104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB3561 Introduced , by Rep. Dagmara Avelar SYNOPSIS AS INTRODUCED: See Index Amends the Illinois Insurance Code. Requires a group or individual policy of accident and health insurance or a managed care plan to provide coverage for at least one early egg allergen introduction dietary supplement and one early peanut allergen introduction dietary supplement. Provides that the required coverage shall be provided at no cost to a covered individual, including deductible payments and cost-sharing amounts charged once a deductible is met. Except as otherwise provided, nothing in the provisions prevents the operation of such a policy provision as a deductible, coinsurance, allowable charge limitation, coordination of benefits, or a provision restricting coverage to services by a licensed, certified, or carrier-approved provider or facility. Provides that the required coverage does not apply to accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care, disability income, or other limited benefit health insurance policies, and that the cost-sharing limitation does not apply to a catastrophic health plan to the extent the cost-sharing limitation would cause the plan to fail to be treated as a catastrophic plan under federal law. Provides that the cost-sharing limitation does not apply to a high deductible health plan to the extent this cost-sharing limitation would cause the plan to fail to be treated as a high deductible health plan under specified provisions of the Internal Revenue Code. Provides that, if the cost-sharing limitation would result in an enrollee becoming ineligible for a health savings account under federal law, the cost-sharing limitation only applies to a qualified high deductible health plan after the enrollee's deductible has been met. 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 10745 BAB 20824 b A BILL FOR 104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB3561 Introduced , by Rep. Dagmara Avelar SYNOPSIS AS INTRODUCED: See Index See Index Amends the Illinois Insurance Code. Requires a group or individual policy of accident and health insurance or a managed care plan to provide coverage for at least one early egg allergen introduction dietary supplement and one early peanut allergen introduction dietary supplement. Provides that the required coverage shall be provided at no cost to a covered individual, including deductible payments and cost-sharing amounts charged once a deductible is met. Except as otherwise provided, nothing in the provisions prevents the operation of such a policy provision as a deductible, coinsurance, allowable charge limitation, coordination of benefits, or a provision restricting coverage to services by a licensed, certified, or carrier-approved provider or facility. Provides that the required coverage does not apply to accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care, disability income, or other limited benefit health insurance policies, and that the cost-sharing limitation does not apply to a catastrophic health plan to the extent the cost-sharing limitation would cause the plan to fail to be treated as a catastrophic plan under federal law. Provides that the cost-sharing limitation does not apply to a high deductible health plan to the extent this cost-sharing limitation would cause the plan to fail to be treated as a high deductible health plan under specified provisions of the Internal Revenue Code. Provides that, if the cost-sharing limitation would result in an enrollee becoming ineligible for a health savings account under federal law, the cost-sharing limitation only applies to a qualified high deductible health plan after the enrollee's deductible has been met. 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 10745 BAB 20824 b LRB104 10745 BAB 20824 b A BILL FOR 104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB3561 Introduced , by Rep. Dagmara Avelar SYNOPSIS AS INTRODUCED: See Index See Index See Index Amends the Illinois Insurance Code. Requires a group or individual policy of accident and health insurance or a managed care plan to provide coverage for at least one early egg allergen introduction dietary supplement and one early peanut allergen introduction dietary supplement. Provides that the required coverage shall be provided at no cost to a covered individual, including deductible payments and cost-sharing amounts charged once a deductible is met. Except as otherwise provided, nothing in the provisions prevents the operation of such a policy provision as a deductible, coinsurance, allowable charge limitation, coordination of benefits, or a provision restricting coverage to services by a licensed, certified, or carrier-approved provider or facility. Provides that the required coverage does not apply to accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care, disability income, or other limited benefit health insurance policies, and that the cost-sharing limitation does not apply to a catastrophic health plan to the extent the cost-sharing limitation would cause the plan to fail to be treated as a catastrophic plan under federal law. Provides that the cost-sharing limitation does not apply to a high deductible health plan to the extent this cost-sharing limitation would cause the plan to fail to be treated as a high deductible health plan under specified provisions of the Internal Revenue Code. Provides that, if the cost-sharing limitation would result in an enrollee becoming ineligible for a health savings account under federal law, the cost-sharing limitation only applies to a qualified high deductible health plan after the enrollee's deductible has been met. 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 10745 BAB 20824 b LRB104 10745 BAB 20824 b LRB104 10745 BAB 20824 b A BILL FOR HB3561LRB104 10745 BAB 20824 b HB3561 LRB104 10745 BAB 20824 b HB3561 LRB104 10745 BAB 20824 b 1 AN ACT concerning regulation. 