Illinois 2025-2026 Regular Session

Illinois House Bill HB2371 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	HB2371 EngrossedLRB104 06098 BAB 16131 b HB2371 Engrossed LRB104 06098 BAB 16131 b
2		-	HB2371 Engrossed LRB104 06098 BAB 16131 b
	1	+	104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB2371 Introduced , by Rep. Nicolle Grasse SYNOPSIS AS INTRODUCED: 215 ILCS 5/370a from Ch. 73, par. 982a Amends the Illinois Insurance Code. Provides that no provision of the Illinois Insurance Code, or any other law, prohibits assignability rights to an insured under any policy of dental insurance (in addition to accident and health insurance). Provides that if an enrollee or insured of an insurer, health maintenance organization, managed care plan, health care plan, preferred provider organization, dental service plan corporation, dental insurer, or third party administrator assigns a claim to a health care professional, or health care facility, a dental care provider, or a dental care facility, then payment shall be made directly to the health care professional, or health care facility, dental care provider, or dental care facility, including any required interest. Effective immediately. LRB104 06098 BAB 16131 b A BILL FOR 104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB2371 Introduced , by Rep. Nicolle Grasse SYNOPSIS AS INTRODUCED: 215 ILCS 5/370a from Ch. 73, par. 982a 215 ILCS 5/370a from Ch. 73, par. 982a Amends the Illinois Insurance Code. Provides that no provision of the Illinois Insurance Code, or any other law, prohibits assignability rights to an insured under any policy of dental insurance (in addition to accident and health insurance). Provides that if an enrollee or insured of an insurer, health maintenance organization, managed care plan, health care plan, preferred provider organization, dental service plan corporation, dental insurer, or third party administrator assigns a claim to a health care professional, or health care facility, a dental care provider, or a dental care facility, then payment shall be made directly to the health care professional, or health care facility, dental care provider, or dental care facility, including any required interest. Effective immediately. LRB104 06098 BAB 16131 b LRB104 06098 BAB 16131 b A BILL FOR
	2	+	104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB2371 Introduced , by Rep. Nicolle Grasse SYNOPSIS AS INTRODUCED:
	3	+	215 ILCS 5/370a from Ch. 73, par. 982a 215 ILCS 5/370a from Ch. 73, par. 982a
	4	+	215 ILCS 5/370a from Ch. 73, par. 982a
	5	+	Amends the Illinois Insurance Code. Provides that no provision of the Illinois Insurance Code, or any other law, prohibits assignability rights to an insured under any policy of dental insurance (in addition to accident and health insurance). Provides that if an enrollee or insured of an insurer, health maintenance organization, managed care plan, health care plan, preferred provider organization, dental service plan corporation, dental insurer, or third party administrator assigns a claim to a health care professional, or health care facility, a dental care provider, or a dental care facility, then payment shall be made directly to the health care professional, or health care facility, dental care provider, or dental care facility, including any required interest. Effective immediately.
	6	+	LRB104 06098 BAB 16131 b LRB104 06098 BAB 16131 b
	7	+	LRB104 06098 BAB 16131 b
	8	+	A BILL FOR
	9	+	HB2371LRB104 06098 BAB 16131 b HB2371 LRB104 06098 BAB 16131 b
	10	+	HB2371 LRB104 06098 BAB 16131 b
3	11		1 AN ACT concerning regulation.
4	12		2 Be it enacted by the People of the State of Illinois,
5	13		3 represented in the General Assembly:
6	14		4 Section 5. The Illinois Insurance Code is amended by
7	15		5 changing Section 370a as follows:
8	16		6 (215 ILCS 5/370a) (from Ch. 73, par. 982a)
9		-	7 Sec. 370a. Assignability of ~~Accident~~ and ~~Health Insurance,~~
10		-	8 ~~including dental~~ insurance. ~~No provision of the Illinois~~
11		-	9 Insurance Code, or any other ~~law, prohibits an insured under~~
12		-	10 any policy of dental insurance ~~or accident and health~~
13		-	11 insurance or any other person who may be ~~the owner of any~~
14		-	12 rights under any such policy from making an ~~assignment of all~~
15		-	13 or any part of his rights and privileges ~~under the policy~~
16		-	14 including but not limited to the right to ~~designate a~~
17		-	15 beneficiary and to have an individual policy ~~issued in~~
18		-	16 accordance with its terms. Subject to the terms of ~~the policy~~
19		-	17 or any contract relating thereto, an assignment by ~~an insured~~
20		-	18 or by any other owner of rights under the policy, ~~made before~~
21		-	19 or after the effective date of this amendatory Act ~~of 1969 is~~
22		-	20 valid for the purpose of vesting in the assignee, in
	17	+	7 Sec. 370a. Assignability of dental insurance and accident
	18	+	8 and health insurance Accident and Health Insurance.
