IL
Illinois House Bill HB1141

Illinois 2025-2026 Regular Session

Illinois House Bill HB1141 Compare Versions

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1-HB1141 EngrossedLRB104 05570 BAB 15600 b HB1141 Engrossed LRB104 05570 BAB 15600 b
2- HB1141 Engrossed LRB104 05570 BAB 15600 b
1+104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB1141 Introduced , by Rep. William E Hauter SYNOPSIS AS INTRODUCED: 5 ILCS 375/6.1155 ILCS 5/5-1069.365 ILCS 5/10-4-2.3105 ILCS 5/10-22.3f215 ILCS 5/356z.80 new215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2215 ILCS 130/4003 from Ch. 73, par. 1504-3215 ILCS 165/10 from Ch. 32, par. 604305 ILCS 5/5-16.8 Amends the Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance or managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2026 shall provide coverage for medically necessary general anesthesia, regardless of the duration, for any procedure covered by the policy, and that medical necessity shall be determined by the attending anesthesiologist or licensed anesthesia provider. Provides that an individual or group policy of accident and health insurance is prohibited from denying payment or reimbursement for anesthesia services solely because the duration of care exceeded a preset time limit. Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, the Limited Health Service Organization Act, the Voluntary Services Plans Act, and the Illinois Public Aid Code to require coverage under those provisions. Effective immediately. LRB104 05570 BAB 15600 b A BILL FOR 104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB1141 Introduced , by Rep. William E Hauter SYNOPSIS AS INTRODUCED: 5 ILCS 375/6.1155 ILCS 5/5-1069.365 ILCS 5/10-4-2.3105 ILCS 5/10-22.3f215 ILCS 5/356z.80 new215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2215 ILCS 130/4003 from Ch. 73, par. 1504-3215 ILCS 165/10 from Ch. 32, par. 604305 ILCS 5/5-16.8 5 ILCS 375/6.11 55 ILCS 5/5-1069.3 65 ILCS 5/10-4-2.3 105 ILCS 5/10-22.3f 215 ILCS 5/356z.80 new 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 165/10 from Ch. 32, par. 604 305 ILCS 5/5-16.8 Amends the Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance or managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2026 shall provide coverage for medically necessary general anesthesia, regardless of the duration, for any procedure covered by the policy, and that medical necessity shall be determined by the attending anesthesiologist or licensed anesthesia provider. Provides that an individual or group policy of accident and health insurance is prohibited from denying payment or reimbursement for anesthesia services solely because the duration of care exceeded a preset time limit. Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, the Limited Health Service Organization Act, the Voluntary Services Plans Act, and the Illinois Public Aid Code to require coverage under those provisions. Effective immediately. LRB104 05570 BAB 15600 b LRB104 05570 BAB 15600 b A BILL FOR
2+104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB1141 Introduced , by Rep. William E Hauter SYNOPSIS AS INTRODUCED:
3+5 ILCS 375/6.1155 ILCS 5/5-1069.365 ILCS 5/10-4-2.3105 ILCS 5/10-22.3f215 ILCS 5/356z.80 new215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2215 ILCS 130/4003 from Ch. 73, par. 1504-3215 ILCS 165/10 from Ch. 32, par. 604305 ILCS 5/5-16.8 5 ILCS 375/6.11 55 ILCS 5/5-1069.3 65 ILCS 5/10-4-2.3 105 ILCS 5/10-22.3f 215 ILCS 5/356z.80 new 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 165/10 from Ch. 32, par. 604 305 ILCS 5/5-16.8
4+5 ILCS 375/6.11
5+55 ILCS 5/5-1069.3
6+65 ILCS 5/10-4-2.3
7+105 ILCS 5/10-22.3f
8+215 ILCS 5/356z.80 new
9+215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2
10+215 ILCS 130/4003 from Ch. 73, par. 1504-3
11+215 ILCS 165/10 from Ch. 32, par. 604
12+305 ILCS 5/5-16.8
13+Amends the Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance or managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2026 shall provide coverage for medically necessary general anesthesia, regardless of the duration, for any procedure covered by the policy, and that medical necessity shall be determined by the attending anesthesiologist or licensed anesthesia provider. Provides that an individual or group policy of accident and health insurance is prohibited from denying payment or reimbursement for anesthesia services solely because the duration of care exceeded a preset time limit. Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, the Limited Health Service Organization Act, the Voluntary Services Plans Act, and the Illinois Public Aid Code to require coverage under those provisions. Effective immediately.
14+LRB104 05570 BAB 15600 b LRB104 05570 BAB 15600 b
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16+A BILL FOR
17+HB1141LRB104 05570 BAB 15600 b HB1141 LRB104 05570 BAB 15600 b
18+ HB1141 LRB104 05570 BAB 15600 b
319 1 AN ACT concerning regulation.
420 2 Be it enacted by the People of the State of Illinois,
521 3 represented in the General Assembly:
622 4 Section 5. The State Employees Group Insurance Act of 1971
723 5 is amended by changing Section 6.11 as follows:
824 6 (5 ILCS 375/6.11)
925 7 Sec. 6.11. Required health benefits; Illinois Insurance
1026 8 Code requirements. The program of health benefits shall
1127 9 provide the post-mastectomy care benefits required to be
1228 10 covered by a policy of accident and health insurance under
1329 11 Section 356t of the Illinois Insurance Code. The program of
1430 12 health benefits shall provide the coverage required under
1531 13 Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10,
1632 14 356w, 356x, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8,
1733 15 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
1834 16 356z.17, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32,
1935 17 356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
2036 18 356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59,
2137 19 356z.60, 356z.61, 356z.62, 356z.64, 356z.67, 356z.68, and
2238 20 356z.70, and 356z.71, 356z.74, 356z.76, 356z.77, and 356z.80
2339 21 of the Illinois Insurance Code. The program of health benefits
2440 22 must comply with Sections 155.22a, 155.37, 355b, 356z.19,
2541 23 370c, and 370c.1 and Article XXXIIB of the Illinois Insurance
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45+104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB1141 Introduced , by Rep. William E Hauter SYNOPSIS AS INTRODUCED:
46+5 ILCS 375/6.1155 ILCS 5/5-1069.365 ILCS 5/10-4-2.3105 ILCS 5/10-22.3f215 ILCS 5/356z.80 new215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2215 ILCS 130/4003 from Ch. 73, par. 1504-3215 ILCS 165/10 from Ch. 32, par. 604305 ILCS 5/5-16.8 5 ILCS 375/6.11 55 ILCS 5/5-1069.3 65 ILCS 5/10-4-2.3 105 ILCS 5/10-22.3f 215 ILCS 5/356z.80 new 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 165/10 from Ch. 32, par. 604 305 ILCS 5/5-16.8
47+5 ILCS 375/6.11
48+55 ILCS 5/5-1069.3
49+65 ILCS 5/10-4-2.3
50+105 ILCS 5/10-22.3f
51+215 ILCS 5/356z.80 new
52+215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2
53+215 ILCS 130/4003 from Ch. 73, par. 1504-3
54+215 ILCS 165/10 from Ch. 32, par. 604
55+305 ILCS 5/5-16.8
56+Amends the Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance or managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2026 shall provide coverage for medically necessary general anesthesia, regardless of the duration, for any procedure covered by the policy, and that medical necessity shall be determined by the attending anesthesiologist or licensed anesthesia provider. Provides that an individual or group policy of accident and health insurance is prohibited from denying payment or reimbursement for anesthesia services solely because the duration of care exceeded a preset time limit. Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, the Limited Health Service Organization Act, the Voluntary Services Plans Act, and the Illinois Public Aid Code to require coverage under those provisions. Effective immediately.
57+LRB104 05570 BAB 15600 b LRB104 05570 BAB 15600 b
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59+A BILL FOR
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65+5 ILCS 375/6.11
66+55 ILCS 5/5-1069.3
67+65 ILCS 5/10-4-2.3
68+105 ILCS 5/10-22.3f
69+215 ILCS 5/356z.80 new
70+215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2
71+215 ILCS 130/4003 from Ch. 73, par. 1504-3
72+215 ILCS 165/10 from Ch. 32, par. 604
73+305 ILCS 5/5-16.8
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3492 1 Code. The program of health benefits shall provide the
3593 2 coverage required under Section 356m of the Illinois Insurance
3694 3 Code and, for the employees of the State Employee Group
3795 4 Insurance Program only, the coverage as also provided in
3896 5 Section 6.11B of this Act. The Department of Insurance shall
3997 6 enforce the requirements of this Section with respect to
4098 7 Sections 370c and 370c.1 of the Illinois Insurance Code; all
4199 8 other requirements of this Section shall be enforced by the
42100 9 Department of Central Management Services.
