Illinois 2025 2025-2026 Regular Session

Illinois Senate Bill SB1418 Introduced / Bill

Filed 01/31/2025

                    104TH GENERAL ASSEMBLY
 State of Illinois
 2025 and 2026 SB1418 Introduced 1/31/2025, by Sen. Napoleon Harris, III 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 plan of accident and health insurance or managed care plan amended, delivered, issued, or renewed after January 1, 2026 must provide coverage, no less than once every 12 months, for a peripheral artery disease screening test for any at-risk individual. 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 06136 BAB 16169 b   A BILL FOR 104TH GENERAL ASSEMBLY
 State of Illinois
 2025 and 2026 SB1418 Introduced 1/31/2025, by Sen. Napoleon Harris, III 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 plan of accident and health insurance or managed care plan amended, delivered, issued, or renewed after January 1, 2026 must provide coverage, no less than once every 12 months, for a peripheral artery disease screening test for any at-risk individual. 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 06136 BAB 16169 b     LRB104 06136 BAB 16169 b   A BILL FOR
104TH GENERAL ASSEMBLY
 State of Illinois
 2025 and 2026 SB1418 Introduced 1/31/2025, by Sen. Napoleon Harris, III 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
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 plan of accident and health insurance or managed care plan amended, delivered, issued, or renewed after January 1, 2026 must provide coverage, no less than once every 12 months, for a peripheral artery disease screening test for any at-risk individual. 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 06136 BAB 16169 b     LRB104 06136 BAB 16169 b
    LRB104 06136 BAB 16169 b
A BILL FOR
SB1418LRB104 06136 BAB 16169 b   SB1418  LRB104 06136 BAB 16169 b
  SB1418  LRB104 06136 BAB 16169 b
1  AN ACT concerning regulation.
2  Be it enacted by the People of the State of Illinois,
3  represented in the General Assembly:
4  Section 1. Findings. The General Assembly finds that:
5  (1) Atherosclerosis occurs when blood flow is reduced
6  because arteries become narrowed or blocked with fatty
7  deposits.
8  (2) Atherosclerosis is responsible for more deaths in
9  the United States than any other condition, and heart
10  attacks resulting from clogged coronary arteries are the
11  leading cause of death in America.
12  (3) Atherosclerosis also occurs in the legs and is
13  known as peripheral artery disease (referred to as "PAD"),
14  and having PAD significantly increases the risk for heart
15  attack, stroke, amputation, and death.
16  (4) While most Americans are aware of atherosclerosis
17  in the heart, many Americans have never heard of PAD and
18  Americans with PAD are often unaware of the serious risks
19  of the disease.
20  (5) An estimated 21,000,000 Americans have PAD, and
21  about 200,000 of them, who are disproportionately
22  minorities, suffer avoidable amputations every year as a
23  result of such disease.
24  (6) Screening and arterial testing for PAD is cost

 

104TH GENERAL ASSEMBLY
 State of Illinois
 2025 and 2026 SB1418 Introduced 1/31/2025, by Sen. Napoleon Harris, III 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
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 plan of accident and health insurance or managed care plan amended, delivered, issued, or renewed after January 1, 2026 must provide coverage, no less than once every 12 months, for a peripheral artery disease screening test for any at-risk individual. 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.
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    LRB104 06136 BAB 16169 b
A BILL FOR

 

 

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



    LRB104 06136 BAB 16169 b

 

 



 

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1  effective and should be part of routine medical care.
2  (7) Once PAD is detected, amputations and deaths can
3  be reduced through the use of national, evidence-based PAD
4  care guidelines.
5  Section 5. The State Employees Group Insurance Act of 1971
6  is amended by changing Section 6.11 as follows:
7  (5 ILCS 375/6.11)
8  Sec. 6.11. Required health benefits; Illinois Insurance
9  Code requirements. The program of health benefits shall
10  provide the post-mastectomy care benefits required to be
11  covered by a policy of accident and health insurance under
12  Section 356t of the Illinois Insurance Code. The program of
13  health benefits shall provide the coverage required under
14  Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10,
15  356w, 356x, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8,
16  356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
17  356z.17, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32,
18  356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
19  356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59,
20  356z.60, 356z.61, 356z.62, 356z.64, 356z.67, 356z.68, and
21  356z.70, and 356z.71, 356z.74, 356z.76, 356z.77, and 356z.80
22  of the Illinois Insurance Code. The program of health benefits
23  must comply with Sections 155.22a, 155.37, 355b, 356z.19,
24  370c, and 370c.1 and Article XXXIIB of the Illinois Insurance

 

 