	19	+	9 No provision of the Illinois Insurance Code, or any other
	20	+	10 law, prohibits an insured under any policy of dental insurance
	21	+	11 or accident and health insurance or any other person who may be
	22	+	12 the owner of any rights under any such policy from making an
	23	+	13 assignment of all or any part of his rights and privileges
	24	+	14 under the policy including but not limited to the right to
	25	+	15 designate a beneficiary and to have an individual policy
	26	+	16 issued in accordance with its terms. Subject to the terms of
	27	+	17 the policy or any contract relating thereto, an assignment by
	28	+	18 an insured or by any other owner of rights under the policy,
	29	+	19 made before or after the effective date of this amendatory Act
	30	+	20 of 1969 is valid for the purpose of vesting in the assignee, in
23	31		21 accordance with any provisions included therein as to the time
24	32		22 at which it is effective, all rights and privileges so
25	33		23 assigned. However, such assignment is without prejudice to the
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	37	+	104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB2371 Introduced , by Rep. Nicolle Grasse SYNOPSIS AS INTRODUCED:
	38	+	215 ILCS 5/370a from Ch. 73, par. 982a 215 ILCS 5/370a from Ch. 73, par. 982a
	39	+	215 ILCS 5/370a from Ch. 73, par. 982a
	40	+	Amends the Illinois Insurance Code. Provides that no provision of the Illinois Insurance Code, or any other law, prohibits assignability rights to an insured under any policy of dental insurance (in addition to accident and health insurance). Provides that if an enrollee or insured of an insurer, health maintenance organization, managed care plan, health care plan, preferred provider organization, dental service plan corporation, dental insurer, or third party administrator assigns a claim to a health care professional, or health care facility, a dental care provider, or a dental care facility, then payment shall be made directly to the health care professional, or health care facility, dental care provider, or dental care facility, including any required interest. Effective immediately.
	41	+	LRB104 06098 BAB 16131 b LRB104 06098 BAB 16131 b
	42	+	LRB104 06098 BAB 16131 b
	43	+	A BILL FOR
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	49	+	215 ILCS 5/370a from Ch. 73, par. 982a
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	53	+	LRB104 06098 BAB 16131 b
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	67	+	HB2371 - 2 - LRB104 06098 BAB 16131 b
34	68		1 company on account of any payment it makes or individual
35	69		2 policy it issues before receipt of notice of the assignment.
36	70		3 This amendatory Act of 1969 acknowledges, declares and
37	71		4 codifies the existing right of assignment of interests under
38	72		5 accident and health insurance policies. If an enrollee or
39	73		6 insured of an insurer, health maintenance organization,
40	74		7 managed care plan, health care plan, preferred provider
41	75		8 organization, dental service plan corporation, dental insurer,
42	76		9 or third party administrator assigns a claim to a health care
43	77		10 professional, or health care facility, dental care provider,
44	78		11 or dental care facility, then payment shall be made directly
45	79		12 to the health care professional, or health care facility,
46	80		13 dental care provider, or dental care facility, including any
47	81		14 interest required under Section 368a, of this Code for failure
48	82		15 to pay claims within 30 days after receipt by the insurer of
49	83		16 due proof of loss. Nothing in this Section shall be construed
50	84		17 to prevent any parties from reconciling duplicate payments.
51	85		18 (Source: P.A. 91-605, eff. 12-14-99; 91-788, eff. 6-9-00.)
52		-	19 Section 10. The Dental Service Plan Act is amended by
53		-	20 adding Section 38.1 as follows:
54		-	21 (215 ILCS 110/38.1 new)
55		-	22 Sec. 38.1. Illinois Insurance Code provisions. Every
56		-	23 dental service plan corporation shall comply with Section 370a
57		-	24 of the Illinois Insurance Code.
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68		-	1 Section 15. The Health Maintenance Organization Act is
69		-	2 amended by changing Section 5-3 as follows:
70		-	3 (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
71		-	4 (Text of Section before amendment by P.A. 103-808)
72		-	5 Sec. 5-3. Illinois Insurance Code provisions.