43101 10 Rulemaking authority to implement Public Act 95-1045, if
44102 11 any, is conditioned on the rules being adopted in accordance
45103 12 with all provisions of the Illinois Administrative Procedure
46104 13 Act and all rules and procedures of the Joint Committee on
47105 14 Administrative Rules; any purported rule not so adopted, for
48106 15 whatever reason, is unauthorized.
49107 16 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
50108 17 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
51109 18 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-768,
52110 19 eff. 1-1-24; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
53111 20 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
54112 21 1-1-23; 102-1117, eff. 1-13-23; 103-8, eff. 1-1-24; 103-84,
55113 22 eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, eff. 1-1-24;
56114 23 103-445, eff. 1-1-24; 103-535, eff. 8-11-23; 103-551, eff.
57115 24 8-11-23; 103-605, eff. 7-1-24; 103-718, eff. 7-19-24; 103-751,
58116 25 eff. 8-2-24; 103-870, eff. 1-1-25; 103-914, eff. 1-1-25;
59117 26 103-918, eff. 1-1-25; 103-951, eff. 1-1-25; 103-1024, eff.
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70128 1 1-1-25; revised 11-26-24.)
71129 2 Section 10. The Counties Code is amended by changing
72130 3 Section 5-1069.3 as follows:
73131 4 (55 ILCS 5/5-1069.3)
74132 5 Sec. 5-1069.3. Required health benefits. If a county,
75133 6 including a home rule county, is a self-insurer for purposes
76134 7 of providing health insurance coverage for its employees, the
77135 8 coverage shall include coverage for the post-mastectomy care
78136 9 benefits required to be covered by a policy of accident and
79137 10 health insurance under Section 356t and the coverage required
80138 11 under Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u,
81139 12 356u.10, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9,
82140 13 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
83141 14 356z.25, 356z.26, 356z.29, 356z.30, 356z.32, 356z.33, 356z.36,
84142 15 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51,
85143 16 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, 356z.61,
86144 17 356z.62, 356z.64, 356z.67, 356z.68, and 356z.70, and 356z.71,
87145 18 356z.74, 356z.77, and 356z.80 of the Illinois Insurance Code.
88146 19 The coverage shall comply with Sections 155.22a, 355b,
89147 20 356z.19, and 370c of the Illinois Insurance Code. The
90148 21 Department of Insurance shall enforce the requirements of this
91149 22 Section. The requirement that health benefits be covered as
92150 23 provided in this Section is an exclusive power and function of
93151 24 the State and is a denial and limitation under Article VII,
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104162 1 Section 6, subsection (h) of the Illinois Constitution. A home
105163 2 rule county to which this Section applies must comply with
106164 3 every provision of this Section.
107165 4 Rulemaking authority to implement Public Act 95-1045, if
108166 5 any, is conditioned on the rules being adopted in accordance
109167 6 with all provisions of the Illinois Administrative Procedure
110168 7 Act and all rules and procedures of the Joint Committee on
111169 8 Administrative Rules; any purported rule not so adopted, for
112170 9 whatever reason, is unauthorized.
113171 10 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
114172 11 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
115173 12 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
116174 13 eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
117175 14 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
118176 15 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
119177 16 eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
120178 17 103-535, eff. 8-11-23; 103-551, eff. 8-11-23; 103-605, eff.
121179 18 7-1-24; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-914,
122180 19 eff. 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25;
123181 20 revised 11-26-24.)
124182 21 Section 15. The Illinois Municipal Code is amended by
125183 22 changing Section 10-4-2.3 as follows:
126184 23 (65 ILCS 5/10-4-2.3)
127185 24 Sec. 10-4-2.3. Required health benefits. If a
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138196 1 municipality, including a home rule municipality, is a
139197 2 self-insurer for purposes of providing health insurance
140198 3 coverage for its employees, the coverage shall include
141199 4 coverage for the post-mastectomy care benefits required to be
142200 5 covered by a policy of accident and health insurance under
143201 6 Section 356t and the coverage required under Sections 356g,
144202 7 356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10, 356w, 356x,
145203 8 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11,
146204 9 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26,
147205 10 356z.29, 356z.30, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
148206 11 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
149207 12 356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64,
150208 13 356z.67, 356z.68, and 356z.70, and 356z.71, 356z.74, 356z.77,
151209 14 and 356z.80 of the Illinois Insurance Code. The coverage shall
152210 15 comply with Sections 155.22a, 355b, 356z.19, and 370c of the
153211 16 Illinois Insurance Code. The Department of Insurance shall
154212 17 enforce the requirements of this Section. The requirement that
155213 18 health benefits be covered as provided in this is an exclusive
156214 19 power and function of the State and is a denial and limitation
157215 20 under Article VII, Section 6, subsection (h) of the Illinois
158216 21 Constitution. A home rule municipality to which this Section
159217 22 applies must comply with every provision of this Section.
160218 23 Rulemaking authority to implement Public Act 95-1045, if
161219 24 any, is conditioned on the rules being adopted in accordance
162220 25 with all provisions of the Illinois Administrative Procedure
163221 26 Act and all rules and procedures of the Joint Committee on
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174232 1 Administrative Rules; any purported rule not so adopted, for
175233 2 whatever reason, is unauthorized.
176234 3 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
177235 4 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
178236 5 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
179237 6 eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
180238 7 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
181239 8 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
182240 9 eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
183241 10 103-535, eff. 8-11-23; 103-551, eff. 8-11-23; 103-605, eff.
184242 11 7-1-24; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-914,
185243 12 eff. 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25;
186244 13 revised 11-26-24.)
187245 14 Section 20. The School Code is amended by changing Section
188246 15 10-22.3f as follows:
189247 16 (105 ILCS 5/10-22.3f)
190248 17 Sec. 10-22.3f. Required health benefits. Insurance
191249 18 protection and benefits for employees shall provide the
192250 19 post-mastectomy care benefits required to be covered by a
193251 20 policy of accident and health insurance under Section 356t and
194252 21 the coverage required under Sections 356g, 356g.5, 356g.5-1,
195253 22 356m, 356q, 356u, 356u.10, 356w, 356x, 356z.4, 356z.4a,
196254 23 356z.6, 356z.8, 356z.9, 356z.11, 356z.12, 356z.13, 356z.14,
197255 24 356z.15, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32,
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208266 1 356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
209267 2 356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60,
210268 3 356z.61, 356z.62, 356z.64, 356z.67, 356z.68, and 356z.70, and
211269 4 356z.71, 356z.74, 356z.77, and 356z.80 of the Illinois
212270 5 Insurance Code. Insurance policies shall comply with Section
213271 6 356z.19 of the Illinois Insurance Code. The coverage shall
214272 7 comply with Sections 155.22a, 355b, and 370c of the Illinois
215273 8 Insurance Code. The Department of Insurance shall enforce the
216274 9 requirements of this Section.
217275 10 Rulemaking authority to implement Public Act 95-1045, if
218276 11 any, is conditioned on the rules being adopted in accordance
219277 12 with all provisions of the Illinois Administrative Procedure
220278 13 Act and all rules and procedures of the Joint Committee on
221279 14 Administrative Rules; any purported rule not so adopted, for
222280 15 whatever reason, is unauthorized.
223281 16 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
224282 17 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
225283 18 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804,
226284 19 eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
227285 20 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff.
228286 21 1-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420,
229287 22 eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. 8-11-23;
230288 23 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-718, eff.
231289 24 7-19-24; 103-751, eff. 8-2-24; 103-914, eff. 1-1-25; 103-918,
232290 25 eff. 1-1-25; 103-1024, eff. 1-1-25; revised 11-26-24.)
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242- HB1141 Engrossed - 8 - LRB104 05570 BAB 15600 b
299+HB1141- 8 -LRB104 05570 BAB 15600 b HB1141 - 8 - LRB104 05570 BAB 15600 b
300+ HB1141 - 8 - LRB104 05570 BAB 15600 b
243301 1 Section 22. The Illinois Insurance Code is amended by
244302 2 adding Section 356z.80 as follows:
245303 3 (215 ILCS 5/356z.80 new)
246-4 Sec. 356z.80. Coverage for anesthesia services.
304+4 Sec. 356z.80. Coverage for general anesthesia.
247305 5 (a) A group or individual policy of accident and health
248306 6 insurance or a managed care plan that is amended, delivered,
249307 7 issued, or renewed on or after January 1, 2026 shall provide
250-8 coverage for medically necessary anesthesia services,
308+8 coverage for medically necessary general anesthesia,
251309 9 regardless of the duration, for any procedure covered by the
252-10 policy.
253-11 (b) An individual or group policy of accident and health
254-12 insurance is prohibited from denying payment or reimbursement
255-13 for anesthesia services solely because the duration of care
256-14 exceeded a preset time limit.
