Illinois 2023-2024 Regular Session

Illinois Senate Bill SB0773 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	Public Act 103-0751
2	1		SB0773 EnrolledLRB103 03229 AMQ 48235 b SB0773 Enrolled LRB103 03229 AMQ 48235 b
3	2		SB0773 Enrolled LRB103 03229 AMQ 48235 b
4		-	AN ACT concerning regulation.
5		-	Be it enacted by the People of the State of Illinois,
6		-	represented in the General Assembly:
7		-	Section 5. The State Employees Group Insurance Act of 1971
8		-	is amended by changing Sections 6.11 and 6.11B as follows:
9		-	(5 ILCS 375/6.11)
10		-	Sec. 6.11. Required health benefits; Illinois Insurance
11		-	Code requirements. The program of health benefits shall
12		-	provide the post-mastectomy care benefits required to be
13		-	covered by a policy of accident and health insurance under
14		-	Section 356t of the Illinois Insurance Code. The program of
15		-	health benefits shall provide the coverage required under
16		-	Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x,
17		-	356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
18		-	356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,
19		-	356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
20		-	356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
21		-	356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59, 356z.60,
22		-	and 356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, 356z.70,
23		-	and 356z.71 of the Illinois Insurance Code. The program of
24		-	health benefits must comply with Sections 155.22a, 155.37,
25		-	355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of the
26		-	Illinois Insurance Code. The program of health benefits shall
	3	+	1 AN ACT concerning regulation.
	4	+	2 Be it enacted by the People of the State of Illinois,
	5	+	3 represented in the General Assembly:
	6	+	4 Section 5. The State Employees Group Insurance Act of 1971
	7	+	5 is amended by changing Sections 6.11 and 6.11B as follows:
	8	+	6 (5 ILCS 375/6.11)
	9	+	7 Sec. 6.11. Required health benefits; Illinois Insurance
	10	+	8 Code requirements. The program of health benefits shall
	11	+	9 provide the post-mastectomy care benefits required to be
	12	+	10 covered by a policy of accident and health insurance under
	13	+	11 Section 356t of the Illinois Insurance Code. The program of
	14	+	12 health benefits shall provide the coverage required under
	15	+	13 Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x,
	16	+	14 356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
	17	+	15 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,
	18	+	16 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
	19	+	17 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
	20	+	18 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59, 356z.60,
	21	+	19 and 356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, 356z.70,
	22	+	20 and 356z.71 of the Illinois Insurance Code. The program of
	23	+	21 health benefits must comply with Sections 155.22a, 155.37,
	24	+	22 355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of the
	25	+	23 Illinois Insurance Code. The program of health benefits shall
27	26
28	27
29	28
30	29		SB0773 Enrolled LRB103 03229 AMQ 48235 b
31	30
32	31
33		-	provide the coverage required under Section 356m of the
34		-	Illinois Insurance Code and, for the employees of the State
35		-	Employee Group Insurance Program only, the coverage as also
36		-	provided in Section 6.11B of this Act. The Department of
37		-	Insurance shall enforce the requirements of this Section with
38		-	respect to Sections 370c and 370c.1 of the Illinois Insurance
39		-	Code; all other requirements of this Section shall be enforced
40		-	by the Department of Central Management Services.
41		-	Rulemaking authority to implement Public Act 95-1045, if
42		-	any, is conditioned on the rules being adopted in accordance
43		-	with all provisions of the Illinois Administrative Procedure
44		-	Act and all rules and procedures of the Joint Committee on
45		-	Administrative Rules; any purported rule not so adopted, for
46		-	whatever reason, is unauthorized.
47		-	(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
48		-	102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
49		-	1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-768,
50		-	eff. 1-1-24; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
51		-	102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
52		-	1-1-23; 102-1117, eff. 1-13-23; 103-8, eff. 1-1-24; 103-84,
53		-	eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, eff. 1-1-24;
54		-	103-445, eff. 1-1-24; 103-535, eff. 8-11-23; 103-551, eff.
55		-	8-11-23; revised 8-29-23.)
56		-	(5 ILCS 375/6.11B)
57		-	Sec. 6.11B. Infertility coverage.
	32	+	SB0773 Enrolled- 2 -LRB103 03229 AMQ 48235 b SB0773 Enrolled - 2 - LRB103 03229 AMQ 48235 b
	33	+	SB0773 Enrolled - 2 - LRB103 03229 AMQ 48235 b
	34	+	1 provide the coverage required under Section 356m of the
	35	+	2 Illinois Insurance Code and, for the employees of the State
	36	+	3 Employee Group Insurance Program only, the coverage as also
	37	+	4 provided in Section 6.11B of this Act. The Department of
	38	+	5 Insurance shall enforce the requirements of this Section with
	39	+	6 respect to Sections 370c and 370c.1 of the Illinois Insurance
	40	+	7 Code; all other requirements of this Section shall be enforced
	41	+	8 by the Department of Central Management Services.
	42	+	9 Rulemaking authority to implement Public Act 95-1045, if
	43	+	10 any, is conditioned on the rules being adopted in accordance
	44	+	11 with all provisions of the Illinois Administrative Procedure
	45	+	12 Act and all rules and procedures of the Joint Committee on
	46	+	13 Administrative Rules; any purported rule not so adopted, for
	47	+	14 whatever reason, is unauthorized.
	48	+	15 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
	49	+	16 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
	50	+	17 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-768,
	51	+	18 eff. 1-1-24; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
	52	+	19 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
	53	+	20 1-1-23; 102-1117, eff. 1-13-23; 103-8, eff. 1-1-24; 103-84,
	54	+	21 eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, eff. 1-1-24;
	55	+	22 103-445, eff. 1-1-24; 103-535, eff. 8-11-23; 103-551, eff.
	56	+	23 8-11-23; revised 8-29-23.)
	57	+	24 (5 ILCS 375/6.11B)
	58	+	25 Sec. 6.11B. Infertility coverage.
58	59
59	60
60		-	(a) Beginning on January 1, 2024, the State Employees
61		-	Group Insurance Program shall provide coverage for the
62		-	diagnosis and treatment of infertility, including, but not
63		-	limited to, in vitro fertilization, uterine embryo lavage,
64		-	embryo transfer, artificial insemination, gamete
65		-	intrafallopian tube transfer, zygote intrafallopian tube
66		-	transfer, and low tubal ovum transfer. The coverage required
67		-	shall include procedures necessary to screen or diagnose a
68		-	fertilized egg before implantation, including, but not limited
69		-	to, preimplantation genetic diagnosis, preimplantation genetic
70		-	screening, and prenatal genetic diagnosis.
71		-	(b) Beginning on January 1, 2024, coverage under this
72		-	Section for procedures for in vitro fertilization, gamete
73		-	intrafallopian tube transfer, or zygote intrafallopian tube
74		-	transfer shall be required only if the procedures:
75		-	(1) are considered medically appropriate based on
76		-	clinical guidelines or standards developed by the American
77		-	Society for Reproductive Medicine, the American College of
78		-	Obstetricians and Gynecologists, or the Society for
79		-	Assisted Reproductive Technology; and
80		-	(2) are performed at medical facilities or clinics
81		-	that conform to the American College of Obstetricians and
82		-	Gynecologists guidelines for in vitro fertilization or the
83		-	American Society for Reproductive Medicine minimum
84		-	standards for practices offering assisted reproductive
85		-	technologies.
86	61
87	62
88		-	(c) As used in this Section, "infertility" means a
89		-	disease, condition, or status characterized by:
90		-	(1) a failure to establish a pregnancy or to carry a
91		-	pregnancy to live birth after 12 months of regular,
92		-	unprotected sexual intercourse if the woman is 35 years of
93		-	age or younger, or after 6 months of regular, unprotected
94		-	sexual intercourse if the woman is over 35 years of age;
95		-	conceiving but having a miscarriage does not restart the
96		-	12-month or 6-month term for determining infertility;
97		-	(2) a person's inability to reproduce either as a
98		-	single individual or with a partner without medical
99		-	intervention; or
100		-	(3) a licensed physician's findings based on a
101		-	patient's medical, sexual, and reproductive history, age,
102		-	physical findings, or diagnostic testing.
103		-	(d) The State Employees Group Insurance Program may not
104		-	impose any exclusions, limitations, or other restrictions on
105		-	coverage of fertility medications that are different from
106		-	those imposed on any other prescription medications, nor may
107		-	it impose any exclusions, limitations, or other restrictions
108		-	on coverage of any fertility services based on a covered
109		-	individual's participation in fertility services provided by
110		-	or to a third party, nor may it impose deductibles,
111		-	copayments, coinsurance, benefit maximums, waiting periods, or
112		-	any other limitations on coverage for the diagnosis of
113		-	infertility, treatment for infertility, and standard fertility
	63	+
	64	+	SB0773 Enrolled - 2 - LRB103 03229 AMQ 48235 b
114	65
115	66
116		-	preservation services, except as provided in this Section,
117		-	that are different from those imposed upon benefits for
118		-	services not related to infertility.
