Illinois 2025-2026 Regular Session

Illinois House Bill HB3561 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	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
2	2	104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB3561 Introduced , by Rep. Dagmara Avelar SYNOPSIS AS INTRODUCED:
3	3	See Index See Index
4	4	See Index
5	5	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.
6	6	LRB104 10745 BAB 20824 b LRB104 10745 BAB 20824 b
7	7	LRB104 10745 BAB 20824 b
8	8	A BILL FOR
9	9	HB3561LRB104 10745 BAB 20824 b HB3561 LRB104 10745 BAB 20824 b
10	10	HB3561 LRB104 10745 BAB 20824 b
11	11	1 AN ACT concerning regulation.
12	12	2 Be it enacted by the People of the State of Illinois,
13	13	3 represented in the General Assembly:
14	14	4 Section 5. The State Employees Group Insurance Act of 1971
15	15	5 is amended by changing Section 6.11 as follows:
16	16	6 (5 ILCS 375/6.11)
17	17	7 Sec. 6.11. Required health benefits; Illinois Insurance
18	18	8 Code requirements. The program of health benefits shall
19	19	9 provide the post-mastectomy care benefits required to be
20	20	10 covered by a policy of accident and health insurance under
21	21	11 Section 356t of the Illinois Insurance Code. The program of
22	22	12 health benefits shall provide the coverage required under
23	23	13 Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10,
24	24	14 356w, 356x, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8,
25	25	15 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
26	26	16 356z.17, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32,
27	27	17 356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
28	28	18 356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59,
29	29	19 356z.60, 356z.61, 356z.62, 356z.64, 356z.67, 356z.68, and
30	30	20 356z.70, and 356z.71, 356z.74, 356z.76, 356z.77, and 356z.80
31	31	21 of the Illinois Insurance Code. The program of health benefits
32	32	22 must comply with Sections 155.22a, 155.37, 355b, 356z.19,
33	33	23 370c, and 370c.1 and Article XXXIIB of the Illinois Insurance
34	34
35	35
36	36
37	37	104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB3561 Introduced , by Rep. Dagmara Avelar SYNOPSIS AS INTRODUCED:
38	38	See Index See Index
39	39	See Index
40	40	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.
41	41	LRB104 10745 BAB 20824 b LRB104 10745 BAB 20824 b
42	42	LRB104 10745 BAB 20824 b
43	43	A BILL FOR
44	44
45	45
46	46
47	47
48	48
49	49	See Index
50	50
51	51
52	52
53	53	LRB104 10745 BAB 20824 b
54	54
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63	63	HB3561 LRB104 10745 BAB 20824 b
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66	66	HB3561- 2 -LRB104 10745 BAB 20824 b HB3561 - 2 - LRB104 10745 BAB 20824 b
67	67	HB3561 - 2 - LRB104 10745 BAB 20824 b
68	68	1 Code. The program of health benefits shall provide the
69	69	2 coverage required under Section 356m of the Illinois Insurance
70	70	3 Code and, for the employees of the State Employee Group
71	71	4 Insurance Program only, the coverage as also provided in
72	72	5 Section 6.11B of this Act. The Department of Insurance shall
73	73	6 enforce the requirements of this Section with respect to
74	74	7 Sections 370c and 370c.1 of the Illinois Insurance Code; all
75	75	8 other requirements of this Section shall be enforced by the
76	76	9 Department of Central Management Services.
77	77	10 Rulemaking authority to implement Public Act 95-1045, if
78	78	11 any, is conditioned on the rules being adopted in accordance
79	79	12 with all provisions of the Illinois Administrative Procedure
80	80	13 Act and all rules and procedures of the Joint Committee on
81	81	14 Administrative Rules; any purported rule not so adopted, for
82	82	15 whatever reason, is unauthorized.
83	83	16 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
84	84	17 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
85	85	18 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-768,
86	86	19 eff. 1-1-24; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
87	87	20 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
88	88	21 1-1-23; 102-1117, eff. 1-13-23; 103-8, eff. 1-1-24; 103-84,
89	89	22 eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, eff. 1-1-24;
90	90	23 103-445, eff. 1-1-24; 103-535, eff. 8-11-23; 103-551, eff.
91	91	24 8-11-23; 103-605, eff. 7-1-24; 103-718, eff. 7-19-24; 103-751,
92	92	25 eff. 8-2-24; 103-870, eff. 1-1-25; 103-914, eff. 1-1-25;
93	93	26 103-918, eff. 1-1-25; 103-951, eff. 1-1-25; 103-1024, eff.
94	94
95	95
96	96
97	97
98	98
99	99	HB3561 - 2 - LRB104 10745 BAB 20824 b
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102	102	HB3561- 3 -LRB104 10745 BAB 20824 b HB3561 - 3 - LRB104 10745 BAB 20824 b
103	103	HB3561 - 3 - LRB104 10745 BAB 20824 b
104	104	1 1-1-25; revised 11-26-24.)
105	105	2 Section 10. The Counties Code is amended by changing
106	106	3 Section 5-1069.3 as follows:
107	107	4 (55 ILCS 5/5-1069.3)
108	108	5 Sec. 5-1069.3. Required health benefits. If a county,
109	109	6 including a home rule county, is a self-insurer for purposes
110	110	7 of providing health insurance coverage for its employees, the
111	111	8 coverage shall include coverage for the post-mastectomy care
112	112	9 benefits required to be covered by a policy of accident and
113	113	10 health insurance under Section 356t and the coverage required
114	114	11 under Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u,
115	115	12 356u.10, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9,
116	116	13 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
117	117	14 356z.25, 356z.26, 356z.29, 356z.30, 356z.32, 356z.33, 356z.36,
118	118	15 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51,
119	119	16 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, 356z.61,
120	120	17 356z.62, 356z.64, 356z.67, 356z.68, and 356z.70, and 356z.71,
121	121	18 356z.74, 356z.77, and 356z.80 of the Illinois Insurance Code.
