Illinois 2025-2026 Regular Session

Illinois Senate Bill SB0175 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	SB0175 EngrossedLRB104 06566 BAB 16602 b SB0175 Engrossed LRB104 06566 BAB 16602 b
2		-	SB0175 Engrossed LRB104 06566 BAB 16602 b
	1	+	104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB0175 Introduced 1/17/2025, by Sen. Laura Fine SYNOPSIS AS INTRODUCED: 5 ILCS 375/6.1155 ILCS 5/5-1069.365 ILCS 5/10-4-2.3105 ILCS 5/10-22.3f215 ILCS 5/356z.80 new215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2215 ILCS 130/4003 from Ch. 73, par. 1504-3215 ILCS 165/10 from Ch. 32, par. 604305 ILCS 5/5-16.8 Amends the Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2026 shall provide coverage for the cost of a karyotype test or related hormone testing to diagnose Klinefelter syndrome. 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 06566 BAB 16602 b A BILL FOR 104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB0175 Introduced 1/17/2025, by Sen. Laura Fine SYNOPSIS AS INTRODUCED: 5 ILCS 375/6.1155 ILCS 5/5-1069.365 ILCS 5/10-4-2.3105 ILCS 5/10-22.3f215 ILCS 5/356z.80 new215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2215 ILCS 130/4003 from Ch. 73, par. 1504-3215 ILCS 165/10 from Ch. 32, par. 604305 ILCS 5/5-16.8 5 ILCS 375/6.11 55 ILCS 5/5-1069.3 65 ILCS 5/10-4-2.3 105 ILCS 5/10-22.3f 215 ILCS 5/356z.80 new 215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2 215 ILCS 130/4003 from Ch. 73, par. 1504-3 215 ILCS 165/10 from Ch. 32, par. 604 305 ILCS 5/5-16.8 Amends the Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2026 shall provide coverage for the cost of a karyotype test or related hormone testing to diagnose Klinefelter syndrome. 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 06566 BAB 16602 b LRB104 06566 BAB 16602 b A BILL FOR
	2	+	104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB0175 Introduced 1/17/2025, by Sen. Laura Fine SYNOPSIS AS INTRODUCED:
	3	+	5 ILCS 375/6.1155 ILCS 5/5-1069.365 ILCS 5/10-4-2.3105 ILCS 5/10-22.3f215 ILCS 5/356z.80 new215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2215 ILCS 130/4003 from Ch. 73, par. 1504-3215 ILCS 165/10 from Ch. 32, par. 604305 ILCS 5/5-16.8 5 ILCS 375/6.11 55 ILCS 5/5-1069.3 65 ILCS 5/10-4-2.3 105 ILCS 5/10-22.3f 215 ILCS 5/356z.80 new 215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2 215 ILCS 130/4003 from Ch. 73, par. 1504-3 215 ILCS 165/10 from Ch. 32, par. 604 305 ILCS 5/5-16.8
	4	+	5 ILCS 375/6.11
	5	+	55 ILCS 5/5-1069.3
	6	+	65 ILCS 5/10-4-2.3
	7	+	105 ILCS 5/10-22.3f
	8	+	215 ILCS 5/356z.80 new
	9	+	215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2
	10	+	215 ILCS 130/4003 from Ch. 73, par. 1504-3
	11	+	215 ILCS 165/10 from Ch. 32, par. 604
	12	+	305 ILCS 5/5-16.8
	13	+	Amends the Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2026 shall provide coverage for the cost of a karyotype test or related hormone testing to diagnose Klinefelter syndrome. Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, the Limited Health Service Organization Act, the Voluntary Health Services Plans Act, and the Illinois Public Aid Code to require coverage under those provisions.
	14	+	LRB104 06566 BAB 16602 b LRB104 06566 BAB 16602 b
	15	+	LRB104 06566 BAB 16602 b
	16	+	A BILL FOR
	17	+	SB0175LRB104 06566 BAB 16602 b SB0175 LRB104 06566 BAB 16602 b
	18	+	SB0175 LRB104 06566 BAB 16602 b
3	19		1 AN ACT concerning regulation.
4	20		2 Be it enacted by the People of the State of Illinois,
5	21		3 represented in the General Assembly:
6	22		4 Section 5. The State Employees Group Insurance Act of 1971
7	23		5 is amended by changing Section 6.11 as follows:
8	24		6 (5 ILCS 375/6.11)
9	25		7 Sec. 6.11. Required health benefits; Illinois Insurance
10	26		8 Code requirements. The program of health benefits shall
11	27		9 provide the post-mastectomy care benefits required to be
12	28		10 covered by a policy of accident and health insurance under
13	29		11 Section 356t of the Illinois Insurance Code. The program of
14	30		12 health benefits shall provide the coverage required under
15	31		13 Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10,
16	32		14 356w, 356x, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8,
17	33		15 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
18	34		16 356z.17, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32,
19	35		17 356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
20	36		18 356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59,
21	37		19 356z.60, 356z.61, 356z.62, 356z.64, 356z.67, 356z.68, and
22	38		20 356z.70, and 356z.71, 356z.74, 356z.76, 356z.77, and 356z.80
23	39		21 of the Illinois Insurance Code. The program of health benefits
24	40		22 must comply with Sections 155.22a, 155.37, 355b, 356z.19,
25	41		23 370c, and 370c.1 and Article XXXIIB of the Illinois Insurance
26	42
27	43
28	44
29		-	SB0175 Engrossed LRB104 06566 BAB 16602 b
	45	+	104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB0175 Introduced 1/17/2025, by Sen. Laura Fine SYNOPSIS AS INTRODUCED:
	46	+	5 ILCS 375/6.1155 ILCS 5/5-1069.365 ILCS 5/10-4-2.3105 ILCS 5/10-22.3f215 ILCS 5/356z.80 new215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2215 ILCS 130/4003 from Ch. 73, par. 1504-3215 ILCS 165/10 from Ch. 32, par. 604305 ILCS 5/5-16.8 5 ILCS 375/6.11 55 ILCS 5/5-1069.3 65 ILCS 5/10-4-2.3 105 ILCS 5/10-22.3f 215 ILCS 5/356z.80 new 215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2 215 ILCS 130/4003 from Ch. 73, par. 1504-3 215 ILCS 165/10 from Ch. 32, par. 604 305 ILCS 5/5-16.8
	47	+	5 ILCS 375/6.11
	48	+	55 ILCS 5/5-1069.3
	49	+	65 ILCS 5/10-4-2.3
	50	+	105 ILCS 5/10-22.3f
	51	+	215 ILCS 5/356z.80 new
	52	+	215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2
	53	+	215 ILCS 130/4003 from Ch. 73, par. 1504-3
	54	+	215 ILCS 165/10 from Ch. 32, par. 604
	55	+	305 ILCS 5/5-16.8
	56	+	Amends the Illinois Insurance Code. Provides that a group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2026 shall provide coverage for the cost of a karyotype test or related hormone testing to diagnose Klinefelter syndrome. Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, the Limited Health Service Organization Act, the Voluntary Health Services Plans Act, and the Illinois Public Aid Code to require coverage under those provisions.