257-15 Section 25. The Health Maintenance Organization Act is
258-16 amended by changing Section 5-3 as follows:
259-17 (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
260-18 (Text of Section before amendment by P.A. 103-808)
310+10 policy. Medical necessity shall be determined by the attending
311+11 anesthesiologist or licensed anesthesia provider.
312+12 (b) An individual or group policy of accident and health
313+13 insurance is prohibited from denying payment or reimbursement
314+14 for anesthesia services solely because the duration of care
315+15 exceeded a preset time limit.
316+16 Section 25. The Health Maintenance Organization Act is
317+17 amended by changing Section 5-3 as follows:
318+18 (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
319+19 (Text of Section before amendment by P.A. 103-808)
320+20 Sec. 5-3. Insurance Code provisions.
321+21 (a) Health Maintenance Organizations shall be subject to
322+22 the provisions of Sections 133, 134, 136, 137, 139, 140,
323+23 141.1, 141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151,
324+
325+
326+
327+
328+
329+ HB1141 - 8 - LRB104 05570 BAB 15600 b
330+
331+
332+HB1141- 9 -LRB104 05570 BAB 15600 b HB1141 - 9 - LRB104 05570 BAB 15600 b
333+ HB1141 - 9 - LRB104 05570 BAB 15600 b
334+1 152, 153, 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a,
335+2 155.49, 352c, 355.2, 355.3, 355.6, 355b, 355c, 356f, 356g.5-1,
336+3 356m, 356q, 356u.10, 356v, 356w, 356x, 356z.2, 356z.3a,
337+4 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10,
338+5 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.18,
339+6 356z.19, 356z.20, 356z.21, 356z.22, 356z.23, 356z.24, 356z.25,
340+7 356z.26, 356z.28, 356z.29, 356z.30, 356z.31, 356z.32, 356z.33,
341+8 356z.34, 356z.35, 356z.36, 356z.37, 356z.38, 356z.39, 356z.40,
342+9 356z.40a, 356z.41, 356z.44, 356z.45, 356z.46, 356z.47,
343+10 356z.48, 356z.49, 356z.50, 356z.51, 356z.53, 356z.54, 356z.55,
344+11 356z.56, 356z.57, 356z.58, 356z.59, 356z.60, 356z.61, 356z.62,
345+12 356z.63, 356z.64, 356z.65, 356z.66, 356z.67, 356z.68, 356z.69,
346+13 356z.70, 356z.71, 356z.72, 356z.73, 356z.74, 356z.75, 356z.77,
347+14 356z.80, 364, 364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b,
348+15 368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A,
349+16 408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of
350+17 subsection (2) of Section 367, and Articles IIA, VIII 1/2,
351+18 XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the
352+19 Illinois Insurance Code.
353+20 (b) For purposes of the Illinois Insurance Code, except
354+21 for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
355+22 Health Maintenance Organizations in the following categories
356+23 are deemed to be "domestic companies":
357+24 (1) a corporation authorized under the Dental Service
358+25 Plan Act or the Voluntary Health Services Plans Act;
359+26 (2) a corporation organized under the laws of this
360+
361+
362+
363+
364+
365+ HB1141 - 9 - LRB104 05570 BAB 15600 b
366+
367+
368+HB1141- 10 -LRB104 05570 BAB 15600 b HB1141 - 10 - LRB104 05570 BAB 15600 b
369+ HB1141 - 10 - LRB104 05570 BAB 15600 b
370+1 State; or
371+2 (3) a corporation organized under the laws of another
372+3 state, 30% or more of the enrollees of which are residents
373+4 of this State, except a corporation subject to
374+5 substantially the same requirements in its state of
375+6 organization as is a "domestic company" under Article VIII
376+7 1/2 of the Illinois Insurance Code.
377+8 (c) In considering the merger, consolidation, or other
378+9 acquisition of control of a Health Maintenance Organization
379+10 pursuant to Article VIII 1/2 of the Illinois Insurance Code,
380+11 (1) the Director shall give primary consideration to
381+12 the continuation of benefits to enrollees and the
382+13 financial conditions of the acquired Health Maintenance
383+14 Organization after the merger, consolidation, or other
384+15 acquisition of control takes effect;
385+16 (2)(i) the criteria specified in subsection (1)(b) of
386+17 Section 131.8 of the Illinois Insurance Code shall not
387+18 apply and (ii) the Director, in making his determination
388+19 with respect to the merger, consolidation, or other
389+20 acquisition of control, need not take into account the
390+21 effect on competition of the merger, consolidation, or
391+22 other acquisition of control;
392+23 (3) the Director shall have the power to require the
393+24 following information:
394+25 (A) certification by an independent actuary of the
395+26 adequacy of the reserves of the Health Maintenance
396+
397+
398+
399+
400+
401+ HB1141 - 10 - LRB104 05570 BAB 15600 b
402+
403+
404+HB1141- 11 -LRB104 05570 BAB 15600 b HB1141 - 11 - LRB104 05570 BAB 15600 b
405+ HB1141 - 11 - LRB104 05570 BAB 15600 b
406+1 Organization sought to be acquired;
407+2 (B) pro forma financial statements reflecting the
408+3 combined balance sheets of the acquiring company and
409+4 the Health Maintenance Organization sought to be
410+5 acquired as of the end of the preceding year and as of
411+6 a date 90 days prior to the acquisition, as well as pro
412+7 forma financial statements reflecting projected
413+8 combined operation for a period of 2 years;
414+9 (C) a pro forma business plan detailing an
415+10 acquiring party's plans with respect to the operation
416+11 of the Health Maintenance Organization sought to be
417+12 acquired for a period of not less than 3 years; and
418+13 (D) such other information as the Director shall
419+14 require.
420+15 (d) The provisions of Article VIII 1/2 of the Illinois
421+16 Insurance Code and this Section 5-3 shall apply to the sale by
422+17 any health maintenance organization of greater than 10% of its
423+18 enrollee population (including, without limitation, the health
424+19 maintenance organization's right, title, and interest in and
425+20 to its health care certificates).
426+21 (e) In considering any management contract or service
427+22 agreement subject to Section 141.1 of the Illinois Insurance
428+23 Code, the Director (i) shall, in addition to the criteria
429+24 specified in Section 141.2 of the Illinois Insurance Code,
430+25 take into account the effect of the management contract or
431+26 service agreement on the continuation of benefits to enrollees
432+
433+
434+
435+
436+
437+ HB1141 - 11 - LRB104 05570 BAB 15600 b
438+
439+
440+HB1141- 12 -LRB104 05570 BAB 15600 b HB1141 - 12 - LRB104 05570 BAB 15600 b
441+ HB1141 - 12 - LRB104 05570 BAB 15600 b
442+1 and the financial condition of the health maintenance
443+2 organization to be managed or serviced, and (ii) need not take
444+3 into account the effect of the management contract or service
445+4 agreement on competition.
446+5 (f) Except for small employer groups as defined in the
447+6 Small Employer Rating, Renewability and Portability Health
448+7 Insurance Act and except for medicare supplement policies as
449+8 defined in Section 363 of the Illinois Insurance Code, a
450+9 Health Maintenance Organization may by contract agree with a
451+10 group or other enrollment unit to effect refunds or charge
452+11 additional premiums under the following terms and conditions:
453+12 (i) the amount of, and other terms and conditions with
454+13 respect to, the refund or additional premium are set forth
455+14 in the group or enrollment unit contract agreed in advance
456+15 of the period for which a refund is to be paid or
457+16 additional premium is to be charged (which period shall
458+17 not be less than one year); and
459+18 (ii) the amount of the refund or additional premium
460+19 shall not exceed 20% of the Health Maintenance
461+20 Organization's profitable or unprofitable experience with
462+21 respect to the group or other enrollment unit for the
463+22 period (and, for purposes of a refund or additional
464+23 premium, the profitable or unprofitable experience shall
465+24 be calculated taking into account a pro rata share of the
466+25 Health Maintenance Organization's administrative and
467+26 marketing expenses, but shall not include any refund to be
468+
469+
470+
471+
472+
473+ HB1141 - 12 - LRB104 05570 BAB 15600 b
474+
475+
476+HB1141- 13 -LRB104 05570 BAB 15600 b HB1141 - 13 - LRB104 05570 BAB 15600 b
477+ HB1141 - 13 - LRB104 05570 BAB 15600 b
478+1 made or additional premium to be paid pursuant to this
479+2 subsection (f)). The Health Maintenance Organization and
480+3 the group or enrollment unit may agree that the profitable
481+4 or unprofitable experience may be calculated taking into
482+5 account the refund period and the immediately preceding 2
483+6 plan years.