73		-	6 (a) Health Maintenance Organizations shall be subject to
74		-	7 the provisions of Sections 133, 134, 136, 137, 139, 140,
75		-	8 141.1, 141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151,
76		-	9 152, 153, 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a,
77		-	10 155.49, 352c, 355.2, 355.3, 355.6, 355b, 355c, 356f, 356g.5-1,
78		-	11 356m, 356q, 356u.10, 356v, 356w, 356x, 356z.2, 356z.3a,
79		-	12 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10,
80		-	13 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.18,
81		-	14 356z.19, 356z.20, 356z.21, 356z.22, 356z.23, 356z.24, 356z.25,
82		-	15 356z.26, 356z.28, 356z.29, 356z.30, 356z.31, 356z.32, 356z.33,
83		-	16 356z.34, 356z.35, 356z.36, 356z.37, 356z.38, 356z.39, 356z.40,
84		-	17 356z.40a, 356z.41, 356z.44, 356z.45, 356z.46, 356z.47,
85		-	18 356z.48, 356z.49, 356z.50, 356z.51, 356z.53, 356z.54, 356z.55,
86		-	19 356z.56, 356z.57, 356z.58, 356z.59, 356z.60, 356z.61, 356z.62,
87		-	20 356z.63, 356z.64, 356z.65, 356z.66, 356z.67, 356z.68, 356z.69,
88		-	21 356z.70, 356z.71, 356z.72, 356z.73, 356z.74, 356z.75, 356z.77,
89		-	22 364, 364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b, 368c,
90		-	23 368d, 368e, 370a, 370c, 370c.1, 401, 401.1, 402, 403, 403A,
91		-	24 408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of
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102		-	1 subsection (2) of Section 367, and Articles IIA, VIII 1/2,
103		-	2 XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the
104		-	3 Illinois Insurance Code.
105		-	4 (b) For purposes of the Illinois Insurance Code, except
106		-	5 for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
107		-	6 Health Maintenance Organizations in the following categories
108		-	7 are deemed to be "domestic companies":
109		-	8 (1) a corporation authorized under the Dental Service
110		-	9 Plan Act or the Voluntary Health Services Plans Act;
111		-	10 (2) a corporation organized under the laws of this
112		-	11 State; or
113		-	12 (3) a corporation organized under the laws of another
114		-	13 state, 30% or more of the enrollees of which are residents
115		-	14 of this State, except a corporation subject to
116		-	15 substantially the same requirements in its state of
117		-	16 organization as is a "domestic company" under Article VIII
118		-	17 1/2 of the Illinois Insurance Code.
119		-	18 (c) In considering the merger, consolidation, or other
120		-	19 acquisition of control of a Health Maintenance Organization
121		-	20 pursuant to Article VIII 1/2 of the Illinois Insurance Code,
122		-	21 (1) the Director shall give primary consideration to
123		-	22 the continuation of benefits to enrollees and the
124		-	23 financial conditions of the acquired Health Maintenance
125		-	24 Organization after the merger, consolidation, or other
126		-	25 acquisition of control takes effect;
127		-	26 (2)(i) the criteria specified in subsection (1)(b) of
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138		-	1 Section 131.8 of the Illinois Insurance Code shall not
139		-	2 apply and (ii) the Director, in making his determination
140		-	3 with respect to the merger, consolidation, or other
141		-	4 acquisition of control, need not take into account the
142		-	5 effect on competition of the merger, consolidation, or
143		-	6 other acquisition of control;
144		-	7 (3) the Director shall have the power to require the
145		-	8 following information:
146		-	9 (A) certification by an independent actuary of the
147		-	10 adequacy of the reserves of the Health Maintenance
148		-	11 Organization sought to be acquired;
149		-	12 (B) pro forma financial statements reflecting the
150		-	13 combined balance sheets of the acquiring company and
151		-	14 the Health Maintenance Organization sought to be
152		-	15 acquired as of the end of the preceding year and as of
153		-	16 a date 90 days prior to the acquisition, as well as pro
154		-	17 forma financial statements reflecting projected
155		-	18 combined operation for a period of 2 years;
156		-	19 (C) a pro forma business plan detailing an
157		-	20 acquiring party's plans with respect to the operation
158		-	21 of the Health Maintenance Organization sought to be
159		-	22 acquired for a period of not less than 3 years; and
160		-	23 (D) such other information as the Director shall
161		-	24 require.
162		-	25 (d) The provisions of Article VIII 1/2 of the Illinois
163		-	26 Insurance Code and this Section 5-3 shall apply to the sale by
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174		-	1 any health maintenance organization of greater than 10% of its
175		-	2 enrollee population (including, without limitation, the health
176		-	3 maintenance organization's right, title, and interest in and
177		-	4 to its health care certificates).
