
whatever reason, is unauthorized. |
(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; |
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. |
1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, |
eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; |
102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. |
1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, |
eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24; |
103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised |
8-29-23.)
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Section 15. The Illinois Municipal Code is amended by |
changing Section 10-4-2.3 as follows:
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(65 ILCS 5/10-4-2.3) |
Sec. 10-4-2.3. Required health benefits. If a |
municipality, including a home rule municipality, is a |
self-insurer for purposes of providing health insurance |
coverage for its employees, the coverage shall include |
coverage for the post-mastectomy care benefits required to be |
covered by a policy of accident and health insurance under |
Section 356t and the coverage required under Sections 356g, |
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356g.5, 356g.5-1, 356q, 356u, 356u.10, 356w, 356x, 356z.4, |
356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, |
356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29, |
356z.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, and 356z.70 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 |
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; |
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102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. |
1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, |
eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24; |
103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised |
8-29-23.)
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Section 20. The School Code is amended by changing Section |
10-22.3f as follows:
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(105 ILCS 5/10-22.3f) |
Sec. 10-22.3f. Required health benefits. Insurance |
protection and benefits for employees shall provide the |
post-mastectomy care benefits required to be covered by a |
policy of accident and health insurance under Section 356t and |
the coverage required under Sections 356g, 356g.5, 356g.5-1, |
356q, 356u, 356u.10, 356w, 356x, 356z.4, 356z.4a, 356z.6, |
356z.8, 356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, |
356z.22, 356z.25, 356z.26, 356z.29, 356z.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, and |
356z.70 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. |
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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; 102-642, eff. |
1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804, |
eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; |
102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff. |
1-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, |
eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. 8-11-23; |
103-551, eff. 8-11-23; revised 8-29-23.)
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Section 25. The Illinois Insurance Code is amended by |
adding Section 356u.10 as follows:
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(215 ILCS 5/356u.10 new) |
Sec. 356u.10. Genetic testing and evidence-based |
screenings for an inherited gene mutation. |
(a) In this Section, "genetic testing for an inherited |
mutation" means germline multi-gene testing for an inherited |
mutation associated with an increased risk of cancer in |
accordance with evidence-based, clinical practice guidelines. |
(b) A group policy of accident and health insurance or |
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managed care plan that is amended, delivered, issued, or |
renewed after January 1, 2026 shall provide coverage for |
clinical genetic testing for an inherited gene mutation for |
individuals with a personal or family history of cancer, as |
recommended by a health care professional in accordance with |
current evidence-based clinical practice guidelines, |
including, but not limited to, the current version of the |
National Comprehensive Cancer Network clinical practice |
guidelines. The coverage shall limit the total amount that a |
covered person is required to pay for a clinical genetic test |
under this subsection to an amount not to exceed $50, except |
for services for which cost sharing is prohibited under 42 |
U.S.C. 300gg-13. This subsection (b) shall not apply to |
coverage of genetic testing 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. |
(c) For individuals with a genetic test that is positive |
for an inherited mutation associated with an increased risk of |
cancer, coverage required under this Section shall include any |
evidence-based screenings, as recommended by a health care |
professional in accordance with current evidence-based |
clinical practice guidelines, to the extent that the |
management recommendation is not already covered by the |
policy, except that coverage for evidence-based screenings |
under this subsection (c) may be subject to a deductible, |
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coinsurance, or other cost-sharing limitation so long as the |
limitation is not greater than that required for other related |
cancer risk management benefits covered under the policy. In |
this subsection, "evidence-based cancer screenings" means |
medically recommended evidence-based screening modalities in |
accordance with current clinical practice guidelines.
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Section 30. The Health Maintenance Organization Act is |
amended by changing Section 5-3 as follows:
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(215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2) |
Sec. 5-3. Insurance Code provisions. |
(a) Health Maintenance Organizations shall be subject to |
the provisions of Sections 133, 134, 136, 137, 139, 140, |
141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, |
154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 155.49, |
355.2, 355.3, 355b, 355c, 356f, 356g.5-1, 356m, 356q, 356u.10, |
356v, 356w, 356x, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, |
356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, |
356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.20, 356z.21, |
356z.22, 356z.23, 356z.24, 356z.25, 356z.26, 356z.28, 356z.29, |
356z.30, 356z.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, |
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356z.68, 364, 364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b, |
368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A, |
408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of |
subsection (2) of Section 367, and Articles IIA, VIII 1/2, |
XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the |
Illinois Insurance Code. |
(b) For purposes of the Illinois Insurance Code, except |
for Sections 444 and 444.1 and Articles XIII and XIII 1/2, |
Health Maintenance Organizations in the following categories |
are deemed to be "domestic companies": |
(1) a corporation authorized under the Dental Service |
Plan Act or the Voluntary Health Services Plans Act; |
(2) a corporation organized under the laws of this |
State; or |
(3) a corporation organized under the laws of another |
state, 30% or more of the enrollees of which are residents |
of this State, except a corporation subject to |
substantially the same requirements in its state of |
organization as is a "domestic company" under Article VIII |