484+7 The Health Maintenance Organization shall include a
485+8 statement in the evidence of coverage issued to each enrollee
486+9 describing the possibility of a refund or additional premium,
487+10 and upon request of any group or enrollment unit, provide to
488+11 the group or enrollment unit a description of the method used
489+12 to calculate (1) the Health Maintenance Organization's
490+13 profitable experience with respect to the group or enrollment
491+14 unit and the resulting refund to the group or enrollment unit
492+15 or (2) the Health Maintenance Organization's unprofitable
493+16 experience with respect to the group or enrollment unit and
494+17 the resulting additional premium to be paid by the group or
495+18 enrollment unit.
496+19 In no event shall the Illinois Health Maintenance
497+20 Organization Guaranty Association be liable to pay any
498+21 contractual obligation of an insolvent organization to pay any
499+22 refund authorized under this Section.
500+23 (g) Rulemaking authority to implement Public Act 95-1045,
501+24 if any, is conditioned on the rules being adopted in
502+25 accordance with all provisions of the Illinois Administrative
503+26 Procedure Act and all rules and procedures of the Joint
504+
505+
506+
507+
508+
509+ HB1141 - 13 - LRB104 05570 BAB 15600 b
510+
511+
512+HB1141- 14 -LRB104 05570 BAB 15600 b HB1141 - 14 - LRB104 05570 BAB 15600 b
513+ HB1141 - 14 - LRB104 05570 BAB 15600 b
514+1 Committee on Administrative Rules; any purported rule not so
515+2 adopted, for whatever reason, is unauthorized.
516+3 (Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
517+4 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
518+5 1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
519+6 eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
520+7 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
521+8 1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
522+9 eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;
523+10 103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.
524+11 6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
525+12 eff. 1-1-24; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24;
526+13 103-618, eff. 1-1-25; 103-649, eff. 1-1-25; 103-656, eff.
527+14 1-1-25; 103-700, eff. 1-1-25; 103-718, eff. 7-19-24; 103-751,
528+15 eff. 8-2-24; 103-753, eff. 8-2-24; 103-758, eff. 1-1-25;
529+16 103-777, eff. 8-2-24; 103-914, eff. 1-1-25; 103-918, eff.
530+17 1-1-25; 103-1024, eff. 1-1-25; revised 9-26-24.)
531+18 (Text of Section after amendment by P.A. 103-808)
261532 19 Sec. 5-3. Insurance Code provisions.
262533 20 (a) Health Maintenance Organizations shall be subject to
263534 21 the provisions of Sections 133, 134, 136, 137, 139, 140,
264535 22 141.1, 141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151,
265536 23 152, 153, 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a,
537+24 155.49, 352c, 355.2, 355.3, 355.6, 355b, 355c, 356f, 356g,
538+25 356g.5-1, 356m, 356q, 356u.10, 356v, 356w, 356x, 356z.2,
266539
267540
268541
269542
270543
271- HB1141 Engrossed - 8 - LRB104 05570 BAB 15600 b
544+ HB1141 - 14 - LRB104 05570 BAB 15600 b
272545
273546
274-HB1141 Engrossed- 9 -LRB104 05570 BAB 15600 b HB1141 Engrossed - 9 - LRB104 05570 BAB 15600 b
275- HB1141 Engrossed - 9 - LRB104 05570 BAB 15600 b
276-1 155.49, 352c, 355.2, 355.3, 355.6, 355b, 355c, 356f, 356g.5-1,
277-2 356m, 356q, 356u.10, 356v, 356w, 356x, 356z.2, 356z.3a,
278-3 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10,
279-4 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.18,
280-5 356z.19, 356z.20, 356z.21, 356z.22, 356z.23, 356z.24, 356z.25,
281-6 356z.26, 356z.28, 356z.29, 356z.30, 356z.31, 356z.32, 356z.33,
282-7 356z.34, 356z.35, 356z.36, 356z.37, 356z.38, 356z.39, 356z.40,
283-8 356z.40a, 356z.41, 356z.44, 356z.45, 356z.46, 356z.47,
284-9 356z.48, 356z.49, 356z.50, 356z.51, 356z.53, 356z.54, 356z.55,
285-10 356z.56, 356z.57, 356z.58, 356z.59, 356z.60, 356z.61, 356z.62,
286-11 356z.63, 356z.64, 356z.65, 356z.66, 356z.67, 356z.68, 356z.69,
287-12 356z.70, 356z.71, 356z.72, 356z.73, 356z.74, 356z.75, 356z.77,
288-13 356z.80, 364, 364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b,
289-14 368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A,
290-15 408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of
291-16 subsection (2) of Section 367, and Articles IIA, VIII 1/2,
292-17 XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the
293-18 Illinois Insurance Code. Section 365z.80 of the Illinois
294-19 Insurance Code is not applicable to health care plans under
295-20 contract with the Department of Healthcare and Family
296-21 Services.
297-22 (b) For purposes of the Illinois Insurance Code, except
298-23 for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
299-24 Health Maintenance Organizations in the following categories
300-25 are deemed to be "domestic companies":
301-26 (1) a corporation authorized under the Dental Service
547+HB1141- 15 -LRB104 05570 BAB 15600 b HB1141 - 15 - LRB104 05570 BAB 15600 b
548+ HB1141 - 15 - LRB104 05570 BAB 15600 b
549+1 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9,
550+2 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17,
551+3 356z.18, 356z.19, 356z.20, 356z.21, 356z.22, 356z.23, 356z.24,
552+4 356z.25, 356z.26, 356z.28, 356z.29, 356z.30, 356z.31, 356z.32,
553+5 356z.33, 356z.34, 356z.35, 356z.36, 356z.37, 356z.38, 356z.39,
554+6 356z.40, 356z.40a, 356z.41, 356z.44, 356z.45, 356z.46,
555+7 356z.47, 356z.48, 356z.49, 356z.50, 356z.51, 356z.53, 356z.54,
556+8 356z.55, 356z.56, 356z.57, 356z.58, 356z.59, 356z.60, 356z.61,
557+9 356z.62, 356z.63, 356z.64, 356z.65, 356z.66, 356z.67, 356z.68,
558+10 356z.69, 356z.70, 356z.71, 356z.72, 356z.73, 356z.74, 356z.75,
559+11 356z.77, 356z.80, 364, 364.01, 364.3, 367.2, 367.2-5, 367i,
560+12 368a, 368b, 368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402,
561+13 403, 403A, 408, 408.2, 409, 412, 444, and 444.1, paragraph (c)
562+14 of subsection (2) of Section 367, and Articles IIA, VIII 1/2,
563+15 XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the
564+16 Illinois Insurance Code.
565+17 (b) For purposes of the Illinois Insurance Code, except
566+18 for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
567+19 Health Maintenance Organizations in the following categories
568+20 are deemed to be "domestic companies":
569+21 (1) a corporation authorized under the Dental Service
570+22 Plan Act or the Voluntary Health Services Plans Act;
571+23 (2) a corporation organized under the laws of this
572+24 State; or
573+25 (3) a corporation organized under the laws of another
574+26 state, 30% or more of the enrollees of which are residents
302575
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310-HB1141 Engrossed- 10 -LRB104 05570 BAB 15600 b HB1141 Engrossed - 10 - LRB104 05570 BAB 15600 b
311- HB1141 Engrossed - 10 - LRB104 05570 BAB 15600 b
312-1 Plan Act or the Voluntary Health Services Plans Act;
313-2 (2) a corporation organized under the laws of this
314-3 State; or
315-4 (3) a corporation organized under the laws of another
316-5 state, 30% or more of the enrollees of which are residents
317-6 of this State, except a corporation subject to
318-7 substantially the same requirements in its state of
319-8 organization as is a "domestic company" under Article VIII
320-9 1/2 of the Illinois Insurance Code.
321-10 (c) In considering the merger, consolidation, or other
322-11 acquisition of control of a Health Maintenance Organization
323-12 pursuant to Article VIII 1/2 of the Illinois Insurance Code,
324-13 (1) the Director shall give primary consideration to
325-14 the continuation of benefits to enrollees and the
326-15 financial conditions of the acquired Health Maintenance
327-16 Organization after the merger, consolidation, or other
328-17 acquisition of control takes effect;
329-18 (2)(i) the criteria specified in subsection (1)(b) of
330-19 Section 131.8 of the Illinois Insurance Code shall not
331-20 apply and (ii) the Director, in making his determination
332-21 with respect to the merger, consolidation, or other
333-22 acquisition of control, need not take into account the
334-23 effect on competition of the merger, consolidation, or
335-24 other acquisition of control;
336-25 (3) the Director shall have the power to require the
337-26 following information:
583+HB1141- 16 -LRB104 05570 BAB 15600 b HB1141 - 16 - LRB104 05570 BAB 15600 b
584+ HB1141 - 16 - LRB104 05570 BAB 15600 b
585+1 of this State, except a corporation subject to
586+2 substantially the same requirements in its state of
587+3 organization as is a "domestic company" under Article VIII
588+4 1/2 of the Illinois Insurance Code.