178		-	5 (e) In considering any management contract or service
179		-	6 agreement subject to Section 141.1 of the Illinois Insurance
180		-	7 Code, the Director (i) shall, in addition to the criteria
181		-	8 specified in Section 141.2 of the Illinois Insurance Code,
182		-	9 take into account the effect of the management contract or
183		-	10 service agreement on the continuation of benefits to enrollees
184		-	11 and the financial condition of the health maintenance
185		-	12 organization to be managed or serviced, and (ii) need not take
186		-	13 into account the effect of the management contract or service
187		-	14 agreement on competition.
188		-	15 (f) Except for small employer groups as defined in the
189		-	16 Small Employer Rating, Renewability and Portability Health
190		-	17 Insurance Act and except for medicare supplement policies as
191		-	18 defined in Section 363 of the Illinois Insurance Code, a
192		-	19 Health Maintenance Organization may by contract agree with a
193		-	20 group or other enrollment unit to effect refunds or charge
194		-	21 additional premiums under the following terms and conditions:
195		-	22 (i) the amount of, and other terms and conditions with
196		-	23 respect to, the refund or additional premium are set forth
197		-	24 in the group or enrollment unit contract agreed in advance
198		-	25 of the period for which a refund is to be paid or
199		-	26 additional premium is to be charged (which period shall
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210		-	1 not be less than one year); and
211		-	2 (ii) the amount of the refund or additional premium
212		-	3 shall not exceed 20% of the Health Maintenance
213		-	4 Organization's profitable or unprofitable experience with
214		-	5 respect to the group or other enrollment unit for the
215		-	6 period (and, for purposes of a refund or additional
216		-	7 premium, the profitable or unprofitable experience shall
217		-	8 be calculated taking into account a pro rata share of the
218		-	9 Health Maintenance Organization's administrative and
219		-	10 marketing expenses, but shall not include any refund to be
220		-	11 made or additional premium to be paid pursuant to this
221		-	12 subsection (f)). The Health Maintenance Organization and
222		-	13 the group or enrollment unit may agree that the profitable
223		-	14 or unprofitable experience may be calculated taking into
224		-	15 account the refund period and the immediately preceding 2
225		-	16 plan years.
226		-	17 The Health Maintenance Organization shall include a
227		-	18 statement in the evidence of coverage issued to each enrollee
228		-	19 describing the possibility of a refund or additional premium,
229		-	20 and upon request of any group or enrollment unit, provide to
230		-	21 the group or enrollment unit a description of the method used
231		-	22 to calculate (1) the Health Maintenance Organization's
232		-	23 profitable experience with respect to the group or enrollment
233		-	24 unit and the resulting refund to the group or enrollment unit
234		-	25 or (2) the Health Maintenance Organization's unprofitable
235		-	26 experience with respect to the group or enrollment unit and
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246		-	1 the resulting additional premium to be paid by the group or
247		-	2 enrollment unit.
248		-	3 In no event shall the Illinois Health Maintenance
249		-	4 Organization Guaranty Association be liable to pay any
250		-	5 contractual obligation of an insolvent organization to pay any
251		-	6 refund authorized under this Section.
252		-	7 (g) Rulemaking authority to implement Public Act 95-1045,
253		-	8 if any, is conditioned on the rules being adopted in
254		-	9 accordance with all provisions of the Illinois Administrative
255		-	10 Procedure Act and all rules and procedures of the Joint
256		-	11 Committee on Administrative Rules; any purported rule not so
257		-	12 adopted, for whatever reason, is unauthorized.
258		-	13 (Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
259		-	14 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
260		-	15 1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
261		-	16 eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
262		-	17 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
263		-	18 1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
264		-	19 eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;
265		-	20 103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.
266		-	21 6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
267		-	22 eff. 1-1-24; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24;
268		-	23 103-618, eff. 1-1-25; 103-649, eff. 1-1-25; 103-656, eff.
269		-	24 1-1-25; 103-700, eff. 1-1-25; 103-718, eff. 7-19-24; 103-751,
270		-	25 eff. 8-2-24; 103-753, eff. 8-2-24; 103-758, eff. 1-1-25;
271		-	26 103-777, eff. 8-2-24; 103-914, eff. 1-1-25; 103-918, eff.
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282		-	1 1-1-25; 103-1024, eff. 1-1-25; revised 9-26-24.)
283		-	2 (Text of Section after amendment by P.A. 103-808)
284		-	3 Sec. 5-3. Illinois Insurance Code provisions.