	57	+	LRB104 06566 BAB 16602 b LRB104 06566 BAB 16602 b
	58	+	LRB104 06566 BAB 16602 b
	59	+	A BILL FOR
30	60
31	61
32		-	SB0175 Engrossed- 2 -LRB104 06566 BAB 16602 b SB0175 Engrossed - 2 - LRB104 06566 BAB 16602 b
33		-	SB0175 Engrossed - 2 - LRB104 06566 BAB 16602 b
	62	+
	63	+
	64	+
	65	+	5 ILCS 375/6.11
	66	+	55 ILCS 5/5-1069.3
	67	+	65 ILCS 5/10-4-2.3
	68	+	105 ILCS 5/10-22.3f
	69	+	215 ILCS 5/356z.80 new
	70	+	215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2
	71	+	215 ILCS 130/4003 from Ch. 73, par. 1504-3
	72	+	215 ILCS 165/10 from Ch. 32, par. 604
	73	+	305 ILCS 5/5-16.8
	74	+
	75	+
	76	+
	77	+	LRB104 06566 BAB 16602 b
	78	+
	79	+
	80	+
	81	+
	82	+
	83	+
	84	+
	85	+
	86	+
	87	+	SB0175 LRB104 06566 BAB 16602 b
	88	+
	89	+
	90	+	SB0175- 2 -LRB104 06566 BAB 16602 b SB0175 - 2 - LRB104 06566 BAB 16602 b
	91	+	SB0175 - 2 - LRB104 06566 BAB 16602 b
34	92		1 Code. The program of health benefits shall provide the
35	93		2 coverage required under Section 356m of the Illinois Insurance
36	94		3 Code and, for the employees of the State Employee Group
37	95		4 Insurance Program only, the coverage as also provided in
38	96		5 Section 6.11B of this Act. The Department of Insurance shall
39	97		6 enforce the requirements of this Section with respect to
40	98		7 Sections 370c and 370c.1 of the Illinois Insurance Code; all
41	99		8 other requirements of this Section shall be enforced by the
42	100		9 Department of Central Management Services.
43	101		10 Rulemaking authority to implement Public Act 95-1045, if
44	102		11 any, is conditioned on the rules being adopted in accordance
45	103		12 with all provisions of the Illinois Administrative Procedure
46	104		13 Act and all rules and procedures of the Joint Committee on
47	105		14 Administrative Rules; any purported rule not so adopted, for
48	106		15 whatever reason, is unauthorized.
49	107		16 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
50	108		17 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
51	109		18 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-768,
52	110		19 eff. 1-1-24; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
53	111		20 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
54	112		21 1-1-23; 102-1117, eff. 1-13-23; 103-8, eff. 1-1-24; 103-84,
55	113		22 eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, eff. 1-1-24;
56	114		23 103-445, eff. 1-1-24; 103-535, eff. 8-11-23; 103-551, eff.
57	115		24 8-11-23; 103-605, eff. 7-1-24; 103-718, eff. 7-19-24; 103-751,
58	116		25 eff. 8-2-24; 103-870, eff. 1-1-25; 103-914, eff. 1-1-25;
59	117		26 103-918, eff. 1-1-25; 103-951, eff. 1-1-25; 103-1024, eff.
60	118
61	119
62	120
63	121
64	122
65		-	SB0175 ~~Engrossed~~ - 2 - LRB104 06566 BAB 16602 b
	123	+	SB0175 - 2 - LRB104 06566 BAB 16602 b
66	124
67	125
68		-	SB0175 ~~Engrossed~~- 3 -LRB104 06566 BAB 16602 b SB0175 ~~Engrossed~~ - 3 - LRB104 06566 BAB 16602 b
69		-	SB0175 ~~Engrossed~~ - 3 - LRB104 06566 BAB 16602 b
	126	+	SB0175- 3 -LRB104 06566 BAB 16602 b SB0175 - 3 - LRB104 06566 BAB 16602 b
	127	+	SB0175 - 3 - LRB104 06566 BAB 16602 b
70	128		1 1-1-25; revised 11-26-24.)
71	129		2 Section 10. The Counties Code is amended by changing
72	130		3 Section 5-1069.3 as follows:
73	131		4 (55 ILCS 5/5-1069.3)
74	132		5 Sec. 5-1069.3. Required health benefits. If a county,
75	133		6 including a home rule county, is a self-insurer for purposes
76	134		7 of providing health insurance coverage for its employees, the
77	135		8 coverage shall include coverage for the post-mastectomy care
78	136		9 benefits required to be covered by a policy of accident and
79	137		10 health insurance under Section 356t and the coverage required
80	138		11 under Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u,
81	139		12 356u.10, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9,
82	140		13 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
83	141		14 356z.25, 356z.26, 356z.29, 356z.30, 356z.32, 356z.33, 356z.36,
84	142		15 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51,
85	143		16 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, 356z.61,
86	144		17 356z.62, 356z.64, 356z.67, 356z.68, and 356z.70, and 356z.71,
87	145		18 356z.74, 356z.77, and 356z.80 of the Illinois Insurance Code.
88	146		19 The coverage shall comply with Sections 155.22a, 355b,
89	147		20 356z.19, and 370c of the Illinois Insurance Code. The
90	148		21 Department of Insurance shall enforce the requirements of this
91	149		22 Section. The requirement that health benefits be covered as
92	150		23 provided in this Section is an exclusive power and function of
93	151		24 the State and is a denial and limitation under Article VII,
94	152
95	153
96	154
97	155
98	156
99		-	SB0175 ~~Engrossed~~ - 3 - LRB104 06566 BAB 16602 b
	157	+	SB0175 - 3 - LRB104 06566 BAB 16602 b
100	158
101	159
102		-	SB0175 ~~Engrossed~~- 4 -LRB104 06566 BAB 16602 b SB0175 ~~Engrossed~~ - 4 - LRB104 06566 BAB 16602 b
103		-	SB0175 ~~Engrossed~~ - 4 - LRB104 06566 BAB 16602 b
	160	+	SB0175- 4 -LRB104 06566 BAB 16602 b SB0175 - 4 - LRB104 06566 BAB 16602 b
	161	+	SB0175 - 4 - LRB104 06566 BAB 16602 b
104	162		1 Section 6, subsection (h) of the Illinois Constitution. A home
105	163		2 rule county to which this Section applies must comply with
106	164		3 every provision of this Section.
107	165		4 Rulemaking authority to implement Public Act 95-1045, if
108	166		5 any, is conditioned on the rules being adopted in accordance
109	167		6 with all provisions of the Illinois Administrative Procedure
110	168		7 Act and all rules and procedures of the Joint Committee on
111	169		8 Administrative Rules; any purported rule not so adopted, for
112	170		9 whatever reason, is unauthorized.
113	171		10 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
114	172		11 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
115	173		12 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
116	174		13 eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
117	175		14 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
118	176		15 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
119	177		16 eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
120	178		17 103-535, eff. 8-11-23; 103-551, eff. 8-11-23; 103-605, eff.
121	179		18 7-1-24; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-914,
122	180		19 eff. 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25;
123	181		20 revised 11-26-24.)
