Illinois 2025-2026 Regular Session

Illinois House Bill HB3248 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	HB3248 EngrossedLRB104 08344 BAB 18395 b HB3248 Engrossed LRB104 08344 BAB 18395 b
2		-	HB3248 Engrossed LRB104 08344 BAB 18395 b
	1	+	104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB3248 Introduced , by Rep. Lilian Jimnez 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 any group or individual policy of accident or health insurance or a managed care plan that is amended, delivered, issued, or renewed after January 1, 2027 shall provide coverage for laser hair removal if the procedure is prescribed medical treatment in accordance with generally accepted standards of medical care. Provides that the coverage shall apply to individuals with conditions including, but not limited to, body dysmorphia, hidradentis suppreativa, polycystic ovary syndrome, or other similar skin conditions. 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 Health Services Plans Act, and the Illinois Public Aid code to require coverage under those provisions. LRB104 08344 BAB 18395 b A BILL FOR 104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB3248 Introduced , by Rep. Lilian Jimnez 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 any group or individual policy of accident or health insurance or a managed care plan that is amended, delivered, issued, or renewed after January 1, 2027 shall provide coverage for laser hair removal if the procedure is prescribed medical treatment in accordance with generally accepted standards of medical care. Provides that the coverage shall apply to individuals with conditions including, but not limited to, body dysmorphia, hidradentis suppreativa, polycystic ovary syndrome, or other similar skin conditions. 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 Health Services Plans Act, and the Illinois Public Aid code to require coverage under those provisions. LRB104 08344 BAB 18395 b LRB104 08344 BAB 18395 b A BILL FOR
	2	+	104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB3248 Introduced , by Rep. Lilian Jimnez 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 any group or individual policy of accident or health insurance or a managed care plan that is amended, delivered, issued, or renewed after January 1, 2027 shall provide coverage for laser hair removal if the procedure is prescribed medical treatment in accordance with generally accepted standards of medical care. Provides that the coverage shall apply to individuals with conditions including, but not limited to, body dysmorphia, hidradentis suppreativa, polycystic ovary syndrome, or other similar skin conditions. 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 Health Services Plans Act, and the Illinois Public Aid code to require coverage under those provisions.
	14	+	LRB104 08344 BAB 18395 b LRB104 08344 BAB 18395 b
	15	+	LRB104 08344 BAB 18395 b
	16	+	A BILL FOR
	17	+	HB3248LRB104 08344 BAB 18395 b HB3248 LRB104 08344 BAB 18395 b
	18	+	HB3248 LRB104 08344 BAB 18395 b
3	19		1 AN ACT concerning regulation.
4	20		2 Be it enacted by the People of the State of Illinois,
5	21		3 represented in the General Assembly:
6	22		4 Section 5. The State Employees Group Insurance Act of 1971
7	23		5 is amended by changing Section 6.11 as follows:
8	24		6 (5 ILCS 375/6.11)
9	25		7 Sec. 6.11. Required health benefits; Illinois Insurance
10	26		8 Code requirements. The program of health benefits shall
11	27		9 provide the post-mastectomy care benefits required to be
12	28		10 covered by a policy of accident and health insurance under
13	29		11 Section 356t of the Illinois Insurance Code. The program of
14	30		12 health benefits shall provide the coverage required under
15	31		13 Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10,
16	32		14 356w, 356x, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8,
17	33		15 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
18	34		16 356z.17, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32,
19	35		17 356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
20	36		18 356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59,
21	37		19 356z.60, 356z.61, 356z.62, 356z.64, 356z.67, 356z.68, and
22	38		20 356z.70, and 356z.71, 356z.74, 356z.76, 356z.77, and 356z.80
23	39		21 of the Illinois Insurance Code. The program of health benefits
24	40		22 must comply with Sections 155.22a, 155.37, 355b, 356z.19,
25	41		23 370c, and 370c.1 and Article XXXIIB of the Illinois Insurance
26	42
27	43
28	44
29		-	HB3248 Engrossed LRB104 08344 BAB 18395 b
	45	+	104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB3248 Introduced , by Rep. Lilian Jimnez 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 any group or individual policy of accident or health insurance or a managed care plan that is amended, delivered, issued, or renewed after January 1, 2027 shall provide coverage for laser hair removal if the procedure is prescribed medical treatment in accordance with generally accepted standards of medical care. Provides that the coverage shall apply to individuals with conditions including, but not limited to, body dysmorphia, hidradentis suppreativa, polycystic ovary syndrome, or other similar skin conditions. 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 Health Services Plans Act, and the Illinois Public Aid code to require coverage under those provisions.
	57	+	LRB104 08344 BAB 18395 b LRB104 08344 BAB 18395 b
	58	+	LRB104 08344 BAB 18395 b
	59	+	A BILL FOR
30	60
31	61
32		-	HB3248 Engrossed- 2 -LRB104 08344 BAB 18395 b HB3248 Engrossed - 2 - LRB104 08344 BAB 18395 b
33		-	HB3248 Engrossed - 2 - LRB104 08344 BAB 18395 b
	62	+
	63	+
	64	+
	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
	74	+
	75	+
	76	+
	77	+	LRB104 08344 BAB 18395 b
	78	+
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	85	+
	86	+
	87	+	HB3248 LRB104 08344 BAB 18395 b
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	90	+	HB3248- 2 -LRB104 08344 BAB 18395 b HB3248 - 2 - LRB104 08344 BAB 18395 b
	91	+	HB3248 - 2 - LRB104 08344 BAB 18395 b
34	92		1 Code. The program of health benefits shall provide the
35	93		2 coverage required under Section 356m of the Illinois Insurance
36	94		3 Code and, for the employees of the State Employee Group
37	95		4 Insurance Program only, the coverage as also provided in
38	96		5 Section 6.11B of this Act. The Department of Insurance shall
39	97		6 enforce the requirements of this Section with respect to
40	98		7 Sections 370c and 370c.1 of the Illinois Insurance Code; all
41	99		8 other requirements of this Section shall be enforced by the
42	100		9 Department of Central Management Services.
43	101		10 Rulemaking authority to implement Public Act 95-1045, if
44	102		11 any, is conditioned on the rules being adopted in accordance
45	103		12 with all provisions of the Illinois Administrative Procedure
46	104		13 Act and all rules and procedures of the Joint Committee on
47	105		14 Administrative Rules; any purported rule not so adopted, for
48	106		15 whatever reason, is unauthorized.
49	107		16 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
50	108		17 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
51	109		18 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-768,
52	110		19 eff. 1-1-24; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
53	111		20 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
54	112		21 1-1-23; 102-1117, eff. 1-13-23; 103-8, eff. 1-1-24; 103-84,
55	113		22 eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, eff. 1-1-24;
56	114		23 103-445, eff. 1-1-24; 103-535, eff. 8-11-23; 103-551, eff.
57	115		24 8-11-23; 103-605, eff. 7-1-24; 103-718, eff. 7-19-24; 103-751,
58	116		25 eff. 8-2-24; 103-870, eff. 1-1-25; 103-914, eff. 1-1-25;
59	117		26 103-918, eff. 1-1-25; 103-951, eff. 1-1-25; 103-1024, eff.
60	118
61	119
62	120
63	121
64	122
65		-	HB3248 ~~Engrossed~~ - 2 - LRB104 08344 BAB 18395 b
	123	+	HB3248 - 2 - LRB104 08344 BAB 18395 b
66	124
67	125
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69		-	HB3248 ~~Engrossed~~ - 3 - LRB104 08344 BAB 18395 b
	126	+	HB3248- 3 -LRB104 08344 BAB 18395 b HB3248 - 3 - LRB104 08344 BAB 18395 b
	127	+	HB3248 - 3 - LRB104 08344 BAB 18395 b
70	128		1 1-1-25; revised 11-26-24.)
71	129		2 Section 10. The Counties Code is amended by changing
72	130		3 Section 5-1069.3 as follows:
73	131		4 (55 ILCS 5/5-1069.3)
74	132		5 Sec. 5-1069.3. Required health benefits. If a county,
75	133		6 including a home rule county, is a self-insurer for purposes
76	134		7 of providing health insurance coverage for its employees, the
77	135		8 coverage shall include coverage for the post-mastectomy care
78	136		9 benefits required to be covered by a policy of accident and
79	137		10 health insurance under Section 356t and the coverage required
80	138		11 under Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u,
81	139		12 356u.10, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9,
82	140		13 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
83	141		14 356z.25, 356z.26, 356z.29, 356z.30, 356z.32, 356z.33, 356z.36,
84	142		15 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51,
85	143		16 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, 356z.61,
86	144		17 356z.62, 356z.64, 356z.67, 356z.68, and 356z.70, and 356z.71,
87	145		18 356z.74, 356z.77, and 356z.80 of the Illinois Insurance Code.
88	146		19 The coverage shall comply with Sections 155.22a, 355b,
89	147		20 356z.19, and 370c of the Illinois Insurance Code. The
90	148		21 Department of Insurance shall enforce the requirements of this
91	149		22 Section. The requirement that health benefits be covered as
92	150		23 provided in this Section is an exclusive power and function of
93	151		24 the State and is a denial and limitation under Article VII,
94	152
95	153
96	154
97	155
98	156
99		-	HB3248 ~~Engrossed~~ - 3 - LRB104 08344 BAB 18395 b
	157	+	HB3248 - 3 - LRB104 08344 BAB 18395 b
100	158
101	159
102		-	HB3248 ~~Engrossed~~- 4 -LRB104 08344 BAB 18395 b HB3248 ~~Engrossed~~ - 4 - LRB104 08344 BAB 18395 b
103		-	HB3248 ~~Engrossed~~ - 4 - LRB104 08344 BAB 18395 b
	160	+	HB3248- 4 -LRB104 08344 BAB 18395 b HB3248 - 4 - LRB104 08344 BAB 18395 b
	161	+	HB3248 - 4 - LRB104 08344 BAB 18395 b
104	162		1 Section 6, subsection (h) of the Illinois Constitution. A home
105	163		2 rule county to which this Section applies must comply with
106	164		3 every provision of this Section.
107	165		4 Rulemaking authority to implement Public Act 95-1045, if
108	166		5 any, is conditioned on the rules being adopted in accordance
109	167		6 with all provisions of the Illinois Administrative Procedure
110	168		7 Act and all rules and procedures of the Joint Committee on
111	169		8 Administrative Rules; any purported rule not so adopted, for
112	170		9 whatever reason, is unauthorized.
113	171		10 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
114	172		11 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
115	173		12 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
116	174		13 eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
117	175		14 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
118	176		15 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
119	177		16 eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
120	178		17 103-535, eff. 8-11-23; 103-551, eff. 8-11-23; 103-605, eff.
121	179		18 7-1-24; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-914,
122	180		19 eff. 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25;
123	181		20 revised 11-26-24.)
124	182		21 Section 15. The Illinois Municipal Code is amended by
125	183		22 changing Section 10-4-2.3 as follows:
126	184		23 (65 ILCS 5/10-4-2.3)
127	185		24 Sec. 10-4-2.3. Required health benefits. If a
128	186
129	187
130	188
131	189
132	190
133		-	HB3248 ~~Engrossed~~ - 4 - LRB104 08344 BAB 18395 b
	191	+	HB3248 - 4 - LRB104 08344 BAB 18395 b
134	192
135	193
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137		-	HB3248 ~~Engrossed~~ - 5 - LRB104 08344 BAB 18395 b
	194	+	HB3248- 5 -LRB104 08344 BAB 18395 b HB3248 - 5 - LRB104 08344 BAB 18395 b
	195	+	HB3248 - 5 - LRB104 08344 BAB 18395 b
138	196		1 municipality, including a home rule municipality, is a
139	197		2 self-insurer for purposes of providing health insurance
140	198		3 coverage for its employees, the coverage shall include
141	199		4 coverage for the post-mastectomy care benefits required to be
142	200		5 covered by a policy of accident and health insurance under
143	201		6 Section 356t and the coverage required under Sections 356g,
144	202		7 356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10, 356w, 356x,
145	203		8 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11,
146	204		9 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26,
147	205		10 356z.29, 356z.30, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
148	206		11 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
149	207		12 356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64,
150	208		13 356z.67, 356z.68, and 356z.70, and 356z.71, 356z.74, 356z.77,
151	209		14 and 356z.80 of the Illinois Insurance Code. The coverage shall
152	210		15 comply with Sections 155.22a, 355b, 356z.19, and 370c of the
153	211		16 Illinois Insurance Code. The Department of Insurance shall
154	212		17 enforce the requirements of this Section. The requirement that
155	213		18 health benefits be covered as provided in this is an exclusive
156	214		19 power and function of the State and is a denial and limitation
157	215		20 under Article VII, Section 6, subsection (h) of the Illinois
158	216		21 Constitution. A home rule municipality to which this Section
159	217		22 applies must comply with every provision of this Section.
