103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB2836 Introduced 1/19/2024, by Sen. Laura Fine SYNOPSIS AS INTRODUCED: 215 ILCS 5/121-2.05 from Ch. 73, par. 733-2.05215 ILCS 5/352c new215 ILCS 5/356z.18215 ILCS 5/367.3 from Ch. 73, par. 979.3215 ILCS 5/367a from Ch. 73, par. 979a215 ILCS 5/368f215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2215 ILCS 130/4003 from Ch. 73, par. 1504-3215 ILCS 190/Act rep. Amends the Illinois Insurance Code. Sets forth provisions concerning short-term, limited-duration insurance. Provides that on and after January 1, 2025, no company shall issue, deliver, amend, or renew short-term, limited-duration insurance to any natural or legal person that is a resident or domiciled in the State. Provides that the Department of Insurance may adopt rules as deemed necessary that prescribe specific standards for or restrictions on policy provisions, benefit design, disclosures, and sales and marketing practices for excepted benefits. Provides that the Director of Insurance's authority under specified provisions is extended to group and blanket excepted benefits. Provides that the language does not apply to limited-scope dental, limited-scope vision, long-term care, Medicare supplement, credit life, credit health, or any excepted benefits that are filed under specified provisions. Provides that nothing in the language shall be construed to limit the Director's authority under other statutes. Makes conforming changes in the Health Maintenance Organization Act and the Limited Health Service Organization Act. Repeals the Short-Term, Limited-Duration Health Insurance Coverage Act. Effective January 1, 2025. LRB103 35223 JAG 65205 b A BILL FOR 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB2836 Introduced 1/19/2024, by Sen. Laura Fine SYNOPSIS AS INTRODUCED: 215 ILCS 5/121-2.05 from Ch. 73, par. 733-2.05215 ILCS 5/352c new215 ILCS 5/356z.18215 ILCS 5/367.3 from Ch. 73, par. 979.3215 ILCS 5/367a from Ch. 73, par. 979a215 ILCS 5/368f215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2215 ILCS 130/4003 from Ch. 73, par. 1504-3215 ILCS 190/Act rep. 215 ILCS 5/121-2.05 from Ch. 73, par. 733-2.05 215 ILCS 5/352c new 215 ILCS 5/356z.18 215 ILCS 5/367.3 from Ch. 73, par. 979.3 215 ILCS 5/367a from Ch. 73, par. 979a 215 ILCS 5/368f 215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2 215 ILCS 130/4003 from Ch. 73, par. 1504-3 215 ILCS 190/Act rep. Amends the Illinois Insurance Code. Sets forth provisions concerning short-term, limited-duration insurance. Provides that on and after January 1, 2025, no company shall issue, deliver, amend, or renew short-term, limited-duration insurance to any natural or legal person that is a resident or domiciled in the State. Provides that the Department of Insurance may adopt rules as deemed necessary that prescribe specific standards for or restrictions on policy provisions, benefit design, disclosures, and sales and marketing practices for excepted benefits. Provides that the Director of Insurance's authority under specified provisions is extended to group and blanket excepted benefits. Provides that the language does not apply to limited-scope dental, limited-scope vision, long-term care, Medicare supplement, credit life, credit health, or any excepted benefits that are filed under specified provisions. Provides that nothing in the language shall be construed to limit the Director's authority under other statutes. Makes conforming changes in the Health Maintenance Organization Act and the Limited Health Service Organization Act. Repeals the Short-Term, Limited-Duration Health Insurance Coverage Act. Effective January 1, 2025. LRB103 35223 JAG 65205 b LRB103 35223 JAG 65205 b A BILL FOR
103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB2836 Introduced 1/19/2024, by Sen. Laura Fine SYNOPSIS AS INTRODUCED:
215 ILCS 5/121-2.05 from Ch. 73, par. 733-2.05215 ILCS 5/352c new215 ILCS 5/356z.18215 ILCS 5/367.3 from Ch. 73, par. 979.3215 ILCS 5/367a from Ch. 73, par. 979a215 ILCS 5/368f215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2215 ILCS 130/4003 from Ch. 73, par. 1504-3215 ILCS 190/Act rep. 215 ILCS 5/121-2.05 from Ch. 73, par. 733-2.05 215 ILCS 5/352c new 215 ILCS 5/356z.18 215 ILCS 5/367.3 from Ch. 73, par. 979.3 215 ILCS 5/367a from Ch. 73, par. 979a 215 ILCS 5/368f 215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2 215 ILCS 130/4003 from Ch. 73, par. 1504-3 215 ILCS 190/Act rep.
215 ILCS 5/121-2.05 from Ch. 73, par. 733-2.05
215 ILCS 5/352c new
215 ILCS 5/356z.18
215 ILCS 5/367.3 from Ch. 73, par. 979.3
215 ILCS 5/367a from Ch. 73, par. 979a
215 ILCS 5/368f
215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2
215 ILCS 130/4003 from Ch. 73, par. 1504-3
215 ILCS 190/Act rep.
Amends the Illinois Insurance Code. Sets forth provisions concerning short-term, limited-duration insurance. Provides that on and after January 1, 2025, no company shall issue, deliver, amend, or renew short-term, limited-duration insurance to any natural or legal person that is a resident or domiciled in the State. Provides that the Department of Insurance may adopt rules as deemed necessary that prescribe specific standards for or restrictions on policy provisions, benefit design, disclosures, and sales and marketing practices for excepted benefits. Provides that the Director of Insurance's authority under specified provisions is extended to group and blanket excepted benefits. Provides that the language does not apply to limited-scope dental, limited-scope vision, long-term care, Medicare supplement, credit life, credit health, or any excepted benefits that are filed under specified provisions. Provides that nothing in the language shall be construed to limit the Director's authority under other statutes. Makes conforming changes in the Health Maintenance Organization Act and the Limited Health Service Organization Act. Repeals the Short-Term, Limited-Duration Health Insurance Coverage Act. Effective January 1, 2025.