124	182		21 Section 15. The Illinois Municipal Code is amended by
125	183		22 changing Section 10-4-2.3 as follows:
126	184		23 (65 ILCS 5/10-4-2.3)
127	185		24 Sec. 10-4-2.3. Required health benefits. If a
128	186
129	187
130	188
131	189
132	190
133		-	SB0175 ~~Engrossed~~ - 4 - LRB104 06566 BAB 16602 b
	191	+	SB0175 - 4 - LRB104 06566 BAB 16602 b
134	192
135	193
136		-	SB0175 ~~Engrossed~~- 5 -LRB104 06566 BAB 16602 b SB0175 ~~Engrossed~~ - 5 - LRB104 06566 BAB 16602 b
137		-	SB0175 ~~Engrossed~~ - 5 - LRB104 06566 BAB 16602 b
	194	+	SB0175- 5 -LRB104 06566 BAB 16602 b SB0175 - 5 - LRB104 06566 BAB 16602 b
	195	+	SB0175 - 5 - LRB104 06566 BAB 16602 b
138	196		1 municipality, including a home rule municipality, is a
139	197		2 self-insurer for purposes of providing health insurance
140	198		3 coverage for its employees, the coverage shall include
141	199		4 coverage for the post-mastectomy care benefits required to be
142	200		5 covered by a policy of accident and health insurance under
143	201		6 Section 356t and the coverage required under Sections 356g,
144	202		7 356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10, 356w, 356x,
145	203		8 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11,
146	204		9 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26,
147	205		10 356z.29, 356z.30, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
148	206		11 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
149	207		12 356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64,
150	208		13 356z.67, 356z.68, and 356z.70, and 356z.71, 356z.74, 356z.77,
151	209		14 and 356z.80 of the Illinois Insurance Code. The coverage shall
152	210		15 comply with Sections 155.22a, 355b, 356z.19, and 370c of the
153	211		16 Illinois Insurance Code. The Department of Insurance shall
154	212		17 enforce the requirements of this Section. The requirement that
155	213		18 health benefits be covered as provided in this is an exclusive
156	214		19 power and function of the State and is a denial and limitation
157	215		20 under Article VII, Section 6, subsection (h) of the Illinois
158	216		21 Constitution. A home rule municipality to which this Section
159	217		22 applies must comply with every provision of this Section.
160	218		23 Rulemaking authority to implement Public Act 95-1045, if
161	219		24 any, is conditioned on the rules being adopted in accordance
162	220		25 with all provisions of the Illinois Administrative Procedure
163	221		26 Act and all rules and procedures of the Joint Committee on
164	222
165	223
166	224
167	225
168	226
169		-	SB0175 ~~Engrossed~~ - 5 - LRB104 06566 BAB 16602 b
	227	+	SB0175 - 5 - LRB104 06566 BAB 16602 b
170	228
171	229
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173		-	SB0175 ~~Engrossed~~ - 6 - LRB104 06566 BAB 16602 b
	230	+	SB0175- 6 -LRB104 06566 BAB 16602 b SB0175 - 6 - LRB104 06566 BAB 16602 b
	231	+	SB0175 - 6 - LRB104 06566 BAB 16602 b
174	232		1 Administrative Rules; any purported rule not so adopted, for
175	233		2 whatever reason, is unauthorized.
176	234		3 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
177	235		4 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
178	236		5 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
179	237		6 eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
180	238		7 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
181	239		8 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
182	240		9 eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
183	241		10 103-535, eff. 8-11-23; 103-551, eff. 8-11-23; 103-605, eff.
184	242		11 7-1-24; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-914,
185	243		12 eff. 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25;
186	244		13 revised 11-26-24.)
187	245		14 Section 20. The School Code is amended by changing Section
188	246		15 10-22.3f as follows:
189	247		16 (105 ILCS 5/10-22.3f)
190	248		17 Sec. 10-22.3f. Required health benefits. Insurance
191	249		18 protection and benefits for employees shall provide the
192	250		19 post-mastectomy care benefits required to be covered by a
193	251		20 policy of accident and health insurance under Section 356t and
194	252		21 the coverage required under Sections 356g, 356g.5, 356g.5-1,
195	253		22 356m, 356q, 356u, 356u.10, 356w, 356x, 356z.4, 356z.4a,
196	254		23 356z.6, 356z.8, 356z.9, 356z.11, 356z.12, 356z.13, 356z.14,
197	255		24 356z.15, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32,
198	256
199	257
200	258
201	259
202	260
203		-	SB0175 ~~Engrossed~~ - 6 - LRB104 06566 BAB 16602 b
	261	+	SB0175 - 6 - LRB104 06566 BAB 16602 b
204	262
205	263
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207		-	SB0175 ~~Engrossed~~ - 7 - LRB104 06566 BAB 16602 b
	264	+	SB0175- 7 -LRB104 06566 BAB 16602 b SB0175 - 7 - LRB104 06566 BAB 16602 b
	265	+	SB0175 - 7 - LRB104 06566 BAB 16602 b
208	266		1 356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
209	267		2 356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60,
210	268		3 356z.61, 356z.62, 356z.64, 356z.67, 356z.68, and 356z.70, and
211	269		4 356z.71, 356z.74, 356z.77, and 356z.80 of the Illinois
212	270		5 Insurance Code. Insurance policies shall comply with Section
213	271		6 356z.19 of the Illinois Insurance Code. The coverage shall
214	272		7 comply with Sections 155.22a, 355b, and 370c of the Illinois
215	273		8 Insurance Code. The Department of Insurance shall enforce the
216	274		9 requirements of this Section.
217	275		10 Rulemaking authority to implement Public Act 95-1045, if
218	276		11 any, is conditioned on the rules being adopted in accordance
219	277		12 with all provisions of the Illinois Administrative Procedure
220	278		13 Act and all rules and procedures of the Joint Committee on
221	279		14 Administrative Rules; any purported rule not so adopted, for
222	280		15 whatever reason, is unauthorized.
223	281		16 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
224	282		17 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
225	283		18 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804,
226	284		19 eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
227	285		20 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff.
228	286		21 1-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420,
229	287		22 eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. 8-11-23;
230	288		23 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-718, eff.
231	289		24 7-19-24; 103-751, eff. 8-2-24; 103-914, eff. 1-1-25; 103-918,
232	290		25 eff. 1-1-25; 103-1024, eff. 1-1-25; revised 11-26-24.)
233	291
234	292
235	293
236	294
237	295
238		-	SB0175 ~~Engrossed~~ - 7 - LRB104 06566 BAB 16602 b
	296	+	SB0175 - 7 - LRB104 06566 BAB 16602 b
239	297
240	298
241		-	SB0175 ~~Engrossed~~- 8 -LRB104 06566 BAB 16602 b SB0175 ~~Engrossed~~ - 8 - LRB104 06566 BAB 16602 b
242		-	SB0175 ~~Engrossed~~ - 8 - LRB104 06566 BAB 16602 b
	299	+	SB0175- 8 -LRB104 06566 BAB 16602 b SB0175 - 8 - LRB104 06566 BAB 16602 b
	300	+	SB0175 - 8 - LRB104 06566 BAB 16602 b
243	301		1 Section 25. The Illinois Insurance Code is amended by
244	302		2 adding Section 356z.80 as follows:
245	303		3 (215 ILCS 5/356z.80 new)
246	304		4 Sec. 356z.80. Coverage for testing for Klinefelter
247	305		5 syndrome. A group or individual policy of accident and health
248	306		6 insurance or a managed care plan that is amended, delivered,
249		-	7 issued, or renewed on or after January 1, ~~2027~~ shall provide
250		-	8 coverage for a karyotype test or related hormone ~~testing to~~
251		-	9 diagnose Klinefelter syndrome.
	307	+	7 issued, or renewed on or after January 1, 2026 shall provide
	308	+	8 coverage for the cost of a karyotype test or related hormone
	309	+	9 testing to diagnose Klinefelter syndrome.
252	310		10 Section 30. The Health Maintenance Organization Act is
253	311		11 amended by changing Section 5-3 as follows:
254	312		12 (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
255	313		13 (Text of Section before amendment by P.A. 103-808)
256	314		14 Sec. 5-3. Insurance Code provisions.
