Illinois 2025-2026 Regular Session

Illinois Senate Bill SB1746 Compare Versions

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

Old	New	Differences
1	1	104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB1746 Introduced 2/5/2025, by Sen. Cristina Castro 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.26a new215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2215 ILCS 165/10 from Ch. 32, par. 604 Amends the Illinois Insurance Code. Provides that a health benefit plan amended, delivered, issued, or renewed on or after January 1, 2026 that provides prescription drug coverage through a medical or pharmacy health benefit or its contracted pharmacy benefit manager shall not engage in or require an enrollee to engage in specified prohibited acts. Provides that a clinician-administered drug shall meet the supply chain security controls and chain of distribution set by the federal Drug Supply Chain Security Act. Provides that the Department of Insurance may adopt rules as necessary to implement the provisions. Defines terms. Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, and the Voluntary Health Services Plans Act to require policies under those Acts to comply with the provisions. LRB104 10199 BAB 20272 b A BILL FOR 104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB1746 Introduced 2/5/2025, by Sen. Cristina Castro 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.26a new215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2215 ILCS 165/10 from Ch. 32, par. 604 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.26a new 215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2 215 ILCS 165/10 from Ch. 32, par. 604 Amends the Illinois Insurance Code. Provides that a health benefit plan amended, delivered, issued, or renewed on or after January 1, 2026 that provides prescription drug coverage through a medical or pharmacy health benefit or its contracted pharmacy benefit manager shall not engage in or require an enrollee to engage in specified prohibited acts. Provides that a clinician-administered drug shall meet the supply chain security controls and chain of distribution set by the federal Drug Supply Chain Security Act. Provides that the Department of Insurance may adopt rules as necessary to implement the provisions. Defines terms. Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, and the Voluntary Health Services Plans Act to require policies under those Acts to comply with the provisions. LRB104 10199 BAB 20272 b LRB104 10199 BAB 20272 b A BILL FOR
2	2	104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB1746 Introduced 2/5/2025, by Sen. Cristina Castro SYNOPSIS AS INTRODUCED:
3	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.26a new215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2215 ILCS 165/10 from Ch. 32, par. 604 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.26a new 215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2 215 ILCS 165/10 from Ch. 32, par. 604
4	4	5 ILCS 375/6.11
5	5	55 ILCS 5/5-1069.3
6	6	65 ILCS 5/10-4-2.3
7	7	105 ILCS 5/10-22.3f
8	8	215 ILCS 5/356z.26a new
9	9	215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2
10	10	215 ILCS 165/10 from Ch. 32, par. 604
11	11	Amends the Illinois Insurance Code. Provides that a health benefit plan amended, delivered, issued, or renewed on or after January 1, 2026 that provides prescription drug coverage through a medical or pharmacy health benefit or its contracted pharmacy benefit manager shall not engage in or require an enrollee to engage in specified prohibited acts. Provides that a clinician-administered drug shall meet the supply chain security controls and chain of distribution set by the federal Drug Supply Chain Security Act. Provides that the Department of Insurance may adopt rules as necessary to implement the provisions. Defines terms. Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, and the Voluntary Health Services Plans Act to require policies under those Acts to comply with the provisions.
12	12	LRB104 10199 BAB 20272 b LRB104 10199 BAB 20272 b
13	13	LRB104 10199 BAB 20272 b
14	14	A BILL FOR
15	15	SB1746LRB104 10199 BAB 20272 b SB1746 LRB104 10199 BAB 20272 b
16	16	SB1746 LRB104 10199 BAB 20272 b
17	17	1 AN ACT concerning regulation.
18	18	2 Be it enacted by the People of the State of Illinois,
19	19	3 represented in the General Assembly:
20	20	4 Section 5. The State Employees Group Insurance Act of 1971
21	21	5 is amended by changing Section 6.11 as follows:
22	22	6 (5 ILCS 375/6.11)
23	23	7 Sec. 6.11. Required health benefits; Illinois Insurance
24	24	8 Code requirements. The program of health benefits shall
25	25	9 provide the post-mastectomy care benefits required to be
26	26	10 covered by a policy of accident and health insurance under
27	27	11 Section 356t of the Illinois Insurance Code. The program of
28	28	12 health benefits shall provide the coverage required under
29	29	13 Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10,
30	30	14 356w, 356x, 356z.2, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8,
31	31	15 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15,
32	32	16 356z.17, 356z.22, 356z.25, 356z.26, 356z.26a, 356z.29,
33	33	17 356z.30, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41, 356z.45,
34	34	18 356z.46, 356z.47, 356z.51, 356z.53, 356z.54, 356z.55, 356z.56,
35	35	19 356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64, 356z.67,
36	36	20 356z.68, and 356z.70, and 356z.71, 356z.74, 356z.76, and
37	37	21 356z.77 of the Illinois Insurance Code. The program of health
38	38	22 benefits must comply with Sections 155.22a, 155.37, 355b,
39	39	23 356z.19, 370c, and 370c.1 and Article XXXIIB of the Illinois
40	40
41	41
42	42
43	43	104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB1746 Introduced 2/5/2025, by Sen. Cristina Castro SYNOPSIS AS INTRODUCED:
44	44	5 ILCS 375/6.1155 ILCS 5/5-1069.365 ILCS 5/10-4-2.3105 ILCS 5/10-22.3f215 ILCS 5/356z.26a new215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2215 ILCS 165/10 from Ch. 32, par. 604 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.26a new 215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2 215 ILCS 165/10 from Ch. 32, par. 604
45	45	5 ILCS 375/6.11
46	46	55 ILCS 5/5-1069.3
47	47	65 ILCS 5/10-4-2.3
48	48	105 ILCS 5/10-22.3f
49	49	215 ILCS 5/356z.26a new
50	50	215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2
51	51	215 ILCS 165/10 from Ch. 32, par. 604
52	52	Amends the Illinois Insurance Code. Provides that a health benefit plan amended, delivered, issued, or renewed on or after January 1, 2026 that provides prescription drug coverage through a medical or pharmacy health benefit or its contracted pharmacy benefit manager shall not engage in or require an enrollee to engage in specified prohibited acts. Provides that a clinician-administered drug shall meet the supply chain security controls and chain of distribution set by the federal Drug Supply Chain Security Act. Provides that the Department of Insurance may adopt rules as necessary to implement the provisions. Defines terms. Amends the State Employees Group Insurance Act of 1971, the Counties Code, the Illinois Municipal Code, the School Code, the Health Maintenance Organization Act, and the Voluntary Health Services Plans Act to require policies under those Acts to comply with the provisions.