LRB103 35223 JAG 65205 b LRB103 35223 JAG 65205 b
LRB103 35223 JAG 65205 b
A BILL FOR
SB2836LRB103 35223 JAG 65205 b SB2836 LRB103 35223 JAG 65205 b
SB2836 LRB103 35223 JAG 65205 b
1 AN ACT concerning regulation.
2 Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
4 Section 5. The Illinois Insurance Code is amended by
5 changing Sections 121-2.05, 356z.18, 367.3, 367a, and 368f and
6 by adding Section 352c as follows:
7 (215 ILCS 5/121-2.05) (from Ch. 73, par. 733-2.05)
8 Sec. 121-2.05. Group insurance policies issued and
9 delivered in other State-Transactions in this State. With the
10 exception of insurance transactions authorized under Sections
11 230.2 or 367.3 of this Code or transactions described under
12 Section 352c, transactions in this State involving group
13 legal, group life and group accident and health or blanket
14 accident and health insurance or group annuities where the
15 master policy of such groups was lawfully issued and delivered
16 in, and under the laws of, a State in which the insurer was
17 authorized to do an insurance business, to a group properly
18 established pursuant to law or regulation, and where the
19 policyholder is domiciled or otherwise has a bona fide situs.
20 (Source: P.A. 86-753.)
21 (215 ILCS 5/352c new)
22 Sec. 352c. Short-term, limited-duration insurance
103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB2836 Introduced 1/19/2024, by Sen. Laura Fine SYNOPSIS AS INTRODUCED:
215 ILCS 5/121-2.05 from Ch. 73, par. 733-2.05215 ILCS 5/352c new215 ILCS 5/356z.18215 ILCS 5/367.3 from Ch. 73, par. 979.3215 ILCS 5/367a from Ch. 73, par. 979a215 ILCS 5/368f215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2215 ILCS 130/4003 from Ch. 73, par. 1504-3215 ILCS 190/Act rep. 215 ILCS 5/121-2.05 from Ch. 73, par. 733-2.05 215 ILCS 5/352c new 215 ILCS 5/356z.18 215 ILCS 5/367.3 from Ch. 73, par. 979.3 215 ILCS 5/367a from Ch. 73, par. 979a 215 ILCS 5/368f 215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2 215 ILCS 130/4003 from Ch. 73, par. 1504-3 215 ILCS 190/Act rep.
215 ILCS 5/121-2.05 from Ch. 73, par. 733-2.05
215 ILCS 5/352c new
215 ILCS 5/356z.18
215 ILCS 5/367.3 from Ch. 73, par. 979.3
215 ILCS 5/367a from Ch. 73, par. 979a
215 ILCS 5/368f
215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2
215 ILCS 130/4003 from Ch. 73, par. 1504-3
215 ILCS 190/Act rep.
Amends the Illinois Insurance Code. Sets forth provisions concerning short-term, limited-duration insurance. Provides that on and after January 1, 2025, no company shall issue, deliver, amend, or renew short-term, limited-duration insurance to any natural or legal person that is a resident or domiciled in the State. Provides that the Department of Insurance may adopt rules as deemed necessary that prescribe specific standards for or restrictions on policy provisions, benefit design, disclosures, and sales and marketing practices for excepted benefits. Provides that the Director of Insurance's authority under specified provisions is extended to group and blanket excepted benefits. Provides that the language does not apply to limited-scope dental, limited-scope vision, long-term care, Medicare supplement, credit life, credit health, or any excepted benefits that are filed under specified provisions. Provides that nothing in the language shall be construed to limit the Director's authority under other statutes. Makes conforming changes in the Health Maintenance Organization Act and the Limited Health Service Organization Act. Repeals the Short-Term, Limited-Duration Health Insurance Coverage Act. Effective January 1, 2025.
LRB103 35223 JAG 65205 b LRB103 35223 JAG 65205 b
LRB103 35223 JAG 65205 b
A BILL FOR
215 ILCS 5/121-2.05 from Ch. 73, par. 733-2.05
215 ILCS 5/352c new
215 ILCS 5/356z.18
215 ILCS 5/367.3 from Ch. 73, par. 979.3
215 ILCS 5/367a from Ch. 73, par. 979a
215 ILCS 5/368f
215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2
215 ILCS 130/4003 from Ch. 73, par. 1504-3
215 ILCS 190/Act rep.
LRB103 35223 JAG 65205 b
SB2836 LRB103 35223 JAG 65205 b
SB2836- 2 -LRB103 35223 JAG 65205 b SB2836 - 2 - LRB103 35223 JAG 65205 b
SB2836 - 2 - LRB103 35223 JAG 65205 b
1 prohibited; rules for excepted benefits.
2 (a) Definitions. As used in this Section:
3 "Excepted benefits" has the meaning given to that term in
4 42 U.S.C. 300gg-91 and implementing regulations. "Excepted
5 benefits" includes individual, group, or blanket coverage.
6 "Short-term, limited-duration insurance" means any type of
7 accident and health insurance offered or provided within this
8 State pursuant to a group or individual policy or individual
9 certificate by a company, regardless of the situs state of the
10 delivery of the policy, that has an expiration date specified
11 in the contract that is fewer than 365 days after the original
12 effective date. Regardless of the duration of coverage,
13 "short-term, limited-duration insurance" does not include
14 excepted benefits or any student health insurance coverage.