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1  Code. The program of health benefits shall provide the
2  coverage required under Section 356m of the Illinois Insurance
3  Code and, for the employees of the State Employee Group
4  Insurance Program only, the coverage as also provided in
5  Section 6.11B of this Act. The Department of Insurance shall
6  enforce the requirements of this Section with respect to
7  Sections 370c and 370c.1 of the Illinois Insurance Code; all
8  other requirements of this Section shall be enforced by the
9  Department of Central Management Services.
10  Rulemaking authority to implement Public Act 95-1045, if
11  any, is conditioned on the rules being adopted in accordance
12  with all provisions of the Illinois Administrative Procedure
13  Act and all rules and procedures of the Joint Committee on
14  Administrative Rules; any purported rule not so adopted, for
15  whatever reason, is unauthorized.
16  (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
17  102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
18  1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-768,
19  eff. 1-1-24; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
20  102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
21  1-1-23; 102-1117, eff. 1-13-23; 103-8, eff. 1-1-24; 103-84,
22  eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, eff. 1-1-24;
23  103-445, eff. 1-1-24; 103-535, eff. 8-11-23; 103-551, eff.
24  8-11-23; 103-605, eff. 7-1-24; 103-718, eff. 7-19-24; 103-751,
25  eff. 8-2-24; 103-870, eff. 1-1-25; 103-914, eff. 1-1-25;
26  103-918, eff. 1-1-25; 103-951, eff. 1-1-25; 103-1024, eff.

 

 

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1  1-1-25; revised 11-26-24.)
2  Section 10. The Counties Code is amended by changing
3  Section 5-1069.3 as follows:
4  (55 ILCS 5/5-1069.3)
5  Sec. 5-1069.3. Required health benefits. If a county,
6  including a home rule county, is a self-insurer for purposes
7  of providing health insurance coverage for its employees, the
8  coverage shall include coverage for the post-mastectomy care
9  benefits required to be covered by a policy of accident and
10  health insurance under Section 356t and the coverage required
11  under Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u,
12  356u.10, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9,
13  356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
14  356z.25, 356z.26, 356z.29, 356z.30, 356z.32, 356z.33, 356z.36,
15  356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51,
16  356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, 356z.61,
17  356z.62, 356z.64, 356z.67, 356z.68, and 356z.70, and 356z.71,
18  356z.74, 356z.77, and 356z.80 of the Illinois Insurance Code.
19  The coverage shall comply with Sections 155.22a, 355b,
20  356z.19, and 370c of the Illinois Insurance Code. The
21  Department of Insurance shall enforce the requirements of this
22  Section. The requirement that health benefits be covered as
23  provided in this Section is an exclusive power and function of
24  the State and is a denial and limitation under Article VII,

 

 

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1  Section 6, subsection (h) of the Illinois Constitution. A home
2  rule county to which this Section applies must comply with
3  every provision of this Section.
4  Rulemaking authority to implement Public Act 95-1045, if
5  any, is conditioned on the rules being adopted in accordance
6  with all provisions of the Illinois Administrative Procedure
7  Act and all rules and procedures of the Joint Committee on
8  Administrative Rules; any purported rule not so adopted, for
9  whatever reason, is unauthorized.
10  (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
11  102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
12  1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
13  eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
14  102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
15  1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
16  eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
17  103-535, eff. 8-11-23; 103-551, eff. 8-11-23; 103-605, eff.
18  7-1-24; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-914,
19  eff. 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25;
20  revised 11-26-24.)
21  Section 15. The Illinois Municipal Code is amended by
22  changing Section 10-4-2.3 as follows:
23  (65 ILCS 5/10-4-2.3)
24  Sec. 10-4-2.3. Required health benefits. If a

 

 

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1  municipality, including a home rule municipality, is a
2  self-insurer for purposes of providing health insurance
3  coverage for its employees, the coverage shall include
4  coverage for the post-mastectomy care benefits required to be
5  covered by a policy of accident and health insurance under
6  Section 356t and the coverage required under Sections 356g,
7  356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10, 356w, 356x,
8  356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11,
9  356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26,
10  356z.29, 356z.30, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41,
11  356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54,
12  356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64,
13  356z.67, 356z.68, and 356z.70, and 356z.71, 356z.74, 356z.77,
14  and 356z.80 of the Illinois Insurance Code. The coverage shall
15  comply with Sections 155.22a, 355b, 356z.19, and 370c of the
16  Illinois Insurance Code. The Department of Insurance shall
17  enforce the requirements of this Section. The requirement that
18  health benefits be covered as provided in this is an exclusive
19  power and function of the State and is a denial and limitation
20  under Article VII, Section 6, subsection (h) of the Illinois
21  Constitution. A home rule municipality to which this Section
22  applies must comply with every provision of this Section.
23  Rulemaking authority to implement Public Act 95-1045, if
24  any, is conditioned on the rules being adopted in accordance
25  with all provisions of the Illinois Administrative Procedure
26  Act and all rules and procedures of the Joint Committee on

 

 