122	122	19 The coverage shall comply with Sections 155.22a, 355b,
123	123	20 356z.19, and 370c of the Illinois Insurance Code. The
124	124	21 Department of Insurance shall enforce the requirements of this
125	125	22 Section. The requirement that health benefits be covered as
126	126	23 provided in this Section is an exclusive power and function of
127	127	24 the State and is a denial and limitation under Article VII,
128	128
129	129
130	130
131	131
132	132
133	133	HB3561 - 3 - LRB104 10745 BAB 20824 b
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136	136	HB3561- 4 -LRB104 10745 BAB 20824 b HB3561 - 4 - LRB104 10745 BAB 20824 b
137	137	HB3561 - 4 - LRB104 10745 BAB 20824 b
138	138	1 Section 6, subsection (h) of the Illinois Constitution. A home
139	139	2 rule county to which this Section applies must comply with
140	140	3 every provision of this Section.
141	141	4 Rulemaking authority to implement Public Act 95-1045, if
142	142	5 any, is conditioned on the rules being adopted in accordance
143	143	6 with all provisions of the Illinois Administrative Procedure
144	144	7 Act and all rules and procedures of the Joint Committee on
145	145	8 Administrative Rules; any purported rule not so adopted, for
146	146	9 whatever reason, is unauthorized.
147	147	10 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
148	148	11 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
149	149	12 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
150	150	13 eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
151	151	14 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
152	152	15 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
153	153	16 eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
154	154	17 103-535, eff. 8-11-23; 103-551, eff. 8-11-23; 103-605, eff.
155	155	18 7-1-24; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-914,
156	156	19 eff. 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25;
157	157	20 revised 11-26-24.)
158	158	21 Section 15. The Illinois Municipal Code is amended by
159	159	22 changing Section 10-4-2.3 as follows:
160	160	23 (65 ILCS 5/10-4-2.3)
161	161	24 Sec. 10-4-2.3. Required health benefits. If a
162	162
163	163
164	164
165	165
166	166
167	167	HB3561 - 4 - LRB104 10745 BAB 20824 b
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170	170	HB3561- 5 -LRB104 10745 BAB 20824 b HB3561 - 5 - LRB104 10745 BAB 20824 b
171	171	HB3561 - 5 - LRB104 10745 BAB 20824 b
172	172	1 municipality, including a home rule municipality, is a
173	173	2 self-insurer for purposes of providing health insurance
174	174	3 coverage for its employees, the coverage shall include
175	175	4 coverage for the post-mastectomy care benefits required to be
176	176	5 covered by a policy of accident and health insurance under
177	177	6 Section 356t and the coverage required under Sections 356g,
178	178	7 356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10, 356w, 356x,
179	179	8 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11,
180	180	9 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26,
181	181	10 356z.29, 356z.30, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
182	182	11 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
183	183	12 356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64,
184	184	13 356z.67, 356z.68, and 356z.70, and 356z.71, 356z.74, 356z.77,
185	185	14 and 356z.80 of the Illinois Insurance Code. The coverage shall
186	186	15 comply with Sections 155.22a, 355b, 356z.19, and 370c of the
187	187	16 Illinois Insurance Code. The Department of Insurance shall
188	188	17 enforce the requirements of this Section. The requirement that
189	189	18 health benefits be covered as provided in this is an exclusive
190	190	19 power and function of the State and is a denial and limitation
191	191	20 under Article VII, Section 6, subsection (h) of the Illinois
192	192	21 Constitution. A home rule municipality to which this Section
193	193	22 applies must comply with every provision of this Section.
194	194	23 Rulemaking authority to implement Public Act 95-1045, if
195	195	24 any, is conditioned on the rules being adopted in accordance
196	196	25 with all provisions of the Illinois Administrative Procedure
197	197	26 Act and all rules and procedures of the Joint Committee on
198	198
199	199
200	200
201	201
202	202
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206	206	HB3561- 6 -LRB104 10745 BAB 20824 b HB3561 - 6 - LRB104 10745 BAB 20824 b
207	207	HB3561 - 6 - LRB104 10745 BAB 20824 b
208	208	1 Administrative Rules; any purported rule not so adopted, for
209	209	2 whatever reason, is unauthorized.
210	210	3 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
211	211	4 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
212	212	5 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
213	213	6 eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
214	214	7 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
215	215	8 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
216	216	9 eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
217	217	10 103-535, eff. 8-11-23; 103-551, eff. 8-11-23; 103-605, eff.
218	218	11 7-1-24; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-914,
219	219	12 eff. 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25;
220	220	13 revised 11-26-24.)
221	221	14 Section 20. The School Code is amended by changing Section
222	222	15 10-22.3f as follows:
223	223	16 (105 ILCS 5/10-22.3f)
224	224	17 Sec. 10-22.3f. Required health benefits. Insurance
225	225	18 protection and benefits for employees shall provide the
226	226	19 post-mastectomy care benefits required to be covered by a
227	227	20 policy of accident and health insurance under Section 356t and
228	228	21 the coverage required under Sections 356g, 356g.5, 356g.5-1,
229	229	22 356m, 356q, 356u, 356u.10, 356w, 356x, 356z.4, 356z.4a,
230	230	23 356z.6, 356z.8, 356z.9, 356z.11, 356z.12, 356z.13, 356z.14,
231	231	24 356z.15, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32,
232	232
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235	235
236	236
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241	241	HB3561 - 7 - LRB104 10745 BAB 20824 b
242	242	1 356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
243	243	2 356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60,
244	244	3 356z.61, 356z.62, 356z.64, 356z.67, 356z.68, and 356z.70, and
245	245	4 356z.71, 356z.74, 356z.77, and 356z.80 of the Illinois
246	246	5 Insurance Code. Insurance policies shall comply with Section
247	247	6 356z.19 of the Illinois Insurance Code. The coverage shall
248	248	7 comply with Sections 155.22a, 355b, and 370c of the Illinois
249	249	8 Insurance Code. The Department of Insurance shall enforce the
250	250	9 requirements of this Section.
251	251	10 Rulemaking authority to implement Public Act 95-1045, if
252	252	11 any, is conditioned on the rules being adopted in accordance
253	253	12 with all provisions of the Illinois Administrative Procedure
254	254	13 Act and all rules and procedures of the Joint Committee on
255	255	14 Administrative Rules; any purported rule not so adopted, for
256	256	15 whatever reason, is unauthorized.
257	257	16 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
258	258	17 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
259	259	18 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804,
260	260	19 eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
261	261	20 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff.
