Illinois 2023-2024 Regular Session

Illinois Senate Bill SB1527 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	Public Act 103-0091
2	1		SB1527 EnrolledLRB103 27266 BMS 53637 b SB1527 Enrolled LRB103 27266 BMS 53637 b
3	2		SB1527 Enrolled LRB103 27266 BMS 53637 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 Section 6.11 as follows:
9		-	(5 ILCS 375/6.11)
10		-	(Text of Section before amendment by P.A. 102-768)
11		-	Sec. 6.11. Required health benefits; Illinois Insurance
12		-	Code requirements. The program of health benefits shall
13		-	provide the post-mastectomy care benefits required to be
14		-	covered by a policy of accident and health insurance under
15		-	Section 356t of the Illinois Insurance Code. The program of
16		-	health benefits shall provide the coverage required under
17		-	Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x,
18		-	356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
19		-	356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,
20		-	356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
21		-	356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
22		-	356z.53, 356z.54, 356z.56, 356z.57, 356z.59, and 356z.60 of
23		-	the Illinois Insurance Code. The program of health benefits
24		-	must comply with Sections 155.22a, 155.37, 355b, 356z.19,
25		-	370c, and 370c.1 and Article XXXIIB of the Illinois Insurance
26		-	Code. The Department of Insurance shall enforce the
	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 Section 6.11 as follows:
	8	+	6 (5 ILCS 375/6.11)
	9	+	7 (Text of Section before amendment by P.A. 102-768)
	10	+	8 Sec. 6.11. Required health benefits; Illinois Insurance
	11	+	9 Code requirements. The program of health benefits shall
	12	+	10 provide the post-mastectomy care benefits required to be
	13	+	11 covered by a policy of accident and health insurance under
	14	+	12 Section 356t of the Illinois Insurance Code. The program of
	15	+	13 health benefits shall provide the coverage required under
	16	+	14 Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x,
	17	+	15 356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
	18	+	16 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,
	19	+	17 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
	20	+	18 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
	21	+	19 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, and 356z.60 of
	22	+	20 the Illinois Insurance Code. The program of health benefits
	23	+	21 must comply with Sections 155.22a, 155.37, 355b, 356z.19,
	24	+	22 370c, and 370c.1 and Article XXXIIB of the Illinois Insurance
	25	+	23 Code. The Department of Insurance shall enforce the
27	26
28	27
29	28
30	29		SB1527 Enrolled LRB103 27266 BMS 53637 b
31	30
32	31
33		-	requirements of this Section with respect to Sections 370c and
34		-	370c.1 of the Illinois Insurance Code; all other requirements
35		-	of this Section shall be enforced by the Department of Central
36		-	Management Services.
37		-	Rulemaking authority to implement Public Act 95-1045, if
38		-	any, is conditioned on the rules being adopted in accordance
39		-	with all provisions of the Illinois Administrative Procedure
40		-	Act and all rules and procedures of the Joint Committee on
41		-	Administrative Rules; any purported rule not so adopted, for
42		-	whatever reason, is unauthorized.
43		-	(Source: P.A. 101-13, eff. 6-12-19; 101-281, eff. 1-1-20;
44		-	101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
45		-	1-1-20; 101-625, eff. 1-1-21; 102-30, eff. 1-1-22; 102-103,
46		-	eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
47		-	102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff.
48		-	1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816,
49		-	eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
50		-	revised 12-13-22.)
51		-	(Text of Section after amendment by P.A. 102-768)
52		-	Sec. 6.11. Required health benefits; Illinois Insurance
53		-	Code requirements. The program of health benefits shall
54		-	provide the post-mastectomy care benefits required to be
55		-	covered by a policy of accident and health insurance under
56		-	Section 356t of the Illinois Insurance Code. The program of
57		-	health benefits shall provide the coverage required under
	32	+	SB1527 Enrolled- 2 -LRB103 27266 BMS 53637 b SB1527 Enrolled - 2 - LRB103 27266 BMS 53637 b
	33	+	SB1527 Enrolled - 2 - LRB103 27266 BMS 53637 b
	34	+	1 requirements of this Section with respect to Sections 370c and
	35	+	2 370c.1 of the Illinois Insurance Code; all other requirements
	36	+	3 of this Section shall be enforced by the Department of Central
	37	+	4 Management Services.
	38	+	5 Rulemaking authority to implement Public Act 95-1045, if
	39	+	6 any, is conditioned on the rules being adopted in accordance
	40	+	7 with all provisions of the Illinois Administrative Procedure
	41	+	8 Act and all rules and procedures of the Joint Committee on
	42	+	9 Administrative Rules; any purported rule not so adopted, for
	43	+	10 whatever reason, is unauthorized.
	44	+	11 (Source: P.A. 101-13, eff. 6-12-19; 101-281, eff. 1-1-20;
	45	+	12 101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
	46	+	13 1-1-20; 101-625, eff. 1-1-21; 102-30, eff. 1-1-22; 102-103,
	47	+	14 eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
	48	+	15 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff.
	49	+	16 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816,
	50	+	17 eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
	51	+	18 revised 12-13-22.)
	52	+	19 (Text of Section after amendment by P.A. 102-768)
	53	+	20 Sec. 6.11. Required health benefits; Illinois Insurance
	54	+	21 Code requirements. The program of health benefits shall
	55	+	22 provide the post-mastectomy care benefits required to be
	56	+	23 covered by a policy of accident and health insurance under
	57	+	24 Section 356t of the Illinois Insurance Code. The program of
	58	+	25 health benefits shall provide the coverage required under
58	59
59	60
60		-	Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x,
61		-	356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
62		-	356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,
63		-	356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
64		-	356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
65		-	356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59, and
66		-	356z.60, and 356z.61 of the Illinois Insurance Code. The
67		-	program of health benefits must comply with Sections 155.22a,
68		-	155.37, 355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of
69		-	the Illinois Insurance Code. The Department of Insurance shall
70		-	enforce the requirements of this Section with respect to
71		-	Sections 370c and 370c.1 of the Illinois Insurance Code; all
72		-	other requirements of this Section shall be enforced by the
73		-	Department of Central Management Services.
74		-	Rulemaking authority to implement Public Act 95-1045, if
75		-	any, is conditioned on the rules being adopted in accordance
76		-	with all provisions of the Illinois Administrative Procedure
77		-	Act and all rules and procedures of the Joint Committee on
78		-	Administrative Rules; any purported rule not so adopted, for
79		-	whatever reason, is unauthorized.
80		-	(Source: P.A. 101-13, eff. 6-12-19; 101-281, eff. 1-1-20;
81		-	101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
82		-	1-1-20; 101-625, eff. 1-1-21; 102-30, eff. 1-1-22; 102-103,
83		-	eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
84		-	102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff.
85		-	1-1-23; 102-768, eff. 1-1-24; 102-804, eff. 1-1-23; 102-813,
86	61
87	62
88		-	eff. 5-13-22; 102-816, eff. 1-1-23; 102-860, eff. 1-1-23;
89		-	102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23.)