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1  Administrative Rules; any purported rule not so adopted, for
2  whatever reason, is unauthorized.
3  (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
4  102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
5  1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
6  eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
7  102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
8  1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
9  eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
10  103-535, eff. 8-11-23; 103-551, eff. 8-11-23; 103-605, eff.
11  7-1-24; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-914,
12  eff. 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25;
13  revised 11-26-24.)
14  Section 20. The School Code is amended by changing Section
15  10-22.3f as follows:
16  (105 ILCS 5/10-22.3f)
17  Sec. 10-22.3f. Required health benefits. Insurance
18  protection and benefits for employees shall provide the
19  post-mastectomy care benefits required to be covered by a
20  policy of accident and health insurance under Section 356t and
21  the coverage required under Sections 356g, 356g.5, 356g.5-1,
22  356m, 356q, 356u, 356u.10, 356w, 356x, 356z.4, 356z.4a,
23  356z.6, 356z.8, 356z.9, 356z.11, 356z.12, 356z.13, 356z.14,
24  356z.15, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30, 356z.32,

 

 

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1  356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
2  356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60,
3  356z.61, 356z.62, 356z.64, 356z.67, 356z.68, and 356z.70, and
4  356z.71, 356z.74, 356z.77, and 356z.80 of the Illinois
5  Insurance Code. Insurance policies shall comply with Section
6  356z.19 of the Illinois Insurance Code. The coverage shall
7  comply with Sections 155.22a, 355b, and 370c of the Illinois
8  Insurance Code. The Department of Insurance shall enforce the
9  requirements of this Section.
10  Rulemaking authority to implement Public Act 95-1045, if
11  any, is conditioned on the rules being adopted in accordance
12  with all provisions of the Illinois Administrative Procedure
13  Act and all rules and procedures of the Joint Committee on
14  Administrative Rules; any purported rule not so adopted, for
15  whatever reason, is unauthorized.
16  (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
17  102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
18  1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804,
19  eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
20  102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff.
21  1-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420,
22  eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. 8-11-23;
23  103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-718, eff.
24  7-19-24; 103-751, eff. 8-2-24; 103-914, eff. 1-1-25; 103-918,
25  eff. 1-1-25; 103-1024, eff. 1-1-25; revised 11-26-24.)

 

 

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1  Section 22. The Illinois Insurance Code is amended by
2  adding Section 356z.80 as follows:
3  (215 ILCS 5/356z.80 new)
4  Sec. 356z.80. Coverage for peripheral artery disease
5  screening test.
6  (a) As used in this Section:
7  "At-risk individual" means an individual who:
8  (1) is 65 years of age or older;
9  (2) is at least 50 years of age but not older than 64
10  years of age with risk factors for atherosclerosis, such
11  as diabetes mellitus, a history of smoking,
12  hyperlipidemia, or hypertension, or a family history of
13  peripheral artery disease;
14  (3) is younger than 50 years of age with diabetes
15  mellitus and one additional risk factor for
16  atherosclerosis; or
17  (4) has a known atherosclerotic disease in another
18  vascular bed, such as coronary, carotid, subclavian,
19  renal, or mesenteric artery stenosis, or abdominal aortic
20  aneurysm.
21  "Peripheral artery disease screening test" means:
22  (1) noninvasive physiologic studies of extremity
23  arteries (commonly referred to as ankle-brachial index
24  testing); or
25  (2) ankle plethysmographic pulse volume recordings and

 

 

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1  Doppler waveforms.
2  (b) A group or individual plan of accident and health
3  insurance or managed care plan amended, delivered, issued, or
4  renewed after January 1, 2026 must provide coverage, no less
5  than once every 12 months, for a peripheral artery disease
6  screening test for any at-risk individual.
7  Section 25. The Health Maintenance Organization Act is
8  amended by changing Section 5-3 as follows:
9  (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
10  (Text of Section before amendment by P.A. 103-808)
11  Sec. 5-3. Insurance Code provisions.
12  (a) Health Maintenance Organizations shall be subject to
13  the provisions of Sections 133, 134, 136, 137, 139, 140,
14  141.1, 141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151,
15  152, 153, 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a,
16  155.49, 352c, 355.2, 355.3, 355.6, 355b, 355c, 356f, 356g.5-1,
17  356m, 356q, 356u.10, 356v, 356w, 356x, 356z.2, 356z.3a,
18  356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10,
19  356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.18,
20  356z.19, 356z.20, 356z.21, 356z.22, 356z.23, 356z.24, 356z.25,
21  356z.26, 356z.28, 356z.29, 356z.30, 356z.31, 356z.32, 356z.33,
22  356z.34, 356z.35, 356z.36, 356z.37, 356z.38, 356z.39, 356z.40,
23  356z.40a, 356z.41, 356z.44, 356z.45, 356z.46, 356z.47,
24  356z.48, 356z.49, 356z.50, 356z.51, 356z.53, 356z.54, 356z.55,

 

 