262	262	21 1-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420,
263	263	22 eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. 8-11-23;
264	264	23 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-718, eff.
265	265	24 7-19-24; 103-751, eff. 8-2-24; 103-914, eff. 1-1-25; 103-918,
266	266	25 eff. 1-1-25; 103-1024, eff. 1-1-25; revised 11-26-24.)
267	267
268	268
269	269
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275	275	HB3561- 8 -LRB104 10745 BAB 20824 b HB3561 - 8 - LRB104 10745 BAB 20824 b
276	276	HB3561 - 8 - LRB104 10745 BAB 20824 b
277	277	1 Section 22. The Illinois Insurance Code is amended by
278	278	2 adding Section 356z.80 as follows:
279	279	3 (5 ILCS 375/356z.80 new)
280	280	4 Sec. 356z.80. Coverage for allergenic protein dietary
281	281	5 supplements.
282	282	6 (a) As used in this Section:
283	283	7 "Dietary supplement" has the meaning given to that term in
284	284	8 the Federal Food, Drug, and Cosmetic Act, 21 U.S.C. 321.
285	285	9 "Early egg allergen introduction dietary supplement" means
286	286	10 a dietary supplement that is prescribed to an infant by a
287	287	11 health care provider and contains sufficient infant-safe,
288	288	12 well-cooked egg protein to reduce the risk of food allergies.
289	289	13 "Early peanut allergen introduction dietary supplement"
290	290	14 means a dietary supplement that is prescribed to an infant by a
291	291	15 health care provider and contains sufficient infant-safe
292	292	16 peanut protein to reduce the risk of food allergies.
293	293	17 "Health care provider" or "provider" means a physician,
294	294	18 hospital facility, or other health care practitioner licensed,
295	295	19 accredited, or certified to perform specified health care
296	296	20 services consistent with State law, responsible for
297	297	21 recommending health care services on behalf of a covered
298	298	22 person.
299	299	23 "Infant" means a child who has not attained the age of one
300	300	24 year.
301	301	25 (b) A group or individual policy of accident and health
302	302
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304	304
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311	311	HB3561 - 9 - LRB104 10745 BAB 20824 b
312	312	1 insurance or a managed care plan that is amended, delivered,
313	313	2 issued, or renewed on or after January 1, 2027 shall provide
314	314	3 coverage for at least one early egg allergen introduction
315	315	4 dietary supplement and at least one early peanut allergen
316	316	5 introduction dietary supplement.
317	317	6 The coverage required under this subsection shall be
318	318	7 provided at no cost to a covered individual, including
319	319	8 deductible payments and cost-sharing amounts charged once a
320	320	9 deductible is met.
321	321	10 (c) Except as provided under subsection (b) of this
322	322	11 Section, nothing in this Section prevents the operation of a
323	323	12 policy provision required by this Section as a deductible,
324	324	13 coinsurance, allowable charge limitation, coordination of
325	325	14 benefits, or a provision restricting coverage to services by a
326	326	15 licensed, certified, or carrier-approved provider or facility.
327	327	16 (d) This Section does not apply to accident-only,
328	328	17 specified disease, hospital indemnity, Medicare supplement,
329	329	18 long-term care, disability income, or other limited benefit
330	330	19 health insurance policies.
331	331	20 (e) The cost-sharing limitation under subsection (b) does
332	332	21 not apply to:
333	333	22 (1) a catastrophic health plan to the extent this
334	334	23 cost-sharing limitation would cause the plan to fail to be
335	335	24 treated as a catastrophic plan under 42 U.S.C. 18022(e).
336	336	25 (2) a high deductible health plan to the extent this
337	337	26 cost-sharing limitation would cause the plan to fail to be
338	338
339	339
340	340
341	341
342	342
343	343	HB3561 - 9 - LRB104 10745 BAB 20824 b
344	344
345	345
346	346	HB3561- 10 -LRB104 10745 BAB 20824 b HB3561 - 10 - LRB104 10745 BAB 20824 b
347	347	HB3561 - 10 - LRB104 10745 BAB 20824 b
348	348	1 treated as a high deductible health plan under Section
349	349	2 223(c)(2) of the Internal Revenue Code.
350	350	3 If the cost-sharing limitation under subsection (b) would
351	351	4 result in an enrollee becoming ineligible for a health savings
352	352	5 account under federal law, this cost-sharing limitation only
353	353	6 applies to a qualified high deductible health plan after the
354	354	7 enrollee's deductible has been met.
355	355	8 Section 25. The Health Maintenance Organization Act is
356	356	9 amended by changing Section 5-3 as follows:
357	357	10 (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
358	358	11 (Text of Section before amendment by P.A. 103-808)
359	359	12 Sec. 5-3. Insurance Code provisions.
360	360	13 (a) Health Maintenance Organizations shall be subject to
361	361	14 the provisions of Sections 133, 134, 136, 137, 139, 140,
362	362	15 141.1, 141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151,
363	363	16 152, 153, 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a,
364	364	17 155.49, 352c, 355.2, 355.3, 355.6, 355b, 355c, 356f, 356g.5-1,
365	365	18 356m, 356q, 356u.10, 356v, 356w, 356x, 356z.2, 356z.3a,
366	366	19 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10,
367	367	20 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.18,
368	368	21 356z.19, 356z.20, 356z.21, 356z.22, 356z.23, 356z.24, 356z.25,
369	369	22 356z.26, 356z.28, 356z.29, 356z.30, 356z.31, 356z.32, 356z.33,
370	370	23 356z.34, 356z.35, 356z.36, 356z.37, 356z.38, 356z.39, 356z.40,
371	371	24 356z.40a, 356z.41, 356z.44, 356z.45, 356z.46, 356z.47,
372	372
373	373
374	374
375	375
376	376
377	377	HB3561 - 10 - LRB104 10745 BAB 20824 b
378	378
379	379
380	380	HB3561- 11 -LRB104 10745 BAB 20824 b HB3561 - 11 - LRB104 10745 BAB 20824 b
381	381	HB3561 - 11 - LRB104 10745 BAB 20824 b
382	382	1 356z.48, 356z.49, 356z.50, 356z.51, 356z.53, 356z.54, 356z.55,
383	383	2 356z.56, 356z.57, 356z.58, 356z.59, 356z.60, 356z.61, 356z.62,
384	384	3 356z.63, 356z.64, 356z.65, 356z.66, 356z.67, 356z.68, 356z.69,
385	385	4 356z.70, 356z.71, 356z.72, 356z.73, 356z.74, 356z.75, 356z.77,
386	386	5 356z.80, 364, 364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b,
387	387	6 368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A,
388	388	7 408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of
389	389	8 subsection (2) of Section 367, and Articles IIA, VIII 1/2,
390	390	9 XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the
391	391	10 Illinois Insurance Code.