2 Be it enacted by the People of the State of Illinois, 3 represented in the General Assembly: 4 Section 5. The State Employees Group Insurance Act of 1971 5 is amended by changing Section 6.11 as follows: 6 (5 ILCS 375/6.11) 7 Sec. 6.11. Required health benefits; Illinois Insurance 8 Code requirements. The program of health benefits shall 9 provide the post-mastectomy care benefits required to be 10 covered by a policy of accident and health insurance under 11 Section 356t of the Illinois Insurance Code. The program of 12 health benefits shall provide the coverage required under 13 Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10, 14 356w, 356x, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 15 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 16 356z.17, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32, 17 356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 18 356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59, 19 356z.60, 356z.61, 356z.62, 356z.64, 356z.67, 356z.68, and 20 356z.70, and 356z.71, 356z.74, 356z.76, 356z.77, and 356z.80 21 of the Illinois Insurance Code. The program of health benefits 22 must comply with Sections 155.22a, 155.37, 355b, 356z.19, 23 370c, and 370c.1 and Article XXXIIB of the Illinois Insurance 104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB3561 Introduced , by Rep. Dagmara Avelar SYNOPSIS AS INTRODUCED: See Index See Index See Index Amends the Illinois Insurance Code. Requires a group or individual policy of accident and health insurance or a managed care plan to provide coverage for at least one early egg allergen introduction dietary supplement and one early peanut allergen introduction dietary supplement. Provides that the required coverage shall be provided at no cost to a covered individual, including deductible payments and cost-sharing amounts charged once a deductible is met. Except as otherwise provided, nothing in the provisions prevents the operation of such a policy provision as a deductible, coinsurance, allowable charge limitation, coordination of benefits, or a provision restricting coverage to services by a licensed, certified, or carrier-approved provider or facility. Provides that the required coverage does not apply to accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care, disability income, or other limited benefit health insurance policies, and that the cost-sharing limitation does not apply to a catastrophic health plan to the extent the cost-sharing limitation would cause the plan to fail to be treated as a catastrophic plan under federal law. Provides that the cost-sharing limitation does not apply to a high deductible health plan to the extent this cost-sharing limitation would cause the plan to fail to be treated as a high deductible health plan under specified provisions of the Internal Revenue Code. Provides that, if the cost-sharing limitation would result in an enrollee becoming ineligible for a health savings account under federal law, the cost-sharing limitation only applies to a qualified high deductible health plan after the enrollee's deductible has been met. 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 10745 BAB 20824 b LRB104 10745 BAB 20824 b LRB104 10745 BAB 20824 b A BILL FOR See Index LRB104 10745 BAB 20824 b HB3561 LRB104 10745 BAB 20824 b HB3561- 2 -LRB104 10745 BAB 20824 b HB3561 - 2 - LRB104 10745 BAB 20824 b HB3561 - 2 - LRB104 10745 BAB 20824 b 1 Code. The program of health benefits shall provide the 2 coverage required under Section 356m of the Illinois Insurance 3 Code and, for the employees of the State Employee Group 4 Insurance Program only, the coverage as also provided in 5 Section 6.11B of this Act. The Department of Insurance shall 6 enforce the requirements of this Section with respect to 7 Sections 370c and 370c.1 of the Illinois Insurance Code; all 8 other requirements of this Section shall be enforced by the 9 Department of Central Management Services. 10 Rulemaking authority to implement Public Act 95-1045, if 11 any, is conditioned on the rules being adopted in accordance 12 with all provisions of the Illinois Administrative Procedure 13 Act and all rules and procedures of the Joint Committee on 14 Administrative Rules; any purported rule not so adopted, for 15 whatever reason, is unauthorized. 16 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 17 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. 18 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-768, 19 eff. 1-1-24; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 20 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 21 1-1-23; 102-1117, eff. 1-13-23; 103-8, eff. 1-1-24; 103-84, 22 eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, eff. 1-1-24; 23 103-445, eff. 1-1-24; 103-535, eff. 8-11-23; 103-551, eff. 24 8-11-23; 103-605, eff. 7-1-24; 103-718, eff. 7-19-24; 103-751, 25 eff. 8-2-24; 103-870, eff. 1-1-25; 103-914, eff. 1-1-25; 26 103-918, eff. 1-1-25; 103-951, eff. 1-1-25; 103-1024, eff. HB3561 - 2 - LRB104 10745 BAB 20824 b HB3561- 3 -LRB104 10745 BAB 20824 b HB3561 - 3 - LRB104 10745 BAB 20824 b HB3561 - 3 - LRB104 10745 BAB 20824 b 1 1-1-25; revised 11-26-24.) 2 Section 10. The Counties Code is amended by changing 3 Section 5-1069.3 as follows: 4 (55 ILCS 5/5-1069.3) 5 Sec. 5-1069.3. Required health benefits. If a county, 6 including a home rule county, is a self-insurer for purposes 7 of providing health insurance coverage for its employees, the 8 coverage shall include coverage for the post-mastectomy care 9 benefits required to be covered by a policy of accident and 10 health insurance under Section 356t and the coverage required 11 under Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 12 356u.10, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 13 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 14 356z.25, 356z.26, 356z.29, 356z.30, 356z.32, 356z.33, 356z.36, 15 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 16 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 17 356z.62, 356z.64, 356z.67, 356z.68, and 356z.70, and 356z.71, 18 356z.74, 356z.77, and 356z.80 of the Illinois Insurance Code. 19 The coverage shall comply with Sections 155.22a, 355b, 20 356z.19, and 370c of the Illinois Insurance Code. The 21 Department of Insurance shall enforce the requirements of this 22 Section. The requirement that health benefits be covered as 23 provided in this Section is an exclusive power and function of 24 the State and is a denial and limitation under Article VII, HB3561 - 3 - LRB104 10745 BAB 20824 b HB3561- 4 -LRB104 10745 BAB 20824 b HB3561 - 4 - LRB104 10745 BAB 20824 b HB3561 - 4 - LRB104 10745 BAB 20824 b 1 Section 6, subsection (h) of the Illinois Constitution. A home 2 rule county to which this Section applies must comply with 3 every provision of this Section. 