  SB1418 - 10 - LRB104 06136 BAB 16169 b


SB1418- 11 -LRB104 06136 BAB 16169 b   SB1418 - 11 - LRB104 06136 BAB 16169 b
  SB1418 - 11 - LRB104 06136 BAB 16169 b
1  356z.56, 356z.57, 356z.58, 356z.59, 356z.60, 356z.61, 356z.62,
2  356z.63, 356z.64, 356z.65, 356z.66, 356z.67, 356z.68, 356z.69,
3  356z.70, 356z.71, 356z.72, 356z.73, 356z.74, 356z.75, 356z.77,
4  356z.80, 364, 364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b,
5  368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A,
6  408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of
7  subsection (2) of Section 367, and Articles IIA, VIII 1/2,
8  XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the
9  Illinois Insurance Code.
10  (b) For purposes of the Illinois Insurance Code, except
11  for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
12  Health Maintenance Organizations in the following categories
13  are deemed to be "domestic companies":
14  (1) a corporation authorized under the Dental Service
15  Plan Act or the Voluntary Health Services Plans Act;
16  (2) a corporation organized under the laws of this
17  State; or
18  (3) a corporation organized under the laws of another
19  state, 30% or more of the enrollees of which are residents
20  of this State, except a corporation subject to
21  substantially the same requirements in its state of
22  organization as is a "domestic company" under Article VIII
23  1/2 of the Illinois Insurance Code.
24  (c) In considering the merger, consolidation, or other
25  acquisition of control of a Health Maintenance Organization
26  pursuant to Article VIII 1/2 of the Illinois Insurance Code,

 

 

  SB1418 - 11 - LRB104 06136 BAB 16169 b


SB1418- 12 -LRB104 06136 BAB 16169 b   SB1418 - 12 - LRB104 06136 BAB 16169 b
  SB1418 - 12 - LRB104 06136 BAB 16169 b
1  (1) the Director shall give primary consideration to
2  the continuation of benefits to enrollees and the
3  financial conditions of the acquired Health Maintenance
4  Organization after the merger, consolidation, or other
5  acquisition of control takes effect;
6  (2)(i) the criteria specified in subsection (1)(b) of
7  Section 131.8 of the Illinois Insurance Code shall not
8  apply and (ii) the Director, in making his determination
9  with respect to the merger, consolidation, or other
10  acquisition of control, need not take into account the
11  effect on competition of the merger, consolidation, or
12  other acquisition of control;
13  (3) the Director shall have the power to require the
14  following information:
15  (A) certification by an independent actuary of the
16  adequacy of the reserves of the Health Maintenance
17  Organization sought to be acquired;
18  (B) pro forma financial statements reflecting the
19  combined balance sheets of the acquiring company and
20  the Health Maintenance Organization sought to be
21  acquired as of the end of the preceding year and as of
22  a date 90 days prior to the acquisition, as well as pro
23  forma financial statements reflecting projected
24  combined operation for a period of 2 years;
25  (C) a pro forma business plan detailing an
26  acquiring party's plans with respect to the operation

 

 

  SB1418 - 12 - LRB104 06136 BAB 16169 b


SB1418- 13 -LRB104 06136 BAB 16169 b   SB1418 - 13 - LRB104 06136 BAB 16169 b
  SB1418 - 13 - LRB104 06136 BAB 16169 b
1  of the Health Maintenance Organization sought to be
2  acquired for a period of not less than 3 years; and
3  (D) such other information as the Director shall
4  require.
5  (d) The provisions of Article VIII 1/2 of the Illinois
6  Insurance Code and this Section 5-3 shall apply to the sale by
7  any health maintenance organization of greater than 10% of its
8  enrollee population (including, without limitation, the health
9  maintenance organization's right, title, and interest in and
10  to its health care certificates).
11  (e) In considering any management contract or service
12  agreement subject to Section 141.1 of the Illinois Insurance
13  Code, the Director (i) shall, in addition to the criteria
14  specified in Section 141.2 of the Illinois Insurance Code,
15  take into account the effect of the management contract or
16  service agreement on the continuation of benefits to enrollees
17  and the financial condition of the health maintenance
18  organization to be managed or serviced, and (ii) need not take
19  into account the effect of the management contract or service
20  agreement on competition.
21  (f) Except for small employer groups as defined in the
22  Small Employer Rating, Renewability and Portability Health
23  Insurance Act and except for medicare supplement policies as
24  defined in Section 363 of the Illinois Insurance Code, a
25  Health Maintenance Organization may by contract agree with a
26  group or other enrollment unit to effect refunds or charge

 

 