15 "Student health insurance coverage" has the meaning given
16 to that term in 45 CFR 147.145.
17 (b) On and after January 1, 2025, no company shall issue,
18 deliver, amend, or renew short-term, limited-duration
19 insurance to any natural or legal person that is a resident or
20 domiciled in this State.
21 (c) To prevent the use, design, and combination of
22 excepted benefits to circumvent State or federal requirements
23 for comprehensive forms of health insurance coverage, to
24 prevent confusion or misinformation of insureds about
25 duplicate or distinct types of coverage, and to ensure a
26 measure of consistency within product lines across the
SB2836 - 2 - LRB103 35223 JAG 65205 b
SB2836- 3 -LRB103 35223 JAG 65205 b SB2836 - 3 - LRB103 35223 JAG 65205 b
SB2836 - 3 - LRB103 35223 JAG 65205 b
1 individual, group, and blanket markets, the Department may
2 adopt rules as deemed necessary that prescribe specific
3 standards for or restrictions on policy provisions, benefit
4 design, disclosures, and sales and marketing practices for
5 excepted benefits. For purposes of these rules, the Director's
6 authority under subsections (3) and (4) of Section 355a is
7 extended to group and blanket excepted benefits. To ensure
8 compliance with these rules, the Director may require policy
9 forms and rates to be filed as provided in Sections 143 and 355
10 and rules thereunder with respect to excepted benefits
11 coverage intended to be issued to residents of this State
12 under a master contract issued to a group domiciled or
13 otherwise with bona fide situs outside of this State. This
14 subsection does not apply to limited-scope dental,
15 limited-scope vision, long-term care, Medicare supplement,
16 credit life, credit health, or any excepted benefits that are
17 filed under subsections (b) through (l) of Class 2 or under
18 Class 3 of Section 4. Nothing in this subsection shall be
19 construed to limit the Director's authority under other
20 statutes.
21 (215 ILCS 5/356z.18)
22 (Text of Section before amendment by P.A. 103-512)
23 Sec. 356z.18. Prosthetic and customized orthotic devices.
24 (a) For the purposes of this Section:
25 "Customized orthotic device" means a supportive device for
SB2836 - 3 - LRB103 35223 JAG 65205 b
SB2836- 4 -LRB103 35223 JAG 65205 b SB2836 - 4 - LRB103 35223 JAG 65205 b
SB2836 - 4 - LRB103 35223 JAG 65205 b
1 the body or a part of the body, the head, neck, or extremities,
2 and includes the replacement or repair of the device based on
3 the patient's physical condition as medically necessary,
4 excluding foot orthotics defined as an in-shoe device designed
5 to support the structural components of the foot during
6 weight-bearing activities.
7 "Licensed provider" means a prosthetist, orthotist, or
8 pedorthist licensed to practice in this State.
9 "Prosthetic device" means an artificial device to replace,
10 in whole or in part, an arm or leg and includes accessories
11 essential to the effective use of the device and the
12 replacement or repair of the device based on the patient's
13 physical condition as medically necessary.
14 (b) This amendatory Act of the 96th General Assembly shall
15 provide benefits to any person covered thereunder for expenses
16 incurred in obtaining a prosthetic or custom orthotic device
17 from any Illinois licensed prosthetist, licensed orthotist, or
18 licensed pedorthist as required under the Orthotics,
19 Prosthetics, and Pedorthics Practice Act.
20 (c) A group or individual major medical policy of accident
21 or health insurance or managed care plan or medical, health,
22 or hospital service corporation contract that provides
23 coverage for prosthetic or custom orthotic care and is
24 amended, delivered, issued, or renewed 6 months after the
25 effective date of this amendatory Act of the 96th General
26 Assembly must provide coverage for prosthetic and orthotic
SB2836 - 4 - LRB103 35223 JAG 65205 b
SB2836- 5 -LRB103 35223 JAG 65205 b SB2836 - 5 - LRB103 35223 JAG 65205 b
SB2836 - 5 - LRB103 35223 JAG 65205 b
1 devices in accordance with this subsection (c). The coverage
2 required under this Section shall be subject to the other
3 general exclusions, limitations, and financial requirements of
4 the policy, including coordination of benefits, participating
5 provider requirements, utilization review of health care
6 services, including review of medical necessity, case
7 management, and experimental and investigational treatments,
8 and other managed care provisions under terms and conditions
9 that are no less favorable than the terms and conditions that
10 apply to substantially all medical and surgical benefits
11 provided under the plan or coverage.
12 (d) The policy or plan or contract may require prior
13 authorization for the prosthetic or orthotic devices in the
14 same manner that prior authorization is required for any other
15 covered benefit.
16 (e) Repairs and replacements of prosthetic and orthotic
17 devices are also covered, subject to the co-payments and
18 deductibles, unless necessitated by misuse or loss.
19 (f) A policy or plan or contract may require that, if
20 coverage is provided through a managed care plan, the benefits
21 mandated pursuant to this Section shall be covered benefits
22 only if the prosthetic or orthotic devices are provided by a
23 licensed provider employed by a provider service who contracts
24 with or is designated by the carrier, to the extent that the
25 carrier provides in-network and out-of-network service, the
26 coverage for the prosthetic or orthotic device shall be
SB2836 - 5 - LRB103 35223 JAG 65205 b
SB2836- 6 -LRB103 35223 JAG 65205 b SB2836 - 6 - LRB103 35223 JAG 65205 b
SB2836 - 6 - LRB103 35223 JAG 65205 b
1 offered no less extensively.