119		-	(e) This Section applies only to coverage provided on or
120		-	after January 1, 2024 and before July 1, 2026.
121		-	(f) This Section is repealed on July 1, 2026.
122		-	(Source: P.A. 103-8, eff. 1-1-24.)
123		-	Section 10. The Counties Code is amended by changing
124		-	Section 5-1069.3 as follows:
125		-	(55 ILCS 5/5-1069.3)
126		-	Sec. 5-1069.3. Required health benefits. If a county,
127		-	including a home rule county, is a self-insurer for purposes
128		-	of providing health insurance coverage for its employees, the
129		-	coverage shall include coverage for the post-mastectomy care
130		-	benefits required to be covered by a policy of accident and
131		-	health insurance under Section 356t and the coverage required
132		-	under Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w,
133		-	356x, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
134		-	356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25,
135		-	356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, 356z.36,
136		-	356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51,
137		-	356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and
138		-	356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, 356z.70, and
139		-	356z.71 of the Illinois Insurance Code. The coverage shall
	67	+	SB0773 Enrolled- 3 -LRB103 03229 AMQ 48235 b SB0773 Enrolled - 3 - LRB103 03229 AMQ 48235 b
	68	+	SB0773 Enrolled - 3 - LRB103 03229 AMQ 48235 b
	69	+	1 (a) Beginning on January 1, 2024, the State Employees
	70	+	2 Group Insurance Program shall provide coverage for the
	71	+	3 diagnosis and treatment of infertility, including, but not
	72	+	4 limited to, in vitro fertilization, uterine embryo lavage,
	73	+	5 embryo transfer, artificial insemination, gamete
	74	+	6 intrafallopian tube transfer, zygote intrafallopian tube
	75	+	7 transfer, and low tubal ovum transfer. The coverage required
	76	+	8 shall include procedures necessary to screen or diagnose a
	77	+	9 fertilized egg before implantation, including, but not limited
	78	+	10 to, preimplantation genetic diagnosis, preimplantation genetic
	79	+	11 screening, and prenatal genetic diagnosis.
	80	+	12 (b) Beginning on January 1, 2024, coverage under this
	81	+	13 Section for procedures for in vitro fertilization, gamete
	82	+	14 intrafallopian tube transfer, or zygote intrafallopian tube
	83	+	15 transfer shall be required only if the procedures:
	84	+	16 (1) are considered medically appropriate based on
	85	+	17 clinical guidelines or standards developed by the American
	86	+	18 Society for Reproductive Medicine, the American College of
	87	+	19 Obstetricians and Gynecologists, or the Society for
	88	+	20 Assisted Reproductive Technology; and
	89	+	21 (2) are performed at medical facilities or clinics
	90	+	22 that conform to the American College of Obstetricians and
	91	+	23 Gynecologists guidelines for in vitro fertilization or the
	92	+	24 American Society for Reproductive Medicine minimum
	93	+	25 standards for practices offering assisted reproductive
	94	+	26 technologies.
140	95
141	96
142		-	comply with Sections 155.22a, 355b, 356z.19, and 370c of the
143		-	Illinois Insurance Code. The Department of Insurance shall
144		-	enforce the requirements of this Section. The requirement that
145		-	health benefits be covered as provided in this Section is an
146		-	exclusive power and function of the State and is a denial and
147		-	limitation under Article VII, Section 6, subsection (h) of the
148		-	Illinois Constitution. A home rule county to which this
149		-	Section applies must comply with every provision of this
150		-	Section.
151		-	Rulemaking authority to implement Public Act 95-1045, if
152		-	any, is conditioned on the rules being adopted in accordance
153		-	with all provisions of the Illinois Administrative Procedure
154		-	Act and all rules and procedures of the Joint Committee on
155		-	Administrative Rules; any purported rule not so adopted, for
156		-	whatever reason, is unauthorized.
157		-	(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
158		-	102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
159		-	1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
160		-	eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
161		-	102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
162		-	1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
163		-	eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
164		-	103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised
165		-	8-29-23.)
166		-	Section 15. The Illinois Municipal Code is amended by
167	97
168	98
169		-	changing Section 10-4-2.3 as follows:
170		-	(65 ILCS 5/10-4-2.3)
171		-	Sec. 10-4-2.3. Required health benefits. If a
172		-	municipality, including a home rule municipality, is a
173		-	self-insurer for purposes of providing health insurance
174		-	coverage for its employees, the coverage shall include
175		-	coverage for the post-mastectomy care benefits required to be
176		-	covered by a policy of accident and health insurance under
177		-	Section 356t and the coverage required under Sections 356g,
178		-	356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x, 356z.4,
179		-	356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
180		-	356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
181		-	356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
182		-	356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
183		-	356z.56, 356z.57, 356z.59, 356z.60, and 356z.61, and 356z.62,
184		-	356z.64, 356z.67, 356z.68, 356z.70, and 356z.71 of the
185		-	Illinois Insurance Code. The coverage shall comply with
186		-	Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
187		-	Insurance Code. The Department of Insurance shall enforce the
188		-	requirements of this Section. The requirement that health
189		-	benefits be covered as provided in this is an exclusive power
190		-	and function of the State and is a denial and limitation under
191		-	Article VII, Section 6, subsection (h) of the Illinois
192		-	Constitution. A home rule municipality to which this Section
193		-	applies must comply with every provision of this Section.
	99	+
	100	+	SB0773 Enrolled - 3 - LRB103 03229 AMQ 48235 b
194	101
195	102
196		-	Rulemaking authority to implement Public Act 95-1045, if
197		-	any, is conditioned on the rules being adopted in accordance
198		-	with all provisions of the Illinois Administrative Procedure
199		-	Act and all rules and procedures of the Joint Committee on
200		-	Administrative Rules; any purported rule not so adopted, for
201		-	whatever reason, is unauthorized.
202		-	(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
203		-	102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
204		-	1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
205		-	eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
206		-	102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
207		-	1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
208		-	eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
209		-	103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised
210		-	8-29-23.)
211		-	Section 20. The School Code is amended by changing Section
212		-	10-22.3f as follows:
213		-	(105 ILCS 5/10-22.3f)
214		-	Sec. 10-22.3f. Required health benefits. Insurance
215		-	protection and benefits for employees shall provide the
216		-	post-mastectomy care benefits required to be covered by a
217		-	policy of accident and health insurance under Section 356t and
218		-	the coverage required under Sections 356g, 356g.5, 356g.5-1,
219		-	356m, 356q, 356u, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8,
	103	+	SB0773 Enrolled- 4 -LRB103 03229 AMQ 48235 b SB0773 Enrolled - 4 - LRB103 03229 AMQ 48235 b
	104	+	SB0773 Enrolled - 4 - LRB103 03229 AMQ 48235 b
	105	+	1 (c) As used in this Section, "infertility" means a
	106	+	2 disease, condition, or status characterized by:
	107	+	3 (1) a failure to establish a pregnancy or to carry a
	108	+	4 pregnancy to live birth after 12 months of regular,
	109	+	5 unprotected sexual intercourse if the woman is 35 years of
	110	+	6 age or younger, or after 6 months of regular, unprotected
	111	+	7 sexual intercourse if the woman is over 35 years of age;
	112	+	8 conceiving but having a miscarriage does not restart the
	113	+	9 12-month or 6-month term for determining infertility;
	114	+	10 (2) a person's inability to reproduce either as a
	115	+	11 single individual or with a partner without medical
	116	+	12 intervention; or
	117	+	13 (3) a licensed physician's findings based on a
	118	+	14 patient's medical, sexual, and reproductive history, age,
	119	+	15 physical findings, or diagnostic testing.
	120	+	16 (d) The State Employees Group Insurance Program may not
	121	+	17 impose any exclusions, limitations, or other restrictions on
	122	+	18 coverage of fertility medications that are different from
	123	+	19 those imposed on any other prescription medications, nor may
	124	+	20 it impose any exclusions, limitations, or other restrictions
	125	+	21 on coverage of any fertility services based on a covered
	126	+	22 individual's participation in fertility services provided by
	127	+	23 or to a third party, nor may it impose deductibles,
	128	+	24 copayments, coinsurance, benefit maximums, waiting periods, or
	129	+	25 any other limitations on coverage for the diagnosis of
	130	+	26 infertility, treatment for infertility, and standard fertility
220	131
221	132
222		-	356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
223		-	356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
224		-	356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
225		-	356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and
226		-	356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, 356z.70, and
227		-	356z.71 of the Illinois Insurance Code. Insurance policies
228		-	shall comply with Section 356z.19 of the Illinois Insurance
229		-	Code. The coverage shall comply with Sections 155.22a, 355b,
230		-	and 370c of the Illinois Insurance Code. The Department of
231		-	Insurance shall enforce the requirements of this Section.