285		-	4 (a) Health Maintenance Organizations shall be subject to
286		-	5 the provisions of Sections 133, 134, 136, 137, 139, 140,
287		-	6 141.1, 141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151,
288		-	7 152, 153, 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a,
289		-	8 155.49, 352c, 355.2, 355.3, 355.6, 355b, 355c, 356f, 356g,
290		-	9 356g.5-1, 356m, 356q, 356u.10, 356v, 356w, 356x, 356z.2,
291		-	10 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9,
292		-	11 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17,
293		-	12 356z.18, 356z.19, 356z.20, 356z.21, 356z.22, 356z.23, 356z.24,
294		-	13 356z.25, 356z.26, 356z.28, 356z.29, 356z.30, 356z.31, 356z.32,
295		-	14 356z.33, 356z.34, 356z.35, 356z.36, 356z.37, 356z.38, 356z.39,
296		-	15 356z.40, 356z.40a, 356z.41, 356z.44, 356z.45, 356z.46,
297		-	16 356z.47, 356z.48, 356z.49, 356z.50, 356z.51, 356z.53, 356z.54,
298		-	17 356z.55, 356z.56, 356z.57, 356z.58, 356z.59, 356z.60, 356z.61,
299		-	18 356z.62, 356z.63, 356z.64, 356z.65, 356z.66, 356z.67, 356z.68,
300		-	19 356z.69, 356z.70, 356z.71, 356z.72, 356z.73, 356z.74, 356z.75,
301		-	20 356z.77, 364, 364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b,
302		-	21 368c, 368d, 368e, 370a, 370c, 370c.1, 401, 401.1, 402, 403,
303		-	22 403A, 408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of
304		-	23 subsection (2) of Section 367, and Articles IIA, VIII 1/2,
305		-	24 XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the
306		-	25 Illinois Insurance Code.
307		-
308		-
309		-
310		-
311		-
312		-	HB2371 Engrossed - 9 - LRB104 06098 BAB 16131 b
313		-
314		-
315		-	HB2371 Engrossed- 10 -LRB104 06098 BAB 16131 b HB2371 Engrossed - 10 - LRB104 06098 BAB 16131 b
316		-	HB2371 Engrossed - 10 - LRB104 06098 BAB 16131 b
317		-	1 (b) For purposes of the Illinois Insurance Code, except
318		-	2 for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
319		-	3 Health Maintenance Organizations in the following categories
320		-	4 are deemed to be "domestic companies":
321		-	5 (1) a corporation authorized under the Dental Service
322		-	6 Plan Act or the Voluntary Health Services Plans Act;
323		-	7 (2) a corporation organized under the laws of this
324		-	8 State; or
325		-	9 (3) a corporation organized under the laws of another
326		-	10 state, 30% or more of the enrollees of which are residents
327		-	11 of this State, except a corporation subject to
328		-	12 substantially the same requirements in its state of
329		-	13 organization as is a "domestic company" under Article VIII
330		-	14 1/2 of the Illinois Insurance Code.
331		-	15 (c) In considering the merger, consolidation, or other
332		-	16 acquisition of control of a Health Maintenance Organization
333		-	17 pursuant to Article VIII 1/2 of the Illinois Insurance Code,
334		-	18 (1) the Director shall give primary consideration to
335		-	19 the continuation of benefits to enrollees and the
336		-	20 financial conditions of the acquired Health Maintenance
337		-	21 Organization after the merger, consolidation, or other
338		-	22 acquisition of control takes effect;
339		-	23 (2)(i) the criteria specified in subsection (1)(b) of
340		-	24 Section 131.8 of the Illinois Insurance Code shall not
341		-	25 apply and (ii) the Director, in making his determination
342		-	26 with respect to the merger, consolidation, or other
343		-
344		-
345		-
346		-
347		-
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349		-
350		-
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352		-	HB2371 Engrossed - 11 - LRB104 06098 BAB 16131 b
353		-	1 acquisition of control, need not take into account the
354		-	2 effect on competition of the merger, consolidation, or
355		-	3 other acquisition of control;
356		-	4 (3) the Director shall have the power to require the
357		-	5 following information:
358		-	6 (A) certification by an independent actuary of the
359		-	7 adequacy of the reserves of the Health Maintenance
360		-	8 Organization sought to be acquired;
361		-	9 (B) pro forma financial statements reflecting the
362		-	10 combined balance sheets of the acquiring company and
363		-	11 the Health Maintenance Organization sought to be
364		-	12 acquired as of the end of the preceding year and as of
365		-	13 a date 90 days prior to the acquisition, as well as pro
366		-	14 forma financial statements reflecting projected
367		-	15 combined operation for a period of 2 years;
368		-	16 (C) a pro forma business plan detailing an
369		-	17 acquiring party's plans with respect to the operation
370		-	18 of the Health Maintenance Organization sought to be
371		-	19 acquired for a period of not less than 3 years; and
372		-	20 (D) such other information as the Director shall
373		-	21 require.