90		-	Section 10. The Counties Code is amended by changing
91		-	Section 5-1069.3 as follows:
92		-	(55 ILCS 5/5-1069.3)
93		-	Sec. 5-1069.3. Required health benefits. If a county,
94		-	including a home rule county, is a self-insurer for purposes
95		-	of providing health insurance coverage for its employees, the
96		-	coverage shall include coverage for the post-mastectomy care
97		-	benefits required to be covered by a policy of accident and
98		-	health insurance under Section 356t and the coverage required
99		-	under Sections 356g, 356g.5, 356g.5-1, 356q, 356u, 356w, 356x,
100		-	356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11,
101		-	356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26,
102		-	356z.29, 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40,
103		-	356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53,
104		-	356z.54, 356z.56, 356z.57, 356z.59, and 356z.60, and 356z.61
105		-	of the Illinois Insurance Code. The coverage shall comply with
106		-	Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
107		-	Insurance Code. The Department of Insurance shall enforce the
108		-	requirements of this Section. The requirement that health
109		-	benefits be covered as provided in this Section is an
110		-	exclusive power and function of the State and is a denial and
111		-	limitation under Article VII, Section 6, subsection (h) of the
	63	+
	64	+	SB1527 Enrolled - 2 - LRB103 27266 BMS 53637 b
112	65
113	66
114		-	Illinois Constitution. A home rule county to which this
115		-	Section applies must comply with every provision of this
116		-	Section.
117		-	Rulemaking authority to implement Public Act 95-1045, if
118		-	any, is conditioned on the rules being adopted in accordance
119		-	with all provisions of the Illinois Administrative Procedure
120		-	Act and all rules and procedures of the Joint Committee on
121		-	Administrative Rules; any purported rule not so adopted, for
122		-	whatever reason, is unauthorized.
123		-	(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
124		-	101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
125		-	1-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
126		-	eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22;
127		-	102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff.
128		-	1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816,
129		-	eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
130		-	102-1117, eff. 1-13-23.)
131		-	Section 15. The Illinois Municipal Code is amended by
132		-	changing Section 10-4-2.3 as follows:
133		-	(65 ILCS 5/10-4-2.3)
134		-	Sec. 10-4-2.3. Required health benefits. If a
135		-	municipality, including a home rule municipality, is a
136		-	self-insurer for purposes of providing health insurance
137		-	coverage for its employees, the coverage shall include
	67	+	SB1527 Enrolled- 3 -LRB103 27266 BMS 53637 b SB1527 Enrolled - 3 - LRB103 27266 BMS 53637 b
	68	+	SB1527 Enrolled - 3 - LRB103 27266 BMS 53637 b
	69	+	1 Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x,
	70	+	2 356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
	71	+	3 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,
	72	+	4 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
	73	+	5 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
	74	+	6 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59, and
	75	+	7 356z.60, and 356z.61 of the Illinois Insurance Code. The
	76	+	8 program of health benefits must comply with Sections 155.22a,
	77	+	9 155.37, 355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of
	78	+	10 the Illinois Insurance Code. The Department of Insurance shall
	79	+	11 enforce the requirements of this Section with respect to
	80	+	12 Sections 370c and 370c.1 of the Illinois Insurance Code; all
	81	+	13 other requirements of this Section shall be enforced by the
	82	+	14 Department of Central Management Services.
	83	+	15 Rulemaking authority to implement Public Act 95-1045, if
	84	+	16 any, is conditioned on the rules being adopted in accordance
	85	+	17 with all provisions of the Illinois Administrative Procedure
	86	+	18 Act and all rules and procedures of the Joint Committee on
	87	+	19 Administrative Rules; any purported rule not so adopted, for
	88	+	20 whatever reason, is unauthorized.
	89	+	21 (Source: P.A. 101-13, eff. 6-12-19; 101-281, eff. 1-1-20;
	90	+	22 101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
	91	+	23 1-1-20; 101-625, eff. 1-1-21; 102-30, eff. 1-1-22; 102-103,
	92	+	24 eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
	93	+	25 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff.
	94	+	26 1-1-23; 102-768, eff. 1-1-24; 102-804, eff. 1-1-23; 102-813,
138	95
139	96
140		-	coverage for the post-mastectomy care benefits required to be
141		-	covered by a policy of accident and health insurance under
142		-	Section 356t and the coverage required under Sections 356g,
143		-	356g.5, 356g.5-1, 356q, 356u, 356w, 356x, 356z.4, 356z.4a,
144		-	356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
145		-	356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
146		-	356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
147		-	356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
148		-	356z.56, 356z.57, 356z.59, and 356z.60, and 356z.61 of the
149		-	Illinois Insurance Code. The coverage shall comply with
150		-	Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
151		-	Insurance Code. The Department of Insurance shall enforce the
152		-	requirements of this Section. The requirement that health
153		-	benefits be covered as provided in this is an exclusive power
154		-	and function of the State and is a denial and limitation under
155		-	Article VII, Section 6, subsection (h) of the Illinois
156		-	Constitution. A home rule municipality to which this Section
157		-	applies must comply with every provision of this Section.
158		-	Rulemaking authority to implement Public Act 95-1045, if
159		-	any, is conditioned on the rules being adopted in accordance
160		-	with all provisions of the Illinois Administrative Procedure
161		-	Act and all rules and procedures of the Joint Committee on
162		-	Administrative Rules; any purported rule not so adopted, for
163		-	whatever reason, is unauthorized.
164		-	(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
165		-	101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
166	97
167	98
168		-	1-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
169		-	eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22;
170		-	102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff.
171		-	1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816,
172		-	eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
173		-	102-1117, eff. 1-13-23.)
174		-	Section 20. The School Code is amended by changing Section
175		-	10-22.3f as follows:
176		-	(105 ILCS 5/10-22.3f)
177		-	Sec. 10-22.3f. Required health benefits. Insurance
178		-	protection and benefits for employees shall provide the
179		-	post-mastectomy care benefits required to be covered by a
180		-	policy of accident and health insurance under Section 356t and
181		-	the coverage required under Sections 356g, 356g.5, 356g.5-1,
182		-	356q, 356u, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8,
183		-	356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
184		-	356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
185		-	356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
186		-	356z.53, 356z.54, 356z.56, 356z.57, 356z.59, and 356z.60, and
187		-	356z.61 of the Illinois Insurance Code. Insurance policies
188		-	shall comply with Section 356z.19 of the Illinois Insurance
189		-	Code. The coverage shall comply with Sections 155.22a, 355b,
190		-	and 370c of the Illinois Insurance Code. The Department of
191		-	Insurance shall enforce the requirements of this Section.