4 Rulemaking authority to implement Public Act 95-1045, if 5 any, is conditioned on the rules being adopted in accordance 6 with all provisions of the Illinois Administrative Procedure 7 Act and all rules and procedures of the Joint Committee on 8 Administrative Rules; any purported rule not so adopted, for 9 whatever reason, is unauthorized. 10 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 11 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 12 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, 13 eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 14 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 15 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, 16 eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24; 17 103-535, eff. 8-11-23; 103-551, eff. 8-11-23; 103-605, eff. 18 7-1-24; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-914, 19 eff. 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; 20 revised 11-26-24.) 21 Section 15. The Illinois Municipal Code is amended by 22 changing Section 10-4-2.3 as follows: 23 (65 ILCS 5/10-4-2.3) 24 Sec. 10-4-2.3. Required health benefits. If a HB3561 - 4 - LRB104 10745 BAB 20824 b HB3561- 5 -LRB104 10745 BAB 20824 b HB3561 - 5 - LRB104 10745 BAB 20824 b HB3561 - 5 - LRB104 10745 BAB 20824 b 1 municipality, including a home rule municipality, is a 2 self-insurer for purposes of providing health insurance 3 coverage for its employees, the coverage shall include 4 coverage for the post-mastectomy care benefits required to be 5 covered by a policy of accident and health insurance under 6 Section 356t and the coverage required under Sections 356g, 7 356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10, 356w, 356x, 8 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 9 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 10 356z.29, 356z.30, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41, 11 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54, 12 356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64, 13 356z.67, 356z.68, and 356z.70, and 356z.71, 356z.74, 356z.77, 14 and 356z.80 of the Illinois Insurance Code. The coverage shall 15 comply with Sections 155.22a, 355b, 356z.19, and 370c of the 16 Illinois Insurance Code. The Department of Insurance shall 17 enforce the requirements of this Section. The requirement that 18 health benefits be covered as provided in this is an exclusive 19 power and function of the State and is a denial and limitation 20 under Article VII, Section 6, subsection (h) of the Illinois 21 Constitution. A home rule municipality to which this Section 22 applies must comply with every provision of this Section. 23 Rulemaking authority to implement Public Act 95-1045, if 24 any, is conditioned on the rules being adopted in accordance 25 with all provisions of the Illinois Administrative Procedure 26 Act and all rules and procedures of the Joint Committee on HB3561 - 5 - LRB104 10745 BAB 20824 b HB3561- 6 -LRB104 10745 BAB 20824 b HB3561 - 6 - LRB104 10745 BAB 20824 b HB3561 - 6 - LRB104 10745 BAB 20824 b 1 Administrative Rules; any purported rule not so adopted, for 2 whatever reason, is unauthorized. 3 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 4 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 5 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, 6 eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 7 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 8 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, 9 eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24; 10 103-535, eff. 8-11-23; 103-551, eff. 8-11-23; 103-605, eff. 11 7-1-24; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-914, 12 eff. 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; 13 revised 11-26-24.) 14 Section 20. The School Code is amended by changing Section 15 10-22.3f as follows: 16 (105 ILCS 5/10-22.3f) 17 Sec. 10-22.3f. Required health benefits. Insurance 18 protection and benefits for employees shall provide the 19 post-mastectomy care benefits required to be covered by a 20 policy of accident and health insurance under Section 356t and 21 the coverage required under Sections 356g, 356g.5, 356g.5-1, 22 356m, 356q, 356u, 356u.10, 356w, 356x, 356z.4, 356z.4a, 23 356z.6, 356z.8, 356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 24 356z.15, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32, HB3561 - 6 - LRB104 10745 BAB 20824 b HB3561- 7 -LRB104 10745 BAB 20824 b HB3561 - 7 - LRB104 10745 BAB 20824 b HB3561 - 7 - LRB104 10745 BAB 20824 b 1 356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 2 356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, 3 356z.61, 356z.62, 356z.64, 356z.67, 356z.68, and 356z.70, and 4 356z.71, 356z.74, 356z.77, and 356z.80 of the Illinois 5 Insurance Code. Insurance policies shall comply with Section 6 356z.19 of the Illinois Insurance Code. The coverage shall 7 comply with Sections 155.22a, 355b, and 370c of the Illinois 8 Insurance Code. The Department of Insurance shall enforce the 9 requirements of this Section. 10 Rulemaking authority to implement Public Act 95-1045, if 11 any, is conditioned on the rules being adopted in accordance 12 with all provisions of the Illinois Administrative Procedure 13 Act and all rules and procedures of the Joint Committee on 14 Administrative Rules; any purported rule not so adopted, for 15 whatever reason, is unauthorized. 16 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; 17 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. 18 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804, 19 eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 20 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff. 21 1-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, 22 eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. 