53	53	LRB104 10199 BAB 20272 b LRB104 10199 BAB 20272 b
54	54	LRB104 10199 BAB 20272 b
55	55	A BILL FOR
56	56
57	57
58	58
59	59
60	60
61	61	5 ILCS 375/6.11
62	62	55 ILCS 5/5-1069.3
63	63	65 ILCS 5/10-4-2.3
64	64	105 ILCS 5/10-22.3f
65	65	215 ILCS 5/356z.26a new
66	66	215 ILCS 125/5-3 from Ch. 111 1/2, par. 1411.2
67	67	215 ILCS 165/10 from Ch. 32, par. 604
68	68
69	69
70	70
71	71	LRB104 10199 BAB 20272 b
72	72
73	73
74	74
75	75
76	76
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78	78
79	79
80	80
81	81	SB1746 LRB104 10199 BAB 20272 b
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84	84	SB1746- 2 -LRB104 10199 BAB 20272 b SB1746 - 2 - LRB104 10199 BAB 20272 b
85	85	SB1746 - 2 - LRB104 10199 BAB 20272 b
86	86	1 Insurance Code. The program of health benefits shall provide
87	87	2 the coverage required under Section 356m of the Illinois
88	88	3 Insurance Code and, for the employees of the State Employee
89	89	4 Group Insurance Program only, the coverage as also provided in
90	90	5 Section 6.11B of this Act. The Department of Insurance shall
91	91	6 enforce the requirements of this Section with respect to
92	92	7 Sections 370c and 370c.1 of the Illinois Insurance Code; all
93	93	8 other requirements of this Section shall be enforced by the
94	94	9 Department of Central Management Services.
95	95	10 Rulemaking authority to implement Public Act 95-1045, if
96	96	11 any, is conditioned on the rules being adopted in accordance
97	97	12 with all provisions of the Illinois Administrative Procedure
98	98	13 Act and all rules and procedures of the Joint Committee on
99	99	14 Administrative Rules; any purported rule not so adopted, for
100	100	15 whatever reason, is unauthorized.
101	101	16 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
102	102	17 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
103	103	18 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-768,
104	104	19 eff. 1-1-24; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
105	105	20 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
106	106	21 1-1-23; 102-1117, eff. 1-13-23; 103-8, eff. 1-1-24; 103-84,
107	107	22 eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, eff. 1-1-24;
108	108	23 103-445, eff. 1-1-24; 103-535, eff. 8-11-23; 103-551, eff.
109	109	24 8-11-23; 103-605, eff. 7-1-24; 103-718, eff. 7-19-24; 103-751,
110	110	25 eff. 8-2-24; 103-870, eff. 1-1-25; 103-914, eff. 1-1-25;
111	111	26 103-918, eff. 1-1-25; 103-951, eff. 1-1-25; 103-1024, eff.
112	112
113	113
114	114
115	115
116	116
117	117	SB1746 - 2 - LRB104 10199 BAB 20272 b
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121	121	SB1746 - 3 - LRB104 10199 BAB 20272 b
122	122	1 1-1-25; revised 11-26-24.)
123	123	2 Section 10. The Counties Code is amended by changing
124	124	3 Section 5-1069.3 as follows:
125	125	4 (55 ILCS 5/5-1069.3)
126	126	5 Sec. 5-1069.3. Required health benefits. If a county,
127	127	6 including a home rule county, is a self-insurer for purposes
128	128	7 of providing health insurance coverage for its employees, the
129	129	8 coverage shall include coverage for the post-mastectomy care
130	130	9 benefits required to be covered by a policy of accident and
131	131	10 health insurance under Section 356t and the coverage required
132	132	11 under Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u,
133	133	12 356u.10, 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9,
134	134	13 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22,
135	135	14 356z.25, 356z.26, 356z.26a, 356z.29, 356z.30, 356z.32,
136	136	15 356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47,
137	137	16 356z.48, 356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59,
138	138	17 356z.60, 356z.61, 356z.62, 356z.64, 356z.67, 356z.68, and
139	139	18 356z.70, and 356z.71, 356z.74, and 356z.77 of the Illinois
140	140	19 Insurance Code. The coverage shall comply with Sections
141	141	20 155.22a, 355b, 356z.19, and 370c of the Illinois Insurance
142	142	21 Code. The Department of Insurance shall enforce the
143	143	22 requirements of this Section. The requirement that health
144	144	23 benefits be covered as provided in this Section is an
145	145	24 exclusive power and function of the State and is a denial and
146	146
147	147
148	148
149	149
150	150
151	151	SB1746 - 3 - LRB104 10199 BAB 20272 b
152	152
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154	154	SB1746- 4 -LRB104 10199 BAB 20272 b SB1746 - 4 - LRB104 10199 BAB 20272 b
155	155	SB1746 - 4 - LRB104 10199 BAB 20272 b
156	156	1 limitation under Article VII, Section 6, subsection (h) of the
157	157	2 Illinois Constitution. A home rule county to which this
158	158	3 Section applies must comply with every provision of this
159	159	4 Section.
160	160	5 Rulemaking authority to implement Public Act 95-1045, if
161	161	6 any, is conditioned on the rules being adopted in accordance
162	162	7 with all provisions of the Illinois Administrative Procedure
163	163	8 Act and all rules and procedures of the Joint Committee on
164	164	9 Administrative Rules; any purported rule not so adopted, for
165	165	10 whatever reason, is unauthorized.
166	166	11 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
167	167	12 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
168	168	13 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
169	169	14 eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
170	170	15 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
171	171	16 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
172	172	17 eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
173	173	18 103-535, eff. 8-11-23; 103-551, eff. 8-11-23; 103-605, eff.
174	174	19 7-1-24; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-914,
175	175	20 eff. 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25;
176	176	21 revised 11-26-24.)