589+5 (c) In considering the merger, consolidation, or other
590+6 acquisition of control of a Health Maintenance Organization
591+7 pursuant to Article VIII 1/2 of the Illinois Insurance Code,
592+8 (1) the Director shall give primary consideration to
593+9 the continuation of benefits to enrollees and the
594+10 financial conditions of the acquired Health Maintenance
595+11 Organization after the merger, consolidation, or other
596+12 acquisition of control takes effect;
597+13 (2)(i) the criteria specified in subsection (1)(b) of
598+14 Section 131.8 of the Illinois Insurance Code shall not
599+15 apply and (ii) the Director, in making his determination
600+16 with respect to the merger, consolidation, or other
601+17 acquisition of control, need not take into account the
602+18 effect on competition of the merger, consolidation, or
603+19 other acquisition of control;
604+20 (3) the Director shall have the power to require the
605+21 following information:
606+22 (A) certification by an independent actuary of the
607+23 adequacy of the reserves of the Health Maintenance
608+24 Organization sought to be acquired;
609+25 (B) pro forma financial statements reflecting the
610+26 combined balance sheets of the acquiring company and
338611
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347- HB1141 Engrossed - 11 - LRB104 05570 BAB 15600 b
348-1 (A) certification by an independent actuary of the
349-2 adequacy of the reserves of the Health Maintenance
350-3 Organization sought to be acquired;
351-4 (B) pro forma financial statements reflecting the
352-5 combined balance sheets of the acquiring company and
353-6 the Health Maintenance Organization sought to be
354-7 acquired as of the end of the preceding year and as of
355-8 a date 90 days prior to the acquisition, as well as pro
356-9 forma financial statements reflecting projected
357-10 combined operation for a period of 2 years;
358-11 (C) a pro forma business plan detailing an
359-12 acquiring party's plans with respect to the operation
360-13 of the Health Maintenance Organization sought to be
361-14 acquired for a period of not less than 3 years; and
362-15 (D) such other information as the Director shall
363-16 require.
364-17 (d) The provisions of Article VIII 1/2 of the Illinois
365-18 Insurance Code and this Section 5-3 shall apply to the sale by
366-19 any health maintenance organization of greater than 10% of its
367-20 enrollee population (including, without limitation, the health
368-21 maintenance organization's right, title, and interest in and
369-22 to its health care certificates).
370-23 (e) In considering any management contract or service
371-24 agreement subject to Section 141.1 of the Illinois Insurance
372-25 Code, the Director (i) shall, in addition to the criteria
373-26 specified in Section 141.2 of the Illinois Insurance Code,
619+HB1141- 17 -LRB104 05570 BAB 15600 b HB1141 - 17 - LRB104 05570 BAB 15600 b
620+ HB1141 - 17 - LRB104 05570 BAB 15600 b
621+1 the Health Maintenance Organization sought to be
622+2 acquired as of the end of the preceding year and as of
623+3 a date 90 days prior to the acquisition, as well as pro
624+4 forma financial statements reflecting projected
625+5 combined operation for a period of 2 years;
626+6 (C) a pro forma business plan detailing an
627+7 acquiring party's plans with respect to the operation
628+8 of the Health Maintenance Organization sought to be
629+9 acquired for a period of not less than 3 years; and
630+10 (D) such other information as the Director shall
631+11 require.
632+12 (d) The provisions of Article VIII 1/2 of the Illinois
633+13 Insurance Code and this Section 5-3 shall apply to the sale by
634+14 any health maintenance organization of greater than 10% of its
635+15 enrollee population (including, without limitation, the health
636+16 maintenance organization's right, title, and interest in and
637+17 to its health care certificates).
638+18 (e) In considering any management contract or service
639+19 agreement subject to Section 141.1 of the Illinois Insurance
640+20 Code, the Director (i) shall, in addition to the criteria
641+21 specified in Section 141.2 of the Illinois Insurance Code,
642+22 take into account the effect of the management contract or
643+23 service agreement on the continuation of benefits to enrollees
644+24 and the financial condition of the health maintenance
645+25 organization to be managed or serviced, and (ii) need not take
646+26 into account the effect of the management contract or service
374647
375648
376649
377650
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379- HB1141 Engrossed - 11 - LRB104 05570 BAB 15600 b
652+ HB1141 - 17 - LRB104 05570 BAB 15600 b
380653
381654
382-HB1141 Engrossed- 12 -LRB104 05570 BAB 15600 b HB1141 Engrossed - 12 - LRB104 05570 BAB 15600 b
383- HB1141 Engrossed - 12 - LRB104 05570 BAB 15600 b
384-1 take into account the effect of the management contract or
385-2 service agreement on the continuation of benefits to enrollees
386-3 and the financial condition of the health maintenance
387-4 organization to be managed or serviced, and (ii) need not take
388-5 into account the effect of the management contract or service
389-6 agreement on competition.
390-7 (f) Except for small employer groups as defined in the
391-8 Small Employer Rating, Renewability and Portability Health
392-9 Insurance Act and except for medicare supplement policies as
393-10 defined in Section 363 of the Illinois Insurance Code, a
394-11 Health Maintenance Organization may by contract agree with a
395-12 group or other enrollment unit to effect refunds or charge
396-13 additional premiums under the following terms and conditions:
397-14 (i) the amount of, and other terms and conditions with
398-15 respect to, the refund or additional premium are set forth
399-16 in the group or enrollment unit contract agreed in advance
400-17 of the period for which a refund is to be paid or
401-18 additional premium is to be charged (which period shall
402-19 not be less than one year); and
403-20 (ii) the amount of the refund or additional premium
404-21 shall not exceed 20% of the Health Maintenance
405-22 Organization's profitable or unprofitable experience with
406-23 respect to the group or other enrollment unit for the
407-24 period (and, for purposes of a refund or additional
408-25 premium, the profitable or unprofitable experience shall
409-26 be calculated taking into account a pro rata share of the
655+HB1141- 18 -LRB104 05570 BAB 15600 b HB1141 - 18 - LRB104 05570 BAB 15600 b
656+ HB1141 - 18 - LRB104 05570 BAB 15600 b
657+1 agreement on competition.
658+2 (f) Except for small employer groups as defined in the
659+3 Small Employer Rating, Renewability and Portability Health
660+4 Insurance Act and except for medicare supplement policies as
661+5 defined in Section 363 of the Illinois Insurance Code, a
662+6 Health Maintenance Organization may by contract agree with a
663+7 group or other enrollment unit to effect refunds or charge
664+8 additional premiums under the following terms and conditions:
665+9 (i) the amount of, and other terms and conditions with
666+10 respect to, the refund or additional premium are set forth
667+11 in the group or enrollment unit contract agreed in advance
668+12 of the period for which a refund is to be paid or
669+13 additional premium is to be charged (which period shall
670+14 not be less than one year); and
671+15 (ii) the amount of the refund or additional premium
672+16 shall not exceed 20% of the Health Maintenance
673+17 Organization's profitable or unprofitable experience with
674+18 respect to the group or other enrollment unit for the
675+19 period (and, for purposes of a refund or additional
676+20 premium, the profitable or unprofitable experience shall
677+21 be calculated taking into account a pro rata share of the
678+22 Health Maintenance Organization's administrative and
679+23 marketing expenses, but shall not include any refund to be
680+24 made or additional premium to be paid pursuant to this
681+25 subsection (f)). The Health Maintenance Organization and
682+26 the group or enrollment unit may agree that the profitable
410683
411684
412685
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414687
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688+ HB1141 - 18 - LRB104 05570 BAB 15600 b
416689
417690
418-HB1141 Engrossed- 13 -LRB104 05570 BAB 15600 b HB1141 Engrossed - 13 - LRB104 05570 BAB 15600 b
419- HB1141 Engrossed - 13 - LRB104 05570 BAB 15600 b
420-1 Health Maintenance Organization's administrative and
421-2 marketing expenses, but shall not include any refund to be
422-3 made or additional premium to be paid pursuant to this
423-4 subsection (f)). The Health Maintenance Organization and
424-5 the group or enrollment unit may agree that the profitable
425-6 or unprofitable experience may be calculated taking into
426-7 account the refund period and the immediately preceding 2
427-8 plan years.