	99	+
	100	+	SB1527 Enrolled - 3 - LRB103 27266 BMS 53637 b
192	101
193	102
194		-	Rulemaking authority to implement Public Act 95-1045, if
195		-	any, is conditioned on the rules being adopted in accordance
196		-	with all provisions of the Illinois Administrative Procedure
197		-	Act and all rules and procedures of the Joint Committee on
198		-	Administrative Rules; any purported rule not so adopted, for
199		-	whatever reason, is unauthorized.
200		-	(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
201		-	101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
202		-	1-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
203		-	eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. 1-1-22;
204		-	102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804, eff.
205		-	1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860,
206		-	eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23.)
207		-	Section 25. The Illinois Insurance Code is amended by
208		-	adding Section 356z.61 as follows:
209		-	(215 ILCS 5/356z.61 new)
210		-	Sec. 356z.61. Coverage for compression sleeves. A group or
211		-	individual policy of accident and health insurance or a
212		-	managed care plan that is amended, delivered, issued, or
213		-	renewed on or after January 1, 2025 shall provide coverage for
214		-	compression sleeves that is medically necessary for the
215		-	enrollee to prevent or mitigate lymphedema.
216		-	Section 30. The Health Maintenance Organization Act is
	103	+	SB1527 Enrolled- 4 -LRB103 27266 BMS 53637 b SB1527 Enrolled - 4 - LRB103 27266 BMS 53637 b
	104	+	SB1527 Enrolled - 4 - LRB103 27266 BMS 53637 b
	105	+	1 eff. 5-13-22; 102-816, eff. 1-1-23; 102-860, eff. 1-1-23;
	106	+	2 102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23.)
	107	+	3 Section 10. The Counties Code is amended by changing
	108	+	4 Section 5-1069.3 as follows:
	109	+	5 (55 ILCS 5/5-1069.3)
	110	+	6 Sec. 5-1069.3. Required health benefits. If a county,
	111	+	7 including a home rule county, is a self-insurer for purposes
	112	+	8 of providing health insurance coverage for its employees, the
	113	+	9 coverage shall include coverage for the post-mastectomy care
	114	+	10 benefits required to be covered by a policy of accident and
	115	+	11 health insurance under Section 356t and the coverage required
	116	+	12 under Sections 356g, 356g.5, 356g.5-1, 356q, 356u, 356w, 356x,
	117	+	13 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11,
	118	+	14 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26,
	119	+	15 356z.29, 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40,
	120	+	16 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53,
	121	+	17 356z.54, 356z.56, 356z.57, 356z.59, and 356z.60, and 356z.61
	122	+	18 of the Illinois Insurance Code. The coverage shall comply with
	123	+	19 Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
	124	+	20 Insurance Code. The Department of Insurance shall enforce the
	125	+	21 requirements of this Section. The requirement that health
	126	+	22 benefits be covered as provided in this Section is an
	127	+	23 exclusive power and function of the State and is a denial and
	128	+	24 limitation under Article VII, Section 6, subsection (h) of the
217	129
218	130
219		-	amended by changing Section 5-3 as follows:
220		-	(215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
221		-	Sec. 5-3. Insurance Code provisions.
222		-	(a) Health Maintenance Organizations shall be subject to
223		-	the provisions of Sections 133, 134, 136, 137, 139, 140,
224		-	141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
225		-	154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2,
226		-	355.3, 355b, 355c, 356g.5-1, 356m, 356q, 356v, 356w, 356x,
227		-	356y, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6,
228		-	356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14,
229		-	356z.15, 356z.17, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25,
230		-	356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33,
231		-	356z.35, 356z.36, 356z.40, 356z.41, 356z.46, 356z.47, 356z.48,
232		-	356z.50, 356z.51, 356z.53 256z.53, 356z.54, 356z.56, 356z.57,
233		-	356z.59, 356z.60, 356z.61, 364, 364.01, 364.3, 367.2, 367.2-5,
234		-	367i, 368a, 368b, 368c, 368d, 368e, 370c, 370c.1, 401, 401.1,
235		-	402, 403, 403A, 408, 408.2, 409, 412, 444, and 444.1,
236		-	paragraph (c) of subsection (2) of Section 367, and Articles
237		-	IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and
238		-	XXXIIB of the Illinois Insurance Code.
239		-	(b) For purposes of the Illinois Insurance Code, except
240		-	for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
241		-	Health Maintenance Organizations in the following categories
242		-	are deemed to be "domestic companies":
243		-	(1) a corporation authorized under the Dental Service
244	131
245	132
246		-	Plan Act or the Voluntary Health Services Plans Act;
247		-	(2) a corporation organized under the laws of this
248		-	State; or
249		-	(3) a corporation organized under the laws of another
250		-	state, 30% or more of the enrollees of which are residents
251		-	of this State, except a corporation subject to
252		-	substantially the same requirements in its state of
253		-	organization as is a "domestic company" under Article VIII
254		-	1/2 of the Illinois Insurance Code.
255		-	(c) In considering the merger, consolidation, or other
256		-	acquisition of control of a Health Maintenance Organization
257		-	pursuant to Article VIII 1/2 of the Illinois Insurance Code,
258		-	(1) the Director shall give primary consideration to
259		-	the continuation of benefits to enrollees and the
260		-	financial conditions of the acquired Health Maintenance
261		-	Organization after the merger, consolidation, or other
262		-	acquisition of control takes effect;
263		-	(2)(i) the criteria specified in subsection (1)(b) of
264		-	Section 131.8 of the Illinois Insurance Code shall not
265		-	apply and (ii) the Director, in making his determination
266		-	with respect to the merger, consolidation, or other
267		-	acquisition of control, need not take into account the
268		-	effect on competition of the merger, consolidation, or
269		-	other acquisition of control;
270		-	(3) the Director shall have the power to require the
271		-	following information:
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272	135
273	136
274		-	~~(A) certification by an independent actuary of the~~
275		-	~~adequacy of the reserves of the Health Maintenance~~
276		-	~~Organization sought~~ to ~~be acquired;~~
277		-	~~(B) pro forma financial statements reflecting the~~
278		-	~~combined balance sheets of the acquiring company and~~
279		-	~~the Health Maintenance Organization sought~~ to be
280		-	~~acquired as of~~ the ~~end of the preceding year and as of~~
281		-	~~a date 90 days prior to~~ the ~~acquisition, as well as pro~~
282		-	~~forma financial statements reflecting projected~~
283		-	~~combined operation~~ for ~~a period of 2 years;~~
284		-	~~(C) a pro forma business plan detailing an~~
285		-	~~acquiring party's plans with respect to the operation~~
286		-	~~of the Health Maintenance Organization sought to be~~
287		-	~~acquired for a period of not less than 3 years~~; ~~and~~
288		-	~~(D) such other information as the Director shall~~
289		-	~~require~~.
290		-	~~(d) The provisions of Article VIII~~ 1~~/2 of the Illinois~~
291		-	~~Insurance Code and this Section 5-3 shall apply to the sale by~~
292		-	~~any health maintenance organization of greater than 10% of its~~
293		-	~~enrollee population (including~~ ~~without limitation~~ the ~~health~~
294		-	~~maintenance organization's right,~~ ~~title, and interest in and~~
295		-	~~to its health care certificates~~).