177	177	22 Section 15. The Illinois Municipal Code is amended by
178	178	23 changing Section 10-4-2.3 as follows:
179	179	24 (65 ILCS 5/10-4-2.3)
180	180
181	181
182	182
183	183
184	184
185	185	SB1746 - 4 - LRB104 10199 BAB 20272 b
186	186
187	187
188	188	SB1746- 5 -LRB104 10199 BAB 20272 b SB1746 - 5 - LRB104 10199 BAB 20272 b
189	189	SB1746 - 5 - LRB104 10199 BAB 20272 b
190	190	1 Sec. 10-4-2.3. Required health benefits. If a
191	191	2 municipality, including a home rule municipality, is a
192	192	3 self-insurer for purposes of providing health insurance
193	193	4 coverage for its employees, the coverage shall include
194	194	5 coverage for the post-mastectomy care benefits required to be
195	195	6 covered by a policy of accident and health insurance under
196	196	7 Section 356t and the coverage required under Sections 356g,
197	197	8 356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10, 356w, 356x,
198	198	9 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11,
199	199	10 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26,
200	200	11 356z.26a, 356z.29, 356z.30, 356z.32, 356z.33, 356z.36,
201	201	12 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51,
202	202	13 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, 356z.61,
203	203	14 356z.62, 356z.64, 356z.67, 356z.68, and 356z.70, and 356z.71,
204	204	15 356z.74, and 356z.77 of the Illinois Insurance Code. The
205	205	16 coverage shall comply with Sections 155.22a, 355b, 356z.19,
206	206	17 and 370c of the Illinois Insurance Code. The Department of
207	207	18 Insurance shall enforce the requirements of this Section. The
208	208	19 requirement that health benefits be covered as provided in
209	209	20 this is an exclusive power and function of the State and is a
210	210	21 denial and limitation under Article VII, Section 6, subsection
211	211	22 (h) of the Illinois Constitution. A home rule municipality to
212	212	23 which this Section applies must comply with every provision of
213	213	24 this Section.
214	214	25 Rulemaking authority to implement Public Act 95-1045, if
215	215	26 any, is conditioned on the rules being adopted in accordance
216	216
217	217
218	218
219	219
220	220
221	221	SB1746 - 5 - LRB104 10199 BAB 20272 b
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224	224	SB1746- 6 -LRB104 10199 BAB 20272 b SB1746 - 6 - LRB104 10199 BAB 20272 b
225	225	SB1746 - 6 - LRB104 10199 BAB 20272 b
226	226	1 with all provisions of the Illinois Administrative Procedure
227	227	2 Act and all rules and procedures of the Joint Committee on
228	228	3 Administrative Rules; any purported rule not so adopted, for
229	229	4 whatever reason, is unauthorized.
230	230	5 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
231	231	6 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
232	232	7 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731,
233	233	8 eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22;
234	234	9 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff.
235	235	10 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
236	236	11 eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
237	237	12 103-535, eff. 8-11-23; 103-551, eff. 8-11-23; 103-605, eff.
238	238	13 7-1-24; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-914,
239	239	14 eff. 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25;
240	240	15 revised 11-26-24.)
241	241	16 Section 20. The School Code is amended by changing Section
242	242	17 10-22.3f as follows:
243	243	18 (105 ILCS 5/10-22.3f)
244	244	19 Sec. 10-22.3f. Required health benefits. Insurance
245	245	20 protection and benefits for employees shall provide the
246	246	21 post-mastectomy care benefits required to be covered by a
247	247	22 policy of accident and health insurance under Section 356t and
248	248	23 the coverage required under Sections 356g, 356g.5, 356g.5-1,
249	249	24 356m, 356q, 356u, 356u.10, 356w, 356x, 356z.4, 356z.4a,
250	250
251	251
252	252
253	253
254	254
255	255	SB1746 - 6 - LRB104 10199 BAB 20272 b
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260	260	1 356z.6, 356z.8, 356z.9, 356z.11, 356z.12, 356z.13, 356z.14,
261	261	2 356z.15, 356z.22, 356z.25, 356z.26, 356z.26a, 356z.29,
262	262	3 356z.30, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41, 356z.45,
263	263	4 356z.46, 356z.47, 356z.51, 356z.53, 356z.54, 356z.56, 356z.57,
264	264	5 356z.59, 356z.60, 356z.61, 356z.62, 356z.64, 356z.67, 356z.68,
265	265	6 and 356z.70, and 356z.71, 356z.74, and 356z.77 of the Illinois
266	266	7 Insurance Code. Insurance policies shall comply with Section
267	267	8 356z.19 of the Illinois Insurance Code. The coverage shall
268	268	9 comply with Sections 155.22a, 355b, and 370c of the Illinois
269	269	10 Insurance Code. The Department of Insurance shall enforce the
270	270	11 requirements of this Section.
271	271	12 Rulemaking authority to implement Public Act 95-1045, if
272	272	13 any, is conditioned on the rules being adopted in accordance
273	273	14 with all provisions of the Illinois Administrative Procedure
274	274	15 Act and all rules and procedures of the Joint Committee on
275	275	16 Administrative Rules; any purported rule not so adopted, for
276	276	17 whatever reason, is unauthorized.
277	277	18 (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22;
278	278	19 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff.
279	279	20 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804,
280	280	21 eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
281	281	22 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff.
282	282	23 1-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420,
283	283	24 eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. 8-11-23;
284	284	25 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-718, eff.
285	285	26 7-19-24; 103-751, eff. 8-2-24; 103-914, eff. 1-1-25; 103-918,
286	286
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296	296	1 eff. 1-1-25; 103-1024, eff. 1-1-25; revised 11-26-24.)
297	297	2 Section 25. The Illinois Insurance Code is amended by
298	298	3 adding Section 356z.26a as follows:
299	299	4 (215 ILCS 5/356z.26a new)
300	300	5 Sec. 356z.26a. Clinician-administered drugs.
301	301	6 (a) As used in this Section:
302	302	7 "Clinician-administered drug" means an outpatient
303	303	8 prescription drug other than a vaccine that:
304	304	9 (1) cannot reasonably be self-administered by the
305	305	10 patient to whom the drug is prescribed or by an individual
306	306	11 assisting the patient with the self-administration; and
307	307	12 (2) is typically administered:
308	308	13 (A) by a health care provider authorized under the
309	309	14 laws of this State to administer the drug, including a
310	310	15 health care provider acting under a physician's
311	311	16 delegation and supervision; and
312	312	17 (B) in a physician's office, hospital outpatient
313	313	18 infusion center, or other clinical setting.
314	314	19 "Health benefit plan" means an individual or group policy
315	315	20 of accident or health insurance, health care plan, or other
316	316	21 hospital or medical policy, certificate, or contract.