392	392	11 (b) For purposes of the Illinois Insurance Code, except
393	393	12 for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
394	394	13 Health Maintenance Organizations in the following categories
395	395	14 are deemed to be "domestic companies":
396	396	15 (1) a corporation authorized under the Dental Service
397	397	16 Plan Act or the Voluntary Health Services Plans Act;
398	398	17 (2) a corporation organized under the laws of this
399	399	18 State; or
400	400	19 (3) a corporation organized under the laws of another
401	401	20 state, 30% or more of the enrollees of which are residents
402	402	21 of this State, except a corporation subject to
403	403	22 substantially the same requirements in its state of
404	404	23 organization as is a "domestic company" under Article VIII
405	405	24 1/2 of the Illinois Insurance Code.
406	406	25 (c) In considering the merger, consolidation, or other
407	407	26 acquisition of control of a Health Maintenance Organization
408	408
409	409
410	410
411	411
412	412
413	413	HB3561 - 11 - LRB104 10745 BAB 20824 b
414	414
415	415
416	416	HB3561- 12 -LRB104 10745 BAB 20824 b HB3561 - 12 - LRB104 10745 BAB 20824 b
417	417	HB3561 - 12 - LRB104 10745 BAB 20824 b
418	418	1 pursuant to Article VIII 1/2 of the Illinois Insurance Code,
419	419	2 (1) the Director shall give primary consideration to
420	420	3 the continuation of benefits to enrollees and the
421	421	4 financial conditions of the acquired Health Maintenance
422	422	5 Organization after the merger, consolidation, or other
423	423	6 acquisition of control takes effect;
424	424	7 (2)(i) the criteria specified in subsection (1)(b) of
425	425	8 Section 131.8 of the Illinois Insurance Code shall not
426	426	9 apply and (ii) the Director, in making his determination
427	427	10 with respect to the merger, consolidation, or other
428	428	11 acquisition of control, need not take into account the
429	429	12 effect on competition of the merger, consolidation, or
430	430	13 other acquisition of control;
431	431	14 (3) the Director shall have the power to require the
432	432	15 following information:
433	433	16 (A) certification by an independent actuary of the
434	434	17 adequacy of the reserves of the Health Maintenance
435	435	18 Organization sought to be acquired;
436	436	19 (B) pro forma financial statements reflecting the
437	437	20 combined balance sheets of the acquiring company and
438	438	21 the Health Maintenance Organization sought to be
439	439	22 acquired as of the end of the preceding year and as of
440	440	23 a date 90 days prior to the acquisition, as well as pro
441	441	24 forma financial statements reflecting projected
442	442	25 combined operation for a period of 2 years;
443	443	26 (C) a pro forma business plan detailing an
444	444
445	445
446	446
447	447
448	448
449	449	HB3561 - 12 - LRB104 10745 BAB 20824 b
450	450
451	451
452	452	HB3561- 13 -LRB104 10745 BAB 20824 b HB3561 - 13 - LRB104 10745 BAB 20824 b
453	453	HB3561 - 13 - LRB104 10745 BAB 20824 b
454	454	1 acquiring party's plans with respect to the operation
455	455	2 of the Health Maintenance Organization sought to be
456	456	3 acquired for a period of not less than 3 years; and
457	457	4 (D) such other information as the Director shall
458	458	5 require.
459	459	6 (d) The provisions of Article VIII 1/2 of the Illinois
460	460	7 Insurance Code and this Section 5-3 shall apply to the sale by
461	461	8 any health maintenance organization of greater than 10% of its
462	462	9 enrollee population (including, without limitation, the health
463	463	10 maintenance organization's right, title, and interest in and
464	464	11 to its health care certificates).
465	465	12 (e) In considering any management contract or service
466	466	13 agreement subject to Section 141.1 of the Illinois Insurance
467	467	14 Code, the Director (i) shall, in addition to the criteria
468	468	15 specified in Section 141.2 of the Illinois Insurance Code,
469	469	16 take into account the effect of the management contract or
470	470	17 service agreement on the continuation of benefits to enrollees
471	471	18 and the financial condition of the health maintenance
472	472	19 organization to be managed or serviced, and (ii) need not take
473	473	20 into account the effect of the management contract or service
474	474	21 agreement on competition.
475	475	22 (f) Except for small employer groups as defined in the
476	476	23 Small Employer Rating, Renewability and Portability Health
477	477	24 Insurance Act and except for medicare supplement policies as
478	478	25 defined in Section 363 of the Illinois Insurance Code, a
479	479	26 Health Maintenance Organization may by contract agree with a
480	480
481	481
482	482
483	483
484	484
485	485	HB3561 - 13 - LRB104 10745 BAB 20824 b
486	486
487	487
488	488	HB3561- 14 -LRB104 10745 BAB 20824 b HB3561 - 14 - LRB104 10745 BAB 20824 b
489	489	HB3561 - 14 - LRB104 10745 BAB 20824 b
490	490	1 group or other enrollment unit to effect refunds or charge
491	491	2 additional premiums under the following terms and conditions:
492	492	3 (i) the amount of, and other terms and conditions with
493	493	4 respect to, the refund or additional premium are set forth
494	494	5 in the group or enrollment unit contract agreed in advance
495	495	6 of the period for which a refund is to be paid or
496	496	7 additional premium is to be charged (which period shall
497	497	8 not be less than one year); and
498	498	9 (ii) the amount of the refund or additional premium
499	499	10 shall not exceed 20% of the Health Maintenance
500	500	11 Organization's profitable or unprofitable experience with
501	501	12 respect to the group or other enrollment unit for the
502	502	13 period (and, for purposes of a refund or additional
503	503	14 premium, the profitable or unprofitable experience shall
504	504	15 be calculated taking into account a pro rata share of the
505	505	16 Health Maintenance Organization's administrative and
506	506	17 marketing expenses, but shall not include any refund to be
507	507	18 made or additional premium to be paid pursuant to this
508	508	19 subsection (f)). The Health Maintenance Organization and
509	509	20 the group or enrollment unit may agree that the profitable
510	510	21 or unprofitable experience may be calculated taking into
511	511	22 account the refund period and the immediately preceding 2
512	512	23 plan years.