296		-	~~(e) In considering any management contract or service~~
297		-	~~agreement subject to Section 141.1 of the Illinois Insurance~~
298		-	~~Code, the Director (i) shall,~~ ~~in addition to the criteria~~
299		-	~~specified in Section 141.2 of~~ the ~~Illinois Insurance Code,~~
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	139	+	1 Illinois Constitution. A home rule county to which this
	140	+	2 Section applies must comply with every provision of this
	141	+	3 Section.
	142	+	4 Rulemaking authority to implement Public Act 95-1045, if
	143	+	5 any, is conditioned on the rules being adopted in accordance
	144	+	6 with all provisions of the Illinois Administrative Procedure
	145	+	7 Act and all rules and procedures of the Joint Committee on
	146	+	8 Administrative Rules; any purported rule not so adopted, for
	147	+	9 whatever reason, is unauthorized.
	148	+	10 (Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
	149	+	11 101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
	150	+	12 1-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
	151	+	13 eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22;
	152	+	14 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff.
	153	+	15 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816,
	154	+	16 eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
	155	+	17 102-1117, eff. 1-13-23.)
	156	+	18 Section 15. The Illinois Municipal Code is amended by
	157	+	19 changing Section 10-4-2.3 as follows:
	158	+	20 (65 ILCS 5/10-4-2.3)
	159	+	21 Sec. 10-4-2.3. Required health benefits. If a
	160	+	22 municipality, including a home rule municipality, is a
	161	+	23 self-insurer for purposes of providing health insurance
	162	+	24 coverage for its employees, the coverage shall include
300	163
301	164
302		-	take into account the effect of the management contract or
303		-	service agreement on the continuation of benefits to enrollees
304		-	and the financial condition of the health maintenance
305		-	organization to be managed or serviced, and (ii) need not take
306		-	into account the effect of the management contract or service
307		-	agreement on competition.
308		-	(f) Except for small employer groups as defined in the
309		-	Small Employer Rating, Renewability and Portability Health
310		-	Insurance Act and except for medicare supplement policies as
311		-	defined in Section 363 of the Illinois Insurance Code, a
312		-	Health Maintenance Organization may by contract agree with a
313		-	group or other enrollment unit to effect refunds or charge
314		-	additional premiums under the following terms and conditions:
315		-	(i) the amount of, and other terms and conditions with
316		-	respect to, the refund or additional premium are set forth
317		-	in the group or enrollment unit contract agreed in advance
318		-	of the period for which a refund is to be paid or
319		-	additional premium is to be charged (which period shall
320		-	not be less than one year); and
321		-	(ii) the amount of the refund or additional premium
322		-	shall not exceed 20% of the Health Maintenance
323		-	Organization's profitable or unprofitable experience with
324		-	respect to the group or other enrollment unit for the
325		-	period (and, for purposes of a refund or additional
326		-	premium, the profitable or unprofitable experience shall
327		-	be calculated taking into account a pro rata share of the
328	165
329	166
330		-	Health Maintenance Organization's administrative and
331		-	marketing expenses, but shall not include any refund to be
332		-	made or additional premium to be paid pursuant to this
333		-	subsection (f)). The Health Maintenance Organization and
334		-	the group or enrollment unit may agree that the profitable
335		-	or unprofitable experience may be calculated taking into
336		-	account the refund period and the immediately preceding 2
337		-	plan years.
338		-	The Health Maintenance Organization shall include a
339		-	statement in the evidence of coverage issued to each enrollee
340		-	describing the possibility of a refund or additional premium,
341		-	and upon request of any group or enrollment unit, provide to
342		-	the group or enrollment unit a description of the method used
343		-	to calculate (1) the Health Maintenance Organization's
344		-	profitable experience with respect to the group or enrollment
345		-	unit and the resulting refund to the group or enrollment unit
346		-	or (2) the Health Maintenance Organization's unprofitable
347		-	experience with respect to the group or enrollment unit and
348		-	the resulting additional premium to be paid by the group or
349		-	enrollment unit.
350		-	In no event shall the Illinois Health Maintenance
351		-	Organization Guaranty Association be liable to pay any
352		-	contractual obligation of an insolvent organization to pay any
353		-	refund authorized under this Section.
354		-	(g) Rulemaking authority to implement Public Act 95-1045,
355		-	if any, is conditioned on the rules being adopted in
	167	+
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356	169
357	170
358		-	accordance with all provisions of the Illinois Administrative
359		-	Procedure Act and all rules and procedures of the Joint
360		-	Committee on Administrative Rules; any purported rule not so
361		-	adopted, for whatever reason, is unauthorized.
362		-	(Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19;
363		-	101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-393, eff.
364		-	1-1-20; 101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625,
365		-	eff. 1-1-21; 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
366		-	102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
367		-	1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
368		-	eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
369		-	102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
370		-	1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
371		-	eff. 1-1-23; 102-1117, eff. 1-13-23; revised 1-22-23.)
372		-	Section 35. The Limited Health Service Organization Act is
373		-	amended by changing Section 4003 as follows:
374		-	(215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
375		-	Sec. 4003. Illinois Insurance Code provisions. Limited
376		-	health service organizations shall be subject to the
377		-	provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
378		-	141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
379		-	154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 355.2, 355.3,
380		-	355b, 356q, 356v, 356z.4, 356z.4a, 356z.10, 356z.21, 356z.22,
381		-	356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
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	173	+	1 coverage for the post-mastectomy care benefits required to be
	174	+	2 covered by a policy of accident and health insurance under
	175	+	3 Section 356t and the coverage required under Sections 356g,
	176	+	4 356g.5, 356g.5-1, 356q, 356u, 356w, 356x, 356z.4, 356z.4a,
	177	+	5 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
	178	+	6 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29,
	179	+	7 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
	180	+	8 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
	181	+	9 356z.56, 356z.57, 356z.59, and 356z.60, and 356z.61 of the
	182	+	10 Illinois Insurance Code. The coverage shall comply with
	183	+	11 Sections 155.22a, 355b, 356z.19, and 370c of the Illinois
	184	+	12 Insurance Code. The Department of Insurance shall enforce the
	185	+	13 requirements of this Section. The requirement that health
	186	+	14 benefits be covered as provided in this is an exclusive power
	187	+	15 and function of the State and is a denial and limitation under
	188	+	16 Article VII, Section 6, subsection (h) of the Illinois
	189	+	17 Constitution. A home rule municipality to which this Section
	190	+	18 applies must comply with every provision of this Section.
	191	+	19 Rulemaking authority to implement Public Act 95-1045, if
	192	+	20 any, is conditioned on the rules being adopted in accordance
	193	+	21 with all provisions of the Illinois Administrative Procedure
	194	+	22 Act and all rules and procedures of the Joint Committee on
	195	+	23 Administrative Rules; any purported rule not so adopted, for
	196	+	24 whatever reason, is unauthorized.