428-9 The Health Maintenance Organization shall include a
429-10 statement in the evidence of coverage issued to each enrollee
430-11 describing the possibility of a refund or additional premium,
431-12 and upon request of any group or enrollment unit, provide to
432-13 the group or enrollment unit a description of the method used
433-14 to calculate (1) the Health Maintenance Organization's
434-15 profitable experience with respect to the group or enrollment
435-16 unit and the resulting refund to the group or enrollment unit
436-17 or (2) the Health Maintenance Organization's unprofitable
437-18 experience with respect to the group or enrollment unit and
438-19 the resulting additional premium to be paid by the group or
439-20 enrollment unit.
440-21 In no event shall the Illinois Health Maintenance
441-22 Organization Guaranty Association be liable to pay any
442-23 contractual obligation of an insolvent organization to pay any
443-24 refund authorized under this Section.
444-25 (g) Rulemaking authority to implement Public Act 95-1045,
445-26 if any, is conditioned on the rules being adopted in
691+HB1141- 19 -LRB104 05570 BAB 15600 b HB1141 - 19 - LRB104 05570 BAB 15600 b
692+ HB1141 - 19 - LRB104 05570 BAB 15600 b
693+1 or unprofitable experience may be calculated taking into
694+2 account the refund period and the immediately preceding 2
695+3 plan years.
696+4 The Health Maintenance Organization shall include a
697+5 statement in the evidence of coverage issued to each enrollee
698+6 describing the possibility of a refund or additional premium,
699+7 and upon request of any group or enrollment unit, provide to
700+8 the group or enrollment unit a description of the method used
701+9 to calculate (1) the Health Maintenance Organization's
702+10 profitable experience with respect to the group or enrollment
703+11 unit and the resulting refund to the group or enrollment unit
704+12 or (2) the Health Maintenance Organization's unprofitable
705+13 experience with respect to the group or enrollment unit and
706+14 the resulting additional premium to be paid by the group or
707+15 enrollment unit.
708+16 In no event shall the Illinois Health Maintenance
709+17 Organization Guaranty Association be liable to pay any
710+18 contractual obligation of an insolvent organization to pay any
711+19 refund authorized under this Section.
712+20 (g) Rulemaking authority to implement Public Act 95-1045,
713+21 if any, is conditioned on the rules being adopted in
714+22 accordance with all provisions of the Illinois Administrative
715+23 Procedure Act and all rules and procedures of the Joint
716+24 Committee on Administrative Rules; any purported rule not so
717+25 adopted, for whatever reason, is unauthorized.
718+26 (Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
446719
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448721
449722
450723
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724+ HB1141 - 19 - LRB104 05570 BAB 15600 b
452725
453726
454-HB1141 Engrossed- 14 -LRB104 05570 BAB 15600 b HB1141 Engrossed - 14 - LRB104 05570 BAB 15600 b
455- HB1141 Engrossed - 14 - LRB104 05570 BAB 15600 b
456-1 accordance with all provisions of the Illinois Administrative
457-2 Procedure Act and all rules and procedures of the Joint
458-3 Committee on Administrative Rules; any purported rule not so
459-4 adopted, for whatever reason, is unauthorized.
460-5 (Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
461-6 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
462-7 1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
463-8 eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
464-9 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
465-10 1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
466-11 eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;
467-12 103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.
468-13 6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
469-14 eff. 1-1-24; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24;
470-15 103-618, eff. 1-1-25; 103-649, eff. 1-1-25; 103-656, eff.
471-16 1-1-25; 103-700, eff. 1-1-25; 103-718, eff. 7-19-24; 103-751,
472-17 eff. 8-2-24; 103-753, eff. 8-2-24; 103-758, eff. 1-1-25;
473-18 103-777, eff. 8-2-24; 103-914, eff. 1-1-25; 103-918, eff.
474-19 1-1-25; 103-1024, eff. 1-1-25; revised 9-26-24.)
475-20 (Text of Section after amendment by P.A. 103-808)
476-21 Sec. 5-3. Insurance Code provisions.
477-22 (a) Health Maintenance Organizations shall be subject to
478-23 the provisions of Sections 133, 134, 136, 137, 139, 140,
479-24 141.1, 141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151,
480-25 152, 153, 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a,
727+HB1141- 20 -LRB104 05570 BAB 15600 b HB1141 - 20 - LRB104 05570 BAB 15600 b
728+ HB1141 - 20 - LRB104 05570 BAB 15600 b
729+1 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
730+2 1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
731+3 eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
732+4 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
733+5 1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
734+6 eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;
735+7 103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.
736+8 6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
737+9 eff. 1-1-24; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24;
738+10 103-618, eff. 1-1-25; 103-649, eff. 1-1-25; 103-656, eff.
739+11 1-1-25; 103-700, eff. 1-1-25; 103-718, eff. 7-19-24; 103-751,
740+12 eff. 8-2-24; 103-753, eff. 8-2-24; 103-758, eff. 1-1-25;
741+13 103-777, eff. 8-2-24; 103-808, eff. 1-1-26; 103-914, eff.
742+14 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; revised
743+15 11-26-24.)
744+16 Section 30. The Limited Health Service Organization Act is
745+17 amended by changing Section 4003 as follows:
746+18 (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
747+19 Sec. 4003. Illinois Insurance Code provisions. Limited
748+20 health service organizations shall be subject to the
749+21 provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
750+22 141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151, 152, 153,
751+23 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 352c,
752+24 355.2, 355.3, 355b, 355d, 356m, 356q, 356v, 356z.4, 356z.4a,
481753
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483755
484756
485757
486- HB1141 Engrossed - 14 - LRB104 05570 BAB 15600 b
758+ HB1141 - 20 - LRB104 05570 BAB 15600 b
487759
488760
489-HB1141 Engrossed- 15 -LRB104 05570 BAB 15600 b HB1141 Engrossed - 15 - LRB104 05570 BAB 15600 b
490- HB1141 Engrossed - 15 - LRB104 05570 BAB 15600 b
491-1 155.49, 352c, 355.2, 355.3, 355.6, 355b, 355c, 356f, 356g,
492-2 356g.5-1, 356m, 356q, 356u.10, 356v, 356w, 356x, 356z.2,
493-3 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9,
494-4 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17,
495-5 356z.18, 356z.19, 356z.20, 356z.21, 356z.22, 356z.23, 356z.24,
496-6 356z.25, 356z.26, 356z.28, 356z.29, 356z.30, 356z.31, 356z.32,
497-7 356z.33, 356z.34, 356z.35, 356z.36, 356z.37, 356z.38, 356z.39,
498-8 356z.40, 356z.40a, 356z.41, 356z.44, 356z.45, 356z.46,
499-9 356z.47, 356z.48, 356z.49, 356z.50, 356z.51, 356z.53, 356z.54,
500-10 356z.55, 356z.56, 356z.57, 356z.58, 356z.59, 356z.60, 356z.61,
501-11 356z.62, 356z.63, 356z.64, 356z.65, 356z.66, 356z.67, 356z.68,
502-12 356z.69, 356z.70, 356z.71, 356z.72, 356z.73, 356z.74, 356z.75,
503-13 356z.77, 356z.80, 364, 364.01, 364.3, 367.2, 367.2-5, 367i,
504-14 368a, 368b, 368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402,
505-15 403, 403A, 408, 408.2, 409, 412, 444, and 444.1, paragraph (c)
506-16 of subsection (2) of Section 367, and Articles IIA, VIII 1/2,
507-17 XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the
508-18 Illinois Insurance Code.
509-19 (b) For purposes of the Illinois Insurance Code, except
510-20 for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
511-21 Health Maintenance Organizations in the following categories
512-22 are deemed to be "domestic companies":
513-23 (1) a corporation authorized under the Dental Service
514-24 Plan Act or the Voluntary Health Services Plans Act;
515-25 (2) a corporation organized under the laws of this
516-26 State; or
761+HB1141- 21 -LRB104 05570 BAB 15600 b HB1141 - 21 - LRB104 05570 BAB 15600 b
762+ HB1141 - 21 - LRB104 05570 BAB 15600 b
763+1 356z.10, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.32,
764+2 356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
765+3 356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68, 356z.71,
766+4 356z.73, 356z.74, 356z.75, 356z.80, 364.3, 368a, 401, 401.1,
767+5 402, 403, 403A, 408, 408.2, 409, 412, 444, and 444.1 and
768+6 Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and
769+7 XXVI of the Illinois Insurance Code. Nothing in this Section
770+8 shall require a limited health care plan to cover any service
771+9 that is not a limited health service. For purposes of the
772+10 Illinois Insurance Code, except for Sections 444 and 444.1 and
773+11 Articles XIII and XIII 1/2, limited health service
774+12 organizations in the following categories are deemed to be
775+13 domestic companies:
776+14 (1) a corporation under the laws of this State; or
777+15 (2) a corporation organized under the laws of another
778+16 state, 30% or more of the enrollees of which are residents
779+17 of this State, except a corporation subject to
780+18 substantially the same requirements in its state of
781+19 organization as is a domestic company under Article VIII
782+20 1/2 of the Illinois Insurance Code.