257	315		15 (a) Health Maintenance Organizations shall be subject to
258	316		16 the provisions of Sections 133, 134, 136, 137, 139, 140,
259	317		17 141.1, 141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151,
260	318		18 152, 153, 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a,
261	319		19 155.49, 352c, 355.2, 355.3, 355.6, 355b, 355c, 356f, 356g.5-1,
262	320		20 356m, 356q, 356u.10, 356v, 356w, 356x, 356z.2, 356z.3a,
263	321		21 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10,
264	322		22 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.18,
265	323		23 356z.19, 356z.20, 356z.21, 356z.22, 356z.23, 356z.24, 356z.25,
266	324
267	325
268	326
269	327
270	328
271		-	SB0175 ~~Engrossed~~ - 8 - LRB104 06566 BAB 16602 b
	329	+	SB0175 - 8 - LRB104 06566 BAB 16602 b
272	330
273	331
274		-	SB0175 ~~Engrossed~~- 9 -LRB104 06566 BAB 16602 b SB0175 ~~Engrossed~~ - 9 - LRB104 06566 BAB 16602 b
275		-	SB0175 ~~Engrossed~~ - 9 - LRB104 06566 BAB 16602 b
	332	+	SB0175- 9 -LRB104 06566 BAB 16602 b SB0175 - 9 - LRB104 06566 BAB 16602 b
	333	+	SB0175 - 9 - LRB104 06566 BAB 16602 b
276	334		1 356z.26, 356z.28, 356z.29, 356z.30, 356z.31, 356z.32, 356z.33,
277	335		2 356z.34, 356z.35, 356z.36, 356z.37, 356z.38, 356z.39, 356z.40,
278	336		3 356z.40a, 356z.41, 356z.44, 356z.45, 356z.46, 356z.47,
279	337		4 356z.48, 356z.49, 356z.50, 356z.51, 356z.53, 356z.54, 356z.55,
280	338		5 356z.56, 356z.57, 356z.58, 356z.59, 356z.60, 356z.61, 356z.62,
281	339		6 356z.63, 356z.64, 356z.65, 356z.66, 356z.67, 356z.68, 356z.69,
282	340		7 356z.70, 356z.71, 356z.72, 356z.73, 356z.74, 356z.75, 356z.77,
283	341		8 356z.80, 364, 364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b,
284	342		9 368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A,
285	343		10 408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of
286	344		11 subsection (2) of Section 367, and Articles IIA, VIII 1/2,
287	345		12 XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the
288	346		13 Illinois Insurance Code.
289	347		14 (b) For purposes of the Illinois Insurance Code, except
290	348		15 for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
291	349		16 Health Maintenance Organizations in the following categories
292	350		17 are deemed to be "domestic companies":
293	351		18 (1) a corporation authorized under the Dental Service
294	352		19 Plan Act or the Voluntary Health Services Plans Act;
295	353		20 (2) a corporation organized under the laws of this
296	354		21 State; or
297	355		22 (3) a corporation organized under the laws of another
298	356		23 state, 30% or more of the enrollees of which are residents
299	357		24 of this State, except a corporation subject to
300	358		25 substantially the same requirements in its state of
301	359		26 organization as is a "domestic company" under Article VIII
302	360
303	361
304	362
305	363
306	364
307		-	SB0175 ~~Engrossed~~ - 9 - LRB104 06566 BAB 16602 b
	365	+	SB0175 - 9 - LRB104 06566 BAB 16602 b
308	366
309	367
310		-	SB0175 ~~Engrossed~~- 10 -LRB104 06566 BAB 16602 b SB0175 ~~Engrossed~~ - 10 - LRB104 06566 BAB 16602 b
311		-	SB0175 ~~Engrossed~~ - 10 - LRB104 06566 BAB 16602 b
	368	+	SB0175- 10 -LRB104 06566 BAB 16602 b SB0175 - 10 - LRB104 06566 BAB 16602 b
	369	+	SB0175 - 10 - LRB104 06566 BAB 16602 b
312	370		1 1/2 of the Illinois Insurance Code.
313	371		2 (c) In considering the merger, consolidation, or other
314	372		3 acquisition of control of a Health Maintenance Organization
315	373		4 pursuant to Article VIII 1/2 of the Illinois Insurance Code,
316	374		5 (1) the Director shall give primary consideration to
317	375		6 the continuation of benefits to enrollees and the
318	376		7 financial conditions of the acquired Health Maintenance
319	377		8 Organization after the merger, consolidation, or other
320	378		9 acquisition of control takes effect;
321	379		10 (2)(i) the criteria specified in subsection (1)(b) of
322	380		11 Section 131.8 of the Illinois Insurance Code shall not
323	381		12 apply and (ii) the Director, in making his determination
324	382		13 with respect to the merger, consolidation, or other
325	383		14 acquisition of control, need not take into account the
326	384		15 effect on competition of the merger, consolidation, or
327	385		16 other acquisition of control;
328	386		17 (3) the Director shall have the power to require the
329	387		18 following information:
330	388		19 (A) certification by an independent actuary of the
331	389		20 adequacy of the reserves of the Health Maintenance
332	390		21 Organization sought to be acquired;
333	391		22 (B) pro forma financial statements reflecting the
334	392		23 combined balance sheets of the acquiring company and
335	393		24 the Health Maintenance Organization sought to be
336	394		25 acquired as of the end of the preceding year and as of
337	395		26 a date 90 days prior to the acquisition, as well as pro
338	396
339	397
340	398
341	399
342	400
343		-	SB0175 ~~Engrossed~~ - 10 - LRB104 06566 BAB 16602 b
	401	+	SB0175 - 10 - LRB104 06566 BAB 16602 b
344	402
345	403
346		-	SB0175 ~~Engrossed~~- 11 -LRB104 06566 BAB 16602 b SB0175 ~~Engrossed~~ - 11 - LRB104 06566 BAB 16602 b
347		-	SB0175 ~~Engrossed~~ - 11 - LRB104 06566 BAB 16602 b
	404	+	SB0175- 11 -LRB104 06566 BAB 16602 b SB0175 - 11 - LRB104 06566 BAB 16602 b
	405	+	SB0175 - 11 - LRB104 06566 BAB 16602 b
348	406		1 forma financial statements reflecting projected
349	407		2 combined operation for a period of 2 years;
350	408		3 (C) a pro forma business plan detailing an
351	409		4 acquiring party's plans with respect to the operation
352	410		5 of the Health Maintenance Organization sought to be
353	411		6 acquired for a period of not less than 3 years; and
354	412		7 (D) such other information as the Director shall
355	413		8 require.
356	414		9 (d) The provisions of Article VIII 1/2 of the Illinois
357	415		10 Insurance Code and this Section 5-3 shall apply to the sale by
358	416		11 any health maintenance organization of greater than 10% of its
359	417		12 enrollee population (including, without limitation, the health
360	418		13 maintenance organization's right, title, and interest in and
361	419		14 to its health care certificates).
362	420		15 (e) In considering any management contract or service
363	421		16 agreement subject to Section 141.1 of the Illinois Insurance
364	422		17 Code, the Director (i) shall, in addition to the criteria
365	423		18 specified in Section 141.2 of the Illinois Insurance Code,
366	424		19 take into account the effect of the management contract or
367	425		20 service agreement on the continuation of benefits to enrollees
368	426		21 and the financial condition of the health maintenance
369	427		22 organization to be managed or serviced, and (ii) need not take
370	428		23 into account the effect of the management contract or service
371	429		24 agreement on competition.