	197	+	25 (Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
	198	+	26 101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
382	199
383	200
384		-	356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54, 356z.57,
385		-	356z.59, 356z.61, 364.3, 368a, 401, 401.1, 402, 403, 403A,
386		-	408, 408.2, 409, 412, 444, and 444.1 and Articles IIA, VIII
387		-	1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and XXVI of the
388		-	Illinois Insurance Code. Nothing in this Section shall require
389		-	a limited health care plan to cover any service that is not a
390		-	limited health service. For purposes of the Illinois Insurance
391		-	Code, except for Sections 444 and 444.1 and Articles XIII and
392		-	XIII 1/2, limited health service organizations in the
393		-	following categories are deemed to be domestic companies:
394		-	(1) a corporation under the laws of this State; or
395		-	(2) a corporation organized under the laws of another
396		-	state, 30% or more of the enrollees of which are residents
397		-	of this State, except a corporation subject to
398		-	substantially the same requirements in its state of
399		-	organization as is a domestic company under Article VIII
400		-	1/2 of the Illinois Insurance Code.
401		-	(Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
402		-	101-393, eff. 1-1-20; 101-625, eff. 1-1-21; 102-30, eff.
403		-	1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642,
404		-	eff. 1-1-22; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
405		-	102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860, eff.
406		-	1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23.)
407		-	Section 40. The Voluntary Health Services Plans Act is
408		-	amended by changing Section 10 as follows:
409	201
410	202
411		-	(215 ILCS 165/10) (from Ch. 32, par. 604)
412		-	Sec. 10. Application of Insurance Code provisions. Health
413		-	services plan corporations and all persons interested therein
414		-	or dealing therewith shall be subject to the provisions of
415		-	Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
416		-	143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
417		-	356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356v, 356w,
418		-	356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5,
419		-	356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
420		-	356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25,
421		-	356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33,
422		-	356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
423		-	356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 364.01, 364.3,
424		-	367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412,
425		-	and paragraphs (7) and (15) of Section 367 of the Illinois
426		-	Insurance Code.
427		-	Rulemaking authority to implement Public Act 95-1045, if
428		-	any, is conditioned on the rules being adopted in accordance
429		-	with all provisions of the Illinois Administrative Procedure
430		-	Act and all rules and procedures of the Joint Committee on
431		-	Administrative Rules; any purported rule not so adopted, for
432		-	whatever reason, is unauthorized.
433		-	(Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19;
434		-	101-281, eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff.
435		-	1-1-21; 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; 102-306,
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436	205
437	206
438		-	eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21;
439		-	102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804, eff.
440		-	1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860,
441		-	eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff. 1-1-23;
442		-	102-1117, eff. 1-13-23.)
443		-	Section 45. The Illinois Public Aid Code is amended by
444		-	changing Section 5-16.8 as follows:
445		-	(305 ILCS 5/5-16.8)
446		-	Sec. 5-16.8. Required health benefits. The medical
447		-	assistance program shall (i) provide the post-mastectomy care
448		-	benefits required to be covered by a policy of accident and
449		-	health insurance under Section 356t and the coverage required
450		-	under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6,
451		-	356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,
452		-	356z.47, 356z.51, 356z.53, 356z.56, 356z.59, and 356z.60, and
453		-	356z.61 of the Illinois Insurance Code, (ii) be subject to the
454		-	provisions of Sections 356z.19, 356z.44, 356z.49, 364.01,
455		-	370c, and 370c.1 of the Illinois Insurance Code, and (iii) be
456		-	subject to the provisions of subsection (d-5) of Section 10 of
457		-	the Network Adequacy and Transparency Act.
458		-	The Department, by rule, shall adopt a model similar to
459		-	the requirements of Section 356z.39 of the Illinois Insurance
460		-	Code.
461		-	On and after July 1, 2012, the Department shall reduce any
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	209	+	1 1-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
	210	+	2 eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 1-1-22;
	211	+	3 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, eff.
	212	+	4 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816,
	213	+	5 eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
	214	+	6 102-1117, eff. 1-13-23.)
	215	+	7 Section 20. The School Code is amended by changing Section
	216	+	8 10-22.3f as follows:
	217	+	9 (105 ILCS 5/10-22.3f)
	218	+	10 Sec. 10-22.3f. Required health benefits. Insurance
	219	+	11 protection and benefits for employees shall provide the
	220	+	12 post-mastectomy care benefits required to be covered by a
	221	+	13 policy of accident and health insurance under Section 356t and
	222	+	14 the coverage required under Sections 356g, 356g.5, 356g.5-1,
	223	+	15 356q, 356u, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8,
	224	+	16 356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
	225	+	17 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
	226	+	18 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
	227	+	19 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, and 356z.60, and
	228	+	20 356z.61 of the Illinois Insurance Code. Insurance policies
	229	+	21 shall comply with Section 356z.19 of the Illinois Insurance
	230	+	22 Code. The coverage shall comply with Sections 155.22a, 355b,
	231	+	23 and 370c of the Illinois Insurance Code. The Department of
	232	+	24 Insurance shall enforce the requirements of this Section.
462	233
463	234
464		-	rate of reimbursement for services or other payments or alter
465		-	any methodologies authorized by this Code to reduce any rate
466		-	of reimbursement for services or other payments in accordance
467		-	with Section 5-5e.
468		-	To ensure full access to the benefits set forth in this
469		-	Section, on and after January 1, 2016, the Department shall
470		-	ensure that provider and hospital reimbursement for
471		-	post-mastectomy care benefits required under this Section are
472		-	no lower than the Medicare reimbursement rate.
473		-	(Source: P.A. 101-81, eff. 7-12-19; 101-218, eff. 1-1-20;
474		-	101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-574, eff.
475		-	1-1-20; 101-649, eff. 7-7-20; 102-30, eff. 1-1-22; 102-144,
476		-	eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
477		-	102-530, eff. 1-1-22; 102-642, eff. 1-1-22; 102-804, eff.
478		-	1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093,
479		-	eff. 1-1-23; 102-1117, eff. 1-13-23.)
480		-	Section 95. No acceleration or delay. Where this Act makes
481		-	changes in a statute that is represented in this Act by text
482		-	that is not yet or no longer in effect (for example, a Section
483		-	represented by multiple versions), the use of that text does
484		-	not accelerate or delay the taking effect of (i) the changes
485		-	made by this Act or (ii) provisions derived from any other
486		-	Public Act.
	235	+
	236	+
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	239	+
	240	+
	241	+	SB1527 Enrolled- 8 -LRB103 27266 BMS 53637 b SB1527 Enrolled - 8 - LRB103 27266 BMS 53637 b
	242	+	SB1527 Enrolled - 8 - LRB103 27266 BMS 53637 b
	243	+	1 Rulemaking authority to implement Public Act 95-1045, if
	244	+	2 any, is conditioned on the rules being adopted in accordance
	245	+	3 with all provisions of the Illinois Administrative Procedure
	246	+	4 Act and all rules and procedures of the Joint Committee on
	247	+	5 Administrative Rules; any purported rule not so adopted, for
	248	+	6 whatever reason, is unauthorized.