1/2 of the Illinois Insurance Code. |
(c) In considering the merger, consolidation, or other |
acquisition of control of a Health Maintenance Organization |
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 |
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Organization after the merger, consolidation, or other |
acquisition of control takes effect; |
(2)(i) the criteria specified in subsection (1)(b) of |
Section 131.8 of the Illinois Insurance Code shall not |
apply and (ii) the Director, in making his determination |
with respect to the merger, consolidation, or other |
acquisition of control, need not take into account the |
effect on competition of the merger, consolidation, or |
other acquisition of control; |
(3) the Director shall have the power to require the |
following information: |
(A) certification by an independent actuary of the |
adequacy of the reserves of the Health Maintenance |
Organization sought to be acquired; |
(B) pro forma financial statements reflecting the |
combined balance sheets of the acquiring company and |
the Health Maintenance Organization sought to be |
acquired as of the end of the preceding year and as of |
a date 90 days prior to the acquisition, as well as pro |
forma financial statements reflecting projected |
combined operation for a period of 2 years; |
(C) a pro forma business plan detailing an |
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 |
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require. |
(d) The provisions of Article VIII 1/2 of the Illinois |
Insurance Code and this Section 5-3 shall apply to the sale by |
any health maintenance organization of greater than 10% of its |
enrollee population (including, without limitation, the health |
maintenance organization's right, title, and interest in and |
to its health care certificates). |
(e) In considering any management contract or service |
agreement subject to Section 141.1 of the Illinois Insurance |
Code, the Director (i) shall, in addition to the criteria |
specified in Section 141.2 of the Illinois Insurance Code, |
take into account the effect of the management contract or |
service agreement on the continuation of benefits to enrollees |
and the financial condition of the health maintenance |
organization to be managed or serviced, and (ii) need not take |
into account the effect of the management contract or service |
agreement on competition. |
(f) Except for small employer groups as defined in the |
Small Employer Rating, Renewability and Portability Health |
Insurance Act and except for medicare supplement policies as |
defined in Section 363 of the Illinois Insurance Code, a |
Health Maintenance Organization may by contract agree with a |
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 |
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in the group or enrollment unit contract agreed in advance |
of the period for which a refund is to be paid or |
additional premium is to be charged (which period shall |
not be less than one year); and |
(ii) the amount of the refund or additional premium |
shall not exceed 20% of the Health Maintenance |
Organization's profitable or unprofitable experience with |
respect to the group or other enrollment unit for the |
period (and, for purposes of a refund or additional |
premium, the profitable or unprofitable experience shall |
be calculated taking into account a pro rata share of the |
Health Maintenance Organization's administrative and |
marketing expenses, but shall not include any refund to be |
made or additional premium to be paid pursuant to this |
subsection (f)). The Health Maintenance Organization and |
the group or enrollment unit may agree that the profitable |
or unprofitable experience may be calculated taking into |
account the refund period and the immediately preceding 2 |
plan years. |
The Health Maintenance Organization shall include a |
statement in the evidence of coverage issued to each enrollee |
describing the possibility of a refund or additional premium, |
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 |
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unit and the resulting refund to the group or enrollment unit |
or (2) the Health Maintenance Organization's unprofitable |
experience with respect to the group or enrollment unit and |
the resulting additional premium to be paid by the group or |
enrollment unit. |
In no event shall the Illinois Health Maintenance |
Organization Guaranty Association be liable to pay any |
contractual obligation of an insolvent organization to pay any |
refund authorized under this Section. |
(g) Rulemaking authority to implement Public Act 95-1045, |
if any, is conditioned on the rules being adopted in |
accordance with all provisions of the Illinois Administrative |
Procedure Act and all rules and procedures of the Joint |
Committee on Administrative Rules; any purported rule not so |
adopted, for whatever reason, is unauthorized. |
(Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21; |
102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. |
1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, |
eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; |
102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. |
1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, |
eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; |
103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff. |
6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445, |
eff. 1-1-24; 103-551, eff. 8-11-23; revised 8-29-23.)
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Section 35. 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, 356q, 356r, 356t, 356u, 356u.10, 356v, |
356w, 356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, |
356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, |
356z.13, 356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22, |
356z.25, 356z.26, 356z.29, 356z.30, 356z.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.61, 356z.62, |
356z.64, 356z.67, 356z.68, 364.01, 364.3, 367.2, 368a, 401, |
401.1, 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7) |
and (15) of Section 367 of the Illinois Insurance Code. |
Rulemaking authority to implement Public Act 95-1045, if |
any, is conditioned on the rules being adopted in accordance |
with all provisions of the Illinois Administrative Procedure |
Act and all rules and procedures of the Joint Committee on |
Administrative Rules; any purported rule not so adopted, for |
whatever reason, is unauthorized. |
(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; |
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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.)
|
Section 40. The Illinois Public Aid Code is amended by |
adding Section 5-52 as follows:
|
(305 ILCS 5/5-52 new) |
Sec. 5-52. Genetic testing and evidence-based screenings |
for an inherited gene mutation. |
(a) In this Section, "genetic testing for an inherited |
mutation" means germline multi-gene testing for an inherited |
mutation associated with an increased risk of cancer in |
accordance with evidence-based, clinical practice guidelines. |
(b) Subject to federal approval, the medical assistance |
program, after January 1, 2026, shall provide coverage for |
clinical genetic testing for an inherited gene mutation for |
individuals with a personal or family history of cancer, as |
recommended by a health care professional in accordance with |
current evidence-based clinical practice guidelines, |
including, but not limited to, the current version of the |
National Comprehensive Cancer Network clinical practice |