372	430		25 (f) Except for small employer groups as defined in the
373	431		26 Small Employer Rating, Renewability and Portability Health
374	432
375	433
376	434
377	435
378	436
379		-	SB0175 ~~Engrossed~~ - 11 - LRB104 06566 BAB 16602 b
	437	+	SB0175 - 11 - LRB104 06566 BAB 16602 b
380	438
381	439
382		-	SB0175 ~~Engrossed~~- 12 -LRB104 06566 BAB 16602 b SB0175 ~~Engrossed~~ - 12 - LRB104 06566 BAB 16602 b
383		-	SB0175 ~~Engrossed~~ - 12 - LRB104 06566 BAB 16602 b
	440	+	SB0175- 12 -LRB104 06566 BAB 16602 b SB0175 - 12 - LRB104 06566 BAB 16602 b
	441	+	SB0175 - 12 - LRB104 06566 BAB 16602 b
384	442		1 Insurance Act and except for medicare supplement policies as
385	443		2 defined in Section 363 of the Illinois Insurance Code, a
386	444		3 Health Maintenance Organization may by contract agree with a
387	445		4 group or other enrollment unit to effect refunds or charge
388	446		5 additional premiums under the following terms and conditions:
389	447		6 (i) the amount of, and other terms and conditions with
390	448		7 respect to, the refund or additional premium are set forth
391	449		8 in the group or enrollment unit contract agreed in advance
392	450		9 of the period for which a refund is to be paid or
393	451		10 additional premium is to be charged (which period shall
394	452		11 not be less than one year); and
395	453		12 (ii) the amount of the refund or additional premium
396	454		13 shall not exceed 20% of the Health Maintenance
397	455		14 Organization's profitable or unprofitable experience with
398	456		15 respect to the group or other enrollment unit for the
399	457		16 period (and, for purposes of a refund or additional
400	458		17 premium, the profitable or unprofitable experience shall
401	459		18 be calculated taking into account a pro rata share of the
402	460		19 Health Maintenance Organization's administrative and
403	461		20 marketing expenses, but shall not include any refund to be
404	462		21 made or additional premium to be paid pursuant to this
405	463		22 subsection (f)). The Health Maintenance Organization and
406	464		23 the group or enrollment unit may agree that the profitable
407	465		24 or unprofitable experience may be calculated taking into
408	466		25 account the refund period and the immediately preceding 2
409	467		26 plan years.
410	468
411	469
412	470
413	471
414	472
415		-	SB0175 ~~Engrossed~~ - 12 - LRB104 06566 BAB 16602 b
	473	+	SB0175 - 12 - LRB104 06566 BAB 16602 b
416	474
417	475
418		-	SB0175 ~~Engrossed~~- 13 -LRB104 06566 BAB 16602 b SB0175 ~~Engrossed~~ - 13 - LRB104 06566 BAB 16602 b
419		-	SB0175 ~~Engrossed~~ - 13 - LRB104 06566 BAB 16602 b
	476	+	SB0175- 13 -LRB104 06566 BAB 16602 b SB0175 - 13 - LRB104 06566 BAB 16602 b
	477	+	SB0175 - 13 - LRB104 06566 BAB 16602 b
420	478		1 The Health Maintenance Organization shall include a
421	479		2 statement in the evidence of coverage issued to each enrollee
422	480		3 describing the possibility of a refund or additional premium,
423	481		4 and upon request of any group or enrollment unit, provide to
424	482		5 the group or enrollment unit a description of the method used
425	483		6 to calculate (1) the Health Maintenance Organization's
426	484		7 profitable experience with respect to the group or enrollment
427	485		8 unit and the resulting refund to the group or enrollment unit
428	486		9 or (2) the Health Maintenance Organization's unprofitable
429	487		10 experience with respect to the group or enrollment unit and
430	488		11 the resulting additional premium to be paid by the group or
431	489		12 enrollment unit.
432	490		13 In no event shall the Illinois Health Maintenance
433	491		14 Organization Guaranty Association be liable to pay any
434	492		15 contractual obligation of an insolvent organization to pay any
435	493		16 refund authorized under this Section.
436	494		17 (g) Rulemaking authority to implement Public Act 95-1045,
437	495		18 if any, is conditioned on the rules being adopted in
438	496		19 accordance with all provisions of the Illinois Administrative
439	497		20 Procedure Act and all rules and procedures of the Joint
440	498		21 Committee on Administrative Rules; any purported rule not so
441	499		22 adopted, for whatever reason, is unauthorized.
442	500		23 (Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
443	501		24 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
444	502		25 1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
445	503		26 eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
446	504
447	505
448	506
449	507
450	508
451		-	SB0175 ~~Engrossed~~ - 13 - LRB104 06566 BAB 16602 b
	509	+	SB0175 - 13 - LRB104 06566 BAB 16602 b
452	510
453	511
454		-	SB0175 ~~Engrossed~~- 14 -LRB104 06566 BAB 16602 b SB0175 ~~Engrossed~~ - 14 - LRB104 06566 BAB 16602 b
455		-	SB0175 ~~Engrossed~~ - 14 - LRB104 06566 BAB 16602 b
	512	+	SB0175- 14 -LRB104 06566 BAB 16602 b SB0175 - 14 - LRB104 06566 BAB 16602 b
	513	+	SB0175 - 14 - LRB104 06566 BAB 16602 b
456	514		1 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
457	515		2 1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
458	516		3 eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;
459	517		4 103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.
460	518		5 6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
461	519		6 eff. 1-1-24; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24;
462	520		7 103-618, eff. 1-1-25; 103-649, eff. 1-1-25; 103-656, eff.
463	521		8 1-1-25; 103-700, eff. 1-1-25; 103-718, eff. 7-19-24; 103-751,
464	522		9 eff. 8-2-24; 103-753, eff. 8-2-24; 103-758, eff. 1-1-25;
465	523		10 103-777, eff. 8-2-24; 103-914, eff. 1-1-25; 103-918, eff.
466	524		11 1-1-25; 103-1024, eff. 1-1-25; revised 9-26-24.)
467	525		12 (Text of Section after amendment by P.A. 103-808)
468	526		13 Sec. 5-3. Insurance Code provisions.
469	527		14 (a) Health Maintenance Organizations shall be subject to
470	528		15 the provisions of Sections 133, 134, 136, 137, 139, 140,
471	529		16 141.1, 141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151,
472	530		17 152, 153, 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a,
473	531		18 155.49, 352c, 355.2, 355.3, 355.6, 355b, 355c, 356f, 356g,
474	532		19 356g.5-1, 356m, 356q, 356u.10, 356v, 356w, 356x, 356z.2,
475	533		20 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9,
476	534		21 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17,
477	535		22 356z.18, 356z.19, 356z.20, 356z.21, 356z.22, 356z.23, 356z.24,
478	536		23 356z.25, 356z.26, 356z.28, 356z.29, 356z.30, 356z.31, 356z.32,
479	537		24 356z.33, 356z.34, 356z.35, 356z.36, 356z.37, 356z.38, 356z.39,
480	538		25 356z.40, 356z.40a, 356z.41, 356z.44, 356z.45, 356z.46,
481	539
482	540
483	541
484	542
485	543
486		-	SB0175 ~~Engrossed~~ - 14 - LRB104 06566 BAB 16602 b
	544	+	SB0175 - 14 - LRB104 06566 BAB 16602 b
487	545
488	546
489		-	SB0175 ~~Engrossed~~- 15 -LRB104 06566 BAB 16602 b SB0175 ~~Engrossed~~ - 15 - LRB104 06566 BAB 16602 b
490		-	SB0175 ~~Engrossed~~ - 15 - LRB104 06566 BAB 16602 b
	547	+	SB0175- 15 -LRB104 06566 BAB 16602 b SB0175 - 15 - LRB104 06566 BAB 16602 b
	548	+	SB0175 - 15 - LRB104 06566 BAB 16602 b
491	549		1 356z.47, 356z.48, 356z.49, 356z.50, 356z.51, 356z.53, 356z.54,
492	550		2 356z.55, 356z.56, 356z.57, 356z.58, 356z.59, 356z.60, 356z.61,
493	551		3 356z.62, 356z.63, 356z.64, 356z.65, 356z.66, 356z.67, 356z.68,
494	552		4 356z.69, 356z.70, 356z.71, 356z.72, 356z.73, 356z.74, 356z.75,
495	553		5 356z.77, 356z.80, 364, 364.01, 364.3, 367.2, 367.2-5, 367i,
496	554		6 368a, 368b, 368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402,
497	555		7 403, 403A, 408, 408.2, 409, 412, 444, and 444.1, paragraph (c)
498	556		8 of subsection (2) of Section 367, and Articles IIA, VIII 1/2,
499	557		9 XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the
500	558		10 Illinois Insurance Code.