8-11-23; 23 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-718, eff. 24 7-19-24; 103-751, eff. 8-2-24; 103-914, eff. 1-1-25; 103-918, 25 eff. 1-1-25; 103-1024, eff. 1-1-25; revised 11-26-24.) HB3561 - 7 - LRB104 10745 BAB 20824 b HB3561- 8 -LRB104 10745 BAB 20824 b HB3561 - 8 - LRB104 10745 BAB 20824 b HB3561 - 8 - LRB104 10745 BAB 20824 b 1 Section 22. The Illinois Insurance Code is amended by 2 adding Section 356z.80 as follows: 3 (5 ILCS 375/356z.80 new) 4 Sec. 356z.80. Coverage for allergenic protein dietary 5 supplements. 6 (a) As used in this Section: 7 "Dietary supplement" has the meaning given to that term in 8 the Federal Food, Drug, and Cosmetic Act, 21 U.S.C. 321. 9 "Early egg allergen introduction dietary supplement" means 10 a dietary supplement that is prescribed to an infant by a 11 health care provider and contains sufficient infant-safe, 12 well-cooked egg protein to reduce the risk of food allergies. 13 "Early peanut allergen introduction dietary supplement" 14 means a dietary supplement that is prescribed to an infant by a 15 health care provider and contains sufficient infant-safe 16 peanut protein to reduce the risk of food allergies. 17 "Health care provider" or "provider" means a physician, 18 hospital facility, or other health care practitioner licensed, 19 accredited, or certified to perform specified health care 20 services consistent with State law, responsible for 21 recommending health care services on behalf of a covered 22 person. 23 "Infant" means a child who has not attained the age of one 24 year. 25 (b) A group or individual policy of accident and health HB3561 - 8 - LRB104 10745 BAB 20824 b HB3561- 9 -LRB104 10745 BAB 20824 b HB3561 - 9 - LRB104 10745 BAB 20824 b HB3561 - 9 - LRB104 10745 BAB 20824 b 1 insurance or a managed care plan that is amended, delivered, 2 issued, or renewed on or after January 1, 2027 shall provide 3 coverage for at least one early egg allergen introduction 4 dietary supplement and at least one early peanut allergen 5 introduction dietary supplement. 6 The coverage required under this subsection shall be 7 provided at no cost to a covered individual, including 8 deductible payments and cost-sharing amounts charged once a 9 deductible is met. 10 (c) Except as provided under subsection (b) of this 11 Section, nothing in this Section prevents the operation of a 12 policy provision required by this Section as a deductible, 13 coinsurance, allowable charge limitation, coordination of 14 benefits, or a provision restricting coverage to services by a 15 licensed, certified, or carrier-approved provider or facility. 16 (d) This Section does not apply to accident-only, 17 specified disease, hospital indemnity, Medicare supplement, 18 long-term care, disability income, or other limited benefit 19 health insurance policies. 20 (e) The cost-sharing limitation under subsection (b) does 21 not apply to: 22 (1) a catastrophic health plan to the extent this 23 cost-sharing limitation would cause the plan to fail to be 24 treated as a catastrophic plan under 42 U.S.C. 18022(e). 25 (2) a high deductible health plan to the extent this 26 cost-sharing limitation would cause the plan to fail to be HB3561 - 9 - LRB104 10745 BAB 20824 b HB3561- 10 -LRB104 10745 BAB 20824 b HB3561 - 10 - LRB104 10745 BAB 20824 b HB3561 - 10 - LRB104 10745 BAB 20824 b 1 treated as a high deductible health plan under Section 2 223(c)(2) of the Internal Revenue Code. 3 If the cost-sharing limitation under subsection (b) would 4 result in an enrollee becoming ineligible for a health savings 5 account under federal law, this cost-sharing limitation only 6 applies to a qualified high deductible health plan after the 7 enrollee's deductible has been met. 8 Section 25. The Health Maintenance Organization Act is 9 amended by changing Section 5-3 as follows: 10 (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2) 11 (Text of Section before amendment by P.A. 103-808) 12 Sec. 5-3. Insurance Code provisions. 13 (a) Health Maintenance Organizations shall be subject to 14 the provisions of Sections 133, 134, 136, 137, 139, 140, 15 141.1, 141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151, 16 152, 153, 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 17 155.49, 352c, 355.2, 355.3, 355.6, 355b, 355c, 356f, 356g.5-1, 18 356m, 356q, 356u.10, 356v, 356w, 356x, 356z.2, 356z.3a, 19 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 20 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.18, 21 356z.19, 356z.20, 356z.21, 356z.22, 356z.23, 356z.24, 356z.25, 22 356z.26, 356z.28, 356z.29, 356z.30, 356z.31, 356z.32, 356z.33, 23 356z.34, 356z.35, 356z.36, 356z.37, 356z.38, 356z.39, 356z.40, 24 356z.40a, 356z.41, 356z.44, 356z.45, 356z.46, 356z.47, HB3561 - 10 - LRB104 10745 BAB 20824 b HB3561- 11 -LRB104 10745 BAB 20824 b HB3561 - 11 - LRB104 10745 BAB 20824 b HB3561 - 11 - LRB104 10745 BAB 20824 b 1 356z.48, 356z.49, 356z.50, 356z.51, 356z.53, 356z.54, 356z.55, 2 356z.56, 356z.57, 356z.58, 356z.59, 356z.60, 356z.61, 356z.62, 3 356z.63, 356z.64, 356z.65, 356z.66, 356z.67, 356z.68, 356z.69, 4 356z.70, 356z.71, 356z.72, 356z.73, 356z.74, 356z.75, 356z.77, 5 356z.80, 364, 364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b, 6 368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A, 7 408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of 8 subsection (2) of Section 367, and Articles IIA, VIII 1/2, 9 XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the 10 Illinois Insurance Code. 11 (b) For purposes of the Illinois Insurance Code, except 12 for Sections 444 and 444.1 and Articles XIII and XIII 1/2, 13 Health Maintenance Organizations in the following categories 14 are deemed to be "domestic companies": 15 (1) a corporation authorized under the Dental Service 16 Plan Act or the Voluntary Health Services Plans Act; 17 (2) a corporation organized under the laws of this 18 State; or 19 (3) a corporation organized under the laws of another 20 state, 30% or more of the enrollees of which are residents 21 of this State, except a corporation subject to 22 substantially the same requirements in its state of 23 organization as is a "domestic company" under Article VIII 24 1/2 of the Illinois Insurance Code. 25 (c) In considering the merger, consolidation, or other 26 acquisition