232		-	Rulemaking authority to implement Public Act 95-1045, if
233		-	any, is conditioned on the rules being adopted in accordance
234		-	with all provisions of the Illinois Administrative Procedure
235		-	Act and all rules and procedures of the Joint Committee on
236		-	Administrative Rules; any purported rule not so adopted, for
237		-	whatever reason, is unauthorized.
238		-	(Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
239		-	102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
240		-	1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804,
241		-	eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
242		-	102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff.
243		-	1-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420,
244		-	eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. 8-11-23;
245		-	103-551, eff. 8-11-23; revised 8-29-23.)
246		-	Section 25. The Illinois Insurance Code is amended by
247	133
248	134
249		-	changing Sections 356m and 356z.32 and by adding Section
250		-	356z.71 as follows:
251		-	(215 ILCS 5/356m) (from Ch. 73, par. 968m)
252		-	Sec. 356m. Infertility coverage.
253		-	(a) No group policy of accident and health insurance
254		-	providing coverage for more than 25 employees that provides
255		-	pregnancy-related pregnancy related benefits may be issued,
256		-	amended, delivered, or renewed in this State after January 1,
257		-	2016 and through December 31, 2025 the effective date of this
258		-	amendatory Act of the 99th General Assembly unless the policy
259		-	contains coverage for the diagnosis and treatment of
260		-	infertility including, but not limited to, in vitro
261		-	fertilization, uterine embryo lavage, embryo transfer,
262		-	artificial insemination, gamete intrafallopian tube transfer,
263		-	zygote intrafallopian tube transfer, and low tubal ovum
264		-	transfer.
265		-	(a-5) No group policy of accident and health insurance
266		-	that provides pregnancy-related benefits may be issued,
267		-	amended, delivered, or renewed in this State on or after
268		-	January 1, 2026 unless the policy contains coverage for the
269		-	diagnosis and treatment of infertility, including, but not
270		-	limited to, in vitro fertilization, uterine embryo lavage,
271		-	embryo transfer, artificial insemination, gamete
272		-	intrafallopian tube transfer, zygote intrafallopian tube
273		-	transfer, surgical sperm extraction procedures, and low tubal
	135	+
	136	+	SB0773 Enrolled - 4 - LRB103 03229 AMQ 48235 b
274	137
275	138
276		-	~~ovum transfer.~~ ~~The coverage required shall include procedures~~
277		-	~~necessary to screen or diagnose a fertilized egg before~~
278		-	~~implantation~~, ~~including~~, ~~but not limited to, preimplantation~~
279		-	~~genetic testing~~ for ~~aneuploidy, preimplantation genetic~~
280		-	~~testing for chromosome structural rearrangements,~~ ~~and~~
281		-	~~preimplantation genetic testing for monogenic~~ or ~~single gene~~
282		-	~~disorders~~. ~~Coverage under this subsection for the diagnosis~~
283		-	~~and treatment of infertility shall be required only if the~~
284		-	~~procedures~~:
285		-	~~(1) are considered medically appropriate~~ by ~~the~~
286		-	~~patient's medical provider based on clinical guidelines or~~
287		-	~~standards developed by the American Society for~~
288		-	~~Reproductive Medicine~~, ~~the American College of~~
289		-	~~Obstetricians and Gynecologists~~, ~~or the Society~~ for
290		-	~~Assisted Reproductive Technology;~~ ~~and~~
291		-	~~(2) are performed at medical facilities or clinics~~
292		-	~~that are members in good standing~~ of ~~the Society for~~
293		-	~~Assisted Reproductive Technology.~~
294		-	~~(b) The coverage required~~ under ~~subsection (a) for~~
295		-	~~procedures for in vitro fertilization~~, ~~gamete intrafallopian~~
296		-	~~tube transfer~~, ~~or zygote intrafallopian tube transfer shall be~~
297		-	~~required only if is subject to the following conditions:~~
298		-	~~(1) Coverage for procedures for in vitro~~
299		-	~~fertilization~~, ~~gamete intrafallopian tube transfer~~, or
300		-	~~zygote intrafallopian tube transfer shall be required only~~
301		-	~~if:~~
	139	+	SB0773 Enrolled- 5 -LRB103 03229 AMQ 48235 b SB0773 Enrolled - 5 - LRB103 03229 AMQ 48235 b
	140	+	SB0773 Enrolled - 5 - LRB103 03229 AMQ 48235 b
	141	+	1 preservation services, except as provided in this Section,
	142	+	2 that are different from those imposed upon benefits for
	143	+	3 services not related to infertility.
	144	+	4 (e) This Section applies only to coverage provided on or
	145	+	5 after January 1, 2024 and before July 1, 2026.
	146	+	6 (f) This Section is repealed on July 1, 2026.
	147	+	7 (Source: P.A. 103-8, eff. 1-1-24.)
	148	+	8 Section 10. The Counties Code is amended by changing
	149	+	9 Section 5-1069.3 as follows:
	150	+	10 (55 ILCS 5/5-1069.3)
	151	+	11 Sec. 5-1069.3. Required health benefits. If a county,
	152	+	12 including a home rule county, is a self-insurer for purposes
	153	+	13 of providing health insurance coverage for its employees, the
	154	+	14 coverage shall include coverage for the post-mastectomy care
	155	+	15 benefits required to be covered by a policy of accident and
	156	+	16 health insurance under Section 356t and the coverage required
	157	+	17 under Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w,
	158	+	18 356x, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
	159	+	19 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25,
	160	+	20 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, 356z.36,
	161	+	21 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51,
	162	+	22 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and
	163	+	23 356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, 356z.70, and
	164	+	24 356z.71 of the Illinois Insurance Code. The coverage shall
302	165
303	166
304		-	(1) (A) the covered individual has been unable to
305		-	attain a viable pregnancy, maintain a viable pregnancy, or
306		-	sustain a successful pregnancy through reasonable, less
307		-	costly medically appropriate infertility treatments for
308		-	which coverage is available under the policy, plan, or
309		-	contract;
310		-	(2) (B) the covered individual has not undergone 4
311		-	completed oocyte retrievals, except that if a live birth
312		-	follows a completed oocyte retrieval, then 2 more
313		-	completed oocyte retrievals shall be covered; and
314		-	(3) (C) the procedures are performed at medical
315		-	facilities that conform to the American College of
316		-	Obstetric and Gynecology guidelines for in vitro
317		-	fertilization clinics or to the American Fertility Society
318		-	minimal standards for programs of in vitro fertilization.
319		-	(2) The procedures required to be covered under this
320		-	Section are not required to be contained in any policy or
321		-	plan issued to or by a religious institution or
322		-	organization or to or by an entity sponsored by a
323		-	religious institution or organization that finds the
324		-	procedures required to be covered under this Section to
325		-	violate its religious and moral teachings and beliefs.
326		-	(c) As used in this Section, "infertility" means a
327		-	disease, condition, or status characterized by:
328		-	(1) a failure to establish a pregnancy or to carry a
329		-	pregnancy to live birth after 12 months of regular,
330	167
331	168
332		-	unprotected sexual intercourse if the woman is 35 years of
333		-	age or younger, or after 6 months of regular, unprotected
334		-	sexual intercourse if the woman is over 35 years of age;
335		-	conceiving but having a miscarriage does not restart the
336		-	12-month or 6-month term for determining infertility;
337		-	(2) a person's inability to reproduce either as a
338		-	single individual or with a partner without medical
339		-	intervention; or
340		-	(3) a licensed physician's findings based on a
341		-	patient's medical, sexual, and reproductive history, age,
342		-	physical findings, or diagnostic testing.
343		-	(d) A policy, contract, or certificate may not impose any
344		-	exclusions, limitations, or other restrictions on coverage of
345		-	fertility medications that are different from those imposed on
346		-	any other prescription medications, nor may it impose any
347		-	exclusions, limitations, or other restrictions on coverage of
348		-	any fertility services based on a covered individual's
349		-	participation in fertility services provided by or to a third
350		-	party, nor may it impose deductibles, copayments, coinsurance,
351		-	benefit maximums, waiting periods, or any other limitations on
352		-	coverage for the diagnosis of infertility, treatment for
353		-	infertility, and standard fertility preservation services,
354		-	except as provided in this Section, that are different from
355		-	those imposed upon benefits for services not related to
356		-	infertility.
357		-	(e) The procedures required to be covered under this
	169	+
	170	+	SB0773 Enrolled - 5 - LRB103 03229 AMQ 48235 b
358	171
359	172
360		-	Section are not required to be contained in any policy or plan
361		-	issued to or by a religious institution or organization or to
362		-	or by an entity sponsored by a religious institution or
363		-	organization that finds the procedures required to be covered
364		-	under this Section to violate its religious and moral
365		-	teachings and beliefs.
366		-	(Source: P.A. 102-170, eff. 1-1-22.)
367		-	(215 ILCS 5/356z.71 new)
368		-	Sec. 356z.71. Coverage for annual menopause health visit.