513	513	24 The Health Maintenance Organization shall include a
514	514	25 statement in the evidence of coverage issued to each enrollee
515	515	26 describing the possibility of a refund or additional premium,
516	516
517	517
518	518
519	519
520	520
521	521	HB3561 - 14 - LRB104 10745 BAB 20824 b
522	522
523	523
524	524	HB3561- 15 -LRB104 10745 BAB 20824 b HB3561 - 15 - LRB104 10745 BAB 20824 b
525	525	HB3561 - 15 - LRB104 10745 BAB 20824 b
526	526	1 and upon request of any group or enrollment unit, provide to
527	527	2 the group or enrollment unit a description of the method used
528	528	3 to calculate (1) the Health Maintenance Organization's
529	529	4 profitable experience with respect to the group or enrollment
530	530	5 unit and the resulting refund to the group or enrollment unit
531	531	6 or (2) the Health Maintenance Organization's unprofitable
532	532	7 experience with respect to the group or enrollment unit and
533	533	8 the resulting additional premium to be paid by the group or
534	534	9 enrollment unit.
535	535	10 In no event shall the Illinois Health Maintenance
536	536	11 Organization Guaranty Association be liable to pay any
537	537	12 contractual obligation of an insolvent organization to pay any
538	538	13 refund authorized under this Section.
539	539	14 (g) Rulemaking authority to implement Public Act 95-1045,
540	540	15 if any, is conditioned on the rules being adopted in
541	541	16 accordance with all provisions of the Illinois Administrative
542	542	17 Procedure Act and all rules and procedures of the Joint
543	543	18 Committee on Administrative Rules; any purported rule not so
544	544	19 adopted, for whatever reason, is unauthorized.
545	545	20 (Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
546	546	21 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
547	547	22 1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
548	548	23 eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
549	549	24 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
550	550	25 1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
551	551	26 eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;
552	552
553	553
554	554
555	555
556	556
557	557	HB3561 - 15 - LRB104 10745 BAB 20824 b
558	558
559	559
560	560	HB3561- 16 -LRB104 10745 BAB 20824 b HB3561 - 16 - LRB104 10745 BAB 20824 b
561	561	HB3561 - 16 - LRB104 10745 BAB 20824 b
562	562	1 103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.
563	563	2 6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
564	564	3 eff. 1-1-24; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24;
565	565	4 103-618, eff. 1-1-25; 103-649, eff. 1-1-25; 103-656, eff.
566	566	5 1-1-25; 103-700, eff. 1-1-25; 103-718, eff. 7-19-24; 103-751,
567	567	6 eff. 8-2-24; 103-753, eff. 8-2-24; 103-758, eff. 1-1-25;
568	568	7 103-777, eff. 8-2-24; 103-914, eff. 1-1-25; 103-918, eff.
569	569	8 1-1-25; 103-1024, eff. 1-1-25; revised 9-26-24.)
570	570	9 (Text of Section after amendment by P.A. 103-808)
571	571	10 Sec. 5-3. Insurance Code provisions.
572	572	11 (a) Health Maintenance Organizations shall be subject to
573	573	12 the provisions of Sections 133, 134, 136, 137, 139, 140,
574	574	13 141.1, 141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151,
575	575	14 152, 153, 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a,
576	576	15 155.49, 352c, 355.2, 355.3, 355.6, 355b, 355c, 356f, 356g,
577	577	16 356g.5-1, 356m, 356q, 356u.10, 356v, 356w, 356x, 356z.2,
578	578	17 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9,
579	579	18 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17,
580	580	19 356z.18, 356z.19, 356z.20, 356z.21, 356z.22, 356z.23, 356z.24,
581	581	20 356z.25, 356z.26, 356z.28, 356z.29, 356z.30, 356z.31, 356z.32,
582	582	21 356z.33, 356z.34, 356z.35, 356z.36, 356z.37, 356z.38, 356z.39,
583	583	22 356z.40, 356z.40a, 356z.41, 356z.44, 356z.45, 356z.46,
584	584	23 356z.47, 356z.48, 356z.49, 356z.50, 356z.51, 356z.53, 356z.54,
585	585	24 356z.55, 356z.56, 356z.57, 356z.58, 356z.59, 356z.60, 356z.61,
586	586	25 356z.62, 356z.63, 356z.64, 356z.65, 356z.66, 356z.67, 356z.68,
587	587
588	588
589	589
590	590
591	591
592	592	HB3561 - 16 - LRB104 10745 BAB 20824 b
593	593
594	594
595	595	HB3561- 17 -LRB104 10745 BAB 20824 b HB3561 - 17 - LRB104 10745 BAB 20824 b
596	596	HB3561 - 17 - LRB104 10745 BAB 20824 b
597	597	1 356z.69, 356z.70, 356z.71, 356z.72, 356z.73, 356z.74, 356z.75,
598	598	2 356z.77, 356z.80, 364, 364.01, 364.3, 367.2, 367.2-5, 367i,
599	599	3 368a, 368b, 368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402,
600	600	4 403, 403A, 408, 408.2, 409, 412, 444, and 444.1, paragraph (c)
601	601	5 of subsection (2) of Section 367, and Articles IIA, VIII 1/2,
602	602	6 XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the
603	603	7 Illinois Insurance Code.
604	604	8 (b) For purposes of the Illinois Insurance Code, except
605	605	9 for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
606	606	10 Health Maintenance Organizations in the following categories
607	607	11 are deemed to be "domestic companies":
608	608	12 (1) a corporation authorized under the Dental Service
609	609	13 Plan Act or the Voluntary Health Services Plans Act;
610	610	14 (2) a corporation organized under the laws of this
611	611	15 State; or
612	612	16 (3) a corporation organized under the laws of another
613	613	17 state, 30% or more of the enrollees of which are residents
614	614	18 of this State, except a corporation subject to
615	615	19 substantially the same requirements in its state of
616	616	20 organization as is a "domestic company" under Article VIII
617	617	21 1/2 of the Illinois Insurance Code.