160	218		23 Rulemaking authority to implement Public Act 95-1045, if
161	219		24 any, is conditioned on the rules being adopted in accordance
162	220		25 with all provisions of the Illinois Administrative Procedure
163	221		26 Act and all rules and procedures of the Joint Committee on
164	222
165	223
166	224
167	225
168	226
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	227	+	HB3248 - 5 - LRB104 08344 BAB 18395 b
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	231	+	HB3248 - 6 - LRB104 08344 BAB 18395 b
174	232		1 Administrative Rules; any purported rule not so adopted, for
175	233		2 whatever reason, is unauthorized.
176	234		3 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
177	235		4 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
178	236		5 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
179	237		6 eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
180	238		7 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
181	239		8 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
182	240		9 eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
183	241		10 103-535, eff. 8-11-23; 103-551, eff. 8-11-23; 103-605, eff.
184	242		11 7-1-24; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-914,
185	243		12 eff. 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25;
186	244		13 revised 11-26-24.)
187	245		14 Section 20. The School Code is amended by changing Section
188	246		15 10-22.3f as follows:
189	247		16 (105 ILCS 5/10-22.3f)
190	248		17 Sec. 10-22.3f. Required health benefits. Insurance
191	249		18 protection and benefits for employees shall provide the
192	250		19 post-mastectomy care benefits required to be covered by a
193	251		20 policy of accident and health insurance under Section 356t and
194	252		21 the coverage required under Sections 356g, 356g.5, 356g.5-1,
195	253		22 356m, 356q, 356u, 356u.10, 356w, 356x, 356z.4, 356z.4a,
196	254		23 356z.6, 356z.8, 356z.9, 356z.11, 356z.12, 356z.13, 356z.14,
197	255		24 356z.15, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32,
198	256
199	257
200	258
201	259
202	260
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	261	+	HB3248 - 6 - LRB104 08344 BAB 18395 b
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208	266		1 356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
209	267		2 356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60,
210	268		3 356z.61, 356z.62, 356z.64, 356z.67, 356z.68, and 356z.70, and
211	269		4 356z.71, 356z.74, 356z.77, and 356z.80 of the Illinois
212	270		5 Insurance Code. Insurance policies shall comply with Section
213	271		6 356z.19 of the Illinois Insurance Code. The coverage shall
214	272		7 comply with Sections 155.22a, 355b, and 370c of the Illinois
215	273		8 Insurance Code. The Department of Insurance shall enforce the
216	274		9 requirements of this Section.
217	275		10 Rulemaking authority to implement Public Act 95-1045, if
218	276		11 any, is conditioned on the rules being adopted in accordance
219	277		12 with all provisions of the Illinois Administrative Procedure
220	278		13 Act and all rules and procedures of the Joint Committee on
221	279		14 Administrative Rules; any purported rule not so adopted, for
222	280		15 whatever reason, is unauthorized.
223	281		16 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
224	282		17 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
225	283		18 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804,
226	284		19 eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
227	285		20 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff.
228	286		21 1-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420,
229	287		22 eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. 8-11-23;
230	288		23 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-718, eff.
231	289		24 7-19-24; 103-751, eff. 8-2-24; 103-914, eff. 1-1-25; 103-918,
232	290		25 eff. 1-1-25; 103-1024, eff. 1-1-25; revised 11-26-24.)
233	291
234	292
235	293
236	294
237	295
238		-	HB3248 ~~Engrossed~~ - 7 - LRB104 08344 BAB 18395 b
	296	+	HB3248 - 7 - LRB104 08344 BAB 18395 b
239	297
240	298
241		-	HB3248 ~~Engrossed~~- 8 -LRB104 08344 BAB 18395 b HB3248 ~~Engrossed~~ - 8 - LRB104 08344 BAB 18395 b
242		-	HB3248 ~~Engrossed~~ - 8 - LRB104 08344 BAB 18395 b
	299	+	HB3248- 8 -LRB104 08344 BAB 18395 b HB3248 - 8 - LRB104 08344 BAB 18395 b
	300	+	HB3248 - 8 - LRB104 08344 BAB 18395 b
243	301		1 Section 25. The Illinois Insurance Code is amended by
244	302		2 adding Section 356z.80 as follows:
245	303		3 (215 ILCS 5/356z.80 new)
246	304		4 Sec. 356z.80. Laser hair removal. Any group or individual
247	305		5 policy of accident or health insurance or a managed care plan
248	306		6 that is amended, delivered, issued, or renewed after January
249		-	7 1, 2027 shall provide coverage for ~~medically necessary laser~~
250		-	8 ~~hair removal if the~~ procedure is a prescribed medical
251		-	9 ~~treatment in accordance with~~ generally accepted standards of
252		-	10 ~~medical care.~~
253		-	11 ~~Section 30.~~ ~~The Health Maintenance Organization Act is~~
254		-	12 ~~amended by changing Section 5-3~~ ~~as follows:~~
255		-	13 ~~(215 ILCS 125/5-3) (from Ch~~. ~~111 1/2, par.~~ ~~1411.2)~~
256		-	14 ~~(Text of~~ Section ~~before amendment by P.A. 103-808)~~
257		-	15 ~~Sec.~~ 5-3. ~~Insurance Code provisions~~.
258		-	16 (a) ~~Health Maintenance Organizations shall be subject to~~
259		-	17 ~~the~~ provisions ~~of Sections 133, 134, 136, 137, 139, 140,~~
260		-	18 ~~141.1, 141.2, 141.3, 143,~~ ~~143.31, 143c,~~ ~~147, 148, 149, 151,~~
261		-	19 ~~152~~, ~~153~~, ~~154~~, ~~154.5~~, ~~154.6~~, ~~154.7~~, ~~154.8, 155.04, 155.22a,~~
262		-	20 ~~155~~.49, ~~352c, 355~~.2, ~~355~~.3, ~~355.6~~, ~~355b~~, ~~355c~~, ~~356f~~, ~~356g.5-1~~,
263		-	21 ~~356m~~, ~~356q~~, ~~356u.10~~, ~~356v~~, ~~356w~~, ~~356x~~, ~~356z~~.2, ~~356z~~.3a,
264		-	22 ~~356z~~.4, ~~356z.4a~~, ~~356z~~.5, ~~356z~~.6, ~~356z.8~~, ~~356z.9~~, ~~356z~~.10,
265		-	23 ~~356z~~.11, 356z.12, 356z.13, ~~356z.14, 356z.15, 356z.17, 356z.18,~~
	307	+	7 1, 2027 shall provide coverage for laser hair removal if the
	308	+	8 procedure is prescribed medical treatment in accordance with
	309	+	9 generally accepted standards of medical care. This coverage
	310	+	10 shall apply to individuals with conditions including, but not
	311	+	11 limited to, body dysmorphia, hidradentis suppreativa,
	312	+	12 polycystic ovary syndrome, or other similar skin conditions.
	313	+	13 Section 30. The Health Maintenance Organization Act is
	314	+	14 amended by changing Section 5-3 as follows:
	315	+	15 (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
	316	+	16 (Text of Section before amendment by P.A. 103-808)
	317	+	17 Sec. 5-3. Insurance Code provisions.
	318	+	18 (a) Health Maintenance Organizations shall be subject to
	319	+	19 the provisions of Sections 133, 134, 136, 137, 139, 140,
	320	+	20 141.1, 141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151,
	321	+	21 152, 153, 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a,
	322	+	22 155.49, 352c, 355.2, 355.3, 355.6, 355b, 355c, 356f, 356g.5-1,
	323	+	23 356m, 356q, 356u.10, 356v, 356w, 356x, 356z.2, 356z.3a,
266	324
267	325
268	326
269	327
270	328
271		-	HB3248 ~~Engrossed~~ - 8 - LRB104 08344 BAB 18395 b
	329	+	HB3248 - 8 - LRB104 08344 BAB 18395 b
272	330
273	331
274		-	HB3248 ~~Engrossed~~- 9 -LRB104 08344 BAB 18395 b HB3248 ~~Engrossed~~ - 9 - LRB104 08344 BAB 18395 b
275		-	HB3248 ~~Engrossed~~ - 9 - LRB104 08344 BAB 18395 b
276		-	1 356z.19, 356z.20, 356z.21, 356z.22, 356z.23, 356z.24, 356z.25,
277		-	2 356z.26, 356z.28, 356z.29, 356z.30, 356z.31, 356z.32, 356z.33,
278		-	3 356z.34, 356z.35, 356z.36, 356z.37, 356z.38, 356z.39, 356z.40,
279		-	4 356z.~~40a~~, 356z.41, 356z.44, 356z.45, 356z.46, 356z.47,
280		-	5 356z.48, 356z.49, 356z.50, 356z.51, 356z.53, 356z.54, 356z.55,
281		-	6 356z.56, 356z.57, 356z.58, 356z.59, 356z.60, 356z.61, ~~356z.62,~~
282		-	7 356z.63, 356z.64, 356z.65, 356z.66, 356z.67, 356z.68, 356z.69,
283		-	8 356z.70, 356z.71, 356z.72, 356z.73, 356z.74, 356z.75, 356z.77,
284		-	9 356z.80, ~~364~~, ~~364~~.01, ~~364~~.3, ~~367~~.2, ~~367~~.~~2-5~~, ~~367i~~, ~~368a, 368b,~~
285		-	10 ~~368c~~, ~~368d~~, ~~368e~~, ~~370c~~, ~~370c~~.1, ~~401~~, ~~401~~.1, ~~402, 403, 403A,~~
286		-	11 ~~408~~, ~~408~~.2, ~~409~~, ~~412~~, ~~444~~, ~~and 444.1~~, ~~paragraph (c) of~~
287		-	12 ~~subsection (2) of Section 367~~, ~~and Articles IIA~~, ~~VIII~~ 1/2,
288		-	13 ~~XII~~, ~~XII 1/~~2, ~~XIII~~, ~~XIII 1/2~~, ~~XXV, XXVI~~, and ~~XXXIIB~~ of ~~the~~
289		-	14 ~~Illinois Insurance Code.~~
290		-	15 ~~(b) For purposes~~ of the ~~Illinois Insurance Code, except~~
291		-	16 ~~for Sections 444 and 444~~.~~1 and Articles XIII and XIII 1/2,~~
292		-	17 ~~Health Maintenance Organizations in~~ the ~~following categories~~
293		-	18 ~~are deemed to be "domestic~~ ~~companies":~~
294		-	19 ~~(1) a corporation authorized under~~ the ~~Dental Service~~
295		-	20 ~~Plan Act or the Voluntary Health Services Plans Act;~~
296		-	21 (2) a corporation ~~organized~~ under the ~~laws of this~~
297		-	22 ~~State;~~ or
298		-	23 (3) a corporation organized under the laws of ~~another~~
299		-	24 state~~, 30%~~ or ~~more of the enrollees of which are residents~~
300		-	25 ~~of this State, except~~ a corporation ~~subject to~~
301		-	26 ~~substantially~~ the ~~same requirements in its state~~ of
	332	+	HB3248- 9 -LRB104 08344 BAB 18395 b HB3248 - 9 - LRB104 08344 BAB 18395 b
	333	+	HB3248 - 9 - LRB104 08344 BAB 18395 b
	334	+	1 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10,
	335	+	2 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.18,
	336	+	3 356z.19, 356z.20, 356z.21, 356z.22, 356z.23, 356z.24, 356z.25,
	337	+	4 356z.26, 356z.28, 356z.29, 356z.30, 356z.31, 356z.32, 356z.33,
	338	+	5 356z.34, 356z.35, 356z.36, 356z.37, 356z.38, 356z.39, 356z.40,
	339	+	6 356z.40a, 356z.41, 356z.44, 356z.45, 356z.46, 356z.47,
	340	+	7 356z.48, 356z.49, 356z.50, 356z.51, 356z.53, 356z.54, 356z.55,
	341	+	8 356z.56, 356z.57, 356z.58, 356z.59, 356z.60, 356z.61, 356z.62,
	342	+	9 356z.63, 356z.64, 356z.65, 356z.66, 356z.67, 356z.68, 356z.69,
	343	+	10 356z.70, 356z.71, 356z.72, 356z.73, 356z.74, 356z.75, 356z.77,
	344	+	11 356z.80, 364, 364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b,
	345	+	12 368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A,
	346	+	13 408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of
	347	+	14 subsection (2) of Section 367, and Articles IIA, VIII 1/2,
	348	+	15 XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the
	349	+	16 Illinois Insurance Code.