  SB1418 - 13 - LRB104 06136 BAB 16169 b


SB1418- 14 -LRB104 06136 BAB 16169 b   SB1418 - 14 - LRB104 06136 BAB 16169 b
  SB1418 - 14 - LRB104 06136 BAB 16169 b
1  additional premiums under the following terms and conditions:
2  (i) the amount of, and other terms and conditions with
3  respect to, the refund or additional premium are set forth
4  in the group or enrollment unit contract agreed in advance
5  of the period for which a refund is to be paid or
6  additional premium is to be charged (which period shall
7  not be less than one year); and
8  (ii) the amount of the refund or additional premium
9  shall not exceed 20% of the Health Maintenance
10  Organization's profitable or unprofitable experience with
11  respect to the group or other enrollment unit for the
12  period (and, for purposes of a refund or additional
13  premium, the profitable or unprofitable experience shall
14  be calculated taking into account a pro rata share of the
15  Health Maintenance Organization's administrative and
16  marketing expenses, but shall not include any refund to be
17  made or additional premium to be paid pursuant to this
18  subsection (f)). The Health Maintenance Organization and
19  the group or enrollment unit may agree that the profitable
20  or unprofitable experience may be calculated taking into
21  account the refund period and the immediately preceding 2
22  plan years.
23  The Health Maintenance Organization shall include a
24  statement in the evidence of coverage issued to each enrollee
25  describing the possibility of a refund or additional premium,
26  and upon request of any group or enrollment unit, provide to

 

 

  SB1418 - 14 - LRB104 06136 BAB 16169 b


SB1418- 15 -LRB104 06136 BAB 16169 b   SB1418 - 15 - LRB104 06136 BAB 16169 b
  SB1418 - 15 - LRB104 06136 BAB 16169 b
1  the group or enrollment unit a description of the method used
2  to calculate (1) the Health Maintenance Organization's
3  profitable experience with respect to the group or enrollment
4  unit and the resulting refund to the group or enrollment unit
5  or (2) the Health Maintenance Organization's unprofitable
6  experience with respect to the group or enrollment unit and
7  the resulting additional premium to be paid by the group or
8  enrollment unit.
9  In no event shall the Illinois Health Maintenance
10  Organization Guaranty Association be liable to pay any
11  contractual obligation of an insolvent organization to pay any
12  refund authorized under this Section.
13  (g) Rulemaking authority to implement Public Act 95-1045,
14  if any, is conditioned on the rules being adopted in
15  accordance with all provisions of the Illinois Administrative
16  Procedure Act and all rules and procedures of the Joint
17  Committee on Administrative Rules; any purported rule not so
18  adopted, for whatever reason, is unauthorized.
19  (Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
20  102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
21  1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
22  eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
23  102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
24  1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
25  eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;
26  103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.

 

 

  SB1418 - 15 - LRB104 06136 BAB 16169 b


SB1418- 16 -LRB104 06136 BAB 16169 b   SB1418 - 16 - LRB104 06136 BAB 16169 b
  SB1418 - 16 - LRB104 06136 BAB 16169 b
1  6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
2  eff. 1-1-24; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24;
3  103-618, eff. 1-1-25; 103-649, eff. 1-1-25; 103-656, eff.
4  1-1-25; 103-700, eff. 1-1-25; 103-718, eff. 7-19-24; 103-751,
5  eff. 8-2-24; 103-753, eff. 8-2-24; 103-758, eff. 1-1-25;
6  103-777, eff. 8-2-24; 103-914, eff. 1-1-25; 103-918, eff.
7  1-1-25; 103-1024, eff. 1-1-25; revised 9-26-24.)
8  (Text of Section after amendment by P.A. 103-808)
9  Sec. 5-3. Insurance Code provisions.
10  (a) Health Maintenance Organizations shall be subject to
11  the provisions of Sections 133, 134, 136, 137, 139, 140,
12  141.1, 141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151,
13  152, 153, 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a,
14  155.49, 352c, 355.2, 355.3, 355.6, 355b, 355c, 356f, 356g,
15  356g.5-1, 356m, 356q, 356u.10, 356v, 356w, 356x, 356z.2,
16  356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9,
17  356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17,
18  356z.18, 356z.19, 356z.20, 356z.21, 356z.22, 356z.23, 356z.24,
19  356z.25, 356z.26, 356z.28, 356z.29, 356z.30, 356z.31, 356z.32,
20  356z.33, 356z.34, 356z.35, 356z.36, 356z.37, 356z.38, 356z.39,
21  356z.40, 356z.40a, 356z.41, 356z.44, 356z.45, 356z.46,
22  356z.47, 356z.48, 356z.49, 356z.50, 356z.51, 356z.53, 356z.54,
23  356z.55, 356z.56, 356z.57, 356z.58, 356z.59, 356z.60, 356z.61,
24  356z.62, 356z.63, 356z.64, 356z.65, 356z.66, 356z.67, 356z.68,
25  356z.69, 356z.70, 356z.71, 356z.72, 356z.73, 356z.74, 356z.75,

 

 