374		-	22 (d) The provisions of Article VIII 1/2 of the Illinois
375		-	23 Insurance Code and this Section 5-3 shall apply to the sale by
376		-	24 any health maintenance organization of greater than 10% of its
377		-	25 enrollee population (including, without limitation, the health
378		-	26 maintenance organization's right, title, and interest in and
379		-
380		-
381		-
382		-
383		-
384		-	HB2371 Engrossed - 11 - LRB104 06098 BAB 16131 b
385		-
386		-
387		-	HB2371 Engrossed- 12 -LRB104 06098 BAB 16131 b HB2371 Engrossed - 12 - LRB104 06098 BAB 16131 b
388		-	HB2371 Engrossed - 12 - LRB104 06098 BAB 16131 b
389		-	1 to its health care certificates).
390		-	2 (e) In considering any management contract or service
391		-	3 agreement subject to Section 141.1 of the Illinois Insurance
392		-	4 Code, the Director (i) shall, in addition to the criteria
393		-	5 specified in Section 141.2 of the Illinois Insurance Code,
394		-	6 take into account the effect of the management contract or
395		-	7 service agreement on the continuation of benefits to enrollees
396		-	8 and the financial condition of the health maintenance
397		-	9 organization to be managed or serviced, and (ii) need not take
398		-	10 into account the effect of the management contract or service
399		-	11 agreement on competition.
400		-	12 (f) Except for small employer groups as defined in the
401		-	13 Small Employer Rating, Renewability and Portability Health
402		-	14 Insurance Act and except for medicare supplement policies as
403		-	15 defined in Section 363 of the Illinois Insurance Code, a
404		-	16 Health Maintenance Organization may by contract agree with a
405		-	17 group or other enrollment unit to effect refunds or charge
406		-	18 additional premiums under the following terms and conditions:
407		-	19 (i) the amount of, and other terms and conditions with
408		-	20 respect to, the refund or additional premium are set forth
409		-	21 in the group or enrollment unit contract agreed in advance
410		-	22 of the period for which a refund is to be paid or
411		-	23 additional premium is to be charged (which period shall
412		-	24 not be less than one year); and
413		-	25 (ii) the amount of the refund or additional premium
414		-	26 shall not exceed 20% of the Health Maintenance
415		-
416		-
417		-
418		-
419		-
420		-	HB2371 Engrossed - 12 - LRB104 06098 BAB 16131 b
421		-
422		-
423		-	HB2371 Engrossed- 13 -LRB104 06098 BAB 16131 b HB2371 Engrossed - 13 - LRB104 06098 BAB 16131 b
424		-	HB2371 Engrossed - 13 - LRB104 06098 BAB 16131 b
425		-	1 Organization's profitable or unprofitable experience with
426		-	2 respect to the group or other enrollment unit for the
427		-	3 period (and, for purposes of a refund or additional
428		-	4 premium, the profitable or unprofitable experience shall
429		-	5 be calculated taking into account a pro rata share of the
430		-	6 Health Maintenance Organization's administrative and
431		-	7 marketing expenses, but shall not include any refund to be
432		-	8 made or additional premium to be paid pursuant to this
433		-	9 subsection (f)). The Health Maintenance Organization and
434		-	10 the group or enrollment unit may agree that the profitable
435		-	11 or unprofitable experience may be calculated taking into
436		-	12 account the refund period and the immediately preceding 2
437		-	13 plan years.
438		-	14 The Health Maintenance Organization shall include a
439		-	15 statement in the evidence of coverage issued to each enrollee
440		-	16 describing the possibility of a refund or additional premium,
441		-	17 and upon request of any group or enrollment unit, provide to
442		-	18 the group or enrollment unit a description of the method used
443		-	19 to calculate (1) the Health Maintenance Organization's
444		-	20 profitable experience with respect to the group or enrollment
445		-	21 unit and the resulting refund to the group or enrollment unit
446		-	22 or (2) the Health Maintenance Organization's unprofitable
447		-	23 experience with respect to the group or enrollment unit and
448		-	24 the resulting additional premium to be paid by the group or
449		-	25 enrollment unit.