	350	+	17 (b) For purposes of the Illinois Insurance Code, except
	351	+	18 for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
	352	+	19 Health Maintenance Organizations in the following categories
	353	+	20 are deemed to be "domestic companies":
	354	+	21 (1) a corporation authorized under the Dental Service
	355	+	22 Plan Act or the Voluntary Health Services Plans Act;
	356	+	23 (2) a corporation organized under the laws of this
	357	+	24 State; or
	358	+	25 (3) a corporation organized under the laws of another
	359	+	26 state, 30% or more of the enrollees of which are residents
302	360
303	361
304	362
305	363
306	364
307		-	HB3248 ~~Engrossed~~ - 9 - LRB104 08344 BAB 18395 b
	365	+	HB3248 - 9 - LRB104 08344 BAB 18395 b
308	366
309	367
310		-	HB3248 ~~Engrossed~~- 10 -LRB104 08344 BAB 18395 b HB3248 ~~Engrossed~~ - 10 - LRB104 08344 BAB 18395 b
311		-	HB3248 ~~Engrossed~~ - 10 - LRB104 08344 BAB 18395 b
312		-	1 ~~organization as is~~ a ~~"domestic company"~~ ~~under Article VIII~~
313		-	2 ~~1/2 of~~ the ~~Illinois Insurance Code.~~
314		-	3 ~~(c) In considering the merger,~~ ~~consolidation, or other~~
315		-	4 ~~acquisition~~ of ~~control of a Health Maintenance Organization~~
316		-	5 ~~pursuant to Article VIII 1/2 of~~ the ~~Illinois Insurance Code,~~
317		-	6 ~~(1) the Director shall give primary consideration to~~
318		-	7 ~~the continuation~~ of ~~benefits to enrollees and the~~
319		-	8 ~~financial conditions of~~ the ~~acquired Health Maintenance~~
320		-	9 ~~Organization after~~ the ~~merger, consolidation, or other~~
321		-	10 ~~acquisition~~ of ~~control takes effect;~~
322		-	11 ~~(2)(i)~~ the ~~criteria specified in subsection (1)(b) of~~
323		-	12 ~~Section 131.8~~ of ~~the Illinois Insurance Code shall not~~
324		-	13 ~~apply and~~ (ii) the ~~Director,~~ in ~~making his determination~~
325		-	14 ~~with respect to~~ the ~~merger, consolidation,~~ ~~or other~~
326		-	15 ~~acquisition of control~~, ~~need not take into account the~~
327		-	16 ~~effect on competition of~~ the merger, consolidation, or
328		-	17 ~~other~~ acquisition of control;
329		-	18 ~~(3)~~ the ~~Director shall have the power to require the~~
330		-	19 ~~following information:~~
331		-	20 (A) ~~certification by an independent actuary of~~ the
332		-	21 ~~adequacy of the reserves of the Health Maintenance~~
333		-	22 ~~Organization sought to be acquired;~~
334		-	23 ~~(B) pro forma financial statements reflecting~~ the
335		-	24 ~~combined balance sheets of the acquiring company and~~
336		-	25 the ~~Health Maintenance Organization sought to be~~
337		-	26 ~~acquired as~~ of the ~~end of the preceding year~~ and ~~as of~~
	368	+	HB3248- 10 -LRB104 08344 BAB 18395 b HB3248 - 10 - LRB104 08344 BAB 18395 b
	369	+	HB3248 - 10 - LRB104 08344 BAB 18395 b
	370	+	1 of this State, except a corporation subject to
	371	+	2 substantially the same requirements in its state of
	372	+	3 organization as is a "domestic company" under Article VIII
	373	+	4 1/2 of the Illinois Insurance Code.
	374	+	5 (c) In considering the merger, consolidation, or other
	375	+	6 acquisition of control of a Health Maintenance Organization
	376	+	7 pursuant to Article VIII 1/2 of the Illinois Insurance Code,
	377	+	8 (1) the Director shall give primary consideration to
	378	+	9 the continuation of benefits to enrollees and the
	379	+	10 financial conditions of the acquired Health Maintenance
	380	+	11 Organization after the merger, consolidation, or other
	381	+	12 acquisition of control takes effect;
	382	+	13 (2)(i) the criteria specified in subsection (1)(b) of
	383	+	14 Section 131.8 of the Illinois Insurance Code shall not
	384	+	15 apply and (ii) the Director, in making his determination
	385	+	16 with respect to the merger, consolidation, or other
	386	+	17 acquisition of control, need not take into account the
	387	+	18 effect on competition of the merger, consolidation, or
	388	+	19 other acquisition of control;
	389	+	20 (3) the Director shall have the power to require the
	390	+	21 following information:
	391	+	22 (A) certification by an independent actuary of the
	392	+	23 adequacy of the reserves of the Health Maintenance
	393	+	24 Organization sought to be acquired;
	394	+	25 (B) pro forma financial statements reflecting the
	395	+	26 combined balance sheets of the acquiring company and
338	396
339	397
340	398
341	399
342	400
343		-	HB3248 ~~Engrossed~~ - 10 - LRB104 08344 BAB 18395 b
	401	+	HB3248 - 10 - LRB104 08344 BAB 18395 b
344	402
345	403
346		-	HB3248 ~~Engrossed~~- 11 -LRB104 08344 BAB 18395 b HB3248 ~~Engrossed~~ - 11 - LRB104 08344 BAB 18395 b
347		-	HB3248 ~~Engrossed~~ - 11 - LRB104 08344 BAB 18395 b
348		-	1 ~~a date 90 days prior~~ to ~~the acquisition, as well as pro~~
349		-	2 ~~forma financial statements reflecting projected~~
350		-	3 ~~combined operation for~~ a ~~period of 2 years;~~
351		-	4 ~~(C) a pro~~ forma ~~business plan detailing an~~
352		-	5 ~~acquiring party's plans with respect to the~~ operation
353		-	6 ~~of the Health Maintenance Organization sought to be~~
354		-	7 ~~acquired for a period of not less than 3 years; and~~
355		-	8 ~~(D) such other information as~~ the ~~Director shall~~
356		-	9 ~~require.~~
357		-	10 (d) ~~The provisions of Article VIII 1/2 of~~ the ~~Illinois~~
358		-	11 ~~Insurance Code and this Section 5-3 shall apply to the sale by~~
359		-	12 ~~any health maintenance organization~~ of ~~greater than 10%~~ of ~~its~~
360		-	13 ~~enrollee population (including, without limitation,~~ the ~~health~~
361		-	14 maintenance organization~~'s right,~~ ~~title, and interest in and~~
362		-	15 ~~to its~~ health ~~care certificates).~~
363		-	16 ~~(e)~~ In ~~considering any management contract or service~~
364		-	17 ~~agreement subject~~ to ~~Section 141~~.~~1 of the Illinois Insurance~~
365		-	18 ~~Code, the Director~~ (i) ~~shall,~~ in ~~addition to the criteria~~
366		-	19 ~~specified in~~ Section 141.2 of the Illinois Insurance ~~Code,~~
367		-	20 ~~take into account~~ the ~~effect of~~ the ~~management contract or~~
368		-	21 ~~service agreement on~~ the ~~continuation of benefits to enrollees~~
369		-	22 ~~and~~ the ~~financial condition~~ of the ~~health maintenance~~
370		-	23 ~~organization~~ to ~~be managed or serviced, and (ii) need not take~~
371		-	24 ~~into account~~ the ~~effect~~ of the ~~management contract or service~~
372		-	25 ~~agreement on competition.~~
373		-	26 ~~(f) Except for small employer groups as defined in~~ the
	404	+	HB3248- 11 -LRB104 08344 BAB 18395 b HB3248 - 11 - LRB104 08344 BAB 18395 b
	405	+	HB3248 - 11 - LRB104 08344 BAB 18395 b
	406	+	1 the Health Maintenance Organization sought to be
	407	+	2 acquired as of the end of the preceding year and as of
	408	+	3 a date 90 days prior to the acquisition, as well as pro
	409	+	4 forma financial statements reflecting projected
	410	+	5 combined operation for a period of 2 years;
	411	+	6 (C) a pro forma business plan detailing an
	412	+	7 acquiring party's plans with respect to the operation
	413	+	8 of the Health Maintenance Organization sought to be
	414	+	9 acquired for a period of not less than 3 years; and
	415	+	10 (D) such other information as the Director shall
	416	+	11 require.
	417	+	12 (d) The provisions of Article VIII 1/2 of the Illinois
	418	+	13 Insurance Code and this Section 5-3 shall apply to the sale by
	419	+	14 any health maintenance organization of greater than 10% of its
	420	+	15 enrollee population (including, without limitation, the health
	421	+	16 maintenance organization's right, title, and interest in and
	422	+	17 to its health care certificates).
	423	+	18 (e) In considering any management contract or service
	424	+	19 agreement subject to Section 141.1 of the Illinois Insurance
	425	+	20 Code, the Director (i) shall, in addition to the criteria
	426	+	21 specified in Section 141.2 of the Illinois Insurance Code,
	427	+	22 take into account the effect of the management contract or
	428	+	23 service agreement on the continuation of benefits to enrollees
	429	+	24 and the financial condition of the health maintenance
	430	+	25 organization to be managed or serviced, and (ii) need not take
	431	+	26 into account the effect of the management contract or service
374	432
375	433
376	434
377	435
378	436
379		-	HB3248 ~~Engrossed~~ - 11 - LRB104 08344 BAB 18395 b
	437	+	HB3248 - 11 - LRB104 08344 BAB 18395 b
380	438
381	439
382		-	HB3248 ~~Engrossed~~- 12 -LRB104 08344 BAB 18395 b HB3248 ~~Engrossed~~ - 12 - LRB104 08344 BAB 18395 b
383		-	HB3248 ~~Engrossed~~ - 12 - LRB104 08344 BAB 18395 b
384		-	1 ~~Small Employer Rating, Renewability and Portability Health~~
385		-	2 ~~Insurance Act and~~ except for ~~medicare supplement policies~~ as
386		-	3 ~~defined in Section 363 of the Illinois Insurance Code~~, a
387		-	4 ~~Health Maintenance Organization may by contract agree with a~~
388		-	5 ~~group or other enrollment unit to effect refunds or charge~~
389		-	6 ~~additional premiums under the following terms and conditions:~~
390		-	7 ~~(i) the amount of, and~~ other ~~terms and conditions with~~
391		-	8 ~~respect to,~~ the ~~refund or additional premium are set forth~~
392		-	9 in the ~~group or enrollment unit contract agreed in advance~~
393		-	10 of the ~~period for which a~~ refund ~~is to be paid or~~
394		-	11 ~~additional premium is to be charged (which~~ ~~period shall~~
395		-	12 ~~not~~ be ~~less than one year); and~~
396		-	13 ~~(ii) the amount of the refund or~~ additional premium
397		-	14 ~~shall~~ not ~~exceed 20%~~ ~~of the Health Maintenance~~
398		-	15 ~~Organization's profitable~~ or ~~unprofitable experience with~~
399		-	16 ~~respect to~~ the ~~group or other enrollment unit for the~~
400		-	17 ~~period (and, for purposes of a refund~~ or ~~additional~~
401		-	18 ~~premium,~~ the ~~profitable~~ or ~~unprofitable experience shall~~
402		-	19 ~~be calculated taking into account~~ a ~~pro rata share of the~~
403		-	20 ~~Health Maintenance Organization's administrative and~~
404		-	21 ~~marketing expenses,~~ ~~but shall not include any refund to be~~
405		-	22 ~~made or additional premium to be paid pursuant to this~~
406		-	23 ~~subsection (f)). The Health Maintenance Organization and~~
407		-	24 ~~the group~~ or ~~enrollment unit may agree that the profitable~~
408		-	25 ~~or unprofitable experience may be calculated taking into~~
409		-	26 ~~account~~ the ~~refund period and the immediately preceding 2~~
	440	+	HB3248- 12 -LRB104 08344 BAB 18395 b HB3248 - 12 - LRB104 08344 BAB 18395 b
	441	+	HB3248 - 12 - LRB104 08344 BAB 18395 b
	442	+	1 agreement on competition.