501	559		11 (b) For purposes of the Illinois Insurance Code, except
502	560		12 for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
503	561		13 Health Maintenance Organizations in the following categories
504	562		14 are deemed to be "domestic companies":
505	563		15 (1) a corporation authorized under the Dental Service
506	564		16 Plan Act or the Voluntary Health Services Plans Act;
507	565		17 (2) a corporation organized under the laws of this
508	566		18 State; or
509	567		19 (3) a corporation organized under the laws of another
510	568		20 state, 30% or more of the enrollees of which are residents
511	569		21 of this State, except a corporation subject to
512	570		22 substantially the same requirements in its state of
513	571		23 organization as is a "domestic company" under Article VIII
514	572		24 1/2 of the Illinois Insurance Code.
515	573		25 (c) In considering the merger, consolidation, or other
516	574		26 acquisition of control of a Health Maintenance Organization
517	575
518	576
519	577
520	578
521	579
522		-	SB0175 ~~Engrossed~~ - 15 - LRB104 06566 BAB 16602 b
	580	+	SB0175 - 15 - LRB104 06566 BAB 16602 b
523	581
524	582
525		-	SB0175 ~~Engrossed~~- 16 -LRB104 06566 BAB 16602 b SB0175 ~~Engrossed~~ - 16 - LRB104 06566 BAB 16602 b
526		-	SB0175 ~~Engrossed~~ - 16 - LRB104 06566 BAB 16602 b
	583	+	SB0175- 16 -LRB104 06566 BAB 16602 b SB0175 - 16 - LRB104 06566 BAB 16602 b
	584	+	SB0175 - 16 - LRB104 06566 BAB 16602 b
527	585		1 pursuant to Article VIII 1/2 of the Illinois Insurance Code,
528	586		2 (1) the Director shall give primary consideration to
529	587		3 the continuation of benefits to enrollees and the
530	588		4 financial conditions of the acquired Health Maintenance
531	589		5 Organization after the merger, consolidation, or other
532	590		6 acquisition of control takes effect;
533	591		7 (2)(i) the criteria specified in subsection (1)(b) of
534	592		8 Section 131.8 of the Illinois Insurance Code shall not
535	593		9 apply and (ii) the Director, in making his determination
536	594		10 with respect to the merger, consolidation, or other
537	595		11 acquisition of control, need not take into account the
538	596		12 effect on competition of the merger, consolidation, or
539	597		13 other acquisition of control;
540	598		14 (3) the Director shall have the power to require the
541	599		15 following information:
542	600		16 (A) certification by an independent actuary of the
543	601		17 adequacy of the reserves of the Health Maintenance
544	602		18 Organization sought to be acquired;
545	603		19 (B) pro forma financial statements reflecting the
546	604		20 combined balance sheets of the acquiring company and
547	605		21 the Health Maintenance Organization sought to be
548	606		22 acquired as of the end of the preceding year and as of
549	607		23 a date 90 days prior to the acquisition, as well as pro
550	608		24 forma financial statements reflecting projected
551	609		25 combined operation for a period of 2 years;
552	610		26 (C) a pro forma business plan detailing an
553	611
554	612
555	613
556	614
557	615
558		-	SB0175 ~~Engrossed~~ - 16 - LRB104 06566 BAB 16602 b
	616	+	SB0175 - 16 - LRB104 06566 BAB 16602 b
559	617
560	618
561		-	SB0175 ~~Engrossed~~- 17 -LRB104 06566 BAB 16602 b SB0175 ~~Engrossed~~ - 17 - LRB104 06566 BAB 16602 b
562		-	SB0175 ~~Engrossed~~ - 17 - LRB104 06566 BAB 16602 b
	619	+	SB0175- 17 -LRB104 06566 BAB 16602 b SB0175 - 17 - LRB104 06566 BAB 16602 b
	620	+	SB0175 - 17 - LRB104 06566 BAB 16602 b
563	621		1 acquiring party's plans with respect to the operation
564	622		2 of the Health Maintenance Organization sought to be
565	623		3 acquired for a period of not less than 3 years; and
566	624		4 (D) such other information as the Director shall
567	625		5 require.
568	626		6 (d) The provisions of Article VIII 1/2 of the Illinois
569	627		7 Insurance Code and this Section 5-3 shall apply to the sale by
570	628		8 any health maintenance organization of greater than 10% of its
571	629		9 enrollee population (including, without limitation, the health
572	630		10 maintenance organization's right, title, and interest in and
573	631		11 to its health care certificates).
574	632		12 (e) In considering any management contract or service
575	633		13 agreement subject to Section 141.1 of the Illinois Insurance
576	634		14 Code, the Director (i) shall, in addition to the criteria
577	635		15 specified in Section 141.2 of the Illinois Insurance Code,
578	636		16 take into account the effect of the management contract or
579	637		17 service agreement on the continuation of benefits to enrollees
580	638		18 and the financial condition of the health maintenance
581	639		19 organization to be managed or serviced, and (ii) need not take
582	640		20 into account the effect of the management contract or service
583	641		21 agreement on competition.
584	642		22 (f) Except for small employer groups as defined in the
585	643		23 Small Employer Rating, Renewability and Portability Health
586	644		24 Insurance Act and except for medicare supplement policies as
587	645		25 defined in Section 363 of the Illinois Insurance Code, a
588	646		26 Health Maintenance Organization may by contract agree with a
589	647
590	648
591	649
592	650
593	651
594		-	SB0175 ~~Engrossed~~ - 17 - LRB104 06566 BAB 16602 b
	652	+	SB0175 - 17 - LRB104 06566 BAB 16602 b
595	653
596	654
597		-	SB0175 ~~Engrossed~~- 18 -LRB104 06566 BAB 16602 b SB0175 ~~Engrossed~~ - 18 - LRB104 06566 BAB 16602 b
598		-	SB0175 ~~Engrossed~~ - 18 - LRB104 06566 BAB 16602 b
	655	+	SB0175- 18 -LRB104 06566 BAB 16602 b SB0175 - 18 - LRB104 06566 BAB 16602 b
	656	+	SB0175 - 18 - LRB104 06566 BAB 16602 b
599	657		1 group or other enrollment unit to effect refunds or charge
600	658		2 additional premiums under the following terms and conditions:
601	659		3 (i) the amount of, and other terms and conditions with
602	660		4 respect to, the refund or additional premium are set forth
603	661		5 in the group or enrollment unit contract agreed in advance
604	662		6 of the period for which a refund is to be paid or
605	663		7 additional premium is to be charged (which period shall
606	664		8 not be less than one year); and
607	665		9 (ii) the amount of the refund or additional premium
608	666		10 shall not exceed 20% of the Health Maintenance
609	667		11 Organization's profitable or unprofitable experience with
610	668		12 respect to the group or other enrollment unit for the
611	669		13 period (and, for purposes of a refund or additional
612	670		14 premium, the profitable or unprofitable experience shall
613	671		15 be calculated taking into account a pro rata share of the
614	672		16 Health Maintenance Organization's administrative and
615	673		17 marketing expenses, but shall not include any refund to be
616	674		18 made or additional premium to be paid pursuant to this
617	675		19 subsection (f)). The Health Maintenance Organization and
618	676		20 the group or enrollment unit may agree that the profitable
619	677		21 or unprofitable experience may be calculated taking into
620	678		22 account the refund period and the immediately preceding 2
621	679		23 plan years.