450		-	26 In no event shall the Illinois Health Maintenance
451		-
452		-
453		-
454		-
455		-
456		-	HB2371 Engrossed - 13 - LRB104 06098 BAB 16131 b
457		-
458		-
459		-	HB2371 Engrossed- 14 -LRB104 06098 BAB 16131 b HB2371 Engrossed - 14 - LRB104 06098 BAB 16131 b
460		-	HB2371 Engrossed - 14 - LRB104 06098 BAB 16131 b
461		-	1 Organization Guaranty Association be liable to pay any
462		-	2 contractual obligation of an insolvent organization to pay any
463		-	3 refund authorized under this Section.
464		-	4 (g) Rulemaking authority to implement Public Act 95-1045,
465		-	5 if any, is conditioned on the rules being adopted in
466		-	6 accordance with all provisions of the Illinois Administrative
467		-	7 Procedure Act and all rules and procedures of the Joint
468		-	8 Committee on Administrative Rules; any purported rule not so
469		-	9 adopted, for whatever reason, is unauthorized.
470		-	10 (Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
471		-	11 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
472		-	12 1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
473		-	13 eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
474		-	14 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
475		-	15 1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
476		-	16 eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;
477		-	17 103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.
478		-	18 6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
479		-	19 eff. 1-1-24; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24;
480		-	20 103-618, eff. 1-1-25; 103-649, eff. 1-1-25; 103-656, eff.
481		-	21 1-1-25; 103-700, eff. 1-1-25; 103-718, eff. 7-19-24; 103-751,
482		-	22 eff. 8-2-24; 103-753, eff. 8-2-24; 103-758, eff. 1-1-25;
483		-	23 103-777, eff. 8-2-24; 103-808, eff. 1-1-26; 103-914, eff.
484		-	24 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; revised
485		-	25 11-26-24.)
486		-
487		-
488		-
489		-
490		-
491		-	HB2371 Engrossed - 14 - LRB104 06098 BAB 16131 b
492		-
493		-
494		-	HB2371 Engrossed- 15 -LRB104 06098 BAB 16131 b HB2371 Engrossed - 15 - LRB104 06098 BAB 16131 b
495		-	HB2371 Engrossed - 15 - LRB104 06098 BAB 16131 b
496		-	1 Section 20. The Limited Health Service Organization Act is
497		-	2 amended by changing Section 4003 as follows:
498		-	3 (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
499		-	4 Sec. 4003. Illinois Insurance Code provisions. Limited
500		-	5 health service organizations shall be subject to the
501		-	6 provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
502		-	7 141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151, 152, 153,
503		-	8 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 352c,
504		-	9 355.2, 355.3, 355b, 355d, 356m, 356q, 356v, 356z.4, 356z.4a,
505		-	10 356z.10, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.32,
506		-	11 356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
507		-	12 356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68, 356z.71,
508		-	13 356z.73, 356z.74, 356z.75, 364.3, 368a, 370a, 401, 401.1, 402,
509		-	14 403, 403A, 408, 408.2, 409, 412, 444, and 444.1 and Articles
510		-	15 IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and XXVI of
511		-	16 the Illinois Insurance Code. Nothing in this Section shall
512		-	17 require a limited health care plan to cover any service that is
513		-	18 not a limited health service. For purposes of the Illinois
514		-	19 Insurance Code, except for Sections 444 and 444.1 and Articles
515		-	20 XIII and XIII 1/2, limited health service organizations in the
516		-	21 following categories are deemed to be domestic companies:
517		-	22 (1) a corporation under the laws of this State; or
518		-	23 (2) a corporation organized under the laws of another
519		-	24 state, 30% or more of the enrollees of which are residents
520		-	25 of this State, except a corporation subject to
521		-
522		-
523		-
524		-
525		-
526		-	HB2371 Engrossed - 15 - LRB104 06098 BAB 16131 b
527		-
528		-
529		-	HB2371 Engrossed- 16 -LRB104 06098 BAB 16131 b HB2371 Engrossed - 16 - LRB104 06098 BAB 16131 b
530		-	HB2371 Engrossed - 16 - LRB104 06098 BAB 16131 b
531		-	1 substantially the same requirements in its state of
532		-	2 organization as is a domestic company under Article VIII
533		-	3 1/2 of the Illinois Insurance Code.
534		-	4 (Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
535		-	5 102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-731, eff.