	443	+	2 (f) Except for small employer groups as defined in the
	444	+	3 Small Employer Rating, Renewability and Portability Health
	445	+	4 Insurance Act and except for medicare supplement policies as
	446	+	5 defined in Section 363 of the Illinois Insurance Code, a
	447	+	6 Health Maintenance Organization may by contract agree with a
	448	+	7 group or other enrollment unit to effect refunds or charge
	449	+	8 additional premiums under the following terms and conditions:
	450	+	9 (i) the amount of, and other terms and conditions with
	451	+	10 respect to, the refund or additional premium are set forth
	452	+	11 in the group or enrollment unit contract agreed in advance
	453	+	12 of the period for which a refund is to be paid or
	454	+	13 additional premium is to be charged (which period shall
	455	+	14 not be less than one year); and
	456	+	15 (ii) the amount of the refund or additional premium
	457	+	16 shall not exceed 20% of the Health Maintenance
	458	+	17 Organization's profitable or unprofitable experience with
	459	+	18 respect to the group or other enrollment unit for the
	460	+	19 period (and, for purposes of a refund or additional
	461	+	20 premium, the profitable or unprofitable experience shall
	462	+	21 be calculated taking into account a pro rata share of the
	463	+	22 Health Maintenance Organization's administrative and
	464	+	23 marketing expenses, but shall not include any refund to be
	465	+	24 made or additional premium to be paid pursuant to this
	466	+	25 subsection (f)). The Health Maintenance Organization and
	467	+	26 the group or enrollment unit may agree that the profitable
410	468
411	469
412	470
413	471
414	472
415		-	HB3248 ~~Engrossed~~ - 12 - LRB104 08344 BAB 18395 b
	473	+	HB3248 - 12 - LRB104 08344 BAB 18395 b
416	474
417	475
418		-	HB3248 ~~Engrossed~~- 13 -LRB104 08344 BAB 18395 b HB3248 ~~Engrossed~~ - 13 - LRB104 08344 BAB 18395 b
419		-	HB3248 ~~Engrossed~~ - 13 - LRB104 08344 BAB 18395 b
420		-	1 ~~plan years.~~
421		-	2 The ~~Health Maintenance Organization shall include a~~
422		-	3 ~~statement in the evidence of coverage issued to each enrollee~~
423		-	4 ~~describing~~ the ~~possibility of~~ a ~~refund or additional premium,~~
424		-	5 ~~and upon request~~ of ~~any group or enrollment unit, provide~~ to
425		-	6 the ~~group~~ or ~~enrollment unit a description of the method used~~
426		-	7 to ~~calculate (1) the Health Maintenance Organization's~~
427		-	8 ~~profitable experience with respect to~~ the group or enrollment
428		-	9 ~~unit and~~ the ~~resulting refund to the group or enrollment unit~~
429		-	10 ~~or (2)~~ the ~~Health Maintenance Organization's unprofitable~~
430		-	11 ~~experience with respect~~ to the group or enrollment unit ~~and~~
431		-	12 ~~the resulting additional premium to be paid by~~ the ~~group or~~
432		-	13 enrollment unit.
433		-	14 ~~In no event shall~~ the ~~Illinois Health Maintenance~~
434		-	15 ~~Organization Guaranty Association be liable to pay any~~
435		-	16 ~~contractual obligation of an insolvent organization to pay any~~
436		-	17 ~~refund authorized under this Section.~~
437		-	18 ~~(g) Rulemaking authority~~ to ~~implement Public Act 95-1045,~~
438		-	19 ~~if any,~~ ~~is conditioned on the rules being adopted in~~
439		-	20 ~~accordance with all provisions of the Illinois Administrative~~
440		-	21 ~~Procedure Act and all~~ rules ~~and procedures of the Joint~~
441		-	22 ~~Committee on~~ Administrative ~~Rules; any purported rule not so~~
442		-	23 ~~adopted, for whatever reason,~~ ~~is unauthorized.~~
443		-	24 ~~(Source: P.A. 102-30, eff. 1-1-22~~; ~~102-34, eff.~~ ~~6-25-21;~~
444		-	25 ~~102-203~~, ~~eff. 1-1-22; 102-306~~, ~~eff~~. ~~1-1-22; 102-443, eff.~~
445		-	26 ~~1-1-22;~~ 102-~~589~~, eff. 1-1-22; 102-~~642~~, eff. ~~1-1-22~~; ~~102-665,~~
	476	+	HB3248- 13 -LRB104 08344 BAB 18395 b HB3248 - 13 - LRB104 08344 BAB 18395 b
	477	+	HB3248 - 13 - LRB104 08344 BAB 18395 b
	478	+	1 or unprofitable experience may be calculated taking into
	479	+	2 account the refund period and the immediately preceding 2
	480	+	3 plan years.
	481	+	4 The Health Maintenance Organization shall include a
	482	+	5 statement in the evidence of coverage issued to each enrollee
	483	+	6 describing the possibility of a refund or additional premium,
	484	+	7 and upon request of any group or enrollment unit, provide to
	485	+	8 the group or enrollment unit a description of the method used
	486	+	9 to calculate (1) the Health Maintenance Organization's
	487	+	10 profitable experience with respect to the group or enrollment
	488	+	11 unit and the resulting refund to the group or enrollment unit
	489	+	12 or (2) the Health Maintenance Organization's unprofitable
	490	+	13 experience with respect to the group or enrollment unit and
	491	+	14 the resulting additional premium to be paid by the group or
	492	+	15 enrollment unit.
	493	+	16 In no event shall the Illinois Health Maintenance
	494	+	17 Organization Guaranty Association be liable to pay any
	495	+	18 contractual obligation of an insolvent organization to pay any
	496	+	19 refund authorized under this Section.
	497	+	20 (g) Rulemaking authority to implement Public Act 95-1045,
	498	+	21 if any, is conditioned on the rules being adopted in
	499	+	22 accordance with all provisions of the Illinois Administrative
	500	+	23 Procedure Act and all rules and procedures of the Joint
	501	+	24 Committee on Administrative Rules; any purported rule not so
	502	+	25 adopted, for whatever reason, is unauthorized.
	503	+	26 (Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
446	504
447	505
448	506
449	507
450	508
451		-	HB3248 ~~Engrossed~~ - 13 - LRB104 08344 BAB 18395 b
	509	+	HB3248 - 13 - LRB104 08344 BAB 18395 b
452	510
453	511
454		-	HB3248 ~~Engrossed~~- 14 -LRB104 08344 BAB 18395 b HB3248 ~~Engrossed~~ - 14 - LRB104 08344 BAB 18395 b
455		-	HB3248 ~~Engrossed~~ - 14 - LRB104 08344 BAB 18395 b
456		-	1 ~~eff. 10-8-21;~~ 102-~~731~~, eff. 1-1-23; 102-~~775~~, eff. ~~5-13~~-22;
457		-	2 102-~~804~~, eff. 1-1-23; 102-~~813~~, eff. ~~5-13~~-22; 102-~~816~~, ~~eff.~~
458		-	3 ~~1-1-23~~; 102-~~860~~, eff. 1-1-23; 102-~~901~~, eff. ~~7-1~~-22; ~~102-1093,~~
459		-	4 eff. 1-1-23; 102-~~1117~~, eff. 1-13-23; ~~103-84~~, eff. ~~1-1-24;~~
460		-	5 ~~103-91~~, eff. 1-1-24; ~~103-123~~, eff. 1-1-24; ~~103-154~~, ~~eff.~~
461		-	6 ~~6-30~~-23; 103-~~420~~, eff. 1-1-24; ~~103-426, eff. 8-4-23; 103-445,~~
462		-	7 eff. 1-1-24; 103-~~551~~, eff. ~~8-11-23; 103-605, eff. 7~~-1-24;
463		-	8 103-~~618~~, eff. 1-1-25; 103-~~649~~, eff. ~~1-1-25~~; 103-~~656~~, ~~eff.~~
464		-	9 ~~1-1-25; 103-700,~~ eff. 1-1-25; 103-~~718~~, eff. 7-19-24; ~~103-751,~~
465		-	10 ~~eff. 8-2-24;~~ 103-~~753, eff. 8-2-24; 103-758~~, eff. 1-1-25;
466		-	11 ~~103-777, eff. 8-2-24~~; 103-~~914~~, eff. 1-1-25; 103-~~918~~, eff.
467		-	12 ~~1-1-25~~; 103-~~1024~~, eff. 1-1-25; ~~revised 9-26-24.)~~
468		-	13 ~~(Text of Section after amendment by P.A.~~ 103-~~808)~~
469		-	14 ~~Sec~~. ~~5-3~~. ~~Insurance Code provisions.~~
470		-	15 (a) ~~Health Maintenance Organizations shall be subject to~~
471		-	16 ~~the~~ provisions ~~of Sections 133, 134, 136, 137, 139, 140,~~
472		-	17 ~~141.1, 141.2, 141.3, 143,~~ ~~143.31, 143c,~~ ~~147, 148, 149, 151,~~
473		-	18 ~~152~~, ~~153~~, ~~154~~, ~~154.5~~, ~~154.6~~, ~~154.7~~, ~~154.8, 155.04, 155.22a,~~
474		-	19 ~~155~~.49, ~~352c, 355~~.2, ~~355~~.3, ~~355.6~~, ~~355b~~, ~~355c~~, ~~356f~~, ~~356g~~,
475		-	20 ~~356g~~.5-1, ~~356m~~, ~~356q~~, ~~356u~~.10, ~~356v~~, ~~356w~~, ~~356x, 356z.2,~~
476		-	21 ~~356z~~.3a, ~~356z.4~~, ~~356z~~.4a, ~~356z~~.5, ~~356z~~.6, ~~356z.8~~, ~~356z.9~~,
477		-	22 ~~356z~~.10, ~~356z.11~~, 356z.12, ~~356z.13, 356z.14, 356z.15, 356z.17,~~
478		-	23 356z.18, 356z.19, 356z.20, 356z.21, 356z.22, 356z.23, 356z.24,
479		-	24 356z.25, 356z.26, 356z.28, 356z.29, 356z.30, 356z.31, 356z.32,
480		-	25 356z.33, 356z.34, 356z.35, 356z.36, 356z.37, 356z.38, 356z.39,
	512	+	HB3248- 14 -LRB104 08344 BAB 18395 b HB3248 - 14 - LRB104 08344 BAB 18395 b
	513	+	HB3248 - 14 - LRB104 08344 BAB 18395 b
	514	+	1 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
	515	+	2 1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
	516	+	3 eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
	517	+	4 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
	518	+	5 1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
	519	+	6 eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;
	520	+	7 103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.
	521	+	8 6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
	522	+	9 eff. 1-1-24; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24;
	523	+	10 103-618, eff. 1-1-25; 103-649, eff. 1-1-25; 103-656, eff.
	524	+	11 1-1-25; 103-700, eff. 1-1-25; 103-718, eff. 7-19-24; 103-751,
	525	+	12 eff. 8-2-24; 103-753, eff. 8-2-24; 103-758, eff. 1-1-25;
	526	+	13 103-777, eff. 8-2-24; 103-914, eff. 1-1-25; 103-918, eff.
	527	+	14 1-1-25; 103-1024, eff. 1-1-25; revised 9-26-24.)