317	317	22 "Health care plan" has the meaning given to that term in
318	318	23 Section 1-2 of the Health Maintenance Organization Act.
319	319	24 "Health care plan" does not include a managed care
320	320
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327	327
328	328	SB1746- 9 -LRB104 10199 BAB 20272 b SB1746 - 9 - LRB104 10199 BAB 20272 b
329	329	SB1746 - 9 - LRB104 10199 BAB 20272 b
330	330	1 organization that provides, arranges, or reimburses for the
331	331	2 delivery of health care services to individuals who are
332	332	3 enrolled in the program of medical assistance under the
333	333	4 Illinois Public Aid Code or under the Children's Health
334	334	5 Insurance Program Act.
335	335	6 "Pharmacy" has the meaning given to that term in Section 3
336	336	7 of the Pharmacy Practice Act.
337	337	8 "Provider" has the meaning given to that term in Section
338	338	9 370g.
339	339	10 "Site of service" means the physical location where a
340	340	11 clinician-administered drug is administered, including, but
341	341	12 not limited to, an outpatient hospital, physician's office,
342	342	13 ambulatory infusion site, home-based site, or other clinical
343	343	14 setting.
344	344	15 (b) To ensure access to safe and effective drug therapies,
345	345	16 a health benefit plan amended, delivered, issued, or renewed
346	346	17 on or after January 1, 2026 that provides prescription drug
347	347	18 coverage through a medical or pharmacy health benefit or its
348	348	19 contracted pharmacy benefit manager shall not:
349	349	20 (1) require an enrollee to obtain a covered
350	350	21 clinician-administered drug from a pharmacy selected by
351	351	22 the health benefit plan or pharmacy benefit manager with
352	352	23 the intent to transport the drug to another site of
353	353	24 service for administration;
354	354	25 (2) require an enrollee to obtain a covered
355	355	26 clinician-administered drug from a pharmacy selected by
356	356
357	357
358	358
359	359
360	360
361	361	SB1746 - 9 - LRB104 10199 BAB 20272 b
362	362
363	363
364	364	SB1746- 10 -LRB104 10199 BAB 20272 b SB1746 - 10 - LRB104 10199 BAB 20272 b
365	365	SB1746 - 10 - LRB104 10199 BAB 20272 b
366	366	1 the health benefit plan or pharmacy benefit manager;
367	367	2 (3) notwithstanding any other provision of law, steer
368	368	3 or offer financial or other incentives to induce an
369	369	4 enrollee to obtain a clinician-administered drug from a
370	370	5 pharmacy identified by the health benefit plan or pharmacy
371	371	6 benefit manager;
372	372	7 (4) condition, deny, restrict, refuse to authorize, or
373	373	8 otherwise limit benefits and coverage to an enrollee for
374	374	9 medically necessary clinician-administered drugs and
375	375	10 related services obtained from the provider that
376	376	11 administers the drug or from a pharmacy that is not
377	377	12 selected by the health benefit plan or pharmacy benefit
378	378	13 manager;
379	379	14 (5) condition, deny, restrict, refuse to authorize, or
380	380	15 otherwise limit reimbursement to a provider for covered
381	381	16 medically necessary clinician-administered drugs and
382	382	17 related services obtained from the provider that
383	383	18 administers the drug or from a pharmacy that is not
384	384	19 selected by the health benefit plan or pharmacy benefit
385	385	20 manager;
386	386	21 (6) assess higher deductibles, copayments,
387	387	22 coinsurance, or other cost-sharing amounts for
388	388	23 clinician-administered drugs obtained from the provider
389	389	24 that administers the drug or from a pharmacy that is not
390	390	25 selected by the health benefit plan or pharmacy benefit
391	391	26 manager;
392	392
393	393
394	394
395	395
396	396
397	397	SB1746 - 10 - LRB104 10199 BAB 20272 b
398	398
399	399
400	400	SB1746- 11 -LRB104 10199 BAB 20272 b SB1746 - 11 - LRB104 10199 BAB 20272 b
401	401	SB1746 - 11 - LRB104 10199 BAB 20272 b
402	402	1 (7) require an enrollee to use a home infusion
403	403	2 pharmacy to receive clinician-administered drugs in the
404	404	3 enrollee's home or to use a site of service identified by
405	405	4 the health benefit plan or pharmacy benefit manager;
406	406	5 (8) include the site of service in prior approval or
407	407	6 medical necessity criteria for clinician-administered
408	408	7 drugs;
409	409	8 (9) require an enrollee to use the pharmacy benefit
410	410	9 for specific clinician-administered drugs; or
411	411	10 (10) prohibit a provider from billing the health
412	412	11 benefit plan for reimbursement of clinician-administered
413	413	12 drugs.
414	414	13 (c) A clinician-administered drug shall meet the supply
415	415	14 chain security controls and chain of distribution set by the
416	416	15 federal Drug Supply Chain Security Act.
417	417	16 (d) The Department may adopt rules as necessary to
418	418	17 implement the provisions of this Section.
419	419	18 Section 30. The Health Maintenance Organization Act is
420	420	19 amended by changing Section 5-3 as follows:
421	421	20 (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2)
422	422	21 (Text of Section before amendment by P.A. 103-808)
423	423	22 Sec. 5-3. Insurance Code provisions.