369		-	A group or individual policy of accident and health insurance
370		-	providing coverage for more than 25 employees that is amended,
371		-	delivered, issued, or renewed on or after January 1, 2026
372		-	shall provide, for individuals 45 years of age and older,
373		-	coverage for an annual menopause health visit. A policy
374		-	subject to this Section shall not impose a deductible,
375		-	coinsurance, copayment, or any other cost-sharing requirement
376		-	on the coverage provided; except that this Section does not
377		-	apply to this coverage to the extent such coverage would
378		-	disqualify a high-deductible health plan from eligibility for
379		-	a health savings account pursuant to Section 223 of the
380		-	Internal Revenue Code.
381		-	Section 30. The Health Maintenance Organization Act is
382		-	amended by changing Section 5-3 as follows:
	173	+	SB0773 Enrolled- 6 -LRB103 03229 AMQ 48235 b SB0773 Enrolled - 6 - LRB103 03229 AMQ 48235 b
	174	+	SB0773 Enrolled - 6 - LRB103 03229 AMQ 48235 b
	175	+	1 comply with Sections 155.22a, 355b, 356z.19, and 370c of the
	176	+	2 Illinois Insurance Code. The Department of Insurance shall
	177	+	3 enforce the requirements of this Section. The requirement that
	178	+	4 health benefits be covered as provided in this Section is an
	179	+	5 exclusive power and function of the State and is a denial and
	180	+	6 limitation under Article VII, Section 6, subsection (h) of the
	181	+	7 Illinois Constitution. A home rule county to which this
	182	+	8 Section applies must comply with every provision of this
	183	+	9 Section.
	184	+	10 Rulemaking authority to implement Public Act 95-1045, if
	185	+	11 any, is conditioned on the rules being adopted in accordance
	186	+	12 with all provisions of the Illinois Administrative Procedure
	187	+	13 Act and all rules and procedures of the Joint Committee on
	188	+	14 Administrative Rules; any purported rule not so adopted, for
	189	+	15 whatever reason, is unauthorized.
	190	+	16 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
	191	+	17 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
	192	+	18 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
	193	+	19 eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
	194	+	20 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
	195	+	21 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
	196	+	22 eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
	197	+	23 103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised
	198	+	24 8-29-23.)
	199	+	25 Section 15. The Illinois Municipal Code is amended by
383	200
384	201
385		-	(215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
386		-	Sec. 5-3. Insurance Code provisions.
387		-	(a) Health Maintenance Organizations shall be subject to
388		-	the provisions of Sections 133, 134, 136, 137, 139, 140,
389		-	141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
390		-	154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 155.49,
391		-	355.2, 355.3, 355b, 355c, 356f, 356g.5-1, 356m, 356q, 356v,
392		-	356w, 356x, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6,
393		-	356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14,
394		-	356z.15, 356z.17, 356z.18, 356z.19, 356z.20, 356z.21, 356z.22,
395		-	356z.23, 356z.24, 356z.25, 356z.26, 356z.28, 356z.29, 356z.30,
396		-	356z.30a, 356z.31, 356z.32, 356z.33, 356z.34, 356z.35,
397		-	356z.36, 356z.37, 356z.38, 356z.39, 356z.40, 356z.41, 356z.44,
398		-	356z.45, 356z.46, 356z.47, 356z.48, 356z.49, 356z.50, 356z.51,
399		-	356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.58, 356z.59,
400		-	356z.60, 356z.61, 356z.62, 356z.64, 356z.65, 356z.67, 356z.68,
401		-	356z.71, 364, 364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b,
402		-	368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A,
403		-	408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of
404		-	subsection (2) of Section 367, and Articles IIA, VIII 1/2,
405		-	XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the
406		-	Illinois Insurance Code.
407		-	(b) For purposes of the Illinois Insurance Code, except
408		-	for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
409		-	Health Maintenance Organizations in the following categories
410		-	are deemed to be "domestic companies":
411	202
412	203
413		-	(1) a corporation authorized under the Dental Service
414		-	Plan Act or the Voluntary Health Services Plans Act;
415		-	(2) a corporation organized under the laws of this
416		-	State; or
417		-	(3) a corporation organized under the laws of another
418		-	state, 30% or more of the enrollees of which are residents
419		-	of this State, except a corporation subject to
420		-	substantially the same requirements in its state of
421		-	organization as is a "domestic company" under Article VIII
422		-	1/2 of the Illinois Insurance Code.
423		-	(c) In considering the merger, consolidation, or other
424		-	acquisition of control of a Health Maintenance Organization
425		-	pursuant to Article VIII 1/2 of the Illinois Insurance Code,
426		-	(1) the Director shall give primary consideration to
427		-	the continuation of benefits to enrollees and the
428		-	financial conditions of the acquired Health Maintenance
429		-	Organization after the merger, consolidation, or other
430		-	acquisition of control takes effect;
431		-	(2)(i) the criteria specified in subsection (1)(b) of
432		-	Section 131.8 of the Illinois Insurance Code shall not
433		-	apply and (ii) the Director, in making his determination
434		-	with respect to the merger, consolidation, or other
435		-	acquisition of control, need not take into account the
436		-	effect on competition of the merger, consolidation, or
437		-	other acquisition of control;
438		-	(3) the Director shall have the power to require the
	204	+
	205	+	SB0773 Enrolled - 6 - LRB103 03229 AMQ 48235 b
439	206
440	207
441		-	following information:
442		-	(A) certification by an independent actuary of the
443		-	adequacy of the reserves of the Health Maintenance
444		-	Organization sought to be acquired;
445		-	(B) pro forma financial statements reflecting the
446		-	combined balance sheets of the acquiring company and
447		-	the Health Maintenance Organization sought to be
448		-	acquired as of the end of the preceding year and as of
449		-	a date 90 days prior to the acquisition, as well as pro
450		-	forma financial statements reflecting projected
451		-	combined operation for a period of 2 years;
452		-	(C) a pro forma business plan detailing an
453		-	acquiring party's plans with respect to the operation
454		-	of the Health Maintenance Organization sought to be
455		-	acquired for a period of not less than 3 years; and
456		-	(D) such other information as the Director shall
457		-	require.
458		-	(d) The provisions of Article VIII 1/2 of the Illinois
459		-	Insurance Code and this Section 5-3 shall apply to the sale by
460		-	any health maintenance organization of greater than 10% of its
461		-	enrollee population (including, without limitation, the health
462		-	maintenance organization's right, title, and interest in and
463		-	to its health care certificates).
464		-	(e) In considering any management contract or service
465		-	agreement subject to Section 141.1 of the Illinois Insurance
466		-	Code, the Director (i) shall, in addition to the criteria
	208	+	SB0773 Enrolled- 7 -LRB103 03229 AMQ 48235 b SB0773 Enrolled - 7 - LRB103 03229 AMQ 48235 b
	209	+	SB0773 Enrolled - 7 - LRB103 03229 AMQ 48235 b
	210	+	1 changing Section 10-4-2.3 as follows:
	211	+	2 (65 ILCS 5/10-4-2.3)
	212	+	3 Sec. 10-4-2.3. Required health benefits. If a
	213	+	4 municipality, including a home rule municipality, is a
	214	+	5 self-insurer for purposes of providing health insurance
	215	+	6 coverage for its employees, the coverage shall include
	216	+	7 coverage for the post-mastectomy care benefits required to be
	217	+	8 covered by a policy of accident and health insurance under
	218	+	9 Section 356t and the coverage required under Sections 356g,
	219	+	10 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x, 356z.4,
	220	+	11 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
	221	+	12 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
	222	+	13 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
	223	+	14 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
	224	+	15 356z.56, 356z.57, 356z.59, 356z.60, and 356z.61, and 356z.62,
	225	+	16 356z.64, 356z.67, 356z.68, 356z.70, and 356z.71 of the
	226	+	17 Illinois Insurance Code. The coverage shall comply with
	227	+	18 Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
	228	+	19 Insurance Code. The Department of Insurance shall enforce the
	229	+	20 requirements of this Section. The requirement that health
	230	+	21 benefits be covered as provided in this is an exclusive power
	231	+	22 and function of the State and is a denial and limitation under
	232	+	23 Article VII, Section 6, subsection (h) of the Illinois
	233	+	24 Constitution. A home rule municipality to which this Section
	234	+	25 applies must comply with every provision of this Section.
467	235
468	236
469		-	specified in Section 141.2 of the Illinois Insurance Code,
470		-	take into account the effect of the management contract or
471		-	service agreement on the continuation of benefits to enrollees
472		-	and the financial condition of the health maintenance
473		-	organization to be managed or serviced, and (ii) need not take
474		-	into account the effect of the management contract or service
475		-	agreement on competition.