	528	+	15 (Text of Section after amendment by P.A. 103-808)
	529	+	16 Sec. 5-3. Insurance Code provisions.
	530	+	17 (a) Health Maintenance Organizations shall be subject to
	531	+	18 the provisions of Sections 133, 134, 136, 137, 139, 140,
	532	+	19 141.1, 141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151,
	533	+	20 152, 153, 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a,
	534	+	21 155.49, 352c, 355.2, 355.3, 355.6, 355b, 355c, 356f, 356g,
	535	+	22 356g.5-1, 356m, 356q, 356u.10, 356v, 356w, 356x, 356z.2,
	536	+	23 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9,
	537	+	24 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17,
	538	+	25 356z.18, 356z.19, 356z.20, 356z.21, 356z.22, 356z.23, 356z.24,
481	539
482	540
483	541
484	542
485	543
486		-	HB3248 ~~Engrossed~~ - 14 - LRB104 08344 BAB 18395 b
	544	+	HB3248 - 14 - LRB104 08344 BAB 18395 b
487	545
488	546
489		-	HB3248 ~~Engrossed~~- 15 -LRB104 08344 BAB 18395 b HB3248 ~~Engrossed~~ - 15 - LRB104 08344 BAB 18395 b
490		-	HB3248 ~~Engrossed~~ - 15 - LRB104 08344 BAB 18395 b
491		-	1 356z.40, 356z.~~40a~~, 356z.41, 356z.44, 356z.45, 356z.46,
492		-	2 356z.47, 356z.48, 356z.49, 356z.50, 356z.51, 356z.53, 356z.54,
493		-	3 356z.55, 356z.56, 356z.57, 356z.58, 356z.59, 356z.60, ~~356z.61,~~
494		-	4 356z.62, 356z.63, 356z.64, 356z.65, 356z.66, 356z.67, 356z.68,
495		-	5 356z.69, 356z.70, 356z.71, 356z.72, 356z.73, 356z.74, 356z.75,
496		-	6 356z.77, 356z.80, ~~364~~, ~~364~~.01, ~~364~~.3, ~~367~~.2, ~~367~~.~~2-5~~, ~~367i,~~
497		-	7 ~~368a~~, ~~368b~~, ~~368c~~, ~~368d~~, ~~368e~~, ~~370c~~, ~~370c~~.1, ~~401, 401.1, 402,~~
498		-	8 ~~403~~, ~~403A~~, ~~408~~, ~~408~~.2, ~~409~~, ~~412~~, ~~444, and 444.1, paragraph (c)~~
499		-	9 ~~of subsection (2) of Section 367~~, ~~and Articles IIA~~, ~~VIII~~ 1/2,
500		-	10 ~~XII~~, ~~XII 1/~~2, ~~XIII~~, ~~XIII 1/2~~, ~~XXV, XXVI~~, and ~~XXXIIB of the~~
501		-	11 ~~Illinois Insurance Code.~~
502		-	12 ~~(b) For purposes~~ of the ~~Illinois Insurance Code, except~~
503		-	13 ~~for Sections 444 and 444~~.~~1 and Articles XIII and XIII 1/2,~~
504		-	14 ~~Health Maintenance Organizations in~~ the ~~following categories~~
505		-	15 ~~are deemed to be "domestic~~ ~~companies":~~
506		-	16 ~~(1) a corporation authorized under~~ the ~~Dental Service~~
507		-	17 ~~Plan Act or the Voluntary Health Services Plans Act;~~
508		-	18 (2) a corporation ~~organized~~ under the ~~laws of this~~
509		-	19 ~~State;~~ or
510		-	20 (3) a corporation organized under the laws of ~~another~~
511		-	21 state~~, 30%~~ or ~~more of the enrollees of which are residents~~
512		-	22 ~~of this State, except~~ a corporation ~~subject to~~
513		-	23 ~~substantially~~ the ~~same requirements in its state~~ of
514		-	24 ~~organization as is~~ a ~~"domestic company"~~ ~~under Article VIII~~
515		-	25 ~~1/2 of~~ the ~~Illinois Insurance Code.~~
516		-	26 ~~(c) In considering the merger,~~ ~~consolidation, or other~~
	547	+	HB3248- 15 -LRB104 08344 BAB 18395 b HB3248 - 15 - LRB104 08344 BAB 18395 b
	548	+	HB3248 - 15 - LRB104 08344 BAB 18395 b
	549	+	1 356z.25, 356z.26, 356z.28, 356z.29, 356z.30, 356z.31, 356z.32,
	550	+	2 356z.33, 356z.34, 356z.35, 356z.36, 356z.37, 356z.38, 356z.39,
	551	+	3 356z.40, 356z.40a, 356z.41, 356z.44, 356z.45, 356z.46,
	552	+	4 356z.47, 356z.48, 356z.49, 356z.50, 356z.51, 356z.53, 356z.54,
	553	+	5 356z.55, 356z.56, 356z.57, 356z.58, 356z.59, 356z.60, 356z.61,
	554	+	6 356z.62, 356z.63, 356z.64, 356z.65, 356z.66, 356z.67, 356z.68,
	555	+	7 356z.69, 356z.70, 356z.71, 356z.72, 356z.73, 356z.74, 356z.75,
	556	+	8 356z.77, 356z.80, 364, 364.01, 364.3, 367.2, 367.2-5, 367i,
	557	+	9 368a, 368b, 368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402,
	558	+	10 403, 403A, 408, 408.2, 409, 412, 444, and 444.1, paragraph (c)
	559	+	11 of subsection (2) of Section 367, and Articles IIA, VIII 1/2,
	560	+	12 XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the
	561	+	13 Illinois Insurance Code.
	562	+	14 (b) For purposes of the Illinois Insurance Code, except
	563	+	15 for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
	564	+	16 Health Maintenance Organizations in the following categories
	565	+	17 are deemed to be "domestic companies":
	566	+	18 (1) a corporation authorized under the Dental Service
	567	+	19 Plan Act or the Voluntary Health Services Plans Act;
	568	+	20 (2) a corporation organized under the laws of this
	569	+	21 State; or
	570	+	22 (3) a corporation organized under the laws of another
	571	+	23 state, 30% or more of the enrollees of which are residents
	572	+	24 of this State, except a corporation subject to
	573	+	25 substantially the same requirements in its state of
	574	+	26 organization as is a "domestic company" under Article VIII
517	575
518	576
519	577
520	578
521	579
522		-	HB3248 ~~Engrossed~~ - 15 - LRB104 08344 BAB 18395 b
	580	+	HB3248 - 15 - LRB104 08344 BAB 18395 b
523	581
524	582
525		-	HB3248 ~~Engrossed~~- 16 -LRB104 08344 BAB 18395 b HB3248 ~~Engrossed~~ - 16 - LRB104 08344 BAB 18395 b
526		-	HB3248 ~~Engrossed~~ - 16 - LRB104 08344 BAB 18395 b
527		-	1 ~~acquisition~~ of ~~control of a Health Maintenance Organization~~
528		-	2 ~~pursuant to Article VIII 1/2 of~~ the ~~Illinois Insurance Code,~~
529		-	3 ~~(1) the Director shall give primary consideration to~~
530		-	4 ~~the continuation~~ of ~~benefits to enrollees and the~~
531		-	5 ~~financial conditions of~~ the ~~acquired Health Maintenance~~
532		-	6 ~~Organization after~~ the ~~merger, consolidation, or other~~
533		-	7 ~~acquisition~~ of ~~control takes effect;~~
534		-	8 ~~(2)(i)~~ the ~~criteria specified in subsection (1)(b) of~~
535		-	9 ~~Section 131.8~~ of ~~the Illinois Insurance Code shall not~~
536		-	10 ~~apply and~~ (ii) the ~~Director,~~ in ~~making his determination~~
537		-	11 ~~with respect to~~ the ~~merger, consolidation,~~ ~~or other~~
538		-	12 ~~acquisition of control~~, ~~need not take into account the~~
539		-	13 ~~effect on competition of~~ the merger, consolidation, or
540		-	14 ~~other~~ acquisition of control;
541		-	15 ~~(3)~~ the ~~Director shall have the power to require the~~
542		-	16 ~~following information:~~
543		-	17 (A) ~~certification by an independent actuary of~~ the
544		-	18 ~~adequacy of the reserves of the Health Maintenance~~
545		-	19 ~~Organization sought to be acquired;~~
546		-	20 ~~(B) pro forma financial statements reflecting~~ the
547		-	21 ~~combined balance sheets of the acquiring company and~~
548		-	22 the ~~Health Maintenance Organization sought to be~~
549		-	23 ~~acquired as~~ of the ~~end of the preceding year~~ and ~~as of~~
550		-	24 ~~a date 90 days prior~~ to ~~the acquisition, as well as pro~~
551		-	25 ~~forma financial statements reflecting projected~~
552		-	26 ~~combined operation for~~ a ~~period of 2 years;~~
	583	+	HB3248- 16 -LRB104 08344 BAB 18395 b HB3248 - 16 - LRB104 08344 BAB 18395 b
	584	+	HB3248 - 16 - LRB104 08344 BAB 18395 b
	585	+	1 1/2 of the Illinois Insurance Code.
	586	+	2 (c) In considering the merger, consolidation, or other
	587	+	3 acquisition of control of a Health Maintenance Organization
	588	+	4 pursuant to Article VIII 1/2 of the Illinois Insurance Code,
	589	+	5 (1) the Director shall give primary consideration to
	590	+	6 the continuation of benefits to enrollees and the
	591	+	7 financial conditions of the acquired Health Maintenance
	592	+	8 Organization after the merger, consolidation, or other
	593	+	9 acquisition of control takes effect;
	594	+	10 (2)(i) the criteria specified in subsection (1)(b) of
	595	+	11 Section 131.8 of the Illinois Insurance Code shall not
	596	+	12 apply and (ii) the Director, in making his determination
	597	+	13 with respect to the merger, consolidation, or other
	598	+	14 acquisition of control, need not take into account the
	599	+	15 effect on competition of the merger, consolidation, or
	600	+	16 other acquisition of control;
	601	+	17 (3) the Director shall have the power to require the
	602	+	18 following information:
	603	+	19 (A) certification by an independent actuary of the
	604	+	20 adequacy of the reserves of the Health Maintenance
	605	+	21 Organization sought to be acquired;
	606	+	22 (B) pro forma financial statements reflecting the
	607	+	23 combined balance sheets of the acquiring company and
	608	+	24 the Health Maintenance Organization sought to be
	609	+	25 acquired as of the end of the preceding year and as of
	610	+	26 a date 90 days prior to the acquisition, as well as pro
553	611
554	612
555	613
556	614
557	615
558		-	HB3248 ~~Engrossed~~ - 16 - LRB104 08344 BAB 18395 b
	616	+	HB3248 - 16 - LRB104 08344 BAB 18395 b
559	617
560	618
561		-	HB3248 ~~Engrossed~~- 17 -LRB104 08344 BAB 18395 b HB3248 ~~Engrossed~~ - 17 - LRB104 08344 BAB 18395 b
562		-	HB3248 ~~Engrossed~~ - 17 - LRB104 08344 BAB 18395 b
563		-	1 ~~(C) a pro~~ forma ~~business plan detailing an~~
564		-	2 ~~acquiring party's plans with respect to the~~ operation
565		-	3 ~~of the Health Maintenance Organization sought to be~~
566		-	4 ~~acquired for a period of not less than 3 years; and~~
567		-	5 ~~(D) such other information as~~ the ~~Director shall~~
568		-	6 ~~require.~~
569		-	7 (d) ~~The provisions of Article VIII 1/2 of~~ the ~~Illinois~~
570		-	8 ~~Insurance Code and this Section 5-3 shall apply to the sale by~~
571		-	9 ~~any health maintenance organization~~ of ~~greater than 10%~~ of ~~its~~
572		-	10 ~~enrollee population (including, without limitation,~~ the ~~health~~
573		-	11 maintenance organization~~'s right,~~ ~~title, and interest in and~~
574		-	12 ~~to its~~ health ~~care certificates).~~
575		-	13 ~~(e)~~ In ~~considering any management contract or service~~
576		-	14 ~~agreement subject~~ to ~~Section 141~~.~~1 of the Illinois Insurance~~
577		-	15 ~~Code, the Director~~ (i) ~~shall,~~ in ~~addition to the criteria~~
578		-	16 ~~specified in~~ Section 141.2 of the Illinois Insurance ~~Code,~~
579		-	17 ~~take into account~~ the ~~effect of~~ the ~~management contract or~~
580		-	18 ~~service agreement on~~ the ~~continuation of benefits to enrollees~~
581		-	19 ~~and~~ the ~~financial condition~~ of the ~~health maintenance~~
582		-	20 ~~organization~~ to ~~be managed or serviced, and (ii) need not take~~
583		-	21 ~~into account~~ the ~~effect~~ of the ~~management contract or service~~
584		-	22 ~~agreement on competition.~~
585		-	23 ~~(f) Except for small employer groups as defined in~~ the
586		-	24 ~~Small Employer Rating, Renewability and Portability Health~~
587		-	25 ~~Insurance Act and~~ except for ~~medicare supplement policies~~ as
588		-	26 ~~defined in Section 363 of the Illinois Insurance Code~~, a
	619	+	HB3248- 17 -LRB104 08344 BAB 18395 b HB3248 - 17 - LRB104 08344 BAB 18395 b
	620	+	HB3248 - 17 - LRB104 08344 BAB 18395 b
	621	+	1 forma financial statements reflecting projected
	622	+	2 combined operation for a period of 2 years;
	623	+	3 (C) a pro forma business plan detailing an
	624	+	4 acquiring party's plans with respect to the operation
	625	+	5 of the Health Maintenance Organization sought to be
	626	+	6 acquired for a period of not less than 3 years; and
	627	+	7 (D) such other information as the Director shall
	628	+	8 require.