2 (g) The policy or plan or contract shall also meet
3 adequacy requirements as established by the Health Care
4 Reimbursement Reform Act of 1985 of the Illinois Insurance
5 Code.
6 (h) This Section shall not apply to accident only,
7 specified disease, short-term travel hospital or medical,
8 hospital confinement indemnity, credit, dental, vision,
9 Medicare supplement, long-term care, basic hospital and
10 medical-surgical expense coverage, disability income insurance
11 coverage, coverage issued as a supplement to liability
12 insurance, workers' compensation insurance, or automobile
13 medical payment insurance.
14 (Source: P.A. 96-833, eff. 6-1-10.)
15 (Text of Section after amendment by P.A. 103-512)
16 Sec. 356z.18. Prosthetic and customized orthotic devices.
17 (a) For the purposes of this Section:
18 "Customized orthotic device" means a supportive device for
19 the body or a part of the body, the head, neck, or extremities,
20 and includes the replacement or repair of the device based on
21 the patient's physical condition as medically necessary,
22 excluding foot orthotics defined as an in-shoe device designed
23 to support the structural components of the foot during
24 weight-bearing activities.
25 "Licensed provider" means a prosthetist, orthotist, or
SB2836 - 6 - LRB103 35223 JAG 65205 b
SB2836- 7 -LRB103 35223 JAG 65205 b SB2836 - 7 - LRB103 35223 JAG 65205 b
SB2836 - 7 - LRB103 35223 JAG 65205 b
1 pedorthist licensed to practice in this State.
2 "Prosthetic device" means an artificial device to replace,
3 in whole or in part, an arm or leg and includes accessories
4 essential to the effective use of the device and the
5 replacement or repair of the device based on the patient's
6 physical condition as medically necessary.
7 (b) This amendatory Act of the 96th General Assembly shall
8 provide benefits to any person covered thereunder for expenses
9 incurred in obtaining a prosthetic or custom orthotic device
10 from any Illinois licensed prosthetist, licensed orthotist, or
11 licensed pedorthist as required under the Orthotics,
12 Prosthetics, and Pedorthics Practice Act.
13 (c) A group or individual major medical policy of accident
14 or health insurance or managed care plan or medical, health,
15 or hospital service corporation contract that provides
16 coverage for prosthetic or custom orthotic care and is
17 amended, delivered, issued, or renewed 6 months after the
18 effective date of this amendatory Act of the 96th General
19 Assembly must provide coverage for prosthetic and orthotic
20 devices in accordance with this subsection (c). The coverage
21 required under this Section shall be subject to the other
22 general exclusions, limitations, and financial requirements of
23 the policy, including coordination of benefits, participating
24 provider requirements, utilization review of health care
25 services, including review of medical necessity, case
26 management, and experimental and investigational treatments,
SB2836 - 7 - LRB103 35223 JAG 65205 b
SB2836- 8 -LRB103 35223 JAG 65205 b SB2836 - 8 - LRB103 35223 JAG 65205 b
SB2836 - 8 - LRB103 35223 JAG 65205 b
1 and other managed care provisions under terms and conditions
2 that are no less favorable than the terms and conditions that
3 apply to substantially all medical and surgical benefits
4 provided under the plan or coverage.
5 (d) With respect to an enrollee at any age, in addition to
6 coverage of a prosthetic or custom orthotic device required by
7 this Section, benefits shall be provided for a prosthetic or
8 custom orthotic device determined by the enrollee's provider
9 to be the most appropriate model that is medically necessary
10 for the enrollee to perform physical activities, as
11 applicable, such as running, biking, swimming, and lifting
12 weights, and to maximize the enrollee's whole body health and
13 strengthen the lower and upper limb function.
14 (e) The requirements of this Section do not constitute an
15 addition to this State's essential health benefits that
16 requires defrayal of costs by this State pursuant to 42 U.S.C.
17 18031(d)(3)(B).
18 (f) The policy or plan or contract may require prior
19 authorization for the prosthetic or orthotic devices in the
20 same manner that prior authorization is required for any other
21 covered benefit.
22 (g) Repairs and replacements of prosthetic and orthotic
23 devices are also covered, subject to the co-payments and
24 deductibles, unless necessitated by misuse or loss.
25 (h) A policy or plan or contract may require that, if
26 coverage is provided through a managed care plan, the benefits
SB2836 - 8 - LRB103 35223 JAG 65205 b
SB2836- 9 -LRB103 35223 JAG 65205 b SB2836 - 9 - LRB103 35223 JAG 65205 b
SB2836 - 9 - LRB103 35223 JAG 65205 b
1 mandated pursuant to this Section shall be covered benefits
2 only if the prosthetic or orthotic devices are provided by a
3 licensed provider employed by a provider service who contracts
4 with or is designated by the carrier, to the extent that the
5 carrier provides in-network and out-of-network service, the
6 coverage for the prosthetic or orthotic device shall be
7 offered no less extensively.
8 (i) The policy or plan or contract shall also meet
9 adequacy requirements as established by the Health Care
10 Reimbursement Reform Act of 1985 of the Illinois Insurance
11 Code.
12 (j) This Section shall not apply to accident only,
13 specified disease, short-term travel hospital or medical,
14 hospital confinement indemnity, credit, dental, vision,
15 Medicare supplement, long-term care, basic hospital and
16 medical-surgical expense coverage, disability income insurance
17 coverage, coverage issued as a supplement to liability
18 insurance, workers' compensation insurance, or automobile
19 medical payment insurance.
20 (Source: P.A. 103-512, eff. 1-1-25.)
21 (215 ILCS 5/367.3) (from Ch. 73, par. 979.3)
22 Sec. 367.3. Group accident and health insurance;
23 discretionary groups.