  SB1418 - 16 - LRB104 06136 BAB 16169 b


SB1418- 17 -LRB104 06136 BAB 16169 b   SB1418 - 17 - LRB104 06136 BAB 16169 b
  SB1418 - 17 - LRB104 06136 BAB 16169 b
1  356z.77, 356z.80, 364, 364.01, 364.3, 367.2, 367.2-5, 367i,
2  368a, 368b, 368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402,
3  403, 403A, 408, 408.2, 409, 412, 444, and 444.1, paragraph (c)
4  of subsection (2) of Section 367, and Articles IIA, VIII 1/2,
5  XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the
6  Illinois Insurance Code.
7  (b) For purposes of the Illinois Insurance Code, except
8  for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
9  Health Maintenance Organizations in the following categories
10  are deemed to be "domestic companies":
11  (1) a corporation authorized under the Dental Service
12  Plan Act or the Voluntary Health Services Plans Act;
13  (2) a corporation organized under the laws of this
14  State; or
15  (3) a corporation organized under the laws of another
16  state, 30% or more of the enrollees of which are residents
17  of this State, except a corporation subject to
18  substantially the same requirements in its state of
19  organization as is a "domestic company" under Article VIII
20  1/2 of the Illinois Insurance Code.
21  (c) In considering the merger, consolidation, or other
22  acquisition of control of a Health Maintenance Organization
23  pursuant to Article VIII 1/2 of the Illinois Insurance Code,
24  (1) the Director shall give primary consideration to
25  the continuation of benefits to enrollees and the
26  financial conditions of the acquired Health Maintenance

 

 

  SB1418 - 17 - LRB104 06136 BAB 16169 b


SB1418- 18 -LRB104 06136 BAB 16169 b   SB1418 - 18 - LRB104 06136 BAB 16169 b
  SB1418 - 18 - LRB104 06136 BAB 16169 b
1  Organization after the merger, consolidation, or other
2  acquisition of control takes effect;
3  (2)(i) the criteria specified in subsection (1)(b) of
4  Section 131.8 of the Illinois Insurance Code shall not
5  apply and (ii) the Director, in making his determination
6  with respect to the merger, consolidation, or other
7  acquisition of control, need not take into account the
8  effect on competition of the merger, consolidation, or
9  other acquisition of control;
10  (3) the Director shall have the power to require the
11  following information:
12  (A) certification by an independent actuary of the
13  adequacy of the reserves of the Health Maintenance
14  Organization sought to be acquired;
15  (B) pro forma financial statements reflecting the
16  combined balance sheets of the acquiring company and
17  the Health Maintenance Organization sought to be
18  acquired as of the end of the preceding year and as of
19  a date 90 days prior to the acquisition, as well as pro
20  forma financial statements reflecting projected
21  combined operation for a period of 2 years;
22  (C) a pro forma business plan detailing an
23  acquiring party's plans with respect to the operation
24  of the Health Maintenance Organization sought to be
25  acquired for a period of not less than 3 years; and
26  (D) such other information as the Director shall

 

 

  SB1418 - 18 - LRB104 06136 BAB 16169 b


SB1418- 19 -LRB104 06136 BAB 16169 b   SB1418 - 19 - LRB104 06136 BAB 16169 b
  SB1418 - 19 - LRB104 06136 BAB 16169 b
1  require.
2  (d) The provisions of Article VIII 1/2 of the Illinois
3  Insurance Code and this Section 5-3 shall apply to the sale by
4  any health maintenance organization of greater than 10% of its
5  enrollee population (including, without limitation, the health
6  maintenance organization's right, title, and interest in and
7  to its health care certificates).
8  (e) In considering any management contract or service
9  agreement subject to Section 141.1 of the Illinois Insurance
10  Code, the Director (i) shall, in addition to the criteria
11  specified in Section 141.2 of the Illinois Insurance Code,
12  take into account the effect of the management contract or
13  service agreement on the continuation of benefits to enrollees
14  and the financial condition of the health maintenance
15  organization to be managed or serviced, and (ii) need not take
16  into account the effect of the management contract or service
17  agreement on competition.
18  (f) Except for small employer groups as defined in the
19  Small Employer Rating, Renewability and Portability Health
20  Insurance Act and except for medicare supplement policies as
21  defined in Section 363 of the Illinois Insurance Code, a
22  Health Maintenance Organization may by contract agree with a
23  group or other enrollment unit to effect refunds or charge
24  additional premiums under the following terms and conditions:
25  (i) the amount of, and other terms and conditions with
26  respect to, the refund or additional premium are set forth

 

 

  SB1418 - 19 - LRB104 06136 BAB 16169 b


SB1418- 20 -LRB104 06136 BAB 16169 b   SB1418 - 20 - LRB104 06136 BAB 16169 b
  SB1418 - 20 - LRB104 06136 BAB 16169 b
1  in the group or enrollment unit contract agreed in advance
2  of the period for which a refund is to be paid or
3  additional premium is to be charged (which period shall
4  not be less than one year); and
5  (ii) the amount of the refund or additional premium
6  shall not exceed 20% of the Health Maintenance
7  Organization's profitable or unprofitable experience with
8  respect to the group or other enrollment unit for the
9  period (and, for purposes of a refund or additional
10  premium, the profitable or unprofitable experience shall
11  be calculated taking into account a pro rata share of the
12  Health Maintenance Organization's administrative and
13  marketing expenses, but shall not include any refund to be
14  made or additional premium to be paid pursuant to this
15  subsection (f)). The Health Maintenance Organization and
16  the group or enrollment unit may agree that the profitable
17  or unprofitable experience may be calculated taking into
18  account the refund period and the immediately preceding 2
19  plan years.
20  The Health Maintenance Organization shall include a
21  statement in the evidence of coverage issued to each enrollee
22  describing the possibility of a refund or additional premium,
23  and upon request of any group or enrollment unit, provide to
24  the group or enrollment unit a description of the method used
25  to calculate (1) the Health Maintenance Organization's
26  profitable experience with respect to the group or enrollment