	629	+	9 (d) The provisions of Article VIII 1/2 of the Illinois
	630	+	10 Insurance Code and this Section 5-3 shall apply to the sale by
	631	+	11 any health maintenance organization of greater than 10% of its
	632	+	12 enrollee population (including, without limitation, the health
	633	+	13 maintenance organization's right, title, and interest in and
	634	+	14 to its health care certificates).
	635	+	15 (e) In considering any management contract or service
	636	+	16 agreement subject to Section 141.1 of the Illinois Insurance
	637	+	17 Code, the Director (i) shall, in addition to the criteria
	638	+	18 specified in Section 141.2 of the Illinois Insurance Code,
	639	+	19 take into account the effect of the management contract or
	640	+	20 service agreement on the continuation of benefits to enrollees
	641	+	21 and the financial condition of the health maintenance
	642	+	22 organization to be managed or serviced, and (ii) need not take
	643	+	23 into account the effect of the management contract or service
	644	+	24 agreement on competition.
	645	+	25 (f) Except for small employer groups as defined in the
	646	+	26 Small Employer Rating, Renewability and Portability Health
589	647
590	648
591	649
592	650
593	651
594		-	HB3248 ~~Engrossed~~ - 17 - LRB104 08344 BAB 18395 b
	652	+	HB3248 - 17 - LRB104 08344 BAB 18395 b
595	653
596	654
597		-	HB3248 ~~Engrossed~~- 18 -LRB104 08344 BAB 18395 b HB3248 ~~Engrossed~~ - 18 - LRB104 08344 BAB 18395 b
598		-	HB3248 ~~Engrossed~~ - 18 - LRB104 08344 BAB 18395 b
599		-	1 ~~Health Maintenance Organization may by contract agree with a~~
600		-	2 ~~group or other enrollment unit to effect refunds or charge~~
601		-	3 ~~additional premiums under the following terms and conditions:~~
602		-	4 ~~(i) the amount of, and~~ other ~~terms and conditions with~~
603		-	5 ~~respect to,~~ the ~~refund or additional premium are set forth~~
604		-	6 in the ~~group or enrollment unit contract agreed in advance~~
605		-	7 of the ~~period for which a~~ refund ~~is to be paid or~~
606		-	8 ~~additional premium is to be charged (which~~ ~~period shall~~
607		-	9 ~~not~~ be ~~less than one year); and~~
608		-	10 ~~(ii) the amount of the refund or~~ additional premium
609		-	11 ~~shall~~ not ~~exceed 20%~~ ~~of the Health Maintenance~~
610		-	12 ~~Organization's profitable~~ or ~~unprofitable experience with~~
611		-	13 ~~respect to~~ the ~~group or other enrollment unit for the~~
612		-	14 ~~period (and, for purposes of a refund~~ or ~~additional~~
613		-	15 ~~premium,~~ the ~~profitable~~ or ~~unprofitable experience shall~~
614		-	16 ~~be calculated taking into account~~ a ~~pro rata share of the~~
615		-	17 ~~Health Maintenance Organization's administrative and~~
616		-	18 ~~marketing expenses,~~ ~~but shall not include any refund to be~~
617		-	19 ~~made or additional premium to be paid pursuant to this~~
618		-	20 ~~subsection (f)). The Health Maintenance Organization and~~
619		-	21 ~~the group~~ or ~~enrollment unit may agree that the profitable~~
620		-	22 ~~or unprofitable experience may be calculated taking into~~
621		-	23 ~~account~~ the ~~refund period and the immediately preceding 2~~
622		-	24 ~~plan years.~~
623		-	25 The ~~Health Maintenance Organization shall include a~~
624		-	26 ~~statement in the evidence of coverage issued to each enrollee~~
	655	+	HB3248- 18 -LRB104 08344 BAB 18395 b HB3248 - 18 - LRB104 08344 BAB 18395 b
	656	+	HB3248 - 18 - LRB104 08344 BAB 18395 b
	657	+	1 Insurance Act and except for medicare supplement policies as
	658	+	2 defined in Section 363 of the Illinois Insurance Code, a
	659	+	3 Health Maintenance Organization may by contract agree with a
	660	+	4 group or other enrollment unit to effect refunds or charge
	661	+	5 additional premiums under the following terms and conditions:
	662	+	6 (i) the amount of, and other terms and conditions with
	663	+	7 respect to, the refund or additional premium are set forth
	664	+	8 in the group or enrollment unit contract agreed in advance
	665	+	9 of the period for which a refund is to be paid or
	666	+	10 additional premium is to be charged (which period shall
	667	+	11 not be less than one year); and
	668	+	12 (ii) the amount of the refund or additional premium
	669	+	13 shall not exceed 20% of the Health Maintenance
	670	+	14 Organization's profitable or unprofitable experience with
	671	+	15 respect to the group or other enrollment unit for the
	672	+	16 period (and, for purposes of a refund or additional
	673	+	17 premium, the profitable or unprofitable experience shall
	674	+	18 be calculated taking into account a pro rata share of the
	675	+	19 Health Maintenance Organization's administrative and
	676	+	20 marketing expenses, but shall not include any refund to be
	677	+	21 made or additional premium to be paid pursuant to this
	678	+	22 subsection (f)). The Health Maintenance Organization and
	679	+	23 the group or enrollment unit may agree that the profitable
	680	+	24 or unprofitable experience may be calculated taking into
	681	+	25 account the refund period and the immediately preceding 2
	682	+	26 plan years.
625	683
626	684
627	685
628	686
629	687
630		-	HB3248 ~~Engrossed~~ - 18 - LRB104 08344 BAB 18395 b
	688	+	HB3248 - 18 - LRB104 08344 BAB 18395 b
631	689
632	690
633		-	HB3248 ~~Engrossed~~- 19 -LRB104 08344 BAB 18395 b HB3248 ~~Engrossed~~ - 19 - LRB104 08344 BAB 18395 b
634		-	HB3248 ~~Engrossed~~ - 19 - LRB104 08344 BAB 18395 b
635		-	1 ~~describing~~ the ~~possibility of~~ a ~~refund or additional premium,~~
636		-	2 ~~and upon request~~ of ~~any group or enrollment unit, provide~~ to
637		-	3 the ~~group~~ or ~~enrollment unit a description of the method used~~
638		-	4 to ~~calculate (1) the Health Maintenance Organization's~~
639		-	5 ~~profitable experience with respect to~~ the group or enrollment
640		-	6 ~~unit and~~ the ~~resulting refund to the group or enrollment unit~~
641		-	7 ~~or (2)~~ the ~~Health Maintenance Organization's unprofitable~~
642		-	8 ~~experience with respect~~ to the group or enrollment unit ~~and~~
643		-	9 ~~the resulting additional premium to be paid by~~ the ~~group or~~
644		-	10 enrollment unit.
645		-	11 ~~In no event shall~~ the ~~Illinois Health Maintenance~~
646		-	12 ~~Organization Guaranty Association be liable to pay any~~
647		-	13 ~~contractual obligation of an insolvent organization to pay any~~
648		-	14 ~~refund authorized under this Section.~~
649		-	15 ~~(g) Rulemaking authority~~ to ~~implement Public Act 95-1045,~~
650		-	16 ~~if any,~~ ~~is conditioned on the rules being adopted in~~
651		-	17 ~~accordance with all provisions of the Illinois Administrative~~
652		-	18 ~~Procedure Act and all~~ rules ~~and procedures of the Joint~~
653		-	19 ~~Committee on~~ Administrative ~~Rules; any purported rule not so~~
654		-	20 ~~adopted, for whatever reason,~~ ~~is unauthorized.~~
655		-	21 ~~(Source: P.A. 102-30, eff. 1-1-22~~; ~~102-34, eff.~~ ~~6-25-21;~~
656		-	22 ~~102-203~~, ~~eff. 1-1-22; 102-306~~, ~~eff~~. ~~1-1-22; 102-443, eff.~~
657		-	23 ~~1-1-22;~~ 102-~~589~~, eff. 1-1-22; 102-~~642~~, eff. ~~1-1-22~~; ~~102-665,~~
658		-	24 ~~eff. 10-8-21;~~ 102-~~731~~, eff. 1-1-23; 102-~~775~~, eff. ~~5-13~~-22;
659		-	25 102-~~804~~, eff. 1-1-23; 102-~~813~~, eff. ~~5-13~~-22; 102-~~816~~, ~~eff.~~
660		-	26 ~~1-1-23~~; 102-~~860~~, eff. 1-1-23; 102-~~901~~, eff. ~~7-1~~-22; ~~102-1093,~~
	691	+	HB3248- 19 -LRB104 08344 BAB 18395 b HB3248 - 19 - LRB104 08344 BAB 18395 b
	692	+	HB3248 - 19 - LRB104 08344 BAB 18395 b
	693	+	1 The Health Maintenance Organization shall include a
	694	+	2 statement in the evidence of coverage issued to each enrollee
	695	+	3 describing the possibility of a refund or additional premium,
	696	+	4 and upon request of any group or enrollment unit, provide to
	697	+	5 the group or enrollment unit a description of the method used
	698	+	6 to calculate (1) the Health Maintenance Organization's
	699	+	7 profitable experience with respect to the group or enrollment
	700	+	8 unit and the resulting refund to the group or enrollment unit
	701	+	9 or (2) the Health Maintenance Organization's unprofitable
	702	+	10 experience with respect to the group or enrollment unit and
	703	+	11 the resulting additional premium to be paid by the group or
	704	+	12 enrollment unit.
	705	+	13 In no event shall the Illinois Health Maintenance
	706	+	14 Organization Guaranty Association be liable to pay any
	707	+	15 contractual obligation of an insolvent organization to pay any
	708	+	16 refund authorized under this Section.
	709	+	17 (g) Rulemaking authority to implement Public Act 95-1045,
	710	+	18 if any, is conditioned on the rules being adopted in
	711	+	19 accordance with all provisions of the Illinois Administrative
	712	+	20 Procedure Act and all rules and procedures of the Joint
	713	+	21 Committee on Administrative Rules; any purported rule not so
	714	+	22 adopted, for whatever reason, is unauthorized.