24 (a) No group health insurance offered to a resident of
25 this State under a policy issued to a group, other than one
SB2836 - 9 - LRB103 35223 JAG 65205 b
SB2836- 10 -LRB103 35223 JAG 65205 b SB2836 - 10 - LRB103 35223 JAG 65205 b
SB2836 - 10 - LRB103 35223 JAG 65205 b
1 specifically described in Section 367(1), shall be delivered
2 or issued for delivery in this State unless the Director
3 determines that:
4 (1) the issuance of the policy is not contrary to the
5 public interest;
6 (2) the issuance of the policy will result in
7 economies of acquisition and administration; and
8 (3) the benefits under the policy are reasonable in
9 relation to the premium charged.
10 (b) No such group health insurance may be offered in this
11 State under a policy issued in another state unless this State
12 or the state in which the group policy is issued has made a
13 determination that the requirements of subsection (a) have
14 been met.
15 Where insurance is to be offered in this State under a
16 policy described in this subsection, the insurer shall file
17 for informational review purposes:
18 (1) a copy of the group master contract;
19 (2) a copy of the statute authorizing the issuance of
20 the group policy in the state of situs, which statute has
21 the same or similar requirements as this State, or in the
22 absence of such statute, a certification by an officer of
23 the company that the policy meets the Illinois minimum
24 standards required for individual accident and health
25 policies under authority of Section 401 of this Code, as
26 now or hereafter amended, as promulgated by rule at 50
SB2836 - 10 - LRB103 35223 JAG 65205 b
SB2836- 11 -LRB103 35223 JAG 65205 b SB2836 - 11 - LRB103 35223 JAG 65205 b
SB2836 - 11 - LRB103 35223 JAG 65205 b
1 Illinois Administrative Code, Ch. I, Sec. 2007, et seq.,
2 as now or hereafter amended, or by a successor rule;
3 (3) evidence of approval by the state of situs of the
4 group master policy; and
5 (4) copies of all supportive material furnished to the
6 state of situs to satisfy the criteria for approval.
7 (c) The Director may, at any time after receipt of the
8 information required under subsection (b) and after finding
9 that the standards of subsection (a) have not been met, order
10 the insurer to cease the issuance or marketing of that
11 coverage in this State.
12 (d) Notwithstanding subsections (a) and (b), group Group
13 accident and health insurance subject to the provisions of
14 this Section is also subject to the provisions of Sections
15 352c and Section 367i of this Code and rules thereunder.
16 (Source: P.A. 90-655, eff. 7-30-98.)
17 (215 ILCS 5/367a) (from Ch. 73, par. 979a)
18 Sec. 367a. Blanket accident and health insurance.
19 (1) Blanket accident and health insurance is the that form
20 of accident and health insurance providing excepted benefits,
21 as defined in Section 352c, that covers covering special
22 groups of persons as enumerated in one of the following
23 paragraphs (a) to (g), inclusive:
24 (a) Under a policy or contract issued to any carrier for
25 hire, which shall be deemed the policyholder, covering a group
SB2836 - 11 - LRB103 35223 JAG 65205 b
SB2836- 12 -LRB103 35223 JAG 65205 b SB2836 - 12 - LRB103 35223 JAG 65205 b
SB2836 - 12 - LRB103 35223 JAG 65205 b
1 defined as all persons who may become passengers on such
2 carrier.
3 (b) Under a policy or contract issued to an employer, who
4 shall be deemed the policyholder, covering all employees or
5 any group of employees defined by reference to exceptional
6 hazards incident to such employment.
7 (c) Under a policy or contract issued to a college,
8 school, or other institution of learning or to the head or
9 principal thereof, who or which shall be deemed the
10 policyholder, covering students or teachers. However, except
11 where inconsistent with 45 CFR 147.145, student health
12 insurance coverage other than excepted benefits that is
13 provided pursuant to a written agreement with an institution
14 of higher education for the benefit of its enrolled students
15 and their dependents shall remain subject to the standards and
16 requirements for individual coverage.
17 (d) Under a policy or contract issued in the name of any
18 volunteer fire department, first aid, or other such volunteer
19 group, which shall be deemed the policyholder, covering all of
20 the members of such department or group.
21 (e) Under a policy or contract issued to a creditor, who
22 shall be deemed the policyholder, to insure debtors of the
23 creditors; Provided, however, that in the case of a loan which
24 is subject to the Small Loans Act, no insurance premium or
25 other cost shall be directly or indirectly charged or assessed
26 against, or collected or received from the borrower.
SB2836 - 12 - LRB103 35223 JAG 65205 b
SB2836- 13 -LRB103 35223 JAG 65205 b SB2836 - 13 - LRB103 35223 JAG 65205 b
SB2836 - 13 - LRB103 35223 JAG 65205 b
1 (f) Under a policy or contract issued to a sports team or
2 to a camp, which team or camp sponsor shall be deemed the
3 policyholder, covering members or campers.
4 (g) Under a policy or contract issued to any other
5 substantially similar group which, in the discretion of the
6 Director, may be subject to the issuance of a blanket accident
7 and health policy or contract.
8 (2) Any insurance company authorized to write accident and
9 health insurance in this state shall have the power to issue
10 blanket accident and health insurance. No such blanket policy
11 may be issued or delivered in this State unless a copy of the
12 form thereof shall have been filed in accordance with Section
13 355, and it contains in substance such of those provisions
14 contained in Sections 357.1 through 357.30 as may be
15 applicable to blanket accident and health insurance and the
16 following provisions:
17 (a) A provision that the policy and the application shall
18 constitute the entire contract between the parties, and that
19 all statements made by the policyholder shall, in absence of
20 fraud, be deemed representations and not warranties, and that
21 no such statements shall be used in defense to a claim under
22 the policy, unless it is contained in a written application.