622	680		24 The Health Maintenance Organization shall include a
623	681		25 statement in the evidence of coverage issued to each enrollee
624	682		26 describing the possibility of a refund or additional premium,
625	683
626	684
627	685
628	686
629	687
630		-	SB0175 ~~Engrossed~~ - 18 - LRB104 06566 BAB 16602 b
	688	+	SB0175 - 18 - LRB104 06566 BAB 16602 b
631	689
632	690
633		-	SB0175 ~~Engrossed~~- 19 -LRB104 06566 BAB 16602 b SB0175 ~~Engrossed~~ - 19 - LRB104 06566 BAB 16602 b
634		-	SB0175 ~~Engrossed~~ - 19 - LRB104 06566 BAB 16602 b
	691	+	SB0175- 19 -LRB104 06566 BAB 16602 b SB0175 - 19 - LRB104 06566 BAB 16602 b
	692	+	SB0175 - 19 - LRB104 06566 BAB 16602 b
635	693		1 and upon request of any group or enrollment unit, provide to
636	694		2 the group or enrollment unit a description of the method used
637	695		3 to calculate (1) the Health Maintenance Organization's
638	696		4 profitable experience with respect to the group or enrollment
639	697		5 unit and the resulting refund to the group or enrollment unit
640	698		6 or (2) the Health Maintenance Organization's unprofitable
641	699		7 experience with respect to the group or enrollment unit and
642	700		8 the resulting additional premium to be paid by the group or
643	701		9 enrollment unit.
644	702		10 In no event shall the Illinois Health Maintenance
645	703		11 Organization Guaranty Association be liable to pay any
646	704		12 contractual obligation of an insolvent organization to pay any
647	705		13 refund authorized under this Section.
648	706		14 (g) Rulemaking authority to implement Public Act 95-1045,
649	707		15 if any, is conditioned on the rules being adopted in
650	708		16 accordance with all provisions of the Illinois Administrative
651	709		17 Procedure Act and all rules and procedures of the Joint
652	710		18 Committee on Administrative Rules; any purported rule not so
653	711		19 adopted, for whatever reason, is unauthorized.
654	712		20 (Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
655	713		21 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
656	714		22 1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
657	715		23 eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
658	716		24 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
659	717		25 1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
660	718		26 eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;
661	719
662	720
663	721
664	722
665	723
666		-	SB0175 ~~Engrossed~~ - 19 - LRB104 06566 BAB 16602 b
	724	+	SB0175 - 19 - LRB104 06566 BAB 16602 b
667	725
668	726
669		-	SB0175 ~~Engrossed~~- 20 -LRB104 06566 BAB 16602 b SB0175 ~~Engrossed~~ - 20 - LRB104 06566 BAB 16602 b
670		-	SB0175 ~~Engrossed~~ - 20 - LRB104 06566 BAB 16602 b
	727	+	SB0175- 20 -LRB104 06566 BAB 16602 b SB0175 - 20 - LRB104 06566 BAB 16602 b
	728	+	SB0175 - 20 - LRB104 06566 BAB 16602 b
671	729		1 103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.
672	730		2 6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
673	731		3 eff. 1-1-24; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24;
674	732		4 103-618, eff. 1-1-25; 103-649, eff. 1-1-25; 103-656, eff.
675	733		5 1-1-25; 103-700, eff. 1-1-25; 103-718, eff. 7-19-24; 103-751,
676	734		6 eff. 8-2-24; 103-753, eff. 8-2-24; 103-758, eff. 1-1-25;
677	735		7 103-777, eff. 8-2-24; 103-808, eff. 1-1-26; 103-914, eff.
678	736		8 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; revised
679	737		9 11-26-24.)
680	738		10 Section 35. The Limited Health Service Organization Act is
681	739		11 amended by changing Section 4003 as follows:
682	740		12 (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
683	741		13 Sec. 4003. Illinois Insurance Code provisions. Limited
684	742		14 health service organizations shall be subject to the
685	743		15 provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
686	744		16 141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151, 152, 153,
687	745		17 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 352c,
688	746		18 355.2, 355.3, 355b, 355d, 356m, 356q, 356v, 356z.4, 356z.4a,
689	747		19 356z.10, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.32,
690	748		20 356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
691	749		21 356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68, 356z.71,
692	750		22 356z.73, 356z.74, 356z.75, 356z.80, 364.3, 368a, 401, 401.1,
693	751		23 402, 403, 403A, 408, 408.2, 409, 412, 444, and 444.1 and
694	752		24 Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and
695	753
696	754
697	755
698	756
699	757
700		-	SB0175 ~~Engrossed~~ - 20 - LRB104 06566 BAB 16602 b
	758	+	SB0175 - 20 - LRB104 06566 BAB 16602 b
701	759
702	760
703		-	SB0175 ~~Engrossed~~- 21 -LRB104 06566 BAB 16602 b SB0175 ~~Engrossed~~ - 21 - LRB104 06566 BAB 16602 b
704		-	SB0175 ~~Engrossed~~ - 21 - LRB104 06566 BAB 16602 b
	761	+	SB0175- 21 -LRB104 06566 BAB 16602 b SB0175 - 21 - LRB104 06566 BAB 16602 b
	762	+	SB0175 - 21 - LRB104 06566 BAB 16602 b
705	763		1 XXVI of the Illinois Insurance Code. Nothing in this Section
706	764		2 shall require a limited health care plan to cover any service
707	765		3 that is not a limited health service. For purposes of the
708	766		4 Illinois Insurance Code, except for Sections 444 and 444.1 and
709	767		5 Articles XIII and XIII 1/2, limited health service
710	768		6 organizations in the following categories are deemed to be
711	769		7 domestic companies:
712	770		8 (1) a corporation under the laws of this State; or
713	771		9 (2) a corporation organized under the laws of another
714	772		10 state, 30% or more of the enrollees of which are residents
715	773		11 of this State, except a corporation subject to
716	774		12 substantially the same requirements in its state of
717	775		13 organization as is a domestic company under Article VIII
718	776		14 1/2 of the Illinois Insurance Code.
719	777		15 (Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
720	778		16 102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-731, eff.
721	779		17 1-1-23; 102-775, eff. 5-13-22; 102-813, eff. 5-13-22; 102-816,
722	780		18 eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
723	781		19 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
724	782		20 1-1-24; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
725	783		21 eff. 1-1-24; 103-605, eff. 7-1-24; 103-649, eff. 1-1-25;
726	784		22 103-656, eff. 1-1-25; 103-700, eff. 1-1-25; 103-718, eff.
727	785		23 7-19-24; 103-751, eff. 8-2-24; 103-758, eff. 1-1-25; 103-832,
728	786		24 eff. 1-1-25; 103-1024, eff. 1-1-25; revised 11-26-24.)