	715	+	23 (Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
	716	+	24 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
	717	+	25 1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
	718	+	26 eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
661	719
662	720
663	721
664	722
665	723
666		-	HB3248 ~~Engrossed~~ - 19 - LRB104 08344 BAB 18395 b
	724	+	HB3248 - 19 - LRB104 08344 BAB 18395 b
667	725
668	726
669		-	HB3248 ~~Engrossed~~- 20 -LRB104 08344 BAB 18395 b HB3248 ~~Engrossed~~ - 20 - LRB104 08344 BAB 18395 b
670		-	HB3248 ~~Engrossed~~ - 20 - LRB104 08344 BAB 18395 b
671		-	1 eff. 1-1-23; 102-~~1117~~, eff. 1-13-23; ~~103-84~~, eff. ~~1-1-24;~~
672		-	2 ~~103-91~~, eff. 1-1-24; ~~103-123~~, eff. 1-1-24; ~~103-154~~, ~~eff.~~
673		-	3 ~~6-30~~-23; 103-~~420~~, eff. 1-1-24; ~~103-426, eff. 8-4-23; 103-445,~~
674		-	4 eff. 1-1-24; 103-~~551~~, eff. ~~8-11-23; 103-605, eff. 7~~-1-24;
675		-	5 103-~~618~~, eff. 1-1-25; 103-~~649~~, eff. ~~1-1-25~~; 103-~~656~~, ~~eff.~~
676		-	6 ~~1-1-25; 103-700,~~ eff. 1-1-25; 103-~~718~~, eff. 7-19-24; ~~103-751,~~
677		-	7 ~~eff. 8-2-24;~~ 103-~~753, eff. 8-2-24; 103-758~~, eff. 1-1-25;
678		-	8 ~~103-777, eff. 8-2-24~~; 103-~~808~~, eff. 1-1-26; 103-~~914~~, eff.
679		-	9 ~~1-1-25~~; 103-~~918~~, eff. 1-1-25; ~~103-1024, eff. 1-1-25; revised~~
680		-	10 11-26~~-24~~.)
681		-	11 ~~Section 35~~. ~~The Limited Health Service Organization Act is~~
682		-	12 ~~amended by changing Section 4003 as follows:~~
683		-	13 ~~(215 ILCS 130/4003) (from Ch~~. ~~73, par.~~ ~~1504-3)~~
684		-	14 ~~Sec.~~ 4003~~. Illinois Insurance Code provisions. Limited~~
685		-	15 ~~health service organizations shall be subject to the~~
686		-	16 provisions ~~of Sections 133, 134, 136, 137, 139, 140, 141.1,~~
687		-	17 ~~141.2, 141.3, 143,~~ ~~143.31, 143c,~~ ~~147, 148,~~ ~~149, 151, 152, 153,~~
688		-	18 ~~154~~, ~~154.5~~, ~~154.6~~, ~~154.7~~, ~~154.8~~, ~~155.04~~, ~~155~~.37, ~~155.49, 352c,~~
689		-	19 ~~355~~.2, ~~355~~.3, ~~355b~~, ~~355d~~, ~~356m~~, ~~356q~~, ~~356v~~, ~~356z.4~~, ~~356z.4a~~,
690		-	20 ~~356z.10~~, ~~356z~~.21, ~~356z~~.22, ~~356z~~.25, ~~356z~~.26, ~~356z~~.29, ~~356z~~.32,
691		-	21 ~~356z~~.33, 356z.41, 356z.46, ~~356z.47, 356z.51, 356z.53, 356z.54,~~
692		-	22 356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68, 356z.71,
693		-	23 356z.73, 356z.74, 356z.75, 356z.80, ~~364~~.3, ~~368a~~, ~~401~~, ~~401.1,~~
694		-	24 ~~402~~, ~~403~~, ~~403A~~, ~~408~~, ~~408~~.2, ~~409~~, ~~412~~, ~~444, and 444.1 and~~
	727	+	HB3248- 20 -LRB104 08344 BAB 18395 b HB3248 - 20 - LRB104 08344 BAB 18395 b
	728	+	HB3248 - 20 - LRB104 08344 BAB 18395 b
	729	+	1 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
	730	+	2 1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
	731	+	3 eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;
	732	+	4 103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.
	733	+	5 6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
	734	+	6 eff. 1-1-24; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24;
	735	+	7 103-618, eff. 1-1-25; 103-649, eff. 1-1-25; 103-656, eff.
	736	+	8 1-1-25; 103-700, eff. 1-1-25; 103-718, eff. 7-19-24; 103-751,
	737	+	9 eff. 8-2-24; 103-753, eff. 8-2-24; 103-758, eff. 1-1-25;
	738	+	10 103-777, eff. 8-2-24; 103-808, eff. 1-1-26; 103-914, eff.
	739	+	11 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; revised
	740	+	12 11-26-24.)
	741	+	13 Section 35. The Limited Health Service Organization Act is
	742	+	14 amended by changing Section 4003 as follows:
	743	+	15 (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
	744	+	16 Sec. 4003. Illinois Insurance Code provisions. Limited
	745	+	17 health service organizations shall be subject to the
	746	+	18 provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
	747	+	19 141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151, 152, 153,
	748	+	20 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 352c,
	749	+	21 355.2, 355.3, 355b, 355d, 356m, 356q, 356v, 356z.4, 356z.4a,
	750	+	22 356z.10, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.32,
	751	+	23 356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
	752	+	24 356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68, 356z.71,
695	753
696	754
697	755
698	756
699	757
700		-	HB3248 ~~Engrossed~~ - 20 - LRB104 08344 BAB 18395 b
	758	+	HB3248 - 20 - LRB104 08344 BAB 18395 b
701	759
702	760
703		-	HB3248 Engrossed- 21 -LRB104 08344 BAB 18395 b HB3248 Engrossed - 21 - LRB104 08344 BAB 18395 b
704		-	HB3248 Engrossed - 21 - LRB104 08344 BAB 18395 b
705		-	1 Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and
706		-	2 XXVI of the Illinois Insurance Code. Nothing in this Section
707		-	3 shall require a limited health care plan to cover any service
708		-	4 that is not a limited health service. For purposes of the
709		-	5 Illinois Insurance Code, except for Sections 444 and 444.1 and
710		-	6 Articles XIII and XIII 1/2, limited health service
711		-	7 organizations in the following categories are deemed to be
712		-	8 domestic companies:
713		-	9 (1) a corporation under the laws of this State; or
714		-	10 (2) a corporation organized under the laws of another
715		-	11 state, 30% or more of the enrollees of which are residents
716		-	12 of this State, except a corporation subject to
717		-	13 substantially the same requirements in its state of
718		-	14 organization as is a domestic company under Article VIII
719		-	15 1/2 of the Illinois Insurance Code.
720		-	16 (Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
721		-	17 102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-731, eff.
722		-	18 1-1-23; 102-775, eff. 5-13-22; 102-813, eff. 5-13-22; 102-816,
723		-	19 eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
724		-	20 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
725		-	21 1-1-24; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
726		-	22 eff. 1-1-24; 103-605, eff. 7-1-24; 103-649, eff. 1-1-25;
727		-	23 103-656, eff. 1-1-25; 103-700, eff. 1-1-25; 103-718, eff.
728		-	24 7-19-24; 103-751, eff. 8-2-24; 103-758, eff. 1-1-25; 103-832,
729		-	25 eff. 1-1-25; 103-1024, eff. 1-1-25; revised 11-26-24.)
	761	+	HB3248- 21 -LRB104 08344 BAB 18395 b HB3248 - 21 - LRB104 08344 BAB 18395 b
	762	+	HB3248 - 21 - LRB104 08344 BAB 18395 b
	763	+	1 356z.73, 356z.74, 356z.75, 356z.80, 364.3, 368a, 401, 401.1,
	764	+	2 402, 403, 403A, 408, 408.2, 409, 412, 444, and 444.1 and
	765	+	3 Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and
	766	+	4 XXVI of the Illinois Insurance Code. Nothing in this Section
	767	+	5 shall require a limited health care plan to cover any service
	768	+	6 that is not a limited health service. For purposes of the
	769	+	7 Illinois Insurance Code, except for Sections 444 and 444.1 and
	770	+	8 Articles XIII and XIII 1/2, limited health service
	771	+	9 organizations in the following categories are deemed to be
	772	+	10 domestic companies:
	773	+	11 (1) a corporation under the laws of this State; or
	774	+	12 (2) a corporation organized under the laws of another
	775	+	13 state, 30% or more of the enrollees of which are residents
	776	+	14 of this State, except a corporation subject to
	777	+	15 substantially the same requirements in its state of
	778	+	16 organization as is a domestic company under Article VIII
	779	+	17 1/2 of the Illinois Insurance Code.
	780	+	18 (Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
	781	+	19 102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-731, eff.
	782	+	20 1-1-23; 102-775, eff. 5-13-22; 102-813, eff. 5-13-22; 102-816,
	783	+	21 eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
	784	+	22 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
	785	+	23 1-1-24; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
	786	+	24 eff. 1-1-24; 103-605, eff. 7-1-24; 103-649, eff. 1-1-25;
	787	+	25 103-656, eff. 1-1-25; 103-700, eff. 1-1-25; 103-718, eff.
	788	+	26 7-19-24; 103-751, eff. 8-2-24; 103-758, eff. 1-1-25; 103-832,
730	789
731	790
732	791
733	792
734	793
735		-	HB3248 ~~Engrossed~~ - 21 - LRB104 08344 BAB 18395 b
	794	+	HB3248 - 21 - LRB104 08344 BAB 18395 b
736	795
737	796
738		-	HB3248 Engrossed- 22 -LRB104 08344 BAB 18395 b HB3248 Engrossed - 22 - LRB104 08344 BAB 18395 b
739		-	HB3248 Engrossed - 22 - LRB104 08344 BAB 18395 b
740		-	1 Section 40. The Voluntary Health Services Plans Act is
741		-	2 amended by changing Section 10 as follows:
742		-	3 (215 ILCS 165/10) (from Ch. 32, par. 604)
743		-	4 Sec. 10. Application of Insurance Code provisions. Health
744		-	5 services plan corporations and all persons interested therein
745		-	6 or dealing therewith shall be subject to the provisions of
746		-	7 Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
747		-	8 143, 143.31, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3,
748		-	9 355b, 355d, 356g, 356g.5, 356g.5-1, 356m, 356q, 356r, 356t,
749		-	10 356u, 356u.10, 356v, 356w, 356x, 356y, 356z.1, 356z.2,
750		-	11 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9,
751		-	12 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18,
752		-	13 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30,
753		-	14 356z.32, 356z.32a, 356z.33, 356z.40, 356z.41, 356z.46,
754		-	15 356z.47, 356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59,
755		-	16 356z.60, 356z.61, 356z.62, 356z.64, 356z.67, 356z.68, 356z.71,
756		-	17 356z.72, 356z.74, 356z.75, 356z.77, 356z.80, 364.01, 364.3,
757		-	18 367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412,
758		-	19 and paragraphs (7) and (15) of Section 367 of the Illinois
759		-	20 Insurance Code.
760		-	21 Rulemaking authority to implement Public Act 95-1045, if
761		-	22 any, is conditioned on the rules being adopted in accordance
762		-	23 with all provisions of the Illinois Administrative Procedure
763		-	24 Act and all rules and procedures of the Joint Committee on
764		-	25 Administrative Rules; any purported rule not so adopted, for
	797	+	HB3248- 22 -LRB104 08344 BAB 18395 b HB3248 - 22 - LRB104 08344 BAB 18395 b
	798	+	HB3248 - 22 - LRB104 08344 BAB 18395 b
	799	+	1 eff. 1-1-25; 103-1024, eff. 1-1-25; revised 11-26-24.)
	800	+	2 Section 40. The Voluntary Health Services Plans Act is
	801	+	3 amended by changing Section 10 as follows:
	802	+	4 (215 ILCS 165/10) (from Ch. 32, par. 604)
	803	+	5 Sec. 10. Application of Insurance Code provisions. Health
	804	+	6 services plan corporations and all persons interested therein
	805	+	7 or dealing therewith shall be subject to the provisions of
	806	+	8 Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
	807	+	9 143, 143.31, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3,
	808	+	10 355b, 355d, 356g, 356g.5, 356g.5-1, 356m, 356q, 356r, 356t,
	809	+	11 356u, 356u.10, 356v, 356w, 356x, 356y, 356z.1, 356z.2,
	810	+	12 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9,
	811	+	13 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18,
	812	+	14 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30,
	813	+	15 356z.32, 356z.32a, 356z.33, 356z.40, 356z.41, 356z.46,
	814	+	16 356z.47, 356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59,
	815	+	17 356z.60, 356z.61, 356z.62, 356z.64, 356z.67, 356z.68, 356z.71,
	816	+	18 356z.72, 356z.74, 356z.75, 356z.77, 356z.80, 364.01, 364.3,
	817	+	19 367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412,
	818	+	20 and paragraphs (7) and (15) of Section 367 of the Illinois
	819	+	21 Insurance Code.