618	618	22 (c) In considering the merger, consolidation, or other
619	619	23 acquisition of control of a Health Maintenance Organization
620	620	24 pursuant to Article VIII 1/2 of the Illinois Insurance Code,
621	621	25 (1) the Director shall give primary consideration to
622	622	26 the continuation of benefits to enrollees and the
623	623
624	624
625	625
626	626
627	627
628	628	HB3561 - 17 - LRB104 10745 BAB 20824 b
629	629
630	630
631	631	HB3561- 18 -LRB104 10745 BAB 20824 b HB3561 - 18 - LRB104 10745 BAB 20824 b
632	632	HB3561 - 18 - LRB104 10745 BAB 20824 b
633	633	1 financial conditions of the acquired Health Maintenance
634	634	2 Organization after the merger, consolidation, or other
635	635	3 acquisition of control takes effect;
636	636	4 (2)(i) the criteria specified in subsection (1)(b) of
637	637	5 Section 131.8 of the Illinois Insurance Code shall not
638	638	6 apply and (ii) the Director, in making his determination
639	639	7 with respect to the merger, consolidation, or other
640	640	8 acquisition of control, need not take into account the
641	641	9 effect on competition of the merger, consolidation, or
642	642	10 other acquisition of control;
643	643	11 (3) the Director shall have the power to require the
644	644	12 following information:
645	645	13 (A) certification by an independent actuary of the
646	646	14 adequacy of the reserves of the Health Maintenance
647	647	15 Organization sought to be acquired;
648	648	16 (B) pro forma financial statements reflecting the
649	649	17 combined balance sheets of the acquiring company and
650	650	18 the Health Maintenance Organization sought to be
651	651	19 acquired as of the end of the preceding year and as of
652	652	20 a date 90 days prior to the acquisition, as well as pro
653	653	21 forma financial statements reflecting projected
654	654	22 combined operation for a period of 2 years;
655	655	23 (C) a pro forma business plan detailing an
656	656	24 acquiring party's plans with respect to the operation
657	657	25 of the Health Maintenance Organization sought to be
658	658	26 acquired for a period of not less than 3 years; and
659	659
660	660
661	661
662	662
663	663
664	664	HB3561 - 18 - LRB104 10745 BAB 20824 b
665	665
666	666
667	667	HB3561- 19 -LRB104 10745 BAB 20824 b HB3561 - 19 - LRB104 10745 BAB 20824 b
668	668	HB3561 - 19 - LRB104 10745 BAB 20824 b
669	669	1 (D) such other information as the Director shall
670	670	2 require.
671	671	3 (d) The provisions of Article VIII 1/2 of the Illinois
672	672	4 Insurance Code and this Section 5-3 shall apply to the sale by
673	673	5 any health maintenance organization of greater than 10% of its
674	674	6 enrollee population (including, without limitation, the health
675	675	7 maintenance organization's right, title, and interest in and
676	676	8 to its health care certificates).
677	677	9 (e) In considering any management contract or service
678	678	10 agreement subject to Section 141.1 of the Illinois Insurance
679	679	11 Code, the Director (i) shall, in addition to the criteria
680	680	12 specified in Section 141.2 of the Illinois Insurance Code,
681	681	13 take into account the effect of the management contract or
682	682	14 service agreement on the continuation of benefits to enrollees
683	683	15 and the financial condition of the health maintenance
684	684	16 organization to be managed or serviced, and (ii) need not take
685	685	17 into account the effect of the management contract or service
686	686	18 agreement on competition.
687	687	19 (f) Except for small employer groups as defined in the
688	688	20 Small Employer Rating, Renewability and Portability Health
689	689	21 Insurance Act and except for medicare supplement policies as
690	690	22 defined in Section 363 of the Illinois Insurance Code, a
691	691	23 Health Maintenance Organization may by contract agree with a
692	692	24 group or other enrollment unit to effect refunds or charge
693	693	25 additional premiums under the following terms and conditions:
694	694	26 (i) the amount of, and other terms and conditions with
695	695
696	696
697	697
698	698
699	699
700	700	HB3561 - 19 - LRB104 10745 BAB 20824 b
701	701
702	702
703	703	HB3561- 20 -LRB104 10745 BAB 20824 b HB3561 - 20 - LRB104 10745 BAB 20824 b
704	704	HB3561 - 20 - LRB104 10745 BAB 20824 b
705	705	1 respect to, the refund or additional premium are set forth
706	706	2 in the group or enrollment unit contract agreed in advance
707	707	3 of the period for which a refund is to be paid or
708	708	4 additional premium is to be charged (which period shall
709	709	5 not be less than one year); and
710	710	6 (ii) the amount of the refund or additional premium
711	711	7 shall not exceed 20% of the Health Maintenance
712	712	8 Organization's profitable or unprofitable experience with
713	713	9 respect to the group or other enrollment unit for the
714	714	10 period (and, for purposes of a refund or additional
715	715	11 premium, the profitable or unprofitable experience shall
716	716	12 be calculated taking into account a pro rata share of the
717	717	13 Health Maintenance Organization's administrative and
718	718	14 marketing expenses, but shall not include any refund to be
719	719	15 made or additional premium to be paid pursuant to this
720	720	16 subsection (f)). The Health Maintenance Organization and
721	721	17 the group or enrollment unit may agree that the profitable
722	722	18 or unprofitable experience may be calculated taking into
723	723	19 account the refund period and the immediately preceding 2
724	724	20 plan years.