	249	+	7 (Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
	250	+	8 101-393, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625, eff.
	251	+	9 1-1-21; 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 102-203,
	252	+	10 eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. 1-1-22;
	253	+	11 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804, eff.
	254	+	12 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860,
	255	+	13 eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23.)
	256	+	14 Section 25. The Illinois Insurance Code is amended by
	257	+	15 adding Section 356z.61 as follows:
	258	+	16 (215 ILCS 5/356z.61 new)
	259	+	17 Sec. 356z.61. Coverage for compression sleeves. A group or
	260	+	18 individual policy of accident and health insurance or a
	261	+	19 managed care plan that is amended, delivered, issued, or
	262	+	20 renewed on or after January 1, 2025 shall provide coverage for
	263	+	21 compression sleeves that is medically necessary for the
	264	+	22 enrollee to prevent or mitigate lymphedema.
	265	+	23 Section 30. The Health Maintenance Organization Act is
	266	+
	267	+
	268	+
	269	+
	270	+
	271	+	SB1527 Enrolled - 8 - LRB103 27266 BMS 53637 b
	272	+
	273	+
	274	+	SB1527 Enrolled- 9 -LRB103 27266 BMS 53637 b SB1527 Enrolled - 9 - LRB103 27266 BMS 53637 b
	275	+	SB1527 Enrolled - 9 - LRB103 27266 BMS 53637 b
	276	+	1 amended by changing Section 5-3 as follows:
	277	+	2 (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
	278	+	3 Sec. 5-3. Insurance Code provisions.
	279	+	4 (a) Health Maintenance Organizations shall be subject to
	280	+	5 the provisions of Sections 133, 134, 136, 137, 139, 140,
	281	+	6 141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
	282	+	7 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 355.2,
	283	+	8 355.3, 355b, 355c, 356g.5-1, 356m, 356q, 356v, 356w, 356x,
	284	+	9 356y, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6,
	285	+	10 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14,
	286	+	11 356z.15, 356z.17, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25,
	287	+	12 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33,
	288	+	13 356z.35, 356z.36, 356z.40, 356z.41, 356z.46, 356z.47, 356z.48,
	289	+	14 356z.50, 356z.51, 356z.53 256z.53, 356z.54, 356z.56, 356z.57,
	290	+	15 356z.59, 356z.60, 356z.61, 364, 364.01, 364.3, 367.2, 367.2-5,
	291	+	16 367i, 368a, 368b, 368c, 368d, 368e, 370c, 370c.1, 401, 401.1,
	292	+	17 402, 403, 403A, 408, 408.2, 409, 412, 444, and 444.1,
	293	+	18 paragraph (c) of subsection (2) of Section 367, and Articles
	294	+	19 IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and
	295	+	20 XXXIIB of the Illinois Insurance Code.
	296	+	21 (b) For purposes of the Illinois Insurance Code, except
	297	+	22 for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
	298	+	23 Health Maintenance Organizations in the following categories
	299	+	24 are deemed to be "domestic companies":
	300	+	25 (1) a corporation authorized under the Dental Service
	301	+
	302	+
	303	+
	304	+
	305	+
	306	+	SB1527 Enrolled - 9 - LRB103 27266 BMS 53637 b
	307	+
	308	+
	309	+	SB1527 Enrolled- 10 -LRB103 27266 BMS 53637 b SB1527 Enrolled - 10 - LRB103 27266 BMS 53637 b
	310	+	SB1527 Enrolled - 10 - LRB103 27266 BMS 53637 b
	311	+	1 Plan Act or the Voluntary Health Services Plans Act;
	312	+	2 (2) a corporation organized under the laws of this
	313	+	3 State; or
	314	+	4 (3) a corporation organized under the laws of another
	315	+	5 state, 30% or more of the enrollees of which are residents
	316	+	6 of this State, except a corporation subject to
	317	+	7 substantially the same requirements in its state of
	318	+	8 organization as is a "domestic company" under Article VIII
	319	+	9 1/2 of the Illinois Insurance Code.
	320	+	10 (c) In considering the merger, consolidation, or other
	321	+	11 acquisition of control of a Health Maintenance Organization
	322	+	12 pursuant to Article VIII 1/2 of the Illinois Insurance Code,
	323	+	13 (1) the Director shall give primary consideration to
	324	+	14 the continuation of benefits to enrollees and the
	325	+	15 financial conditions of the acquired Health Maintenance
	326	+	16 Organization after the merger, consolidation, or other
	327	+	17 acquisition of control takes effect;
	328	+	18 (2)(i) the criteria specified in subsection (1)(b) of
	329	+	19 Section 131.8 of the Illinois Insurance Code shall not
	330	+	20 apply and (ii) the Director, in making his determination
	331	+	21 with respect to the merger, consolidation, or other
	332	+	22 acquisition of control, need not take into account the
	333	+	23 effect on competition of the merger, consolidation, or
	334	+	24 other acquisition of control;
	335	+	25 (3) the Director shall have the power to require the
	336	+	26 following information:
	337	+
	338	+
	339	+
	340	+
	341	+
	342	+	SB1527 Enrolled - 10 - LRB103 27266 BMS 53637 b
	343	+
	344	+
	345	+	SB1527 Enrolled- 11 -LRB103 27266 BMS 53637 b SB1527 Enrolled - 11 - LRB103 27266 BMS 53637 b
	346	+	SB1527 Enrolled - 11 - LRB103 27266 BMS 53637 b
	347	+	1 (A) certification by an independent actuary of the
	348	+	2 adequacy of the reserves of the Health Maintenance
	349	+	3 Organization sought to be acquired;
	350	+	4 (B) pro forma financial statements reflecting the
	351	+	5 combined balance sheets of the acquiring company and
	352	+	6 the Health Maintenance Organization sought to be
	353	+	7 acquired as of the end of the preceding year and as of
	354	+	8 a date 90 days prior to the acquisition, as well as pro
	355	+	9 forma financial statements reflecting projected
	356	+	10 combined operation for a period of 2 years;
	357	+	11 (C) a pro forma business plan detailing an
	358	+	12 acquiring party's plans with respect to the operation
	359	+	13 of the Health Maintenance Organization sought to be
	360	+	14 acquired for a period of not less than 3 years; and
	361	+	15 (D) such other information as the Director shall
	362	+	16 require.
	363	+	17 (d) The provisions of Article VIII 1/2 of the Illinois
	364	+	18 Insurance Code and this Section 5-3 shall apply to the sale by
	365	+	19 any health maintenance organization of greater than 10% of its
	366	+	20 enrollee population (including without limitation the health
	367	+	21 maintenance organization's right, title, and interest in and
	368	+	22 to its health care certificates).