of control of a Health Maintenance Organization HB3561 - 11 - LRB104 10745 BAB 20824 b HB3561- 12 -LRB104 10745 BAB 20824 b HB3561 - 12 - LRB104 10745 BAB 20824 b HB3561 - 12 - LRB104 10745 BAB 20824 b 1 pursuant to Article VIII 1/2 of the Illinois Insurance Code, 2 (1) the Director shall give primary consideration to 3 the continuation of benefits to enrollees and the 4 financial conditions of the acquired Health Maintenance 5 Organization after the merger, consolidation, or other 6 acquisition of control takes effect; 7 (2)(i) the criteria specified in subsection (1)(b) of 8 Section 131.8 of the Illinois Insurance Code shall not 9 apply and (ii) the Director, in making his determination 10 with respect to the merger, consolidation, or other 11 acquisition of control, need not take into account the 12 effect on competition of the merger, consolidation, or 13 other acquisition of control; 14 (3) the Director shall have the power to require the 15 following information: 16 (A) certification by an independent actuary of the 17 adequacy of the reserves of the Health Maintenance 18 Organization sought to be acquired; 19 (B) pro forma financial statements reflecting the 20 combined balance sheets of the acquiring company and 21 the Health Maintenance Organization sought to be 22 acquired as of the end of the preceding year and as of 23 a date 90 days prior to the acquisition, as well as pro 24 forma financial statements reflecting projected 25 combined operation for a period of 2 years; 26 (C) a pro forma business plan detailing an HB3561 - 12 - LRB104 10745 BAB 20824 b HB3561- 13 -LRB104 10745 BAB 20824 b HB3561 - 13 - LRB104 10745 BAB 20824 b HB3561 - 13 - LRB104 10745 BAB 20824 b 1 acquiring party's plans with respect to the operation 2 of the Health Maintenance Organization sought to be 3 acquired for a period of not less than 3 years; and 4 (D) such other information as the Director shall 5 require. 6 (d) The provisions of Article VIII 1/2 of the Illinois 7 Insurance Code and this Section 5-3 shall apply to the sale by 8 any health maintenance organization of greater than 10% of its 9 enrollee population (including, without limitation, the health 10 maintenance organization's right, title, and interest in and 11 to its health care certificates). 12 (e) In considering any management contract or service 13 agreement subject to Section 141.1 of the Illinois Insurance 14 Code, the Director (i) shall, in addition to the criteria 15 specified in Section 141.2 of the Illinois Insurance Code, 16 take into account the effect of the management contract or 17 service agreement on the continuation of benefits to enrollees 18 and the financial condition of the health maintenance 19 organization to be managed or serviced, and (ii) need not take 20 into account the effect of the management contract or service 21 agreement on competition. 22 (f) Except for small employer groups as defined in the 23 Small Employer Rating, Renewability and Portability Health 24 Insurance Act and except for medicare supplement policies as 25 defined in Section 363 of the Illinois Insurance Code, a 26 Health Maintenance Organization may by contract agree with a HB3561 - 13 - LRB104 10745 BAB 20824 b HB3561- 14 -LRB104 10745 BAB 20824 b HB3561 - 14 - LRB104 10745 BAB 20824 b HB3561 - 14 - LRB104 10745 BAB 20824 b 1 group or other enrollment unit to effect refunds or charge 2 additional premiums under the following terms and conditions: 3 (i) the amount of, and other terms and conditions with 4 respect to, the refund or additional premium are set forth 5 in the group or enrollment unit contract agreed in advance 6 of the period for which a refund is to be paid or 7 additional premium is to be charged (which period shall 8 not be less than one year); and 9 (ii) the amount of the refund or additional premium 10 shall not exceed 20% of the Health Maintenance 11 Organization's profitable or unprofitable experience with 12 respect to the group or other enrollment unit for the 13 period (and, for purposes of a refund or additional 14 premium, the profitable or unprofitable experience shall 15 be calculated taking into account a pro rata share of the 16 Health Maintenance Organization's administrative and 17 marketing expenses, but shall not include any refund to be 18 made or additional premium to be paid pursuant to this 19 subsection (f)). The Health Maintenance Organization and 20 the group or enrollment unit may agree that the profitable 21 or unprofitable experience may be calculated taking into 22 account the refund period and the immediately preceding 2 23 plan years. 24 The Health Maintenance Organization shall include a 25 statement in the evidence of coverage issued to each enrollee 26 describing the possibility of a refund or additional premium, HB3561 - 14 - LRB104 10745 BAB 20824 b HB3561- 15 -LRB104 10745 BAB 20824 b HB3561 - 15 - LRB104 10745 BAB 20824 b HB3561 - 15 - LRB104 10745 BAB 20824 b 1 and upon request of any group or enrollment unit, provide to 2 the group or enrollment unit a description of the method used 3 to calculate (1) the Health Maintenance Organization's 4 profitable experience with respect to the group or enrollment 5 unit and the resulting refund to the group or enrollment unit 6 or (2) the Health Maintenance Organization's unprofitable 7 experience with respect to the group or enrollment unit and 8 the resulting additional premium to be paid by the group or 9 enrollment unit. 10 In no event shall the Illinois Health Maintenance 11 Organization Guaranty Association be liable to pay any 12 contractual obligation of an insolvent organization to pay any 13 refund authorized under this Section. 14 (g) Rulemaking authority to implement Public Act 95-1045, 15 if any, is conditioned on the rules being adopted in 16 accordance with all provisions of the Illinois Administrative 17 Procedure Act and all rules and procedures of the Joint 18 Committee on Administrative Rules; any purported rule not so 19 adopted, for whatever reason, is unauthorized. 