725	725	21 The Health Maintenance Organization shall include a
726	726	22 statement in the evidence of coverage issued to each enrollee
727	727	23 describing the possibility of a refund or additional premium,
728	728	24 and upon request of any group or enrollment unit, provide to
729	729	25 the group or enrollment unit a description of the method used
730	730	26 to calculate (1) the Health Maintenance Organization's
731	731
732	732
733	733
734	734
735	735
736	736	HB3561 - 20 - LRB104 10745 BAB 20824 b
737	737
738	738
739	739	HB3561- 21 -LRB104 10745 BAB 20824 b HB3561 - 21 - LRB104 10745 BAB 20824 b
740	740	HB3561 - 21 - LRB104 10745 BAB 20824 b
741	741	1 profitable experience with respect to the group or enrollment
742	742	2 unit and the resulting refund to the group or enrollment unit
743	743	3 or (2) the Health Maintenance Organization's unprofitable
744	744	4 experience with respect to the group or enrollment unit and
745	745	5 the resulting additional premium to be paid by the group or
746	746	6 enrollment unit.
747	747	7 In no event shall the Illinois Health Maintenance
748	748	8 Organization Guaranty Association be liable to pay any
749	749	9 contractual obligation of an insolvent organization to pay any
750	750	10 refund authorized under this Section.
751	751	11 (g) Rulemaking authority to implement Public Act 95-1045,
752	752	12 if any, is conditioned on the rules being adopted in
753	753	13 accordance with all provisions of the Illinois Administrative
754	754	14 Procedure Act and all rules and procedures of the Joint
755	755	15 Committee on Administrative Rules; any purported rule not so
756	756	16 adopted, for whatever reason, is unauthorized.
757	757	17 (Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
758	758	18 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
759	759	19 1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
760	760	20 eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
761	761	21 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
762	762	22 1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
763	763	23 eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;
764	764	24 103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.
765	765	25 6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
766	766	26 eff. 1-1-24; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24;
767	767
768	768
769	769
770	770
771	771
772	772	HB3561 - 21 - LRB104 10745 BAB 20824 b
773	773
774	774
775	775	HB3561- 22 -LRB104 10745 BAB 20824 b HB3561 - 22 - LRB104 10745 BAB 20824 b
776	776	HB3561 - 22 - LRB104 10745 BAB 20824 b
777	777	1 103-618, eff. 1-1-25; 103-649, eff. 1-1-25; 103-656, eff.
778	778	2 1-1-25; 103-700, eff. 1-1-25; 103-718, eff. 7-19-24; 103-751,
779	779	3 eff. 8-2-24; 103-753, eff. 8-2-24; 103-758, eff. 1-1-25;
780	780	4 103-777, eff. 8-2-24; 103-808, eff. 1-1-26; 103-914, eff.
781	781	5 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; revised
782	782	6 11-26-24.)
783	783	7 Section 30. The Limited Health Service Organization Act is
784	784	8 amended by changing Section 4003 as follows:
785	785	9 (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
786	786	10 Sec. 4003. Illinois Insurance Code provisions. Limited
787	787	11 health service organizations shall be subject to the
788	788	12 provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
789	789	13 141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151, 152, 153,
790	790	14 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 352c,
791	791	15 355.2, 355.3, 355b, 355d, 356m, 356q, 356v, 356z.4, 356z.4a,
792	792	16 356z.10, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.32,
793	793	17 356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
794	794	18 356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68, 356z.71,
795	795	19 356z.73, 356z.74, 356z.75, 356z.80, 364.3, 368a, 401, 401.1,
796	796	20 402, 403, 403A, 408, 408.2, 409, 412, 444, and 444.1 and
797	797	21 Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and
798	798	22 XXVI of the Illinois Insurance Code. Nothing in this Section
799	799	23 shall require a limited health care plan to cover any service
800	800	24 that is not a limited health service. For purposes of the
801	801
802	802
803	803
804	804
805	805
806	806	HB3561 - 22 - LRB104 10745 BAB 20824 b
807	807
808	808
809	809	HB3561- 23 -LRB104 10745 BAB 20824 b HB3561 - 23 - LRB104 10745 BAB 20824 b
810	810	HB3561 - 23 - LRB104 10745 BAB 20824 b
811	811	1 Illinois Insurance Code, except for Sections 444 and 444.1 and
812	812	2 Articles XIII and XIII 1/2, limited health service
813	813	3 organizations in the following categories are deemed to be
814	814	4 domestic companies:
815	815	5 (1) a corporation under the laws of this State; or
816	816	6 (2) a corporation organized under the laws of another
817	817	7 state, 30% or more of the enrollees of which are residents
818	818	8 of this State, except a corporation subject to
819	819	9 substantially the same requirements in its state of
820	820	10 organization as is a domestic company under Article VIII
821	821	11 1/2 of the Illinois Insurance Code.
822	822	12 (Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
823	823	13 102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-731, eff.
824	824	14 1-1-23; 102-775, eff. 5-13-22; 102-813, eff. 5-13-22; 102-816,
825	825	15 eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
826	826	16 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
827	827	17 1-1-24; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
828	828	18 eff. 1-1-24; 103-605, eff. 7-1-24; 103-649, eff. 1-1-25;
829	829	19 103-656, eff. 1-1-25; 103-700, eff. 1-1-25; 103-718, eff.
830	830	20 7-19-24; 103-751, eff. 8-2-24; 103-758, eff. 1-1-25; 103-832,
831	831	21 eff. 1-1-25; 103-1024, eff. 1-1-25; revised 11-26-24.)
832	832	22 Section 35. The Voluntary Health Services Plans Act is
833	833	23 amended by changing Section 10 as follows:
834	834	24 (215 ILCS 165/10) (from Ch. 32, par. 604)
835	835
836	836
837	837
838	838
839	839
840	840	HB3561 - 23 - LRB104 10745 BAB 20824 b
841	841
842	842
843	843	HB3561- 24 -LRB104 10745 BAB 20824 b HB3561 - 24 - LRB104 10745 BAB 20824 b
844	844	HB3561 - 24 - LRB104 10745 BAB 20824 b
845	845	1 Sec. 10. Application of Insurance Code provisions. Health
846	846	2 services plan corporations and all persons interested therein
847	847	3 or dealing therewith shall be subject to the provisions of
848	848	4 Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
849	849	5 143, 143.31, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3,
850	850	6 355b, 355d, 356g, 356g.5, 356g.5-1, 356m, 356q, 356r, 356t,
851	851	7 356u, 356u.10, 356v, 356w, 356x, 356y, 356z.1, 356z.2,
852	852	8 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9,
853	853	9 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18,
854	854	10 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30,
855	855	11 356z.32, 356z.32a, 356z.33, 356z.40, 356z.41, 356z.46,
856	856	12 356z.47, 356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59,
857	857	13 356z.60, 356z.61, 356z.62, 356z.64, 356z.67, 356z.68, 356z.71,
858	858	14 356z.72, 356z.74, 356z.75, 356z.77, 356z.80, 364.01, 364.3,
859	859	15 367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412,
860	860	16 and paragraphs (7) and (15) of Section 367 of the Illinois
861	861	17 Insurance Code.