23 (b) A provision that to the group or class thereof
24 originally insured shall be added from time to time all new
25 persons or individuals eligible for coverage.
26 (3) An individual application shall not be required from a
SB2836 - 13 - LRB103 35223 JAG 65205 b
SB2836- 14 -LRB103 35223 JAG 65205 b SB2836 - 14 - LRB103 35223 JAG 65205 b
SB2836 - 14 - LRB103 35223 JAG 65205 b
1 person covered under a blanket accident or health policy or
2 contract, nor shall it be necessary for the insurer to furnish
3 each person a certificate.
4 (4) All benefits under any blanket accident and health
5 policy shall be payable to the person insured, or to his
6 designated beneficiary or beneficiaries, or to his or her
7 estate, except that if the person insured be a minor or person
8 under legal disability, such benefits may be made payable to
9 his or her parent, guardian, or other person actually
10 supporting him or her. Provided further, however, that the
11 policy may provide that all or any portion of any indemnities
12 provided by any such policy on account of hospital, nursing,
13 medical or surgical services may, at the insurer's option, be
14 paid directly to the hospital or person rendering such
15 services; but the policy may not require that the service be
16 rendered by a particular hospital or person. Payment so made
17 shall discharge the insurer's obligation with respect to the
18 amount of insurance so paid.
19 (5) Nothing contained in this section shall be deemed to
20 affect the legal liability of policyholders for the death of
21 or injury to, any such member of such group.
22 (Source: P.A. 83-1362.)
23 (215 ILCS 5/368f)
24 Sec. 368f. Military service member insurance
25 reinstatement.
SB2836 - 14 - LRB103 35223 JAG 65205 b
SB2836- 15 -LRB103 35223 JAG 65205 b SB2836 - 15 - LRB103 35223 JAG 65205 b
SB2836 - 15 - LRB103 35223 JAG 65205 b
1 (a) No Illinois resident activated for military service
2 and no spouse or dependent of the resident who becomes
3 eligible for a federal government-sponsored health insurance
4 program, including the TriCare program providing coverage for
5 civilian dependents of military personnel, as a result of the
6 activation shall be denied reinstatement into the same
7 individual health insurance coverage with the health insurer
8 that the resident lapsed as a result of activation or becoming
9 covered by the federal government-sponsored health insurance
10 program. The resident shall have the right to reinstatement in
11 the same individual health insurance coverage without medical
12 underwriting, subject to payment of the current premium
13 charged to other persons of the same age and gender that are
14 covered under the same individual health coverage. Except in
15 the case of birth or adoption that occurs during the period of
16 activation, reinstatement must be into the same coverage type
17 as the resident held prior to lapsing the individual health
18 insurance coverage and at the same or, at the option of the
19 resident, higher deductible level. The reinstatement rights
20 provided under this subsection (a) are not available to a
21 resident or dependents if the activated person is discharged
22 from the military under other than honorable conditions.
23 (b) The health insurer with which the reinstatement is
24 being requested must receive a request for reinstatement no
25 later than 63 days following the later of (i) deactivation or
26 (ii) loss of coverage under the federal government-sponsored
SB2836 - 15 - LRB103 35223 JAG 65205 b
SB2836- 16 -LRB103 35223 JAG 65205 b SB2836 - 16 - LRB103 35223 JAG 65205 b
SB2836 - 16 - LRB103 35223 JAG 65205 b
1 health insurance program. The health insurer may request proof
2 of loss of coverage and the timing of the loss of coverage of
3 the government-sponsored coverage in order to determine
4 eligibility for reinstatement into the individual coverage.
5 The effective date of the reinstatement of individual health
6 coverage shall be the first of the month following receipt of
7 the notice requesting reinstatement.
8 (c) All insurers must provide written notice to the
9 policyholder of individual health coverage of the rights
10 described in subsection (a) of this Section. In lieu of the
11 inclusion of the notice in the individual health insurance
12 policy, an insurance company may satisfy the notification
13 requirement by providing a single written notice:
14 (1) in conjunction with the enrollment process for a
15 policyholder initially enrolling in the individual
16 coverage on or after the effective date of this amendatory
17 Act of the 94th General Assembly; or
18 (2) by mailing written notice to policyholders whose
19 coverage was effective prior to the effective date of this
20 amendatory Act of the 94th General Assembly no later than
21 90 days following the effective date of this amendatory
22 Act of the 94th General Assembly.
23 (d) The provisions of subsection (a) of this Section do
24 not apply to any policy or certificate providing coverage for
25 any specified disease, specified accident or accident-only
26 coverage, credit, dental, disability income, hospital
SB2836 - 16 - LRB103 35223 JAG 65205 b
SB2836- 17 -LRB103 35223 JAG 65205 b SB2836 - 17 - LRB103 35223 JAG 65205 b
SB2836 - 17 - LRB103 35223 JAG 65205 b
1 indemnity, long-term care, Medicare supplement, vision care,
2 or short-term travel nonrenewable health policy or other
3 limited-benefit supplemental insurance, or any coverage issued
4 as a supplement to any liability insurance, workers'
5 compensation or similar insurance, or any insurance under
6 which benefits are payable with or without regard to fault,
7 whether written on a group, blanket, or individual basis.
8 (e) Nothing in this Section shall require an insurer to
9 reinstate the resident if the insurer requires residency in an
10 enrollment area and those residency requirements are not met
11 after deactivation or loss of coverage under the
12 government-sponsored health insurance program.