476		-	(f) Except for small employer groups as defined in the
477		-	Small Employer Rating, Renewability and Portability Health
478		-	Insurance Act and except for medicare supplement policies as
479		-	defined in Section 363 of the Illinois Insurance Code, a
480		-	Health Maintenance Organization may by contract agree with a
481		-	group or other enrollment unit to effect refunds or charge
482		-	additional premiums under the following terms and conditions:
483		-	(i) the amount of, and other terms and conditions with
484		-	respect to, the refund or additional premium are set forth
485		-	in the group or enrollment unit contract agreed in advance
486		-	of the period for which a refund is to be paid or
487		-	additional premium is to be charged (which period shall
488		-	not be less than one year); and
489		-	(ii) the amount of the refund or additional premium
490		-	shall not exceed 20% of the Health Maintenance
491		-	Organization's profitable or unprofitable experience with
492		-	respect to the group or other enrollment unit for the
493		-	period (and, for purposes of a refund or additional
494		-	premium, the profitable or unprofitable experience shall
495	237
496	238
497		-	be calculated taking into account a pro rata share of the
498		-	Health Maintenance Organization's administrative and
499		-	marketing expenses, but shall not include any refund to be
500		-	made or additional premium to be paid pursuant to this
501		-	subsection (f)). The Health Maintenance Organization and
502		-	the group or enrollment unit may agree that the profitable
503		-	or unprofitable experience may be calculated taking into
504		-	account the refund period and the immediately preceding 2
505		-	plan years.
506		-	The Health Maintenance Organization shall include a
507		-	statement in the evidence of coverage issued to each enrollee
508		-	describing the possibility of a refund or additional premium,
509		-	and upon request of any group or enrollment unit, provide to
510		-	the group or enrollment unit a description of the method used
511		-	to calculate (1) the Health Maintenance Organization's
512		-	profitable experience with respect to the group or enrollment
513		-	unit and the resulting refund to the group or enrollment unit
514		-	or (2) the Health Maintenance Organization's unprofitable
515		-	experience with respect to the group or enrollment unit and
516		-	the resulting additional premium to be paid by the group or
517		-	enrollment unit.
518		-	In no event shall the Illinois Health Maintenance
519		-	Organization Guaranty Association be liable to pay any
520		-	contractual obligation of an insolvent organization to pay any
521		-	refund authorized under this Section.
522		-	(g) Rulemaking authority to implement Public Act 95-1045,
	239	+
	240	+	SB0773 Enrolled - 7 - LRB103 03229 AMQ 48235 b
523	241
524	242
525		-	if any, is conditioned on the rules being adopted in
526		-	accordance with all provisions of the Illinois Administrative
527		-	Procedure Act and all rules and procedures of the Joint
528		-	Committee on Administrative Rules; any purported rule not so
529		-	adopted, for whatever reason, is unauthorized.
530		-	(Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
531		-	102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
532		-	1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
533		-	eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
534		-	102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
535		-	1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
536		-	eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;
537		-	103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.
538		-	6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
539		-	eff. 1-1-24; 103-551, eff. 8-11-23; revised 8-29-23.)
540		-	Section 35. The Limited Health Service Organization Act is
541		-	amended by changing Section 4003 as follows:
542		-	(215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
543		-	Sec. 4003. Illinois Insurance Code provisions. Limited
544		-	health service organizations shall be subject to the
545		-	provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
546		-	141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
547		-	154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 355.2,
548		-	355.3, 355b, 356m, 356q, 356v, 356z.4, 356z.4a, 356z.10,
	243	+	SB0773 Enrolled- 8 -LRB103 03229 AMQ 48235 b SB0773 Enrolled - 8 - LRB103 03229 AMQ 48235 b
	244	+	SB0773 Enrolled - 8 - LRB103 03229 AMQ 48235 b
	245	+	1 Rulemaking authority to implement Public Act 95-1045, if
	246	+	2 any, is conditioned on the rules being adopted in accordance
	247	+	3 with all provisions of the Illinois Administrative Procedure
	248	+	4 Act and all rules and procedures of the Joint Committee on
	249	+	5 Administrative Rules; any purported rule not so adopted, for
	250	+	6 whatever reason, is unauthorized.
	251	+	7 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
	252	+	8 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
	253	+	9 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
	254	+	10 eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
	255	+	11 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
	256	+	12 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
	257	+	13 eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
	258	+	14 103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised
	259	+	15 8-29-23.)
	260	+	16 Section 20. The School Code is amended by changing Section
	261	+	17 10-22.3f as follows:
	262	+	18 (105 ILCS 5/10-22.3f)
	263	+	19 Sec. 10-22.3f. Required health benefits. Insurance
	264	+	20 protection and benefits for employees shall provide the
	265	+	21 post-mastectomy care benefits required to be covered by a
	266	+	22 policy of accident and health insurance under Section 356t and
	267	+	23 the coverage required under Sections 356g, 356g.5, 356g.5-1,
	268	+	24 356m, 356q, 356u, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8,
549	269
550	270
551		-	356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30a,
552		-	356z.32, 356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53,
553		-	356z.54, 356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68,
554		-	356z.71, 364.3, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2,
555		-	409, 412, 444, and 444.1 and Articles IIA, VIII 1/2, XII, XII
556		-	1/2, XIII, XIII 1/2, XXV, and XXVI of the Illinois Insurance
557		-	Code. Nothing in this Section shall require a limited health
558		-	care plan to cover any service that is not a limited health
559		-	service. For purposes of the Illinois Insurance Code, except
560		-	for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
561		-	limited health service organizations in the following
562		-	categories are deemed to be domestic companies:
563		-	(1) a corporation under the laws of this State; or
564		-	(2) a corporation organized under the laws of another
565		-	state, 30% or more of the enrollees of which are residents
566		-	of this State, except a corporation subject to
567		-	substantially the same requirements in its state of
568		-	organization as is a domestic company under Article VIII
569		-	1/2 of the Illinois Insurance Code.
570		-	(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
571		-	102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-731, eff.
572		-	1-1-23; 102-775, eff. 5-13-22; 102-813, eff. 5-13-22; 102-816,
573		-	eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
574		-	102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
575		-	1-1-24; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
576		-	eff. 1-1-24; revised 8-29-23.)
577	271
578	272
579		-	Section 40. The Voluntary Health Services Plans Act is
580		-	amended by changing Section 10 as follows:
581		-	(215 ILCS 165/10) (from Ch. 32, par. 604)
582		-	Sec. 10. Application of Insurance Code provisions. Health
583		-	services plan corporations and all persons interested therein
584		-	or dealing therewith shall be subject to the provisions of
585		-	Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
586		-	143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
587		-	356g, 356g.5, 356g.5-1, 356m, 356q, 356r, 356t, 356u, 356v,
588		-	356w, 356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a,
589		-	356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
590		-	356z.13, 356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22,
591		-	356z.25, 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32,
592		-	356z.32a, 356z.33, 356z.40, 356z.41, 356z.46, 356z.47,
593		-	356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60,
594		-	356z.61, 356z.62, 356z.64, 356z.67, 356z.68, 356z.71, 364.01,
595		-	364.3, 367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2,
596		-	and 412, and paragraphs (7) and (15) of Section 367 of the
597		-	Illinois Insurance Code.
598		-	Rulemaking authority to implement Public Act 95-1045, if
599		-	any, is conditioned on the rules being adopted in accordance
600		-	with all provisions of the Illinois Administrative Procedure
601		-	Act and all rules and procedures of the Joint Committee on
602		-	Administrative Rules; any purported rule not so adopted, for
	273	+
	274	+	SB0773 Enrolled - 8 - LRB103 03229 AMQ 48235 b
603	275
604	276
605		-	whatever reason, is unauthorized.
606		-	(Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
607		-	102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff.
608		-	10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804,
609		-	eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
610		-	102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff.
611		-	1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
612		-	eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
613		-	103-551, eff. 8-11-23; revised 8-29-23.)
	277	+	SB0773 Enrolled- 9 -LRB103 03229 AMQ 48235 b SB0773 Enrolled - 9 - LRB103 03229 AMQ 48235 b
	278	+	SB0773 Enrolled - 9 - LRB103 03229 AMQ 48235 b
	279	+	1 356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
	280	+	2 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
	281	+	3 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
	282	+	4 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and
	283	+	5 356z.61, and 356z.62, 356z.64, 356z.67, 356z.68, 356z.70, and
	284	+	6 356z.71 of the Illinois Insurance Code. Insurance policies
	285	+	7 shall comply with Section 356z.19 of the Illinois Insurance
	286	+	8 Code. The coverage shall comply with Sections 155.22a, 355b,
	287	+	9 and 370c of the Illinois Insurance Code. The Department of
	288	+	10 Insurance shall enforce the requirements of this Section.
	289	+	11 Rulemaking authority to implement Public Act 95-1045, if
	290	+	12 any, is conditioned on the rules being adopted in accordance
	291	+	13 with all provisions of the Illinois Administrative Procedure
	292	+	14 Act and all rules and procedures of the Joint Committee on
	293	+	15 Administrative Rules; any purported rule not so adopted, for
	294	+	16 whatever reason, is unauthorized.