20 (Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21; 21 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 22 1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, 23 eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 24 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 25 1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, 26 eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; HB3561 - 15 - LRB104 10745 BAB 20824 b HB3561- 16 -LRB104 10745 BAB 20824 b HB3561 - 16 - LRB104 10745 BAB 20824 b HB3561 - 16 - LRB104 10745 BAB 20824 b 1 103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff. 2 6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445, 3 eff. 1-1-24; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 4 103-618, eff. 1-1-25; 103-649, eff. 1-1-25; 103-656, eff. 5 1-1-25; 103-700, eff. 1-1-25; 103-718, eff. 7-19-24; 103-751, 6 eff. 8-2-24; 103-753, eff. 8-2-24; 103-758, eff. 1-1-25; 7 103-777, eff. 8-2-24; 103-914, eff. 1-1-25; 103-918, eff. 8 1-1-25; 103-1024, eff. 1-1-25; revised 9-26-24.) 9 (Text of Section after amendment by P.A. 103-808) 10 Sec. 5-3. Insurance Code provisions. 11 (a) Health Maintenance Organizations shall be subject to 12 the provisions of Sections 133, 134, 136, 137, 139, 140, 13 141.1, 141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151, 14 152, 153, 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 15 155.49, 352c, 355.2, 355.3, 355.6, 355b, 355c, 356f, 356g, 16 356g.5-1, 356m, 356q, 356u.10, 356v, 356w, 356x, 356z.2, 17 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, 18 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 19 356z.18, 356z.19, 356z.20, 356z.21, 356z.22, 356z.23, 356z.24, 20 356z.25, 356z.26, 356z.28, 356z.29, 356z.30, 356z.31, 356z.32, 21 356z.33, 356z.34, 356z.35, 356z.36, 356z.37, 356z.38, 356z.39, 22 356z.40, 356z.40a, 356z.41, 356z.44, 356z.45, 356z.46, 23 356z.47, 356z.48, 356z.49, 356z.50, 356z.51, 356z.53, 356z.54, 24 356z.55, 356z.56, 356z.57, 356z.58, 356z.59, 356z.60, 356z.61, 25 356z.62, 356z.63, 356z.64, 356z.65, 356z.66, 356z.67, 356z.68, HB3561 - 16 - LRB104 10745 BAB 20824 b HB3561- 17 -LRB104 10745 BAB 20824 b HB3561 - 17 - LRB104 10745 BAB 20824 b HB3561 - 17 - LRB104 10745 BAB 20824 b 1 356z.69, 356z.70, 356z.71, 356z.72, 356z.73, 356z.74, 356z.75, 2 356z.77, 356z.80, 364, 364.01, 364.3, 367.2, 367.2-5, 367i, 3 368a, 368b, 368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 4 403, 403A, 408, 408.2, 409, 412, 444, and 444.1, paragraph (c) 5 of subsection (2) of Section 367, and Articles IIA, VIII 1/2, 6 XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the 7 Illinois Insurance Code. 8 (b) For purposes of the Illinois Insurance Code, except 9 for Sections 444 and 444.1 and Articles XIII and XIII 1/2, 10 Health Maintenance Organizations in the following categories 11 are deemed to be "domestic companies": 12 (1) a corporation authorized under the Dental Service 13 Plan Act or the Voluntary Health Services Plans Act; 14 (2) a corporation organized under the laws of this 15 State; or 16 (3) a corporation organized under the laws of another 17 state, 30% or more of the enrollees of which are residents 18 of this State, except a corporation subject to 19 substantially the same requirements in its state of 20 organization as is a "domestic company" under Article VIII 21 1/2 of the Illinois Insurance Code. 22 (c) In considering the merger, consolidation, or other 23 acquisition of control of a Health Maintenance Organization 24 pursuant to Article VIII 1/2 of the Illinois Insurance Code, 25 (1) the Director shall give primary consideration to 26 the continuation of benefits to enrollees and the HB3561 - 17 - LRB104 10745 BAB 20824 b HB3561- 18 -LRB104 10745 BAB 20824 b HB3561 - 18 - LRB104 10745 BAB 20824 b HB3561 - 18 - LRB104 10745 BAB 20824 b 1 financial conditions of the acquired Health Maintenance 2 Organization after the merger, consolidation, or other 3 acquisition of control takes effect; 4 (2)(i) the criteria specified in subsection (1)(b) of 5 Section 131.8 of the Illinois Insurance Code shall not 6 apply and (ii) the Director, in making his determination 7 with respect to the merger, consolidation, or other 8 acquisition of control, need not take into account the 9 effect on competition of the merger, consolidation, or 10 other acquisition of control; 11 (3) the Director shall have the power to require the 12 following information: 13 (A) certification by an independent actuary of the 14 adequacy of the reserves of the Health Maintenance 15 Organization sought to be acquired; 16 (B) pro forma financial statements reflecting the 17 combined balance sheets of the acquiring company and 18 the Health Maintenance Organization sought to be 19 acquired as of the end of the preceding year and as of 20 a date 90 days prior to the acquisition, as well as pro 21 forma financial statements reflecting projected 22 combined operation for a period of 2 years; 23 (C) a pro forma business plan detailing an 24 acquiring party's plans with respect to the operation 25 of the Health Maintenance Organization sought to be 26 acquired for a period of not less than 3 years; and HB3561 - 18 - LRB104 10745 BAB 20824 b HB3561- 19 -LRB104 10745 BAB 20824 b HB3561 - 19 - LRB104 10745 BAB 20824 b HB3561 - 19 - LRB104 10745 BAB 20824 b 1 (D) such other information as the Director shall 2 require. 3 (d) The provisions of Article VIII 1/2 of the Illinois 4 Insurance Code and this Section 5-3 shall apply to the sale by 5 any health maintenance organization of greater than 10% of its 6 enrollee population (including, without limitation, the health 7 maintenance organization's right, title, and interest in and 8 to its health care certificates). 9 (e) In considering any management contract or service 10 agreement subject to Section 141.1 of the Illinois Insurance 11 Code, the Director (i) shall, in addition to the criteria 12 specified in Section 141.2 of the Illinois Insurance Code, 13 take into account the effect of the management contract or 14 service agreement on the continuation of benefits to enrollees 15 and the financial condition of the health maintenance 16 organization to be managed or serviced, and (ii) need not take 17 into account the effect of the management contract or service 18 agreement on competition. 