424	424	23 (a) Health Maintenance Organizations shall be subject to
425	425	24 the provisions of Sections 133, 134, 136, 137, 139, 140,
426	426
427	427
428	428
429	429
430	430
431	431	SB1746 - 11 - LRB104 10199 BAB 20272 b
432	432
433	433
434	434	SB1746- 12 -LRB104 10199 BAB 20272 b SB1746 - 12 - LRB104 10199 BAB 20272 b
435	435	SB1746 - 12 - LRB104 10199 BAB 20272 b
436	436	1 141.1, 141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151,
437	437	2 152, 153, 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a,
438	438	3 155.49, 352c, 355.2, 355.3, 355.6, 355b, 355c, 356f, 356g.5-1,
439	439	4 356m, 356q, 356u.10, 356v, 356w, 356x, 356z.2, 356z.3a,
440	440	5 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9, 356z.10,
441	441	6 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.18,
442	442	7 356z.19, 356z.20, 356z.21, 356z.22, 356z.23, 356z.24, 356z.25,
443	443	8 356z.26, 356z.26a, 356z.28, 356z.29, 356z.30, 356z.31,
444	444	9 356z.32, 356z.33, 356z.34, 356z.35, 356z.36, 356z.37, 356z.38,
445	445	10 356z.39, 356z.40, 356z.40a, 356z.41, 356z.44, 356z.45,
446	446	11 356z.46, 356z.47, 356z.48, 356z.49, 356z.50, 356z.51, 356z.53,
447	447	12 356z.54, 356z.55, 356z.56, 356z.57, 356z.58, 356z.59, 356z.60,
448	448	13 356z.61, 356z.62, 356z.63, 356z.64, 356z.65, 356z.66, 356z.67,
449	449	14 356z.68, 356z.69, 356z.70, 356z.71, 356z.72, 356z.73, 356z.74,
450	450	15 356z.75, 356z.77, 364, 364.01, 364.3, 367.2, 367.2-5, 367i,
451	451	16 368a, 368b, 368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402,
452	452	17 403, 403A, 408, 408.2, 409, 412, 444, and 444.1, paragraph (c)
453	453	18 of subsection (2) of Section 367, and Articles IIA, VIII 1/2,
454	454	19 XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the
455	455	20 Illinois Insurance Code.
456	456	21 (b) For purposes of the Illinois Insurance Code, except
457	457	22 for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
458	458	23 Health Maintenance Organizations in the following categories
459	459	24 are deemed to be "domestic companies":
460	460	25 (1) a corporation authorized under the Dental Service
461	461	26 Plan Act or the Voluntary Health Services Plans Act;
462	462
463	463
464	464
465	465
466	466
467	467	SB1746 - 12 - LRB104 10199 BAB 20272 b
468	468
469	469
470	470	SB1746- 13 -LRB104 10199 BAB 20272 b SB1746 - 13 - LRB104 10199 BAB 20272 b
471	471	SB1746 - 13 - LRB104 10199 BAB 20272 b
472	472	1 (2) a corporation organized under the laws of this
473	473	2 State; or
474	474	3 (3) a corporation organized under the laws of another
475	475	4 state, 30% or more of the enrollees of which are residents
476	476	5 of this State, except a corporation subject to
477	477	6 substantially the same requirements in its state of
478	478	7 organization as is a "domestic company" under Article VIII
479	479	8 1/2 of the Illinois Insurance Code.
480	480	9 (c) In considering the merger, consolidation, or other
481	481	10 acquisition of control of a Health Maintenance Organization
482	482	11 pursuant to Article VIII 1/2 of the Illinois Insurance Code,
483	483	12 (1) the Director shall give primary consideration to
484	484	13 the continuation of benefits to enrollees and the
485	485	14 financial conditions of the acquired Health Maintenance
486	486	15 Organization after the merger, consolidation, or other
487	487	16 acquisition of control takes effect;
488	488	17 (2)(i) the criteria specified in subsection (1)(b) of
489	489	18 Section 131.8 of the Illinois Insurance Code shall not
490	490	19 apply and (ii) the Director, in making his determination
491	491	20 with respect to the merger, consolidation, or other
492	492	21 acquisition of control, need not take into account the
493	493	22 effect on competition of the merger, consolidation, or
494	494	23 other acquisition of control;
495	495	24 (3) the Director shall have the power to require the
496	496	25 following information:
497	497	26 (A) certification by an independent actuary of the
498	498
499	499
500	500
501	501
502	502
503	503	SB1746 - 13 - LRB104 10199 BAB 20272 b
504	504
505	505
506	506	SB1746- 14 -LRB104 10199 BAB 20272 b SB1746 - 14 - LRB104 10199 BAB 20272 b
507	507	SB1746 - 14 - LRB104 10199 BAB 20272 b
508	508	1 adequacy of the reserves of the Health Maintenance
509	509	2 Organization sought to be acquired;
510	510	3 (B) pro forma financial statements reflecting the
511	511	4 combined balance sheets of the acquiring company and
512	512	5 the Health Maintenance Organization sought to be
513	513	6 acquired as of the end of the preceding year and as of
514	514	7 a date 90 days prior to the acquisition, as well as pro
515	515	8 forma financial statements reflecting projected
516	516	9 combined operation for a period of 2 years;
517	517	10 (C) a pro forma business plan detailing an
518	518	11 acquiring party's plans with respect to the operation
519	519	12 of the Health Maintenance Organization sought to be
520	520	13 acquired for a period of not less than 3 years; and
521	521	14 (D) such other information as the Director shall
522	522	15 require.
523	523	16 (d) The provisions of Article VIII 1/2 of the Illinois
524	524	17 Insurance Code and this Section 5-3 shall apply to the sale by
525	525	18 any health maintenance organization of greater than 10% of its
526	526	19 enrollee population (including, without limitation, the health
527	527	20 maintenance organization's right, title, and interest in and
528	528	21 to its health care certificates).
529	529	22 (e) In considering any management contract or service
530	530	23 agreement subject to Section 141.1 of the Illinois Insurance
531	531	24 Code, the Director (i) shall, in addition to the criteria
532	532	25 specified in Section 141.2 of the Illinois Insurance Code,
533	533	26 take into account the effect of the management contract or
534	534
535	535
536	536
537	537
538	538
539	539	SB1746 - 14 - LRB104 10199 BAB 20272 b
540	540
541	541
542	542	SB1746- 15 -LRB104 10199 BAB 20272 b SB1746 - 15 - LRB104 10199 BAB 20272 b
543	543	SB1746 - 15 - LRB104 10199 BAB 20272 b
544	544	1 service agreement on the continuation of benefits to enrollees
545	545	2 and the financial condition of the health maintenance
546	546	3 organization to be managed or serviced, and (ii) need not take
547	547	4 into account the effect of the management contract or service
548	548	5 agreement on competition.