	369	+	23 (e) In considering any management contract or service
	370	+	24 agreement subject to Section 141.1 of the Illinois Insurance
	371	+	25 Code, the Director (i) shall, in addition to the criteria
	372	+	26 specified in Section 141.2 of the Illinois Insurance Code,
	373	+
	374	+
	375	+
	376	+
	377	+
	378	+	SB1527 Enrolled - 11 - LRB103 27266 BMS 53637 b
	379	+
	380	+
	381	+	SB1527 Enrolled- 12 -LRB103 27266 BMS 53637 b SB1527 Enrolled - 12 - LRB103 27266 BMS 53637 b
	382	+	SB1527 Enrolled - 12 - LRB103 27266 BMS 53637 b
	383	+	1 take into account the effect of the management contract or
	384	+	2 service agreement on the continuation of benefits to enrollees
	385	+	3 and the financial condition of the health maintenance
	386	+	4 organization to be managed or serviced, and (ii) need not take
	387	+	5 into account the effect of the management contract or service
	388	+	6 agreement on competition.
	389	+	7 (f) Except for small employer groups as defined in the
	390	+	8 Small Employer Rating, Renewability and Portability Health
	391	+	9 Insurance Act and except for medicare supplement policies as
	392	+	10 defined in Section 363 of the Illinois Insurance Code, a
	393	+	11 Health Maintenance Organization may by contract agree with a
	394	+	12 group or other enrollment unit to effect refunds or charge
	395	+	13 additional premiums under the following terms and conditions:
	396	+	14 (i) the amount of, and other terms and conditions with
	397	+	15 respect to, the refund or additional premium are set forth
	398	+	16 in the group or enrollment unit contract agreed in advance
	399	+	17 of the period for which a refund is to be paid or
	400	+	18 additional premium is to be charged (which period shall
	401	+	19 not be less than one year); and
	402	+	20 (ii) the amount of the refund or additional premium
	403	+	21 shall not exceed 20% of the Health Maintenance
	404	+	22 Organization's profitable or unprofitable experience with
	405	+	23 respect to the group or other enrollment unit for the
	406	+	24 period (and, for purposes of a refund or additional
	407	+	25 premium, the profitable or unprofitable experience shall
	408	+	26 be calculated taking into account a pro rata share of the
	409	+
	410	+
	411	+
	412	+
	413	+
	414	+	SB1527 Enrolled - 12 - LRB103 27266 BMS 53637 b
	415	+
	416	+
	417	+	SB1527 Enrolled- 13 -LRB103 27266 BMS 53637 b SB1527 Enrolled - 13 - LRB103 27266 BMS 53637 b
	418	+	SB1527 Enrolled - 13 - LRB103 27266 BMS 53637 b
	419	+	1 Health Maintenance Organization's administrative and
	420	+	2 marketing expenses, but shall not include any refund to be
	421	+	3 made or additional premium to be paid pursuant to this
	422	+	4 subsection (f)). The Health Maintenance Organization and
	423	+	5 the group or enrollment unit may agree that the profitable
	424	+	6 or unprofitable experience may be calculated taking into
	425	+	7 account the refund period and the immediately preceding 2
	426	+	8 plan years.
	427	+	9 The Health Maintenance Organization shall include a
	428	+	10 statement in the evidence of coverage issued to each enrollee
	429	+	11 describing the possibility of a refund or additional premium,
	430	+	12 and upon request of any group or enrollment unit, provide to
	431	+	13 the group or enrollment unit a description of the method used
	432	+	14 to calculate (1) the Health Maintenance Organization's
	433	+	15 profitable experience with respect to the group or enrollment
	434	+	16 unit and the resulting refund to the group or enrollment unit
	435	+	17 or (2) the Health Maintenance Organization's unprofitable
	436	+	18 experience with respect to the group or enrollment unit and
	437	+	19 the resulting additional premium to be paid by the group or
	438	+	20 enrollment unit.
	439	+	21 In no event shall the Illinois Health Maintenance
	440	+	22 Organization Guaranty Association be liable to pay any
	441	+	23 contractual obligation of an insolvent organization to pay any
	442	+	24 refund authorized under this Section.
	443	+	25 (g) Rulemaking authority to implement Public Act 95-1045,
	444	+	26 if any, is conditioned on the rules being adopted in
	445	+
	446	+
	447	+
	448	+
	449	+
	450	+	SB1527 Enrolled - 13 - LRB103 27266 BMS 53637 b
	451	+
	452	+
	453	+	SB1527 Enrolled- 14 -LRB103 27266 BMS 53637 b SB1527 Enrolled - 14 - LRB103 27266 BMS 53637 b
	454	+	SB1527 Enrolled - 14 - LRB103 27266 BMS 53637 b
	455	+	1 accordance with all provisions of the Illinois Administrative
	456	+	2 Procedure Act and all rules and procedures of the Joint
	457	+	3 Committee on Administrative Rules; any purported rule not so
	458	+	4 adopted, for whatever reason, is unauthorized.
	459	+	5 (Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19;
	460	+	6 101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-393, eff.
	461	+	7 1-1-20; 101-452, eff. 1-1-20; 101-461, eff. 1-1-20; 101-625,
	462	+	8 eff. 1-1-21; 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
	463	+	9 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
	464	+	10 1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
	465	+	11 eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
	466	+	12 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
	467	+	13 1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
	468	+	14 eff. 1-1-23; 102-1117, eff. 1-13-23; revised 1-22-23.)
	469	+	15 Section 35. The Limited Health Service Organization Act is
	470	+	16 amended by changing Section 4003 as follows:
	471	+	17 (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
	472	+	18 Sec. 4003. Illinois Insurance Code provisions. Limited
	473	+	19 health service organizations shall be subject to the
	474	+	20 provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
	475	+	21 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
	476	+	22 154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 355.2, 355.3,
	477	+	23 355b, 356q, 356v, 356z.4, 356z.4a, 356z.10, 356z.21, 356z.22,
	478	+	24 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
	479	+
	480	+
	481	+
	482	+
	483	+
	484	+	SB1527 Enrolled - 14 - LRB103 27266 BMS 53637 b
	485	+
	486	+
	487	+	SB1527 Enrolled- 15 -LRB103 27266 BMS 53637 b SB1527 Enrolled - 15 - LRB103 27266 BMS 53637 b
	488	+	SB1527 Enrolled - 15 - LRB103 27266 BMS 53637 b
	489	+	1 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54, 356z.57,
	490	+	2 356z.59, 356z.61, 364.3, 368a, 401, 401.1, 402, 403, 403A,
	491	+	3 408, 408.2, 409, 412, 444, and 444.1 and Articles IIA, VIII
	492	+	4 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and XXVI of the
	493	+	5 Illinois Insurance Code. Nothing in this Section shall require
	494	+	6 a limited health care plan to cover any service that is not a
	495	+	7 limited health service. For purposes of the Illinois Insurance
	496	+	8 Code, except for Sections 444 and 444.1 and Articles XIII and
	497	+	9 XIII 1/2, limited health service organizations in the
	498	+	10 following categories are deemed to be domestic companies:
	499	+	11 (1) a corporation under the laws of this State; or
	500	+	12 (2) a corporation organized under the laws of another
	501	+	13 state, 30% or more of the enrollees of which are residents
	502	+	14 of this State, except a corporation subject to
	503	+	15 substantially the same requirements in its state of
	504	+	16 organization as is a domestic company under Article VIII
	505	+	17 1/2 of the Illinois Insurance Code.