	295	+	17 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
	296	+	18 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
	297	+	19 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804,
	298	+	20 eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
	299	+	21 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff.
	300	+	22 1-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420,
	301	+	23 eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. 8-11-23;
	302	+	24 103-551, eff. 8-11-23; revised 8-29-23.)
	303	+	25 Section 25. The Illinois Insurance Code is amended by
	304	+
	305	+
	306	+
	307	+
	308	+
	309	+	SB0773 Enrolled - 9 - LRB103 03229 AMQ 48235 b
	310	+
	311	+
	312	+	SB0773 Enrolled- 10 -LRB103 03229 AMQ 48235 b SB0773 Enrolled - 10 - LRB103 03229 AMQ 48235 b
	313	+	SB0773 Enrolled - 10 - LRB103 03229 AMQ 48235 b
	314	+	1 changing Sections 356m and 356z.32 and by adding Section
	315	+	2 356z.71 as follows:
	316	+	3 (215 ILCS 5/356m) (from Ch. 73, par. 968m)
	317	+	4 Sec. 356m. Infertility coverage.
	318	+	5 (a) No group policy of accident and health insurance
	319	+	6 providing coverage for more than 25 employees that provides
	320	+	7 pregnancy-related pregnancy related benefits may be issued,
	321	+	8 amended, delivered, or renewed in this State after January 1,
	322	+	9 2016 and through December 31, 2025 the effective date of this
	323	+	10 amendatory Act of the 99th General Assembly unless the policy
	324	+	11 contains coverage for the diagnosis and treatment of
	325	+	12 infertility including, but not limited to, in vitro
	326	+	13 fertilization, uterine embryo lavage, embryo transfer,
	327	+	14 artificial insemination, gamete intrafallopian tube transfer,
	328	+	15 zygote intrafallopian tube transfer, and low tubal ovum
	329	+	16 transfer.
	330	+	17 (a-5) No group policy of accident and health insurance
	331	+	18 that provides pregnancy-related benefits may be issued,
	332	+	19 amended, delivered, or renewed in this State on or after
	333	+	20 January 1, 2026 unless the policy contains coverage for the
	334	+	21 diagnosis and treatment of infertility, including, but not
	335	+	22 limited to, in vitro fertilization, uterine embryo lavage,
	336	+	23 embryo transfer, artificial insemination, gamete
	337	+	24 intrafallopian tube transfer, zygote intrafallopian tube
	338	+	25 transfer, surgical sperm extraction procedures, and low tubal
	339	+
	340	+
	341	+
	342	+
	343	+
	344	+	SB0773 Enrolled - 10 - LRB103 03229 AMQ 48235 b
	345	+
	346	+
	347	+	SB0773 Enrolled- 11 -LRB103 03229 AMQ 48235 b SB0773 Enrolled - 11 - LRB103 03229 AMQ 48235 b
	348	+	SB0773 Enrolled - 11 - LRB103 03229 AMQ 48235 b
	349	+	1 ovum transfer. The coverage required shall include procedures
	350	+	2 necessary to screen or diagnose a fertilized egg before
	351	+	3 implantation, including, but not limited to, preimplantation
	352	+	4 genetic testing for aneuploidy, preimplantation genetic
	353	+	5 testing for chromosome structural rearrangements, and
	354	+	6 preimplantation genetic testing for monogenic or single gene
	355	+	7 disorders. Coverage under this subsection for the diagnosis
	356	+	8 and treatment of infertility shall be required only if the
	357	+	9 procedures:
	358	+	10 (1) are considered medically appropriate by the
	359	+	11 patient's medical provider based on clinical guidelines or
	360	+	12 standards developed by the American Society for
	361	+	13 Reproductive Medicine, the American College of
	362	+	14 Obstetricians and Gynecologists, or the Society for
	363	+	15 Assisted Reproductive Technology; and
	364	+	16 (2) are performed at medical facilities or clinics
	365	+	17 that are members in good standing of the Society for
	366	+	18 Assisted Reproductive Technology.
	367	+	19 (b) The coverage required under subsection (a) for
	368	+	20 procedures for in vitro fertilization, gamete intrafallopian
	369	+	21 tube transfer, or zygote intrafallopian tube transfer shall be
	370	+	22 required only if is subject to the following conditions:
	371	+	23 (1) Coverage for procedures for in vitro
	372	+	24 fertilization, gamete intrafallopian tube transfer, or
	373	+	25 zygote intrafallopian tube transfer shall be required only
	374	+	26 if:
	375	+
	376	+
	377	+
	378	+
	379	+
	380	+	SB0773 Enrolled - 11 - LRB103 03229 AMQ 48235 b
	381	+
	382	+
	383	+	SB0773 Enrolled- 12 -LRB103 03229 AMQ 48235 b SB0773 Enrolled - 12 - LRB103 03229 AMQ 48235 b
	384	+	SB0773 Enrolled - 12 - LRB103 03229 AMQ 48235 b
	385	+	1 (1) (A) the covered individual has been unable to
	386	+	2 attain a viable pregnancy, maintain a viable pregnancy, or
	387	+	3 sustain a successful pregnancy through reasonable, less
	388	+	4 costly medically appropriate infertility treatments for
	389	+	5 which coverage is available under the policy, plan, or
	390	+	6 contract;
	391	+	7 (2) (B) the covered individual has not undergone 4
	392	+	8 completed oocyte retrievals, except that if a live birth
	393	+	9 follows a completed oocyte retrieval, then 2 more
	394	+	10 completed oocyte retrievals shall be covered; and
	395	+	11 (3) (C) the procedures are performed at medical
	396	+	12 facilities that conform to the American College of
	397	+	13 Obstetric and Gynecology guidelines for in vitro
	398	+	14 fertilization clinics or to the American Fertility Society
	399	+	15 minimal standards for programs of in vitro fertilization.
	400	+	16 (2) The procedures required to be covered under this
	401	+	17 Section are not required to be contained in any policy or
	402	+	18 plan issued to or by a religious institution or
	403	+	19 organization or to or by an entity sponsored by a
	404	+	20 religious institution or organization that finds the
	405	+	21 procedures required to be covered under this Section to
	406	+	22 violate its religious and moral teachings and beliefs.
	407	+	23 (c) As used in this Section, "infertility" means a
	408	+	24 disease, condition, or status characterized by:
	409	+	25 (1) a failure to establish a pregnancy or to carry a
	410	+	26 pregnancy to live birth after 12 months of regular,
	411	+
	412	+
	413	+
	414	+
	415	+
	416	+	SB0773 Enrolled - 12 - LRB103 03229 AMQ 48235 b
	417	+
	418	+
	419	+	SB0773 Enrolled- 13 -LRB103 03229 AMQ 48235 b SB0773 Enrolled - 13 - LRB103 03229 AMQ 48235 b
	420	+	SB0773 Enrolled - 13 - LRB103 03229 AMQ 48235 b
	421	+	1 unprotected sexual intercourse if the woman is 35 years of
	422	+	2 age or younger, or after 6 months of regular, unprotected
	423	+	3 sexual intercourse if the woman is over 35 years of age;
	424	+	4 conceiving but having a miscarriage does not restart the
	425	+	5 12-month or 6-month term for determining infertility;
	426	+	6 (2) a person's inability to reproduce either as a
	427	+	7 single individual or with a partner without medical
	428	+	8 intervention; or
	429	+	9 (3) a licensed physician's findings based on a
	430	+	10 patient's medical, sexual, and reproductive history, age,
	431	+	11 physical findings, or diagnostic testing.
	432	+	12 (d) A policy, contract, or certificate may not impose any
	433	+	13 exclusions, limitations, or other restrictions on coverage of
	434	+	14 fertility medications that are different from those imposed on
	435	+	15 any other prescription medications, nor may it impose any
	436	+	16 exclusions, limitations, or other restrictions on coverage of
	437	+	17 any fertility services based on a covered individual's
	438	+	18 participation in fertility services provided by or to a third
	439	+	19 party, nor may it impose deductibles, copayments, coinsurance,
	440	+	20 benefit maximums, waiting periods, or any other limitations on
	441	+	21 coverage for the diagnosis of infertility, treatment for
	442	+	22 infertility, and standard fertility preservation services,
	443	+	23 except as provided in this Section, that are different from
	444	+	24 those imposed upon benefits for services not related to
	445	+	25 infertility.
	446	+	26 (e) The procedures required to be covered under this
	447	+
	448	+
	449	+
	450	+
	451	+
	452	+	SB0773 Enrolled - 13 - LRB103 03229 AMQ 48235 b
	453	+
	454	+
	455	+	SB0773 Enrolled- 14 -LRB103 03229 AMQ 48235 b SB0773 Enrolled - 14 - LRB103 03229 AMQ 48235 b
	456	+	SB0773 Enrolled - 14 - LRB103 03229 AMQ 48235 b
	457	+	1 Section are not required to be contained in any policy or plan
	458	+	2 issued to or by a religious institution or organization or to
	459	+	3 or by an entity sponsored by a religious institution or
	460	+	4 organization that finds the procedures required to be covered
	461	+	5 under this Section to violate its religious and moral
	462	+	6 teachings and beliefs.