19 (f) Except for small employer groups as defined in the 20 Small Employer Rating, Renewability and Portability Health 21 Insurance Act and except for medicare supplement policies as 22 defined in Section 363 of the Illinois Insurance Code, a 23 Health Maintenance Organization may by contract agree with a 24 group or other enrollment unit to effect refunds or charge 25 additional premiums under the following terms and conditions: 26 (i) the amount of, and other terms and conditions with HB3561 - 19 - LRB104 10745 BAB 20824 b HB3561- 20 -LRB104 10745 BAB 20824 b HB3561 - 20 - LRB104 10745 BAB 20824 b HB3561 - 20 - LRB104 10745 BAB 20824 b 1 respect to, the refund or additional premium are set forth 2 in the group or enrollment unit contract agreed in advance 3 of the period for which a refund is to be paid or 4 additional premium is to be charged (which period shall 5 not be less than one year); and 6 (ii) the amount of the refund or additional premium 7 shall not exceed 20% of the Health Maintenance 8 Organization's profitable or unprofitable experience with 9 respect to the group or other enrollment unit for the 10 period (and, for purposes of a refund or additional 11 premium, the profitable or unprofitable experience shall 12 be calculated taking into account a pro rata share of the 13 Health Maintenance Organization's administrative and 14 marketing expenses, but shall not include any refund to be 15 made or additional premium to be paid pursuant to this 16 subsection (f)). The Health Maintenance Organization and 17 the group or enrollment unit may agree that the profitable 18 or unprofitable experience may be calculated taking into 19 account the refund period and the immediately preceding 2 20 plan years. 21 The Health Maintenance Organization shall include a 22 statement in the evidence of coverage issued to each enrollee 23 describing the possibility of a refund or additional premium, 24 and upon request of any group or enrollment unit, provide to 25 the group or enrollment unit a description of the method used 26 to calculate (1) the Health Maintenance Organization's HB3561 - 20 - LRB104 10745 BAB 20824 b HB3561- 21 -LRB104 10745 BAB 20824 b HB3561 - 21 - LRB104 10745 BAB 20824 b HB3561 - 21 - LRB104 10745 BAB 20824 b 1 profitable experience with respect to the group or enrollment 2 unit and the resulting refund to the group or enrollment unit 3 or (2) the Health Maintenance Organization's unprofitable 4 experience with respect to the group or enrollment unit and 5 the resulting additional premium to be paid by the group or 6 enrollment unit. 7 In no event shall the Illinois Health Maintenance 8 Organization Guaranty Association be liable to pay any 9 contractual obligation of an insolvent organization to pay any 10 refund authorized under this Section. 11 (g) Rulemaking authority to implement Public Act 95-1045, 12 if any, is conditioned on the rules being adopted in 13 accordance with all provisions of the Illinois Administrative 14 Procedure Act and all rules and procedures of the Joint 15 Committee on Administrative Rules; any purported rule not so 16 adopted, for whatever reason, is unauthorized. 17 (Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21; 18 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. 19 1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, 20 eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 21 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 22 1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, 23 eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 24 103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff. 25 6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445, 26 eff. 1-1-24; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; HB3561 - 21 - LRB104 10745 BAB 20824 b HB3561- 22 -LRB104 10745 BAB 20824 b HB3561 - 22 - LRB104 10745 BAB 20824 b HB3561 - 22 - LRB104 10745 BAB 20824 b 1 103-618, eff. 1-1-25; 103-649, eff. 1-1-25; 103-656, eff. 2 1-1-25; 103-700, eff. 1-1-25; 103-718, eff. 7-19-24; 103-751, 3 eff. 8-2-24; 103-753, eff. 8-2-24; 103-758, eff. 1-1-25; 4 103-777, eff. 8-2-24; 103-808, eff. 1-1-26; 103-914, eff. 5 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; revised 6 11-26-24.) 7 Section 30. The Limited Health Service Organization Act is 8 amended by changing Section 4003 as follows: 9 (215 ILCS 130/4003) (from Ch. 73, par. 1504-3) 10 Sec. 4003. Illinois Insurance Code provisions. Limited 11 health service organizations shall be subject to the 12 provisions of Sections 133, 134, 136, 137, 139, 140, 141.1, 13 141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151, 152, 153, 14 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 352c, 15 355.2, 355.3, 355b, 355d, 356m, 356q, 356v, 356z.4, 356z.4a, 16 356z.10, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.32, 17 356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54, 18 356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68, 356z.71, 19 356z.73, 356z.74, 356z.75, 356z.80, 364.3, 368a, 401, 401.1, 20 402, 403, 403A, 408, 408.2, 409, 412, 444, and 444.1 and 21 Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and 22 XXVI of the Illinois Insurance Code. Nothing in this Section 23 shall require a limited health care plan to cover any service 24 that is not a limited health service. For purposes of the HB3561 - 22 - LRB104 10745 BAB 20824 b HB3561- 23 -LRB104 10745 BAB 20824 b HB3561 - 23 - LRB104 10745 BAB 20824 b HB3561 - 23 - LRB104 10745 BAB 20824 b 1 Illinois Insurance Code, except for Sections 444 and 444.1 and 2 Articles XIII and XIII 1/2, limited health service 3 organizations in the following categories are deemed to be 4 domestic companies: 5 (1) a corporation under the laws of this State; or 6 (2) a corporation organized under the laws of another 7 state, 30% or more of the enrollees of which are residents 8 of this State, except a corporation subject to 9 substantially the same requirements in its state of 10 organization as is a domestic company under Article VIII 11 1/2 of the Illinois Insurance Code. 12 (Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; 13 102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-731, eff. 14 1-1-23; 102-775, eff. 5-13-22; 102-813, eff. 5-13-22; 102-816, 15 eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 16 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff. 17 1-1-24; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445, 18 eff. 1-1-24; 103-605, eff. 7-1-24; 103-649, eff. 1-1-25; 19 103-656, eff. 1-1-25; 103-700, eff. 1-1-25; 103-718, eff. 20 7-19-24; 103-751, eff. 8-2-24; 103-758, eff. 1-1-25; 103-832, 21 eff. 1-1-25; 103-1024, eff. 1-1-25; revised 11-26-24.) 