	506	+	18 (Source: P.A. 101-81, eff. 7-12-19; 101-281, eff. 1-1-20;
	507	+	19 101-393, eff. 1-1-20; 101-625, eff. 1-1-21; 102-30, eff.
	508	+	20 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642,
	509	+	21 eff. 1-1-22; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
	510	+	22 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860, eff.
	511	+	23 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff. 1-13-23.)
	512	+	24 Section 40. The Voluntary Health Services Plans Act is
	513	+	25 amended by changing Section 10 as follows:
	514	+
	515	+
	516	+
	517	+
	518	+
	519	+	SB1527 Enrolled - 15 - LRB103 27266 BMS 53637 b
	520	+
	521	+
	522	+	SB1527 Enrolled- 16 -LRB103 27266 BMS 53637 b SB1527 Enrolled - 16 - LRB103 27266 BMS 53637 b
	523	+	SB1527 Enrolled - 16 - LRB103 27266 BMS 53637 b
	524	+	1 (215 ILCS 165/10) (from Ch. 32, par. 604)
	525	+	2 Sec. 10. Application of Insurance Code provisions. Health
	526	+	3 services plan corporations and all persons interested therein
	527	+	4 or dealing therewith shall be subject to the provisions of
	528	+	5 Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
	529	+	6 143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b,
	530	+	7 356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356v, 356w,
	531	+	8 356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5,
	532	+	9 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
	533	+	10 356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25,
	534	+	11 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, 356z.33,
	535	+	12 356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
	536	+	13 356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 364.01, 364.3,
	537	+	14 367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412,
	538	+	15 and paragraphs (7) and (15) of Section 367 of the Illinois
	539	+	16 Insurance Code.
	540	+	17 Rulemaking authority to implement Public Act 95-1045, if
	541	+	18 any, is conditioned on the rules being adopted in accordance
	542	+	19 with all provisions of the Illinois Administrative Procedure
	543	+	20 Act and all rules and procedures of the Joint Committee on
	544	+	21 Administrative Rules; any purported rule not so adopted, for
	545	+	22 whatever reason, is unauthorized.
	546	+	23 (Source: P.A. 101-13, eff. 6-12-19; 101-81, eff. 7-12-19;
	547	+	24 101-281, eff. 1-1-20; 101-393, eff. 1-1-20; 101-625, eff.
	548	+	25 1-1-21; 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; 102-306,
	549	+
	550	+
	551	+
	552	+
	553	+
	554	+	SB1527 Enrolled - 16 - LRB103 27266 BMS 53637 b
	555	+
	556	+
	557	+	SB1527 Enrolled- 17 -LRB103 27266 BMS 53637 b SB1527 Enrolled - 17 - LRB103 27266 BMS 53637 b
	558	+	SB1527 Enrolled - 17 - LRB103 27266 BMS 53637 b
	559	+	1 eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21;
	560	+	2 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804, eff.
	561	+	3 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-860,
	562	+	4 eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff. 1-1-23;
	563	+	5 102-1117, eff. 1-13-23.)
	564	+	6 Section 45. The Illinois Public Aid Code is amended by
	565	+	7 changing Section 5-16.8 as follows:
	566	+	8 (305 ILCS 5/5-16.8)
	567	+	9 Sec. 5-16.8. Required health benefits. The medical
	568	+	10 assistance program shall (i) provide the post-mastectomy care
	569	+	11 benefits required to be covered by a policy of accident and
	570	+	12 health insurance under Section 356t and the coverage required
	571	+	13 under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6,
	572	+	14 356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,
	573	+	15 356z.47, 356z.51, 356z.53, 356z.56, 356z.59, and 356z.60, and
	574	+	16 356z.61 of the Illinois Insurance Code, (ii) be subject to the
	575	+	17 provisions of Sections 356z.19, 356z.44, 356z.49, 364.01,
	576	+	18 370c, and 370c.1 of the Illinois Insurance Code, and (iii) be
	577	+	19 subject to the provisions of subsection (d-5) of Section 10 of
	578	+	20 the Network Adequacy and Transparency Act.
	579	+	21 The Department, by rule, shall adopt a model similar to
	580	+	22 the requirements of Section 356z.39 of the Illinois Insurance
	581	+	23 Code.
	582	+	24 On and after July 1, 2012, the Department shall reduce any
	583	+
	584	+
	585	+
	586	+
	587	+
	588	+	SB1527 Enrolled - 17 - LRB103 27266 BMS 53637 b
	589	+
	590	+
	591	+	SB1527 Enrolled- 18 -LRB103 27266 BMS 53637 b SB1527 Enrolled - 18 - LRB103 27266 BMS 53637 b
	592	+	SB1527 Enrolled - 18 - LRB103 27266 BMS 53637 b
	593	+	1 rate of reimbursement for services or other payments or alter
	594	+	2 any methodologies authorized by this Code to reduce any rate
	595	+	3 of reimbursement for services or other payments in accordance
	596	+	4 with Section 5-5e.
	597	+	5 To ensure full access to the benefits set forth in this
	598	+	6 Section, on and after January 1, 2016, the Department shall
	599	+	7 ensure that provider and hospital reimbursement for
	600	+	8 post-mastectomy care benefits required under this Section are
	601	+	9 no lower than the Medicare reimbursement rate.
	602	+	10 (Source: P.A. 101-81, eff. 7-12-19; 101-218, eff. 1-1-20;
	603	+	11 101-281, eff. 1-1-20; 101-371, eff. 1-1-20; 101-574, eff.
	604	+	12 1-1-20; 101-649, eff. 7-7-20; 102-30, eff. 1-1-22; 102-144,
	605	+	13 eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
	606	+	14 102-530, eff. 1-1-22; 102-642, eff. 1-1-22; 102-804, eff.
	607	+	15 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093,
	608	+	16 eff. 1-1-23; 102-1117, eff. 1-13-23.)
	609	+	17 Section 95. No acceleration or delay. Where this Act makes
	610	+	18 changes in a statute that is represented in this Act by text
	611	+	19 that is not yet or no longer in effect (for example, a Section
	612	+	20 represented by multiple versions), the use of that text does
	613	+	21 not accelerate or delay the taking effect of (i) the changes
	614	+	22 made by this Act or (ii) provisions derived from any other
	615	+	23 Public Act.
	616	+
	617	+
	618	+
	619	+
	620	+
	621	+	SB1527 Enrolled - 18 - LRB103 27266 BMS 53637 b