	463	+	7 (Source: P.A. 102-170, eff. 1-1-22.)
	464	+	8 (215 ILCS 5/356z.71 new)
	465	+	9 Sec. 356z.71. Coverage for annual menopause health visit.
	466	+	10 A group or individual policy of accident and health insurance
	467	+	11 providing coverage for more than 25 employees that is amended,
	468	+	12 delivered, issued, or renewed on or after January 1, 2026
	469	+	13 shall provide, for individuals 45 years of age and older,
	470	+	14 coverage for an annual menopause health visit. A policy
	471	+	15 subject to this Section shall not impose a deductible,
	472	+	16 coinsurance, copayment, or any other cost-sharing requirement
	473	+	17 on the coverage provided; except that this Section does not
	474	+	18 apply to this coverage to the extent such coverage would
	475	+	19 disqualify a high-deductible health plan from eligibility for
	476	+	20 a health savings account pursuant to Section 223 of the
	477	+	21 Internal Revenue Code.
	478	+	22 Section 30. The Health Maintenance Organization Act is
	479	+	23 amended by changing Section 5-3 as follows:
	480	+
	481	+
	482	+
	483	+
	484	+
	485	+	SB0773 Enrolled - 14 - LRB103 03229 AMQ 48235 b
	486	+
	487	+
	488	+	SB0773 Enrolled- 15 -LRB103 03229 AMQ 48235 b SB0773 Enrolled - 15 - LRB103 03229 AMQ 48235 b
	489	+	SB0773 Enrolled - 15 - LRB103 03229 AMQ 48235 b
	490	+	1 (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
	491	+	2 Sec. 5-3. Insurance Code provisions.
	492	+	3 (a) Health Maintenance Organizations shall be subject to
	493	+	4 the provisions of Sections 133, 134, 136, 137, 139, 140,
	494	+	5 141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
	495	+	6 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 155.49,
	496	+	7 355.2, 355.3, 355b, 355c, 356f, 356g.5-1, 356m, 356q, 356v,
	497	+	8 356w, 356x, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6,
	498	+	9 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14,
	499	+	10 356z.15, 356z.17, 356z.18, 356z.19, 356z.20, 356z.21, 356z.22,
	500	+	11 356z.23, 356z.24, 356z.25, 356z.26, 356z.28, 356z.29, 356z.30,
	501	+	12 356z.30a, 356z.31, 356z.32, 356z.33, 356z.34, 356z.35,
	502	+	13 356z.36, 356z.37, 356z.38, 356z.39, 356z.40, 356z.41, 356z.44,
	503	+	14 356z.45, 356z.46, 356z.47, 356z.48, 356z.49, 356z.50, 356z.51,
	504	+	15 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.58, 356z.59,
	505	+	16 356z.60, 356z.61, 356z.62, 356z.64, 356z.65, 356z.67, 356z.68,
	506	+	17 356z.71, 364, 364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b,
	507	+	18 368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A,
	508	+	19 408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of
	509	+	20 subsection (2) of Section 367, and Articles IIA, VIII 1/2,
	510	+	21 XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the
	511	+	22 Illinois Insurance Code.
	512	+	23 (b) For purposes of the Illinois Insurance Code, except
	513	+	24 for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
	514	+	25 Health Maintenance Organizations in the following categories
	515	+	26 are deemed to be "domestic companies":
	516	+
	517	+
	518	+
	519	+
	520	+
	521	+	SB0773 Enrolled - 15 - LRB103 03229 AMQ 48235 b
	522	+
	523	+
	524	+	SB0773 Enrolled- 16 -LRB103 03229 AMQ 48235 b SB0773 Enrolled - 16 - LRB103 03229 AMQ 48235 b
	525	+	SB0773 Enrolled - 16 - LRB103 03229 AMQ 48235 b
	526	+	1 (1) a corporation authorized under the Dental Service
	527	+	2 Plan Act or the Voluntary Health Services Plans Act;
	528	+	3 (2) a corporation organized under the laws of this
	529	+	4 State; or
	530	+	5 (3) a corporation organized under the laws of another
	531	+	6 state, 30% or more of the enrollees of which are residents
	532	+	7 of this State, except a corporation subject to
	533	+	8 substantially the same requirements in its state of
	534	+	9 organization as is a "domestic company" under Article VIII
	535	+	10 1/2 of the Illinois Insurance Code.
	536	+	11 (c) In considering the merger, consolidation, or other
	537	+	12 acquisition of control of a Health Maintenance Organization
	538	+	13 pursuant to Article VIII 1/2 of the Illinois Insurance Code,
	539	+	14 (1) the Director shall give primary consideration to
	540	+	15 the continuation of benefits to enrollees and the
	541	+	16 financial conditions of the acquired Health Maintenance
	542	+	17 Organization after the merger, consolidation, or other
	543	+	18 acquisition of control takes effect;
	544	+	19 (2)(i) the criteria specified in subsection (1)(b) of
	545	+	20 Section 131.8 of the Illinois Insurance Code shall not
	546	+	21 apply and (ii) the Director, in making his determination
	547	+	22 with respect to the merger, consolidation, or other
	548	+	23 acquisition of control, need not take into account the
	549	+	24 effect on competition of the merger, consolidation, or
	550	+	25 other acquisition of control;
	551	+	26 (3) the Director shall have the power to require the
	552	+
	553	+
	554	+
	555	+
	556	+
	557	+	SB0773 Enrolled - 16 - LRB103 03229 AMQ 48235 b
	558	+
	559	+
	560	+	SB0773 Enrolled- 17 -LRB103 03229 AMQ 48235 b SB0773 Enrolled - 17 - LRB103 03229 AMQ 48235 b
	561	+	SB0773 Enrolled - 17 - LRB103 03229 AMQ 48235 b
	562	+	1 following information:
	563	+	2 (A) certification by an independent actuary of the
	564	+	3 adequacy of the reserves of the Health Maintenance
	565	+	4 Organization sought to be acquired;
	566	+	5 (B) pro forma financial statements reflecting the
	567	+	6 combined balance sheets of the acquiring company and
	568	+	7 the Health Maintenance Organization sought to be
	569	+	8 acquired as of the end of the preceding year and as of
	570	+	9 a date 90 days prior to the acquisition, as well as pro
	571	+	10 forma financial statements reflecting projected
	572	+	11 combined operation for a period of 2 years;
	573	+	12 (C) a pro forma business plan detailing an
	574	+	13 acquiring party's plans with respect to the operation
	575	+	14 of the Health Maintenance Organization sought to be
	576	+	15 acquired for a period of not less than 3 years; and
	577	+	16 (D) such other information as the Director shall
	578	+	17 require.
	579	+	18 (d) The provisions of Article VIII 1/2 of the Illinois
	580	+	19 Insurance Code and this Section 5-3 shall apply to the sale by
	581	+	20 any health maintenance organization of greater than 10% of its
	582	+	21 enrollee population (including, without limitation, the health
	583	+	22 maintenance organization's right, title, and interest in and
	584	+	23 to its health care certificates).
	585	+	24 (e) In considering any management contract or service
	586	+	25 agreement subject to Section 141.1 of the Illinois Insurance
	587	+	26 Code, the Director (i) shall, in addition to the criteria
	588	+
	589	+
	590	+
	591	+
	592	+
	593	+	SB0773 Enrolled - 17 - LRB103 03229 AMQ 48235 b
	594	+
	595	+
	596	+	SB0773 Enrolled- 18 -LRB103 03229 AMQ 48235 b SB0773 Enrolled - 18 - LRB103 03229 AMQ 48235 b
	597	+	SB0773 Enrolled - 18 - LRB103 03229 AMQ 48235 b
	598	+	1 specified in Section 141.2 of the Illinois Insurance Code,
	599	+	2 take into account the effect of the management contract or
	600	+	3 service agreement on the continuation of benefits to enrollees
	601	+	4 and the financial condition of the health maintenance
	602	+	5 organization to be managed or serviced, and (ii) need not take
	603	+	6 into account the effect of the management contract or service
	604	+	7 agreement on competition.