22 Section 35. The Voluntary Health Services Plans Act is 23 amended by changing Section 10 as follows: 24 (215 ILCS 165/10) (from Ch. 32, par. 604) HB3561 - 23 - LRB104 10745 BAB 20824 b HB3561- 24 -LRB104 10745 BAB 20824 b HB3561 - 24 - LRB104 10745 BAB 20824 b HB3561 - 24 - LRB104 10745 BAB 20824 b 1 Sec. 10. Application of Insurance Code provisions. Health 2 services plan corporations and all persons interested therein 3 or dealing therewith shall be subject to the provisions of 4 Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140, 5 143, 143.31, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 6 355b, 355d, 356g, 356g.5, 356g.5-1, 356m, 356q, 356r, 356t, 7 356u, 356u.10, 356v, 356w, 356x, 356y, 356z.1, 356z.2, 8 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, 9 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18, 10 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 11 356z.32, 356z.32a, 356z.33, 356z.40, 356z.41, 356z.46, 12 356z.47, 356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 13 356z.60, 356z.61, 356z.62, 356z.64, 356z.67, 356z.68, 356z.71, 14 356z.72, 356z.74, 356z.75, 356z.77, 356z.80, 364.01, 364.3, 15 367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412, 16 and paragraphs (7) and (15) of Section 367 of the Illinois 17 Insurance Code. 18 Rulemaking authority to implement Public Act 95-1045, if 19 any, is conditioned on the rules being adopted in accordance 20 with all provisions of the Illinois Administrative Procedure 21 Act and all rules and procedures of the Joint Committee on 22 Administrative Rules; any purported rule not so adopted, for 23 whatever reason, is unauthorized. 24 (Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; 25 102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 26 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804, HB3561 - 24 - LRB104 10745 BAB 20824 b HB3561- 25 -LRB104 10745 BAB 20824 b HB3561 - 25 - LRB104 10745 BAB 20824 b HB3561 - 25 - LRB104 10745 BAB 20824 b 1 eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; 2 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff. 3 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, 4 eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24; 5 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-656, eff. 6 1-1-25; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-753, 7 eff. 8-2-24; 103-758, eff. 1-1-25; 103-832, eff. 1-1-25; 8 103-914, eff. 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 9 1-1-25; revised 11-26-24.) 10 Section 40. The Illinois Public Aid Code is amended by 11 changing Section 5-16.8 as follows: 12 (305 ILCS 5/5-16.8) 13 Sec. 5-16.8. Required health benefits. The medical 14 assistance program shall (i) provide the post-mastectomy care 15 benefits required to be covered by a policy of accident and 16 health insurance under Section 356t and the coverage required 17 under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6, 18 356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46, 19 356z.47, 356z.51, 356z.53, 356z.59, 356z.60, 356z.61, 356z.64, 20 and 356z.67, and 356z.71, 356z.75, and 356z.80 of the Illinois 21 Insurance Code, (ii) be subject to the provisions of Sections 22 356z.19, 356z.44, 356z.49, 364.01, 370c, and 370c.1 of the 23 Illinois Insurance Code, and (iii) be subject to the 24 provisions of subsection (d-5) of Section 10 of the Network HB3561 - 25 - LRB104 10745 BAB 20824 b HB3561- 26 -LRB104 10745 BAB 20824 b HB3561 - 26 - LRB104 10745 BAB 20824 b HB3561 - 26 - LRB104 10745 BAB 20824 b 1 Adequacy and Transparency Act. 2 The Department, by rule, shall adopt a model similar to 3 the requirements of Section 356z.39 of the Illinois Insurance 4 Code. 5 On and after July 1, 2012, the Department shall reduce any 6 rate of reimbursement for services or other payments or alter 7 any methodologies authorized by this Code to reduce any rate 8 of reimbursement for services or other payments in accordance 9 with Section 5-5e. 10 To ensure full access to the benefits set forth in this 11 Section, on and after January 1, 2016, the Department shall 12 ensure that provider and hospital reimbursement for 13 post-mastectomy care benefits required under this Section are 14 no lower than the Medicare reimbursement rate. 15 (Source: P.A. 102-30, eff. 1-1-22; 102-144, eff. 1-1-22; 16 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-530, eff. 17 1-1-22; 102-642, eff. 1-1-22; 102-804, eff. 1-1-23; 102-813, 18 eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093, eff. 1-1-23; 19 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff. 20 1-1-24; 103-420, eff. 1-1-24; 103-605, eff. 7-1-24; 103-703, 21 eff. 1-1-25; 103-758, eff. 1-1-25; 103-1024, eff. 1-1-25; 22 revised 11-26-24.) 23 Section 95. No acceleration or delay. Where this Act makes 24 changes in a statute that is represented in this Act by text 25 that is not yet or no longer in effect (for example, a Section HB3561 - 26 - LRB104 10745 BAB 20824 b HB3561- 27 -LRB104 10745 BAB 20824 b HB3561 - 27 - LRB104 10745 BAB 20824 b HB3561 - 27 - LRB104 10745 BAB 20824 b 1 represented by multiple versions), the use of that text does 2 not accelerate or delay the taking effect of (i) the changes 3 made by this Act or (ii) provisions derived from any other 4 Public Act. HB3561- 28 -LRB104 10745 BAB 20824 b 1 INDEX 2 Statutes amended in order of appearance HB3561- 28 -LRB104 10745 BAB 20824 b HB3561 - 28 - LRB104 10745 BAB 20824 b 1 INDEX 2 Statutes amended in order of appearance HB3561- 28 -LRB104 10745 BAB 20824 b HB3561 - 28 - LRB104 10745 BAB 20824 b HB3561 - 28 - LRB104 10745 BAB 20824 b 1 INDEX 2 Statutes amended in order of appearance HB3561 - 27 - LRB104 10745 BAB 20824 b HB3561- 28 -LRB104 10745 BAB 20824 b HB3561 - 28 - LRB104 10745 BAB 20824 b HB3561 - 28 - LRB104 10745 BAB 20824 b 1 INDEX 2 Statutes amended in order of appearance HB3561 - 28 - LRB104 10745 BAB 20824 b