	820	+	22 Rulemaking authority to implement Public Act 95-1045, if
	821	+	23 any, is conditioned on the rules being adopted in accordance
	822	+	24 with all provisions of the Illinois Administrative Procedure
765	823
766	824
767	825
768	826
769	827
770		-	HB3248 ~~Engrossed~~ - 22 - LRB104 08344 BAB 18395 b
	828	+	HB3248 - 22 - LRB104 08344 BAB 18395 b
771	829
772	830
773		-	HB3248 ~~Engrossed~~- 23 -LRB104 08344 BAB 18395 b HB3248 ~~Engrossed~~ - 23 - LRB104 08344 BAB 18395 b
774		-	HB3248 ~~Engrossed~~ - 23 - LRB104 08344 BAB 18395 b
775		-	1 ~~whatever reason,~~ ~~is unauthorized.~~
776		-	2 ~~(Source: P.A. 102-30~~, ~~eff. 1-1-22; 102-203, eff. 1-1-22;~~
777		-	3 ~~102-306~~, ~~eff~~. ~~1-1-22; 102-642, eff. 1-1-22; 102-665, eff.~~
778		-	4 ~~10-8-21;~~ 102-~~731~~, eff. 1-1-23; 102-~~775~~, eff. ~~5-13~~-22; ~~102-804,~~
779		-	5 ~~eff. 1-1-23;~~ 102-~~813, eff. 5-13-22; 102-816~~, eff. 1-1-23;
780		-	6 102-~~860~~, eff. 1-1-23; 102-~~901~~, eff. ~~7-1~~-22; 102-~~1093~~, ~~eff.~~
781		-	7 1-1-23; 102-~~1117~~, eff. 1-13-23; ~~103-84~~, eff. 1-1-24; ~~103-91,~~
782		-	8 ~~eff. 1-1-24; 103-420~~, eff. 1-1-24; ~~103-445~~, eff. 1-1-24;
783		-	9 ~~103-551~~, eff. ~~8-11~~-23; 103-~~605~~, eff. 7-1-24; 103-~~656~~, ~~eff.~~
784		-	10 1-1~~-25; 103-718, eff. 7-19~~-24; 103-~~751~~, eff. ~~8-2~~-24; 103-~~753~~,
785		-	11 eff. 8-2-24; 103-~~758~~, eff. ~~1-1-25; 103-832, eff. 1-1-25;~~
786		-	12 ~~103-914, eff.~~ 1-1-25; 103-~~918~~, eff. ~~1-1-25~~; 103-~~1024~~, eff.
787		-	13 1-1-25; ~~revised 11-26-24.)~~
788		-	14 ~~Section 45~~. ~~The Illinois Public Aid Code is amended by~~
789		-	15 ~~changing Section 5-16~~.~~8 as follows:~~
790		-	16 ~~(305 ILCS 5/5-16.8)~~
791		-	17 ~~Sec.~~ 5-16.8~~. Required health benefits. The medical~~
792		-	18 ~~assistance program shall (i~~) ~~provide the post-mastectomy care~~
793		-	19 ~~benefits~~ required ~~to be covered by a policy of accident and~~
794		-	20 ~~health insurance under Section 356t and~~ the ~~coverage required~~
795		-	21 ~~under Sections 356g.5, 356q,~~ ~~356u, 356w,~~ ~~356x, 356z.6,~~
796		-	22 ~~356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,~~
797		-	23 ~~356z~~.47, 356z.51, ~~356z.53, 356z.59, 356z.60, 356z.61, 356z.64,~~
798		-	24 ~~and~~ 356z.~~67, and 356z.71~~, 356z.75, ~~and~~ 356z.~~80 of the Illinois~~
	831	+	HB3248- 23 -LRB104 08344 BAB 18395 b HB3248 - 23 - LRB104 08344 BAB 18395 b
	832	+	HB3248 - 23 - LRB104 08344 BAB 18395 b
	833	+	1 Act and all rules and procedures of the Joint Committee on
	834	+	2 Administrative Rules; any purported rule not so adopted, for
	835	+	3 whatever reason, is unauthorized.
	836	+	4 (Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
	837	+	5 102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff.
	838	+	6 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804,
	839	+	7 eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
	840	+	8 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff.
	841	+	9 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
	842	+	10 eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
	843	+	11 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-656, eff.
	844	+	12 1-1-25; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-753,
	845	+	13 eff. 8-2-24; 103-758, eff. 1-1-25; 103-832, eff. 1-1-25;
	846	+	14 103-914, eff. 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff.
	847	+	15 1-1-25; revised 11-26-24.)
	848	+	16 Section 45. The Illinois Public Aid Code is amended by
	849	+	17 changing Section 5-16.8 as follows:
	850	+	18 (305 ILCS 5/5-16.8)
	851	+	19 Sec. 5-16.8. Required health benefits. The medical
	852	+	20 assistance program shall (i) provide the post-mastectomy care
	853	+	21 benefits required to be covered by a policy of accident and
	854	+	22 health insurance under Section 356t and the coverage required
	855	+	23 under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6,
	856	+	24 356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,
799	857
800	858
801	859
802	860
803	861
804		-	HB3248 ~~Engrossed~~ - 23 - LRB104 08344 BAB 18395 b
	862	+	HB3248 - 23 - LRB104 08344 BAB 18395 b
805	863
806	864
807		-	HB3248 ~~Engrossed~~- 24 -LRB104 08344 BAB 18395 b HB3248 ~~Engrossed~~ - 24 - LRB104 08344 BAB 18395 b
808		-	HB3248 ~~Engrossed~~ - 24 - LRB104 08344 BAB 18395 b
809		-	1 ~~Insurance Code~~, ~~(ii) be subject to the provisions of Sections~~
810		-	2 356z.19, 356z.~~44, 356z.49, 364.01, 370c~~, and ~~370c~~.1 of the
811		-	3 ~~Illinois~~ Insurance Code, ~~and~~ (~~iii~~) be subject to the
812		-	4 ~~provisions of subsection (d-5) of Section 10~~ of the ~~Network~~
813		-	5 ~~Adequacy~~ and ~~Transparency Act.~~
814		-	6 The ~~Department, by rule, shall adopt a model similar to~~
815		-	7 ~~the requirements of Section 356z~~.~~39 of the Illinois Insurance~~
816		-	8 ~~Code.~~
817		-	9 ~~On and after July 1,~~ ~~2012,~~ the ~~Department shall reduce any~~
818		-	10 ~~rate of reimbursement for services or other payments or alter~~
819		-	11 ~~any methodologies authorized by this Code to~~ reduce any ~~rate~~
820		-	12 of reimbursement for services or other payments ~~in accordance~~
821		-	13 ~~with Section 5-5e.~~
822		-	14 ~~To ensure full access to the benefits set forth~~ in ~~this~~
823		-	15 Section~~, on and after January 1, 2016, the Department shall~~
824		-	16 ensure ~~that provider and hospital reimbursement for~~
825		-	17 ~~post-mastectomy care benefits required under this Section are~~
826		-	18 ~~no lower than the Medicare~~ reimbursement ~~rate.~~
827		-	19 ~~(Source: P.A. 102-30, eff.~~ ~~1-1-22; 102-144, eff.~~ ~~1-1-22;~~
828		-	20 ~~102-203, eff~~. ~~1-1-22; 102-306, eff. 1-1-22; 102-530, eff.~~
829		-	21 ~~1-1-22;~~ 102-~~642~~, eff. 1-1-22; 102-~~804~~, eff. 1-1-23; ~~102-813,~~
830		-	22 ~~eff. 5-13-22;~~ 102-~~816~~, eff. 1-1-23; 102-~~1093~~, eff. 1-1-23;
831		-	23 102-~~1117, eff. 1-13-23; 103-84~~, eff. 1-1-24; ~~103-91~~, eff.
832		-	24 ~~1-1-24~~; ~~103-420~~, eff. 1-1-24; ~~103-605~~, eff. 7-1-24; ~~103-703,~~
833		-	25 eff. 1-~~1-25~~; 103-~~758~~, eff. 1-1-25; 103-~~1024~~, eff. ~~1-1-25;~~
834		-	26 ~~revised 11-26~~-24.)
	865	+	HB3248- 24 -LRB104 08344 BAB 18395 b HB3248 - 24 - LRB104 08344 BAB 18395 b
	866	+	HB3248 - 24 - LRB104 08344 BAB 18395 b
	867	+	1 356z.47, 356z.51, 356z.53, 356z.59, 356z.60, 356z.61, 356z.64,
	868	+	2 and 356z.67, and 356z.71, 356z.75, and 356z.80 of the Illinois
	869	+	3 Insurance Code, (ii) be subject to the provisions of Sections
	870	+	4 356z.19, 356z.44, 356z.49, 364.01, 370c, and 370c.1 of the
	871	+	5 Illinois Insurance Code, and (iii) be subject to the
	872	+	6 provisions of subsection (d-5) of Section 10 of the Network
	873	+	7 Adequacy and Transparency Act.
	874	+	8 The Department, by rule, shall adopt a model similar to
	875	+	9 the requirements of Section 356z.39 of the Illinois Insurance
	876	+	10 Code.
	877	+	11 On and after July 1, 2012, the Department shall reduce any
	878	+	12 rate of reimbursement for services or other payments or alter
	879	+	13 any methodologies authorized by this Code to reduce any rate
	880	+	14 of reimbursement for services or other payments in accordance
	881	+	15 with Section 5-5e.
	882	+	16 To ensure full access to the benefits set forth in this
	883	+	17 Section, on and after January 1, 2016, the Department shall
	884	+	18 ensure that provider and hospital reimbursement for
	885	+	19 post-mastectomy care benefits required under this Section are
	886	+	20 no lower than the Medicare reimbursement rate.
	887	+	21 (Source: P.A. 102-30, eff. 1-1-22; 102-144, eff. 1-1-22;
	888	+	22 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-530, eff.
	889	+	23 1-1-22; 102-642, eff. 1-1-22; 102-804, eff. 1-1-23; 102-813,
	890	+	24 eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093, eff. 1-1-23;
	891	+	25 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
	892	+	26 1-1-24; 103-420, eff. 1-1-24; 103-605, eff. 7-1-24; 103-703,
835	893
836	894
837	895
838	896
839	897
840		-	HB3248 ~~Engrossed~~ - 24 - LRB104 08344 BAB 18395 b
	898	+	HB3248 - 24 - LRB104 08344 BAB 18395 b
841	899
842	900
843		-	HB3248 Engrossed- 25 -LRB104 08344 BAB 18395 b HB3248 Engrossed - 25 - LRB104 08344 BAB 18395 b
844		-	HB3248 Engrossed - 25 - LRB104 08344 BAB 18395 b
845		-	1 Section 95. No acceleration or delay. Where this Act makes
846		-	2 changes in a statute that is represented in this Act by text
847		-	3 that is not yet or no longer in effect (for example, a Section
848		-	4 represented by multiple versions), the use of that text does
849		-	5 not accelerate or delay the taking effect of (i) the changes
850		-	6 made by this Act or (ii) provisions derived from any other
851		-	7 Public Act.
	901	+	HB3248- 25 -LRB104 08344 BAB 18395 b HB3248 - 25 - LRB104 08344 BAB 18395 b
	902	+	HB3248 - 25 - LRB104 08344 BAB 18395 b
	903	+	1 eff. 1-1-25; 103-758, eff. 1-1-25; 103-1024, eff. 1-1-25;
	904	+	2 revised 11-26-24.)
852	905
853	906
854	907
855	908
856	909
857		-	HB3248 ~~Engrossed~~ - 25 - LRB104 08344 BAB 18395 b
	910	+	HB3248 - 25 - LRB104 08344 BAB 18395 b