549	549	6 (f) Except for small employer groups as defined in the
550	550	7 Small Employer Rating, Renewability and Portability Health
551	551	8 Insurance Act and except for medicare supplement policies as
552	552	9 defined in Section 363 of the Illinois Insurance Code, a
553	553	10 Health Maintenance Organization may by contract agree with a
554	554	11 group or other enrollment unit to effect refunds or charge
555	555	12 additional premiums under the following terms and conditions:
556	556	13 (i) the amount of, and other terms and conditions with
557	557	14 respect to, the refund or additional premium are set forth
558	558	15 in the group or enrollment unit contract agreed in advance
559	559	16 of the period for which a refund is to be paid or
560	560	17 additional premium is to be charged (which period shall
561	561	18 not be less than one year); and
562	562	19 (ii) the amount of the refund or additional premium
563	563	20 shall not exceed 20% of the Health Maintenance
564	564	21 Organization's profitable or unprofitable experience with
565	565	22 respect to the group or other enrollment unit for the
566	566	23 period (and, for purposes of a refund or additional
567	567	24 premium, the profitable or unprofitable experience shall
568	568	25 be calculated taking into account a pro rata share of the
569	569	26 Health Maintenance Organization's administrative and
570	570
571	571
572	572
573	573
574	574
575	575	SB1746 - 15 - LRB104 10199 BAB 20272 b
576	576
577	577
578	578	SB1746- 16 -LRB104 10199 BAB 20272 b SB1746 - 16 - LRB104 10199 BAB 20272 b
579	579	SB1746 - 16 - LRB104 10199 BAB 20272 b
580	580	1 marketing expenses, but shall not include any refund to be
581	581	2 made or additional premium to be paid pursuant to this
582	582	3 subsection (f)). The Health Maintenance Organization and
583	583	4 the group or enrollment unit may agree that the profitable
584	584	5 or unprofitable experience may be calculated taking into
585	585	6 account the refund period and the immediately preceding 2
586	586	7 plan years.
587	587	8 The Health Maintenance Organization shall include a
588	588	9 statement in the evidence of coverage issued to each enrollee
589	589	10 describing the possibility of a refund or additional premium,
590	590	11 and upon request of any group or enrollment unit, provide to
591	591	12 the group or enrollment unit a description of the method used
592	592	13 to calculate (1) the Health Maintenance Organization's
593	593	14 profitable experience with respect to the group or enrollment
594	594	15 unit and the resulting refund to the group or enrollment unit
595	595	16 or (2) the Health Maintenance Organization's unprofitable
596	596	17 experience with respect to the group or enrollment unit and
597	597	18 the resulting additional premium to be paid by the group or
598	598	19 enrollment unit.
599	599	20 In no event shall the Illinois Health Maintenance
600	600	21 Organization Guaranty Association be liable to pay any
601	601	22 contractual obligation of an insolvent organization to pay any
602	602	23 refund authorized under this Section.
603	603	24 (g) Rulemaking authority to implement Public Act 95-1045,
604	604	25 if any, is conditioned on the rules being adopted in
605	605	26 accordance with all provisions of the Illinois Administrative
606	606
607	607
608	608
609	609
610	610
611	611	SB1746 - 16 - LRB104 10199 BAB 20272 b
612	612
613	613
614	614	SB1746- 17 -LRB104 10199 BAB 20272 b SB1746 - 17 - LRB104 10199 BAB 20272 b
615	615	SB1746 - 17 - LRB104 10199 BAB 20272 b
616	616	1 Procedure Act and all rules and procedures of the Joint
617	617	2 Committee on Administrative Rules; any purported rule not so
618	618	3 adopted, for whatever reason, is unauthorized.
619	619	4 (Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
620	620	5 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
621	621	6 1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
622	622	7 eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
623	623	8 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
624	624	9 1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
625	625	10 eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;
626	626	11 103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.
627	627	12 6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
628	628	13 eff. 1-1-24; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24;
629	629	14 103-618, eff. 1-1-25; 103-649, eff. 1-1-25; 103-656, eff.
630	630	15 1-1-25; 103-700, eff. 1-1-25; 103-718, eff. 7-19-24; 103-751,
631	631	16 eff. 8-2-24; 103-753, eff. 8-2-24; 103-758, eff. 1-1-25;
632	632	17 103-777, eff. 8-2-24; 103-914, eff. 1-1-25; 103-918, eff.
633	633	18 1-1-25; 103-1024, eff. 1-1-25; revised 9-26-24.)
634	634	19 (Text of Section after amendment by P.A. 103-808)
635	635	20 Sec. 5-3. Insurance Code provisions.
636	636	21 (a) Health Maintenance Organizations shall be subject to
637	637	22 the provisions of Sections 133, 134, 136, 137, 139, 140,
638	638	23 141.1, 141.2, 141.3, 143, 143.31, 143c, 147, 148, 149, 151,
639	639	24 152, 153, 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a,
640	640	25 155.49, 352c, 355.2, 355.3, 355.6, 355b, 355c, 356f, 356g,
641	641
642	642
643	643
644	644
645	645
646	646	SB1746 - 17 - LRB104 10199 BAB 20272 b
647	647
648	648
649	649	SB1746- 18 -LRB104 10199 BAB 20272 b SB1746 - 18 - LRB104 10199 BAB 20272 b
650	650	SB1746 - 18 - LRB104 10199 BAB 20272 b
651	651	1 356g.5-1, 356m, 356q, 356u.10, 356v, 356w, 356x, 356z.2,
652	652	2 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9,
653	653	3 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17,
654	654	4 356z.18, 356z.19, 356z.20, 356z.21, 356z.22, 356z.23, 356z.24,
655	655	5 356z.25, 356z.26, 356z.26a, 356z.28, 356z.29, 356z.30,
656	656	6 356z.31, 356z.32, 356z.33, 356z.34, 356z.35, 356z.36, 356z.37,
657	657	7 356z.38, 356z.39, 356z.40, 356z.40a, 356z.41, 356z.44,
658	658	8 356z.45, 356z.46, 356z.47, 356z.48, 356z.49, 356z.50, 356z.51,
659	659	9 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.58, 356z.59,
660	660	10 356z.60, 356z.61, 356z.62, 356z.63, 356z.64, 356z.65, 356z.66,
661	661	11 356z.67, 356z.68, 356z.69, 356z.70, 356z.71, 356z.72, 356z.73,
662	662	12 356z.74, 356z.75, 356z.77, 364, 364.01, 364.3, 367.2, 367.2-5,
663	663	13 367i, 368a, 368b, 368c, 368d, 368e, 370c, 370c.1, 401, 401.1,
664	664	14 402, 403, 403A, 408, 408.2, 409, 412, 444, and 444.1,
665	665	15 paragraph (c) of subsection (2) of Section 367, and Articles
666	666	16 IIA, VIII 1/2, XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and
667	667	17 XXXIIB of the Illinois Insurance Code.