783+21 (Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
784+22 102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-731, eff.
785+23 1-1-23; 102-775, eff. 5-13-22; 102-813, eff. 5-13-22; 102-816,
786+24 eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
787+25 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
788+26 1-1-24; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
517789
518790
519791
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794+ HB1141 - 21 - LRB104 05570 BAB 15600 b
523795
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525-HB1141 Engrossed- 16 -LRB104 05570 BAB 15600 b HB1141 Engrossed - 16 - LRB104 05570 BAB 15600 b
526- HB1141 Engrossed - 16 - LRB104 05570 BAB 15600 b
527-1 (3) a corporation organized under the laws of another
528-2 state, 30% or more of the enrollees of which are residents
529-3 of this State, except a corporation subject to
530-4 substantially the same requirements in its state of
531-5 organization as is a "domestic company" under Article VIII
532-6 1/2 of the Illinois Insurance Code.
533-7 (c) In considering the merger, consolidation, or other
534-8 acquisition of control of a Health Maintenance Organization
535-9 pursuant to Article VIII 1/2 of the Illinois Insurance Code,
536-10 (1) the Director shall give primary consideration to
537-11 the continuation of benefits to enrollees and the
538-12 financial conditions of the acquired Health Maintenance
539-13 Organization after the merger, consolidation, or other
540-14 acquisition of control takes effect;
541-15 (2)(i) the criteria specified in subsection (1)(b) of
542-16 Section 131.8 of the Illinois Insurance Code shall not
543-17 apply and (ii) the Director, in making his determination
544-18 with respect to the merger, consolidation, or other
545-19 acquisition of control, need not take into account the
546-20 effect on competition of the merger, consolidation, or
547-21 other acquisition of control;
548-22 (3) the Director shall have the power to require the
549-23 following information:
550-24 (A) certification by an independent actuary of the
551-25 adequacy of the reserves of the Health Maintenance
552-26 Organization sought to be acquired;
797+HB1141- 22 -LRB104 05570 BAB 15600 b HB1141 - 22 - LRB104 05570 BAB 15600 b
798+ HB1141 - 22 - LRB104 05570 BAB 15600 b
799+1 eff. 1-1-24; 103-605, eff. 7-1-24; 103-649, eff. 1-1-25;
800+2 103-656, eff. 1-1-25; 103-700, eff. 1-1-25; 103-718, eff.
801+3 7-19-24; 103-751, eff. 8-2-24; 103-758, eff. 1-1-25; 103-832,
802+4 eff. 1-1-25; 103-1024, eff. 1-1-25; revised 11-26-24.)
803+5 Section 35. The Voluntary Health Services Plans Act is
804+6 amended by changing Section 10 as follows:
805+7 (215 ILCS 165/10) (from Ch. 32, par. 604)
806+8 Sec. 10. Application of Insurance Code provisions. Health
807+9 services plan corporations and all persons interested therein
808+10 or dealing therewith shall be subject to the provisions of
809+11 Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
810+12 143, 143.31, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3,
811+13 355b, 355d, 356g, 356g.5, 356g.5-1, 356m, 356q, 356r, 356t,
812+14 356u, 356u.10, 356v, 356w, 356x, 356y, 356z.1, 356z.2,
813+15 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9,
814+16 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18,
815+17 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30,
816+18 356z.32, 356z.32a, 356z.33, 356z.40, 356z.41, 356z.46,
817+19 356z.47, 356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59,
818+20 356z.60, 356z.61, 356z.62, 356z.64, 356z.67, 356z.68, 356z.71,
819+21 356z.72, 356z.74, 356z.75, 356z.77, 356z.80, 364.01, 364.3,
820+22 367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412,
821+23 and paragraphs (7) and (15) of Section 367 of the Illinois
822+24 Insurance Code.
553823
554824
555825
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828+ HB1141 - 22 - LRB104 05570 BAB 15600 b
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562- HB1141 Engrossed - 17 - LRB104 05570 BAB 15600 b
563-1 (B) pro forma financial statements reflecting the
564-2 combined balance sheets of the acquiring company and
565-3 the Health Maintenance Organization sought to be
566-4 acquired as of the end of the preceding year and as of
567-5 a date 90 days prior to the acquisition, as well as pro
568-6 forma financial statements reflecting projected
569-7 combined operation for a period of 2 years;
570-8 (C) a pro forma business plan detailing an
571-9 acquiring party's plans with respect to the operation
572-10 of the Health Maintenance Organization sought to be
573-11 acquired for a period of not less than 3 years; and
574-12 (D) such other information as the Director shall
575-13 require.
576-14 (d) The provisions of Article VIII 1/2 of the Illinois
577-15 Insurance Code and this Section 5-3 shall apply to the sale by
578-16 any health maintenance organization of greater than 10% of its
579-17 enrollee population (including, without limitation, the health
580-18 maintenance organization's right, title, and interest in and
581-19 to its health care certificates).
582-20 (e) In considering any management contract or service
583-21 agreement subject to Section 141.1 of the Illinois Insurance
584-22 Code, the Director (i) shall, in addition to the criteria
585-23 specified in Section 141.2 of the Illinois Insurance Code,
586-24 take into account the effect of the management contract or
587-25 service agreement on the continuation of benefits to enrollees
588-26 and the financial condition of the health maintenance
831+HB1141- 23 -LRB104 05570 BAB 15600 b HB1141 - 23 - LRB104 05570 BAB 15600 b
832+ HB1141 - 23 - LRB104 05570 BAB 15600 b
833+1 Rulemaking authority to implement Public Act 95-1045, if
834+2 any, is conditioned on the rules being adopted in accordance
835+3 with all provisions of the Illinois Administrative Procedure
836+4 Act and all rules and procedures of the Joint Committee on
837+5 Administrative Rules; any purported rule not so adopted, for
838+6 whatever reason, is unauthorized.
839+7 (Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
840+8 102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff.
841+9 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804,
842+10 eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
843+11 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff.
844+12 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
845+13 eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
846+14 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-656, eff.
847+15 1-1-25; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-753,
848+16 eff. 8-2-24; 103-758, eff. 1-1-25; 103-832, eff. 1-1-25;
849+17 103-914, eff. 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff.
850+18 1-1-25; revised 11-26-24.)
851+19 Section 40. The Illinois Public Aid Code is amended by
852+20 changing Section 5-16.8 as follows:
853+21 (305 ILCS 5/5-16.8)
854+22 Sec. 5-16.8. Required health benefits. The medical
855+23 assistance program shall (i) provide the post-mastectomy care
856+24 benefits required to be covered by a policy of accident and
589857
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862+ HB1141 - 23 - LRB104 05570 BAB 15600 b
595863
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597-HB1141 Engrossed- 18 -LRB104 05570 BAB 15600 b HB1141 Engrossed - 18 - LRB104 05570 BAB 15600 b
598- HB1141 Engrossed - 18 - LRB104 05570 BAB 15600 b
599-1 organization to be managed or serviced, and (ii) need not take
600-2 into account the effect of the management contract or service
601-3 agreement on competition.
602-4 (f) Except for small employer groups as defined in the
603-5 Small Employer Rating, Renewability and Portability Health
604-6 Insurance Act and except for medicare supplement policies as
605-7 defined in Section 363 of the Illinois Insurance Code, a
606-8 Health Maintenance Organization may by contract agree with a
607-9 group or other enrollment unit to effect refunds or charge
608-10 additional premiums under the following terms and conditions:
609-11 (i) the amount of, and other terms and conditions with
610-12 respect to, the refund or additional premium are set forth
611-13 in the group or enrollment unit contract agreed in advance
612-14 of the period for which a refund is to be paid or
613-15 additional premium is to be charged (which period shall
614-16 not be less than one year); and
615-17 (ii) the amount of the refund or additional premium
616-18 shall not exceed 20% of the Health Maintenance
617-19 Organization's profitable or unprofitable experience with
618-20 respect to the group or other enrollment unit for the
619-21 period (and, for purposes of a refund or additional
620-22 premium, the profitable or unprofitable experience shall
621-23 be calculated taking into account a pro rata share of the
622-24 Health Maintenance Organization's administrative and
623-25 marketing expenses, but shall not include any refund to be
624-26 made or additional premium to be paid pursuant to this
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867+1 health insurance under Section 356t and the coverage required
868+2 under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6,
869+3 356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,
870+4 356z.47, 356z.51, 356z.53, 356z.59, 356z.60, 356z.61, 356z.64,
871+5 and 356z.67, and 356z.71, 356z.75, and 356z.80 of the Illinois
872+6 Insurance Code, (ii) be subject to the provisions of Sections
873+7 356z.19, 356z.44, 356z.49, 364.01, 370c, and 370c.1 of the
874+8 Illinois Insurance Code, and (iii) be subject to the
875+9 provisions of subsection (d-5) of Section 10 of the Network
876+10 Adequacy and Transparency Act.