729	787		25 Section 40. The Voluntary Health Services Plans Act is
730	788
731	789
732	790
733	791
734	792
735		-	SB0175 ~~Engrossed~~ - 21 - LRB104 06566 BAB 16602 b
	793	+	SB0175 - 21 - LRB104 06566 BAB 16602 b
736	794
737	795
738		-	SB0175 ~~Engrossed~~- 22 -LRB104 06566 BAB 16602 b SB0175 ~~Engrossed~~ - 22 - LRB104 06566 BAB 16602 b
739		-	SB0175 ~~Engrossed~~ - 22 - LRB104 06566 BAB 16602 b
	796	+	SB0175- 22 -LRB104 06566 BAB 16602 b SB0175 - 22 - LRB104 06566 BAB 16602 b
	797	+	SB0175 - 22 - LRB104 06566 BAB 16602 b
740	798		1 amended by changing Section 10 as follows:
741	799		2 (215 ILCS 165/10) (from Ch. 32, par. 604)
742	800		3 Sec. 10. Application of Insurance Code provisions. Health
743	801		4 services plan corporations and all persons interested therein
744	802		5 or dealing therewith shall be subject to the provisions of
745	803		6 Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
746	804		7 143, 143.31, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3,
747	805		8 355b, 355d, 356g, 356g.5, 356g.5-1, 356m, 356q, 356r, 356t,
748	806		9 356u, 356u.10, 356v, 356w, 356x, 356y, 356z.1, 356z.2,
749	807		10 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9,
750	808		11 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18,
751	809		12 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30,
752	810		13 356z.32, 356z.32a, 356z.33, 356z.40, 356z.41, 356z.46,
753	811		14 356z.47, 356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59,
754	812		15 356z.60, 356z.61, 356z.62, 356z.64, 356z.67, 356z.68, 356z.71,
755	813		16 356z.72, 356z.74, 356z.75, 356z.77, 356z.80, 364.01, 364.3,
756	814		17 367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412,
757	815		18 and paragraphs (7) and (15) of Section 367 of the Illinois
758	816		19 Insurance Code.
759	817		20 Rulemaking authority to implement Public Act 95-1045, if
760	818		21 any, is conditioned on the rules being adopted in accordance
761	819		22 with all provisions of the Illinois Administrative Procedure
762	820		23 Act and all rules and procedures of the Joint Committee on
763	821		24 Administrative Rules; any purported rule not so adopted, for
764	822		25 whatever reason, is unauthorized.
765	823
766	824
767	825
768	826
769	827
770		-	SB0175 ~~Engrossed~~ - 22 - LRB104 06566 BAB 16602 b
	828	+	SB0175 - 22 - LRB104 06566 BAB 16602 b
771	829
772	830
773		-	SB0175 ~~Engrossed~~- 23 -LRB104 06566 BAB 16602 b SB0175 ~~Engrossed~~ - 23 - LRB104 06566 BAB 16602 b
774		-	SB0175 ~~Engrossed~~ - 23 - LRB104 06566 BAB 16602 b
	831	+	SB0175- 23 -LRB104 06566 BAB 16602 b SB0175 - 23 - LRB104 06566 BAB 16602 b
	832	+	SB0175 - 23 - LRB104 06566 BAB 16602 b
775	833		1 (Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
776	834		2 102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff.
777	835		3 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804,
778	836		4 eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
779	837		5 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff.
780	838		6 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
781	839		7 eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
782	840		8 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-656, eff.
783	841		9 1-1-25; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-753,
784	842		10 eff. 8-2-24; 103-758, eff. 1-1-25; 103-832, eff. 1-1-25;
785	843		11 103-914, eff. 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff.
786	844		12 1-1-25; revised 11-26-24.)
787	845		13 Section 45. The Illinois Public Aid Code is amended by
788	846		14 changing Section 5-16.8 as follows:
789	847		15 (305 ILCS 5/5-16.8)
790	848		16 Sec. 5-16.8. Required health benefits. The medical
791	849		17 assistance program shall (i) provide the post-mastectomy care
792	850		18 benefits required to be covered by a policy of accident and
793	851		19 health insurance under Section 356t and the coverage required
794	852		20 under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6,
795	853		21 356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,
796	854		22 356z.47, 356z.51, 356z.53, 356z.59, 356z.60, 356z.61, 356z.64,
797	855		23 and 356z.67, and 356z.71, 356z.75, and 356z.80 of the Illinois
798	856		24 Insurance Code, (ii) be subject to the provisions of Sections
799	857
800	858
801	859
802	860
803	861
804		-	SB0175 ~~Engrossed~~ - 23 - LRB104 06566 BAB 16602 b
	862	+	SB0175 - 23 - LRB104 06566 BAB 16602 b
805	863
806	864
807		-	SB0175 ~~Engrossed~~- 24 -LRB104 06566 BAB 16602 b SB0175 ~~Engrossed~~ - 24 - LRB104 06566 BAB 16602 b
808		-	SB0175 ~~Engrossed~~ - 24 - LRB104 06566 BAB 16602 b
	865	+	SB0175- 24 -LRB104 06566 BAB 16602 b SB0175 - 24 - LRB104 06566 BAB 16602 b
	866	+	SB0175 - 24 - LRB104 06566 BAB 16602 b
809	867		1 356z.19, 356z.44, 356z.49, 364.01, 370c, and 370c.1 of the
810	868		2 Illinois Insurance Code, and (iii) be subject to the
811	869		3 provisions of subsection (d-5) of Section 10 of the Network
812	870		4 Adequacy and Transparency Act.
813	871		5 The Department, by rule, shall adopt a model similar to
814	872		6 the requirements of Section 356z.39 of the Illinois Insurance
815	873		7 Code.
816	874		8 On and after July 1, 2012, the Department shall reduce any
817	875		9 rate of reimbursement for services or other payments or alter
818	876		10 any methodologies authorized by this Code to reduce any rate
819	877		11 of reimbursement for services or other payments in accordance
820	878		12 with Section 5-5e.
821	879		13 To ensure full access to the benefits set forth in this
822	880		14 Section, on and after January 1, 2016, the Department shall
823	881		15 ensure that provider and hospital reimbursement for
824	882		16 post-mastectomy care benefits required under this Section are
825	883		17 no lower than the Medicare reimbursement rate.
826	884		18 (Source: P.A. 102-30, eff. 1-1-22; 102-144, eff. 1-1-22;
827	885		19 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-530, eff.
828	886		20 1-1-22; 102-642, eff. 1-1-22; 102-804, eff. 1-1-23; 102-813,
829	887		21 eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093, eff. 1-1-23;
830	888		22 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
831	889		23 1-1-24; 103-420, eff. 1-1-24; 103-605, eff. 7-1-24; 103-703,
832	890		24 eff. 1-1-25; 103-758, eff. 1-1-25; 103-1024, eff. 1-1-25;
833	891		25 revised 11-26-24.)
834	892
835	893
836	894
837	895
838	896
839		-	SB0175 ~~Engrossed~~ - 24 - LRB104 06566 BAB 16602 b
	897	+	SB0175 - 24 - LRB104 06566 BAB 16602 b
840	898
841	899
842		-	SB0175 Engrossed- 25 -LRB104 06566 BAB 16602 b SB0175 Engrossed - 25 - LRB104 06566 BAB 16602 b
843		-	SB0175 Engrossed - 25 - LRB104 06566 BAB 16602 b
844		-	1 Section 95. No acceleration or delay. Where this Act makes
845		-	2 changes in a statute that is represented in this Act by text
846		-	3 that is not yet or no longer in effect (for example, a Section
847		-	4 represented by multiple versions), the use of that text does
848		-	5 not accelerate or delay the taking effect of (i) the changes
849		-	6 made by this Act or (ii) provisions derived from any other
850		-	7 Public Act.
	900	+	SB0175- 25 -LRB104 06566 BAB 16602 b SB0175 - 25 - LRB104 06566 BAB 16602 b
	901	+	SB0175 - 25 - LRB104 06566 BAB 16602 b
851	902
852	903
853	904
854	905
855	906
856		-	SB0175 ~~Engrossed~~ - 25 - LRB104 06566 BAB 16602 b
	907	+	SB0175 - 25 - LRB104 06566 BAB 16602 b