	605	+	8 (f) Except for small employer groups as defined in the
	606	+	9 Small Employer Rating, Renewability and Portability Health
	607	+	10 Insurance Act and except for medicare supplement policies as
	608	+	11 defined in Section 363 of the Illinois Insurance Code, a
	609	+	12 Health Maintenance Organization may by contract agree with a
	610	+	13 group or other enrollment unit to effect refunds or charge
	611	+	14 additional premiums under the following terms and conditions:
	612	+	15 (i) the amount of, and other terms and conditions with
	613	+	16 respect to, the refund or additional premium are set forth
	614	+	17 in the group or enrollment unit contract agreed in advance
	615	+	18 of the period for which a refund is to be paid or
	616	+	19 additional premium is to be charged (which period shall
	617	+	20 not be less than one year); and
	618	+	21 (ii) the amount of the refund or additional premium
	619	+	22 shall not exceed 20% of the Health Maintenance
	620	+	23 Organization's profitable or unprofitable experience with
	621	+	24 respect to the group or other enrollment unit for the
	622	+	25 period (and, for purposes of a refund or additional
	623	+	26 premium, the profitable or unprofitable experience shall
	624	+
	625	+
	626	+
	627	+
	628	+
	629	+	SB0773 Enrolled - 18 - LRB103 03229 AMQ 48235 b
	630	+
	631	+
	632	+	SB0773 Enrolled- 19 -LRB103 03229 AMQ 48235 b SB0773 Enrolled - 19 - LRB103 03229 AMQ 48235 b
	633	+	SB0773 Enrolled - 19 - LRB103 03229 AMQ 48235 b
	634	+	1 be calculated taking into account a pro rata share of the
	635	+	2 Health Maintenance Organization's administrative and
	636	+	3 marketing expenses, but shall not include any refund to be
	637	+	4 made or additional premium to be paid pursuant to this
	638	+	5 subsection (f)). The Health Maintenance Organization and
	639	+	6 the group or enrollment unit may agree that the profitable
	640	+	7 or unprofitable experience may be calculated taking into
	641	+	8 account the refund period and the immediately preceding 2
	642	+	9 plan years.
	643	+	10 The Health Maintenance Organization shall include a
	644	+	11 statement in the evidence of coverage issued to each enrollee
	645	+	12 describing the possibility of a refund or additional premium,
	646	+	13 and upon request of any group or enrollment unit, provide to
	647	+	14 the group or enrollment unit a description of the method used
	648	+	15 to calculate (1) the Health Maintenance Organization's
	649	+	16 profitable experience with respect to the group or enrollment
	650	+	17 unit and the resulting refund to the group or enrollment unit
	651	+	18 or (2) the Health Maintenance Organization's unprofitable
	652	+	19 experience with respect to the group or enrollment unit and
	653	+	20 the resulting additional premium to be paid by the group or
	654	+	21 enrollment unit.
	655	+	22 In no event shall the Illinois Health Maintenance
	656	+	23 Organization Guaranty Association be liable to pay any
	657	+	24 contractual obligation of an insolvent organization to pay any
	658	+	25 refund authorized under this Section.
	659	+	26 (g) Rulemaking authority to implement Public Act 95-1045,
	660	+
	661	+
	662	+
	663	+
	664	+
	665	+	SB0773 Enrolled - 19 - LRB103 03229 AMQ 48235 b
	666	+
	667	+
	668	+	SB0773 Enrolled- 20 -LRB103 03229 AMQ 48235 b SB0773 Enrolled - 20 - LRB103 03229 AMQ 48235 b
	669	+	SB0773 Enrolled - 20 - LRB103 03229 AMQ 48235 b
	670	+	1 if any, is conditioned on the rules being adopted in
	671	+	2 accordance with all provisions of the Illinois Administrative
	672	+	3 Procedure Act and all rules and procedures of the Joint
	673	+	4 Committee on Administrative Rules; any purported rule not so
	674	+	5 adopted, for whatever reason, is unauthorized.
	675	+	6 (Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
	676	+	7 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
	677	+	8 1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
	678	+	9 eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
	679	+	10 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
	680	+	11 1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
	681	+	12 eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;
	682	+	13 103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.
	683	+	14 6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
	684	+	15 eff. 1-1-24; 103-551, eff. 8-11-23; revised 8-29-23.)
	685	+	16 Section 35. The Limited Health Service Organization Act is
	686	+	17 amended by changing Section 4003 as follows:
	687	+	18 (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
	688	+	19 Sec. 4003. Illinois Insurance Code provisions. Limited
	689	+	20 health service organizations shall be subject to the
	690	+	21 provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
	691	+	22 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
	692	+	23 154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 355.2,
	693	+	24 355.3, 355b, 356m, 356q, 356v, 356z.4, 356z.4a, 356z.10,
	694	+
	695	+
	696	+
	697	+
	698	+
	699	+	SB0773 Enrolled - 20 - LRB103 03229 AMQ 48235 b
	700	+
	701	+
	702	+	SB0773 Enrolled- 21 -LRB103 03229 AMQ 48235 b SB0773 Enrolled - 21 - LRB103 03229 AMQ 48235 b
	703	+	SB0773 Enrolled - 21 - LRB103 03229 AMQ 48235 b
	704	+	1 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30a,
	705	+	2 356z.32, 356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53,
	706	+	3 356z.54, 356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68,
	707	+	4 356z.71, 364.3, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2,
	708	+	5 409, 412, 444, and 444.1 and Articles IIA, VIII 1/2, XII, XII
	709	+	6 1/2, XIII, XIII 1/2, XXV, and XXVI of the Illinois Insurance
	710	+	7 Code. Nothing in this Section shall require a limited health
	711	+	8 care plan to cover any service that is not a limited health
	712	+	9 service. For purposes of the Illinois Insurance Code, except
	713	+	10 for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
	714	+	11 limited health service organizations in the following
	715	+	12 categories are deemed to be domestic companies:
	716	+	13 (1) a corporation under the laws of this State; or
	717	+	14 (2) a corporation organized under the laws of another
	718	+	15 state, 30% or more of the enrollees of which are residents
	719	+	16 of this State, except a corporation subject to
	720	+	17 substantially the same requirements in its state of
	721	+	18 organization as is a domestic company under Article VIII
	722	+	19 1/2 of the Illinois Insurance Code.
	723	+	20 (Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
	724	+	21 102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-731, eff.
	725	+	22 1-1-23; 102-775, eff. 5-13-22; 102-813, eff. 5-13-22; 102-816,
	726	+	23 eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
	727	+	24 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
	728	+	25 1-1-24; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
	729	+	26 eff. 1-1-24; revised 8-29-23.)
	730	+
	731	+
	732	+
	733	+
	734	+
	735	+	SB0773 Enrolled - 21 - LRB103 03229 AMQ 48235 b
	736	+
	737	+
	738	+	SB0773 Enrolled- 22 -LRB103 03229 AMQ 48235 b SB0773 Enrolled - 22 - LRB103 03229 AMQ 48235 b
	739	+	SB0773 Enrolled - 22 - LRB103 03229 AMQ 48235 b
	740	+	1 Section 40. The Voluntary Health Services Plans Act is
	741	+	2 amended by changing Section 10 as follows:
	742	+	3 (215 ILCS 165/10) (from Ch. 32, par. 604)
	743	+	4 Sec. 10. Application of Insurance Code provisions. Health
	744	+	5 services plan corporations and all persons interested therein
	745	+	6 or dealing therewith shall be subject to the provisions of
	746	+	7 Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
	747	+	8 143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
	748	+	9 356g, 356g.5, 356g.5-1, 356m, 356q, 356r, 356t, 356u, 356v,
	749	+	10 356w, 356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a,
	750	+	11 356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12,
	751	+	12 356z.13, 356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22,
	752	+	13 356z.25, 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32,
	753	+	14 356z.32a, 356z.33, 356z.40, 356z.41, 356z.46, 356z.47,
	754	+	15 356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60,
	755	+	16 356z.61, 356z.62, 356z.64, 356z.67, 356z.68, 356z.71, 364.01,
	756	+	17 364.3, 367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2,
	757	+	18 and 412, and paragraphs (7) and (15) of Section 367 of the
	758	+	19 Illinois Insurance Code.
	759	+	20 Rulemaking authority to implement Public Act 95-1045, if
	760	+	21 any, is conditioned on the rules being adopted in accordance
	761	+	22 with all provisions of the Illinois Administrative Procedure
	762	+	23 Act and all rules and procedures of the Joint Committee on
	763	+	24 Administrative Rules; any purported rule not so adopted, for
	764	+
	765	+
	766	+
	767	+
	768	+
	769	+	SB0773 Enrolled - 22 - LRB103 03229 AMQ 48235 b
	770	+
	771	+
	772	+	SB0773 Enrolled- 23 -LRB103 03229 AMQ 48235 b SB0773 Enrolled - 23 - LRB103 03229 AMQ 48235 b
	773	+	SB0773 Enrolled - 23 - LRB103 03229 AMQ 48235 b
	774	+	1 whatever reason, is unauthorized.
	775	+	2 (Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
	776	+	3 102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff.
	777	+	4 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804,
	778	+	5 eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
	779	+	6 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff.
	780	+	7 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
	781	+	8 eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
	782	+	9 103-551, eff. 8-11-23; revised 8-29-23.)
	783	+
	784	+
	785	+
	786	+
	787	+
	788	+	SB0773 Enrolled - 23 - LRB103 03229 AMQ 48235 b