536		-	6 1-1-23; 102-775, eff. 5-13-22; 102-813, eff. 5-13-22; 102-816,
537		-	7 eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
538		-	8 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
539		-	9 1-1-24; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
540		-	10 eff. 1-1-24; 103-605, eff. 7-1-24; 103-649, eff. 1-1-25;
541		-	11 103-656, eff. 1-1-25; 103-700, eff. 1-1-25; 103-718, eff.
542		-	12 7-19-24; 103-751, eff. 8-2-24; 103-758, eff. 1-1-25; 103-832,
543		-	13 eff. 1-1-25; 103-1024, eff. 1-1-25; revised 11-26-24.)
544		-	14 Section 25. The Voluntary Health Services Plans Act is
545		-	15 amended by changing Section 10 as follows:
546		-	16 (215 ILCS 165/10) (from Ch. 32, par. 604)
547		-	17 Sec. 10. Application of Illinois Insurance Code
548		-	18 provisions. Health services plan corporations and all persons
549		-	19 interested therein or dealing therewith shall be subject to
550		-	20 the provisions of Articles IIA and XII 1/2 and Sections 3.1,
551		-	21 133, 136, 139, 140, 143, 143.31, 143c, 149, 155.22a, 155.37,
552		-	22 354, 355.2, 355.3, 355b, 355d, 356g, 356g.5, 356g.5-1, 356m,
553		-	23 356q, 356r, 356t, 356u, 356u.10, 356v, 356w, 356x, 356y,
554		-	24 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6,
555		-
556		-
557		-
558		-
559		-
560		-	HB2371 Engrossed - 16 - LRB104 06098 BAB 16131 b
561		-
562		-
563		-	HB2371 Engrossed- 17 -LRB104 06098 BAB 16131 b HB2371 Engrossed - 17 - LRB104 06098 BAB 16131 b
564		-	HB2371 Engrossed - 17 - LRB104 06098 BAB 16131 b
565		-	1 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14,
566		-	2 356z.15, 356z.18, 356z.19, 356z.21, 356z.22, 356z.25, 356z.26,
567		-	3 356z.29, 356z.30, 356z.32, 356z.32a, 356z.33, 356z.40,
568		-	4 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54, 356z.56,
569		-	5 356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64, 356z.67,
570		-	6 356z.68, 356z.71, 356z.72, 356z.74, 356z.75, 356z.77, 364.01,
571		-	7 364.3, 367.2, 368a, 370a, 401, 401.1, 402, 403, 403A, 408,
572		-	8 408.2, and 412, and paragraphs (7) and (15) of Section 367 of
573		-	9 the Illinois Insurance Code.
574		-	10 Rulemaking authority to implement Public Act 95-1045, if
575		-	11 any, is conditioned on the rules being adopted in accordance
576		-	12 with all provisions of the Illinois Administrative Procedure
577		-	13 Act and all rules and procedures of the Joint Committee on
578		-	14 Administrative Rules; any purported rule not so adopted, for
579		-	15 whatever reason, is unauthorized.
580		-	16 (Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
581		-	17 102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff.
582		-	18 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804,
583		-	19 eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
584		-	20 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff.
585		-	21 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
586		-	22 eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
587		-	23 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-656, eff.
588		-	24 1-1-25; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-753,
589		-	25 eff. 8-2-24; 103-758, eff. 1-1-25; 103-832, eff. 1-1-25;
590		-	26 103-914, eff. 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff.
591		-
592		-
593		-
594		-
595		-
596		-	HB2371 Engrossed - 17 - LRB104 06098 BAB 16131 b
597		-
598		-
599		-	HB2371 Engrossed- 18 -LRB104 06098 BAB 16131 b HB2371 Engrossed - 18 - LRB104 06098 BAB 16131 b
600		-	HB2371 Engrossed - 18 - LRB104 06098 BAB 16131 b
601		-	1 1-1-25; revised 11-26-24.)
602		-	2 Section 95. No acceleration or delay. Where this Act makes
603		-	3 changes in a statute that is represented in this Act by text
604		-	4 that is not yet or no longer in effect (for example, a Section
605		-	5 represented by multiple versions), the use of that text does
606		-	6 not accelerate or delay the taking effect of (i) the changes
607		-	7 made by this Act or (ii) provisions derived from any other
608		-	8 Public Act.
609		-	9 Section 99. Effective date. This Act takes effect January
610		-	10 1, 2026.
611		-
612		-
613		-
614		-
615		-
616		-	HB2371 Engrossed - 18 - LRB104 06098 BAB 16131 b
	91	+	HB2371 - 2 - LRB104 06098 BAB 16131 b