668	668	18 (b) For purposes of the Illinois Insurance Code, except
669	669	19 for Sections 444 and 444.1 and Articles XIII and XIII 1/2,
670	670	20 Health Maintenance Organizations in the following categories
671	671	21 are deemed to be "domestic companies":
672	672	22 (1) a corporation authorized under the Dental Service
673	673	23 Plan Act or the Voluntary Health Services Plans Act;
674	674	24 (2) a corporation organized under the laws of this
675	675	25 State; or
676	676	26 (3) a corporation organized under the laws of another
677	677
678	678
679	679
680	680
681	681
682	682	SB1746 - 18 - LRB104 10199 BAB 20272 b
683	683
684	684
685	685	SB1746- 19 -LRB104 10199 BAB 20272 b SB1746 - 19 - LRB104 10199 BAB 20272 b
686	686	SB1746 - 19 - LRB104 10199 BAB 20272 b
687	687	1 state, 30% or more of the enrollees of which are residents
688	688	2 of this State, except a corporation subject to
689	689	3 substantially the same requirements in its state of
690	690	4 organization as is a "domestic company" under Article VIII
691	691	5 1/2 of the Illinois Insurance Code.
692	692	6 (c) In considering the merger, consolidation, or other
693	693	7 acquisition of control of a Health Maintenance Organization
694	694	8 pursuant to Article VIII 1/2 of the Illinois Insurance Code,
695	695	9 (1) the Director shall give primary consideration to
696	696	10 the continuation of benefits to enrollees and the
697	697	11 financial conditions of the acquired Health Maintenance
698	698	12 Organization after the merger, consolidation, or other
699	699	13 acquisition of control takes effect;
700	700	14 (2)(i) the criteria specified in subsection (1)(b) of
701	701	15 Section 131.8 of the Illinois Insurance Code shall not
702	702	16 apply and (ii) the Director, in making his determination
703	703	17 with respect to the merger, consolidation, or other
704	704	18 acquisition of control, need not take into account the
705	705	19 effect on competition of the merger, consolidation, or
706	706	20 other acquisition of control;
707	707	21 (3) the Director shall have the power to require the
708	708	22 following information:
709	709	23 (A) certification by an independent actuary of the
710	710	24 adequacy of the reserves of the Health Maintenance
711	711	25 Organization sought to be acquired;
712	712	26 (B) pro forma financial statements reflecting the
713	713
714	714
715	715
716	716
717	717
718	718	SB1746 - 19 - LRB104 10199 BAB 20272 b
719	719
720	720
721	721	SB1746- 20 -LRB104 10199 BAB 20272 b SB1746 - 20 - LRB104 10199 BAB 20272 b
722	722	SB1746 - 20 - LRB104 10199 BAB 20272 b
723	723	1 combined balance sheets of the acquiring company and
724	724	2 the Health Maintenance Organization sought to be
725	725	3 acquired as of the end of the preceding year and as of
726	726	4 a date 90 days prior to the acquisition, as well as pro
727	727	5 forma financial statements reflecting projected
728	728	6 combined operation for a period of 2 years;
729	729	7 (C) a pro forma business plan detailing an
730	730	8 acquiring party's plans with respect to the operation
731	731	9 of the Health Maintenance Organization sought to be
732	732	10 acquired for a period of not less than 3 years; and
733	733	11 (D) such other information as the Director shall
734	734	12 require.
735	735	13 (d) The provisions of Article VIII 1/2 of the Illinois
736	736	14 Insurance Code and this Section 5-3 shall apply to the sale by
737	737	15 any health maintenance organization of greater than 10% of its
738	738	16 enrollee population (including, without limitation, the health
739	739	17 maintenance organization's right, title, and interest in and
740	740	18 to its health care certificates).
741	741	19 (e) In considering any management contract or service
742	742	20 agreement subject to Section 141.1 of the Illinois Insurance
743	743	21 Code, the Director (i) shall, in addition to the criteria
744	744	22 specified in Section 141.2 of the Illinois Insurance Code,
745	745	23 take into account the effect of the management contract or
746	746	24 service agreement on the continuation of benefits to enrollees
747	747	25 and the financial condition of the health maintenance
748	748	26 organization to be managed or serviced, and (ii) need not take
749	749
750	750
751	751
752	752
753	753
754	754	SB1746 - 20 - LRB104 10199 BAB 20272 b
755	755
756	756
757	757	SB1746- 21 -LRB104 10199 BAB 20272 b SB1746 - 21 - LRB104 10199 BAB 20272 b
758	758	SB1746 - 21 - LRB104 10199 BAB 20272 b
759	759	1 into account the effect of the management contract or service
760	760	2 agreement on competition.
761	761	3 (f) Except for small employer groups as defined in the
762	762	4 Small Employer Rating, Renewability and Portability Health
763	763	5 Insurance Act and except for medicare supplement policies as
764	764	6 defined in Section 363 of the Illinois Insurance Code, a
765	765	7 Health Maintenance Organization may by contract agree with a
766	766	8 group or other enrollment unit to effect refunds or charge
767	767	9 additional premiums under the following terms and conditions:
768	768	10 (i) the amount of, and other terms and conditions with
769	769	11 respect to, the refund or additional premium are set forth
770	770	12 in the group or enrollment unit contract agreed in advance
771	771	13 of the period for which a refund is to be paid or
772	772	14 additional premium is to be charged (which period shall
773	773	15 not be less than one year); and
774	774	16 (ii) the amount of the refund or additional premium
775	775	17 shall not exceed 20% of the Health Maintenance
776	776	18 Organization's profitable or unprofitable experience with
777	777	19 respect to the group or other enrollment unit for the
778	778	20 period (and, for purposes of a refund or additional
779	779	21 premium, the profitable or unprofitable experience shall
780	780	22 be calculated taking into account a pro rata share of the
781	781	23 Health Maintenance Organization's administrative and
782	782	24 marketing expenses, but shall not include any refund to be
783	783	25 made or additional premium to be paid pursuant to this
784	784	26 subsection (f)). The Health Maintenance Organization and
785	785
786	786
787	787
788	788
789	789
790	790	SB1746 - 21 - LRB104 10199 BAB 20272 b
791	791
792	792
793	793	SB1746- 22 -LRB104 10199 BAB 20272 b SB1746 - 22 - LRB104 10199 BAB 20272 b
794	794	SB1746 - 22 - LRB104 10199 BAB 20272 b
795	795	1 the group or enrollment unit may agree that the profitable
796	796	2 or unprofitable experience may be calculated taking into
797	797	3 account the refund period and the immediately preceding 2
798	798	4 plan years.