13 (f) All terms, conditions, and limitations of the
14 individual coverage into which reinstatement is made apply
15 equally to all insureds enrolled in the coverage.
16 (g) The Secretary may adopt rules as may be necessary to
17 carry out the provisions of this Section.
18 (Source: P.A. 94-1037, eff. 7-20-06.)
19 Section 10. The Health Maintenance Organization Act is
20 amended by changing Section 5-3 as follows:
21 (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
22 Sec. 5-3. Insurance Code provisions.
23 (a) Health Maintenance Organizations shall be subject to
24 the provisions of Sections 133, 134, 136, 137, 139, 140,
SB2836 - 17 - LRB103 35223 JAG 65205 b
SB2836- 18 -LRB103 35223 JAG 65205 b SB2836 - 18 - LRB103 35223 JAG 65205 b
SB2836 - 18 - LRB103 35223 JAG 65205 b
1 141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153,
2 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 155.49,
3 352c, 355.2, 355.3, 355b, 355c, 356f, 356g.5-1, 356m, 356q,
4 356v, 356w, 356x, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5,
5 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13,
6 356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.20, 356z.21,
7 356z.22, 356z.23, 356z.24, 356z.25, 356z.26, 356z.28, 356z.29,
8 356z.30, 356z.30a, 356z.31, 356z.32, 356z.33, 356z.34,
9 356z.35, 356z.36, 356z.37, 356z.38, 356z.39, 356z.40, 356z.41,
10 356z.44, 356z.45, 356z.46, 356z.47, 356z.48, 356z.49, 356z.50,
11 356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.58,
12 356z.59, 356z.60, 356z.61, 356z.62, 356z.64, 356z.65, 356z.67,
13 356z.68, 364, 364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b,
14 368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A,
15 408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of
16 subsection (2) of Section 367, and Articles IIA, VIII 1/2,
17 XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the
18 Illinois Insurance Code.
19 (b) For purposes of the Illinois Insurance Code, except
20 for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
21 Health Maintenance Organizations in the following categories
22 are deemed to be "domestic companies":
23 (1) a corporation authorized under the Dental Service
24 Plan Act or the Voluntary Health Services Plans Act;
25 (2) a corporation organized under the laws of this
26 State; or
SB2836 - 18 - LRB103 35223 JAG 65205 b
SB2836- 19 -LRB103 35223 JAG 65205 b SB2836 - 19 - LRB103 35223 JAG 65205 b
SB2836 - 19 - LRB103 35223 JAG 65205 b
1 (3) a corporation organized under the laws of another
2 state, 30% or more of the enrollees of which are residents
3 of this State, except a corporation subject to
4 substantially the same requirements in its state of
5 organization as is a "domestic company" under Article VIII
6 1/2 of the Illinois Insurance Code.
7 (c) In considering the merger, consolidation, or other
8 acquisition of control of a Health Maintenance Organization
9 pursuant to Article VIII 1/2 of the Illinois Insurance Code,
10 (1) the Director shall give primary consideration to
11 the continuation of benefits to enrollees and the
12 financial conditions of the acquired Health Maintenance
13 Organization after the merger, consolidation, or other
14 acquisition of control takes effect;
15 (2)(i) the criteria specified in subsection (1)(b) of
16 Section 131.8 of the Illinois Insurance Code shall not
17 apply and (ii) the Director, in making his determination
18 with respect to the merger, consolidation, or other
19 acquisition of control, need not take into account the
20 effect on competition of the merger, consolidation, or
21 other acquisition of control;
22 (3) the Director shall have the power to require the
23 following information:
24 (A) certification by an independent actuary of the
25 adequacy of the reserves of the Health Maintenance
26 Organization sought to be acquired;
SB2836 - 19 - LRB103 35223 JAG 65205 b
SB2836- 20 -LRB103 35223 JAG 65205 b SB2836 - 20 - LRB103 35223 JAG 65205 b
SB2836 - 20 - LRB103 35223 JAG 65205 b
1 (B) pro forma financial statements reflecting the
2 combined balance sheets of the acquiring company and
3 the Health Maintenance Organization sought to be
4 acquired as of the end of the preceding year and as of
5 a date 90 days prior to the acquisition, as well as pro
6 forma financial statements reflecting projected
7 combined operation for a period of 2 years;
8 (C) a pro forma business plan detailing an
9 acquiring party's plans with respect to the operation
10 of the Health Maintenance Organization sought to be
11 acquired for a period of not less than 3 years; and
12 (D) such other information as the Director shall
13 require.
14 (d) The provisions of Article VIII 1/2 of the Illinois
15 Insurance Code and this Section 5-3 shall apply to the sale by
16 any health maintenance organization of greater than 10% of its
17 enrollee population (including, without limitation, the health
18 maintenance organization's right, title, and interest in and
19 to its health care certificates).
20 (e) In considering any management contract or service
21 agreement subject to Section 141.1 of the Illinois Insurance
22 Code, the Director (i) shall, in addition to the criteria
23 specified in Section 141.2 of the Illinois Insurance Code,
24 take into account the effect of the management contract or
25 service agreement on the continuation of benefits to enrollees
26 and the financial condition of the health maintenance
SB2836 - 20 - LRB103 35223 JAG 65205 b
SB2836- 21 -LRB103 35223 JAG 65205 b SB2836 - 21 - LRB103 35223 JAG 65205 b
SB2836 - 21 - LRB103 35223 JAG 65205 b
1 organization to be managed or serviced, and (ii) need not take
2 into account the effect of the management contract or service
3 agreement on competition.