877+11 The Department, by rule, shall adopt a model similar to
878+12 the requirements of Section 356z.39 of the Illinois Insurance
879+13 Code.
880+14 On and after July 1, 2012, the Department shall reduce any
881+15 rate of reimbursement for services or other payments or alter
882+16 any methodologies authorized by this Code to reduce any rate
883+17 of reimbursement for services or other payments in accordance
884+18 with Section 5-5e.
885+19 To ensure full access to the benefits set forth in this
886+20 Section, on and after January 1, 2016, the Department shall
887+21 ensure that provider and hospital reimbursement for
888+22 post-mastectomy care benefits required under this Section are
889+23 no lower than the Medicare reimbursement rate.
890+24 (Source: P.A. 102-30, eff. 1-1-22; 102-144, eff. 1-1-22;
891+25 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-530, eff.
892+26 1-1-22; 102-642, eff. 1-1-22; 102-804, eff. 1-1-23; 102-813,
625893
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635-1 subsection (f)). The Health Maintenance Organization and
636-2 the group or enrollment unit may agree that the profitable
637-3 or unprofitable experience may be calculated taking into
638-4 account the refund period and the immediately preceding 2
639-5 plan years.
640-6 The Health Maintenance Organization shall include a
641-7 statement in the evidence of coverage issued to each enrollee
642-8 describing the possibility of a refund or additional premium,
643-9 and upon request of any group or enrollment unit, provide to
644-10 the group or enrollment unit a description of the method used
645-11 to calculate (1) the Health Maintenance Organization's
646-12 profitable experience with respect to the group or enrollment
647-13 unit and the resulting refund to the group or enrollment unit
648-14 or (2) the Health Maintenance Organization's unprofitable
649-15 experience with respect to the group or enrollment unit and
650-16 the resulting additional premium to be paid by the group or
651-17 enrollment unit.
652-18 In no event shall the Illinois Health Maintenance
653-19 Organization Guaranty Association be liable to pay any
654-20 contractual obligation of an insolvent organization to pay any
655-21 refund authorized under this Section.
656-22 (g) Rulemaking authority to implement Public Act 95-1045,
657-23 if any, is conditioned on the rules being adopted in
658-24 accordance with all provisions of the Illinois Administrative
659-25 Procedure Act and all rules and procedures of the Joint
660-26 Committee on Administrative Rules; any purported rule not so
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902+ HB1141 - 25 - LRB104 05570 BAB 15600 b
903+1 eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093, eff. 1-1-23;
904+2 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
905+3 1-1-24; 103-420, eff. 1-1-24; 103-605, eff. 7-1-24; 103-703,
906+4 eff. 1-1-25; 103-758, eff. 1-1-25; 103-1024, eff. 1-1-25;
907+5 revised 11-26-24.)
908+6 Section 95. No acceleration or delay. Where this Act makes
909+7 changes in a statute that is represented in this Act by text
910+8 that is not yet or no longer in effect (for example, a Section
911+9 represented by multiple versions), the use of that text does
912+10 not accelerate or delay the taking effect of (i) the changes
913+11 made by this Act or (ii) provisions derived from any other
914+12 Public Act.
661915
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671-1 adopted, for whatever reason, is unauthorized.
672-2 (Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
673-3 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
674-4 1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
675-5 eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
676-6 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
677-7 1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
678-8 eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;
679-9 103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.
680-10 6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
681-11 eff. 1-1-24; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24;
682-12 103-618, eff. 1-1-25; 103-649, eff. 1-1-25; 103-656, eff.
683-13 1-1-25; 103-700, eff. 1-1-25; 103-718, eff. 7-19-24; 103-751,
684-14 eff. 8-2-24; 103-753, eff. 8-2-24; 103-758, eff. 1-1-25;
685-15 103-777, eff. 8-2-24; 103-808, eff. 1-1-26; 103-914, eff.
686-16 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; revised
687-17 11-26-24.)
688-18 Section 30. The Limited Health Service Organization Act is
689-19 amended by changing Section 4003 as follows:
690-20 (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
691-21 Sec. 4003. Illinois Insurance Code provisions. Limited
692-22 health service organizations shall be subject to the
693-23 provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
694-24 141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151, 152, 153,
695-
696-
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705-1 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 352c,
706-2 355.2, 355.3, 355b, 355d, 356m, 356q, 356v, 356z.4, 356z.4a,
707-3 356z.10, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.32,
708-4 356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
709-5 356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68, 356z.71,
710-6 356z.73, 356z.74, 356z.75, 356z.80, 364.3, 368a, 401, 401.1,
711-7 402, 403, 403A, 408, 408.2, 409, 412, 444, and 444.1 and
712-8 Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and
713-9 XXVI of the Illinois Insurance Code. Nothing in this Section
714-10 shall require a limited health care plan to cover any service
715-11 that is not a limited health service. For purposes of the
716-12 Illinois Insurance Code, except for Sections 444 and 444.1 and
717-13 Articles XIII and XIII 1/2, limited health service
718-14 organizations in the following categories are deemed to be
719-15 domestic companies:
720-16 (1) a corporation under the laws of this State; or
721-17 (2) a corporation organized under the laws of another
722-18 state, 30% or more of the enrollees of which are residents
723-19 of this State, except a corporation subject to
724-20 substantially the same requirements in its state of
725-21 organization as is a domestic company under Article VIII
726-22 1/2 of the Illinois Insurance Code.
727-23 (Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
728-24 102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-731, eff.
729-25 1-1-23; 102-775, eff. 5-13-22; 102-813, eff. 5-13-22; 102-816,
730-26 eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
731-
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741-1 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
742-2 1-1-24; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
743-3 eff. 1-1-24; 103-605, eff. 7-1-24; 103-649, eff. 1-1-25;
744-4 103-656, eff. 1-1-25; 103-700, eff. 1-1-25; 103-718, eff.
745-5 7-19-24; 103-751, eff. 8-2-24; 103-758, eff. 1-1-25; 103-832,
746-6 eff. 1-1-25; 103-1024, eff. 1-1-25; revised 11-26-24.)
747-7 Section 35. The Voluntary Health Services Plans Act is
748-8 amended by changing Section 10 as follows:
749-9 (215 ILCS 165/10) (from Ch. 32, par. 604)
750-10 Sec. 10. Application of Insurance Code provisions. Health
751-11 services plan corporations and all persons interested therein
752-12 or dealing therewith shall be subject to the provisions of
753-13 Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
754-14 143, 143.31, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3,
755-15 355b, 355d, 356g, 356g.5, 356g.5-1, 356m, 356q, 356r, 356t,
756-16 356u, 356u.10, 356v, 356w, 356x, 356y, 356z.1, 356z.2,
757-17 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9,
758-18 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18,
759-19 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30,
760-20 356z.32, 356z.32a, 356z.33, 356z.40, 356z.41, 356z.46,
761-21 356z.47, 356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59,
762-22 356z.60, 356z.61, 356z.62, 356z.64, 356z.67, 356z.68, 356z.71,
763-23 356z.72, 356z.74, 356z.75, 356z.77, 356z.80, 364.01, 364.3,
764-24 367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412,
765-
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775-1 and paragraphs (7) and (15) of Section 367 of the Illinois
776-2 Insurance Code.
777-3 Rulemaking authority to implement Public Act 95-1045, if
778-4 any, is conditioned on the rules being adopted in accordance
779-5 with all provisions of the Illinois Administrative Procedure
780-6 Act and all rules and procedures of the Joint Committee on
781-7 Administrative Rules; any purported rule not so adopted, for
782-8 whatever reason, is unauthorized.
783-9 (Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
784-10 102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff.
785-11 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804,
786-12 eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
787-13 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff.
788-14 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
789-15 eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
790-16 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-656, eff.
791-17 1-1-25; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-753,
792-18 eff. 8-2-24; 103-758, eff. 1-1-25; 103-832, eff. 1-1-25;
793-19 103-914, eff. 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff.
794-20 1-1-25; revised 11-26-24.)
795-21 Section 95. No acceleration or delay. Where this Act makes
796-22 changes in a statute that is represented in this Act by text
797-23 that is not yet or no longer in effect (for example, a Section
798-24 represented by multiple versions), the use of that text does
799-25 not accelerate or delay the taking effect of (i) the changes
800-
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810-1 made by this Act or (ii) provisions derived from any other
811-2 Public Act.
812-3 Section 99. Effective date. This Act takes effect upon
813-4 becoming law.
814-
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