799	799	5 The Health Maintenance Organization shall include a
800	800	6 statement in the evidence of coverage issued to each enrollee
801	801	7 describing the possibility of a refund or additional premium,
802	802	8 and upon request of any group or enrollment unit, provide to
803	803	9 the group or enrollment unit a description of the method used
804	804	10 to calculate (1) the Health Maintenance Organization's
805	805	11 profitable experience with respect to the group or enrollment
806	806	12 unit and the resulting refund to the group or enrollment unit
807	807	13 or (2) the Health Maintenance Organization's unprofitable
808	808	14 experience with respect to the group or enrollment unit and
809	809	15 the resulting additional premium to be paid by the group or
810	810	16 enrollment unit.
811	811	17 In no event shall the Illinois Health Maintenance
812	812	18 Organization Guaranty Association be liable to pay any
813	813	19 contractual obligation of an insolvent organization to pay any
814	814	20 refund authorized under this Section.
815	815	21 (g) Rulemaking authority to implement Public Act 95-1045,
816	816	22 if any, is conditioned on the rules being adopted in
817	817	23 accordance with all provisions of the Illinois Administrative
818	818	24 Procedure Act and all rules and procedures of the Joint
819	819	25 Committee on Administrative Rules; any purported rule not so
820	820	26 adopted, for whatever reason, is unauthorized.
821	821
822	822
823	823
824	824
825	825
826	826	SB1746 - 22 - LRB104 10199 BAB 20272 b
827	827
828	828
829	829	SB1746- 23 -LRB104 10199 BAB 20272 b SB1746 - 23 - LRB104 10199 BAB 20272 b
830	830	SB1746 - 23 - LRB104 10199 BAB 20272 b
831	831	1 (Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21;
832	832	2 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff.
833	833	3 1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665,
834	834	4 eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22;
835	835	5 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff.
836	836	6 1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093,
837	837	7 eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24;
838	838	8 103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff.
839	839	9 6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445,
840	840	10 eff. 1-1-24; 103-551, eff. 8-11-23; 103-605, eff. 7-1-24;
841	841	11 103-618, eff. 1-1-25; 103-649, eff. 1-1-25; 103-656, eff.
842	842	12 1-1-25; 103-700, eff. 1-1-25; 103-718, eff. 7-19-24; 103-751,
843	843	13 eff. 8-2-24; 103-753, eff. 8-2-24; 103-758, eff. 1-1-25;
844	844	14 103-777, eff. 8-2-24; 103-808, eff. 1-1-26; 103-914, eff.
845	845	15 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff. 1-1-25; revised
846	846	16 11-26-24.)
847	847	17 Section 35. The Voluntary Health Services Plans Act is
848	848	18 amended by changing Section 10 as follows:
849	849	19 (215 ILCS 165/10) (from Ch. 32, par. 604)
850	850	20 Sec. 10. Application of Insurance Code provisions. Health
851	851	21 services plan corporations and all persons interested therein
852	852	22 or dealing therewith shall be subject to the provisions of
853	853	23 Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140,
854	854	24 143, 143.31, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3,
855	855
856	856
857	857
858	858
859	859
860	860	SB1746 - 23 - LRB104 10199 BAB 20272 b
861	861
862	862
863	863	SB1746- 24 -LRB104 10199 BAB 20272 b SB1746 - 24 - LRB104 10199 BAB 20272 b
864	864	SB1746 - 24 - LRB104 10199 BAB 20272 b
865	865	1 355b, 355d, 356g, 356g.5, 356g.5-1, 356m, 356q, 356r, 356t,
866	866	2 356u, 356u.10, 356v, 356w, 356x, 356y, 356z.1, 356z.2,
867	867	3 356z.3a, 356z.4, 356z.4a, 356z.5, 356z.6, 356z.8, 356z.9,
868	868	4 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.18,
869	869	5 356z.19, 356z.21, 356z.22, 356z.25, 356z.26, 356z.26a,
870	870	6 356z.29, 356z.30, 356z.32, 356z.32a, 356z.33, 356z.40,
871	871	7 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, 356z.54, 356z.56,
872	872	8 356z.57, 356z.59, 356z.60, 356z.61, 356z.62, 356z.64, 356z.67,
873	873	9 356z.68, 356z.71, 356z.72, 356z.74, 356z.75, 356z.77, 364.01,
874	874	10 364.3, 367.2, 368a, 401, 401.1, 402, 403, 403A, 408, 408.2,
875	875	11 and 412, and paragraphs (7) and (15) of Section 367 of the
876	876	12 Illinois Insurance Code.
877	877	13 Rulemaking authority to implement Public Act 95-1045, if
878	878	14 any, is conditioned on the rules being adopted in accordance
879	879	15 with all provisions of the Illinois Administrative Procedure
880	880	16 Act and all rules and procedures of the Joint Committee on
881	881	17 Administrative Rules; any purported rule not so adopted, for
882	882	18 whatever reason, is unauthorized.
883	883	19 (Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22;
884	884	20 102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff.
885	885	21 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804,
886	886	22 eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23;
887	887	23 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff.
888	888	24 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91,
889	889	25 eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24;
890	890	26 103-551, eff. 8-11-23; 103-605, eff. 7-1-24; 103-656, eff.
891	891
892	892
893	893
894	894
895	895
896	896	SB1746 - 24 - LRB104 10199 BAB 20272 b
897	897
898	898
899	899	SB1746- 25 -LRB104 10199 BAB 20272 b SB1746 - 25 - LRB104 10199 BAB 20272 b
900	900	SB1746 - 25 - LRB104 10199 BAB 20272 b
901	901	1 1-1-25; 103-718, eff. 7-19-24; 103-751, eff. 8-2-24; 103-753,
902	902	2 eff. 8-2-24; 103-758, eff. 1-1-25; 103-832, eff. 1-1-25;
903	903	3 103-914, eff. 1-1-25; 103-918, eff. 1-1-25; 103-1024, eff.
904	904	4 1-1-25; revised 11-26-24.)
905	905
906	906
907	907
908	908
909	909
910	910	SB1746 - 25 - LRB104 10199 BAB 20272 b