 

 

  SB1418 - 20 - LRB104 06136 BAB 16169 b


SB1418- 21 -LRB104 06136 BAB 16169 b   SB1418 - 21 - LRB104 06136 BAB 16169 b
  SB1418 - 21 - LRB104 06136 BAB 16169 b
1  unit and the resulting refund to the group or enrollment unit
2  or (2) the Health Maintenance Organization's unprofitable
3  experience with respect to the group or enrollment unit and
4  the resulting additional premium to be paid by the group or
5  enrollment unit.
6  In no event shall the Illinois Health Maintenance
7  Organization Guaranty Association be liable to pay any
8  contractual obligation of an insolvent organization to pay any
9  refund authorized under this Section.
10  (g) Rulemaking authority to implement Public Act 95-1045,
11  if any, is conditioned on the rules being adopted in
12  accordance with all provisions of the Illinois Administrative
13  Procedure Act and all rules and procedures of the Joint
14  Committee on Administrative Rules; any purported rule not so
15  adopted, for whatever reason, is unauthorized.
16  (Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
17  102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
18  1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
19  eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
20  102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
21  1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
22  eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;
23  103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.
24  6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
25  eff. 1-1-24; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24;
26  103-618, eff. 1-1-25; 103-649, eff. 1-1-25; 103-656, eff.

 

 

  SB1418 - 21 - LRB104 06136 BAB 16169 b


SB1418- 22 -LRB104 06136 BAB 16169 b   SB1418 - 22 - LRB104 06136 BAB 16169 b
  SB1418 - 22 - LRB104 06136 BAB 16169 b
1  1-1-25; 103-700, eff. 1-1-25; 103-718, eff. 7-19-24; 103-751,
2  eff. 8-2-24; 103-753, eff. 8-2-24; 103-758, eff. 1-1-25;
3  103-777, eff. 8-2-24; 103-808, eff. 1-1-26; 103-914, eff.
4  1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; revised
5  11-26-24.)
6  Section 30. The Limited Health Service Organization Act is
7  amended by changing Section 4003 as follows:
8  (215 ILCS 130/4003) (from Ch. 73, par. 1504-3)
9  Sec. 4003. Illinois Insurance Code provisions. Limited
10  health service organizations shall be subject to the
11  provisions of Sections 133, 134, 136, 137, 139, 140, 141.1,
12  141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151, 152, 153,
13  154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.37, 155.49, 352c,
14  355.2, 355.3, 355b, 355d, 356m, 356q, 356v, 356z.4, 356z.4a,
15  356z.10, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.32,
16  356z.33, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54,
17  356z.57, 356z.59, 356z.61, 356z.64, 356z.67, 356z.68, 356z.71,
18  356z.73, 356z.74, 356z.75, 356z.80, 364.3, 368a, 401, 401.1,
19  402, 403, 403A, 408, 408.2, 409, 412, 444, and 444.1 and
20  Articles IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, and
21  XXVI of the Illinois Insurance Code. Nothing in this Section
22  shall require a limited health care plan to cover any service
23  that is not a limited health service. For purposes of the
24  Illinois Insurance Code, except for Sections 444 and 444.1 and

 

 

  SB1418 - 22 - LRB104 06136 BAB 16169 b


SB1418- 23 -LRB104 06136 BAB 16169 b   SB1418 - 23 - LRB104 06136 BAB 16169 b
  SB1418 - 23 - LRB104 06136 BAB 16169 b
1  Articles XIII and XIII 1/2, limited health service
2  organizations in the following categories are deemed to be
3  domestic companies:
4  (1) a corporation under the laws of this State; or
5  (2) a corporation organized under the laws of another
6  state, 30% or more of the enrollees of which are residents
7  of this State, except a corporation subject to
8  substantially the same requirements in its state of
9  organization as is a domestic company under Article VIII
10  1/2 of the Illinois Insurance Code.
11  (Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
12  102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-731, eff.
13  1-1-23; 102-775, eff. 5-13-22; 102-813, eff. 5-13-22; 102-816,
14  eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23;
15  102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
16  1-1-24; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
17  eff. 1-1-24; 103-605, eff. 7-1-24; 103-649, eff. 1-1-25;
18  103-656, eff. 1-1-25; 103-700, eff. 1-1-25; 103-718, eff.
19  7-19-24; 103-751, eff. 8-2-24; 103-758, eff. 1-1-25; 103-832,
20  eff. 1-1-25; 103-1024, eff. 1-1-25; revised 11-26-24.)
21  Section 35. The Voluntary Health Services Plans Act is
22  amended by changing Section 10 as follows:
23  (215 ILCS 165/10) (from Ch. 32, par. 604)
24  Sec. 10. Application of Insurance Code provisions. Health