862	862	18 Rulemaking authority to implement Public Act 95-1045, if
863	863	19 any, is conditioned on the rules being adopted in accordance
864	864	20 with all provisions of the Illinois Administrative Procedure
865	865	21 Act and all rules and procedures of the Joint Committee on
866	866	22 Administrative Rules; any purported rule not so adopted, for
867	867	23 whatever reason, is unauthorized.
868	868	24 (Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
869	869	25 102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff.
870	870	26 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804,
871	871
872	872
873	873
874	874
875	875
876	876	HB3561 - 24 - LRB104 10745 BAB 20824 b
877	877
878	878
879	879	HB3561- 25 -LRB104 10745 BAB 20824 b HB3561 - 25 - LRB104 10745 BAB 20824 b
880	880	HB3561 - 25 - LRB104 10745 BAB 20824 b
881	881	1 eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
882	882	2 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff.
883	883	3 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
884	884	4 eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
885	885	5 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-656, eff.
886	886	6 1-1-25; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-753,
887	887	7 eff. 8-2-24; 103-758, eff. 1-1-25; 103-832, eff. 1-1-25;
888	888	8 103-914, eff. 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff.
889	889	9 1-1-25; revised 11-26-24.)
890	890	10 Section 40. The Illinois Public Aid Code is amended by
891	891	11 changing Section 5-16.8 as follows:
892	892	12 (305 ILCS 5/5-16.8)
893	893	13 Sec. 5-16.8. Required health benefits. The medical
894	894	14 assistance program shall (i) provide the post-mastectomy care
895	895	15 benefits required to be covered by a policy of accident and
896	896	16 health insurance under Section 356t and the coverage required
897	897	17 under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6,
898	898	18 356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,
899	899	19 356z.47, 356z.51, 356z.53, 356z.59, 356z.60, 356z.61, 356z.64,
900	900	20 and 356z.67, and 356z.71, 356z.75, and 356z.80 of the Illinois
901	901	21 Insurance Code, (ii) be subject to the provisions of Sections
902	902	22 356z.19, 356z.44, 356z.49, 364.01, 370c, and 370c.1 of the
903	903	23 Illinois Insurance Code, and (iii) be subject to the
904	904	24 provisions of subsection (d-5) of Section 10 of the Network
905	905
906	906
907	907
908	908
909	909
910	910	HB3561 - 25 - LRB104 10745 BAB 20824 b
911	911
912	912
913	913	HB3561- 26 -LRB104 10745 BAB 20824 b HB3561 - 26 - LRB104 10745 BAB 20824 b
914	914	HB3561 - 26 - LRB104 10745 BAB 20824 b
915	915	1 Adequacy and Transparency Act.
916	916	2 The Department, by rule, shall adopt a model similar to
917	917	3 the requirements of Section 356z.39 of the Illinois Insurance
918	918	4 Code.
919	919	5 On and after July 1, 2012, the Department shall reduce any
920	920	6 rate of reimbursement for services or other payments or alter
921	921	7 any methodologies authorized by this Code to reduce any rate
922	922	8 of reimbursement for services or other payments in accordance
923	923	9 with Section 5-5e.
924	924	10 To ensure full access to the benefits set forth in this
925	925	11 Section, on and after January 1, 2016, the Department shall
926	926	12 ensure that provider and hospital reimbursement for
927	927	13 post-mastectomy care benefits required under this Section are
928	928	14 no lower than the Medicare reimbursement rate.
929	929	15 (Source: P.A. 102-30, eff. 1-1-22; 102-144, eff. 1-1-22;
930	930	16 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-530, eff.
931	931	17 1-1-22; 102-642, eff. 1-1-22; 102-804, eff. 1-1-23; 102-813,
932	932	18 eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093, eff. 1-1-23;
933	933	19 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
934	934	20 1-1-24; 103-420, eff. 1-1-24; 103-605, eff. 7-1-24; 103-703,
935	935	21 eff. 1-1-25; 103-758, eff. 1-1-25; 103-1024, eff. 1-1-25;
936	936	22 revised 11-26-24.)
937	937	23 Section 95. No acceleration or delay. Where this Act makes
938	938	24 changes in a statute that is represented in this Act by text
939	939	25 that is not yet or no longer in effect (for example, a Section
940	940
941	941
942	942
943	943
944	944
945	945	HB3561 - 26 - LRB104 10745 BAB 20824 b
946	946
947	947
948	948	HB3561- 27 -LRB104 10745 BAB 20824 b HB3561 - 27 - LRB104 10745 BAB 20824 b
949	949	HB3561 - 27 - LRB104 10745 BAB 20824 b
950	950	1 represented by multiple versions), the use of that text does
951	951	2 not accelerate or delay the taking effect of (i) the changes
952	952	3 made by this Act or (ii) provisions derived from any other
953	953	4 Public Act.
954	954	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
955	955	HB3561- 28 -LRB104 10745 BAB 20824 b HB3561 - 28 - LRB104 10745 BAB 20824 b
956	956	HB3561 - 28 - LRB104 10745 BAB 20824 b
957	957	1 INDEX
958	958	2 Statutes amended in order of appearance
959	959
960	960
961	961
962	962
963	963
964	964	HB3561 - 27 - LRB104 10745 BAB 20824 b
965	965
966	966
967	967
968	968	HB3561- 28 -LRB104 10745 BAB 20824 b HB3561 - 28 - LRB104 10745 BAB 20824 b
969	969	HB3561 - 28 - LRB104 10745 BAB 20824 b
970	970	1 INDEX
971	971	2 Statutes amended in order of appearance
972	972
973	973
974	974
975	975
976	976
977	977	HB3561 - 28 - LRB104 10745 BAB 20824 b