4 (f) Except for small employer groups as defined in the
5 Small Employer Rating, Renewability and Portability Health
6 Insurance Act and except for medicare supplement policies as
7 defined in Section 363 of the Illinois Insurance Code, a
8 Health Maintenance Organization may by contract agree with a
9 group or other enrollment unit to effect refunds or charge
10 additional premiums under the following terms and conditions:
11 (i) the amount of, and other terms and conditions with
12 respect to, the refund or additional premium are set forth
13 in the group or enrollment unit contract agreed in advance
14 of the period for which a refund is to be paid or
15 additional premium is to be charged (which period shall
16 not be less than one year); and
17 (ii) the amount of the refund or additional premium
18 shall not exceed 20% of the Health Maintenance
19 Organization's profitable or unprofitable experience with
20 respect to the group or other enrollment unit for the
21 period (and, for purposes of a refund or additional
22 premium, the profitable or unprofitable experience shall
23 be calculated taking into account a pro rata share of the
24 Health Maintenance Organization's administrative and
25 marketing expenses, but shall not include any refund to be
26 made or additional premium to be paid pursuant to this
SB2836 - 21 - LRB103 35223 JAG 65205 b
SB2836- 22 -LRB103 35223 JAG 65205 b SB2836 - 22 - LRB103 35223 JAG 65205 b
SB2836 - 22 - LRB103 35223 JAG 65205 b
1 subsection (f)). The Health Maintenance Organization and
2 the group or enrollment unit may agree that the profitable
3 or unprofitable experience may be calculated taking into
4 account the refund period and the immediately preceding 2
5 plan years.
6 The Health Maintenance Organization shall include a
7 statement in the evidence of coverage issued to each enrollee
8 describing the possibility of a refund or additional premium,
9 and upon request of any group or enrollment unit, provide to
10 the group or enrollment unit a description of the method used
11 to calculate (1) the Health Maintenance Organization's
12 profitable experience with respect to the group or enrollment
13 unit and the resulting refund to the group or enrollment unit
14 or (2) the Health Maintenance Organization's unprofitable
15 experience with respect to the group or enrollment unit and
16 the resulting additional premium to be paid by the group or
17 enrollment unit.
18 In no event shall the Illinois Health Maintenance
19 Organization Guaranty Association be liable to pay any
20 contractual obligation of an insolvent organization to pay any
21 refund authorized under this Section.
22 (g) Rulemaking authority to implement Public Act 95-1045,
23 if any, is conditioned on the rules being adopted in
24 accordance with all provisions of the Illinois Administrative
25 Procedure Act and all rules and procedures of the Joint
26 Committee on Administrative Rules; any purported rule not so
SB2836 - 22 - LRB103 35223 JAG 65205 b
SB2836- 23 -LRB103 35223 JAG 65205 b SB2836 - 23 - LRB103 35223 JAG 65205 b
SB2836 - 23 - LRB103 35223 JAG 65205 b
1 adopted, for whatever reason, is unauthorized.
2 (Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
3 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
4 1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
5 eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
6 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
7 1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
8 eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;
9 103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.
10 6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
11 eff. 1-1-24; 103-551, eff. 8-11-23; revised 8-29-23.)
12 Section 15. The Limited Health Service Organization Act is
13 amended by changing Section 4003 as follows:
14 (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
15 Sec. 4003. Illinois Insurance Code provisions. Limited
16 health service organizations shall be subject to the
17 provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
18 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, 154,
19 154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 352c,
20 355.2, 355.3, 355b, 356q, 356v, 356z.4, 356z.4a, 356z.10,
21 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30a,
22 356z.32, 356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53,
23 356z.54, 356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68,
24 364.3, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, 409, 412,
SB2836 - 23 - LRB103 35223 JAG 65205 b
SB2836- 24 -LRB103 35223 JAG 65205 b SB2836 - 24 - LRB103 35223 JAG 65205 b
SB2836 - 24 - LRB103 35223 JAG 65205 b
1 444, and 444.1 and Articles IIA, VIII 1/2, XII, XII 1/2, XIII,
2 XIII 1/2, XXV, and XXVI of the Illinois Insurance Code.
3 Nothing in this Section shall require a limited health care
4 plan to cover any service that is not a limited health service.
5 For purposes of the Illinois Insurance Code, except for
6 Sections 444 and 444.1 and Articles XIII and XIII 1/2, limited
7 health service organizations in the following categories are
8 deemed to be domestic companies:
9 (1) a corporation under the laws of this State; or
10 (2) a corporation organized under the laws of another
11 state, 30% or more of the enrollees of which are residents
12 of this State, except a corporation subject to
13 substantially the same requirements in its state of
14 organization as is a domestic company under Article VIII
15 1/2 of the Illinois Insurance Code.
16 (Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
17 102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-731, eff.
18 1-1-23; 102-775, eff. 5-13-22; 102-813, eff. 5-13-22; 102-816,
19 eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
20 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
21 1-1-24; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
22 eff. 1-1-24; revised 8-29-23.)
23 (215 ILCS 190/Act rep.)
24 Section 20. The Short-Term, Limited-Duration Health
25 Insurance Coverage Act is repealed.
SB2836 - 24 - LRB103 35223 JAG 65205 b
SB2836- 25 -LRB103 35223 JAG 65205 b SB2836 - 25 - LRB103 35223 JAG 65205 b
SB2836 - 25 - LRB103 35223 JAG 65205 b
1 Section 95. No acceleration or delay. Where this Act makes
2 changes in a statute that is represented in this Act by text
3 that is not yet or no longer in effect (for example, a Section
4 represented by multiple versions), the use of that text does
5 not accelerate or delay the taking effect of (i) the changes
6 made by this Act or (ii) provisions derived from any other
7 Public Act.
SB2836 - 25 - LRB103 35223 JAG 65205 b