 

 

  SB1418 - 23 - LRB104 06136 BAB 16169 b


SB1418- 24 -LRB104 06136 BAB 16169 b   SB1418 - 24 - LRB104 06136 BAB 16169 b
  SB1418 - 24 - LRB104 06136 BAB 16169 b
1  services plan corporations and all persons interested therein
2  or dealing therewith shall be subject to the provisions of
3  Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
4  143, 143.31, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3,
5  355b, 355d, 356g, 356g.5, 356g.5-1, 356m, 356q, 356r, 356t,
6  356u, 356u.10, 356v, 356w, 356x, 356y, 356z.1, 356z.2,
7  356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9,
8  356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18,
9  356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.29, 356z.30,
10  356z.32, 356z.32a, 356z.33, 356z.40, 356z.41, 356z.46,
11  356z.47, 356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59,
12  356z.60, 356z.61, 356z.62, 356z.64, 356z.67, 356z.68, 356z.71,
13  356z.72, 356z.74, 356z.75, 356z.77, 356z.80, 364.01, 364.3,
14  367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2, and 412,
15  and paragraphs (7) and (15) of Section 367 of the Illinois
16  Insurance Code.
17  Rulemaking authority to implement Public Act 95-1045, if
18  any, is conditioned on the rules being adopted in accordance
19  with all provisions of the Illinois Administrative Procedure
20  Act and all rules and procedures of the Joint Committee on
21  Administrative Rules; any purported rule not so adopted, for
22  whatever reason, is unauthorized.
23  (Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
24  102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff.
25  10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804,
26  eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;

 

 

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1  102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff.
2  1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
3  eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
4  103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-656, eff.
5  1-1-25; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-753,
6  eff. 8-2-24; 103-758, eff. 1-1-25; 103-832, eff. 1-1-25;
7  103-914, eff. 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff.
8  1-1-25; revised 11-26-24.)
9  Section 40. The Illinois Public Aid Code is amended by
10  changing Section 5-16.8 as follows:
11  (305 ILCS 5/5-16.8)
12  Sec. 5-16.8. Required health benefits. The medical
13  assistance program shall (i) provide the post-mastectomy care
14  benefits required to be covered by a policy of accident and
15  health insurance under Section 356t and the coverage required
16  under Sections 356g.5, 356q, 356u, 356w, 356x, 356z.6,
17  356z.26, 356z.29, 356z.32, 356z.33, 356z.34, 356z.35, 356z.46,
18  356z.47, 356z.51, 356z.53, 356z.59, 356z.60, 356z.61, 356z.64,
19  and 356z.67, and 356z.71, 356z.75, and 356z.80 of the Illinois
20  Insurance Code, (ii) be subject to the provisions of Sections
21  356z.19, 356z.44, 356z.49, 364.01, 370c, and 370c.1 of the
22  Illinois Insurance Code, and (iii) be subject to the
23  provisions of subsection (d-5) of Section 10 of the Network
24  Adequacy and Transparency Act.

 

 

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1  The Department, by rule, shall adopt a model similar to
2  the requirements of Section 356z.39 of the Illinois Insurance
3  Code.
4  On and after July 1, 2012, the Department shall reduce any
5  rate of reimbursement for services or other payments or alter
6  any methodologies authorized by this Code to reduce any rate
7  of reimbursement for services or other payments in accordance
8  with Section 5-5e.
9  To ensure full access to the benefits set forth in this
10  Section, on and after January 1, 2016, the Department shall
11  ensure that provider and hospital reimbursement for
12  post-mastectomy care benefits required under this Section are
13  no lower than the Medicare reimbursement rate.
14  (Source: P.A. 102-30, eff. 1-1-22; 102-144, eff. 1-1-22;
15  102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-530, eff.
16  1-1-22; 102-642, eff. 1-1-22; 102-804, eff. 1-1-23; 102-813,
17  eff. 5-13-22; 102-816, eff. 1-1-23; 102-1093, eff. 1-1-23;
18  102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, eff.
19  1-1-24; 103-420, eff. 1-1-24; 103-605, eff. 7-1-24; 103-703,
20  eff. 1-1-25; 103-758, eff. 1-1-25; 103-1024, eff. 1-1-25;
21  revised 11-26-24.)
22  Section 95. No acceleration or delay. Where this Act makes
23  changes in a statute that is represented in this Act by text
24  that is not yet or no longer in effect (for example, a Section
25  represented by multiple versions), the use of that text does

 

 

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